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2109 Sumner Avenue
Aberdeen, WA
United States

(360) 532-8631

Epi News

Health Advisory: Get your patients back on track with routine vaccinations.

Grays Harbor County Public Health & Social Services Department

The COVID-19 pandemic has impacted all aspects of life, including patients’ ability to attend important appointments and receive routine vaccinations. Many patients had to postpone or cancel appointments and still may not have had the opportunity to catch back up on needed healthcare.

Public Health encourages your patients to schedule appointments to ensure they are up to date on annual exams and recommended vaccines. Research has consistently shown that healthcare professionals are the most trusted source of vaccine information for parents and patients.

Many of our Washington kids are vulnerable to serious but preventable diseases, “We need to get children caught up now on vaccines they missed. They are headed back to school soon, and flu activity often picks up in the fall, so let’s get them protected before they’re exposed.” Acting Assistant Secretary Michele Roberts said in a press release.

Some of the notable drops seen among the 11 and 12-year-olds were:

  • An 11% decrease in Tdap (tetanus, diphtheria, and whooping cough) vaccine, from 60.3% in 2019 to 49.2% in 2020. One dose of Tdap is required to enter 7th grade in Washington State.

  • An 8.4% decrease in meningococcal vaccine, from 50.7% in 2019 to 42.3% in 2020.

  • A 5.6% decrease in HPV vaccine, from 42.0% in 2019 to 36.4% in 2020. The HPV vaccine prevents several types of cancer and is more effective when given at the recommended age.

  • A 6.0% decrease in the proportion receiving the 1:1:1 series (1 dose of Tdap, 1 or more doses of meningococcal vaccine, and 1 or more doses of HPV vaccine) from 39.4% in 2019 to 33.4% in 2020.

We know providers are taking many precautions to keep families safe during preventive visits. It is also convenient to protect older children against COVID-19 now that kids who are 12 and up can get the COVID-19 vaccine at the same time as the rest of their vaccines. Let’s get everyone back to school safely after the disruption of the last two school years, knowing we’re protecting them from outbreaks of many diseases.

Updated Treatment Recommendations for Gonococcal Infection

Guest User

Antimicrobial resistance in bacterial pathogens like Neisseria gonorrhoeae continues to be a threat, and we cannot address this serious public health concern alone. As a result of continued trends in antimicrobial resistance, we are asking health care providers to update their STD management practices to treat uncomplicated gonococcal infection with just one higher dosage (500mg) injection of ceftriaxone. Additionally, if chlamydial infection has not been excluded, persons should be treated for coinfection with oral doxycycline (100 mg twice daily for 7 days). Please review CDCs' December 17, 2020 Morbidity and Mortality Weekly Report for full details and recommended guidance.

 

We appreciate all that you do to combat STDs including HIV and adult viral hepatitis and even more so as our nation forges a path to recover from the COVID-19 pandemic.

 

Actions Requested

·         Treat uncomplicated gonococcal infection with a single intramuscular dose of 500 mg ceftriaxone.

·         For uncomplicated rectal, vaginal, or urethral infections, oral treatment with 800 mg cefixime is an alternative treatment.

·         If chlamydia has not been ruled out, treat additionally with doxycycline, 100 mg twice daily for 7 days. If the patient is pregnant, or if adherence to a full week regimen may be an issue, treat with azithromycin 1 g.

·         If cephalosporins cannot be used, treat with a single 240 mg dose of gentamycin with 2 g azithromycin.

·         Consult an infectious disease specialist for alternative treatment options for treating persons with an anaphylactic or other severe reaction to ceftriaxone, especially for pharyngeal infection, for which there is no highly effective second line therapy.

·         Incorporate patient delivered partner therapy (PDPT) into your STD management practices for controlling chlamydial and gonorrheal infections.  

o   For expedited partner therapy to treat partners of patients who have tested positive for gonorrhea, the recommended dosages are 800 mg cefixime in a single dose and doxycycline, 100 mg twice daily for 7 days. If adherence is an issue, 2 grams of azithromycin in a single dose can be prescribed instead of doxycycline.

o   PDPT/EPT is not recommended for partners of patients who are MSM (men who have sex with men). MSM patients and their partners should be offered testing for HIV and syphilis alongside testing and treatment for gonorrhea and chlamydia.

·         DO NOT TREAT gonorrhea with 2 grams of azithromycin alone.

·         Offer test of cure (TOC) for all gonococcal infections of the pharynx at 7-14 days after treatment.

·         Stay up-to-date on the National STD Curriculum at https://www.std.uw.edu/.

 

Questions:  Contact Zandt Bryan 360.890.5816, Katrina Miller 360.236.3425, or Kari Haecker 360.890.6897.

Cases should be reported to your local health department. Reporting information and forms for public health jurisdictions can be found on the DOH website.  

Recommendations

Regimen for uncomplicated gonococcal infections of the cervix, urethra, or rectum:

Ceftriaxone 500 mg IM as a single dose for persons weighing <150 kg (300 lb).

• For persons weighing ≥150 kg (300 lb), 1 g of IM ceftriaxone should be administered.

• If chlamydial infection has not been excluded, providers should treat for chlamydia with doxycycline 100 mg orally twice daily for 7 days. Azithromycin 1 g as a single dose is still a second line treatment for chlamydia, and is the preferred alternative to doxycycline in pregnant patients.

