Note: This information is based on currently available evidence, resources, information, emergency use authorization, and expert opinion, and is subject to change.
COVID-19 Basics
General Questions
What is SARS-CoV-2?SARS-CoV-2 is the name of the specific type of coronavirus that causes COVID-19. “SARS” stands for Severe Acute Respiratory Syndrome, the name of the group of symptoms that is seen in the most severe COVID-19 cases. “CoV” stands for coronavirus. This SARS-CoV-2 virus is related to the original SARS virus that emerged in China in 2002, hence the current number “2.”
What is COVID-19?COVID-19 (“Coronavirus Disease 2019”) is an infectious respiratory disease caused by the SARS-CoV-2 coronavirus that initially emerged in Wuhan, Hubei Province, China in late 2019.
How soon after exposure do symptoms occur?Symptoms of COVID-19 typically appear 2-14 days after exposure to someone infected with the virus.
How is COVID-19 spread between people? (Last updated 4/13/22)COVID-19 spreads when an infected person breathes out droplets and very small particles that contain the virus. These droplets and particles can be breathed in by other people or land on their eyes, nose, or mouth. People who are closer than 6 feet from the infected person are most likely to get infected.
COVID-19 is spread in three main ways:
- Breathing in air when close to an infected person who is breathing out small droplets and particles that contain the virus.
- Having these small droplets and particles that contain virus land on the eyes, nose, or mouth, especially through splashes and sprays like a cough or sneeze.
- Touching eyes, nose, or mouth with hands that have the virus on them.
For more information about how COVID-19 spreads, visit CDC’s How COVID-19 Spreads page. Easy to read material on how COVID-19 spreads is available.
What does close contact mean? (Last updated 1/24/22)Close contact means being within 6 feet of a person with COVID-19 during their contagious (infectious) period for a cumulative total of 15 minutes or more over a 24-hour period or having direct contact with the person’s respiratory secretions (for example, being coughed or sneezed on). For example, briefly walking by someone with COVID-19 in a store is not considered close contact.
In K-12 school settings, a student who was within 3–6 feet of an infected student is not considered a close contact as long as both students were wearing masks the entire time and the school has other prevention strategies in place. This exception may also be applied to school buses when the following criteria are met: 1) Documented seating charts and 2) Assurance that masks were worn and students remained in assigned seats, either via video monitoring if available, or attestation from the bus driver or monitor. This within 3-6 foot exception does not apply to teachers, staff, or other adults in indoor K-12 settings.
A person with COVID-19 is considered to be contagious 48 hours or 2 days before they become sick with symptoms (or 2 days before they tested positive if they never had symptoms) until they meet the criteria to discontinue isolation. People that are exposed to someone with COVID-19 after they complete isolation are not considered close contacts, regardless of mask use.
What is contact tracing? (Last updated 2/1/22)Contact tracing is a method often used by public health authorities to prevent the spread of disease. For COVID-19, contact tracing means making sure that everyone who has been in close contact with someone with COVID-19 is aware that they might have been exposed.
VDH is refocusing from investigating every case of COVID-19 and tracing all contacts to focusing on follow-up of COVID-19 clusters and outbreaks in long-term care facilities, congregate settings, healthcare settings, and other high-risk settings. VDH will focus on follow-up with individuals most at risk for developing severe COVID-19.
More information about contact tracing can be found on VDH’s Contact Tracing page.
What are the most reliable sources of COVID-19 information? (Last updated 6/1/22)For those with access to the internet, the best sources of up-to-date information on COVID-19 are the Virginia Department of Health website, COVID.gov, and the Centers for Disease Control and Prevention (CDC) website. You can also call 877-ASK-VDH3 (877-829-4682) Monday–Friday from 8:00am–5:00pm for additional information.
What should I know about fraud and scams related to COVID-19? (Last updated 2/7/22)The U.S. Department of Health and Human Services Office of Inspector General provides information related to COVID-19 frauds. There have been many COVID-19 fraud and scams. Some include fake QR Coded Test Results, fake vaccination cards,and the resale of fake or expired COVID-19 test kits on ebay, Facebook, and Craigslist. If you suspect COVID-19 health care fraud, report it immediately online or call 800-HHS-TIPS (800-447-8477).
The Federal Trade Commission provides advice for consumers to avoid COVID-19 scams.
What should I know about myths and facts related to COVID-19 or to COVID-19 vaccines?There are many myths on the internet about COVID-19. Make sure you get your information from a trusted public health source such as VDH, the Centers for Disease Control and Prevention or the World Health Organization.
The CDC provides information addressing Myths and Facts about COVID-19 Vaccination.
VDH addresses these on its Facts About COVID-19 page.
With three COVID-19 vaccines available in the United States, it is important to get accurate vaccine information. Additional information is available in VDH’s Vaccination Frequently Asked Questions (FAQs).
Does natural immunity protect me as much as the COVID-19 vaccines do? (Last updated 1/12/22)Both individuals who are up to date on their COVID-19 vaccines and individuals with previous SARS-CoV-2 infection have a low risk of reinfection in the first several months. People are considered up to date on their vaccines when they have received the appropriate booster dose after having completed their initial primary series of COVID-19 vaccinations.
Many studies indicate that SARS-CoV-2 infection leads to a robust immune response in terms of both antibodies and cellular immunity. However, the response varies depending on the severity of illness. People with more severe COVID-19 disease tend to have higher initial immunity levels than people with milder disease.
Although there appears to be varying evidence regarding the relative protection that occurs after surviving COVID-19 as compared with completing vaccination, there is substantial immunologic and increasing epidemiologic evidence that vaccination following infection further increases protection against subsequent illness among those who have been previously infected.
For most people, the “natural immunity” provided by COVID-19 illness alone provides good protection from reinfection for a short time after the illness. However, studies have shown that compared to the “natural immunity” in people who had COVID-19 illness before but have NOT been vaccinated yet, the immunity provided by COVID-19 vaccination after COVID-19 illness is both stronger (that is, provides higher antibody levels) and broader (that is, it can better protect against some of the new variant strains).
A good example of this issue is a report that discusses the results of COVID-19 vaccination after COVID-19 disease. Among all people who had previously had COVID-19 disease, those who did not get a COVID-19 vaccination later, after their COVID-19 disease, were more than twice as likely to get re-infected with the virus that causes COVID-19 compared to those who were vaccinated after their original COVID-19 disease.
In addition, as variants of COVID-19 continue to appear and to spread more widely, staying up to date on COVID-19 vaccinations becomes even more important for those previously infected with COVID-19. The Delta variant of COVID-19 is both more infectious and less likely to be prevented by antibodies against earlier forms of the SARS-CoV-2 virus. Fortunately, the available vaccines continue to work well against Delta and all other variants that have been identified so far.
While there is no recommended minimum interval between infection and vaccination, current evidence suggests that the risk of reinfection is low in the first 2-3 months after initial infection but, after that, may increase with time due to waning immunity.
For all these reasons, VDH and CDC recommend staying up to date on COVID-19 vaccinations for every unvaccinated person, regardless of whether or not they previously had a COVID-19 infection. As long as the individual has no medical reason (contra-indication) to not get vaccinated, has no symptoms, and is also out of the isolation period, they can and should get COVID-19 vaccinated.
How well does a previous COVID-19 infection protect against reinfection? (Last updated 4/16/22)The amount of protection will depend on several factors. These factors include (1) the length of time since the previous infection occurred; (2) the COVID-19 variant you are being exposed to; and (3) the person’s characteristics (for example, age and immune system). The natural immunity that occurs after COVID-19 infection in people with normal immune systems has appeared to reduce the risk of reinfection for a period of time.
An article in the New England Journal of Medicine estimates that the effectiveness of previous infection in preventing reinfection involving symptoms was estimated to be about 90% against the Alpha variant, 86% against the Beta variant, 92% against the Delta variant, and 56% against the Omicron variant. The effectiveness with respect to severe, critical, or fatal COVID-19 was estimated to be 69% against the alpha variant, 88% against the beta variant, 100% against the delta variant, and 87% against the Omicron variant. Data about the BA.2 Omicron subvariant were not available for this study.
There appears to be a lot of variability in the protection provided from natural infection. For example, immunity after milder COVID-19 infections appears weaker than immunity after moderate or severe infections. The level of protection also varies by age, with older adults being less protected than younger adults. The variants that are involved in the initial infection and the ones that later circulate likely play critical roles in determining protection. Before the Omicron variant was circulating, reinfections were not very common. The Omicron variant can evade antibodies produced in response to infection with earlier variants and, based on limited information, a history of prior infection seems to have provided little if any protection from reinfection with that variant; another South African study has suggested that cell-mediated (T-cell) immunity may provide some of the protection against the severity of COVID-19 re-infection seen after natural infection. Preprint information shows evidence that Omicron BA.2 reinfections do occur shortly after BA.1 infections but are rare. Omicron sub variants- BA.2.12.1, BA.4 and BA.5, appear to cause more cases of reinfection, even in individuals previously infected with Omicron. BA.4/5 are “capable of escaping immune protection induced by infection with earlier Omicron and other prior variants, earning them the term “stealth viruses”. Studies suggest that reinfection with SARS-CoV-2 with the same virus variant as the initial infection or reinfection with a different variant are both possible; early reinfection within 90 days of the initial infection can occur.
In terms of protecting populations, we are not sure yet how well Omicron or Omicron sub variants can be transmitted from reinfected but unvaccinated people to any of their close contacts.
What are the risks of depending only on natural immunity to protect you in the future? (Last updated 4/19/22)There appears to be a lot of variability in the level of a person’s protection through the natural immunity from a prior infection. For example, the level of protection depends on how severe the initial infection was and the person’s age. Also, we don’t know yet how long natural immunity will protect individuals from being reinfected with the Omicron variant or future variants. We do know that protection against reinfection decreases over time, for at least two reasons: (1) changes over time in the immune system itself AND (2) changes in the viral targets of the immune system.
(1) Decreasing immunity levels: The amount of COVID-19 antibodies in the blood decreases over time. As is the case with other viruses, protection from cellular immunity, the other major part of the immune system, probably decreases over time as well. The speed of that decrease for COVID-19 is still uncertain.
(2) Escape of viral variants from the immune system: Because new variants such as the Omicron variant are likely to have some different proteins on their outer coats, they appear to be less susceptible to being neutralized by immunity that was produced in response to an earlier infection by a different variant. Future variants might behave like the Omicron variant, meaning that protection after a natural infection is not as strong or does not work as well against these variants.
Relying only on a previous infection might also be risky for developing long-term COVID-19 complications. Published studies so far have focused on how prior infection, vaccination, or both can protect against future infection. But less is known about how these can protect against developing Long COVID (also called post-COVID conditions) if you are reinfected.
How do I learn more about COVID-19 if I speak a different language? (Last updated 3/22/21)At the top of all VDH web pages, there is a Google Translate button that says 'Select Language.' The button looks like this:
Clicking on this button translates web page content into 100+ different languages immediately. From there, you can go to the main COVID-19 page at: https://www.vdh.virginia.gov/coronavirus/ where you can learn more about COVID-19.
The vdh.virginia.gov website is providing the “Google Translate” option to assist you in reading the vdh.virginia.gov website in languages other than English. Google Translate cannot translate all types of documents, and may not provide an exact translation.
¿Cómo puedo obtener más información sobre COVID-19 si hablo un idioma diferente? (Última actualización 3/22/21)En la parte superior de todas las páginas de web del VDH, hay un botón del Traductor de Google que dice "Seleccionar idioma". En inglés, el botón de Traductor de Google dice “Select Language” y aparece así:
Al hacer clic y seleccionar el idioma preferido, el contenido de la página web puede ser traducido a más de 100 idiomas diferentes inmediatamente. Desde allí, puede ir a la página principal de COVID-19: COVID-19 en Virginia donde puede obtener más información sobre el COVID-19.
El sitio web vdh.virginia.gov ofrece la opción "Traductor de Google" para ayudarle a leer el sitio web de vdh.virginia.gov en otros idiomas además de inglés. Google Translate no puede traducir todos los tipos de documentos y es posible que no proporcione una traducción exacta.
Virginia Questions
What is the current status of COVID-19 in Virginia? (Last updated 3/6/22)Spread of the Omicron variant of COVID-19 is happening throughout Virginia. Check the VDH Website for daily updates of cases, hospitalizations and deaths associated with COVID-19 as well as outbreak and testing information. To find your COVID-19 Community Level, visit the CDC website.
What is VDH doing to monitor the status of COVID-19 in Virginia? (Last updated 4/29/22)VDH continues to collect and monitor the data on COVID-19 cases, hospitalizations, and deaths.
VDH continues to work with our laboratory partners at the Division of Consolidated Laboratory Services. Genomic surveillance of positive samples to identify how the SARS-CoV-2 virus can be genetically different, helps us monitor for specific variants and to detect other genetic changes in the virus that are present in positive cases in Virginia.
VDH epidemiologists might identify situations of concern, for example, COVID-19 infection in people who had recent international travel to an area where new variants are coming up, outbreaks that seem to spread very quickly, or cases of illness that are more severe than expected. In these situations, whole genome sequencing of samples can be requested to help our public health investigation and response efforts.
The VDH wastewater surveillance program can provide an early signal for a rise in COVID-19 cases, including cases with and without symptoms, and samples can also be tested for variants. Wastewater surveillance can also provide data on the prevalence (proportion of the population that have an infection) of the virus in the community when patient testing data is limited.
We are closely watching the effect of variants on several dynamics of the pandemic including the effect on how easily they spread, disease severity, on immunity after vaccination or natural infection, on the ability of tests to detect the virus, on the effectiveness of monoclonal antibody treatments, and on vaccine effectiveness.
COVID-19 Community Levels can help communities and individuals make decisions based on the level of COVID-19 transmission in their specific county,and their unique needs.
How can I find out which health district or health region my city or county is in?Use the VDH Geography Locator Tool to help you identify your health district and health region.
How is VDH responding to COVID-19 cases, people who have come in contact with sick people and outbreaks in Virginia? (Last updated 1/31/22)VDH is changing from trying to investigate every case of COVID-19 and trace all contacts to focusing on follow-up of outbreaks and cases in high risk settings. Public health staff will prioritize responding to COVID-19 clusters and outbreaks in long-term care facilities and other congregate settings, healthcare settings, and other high-risk settings, and will focus on follow-up with individuals most at risk for negative health effects from COVID-19. More information on contact tracing is available on the VDH website.
What is COVIDWISE? (Last updated 6/28/21)COVIDWISE is the official Virginia Exposure Notification System (ENS) app. This free smartphone app is available to all Virginians on Google Play and in the App Store. Your phone can be used to notify you quickly if you’ve been exposed. Using the app is voluntary and your privacy is protected. Location is never used and the app has a feature that can take symptom onset date into consideration.
Information on COVIDWISE can be found on VDH’s COVIDWISE webpage
FAQs regarding COVIDWISE can be found on VDH's COVIDWISE FAQ page.
Why did I receive a text message from VDH after my COVID-19 test? (Last updated 1/7/22)VDH will send a series of text messages to people who received a POSITIVE COVID-19 viral test. The texts will come from 804-336-3915 or 855-922-2644 and will only be sent between 8 a.m. and 8 p.m. The texts will provide rapid notification and encourage anyone who has tested positive for COVID-19 to stay home and away from other people. The texts will also provide a link to the COVIDWISE Verification Code Portal. This portal will allow individuals who have tested positive for COVID-19 to get a verification code, which will let them anonymously submit their test result through COVIDWISE, Virginia's free Exposure Notification app.
What should I do if I receive an exposure notification from COVIDWISE or COVIDWISE Express? (Last updated 6/14/22)If you receive an exposure notification from COVIDWISE or COVIDWISE Express, that means your device was in close contact with a device of someone who tested positive for COVID-19. VDH recommends that, if you are not up to date on COVID-19 vaccines or you have not tested positive with a viral test for COVID-19 in the last 6 months, you stay at home and away from others, especially from those at a higher risk of severe illness, as much as possible. Wear a mask for at least 10 days, get tested at least 5 days after your exposure and monitor your health. For more information on what to do following a potential exposure, please visit VDH's Exposed to COVID-19 website.
What is Sara Alert™? (Last updated 3/9/22)If you are exposed to someone with COVID-19, your local health department may ask you to check in with Sara Alert™. Sara Alert™ is an online tool developed by the national non-profit MITRE, in collaboration with state and national public health organizations to use daily health checks to monitor people who are sick with COVID-19 or who may have been exposed. If you are identified as being exposed to COVID-19 by your local health department, you will get a daily message from Sara Alert™ asking a few questions about how you’re feeling. The message will come from 844-957-2721 or an email from notifications@saraalert.org. By checking in with Sara Alert™, you can let the health department know via text, email, or phone how you’re feeling and help to slow the spread of COVID-19 in your community. Learn more about How Sara Alert™ Works.
Information on Sara Alert can be found on the Sara Alert webpage.
Disease Prevention
What prevention measures should individuals follow? (Last updated 6/16/22)Regardless of community transmission levels, VDH encourages everyone to stay up to date on their COVID-19 vaccines, including boosters, and to increase ventilation in indoor spaces.
Knowing the COVID-19 Community Level in your area will help you know what additional prevention measures to take when you are in the community.
Mask guidance:
- People with symptoms, a positive test, or who were exposed to someone with COVID-19 (and either not up to date on COVID-19 vaccines or have not tested positive for COVID-19 in the last 6 months) should wear a mask.
- People should also wear a mask based on the COVID-19 Community Level (low, medium or high) in areas where they live.
- People with weakened immune systems or who are at increased risk for severe illness :
- should talk to their healthcare provider about what extra precautions, like masking, that they may need.
- should wear a mask or respirator that gives them more protection when their COVID-19 Community Level is high.
- should avoid non-essential indoor activities when COVID-19 Community Level is high.
- People may choose to mask at any time.
- Please note, the COVID-19 Community Level mask guidance does not apply to healthcare settings; in these settings please follow CDC’s infection prevention and control recommendations for healthcare settings.
Testing guidance:
- At all COVID-19 Community Levels, get tested if you have COVID-19 symptoms.
- You should get tested five days after you are exposed to someone with COVID-19, if you have not recovered from COVID-19 (with a positive viral test) in the past 6 months or you are not up to date on your COVID-19 vaccines.
- People with weakened immune systems or who are at increased risk for severe illness should talk to their healthcare provider about testing recommendations, regardless of the COVID-19 Community Level.
- Medium or High COVID-19 Community Level: If you have household or social contact with someone at high risk for severe disease, you should consider self-testing to detect infection before contact.
- Treatments work best when started early, so rapid access to testing is critical for people at increased risk, in addition to other layers of prevention.
You can visit COVID.gov for information on COVID-19 vaccines, tests, treatments, and masks, as well as getting the latest updates on COVID-19 in your area.
Can wearing a mask protect me from getting or spreading COVID-19 if I have it? (Last updated 5/16/22)Yes.
While all masks and respirators provide some level of protection, properly fitted respirators provide the highest level of protection. Wearing a highly protective mask or respirator may be most important for certain higher risk situations (e.g., taking care of someone who has COVID-19), or by some people at higher risk for severe illness.
Masks can also help protect others in the surrounding area by reducing the amount of virus that any infected person, even someone who does not know yet that they are infected, can spread to others. This added protection is particularly important since many people infected with the Omicron, BA.2 and BA.2.12.1 variants can be infected but “asymptomatic”. Wearing a well-fitting mask can help reduce the amount of virus that an infected person, even an asymptomatic one, breathes out into her or his surroundings. Anyone around an infected person with no symptoms can still be protected in part if that infected person is wearing a mask and is thus breathing out smaller amounts of virus.
Some masks and respirators may be harder to tolerate or wear consistently than others. Therefore, it’s important that you always choose a well-fitting and comfortable mask or respirator and wear it properly (covering your nose and mouth). A mask or respirator will be less effective if it is not worn properly or taken off frequently.
The latest VDH guidance on masks, and when to wear one, can be found on the mask webpage. Masking guidance varies depending on the community level of COVID-19 transmission and the updated guidance does not apply to congregate or healthcare settings.
The CDC has a new webpage to help you Find Free Masks. Information on how to use your N95 respirator is available on the CDC website.
How can I get a free N95 mask? (Last Updated 3/17/22)High-quality non-surgical N95 masks are being made available to all Americans for free. Masks are available at community health centers and retail pharmacies across the U.S. Up to three masks will be available to each person for free.
You can visit CDC’s Find Free Masks (N95 Respirators) webpage where you can enter your zip code to find free respirators at participating locations.
You can also visit:
- Vaccines.gov to find pharmacies near you that are distributing free masks.
- HRSA Health Center COVID-19 N95 Mask Program to find community health centers distributing free masks.
Do I have to wear a mask when I go out in public or when I travel? (Last updated 2/7/22)If you are up to date with your vaccines, you should wear a mask in public indoor settings in areas of substantial and high transmission. This means you are in a place where the spread of COVID-19 is happening more often. You do not have to wear a mask or practice physical distancing in most outdoor settings except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance.
CDC has issued an order that requires masks to be worn by all travelers (irrespective of vaccination status) while on public transportation, such as airplanes, ships, buses (including school buses), trains (which includes all passengers and all personnel operating conveyances), and when in indoor transportation hubs. Travelers are not required to wear a mask in outdoor areas of a conveyance (like on a ferry or the top deck of a bus) or while outdoors at transportation hubs. This requirement to wear a mask on airplanes, rail travel, and public transportation has been extended through March 18, 2022.
CDC recommends that travelers who are not fully vaccinated continue to wear a mask and maintain physical distance when traveling.
You should wear a mask, regardless of vaccination status, when in healthcare settings, correctional or detention facilities, homeless shelters, in child care settings and while inside elementary schools.
Masks and respirators are effective at reducing the spread of the virus that causes COVID-19, when worn consistently and correctly.Some masks and respirators give more protection than others, and some may be harder to tolerate or wear frequently than others. It is most important to wear a well-fitted mask or respirator correctly that is comfortable for you and that provides good protection.
Masks should be washed after each use, if they are the washable, non-disposable type. Masks should not be placed on children younger than 2 years of age, anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the cover without assistance.
Visit Your Guide to Masks for additional information from the CDC.
Visit the Mask webpage for more information from VDH.
Where can I find guidance on cleaning and disinfecting surfaces in my home? (Last updated 1/24/22)In most situations, cleaning alone with a household cleaner that contains soap or detergent removes most virus particles on surfaces. You should clean AND disinfect to reduce transmission of COVID-19 when someone in your home is sick or if someone who is positive for COVID-19 has been in your home within the last 24 hours. Please see CDC’s guidance on cleaning and disinfecting your home. CDC also provides easy to read material.
Can portable HEPA filters be used to protect my household, while I am recovering from COVID-19? (Last updated 4/28/22)Portable air cleaners (also known as air sanitizers or purifiers) can help get clean air delivered by using a high-efficiency particulate air (HEPA) filter. A HEPA filter is a type of mechanical air filter that can likely remove at least 99.7% of dust, pollen, mold, bacteria, and small airborne particles.
When used properly, portable air cleaners and HEPA filters can help reduce airborne contaminants. Portable HEPA filters may be especially helpful when you cannot let in outdoor air without compromising indoor comfort (temperature or humidity), or when outdoor air pollution is high. Portable air cleaners and HEPA filters can be used along with other best practices recommended by CDC and VDH, as part of a plan to protect households. But by itself, portable air cleaning or HEPA filtration is not enough to protect people from exposure to the virus that causes COVID-19. It is important to stay up to date on COVID-19 vaccines and use other prevention measures.
The VDH fact sheet has information on how to improve ventilation, to reduce the risk of COVID-19 spread indoors.
You can view the CDC Interactive Ventilation Tool to see how particle levels change indoors, as you adjust ventilation settings.
Additional household precautions and other best practices recommended are available:
Caring for Someone with COVID-19
The United States Environmental Protection Agency (EPA) provides information about Air Cleaners, HVAC Filters, and Coronavirus (COVID-19) and also provides a Guide to Air Cleaners in the Home.
How can I improve ventilation in my building or place of residence? (Last updated 4/28/22)SARS-CoV-2 viral particles spread between people more easily indoors than outdoors. Ask experienced heating, ventilation, and air conditioning (HVAC) professionals when considering changes to HVAC systems and equipment.
Ways to improve ventilation indoors are available on the CDC website.
More detailed information about improving ventilation can be found on CDC’s Ventilation in Buildings page. The Environmental Protection Agency (EPA) also issued guidance in March 2022 (Clean Air in Buildings Challenge: Guidance to Help Building Owners and Operators Improve Indoor Air Quality and Protect Public Health).
The VDH fact sheet has information on how to improve ventilation, to reduce the risk of COVID-19 spread indoors.
You can also view the CDC Interactive Ventilation Tool where you can create different scenarios by selecting options, to see how particle levels change indoors, as you adjust ventilation settings.
Exposure to COVID-19
How can I determine if I have been exposed to COVID-19? (Last updated 4/15/22)To be considered exposed to COVID-19, you have to have had close contact with someone who is suspected or confirmed to have COVID-19 while they are contagious (can spread the infection).
Close contact means:
- Being within 6 feet of a person with COVID-19 for a total of 15 minutes or more over a 24-hour period, OR
- Having exposure to respiratory secretions from a person with COVID-19 (e.g., being coughed or sneezed on, sharing a drinking glass or utensils, kissing)
A person with COVID-19 is considered to be contagious starting two (2) days before they become sick (or 2 days before they test positive if they never had symptoms) and lasting until they meet the criteria to discontinue isolation.
Using the COVIDWISE app on your phone can help keep track of exposure. COVIDWISE is an early notification tool that individuals can use to notify contacts, or be notified themselves of an exposure.
For more information visit VDH’s what to do if you've been exposed to COVID-19. CDC has a fact sheet with Recommendations for COVID-19 Close Contacts.
What should I do if I am not up to date with my COVID-19 vaccines but have had close contact with someone with COVID-19? (Last updated 2/23/22)Visit VDH’s what to do if you've been exposed to COVID-19 for complete guidance.
- Quarantine. Counting the last time you had contact with that person as Day 0, you should quarantine (stay home) for 5 days afterwards (i.e. Day 0-5).
- Wear a well-fitting mask around other people, inside your home or in public for 10 days. Do not go to places where you are unable to wear a mask. Avoid travel for 10 days.
- Monitor your health for 10 days after your last contact. Look for common symptoms of COVID-19.
- Get tested on Day 5 or soon after, if possible. Get tested immediately if you develop symptoms. If your test is positive, follow the isolation guidance.
- Respond to notifications. If you use the COVIDWISE app and receive a notice that you have been exposed, stay home (quarantine), and monitor your health after the possible exposure.
Who is NOT required to quarantine if they have been exposed? (Last updated 6/10/22)These people are not required to stay home (quarantine) after exposure:
- People who are up to date with your COVID-19 vaccines.
- People who had COVID-19 within the last 6 months (you tested positive using a viral test) if they have fully recovered and remain asymptomatic.
- People who had COVID-19 within the last 90 days (you tested positive using a viral test) if they have fully recovered and remain asymptomatic in the following settings: healthcare workers/facilities or staff and residents of long term care facilities, correctional facilities, or homeless shelters.
Other people might not have to stay home (quarantine) after exposure.
