Diagnostic Testing

Diagnostic testing is intended to identify current infection in individuals and should be performed on anyone that has signs and symptoms consistent with COVID-19 and/or following recent known or suspected exposure to SARS-CoV-2.

Examples of diagnostic testing include:

• Testing anyone with symptoms consistent with COVID-19
• Testing vaccinated and unvaccinated people who were exposed to someone with a confirmed or suspected case of COVID-19

Screening Testing

Screening tests are intended to identify people with COVID-19 who are asymptomatic and do not have known, suspected, or reported exposure to SARS-CoV-2. Screening helps to identify unknown cases so that measures can be taken to prevent further transmission.

Examples of screening include testing:

• Employees in a workplace setting
• Students, faculty, and staff in a school setting
• A person before or after travel
• Someone at home who does not have symptoms associated with COVID-19 and no known exposures to someone with COVID-19

Public Health Surveillance Testing

Public health surveillance is the ongoing, systematic collection, analysis, and interpretation of health-related data essential to the planning, implementation, and evaluation of public health practice. See CDC’s Introduction to Public Health Surveillance.

Public health surveillance testing is intended to monitor community- or population-level outbreaks of disease, or to characterize the incidence and prevalence of disease. Surveillance testing is performed on de-identified specimens, and thus, results are not linked to individual people. Public health surveillance testing results cannot be used for individual decision-making.

Public health surveillance testing may sample a certain percentage of a specific population to monitor for increasing or decreasing prevalence, or to determine the population effect from community interventions such as social distancing. An example of public health surveillance testing is when a state public health department develops a plan to randomly select and sample a percentage of all people in a city on a rolling basis to assess local infection rates and trends.

Regulatory Requirements for Diagnostic, Screening, and Public Health Surveillance Testing

Any laboratory or testing site that performs diagnostic or screening testing must have a Clinical Laboratory Improvement Amendments (CLIA) certificate and meet all applicable CLIA requirements. For more information, see the Centers for Medicare & Medicaid Services CLIA websiteexternal icon. Tests used for SARS-CoV-2 diagnostic or screening testing must have received an Emergency Use Authorization from the U.S. Food and Drug Administration (FDA) or be offered under the policies in FDA’s Policy for COVID-19 Testsexternal icon.

Tests used for SARS-CoV-2 public health surveillance on de-identified human specimens do not need to meet FDA and CLIA requirements for diagnostic and screening testing.

Reporting Diagnostic, Screening, and Public Health Surveillance Testing Results

Both diagnostic and screening testing results should be reported to the people whose specimens were tested and/or to their healthcare providers.

In addition, laboratories that perform diagnostic and screening testing must report positive diagnostic and screening test results to the local, state, tribal, or territory health department in accordance with Public Law 116-136, § 18115(a), the Coronavirus Aid, Relief, and Economic Security (CARES) Act. As of April 4, 2022, laboratories are no longer required to report negative results for non-NAAT tests (rapid or antigen test results). The Department of Health and Human Services published guidance on COVID-19 Pandemic Response, Laboratory Data Reporting: CARES Act Section 18115pdf iconexternal icon that specifies what data, in addition to test results, laboratories and testing sites should collect and electronically report.

Public health surveillance testing results cannot be reported directly to the people whose specimens have been tested and are not reported to their healthcare providers. Public health surveillance testing results (test results that are de-identified) can be reported in aggregate to local, state, tribal, or territory health departments upon request. Results from testing that is performed outside of a CLIA-certified facility or without an FDA-authorized test can only be reported to a health department if those results are used strictly for public health surveillance purposes, and not used for individual decision making.

Summary of Testing for COVID-19

	Diagnostic	Screening	Public Health Surveillance
Symptomatic	Yes	No	N/A
Unvaccinated or vaccinated with known or suspected exposure	Yes	No	N/A
Unvaccinated and Asymptomatic without Known or Reported Suspected Exposure	No	Yes	N/A
Characterize Incidence and Prevalence in the Community	N/A	N/A	Yes
Testing of Personally Identifiable Specimens	Yes	Yes	No
Results may be Returned to Individuals	Yes	Yes	No
Results Returned in Aggregate to Requesting Institution	No	No	Yes
Results Reported to State Public Health Departments	Yes	Yes	If requested
Testing can be Performed in CLIA-Certified Laboratory	Yes	Yes	Yes
Testing can be Performed in a Non-CLIA-Certified Laboratory	No	No	Yes
Test System Must be FDA Authorized or be Offered under the Policies in FDA’s Guidance	Yes	Yes	No

To learn more, please visit https://www.cdc.gov/coronavirus/2019-ncov/lab/resources/sars-cov2-testing-strategies.html

To help prevent the spread of COVID-19 and help our country cope during the pandemic, CDC has occasionally issued legally binding orders and regulations.

• Face Masks Required on Public Transportation and at Transportation Hubs

People must wear face masks in indoor areas of public transportation traveling into, within, or out of the United States and indoors at U.S. transportation hubs, including airports.

• Negative COVID-19 Test or Documentation of Recovery Needed to Board a Flight to the US

Air passengers, 2 years or older, traveling to the United States from another country must present a negative COVID-19 test result or documentation of recovery from COVID-19 before boarding their flights. Regardless of vaccination status, passengers ages 2 or older are required to present a negative COVID-19 viral test result from a sample taken no more than 1 day before travel. Alternatively, passengers may present documentation showing that they tested positive for COVID-19 on a sample taken within the past 90 days and have been cleared to travel (documentation of recovery).

