Testing Information for Health Care Professionals

Testing Information for Health Care Professionals

man having a nasal swab test

Coordinating Our Response

Vermont needs health care providers and facilities across the state to collaborate in the COVID-19 testing effort. The Vermont Department of Health alone cannot meet the need for testing. By building capacity for prioritized testing everywhere in the state, we are also building capacity to respond to changing needs.

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?

Who should be tested?

  • Anyone with symptoms of COVID-19.
  • People 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. 
  • People without symptoms who will be attending or recently attended a gathering of people from more than one household.
  • People who often gather socially with other people from outside their household.
  • People without symptoms in quarantine due to exposure to someone who has tested positive for COVID-19, or people who have traveled and wish to end quarantine early with a negative test. In both cases, the test should be done on or after day 7.
  • College students returning to Vermont from out-of-state colleges should be tested on or after day 7 of their quarantine.
  • People working in health care or congregate care settings may need to be tested at regular intervals per Health Department guidance.
  • Patients scheduled for a procedure or surgery involving airway management may need to be tested prior to the procedure (see Inpatient/Outpatient Medical Services for details). These patients should be referred by their provider to the hospital or health care setting for testing to ensure timely reporting of results.
  • Patients being referred to congregate psychiatric settings from a hospital emergency department must be tested and receive a negative result before they are transported.
  • 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

Read the COVID-19 PCR Testing Guidance for Adult Patients

Find health alerts with guidance

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.
Collecting Samples

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)

Or

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. 

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.

Symptoms

Symptoms of COVID-19 include:

  • Fever (100.4 F or higher)
  • Cough
  • Shortness of breath or difficulty breathing
  • Chills
  • Fatigue
  • Muscle pain or aches
  • Headache
  • Sore throat
  • New loss of taste or smell
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea
Types of tests

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

Antigen Tests

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. 

Ordering test kits

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. 

Sending samples

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.

Courier Service

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.

Receiving and reporting results

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.

Receiving Results through the Lab Web Portal

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

Reporting Results

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

Interpreting positive PCR 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.

Contacts

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