DHEC continues to work with federal, state and local partners as it investigates COVID-19 cases in South Carolina. DHEC’s top priority remains protecting the public during this national and state emergency.
What if my patient is requesting to be seen in my clinic for respiratory symptoms?
As standard practice, sick patients should be isolated from others and roomed as quickly as possible. Healthcare personnel should also utilize appropriate personal protective equipment (PPE). Patients should preferably be placed in a negative pressure room, but a standard room where they will be isolated from other patients can be used. The CDC also has information about Infection Prevention when seeing patients with suspected COVID-19.
If you do not have appropriate equipment to keep you and your staff safe, consider referral to a local telehealth virtual care if available. It is not necessary to refer patients to emergency departments or urgent cares simply to get tested. They should only be referred if you believe they require an urgent medical evaluation. Advise patients to isolate while they are symptomatic.
When should I test for COVID-19?
DHEC will continue to update and communicate testing guidance through the South Carolina Health Alert Network (SCHAN). Providers are not required to receive prior approval from DHEC for patients they deem candidates for testing. In general, patients considered for PCR testing should be symptomatic with respiratory illness and alternative diagnoses should have been considered. Additional testing considerations are available from the CDC.
Should I use PCR testing for patients who do not have symptoms?
Providers should refer to the DHEC guidance for testing provided through the South Carolina Health Alert Network (SCHAN) to determine the appropriateness of testing. Testing of asymptomatic patients should only proceed if testing can be assured for those in priority groups and for those with symptoms and not in a priority group. Patients should understand that PCR testing can only detect the virus if it is present at sufficient levels, so they may test negative even though they have been exposed to the virus and may eventually have symptoms. Any patient testing PCR positive and who has no symptoms must complete isolation until ten (10) days after the test specimen was collected.
Should I use antibody testing?
DHEC provided guidance for antibody testing through the South Carolina Health Alert Network (SCHAN). These tests are new and their reliability has not yet been established. DHEC does NOT recommend using this testing to diagnosis an acute infection. PCR testing is the preferred method for identifying new cases. Until more is known about this testing, patients should NOT assume immunity to COVID-19 on the basis of this testing.
What specimen do I collect for PCR testing and where do I send it?
Only one specimen needs to be collected. CDC identifies five acceptable specimen types as nasopharyngeal (NP), oropharyngeal (OP), nasal mid-turbinate, or anterior nares (nasal) swabs; or nasopharyngeal wash/aspirate or nasal wash/aspirate specimens.
The DHEC Public Health Laboratory (PHL) can run samples collected by providers. Directions for completion of paperwork and for specimen transport to the DHEC PHL can be found on the SC DHEC website. A variety of private labs can be utilized for testing. Regardless of the laboratory used for testing, please fill out the lab requisition form with the patient’s appropriate contact information. The initiation of contact investigations can be delayed if follow up is needed to obtain case information from ordering facilities.
How long will it take to get test results?
The time to receive results from private laboratories varies depending on which laboratory is utilized. Please speak with your lab representative in order to give accurate expectations to your patients. Results from the PHL usually take 24-48 hours to report and are available via OpenElis, the secure laboratory web portal. A customer ID is needed to access results electronically. That timeframe may change based on testing volume or demand. Whichever laboratory is used, patients should be advised to isolate while their results are pending. Also, their home/close contacts should minimize their activities outside the home as well. Please report the results to your patient as soon as you receive them. Due to the necessity to urgently start public health investigations and provide isolation guidance, DHEC staff will contact all patients and will not be able to confirm they have been contacted by their provider.
A patient tested positive. What do I do?
Please notify DHEC of positive results. COVID-19 cases and deaths are urgently reportable on the South Carolina List of Reportable Conditions. They must be reported by phone within 24 hours to the appropriate regional health department. When reporting, please alert DHEC if your patient is 65 years old or greater, 5 years old or younger, pregnant, hospitalized, or someone who resides in or attends a congregate setting (e.g. nursing home, long-term care facility, behavioral health facility, or child care).
Please notify the patient of their results and if able to remain or care for themselves at home, advise them to remain in isolation until they meet all of the following conditions:
- No fever for at least three (3) days or 72 hours without the use of fever reducing medication – and -
- It has been least ten (10) days from the start of their initial symptoms – and -
- Their respiratory symptoms have improved.
Their home/close contacts should remain in quarantine for an additional seven days after the date that the patient’s period of isolation ends.
Patients who test positive but did not have symptoms will need to continue isolation until ten (10) days after the test specimen was collected.
Do I need to notify patients who were in the clinic they were exposed to someone with COVID-19?
Since most exposures between patients in a physician’s office are brief and are not in close contact for a prolonged period, a notification of other patients in the clinic is likely unnecessary.
Do I and my staff need to quarantine?
If the patient was wearing a surgical mask and you and your personnel caring for the patient were wearing appropriate PPE, the risk of transmission is low. Health care staff may continue to work while monitoring for symptoms and checking their temperature daily and prior to starting their shifts. If available, you and your staff who cared for the patient may wish to wear face masks while you monitor for symptoms. If you or your staff develop fever or respiratory illness, you should isolate and seek medical evaluation. Please see the CDC website for risk stratification in your decision-making process.