LAC DPH Health Advisory: COVID-19 Clinical Laboratory Testing

The Los Angeles County Department of Public Health (LAC DPH) issued a health advisory on March 6, 2020 that includes updates on the availability of COVID-19 testing, personal protective equipment (PPE), reporting and exposure monitoring.

 

Situation

LAC DPH has recently confirmed 4 new cases of COVID-19 bringing the new total to 11 confirmed cases in Los Angeles County. All confirmed cases are being isolated and close contacts will be quarantined. Currently, LAC DPH is publishing new cases on the press release section of the LAC DPH coronavirus website.

Healthcare providers and laboratories must report all positive COVID-19 laboratory results from clinical laboratories to LAC DPH (See Reporting). Clinical laboratories have announced COVID-19 testing is now or will soon be available, thus expanding testing to a wider group of symptomatic patients.

 

COVID-19 Testing

Yesterday afternoon, LabCorp announced that that their novel coronavirus (COVID-19), nucleic acid amplification (NAA) test is now available for ordering by healthcare providers. Quest Laboratory intends to provide testing for COVID-19 as soon as Monday, March 9. 

The LabCorp COVID-19 test is for provider-collected specimens (nasopharyngeal swab in viral transport medium, bronchial washings or bronchoalveloar lavage specimens) from symptomatic patients who meet current CDC clinical criteria. 

Healthcare providers should continue to contact Los Angeles County Department of Public Health (LAC DPH) to arrange for COVID-19 testing for those patients meeting the LAC DPH PHL COVID-19 testing criteria as these are high risk patients and need a rapid public health response if confirmed to be infected.

As this expands the opportunity for testing to broader settings including outpatient, it is critical that healthcare workers wear appropriate PPE for specimen collection. Healthcare workers must wear PPE that is appropriate for the mode of COVID-19 specimen collection. High risk aerosol generating procedures require a higher level of PPE than do nasopharyngeal and oropharyngeal sampling. 

 

Cost-Sharing

In addition, yesterday Governor Gavin Newsom directed all commercial and Medi-Cal health plans to immediately reduce cost-sharing to zero for all medically necessary screening and testing for the COVID-19 in the All Plan Letter. 

This includes waiving cost-sharing for emergency room, urgent care, or provider office visits when the purpose of the visit is to be screened and tested for COVID-19. 

 

Actions Requested of Providers

Screen patients for any signs or symptoms of febrile respiratory illness. If present, healthcare workers should don surgical masks. The patient should be instructed to wear a surgical mask and be placed in a private room with the door closed or separated from others by at least 6 feet.

Implement infection control precautions for patient interview and exam:

• Patient should be in a private room with the door closed and should continue to wear the surgical mask though all healthcare worker encounters.
• Healthcare providers should wear a surgical mask, gloves, and eye protection for the history and basic exam. A gown is recommended.

 

Determine if the patient has signs and symptoms compatible with COVID-19. Follow the LAC DPH Provider Checklist: Evaluating Patients Who May Have COVID-19.

• If the patient meets the LAC DPH Public Health Laboratory (PHL) testing criteria, contact LAC DPH to approve testing and arrange for courier. Weekdays 8:30am–5pm: call 213-240-7941. After-hours: call 213-974-1234 and ask for the physician on call.
• If the patient does not meet PHL testing criteria but has signs and symptoms compatible with COVID-19 per CDC clinical criteria, specimens can be collected and submitted to the appropriate clinical laboratory with COVID-19 testing capability. Follow the clinical laboratory guidance for appropriate specimen collection and pick-up.
• Healthcare workers must wear the appropriate PPE for the mode of COVID-19 specimen collection (see PPE for Specimen Collection).

 

Instruct non-hospitalized patients being tested for COVID-19 to self-isolate. Patients should follow home care instructions until their test result is negative or until they are told by LAC DPH or their healthcare provider that they are no longer infectious.

Report any positive COVID-19 results received from clinical laboratories.