Infectious Diseases Experts Discuss the Who, When, and Why of COVID-19 Testing
On Oct. 26, the Arlington, Va.-based Infectious Diseases Society of America (IDSA) conducted a media briefing featuring Nira Pollock, M.D., Ph.D., associate medical director of the Infectious Diseases Diagnostic Laboratory at Boston Children's Hospital, infectious disease specialist at Beth Israel Deaconess Medical Center, and associate professor of pathology and medicine, Harvard Medical School; and Dial Hewlett Jr., M.D., medical director of the Division of Disease Control at the Westchester County Department of Health in White Plains, New York, and IDSA fellow. Chris Busky, CEO, IDSA moderated the briefing. The briefing focused on COVID-19 testing, particularly the expansion of at-home testing.
Pollock said in the beginning of the briefing that “We all remember the beginning of the pandemic when there was very little access to testing.” She went on to explain that since then we have evolved tremendously, but even with more testing options it is still a challenge. She commented that COVID-19 test costs, access, and supply can be limited and individuals report difficulty obtaining an appointment for a test.
Pollock then touched on at-home testing, saying that most at-home tests are rapid antigen tests. “The issue is performance,” she said. “We know that antigen tests have lower analytical sensitivity than PCR, so they're less sensitive at picking up the virus.” The advantage, she explained, is lower turnaround time and cost.
There is a debate, according to Pollock, about whether antigen test results can be used to determine the infectiousness of an individual. “Despite these limitations, antigen tests have a role,” she said. “And a negative antigen test is still useful.” She then reminded the audience that if a patient is symptomatic, even if they don’t have COVID (because of a negative test), they still need to stay home because they can infect others who will then need testing too.
Hewlett addressed the audience starting with the topic of mandates. “We as a county health department follow the guidance from our state department of health, and our state department of health recommended that those working in healthcare settings must be vaccinated,” he said. “There are provisions in place for certain types of exemptions, but for the most part we have been successful in getting most of our clinical staffs and those interacting with patients vaccinated.”
Hewlett said that “There are some shortcomings to testing.” He then explained that the individuals who were granted exemptions are required to “test out” on a weekly basis. The test has to be molecular, as at-home tests are not accepted. The shortcoming is that an individual may test negative on Monday, but then test positive on Tuesday, therefore exposing other individuals.
The briefing was opened at the end to respond to questions from the press. A member of the media explained that she had heard and read stories about extremely high fees being charged to third parties and the government. She asked, “Should the government set a fee for what can be charged for tests?”
Hewlett said that “I think it is very unfortunate that we have profiteering that is going on, but it is something that is naturally going to occur.” He commented that he agreed that there should be regulatory control over the pricing of tests. “We should be taking a very close look at people or firms or companies that are taking advantage of the public,” he concluded.
Pollock also responded, saying that “I think this whole area of test cost is very important.” She didn’t have any quantitative information on the fees being chard to third-party payers (and neither did Hewlett in his response). But she was adamant that cost being an issue is troublesome. “The fact that cost of testing is still an access issue, a barrier, and an area of disparity is really not OK,” she commented.
