HCAOA The Voice Summer 2020

19 Spring/Summer 2020 PUBLIC POLICY Testing for the presence of active infection provides critical information that can be used to manage the COVID-19 response. There are three primary purposes for active infection testing: • Diagnostic Testing is used to confirm or support a clinical diagnosis of viral infection in symptomatic individuals and inform treatment and implement preventive measures to contain further spread. • Testing for Contact Tracing is a process to trace, test, and monitor persons that may have been in contact with infected individuals. This type of testing supports the identification and rapid isolation of new cases or those with presence of virus and no symptoms and helps to prevent further spread. • Surveillance Testing is used to limit the spread of disease and enable public health authorities to assess and manage the risks associated with COVID-19, including testing asymptomatic individuals. Objectives of surveillance include enabling rapid detection, isolation, testing, and management of suspected cases; guiding the implementation of control measures; detect - ing and containing outbreaks among vulnerable populations; and monitoring long-term epidemiological trends. In addition to testing for an active infection, testing for a previous infection is performed using serologic tests. Serology (antibody) testing complements diagnostic testing (testing for active infection) by evaluating the prevalence of individuals in a com - munity and across the U.S. who were previously infected by the virus. At this time, a positive antibody test does not indicate with certainty that an individual is immune to reinfection. Additional studies are ongoing to determine if the presence of antibodies to the virus, and at what levels, correlates with protective immunity. The specific number of tests that are required in each state, and in each geographical region within each state, depends on numerous factors, including but not limited to: • The percent positives in a state, territory, or tribe. The World Health Organization (WHO) set an objective that the percent of tests being positive should be 10 percent or lower, demon - strating that 10 times as many people are being tested as have the disease. This indicates enough testing exists to ensure broad coverage of the population. The amount of testing needed in a community is situational (based on geography, transmission, vulnerable populations, etc.), but in general, achieving this benchmark begins to ensure rapid diagnosis of symptomatic and asymptomatic individuals. • The characteristics of the population. Areas with large numbers of individuals at high risk of contracting or transmit - ting the virus, or who may be highly vulnerable for having poor outcomes, will require increased surveillance testing. • The degree of mitigation employed in that community. Mitigation strategies such as social distancing help control the spread of disease. In areas where mitigation strategies are strictly implemented, there will be less contact tracing needed and less concern of spread to vulnerable populations. When mitigation measures are relaxed, the number of social contacts will increase as does the potential risk of infection—making widespread testing and early warning more critical than during full community mitigation. In addition to the factors listed above, there are many additional considerations, such as the availability of resources; presence of concurrent, seasonal respiratory infections (such as influenza); and the prevalence of potentiating risk factors among communities, such as asthma or diabetes, that must be taken into account when developing and or adapting a testing strategy. Therefore, the testing strategy, as well as the specific quantitative goals for testing, should be continually informed by epidemiological data as well as our evolving understanding of the ecology of the virus. The Centers for Disease Control and Prevention (CDC) has issued guidelines for who has priority for diagnostic testing: High Priority • Hospitalized patients with symptoms • Healthcare facility workers, workers in congregate living settings, and first responders with symptoms • Residents in long-term care facilities or other congregate living settings, including prisons and shelters, with symptoms Priority • Persons with symptoms of potential COVID-19 infection, including: fever, cough, shortness of breath, chills, muscle pain, new loss of taste or smell, vomiting or diarrhea, and/or sore throat. • Persons without symptoms who are prioritized by health departments or clinicians, for any reason, including but not limited to: public health monitor - ing, sentinel surveillance, or screening of other asymptomatic individuals according to state and local plans. continues on next page >>