Frequently Asked Questions about COVID-19 for College Health Professionals

Coronaviruses are a large family of viruses that are common in both humans and animals. There are currently seven strains of human coronaviruses that have been identified. Four of these strains are common throughout the world and typically cause a mild respiratory illness. Other strains of coronavirus cause more severe illness, including SARS and MERS. In 2019, a new strain of human coronavirus emerged to cause COVID-19.

Posted March 25, 2020

COVID-19 is caused by a novel coronavirus never seen in human populations before, so everyone is susceptible, and nobody is immune. Early in the epidemic, most U.S. cases were associated with exposure that occurred during international travel. As COVID-19 became a pandemic, cases at the local level (community spread) became common. Community spread is defined as the spread when the source is unknown.  As the outbreak expands, the risk will increase. Current groups considered to be at an elevated risk of exposure include:

• People in places where ongoing community spread of the virus that causes COVID-19 has been reported, with the level of risk dependent on the location.
• Health care workers caring for patients with COVID-19.
• Close contacts of persons with COVID-19.
• Travelers returning from affected locations where community spread is occurring, with the level of risk dependent on where they traveled.

Risk factors for developing severe illness may include, but are not limited to, older age, people who live in a nursing home or long term care facility, individuals of any age with underlying chronic medical conditions such as lung disease, moderate or severe asthma,  cancer, heart failure, cardiovascular disease, renal disease, liver disease, diabetes, immunocompromising conditions, and pregnancy. Individuals with a BMI greater than or equal to 40 also seem to be at increased risk of developing severe illness. While older age is a risk factor, COVID-19 does not discriminate solely on the basis of age.  

Posted March 25, 2020

The mean incubation period (time from exposure to the onset of symptoms) is estimated at 4 days, with a median of 5.1 days (95% CI 4.5-5.8 days). About 98% of infected persons develop symptoms within 12 days. Data for human infection with other coronaviruses (e.g., MERS-CoV, SARS-CoV) suggest that the incubation period may range from 2-14 days. [CDC, Annals Int Med]

Posted March 25, 2020

Reported illnesses have ranged from very mild (including some with no reported symptoms) to severe, including illness resulting in death. The most commonly reported symptoms include fever (77–98%), cough (46%–82%), myalgia or fatigue (11–52%), and shortness of breath (3-31%) at illness onset. Other less commonly reported respiratory symptoms include sore throat, headache, cough with sputum production and/or hemoptysis. Some patients have experienced gastrointestinal symptoms such as diarrhea and nausea prior to developing fever and lower respiratory tract signs and symptoms. The complete clinical picture with regard to COVID-19 is not fully known. [CDC]

Posted March 25, 2020

Probably. Recent evidence of transmission by mildly symptomatic and asymptomatic persons suggest that the time from exposure to onset of infectiousness (latent period) may be shorter than the incubation period. Infected persons likely shed virus in their respiratory secretions prior to developing or recognizing symptoms. This has important implications for transmission dynamics, but the contribution to overall spread is yet to be determined.

Posted March 25, 2020

Most likely from 24-48 hours prior to the onset of symptoms, to at least 72 hours after the resolution of fever and productive cough. Some people will continue to shed virus after this time however. Isolation is recommended to continue for a minimum of 7 days after the onset of symptoms. See CDC Guidance for home isolation without testing.

Posted March 25, 2020

No specific treatment for COVID-19 is currently available. Clinical management includes prompt implementation of recommended infection prevention and control measures and supportive management of complications. Corticosteroids should be avoided, because of the potential for prolonging viral replication as observed in MERS-CoV patients, unless indicated for other reasons. [CDC] Please carefully check information being circulated related to medications that suggest “a cure.”

Posted March 25, 2020

Students with underlying health conditions should adhere to the same advice given for other high risk populations: avoid public spaces, maintain a distance of greater than or equal to 6 feet from other people, clean surfaces with an antiviral cleaning agent especially surfaces that are used by others, and meticulously practice good hand hygiene. Solicit the help of others who can assist with grocery shopping and pharmacy trips or use a delivery service. If the student develops symptoms like fever, cough, or shortness of breath, they should contact their health care provider immediately by phone for advice.

Posted March 25, 2020

Quarantine means the separation of a person or group of people reasonably believed to have been exposed to a communicable disease but not yet symptomatic, from others who have not been so exposed, to prevent the possible spread of the communicable disease.

