COVID-19: Health Care Providers

Health care professionals are those responsible for treating and working with patients and families affected by COVID-19. This page houses information and resources for health care professionals responding to COVID-19.

Monitoring Resources

PPE

 

What Safer at Home means for health care facilities fact sheet

 

 Reporting and Surveillance Guidance

The state epidemiologist has declared COVID-19 a Category I reportable disease per a memo issued on Feb. 4, 2020.

  • Report IMMEDIATELY by TELEPHONE to the patient's local public health department upon identification of a confirmed or suspected case. The local health department shall then notify the state epidemiologist immediately of any confirmed or suspected cases. Within 24 hours, submit a case report electronically through the Wisconsin Electronic Disease Surveillance System (WEDSS), by mail or fax using an Acute and Communicable Disease case report, F44151 or by other means.

  • Information on communicable disease reporting

Clinical Description: People with confirmed COVID-19 infections (also known as SARS-CoV-2, nCoV) can have a wide range of symptoms, from mild to severe. Mild illness may include sore throat, headache, myalgia, fatigue, and upper respiratory symptoms. Symptoms of more severe illness may include fever, cough and shortness of breath. Some people also have gastrointestinal symptoms, including nausea, vomiting, or diarrhea. Loss of smell (anosmia) and taste (ageusia) have also been reported among some patients. Infrequently people with COVID-19 may experience complications, such as pneumonia and acute respiratory distress syndrome (ARDS). Asymptomatic infections have also been reported.

Confirmatory laboratory criteria for COVID-19 infection: Isolation of SARS-CoV-2 virus, or demonstration of specific viral antigen or nucleic acid from a clinical specimen.

Confirmed: Any case that has a confirmatory laboratory result of the virus causing COVID-19 infection (SARS-CoV-2) irrespective of clinical signs or symptoms

Probable:

  • An illness with clinically compatible symptoms of COVID-19 infection where laboratory testing for the virus causing COVID-19 infection ( SARS-CoV-2) is inconclusive according to the test results reported by the laboratory.

         OR

  • An illness with clinically compatible symptoms of COVID-19 infection, with no other known etiology for the clinical illness, for whom COVID-19 laboratory testing has not been done, AND who is epi-linked to a confirmed case. Epi-linked is defined as close contact with a confirmed COVID-19 case or a member of a cluster of illnesses where at least one confirmed case has been diagnosed, in the 14 days before onset of symptoms.

Suspect:

  • An illness with clinically compatible symptoms of COVID-19 infection, for whom laboratory confirmation is pending, and who has no known epi-link to a confirmed COVID-19 case.
  • Any case of COVID-19 infection reported to public health that does not meet a confirmed or probable case definition, and does not have a negative laboratory result for COVID-19.
  • An illness with clinically compatible symptoms of COVID-19 infection for whom COVID-19 laboratory testing has not been done, AND who is epi-linked to a probable case.

Not a Case: Any illness reported that has a negative laboratory result for COVID-19.

 Testing Criteria

General guidance for health care providers on testing for COVID-19 can be found on CDC’s Evaluating and Testing Persons for Coronavirus Disease 2019 (COVID-19) webpage. Providers should use their clinical judgement and are advised to refer to the CDC Priorities for Testing Patients with Suspected COVID-19 Infection for additional guidance on overall testing priorities.

There is still a shortage of ingredients needed to run COVID-19 tests. While testing has expanded in recent weeks, nationally and within Wisconsin, many states across the country continue to grapple with this same problem. We have been working with partners in the private sector and public universities to try to get the ingredients needed to run these tests. Wisconsin’s two public health labs testing for COVID-19, the Wisconsin State Laboratory of Hygiene (WSLH) and Milwaukee Health Department Laboratory (MHDL), have worked with DHS to develop a priority list for public health lab testing for COVID-19.

