The Wisconsin Department of Health Services (DHS) is pleased to support COVID-19 testing in county jails. This testing support is subject to the availability of testing supplies and is intended to complement COVID-19 prevention efforts. Participation is voluntary.
Close contact: being in 6 feet of another person for at least 15 minutes or more.
Asymptomatic: a person who does not report or appear to have any symptoms or signs of illness.
Symptomatic: a person exhibiting symptoms.
Quarantine: is used to keep someone who might have been exposed to the virus away from others.
Isolation: is used to separate people infected with COVID-19 from those who are not infected.
Fully vaccinated: In general, people are considered fully vaccinated: 2 weeks after their second dose in a 2-dose series, such as the Pfizer or Moderna vaccines, or 2 weeks after a single-dose vaccine, such as Johnson & Johnson’s vaccine.
Molecular test: is a type of highly accurate diagnostic test than can detect if you have an active COVID-19 infection. Samples for diagnostic tests are typically collected with a nasal swab, or saliva collected by spitting into a tube. Samples are usually sent out to a lab for processing.
Antigen test: is a type of diagnostic test than can detect if you have an active COVID-19 infection. Samples for diagnostic tests are typically collected with a nasal swab. Results are available in 15-30 minutes. If individual is symptomatic and tests negative, they will require a follow up molecular test.
Key reasons to test in jails
- The Centers for Disease Control and Prevention encourages testing as part of a comprehensive approach to preventing the spread of COVID-19 in correctional and detention facilities.
- Testing individuals who are symptomatic and close contacts helps enable rapid detection of cases in jails to reduce or prevent outbreaks. A routine screening testing program, which regularly tests people without symptoms or known exposures, is a tool to reduce “silent” spread of the virus and can help inmates and staff. According to the CDC, at least 50% of infections are likely contracted from someone that is asymptomatic (showing no symptoms) or pre-symptomatic (not currently showing symptoms but may develop them in the future).
- Testing in jails ensures incarcerated individuals have convenient and equitable access to testing resources.
Who should be tested?
- Symptomatic individuals. The CDC lists possible symptoms of COVID-19 as fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, and/or sore throat.
- Close contacts of someone who has tested positive for COVID-19.
- Asymptomatic staff and incarcerated individuals as part of a routine screening program. This may include testing inmates and staff each week. Individuals who are fully vaccinated do not need to complete routine screening testing.
When to test?
Jails should consult with public health to determine the best testing model(s) to meet their needs and may consider following the CDC Testing in Correctional & Detention Facilities. In the event of one or more cases of COVID-19 in a jail, consult with your local or tribal health department to determine the best outbreak response, which may include expanded testing.
Preparing for COVID-19 testing: step-by-step instructions
1. Determine the right testing supplies for your jail.
Testing supplies are available through the DHS COVID-19 testing supplies website. Jails have the option to order and use testing supplies that best meet their needs for inmates and staff, including rapid point-of-care antigen tests and highly accurate lab-based tests.
Highly accurate, lab-based molecular tests
Laboratory-based molecular tests (for example, RT-PCR) are the gold standard for COVID-19 testing. Conducted in a specialized environment by trained professionals, molecular tests are the most accurate tests available. The test supplies are shelf-stable, but specimens collected for a molecular test must be return-shipped or couriered to the laboratory for processing. Test results are usually available in 24-48 hours. The laboratory conducts all required certificates and reporting for jails.
Rapid, point-of-care antigen tests
Abbott BinaxNOW rapid antigen tests are available for use in jails and provide results in 15 minutes. These instrument-less, shelf-stable supplies are shipped in boxes of 40 tests. BinaxNOW tests are the most accurate for individuals with symptoms and sometimes require a follow-up test to confirm the result.
To use BinaxNOW tests, jails must:
- Obtain a Clinical Laboratory Improvement Amendment (CLIA) Certificate of Waiver. The CLIA certificate process is fast and easy.
- Report results to state and federal authorities within 24 hours of receiving the result.
- Facilitate access to confirmatory testing when needed. DHS will provide lab-based molecular testing supplies to jails for confirmatory testing.
- Negative BinaxNOW test results occurring in individuals with COVID-19-like symptoms should be confirmed by a lab-based molecular test, because of the risk of false negative results.
- Positive BinaxNOW test results occurring in asymptomatic individuals (e.g. tests conducted as part of a routine screening program) should be confirmed by a lab-based molecular test, because of the risk of false positive results.
2. Obtain a CLIA Certificate of Waiver (only for rapid point of care tests).
When ordering rapid antigen tests from DHS, you will need to submit your CLIA Certificate of Waiver number.
To obtain a CLIA Certificate of Waiver, you will need to submit a completed application to DHSDQACLIA@Wisconsin.gov.
3. Partner with a clinician.
All COVID-19 testing needs to occur under the authority of a clinician with prescribing authority (MD, DO, PA, or NP).
If you do not have a local clinician who manages your jail’s health services, you can complete the attestation form and submit to WICOVIDTest@Wisconsin.gov. This will allow you to conduct testing under the statewide standing order for COVID-19 tests prescribed by the Wisconsin DHS Chief Medical Officer.
