• Providers are encouraged to obtain specimens for COVID-19 molecular testing for all patients seeking care who are symptomatic, even those with mild symptoms.
  • Providers unable to gain access to reference laboratories, may leverage public health resources for testing: http://www.dph.illinois.gov/testing
• All providers and testing sites must report to Public Health all individuals tested for COVID-19, in accordance with the Illinois Control of Communicable Diseases Code (77 Ill. Adm. Code 690.200(a)(5)).
  • Sites should submit electronically through the Illinois National Electronic Disease Surveillance System (I-NEDSS) via integrated Electronic Laboratory Reporting (ELR).
  • All health care providers that are unable to establish an electronic laboratory reporting feed to INEDSS shall use another electronic mechanism to submit
    such data, which may include a Health Level Seven (HL7) electronic data feed or submit through an established REDCap electronic case submission form. These submissions shall be completed within 24 hours of ordering a COVID-19 laboratory test, and within 24 hours of a laboratory result. To establish an HL7 feed, please reach out for assistance at: CDPHCovidDataHub@rush.edu. A REDCap case report form can be submitted at: https://redcap.dph.illinois.gov/surveys/?s=FR7MAJAY84.
  • Additionally, entities that are not reporting through I-NEDSS need to notify CDPH via email of the location of
    testing and type of test offered at: covid19pui@cityofchicago.org.

Laboratory capacity to diagnose COVID-19 infections has increased to support testing for many patients in outpatient settings who have symptoms suggestive of COVID-19.

When testing resource limitations necessitate prioritization of testing decisions, providers should refer to CDC PRIORITIES FOR COVID-19 TESTING for molecular testing, which are summarized below. However, when adequate testing capacity is available, all symptomatic patients should be tested.

• Testing of other individuals, including asymptomatic individuals identified in health care settings, congregate living settings, and workplaces may occur in limited settings as part of public health investigations and infection control interventions.

COVID-19 Testing at IDPH laboratories

Submission of specimens for molecular testing for COVID-19 at IDPH labs no longer requires prior approval from CDPH. Acceptable specimens collected by healthcare personnel for molecular testing include:

• Nasopharyngeal swab video
• Nasal mid turbinate swab (deep Nasal Swab)
• Oropharyngeal swab
• Nasopharyngeal wash or nasal aspirate

• IDPH Specimen Submission Process:
  • A lab requisition should be completed for each specimen and submitted along with the specimen: IDPH lab requisition form
  • Complete one test requisition form for each specimen submitted
  • Clearly label patient identifiers for tracking and reporting purposes on both the specimen tube and IDPH lab requisition form
  • Specimen storage: Specimens ≤ 72 hours from submission should be held at 2-8°C and sent on ice packs to:

IDPH-Chicago Laboratory
2121 W. Taylor St.
Chicago, IL 60612

Interim Laboratory Biosafety Guidelines for Handling and Processing Specimens Associated with Coronavirus Disease 2019 (COVID-19)

Considerations for Collection of Diagnostic Respiratory Specimens

Some specimen collection guidance has changed since July 8, 2020. See Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for 2019 Novel Coronavirus (2019-nCoV). When collecting diagnostic respiratory specimens (e.g., nasopharyngeal swab) from a patient with possible COVID-19, the following should occur:

• Specimen collection should be performed in a normal examination room with the door closed.
• HCP in the room may wear a facemask, eye protection, gloves, and a gown.
  • N95 respirators should be prioritized for other procedures at higher risk for producing infectious aerosols (e.g., intubation), instead of for collecting nasopharyngeal swabs.
• The number of HCP present during the procedure should be limited to only those essential for patient care and procedure support. Visitors should not be present for specimen collection.

Outpatient Environmental Infection Control Tips

• Routine cleaning and disinfection procedures (e.g., using cleaners and water to pre-clean surfaces prior to applying an EPA-registered, hospital-grade disinfectant to frequently touched surfaces or objects for appropriate contact times as indicated on the product’s label) are appropriate for SARS-CoV-2 in healthcare settings.
  • Refer to List N on the EPA website for EPA-registered disinfectants that have qualified under EPA’s emerging viral pathogens program for use against SARS-CoV-2.