  • In order to conserve supplies for testing in the public health labs, WSLH and MHDL are prioritizing testing to include samples for the following patients:
    • Hospitalized patients with COVID-19 symptoms    
    • Patients with COVID-19 symptoms for whom rapid diagnosis is needed to inform infection control practices (e.g., labor and delivery, dialysis, aerosol-generating procedures, etc.)
    • Residents of a long-term care facility with COVID-19 symptoms
    • Residents in a jail, prison, or other congregate setting with COVID-19 symptoms
    • Health care workers or first responders (e.g., fire, EMS, police) with COVID-19 symptoms
    • Essential staff in high-consequence congregate settings (e.g., prisons or jails) with COVID-19 symptoms
  • Providers may send specimens to WSLH or MHDL only if they meet Wisconsin public health laboratory testing priorities listed above. If equivalent or more rapid turnaround is available through an in-house or commercial lab, providers are encouraged to use these other laboratory options.
  • The CDC-developed Person Under investigation (PUI) form is no longer required to be completed or submitted at the time of testing. Please use Wisconsin’s Patient Information Form to accompany specimens in its place. This form MUST accompany the lab requisition form for specimens submitted to WSLH or MHDL.
  • Testing for patients who do not meet one of the Wisconsin public health laboratory priorities listed above, but for whom testing is requested by a provider, should have their specimen submitted to in-house or commercial labs for testing.
  • We encourage all clinicians to test patients in the clinic and outpatient setting to reduce demand on hospitals and emergency departments.
  • Providers should educate patients who are being tested about how to properly isolate themselves and are encouraged to share DHS’s What should I do if I was tested for COVID-19 and am awaiting results?
  • Counsel patients who can't be tested to self-isolate at home, separated from household contacts.
    • Share DHS’s What should I do if I am diagnosed with COVID-19?
    • Remind them that their household and intimate contacts should limit public activities for 14 days.
    • Providers are being asked to report patients who they have diagnosed with COVID-19 but who are not being tested as suspect cases. These reports are important to the public health response and will help us to better understand the burden of disease
    • Reports can be made via WEDSS or by submitting Wisconsin’s Patient Information Form to the patient’s local health jurisdiction.
Responses to common questions about testing

Where should I send specimens?
Many commercial and clinical labs are now performing COVID-19 testing. If your health system is performing large numbers of tests (such as drive-through testing sites, testing of ill health care workers), these specimens should be sent to commercial or in-house labs. Health plans have been asked to waive cost-sharing for COVID-19 laboratory and radiology testing.

How will we get patient results?
As with other testing, clinicians can expect results to be communicated directly from the lab. Please do not contact DHS or your local health department for test results.

How will my patient get their results?
As with other testing, clinicians should share test results with patients directly. Please do NOT tell patients to contact their local health department or DHS for test results, or updates on the status of their testing.

What are other testing considerations?

  • Number of health care providers present during the procedure should be limited to those essential for patient care and procedure support. Visitors should not be present for specimen collection. Specimen collection should be performed in a normal examination room with the door closed.
  • A single nasopharyngeal (NP) swab is sufficient for testing. Specimen collection should be done by trained individuals.
  • The ordering provider is responsible for receiving COVID-19 test results from the laboratory and communicating the result to the patient.

 

 Isolation and Quarantine Guidance

 

For information on whether or not people should self-quarantine, self-isolate, or self-monitor, please see the DHS COVID-19 monitoring webpage.

Guidance for Local Health Department Enforcement of Quarantine

When possible, DHS recommends voluntary quarantine or isolation. If there is reason to believe that an individual may not voluntarily abide by quarantine or isolation recommendations, the LHD should evaluate the individual’s circumstances that make nonadherence likely, and provide linkages to available resources that can support quarantine at home.

These may include:

  • Food delivery
  • Social support
  • Telehealth/information resources
  • Mental health resources

If individuals demonstrate they are unwilling to voluntarily isolate, the LHD may have to issue a quarantine/isolation order. The quarantine/isolation order should be issued in writing. If the person fails to comply, the LHD may petition a court to order compliance. The LHD must prove by clear and convincing evidence that the directive is the least restrictive measure that will protect the public’s health.