Isolation means the separation of a person or group of people known or reasonably believed to be infected with a communicable disease, and potentially infectious, from those who are not infected, in order to prevent spread of the communicable disease.

Posted March 25, 2020

Self-quarantine (or self-isolation) means an exposed (or ill) person is asked to minimize their contact with others by staying in their apartment or home (or other location approved by the local health department). During this time, quarantined (or isolated) persons may not attend classes/labs/exams, go to work, be in public areas, use any public transportation (including ride-sharing services), or attend large gatherings or events. They should not go out to restaurants, coffee shops, or receive guests.

Persons in quarantine (but not isolation) may leave their home (in a private vehicle) for a limited time to take care of routine and necessary activities, such as grocery shopping or visiting the pharmacy.

Self-quarantine and isolation may be difficult to manage in communal living situations, especially for students. Students residing in university housing will need assistance. Other students should take appropriate steps to self-quarantine or isolate, including relocating, asking roommates to relocate, or taking measures to minimize contact with others. People with low risk exposures may only require self-observation rather than quarantine. Recommendations for who should be in quarantine vs. observation are in flux and depend on the risk of exposure. Consult with your local health department and the CDC COVID-19 website for additional guidance.

Posted March 25, 2020

Persons with an elevated risk of exposure to COVID-19 may be asked to “self-monitor” for symptoms. This means they should measure (and record) their temperature twice daily and watch for fever, cough, or trouble breathing. In the event these symptoms develop, or they have a fever greater than 100.4°F, they should contact a health care provider.

Posted March 25, 2020

Patients who are tested for COVID-19 because there is clinical suspicion, but who do not have known or suspected exposure to SARS-CoV-2 should be in appropriate isolation while the test is pending, but do not require prolonged isolation if the test for COVID-19 is negative. They can return to their normal activities, while remaining mindful of signs and symptoms, and continuing to practice good hand hygiene and respiratory etiquette.

Symptomatic patients who are tested and are medium or high risk contacts of a COVID-19 case, or have traveled from a country with a level 3 travel health notice or a U.S. state with community transmission, should remain in isolation for at least 14 days after their last exposure (or last date in the affected country/state), even if their COVID-19 test is negative (i.e, they remain in quarantine). Separation of individuals with exposure to COVID-19 for 14 days is recommended, regardless of if the individual is symptomatic, or if they have respiratory symptoms from any cause.

Posted March 25, 2020

In general, people should adhere to home isolation until the risk of secondary transmission is thought to be low. The decision to discontinue home isolation should be made in the context of local circumstances, so follow instructions from your local or state health department. For patients diagnosed with COVID-19 who are recovering in a home setting, isolation may usually be discontinued when both of the following have occurred: (1) The patient is free of fever without the use of fever reducing medications, productive cough and other acute symptoms of respiratory infection for 72 hours, AND (2) 7 days have elapsed from the day the patient first experienced symptoms. See CDC Guidance. 

Posted March 25, 2020

Persons who are contacts of exposed but asymptomatic persons are not considered to be at increased risk, and no special guidance applies. For example, the roommate of an exposed person who is in self-quarantine is not restricted in their activities. For more information, consult the CDC COVID-19 website for the definition of what constitutes an exposure.

Posted March 25, 2020

If the student needs emergency medical attention, they should call 911 and let them know they may have COVID-19 (based on travel history, exposure, quarantine status, or symptoms).

If the student is being referred to another health care facility, contact the facility in advance and follow their instructions.

Students should be encouraged to call the student health center before going to the center for a visit or entering the waiting room. This information with a phone number should be posted to websites and on the entrance to the health center.  If after telephone triage, it appears that the student should be seen for an in-person visit, consider referral to an appropriate community provider. If they are to be seen by the college health service arrange for them to enter via an alternate entrance if possible and meet them at the door. Immediately provide a mask to the ill person on arrival at your facility.

Any ill person seeking health care should be advised:

• Call your health care provider for advice.  
• If you have fever and are experiencing difficulty breathing, call 911.
• Do not use public transportation, ridesharing, or taxis.
• Wear a facemask if possible.
• Cover your mouth and nose with a tissue when you cough or sneeze and dispose of that tissue in an enclosed receptacle. 

Students with no symptoms should be provided with self-care instructions, including hygiene within the home, how to disinfect the home, and signs and symptoms which should trigger a health care visit. When possible, try to ensure access to a thermometer. While there is some emerging evidence that patients who use non-steroidal anti-inflammatory drugs (NSAIDs) may be at higher risk of complications, there has been no official guidance to providers about avoiding the use of these drugs.

