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
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
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
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
Testing Considerations for Patients with Expected Discharge
Assess Symptoms Type of Test Recommended
Symptoms Present
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
  • Note:
  • Children with severe COVID infection or those with weakened immune systems may require longer periods of isolation of 10-20 days, parents and patients should discuss with their individual provider.
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
Stable for Outpatient Treatment
Transfer for Continued Evaluation
Treatment is Required
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, June 2021, August 2021,
September, 2021
Authors: K. Cohn, MD; L. Handy, MD; J. Sammons, MD; V. Kampalath MD; J. Lavelle MD