Medical Society of Delaware answers FAQs on coronavirus

The Medical Society of Delaware provided the following answers to frequently asked questions about COVID-19 for the public and health-care providers about the pandemic.

What are symptoms of coronavirus:  Symptoms now include myalgia (body aches), sore throat, nausea and diarrhea in addition to fever, cough, and shortness of breath.

For commercial and state testing, what are turnaround times for results? 

  • Commercial labs provide results 2 to 4 days
  • State lab turnaround time is 1 to 2 days (DPH prioritizes DPH lab use for high risk patients, which includes, health care providers and staff, first responders, those hospitalized, and those in high risk situations for potential large community spread such as nursing homes)
  • DPH is actively looking into rapid testing as another modality

How long after an infection is a person considered non-infectious? CDC recommends 72 hours to relieve someone from isolation.

What recommendations can you give for private practices? Should we shut down or continue patient care?  Offices should remain open, offices should protect their staff and patients, private practices are urged to remain open, and consider using telemedicine services.

The Division of Public Health is relying on individual practices to maintain safe patient care.  There are no strict recommendations at this time regarding limiting patient visits.  DPH recommends utilization of telemedicine, and implementing proper screening protocols (screen on the phone, at the door, during the visit, etc.).  The goal is to prevent spread of the virus.  It is recommended to keep as many people out of the office as absolutely possible and screening can make a difference.  It is strongly recommended that all elective procedures be curtailed. With the recent stay a home order from the Governor, it is suggested to cancel “non-essential” visits.

Are there any restrictions to ambulatory surgery centers?  There are no official restrictions.

Is the state considering using retired physicians and utilizing telemedicine to stretch physician power if the pandemic continues?  Delaware is seeking volunteers through the Delaware Medical Reserve Corps and any health care professional including those who are retired.  Gov. Carney declared a Public Health Emergency on 3/23/2020 releasing a more robust order to assist Delaware’s response to COVID-19.  A companion order was issued focused on strengthening Delaware’s health care workforce.  https://governor.delaware.gov/wp-content/uploads/sites/24/2020/03/DEMA-and-DPH-Order-3.23.20.pdf

Bayhealth staffers look at a computer monitor during a drive-up coronavirus testing at Dover International Speedway Wednesday. (Delaware State News/Marc Clery)

For patients/health care workers who test positive, how long until they can go back into the mainstream? Patients are considered fully recovered seven days after the resolution of their symptoms (three days after symptoms resolve they are no longer required to self-isolate at home; however, they must continue to practice extreme social distancing for the remaining four days)

What is the process for return to work for a health care worker? If the health care worker tests negative, they should follow their employer’s HR process. There should be no fever for 24 hours without use of pain meds or fever reducing medication.

How can practices obtain masks to expedite patient care and maintain staff safety in outpatient health care facilities?  DPH released health alert notice on PPE guidelines, supplies and usage. N95s should only be used for high risk procedures (aerosol procedures). Offices are urged to do their own risk assessments to determine if the use of N95 masks are required. Visit the MSD Coronavirus Resource page to instructions and SHOC order form for at https://tinyurl.com/MSDCOVID19

In order to protect health care workers, should everyone wear a mask? For general public contact, masks are not mandatory. Everyone treating a patient with symptoms consistent with COVID-19 should wear a mask and PPE.

Is mask wearing recommended when seeing patients with no COVID-19 symptoms? If you are sure the patient is symptom free, it is not necessary to wear a mask.  However, we are seeing a mix of patients: those that have symptoms and those that have no symptoms who are testing positive.  A suggestion is to wear a mask throughout the day and to conserve use of PPE. 

What is the recommendation now for health care providers to wear masks at all times? CDC guidance is for all facilities to evaluate their process and use of PPE to best conserve supplies.  For those providers who cannot screen or that knowledge of symptoms do not arise during an assessment, some are using one mask for an entire shift, as long as it is not contaminated or visibly soiled.  It would depend on your operations, and can be a great way to conserve PPE supplies and protect staff.

