Coronavirus Disease 2019 (COVID-19) Outbreak, Update # 21

On September 2, 2020, NH DHHS issued health alert COVID-19 outbreak update #21 regarding updated recommendations on antigen testing and new school guidance. 

Key Points and Recommendations:

• NH DPHS continues to recommend that schools and businesses exclude persons with new or unexplained symptoms of COVID-19, even mild symptoms (e.g., rhinorrhea, nasal congestion, etc.). If these individuals are not tested for COVID-19 (using a PCR- or antigen-based test), then they should be excluded for at least 10 days from the onset of their symptoms following guidance for discontinuation of isolation. 
• Multiple antigen-based tests are available for rapid diagnosis of COVID-19 under the Food and Drug Administration (FDA) Emergency Use Authorization (EUA). See the table in the full health alert for a summary of the different tests and characteristics, including links to manufacturer instructions.
  • We continue to recommend that antigen testing be used only in symptomatic individuals and advise against their use for screening or testing asymptomatic persons. 
  • Use of antigen testing should ideally occur within 5 days of symptom onset, even though newer platforms (LumiraDX and BinaxNOW) allow for testing longer after symptom onset. 
• To facilitate rapid testing for symptomatic persons, NH Division of Public Health Services (DPHS) recommends that providers and ambulatory practices consider implementing point-of-care testing for their patients, as previously recommended. 
• Most point-of-care tests (e.g., for COVID-19, Strep, influenza, etc.) are limited by decreased sensitivity. Providers should use clinical judgement when deciding whether a negative result on a point-of-care test (either an antigen- or molecular-based test [e.g., Abbott ID NOW]) requires confirmation with a laboratory-based molecular (RT-PCR) test. 
  • When testing is conducted early after symptom onset and suspicion is low for COVID-19 (e.g., community transmission is low, patient does not have an identified exposure risk for COVID-19, etc.), confirmation of a negative result may not be necessary. 
  • Consider confirming any negative result in a symptomatic patient with a high suspicion for COVID-19 (based on risk factors, symptoms, etc.). 
• Most point-of-care tests are not automatically reported to NH DPHS. Therefore, providers must report all positive test results from point-of-care testing (including PCR- and antigen-based tests) by submitting a completed COVID-19 Case Report Form.

School Guidance:

• NH DPHS has released new guidance for schools (grades K-12) defining levels of community transmission and school impact to guide when schools should consider transitioning between different instructional models (in-person vs. hybrid vs. remote). 
• To facilitate tracking community transmission and school impact, a new data analytics dashboard has been created and will be updated daily (see “Schools” tab): https://www.nh.gov/covid19/dashboard/overview.htm.