Posted March 25, 2020

Via person-to-person transmission. This most commonly happens during close exposure to a person infected with COVID-19, primarily via respiratory droplets produced when the infected person coughs or sneezes. Droplets can land in the mouths, noses, or eyes of people who are nearby or possibly be inhaled into the lungs of those within close proximity (within about 6 feet). Airborne transmission from person-to-person over longer distances is believed to be a less likely mechanism of spread. The virus can also spread when someone touches an object with the virus on it and then touches their mouth, nose, face, or eyes. [CDC]. COVID -19 can be aerosolized during certain invasive  procedures such as bronchoscopy or intubation requiring higher levels of respiratory protection in addition to the standard contact PPE for those healthcare workers performing these procedures. 

Posted March 25, 2020

Viral RNA has been detected in stool specimens, suggesting that infection with the COVID-19 virus may lead to intestinal infection, but there has not been documentation of fecal-oral transmission to date. See: Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations.

Posted April 16, 2020

Yes. Tests for COVID-19 can be done in any clinical setting, subject to restrictions that may be imposed by your laboratory, your institution or your local health department. The facility should be adequately resourced to provide clinicians appropriate PPE for protection. Decisions to perform testing for COVID-19 should be made by clinicians, who should take into consideration patients’ risk of exposure to the virus, symptoms, medical complications, and local epidemiology as well as the risk to the provider. While most labs do not provide collection of the swabs, several commercial reference laboratories can now conduct diagnostic testing for the virus that causes COVID-19. The room where the person under investigation and/or swab is taken should be cleaned thoroughly after the patient exits the facility per CDC guidelines. Tests continue to be difficult to obtain, and in some states, there are specific restrictions regarding who is eligible to be tested. 

Posted March 25, 2020

No. Transportation of patients between health care facilities for the purpose of obtaining testing for COVID-19 should be avoided as much as possible. In areas with community transmission, acute care facilities will be quickly overwhelmed by transfers of patients who have only mild illness and do not require hospitalization. To minimize the risk of COVID-19 exposure to medically vulnerable patients, student health centers might also consider strategies where testing can be done in other settings such as off-site venues.

Posted March 25, 2020

Collection of respiratory specimens for COVID-19 testing should be conducted in ambulatory settings using no less than droplet and contact precautions, including masks, gowns, gloves, and eye protection. Testing should not be deferred if N95 respirators or airborne isolation rooms are unavailable. Specimen collection may be performed in a normal examination room with the door closed. Interim guidance from CDC has been updated to provide recommendations for infection prevention and control for patients with COVID-19 in health care settings. CDC guidance regarding personal protective equipment (PPE) acknowledges that use of N95 respirators offers a higher level of protection and should be used instead of a facemask when performing or present for aerosol-generating procedures. Simple facemasks are acceptable for routine patient care if the supply of respirators cannot meet the demand. A process should be in place to ensure tracking of all staff members who provide care or enter the patient room for all encounters. This will facilitate contact tracing in the event a case is confirmed.

Posted March 25, 2020

It’s important to follow the specimen submission instructions specific to your laboratory. Generally, collect both a pharyngeal and a nasopharyngeal (NP) swab and submit them together in standard viral transport media. The technique is similar to testing for influenza.  If swabs are in short supply, a single nasopharyngeal swab may be sufficient (subject to guidance from your lab). Providers unfamiliar with NP swab collection technique may find this video from NEJM helpful. Always read the instructions for the test kit and transport media being used. The number of health care providers present during the procedure should be limited to only those essential for patient care and procedure support. Visitors should not be present for specimen collection. See CDC: Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Posted March 25, 2020

Clinicians should use their judgment to 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 should include: 

• Symptomatic individuals such as older adults (age ≥ 65 years) and individuals with chronic medical conditions, and/or an immunocompromised state that may put them at higher risk for poor outcomes (e.g., diabetes, heart disease, receiving immunosuppressive medications, chronic lung disease, chronic kidney disease).
• Any persons, including health care personnel, who within 14 days of symptom onset had close contact with a suspect or laboratory-confirmed COVID-19 patient, or who have a history of travel from high risk geographic areas within 14 days of their symptom onset. Testing should be considered for individuals in these groups even if symptoms are mild (e.g., sore throat). 
• Hospitalized patients who have signs and symptoms compatible with COVID-19 in order to inform decisions related to infection control.

