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IMPORTANT INFORMATION RELATED TO
CORONAVIRUS/COVID-19 FROM VALLEY PREFERRED


We are here for you
  1. We are providing contact information and resources (below)
  2. We have a 24/7 Nurse hotline: 1-888-402-LVHN for patients
  3. We have regional centers for all testing.  Send all your testing to regional centers – DO NOT perform in office testing – we would prefer to run the tests so that we can monitor the results

These two websites are live and operational
for up-to-date COVID-19 information


To access the sites below, use your SUI code and network password to log into the Intranet. If you need assistance, call the Help Desk at 610-402-8303.

LVHN intranet LINK – This provides all the most up-to-date LVHN information on the COVID-19 response.

LVPG intranet LINK – This provides all the most up-to-date LVPG operational information on our communication channels, regional sites and patient scripting.

Command Center, questions, and testing recommendations
 

There is a LVPG Command Center working to maintain an organized approach – the center is open 7:30 a.m.-6:00 p.m.
 
Please call 1-888-304-0934 for operational or clinical practice questions. If you leave a message, we will call you back right away. ANYONE can call this operational number for guidance!
 

Valley Preferred and LVHN recommend all Independent Physicians send their patients to regional testing centers rather than order coronavirus testing themselves. We are tracking results through those sites. We cannot track the patients if physicians perform the testing / orders.


If anyone in our community feels they have COVID-19 or may have been exposed to someone who does, we are strongly advising them to stay home. Screening patients can be managed via phone, video visits, eVisits or within the practices for any patient who arrives and reports symptoms:

  1. 24/7 Nurse hotline: 1-888-402-LVHN. Anyone can call at any time and receive clinical guidance from the RN hotline – for COVID-19 or any other issue.
  2. MyLVHN eVisits: Asynchronous visits are available on the secure patient portal; anyone 18 years or older can submit. A physician / APC will respond back with guidance, usually within an hour. No charge.
  3. Video Visits: Right now you have to schedule a time but that may be eliminated within the next few days. Staffed by APCs / physicians. No charge to patients.
If screening suggests the need for viral testing or medical assessment, symptomatic patients can be referred to one of the designated LVPG COVID-19 regional testing centers.
LVPG & LVPHO Guidance & Talking Points for COVID-19
REGIONAL COVID-19 TESTING LOCATIONS
COVID-19 TESTING

This message is being sent on behalf of
Luther (Pat) Rhodes MD, FACP, FIDSA, FSHEA,
Chief Infection Control and Hospital Epidemiology,
Timothy Friel MD, FIDSA, Chair, Department of Medicine

 LVPG/LVPHO/LVHN Guidance for COVID-19 Testing
(3/13/2020)
Colleagues:
 
We have been asked to provide additional guidance about recommendations for testing patients for COVID-19. In an effort to provide greater clarity, we would like to propose the following guidance:
(Please note – these recommendations reflect the current state and are based on evolving data and observations. Recommendation will be updated if more formal recommendations become available.)
 
The Centers for Disease Control currently state that physicians should use their best judgement to determine if a patient has symptoms or signs compatible with COVID-19 and whether to recommend testing.
 
The most commonly reported symptoms in patients with confirmed COVID-19 infection include the following:
  1. Fever
  2. Cough
  3. Shortness of breath or trouble breathing
Asymptomatic patients should NOT be tested. Current tests are only capable of making the diagnosis of active COVID-19. The test does NOT confirm exposure.
 
The following patients should be prioritized for testing:
  1. Hospitalized patients who have signs and symptoms compatible with COVID-19 (including fever with pulmonary infiltrates or Chest CT abnormalities in the absence of another established or reasonable alternative diagnosis). 
  2. Symptomatic individuals such as older adults and individuals with chronic medical conditions and/or an immunocompromised state that may put them at higher risk for poor outcomes (e.g., diabetes, heart disease, receiving immunosuppressive medications, chronic lung disease, chronic kidney disease).
  3. Any persons including healthcare personnel who within 14 days of symptom onset had close contact[i] with a suspect or laboratory-confirmed COVID-19 patient, or who have a history of travel from affected geographic areas.
In addition, recognizing that we still have limited understanding of the current level of community spread of SARS-CoV-2 in our community, we ask that providers use the following guidance when assessing patients that do not fall into the priority groups defined above:
  1.  Any symptomatic patient who would be considered for possible influenza testing based on current guidelines – if you plan to test for influenza, include testing for COVID-19.
    • Pregnancy: OB/GYN providers should follow same guidance typically used for making decisions about influenza testing – if the patient has symptoms warranting R/O influenza, COVID-19 testing should be ordered at the same time.
    • Pediatric Patients: Providers caring for pediatric patients should follow the same protocols used to make decisions about influenza testing – if a pediatric patient has symptoms or circumstances warranting R/O influenza, COVID-19 testing should be ordered at the same time. Decisions about testing are often influenced by the presence of a high-risk household contacts. For detailed recommendations about the testing and management of pediatric patients, please see “Special Populations” section below.
  2. Patient with mild respiratory symptoms and no known high-risk exposures should not typically be tested. These patients should be encouraged to remain at home and follow same recommendations typically provided to patients with upper respiratory tract infections.
Testing is performed by obtaining a nasopharyngeal swab in viral transport media. Health Network Labs will accept a single (1) nasopharyngeal swab in viral transport media (VTM) for the following test combinations:
  1. Influenza A,B, RSV and COVID-19 – These two tests should be ordered for outpatients with symptoms suggestive of possible COVID-19 illness. The orders for the two tests must be entered separately. However, a single nasopharyngeal specimen is sufficient.
  2. Comprehensive Respiratory Viral Panel and COVID-19 – These two tests should be ordered only for symptomatic patients requiring admission. The orders for the two tests must be entered separately. However, a single nasopharyngeal specimen is sufficient.
Screening patients can be managed via phone, video visits, eVisits or within the practices for any patient who arrives and reports symptoms. If screening suggests the need for viral testing or medical assessment, symptomatic patients can be referred to one of the designated LVPG COVID-19 testing centers located in every region (a current listing is attached).

