Expanding Access to Testing: Updated Interim Guidance on Prioritization for COVID-19 Laboratory Testing

California Department of Health

April 19, 2020

TO: Public Health Departments, Health Care Providers, and COVID-19 Testing Laboratories

SUBJECT: Expanding Access to Testing: Updated Interim Guidance on Prioritization for COVID-19 Laboratory Testing

​Testing for Coronavirus Disease 2019 (COVID-19), both PCR and serology, is becoming more readily available at hospital, academic, commercial, and public health laboratories across California. Governor Newsom and the Testing Task Force are committed to rapidly expanding testing across California, ensuring that more Californians get tested. Expanded testing will help protect vulnerable groups and allow us to better understand the spread of COVID-19 in our communities. 

This interim guidance is intended to support public health officials, health care providers, and laboratories in determining prioritization of specific groups for PCR molecular testing. The guidance will be reassessed on a weekly basis based on California’s evolving situation and input from stakeholders. The prioritization categories below are suggested as guidance to sequential expansion of testing. As testing capacity increases, testing should expand accordingly at the discretion of the Local Health Officer.

Priority 1:

• Hospitalized patients
• Symptomatic healthcare workers
• Persons identified for testing by public health contact investigations and disease control activities in high risk settings, including both residents and staff
• E.g., congregate living facilities, correctional facilities

Priority 2:

• Screening of asymptomatic residents of congregate living facilities prior to admission or re-admission to congregate living facility
  • E.g., a hospitalized patient will be screened for COVID-19 prior to discharge to a congregate living facility
• Screening of asymptomatic healthcare workers
  • E.g., skilled nursing facility workers, hospital workers
• Symptomatic persons in essential health and public safety occupations
  • E.g., first responders, law enforcement, congregate living facility workers
• Symptomatic persons >65 years of age or with chronic medical conditions 

Priority 3:

• Symptomatic persons in essential infrastructure occupations
  • E.g., utility workers, food supply workers, other public employees

Priority 4:

• Community-based testing of all low-risk symptomatic persons
• Surveillance testing of asymptomatic persons

All persons should stay home and away from others until there has been no fever without the use of fever-reducing medications, there has been improvement in respiratory symptoms (e.g., cough, shortness of breath) for at least 3 days; AND it is at least 7 days since symptoms first appeared, i.e., the minimum length of time will be 7 days.

Additional Resources

Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for COVID-19

California Department of Public Health’s Guidance web page

California Department of Public Health’s Resource web page

 California Department of Public Healths All Facilities Letters – 2020 web page