Bureau of Communicable Diseases, July 1, 2020
- The Wisconsin Department of Health Services (DHS) has revised recommendations for who should get tested for COVID-19. Testing is recommended for the following groups:
- Individuals experiencing any symptoms of COVID-19, which are listed below
- Individuals who have been in close contact with a person with COVID-19, regardless of symptoms
- Asymptomatic individuals who have been instructed by a public health agency or a health care provider to get a COVID-19 test for the purpose of preventing the spread of infection
The COVID-19 pandemic is entering a concerning new phase in the United States. There are large surges of disease in many areas of the country. In Wisconsin, there has been a dramatic shift in the epidemiology of COVID-19. The proportion of confirmed cases among young adults under 30 has more than doubled, meaning that a larger share of infected people are expected to have minimal or no symptoms. In response, public health and health care partners must work harder to find cases and implement local containment strategies.
Widespread testing and contact tracing is most effective when done at levels that identify disease transmission and trends, and encourages isolation and quarantine to reduce disease spread in the community. The overall testing strategy must take into account available testing capacity and resources, which may be insufficient to achieve the ideal level of COVID-19 testing in some settings. Therefore, the State of Wisconsin recommends testing populations and settings where disease identification is most likely to promote proper and timely intervention to limit the spread of COVID-19.
The following table outlines recommendations for who should receive COVID-19 testing in Wisconsin:
Table 1: COVID-19 Testing Recommendations
|Wisconsin residents are recommended to receive COVID-19 testing if they fall into any of the four categories:|
|1. People who have recently developed any one or more of the following symptoms:
||2. People who have been in close contact of a person with COVID-19, regardless of symptoms|
|3. People who have been instructed by a public health agency to get a COVID-19 test as part of a public health investigation, regardless of symptoms
Scenarios in which public health agencies may recommend testing for asymptomatic people include the following:
3.1 Investigation of outbreaks, such as multiple cases in a workplace, residential facility or correctional facility
3.2 Testing all residents and staff in high-risk congregate facilities to prevent or contain outbreaks
3.3 When testing is needed to contain an epidemic in a community with high-level transmission, and resources are sufficient for appropriate follow-up and case investigation, as determined in partnership with state and local health officials†
|4. People who have been instructed by a health care provider to get a COVID-19 test for the purpose of infection control, regardless of symptoms
Scenarios in which health care providers may recommend testing for asymptomatic people include the following:
4.1 As part of a test-based strategy to inform return-to-work decisions for individuals diagnosed with COVID-19
4.2 Outbreak investigations in health care settings, to understand prevalence among staff and patients
4.3 Screening before aerosol generating procedures, such as endoscopy, dentistry, or procedures requiring intubation
†Considerations for when routine testing of asymptomatic community members is appropriate may be based on a combination of factors, including high percent test positivity, the presence of multiple unrelated transmission clusters, the availability of laboratory capacity with acceptable turnaround time, and a data infrastructure in the local jurisdiction to ensure timely communication of test results.
When local resources permit, health care providers are encouraged to obtain testing for household members and other close contacts of patients with confirmed COVID-19. Proactive testing of asymptomatic close contacts of known COVID-19 cases serves an important preventive health function, by allowing for investigation of transmission clusters and supporting isolation and quarantine. Close contact is defined by CDC and DHS as being within 6 feet of a person with confirmed or probable COVID-19 for at least 15 minutes during a single day. Close contacts should wait at least 24 hours after exposure before they are tested, because SARS CoV-2 is most commonly first detectable 2-5 days after exposure. A negative test result should not exempt a contact from the requirement to quarantine, which should be continued for the recommended 14 days in all cases. In some cases, repeat testing near the end of the quarantine period may be considered to exclude asymptomatic infection before resuming activities that involve close contact with individuals at risk for severe COVID-19.
Thank you for your collaboration in this effort.
Ryan Westergaard, MD, PhD, MPH
Chief Medical Officer and State Epidemiologist for Communicable Diseases
Wisconsin Department of Health Services