• Order Implementing Proclamation on Safe Resumption of Global Travel During the COVID-19 Pandemic

CDC issued an Order to implement the President’s direction on safe resumption of global travel during the COVID-19 pandemic and provided guidance to airlines, other aircraft operators, and passengers in Technical Instructions and Frequently Asked Questions.

All non-U.S.-citizen, non-immigrants, with limited exceptions, traveling to the United States by air must be fully vaccinated and show proof of vaccination.

• Order Requiring Airlines to Collect Contact Information for All Passengers Arriving into the United States

CDC issued an Order on October 25, 2021 requiring airlines and other aircraft operators to collect contact information for passengers before they board a flight to the United States from a foreign country. The purpose of collecting this information is to identify and locate passengers who may have been exposed to a person with a communicable disease for public health follow-up. Airlines will retain the information for 30 days and transmit the information to CDC upon request for contact tracing and public health follow-up to keep people safe.

• Public Health Determination and Order Regarding the Right to Introduce Certain Persons from Countries Where a Quarantinable Communicable Disease Exists pdf icon[534 KB, 30 pages]

Following a public health determination, the CDC Director is terminating the Order under 42 U.S.C. §§ 265, 268 and 42 C.F.R. § 71.40 suspending the right to introduce certain persons into the United States. The implementation of the termination of the Order will be on May 23, 2022.

CDC considered multiple factors in its public health assessment and finds that, at this time, the available COVID-19 mitigation tools, as well as the fact that 97% of the U.S. population lives in a county identified as having “low” COVID-19 Community Level, will sufficiently mitigate the COVID-19 risk for U.S. communities and make an order under 42 U.S.C. §§ 265, 268 and 42 C.F.R. § 71.40 no longer necessary. This Termination will be implemented on May 23, 2022, to enable the Department of Homeland Security (DHS) to implement appropriate COVID-19 mitigation protocols, such as scaling up a program to provide COVID-19 vaccinations to migrants, and prepare for full resumption of regular migration processing under Title 8 authorities.

The initial CDC Order Suspending Introduction of Certain Persons from Countries where a Communicable Disease Exists was issued on 3/20/2020 pdf icon[2.1 MB, 43 pages], extended on 4/22/2020external icon and extended and amended on 5/19/2020 pdf icon[136 KB, 12 pages]. The Order was replaced with the Order Suspending the Right to Introduce Certain Persons from Countries Where a Quarantinable Communicable Disease Exists on 10/16/2020external icon and replaced again on 8/2/2021 pdf icon[296 KB, 24 pages]. This Order and accompanying public health determination terminate all previous orders.

• Public Health Reassessment and Immediate Termination of Order Suspending the Right to Introduce Certain Persons from Countries Where a Quarantinable Communicable Disease Exists with Respect to Unaccompanied Noncitizen Children pdf icon[370 KB, 21 pages]

During the COVID-19 pandemic, CDC issued an order suspending the right to introduce certain noncitizens attempting to enter the U.S. from Canada or Mexico (regardless of country of origin) at or between ports of entry. CDC has terminated the Order with respect to unaccompanied noncitizen children.

To learn more, please visit https://www.cdc.gov/coronavirus/2019-ncov/cdcresponse/laws-regulations.html.

On October 21, 2021, CDC Director Rochelle P. Walensky, M.D., M.P.H., endorsed the CDC Advisory Committee on Immunization Practices’ (ACIP) recommendation for a booster shot of COVID-19 vaccine in certain populations. The FDA’s authorization and CDC’s recommendation for use are important steps forward as we work to stay ahead of the virus and keep Americans safe.

For individuals who received a Pfizer-BioNTech or Moderna COVID-19 vaccine, the following groups are eligible for a booster shot at 6 months or more after their initial series:

• 65 years and older
• Age 18+ who live in long-term care settings
• Age 18+ who have underlying medical conditions
• Age 18+ who work or live in high-risk settings

For the nearly 15 million people who got the Johnson & Johnson COVID-19 vaccine, booster shots are also recommended for those who are 18 and older and who were vaccinated two or more months ago.

There are now booster recommendations for all three available COVID-19 vaccines in the United States. Eligible individuals may choose which vaccine they receive as a booster dose. Some people may have a preference for the vaccine type that they originally received, and others may prefer to get a different booster. CDC’s recommendations now allow for this type of mix and match dosing for booster shots.

Millions of people are newly eligible to receive a booster shot and will benefit from additional protection. However, today’s action should not distract from the critical work of ensuring that unvaccinated people take the first step and get an initial COVID-19 vaccine. More than 65 million American remain unvaccinated, leaving themselves- and their children, families, loved ones, and communities- vulnerable.

Available data right now show that all three of the COVID-19 vaccines approved or authorized in the United States continue to be highly effective in reducing risk of severe disease, hospitalization, and death, even against the widely circulating Delta variant. Vaccination remains the best way to protect yourself and reduce the spread of the virus and help prevent new variants from emerging.

The following is attributable to Dr. Walensky:

“These recommendations are another example of our fundamental commitment to protect as many people as possible from COVID-19. The evidence shows that all three COVID-19 vaccines authorized in the United States are safe- as demonstrated by the over 400 million vaccine doses already given. An, they are all highly effective in reducing the risk of severe disease, hospitalization, and death, even in the midst of the widely circulating Delta variant.”

