Childrens’ (CHOA) ED COVID-19/Flu Testing Algorithm

by Thuy Bui

According to the Centers for Disease Control and Prevention (CDC), COVID-19 cases, hospitalizations, and deaths across the United States are rising.  With the socialization that comes with the holiday season and the arrival of cold weather driving more people indoors, this rise in COVID cases will not likely improve any time soon.  Due to the concern of a worsening COVID surge, the possibility of a “twindemic” with the arrival of influenza, and continued limited testing capacity at our hospitals and EDs, medical leadership from Emergency Medicine and Infection Prevention at Children’s Healthcare of Atlanta created an algorithm to help determine how to best utilize available tests for SARS-CoV-2.  

This testing algorithm, which takes into account CDC recommendations, provides a general framework for testing in our emergency departments.  Basic considerations of the algorithm include:

  1. Has the patient had a recent positive COVID PCR or antigen test?
  2. Does the patient exhibit symptoms of COVID-19?
  3. Will the results of the COVID test directly impact acute clinical care or medical management of this patient?
  4. Will the results of the COVID test help in management of a child with a chronic or underlying medical condition?
  5. Will testing impact a child or parent’s ability to return to school or work?

These are the questions our ED providers will have in mind if a child presents or is referred to any of our emergency departments with a concern of COVID-19.

The first consideration is whether or not the child has had a positive COVID PCR or antigen test in the past 3 months.  Since it has been shown that patients may test positive for up to 3 months after recovering from an acute COVID infection and not be contagious to others, COVID testing is not routinely recommended during this time frame.  Testing for other etiologies including influenza and Multisystem Inflammatory Syndrome in Children (MIS-C) may need to be considered.