• Clean and disinfect procedure room surfaces promptly after diagnostic respiratory specimens obtained. In general, only essential personnel should enter the room of patients with suspected or confirmed COVID-19.
• Although spread of SARS-CoV-2 is believed to be primarily via respiratory droplets, the contribution of small respirable particles to close proximity transmission is currently uncertain. Airborne transmission from person-to-person over long distances is unlikely.
• The amount of time that the air inside an examination room remains potentially infectious is not known and may depend on a number of factors including the size of the room, the number of air changes per hour, how long the patient was in the room, if the patient was coughing or sneezing, and if an aerosol-generating procedure was performed. Facilities will need to consider these factors when deciding when the vacated room can be entered by someone who is not wearing PPE.
  • For a patient who was not coughing or sneezing, did not undergo an aerosol-generating procedure, and occupied the room for a short period of time (e.g., a few minutes), any risk to HCP and subsequent patients likely dissipates over a matter of minutes. However, for a patient who was coughing and remained in the room for a longer period of time or underwent an aerosol-generating procedure, the risk period is likely longer.
  • For these higher risk scenarios, it is reasonable to apply a similar time period as that used for pathogens spread by the airborne route (e.g., measles, tuberculosis) and to restrict HCP and patients without PPE from entering the room until sufficient time has elapsed for enough air changes to remove potentially infectious particles.

• HCP already in PPE or Environmental Services (EVS) personnel may enter the room after sufficient time has elapsed, depending on the use of the room as above, and should wear a gown and gloves when performing terminal cleaning. HCP/EVS personnel should clean and disinfect environmental surfaces and shared equipment before the room is used for another patient.
  • A facemask (if not already wearing for source control) and eye protection should be added if splashes or sprays during cleaning and disinfection activities are anticipated or otherwise required based on the selected cleaning products. Shoe covers are not recommended at this time for personnel caring for patients with COVID-19.

Considerations for Protecting and Managing Healthcare Personnel (HCP)

Many facilities have already experienced staffing shortages due to HCP exposures, illness, or need to care for family members at home. Plans and processes to mitigate staffing shortages can always be improved and current recommendations are described below.

• Facilities and organizations providing healthcare should implement sick leave policies for HCP that are non-punitive, flexible, and consistent with public health guidance.
• As part of routine practice, HCP should be asked to regularly monitor themselves for fever and symptoms of COVID-19.
• HCP should be reminded to stay home when they are ill.
• Screen all HCP at the beginning of their shift for fever and symptoms consistent with COVID-19*
  • Actively take their temperature and document absence of symptoms consistent with COVID-19*. If they are ill, have them keep their cloth face covering or facemask on and leave the workplace.
  • *Fever is either measured temperature >100.0°F or subjective fever. Note that fever may be intermittent or may not be present in some individuals, such as those who are elderly, immunosuppressed, or taking certain medications (e.g., NSAIDs). Clinical judgement should be used to guide testing of individuals in such situations. Respiratory symptoms consistent with COVID-19 are cough, shortness of breath, and sore throat. Medical evaluation may be warranted for lower temperatures (<100.0°F) or other symptoms (e.g., muscle aches, nausea, vomiting, diarrhea, abdominal pain headache, runny nose, fatigue) based on assessment by occupational health.
• If HCP develop fever (T≥100.0°F) or symptoms consistent with COVID-19* while at work they should keep their cloth face covering or facemask on, inform their supervisor, and leave the workplace.
• HCP with suspected COVID-19 should be prioritized for testing. See updated CDC guidance (August 24, 2020) on Overview on Testing for SARS-CoV-2 (COVID-19) as well as April 29, 2020 Health Alert: Recommendations for Health Care Providers to Test All Patients with Acute Respiratory Illness for COVID-19.
• Healthcare facilities should consider foregoing contact tracing in favor of universal source control for HCP and screening for fever and symptoms before every shift.

Return to Work Criteria for HCP with Confirmed or Suspected COVID-19

As of August 10, 2020, CDC recommends new criteria for return to work for HCP with confirmed or suspected COVID-19 which include a symptom-based (i.e., time-since-illness-onset and time-since-recovery strategy), time-based strategy or a test-based strategy (symptom-based preferred). Of note, there have been reports of prolonged detection of RNA without direct correlation to viral culture. Detecting viral RNA via PCR does not necessarily mean that infectious virus is present.