To learn more, visit https://www.cdc.gov/media/releases/2021/p1021-covid-booster.html

Although most people with COVID-19 get better within weeks of illness, some people experience post-COVID conditions. Post-COVID conditions are a wide range of new, returning, or ongoing health problems people can experience four or more weeks after first being infected with the virus that causes COVID-19. Even people who did not have COVID-19 symptoms in the days or weeks after they were infected can have post-COVID conditions. These conditions can present as different types and combinations of health problems for different lengths of time.

These post-COVID conditions may also be known as long COVID, long-haul COVID, post-acute COVID-19, long-term effects of COVID, or chronic COVID. CDC and experts around the world are working to learn more about short- and long-term health effects associated with COVID-19, who gets them, and why.

Types of Post-COVID Conditions

New or Ongoing Symptoms

Some people experience a range of new or ongoing symptoms that can last weeks or months after first being infected with the virus that causes COVID-19. Unlike some of the other types of post-COVID conditions that tend only to occur in people who have had severe illness, these symptoms can happen to anyone who has had COVID-19, even if the illness was mild, or if they had no initial symptoms. People commonly report experiencing different combinations of the following symptoms:

• Difficulty breathing or shortness of breath
• Tiredness or fatigue
• Symptoms that get worse after physical or mental activities (also known as post-exertional malaise)
• Difficulty thinking or concentrating (sometimes referred to as “brain fog”
• Cough
• Chest or stomach pain
• Headache
• Fast-beating or pound heart (also known as heart palpitations)
• Joint or muscle pain
• Pins-and-needles feeling
• Diarrhea
• Sleep problems
• Fever
• Dizziness on standing (lightheadedness)
• Rash
• Mood changes
• Change in smell or taste
• Changes in menstrual period cycles

Multiorgan Effects of COVID-19

Some people who had severe illness with COVID-19 experience multiorgan effects or autoimmune conditions over a longer time with symptoms lasting weeks or months after COVID-19 illness. Multiorgan effects can affect many, if not all, body systems, including heart, lung, kidney, skin, and brain functions. Autoimmune conditions happen when you immune system attacks healthy cells in your body by mistake, causing inflammation (swelling) or tissue damage in the affected parts of the body.

While it is very rare, some people, mostly children, experience multisystem inflammatory syndrome (MIS) during or immediately after a COVID-19 infection. MIS is a condition where different body parts can become inflamed. MIS can lead to post-COVID conditions if a person continues to experience multiorgan effects or other symptoms.

Effects of COVID-19 Illness or Hospitalization

Hospitalizations and severe illness for lung-related diseases, including COVID-19, can cause health effects like severe weakness and exhaustion during the recovery period.

Effects of hospitalization can also include post-intensive care syndrome (PICS), which refers to health effects that begin when a person is in intensive care unit (ICU) and can remain after a person returns home. These effects can include severe weakness, problems with thinking and judgement, and post-traumatic stress disorder (PTSD). PTSD involves long-term reactions to a very stressful event.

Some symptoms that can occur after hospitalization are similar to some of the symptoms that people with initially mild or no symptoms may experience many weeks after COVID-19. It can be difficult to know whether they are caused by the effects of hospitalization, the long-term effects of the virus, or a combination of both. These conditions might also be complicated by other effects related to the COVID-19 pandemic, including mental health effects from isolation, negative economic situations, and lack of access to healthcare for managing underlying conditions. These factors have affected both people who have experienced COVID-19 and those who have not.

Prevention

The best way to prevent post-COVID conditions is to prevent COVID-19 illness. For people who are eligible, getting vaccinated against COVID-19 as soon as you can is the best way to prevent getting COVID-19 and can also help protect those around you.

Stopping a pandemic takes all the tools in our toolbox:

• Get vaccinated and stay up to date on your COVID-19 vaccines.
• Know when to wear a well-fitted mask to help protect yourself and others.
• Avoid crowds and poorly ventilated indoor spaces.
• Test to prevent spread to others.
• Stay 6 feet apart from others who don’t live with you.
• Wash you hands often with soap and water. Use hand sanitizer if soap and water aren’t available.

If you are NOT yet fully vaccinated, prevent long-term complications by protecting yourself and others from COVID-19.

Although media articles have reported that some people with post-COVID conditions say their symptoms improved after being vaccinated, studies are needed to determine the effects of vaccination on post-COVID symptoms.

What CDC is Doing

CDC continues to work to identify how common post-COVID conditions are, who is most likely to get them, and why some symptoms eventually improve for some people and may last longer for other people. Rapid and multi-year studies are underway to further investigate post-COVID conditions in more detail. These studies will help us better understand post-COVID conditions and how to treat patients with these longer-term effects.

For more information, please visit https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html.

A resource for Providers Participating in the CDC COVID-19 Vaccination Program, Long-term Care Residents & Their Families

In response to inquiries about medical consent surrounding the administration of a booster shot of Pfizer-BioNTech COVID-19 vaccine to residents in long-term care (LTC) settings at least five months after their Pfizer-BioNTech primary series, the Centers for Disease Control and Prevention (CDC) has developed the following responses to frequently asked questions (FAQs).

