Two months ago, I wrote about what might happen after we phased out shelter in place. Unfortunately, increased activity has led to rising rates of COVID-19 infections. Some states, such as Texas and Florida, which were never very compliant with social distancing are now suffering from rapidly accelerating rates of infection. Even here in Contra Costa County, where we did a stellar job of sheltering in place, our infection rates have now doubled and are slowly continuing to climb. https://www.coronavirus.cchealth.org/dashboard
In order to navigate in the newly opened society, we are using COVID-19 PCR testing to try to reduce risk. Tests are being required prior to elective surgery, to prevent quarantine requirements when travelling to other states and before social gatherings, often with the requirement to have the results in 72 hours or less. This approach can mitigate risk but not eliminate it. PCR testing has a distressingly high false negative rate, at least 20-30%. That is, you have the illness, but the test comes out negative.
Also, we are facing surging rates of COVID-19 across the nation, placing increased stress on our testing capacity. Most nationwide labs are reporting turn-around times (TATs) in the 5 to 7 day range, increasing the challenge of meeting a 72 hour deadline. To address your COVID-19 PCR testing needs we have been investigating and tracking TAT’s for various testing options. The situation remains fluid and subject to change.
We are monitoring the following options:
Pixel by LabCorp: A home based test using nostril (lower nose NOT nasopharyngeal) sampling. Even though it is a national based lab, we have had success with the test kit arriving overnight and results reported 1-2 days after sending back the test kit.
Vault: Another home-based testing option using saliva collection and reporting a 48-72-hour (several day) TAT
BASS Laboratories: Requires a nostril specimen taken at their lab in Walnut Creek which is processed locally by Precision Labs in San Ramon. They have had a 24-72 hour TAT. However, as of July 8, 2020, in response to a shortage of testing reagents, they have had to reduce their testing capacity which may increase their TAT.
Moving forward, as the nationwide demand for COVID-19 testing rises, it will become progressively more difficult to guarantee a 72-hour TAT. We will continue to monitor testing options and can direct you to the most promising labs. However, you will need to be prepared for the possibility of NOT receiving the results within 72 hours.
Another timing issue relates to when to test after a possible exposure to COVID-19. The first instinct is to rush to be tested. However, the COVID-19 PCR tests have the highest probability of detecting and infection around seven days after the possible exposure. Too soon, and the body may not have enough virus in the upper airways to be detected. Thus, timing will be important. Please contact me and I can work with you around the best options for COVID-19 PCR testing.
In the distant past, (such as March or April), avoiding risk was rather straightforward. Since then, we have opened many aspects of the economy with more options yet greater risk. Moving forward we all need to make careful choices, balancing benefits against risks. Assessing risk can be complicated. There are some general principles that can guide you:
— Being around masked people safer than those not masked
— Outside much safer than inside
— Short exposure safer than long one
— Small groups safer than large groups
— washing hands is important, wiping surfaces maybe less so
Also, I have included a helpful chart created by the Texas Medical Association that ranks the possible scenarios according to exposure risk.
Bottom line: I am here as a resource for you to assist with mitigating risk and strategically using COVID-19 PCR testing.
Please contact me with any questions or concerns
Barry Rotman MD