In Bethel Park program, emergency medical specialist discusses COVID-19 testing
The chart indicates the time elements with regard to two types of diagnostic testing for COVID-19. Polymerase chain reaction (PCR) testing is the most sensitive technique for detection currently available, but the time necessary to determine results can cause people to be deemed as positive “well beyond the time when they are no longer infectious,” according to Dr. Frank Gaudio. A test with low analytic sensitivy, on the other hand, can produce results in a much more expedient manner.
Dr. Frank Gaudio presents “The Current COVID-19 Situation and What You Need to Know,” offered virtually as part of the municipality of Bethel Park’s Live Well series.
A representation of areas for people with and without COVID-19 symptoms, and a buffer between. Dr. Frank Gaudio recommends a similar setup in homes if someone displays signs or symptoms of the disease.
Editor’s note: This is the second installment of a three-part series.
In the medical community, the preferred method of determining if an individual has an infectious disease is to conduct the type of definitive testing that produces few false negatives, on patients who already are displaying symptoms.
But a problem, as it pertains to testing for COVID-19, is the waiting period for results while samples are analyzed in laboratories.
“The time when you’re probably most infectious is when you’re asymptomatic, or two days before you start to have symptoms,” Dr. Frank Gaudio said. “So having a test that doesn’t give you an answer for five days does not help in terms of what we’re doing to prevent the spread of this.”
An emergency medicine specialist with Washington Health System and Upper St. Clair resident, Gaudio recently gave a virtual presentation as part of Bethel Park’s Live Well speaker series in which he provided comprehensive information about numerous facets of the fight against COVID-19, including determining whether someone has the disease.
“What you want is something that’s going to give you a result as quickly as possible,” he said. “We need a test that will help us reduce the amount of virus, the amount of COVID, in the community and reduce the amount of people who are contracting COVID.”
Some good news in that regard is the availability of at-home testing kits that can be purchased without a prescription, as recently authorized for emergency use by the U.S. Food and Drug Administration. A nasal swab, which can produce results in as little as 20 minutes, detects the presence of antigens, substances given off by a virus that cause an immune response.
A different approach is the relatively lengthy process of testing for molecular-genetic material, known in scientific terms as a reverse transcription-polymerase chain reaction assay.
“It is very accurate as to whether or not you have the virus in you, but it doesn’t tell you whether you’re infectious,” Gaudio said. “What you’d rather have is that lower-sensitivity test, but something that’s rapid.”
Another issue with the RT-CPR assay, he said, is it amplifies the viral material it finds, up to 100 times, “which is why it picks up very small amounts of virus if you have it in you.”
“With the rapid test, we don’t have that amplification step. So what we’re finding is, it may be a better indicator of who is infectious. And that’s what we’re looking for,” he said.
Gaudio also spoke about what people who may have contracted COVID-19 can expect when seeking treatment.
“When you come to the emergency department, when you go to your physician’s office of if you’re at home, what you want to try to ascertain is, who might have it?” he said. “The most important thing at that point is having infection prevention and control measures started.”
Citing Washington Health System emergency department, Gaudio said the area is divided into zones: “hot” for patients suspected of having COVID-19, “cold” or “green” for everybody who does not, and a “warm” buffer in between.
“We don’t want to have people going back and forth, and having contamination, because then everyone who sits or works or is treating a patient in the ‘green’ zone now becomes problematic,” he said.
As such, limitations can be expected.
“When you come into the emergency department, we’re going to try and limit who’s in and out of the room. We’re going to try and limit how often you or the patient moves in and out of the room,” Gaudio said.
“Don’t be surprised if we don’t allow other people to come in, which I understand is a burden, and we do try to work around that as much as possible,” he continued. “But for your protection, for our protection and for the patient’s protection, limiting the number of people in that room is so important.”
He outlined other safety precautions – including the wearing of mouth, nose and eye protection, along with gowns and gloves – and urged people to consider taking such measures in their own homes, especially if someone displays signs or symptoms of COVID-19.
“This is the kind of thing that you need to be thinking about: What will I use for eye protection? Do I have gloves? Should I wear a gown? Do I have enough hand hygiene? And am I cleaning the surfaces often enough, not to mention keeping track of everyone who goes in and out of the room,” he said. “That’s all part of contact tracing.”
Next week: COVID-19 vaccines