If wearing the same PPE throughout the shift, how does one know they are not transmitting the virus to others? Those PPE that can be worn throughout the shift without changing, unless they are visibly soiled or known to be contaminated are:  face shield, goggles, mask.  Gloves are either to be changed between patients or use hand sanitizer on gloves between patient contact.

Are N95 masks required? The WHO (World Health Organization) and CDC recommendations are to use N95 masks when performing high risk procedures.  Otherwise, health care providers can wear regular masks.

What are the steps to have a patient seen at a designated testing site in Delaware? The patient should first contact their physician.  The physician is to determine if testing is appropriate for the patient.  If testing is deemed appropriate, the physician should provide the appropriate phone number to the patient of the preferred testing site.  The physician is to provide either a written prescription or electronic documentation to the test site for the patient.  The patient is to call the testing site to set up an appointment (the physician’s office can do this on behalf of the patient if there are barriers for the patient to do so).  It is important the patient have an appointment so there are no large mass congregations.  A specimen will be collected and sent to a commercial lab.  The lab will contact the physician with the results.  The physician then contacts the patient.  The patient should be self-isolating until the results are received (and continue to isolate if the results are positive).  (*Bayhealth patients will be pre-screened via phone without needing to see a provider first.)

If the patient does not have a primary care provider, they are to contact the DPH Call Center (866) 408-1899 or 7-1-1 for individuals with a hearing impairment).  A medical screening will be performed and if testing is recommended, the patient follows the same steps above and makes an appointment at a preferred testing site.  DPH will contact the patient when the results are available.

Testing sites will be performing a secondary screening process when the patient arrives. Testing may not be done, based on the secondary screening results.  It is important the physicians inform their patients of this.

The DPH call center operates Monday through Friday from 8:30 a.m. to 8 p.m. and Saturday and Sunday from 10 a.m. to 4 p.m. Visit  https://coronavirus.delaware.gov/testing/

When will Delaware ramp up testing for asymptomatic people? In general, DPH is not expecting to test asymptomatic people.  The CDC has guidance on the evolution of the pandemic and we currently know there is significant community spread.  Everyone should act as if they have the coronavirus and practice safe distancing.  Asymptomatic testing could be helpful for research or surveillance purposes; however, we are currently experiencing a problem now with the availability of testing supplies.

How should health care provider testing be handled, through their own physician, at the physician office where they work, or through the DPH lab? Ideally, it is recommended that the health care provider see their own physician for consultation about testing. 

If my significant other was exposed, do we wait for a positive result on the significant other? If there are no symptoms, no testing is recommended. They should wait until the exposure was tested positive for COVID-19 and they should then remain at home for 14 days and self-quarantine away from everyone in the household. 

If the physician in the office tests positive, what should be done with others in the office/patients? DPH will have a conversation with the physician to determine who he/she was exposed.  The physician is to quarantine and not practice for at least 14 days.

Should PPE be utilized when there is a sick patient at home, but asymptomatic ourselves? Caregivers taking care of those with symptoms of COVID-19 should wear PPE.

If a practice has over 10 employees are there any concerns given the Governor’s Emergency Order? Medical practices are an essential business and are asked not to close.

When should we screen?  Offices should screen patients at every point of communication to include initial phone call, appointment day, upon arrival for appointment and during exam

Should private practices such as primary care defer unnecessary visits, such as well visits and physicals during this time? Take into consideration moving your patient schedule around to lessen the chances of exposure to other patients. If you can delay unnecessary visits, please take this into consideration to help lessen the chances of exposure.  With the recent stay at home measures, it is suggested to cancel these “non-essential” appointments.

Do you recommend physicians with underlying health conditions continuing to work?  Physicians having any health conditions should consider removing themselves for protection.

Can telemedicine be done from home?  Flexibility will be introduced, and doing telemedicine from home will become an option. The state is working on making that an option.


Helpful Coronavirus links

Delaware Division of Health Coronavirus Page
CDC: About the Coronavirus Disease 2019
CDC: What to do if You Are Sick
Johns Hopkins Coronavirus Resource Center
AP News Coronavirus Coverage
Reopening Delaware: Resources for Businesses
Delaware Phase 2 guidance

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