Another COVID-19 Piece…

It’s early January 2022 as I write this. We are in the throes of another COVID-19 surge. This time, it is everywhere and is affecting health systems in a different way. Primary care is overwhelmed, urgent care and emergency departments are overwhelmed, and intensive care units are overwhelmed. There seems to be less fear of the unknown then in March 2020. Omicron is highly infectious but maybe less deadly. The difference is the staffing issues. “Residents are falling left and right,” my resident tells me in clinic. Some clinics are actually shutting down entirely from staffing shortages. Add being a parent to a small child, and daycare classrooms are closing too. I, like most of you, have had my fill of COVID-19. I’m sick of what it does clinically, I’m sick of my patients being afraid, and I’m frankly getting tired of listening to people’s reasons for not getting vaccinated. As a primary care physician, there is also a lot to keep track of on a daily basis. Which antibody works, which doesn’t, how many doses does our network have, where can patients get tested, where can staff get tested, where can kids get tested? All of our heads are collectively spinning, so any evidence that exists helps.

In Kucirka and colleagues article in Annals (1), the false-negative rate of COVID-19 polymerase chain reaction tests is explored. The study finds, “On the day of symptom onset, the median false-negative rate was 38% (CI, 18% to 65%) (Figure 2, top). This decreased to 20% (CI, 12% to 30%) on day 8 (3 days after symptom onset) then began to increase again, from 21% (CI, 13% to 31%) on day 9 to 66% (CI, 54% to 77%) on day 21.” A false-negative rate of 38% is not an insignificant number. There have been many patients I have seen in the past 2 weeks who have tested negative on day 1 of symptoms who I still advise to quarantine until asymptomatic, and consider retesting if suspicion is high. But practically, how many are actually quarantining? People have jobs, families, and commitments that they are still responsible for. Will they be responsible to the greater good of COVID-19 spread or to their own commitments? A patient who was able to be tested in the office today told me in the community she could not get an appointment scheduled for testing until the following week. She has insurance, access to health care, and is plugged into primary care. I knew I could get her tested but how many among us do not have health care access? How many are not testing, or getting tested and getting false negatives and re-entering the world?

As Omicron spreads further and an inevitable new variant comes into play, we need to take what evidence we have and apply it to the world we live in right now. Access to testing is not where it needs to be. Either increase that access (how that happens I am not sure) or change guidelines such that anyone with symptoms quarantines regardless of testing results.  

I appreciate the speed with which evidence is readily available to practicing internist. It helps inform my conversations with patients.  

References 

1. Kucirka LM, Lauer SA, Laeyendecker O, et al. Variation in false-negative rate of reverse transcriptase polymerase chain reaction-based SARS-CoV-2 tests by time since exposure. Ann Intern Med. 2020;173:262-267. [PMID: 32422057] doi:10.7326/M20-1495