Clamor over tests can override real issues in avoiding COVID-19
"Coronavirus testing causes chaos across U.S." Headlines such as this do more disservice and generate unwarranted confusion during this "novel" pandemic, turning apprehension into a panic attack among Americans all over the map. This being a new germ, we are all learning together.
The way this virus operates -- traveling far and near with unmitigated speed, preying upon our young, old and the sick, spreading to and killing the most vulnerable among us -- is like nothing the world has ever seen before. However, a few patterns are emerging.
Once the initial infection and exposure occurs, the disease may never announce itself or may decide to show its cards five days to 15 days later; and, a history of travel or exposure to a known patient is reported less and less frequently, now that the virus has nested in our communities. A pro-active social and physical distancing and universal flu precautions are all we have at our disposal on the prevention menu, while vaccine trials are under way; hope is growing, but there is no approved specific treatment at this moment other than respiratory and fluid support; and, 98% of those with diagnosed disease usually survive, but remain at risk for re-infection.
Testing an asymptomatic population, or the worried well, appears unnecessary, probably ill-advised. A test is beneficial once the symptoms appear -- aches, cough, runny nose, or high fever etc. -- especially in elderly, immunocompromised patients with preexisting medical conditions or those living in nursing homes with clusters of previously infected patients.
A test may be essential if required to differentiate coronavirus infection from other treatable conditions under consideration in a sick or at-risk patient.
There may never be enough kits to test 331 million of us Americans, but first, why even get the test?
1. Since the test has been developed in response to a disease which was relatively unknown until its appearance in China four months ago, not known to CDC until early January, the quality and accuracy of the test is not yet fully established. Data is not there to decipher a False Positive or False Negative rate.
2. Some people may never contract this disease in spite of exposure or close contact with infected people, and even after contact, it might take another 15 days for a test to turn positive. Let us assume a healthy-appearing, asymptomatic individual shows a positive test today: absent specific treatment, no additional action would be indicated, other than self-quarantine at home for 14 days, already prescribed for us all, with few exceptions.
3. Although, there is a normal tendency to avoid close contact with a symptomatic or sick patient, most infectious diseases are relatively easily transmitted in the days before symptoms develop. A history of exposure to an individual with symptoms or a positive test, might not help much, especially since this virus has already penetrated our communities so deeply and widely.
4. Time will tell if previous exposure or infection by other forms of the coronavirus will also test positive for COVID-19.
5. Diagnostic tests in medicine are generally useful and cost-effective for an individual patient, under two circumstances: when the test results would alter the course of treatment or to help determine prognosis in a given situation.
Let us recognize that we ourselves and many around us might already carry the virus without appearing sick. So, instead of fretting about paucity of available testing kits or test sites, let us listen to what our president, the governor and the public health agencies are articulating every day: Home is the safest place to be; follow universal flu precautions; and, wash hands early, often and long enough.
At this time, medical help and testing is indicated for symptoms consistent with sickness of the body, not so much when uneasiness in a concerned mind is the only reason to get tested.
• Dr. Arvind K. Goyal, of South Barrington, is medical director for the Illinois Medicaid Deptartment of Healthcare & Family Services and clinical associate professor for Family Medicine & Preventive Medicine at the Chicago Medical School/ Rosalind. The view reflected here are his own and do not necessarily represent official positions of the state of Illinois.