JIC RELEASE NO. 456 - DPHSS Issues Guidance Memo 2020-43; DPHSS Launches Guam Respond System to Monitor Confirmed Cases and Close Contacts

For information on COVID-19 cases, visit the official COVID-19 Situation Report and Dashboard at http://dphss.guam.gov/covid-19/.

DPHSS Issues Guidance Memo 2020-43
The purpose of this Guidance Memo is to advise the medical community on the actions to take if their patient tests positive for COVID-19 or the patient becomes exposed to an individual with COVID-19. This guidance is in accordance with the recommendations of the U.S. Centers for Disease Control and Prevention (CDC). 
 

 

A. Definitions used in this guidance memorandum:

1. “Close Contact” is someone who was within 6 feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period starting from 2 days before illness onset (or, for asymptomatic patients, 2 days prior to test specimen collection) until the time the patient is isolated.

2. “Contact of a Close Contact” is an individual who was exposed to a person who was in close contact to a person who was positive for COVID -19.  (e.g. spouse, children, parents, coworkers, friends) 

3. “Exposure” is having come into contact with a person who is COVID-19 positive.  

4. “Isolation” is the separation of a person or group of people known or reasonably believed to be infected with COVID-19 and potentially infectious from those who are not infected to prevent spread of COVID-19. (Person who is COVID-19 positive is placed in isolation).  

5. “Quarantine” is the separation of a person or group of people reasonably believed to have been exposed to a COVID-19 positive individual but not yet symptomatic from others who have not been so exposed to prevent the possible spread of COVID-19. (Person who is negative but was in close contact to a person who is COVID-19 positive is quarantined.).

 

B. Addressing Sick Patients

1. An individual who is sick, should be advised to: 

   1. Stay home

   2. Not leave the house, except to get medical care.  Call ahead before visiting the clinic/doctor.

   3. Not visit public areas.

   4. Monitor for symptoms including fever, cough, and shortness of breath, fatigue, body aches, headaches, loss of taste or small, sore throat, congestion, nausea and diarrhea.

   5. Look for emergency warning signs for COVID-19 and seek emergency medical care immediately or call “911’:

      1. Trouble-breathing

      2. Persistent pain or pressure in the chest 

      3. New confusion 

      4. Inability to wake or stay awake 

      5. Bluish lips or face

 

C. When to Test Patients for COVID-19

1. On average, symptoms of the virus develop five to six days post exposure but the incubation period can be as long as 14 days. 

2. The best time to test for COVID-19 is 5-7 days after a probable exposure.

 

D. Instructions to Give for Patients Who Get Tested 

1. While waiting for their test result, the patient should be advised to self-quarantine at home, stay away from others and to monitor for symptoms of COVID-19.

2. Advise patient to not go to public places.

 

E. The Investigation Unit 

1. Calls the patient and finds out names of close and household contacts.

2. Calls close contacts and schedules them for testing at Northern Region Community Health Center (NRCHC).

3. Quarantine Unit is called and close and household contacts are placed in home quarantine and monitored daily for the next 14 days.  

4. Once the patient meets the criteria to release from quarantine, they will be given a clearance from Public Health.

5. If any of the contacts turn positive, they may either be moved to the government isolation facility or do home isolation.  

 

F. When a Patient Tests Positive for COVID-19

1. The patient must isolate at home or at the government isolation facility for at least 10 days. DPHSS will conduct a home assessment to make the determination

2. Self-isolation

   1. Eat in separate room or area

   2. Wash dishes and utensils using gloves and hot water

   3. Avoid sharing personal items – dishes, cups/glasses, silverware, towels, bedding or electronics (e.g. cell phone)

   4. Wear masks

   5. Wash hands often (soap and water or hand sanitizer)

   6. Avoid touching eyes, nose or mouth with unwashed hands

   7. Clean and disinfect “high touch” surfaces and items every day (tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks, electronics)

   8. Clean the area or item with soap and water if it is dirty then use a household disinfectant.

   9. Use separate bedroom

   10. Use trash liners in trash can

   11. Use separate bathroom.  If sharing a bathroom, the person who is sick should clean and disinfect after each use.

3. If the patient is symptomatic, they can leave isolation after:  

   1. 10 days since symptoms first started, and

   2. 24 hours with no fever without the use of fever-reducing medications, and

   3. Other symptoms of COVID-19 are improving

4. If the employee is asymptomatic, they can leave isolation after 10 days have passed since testing positive for COVID-19.

5. If the patient was monitored by DPHSS staff, a discharge clearance letter will be issued to the patient when cleared.

6. If symptoms worsen while in isolation or become moderate/severe, such as shortness of breath or severe fatigue, patient needs to contact healthcare provider immediately, seek emergency care, or call 911.

7. People who have tested positive for COVID-19 do not need to quarantine or get tested again for up to 3 months as long as they do not develop symptoms again. People who develop symptoms again within 3 months of their first bout of COVID-19 may need to be tested again if there is no other cause identified for their symptoms.

 

G. A Patient who is a “Close Contact” 

1. Needs to take a test.

2. Needs to quarantine at home for 14 days even if they test negative for COVID-19 or feel healthy.

3. Symptoms may appear 2-14 days after exposure to the virus.

 

H. A Patient who is a “Contact to a Close Contact”

1. Are at low risk of getting COVID-19. 

2. Does not have to quarantine

DPHSS Launches Guam Respond System to Monitor Confirmed Cases and Close Contacts
The Department of Public Health and Social Services (DPHSS) announces the launch of an additional automated tool to respond to the COVID-19 pandemic. In addition to the Guam COVID Alert and Sara AlertTM, the Guam Respond tool provides public health officials with accurate and timely data and workflows to manage case investigations and contact tracing. The tool is used for people who are in home quarantine or who have laboratory confirmed test results of COVID-19.

The Guam Respond is an integrated solution that uses an enhanced version of the Sara AlertTM software developed by MITRE. This free tool uses advanced symptom monitoring and contact tracing through public engagement. DPHSS enrolls confirmed cases and close contacts into the Guam Respond system to conduct exposure monitoring for close contacts, and isolation monitoring for confirmed cases.

Individuals can update DPHSS on their health status on a daily basis during the period of time they are participating in public health monitoring. Those being monitored may either respond by SMS text messaging, email, or by phone call. If DPHSS does not hear back from the monitorees, DPHSS will call those individuals.

The Guam Respond system does not collect or ask for other personal identifying information like social security numbers, bank account numbers or other financial information. This enhanced version of Sara AlertTM is already in use in several other states and territories.

Click Here to view DPHSS Guidance Memo 2020-43 Guidance for Medical Providers when patients test positive (11-19-20)