 

Alternative regimens for uncomplicated gonococcal infections of the cervix, urethra, or rectum if ceftriaxone is not available:

Gentamicin 240 mg IM as a single dose plus azithromycin 2 g orally as a single dose OR

Cefixime 800 mg orally as a single dose. If treating with cefixime, and chlamydial infection has not been excluded, providers should treat for chlamydia with doxycycline 100 mg orally twice daily for 7 days. During pregnancy, azithromycin 1 g as a single dose is recommended to treat chlamydia.

 

Recommended regimen for uncomplicated gonococcal infections of the pharynx:

Ceftriaxone 500 mg IM as a single dose for persons weighing <150 kg (300 lb).

·         For persons weighing ≥150 kg (300 lb), 1 g of IM ceftriaxone should be administered.

·         If chlamydia coinfection is identified when pharyngeal gonorrhea testing is performed, providers should treat for chlamydia with doxycycline 100 mg orally twice a day for 7 days. During pregnancy, azithromycin 1 g as a single dose is recommended to treat chlamydia.

·         No reliable alternative treatments are available for pharyngeal gonorrhea. For persons with a history of a beta-lactam allergy, a thorough assessment of the reaction is recommended.*

·         For persons with an anaphylactic or other severe reaction (e.g., Stevens Johnson syndrome) to ceftriaxone, consult an infectious disease specialist for an alternative treatment recommendation.

 Abbreviation: IM = intramuscular.

*CDC. Sexually transmitted diseases treatment guidelines. MMWR Recomm Rep 2015;64(No. RR-3). https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htm. 

 

Resources

·         National Network of STD Clinical Prevention Training Centers: 

o   Resources:  https://nnptc.org/resources/

·         Washington State Provider Guidelines for Patient Delivered Therapy (PDF)

·         Department of Health Expedited Therapy

·         Expedited Partner Therapy (CDC)

·         Department of Health Statement Regarding STD Management During COVID-19 (April 2020)

·         STD Treatment Options (CDC, April 2020); Clarification (CDC, May 2020)

 

References

St. Cyr S, Barbee L, Workowski KA, et al. Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1911–1916. DOI: http://dx.doi.org/10.15585/mmwr.mm6950a6external icon

COVID-19 updates for providers: Expanded demographics required by providers and laboratories on all COVID-19 testing and result reporting

Grays Harbor County Public Health & Social Services Department

Requested actions:

  • Be aware that as of June 8, 2020 all clinical providers ordering a COVID-19 lab test must supply, to the lab, all patient contact information and demographics to include:

    • Name

    • Date of birth

    • Gender

    • Race

    • Ethnicity

    • Full address

    • Phone number

  • Be aware, all labs performing COVID-19 testing will submit, along with lab results, data as required under WAC 246-101 Notifiable Conditions as referenced above.

  • Note that any positive result for COVID-19, including a positive serologic test, is immediately reportable to Public Health.

Background:

  • On June 8, 2020, the State of Washington Department of Health (DOH) Deputy Health Officer Scott Lindquist, MD, MPH, sent a letter directing all laboratories and providers to expand reporting demographics and use of electronic case reporting. https://www.doh.wa.gov/Portals/1/Documents/1500/CLR-LabProvDemoRptLtr.pdf

  • WAC 246-101-315 and WAC 246-101-225 allows the state health officer to require other information to be reported. Race and ethnicity data are critical to documenting testing and positive case disparities, which would help public health, improve testing capabilities in under-served populations and better target prevention efforts.

  • In Washington State, laboratories are legally required to notify public health authorities of suspected or confirmed cases of selected diseases or conditions. This is referred to as notifiable conditions reporting.

  • Per the Washington State Board of Health (WAC 246-101-005), the purpose of notifiable conditions reporting is to provide the information necessary for public health officials to protect the public’s health by tracking communicable diseases and other conditions. These data are critical to local health departments and the Departments of Health (DOH) and Labor and Industries in their efforts to prevent and control the spread of diseases and other conditions. Public Health officials take steps to protect the public based on these notifications.

Situation update

Grays Harbor County has 20 confirmed cases of COVID-19.

·         March 2020: 2 cases 

·         April 2020: 10 cases

·         May: 5 cases

·         June: 3 cases

Grays Harbor Public Health’s COVID-19 Task Force and Grays Harbor Emergency Operations Center remain prepared to respond if any additional cases are identified.

Grays Harbor County Public Health will continue to operate a COVID-19 call center that will assist people with testing referrals. Assistance is available in both English and Spanish. Call (360) 964-1850. The call center is available Monday through Friday, 8:30am to 12:00pm and 12:30 pm to 4pm. Testing resources and locations can be found on the Grays Harbor Public Health website.

Additional resources

Health Update: COVID-19 updates for providers & New Health Order

Grays Harbor County Public Health & Social Services Department

Requested actions:  

  • Be aware that Health Order 2020-08 has been issued regarding COVID-19 testing. The updated Health Order expands the list of COVID-19 symptoms per the CDC.

  • Note that testing shall be allowed for asymptomatic close contacts of confirmed cases of COVID-19 as part of Public Health case investigation and contact tracing.

  • Note that any positive result for COVID-19, including a positive serologic test, is immediately reportable to Public Health.

Situation update

Grays Harbor County has 17 confirmed cases of COVID-19

·         March 2020: 2 cases 

·         April 2020: 10 cases

·         May: 5 cases

Grays Harbor Public Health’s COVID-19 Task Force and Grays Harbor Emergency Operations Center remain prepared to respond if any additional cases are identified.

