Update and Testing Will Empower Personal Decisions
COVID-19 continues to wreak havoc with the personal and public health, as well as the economies of the world. The USA (3rd in world population) continues to lead the world in both COVID-19 infections, approximately 1.4 million, and in deaths, approximately 87,000. Some 160,000 Americans have been hospitalized and recovered. Jobs lost in the USA have now reached 36 million. Recent information from the British medical journal, Lancet, confirmed that the particles that contain the virus can be transmitted by just talking. Amidst all that bad news, the risk of infection is decreasing in the US due to the measures of social distancing, wearing face covering, washing hands, and minimizing the touching of surfaces. We may also be seeing some lessening of infection rate of transmission because of the seasonal effect of warmer weather in some parts of the country. There remains no proven preventative medication. A large study came out this week concluding that hydroxychloroquine not only failed to show any beneficial effect, but study patients were twice as likely to experience cardiac side effects. An antiviral intravenous medication named Remdesivir has been proven to shorten the length of hospital stay, by an average of 4 days, for people with moderate and severe infection. Early studies show a trend toward Remdesivir improving mortality, but further research is needed. An effective vaccine is still projected to be 12-18 months away.
The journey to returning our citizens toward our desired way of life will be paved by social distancing, testing, contact tracing, isolation, and treatment. Rapid and accurate results of testing is the key to getting people back to work, school, places of worship, entertainment, restaurants, sporting events, non-emergent healthcare, travel, vacations, beauty salons and barber shops, spa/gyms, etc. A test that does not accurately detect the presence or absence of COVID-19 is worse than no test at all. Let us step back and discuss the purpose of testing.
There are two general types of tests in the COVID-19 context. The first type is the diagnostic test which detects the actual presence of the virus (SARS-CoV-2) that causes COVID-19. Typically, in the USA, it requires a swab of the nose/nasal pharynx. A recently released test can be done with a mouth or throat swab. South Korea uses a test that requires a patient to spit into a tube. Their test is reliable and so quick that it is done at the airport for people flying into South Korean. The company that produces it is scheduled to ship supplies to the US by the end of May, which will allow 20 million tests to be performed. As a health care organization, we again ask why the Defense Production Act has not been used for US to produce this product as well as adequate PPE. It is not a new test, as South Korea has used it very extensively since early March. They have 260 deaths, to-date although their first death occurred on January 20, 2020 (vs Feb. 6,2020 in the USA). We use at least three brands of diagnostic tests around the country. The FDA issued a warning today about the Abbott test being used at the White House. Various studies show that it has a false negative rate between 15% and 48%. Clearly, there is work that needs to be done.
The second general class of tests are blood antibody (serologic) tests which are designed to detect whether a person has been infected by the virus and has recovered. Remember that up to 25% of infected people are totally without symptoms. Dozens of companies around the world have manufactured these tests. There is considerable variability as far as accuracy is concerned.
Although there are some states where wanting a diagnostic test means you can get a diagnostic test, Ohio is not one of those states. The availability of reliable, rapid results testing would allow us to achieve the steps laid out in the CDC coronavirus -19 flowsheets just released yesterday.
There is indeed a great deal of anxiety about, not only our day to day lives, but about our futures. We know the measures that will help protect us as individuals (social distancing, hand washing, wearing a face covering). If you are in a vulnerable group, do your part by just staying home except for essential reasons. As an organization of healthcare providers, we ask the our government, on all levels to do their part by providing universal, reliable, and widespread testing as well as contact tracing in a federally coordinated manner.
