• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • 0 CME Hours
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
COVID-19: Management
CMECNE

COVID-19 Guidance: Key Highlights for Healthcare Professionals

image_pdfFavoriteLoadingFavorite

Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. Describe reporting and testing for the novel 2019 coronavirus
2. Discuss CDC guidelines for prevention of transmission of the novel 2019 coronavirus

Estimated time to complete activity: 0.5 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from 03-23-2020 through 03-23-2021, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.5 contact hours.

Read Disclaimer & Fine Print

NOTE: Information and guidelines may change rapidly. Check in with listed references in ‘Learn More – Primary Sources’ to best keep up to date. This summary has been updated with the latest CDC guidelines on when to end quarantine.

SUMMARY:

The novel coronavirus, named SARS-CoV-2, is the pathogen underlying the pandemic (a global outbreak of disease). The disease associated with this virus has been officially named COVID-19. Coronaviruses represent a large family of viruses. They can cause human illness, but many are found in animals and, rarely, animal coronaviruses can evolve and infect people as was the case in previous infectious outbreaks such as MERS and SARS.


  • Symptoms
  • Those at Risk
  • Travel Warnings
  • Recommendations for Reporting, Testing, and Specimen Collection
  • Healthcare Personnel: Infection Prevention
  • Discontinuation of Transmission-Based Precautions
  • Hospital Discharge
  • Quarantine

Symptoms

  • Incubation period
    • Time from exposure to development of symptoms: 2 to 14 days
    • 97.5% of persons with COVID-19 who develop symptoms will do so within 11.5 days of SARS-CoV-2 infection (see ‘Related ObG Topics’ below)
    • Median time from exposure to symptoms onset: 4-5 days
  • Signs and Symptoms
    • Fever (83% to 99%)
    • Cough (59% to 82%)
    • Fatigue (44% to 70%)
    • Anorexia (40% to 84%)
    • Shortness of breath (31% to 40%)
    • Sputum production (28% to 33%)
    • Myalgias (11% to 35%)
  • Atypical presentations
    • Older adults: Especially those with comorbidities may have delayed presentation of fever and respiratory symptoms.
  • Other symptoms that have been described in the literature (<10%)
    • Headache | Confusion | Rhinorrhea | Sore throat | Hemoptysis | Vomiting | Diarrhea
    • GI symptoms (diarrhea and nausea) may present prior to developing fever and lower respiratory tract signs | Anosmia or ageusia (taste) have also been reported (see ‘Related ObG Topics’ below) | CDC also lists chills and repeated shaking with chills as symptoms

Those at Risk

CDC Currently Considers the Following Individuals to be at Higher Risk

  • Age
    • Risk of severe illness increases with age
    • Approximately 80% of COVID-19 deaths have been in the ≥65 age group
  • People of any age with certain underlying medical conditions are at increased risk for severe illness from COVID-19
    • Pregnancy
    • Cancer
    • Chronic kidney disease
    • COPD (chronic obstructive pulmonary disease)
    • Heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
    • Immunocompromised state (weakened immune system) from solid organ transplant
    • Obesity (body mass index [BMI] of 30 kg/m2 or higher but < 40 kg/m2)
    • Severe Obesity (BMI ≥ 40 kg/m2)
    • Sickle cell disease
    • Smoking
    • Type 2 diabetes mellitus

Pediatric population: Medically complex conditions | Neurologic, genetic, metabolic conditions | Congenital heart disease

Those Who Might be at an Increased Risk

  • Asthma (moderate-to-severe)
  • Cerebrovascular disease (affects blood vessels and blood supply to the brain)
  • Cystic fibrosis
  • Hypertension or high blood pressure
  • Immunocompromised state (weakened immune system) from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines
  • Neurologic conditions, such as dementia
  • Liver disease
  • Overweight (BMI > 25 kg/m2, but < 30 kg/m2)
  • Pulmonary fibrosis (having damaged or scarred lung tissues)
  • Smoking
  • Thalassemia (a type of blood disorder)
  • Type 1 diabetes mellitus

