Healthcare Providers

Monoclonal Antibody (MABS) Treatment

MABS treatments are available for adult and pediatric outpatients who test positive for COVID-19, are age 12 years and older, weigh 40 kg or more, started having mild to moderate symptoms in the past 10 days, and are at high risk for progressing to severe disease and/or hospitalization. MABS treatments are also now available for emergency use as post-exposure prophylaxis in certain adults and pediatric individuals.

For details on medical conditions and other factors associated with increased risk for progression to severe COVID-19, including race and ethnicity, review the HHS flyer High-Risk COVID-19 Patients May Avoid Hospitalization with Monoclonal Antibody Treatment and the CDC web page People with Certain Medical Conditions.

MABS Treatment Options

• Bamlanivimab and etesevimab  EUA | EUA Provider Fact Sheet | EUA Patient Fact Sheet | Baseball Card

• Casirivimab and imdevimab (REGEN-COV) EUA | EUA Provider Fact Sheet | EUA Patient Fact Sheet | Baseball Card

Patients without a regular healthcare provider can visit health.ri.gov/find/urgentcare or schedule treatment directly with Atmed Urgent Care at atmedurgentcare.net. Patients who don't have or have lost their health insurance can learn about urgent care and health centers and accessing healthcare and support services.

MABS Resources

• combatcovid.hhs.gov
• PHE.gov web pages
• Find all MABS treatment locations in Rhode Island

Treatment Resources

• RIDOH, Current Treatments for the Coronavirus (COVID-19)
• CDC, Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19)
• IDSA, Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19
• NIH, COVID-19 Treatment Guidelines
• Dr. Mitchell Levy, Brown University, Inpatient Treatment of COVID-19: An Update

• Learn about and enroll to be a COVID-19 vaccine provider.
• For answers to frequently asked questions about COVID-19 vaccination, please see COVID-19 Vaccine FAQs

The Rhode Island Department of Health requires that all employees, interns, and volunteers in RIDOH-licensed healthcare facilities and all RIDOH-licensed healthcare providers must receive their final dose of COVID-19 vaccine by October 1, 2021, effective August 18.

• Requirement for Immunization Against COVID-19 (216-RICR-20-15-8)
• Medical Immunization Exemption Certificate for COVID-19 Vaccination
• Vaccination Requirement FAQ

The Rhode Island Department of Health (RIDOH) recommends COVID-19 testing for vaccinated and unvaccinated people who:

• have symptoms of COVID-19
• may have been exposed to someone with COVID-19
• have recently traveled out of state

People who are not yet fully vaccinated should get tested weekly.

Test Ordering Options

Primary care providers and respiratory clinics performing in-office specimen collection and sending tests to a lab for processing should order tests according to the office’s or lab’s protocol.

Outpatient healthcare providers can order COVID-19 tests for patients of all ages in the following ways:

• Use the online ordering system at schedulecovidtest.ri.gov to order a test for a patient who has symptoms or may have been exposed to someone with COVID-19. The ordering clinician may choose from a list of State-run testing sites located throughout Rhode Island. 
  • Please note: If you’re still ordering COVID-19 tests through the physician portal, RIDOH encourages you to explore other testing options for your patients like the ones listed below.

• Direct patients to local pharmacies in your community. You can find a pharmacy that offers COVID-19 testing near you by going to covid.ri.gov/testing and clicking on the map.  
  • Free COVID-19 testing for Rhode Islanders ages three and older is available at Walgreens Pharmacies across the State.

• Refer patients to a local respiratory clinic for COVID-19 testing.

COVID-19 swabbing supplies are available for healthcare providers who need them. To request kits, email [email protected] and ask to be connected with a member of the RIDOH COVID-19 testing team.   

• A swabbing kit includes three items inside a biobag: one nasal swab, one viral transport media (VTM) tube, and one absorbent pad.
• Swabbing kit pick up occurs at the Rhode Island Emergency Management Agency (RIEMA) warehouse at 2700 Plainfield Pike in Cranston. 

All Rhode Islanders can also self-schedule a free COVID-19 test at a State-run test site or a local Walgreens Pharmacy, regardless of whether they have symptoms or insurance.

For more information about COVID-19 testing in Rhode Island, including an up-to-date list of testing sites and guidance about testing for different populations, visit covid.ri.gov/testing.

If a patient was scheduled for testing through schedulecovidtest.ri.gov, the ordering clinician will receive lab results directly from the commercial lab. Please communicate these results to your patient. Note: To ensure proper processing of test results, it is important that a provider’s National Provider Identifier (NPI) and fax number are correctly entered.

RIDOH encourages coordination between primary care providers and respiratory clinics in providing and obtaining patient test results.

Anyone tested for COVID-19 at a State-run test site can access an official record of their test result on portal.ri.gov/results. All test results reported to RIDOH are available at this site. This step-by-step guide explains how to use the online result portal.

Patients who got a COVID-19 test at a medical office, retail pharmacy, in their workplace, or in school should contact the location where they were tested for a copy of their result. More information about COVID-19 test results is available here. 

Positive Test Results

If a patient tests positive for COVID-19 on a PCR or NAAT test, inform them that they need to isolate immediately.  Anyone who tests positive should also inform their close contacts to quarantine and possibly get tested. A representative from RIDOH will also contact the patient directly for follow up. MORE

Rapid Antigen Test Results

Follow the rapid antigen testing algorithm for confirmatory testing when an asymptomatic person tests positive or a symptomatic person tests negative on a COVID-19 rapid antigen test. 