Grays Harbor County Public Health will continue to operate a COVID-19 call center that will assist people with testing referrals. Assistance is available in both English and Spanish. Call (360) 964-1850. The call center is available Monday through Friday, 8:30am to 12:00pm and 12:30 pm to 4pm. Testing resources and locations can be found on the Grays Harbor Public Health website.

Additional resources

Health Update: COVID-19 updates for providers

Grays Harbor County Public Health & Social Services Department

Requested actions

Situation update

Grays Harbor County has 16 confirmed cases of COVID-19.

·         March 2020: 2 cases 

·         April 2020: 10 cases

·         May: 4 cases

Grays Harbor Public Health’s COVID-19 Task Force and Grays Harbor Emergency Operations Center remain prepared to respond if any additional cases are identified.

Grays Harbor County Public Health will continue to operate a COVID-19 call center that will assist people with testing referrals. Assistance is available in both English and Spanish. Call (360) 964-1850. The call center is available Monday through Friday, 8:30am to 4pm. Please note that the call center will be closed Monday, May 25 for the Memorial Day holiday. Testing resources and locations can be found on the Grays Harbor Public website.

Additional resources

Health Update: The use of experimental antiviral medication remdesivir to treat severe cases of COVID-19

Grays Harbor County Public Health & Social Services Department

Requested actions:

•        Be aware that the drug remdesivir is being used to treat patients hospitalized with severe cases of COVID-19. The FDA, under a federally approved emergency use authorization, has approved remdesivir, an experimental antiviral medication.

•        Be aware that Washington State Department of Health has received 800 vials of remdesivir from the federal government and is distributing these vials to 11 hospitals across Washington State, based on an allocation plan.

•        Be aware that, at this time, Public Health does not foresee any hospital allocations for Grays Harbor County hospitals, but this may change in the future

BACKGROUND

·         On May 2, 2020, the U.S. Food and Drug Administration FDA issued an Emergency Use Authorization (EUA) to permit the emergency use of the unapproved product remdesivir for treatment of suspected or laboratory-confirmed coronavirus disease 2019 (COVID-19) in adults and children hospitalized with severe disease.

·         The producer of remdesivir (Gilead) donated its drug to the federal government. The federal government, in turn, decided to distribute allotments of remdesivir to states for distribution.

·         On May 11, 2020 after learning the federal government was sending 800 vials of remdesivir (treatment for approximately 100 patients) to Washington, the Department of Health (DOH) convened the Disaster Medical Advisory Committee, infectious disease experts, critical care experts, and community and equity leaders in Washington to provide advice to the Department of Health on two key policy questions:

1.      How should remdesivir be distributed in Washington?

2.      Which patients should be highest priority for receiving remdesivir?

·        After receiving input from experts on the above two questions, DOH developed an allocation plan for this initial shipment of remdesivir.

DOH will allocate remdesivir to hospitals based on:

o   Incidence of COVID-19 cases in the county during the past week

o   Incidence of deaths in the county during the past weeks (didn’t have time to consider)

o   Number of COVID-19 patients in the hospital

o   Health inequities (i.e., prioritize communities experiencing disproportionate burden of disease)

o   Access to remdesivir through a clinical trial or the Gilead Expanded Access Program (Hospitals who are currently participating or recently participated in a remdesivir trial or the Gilead Expanded Access Program will not receive any of the initial remdesivir shipment.)

·         DOH expects to receive additional shipments in the future.

RESOURCES

·         https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-issues-emergency-use-authorization-potential-covid-19-treatment

·         https://www.fda.gov/media/137566/download

·         https://www.fda.gov/media/137565/download

Situation update

Grays Harbor County has 15 confirmed cases of COVID-19.

·         March 2020: 2 cases 

·         April 2020: 10 cases

·         May: 3 cases

Grays Harbor Public Health Incident Management Team (IMT) remains prepared to respond if any additional cases are identified.

Additional resources

·         Our web page for healthcare providers: http://www.healthygh.org/directory/providers

·         Our web page for COVID-19 guidance: http://www.healthygh.org/directory/covid19guidance

Our web page for general COVID-19 information: http://www.healthygh.org/directory/covid19

Health Advisory: Pediatric multi-system inflammatory syndrome potentially associated with coronavirus disease (COVID-19) in children

Grays Harbor County Public Health & Social Services Department

ACTIONS:

  • Be aware that the Novel Coronavirus (COVID-19) has been recently reported as possibly linked with a pediatric multi-system inflammatory syndrome disease – “Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19.”

  • Consider “Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19” in children who present with persistent fever, inflammation (e.g., neutrophilia, elevated C-reactive protein and lymphopenia) and evidence of single or multi-organ dysfunction (shock, cardiac, respiratory, renal, gastrointestinal or neurological disorder). See below for additional information.

  • Immediately report cases of pediatric multi-system inflammatory syndrome potentially associated with COVID-19 in patients who are under 21 years of age to your local health jurisdiction.

  • Perform a PCR and serological test to detect the presence of SARS-COV-2, the virus that causes COVID-19, or corresponding antibodies in the patient.

  • Use COVID-19 PPE and infection control precautions while patients are under evaluation for and if diagnosed with COVID-19.

BACKGROUND

  • In the United Kingdom and Europe, a possible link has been reported between COVID-19 and a serious inflammatory disease recently termed “Pediatric Multi-System Inflammatory Syndrome Temporally Associated with COVID-19.”

