Health Alert:   COVID-19 Transmission Level:   MODERATE   More information
Wear a mask; stay home.
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COVID-19 Health and Other Partner Resources

UPDATED January 28, 2021

< COVID-19 Home

Coordination and planning with our many healthcare and community partners are the most important elements of our countywide response to the spread of COVID-19. Please find the most up-to-date resources available in the tabs below.


Healthcare providers or caregivers who have questions about symptoms they or their patients exhibit should call 1-844-542-8201, anytime.

Healthcare providers who need assistance assessing a patient with COVID-19 concerns may call 520-724-7797, anytime if the case meets specific guidelines

Members of the general public who have questions should call 2-1-1 from 8 a.m. to 8 p.m. or visit pima.gov/covid19 anytime.

Healthcare and response partner resource requests

PCHD is coordinating relief efforts to get healthcare and other response partners the supplies they need. Current stock is limited and requestors are encouraged to continue working with their commercial suppliers in addition to requesting support from PCHD.




Arizona clinicians are recommended to:

  • Mask and isolate suspected COVID-19 patients or other patients presenting with acute respiratory illness. Isolation should take place in a private room with the door closed.
  • Immediately notify your healthcare facility’s infection control personnel.
  • Healthcare personnel encountering a suspect patient should use standard precautions, contact precautions, droplet precautions, and use eye protection (e.g., goggles or a face shield).
  • Consider testing for seasonal respiratory illnesses, like influenza.

For all patients who meet COVID-19 PUI criteria:

  1. Healthcare personnel entering the room should use droplet, contact, and standard precautions, plus eye protection (e.g., goggles or a face shield) and patients can be evaluated in a private room with the door closed (unless performing aerosol-generating procedures, which should be performed in an AIIR);
  2. Immediately notify your healthcare facility’s infection control personnel;
  3. If you are seeking approval for COVID-19 testing through the ASPHL only - notify Pima County Health Department at 520-724-7797 during both business and after hours.
  4. Immediately call the Arizona COVID-19 Hotline (1-844-542-8201);
  5. Collect Nasopharyngeal (NP) swab for testing for COVID-19.

Health Department Guidance and Recommendations

ADDITIONAL RESOURCES

Healthcare providers caring for a patient with fever and/or acute respiratory symptoms should:

  • Consider ordering a respiratory viral panel to potentially identify other treatable diagnoses.
  • Obtain a detailed recent travel history from if COVID-19 is suspected.

For all patients who meet COVID-19 PUI criteria:

  • Healthcare personnel who enter the room should use droplet, contact, and standard precautions, plus eye protection (e.g., goggles or a face shield), and patients can be evaluated in a private room with the door closed (unless performing aerosol-generating procedures, which should be performed in a AIIR);
  • Immediately notify your healthcare facility's Infection Control Personnel
  • Immediately call the Arizona COVID-19 Hotline (1-844-542-8201);
  • Collect Nasopharyngeal (NP) swab for testing for COVID-19.

Commercial COVID-19 Testing

Private tests are available. Note that the specimens MUST be collected by a provider.

Personal Protective Equipment

Based on the available evidence, SARS-CoV-2, the virus that causes COVID-19 infection, is transmitted via respiratory droplets between people in close contact, and the risk of airborne transmission is low.

Due to this, ADHS now recommends that healthcare providers:

  • Use standard, contact, and droplet precautions with eye protection for suspect or confirmed COVID-19 cases.
  • Use gowns, gloves, respirators (such as N95 mask) and eye protection (goggles or face shield) when performing aerosol-generating procedures (e.g., tracheal intubation, non-invasive ventilation, tracheostomy, cardiopulmonary resuscitation, manual ventilation before intubation, bronchoscopy).
For more, visit the ADHS website.



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If there is not a clear emergency requiring emergency services, it is preferable to have the person pre-evaluated by public health officials in the location where they reside.

If possible, it may be preferable to arrange for private vehicle transport instead of using emergency medical services. Note: Local travel by private vehicle is only permissible if the symptomatic person is wearing a facemask. 

