It is important that our provider community consider monkeypox in their differential diagnosis for those who have a rash consistent with monkeypox and/or epidemiological risk factors for exposure to monkeypox. As most cases of monkeypox resolve without treatment and are not severe, referral for testing to local emergency departments/urgent care centers is not usually necessary.

This order primarily provides updated requirements for hospitals; however, 

Hospice Inpatient Units are still expected to update the Post Acute Capacity Tracker (PACCT) every 24 hours to indicate their availability to accept patients with suspected or confirmed COVID-19 from hospitals, skilled nursing facilities and other healthcare settings.  Our community partners have indicated the information in the PACCT is invaluable in ensuring patients receive the care they need in the most appropriate setting while reducing the strain on our healthcare system.  

• AHPCO Members are welcome to contact the AHPCOC Office with questions about other Executive Orders that pertain to Hospice or Palliative Care Providers, including assistance with how to use the PACCT. 
• To access the PACCT, visit: https://gis.azdhs.gov/pacctsignup
  

Key provisions of the above referenced order include the following:

• Continuance of COVID-19 line list reporting requirements by all licensed hospitals, as defined in Arizona Administrative Code (“A.A.C.”) R9-10-101(108)
• Continuance of hospital reporting through EMResources of ICU beds, ventilators, and ECMOs by hospitals as defined in A.A.C. R9-10-101(108)
• Continuance of reporting of results of all COVID-19 tests by laboratories as defined in A.R.S § 36-451(4) 
• Continuance of COVID-19 vaccine reporting requirements by individuals, healthcare providers, or local health agencies administering COVID-19 vaccines
• Continuance of the Post Acute Care Capacity Tracker reporting for specialized care institutions
• New reporting requirements for hospitals, as defined in A.A.C. R9-10-101, at noon every 24 hours

o   Number of patients pending transfer out of system, greater than 24 hours
o   Number of holds awaiting an inpatient bed
o   Number of intubations performed each day for respiratory distress
o   Number of COVID-19 positive patients or patients with suspected COVID-19 discharged per day 

• Discontinuation of two reporting requirements into EMResource for hospitals, as defined in A.A.C. R9-10-101 (ECMO reporting still required into the ECMO Tracker)

o   Number of ECMOs in use
o   Number of ECMOs available for use

For more information and full reporting requirements, see E.O. 2021-21.

Click here for more information

From today forward, close contacts in non-congregate living settings** (defined below) need to quarantine at home for 10 full days* following their last exposure to someone with COVID-19.

*Close contacts also have the option to end quarantine after 7 full days if they have:

• Been tested for COVID-19 by PCR or antigen test collected after at least 5 full days following their last known exposure; AND
• Received a negative test result; AND
• Remained symptom-free since their last exposure.

Click here for Quarantine Guidance for Household and Close Contacts of a Person with COVID-19 (English)

Click here for Quarantine Guidance for Household and Close Contacts of a Person with COVID-19 (Spanish)

Recommendation: Shift to Contingency PPE, Prepare for Crisis Measures

Standards for PPE use should be shifted from conventional to contingency measures; organizations sho

uld prepare for crisis measures.  Recommendations for contingency use of different elements of PPE include extended use strategies.  Further details can be found online under CDC’s Strategies for Optimizing the Supply of PPE.  

Recommendation: Set Testing Prioritization 

Given limited testing supplies, both reagents and swabs, and limited PPE, the SDMAC approved the following testing priorities.  The goal of testing should be to limit introduction of COVID-19 in healthcare and congregate settings and vulnerable populations.

• Public health and healthcare professionals should prioritize testing among three specific groups until sufficient and consistent PPE, testing supplies and capacity are widely available:

• Community-based COVID-19 testing (drive-through, walk-up, etc.) should be focused on making tests available to the three priority groups above.

• Healthy individuals and those with mild disease do not require testing. These individuals should practice social distancing and follow the recommendations of their local and state public health authorities. 

More information on the SDMAC and the guidance reported here can be found on the ADHS website for SDMAC.

