Tina Tan, MD: Wendy, if you had to summarize this with regard to what you think providers and patients need to know about the correct utilization of these testing modalities, what would you say?
Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: If I were to summarize, I would say test early when you’re symptomatic. The rapid antigen testing we’re using in our clinic is not great for asymptomatic people. If I have people who have been exposed, I would be more likely to send out a PCR [polymerase chain reaction] test, but I would also say that using these early on gives us some sense, particularly if it’s positive, we feel pretty confident in those results. If it’s negative and you continue to be sick, don’t count that 1 test as being the end-all-be-all. We need to bring you back because it may evolve such that we can pick this up and get you treated. Then for the right people, I believe that antiviral medications should be offered. I know that the CDC has a pretty extensive list of people who qualify for antivirals, and I think we ought to be using that, recognizing that it is difficult to get some of these, but not always impossible. People are pretty industrious when they are told this is really important to their overall health. That’s how I would best summarize it.
We use the rapid antigens in the office, and I’ll tell you, we have I think 5 or 6 machines, and they are going nonstop all day long, and we’re hearing beeps, and this is going off and that is going off. But you know what? I’ve been around long enough to remember when we had none of this. We’re trying to figure this out, and we’re trying to treat people without any resources. I’d rather have resources, even if they are not as accurate as we would love them to be, but at least it’s something that helps to guide us, and people feel reassured. I want to jump back to what Priya said a while ago when we talk about rationing care. We often ration care when we don’t have options available and we can’t get these medications, but we don’t always know who these people live with. Who’s at home? By not offering these tests and these treatments, we may be putting people at risk that we as their providers don’t know exist in their homes, etc.
Tina Tan, MD: With multigenerational households and individuals having multiple underlying conditions, that’s a really valid point. We should be offering the same type of care to anyone who walks through our door and not ration based upon ability to pay, etc.
JAM [Jacinda], in the pharmacy setting, what type of education do you think pharmacists should be providing to people who come into the pharmacy? Because that occurs many times, where they don’t have access or they don’t want to go to, say, an urgent care or their own primary care provider, so they walk into the pharmacy and they ask the pharmacist, “What tests should I be getting and what should I be treated with?”
Jacinda Abdul-Mutakabbir, PharmD: Absolutely. That is an amazing question, and honestly, one that I get very often as a pharmacist in terms of what to do. Thankfully, we did get the antigen test for COVID-19, and that was something I was able to educate individuals about using. You would be surprised, directions are provided, but it’s hard to interpret the results. I don’t work in the community pharmacy setting, but I do work in a setting in which patients can contact me. I do community clinics, so I go within the community to do vaccinations. I would have individuals come to the clinics and say, “Hey, I got this test, and I’m not exactly sure what these results mean. The line is faded.” I was able to walk them through, “OK, when you see the faded line, but it’s 2 lines there for this particular test, let’s lean toward that being positive. Then for negative results, you won’t see the line there.”
Then I talk to them about serially retesting. When you test positive, you want to go ahead and make sure you adhere to what it is for being positive, or the CDC directions. Let’s try to quarantine. That might not be possible, especially when we think about individuals of racial and ethnic minority groups. I have the privilege of being able to go to the other room in my house so I don’t expose my husband, but not everybody has the ability to do that. I tell them to mask when they’re around other people in the household. If there’s a way to stay away from them, then let’s try to do that. Let’s make sure we take supportive care medications if we aren’t in a place where we need to go to the hospital, and then I’m also able to walk them through when it is important to go to the hospital.
One thing I’ve recommended is to get a pulse-ox [pulse oximeter] machine. When do you go to the hospital? When you start feeling decompensation. When it becomes harder to breathe and is unmanageable at home. I’ve been able to provide that guidance. I think pharmacists everywhere have been able to provide that guidance in terms of interpreting tests and when it’s important to take a COVID-19 test and pushing that education as we’re going back for the holidays. Test before you go to these holiday events. If the test comes back positive, do not go to the holiday events. Stay home, quarantine, and make sure you don’t give this illness to others. I’ve really seen education there. The American Pharmacists Association has amazing tools for pharmacists to talk to individuals regarding testing and other vaccinations.
Tina Tan, MD: Priya, are there barriers that you foresee concerning access to testing for many of these individuals?
Priya Nori, MD: Great question, Tina. I first wanted to piggyback off of what JAM said and add that pharmacists are among our most trusted providers and health care workers universally. Pharmacists are certainly far more trusted than I think physicians in a lot of cases. So coming from them, it really goes very far and means a lot, especially when they have that established relationship with community members.
Back to the question, which is, do I worry about the status of testing going forward? I would like to maintain some degree of optimism about it. I think we were caught off guard a bit in terms of how early the flu season struck this year. I think optimistically what is needed is time to catch up with that and to ramp up the production of both antivirals and testing materials. We’ve seen this happen before in recent memory. We’ve had periodic shortages of things and well-meaning individuals and people in the business of providing care for patients. We always managed to find a way. I’m confident, especially after all the lessons we’ve learned in the past 2 or 3 years, that we will find a way to get through this, even with testing challenges, even with treatment challenges.
Transcript edited for clarity