DHEC continues to work with federal, state and local partners as it investigates COVID-19 cases in South Carolina. DHEC’s top priority remains protecting the public during this national and state emergency.
What if my patient is requesting to be seen in my clinic for respiratory symptoms?
As standard practice, sick patients should be isolated from others and roomed as quickly as possible. Healthcare personnel should also utilize appropriate personal protective equipment (PPE). Patients should preferably be placed in a negative pressure room, but a standard room where they will be isolated from other patients can be used. If a standard room is used, the room should be thoroughly cleaned before reuse. It is preferable to leave the room unused for two (2) hours after the patient with the respiratory complaint was present or to schedule these patients at the end of the day when feasible. The CDC also has information about Infection Prevention when seeing patients with suspected COVID-19.
If you do not have appropriate equipment to keep you and your staff safe, consider referral to a local telehealth virtual care if available. It is not necessary to refer patients to emergency departments or urgent cares simply to get tested. They should only be referred if you believe they require an urgent medical evaluation. Advise patients to isolate while they are symptomatic.
When should I test for COVID-19?
DHEC will continue to update and communicate testing guidance through the South Carolina Health Alert Network (SCHAN). In general, patients who are being considered for PCR testing should be symptomatic with respiratory illness and alternative diagnoses should have been considered. Antibody testing is not recommended to diagnose an acute illness.
It is recommended that close contacts to those contagious with COVID-19 also be tested immediately if they have symptoms or, if they have no symptoms, at least seven (7) days after their first contact with the COVID-19 case. The delay is recommended to allow the virus to reach a detectable level after the exposure. Healthcare providers should use clinical judgement to determine when close contacts should be tested earlier. This could include household contacts with similar exposures as the case.
Patients should understand that PCR testing can only detect the virus if it is present at sufficient levels, so they may test negative even though they have been exposed to the virus and may eventually have symptoms. Any patient who is a close contact of a case and has been instructed to quarantine MUST COMPLETE their full quarantine period even if the test is negative. Any patient testing PCR positive and who has no symptoms must complete isolation until ten (10) days after the test specimen was collected.
Additional testing considerations are available from the CDC.
Should I use antibody testing?
DHEC provided guidance for antibody testing through the South Carolina Health Alert Network (SCHAN). DHEC does NOT recommend using this testing to diagnose an acute infection. PCR testing is the preferred method for identifying new cases. Until more is known about this testing, patients should NOT assume immunity to COVID-19 on the basis of this testing. Use the CDC guidance when considering implementing antibody testing.
What specimen do I collect for PCR testing and where do I send it?
CDC identifies five acceptable specimen types as nasopharyngeal (NP), oropharyngeal (OP), nasal mid-turbinate, or anterior nares (nasal) swabs; or nasopharyngeal wash/aspirate or nasal wash/aspirate specimens. Only one specimen needs to be collected.
The DHEC Public Health Laboratory (PHL) can run samples collected by providers. Directions for completion of paperwork and for specimen transport to the DHEC PHL can be found on the SC DHEC website. A variety of private labs can be utilized for testing. Regardless of the laboratory used for testing, please fill out the lab requisition form with the patient’s appropriate contact information. The initiation of contact investigations can be delayed if follow up is needed to obtain case information from ordering facilities.
How long will it take to get test results?
The time to receive results from private laboratories varies depending on which laboratory is utilized. Please speak with your lab representative in order to give accurate expectations to your patients. Results from the PHL usually take 24-48 hours to report and are available via OpenElis, the secure laboratory web portal. A customer ID is needed to access results electronically. That timeframe may change based on testing volume or demand. Whichever laboratory is used, patients should be advised to isolate while their results are pending. Also, their home/close contacts should minimize their activities outside the home as well. Please report the results to your patient as soon as you receive them. Due to the necessity to urgently start public health investigations and provide isolation guidance, DHEC staff will contact all patients and will not be able to confirm they have been contacted by their provider.
A patient tested positive. What do I do?
Please notify DHEC of positive results. COVID-19 cases and deaths are urgently reportable per the South Carolina List of Reportable Conditions. They must be reported by phone within 24 hours to the appropriate regional health department. When reporting, please alert DHEC if your patient is 65 years old or greater, 5 years old or younger, pregnant, hospitalized, or someone who resides in or attends a congregate setting (e.g. nursing home, long-term care facility, behavioral health facility, or child care).
Please notify the patient of their results and if able to remain or care for themselves at home, advise them to remain in isolation until they meet all of the following conditions:
- No fever for at least 24 hours without the use of fever reducing medication – and -
- It has been least ten (10) days* from the start of their initial symptoms – and -
- Their symptoms have improved.
* - Some patient with severe illness or immunocompromised states are recommended to extend this time period from ten (10) to twenty (20) days. See the SCHAN notice for guidance on this.
Note that the CDC no longer recommends using the test-based strategy for ending isolation except in rare cases of severely immunocompromised patients in which there is concern for extended shedding of virus. The symptom-based strategy described above is sufficient for almost all cases of COVID-19, including as criteria for allowing healthcare workers to return to work.
Their home/close contacts should remain in quarantine for an additional fourteen (14) days after the date that the patient’s period of isolation ends. Patients who test positive but did not have symptoms will need to continue isolation until ten (10) days after the test specimen was collected. Resources are available for cases and contacts on the DHEC website and can be provided prior to being contacted by DHEC.
My patient is now recovered and meets criteria to end isolation. Will they need to quarantine if they have close contact to another case?
It is not known at this point, to what extent recovery from a confirmed infection offers protection against reinfection, but there is evidence of short-term immunity against reinfection. Cases confirmed by PCR testing who meet criteria to end their isolation period may do so even if there are other COVID-19 cases still in isolation in the same household. They do not need to quarantine for any contacts occurring within three (3) months after the start of their symptoms (or the date their test sample was collected if they have no symptoms). Any close contact with a case that occurs outside that three (3) month window will require quarantine based on the current recommendations. Antibody testing should not be used to make this determination of immunity until more is known about these tests and the significance of the antibodies they detect.
Do I need to notify patients who were in the clinic they were exposed to someone with COVID-19?
Since most exposures between patients in a physician’s office are brief and patients are not in close contact for a prolonged period, a notification of other patients in the clinic is likely unnecessary. Measures should be in place to ensure proper social distancing between patients waiting for appointments and mask use should be encouraged.
Do I and my staff need to quarantine?
If the patient was wearing a surgical mask and you and your personnel caring for the patient were wearing appropriate PPE, the risk of transmission is low. Health care staff may continue to work while monitoring for symptoms and checking their temperature daily and prior to starting their shifts. You and your staff who cared for the patient should wear face masks in the office at all times while you monitor for symptoms. Any staff who had a high risk exposure where PPE was not utilized should be excluded from work if possible, but if they must continue to work as essential workers, they should quarantine when outside of work to avoid exposing others. If you or your staff develop fever or respiratory illness, you should isolate and seek medical evaluation. Please see the CDC website for risk stratification in your decision-making process.