My opinions on covid-19 testing (my 2 cents)

Off Topic
#1

Something about testing that I don’t think people understand. There is no treatment for Covid – 19.

So, if you call me and tell me you have a sore throat a fever and a dry cough I am going to say to you that you probably have Covid 19 and that you need to stay home and take Tylenol first and if that doesn’t work ibuprofen for your pain and fever. You need to wear a cloth covering over your nose and mouth. You cannot wash your hand too much, if you aren’t washing your hands, you should be thinking about washing your hands. Clean all high touch surfaces every day. You need to isolate yourself from all others who might not be immune to this virus. I am going to tell you that should you develop shortness of breath, chest pain, mental confusion, or cyanosis (bluish tinge to nail beds or lips) you need to go to the emergency room. If you don’t have these symptoms you need to stay away from the emergency room because they’re busy enough. And wash your hands again.

Now if you go and get tested and call me and tell me I have sore throat fever and cough and I have tested positive for Covid 19, I am going to tell you that you need to stay home and take Tylenol first and if that doesn’t work ibuprofen for your pain and fever. You need to wear a cloth covering over your nose and mouth. You cannot wash your hand too much, if you aren’t washing your hands, you should be thinking about washing your hands. Clean all high touch surfaces every day. You need to isolate yourself from all others who might not be immune to this virus. I am going to tell you that should you develop shortness of breath, chest pain, mental confusion, or cyanosis (bluish tinge to nail beds or lips) you need to go to the emergency room. If you don’t have these symptoms you need to stay away from the emergency room because they’re busy enough. And wash your hands again.

Now if you call me and you tell me you have fever sore throat and dry cough and you went and were tested negative I am going to tell you that that you need to stay home and take Tylenol first and if that doesn’t work ibuprofen for your pain and fever. You need to wear a cloth covering over your nose and mouth. You cannot wash your hand too much, if you aren’t washing your hands, you should be thinking about washing your hands. Clean all high touch surfaces every day. You need to isolate yourself from all others who might not be immune to this virus. I am going to tell you that should you develop shortness of breath, chest pain, mental confusion, or cyanosis (bluish tinge to nail beds or lips) you need to go to the emergency room. If you don’t have these symptoms you need to stay away from the emergency room because they’re busy enough. And wash your hands again.

The tests have three weaknesses, first at least the tests they are doing now take several days to a week to get the results. Secondly, testing only tells whether or not the virus is present at the very moment they collect the specimen. In other words, the fact that you tested negative today does not mean you can’t test positive tomorrow. Thirdly, no one knows the sensitivity and specificity of the tests, in other words, no one knows how accurate they are. ( I have searched for information on the sensitivity and specificity of these tests, and I can’t find it anywhere. If anyone has this information, I would greatly appreciate having it.)

I know that soon there are going to be tests that give results much more rapidly and that will certainly increase their utility, but it will not change the fact that there is no treatment for this illness.

In other words, as there is no specific treatment for this illness, testing is of limited value. About the only benefits I can see from being tested is that if one is tests positive one is much more likely to take their isolation seriously, and the healthy people around you are for sure going to take it seriously. Also testing does give some idea of the disease burden in other words the amount of disease that is out there. Unfortunately since it appears that many people infected with Covid 19 have a very mild illness, testing as is being done now (people with symptoms and a fever) probably greatly under estimates disease burden.

Lastly, I’m not sure if this is a problem. However with the lack of PPE, are the people performing the tests changing their mask, face shields, gowns, gloves between testing patients? I hope to heck they are at least changing their gloves, but I haven’t been by there to see. If not and they are testing lots of patients that actually have Covid, the potential for their PPE to become contaminated is high. Now I am sure that both the person performing the test and the patient are very careful, so I doubt people are becoming infected during the collection of the testing specimen. However, I myself would prefer to stay far away from anything that I think might be contaminated with Covid – 19.

These are strictly my opinions, and I readily admit that I can be wrong. I am getting a lot of calls from people that want to be tested and I don’t think that people really understand that testing isn’t really changing the management of this disease. We here in north Texas have not seen the worst of this illness, there is a good chance that many of us are going to get sick in the next month. So:

ABSOLUTELY EVERYONE SHOULD READ THIS SITE: (Now, before you get sick.)

From the above web site:

When to Seek Medical Attention

If you develop emergency warning signs for COVID-19 get medical attention immediately. Emergency warning signs include*:

Trouble breathing
Persistent pain or pressure in the chest
New confusion or inability to arouse
Bluish lips or face

*This list is not all inclusive. Please consult your medical provider for any other symptoms that are severe or concerning.

How to discontinue home isolation

People with COVID-19 who have stayed home (home isolated) can stop home isolation under the following conditions:

If you will not have a test to determine if you are still contagious, you can leave home after these three things have happened:
    You have had no fever for at least 72 hours (that is three full days of no fever without the use medicine that reduces fevers)
    AND
    other symptoms have improved (for example, when your cough or shortness of breath have improved)
    AND
    at least 7 days have passed since your symptoms first appeared
If you will be tested to determine if you are still contagious, you can leave home after these three things have happened:
    You no longer have a fever (without the use medicine that reduces fevers)
    AND
    other symptoms have improved (for example, when your cough or shortness of breath have improved)
    AND
    you received two negative tests in a row, 24 hours apart. Your doctor will follow CDC guidelines.

In all cases, follow the guidance of your healthcare provider and local health department. The decision to stop home isolation should be made in consultation with your healthcare provider and state and local health departments. Local decisions depend on local circumstances.

NOTICE THE TWO NEGATIVE TESTS 24 HOURS APART. THE CDC DOESN’T APPARENTLY TRUST THE TEST ENOUGH TO DEPEND ON ONE. Neither should you!