All EMS Partners should:

  • Use standard, contact, and droplet precautions with eye protection for suspect or confirmed COVID-19 cases. 
  • Use gowns, gloves, respirators (such as N95 mask) and eye protection (goggles or face shield) when performing aerosol-generating procedures (e.g., tracheal intubation, non-invasive ventilation, tracheostomy, cardiopulmonary resuscitation, manual ventilation before intubation, bronchoscopy). 
  • Due to the change in transmission-based precautions from airborne to droplet, it is not necessary to place a suspect patient in an airborne infection isolation room (AIIR). A private room with a closed-door is acceptable. Using an AIIR for aerosol-generating procedures is still recommended.
  • If a patient suspected to be exposed to COVID-19 is arriving via transport by emergency medical services (EMS), the ambulance attendant should contact the receiving emergency department (ED) or healthcare facility to allow the healthcare facility to prepare for receipt of the patient.

Patient Management Precautions:

  • When possible, mask patients as soon as possible if they report recent travel to areas with confirmed spread of COVID-19.
  • Ideally, patients should be evaluated in a private space with minimal contact with others.
  • Immediately notify your chain of command. Response agencies should notify the Health Department if they have a patient who reports travel to an affected area in the past 14 days AND is exhibiting symptoms like fever, cough, shortness of breath or difficulty breathing.
  • The number of EMS and hospital personnel should be limited to those providing essential care services to minimize potential exposures
More information from the CDC
Interim Healthcare Infection Prevention and Control Recommendations for Patients Under Investigation for 2019 Novel Coronavirus.

As additional information is available, the Department will post up-to-date resources from the CDC, ASPR, and NHTSA and on the EMS website.

Update for Elective Surgeries

In accordance with Executive Order 2020-32, dental facilities must request exemption from Executive Order 2020-10 and demonstrate they meet the following criteria in order to resume elective, non-essential surgeries on or after May 1, 2020:

  • Demonstrating greater than a 14 day supply of PPE.
  • Ensuring adequate staffing and beds.
  • Testing patients prior to surgery and all at-risk health care workers.
  • Ensuring a universal symptom screening process for staff, patients, and visitors.
  • Establishing an enhanced cleaning process for waiting areas.
  • Prioritizing the restart of elective surgeries based on urgency.

Arizona Department of Health Services has a FAQ regarding EO 2020-32.

Dental Care

The practice of dentistry involves the use of rotary dental and surgical instruments (e.g., handpieces or ultrasonic scalers) and air-water syringes. These instruments create a visible spray that contains large particle droplets of water, saliva, blood, microorganisms, and other debris. This spray travels only a short distance and settles out quickly, landing on the floor, nearby operatory surfaces, dental health care personnel (DHCP), or the patient. The spray also might contain certain aerosols.

Caring for patients requiring transmission-based precautions is not possible in most dental settings as they are not designed for or equipped to provide this standard of care (i.e. lack of airborne isolation rooms or single-patient rooms, and N95 respirators).

Because of this, Arizona Department of Health Services recommends the following:

