Healthcare Providers: General Questions
Recommendations for how and when to use source control are outlined in the Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic.
Source control is recommended for individuals in healthcare settings who:
- Have suspected or confirmed SARS-CoV-2 infection or other respiratory infection (e.g., those with runny nose, cough, sneeze); or
- Had close contact (patients and visitors) or a higher-risk exposure (HCP) with someone with SARS-CoV-2 infection, for 10 days after their exposure
Source control is recommended more broadly in the following circumstances:
- By those residing or working on a unit or area of the facility experiencing a SARS-CoV-2 outbreak; universal use of source control could be discontinued as a mitigation measure once no new cases have been identified for 14 days; or
- Facility-wide or, based on a facility risk assessment, targeted toward higher risk areas or higher risk patient populations during periods of higher levels of community SARS-CoV-2 or other respiratory virus transmission; or
- Have otherwise had source control recommended by public health authorities
Individuals might also choose to continue using source control based on personal preference.
Note that CDC defines healthcare settings as “places where healthcare is delivered and includes, but is not limited to, acute care facilities, long-term acute care facilities, nursing homes, home healthcare, vehicles where healthcare is delivered (e.g., mobile clinics), and outpatient facilities, such as dialysis centers, physician offices, dental offices, and others.” A laboratory that only processes samples but does not have patient interactions would not be considered a healthcare setting. Additional considerations for determining when healthcare IPC recommendations apply to long-term care settings (excluding nursing homes) are outlined in the Nursing Homes and Assisted Living Facilities section of these FAQs.
More guidance on protection from COVID-19 by masks or other face coverings can be found on the CDC mask website.
Virginia Department of Health regularly updates its websites with the latest information on COVID-19 in Virginia. For additional information, please see the VDH COVID-19 website for Health Professionals.
The CDC provides detailed and frequently updated COVID-19 resources for clinicians. The CDC’s Clinician Call Center is a hotline with CDC clinicians standing by to answer questions about COVID-19. Call the main CDC information line at 800-CDC-INFO (800-232-4636) and ask for the COVID-19 Clinician's Call Center.
The FDA COVID-19 website provides frequently updated information on COVID-19-related treatments, vaccines, and test materials.
As required by state regulations, clinicians should use VDH’s secure Confidential Morbidity Report Portal to report COVID-19 cases within 3 days of being identified. Please include in your report symptoms and other critical epidemiologic fields, including race and ethnicity. VDH personnel with access to the data are required by state law to protect the anonymity of patients and healthcare providers.
Point of Care (POC) testing sites should go to the VDH COVID-19 Manual Reporting site to register for the POC Reporting Portal. Sites that have been reporting positive POC results through the Confidential Morbidity Portal no longer need to do so once they begin reporting through the POC Reporting Portal.
Healthcare providers’ reports of positive at-home COVID-19 tests will be treated as COVID-19 cases.
For complete recommendations, see CDC Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2. This guidance describes conventional strategies for return to the workplace for HCP with SARS-CoV-2 infection or higher-risk exposures.
Additional CDC guidance addressing staffing shortages due to COVID-19 can be found here: Strategies to Mitigate Healthcare Personnel Staffing Shortages. This guidance describes contingency and crisis capacity strategies.
CDC and VDH recommend when to return to work for healthcare personnel with SARS-CoV-2 infection based on staffing levels. In general, conventional strategies, when the facility is not being impacted by staffing shortages, is the recommended safest practice.
If a facility is expecting or experiencing staffing shortages due to COVID-19 despite implementing recommendations from conventional strategies (e.g. employee COVID-19 vaccine, understanding staffing patterns/needs, communication with local healthcare coalitions and public health partners to identify backup HCP, etc.), CDC outlines mitigation strategies (contingency and crisis) a healthcare facility can consider.
VDH periodically schedules train-the-trainer sessions for respirator fit testing. By the end of the training, attendees can train others in the proper procedures for fit-testing. Information on upcoming sessions (date, time, location) is available.
For facilities that need additional information on developing and implementing a respiratory protection program, VDH has posted a resource guide.
Healthcare Providers: Testing for COVID-19
Different COVID-19 laboratory tests use different clinical specimens. Viral tests typically use upper respiratory tract specimens such as a nasopharyngeal swab, nasal swab, throat swab, or saliva specimen.