  • As of May 11, 2020, one suspected pediatric clinical cases compatible with multi-system inflammatory syndrome associated with COVID-19 has been reported in children in Washington State. As of May 5, 2020, 64 cases have been reported in children in New York State.

  • This syndrome has features which overlap with Kawasaki Disease and Toxic Shock Syndrome. Inflammatory markers may be elevated, and fever and abdominal symptoms may be prominent. Rash also may be present. Myocarditis and other cardiovascular changes may be seen. Additionally, some patients have developed cardiogenic or vasogenic shock and required intensive care. This inflammatory syndrome may occur days to weeks after acute COVID-19 illness.

  • The syndrome may include:

    A child presenting with persistent fever, inflammation (e.g., neutrophilia, elevated C-reactive protein, ferritin, and lymphopenia) and evidence of single or multi-organ dysfunction (shock, cardiac, respiratory, renal, gastrointestinal or neurological disorder). This may include children meeting full or partial criteria for Kawasaki disease.

    Exclusion of any other microbial cause, including bacterial sepsis, staphylococcal or streptococcal shock syndromes, and infections associated with myocarditis such as enterovirus. Clinicians should not delay seeking expert advice while waiting for results of these investigations.

  • Early recognition by pediatricians and prompt referral to an in-patient specialist, including to critical care is essential.

  • This syndrome should be considered by pediatricians and specialists, particularly when other microbial etiologies have not been identified.

  • Pediatricians and specialists should elicit any recent history of illness with COVID-19 or close contact with individuals who are known to have COVID-19 in children presenting with symptoms that are compatible with pediatric multi-system inflammatory syndrome potentially associated with COVID-19.

  • The majority of patients who have presented with this syndrome have tested positive for SARS-CoV- 2 or corresponding antibodies. Some tested positive on diagnostic, molecular testing for SARS-CoV-2, others were positive on serological testing for corresponding antibodies.

RESOURCES

•  Lancet correspondence (May 6, 20120): https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31094-1/fulltext

•  Centers for Disease Control and Prevention (CDC) COVID-19 Website: https://www.cdc.gov/coronavirus/2019-ncov/index.html

• Royal College of Paediatrics and Child Health Guidance: Paediatric Multisystem Inflammatory Syndrome Temporally Associated with COVID-19: https://www.rcpch.ac.uk/sites/default/files/2020-05/COVID-19-Paediatric-multisystem-%20inflammatory%20syndrome-20200501.pdf

Situation update

Grays Harbor County has 13 confirmed cases of COVID-19.

  • March 2020: 2 cases 

  • April 2020: 10 cases

  • May: 1 case (previously reported as 2 cases; 1 case has been reassigned to a different county following investigation)

Grays Harbor Public Health Incident Management Team (IMT) remains prepared to respond if any additional cases are identified.

Additional resources

Our web page for healthcare providers: http://www.healthygh.org/directory/providers

Our web page for COVID-19 guidance: http://www.healthygh.org/directory/covid19guidance

Our web page for general COVID-19 information: http://www.healthygh.org/directory/covid19

Health Update: New isolation guidance for COVID-19

Grays Harbor County Public Health & Social Services Department

Requested actions

  • Counsel patients recovered from COVID-19 to maintain isolation for:

    • at least 10 days after illness onset and

    • at least 3 days (72 hours) after recovery.

Definitions:

Illness onset: Date symptoms begin.

Recovery: Resolution of fever without the use of fever-reducing medication with progressive improvement or resolution of other symptoms.

Background information:

The Centers for The Centers for Disease Control and Prevention on May 3, 2020 updated their recommendation for persons discontinuing isolation after COVID-19 illness.  This change increases the period of recommended isolation by 3 days, from 7 to 10. This more cautious approach is intended to more stringently limit transmission that may occur from persons following recovery from illness and thereby enhance ongoing efforts to control COVID-19 illness.

 The CDC’s complete recommendations are available at https://www.cdc.gov/coronavirus/2019-ncov/community/strategy-discontinue-isolation.html?deliveryName=USCDC_2067-DM27395.

Situation update

Grays Harbor County has 14 confirmed cases of COVID-19.

·         March 2020: 2 cases 

·         April 2020: 10 cases

·         May: 2 cases

Grays Harbor Public Health Incident Management Team (IMT) remains prepared to respond if any additional cases are identified.

Additional resources

·         Our web page for healthcare providers: http://www.healthygh.org/directory/providers

·         Our web page for COVID-19 guidance: http://www.healthygh.org/covid19guidance

·         Our web page for general COVID-19 information: http://www.healthygh.org/covid19

Health Advisory: COVID-19 updates for providers

Grays Harbor County Public Health & Social Services Department

Requested actions

  • Continue to follow Grays Harbor County Health Order 2020-06

  • Be aware that Washington State Department of Health’s new interim COVID-19 testing guidance for healthcare providers expands testing to all symptomatic and certain asymptomatic people. However, please continue to operate under Grays Harbor County Health Order 2020-06, issued April 23, until further notice. Local supply levels are not yet adequate to support unrestricted testing.

  • Note that Washington State Secretary of Health, Dr. John Wiesman, has issued a call-to-action for health care providers and laboratories to support the rapid identification, investigation, isolation, and contact tracing of COVID-19 cases.

  • Complete a survey from Washington State Department of Health and Public Health – Seattle & King County for healthcare providers about access and barriers to SARS-CoV-2 testing. The results of the survey will help Public Health better understand access and barriers to testing in our community.

