COVID-19 Info for SF Healthcare Providers

• Interim Guidance: Discharging Suspected or Confirmed COVID-19 Cases From an Emergency Department, Hospital, or Skilled Nursing Facility (SFDPH, 5/15/2020)
• Interim Guidance: Interpretation of COVID-19 PCR Diagnostic Test Results Frequently Asked Questions (SFDPH, 5/11/2020)
• Statement on Serologic Testing for SARS-CoV-2 (SFDPH, 5/6/2020)
• Expanding COVID-19 Diagnostic Testing to Asymptomatic Frontlineor Essential Workers (SFDPH, 5/5/2020)
• COVID19 Specimen Collection & Handling (SFDPH, Updated 4/9/2020)
• COVID-19 Guidance for EMS Providers

• Packet of Isolation & Quarantine Directives and Guidelines (SFDPH, 5/14/2020)   [Spanish]   [Chinese]   [Tagalog]
  • Isolation and Quarantine Steps for People Before and After COVID-19 Diagnostic Test Results (SFDPH, 5/14/2020)   [Spanish]   [Chinese]   [Tagalog]
  • Home Isolation and Quarantine Guidelines for People with Coronavirus-2019 (COVID-19) Infection and their Household or Close Contacts (SFDPH, 5/14/2020)   [Spanish]   [Chinese]   [Tagalog]
• San Francisco Public Health Emergency Isolation & Quarantine Directives Frequently Asked Questions for Healthcare Providers (SFDPH, 5/14/2020)   [Spanish]   [Chinese]   [Tagalog]
• San Francisco Public Health Emergency Isolation & Quarantine Directives Frequently Asked Questions for the Public (SFDPH, 5/14/2020)   [Spanish]   [Chinese]   [Tagalog]

• Interim Guidance: Leaving Isolation or Returning to Work for Those Who Have Confirmed or Suspected COVID-19 (SFDPH, Updated 5/12/2020)   [Spanish]   [Chinese]   [Tagalog]

• Instructions for PPE Use and Re-Use by City and County of San Francisco (CCSF) and Contractor Health Care Personnel (HCP) Working in a CCSF Outpatient Clinic Setting Caring for Patients with Suspected or Confirmed COVID-19 (SFDPH, 5/24/2020)
• Interim Framework for PPE Use by City and County of San Francisco (CCSF) and Contractor Home Health Care Personnel (HCP) Caring for Clients with Suspected or Confirmed, Including Asymptomatic, COVID-19 (SFDPH, 5/23/2020)
• Instructions for Personal Protective Equipment (PPE) Use and Re-Use by CCSF and Contractor Home Health Care Personnel (HCP) Caring for Clients with Suspected or Confirmed, Including Asymptomatic, COVID-19 (SFDPH, 5/23/2020)
• Interim Framework During the COVID-19 Pandemic for PPE Use by City and County of San Francisco (CCSF) Disaster Service Workers and Contractors Working in Settings with Significant Commingling of Individuals with Varying COVID-19 Status (SFDPH, 5/23/2020)

• Interim Guidance: Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with COVID-19 In the Setting of Community Transmission (SFDPH, Updated 4/29/2020)

• Interim Guidance for Providers: Prenatal Care Considerations During the COVID-19 Pandemic

• Guidance for Resuming Deferred and Preventative Dental Care (CDPH, 5/7/2020)

• Interim Guidance for Providers: Addressing Needs of People Who Use Alcohol, Tobacco, or Other Drugs Who are Sheltering in Place or Require Isolation or Quarantine Related to COVID-19 (SFDPH, Updated 4/6/2020)

• Interim Guidance: Preventing and Managing COVID-19 Transmission in Shelters and Navigation Centers (SFDPH, Updated 5/23/2020)
• Interim Framework During the COVID-19 Pandemic for PPE Use by City and County of San Francisco (CCSF) Disaster Service Workers and Contractors Working in Settings with Significant Commingling of Individuals with Varying COVID-19 Status (SFDPH, 5/23/2020)

• COVID-19 Preparedness and Management Toolkit for Skilled Nursing Facilities (SFDPH, Updated 5/27/2020)
• Instructions for Discharge of Transfer of Patients with COVID-19 to SNFs (SFDPH, 4/30/2020)
• Interim Guidance: Prevention and Management of COVID-19 in Long-Term Care Facilities (SFDPH, Updated 4/19/2020)
• Guidance for Adult Elder and Residential Care Facilities Licensed by CA Department of Social Services (CDSS, 3/5/2020)