When considering COVID-19 in any patient presenting with respiratory symptoms, you should also test for other common causes of respiratory illness (e.g., influenza, RSV) when possible. Access to tests and laboratory capacity will also impact testing decisions at the local level.

Posted March 25, 2020

COVID-19 testing is typically not indicated for patients without an exposure risk who have mild respiratory illness or who are asymptomatic. If the prevalence of COVID-19 in communities increases substantially and widespread transmission is understood to be occurring, then testing individuals with mild symptoms will become less informative in ambulatory settings. Testing will continue to play a critical role for hospitalized patients and for symptomatic health care workers, to inform infection control strategies and prevent infections within medically vulnerable groups. Your local health department may provide additional guidance.

Posted March 25, 2020

PCR (polymerase chain reaction) is a process used to detect genetic material (in this case, pieces of viral RNA) via nucleic acid amplification from a patient sample. It is a diagnostic test, and available on multiple platforms including both high-throughput (batch) and “sample to answer” individual rapid tests. PCR and similar methods are referred to as molecular tests. They are the gold standard for diagnosis of COVID-19.

Antibody (serologic) tests detect the presence of antibodies (in this case, against SARS-CoV-2) in a blood sample. Antibodies are produced by the immune system in response to an infection, and it can take from several days to several weeks to develop detectable antibodies. A positive antibody test reflects past rather than current infection. For this reason, they are not reliable as a diagnostic test and cannot substitute for a molecular test. Serologic tests are particularly useful for surveillance and to determine the extent of an outbreak in a population.

Posted April 16, 2020

In general, molecular methods of testing like PCR are extremely accurate. Because this is a new test for a new virus, there is not yet a standard against which to evaluate its performance, so the true sensitivity and specificity is undetermined. However, because the test uses unique segments of viral RNA to detect SARS-CoV-2 not found in other coronaviruses, the specificity is likely to be extremely high. Sensitivity by contrast may be lower since it is highly dependent on accurate specimen collection. A PCR test may be negative in situations in which a person was not shedding virus at the time of specimen collection or if the specimen did not sample tissue or fluid where the virus was present.

It should also be noted that molecular tests detect only targeted segments of the viral genome and not whole virus. This is why a result will be reported as “viral RNA detected.” In some cases, this might mean that a person is not actually infectious but simply shedding viral RNA in pieces, following a recent infection.

Posted April 16, 2020

The currently available serologic tests for the COVID-19 virus were approved by the FDA under an emergency use authorization (EUA) process. This is designed to make a test available quickly, but it does not involve the usual oversight from FDA to determine efficacy, safety, and accuracy. Thus, many of these serologic tests have not undergone rigorous evaluation before coming to market. Test sensitivity and specificity, positive and negative predictive value, and overall performance may not be ideal. For example, concerns have been raised that these tests may cross react with other common coronaviruses.

Posted April 16, 2020

Researchers have not yet confirmed whether the presence of SARS-CoV-2 antibodies in a person’s blood means they are fully protected from COVID-19. Based on what is known about similar viruses, this protection is likely; however, more research is needed. Currently available tests cannot tell if a person has developed neutralizing antibodies that would protect against future infection, and so a correlate of protection is undetermined at this time.

Posted April 16, 2020

Travel advice and restrictions have changed significantly as the pandemic has evolved. Current guidance can be obtained at the CDC Travel site here and the U.S. State Department Travel site here.

Many additional and frequently updated travel-related resources are available in the ACHA Connect Travel Health Coalition library.

Posted March 25, 2020

On March 19, 2020, the Department of State issued an unprecedented Level 4 “Do Not Travel” Global Health Advisory. This advises all U.S. citizens to avoid all international travel due to the global impact of COVID-19. Citizens abroad should arrange for immediate return to the US unless they are prepared to remain abroad for an indefinite period.

The full advisory and further information is available here.

Posted March 25, 2020

Routine cleaning and disinfection procedures (e.g., using cleaners and water to pre-clean surfaces prior to applying an EPA-registered, hospital-grade disinfectant) are appropriate for SARS-CoV-2 in health care settings, including those patient-care areas in which aerosol-generating procedures are performed. Appropriate PPE (a minimum of gown and gloves) must be used by personnel who clean the room. [CDC]

Posted March 25, 2020

If a student health center pharmacy remains open, students should call to make sure they can pick up their prescriptions as they normally would. If students are away from campus, the student health center pharmacy may be able to mail medications to students. If the campus pharmacy has closed, most student health insurance/benefits plans (SHIBPs) have a network of pharmacies so students can use pharmacies close to home. Students enrolled in a SHIBP should contact the customer service number on their health insurance card for assistance with locating an in-network pharmacy.

