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South Korea screened over 300,000 patients in the 9 weeks after coronavirus hit. The US? Not so much. Which COVID diagnostics are ready for prime time?
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RT-PCR nasal or respiratory swabs are far and away the most widely used tests for diagnosis. They work best when patients are symptomatic, and sensitivity in the asymptomatic or incubation phase is unclear. We’ve seen plenty of indeterminate tests or false negatives, so don’t rely on a single PCR test to rule out COVID. You’ll probably want to get 2 negative PCR tests, separated by > 24 hours, to document COVID clearance.
Annals
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Point of care tests are on their way and will be a critical tool for mass testing, but data on sensitivity and specificity are sparse. Platforms like Abbott ID NOW, BioFire, and GeneXpert are 'CLIA waived', meaning they can be used in all settings and operated by nonlaboratory personnel. We keep hearing they'll be available any day now, though it will take time to ramp up to mass production.
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Serologic tests are the key to determining who’s been infected and may have immunity. Anti-COVID IgG is detectable between 8 and 14 days after symptom onset, and 95% of individuals will test positive 2 weeks after infection. The FDA has approved 3 serologic tests as of writing with many more on the way.
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More COVID tips from the NYC trenches
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- Steroids are back on. After early concerns that steroids were harmful, a retrospective cohort of COVID+ patients in Wuhan found that steroid treatment was associated with reduced mortality (46% vs. 62%) in patients with ARDS. Steroids for vented patients is now standard practice in many ICUs.
- Watch out for clots. Incidence is strikingly high in COVID patients and VTE prophylaxis recs are fluid. Some centers are using full dose anticoagulation in ICU patients and higher-than-standard doses in patients with elevated inflammatory markers.
- Keep your phone clean. You use it all day in the hospital – try placing within a ziplock bag or plastic wrap during your shift. Can @apple get working on a mask-compliant FaceID?
- COVID X-rays just look like COVID. It's pretty distinct.
- Video chat really helps for family updates and goals of care.
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No one knows, but the number could surprise. SARS-CoV-2 screening in pregnant women admitted for delivery found a prevalence of 15% among 210 patients, even though < 2% of tested patients had symptoms.
NEJM Corres
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Follow @MedicineScope for COVID news, tips, and research summaries.
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When the ED is still going to page, but maybe you can go back to sleep
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GI fellows everywhere are taking a moment to breathe after a trial of 500+ patients with overt signs of acute upper GI bleeding were randomized to urgent (within 6 hours) or early (within 24 hours) endoscopy. Overall numbers were similar between groups, but 30-day mortality (8.9% vs. 6.6%) and 30-day further bleeding (11% vs. 7.8%) were higher in the urgent endoscopy group. Patients with hypotensive shock who failed initial resuscitation were excluded and should still receive urgent endoscopic intervention.
NEJM
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What your finance friends are talking about
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Markets are going nuts after news leaked of encouraging results for COVID-candidate drug remsdesivir at UChicago. Here's hoping formal RCTs, due to report 'soon', agree.
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A huge thanks to the wonderful people and restaurants who have sent (and keep sending) PPE and meals to NYC hospitals! It really helps.
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