Public officials should consider racial differences among patients with COVID-19, according to a study in the Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report.
The study found that black patients were overrepresented in a cohort of 305 hospitalized adults with COVID-19 in Georgia. One in four hospitalized patients had no recognized risk factors for severe COVID-19. This research underscores the importance of recognizing and mitigating the racial, social, and economic factors in COVID-19 acquisition risk.
CDC Guidance Updates
Testing and Evaluation Guidelines
The agency on May 3 updated recommendations for testing, specimen collection, and reporting. CDC noted that some point-of-care tests advocate against the use of viral transport medium, a nutrient substance used to keep specimens viable during transport to a lab.
CDC also removed a previously specified preference for nasopharyngeal specimens, noting that other respiratory specimens also are acceptable. The agency noted that testing lower respiratory tract specimens, such as sputum produced from a cough, also may be tested.
Health care providers collecting specimens and working within six feet of patients should wear an N95 or higher-level respirator, eye protection, gloves, and a gown. Providers handling specimens but not working in collection should follow standard precautions and are recommended to wear gloves and a mask.
Clinicians should report positive test results to their local or state health department only.
CDC does not currently recommend using antibody testing alone for diagnostic purposes.
Isolation Guidelines
The agency also updated its criteria for health care personnel returning to work after confirmed or suspected COVID-19. The agency changed the name “non–test-based strategy” to the “symptom-based strategy” for symptomatic personnel and “time-based strategy” for asymptomatic personnel. This guidance extends the duration of exclusion from work to at least 10 days since symptoms first appeared, based on evidence suggesting a longer duration of viral shedding.
Additionally, CDC added criteria for discontinuing transmission-based precautions (TBP) for asymptomatic patients with laboratory-confirmed COVID-19. These patients should remain under TBP until either:
- 10 days have passed since their first positive COVID-19 diagnostic test; or
- they receive negative results of a Food and Drug Administration emergency use authorized molecular assay for detection of SARS-CoV-2 RNA from at least two consecutive respiratory specimens collected more than 24 hours apart.
The agency also updated guidance for discontinuation of isolation for people with COVID-19 who are not in health care settings. Symptomatic patients should follow the symptom-based strategy and discontinue isolation if:
- at least three days have passed since recovery, defined as fever resolution without medication use and improved respiratory symptoms; and
- at least 10 days have passed since symptoms first appeared.
CDC also added a time-based strategy for asymptomatic patients who tested positive. These patients may discontinue isolation 10 days after their first positive COVID-19 test, assuming they have not developed symptoms.
CDC Launches Data Dashboards
Data from CDC’s National Healthcare Safety Network (NHSN) COVID-19 module now are available for state and local health departments and health care systems. The dashboard, updated daily at 9 am ET, includes data for every facility that reported in NHSN for the last three days. The dashboard currently includes data from the Patient Impact & Hospital Capacity reporting pathway. The dashboard will include the Healthcare Worker Staffing and Healthcare Supply pathways, which launched April 14, when there is sufficient data to report.
Health care providers now can access CDC’s personal protective equipment (PPE) burn rate calculator on mobile devices using the NIOSH PPE Tracker app. Based on the PPE burn rate calculator spreadsheet, the app estimates how many days a PPE supply will last.
CMS Issues Additional Waivers, New Rules
The Centers for Medicare & Medicaid Services (CMS) on April 30 issued a second round of waivers and rule changes to federal requirements to provide flexibility to hospitals and improve access to testing for beneficiaries. These changes update waivers issued March 30 to mitigate patient surge.
The association outlines key provisions of these waivers and rule changes in a new update.
Visit the America’s Essential Hospitals coronavirus resource page for more information about the outbreak.
Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.