These FAQs are intended to clarify that medical consent is not required by federal law for COVID-19 vaccination in the United States.

Providers enrolled in the CDC COVID-19 Vaccination Program, including those administering vaccines to residents in LTC settings, are required by the CDC Provider Agreement to follow applicable state and territorial laws on medical consent. Providers should consult their legal counsel on such requirements.

Frequently Asked Questions

Is medical consent required for LTC residents to receive a booster shot of the Pfizer-BioNTech COVID-19 vaccine?

Medical consent is not required by federal law for COVID-19 vaccination in the United States.

COVID-19 vaccine providers should consult with their own legal counsel for state or territorial requirements related to consent; compliance with all applicable state and territorial laws is required under the CDC Provider Agreement.

The COVID-19 Provider Agreement contains the following requirements:

• Before administering a COVID-19 vaccine with Emergency Use Authorization (EUA), the provider must provide the approved EUA fact sheet (or Vaccine Information Sheet, as applicable) to each vaccine recipient, the adult caregiver accompanying the recipient (as applicable), or other legal representative (as applicable). The fact sheet/information sheet explains risks and benefits of the particular COVID-19 vaccine and what to expect but is not a consent document.

Is consent required for the booster shot if consent was previously given for the Pfizer-BioNTech primary series?

Explaining the risks and benefits of any treatment to a patient – in a way that they understand – is the standard of care.

Providers should consult with their legal counsel to determine whether previous medical consent obtained from a resident or their representative is legally sufficient under the applicable laws of the state or territory for purposes of administration of a booster dose of Pfizer-BioNTech COVID-19 vaccine.

Is consent for a booster shot of the Pfizer-BioNTech COVID-19 vaccine required if the vaccine is being administered by a different provider?

Providers should consult with their legal counsel to determine whether consent for the Pfizer-BioNTech primary series previously obtained from an LTC resident or their guardian by a different provider is sufficient, or if consent should be obtained prior to administration of the booster shot of Pfizer-BioNTech vaccine, in accordance with any applicable laws of the state or territory.

Does CDC have a consent form that should be used to receive a COVID-19 vaccine?

No. Since applicable medical consent laws are a matter of state, tribal, or territorial law, providers are advised to consult with their legal counsel to assure compliance with the scope of those consent laws.

A written form is not needed if state law allows for oral consent and the organization/provider does not otherwise require it.

• COVID-19 vaccines are safe and effective.
• Everyone 5 years and older is now eligible to get a free COVID-19 vaccination.
• Learn about different vaccines available.
• Search vaccines.gov, text your zip code to 438829, or call 1-800-232-0233 to find COVID-19 vaccine locations near you.

Find a COVID-19 Vaccine

How do I get a COVID-19 Vaccine?

• https://www.cdc.gov/coronavirus/2019-ncov/vaccines/How-Do-I-Get-a-COVID-19-Vaccine.html

When You Get the Vaccine

What are the possible side effects?

Do I need a booster shot?

Register for v-safe

• https://www.cdc.gov/coronavirus/2019-ncov/vaccines/expect.html

Vaccine Information for Specific Groups of People

What if I’m at risk for severe illness?

Can my child get vaccinated?

What if I’m pregnant or breastfeeding?

• https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/specific-groups.html

To learn more, please visit https://www.cdc.gov/coronavirus/2019-ncov/vaccines/your-vaccination.html.

As more people are getting vaccinated and resuming activities they did before the pandemic, parents and caregivers are making hard decisions on how to protect their families. Not everyone is able to get vaccinated, so you may be confused about how to keep your family safe, especially if your family has vaccinated and unvaccinated members. Below are some things to consider when planning outings with your family.

What is Your Family’s Vaccination Status?

• Everyone 5 years and older should get a COVID-19 vaccination to help protect against COVID-19.
• People who are not up to date on their COVID-19 vaccines and children under 5 years old who are not able to get a COVID-19 vaccine should continue taking steps to prevent getting sick.
• Everyone ages 2 years and older should properly wear a well-fitting mask indoors in public in areas where the COVID-19 Community Level is high, regardless of vaccination status.
• In general, people do not need to wear masks when outdoors.
• If you are sick and need to be around others, or are caring for someone who has COVID-19, wear a mask.
• If the COVID-19 Community Level where you live is
  • Low
    • Wear a mask based on your personal preference, informed by your personal level of risk.
  • Medium
    • If you are at risk for severe illness, talk to your healthcare provider about wearing masks indoors in public.
    • If you live with or will gather with someone at risk for severe illness, wear a mask when indoors with them.
  • High
    • If you are 2 or older, wear a well-fitting mask indoors in public, regardless of vaccination status or individual risk (including in K-12 schools and other community settings).
• If you are at risk for severe illness, wear a mask or respirator that provides you with greater protection.

Do You Have Family Member with Medical Conditions or a Weakened Immune System?

• People with certain underlying medical conditions are at increased risk for severe illness from COVID-19.
• People who have a condition or are taking medications that weaken their immune system may not be fully protected even if they are up to date with their COVID-19 vaccines. They should talk to their healthcare provider about what precautions may be needed.
• If you are at increased risk for severe illness, or live with or spend time with someone at higher risk, speak to your healthcare provider about wearing a mask at medium COVID-19 Community Levels.

Where is Your Family Going?

