Related Materials: Antigen Tests Fact Sheet (PDF) | Antigen, PCR, and Serology Tests Fact Sheet (PDF) | More Healthcare & Testing Guidance |All Guidance
As of June 15, the state transitioned Beyond the Blueprint, where all industry and business sectors listed in the current Blueprint Activities and Business Tiers Chart may return to usual operations with no capacity limits or physical distancing requirements, with limited exceptions for mega events.
Furthermore, as we increase access to the COVID-19 vaccines, adapting testing guidance to focus testing on high-risk populations and individuals who have not been vaccinated allows us to further mitigate the spread of the virus by assisting with early detection and deploying both pharmaceutical and non-pharmaceutical preventative interventions when cases and outbreaks are identified.
As case rates decline, testing provides better insights into community prevalence and transmission as well as enabling us to perform genomic sequencing on respiratory samples from infected people to monitor the introduction of new variants into the community and the evolution of the virus.
Testing is one layer in a multi-layered approach to COVID-19 prevention, in addition to other key measures such as vaccination, mask wearing, improved ventilation, physical distancing, and respiratory and hand hygiene.
Local jurisdictions may modify these guidelines to account for local conditions or patterns of transmission. Additionally, the California Department of Public Health (CDPH) will continue to reassess this guidance and adjust accordingly based on emerging evidence and U.S. Centers for Disease Control and Prevention (CDC) updates.
Diagnostic testing for COVID-19 is used to test an individual for SARS-Cov-2 infection. SARS-Cov-2 is the virus that causes COVID-19.
CDC's list of symptoms of COVID -19 includes fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea. Severe symptoms of COVID-19 include but are not limited to trouble breathing, persistent pain or pressure in the chest, new confusion, inability to wake or stay awake, pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone. Lists are available at the CDC symptoms and testing page.
Diagnostic testing should be considered for all individuals with symptoms or exposure to COVID-19.
Diagnostic testing may be performed using either molecular testing or antigen testing (see details of antigen and molecular testing below in the tests section). For symptomatic individuals who test negative on an initial antigen, repeat molecular testing should be performed within 1 day of the initial test and individuals should remain in isolation until confirmatory molecular test results are available.
Diagnostic screening testing is recurrent testing of asymptomatic individuals in certain high-risk non-healthcare and healthcare settings to detect COVID-19 early and stop transmission quickly.
Diagnostic screening testing can be used as a public health strategy to identify individuals who are infectious with SARS-CoV-2 but have no or very mild symptoms and to have them isolate so that they do not spread infection to others. The goal of screening testing is to detect cases early, and reduce the number of new infections or outbreaks in a given cohort. The CDC estimates that up to 60% of infections are transmitted while individuals are asymptomatic (and includes people who are pre-symptomatic and those who will never develop symptoms).
Fully vaccinated individuals do not need to undergo diagnostic screening testing in non-healthcare setting workplaces.
Non-healthcare workplace settings for which employee screening testing should be considered among non-vaccinated individuals, include:
Employees (Healthcare Personnel – HCP) in Acute Health Care and Long-Term Care Facilities:
Diagnostic screening testing of asymptomatic employees should continue regardless of vaccination status, with the following exceptions:
Employers who conduct workplace screening testing should have a plan in place for tracking test results, conducting workplace contact tracing, and reporting results to public health departments and there are IT platforms available that can facilitate this for employers. Employers should also consult CDPH/ CDC guidance on workplace screening testing for additional cohort specific considerations. Testing is not a substitute for other COVID-19 prevention measures, such as vaccination, mask wearing, physical distancing, improved ventilation, hand hygiene and cleaning and disinfection.
Antigen or molecular tests can be used for screening individuals who are asymptomatic but infected with COVID-19 and must either have Emergency Use Authorization by the U.S. Food and Drug Administration or be operating per the Laboratory Developed Test requirements by the U.S. Centers for Medicare and Medicaid Services. These tests need to be used at different frequencies, please see below for details.
Screening testing frequency with molecular tests
The recommended minimum molecular test screening frequency is once weekly. Molecular testing as a screening tool is most effective when turnaround times are short (<2 days). If the turnaround time is longer than 2 days, screening testing with PCR or NAAT is not as effective of a screening method.
