COVID-19 Health and Other Partner Resources

Arizona clinicians are recommended to:

• Mask and isolate suspected COVID-19 patients or other patients presenting with acute respiratory illness. Isolation should take place in a private room with the door closed.
• Immediately notify your healthcare facility’s infection control personnel.
• Healthcare personnel encountering a suspect patient should use standard precautions, contact precautions, droplet precautions, and use eye protection (e.g., goggles or a face shield).
• Consider testing for seasonal respiratory illnesses, like influenza.

For all patients who meet COVID-19 PUI criteria:

Health Department Guidance and Recommendations

• Healthcare Facility Guidance
• Shelter Guidance
• Healthcare and First Responder Post-Exposure Guidance
• Lab Testing Guidance
• Ending Isolation Guidance
• Person Under Investigation and Household Contacts Guidance
• Longterm Care Guidance
• Assisted Living Guidance
• Childcare Center Guidance

ADDITIONAL RESOURCES

• Clinician Fact Sheet - ADHS
• Information for Healthcare Professionals - CDC
• Strategies for Optimizing the Supply of N95 Respirators - CDC
• Coronavirus Disease 2019 (COVID-19) Hospital Preparedness Checklist - CDC
• Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected - WHO

Healthcare providers caring for a patient with fever and/or acute respiratory symptoms should:

• Consider ordering a respiratory viral panel to potentially identify other treatable diagnoses.
• Obtain a detailed recent travel history from if COVID-19 is suspected.

For all patients who meet COVID-19 PUI criteria:

• Healthcare personnel who enter the room should use droplet, contact, and standard precautions, plus eye protection (e.g., goggles or a face shield), and patients can be evaluated in a private room with the door closed (unless performing aerosol-generating procedures, which should be performed in a AIIR);
• Immediately notify your healthcare facility's Infection Control Personnel; 
• Immediately call the Arizona COVID-19 Hotline (1-844-542-8201);
• Collect Nasopharyngeal (NP) swab for testing for COVID-19.

Commercial COVID-19 Testing

Private tests are available. Note that the specimens MUST be collected by a provider.

• Lab Testing Guidance

Personal Protective Equipment

Based on the available evidence, SARS-CoV-2, the virus that causes COVID-19 infection, is transmitted via respiratory droplets between people in close contact, and the risk of airborne transmission is low.

Due to this, ADHS now recommends that healthcare providers:

• Use standard, contact, and droplet precautions with eye protection for suspect or confirmed COVID-19 cases.
• Use gowns, gloves, respirators (such as N95 mask) and eye protection (goggles or face shield) when performing aerosol-generating procedures (e.g., tracheal intubation, non-invasive ventilation, tracheostomy, cardiopulmonary resuscitation, manual ventilation before intubation, bronchoscopy).

For more, visit the ADHS website.

PRINTABLE:

If there is not a clear emergency requiring emergency services, it is preferable to have the person pre-evaluated by public health officials in the location where they reside.

If possible, it may be preferable to arrange for private vehicle transport instead of using emergency medical services. Note: Local travel by private vehicle is only permissible if the symptomatic person is wearing a facemask. 

All EMS Partners should:

• Use standard, contact, and droplet precautions with eye protection for suspect or confirmed COVID-19 cases. 
• Use gowns, gloves, respirators (such as N95 mask) and eye protection (goggles or face shield) when performing aerosol-generating procedures (e.g., tracheal intubation, non-invasive ventilation, tracheostomy, cardiopulmonary resuscitation, manual ventilation before intubation, bronchoscopy). 
• Due to the change in transmission-based precautions from airborne to droplet, it is not necessary to place a suspect patient in an airborne infection isolation room (AIIR). A private room with a closed-door is acceptable. Using an AIIR for aerosol-generating procedures is still recommended.
• If a patient suspected to be exposed to COVID-19 is arriving via transport by emergency medical services (EMS), the ambulance attendant should contact the receiving emergency department (ED) or healthcare facility to allow the healthcare facility to prepare for receipt of the patient.

Patient Management Precautions:

• When possible, mask patients as soon as possible if they report recent travel to areas with confirmed spread of COVID-19.
• Ideally, patients should be evaluated in a private space with minimal contact with others.
• Immediately notify your chain of command. Response agencies should notify the Health Department if they have a patient who reports travel to an affected area in the past 14 days AND is exhibiting symptoms like fever, cough, shortness of breath or difficulty breathing.
• The number of EMS and hospital personnel should be limited to those providing essential care services to minimize potential exposures

More information from the CDC

Interim Healthcare Infection Prevention and Control Recommendations for Patients Under Investigation for 2019 Novel Coronavirus.

As additional information is available, the Department will post up-to-date resources from the CDC, ASPR, and NHTSA and on the EMS website.

