is intended for clinicians who may collect specimens to be referred for
information and resources about COVID-19 in Maryland — including frequently
asked questions, case counts and other general information — is available
COVID-19 (2019 Novel Coronavirus) Guidance
What steps to take if
you suspect a COVID-19 infection
The Maryland Department of Health
Laboratory is testing locally using the Centers for Disease Control and
Prevention (CDC) 2019-Novel Coronavirus (2019-nCoV) Real-Time Reverse
Transcriptase (RT)-PCR Diagnostic Panel which has been approved for
emergency use authorization (EUA) by the Federal Food and Drug
Clinicians considering testing of persons with possible COVID-19
should continue to work with their local and state health departments to
coordinate testing through public health laboratories, or use COVID-19
diagnostic testing, authorized by the Food and Drug Administration under an
Emergency Use Authorization (EUA) through clinical laboratories.
Clinicians should use their judgment to determine if a patient has
signs and symptoms compatible with COVID-19 and whether the patient should be
tested. Most patients with confirmed COVID-19 have developed fever and/or
symptoms of acute respiratory illness (e.g., cough, difficulty breathing).
Priorities for testing include:
Hospitalized patients, who should be
tested by the most expeditious means available (either a hospital lab, private
lab, or the State Laboratory).
Symptomatic Emergency Medical Service Personnel, healthcare
workers, and law enforcement personnel (should be tested by available means).
Symptomatic patients in nursing homes, long-term care facilities,
or in congregate living facilities housing individuals who are medically
Symptomatic high-risk unstable patients whose care would be
altered by a diagnosis of COVID-19.
COVID-19 Testing Priorities Guidance Memo (3-26-2020)
On the MDH Laboratories Administration test
order form you MUST indicate the specimen’s Priority Level.
The MDH Laboratories Administration no longer
requires prior approval for specimen submission; however, the laboratory cannot
accept lower priority specimens for COVID-19 testing. The
MDH Laboratories Administration will continue to conduct COVID-19 testing in
support of local health departments for outbreak and death investigations.
Guidance and Instructions for Submission of Specimens for Suspected COVID-19
Infections: Testing at the Maryland Department of Health (MDH) Laboratory
Please note: At present
(02/24/2020) the naming of the CDC 2019-nCoV real time PCR assay cannot be
changed to SARSCoV-2 until a formal application is made to the FDA to modify
the Emergency Use Authorization (EUA) package insert for this assay.
Coronavirus (COVID-19) Specimen Collection and Shipping
Specimen Types - Following recent CDC guidelines only one upper respiratory specimen,
a Nasopharyngeal (NP) Swab, is necessary to be collected from outpatients for
COVID-19 testing. An Oropharyngeal specimen (OP) is as an acceptable specimen type if
NP swabs are not available. Collection of two specimen types, lower
respiratory and upper respiratory, is still recommended for hospitalized patients for COVID-19 testing. CDC also
recommends testing lower respiratory tract specimens, if available. Specimens
should be collected as soon as possible once a PUI is identified regardless of
symptom onset. Currently, the MDH Laboratories Administration is not accepting
nasal mid-turbinate (NMT) swab or anterior nares specimens as recently recommended
by the CDC until data is made available by the CDC or others that indicate
these are reliable specimen types for COVID-19 pcr testing. Maintain proper
infection control when collecting specimens. Refer to chart below for
collection and storage instructions.
Specimen Collection & Storage Instructions
Lower Respiratory (sputum, bronchoalveolar lavage, and
For bronchoalveolar lavage
and tracheal aspirates collect 2-3 ml into a leak-proof, sterile, screw cap
sputum collection cup or sterile dry container. Refrigerate
at 2-8°C and ship on ice pack to the Maryland Department of Health
Laboratory. For sputum collections, have the patient rinse their mouth with
water and then expectorate deep cough sputum directly into a leak-proof,
sterile, screw cap sputum collection cup. The induction of sputum is not recommended. When it is
clinically indicated (e.g., those receiving invasive mechanical ventilation),
a lower respiratory tract aspirate or bronchoalveolar lavage sample should be
collected and tested as a lower respiratory tract specimen.
Upper respiratory (nasopharyngeal swab (NPS))
(oropharyngeal swab (OP) e.g.
Wash/Aspirate or Nasal Aspirate
Collect a nasopharyngeal
swab in a viral transport media tube (2-3ml). Use only synthetic fiber swabs
with plastic shafts. Do not use calcium alginate swabs or swabs with wooden
shafts as they may inhibit PCR testing or inactivate some viruses. Insert a
swab into the nostril parallel to the palate. Insert a swab into nostril
parallel to the palate. Swab should reach depth equal to distance from
nostrils to outer opening of the ear. Leave swab in place for several seconds
to absorb secretions. Slowly remove swab while rotating it. Place swab, after
collecting patient specimen, directly into 2-3 ml of viral transport media. Refrigerate
specimens at 2-8°C and ship on ice pack to the Maryland Department of Health
posterior pharynx, avoiding the tongue.
If both NP and
OP swabs both are collected, they should be combined in a single tube to
maximize test sensitivity and limit testing resources.
wash/aspirate or nasal aspirate, collect 2-3 mL into a sterile, leak-proof,
screw-cap sputum collection cup or sterile dry container. Refrigerate
specimen at 2-8°C and ship on ice pack to the Maryland Department
of Health Laboratory.
Specimen collection kits (Viral Culture Kit) can be ordered by the local health department by calling 443-681-3777 and submitting via email or fax the Outfit Supply Requisition form. (See link below)
The MDH Laboratories Administration Form # 4676 Infectious
Agents: Culture /Detection must be completed and submitted with each of the
recommended specimens (1) lower respiratory and (2) upper respiratory.
Click an example of the
completed form #4676 and the electronic fillable form.
Specimens must be packaged in a triple packaging system to
ensure that under normal conditions of transport they cannot break, be
punctured or leak their contents (Refer to page 9 in the Lab Services
request COVID-19 testing for a suspect case, health care providers must contact
the MDH Infectious Disease Bureau at 410-767-6700 during business hours and
after hours call the MDH Emergency Call Center at 410-795-7365 to arrange the
initial disease consultation.
questions or concerns, please contact the Division of Molecular Biology
Laboratory at 443-681-3924 or 443-681-3800 during normal business hours from
1770 Ashland Ave, Baltimore,