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U.S. Department of Health & Human Services

10/21/2020 | Press release | Archived content

Investigating a COVID-19 Case

Once a COVID-19 laboratory or provider report is received, this information will be entered into the health department surveillance system. With expanded laboratory testing in both public and private sectors, it is important to establish electronic laboratory reporting systems to enhance the timeliness of data to inform public health action.

The health department should use a triage system to use any information known about a patient diagnosed with COVID-19, prior to case interview, to delegate the investigation to either a case investigator or special infection control team (specific settings where a special team is needed are included in Outbreak Investigations).

Health departments can communicate with healthcare providers by phone when a positive laboratory test is reported to obtain information necessary for triaging. Conversely, health departments could request that providers phone-in case information on the same day that a provider receives a positive SARS-CoV-2 test result in a Priority 1 or Priority 2 patient (see Box 1).

In addition to identifying potential outbreaks, information to assist in case prioritization includes a patient's COVID-19 symptoms, underlying health conditions, locating information (residence type/location/contact information), workplace role and location, confirmation that patient was notified of test result, and initiation of self-isolation.

Triage staff should have rapid turn-around times with provider queries (within 24 hours). Triage staff should then prioritize cases for investigation to either a case investigator or special infection control team based on known information. These strategies are only feasible with adequate staff to provide triage support and sufficient patient information available to allow for prioritizing.

For areas that have limited public health resources to investigate all cases, the following case investigation hierarchy (Box 1) can be used to help guide prioritization when information is known about the case. The hierarchy is based on the assumption that clients with a confirmed or probable diagnosis of COVID-19 in Priority 1 are likely to have exposed a larger number of people and/or are likely to have close contacts who could potentially expose many people, those at higher risk for severe disease, or critical infrastructure workersexternal icon . Priority 2 includes clients who may be at higher risk for severe disease and will need prompt risk assessment and linkage to any needed medical and support services. Clients should be prioritized based on the highest priority category they fall into.

When prioritizing clients with a positive SARS-CoV-2 test result or a probable diagnosis of COVID-19 to investigate, jurisdictions should be guided by the local characteristics of disease transmission, demographics, and public health and healthcare system capacity. Decisions should be supported by local guidance and circumstances.