VDH Updated Guidance on Testing for COVID-19

VDH SARS-CoV-2 Viral Testing Prioritization – Updated December 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. All COVID-19 reports from clinicians or facilities based on point-of-care tests should be reported using the VDH Point-of-Care (POC) Portal, not the Confidential Morbidity Portal.

Table 1. VDH Recommendations for Prioritizing SARS-CoV-2 Molecular or Antigen Tests

 

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 populations with 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)
    •  Persons who participated in higher-risk activities in which they cannot physically distance as needed (e.g., travel, attending large social or mass gatherings, or being in crowded indoor settings)
  • 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 a total of 15 minutes or more over a 24-hour period 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 asymptomatic close contacts 5 days or more after the date of last exposure. If the close contact is tested too early, the test might not be able to detect COVID-19 infection. Close contacts who do not have symptoms and test negative for COVID-19 should still complete the full 14-day quarantine. VDH and CDC continue to recommend a 14-day quarantine period as the safest option. If the person cannot stay home for the full 14 days after exposure and does not have symptoms, the person may end quarantine earlier. Counting the date of last exposure as Day 0, the person may leave home after Day 10 without testing or after Day 7 with a negative PCR or antigen test performed on or after Day 5. If the person does not stay home for the recommended 14 days, the person should continue monitoring for symptoms and follow all other recommendations (e.g., wear a mask, watch their distance, and wash hands often) for the full 14-day period after the last exposure.

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.

Revisions:

  • On December 14, 2020, updated that facilities reporting point-of-care (POC) test results should report using the POC portal, not the Confidentiality Report Portal. Updated Table 1 in the Priority row and Private/Commercial Lab testing column by adding ”Persons without symptoms who have participated in higher-risk activities in which they cannot physically distance as needed.” Also updated the footnote for close contact. Specifically, changed the period when close contacts should be tested from “approximately 1 week” to “5 days or more” after the date of last contact. Also, changed the duration of quarantine to include two alternatives if the person is not able to stay home for the recommended 14 days after last exposure and has no symptoms. These options are to end quarantine are “after Day 10 without testing” or after Day 7 with a negative PCR or antigen test performed on or after Day 5;” If these alternatives are used, the person should still monitor symptoms and follow other public health recommendations for the full 14-day period.
  • On October 27, 2020, updated part of the footnote for close contact. Specifically, changed the duration of close contact from “for at least 15 minutes” to “a total of 15 minutes or more over a 24-hour period.”