The LHD may employ quarantine guards if intent to violate a quarantine order is shown. Typically, the LHD employs local law enforcement. The quarantine guards have police powers to use all necessary means to enforce the quarantine. The costs of the quarantine guards are the responsibility of the county or municipality. During a state of emergency, if the person is quarantined outside their home, those costs may be reimbursable by the state. If necessary, the LHD can remove a person to a separate place for quarantine/isolation if removal would not endanger the person’s health.

Anyone who enters a quarantine/isolation premises without authorization is subject to a fine not to exceed $10,000 or nine months in jail, or both. Anyone who willfully violates laws relating to public health may be subject to 30 days in jail or fined not more than $500, or both. DHS has a toolkit of legal forms to assist LHDs with quarantine/isolation enforcement issues.

 Memos Issued by DHS

Below is a listing of all memos issued by DHS containing guidance for COVID-19.

Official Number Description Issue Date Attachments Obsolete Date
20-002
CMS 1135 Waiver Provisions – Wisconsin Hospitals April 6, 2020
BCD 2020-17
Changes to COVID-19 Reporting Requirements for Wisconsin Hospitals and Health Departments April 6, 2020
20-001
State Licensure Application for Temporary Expansion Locations during Public Health Emergency related to COVID-19 April 3, 2020
2020-04
Minimum Contact Standards for Support and Service Coordination: New Requirements Necessitated by the Novel Coronavirus (COVID-19) Pandemic April 2, 2020
BCD 2020-14
Information for Dental Health Care Professionals (DHCP): What You Need to Know about Coronavirus Disease (COVID-19) March 20, 2020
BCD 2020-15
Important Information for Recipients of Personal Protective Equipment (PPE) from the Strategic National Stockpile (SNS) March 20, 2020
BCD 2020-16
Important Guidance for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) (REVISED) in Long-Term Care Facilities and Assisted Living Facilities March 20, 2020
BCD 2020-12
Updated guidance for local health departments and government partners about home isolation and quarantine for COVID-19 March 19, 2020
BCD 2020-13
What to do if someone breaks quarantine: Guidance for Local Health Departments (LHDs) March 19, 2020
BCD 2020-10
Ryan White Part B and Life Care Services Emergency Financial Assistance Policy in Response to COVID-19 March 18, 2020
BCD 2020-11
Adult/Juvenile Correctional Facilities, Local Jails, and Secure Treatment Centers in Wisconsin Guidance for Coronavirus Disease 2019 (COVID-19) March 18, 2020
BCD 2020-09
Urgent Update – Prioritization of COVID-19 Testing for Hospitalized Patients March 17, 2020
BCD 2020-07
Important Recommendations for Prevention of COVID-19 in Long-Term Care Facilities and Assisted Living Facilities March 13, 2020
March 20, 2020
BCD 2020-08
Public Health Guidance for Discontinuation of Home Isolation and Voluntary Home Quarantine for Individuals Infected with or Exposed to COVID-19 March 13, 2020
BCD 2020-04
Coronavirus Disease 2019 (COVID-19) Update: Recommendations on Domestic and International Travel March 12, 2020
BCD 2020-05
New Mass Gathering Guidance for Novel Coronavirus (COVID-19) March 12, 2020
March 19, 2020
BCD 2020-06
Updated Guidance on Infection Control during Specimen Collection for COVID-19 in Outpatient Settings March 12, 2020
EMS 20-02
Interim Guidance for Emergency Medical Services (EMS) Systems, Practitioners and Public Safety Answering Points (PSAPs) Regarding COVID-19 March 12, 2020
BCD 2020-03
Updates to COVID-19 Testing Procedures March 9, 2020
March 19, 2020
BCD 2020-02
New Requirements for Reporting Cases and Patients Under Investigation for COVID-19 February 4, 2020
EMS 20-01
Interim Guidance for Emergency Medical Service (EMS) Providers in Wisconsin Regarding COVID-19 Associated with the Outbreak in Wuhan, China January 31, 2020

 Dental Health Care Professionals Guidance

Should I Remain Open?

