LAC DPH: Revised Evaluation Criteria for COVID-19

The Los Angeles County Department of Public Health (LAC DPH) issued an advisory on February 29, 2020 regarding revised evaluation criteria for the coronavirus.

Now called coronavirus disease-19 or COVID-19, the coronavirus was recently diagnosed in a Northern California patient with no known travel links or contact to a known case. This person is hospitalized and requiring ICU care.

In light of this case, the Centers for Disease Control and Prevention (CDC) released updated evaluation criteria. Based on the CDC criteria, LAC DPH has updated the local evaluation criteria for COVID-19.

While there has been only one confirmed case of COVID-19 in a non-resident traveler from China to date in Los Angeles County, LAC DPH is urging health care facilities to be ready in the event of widespread COVID-19 transmission. Healthcare facilities should review their infection control procedures and infectious disease surge plans to ensure that they are ready for implementation.

 

Revised Evaluation Criteria for Coronavirus Disease 2019 (COVID-19)

 

The LAC DPH COVID-19 evaluation criteria differ from the CDC's and are intended to prioritize SARS-CoV-2 testing in a setting of limited local testing capacity. Providers should keep in mind that these evaluation criteria were developed to identify patients at highest risk for COVID-19.

Health care providers are advised to check the LAC DPH COVID-19 Healthcare Providers website for the most up to date local guidance and resources. 

 

Actions Requested of Providers

 

Work with Facility Administrators to:

  • Place signage requesting visitors with a fever and respiratory symptoms and recent international travel to immediately notify healthcare staff.
  • Screen patients at triage for any signs or symptoms of febrile respiratory illness. If signs or symptoms are present, the healthcare worker should don a surgical mask. The patient should also be instructed to wear a surgical mask and be placed in a private room with the door closed or separated from others by at least 6 feet.

 

Assess if the patient meets criteria for COVID-19 evaluation. 

  • Patients with milder presentations who do not meet COVID-19 evaluation criteria should be instructed to isolate at home until 24 hours after the resolution of fever and/or improvement of respiratory symptoms. Patients should contact their provider if symptoms worsen.

 

If patient meets COVID-19 evaluation criteria:

  • Implement additional infection control procedures for healthcare workers entering the room. These include standard precautions, contact precautions (gloves, gown), airborne precautions (N95 mask or PAPR), and the use of eye protection.
  • Follow the LAC DPH Provider Checklist for evaluating patients who may have COVID-19. The checklist is available at the LAC DPH Coronavirus Webpage for Health Professionals.
  • Promptly contact and report patient to LAC DPH. LAC DPH will advise on next steps, including patient testing and specimen collection, if indicated. Approval from LAC DPH is required before specimens can be submitted to the LAC Public Health Laboratory (PHL) for testing. 

LAC DPH COVID-19 Evaluation Criteria

Clinical Features: Fever or signs/symptoms of lower respiratory illness (e.g. cough, shortness of breath) AND Epidemiologic Risk Factors: Any person (including health care workers) who in the last 14 days before symptom onset has had close contact with a laboratory-confirmed COVID-19 patient

Clinical Features: Fever and signs/symptoms of a community-acquired lower respiratory illness (e.g. cough or shortness of breath) requiring hospitalization AND Epidemiologic Risk Factors: A history of travel from affected geographic areas* in the last 14 days before symptom onset 

Clinical Features: Fever with severe acute community acquired lower respiratory illness (e.g. pneumonia, ARDS) requiring ICU care without alternative explanatory diagnosis. (Must have negative rapid influenza/ RSV tests; and a negative molecular respiratory panel if this testing is available at the facility) AND Epidemiologic Risk Factors: No source of exposure has been identified
 

*Affected Geographic Areas with Widespread or Sustained Community Transmission China, Iran, Italy, Japan, South Korea. Last updated February 28, 2020

CDC defines affected areas as geographic regions where sustained community transmission has been identified. Relevant affected areas will be defined as a country with at least a CDC Level 2 Travel Health Notice. See all COVID-19 Travel Health Notices.
 

 

Reporting

 

Los Angeles County DPH Acute Communicable Disease Control:

 

Long Beach Health and Human Services:

 

Pasadena Public Health Department:

 

Keep up to date by visiting the LAC DPH Coronavirus Webpage for Health Professionals.