Updated November 23, 2020

Laboratory testing is the only way to distinguish between infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other infections with similar symptoms. Furthermore, laboratory testing is the only way to determine cases of viral coinfection.¹ Patients may be infected with multiple viruses at the same time, so diagnosis of infection with one respiratory virus does not exclude the possibility of infection with another virus.^2,3 The National Institutes of Health (NIH) recommends cotesting to determine proper medical management if multiple viruses (eg, SARS-CoV-2, respiratory syncytial virus (RSV), and influenza A/B) are circulating, such as during flu season.^1,3

Updated September 14, 2020

Viral testing for SARS-CoV-2 infection may 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). Nucleic acid amplification (NAA) testing is the gold standard for detection of SARS-CoV-2 virus.^4,5

Updated November 23, 2020

Yes. Some multipathogen molecular assays can detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).² For example, ARUP offers a multipathogen assay that detects and differentiates COVID-19, influenza A/B, and respiratory syncytial virus (RSV). Clinicians are advised to confirm which respiratory viruses are detected by an assay before ordering. The U.S. Food and Drug Administration (FDA) maintains a list of COVID-19 assays with Emergency Use Authorization (EUA) that includes respiratory virus panels.

Updated September 14, 2020

According to the CDC, viral detection testing (eg, NAA, antigen testing) is recommended for⁴:

• Individuals with signs or symptoms consistent with COVID-19
• Individuals who work or reside in a nursing home or long-term care facility
• Critical infrastructure workers, health care workers, or first responders (in accordance with employer guidelines)

Diagnostic testing for asymptomatic individuals with known or suspected recent exposure to SARS-CoV-2 may also be advised.⁴

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.

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.⁶

Updated September 14, 2020

Children of all ages are at risk for COVID-19 infection, but there are relatively fewer cases of COVID-19 among children compared with adults. Children appear to present with more mild signs and symptoms than adults.⁷ Although severe disease is uncommon, children are still at risk of developing severe illness and complications from COVID-19. Early case studies and reports suggest that infants may be at a higher risk for severe illness from COVID-19 when compared with older children.⁷

It is unclear whether children are as susceptible to SARS-CoV-2 infection compared with adults. Children can transmit the virus, but data are limited as to whether they can transmit the virus as effectively as adults. Recent studies have suggested that young children (those younger than 5 years) have higher viral loads in their nasopharynxes as compared with adults⁸ and that children can spread the virus effectively in households and camp settings.⁹

Due to early community mitigation efforts and school closures, transmission of SARS-CoV-2 to and among children may have been reduced in the U.S. during the pandemic in the spring and early summer of 2020. It is possible that comparing trends in pediatric infections before and after the return to in-person school and other activities may provide additional understanding about infections in children.

Updated September 14, 2020

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.⁷ For more information, refer to the CDC’s case definition for MIS-C.

Updated November 23, 2020

Nasopharyngeal (NP) specimens are the gold standard for COVID-19 viral detection. Some laboratories may accept alternative specimen types such as saliva, oropharyngeal (OP) swabs, midturbinate swabs, or anterior nares swabs.^5,10 Clinicians are advised to check with their performing laboratory for specific specimen requirements.

Recent studies, including one performed by researchers at ARUP and University of Utah Health,¹¹ found that self-collected saliva and NP swabs collected by healthcare providers are equally effective for SARS-CoV-2 detection. Both saliva and NP swabs are superior to anterior nasal swabs. The study, published in the Journal of Clinical Microbiology, represents one of the largest COVID specimen-type comparisons to date.¹¹ However, saliva specimens are not suitable for all tests that detect SARS-CoV-2 (eg, ARUP’s multipathogen assay that detects and differentiates COVID-19, influenza A/B, and respiratory syncytial virus [RSV]).

Detection rates in specimen types vary from patient to patient and may change over the course of the illness.¹² 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.^13,14

Point-of-care antibody tests use fingerstick whole blood samples. Serum or plasma specimens are generally required for antibody tests that are analyzed in a laboratory.⁶

Updated September 14, 2020

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.

Saliva specimens are self-collected in ARUP’s saliva collection tubes. This method reduces healthcare providers’ risk of exposure during the collection process. The patient should not eat or drink for 30 minutes prior to providing a saliva sample. Saliva should not surpass the fill line on the tube. Saliva specimens must be collected in the presence of a healthcare provider.

For more information, refer to ARUP’s COVID-19 Specimen Collection Guide. For alternative transport media, refer to the FDA’s guidance on specimen collection for SARS-CoV-2 molecular diagnostic testing.¹⁰