Follow up for Positive COVID 19 Cases and their Close Contacts - - PowerPoint PPT Presentation
Follow up for Positive COVID 19 Cases and their Close Contacts Tools for LBOHs July 7, 2020 Hillary Johnson, MHS, Infectious Disease Epidemiologist Scott Troppy, MPH, PMP, CIC, Surveillance Epidemiologist Bureau of Infectious Disease and
Hillary Johnson, MHS, Infectious Disease Epidemiologist Scott Troppy, MPH, PMP, CIC, Surveillance Epidemiologist Bureau of Infectious Disease and Laboratory Sciences MA Department of Public Health
July 7, 2020
Death
lab is obtained.
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Reed Sherrill, Surveillance Epidemiologist Scott Troppy, Surveillance Epidemiologist Bureau of Infectious Disease and Laboratory Sciences MA Department of Public Health
As of 7/7/2020
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Status Count N ew Users (added week of 7/6/2020)
In Training
Trained Users
Total New Users Trained Or In Process
Total System (MAVEN) Users
*these data is accurate as of 7/06/2020 at 8:30PM. New Users = Received user requests and forwarded to the VG for user account creation (2 day process) In Training = The VG account has been created and waiting on MAVEN Training (Mondays from 11‐12:30) Trained Users = Trained internal and external staff with VG MAVEN accounts created and MAVEN accounts created by ISIS staff and then access granted appropriate access Total System (MAVEN) Users = Includes MDPH, LBOH, Infection Prevention and other trained staff
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Program Area Count Division of Global Populations
Epidemiology
Immunization (COVID‐19)
Informatics and Surveillance (ISIS)
Total On‐Call MAVEN Events
*these data is accurate as of 7/06/2020 at 8:30PM
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Program Area Count Division of Global Populations
Epidemiology Program
Immunization Program (COVID‐19)
Informatics and Surveillance (ISIS)
Total On‐Call MAVEN Events
*these data is accurate as of 7/06/2020 at 8:30PM
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2015 6,739 2016 12,830 2017 12,605 2018 9,296 2019 10,652 So far in 2020 23,699
*these data is accurate as of 7/06/2020 at 8:30PM
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Month Count
*these data is accurate as of 7/06/2020 at 8:30PM
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for your jurisdiction.
your Step 1‐ LBOH Notification to “Yes” to clear out this workflow.
(Investigation Started) & 3 (LBOH Investigator (name, lboh, phone number)
(Final Review)
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the goal until that strategy changes/evolves.
you should document your work.
Facility
your help.
Tuesdays @ 11am will continue in July
MAVEN Help has Guidance Documents and Previous Webinars: http://www.maventrainingsite.com/maven‐help/toc.html
MDPH Epi Program: 617‐983‐6800 MDPH MAVEN Help Desk: isishelp@state.ma.us MDPH Food Protection Program: 617‐983‐6712 CTC Help Desk: 857‐305‐2828 COVID19CommunityTracingCollaborativeQuestions@mass.gov 13
contacts quarantined. Serology positive but no recent symptoms do not require further public health follow‐up at this time.
COVID‐19 Cases
https://www.mass.gov/doc/covid‐19‐testing‐guidance/download https://www.mass.gov/doc/notification‐to‐test‐contacts‐regardless‐of‐symptoms‐0/download
http://www.maventrainingsite.com/maven‐help/pdf/Serology%20Interpretation%20for%20LBOH_ver3.0_June1.pdf https://www.mass.gov/doc/healthcare‐personnel‐occupational‐exposure‐return‐to‐work‐ guidance/download https://www.mass.gov/doc/non‐healthcare‐workers‐occupational‐exposure‐return‐to‐work‐guidance/download
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cause of death are considered probable cases.
down on duplicate reporting.
have not matched.
close contacts should be identified
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testing for COVID‐19.
