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COVID-19 Testing Task Force
The Loudoun County COVID-19 Testing Task Force was organized to help facilitate the availability of more COVID-19 testing in the community. It provides information and recommendations to the Board of Supervisors and the County Administrator who are closely monitoring the progress of the pandemic.
Purpose
The task force is addressing the following matters:
- Identity the steps necessary to increase the number of COVID-19 tests performed in the county overall.
- Identify the best diagnostic tests and the efforts necessary to have access to those tests, and all necessary testing materials, and safe specimen collection activities.
- Identify future steps to conduct serology, or antibody, testing and provide advisement/recommendations.
Resources
The documents included at the links below have been provided by members of the Loudoun County COVID-19 Testing Task Force as informative resources to physicians and the public. The information does not represent a formal position of Loudoun County Government or the Virginia Department of Health.
- Information for Physicians
- Includes updates from task force infectious disease specialists Dr. Rhee and Dr. Levorson.
- Sanford Guide: Summary of scientific based conclusions on COVID
- Health care practitioners may email our infectious disease advisers to ask questions.
- Task Force Meeting Agendas and Summaries
- Includes meeting summaries and agendas.
- Information for Patients
- If you have been tested for COVID-19 and have questions about the results, additional resource information is included.
Testing Guidance December 2020
There are currently several testing methods to detect the virus that causes COVID-19 and many people have wondered which tests are best and which tests they should seek. The following guidance can help you determine the type of test to request, depending on your specific situation. This is general guidance and your specific care should be discussed with your health care provider. View more about the differences between the antigen (rapid) test and polymerase chain reaction (PCR) test.
Type of Test to Request
- If you have symptoms of COVID-19:
Testing can be done beginning day 1 through 5 of onset of symptoms with either an antigen (rapid) or PCR test. A negative antigen test should be repeated with a PCR test, as it could be a false negative reading. If you test positive for COVID-19, it is important that you self-isolate and stay away from others until it is safe. - If you were exposed to a positive COVID-19 individual and are not experiencing symptoms (asymptomatic):
Testing should be done by PCR test, not antigen, and is best performed on day 5-7 after exposure to a positive COVID-19 individual. If you were exposed, stay home and away from others, quarantine, for 14 days after your last contact. - If you are asymptomatic and were not exposed to a positive COVID-19 individual. You might require a test for travel, returning to college campus or visiting a high-risk individual:
Testing should be done by PCR test, not antigen. A positive antigen test should be repeated with a PCR test, as it could be a false positive reading. You should carefully follow all public health precautions after being tested (PDF).
Loudoun County Testing Locations
Testing Task Force Recommendations
Asymptomatic testing
The Loudoun County Task Force is aware of the confusion regarding the best use and timing of COVID 19 testing if you DO NOT have any symptoms.
The recent statement by the CDC on this topic was interpreted in different ways by physicians, non-physicians, politicians, etc.
Here is a summary of your local trusted Infectious disease experts, healthcare practitioners, Virginia Department of Health and Government officials:
- The CDC states “If you do not have COVID-19 symptoms and have not been in close contact with someone known to have a COVID-19 infection you do not need a test.” There continues to be a nationwide shortage of testing material. Results from PCR testing can take anywhere from 2 to 14 days. In light of this, we agree that mass testing of asymptomatic persons who have no known contact and are not in a high risk group is generally not necessary. This does not apply to routine screening or surveillance testing at work, school, or similar situations.
That said, a known contact of a person with COVID 19, as determined by the Virginia Department of Health, should be tested, if supplies are available, on day 5-7 after exposure. A negative test does not provide absolute assurance that you may end quarantine. We recommend continued avoidance of all high risk individuals for 14 days after your last known contact with the positive case.
Brief description of testing options and interpretation of results:
PCR tests
Done by nasopharyngeal swab (swab inserted DEEPLY into the nasal passage) and detects genetic material unique to the virus (in this case Rna). Complex process and takes time to complete, as the sample must be heated, cooled, and reheated to complete.
This is the most common test done today, but our nation is facing shortages in swabs, testing reagents (like missing yeast to make bread), and there is a back log of tests, where the “turn around” time has climbed to as high as 14 days, rendering the results useless. By the time the results are known, the patient’s contagious period is likely over.
The other problem with this test is that it does not tell you WHEN in the course of the illness you may be presenting. For example, the Rna will stay in a person’s nasopharynx for up to 3 months AFTER you are contagious but is also detectable in the early “asymptomatic” phase.
Example: certain colleges/universities are asking for this test prior to students returning to campus. If negative, it is reassuring that the student is not sick or contagious on the day of the test, and likely has not had the virus in the recent past. But, if positive and they have no symptoms, the student could be on Day 2 post infection (contagious) or Day 50 (non-contagious).
This is why, once a person is known to have tested positive, a negative test is NOT recommended to drive back to work/school decisions.
Antigen tests
This is a test looking for protein from the virus that is unique to that virus only. The most common tests are “cartridge” based tests, used in offices, and have a 15-minute turnaround time. This is performed with a nasal swab (not as far into the nasal cavity).
These are not as sensitive at picking up small viral loads as the PCR. That does not mean they are not useful. WHEN SYMPTOMATIC, the sensitivity is around 80-95 percent. The best time to be tested is Day 1-5 of illness, and sensitivity drops as you reach day 7 (less virus, harder to detect).
These are not useful for asymptomatic screening, hence, the pre-college, or post exposure but asymptomatic patient will still need a PCR.
The utility here is the quick turn around and the ability to identify and isolate a potentially contagious person early.
A salivary test is under review and potentially exciting. This is a take at home test where saliva can be used to identify the spike protein on the outside of the coronavirus. It is less sensitive, but again, the rapid result makes it a possible tool in the prevention of spread within a community if used on a large scale, it could be helpful in reducing disease transmission through early identification.
Social distancing, mask wearing, staying away from others when sick, and seeking medical care when sick are the prudent measures to mitigate this disease. It is just not feasible to test every asymptomatic person every couple of days, as we do not have the testing supplies for such an endeavor.
Antibody Testing
At this time, we do not recommend antibody tests also known as serology testing for COVID-19. The antibody tests that are currently available are NOT specific enough for COVID-19 and false positives are a strong possibility. Remember, about 1/3 of all common colds are in the coronavirus family, and we have all likely been infected with a coronavirus at some point. Therefore a positive test does not mean you have COVID-19 immunity. There is also no evidence to suggest that past infection with COVID-19 is protective against re-infection with COVID-19. In addition, we do not have enough data about how human antibody patterns behave to COVID-19, so we could be seeing false negatives as well depending on how long people make antibodies. As more specific COVID-19 strain antibody tests are developed, these guidelines may likely change, but again at this time, COVID-19 antibody testing is not recommended.
Membership
- Dr. John Farrell, Loudoun Health Council - Chairman
- Charles Yudd, Deputy County Administrator - Co-chair
- Hospital Corporation of America (HCA) - Matthew Mathias
- Inova - Stacey A. Metcalfe and Dr. Jill McCabe
- Loudoun Medical Group - Dr. Kevin O'Connor
- Healthworks - Carol Jameson
- Urgent care facilities - Dr. Roshelle Beckwith and Michelle Fitz (MetroMed) and Dr. John Strazzullo (Patient First)
- Loudoun Free Clinic - Maribeth Goldin
- Dr. Henry Rhee
- Dr. Rebecca Levorson
- Loudoun County Health Department Director Dr. David Goodfriend