Who Should Be Tested for COVID-19, When Should They Be Tested & With Which Test?

Recommendations for Healthcare Workers Who Have Been Properly Wearing PPE

  1. No illness or symptoms – No testing recommended
  2. No illness or symptoms, but came in contact with a patient known to be COVID-19 positive – A PCR-RNA nasal swab test, if available, or quarantine for 7-14 days; if no symptoms develop, return to work. The Flowchart below addresses how the patient’s Exposure Risk Level helps determine the return-to-work plan for the patient. This must be determined on a case-by-case level after appropriate screening is performed either in our office or via a Telemedicine visit.
  3. Symptomatic with fever, cough, shortness of breath, abdominal pain and/or diarrhea – A PCR-RNA nasal swab test and quarantine for 14 days; may need hospitalization for shortness of breath or pulse oximetry on room air under 94%

COVID-19 Return-to-Work Guidelines for HCWs Van Nuys CA

Return-to-Work Criteria for Healthcare Workers With Confirmed or Suspected COVID-19

Test-Based Strategy

Exclude from work until:

The Test-Based Strategy is the preferred method for determining when a healthcare worker may return to work in a healthcare setting. If the Test-Based Strategy cannot be used, the Non-Test-Based Strategy should be used.

Non-Test-Based Strategy

Exclude from work until:

  • At least 3 days (72 hours) have passed since recovery, which is defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and
  • At least 10 days have passed since symptoms first appeared

Healthcare workers with laboratory-confirmed COVID-19 who have not had any symptoms should be excluded from work until 10 days have passed since the date of their first positive COVID-19 diagnostic test, assuming they have not subsequently developed symptoms since their positive test.

For healthcare workers who had COVID-19 ruled out and have an alternate diagnosis (e.g., tested positive for influenza), the return-to-work criteria should be determined based on the alternate diagnosis.

Recommendations for Patients With a Comorbiditity (Diabetes, Heart Disease, Cancer or Compromised Immune System)

  1. No illness or symptoms – No testing recommended
  2. No illness or symptoms, but came in contact with a patient known to be COVID-19 positive – A PCR-RNA nasal swab test, if available, and may need to quarantine for 14 days
  3. Symptomatic with fever, cough, shortness of breath, abdominal pain and/or diarrhea – A PCR-RNA nasal swab test and quarantine for 14 days; may need hospitalization for shortness of breath or pulse oximetry on room air under 94%

Recommendations for Patients Who Live With an Individual Who Is Elderly or Immunocompromised

  1. No illness or symptoms – No testing recommended
  2. No illness or symptoms, but came in contact with a patient known to be COVID-19 positive – A PCR-RNA nasal swab test or an IGG blood test, and may need to quarantine for 14 days
  3. Symptomatic with fever, cough, shortness of breath, abdominal pain and/or diarrhea – A PCR-RNA nasal swab test and quarantine for 14 days; may need hospitalization for shortness of breath or pulse oximetry on room air under 94%
  4. No illness or symptoms but patient demands testing – A PCR-RNA nasal swab test, if available, or an IGG blood test

Recommendations for Pre-Surgical & Pre-Procedure Screenings

For patients who are scheduled to undergo a surgical procedure, either in a hospital or an outpatient surgical center, we recommend a PCR-RNA nasal swab test, if available.

COVID-19 Tests

The rapid test requires a very small amount of blood from a fingerstick, typically similar to what we would do when testing a diabetic. The rapid test looks for the IgM and IgG antibodies which, as mentioned above, have a very high rate of false negatives (in the 30-40% range). This false negative problem primarily occurs because the antibody can be present at such a low level that the test cannot detect it.

Likewise, the rapid test cannot differentiate between the immediate IgM antibody that can appear with the common cold and does not represent COVID-19. We therefore elected not to purchase rapid tests, as we felt that we would be providing our patients with false information. The rapid tests currently are not approved by the FDA because of their lack of validity. The last thing we would ever want to do is to tell a patient that their COVID-19 test was negative and then they go and expose family members at home or coworkers in the workplace, which could potentially lead to a COVID-19 outbreak based upon a false negative test.

The gold standard for testing for COVID-19 currently is the PCR-RNA nasal swab test, which also can produce false negatives based upon primarily poor sampling when the nasal swab was obtained. The nasal swab has to be inserted deep into the nasal-pharyngeal cavity, which for some patients can be quite uncomfortable and cause nasal bleeding. The swab has to be left in place for up to 20 seconds before it is removed, which some patients simply cannot tolerate. Healthcare providers who perform the test must wear proper protective equipment, including a plastic face shield, an N95 mask, a disposable gown and disposable gloves. Secondary to a shortage of PPE, nasal swab testing has been limited to only patients who have clear-cut symptoms of COVID-19 or are highly suspected of having it secondary to exposure to another person known to have COVID-19. There has also been a shortage of transport medium, which has required us to ration the testing to only those who met the strict criteria. Up until recently, we could only get the transport media if we filled out a questionnaire with the county health department and the patient met the strict criteria for the test. As more COVID-19 testing kits become available, the restrictions on who can receive a nasal swab test will become less stringent.

We now have an IgG blood test (the Abbott test) available to us because Abbott Labs developed the equipment and reagent specific to detect the IgG antibody that occurs 7 to 10 days after COVID-19 symptoms began. This test has recently received Emergency Use Authorization (EUA) from the FDA. The IgG test can tell us whether or not the patient has had exposure to Coronavirus and developed antibodies to it. The test does not tell us whether or not the patient is actively sick with the Coronavirus or if the patient is contagious to other people.  Only a select few labs and Hospitals have the Abbott equipment available to them and currently many hospitals in our community still do not have it. This may be a good alternative test to determine who in a population does not have COVID-19.

Detecting viral presence with any test is currently far less than 100% accurate. Diagnosing the Coronavirus is complicated. Proper interpretation of the test results must be done in conjunction with a good history and physical exam performed by a medical provider who is well informed on the complexity of making this diagnosis.

The oral swab test is also being used, but the amount of antigen in the oral mucosa is much less than in the nasal pharyngeal region and may limit the effectiveness of the test. Additional studies are forthcoming on the efficacy of home testing for COVID-19 by an oral mucosal or a mid-turbinate swab test, and we hope to know more soon.