COVID-19 FAQs for Medication Assisted Treatment Providers

Updated 1/13/22

General Information

What recommendations can I give patients to protect themselves and their family?

You can prevent infection by doing the following:

• Encourage a COVID-19 vaccine for your patients and their family members
• Wear a mask while indoors
• Practice social distancing by keeping at least 6 feet between you and others
• Stay home when you are sick
• Avoid close contact with people who are sick
• Avoid crowds and poorly ventilated spaces
• Avoid touching your eyes, nose, and mouth
• Wash your hands often with soap and water
• Cover your cough or sneeze
• Clean and disinfect frequently touched objects and surfaces
• Don’t share drinking cups or utensils with other people
• A list of products approved to kill coronavirus can be found HERE

How soon after exposure do symptoms start?

In general, symptoms appear 2 – 14 days after exposure.

What can I tell my patients about the COVID-19 vaccines?

At this time, there are three vaccines for COVID-19 in the United States:

1. Comirnaty/Pfizer
   1. Two-dose vaccine given 21 days apart
   2. Fully approved for use in individuals 16 and older, under Emergency Use Authorization (EUA) for use in individuals 12 to 15
2. Moderna
   1. Two-dose vaccine given 28 days apart
   2. Under EUA for use in individuals 18 and older
3. Johnson and Johnson (J&)
   1. One-dose vaccine
   2. Under EUA for use in individuals 18 and older

For more information on the COVID-19 vaccines, visit www.sedgwickcounty.org/covid-19/vaccine/

Where can my patients find a COVID-19 vaccine clinic near them?

Have them visit www.sedgwickcounty.org/covid-19/vaccine/clinic-locations/ or www.vaccines.gov

Is there a treatment?

The U.S. Food and Drug Administration (FDA) has approved one drug, Remdesivir, to treat COVID-19 in certain situations. Most people with mild coronavirus illness will recover on their own by drinking plenty of fluids, resting, and taking pain and fever medications. However, some people have developed pneumonia and require medical care or hospitalization.

Guidance Specific to Opioid Treatment Programs:

Infection Control and Social Distancing

Ask patients who have symptoms, are quarantined, or diagnosed with COVID-19 to call the program so the opioid treatment program can plan accordingly.

What can opioid treatment programs do to assist with social distancing?

Consider ways to limit close contact of both patients and staff. Close contact is defined as being within 6 feet of another person for 10 or more minutes.

• Limit staff and client interactions using
  • glass windows
  • tele-communications devices within that same facility
  • telehealth if appropriate
• Maximize Take Home Doses
  • SAMSHA exemption allows for up to 28 days of take home medication for patients who are stable and up to 14 days for those who are less stable but whom the program believes can safely handle this level of medication.
  • Allow all patients with “earned take-homes” to use them. While it can be an incentive to draw patients to attend counseling, please reduce patient appearance at the clinic as much as possible by maximizing take-home doses at the prescriber’s discretion.
    • When possible, please include the “earned time” at other opioid treatment programs, providing there is clear and consistent documentation that the patient met the requirements of that program.
• Consider expanding hours to reducing waiting room congestion and lines.

Can programs dose someone in a separate room if they present with a fever or cough?

Yes. Develop procedures for staff to take patients who present with respiratory symptoms such as fever and cough to a location other than the general dispensary or lobby, to dose patients in closed rooms as needed. Provide masks for patients with symptoms. Follow CDC guidelines for infection control in a healthcare setting.

Can existing patients be seen through telehealth?

Yes.

What SUD services by billing code are approved by KDHE for telephonic delivery in the home for KanCare SUD, Kansas Block Grant, and DUI providers?

SUD Providers: H0001, H0004, H0005 U5, H0006 U5, H0015 U5, H0038, H0038 HQ

Kansas Block Grant and DUI Providers: H0001 GT, H0004 GT, H0005 U5/GT, H0006 U5/GT, H0006 U5/HV/GT, H0007 GT, H0015 U5, H0015 U5/HA, H0038 GT/HF Individual, H0038 GT/HQ/HF Group.

Can opioid treatment programs provide take-home doses of prescriptions to stable patients?

Yes, SAMHSA has issued a blanket exemption to states that allow for up to 28 days of take home medication for patients who are stable and up to 14 days for those who are less stable but whom the program believes can safely handle this level of medication.

