Practical Considerations for In-Office Testing for SARS-CoV-2

Decisions about offering in-office SARS-CoV-2 testing may involve many factors, including:

• Staffing availability
• Equipment and supply availability and cost
• Access to specific testing platforms
• Staff training and need for CLIA certification for some platforms
• Patient/family convenience and access to other sites for testing
• Reporting and other regulatory requirements
• Potential for increased wait times if families wait for results

PPE requirements: The AAP has published Interim Guidance for the Use of Personal Protective Equipment (PPE) for Pediatric Care in Ambulatory Care Settings During the SARS-CoV-2 Pandemic. PPE is often necessary for testing but depends on the test being used (saliva vs nasal vs nasopharyngeal specimens), the developmental age of the patient and the potential to aerosolize during the testing process. At a minimum, the use of gloves, face mask and eye protection is necessary for all specimen handling and collection. When collecting samples using nasopharyngeal swab; for patients for whom crying, gagging or coughing is likely; or for patients who are otherwise deemed as higher risk, such as high suspicion of SARS-CoV-2 infection based on household contacts, the addition of gowns and N95 masks is encouraged. Gowns and gloves should be changed between each collection. For tests that can be administered as self-swabs, no additional PPE is required (although staff members must directly observe to ensure adequate sample collection).

Reporting test results to local public health authorities: At a minimum, pediatricians should follow state and local guidelines regarding reporting test results to public health officials to allow for contact tracing and quarantine, if appropriate. Local and state health department guidelines on reporting persons under investigation (PUIs) may vary; however, the CDC is not monitoring PUIs at this time. Although many reference laboratories will report testing directly to local health departments, point-of-care testing requires daily submission of positive, and sometimes negative, results depending on state requirements. This is relevant to pediatricians who elect to perform in-office testing.