Testing for 2019 Novel Coronavirus: Recommendations for Orange County Providers
March 27, 2020
Orange County has now had over 300 cases of 2019 Novel Coronavirus (COVID-19) reported. There has been a rapid increase in daily reports of COVID-19 cases over the last several days and community transmission is becoming more widespread.  
Key Testing Recommendations For Providers
  • COVID-19 testing should be performed for persons who have significant respiratory illness requiring hospitalization, or belong to other populations prioritized for testing (see below); testing of non-priority populations can be performed based on provider discretion and available resources.
  • Patients who have mild illness and do not belong to a high priority population do not need to be tested.
  • OCHCA can assist with testing hospitalized patients, symptomatic healthcare workers and symptomatic residents/staff of long term care facilities.
  • OCHCA’s Public Health Laboratory (PHL) is currently operating seven days a week and can generally provide results in 24-48 hours. Providers may consider submitting NP specimens for PCR testing from hospitalized patients to OCHCA PHL if the patient is seriously ill and/or being considered for a COVID-19 drug trial.
  • When using Quest Laboratory for testing, providers are recommended to choose Test 39444 for COVID-19. Quest performs other PCR tests, but they confer no clinical advantage and take longer to result.
  • Quest and LabCorp are consistently reporting laboratory positive results to OCHCA. Providers do not need to report confirmed cases tested through these laboratories unless they belong to the priority populations below.  
  • Given current limitations in testing capacity, OCHCA does not recommend testing asymptomatic persons regardless of potential or documented COVID-19 exposure.
  • Area hospitals are experiencing a surge in admissions due to suspect and confirmed COVID-19 cases. In this setting, patients who are clinically stable for discharge do not need to remain hospitalized pending COVID-19 testing results. These patients may be discharged with results pending, including to skilled nursing facilities. Appropriate infection control precautions should be taken at the receiving facility pending results.
  • OCHCA has received multiple reports of physicians prescribing hydroxychloroquine to treat outpatients with COVID-19. While trials are ongoing, there are no currently available data from randomized clinical trials to inform clinical guidance on the use, dosing, or duration of hydroxychloroquine for prophylaxis or treatment of SARS-CoV-2 infection. Hydroxychloroquine has potential toxicities and its routine use for outpatient COVID-19 illness is not recommended.
Priority Populations for COVID-19 Testing
The CDC has released new testing priority recommendations. Given limited testing capacity, OCHCA recommends that testing be prioritized to CDC-defined Priority One groups, which includes any hospitalized patients and symptomatic health care workers; additionally, OCHCA is conducting outreach to assist with testing patients in long-term care facilities with symptoms. Providers should consider testing other patients according to CDC’s priority groups and testing availability. CDC's priority guidance can be found at https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html.
Education for Patients with Fever and Cough Who Do Not Belong to a Priority Testing Population
Patients with fever and cough who have mild disease, are not in a priority group or are at high risk for complications do not need COVID-19 testing. They should be instructed to isolate at home as if a confirmed case (see below) and to seek healthcare evaluation if they develop dyspnea or other symptoms of severe disease.
Education for Patients with Confirmed COVID-19
At this point the Orange County Health Care Agency (OCHCA) will only be conducting investigations of cases identified in hospitalized patients, health care workers, and residents of congregate living facilities. Providers should inform their patients of test results and give them education on disease prevention and monitoring for worsening disease (see below for more details). Providers should inform their outpatients who test positive of their results and deliver the following messages:
  • Duration of isolation: self-isolate for at least 7 days after illness onset; must have no fever (without use of antipyretics) for at least 72 hours AND have symptom improvement to be released from isolation. Clearance testing is no longer recommended. Instruct patient to not leave the house during this time, except for urgently needed medical care (call ahead to alert facility of COVID+ status); have friends or family members run errands as needed.
  • Prevent transmission in the household: separate from family members as much as possible; stay in a separate bedroom and use a separate bathroom, have meals delivered to the bedroom and do not spend time in same room as family members without a mask. Open windows (weather permitting) to increase ventilation. Do not allow visitors to come into the home. 
  • Monitor for severe disease: warning signs of more severe disease include shortness of breath, chest pain, weakness and confusion. Clinical decompensation tends to occur in second or third week of illness. Help patient decide where he/she would go for further evaluation if needed. 
  • Management of household members: household members with close contact to the patient while symptomatic should be quarantined at home for 10 days beyond last unprotected contact with patient (i.e, since admission to hospital or separation into a different room). People on quarantine can leave the house on errands to get food, medicines or other essentials, or to exercise, but should avoid close contact with others as much as possible. They also should monitor themselves for fever, cough, body aches or other symptoms, and isolate themselves if such symptoms occur.
  • Inform contacts: ask patients to notify people they have had prolonged close contact with while they were having symptoms.
Case numbers are updated daily on our website: https://www.ochealthinfo.com/novelcoronavirus

Contact Information:
For questions or concerns, please contact the Communicable Disease Control Division at 714-834-8180. Please note that this number is now operational 24/7 for providers.
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