Interim Public Health Testing Utilization Plan (Revision Date: 6/04/20) SUBJECT TO CHANGE

This document is meant to aid in selection and frequency testing of individuals and populations for COVID-19. CDC guidance for COVID-19 may be adapted by state and local health departments to respond to rapidly changing local circumstances. Clinicians should use their judgment to
determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Asymptomatic infection with SARS-CoV-2, the virus that causes COVID-19, has been reported. Most patients with confirmed COVID-19 have developed fever and/or
symptoms of acute respiratory illness (e.g., cough, difficulty breathing) but some people may present with other symptoms as well. Other considerations that may guide testing are epidemiologic factors such as the occurrence of local community transmission of COVID-19 in a jurisdiction.
Clinicians are encouraged to test for other causes of respiratory illness.
Other considerations that may guide testing are epidemiologic factors such as known exposure to an individual who has tested positive for SARS-CoV-2, and the occurrence of local community transmission or transmission within a specific setting/facility (e.g., nursing homes) of COVID-19.
Clinicians are strongly encouraged to test for other causes of respiratory illness, for example influenza, in addition to testing for SARS-CoV-2. Another population in which to prioritize testing of minimally symptomatic and even asymptomatic persons are long-term care facility residents,
especially in facilities where one or more other residents have been diagnosed with symptomatic or asymptomatic COVID-19.

SARS-CoV-2 can cause asymptomatic, pre-symptomatic, and minimally symptomatic infections, leading to viral shedding that may result in transmission to others who are particularly vulnerable to severe disease and death. Even mild signs and symptoms (e.g., sore throat) of COVID-19
should be evaluated among potentially exposed healthcare personnel, due to their extensive and close contact with vulnerable patients in healthcare settings. Additional information is available in CDC’s Interim U.S. Guidance for Risk Assessment and Public Health Management of
Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease 2019 (COVID-19).

483628480.xlsx
Testing Objective1 Public Health Clinical
Population2, 10 Priority Epidemiological Assessment4, 10 Clinical/Public Health Rationale Frequency of Testing5, 10 Public Health Prioritization if Limited Resources 10
"Use Cases" Populations Assessment3, 10

Consider a test-based strategy to discontinue

Post-symptomatic Based on past testing results isolation, if non-test based strategy is not utilized Twice, separated by ≥24 hrs Low Priority (may be important clinically)

Individual with known exposure to COVID- Rapid diagnosis, isolation, and treatment of Once, on identification of close contact
19 case suspected cases exposure. Only repeat if symptoms develop High priority

Residents in congregate living
Protection of settings serving individuals at
vulnerable most risk of severe
populations consequences (e.g. long-term
care facilities, assisted living)
At intake and repeated at least weekly until Highest priority: Prioritize facilities with highest
Rapid identification and containment through staff and residents/patients are all negative, 14
Facility with at least 1 facility associated isolation and cohorting or (nursing home) transfer to days after last positive. Consider increasing prevalence of individuals at risk of severe consequences
COVID-19 case of infection (i.e., long term care facility, homes for aged
regional hub frequency if significant community over general prison population)
transmission.
HIGHEST
Asymptomatic

Prioritize facilities with staff or transfers from facilities

A region of medium risk or higher, or Rapid identification and containment through At intake and repeated at least weekly until with known outbreaks; prioritize facilities with
receiving patients from an area of medium isolation and cohorting or (nursing home) transfer to staff and residents/patients are all negative for individuals most at risk of severe consequences of
risk or higher 7 regional hub 14 days after last positive test infection. If resources lacking, could test most likely
exposed population within facility

483628480.xlsx
Testing Objective1 Public Health Clinical
Population2, 10 Priority Epidemiological Assessment4, 10 Clinical/Public Health Rationale Frequency of Testing5, 10 Public Health Prioritization if Limited Resources 10
"Use Cases" Populations Assessment3, 10

Individual with known exposure to COVID- Rapid diagnosis, isolation, and treatment of Once, on identification of close contact
Asymptomatic 19 case suspected cases exposure. Only repeat if symptoms develop Highest priority

Consider a test-based strategy to discontinue

Low income workers in risky
professions (migrant
agricultural, meat packing,
animal husbandry)
Post-symptomatic Based on patient's testing result isolation, if non-test based strategy is not utilized Twice, separated by ≥24 hrs Low Priority (may be important clinically)
HIGHEST
Proactive response to low access to testing; potential
for exposure through housing, travel, and worksite, Prioritize testing to facilities with known outbreaks or
People who have been going to work in Every two weeks until outbreaks in these at risk
Asymptomatic industries seeing recent outbreaks inability to self-quarantine/essential workforce, and industries no longer occuring that share staff/customers with facilities with known
occurrence of multiple outbreaks in meat packing, outbreaks
poultry and agricultural sites

Individual with known exposure to COVID- Rapid diagnosis, isolation, and treatment of Rapid test on intake; following contact with
19 case suspected cases known case Highest priority

