The decision of who should get tested for COVID-19 is not an easy one.

The main reason is because as of right now, there aren’t many tests available. Last time I checked the CDC, that number is around 80,000 or so. Probably more by the time you watch this video, because they are ramping up production.

When reports asked President trump and Vice President Trump about testing, there response was…

“Anyone in this country who needs a test can get a test”

Well, that’s not true.

Because I can tell you from first-hand experience, If I want to test someone, it first has to be approved by the state DOH. And this is the case with thousands of other doctors in this country.

Why is this the case?

Because there are only so many tests available.

Yes there are more and more tests being made.

But there still are not enough.

You see, South Korea was prepared, before the virus hit them.

When they saw the outbreak start in December 2019 in Wuhan, they immediately got the RNA genetic code of the virus from China, and a private company in South Korea started working on developing the PCR test before it even hit South Korea. That’s why they were able to test so many people so quickly. And that also why their case fatality rate was so low because they were testing so many people, not just the sickest people. By identifying those who had it, they could isolate them, and minimize the spread there.

But the US has had more than 2 months to prepare, but we were not prepared. And we do not have enough tests. There are 4 reasons for that.

1)         Our current administration drastically reduced our public health infrastructure, and two years ago, the CDC stopped funding epidemic prevention activities in 39 countries, including China…. At that time, former CDC director Dr. Tom Frieden said the move “would significantly increase the chance an epidemic will spread without our knowledge and endanger lives in our country and around the world”…well, looks like he nailed that prediction

2)         The 2nd reason why there are so few tests is because there were malfunctions in the test kits, which lead to delays in manufacturing

3)         About 5 weeks ago we could have used the WHO’s test but that was rejected for whatever reason

4)         In the beginning, unlike South Korea, we did not have private companies making testing kits

But we can’t rewrite the past. So in the here and the now, moving forward,we have to be selective in who we test.

The CDC says it’s the physician’s clinical judgment on who we test. But that’s only partially true, because like I said, I still need approval from the state Dept of Health in order to test someone. And this has already happened to me several times. 

And that is a common frustration among all of us doctors on the front lines.

The way most physicians are deciding on who to test falls into one of the following 4 scenarios:

If that person had a fever and/or lower respiratory tract symptoms such as cough and SOB, who have had any of the following in the prior 14 days:

1)         Close contact with a confirmed or suspected case of COVID-19, including in a health care setting. Close contact includes being within approximately six feet of a patient for a prolonged period of time while not wearing personal protective equipment or having direct contact with infectious secretions while not wearing personal protective equipment.

2)         Residence in or travel to hotspot areas, meaning where widespread community transmission has been reported (China, South Korea, Japan, Iran, and most of Europe [especially Italy]. Within the US, this would especially mean NYC, state of Washington, Colorado, California, and others.

3)         Potential exposure through attendance at events or spending time in specific settings where COVID-19 cases have been reported.

4)         Those with severe lower respiratory tract illness when an alternative diagnosis cannot be identified, even if there has been no clear exposure. So this would include things like low oxygen levels, abnormal findings on CXR or CT scan of the lungs, or patients who are clinically unstable.

Let’s take the following scenario:

Lets say someone is at home, and has a little bit of fever, and feels very fatigued. Perhaps they even have a dry cough.

Well, that could be the common cold. It could also be COVID-19. And in some cases, those symptoms could be a mild version of the flu, which is exactly what just happened to my uncle, he had those very mild symptoms and tested positive for the flu.

But based on those symptoms alone, it could be the common cold, COVID-19, or the flu.

The only way to know is to do the test with a nasal and oral swab.

But if someone is only having mild symptoms, is it really worth sending that person to the hospital or clinic to get tested? Because if you do that, you will likely spread the disease there, and that means spreading the disease to people who are already sick with other illnesses. And also spreading the disease to health care workers. And health care workers need to be protected from illness, because if we become ill, who is left to take care of others who are ill?

That’s why drive through diagnostic testing is great, but there aren’t that many that exist.

This past week, cities in California, Colorado, Connecticut, Minnesota, New York, Texas, and Washington, have opened drive-through Coronavirus testing stations, emulating what the South Koreans did.

People can drive up and be swabbed without having to leave your car. But, before doing so, they need at least a doctor’s note before doing so, or a phone call with doctor approval. And that tests are free in most, if not all of these locations.

Healthcare workers in personal protective gear take a driver’s temperature, check for breathing difficulties, and swab the passenger to get a sample that the worker sends to a nearby lab.

So far, the US has run an estimated 20,000 number of tests. In comparison, South Korea was running 10,000 tests per day.

But the plan is for more and more drive-thrus to be set up, which will allow for faster testing, and will ultimately help to slow the spread of this virus.

Just remember, the most common symptoms are fever, fatigue, and dry cough. But some people might not have any symptoms. The most concerning symptom are shortness of breath, and that is the biggest reason why someone should seek medical attention.

Dr. Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine

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