I received the following guidelines on testing from the Connecticut Department of Health today. There are two documents, and I have simply copied them here: The second one is a FAQ (frequently asked questions) I have not included the references although for the sake of time I’ve left the footnotes in.

INFECTIOUS DISEASES SECTION
COVID-19 Testing: Recommendations for the Use of Nucleic Acid Tests to Diagnose Persons with Current Infection with SARS-CoV-2 Virus
(6-16-2020)
This guidance details the current public health recommendations for COVID-19 testing in Connecticut. Health care professionals will order this kind of test to diagnose and treat a person who is sick or may be infected with COVID-19. Public health professionals will use the results of these tests to identify and control new outbreaks of COVID-19, especially in communities where the risk of serious illness and death from COVID-19 is high.
TYPES OF TESTS1
SARS-CoV-2 is the name of the virus that causes COVID-19. Nucleic acid tests such as reverse transcriptase polymerase chain reaction (RT-PCR) help determine if a person is infected with the SARS-CoV-2 virus.
The following recommendations are for the use of nucleic acid tests to diagnose persons with current infection with SARS-CoV-2 virus and will be updated periodically, as needed.
This document does not cover the use of antibody tests to help determine if someone was infected with SARS-CoV-2 virus in the past.
WHO CAN ORDER A DIAGNOSTIC TEST FOR COVID-19?
An order by a licensed health care provider is required to obtain a test for COVID-19.2 Health care providers who can order a COVID-19 test include physicians, nurse practitioners, physician assistants and pharmacists. An individual health care provider for a specific patient may issue an order or a provider facilitating COVID-19 testing at a community, hospital, pharmacy, or other site may issue the order. A consultation with a provider may be advised but is not required before getting the test.
Information about testing sites in Connecticut is available from 2-1-1. Some sites only test symptomatic persons and others test both symptomatic and asymptomatic persons. Page 2 of 5

WHO SHOULD GET TESTED?
At the onset of the COVID-19 pandemic, nucleic acid testing was not widely available, and testing was limited to symptomatic individuals who may have been in contact with someone who was ill with COVID-19. Now that testing is more widely available, testing is recommended for all persons who are symptomatic and for those without symptoms in certain circumstances.
The goals of testing people without symptoms in certain populations or groups include the following: 1) prevent transmission in congregate settings among high risk persons; 2) inform infection control measures in healthcare settings and congregate facilities; and 3) protect persons living and working in high risk settings.
Symptomatic persons
Symptomatic persons are the highest priority for testing. Persons who test positive for the virus that causes COVID-19 need to be isolated and their close contacts need to be identified and asked to self-quarantine.
The virus that causes COVID- 19 is still being passed from person-to-person in Connecticut, although much less than what was seen in April and early May 2020. Persons that have any of the following symptoms should talk to a health care provider about being tested for COVID-19 or seek testing at a community site, even if these symptoms are mild:
a. Fever or feeling feverish
b. Cough
c. Difficulty breathing
d. Sore throat
e. Muscle or body aches
f. Vomiting or diarrhea
g. New loss of taste or smell

Contacts to persons with COVID-19
Testing is recommended for asymptomatic persons who are contacts of persons with confirmed or probable COVID-19.3,4 Persons who are contacts to a person with COVID-19 should quarantine for 14 days after their last exposure to that person. If an asymptomatic person who had been in close contact with a person with laboratory-confirmed COVID-19 tests negative during their 14-day quarantine period, this person should continue to observe quarantine for the full 14-days by remaining separated from others within their residence and monitoring for symptoms.
The Centers for Disease Control and Prevention (CDC) defines a close contact as someone who was within 6 feet of an infected person for at least 15 minutes starting from 2 days before illness onset (or, for asymptomatic patients, 2 days prior to specimen collection).5
Asymptomatic persons
Testing of asymptomatic persons is not a replacement for other measures to prevent the spread of SARS-CoV-2, including wearing appropriate personal protective equipment (PPE)6, social distancing (when possible), wearing of facemasks or cloth face coverings in congregate settings (“universal source control”), good hand hygiene, and regular cleaning and disinfection procedures.
Because some groups (see below) have been shown to be at higher risk for infection and rapid spread of COVID- 19, repeated testing is recommended for asymptomatic persons without a history of recent infection in these groups for as long as infection remains present in those settings. Page 3 of 5

