The State of COVID-19: Testing

On March 11th, 2020, The World Health Organization declared the COVID-19 outbreak a global pandemic. This set off a massive mobilization of the medical, health, and scientific communities to develop safety protocols, testing, and vaccines. The speed with which these communities responded is nothing short of astounding. 

Within days, we had clear safety protocols. Within months, we had reasonably dependable tests. In less than a year, we have several vaccines. There has been very little to celebrate during this global pandemic. But the medical, health, and scientific communities have given us all something to cheer for. 

As we approach the one-year anniversary of this pandemic, let’s take stock of the situation so that we can clearly understand where we are and where we must go. 

This article is part of an on-going series that will closely examine COVID-19 from several angles. We will look at testing, vaccines, the virus itself, and possible paths forward. By assessing the state of things, we can all move forward together, safely.

This installment of the State of COVID-19 will look at the state of testing. This article will be broken into four parts:

Before we get into the types of tests, we must take a moment to go over a few things.

COVID-19 Safety

During this time of rampant misinformation, I want to be sure that we all understand how to best prevent the spread of this virus. 

The longer we study the virus, the more we learn. We may never know everything about the SARS-CoV-2 virus but, thanks to the CDC, we do understand several things to be true at this point:

Most Often Spreads

Sometimes Spreads

Rarely Spreads

Person-to-person

Airborne transmission

From people to animals

Close contact with people less than 6ft apart

Contact with contaminated surfaces

From animals to people

We understand that the leading cause of infections is exposure to respiratory droplets from someone who has COVID-19. These droplets are most problematic when someone is in close proximity (less than six feet) from an infected person. 

People within that six-foot zone—or who come into direct contact with an infected person—are at the highest risk of infection. The data we have right now shows that the droplets dissipate the farther from the infected individual one gets. These respiratory droplets cause infections when they come in contact with our own respiratory system and mucus membranes.

Less common forms of transmission involve airborne transmission outside the six-foot distance (usually due to inadequate ventilation systems) and from respiratory droplets lingering on contaminated surfaces, especially one’s hands. 

With this information in mind, we can clearly understand the procedures we must take to stymie transmission of COVID-19.

How to Mitigate the Spread of COVID-19

cover nose and mouth

Cover nose and mouth

6 ft

Stay 6ft apart

Avoid Indoor Settings

Avoid indoor settings

Wash

Wash hands often

Isolate

Isolate when possible

routinely disinfect

Routinely disinfect

These are the basic steps we can all take to help stem the rate of infection. These measures impede the respiratory droplets’ flow, decrease their contact with uninfected persons, and help keep the droplets out of the nose, mouth, and lungs. 

Viruses are built to spread and spread they will. COVID-19 spreads more easily than influenza but not as easily as measles (one of the most contagious human viruses). 

Despite some of our best efforts, the coronavirus will capitalize on our mistakes (which we will make) and find ways to infect new people. For this reason, we need rigorous contact tracing and widespread testing with quick turnaround. 

The arrival of vaccines does not mean that we can stop these important preventative methods. It is only with the combination of prevention, tracing, testing, and vaccination that we will truly defeat this pandemic. 

In fact, vaccinations may actually increase the need for testing. That is the subject of our next article, so we’ll leave it for another day. Today, I want to take a closer look at what tests are currently available.

Types of COVID-19 Tests

The available COVID-19 tests fall into two basic categories:

Both categories are essential in the fight against the spread of this virus, and both play a vital role in saving lives. Neither category is without drawbacks, however.

Let’s look at each category and the tests that fall within them.

“Am I Infected?” Tests

Medical professionals call these diagnostic tests. Essentially these tests tell you if you are currently infected with the SARS-CoV-2 virus. To determine if you are currently infected, these tests take a sample of bodily fluid and test it for evidence of the virus. There are two major types of tests in this category; molecular tests and antigen tests.

Molecular Tests

Antigen Tests

Also called

PCR, Nucleic Acid Tests, Viral RNA Tests

Protein Tests, Rapid Tests

How am I tested?

Swab of nose/throat

Test of saliva or other bodily fluids

Swab of nose or throat

What does it test for?

Genetic material of the virus

Protein fragments (antigens) of the virus

How long does it take?

Depends on lab and demand

[Average time: 1-3 Days]

Just a few minutes

Will it tell me I am infected when I am not?

Extremely unlikely

[Most instances of this have been attributed to contaminated labs, not inaccurate testing.]

Unlikely but possible

[Current data suggest far higher accuracy rates when used on symptomatic individuals.  In general, antigen tests are less sensitive than molecular tests.]

Will it tell me I am not infected when I really am?

Possible but unlikely 

[If you test too early, it may not detect the virus. According to one study, after approx. 5 days the likelihood of this happening is less than 20%.]

Possible, even likely

[According to the a recent study, rates of this vary widely (from 20% to over 50%), due primarily to whether or not the test subject is symtopmatic. For this reason, antigen tests are not recommended as a single testing option. Repeated testing is recommended.]

Where can I get it?

Hospital, clinic, doctor’s office, drive-thru sites, and at-home tests.

Hospital, clinic, doctor’s office, drive-thru sites, and at-home tests.

There are currently hundreds of approved diagnostic tests. For more information on each one and to keep track of what’s available, be sure to check the FDA’s list of approved tests. The current best practices for diagnostic testing recommend using molecular tests as the primary option for initial diagnosis. In certain cases (e.g., traveling internationally), it may be the only option accepted. 

