LAC | DPH | Interim Guidelines for COVID-19 Antigen Testing in Skilled Nursing Facilitie

Signs or symptoms compatible with COVID-19

Signs and symptoms compatible with COVID-19 include:

Fever, cough, dyspnea, new loss of taste or smell, chills/rigors, myalgias, rhinorrhea, vomiting or diarrhea, sore throat, fatigue, headache, and confusion.

For more information, see CDC Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease and Information for Pediatric Healthcare Providers.

What is the clinical presentation of COVID-19?

Adults

The signs and symptoms present at illness onset vary, but over the course of the disease, most patients with confirmed COVID-19 have developed an influenza-like illness with fever and lower respiratory tract symptoms. Atypical presentations have been described and older adults and person with medical co-morbidities may have delayed presentation of fever and respiratory symptoms. Asymptomatic infections have been well documented as well.

Symptoms may appear 2-14 days after exposure to the virus.

Symptoms reported among people with COVID-19 include:

Fever
Cough
Dyspnea (new or worsening over baseline)
New loss of taste or smell
Chills/rigors
Myalgias
Rhinorrhea
Vomiting or diarrhea
Sore throat
Fatigue
Confusion
Headache

Various other symptoms have been associated with COVID-19, see CDC Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease for a more detailed discussion of COVID-19 presentations and asymptomatic infection in adults.

Children

Illness among pediatric cases appears to be mild, with most cases presenting with symptoms of upper respiratory infection such as:

Fever
Cough
Nasal congestion
Rhinorrhea
Sore throat

Children with COVID-19 may not initially present with fever and cough as often as adult patients. See CDC Information for Pediatric Healthcare Providers for more information.

Who is considered a close contact of COVID-19?

A “close contact” refers to any of the following people who were exposed to a patient with presumed or confirmed COVID-19 (“patient”) while they were infectious*:

An individual who was within 6 feet of the patient for a total of 15 minutes or more within a 24-hour period
An individual who had unprotected contact with the patient’s body fluids and/or secretions, for example, being coughed or sneezed on, sharing utensils or saliva, or providing care without wearing appropriate protective equipment.

*A patient with presumed or confirmed COVID-19 is considered to be infectious from 2 days before their symptoms started until their isolation period ends (see When is someone infectious). Asymptomatic patients with laboratory-confirmed COVID-19 infection are considered to be infectious from 2 days before their test was taken until 10 days after their test was taken.

When can a close contact leave quarantine and return to work/school?

Close Contacts must stay in quarantine for 14 days from when they last had contact with the infectious person (case). If they continue to have close contact with the case during the case’s isolation period (e.g. shared household and/or caregiver) then they need to stay in quarantine for 14 days after their last exposure to the case. See “How to calculate when quarantine period ends” for more information.

As long as the close contact has remained asymptomatic during quarantine, they may return to regular activities including work or school after the 14 days have passed. Neither Public Health clearance nor a negative COVID-19 test is required for return to work/school. Contacts should be reminded to continue to practice physical distancing (stay 6 feet away from others) and to wear a cloth face covering when they are in public settings where other people are present to reduce the risk of COVID-19 transmission or acquisition in the future.

See LAC DPH Isolation and Quarantine Provider webpage—Ending Quarantine and Return to Work

What actions need to occur if a HCP is exposed to a COVID-19 patient?

If the health care exposure was not a high-risk exposure, then there are no work restrictions. The HCP should continue to follow all recommended infection control practices including universal source control and twice daily self-monitoring.

HCP with high risk exposures to COVID-19 should be excluded from work for 14 days (with exceptions made for staffing shortages). They should be instructed to monitor themselves for fever or symptoms consistent with COVID-19 and to immediately contact their established point of contact (e.g. occupational health program) if symptoms develop. HCP can return to work after 14 days if they have never had symptoms.

See LAC DPH Guidance for Monitoring Healthcare Personnel.

Severely immunocompromised

Severely immunocompromised-The CDC suggests the following as conditions that may warrant extending the duration of isolation or transmission-based precautions: chemotherapy for cancer, untreated HIV infection with CD4 T lymphocyte count < 200, combined primary immunodeficiency disorder, hematopoietic stem cell or solid organ transplant, and receipt of prednisone >20mg/day for more than 14 days.

Factors such as advanced age, diabetes mellitus, or end-stage renal disease, may pose a much lower degree of immunocompromise and not clearly affect decisions about duration of isolation and precautions.

Ultimately, the degree of immunocompromise for the patient is determined by the treating provider, and preventive actions are tailored to each individual and situation.

A person is considered recovered from COVID when:

At least 10 days have passed since your symptoms first started and
You have had no fever for at least 24 hours (without the use of medicine that reduces fevers) and
Your symptoms have improved (for example, cough or shortness of breath)

If you tested positive for COVID-19 but never had any symptoms, you are considered recovered after 10 days have passed since the date of your first positive test.

Una persona se considera recuperada de COVID cuando:

Han pasado al menos 10 días* desde que comenzaron sus síntomas y
No ha tenido fiebre durante al menos 24 horas (sin el uso de medicamentos que reducen las fiebres) y
Sus síntomas han mejorado (por ejemplo, tos o falta de aire)

Si su prueba dio positivo con el COVID-19 pero nunca tuvo ningún síntomas, se considera recuperado después de que hayan pasado 10 días desde la fecha de su primera prueba positiva.

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Public Health has made reasonable efforts to provide accurate translation. However, no computerized translation is perfect and is not intended to replace traditional translation methods. If questions arise concerning the accuracy of the information, please refer to the English edition of the website, which is the official version.

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Coronavirus Disease 2019

Interim Guidelines for COVID-19 Antigen Testing in Skilled Nursing Facilities