COVID

COVID: TESTING

Patients

• Adult Ambulatory COVID and Influenza Clinical Algorithm 

• Ambulatory Guidance: Screening, Testing, PPE, and Transmission Precautions 

• How to collect the Nasopharyngeal swab 

• If a patient is being seen in the practice and needs a COVID test is should be done onsite. 

• If a patient is being seen via telehealth or walks in in to the practice and needs a COVID test you can refer them to the ACN mobile medical unit which is located outside of 21 Audubon but it is by appointment only. To refer a patient please send a secure chat to the CUIMC W ACN MMU COVID TESTING or send an inbasket message to ACNW MMU SYMPTOMATIC COVID TESTING [17425] pool. No need to place order. 

Employees

• Every home in the U.S. is eligible to order 4 free at-home COVID tests: www.covidtest.gov  

• Antigen rapid tests done outside NYP with a positive result should be entered into the COVID tracker

  • If Antigen rapid test results are negative but the employee is symptomatic, PCR test is needed.

• PCR testing available for symptomatic employees: Guide to schedule Employee COVID testing 

• Employees should leverage the antigen tests available at the clinics to test at work (see last week's email)

COVID: TREATMENT

• Adult Ambulatory COVID and Influenza Clinical Algorithm 

• Updated COVID Treatment Guide 

• Note: Fully vaccinated is currently defined as having received two doses of an mRNA vaccine, or a single dose of the Johnson & Johnson vaccine

COVID: ISOLATION

• COVID POSITIVE: Ending Isolation

• Children and adults with mild, symptomatic COVID-19: Isolation can end at least 5 days after symptom onset and after fever ends for 24 hours (without the use of fever-reducing medication) and symptoms are improving, if these people can continue to properly wear a well-fitted mask around others for 5 more days after the 5-day isolation period. Day 0 is the first day of symptoms.

• People who are infected but asymptomatic (never develop symptoms): Isolation can end at least 5 days after the first positive test (with day 0 being the date their specimen was collected for the positive test), if these people can continue to wear a properly well-fitted mask around others for 5 more days after the 5-day isolation period. However, if symptoms develop after a positive test, their 5-day isolation period should start over (day 0 changes to the first day of symptoms).

• People who have moderate COVID-19 illness: Isolate for 10 days.

• People who are severely ill (i.e., requiring hospitalization, intensive care, or ventilation support): Extending the duration of isolation and precautions to at least 10 days and up to 20 days after symptom onset, and after fever ends (without the use of fever-reducing medication) and symptoms are improving, may be warranted.

• People who are moderately or severely immunocompromised might have a longer infectious period: Extend isolation to 20 or more days (day 0 is the first day of symptoms or a positive viral test). Use a test-based strategy and consult with an infectious disease specialist to determine the appropriate duration of isolation and precautions.

• Recovered patients: Patients who have recovered from COVID-19 can continue to have detectable SARS-CoV-2 RNA in upper respiratory specimens for up to 3 months after illness onset. However, replication-competent virus has not been reliably recovered from such patients, and they are not likely infectious. 

How to seperate safely at home ENGLISH SPANISH 

COVID: RETURN TO WORK 

Employees

•  Fully vaccinated employees1 may now return to work after Day 5 of their isolation period (where day 0 is the day of symptom onset or, if asymptomatic, the day of a positive test) IF:

  • • No fever for at least 72 hours without the use of fever-reducing medications (such as Tylenol, ibuprofen, or aspirin), AND

    • Other symptoms (e.g., runny nose, cough) are improving and are minimal enough to wear a well-fitting surgical mask or N95 respirator continuously when around patients, visitors, and other HCP, AND

    • HCP is NOT moderately or severely immunocompromised2

• HCP who meet the criteria to return to work after Day 5 of isolation must wear an N95 respirator or well-fitting surgical mask at all times when around patients, visitors and other HCP for another 5 days. HCP returning to work after Day 5 should not be assigned to work in clinical areas or on clinical services dedicated to severely immunocompromised patients until at least 7 days have passed since the onset of symptoms or, if asymptomatic, the date of the positive test. Such units include dedicated transplant areas (inpatient and outpatient), dedicated oncology areas (inpatient and outpatient) and neonatal ICUs.