• Outdoor activities and settings are safer than indoor ones.
• Avoid places that are poorly ventilated.
• If someone in your family is younger than 2 years old or cannot wear a mask, limit visits with people who are not vaccinated or whose vaccination status is unknown and keep distance between your child and other people in public.

Regardless of which safer activities your family chooses, remember to protects yourself and others.

What are the Number of COVID-19 Cases and Vaccinated People in Your Community or the Community You are Visiting?

• Use CDC Data Tracker to learn about the situation in your community.
• If your community has a high number of COVID-19 cases or a low number of vaccinated people, consider choosing safer activities.

How to Talk to People Who Care for or Spend Time with Your Family Member

Learn how to talk to professional caregivers, extended family members, family friends, teachers, or other people your loved one spends time with about how to keep your loved one safe from COVID-19.

• Check that your child’s school, childcare program, your family member’s adult care program, or other caregivers are taking the necessary steps to protect your loved ones in their care.
  • Learn more about CDC’s latest recommendations for K-12 schools and early care and education programs.
• Tell them to encourage your family member to weak a mask indoors in public during times when the COVID-19 Community Level is high.
  • Caregivers can help model mask-wearing for children who are too young to get vaccinated.
• Let caregivers know, as appropriate, if your loved one or someone they live with has an underlying medical condition or a weakened immune system.
• Pack an extra mask in your child’s backpack. If your child is old enough, ask if your child can bring hand sanitizer from home to use when they cannot wash their hands with soap and water.

Helping Your Family Member Cope

As families participate in more activities, children or other family members may worry about themselves, their family, and friends getting sick with COVID-19. They may feel anxious about going to school, childcare, or normal activities like grocery shopping or gatherings. Parents, family members, and other trusted adults can help your loved one make sense of what they hear.

• Make yourself available to listen and talk. Let your family member know they can come to you when they have questions.
• Reassure your child or family member that they are safe.
• Let them know it is okay if they feel upset. Share with them how you deal with your own stress so that they can learn how to cope from you.
• Answer questions honestly and share facts about COVID-19 in a way that your family members can understand.
• Teach children and other family members everyday actions to reduce the spread of germs.
  • Parents and caregivers can help by modeling these behaviors themselves.
• Discuss with your family member any actions or routines that may be taken at school, childcare, adult care, or other activities to help protect them and others.
• Take steps to protect you and your family’s mental health.
  • Try to keep up with regular routines.
  • Find safe ways to keep your family connected with friends and other family members.
  • Teach your family healthy coping skills by modeling them yourself. Take breaks, get plenty of sleep, exercise, and eat well.

If you test positive for COVID-19 and have one or more health conditions that increase your risk of becoming very sick, treatment may be available. Contact a health professional right away after a positive test to determine if you may be eligible, even if your symptoms are mild right now. Don’t delay: Treatment must be started within the first few days to be effective.

What You Need to Know

• A person with any of the medical conditions listed below is more likely to get very sick with COVID-19.
• Staying up to date with COVID-19 vaccines (getting primary series and booster) and following preventive measures for COVID-19 are important. This is especially important if you are older or have severe health conditions or more than one health condition, including those on the list below.
• Approved and authorized COVID-19 vaccines (primary series and booster) are safe and effective.
• Some immunocompromised people, or people with weakened immune systems, may be eligible for a COVID-19 additional primary shot.
• The list below does not include all possible conditions that put you at higher risk of severe illness from COVID-19. If you have a condition not included on this list, talk to your healthcare professional about how best to manage your condition and protect yourself from COVID-19.

Overview

Based on current evidence, a person with any of the conditions listed below is more likely to get very sick with COVID-19. This means that a person with one or more of these conditions and who gets very sick with COVID-19 more likely to:

• Be hospitalized
• Need intensive care
• Require a ventilator to help them breathe
• Die

In addition:

• Older adults are more likely to get very sick from COVID-19. More than 81% of COVID-19 deaths occur in people over age 65. The number of deaths among people over age 65 is 97 times higher than the number of deaths among people ages 18-29 years.
• A person’s risk of severe illness from COVID-19 increases as the number of underlying medical conditions they have increases.
• Some people are at increased risk of getting very sick or dying from COVID-19 because of where they live or work, or because they can’t get health care. This includes many people from racial and ethnic minority groups and people with disabilities.
  • Studies have shown people from racial and ethnic minority groups are also dying from COVID-19 at younger ages. People in racial and ethnic minority groups are often younger when they develop chronic medical conditions and may be more likely to have more than one medical condition.
  • People with disabilities are more likely than those without disabilities to have chronic health conditions, live in shared group settings, and face more barriers in accessing health care. Studies have shown that some people with certain disabilities are more likely to get COVID-19 and have worse outcomes.

Staying up to date with COVID-19 vaccines (getting primary series and booster) and following preventive measures for COVID-19 are important. This is especially important if you are older or have severe health conditions or more than one health condition, including those on this list. Learn more about how CDC develops COVID-19 vaccination recommendations. If you have a medical condition, learn more about Actions You Can Take.