Due to this, ADHS now recommends that healthcare providers:

•  Use standard, contact, and droplet precautions with eye protection for suspect or confirmed COVID-19 cases. 
•  Use gowns, gloves, respirators (such as N95 mask) and eye protection (goggles or face shield) when performing aerosol-generating procedures (e.g., tracheal intubation, non-invasive ventilation, tracheostomy, cardiopulmonary resuscitation, manual ventilation before intubation, bronchoscopy).
• Due to the change in transmission-based precautions from airborne to droplet, it is not necessary to place a suspect patient in an airborne infection isolation room (AIIR). A private room with a closed-door is acceptable. Using an AIIR for aerosol-generating procedures is still recommended.

The CDC is offering guidance to health professionals about the coronavirus and evaluating patients for home care or patients with symptoms who present at home.  https://www.cdc.gov/coronavirus/2019-ncov/guidance-prevent-spread.html and https://www.cdc.gov/coronavirus/2019-ncov/guidance-home-care.html    Attached also find a one page information sheet to use with staff, patients and other caregivers who may be increasingly concerned.

Please note, this is a good time to review handwashing practices with all staff, and also document your actions to support your emergency preparedness plan related to infectious disease, as the CDC has initiated outreach to local and state health departments-which are a resource to you and your staff. 

The risk in the US remains low, however, there is now evidence of person-to-person transmission without the infected person having been in Wuhan China. The World Health Organization’s (WHO) designation of coronavirus as an emergency relates to this information and supports international action and resources to address the virus’ spread.

 Pursuant to A.R.S. §36-782, an Enhanced Surveillance Advisory  has been issued to track opioid morbidity and mortality.  

Required reporting within 24 hours of the items below will go into effect June 15, 2017.

Thank you for your cooperation.  Please forward this message and resources onto other partners and listservs.  It will take a multi-level, multi-agency, collective effort to bring the Arizona epidemic under control.

Resources

Arizona's Declaration of Emergency

Arizona Executive Order for Enhanced Surveillance

Arizona Clinical Guidelines and References for Opioid Prescribing

Arizona 2016 Opioid Report

Arizona Opioid Website

Arizona Opioid Training Website

Thank you,
Arizona Health Alert Network

• Read Extension Declaration
• View CMS Waivers

Additional Resources for Hospice and Palliative Care Providers is available in the AHPCO Coronavirus Resource Center.

Have a Regulatory Question?

Members may contact the AHPCO office or submit a question through the AHPCO Regulatory Center (requires login).

Arizona clinicians are recommended to:

• Obtain a detailed travel history for patients being evaluated with fever and acute respiratory illness. Consider testing for seasonal respiratory illnesses, like influenza.
• Isolate and mask patients presenting with acute respiratory illness and recent travel from Wuhan City, China in the last 14 days.
• Healthcare personnel entering the room should use standard precautions, contact precautions, airborne precautions, and use eye protection (e.g., goggles or a face shield). 
• Immediately notify your healthcare facility’s infection control personnel and local health department.
• Coordinate with the local health department for specimen collection, transport, and testing for suspect cases.

The Arizona Department of Health Services and local health departments are coordinating surveillance and communication with the Centers for Disease Control and Prevention regarding 2019-nCoV.

For more information on 2019-nCoV, please visit the CDC website. If you have any questions, please contact your local health department.

Providers should:

• Take precautions to ensure your patients are not exposed by:
  -Making surgical masks available.
  -Having patients with febrile rash illness be the last appointment of the day to prevent exposing other patients
  -Having suspect cases wear surgical masks in common areas when airborne isolation is not available
• Immediately mask and place patients presenting with a febrile rash illness in airborne isolation if available, obtain vaccine and travel history. 
• Consider measles as a diagnosis for patients with a febrile rash illness and immediately report this to your local health department.
• Coordinate with your local health department for specimen collection, transport, and testing for suspect measles cases.

• Make sure your staff is fully immunized. 
  -Healthcare workers should receive two doses of MMR, regardless of year of birth, unless they have documentation of previous immunity.

To report cases or for additional information, please contact your local health department: http://www.azdhs.gov/preparedness/epidemiology-disease-control/index.php#resources-county

A measles surveillance toolkit for healthcare facilities is available at http://www.azdhs.gov/documents/preparedness/epidemiology-disease-control/measles/measles-surveillance-toolkit.pdf 

For more information on this situation, please visit the ADHS public information website at
http://azdhs.gov/director/public-information-office/index.php#releases-adhs

For more information on measles, please visit the ADHS measles webpage at http://www.azdhs.gov/preparedness/epidemiology-disease-control/measles/index.php