  • Services should be limited to emergency visits only during this time. Postpone all elective procedures, surgeries, and non-urgent dental visits to help staff and patients stay safe, preserve personal protective equipment and patient care supplies, and expand available health system capacity.
  • Implement sick leave policies that are flexible, non-punitive, and consistent with public health guidance (e.g., allowing employees to stay home if they have symptoms of respiratory infection).
    • Staff that begin to develop symptoms while at work should immediately put on a facemask, notify a facility administrator, and self-isolate at home.
    • Facility administrators should implement a tracking system for clearing ill staff to return to work.
  • Telephone screen all patients in need of emergency dental care for symptoms of respiratory illness(e.g., fever, cough, shortness of breath). If the patient reports signs or symptoms of respiratory illness, avoid dental care. If possible, delay emergency dental care until the patient has recovered from the respiratory infection.
    • If they will receive care, patients should also be screened for fever and other respiratory symptoms upon check-in.
  • The waiting room should provide spacing for patients to sit at least six feet apart, or patients should be asked to wait in their car until they can be seen.
    • Items in waiting rooms such as magazines or toys should be removed at this time.
    • Respiratory hygiene supplies (e.g. tissues) should be available for patients.
  • People with respiratory symptoms should be deferred until they have cleared home isolation clearance.
  • The following home isolation guidance should be applied to patients and staff:
    • If individual has been tested for COVID-19 and is awaiting results, they should remain under home isolation precautions.
    • If individual has tested positive for COVID-19, they should remain under home isolation precautions for 7 days from specimen collection OR until 3 days (72 hours) after fever is gone and symptoms of acute infection resolve, whichever is longer.
    • If individual has tested negative for COVID-19 and has compatible symptoms (fever, cough, shortness of breath), they should stay home away from others until 3 days (72 hours) after all symptoms of acute infection resolve.
    • If individual has not been tested for COVID-19 and has compatible symptoms (fever, cough, shortness of breath), they should stay home away from others until 3 days (72 hours) after all symptoms of acute infection resolve.
  • For urgent clinical care of patients with known or suspected COVID-19, dental personnel and medical providers should work together to determine an appropriate facility for treatment and should follow the Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings. The urgency and need for a procedure are decisions based on clinical judgement and should be made on a case-by-case basis.
Additional Resources for Healthcare Providers:
Additional Resources for Patients:
For more information about monoclonal antibodies, visit the mAB page.

Frequently asked questions about monoclonal antibodies (mAB)

What are monoclonal antibodies?

According to the U.S. Food and Drug Administration (FDA) monoclonal antibodies (mABs) are laboratory-produced molecules that act as substitute antibodies that can restore, enhance or mimic the immune system's attack on cells. Monoclonal antibodies for SARS-CoV-2, the virus that causes COVID-19, may prevent it from attaching to human cells, making it more difficult for the COVID-19 to reproduce and cause harm. mABs also may neutralize a virus.

Bamlanivimab, casirivimab, and imdevimab are all monoclonal antibodies. According to the CDC, preliminary data suggest some outpatients at high risk for severe illness may benefit from receiving anti-SARS-CoV-2 mABs early in the course of infection.

The Health Department expects data on efficacy and best use of these drugs to evolve with expanded usage and ongoing clinical study.

Sources:
COVID-19 Frequently Asked Questions: What are Monoclonal Antibodies? FDA, 1/26/21.
Monoclonal Antibody Treatment: Frequently Asked Questions Minnesota Department of Health, 12/30/20.
Treatments Your Healthcare Provider Might Recommend if You Are Sick CDC, 12/8/20.

Which mABs have been approved?

In November 2020, the FDA issued an Emergency Use Authorization (EUA) for the use of the combination of casirivimab plus imdevimab for the treatment of mild to moderate COVID-19 in non-hospitalized patients at high risk of disease progression and severe illness.

The third SARS-CoV-2 neutralizing antibody, bamlanivimab, also received an EUA in November 2020 for treatment of mild to moderate COVID-19 for the same patient populations. 

Sources:
The COVID-19 Treatment Guidelines Panel’s Statement on the Emergency Use Authorization of the Casirivimab Plus Imdevimab Combination for the Treatment of COVID-19 NIH, 12/2/20.
The COVID-19 Treatment Guidelines Panel’s Statement on the Emergency Use Authorization of Bamlanivimab for the Treatment of COVID-19 NIH, 11/18/20.

Are mABs considered investigational?

Yes. Bamlanivimab, casirivimab, and imdevimab are all considered investigational drug products because studies continue for the uses authorized in the Emergency Use Authorization (EUA). They are not currently FDA-approved to treat any diseases or conditions, including COVID-19.

EUAs allow healthcare providers to use products that are not yet approved, or that are approved for other uses, to treat patients with COVID-19 if certain legal requirements are met.

