Coronavirus Disease 2019 (COVID-19)

Resources for Clinicians and Your Patients

   
Page updated August 3, 2020Linkedin     Email

 

SARS-CoV-2, the virus that causes COVID-19, continues to spread in the United States and many other countries, straining the capacity of healthcare systems in some states to treat patients with the infection. Older adults remain most at risk for hospitalization due to severe COVID-19 disease, but younger individuals are more responsible for the spread of infection than they were in the winter and spring of 2020.

Molecular testing is recommended for COVID-19 diagnosis. Testing decisions should be based on local epidemiology, clinical signs and symptoms, and the course of illness. Antibody testing can be used to evaluate exposure to SARS-CoV-2, but is not recommended for diagnosis of acute illness.

 

Quick Answers for Clinicians

 

In which scenarios is molecular diagnostic testing (eg, nucleic acid amplification [NAA], polymerase chain reaction [PCR]) recommended?

Updated July 17, 2020

The CDC suggests that molecular testing (eg, PCR, NAA) can be used for diagnostic purposes (eg, when testing individuals with symptoms consistent with COVID-19), screening purposes (eg, when testing asymptomatic individuals with known or suspected recent exposure to SARS-CoV-2), and surveillance purposes (eg, when testing asymptomatic individuals to detect transmission hot spots or characterize disease trends).1

What is the latest guidance from the CDC regarding who should be tested for COVID-19?

Updated July 17, 2020

According to the CDC, molecular diagnostic testing (eg, NAA, PCR) is appropriate for the following groups1:

  • Individuals with signs or symptoms consistent with COVID-19
  • Asymptomatic individuals with recent known or suspected exposure to SARS-CoV-2 to control transmission
  • Asymptomatic individuals without known or suspected exposure to SARS-CoV-2 for early identification in special settings
  • Individuals being tested to determine if infections have resolved
  • Individuals being testing for purposes of public health surveillance for SARS-CoV-2

Local and regional health authorities may provide additional guidance for prioritizing patients for COVID-19 testing. Clinicians are also encouraged to consider testing for other causes of respiratory illness, including influenza.

The environment surrounding COVID-19 testing is evolving rapidly. For the most up-to-date guidance, please visit the CDC’s Overview of Testing for SARS-CoV-2 page.

When is serology testing recommended?

Updated May 23, 2020

Antibody testing is not currently recommended to diagnose infection or to infer an individual’s immunity to the virus. It may aid in determining the rate of exposure in a given population. Antibody testing can also help identify individuals who have been exposed to SARS-CoV-2 in order to qualify potential convalescent plasma donors. COVID-19 convalescent plasma is currently being studied as a possible treatment for individuals who are critically ill with COVID-19 and as a prophylactic means of protecting individuals at high risk of exposure.2

How does COVID-19 affect children compared with adults?

Updated July 17, 2020

Based on available evidence, children do not appear to be at higher risk for COVID-19 than adults. Limited information is available about the spectrum of clinical illness related to COVID-19 in children, although they do appear to present with more mild signs and symptoms than adults.3 Although severe disease is uncommon, early case studies and reports suggest that infants may be at a higher risk for severe illness from COVID-19 compared with older children.3

The CDC is investigating reports of multisystem inflammatory syndrome in children (MIS-C), a serious condition marked by inflammation that may be related to resolved COVID-19 infection. At this time, there is limited information available about risk factors, pathogenesis, and clinical course. The CDC has issued a health advisory instructing clinicians to watch for signs and symptoms, which may include a persistent fever, elevated inflammatory markers, and multiorgan (eg, cardiac, gastrointestinal, renal) involvement.3

Do existing respiratory virus panels detect SARS-CoV-2?

Updated July 7, 2020

Yes, some multipathogen molecular assays can detect SARS-CoV-2.4

Clinicians are advised to confirm which respiratory viruses are detected by an assay before ordering it.

Which specimens are acceptable for COVID-19 molecular diagnostic testing? Which collection media is preferred?

Updated July 24, 2020

Nasopharyngeal (NP) specimens are preferred for swab-based COVID-19 diagnostic testing. If NP specimens are not available, an oropharyngeal (OP), midturbinate, or anterior nares specimen is acceptable.5,6

Detection rates in specimen types vary from patient to patient and may change over the course of the illness. For example, because of potentially discordant shedding of virus in the upper versus the lower respiratory tract, patients with pneumonia may have negative nasal or OP samples but positive lower airway samples.7,8

Swab specimens should be collected with NP ultrafine or equivalent swabs. Dacron, polyester-tipped, or any other flocked swabs are acceptable alternatives. Calcium alginate swabs or swabs with wooden shafts are NOT acceptable due to test interference. Viral transport media and universal transport media (VTM/UTM) are the preferred collection systems for swabs. Media types that are equivalent to VTM/UTM are also acceptable. For alternative transport media, refer to the FDA’s guidance on specimen collection for SARS-CoV-2 molecular diagnostic testing.6

Some laboratories may accept alternative specimen types; clinicians are advised to check with their performing laboratory for specific specimen requirements. There are limited data on how alternative specimen types affect test sensitivity, but evidence thus far suggests that specimens such as nasal swabs may be less sensitive than NP swabs.9

For the FDA’s full recommendations on specimen type and collection, refer to FAQs on Testing for SARS-CoV-2.

 
Decision Support Tools
Clinical Resources

Testing Guidance

COVID-19 Journal Article Publications

  • LitCOVID
    • A curated literature hub for tracking up-to-date scientific information, hosted by the NIH
References
  1. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). Overview of testing for SARS-CoV-2. [Updated: Jul 17, 2020; Accessed: Jul 27, 2020]
  2. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). Antibody testing interim guidelines. [Updated: May 23, 2020; Accessed: Jul 28, 2020]
  3. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). Healthcare workers: care for children. [Updated: Jul 17, 2020; Accessed: Jul 27, 2020]
  4. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). Healthcare workers: FAQs. [Updated: Jul 26, 2020; Accessed: Jul 28, 2020]
  5. Hanson KE, Caliendo AM, Arias CA, et al. Infectious Diseases Society of America guidelines on the diagnosis of COVID-19. [Published: May 6, 2020; Accessed: Jul 27, 2020]
  6. U.S. Department of Health and Human Services, Food and Drug Administration. FAQs on testing for SARS-CoV-2. [Last updated: Jul 24, 2020; Accessed: Jul 27, 2020]
  7. Patel R, Babady E, Theel ES, et al. Report from the American Society for Microbiology COVID-19 International Summit, 23 March 2020: value of diagnostic testing for SARS-CoV-2/COVID-19. mBio. 2020;11(2):e00722-20. PubMed
  8. National Institutes of Health. COVID-19 treatment guidelines: Laboratory diagnosis. [Updated: Apr 21, 2020; Accessed: Jul 27, 2020]
  9. Wang W, Xu Y, Gao R, et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA. 2020;323(18):1843-1844. PubMed