Situation update

Grays Harbor County has 12 confirmed cases of COVID-19.

  • March 2020: 2 cases 

  • April 2020: 10 cases

No additional cases of COVID-19 have been identified in Grays Harbor County since April 12. Grays Harbor Public Health Incident Management Team (IMT) remains prepared to respond if any additional cases are identified.

Additional resources

Health Advisory: Health Officer Interim Recommendations for SARS-CoV2 Antibody Testing

Grays Harbor County Public Health & Social Services Department

Grays Harbor Public Health is aware that there is an increasing public interest in antibody testing for COVID-19.  At this time we are not recommending the use of antibody tests or providing guidance about how to interpret the results.

While increasingly available under FDA Emergency Use Authorization protocols, antibody tests are not recommended for making a diagnosis of COVID-19 or to reliably determine whether or not a patient has experienced a past infection with COVID-19.  It is not yet known whether infection with COVID-19 confers long-term immunity; therefore, the medical significance of a positive or negative serology is unclear.

The preferred diagnostic test for COVID-19 is a PCR-based test to detect the presence of viral particles.  If the decision is made to order antibody testing, it is important to counsel patients about the limitations of currently available tests to avoid a false sense of security against future infection.  Patients with a positive COVID-19 serologic test should continue to consider themselves at risk of infection.

Any positive result for COVID-19, including a positive serologic test, is reportable to Public Health.

Please visit our website for the most current COVID-19 information at www.healthygh.org/covid19.

Health Update: Continued Testing at Community-Based Testing Site

Grays Harbor County Public Health & Social Services Department

Grays Harbor County Public Health and the Washington Army National Guard has extended the drive-through COVID-19 testing site until Friday, May 1, 2020.

With the support of the Washington State Public Health Lab, we will expand testing to include all persons age 18 and older who have symptoms of COVID-19 (fever [subjective or measured] cough and/or shortness of breath, repeated shaking with chills, muscle pain, headache, sore throat and/or new loss of taste or smell).  We are expanding eligibility to take full advantage of the increased testing capacity afforded by the support of the Army National Guard.

At this time we are NOT changing Health Order 2020-04 other than adding the additional CDC symptoms listed above and announcing the continued test site operations through May 1, 2020. Hospitals and providers should continue to provide testing to the priority populations identified in the order.  We will adjust the Health Order when the supply chain can support a sustained increase in the number of tests provided by local systems.

Please instruct patients who meet these criteria to call the Public Health COVID-19 call center. Call center staff will screen patients and schedule a testing appointment.

Public Health COVID-19 Call Center

360-964-1850

Please visit our website for the most current COVID-19 information at www.healthygh.org/covid19.

Health Update: Expanded Testing at Community-Based Testing Site Continues Through April 27, 2020

Grays Harbor County Public Health & Social Services Department

Grays Harbor County Public Health and the Washington National Guard will continue to operate a drive-through COVID-19 testing site through Monday, April 27, 2020, including over the weekend.

With the continued support of the Washington State Public Health Lab, we will test all persons age 18 and older who have symptoms of COVID-19 (fever [subjective or measured]or cough and/or shortness of breath).  We are offering expanded testing eligibility at the community-based drive-through site to take full advantage of the increased testing capacity afforded by the support of the Washington National Guard.

At this time we are NOT changing Health Order 2020-04 (attached and available on our website at www.healthygh.org/covid19guidance).  Hospitals and providers should continue to provide testing to the priority populations identified in the order.  We will adjust the Health Order when the supply chain can support a sustained increase in the number of tests provided by local systems.

Please instruct patients who meet these criteria to call the Public Health COVID-19 call center. Call center staff will screen patients and schedule a testing appointment.

Public Health COVID-19 Call Center

360-964-1850

Please visit our website for the most current COVID-19 information at www.healthygh.org/covid19.

Health Update: Guidance for Daily COVID-19 Screening of Staff and Visitors

Grays Harbor County Public Health & Social Services Department

Attached are guidance documents that Grays  Harbor County Public Health is sharing with local Health Care Providers.  These guidance documents are based on recommendations from the Center for Disease Control, the Washington State Department of Health and a literature review of COVID-19 signs and symptoms.

Please feel free to utilize these recommendations and screening logs in your clinical practice.  Screening staff and visitors daily for COVID-19 symptoms and the use of social distancing are the cornerstones of preventing the spread of COVID-19 in the community.

Questions?

Public Health COVID-19 Call Center

360-964-1850

Please visit our website for the most current COVID-19 information at www.healthygh.org/covid19.

Health Update: Expanded Testing at Community-Based Testing Site

Grays Harbor County Public Health & Social Services Department

Grays Harbor County Public Health and the Washington Army National Guard will operate a drive-through COVID-19 testing site starting Wednesday, April 15, 2020 and running daily as long as supplies permit.

With the support of the Washington State Public Health Lab, we will expand testing to include all persons age 18 and older who have symptoms of COVID-19 (fever [subjective or measured] and cough and/or shortness of breath).  We are expanding eligibility to take full advantage of the increased testing capacity afforded by the support of the Army National Guard.

At this time we are NOT changing Health Order 2020-04 (attached and available on our website at www.healthygh.org/covid19guidance).  Hospitals and providers should continue to provide testing to the priority populations identified in the order.  We will adjust the Health Order when the supply chain can support a sustained increase in the number of tests provided by local systems.

Please instruct patients who meet these criteria to call the Public Health COVID-19 call center. Call center staff will screen patients and schedule a testing appointment.

