Evaluating and Testing Persons for Coronavirus Disease 2019 (COVID-19)
CDC guidance for COVID-19 may be adapted by state and local health departments to respond to rapidly changing local circumstances.
Revisions were made on May 3, 2020 to reflect the following:
- Updated recommendations for testing, specimen collection, and reporting patients and reporting positive test results
- Specification of testing priorities
Revisions were made on April 27, 2020 to reflect the following:
- Updated priorities for testing patients with suspected COVID-19 infection
Revisions were made on March 24, 2020 to reflect the following:
- Updated priorities for testing patients with suspected COVID-19 infection
Revisions were made on March 9, 2020, to reflect the following:
- Reorganized the Criteria to Guide Evaluation and Laboratory Testing for COVID-19 section
Revisions were made on March 4, 2020, to reflect the following:
- Criteria for evaluation of persons for testing for COVID-19 were expanded to include a wider group of symptomatic patients.
No vaccine for COVID-19 is currently available however vaccine trials are in progressexternal icon; The National Institutes of Health recently published guidelines on prophylaxis use, testing, and management of COVID-19 patients. For more information, please visit: National Institutes of Health: Coronavirus Disease 2019 (COVID-19) Treatment Guidelinesexternal icon.
The CDC clinical criteria for considering testing for COVID-19 have been developed based on what is known about COVID-19 and are subject to change as additional information becomes available.
Update and Interim Guidance on Outbreak of Coronavirus Disease 2019 (COVID-19)
CDC continues to closely monitor an outbreak of respiratory illness caused by COVID-19 that was initially detected in Wuhan City, Hubei Province, China. This HAN Update provides a situational update and guidance to state and local health departments and health care providers.
Healthcare providers should immediately notify their localexternal icon or stateexternal icon health department in the event of the identification of a PUI for COVID-19. When working with your local or state health department check their available hours.
PRIORITIES FOR COVID-19 TESTING
(Nucleic Acid or Antigen)
High Priority
- Hospitalized patients
- Healthcare facility workers, workers in congregate living settings, and first responders with symptoms
- Residents in long-term care facilities or other congregate living settings, including correctional and detention facilities and shelters, with symptoms
Persons identified by public health officials or clinicians as high priority
- Persons with symptoms of a possible infection with COVID-19, including: fever, cough, shortness of breath, chills, muscle pain, new loss of taste or smell, vomiting or diarrhea, and/or sore throat.
- Persons without symptoms who come from racial and ethnic minority groups disproportionately affected by adverse COVID-19 outcomes-currently African Americans, Hispanics and Latinos, some American Indian tribes (e.g., Navajo Nation).
- Persons without symptoms who are prioritized by health departments or clinicians, including but not limited to: public health monitoring, sentinel surveillance, presence of underlying medical condition or disability, residency in a congregate housing setting such as a homeless shelter or long term care facility, or screening of other asymptomatic individuals according to state and local plans.
Clinicians considering diagnostic testing of people with possible COVID-19 should continue to work with their local and state health departments to coordinate testing through public health laboratoriesexternal icon, or work with commercial or clinical laboratories using diagnostic tests authorized for emergency use by the U.S. Food and Drug Administration.
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 fever1 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 contact2 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).
Recommendations for Viral Testing, Specimen Collection, and Reporting
Updated May 3, 2020
Clinicians should immediately implement recommended infection prevention and control practices, including use of recommended personal protective equipment (PPE), if a patient is suspected of having COVID-19. They should also notify infection control personnel at their healthcare facility if a patient is classified as a Patient Under Investigation (PUI) for COVID-19.
For diagnostic testing for COVID-19 see the Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from PUIs for COVID-19 and Biosafety FAQs for handling and processing specimens from possible cases and PUIs.
Clinicians should report positive test results to their local or state health department only.
Recommendations for Antibody Testing
Updated May 3, 2020
CDC does not currently recommend using antibody testing alone for diagnostic purposes.
Additional Resources:
- Nasal (Anterior Nasal) Specimen Collection for SARS-CoV-2 Diagnostic Testing pdf icon[1 page]
- Guidance – Proposed Use of Point-of-Care (POC) Testing Platforms for SARS-CoV-2 (COVID-19) pdf icon[2 pages]
- State health department after-hours contact listexternal icon
- Directory of Local Health Departmentsexternal icon
- World Health Organization (WHO) Coronavirusexternal icon
- WHO guidance on clinical management of severe acute respiratory infection when COVID-19 is suspectedexternal icon
- NIH Coronavirus Disease 2019 (COVID-19) and Treatment Guidelinesexternal icon
- CMS Guidelinesexternal icon
- FAQs on Diagnostic Testing from the FDAexternal icon
Footnotes
1Fever may be subjective or confirmed
a) being within approximately 6 feet (2 meters) of a COVID-19 case; 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)
Additional information is available in CDC’s Interim Infection Prevention and Control Recommendations for Patients with Confirmed COVID-19 or Persons Under Investigation for COVID-19 in Healthcare Settings.