- Students ages 5-11 years who completed their COVID-19 primary vaccine series but have not yet received a booster can forgo quarantine at this time. However, starting with the beginning of the 2022-2023 academic school year, all students should follow general CDC Quarantine Guidance, and should quarantine if they are not up to date on COVID-19 vaccines (including booster doses, when eligible).
- Healthcare personnel (HCP) who are up to date on their vaccinations for COVID-19 should be tested immediately (but generally not earlier than 24 hours after the exposure) and 5–7 days after exposure, even if they don’t have symptoms. However, they do not need to stay home (self-quarantine) after a workplace or community-associated exposure or be restricted from work as long as they are not immunocompromised (e.g., organ transplant, cancer treatment) or do not have any symptoms. HCP who have recovered from SARS-CoV-2 infection in the prior 90 days and do not have any new symptoms do not require work restriction following a higher-risk exposure. HCP should continue to follow quarantine recommendations after close contact and follow all travel recommendations. For additional details, visit CDC’s Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the COVID-19 Pandemic.
- People who traveled in the United States or arrived back in the United States after traveling internationally should visit VDH’s Travelers website for information about testing requirements and recommendations for travelers.
People who are not required to stay home (quarantine) after exposure should still watch for symptoms of COVID-19 for 10 days and continue to wear a mask, stay at least 6 feet away from others, avoid crowds and poorly ventilated indoor spaces, and wash hands often.
If I am a close contact of a person with COVID-19, when should I get tested? (Last updated 6/20/22)It depends on the situation.
- If you develop COVID-19 symptoms, you should get tested immediately.
- If you do not develop COVID-19 symptoms and are not up to date on COVID-19 vaccines, you should consider getting tested 5 days (or soon after) following your last close contact with the person with COVID-19. If you have ongoing exposure (e.g.,as a household contact or caregiver), even if you are up to date on COVID-19 vaccines, you should consider getting tested twice.The first time is 5–7 days after the first exposure. The second time is 5–7 days after the end of isolation for the person with COVID-19.
- If you tested positive for COVID-19 with a viral test within the previous 6 months and recovered afterwards, and remain without COVID-19 symptoms, you do not need to get tested after close contact.
More information can be found on the VDH COVID-19 Testing website.
If I test negative after exposure and have quarantined, can I leave home and go back to work? (Last updated 1/11/22)People who are not up to date with their COVID-19 vaccinations should quarantine for 5 days following their last exposure, even if they have a negative test during this period: If you do not develop symptoms, counting your date of last exposure as Day 0, you should get tested on or soon after Day 5, if possible. If you test negative on or after Day 5, you can end quarantine (leave your home) after Day 5 if you do not have COVID-19 symptoms. You should continue to wear a mask when around others and in public for Days 6–10. If you cannot wear a mask around others, quarantine at home until Day 10 after your last exposure.
It can take up to 10 days after an exposure for you to develop symptoms of COVID-19.People who are up to date with their COVID-19 vaccinations and those who had COVID-19 in the last 3 months (90 days) do not need to quarantine if they do not have COVID-19 symptoms.
More information can be found on the VDH COVID-19 Testing website.
What should I do if I am a contact of a close contact? (Last updated 1/11/22)You do not need to be tested or stay home (quarantine) if you are a contact of a contact. But you should stay in touch with that contact person. If your contact person tests positive for COVID-19, then you become a true close contact and may have to be tested and stay home (quarantine), depending on your vaccination, booster or recent COVID-19 recovery status.
How do I monitor my health at home if I believe I have been exposed to COVID-19? (Last updated 5/20/21)If you have been in close contact with a person with COVID-19, you should take your temperature twice daily and remain alert for COVID-19 symptoms. It is important to not eat, drink, or exercise for at least 30 minutes before taking your temperature. These symptoms include fever, cough, chills, muscle or body aches, headache, sore throat, new loss of taste or smell, shortness of breath or difficulty breathing, congestion or runny nose, nausea or vomiting or and diarrhea.
It may take up to 10 days after an exposure for you to develop COVID-19. You can download VDH’s Daily Symptom Monitoring Log to help keep track of your symptoms. The health department might also use an electronic symptom monitoring program for those who have been assessed as exposed to COVID-19.
For more information, visit VDH’s If you are sick or Infected website.
Where can I get more information about monitoring myself after a potential COVID-19 exposure?For more information on what you should do if you have been exposed to COVID-19, visit the VDH Exposure to COVID-19 Website.
Illness from COVID-19
What are COVID-19 symptoms? (Last updated 9/3/21)People with COVID-19 might not have any symptoms. If they do have symptoms, these can range from mild to severe.
Symptoms can include:
- Fever
- Chills
- Cough
- Shortness of breath or difficulty breathing
- Fatigue (feeling very tired)
- Muscle or body aches
- Diarrhea
- Headache
- Sore throat
- New loss or change in taste or smell
- Stuffy or runny nose, and
- Nausea or vomiting
This list does not include all possible symptoms and will be updated as we learn more about COVID-19. See the list of symptoms on the CDC website.
Because COVID-19 symptoms can look different in different people, it is important to get tested and/or speak to your healthcare provider if you have any concerns about your symptoms. You can use the Coronavirus Self-Checker to help you decide when to seek testing or medical care.
Is it possible to have the flu and COVID-19 at the same time? How can I tell if I have the flu or COVID-19? (Last updated 1/25/22)Yes. It is possible to be infected by the flu and COVID-19 at the same time. The best way to prevent this from happening is to get vaccinated against both COVID-19 and the flu. One vaccine is not a substitute or a replacement for the other.
Both influenza (flu) and COVID-19 are contagious respiratory illnesses, but they are caused by different viruses. COVID-19 is caused by the SARS-COV-2 virus and flu is caused by influenza viruses. Symptoms of flu and COVID-19 can be similar, so testing will be needed during flu season to know which disease you have.
If you have flu or COVID-19 symptoms, you should stay home and contact your Healthcare Provider for evaluation, treatment, and testing.
More information regarding similarities and differences between flu and COVID-19 is available on the CDC website.
How do the symptoms of COVID-19 compare to other common illnesses?VDH created a chart comparing the symptoms of seasonal allergies, the common cold, strep throat, flu, and COVID-19.
If you have concerning symptoms, you should stay home and contact your healthcare provider for evaluation, treatment, and possible testing.
What should I do if I have a positive test for COVID-19 or if I was instructed to isolate (stay home)? (Last updated 4/7/22)If you have symptoms or a positive test for COVID-19, follow the steps below to prevent spreading COVID-19 to people in your home and community:
- Contact your healthcare provider right away and call ahead before visiting your healthcare provider if you think you might have COVID-19, to determine if you need treatment.
- Stay home (isolate) for at least 5 days, except to get medical care. Visit VDH’s Isolation Calculator. Do not go to work, school, or public areas and avoid using public or group transportation. Stay in touch with your doctor. Be sure to get care or find treatment options if you feel worse or think it is a medical emergency. Your first day of symptoms should be counted as Day 0. If you have a positive test and no symptoms, Day 0 is the day you tested. You can leave isolation on Day 6 if you are fever-free for 24 hours without fever-reducing medication, your other symptoms have improved, and you can wear a mask around other people through Day 10.
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- Separate yourself from other people and animals in your home as much as possible and avoid contact with other household members, including pets.
- If you are immunocompromised, consult your healthcare provider for the duration of your isolation and visit CDC’s Ending Isolation web page.
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- Get tested if you have symptoms, regardless of vaccination status. If you cannot find a test, continue to follow steps for isolation until you can get tested.
- Wear a well-fitting mask or respirator for 10 days when you are around other people (e.g., sharing a room or vehicle) or pets.
- Cover your coughs and sneezes and dispose of any tissues in a lined trash can. If you are able to, wash your hands with soap or use an alcohol-based hand sanitizer that contains at least 60% alcohol right away.
- Wash or clean your hands often with soap and water for at least 20 seconds. Avoid touching your eyes, nose, and mouth. If you can’t wash your hands with soap and water, use an alcohol-based hand sanitizer with at least 60% alcohol, covering all surfaces of your hands and wrists and rubbing them together until they feel dry.
- Avoid sharing personal household items (e.g., dishes, drinking glasses, towels, etc.)
- Clean all “high-touch” surfaces every day and your “sick room.”
- Tell your recent close contacts that they may have been exposed to COVID-19. An infected person can spread COVID-19 starting 48 hours (or 2 days) before the person has any symptoms or tests positive.
- Call 9-1-1 if you have a medical emergency. Emergency warning signs include (but are not limited to): trouble breathing, persistent pain or pressure in the chest, new confusion or inability to arouse a person, or pale, gray or blue-colored skin, lips or nail beds, depending on skin tone. Please consult your healthcare provider for any symptoms that are severe or concerning.
Find more details about what to do if you are sick at: What to do if you are Sick. CDC has fact sheets with recommendations for people with COVID-19 and CDC Interim Guidance on Home Isolation
This VDH guidance applies to general community settings, including K-12 schools, colleges and universities, and workplaces. It does not apply to healthcare facilities or high-risk congregate settings (e.g., correctional and detention facilities, homeless shelters, or cruise ships). Visit VDH’s Schools, Workplaces, & Community Locations webpage for additional details for how to isolate in your particular setting.
Who is at risk for serious illness from COVID-19? (Last updated 4/5/21)These groups, or people that fit into more than one of these groups, are at higher risk for developing severe illness:
- Older people
- People living in a nursing home or long-term care facility
- People with weakened immune systems
- People of any age with certain medical conditions and disabilities
- People from racial and ethnic minority groups
What is a breakthrough infection with COVID-19? (Last updated 4/21/22)”Breakthrough infection” is a term describing a SARS-CoV-2 virus infection that causes a usually mild COVID-19 illness even after you have been fully vaccinated or are up-to-date with your COVID-19 vaccinations. In public health terms, breakthrough infections should not be considered vaccine failures because they are expected to occur in some people who receive any vaccine, since no vaccine is 100% effective. Breakthrough infections are nearly always mild although they can sometimes be more severe in people whose immunity is weakened because of an underlying illness or because they are elderly. In nearly everyone else, being up to date with COVID-19 vaccination is highly protective against severe illness and hospitalization.
Are there long-term health effects associated with COVID-19? (Last Updated 4/20/21)Yes, there can be.
Although most people with COVID-19 get better within weeks to months of illness, some do not. Scientists around the world are working to learn more about short- and long-term health effects associated with COVID-19, who gets them, and why. CDC uses the term post-COVID conditions to describe health issues that persist more than four weeks after first being infected with the virus that causes COVID-19.
Experts do not know why or how often some people experience post-COVID conditions. Other infectious diseases can also cause longer-term symptoms for a variety of reasons. Some post-COVID conditions are likely to be similar to those seen in other infectious diseases, but others may be more specific to COVID-19.
The best way to prevent long-term effects of COVID-19 is by getting vaccinated against COVID-19 as soon as you can.
More information on long-term effects of SARS-CoV-2 infection and COVID-19 illness can be found on CDC’s Post-COVID Conditions website.
Where can I find more information about symptoms and illness associated with COVID-19? (Last updated 5/4/21)Check out the following website(s):
VDH What to do if you have confirmed or suspected coronavirus disease (COVID-19)?
CDC also provides easy to read materials:
Long COVID
What is Long COVID? (Last Updated 3/19/22)Long COVID is also known as post-COVID conditions. People suffering from Long COVID are sometimes called “Long Haulers”. Long COVID is a range of symptoms that can last weeks or months after first being infected with the SARS-CoV-2 virus that causes COVID-19. Long COVID symptoms can appear weeks after initial infection. Long COVID can happen to anyone who has had COVID-19, even if the illness was mild, or even if they had no symptoms. People with long COVID report experiencing different combinations of the following symptoms:
- Tiredness or fatigue
- Difficulty thinking or concentrating (sometimes referred to as “brain fog”)
- Headache
- Loss of smell or taste
- Dizziness on standing
- Fast-beating or pounding heart (also known as heart palpitations)
- Chest pain
- Difficulty breathing or shortness of breath
- Cough
- Joint or muscle pain
- Depression or anxiety
- Fever
Some of these symptoms can get worse after physical or mental activities.
More information on long-term effects of COVID-19 illness can be found on CDC’s Post-COVID Conditions website.
The World Health Organization (WHO) developed a clinical case definition of post COVID-19 condition in October 2021, stating that the condition is “usually 3 months from the onset of COVID-19 with symptoms and that last for at least 2 months and cannot be explained by an alternative diagnosis.”
Can “Long COVID” occur in people who are up to date with their COVID-19 vaccines? (Last updated 5/26/22)Yes. However, being up to date with COVID-19 vaccination reduces the risk of getting Long COVID.
The extent of protection from Long COVID with vaccination is uncertain. Among people who do get COVID-19 disease, recent information from a large British study suggests that, compared to vaccinated people who get breakthrough COVID-19 infections, about twice as many unvaccinated people who get COVID-19 have symptoms lasting more than 28 days. Another large study suggests that vaccines offer less protection against long term symptoms than previously expected. This is an evolving area of research. Additional studies will be needed to clarify the ultimate burden of “Long COVID” in vaccine breakthrough cases.
Can “Long COVID” occur in children? (Last updated 3/16/22)Yes. According to a recent large review (that is not yet peer reviewed), 1 in 4 children with COVID-19 symptoms develop "Long COVID”. The most common reported symptoms were mood symptoms, fatigue, and sleep disorders.
The information on Long COVID is evolving. What have we learned recently? (Last updated 5/12/22)As more is learned about the natural history of SARS-CoV-2 infection, the symptoms and conditions will likely change over time.
A UK study, published in the journal called Nature, shows that even mild COVID-19 illness can lead to changes in the brain, with less gray matter in the parts related to smell and memory.
A study published in the medical journal Radiology shows that small airway disease and air trapping occurs and persists in some individuals, regardless of the severity of their prior COVID-19 illness.
A study published in Nature, showed that individuals with COVID-19 , even those who were not hospitalized, are at increased long term risk of cardiovascular disease (including cerebrovascular disorders, dysrhythmias, ischemic and non-ischemic heart disease, pericarditis, myocarditis, heart failure and thromboembolic disease.)
A CDC MMWR shows that approximately 1 in 5 adults 18+ have a health condition that might be related to their previous COVID-19 illness.
See how CDC is using science to learn more about long COVID
Are there clinics in Virginia specifically dedicated to post COVID-19 conditions? (Last updated 7/8/21)Most post-COVID conditions can be diagnosed and managed by primary care providers. If needed, specialty care providers and support services (e.g., occupational therapy, physical therapy, social work) can work with people with this condition to help them rehabilitate and regain their strength and abilities. Healthcare professionals may also consider referral to post-COVID care centers for additional care.
There are a number of post-COVID care centers (PCCC) in Virginia. The following list may not include all centers. VDH does not recommend or endorse specific clinics.
INOVA Post COVID-19 Recovery and Rehabilitation (Northern Virginia)
UVA Post COVID clinic (Charlottesville, VA)
Sheltering Arms Post-COVID-19 (coronavirus) rehabilitation (Mechanicsville, VA)
Centra Health Post-COVID Recovery Care Program (Lynchburg, VA)
Sentara Heart Hospital Post-COVID Clinic (Norfolk, VA)
The VCU Health Long COVID-19 Clinic (Richmond, VA)
How can I participate in a long COVID study? (Last updated 3/16/22)The RECOVER (Researching COVID to Enhance Recovery) initiative is working on a nationwide study population to support research on the long-term effects of COVID-19. This program is a research initiative from the National Institutes of Health (NIH). Interested volunteers can visit the website for more information.
How is Long COVID usually treated? (Last updated 3/19/22)Because people with Long COVID have such a large range of possible symptoms, the evaluation and treatment of each Long COVID patient is individualized to the specific symptoms of that patient.
Is Long COVID occurring after infection with the Omicron variants BA.2 or BA.2.12.1? (Last updated 4/14/22)Because the Omicron and its sub-variants have been causing COVID-19 disease for only a short period and because disease caused by them is milder than COVID-19 disease caused by earlier variants, it is not yet clear whether the risk of Long COVID after Omicron or BA.2 infections is any different from the Long COVID risk after earlier COVID-19 variants.
Are people diagnosed with Long COVID eligible for disability benefits? (Last updated 3/18/22)As of July 2021, Long COVID can be considered a disability under the Americans with Disabilities Act (ADA). Learn more: Guidance on “Long COVID” as a Disability Under the ADA, Section | HHS.gov.
Treatment for COVID-19
What is the recommended treatment for COVID-19 and other coronaviruses? (Last updated 2/22/22)People with known or suspected COVID-19 should contact their healthcare provider for specific medical advice. In general, people with mild illness should stay home, rest, drink plenty of fluids, and take over-the-counter (OTC) medication(s) to help relieve symptoms they are having. Be sure to follow the instructions on the package of the OTC medication, and do not give OTC cough or cold medicine to children under 6 years old. A table of types of OTC medication(s) you can take for each symptom is available on VDH’s web page What to do if you have confirmed or suspected coronavirus disease (COVID-19). Continue to monitor your symptoms and call your healthcare provider if they get worse or you are concerned. Be sure to stay away from others (isolate) in the home to prevent the spread of disease.
For most persons with mild illness, the measures noted above may be all that is needed. Healthcare providers may recommend treatment with a monoclonal antibody or antiviral medication for people with mild to moderate COVID-19 illness who are considered high risk for progression to severe COVID-19. Persons with medical conditions or disabilities that put them at high-risk for severe COVID-19 should contact their healthcare provider as soon as symptoms start.
People with more serious illness should call their healthcare provider and follow their recommendations for treatment and self-care.
People who develop emergency warning signs such as (1) trouble breathing, (2) persistent pain or pressure in the chest, (3) new confusion or inability to arouse or (4) bluish lips or face, need immediate medical attention and 911 should be called. Please note this list is not all inclusive and any person who has other severe or concerning symptoms should contact his/her medical provider. If you need to call 911, notify the dispatch personnel that you have, or are being evaluated for, COVID-19. If possible, put on a mask before emergency medical services arrive. Do not place a mask of any kind on children under 2 years of age. Please see the American Academy of Pediatrics (AAP) recommendations on Face Masks for Children During COVID-19.
Please consult a physician or other healthcare provider for additional recommendations about disease treatment. Further information can be found on CDC’s Treatments Your Healthcare Provider Might Recommend if You Are Sick webpage and on VDH’s Treatments are available for COVID-19 and COVID-19 Therapeutics websites.
What is remdesivir? How can it be used? (Last updated 5/3/22)Remdesivir (brand name = Veklury) is an antiviral drug that is used to treat patients with COVID-19. The drug can be used to treat patients who are hospitalized or those who don’t need to be in the hospital. The FDA has approved remdesivir to treat hospitalized adults and children aged 28 days or older weighing at least 3 kg and who 1) are hospitalized, or 2) are not hospitalized and have mild-to-moderate COVID-19, and are at high risk for progression to severe COVID-19, including hospitalization or death. Remdesivir is given by a healthcare provider who injects the drug into a person’s vein.
Are there other drugs or therapies for the treatment of COVID-19? (Last updated 6/1/22)Yes.
Paxlovid (nirmatrelvir and ritonavir) is a prescription antiviral pill that can be taken at home. On December 22, 2021, FDA granted the drug an Emergency Use Authorization (EUA) to treat COVID-19 patients 12 years or older who are at high-risk of developing severe COVID-19. A large study indicated that if the drug was used within the first five days of illness onset, it was nearly 90% effective in preventing the development of severe COVID-19. Effectiveness in those 65 years or older was about 94%.
Molnupiravir (brand name is Lagevrio) was authorized by FDA on December 23, 2021 to treat infected adults aged 18 years and older who are felt to be at high-risk of severe outcomes from COVID-19. Molnupiravir is a prescription antiviral capsule that can be taken at home. Because testing of molnupiravir in animals suggested a risk of fetal harm, it should not be used in women who are pregnant, at risk of becoming pregnant, or who are breastfeeding.
Paxlovid and Molnupiravir are NOT to be considered as a substitute for COVID-19 vaccination.
For more information about therapies for COVID-19, please visit CDC’s Treatments Your Healthcare Provider Might Recommend if You Are Sick webpage and VDH’s Treatments are available for COVID-19 and COVID-19 Therapeutics websites.
Where can I get the oral antiviral medication Paxlovid and Molnupiravir? (Last updated 2/23/22)Patients can use the COVID-19 Treatment Locator to find a pharmacy near them that carries the medication. Both oral antiviral medications require a prescription from a healthcare provider.
What are monoclonal antibodies and how can they be used to treat COVID-19? (Last updated 5/17/22)When a virus (or other germ) enters your body, your immune system responds by producing antibodies, which help the body fight off infection. Monoclonal antibodies against the SARS-CoV-2 virus (the virus that causes COVID-19) are versions of the antibodies your body naturally makes against the virus, but are made in a laboratory.
Monoclonal antibodies can be used in three different ways: 1) to prevent COVID-19 in someone before they are exposed to the virus (pre-exposure prophylaxis), 2) to prevent COVID-19 in someone who has already been exposed to the virus (post-exposure prophylaxis), and 3) to treat someone who has COVID-19 (treatment).
Pre-Exposure Prophylaxis
The FDA has authorized Evusheld, a combination of two different monoclonal antibodies (tixagevimab and cilgavimab), for emergency use for pre-exposure prophylaxis (prevention before exposure) against COVID-19 in adults and pediatric patients (12 years of age and older weighing at least 40 kg) who are not currently infected with SARS-CoV-2 and who have not had a known recent exposure to an individual infected with SARS-CoV-2 AND:
- Who have moderate to severe immune compromise and may not mount an adequate immune response to COVID-19 vaccination, OR
- For whom vaccination with any available COVID-19 vaccine, according to the approved or authorized schedule, is not recommended due to a history of a severe adverse reaction.
Post-Exposure Prophylaxis
The FDA had previously authorized two combinations of monoclonal antibodies for emergency use as post-exposure prophylaxis (prevention after exposure) for COVID-19 in certain adults and children who were at high risk for progression to severe COVID-19. These were:
- REGEN-COV
- Bamlanivimab and etesevimab
Both of these monoclonal products, however, are not currently authorized because they are not effective against the Omicron variant that is dominant in the U.S. There are currently no FDA authorized or approved medications for post-exposure prophylaxis against COVID-19.
Treatment
Use of the monoclonal antibody bebtelovimab has been authorized by FDA to treat non-hospitalized patients 12 years and older who are confirmed to have COVID-19 and are at high-risk of progression to severe COVID-19. Current data shows that bebtelovimab has activity against the Omicron BA.2 subvariant.
Information on other specific therapies can be found on VDH’s COVID-19 Therapeutics webpage and NIH’s COVID-19 Treatment Guidelines website.
There are clinical trials underway to see if other monoclonal antibodies are safe and effective at preventing or treating COVID-19. For more information about monoclonal antibodies and COVID-19, visit the National Institutes of Health (NIH) websites and the VDH COVID-19 Therapeutics website.
Where can I get Evusheld (monoclonal antibodies) for pre-exposure prophylaxis? (Last updated 12/29/21)Patients can use the COVID-19 Treatment Locator to find a monoclonal antibody administration site near them. Most monoclonal antibody administration sites require a prescription and an appointment for treatment.
Does my healthcare provider need to refer me to a monoclonal antibody administration site? (Last updated 2/23/22)Yes. Most monoclonal antibody administration sites require a referral or prescription from a healthcare provider and an appointment to receive treatment. Most sites do not take walk-in patients.
Are there side effects after taking the monoclonal antibodies or oral antiviral medications? (Last updated 2/23/22)Side-effects vary by the type of treatment. Please consult the package insert for the specific product to see reported side effects. Package inserts can be found on the FDA website for COVID-19 therapies. Reported side effects (not an all-inclusive list) across products may include nausea, diarrhea, skin rash and allergic reactions.
IV infusions and injections also may cause brief pain, bleeding, skin bruising, soreness, swelling, and infection at the location where the IV was placed. Talk to your healthcare provider if you experience any side effect that bothers you or does not go away quickly.
What will it cost me to receive monoclonal antibodies and/or oral antiviral medications? (Last updated 5/17/22)The following medications have been purchased by the U.S. Government and are free to all patients:
- Paxlovid
- Molnupiravir (Lagevrio)
- Bebtelovimab
- Evusheld
Pharmacies that dispense Paxlovid and molnupiravir are not allowed to charge for the medications. Facilities that administer bebtelovimab and Evusheld may not charge for the medication itself, however, they are allowed to charge an administration fee for giving the medication intravenously or by intramuscular injection. Patients must have a prescription from their physician to receive these medications.
Is it safe to take ibuprofen if I have COVID-19?Yes. There is currently no scientific evidence to show that taking ibuprofen while sick with COVID-19 will lead to worsening illness. Either ibuprofen or acetaminophen is commonly used to reduce fever. However, both acetaminophen and ibuprofen, like any medication, can have serious side effects. If you use ibuprofen and/or acetaminophen, be sure to use it according to the instructions that came with the product. If you are unsure what the best or appropriate medication is for you, be sure to consult with your healthcare provider.
Should animal ivermectin be used to treat COVID-19 in humans? (Last updated 2/22/22)No. Animal products containing ivermectin SHOULD NOT be used in people. These products can cause serious health effects, including death. While there are approved uses for ivermectin in people and animals, ivermectin has not been shown to be a safe or effective way to prevent or treat COVID-19. According to a study in JAMA Internal Medicine from February 2022, early treatment with ivermectin in adults with mild to moderate COVID-19 and other medical conditions did not lower the risk of severe disease compared to similar study participants who did not receive ivermectin. Additionally, a research team that looked at patients in Brazil, found no meaningful difference in outcomes for patients taking ivermectin vs. placebo, and the drug did not reduce hospital admissions.
Ivermectin is approved by the FDA to treat people with intestinal strongyloidiasis and onchocerciasis, two conditions caused by parasitic worms. In addition, some topical forms of ivermectin are approved to treat external parasites like head lice and for skin conditions such as rosacea. If your health care provider writes you an ivermectin prescription, fill it through a legitimate source such as a pharmacy, and take it exactly as prescribed.
Seek immediate medical attention or call the poison control center hotline (1-800-222-1222) for advice if you have taken ivermectin or a product that contains ivermectin and are having concerning side effects. Side effects may include gastrointestinal effects (nausea, vomiting, abdominal pain, and diarrhea), headache, blurred vision, dizziness, fast heart rate, and low blood pressure. Other severe nervous system effects have been reported, including tremors, seizures, hallucinations, confusion, loss of coordination and balance, decreased alertness, and coma.
For more information, please see FDA FAQ: COVID-19 and Ivermectin Intended for Animals and FDA: Why You Should Not Use Ivermectin to Treat or Prevent COVID-19
What is COVID rebound? (Last updated 5/31/22)COVID rebound is characterized by a recurrence of COVID-19 symptoms or a new positive test after an original COVID-19 diagnosis and resolution of symptoms or negative test. This rebound has been reported to occur between 2 and 8 days after initial recovery, and there are no reports of severe disease in these cases. While COVID-19 rebound syndrome is mentioned in association with Paxlovid, the Centers for Disease Control and Prevention (CDC) has stated that COVID-19 rebound may be part of the natural infection process, regardless of Paxlovid treatment or vaccination status.
Paxlovid continues to be recommended for early-stage treatment of mild to moderate COVID-19 among persons at high risk for progression to severe disease. Currently, there is no evidence supporting the need for additional treatment in cases where COVID rebound is suspected.