4. Submit a request for testing supplies.
- To receive rapid point-of-care antigen tests, complete all fields under BinaxNOW Testing Supplies.
- To receive lab-based molecular tests, in the PCR Testing Supplies field, type “Exact” for the Clinical Laboratory, click “Add Item,” and select “Collection Supplies and Laboratory Services.” Complete fields in form.
- To order both rapid point-of-care and lab-based molecular tests, complete both PCR Testing Supplies and BinaxNOW Testing Supplies fields.
5. Complete training.
Any staff who will administer COVID-19 testing at the jail must complete training to assure they are using the tests safely and effectively.
Performing and Reporting the BinaxNOW test (Rapid Antigen)
BinaxNOW antigen testing does not allow for a self collection option.
- How to do a nasal swab video
- How to use BinaxNOW test video
- How to interpret BinaxNOW test video
- BinaxNOW package insert
- Reporting antigen results to public health
Performing and Reporting PCR test in jails
6. Set up an account with the Wisconsin State Lab of Hygiene to report results.
COVID-19 is a Category I reportable condition in Wisconsin. As such, test results must be reported to the State of Wisconsin and to federal authorities (HHS). To report results, set up an account.
Resources to learn more
If you have questions about ordering testing supplies or jail testing in general, please email WICOVIDTest@Wisconsin.gov.
Frequently asked questions by category
- What support is the Department of Health Services providing jails to conduct COVID-19 testing? The Department of Health Services is offering free Abbott BinaxNOW point-of-care tests with optional confirmatory PCR supplies and comprehensive testing services through approved vendors. Tests may be used for staff and inmates who are symptomatic and close contacts, to conduct surveillance testing, or to test inmates who have appointments outside of the facility.
- Is it mandatory for jails to test inmates and staff? No, participation in the testing is voluntary.
- Will the state offer funding for additional staff to conduct testing? No. Direct funding to pay staff is currently not covered.
- How do I order Abbott BinaxNOW tests under this program? Free Abbott BinaxNOW tests may be ordered through the Wisconsin COVID-19 Collection Supply Request website. Jails conducting testing must provide a valid CLIA Certificate of Waiver number during the ordering process.
- Is the cost associated with biohazard waste disposal covered? No. The cost of biohazard waste disposal is not covered under this program. Jails are responsible for safely disposing of waste. Options include the use of biohazard bags for used Abbott BinaxNOW cards, hard-sided biohazard containers for used swabs, and/or the use of a medical biohazard disposal service. For additional information, see CDC Waste Management Guidelines for SARS-CoV-2 Point-of-Care Testing.
CLIA Certificate of Waiver
- When does a jail need a Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver? For a jail to conduct point of care tests (like the COVID-19 Abbott BinaxNOW tests or diabetic glucose checks), the jail must apply for and receive a CLIA Certificate of Waiver. Jails may not conduct testing until the certificate of waiver has been approved. A jail does not need a certificate of waiver if they collaborate with another entity willing to conduct testing at the jail under that entity’s CLIA Certificate of Waiver or if the jail is not conducting point of care tests.
- What responsibilities must a jail fulfill as an organization with a CLIA waiver? Any organization with a CLIA Certificate of Waiver is responsible for the safety and effectiveness of services they provide. For jails conducting COVID-19 point of care testing, this includes staff training, effective infection control practices, and reporting infectious disease test results to the state of Wisconsin and to the federal authorities (HHS). Guidance about how to set up an account and report COVID-19 point of care test results is available from the Wisconsin State Laboratory of Hygiene. If a jail coordinates with a testing partner, or is providing lab-based molecular tests (not point of care tests), then the laboratory will assume the responsibility for the safety and effectiveness of testing – including responsibility for reporting test results on the jail’s behalf.
- If a jail uses another company to conduct point of care antigen testing, does the jail still need to obtain a CLIA Certificate of Waiver? No. If the jail partners with an entity to come to their facility to swab and result the point of care antigen test, then the jail does not need to obtain their own CLIA certificate of Waiver. All testing would occur under the external entity’s CLIA certificate. Jails should verify that the external entity conducting the test has a valid CLIA Certificate of Waiver. To find out if an entity has a valid CLIA Certificate of Waiver, request the CLIA number from the testing partner and verify it by checking the CDC CLIA Laboratory Search website or emailing DHSDQACLIA@wi.gov. All entities ordering BinaxNOW supplies from DHS are required to provide their CLIA number when placing their orders.
- How does a jail apply for a CLIA Certificate of Waiver? To apply to receive a CLIA Certificate of Waiver, the jail must fill out the Center for Medicare and Medicaid Services (CMS) application form CMS-116 CLIA Application and submit it to the State of Wisconsin CLIA Section at DHSDQACLIA@wi.gov. Once approved, CMS will assign a CLIA number and send a letter or email of confirmation to the county jail. For more information on CLIA certification, reference the CMS Laboratory Quick Start Guide.