Medical Conditions

• The conditions on this list are in alphabetical order. They are not in order of risk.
• CDC completed a review for each medical condition on this list. This was done to ensure that these conditions met criteria for inclusion on this list. CDC conducts ongoing reviews of additional underlying conditions. If other medical conditions have enough evidence, they might be added to this list.
• Because we are learning more about COVID-19 every day, this list does not include all medical conditions that place a person at higher risk of severe illness from COVID-19. Rare medical conditions, including many conditions that mostly affect children, may not be included on the list below. We will update the list as we learn more.
• A person with a condition that is not listed may still be at greater risk of getting very sick from COVID-19 than other people who do not have the condition. It is important that you talk with your healthcare professional about your risk.

Cancer

Having cancer can make you more likely to get very sick from COVID-19. Treatments for many types of cancer can weaken your body’s ability to fight off disease. At this time, based on available studies, having a history of cancer may increase your risk.

Get more information:

• Cancer
• COVID-19: What People with Cancer Should Know – National Cancer Institute

Chronic Kidney Disease

Having chronic kidney disease of any stage can make you more likely to get very sick from COVID-19.

Get more information:

• Chronic Kidney Disease
• National Kidney Foundation: Kidney Disease and COVID-19

Chronic Liver Disease

Having chronic liver disease can make you more likely to get very sick from COVID-19. Chronic liver disease can include alcohol-related liver disease, non-alcoholic fatty liver disease, autoimmune hepatitis, and cirrhosis (or scarring of the liver).

Get more information:

• Liver Disease
• American Liver Foundation: Your Liver and COVID-19

Chronic Lung Diseases

Having a chronic lung disease can make you more likely to get very sick from COVID-19. Chronic lung diseases can include:

• Asthma, if it’s moderate to severe
• Bronchiectasis (thickening of the lungs’ airways)
• Bronchopulmonary dysplasia (chronic lung disease affecting newborns)
• Chronic obstructive pulmonary disease (COPD), including emphysema and chronic bronchitis
• Having damaged or scarred lung tissue known as interstitial lung disease (including idiopathic pulmonary fibrosis)
• Pulmonary embolism (blood clot in the lungs)
• Pulmonary hypertension (high blood pressure in the lungs)

Get more information:

• COPD
• Asthma
• People with Moderate to Severe Asthma
• American Lung Association: Controlling Lung Diseases Amid COVID-19

Cystic Fibrosis

Having cystic fibrosis, with or without lung or other solid organ transplant (like kidney, liver, intestines, heart, and pancreas) can make you more likely to get very sick from COVID-19.

Get more information:

• Cystic Fibrosis
• CF and COVID-19 | Cystic Fibrosis Foundation

Dementia or Other Neurological Conditions

Having neurological conditions, such as dementia, can make you more likely to get very sick from COVID-19.

Get more information:

• Dementia
• Alzheimer’s Association: COVID-19, Alzheimer’s and Dementia

Diabetes (Type 1 or 2)

Having either type 1 or type 2 diabetes can make you more likely to get very sick from COVID-19.

Get more information:

• Diabetes
• American Diabetes Association: How COVID-19 Impacts People with Diabetes

Disabilities

People with some types of disabilities may be more likely to get very sick from COVID-19 because of underlying medical conditions, living in congregate settings, or systemic health and social inequities, including:

• People with any type of disability that makes it more difficult to do certain activities or interact with the world around them, including people who need help with self-care or daily activities.
• People with attention-deficit/hyperactivity disorder (ADHD)
• People with cerebral palsy
• People with birth defects
• People with intellectual and developmental disabilities
• People with learning disabilities
• People with spinal cord injuries
• People with Down syndrome

Get more information:

• People with Disabilities | COVID-19

Heart Conditions

Having heart conditions such as heart failure, coronary artery disease, cardiomyopathies, and possibly high blood pressure (hypertension) can make you more likely to get very sick from COVID-19.

Get more information:

• Heart Disease
• American Heart Association: COVID-19
• NHLBI Information and Resources on COVID-19

HIV Infection

Having HIV (Human Immunodeficiency Virus) can make you more likely to get very sick from COVID-19.

Get more information:

• HIV Infection
• Interim Guidance for COVID-19 and Persons with HIV

Immunocompromised State (Weakened Immune System)

Some people are immunocompromised or have a weakened immune system. For example, people on chemotherapy or who have had solid organ transplant, like a kidney transplant or heart transplant. Being immunocompromised can make you more likely to get very sick from COVID-19. Many conditions and treatments can cause a person to be immunocompromised or have a weakened immune system. For example, some people inherit problems with their immune system. Once example is called Primary immunodeficiency. Other people have to use certain types of medicines for a long time, like corticosteroids, that weaken their immune system. Such long-term uses can lead to secondary or acquired immunodeficiency.

People who are immunocompromised or are taking medicines that weaken their immune system may not be protected even if they are up to date on their vaccines. They should continue to take all precautions recommended for people who are not vaccinated, including wearing a well-fitting mask, until advised otherwise by their healthcare professionals.

After completing the primary series, some moderately or severely immunocompromised people should get an additional primary shot.

Everyone 12 years and older, including immunocompromised people, should get a booster shot. If you are eligible for an additional primary shot, you should get this dose first before you get a booster shot.

Get more information:

• Types of Primary Immune Deficiency Diseases
• Jeffrey Modell Foundation
• Immune Deficiency Foundation
• Primary Immunodeficiency (PI)

Mental Health Conditions

Having mood disorders, including depression, and schizophrenia spectrum disorders can make you more likely to get very sick from COVID-19.