some clarifications
virus using a molecular diagnostic test such as PCR:
https://www.mass.gov/doc/covid‐19‐testing‐guidance/download 16
COVID‐19 Testing for current infection:
detect the presence of the virus by polymerase chain reaction (PCR) or
antigen test. Although the newer diagnostic antigen tests are faster to run, they are less sensitive and a negative antigen test result still requires a molecular test to confirm a negative result due to their decreased sensitivity
https://www.mass.gov/doc/covid‐19‐testing‐guidance/download
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Close Contacts of COVID Cases:
close contacts should be tested. A Local Board
Public Health, the Community Tracing Collaborative, or a healthcare provider can recommend testing of a close contact.
https://www.mass.gov/doc/covid‐19‐testing‐guidance/download
Yes! The Testing Guidance recommends Close Contacts Get Tested, regardless of current symptoms. *NOTE: Contacts that test NEGATIVE must still complete their full 14 day quarantine period. 18
Recommended timing of testing for close contacts:
period, even if the person previously had a negative test result within that same period.
notified of their exposure to COVID‐19. The contact is required to quarantine for the full 14 days, even following a negative test result.
https://www.mass.gov/doc/covid‐19‐testing‐guidance/download
Yes! The Testing Guidance recommends Close Contacts Get Tested, regardless of current symptoms. *NOTE: Contacts that test NEGATIVE must still complete their full 14 day quarantine period. 19
Admission to a Healthcare Facility:
to, a hospital operated or licensed by the Department of Public Health or Mental Health, long‐ term acute care hospital, or skilled nursing facility.
Asymptomatic Individuals:
testing at the direction of their healthcare provider, the Department of Public Health or a state agency, or a local Board of Health. Testing generally requires a clinician’s order and asymptomatic individuals are strongly encouraged to contact their insurer to confirm coverage.
https://www.mass.gov/doc/covid‐19‐testing‐guidance/download
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Serology Testing:
with SARS‐CoV‐2 and antibody testing is important to help understand how many people in a population have been exposed to the virus. However, antibody tests are rarely indicated for diagnostic purposes in adults.
characteristics of these tests, the immune response to COVID‐19, the timing and duration of antibody response, and how antibodies correlate to protective immunity.
https://www.mass.gov/doc/covid‐19‐testing‐guidance/download
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Serology Testing:
isolation or for return to work purposes and are rarely indicated for diagnostic purposes.
https://www.mass.gov/doc/covid‐19‐testing‐guidance/download
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Previously Positive Individual Cleared from Isolation:
retesting is not recommended for the next 6 weeks.
after recovery).
https://www.mass.gov/doc/covid‐19‐testing‐guidance/download
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Previously Positive Individual Cleared from Isolation who Develops NEW SYMPTOMS:
with COVID‐19, are more than 6 weeks past their release from isolation, and who develop clinically compatible symptoms, should be retested.
considered to be re‐infected.
https://www.mass.gov/doc/covid‐19‐testing‐guidance/download
*NOTE: New PCR+ test results >6 weeks after recovery require new isolation (again).
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MAVEN, however if you identify them and have questions on follow‐up, please let us know.
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For LBOHs who identify previously confirmed cases with new +PCRs >6‐8 weeks after their initial recovery:
Interview this Patient 27
Instructions for Isolation in Previously PCR+ individuals with new PCR+ labs >6 weeks after recovery:
suspicion of new illness, the patient should still isolate at this time for 10 days following date of
positive throughout regular testing in the 6‐8 weeks following initial recovery, they continue to be asymptomatic, and have no indication of new exposures or illness, they may not need to isolate at this
and possibility of reinfection.
Isolate this Patient 28
On the topic of repeat PCR testing…
evolution and that our guidance will almost certainly change as we learn more in coming weeks.
and recognize it may lengthen as we learn more.
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What we know:
transmission from a recovered patient has not been reported.
but its duration and its correlation with antibody is not known.
community associated coronaviruses occurs frequently within a year of initial infection.
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What we know:
positive PCR and recovery, and would disregard any positive results obtained before then.
is likely to result in longer isolation and may be logistically difficult.