RECOMMENDATIONS FOR TESTING CERTAIN GROUPS
Nursing Home and Assisted Living residents and staff7–10
Symptomatic residents and staff should have rapid access to testing. In addition, to contain spread both the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) recommend weekly testing of asymptomatic nursing home residents and staff (who have not previously tested positive) until there have been no new positive test results for 14 days among either residents or staff. Once these criteria are met, testing of asymptomatic residents and staff can be discontinued; weekly testing should resume when a single new confirmed or suspected case of COVID-19 is identified among residents or staff.
Residents and staff who have previously tested positive for SARS-CoV-2 do not need to be included in subsequent rounds of testing of asymptomatic individuals. Only residents or staff with no prior positive viral tests should be included in repeated testing of asymptomatic individuals. The same recommendations outlined above should also be applied to assisted living residents and staff.
Department of Correction staff and inmates
Department of Correction (DOC) facilities should have procedures in place to screen all new admissions for symptoms consistent with COVID-19 to facilitate isolation and rapid access to testing.11 In addition to symptom-based screening, DOC facilities should test all new asymptomatic persons on admission before they enter the general inmate population. If it is possible to quarantine new inmates before they enter the general inmate population, testing should be considered at the end of the 14-day quarantine period. Testing should also be considered at the time of release to the community and on transfer to other DOC facilities.
Testing of all staff and inmates currently underway should be completed for all facilities. Retesting of previously negative asymptomatic staff and inmates should continue until there are no new positive test results in a facility. Consideration can be made for retesting to be focused on subunits within a DOC facility if positive test results are concentrated in one area of the facility.
After current testing plans are completed, testing of asymptomatic persons in DOC facilities (staff or inmates) should be conducted for close contacts of confirmed cases among other staff or inmates.
These recommendations might change as CDC recommendations for correctional facilities are updated.
Persons living in high risk communities
COVID-19 incidence has been higher among certain racial and ethnic groups, as well as in low income and densely populated areas. To reduce the impact of COVID-19, testing of symptomatic individuals in these groups should be a priority. Asymptomatic adult individuals should also be offered testing within these communities. This can be done regularly (e.g. monthly) at community-based facilities, through mobile units, or at community testing events with local partners.
Homeless shelters
Shelters should have procedures in place to screen all persons staying at the shelter on entry to the facility for symptoms consistent with COVID-19 and to refer symptomatic persons for rapid access to testing. A negative test should not be a requirement for entry to a homeless or other shelter. If a new case of COVID-19 is identified in a shelter resident or staff, testing of all asymptomatic residents and staff in that facility, should be conducted.12 Page 4 of 5

First responders and law enforcement
Symptomatic first responders and law enforcement staff should have rapid access to testing. Testing should be conducted for asymptomatic first responders and law enforcement staff who have had known close contact to a person with laboratory-confirmed COVID-19, if appropriate personal protection equipment (PPE) was not worn at the time of the interaction.13
Healthcare organizations
Symptomatic health care workers who provide direct patient care are among the highest priority to have rapid access to testing for COVID-19. Many Connecticut acute care hospitals are currently testing asymptomatic health care workers and staff to determine prevalence of infection.
Healthcare organizations should develop protocols for testing health care workers and other staff working in their facilities based on CDC recommendations.13 Testing should be conducted for asymptomatic health care workers who have had known close contact to a person with laboratory-confirmed COVID-19 if appropriate PPE was not worn at the time of the interaction.
Congregate Residential Facilities
Many group living facilities (e.g. group homes, residential care homes, residential substance use disorder treatment facilities) are currently testing asymptomatic health care workers, staff and residents to determine prevalence of infection.
Symptomatic residents and staff should have rapid access to testing. If a resident or staff person tests positive, testing of asymptomatic residents or staff who are considered close contacts should be conducted. Testing should be conducted for asymptomatic staff who have had known close contact to a person with laboratory-confirmed COVID-19 if appropriate PPE was not worn at the time of the interaction.