Public Health COVID-19 Call Center

360-964-1850

Please visit our website for the most current COVID-19 information at www.healthygh.org/covid19.

Health Update: Commuity Based Testing Site Offered for COVID-19 Priority Population

Grays Harbor County Public Health & Social Services Department

Grays Harbor County Public Health and the Washington Army National Guard will operate a drive-through COVID-19 testing site starting Wednesday, April 15, 2020 and running daily as long as supplies permit.

With the support of the Washington State Public Health Lab, testing will be provided to people who:

1.    Have symptoms of COVID-19 (fever [subjective or measured] and cough and/or shortness of breath); AND

2.    meet the criteria priority populations outlined in Grays Harbor County Health Order 2020-04 (attached and available on our website at www.healthygh.org/covid19guidance).

Please instruct patients who meet these criteria to call the Public Health COVID-19 call center starting Monday,  April 13, 2020 at 8:30AM. Call center staff will screen patients and schedule a testing appointment.

Public Health COVID-19 Call Center

360-964-1850

Please visit our website for the most current COVID-19 information at www.healthygh.org/covid19.

Health Update: COVID-19 Priority Testing

Grays Harbor County Public Health & Social Services Department

Grays Harbor Community Hospital and Summit Pacific Medical Center are now providing COVID-19 testing to symptomatic priority populations as per Health Officer order.

 If you are unable to test in your clinic and  have a patient who meets criteria for testing, please complete the attached screening tool for your patient and fax the form to one of the screening sites below.  Please remember, testing will only be done if both the patient is symptomatic and identifies as one of the priority populations. 

 Please fax the completed screening tool to either facililty:

  • Grays Harbor Community Hospital:  360-537-5034

  • Summit Pacific Medical Center:  360-495-5741

 Instruct your patient that they will receive a phone call to schedule their test.

 As testing supplies beome more readily available, the testing order will be re-evlauated.

 Please visit our website for the most current COVID-19 information at www.healthygh.org/covid19

 Additional information

Health Update: COVID-19 Outbreak

Grays Harbor County Public Health & Social Services Department

Updated PPE Recommendations/New Testing Guidance

As of March 16, 2020 – New updated interim infection prevention and control recommendations for patients with suspected or confirmed COVID-19 in Health care setting can be located at https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html

Highlights include:

·         Facemasks are an acceptable alternative when the supply chain of respirators cannot meet the demand

·         Facemasks protect the wearer from splashes and sprays

·         Respirators which filter inspired air, offer respiratory protection

·         Eye protection, gown, and gloves continue to be recommended

Grays Harbor County Health Officer, Dr. Bausher, will not order quarantine of first responders and health care professionals caring for persons known to be infected with COVID-19 if they have practiced standard use of PPE and procedures to limit the spread of respiratory illnesses.

 COVID-19 Testing Information for Health Care Providers

There are currently no restrictions on who can be tested for COVID-19 and commercial testing is becoming more available. Healthcare providers may test any patient with symptoms consistent with COVID-19 (e.g., fever, cough, shortness of breath) but until testing supplies and laboratory capacity are widely available, public health is asking providers to follow the below recommendations.

The following patients with COVID-19 symptoms should be tested for COVID-19:

·         Patients hospitalized with severe lower respiratory illness

·         Staff that work in any setting where healthcare services are delivered (e.g., clinics,   hospitals, behavioral health care clinics).

·         Patients in other public safety occupations (e.g., law enforcement, fire fighter, EMS)

·         Patients who live or work in in an institutional setting (e.g., corrections, long term care facility, homeless/shelters)

The following patients with COVID-19 symptoms should contact their healthcare provider and be tested for COVID-19 if their symptoms worsen or their healthcare provider recommends testing:

·         Patients older than 60 years

·         Patients with underlying medical conditions

·         Pregnant women

Younger, healthy individuals with mild illness do not need to be tested and testing is not recommended in persons who are asymptomatic. A negative test result does not rule out an infection.

 Many commercial labs are testing for COVID-19 and more are being added.  Please see each laboratory’s test menu for specimen collection instructions, submission forms, and shipping requirements.  As of 3/16/20, the following labs are providing testing.  Many more labs will become available as FDA approves testing facilities.

·         University of Washington Virology Lab

·         Laboratory Corporation of America

·         Quest Diagnositcs

·         Virginia Mason Medical Center

Testing at the Public Health Laboratories

Specimens from the following patients only can be sent to the Washington State Public Health Laboratories:

·         Healthcare workers

·         Patients in other public safety occupations (e.g., law enforcement, fire fighter, EMS)

·         Patients involved in an illness cluster in a facility or group (e.g., healthcare, school, corrections, business)

·         Patients with no health insurance

If seeking testing at the Public Health Laboratories, call Grays Harbor Public Health  with the above information to discuss the case. If possible, please call 8 AM – 4:30 PM. Public Health Lab will fax its results to the submitter and Grays Harbor Public Health.

Additional information

·         Washington State Department of Health:   https://www.doh.wa.gov/Emergencies/NovelCoronavirusOutbreak2020/HealthcareProviders

·         CDC: https://www.cdc.gov/coronavirus/2019-nCoV/guidance-hcp.html   

·         WA State Department of Health  - Healthcare Provider Resources and Recommendations: https://www.doh.wa.gov/Emergencies/NovelCoronavirusOutbreak2020/HealthcareProviders

Health Advisory: COVID-19 Outbreak

Grays Harbor County Public Health & Social Services Department

Minimize your clinic’s chance of exposure of COVID-19

Measures should be implemented before patient arrival, upon arrival, throughout the duration of the patient’s visit, and until the patient’s room is cleaned and disinfected. It is particularly important to protect individuals at increased risk for adverse outcomes from COVID-19 (e.g. individuals with comorbid conditions and/or over age 60), including HCP who are in a recognized risk category.

