Information For Healthcare Professionals

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Long-Term Care Settings Outbreak Protocol

RIDOH COVID-19 Reporting Portal

Visitation

  • Additional information about visitation for nursing homes is available from the Centers for Medicare & Medicaid Services.

Nursing Home Guidance

Assisted Living Residence Guidance

There are three authorized treatments for COVID-19. Paxlovid (oral antiviral) is the preferred treatment for COVID-19. If a patient cannot take Paxlovid, consider Remdesivir (IV antiviral). If a patient cannot take Remdesivir, consider Molnupiravir (oral antiviral). 

Treatment is most important for people at high risk for progressing to severe disease and/or hospitalization. For details on medical conditions and other factors associated with increased risk for progression to severe COVID-19, including race and ethnicity, review the Centers for Disease Control and Prevention (CDC)’s People with Certain Medical Conditions website.

Learn about patient assistance programs for COVID-19 treatments.

Paxlovid (oral antiviral)

Who: Paxlovid is available for outpatients age 12 and older who are diagnosed with COVID-19 and started having mild to moderate symptoms in the last five days. A positive COVID-19 test is no longer required to prescribe Paxlovid.

When: To make sure treatment is effective, it is important to start treatment as soon as possible. Healthcare professionals should encourage patients who are diagnosed with COVID-19 to learn about treatment options.

How: Paxlovid is available in certain pharmacies across the state. To view current availability before submitting a script to a participating pharmacy in Rhode Island, go to the HHS COVID-19 Treatment Locator. 

Remdesivir (IV antiviral)

Who: Intravenous (IV) Remdesivir is available for those who test positive for COVID-19, started having mild to moderate symptoms in the last seven days, and are not a candidate for Paxlovid to treat COVID-19. Children who test positive for COVID-19, are age 28 days or older, weigh 3 kg (approximately 6.5 pounds) or more, and have had mild to moderate symptoms in the last seven days, are also eligible for treatment.

When: Remdesivir is highly effective when administered within seven days of symptom onset. This treatment must be administered by IV over three days.

How: To find treatment locations, go to the HHS COVID-19 Treatment Locator.

Molnupiravir (oral antiviral)

Who: Molnupiravir is available for outpatients age 18 and older who test positive for COVID-19, started having mild to moderate symptoms in the last five days, and are not candidates for Paxlovid or Remdesivir.

When: To make sure treatment is effective, it's important to start treatment as soon as possible. Healthcare professionals should encourage patients who are diagnosed with COVID-19 to learn about treatment options.

How: Molnupiravir is available in certain pharmacies across the state. To view current availability before submitting a script to a participating pharmacy in Rhode Island, go to the HHS COVID-19 Treatment Locator. 

Treatment Resources

The Rhode Island Department of Health (RIDOH) recommends COVID-19 testing for patients who have symptoms of COVID-19 or may have been exposed to someone with COVID-19.

RIDOH strongly recommends that healthcare professionals offer on-site COVID-19 testing to their patients for three reasons:

  • Patients value getting COVID-19 testing and advice about treatment from a trusted healthcare professional who knows them and their health history.
  • As we enter year four of the pandemic, resources will need to shift back to regular healthcare channels to create a sustainable system.
  • If a patient tests positive, they may need to provide formal documentation to schools or their employer while they isolate. This letter, like other forms of medical documentation, should come from their healthcare professional.

Healthcare professionals can offer COVID-19 PCR specimen collection or point-of-care antigen testing to their patients.

PCR Specimen Collection

Healthcare professionals interested in collecting PCR specimens should reach out to their partner laboratories to determine if they provide this service. Most clinical laboratories in Rhode Island can test respiratory specimens for COVID-19.

Healthcare professionals and respiratory clinics that are already performing in-office PCR specimen collection and sending tests to a laboratory for processing should order tests according to the office’s or laboratory’s protocol.

Point-of-Care Antigen Testing

Point-of-care antigen tests are a fast and easy way to test your patients for COVID-19 in your office. Any office can procure rapid antigen test kits themselves through medical supply vendors. Most are relatively inexpensive to purchase and can be reimbursed through insurance.