Update for Elective Surgeries

In accordance with Executive Order 2020-32, dental facilities must request exemption from Executive Order 2020-10 and demonstrate they meet the following criteria in order to resume elective, non-essential surgeries on or after May 1, 2020:

• Demonstrating greater than a 14 day supply of PPE.
• Ensuring adequate staffing and beds.
• Testing patients prior to surgery and all at-risk health care workers.
• Ensuring a universal symptom screening process for staff, patients, and visitors.
• Establishing an enhanced cleaning process for waiting areas.
• Prioritizing the restart of elective surgeries based on urgency.

Arizona Department of Health Services has a FAQ regarding EO 2020-32.

Dental Care

The practice of dentistry involves the use of rotary dental and surgical instruments (e.g., handpieces or ultrasonic scalers) and air-water syringes. These instruments create a visible spray that contains large particle droplets of water, saliva, blood, microorganisms, and other debris. This spray travels only a short distance and settles out quickly, landing on the floor, nearby operatory surfaces, dental health care personnel (DHCP), or the patient. The spray also might contain certain aerosols.

Caring for patients requiring transmission-based precautions is not possible in most dental settings as they are not designed for or equipped to provide this standard of care (i.e. lack of airborne isolation rooms or single-patient rooms, and N95 respirators).

Because of this, Arizona Department of Health Services recommends the following:

• Services should be limited to emergency visits only during this time. Postpone all elective procedures, surgeries, and non-urgent dental visits to help staff and patients stay safe, preserve personal protective equipment and patient care supplies, and expand available health system capacity.
• Implement sick leave policies that are flexible, non-punitive, and consistent with public health guidance (e.g., allowing employees to stay home if they have symptoms of respiratory infection).
  • Staff that begin to develop symptoms while at work should immediately put on a facemask, notify a facility administrator, and self-isolate at home.
  • Facility administrators should implement a tracking system for clearing ill staff to return to work.
• Telephone screen all patients in need of emergency dental care for symptoms of respiratory illness(e.g., fever, cough, shortness of breath). If the patient reports signs or symptoms of respiratory illness, avoid dental care. If possible, delay emergency dental care until the patient has recovered from the respiratory infection.
  • If they will receive care, patients should also be screened for fever and other respiratory symptoms upon check-in.
• The waiting room should provide spacing for patients to sit at least six feet apart, or patients should be asked to wait in their car until they can be seen.
  • Items in waiting rooms such as magazines or toys should be removed at this time.
  • Respiratory hygiene supplies (e.g. tissues) should be available for patients.
• People with respiratory symptoms should be deferred until they have cleared home isolation clearance.
• The following home isolation guidance should be applied to patients and staff:
  • If individual has been tested for COVID-19 and is awaiting results, they should remain under home isolation precautions.
  • If individual has tested positive for COVID-19, they should remain under home isolation precautions for 7 days from specimen collection OR until 3 days (72 hours) after fever is gone and symptoms of acute infection resolve, whichever is longer.
  • If individual has tested negative for COVID-19 and has compatible symptoms (fever, cough, shortness of breath), they should stay home away from others until 3 days (72 hours) after all symptoms of acute infection resolve.
  • If individual has not been tested for COVID-19 and has compatible symptoms (fever, cough, shortness of breath), they should stay home away from others until 3 days (72 hours) after all symptoms of acute infection resolve.
• For urgent clinical care of patients with known or suspected COVID-19, dental personnel and medical providers should work together to determine an appropriate facility for treatment and should follow the Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings. The urgency and need for a procedure are decisions based on clinical judgement and should be made on a case-by-case basis.

Additional Resources for Healthcare Providers:

• Recommendations for Dental Procedures - CDC
• Infection Control in Dental Settings - CDC
• What Constitutes a Dental Emergency - ADA
• Coronavirus Center for Dentists - ADA
• Coding & Billing Guidance - ADA

Additional Resources for Patients:

• What is a Dental Emergency? - ADA
• Dental Appointments & COVID-19 - ADA

Monoclonal antibodies are not currently available for COVID-19 treatment.

On November 30, 2022, the FDA announced that bebtelovimab, the remaining mAB product for the treatment of COVID-19, was no longer authorized for use in the U.S. This decision was due to the increasing prevalence of omicron subvariants BQ.1 and BQ.1.1, against which bebtelovimab was not efficacious. mABs for treatment are no longer available. Paxlovid, Veklury, or Lagevrio remain therapeutic options. For certain patient populations, COVID-19 convalescent plasma may be considered.

On January 26, 2023, the FDA announced that the PrEP mAB Evusheld was no longer authorized for use in the U.S. due to inefficacy against currently circulating SARS-CoV-2 variants.

More information is available on the Pima County Health Department’s COVID-19 treatment page, and the HHS/ASPR COVID-19 Therapeutics page offers the latest clinical guidance.