By regulation (42 CFR Section 8.12(i)(2)), the medical director shall make treatment program decisions on dispensing opioid treatment medications to patients for unsupervised use. An exemption request to SAMSHA will be needed if another physician takes responsibility for making decisions regarding unsupervised take home medication orders or dosing changes.

What if I cannot obtain written consent to disclose information because I am seeing a patient through telephone or telehealth technology?

KDADS has release guidance for SUD providers stating verbal consent obtained over the phone or the internet will be acceptable in place of signed consent where normally required.

42 CFR part 2 allows for a disclosure without consent to the extent necessary to meet a bona fide medical emergency in which a patient’s prior informed consent could not be obtained. Such disclosures must be documented the patient’s record. Providers determine whether a bona fide medical emergency exists for purposes of providing needed treatment to patients.

Can a new patient be admitted to an Opioid Treatment Program using telehealth?

• Yes, if patient is treated with buprenorphine and an adequate evaluation can be accomplished via telehealth as supervised by the program physician.
• No, if patient is treated with methadone since patients would likely be taking a sub-therapeutic dose for an extended period.

What should an opioid treatment program do if a patent is under quarantine or isolation with the coronavirus?

1. Document that the patient is medically ordered to be under isolation or quarantine. When possible, confirm source of information. The Sedgwick County Health Department can be reached at 316-660-7300.
2. Identify a trustworthy, patient-designated, uninfected member of the household to deliver the medications using the OTP’s established chain of custody protocol for take home medication. OTPs should obtain documentation now as to who is designated permission to pick up medication for each patient.
3. If a trustworthy member of the household is unavailable, then the OTP should prepare a “doorstep” delivery of take home medications. Any medication taken out of the OTP must be in an approved lock box. Contact the Kansas Opioid Treatment Authority (785-296-4079) to learn more about approved lock boxes. Contact the Medical Society at 316-683-7557 if you need assistance obtaining supplies due to shortages.

The OTP should always communicate with the patient prior to delivery to reduce risk of diversion. This may involve, but is not limited to: 

1. Call placed to the patient prior to staff departure to deliver the medication ensuring that the patient or their approved designee (who must be a member of the patient’s household) is available to receive the medication at the address provided by the patient and recorded in the patient’s OTP medical record.
2. Upon arrival, medication is delivered to the patient’s residence door and another call is made to the patient/designee notifying that the medications are at the door.
3. The OTP staff is to retreat a minimum of 6 feet to observe that the medications are picked up by the patient or the designated person to receive the medications. The OTP staff person must ask the person who is retrieving the medication to identify themselves. Staff should determine that the person appearing to retrieve the medication is the patient or the household member named by the patient as having permission to do so. The OTP staff who deliver the medication shall remain until they have observe the retrieval of the medication by the patient or household member, and then document confirmation that medications were received by the patient or household member identified as permitted to pick up the medication.
4. Do not leave medication in an unsecured area. OTP staff must remain with the medication until the patient or designated household member arrives and retrieves the medication.
5. If the person who is to receive the medication is not at the designated location, an attempt should be made to reach that person. If the person does not arrive in a reasonable period of time, then the staff person must bring the medication back to the OTP where it will be stored in the pharmacy area until a determination is made whether another attempt will be made. Any medication returned to the OTP must be logged in. The medication delivery and pick up by the patient or designated household member, or return of medications to the OTP, must be documented in the patient’s OTP record and appropriate pharmacy records.

Business Continuity Planning

Opioid treatment programs (OTP’s) are an essential service. Programs should be prepared for staffing shortages as more people become sick and to provide more services should the capacity of other opioid treatment programs decrease.

If the supervising provider becomes sick or can otherwise no longer provide supervision, can mid-level practitioners continue to dispense and administer opioid agonist medications?

Yes, as long as the mid-level provider is a pharmacist, registered nurse, licensed practical nurse, or any other healthcare professional authorized by Federal and State law to administer or dispense opioid drugs; however, the mid-level provider would be acting as an “agent” of the supervising provider. The supervising provider would still assume responsibility for administering all medical services performed by the opioid treatment program.

May an OTP request an exemption to allow mid-level practitioners to perform functions that are required to be performed by an OTP physician or the medical director (under 42 C.F.R. § 8.12) in the event the medical director or physician cannot perform the regulatory functions?