Homeless shelters HIGHEST Asymptomatic A region of medium risk or higher, or Individuals have little control over environment or
receiving patients from an area of medium ability to control personal exposure. Ongoing risk Using rapid testing at intake and every two Prioritize testing at intake for all facilities. Prioritize
weeks following testing all individuals in facilities with known outbreak
risk or higher 7 due to transient nature of housing.
Individual with known exposure to COVID- Transient population Rapid test on intake; following contact with Highest priority
19 case known case
Asymptomatic A region of medium risk or higher, or
Rapid test on intake and transfer; every 14 days Prioritize testing at intake for all facilities. Prioritize
receiving patients from an area of medium Transient population for those who remain in the facility testing all individuals in facilities with known outbreak
Jails HIGHEST risk or higher 7

Post-symptomatic Based on patient's testing result Consider a test-based strategy to discontinue Twice, separated by ≥24 hrs Low Priority (may be important clinically)
isolation, if non-test based strategy is inappropriate

483628480.xlsx
Testing Objective1 Public Health Clinical
Population2, 10 Priority Epidemiological Assessment4, 10 Clinical/Public Health Rationale Frequency of Testing5, 10 Public Health Prioritization if Limited Resources 10
"Use Cases" Populations Assessment3, 10

Individual with known exposure to COVID- Rapid diagnosis, isolation, and treatment of Once, on identification as contact. Only repeat
19 case suspected cases if symptoms develop Highest priority
Asymptomatic
7 Reduce exposure at workplace and prevent exposure Every two weeks until no longer medium risk High priority
A region of medium risk or higher
Healthcare workers to the public region

Consider a test-based strategy to discontinue

Post-symptomatic Based on patient's testing result Twice, separated by ≥24 hrs High priority if non-test based strategy is not utililized
isolation, if non-test based strategy is not utilized

Individual with known exposure to COVID- Rapid diagnosis, isolation, and treatment of Once, on identification as contact. Only repeat Highest priority
19 case suspected cases if symptoms develop

Health care facility workers in Reduce exposure at workplace and prevent exposure Repeat at least weekly until staff and
congregate living settings, HIGHEST Asymptomatic Working in facility with COVID-19 outbreak Highest priority
to the public residents/patients are all negative
first responders
Reduce exposure at workplace and prevent exposure Repeat at least weekly until no longer medium
A region of medium risk or higher7 High priority
to the public or higher risk region
Protection of
essential service Once, at least three to four days after close
workforce Individual with known exposure to COVID- Rapid diagnosis, isolation, and treatment of
contact exposure. Only repeat if symptoms High priority
19 case suspected cases
develop

Consider Initial test to set baseline and biweekly

People who have been going to work in a
region of medium-high risk or higher7
Non-healthcare essential
Asymptomatic
service workers
People in service professions with daily
close contact with the public, in a region of
medium high risk or higher7
Every two weeks until no longer medium-high
testing follow up to reduce exposure at workplace risk region Lower priority
and prevent exposure to the public
Consider Initial test to set baseline and biweekly
Every two weeks until no longer medium-high
testing follow up to reduce exposure at workplace risk region Highest priority
and prevent exposure to the public

Workers who have been at home for 14

days for nonquarantine reasons who are These individuals have low likelihood of being Every two weeks until no longer medium-high
exposed and testing utility is limited (risk of false Lower priority
returning to work in a region of medium positive could exclude someone from work) risk region
high risk or higher 7

483628480.xlsx
Testing Objective1 Public Health Clinical
Population2, 10 Priority Epidemiological Assessment4, 10 Clinical/Public Health Rationale Frequency of Testing5, 10 Public Health Prioritization if Limited Resources 10
"Use Cases" Populations Assessment3, 10

Increase testing rates per million per day in Population strategy: daily mobile or pop up
Population with Racial/ethnic minority higher rates of Populations who have had less access to communities facing inequity in access (i.e., rate of testing strategy in high need areas; be aware of
lack of access to HIGHEST COVID-19 testing; consider social testing in areas with higher proportion of lack of transportation; consider proactive High Priority
testing populations severe outcomes vulnerability index racial/ethnic minorities is equal to or above that for strategy going directly to individuals in hard to
majority areas) reach populations

Individual with known exposure to COVID- Assurance of safe work environment and protection Once, on identification of close contact
19 case of general public receiving services exposure. Only repeat if symptoms develop High priority

Other workforce Workers employed in People in service professions with daily Assurance of safe work environment and protection Bi-weekly (frequency recommendation may be
occupations and settings Asymptomatic close contact with the public, in regions of adjusted based on level of ongoing exposure High priority
protection other than noted above of general public receiving services risk)
medium risk7
Sporadic cases, linked to travel/contacts Testing would depend on judgement of level of
Low priority
outside community contact

Rapid testing may be indicated for urgent surgical

With or without close contact to a case procedures, to allow anesthesia to make Once, on identification of close contact High priority
exposure. Only repeat if symptoms develop
Asymptomatic perioperative management adjustments as needed
Healthcare facility Hospitalized patients
infection control Reduce exposure at workplace and prevent exposure Once, on admission. Only repeat if symptoms
From a region of medium risk or higher 7 High priority
to the public develop

