STATE OF WISCONSIN
Department of Health Services
Division of Public Health

1 West Wilson Street
PO Box 2659
Madison WI 53701-2659
Telephone: 608-267-9003
Fax: 608-261-4976
TTY: 888-701-1253

Date:

March 17, 2020

BCD 2020-09

To:

Wisconsin Local Health Officers, Tribal Health Officials, Infection Preventionists, and
Health Care Providers

From:

Ryan Westergaard, MD, PhD, MPH
Chief Medical Officer and State Epidemiologist for Communicable Diseases

Urgent Update – Prioritization of COVID-19 Testing for Hospitalized Patients
The Wisconsin State Laboratory of Hygiene and City of Milwaukee Health Department
Laboratory can no Longer Process Low Priority Tests in a Timely Manner

PLEASE DISTRIBUTE WIDELY
Main Message:
Although the Wisconsin State Laboratory of Hygiene (WSLH) and the Milwaukee Health Department
Laboratory (MHDL) have significantly increased their capacity for COVID-19 testing, the number of
specimens being received during the week of March 16, 2020, far exceeds their daily capacity.
In order to avoid depleting the reagents and supplies for testing, the Department of Health Services
(DHS) is working with WSLH and MHDL to use the reagents and supplies to test the specimens from
the highest priority patients. Both public health laboratories will test high-priority specimens (Tier 1 and
2 in table below), and DHS, in coordination with WSLH and MHDL, will identify laboratories in the
state and country to send the lower priority specimens to for testing. The lower priority specimens will
have a longer time to result.
To allow DHS and WSLH and MHDL to triage the specimens, submitters MUST include the new DHS
COVID-19 triage form with the specimen and requisition form.
Summary
The WSLH has increased capacity for COVID-19 testing. The WSLH is:
• Testing seven days/week and significantly expanded work hours each day
• Can test up to 400 specimens per day
• Can report results on priority specimens one to two days after receipt of the specimen at WSLH
The MHDL has increased capacity for COVID-19 testing. The MHDL is:
• Testing seven days/week and significantly expanded work hours each day
• Can test up to 150 specimens per day
• Can report results on priority specimens one to two days after receipt of the specimen at WSLH
www.dhs.wisconsin.gov

 DPH Memo
Page 2 of 3
However, WSLH and MHDL has a finite number of reagents and supplies available for this testing, and
WSLH received 700 samples on March 16, 2020 and more than 450 just in the morning on March 17.
The nationwide supply chain for reagents and other testing supplies is very fragile as more laboratories
begin testing.
With the increased number of cases of COVID-19 reported nationally and the growing likelihood of
widespread community transmission in all areas of the country, the number of people requiring testing
for COVID-19 is increasing significantly. Priority should therefore be given to the testing of specimens
from patients for whom a timely diagnosis is most urgent.
Clinicians may make decisions to test patients for COVID-19 based on their clinical judgment, but at
this time, providers are urged to prioritize testing for hospitalized patients for whom timely diagnosis of
COVID-19 is critical to inform management decisions. Going forward, DHS and WSLH and MHDL
will only test Tier 1 and Tier 2 specimens (see table below). Healthcare providers should begin
identifying alternate laboratories for testing lower priority specimens.
It should be emphasized to patients and providers that there is no role for testing asymptomatic
individuals. Testing should be reserved for making a diagnosis of COVID-19 in patients suspected of
having the disease, in order to inform clinical management and infection control decisions.
Testing is NOT recommended for patients with mild, upper respiratory symptoms, except in
limited circumstances. Patients without significant comorbidities, and who are not health care workers,
should not be tested if they have mild illnesses for which they would not normally seek medical care. It
should be recommended that these patients self-isolate at home until their symptoms improve.
Testing should be prioritized based on clinical criteria. Based on recommendations from the
Infectious Disease Society of America, DHS and the WSLH have established criteria for prioritizing
laboratory specimens, as shown in Table 1. In situations when the volume of tests requested exceeds the
capacity for processing all specimens with a standard turn-around time of one to two days, WSLH will
prioritize specimens in the Tier 1 and Tier 2 categories.
The Centers for Disease Control and Prevention (CDC)-developed Person Under investigation
(PUI) form is no longer required to be completed or submitted at the time of testing. In its place, a
new form containing limited patient information, and a designation of the priority level for the patient.
A copy of the form is attached to this memo in the memo library.

 DPH Memo
Page 3 of 3
Table 1. Priority levels for COVID-19 testing.
Tier One:
•

Patient is critically ill and receiving ICU level care with unexplained viral pneumonia or
respiratory failure

-OR•

Patient is hospitalized (non-ICU) with fever or signs and symptoms of lower respiratory tract
illness (cough, shortness of breath) AND either of the following high risk conditions:
o Known exposure to a laboratory-confirmed COVID-19 patient

o Travel to an area where sustained community transmission has been identified
Tier Two:
•

Hospitalized (non-ICU) patients and long-term care residents with unexplained fever AND
signs/symptoms of a lower respiratory tract illness

-ORHealth care workers with unexplained fever AND signs/symptoms of a lower-respiratory tract
illness, regardless of hospitalization
Tier Three:
•

•

Patient is in an outpatient setting and meets criteria for influenza testing. This includes
individuals with co-morbid conditions including diabetes, COPD, congestive heart failure, age
>50, immunocompromised hosts among others

-ORHealth care workers with mild upper respiratory symptoms (rhinorrhea, congestion, sore
throat) without fever
Tier Four:
•

Other patients, as directed by public health or infection control authorities (e.g. community
surveillance or public health investigations)
Do NOT Test
•

Patients without symptoms
Patients with mild upper respiratory symptoms only who are not health care workers