  • If your office already has a CLIA certificate of waiver to perform on-site testing, you can start testing patients right away. Any office currently performing strep or influenza testing should already have a CLIA certificate of waiver to perform on-site testing.
  • If your office doesn’t already have a CLIA certificate of waiver, you will need to submit an application for licensure to RIDOH to begin testing patients on site. Send your completed application to RIDOH’s State Health Laboratories by email to [email protected]. You can learn more about how to submit an application for a CLIA certificate of waiver at cms.gov.

COVID-19 Testing Referral Options

Outpatient healthcare professionals who don’t offer in-office specimen collection or point-of-care antigen testing can direct patients to a local pharmacy or respiratory clinic. Patients may also test themselves for COVID-19 at home.

For more information about COVID-19 testing options in Rhode Island and to find a test site near you, visit covid.ri.gov/testing.

ICATT Program

The Centers for Disease Control and Prevention's (CDC’s) Increasing Community Access to Testing (ICATT) program supports free COVID-19 testing for people who have symptoms or have been exposed to someone with COVID-19. To find an ICATT site near you, visit cdc.gov/icatt/AboutICATT.html.

Test to Treat

Rhode Island has several Test to Treat sites where patients can get tested for COVID-19 and, if they’re positive and eligible, get a prescription for treatment all at one location. To find local Test to Treat sites, visit aspr.hhs.gov/TestToTreat. 

Home Test to Treat

The Home Test to Treat program provides access to free COVID-19 and flu telehealth visits and treatment for anyone who tests positive for either condition. Treatment can be shipped or picked up at a local pharmacy at no cost for those eligible. Those uninsured or enrolled in Medicare, Medicaid, Indian Health Service, or VA Healthcare can sign up and get free at-home COVID-19 tests even if they're not currently positive. Regardless of insurance status, anyone with a current positive COVID-19 test may enroll for free telehealth treatment. To learn more and register, visit www.test2treat.org or call 1-800-682-2829.

Exposure and Isolation for Healthcare Workers

The following resources and tools help providers assess whether a staff member or patient who tests positive for COVID-19 may have exposed others in the practice. The Rhode Island Department of Health (RIDOH) encourages practices to use these tools to identify and inform staff and patients who are close contacts to self-monitor for symptoms for 10 days from exposure.

Isolation for Patients

RIDOH is partnering with the Executive Office of Health and Human Services (EOHHS) to provide medical respite housing to people who are housing insecure or homeless and who need a place to isolate because of an infectious disease, like COVID-19. A limited number of medical respite beds are dedicated for isolation because of infectious disease.

Healthcare professionals can refer patients for consideration for a medical respite isolation bed using the Medical Respite Pilot Program Isolation Support Referral Form.

Patient Vaccination

Healthcare Worker Vaccination

The most effective way to prevent the spread of COVID-19 and to protect against severe illness, hospitalization, and death is to stay up to date with your COVID-19 vaccinations. Rhode Island regulations (216-RICR-20-15-7) require that healthcare workers or assisted living residence workers shall be up to date with their COVID-19 vaccines, meaning a person has received all recommended doses of COVID-19—including a booster dose when eligible—or wear a National Institute for Occupational Safety & Health (NIOSH)-approved N95 mask while working in healthcare facilities during a period in which the COVID-19 prevalence rate in the State is greater than or equal to 50 cases per 100,000 people per week.

For more information on health care worker vaccination regulations, visit these links:

All settings that offer rapid COVID-19 tests on site should report positive test results to the Rhode Island Department of Health (RIDOH). To learn more, email [email protected]. Test results processed through laboratory systems are automatically reported to RIDOH.

Centers for Disease Control and Prevention (CDC) now recommends reporting of MIS-C and MIS-A. Clinical criteria for each condition follows. Report cases to Rhode Island’s Center for Acute Infectious Disease Epidemiology by calling 401-222-2577 Monday through Friday from 8:30 a.m. to 4:30 p.m. If after hours, please call RIDOH’s answering service at 401-276-8046 to connect with the medical staff on call.

