Bureau of Communicable Diseases, April 7, 2020
- The Department of Health Services (DHS) has issued a new memo making COVID-19 related hospitalizations and deaths reportable.
- The memo reiterates that as a Category I Reportable Condition, all cases of COVID-19 are reportable to DHS. This includes patients diagnosed based on clinical grounds who are not tested for the disease and who may be classified as suspect or probable cases.
- COVID-19 testing capacity continues to increase in Wisconsin. Clinicians may order COVID-19 testing for any patient for whom diagnosis will inform the care of the patient, without prior approval. A revised Patient Information Form has been developed to clarify scenarios in which testing can be ordered at public health laboratories. Tests for all other patients may be sent to any laboratory able to perform COVID-19 testing.
Dear Colleagues,
During the first week of April, the number of new cases of COVID-19 continues to increase in Wisconsin. As of 4/6/2020, a total of 2,440 individuals have tested positive for the disease, and 77 Wisconsinites have died. Between 1,500 and 2,000 tests for COVID-19 have been conducted each day in the past week. Between 150-200 new diagnoses per day are reported to DHS, for an overall positivity rate of about 10% of tests.
The recent increase in COVID-19 cases in Wisconsin has not followed the exponential growth trajectory observed in other areas of the country. This is encouraging news that suggests the effectiveness of social distancing measures being taken across the state and supports the need to continue with these efforts. However, the State Emergency Operations Center continues to actively monitor health system capacity in preparation for a possible surge of cases in the coming weeks. Accurate and timely surveillance of the system capacity and the burden of illness are needed when making decisions about resource allocation and mitigation steps.
Reporting and data needs
A critical data need for monitoring health system capacity is a real-time assessment of acute care hospital beds, ICU and ventilator capacity, as well as PPE. Hospitals began supplying this information to DHS on a daily basis using the EMResource system and their efforts to keep this information up-to-date will be critical as decisions are being made related to surge capacity and response.
Critical to the outbreak response having is accurate COVID-19 related morbidity and mortality data. The Department of Health Services (DHS) issued a memo on April 6, 2020 making COVID-19 related hospitalizations and deaths reportable in Wisconsin and reiterating the need to report all cases of COVID-19, including for patients who will not be tested. This decision was made due to a significant gap in availability of hospitalization and death data and a recognition that many patients will not be tested given the current limitations.
- Hospitalization status now must be reported along with COVID-19 test results, including whether patients are hospitalized at the time of diagnosis, and incident hospitalizations among patients previously diagnosed in the outpatient setting.
- Deaths due to COVID-19 must be reported within 24 hours of the time of death. COVID-19-related deaths should be reported to local health departments by telephone, fax, or WEDSS web report, similar to notification for other reportable conditions.
Recognizing the reporting burden created by COVID-19, DHS is no longer requiring that COVID-19 cases be reported to public health by telephone, which is the standard expected for other Category I Reportable Conditions. During this public health emergency, acceptable methods for reporting cases and hospitalizations include:
- Entering a new case in WEDSS at the time the patient is tested for or diagnosed (without testing) with COVID-19.
- Entering a new case in WEDSS when a patient who previously was reported with COVID-19 as an outpatient becomes admitted to an inpatient facility.
- Faxing a completed Patient Information Form at the time a patient is tested for COVID-19 to the patient’s local health department.
- Faxing a completed Patient Information Form at the time a patient is diagnosed with COVID-19 to the patient’s local health department, even if the patient will not be tested.
- Faxing information about cases using an Acute and Communicable Disease Case Report (F44151) to the patient’s local health department.
Testing
Guidance to clinicians about testing priorities and test availability continues to evolve. DHS recommends that clinicians reference CDC’s Evaluating and Testing Persons for Coronavirus Disease 2019 (COVID-19) webpage and use the CDC Priorities for Testing Patients with Suspected COVID-19 Infection for overall guidance about which patients to consider for testing. The CDC guidance depends on clinicians to use their judgment about whom to test, and also recognizes that local testing practices must vary based on resource limitations.
While availability has expanded in recent weeks and is anticipated to continue to improve, both nationally and within Wisconsin shortages of supplies and access to testing is still a reality. Because of this, Wisconsin’s two public health labs testing for COVID-19, the Wisconsin State Laboratory of Hygiene (WSLH) and Milwaukee Health Department Laboratory (MHDL), have worked with DHS to develop a priority list for public health lab testing for COVID-19.
In order to conserve supplies for testing in the public health labs, WSLH and MHDL are prioritizing testing to include samples for the following patients:
- Hospitalized patients with COVID-19 symptoms
- Patients with COVID-19 symptoms for whom rapid diagnosis is needed to inform infection control practices (e.g., labor and delivery, dialysis, aerosol-generating procedures, etc.)
- Residents of a long-term care facility with COVID-19 symptoms
- Residents in a jail, prison, or other congregate setting with COVID-19 symptoms
- Health care workers or first responders (e.g., fire, EMS, police) with COVID-19 symptoms
- Essential staff in high-consequence congregate settings (e.g., prisons or jails) with COVID-19 symptoms
Providers may send specimens to WSLH or MHDL only if they meet Wisconsin public health laboratory testing priorities listed above. If equivalent or more rapid turnaround is available through an in-house or commercial lab, providers are encouraged to use these other laboratory options to help maintain availability of testing in the public health laboratories.
The Wisconsin Patient Information Form replaced the CDC PUI form and MUST accompany the lab requisition form for specimens submitted to WSLH or MHDL. Please check with other laboratories to make sure submission requirements are met.
Testing for patients who do not meet one of the Wisconsin public health laboratory priorities listed above, but for whom testing is requested by a provider, should have their specimen submitted to in-house or commercial labs for testing.
Wisconsin DHS and CDC continue to recommend not testing asymptomatic individuals for COVID-19 who may have been exposed to the disease. Individuals with possible exposure should be recommended to self-quarantine and monitor their symptoms. COVID-19 testing should only be used for making a diagnosis in patients with a clinical syndrome suggestive of the disease.
Thank you for your collaboration and support during these challenging times.
Sincerely,
Ryan Westergaard, MD, PhD, MPH
Chief Medical Officer and State Epidemiologist for Communicable Diseases
Wisconsin Department of Health Services
About the COVID-19 Health Alert Network
The content of this message is intended for public health and health care personnel and response partners who have a need to know the information to perform their duties. The HAN will be the primary method for sharing time-sensitive public health information with clinical partners during the COVID-19 response. Health care providers and other officials can subscribe and unsubscribe using their preferred email address at the DHS COVID-19 website.
