Update on 3/11/20 – Testing Patients for COVID-19
Disclaimer:  The situation with COVID-19 is changing constantly so information and testing may change at any time.
 
[Testing will not be performed at Eastern Idaho Public Health (EIPH) nor will EIPH supply testing materials.]
 
Situation Overview
Commercial laboratories have now begun testing for COVID-19.  Criteria to guide testing of patients for COVID-19 have been expanded to a wider group of symptomatic patients. See https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html.
 
 
Recommendations for Healthcare Providers
Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested.  Clinicians are strongly encouraged to test for other causes of respiratory illness, including infections such as influenza before seeking COVID-19 testing.  Most patients with confirmed COVID-19 have developed fever and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing).

Commercial Testing Capability
Commercial laboratories have begun offering testing for COVID-19 . These commercial tests do not require public health notification prior to testing. Please contact your local laboratory of choice for specific information ( i.e. process, price, turn around, etc). Positive results will need to be reported to public health officials, who will contact patients and may contact providers.

Idaho Bureau of Labs testing
If you would like the Idaho Bureau of Laboratories to test a specimen, please contact Eastern Idaho Public Health at 208-533-3152 for priority assignment. Testing at Idaho Bureau of Laboratories (IBL) is not offered for asymptomatic people. 
 
Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested.  Clinicians are strongly encouraged to test for other causes of respiratory illness, including infections such as influenza before seeking COVID-19 testing.  Most patients with confirmed COVID-19 have developed fever and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing).  Patients with mild respiratory symptoms do not meet High Priority Testing criteria as outlined below. 
 
To test specimens for COVID-19 at the IBL, notify public health officials.
Please call EIPH at 208-533-3152 and choose the option for COVID-19 information.  If unable to speak with EIPH staff, call Bureau of Communicable Disease (BCDP) at 208-334-5939 during work hours.  If after business hours, please call State Communications at 800-632-8000 for assistance with COVID-19 testing.  Turnaround time for test results will be variable based on volume of testing and prioritization since High Priority Testing will have preference at IBL. 
 
 
High Priority Testing
 
Patient has cold-like or flu-like respiratory symptoms
 
AND any of the following criteria
 
1.      Patient has contact with a lab confirmed case of COVID-19*
 
2.      Patient has traveled to an area or country with widespread community spread of COVID-19**
 
3.      Hospitalized patients with severe acute respiratory illness and all other possibilities have been ruled out
 
4.      Are healthcare workers
 
5.      Are long-term care facility residents with negative influenza testing results
 
 
*If a patient has contact with a lab confirmed case, EIPH will need the name, date of birth, and address of lab confirmed case to verify with state or country where lab testing was performed.
 
**Countries with widespread community spread of COVID-19 will have travel advisories from the Centers for Disease Control (CDC) of level 2 or higher which can be found at https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html
 
The following is a step-by-step process for Collecting, Handling, and Shipping Specimens for COVID-19 testing
 
1.      Collecting Samples
 
a.      At a minimum, collect Nasopharyngeal swab AND oropharyngeal swab (NP/OP swab) by using only synthetic fiber swabs with plastic shafts. Do not use calcium alginate swabs or swabs with wooden shafts, as they may contain substances that inactivate some viruses and inhibit PCR testing. New!! Place both swabs immediately into one sterile tube containing 2-3 ml of viral transport media. NP and OP specimens should be kept in separate vials. Refrigerate specimen at 2-8°C and ship overnight to Idaho Bureau of Laboratories on ice pack.
 
                                     i.      Nasopharyngeal swab: Insert a swab into the nostril parallel to the palate. Leave the swab in place for a few seconds to absorb secretions.
 
                                     ii.      Oropharyngeal swab (e.g., throat swab): Swab the posterior pharynx, avoiding the tongue.
 
b.      If possible for patients with productive coughs, collect a Sputum sample.  Induction of sputum is not recommended.  Have the patient rinse the mouth with water and then expectorate deep cough sputum directly into a sterile, leak-proof, screw-cap sputum collection cup or sterile dry container. Refrigerate specimen at 2-8°C and ship overnight to Idaho Bureau of Laboratories on ice pack.
 
c.       If patient is hospitalized and a Bronchoalveolar lavage, tracheal aspirate can be collected safely, collect 2-3 mL into a sterile, leak-proof, screw-cap sputum collection cup or sterile dry container. Refrigerate specimen at 2-8°C and ship overnight to Idaho Bureau of Laboratories on ice pack.
 
2.      Packing, Shipping and Transport
 
a.      Complete the Clinical Test Request Form at  https://healthandwelfare.idaho.gov/Portals/0/Health/Labs/Clinical_Test_Request_Form.pdf     for each specimen submitted.  In the Virology section of the form, under PCR select “Other” and write in “COVID-19.”
 
b.      Packaging, shipping, and transport of specimens from suspect cases of COVID-19 must follow the current edition of the International Air Transport Association (IATA) Dangerous Goods. Follow shipping regulations for UN 3373 Biological Substance, Category B when sending potential COVID-19 patient specimens.
 
c.       Samples need to get to the lab before noon to be tested that day.  Send samples overnight, next business morning to:
 
Idaho Bureau of Laboratories
2220 Old Penitentiary Road
Boise, ID  83712
 
d.      If you have any questions on sampling or shipping COVID-19 samples, please call the Idaho Bureau of Laboratories at 208-334-2235.