Rapid, In-Office COVID Testing

Hello, friends and families!

In addition to the traditional PCR COVID-19 test, I now offer rapid testing in the New York office. Not only can we get results in 15 minutes, but this no longer requires the deep “nasopharyngeal” swab that involves pushing a Q-tip 3-4 inches into the nose, hitting the back of the throat. Even in good hands, that was pretty uncomfortable, especially for children. Our new testing unit works with a nasal brushing only, which means that the swab only needs to go a short way in to the front of the nose to get reliable results.

There is one important point to keep in mind about this test in my office (or at any other testing facility). We are dependent on the manufacturer to supply us with the kits that are used in the unit. While we hope to have these regularly available, the pandemic affects the supply lines of all types of medical equipment. Especially as the infection rates rise in the winter months and demand increases, we may be in a situation where we are out of test kits.

If you are just coming in for COVID testing, realize that there is a chance that the rapid test will not be available, and the staff will contact you in that situation. However, we still offer a traditional PCR swab test which is sent out to a lab. I can now get these results fairly quickly, usually in about 24-48 hours. In most cases, this is an adequate (and even more accurate) alternative, and we have plenty of those kits available.

Now for the details.  To summarize my last email on this topic, there are basically three types of COVID tests: antigen tests, antibody tests and molecular tests. Antibody tests shows evidence of past infection, but they are not recommended for clinical practice - they are mainly used for research and screening recovered patients who want to donate plasma. Antigen tests look for proteins on the surface of the virus. They are not considered reliable enough for preoperative screening, since they have a high rate of false negative results, and may miss contagious patients. They are used for frequent screening of large populations at risk (like in nursing homes). Molecular tests look for RNA, the chemical that lets the virus reproduce. There are different types of these, but they are all considered accurate enough for most operating rooms. You may have heard the term “PCR”. This is one type of molecular test, and while the details are complicated, that term is commonly used to describe a nasopharyngeal swab that is sent out to a lab for analysis, and is considered to be highly accurate.

During the pandemic, I had been doing standard PCR testing. This was primarily done for my surgical patients who needed clearance to enter the operating room, and occasionally for patients with suspected exposure to the virus. Being dependent on an outside lab meant unpredictable delays in the results, and the possibility of cancelled surgery. At the height of these lab delays, some specimens were not read for nearly two weeks!

Lately, there has been an increased demand for testing of children without symptoms, driven by school requirements and more aggressive tracing of contacts. Furthermore, as of November 4th, the new state guidelines from Governor Cuomo have allowed for travelers arriving to New York from non-bordering states to "test out" of the mandatory 14 day quarantine. To satisfy this requirement, testing must be done within three days of departure and four days after arrival, if out-of-state for more than 24 hours.

The new unit in my office is the Abbott ID NOW machine, which is a molecular test that gives accurate results in about 15 minutes. While no test is 100% accurate, this unit has been shown to be 95% sensitive during the first week of infection. It is accepted by New York State for testing out of quarantine, and by the Manhattan Surgery Center (where I do most of my operations) for preoperative clearance. Here is more detailed recent information about the test's accuracy. Like all COVID-19 tests, ID NOW is available under the FDA's Emergency Use Authorization, no tests are yet formally FDA approved.

All tests are dependent on the amount of virus being shed, and even the most sensitive lab tests can theoretically miss contagious patients either very early on in the infection or in early recovery. There are going to be clinical situations where a positive or negative rapid point of care test (like the ID NOW) needs to be followed up with a lab test, but that will be rare in my practice.

So what does this mean for testing, and when should you get this test in my office? Almost all of my surgical patients can be cleared with the ID Now, and there will be no issue of the results not being ready in time for surgery. I will do this as a routine part of my preoperative visit. These patients will come into the office with the same standard COVID-era precautions (masks, hand hygiene, etc..) used for my regular in-person consultations.

Patients who are symptomatic and may have COVID, patients who are under quarantine due to travel, or patients who have had an exposure to an infected contact need to be treated differently, to minimize the risk to my staff and other patients in the office. These protocols apply to both the standard PCR lab tests and the rapid ID NOW test.

Registration forms, payments and the scheduling of followup visits must all be done remotely by email or through my website. I am happy to spend as much time as necessary discussing things, but this discussion will be by telemedicine (e.g. FaceTime, Skype or telephone). The actual testing will be done outside of the office, either in a car or by the back entrance. You will be given specific directions and I will meet you quickly so that you will not need to wait in the cold! We will then give you your results within a short time, along with any documentation that you might need for school, work, other doctor's appointments or travel.

I know that this is not easy, and we are all struggling to adapt to this new world. Hopefully, rapid COVID testing in my office will make things a little easier for you. Let me know if you have any questions, or any suggestions on how we can improve this process.

Finally, PLEASE take this virus seriously, especially now as our numbers start to rise and as the cold weather makes outdoor dining, socializing and other activities less and less appealing. New cases are now at record levels, and hospital capacity is again at 100% in parts of the country. In New York City, we all remember what that looked like.

It’s great that a vaccine seems promising, but that’s even MORE of a reason to try to limit infections now. If we knew that there was never going to be a vaccine, we might just give up, assume that COVID-19 will eventually spread to the whole country, and accept the inevitable death toll and long term disabilities in some recovered patients. The virus would become endemic, and never be eliminated. But fortunately, that may not be the case. It could be a year before the vaccine can be widely distributed, but if it's coming, an infection or a death avoided today may be one that never happens at all.

Please wear a mask. Please do regular hand hygiene. Please observe social distancing where appropriate and limit the size of your indoor gatherings. Please don’t spend time maskless around people other than those you live with. We have come so far and we have learned so much. In April we had an excuse - we didn’t understand the virus very well. We don’t have that excuse any more.

I wish all of you health, safety and happiness for the holiday season!

Michael Rothschild, MD