Health Alert:   COVID-19 Transmission Level:   HIGH   More information
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COVID-19 Health and Other Partner Resources

UPDATED January 28, 2021

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Coordination and planning with our many healthcare and community partners are the most important elements of our countywide response to the spread of COVID-19. Please find the most up-to-date resources available in the tabs below.


Healthcare providers or caregivers who have questions about symptoms they or their patients exhibit should call 1-844-542-8201, anytime.

Healthcare providers who need assistance assessing a patient with COVID-19 concerns may call 520-724-7797, anytime if the case meets specific guidelines

Members of the general public who have questions should call 2-1-1 from 8 a.m. to 8 p.m. or visit pima.gov/covid19 anytime.

Healthcare and response partner resource requests

PCHD is coordinating relief efforts to get healthcare and other response partners the supplies they need. Current stock is limited and requestors are encouraged to continue working with their commercial suppliers in addition to requesting support from PCHD.




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:

  1. Healthcare personnel entering 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 an AIIR);
  2. Immediately notify your healthcare facility’s infection control personnel;
  3. If you are seeking approval for COVID-19 testing through the ASPHL only - notify Pima County Health Department at 520-724-7797 during both business and after hours.
  4. Immediately call the Arizona COVID-19 Hotline (1-844-542-8201);
  5. Collect Nasopharyngeal (NP) swab for testing for COVID-19.

Health Department Guidance and Recommendations

ADDITIONAL RESOURCES

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.

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.



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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:
Additional Resources for Patients:
For more information about monoclonal antibodies, visit the mAB page.

Frequently asked questions about monoclonal antibodies (mAB)

Revised Dec. 10: What are monoclonal antibodies?

Monoclonal antibodies (mABs) are laboratory-produced proteins that act as substitute antibodies that mimic the immune system's ability to block viruses from entering cells and slow down the progression of infection. Three products, REGEN-COV (casirivimab with imdevimab to be administered together), bamlanivimab administered together with etesevimab, and sotrovimab are available for use under an Emergency Use Authorization (EUA) granted by the FDA.

Monoclonal antibodies are available as a treatment for COVID-19 patients 12 years of age or older (or for neonates to adults for bamlanivimab administered with etesevimab) with mild to moderate disease who are at high risk of progression to severe disease or hospitalization. The EUAs for two mAB products, REGEN-COV and bamlanivimab administered with etesevimab allow for post-exposure prophylaxis in certain individuals at high risk of acquiring SARS-CoV-2 infection and at high risk of progressing to serious illness. 

For details on each mAB product, see the FDA’s fact sheets for REGEN-COV, bamlanivimab/etesevimab, and sotrovimab.

The NIH has more information on the use of mABs as treatment and prophylaxis against COVID-19. 
 

Revised Dec. 10: Which mABs have been authorized?

The FDA issued Emergency Use Authorizations (EUA) for the following three products: REGEN-COV (casirivimab with imdevimab to be administered together), bamlanivimab administered with etesevimab, and sotrovimab. These products are authorized for the treatment of mild to moderate COVID-19 in adults and pediatric patients (neonates to adults for bamlanivimab administered with etesevimab) with positive results of direct SARS-CoV-2 viral testing, within 10 days of start of symptoms, and who are at high risk for progressing to severe COVID-19 and/or hospitalization. 


The EUA for REGEN-COV and bamlanivimab administered with etesevimab was expanded to allow use of these products for post-exposure prophylaxis in individuals at high risk of acquiring SARS-CoV-2 infection who if infected are at high risk of progressing to serious illness. Specifically for individuals who:
  • Are not fully vaccinated or who are not expected to mount an adequate immune response to complete COVID-19 vaccination (such as people with immunocompromising conditions, including those taking immunosuppressive medications) and
  • Have been exposed in close contact to an individual infected with SARS-CoV-2 or
  • Who are at high risk of exposure to a person infected with SARS-CoV-2 because of occurrence of SARS-CoV-2 infection in other people in the same institutional setting (such as a nursing home or a prison).
For details on each mAB product, see the FDA’s fact sheets for REGEN-COV, bamlanivimab/etesevimab, and sotrovimab. The latest treatment guidelines are available from the NIH, and the ADHS maintains a mAB treatment page for providers.


Revised Sept. 30: Are mABs considered investigational?

Yes. REGEN-COV (casirivimab and imdevimab, to be administered together), bamlanivimab administered with etesevimab, and sotrovimab are all considered investigational drug products because studies continue for their use as authorized in the FDA’s Emergency Use Authorization (EUA). They have not been approved by the FDA to treat any diseases or conditions, including COVID-19. The EUA allows healthcare providers to use products that are not yet approved, or that are approved for other uses, to treat patients with COVID-19 if certain legal requirements are met.

