Guidance for Healthcare Providers

People with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have COVID-19:

• Fever or chills
• Cough
• Shortness of breath or difficulty breathing
• Fatigue
• Muscle or body aches
• Headache
• New loss of taste or smell
• Sore throat
• Congestion or runny nose
• Nausea or vomiting
• Diarrhea

Given that there is community spread of the virus in our state, anyone can contract the virus from their daily interactions with other people. At this point in the pandemic, people with the virus may not know where they became infected or who transmitted the virus to them.

Please follow the excellent guidance provided by NCDHHS. In general, healthcare providers should screen patients before they enter the facility, either via telephone or telehealth/video triage. Telehealth or telephone triage allows clinicians to evaluate patients with mild symptoms and provide guidance on home care and follow-up, while preventing further spread of COVID-19.

If the patient is experiencing fever (subjective or measured), respiratory or GI  symptoms, they should be advised to isolate at home for at least 10 days since symptoms first appeared AND at least 72 hours since resolution of fever (without the use of fever reducing medications) AND improvement in respiratory symptoms. They should also be advised to contact their provider if their symptoms are not getting better.

If, however, their symptoms become more serious (difficulty breathing, altered mental status), patients should be advised to call before seeking in-person care or call 9-1-1, and disclose their symptoms so emergency medical providers can take appropriate steps in transporting the patient to a facility where they can be treated.

Patients who enter a healthcare facility exhibiting fever or flu-like symptoms should be masked immediately and providers should ensure proper use of personal protective equipment. The patient should be separated from other patients, ideally in a well-ventilated space.

Current NCDHHS Guidance suggests that clinicians should conduct or arrange for diagnostic COVID-19 testing for:

• Anyone with symptoms suggestive of COVID-19
• Close contacts of known positive cases, regardless of symptoms
• The following groups are some of the populations with higher risk of exposure or a higher risk of severe disease if they become infected. People in these groups should get tested if they believe they may have been exposed to COVID-19, whether or not they have symptoms.
  • People who live in or have regular contact with high-risk settings (e.g., long-term care facility, homeless shelter, correctional facility, migrant farmworker camp)
  • Historically Marginalized populations who may be at higher risk for exposure
  • Frontline and essential workers (grocery store clerks, gas station attendants, childcare workers, construction sites, processing plants, etc.) in settings where social distancing is difficult to maintain
  • Health care workers or first responders (e.g. EMS, law enforcement, fire department, military)
  • People who are at high risk of severe illness (e.g., people over 65 years of age, people of any age with underlying health conditions)
• People who have attended protests, rallies, or other mass gatherings could have been exposed to someone with COVID-19 or could have exposed others. Testing should be considered for people who attended such events, particularly if they were in crowds or other situations where they couldn’t practice effective social distancing.

Physicians should consider testing for flu prior to testing for COVID-19.

Each time a provider tests a patient for COVID-19, the practice must:

• Fill out a PUI form and fax it to the Wake County Public Health Division (919-212-9291) and the state (919-733-0490).
• If patient was tested but has not symptoms and no known exposure to someone with COVID-19 (for example, as a part of a workplace screening program, they do not need to stay home while waiting results unless told to do so by an employer or by public health.

If the result of the test is positive, healthcare providers must notify the patient and advise that they be isolated at home. In addition, other people in the patient’s home should remain quarantined at home, away from the patient, and self-monitor for fever and symptoms for 14 days.

Results may be faxed to Wake County Public Health at 919-743-7362.

The patient should also be advised that if they begin to experience severe symptoms to call their healthcare provider before going to the provider’s office. In the case of a medical emergency, patients should call 9-1-1 and disclose that they have been diagnosed with COVID-19 so that emergency providers can be sure to respond appropriately.

Once a test is confirmed positive, Wake County Public Health will contact the patient. This includes reaching out to the healthcare provider to determine whether any practice staff had a significant exposure.

Please note that false negative results are possible. If COVID-19 testing is negative, consider if patient’s recent exposure and clinical presentation are consistent with COVID-19. Retesting should be considered in consultation with local public health.

