Disease Prevention and Control, San Francisco Department of Public Health

COVID-19 Info for SF Healthcare Providers

This illustration, created at the Centers for Disease Control and Prevention (CDC), reveals ultrastructural morphology exhibited by coronaviruses.
Go to SFCDCP.ORG COVID-19 Vaccination Page for SF Providers.
Go To SFCDCP.ORG COVID-19 Page For The Public.
Go To SFCDCP.ORG COVID-19 Page For Businesses, Employers, and Employees.

COVID-19 Quick Links

SFDPH Health Advisories/Alerts/Updates

SF Provider Guidance by Topic

COVID-19 Vaccination

Visit the COVID-19 vaccination page for SF healthcare providers or use this shortcut — https://www.sfcdcp.org/covidvax

If you’re a SF healthcare worker seeking to be vaccinated

Personal Protective Equipment (PPE)

For PPE recommendations for non-healthcare workers, see www.sfcdcp.org/PPE

Please note that the documents below are intended for City-operated facilities.

Outpatient Clinic Setting

Homecare Providers

FAQ for Health Care Providers

What is the definition of a Close Contact for COVID-19?

“LONG” DEFINITION OF CLOSE CONTACT FOR COVID-19 (11/19/2020)

 

Definition of “close contact” for COVID-19. The SFDPH has adopted the CDC’s updated definition of “close contact” (CDC) for exposure to COVID-19:
A close contact is “someone who was within 6 feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period starting from 2 days before illness onset (or, for asymptomatic patients, 2 days prior to test specimen collection) until the time the patient is isolated.”

A key change to the definition is that the exposure does not have to be 15 consecutive minutes, rather can be cumulative. “Cumulative” means shorter periods are added up over a 24 hour period. For example, three 5-minute exposures make a total of 15 minutes, or dozens of brief encounters over the course of a working shift may add to more than 15 minutes. This new definition is in keeping with our understanding of risk and the chance of getting infected. The CDC’s decision to change the definition was influenced by evidence of COVID-19 acquired by an employee with video documentation of not meeting the old definition while meeting the new definition (Pringle et al).

SFDPH recognizes challenges in implementing this new definition. Recalling, measuring, and adding up brief encounters is difficult. The number of persons categorized as close contacts and requiring quarantine may greatly increase. Moreover, data are limited, making it difficult to precisely define “close contact”. Therefore, SFDPH recommends using cumulative exposure as an operational definition while also taking into account other factors that affect the risk of getting COVID-19. Consistent with CDC guidance (CDC) and other health jurisdictions (CDPH, LACDPH, WSDH), the following factors should also be considered:

  • Proximity (closer distance likely increases exposure risk)
  • Duration of exposure (longer exposure time likely increases exposure risk)
  • Whether the infected individual has symptoms (the period around onset of symptoms is associated with the highest levels of viral shedding; PCR cycle threshold value may also be an indication of viral shedding, see Tom et al)
  • If the infected person was likely to generate respiratory aerosols (e.g., was coughing, singing, shouting, talking)
  • Environmental factors (e.g., crowding, adequacy of ventilation) and whether exposure was indoors or outdoors (e.g., parents waiting outside to pick up children).

Because the general public has not received training on proper use of respiratory PPE, determining if someone other than healthcare personnel is a close contact should be made irrespective of whether the contact or infected person was wearing respiratory PPE. The use of fabric face coverings should not be used to determine if someone is or is not a close contact.

As previously defined, SFDPH continues to consider the following persons as close contacts regardless of the cumulative time of exposure:

  • A person who had direct contact with that person’s body fluids or secretions while they were not wearing a facemask, gown, and gloves
  • People in the home of, sex partners of, and people who take care of or are taken care of by the person with COVID-19
  • For pods/cohorts of children under 12, SFDPH considers all children and staff in a cohort to be close contacts

 

References

Who is at higher risk for severe illness due to COVID-19? Which additional groups need to take extra precautions?