Sources:
Treatments Your Healthcare Provider Might Recommend if You Are Sick CDC, 12/8/20.
Frequently Asked Questions on the Emergency Use Authorization of Casirivimab + Imdevimab FDA, 11/21/20.
Fact Sheet for Patients, Parents and Caregivers: Emergency Use Authorization (EUA) of Bamlanivimab for Coronavirus Disease 2019 (COVID-19) (PDF) FDA, 11/2020.

How and where are they administered?

These products are given as a single dose by intravenous infusion over a period of 1-2 hours. They must be administered in a facility with providers equipped to identify and manage anaphylaxis and infusion reactions.

Source:
Monoclonal Antibody Treatment: Frequently Asked Questions Minnesota Department of Health, 12/30/20.
An EUA for Bamlanivimab—A Monoclonal Antibody for COVID-19 JAMA, 12-11-20. 
The importance of early identification of infusion-related reactions to monoclonal antibodies Ther Clin Risk Manag., Aug 1, 2019. 

What side effects have been observed with mAB treatments?

The most commonly reported side effects in clinical trials with bamlanivimab were nausea, diarrhea, dizziness, headache, skin irritation, and vomiting. The most commonly reported side effects with casirivimab and imdevimab were pneumonia, hyperglycemia, nausea and vomiting. 

Providers must monitor for serious anaphylactic or hypersensitivity reactions during administration with any of these products. Signs of these reactions may include shortness of breath, wheezing, hives, itching, swelling of the lips, face or throat, dizziness, fever or chills. 

Sources:
Fact Sheet for Patients, Parents and Caregivers Emergency Use Authorization (EUA) of Casirivimab and Imdevimab for Coronavirus Disease 2019 (PDF) Regeneron Pharmaceuticals, 11-2020.
Fact Sheet for Health Care Providers Emergency Use Authorization (EUA) of Casirivimab and Imdevimab (PDF) Regeneron Pharmaceuticals, revised 12-2020.
Coronavirus (COVID-19) Update: FDA Authorizes Monoclonal Antibodies for Treatment of COVID-19 FDA, 11-21-20.
Frequently Asked Questions on the Emergency Use Authorization for Bamlanivimab (PDF) FDA, 11-19-20.
Fact Sheet for Patients, Parents and Caregivers Emergency Use Authorization (EUA) of Bamlanivimab for Coronavirus Disease 2019 (COVID-19) (PDF) Eli Lilly and Company, 11-2020.
What you need to know about bamlanivimab Patient guide (PDF) Eli Lilly and Company, 11-20-20.

If I was treated with monoclonal antibody therapy for COVID-19, should I get vaccinated?

COVID-19 reinfection appears uncommon in the first 90 days after illness. The CDC advises persons who have received monoclonal antibodies and convalescent plasma therapy wait to get vaccinated “for at least 90 days, as a precautionary measure until additional information becomes available, to avoid interference of the antibody treatment with vaccine-induced immune responses.

This recommendation may change as more is learned about COVID-19 and these therapies.

Source:
Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines Currently Authorized in the United States CDC, 1-21-21.

Are there any resources for sites administering mABs, including long-term care facilities?

The federal government has created a Monoclonal Antibody Playbook (PDF) to support sites interested in administration of mAB therapy. It addresses supplies and staffing needed, space requirements and the drug administration process. 

Lilly also created instructional videos demonstrating preparation and administration of bamlanivimab, and a patient counseling guide and a patient educational handout.

Sources:
OWS Therapeutics: Monoclonal Antibody Playbook (PDF) Operation Warp Speed, Department of Defense, Department of Health and Human Services, 12-19-20.
Lilly Bamlanivimab Antibody Playbook (PDF) Eli Lilly and Company, 12-2020.
Dosage and Administration Overview Eli Lilly and Company, 12-2020.
What to expect during a COVID-19 neutralizing antibody treatment infusion (PDF) Eli Lilly and Company, 12-2020.