• Interim Guidance: Prevention and Management of COVID-19 in Residential Treatment Settings (SFDPH, 6/2/2020)

• Interim Guidance: Prevention, Screening, and Management of COVID-19 in Outpatient Hemodialysis Centers (SFDPH, Updated 4/6/2020)
• COVID-19 Outpatient Dialysis Facility Preparedness Assessment Tool (CDC, 3/24/2020)

• Interim Framework for PPE Use by City and County of San Francisco (CCSF) and Contractor Home Health Care Personnel (HCP) Caring for Clients with Suspected or Confirmed, Including Asymptomatic, COVID-19 (SFDPH, 5/23/2020)
• Instructions for Personal Protective Equipment (PPE) Use and Re-Use by CCSF and Contractor Home Health Care Personnel (HCP) Caring for Clients with Suspected or Confirmed, Including Asymptomatic, COVID-19 (SFDPH, 5/23/2020)

• Use of Expired Hand Sanitizer (SFDPH, 3/14/2020)

• CDPH COVID-19 Prevention Graphics [English] [Spanish]

Updated May 20, 2020

SFDPH considers persons in the following groups or with the following conditions to be at higher risk for severe illness if they develop COVID-19 infection.  Except where noted, this list aligns with CDC guidance.

• Age 60 years and older*
• Staying in a nursing home or long-term care facility
• Asthma (moderate-to-severe)
• Chronic lung disease
• Diabetes (type 1, type 2, or gestational)
• Serious heart conditions (including heart failure, coronary artery disease, congenital heart disease, cardiomyopathies, and pulmonary hypertension)
• Hypertension**
• Chronic kidney disease being treated with dialysis
• Severe obesity (body mass index of 40 or greater)
• Immunocompromised (including cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, HIV with a low CD4 cell count or not on HIV treatment, and prolonged use of corticosteroids and other immune weakening medications)
• Chronic liver disease

Other groups of persons are recommended by CDC to take extra precautions, as emerging data indicate some populations bear disproportionate burden of COVID-19 disease and death, have higher prevalence of underlying conditions, or are experiencing conditions that may facilitate the spread of infection (see https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/other-at-risk-populations.html).

• People with disabilities
• People who are pregnant or breastfeeding
• People experiencing homelessness
• Racial and ethnic minority groups

*CDC states age 65 years and older.  However, recently published data on COVID-19 mortality in China find a gradient of increasing age associated with increasing fatality ratios. While the CDC currently classifies adults over age 65 years as at high-risk, the SF Department of Public Health bases their classification of over 60 years on the data from the above cited article and evidence of premature aging among other vulnerable populations, including persons experiencing homelessness.

**CDC does not specifically include hypertension, other than pulmonary hypertension.  In a recent published review, hypertension was cited as likely to be an independent risk factor for more severe disease and increased mortality.

No. These multi-pathogen molecular assays can detect a number of human respiratory viruses, including other coronaviruses that can cause acute respiratory illness, but they do not detect COVID-19.

Do not discard unused, expired N95 respirators.  Instead, contact your Infection Control or Health & Safety office. Per CDC, in times of shortage, consideration can be made to use N95 respirators beyond the manufacturer-designated expiration date.  See details here: Strategies for Optimizing the Supply of N95 Respirators and Release of Stockpiled N95 Filtering Facepiece Respirators Beyond the Manufacturer-Designated Shelf Life: Considerations for the COVID-19 Response.  Please note that CDC does not recommend using N95s beyond the manufacturer-designated shelf life in surgical settings.

Medical waste (trash) coming from healthcare facilities treating COVID-2019 patients is no different than waste coming from facilities without COVID-19 patients. CDC guidance states that management of laundry, food service utensils, and medical waste should be performed in accordance with routine procedures. There is no evidence to suggest that facility waste needs any additional disinfection.

Providers should use standard operating procedures for the containment and disposal of used PPE and medical waste. Anything that has been contaminated with liquid blood or body fluids should be placed in red boxes or red bags and disposed of as medical waste. PPE not contaminated with fluid blood or body fluids can be placed in garbage bags, sealed, and placed with the regular garbage. Management of laundry and food service utensils should also be performed in accordance with routine procedures.