Coordinating Our Response
Vermont works with health care providers and facilities across the state to collaborate in the COVID-19 testing effort. Primary care providers play a vital role in COVID-19 testing and referral in Vermont. Having reliable local access to testing is essential for both symptomatic and asymptomatic patients. We encourage providers to test patients in their own facilities. Using the guidance below, providers can test patients quickly and safely.
Who should be tested?
- Anyone with symptoms of COVID-19, regardless of vaccination status or prior infection.
- People who are not vaccinated, without symptoms, who have had close contact (within 6 feet for a total of 15 minutes or more over a 24-hour period) with someone who tested positive for COVID-19. Testing should happen on or after day 7 and quarantine can end if the test is negative.
- Patients for whom a provider determines a test is warranted.
If someone does not fit in these categories and the provider does not see a clinical, health, or exposure-related reason to test, the person should only be tested if there is the capacity for that testing.
Get a standing order for testing signed by Dr. Levine
Who should not be tested?
- People who tested positive previously and had symptoms of COVID-19, unless determined necessary by a health care provider.
- People who tested positive previously and did not have symptoms of COVID-19, except in special cases.
Polymerase Chain Reaction (PCR)
The PCR test is the standard test for detecting SARS-CoV-2, the virus that causes COVID-19. Health care professionals are encouraged to use PCR tests. Nasal swab kits, used for anterior nares specimen collection are available to certain health care providers in Vermont
SARSCoV-2 antigen testing should only be used when PCR testing is not available, or when very rapid turn-around is required (especially for symptomatic patients), for example in the following circumstances:
- Symptomatic patients in a primary care setting
- Patients being admitted to hospitals with limited availability of PCR testing
Antigen tests could be used for screening asymptomatic residents and staff at a long-term care facility if the tests were performed at least weekly. If used this way, positive antigen tests would be considered presumptive positive and would need confirmation by PCR. Infection and control measures should be implemented pending confirmation.
Testing for COVID-19 can occur in the provider office with minimal risk once appropriate planning has taken place. Provider offices will already be implementing many of the key infection prevention and control measures recommended, such as effective hand hygiene and maximizing social distancing where possible.
Make a plan for how testing is going to occur in office. Consider the following:
- Management of patient flow (appointments, check-in location). The goal should be to prevent grouping and promote social distancing. Sick patients should not be sitting/waiting near other patients in the office.
- Staff safety (PPE needs). Read more below.
- Instructions to give patients (require masks, what to bring, payment information)
- Utilization of tele-health resources as much as possible (check-in via tele-health)
- Location of designated testing area (entrance, exit, air flow, cleaning requirements)
- The area where patients are unmasking for specimen collection should be in a separate room or protected space
Choose less invasive, lower risk collection methods
Providers should consider implementing collection methods that are less likely to induce coughing or sneezing.
Anterior nares (nasal) swabbing is less invasive and has the potential to conserve PPE when utilizing the option of self-administered nasal swabbing. Both Anterior nares (nasal) swabbing and nasopharyngeal swabs are tested via RT-PCR and are similarly effective at detecting coronavirus.
Anterior Nares (nasal) Swabbing Instructions
“Using a flocked or spun polyester swab, insert the entire absorbent tip of the swab, usually1/2 to 3/4 of an inch (1 to 1.5 cm) inside the nostril and firmly sample the nasal wall by rotating the swab in a circular path against the nasal wall at least 4 times. Take approximately 15 seconds to collect the sample. Be sure to collect any nasal drainage that may be present on the swab. Sample both nostrils with same swab.” From the Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for COVID-19 (CDC)
Provide instructions to the patient to do anterior nares (nasal) swab. The Center for Disease Control and Prevention (CDC) has developed an excellent visual guide that can be printed out and shared with patients. How To Collect Your Anterior Nasal Swab Sample For Covid-19 Testing infographic (CDC).
Implement protocols for safe specimen collection, storage, and handling.
For both indoor and outdoor environments and drive-through/drive-up specimen collection specific measures to maintain staff safety are important.
Less than 6 feet from the patient during collection: Maintain proper infection control. Recommended PPE includes an N95 filtering facepiece or higher-level respirator, eye protection (face shield or goggles), gloves, and a gown.
Greater than 6 feet from the patient during collection: PPE use can be minimized through patient self-collection while the healthcare provider maintains at least 6 feet of separation. Follow Standard Precautions. Recommended PPE includes gloves. Additionally, healthcare personnel must wear a form of source control (facemask or cloth face covering) at all times while in the healthcare facility.
Periodically revisit the COVID-19 testing process and plan in the office. Consider possible improvements and efficacies that can be made. Elicit feedback from staff and patients on the process and take steps to address any concerns that are raised. Like any procedure quality assurance and improvement are key aspect to continued success.
