Definition of Symptoms and COVID Suspected Patients

COVID Symptoms	Concerning Symptoms	Sustained cough Shortness of breath Difficulty breathing Loss of taste or smell
	Symptom Categories non-specific to COVID	Fever Fatigue Chills/rigors Headache Myalgia Sore throat Congestion/rhinorrhea Nausea Vomiting/diarrhea
COVID Suspected	≥ 1 Concerning Symptom or ≥ 2 Non-specific Symptom Category Without evidence of another explanatory non-respiratory or viral illness Examples: Cellulitis, classic Hand-foot-mouth, GAS pharyngitis, UTI Exceptions: Bronchiolitis, pneumonia

Exposure

Full Exposure Definition with Examples Prolonged (> 15 minutes), close (< 6 feet) contact with a person who is COVID-positive Spent 15 cumulative minutes close (< 6 feet) contact with a person who is COVID-positive

PPE Recommendations and Isolation and Don Personal Protective Equipment (PPE) Video

Asymptomatic, Non-specific symptoms	Standard Precautions Surgical Mask + Eye Protection + Hand Hygiene Don gloves when exposed to body fluid	Routine Care Process
Suspected COVID Concerning Symptoms or Exposed	Modified Expanded Hand Hygiene Gown + Gloves + Surgical Mask + Eye Protection	Expedite to Exam Room. Door closed. Use negative pressure as available. Buerger neg pressure rooms remain closed 30 minutes after AGP. Clean room with hospital-approved disinfectant while still in PPE. All other locations: Close room for 1 hour if AGP performed, such as nebulization treatment, Clean room with hospital-approved disinfectant while still in PPE.
Aerosol Generating Procedure (AGP) and Suspected COVID or Exposed	Expanded Precautions Hand Hygiene Gown + Gloves + N95 Mask + Eye Protection Aerosolized Generating Procedures

Testing Considerations for Patients with Expected Discharge
Assess Symptoms	Type of Test Recommended
Symptoms Present	COVID Antigen Test Positive Rapid Test: Assume COVID diagnosis Negative Rapid Test: Assume no COVID infection unless: Symptoms + known exposure Loss of taste or smell During Influenza season as indicated send: Consider Rapid Flu Test Influenza Pathway   Testing Guidance – Rapid COVID-19 Platforms in Outpatient Specialty Care and Primary Care Settings
No Symptoms; Regardless of Exposure status; Able to Mask	No Testing   Consider if returning to residential or other congregate living settings
No Symptoms and Exposed And Unable to Mask	Consider PCR or Antigen Test Day no earlier than 5 days post exposure to support return to school unmasked   Consider if returning to residential or other congregate living settings
Hospital admission, procedure, AGP scheduled within the next 72 hours	PCR or other CHOP approved Test required

Exposed And NO Symptoms

No quarantine if: Age ≥ 18 yrs, received all recommended vaccines     OR Age 5 - 17 yrs, completed primary vaccine series   OR Any age, Confirmed COVID within the last 90 days   Wear a mask for 10 days from the date of last contact Consider test 5 days after last contact, pending test availability If develop symptoms or have a positive test, follow isolation guidance   Quarantine is needed for the following people: Age ≥ 18 yrs, who have not received all recommended vaccines   Received single dose Johnson & Johnson over 2 months ago, and no booster Anyone not vaccinated or not completed primary series   Wear a mask and stay home for 5 days after last contact with COVID + person and monitor symptoms If symptoms develop, get tested and isolate pending test results If no symptoms develop, can leave the house and return to school / daycare and continue to wear a mask for 5 days Consider test 5 days after last contact, pending test availability If develop symptoms or have a positive test, follow isolation guidance   Unable to wear mask Assess ability for all child under 5 to wear a mask; if able follow above guidance If unable, child must stay home 10 days after exposure, or 7 days with a negative test at day 5 or later  If develops symptoms, follow isolation guidance

COVID Positive Test or Clinical diagnosis of COVID

Isolate Regardless of vaccination, stay home for 5 days Day 0 is 1st day of symptoms, if no symptoms day of + test   If symptoms are significantly improved after 5 days of isolation, with no fever for 24 hours, child can leave the house and return to school and continue to wear a mask for 5 days No additional testing is required for return to school / daycare   Unable to wear mask Assess ability for all children under 5 to wear a mask; if able follow above guidance If unable child must stay home 10 days for positive test result