Travel Warnings

  • Updated travelers’ warnings can be found within the CDC Novel Coronavirus Summary page below (‘Learn More – Primary Sources’)

KEY POINTS:

Recommendations for Reporting, Testing, and Specimen Collection

Diagnostic Testing – Specimen Collection

  • Obtain an upper respiratory specimen for initial diagnostic testing
    • A nasopharyngeal (NP) specimen collected by a healthcare professional or
    • An oropharyngeal (OP) specimen collected by a healthcare professional or
    • A nasal mid-turbinate swab collected by a healthcare professional or by a supervised onsite self-collection (using a flocked tapered swab) or
    • An anterior nares (nasal swab) specimen collected by a healthcare professional or by onsite or home self-collection (using a flocked or spun polyester swab) or
    • Nasopharyngeal wash/aspirate or nasal wash/aspirate (NW) specimen collected by a healthcare professional
  • Lower respiratory tract specimens
    • Collect and test sputum in patients who develop a productive cough | Induction of sputum is not recommended
    • Under certain clinical circumstances (e.g., those receiving invasive mechanical ventilation), a lower respiratory tract aspirate or bronchoalveolar lavage sample should be collected and tested as a lower respiratory tract specimen

Note: CDC does not recommend using antibody testing to diagnose acute infection | Use a viral (nucleic acid or antigen) test to diagnose acute infection

Healthcare Personnel: Infection Prevention

  • Healthcare personnel: CDC advises use of
    • Gloves
    • Gowns
    • Airborne precautions
    • Eye protection (e.g., goggles or a face shield)
  • Face masks are an acceptable alternative when the supply chain of N95 respirators (or similar respirators that filter inspired air and offer respiratory protection) cannot meet the demand
  • If respirators are in short supply, priority should be given to aerosol-generating procedures
  • CDC addresses alternatives in the setting of face mask shortages on the page entitled Strategies for Optimizing the Supply of Facemasks (see ‘Learn More – Primary Sources’)

Discontinuation of Transmission-Based Precautions: Now Symptom-Based

Patients with mild to moderate illness who are not severely immunocompromised

  • ≥10 days since symptoms first appeared and
  • ≥24 hours have passed since last fever without the use of fever-reducing medications and
  • Symptoms (e.g., cough, shortness of breath) have improved

Note: For patients who are not severely immunocompromised and who were asymptomatic throughout their infection: Transmission-Based Precautions may be discontinued when ≥10 days have passed since the date of their first positive viral diagnostic test

Patients with severe to critical illness or who are severely immunocompromised

  • ≥10 days and up to 20 days have passed since symptoms first appeared and
  • ≥24 hours have passed since last fever without the use of fever-reducing medications and
  • Symptoms (e.g., cough, shortness of breath) have improved
  • Consider consultation with infection control experts

Note: For severely immunocompromised patients who were asymptomatic throughout their infection: Transmission-Based Precautions may be discontinued when at least 10 days and up to 20 days have passed since the date of their first positive viral diagnostic test

When to Consider Test-Based Strategy

  • Test-based strategy can be considered for the following scenarios
    • Test-based strategy may release individual from isolation sooner
      • May be of limited utility due to prolonged viral shedding
      • Individuals who re severely immunocompromised (in discussion with ID expert) if concern that patient may be infection for more than 20 days

Test-Based Strategy

Patients who are symptomatic

  • Resolution of fever without the use of fever-reducing medications and
  • Symptoms (e.g., cough, shortness of breath) have improved and
  • Results are negative from ≥2 consecutive respiratory specimens collected ≥24 hours apart (total of two negative specimens) tested using an FDA-authorized molecular viral assay to detect SARS-CoV-2 RNA

Patients who are not symptomatic

  • Results are negative from ≥2 consecutive respiratory specimens collected ≥24 hours apart (total of two negative specimens) tested using an FDA-authorized molecular viral assay to detect SARS-CoV-2 RNA