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Frequently Asked Questions (FAQs) on State Testing Strategy June 17, 2020
The Connecticut Department of Public Health (CT DPH) is sharing these Frequently Asked Questions (FAQs) to help answer common inquiries about how to get tested for coronavirus disease 2019 (COVID-19).
If you have additional questions, please visit the state coronavirus website at ct.gov/coronavirus or call 2-1-1.
1. Who should get tested for COVID-19?
• If you are experiencing any symptoms that the Centers for Disease Control and Prevention (CDC) has identified for COVID-19, you need to get tested.
o What are the symptoms of COVID-19?
– People with COVID-19 can have mild symptoms to severe illness. Symptoms can appear two to 14 days after being exposed to the virus.
– Symptoms can include: cough, shortness of breath or difficulty breathing, fever or chills, muscle or body aches, sore throat, headache, nausea or vomiting, diarrhea, runny nose or stuffy nose, fatigue, recent loss of taste or smell. Children have similar symptoms to adults and generally have mild illness.
• In certain situations, it is recommended that you to be tested if you are a health care worker, first responder, congregate care facility resident or staff (includes nursing homes, assisted living facilities, residential care homes, group homes, correctional institution) homeless, or living in communities hardest hit by the pandemic. Some of these situations include being exposed to someone with COVID-19 or working in a congregate setting where COVID-19 can spread easily (e.g. nursing homes, assisted living or correctional facilities).

2. What type of test should I get for COVID-19?
• There are two types of tests available for COVID-19: a nucleic acid test which is used to diagnose a person with current infection with the SARS-CoV-2, the virus that causes COVID-19, and an antibody test that helps determine if someone was infected with the SARS-CoV-2 virus in the past.
• If you are having symptoms for COVID-19, or are not sick but want to know if you might have the virus right now, you should have a nucleic acid diagnostic test.
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3. How do I get tested for COVID-19?
• If you think you have COVID-19 and feel like you have symptoms, you should first call your primary care provider to talk about your symptoms and get scheduled for a test. Many primary care providers are set up to test their patients on site.
• Drive-up and walk-up testing is available at acute care hospitals, urgent care centers, community health centers and certain pharmacy based testing sites. Please call 2-1-1 or visit www.211ct.org to find a testing location near you.

4. I don’t have a primary care provider. Does that mean I can’t get tested?
• If you don’t have a primary care provider, you can still get tested for COVID-19. There are places like community health centers across the state that are taking new patients. They offer on-site health evaluations as well as on-site COVID-19 testing. Please call 2-1-1 or visit www.211ct.org to find a testing location near you.
5. I’ve heard that there are walk-up COVID-19 testing sites. Is this true?
• Yes. There are many walk-up testing sites available in Connecticut. Please call 2-1-1 or visit www.211ct.org/search to find a testing location near you.
6. What will I be charged for a COVID-19 test?
• For those with symptoms of COVID-19, private insurance carriers and the state’s HUSKY Health Program will not charge out-of-pocket costs for COVID 19 testing. Health insurers have voluntarily waived cost sharing for testing on a temporary basis. Any person enrolled in a fully-insured or self-insured health plan will not pay any out of pocket costs. The State Medicaid and Children’s Health Insurance programs, known as HUSKY Health, are covering all costs for testing. Any individual enrolled in a HUSKY Health plan will not pay out of pocket costs. In addition, HUSKY Health is now covering COVID-19 testing for uninsured Connecticut residents who are U.S. citizens or have a qualifying immigration status, regardless of income; and covering COVID-19 testing for residents without a qualifying immigration status if they meet HUSKY income requirements and have COVID-19 symptoms.

