PORTLAND, Ore. — The Oregon Health Authority on Tuesday released new guidelines widening the pool of Oregonians eligible for coronavirus testing after acknowledging last week that more tests could be completed with the supplies on hand.
State officials stopped their practice of discouraging people with mild symptoms from seeking testing, emphasizing that it’s up to a doctor or nurse to decide if testing is warranted.
“It is recommended that people without symptoms and those with symptoms that do not necessitate medical evaluation call their provider to discuss symptoms and whether they need to be evaluated,” the new advice says.
That’s a departure from the old guidance, which said in bold letters that such people were "not recommended for testing at this time.”
In another change, the state has now blessed coronavirus tests for people without symptoms in limited circumstances: for residents, children, employees and others in care facilities such as nursing homes, schools, day cares, health care facilities, or in jails and prisons. Screening is conditioned on laboratories having enough capacity to process the tests.
The state has also expanded the pool of people with symptoms of cough, fever and shortness of breath who are eligible for testing. The new group includes people of color and people who provide direct care, such as hospice workers, physical therapists, and also front-line workers.
Front-line workers include people who work in grocery stores, pharmacies, delivery, food service and transportation.
The other notable change in testing is at the Oregon State Public Health Lab, which is run by the health authority.
The state now says it will analyze tests at its lab for people with symptoms at care facilities, and may consider testing people without symptoms. That’s a big shift: state officials originally said they would use their lab to run tests for people in care facilities, then reversed course and said they would only provide minimal testing assistance because they were too busy.
Now the pendulum has swung back toward full testing by the state lab. The change is happening as state officials have few tests to process, with most hospitalized patients now having test results analyzed by in-house hospital labs.
The Oregonian/OregonLive published a story over the weekend showing that other states, such as Utah and New Mexico, have broadened the criteria for who should be tested for coronavirus. As of Friday, Oregon ranked 31st nationally in testing per capita.
Dr. Dean Sidelinger, the state epidemiologist and health officer, said more testing could be done in Oregon with existing supplies but providers weren’t pursuing it.
“What we’re seeing is the demand, that’s what people are asking for,” Sidelinger told the newsroom last week.
“We know that there is capacity – meaning that additional tests could be done in those settings – if they were received,” he added.
On Tuesday, Sidelinger said in a statement that Oregon revised its testing guidelines “in order to fit the changing shape of the disease outbreak, and to ensure we’re best responding to the current situation.”
“By focusing clinicians’ attention on testing certain groups – including those most at risk for contracting severe forms of COVID-19 – we are making sure people who need to be tested are getting tested and getting the information and treatment they need to manage COVID-19,” Sidelinger added in the statement. “Similarly, increased testing in specific areas will help OHA, other state authorities and partners to understand and manage the epidemic.”
Here’s the state’s latest guidance, which is dated April 20:
It is recommended that people without symptoms and those with symptoms that do not necessitate medical evaluation call their provider to discuss symptoms and whether they need to be evaluated. Individuals with mild symptoms that do not necessitate medical evaluation should remain at home until 72 hours after any fever or cough resolve. People with mild or moderate COVID19-like illness who seek testing risk exposing others in healthcare settings, including members of the public, other patients, and healthcare workers. For individuals with mild symptoms who present for care, testing is at the discretion of the provider. Evaluation and testing of such people in a healthcare setting consumes resources that may become extremely limited, including personal protective equipment (PPE), swabs and viral transport media used to collect diagnostic specimens, and ties up clinical resources, including healthcare staff and rooms.
Testing by doctors and private labs are recommended by the state as follows, for people with fever, cough or shortness of breath:
- Healthcare workers and first responders (EMS, public safety workers)
- Residents, staff, children, or other people in a care facility or group living setting (e.g., healthcare facility, residential care facility, school, child care, or corrections).
- When clinical laboratories have sufficient testing capacity, people in these settings without symptoms can be considered for testing.
- Workers who provide direct care or service in multiple group facilities or who provide in-home services (e.g. hospice care workers, physical or occupational therapists, in-home personal care workers, etc.)
- Essential front-line service workers who have regular contact with large numbers of people (e.g., those working in grocery stores, pharmacies, food service, transportation, delivery, and other critical infrastructure services)
- Patients 60 years of age or older
- Patients with underlying medical conditions, including, but not limited to hypertension, diabetes, cardiovascular disease, lung disease, and immunocompromising conditions
- People who identify as Black, African-American, Latino, Latina, Latinx, Hispanic, American Indian/Alaska Native, or as having a disability; data indicate that these communities are at higher risk for COVID-19 and associated complications due to longstanding social and health inequities
- Pregnant women
- Patients with worsening symptoms
- Patients who had contact with a suspect or lab-confirmed COVID-19 patient within 14 days of their symptom onset
Testing authorized to be analyzed at the Oregon State Public Health Lab:
Residents, staff, children, or other people in a care facility or group living setting (e.g., healthcare facility, residential care facility, school, child care, or corrections) and workers who provide direct care or service in multiple group facilities or who provide in-home services (e.g. hospice care workers, physical or occupational therapists, in-home personal care workers, etc.) will be tested for COVID-19 at OSPHL according to the following criteria:
- OSPHL will test any person with symptoms (fever, cough, or dyspnea) in care facility or group living settings and, as capacity allows, may consider testing asymptomatic people as well.
- OSPHL will test people with symptoms (fever, cough, or dyspnea) who provide direct care or service in multiple group facilities or who provide in-home services
-- Brad Schmidt; firstname.lastname@example.org; 503-294-7628; @_brad_schmidt
This article was originally published by The Oregonian/OregonLive, one of more than a dozen news organizations throughout the state sharing their coverage of the novel coronavirus outbreak to help inform Oregonians about this evolving health issue.