The next consideration in the algorithm is whether or not a child presents with symptoms concerning for COVID-19.  If the child is asymptomatic, the ED will NOT test the patient.  Instead, the family will be instructed to follow the most updated CDC quarantine recommendations.  If the child has had a positive COVID exposure, the CDC recommends a quarantine period of 10 days starting with the last date of exposure.  This was recently decreased from the initial recommendation of 14 days.  Additionally, although our EDs are not testing asymptomatic patients, the child only needs to quarantine for 7 days from the last date of exposure if the child is able to obtain a test elsewhere that is negative.  If there is no identifiable COVID contact, then no quarantine is necessary.

If the patient is symptomatic and it is determined that the result will help direct acute medical care, a COVID test is recommended.  Pertinent symptoms include fever, cough, sore throat, rhinorrhea, myalgias, headache, fatigue, vomiting, diarrhea and loss of smell or taste which was recently added to the CDC’s list of symptoms concerning for COVID-19. 

If the COVID test is positive, then the next determination is whether or not the child is deemed high risk.  High risk patients include those with asthma, chronic lung disease, sickle cell disease, diabetes, immunosuppression or neurologic conditions with potential for airway compromise.  If the patient is high risk, then the ED will consult the appropriate subspecialist regarding further care as some patients may need admission or prolonged isolation (up to 20 days for some immunocompromised patients).  

If the COVID test is positive and the child is not considered high risk and does not warrant admission, the CDC recommends isolation for 10 days until afebrile with improving symptoms without suppressive therapy for at least 24 hours.  If the test is negative, then the general recommendation is to isolate until afebrile with improving symptoms for at least 24 hours.

The last branch point in the algorithm addresses the need to return to school or work.  Availability of testing supplies will dictate whether to test specifically for this reason.  If supplies are adequate, the ED will test if needed or requested.  However, if supplies are limited, any request to test for this reason may be declined, and the family will be asked to follow CDC recommendations for quarantine or isolation as noted above.  For patients who don’t receive a test in the ED, the families will receive a handout upon discharge that identifies testing sites in the community (in addition to those available at CHOA).

Currently, the lab at CHOA has multiple platforms available to run tests as having multiple platforms helps to address limited testing capacity.  The tests available specifically at Scottish Rite and Egleston are:

1. Biofire Respiratory Viral Panel 2.1 
   1. Adenovirus, Coronavirus 229E, HKU1, NL63, OC43, Parainfluenza 1 – 4, HMPV, Rhino/Entero, M. pneumoniae, C. pneumoniae, RSV, Influenza A and B, SARS-CoV-2 
   2. Available at both Scottish Rite and Egleston
   3. Run on demand with an estimated 45 minute turnaround time
2. DiaSorin Coronavirus SARS-CoV-2 PCR test
   1. Only tests for SARS-CoV-2
   2. Available only at Scottish Rite
   3. Estimated 90 minute turnaround time which may be longer as swabs need to be batched
3. Hologic Coronavirus SARS-CoV-2 PCR test
   1. Only tests for SARS-CoV-2
   2. Available only at Egleston
   3. Estimated 180 minute turnaround time but may be longer as swabs need to be batched
4. Cepheid 4 in 1 PCR test 
   1. Tests for Influenza A and B, RSV, and SARS-CoV-2 
   2. Available at both Scottish Rite and Egleston
   3. Run on demand with an estimated 60 minute turnaround time

In addition to what is available at Scottish Rite, Egleston, and Hughes Spalding (which uses a different testing platform), CHOA offers other testing resources that include the drive through testing site at Satellite Boulevard as well as all our Urgent Care Centers. 

The COVID drive through location at Satellite Boulevard (2660 Satellite Blvd, Duluth, GA 30096) has now been fully funded to remain open through May 21, 2021.  Hours of operation have been extended from 9 am to 2 pm daily.  This site uses a molecular PCR test that needs to be couriered to one of our main campuses, so turnaround time is not immediate but usually less than 24 hours.  Community providers may place test orders via AcessCHOA or fax an order form to 404-943-8075.

Our CHOA Urgent Care Centers also offer a COVID PCR test that is currently sent out to a reference lab.  The turnaround time is anywhere from 2-6 days, however it is expected that the rapid Cepheid PCR test with a turnaround time of 30-60 minutes will be offered at our Urgent Care sites in the near future.

As we enter our typically high volume respiratory season especially in conjunction with a COVID surge, we at Children’s Healthcare of Atlanta appreciate your understanding and partnership as we work to ensure that we have sufficient tests for those patients needing this resource the most.  Although our testing algorithm provides a general framework for testing in our EDs, it is a testing recommendation and will not supersede clinical judgment. 

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