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COVID Test: Who Should Get Tested? 

By  Dr. Mike Hansen

COVID Test: The decision of who should get tested for COVID is not an easy one. The main reason is that, as of right now, there aren’t many tests available. The last time I checked the CDC, that number was 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, their 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 must first be approved by the state DOH. And this is the case with thousands of other doctors in this country.

COVID Test

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. A private company in South Korea started 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 is also why their case fatality rate was so low because they tested 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, it looks like he nailed that prediction

2)         The 2nd reason why there are so few tests is that there were malfunctions in the test kits, which led 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, we have to be selective in who we test moving forward.

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 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, 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 widespread community transmission, has been reported (China, South Korea, Japan, Iran, and most of Europe [especially Italy]. This would especially mean NYC, the state of Washington, Colorado, California, and others within the US.

3)         Potential exposure through attending events or spending time in specific settings where COVID 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 clinically unstable patients.

Let’s take the following scenario:

Let’s say someone is at home, 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. 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, or the flu.

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

But if someone has 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, which means spreading the disease to people 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, California, Colorado, Connecticut, Minnesota, New York, Texas, and Washington, have opened drive-through covid testing stations, emulating what the South Koreans did.

People can drive up and be swabbed without having to leave their car. But, before doing so, they need at least a doctor’s note or a phone call with the doctor’s 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 worker’s sample to a nearby lab.

So far, the US has run an estimated 20,000 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 ultimately help 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 is shortness of breath, which is the biggest reason someone should seek medical attention.

Doctor Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine

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