Yes, an OTP may request an exemption from the requirements of 42 CFR § 8.12 in order to have midlevel providers perform functions related to admitting patients, ordering unsupervised take home medication, or changing medication doses during the COVID-19 emergency if consistent with applicable state law and the midlevel provider’s scope of licensure. 

If the OTP has received an exemption from SAMHSA for a mid-level practitioner to perform designated functions of the medical director from SAMHSA and subsequently that mid-level practitioner becomes unavailable, does the OTP need to submit another exemption request identifying the new midlevel by name?

No, if the mid-level exemption request has been approved, but the mid-level practitioner is no longer able to perform the designated duties, for instance due to illness, the OTP is not required to submit another request identifying the new mid-level practitioner. Program sponsors should contact SAMHSA’s Division of Pharmacological Therapies (DPT) in order to request OTP extranet system access for a provider.

When should staff return to work?

Please follow the guidance for healthcare workers located, here.

What else should my opioid treatment program be doing for our response to COVID-19?

• Contact the Kansas Opioid Treatment Authority with questions specific to opioid treatment programs:
  • Cissy McKinzie: tamberly.mckinzie@ks.gov (785)296-4079.
• Ensure you have up-to-date and readily available emergency contact information for your employees and your patients.
  • Update the cell phone and carrier of your patients weekly as part of the dosing and medication pickup process.
• Develop a plan for possible alternative staffing/dosing scheduling in case you experience staffing shortages due to staff illness. Develop a plan for criteria for staff members who may need to stay home when ill and/or return to the workforce when well.
• OTPs are required to have enough medication inventory onsite for ten days’ worth of patient medication. This language is likely to be revised to 15 days or more (medication safe size permitting) in case neighboring OTPs close due to staffing shortages.

Testing and Disease Investigation:

How do we test for COVID-19?

A healthcare provider obtains swabs deep in a person’s nose or throat for the test. The provider sends the swabs to a commercial laboratory or the state health department (Kansas Department of Health and Environment). Another option is through saliva testing, where the person being tested spits into a tube for the test.

Antibody and antigen tests are not confirmatory for COVID-19; therefore, the SCHD is not offering these types of tests.

Testing for COVID-19

A laboratory test for the coronavirus that causes COVID-19 is performed by the state health department laboratory in Topeka or through commercial laboratories.  A small swab from a person’s nose or throat or the person’s saliva is used for the test.

People with symptoms who are currently being tested for COVID-19 should remain in home isolation, or hospital isolation if symptoms are severe enough to be hospitalized until test results are available. People without symptoms may continue normal activities while awaiting test results.

• If the test result is negative, isolation is no longer required.
• If test results are positive for COVID-19, the person must remain in isolation until released by a health department.

For COVID-19 testing through the Sedgwick County Health Department and a list of other testing clinics around Sedgwick County, click here.

Who should be tested?

After infection with a virus, the level of virus in a person’s body increases over time and then decreases when your immune system fights it off. The COVID-19 test will be positive if the amount of virus in your body is high enough to be detected by the test.

• Symptoms are the best indication that the level of virus is detectable, but you can still test positive even if you don’t have symptoms.

A negative COVID-19 test could mean that you do not have the virus OR it could mean that you don’t have enough virus in your body for it to be detectable.

• Testing only indicates what is going on in your body at the time of the test
• A person with a negative test one day can test positive the next day or several days later if the amount of virus in their body increases, or if they are exposed after testing.

Knowing your risk of exposure and your symptoms on the day of testing are important for the lab to properly interpret your results.

What happens if a healthcare worker tests positive for COVID-19?

• Isolate at home for 10 days or 7 days with a negative PCR or antigen test, if asymptomatic or mildly symptomatic with improving symptoms.
• Healthcare workers who are asymptomatic or mildly symptomatic with improving symptoms should work only with COVID-19 positive patients during the 10 day infectious period, unless the facility is in crisis staffing.
• KDHE and SCHD allow for shorter isolation periods under contingency and crisis staffing levels. Healthcare workers should work with their occupational health to determine appropriate isolation periods for their situation and facility.
• More information can be found, here.

How long do test results typically take?

Results are generally available by the afternoon of the next weekday (see table below). These testes are not antibody tests, but show if you have a current infection.

What is a close contact?

You are considered a “close contact” if any of the following situations happened while you were with a person who has tested positive for COVID-19 – even if they did not have symptoms:

• You were within 6 feet of the person for 15 cumulative minutes in a 24-hour period.
• You had contact with the person’s respiratory secretions (sneezing, coughing, sharing a drinking glass, food, towels or other personal items, kissing)
• You live with the person or stayed overnight for at least one night in the person’s house
• You participated in activities that increase respiration (breathing rate), such as sports or singing, with someone who was positive.

