Outpatient Specialty Care and Primary Care Clinical Pathway for Screening Children with Suspected 2019 Novel Coronavirus (COVID-19) Disease

Evaluation and Testing Guidance for Possible COVID-19 Disease
Outpatient Specialty Care and Primary Care Settings
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
  • 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
Clinical Evaluation
  • Ensure family, patient have appropriate masks
  • Review visitation job aid and sibling escalation pathway if more than one caregiver is present with patient
  • Patients, family members remain masked throughout care except for PE as needed
PPE Recommendations and Isolation and Don Personal Protective Equipment (PPE) Video
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
  • 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
Testing Considerations for Patients Stable for Care at Home
Indications for Testing Test Selection, Interpretation

  • Influenza-like Illness (ILI)
    • Fever > 100.4°F and cough and/or sore throat
  • During influenza season
  • Use Rapid Test as available
  • POSITIVE Rapid Test: Assume COVID diagnosis
  • NEGATIVE Rapid Test: Assume no COVID infection unless any of the following 3 exceptions are present. If any present, confirm results with PCR test.
    • Exceptions:
      • Any CONCERNING symptom present
      • Documented exposure history, by exposure definition above
      • Lives in a potential high-risk situation
        e.g. Immunocompromised family member
  • Testing Guidance – Rapid COVID-19 Platforms in Outpatient Specialty Care and Primary Care Settings
Indications for Testing Test Selection, Interpretation
  • Results are needed for contact tracing of exposed patient
  • Exposed patients can be tested on or after day 5-7 and end isolation if negative
  • Required for admission to another facility such as shelters or residential facilities
  • PCR Test
  • Rapid Antigen or PCR tests may be used at or after day 7.
  • If a test is requested on day 5 or 6, it MAY be performed, but should be a PCR only.
  • Quarantine must continue to day 7 in all circumstances.
  • PCR Test required
PCR test required
Clearance of Transmission-Based Precautions
Asymptomatic/SARS-CoV-2 positive At least 10 days have passed since the date of the first positive test
Symptomatic/SARS-CoV-2 Positive or Suspected
  • At least 10 days has passed since symptoms first appeared and
  • At least 24 hours have passed since last fever w/o use of fever medications and
  • Symptoms are improved
No Symptoms and Exposed
  • Exposed patients quarantine for 10 days after last exposure as long as they
    remain asymptomatic
  • This can be reduced to 7 days if they test negative day 7 and remain asymptomatic
  • All patients, regardless of initial clearance date, should monitor for symptoms for 14 days
No symptoms, Vaccinated and Exposure
  • Vaccinated persons with exposure to suspected/confirmed COVID-19 do not need to quarantine if they:
    • Are 2 weeks past their full vaccination series
    • Are within 3 months following the last dose in the series
    • Have remained asymptomatic since their COVID-19 exposure
  • This is true for household exposures
Stable for Outpatient Treatment
Transfer for Continued Evaluation
Treatment is Required
  • Transfer to appropriate hospital
  • Pre-notification if known COVID-19
Posted: January 2020
Revised: February 2020, March 2020, April 2020, May 2020, June 2020, July 2020, September 2020, October 2020,
November 2020, December 2020, January 2021, February 2021, March 2021, April 2021
Authors: K. Cohn, MD; L. Handy, MD; J. Sammons, MD; V. Kampalath MD; J. Lavelle MD