Why is COVID-19 Testing Important?

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Earlier today, March 28, 2020 and According to News 12

Suffolk County Executive Steve Bellone says 4,138 people in the county have tested positive for coronavirus.

Bellone also says 409 people are hospitalized due to coronavirus, with 139 in the ICU.   “There are 2,644 hospital beds, with 570 available. There are also 309 ICU beds, with 78 available.” Clearly, we will soon run out of necessary beds and of course ventilators.

Bellone says there are 30 deaths in the county due to coronavirus.

7 deaths have occurred in the retirement home Peconic Landing

At Peconic Landing, the Greenport retirement home, there was another death today, the seventh.  There are about 40 people known to have tested positive.  Peconic Landing has perhaps 377 staff, and well over 300 residents (301 independent “members” and 86 nursing home patients).  Peconic Landing is the hotbed of COVID-19 in Suffolk county.  Think of it as a “Cruiseship”.  And it is full of frail elderly clients.  Find the updated information regarding Peconic Landing and COVID here.

The leadership of Peconic Landing claims there are no available tests for their home.  I understand that there may be a rush on tests, but isn’t the situation at Peconic Landing a quasi emergency?  Their residents are mostly over 80 years old. If they get sick with COVID-19 one would expect a mortality rate of 10-20% at least.  For the rest of us, the mortality (risk of dying if we get the virus) is more like 1-2% .

Some say “well aren’t they going to die anyway?”   How would you feel if your parent or grandparent were there?

Why is it important to test everyone at Peconic Landing?

There are currently 2 types of testing:

  1. RT-PCR test – it detects viral RNA and therefore a component of the virus itself.  This involves a nasal swab that is sent to a lab and the turnaround is about 1-2 days currently.
  2. Antibody test: A new test for IgM and IgG antibodies (Ab), which are part of the immune system’s response to the virus.  This test takes 15 minutes and involves a pinprick of a finger, like the glucose test performed by diabetics.

Both tests should be done because the combined information might be useful:

Here are the 4 possible outcomes and what they mean.

PCR+ Ab –

you have COVID-19,  symptomatic or asymptomatic. You should take precautions (self-isolation) to avoid transmission of virus to your loved ones.  You absolutely may not have any contact with residents at a home, like Peconic Landing.

PCR+ Ab+

you are likely recovering from COVID-10 (1-3 weeks out); you may have been symptomatic or not.  Because you are still PCR+ you need to take precautions (isolation). Isolation should be for 10 days after symptom onset or for the duration of symptoms plus 3 days after resolution of symptoms.  You absolutely may not have any contact with residents at a home, like Peconic Landing.

PCR- Ab-

you never had COVID-19.  You are susceptible, and if you live or work in a high risk situation, such as Peconic Landing, you shouldn’t be there. But if that is impossible, you should take very stringent precautions.

PCR- Ab+

you are fully recovered from COVID-19.  Generally, this group could be considered “immune” and possibly

    • go back to work
    • might be well suited for caretaker and health provider roles
    • might donate plasma at a blood bank to be administered to critically ill COVID-19 patients in the ICU: this is called passive immunotherapy, used successfully for the Spanish Flu and for Ebola.

On the Diamond Princess Cruise ship, all elderly passengers and those with underlying medical conditions, and all crew were tested. Passengers who had negative [SARS-CoV-2] RT-PCR test results, no respiratory symptoms, and no close contact with a person with a confirmed case of COVID-19 completed a 14-day ship-based quarantine before disembarking.  In other words, testing helped make informed decisions to save as many lives as possible.

We should do the same for our senior friends at Peconic Landing.

About D. Posnett MD

Emeritus Prof. of Medicine, Weill Cornell Medical College
This entry was posted in Coronavirus, Cuomo, Health Care, Uncategorized, Zeldin and tagged , , , , . Bookmark the permalink.

2 Responses to Why is COVID-19 Testing Important?

  1. Pingback: VOTE for your Favorite Blog Post of 2020! | Resist and Replace

  2. Pingback: Frustrations Boil at Pace of Vaccinations at Long-Term Care Facilities | Resist and Replace

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