What options are available to individuals who experience COVID-19 rebound? (Last updated 5/31/22)Individuals may complete a COVID test after resolution of the original infection to ensure no rebound is occurring. If you have a positive COVID test at this point, individuals should take precautions since they may be contagious. On May 24, the CDC issued official guidance regarding COVID rebound. The CDC states that there is currently no evidence to support additional treatment with Paxlovid, or any other COVID-19 treatment, in cases where COVID-19 rebound is suspected.
Other CDC recommendations include following CDC’s guidance on isolation, including taking other precautions to prevent spreading illness. Patients should re-isolate for at least five days. Per CDC guidance, they can end their re-isolation period after five full days if fever has resolved for 24 hours (without the use of fever-reducing medication) and symptoms are improving. The patient should wear a mask for a total of 10 days after rebound symptoms started.
If an individual is experiencing COVID rebound, they should contact a healthcare provider if their COVID-19 rebound symptoms persist or worsen. The CDC encourages individuals to report a possible case of COVID-19 rebound after PAXLOVID treatment to Pfizer using the following online tool: Pfizer Safety Reporting.
Where can I find more information about treating COVID-19? (Last updated 1/10/22)Check out the following websites:
VDH: Treatments are available for COVID-19
VDH: What to do if you have confirmed or suspected coronavirus disease (COVID-19)
CDC: What to Do If You Are Sick
CDC: Caring for Someone Sick at Home
CDC: Treatments Your Healthcare Provider Might Recommend for Severe Illness
COVID-19 Variants
What are COVID-19 variants? (Last updated 5/3/22)When the SARS-CoV-2 virus, that is, the virus that causes COVID-19, infects someone, it uses the person’s cells to make many copies of itself. As part of this copying process, errors in copying DNA molecules can occur and the resulting virus does not have exactly the same genes as the “parent” virus. These changes to the viral genetic material (nucleic acid) are called mutations. It is normal and expected for the genetic material of many types of virus to constantly change through mutation. When a number of these kinds of mutations occur in a virus, it can lead to new variants or strains of the virus. Sometimes these new variants will appear for a short time and then disappear. Other times, these variants can spread in a population because the mutations might be able to affect (1) how easily a virus can spread; (2) the kind or severity of symptoms that develop in infected people; (3) how well the immune response after a natural COVID-19 infection or after COVID-19 vaccination can protect someone;(4) how effective specific treatments are against the variant; (5) how well diagnostic tests can identify the virus, etc.
The best way to stop COVID-19 variants from spreading - and from developing in the first place - is to prevent the spread of the virus that causes COVID-19 through the usual combination of vaccination and other preventive behaviors such as masking, avoiding poorly ventilated spaces, and physical distancing.
Additional resources:
“What causes a virus to change?”
CDC’s What You Need to Know about Variants.
The World Health Organization: the effects of virus variants on COVID-19 vaccines
How are the different variants of the SARS-CoV-2 virus classified? (Last updated 5/3/22)A U.S. government variant classification scheme has four classes of SARS-CoV-2 variants:
- (Variants of Concern (VoCs), the most important category, are those variants that
- have increased spread, or
- cause more severe disease (more hospitalizations or deaths), or
- resist neutralizing antibodies produced during previous COVID-19 infection or vaccination, or
- reduce the effectiveness of treatments or vaccines, or
- standard diagnostic tests are not able to detect.
- The other three variant classes include: (2) Variants of High Consequence (with no variants currently in this category) , (3) Variants of Interest, and (4) Variants Being Monitored.
Detailed information on the classification of variants can be found on CDC’s SARS-CoV-2 Variant Classifications and Definitions webpage.
The World Health Organization (WHO) also classifies some variant viruses as Variants of Concern. U.S. variant classifications may differ somewhat from those of the WHO because the importance of variants may differ by location.
What different variants of the SARS-CoV-2 virus are now in circulation in the United States? (Last updated 6/14/22)Scientists continue to monitor for genetic changes in the virus that causes COVID-19. Before the Omicron variant, many other variants of the virus have circulated but Omicron’s sub-variant called BA.2.12.1 is now the most common variant being seen in the United States and in Virginia. However, the frequency of the BA.4 and BA.5 Omicron sub-variants has been slowly but steadily increasing. See CDC’s Omicron Variant: What You Need to Know webpage, for some additional information about the Omicron Variant.
For the most up to date information on U.S. COVID-19 variants, please see the CDC site: SARS-CoV-2 Variant Classifications and Definitions.
The World Health Organization (WHO) also classifies variant viruses as Variants of Concern and Variants of Interest. U.S. classifications may differ slightly from those of the WHO because the importance of variants may differ by location.
More information on the variant viruses can be found on About Variants of Virus that Causes COVID-19 Detected and Genomic Surveillance for SARS-CoV-2 Variants.
What is known about BA.2 and BA.2.12.1, the most common sub-variants (lineages) of the Omicron variant virus in Virginia? (Last updated 6/13/22)The BA.2 and the related BA.2.12.1 sub-variants of the Omicron variant virus are causing most new COVID-19 cases in Virginia. These sub-variants seem to spread even more quickly than the original Omicron variant (BA.1).
We now know that the mutations of BA.2 and other new sub-variants of the original Omicron variant allow “immune evasion”, that is, they reduce the ability of antibodies from prior natural infection or from vaccination to block infection or re-infection with these variants. Recent infection with the BA.1 Omicron variant itself provides some limited protection against BA.2 infection. However, without vaccination, the natural immunity resulting from a pre-Omicron COVID-19 infection alone provides less protection against infection with BA.2, BA.2.12.1, or other Omicron sub-variants than it did against earlier variants. In contrast, being up to date with current COVID-19 vaccines (including a booster dose when eligible) provides significant protection against severe illness or death from these Omicron variants and sub-variants.
PCR (molecular) COVID-19 tests and most of the rapid antigen tests that are currently available in Virginia are still accurate for diagnosing the BA.2, BA.2.12.1, BA.4, and BA.5 sub-variants.
The severity of the BA.2 and BA.2.12.1 sub-variants seems to be similar to that of the original Omicron variant, with hospitalizations and deaths largely restricted to people with weakened immune systems and to the elderly population. However, severe outcomes for others, especially for unvaccinated people, are still possible.
While our current COVID-19 vaccines provide somewhat lower effectiveness against overall infection with BA.2 and BA.2.12.1, these vaccines continue to work well to prevent severe or fatal COVID-19 disease. In addition, COVID-19 infections that occur in people who are up to date with COVID-19 vaccination have a lower risk of spreading COVID-19 to others, compared to the spread of COVID-19 infections from unvaccinated people.
Although treatment with sotrovimab antibodies no longer works well against BA.2, other treatment drugs such as remdesivir, molnupiravir, Paxlovid, and Evusheld are still effective.
The standard COVID-19 prevention measures that have been effective against earlier COVID-19 variants (staying up to date with vaccination, masking, avoiding poorly ventilated spaces, etc.) are all effective in preventing infection with the BA.2 and BA.2.12.1 sub-variants as well. Additional COVID-19 prevention tips can be found on the CDC website.
For more information, visit CDC’s “Omicron Variant: What You Need to Know.
What is known about other new variants of the SARS-CoV-2 virus? (Last updated 6/13/22)Beyond the BA.2 and its BA.2.12.1 sub-variants, other Omicron sub-variants labeled as BA.4 and BA.5 are being monitored closely in South Africa, where they were first noted. In the United States, their numbers are small but growing steadily. Although the BA.4 and BA.5 variants seem to spread slightly more quickly than the BA.2 variant, there is no evidence yet that the severity of infection with these two sub-variants is greater than that seen with BA.2 or BA.2.12.1. In addition, it seems that vaccinated people have greater resistance than unvaccinated people to infection with these two sub-variants.
In addition, very small numbers of other Omicron sub-variants have been identified, e.g., BA.1.1, BA.3, BA.2.12, XD (a combination of Omicron and Delta), and XE (a combination of BA.1 and BA.2.) but so far, none of these other variants have begun spreading widely.
For information on variants in more detail than that found on the CDC or WHO variant webpages, visit the European CDC page.
Testing for COVID-19
Testing for COVID-19
Who should be tested for COVID-19? (Last updated 6/17/22)- People with symptoms of COVID-19.
- People who are not up to date on COVID-19 vaccines AND who have not had COVID-19 in the last 6 months and have come into close contact with someone with COVID-19 should be tested to check for infection at least 5 days after they last had close contact with someone with COVID-19. The date of the last close contact is considered Day 0.
- People who are not up to date with their COVID-19 vaccines who are prioritized for expanded community screening for COVID-19.
- People, regardless of vaccination status, who have been asked or referred to get testing by their school, workplace, healthcare provider, state, tribal, local, or territorial health department.
- People who plan to travel within the United States and U.S. territories should consider (not mandated) getting tested as close as possible to the time of departure (at least 3 days before travel).
- People who plan to travel internationally should check the COVID-19 situation at their destination with regard to the need for testing. If testing is not required by the foreign country, people should consider (not mandated) getting tested as close as possible to the time of departure (at least 3 days before travel). As of June 12, 2022, people returning to the United States from a foreign country are no longer mandated to show a negative COVID-19 test result.
- If possible, people who participate in activities that are high risk for COVID-19 exposure (e.g. attending large events where social distancing is not possible, or being in crowded indoor settings).
- If possible, people who plan to visit someone who is at high-risk for developing severe COVID-19.
What if I can’t find a COVID-19 test? (Last updated 4/5/22)If you have symptoms that are consistent with COVID-19 and can’t find a test, you should follow the steps for isolation. This is even if you do not know whether you had contact with someone with COVID-19. Follow the steps for isolation until you can schedule a test. To find a testing location near you, visit VDH’s COVID-19 Testing page. Please also see the U.S. Department of Health and Human Services (HHS) webpage about the Test to Treat program which may provide prompt testing and treatment, if needed.
What COVID-19 tests are available to identify infections? (Last updated 4/19/22)Two different categories of COVID-19 tests are currently available: viral (diagnostic) tests and antibody (serology) tests.
- A viral (diagnostic) test tells if you have a current or very recent infection. Two different kinds of viral tests can detect the SARS-CoV-2 virus that causes COVID-19: (a) molecular tests (e.g., RT-PCR tests) look for the virus’s genetic material, and (b) antigen tests look for specific proteins that are part of the virus. How the testing sample is collected depends on the specific brand of test that is used. Viral tests typically use a nasal swab, throat swab, or saliva sample. The sample may need to be collected by a healthcare provider, but can often be done by self-collection. Antigen tests are typically easy to run and affordable, but are not always as accurate as PCR or other molecular tests. Currently, there are multiple COVID-19 antigen tests that can be completed by a person at home.
How do viral antigen tests compare to viral PCR (molecular) tests? (Last updated 2/21/22)PCR and antigen tests are two types of viral diagnostic tests for COVID-19. PCR tests are highly sensitive and specific, and usually do not need to be repeated. Antigen tests are also usually accurate, but false negative and false positive results can occur. Antigen tests are more likely than PCR tests to miss an active COVID-19 infection (a false negative test result). Your healthcare provider may order a PCR test if your antigen test shows a negative result but you have symptoms of COVID-19. After a positive antigen test, your provider may ask you to also have a PCR test if it is available, in order to confirm your antigen test results.
In a patient with typical COVID-19 symptoms and a positive COVID-19 antigen test, additional molecular COVID-19 testing is not generally needed or warranted.
CDC’s website COVID-19 Testing: What You Need To Know provides more information about the different types of COVID-19 tests.
Where can I get tested for COVID-19? (Last updated 6/1/22)COVID-19 testing may be available at your doctor’s office, urgent care center, pharmacy, or other healthcare clinic. Other testing sites include community testing events.
To find testing sites in your area, visit the website Virginia COVID-19 Testing Sites. This site is updated frequently. Each testing site has different policies and procedures for testing and for billing. Please reach out to the individual site for information about testing availability.
If you cannot get to a testing location, you and your healthcare provider might consider using either an at-home test kit or an at-home specimen collection kit. More information about currently available at-home self-tests can be seen on this VDH table. Contact your healthcare provider to see if one of these options is right for you and available in your area.
The federal government currently offers free COVID-19 at-home tests that are mailed to you. Every home in the U.S. is eligible to order a 3rd round of free at-home COVID-19 tests. Tests can be ordered online or by calling toll-free at 1-800-232-0233.
The Test to Treat program gives individuals rapid access, sometimes at no cost, to lifesaving treatment for COVID-19. In this program, people are able to get tested and – if they are positive and treatment is appropriate for them – receive a prescription from a health care provider, and can have their prescription filled all in one location.
What kind of over-the-counter COVID-19 tests are available for use at home? (Last updated 3/21/22)There are two categories of test kits for home use: (1) at-home test kits and (2) home specimen collection kits.
The first category, at-home testing, also called self-testing, allows a person to collect a specimen from themselves or their child and perform either a molecular or antigen test at home according to directions provided with the test kit. Test results are typically available in 10-30 minutes, depending on the test. If you perform a self-test or test your child, be sure to contact your physician or other healthcare provider with the test result, especially if it’s positive, since early treatment options are available. Also, if your school-age child (preschool or K-12) has a positive at home viral test and is in school, be sure to also notify the school about the positive test. More information about currently available self-test kits can be seen on this VDH table.
Another category of home use product is the home specimen collection kit. With home specimen collection kits, the actual testing is NOT done at home. With these kits, a specimen, typically a nasal swab, is collected at home by or from the person to be tested, placed inside protective packaging, and mailed to a lab for the testing. Results are typically available in a few days. Currently, at least 40 brands of self-collection kits are available. Be sure to specify the category of test (a self-testing kit vs. a self-collection kit) so you will get the correct product.
Since March 2021, FDA has authorized multiple tests for over-the-counter (OTC) use without a prescription when used for serial testing. Serial testing is testing that is repeated at different points in time and may be more likely to detect infection compared to COVID-19 testing that’s done at only a single point in time.
Currently, there are multiple at-home tests that have a specific FDA Emergency Use Authorization (EUA) for serial testing. The VDH table of at-home tests shows tests that are authorized for serial testing in the column “Type of test.” Serial testing includes testing people with or without COVID-19 symptoms OR with or without an epidemiological reason to suspect they have COVID-19. A common epidemiological reason, for example, would be serial testing of someone who is a close contact to a known COVID-19 case. All serial tests, except one, are antigen tests.
The FDA released an alert that there is a potential for harm if FDA authorized at-home COVID-19 tests are not used according to the manufacturer’s test instructions.
How do I get my test results? (Last updated 1/13/22)You will get your test results from the healthcare provider or facility that collected your specimens. Ask your provider or facility, when they collect your specimen, about the best way to get your results. Most clinics and healthcare providers will provide results by telephone. If you were tested at a local health department (LHD) event, you should contact that LHD.
If you were tested at a community testing event, you will receive a text message within 2-4 business days that will require a two part authentication process to verify your identity and then provide you with your results (positive or negative).
For self-administered at home and over-the-counter COVID-19 tests, how you get results will vary by the test. However, some test results can be provided in as little as 10-20 minutes. You may also need to have access to a “smart” device such as a smartphone and to download the specific mobile app for that test.
While VDH receives both positive and negative COVID-19 test results from private labs, the best way to know how you will get your results is to talk with your healthcare provider or other person arranging or collecting your test specimen.
If testing is done at a standard test site, how long does it take to receive COVID-19 viral test results? (Last updated 10/3/21)Results from onsite point-of-care (POC) rapid tests may be available at the testing site in less than an hour. However, other viral diagnostic tests (such as PCR) must be sent to an offsite laboratory for analysis, a process that can take up to a few days. In addition, a high demand for testing in some areas may cause a delay in processing tests and providing results.
What should you do if you test positive using an over-the-counter at-home test kit? (Last updated 6/17/22)- If you test positive using an at-home test, you should contact your healthcare provider right away with this information. For some patients, early treatment with medication may be beneficial.
- Isolate yourself from others to help prevent the spread of illness. CDC and VDH recommend that you isolate at home for at least 5 days. Count the day that your symptoms began as Day 0. If you did not develop symptoms, count the day that you were tested as Day 0.
- Wear a well-fitting mask if you need to be around others at home during your 5-day isolation period.
- If you have access to a test and want to test again during isolation, the best approach is to use an antigen test towards the end of the 5-day isolation period. If the second test result is also positive, you should continue to isolate until after Day 10. If your re-test result is negative, you can end isolation after Day 5, but continue to wear a well-fitting mask around others at home and in public until after Day 10.
- You can end isolation after 5 full days (i.e., starting on Day 6) if you are fever-free for 24 hours without the use of fever-reducing medication and if your other symptoms have improved (Loss of taste and smell may persist for weeks or months after recovery and should not delay the end of isolation).
- You should continue to wear a well-fitting mask around others at home and in public for 5 additional days (Day 6 through Day 10) after the end of your 5-day isolation period.
- If you are unable to mask when around others, you should continue isolation for the full 10 days.
- Do not travel until at least 10 days after the start of quarantine or isolation. If you must travel on Days 6–10, wear a well-fitting mask when you are around others for the entire duration of travel.
- Notify contacts. You are able to infect others starting from 2 days before you became sick (or 2 days before you tested positive if you did not have symptoms). Tell your contacts that they may need to stay home, get tested, and monitor their health to make sure they do not get sick and infect others.
- If you live with any household member who is high-risk, that person should contact their healthcare provider. Post-exposure and early treatment options may be available for certain individuals.
- Monitor your symptoms. If you have any serious warning signs (including trouble breathing, persistent chest pain or pressure, etc.), seek emergency medical care immediately. Have your doctor’s phone number on hand. Use CDC’s self-checker tool to help you make decisions about seeking appropriate medical care.
- Mild symptoms can typically be managed at home and with over-the-counter medications. Contact your healthcare provider after testing positive, if your symptoms are worsening OR if you may be at higher risk of progressing to severe illness (even with mild illness initially). If you are uncertain about your personal risk level, please speak to your healthcare provider. Early treatment options are available for certain individuals.
- High risk conditions include cancer; chronic kidney, liver, or lung diseases; dementia or other neurological conditions; diabetes (type 1 or type 2), heart disease, HIV infection, immunocompromised state (weakened immune system); overweight and obesity; and pregnancy among others. This list is not exhaustive, so if you don’t know whether you are at high-risk for severe illness, please contact your physician or healthcare provider.
- Please refer to the test kit manufacturer’s instructions for additional information. If the at-home test has an app or website for consumers to report test results, complete the reporting process. More information about currently available over-the-counter, at-home tests can be seen on this VDH table.
- Please visit the VDH What to do if you have confirmed or suspected coronavirus disease (COVID-19) for additional guidance.
- For more information on at-home testing, please visit the At Home Testing/Point of Care site.
If I had a positive viral diagnostic COVID-19 test earlier, can a later negative test allow me to get out of isolation? (Last updated 2/22/22)No. If you have been infected with SARS-CoV-2 and have tested positive for COVID-19, you should not be testing out of isolation.
However, if you never develop symptoms, you are able to end isolation 5 days after the date of your first positive COVID-19 test. (The day of your positive test counts as day 0.) You should still continue to mask, avoid travel, and avoid being around high-risk people until day 10.
Updated isolation information can be found on the CDC website about Quarantine and Isolation.
If you recently tested positive for COVID-19, why is PCR retesting NOT recommended within 90 days of when your COVID-19 symptoms began? (Last updated 6/13/22)Retesting with a molecular (PCR) test is not recommended in this situation because you might still have a positive PCR test result after you have fully recovered and cannot pass the virus on to others. PCR tests can stay falsely positive for weeks or even months after a person recovers from COVID-19 because the tests can pick up even small amounts of genetic material from the virus, including fragments of dead virus that are still present. In addition, it is rare for people to be reinfected within 90 days of having COVID-19, so retesting within 90 days of an infection is not generally recommended.
VDH recommends the following:
People who had COVID-19 within the last 6 months (tested positive using a viral test) and have fully recovered, do not have to quarantine or test if they have a new exposure and remain asymptomatic.
For healthcare workers, staff and/or residents in healthcare settings, long-term care facilities, correctional or detention facilities, and homeless shelters: Individuals who had COVID-19 within the last 90 days (tested positive using a viral test) and have fully recovered do not need to quarantine if they have a new exposure and remain asymptomatic.
Anyone who develops new symptoms of COVID-19 should quickly contact their healthcare provider, especially if the new symptoms develop within 14 days of having close contact with someone known or suspected to have COVID-19. Your healthcare provider might want to test you or consult with an infectious disease or infection control expert. Stay home and away from others (self-isolate) until the results of your medical evaluation are known. If COVID-19 reinfection is confirmed or suspected, individuals should remain in isolation until they meet the criteria to discontinue isolation.
What should I do if I have a positive viral test? (Last updated 2/22/22)If you test positive for COVID-19 by a viral test (e.g., PCR or antigen test), you should isolate yourself for at least five (5) days after the day that positive test specimen was collected, stay home and away from others regardless of your COVID-19 vaccination status, and follow your healthcare provider’s guidance on other steps to take if you are sick. You can end isolation after 5 days as long as you have been fever-free for 24 hours (without the use of fever-reducing medication) and your symptoms are improving. You should continue to use a face mask, avoid travel and avoid being around people considered to be at high risk from COVID-19 until Day 10 after a positive test. (Do not go to places where you can’t wear a mask, like restaurants or the gym.)
Updated isolation details can be found on CDC’s website on Quarantine and Isolation .
Please see the following link for additional information on what to do if you are sick: What to Do If You Are Sick
What should I do if I am unvaccinated, became exposed, but then had a negative viral test? (Last updated 6/17/22)If you test negative for COVID-19 by a viral diagnostic test, that does not mean for sure that you will not get sick. For example, you might have tested negative because the sample was collected very early in your incubation period, but you could still test positive later during your illness.
According to VDH guidance, a person who is not vaccinated and has not recovered from COVID-19 infection in the previous 6 months should quarantine for 5 full days. If the person does not develop symptoms by day 5 after close contact, it is recommended that they get tested for COVID-19 at that time. If the test is negative, the person may leave quarantine, but should monitor themselves for COVID-19 symptoms for a full 10 days after their exposure. If the person develops COVID-19 symptoms at any time, they should isolate at once and get tested for COVID-19.
You should avoid travel and avoid being around people who are considered to be at high-risk for severe COVID-19 for that same 10 day period.
Finally, unless you have a specific medical reason why you cannot receive the full COVID-19 vaccine series, you should become up to date with that vaccine to protect yourself and others around you.
What does it mean if I have a positive antibody (serology) test result? (Last updated 5/20/21)A positive antibody test result means you may have antibodies from a past infection with the SARS-CoV-2 virus that causes COVID-19 or from receiving a COVID-19 vaccine. However, there is also a small chance that a positive result means that you have antibodies from an infection with a different virus from the same family of coronaviruses, such as one that causes the common cold. Having antibodies to the virus that causes COVID-19 may provide some protection from getting infected with that virus again, but if it does we do not know how much protection the antibodies may provide or how long this protection may last.
You may also test positive for antibodies even if you have never had symptoms of COVID-19. This can happen if you had an infection without symptoms, which is called an asymptomatic infection.
Antibody tests should not be used to evaluate a person’s level of immunity or protection from COVID-19 at any time. Antibody testing should not be used to determine whether a person should receive a COVID-19 vaccine. In particular, it is not recommended for people to get antibody (serology) testing done after vaccination. Talk with your healthcare provider about your test result and the type of test you had to understand what your result means. Your healthcare provider may suggest you take a second type of antibody test to see if the first test was accurate.
What does it mean if I was exposed to COVID-19 but still have a negative antibody (serology) test result now? (Last updated 2/22/22)If you were exposed to COVID-19 but test negative for antibodies (blood test), that could mean that you didn’t have COVID-19. However, because it typically takes 1–3 weeks after infection for your body to make antibodies, the test may also be negative because it was taken too soon after your exposure. In that case, it’s possible you could still get sick from the recent COVID-19 exposure and could still spread the virus if you do get sick.
If you develop COVID-19 symptoms after an exposure and have a negative antibody test, you would need another COVID-19 test called a viral diagnostic test that can identify a current COVID-19 infection.
If you are unclear about the meaning of your test results, please talk with your healthcare provider.
You can find more information about antibody (serology) tests on CDC’s website about COVID-19 Testing.
How much does COVID-19 testing cost? (Last updated 7/1/21)Testing costs depend on the test that is ordered (PCR/molecular or antigen test) and the organization providing the test. For specific information about your health insurance coverage of COVID-19 testing, contact your insurance company. Many health insurance plans cover the cost of COVID-19 testing and most insurance covers at least some testing costs. However, some testing sites might have additional processing or other fees that aren’t covered by your health insurance so it is a good practice to ask about all test costs before getting tested.
To find free testing, visit VDH’s website COVID-19 Testing Sites to find a testing location in Virginia. On this page, you will find the Testing Locator. Enter your zip code, select other options you are looking for (for example, “Free Testing Available”), and click the yellow search box. Your results will then be shown.
FDA has released information about counterfeit COVID-19 at-home tests or problematic COVID-19 tests. Is more information available? (Last updated 5/17/22)On April 29, 2022, FDA issued a notice about counterfeit at-home, over-the-counter Covid-19 diagnostic tests that are being distributed or used in the United States. Thus far, two FDA-authorized Covid-19 tests have been identified as having been counterfeited:
- the Flowflex COVID-19 Antigen Home Test, and
- the iHealth COVID-19 Antigen Home Test
The FDA notice goes into detail about what to look for to distinguish an FDA-authorized legitimate test vs. a counterfeit test.
On May 10, 2022, FDA issued a notice warning people not to use the Skippack Medical Lab SARS-CoV-2 Antigen Rapid Test (Colloidal Gold). This test is not authorized, cleared, or approved by the FDA for distribution or use in the United States.
Where can I find more information about COVID-19 testing?Check out the following websites:
VDH COVID-19 Testing Sites (Information on One-Day Testing Events is located in the table below the map.)
VDH COVID-19 Testing Sites (Information on One-Day/Multi-Day Testing Events is located in the table below the map.)
Data and Surveillance
Data and Surveillance
I am interested in where the COVID-19 data come from and what they mean. Where can I go to find this information?You can learn more about COVID-19 data sources and what data are included on all of the dashboards on the About the Data page. The COVID-19 Data Insights goes into more detail about specific data, such as Race and Ethnicity data and Five Things to Remember When Interpreting Epidemiologic Data.
How does VDH collect COVID-19 surveillance data?COVID-19 surveillance data are collected from a variety of sources by the Virginia Department of Health according to the Regulations for Disease Reporting and Control. These sources include laboratory reports of COVID-19 test results, case investigation interviews conducted by the health department, monitoring of close contacts, and syndromic surveillance for coronavirus-like illness. Case-based data are reported into the Virginia Electronic Disease Surveillance System (VEDSS), which is a system used to receive surveillance data from these various sources and report that data to CDC.
How is VDH counting COVID-19 deaths?The death data that VDH is reporting are not official or final counts. In an effort to report deaths as quickly as possible, VDH is counting as a COVID-19 death any death that occurs in a person who was reported to the health department as having COVID-19 and any death that mentions COVID-19 as a cause of death on a death certificate for a person who was not previously reported to the health department. Some deaths in a person with COVID-19 will not be included in the COVID-19 death count, such as, if the person died as a result of an injury or accident. This method is not standardized nationally, so Virginia death data should not be compared to data from other states or for the United States at this time.
