Victorian coronavirus (COVID-19) testing criteria
20 June 2020
- Fever OR chills in the absence of an alternative diagnosis that explains the clinical presentation*.
- Acute respiratory infection (e.g. cough, sore throat, shortness of breath, runny nose, loss of smell or loss of taste).
*Clinical discretion applies; consider potential for co-infection (e.g. SARS-CoV-2 and influenza).
Additional testing note:
People who are at higher risk of infection due to their environmental exposure should also be tested if they have new onset of other clinical symptoms associated with coronavirus (COVID-19) (e.g. headache, myalgia, stuffy nose, nausea, vomiting, diarrhoea) AND meet the following epidemiological criteria:
- Close contacts of a confirmed case of coronavirus (COVID-19).
- Returned overseas travel in the past 14 days.
- Health care or aged care workers.
A person who tests positive to a validated SARS-CoV-2 nucleic acid test
has the virus isolated in cell culture, with PCR confirmation using a validated method
undergoes a seroconversion to or has a significant rise in SARS-CoV-2 neutralising or IgG antibody level (i.e. four-fold or greater rise in titre)
- A person who has detection of SARS-CoV-2 neutralising or IgG antibody AND has had a compatible clinical illness AND meets one or more of the epidemiological criteria outlined in the additional testing note above.
Only confirmed and probable cases need to be notified to the department. Notify the department of confirmed cases as soon as practicable by calling 1300 651 160, 24 hours a day.
On this page
This page is based off the current Victorian guidelines. Please ensure you refer to the latest version of these documents as guidance may change.
- Case and contact management guidelines – Version 23 - 10 July 2020 (Word)
- General practice quick reference guide – 28 June 2020 (Word)
Who should be tested for coronavirus (COVID-19)?
Test all cases meeting the current criteria for coronavirus (COVID-19) testing:
Fever OR chills in the absence of an alternative diagnosis that explains the clinical presentation (including consideration of potential co-infection with other illness)*
Acute respiratory infection (e.g. cough, sore throat, shortness of breath, runny nose, anosmia or loss of smell or loss of taste)
Note: In addition, testing is recommended for people with new onset of other clinical symptoms consistent with coronavirus (COVID-19)** AND who are close contacts of a confirmed case of coronavirus (COVID-19); who have returned from overseas in the past 14 days; or who are healthcare or aged care workers
*Clinical discretion applies including consideration of the potential for co-infection (e.g. concurrent infection with SARS-CoV-2 and influenza)
**Headache, myalgia, stuffy nose, nausea, vomiting, diarrhoea
Who should not be tested for coronavirus (COVID-19)?
Patients without symptoms should not be tested except in special circumstances such as:
- Recovered cases wishing to return to work in a healthcare facility or aged care facility.
- Where requested by the department as part of outbreak management or enhanced surveillance.
What are the recommendations for testing children?
The same testing criteria that applies to adults applies to children of all ages.
For advice on testing technique in children refer to the Royal Children's COVID-19 swabbing page.
Where possible, family members (parents/carers and children) who meet the testing criteria should be tested at the one location. For advice on which testing sites children can attend for testing refer to the getting tested page.
Asymptomatic parents/carers are not required to self-isolate whilst their child is awaiting their swab results, unless they are a close contact of a confirmed case of coronavirus (COVID-19).
What are the recommendations for testing aged care residents?
Please refer to advice on the Aged Care Sector coronavirus (COVID-19) page.
Why can’t we test everyone for coronavirus (COVID-19)?
All symptomatic patients should be tested for coronavirus (COVID-19). The current testing criteria can be found in the latest version of the Coronavirus disease 2019 (COVID-19) Case and contact management guidelines, located above. Testing criteria will continue to be updated as more is known about the disease and the risk factors for infection.
People without symptoms should not be tested except in special circumstances such as recovered cases wishing to return to work in a healthcare facility or aged care facility or where requested by the department as part of outbreak management or enhanced surveillance.
