New Testing Option Available for Suspected COVID-19

Posted March 4, 2020. Past health advisories and alerts are archived for historical purposes and are not maintained or updated.

The worldwide outbreak of the novel coronavirus disease 2019 (COVID-19) has spread to Washington state, with new cases reported in King and Snohomish Counties. As of March 3, 27 cases have been reported in King County with eight deaths, and six cases in Snohomish County with one death.  Of these cases, many have been linked to Life Care, a skilled nursing facility in Kirkland.

In response to the situation in the Seattle area and the restrictive public health criteria and resources available for testing, the FDA has granted emergency approval allowing the University of Washington to begin using a COVID-19 (SARS-CoV-2) qualitative PCR within their lab. This test is open to all patients at the clinician’s discretion with no restrictions; no public health notification or approval is required. This option should be used for patients who do not meet the strict criteria for testing at the Washington State Public Health Lab (WA PHL) as indicated below but meet symptom criteria consistent with a COVID-19 illness while other respiratory pathogens are being simultaneously ruled out.

As the outbreak expands, emergency departments are likely to become quickly overwhelmed.  Outpatient settings need to have appropriate PPE and plans in place to safely collect appropriate specimens and management of suspect COVID-19 patients.

WHEN TO USE WA PHL

WA PHL testing is primarily reserved at this time for persons with severe illness and travel to countries with widespread or sustained community transmission, persons with contact to a known COVID-19 case, and persons associated with known local outbreaks and clusters of illness (such as with Life Care in Kirkland). For persons reporting travel, use the COVID-19 Assessment for Evaluating Persons with Fever and Acute Respiratory Illness tool.  

Patients who meet the criteria below need to have testing approved by Spokane Regional Health District (SRHD) Epidemiology (before sending specimens to WA PHL) by calling 509-324-1442 during business hours or 509-869-3133 after hours. Please conduct a respiratory pathogen panel to rule out other etiologies.

  • Fever or signs/symptoms of lower respiratory illness (e.g., cough or shortness of breath) AND is a person who has had close contact with a laboratory-confirmed COVID-19 patient within 14 days of symptom onset
  • Fever and signs/symptoms of a lower respiratory illness (e.g., cough or shortness of breath) requiring hospitalization AND

Information on submitting samples to WA PHL, including a link to the required COVID-1- Sample Submission Form, can be found here: https://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/PublicHealthLaboratories/MicrobiologyLabTestMenu. Oropharyngeal (OP) and nasopharyngeal (NP) swabs are preferred.

WHEN TO USE UNIVERSITY OF WASHINGTON LAB (UW LAB)

There are no restrictions or inclusive criteria to use the UW Lab for COVID-19 testing; however, testing of asymptomatic persons is not recommended at this time. If someone does not meet the criteria listed above for testing at the WA PHL, the clinician may order that testing through UW Lab as they would any other commercial testing. Information on how to submit samples to the UW Lab can be found here: https://testguide.labmed.uw.edu/public/view/NCVQLT.


Due to resource constraints, there is no need to notify SRHD Epidemiology in advance about tests sent to UW Lab, with the exception of suspect cases who are healthcare workers. However, if a person tests positive for COVID-19, those results should be immediately reported to 509-869-3133.


If COVID-19 is suspected:

  • Ask patients with suspected COVID-19 infection to wear a surgical mask as soon as they are identified and evaluate them in a private room with the door closed, ideally an airborne infection isolation room if available.
  • All healthcare personnel entering the room should use standard precautions, contact precautions, airborne precautions, and use eye protection (e.g., gown, gloves, N95 mask or PAPR, and face shield or goggles).
  • Immediately notify infection control personnel at your healthcare facility.
  • Collect an upper respiratory specimen (NP or OP swab) and store in viral transport medium. Specimens should be refrigerated and shipped cold. See above for guidance of using WA PHL or UW Lab.
    • Concurrent local commercial testing of a second upper respiratory specimen should occur with a respiratory pathogen panel to rule out other infectious causes, including but not limited to influenza. Results for the respiratory pathogen panel are not necessary for submission to UW PHL (all samples can be obtained at the same time and patient can be sent home to isolate while awaiting test results if further medical care is not needed).
  • Patients should be asked to isolate at home pending test results.

CDC Clinician Outreach and Communication Activity: Coronavirus Disease 2019 (COVID-19) Update—What Clinicians Need to Know to Prepare for COVID-19 in the United States

When: Thursday March 5, 11 am to 12 pm Pacific

What: During this COCA Call, clinicians will learn what they can do to prepare for COVID-19 including identifying persons under investigation, applying infection prevention and control measures, assessing risks for exposures, optimizing the use of personal protective equipment supplies, and managing and caring for patients (inpatient and at home).

Where:  Please click the link to join:  https://zoom.us/j/695903771

Or Telephone: US: +1 646 876 9923 or +1 669 900 6833

Webinar ID: 695 903 771

Archive: If you are unable to attend this live COCA Call, it will be available to view on-demand a few hours after the call.


RESOURCES

Washington State Department of Health and CDC have compiled additional guidance for healthcare providers, which is available on their website (this is a rapidly evolving situation and you should continue to check for updates to these documents): https://www.doh.wa.gov/Emergencies/Coronavirus/Resources