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CDC & MDPH Guidance around this issue:
weeks from completing isolation should be interpreted as possible reinfection.
would be to treat them as cases and isolate accordingly. Complex situations may require consultation with an ID specialist. CDC FAQ updated June 4:
https://www.cdc.gov/coronavirus/2019‐ncov/hcp/faq.html#Patients‐with‐Persistent‐or‐Recurrent‐Positive‐Tests
MDPH Updated Testing Guidance July 3:
https://www.mass.gov/doc/covid‐19‐testing‐guidance/download
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Our Approach to this issue:
results > 6 weeks after recovery are likely to be infectious, out of an abundance
contact with high‐risk individuals, until further data are provided to better understand length of immunity.
Isolate & Interview these Patients 33
Previous Confirmed Cases (PCR+ lab reported): If these individuals have met criteria for exiting isolation based upon a symptom‐based strategy, additional testing is not recommended.
where additional +PCRs WOULD require isolation and quarantine regardless of symptoms?
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a contact at a later point?
symptoms recur at a later date?
and exposure?
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Previously Serology (antibody) Positive Probable Cases (negative PCR
isolate and test via PCR?
PCR.
(and retest with PCR per recommendation for contacts)?
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but its duration and its correlation with antibody is not known.
has completed their most recent isolation, clinicians and public health authorities should consider the possibility of reinfection.”
isolation) because it is a cautious cutoff and we may lengthen it as we learn more.
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after recovery: recommend new quarantine at this time.
information you obtain in these interviews will help inform the big questions on duration of immunity and if patients can get COVID‐19 again.
CoV2.
interview and isolate.
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another state the 14 days before symptom onset?
identifying where your case might have been exposed, although this is less critical information than WHOM your confirmed case might have exposed while infectious.
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Key Demographic Data Needed:
Symptoms
Travel Information:
times,
traveled alone or with others.
If your confirmed or probable case traveled while infectious and may have exposed others via airplane or maritime vessel (cruise or cargo):
Do the best you can. Travel dates & flight numbers are key even if you don’t have seat number.
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Close contact is defined as:
a) Being less than 6 feet from a confirmed or clinically diagnosed COVID‐19 case for at least 10‐15 minutes, while the case was symptomatic or within the 48 hours before symptom onset. Close contact can occur anywhere. Examples include caring for, living with, visiting, or sharing a healthcare waiting area or room with a confirmed or clinically diagnosed COVID‐19 case. OR b) Having direct contact with infectious secretions of a confirmed or clinically diagnosed COVID‐19 case (e.g., being coughed on) while not wearing recommended personal protective equipment or PPE (e.g., gown, gloves, facemask, eye protection).
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individuals where feasible. At the same time, a minimum physical distance of three feet has been established when combined with the other measures
susceptibility in children and lower apparent rates of transmission, establishing a minimum physical distance of three feet is informed by evidence and balances the lower risk of COVID‐19 transmission and the overarching benefits of in‐ person school.”
close contacts if there was an exposure in a school facility.
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quarantine). There may also be a separate list of guests that would appreciate and benefit from an
“We want to let you know that someone who attended this event later tested positive for COVID‐19. While you have not been specifically identified as a close contact (which is good!), the individual wanted to make sure you knew about this event and had the opportunity ask any follow‐up questions you might have and be linked to public health resources as needed.”
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A Note on Mask Wearing:
The hope would be that masks reduced the spread of respiratory droplets while two individuals are in close contact, but the contact is still a close contact if it meets our definition.
case wearing a cloth mask could still expose others through close contact.
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parent? What if a parent starts developing symptoms?
particularly household members if it can be managed. This will reduce the likelihood
be a best practice, but we all understand this may be difficult.
as a suspect case and they should immediately seek testing/clinical assessment, isolate from others, and their household contacts will need to begin official
quarantine until the case recovers and is no longer infectious, then their final 14 days
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better to test a couple days later to be accurate?
someone can test negative because they are very early in their infection when their sample is collected. In such situations, they could test positive later and transmit the virus to
you have to complete the 14 day quarantine period.
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quarantine?
negative test earlier in that 14 day period.
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someone needs to log into MAVEN on those days and mark assistance requested = No.
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home – are instructed to self‐quarantine for 14 days.
are exempt from the directive to self‐quarantine for 14 days if traveling to Massachusetts for work purposes.
19.
19#:~:text=All%20travelers%20arriving%20to%20Massachusetts,in%20Massachusetts%20are%20exempt%20from
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