DHS strongly recommends that dental practices postpone all elective and non-urgent care treatment starting immediately until after the public health emergency has passed. The Occupational Safety and Health Administration (OSHA) has developed guidance to assess the level of exposure risk of different occupations, and dentists performing aerosol-generating procedures on known or suspected COVID-19 patients are in the very highest category. The American Dental Association has resources and information for dentists, including guidance on determining nonemergent, urgent, emergent care situations.

It is anticipated that Dental Health Care Professionals would continue to be available for emergency treatment, as needed. DHS realizes that defining emergency dental care can be difficult and subjective. We encourage dentists to use their clinical judgment based on experience and evidence-based practices. These decisions can be influenced by many factors, including:

  • The likelihood of the problem getting worse.
  • The need to alleviate pain or manage infection.
  • The presence of pre-existing serious medical conditions.
  • Challenges with diagnosing dental conditions over the phone. (Providers may consider asking patients to text a photo of the affected area to facilitate triage.)
  • Patients at increased risk for adverse health outcomes from COVID-19, such as adults over 60 and those with chronic health conditions such as diabetes, or heart or lung disease.

Patients experiencing a dental emergency should not be directed to an emergency room, including after hours, unless they are experiencing a life-threatening emergency.

What can I do to slow or prevent COVID-19 illnesses in my workplace?

  • Refer to CDC’s Guidance for Employers for general workplace preventive recommendations.
  • Implement social distancing strategies that limit group size to 10 people or less and maintaining a distance of 6 feet between people when possible. Examples in practice can include:
    • Limiting or staggering patient appointments.
    • Requesting that patients do not show up early for their appointments or wait in their cars until their appointment time.
    • Remove from your waiting room magazines, reading materials, toys or other objects that may be touched by others and are not easily disinfected.
  • Screen patients for COVID-19 risk factors, such as travel to locations with community spread or close contact with individuals with suspected or confirmed COVID-19, while updating their medical history. Be aware that patient response and symptoms to COVID-19 vary, so use your best clinical judgment and evidence-based guidelines during assessments.
  • Use appropriate personal protective equipment (PPE).
    • Refer to CDC guidance on appropriate gowns, gloves, and respirators to use during the COVID-19 outbreak.
    • Because PPE is in short supply, implement strategies for optimizing the supply of PPE that you have. The state is actively working to get more PPE into the state.
    • When appropriate PPE is not available, consider lower protection level alternatives, such as using a surgical mask, safety goggles with closed side shields, a full face shield, and disposable gowns and gloves.
  • Use engineering controls, such as performing procedures in a closed treatment room and not in an open-concept operation room setting.
  • Perform routine environmental cleaning.
    • Routinely clean all frequently touched surfaces in the workplace, such as workstations, countertops, and doorknobs. Use the cleaning agents that are usually used in these areas and follow the directions on the label.
    • Provide disposable wipes so that commonly used surfaces (for example, doorknobs, keyboards, remote controls, desks) can be wiped down by employees before each use.
    • If an individual with suspected or confirmed COVID-19 has visited your clinic, more stringent environmental cleaning and disinfection protocols should be followed.
    • For additional guidance and resources, please refer to the OSHA guidance on preparing workplaces for COVID-19.
  • Determine an appropriate facility for treatment for patients with suspected or known COVID-19 infection. The ideal would be an isolation room or airborne infection isolation room (AIIR).

Where can I turn for more information?

 Caring for Pregnant Women

  • The CDC outlines interim considerations for infection prevention and control of 2019 Coronavirus Disease 2019 (COVID-19) in inpatient obstetric healthcare settings.
  • The American College of Obstetricians and Gynecologist (ACOG) has practice guidelines for health care providers who see pregnant women.
  • The Maternal Child Health (MCH) Navigator has resources and information on COVID-19 as it relates to the MCH Leadership Competencies including ethics, critical thinking, communication, family-professional partnerships, cultural competency, working with communities and systems, and others.  

