Coronavirus Disease 2019 (COVID-19)

Resources for Clinicians and Your Patients


Page updated September 14, 2020Linkedin Email

Nucleic acid amplification (NAA) testing on saliva specimens is now available. Learn more.

 

 

SARS-CoV-2, the virus that causes COVID-19, continues to spread in the United States and many other countries, straining the capacity of healthcare systems in some states to treat patients with the infection. Older adults remain most at risk for hospitalization due to severe COVID-19 disease, but younger individuals are more responsible for the spread of infection than they were in the winter and spring of 2020.

Viral detection testing is recommended for COVID-19 diagnosis. Testing decisions should be based on local epidemiology, clinical signs and symptoms, and the course of illness. Antibody testing can be used to evaluate exposure to SARS-CoV-2, but is not recommended for diagnosis of acute illness.

 

Quick Answers for Clinicians

In which scenarios is viral detection testing (eg, nucleic acid amplification [NAA], polymerase chain reaction [PCR], antigen testing) recommended?

Updated September 14, 2020

Viral testing for SARS-CoV-2 infection may be used for diagnostic purposes (eg, when testing individuals with symptoms consistent with COVID-19), screening purposes (eg, when testing asymptomatic individuals with known or suspected recent exposure to SARS-CoV-2), and surveillance purposes (eg, when testing asymptomatic individuals to detect transmission hot spots or characterize disease trends). Nucleic acid amplification (NAA) testing is the gold standard for detection of SARS-CoV-2 virus.1,2

What is the latest guidance from the CDC regarding who should be tested for COVID-19?

Updated September 14, 2020

According to the CDC, viral detection testing (eg, NAA, antigen testing) is recommended for1:

  • Individuals with signs or symptoms consistent with COVID-19
  • Individuals who work or reside in a nursing home or long-term care facility
  • Critical infrastructure workers, health care workers, or first responders (in accordance with employer guidelines)

Diagnostic testing for asymptomatic individuals with known or suspected recent exposure to SARS-CoV-2 may also be advised.1

Local and regional health authorities may provide additional guidance for prioritizing patients for COVID-19 testing. Clinicians are also encouraged to consider testing for other causes of respiratory illness, including influenza.

When is serology testing recommended?

Updated May 23, 2020

Antibody testing is not currently recommended to diagnose infection or to infer an individual’s immunity to the virus. It may aid in determining the rate of exposure in a given population. Antibody testing can also help identify individuals who have been exposed to SARS-CoV-2 in order to qualify potential convalescent plasma donors. COVID-19 convalescent plasma is currently being studied as a possible treatment for individuals who are critically ill with COVID-19 and as a prophylactic means of protecting individuals at high risk of exposure.3

How does COVID-19 affect children compared with adults?

Updated September 14, 2020

Children of all ages are at risk for COVID-19 infection, but there are relatively fewer cases of COVID-19 among children compared with adults. Children appear to present with more mild signs and symptoms than adults.4 Although severe disease is uncommon, children are still at risk of developing severe illness and complications from COVID-19. Early case studies and reports suggest that infants may be at a higher risk for severe illness from COVID-19 when compared with older children.4

It is unclear whether children are as susceptible to SARS-CoV-2 infection compared with adults. Children can transmit the virus, but data are limited as to whether they can transmit the virus as effectively as adults. Recent studies have suggested that young children (those younger than 5 years) have higher viral loads in their nasopharynxes as compared with adults5 and that children can spread the virus effectively in households and camp settings.6

Due to early community mitigation efforts and school closures, transmission of SARS-CoV-2 to and among children may have been reduced in the U.S during the pandemic in the spring and early summer of 2020. It is possible that comparing trends in pediatric infections before and after the return to in-person school and other activities may provide additional understanding about infections in children.

What is multisystem inflammatory syndrome in children (MIS-C), and how is it related to COVID-19?

Updated September 14, 2020

The CDC is investigating reports of multisystem inflammatory syndrome in children (MIS-C), a serious condition marked by inflammation that may be related to resolved COVID-19 infection.

At this time, there is limited information available about risk factors, pathogenesis, and clinical course. The CDC has issued a health advisory instructing clinicians to watch for signs and symptoms, which may include a persistent fever, elevated inflammatory markers, and multiorgan (eg, cardiac, gastrointestinal, renal) involvement.4 For more information, refer to the CDC’s case definition for MIS-C.

Do existing respiratory virus panels detect SARS-CoV-2?

Updated September 14, 2020

Yes, some multipathogen molecular assays can detect SARS-CoV-2.7

Clinicians are advised to confirm which respiratory viruses are detected by an assay before ordering it. The FDA maintains a list of COVID-19 assays that have received Emergency Use Authorization.