In general, healthcare providers should send specimens for COVID-19 testing to commercial, private, or hospital laboratories. VDH recommends that healthcare providers work with laboratories that use viral tests granted an Emergency Use Authorization (EUA) by FDA or viral tests offered under the policies in FDA’s Policy for COVID-19 Tests. Always evaluate test performance measures. Contact your laboratory partner for specific information about specimen type, collection procedures, and submission protocols. CDC provides Interim Guidelines for Collecting and Handling of Clinical Specimens for COVID-19.
Many community testing sites collect specimens and either perform point-of-care (POC) tests or send specimens to a private or reference laboratory for testing. To find a site for your patient(s), visit Virginia COVID-19 Testing Sites. Each site has different policies and procedures for testing and billing.
Self-testing kits, also called at-home test kits, can be recommended for patients if testing at a local healthcare facility or community testing site is not feasible. For self-testing kits, the collected specimen is tested at home with a result in about 10-30 minutes depending on the test.
Self-collection kits can be used at home by people to collect a specimen (nasal swab, saliva) by themselves or from other people. Self-collection kits typically come with printed instructions on specimen collection or the instruction material may be available online. Once collected, the specimen is packaged and mailed back to the laboratory for testing.
Currently, for self-testing and self-collection kits, both prescription and non-prescription options are available. For more information about currently available self-test kits, visit the FDA webpage on At-Home OTC COVID-19 Diagnostic Tests or the CDC Self-Testing website.
Testing at Virginia’s public health laboratory (Division of Consolidated Laboratory Services or ‘DCLS’) or an affiliated partner is available for (1) the detection or rule out of SARS-CoV-2 using polymerase chain reaction (PCR) or (2) variant identification by whole genome sequencing (WGS) for VDH-approved testing scenarios (outbreaks, point prevalence surveys, individual or other special requests). Clinicians should request public health laboratory testing for these scenarios by contacting their local health department.
Submitters must collect and package specimens and either deliver them to a DCLS courier site, self-deliver to the DCLS loading dock, or ship them to DCLS via commercial courier (e.g., FedEx). Specimens should be stored refrigerated and shipped to DCLS on ice packs to ensure refrigerated conditions. Specimens must arrive under refrigerated conditions within 72 hours of collection with the date and time of collection present on the submission form. If delayed shipping or longer storage is needed, samples should be stored at -70◦C or colder prior to shipment on dry ice.
DCLS Diagnostic PCR Testing: DCLS PCR result reports are released within 48 hours of sample receipt, though most are available sooner. Reports may be obtained immediately by authorized users of medical facilities and health departments with access to the DCLS Connect portal. All hard copy result reports are sent to submitters via a commercial carrier (next day delivery), Monday through Friday. Friday's positive results are faxed to submitters on Saturday.
Whole-genome sequencing testing (WGS): DCLS currently reports variant information determined by WGS within 7 – 14 days of sample receipt. The turnaround time for testing results is determined by the current workload of the laboratory, especially during COVID-19 surges. Results are reported to the submitter as a paper-copy report that includes variant lineage information for Variants of Concern and Variants Being Monitored per Centers for Disease Control and Prevention guidance. DCLS additionally issues WGS results as an electronic laboratory report to the Virginia Department of Health for integration into the Virginia Electronic Disease Surveillance System (VEDSS).
Most samples received through local health departments are retained at DCLS for WGS; however, the partner laboratory network for the Virginia SARS-CoV-2 Strain Surveillance (VAS3) initiative is utilized for surveillance specimens from Virginia hospitals. DCLS can triage samples to contracted VAS3 laboratories with the goal of maximizing sequencing capacity and timeliness. VAS3 Network laboratories provide results directly to VDH for integration into VEDSS. The VAS3 network was devised to improve surveillance and representation of the regions of Virginia in the surveillance system, but not for patient level reporting to hospitals or other non-public health entities. Therefore, samples sequenced by VAS3 partners cannot be reported to hospital and hospital laboratories.
Commercial, Private, or Hospital Laboratory Testing: Each laboratory determines its own turnaround time. Authorized assays for viral testing include those that detect SARS-CoV-2 nucleic acid or antigen. Some tests are point-of-care tests, meaning results may be available at the testing site in less than an hour. Other tests must be sent to a laboratory to analyze, a process that may take 1–2 days once received by the lab.
Yes. COVID-19 tests are considered medical devices by the FDA. FDA maintains a webpage of medical device recalls–this page includes recalls of specific COVID-19 test kits.