Symptomatic HCP with suspected or confirmed COVID-19:

• Symptom-based strategy. Exclude from work until:
  • At least 1 days (24 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,
  • At least 10 days have passed since symptoms first appeared
• Test-based strategy. Exclude from work until (not recommended):
  • Resolution of fever without the use of fever-reducing medications and
  • Improvement in respiratory symptoms (e.g., cough, shortness of breath), and
  • Negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2 RNA from at least two consecutive nasopharyngeal swab specimens collected ≥24 hours apart (total of two negative specimens). Of note, there have been reports of prolonged detection of RNA without direct correlation to viral culture.

HCP with laboratory-confirmed COVID-19 who have not had any symptoms:

• Time-based strategy. Exclude from work until:
  • 10 days have passed since the date of their first positive COVID-19 diagnostic test assuming they have not subsequently developed symptoms since their positive test. If they develop symptoms, then the symptom-based or test-based strategy should be used.
  • Note, because symptoms cannot be used to gauge where these individuals are in the course of their illness, it is possible that the duration of viral shedding could be longer or shorter than 10 days after their first positive test.

• Test-based strategy. Exclude from work until:
  • Negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2 RNA from at least two consecutive nasopharyngeal swab specimens collected ≥24 hours apart (total of two negative specimens).
  • Note, because of the absence of symptoms, it is not possible to gauge where these individuals are in the course of their illness. There have been reports of prolonged detection of RNA without direct correlation to viral culture.

Consider consulting with local infectious disease experts when making decisions about discontinuing Transmission-Based Precautions for individuals who might remain infectious longer than 10 days (e.g., severely immunocompromised).

FOR INFORMATION ON THE COVID-19 VACCINATION PROGRAM
Please click here.

HOW TO REPORT COVID-19 TO CDPH
Both individual lab-confirmed cases and clusters are reportable conditions.
If you are an outpatient facility and do not have access to INEDSS or a congregate community setting (such as a camp, university, childcare setting, correctional facility, etc), please complete the COVID-19 Online Case Report Form (a confidential online survey powered by IDPH REDCap).

If you are a healthcare provider: Select option 1 of the drop-down menu in the linked case report form: https://redcap.link/chicovidreport

Since July 13, 2020, c​​​​​​ommunity locations such as camps, childcare facilities, faith communities, homeless shelters, correctional facilities, etc. are encouraged to report individual reports of COVID-19 illness among group settings as well as clusters.

If you are a community partner: Select option 2 of the drop-down menu in the linked case report form: https://redcap.link/chicovidreport
Contact lists can be uploaded securely at https://redcap.link/chicovidcontacts

***Concerning calls to 311 for COVID-19, 311 calls should be reserved for discussion of management of confirmed COVID-19 cases only or urgent matters related to disposition of PUIs or cases. For these issues, call 311 during business hours / after hours / weekends / holidays and ask to speak with the medical director on call (312-744-5000 if outside the City of Chicago).

During early phases of the COVID-19 response, with limited laboratory capacity, COVID-19 testing was prioritized to optimize care of hospitalized patients, identify those at highest risk of complications from infection, and detect cases in critical infrastructure workers and first responders. Laboratory capacity to diagnose COVID-19 infections has increased to support testing for many in outpatient settings who have symptoms suggestive of COVID-19. Increasing the ability to identify COVID-19 cases and report to public health is fundamental for investigation and isolation of cases to mitigate spread.

Providers are encouraged to obtain specimens for COVID-19 molecular testing for all patients seeking care who are symptomatic, even those with mild symptoms as well as asymptomatic exposures to known positive cases.

A list of commercial and hospital-based laboratories may be found here.