Please note: Results of COVID-19 testing are not immediately available. The current turn-around time for test results is 3-5 days. We are hopeful that this turn-around time will decrease in the future. Stable patients who are tested must be advised to remain at home in quarantine until results are available. Quarantine can be discontinued after the receipt of a negative COVID-19 result – unless the patient experienced a significant exposure to a known or highly suspected case of COVID-19; these patients must remain at home in quarantine for 14 days.
 

Guidance for Special Populations

Comprehensive Recommendations for COVID-19 Testing and Management of Children (3/13/2020)
  • ASYMPTOMATIC CHILDREN:
    • COVID-19 testing of ASYMPTOMATIC children is NOT RECOMMENDED
    • Children who are asymptomatic should not be COVID-19 tested, even if they have exposure to a COVID-19 positive person
  • AFEBRILE CHILDREN WITH MILD RESPIRATORY SYMPTOMS:
    • COVID-19 testing of children with mild respiratory symptoms is NOT RECOMMENDED
    • Homecare advice should be given and parents should be instructed to call back if symptoms worsen
  • FEBRILE CHILDREN WITH RESPIRATORY SYMPTOMS who are AT LOW RISK FOR INFLUENZA COMPLICATIONS:
    • COVID-19 testing of children considered low risk for Influenza (> 23 months of age, no high risk chronic health conditions, no high risk household members) is NOT RECOMMENDED
    • Homecare advice for influenza-like illness (ILI) should be given and should be instructed to call back if symptoms worsen or persist
    • Video visits can be offered for concerned parents.  LVHN STAFF MEMBERS SHOULD SET UP PROXY ACCESS FOR MYLVHN DURING THE TRIAGE CALL IF THE PATIENT IS NOT ALREADY ACTIVATED
  • FEBRILE CHILDREN WITH RESPIRATORY SYMPTOMS who are AT INCREASED RISK FOR INFLUENZA COMPLICATIONS:
    • For sites with capabilities of performing rapid influenza screening:
      • COVID-19 testing of children considered at increased risk for influenza who are rapid tested for influenza and are negative should then be TESTED FOR COVID-19
      • COVID-19 testing of children considered at increased risk for influenza who are rapid tested for influenza and are positive should NOT be TESTED FOR COVID-19
    • For sites without access to rapid influenza screening:
      • COVID-19 testing of children considered at increased risk for influenza who are being tested for influenza SHOULD ALSO BE TESTED FOR COVID-19 simultaneously
    • Children at increased risk of influenza include infants and toddlers < 24 months of age and those with chronic health conditions
  • FEBRILE CHILDREN WITH RESPIRATORY SYMPTOMS who are low risk themselves but have HIGH RISK HOUSEHOLD CONTACTS:
    • For sites with capabilities of performing rapid influenza screening:
      • Low risk children SHOULD BE TESTED FOR COVID-19 if they have influenza-like illness symptoms, have rapid tested negative for influenza, AND have household members in the following categories:
        • Infants < 6 months of age
        • Pregnant women
        • Adults or children with chronic health conditions including asthma, heart disease, diabetes
        • Adults or children with Immunocompromising conditions
        • Age 60 years and older
    • For sites without access to rapid influenza screening:
      • Low risk children SHOULD BE TESTED FOR COVID-19 and influenza simultaneously if they have influenza-like illness symptoms have household members in the following categories:
        • Infants < 6 months of age
        • Pregnant women
        • Adults or children with chronic health conditions including asthma, heart disease, diabetes
        • Adults or children with Immunocompromising conditions
        • Age 60 years and older
    • Children in this category who do not require an office visit for their own illness can be referred to an LVPG COVID-19 testing center, with an Epic order for influenza and COVID-19 testing. 
 It is IMPORTANT for all clinicians to follow this approach to avoid confusion and angst for parents.
 
[1] Close contact is defined as the following in the absence of wearing recommended personal protective equipment:
a) being within approximately 6 feet (2 meters) of a COVID-19 case for a prolonged period of time; close contact can occur while caring for, living with, visiting, or sharing a healthcare waiting area or room with a  COVID-19 case
– or –
b) having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on)
Copyright © 2020 Lehigh Valley Physician Hospital Organization, Inc./Valley Preferred, All rights reserved.


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