Eventually, all death records will be processed in a standardized manner and become available in a final form. You might see delays in reporting deaths or a backlog of death data because of how death certificates are processed and how mortality, due to COVID-19, is assigned in the surveillance data system. You can learn more about how VDH counts COVID-19-associated deaths on the Data Insights page.
Current VDH death counts are updated on Monday – Friday and posted on the VDH Cases Dashboard. Any deaths that are reported over the weekend (Saturday or Sunday) can be viewed when the statistics are updated on Monday morning.
I am hearing about an outbreak that isn’t listed on any of VDH’s outbreak-related dashboards. Why is the outbreak not on the dashboard? (Last updated 11/30/21)The cases reported in VDH’s COVID-19 Outbreaks dashboard are cases in a suspected or confirmed COVID-19 outbreak associated with that particular setting. Individual cases that are not a part of an outbreak associated with that setting would not be included on the Outbreaks dashboard. VDH follows the CDC Coronavirus Disease 2019 case definition to report cases of COVID-19. Other reporting entities are not required to use the surveillance case definitions, and due to varying reporting requirements, their data may not match VDH data exactly.
There are also a few things to note if you do not see a particular outbreak on the dashboard:
- It is possible there may be positive COVID-19 cases in a particular setting; however, if those cases were not directly associated with that particular event/setting, such as a person got COVID-19 from a separate gathering, those cases would not be reported as a part of the outbreak. They would still be reported to VDH as a positive COVID-19 case, as COVID-19 is a reportable disease in Virginia.
- The setting may have a suspected or confirmed COVID-19 outbreak; however, the dashboard has not been updated yet. VDH reports new information on the Outbreaks dashboard on Monday-Friday by 10:00am. VDH is in the process of collecting and verifying information about the outbreak to ensure accuracy before reporting the information publicly. Outbreak investigations, case investigations, and data quality assurance processes are ongoing. VDH reports real-time COVID-19 data, and there are inherent delays in public reporting as data are collected and reviewed. In addition, VDH may need additional time to review outbreak data due to limited staff capacity.
Where can I find data about COVID-19 outbreaks in nursing homes or other long-term care facilities?Long-term care facilities that have experienced a COVID-19 outbreak can be found on the Virginia Long-Term Care Task Force page. The list of facilities included in the report represent nursing, assisted living, or multi-care facilities. This information is intended to provide awareness of COVID-19 outbreaks among a vulnerable population. The presence of an outbreak does not indicate a facility's given capacity to care for its residents.
Where can I see COVID-19 vaccine data on the VDH website? (Last updated 5/17/22)COVID-19 vaccine data is available. There are two dashboards to see data on COVID-19 vaccines: Summary and Demographics.
The Summary dashboard shows data on vaccine doses that were given to people (vaccine administered).
The Demographics dashboard shows data about people who have gotten the vaccine, including age group, sex, and race and ethnicity.
Vaccination
Vaccination
Vaccination FAQ
Schools, Workplaces & Community Locations
Community Questions and Concerns
What are the CDC Community Levels? (Last updated 4/8/22)The CDC’s COVID-19 Community Levels are used as a measure of the impact of COVID-19 illness on health and healthcare systems. Community levels may identify localities that are more likely to experience more severe COVID-19 outcomes in the weeks ahead. This framework is a better tool to demonstrate the risk COVID-19 poses to communities and the people in those communities.
Community levels are determined for every locality (a city or county) in the United States. The COVID-19 Community Levels, which are ranked as either “Low,” “Medium,” or “High,” are based on information about the number of new cases of COVID-19 in a locality, how many people in that area are sick enough to require hospital care, and if the area’s healthcare system has the resources to provide care for all patients, whether or not they have COVID-19. Based on the community level (low, medium, or high), CDC recommends or suggests actions that can be taken by individuals and communities to protect against COVID-19. The COVID-19 Community Levels website goes into notable detail about these actions.
NOTE: Regardless of their COVID-19 Community Level, people in ALL communities should stay up to date on COVID-19 vaccinations and should also use strategies to improve ventilation.
When is masking recommended? (Last updated 5/31/22)Knowing the COVID-19 Community Level in your area will help you know when to wear a mask.
- People with COVID-19 symptoms, a positive COVID-19 viral test, or exposure to someone with COVID-19 (and not up to date on COVID-19 vaccines or who have not tested positive for COVID-19 in the last 6 months) should always wear a mask.
- For other people in areas where the COVID-19 Community Level is
- Low: Wear a mask based on your personal preference and your level of risk of developing severe illness.
- Medium: Wear a mask based on your personal preference, your level of risk of developing severe illness, and the risk of the people you live or spend time with. If you are at high-risk for severe illness, talk with your healthcare provider about whether you need to wear a mask and take other precautions against COVID-19.
- High:
- Everyone, regardless of vaccination status, should wear a mask indoors in public in areas where the COVID-19 Community Levels are high.
- People at increased risk should wear a mask or respirator that provides them with greater protection, like an N95 or KN95.
- People with weakened immune systems or who are at increased risk for severe illness should talk to their healthcare provider about what extra precautions, like masks or extra vaccine doses, they may need.
- People may choose to mask at any time.
The COVID-19 Community Level mask guidance does not apply to healthcare settings.
These recommendations are for people aged 2 years and older. Masks should not be worn by children under the age of 2. Adults should use their best judgment in putting masks on children aged 2-4 while inside public areas.
See the VDH mask page for more information.
Do I need to wear a mask in healthcare settings? (Last updated 2/28/22)CDC recommends that masks are worn in healthcare settings.
The CDC defines healthcare settings as places where healthcare is delivered and includes, but is not limited to, hospitals, clinics, and physicians’ offices, acute care facilities; inpatient rehabilitation facilities; nursing homes and assisted living facilities; home healthcare, vehicles where healthcare is delivered (e.g., mobile clinics), and outpatient facilities such as dialysis centers, and others.
CDC provides Recommendations for Healthcare Personnel.
What recommendations does VDH have regarding masks, including mask types and fit? (Last updated 2/28/22)To protect yourself and others from COVID-19, CDC and VDH continue to recommend that, depending on the COVID-19 Community Level, you wear the most protective mask you can that fits well and that you will wear consistently.
Masks and respirators are effective at reducing transmission of SARS-CoV-2, the virus that causes COVID-19, when worn consistently and correctly.
Some masks and respirators offer higher levels of protection than others, and some may be harder to tolerate or wear consistently than others. It is most important to wear a well-fitted mask or respirator correctly that is comfortable for you and that provides good protection.
Additional VDH guidance for masks can be found on the Mask Webpage.
CDC's mask recommendations can be found on the Use and Care of Masks webpage.
Does the updated isolation and quarantine guidance apply in high-risk congregate settings? (Last updated 1/11/22)No. In certain congregate settings that have a high risk of secondary transmission (such as correctional and detention facilities, homeless shelters, or cruise ships), CDC recommends a 10-day isolation period after a positive test and a 10-day quarantine period after exposure for residents, regardless of their vaccination and booster status.
How do public health recommendations apply to private organizations or businesses? (Last updated 5/19/22)Private organizations and businesses create their own policies related to masks, testing requirements, symptom screening, or vaccination requirements for customers, clients or visitors. VDH provides public health recommendations for general business (non-healthcare) settings in Virginia.
Although public health makes recommendations regarding appropriate time periods for isolation and quarantine, private entities (including private child care settings) make the decisions related to whether to exclude individuals from those settings for certain periods of time that may or may not be aligned with public health recommendations.
The vast majority of organizations adhere to public health recommendations. If outbreaks are occurring in these settings, stricter recommendations may be employed.
For more detailed guidance and requirements for specific settings (such as schools, sports, camps, pools, etc.), please see the VDH Website for Schools, Workplaces, and Communities and also CDC guidance.
I am planning a large event. Do you have any information I can post around my venue and any guidance for minimizing chances of COVID-19 transmission? (Last updated 4/8/22)Example signage is available in the VDH COVID-19 Signage Toolkit. Additional guidelines for social gatherings can be found on the VDH Social Gatherings and Events webpage. Guidance is available from the CDC for Small and Large Gatherings.
Supporting Testing Access through Community Collaboration
What is the Supporting Testing Access through Community Collaboration (STACC) program? (Last updated 3/18/22)The Virginia Department of Health (VDH) is partnering with libraries as a trusted community resource to support access to testing resources. The partnership will help give broader access to at-home rapid antigen tests to Virginians.
Up-to-date information on the STACC program is available at the STACC webpage.
Which libraries are participating in the STACC program? (Last updated 5/26/22)The locations of library systems that are participating in the STACC program are available at the STACC webpage. Library systems opt-in to participating in STACC, and library systems in socially vulnerable communities are prioritized.
Is STACC a program for businesses to have employees tested? (Last updated 3/17/22)No. Businesses are responsible for acquiring tests for their employees. Call your HR department for more information.
Is STACC a program for K-12 school testing? (Last updated 3/17/22)No. VDH has the ViSSTA program and Test-to-Stay program and additional testing resources in schools. Call your local school leaders for more information.
What kinds of COVID-19 tests are distributed? (Last updated 5/26/22)VDH is currently supplying libraries with ACON Flowflex COVID-19 Antigen Home Test as supplies are available. During the initial phase of the program, VDH supplied libraries with virtually guided rapid antigen tests using eMed-proctored Abbott BinaxNOW COVID-19 Antigen Card Home Test. Libraries will be a pick-up location for community members as resources allow. Rapid antigen tests provide results in 15 minutes.
Are the test kits authorized by the FDA? (Last updated 5/26/22)Yes. The ACON Flowflex COVID-19 Antigen Home Test is authorized by the FDA.
NOTE: The FDA issued a safety warning against the use of a different ACON Flowflex COVID-19 test, which is called the ACON Biotech Flowflex SARS-CoV-2 Antigen Rapid Test (Self-Testing). The ACON Biotech Flowflex SARS-CoV-2 Antigen Rapid Test (Self-Testing) has not been authorized or approved for use by the FDA. The FDA is concerned about the risk of false results when using this unauthorized test.
Are the distributed COVID-19 tests free? (Last updated 3/17/22)Yes.
Who should get tested? (Last updated 3/17/22)Visit the VDH COVID-19 Testing webpage for information on who should get tested and when. VDH recommends having a plan for testing based on criteria and not relying on same day appointments for best utilization of resources.
How can I receive a test through a library? (Last updated 3/17/22)You can request a free test kit from your local library by following the library’s directions as supplies are available. You will not need to show a library card or prove your residency to get a test kit.
Can I go to the library to get a test if I have symptoms? (Last updated 3/17/22)If you have symptoms, you should not go inside your library’s building. Use your library’s contactless distribution option or have someone pick up the test on your behalf. You should always wear a mask if you go to a library to pick up a test, regardless of whether you have symptoms. If you are ill, VDH recommends that you seek care from your healthcare provider.
Can I take the test at the library? (Last updated 3/17/22)Taking the test inside the library is not allowed because of the risk of exposing others to COVID-19 and biohazardous materials. Dispose of used kits in your home garbage.
How many COVID-19 tests can I take home? (Last updated 3/17/22)As supplies are available, VDH recommends taking the number of tests that you need, within your library’s guidelines. If multiple people in your household need a COVID-19 test, we recommend taking a test for each person who needs one. You should have a plan to use the test kits you receive within two weeks to avoid wastage if they expire.
How do I use the test? (Last updated 3/17/22)Follow the written instructions in the manufacturer’s product insert. The test kit contains all the equipment materials you need to take the test.
How soon after the rapid antigen test are results available? (Last updated 3/17/22)Results for the rapid antigen test are available approximately 15 minutes after completion of the test.
Who should I contact with questions about the test? (Last updated 5/26/22)Do not contact library staff. For questions about the ACON Flowflex COVID-19 Antigen Home Test, call ACON Laboratories Customer Support at 1-800-838-9502 or visit the manufacturer’s website at: https://flowflexcovid.com/.
What if my rapid antigen test is positive for COVID-19? (Last updated 3/17/22)If you test positive, you should immediately isolate yourself (stay away from others) and call your healthcare provider or your local health department.
The VDH Protect Your Health - Isolation and Quarantine webpage has helpful guidance following a positive or negative test result.
Who should I contact with questions about the test results? (Last updated 3/17/22)Do not contact library staff with questions. If you have questions, please contact your healthcare provider or your local health department, visit the VDH Protect Your Health - Isolation and Quarantine webpage, or call the Virginia COVID Information Center at 1-877-829-4682 Mon-Fri 8am-5pm.
Schools (K-12)
What CDC and VDH Guidance should schools follow to minimize the spread of COVID-19? (Last updated 5/17/22)Virginia law requires that school boards provide in-person instruction in the 2021–2022 school year. Virginia schools should select appropriate, layered prevention strategies to decrease the transmission of COVID-19 in schools. School officials, together with public health officials, need to consider multiple factors when making decisions about layered prevention strategies.
The state recommends that school divisions follow CDC guidance on best practices for preventing the spread of COVID-19.
To help school divisions decide how to best serve their communities, VDH has the following resources:
- Interim Guidance for COVID-19 Prevention in Virginia Pre-K-12 Schools
- K-12 COVID-19 Parent Flowchart
Reducing the risk of exposure to COVID-19 by cleaning and disinfection is an important part of school operations. The CDC has developed reopening guidance for cleaning and disinfecting schools and an infographic on cleaning your facility when someone has been diagnosed with COVID-19
Ventilation is one component of maintaining healthy environments, and is an important COVID-19 prevention strategy for schools and childcare programs. Ventilation systems clean and disperse air, decreasing the likelihood that students will inhale particles suspended in the air that are contaminated with the virus that causes COVID-19. Please refer to CDC’s information on Ventilation in Schools and Child Care Programs, VDH Ventilation Best Practices, VDH Interim Guidance for COVID-19 Prevention in Virginia PreK-12 Schools, and EPA’s Clean Air in Buildings Challenge: Guidance to Help Building Owners and Operators Improve Indoor Air Quality and Protect Public Health.
- Per Executive Order Two, schools should marshal available resources to improve inspection, testing, maintenance, repair, replacement and upgrades of equipment to improve the indoor air quality in school facilities, including mechanical and nonmechanical heating, ventilation, and air conditioning systems, filtering, purification, fans, control systems and window and door repair.
- Have an HVAC expert ensure the school building’s HVAC system is operating properly. The damper should be adjusted to increase the amount of exterior air that is brought in, and filters should be changed frequently and upgraded when possible to better remove respiratory particles from the air. Exhaust fans should be run to further improve air exchange. Consider additional ways to improve ventilation, such as opening doors and windows, using window fans to direct air out of windows, or using portable room air cleaners using a HEPA filter. If doors and windows are opened, eliminate any safety hazards (e.g., do not open windows if a child could fall out).
- Reduce the risk of exposure of children and school bus drivers to the virus that causes COVID-19 by opening bus windows when possible. Consider upgrading school bus filters to a highest efficiency (MERV) possible. Filters up to MERV-13 are available. Make sure that the filters chosen are compatible with your bus’s ventilation system.
Should a mask be worn during school? (Last updated 6/13/22)Executive Order 2 and law SB739 allows parents to decide if their child will wear a mask at school. While parents and families can decide whether their child wears a mask at school, VDH recommends that:
- All persons aged two years and older consider masking based on the COVID-19 community level and refer to the updated VDH masking guidance.
- At low COVID-19 community levels: wear a mask based on your personal preference and your level of risk of developing severe illness.
- At medium COVID-19 community levels: talk to your healthcare provider about wearing a mask indoors in K-12 schools if you have a weakened immune system or at high risk for severe illness.
- At high COVID-19 community levels: CDC recommends wearing a well-fitting mask indoors in public regardless of vaccination status or individual risk. At high levels, people at high risk for severe illness should wear a mask that provides greater protection like an N95 or KN95.
- People wear a mask when they return to school on Days 6–10 following a 5-day isolation or quarantine period*
- Schools review the Virginia Department of Labor and Industry (DOLI) has guidance for minimizing the risks of COVID-19 in workplaces.
*Following a 5-day isolation or quarantine period, parents have a choice to either send their child back to school wearing a mask on Days 6–10 or to keep their child home for the entire 10 days.
What are the quarantine and isolation recommendations for students in K-12 schools? (Last updated 3/21/22)If your child is identified as a close contact of someone with COVID-19 or tests positive for COVID-19, your child needs to follow quarantine or isolation guidance from your school. A representative from the local health department may also call parents of close contacts to provide quarantine guidance. Please refer to VDH updated Interim Guidance for COVID-19 Prevention in Virginia PreK-12 Schools and the VDH K-12 COVID-19 Parent Flowchart for isolation and quarantine recommendations. School districts may choose to continue more stringent isolation and quarantine requirements or may implement the CDC guidance on quarantine and isolation. Please contact your school or school district for details on their isolation and quarantine policies.
Are schools required to report outbreaks? (Last updated 4/7/22)Schools are subject to Board of Health disease reporting regulations. Any person in charge of a school, summer camp, or child care center is required to report suspected outbreaks of any illness that might be spread from one person to another. Schools should refer to the Rules and Regulations of the Board of Health for requirements. If a known or suspected outbreak of COVID-19 occurs (among students or staff), the school is advised to call their local health department to discuss the situation. The local health department will work with the facility to provide disease control and prevention recommendations to slow or stop the spread of COVID-19. Schools may also use the new VDH outbreak reporting tool to report suspected outbreaks of COVID-19 or other communicable diseases.
If a student or school staff member has an ongoing exposure to a household member with COVID-19, how does this impact the isolation and quarantine recommendations? (Last updated 3/22/22)The student or staff member would be considered a close contact of the household member with COVID-19. While someone is isolating at home, try to minimize close contact with others in the household as much as possible. This includes having the person with COVID-19 in a separate bedroom and using a separate bathroom if possible, staying at least 6 feet apart, minimizing time spent with each other, wearing well-fitted masks, and improving air flow by opening a window. If a household member has close contact with the person isolating at home during their 5-day isolation, then the household member needs to take steps to protect themselves and might need to quarantine. Those who test positive or develop COVID-19 symptoms should follow recommendations for isolation. See VDH isolation and quarantine guidance and CDC Guidance for K-12 Schools.
People with COVID-19 should continue to wear a well-fitting mask around others at home and in public for 5 additional days (Day 6 through Day 10) after the end of their 5-day isolation period. People that are exposed to someone with COVID-19 after they complete isolation are not considered close contacts.
CDC provides FAQs for individuals with ongoing COVID-19 exposures.
Be sure to notify your school if this happens and reach out to your healthcare provider.
Will students or staff who exhibit COVID-19 symptoms be required to show a negative COVID-19 test to return to school or work? (Last updated 2/22/22)CDC and VDH do NOT recommend requiring a negative COVID-19 test in order for students or staff to return to school. Please see VDH updated Interim Guidance for COVID-19 Prevention in Virginia PreK-12 Schools and the K-12 COVID-19 Parent Flowchart. However, some school divisions may require a note from a healthcare provider to return to school or work. Please check with your local school division for guidance.
How should lunch time be handled for children who are in the 6–10 Day period after isolation or quarantine? (Last updated 3/21/22)Children who are in the 6–10 Day period after isolation or quarantine should ideally be at least 6 feet away from others during meals and snacks, or other unmasked periods.
Will a COVID-19 vaccination be a requirement for school? (Last updated 11/16/21)No, currently, the COVID-19 vaccine is not mandatory. However, the vaccine is one of the critical tools needed to reduce the spread of this virus. Having teachers, school staff, and students be up to date with vaccination, including boosters when eligible, is a critical layer of prevention and protection to help schools safely operate. We encourage you to have a conversation with your child’s healthcare provider.
What guidance is there for athletes and spectators of school sports? (Last updated 2/23/22)Schools and families should be aware that participating in team sports or other extracurricular activities, especially indoor activities involving shouting or singing, increase the risk of SARS-CoV2 transmission. Additional guidance and consideration can be found in the American Academy of Pediatrics Sports and Physical Activities Guidance, VDH Considerations for Recreational Sports, and VDH Interim Guidance for COVID-19 Prevention in Virginia PreK-12 Schools.
The Virginia High School League governs athletic competitions; local school divisions may also have their own policies in place (such as vaccine requirements for athletes or mask mandates for outdoor spectators).
Students enrolled in school for the 2021-2022 school year will need to be up to date on their required school immunizations. Please consult with your healthcare provider for school required vaccine guidance.
Are water fountains safe to use? (Last updated 2/23/22)Drinking fountains should be cleaned and sanitized, but encourage staff and students to bring their own water to minimize use and touching of water fountains.
Should schools screen students or staff for COVID-19 symptoms? (Last Updated 1/24/22)The CDC does not currently recommend universal symptom screening for K-12 schools. Screening procedures are available at school for students and staff who arrive with or develop symptoms during the course of the day. VDH updated Interim Guidance for COVID-19 Prevention in Virginia PreK-12 Schools. Additionally, VDH provides a K-12 COVID-19 Parent Flowchart.VDH has adopted new CDC isolation and quarantine guidance for K-12 schools. See isolation and quarantine guidance provided by CDC Guidance for K-12 Schools. Please discuss any concern you may have with your local school division.
What should schools do if an individual is experiencing flu-like or COVID-19 symptoms? (Last updated 2/23/22)If a student or employee experiences symptoms of COVID-19 while at school, move the individual out of the classroom or group setting, isolate in a predetermined location, and inform the school nurse or school health staff member. School health staff must wear personal protective equipment (PPE), including an N-95 or surgical mask, goggles, and gloves before entering into the room to evaluate the individual. Call the student’s parent or the employee’s family member to pick up and take home the ill person. If symptoms persist or worsen, or if laboratory testing might be warranted, they should contact their healthcare provider. If COVID-19 is suspected or confirmed, the ill person must stay home and be isolated from others.
What can schools do to protect vulnerable students and employees from COVID-19? (Last updated 5/17/22)Based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19.
Parents of children who are medically fragile or have one or more chronic conditions should check with their healthcare provider about school attendance, especially if the student is unvaccinated and if masking is no longer practiced at the school. Make sure that you provide the school with healthcare provider documentation (HCP) of the child’s healthcare needs and treatment protocols. This includes HCP authorization and parental consent to administer medication or administer treatments to students. The CDC offers guidance for families of children needing extra precautions during COVID-19. Families are encouraged to meet with school staff, including teachers, school nurses and administrators, to discuss safety measures and establish/update a Section 504 plan. Please discuss any concern you may have with your local school division.
In addition, employees that meet the criteria listed for ‘higher risk’ populations should check with their healthcare provider before returning to work.
Schools should provide remote learning exceptions and teleworking options for students and staff who are at high risk of severe illness (as defined by the CDC). People who have a condition or are taking medications that weaken their immune system may not be fully protected even if they are fully vaccinated. Please discuss any concern you may have with your health care provider and local school division.
What should schools do if an unvaccinated student or staff member is exposed to a COVID-19 positive person? (Last updated 2/23/22)VDH has updated Interim Guidance for COVID-19 Prevention in Virginia PreK-12 Schools. Additionally, VDH provides a K-12 COVID-19 Parent Flowchart.
Recommendations for people who have been exposed are available at VDH's What to do if you were potentially exposed to COVID-19 and VDH When Is It Safe to Be Around Others Guidance.
The CDC and VDH recommend people stay home (quarantine) for at least 5 days, and get tested on or as soon after Day 5 if possible. A person can end quarantine after Day 5 if they have no symptoms and can wear a mask when around others through Day 10 after their last contact with someone with COVID-19. VDH recommends a 10-day isolation or quarantine period for students who are not willing to wear a mask in school on Days 6–10 after quarantine or isolation. See isolation and quarantine guidance provided by CDC Guidance for K-12 Schools. Please discuss any concern you may have with your local school division.
If a child who has recently tested positive for COVID-19 is exposed again, does the child need to quarantine or be re-tested? (Last updated 6/13/22)No.
Those who have tested positive using a viral test in the past 90 days do not need to quarantine or get tested after exposure as long as they have recovered from their previous illness and have no new symptoms. Please see Interim Guidance for COVID-19 Prevention in Virginia PreK-12 Schools. Additionally, VDH provides a K-12 COVID-19 Parent Flowchart. See isolation and quarantine guidance provided by CDC Guidance for K-12 Schools.
If a person tests negative for COVID-19, but is diagnosed with COVID-19 by their healthcare provider based on symptoms, when can they return to school? (Last updated 2/23/22)An individual diagnosed with COVID-19 should not return to work or school until they meet all criteria to end isolation. Please refer to the following resources:
For children who require suctioning or need breathing treatments during school hours, do schools need to be concerned about aerosolizing the virus that causes COVID-19? (Last updated 3/9/21)During the COVID-19 pandemic, asthma treatments using inhalers with spacers (with or without a face mask, according to each student’s individualized treatment plan) are preferred over nebulizer treatments whenever possible in the school setting. The use of asthma inhalers (with or without spacers or face masks) is not considered an aerosol-generating procedure.
CDC recommends that nebulizers in school should be reserved for instances where children cannot use inhalers, do not have access to an inhaler or for children who are in significant respiratory distress while awaiting emergency transport.
Because they are considered aerosol-generating procedures, suctioning and nebulizer treatments should be performed in a space that limits exposure to others and with minimal staff present, limited to the student and staff member performing the treatment. The staff member should put on proper personal protective equipment (N95 respirator, goggles or face shield, gloves and gown). Rooms should be well ventilated or the treatment should be performed outside. After the student receives treatment, the room should undergo routine cleaning and disinfection. Routine cleaning and disinfecting of the room is adequate and the room does not need to be vacated for any period of time. A list of EPA-approved disinfectants can be found: https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2
Schools (K-12): Testing
What COVID-19 testing resources are available for K-12 Schools? (Last updated 6/13/22)VDH offers K-12 schools resources for screening testing, at-home rapid antigen test kits for diagnostic testing, and support for Test to Stay. Please visit VDH K-12 Schools COVID-19 Testing or email testinginfo@vdh.virginia.gov for more information.
What is is screening testing? What screening testing does VDH offer for K-12 Schools? (Last updated 10/8/21)Screening testing means testing of people without COVID-19 symptoms or exposure to identify unknown cases so that actions can be taken to quickly prevent further spread of COVID-19. The Virginia School Screening Testing for Assurance program, or ViSSTA, is an optional, free COVID-19 screening testing program for Virginia public and private K-12 students, teachers, and staff. for the 2021–22 school year.
Participation in the ViSSTA program is optional for schools. All testing is voluntary and requires parental consent. For more information, please visit the VDH ViSSTA webpage, read the ViSSTA FAQs, or contact your local school or school division.
Which schools participate in ViSSTA? How many are participating?The list of public and private schools participating in ViSSTA is available here.
What is the difference between screening testing, pooled testing, and diagnostic testing? (Last updated 6/13/22)Please visit CDC Testing Strategies for SARS-CoV-2 for more information on the difference between screening and diagnostic testing. Screening testing means testing of people without COVID-19 symptoms or exposure to identify unknown cases so that actions can be taken to quickly prevent further spread of COVID-19. Screening testing can help promptly identify and isolate cases, quarantine those who may have been exposed to COVID-19 and are not fully vaccinated, and identify clusters. This can help reduce the risk to students, teachers and staff, and control outbreaks before they expand to limit disruption to in-person education.
