The Los Angeles County Department of Public Health (LAC DPH) issued a health advisory on March 4, 2020 regarding N95 respirators and the limited supply of SARS-CoV-2 testing. It also includes updated guidance for providers that supercedes those outlined in the February 29 advisory.
The COVID-19 disease situation is evolving in the United States with more cases being identified and reported each day. LAC DPH has recently confirmed 6 new cases of COVID-19 bringing the total to 7 confirmed cases to date in Los Angeles County.
All of the new cases have known or likely sources of exposure and none provide direct evidence of community transmission. None of these cases were linked to the first case reported in a non-resident traveler in January.
There is a very limited supply of SARS-CoV-2 testing available to L.A. County at this time. Until testing is more widely available, testing must be reserved for patients with severe illness and the close contacts of confirmed cases of coronavirus disease 2019 (COVID-19).
This notification is to provide health care providers and facilities with information on maintaining supplies of N95 respirators as well as guidance on the current management of patients with mild illness who do not meet the current criteria for SARS-CoV-2 testing.
NOTE: In anticipation of increased diagnostic testing at clinical laboratories, the Centers for Disease Control and Prevention (CDC) has removed the criteria for testing and suggested expanding testing to a wider group of symptomatic patients.
Please be aware that this is currently not feasible at the local level. In L.A. County, the only COVID-19 testing is through the LAC DPH Public Health Lab that has limited testing capacity. Public Health is aware that increased testing is needed by the medical community, is seeking to expand local testing capacity, and will provide updated information to healthcare providers as this becomes available in the future.
The Los Angeles County Department of Public Health (LAC DPH) is authorizing the adoption of the CDC contingency capacity strategies for healthcare facilities experiencing critical shortages of N95 respirators.
LAC DPH has created guidance to allow for the use of N95 respirators beyond their manufacturer-designated shelf life and the limited reuse and extended use of N95 respirators to help with increased demands and decreased supplies.
Healthcare providers should contact LAC DPH to arrange for SARS-CoV-2 testing for any patients that meet the current LAC DPH COVID-19 Evaluation Criteria outlined in the February 29 LAHAN and included below.
Due to the very limited supply of SARS-CoV-2 testing available to L.A. County at this time, testing is being restricted for use in patients with severe illness and those who are known close contacts to confirmed cases.
Patients with mild illness who do not meet the current LAC DPH COVID-19 Evaluation Criteria should be instructed to follow home care instructions and do not need to be reported to LAC DPH. Healthcare facilities and clinics are strongly encouraged to communicate with patients, staff, and visitors about the importance of staying home when they have mild cold or flu-like symptoms.
Actions Requested of Providers
Screen patients for any signs or symptoms of febrile respiratory illness. If present, healthcare workers should don surgical masks. The patient should be instructed to wear a surgical mask and be placed in a private room with the door closed or separated from others by at least 6 feet.
Assess if the patient meets criteria for testing using the LAC DPH Provider Checklist: Evaluating Patients Who May Have COVID-19. If the patient meets criteria, follow the guidance on additional infection control procedures and contact LAC DPH to approve specimen collection for SARS-CoV-2 testing.
Manage patients with mild illness at home according to their clinical status. Due to the limited availability of SARS-CoV-2 testing at this time, patients with mild presentations who do not meet the LAC DPH COVID-19 Evaluation Criteria are not eligible to receive SARS-CoV-2 testing and do not need to be reported to DPH. Supportive care is recommended. Instruct patients to follow home care instructions including:
- Stay home for at least 24 hours after the resolution of febrile illness without the use of fever-reducing medicines.
- Phone their provider if symptoms worsen.
Please visit the Los Angeles County Health Alert Network (LAHAN) to see the latest updates, and to view the full LAC DPH Health Advisory: COVID-19 Guidance-Optimizing N95 Supplies and Managing Mild Illness. The full health advisory includes actions recommended for health care systems and clinics, as well as additional details on N95 respirators and clinical presentation.
LAC DPH COVID-19 Evaluation Criteria
Clinical Features: Fever or signs/symptoms of lower respiratory illness (e.g. cough, shortness of breath) AND Epidemiologic Risk Factors: Any person (including health care workers) who in the last 14 days before symptom onset has had close contact with a laboratory-confirmed COVID-19 patient
Clinical Features: Fever and signs/symptoms of a community-acquired lower respiratory illness (e.g. cough or shortness of breath) requiring hospitalization AND Epidemiologic Risk Factors: A history of travel from affected geographic areas* in the last 14 days before symptom onset
Clinical Features: Fever with severe acute community acquired lower respiratory illness (e.g. pneumonia, ARDS) requiring ICU care without alternative explanatory diagnosis. (Must have negative rapid influenza/ RSV tests; and a negative molecular respiratory panel if this testing is available at the facility) AND Epidemiologic Risk Factors: No source of exposure has been identified
*Affected Geographic Areas with Widespread or Sustained Community Transmission: China, Iran, Italy, Japan, South Korea. Last updated February 28, 2020
CDC defines affected areas as geographic regions where sustained community transmission has been identified. Relevant affected areas will be defined as a country with at least a CDC Level 2 Travel Health Notice. See all COVID-19 Travel Health Notices.
Patients not meeting COVID-19 evaluation criteria do not need to be reported.
Los Angeles County DPH Acute Communicable Disease Control:
- Call 220.127.116.1141 on weekdays from 8:30 a.m. to 5:00 p.m.
- For after-hours, call 1.213.974.1234 and ask for the physician on call.
Long Beach Health and Human Services:
- Call 1.562.570.4302 on weekdays from 8:00 a.m. to 5:00 p.m.
- For after-hours, call the Duty Officer at 1.562.500.5537.
Pasadena Public Health Department:
- Call 1.626.744.6089 on weekdays from 8:00 a.m. to 5:00 p.m. (note: closed every other Friday)
- For after-hours, call 1.626.744.6043.
Keep up to date by visiting the LAC DPH Coronavirus Webpage for Health Professionals.