The California Department of Public Health has issued new guidance that establishes a tiered system to determine who should get COVID-19 tests and the priority order for processing those tests. 

When announcing the new guidelines, California Health and Human Services Secretary Mark Ghaly, M.D., said that the surge in COVID-19 cases has set California back, requiring health care workers to once again prioritize testing for those who are suffering symptoms, including fever, shortness of breath and fatigue.

The new guidelines prioritize testing based on four tiers: 

1. Hospitalized patients with COVID-19 symptoms, close contacts of confirmed cases and people who may be linked to outbreaks.
2. All others with COVID-19 symptoms, as well as asymptomatic individuals in high-risk situations, including health care workers, those who live or work in congregate care facilities, and patients being screened for surgery.
3. Other frontline workers, including individuals working in retail, food service, agricultural, public transit and education who have frequent interactions with the public. 
4. All other people without symptoms.

The new guidelines direct labs to prioritize processing tests according to these tiers. Individuals in the lowest priority 4th tier will only  be able to get tested when the state’s testing turnaround time , as monitored by CDPH, is less than 48 hours.

CDPH also emphasized that employers may not use testing to impermissibly discriminate against employees who have previously tested positive for COVID-19, and proof of a negative test should not be required prior to returning to the workplace after documented COVID infection. 

This does not mean an employer must allow an employee who currently has COVID-19 to return to work before the employee's infection is resolved. Rather, it means that employers cannot discriminate against employees who have had positive COVID-19 tests, and that symptom- or protocol-based criteria should be used in determining when an employee is safe to return to the workplace.

CMA Urges Action to Expand Availability of Testing Supplies

Adequate testing is a key component to getting this pandemic under control and reopening our state. The California Medical Association (CMA) is concerned that public health officials are encouraging patients to seek tests through existing community health care providers—such as physician offices, health center and pharmacies—rather than large-scale testing sites.

“Providing COVID-19 tests through physician offices, pharmacies and health centers can ensure more coordinated patient care, but this care requires access to COVID-19 testing materials that continue to be in short supply,” said CMA President Peter N. Bretan, Jr., M.D; California Primary Care Association President and CEO Carmela Castellano-Garcia; and California Pharmacists Association CEO Susan Bonilla in a joint statement. “However, we want to make clear that most physician practices, health centers and pharmacies simply do not have the supplies on hand to meet the current need for COVID-19 testing.”

Physicians, community health centers and pharmacists cannot collect samples or process them without adequate supplies—including PPE, test kits and reagents—which they currently do not have. Providers must also be adequately reimbursed for collecting test samples and CMA looks forward to working with the California Department of Managed Health Care on implementation of its new regulations that require health plans to cover COVID-19 tests.

COVID-19 is here for the foreseeable future and California desperately needs to build a supply chain that will ensure California physicians, pharmacists and other health care providers have the supplies they need to provide California residents with the tests necessary to suppress this growing pandemic. CMA is urging the Governor to commit state resources to immediately expand the supply of COVID-19 testing materials available to physicians, pharmacies and community health centers.