The current COVID-19 testing climate is unnecessarily complicated

By | August 1, 2020

.Its 7 a.m. on a Monday morning, and my wife and I had canceled our family vacation to the beaches of Cape San Blas, Florida, where we had planned on spending our week off, relaxing on an isolated beach. My daughter wakes up at 7:15 a.m. on that Monday, and my wife immediately after nursing her thinks, “she feels warm.” Mom thermometer is almost always accurate, and with two different thermometers, we obtain temperatures of greater than 100.4°F, with a maximum temperature of 101°F axillary. My two year old has a fever. Questions rummage through my head like, “We’ve been isolating 99 percent of the time,” “We’ve seen our elderly family members recently who also have been isolating,” and “How do we get tested for COVID-19.”

Well, first and foremost, I am an emergency room physician, and I can get tested pretty easily. I log into our online-virtual nursing line, and within 15 minutes, I have a scheduled appointment to get a nasal PCR COVID-19 swab. This is to ensure I am not an asymptomatic carrier, given my occupational hazard.

We call the pediatrician. “Well, a few hours of fever and otherwise no symptoms, let’s do watch and wait,” says the triage nurse. Watch and wait are what I would recommend when treating similar kids in the emergency department (ED), but it’s different when it’s your own child. Our pediatrician works through the same institution that I practice in, and we were able to get my daughter swabbed at the same drive-through clinic that I got swabbed at. After enduring the oral and nasal swabs myself, the technician who clearly isn’t cleaning her face shield in-between patients, wearing the same gown between cars, asks me to hold my daughter down for her nasal swab. Fine, we get this done, and are informed you should have your results within 72 hours. We are six months into a pandemic, how does it still take 72 hours to receive a PCR test that takes 1 hour to run, for a front line ED physician none-the-less?

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To explore this further, I looked into getting my wife, and elderly family members tested as well. Our state, Indiana, has a dashboard for some COVID-19 testing. My county is a “hot spot” and has 28 testing sites registered on the centralized dashboard. There are numerous other private testing labs and facilities that are not readily apparent that also offer COVID-19 blood tests that include IgG and IgM testing, and some that offer acute PCR testing.

In attempting to get my family tested within this county, there are 7 CVS pharmacies that offer testing. In calling of these seven pharmacies, I could not get an asymptomatic individual tested in less than five days. Further, there are anecdotal reports on social media within our community that these testing opportunities have had results come back in no less than 14 days, which is evident by the figure on CVS’s website, where they say, “Please allow 6 to 10 days for results.”

Trying some of the other locations, including the county health department and urgent cares, several of the registered urgent cares allow one to register online, but in checking with 4 of the urgent cares, I could not get a time in the future. I could register for one day ago or several hours prior to my investigations, but no future appointments, clearly some technical issues. How about the Marion County Health Department website that is supposed to be the leader for COVID-19 testing in our county. Well, their link produces this quote “HTTP Error 404, the requested resource is not found.” Some of the local hospitals offer immediate testing, but again, scheduled appointments are well in the future and also have several day turn arounds on their test. We were able to secure testing at a Walgreens Pharmacy in 5 days’ time, with a 1-hour turnaround, which ended up being the fasted method of having asymptomatic family members tested.

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Again, referencing social media, our local community maintains a social media page, and several families have suffered through similar experiences. A quick search of our local page has about 60 unique threads mentioning COVID-19 testing. From here, several private urgent cares have expeditious testing with results touted in about one day. This was confirmed, and the realization is that word of mouth, and social media is a more reliable method of obtaining expeditious COVID-19 tests than our state’s central testing resource.

Ultimately everyone was tested and results within one week; however, this process was unnecessarily complicated for being six months into a pandemic, and I’m a front line worker with medical competence and awareness. How can we responsibly open the country, schools, and jobs if we can’t get accessible and expeditious COVID-19 testing? Why is there so much heterogeneity in how quickly people can get tested, how quickly tests can result (1 hour to 14 days), and the types of tests offered (blood antibody testing, self-administered nasal swabs, and oral-nasal swabs)? This needs to be remedied so that people aren’t harmed from irresponsible decisions. Six months in, and we still need adequate testing.

The current testing climate is unnecessarily complicated. Meanwhile, rapid tests are readily available for admitted patients (and apparently MLB teams). There needs to be a call to our national leadership and organizations to uncomplicate the testing process and develop a uniform process for testing both symptomatic and asymptomatic people. People will avoid the testing process and unnecessarily spread COVID-19 if it doesn’t improve. We need guidance as a nation on how to get tested, which will allow us to have our lives return to some sense of normalcy.

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Nicholas Pettit is an emergency physician.

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