What are the quarantine and isolation requirements for healthcare workers?

Please follow the guidance located, here.

Modified Disease Investigation

• The Health Department has prioritized COVID-19 case investigations based on the level of risk for the spread of disease.
• To help contain the spread of disease, if you test positive, you should reach out to your own close contacts and let them know of their potential exposure and about the 5 day in-home quarantine with 5 additional days wearing a mask under the guidance above. If they have questions, they can call the Health Department at 316-660-1022.

When can a person who tests positive resume normal activities?

See detailed information located, here.

Personal Protective Equipment (PPE) Requirements for Healthcare Providers Collecting Specimen Swabs from a Patient Suspected of Having COVID-19

• Gowns 
• Gloves
• Eye Protection (goggles or faceshield)
• Respiratory Protection – use a fit-tested N95 respirator (facemasks are an acceptable alternative for collecting sample swabs when the supply chain of respirators cannot meet the demand)

What testing and standards should I consider when looking for CDC-recommended protective clothing?

• CDC’s guidance for Considerations for Selecting Protective Clothing used in Healthcare for Protection against Microorganisms in Blood and Body Fluids outlines the scientific evidence and information on national and international standards, test methods, and specifications for fluid-resistant and impermeable gowns and coveralls used in healthcare.
• Many organizations have published guidelines for the use of personal protective equipment (PPE) in medical settings. The American National Standards Institute (ANSI) and the Association of the Advancement of Medical Instrumentation (AAMI) describe the liquid barrier performance and a classification of surgical and isolation gowns for use in health care facilities.
• As with any type of PPE, the key to proper selection and use of protective clothing is to understand the hazards and the risk of exposure. Some of the factors important to assessing the risk of exposure in health facilities include source, modes of transmission, pressures and types of contact, and duration and type of tasks to be performed by the user of the PPE.
• For gowns, it is important to have sufficient overlap of the fabric so that it wraps around the body to cover the back (ensuring that if the wearer squats or sits down, the gown still protects the back area of the body).

Gowns

What type of gown is recommended for patients with suspected or confirmed COVID-19?

• Non-sterile, disposable patient isolation gowns, which are used for routine patient care in healthcare settings, are appropriate for use by patients with suspected or confirmed COVID-19.

What type of gowns are available for healthcare personnel to protect from COVID-19?

Gowns are available that protect against microorganisms. The choice of gown should be made based on the level of risk of contamination. Certain areas of surgical and isolation gowns are defined as “critical zones” where direct contact with blood, body fluids, and/or other potentially infectious materials is most likely to occur.

• If there is a medium to high risk of contamination and need for a large critical zone, isolation gowns that claim moderate to high barrier protection can be used.
• For healthcare activities with low, medium, or high risk of contamination, surgical gowns, can be used. These gowns are intended to be worn by healthcare personnel during surgical procedures.
• If the risk of bodily fluid exposure is low or minimal, gowns that claim minimal or low levels of barrier protection can be used. These gowns should not be worn during surgical or invasive procedures, or for medium to high risk contamination patient care activities.

What is the difference between gowns and coveralls?

• CDC’s guidance for Considerations for Selecting Protective Clothing used in Healthcare for Protection against Microorganisms in Blood and Body Fluids provides additional comparisons between gowns and coveralls.
• Gowns are easier to put on and, in particular, to take off. They are generally more familiar to healthcare workers and hence more likely to be used and removed correctly. These factors also facilitate training in their correct use.
• Coveralls typically provide 360-degree protection because they are designed to cover the whole body, including the back and lower legs, and sometimes the head and feet as well. Surgical/isolation gowns do not provide continuous whole-body protection (e.g., they have possible openings in the back, and typically provide coverage to the mid-calf only).
• The level of heat stress generated due to the added layer of clothing is also expected to be less for gowns when compared to coveralls due to several factors, such as the openings in the design of gowns and total area covered by the fabric.

How do I put on (don) and take off (doff) my gown?