Hospital Discharge

  • Patient can be discharged from hospital with COVID-19 when clinically indicated even if not having met criteria for discontinuation of Transmission-Based Precautions
  • If not yet met criteria for discontinuation of Transmission-Based Precautions
    • Decision should be made with clinical care team and local or state public health departments
    • Take in to consideration patient’s home situation and whether it is appropriate for home isolation recommendations (e.g., separate bedroom, appropriate caregivers, access to PPE, potential risk to others in the home who may be at risk)

Quarantine

  • The purpose of quarantine is to separate someone who might have been exposed to COVID-19 with the goal of preventing transmission to others
  • CDC recommends a 14 day quarantine period

2 ‘Acceptable’ CDC Options to Reduce Time Period to <14 Days

  • Quarantine can end after Day 10 without testing
    • If no symptoms have been reported during daily monitoring
    • With this strategy, residual post-quarantine transmission risk is estimated to be about 1% with an upper limit of about 10%
  • Quarantine can end after Day 7 if a diagnostic testing if
    • Testing is negative and if no symptoms were reported during daily monitoring
    • The specimen may be collected and tested within 48 hours before the time of planned quarantine discontinuation (e.g., in anticipation of testing delays)
    • Quarantine cannot be discontinued earlier than after Day 7
    • With this strategy, the residual post-quarantine transmission risk is estimated to be about 5% with an upper limit of about 12%.

Note: In both cases, additional criteria (e.g., continued symptom monitoring and masking through Day 14) must be met 

Learn More – Primary Sources:

CDC: 2019 Cases, Data, & Surveillance

CDC: COVID-19 and Older Adults

CDC: People of Any Age with Underlying Medical Conditions

CDC Coronavirus Disease 2019: Overview of Testing for SARS-CoV-2

CDC: Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19)

CDC: Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance)

CDC Coronavirus Disease 2019: Guidelines for Clinical Specimens

CDC: Interim U.S. Guidance for Risk Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure to COVID-19

CDC: Coronavirus Disease 2019 Information for Travel

CDC FAQs for Healthcare Professionals

CDC: Strategies for Optimizing the Supply of Facemasks

CDC: Disposition of Hospitalized Patients with COVID-19

CDC: Implementing Home Care

CDC: Options to Reduce Quarantine for Contacts of Persons with SARS-CoV-2 Infection Using Symptom Monitoring and Diagnostic Testing

WHO: Novel coronavirus Information Page

An ACP Physician’s Guide + Resources

BMJ: Coronavirus Updates

Lancet: Coronavirus Hub

NEJM: 2019 Novel Coronavirus

Annals of Internal Medicine: Content Related to Coronavirus in Annals of Internal Medicine

CDC: Standard Precautions

CDC: Contact and Airborne Precautions

CDC: Middle East Respiratory Syndrome (MERS)

CDC: Severe acute respiratory syndrome (SARS)

JAMA: What Is a Pandemic?

Take a post-test and get CME credits

TAKE THE POST TEST

Get Guideline Notifications direct to your phone with ObGFirst®

Try It Free »

image_pdfFavoriteLoadingFavorite
< Previous
All COVID-19: Management Posts
Next >

Related ObG Topics:

Coronavirus and Pregnancy: CDC Guidance and Professional Recommendations
ARDS, Critical Care and COVID-19: ‘Surviving Sepsis Campaign’ Guidelines and Key Points
COVID-19 and NSAIDs: Is There Reason for Concern with Use of Ibuprofen?
COVID-19: The Importance of GI Symptoms and Elevated LFTs
Further Evidence for a 5 Day COVID-19 Incubation Period
Loss of Taste and Smell: Key Symptoms of COVID-19 Infection

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • #Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

ObG Library

  • Hysteroscopy
  • Fertility
  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Log In to ObG First

Please log in to access OBGFirst and the 2T Ultrasound Atlas

Password Trouble?

Sign Up for ObGFirst

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!

ObG First Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site