If a person without symptoms is tested and the result is negative, it does not mean that they have not been infected, as they might still be incubating the virus (See also: “What is the incubation period?”). In other words, a negative test in an asymptomatic person does not rule out coronavirus (COVID-19) infection.
Assessment and procedures
What should I do when assessing a patient with respiratory symptoms in a community setting?
- Separate from other patients.
- Place single-use surgical mask on the patient.
- Use droplet and contact precautions (gown, gloves, eye protection and single-use face mask) when assessing the patient.
- Conduct a medical assessment, and focus on:
- History of contact with sick people or confirmed coronavirus (COVID-19) cases.
- Travel history, occupation and/or residence in high risk settings.
- The date of onset of illness and especially whether there are symptoms or signs of pneumonia.
- If the patient has symptoms and signs suggestive of pneumonia, viral load might be higher. These patients should be tested and treated in hospital. If clinically required, ambulance transport should be used - advise 000 operator of suspected coronavirus (COVID-19).
How do I perform a coronavirus (COVID-19) swab?
If you have a patient who meets the criteria for coronavirus (COVID-19) testing (and who does not have symptoms or signs of pneumonia):
- Place a surgical mask on the patient and isolate them in a single room with door closed.
- Use droplet and contact precautions (single-use surgical face mask, eye protection, gown and gloves).
- Collect specimens for coronavirus (COVID-19) testing:
- Take a single oropharyngeal and deep nasal swab for coronavirus (COVID-19) PCR. To conserve swabs the same swab that has been used to sample the oropharynx should be utilised for deep nose sampling (i.e. one swab per patient only).
- Oropharyngeal (throat): swab the tonsillar beds and the back of the throat, avoiding the tongue.
- Deep nasal:
- Using a pencil grip and while gently rotating the swab, insert the tip 2-3 cm (or until resistance is met) into the nostril, parallel to the palate, to absorb mucoid secretion.
- Rotate the swab several times against the nasal wall.
- Withdraw the swab and repeat the process in the other nostril. To conserve swabs, the same swab that has been used to sample the oropharynx should be utilised for nasal sampling.
- Place the swab back into the accompanying transport medium.
- Take blood in a serum tube for storage at VIDRL.
- Consider alternative causes, in particular consider testing for other respiratory viruses using a multiplex PCR if available. Ask your local laboratory if they require a second swab for this.
If appropriate personal protective equipment is unavailable, direct the patient to the nearest coronavirus (COVID-19) assessment centre.
Patients with symptoms and signs suggestive of pneumonia should be tested and treated in hospital.
All patients who meet the criteria for coronavirus (COVID-19) testing should be advised to self-isolate until the results of the test are known; further advice should be provided based on test results.
For advice on testing technique in children refer to the Royal Children's COVID-19 swabbing page.
Where are coronavirus (COVID-19) test locations?
This map provides GPs and primary care practitioners with details of local Coronavirus (COVID-19) GP Respiratory Clinics and Hospital Respiratory Clinics for referral purposes: GP Respiratory Clinics and Hospital Respiratory Clinics (COVID-19)
What testing is currently available for coronavirus (COVID-19)?
Molecular testing on a well-collected single throat and deep nasal swab is the current test of choice for the diagnosis of acute coronavirus (COVID-19) infection. Molecular tests use real-time polymerase chain reaction (PCR) to look for evidence of the genetic material (RNA) of SARS-CoV-2 (the virus that causes coronavirus COVID-19). Because these tests directly detect viral RNA, they are an indicator for viral shedding.
A positive PCR result indicates current or very recent infection. SARS-CoV-2 RNA is generally detectable in respiratory specimens from about one day prior to symptom onset, and during the acute phase of infection. Patients may continue to shed viral RNA after their symptoms resolve, but the extent to which this correlates with transmissibility is currently unclear. Clinical resolution (and for some cases two consecutive negative PCR tests) are currently being used as criteria when considering release from isolation. However, this may change as our knowledge of the virus increases.
