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Actual Criteria for Coronavirus Testing

By Jeffrey Sterling, MD July 14, 2020

Introduction

Do you have any idea about the actual criteria for coronavirus testing? Even if you don’t want to know, if you’re talking or visiting a physician, you should be aware of what’s being used to determine (under current recommendations) your eligibility. This Straight, No Chaser presents an active set of criteria for your review.

Meanwhile, the need to expand coronavirus testing criteria and to expand the availability of tests continues. Let your voices be heard. #WhereAreTheTests

Whom Should Physicians Test for COVID-19?

Physicians may test any patient with symptoms consistent with COVID-19. Examples of these typically include fever, cough and shortness of breath. As commercial testing becomes even more increasingly accessible, expect criteria to expand.

However, the following patients should be prioritized for testing:

  • Critically ill patients receiving ICU-level care with unexplained viral pneumonia or respiratory failure. This is regardless of travel history or close contact with suspected or confirmed COVD-19 patients. This is meant to inform decisions about infection control and investigational therapeutics.
  • Any persons with fever (subjective or confirmed) and/or symptoms of a lower respiratory tract illness and a history of close contact with a laboratory-confirmed COVID-19 patient within 14 days of symptom onset. This includes all residents of a long-term care facility that have had a laboratory-confirmed COVID-19 case.
    1. “Close contact” is defined as being within approximately six feet of a COVID-19 case for a prolonged period. A prolonged period equals more than about 10 minutes per current public health contact-tracing practice. It also includes those having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on).
    2. Here’s when physicians and other health care personnel (e.g., nurses and administrative staff) should be tested. Testing may be considered if there has been exposure to a person with suspected COVID-19 even without laboratory confirmation. Even mild signs and symptoms (e.g., sore throat) of COVID-19 should be evaluated among potentially exposed health care personnel. This is warranted given their extensive and close contact with vulnerable patients in health care settings.
  • Any symptomatic individuals with a history of travel within 14 days of symptom onset to geographic regions where sustained community transmission has been identified.
  • Any symptomatic individuals who may be at higher risk of poor outcomes. These include those who are ≥ 65 years of age, immunosuppressed, or have high-risk chronic medical conditions (e.g., diabetes, heart disease, chronic lung disease, chronic kidney disease).
  • Individuals with fever and/or symptoms of a lower respiratory tract illness who are critical to pandemic response. These include health care personnel, public health officials, and other essential leaders.

Whom should physicians NOT test for COVID-19?

  • Asymptomatic individuals are not recommended to be tested for COVID-19, regardless of exposure history.
  • If an alternative diagnosis can be determined (e.g., rapid strep, rapid flu, BioFire viral panel), a clinical determination can be made that a COVID-19 test is not necessary. This is especially true if there is not yet community transmission of the disease in your area.
  • CDC recommends that mildly ill patients should be encouraged to stay home. You should contact your physician by phone for guidance about clinical management. If telemedicine is available and determines that symptoms are mild, patient’s should be referred to a mobile testing site if available. Otherwise, your doctor may elect to test you at the end of the day in the office away from other patients. This can protect staff and other patients and preserves the use of personal protective equipment.  

You would do well to print this out. Use it as a guide to determine if your symptoms meet criteria for coronavirus testing under current guidelines. Use it to insist on testing if you meet criteria. #KnowledgeIsPower #KnowledgeIsHealth

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