Victorian COVID-19 testing criteria
9 April 2021
- Fever OR chills in the absence of an alternative diagnosis that explains the clinical presentation*
- Acute respiratory infection (including cough, sore throat, shortness of breath, runny nose)**
- Loss of smell or loss of taste.
*Clinical discretion applies; consider potential for co-infection (such as SARS-CoV-2 and influenza).
**Older people may present with other atypical symptoms including functional decline, delirium, exacerbation of underlying chronic condition, falls, loss of appetite, malaise, nausea, diarrhoea and myalgia.
Other clinical symptoms
People in the following groups should be tested if they have new onset of other clinical symptoms associated with COVID-19 (including headache, myalgia, stuffy nose, nausea, vomiting or diarrhoea):
- people who are most at risk of severe illness
- higher prevalence groups and settings
- settings with a high risk of transmission.
Clinical judgement and reasoningshould be used, including consideration of epidemiological risk factors for acquisition and transmission.
A confirmed case requires laboratory definitive evidence.
- Detection of SARS-CoV-2 by nucleic acid testing.1
- Isolation of SARS-CoV-2 in cell culture, with confirmation using a nucleic acid test.
- SARS-CoV-2 IgG seroconversion or a four-fold or greater increase in SARS-CoV-2 antibodies of any immunoglobulin subclass including ‘total’ assays in acute and convalescent sera, in the absence of vaccination.2
- A historical case requires laboratory suggestive evidence supported by either previous (prior to the past 14 days) clinical evidence.
- Previous (prior to the past 14 days) epidemiological evidence.
A historical case should not have any symptoms of COVID-19 (or not have had symptoms of COVID-19 for the past 14 days).
Laboratory suggestive evidence
- Detection of SARS-CoV-2 by polymerase chain reaction (PCR) on two specimens at least 24 hours apart with high Ct values3 on both specimens AND detection of IgG or total antibody, in the absence of vaccination.2,4
- Negative PCR result AND detection of IgG or total antibody, in the absence of vaccination.2
- High PCR Ct result on first result, and higher PCR Ct result or negative PCR result on second test, taken >24 hours apart.2
- History of measured (≥37.5°C) or self-reported fever (for example, night sweats, chills).
- History of an acute respiratory infection (for example, cough, shortness of breath, sore throat).
- Loss of smell or taste.
In the 14 days prior to illness onset:
- close contact with a confirmed case
- international travel
- workers supporting designated COVID-19 quarantine and isolation services
- international border staff
- air and maritime crew
- health, aged or residential care workers and staff with potential COVID-19 patient contact
- people who have been in a setting where there is a COVID-19 case
- people who have been in areas with recent local transmission of SARS-CoV-26.
- There is possibility for false negative PCR (polymerase chain reaction) results in children, who may mount a brisk immune response resulting in a lower viral load. Public health units may seek serological evidence of SARS-CoV-2 immunity in symptomatic children who are repeatedly PCR negative but are known primary close contacts.
- Antibody detection must be by a validated assay and included in an external quality assurance program. For all serological responses to be counted as laboratory evidence, a person should not have had a recent history of COVID-19 vaccination.
- The cycle threshold (Ct) value of a reaction is the cycle number when the fluorescence of a PCR product is first detected above the background signal. The lower the Ct value, the more virus is present in the sample being tested, as fewer amplification cycles are required before the threshold for detection is met. A high Ct value generally indicates that more cycles are required to detect the virus, indicating that there is less viral RNA present in the sample. Each PCR assay may have a different Ct value that is used for detecting SARS-CoV-2. Ct values for one in-vitro diagnostic (IVD) device should not be compared with Ct values from other platforms. This means there is no ‘set’ Ct value to aim for across all platforms. High Ct values are as defined in consultation with the responsible supervising pathologist.
- Occasionally a person may have a positive PCR result, with high Ct values, on a subset of gene targets in the PCR assay/s used. These scenarios may be due to acute infection but could also represent previous infection (that is, intermittent/persistent SARS-CoV-2 shedding in a historical case), sometimes with a concurrent upper respiratory tract infection due to another organism. A further swab collected at least 24 hours after the positive sample and serology testing can assist in distinguishing an acute from a historical COVID-19 infection. If the person is symptomatic, a full respiratory panel for other pathogens should be done.
Who should not be tested for COVID-19?
