Skip Navigation LinksUpdated-COVID-19-Testing-Guidance

State of Cal Logo
EDMUND G. BROWN JR.
Governor

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


July 14, 2020


TO:
Public health officials, healthcare providers and laboratories

SUBJECT:
Updated COVID-19 Testing Guidance

Originally released: July 14, 2020

Last updated: September 22, 2020


Updates since July 14:
  • As of September 22, 2020, California's testing capacity and turnaround time have improved. As a result and until further notice, all four tiers in the Testing Prioritization Guidance originally dated July 14, 2020 will have equal priority for testing.
  • Close contacts of confirmed cases moved from Tier 1 priority to Tier 2 priority on July 23.
  • The definition of individuals working in the emergency services sector was expanded on August 3.

This guidance is an update to the interim COVID-19 testing guidance issued by the California Department of Public Health (CDPH) on May 1, 2020. This updated guidance is intended to support public health officials, health care providers, and laboratories in determining who should be tested given the current context of the COVID-19 pandemic in California.

What's new in this revision compared to May 1, 2020 Testing Guidance?

COVID-19 testing in California has rapidly expanded over the past three months and we have learned much about COVID-19 and which populations and communities it impacts disproportionately.

Consequently, CDPH recommends first prioritizing testing of hospitalized individuals with signs or symptoms of COVID-19 infection followed by testing of other symptomatic individuals and higher risk asymptomatic individuals and then other asymptomatic individuals when certain conditions exist. This guidance should be used for prioritization of patient populations as well as for the purposes of guiding laboratories in managing specimen processing.


​Tier One Priority

  • Hospitalized individuals with COVID-19 symptoms.
  • Investigation and management of outbreaks, under direction of state and local public health departments (includes contact tracing). 

Tier Two Priority 

  • All other individuals with COVID-19 symptoms.
  • Close contacts of confirmed cases.
  • Individuals who are asymptomatic (having no symptoms of COVID 19), who fall into one of the following categories:
    1. Live in higher risk congregate care facilities including skilled nursing facilities, residential care facilities for the elderly, correctional facilities, or homeless shelters.
    2. Work in the health care sector who have frequent interactions with the public or with people who may have COVID-19 or have been exposed to SARS-CoV-2. The health care sector includes: hospitals; skilled nursing facilities; long-term care facilities; ambulatory surgery centers; health care providers' offices; health care clinics; pharmacies; blood banks; dialysis centers; hospices; and, home health providers
    3. Work in a congregate care facility, including shelters for people experience homelessness and residential care facilities for the elderly.
    4. Provide care to an elderly person or a person with a disability in the home, including a person providing care through California's In-Home Supportive Services Program.
    5. Work in the emergency services sector who have frequent interactions with the public or with people who may have COVID-19 or have been exposed to SARS-CoV-2. The emergency services sector includes police and other public safety departments (including, for example, child protective services and adult protective services departments), fire departments, and emergency service response operations. 
    6. Work in a correctional facility.
    7. Patients requiring pre-operative/pre-hospital admission screening.
    8. Patients being discharged from hospitals to lower levels of care.

Tier Three Priority

The following individuals who are asymptomatic (having no symptoms of COVID 19), and fall into one of the following categories:

  • Individuals who work in the retail or manufacturing sectors who have frequent interactions with the public or who works in an environment where it is not practical to maintain at least six feet of space from other workers on a consistent basis.
  • Individuals who work in the food services sector who have frequent interactions with the public. The food services sector includes grocery stores, convenience stores, restaurants, and grocery or meal delivery services.
  • Individuals who work in the agricultural or food manufacturing sector who have frequent interactions with the public or who works in an environment where it is not practical to maintain at least six feet of space from other workers on a consistent basis. The agricultural or food manufacturing sector includes food production and processing facilities, slaughter facilities, harvesting sites or facilities, and food packing facilities.
  • Individuals who work in the public transportation sector who have frequent interactions with the public. The public transportation sector includes public transit, passenger rail service, passenger ferry service, public airports, and commercial airlines.
  • Individuals who work in the education sector who have frequent interactions with students or the public. The education sector includes public and private childcare establishments; public and private pre-kindergarten programs; primary and secondary schools; and public and private colleges and universities. 

Tier Four Priority

Tier Four would be implemented when the state's testing turnaround time, as monitored by CDPH, is less than 48 hours.

  • Other individuals not specified above including: those who are asymptomatic but believe they have a risk for being actively infected as well as routine testing by employers.


Testing Discrimination and Inappropriate Workplace Testing

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 previously 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).  This does not mean an employer must allow an employee who currently has COVID-19 to return to work before the employee's infection is resolved. Further, because PCR tests can remain positive long after an individual is no longer infectious, proof of a negative test should not be required prior to returning to the workplace after documented COVID infection.  Rather, symptom- or protocol-based criteria should be used in determining when an employee is safe to return to the workplace.

Types of Tests

Diagnostic Tests

Assesses the presence of the virus at a given point in time. A negative means only that an individual was negative at the time the test.

  • Polymerase Chain Reaction (PCR) Tests and Nucleic Acid Amplification Testing:  Detects the RNA genetic material in the COVID-19 virus and are often collected via nasal pharyngeal, mid turbinate, nasal, oral or throat swab or saliva collection. 
  • Antigen Tests: Not currently widely utilized. Detects the presence of COVID-19 specific protein particles and is collected via a respiratory sample. 

Note: No test is perfect. There is a false negative rate and false positive rate that varies depending on the test and the collection modality
Non- Diagnostic Tests

Reminder - These are statewide guidelines. Local jurisdictions may modify these guidelines to account for local conditions or patterns of transmission.

Page Last Updated :