VDH Updated Guidance on Testing for COVID-19

Updated 4/2/20

The Virginia Department of Health (VDH) continues to update its guidance in response to this emerging, rapidly evolving situation.

In the setting of limited availability of tests, testing performed at DCLS, Virginia’s state lab, is reserved for patients who meet VDH’s four priority investigation criteria below. If you have a patient who meets VDH criteria, please request testing via the online COVID-19 Testing Request Form. If you are unable to submit your request online, please contact your local health department.

  1. Healthcare worker or first responder with fever OR signs/symptoms of a lower respiratory illness.
  2. Potential cluster of unknown respiratory illness, with priority for healthcare facility outbreaks. All suspected clusters or outbreaks should be reported to the local health department immediately.
  3. Person hospitalized with fever OR signs of lower respiratory illness. Priority will be given to patients where circumstances require a confirmed COVID-19 diagnosis for compassionate use treatment with antivirals.
  4. Person who resides or works in a congregate setting (e.g., homeless shelter, assisted living facility, group home, prison, detention center, jail, or nursing home) AND who has fever or signs/symptoms of a lower respiratory illness.

For other patients who need COVID-19 testing, please contact a private laboratory to ask about how to submit specimens for testing. VDH approval is not needed for testing at private labs.

If a clinician suspects COVID-19 and public health resources are not available for testing, clinicians should:

  • Take appropriate infection control precautions in the healthcare setting.
  • Advise patients with mild illness to isolate at home, according to CDC recommendations.
  • Advise the patient to call the healthcare provider if symptoms worsen.
  • Advise the patient to get medical attention immediately if the patient develops emergency warning signs, which include, but are not limited to, trouble breathing, persistent pain or pressure in the chest, new confusion or inability to arouse, or bluish lips or face.

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. Even if testing is being pursued at a private laboratory, VDH strongly recommends that clinicians use the priority investigation criteria listed above to conserve resources (e.g., personal protective equipment and specimen collection supplies). Most patients with confirmed COVID-19 have developed fever and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing). There are epidemiologic factors that may also help guide decisions about COVID-19 testing. Documented COVID-19 infections in a jurisdiction and known community transmission may contribute to an epidemiologic risk assessment to inform testing decisions. Clinicians are strongly encouraged to test for other causes of respiratory illness (e.g., influenza).

Clinical diagnosis of COVID-19 is a reportable condition, regardless of whether testing is pursued or not. Clinicians should utilize the VDH Online Morbidity Report Portal to report individual cases that do not meet the criteria for DCLS testing noted above: http://www.vdh.virginia.gov/surveillance-and-investigation/commonwealth-of-virginiastate-board-of-health/

For more information, refer to the CDC guidance about evaluating and testing persons for COVID-19 at www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html. Virginia’s local health departments do not provide primary care and thus are not equipped to clinically evaluate patients with respiratory symptoms.