Revised Sept. 30: How and where are they administered?

Monoclonal antibodies may only be administered in settings in which health care providers have immediate access to medications to treat a severe infusion or hypersensitivity reactions, such as anaphylaxis, and the ability to activate the emergency medical system as necessary. Depending upon the particular product used, and the indication for which it is given, antibody treatment is usually intravenous, but certain products may be administered subcutaneously. When used for prevention of disease after exposure, repeat doses may administered every several weeks. 

For details on each mAB product, see the FDA’s fact sheets for REGEN-COV, bamlanivimab/etesevimab, and sotrovimab. The latest treatment guidelines are available from the NIH, and the ADHS maintains a mAB treatment page for providers. See a listing of locations administering mABs in Pima County.

Revised Sept. 30: What side effects have been observed with mAB treatments?

Providers must monitor for serious anaphylactic or hypersensitivity reactions during administration of any of these products. Providers should carefully review the FDA’s fact sheets for REGEN-COV, bamlanivimab/etesevimab, and sotrovimab.
 
Allergic reactions and clinical worsening of COVID-19 after administration of mAB treatment with REGEN-COV and sotrovimab has been reported and may include signs or symptoms of fever, hypoxia or increased respiratory difficulty, arrhythmia (e.g., atrial fibrillation, tachycardia, and bradycardia), fatigue, and altered mental status. Some of these events required hospitalization. It is not known if these events were related to the specific mAB therapy or were due to progression of COVID-19.  Because mAB treatment is investigational and still being studied it is possible that there may be additional risks and side effects that are not yet known. 

Revised Dec. 22: Should patients who received monoclonal antibody therapy for COVID-19 wait to get the vaccine?

Based on the estimated half-life of mAB therapy, or anticipated post-infection protection, current CDC clinical guidance is that patients who received passive antibody therapy defer COVID-19 vaccination temporarily to avoid potential interference of mABs with COVID-19 vaccine-induced immune responses. Specifically:
  • If mAB was used for COVID-19 treatment, vaccination should be deferred 90 days.
  • If mAB used for post-exposure prophylaxis, vaccination should be deferred 30 days.
 This guidance is subject to change as more information becomes available about COVID-19 vaccination and these therapies.

Revised Sept. 30: Are there any resources for sites administering mABs, including long-term care facilities?

The NIH has updated information for clinicians regarding usage guidelines, recommendations, and criteria in the COVID-19 Treatment Guidelines, and the HHS offers the latest announcements, clinical evidence and resources on the COVID-19 Monoclonal Antibody Therapeutics website. The Arizona Department of Health Services maintains a website on mABs for healthcare providers and facilities featuring a variety of updated links and resources.

Providers should carefully review the FDA’s fact sheets for REGEN-COV, bamlanivimab/etesevimab, and sotrovimab. These fact sheets provide information on criteria for patient selection, safety summaries, clinical trial results, antiviral resistance, dosage, preparation and administration, patient monitoring, anaphylaxis, and updated warnings.

Regeneron (the manufacturer of REGEN-COV) offers updated resources for clinicians and patients including links to the latest fact sheets and handouts in English and Spanish on their REGEN-COV website. GSK (the manufacturer of sotrovimab) offers a variety of resources for health care providers and patients on the sotrovimab website.

Dec. 14: Are there any mABs for pre-exposure prophylaxis for prevention of COVID-19?

On December 8, 2021, the FDA granted Emergency Approval Authorization (EUA) for Evusheld, a monoclonal long-acting antibody (LAAB) for pre-exposure prophylaxis (PrEP) for prevention of COVID-19 in those 12 and older:
  • Who are not currently infected with SARS-CoV-2 and who have not had a known recent exposure to an individual infected with SARS-CoV-2 AND
    • Who have moderate to severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments and may not mount an adequate immune response to COVID-19 vaccination OR
    • For whom vaccination with any available COVID-19 vaccine, according to the approved or authorized schedule, is not recommended due to a history of severe adverse reaction (e.g., severe allergic reaction) to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s).
Evusheld is a combination of two different mABs, tixagevimab and cilgavimab co-packaged together, and administered as two separate consecutive IM injections, preferable into gluteal muscles. People can be re-dosed every 6 months if needed. AstraZeneca reported headache, fatigue and cough as the most commonly reported adverse effects in clinical trials. At this time, Evusheld continues to be investigational; as such, not all adverse effects are known.

More details on Evusheld including indications, contraindications, warnings and precautions are available from the FDA’s Fact Sheet for Healthcare Providers, the FDA’s Evusheld FAQs and the manufacturer’s website.

The NIH has more information on the use of mABs as treatment and prophylaxis against COVID-19.