BCHHS Public Health Provider Alert: Updated COVID-19 testing guidance

May 18, 2020

Situation Update:

  • As of 2pm on 5/16/2020, there have been a total of 134 lab-confirmed cases of COVID-19 in Buncombe County residents, including 4 fatalities. Basic demographic information on Buncombe County cases is updated daily on the Buncombe County COVID-19 data dashboard.
  •          Late this week, we announced the first outbreaks of COVID-19 in two long-term care facilities in Buncombe County. All staff and residents in those facilities have been tested and retesting is scheduled for those initially testing negative. We are working closely with those facilities to ensure proper infection control practices are being followed to prevent further spread as well as to make sure they have the resources they need to keep residents and staff safe. More detailed info on outbreaks in NC congregate living settings can be found on the NC DHHS website.


Updated Provider Guidance

  •          The new state guidance states that providers should ensure the following populations have access to testing:
    •    Anyone with symptoms suggestive of COVID-19
    •    Anyone (with or without symptoms) who is a close contact of a known positive case
    •    Anyone at higher risk of exposure or at a higher risk for severe disease:
      •   Persons who live in or have regular contact with high-risk settings (e.g., long-term care facility, homeless shelter, correctional facility, migrant farmworker camp)2
      •   Persons who are at high risk of severe illness (e.g., people over 65 years of age, people of any age with underlying health conditions)
      •   Persons who come from historically marginalized populations
      •   Healthcare workers or first responders (e.g. EMS, law enforcement, fire department, military)
      •   Front-line and essential workers (grocery store clerks, gas station attendants, etc.) in settings where social distancing is difficult to maintain
  •          This guidance represents a big push to expand testing as the state moves through the phases of easing back on restrictions.
  •          At this time, for diagnostic testing for SARS-CoV-2 (the virus that causes COVID-19), CDC recommends collecting and testing an upper respiratory specimen.
    •    The following are acceptable specimens (there is no longer any preference and all can be used for symptomatic or asymptomatic individuals):
      •   A nasopharyngeal (NP) specimen collected by a healthcare professional; or
      •   An oropharyngeal (OP) specimen collected by a healthcare professional; or
      •   A nasal mid-turbinate swab collected by a healthcare professional or by a supervised onsite self-collection (using a flocked tapered swab); or
      •   An anterior nares (nasal swab) specimen collected by a healthcare professional or by onsite or home self-collection (using a flocked or spun polyester swab); or
      •   Nasopharyngeal wash/aspirate or nasal wash/aspirate (NW) specimen collected by a healthcare professional.
    •    Testing lower respiratory tract specimens is also an option. For patients who develop a productive cough, sputum should be collected and tested for SARS-CoV-2. 
  •          If you are unable to collect specimens for COVID testing in your clinic, please refer your patients who meet the above criteria to one of the local clinics that are providing testing or to one of the community-based testing sites run by Western North Carolina Community Health Services in partnership with Buncombe County.
  •          I recognize that the state’s new guidance is lacking some important information including when to repeat testing in an asymptomatic individual with a negative COVID test and ongoing risk.
    •    That guidance is being determined. For now, the focus of the state is to get individuals in these higher risk groups tested at least initially.
    •    I have been told that this coming Thursday (5/21) evening NC DHHS COVID-19 Healthcare Professional Webinar Series will be focused on testing. Additional info about that webinar will be announced early next week.
  •          Please review and provide the Person Under Investigation Guidance (English and Spanish) to all patients undergoing testing and make sure they understand they need to stay isolated until their test is negative or they meet criteria for release from isolation.
    •    If you identify an individual who is unable to isolate or quarantine safely in their place of residence or who is unhoused and needs a place to isolate or quarantine, contact our Communicable Disease staff at 828-250-5109. Buncombe County has Isolation & Quarantine housing available for free for those in need.
    •    With regard to test results, I encourage you to follow the guidance we all learned in school – treat the patient, not the number/test. If your clinical suspicion is high for COVID in an individual whose test comes back negative, encourage them to follow isolation guidance. Issues with test characteristics, the timing of testing in the course of infection, and specimen collection remain.
  •          To enable us to know what our local trends are related to testing & percent positivity, we continue to track the number of tests performed in Buncombe County residents. Please fax a completed Communicable Disease Report Form to 828-250-6169 on anyone you test for COVID-19. Make sure to complete the basic demographic data on the form as we are using that information as part of an equity analysis of testing in our county.

Multisystem Inflammatory Syndrome in Children Associated with COVID-19

  •          Please see the attached information and guidance for clinicians on multisystem inflammatory syndrome in children associated with COVID-19.
  •          NC DHHS is requesting voluntary reporting of cases of this syndrome to the Communicable Disease Branch epidemiologist on call at 919-733-3419.

This remains an ever-changing situation. Please continue to check the CDC and NC DHHS websites for more information. Contact the Buncombe County Communicable Disease staff at 828-250-5109 (available 24/7) or the NC Division of Public Health epidemiologist on-call line at 919-733-3419 (available 24/7) for additional consultation about COVID-19 or other public health concerns.

Encourage everyone to follow the 3 W’s when they leave their home – Wear a cloth face covering. Wait 6 feet apart from others. Wash hands often or use hand sanitizer.

Continued thanks for everything you are doing to keep our community safe and healthy,

Jennifer Mullendore, MD, MSPH


Health & Human Services,

Medical Director &

Interim Health Director

p. (828) 250-6308  c. 828-989-6145

40 Coxe Ave. - Asheville, NC 28801

Respect. Honesty. Integrity. Collaboration. Equity.