Get more information:

• National Institute of Mental Health (NIMH) Shareable Resources on Coping with COVID-19
• National Institute of Mental Health (NIMH) Depression
• Mood Disorders

Overweight and Obesity

Overweight, obesity, or severe obesity, can make you more likely to get very sick from COVID-19. The risk of severe COVID-19 illness increases sharply with higher BMI.

Get more information:

• Overweight & Obesity | CDC
• Obesity, Race/Ethnicity, and COVID-19
• Obesity Action Coalition: COVID-19 and Obesity

Physical Inactivity

People who do little or no physical activity, or exercise, are more likely to get very sick from COVID-19 than those who are physically active. Being physically active (or exercising regularly) is important to being healthy. Get more information on physical activity and health, physical activity recommendations, how to become more active, and how to create activity-friendly communities:

• Physical Activity
• Physical Activity Guidelines for Americans, 2^nd Edition
• Move Your Way
• Active People, Healthy Nation: Strategies to Increase Physical Activity
• National Center on Health, Physical Activity and Disability – Building Healthy Inclusive Communities

Pregnancy

Pregnant and recently pregnant people (for at least 42 days following end of pregnancy) are most likely to get very sick from COVID-19 compared with non-pregnant people.

Get more information:

• Pregnant and Recently Pregnant People
• Toolkit for Pregnant People and New Parents
• Investigating the Impact of COVID-19 during Pregnancy

Sickle Cell Disease or Thalassemia

Having hemoglobin blood disorders like sick cell disease (SCD) or thalassemia can make you more likely to get very sick from COVID-19.

Get more information:

• Sickle Cell Disease
• Thalassemia

Smoking, Current or Former

Being a current or former cigarette smoker can make you more likely to get very sick from COVID-19. If you currently smoke, quit. If you used to smoke, don’t start again. If you’ve never smoked, don’t smart.

Get more information:

• Smoking & Tobacco Use
• Tips from Former Smokers
• Health Benefits of Quitting Smoking

Solid Organ or Blood Stem Cell Transplant

Having a solid organ or blood stem cell transplant, which includes marrow transplants, can make you more likely to get very sick from COVID-19.

Get more information:

• Transplant Safety
• COVID-19 Resources for Transplant Community

Stroke or Cerebrovascular Disease

Having cerebrovascular disease, which affects blood flow to the brain, can make you more likely to get very sick from COVID-19.

Get more information:

• Stroke
• COVID-19 Stroke Podcast Series for Patients and Caregivers

Substance Use Disorders

Having a substance use disorder (such as alcohol, opioid, or cocaine use disorder) can make you more likely to get very sick from COVID-19.

Get more information:

• How to Recognize a Substance Use Disorder
• Drug Overdose

Tuberculosis

Having tuberculosis can make you more likely to get very sick from COVID-19.

Get more information:

• Basic TB Facts
• Public Health Emergencies

Actions You Can Take

It is important to protect yourself and others by taking preventive measures against COVID-19:

• Stay up to date with your COVID-19 vaccines
• Wear a well-fitting mask
• Avoid crowds and poorly ventilated spaces
• Test to prevent the spread to others
• Wash your hands often
• Cover coughs and sneezes
• Monitor your health daily

Seek Care When Needed

• Call your healthcare professionals if you have any concerns about your medical conditions or if you get sick and think that you may have COVID-19. Discuss steps you can take to manage your health and risks. If you need emergency help, call 911 right away.
• Do not delay getting care for your medical condition because of COVID-19. Emergency departments, urgent care, clinics, and your healthcare professionals have infection prevention plans to help protect you from getting COVID-19 if you need care.

To learn more, please visit https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html

Summary of Changes

• Guidance streamlined
• Added links to guidance on testing for determining length of work restriction for healthcare personnel with SARS-CoV-2 infection or exposure to SARS-CoV-2 and for mitigating staff shortages in healthcare settings
• Time period for confirmatory testing was clarified

This document is intended to assist long-term care facility (LTCF) providers and state and local public health departments with interpretation of and response to results of antigen tests used to diagnose new SARS-CoV-2 infections in the following circumstances:

• Testing of symptomatic residents and healthcare personnel (HCP),
• Testing of asymptomatic residents and HCP in facilities as part of a SARS-CoV-2 outbreak response or following close contact with someone with SARS-CoV-2 infection, and
• Testing of asymptomatic HCP as part of expanded screening testing in facilities without a SARS-CoV-2 outbreak.

Information on the role of testing in determining the length of work restriction  for HCP with SARS-CoV-2 infection or exposure to SARS-CoV-2 is available here: https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html.

Information on the role of testing in mitigating staff shortages is available here: https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html

Testing Symptomatic Residents or HCP

• Recommended infection prevention and control precautions for residents and HCP with suspected or confirmed SARS-CoV-2 infection are described in:
  • Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes
  • Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2 | CDC

• If an antigen test is positive, confirmatory testing is generally not necessary.  The symptomatic individual should be classified as having SARS-CoV-2 infection.
  • Residents should be placed on Transmission-Based Precautions and HCP should be excluded from work until they meet criteria to discontinue isolation.
  • If the resident or healthcare worker is the first positive case of SARS-CoV-2 within the facility (i.e., an index case), an outbreak response might be indicated.