• Check to see if your facility has guidance on how to don and doff PPE. The procedure to don and doff should be tailored to the specific type of PPE that you have available at your facility.
• If your facility does not have specific guidance, the CDC has recommended sequences for donning and doffing of PPE.
• Healthcare providers should perform hand hygiene before and after removing PPE. Hand hygiene should be performed by using alcohol-based hand sanitizer that contains 60-95% alcohol or washing hands with soap and water for at least 20 seconds. If hands are visibly soiled, soap and water should be used before returning to alcohol-based hand sanitizer.

Is it acceptable for emergency medical services to wear coveralls as an alternative to gowns when COVID-19 is suspected in a patient needing emergency transport?

• CDC’s Considerations for Selecting Protective Clothing used in Healthcare for Protection against Microorganisms in Blood and Body Fluids guidance provides a comparison between gowns and coveralls, including test methods and performance requirements.
• While no clinical studies have been done to compare gowns and coveralls, both have been used effectively by healthcare workers in clinical settings during patient care.
• Unlike patient care in the controlled environment of a healthcare facility, care and transport by EMS present unique challenges because of the nature of the setting.
• Coveralls are an acceptable alternative to gowns when caring for and transporting suspect COVID-19 patients.
• Coveralls typically provide 360-degree protection because they are designed to cover the whole body, including the back and lower legs, and sometimes the head and feet as well. This added coverage may be necessary for some work tasks involved in medical transport.
• However, coveralls may lead to increased heat stress compared to gowns due to the total area covered by the fabric.
• Training on how to properly remove (doff) a coverall is important to prevent self-contamination. Comparatively, gowns are easier to put on and, in particular, to take off.

Gloves

What type of glove is recommended to care for suspected or confirmed COVID-19 patients in healthcare settings?

• Nonsterile disposable patient examination gloves, which are used for routine patient care in healthcare settings, are appropriate for the care of patients with suspected or confirmed COVID-19.

What standards should be considered when choosing gloves?

• The American Society for Testing and Materials (ASTM) external has developed standards for patient examination gloves.
• Standard specifications for nitrile gloves, natural rubber gloves, and polychloroprene gloves indicate higher minimum tensile strength and elongation requirements compared to vinyl gloves.
• The ASTM has developed standards for patient examination gloves. Length requirements for patient exam gloves must be a minimum of 220mm-230mm depending on glove size and material type.

Is double gloving necessary when caring for suspected or confirmed COVID-19 patients in healthcare settings?

• CDC guidance does not recommend double gloves when providing care to suspected or confirmed COVID-19 patients.

Are extended length gloves necessary when caring for suspected or confirmed COVID-19 patients in healthcare settings?

• According to CDC guidance, extended length gloves are not necessary when providing care to suspected or confirmed COVID-19 patients. Extended length gloves can be used, but CDC does not specifically recommend them at this time.

How I do put on (don) and take off (doff) my gloves?

• Check to see if your facility has guidance on how to don and doff PPE. The procedure to don and doff should be tailored to the specific type of PPE that you have available at your facility.
• If your facility does not have specific guidance, the CDC has recommended sequences for donning and doffing of PPE.
• Healthcare providers should perform hand hygiene before and after removing PPE. Hand hygiene should be performed by using an alcohol-based hand sanitizer that contains 60-95% alcohol or washing hands with soap and water for at least 20 seconds. If hands are visibly soiled, soap and water should be used before returning to alcohol-based hand sanitizer.

Eye Protection

• Put on eye protection (e.g., goggles, a disposable face shield that covers the front and sides of the face) upon entry to the patient room or care area.
• Remove eye protection before leaving the patient room or care area. Reusable eye protection (e.g., goggles) must be cleaned and disinfected according to manufacturer’s reprocessing instructions prior to re-use. Disposable eye protection should be discarded after use.

Respirators

Should I wear a respirator, such as an N95 respirator, in public?