• Fully vaccinated employees who do not meet criteria to return to work after Day 5 of their isolation period may return to work after Day 7 of their isolation period (where day 0 is the day of symptom onset or, if asymptomatic, the day of the positive test) IF:

  • • No fever for at least 24 hours without the use of fever-reducing medications (such as Tylenol, ibuprofen, or aspirin), AND

    •  Symptoms have markedly improved

• HCP who meet the above criteria DO NOT need to call the NYP COVID Hotline or update the NYP COVID Tracker for return to work clearance.

• Unvaccinated employees must continue to isolate for at least 10 days and meet other criteria as above. Please see updated Interim Guidance for Ill Healthcare Personnel (HCP), Exposure Investigations, and Travel for more details on what to do if you are sick or have been exposed to someone with COVID-19.

• Fully vaccinated = >2 weeks after receiving the second dose of Pfizer or Moderna vaccine or >2 weeks after receiving one dose of the Johnson & Johnson (Janssen) vaccine.

• Moderate and severe immunocompromising conditions and treatments include:

  • • Active treatment for solid tumor and hematologic malignancies

    • Receipt of solid-organ transplant and taking immunosuppressive therapy

    • Receipt of CAR-T-cell therapy or hematopoietic cell transplant (HCT) (within 2 years of transplantation or taking immunosuppression therapy)

    • Moderate or severe primary immunodeficiency (e.g., DiGeorge syndrome, Wiskott-Aldrich syndrome)

    • Advanced or untreated HIV infection (people with HIV and CD4 cell counts <200/mm3, history of an AIDS-defining illness without immune reconstitution, or clinical manifestations of symptomatic HIV)

    • Active treatment with high-dose corticosteroids (i.e., ≥20 mg prednisone or equivalent per day when administered for ≥2 weeks), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, tumor necrosis factor (TNF) blockers, and other biologic agents that are immunosuppressive or immunomodulatory.

Pediatric Return to Play Guidelines 

May 1, 2023

Dear Colleague,

The Centers for Disease Control and Prevention (CDC) updated its recommendations to simplify the COVID-19 vaccination schedule. The CDC’s recommendations follow regulatory changes by the US Food and Drug Administration. With these updates:

• Bivalent mRNA COVID-19 vaccines are now recommended for all doses administered to people ages 6 months and older.

• Monovalent Moderna and Pfizer COVID-19 vaccines are no longer authorized for use.

Below is a summary of the changes. For full vaccine schedule and administration guidance, please see the CDC’s Interim Clinical Considerations. 

People ages 6 years and older

• People who are unvaccinated (i.e., they have never received a COVID-19 vaccine) should receive a single bivalent mRNA vaccine dose, rather than multiple primary series and booster doses. This means that people six years of age and older who are newly vaccinated will be considered up to date after just one bivalent vaccine dose. 

• People who previously received only monovalent vaccines should receive one dose of a bivalent mRNA vaccine at least two months after receipt of any monovalent COVID-19 vaccine. 

• Most people who completed a monovalent primary series and received one bivalent booster vaccine dose are not recommended to receive any additional bivalent doses at this time. 

• The following groups may receive additional bivalent doses:

  • People ages 65 years and older may receive one additional bivalent dose at least four months after their initial bivalent dose (a total of two bivalent vaccine doses).

  • People who are immunocompromised may receive one additional bivalent dose at least two months after their initial bivalent dose, and additional bivalent doses may be administered at the discretion of their healthcare provider, at least two months after their last bivalent dose.

Children younger than 6 years of age

• Children who are unvaccinated: Children 6 months through 4 years of age who are unvaccinated should receive a two-dose series of the Moderna bivalent vaccine or a three-dose series of the Pfizer bivalent vaccine, and children 5 years of age who are unvaccinated should receive two doses of the Moderna bivalent vaccine or a single dose of the Pfizer bivalent vaccine.

• Children who have received monovalent vaccine: Children ages 6 months through 5 years of age who have received one, two or three doses of a monovalent COVID-19 vaccine may receive a bivalent vaccine, but the number of doses they receive will depend on the vaccine and their vaccination history.