COVID-19 Health Alert # 3
Evolving Priorities for COVID-19 Testing in Health Care, Long-Term Care, and Other Settings
Bureau of Communicable Diseases, March 27, 2020
- The Wisconsin State Laboratory of Hygiene (WSLH) and the Milwaukee Health Department Laboratory (MHDL) will continue to prioritize COVID-19 testing for patients with respiratory illness requiring hospitalization, and individuals with acute respiratory symptoms who are health care workers or provide other essential services such as first responders, law enforcement, and other public safety roles.
- Post-mortem testing can be performed at Wisconsin’s two public health laboratories, and will be prioritized (Tier 1) when it is necessary to inform public health investigations or infection control interventions.
- DHS and CDC continue to recommend against COVID-19 testing for asymptomatic individuals.
Dear Colleagues,
During the week of 3/23/2020, the overall laboratory capacity for COVID-19 testing in Wisconsin has increased. DHS has now received electronic laboratory results from at least 40 different clinical and reference laboratories, and the number of hospital-based laboratories conducting COVID-19 testing continues to grow. The volume of test results received by DHS is approaching 2,000 per day, and the proportion of tests that are positive this week has been between 3% and 4%.
Today, the CDC released updated guidance about which individuals should be prioritized for COVID-19 testing, which are now summarized on the CDC website. The CDC guidance acknowledges that clinicians should use their judgment about whom to test, and also recognizes that local testing practices must vary based on resource limitations.
At this time, the Wisconsin State Laboratory of Hygiene (WSLH) and the Milwaukee Health Department Laboratory (MHDL) must continue to restrict COVID-19 testing to specific situations, to ensure that priority specimens are processed with the quickest turn-around time. We have, however, modified the criteria for which individuals will be considered highest priority (Tier 1 and 2), to support clinical and public health decisions in a timely manner. The modified table is below, and should replace the criteria described in memo BCD 2020-09 dated 3/17/2020.
Specimens submitted to WSLH and MHDL should be accompanied by the Patient Information Form as well as the appropriate laboratory requisition form. The Patient Information Form has been modified to reflect the updated priority criteria outlined below.
The priority criteria developed by Wisconsin DHS for the public health laboratories are somewhat different than the criteria used in the new CDC guidance, but both agree in prioritization of testing for hospitalized patients and health care facility workers. Wisconsin providers can obtain COVID-19 testing for any patient using their clinical judgment, but at this time, tests not meeting the criteria listed in Tier 1 and Tier 2 should be performed at laboratories other than WSLH and MHDL.
TIER ONE:
Patients who are critically ill and receiving ICU level care with unexplained viral pneumonia or respiratory failure
-OR-
Patients who are residents of long-term care facilities or other high consequence congregate settings (e.g. prisons or jails), with unexplained fever OR signs/symptoms of acute respiratory illness.
-OR-
Post-mortem testing for people who died of unknown causes, if COVID-19 testing would influence infection control interventions or inform a public health response
TIER TWO:
Hospitalized (non-ICU) patients with unexplained fever AND signs/symptoms of acute respiratory illness
-OR-
Health care workers and first responders with unexplained fever AND signs/symptoms of acute respiratory illness, regardless of hospitalization
-OR-
Essential staff in high consequence congregate settings (e.g. correctional officers) with unexplained fever AND signs/symptoms of acute respiratory illness, regardless of hospitalization
TIER THREE: TESTING OF TIER THREE SPECIMENS WILL NOT BE PERFORMED AT WSLH OR MHDL
Patient is in an outpatient setting and meets criteria for influenza testing. This includes individuals with co-morbid conditions including diabetes, COPD, congestive heart failure, age >50, immunocompromised hosts among others
-OR-
Health care workers with acute respiratory symptoms (e.g. rhinorrhea, congestion, sore throat, cough) without fever
TIER FOUR: TESTING OF TIER FOUR SPECIMENS WILL NOT BE PERFORMED AT WSLH OR MHDL
Other patients, as directed by public health or infection control authorities (e.g. community surveillance or public health investigations)
DO NOT TEST
Patients without symptoms
Patients with mild respiratory symptoms only who are not health care workers
Wisconsin DHS and CDC continue to recommend not testing asymptomatic individuals for COVID-19 who may have been exposed to the disease. Individuals with possible exposure should be recommended to self-quarantine and monitor their symptoms. COVID-19 testing should only be used for making a diagnosis in patients with a clinical syndrome suggestive of the disease.
Thank you for your collaboration and support during these challenging times.
Sincerely,
Ryan Westergaard, MD, PhD, MPH
Chief Medical Officer and State Epidemiologist for Communicable Diseases
Wisconsin Department of Health Services
About the COVID-19 Health Alert Network
The content of this message is intended for public health and health care personnel and response partners who have a need to know the information to perform their duties. The HAN will be the primary method for sharing time-sensitive public health information with clinical partners during the COVID-19 response. Health care providers and other officials can subscribe and unsubscribe using their preferred email address at the DHS COVID-19 website.
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