VDH Updated Guidance on Testing for COVID-19

VDH SARS-CoV-2 Viral Testing Prioritization – Updated September 14, 2020

Viral testing for SARS-CoV-2 informs patient management and is a critical first step in identifying and isolating people with COVID-19, quarantining their close contacts, minimizing community spread, and ultimately reducing the overall morbidity and mortality associated with COVID-19. Although testing capacity at commercial, private, and hospital laboratories performing SARS-CoV-2 testing has increased in Virginia, the availability of testing supplies continues to challenge the ability to meet the high demand for testing and timely results.

Because testing is not unlimited, VDH developed recommendations for prioritizing viral testing that are summarized in the table below. Viral testing includes molecular and antigen testing. If viral testing in the private sector is not available, clinicians may request molecular testing for patients listed in the table below at Virginia’s Division of Consolidated Laboratory Services (DCLS) or other public health laboratories by contacting their local health department. Submitters using public health testing must be willing and capable of collecting and packaging specimens, and either delivering them to a DCLS courier site or shipping them via commercial courier (e.g., FedEx).

Clinicians should utilize the Confidential Morbidity Portal to report suspected and confirmed COVID-19 cases as soon as they are identified. Please include in your report symptoms and other critical epidemiologic fields, including race and ethnicity.  If the clinician is using the VDH Point-of-Care (POC) Portal to report POC test results to VDH, then reporting via the Confidential Morbidity Portal is not needed.

Table 1. VDH Recommendations for prioritizing SARS-CoV-2 testing

 

Private/Commercial Lab Testing

Public Health Lab Testing

High Priority

  • Hospitalized patients with COVID-19 symptoms* or close contact
  • Critical infrastructure workers (e.g., healthcare workers, first responders, teachers)§ with COVID-19 symptoms* or close contact
  • Un- or underinsured persons with COVID-19 symptoms*or close contact
  • Other vulnerable populationswith COVID-19 symptoms*or close contact
  • Residents and workers with COVID-19 symptoms* or close contact in, or newly arriving to, congregate settings (e.g., long-term care facilities, prisons, jails, behavioral health facilities, or intermediate care facilities for individuals with intellectual disabilities)
  • Outbreak investigations**
  • Public health surveillance testing (e.g., sentinel surveillance)
  • Community testing events organized by the local health department††
  • Un- or under-insured persons with COVID-19 symptoms*
  • Other vulnerable populations with COVID-19 symptoms*

Priority

  • Persons with COVID-19 symptoms*
  • Persons without symptoms
    • Close contacts of cases
    • Prioritized by clinicians based on their best clinical judgment (e.g., for medical procedures)
  • Point prevalence surveys as approved by the local health department§§
  • Other special situations approved by the local health department

* Description of symptoms associated with COVID-19. Atypical presentations have been described, and older adults and persons with medical comorbidities may have delayed presentation of fever and respiratory symptoms. Children might have different symptoms and presentations and healthcare providers should consider referencing the CDC information for pediatric providers. Clinicians are encouraged to consider testing for other causes of respiratory illness, for example influenza, in addition to testing for SARS-CoV-2 depending on patient age, season, or clinical setting; detection of one respiratory pathogen (e.g., influenza) does not exclude the potential for co-infection with SARS-CoV-2.

A close contact is any person who was within 6 feet of an infected person for at least 15 minutes or who had exposure to respiratory secretions from an infected person (e.g., being coughed or sneezed on, sharing a drinking glass or utensils; kissing), starting from 2 days before the person became sick (or 2 days before specimen collection if asymptomatic) until the person was isolated. If testing is not readily available, prioritize testing of symptomatic close contacts or those at increased risk for severe COVID-19. If there is a known exposure date, it is reasonable to test close contacts approximately one week after exposure based on the average incubation period and available evidence to date. Close contacts who do not have symptoms and test negative for COVID-19 should still complete the full 14-day quarantine before it is safe to be around others. This is because it can take up to 14 days for COVID-19 symptoms to develop; if the close contact is tested too early within the 14-day period, the test might not be able to detect COVID-19 infection.

§Critical infrastructure workers are defined by the Cybersecurity & Infrastructure Security Agency (CISA) in their Guidance on the Essential Critical Infrastructure Workforce: Ensuring Community and National Resilience in COVID-19 Response. Of note, workers in the education sector or those who support the education sector were recently added as critical infrastructure workers.

Vulnerable populations include low-income individuals and families; people of color (i.e. Black or African American, Hispanic or Latino); individuals defined by CDC as having increased risk of severe COVID-19 because of older age or medical condition (e.g., hypertension, diabetes, asthma, chronic obstructive pulmonary disease [COPD]) or requiring extra precautions (e.g., individuals living in rural communities, people experiencing homelessness, women who are pregnant or breastfeeding, people with developmental and behavioral disorders); individuals living in multi-generational households; individuals who are uninsured or underinsured; and individuals living with disabilities, access, or functional needs.

** Testing for outbreak investigations means confirming the presence of an outbreak (i.e., two or more laboratory-confirmed cases within a 14-day period). Typically, this involves testing specimens from 2–5 persons. If an outbreak is confirmed, VDH might recommend additional testing at a private/commercial or a public health laboratory, depending on the affected setting.

†† Community testing events are often designed to reach vulnerable populations.

§§ A point prevalence survey (PPS) involves testing all people in a facility at a specific point in time, regardless of symptoms. There are different types of PPS. A baseline PPS can be performed, regardless of whether sporadic COVID-19 infections have been previously identified. A PPS can also be performed after an outbreak has been confirmed as part of the overall outbreak response. Examples of when public health is likely to recommend testing at a private/commercial laboratory include facility-wide testing in child care facilities, K-12 schools, institutes of higher education, and workplaces. For additional information on how public health prioritizes PPS, see here. For assistance with point prevalence surveys, please contact your local health department.