Push For Better Testing
MEDICAL AND MENTAL HEALTH UPDATE
After talking to patients all weekend on call for my group medical practice, three things are clear to me:
I really love my job. Despite the 3 am phone calls, I’m grateful as hell to have this portable skill set that seems to help people when they are vulnerable, afraid, and sick.
People are weary from the combination of blistering heat, unrelenting bad news, and the lack of a clear path out of this mess. And stress is making some of us sick.
The testing landscape is still very confusing to most people—including doctors!
So today we’ll go over TESTING FAQs. Then later this week we’ll revisit stress management and some reasons for HOPE. (They exist, and I’ll give you a taste today!)
You are probably hearing about these TWO commonly used types of COVID-19 testing (though others are in the pipeline):
The nasal swab: the test for active infection with coronavirus. This is the most common test around—it is a “PCR” test that detects the genetic material (or RNA) of the virus. There is the standard test and a rapid version.
The blood test: the test for antibodies looking for evidence of PAST infection.
Q: So what test should I get if I feel SICK?
A: You want the nasal swab test for active virus. Also be sure to call your doctor!
Q: What test do I need if I FEEL WELL but I had a potential coronavirus exposure or if I need a test for travel?
A: Same as above.
Q: What about an antibody test? If I have antibodies, aren’t I immune to coronavirus?
A: Sorry, we just don’t know quite yet. We are seeing some patients with antibodies experience a decline in their levels over time. More research is needed to understand what this means before we can reassure anyone about lasting immunity.
Q: Where can I get a test in the DC area?
A: I am sending asymptomatic patients to various free testing sites around the city in addition to some CVS’s, fire stations, urgent care centers, etc. Of course for patients with symptoms, I am testing and treating them on a case-by-case basis and writing specific testing orders. CLICK HERE for my answers to some earlier FAQs on isolation, quarantining, and COVID testing.
Q: What if my travel destination or school requires a negative COVID test within 72 hours of arrival but my test result won’t be back for 7-10 days? Argh!
A: I feel for you, but sadly I don’t have a great solution except to suggest that you seek out a rapid test which gets results in under 30 minutes but can be hard to find and quite expensive.
Q: But aren’t the rapid tests less accurate?
A: Yes and no. If we ONLY ask the rapid test the specific question that it is able to answer, it does a FABULOUS job. But if we ask the rapid test a question that it cannot answer, it is useless. Context matters! Please read on.
We now know that it’s ONLY when the virus makes enough copies of itself and produces approximately one million fragments of its genetic material (RNA) inside the human host that a person can transmit the virus to other people.
The rapid test, like Abbott’s “ID NOW,” is a PCR test that can ONLY detect the higher levels of viral particles which (when present) is when people are infectious.
In short, a rapid test like this does a GREAT JOB answering the question: “Am I infected with enough virus to be infectious to others?”
This test, however, misses people with lower—e.g. Non-transmissible—levels of virus. In other words, it DOES NOT fully rule out the presence of coronavirus in your body.
Q: So what does a negative rapid test mean?? Are you saying that I cannot feel reassured by a negative rapid test?
A: A negative rapid PCR test tells us with great certainty that you do not have enough virus in your body to infect others. That’s good!! But it does NOT necessarily mean you are free of virus altogether. A negative test does NOT rule out the possibility of very low levels of virus that are actively replicating to later cause symptoms and/or spread to others.
Q: So how long would it take for me to go from having an undetectable amount of virus to having a detectable (e.g. contagious) amount of virus—using a rapid PCR test like Abbott’s ID NOW?
A: BE STILL MY BEATING HEART. That is the best question I’ve been asked ALL SUMMER. The answer is: NOT LONG. You can go from having a negative rapid test to having a positive rapid test within hours.
Q: What?!? So I could get a negative rapid test and be contagious hours later with coronavirus?
A: Yes.
Q: So if the rapid test can accurately tell me that I am contagious—and this status could FLIP within hours as the virus copies itself—maybe I should get a rapid test more often than just once?
A: Oh, joy to the world. You are getting the gist!! The answer is YES YES YES.
Q: OK, cool. So how come we don’t have these tests widely available?
A: You are singing my song now, sister!! In my opinion, the ticket out of the pandemic is developing, expanding, and distributing existing technology to test asymptomatic people FREQUENTLY, using CHEAP, RAPID TESTS that can be administered at home. The key is surveying the entire population regularly to capture those who are unknowingly spreading the virus.
It’s relatively easy to identify sick people and isolate them, right? Sick people are sick! But because the virus is being propagated by people going to work, the gym, on airplanes, and social gatherings—people who don’t even know they are sick—widespread surveillance is essential to crush COVID-19.
Q: I’ve heard of saliva tests that can give COVID results quickly, too?
A: The technology exists, yes. They are less sensitive than, say, the Abbott ID NOW, but are still able to pick up the level of virus at which it is transmissible to others—e.g. when people are infectious.
Q: So this sounds hopeful, right?
A: Yes. Because these rapid tests are simple and inexpensive enough that they can be administered frequently, they can identify the majority of people while they are capable of transmitting the virus to other people. And indeed these tests could be made and distributed CHEAPLY and would be self-administered at home! This means that people can immediately self-isolate and stop the spread of SARS-CoV-2. A large scale, frequent, rapid turnaround testing strategy is cost-effective and certainly cannot be more expensive than another shutdown.
Q: Why don’t we just test all asymptomatic people NOW with the regular/standard nasal swab? I mean, back in March they were impossible to get and now they are more readily available, right?
A: This was a good strategy in theory, but now that these tests are in short supply relative to the high demand, we can’t use them well as screening tools. They are also expensive. Plus, results can take up to 10-14 days to come in (because of limited supplies and lab sites to run the samples). This lag time can render the test useless in many cases.
Q: Then, it sounds like widespread testing with cheap, self-administered tests with instant results are the way forward! What’s the hold-up?
A: This technology has been available since early May but needs to be scaled up quickly. It is essential to beat back COVID! However the FDA has yet to approve these tests—probably because of the lower sensitivity threshold, but, as above, this can be offset by using them frequently!
Q: What can I do to help?
A: You can write a letter to your congressional representative! CLICK HERE for sample letters to get you started. Go to work! It’s all hands on deck!
And last, here I am on the Sunday morning news in DC talking about this very issue. (Skip to 1 min 30 seconds for my piece). Let’s make this happen, people!
I will check in later in the week. Until then, be well.