• CDC does not recommend the routine use of respirators outside of healthcare settings. Instead, CDC recommends everyday preventive actions to prevent the spread of respiratory viruses, such as avoiding people who are sick, avoiding touching your eyes or nose with unwashed hands, and covering your cough or sneeze with a tissue and then throwing the tissue in the trash.
• People who are sick should stay home and not go into crowded public places or visit people in hospitals. Workers who are sick should follow CDC guidelines and stay home when they are sick.
• If you are sick and must leave your house, please wear a mask to keep your germs from spreading to others.  The Centers for Disease Control and Prevention (CDC) recommends everyone who will be in a public setting where other social distancing measures are difficult to maintain (e.g. grocery stores and pharmacies), especially in areas of significant community-based transmission, to wear a cloth face covering.
• Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance.
• Homemade face coverings/masks are another tool to keep people from unknowingly spreading the virus. 
• Use this acronym when considering safe, homemade mask use: 
  • Multi-layered, tightly-woven 100% Cotton.  Use a thread count of 180 or higher. Don’t buy surgical or N95 masks.  
  • Avoid your face and remove it from behind.  Never touch the front of the mask, and always remove it from behind your head.  
  • Scrap it if it’s damaged, soiled, or doesn’t fit.  Make sure it’s breathable and fits snug. Don’t use it while it’s damp, wet, or dirty.  
  • Keep the mask and your hands clean.  Wash your hands before you put the mask on/after you take it off. Wash or dispose the mask after every use.

What is a respirator?

• A respirator is a personal protective device that is worn on the face or head and covers at least the nose and mouth. A respirator is used to reduce the wearer’s risk of inhaling hazardous airborne particles (including infectious agents), gases or vapors. Respirators, including those intended for use in healthcare settings, are certified by the CDC/NIOSH.

What is an N95 filtering facepiece respirator (FFR)?

• An N95 FFR is a type of respirator which removes particles from the air that are breathed through it. These respirators filter out at least 95% of very small (0.3 micron) particles. N95 FFRs are capable of filtering out all types of particles, including bacteria and viruses.

What are the two main types of masks for medical use?

There are two main types of masks for medical use – N95 or “facemasks” (also called surgical or earloop masks).

• N95 respirator masks are used by healthcare employees to protect from exposures to respiratory pathogens. They reduce the wearer’s exposure to particles including small particle aerosols and large droplets.
• Facemasks (also called surgical, procedure, or earloop masks) are fluid resistant and provides the wearer protection against large droplets, splashes, or sprays of bodily or other hazardous fluids. Protects the patient from the wearer’s respiratory emissions.

What is an N95 respirator?

N95 respirators are used by healthcare employees who have exposures to respiratory pathogens.

• They are tight‐fitting respirators that filter out at least 95% of particles in the air, including large and small particles.
• Before using an N95 respirator, workers must have a medical evaluation and be fit‐tested to make sure that they are able to wear a respirator safely and confirm a proper seal.
• When properly fitted and worn, minimal leakage occurs around edges of the respirator when the user inhales. This means almost all of the air is directed through the filter media.

What is a facemask (also called a surgical mask, procedure mask, or earloop mask)?

• If you are sick and must leave your house, please wear a mask to keep your germs from spreading to others.  The Centers for Disease Control and Prevention (CDC) recommends everyone who will be in a public setting where other social distancing measures are difficult to maintain (e.g. grocery stores and pharmacies), especially in areas of significant community-based transmission, to wear a cloth face covering.
• Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance.
• Homemade face coverings/masks are another tool to keep people from unknowingly spreading the virus.   Use this acronym when considering safe, homemade mask use:
• Multi-layered, tightly-woven 100% Cotton.  Use a thread count of 180 or higher. Don’t buy surgical or N95 masks.  
• Avoid your face and remove it from behind.  Never touch the front of the mask, and always remove it from behind your head.  
• Scrap it if it’s damaged, soiled, or doesn’t fit.  Make sure it’s breathable and fits snug. Don’t use it while it’s damp, wet, or dirty.  
• Keep the mask and your hands clean.  Wash your hands before you put the mask on/after you take it off. Wash or dispose the mask after every use.
• They are loose‐fitting and provide only barrier protection against droplets, including large respiratory particles.
• The cloth face coverings recommended are not surgical masks or N95 respirators. 
• No fit testing or seal check is necessary with facemasks. Most facemasks do not effectively filter small particles from the air and do not prevent leakage around the edge of the mask when the user inhales.

What is a Surgical N95 respirator and who needs to wear it?

• A surgical N95 (also referred as a medical respirator) is recommended only for use by healthcare personnel who need protection from both airborne and fluid hazards (e.g., splashes, sprays). These respirators are not used or needed outside of healthcare settings. In times of shortage, only personnel who are working in a sterile field or who may be exposed to high velocity splashes, sprays, or splatters of blood or body fluids should wear these respirators, such as in operative or procedural settings. Most personnel caring for confirmed or suspected COVID-19 patients should not need to use surgical N95 respirators and can use standard N95 respirators.
• If a surgical N95 is not available for use in operative or procedural settings, then an unhalved N95 respirator may be used with a face shield to help block high velocity streams of blood and body fluids.