Currently, there are three main COVID-19 diagnostic tests. Molecular SARS-CoV-2 and rapid antigen tests are known as “viral” tests and are used for the diagnosis of acute SARS-CoV-2 infection. COVID-19 antibody tests, which have limited usefulness, may be able to identify people who’ve had prior SARS-CoV-2 infection. Antibody testing is not meant for the diagnosis of acute COVID-19 and results do not indicate that a person is immune (or not immune) to the SARS-CoV-2 virus. Antibody test results should NOT be used to determine whether a person should receive an updated COVID-19 vaccine or additional doses. Unless a person has a medical reason to not get vaccinated, all people are recommended to be up to date with COVID-19 immunizations.
CDC’s webpages COVID-19 Testing: What You Need to Know, Overview of Testing for SARS-CoV-2, the virus that causes COVID-19, and Guidance for Antigen Testing for SARS-CoV-2 for Healthcare Providers Testing Individuals in the Community provide detail about SARS-CoV-2 molecular, antigen, and antibody testing and interpretation of test results.
Yes, a CLIA Certificate of Waiver, Certificate of Compliance, or Certificate of Accreditation is required for onsite antigen testing. Visit CMS’ CLIA website for information on CLIA regulations and obtaining a CLIA certificate.
Healthcare Providers: Infection Prevention and Control
Per CDC recommendations, healthcare facilities are recommended to have processes in place to identify and manage individuals with suspected or confirmed SARS-CoV-2 infection. However, having someone stationed at a facility entrance to take temperatures and ask screening questions is not explicitly recommended.
Anyone entering the facility with (1) a positive viral test for SARS-CoV-2, (2) symptoms of COVID-19, or (3) close contact with someone with SARS-CoV-2 (or a higher-risk exposure for healthcare personnel) should be aware of the facility’s recommended actions to prevent transmission to others. Visual alerts like posted signs at entrances and communications to healthcare personnel about how to report any of the three above criteria can accomplish this.
Refer to the CDC healthcare infection prevention and control recommendations for more detail.
Given current availability of PPE supplies, conventional use strategies should be used related to PPE. CDC’s Infection Prevention and Control Recommendations for Healthcare Personnel outline what types of PPE are indicated for care of patients/residents with and without suspected or confirmed SARS-CoV-2 infection.
Healthcare facilities should consider performing a risk assessment to determine their infection prevention and control recommendations, including when broader use of source control or universal use of personal protective equipment (e.g., eye protection for all patient care encounters) in the facility might be warranted. Some factors to be considered are available local data metrics, including county-level SARS-CoV-2 hospital admissions data on the CDC COVID-19 Data Tracker and VDH emergency department visits for COVID-like illness, and facility-level information (e.g., recent transmission inside the facility, the population’s risk for severe outcomes from COVID-19, and facility characteristics that could accelerate spread) to determine when to add and remove prevention strategies. Facilities could also follow trends of several respiratory viruses using CDC RESP-NET interactive dashboard or data from the National Emergency Department Visits for COVID-19, Influenza, and RSV to make decisions about broader use of source control based on national respiratory virus incidence. For more information, visit updated CDC COVID-19 Infection Prevention and Control guidance.
Healthcare Providers: Treatment for COVID-19
VDH summarizes information for healthcare providers on this page. Additional information on therapeutics may be found in the following:
NIH COVID-19 Treatment Guidelines
Coronavirus (COVID-19) | Drugs | FDA
The COVID-19 Treatment Locator Tool is available to help healthcare providers and the public locate certain COVID-19 treatments. Users can enter their zip code and check the box for the specific product they are looking for.
Patients should coordinate with their healthcare provider prior to contacting a location as a provider prescription is required. Locations may require an appointment and treatment availability may be limited.
Paxlovid can now be prescribed by pharmacists in limited situations to increase timely access to patients.
In the case of coinfection of influenza and COVID-19, Paxlovid or Lagevrio (molnupiravir) can be administered to individuals for the treatment of COVID-19. Neither of these medications interact with Tamiflu and can be administered together if the patient does not have any contraindications to either medication. More information can be found in these resources:
Get the Latest Guidance COVID-19 Therapeutics Virginia (VDH)
Yes. CDC maintains a COVID-19 Clinician On-Call Center which is available 24/7 and can respond to questions from health departments, healthcare providers, community organizations, and healthcare facilities. To reach the Clinician On-Call Center, call the CDC Emergency Operations Center Watch Desk at 770-488-7100 and ask for the Clinician On-Call Center. The U.S. Department of Health and Human Services (HHS) also responds to clinician questions about COVID-19 therapeutics. They can be reached by email at COVID19therapeutics@hhs.gov.
