Dr. Marc Siegel: Coronavirus testing's next step – rapid point-of-care tests will be a game-changer

COVID-19 is a moving target. It is highly contagious. In fact, there is evidence that it can be passed from one person to the next simply by speaking.

Accumulating data from around the planet indicates that those infected are frequently symptom-free, or suffer from minor symptoms that are easily confused with other respiratory viruses. Therefore, it would seem that the only way to prevent spread in the absence of a vaccine or a significant community immunity (pandemics are too new for the population to have built up enough immunity to slow down the virus) would be social distancing, shutting down society and keeping as many people at home as possible. A recent study in Nature Medicine suggests that the use of surgical masks when worn in public may be helpful as wells. 

This science-fiction image has become today’s reality. But there is another important tool that could ease the pressure and the focus on social distancing and obsessive disinfection as the only method to decrease the spread of this dangerous new virus.

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This tool is testing, and by testing I do not mean not the long lines of cars awaiting the deep probe of a nasopharyngeal swab administered by a health care worker in a hazmat suit. Rather, the solution is to be found in rapid point-of-care testing, not only a self-administered nasal swab to see whether you have COVID-19 or not, but an accompanying finger prick for a drop of blood to test for immunity to the SARS COV 2 virus.

This week I spoke with Adm. (Dr.) Brett Giroir, assistant secretary of Health and Human Services (HHS) for health. He is a member of President Trump’s coronavirus task force, and he has been put in the hot seat in charge of diagnostic testing since March 12. Dr. Giroir has marshalled the forces to bring what he says are now 41 mobile test sites around the country, leading to over a million COVID-19 tests over the past few weeks.

But the problem is that the testing is cumbersome, inefficient, often inaccurate and requires personal protective equipment that we would much prefer to see used in hospitals, clinics, doctor’s offices and ambulances. Plus, in most places there are only enough tests for the severely ill to receive them, which means that I and others have to diagnose our patients as having COVID 19 by clinical observations alone. This leads to too many people having it without knowing they have it, which increases the risk of spread despite all the social distancing and face mask-wearing.

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Giroir indicated to me that he thinks the solution to this problem is rapid point-of-care testing, both in terms of a molecular genetics-based test to determine active infection, as well as an immunoassay to test for antibodies against COVID-19. He likes Abbott’s Now platform, which has just released a COVID-19 test that can be used on the 18,000 units placed around the country – and already used to test for influenza – leading to 55,000 tests a day. Giroir told me he thinks the Abbott test is relatively accurate. 

The test for antibodies against the virus can be done with a simple pinprick for a drop of blood and the results also determined immediately, but Giroir pointed out that there needs to be a  standardization of quality before these antibody tests can be widely used. Not only that, but it isn’t yet clear what degree of Immunoglobin G and neutralizing antibodies are necessary to constitute long-term immunity against the SARS COV 2 virus.

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Nevertheless, Giroir told me he believes that over the next few weeks we will have widely available (and quality controlled) rapid point-of-care tests for both infection, as well as recovered infection. This will be a game-changer when used to augment and even replace the ancient problematic techniques of shelter at home and social distancing that we are using now. We will be able to isolate and separate out people who really have the virus and then tell them when they are well enough to return to work. Known human islands of immunity will help us decrease disease spread.

I am currently seeing dozens of COVID and potential COVID patients per week via telemedicine. Most of these patients are frightened, and they don’t know whether the vague symptoms they have add up to COVID or not. All too often, I can’t tell them, which means we as a society risk further spread from unidentified sources, a prospect we can no longer afford. Extensive on the spot testing can and will change all that.

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