Last week, Here & Now host Robin Young experienced one of the most talked-about and elusive activities in the United States today: getting tested for coronavirus.
Young is a resident of Cambridge, a city in the Boston metropolitan area that announced it would offer free testing to any of its residents over eight years old earlier this month. So Young got in her car, equipped with a mask and a recording device, and headed over to the drive-in testing site in her neighborhood.
Once there, medical workers swathed in protective gear guided Young through the site. The worker administering the test warned her it might be uncomfortable, of which Young was well aware. She pulled her mask down as instructed and suddenly, the long swab went up her nose.
The worker counted up to three, then down from 10.
Young grew weary as the counting continued, only letting a slightly drawn out “Oh boy” slip before the test was done.
“A little sting," she says once it’s over. The medical worker told her she would get a call in five days with results, and Young drove home. Sure enough, five days later she learned her test was negative.
But that comes with a caveat: the test could be a false negative, or her results could have already changed had she caught the virus any time after she was tested.
The caveats underscore a reality across the country: Even if you can get a test, they’re not always accurate and often have such long wait times for results that they become obsolete.
Despite shortcomings, getting tested is extremely important on a larger-scale view, says Dr. Matthew Heinz, an internalist at Tucson Medical Center and former director of provider outreach for Health and Human Services under President Obama during the Ebola epidemic.
“I would never discourage people from being tested,” he says. “I think it's so important to gather as much reliable testing data as we possibly can to help track where the virus is, where there are hotspots, and address that by directing resources properly.”
But the lack of testing is far from lost on him, Heinz says. When he tried to order his first test for a patient in early February, it took him hours on the phone with various health departments. The test had to be flown in directly from the Centers for Disease Control and Prevention, the only place in the U.S. with a test for weeks, he says.
“It has been a frustration for me personally as a physician and all of my colleagues in the health care system that I work with, that we're seeing these, for a while there, tests coming back in 10, 12, eight days later,” he says. “That's just clinically useless. It's extremely frustrating.”
On overall progress in U.S. coronavirus testing
“Certainly overall, the numbers of tests have gone up. It's easier to order them as a physician. But for example, the rapid test is still very, very limited, even in the hospital setting. It's very difficult to get the test that comes back in less than an hour. And in terms of distribution around the country where we need to be doing more testing in hotspot areas like the Navajo Nation and in other areas where we can identify an increasing number of cases, we really need to be directing and making more testing supplies available in those areas, not having enough nasal swabs to obtain a sample or reagents to run the test once they get the sample.”
On why the U.S. doesn’t have enough tests
“I truly don't know. It has been absolutely frustrating and confounding to me ever since they had tried to order my very first test on February 5th, which was a three and a half hour-long process. The public health department of my county didn't have any. And the state of Arizona's public health department called us back, they didn't have any testing. And eventually we were able to get the person tested, have their sample couriered to the state. And overnight, I think they flew it to Atlanta, to the CDC, which was literally the only place in the country for weeks that had any kind of test. A part of the testing did get messed up early on, but there was a test the [World Health Organization] developed forever ago that we could have just used as soon as that one didn't work. And I don't understand the decision making. It's just a very different department at HHS, which the CDC is housed in, than when I was serving. I don't know. So, a combination of bad luck and I don't think the scientists were allowed to be in charge of this. Either way, we're catching up, finally.”
On rapid tests and their shortcomings
“They all have some inherent trouble in terms of potential for false negatives, which, you know, when you have tests that can in some cases have 15, 20, 30, maybe even higher false negatives. As a physician, I'm going to give you the same advice as I would give you if it had come back positive in many cases. But yes, the rapid test is particularly useful when it is positive. That helps us figure out where to safely admit patients to the hospital. It allows us to move forward with surgeries because it wouldn't be safe, of course, to be intubating people that are actively shedding virus for an elective procedure that would expose people unnecessarily. But again, those rapid tests are still very hard to come across, even in the hospital setting.”
On why false negatives happen
“I think it's multifactorial. And for sure, the difference in sampling technique is, I think, a major one. Most of the manufacturers recommend that nasopharyngeal swab be placed to the back of the nasal cavity and held there. The testing instructions I've seen, say, 20 or 30 seconds. They're not pushing it all the way back and it's uncomfortable. No one likes to, you know, make someone squirm, but it's very important. You got to get that little swab into the right area, and hold it there for long enough so that a good sample that potentially has those viral particles there can be obtained. Honestly, the tests are only as good as the samples that we feed into them. So that is a major problem. I think also, if there's any type of delay, potentially, I know this was something that Abbott was bringing up about their testing that had [a] high false negative rate, their rapid test, and one of the issues that they identified was the length of time between obtaining the sample, putting in that reagent solution and then getting it to the actual device that does the testing. If there's a significant delay there, that can cause some false negatives as well.”
On when and how often to get tested
“If people are having symptoms or think they've been exposed, those are situations where we absolutely need to have testing. But more broadly, I think we must have more testing for sure. And our hospitals, our nursing homes and rehab centers. And if they're going to be admitted to the hospital, they should just get a test. I mean, not every day, obviously, but for sure. And a symptomatic situation also in general. I just think we need to up the testing rates overall. We're gonna get through this faster and with more people alive, frankly, and less illness, the more people get tested, the faster we can get up to that minimum level of testing, which depending on the experts who believe close to about a million tests a today we should be seeing probably in the United States overall, we're about a third of the way there, about 400,000 tests that we're doing. When we get to those levels. We know we can reopen stuff more safely and kind of get things back back to sort of the way they were with some modifications.”
This segment aired on May 27, 2020.