March 25, 2020
The Tennessee Department of Health (TDH) is providing this update regarding the COVID-19 outbreak.
Cases in healthcare workers or in your facility:
As COVID-19 spreads, healthcare related exposures are increasing. We have developed the guidance below for individual providers and facilities on how to respond if there is a case (or suspected case) in a healthcare staff member.
- Guidance for healthcare providers diagnosed with COVID-19
Communicating with patients:
TDH has developed resources that may be useful in communicating with your patients. These documents provide actionable steps and guidance for those who may have been exposed, those awaiting test results, and those diagnosed.
- What to expect if you were possibly exposed to COVID-19
- What to expect after being tested for COVID-19
- What to expect after being diagnosed with COVID-19
Not every patient with respiratory illness needs to be tested for COVID-19. Most people have mild illness and are able to recover at home, and there is no treatment specifically approved for this virus.
TDH’s triage and assessment criteria are available here.We continue to encourage patients to seek care first from their usual site of care and we are working to enable providers to accommodate that need. We know that shortages of PPE, testing supplies, and testing sites are common. A number of healthcare facilities have established remote assessment sites which can be accessed across the state. While we are looking at every opportunity to fix those problems, permanent solutions are not immediately available and we need your help in addressing these shortages by implementing strategies to conserve PPE and by minimizing unnecessary tests. While providers do not need to consult with public health before sending a test to a commercial lab, providers should prioritize testing for individuals who are the sickest, have comorbid conditions putting them at higher risk, or who are healthcare workers. Prioritizing tests for those individuals is essential to improving turnaround times while there is national shortage of test reagents and supplies, among public health and commercial laboratories.
Counterfeit COVID-19 tests
The Food & Drug Administration and U.S. Immigrations and Customs Enforcement Homeland Security Investigations team are monitoring reports about counterfeit COVID-19 testing kits. At this time, the FDA has not authorized any test that is available to purchase for testing yourself at home for COVID-19. More information can be found here: https://www.fda.gov/news-events/press-announcements/coronaviruscovid-19-update-fda-alerts-consumers-about-unauthorized-fraudulent-covid-19-test-kits. TDH encourages use of reputable and known testing resources to prevent retesting and delays in healthcare and public health actions.
If you believe you may have received a counterfeit COVID-19 test, you can report it to the HSI Tip Line at (866) 347-2423 or via an anonymous online form at: https://www.ice.gov/webform/hsi-tip-form.
Reporting COVID-19 cases and deaths:
COVID-19 cases and deaths are immediately reportable to TDH and full guidance is available online here Cases: Healthcare providers have 3 options for reporting laboratory confirmed cases:
- Fax the PUI Form and a copy of the positive laboratory report to 615-741-3857
- Call the TDH COVID-19 call center between 8am-8pm, 615-741-7247
- Submit an electronic Morbidity Report*
*If you already report diseases or conditions to TDH via Morbidity Reports, you can continue to do this for COVID-19 positive labs. These are electronically submitted to NBS through https://hssi.tn.gov/auth/login.
Death: Providers have 2 options for reporting deaths in a suspected or laboratory-confirmed COVID19 case among their patients or in their facility:
- Providers can inform their county medical examiner of the death, and the county medical examiner will then notify the Office of the State Chief Medical Examiner.
- Fax the PUI Form (noting the field indicating death) and a copy of the positive laboratory report to 615-741-3857. An updated form can be submitted indicating death.
Elective dental and medical procedures
Governor Lee has signed Executive Order 18, which states that dental service providers shall not perform any non-emergency dental or oral procedures. All hospitals and surgical outpatient facilities in the State of Tennessee shall not perform non-essential procedures, which include any medical procedure that is not necessary to address a medical emergency or to preserve the health and safety of a patient, as determined by a licensed medical provider. Ambulatory providers should continue to treat patients, preferably via telehealth and telemedicine when possible to minimize exposure risks.
This order will preserve staff, personal protective equipment, and patient care supplies, ensure staff and patient safety, and expand available capacity.
There has been a rapid expansion in reimbursement opportunities for telehealth, now including homebased telehealth coverage by nearly every plan in the state during this time of public health response. Please utilize telehealth and telephone triage as much as possible for both sick and well patients. This is critical to minimize public exposure to illness and to optimize capacity for routine and emergent are. Several resources have been put together that I’ve listed below. Utilization of telehealth and telephonic management should be optimized in all settings.
- CMS https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-providerfact-sheet
- TMA https://www.tnmed.org/TMA/Member_Resources/Telehealth_and_COVID-19
- TNAAP COVID-19 Telehealth Coding Guidance
- TNAAP COVID-19 Telehealth Guidelines by Payer
- TennCare https://www.tn.gov/tenncare/information-statistics/tenncare-information-aboutcoronavirus.html
- TDMHSAS https://www.tn.gov/behavioral-health/covid19.html https://www.tn.gov/content/dam/tn/mentalhealth/documents/TDMHSAS_Email_Providers_3.14.20. pdf
TDH has provided a series of webinars to share clinical and public health updates for front-line clinicians. Recordings of past webinars, and information to join future ones are available here. The TDH site for COVID-19 resources is https://www.tn.gov/health/cedep/ncov.html. It is updated continuously.
CDC Clinician Outreach & Communication Activity (COCA) call
CDC has scheduled another COCA call TODAY (Wednesday, March 25, 2020 from 2:00–3:00 EDT. The presenters will provide a COVID-19 update and discuss strategies for healthcare facilities to optimize personal protective equipment (PPE) supplies such as eye protection, isolation gowns, facemasks, and N95 respirators. More details available here.
Thank you for all that you do in keeping Tennesseans safe and healthy.
Tennessee Department of Health