Posted April 16, 2020
Revised April 20, 2020

Many campus health centers are now using telehealth options to provide care to their students remotely anywhere in the world. When a student needs an in-person visit but they are no longer on campus, they will need to be referred to a local health care provider. The situation is similar to students being away from the campus during break periods. Campuses could also encourage these students to consider contacting the campus SHIBP administrator to understand how and when to enroll or get coverage through their parent’s plan, a plan through the ACA Marketplace, or Medicaid, when appropriate.

Posted April 16, 2020
Revised April 20, 2020

Student health insurance/benefits plans (SHIBPs) are specifically designed for students and are therefore created in a way that accounts for the mobile nature of student life. Most SHIBPs offer coverage that will meet the needs of students during the COVID-19 situation. The campus SHIBP administrator should identify and communicate any changes or relaxation of rules of the SHIBP to critical stakeholders, including the affected students, the student health service, graduate student office, human resources or others involved in the SHIBP. Many of the larger SHIBP providers have resources listed on their websites discussing coverage and changes in benefits. Students who have a SHBIP may call the customer service number on their health insurance card for benefit information.

Additional information:

• Most SHIBPs provide coverage to students until the start of the next academic year. If coverage ends prior to the beginning of the academic year, be sure to communicate this information early and often so students can research other health insurance options. 
• Most plans offer comprehensive coverage to the student regardless of whether they are on campus or back home.
• Most SHIBPs are specifically designed to provide coverage to students when they are off campus during the academic year. Examples include internships, research projects, clinical rotations, and breaks during and after semesters. The COVID-19 situation essentially sent students off campus one to two months earlier than normal.
• Visit ACHA’s dedicated webpage to SHIBPs which includes ACHA’s standards for SHIBPs. Many SHIBPs align with ACHA’s standards.

Posted April 16, 2020
Revised April 20, 2020

Many student health centers remain open and are able to provide telehealth services, for both medical and mental health care. For situations in which this is not possible, your campus should work directly with the SHIBP provider to create an alternative plan for students. This information should be well communicated directly to the students as well as posted on the health center website. Students who have a SHIBP can call the customer service number on their health insurance card for provider network information. Many SHIBPs also have dedicated websites for student health insurance.

Posted April 16, 2020
Revised April 20, 2020

Yes: health profession students, homeless students, international students, students of color, students with an unstable home life or who experience violence at home, and uninsured or underinsured students are some of the groups that may need special attention. Be proactive in reaching out to these groups to see what their needs may be. Services for these students may need to be targeted or modified.

Posted April 16, 2020

Here are three steps you can take right now: 

1. Stay informed. The CDC, ACHA, and many state health department websites are being updated continuously, so check back regularly to see what’s new. Keep abreast of the current status of services and operations on your campus.
2. Be engaged. Help your health service and campus with continuity of operations plans as they develop the surge capacity needed for an increasing number of ill students, faculty, and staff. If your role is instruction, plan how you can switch to alternative delivery of instruction. If your work is in other areas, work with your supervisor, dean, or director on continuity planning in your own unit.
3. Take care of yourself and your family by following best practices and current CDC recommendations around health and travel.

Posted March 25, 2020

Yes, CDC has developed extensive guidance for institutions, available here.

Posted March 25, 2020

Social distancing means remaining out of congregate settings, avoiding mass gatherings, and maintaining distance (approximately 6 feet or 2 meters) from others when possible. Each person with whom a person is in contact brings their prior contacts; therefore, one should consider that contacts outside one’s household would also include that person’s outside contacts, thus increasing risk.

Posted March 25, 2020

It appears unlikely that there is a seasonal component to COVID-19.

Posted March 25, 2020

While guidelines and regulations promulgated by national organizations and even federal agencies can help to inform best practices in helping our campuses respond to the COVID-19 emergency, deference must be ceded to local authorities on many of the issues. Local, in this context, is meant to refer to the county or municipal health department having jurisdiction over the particular campus and legal and risk management guidance from campus officials. For example, shelter-in-place requirements for a particular county might be stricter than those issued by the state. Or there might be temporary relaxation of health care licensing requirements to facilitate cross-state practice of telehealth, but if the malpractice insurance carrier for the campus’ health center has not agreed to the expanded scope, clinicians might be practicing telehealth at their own peril.

Posted April 16, 2020