Summary Points
- COVID-19 testing is available at both commercial and public health laboratories.
- Providers are encouraged to test patients with compatible illness through commercial laboratories
- Testing at the public health laboratory is prioritized for high risk patients and requires approval.
- Outpatients without risk factors should be tested at commercial laboratories. Approval is not required by public health laboratories.
As the number of COVID-19 cases in the U.S. and in metropolitan Philadelphia continues to increase, timely identification of cases is crucial for implementation of containment strategies. Diagnostic testing capabilities have expanded in both public health and commercial laboratories. To ensure their efficient utilization, the Pennsylvania State Department of Health has issued updated guidance for whom to test through the Bureau of Laboratories (BOL) and whom to test through commercial laboratories. The Philadelphia Department of Public Health (PDPH) issued this health alert to review criteria for high risk individuals for COVID-19 testing and to encourage providers to be more flexible for testing patients through commercial laboratories.
Patient Assessment and Management:
Clinicians can continue to use their judgement to determine if a patient with symptoms should be tested. This decision should consider epidemiologic risk criteria, including presence of local transmission, travel history, risk factors for severe COVID-19 disease, residence in a congregate setting and occupational setting. Providers should continue to prioritize testing for the following patients:
- Patient has exposure risk factors including close contact with a confirmed COVID-19 case OR any international travel within 14 days. Exposure should also be considered for domestic travel to affected areas, especially for persons who attended a mass gathering (i.e., a conference).
- Patient is at risk for severe disease (age >50 years, chronic medical conditions)
- Patient resides in a congregate setting (nursing home, assisted living, prison, dormitories, etc.)
- Patient is a healthcare worker
- Patient requires hospitalization for symptoms
- Patient is presenting with progressive acute respiratory illness with no apparent cause
For providers who can send specimens to commercial laboratories (LabCorp and Quest), PDPH is encouraging greater flexibility to test for patients who present with compatible illness of COVID-19 disease. Symptoms include fever >100.5 F, though not always present, or dry cough with shortness of breath. Presence of headache, fatigue, lethargy, myalgias, sore throat are all symptoms that may be present as well. Testing for SARS-CoV-2 (virus that causes COVID-19) is available through the state public health laboratory AND commercial laboratories. The state public health laboratory will now only perform testing for patients who are: contacts of a confirmed case, residents of a congregate care setting, healthcare workers or hospitalized with no alternative diagnosis. Please contact PDPH (business hours: (215) 685-6742, after hours: (215) 686-4514) for any patients who meet those criteria to provide approval and assist with submission of specimens.
For patients who do not meet the criteria for the state public health laboratory, testing should be performed through commercial laboratories. Public health approval is not required for testing at commercial laboratories. Consultation with PDPH is only required in the following instances:
- Request approval for testing at the state public health laboratory
- Assist with identification of a testing facility for providers who have a patient who meets criteria for COVID-19 testing but do not have specimen collection supplies.
Collect the following respiratory specimens for testing:
- Outpatients: Nasopharyngeal swab placed in viral transport media.
- Inpatients: Nasopharyngeal specimen AND a lower respiratory specimen (sputum for those with productive coughs or a tracheal aspirate)
For further details about specimen collection, visit: https://www.cdc.gov/coronavirus/2019-nCoV/guidelines-clinical-specimens.html.
Patients who have had a known exposure to a suspected or confirmed COVID-19 case or who have a history of recent travel should be advised to seek care with advance notification to the healthcare facility and take routine steps to limit the transmission of respiratory viruses (i.e., staying home from work and school, hand washing, good respiratory etiquette). Patients with mild symptoms may remain at home to reduce unnecessary emergency room or clinic utilization.
Additional Resources:
- CDC: 2019 Novel Coronavirus Information for Healthcare Professionals: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html
- PDPH: Novel Coronavirus (COVID-19): https://hip.phila.gov/EmergentHealthTopics/2019-nCoV
Originally released by the Philadelphia Department of Public Health on March 15, 2020.