Information on Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19)

Coronavirus Response Center Links

• Latest Congregate Setting Guidance
• Testing Sites
• COVID Dashboard
• Hospital Capacity Dashboard

Important COVID-19 Information for Facilities

• COVID-19 Guidance and Toolkit for Acute Care Facilities
• COVID-19 Guidance and Toolkit for Long-term Care Facilities
• COVID-19 Guidance for Outpatient Settings
• Tips for Non-Traditional COVID-19 Diagnostic Testing in the Outpatient Setting
• CDPH COVID-19 Data Sharing Overview

Quarantine/Isolation Facility Information:

• Webpage: https://www.chicago.gov/city/en/sites/health-care-workers/home/chicago-COVID-19-isolation-facilities.html.

• SARS-CoV-2 antibody tests are available but currently not approved by the Food and Drug Administration.
• Sensitivity, specificity, and reliability of available antibody tests has not yet been determined, and as such, PCR testing is recommended in conjunction with antibody testing in order to diagnose or exclude SARS-CoV-2 infection.
• False positives antibody tests might occur in the presence of past or present infection with other coronaviruses such as HKU1, NL63, OC43, or 229E.
• Although serologic testing by itself should not be used to diagnose infection with SARS-CoV-2, any positive IgM or IgG results should be reported to public health via the Illinois National Electronic Disease Surveillance System (I-NEDSS). For providers not able to report via I-NEDSS, results may be reported through the COVID-19 Online Case Report Form (confidential online survey powered by REDCap).
• Please review information from the Infectious Diseases Society of America regarding COVID-19 Antibody Testing Primer.

NEW Resource for Discharge of High-Risk COVID-19 Persons Under Investigation (PUI) or Confirmed Cases issued March 22, 2020

CDPH COVID-19 PPE Conservation Guidance for Hospitals issued March 19, 2020
Updated Guidance for Outpatient Facilities issued May 5, 2020
CDPH Order: Duties of Hospitals and Other Congregate Facilities issued March 19, 2020
IDPH Respirator Reuse Guidance issued March 19, 2020
URGENT Updated COVID-19 Guidance for Hospitals issued March 18, 2020
Tips for Outpatient Healthcare Facilities During COVID-19 Community Transmission issued March 16, 2020
COVID-19: Testing Recommendations and Public Health Testing Updates issued March 16, 2020
COVID-19: Interim Infection Control Guidance & Lab Testing issued March 12, 2020
Clarifying PUI Testing for COVID-19, issued March 5, 2020
COVID-19 Sample Submission to IDPH, issued March 4, 2020
Novel Coronavirus Updates: Presumptive Positive Cook County Case, Launch of Sentinel Surveillance, Continued Hospital Preparations, issued March 2, 2020
Flow chart to Identify and Assess 2019 Novel Coronavirus, issued Feb 1, 2020
Feb 1, 2020 CDC Update and Interim Guidance on Outbreak of 2019-nCoV
Healthcare Facility Environmental Disinfection Guidance_013120
Jan 30, 2020 HAN #4: 1st Case of Human-to-Human Transmission of Novel Coronavirus (2019-nCoV) Identified in Chicago
Jan 24, 2020 HAN #3: Confirmed Case of Novel Coronavirus (2019-nCoV) in Chicago Resident
Jan 21, 2020 HAN #2: Chicago O’Hare international airport to be added as screening site 2019-nCoV
Jan 17, 2020 CDC HAN Advisory #1 - Chicago HAN Document
Update and Interim Guidance on Outbreak of 2019 Novel Coronavirus (2019-nCoV) in Wuhan, China
CDC 2019 Novel Coronavirus, Wuhan China Situation Summary
CDC Interim Guidance for Healthcare Professionals and criteria for evaluation of patients under investigation 2019 novel coronavirus:
CDC Interim Healthcare Infection Prevention and Control Recommendations for patients under investigation for 2019 novel coronavirus
WHO infection prevention and control during health care when novel coronavirus (nCoV) is suspected
CDC Information for Laboratories for working with specimens from patients under investigation for human infections with 2019 novel coronavirus
IDSA 2019-nCoV Reference Library
CDC Travel Guidance

• Learn more about SAMHSA’s COVID-19 Guidance for Opioid Treatment Programs here.
• Access the Drug Enforcement Administration’s guidelines on Use of Telemedicine While Providing Medication Assisted Treatment (MAT) here.
• For the most up-to-date information on responses to COVID-19 for the Substance Use Disorder Treatment field, go to https://www.samhsa.gov/