Based on patient's testing result, if a test Consider a test-based strategy to discontinue

Post-symptomatic Twice, separated by ≥24 hrs Lower priority (clinical prioritization may differ)
based strategy is utilized isolation, if non-test based strategy is not utilized

Persons identified through High risk exposure to confirmed case (i.e.,

public health contact tracing within 6 feet for more than 10 minutes, Rapid diagnosis, isolation, and treatment of Once, on identification of close contact
Contact tracing HIGHEST Asymptomatic Highest priority
or cluster investigations (i.e. household member, or close droplet suspected cases and information for contacts exposure. Only repeat if symptoms develop
case contacts) exposure)

Persons prioritized by health

departments or clinicians, for Sporadic cases, linked to travel/contacts Assess trends for early warning of public health 250 samples per week High Priority
any reason, including but not outside community system
limited to: public health
Community monitoring, sentinel HIGHEST
surveillance
surveillance, or screening of
other asymptomatic
individuals according to state
and local plans Determine community prevalence of history of
Transmission at any level infection and possible immunity (not yet PROTOCOL UNDER DEVELOPMENT Low priority
determined) via serologic testing

483628480.xlsx
Testing Objective1 Public Health Clinical
Population2, 10 Priority Epidemiological Assessment4, 10 Clinical/Public Health Rationale Frequency of Testing5, 10 Public Health Prioritization if Limited Resources 10
"Use Cases" Populations Assessment3, 10

Rapid diagnosis, isolation, and treatment of If negative, repeat in 1-3 days to confirm if true
Symptomatic With or without close contact8 to case9 suspected cases negative vs. false negative Highest priority

Consider a test-based strategy to discontinue Low public health priority, clinical prioritization may
Post-symptomatic Based on patient's testing result isolation, if non-test based strategy is inappropriate Twice, separated by ≥24 hrs differ
Hospitalized patients

Asymptomatic Patient has close contact with known case Rapid diagnosis, isolation, and treatment of Once, on identification as contact. Only repeat High priority
or from a region of medium risk or higher 7 suspected cases if symptoms develop
Clinical evaluation
and management If negative and other work-up also negative,
Rapid diagnosis, isolation, and treatment of
Symptomatic With or without close contact to case suspected cases may repeat testing in 1-3 days if symptoms are Highest priority
persisting or worsening

Consider a test-based strategy to discontinue Low public health priority, clinical prioritization may
Non-hospitalized patients Post-symptomatic Based on patient's testing result Twice, separated by ≥24 hrs
isolation, if non-test based strategy is inappropriate differ

Rapid diagnosis, isolation, and treatment of Once, on identification as contact. Only repeat
Asymptomatic Known close contact to COVID-19 Case suspected cases and information for contacts; self- High priority
quarantine is acceptable strategy if symptoms develop

Notes:
1. All testing indicated above is with Nucleic acid testing, except for use of serologic testing for Community Surveillance
2. Test results are highly dependent on the prevalence of COVID-19 in each population. In populations with low prevalence of COVID-19 infection and in asymptomatic individuals the likelihood of false-positive test results is increased. A negative test means that the SARS-CoV-2 RNA
was not present in the specimen above the limit of detection. A negative result does not rule out COVID-19 and should not be used as the sole basis for treatment or patient management decisions. A negative result does not exclude the possibility of COVID-19.
3. Symptomatic refers to signs or symptoms of potential COVID-19 infections: fever, cough, shortness of breath, chills, muscle pain, new loss of taste or smell, vomiting or diarrhea and/or sore throat
4. Case contacts may occur in a healthcare setting or community setting
5. There is currently no guidance as to recommended frequency for repeating testing. Frequency should be based on a determination of a person’s level of ongoing risk of exposure since a single negative test cannot rule out the possibility of active early infection or becoming
infected in the subsequent days to weeks.

6. Updated guidance available at: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html

7. A region of medium risk or higher based on 7-20 lab confirmed cases per million population per day; 2 weeks decreasing lab confirmed cases; 3-10% Positivity of diagnostic testing; and/or 2 weeks decreasing positivity. Medium-High risk region has 20-40 cases per million
population per day or <2 weeks decreasing cases or >10-20% Positivity. A local health department may also assess community transmission assessed as presence of cases not involved in a known outbreak (unidentifiable source) .

8. Close contact is defined as a) being within approximately 6 feet (2 meters) of a COVID-19 case for 15 minutes; close contact can occur while caring for, living with, visiting, or sharing a healthcare waiting area or room with a COVID-19 case; or b) having direct contact with infectious
secretions of a COVID-19 case (e.g., being coughed on).
9. Case: person who has had a positive lab diagnostic test or clinical diagnosis of COVID-19
10. Prioritization in a county/city should take place in consultation with the Local Health Department

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