Date: March 25, 2020
To: Health Care Providers
MEMORANDUM
From: Joneigh Khaldun, MD, MPH, FACEP
Chief Medical Executive and Chief Deputy for Health Michigan Department of Health and Human Services
As the COVID-19 situation in the State of Michigan rapidly evolves, MDHHS continues to adapt resource and capacity planning to support the varied needs of our partners in healthcare and local public health organizations. The Michigan COVID-19 Laboratory Emergency Response Network (MI-CLERN) is used to coordinate scarce resources and increase laboratory capacity. The MiCLERN provider hotline (888-277-9894) was stood up to enable providers to gain access to testing resources. MDHHS recently ordered that all health professionals should conduct testing for the Novel Coronavirus in accordance with the COVID-19 prioritization criteria published by MDHHS. This letter informs you of three changes to this system.
- Change in Prioritization Criteria
Given the shortage of specimen collection and laboratory testing resources for COVID-19 in the nation and revised guidance from the U.S. Public Health Service, MDHHS is revising the prioritization criteria for the collection and testing of specimens for COVID-19 testing. At this time, Priority Groups One and Two in the PHS Guidance (https://www.cdc.gov/coronavirus/2019- ncov/hcp/clinical-criteria.html) are eligible for testing by health care providers in Michigan:
1.) Ensuring optimal care options for all hospitalized patients, lessen the risk of healthcare- associated infections, and maintain the integrity of the U.S. healthcare system. This includes:
- Hospitalized Patients
- Healthcare facility workers with symptoms
2.) Ensuring that those at highest risk of complication of infection are rapidly identified and appropriately triaged. This includes:
- Patients in long-term care facilities with symptoms
- Patients over age 65 years with symptoms
- Patients with underlying conditions with symptoms
- First responders with symptoms
While not required, MDHHS does recommend that health care providers first attempt to rule out other potential etiologies through available testing means (e.g., rapid influenza tests or respiratory infectious disease panel [RIDP]) for these patients before testing for COVID-19. MiCLERN agents will document these efforts in the PUI issuance process.
We believe that this model will help to preserve strained testing and resource capacity in the system and will meet the needs of both high disease-burdened areas and non-high-burdened areas of the State alike. These new prioritization criteria will take effect at 8:00 PM on Wednesday, March 25, 2020.
- Expansion of access to PUI authorization
To reduce the time burden on busy health care providers, MDHHS, in consultation with the Michigan Health and Hospital Association, is broadening access to PUI authorization for testing of inpatient specimens or symptomatic health care worker specimens. Hospitals may have their physicians consult with a member of their health system (most commonly Infection Prevention) to input the patient into the Michigan Disease Surveillance System (MDSS) to receive a PUI Number (the MDSS Investigation ID). The hospital, for inpatient specimens, may enter data into MDSS in place of calling the MiCLERN 24/7 hotline. If sending to the MDHHS BOL, the submitter must continue to put the PUI number on the MDHHS BOL laboratory requisition form for the sample to be tested. If this process is not feasible for hospitals, they may continue to call MI-CLERN at (888) 277- 9894 for approval for testing.
At this time, MDHHS is asking that providers and/or Infection Prevention personnel continue to fax the Michigan Interim 2019 Novel Coronavirus (COVID-19) Person Under Investigation (PUI) Case Report Form and Cover Sheet the local health department of patient residence. However, MDHHS is revising PUI Case Report Guidance in the coming days to reduce the data collection burden.
- Reminder about MDHHS Bureau of Laboratories (BOL) submissions
When submitting specimens to BOL for testing, submitters must include the PUI on all necessary BOL test requisitions documents and on the specimen container. BOL prioritizes specimen testing relative to those that present the greatest public health concern. BOL will not prioritize specimens that arrive without a corresponding PUI identifier.
Upon completion of the test, BOL will notify both the ordering physician and the patient’s respective local health department of the results. Healthcare providers should not contact the MDHHS public information hotline or the MiCLERN Provider hotline for test results. Agents responding to calls on both hotlines do not have access to the test results. Healthcare providers should not refer patients to these hotlines or any state agencies to obtain their test results as MDHHS will not provide results directly to patients. These calls delay work being done to process specimens and frustrates patients.
MDHHS is making these changes to ensure that testing is available for decision making to protect the health care work force and those most vulnerable to severe outcomes of COVID-19. Thank you for all you do to serve the residents of Michigan at this difficult time.
For the latest information on Michigan’s response to COVID-19, please visit www.michigan.gov/coronavirus. You may also email our Community Health Emergency Coordination Center at: checcdeptcoor@michigan.gov.