Let’s Rethink Testing
MEDICAL AND MENTAL HEALTH UPDATE
Today with my patient’s permission, I have a true COVID story to share. It’s a case that illustrates just how badly we need to RETHINK TESTING in this country.
I also have HOPE for a potential solution to help get us out of this mess. Read on.
Just this morning, my patient called me from a hotel to discuss her positive COVID-19 test. She had the nasal swab done a week ago, but she only just got the result today. She was shocked because she feels completely well. She was also naturally quite worried: over the weekend she spent hours in a car full of family members on the way to visit a sick relative.
In fact, she only TOOK the test in the first place to make sure she didn’t have COVID in advance of this family visit.
The glaring problem here is the delayed turnaround time of this test. Over the week, she has potentially and unwittingly spread the virus to her family and others. Indeed, a crowded car provides an ideal setting for viral transmission.
My advice to my dear patient? She needs to isolate herself for 10 days since the test was taken—that is, for three more days. (Even though the cat may be out of the proverbial bag.)
My advice to her family? They need to quarantine for 14 days. And assume they are high risk since they were in close contact.
But here’s another kicker: we actually don’t have ANY idea how long she has been positive.
What do I mean by this? We are learning that infected people with or without symptoms can test positive with the gold-standard nasal swab test for up to TWELVE WEEKS after initial infection. And since my patient never had symptoms or a prior test for reference, who the HECK knows when she would have first tested positive! In April? June?
In other words, without CONTEXT for this lone test, we will never know when she got infected and, more importantly, when she was contagious.
This means that her family will quarantine in fear and my patient will isolate for three days but with no certainty of WHEN she actually got infected and whether or not her loved ones are truly at risk.
Let’s pretend, for just a utopian minute, that my patient HAD had repeated COVID testing—like, daily surveillance testing!—and let’s say these results came back in real time. In that ideal scenario, a positive test on a Monday after a negative test on Sunday would mean—AHA! We could better identify the window of infection! And as a result, we’d know WHEN to start her 10-day isolation, WHO to quarantine, and WHICH contacts to warn. In short, we’d be able to contain the virus and completely shut it down.
But instead, all we have today is a positive test with NO context and a gaggle of worried and potentially infected family members when it’s possible that the positive test represents non-contagious viral “debris” from an infection as long as three months ago.
So why AREN’T we testing people more frequently to give us this important context? Why aren’t we getting test results back quickly and in some situations up to two weeks after the initial test?
Because of a shortage of supplies to run the tests, backlogs at laboratories that process the tests, and skyrocketing growth of the virus.
In short, the prospect of daily surveillance testing is pie in the sky right now—at least with the current nasal swab test. But without regular, real-time testing, containing the virus with the economy open will remain extremely difficult.
And because we can’t well identify asymptomatic infected people—and because they are the very people who are spreading the virus—we are going to have a very hard time beating this virus without shutting down the economy again.
But instead of being depressed about this, I am BOUNCING with hope. Why?
First off, I’ve decided there is no other option. As the late Rep. John Lewis elegantly put it, “If you're not hopeful and optimistic, then you just give up. You have to take the long hard look and just believe that if you're consistent, you will succeed.” I am taking his word for it.
And then yesterday while standing at Washington Monument, it clicked. I suddenly wrapped my head around something that I think could help us reopen schools, shut this virus down, and reclaim our lives. What is it?
I’ll take a page from Days of Our Lives and leave you with this cliff-hanger: you’ll find out later this week!
Meantime, JOIN ME tomorrow night at 8 pm to discuss SCHOOL REOPENING! You can find me and parenting expert Meghan Leahy on Facebook Live. It should be a lively discussion.
I hope to see you there. Until then, be well.