While continuing to stress the importance of decreasing potential exposure to COVID-19, the Missouri Department of Health and Senior Services has announced changes in testing criteria and guidance for those with coronavirus when it comes to how long they need to isolate at home.

Here’s the full press release from DHSS:

JEFFERSON CITY, MO—Saturday, Governor Mike Parson announced that he was directing DHSS Director Dr. Randall Williams to utilize the authority granted to him by statute to order everyone in the State of Missouri to follow social distancing measures in accordance with guidelines from the President of the United States and the Centers for Disease Control and Prevention (CDC).

The Order, which went into effect at 12:01 this morning remains in effect until 12:01 a.m. April 6, 2020 unless extended by further order. Every person in Missouri shall:

  1. Shall avoid social gatherings of more than ten (10) people. For purposes of this Order, “social gatherings” shall mean any planned or spontaneous event or convening that would bring together more than ten (10) people in a single space at the same time.
  2. Shall avoid eating or drinking at restaurants, bars, or food courts; provided, however, that the use of drive-thru, pickup, or delivery options is allowed throughout the duration of this Order.
  3. Shall not visit nursing homes, long-term care facilities, retirement homes, or assisted living homes unless to provide critical assistance.

Schools shall remain closed for the duration of this Order. This Order does not prohibit schools from providing child care and Food and Nutritional Services for those children that qualify. Teachers and staff may enter the building as long as they follow the directives set forth in this Order.

“People talk about the need for more supplies, but the best way to decrease the need for testing supplies and personal protective equipment is for everyone to limit their chances of getting sick,” said Dr. Randall Williams, director of DHSS. “Practicing social distancing is key to preventing spread of this virus both to yourself and to others.”

Mobile testing sites

Health care centers and systems have been setting up mobile testing sites throughout the state to provide greater accessibility to patients while also limiting physical interactions with those suspected of COVID-19 infection. There are now 28 sites throughout the state offering wider testing which is reflected in the number of tests coming back positive. A list of mobile testing sites can be found on the DHSS website.

Testing criteria change

With the changing epidemiological landscape in Missouri, new COVID-19 testing criteria are being implemented today.

“We are very much responding to the request from clinicians and our first responders about their need to make rapid diagnoses in certain cases,” said Williams. “Our new criteria reflects CDC’s new recommendations to ensure that we have testing available for high-risk groups and to help clinicians and first responders safely provide service to the people of Missouri.”

Testing for COVID-19 is available through the Missouri State Public Health Laboratory as well as commercial clinical laboratories. Clinicians who wish to submit specimens to the state laboratory must submit proper documentation and be approved by contacting the DHSS Emergency Response Center. Providers do not need to seek approval from DHSS to submit specimens for testing to commercial laboratories.

Clinicians should determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Most patients with confirmed COVID-19 have developed fever and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing). Priorities for testing may include:

  1. Hospitalized patients who have signs and symptoms compatible with COVID-19 in order to inform decisions related to infection control.
  2. Symptomatic residents of congregate living facilities that house adults ages 65 or older and individuals with chronic medical conditions and/or an immunocompromised state that may put them at higher risk for poor outcomes (e.g., diabetes, chronic heart disease, such as heart failure, receiving immunosuppressive medications, chronic lung disease, chronic kidney disease).
  3. Any persons including health care personnel, who within 14 days of symptom onset had close contact with a suspect COVID-19 patient with pending laboratory testing or laboratory-confirmed COVID-19 patient.

Change in guidance for those with COVID-19

Guidance is also changing for those with COVID-19 under home isolation regarding when they may discontinue home isolation. This decision should be made in the context of local circumstances.

In addition to the test-based strategy, an additional option now includes a time-since-illness-onset and time-since-recovery (non-test-based) strategy.

People can discontinue home isolation under the following conditions:

  • At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,
  • At least 7 days have passed since symptoms first appeared.

Previous recommendations for a test-based strategy remain applicable (two negative test results from specimens collected at least 24 hours apart); however, a test-based strategy is contingent on the availability of ample testing supplies and laboratory capacity as well as convenient access to testing. Additional information related to the new guidance can be found on the DHSS website.

Individuals with laboratory-confirmed COVID-19 who have not had any symptoms may discontinue home isolation when at least 7 days have passed since the date of their first positive COVID-19 diagnostic test and have had no subsequent illness.

COVID-19 case counts

DHSS will update its website with the latest count of confirmed cases reported throughout the state once they are verified and the patient has been notified. Daily updates will be made available by 2 p.m. at www.health.mo.gov/coronavirus along with data related to counties of patients’ residence, age range and type of transmission.

Personal protective equipment (PPE)

The PPE supply chain shortage is nationwide. The State of Missouri has limited quantities and types of PPE items to support health care providers’ needs. To supplement health care’s supply, the State purchased an estimated $18 million in PPE supplies for front-line health care workers and first responders. More information will be provided as it becomes available.

Prevention

Everyone can do their part to help us respond to this emerging public health threat:

  • Wash your hands often with soap and water for at least 20 seconds
  • Avoid touching your eyes, nose, or mouth with unwashed hands
  • Avoid close contact with people who are sick
  • Avoid close contact with others
  • Cover your mouth and nose with a tissue when you cough or sneeze, then throw the tissue in the trash and wash your hands
  • Clean and disinfect objects and surfaces – View the EPA list of disinfectants

Older people and people with severe chronic conditions should take special precautions because they are at higher risk of developing serious COVID-19 illness.

“It’s going to take personal responsibility to stop the spread of this disease among our communities,” said Williams. “We are at a stage where we truly need everyone to consider the impact we can all make distancing ourselves from one another.”

Visit the CDC website at www.cdc.gov/coronavirus or the DHSS website at www.health.mo.gov/coronavirus for more information or to ask questions using the state site’s COVID-19 interactive chatbot. A statewide COVID-19 hotline also operates 24 hours a day, 7 days a week at 877-435-8411.

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