An Important Announcement from the Virginia State Health Commissioner

As COVID-19 continues to rapidly evolve, please visit the VDH website for updated epidemiological information and clinical guidance. 

COVID-19 in Virginia 

● As community transmission increases in Virginia, healthcare facilities should consider additional actions to reduce the risk of their employees introducing COVID-19 into their facilities. 

● There is growing evidence of asymptomatic and presymptomatic spread. CDC recently changed the start of the infectious period to 48 hours before symptom onset. 

● For people who must leave their home for essential needs (e.g., grocery shopping and picking up pharmacy medications), CDC recommends that people wear cloth face coverings where other social distancing measures are difficult to maintain, especially in areas of significant community-based transmission. N95 respirators and surgical masks are not recommended in these situations so that they can be reserved for HCP and first responders 

● Mildly ill patients may not need to be tested and can be managed at home. Clinical diagnoses of COVID-19 are reportable; given the volume, reporting through the VDH Online Morbidity Report Portal is preferred. Please continue to call your local health department about suspected outbreaks of COVID-19. 

● For COVID-19 patients, please provide this patient handout about home isolation and encourage them to notify their contacts. 

● A COVID-19 Flag Alert has been added to Virginia’s Emergency Department Care Coordination Program. COVID-19 alerts will automatically become inactive after six weeks. 

● VDH has updated work restriction recommendations to allow asymptomatic healthcare personnel who have had an exposure to a COVID-19 patient to continue to work after options to improve staffing have been exhausted and in consultation with their occupational health program. More information can be found on the VDH COVID-19 Healthcare Personnel Risk Assessment Tool. 

Testing 

● VDH criteria for COVID-19 public health testing at DCLS have been updated to remove requirements for influenza testing. Until testing is widely available, prioritizing testing at private labs for high risk groups should also be considered. 

Personal Protective Equipment (PPE) 

● Virginia continues to experience a critical shortage of PPE. CDC has defined acceptable alternative PPE for caring for patients with confirmed or suspected COVID-19. Additional shipments from the Strategic National Stockpile are not expected in the near future. For questions, individual practices, home health and CHCs/FQHCs should check with their local health districts. Hospitals and nursing homes should contact their regional healthcare coalition. 

Congregate Settings 

● As of April 3, 31 confirmed outbreaks (defined as having two or more COVID-19 cases) have been reported and 12 (39%) are in skilled nursing and assisted living facilities. Answers to frequently asked questions are available on the VDH website and guidance is on the CDC website. 

● Other congregate settings, such as jails, prisons, and behavioral health residential facilities also face the threat of COVID-19 introduction and spread. To date, two (7%) confirmed outbreaks have been reported in correctional facilities. CDC guidance and resources are available for correctional facilities and detention centers. 

Thank you for all your efforts on the front line of combat against the COVID-19 pandemic. You are an essential part of the public health campaign to protect the health of the people of the Commonwealth. 

M. Norman Oliver, MD, MA - State Health Commissioner

An Important Announcement From PEMS

The Peninsulas EMS Council COVID-19 Protocol Task Force (“PEMS”) has developed a protocol to guide resource allocation for optimal emergency response and patient transport during the declared State of Emergency in the Commonwealth of Virginia. The protocol is designed for use in situations when the potential for demands for EMS resources exceed regional response capacity.  The overarching goal of the new policy is to ensure the sustained provision of critical medical services during times of significantly increased call volume and/or significant reductions in available resources. 

The COVID-19 Tiered EMS Response Protocol is intended only as medical guidance for agencies to assist in managing scarce resources if the need arises.  The new protocol also includes optional resources to give to patients when they are not transported, as well as a resource for providers who may be dealing with stress resulting from COVID-19 responses. 

This procedure is published on the PEMS website both in the “Latest News” Section and in the “Newly Released COVID-19” section.  The PEMS COVID-19 Tiered EMS Response Protocol document may be downloaded from the “Regional Patient Care Protocols, Policies & Procedures” at   http://www.peninsulas.vaems.org/regional-resources/protocols 

The PEMS Protocol App will be updated at midnight, 03-30-20 so that providers may reference it in the field.  Providers are encouraged to update the app regularly.

Cleaning EMS Transport Vehicles after Treatment of Patient with Potential or Confirmed COVID-19

CDC Guidelines Cleaning EMS Transport Vehicles

The following are general guidelines from the CDC for cleaning or maintaining EMS transport vehicles and equipment after transporting a PUI:

Vehicle Rear Doors Should Remain Open While Cleaning

• After transporting the patient, leave the rear doors of the transport vehicle open to allow for sufficient air changes to remove potentially infectious particles.
  • The time to complete transfer of the patient to the receiving facility and complete all documentation should provide sufficient air changes.
• When cleaning the vehicle, EMS clinicians should wear a disposable gown and gloves. A face shield or facemask and goggles should also be worn if splashes or sprays during cleaning are anticipated.
• Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly, to include the provision of adequate ventilation when chemicals are in use. Doors should remain open when cleaning the vehicle.

EPA-Registered Hospital Grade Disinfectant

• Routine cleaning and disinfection procedures (e.g., using cleaners and water to pre-clean surfaces prior to applying an EPA-registered, hospital-grade disinfectantto frequently touched surfaces or objects for appropriate contact times as indicated on the product’s label) are appropriate for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in healthcare settings, including those patient-care areas in which aerosol-generating procedures are performed.
• Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2. Refer to List Nexternal iconon the EPA website for EPA-registered disinfectants that have qualified under EPA’s emerging viral pathogens program for use against SARS-CoV-2.
• Clean and disinfect the vehicle in accordance with standard operating procedures. All surfaces that may have come in contact with the patient or materials contaminated during patient care (e.g., stretcher, rails, control panels, floors, walls, work surfaces) should be thoroughly cleaned and disinfected using an EPA-registered hospital grade disinfectantin accordance with the product label.
• Clean and disinfect reusable patient-care equipment before use on another patient, according to manufacturer’s instructions.
• Follow standard operating procedures for the containment and disposal of used PPE and regulated medical waste.

Is My Disinfectant Included on the List?

• When purchasing a product, check if its EPA registration numberis included on this list.If it is, you have a match and the product can be used against SARS-CoV-2. You can find this on the product label – just look for the EPA Reg. No. These products may be marketed and sold under different brand names, but if they have the same EPA registration number, they are the same product.

The primary products included on our list may have more recognizable brand names, but there are often “distributor products” that are identical to them.

Identify Products by a Three-Part EPA Registration Number

Although distributor products frequently use different brand names, you can identify them by their three-part EPA Reg. No.

• The first two parts of the EPA Reg. No. match the primary product.
• A third set of numbers represents the Distributor ID number.
  • For example, EPA Reg. No. 12345-12-2567 is a distributor product with an identical formulation and efficacy to the primary product with the EPA Reg. No. 12345-12.
• If EPA Reg. No. 12345-12 is on our list, you can buy EPA Reg. No. 12345-12-2567 and be confident you’re getting the same thing.

Avoid Shaking Linen

• Follow standard operating procedures for containing and laundering used linen. Avoid shaking the linen.