We're testing the wrong people for #Covid_19, let me explain (a thread). (1/12)
OK - tests are limited. That's a given. If they were unlimited, we'd test everyone. That's not an option. We need to triage. (2/12)
But what health systems are doing is selecting those who get tested. And they are picking a very specific group to test:
They focus on those with "classic" symptoms - like fever.
(3/12)
They focus on those with "classic" symptoms - like fever.
(3/12)
They focus on those who are hospitalized, and critically ill.
They focus on those who are ruled out for other infections, like flu. And who have no good alternative explanation for their symptoms.
(4/12)
They focus on those who are ruled out for other infections, like flu. And who have no good alternative explanation for their symptoms.
(4/12)
What this does is inflate the pre-test probability of #Covid_19 . That means the likelihood of a positive test is pretty high (after all, you're reasonably suspicious the patient has the disease).
(5/12)
(5/12)
This is a bad idea, public health wise. If you were absolutely convinced your patient had #Covid_19, you wouldn't need to test at all.
(6/12)
(6/12)
The smartest use of limited tests is to focus on those "gray area" cases. Cases where the results of the test would lead to a meaningful difference in care.
(7/12)
(7/12)
In other words, for patients in the ICU on the vent, with a negative flu test, don't even waste a #Covid_19 test. Just treat them like they have it.
(8/12)
(8/12)
Use the tests for those patients with atypical symptoms (like no fever), who aren't as sick and who aren't getting appropriate isolation.
(9/12)
(9/12)
Testing only those with high pre-test probability means we're missing a TON of cases of mild disease - and those are the ones spreading it. NOT the people in the ICU fighting for their lives.
(10/12)
(10/12)
Testing health care providers is critical - even with mild symptoms - we are needed on the front lines and quarantining us at home is stressing an already stressed system. Test us, and let us get back to work.
(11/12)
(11/12)
In short, until we have more tests, stop testing those you are highly suspicious have the disease - treat them empirically. Test the ones you're not sure about, or who you need to help in the fight. (12/12)