Testing to detect COVID-19 is available through commercial labs and the NC State Laboratory of Public Health (NCSLPH). Testing at the NCSLPH is only available with prior approval by the local health department or the state epidemiologist on call.

LabCorp tests do NOT require confirmation testing from the CDC.

COVID-19 testing requires specimens collected from the nose, throat or lungs. These specimens must be collected by a healthcare provider. Details on how to collect specimens can be found on LabCorp’s site.

View more questions and answers about LabCorps’s test and how it is administered.

There is still much to learn about COVID-19. Based on what is currently known, spread is thought to occur mostly through respiratory droplets. Infectious secretions include sputum, serum, blood and respiratory droplets. If close contact occurs while not wearing appropriate personal protective equipment, health care providers may be at risk of infection.

• Review infection prevention and control guidelines on the Centers for Disease Control and Prevention website.
• Enforce proper hand hygiene practices before and after all patient contact.
• Ask patients with respiratory symptoms to wear a mask and/or separate them from other patients and staff.
• Assess and triage patients with acute respiratory symptoms and risk factors for COVID-19. Ideally, do this before they enter the facility.
• Use standard and transmission-based precautions when caring for possible COVID-19 patients.
• Consider using telemedicine to evaluate suspected cases of COVID-19.
• Consider screening staff for symptoms prior to entering the clinical area.

UNC Health patients with coronavirus symptoms should call their primary care provider’s office to determine if and where they should be tested for COVID-19. This may result in a referral to a UNC Health Respiratory Diagnostic Center or to a UNC Virtual Care center.

UNC Health patients can also call a UNC Health Helpline at 1-888-850-2684 before visiting a doctor’s office or an urgent care location. Please note: This HelpLine is experiencing high volumes of calls.

The current hours for UNC Health Respiratory Diagnostic Centers are 8 a.m.–5 p.m. Monday through Friday, and 8 a.m.–noon Saturday and Sunday.

WakeMed is no longer operating its Respiratory Diagnostic Center. Patients can call the WakeMed Health Help Line at 919-350-5200 between 8 a.m. and 4 p.m. to connect with a provider for an initial phone evaluation.

WakeMed Virtual Urgent Care can also help evaluate COVID-19 risks, assess symptoms and provide support by video to help you find the most appropriate level of care while minimizing exposure.

You can be seen online 24/7 using a smartphone, tablet or computer without leaving home. Consults are available on-demand, and no appointment is necessary. To get started, visit wakemed.org/virtual-urgent-care or download the WakeMed All Access App.

Duke Primary Care and Urgent Care have opened dedicated Respiratory Care Centers to diagnose and address people experiencing COVID-19-like symptoms. People who are experiencing symptoms can call the Duke Health COVID-19 hotline at 919-385-0429 between 8 a.m. -- 8 p.m. seven days a week. Nurses will triage callers and advise on whether self-quarantine, tele-medicine or in-person appointments are recommended.

You can learn more about Duke Health's COVID-19 response  here.

Personal Protective Equipment, or PPE, is in short supply across the country. That’s why Wake County strongly encourages healthcare providers who request PPE from the county to develop a conservation plan.

The Centers for Disease Control and Prevention offers guidance on how to optimize your use of PPE and encourages you to implement a plan now if you haven’t already. The website includes a burn rate calculator and advice on how to safely decontaminate and reuse PPE, as well.

If you suspect someone has current COVID-19 infection, the standard diagnostic test is viral PCR. Antibody testing should not be used for purposes of diagnosis. Providers should understand the limitations of any test they might order. Right now, there’s not enough known about the test to determine its accuracy. It’s unknown whether the test can tell the difference between past infections from SARS-CoV-2 and the six other coronaviruses. It’s also too soon to know whether the presence of antibodies means a patient is immune to a second infection.

No. At this time, COVID-19 antibody test results are not reportable. However, COVID-19 RT-PCR positive results must be reported to Wake County Public Health. You may FAX results to 919-743-7362.