Patients without symptoms should not be tested except in special circumstances or where requested by the department:
- as part of an outbreak investigation/response (active case finding)
- for all primary close contacts and returned international travellers at the start and the end of quarantine
- prior to surgery
- as part of enhanced surveillance to:
- investigate how widespread COVID-19 is in the community, or
- detect and reduce transmission, particularly in higher prevalence groups and settings, and settings with a high risk of transmission.
- The same testing criteria applies to adults and children of all ages.
- For advice on testing technique in children refer to the (Royal Children's Hospital)
- Where possible, all 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
- Asymptomatic parents/carers are not required to self-isolate whilst their child is awaiting their swab results (unless told to by the Department of Health)
Testing aged care residents
How is COVID-19 excluded in symptomatic patients?
For patients with fever or respiratory tract infection who are not hospitalised and who do not have an epidemiological link to a known COVID-19 case, a single negative oropharyngeal and deep nasal swab (plus sputum if possible) is sufficient to exclude COVID-19 infection.
Repeat testing (especially of lower respiratory tract specimens) in clinically compatible cases should be performed if initial results are negative and there remains a high index of suspicion of infection. In unwell patients, consideration should also be given to a respiratory virus panel test, especially if the first COVID-19 test is negative.
Hay fever and asthma
Clinical judgement should be used to decide whether rhinorrhoea represents possible COVID-19 (requiring testing) or allergic rhinitis. There should be a low threshold for testing for COVID-19, particularly if the symptoms are different to the patient’s usual hay fever or asthma symptoms.
Factors that would make allergic rhinitis more likely include:
- history of allergic rhinitis in previous years at a similar time of year
- concomitant itchy nose and eyes
- response to usual treatments.
Factors that would make COVID-19 more likely include:
- other respiratory symptoms (sore throat, cough, anosmia)
- systemic symptoms (such as fever, myalgia, anorexia)
- no or minimal response to usual treatments.
People with known allergic rhinitis or asthma should have:
- their treatment optimised, including through having an up-to-date asthma action plan or hay fever treatment plan
- advice about what symptoms might suggest COVID-19 infection and require them to immediately get tested for COVID-19 and stay home until a negative result is received.
Assessment and procedures
Assessing a patient with respiratory symptoms in a community setting
- Separate them from other patients.
- Place a single-use surgical mask on the patient.
- Use when assessing the patient (gown, gloves, eye protection and single-use face mask).
- Conduct a medical assessment, and focus on:
- date of onset of illness and especially whether there are symptoms or signs of pneumonia
- contact with confirmed or historical cases of COVID-19
- precise travel history and occupation
- history of contact with sick people, travellers, or healthcare facilities
- work or residence in higher prevalence groups and settings, settings with a high risk of transmission or other priority settings and groups
- co-morbidities – see 'People who are most at risk of severe illness' on .
All patients should attend an emergency department if clinical deterioration occurs. If clinically required, ambulance transport should be used - advise 000 operator of suspected COVID-19.
Taking a COVID-19 swab
If you have a patient who meets the criteria for 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 (single-use surgical face mask, eye protection, gown and gloves).
- Take a single oropharyngeal and deep nasal swab for COVID-19 PCR. To conserve swabs, use the same swab to sample the oropharynx and for deep nose sampling (that is, 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, gently rotate the swab, while inserting 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.
- Place the swab back into the accompanying transport medium.
Patients with symptoms and signs suggestive of pneumonia should be tested and treated in hospital.
Do patients need to isolate whilst waiting for test results?
People who are symptomatic at the time of testing for COVID-19 should isolate until COVID-19 is excluded, unless advised to isolate for longer by the department. If their test is negative, they should continue to isolate until the acute symptoms have resolved and they feel well.
People who are asymptomatic at the time of testing for COVID-19 should isolate until COVID-19 is excluded, unless advised otherwise by the department. Some asymptomatic people will not be required to quarantine after testing, such as people tested as part of a surveillance testing or other targeted testing program.
Tests currently available for 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 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 COVID-19).
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.
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.
Rapid antigen testing
Rapid antigen tests are now used as a screening tool for COVID-19 in some workplaces in Victoria. Workers are tested using Point-of-care tests at their workplace or are undertaking rapid antigen tests at home.
Point-of-care (POC) tests must be administered by a health practitioner or trained staff under the supervision of the health practitioner. Supervision of testing must occur; however, remote supervision is acceptable. Record keeping and results management, including the reporting of positive results to the Department, is the responsibility of the health practitioner overseeing the program.
