As more is learned about COVID-19, the Alabama Department of Public Health (ADPH) is providing updated guidance about testing priorities, listing and defining types of tests and quarantine and isolation requirements for COVID-19 patients and their contacts.
"No one is immune to COVID-19, but it impacts some populations and communities disproportionately," ADPH stated in a press release Thursday. "Everyone has a responsibility to help slow the spread of the virus in their homes, workplaces, educational institutions and other places within their communities. ... COVID-19 testing resources are not sufficient to test every person at this time."
As of Thursday night, there have been a cumulative number of 107,483 confirmed COVID-19 cases in Alabama since the beginning of the pandemic. Of those, 13,248 have been confirmed in the last two weeks.
There have been a total of 905 confirmed cases in Tallapoosa County, 62 of those in the last two weeks; 109 in Coosa County, seven of those in the last two weeks; and 1,882 in Elmore County, 204 of those in the last two weeks.
Because of limited testing resources, ADPH recommends the following guidance in a health alert network message to providers.
Testing priorities for patients and laboratories:
Hospitalized individuals with signs or symptoms of COVID-19 infection
Other symptomatic individuals and higher risk asymptomatic individuals including but not limited to those in long-term care facilities
Other individuals not experiencing symptoms when certain conditions exist
Types of tests:
Diagnostic tests assess the presence of the virus at a given point in time. A negative means only that an individual was negative at the time of the test. This can be impacted by factors including but not limited to the quality of the specimen collected, the timing of collection during the incubation period, and the handling of the specimen.
Polymerase Chain Reaction (PCR) tests and Nucleic Acid Amplification testing (also known as viral tests) detect 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. Some of these tests are now available at the point of care.
Antigen tests detect the presence of COVID-19 specific protein particles and are collected via a respiratory sample. Currently, two approved point-of-care tests are being utilized.
Serology (antibody) tests are not diagnostic tests. These tests detect antibodies in the blood indicating possible prior exposure to COVID-19 which may develop 6-14 days after infection. Commercially available antibody tests have variable performance.
Isolation, quarantine and employer requirements about returning to work and retesting:
At the time of testing, persons are instructed to isolate at home while awaiting test results. Persons who are close contacts to COVID-19 cases must complete at least a 14-day quarantine period even with a negative test.
Individuals who test positive for COVID-19 should isolate from others in the home to reduce the risk of spread. If those who test positive cannot isolate from household members, then household members must remain in home quarantine 14 days after the person who tested positive is released from isolation.
Employers should not routinely require a negative laboratory COVID-19 test as a requirement for employees to return to work. This is because PCR tests can remain positive long after an individual is no longer infectious. Instead, symptom- or time-based methods are recommended with some very rare exceptions. However, 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.
Persons who tested positive for COVID-19 and have recovered do not need to be quarantined again or be re-tested for at least 90 days unless they develop new symptoms consistent with COVID-19 infection.
Close contacts and when to leave quarantine:
A close contact is anyone who has known exposure defined as being within 6 feet of a COVID-19 infected person for 15 minutes or greater within a 24-hour period. The 15-minute time is a cumulative period of time. For example, a close contact might be within 6 feet of a COVID-19 positive person for five minutes each at 8 a.m., noon and 5 p.m. This is a standard based on guidance from the CDC.
A person who is a close contact to a confirmed or probable COVID-19 case must complete at least a 14-day quarantine period, regardless of whether a face covering, or regular mask was worn.
Persons with known exposure who are determined to meet the close contact definition cannot leave quarantine, regardless of whether they test negative for COVID-19. This means that a negative COVID-19 test will not allow them to return to work, school or participate in sports or other activities. This is because a person who has been exposed to COVID-19 and meets the close contact definition has up to 14 days to become infected from the time of exposure. This period may be even longer for a small number of people.
Allowances regarding close contacts are made for healthcare personnel who wore the appropriate personal protective equipment.
For more information about COVID-19, visit alabamapublichealth.gov.