We will get through this. Yes, it is going to be unpleasant for a while and tragedy has and is going to strike many families, we will get through this.

5 Likes
#2

“The Scanwell rapid serology test is looking for antibodies in the blood. A positive test result means that you were exposed to the virus previously because it takes time for the antibodies to develop,” said Jeng.

“However, when combined with symptoms consistent with COVID-19 like a fever, cough, and sore throat, a positive test is pretty much diagnostic for the illness,” said Jeng, “That is how these rapid serology tests are being used in China.”

1 Like
#3

Looks like a IgG test, and this will be useful especially for detecting those with minimally symptomatic disease. I wonder if the CDC will say a patient is no longer infectious 7 or 14 days after this test turns positive. That may be reasonable. Or perhaps a positive antibody test and a negative nose and throat swab may mean that you are no longer infectious. That would be useful for allowing people to return to work. Note that they say that it takes 2 weeks after the infection for the test to turn positive. Most people with severe disease are probably going to be symptomatic by then. We will see, but I find this test more interesting and potentially more useful. Undoubtedly will be useful in determining they amount of minimally symptomatic disease (i.e. people who have had the disease and did not realize it). May be very useful for determining that someone is at risk of disease when it is negative. Again back to the question of sensitivity and specificity. I hope this one gets here soon and isn’t too expensive. Also note that the article says it shouldn’t be used for the things I hope it can be used for. Obviously, more data needed.

#4

I’m interested to see whether people who were hospitalized and recovered can be re-infected.

2 Likes
#5

I want to know if this will mutate and come back next fall?

#6

I’m not a doctor, nor do I play one on TV.

However, there is a mounting body of evidence that common anti-malaria drugs are effective at reducing viral replication. These would be the same drugs, widely prescribed, which one would take prophylactically before going on a trip to say Honduras.

However, our Glorious Leaders at the FDA/CDC call this anecdotal evidence.

Seems to me that the best course of action is widespread testing and early treatment of symptoms for anyone who tests positive (and is not asymtomatic).

Even if it doesn’t work 100%, it’s still a lot better for a number of people than drowning in their own fluids.

I’ve taken this stuff, on the off chance an infected mosquito might bite me on a leisure trip. If we can take the risk for something completely voluntary, we sure as hell should try it on sick and dying patients.

#7

A good, if frightening, read about one pulmonologist’s experience with COVID-19:

Remember, there is “no treatment”. Unless, of course, you’re a doctor with doctor buddies.

2 Likes
#8

The CDC is looking into chloroquine, but the existing studies on it are either too small or not entirely conclusive. PLEASE don’t try to self-medicate, especially with prescription-only drugs.

2 Likes
#9

Let’s not suggest people take unproven medications prophylactically on our public-facing forum. DMS should not be giving medical advice.

@Team_Moderators you should consider moving this thread to members-only.

3 Likes
#10

Testing is of great value to epidemiologists and public health statisticians.

#11

Why? This is Off Topic. You’re free to look at it, or not.

#12

How do you know this? Are you a medical professional, epidemiologist, or statistician?

No one suggested this course of action, and your comment seems emotional and knee-jerk.

#13

I agree, also wide spread testing as used in South Korea is absolutely necessary in a strategy of detection, containment, ring vaccination which is the very best strategy. They did a stupendous job, and undoubtedly will be the model of how to respond to this type of illness if nothing changes. Unfortunately, we missed the proverbial boat on that strategy, and are now in a curve flattening strategy where I believe testing is less important. I am not saying that it is unimportant and I believe that serology (IgG antibody) testing will be extremely useful. I do not believe viral testing is of great utility in individual cases at this point, if you have the symptoms fever, malaise, cough you have the disease and need to act accordingly regardless of any testing. A test, positive or negative does not alter that. At this time, there is no evidence based treatment for this illness so the test doesn’t alter therapy.

2 Likes
#14

Because it’s in the public area, and searches for the drug mentioned in the “medical advice” will find DMS offering unfounded medical opinion about what meds to take.

#15

Because of this

This is not happening.

This is just some people on the Internet talking about things…
And, I might add, being appropriately socially distanced one from the other.

4 Likes
#16

Which is good, because I’m coughing and hacking today after attacking the lawn yesterday with a string trimmer and a leaf blower. Xyzal just barely holding allergies at bay. :frowning:

#17

Reasonably clear and comprehensive – for lay people, that is – write-up:

5 Likes
#18

Many physicians prefer to practice what is called evidence based medicine which depends on quality studies and understanding of disease to guide their practice. Hydoxychloroquine may indeed turn out to be beneficial to patients with covid, however, that is not proven at least to my satisfaction. Who does it benefit, what is the benefit and how does that work, what is the dose and dosing schedule, what are the risks and side effects and how do they work, how do you monitor for benefit and side effects. Is it of benefit prophylactic therapy? Hydroxychoroquine is known to have cardiac effects that can be fatal and retinal effects that can cause blindness. Anyone using this medicine for covid at this time is participating in an experiment. I do not recommend that people experiment on themselves at home. However, I do believe this is a free country, and people are free to do things that I think are very unwise.

I am reminded of something I heard a few times while at PMH: “I don’t want no one experimenting on me!”

2 Likes
#19

I wouldn’t call it “an experiment,” because there’s no protocol. At the end, whether it helps you or hurts you, anyone taking this on their own will just be the dread “anecdotal evidence” that @zmetzing warned us about.

Although you should probably keep track of what you take, how much, and when, and take it with you to the ER when it makes you sick.

#20

I didn’t say it was a good experiment!

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