Rhode Island has adopted a confirmatory COVID-19 testing protocol in accordance with guidance from the Centers for Disease Control and Prevention. The updated protocol supports Rhode Island’s effective clinical use of rapid antigen tests in different testing situations. A confirmatory laboratory-based PCR test also confirms whether your patient and their close contacts need to continue isolation or quarantine.

RIDOH recommends getting a confirmatory, laboratory-based PCR test if:

• A symptomatic person has a negative antigen test result.
• An asymptomatic person has a positive antigen test result.

RIDOH does not recommend getting a confirmatory, laboratory-based PCR test if:

• A symptomatic person has a positive antigen test result.
• An asymptomatic person has a negative antigen test result.

It is highly recommended that the patient get their confirmatory PCR test on the same day they had their rapid antigen test.  If an asymptomatic person with a positive antigen test result does not get the recommended PCR test within 48 hours after their rapid antigen test, RIDOH will consider the positive antigen test result final and start contact tracing. 

• If their confirmatory PCR test result is negative, they can end isolation and return to school or work.
• If their confirmatory PCR test result is positive, they need to continue isolating for 10 days from the date of their first test.

If your patient receives a confirmatory PCR test, it is very important that they stay home and away from others as much as possible while they wait for their PCR test result. They should not go to school or work.

Visit this page for more information about the confirmatory testing protocol.

Report any positive cases of COVID-19 to RIDOH within 24 hours, including reinfection and vaccination breakthrough cases. The ordering provider should direct anyone with a positive test result to isolate, whether from rapid antigen or PCR testing.

For reporting positive results from testing you have ordered and sent out through a laboratory system:

• Report positive results only. 
• Please include the patient’s name, DOB, testing date, and testing site. 
• For reinfection and vaccination breakthrough cases, include the initial infection date and/or the patient's vaccine product and injection dates.
• You may report by either of the following methods. We strongly encourage you to send by secure email if possible, as our fax machine can get backed up. For the time being, we do not recommend calling 401-222-8022 with positive results due to phone waiting times.  
  1. Email using secure email. Send the test result to [email protected] with the subject: LAB POSITIVE. Attach the result report to the email or copy and paste the report into the body of the email. 
  2. Fax to 401-222-2488. Include a cover letter (re: LAB POSITIVE). 

For reporting point-of-care and rapid test results performed at your site:

• Report all positive and negative results. 
• Email Chris Jenkins for information on how to send POC results: [email protected]  
• Do not send results to Christine Jenkins.  

It's no longer necessary to report Patients Under Investigation (PUIs). Do not use the PUI form to report positive results to RIDOH.

For reporting possible cases of Multi-Inflammatory Disease in Children (MIS-C), please call the RIDOH Center for Acute Infectious Disease Epidemiology at 401-222-2577 Monday-Friday 8:30 a.m-4:30 p.m. (401-276-8046 after-hours).

Patient Resources

• When do I need to Isolate or Quarantine for COVID-19? (web page)  Eng | Esp | Port
• Close Contact Quarantine Requirements (handout)  Eng | Esp | Port | Cape Verdean Creole
• Close Contact Quarantine FAQ (handout)   Eng | Esp | Port
• Close Contact Quarantine Calculator (Excel file)  Eng | Esp | Port
• RIDOH Letter Requests: Rhode Islanders who need to provide verification of their quarantine status, isolation status, or test results may request a letter by submitting this online form. Letters will be sent by email and are usually ready in 72 hours.  Instructions  Types of Letters  

Provider Resources

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. RIDOH encourages practices to use these tools to identify and inform staff and patients who are close contacts and should quarantine, and to instruct them to self-monitor for symptoms for 14 days from exposure.

• Quarantine and Isolation by Population
• COVID-19 Close Contact Determination in Patient Care Settings
• COVID-19 Isolation and Quarantine Calculator

Quarantine and Isolation Facilities

There is a quarantine and isolation facility for the homeless and others with unstable housing at the Wyndham Hotel at 1850 Post Road in Warwick. Please see this welcome letter for more information about the site.

The facility accepts referrals for people who:

• Have tested positive but do not have a safe place to isolate.
• Have been exposed to someone with COVID-19 and ordered to quarantine but do not have a safe place to quarantine.
  • COVID-19 testing is offered every Wednesday for quarantining residents.

Patient intake can be initiated by the patient or someone requesting housing on their behalf, such as a social worker, physician, or case manager.  Amos House will conduct intake by phone and coordinate with the referring provider as needed. Call Wyndham House at 401-738-4000 and ask for Amos House or extension 339. Intakes and new admissions take place from 9 a.m. – 4 p.m., Monday – Friday. Voicemails left after hours will be returned the next business day.

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 "long haul" COVID, has been described as subacute and chronic multi-system post-infectious sequelae of acute COVID-19 infection. It is 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

CDC, Evaluating and Caring for Patients with Post-COVID Conditions: Interim Guidance

OHIC Resources

• Rhode Island Office of the Health Insurance Commissioner (OHIC) COVID-19 Information
• Guidance regarding Coverage for COVID-19 PCR and Antigen Testing
• Reinstatement of Temporary Emergency Measures Regarding Benefit Determination Review and Network Plans and Health Care Accessibility and Quality Assurance

Clinical Requirements and Guidance

RIDOH advises all healthcare providers to follow Occupational Safety and Health Administration (OSHA) standards and US Centers for Disease Control and Prevention (CDC) guidance in their clinical settings.

• OSHA, Emergency Temporary Standard
• CDC, Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination
• CDC, Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic
• CDC, Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care

Other Resources

• RIDOH, COVID-19 Response Data
• RIDOH, COVID-19 Provider Briefings
• RIDOH, How You Can Help the Rhode Island COVID-19 Response
• CDC, Healthcare Workers: Information on COVID-19