COVID-19 Testing: Who Needs It?
The last week of July, more than a dozen travel executives, including the president and COO of the Venetian and Palazzo, sent a letter to President Donald Trump and congressional leaders.
They urged the adoption of national standards and funding for widespread COVID-19 testing and other protocols, saying it was necessary to save tourism.
Around the same time, University Medical Center changed its guidelines on who should be tested. They are limiting testing to those with symptoms or exposure to someone who has a confirmed case of COVID-19.
“We tend to prioritize base who needs it most urgently," said Dr. Shadaba Asad, the medical director of infectious disease at UMC, "At this point, the highest priority is obviously people who are symptomatic with the infection. But we also test a fair number of people who are asymptomatic.”
Dr. Asad said they are also testing people who are asymptomatic but have had contact with known cases, along with people who are in institutions like nursing homes, prisons, or homeless shelters where a case has been reported.
They are also testing people before they're admitted into the hospital, undergoing major surgery or an immunosuppressant therapy like chemotherapy for cancer.
“There is a number of people that we do test even when they don’t have symptoms of COVID infection, but the highest priority are people who have symptoms of COVID, and secondly, those who don’t have symptoms but have been exposed to somebody who has COVID infection,” Dr. Asad said.
Dr. Cort Lohff is the acting chief medical officer for the Southern Nevada Health District. He agreed that testing needs to be for sick people.
“We really want to try to focus our testing efforts on those folks who most likely can benefit from the testing, including those folks who are symptomatic and those folks who had contacts to known cases,” Dr. Lohff said.
For people who want to get a test, but don't fall into that category, he suggests they go to their medical provider to get a test.
UNLV shut down its curbside testing operation — one of the first to open during the pandemic but that was only to move it inside, said Brian Labus, infectious disease epidemiologist and public health professor at UNLV.
One of the challenges that remain with testing is that demand has outstripped the supply and created a backlog of tests. Labus said that hurts efforts to stop the spread.
“So, if we don’t get a result for a week, we’re kind of chasing this disease when it’s already spread to the next generation of people,” he said.
A change in guidelines from the Centers for Disease Control and Prevention could help with the supply, Dr. Asad said.
Previously, someone who tested positive had to come back with a negative test twice before they were considered recovered.
“On an already strained testing system, that was a lot of extra work,” she said.
Now, the CDC considers someone recovered if they have a remission of symptoms and there has been enough time for them to recover.
Testing and contact tracing, which is informing people who have come in contact with someone who tested positive, must go hand in hand to stop the spread he said.
“Until we get all of these things working optimally, a single one of them isn’t going to make or break the response,” Labus said.
He added that people also need to follow the guidelines for wearing masks, washing hands and social distancing. All of those mitigation efforts, along with testing and contact tracing will do the most to stopping the disease spread.
“I think the biggest thing we have to do is stop disease transmission. And if testing can play some role in it, it will help us get there and that will help tourism rebound,” he said.
One of the points of confusion when it comes to testing is which test is which. There is the viral test, which Dr. Lohff explained, looks to see if someone is currently infected. The antibody test looks to see if someone has had the disease and his or her immune system responded with creating antibodies.
With some diseases, antibodies mean a person is immune to the disease. However, Dr. Asad said whether that is true for COVID-19 is a mystery.
“At this point, anybody who recovers and has detectable anti-bodies whether they are safe from infection again or not, we don’t know that at all,” she said.
One thing about the outbreak that is reassuring is that hospitals around Southern Nevada are more prepared than at the beginning of the pandemic, Dr. Asad said.
“This time around, when we had this surge of infections, we were actually much more prepared in terms of hospital capacity, ICU capacity and we had also learned so much more about how to manage the disease,” she said.
Dr. Asad said hospitals around the region have a fair number of patients and a large percentage of beds are being used for COVID-19 patients but they are not at 100 percent capacity in hospitals or in ICUs
Brian Labus, infectious disease epidemiologist and public health professor, UNLV; Cort Lohff, Acting Chief Medical Officer, Southern Nevada Health District; Shadaba Asad, Medical Director of Infectious Disease, UMC