Healthcare FAQs

Infection Mitigation Compliance

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COVID-19 Testing and Reporting

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COVID-19 Vaccination

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  • Once a COVID-19 vaccine is available, how is the County planning to distribute it?

    Once a vaccine is available in quantities suitable for distribution, the County will adhere to the distribution plan developed by the California Department of Public Health. The CDPH plan consists of a three-phased approach:

    ·         Phases 1A, 1B, and 1C: Potentially Limited Doses Available;

    ·         Phase 2: Larger Number of Doses Available; and

    ·         Phase 3: Continued Vaccination, Shift to Routine Strategy.

    Persons in healthcare settings who have direct exposure to patients (1A) and long-term care facility residents (1A); essential workers (1B); and increased-risk individuals (1C), including the elderly, will be prioritized in the event doses are limited. As supplies of the vaccine increase, the remainder of the population will be vaccinated in Phases 2 and 3.

    In the meantime, the County recommends that HCPs register for the California Reportable Disease Information Exchange (CalREDIE) and San Diego Regional Immunization Registry (SDIR). These services will be used for disease reporting, disease surveillance, and vaccine distribution monitoring.   

  • Do employees still need to wear a mask and practice social distancing after getting a COVID-19 vaccine?

    Yes, individuals who receive a COVID-19 vaccine must continue to adhere to social distancing and masking practices until advised otherwise by health officials. These practices, regardless of vaccination status, will continue to aid in reducing the virus’ spread among the general population. It is unclear whether the vaccine will prevent transmission of the virus to others. Herd immunity may be achieved eventually but is not possible until a majority of the population is vaccinated or develops natural immunity (estimated to be approximately 60-70% of the population).

  • If an employee tested positive for COVID-19 and has since recovered, does he or she still need to get the vaccine?

    Yes, recovered persons should still get a COVID-19 vaccination. While there is likely some degree of immunity lasting for weeks after an infection resolves, this natural immunity duration and the degree to which someone is protected after recovery are unclear at this time. A history of confirmed SARS-CoV-2 infection – symptomatic or asymptomatic – is not a contraindication for vaccination. In addition, serologic testing for antibodies is not recommended before vaccination.

    Per CDC, healthcare workers with a documented SARS-CoV-2 infection within the last 90 days may choose to defer vaccination to allow individuals at higher risk to be vaccinated first. 

  • Will individuals who get vaccinated for COVID-19 be able to infect others?

    Current data suggest that COVID-19 vaccines are effective at preventing individuals from becoming ill. While these results are encouraging, they do not necessarily mean that vaccination will prevent people from becoming infected and subsequently transmitting SARS-CoV-2 to others. Until more is known about post-vaccination infection and transmissibility, it is recommended that vaccinated individuals continue to adhere to non-pharmaceutical interventions, including masking and social distancing, and continue to avoid contact with higher-risk individuals. 

  • Should employees get a flu shot this season?

    Yes, it is extremely important to get an influenza vaccination this season. While cases of influenza have thus far been low, CDC has increased the vaccine’s availability and strongly recommends getting vaccinated. In addition to protecting you from infection and severe illness, flu vaccination will help prevent you from infecting vulnerable populations, which is possible prior to you becoming symptomatic.

    Importantly, getting a flu vaccine will help preserve already limited healthcare resources during the COVID-19 pandemic. It is challenging to distinguish influenza from COVID-19 or other respiratory illnesses. In addition, co-infections can further strain our testing, PPE supplies, and other healthcare resources. 

  • Why should I get the COVID-19 vaccine?