- How long does it take to process the CLIA Certificate of Waiver? Once a jail submits an accurate and complete application, CMS usually processes the Certificate of Waiver in one week or less. Once approved, the jail will be assigned a Federal CLIA number and may begin testing. Provide the CLIA number to DHS when ordering testing supplies.
- Is there a fee associated with applying for a CLIA Certificate of Waiver? Yes. An entity is required to pay $180.00 to CMS before the CLIA Certificate of Waiver is approved. CMS will send an invoice to the jail and you may submit payment to CMS directly or pay online at Pay.Gov.
- Does the CLIA Certificate of Waiver expire? The CLIA Certificate of Waiver is good for two years. CMS will send a renewal invoice 6 months prior to the expiration date of the certificate.
- The CLIA application asks to identify the "director" of the laboratory. Can this be anyone in the jail? The jail may list any employee as the director on the CLIA application. It is recommended that the director is an individual who is or who will become knowledgeable about the requirements of maintaining the CLIA Certificate of Waiver and the jail’s testing operations, including testing and safety protocols, staff training, and reporting of test results. Examples may include the jail nurse, a health aide, or a jail administrator overseeing the health or testing program.
- What other information will the application request? The application requires the jail to provide their tax ID number. The application also requires the jail estimate the number of tests they plan to conduct. This can be a general estimate based on the number of staff and inmates.
- How can a jail verify whether they already hold a CLIA certificate? To verify whether an entity has a valid CLIA Certificate of Waiver, check the CDC CLIA Laboratory Search website or email DHSDQACLIA@wi.gov.
- Who do I contact if I have additional questions about the CLIA Certificate of Waiver process? For any questions about the CLIA Certificate of Waiver and process, email the State of Wisconsin Department of Health Services, Division of Quality Assurance at DHSDQACLIA@wi.gov.
- Who at my jail is allowed to collect the specimen for a COVID-19 test? Does it have to be a nurse? Any staff member who is properly trained is allowed to collect the specimen and test the specimen and result the point of care antigen test. Training may be accessed through many venues, including from a trained clinician (a health care provider) or through the test manufacturer’s materials. If you need assistance finding these vendor materials, email WICovidTest@Wisconsin.gov
- Does a jail need to have access to lab-based molecular tests? All jails conducting point of care testing under Dr. Westergaard's statewide standing order (including Abbott BinaxNOW tests) must assure compliance with the DHS and CDC recommendation for providing follow-up testing to confirm some antigen results. Lab-based molecular tests are recommended for this follow-up testing. Jails can order and provide these follow-up, confirmatory tests, or refer staff to follow-up:
- at a free community testing side that conducts molecular testing
- using a free at-home saliva collection kit
- at the individual’s health care provider or a free or low cost health clinic for those who do not have a health care home (verify if they are conducting COVID-19 molecular testing prior to referral).
- How should jails prepare to test inmates and staff on site? Jails interested in offering onsite testing will need to assure the following:
- a process for notifying individuals of their results.
- necessary testing supplies including personal protective equipment, tables, and cleaning and disposal supplies.
- space to isolate anyone with symptoms and who test positive.
- Should jails require a negative test result for inmates to return to the general population or staff before returning to work after they have been sick? No. It is not recommended to require a negative test before returning. There have been reports that an individual can continue to test positive long after they are considered to be contagious. Inmates and staff who test positive should observe a 10-day isolation period from the date their symptoms first appeared. Additionally, they need to be fever-free for 24-hours and have improved symptoms before they end their isolation period. An asymptomatic person should observe a 10-day isolation period starting on the date the positive specimen was collected.
If a fully vaccinated person is exposed to COVID-19, they need to be tested but do not have to quarantine unless they are symptomatic. Close contacts who are not fully vaccinated should be tested and will need to quarantine for a 14-day period starting with the date of last contact with the infected person. Any staff or inmate who experiences COVID-19 symptoms should get a COVID-19 test.
For additional guidance on this topic:
- Learn about isolation and quarantine.
- Contact your local health department.
- See CDC Testing in Correctional & Detention Facilities guidance.
- When should an individual be referred for follow-up lab-based molecular testing? Follow-up confirmatory molecular testing is recommended for individuals who are symptomatic and test negative using the Abbott BinaxNOW, and for people who are asymptomatic and test positive using the Abbott BinaxNOW. Confirmatory testing should be conducted as soon as possible and within 48 hours. For a simple guide on when to retest, see COVID-19 Antigen Testing: When is it best to retest? Additional guidance for the use of antigen testing is located in the COVID-19 Health Alert #17: Important Considerations for Use of COVID-19 Antigen Tests.
Does a jail need an order signed by a medical provider to do testing? Yes, COVID-19 testing needs to occur under the authority of a medical provider. A jail may obtain a written order through a clinician with prescribing authority (MD, DO, PA, or NP), or opt to use a standing order issued by Dr. Ryan Westergaard, Chief Medical Officer for the Wisconsin Department of Health Services. If a jail chooses to use Dr. Westergaard’s standing order, they must sign an attestation form agreeing to follow the requirements of the order.