 Home Visiting and Prenatal Care Coordination

The following information is for home visiting and prenatal care coordination (PNCC) providers. The Safer at Home order identifies the following:

  • Wisconsinites can continue to work for or obtain human service operations.
  • All essential businesses and operations are encouraged to remain open.
  • Essential businesses and operations will, when possible, use technology to avoid meeting in person.
  • To the greatest extent possible, essential businesses and operations will comply with social distancing requirements, including:
    • Maintain social distancing of 6 feet between people.
    • Wash hands with soap and water for at least 20 seconds as frequently as possible or use hand sanitizer.
    • Cover coughs and sneezes (into the sleeve or elbow, not hands).
    • Regularly clean high-touch surfaces.
    • Avoid shaking hands.
    • Follow all other public health recommendations issued by DHS and the CDC.

Operationalizing Safer at Home for home visiting and prenatal care coordination

  • Home visitors and prenatal care coordinators provide social services for economically disadvantaged individuals and families. These services can be considered human service operations.
  • Home visiting and PNCC services are encouraged to continue because families may have greater needs during the pandemic.
  • During the COVID-19 crisis, home visiting and PNCC services can be maintained through virtual visits.
    • Interactive video conferencing (Skype, FaceTime) and telecommunication (phone) can be utilized. Confidentiality must be maintained during virtual visits; check each company’s privacy agreement to ensure HIPAA compliance.
    • Guidance on the COVID-19 response is provided by the models utilized by the Family Foundations Home Visiting agencies in Wisconsin:
      • Nurse Family Partnership
      • Parents as Teachers
      • Early Head Start
      • Healthy Families America
  • Model-specific recommendations will be continually updated as any new information is received from the Centers for Disease Control and Prevention (CDC), and the federal government. For PNCC providers, Medicaid issued two ForwardHealth Updates related to telehealth services during the public health emergency for COVID-19:
    • 2020-12 - Temporary Changes to Telehealth Policy and Clarifications for Behavioral Health and Targeted Case Management Providers
    • 2020-15  - Additional Services to be Provided Via Telehealth

Note: Forward Health will temporarily allow telehealth services utilizing real-time technology, including phone communication, for currently covered services that can be delivered with functional equivalency to face-to-face services. This applies to all components of PNCC, including assessment, care planning, case management, health education and nutrition counseling, and postpartum services.

Checklist: Questions to ask if a home-based visit is requested

Home visitors and PNCC providers should consult with their supervisor and agency policies if they identify a need for a home-based visit; consider the following:

  • Does the provider or anyone in the home have symptoms or exposure to someone who is symptomatic or tested positive for COVID-19 within the past 14 days?
  • Could the family’s needs be addressed in other ways (medical care, community resources)?
  • Is it possible to follow social distancing requirements for the home visit?
  • Is personal protective equipment appropriate and available?
  • Are there protocols for cleaning tools and equipment (scales, stethoscope, and developmental screening tools) used during the visit?

Note: Due to the fluid nature of the COVID-19 crisis, guidance may change and be updated.

 Infection Preventionists

 Provider Resources

 Preparedness Resources

The following were originally developed for influenza, but may be useful in developing a plan for COVID-19 as many of the strategies are the same.

  • Pandemic Preparedness Resources: CDC webpage containing guidance and tools developed for pandemic influenza planning and preparedness. These can serve as appropriate resources for health departments in the event the current COVID-19 becomes widespread in the community.
  • Public Health Discussion Guide: CDC document to help guide a local health department's discussion in developing and maintaining an outbreak response plan.
  • Get Your School Ready for Pandemic Flu: CDC booklet providing information for schools to help develop strategies to slow the spread of respiratory illness.
  • Planning Resources for Schools: CDC webpage that includes information on planning for a possible COVID-19 outbreak and for creating an outbreak response plan.
  • Hospital Discussion Guide: CDC document to help guide a hospital's discussion in developing and maintaining an outbreak response plan.
  • Emergency Management Discussion Guide: CDC document to help guide a community emergency management planning agency's discussion in developing and maintaining an outbreak response plan.
  • Planning Resources for Business: CDC webpage that includes information on planning for a possible COVID-19 outbreak and for creating an outbreak response plan.
Last Revised: April 6, 2020

 RESPONSE RESOURCES FOR WISCONSINITES — www.dhs.wisconsin.gov/covid-19/help.htm