    Public health experts have determined that COVID-19 vaccine is safe and highly effective. Vaccination greatly reduces the risk of getting sick with COVID-19. If you do contract COVID-19 after vaccination, the course of illness will likely be less severe. Avoiding contracting COVID-19 also prevents long-lasting effects that have been reported. COVID-19 infection has been reported to cause long-term symptoms such as fatigue, shortness of breath, cough, joint pain, chest pain, difficulty thinking and concentrating (“brain fog”), depression, muscle pain, headache, and intermittent fever. In addition, some people have reported ongoing post-infection complications related to their heart, lung, kidney, skin, and nervous system. It is currently unclear whether vaccination prevents infection and the potential to transmit the virus to others, as described in "Do employees still need to wear a mask and practice social distancing after getting a COVID-19 vaccine?" 

  • Is the vaccine required for healthcare personnel?

    No. The vaccine is voluntary, but highly recommended.

  • What is the difference between Emergency Use Authorization (EUA) status and full Food and Drug Administration (FDA) approval for a vaccine?

    When a vaccine’s efficacy and safety has been demonstrated through rigorous testing, its manufacturer can apply for an EUA with 2 months of post-vaccine safety data. In order to apply for full approval, post-vaccine safety data over longer periods must be provided. The FDA is encouraging companies who receive EUA status to apply for full approval as soon as possible. Both EUA-approved vaccine manufacturers have reported outstanding safety data with only rare serious side effects (see Vaccination Question 24). In addition, California (with other western states) have formed their own safety review panel prior to distributing these vaccines; the review workgroup recommendations are available at the CDPH website.

  • What COVID-19 vaccines are currently available?

    Two vaccines are available under EUA: Pfizer and Moderna vaccines.

     

    ► Pfizer

    •         EUA issued on December 11, 2020

    •         Large-scale trial (44,000 participants) showed 95% efficacy

    •         Two-dose vaccine, requires ultra-cold storage (-70 oC)

    •         First shipments to specific cold storage-capable facilities

    •         50 million doses to the world by end 2020 (6.5 million to US)

    •         1.3 billion doses to the world in 2021

    ► Moderna

    •         EUA issued on December 18, 2020

    •         Large-scale trial (30,000 participants) showed 94% efficacy

    •         Two-dose vaccine, requires standard cold storage (-20 ºC)

    •         20 million doses to the world by end 2020

    •         500 million to 1 billion doses to the world in 2021

  • What is an mRNA vaccine?

    The two EUA-approved vaccines are both mRNA vaccines. There is no live virus in mRNA vaccines. These COVID-19 vaccines are not the first mRNA vaccines to be studied: mRNA vaccines have been explored for influenza, rabies, CMV (cytomegalovirus), and Zika viruses. While mRNA technology has been under development for decades, the COVID-19 vaccines represent the first large-scale distribution of mRNA vaccines. Cancer research is also exploring using mRNA technology to trigger the immune system to target cancer cells.

  • How well does the vaccine work?

    Both EUA-approved vaccines are effective at preventing symptomatic illness from COVID-19. The Pfizer and Moderna COVID-19 vaccines have both been tested in large trials involving tens of thousands of participants. In studies, the vaccine group had only 5% of the cases seen in the placebo (non-vaccine) group, a 95% efficacy at preventing COVID-19. For example, if the placebo (non-vaccine) group had 100 cases of COVID-19, the vaccine group would only have 5. Importantly, the vaccine not only prevented COVID-19 cases overall, but also prevented severe COVID-19 symptoms.

    ► Pfizer

    •         COVID-19 vaccine Phase 3 trial (~44,000 participants)

    •         95% efficacy (protection)

    •         All COVID-19 cases: 162 in placebo group vs. 8 in vaccine group

    •         Severe COVID-19 cases: 9 in placebo group vs. 1 in vaccine group

    ► Moderna

    •         COVID-19 vaccine Phase 3 trial (~30,000 participants)

    •         94% efficacy (protection)

    •         All COVID-19 cases: 185 in placebo group vs. 11 in vaccine group

    •         Severe COVID-19 cases: 11 in placebo group vs. 0 in vaccine group

  • How many doses of the vaccine are required and how far apart are they administered?

