On March 4, 2020, the Centers for Disease Control and Prevention (CDC) broadened its criteria for evaluating persons under investigation (PUI) for COVID-19 as access to COVID-19 testing expands to more locations.

As of March 12, 2020, testing for SARS-CoV-2, the virus that causes the COVID-19 illness, will be available at the Guam Public Health Lab (GPHL). As DPHSS continues to monitor for possible cases of COVID-19 and to keep our community safe, GPHL will test specimens from patients who meet the following criteria:

1. COVID-19 PUI- “Patients with symptoms of COVID-19 and are at high risk.”
   • Hospitalized patients with:
     • Fever and signs/symptoms of a lower respiratory illness (e.g., cough or shortness of breath) AND a history of travel from affected geographic areas within 14 days of symptom onset
     • Fever with severe acute lower respiratory illness (e.g., pneumonia, acute respiratory disease syndrome [ARDS]) without alternative explantory diagnosis (e.g., influenza)
   • Persons with clinical signs/symptoms of COVID-19 who have had close contact with a laboratory confirmed COVID-19 patient within 14 days of symtpom onset
2. SURVEILANCE CASE- “Patients that a clinician has judged should be tested, but does not meet the COVID-19 PUI criteria.”
   • Surveillance cases of COVID-19 will be evaluated on a case-by-case basis. Testing of surveillance cases may be capped based on testing availability. Clinicians should work with DPHSS to coordinate testing through GPHL. Clinicians should use their judgement to determine if a patient has signs and symptoms comaptible with COVID-19 and whether the patient should be tested. Most patients with confirmed COVID-19 have developed fever and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing). Clinicians are strongly encouraged to test for other causes of respiratory illness (e.g., influenza).

Priorities for testing surveillance cases include:

• Symptomatic individuals such as older adults (age > 65 years) and individuals with chronic medical conditions and/or an immunocompromised state that may put them at higher risk for poor outcomes (e.g., diabetes, heart disease, receiving immunosuppressive medications, chronic lung disease, chronic kidney disease).
• Any persons including health care personnel, who within 14 days of symptoms onset had close contact with a suspect or laboratory-confirmed COVID-19 patient, or who have a history of travel from affected geographic areas within 14 days of symptoms onset.

 Mildly ill patients should be encouraged to stay home and contact their healthcare provider by phone for guidance about clinical management. Patients who have severe symptoms, such as difficulty breathing, should seek care immediately. Older patients and individuals who have underlying medical conditions or are immunocompromised should contact their physician early in the course of even mild illness. 

After Identifying a PUI

If a patient meets the PUI or surveillance case criteria described above, providers should immediatelty notify DPHSS and implement recommended infection prevention and control practices (https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html) as well as notify infection control personnel at the health care facillity. 

Once a PUI or surveillance case has been determined, health care personnel (HCP) should collect specimens required for COVID-19 testing: one (1) nasopharyngeal (NP) swab. HCP collecting specimens for COVID-19 testing from PUIs and surveillance cases should adhere to Standard, Contact, and Airborne Precautions, including the use of eye protection. These procedures should take place in an Airborne Infection Isolation Room (AIIR) or in an examination room with the door closed. Please follow GPHL’s guidelines for proper Specimen Collection, Submission, and Transport. 

A patient who has been identified as a PUI will be isolated at a health care facility. DPHSS will begin contact tracing (tracking down contacts of the PUI and ask them to stay home in order to prevent the illness from spreading further).

A surveillance case will be home isolated until results from the test specimen is known.

GPHL relocated from its Mangilao facility to the third floor of the RAN-CARE Building at 761 South Marine Corps Drive, Tamuning, Guam 96913.

For more information, contact Anne Marie Santos, GPHL Laboratory Administrator via email at AnneMarie.Santos@dphss.guam.gov. 

LINDA UNPINGCO DENORCEY, MPH

DIRECTOR