Updated CDC K-12 guidance recommends that schools consider implementing screening testing when COVID-19 community levels are medium or high. Schools may consider implementing screening testing for high risk activities (such as indoor sports or extracurricular activities), when returning from breaks (such as spring break or at the start of the school year), and for those serving students at risk of becoming very sick from COVID-19 (such as those with moderate/severe immunocompromise or complex medical conditions).
Pooled testing is a form of screening testing that may be used in schools. Pooled testing involves mixing several individuals’ test samples together into one “pool” and then testing the pooled sample for COVID-19. This approach increases the number of individuals that can be tested at one time and allows regular testing in the school for COVID-19.
Diagnostic testing is intended to identify current infection in individuals and may be performed when an individual has signs and symptoms consistent with COVID-19 or is a close contact of an individual with COVID-19.
For more information about VDH Testing Resources for schools, please visit VDH K-12 Schools COVID-19 Testing or email testinginfo@vdh.virginia.gov.or contact testinginfo@vdh.virginia.gov.
What diagnostic testing resources, such as at-home rapid antigen test kits, are available to schools? (Last updated 6/13/22)Schools or school divisions may request eMed-proctored BinaxNOW Antigen At Home Test Kits. For more information, email testinginfo@vdh.virginia.gov.
These at-home test kits are for diagnostic testing of K-12 students, teachers, and staff who have signs/symptoms of COVID-19 or have been identified as close contacts to an individual with COVID-19. The test kits may be distributed to members of the school community for use at home or can be administered at school per school policy. For more information please refer to the VDH K-12 Testing Webpage and the diagnostic testing FAQ section.
What is the Test to Stay strategy for K-12 Schools? (Last updated 6/13/22)Test to Stay is a strategy that allows students, teachers, and staff who are not up to date on COVID-19 vaccines and who are close contacts of individuals with COVID-19 to remain in the classroom instead of quarantining at home. In the VDH recommended guidance, the student should take a rapid test every day for 5 days after the exposure (except on weekends and holidays), and if the tests continue to be negative and the child remains asymptomatic, they are allowed to stay in school.
Implementation of Test to Stay is voluntary for K-12 schools. VDH provides protocols, guidance, technical assistance, and test kits to support schools implementing Test to Stay. Participation in Test to Stay is voluntary and only those with a signed consent form can participate.
For more information, please visit the VDH K-12 Test to Stay Webpage and the VDH K-12 Test to Stay FAQs. or email test2stay@vdh.virginia.gov.
Child Care Programs
What can my child’s Early Childhood Education or child care center do to prevent the spread of COVID-19? Where can I find COVID-19 guidance? (Last updated 6/1/22Child care programs and centers are encouraged to adapt their service settings as much as possible to align with public health recommendations and encourage staff and families to stay up to date on COVID-19 vaccines. Please refer to VDH Child Care Facility COVID-19 Guidance, CDC Guidance, the Virginia Department of Education (VDOE) COVID-19 child care website and VDOE COVID-19 guidance.
What should my child care center do if a child or staff member in the center has a confirmed or suspected COVID-19 case? (Last updated 6/15/22)- Plan to have an isolation room for children or staff who begin to show symptoms of COVID-19 while in the facility. Ideally this room should have access to a separate restroom. Ensure that isolated children are still under adult supervision. Arrange safe transportation home or to a healthcare facility (if severe symptoms) for the child or staff member if showing symptoms of COVID-19.
- If someone at the child care center is sick or someone with confirmed COVID-19 has been in a room in the last 24 hours, your center should clean and disinfect the room.
If the center has a confirmed case of COVID-19, the center should determine who was in close contact with the infected individual, and quickly alert these close contacts.
When should my childcare center close? (Last updated 3/3/22)- Closure decisions for outbreaks or disease situations are typically made in consultation with the local health department. VDH guidance provides additional recommendations for outbreak control and containment.
What is your guidance for child care centers on COVID-19 isolation and quarantine? (Last updated 6/15/22)On January 28, 2022, the Centers for Disease Control and Prevention updated Guidance for Operating Early Care and Education/Child Care Programs. Isolation and quarantine periods can be reduced to five days for staff and children who can consistently wear well-fitting masks, as long as they remain symptom free, or fever has ended and symptoms have improved. For individuals 2 years of age or older who meet all eligibility criteria, Test to Stay is an option as an alternative to traditional at-home quarantine.
For children and staff who are unable to consistently wear a mask when around others (including all children under 2 years of age) the safest option is to continue to remain at home for 10 days, but VDH recognizes that child care providers also have to balance the importance of children’s access to learning and care when implementing prevention strategies for COVID-19.
In the child care facility setting, if one or both parties are fully masked at the time of exposure, are they considered "close contacts"? (Last updated 4/4/22)Yes, even individuals wearing masks are close contacts if they spend 15 minutes or more within 6 feet of someone with COVID-19. For further guidance, please see What to do if you were potentially exposed to coronavirus disease (COVID-19).
Is there an outbreak reporting requirement for child care settings? (Last updated 4/18/22)Yes.
The person in charge of any child care center, school, or summer camp is required to report suspected outbreaks of any illness that might be spread from one person to another. Child care facility directors should refer to the Rules and Regulations of the Board of Health for requirements. The VDH outbreak reporting tool is available for reporting outbreaks.
If a known or suspected outbreak of COVID-19 (3 or more cases within a 14-day period) occurs, the facility should call the local health department immediately to discuss the situation. The local health department will work with the facility to provide disease control and prevention recommendations to slow or stop the spread of COVID-19.
Child Care Programs: COVID-19 Testing
What COVID-19 testing support is VDH providing to child care facilities? (Last updated 5/17/22)Please see the VDH Summary of Child Care Testing and the VDH Child Care Testing Website for more information. VDH is providing rapid antigen test kits to local health districts to distribute to child care facilities in their district. Test kits can be used for diagnostic testing of students, staff, and teachers ages 2 years or older who have symptoms of COVID-19 or who are close contacts of an individual with COVID-19. In addition, the test kits can be used to support Test to Stay programs for participating child care centers. All testing is voluntary.
Child care facilities are strongly recommended to send test kits home with parents, teachers, or staff. Child care facilities may also make it possible for families/caregivers to come to the facility to pick up a test kit for at-home testing.
More information on the test kits are available
How can child care facilities obtain test kits? (Last updated 5/17/22)Local Health Districts will coordinate distribution of test kits to child care facilities in their districts. Test kits are provided free of charge.
What is the Test to Stay option for child care facilities? (Last updated 5/17/22)Test to Stay (TTS) is a strategy that allows children aged 2 years and older and staff who are either not eligible for COVID-19 vaccines or not up to date on their COVID-19 vaccines remain in child care or at work. With TTS, close contacts who would normally stay at home during their quarantine period are allowed to attend child care as long as they remain asymptomatic, continue to test negative on repeated COVID-19 tests, and wear a mask at the child care facility. It is included as an option for eligible individuals in the VDH COVID-19 Child Care Facility Guidance.
Implementation of Test to Stay is voluntary. Participation in Test to Stay is also voluntary. Only eligible staff members and children with a signed consent form can participate.
Where can I find more information about Test to Stay for child care facilities, including what test kits should be used? (Last updated 4/7/22)Please visit the VDH Child Care Testing website and review the VDH Test to Stay Protocol for Child Care Facilities and VDH Child Care Test to Stay Guidance Informational Presentation. More information on test kits are available.
Why can't children under age 2 participate in Test to Stay? What guidance should be followed for those under 2 years old? (Last updated 4/4/22)Children less than 2 years of age are not eligible to participate in Test to Stay because they are unable to wear masks and the eMed BinaxNOW test kits are not approved for use in this age group. Children under age 2 years who are identified as close contacts of an individual with COVID-19 are recommended to quarantine at home for a full 10 days after the exposure.
Business and Workplaces: General
How can my business ensure workplace safety and prevent COVID-19 spread? (Last updated 4/8/22)The Virginia Department of Labor and Industry (DOLI) has current guidance for minimizing the risks of COVID-19 in workplaces.
In addition, management should encourage employees to stay up to date on COVID-19 vaccines. See VDH General Recommendations for Businesses and other Establishments for additional guidance.
Guidance for ending isolation for persons with COVID-19 in non healthcare settings is available. Further information can be found on the VDH Businesses website.
Are employees required to wear masks in non-healthcare workplace settings in Virginia? (Last updated 3/1/22)No. However, since masks have been found to be effective in reducing the spread of the SARS-CoV-2 virus that causes COVID-19, employees and employers should refer to the VDH mask page for current mask recommendations.
What are additional VDH COVID-19 resources available to businesses? (Last updated 9/20/21)Our resources page includes information on additional topics of interest to individuals.
Under the Businesses section, the resources available include information on relative risk levels in business settings, setting-specific resources and signage toolkits
Are employers required to report cases to the health department? (Last updated 4/7/22)No. However, businesses may voluntarily report suspected outbreaks of COVID-19 using the VDH online reporting portal.
Special Populations
Special Populations
When can immunocompromised individuals with COVID-19 end self-isolation? (Last updated 12/27/21)In some rare cases, severely ill patients with compromised immune systems continue to shed SARS-CoV-2 virus after their symptoms get better. They may be able to transmit the virus to other people for prolonged periods. Severely ill patients should consider isolating for periods longer than the typical 10 days. Patients with COVID-19 who have compromised immune systems should work closely with their healthcare provider to determine when to end self-isolation.
For more information, please see the CDC page on Quarantine and Isolation.
Are pregnant people at increased risk for severe illness with COVID-19? (Last updated 2/22/22)Yes.
Pregnant people are at an increased risk for severe illness from COVID-19 compared to non-pregnant people. Pregnant women are more likely to be admitted to the intensive care unit (ICU), receive invasive ventilation, and are at increased risk of death compared to non-pregnant people. Having certain underlying medical conditions can further increase a pregnant person’s risk for developing severe illness as well.
The CDC and VDH strongly recommend staying up to date with COVID-19 vaccines either before or during pregnancy because the benefits of vaccination for both pregnant persons and their fetus or infant outweigh known or potential risks. For more information about the safety of COVID-19 vaccines during pregnancy visit CDC’s Receipt of COVID-19 Vaccine During Pregnancy Report.
Are pregnant people or infants born to mothers with COVID-19 at increased risk for adverse pregnancy outcomes? (Last updated 2/22/22)People with COVID-19 are at increased risk for stillbirths, preterm labor (delivering earlier than 37 weeks), as well as other negative birth outcomes.
We know that COVID-19 is relatively uncommon in newborns born to people who had COVID-19 during pregnancy. Some newborns have tested positive for the virus that causes COVID-19 shortly after birth. It is unknown what proportion of infected newborns get the virus before, during, or after birth.
Most newborns who have tested positive for COVID-19 had mild or no symptoms and have recovered fully. However, there are a few reports of newborns with severe illness.
For more information, visit the following CDC links:
Pregnant and Recently Pregnant People, Breastfeeding and Caring for Newborns if You Have COVID-19, and COVID-19 Vaccines While Pregnant or Breastfeeding.
What is the risk of my child becoming sick with COVID-19? (Last updated 3/16/22)Children and adolescents can be infected with SARS-CoV-2, can get sick with COVID-19, and can spread the virus to others. Children with underlying medical conditions are more at risk for severe illness compared to children without underlying medical conditions.
According to a CDC study, with Omicron, U.S. infants and children aged 0–4 years were hospitalized at approximately five times the rate of the previous peak during Delta predominance. Infants aged <6 months had the highest rates of hospitalization, but severity of illness was similar in all age groups.
Some children may also develop MIS-C or Post-COVID conditions, or require hospitalization or ICU level care.
More information on this topic is available from the CDC.
What additional steps should families that have a child with an underlying medical condition or special health care need take? (Last updated 3/7/22)Helping children understand and follow recommendations, like physical distancing and wearing a mask, can be challenging if your child has intellectual disabilities, sensory issues, or other special healthcare needs.
Behavioral techniques can be used to address behavioral challenges and to develop new routines. These include social stories, video modeling, picture schedules, and visual cues. Try rewarding your child in small ways with his or her favorite non-food treat or activities to help switch routines and to follow recommendations.
Many of the organizations you turn to for information and support around your child’s complex, chronic medical condition may have information on their websites to help families address issues related to COVID-19. Your child’s therapist(s) and/or teachers may also have resources to help successfully introduce new routines to your child.
Additional information on caring for children and on child development specific conditions are available. The American Academy of Pediatrics also has guidance on this.
CDC released guidance and tools to help people with disabilities and those who serve or care for them make decisions, protect their health, and communicate with their communities. guidance documents to support the needs of people with disabilities.
What is MIS-C, and who is at risk? (Last updated 1/12/22)MIS-C stands for multisystem inflammatory syndrome in children (MIS-C), which is associated with COVID-19. Patients with MIS-C have presented with a persistent fever and a variety of other signs and symptoms including multiorgan (e.g., cardiac, gastrointestinal, renal, hematologic, dermatologic, neurologic) involvement.. Additional symptoms may include abdominal pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes and feeling extra tired. MIS-C may begin at the same time as a COVID-19 infection or weeks after a child is infected. The child may have been asymptomatically infected with COVID-19 and, in some cases, the child and their caregivers may not even know they had been infected with COVID-19. Receipt of 2 doses of the Pfizer vaccine is highly effective in preventing MIS-C in persons aged 12–18 years. These findings further reinforce the COVID-19 vaccination recommendation for eligible children.
Children with a history of MIS-C should consider delaying COVID-19 vaccination until they have recovered from illness and for 90 days after the date of diagnosis of MIS-C. This should be a discussion with the healthcare team.
Additional information about MIS-C can be found at For Parents: Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 and at
Travelers
International Travelers
Where are the high-risk travel areas? (Last updated 3/16/22)The COVID-19 situation varies by country and is subject to change. For the most up-to-date information on travel advisories, please visit CDC's Travel Health Notices webpage and review the U.S. Department of State’s Travel Advisories and country specific COVID-19 recommendations.
I am planning to travel internationally. Should I cancel my trip? (Last updated 5/5/22)Travel increases your chance of getting and spreading COVID-19. Travelers who are up to date with their COVID-19 vaccines are less likely to get and spread COVID-19. However, international travelers may still face additional risks and should follow guidance on the VDH Travel page. Make sure you are up to date with your vaccines before you travel internationally. COVID-19 risk in many countries is high, and all travelers should avoid nonessential travel to high-risk destinations. To check a destination’s COVID-19 risk level see CDC's COVID-19 Travel Recommendations by Destination.
When deciding whether to travel, consider not only the possible risk of COVID-19 but also possible travel restrictions, quarantine, testing requirements, and medical care available in the areas you plan to visit. If you get sick or are exposed to a person with COVID-19 during your trip, you may be isolated or quarantined and your return to the United States may be delayed.
CDC recommends that international travelers leaving the U.S., regardless of vaccination status, consider getting tested no more than 3 days before travel.
CDC also recommends that travelers should make sure they are up to date with their COVID-19 vaccines before cruise ship travel.
For the most up-to-date information on travel advisories, please visit CDC’s travel advisory website and the U.S. Department of State website.
What should I do if I have planned to travel and test positive or have symptoms of COVID-19? (Last updated 6/14/22)Anyone with any symptoms of COVID-19, who has recently tested positive for COVID-19, or is awaiting COVID-19 test results should not travel.
Anyone who recently had close contact with someone with COVID-19 (and are either not up to date on COVID-19 vaccines or have not tested positive for COVID-19 in the last 6 months) should take certain precautions (e.g., get tested at least 5 days after exposure, wear a mask for 10 days when around others, monitor for symptoms).Travelers either not up to date on COVID-19 vaccines or who have not tested positive for COVID-19 in the last 6 months, and had close contact with someone with COVID-19:
- Should quarantine (stay home) for at least 5 days (Day 0–5) after their last contact with a person who has COVID-19 and should not travel if they haven’t ended quarantine, and ideally for the full 10 days after exposure.
- If you must travel before the 10 days are completed, wear a well-fitting mask when you are around others for the entire duration of travel during the 10 days.
- If you are unable to wear a mask, you should not travel during the 10 days.
- Should get tested at least 5 days after their last close contact and make sure their test result is negative and they remain without symptoms before traveling. If you don’t get tested, you should delay travel until 10 days after your last close contact with a person with COVID-19.
Are layovers included in CDC’s recommendation to avoid nonessential travel? (Last updated 6/15/21)Yes. CDC has Travel Health Notices for countries and territories with specific advice for travelers. If CDC recommends avoiding nonessential travel to a country or territory based on your vaccination status, layovers at the airport should also be avoided. If a layover is not avoidable, CDC recommends that travelers not leave the airport. Travelers whose only exposure to a higher risk country was in a layover may still be screened and monitored when entering the United States.
Are there vaccination requirements for international travelers coming to the U.S.? (Last updated 2/7/22)Non-U.S citizens, who are non-immigrants and are traveling by air to the U.S. are required to be fully vaccinated against COVID-19 and show proof of vaccination before flying to the U.S. from a foreign country, if they are aged 18 years or older. There are some limited exceptions. A booster dose is not needed to meet this requirement.
You can use the new CDC assessment tool to find out if you can board a flight to the U.S.
Are there testing requirements for international travelers entering the US from another country? (Last updated 6/13/22)As of June 12, 2022, the Order requiring people to show a negative COVID-19 test result or documentation of recovery from COVID-19 before boarding a flight to the United States, is no longer effective.
This means that air passengers do not need to get tested and show the COVID-19 test result or documentation of recovery from COVID-19 before getting on a flight to the U.S.
Who is considered as fully vaccinated when traveling to the U.S.? (Updated 3/1/22)For the purposes of international travel to the U.S., the definition of fully vaccinated is slightly different from the existing domestic definition. You are considered fully vaccinated if:
- It has been 2 weeks after your dose of an accepted single-dose COVID-19 vaccine.
- It has been 2 weeks after your second dose of an accepted 2-dose series COVID-19 vaccine; or
- It has been 2 weeks after you received the full series of an accepted COVID-19 vaccine (not placebo) in a clinical trial
If it has been 2 weeks after you received 2 doses of any “mix-and-match” combination of accepted COVID-19 vaccines administered at least 17 days apart (This combination strategy is increasingly common in many countries outside of the United States).
More information on the updated definition is available on CDC’s Requirement for Proof of COVID-19 Vaccination for Air Passengers page.
Are other tests or precautions recommended for returning travelers? (Last updated 9/7/21)Up to date recommendations on testing, quarantine, and other precautions are available at CDC’s International Travel page.
If you are returning to Virginia after international travel, VDH will be sending you an email message with health information and guidance. The email message provides information about monitoring for symptoms, staying home (quarantine or isolation), as well as testing recommendations. This email will also have links to helpful information and resources, as well as the option to request a home COVID-19 test kit from VDH.
Are people entering the U.S. from other countries being quarantined? (Last updated 4/14/22)VDH recommends (but does not require) that all international travelers get tested 3-5 days after travel.
Additionally:
- U.S. citizens, U.S. nationals, lawful permanent residents, and immigrants, who are not vaccinated and not up to date with their vaccines should stay home (quarantine) for 5 days after travel.
- Non-U.S citizens, who are non-immigrants, who are not fully vaccinated and have traveled to the U.S. by air through an exception, are required to self-quarantine for a full 5 days, even if they test negative, unless you have documentation of having recovered from COVID-19 in the past 90 days.
- Non-U.S citizens, who are non-immigrants, who are fully vaccinated but not up to date with vaccines should stay home and self-quarantine for a full 5 days after travel.
Additional information on pre-flight testing requirements and testing, quarantine, and other precautions after travel are available at CDC’s International Travel during COVID-19.
My loved one recently returned from another country and is not reporting any symptoms. What are the best ways to protect our family members who all live close together? (Last updated 5/21/21)The family member who recently traveled should follow all testing, quarantine, distancing, and other recommendations provided on CDC’s International Travel website. These recommendations will differ based on vaccination or booster status, or COVID-19 recovery status.
After returning from international travel, when can an employee return to work? (Last updated 5/21/21)Please review the VDH guidance for travelers to learn what to do when you return from a domestic or international trip. Additionally, consult your workplace to learn about their return to work policies. Any traveler who has symptoms or tests positive for COVID-19 should isolate immediately and seek medical care as necessary. Travelers with suspected COVID-19 should get tested. They should not go to work until it is safe to end isolation.
Travelers who do not have symptoms or a recent positive COVID-19 viral test should consider their vaccination and booster status, or whether they recently recovered from COVID-19. Recommendations for testing, staying home (quarantining), and additional precautions will differ based on their status. See CDC’s International Travel webpage to learn what precautions you should take.
Is it safe to go on a cruise? (Last updated 3/16/22)CDC currently recommends that travelers should make sure they are up to date with their COVID-19 vaccines before cruise ship travel. CDC also recommends that travelers who have a weakened immune system or are at increased risk of serious illness (even if they are up to date with their COVID-19 vaccines), talk to their healthcare provider about what additional precautions they may need before, during, and after travel.
If you do decide to travel on a cruise, visit CDC’s COVID-19 and Cruise Ship Travel and Travelers Returning from Cruise Ship and River Cruise Voyages. These pages provide information for travelers based on vaccination or COVID-19 recovery status.
What is the risk of getting COVID-19 on an airplane?Because of how air circulates and is filtered on airplanes, most viruses and other germs do not spread easily on airplanes. Although the risk of infection on an airplane is low, travelers should wear a mask, maintain as much distance from others as possible, try to avoid contact with sick passengers, and wash their hands often with soap and water for at least 20 seconds or use hand sanitizer that contains at least 60% alcohol.
Should I wear a mask during international travel? (Last updated 5/5/22)International travelers should check for mask recommendations and requirements at their destination. These may be different from recommendations and requirements in the United States. Information about mask requirements for your destination may be available from the Office of Foreign Affairs or Ministry of Health, or the U.S. Department of State, Bureau of Consular Affairs, Country Information webpage.
The requirement for all travelers aged 2 years and older to wear face masks while on public transportation into, within, or out of the U. S., and while indoors at U.S. transportation hubs, such as airports and stations ended as of April 18, 2022.
CDC, however, recommends that everyone aged 2 years and older (including passengers and workers ) wear a well-fitting mask or respirator over the nose and mouth in indoor areas of public transportation (such as airplanes, trains, etc.) and transportation hubs (such as airports, stations, etc.).
Masks should not be placed on children younger than 2 years of age, or on anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the cover without assistance.
Where can I find up to date travel information related to COVID-19?For the most up-to-date information on travel advisories, please visit VDH's Travelers site. Additionally, visit the CDC's travel advisory website and the U.S. Department of State website.
U.S. Travelers
Is it safe to travel in the United States? How can I find out if COVID-19 is spreading at my destination? (Last updated 4/4/22)COVID-19 is still spreading within Virginia and across the United States. It is safe to travel in the U.S. if you are up to date with your vaccines. If you are not vaccinated and not up to date with your vaccines, travel can increase your risk of getting or spreading COVID-19.
If you decide to travel and want to know if COVID-19 is spreading at or near your destination, check the CDC’s COVID Data Tracker webpage for U.S. states, cities, and counties. Current considerations for domestic travelers are posted on the CDC’s Domestic Travel During COVID-19. Get important information as you consider traveling to different cities and states across the U.S. on the CDC’s Health Department Directories page. If you are planning to travel for an upcoming holiday, see CDC’s information about Holiday Celebrations.
All travelers should check with the state or local health department where you are, along your route, and where you will be visiting to get the most up-to-date information, in case there are travel restrictions, stay-at-home orders or quarantine requirements upon arrival, state border closures, or other requirements. Plan to keep checking for updates as you travel. If you plan to travel by air, check if your airline requires any testing, vaccination, or other documents.
You can also visit COVID.gov for the latest updates on COVID-19 in the area you are visiting.
I am thinking about traveling within the U.S. or I have recently traveled within the U.S. What should I do? (Last updated 5/5/22)If you are thinking of traveling within the U.S., check the appropriate state recommendations and mandates before travel and understand how to travel safely and take appropriate precautions. Visit CDC’s Health Department Directory to get information about U.S. locations.
Recommendations and requirements for travelers in the U.S. are available at CDC’s Domestic Travel during COVID-19 page.
CDC recommends that people traveling within the U.S., regardless of vaccination status, should consider getting tested no more than 3 days before travel.
If you plan to travel by air, check if your airline requires any testing, vaccination, or other documents.
If you are planning to travel for an upcoming holiday, see CDC’s information about Holiday Celebrations.
CDC recommends that after domestic travel, regardless of vaccination status, you get tested if your travel involved situations with an increased risk of exposure (e.g., being in crowded places while not wearing a well-fitting mask or respirator), and follow quarantine guidance if you know you were exposed to a person with COVID-19.
Visit CDC’s Domestic Travel during COVID-19 to see which other precautions you should take after travel.
Anyone with any symptoms of COVID-19 should follow isolation recommendations.
Should I wear a mask during travel within the United States? (Last updated 5/5/22)The requirement for all travelers aged 2 years and older to wear face masks while on public transportation into, within, or out of the U. S., and while indoors at U.S. transportation hubs, such as airports and stations ended as of April 18, 2022.
CDC, however, recommends that everyone aged 2 years and older (including passengers and workers) wear a well-fitting mask or respirator over the nose and mouth in indoor areas of public transportation (such as airplanes, trains, etc.) and transportation hubs (such as airports, stations, etc.).Travelers should follow state and local mask recommendations and requirements at their destination.
People should follow recommendations as per the COVID-19 Community Levels guidance when at their destination.Masks should not be placed on children younger than 2 years of age, or on anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the cover without assistance.
Can individuals under isolation fly after Day 5 of isolation if they wear a mask? (Last updated 1/11/22)After you end isolation, it is preferred to avoid travel for a full 10 days after your symptoms started or the date of your positive test if you had no symptoms. However, if the traveler (1) has resolving symptoms and has been fever-free for 24 hours without the use of fever-reducing medicine, and (2) cannot avoid travel on Days 6 through 10, the traveler should wear a well fitting mask when around others for the entire duration of travel. If the person is unable to wear a mask, he/she should not travel during Days 6 through 10.
Travelers who still have symptoms at Day 5 or after should delay travel until fever-free for 24 hours without the use of fever-reducing medication and other symptoms have improved.
Where can I find up to date travel information related to COVID-19?Please visit VDH's Travelers site. Additionally, check out the CDC COVID-19 Travel Website.
- Should quarantine (stay home) for at least 5 days (Day 0–5) after their last contact with a person who has COVID-19 and should not travel if they haven’t ended quarantine, and ideally for the full 10 days after exposure.
Animals & Veterinarians
Animals and COVID-19
Can animals be infected with the virus that causes COVID-19? (Last updated 5/19/22)We know that cats, dogs, mink, white-tailed deer, and a few other types of animals can be infected with SARS-CoV-2, the virus that causes COVID-19. We don’t yet know all of the animals that can get infected. Of the animals confirmed to have SARS-CoV-2 in the U.S., it is believed that most of the animals became sick after contact with infected people.
At this time, there is no evidence that animals play a significant role in spreading SARS-CoV-2 to people. People with COVID-19 can spread the virus to animals during close contact. More studies are needed to understand if and how different animals could be affected by SARS-CoV-2.
For more information about COVID-19 and animals, see: CDC: Animals and COVID-19.