• If an antigen test is negative, confirmatory testing¹ with a nucleic acid amplification test (NAAT) should be performed as soon as possible (within 1 to 2 days of the antigen test).  Residents should be kept on Transmission-Based Precautions and HCP should remain excluded from work until NAAT results return.
  • If the confirmatory NAAT is negative:
    • If not in an outbreak facility and no known close contact with someone with SARS-CoV-2 infection, residents and HCP may be treated as not SARS-CoV-2 infected or exposed; further management will depend on the suspected etiology of their symptoms.
    • If in an outbreak facility or there has been close contact with someone with SARS-CoV-2 infection, residents and HCP should be managed as described in current guidance for long-term care infection control and HCP return to work.

• If the confirmatory NAAT is positive:
  • Residents and HCP should be considered to have SARS-CoV-2 infection. Residents should remain on Transmission-Based Precautions  and HCP should be excluded from work until they meet criteria to discontinue isolation.
  • If the resident or healthcare worker is the first positive case of SARS-CoV-2 within the facility (i.e., an index case), an outbreak response might be indicated.

• Facilities should test for both influenza and SARS-CoV-2 if influenza and SARS-CoV-2 are circulating in the community.

Some antigen platforms have higher sensitivity when testing people soon after symptom onset (e.g., within 5 days). Clinical discretion may be used when determining if people who test negative should be retested with NAAT. Confirmatory testing may not be necessary if the individual has a low likelihood of SARS-CoV-2 infection. Factors that might indicate a lower likelihood of infection include: low to moderate levels of community transmission, no known or suspected close contact with someone with SARS-CoV-2 infection, and/or the person is up to date with COVID-19 vaccination.

Asymptomatic residents or HCP in LTCF tested as part of an outbreak response or following close contact with someone with SARS-CoV-2 infection

• If an antigen test is positive, confirmatory NAAT should generally be performed².
  • Residents should be placed on Transmission-based Precautions in a single room or, if single rooms are not available, remain in their current room pending results of confirmatory testing. They should not be transferred to a COVID-19 unit or placed in another shared room with new roommates. HCP should be excluded from work.
  • If confirmatory NAAT is positive, residents and HCP should be considered to have SARS-CoV-2 infection.  Residents should remain on Transmission-Based Precautions  and HCP should be excluded from work until they meet criteria to discontinue isolation.

• If an antigen test is negative OR if the antigen test is positive but the confirmatory NAAT (performed within 1 to 2 days of the antigen test) is negative:
  • Residents and HCP may be treated as not SARS-CoV-2 infected; however, because of their potential exposure (in an outbreak facility or have had close contact) residents and HCP should be managed as described in current guidance for long-term care infection control and HCP return to work.

• Note: In general, asymptomatic people who have recovered from SARS-CoV-2 infection in the past 3 months should not be tested for SARS-CoV-2.

In situations where the pre-test probability is higher (e.g., facility with a large outbreak, a person who is a close contact of someone with SARS-CoV-2 infection and is not up to date with all recommended COVID-19 vaccine doses), the antigen positive test might not require confirmation and the individual should be treated as infected with SARS-CoV-2.

Asymptomatic HCP as part of expanded screening testing in LTCF without an outbreak 

• If an antigen test is positive, perform confirmatory NAAT as soon as possible (within 1 to 2 days of the antigen test). Asymptomatic HCP who are antigen test positive should be excluded from work but initiation of an outbreak response, including facility-wide testing, can be delayed until confirmatory test results are available.
  • If the confirmatory NAAT is positive, then the healthcare worker should be considered infected and guidance for HCP return to work and infection control response in long-care should be followed.
  • If the confirmatory NAAT is negative, the antigen test should be considered a false positive and the HCP may return to work.

• If an antigen test is negative, allow HCP to continue to work following all routine recommended infection control practices.

Note: In general, asymptomatic HCP who have recovered from SARS-CoV-2 infection in the past 3 months should not be tested for SARS-CoV-2.

For more information, please visit https://www.cdc.gov/coronavirus/2019-ncov/hcp/nursing-homes-antigen-testing.html.

Wash hands with soap and water for at least 20 seconds. Use the cleanest water possible, for example, from an improved source. *If soap and water are not available use an alcohol-based hand rub that contains at least 60% alcohol.

Handwashing Solution

Make a Handwashing Solution

Remember, only use chlorine-based handwashing solutions when soap and water or alcohol-based hand rub are not available.

Making Handwashing Solution from 5% Liquid Bleach

Use the MILD chlorine water to wash hands. Make new mild chlorine water every day.

1. Mix 14 tablespoons (1 Cup plus ¾ Cup) of 5% bleach into 20 liters (5 gallons plus 4½ Cups) of clear water. Stir well.
   Label plastic bucket for handwashing only / MILD 05%. Do not drink or use for cooking.
2. Make sure the bucket is covered. Use the MILD chlorine water to wash hands.

Making Handwashing Solution from HTH Chlorine Powder

Use the MILD chlorine water to wash hands. Make new mild chlorine water every day.

1. Mix 1 tablespoon of HTH chlorine powder into 20 liters (5 gallons plus 4½ Cups) of water every day. Stir well. Label plastic bucket for handwashing only /MILD 05%. Do not drink or use for cooking.
2. Stir well and wait 30 minutes.
3. Use the MILD chlorine water to wash hands.

To learn more, please visit: https://www.cdc.gov/coronavirus/2019-ncov/global-covid-19/handwashing.html