Before Arrival

  • When scheduling appointments for routine medical care (e.g., annual physical, elective surgery), instruct patients to call ahead and discuss the need to reschedule their appointment if they develop symptoms of a respiratory infection (e.g., cough, sore throat, fever1) on the day they are scheduled to be seen.

  • When scheduling appointments for patients requesting evaluation for a respiratory infection, use nurse-directed triage protocols to determine if an appointment is necessary or if the patient can be managed from home.

  • If the patient must come in for an appointment, instruct them to call beforehand to inform triage personnel that they have symptoms of a respiratory infection (e.g., cough, sore throat, fever1) and to take appropriate preventive actions (e.g., follow triage procedures, wear a facemask upon entry and throughout their visit or, if a facemask cannot be tolerated, use a tissue to contain respiratory secretions).

Upon Arrival and During the Visit

·         Consider limiting points of entry to the facility.

·         Take steps to ensure all persons with symptoms of COVID-19 or other respiratory infection (e.g., fever, cough) adhere to respiratory hygiene and cough etiquette, hand hygiene, and triage procedures throughout the duration of the visit.

·         Post visual alerts (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias) to provide patients and HCP with instructions (in appropriate languages) about hand hygiene, respiratory hygiene, and cough etiquette. Instructions should include how to use tissues to cover nose and mouth when coughing or sneezing, to dispose of tissues and contaminated items in waste receptacles, and how and when to perform hand hygiene.

·         Provide supplies for respiratory hygiene and cough etiquette, including alcohol-based hand rub (ABHR) with 60-95% alcohol, tissues, and no-touch receptacles for disposal, at healthcare facility entrances, waiting rooms, and patient check-ins.

·         Install physical barriers (e.g., glass or plastic windows) at reception areas to limit close contact between triage personnel and potentially infectious patients.

·         Consider establishing triage stations outside the facility to screen patients before they enter.

o    Ensure rapid safe triage and isolation of patients with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough).

o    Prioritize triage of patients with respiratory symptoms.

o    Triage personnel should have a supply of facemasks and tissues for patients with symptoms of respiratory infection. These should be provided to patients with symptoms of respiratory infection at check-in. Source control (putting a facemask over the mouth and nose of a symptomatic patient) can help to prevent transmission to others.

Ensure that, at the time of patient check-in, all patients are asked about the presence of symptoms of a respiratory infection and history of travel to areas experiencing transmission of COVID-19 or contact with possible COVID-19 patients.

Isolate the patient in an examination room with the door closed. If an examination room is not readily available ensure the patient is not allowed to wait among other patients seeking care.

Identify a separate, well-ventilated space that allows waiting patients to be separated by 6 or more feet, with easy access to respiratory hygiene supplies.

In some settings, patients might opt to wait in a personal vehicle or outside the healthcare facility where they can be contacted by mobile phone when it is their turn to be evaluated.

o Incorporate questions about new onset of respiratory symptoms into daily assessments of all admitted patients. Monitor for and evaluate all new fevers and respiratory illnesses among patients. Place any patient with unexplained fever or respiratory symptoms on appropriate Transmission-Based Precautions and evaluate.

COVID-19 Testing Information for Health Care Providers

Please contact Public Health if you are testing any medical practitioner in your clinic for COVID-19. 

State of Washington Public Health Lab – Prioritized populations for testing

Must get approval from Local Public Health and the Washington State Department of Health. Please call 360-532-8631 for approval for the following patients:

·         Health care workers

·         Patients in other public safety occupations (e.g. law enforcement, fire fighter, EMS)

·         Patients involved in an illness cluster investigation in a facility or group setting

·         Patients with NO health insurance

Testing at Commercial Laboratories

In general, the Washington State Department of Health does not recommend testing asymptomatic persons, however, you can consider testing asymptomatic persons if they have been in close contact with a confirmed case through commercial laboratories. Any other patients can be tested per healthcare provider judgement.

Many commercial labs are testing for COVID-19 and more are being added.  Please see each laboratory’s test menu for specimen collection instructions, submission forms, and shipping requirements.  As of 3/9/20, the following labs are providing testing.  Many more labs will become available as FDA approves testing facilities.

·         University of Washington Virology Lab

·         Laboratory Corporation of America

·         Quest Diagnositcs

·         Virginia Mason Medical Center 

Additional information

·         Washington State Department of Health:   https://www.doh.wa.gov/Emergencies/NovelCoronavirusOutbreak2020/HealthcareProviders

·         CDC: https://www.cdc.gov/coronavirus/2019-nCoV/guidance-hcp.html   

WA State Department of Health  - Healthcare Provider Resources and Recommendations: https://www.doh.wa.gov/Emergencies/NovelCoronavirusOutbreak2020/HealthcareProviders

 EPI NEWS is faxed to healthcare offices during events of public health significance.  Please share or post so that others may see this.  Sign up for Epi News by email at:  lleitz@co.grays-harbor.wa.us.