If workers are undertaking rapid antigen tests at home, and test positive, you are considered a case and must isolate and report your result. For all positive RAT COVID-19 result notifications please fill out the .
The use of antigen-based screening is part of a responsive and adaptive testing system and is determined by epidemiology and the phase of the public health response in Victoria.
The Department of Health will continue to review this policy position as new evidence and experience emerges.
Resources are available detailing how to implement rapid antigen testing:
The Australian Prostate Centre has developed a video and accompanying booklet guide to setting up and performing rapid antigen testing for COVID-19.
COVID-19 ANTIGEN RAPID TEST
POINT OF CARE TESTING GUIDE
A result is delivered 15 minutes after sample collection.
The test requires insertion of the swab into the nasal passage followed by 3-4 turns.
EQUIPMENT & STAFF REQUIRED
Medical Storage & Transport Kit
Clinical waste bin liners
Alcohol cleaning wipes
Tape (for clinical waste bin)
Surgical Face Masks
N-95 Face Masks
Thermo controlled pack containing test kit
Test tube caps
Positive/Negative control sample
Bradma labelling device
QR codes individualised for site
A paper based system can be used as an alternative
The number of staff needed for a clinic will depend on the expected numbers of tests
Based on pilot study data, 4 staff are capable of delivering 20 tests per hour, including:
Overseeing healthcare practitioner
2 trained workforce members
Please consult the TGA website for further guidance on workforce and training
PERSONAL PROTECTIVE EQUIPMENT
Personal protective equipment (PPE) must be worn at all times to minimise the transmission risk of COVID-19
As a minimum, the registration assistant and overseeing healthcare practitioner should wear a surgical mask
Trained workforce members must wear the following PPE:
Trained workforce members
GLOVES (new gloves for each patient)
Unidirectional patient flow from entry to exit
Sample collection station
Sample processing/Result verification station
Clinical waste bin
CONTROL TESTING & PREPARATION
PRIOR TO THE FIRST SAMPLE BEING COLLECTED
Ensure the kit has not expired
Allow kit components to reach a temperature of 15-30˚C prior to testing for 30 minutes
Set up the tube rack
Add buffer solution to test tube, filling to line (8 drops is usually sufficient)
Control testing must be performed prior to the use of each new batch of testing equipment
Dispense 5 drops into the specimen well on the test device
Negative Control 5 drops
Repeat for both positive and negative control sample
Positive Control 5 drops
After confirming control samples, prepare up to 9 test tubes for pending patient samples
Prepare an equivalent number of record slips and test kits on sample processing table
Employee scans QR code
Employee completes online form
Employee presents to registration assistant upon completion
Bradma stickers printed
Proceed to sample collection
Confirm employee details
Add label to record slip
Attach label to test tube
Remove swab from sterile pack
Ask employee to lower their mask & tilt head back
Insert the swab into the nasopharynx or until resistance is met
Gently rub and roll 3-4 times while parallel with palate
Leave the swab in place for several seconds in total
Slowly remove the swab
Put swab into employee’s test tube
Record collection time
Offer tissue to patient upon exit
Remove gloves and put into clinical waste bin
Twist the swab 5 times in the buffer solution
Lift the swab and squeeze the testing tube to milk the swab tip
Break the swab at the breakpoint
Discard in clinical waste bin
Add cap to test tube and close
Dispense 5 drops into the specimen well on the test device
Recap the test tube and dispose in clinical waste bin
Record the time on employee’s record slip
Wait 15-20 minutes or until a clear result is shown on the test device window
Sample processing by trained member documents results
Second trained member verifies result
All positive antigen tests must be escalated to the heath practitioner in charge
Register the result with Test Tracker
Discard testing strip into clinical waste bin
Place record slip into pathology bag
COVID-19 ANTIGEN RAPID TEST
POINT OF CARE TESTING GUIDE
Notifying patients and the department
Medical practitioners, testing clinics and health services should ensure arrangements are in place for contacting the patient with their COVID-19 test result, regardless of whether it is negative or positive.
Contact from the Department of Health
The department receives notification from laboratories of all positive results and contacts confirmed cases (people who test positive). The department may contact a patient before the treating doctor to inform the patient of their result – this ensures that case contact interviews, communications and contact tracing are timely.
Even if the department has already contacted a patient with a positive 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
- there is a clear management plan in place.
Reviewed 29 December 2022