See previous translations: [Chinese]  [Spanish]  [Tagalog]  [Vietnamese]  [Russian] 

See “What can I do to protect myself if I am at higher risk for severe illness from COVID-19 or at higher risk of getting exposed to COVID-19?”.

Updated 2/25/21

Who is at higher risk for severe illness due to COVID-19? Which additional groups need to take extra precautions?Older adults*

Persons with certain underlying medical conditions **

  • Cancer
  • Chronic kidney disease
  • COPD (chronic obstructive pulmonary disease)
  • Down Syndrome
  • Heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
  • Immunocompromised state (weakened immune system) from solid organ transplant
  • Obesity (body mass index [BMI] of 30 kg/m2 or higher but < 40 kg/m2)
  • Severe obesity (BMI ≥ 40 kg/m2)
  • Pregnancy
  • Sickle cell disease
  • Smoking
  • Type 2 diabetes mellitus
  • Children who are medically complex **

For more information on how to protect yourself, see “What can I do to protect myself if I am at higher risk for severe illness from COVID-19 or at higher risk of getting exposed to COVID-19?”

Who might have increased risk for severe illness from COVID-19 ***

Persons with certain underlying medical conditions
  • Asthma (moderate-to-severe)
  • Cerebrovascular disease (affects blood vessels and blood supply to the brain)
  • Cystic fibrosis
  • Hypertension or high blood pressure
  • Immunocompromised state (weakened immune system) from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines
  • Neurologic conditions, such as dementia
  • Liver disease
  • Overweight (BMI > 25 kg/m2, but < 30 kg/m2)
  • Pulmonary fibrosis (having damaged or scarred lung tissues)
  • Thalassemia (a type of blood disorder)
  • Type 1 diabetes mellitus

Who needs extra precautions ****

  • Racial and ethnic minority groups
  • People who are pregnant or breastfeeding
  • People with and caregivers of people with disabilities
  • People with and caregivers of people with developmental and behavioral disorders
  • People with drug use and substance use disorder
  • People living in rural communities
  • People experiencing homelessness
  • Newly resettled refugee populations
  • People who live in a nursing home or long-term care facility
  • People who live in group homes for people with disabilities
  • Caregivers of people living with dementia
Notes

* CDC has published data showing that among adults, the risk for severe illness from COVID-19 increases with age, with older adults at highest risk. For example, people in their 50s are at higher risk for severe illness than people in their 40s. Similarly, people in their 60s or 70s are, in general, at higher risk for severe illness than people in their 50s. The greatest risk for severe illness from COVID-19 is among those aged 85 or older.  While the risk is not zero for younger adults – people in their 20’s, 30’s, and 40’s can and do develop severe COVID-19 illness and should take steps to protect themselves from getting COVID-19.

** The CDC has determined that these conditions place people at higher risk for severe COVID-19 disease based on consistent evidence from multiple small studies or a strong association from a large study. Children who are medically complex, who have neurologic, genetic, metabolic conditions, or who have congenital heart disease are at higher risk for severe illness than other children. See CDC pages on pediatric COVID-19.

*** CDC has determined based on limited data and information at this time, people with these conditions might have increased risk for severe illness from COVID-19.

**** Other groups of persons are recommended by CDC to take extra precautions, as emerging data indicate some populations bear a disproportionate burden of COVID-19 disease and death, have a higher prevalence of underlying conditions, or are experiencing conditions that may facilitate the spread of infection.

Will existing respiratory virus panels, such as those manufactured by Biofire or Genmark, detect COVID-19?

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.

What should I do with my stock of N95 respirators that have passed their manufacturer-designated expiration date?

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.

Should medical waste or general waste from healthcare facilities treating Persons Under Investigation and patients with confirmed COVID-19 be handled any differently or need any additional disinfection?

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.

Are there special handling procedures for COVID-19 medical waste including disposal of used personal protective equipment (PPE), laundry, and food service utensils?

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.

See CDC FAQ for Health Care Professionals