LAC DPH Health Advisory: Expanding COVID-19 Testing and Universal Source Control April 22, 2020 LA County, Coronavirus, COVID-19, LAC DPH, Public Health 1225 Key Messages Molecular testing for SARS CoV-2 is becoming more available. Healthcare providers and systems are encouraged to test more symptomatic persons as resources allow (see Expanded Testing below). Symptomatic patients who are tested for COVID-19 should be instructed to continue to follow home isolation instructions, even if the test result is negative. Guidance is available for patients who test positive or negative in a variety of scenarios. The Centers for Disease Control and Prevention (CDC) now recommend universal source control for everyone entering a healthcare facility, regardless of symptoms. (see Universal Source Control below). The LAC DPH Healthcare Personnel Monitoring Guidance has been revised accordingly. Situation Update LAC DPH has confirmed more than 16,000 COVID-19 cases and more than 700 deaths. Overall, case numbers continue to increase, but modeling suggests that hospital capacity will meet local needs if physical distancing continues. For this reason, the Safer at Home Health Officer order was extended until May 15, 2020. Preliminary findings from a community seroprevalence study released on April 20 indicate that an estimated ~4% of the county’s adult population has antibodies to SARS-CoV-2. This suggests that infections from COVID-19 have been far more widespread in the county than previously thought. In addition, the findings suggest a much lower fatality rate than was estimated based on reported cases of COVID-19. However, given that the vast majority of the population remains susceptible to infection, future efforts to contain the epidemic will require much more expansive diagnostic testing, isolation of cases and quarantine of contacts, and continued strategies to ensure social distancing. LAC DPH continues to post local surveillance data, cases by city and community, and a summary of COVID-19 infection in healthcare workers. We sincerely appreciate your work on the front lines during this pandemic. Diagnostic Testing Situation Update In LA County until now, testing has been prioritized for specific groups and settings due to limited test capacity and PPE supplies. The testing landscape is expanding and changing rapidly as many commercial clinical labs, most hospital systems, and many academic centers are now performing molecular tests for SARS-CoV-2. There are now several molecular tests approved for the point of care (POC) setting. In addition, patient self-collected specimens are now available, thus reducing the need for PPE and the potential for staff exposures. The FDA just authorized the first patient at-home sample collection that should be available in the near future. The LAC DPH Public Health Laboratory (PHL) continues to test specimens from high priority patients and settings, see PHL testing criteria. The County of Los Angeles is now offering free drive-up mobile testing to symptomatic persons on a priority basis. SARS-CoV-2 tests that are used for individual patient care should be authorized by the Food and Drug Administration (FDA) under an Emergency Use Authorization (EUA). To see whether the FDA has issued an EUA for a diagnostic test and the settings where it may be used, click here. Visit the LAC DPH General Testing Guidelines for more information about diagnostic testing, including cautions regarding the use of serology tests for patient care. Expanded Testing Recommendations Healthcare providers and systems are encouraged to expand SARS CoV-2 molecular testing to more patients with symptoms of COVID-19. As facility resources allow, consider using the following testing prioritization scheme: Highest Priority for Testing Symptomatic Hospitalized patients Healthcare workers Patients in long-term care facilities First responders Part of outbreak response/contact investigation in high risk settings People identified by LAC DPH (who may include asymptomatic residents and staff) in settings such as long-term care facilities, congregate living facilities, correctional facilities Rationale includes, ensuring optimal care options for all hospitalized patients, lessening the risk of nosocomial infections, and detecting and preventing outbreaks in in acute- and subacute-care health facilities and non-healthcare congregate living settings. Testing is Encouraged Symptomatic Patients 65 years of age and older Patients with underlying conditions Rationale includes, ensuring that those who are at highest risk of severe disease are promptly identified and appropriately triaged. Consider Testing Symptomatic persons not meeting any the above As resources allow, test mildly ill individuals to decrease community spread. Testing asymptomatic persons is not recommended. Testing asymptomatic persons might be considered in the setting of an outbreak if it can inform public health decisions for isolation and quarantine. Testing asymptomatic persons who are not linked to a known case or an outbreak is not currently recommended. Universal Source Control In order to address asymptomatic and pre-symptomatic transmission of COVID-19, the CDC is now recommending universal source control for all persons entering a healthcare facility, see the CDC Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. HCPs should now wear face coverings at all times while they are in the healthcare facility. Masks or respirators are preferred, but non-medical face coverings can be used for non-patient care activities. Extended use and reuse of masks and respirators should be based on principles set forth in prior CDC PPE optimization guidance. The LAC DPH Healthcare Personnel Monitoring Guidance has been revised to reflect these updated CDC recommendations.