Healthcare Providers

Long-Acting Monoclonal Antibodies (LA-MABS)

LA-MABS to prevent COVID-19 before exposure are available for adult and pediatric outpatients who:

• Have a moderately to severely compromised immune system,
• Are age 12 or older,
• have not recently tested positive for COVID-19,
• have not recently been exposed to someone with COVID-19, AND
• have not gotten a COVID-19 vaccine in the last two weeks.

Treatment Option

• Tixagevimab and cilgavimab (EVUSHELD) – (age 12 and older) EUA | EUA Provider Fact Sheet | EUA Patient Fact Sheet

To refer a patient for pre-exposure prevention of COVID-19, find current providers using the COVID-19 Therapeutics Locator. This website is updated every 24 hours.

There are two options currently authorized for treatment for outpatients who test positive for COVID-19: monoclonal antibodies (MABS) and oral antivirals. 

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.

Monoclonal Antibodies (MABS)

Treatment with MABS is available for outpatients age 12 and older who test positive for COVID-19 and started having mild to moderate symptoms in the last 10 days.

Treatment Option

• Bebtelovimab EUA | EUA Provider Fact Sheet | EUA Patient Fact Sheet

How to Get Treatment for Patients

Encourage patients to get tested as soon as they have COVID-19 symptoms so eligible patients can start treatment as early as possible to maximize treatment effectiveness. Healthcare providers can refer eligible patients to the these MABS infusion centers or services. Some of these services provide in-home treatment. 

Infusion centers and services are using similar referral criteria and treatment processes. Review interim guidelines released by the COVID-19 Treatment Guidelines Panel on Patient Prioritization for Outpatient Anti-SARS-CoV-2 Therapies  on December 23, 2021.

Discuss treatment options with patients and give them the Early Use Authorization (EUA) patient fact sheet.

Patients without a regular healthcare provider can visit health.ri.gov/find/urgentcare. Patients who don't have or have lost their health insurance can learn about accessing healthcare and support services.

MABS Resources

• RIDOH, Guidance for Providers About Monoclonal Antibody Administration and the Omicron Variant
• NIH, The COVID-19 Treatment Guidelines Panel’s Interim Statement on Patient Prioritization for Outpatient Anti-SARS-CoV-2 Therapies or Preventive Strategies When There Are Logistical or Supply Constraints
• HHS, combatcovid.hhs.gov

Oral Antivirals

Oral antiviral treatment is available for outpatients age 12 and older who test positive for COVID-19 and started having mild to moderate symptoms in the last five days.

Treatment Options

• Molnupiravir – (age 18 and older) EUA | EUA Provider Fact Sheet | EUA Patient Fact Sheet
• Nirmatrelvir, nsp5 and ritanovir (PAXLOVID) – (age 12 and older) EUA | EUA Provider Fact Sheet | EUA Patient Fact Sheet

How to Get Treatment for Patients

Encourage patients to get tested as soon as they have COVID-19 symptoms so eligible patients can start oral antiviral treatment as early as possible to maximize treatment effectiveness. Oral antivirals should be prescribed as soon as possible after a COVID-19 diagnosis and within five days of symptom onset.

The oral antivirals will be 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 COVID-19 Therapeutics Locator. This website is updated every 24 hours.

Oral Antiviral Resources

• RIDOH, Guidance for Providers About Use of Paxlovid
• RIDOH, Guidance for Providers About use of Molnupiravir

COVID-19 Treatment Resources

• HHS, COVID-19 Therapeutics Locator
• ASPR, Side-by-Side Overview of Outpatient Therapies Authorized for Treatment of Mild-Moderate 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

• 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 patients who have symptoms of COVID-19 or may have been exposed to someone with COVID-19.

RIDOH strongly recommends that healthcare providers 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 three 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 primary care provider.

Primary care providers can offer PCR specimen collection or point-of-care antigen testing to test their patients for COVID-19.

PCR Specimen Collection

Providers 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.

Primary care providers 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 of them 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 (SHL) via an 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 providers who don’t offer in-office specimen collection or point-of-care antigen testing can direct patients to a local pharmacy, respiratory clinic, or State-run test site. Patients may also test themselves for COVID-19 at home.

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

RIDOH and the Rhode Island Executive Office of Health and Human Services (EOHHS) have partnered with Smart Bio to provide COVID-19 tests for homebound, non-ambulatory patients.

A medical provider must attest that the patient is homebound and non-ambulatory. A lack of transportation does not qualify a person for a homebound test. If the patient is ambulatory but has no transportation, they should be referred to MTM, the State’s transportation vendor, at 855-330-9131 (TTY: 711). 

If the patient has home health services, the medical provider should determine if the home health agency is able to administer a COVID-19 test before requesting a test through this process.

To request a test for a homebound patient:

• The medical provider must complete the State Health Laboratories' test requisition form. This form serves as the medical provider’s order and must be completed.
• The medical provider must send the completed homebound test request form via secure email to [email protected]. The subject line should read "Homebound Test Request" and include the patient’s first name and last initial.
• Smart Bio will provide the medical provider with the test appointment date. The medical provider will notify the patient of their test appointment date. Someone must be in the home to answer the door, like a family member or home health agency.
• The test result will be sent to the ordering provider and reported to RIDOH. The patient will receive a text message or email when their result is ready at portal.ri.gov/results.

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.
     • Please note: This email address is for healthcare providers only. To submit a self-test result to RIDOH, visit portal.ri.gov/s/selftestresult. 
  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 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

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

• Answers to Frequently Asked Questions about COVID-19 Guidance for Nursing Homes
• Answers to Frequently Asked Questions about COVID-19 Guidance for Assisted Living Residences

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