I’m nothing special, just a worker nug — a family doctor in an urgent care clinic in a small southern town in the COVID-19 era. I go to work, put on my PPC (Personal Protective Crap), and try my best to take care of the sick people. However, I am growing increasingly weary of all the well-intentioned ignorance from the talking heads both within government and without. Please allow me to explain as it relates to the coronavirus test.
The Coronavirus Test and Pertinent Terminology
COVID-19 is the disease. SARS-CoV-2 is the virus. There are several promising testing technologies in the pipeline. However, the accepted standard today is called Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR).
RT-PCR is breathtakingly complicated and fairly cumbersome. To all the folks screaming that this should have happened yesterday, tossing blame isn’t going to help. Of course everybody needs a villain, but this is war. Can we stop fixating on the blasted election long enough to work together to save our country? RT-PCR is complicated technology. It takes time to apply it to hundreds of thousands of people.
What is most pertinent here is the capacity of the test to rule in or rule out the disease. Folks in the biz call this a test’s Positive Predictive Value and its Negative Predictive Value. Positive Predictive Value means if the test is positive you have the disease. That’s indeed very important for contact tracing. However, at this point in the outbreak, the test’s Negative Predictive Value is innately unknowable.
The accuracy of the coronavirus test depends upon human factors that are difficult to control. If the sample was not taken properly, was materially inadequate, or was contaminated, then the results are not reliable. Worst case you might have a negative test, but still have the disease.
The Devil Is Always in the Details
That’s the dangerous bit. We cannot clear symptomatic people to re-enter the population on the strength of a negative coronavirus test. Ergo, the tests are fairly useless at the user level where I work at this particular point in the epidemic. It takes days to get the results anyway. Folks need to get their heads around that and stop fixating on tests. Symptomatic patients with negative testing who re-enter the world too soon could eventually kill somebody.
Suspicious symptoms include fever greater than or equal to 100.4, and respiratory symptoms like cough or shortness of breath. If a patient has these symptoms they need to isolate for 14 days. In the context of this pandemic, if symptomatic they need to isolate even if they test negative.
There is no treatment for this wretched thing anyway, so it isn’t like test results change your therapy. You treat this disease symptomatically based upon severity. It’s not like strep throat where a positive test means antibiotics and a negative test doesn’t.
Don’t misunderstand, there are certainly places and circumstances wherein testing for this disease is very important. It is simply that those places and circumstances are not where I live today. Testing will be pertinent to the epidemiologists in retrospect. It matters for contact tracing. It will also matter once we really start stamping out the fire. Right now, however, maintaining separation seems infinitely more important than test status. Separate first and test as able; in my world that is the narrative.
How Test Fixation Can Actually Be Harmful
The worried well are driving us crazy. Distraught soccer moms and verklempt helicopter dads juiced on 24/7 coronavirus news coverage are rabid to get tested. We have had folks present without symptoms saying their employers will not let them come back to work without a negative test. This is well-intentioned ignorance, but it can also be very dangerous.
These folks will walk into a building full of sick people. We will do our best to keep everybody safe. However, if they weren’t sick when they got there, they might be when they leave.
Come to the doctor if you have significant respiratory symptoms and fevers. Go to the ER with significant shortness of breath or chest pain. Test status will indeed make a difference there. If the symptoms are mild, then treat the fevers with Tylenol, isolate from loved ones as best you can, and wait it out. Approximately 80 percent of COVID-19 victims should have relatively mild symptoms that resolve with time. The best thing they can do is stay isolated so they don’t give it to anybody else.
The Long Pole in the Tent
In my world—right now at least—the limiting reagent is not testing capability, it is transport media. The labs can do the tests, but test supplies are critical national resources. Our viral transport tubes are the same things we use to culture genital herpes. Thankfully we haven’t had to do that on a massive scale, so we don’t stock just scads of those. At my clinic we begged a bunch from the nearby GYN clinic because they’re the herpes kings. However, these testing materials will inevitably catch up eventually.
This is the United States of Freaking America. We invented the microchip, put men on the moon, and kicked the Nazis’ teeth in. Once we get tooled up, we will test everybody on the planet twice along with their dogs, cats, hamsters, and goldfish for SARS-CoV-2. However, for the time being we all need to chill out and do what we’re told. We Americans are great at a lot of stuff, but we suck at that.
Take social distancing seriously. Don’t go out and mingle with folks. Shelter in place if that’s the order. Maintain some space when you do have to go out in public. And for Heaven’s sake, wash your hands.
Stay home and separate from your family if you get sick. Go to the hospital only if symptoms are severe, and use this entire experience to re-evaluate some things. Catch up on your reading and spend some quality time with your kids. Try praying. Life is precious, and we have been taking it for granted.