7. Can I get tested for COVID-19 if I don’t have health insurance? 3

• Yes. There are several options to get a free COVID-19 test, regardless of your health insurance or immigration status:
o Make an appointment to get tested at a community-based health center or one of their pop-up locations. Many of these sites offer drive-up and walk-up testing options. When you make an appointment, confirm that the site provides free testing and related services for people without health insurance, regardless of immigration status. Please call 2-1-1 or visit www.211ct.org/search to find a testing location near you.
o Testing is available at various pharmacy based testing locations throughout the state. Go online to be pre-screened for CVS rapid testing and get an appointment.

8. How can I get a COVID-19 test quickly?
• If you need to get a COVID-19 test quickly, CVS Health is offering free drive-up rapid testing. Go online to be pre-screened for an appointment. The rapid testing site will not test people who do not have an appointment or who do not meet the testing criteria.

9. How long will I have to wait to get the results of my COVID-19 test?
• CVS Health testing sites will offer rapid results, usually within 15 minutes. Tests done at other sites will come back in about three to five days. While you are waiting for your test results, it is very important to stay at home and isolate yourself to avoid spreading your symptoms to others.
10. What happens if I test positive?
• Stay at home, wash your hands frequently, wear a face mask (or a cloth face covering if a mask is not available), stay away from other people in your home, and clean “high-touch” surfaces” (doorknobs, railings, phones, counters, faucet handles) every day.
• Your name and contact information will be shared with public health staff at the Connecticut Department of Public Health to help with contact investigation.
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• Someone from CT DPH or your local health department will call you and ask you for a list of people you have had close contact with while you were sick or just before you got sick.

• A contact tracer will only contact you for health matters related to COVID-19 and not for any other reason
• You can leave your home if these two things have happened:

o You must have had no fever for 72 hours (three days) without the use of fever reducing medications, and your respiratory symptoms (cough, shortness of breath) must be getting better; and
o At least 10 days have passed since your symptoms first appeared.
• If you had no symptoms but tested positive, you should stay home until 10 days after your positive test.
• If any of your symptoms get worse, call your healthcare provider.

11. What happens if I test negative?
• If you start having any symptoms of COVID-19 after the test, call your healthcare provider and ask if you should be tested again.
• Wash your hands often and practice social distancing (six feet between you and other people).
• Wear a cloth face covering when you leave your house.
• If you get sick, stay home from work.
• Clean “high-touch” surfaces” (doorknobs, railings, phones, counters, faucet handles) every day.
If you test negative for COVID-19, you most likely were not infected at the time of your test. It is also possible that you were tested very early in your infection and you could test positive later. It is also possible you could be exposed later and get sick. This means that even with a negative test, it is important for healthcare workers and others who work with vulnerable populations to stay home from work while experiencing any symptoms.
12. Why isn’t the State testing everyone in Connecticut? 5

• Testing is an important part of our pandemic response, but it is not the only part. Other behaviors – wearing a mask, hand washing, social distancing, and cleaning – are equally important tools.
• Testing people who have COVID-19 symptoms is still critical.
• For people without symptoms, we are focused on testing people in areas hit hardest by the virus. We are also offering testing to people working in close-contact environments. This will help us monitor the virus and identify places that need support from the health department.

COVID-19 6/17/2020

June 17, 2020

Not much has changed since my last post. In my practice, I am not seeing any increase in respiratory or febrile illness in the last few weeks.

The New York times now follows COVID-19 numbers county by county across the country. The site for Connecticut can be found here.

The current numbers do show a slight uptick in the last few weeks in Windham county, more so in New London County, but have been falling in Tolland county.

Other states can also be accessed from that site. Rhode Island is showing a current uptick in Providence County, and Massachusetts is showing falling rates across all counties.

Some of the increases may be due to changes in the way that the statistics are compiled, with “probable” cases now being included, but I don’t know if that applies in Connecticut or the other states I’ve mentioned.

Nationally, as you probably know, with the recent re-openings many places are showing an increase in cases. As I have previously discussed, rural areas are relatively protected due to the ease of social distancing which is otherwise very difficult in more population-dense areas.

All this leads me to maintain caution. With attention to masks and social distancing, outings which are necessary are probably low-risk, assuming that your destination is not over-populated and is one where others are maintaining proper precautions.