Screening testing frequency with antigen tests
The recommended minimum antigen test screening frequency is twice weekly. Antigen tests conducted serially can be used to screen asymptomatic individuals for COVID-19 and reduce infections.
In some settings (e.g., K-12 schools), screening testing can be used at a cadence of every 2 weeks or less frequently, to understand whether the settings have higher or lower rates of COVID-19 rates than the community, to guide decisions about safety, and to inform LHDs.
Asymptomatic testing at a higher cadence (weekly or twice weekly) can be conducted to identify asymptomatic or pre-symptomatic cases early, in order to exclude cases that might otherwise contribute to transmission.
Screening testing is indicated for situations associated with higher risk (higher community transmission, individuals at higher risk of transmission, etc.).
Post exposure testing for COVID-19 means testing people who are asymptomatic, but have been exposed to a confirmed or suspected case of COVID-19.
Testing in these settings is still recommended because they may face high turnover of residents and/or a higher risk of transmission.
Molecular or antigen tests can be used for post exposure testing.
In general, it is recommended to test immediately after being exposed to someone who has tested positive or has symptoms consistent with COVID-19. If the initial test is negative, and the exposed individual remains asymptomatic, testing is recommended again 5-7 days after exposure. If symptoms develop, diagnostic testing should be performed immediately.
Response testing is repeat testing performed following an exposure that has occurred in high-risk residential congregate settings and high-risk/high-density workplaces, in accordance with CDC guidance. The goal of response testing is to identify asymptomatic infections in individuals in high risk settings and/or outbreaks to prevent further spread of COVID-19. Response testing should be initiated as soon as possible after an individual in a high risk setting has been identified to have COVID-19.
Response testing should occur for all individuals (residents and staff, regardless of vaccination status) in the facility as soon as possible after one (or more) individuals (resident or staff) with COVID-19 is identified in a facility. However, fully vaccinated staff are not required to quarantine or be excluded from work.
Either molecular or antigen testing can be used for response testing. It is recommended using the test with the fastest turn-around time that is available.
The recommended minimum response molecular test frequency is once weekly. Molecular testing as a response testing tool is most effective when turnaround times are short (<2 days). If the turnaround time is longer than 2 days, response testing with molecular tests is not an effective screening method.
The recommended minimum antigen response test frequency is twice weekly. Antigen tests conducted serially can be used for response testing in asymptomatic individuals.
After completion of the first round of response testing, perform serial retesting at least weekly with molecular testing or a minimum of twice weekly with antigen testing of all residents and staff regardless of vaccination status who test negative upon the prior round of testing until no new cases are identified in sequential rounds of testing covering a 14 day period. Facilities should work with their local health department to help with outbreak management.
The Cal/OSHA COVID-19 Prevention Emergency Temporary Standard requires once a week testing (antigen or molecular) of employees duing outbreaks of three or more persons and twice a week testing of employees for outbreaks of twenty or more persons.
Please note: exposed unvaccinated individual(s) should follow CDPH CDC guidelines for quarantine after exposure which can be found below in "Self-Isolation" or "Quarantine". Please refer to CDC guidelines for how to define an exposure to COVID-19.
Pre-entry testing is testing performed prior to someone entering an event, competition, congregate setting, or other venue or business which can reduce the risk of spreading infection for people who are entering these settings. Symptomatic individuals should not be allowed to enter.
Individuals should have pre-entry testing performed if they have not been fully vaccinated  and will be taking part in activities that put them or others at higher risk for COVID-19 exposure. Pre-entry testing should be considered for those attending large indoor social or mass gatherings (such as large private events, live performance events, sporting events, theme parks, etc.), competing in high risk sports, or other events in crowded or poorly-ventilated settings.
Fully vaccinated individuals do not need to undergo pre-entry testing.
Individuals who are not fully vaccinated and must travel should follow pre-entry (pre –travel) testing recommendations in CDC travel guidance before and after travel.
CDPH recommends a point of care test (antigen or molecular) within 24 hours of entry in asymptomatic individuals. If point of care testing is not available, we recommend a molecular test of asymptomatic individuals within 72 hours of the event with results available before entry.
The following are acceptable as proof of a negative COVID-19 test result:
Since there is a possibility of exposure to individuals infected with COVID-19 in gatherings and congregate situations, consider testing 5-7 days after the event if an exposure is suspected and immediately if symptoms develop.