Antigen testing is best used in conjunction with molecular testing to verify the validity of the results. According to the CDC, there are, however, a few circumstances where the antigen test becomes the preferred option:

  • When molecular tests are unavailable
  • When molecular testing results will take too long (over 3 days)
  • When the patient is symptomatic and results are needed quickly
  • In circumstances where testing will take place regularly (long-term care facilities, front-line employment locations, etc.)

The more widely available and accessible these tests are, the more effective they will be in the fight against COVID-19. To maximize our success, we can’t rely solely on prevention and diagnosis. The next step is to track those who have had it. To do this, we must turn to another test.

“Was I Infected?” Tests

There is currently only one type of test in this category: the antibody test. Antibody tests tell you if you once had the virus. We must identify and keep track of people who have had the virus because, as new variants arise, additional protocols may be required. To help facilitate these eventualities, we must know who has already been infected. 

This identification process also helps us identify the short-term and long-term effects of the infection. It is also the key to understanding how the body develops immunity and how long this immunity lasts. These are all vital data sets as we endeavor to get to the other side of this pandemic.

Antibody Test

Also called

Serologic testing

How am I tested?

Blood sample

What does it test for?

Antibodies produced by the immune system in response to the infection

How long does it take?

A few days

Will it tell me I was infected if I was not?

Highly unlikely

[Blood tests are quite thorough. If performed at the right time, this result should not occur. Test too early or too late, and there might not be enough antibodies to register, though.]

Will it tell me I was not infected when I really was?

Possible but unlikely

[This result would most likely happen in the case of testing too early. It takes a couple weeks for the immune system to produce the antibodies.]

Where can I get it?

Hospital, doctors office, blood lab

It is important to note three things here:

  1. Antibody levels may drop after just a few months
  2. It is unclear if the presence of antibodies in the blood indicates long-term immunity, a lack of contagiousness, or both. More long-term data is needed.
  3. It is also unclear if COVID-19 infections confer lasting immunity.

Additional Testing Info

It is imperative to understand that there is no gold-standard test just yet. This virus is new and, therefore, so are all the tests. This means that the data from these tests is still accumulating. The monumental mobilization effort that I talked about earlier is still underway. New labs and new tests are coming online all the time. 

The FDA granted emergency use authorization (EUA) for hundreds of these tests, allowing manufacturers to get their tests on the market very quickly. But this speed can have downsides. The rapid response coupled with the steady rise in new tests and new labs means that results and accuracy may vary. The FDA’s EUA means that tests are not going through the normal rigors of FDA approval, so test variances and data inaccuracies may occur.

The creativity and speed in the development of new tests is inspiring, but we can see there is still more work to be done.

The Path Ahead

Fighting a pandemic requires a combination of efforts on multiple fronts: prevention, tracing, testing, inoculation, and immunity tracking. We will discuss all of these in detail later in this series. 

The good news is, we already have a solid prevention strategy. We simply need to follow it and remain vigilant. We have good testing that is only getting better as we accumulate more accurate data. Testing is becoming more available every day, and vaccines are rolling out at an impressive pace. 

The bad news is, we still have a long way to go. We still lack a cohesive, consistent, nation-wide policy. We still have people refusing to follow proper safety protocols. Testing is still not as accurate as it needs to be. Tests are not as widely available as they need to be, nor as fast as they need to be. 

Fast, cheap, available, and accurate testing can put society back on track by allowing a return to a more normal level of operation. As we have already seen throughout this pandemic, however, any relaxation of preventative measures without fast, cheap, available, and accurate testing leads to spikes, deaths, uncertainty, and agitation.

Bottom Line

The medical, health, and scientific communities are working overtime to optimize every aspect of this process. They delivered clear preventative measures early on. They gave us reasonably accurate testing very quickly and developed vaccines in less than a year. 

These are all reasons to celebrate, but not reasons to relax. Work is constantly underway to improve the speed, accuracy, and availability of testing. As the vaccine roll-out continues, we must remain vigilant in our prevention, reporting, and contact-tracing.

It is only when all of these efforts work in concert that we can begin to think about a future free of COVID-19 or with the virus under control. When we look to that future, we must begin to see a better way to track immunity. And that’s the subject of our next article.  

Join me in two weeks when I look at how we can monitor and track the virus, the vaccine, and immunity itself.

Marvin S. Hausman, MD, is an immunologist and board-certified urological surgeon. He has more than 30 years of drug research and development experience with various pharmaceutical companies, including Bristol-Myers International, Mead-Johnson Pharmaceutical Co., E.R. Squibb, Medco Research, and Axonyx. Dr. Hausman founded Medco Research, which in the 1980s became one of the top contract research organizations (CRO) and a successful pharmaceutical company. At Axonyx, Dr. Hausman successfully licensed in and developed inhibitors for acetyl and butyrylcholinesterase and the drug Posiphen®, a compound that inhibits synthesis of amyloid precursor protein (APP). Dr. Hausman has done residencies in General Surgery at Mt. Sinai Hospital in New York and in Urological Surgery at UCLA Medical Center. He received his medical degree from New York University School of Medicine.

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*DISCLAIMER: This information should not be considered comprehensive and is not a substitute for discussing these matters with your doctor or medical professional. Please consult with your insurance company, your doctors, and all applicable health professionals for personalized advice and information regarding COVID-19 and your health.  

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