Health Alert: Immediate action needed
Health Update: Updated information on Alert or Advisory

Health Advisory: May require immediate action
Info Service: Not of an emergent nature

Health Advisory: COVID-19 Outbreak

Grays Harbor County Public Health & Social Services Department



COVID-19 confirmed in Grays Harbor County resident

The person is receiving hospital care.

Grays Harbor Public Health officials are reporting the County’s first case of novel coronavirus
(COVID-19).  The man in his 60s is in isolation and receiving care at Grays Harbor Community Hospital.  He did not travel outside the United States before becoming ill.

Public Health is working with the patient’s family to identify and evaluate persons who had close contact with him while he was contagious.  Persons believed to be exposed will be asked to quarantine themselves for 14 days past their last exposure and report any symptoms to Public Health.

The risk of COVID-19 in Washington is increasing and Public Health expects that more cases will be
identified now that the criteria for testing have broadened. 

The most recent official counts are available on the Washington State Department of Health’s 2019 Novel Coronavirus Oubreak (COVID-19) webpage (doh.wa.gov/coronavirus). Counts are updated daily.

As of March 10, 2020 – New updated interim infection prevention and control recommendations for patients with suspected or confirmed COVID-19 in Health care setting can be located at https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html

Highlights include:      
Facemasks are an acceptable alternative when the supply chain of respirators cannot meet the demand
Facemasks protect the wearer from splashes and sprays       
Respirators which filter inspired air, offer respiratory protection        
Eye protection, gown, and gloves continue to be recommended

COVID-19 Testing Information for Health Care Providers

State of Washington Public Health Lab – Prioritized populations for testing

Must get approval from Local Public Health and the Washington State Department of Health. Please call 360-532-8631 for approval for the following patients:

Health care workers 
Patients in other public safety occupations (e.g. law enforcement, fire fighter, EMS)  
Patients involved in an illness cluster investigation in a facility or group setting  
Patients with NO health insurance

 Testing at Commercial Laboratories

In general, the Washington State Department of Health does not recommend testing asymptomatic persons, however, you can consider testing asymptomatic persons if they have been in close contact with a confirmed case through commercial laboratories. Any other patients can be tested per healthcare provider judgement.

Many commercial labs are testing for COVID-19 and more are being added.  Please see each laboratory’s test menu for specimen collection instructions, submission forms, and shipping requirements.  As of 3/9/20, the following labs are providing testing.  Many more labs will become available as FDA approves testing facilities.

University of Washington Virology Lab

Laboratory Corporation of America

Quest Diagnostics

Virginia Mason Medical Center


Additional information        
Washington State Department of Health:   https://www.doh.wa.gov/Emergencies/NovelCoronavirusOutbreak2020/HealthcareProviders      
CDC: https://www.cdc.gov/coronavirus/2019-nCoV/guidance-hcp.html          
WA State Department of Health  - Healthcare Provider Resources and Recommendations: https://www.doh.wa.gov/Emergencies/NovelCoronavirusOutbreak2020/HealthcareProvider

 EPI NEWS is faxed to healthcare offices during events of public health significance.  Please share or post so that others may see this.  Sign up for Epi News by email at:  lleitz@co.grays-harbor.wa.us.

Health Alert: Immediate action needed
Health Update: Updated information on Alert or Advisory

Health Advisory: May require immediate action
Info Service: Not of an emergent nature

Health Update: COVID-19 Outbreak

Grays Harbor County Public Health & Social Services Department



COVID-19 Case Counts       
There are no confirmed cases of COVID-19 in Grays Harbor County.
Statewide case counts are changing rapidly.        
The most recent official counts are available on the Washington State Department of Health’s 2019 Novel Coronavirus Oubreak (COVID-19) webpage (doh.wa.gov/coronavirus). Counts are updated daily.

COVID-19 Patient Information Sheets

Please share these information sheets from the Washington State Department of Health with your patients.  They provide key information and targeted messaging for each population.

1).  What to do if you have symptoms of coronavirus disease (COVID-19) and HAVE NOT been around anyone who has been diagnosed with COVID-19. https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/COVIDconcerned.pdf

2).  What to do if you were POTENTIALLY EXPOSED to someone with confirmed coronavirus disease (COVID-19) https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/COVIDexposed.pdf

3).  What to do if you have CONFIRMED OR SUSPECTED coronavirus disease (COVID-19) https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/COVIDcasepositive.pdf

People at high risk for complications from COVID-19:       
People older than 60 years        
People with chronic medical conditions, e.g. heart disease, lung disease and diabetes                          
People with weakened immune systems       
Pregnant people 

Protecting people at high risk of severe disease:        
use telephone triage or virtual care options when possible to avoid having infectious persons in the health care setting;       
mask persons who are coughing upon entry into  the clinic.

Additional information        
Washington State Department of Health:   https://www.doh.wa.gov/Emergencies/NovelCoronavirusOutbreak2020/HealthcareProviders      
CDC: https://www.cdc.gov/coronavirus/2019-nCoV/guidance-hcp.html           
WA State Department of Health  - Healthcare Provider Resources and Recommendations: https://www.doh.wa.gov/Emergencies/NovelCoronavirusOutbreak2020/HealthcareProviders

 EPI NEWS is faxed to healthcare offices during events of public health significance.  Please share or post so that others may see this.  Sign up for Epi News by email at:  lleitz@co.grays-harbor.wa.us.

Health Alert: Immediate action needed
Health Update: Updated information on Alert or Advisory

Health Advisory: May require immediate action
Info Service: Not of an emergent nature