CDC guideline: How to evaluate suspected COVID-19 patients at home

April 22, 2020

CDC tips for evaluating people for coronavirus when face-to-face contact is impossible.

As the COVID-19 coronavirus continues to spread across the globe and stories of the number of asymptomatic cases are reported in the media, the Centers for Disease Control and Prevention have produced guidelines for physicians seeking to evaluate persons under investigation (PUI) for the virus and those who have had close contact with confirmed cases at their home or non-home residential settings.If followed, these guidelines can limit your chance of infection and passing the infection to non-infected patients. These guidelines, as well as much more information about the virus are available on the CDC’s website.For all of our coronavirus coverage click here.

Patients with symptoms

•Make every effort to interview the PUI by telephone, text monitoring system, or video conference especially temperature monitoring which can be reported by phone or shown to a physician on a video conference

If a patient must be interviewed in their home

•The physician should wear recommended personal protective equipment (PPE) including a gown, gloves, eye protection, and respiratory protection that is at least as protective as a NIOSH-approved N95 filtering face piece respirator

•Hand hygiene should be performed before and removing PPE using alcohol-based hand sanitizer with 60 to 95 percent alcohol

•All PPE should be put on before entering the home and if that is not possible it is still preferable for face protection to be put on before entering the home and ask alert people within the home to move away from the entrance or keep a six-foot distance

If a patient must be interviewed in their home (continued)

•Ask the PUI if there is an external trash can at the home or if one can be placed out of doors for the disposal of PPE •PPE should be removed outside the home and should not be transported in the physician’s vehicle.

•If unable to remove PPE outside of the home, keep face protection on until you can leave the home and ask people in the home to leave the room or keep a six-foot distance

Persons without symptoms (asymptomatic close contacts)

•Make every effort to interview the asymptomatic close contact by telephone, text monitoring system, or video conference especially temperature monitoring which can be reported by phone or shown to a physician on a video conference •If an asymptomatic close contact must be interviewed in the home, the physician should stay six feet away and ask if they’ve had fevers or respiratory symptoms and the physician should not enter the home and the patient has been determined to be afebrile by temperature measure

•If the asymptomatic close contact reports fever or symptoms they should be considered a PUI and referred for further medical evaluation; temperature or symptoms should be documented

Persons without symptoms continued

•If the asymptomatic close contact does not report fever or symptoms, they should be instructed to take their own temperature and report the results. If they deny symptoms or fever it remains appropriate to stay six feet away if the physician must enter the home •If the patient can’t take their own temperature the physician should follow previous PPE recommendations

Specimen collection for all individuals at home

•Testing for the coronavirus should be conducted outdoors if the climate allows but if it must be done within the home only the physician and those tested should be in the room while the test is performed, collecting the specimen is likely to induce cough or sneezing, and non-aerosol-generating procedures should be performed before procedures that are aerosol-generating

•Aerosol-generating procedures should be the last procedure performed before leaving the home

Specimen collection for individuals at home (continued)

•Physicians collecting specimens in the home should wear recommended PPE

•See previous PPE guidelines