COVID-19: Update to Testing Guidance, Return to Work, and Utility of Serology Testing, New Resources

Posted May 1, 2020. Past health advisories and alerts are archived for historical purposes and are not maintained or updated.

Community transmission of COVID-19 continues to occur in Washington, including Spokane County. Washington State Department of Health (DOH) is maintaining current case counts by county. Spokane Regional Health District (SRHD) is maintaining a COVID-19 website specifically for healthcare providers, which includes a link to Spokane-specific data which are updated daily.


Summary of Updates In This Alert

  • DOH updated testing guidance for COVID-19. Updates include:
    • Testing is now recommended for patients with new onset of symptoms consistent with COVID-19, regardless of age or health status. Symptoms have been expanded beyond cough and fever.
    • Testing of asymptomatic persons should be limited to those with exposure, such as close contacts of a case or exposure during an outbreak in a congregate setting.
    • Information on acceptable swabs and specimen collection.
  • DOH updated guidance on management of healthcare workers and first responders who test positive for COVID-19.
    • Updates include management of asymptomatic persons who test positive (furlough should be extended to ten days from specimen collection date).
    • SRHD provides updated return-to-work guidance for symptomatic healthcare workers who cannot avoid contact with persons at high risk for complications (e.g., over the age of 65, immunocompromised or with comorbid conditions such as cardiorespiratory disease).
  • Health Resources and Services Administration (HRSA) launched a portal allowing healthcare providers who have conducted COVID-19 testing or treatment for uninsured to request claims reimbursement.
  • Infectious Diseases Society of America released a COVID-19 Antibody Testing Primer outlining the current state of antibody testing including background, information on test quality and interpretation, additional considerations, and outstanding research needs.


Updated Interim COVID-19 Testing Guidance

Please consult the DOH Interim COVID-19 Testing Guidance for Healthcare Providers document for complete information.

Highlights:

  1. 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 or shortness of breath OR at least two of the following: fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, new loss of taste or smell.
  2. Rapidly testing all patients with symptoms consistent with COVID-19 is critical to identifying and isolating cases, quarantining their contacts, and suppressing community spread.
  3. While this guidance expands groups of persons eligible for testing, prioritizing of certain symptomatic persons may be necessary until adequate test supplies are available.
  4. Limit testing of asymptomatic persons to those with exposure, including close contacts and individuals exposed during an outbreak in a congregate setting. (Note: close contacts still need to remain in quarantine for 14 days after their last date of exposure even with a negative test).
  5. The guidance further outlines additional asymptomatic people for which testing can be considered if adequate testing supplies are available. Please consult the full document.
  6. Continue to educate all patients you test, including emphasizing isolation for ill persons and quarantine for exposed contacts:
    1. Patients with confirmed or suspected COVID-19
    2. Patients who were exposed to someone with COVID-19
    3. Unexposed patients with COVID-19 symptoms
  7. The preferred diagnostic test is a PCR-based test.
    1. Specimens sent to CLIA-certified labs for PCR-based tests have demonstrated higher sensitivity and fewer false negatives than point-of-care tests.
    2. Additionally, serology or antibody tests are not recommended for making a COVID-19 diagnosis or to reliably determine whether someone has experienced a past infection with COVID-19 (more below).
  8. The guidance further outlines the types of swabs preferred for COVID-19 testing and appropriate specimen collection and storage/transport, including self-collected nasal swabs under healthcare provider observation. Please consult the full document.


Isolation & Return to Work – Healthcare Workers (HCW) and First Responders (FR) Who Test Positive for COVID-19

HCWs and FRs with confirmed COVID-19 should not return to work until they can meet the criteria listed below.

  • As a reminder, return to work guidance is predicated on:
    • Symptom monitoring, AND
    • The facility exhausting all other options for alternative coverage of the healthcare worker’s duties, AND
    • The individual’s ability to wear a face mask while at work, practice good hand hygiene and respiratory etiquette, AND
    • The facility’s ability to provide face masks for the healthcare worker’s use.
  • For both symptomatic and asymptomatic HCW and FR:
    • Clarified HCW and FR with confirmed COVID-19 who cannot avoid direct contact with persons at higher risk of complications (age ≥ 65, those with comorbid conditions such as cardiovascular disease, diabetes, and/or severely immunocompromised) should be excluded from work for a full 14 days after symptom onset (if symptomatic) or specimen collection date (if asymptomatic).
  • If symptomatic (and tested positive for COVID-19):
  • HCW and FR should not return to work until:
    • At least three days (72 hours) have passed since recovery - defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); AND,
    • At least seven days have passed since symptoms first appeared.
  • When returning to work:
    • After all symptoms have completely resolved or until 14 days after illness onset, whichever is longer:
      • A facemask should be worn at all times while in the healthcare facility.
      • Adherence to respiratory hygiene, hand hygiene, and cough etiquette should be maintained.
  • If asymptomatic (and tested positive for COVID-19):
    • HCWs and FRs should not return to work until:
      • At least ten (updated) days from the collection date of their positive test specimen.
      • The HCW should self-monitor for symptoms and seek re-evaluation from occupational health immediately if fever, respiratory, or other symptoms consistent with COVID-19 illness begin.
    • When returning to work:
      • After all symptoms have completely resolved or until 14 days after illness onset, whichever is longer:
        • A facemask should be worn at all times while in the healthcare facility.
        • Adherence to respiratory hygiene, hand hygiene, and cough etiquette should be maintained.

Guidance document for healthcare workers and first responders: www.doh.wa.gov/Portals...


HRSA COVID-19 Uninsured Claims Reimbursement Portal

The Health Resources and Services Administration (HRSA) launched a new COVID-19 Uninsured Program Portal to allow healthcare providers who have conducted COVID-19 testing or treatment for uninsured COVID-19 patients on or after February 4, 2020 to request claims reimbursement: https://coviduninsuredclaim.linkhealth.com/.


IDSA COVID-19 Antibody Testing Primer

The Infectious Diseases Society of America (IDSA) released a COVID-19 Antibody Testing Primer on April 22, 2020 that addresses multiple issues of available serology issues including test quality and interpretation. IDSA states antibody tests may be better suited for public health surveillance and vaccine development, citing varied and clinically unverified tests.

IDSA does not recommend using these tests as the sole test for diagnostic decisions, nor should they be used to make staffing decisions or decisions regarding the need for personal protective equipment until more evidence about protective immunity is available. We currently have no direct evidence of an IgG response conferring protection. Please review the document for more information.

https://www.idsociety.org/globalassets/idsa/public-health/covid-19/idsa-covid-19-antibody-testing-primer.pdf


Additional Resources

Washington State Department of Health COVID-19 Healthcare Provider Resources and Recommendations: https://www.doh.wa.gov/Emergen...

Centers for Disease Control & Prevention COVID-19 Information for Healthcare Professionals: https://www.cdc.gov/coronaviru...

Spokane Regional Health District Case Information and Provider Alerts: https://srhd.org/covid19hcp