A negative PCR result means that SARS-CoV-2 RNA was not identified in the sample. Negative results do not preclude SARS-CoV-2 infection, and interpretation of such results should be combined with clinical observations, patient history, and epidemiological information.
There are several serology tests currently undergoing assessment in Australia but the accuracy and clinical utility of these have not yet been established. In the interim, clinicians assessing patients with suspected coronavirus (COVID-19) infection can send serum to VIDRL (the state reference laboratory) for storage so that serology can be performed once a test becomes available.
Serology-based tests detect antibodies that develop in response to coronavirus (COVID-19) infection. Early reports indicate that it may take seven days or more from the time a patient first becomes sick for antibodies to be detectable. Therefore, these tests are of limited use for the diagnosis of acute infection. Elderly or immunocompromised patients may never (or only much later) develop antibodies to the virus that causes coronavirus (COVID-19), and therefore may return a negative test despite infection. Because antibody tests do not detect active viral shedding, they cannot detect if an individual is infectious.
Several serology-based point-of-care tests (PoCT) for coronavirus (COVID-19) have recently been approved by the Therapeutic Goods Administration (TGA) subject to conditions. The conditions require that additional evidence to support the ongoing safety and performance of these tests be provided to the TGA within 12 months of approval. These PoCTs are yet to be validated in Australia and are not currently recommended for the acute diagnosis of coronavirus (COVID-19) infection as they will miss patients in the early stages of the disease when they are infectious to other people.
For more information please see Communique: Point of Care Testing for COVID-19 (Word).
See the position statements by the Royal College of Pathologists of Australasia and the Public Health Laboratory Network on PoCT for coronavirus (COVID-19) on the Royal College of Pathologists website. Further information is also available on the TGA website.
When do I need to notify a case to the department?
Notification to the department is only required for confirmed and probable cases – phone 1300 651 160, 24 hours a day.
I am a general practitioner and have ordered a coronavirus (COVID-19) test – who will notify the patient of the results?
It is the responsibility of the general practitioner who ordered the coronavirus (COVID-19) test to ensure arrangements are in place for contacting the patient with the test result, regardless of whether it is negative or positive. If the result is positive, call the Department of Health and Human Services on 1300 651 160 to notify the confirmed case, and agree on next steps for management of the patient.
I am a clinician in a health service and have ordered a coronavirus (COVID-19) test – who will notify the patient of the results?
It is the responsibility of the testing clinician and health service who ordered the coronavirus (COVID-19) test to ensure arrangements are in place for contacting the patient with the test result, regardless of whether it is negative or positive. If the result is positive, the health service infectious diseases lead, or senior clinician should call the Department of Health and Human Services on 1300 651 160 to notify the confirmed case and provide any additional clinical information.
Why is the department also contacting patients with a positive coronavirus (COVID-19) test result?
The department receives notification from laboratories of all positive results. The department contacts all confirmed cases (people who test positive) to conduct an interview, provide information about self-isolation and trace close contacts. To prevent administrative hold-ups in the investigation process, the department is no longer waiting for the treating doctor to inform the patient of their result before making contact.
Even if the department has already contacted your patient with a positive coronavirus (COVID-19) test result, the treating doctor or clinical team representative (as appropriate) should still contact the patient - this is important to ensure that the patient has received their result, any clinical queries have been addressed, and there is a clear management plan in place. Call the department on 1300 651 160 to provide any additional clinical information and/or agree on next steps for management of the patient.
Factsheets for patients with coronavirus (COVID-19) and close contacts
- Coronavirus (COVID-19) confirmed case - what you need to know (Word)
- Factsheet – suspected case (Word)
- Factsheet – close contact (Word)
- Palliative and end of life care factsheet (Word)
Where can I find more information about coronavirus (COVID-19)?
Detailed information for medical practitioners can be found in the Coronavirus: Case and contact management guidelines for health services and general practitioners.