DHS Now Recommends Health Care Providers Test All Patients with Acute Respiratory Illness for COVID-19
Bureau of Communicable Diseases, April 16, 2020
- Health care providers are encouraged to obtain COVID-19 testing for all who are symptomatic, even patients with mild symptoms. This serves an important public health purpose in the next phase of Wisconsin’s COVID-19 response, which will require aggressive efforts for finding and isolating cases in the community.
- Clinicians must play a crucial role in the COVID-19 response if we hope to prevent future waves of infection. Widespread testing, coupled with high-intensity contact tracing, isolation and quarantine will require close partnership between clinicians and local public health agencies.
- Although overall laboratory capacity has increased significantly, not all health systems have equal access to reference laboratories with acceptable turnaround time. Some resources necessary for widespread testing remain limited in different regions of the state. DHS is actively working to help remedy these inequities.
DHS has been closely following trends in laboratory capacity for COVID-19 testing across the state. As of April 16, there is capacity to conduct approximately 7,500 specimens per day for COVID-19. This number exceeds the total number of patients who have been seeking medical care for respiratory illness each day during the current week, based on syndromic surveillance data. The State is also actively working to significantly increase testing capacity beyond current limits in the near future.
- current volume of COVID-19 testing being done in Wisconsin is substantially lower than the overall capacity, which likely reflects prioritization of testing for hospitalized patients during the early phase of the epidemic. At this time, overall laboratory capacity can support testing for many patients in outpatient settings who have symptoms suggestive of COVID-19, and there are important public health reasons for doing so.
Influenza has largely disappeared as a cause of acute respiratory illness in Wisconsin. Providers should therefore have a high index of suspicion that influenza-like illness may represent COVID-19, and have a low threshold for obtaining testing. In addition to the common presentations of fever, headache, cough, and shortness-of-breath, COVID-19 can also present as a mild, afebrile illness with symptoms including sore throat, myalgia and alterations in the sense of taste or smell.
Although overall testing capacity has increased, there is still regional variation in the availability of testing supplies, resulting in longer turn-around times in some settings. Not all health systems have current relationships with laboratories that are able to perform testing. While these inequities are addressed, providers should work with their local health systems to maintain a current understanding of what laboratories are accepting tests.
When local resource limitations necessitate prioritization of testing decisions, providers should refer to CDC Priorities for Testing Patients with Suspected COVID-19 Infection, which are summarized below. However, when adequate testing is locally available, all symptomatic patients should be tested.
Highest Priority: To ensure optimal care options for all hospitalized patients, lessen the risk of healthcare-associated infections, and maintain the integrity of the U.S. healthcare system
- Hospitalized patients
- Health care facility workers with symptoms
Second-Highest Priority: To ensure those at highest risk of complication of infection are rapidly identified and appropriately triaged
- Patients in long-term care facilities with symptoms
- Patients 65 years of age and older with symptoms
- Patients with underlying conditions with symptoms
- First responders with symptoms
Third-Highest Priority: To test individuals necessary for minimizing community spread, and ensure the health of essential workers
- Critical infrastructure workers with symptoms
- Individuals with symptoms who do not meet any of the above categories
Testing individuals without symptoms is not a priority in routine clinical settings. Testing of other individuals, including asymptomatic individuals identified in health care settings, congregate living settings, and workplaces may occur in limited settings as part of public health investigations and infection control interventions.
As a reminder, all suspected, probable, and laboratory-confirmed cases of COVID-19 are reportable conditions in Wisconsin. Electronic reporting via WEDSS is the preferred mechanism for reporting cases to local public health departments. Reporting this information via WEDSS is crucial to coordinating an effective response statewide. The Patient Information Form should be used to report all suspected cases at the time of testing AND should also be used to report probable cases who are diagnosed based on symptoms and exposure to other confirmed cases. This form contains information about which specimens are eligible for fee-exempt testing at the Wisconsin State Laboratory of Hygiene and the Milwaukee Health Department Laboratory.
We at DHS are grateful to all health care partners for their support of Wisconsin residents during this epidemic.
Ryan Westergaard, MD, PhD, MPH
Chief Medical Officer and State Epidemiologist for Communicable Diseases
Wisconsin Department of Health Services
About the COVID-19 Health Alert Network
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IC246 Last Updated 4/17/20