    Both the Pfizer and Moderna vaccines require 2 doses. Both doses are necessary to achieve the 94-95% protection that was observed in the trials. The second dose of the Pfizer vaccine is given 21 days after the first. Similarly, the second dose of the Moderna vaccine is given 28 days after the first. The same manufacturer’s vaccine should be administered at both visits; mixing vaccines from different manufacturers have not been studied. 

  • What side effects do the vaccines have? What should I expect prior to receiving the vaccine?

    Thus far, vaccine trials have shown that COVID-19 mRNA vaccines are highly protective and generate a strong immune response. There may be side effects that feel like the flu, but do not signify infection. Instead, these symptoms are simply a sign that an immune response is generated. Below is some general guidance to consider before getting vaccinated.

    Expect some symptoms after vaccination

    •         Both mRNA COVID-19 vaccines commonly cause mild-to-moderate, non- infectious, “flu-like” symptoms.

    Smart scheduling

    •         While most people can continue regular activities after vaccination, some experience side effects that may inhibit their return to work for a day or two.

    •         Staff on the same shift or division should not all receive the vaccine on the same day.

    •         Staff should plan to receive the vaccine on the last day of a go-round or first day off shift.

    •         Staggering vaccinations by at least 3 days will ensure that agencies do not have a shortages of certain skill sets if employees are absent from work because of vaccine-related side effects.

    Do not take anti-inflammatory medication prior to vaccination

    •         In general, use of over-the-counter medications such as aspirin, acetaminophen (e.g., Tylenol) and ibuprofen (e.g., Motrin, Advil) before receiving a vaccine can blunt the immune response. These medications may be used to treat discomfort after vaccination.

    Please see this detailed information regarding the Pfizer-BioNTech and Moderna vaccines.

  • What if I missed my second dose? Can I get it late?

    Data on vaccine benefit were based upon a fixed number of weeks between doses (3 weeks between Pfizer doses; 4 weeks between Moderna doses). The second dose should be administered, even if delayed. As of now, there remains no maximum allowable interval recommended by the CDC between the first and second dose. Any delay in receiving the second dose should be resolved as soon as possible without restarting the series. 

  • Where can HCPs find additional information on COVID-19 vaccination?

    Providers can consult the following resources from CDC:

    ·         What Every Clinician Should Know About COVID-19 Safety (Video/Slides),

    ·         Post Vaccine Considerations for Healthcare Personnel,

    ·         What to Expect After Getting a COVID-19 Vaccine (for distribution to patients) and

    ·         Healthcare Professionals: Preparing for COVID-19 Vaccination. 

Patient Management

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  • What PPE should providers utilize when contacting patients who are confirmed or suspected to be COVID-19 positive?

    Providers should don appropriate PPE and observe universal precautions when contacting patients who are confirmed or suspected to be COVID-19 positive. Standard, contact, and droplet precautions should also be observed to mitigate risk of exposure especially during aerosol-generating procedures (AGPs). Respirators and gowns should be conserved for procedures with a high risk of aerosol-generation (i.e., sputum induction or bronchoscopy) should they be in short supply.

    Patients with suspected or known COVID-19 can be cared for in a single-person room. Airborne infection isolation rooms (AIIR) should be reserved for patients undergoing for procedures with a high risk of aerosol generation. In addition, patients should adhere to source-control practices by wearing a facemask while receiving medical treatment.

    Depending on the prevalence of COVID-19 in the community, universal precautions may be recommended when initially caring for all patients.

  • What should providers do to minimize the risk of contracting SARS-CoV-2 while performing AGPs?

    CDC has put forth specific Infection Prevention and Control guidance focusing on minimizing the risk of contracting SARS-CoV-2 during aerosol-generating procedures. Such procedures should be performed with the utmost caution or be avoided altogether, if possible. To minimize exposure, CDC recommends:

    ·         wearing appropriate PPE including N95 mask (or equivalent) or respirator (without exhalation valves), eye protection, gloves, and gown;

    ·         minimizing the number of HCPs in the room;

    ·         implementing source-control measures such as placing masks on patients;

    ·         utilizing engineering controls such as smoke-evacuation devices;

    ·         performing procedures in an airborne infection isolation room (AIIR); and

    ·         disinfecting room surfaces promptly in accordance with environmental infection control guidelines.

