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EDMUND G. BROWN JR.
Governor

State of California—Health and Human Services Agency
California Department of Public Health


AFL 17-_
May 11, 2020


TO:
Local Health Departments

SUBJECT:
COVID-19 Outbreak Definition and Reporting Guidance

​Suspected COVID-19 Outbreak

  • Clusters of acute illness compatible with COVID-19* without laboratory testing or with pending laboratory testing.  
  • If laboratory testing in a congregate setting has revealed two or more cases of another laboratory-confirmed respiratory viral infection (not COVID-19), please use the CDPH Influenza and Respiratory Illness Outbreak Quicksheet (PDF) instead of this document. COVID-19 testing may also be considered in these situations, at the discretion of the local health department. 

Laboratory-confirmed COVID-19 Outbreak

  • In a skilled nursing facility: at least one case of laboratory-confirmed COVID-19 in a resident.†
  • In other residential congregate settings: at least one case of laboratory-confirmed COVID-19 in the setting of ≥2 cases of acute illness compatible with COVID-19* in residents or staff members within a 14-day period.†
  • In congregate community settings: three or more laboratory-confirmed COVID-19 cases in different households in a cluster of acute illnesses compatible with COVID-19* with onset within a 14-day period. 

*At least two of the following symptoms: fever (measured or subjective), chills, rigors, myalgia, headache, sore throat, new olfactory and taste disorder(s); OR at least one of the following symptoms: cough, shortness of breath, or difficulty breathing.

†Implementation of infection control measures and active surveillance for additional cases (including testing of asymptomatic residents and staff) should be considered when a single laboratory-confirmed COVID-19 case has been identified in a resident OR staff member, even if other cases of acute illness have tested negative for COVID-19. 

Reporting to Local Health Departments and CDPH

·        Residential congregate facilities should be instructed to notify their local health department (PDF) if they identify a suspected or laboratory-confirmed COVID-19 outbreak, or if they identify a single resident or staff member with laboratory-confirmed COVID-19. 

·        Congregate community settings should be instructed to notify their local health department if they identify a suspected or laboratory-confirmed COVID-19 outbreak.  

·        Local health departments should report laboratory-confirmed COVID-19 outbreaks in residential congregate facilities to CDPH using the Novel Coronavirus 2019 (nCoV-2019) disease outbreak condition in CalREDIE or through an alternate established process. Reporting of suspected outbreaks is optional. 

·        Local health departments should report laboratory-confirmed COVID-19 outbreaks in congregate community settings to CDPH if the local health department assesses the outbreak to have public health importance. 

Laboratory Testing for COVID-19

  • Upper respiratory tract specimens (e.g., nasopharyngeal, nasal, or oropharyngeal swabs in universal viral transport medium) should be submitted for molecular detection of SARS-CoV-2 (the virus that causes COVID-19) via an FDA approved RT-qPCR test kit at a public health laboratory, a clinical laboratory, or a commercial laboratory that is approved to perform this testing by CDPH Laboratory Field Services.
  • Expedited testing of specimens may be available at a public health laboratory in consultation with the local health department. For testing at the CDPH Viral and Rickettsial Disease Laboratory (VRDL), refer to CDPH VRDL COVID-19 testing guidance (PDF)  for details on specimen collection and shipping guidelines.

For additional testing guidance, refer to: CDC guidance for collecting, handling, and testing clinical specimens from persons for COVID-19.


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