I have been diagnosed with COVID-19. Should I avoid pets or other animals while I am sick? (Last Updated 5/19/22)You should restrict contact with pets and other animals while you have COVID-19, just like you would restrict contact with other people, until it is safe for you to end isolation and be around others. Contact includes petting, snuggling, kissing, licking, sharing food, and sleeping in the same bed. Although reports of animals becoming sick with COVID-19 are uncommon, it is still recommended that people with suspected or confirmed COVID-19 should avoid contact with animals, including pets, livestock, and wildlife.
When possible, people should have a healthy member of the household provide care for the animals. In some situations, a person with COVID-19 might have to provide care for an animal. If you must care for your animal while you have COVID-19, limit contact with your animal as much as possible, wear a mask when around your animal, and make sure to wash your hands before and after interacting with your animal.
What about service or therapy animals? (Last updated 5/19/22)There are no restrictions on healthy people (those without suspected or confirmed COVID-19) interacting with service or therapy animals. As animals can spread other diseases to people, it’s always a good idea to wash your hands after being around animals.
VDH recommends that people with COVID-19 avoid contact with animals whenever possible. In some situations, like with service and therapy animals, it might be necessary for a person with COVID-19 to be in contact with these animals. If you must care for your pet or be around animals while you have COVID-19, limit contact with your animal as much as possible, wear a mask when around your animal, and make sure to wash your hands before and after interacting with your animal.
What if I need to self-quarantine because I’m a close contact of a person with COVID-19 and I have a pet? (Last updated 5/19/22)There are no restrictions on healthy people (those without suspected or confirmed COVID-19) interacting with animals. As animals can spread other diseases to people, it’s always a good idea to wash your hands after being around animals.
People with suspected or confirmed COVID-19 should avoid contact with animals, including pets, livestock, and wildlife. This includes avoiding petting, snuggling, being kissed or licked, and sharing food until it is safe to end isolation. If you must care for your pet or be around animals while you have COVID-19, limit contact with your animal as much as possible, wear a mask when around your animal, and make sure to wash your hands before and after interacting with your animal.
Have any animals in Virginia been infected with the virus that causes COVID-19? (Last updated 5/19/22)The USDA National Veterinary Services Laboratories (NVSL) confirmed on December 31, 2020 that a Virginia cat tested positive for SARS-CoV-2, the virus that causes COVID-19 in people. This was the first animal in Virginia that tested positive. It is believed that the cat became ill after being in close contact with people sick with COVID-19. On April 20, 2021, NVSL confirmed that three tigers at a Virginia zoo tested positive for SARS-CoV-2 and on October 28, 2021, a Virginia dog was also confirmed to be infected with SARS-CoV-2. USDA maintains a dashboard that shows confirmed cases of SARS-CoV-2 in animals in the U.S.
Reports of animals infected with SARS-CoV-2 have been documented around the world. Most of these animals became infected after being in contact with people with COVID-19, including owners and caretakers. For more information on how you can prevent transmitting SARS-CoV-2 to animals, check out CDC’s Information about COVID-19, Pets, and Other Animals.
What should I do if I think my animal is sick or I think my pet has the virus? (Last updated 4/21/22)Call your veterinary clinic with any questions about your animal’s health. In order to ensure the veterinary clinic is prepared for the animal, you should call ahead and arrange the hospital or clinic visit. Make sure to tell your veterinarian if your animal was exposed to a person with COVID-19 and if your animal is showing any signs of illness.
In some situations, the decision might be made to test an animal for SARS-CoV-2, the virus that causes COVID-19 in people (for example, if the animal has been exposed to a person or animal with COVID-19 within 14 days of becoming ill). The decision to test should be made collaboratively between the animal’s clinical veterinarian and public and animal health officials. Veterinarians with questions about testing can contact state animal and public health officials, who will help decide whether samples should be collected and tested.
What do we know about wildlife and SARS-CoV-2, the virus that causes COVID-19 in people? (Last updated 4/21/22)Some species of wildlife can be infected with SARS-CoV-2, the virus that causes COVID-19 in people, and there is evidence that some free-ranging wildlife have been infected in the United States. However, there is currently no evidence that wildlife might be a source of infection for people in the United States.
Anyone who comes into close proximity or contact with wildlife is encouraged to take caution to minimize the spread of SARS-CoV-2 between people and wildlife.
Because wildlife can carry multiple zoonotic diseases (i.e., diseases that can make people sick), even without looking sick, it is always important to enjoy wildlife from a distance.
To prevent getting sick from wildlife in the United States:Keep your family, including pets, a safe distance away from wildlife.
- Keep your pets up to date with rabies and other recommended vaccinations.
- Do not feed wildlife or touch wildlife droppings.
- Keep pets away from wildlife and their droppings.
- Always wash your hands and supervise children washing their hands after working or playing outside.
- Leave young animals alone. Often, the parents are close by and will return for their young.
- Consult the Virginia Department of Wildlife Resources for guidance if you are preparing or consuming legally harvested game meat.
Do not approach or touch a sick or dead animal – contact the Virginia Department of Wildlife Resources instead.
What do we know about SARS-CoV-2 and white-tailed deer? (Last updated 2/22/22)Recent research has shown that SARS-CoV-2, the virus that causes COVID-19 in people, is able to infect white-tailed deer. Further evidence suggests that deer do not appear to become sick or show clinical signs of disease when infected, and SARS-CoV-2 can be transmitted from deer to deer. The risk factors for virus spillover from humans to deer, or how deer are becoming exposed to the virus, have not yet been identified.
There are currently no documented cases of humans becoming infected after contact with infected white-tailed deer and there is no evidence that humans can get COVID-19 by eating wild hunted game meat. While the risk of transmission of SARS-CoV-2 from deer to humans is unknown at this time, it is believed to be low. Person-to-person transmission remains the greatest risk for spreading the virus.
Hunters and others who might come into contact with white-tailed deer should practice good hygiene and follow CDC recommendations for Reducing the Risk of SARS-CoV-2 Spreading between People and Wildlife.
For more information, see the Virginia Department of Wildlife Resources SARS-CoV-2 and White-Tailed Deer page.
Where can I find more information about animals and COVID-19?Information for Veterinarians
For veterinarians, how can I protect myself and my employees from COVID-19? (Last updated 4/21/22)Given community transmission of COVID-19 in Virginia and nationally, veterinary clinics should take measures to prevent COVID-19 transmission in the workplace. The following sites contain recommendations for employers to reduce the risk of transmission in the workplace:
As a veterinarian, what messages should I share with my clients about COVID-19? (Last updated 4/21/22)- Educate your clients on the differences between the enteric coronaviruses that circulate in domestic animals and the SARS-CoV-2 coronavirus, which, though it shares the same common name (“coronavirus”), is actually quite different.
- At this time, there is no evidence that animals play a significant role in spreading SARS-CoV-2, the virus that causes COVID-19, to people.
- Do not wipe or bathe your pet with chemical disinfectants, alcohol, hydrogen peroxide, or any other products not approved for animal use.
- People diagnosed with COVID-19 should have a different member of the household care for any mammalian pets in the home, if possible. People with suspected or confirmed COVID-19 should avoid contact with animals, including pets, livestock, and wildlife. This includes avoiding petting, snuggling, being kissed or licked and sharing food with animals.
- For more information, see CDC Information about COVID-19, Pets, and Other Animals
- If an animal needs veterinary care and a person in that pet’s household has COVID-19, encourage clients to inform the veterinary team of the COVID-19 exposure.
- Encourage clients who are sick to reschedule non-urgent pet appointments. If the appointment is urgent, have a healthy person bring the animal for care.
We have a request to board / care for an animal owned by a person with COVID-19. How do I keep my employees and other animals safe? (Last updated 4/21/22)By far, the greatest risk of COVID-19 transmission comes from close contact with other people. At this time, there is no evidence that animals play a significant role in spreading the virus that causes COVID-19; the risk of animals spreading COVID-19 to people is considered to be low. However, because all animals can carry germs that can make people sick, it is always a good idea to practice healthy habits around pets and other animals.
If asked to provide care for an animal exposed to a person with COVID-19, veterinarians and veterinary staff can take the following precautions:
- Whenever possible, have a healthy household member or friend bring the animal to your clinic to limit contact with sick people.
- Wash hands with soap and water or use a hand sanitizer that contains at least 60% alcohol before and after handling animals.
- If an animal needs to be housed in an animal shelter, veterinary clinic, or boarding facility, gloves and gowns or coveralls should be worn while performing routine intake exams and treatments in order to reduce contagious disease risks.
- Gloves and gowns or coveralls are a good infection prevention control practice generally, and continue to be important during the COVID-19 pandemic. Gowns or coveralls should be laundered before reuse if going to be reused.
- Hands should always be washed with soap and water including after gloves and gowns or coveralls are removed and discarded.
- The animal intake area as well as materials in animal areas such as food and water bowls and bedding should be routinely cleaned and sanitized.
- There is no need to bathe an animal because of COVID-19 concerns; at this time, there is no evidence that the virus that causes COVID-19 can spread to people from the skin or fur of pets.
- As a best practice, animals that were in contact with COVID-19 should be separated from the general animal population during the animal’s stay.
- Every effort should be made to promptly reunite sheltered companion animals with their owners.
- Animals that need to be adopted or sent to a foster home should be held for 14 days out of an abundance of caution.
- Dogs should be walked outside for elimination and exercise but direct contact with other companion animals should be avoided as a best practice to protect animal health.
- Routine cleaning and disinfection is important in animal areas. Cleaning of visibly dirty surfaces followed by disinfection is a best practice; normal cleaning and disinfection protocols for both animal housing and common areas used in shelters are sufficient. Increased sanitation of surfaces frequently touched by people (e.g., light switches and door knobs) is recommended to reduce exposure to/from humans.
For additional information, see CDC: Information about COVID-19, Pets, and Other Animals.
What if an animal, owned by a person with COVID-19, becomes sick? How do veterinarians and other animal caretakers safely provide care for that animal? (Last updated 4/21/22)Companion animals presenting with illness or injury should receive veterinary care. By far, the greatest risk of COVID-19 transmission comes from being in close contact with other people. At this time, there is no evidence that animals play a significant role in spreading the virus that causes COVID-19; the risk of animals spreading COVID-19 to people is considered to be low.
If asked to provide care for an animal exposed to a person with COVID-19, veterinarians and veterinary staff can:
- Review CDC's Information about COVID-19, Pets, and Other Animals
- This resource includes information about clinical signs of illness in animals infected with SARS-CoV-2, recommendations for personnel protective equipment, testing considerations, cleaning and disinfection, and more.
- Review VDH’s Testing and Management of an Animal Positive for SARS-CoV-2 in VA
- This resource contains Virginia-specific considerations for case evaluation, testing, and management of animals that test positive for SARS-CoV-2.
- Where appropriate, test for other infectious diseases that commonly cause companion animal illness.
- If testing an animal for SARS-CoV-2 is indicated, the supervising veterinarian should contact the state public health veterinarian or designated animal health official to discuss testing and appropriate next steps in case management.
- For more information, see: VDH Health Professionals: Veterinarians
What is known about animals that have tested positive for SARS-CoV-2, the virus that causes COVID-19 in people? (Last updated 5/19/22)A number of animals worldwide have been infected with the virus that causes COVID-19, including pets like cats and dogs, farmed mink, deer, hamsters, large cats, and non-human primates. Reptiles and birds have not been affected by this virus. The risk of animals spreading the virus to people is low, but people with COVID-19 can spread the virus to animals during close contact. USDA maintains a dashboard that shows confirmed cases of SARS-CoV-2 in animals in the U.S.
The clinical spectrum of illness for SARS-CoV-2 can vary. Animals infected with this virus may or may not get sick. The first description of animal illness associated with natural SARS-CoV-2 was published in a MMWR Report: First Reported Cases of SARS-CoV-2 Infection in Companion Animals — New York, March–April 2020. Illness associated with SARS-CoV-2 in animals tends to be mild and self-limiting. In rare circumstances, SARS-CoV-2 can contribute to or cause death in companion animals with underlying conditions.
What should I know about testing animals for SARS-CoV-2? (Last updated 5/19/22)Some animal health labs have developed testing to detect SARS-CoV-2 (the virus that causes COVID-19 in people). When considering testing a patient for SARS-CoV-2:
- Review CDC's Information about COVID-19, Pets, and Other Animals
- This resource includes information about clinical signs of illness in animals infected with SARS-CoV-2, recommendations for personnel protective equipment, testing considerations, cleaning and disinfection, and more.
- Review VDH’s Testing and Management of an Animal Positive for SARS-CoV-2 in VA
- This resource contains Virginia-specific considerations for case evaluation, testing, and management of animals that test positive for SARS-CoV-2.
- Where appropriate, test for other infectious diseases that commonly cause companion animal illness.
- If testing an animal for SARS-CoV-2 is indicated, the supervising veterinarian should contact the state public health veterinarian or designated animal health official to discuss testing and appropriate next steps in case management.
For more information, see: VDH Health Professionals: Veterinarians
Where can I find more information for veterinarians about COVID-19? (Last updated 9/1/21)- From the CDC:
- CDC: Information about COVID-19, Pets, and Other Animals
- CDC: Animals and COVID-19
- CDC: Reducing the Risk of SARS-CoV-2 Spreading between People and Wildlife
- CDC: Workplaces and Businesses
- CDC: Frequently Asked Questions, COVID-19 and Animals
- CDC: Evaluation for SARS-CoV-2 Testing in Animals
- CDC: Healthy Pets, Healthy People
From the VDH:
From the AVMA:
From the NASPHV
Healthcare Providers
Healthcare Providers: General Questions
What are the masking recommendations for healthcare settings? (Last updated 3/1/22)CDC defines healthcare settings as “places where healthcare is delivered and includes, but is not limited to, acute care facilities, long-term acute care facilities, inpatient rehabilitation facilities, nursing homes and assisted living facilities, home healthcare, vehicles where healthcare is delivered (e.g., mobile clinics), and outpatient facilities, such as dialysis centers, physician offices, and others.”
In all such settings, CDC and VDH recommend that masks are worn by staff, patients, residents, and visitors, regardless of COVID-19 vaccination status. For related information for healthcare settings, visit Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic. CDC’s COVID-19 Community Levels do not change masking recommendations in healthcare facilities.
A developmental disabilities group home would be considered a non-healthcare congregate setting. The independent living component of a continuing care community would also not be considered a healthcare setting unless the independent living facility has chosen to be regulated by the Department of Social Services, in which case it is regulated as an assisted living facility and considered a healthcare setting. A laboratory that only processes samples, but does not have patient interactions would not be considered a healthcare setting.
The most up to date mask guidance can be found on the VDH website. More guidance on protection from COVID-19 by masks or other face coverings can be found on the CDC mask website. The scientific basis underlying both personal and community masking recommendations is updated frequently on the CDC’s science brief on masks website.
How can I learn more about Long COVID and other post- COVID conditions? (Last updated 9/21/21)Post-COVID conditions are being referred to by a wide range of names, including post-acute COVID-19, long-term effects of COVID, Long COVID, post-acute COVID syndrome, chronic COVID, long-haul COVID, late sequelae, and post-acute sequelae of SARS-COV-2 infection (PASC). Although standardized case definitions are still being developed, in the broadest sense, it can be considered a lack of return to a usual state of health following acute COVID-19 illness. It might also include development of new or recurrent symptoms that occur after the symptoms of acute illness have resolved.
As of July 2021, post-COVID conditions can be considered a disability under the Americans with Disabilities Act (ADA). Learn more: Guidance on “Long COVID” as a Disability Under the ADA, Section 504, and Section 5117.
For more information, please see the following:
- CDC’s Post-COVID Conditions: Information for Healthcare Providers
- CDC’s Interim Guidance for caring for these patients
- WHO’s Science in 5 (video): Update on Long COVID
What strategies can healthcare providers and first responders use to reduce their own stresses associated with the COVID-19 pandemic? (Last updated 9/21/21)Responding to COVID-19 can take an emotional toll on first responders, healthcare providers, and public health workers. There are things you can do to reduce secondary traumatic stress (STS) reactions:
- Acknowledge that STS can affect anyone helping families after a traumatic event.
- Learn the symptoms, including physical (fatigue, illness) and mental (fear, withdrawal, guilt) symptoms.
- Allow time for you and your family to recover from responding to the pandemic.
- Create a menu of personal self-care activities that you enjoy, such as spending time with friends and family, exercising, or reading a book.
- Take a break from media coverage of COVID-19.
- Take care of your body. Take deep breaths, stretch, or meditate. Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep, and avoid alcohol and drugs. Stay up to date on your COVID-19 vaccines and other recommended vaccines.
- Connect with others. Talk with people you trust about your concerns and how you are feeling.
- Ask for help if you feel overwhelmed or concerned that COVID-19 is affecting your ability to care for your family and patients as you did before the outbreak.
For more information and resources, please see:
- Center for the Study of Traumatic Stress' Sustaining the Well-Being of Healthcare Personnel During Coronavirus and Other Infectious Disease OutbreaksSustaining the Well-Being of Healthcare Personnel During Coronavirus and Other Infectious Disease Outbreaks
- Mental Health America's The Mental Health of Healthcare Workers in COVID-19The Mental Health of Healthcare Workers in COVID-19
- Minnesota Department of Health's Mental Health and Resiliency Tools for Health Care Workers: COVID-19
- American Medical Association's Managing mental health during COVID-19
- World Health Organization’s Mental health and COVID-19: early evidence of the pandemic’s impact: scientific brief, 2 March 2022
Is there a way for healthcare providers to be reimbursed for providing COVID-19-related care to uninsured individuals? (Last updated 4/5/22)It depends. The HRSA Covid-19 Uninsured Program provides a means for healthcare providers to obtain compensation at Medicare rates for rendering COVID-19 care to a patient with that primary diagnosis. The program covers testing, testing-related office visits, other diagnostic procedures, and treatment of COVID-19 in a variety of settings, including inpatient, outpatient, skilled nursing facility, rehabilitation care, ambulance transport.
The Uninsured Program has stopped accepting claims because of lack of sufficient funds. The program stopped accepting claims for testing and treatment on March 22, 2022 and claims for vaccination on April 5, 2022. Any submitted claims by the respective deadline will be paid based on the availability of funds. Any claims submitted after the respective deadline will not be adjudicated for payment. For additional information, refer to HRSA’s Uninsured Program Shutdown Frequently Asked Questions. You may also contact the HRSA Provider Support Line at 1-833-967-0770; for TTY dial 1-888-970-2920. Hours of operation are 8 a.m. to 8 p.m. ET, Monday through Friday.
A separate program, the HRSA COVID-19 Coverage Assistance Fund, is available to reimburse providers for COVID-19 vaccine administration to underinsured individuals whose health plan either does not include COVID-19 vaccination as a covered benefit or covers COVID-19 vaccine administration but with cost-sharing. The Coverage Assistance Fund stopped accepting vaccination claims on April 5, 2022 because of a lack of sufficient funds. Any submitted claims by the respective deadline will be paid based on the availability of funds. For additional information, refer to HRSA’s COVID-19 Coverage Assistance Fund Shutdown FAQs.
The U.S. Department of Health and Human Services (HHS) continues to have ongoing conversations with Congress to obtain additional funding for these programs.
Alternative resources for uninsured individuals who need COVID-19 services or other health care coverage include:
Where can a Healthcare Provider find more information about COVID-19? (Last updated 11/16/21)The Virginia Department of Health regularly updates its website with the latest information on COVID-19 in Virginia. For additional information, check out the VDH COVID-19 website for Health Professionals.
The CDC provides detailed and frequently updated COVID-19 resources for clinicians. The CDC’s Clinician Call Center is a hotline with CDC clinicians standing by to answer questions about COVID-19. Call the main CDC information line at 800-CDC-INFO (800-232-4636) and ask for the COVID-19 Clinician's Call Center.
The FDA website provides frequently updated information on COVID-19-related treatments, vaccines, and test materials.
How do healthcare providers report a person with suspected or confirmed COVID-19 to VDH? (Last updated 4/5/22)As required by state regulations, clinicians should use VDH’s secure Confidential Morbidity Report Portal to report COVID-19 cases as soon as they are identified. Please include in your report symptoms and other critical epidemiologic fields, including race and ethnicity. VDH personnel with access to the data are required by state law to protect the anonymity of patients and healthcare providers.
Point of Care (POC) testing sites should go to the VDH COVID-19 Manual Reporting site to register for the POC Reporting Portal. Sites that have been reporting positive POC results through the Confidential Morbidity Portal no longer need to do so once they begin reporting through the POC Reporting Portal.
Healthcare providers’ reports of positive at-home COVID-19 tests will be treated as COVID-19 cases.
New laboratory reporting guidance from the U.S. Department of Health and Human Services (HHS) and CDC went into effect on April 4, 2022. The new guidance still requires reporting of all nucleic acid amplification test (NAAT) test results (both positive and negative) and all positive test results except for home tests and antibody tests. The guidance no longer requires reporting negative non-NAAT test results (e.g., rapid or antigen test results) and positive or negative antibody test results.
Where can I find guidance on ending isolation for healthcare workers? (Last updated 1/11/22)CDC released updated guidance for isolation and quarantine for healthcare workers, decreasing their isolation time after infection with COVID-19. Additionally, CDC released an update to the guidance for contingency and crisis management in the setting of significant health care worker shortages.
CDC guidance for patients, residents, and visitors to healthcare settings is also addressed in the Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic.
Healthcare Providers and Clinical Laboratory Staff: Testing for COVID-19
What are the testing recommendations for a healthcare provider who is up to date on COVID-19 vaccines but who had a high risk exposure in a non-healthcare setting to an individual with SARS-CoV-2 infection? (Last updated 1/24/22)According to CDC, asymptomatic HCP who are up to date on COVID-19 vaccines should have a series of two viral tests for SARS-CoV-2 infection, the first one “immediately” (but not earlier than 24 hours after the exposure) and, if negative, then again 5-7 days after the exposure.
Universal masking as source control when working in their facility is also recommended for the exposed HCP for 14 days following their exposure.
Additional recommendations can be found on the CDC website.
What specimens should I collect or recommend for COVID-19 testing and where can these specimens be sent? (Last updated 5/3/22)Different COVID-19 laboratory tests use different clinical specimens. Viral tests typically use upper respiratory tract specimens such as a nasopharyngeal swab, nasal swab, throat swab, or saliva specimen.
In general, healthcare providers should send specimens for COVID-19 testing to commercial, private, or hospital laboratories. VDH recommends that healthcare providers work with laboratories that use viral tests granted an Emergency Use Authorization (EUA) by FDA or viral tests offered under the policies in FDA’s Policy for COVID-19 Tests. Always evaluate test performance measures. Contact your laboratory partner for specific information about specimen type, collection procedures, and submission protocols. CDC provides Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for COVID-19.
Many community testing sites collect specimens and either perform point-of-care (POC) tests or send specimens to a private or reference laboratory for testing. To find a site for your patient(s), visit Virginia COVID-19 Testing Sites. Each site has different policies and procedures for testing and billing.
Self-testing kits, also called at-home test kits, can be recommended for patients if testing at a local healthcare facility or community testing site is not feasible. For self-testing kits, the collected specimen is tested at home with a result in about 10-30 minutes depending on the test.
Self-collection kits can be used at home by people to collect a specimen (nasal swab, saliva) by themselves or from other people. Self-collection kits typically come with printed instructions on specimen collection or the instruction material may be available online. Once collected, the specimen is packaged and mailed back to the relevant laboratory for testing.
Currently, for both self-testing and self-collection kits, a variety of prescription and non-prescription options is available. For more information about currently available self-test kits, visit the VDH table on COVID-19 at-home tests or the CDC Self-Testing website.
When and how are patients tested through the Division of Consolidated Laboratory Services (DCLS) for COVID-19? (Last updated 6/9/22)Testing at Virginia’s public health laboratory (Division of Consolidated Laboratory Services or ‘DCLS’) or an affiliated partner is available for (1) the detection or rule out of SARS-CoV-2 using polymerase chain reaction (PCR) or (2) variant identification by whole genome sequencing (WGS) for VDH-approved testing scenarios (i.e. outbreaks, point prevalence surveys, individual or other special requests). Clinicians should request public health laboratory testing for these scenarios by contacting their local health department.
Submitters must collect and package specimens and either deliver them to a DCLS courier site, self-deliver to the DCLS loading dock, or ship them to DCLS via commercial courier (e.g., FedEx). Specimens should be stored refrigerated and shipped to DCLS on ice packs to ensure refrigerated conditions. Specimens must arrive under refrigerated conditions within 72 hours of collection with the date and time of collection present on the submission form. If delayed shipping or longer storage is needed, samples should be stored at -70◦C or colder prior to shipment on dry ice.
What is the expected turnaround time for reporting SARS-CoV-2 diagnostic polymerase chain reaction (PCR) or whole-genome sequencing (WGS) results? (Last updated 6/9/22)DCLS Diagnostic PCR Testing: DCLS PCR result reports are released within 48 hours of sample receipt, though most are available sooner. Reports may be obtained immediately by authorized users of medical facilities and health departments with access to the DCLS Connect portal. All hard copy result reports are sent to submitters via a commercial carrier (next day delivery), Monday through Friday. Friday's positive results are faxed to submitters on Saturday.
Whole-genome sequencing testing (WGS): DCLS currently reports variant information determined by WGS within 7 – 14 days of sample receipt. The turnaround time for testing results is determined by the current workload of the laboratory, especially during COVID-19 surges. Results are reported to the submitter as a paper-copy report that includes variant lineage information for Variants of Concern and Variants Being Monitored per Centers for Disease Control and Prevention guidance. DCLS additionally issues WGS results as an electronic laboratory report to the Virginia Department of Health for ingestion into the Virginia Electronic Disease Surveillance System (VEDSS).
Most samples received through local health departments are retained at DCLS for WGS; however, the partner laboratory network for the Virginia SARS-CoV-2 Strain Surveillance (VAS3) initiative is utilized for surveillance specimens from Virginia hospitals. DCLS can triage samples to contracted VAS3 laboratories with the goal of maximizing sequencing capacity and timeliness. VAS3 Network laboratories provide results directly to VDH for integration into VEDSS. The VAS3 network was devised to improve surveillance and representation of the regions of Virginia in the surveillance system, but not for patient level reporting to hospitals or other non-public health entities. Therefore, samples sequenced by VAS3 partners cannot be reported to hospital and hospital laboratories.
Commercial, Private, or Hospital Laboratory Testing: Each laboratory determines its own turnaround time. Authorized assays for viral testing include those that detect SARS-CoV-2 nucleic acid or antigen. Some tests are point-of-care tests, meaning results may be available at the testing site in less than an hour. Other tests must be sent to a laboratory to analyze, a process that may take 1–2 days once received by the lab.
Can variants of SARS-CoV-2 lead to false negative results with molecular tests? (Last updated 12/28/21)Yes. The FDA released an update on Dec. 28, 2021 alerting clinical laboratory staff and healthcare providers to the impacts, including false negative test results, that could occur with any molecular test for the detection of SARS-CoV-2 variants if a mutation occurs in the part of the virus’ genome assessed by that test. This update includes specific references to the Omicron variant. The FDA will update this page as significant new information becomes available.
FDA recommends clinical laboratory staff and health care providers who use molecular tests for the detection of SARS-CoV-2 to:
- Be aware that genetic variants of SARS-CoV-2 arise regularly and false negative test results can occur.
