Novel Coronavirus FAQs for Medication Assisted Treatment Providers

This document contains information about COVID-19, testing and reporting information, personal protective equipment, and additional resources.

News Update:

Updated July 31, 2020, 9:00 pm

Every day, the Sedgwick County Health Department investigates reports of diseases from whooping cough and chickenpox to tuberculosis and HIV. You can help. COVID-19 is a new disease but it spreads the same way as the flu, through respiratory droplets. Many of the actions to prevent flu are the same needed to prevent COVID-19.

General Information

What recommendations can I give to patients to protect themselves from COVID-19?

How soon after exposure do symptoms start?

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

Is there a vaccine?

There is currently no vaccine to protect against COVID-19. The best way to prevent infection is to avoid being exposed to this virus (See “What recommendations can I give to patients to protect themselves from COVID-19”)

Is there a treatment?

There are no medications specifically approved for this novel coronavirus, although some, like Remdesivir, are being considered.  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.

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?

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?

whichever is longer.

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

 Testing and Disease Investigation:

When is someone a Person Under Investigation (PUI) and should be tested for COVID-19?

Testing Approval Form

If a patient fits the above criteria, order tests, tell the patient to remain at home until results are obtained, and report positive tests through the KDHE Epidemiology Hotline (1-877-427-7317).

How are patients tested for COVID-19?

First, a medical provider can collect a sample using a nasopharyngeal swab and a media (saline or viral media) following KDHE instructions posted on their website. Facilities and providers should prioritize using internal or commercial laboratory testing for COVID-19. The following reference labs offer COVID-19 testing:

If a patient is in a priority group mentioned in the previous question, a provider can complete the testing form on the KDHE website to send a sample to the Kansas Health and Environment Laboratories (KHEL). KHEL testing will be at no cost to the patient.

What do health department staff do to investigate people who may have COVID-19?

  1. If a person is identified as a Person Under Investigation (PUI) (see criteria above) the person is tested and is instructed to remains at home. The Sedgwick County Health Department is notified and remains in contact with the person.
  2. While waiting for test results, health department staff will interview the PUI to create a detailed timeline of where he or she went while potentially infectious. Officials will create a contact list of people who had close contact with the PUI.
    1. If the test result comes back positive (virus is present), health department staff will contact those who had close contact with the PUI. Contacts will be asked to self-monitor and quarantine for fever, cough, and difficulty breathing for 14 days after the last time they were in close contact with the positive case.
    2. If the test result are negative, the PUI can return to normal activities.

What is a confirmed case?

A confirmed case is defined as a person who has tested positive at the state health department laboratory or at a commercial laboratory. Confirmation with the Centers for Disease Control and Prevention (CDC) is no longer required.

When can a person who tests positive resume normal activities?

A person can resume normal activities when 10 days after the start of symptoms or 72 hours (per KDHE Guidance) after symptoms have ended without taking fever-reducing medications, whichever is longer.

How will people be informed if they have been in contact with a case?

If a person is identified as a contact of a case, the Sedgwick County Health Department will call them. After the initial call, the Sedgwick County Health Department contacts the person via an automated text message or email system every day for 14 days.

How does the automated text message system work?

The text message will prompt the person to press a button if they are experiencing a fever and respiratory symptoms.

Personal Protective Equipment

Who should I contact if I need help obtaining medical equipment and PPE?

Contact the Medical Society of Sedgwick County at 316-683-7557.

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

Review CDC recommendations HERE.

(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?

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

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

What is the difference between gowns and coveralls?

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

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?

Gloves

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

What standards should be considered when choosing gloves?

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

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

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

Respirators

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

What is a respirator?

What is an N95 filtering facepiece respirator (FFR)?

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)

What is an N95 respirator?

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

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

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

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

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

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

How do I know if my respirator is expired?

What do I do with an expired respirator?

Eye Protection

What methods should healthcare facilities consider in order to avoid unintentional loss of PPE during COVID-19?

Can healthcare workers and EMS staff wear facemasks if N95 masks are not available due to supply shortage?

According to CDC guidance updated on March 10, 2020, based on local and regional situational analysis of PPE supplies, facemasks are an acceptable alternative when the supply chain of respirators cannot meet the demand.  During this time, available N95 respirators should be prioritized for procedures that are likely to generate respiratory aerosols, which would pose the highest exposure risk to healthcare workers and EMS staff.

When the supply chain is restored, facilities and agencies with a respiratory protection program should return to use of respirators for patients with known or suspected COVID-19.

Battelle Decon Process Video

Click this link to watch an instructional video on preparing and packing your masks in Sedgwick County for decontamination using the Battelle decon process.

Online Resources:

Centers for Disease Control and Prevention: https://www.cdc.gov/coronavirus/index.html

CDC Infection Control Recommendations in Healthcare Setting:  

[https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhcp%2Finfection-control.html]

Substance Abuse and Mental Health Services Administration: https://www.samhsa.gov/medication-assisted-treatment

Kansas Department of Health and Environment: http://www.kdheks.gov/coronavirus/index.htm

Kansas Department for Aging and Disability Services: https://www.kdads.ks.gov/covid-19