- Testing Guidance and Collection Kit Ordering (Vermont Department of Health)
- More Guidance on Specimen Collection (CDC)
- More Guidance for COVID-19 Personal Protective Equipment (Vermont Department of Health)
- Request COVID-19 PPE Resources
Other Testing Options
Providers may refer patients to centralized testing sites such as local Federally Qualified Health Centers, hospitals, and associated test centers. See the list of COVID-19 Specimen Collection Sites
The Health Department offers pop-up testing clinics to serve people with no symptoms who are unable to get a test elsewhere.
Centralized Testing Sites
Providers may refer patients to centralized testing sites such as local Federally Qualified Health Centers, hospitals, and associated test centers. If you are referring patient to a specimen collection site outside of your facility,
- Refer the patient to a specimen collection site.
- Make sure your patient has all the information they need about where to go for specimen collection, including the appointment time and address.
- Make sure both you and the patient know how to get the test results.
Community testing for people without symptoms
The Health Department offers testing clinics to serve people with no symptoms who are unable to get a test elsewhere.
The Vermont Department of Health Lab and the University of Vermont Medical Center have partnered to provide COVID-19 test kits, free of charge, to certain health care providers in Vermont. Get more information about ordering test kits.
Other providers should order test kits through commercial channels.
Send samples to the University of Vermont Medical Center (UVMMC) Laboratory. Specimens from certain groups will be prioritized, including health care workers who are symptomatic, patients who are hospitalized, long-term care facility residents, people who are incarcerated, and those who are immunocompromised, require dialysis or are deceased. All other non-priority samples will be tested as quickly as resources allow.
All specimens must include a Clinical Test Request Form for COVID-19. Label all specimens with the patient's name and the collection date. If you have questions, call UVMMC Laboratory Customer Service at 800-991-2799.
Hospital labs that have daily courier pickup for UVMMC, please include your sample in that pickup. Otherwise, send your samples to your nearest clinical laboratory for pickup.
The timeline for receiving results is typically:
- 24 hours for priority specimens
- 1-3 days for non-priority specimens
Test results are reported to the hospital or clinical laboratory where the test was collected, which in turn notifies the ordering health care provider. Test results are sent using the fax, email, or phone number that was provided on the clinical test requisition form or through the Lab Web Portal.
The health care provider notifies the patient of the results. However, in the event of a positive result, the Health Department will also reach out to the patient to convey public health recommendations and collect information on contacts. It’s possible that Health Department notification may occur prior to the provider’s conversation with their patient. Patients awaiting lab results should contact their provider with questions.
Health care providers can access COVID-19 test result reports through our Lab Web Portal.
With the Lab Web Portal:
- Reports are delivered securely and in a timely and efficient manner.
- Authorized users can view, print, and download patient reports in a PDF document soon after they are released by the Health Department Laboratory.
- Positive result reports are flagged so that users can prioritize those as needed, and reports can be printed as a batch.
- Users can set up notifications to be emailed when reports have been uploaded to the portal.
At this time, the Lab Web Portal can only be used for COVID-19 results reporting. Test requests must still be made using our Clinical Test Request form.
If you would like more information about the Health Department Laboratory’s Lab Web Portal, please email us at AHS.VDHVTLWPSupport@vermont.gov
All COVID-19 results (positive, negative, etc.) are required to be reported to the Vermont Department of Health within 24 hours of test report completion. Learn about reporting COVID-19 test results.
False positives are considered very rare. Therefore, the Health Department considers all FDA-approved PCR COVID-19 positive results to be true positives unless there is concern about contamination from the performing laboratory. Not having any known exposures to COVID-19 or being asymptomatic should not change the interpretation of a positive PCR lab result.
Asymptomatic patients typically have lower viral loads than symptomatic patients, which means they are more likely to be closer to the threshold of detection for PCR tests. Because of this, retesting of the same sample is not generally recommended. Similarly, subsequent testing with a negative result may mean there was viral clearance, but this does not change the interpretation of a previous positive result, isolation recommendations for the case, or quarantine recommendations for close contacts. Because of this, additional testing is not recommended following a positive PCR result.
Use the CDC's Antigen Test Interpretation flow chart which has the most current guidance to help you interpret the antigen test.
- Standing Order and Procedural Guidance for Licensed Long-Term Care Facilities utilizing a Vermont Department of Health Standing Order for Performing Antigen or PCR testing for COVID-19
- Instructions for Collection and Packaging of Specimens for Novel Coronavirus (COVID-19)
- Clinical Test Request Form - Leave the insurance portion of the form blank.
- Lab results reporting requirements
- COVID-19 Specimen Collection Sites
- Considerations for Implementation of SARS-CoV-2 Rapid Antigen Testing (Association of Public Health Laboratories)
- CT (Cycle Threshold) Values: What They Are and How They Can be Used (Association of Public Health Laboratories)
- Waiting for test results / How to get your COVID-19 test results (information sheet for patients)
- More information for patients on the resources page
UVMMC Laboratory Customer Service for providers: (802) 847-5121 or (800) 991-2799
UVMMC has a COVID-19 Hotline for providers to call if they have questions regarding screening patients for COVID-19 testing: (802) 847-2700