- Be aware that tests that use multiple genetic targets to determine a final result are less likely to be impacted by increased prevalence of genetic variants.
- Consider test results in combination with clinical observations, patient history, and epidemiological information.
- Consider repeat testing with a different test (with different genetic targets) if COVID-19 is still suspected after receiving a negative test result.
Have any COVID-19 molecular viral test kits been associated with false positive test results? (Last updated 10/18/21)Yes. The Abbott Molecular Inc. Alinity SARS-CoV-2 AMP and Alinity m Res-4-Plex AMP Kits, being distributed under an EUA, were identified in September 2021 by the FDA as sometimes associated with false positive test results. Details of this FDA alert can be found on the website.
Has FDA recalled or warned about any COVID-19 test kits? (Last updated 6/1/22)Yes. COVID-19 tests are considered medical devices by the FDA. FDA maintains a webpage of medical device recalls–this page includes recalls of specific COVID-19 test kits. The tests listed below are 2022 recalls thus far. They should no longer be used and healthcare providers should review specific information about any tests used in your facility to decide whether patients tested with them need to be retested or otherwise counseled about their test results.
- 5/16/2022: Woodside Acquisitions Inc. Recalls Oral Rapid SARS-CoV-2 Antigen Rapid Test Kits and Joysbio SARS-CoV-2 Antigen Rapid Test Kits (Colloidal Gold) That Are Not Authorized, Cleared, or Approved by the FDA
- 5/10/2022: SML Distribution LLC Recalls Skippack Medical Lab COVID-19 Direct Antigen Rapid Tests That Are Not Authorized, Cleared, or Approved by the FDA
- 5/9/2022: Mesa Biotech, Inc., Recalls Certain Accula SARS-CoV-2 Tests for Risk of False Positives Caused by Contamination
- 4/28/2022: Celltrion USA Recalls Certain Point of Care DiaTrust COVID-19 Ag Rapid Test Kits Which May Have Been Distributed to Unauthorized, Non-CLIA-Certified Users
- 3/23/2022: Celltrion USA Recalls Certain Point of Care DiaTrust COVID-19 Ag Rapid Test Kits Labeled for Research Use Only
- 3/16/2022: SD Biosensor Recalls STANDARD Q COVID-19 Ag Home Tests That Are Not Authorized, Cleared, or Approved by the FDA and May Give False Results
- 3/15/2022: Celltrion USA Recalls Certain Point of Care Celltrion DiaTrust COVID-19 Ag Rapid Tests for False Positive Test Results and Unauthorized Shelf Life
- 3/14/2022: LuSys Laboratories, Inc Recalls COVID-19 Antigen Tests (Nasal/Saliva) and COVID-19 IgG/IgM Antibody Tests Because They Are Not Authorized, Cleared, or Approved by the FDA
- 2/18/2022: E25Bio Recalls COVID-19 Direct Antigen Rapid Tests That Are Not Authorized, Cleared, or Approved by the FDA and May Give False Results
- 1/28/2022: Empowered Diagnostics Recalls COVID-19 Tests due to Risk of False Results
How should I interpret a positive RT-PCR test result? (Last updated 6/17/22)A positive RT-PCR test result for COVID-19 indicates that RNA from the SARS-CoV-2 virus was detected in the clinical specimen tested, the patient is presumptively infected with SARS-CoV-2, and presumptively still contagious if within ten (10) days of symptom onset. Laboratory test results should always be considered in the context of clinical observations and epidemiological data in making a final diagnosis and patient management decisions.
- RT-PCR test performance varies by the type of test/manufacturer and other factors such as timing of specimen collection, type of specimen, and quality of specimen.
- RT-PCR tests are typically very (99-100%) specific, meaning they produce very few false positive test results when testing occurs in the first few weeks after onset of infection. Please see Table 9 in the IDSA guidelines.
- RT-PCR sensitivity will vary depending on factors like specimen type and timing of specimen collection. Per IDSA guidelines, sensitivities may range from about 55% for oral specimens to near 100% for mid-nasal turbinate specimens. In general, it is best to collect specimens as close to symptom onset as possible or within the first week when viral shedding is believed to be highest (or 5–7 days after exposure, if the patient is asymptomatic). RT-PCR positivity starts to decline around the 3rd week of infection.
The test being used by DCLS has been designed to minimize the likelihood of false positive test results. The current assay has >95% sensitivity and >95% specificity.
It is important to note that some people may continue to test positive by molecular (RT-PCR) tests even after the virus is no longer thought to be live (replication-competent). In these cases of false positive test results, the person is no longer considered to be infectious.
More information on testing characteristics can be found at these sites:
FDA’s Coronavirus Testing Basics
CDC’s Overview of Testing for SARS CoV-2
VDH Testing and Laboratory for Healthcare Providers
Additional guidance on the use of molecular diagnostic testing is available from the Infectious Diseases Society of America (IDSA). See IDSA Guidelines on the Diagnosis of COVID-19: Molecular Diagnostic Testing
How should I interpret a negative RT-PCR test result? (Last updated 6/17/22)A negative RT-PCR test result means that detectable SARS-CoV-2 RNA was not identified in the specimen. However, because PCR results may be falsely negative if tested very soon after an infection begins, a negative result does not completely rule out the possibility of SARS-CoV-2 infection and should not be used as the sole basis for treatment or other patient or contact management decisions.
When diagnostic testing is negative, the possibility of a false negative result should always be considered, especially if the patient’s recent exposures or clinical presentation indicate that SARS-CoV-2 infection is likely, and diagnostic tests for other possible causes of illness (e.g., flu or other respiratory illness) are negative. If COVID-19 is still suspected based on exposure history and clinical findings, re-testing should be considered.
More information on testing characteristics can be found at these sites:
FDA’s Coronavirus Testing Basics
CDC’s Overview of Testing for SARS CoV-2
VDH Testing and Laboratory for Healthcare Providers
Additional guidance on the use of molecular diagnostic testing is available from the Infectious Diseases Society of America (IDSA). See IDSA Guidelines on the Diagnosis of COVID-19: Molecular Diagnostic Testing
Who can order antigen tests? (Last updated 11/3/21)The ability to order COVID-19 antigen testing depends on the test used. Prescription antigen tests must be ordered by licensed practitioners who have prescriptive authority. In Virginia, this includes MDs, DOs, NPs, and PAs.
However, there are now multiple non-prescription COVID-19 antigen tests that do not need a prescription from a medical provider.
For more information about COVID-19 antigen tests, see the CDC document Guidance for Antigen Testing for SARS-CoV-2 for Healthcare Providers Testing Individuals in the Community.
Who can administer viral antigen tests for COVID-19?Virginia Code § 54.1-2901 allows a licensed practitioner to delegate functions that are non-discretionary and that do not require the exercise of professional judgment by unlicensed but trained individuals. Licensed practitioners with prescriptive authority can delegate administration of antigen tests, but they must supervise the personnel and assure they are trained and competent. Both licensed and unlicensed individuals who administer antigen tests must complete training and competency assessments.
How can individuals get training on administration of antigen tests?Training is provided by many of the test manufacturers. For example:
BinaxNOW training can be found on Abbott's website.
BD Veritor training can be found on BD's website.
Sofia training can be found on Quidel’s website.
If the manufacturer offers a certificate of completion of training, people who complete the training should obtain this certificate. Other potential resources for training assistance include the test manufacturer's customer support line or local manufacturer representatives.
Is a CLIA certificate required to conduct onsite antigen testing?Yes, a CLIA Certificate of Waiver, Certificate of Compliance, or Certificate of Accreditation is required for onsite antigen testing. Visit CMS’ CLIA website for information on CLIA regulations and obtaining a CLIA certificate.
How should I interpret a positive antigen test result? (Last updated 6/17/22)Molecular tests remain the “gold standard” for detection of SARS-CoV-2 but a positive antigen result indicates probable current infection. A positive COVID-19 antigen test indicates that viral antigen (typically, the nucleocapsid protein) was detected in the clinical specimen. In general, antigen tests are most accurate in symptomatic people early in the course of acute illness. In a patient with one or more COVID-19 symptoms and a positive antigen test done within the timeframe of the test, this is considered diagnostic of SARS-CoV-2 infection. Additional COVID-19 diagnostic testing is not needed.
False positives are uncommon but can occur, especially in areas of low disease prevalence and, under certain circumstances, CDC recommends nucleic acid amplification testing (NAAT) for confirmatory testing. Confirmatory testing should take place as soon as possible after the antigen test, and not longer than 48 hours after the initial antigen testing. Results should be interpreted in the context of the COVID-19 prevalence, the test device’s performance characteristics, its instructions for use, and the patient’s clinical signs, symptoms, and exposure and vaccination history. If the results are discordant between the antigen test and the confirmatory NAAT, in general the confirmatory test result should be interpreted as definitive for the purpose of clinical diagnosis.
Antigen Testing Recommendations from CDC: Guidance for Antigen Testing for SARS-CoV-2 for Healthcare Providers Testing Individuals in the Community.
CDC Antigen Test Algorithm for Healthcare Providers Testing Individuals in Community Settings
Additional guidance on the use of antigen testing is available from the Infectious Diseases Society of America (IDSA). See IDSA Guidelines on the Diagnosis of COVID-19: Antigen Testing
How should I interpret a negative antigen test result? (Last updated 6/17/22)A negative antigen test result indicates the test did not identify SARS-CoV-2 antigen (typically, the nucleocapsid protein) in the clinical specimen tested. Clinically, this generally indicates that no active SARS-CoV-2 infection was identified at the time of testing. Interpretation of results should factor in the date of specimen collection compared to the date of onset of symptoms or date of last exposure, to ensure the test was not conducted too early or too late to be meaningful. An improperly collected specimen can also result in a negative antigen test result.
If the person had a known exposure to someone with COVID-19 and tests negative, the person should continue to self-quarantine until at least five (5) days after the last known exposure. CDC recommends that exposed people who are not up to date on COVID-19 vaccines should be tested on or soon after Day 5 during quarantine. If the person did not have a known exposure to someone with COVID-19, the person should self-isolate until at least 24 hours after symptoms resolve (if symptomatic) or, if asymptomatic, should follow protective measures in place in the community.
Antigen tests are generally less sensitive than molecular tests and studies have shown that antigen levels in some patients who have been symptomatic for more than five days might drop below the limit of detection of the test. This could result in a false negative test result whereas a more sensitive test, such as a molecular test, might return a positive result. If the result of an antigen test is inconsistent with a patient’s clinical picture, it may be necessary to quickly confirm a negative rapid antigen test result with a molecular test.
Antigen Testing Recommendations from CDC: Guidance for Antigen Testing for SARS-CoV-2 for Healthcare Providers Testing Individuals in the Community.
CDC Antigen Test Algorithm for Healthcare Providers Testing Individuals in Community Settings.
Additional guidance on the use of antigen testing is available from the Infectious Diseases Society of America (IDSA). See IDSA Guidelines on the Diagnosis of COVID-19: Antigen Testing
How should I interpret a positive antibody (serology) test result? (Last updated 6/17/22)A positive antibody (serology) result indicates that the patient was probably infected with the SARS-CoV-2 virus at some point in the past.
- Recommendation: Test the patient with a PCR or antigen test if clinically indicated (for example, if there is concern that a patient has acute COVID-19).
- Caveat: Counsel the patient that detection of antibodies does NOT mean the person is now either infectious with or immune to SARS-CoV-2. A false positive is possible if the test cross-reacts with commonly circulating coronaviruses. For more information, see Infectious Diseases Society of America Guidelines on the Diagnosis of COVID-19: Serologic Testing.
CDC and VDH do not recommend that people get serology testing done to document immunity after vaccination. At this time, do not interpret the results of qualitative, semi-quantitative, or quantitative SARS-CoV-2 antibody tests as an indication of a specific level of immunity or protection from SARS-CoV-2 infection.Please see: Interim Guidelines for COVID-19 Antibody Testing.
Additional guidance on the use of serologic testing is available from the Infectious Diseases Society of America (IDSA). See IDSA Guidelines on the Diagnosis of COVID-19: Serologic Testing
How should I interpret a negative COVID-19 antibody (serology) test result? (Last updated 6/17/22)A negative antibody (serology) result means that antibodies to SARS-CoV-2 were not detected in serum.
- Recommendation: Retest if certainty about SARS-CoV-2 antibody status is needed, or test for current or recent infection with a PCR or antigen test if clinically indicated.
- Caveat: A negative antibody test could indicate (1) that the person has not been infected, (2) that post-infection antibodies had not yet developed when the specimen was collected, or (3) that the immune system did not mount a sufficient antibody response to a COVID-19 exposure (e.g., because of immunosuppression).
Please see: Interim Guidelines for COVID-19 Antibody Testing.
Additional guidance on the use of serologic testing is available from the Infectious Diseases Society of America (IDSA). See IDSA Guidelines on the Diagnosis of COVID-19: Serologic Testing
What is sample pooling and when should it be used?Sample pooling—sometimes referred to as pool testing, pooled testing, or batch testing—means combining samples from multiple people and conducting one laboratory test on the combined pool of samples to detect SARS-CoV-2.
Sample pooling allows laboratories to test more people with fewer testing materials. It could be useful in scenarios such as needing to test to allow the return of large numbers of workers to a specific workplace or for large-scale testing of children at a school.
Pooling should be used only in areas or situations where the proportion or rate of positive test results is expected to be low—for example in areas with a low prevalence of SARS-CoV-2 infections. CDC recommends that laboratories determine prevalence based on a rolling average of the positivity rate of their own SARS-CoV-2 testing over the previous 7–10 days.
CLIA-certified laboratories can use a specimen pooling strategy to expand SARS-CoV-2 nucleic acid diagnostic or screening testing capacity when using a test authorized for such use by FDA. Non-CLIA-Certified Laboratories can use a specimen pooling strategy only for surveillance testing.
For more information, see: Interim Guidance for Use of Pooling Procedures in SARS-CoV-2 Diagnostic, Screening, and Surveillance Testing
How do you interpret the results of a pooled test?If a pooled test result is negative, all specimens contained in the pool that is being tested with the single test can be presumed negative. However, monitoring the prevalence of disease and properly validating the assay and the instrumentation are important to limit the potential for false-negative results. In general, because the formation of a pool dilutes each specimen included in the pool, the larger the specimen pool, the higher the likelihood of generating false-negative results.
If the pooled test result is positive or indeterminate, then all the specimens in the pool need to be retested individually (or in smaller pools). The advantages of this two-stage specimen pooling strategy include preserving testing reagents and resources, reducing the amount of time required to test large numbers of specimens, and lowering the overall costs of testing.
I have heard that a new COVID-19 diagnostic breath test is available. Can you explain more? (Last updated 4/19/2022)On 4/14/2022, the FDA granted an Emergency Use Authorization to a new type of Covid-19 diagnostic test -- a breath test that uses gas chromatography - mass spectrometry (GC-MS) to look for five volatile organic compounds (VOCs) associated with SARS-CoV-2 infection in people's exhaled breath. FDA's news release provides more detail about the test.
The test manufacturer is InspectIR Systems LLC and the test name is the InspectIR COVID-19 Breathalyzer. The test is indicated in individuals 18 years and older with or without symptoms or other epidemiological reasons to suspect COVID-19. The test must be performed by a qualified, trained operator under the supervision of a healthcare provider licensed or authorized by state law to prescribe tests in an environment where the patient specimen is both collected and analyzed.
Positive results should be correlated with the patient's history and other diagnostic information to determine if the patient is felt to have acute SARS-CoV-2 infection. A positive breath test result should be treated as presumptive and confirmed with a molecular assay. Test results are provided in less than 3 minutes. This test is NOT indicated for use at home.
In a study that included asymptomatic people, test sensitivity (with PCR testing as the comparator) was 91.2% and specificity 99.3%. In a study involving symptomatic patients, test sensitivity was 97.8% and specificity 99.1%. A small study showed that the breath test was capable of detecting the Omicron variant. For more information about the test, please go to www.inspect-ir.com.
Healthcare Providers: Quarantine and Isolation
What resources are available for work restrictions and the quarantine of healthcare providers? (Last updated 5/17/22)VDH’s Guidance for Assessing and Managing Exposed, Asymptomatic Healthcare Personnel includes a risk assessment tool to evaluate healthcare personnel exposure to SARS-CoV-2. (Revised Feb 10, 2022)
Recommended work restrictions for healthcare personnel depend on the person’s immune status, vaccination status, and type of exposure. A table of the recommendations is available in the CDC Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2.
Additional CDC guidance on this topic can be found in the following links:
What resources are available to help healthcare facilities determine when to move to contingency or crisis staffing and how to apply return to work criteria under these conditions? (Last updated 5/17/22)CDC has guidance on Strategies to Mitigate Healthcare Personnel Staffing Shortages that address crisis and contingency management. CDC and VDH are concerned about overall healthcare staffing capacity, not just in care of COVID-19 patients. Facilities should make decisions based on their own capacity, and situations may be fluid. Strategies should be considered and implemented sequentially.
Healthcare systems, healthcare facilities, and the appropriate state, local, territorial, and/or tribal health authorities might determine that the recommended approaches cannot be followed due to the need to mitigate healthcare provider (HCP) staffing shortages. When staffing shortages are anticipated, healthcare facilities and employers, in collaboration with human resources and occupational health services, should use contingency capacity strategies to plan and prepare for mitigating this problem. At baseline, healthcare facilities must:
- Understand their staffing needs and the minimum number of staff needed to provide a safe work environment and patient care.
- Be in communication with local healthcare coalitions, federal, state, and local public health partners (e.g., public health emergency preparedness and response staff) to identify additional HCP (e.g., hiring additional HCP, recruiting retired HCP, using students or volunteers), when needed. Please see the CDC website Strategies to Mitigate Healthcare Personnel Staffing Shortages for more detailed recommendations about HCP return to work policies in different scenarios.
If HCP are permitted to return to work before meeting all conventional return to work criteria, what recommendations should be in place?If HCP are permitted to return to work before meeting all conventional Return to Work Criteria due to staffing shortages, the following recommendations should be in place:
- HCP should wear a respirator or well-fitting mask continuously, even when they are in non-patient care areas such as breakrooms.
- If HCP must remove their respirator or well-fitting mask, for example, to eat or drink, they should separate themselves from others.
- HCP should practice physical distancing from coworkers at all times.
- HCP should self-monitor for symptoms and seek re-evaluation from occupational health if symptoms recur or worsen.
- If tolerated, patients/residents should wear well-fitting source control while interacting with these HCP.
Is training available for N95 fit-testing? (Last updated 3/8/22)VDH periodically schedules train-the-trainer sessions for respiratory fit testing. By the end of the training, attendees are able to train others in the proper procedures for fit-testing. Information on upcoming sessions (date, time, location) is available.
For facilities that need additional information on developing and implementing a respiratory protection program, VDH has posted a resource guide.
If a healthcare facility is operating under contingency or crisis standards to mitigate staffing shortages, do the isolation and quarantine recommendations for healthcare personnel in that facility apply to return to work only or do they also apply to situations outside of work? (Last updated 1/24/22)Work restrictions for healthcare personnel outlined in the current CDC guidance for managing infected or exposed healthcare personnel and strategies to mitigate staffing shortages guidance apply only to work in healthcare facilities. For example, if an individual has asymptomatic or mildly symptomatic SARS-CoV-2 infection with improving symptoms and works in a healthcare facility operating under crisis staffing standards, they would be able to work with prioritization of certain duties, per facility policy. However, they should still follow the general public guidance as it pertains to being out in the community. In this example, if the individual has asymptomatic or mild infection, the healthcare worker would need to isolate for at least 5 days (except to go to work). If the healthcare worker is involved with another sector that has its own guidance then guidance for that setting would also need to be applied before returning to that setting following SARS-CoV-2 exposure or infection.
Are HCP who tested positive for COVID-19 but do not have symptoms allowed to work on a COVID-19 unit? (Last updated 1/24/22)It depends on the staffing situation. In conventional staffing situations, all HCP (regardless of vaccination status) who test positive for COVID-19 should be excluded from work until all Return to Work Criteria are met. Healthcare facilities must be prepared for potential staffing shortages and have plans and processes in place to mitigate them, including considerations for permitting HCP to return to work without meeting all return to work criteria. For example, crisis staffing standards permit HCP with asymptomatic or mildly symptomatic SARS-CoV-2 infection to work, with prioritization considerations (e.g., may work on a hot unit but should not work with immunocompromised patients/residents). Refer to CDC’s Strategies to Mitigate Healthcare Personnel Staffing Shortages document for more information.
Healthcare Providers: Infection Prevention and Control
When should healthcare facilities make changes to infection prevention and control interventions based on changes in community transmission levels? (Last updated 6/9/22)Healthcare facilities should consider checking their local Community Transmission level weekly. When the Community Transmission level increases and the increase results in a change in recommended interventions, the new interventions should be implemented as soon as possible. When the community transmission level decreases into a category that leads to relaxation of an intervention (e.g., no longer requiring use of eye protection for all patient care encounters), facilities should consider confirming the reduction is sustained, by monitoring for at least two weeks, before relaxing the intervention.
After a person with suspected or confirmed COVID-19 exits an exam room, what is the recommended cleaning and down-time before the room can be returned to routine use? (Last updated 2/22/21)Healthcare personnel and environment services staff should not enter a room after a patient exits until there has been enough time for the air changes needed to remove potentially infectious particles. Time required for sufficient air changes varies by the ventilation conditions in the room.
- Airborne infection isolation room (AIIR): If the change rate is known, leave the room empty for enough air changes per hour (ACH) to occur, to clear the room of infectious particles.
- Regular exam room: It is unknown how long SARS-CoV-2 remains infectious in the air. In the interim, it is reasonable to wait two hours, which is commonly used for pathogens spread by the airborne route (e.g., measles, tuberculosis).
- More information on air change rates is available.
After enough time has passed, the room should undergo appropriate cleaning, including disinfection of high-touch surfaces, before returning to routine use.
If a person with suspected or confirmed COVID-19 is transported in an ambulance, what is the cleaning procedure and downtime recommendation before that ambulance is allowed back into service? (Last updated 2/3/22)Routine disinfection procedures for rooms, equipment and ambulances are recommended. An EPA-approved disinfectant should be used for disinfection. Any waste generated is not considered Category A waste. Use disposable or dedicated patient-care equipment (e.g., blood pressure cuffs). If equipment must be used for multiple patients, clean and disinfect such equipment before use on another patient according to the manufacturer instructions for use.
After patient unloading, allow a few minutes with ambulance module doors open to rapidly dilute airborne viral particles.
Additional considerations for vehicle configuration when transporting a patient with suspected or confirmed SARS-CoV-2 infection are outlined in CDC’s Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic.
Is a fit-tested N95 respirator required for collecting specimens for SARS-CoV-2 testing?Yes. Healthcare staff in the room should wear an N95 or higher-level respirator (or mask if a respirator is not available), eye protection, gloves, and a gown. The number of healthcare staff 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. Specimen collection can be performed in a normal examination room with the door closed.
What personal protective equipment (PPE) guidance should healthcare facilities be following at this time? (Last updated 2/8/22)Given current availability of PPE supplies, conventional use strategies should be used related to PPE. CDC’s Infection Prevention and Control Recommendations for Healthcare Personnel outline what types of PPE are indicated for care of patients/residents with and without suspected or confirmed SARS-CoV-2 infection.
Should medical waste or general waste from healthcare facilities treating patients with suspected or confirmed COVID-19 be handled any differently or need any additional disinfection?The SARS-CoV-2 virus is not a Category A infectious substance. Waste contaminated with SARS-CoV-2 should be treated routinely as regulated medical waste. There is no evidence to suggest that facility waste needs any additional disinfection. If your contract waste company is applying stricter criteria, the facility should address the issue directly with the contractor.
- Management of laundry, food service utensils and medical waste should also be performed in accordance with routine procedures.
- Use personal protective equipment, such as puncture-resistant gloves and face or eye protection to prevent worker exposure to medical waste, including sharps and other items that can cause injuries or exposures to infectious materials.
- Information for waste collectors and recyclers can be found here:
- Regulated medical waste information is available at:
- For more information on regulated medical waste:
Does a healthcare facility have to supply PPE to visitors?Visitors are required to wear a facemask or cloth mask for the duration of their visit. In case of PPE shortage, visitors should bring their own masks. If the patient or resident being visited is on transmission-based precautions (TBP), other PPE like gowns or gloves might be required for entering their room. In such a scenario, before giving permission to visit a patient or resident on TBP, the facility should ensure that enough PPE is available.
Can HCPs still extend the use of PPE, specifically N95 and eye protection, now that facilities are using conventional strategies for PPE?Extended-use of N95 respirators is recommended as a contingency strategy and not during conventional capacity. NIOSH-approved N95 respirator availability increased in 2021 and healthcare facilities should be following conventional PPE practices. Check the NIOSH Certified Equipment List to identify all NIOSH-approved respirators. More information on optimizing the supply of N95 respirators is available on the CDC website.
In areas of substantial to high transmission in which healthcare personnel are using eye protection for all patient encounters, extended use of eye protection may be considered as a conventional capacity strategy. All other PPE should be removed upon exiting the patient/resident's room and hand hygiene performed. New PPE should be donned before entering a patient/resident's room. Eye protection should be cleaned and disinfected after each patient/resident encounter, per conventional capacity strategies. In addition, eye protection should be removed, cleaned, and disinfected if it becomes visibly soiled or difficult to see through.
Healthcare Providers: Treatment for COVID-19
Who is covered by the 9th amendment of the PREP Act? (Last updated 9/14/21)The U.S. Department of Health and Human Services (HHS) amended the Public Readiness and Emergency Preparedness (PREP) Act declaration to provide liability immunity to and expand the scope of authority for licensed pharmacists to order and administer select COVID-19 therapeutics to populations authorized by the FDA and for pharmacy technicians and pharmacy interns to administer COVID-19 therapeutics to populations authorized by the FDA when certain criteria are met.
What type of treatment is recommended for COVID-19 patients and individuals who are at high-risk for progression to severe disease or hospitalization from COVID-19? (Last updated 6/1/22)Monoclonal antibodies are available for use in three different ways: (1) to prevent COVID-19 in high-risk people before they are exposed to the virus (pre-exposure prophylaxis or PrEP), (2) to prevent COVID-19 in someone who has been exposed to the virus (post-exposure prophylaxis or PEP), and (3) to treat someone with COVID-19 infection (treatment). Antivirals are also available to treat someone with COVID-19.
Pre-Exposure Prophylaxis
The FDA has authorized Evusheld, a combination of two different monoclonal antibodies (tixagevimab and cilgavimab), for emergency use for pre-exposure prophylaxis (prevention before exposure) against COVID-19 in adults and pediatric patients (12 years of age and older weighing at least 40 kg) who are not currently infected with SARS-CoV-2 and who have not had a known recent exposure to an individual infected with SARS-CoV-2 AND:
- Who have moderate to severe immune compromise and may not mount an adequate immune response to COVID-19 vaccination, OR
- For whom vaccination with any available COVID-19 vaccine, according to the approved or authorized schedule, is not recommended due to a history of a severe adverse reaction.
