Editor's note: For the latest news on coronavirus disease 2019, visit https://www.aappublications.org/news/2020/01/28/coronavirus.
People who are hospitalized and symptomatic health care workers should take top priority for coronavirus disease 2019 (COVID-19) testing, according to updated Centers for Disease Control and Prevention (CDC) guidance.
Clinicians should consider a patient’s symptoms, which typically include fever, cough and difficulty breathing, as well as how widespread the SARS-CoV-2 virus is in their community.
The updated CDC guidance lays out four priority levels for testing.
- Tier 1: hospitalized patients and symptomatic health care workers
- Tier 2: people at high risk of complications who also have symptoms, including people in long-term care facilities, people ages 65 and older, people with underlying conditions and first responders
- Tier 3: critical infrastructure workers with symptoms, health care workers and first responders without symptoms, people with mild symptoms in communities with high COVID-19 hospitalizations, other people with symptoms
- Tier 4: people without symptoms
Clinicians who suspect a patient may have COVID-19 should contact their local or state health department immediately to determine if testing is warranted and to receive guidance on collecting specimens.
Those specimens should include an upper respiratory specimen. Nasopharyngeal swab is preferred, but if this is not possible, an oropharyngeal specimen, nasal mid-turbinate swab or anterior nares specimen will suffice, according to updated CDC guidance on specimen collection.
Lower respiratory specimens also are recommended if possible, and sputum should be collected from patients with a productive cough.
The CDC also is reminding clinicians to take proper infection control precautions when collecting these specimens. In light of shortages of personal protective equipment, the CDC has strategies for optimizing supply at https://bit.ly/2QN4CL8 and a new calculator to help plan for shortages at https://bit.ly/2JgCbkL.
