COVID-19 Testing Priorities for Pennsylvania
COVID-19 testing in Pennsylvania has expanded. As we have learned much about COVID-19, and which populations and communities it impacts disproportionately, it is important to develop a strategy and prioritization to assure access and the best outcomes for Pennsylvania's citizens.
Testing of hospitalized individuals with signs or symptoms of COVID-19 infection followed by testing of other symptomatic individuals as well as other asymptomatic individuals with certain conditions will become the priority. This guidance should be used for prioritization of patient populations.
Tier One Priority
Hospitalized individuals with COVID-19 symptoms.
- Investigation and management of outbreaks, under direction of state and local public health departments includes contact tracing with testing of symptomatic close contacts and asymptomatic contacts of positive cases with underlying health conditions.
Tier Two Priority
- All other individuals with COVID-19 symptoms.
- Close contacts of confirmed cases who are asymptomatic.
- Individuals who are asymptomatic (having no symptoms of COVID 19), who fall into one of the following categories contingent upon the disease prevalence rate in their community:
- Live in congregate care facilities including but not limited to personal care homes, assisted living residences, independent care facilities, skilled nursing facilities, community residential rehabilitation services, long term structured residence, residential treatment facilities for adults, residential care facilities for the elderly, correctional facilities, community homes or homeless shelters, as well as Commonwealth facilities including state hospitals, state centers, youth detention centers and youth forestry camp.
- Health Care Workers in the health care sector who have frequent interactions with the public or with people who may have COVID-19 or have been exposed to SARS-CoV-2. The health care sector includes hospitals, skilled nursing facilities, long-term care facilities, ambulatory surgery facilities, health care providers' offices, health care clinics, pharmacies, blood banks, dialysis centers, hospices, and home health providers having direct patient care.
- Workers in non-long-term care congregate care facilities, including shelters for people experiencing homelessness and domestic violence as well as residential care facilities for the elderly and adult day care programs.
- Workers who provide care to an elderly person or a person with a disability in the home, including a person providing care through In-Home Supportive Services Programs.
- Workers in the emergency services sector, including police and other public safety departments, fire departments, and emergency service response operations.
- Workers in child protective services and adult protective services departments.
- Workers in a correctional facility.
- Workers providing compassionate care and hospice services.
- Patients being discharged from a hospital to a lower level of care.
- Utility services sector workers who have frequent interactions with the public or who work in an environment where it is not practical to maintain at least six feet of space from other workers on a consistent basis. The utility services sector includes utility services such as electricity, natural gas, pipeline transmission of natural gas and hazardous material, motor carrier transportation of passengers and property, railroad crossings, telecommunications, and water and wastewater collection and disposal.
Tier Three Priority
The following individuals who are asymptomatic (having no symptoms of COVID 19), and fall into one of the following categories contingent upon the disease prevalence rate in their community:
- Patients requiring pre-operative/pre-hospital admission screening.
- Retail or manufacturing sector workers who have frequent interactions with the public or who work in an environment where it is not practical to maintain at least six feet of space from other workers on a consistent basis.
- Food services sector workers who have frequent interactions with the public. The food services sector includes food safety inspectors, school food service, food banks and food pantries, farmers markets, urban farms, community gardens, grocery stores, convenience stores, restaurants, and grocery or meal delivery services.
- Agricultural or food manufacturing sector workers who have frequent interactions with the public or who work in an environment where it is not practical to maintain at least six feet of space from other workers on a consistent basis. The agricultural or food manufacturing sector includes farms and farmworkers*, food production processing and distribution facilities, meat processing and packing facilities, and food packing facilities and veterinarians and veterinary technicians, and animal shelters and companion animal care providers.
- Public transportation sector workers who have frequent interactions with the public. The public transportation sector includes public transit, passenger rail service, public airports, and commercial airlines as well as taxi, Uber and Lyft drivers.
- Education sector workers who have frequent interactions with students or the public. The education sector includes public and private childcare establishments; public and private pre-kindergarten programs; primary and secondary schools; and public and private colleges and universities; and vocational and technical schools.
Tier Four Priority
Tier Four would be implemented when capacity is available and test results of PA residents turn around in 48 hours or less.
- Other individuals not specified above including those who are asymptomatic but believe they have a risk for being actively infected.
- Routine testing by employers.
Testing Discrimination and Inappropriate Workplace Testing
As modifications are made to public health directives and more sectors of the economy open with adaptations, it is important that employers do not use testing to unintentionally discriminate against employees who have previously tested positive for COVID-19 (such as by preventing them from resuming work after they can do so in a manner consistent with public health and safety). This does not mean an employer must allow an employee who currently has COVID-19 to return to work before the employee's infection is resolved. Further, because PCR tests can remain positive long after an individual is no longer infectious, proof of a negative test should not be required prior to returning to the workplace after documented COVID-19 infection. Rather, symptom- or protocol-based criteria should be used in determining when an employee is safe to return to the workplace.
Types of Tests
1. Diagnostic Tests
Assesses the presence of the virus at a given point in time. A negative means only that an individual was negative at the time the test.
- Polymerase Chain Reaction (PCR) Tests and Nucleic Acid Amplification Testing: Detects the RNA genetic material in the COVID-19 virus and are often collected via nasal pharyngeal; mid turbinate; nasal, oral or throat swab; or saliva collection.
- Antigen Tests: Not currently widely utilized. Detects the presence of COVID-19 specific protein particles and is collected via a respiratory sample.
2. Non-Diagnostic Tests
- Serology (Antibody) Tests: Detect antibodies in the blood indicating possible prior exposure to COVID-19, which may develop 6-14 days after infection.
Note: No test is perfect. There is a false negative rate and false positive rate that varies depending on the test and the collection modality. Accuracy of antigen tests may be problematic due to poor sensitivity.
*This should be inclusive regardless of immigration status (to include H2A, H2B, green card and visa holders, as well as any undocumented farm workers). There may need to be alternative documentation allowances for individuals who are undocumented so they can get tested without having a state ID or drivers license.