CDC provides guidance here: Post-COVID Conditions: Information for Healthcare Providers
As of July 2021, “long COVID,” also known as post-COVID conditions, can be considered a disability under the Americans with Disabilities Act (ADA). Learn more by reading the U.S. Department of Health and Human Services’ Guidance on “Long COVID” as a Disability Under the ADA, Section.
Healthcare Providers: Nursing Homes and Assisted Living Facilities (Long-Term Care Facilities)
All healthcare facilities, including nursing homes, should have a mechanism in place to promptly identify if a patient/resident has signs/symptoms of any communicable disease. The mechanism and frequency of monitoring asymptomatic individuals is at the discretion of the facility.
The Department of Health and Human Services (HHS) distributes BinaxNow tests directly to specified long-term care facilities for required testing of staff. Questions regarding this HHS supply can be sent to email: hhsbinax@hhs.gov.
VDH encourages skilled nursing facilities and assisted living facilities to develop and prepare a sustainable plan for future testing needs by finding a vendor to purchase tests or contract with to perform tests on the facility’s behalf.
If using crisis staffing standards that may jeopardize the health, safety, and well-being of residents of the facility, then nursing facilities licensed by the VDH Office of Licensure and Certification (OLC) and assisted living facilities licensed by the Virginia Department of Social Services are required to notify their licensing entity (the OLC or the DSS regional licensing office, respectively) of the conditions and status of the residents and the physical plant as soon as possible.
Per the Centers for Medicare and Medicaid Services (CMS), visitation should be permitted for all nursing home residents at all times. However, visitors must comply with the core principles of COVID-19 infection prevention and follow guidance outlined in a CMS memo (5/8/2023).
Visitors with confirmed COVID-19 infection or compatible symptoms should defer non-urgent in-person visitation until they meet CDC criteria for healthcare settings to discontinue isolation. It is safest for visitors who have had close contact with someone with COVID-19 infection to defer non-urgent in-person visitation until 10 days after their close contact if they meet criteria described in CDC healthcare guidance (e.g., cannot wear source control).
In rare occasions during an outbreak investigation when other mitigation efforts have failed, restricting visitation may be considered for brief periods of time. Health district or regional public health staff should collaborate with the appropriate regional Office of Licensure and Certification long-term care supervisor prior to recommending that a facility restrict visitation.
The facility under conventional conditions might supply all required PPE to VDH staff visiting the facility. However, during PPE shortage, VDH staff shall bring their own PPE. VDH staff should avoid entering a resident room without wearing the appropriate PPE.
Facilities should develop policies for safely conducting food service activities. Only essential staff are permitted in units/care areas for suspected or confirmed COVID-19 cases, and food delivery can be done by nurses or nursing assistants, if staffing resources allow. When delivering food to a patient or resident with suspected or confirmed COVID-19, staff should perform hand hygiene, don PPE (gloves, gown, N95 respirator, eye protection), drop off food, take off and dispose of PPE and perform hand hygiene. Repeat this process between each room of a resident with suspected or confirmed COVID-19.
When delivering food to a patient/resident without suspected or confirmed COVID-19 infection, staff should perform hand hygiene and don gloves, then remove gloves and repeat hand hygiene if staff has contact with the patient/resident or any surfaces that have significant potential for being contaminated with infectious material in their room.
When conducting facility-wide testing, a large number of residents might be identified with COVID-19 infection and cohorting them can be complicated and might increase the chances of cross-contamination, especially if the facility is experiencing staffing shortages. Consult with the local health department to determine the best approach to address this challenge. “Shelter in place” may be a practical solution in these circumstances if the following conditions are implemented:
- In shared rooms, the distance between resident beds should be at least 6 feet and curtains can be used as a physical barrier. However, staff should don and doff the appropriate PPE between residents in the same room.
- Increase the frequency of environmental cleaning and disinfection.
- Do not cohort residents based on symptoms only.
In general, assisted living facilities and other congregate care settings (e.g., group homes) whose staff provide non-skilled personal care (e.g., bathing, dressing) similar to what is provided by family members in the home should follow community prevention strategies based on COVID-19 hospital admission levels. Additional recommendations for these settings are outlined in the CDC COVID-19 Congregate Living Settings guidance.
However, visiting or shared healthcare personnel who enter the assisted living facility to provide healthcare (e.g., physical therapy, wound care, intravenous injections, catheter care) to one or more residents should follow the healthcare IPC recommendations. Also, staff providing in-person services for a resident with SARS-CoV-2 infection should follow the healthcare IPC guidance.
The Virginia Department of Social Services provides additional guidance for assisted living facilities regarding implementation of the CDC recommendations including masking, screening, and visitation in a memo issued on October 26, 2022.
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