Which specimens are acceptable for COVID-19 molecular viral detection testing?

Updated September 14, 2020

Nasopharyngeal (NP) specimens are the gold standard for COVID-19 viral detection. Some laboratories may accept alternative specimen types such as saliva, oropharyngeal (OP) swabs, midturbinate swabs, or anterior nares swabs.2,8 Clinicians are advised to check with their performing laboratory for specific specimen requirements.

Recent studies, including one performed by researchers at ARUP and University of Utah Health,9 found that self-collected saliva and NP swabs collected by healthcare providers are equally effective for SARS-CoV-2 detection. Both saliva and NP swabs are superior to anterior nasal swabs. The study, published in the Journal of Clinical Microbiology, represents one of the largest COVID specimen-type comparisons to date.9

Detection rates in specimen types vary from patient to patient and may change over the course of the illness.10 For example, because of potentially discordant shedding of virus in the upper versus the lower respiratory tract, patients with pneumonia may have negative nasal or OP samples but positive lower airway samples.11,12

Point-of-care antibody tests use fingerstick whole blood samples. Serum or plasma specimens are generally required for antibody tests that are analyzed in a laboratory.3

Which collection media is preferred for COVID-19 respiratory samples?
Which collection media is preferred for saliva specimens?

Updated September 14, 2020

Swab specimens should be collected with NP ultrafine or equivalent swabs. Dacron, polyester-tipped, or any other flocked swabs are acceptable alternatives. Calcium alginate swabs or swabs with wooden shafts are NOT acceptable due to test interference. Viral transport media and universal transport media (VTM/UTM) are the preferred collection systems for swabs. Media types that are equivalent to VTM/UTM are also acceptable.

Saliva specimens are self-collected in ARUP’s saliva collection tubes. This method reduces healthcare providers’ risk of exposure during the collection process. Saliva specimens must be collected in the presence of a healthcare provider.

For more information, refer to ARUP’s COVID-19 Specimen Collection Guide. For alternative transport media, refer to the FDA’s guidance on specimen collection for SARS-CoV-2 molecular diagnostic testing.8

 
Decision Support Tools
Clinical Resources

Testing Guidance

COVID-19 Journal Article Publications

  • LitCOVID
    • A curated literature hub for tracking up-to-date scientific information, hosted by the NIH
References
  1. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). Overview of testing for SARS-CoV-2. [Updated: Aug 24, 2020; Accessed: Sep 9, 2020]
  2. Hanson KE, Caliendo AM, Arias CA, et al. Infectious Diseases Society of America guidelines on the diagnosis of COVID-19. [Published: May 6, 2020; Accessed: Sep 9, 2020]
  3. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). Interim guidelines for COVID-19 antibody testing. [Updated: Aug 1, 2020; Accessed: Sep 9, 2020]
  4. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). Healthcare workers: information for pediatric healthcare providers. [Updated: Aug 19, 2020; Accessed: Sep 9, 2020]
  5. Heald-Sargent T, Muller J, Zheng X, et al. Age-related differences in nasopharyngeal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) levels in patients with mild to moderate coronavirus disease 2019 (COVID-19). JAMA. [Published online ahead of print, Jul 30, 2020] PubMed
  6. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. SARS-CoV-2 transmission and infection among attendees of an overnight camp – Georgia, June 2020. MMWR. 69(31);1023-1025.
  7. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). Healthcare workers: clinical questions about COVID-19: questions and answers. [Updated: Aug 4, 2020; Accessed: Sep 9, 2020]
  8. U.S. Department of Health and Human Services, Food and Drug Administration. FAQs on testing for SARS-CoV-2. [Last updated: Sep 9, 2020; Accessed: Sep 9, 2020]
  9. Hanson KE, Barker AP, Hillyard DR, et al. Self-collected anterior nasal and saliva specimens versus healthcare worked-collected nasopharyngeal swabs for the molecular detection of SARS-CoV-2. J Clin Microbiol. [Published online ahead of print, Aug 12, 2020]. PubMed
  10. Wang W, Xu Y, Gao R, et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA. 2020;323(18):1843-1844. PubMed
  11. Patel R, Babady E, Theel ES, et al. Report from the American Society for Microbiology COVID-19 International Summit, 23 March 2020: value of diagnostic testing for SARS-CoV-2/COVID-19. mBio. 2020;11(2):e00722-20. PubMed
  12. National Institutes of Health. COVID-19 treatment guidelines: laboratory diagnosis. [Updated: Apr 21, 2020; Accessed: Sep 9, 2020]