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May 1, 2020
Whatcom County Health Department Communicable Disease & Epidemiology Division
Update on COVID-19 testing
- Test all patients with symptoms consistent with COVID-19 regardless of age or health status. COVID-19 can present with symptoms other than cough or dyspnea and may include fever, chills, rigors, myalgia, headache, sore throat, new loss of smell or taste.
- Testing of asymptomatic persons at this time should generally be limited to those with contact to a case or exposure during an outbreak in a congregate setting.
- When adequate supplies are available, testing may be considered for persons who are pregnant and present in labor, people undergoing procedures that increase the risk of aerosolized particle spread, and people undergoing invasive surgical procedures (within 48 hours of procedure)
- If COVID-19 is being considered, whether testing is performed or not, emphasize isolation for ill persons and self-quarantine for exposed contacts. (See links to DOH patient handouts below)
- Washington law requires healthcare providers to include the patient’s name, date of birth, address and phone number when ordering tests for COVID-19. This is critical for timely case investigation, contact tracing, and epidemiological analysis.
- Although laboratories are required to report test results to public health, healthcare providers should also report cases to WCHD to assure timely contact tracing. (Call 24-hour Communicable Disease Report Line 360-778-6150)
- All testing for COVID-19 should be reported to DOH, including POC tests.
WA DOH and CDC have released updated testing guidance (see links below). Major changes include the recommendation that healthcare providers should test all patients with new onset of symptoms consistent with COVID-19, regardless of their age or health status. COVID-19 patients may present with cough, shortness of breath, fever, chills, rigor, myalgia, headache, sore throat, or new loss of taste or smell. Other patients should be tested per clinical judgment. There have been recent reports of coagulopathies associated with COVID-19 (see link to ACC FAQ below).
Testing of asymptomatic persons is prioritized for those with close contact to confirmed cases or with exposure during an outbreak, with consideration for other indications. If adequate supplies are available, testing asymptomatic people can be considered for persons who are pregnant and present in labor, people undergoing procedures that increase the risk of aerosolized particle spread, and people undergoing invasive surgical procedures (within 48 hours of procedure). Testing is currently not generally recommended for new asymptomatic admissions to a healthcare or long-term care facility, unless to a healthcare facility using the information for cohorting.
Patients should be provided with specific guidance from the linked DOH patient handouts if they are a confirmed case, have had recent exposure to a person with confirmed COVID-19, or are symptomatic and without contact to a known case.
Although DOH recommends using only nasopharyngeal swabs for testing asymptomatic persons, CDC has removed that preference from its recommendations. Anterior nasal and nasal mid-turbinate specimens can be self-collected under supervision, reducing PPE use.
The availability of SARS-CoV-2 rRT-PCR laboratory capacity has markedly increased in our region, as has specimen collection at medical practices and through private testing centers. PeaceHealth St. Joseph Medical Center has acquired Roche ID COVID-19 POC instruments and is testing selected patients with this rapid nucleic acid amplification test.
Antibody testing is being offered now, and although detection of anti-SARS-CoV-2 IgG and IgM is available, the clinical utility of these tests has not been determined. It is not known if and at what levels antibodies are protective of subsequent infection, how long immunity lasts if acquired, and for many of the commercial tests, to what extent they cross-react with common human coronaviruses. Currently, antibody testing is most useful for broad-based epidemiological surveillance and research and for identifying donors for convalescent plasma therapy for COVID-19.
Whatcom County Health Department has been providing PCR testing by appointment to patients who have been referred by their clinicians who have not been able to collect specimens in their offices, and for patients without clinicians or insurance. We have also expanded large-scale testing at congregate care facilities for outbreak investigation. We have seen a drop in referrals from clinicians as specimen collection and testing has become more available in the community.
DOH – Interim COVID-19 Testing Guidance for Healthcare Providers (updated 4/28/20) https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/Interim-2019NovelCoronavirusQuicksheetProviders.pdf
American College of Cardiology – FAQ on the potential impact of COVID-19 on thrombotic and/or bleeding risk from ACC’s Science and Quality Committee summarizes the current data on the risk, potential need for hemostasis/coagulation testing, VTE prophylaxis, and therapeutic anticoagulation in patients with COVID-19 without confirmed/suspected thrombosis. https://www.acc.org/latest-in-cardiology/articles/2020/04/17/14/42/thrombosis-and-coronavirus-disease-2019-covid-19-faqs-for-current-practice
CDC – Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons for Coronavirus Disease 2019 (COVID-19) (updated 4/29/20) https://www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html
Johns Hopkins Center for Health Security – Developing a National Strategy for Serology (Antibody Testing) in the United States (4/22/20)
WA DOH Patient Handouts
https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/COVIDconcerned.pdf https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/COVIDcasepositive.pdf https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/COVIDexposed.pdf
For more information, contact:
Whatcom County Health Department Communicable Disease Program
1500 N State Street, Bellingham WA 98225
360-778-6100 Main | 360-778-6150 24-hour Communicable Disease Program Report Line