Multi-System Inflammatory Syndrome in Children (MIS-C)

MIS-C is a condition associated with infection from COVID-19. Clinical criteria for MIS-C diagnosis include:

  • Younger than age 21 and
  • Fever, laboratory evidence of inflammation, severe illness requiring hospitalization, multisystem organ involvement and
  • No alternative plausible diagnosis and
  • Positive for current or recent COVID-19 infection by RT-PCR, serology, or antigen test or exposure to a suspected or confirmed COVID-19 case within the four weeks before symptoms started

Click here for clinical information from Hasbro Children's Hospital and additional resources on MIS-C.

Multi-System Inflammatory Syndrome in Adults (MIS-A)

MIS-A is a condition similar to MIS-C, but in adults. For the MIS-A case definition, providers can use either the same definition for MIS-C or the definition used in the Morbidity and Mortality Weekly Report (MMWR) series.

The MIS-A case definition used in the report includes the following five criteria:

  • Severe illness requiring hospitalization in a person age 21 or older and
  • Positive test result for current or previous COVID-19 infection (nucleic acid, antigen, or antibody) during admission or in the previous 12 weeks and
  • Severe dysfunction of one or more extrapulmonary organ systems (e.g., hypotension or shock, cardiac dysfunction, arterial or venous thrombosis or thromboembolism, or acute liver injury) and
  • Laboratory evidence of severe inflammation (e.g., elevated CRP, ferritin, D-dimer, or interleukin-6) and
  • Absence of severe respiratory illness (to exclude patients in which inflammation and organ dysfunction might be attributable simply to tissue hypoxia)

Long COVID

Long COVID, also known as Post-COVID Conditions, has been described as subacute and chronic multi-system post-infectious sequelae of acute COVID-19 infection. It's distinct from MIS-C and MIS-A.

Referrals

For specialty care of patients with Long COVID, primary care providers can refer their patients to the Infectious Disease and Immunology Clinic at Lifespan.

  • Fax referrals to the Infectious Diseases and Immunology Center at 401-793-7401
  • Send referrals within Lifespan through LifeChart as "Referral to Infectious Diseases"

Resources

Oral healthcare is recognized as an essential component of overall health. It’s critical that infection prevention and control practices are in place to protect the health and safety of patients and dental healthcare personnel (DHCP).

We continue to learn about the transmission and severity of COVID-19 and the implications for dental practice. DHCP have a very high potential for exposure to COVID-19 if performing certain aerosol-generating procedures on known or suspected COVID-19 patients. When providing care, these patients should be isolated in a room with effective ventilation.

Dental settings should balance the need to provide necessary services while minimizing risk to patients and DHCP. The Centers for Disease Control and Prevention (CDC) developed a framework for healthcare personnel and healthcare systems for delivery of non-emergent care during the COVID-19 pandemic. DHCP should use their clinical judgment in determining those procedures that can be performed safely and effectively at this time. The Rhode Island Department of Health (RIDOH) recommends continued review of CDC Guidance for Healthcare Personnel for guidance on screening, source control, use of personal protective equipment, and more. RIDOH defers to this guidance in areas of question.

Individual dental practices should review guidance for healthcare professionals and dental-specific information below and customize it for their clinical setting. This guidance represents suggested minimum standards. Some practices will choose to exceed these standards. For example, practices treating vulnerable patients, including older adults at greater risk for severe COVID-19 outcomes, should use effective source control, including N-95 respirators, when caring for unmasked high-risk patients.

Place signs and posters at facility entrances and in strategic places, such as restrooms, registration desks, waiting rooms, and exam rooms, providing instruction on washing hands, wearing face coverings, and cough etiquette.

Individual healthcare facilities can choose whether to require the use of face masks outside of the clinical areas. RIDOH recommends wearing a mask in all healthcare settings when community transmission rates of COVID-19 are high (greater than or equal to 100/100,000 people) and more routinely when interacting with patients likely to have chronic illness.

Effective ventilation is fundamental to safe practice. The American Society of Heating, Refrigerating and Air-Conditioning Engineers has provided information on dental office design to reduce airborne disease transmission.

We welcome and answer your questions by email at [email protected].

Advisories

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