    For detailed information and considerations related to AGPs, visit CDC’s Infection Control FAQs.  

  • When can patients discontinue their home isolation?

    Quarantine is for individuals who are asymptomatic and have been exposed to the virus. Isolation is for symptomatic or otherwise infectious individuals. Persons infected with COVID-19 must isolate per the California Health and Safety Code, even if they are asymptomatic. For detailed guidance by the County on isolation procedures, refer to the PHO’s order.

    CDC released symptom-based guidance regarding the Discontinuation of Home Isolation for Persons with COVID-19 Not in Healthcare Settings. The update contains information to help providers determine the appropriate amount of time patients should be isolated and what additional precautions should be taken during that time. In addition, the County of San Diego has also released Home Isolation Instructions for COVID-19 for people with confirmed or clinically suspected COVID-19. 

  • What should be done with potential cases at long-term care facilities (e.g., skilled nursing facilities, intermediate care facilities, residential care facilities for the elderly, etc.)?

    Outbreaks in these facilities are associated with high morbidity due to patients’ advanced age and congregate living conditions. The CDPH’s All Facilities Letter (AFL) 20-53.3 details the following information for SNFs:

    ·         general testing guidance,

    ·         arrangements with laboratories to process tests,

    ·         plans to utilize test results, and

    ·         procedures for residents and HCPs who test positive.

    The County of San Diego also issued Congregate Facilities Guidance for COVID-19 elaborating on the CDPH order. Additional guidance can be found on the County’s Long-Term Care and Residential Facilities webpage. 

  • Is additional expert clinical guidance available regarding questions on the clinical management of patients with COVID-19?

    CDC has partnered with the Infectious Diseases Society of America (IDSA) to offer a new service to clinicians treating COVID-19 patients. Clinicians who have questions about the clinical management of patients with COVID-19 can call the main CDC information line at (800) 232-4636. Calls from clinicians will be triaged by CDC to a group of IDSA volunteer clinicians for peer-to-peer support.

  • What is the guidance for healthcare organizations in the event of a respirator shortage?

    While there are still respirator shortages in some sectors, California healthcare providers are no longer experiencing an extreme respirator shortage. Manufacturers are increasing respirator production and many distributors are making respirators available to employers through allocation protocols. In addition, state and local governments are procuring respirators to support healthcare facilities. 

    Cal/OSHA issued interim guidance in the event of Severe Respirator Supply Shortages. Each method below, or a combination thereof, may be used to extend supplies of N95 respirators provided higher-level protections are implemented first. Surgical masks cannot be used where a respirator is required, such as during AGPs on a suspected or confirmed COVID-19 patient. Acceptable optimization strategies to preserve respirators include: 

    ·         using reusable NIOSH-certified respirators instead of disposable filtering facepiece respirators,

    ·         using NIOSH-certified industrial filtering facepiece respirators,

    ·         allowing employees to wear their own respirators if it complies with Cal/OSHA requirements,

    ·         using fit-testing methods that maximize respirator supplies and fit-testing efficiency,

    ·         using certain expired NIOSH-certified filtering facepiece respirators,

    ·         using methods to preserve existing stocks of filtering facepiece respirators,

    ·         extending the use of the same respirator under certain circumstances, and

    ·         storing disinfected filtering facepiece respirators in case of future shortages.

    To request respirators and other PPE from the County, HCPs and offices should contact MOC.LOGS.HHSA@sdcounty.ca.gov.  

Resources for Providers

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General Resources

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Volunteering Opportunities

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For additional questions and resources, please email:  MCSDCallCenter.HHSA@sdcounty.ca.gov