My employees complain that Surgical N95 respirators are hot and uncomfortable – what can I do?

• The requirements for surgical N95 respirators that make them resistant to high velocity streams of body fluids and help protect the sterile field can result in a design that has a higher breathing resistance (makes it more difficult to breath) than a typical N95 respirator. Also, surgical N95 respirators are designed without exhalation valves, which are sometimes perceived as warmer inside the mask than typical N95 respirators.
• If you are receiving complaints, you may consider having employees who are not doing surgery, not working in a sterile field, or not potentially exposed to high velocity streams of body fluids wear a standard N95 with  an exhalation valve.

My N95 respirator has an exhalation valve, is that okay?

An N95 respirator with an exhalation valve does provide the same level of protection to the wearer as one that does not have a valve.

• The presence of an exhalation valve reduces exhalation resistance, which makes it easier to breathe (exhale). Some users feel that a respirator with an exhalation valve keeps the face cooler and reduces moisture build up inside the face piece.
• However, respirators with exhalation valves should not be used in situations where a sterile field must be maintained (e.g., during an invasive procedure in an operating or procedure room) because the exhalation valve allows unfiltered exhaled air to escape into the sterile field.

How can I tell if a respirator is NIOSH-approved?

The NIOSH approval number and approval label are key to identifying NIOSH-approved respirators.

• The NIOSH approval label can be found on or within the packaging of the respirator or sometimes on the respirator itself. The required labeling of NIOSH- Approved N95 filtering face piece includes the NIOSH name, the approval number, filter designations, lot number, and model number to be printed on the respirator.
• You can verify that your respirator approvals are valid by checking the NIOSH Certified Equipment List (CEL).

How do I know if my respirator is expired?

NIOSH does not require approved N95 filtering face piece respirators (FFRs) be marked with an expiration date.

• If an FFR does not have an assigned expiration date, you should refer to the user instructions or seek guidance from the specific manufacturer on whether time and storage conditions (such as temperature or humidity) are expected to have an effect on the respirator’s performance and if the respirators are nearing the end of their shelf life.

What do I do with an expired respirator?

In times of increased demand and decreased supply, consideration can be made to use N95 respirators past their intended shelf life.

• However, the potential exists that the respirator will not perform to the requirements for which it was certified. Over time, components, such as the strap and nose bridge may degrade, which can affect the quality of the fit and seal.
• Prior to use of N95 respirators, the healthcare personnel should inspect the respirator and perform a seal check. Additionally, expired respirators may potentially no longer meet the certification requirements set by NIOSH.
• For further guidance, visit Considerations for Release of Stockpiled N95s Beyond the Manufacturer- Designated Shelf Life: Considerations for the COVID-19 Response.

Where can I find answers to other questions that aren’t included here?

Please visit the CDC’s Clinical Questions about COVID-19: Questions and Answers page for other questions and answers you may have.

Special Considerations for Medication-Assisted Treatment Providers

Contact the Kansas Opioid Treatment Authority with questions specific to opioid treatment programs:

• Cissy McKinzie: tamberly.mckinzie@ks.gov or 1-785-296-4079

Check the Kansas Department for Aging and Disability Services (KDADS) website for guidance specific to Kansas. 

• Guidance for Opioid Treatment Programs (OTPs)/Methadone Clinics Concerning 2019 Novel Coronavirus Illness
• Telephonic Substance Use Disorders Guidance

Check the CDC and SAMHSA websites frequently to find new guidance and trainings.

• See “Training and Technical Assistance Related to COVID-19” for the most up to date webinar offerings.
• OTP Guidance for Patients Quarantined at Home with the Coronavirus (PDF | 160 KB) 
• FAQs: Provision of Methadone and Buprenorphine for the Treatment of Opioid Use Disorder in the COVID-19 Emergency (PDF | 202 KB) 
• Use of Telemedicine While Providing Medication-Assisted Treatment (MAT) (PDF | 146 KB) 

Sedgwick County Drug Misuse Information website with local data and treatment resources.

• Contact the SCHD Epidemiology Program at Disease.Reporting@sedgwick.gov, if your facility’s information needs updated.

Online Resources:

Centers for Disease Control and Prevention

Kansas Department of Health and Environment

SAMHSA - Substance Abuse and Mental Health Services Administration