Evusheld has been shown to retain its effectiveness when used against the Omicron variant of SARS-CoV-2 virus. However, on February 24, 2022, FDA authorized a dose increase in Evusheld because of concern that the original lower dose might be less effective against certain types of the SARS-CoV-2 Omicron variant virus. The new, current dose of Evusheld is a total of 600 mg (300 mg of tixagevimab and 300 mg of cilgavimab). According to the updated April 2022 EUA package insert, Patients who received the previous, lower dose of 300 mg of Evusheld (150 mg of tixagevimab and 150 mg of cilgavimab) three months ago or less should contact their healthcare provider as soon as possible to get receive an additional another 300 mg of Evusheld. Patients who received the original 300 mg dose of Evusheld more than 3 months ago should receive an additional 600 mg of Evusheld. Patients should contact their healthcare provider to arrange an appointment to receive additional Evusheld.
At this time, it has not been determined when patients who continue to meet the criteria for receiving the drug should receive a repeat dose. Please note that the additional dose of Evusheld in the paragraph above is different than repeat dosing of the product.
Currently, Evusheld has shown good activity against the Omicron BA.2 subvariant.
Post-exposure prophylaxis
For post-exposure prophylaxis (prevention after exposure), FDA had authorized two combinations of monoclonal antibodies for emergency use for COVID-19 in adults and pediatric individuals who are at high-risk for progression to severe COVID-19, including hospitalization or death, and meet specific criteria regarding vaccination, expected immune response, and exposure. Both of these monoclonal products, however, are not currently authorized because they are not effective against the Omicron variant that is predominant in the U.S. More information about these drugs can be found at:
- REGEN-COV (casirivimab and imdevimab, administered together) - For individuals 28 days of age and older weighing at least 3 kg.
- Bamlanivimab and etesevimab administered together - For all ages, newborn and older.
- VDH COVID-19 Therapeutics webpage (general information on therapeutics)
With the emergence of the Omicron variant, there have been important updates for available therapeutics. On January 19, 2022, the authors of the National Institutes of Health (NIH) COVID-19 treatment guidelines removed bamlanivimab plus etesevimab and Regeneron’s casirivimab plus imdevimab monoclonal antibody treatments from its guidelines list due to their reduced effectiveness against the Omicron variant. On January 24, 2022, FDA revised the emergency use authorizations for two monoclonal antibody treatments – bamlanivimab and etesevimab (administered together) and REGEN-COV (casirivimab and imdevimab) – to limit their use to only when the patient is likely to have been infected with or exposed to a variant that is susceptible to these treatments. On January 24, 2022, HHS announced that allocation of REGEN-COV and Bam/Ete had been paused due to their lack of effectiveness against the Omicron variant.
Outpatient Treatment
For treatment, it is important to note that most patients with COVID-19 will not require hospitalization. Many patients will have mild illness and be able to care for themselves at home. Supportive care consists of rest, adequate hydration, and treatment of symptoms with over-the-counter medication (such as acetaminophen or ibuprofen for fever, etc.). The decision about whether a patient needs to be hospitalized is made on a case-by-case basis. More information can be found in the NIH Treatment Guidelines and on the VDH COVID-19 Therapeutics website.
There are multiple treatment options for patients with COVID-19 – these include a monoclonal antibody, two oral antivirals, and an intravenous antiviral.
Use of the monoclonal antibody bebtelovimab has been authorized by FDA to treat non-hospitalized patients 12 years and older who are confirmed to have COVID-19 and are at high-risk of progression to severe COVID-19. Current data shows that bebtelovimab has activity against the Omicron BA.2 subvariant. Bebtelovimab must be given within 7 days of symptom onset. FDA announced the authorization of an extension to the shelf-life from 12 months to 18 months for specific lots of the refrigerated bebtelovimab. More information can be found here.
On April 5, 2022, FDA suspended the Emergency Use Authorization (EUA) for the monoclonal antibody sotrovimab across the U.S. and in all U.S. territories. Data has shown that sotrovimab is not likely to be effective against the Omicron BA.2 subvariant. At this time, most cases of COVID-19 in the U.S. are believed to be caused by this subvariant. Therefore, sotrovimab cannot be used for the treatment of COVID-19 until FDA lifts the suspension on the EUA. However, FDA has announced the authorization of an extension to shelf-life from 12 months to 18 months for all lots of the refrigerated sotrovimab.
Two oral antivirals, Paxlovid (nirmatrelvir plus ritonavir, for those 12 years of age and older weighing at least 40 kg) and molnupiravir (for those 18 years of age and older who are not pregnant or breastfeeding), are also treatment options for non-hospitalized patients under FDA EUAs. Administration should be as soon as possible after a positive SARS-CoV-2 viral test and within 5 days of symptom onset. Paxlovid has been shown to be effective against the Omicon variant. Molnupiravir is less effective against Omicron and should be considered if other therapies are not available or feasible.
An intravenous antiviral, remdesivir (Veklury), is another treatment option for non-hospitalized and hospitalized patients. Administration should be as soon as possible after a positive SARS-CoV-2 viral test and within 7 days of symptom onset. Remdesivir may be used in adult and pediatric patients (28 days of age and older who weigh at least 3 kg) with positive results of direct SARS-CoV-2 viral testing, with and who 1) are hospitalized, or 2) are not hospitalized and have mild-to-moderate COVID-19, and are at high risk for progression to severe COVID-19, including hospitalization or death.
Additional information is available in the following webpages:
What is COVID rebound? (Last updated 5/31/22)COVID rebound is characterized by a recurrence of COVID-19 symptoms or a new positive test after an original COVID-19 diagnosis and resolution of symptoms or negative test. This rebound has been reported to occur between 2 and 8 days after initial recovery, and there are no reports of severe disease in these cases. While COVID-19 rebound syndrome is mentioned in association with Paxlovid, the Centers for Disease Control and Prevention (CDC) has stated that COVID-19 rebound may be part of the natural infection process, regardless of Paxlovid treatment or vaccination status.
Paxlovid continues to be recommended for early-stage treatment of mild to moderate COVID-19 among persons at high risk for progression to severe disease. Currently, there is no evidence supporting the need for additional treatment in cases where COVID rebound is suspected.
Please see the CDC Health Alert from May 24, 2022 for more information.
What options are available to individuals who experience COVID-19 rebound? (Last updated 5/31/22)Individuals may complete a COVID test after resolution of the original infection to ensure no rebound is occurring. If patients have a positive COVID test at this point, individuals should take precautions since they may be contagious. On May 24, the CDC issued official guidance regarding COVID rebound. The CDC states that there is currently no evidence to support additional treatment with Paxlovid, or any other COVID-19 treatment, in cases where COVID-19 rebound is suspected.
Other CDC recommendations include following CDC’s guidance on isolation, including taking other precautions to prevent spreading illness. Patients should re-isolate for at least five days. Per CDC guidance, they can end their re-isolation period after five full days if fever has resolved for 24 hours (without the use of fever-reducing medication) and symptoms are improving. The patient should wear a mask for a total of 10 days after rebound symptoms started.
The CDC encourages individuals to report a possible case of COVID-19 rebound after PAXLOVID treatment to Pfizer using the following online tool: Pfizer Safety Reporting.
Where can I find COVID-19 treatments? (Last updated 5/3/22)The COVID-19 Treatment Locator Tool is available to help healthcare providers and the public locate certain COVID-19 treatments. Users can enter their zip code and check the box for the specific product they are looking for.
Patients should coordinate with their healthcare provider prior to contacting a location as a provider prescription is required for monoclonal antibodies, pre-exposure prophylaxis, and oral antiviral medication. Locations may require an appointment and treatment availability may be limited.
Are COVID-19 treatment guidelines available? (Last updated 5/17/22)Yes. The National Institutes of Health has published detailed COVID-19 treatment guidelines. Please read the full report for all details.
The American Academy of Pediatrics has interim guidance on the management of children and adolescents in an outpatient setting.
Are other resources available for clinicians caring for COVID-19 patients?Yes. CDC maintains a COVID-19 Clinician On-Call Center which is available 24/7 and can respond to questions from health departments, healthcare providers, community organizations, and healthcare facilities. To reach the Clinician On-Call Center, call the CDC Emergency Operations Center Watch Desk at 770-488-7100 and ask for the Clinician On-Call Center. The U.S. Department of Health and Human Services (HHS) also responds to clinician questions about COVID-19 therapeutics. They can be reached by email at COVID19therapeutics@hhs.gov.
Is it safe to give ibuprofen to patients with COVID-19?Yes. There is currently no scientific evidence to show that taking ibuprofen while sick with COVID-19 will lead to worsening illness. Either ibuprofen or acetaminophen is commonly used for fever reduction. However, both acetaminophen and ibuprofen, like any other medications, can have serious side effects and healthcare providers should use their clinical judgment to determine the most appropriate treatment for their patient.
What treatments are available for someone with a COVID-19 and influenza co-infection?Anyone who has COVID-19 and concomitant influenza should get lots of rest, stay hydrated, monitor symptoms, and follow instructions for over-the-counter medications if needed. They should seek immediate medical care if emergency warning signs develop.
Influenza antiviral drugs should be administered as soon as possible to people who are hospitalized with flu or are at increased risk for complications (e.g., those 65 years and older, young children, and those with chronic health conditions) and have influenza symptoms. According to National Institutes of Health (NIH) guidance, antiviral treatment for influenza is the same, regardless of whether the individual is co-infected with the virus that causes COVID-19.
For people at increased risk of severe illness from COVID-19, early treatment options are available that may reduce the risk of severe illness and keep them out of the hospital.
What treatment is available for MIS-C? (Last updated 12/9/21)Currently there are no specific drugs approved by FDA for the treatment or prevention of MIS-C. Treatment remains mainly supportive and includes prevention and management of complications. The American College of Rheumatology (ACR) has developed clinical guidance for the management of MIS-C.
Clinicians who suspect MIS-C in a child should use a multidisciplinary approach involving pediatric specialists, which may include but is not limited to cardiology, infectious disease, immunology, hematology, rheumatology, pediatric hospital medicine, and critical care, to guide individual patient treatment. There are 3-4 sub-types of MIS-C that may require slightly different management based on evolution of symptoms and laboratory values. Optimal treatment for a patient with MIS-C is not known; however, is best determined by the multidisciplinary clinical team. There are interventions that have been used, as well as the ACR guidelines.
Is ivermectin an effective treatment for COVID-19? (Last updated 5/3/22)Ivermectin is a U.S. Food and Drug Administration (FDA)-approved prescription medication used to treat certain infections caused by internal and external parasites. When recommended dosing is used as prescribed for approved indications, it is generally safe and well tolerated.
Ivermectin is not authorized or approved by the FDA for prevention or treatment of human COVID-19. The National Institutes of Health’s (NIH) COVID-19 Treatment Guidelines Panel has also determined that there are currently insufficient data to recommend ivermectin for treatment of COVID-19. ClinicalTrials.gov has listings of ongoing clinical trials that might provide more information about these hypothesized uses in the future.
In July 2021, poison control centers across the U.S. received a five-fold increase in the number of calls for human exposures to ivermectin compared to the pre-pandemic baseline. These reports are also associated with increased frequency of adverse effects and emergency department/hospital visits. Clinical effects of ivermectin overdose include gastrointestinal symptoms such as nausea, vomiting, and diarrhea. Overdoses are associated with hypotension and neurologic effects such as decreased consciousness, confusion, hallucinations, seizures, coma, and death. Ivermectin may potentiate the effects of other drugs that cause central nervous system depression such as benzodiazepines and barbiturates. Even the levels of ivermectin for approved human uses can interact with other medications, like blood-thinners.
Health alerts warning consumers and providers about the dangers of ivermectin use for the prevention and treatment of COVID-19 have been issued by the FDA and CDC. The NIH, World Health Organization, and Merck (the manufacturer of the drug) all state there is insufficient evidence to support the use of ivermectin to treat COVID-19. A joint statement was issued on September 1, 2021 by the American Medical Association (AMA), American Pharmacists Association (APhA), and American Society of Health-System Pharmacists (ASHP) strongly opposing the ordering, prescribing, or dispensing of ivermectin to prevent or treat COVID-19 outside of a clinical trial.
A meta-analysis of randomized control trials, published in June 2021, assessed the benefits and harms of the use of ivermectin in COVID-19 patients. The meta-analysis found that ivermectin did not reduce all-cause mortality, length of stay or viral clearance in COVID-19 patients and concluded that ivermectin is not a viable option to treat COVID-19 patients.
In February 2022, the findings of a new prospective, open-label, randomized clinical trial on the use of ivermectin was published; this study found that taking a 5-day course of oral ivermectin during the first week of illness did not reduce the risk of developing severe disease. There was also a notably higher incidence of adverse events in the ivermectin treatment group compared to the control group. The authors concluded that their study findings do not support the use of ivermectin for patients with COVID-19.
While there are approved uses for ivermectin in people and animals, it is not approved for the prevention or treatment of COVID-19. You should not take any medicine to treat or prevent COVID-19 unless it has been prescribed to you by your healthcare provider and acquired from a legitimate source.
Advise patients to immediately seek medical treatment if they have taken any ivermectin or ivermectin-containing products and are experiencing adverse effects. Signs and symptoms of ivermectin toxicity include gastrointestinal effects (nausea, vomiting, abdominal pain, and diarrhea), headache, blurred vision, dizziness, tachycardia, hypotension, visual hallucinations, altered mental status, confusion, loss of coordination and balance, central nervous system depression, and seizures. Ivermectin may increase sedative effects of other medications such as benzodiazepines and barbiturates. Call the poison control center hotline (1-800-222-1222) for medical management advice.
For more information on this topic, see the following links:
- FDA Letter to Stakeholders: Do Not Use Ivermectin Intended for Animals as Treatment for COVID-19 in Humans
- FDA FAQs: COVID-19 and Ivermectin Intended for Animals.
- American College of Medical Toxicology Press Release
- NIH COVID-19 Treatment Ivermectin Guidelines
- CDC HAN Health Advisory: Rapid Increase in Ivermectin Prescriptions and Reports of Severe Illness Associated with Use of Products Containing Ivermectin to Prevent or Treat COVID-19
- CDC COCA Now newsletter: Ivermectin Products are Not Approved by FDA to Prevent or Treat COVID-19
Where can clinicians find guidance for the management of Post-COVID Conditions? (Last updated 8/10/21)The term “Post-COVID Conditions” is an umbrella term for the wide range of physical and mental health consequences experienced by some patients that are present four or more weeks after SARS-CoV-2 infection, including by patients who had initial mild or asymptomatic acute infection. These consequences have sometimes been called “Long COVID” in public discussions.
Based on current information, many post-COVID conditions resolve on their own; many others can be managed by primary care providers, with the incorporation of patient-centered approaches to optimize the quality of life and function in affected patients.
Objective laboratory or imaging findings should not be used as the only measure or assessment of a patient’s well-being; lack of laboratory or imaging abnormalities does not invalidate the existence, severity, or importance of a Post-COVID patient’s symptoms or conditions.
Healthcare professionals and patients are encouraged to set achievable goals through shared decision-making and to approach treatment by focusing on specific symptoms (e.g., headache) or conditions (e.g., dysautonomia); a comprehensive management plan focusing on improving physical, mental, and social wellbeing may be helpful for some patients.
Understanding of post-COVID conditions remains incomplete and guidance for healthcare professionals will likely change over time as the evidence evolves.
As of July 2021, “long COVID,” also known as post-COVID conditions, can be considered a disability under the Americans with Disabilities Act (ADA). Learn more by reading the U.S. Department of Health and Human Services’ Guidance on “Long COVID” as a Disability Under the ADA, Section.
CDC provides guidance: Evaluating and Caring for Patients with Post-COVID Conditions: Interim Guidance and Post-COVID Conditions: Information for Healthcare Providers
Healthcare Providers: Nursing Homes and Assisted Living Facilities (Long-Term Care Facilities)
What are the current testing recommendations or requirements in nursing homes? (Last updated 3/22/22)Please reference CMS testing guidelines (3/10/2022) and CDC guidance for information on when to perform testing triggered by an outbreak investigation and routine testing in nursing homes.
In nursing homes regulated by CMS, routine testing of staff who are not up to date with all recommended doses of COVID-19 vaccine is based on the community transmission level. HCP who are up to date do not have to be routinely tested.
The CDC healthcare personnel (HCP) isolation and quarantine guidance (1/21/2022) provides additional information on when to test HCP following a higher-risk exposure.
What testing resources are available for long-term care facilities (LTCFs)? (Last updated 6/1/22)The Department of Health and Human Services (HHS) distributes BinaxNow tests directly to specified long-term care facilities for required testing of staff. Questions regarding this HHS supply can be sent to email: hhsbinax@hhs.gov.
VDH encourages skilled nursing facilities and assisted living facilities to develop and prepare a sustainable plan for future testing needs by finding a vendor to purchase tests or contract with to perform tests on the facility’s behalf.
As outbreaks continue to occur, the potential for not having testing supplies is a real possibility. Do we have guidelines for facilities that cannot meet outbreak testing or community transmission testing guidelines?If facilities cannot meet testing guidelines due to supply constraints after expending effort to obtain tests, they should make the local health department and their licensing organization aware of the situation.
CDC does not have strong recommendations on this, but some general considerations are as follows:
- Healthcare personnel testing is most critical to mitigate staffing shortages. CDC guidance outlines the ideal test cadence for HCP testing following exposure or infection and gives some suggestions for prioritization if all tests cannot be completed.
- Outbreak testing / screening testing is the next level of priority. CMS guidance suggests focusing on those with signs and symptoms first as well as those with the highest risk of exposure.
- Testing visitors is a lower level of priority.
When testing supplies are limited, facilities should pay special focus on core infection prevention and control measures such as the use of personal protective equipment and wearing source control, hand hygiene, physical distancing, enhanced environmental cleaning and disinfection, appropriate patient/resident placement, and proper use of transmission-based precautions.
Are LTCFs required to notify anyone if they are operating under crisis staffing standards?If using crisis staffing standards that may jeopardize the health, safety, and well-being of residents of the facility, then nursing facilities licensed by the VDH Office of Licensure and Certification (OLC) and assisted living facilities licensed by the Virginia Department of Social Services are required to notify their licensing entity (the OLC or the DSS regional licensing office, respectively) of the conditions and status of the residents and the physical plant as soon as possible.
Is it appropriate for long-term care facilities to restrict residents to their rooms because of COVID-19? What about residents who have dementia? (Last updated 1/24/22)Yes, under certain circumstances, restricting residents to their rooms is recommended (although not mandated). This type of restriction would apply to care of residents with an undiagnosed respiratory illness, or care of symptomatic residents who are awaiting transport to a facility that can provide a higher level of care which the patient needs. Residents diagnosed with, or suspected to have, COVID-19 are recommended to be isolated in their room(s) with the door closed, regardless of vaccination status. However, in some circumstances (e.g., memory care units), keeping the door closed may pose resident safety risks and the door might need to remain open. CDC recommends that if doors must remain open, facilities should work with facility engineers to implement strategies to minimize airflow into the hallway. Residents who are not up to date with COVID-19 vaccination who have had close contact to an individual with COVID-19 should be quarantined according to CDC guidance. Symptomatic residents, regardless of vaccination status, should be restricted to their rooms. If residents leave their rooms, they should wear a mask (preferably one that offers better protection, such as an N95 or surgical mask), practice physical distancing and perform hand hygiene. Residents with dementia or residents admitted to memory care units may have difficulty following infection prevention and control practices such as mask wearing and physical distancing and may require additional assistance and supervision when they leave their rooms.
Is visitation allowed in long-term care facilities (LTCFs) at this time? (Last updated 3/22/22)Per the Centers for Medicare and Medicaid Services (CMS), visitation should be permitted for all nursing home residents at all times. However, visitors must comply with the core principles of COVID-19 infection prevention and follow guidance outlined in a CMS memo (3/10/2022) and updated CMS FAQs (3/10/2022). Updated tips on how to safely comply with this guidance are available from VDH. If a resident with COVID-19 has a visitor, the LTCF is recommended to collect contact information for the visitor(s) and share that information with their local health department for contact tracing purposes.
In rare occasions during an outbreak investigation when other mitigation efforts have failed, restricting visitation may be considered for brief periods of time. Health district or regional public health staff should collaborate with the appropriate regional Office of Licensure and Certification long-term care supervisor prior to making a recommendation that a facility restrict visitation.
Even if they have met community criteria to discontinue isolation or quarantine, visitors should not visit if they have any of the following and have not met the same criteria used to discontinue isolation and quarantine for residents.
- A positive viral test for SARS-CoV-2
- Symptoms of COVID-19
- Close contact with someone with SARS-CoV-2 infection
Where should a facility place residents receiving hemodialysis or leaving the facility on a regular basis for necessary medical care?Quarantining residents who regularly leave the facility for medical appointments (e.g., dialysis, chemotherapy) would result in indefinite isolation of the resident that likely outweighs any potential benefits of quarantine.
CDC states that in most circumstances, quarantine is not recommended for residents who leave the facility for less than 24 hours (e.g., for medical appointments, dialysis sessions) and do not have close contact with someone with SARS-CoV-2 infection.
Facilities might consider quarantining residents who leave the facility if, based on an assessment of risk, uncertainty exists about their adherence or the adherence of those around them to recommended infection prevention and control (IPC) measures.
In addition to the following recommendations:
- Residents should wear a cloth face covering or facemask, if tolerated, when they leave their room and/or facility (including dialysis)
- Regular communication between the dialysis facility or other healthcare facility and the LTCF (in both directions) is essential to help identify patients with symptoms consistent with COVID-19 before they enter the facilities and to help facilitate the resident's care
- LTCFs should comply with all other CDC IPC recommendations.
Do healthcare staff or patients/residents with a previous positive viral test who have recovered from COVID-19 still need to be tested when indicated by the recommendations?CDC recommends that patients/residents and staff who had a positive viral test at any time and become symptomatic after recovering from the initial illness should be re-tested and placed back on the appropriate transmission-based precautions or excluded from work, respectively.
When testing is indicated, asymptomatic individuals who have previously tested positive greater than 3 months (90 days) prior should be re-tested. More information on reinfections is available on the CDC website.
For testing methods, either an antigen test or nucleic acid amplification test (NAAT) can be used. However, antigen testing is preferred when testing asymptomatic healthcare personnel who have recovered from SARS-CoV-2 infection in the prior 90 days because some people may remain NAAT positive for an extended period. More information is available in CDC Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2.
Do up to date staff or patients/residents in healthcare facilities still need to be tested routinely or after an exposure? (2/18/22)Anyone with even mild symptoms of COVID-19, regardless of vaccination status, should receive a viral test as soon as possible.
Asymptomatic HCP with a higher-risk exposure and asymptomatic patients/residents with close contact with someone with SARS-CoV-2 infection, regardless of vaccination status, should have a series of two viral tests for SARS-CoV-2 infection. In these situations, testing is recommended immediately (but not earlier than 24 hours after the exposure) and, if negative, again 5–7 days after the exposure. However, testing is not recommended for people who have had SARS-CoV-2 infection in the last 90 days if they remain asymptomatic.
HCP who are up to date with COVID-19 vaccination may be exempt from routine screening testing.
Guidance for expanded screening testing for nursing homes is described by CMS and CDC.
If a staff member receives a test from an outside entity (e.g., community testing location, drive-thru pharmacy, private practitioner), does that meet the testing recommendation? (Last updated 2/14/22)The staff member should follow the facility’s occupational health policies and procedures regarding what tests are acceptable from outside entities. Diagnostic tests of healthcare facility staff that are performed outside of the facility will likely meet the testing recommendation, as long as the employee has the appropriate documentation to provide to the facility and the test was conducted in a reasonable time frame from when the test was recommended (e.g., 48 hours prior to returning to work after Day 7 for healthcare personnel who tested positive for SARS-CoV-2).
For questions about use of self-tests to determine when HCP with SARS-CoV-2 infection or higher-risk exposures may return to work, please see CDC infection control FAQs.
We have a patient/resident that tested positive for COVID-19 three months ago. The facility tested this person several times during the 90 day period and results are still positive; they are currently asymptomatic and not immunocompromised. What are the recommendations?For persons who have recovered from SARS-CoV-2 infection, a positive PCR during the 90 days after illness onset more likely represents persistent shedding of viral RNA than reinfection.
- If such a person remains asymptomatic during this 90-day period, re-testing is not necessary. Any results from re-testing are unlikely to yield useful information, even if the person had close contact with an infected person.
- If such a person becomes symptomatic during this 90-day period and an evaluation fails to identify a diagnosis other than SARS-CoV-2 infection (e.g., influenza), then the person may warrant evaluation for SARS-CoV-2 reinfection in consultation with an infectious disease or infection control expert. Transmission-based precautions are warranted during this evaluation, particularly if symptoms developed after close contact with an infected person.
More information regarding patients/residents with persistent or recurrent positive tests can be found in the CDC FAQ.
Does the facility have to supply PPE to VDH staff (e.g., OLC surveyors, local health department communicable disease nurses or epidemiologists)?The facility under conventional conditions might supply all required PPE to VDH staff visiting the facility. However, during PPE shortage, VDH staff shall bring their own PPE. VDH staff should avoid entering a resident room without wearing the appropriate PPE.
What infection prevention and control practices should be implemented when serving a meal or delivering a food tray to a resident with a suspected or confirmed COVID-19 infection?Facilities should develop policies for safely conducting food service activities. Only essential staff are permitted in units/care areas for suspected or confirmed COVID-19 cases, and food delivery can be done by nurses or nursing assistants, if staffing resources allow. When delivering food to a patient or resident with suspected or confirmed COVID-19, staff should perform hand hygiene, don PPE (gloves, gown, N95 respirator, eye protection), drop off food, take off and dispose of PPE and perform hand hygiene. Repeat this process between each room of a resident with suspected or confirmed COVID-19.
When delivering food to a patient/resident without suspected or confirmed COVID-19 infection, staff should perform hand hygiene and don gloves, then remove gloves and repeat hand hygiene if staff has contact with the patient/resident or any surfaces that have significant potential for being contaminated with infectious material in their room.
What should a LTCF do if a large number of symptomatic residents or positive COVID-19 cases have been identified?When conducting facility-wide testing, a large number of residents might be identified with COVID-19 infection and cohorting them can be complicated and might increase the chances of cross-contamination, especially if the facility is experiencing staffing shortages. Consult with the local health department to determine the best approach to address this challenge. “Shelter in place” may be a practical solution in these circumstances if the following conditions are implemented:
- In shared rooms, the distance between resident beds should be at least 6 feet and curtains can be used as a physical barrier. However, staff should don and doff the appropriate PPE between residents in the same room.
- Increase the frequency of environmental cleaning and disinfection.
- Do not cohort residents based on symptoms only.
What is the federal government doing to help provide oral antiviral medication to long-term care facilities? (Last updated 6/1/22)On March 7, 2022, the U.S. Department of Health and Human Services (HHS) began distributing oral antiviral medications (Paxlovid and Lagevrio) directly to participating “Test to Treat” pharmacy-based clinics. HHS also directly distributes oral antiviral medications to pharmacies, such as Omnicare and others, that serve long-term care facilities (LTCFs). In the U.S., the greatest number of deaths from COVID-19 have been in older Americans. LTCF residents who develop COVID-19 are at high-risk for progressing to severe illness, including hospitalization and/or death. If a resident is eligible for oral antiviral therapy, it must be started within 5 days of symptom onset. Distribution of oral antiviral medications to LTCF pharmacies allows residents to get these medications as soon as possible once the diagnosis of COVID-19 has been made.