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Analysis

4-Tier Prioritization for Coronavirus Testing Recommended

By Christopher Cheney  
   March 20, 2020

Despite widespread calls to increase U.S. novel coronavirus testing, the tests have been in limited supply since January.

The Infectious Diseases Society of America (IDSA) has issued recommendations for prioritizing novel coronavirus (COVID-19) testing.

COVID-19 tests have been in limited supply since the first U.S. novel coronavirus patient was identified in January. As of March 20, 14,372 cases had been confirmed in the United States, with 217 deaths, worldometer reported.

Public health officials and healthcare providers should prioritize who is tested for COVID-19 for as long as the test shortage persists, the IDSA recommendations say. "Given current limited availability of near-patient, or point-of-care, testing, IDSA has developed recommendations for diagnostic testing prioritization. These recommendations will likely change as testing becomes more widely available or as new information becomes available. IDSA continues to advocate for policies and investments to expand capacity to testing."

The IDSA is recommending a 4-tier approach to prioritize COVID-19 testing for patients, officials, and members of the general public.

Tier 1

There are five categories of people recommended for the highest priority testing:

  • Any hospitalized patients who are critically ill and receiving ICU-level care with unexplained viral pneumonia or respiratory failure
     
  • Anyone with fever and signs of a lower respiratory tract illness who has had close contact with a confirmed COVID-19 patient within 14 days of symptom onset
     
  • Anyone with fever and signs of a lower respiratory tract illness who has traveled within 14 days of symptom onset to countries or areas of the United States that have experienced sustained community transmission of novel coronavirus
     
  • Anyone with fever and signs of a lower respiratory tract illness who is immunosuppressed, elderly, or has underlying chronic health conditions
     
  • Individuals who are critical to pandemic response such as health workers and public health officials who have fever and signs of a lower respiratory tract illness

Tier 2

People at the second highest priority for testing are hospitalized patients and long-term care residents who have unexplained fever and signs of lower respiratory illness. "The number of confirmed COVID-19 cases in the community should be considered. As testing becomes more widely available, routine testing of hospitalized patients may be important for infection prevention and management at discharge," the recommendations say.

Tier 3

Patients in outpatient settings who meet influenza testing criteria, including people with co-morbid conditions such as diabetes and congestive heart failure as well as individuals over age 50. "Given limited available data, testing of pregnant women and symptomatic children with similar risk factors for complications is encouraged. The number of confirmed COVID-19 cases in the community should be considered," the recommendations say.

Tier 4

People targeted for community surveillance by public health or infectious disease officials.

Photo credit: Lev Radin/Shutterstock.com

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

There are five categories of people recommended for the highest priority testing, including patients receiving ICU-level care with unexplained viral pneumonia or respiratory failure.

People at the second highest priority for testing are hospitalized patients and long-term care residents who have unexplained fever and signs of lower respiratory illness.

People at the third highest priority for testing are patients in outpatient settings who meet influenza testing criteria.


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