Symptomatic individuals should obtain diagnostic testing and should not be allowed to attend events or gatherings or be admitted to congregate settings; irrespective of their test results.
Testing after a diagnosis of COVID-19
There is no need to get tested after an initial positive confirmatory test to prove that an individual is no longer infectious and can end isolation. The end of isolation should be based on CDC and CDPH guidelines (currently 10 days) and is based on the time from initial diagnosis or symptom onset. Individuals who had a positive viral test in the past 90 days and are now asymptomatic do not need to be retested as part of a screening testing program; testing should be considered again if it is more than 90 days after the date of onset of the prior infection, or if new symptoms occur. For individuals who develop new symptoms consistent with COVID-19 during the three months after the date of initial symptom onset, if an alternative etiology cannot be identified, then retesting for SARS COV-2 can be considered in consultation with infectious disease or infection control experts.
Molecular tests: Molecular tests amplify and then detect specific fragments of viral RNA. Depending on the test, different sequences of RNA may be targeted and amplified. Examples of this method include polymerase chain reaction (PCR), loop-mediated isothermal amplification (LAMP), and Nucleic Acid Amplification Test (NAAT). The real-time reverse transcriptase polymerase chain reaction (PCR) is the most commonly used molecular test and the most sensitive test for COVID-19. PCR is typically performed in a laboratory and results typically take one to three days. Point-of-care (POC) molecular tests are also available and can produce results in 15 minutes, but may have lower sensitivity (might not detect all active infections) compared with laboratory-based PCR tests.
Antigen tests: Antigen tests identify viral nucleocapsid protein fragments. They are typically performed at the point of care (POC) and produce results in approximately 15- 30 minutes. POC antigen tests have a slightly lower sensitivity (may not detect all active infections), but similar specificity (likelihood of a negative test for those not infected with SARS CoV-2) for detecting SARS-CoV-2 compared to PCR tests.
In symptomatic individuals a negative antigen test requires molecular test (PCR, LAMP, NAAT) confirmation and individuals should isolate until test results are available. If an individual is asymptomatic and tests positive with an antigen-based test, conduct confirmatory testing with a molecular test (PCR, LAMP, NAAT) and individuals should isolate until confirmatory test results are available.
These are the only types of tests that are recommended to diagnose COVID-19 infection. The FDA maintains a list of diagnostic tests for COVID-19 granted Emergency Use Authorization (EUA). No test is 100% accurate and test performance can vary depending on a number of test and patient factors as well as the underlying disease burden and pre-test probability in the individual being tested.
As provided by federal law, health plans and issuers must cover the cost of COVID-19 diagnostic tests without imposing any cost-sharing requirements (including deductibles, copayments, and coinsurance), prior authorization, or other medical management when the purpose of the testing is for individualized diagnosis or treatment of COVID-19. Further, health plans and issuers cannot require the presence of symptoms or a recent known or suspected exposure, or otherwise impose medical screening criteria on coverage of tests.
If you are having trouble accessing a COVID-19 test through your health plan or if you have any questions, please contact the Department of Managed Health Care Help Center at 1-888-466-2219 or visit the California Department of Managed Health Care (DMHC) Help Center web page.
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 impermissibly discriminate against employees who have 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). Employees must complete their isolation period as per CDC and CDPH recommendations prior to returning to work. Further, proof of a negative test should not be required prior to returning to the workplace after documented COVID-19 infection.
 Individuals are considered fully vaccinated for COVID-19 two weeks or more after they have received the second dose in a 2-dose series (Pfizer-BioNTech or Moderna), or two weeks or more after they have received a single-dose vaccine (Johnson and Johnson [J&J]/Janssen ), or other COVID-19 vaccines authorized for use by the US Food and Drug Administration or the World Health Organization. See CDPH Recommendations for Fully Vaccinated People for updates.
 Per CDC levels of community transmission definition.: The indicators listed can be found by county on CDC's website with county view CDC COVID Data Tracker
 In California, these sectors have been identified in outbreak, surveillance and death data as settings with the potential for higher risk of COVID-19 exposure.
 Someone who was within six feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period.
 Frequently Asked Questions on Implementation of FFCRA and CARES Act. Centers for Medicare and Medicaid Services. February 26, 2021. FAQ Part 44 Cover Page (cms.gov)
Orignally Published on June 7, 2021