Central District Health Announces Updated Prioritization of Specimens at IBL, Serologic Testing Information, and Waste Handling Guidelines

On 3/24, the Centers for Disease Control and Prevention (CDC) updated guidance for clinicians on evaluating and testing persons for COVID-19, to include prioritization of groups for testing, and guidance on collecting specimens for COVID-19 testing to allow for use of nasal swabs and self-collection of nasal swabs.

Prioritization of Specimens for Testing at Idaho Bureau of Labs (IBL)
IBL’s priority is to maintain a 24-hour turnaround time for SARS-CoV-2 testing of hospitalized patients. This prioritization may be revised if turnaround time for hospitalized patients cannot be maintained.

IBL will accept specimens for testing for SARS-CoV-2 (the virus that causes COVID-19) on CDC priority categories with either high or routine priority testing at IBL as outlined below. Please notify public health officials prior to specimen submission. Failure to notify public health will lead to delays in testing. Call Central District Health at (208) 327-8625, fax specimen submission reporting form to 208-327-7100 or call the Division of Public Health Epidemiology Section at (208) 334-5939.

IBL High Priority Specimens
(includes all in CDC priority 1, select groups in CDC priority 2, and Idaho public health priority groups)

• Hospitalized patients
• Symptomatic healthcare workers
• Symptomatic patients in long-term care facilities or other congregate living facility
• Severe respiratory illness of no known cause
• Symptomatic staff or inmate in correctional facility in the absence of an identified
  COVID-19 outbreak in the facility
  
  IBL Routine Priority Specimens
  (Remaining CDC priority group 2)
• Symptomatic patients ≥ 65 years of age
• Symptomatic patients who are at high risk of severe disease because of
  underlying medical conditions
• Symptomatic first responders
  

Specimens from patients in CDC priority group 3 should be sent to commercial laboratories. Asymptomatic persons should not be tested.

Specimen Collection and Submission
Either nasopharyngeal (NP) swab specimens or nasal swab (NS) specimens may be tested at IBL. NP swabs are preferred.

Nasal Swabs
Use only synthetic fiber swabs to sample both anterior nares. Do not use cotton swabs, swabs with wood shafts, or swabs with calcium alginate. Specimens may be collected by healthcare professional or self-collected. Oral swabs may be used; NP swab shaft length and flexibility are not desirable. See https://www.youtube.com/watch?v=2cd4gg975ao from the Joint Commission and CDC for nasal swab collection video.

Transport Media
The volume of transport media required is 1 to 3 mls. Laboratories may aliquot media as needed. For specimens submitted to IBL, viral transport medium, Amies transport medium, or sterile saline may be used.

Clinical Test Request Form
Specimens must be accompanied by a completed IBL clinical test request form

Many forms are being submitted with blank Onset Date and Collection Date fields. Both dates are being used to prioritize samples. Samples without these dates completed are processed last. To ensure timely and appropriate notification, the patient city or county must be provided.

Without complete information, laboratorians, epidemiologists, and infection preventionists are losing valuable time tracking down the appropriate jurisdiction for public health intervention. Please help your colleagues by completing all the requested information on the clinical test request form for specimen submissions to IBL.

Serologic Testing for SARS-CoV-2
CDH has been made aware of serologic testing being made available for SARS CoV-2. This testing has not been FDA approved for diagnostic purposes. CDH will not conduct epidemiological investigations on patients having serology as their sole means of testing and these patients will not be included in official COVID-19 case counts.

COVID-19 Waste Handling
Idaho Department of Environmental Quality (DEQ) has advised that PPE from healthcare facilities caring for confirmed or suspected COVID-19 patients should be managed as medical waste. Please refer to DEQ’s COVID-19 Waste Website for more information https://www.deq.idaho.gov/waste mgmt-remediation/solid-waste/covid-19-wastes/