key: cord-0865538-9stz7hlu
authors: Greenky, David; Wiltrakis, Susan
title: COVID-19 testing for providers: Leading by example
date: 2021-01-11
journal: Am J Emerg Med
DOI: 10.1016/j.ajem.2021.01.010
sha: 89801860b9774758575108b834b06363231c9bec
doc_id: 865538
cord_uid: 9stz7hlu

• Hospitals and emergency rooms are facing staffing issues during the pandemic. Providers waiting for COVID-19 test results before returning to work are contributing to this shortage. • Healthcare institutions should prioritize fast results for providers waiting to return to work. • Novel methods such as batched testing have been proposed, but systems are slow to adopt these. • While we slowly progress through this pandemic, continued improvements in testing will help us this winter, and in future outbreaks.

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This may sound like a broken record, but hospitals around the country are short-staffed and healthcare workers are paying the price. 1 An emergency medicine physician colleague at another institution recently confided that she felt terrible because she had to call in backup for a number of days while her COVID test was pending. Another had mild cold symptoms but needed a negative COVID test before working. When he called the hospital employee health COVID line, he was told to get testing in the community, which also took days. No rapid testing was available for employees and turn-around time was at least 48 hours. If some healthcare workers are still having trouble achieving fast, accurate tests months into this pandemic, it means we are even further behind in the community. Indeed, Anthony

Fauci recently said in an interview we need to -flood the system with tests‖. 2 Healthcare institutions in the United States should be leading by example for their own employees. While we have made great progress in the United States, it begs the question, why has the United States lagged so far behind in testing strategies and capacity?

As the pandemic wears on, vaccine approval and increased access to accurate rapid testing offers a glimpse of hope, while simultaneously reminding us that our national response seems patchwork compared to other nations. To appropriately respond to the influx of COVID patients, access to testing for providers is critical this winter. Hospitals will likely continue to require negative COVID tests for symptomatic workers given incomplete vaccination rates, evolving understanding of vaccine efficacy, and COVID mutations that have been detected. Efficient testing has been and remains a critical issue for this pandemic and future outbreaks, and there is much to learn from the approach of other nations.

While testing capacity is often raised as an issue, testing turnaround time is an equally critical issue.

Other countries have proven it can be done. In South Korea, rapid test turnaround for healthcare workers J o u r n a l P r e -p r o o f Journal Pre-proof was thought to have been an important component to their low COVID infection rate despite a large outbreak in Daegu. 3 Switzerland and the Netherlands have also prioritized rapid testing of healthcare workers as part of their COVID strategy. 4 Although rapid antigen tests have a higher false negative rate compared to RT-PCR tests, it is still thought to be a good option during the symptomatic period of infection, making it a good option for symptomatic healthcare providers. 5 Increased access to quicker turnaround RT-PCR tests is another viable option.

In smaller communities, such as workers in a hospital, batched testing has been offered as a possible solution. Instead of each sample being tested separately, samples are batched together and only tested separately if there is a positive sample in the larger group. Batched testing only makes sense with low disease prevalence and has been used to some degree of success China, Germany, Israel and others. This method saves resources and allows for large numbers of tests to result faster. It may not be the holy grail for controlling community spread in higher prevalence areas, but may be useful for surveillance or symptomatic testing in hospital or nursing home workers. 6 Novel rapid tests such as saliva testing make this approach even more plausible. 7 While this has been suggested for months, its implementation has lagged.

We know testing works. On a larger scale, countries such as Germany and the United Kingdom have recently pivoted to distributing large amounts of rapid tests among segments of its population to better control COVID outbreaks. China, South Korea, Singapore and others successfully employed this strategy earlier in the pandemic. 

Hospitals Can't Go On Like This. The Atlantic

Opinion | When Will We Throw Our Masks Away? I Asked Dr. Fauci. The New York Times

Gawande Atul A. How South Korea Responded to the Covid-19 Outbreak in Daegu

Monitoring approaches for health-care workers during the COVID-19 pandemic

Centers for Disease Control and Prevention

Large-scale implementation of pooled RNA extraction and RT-PCR for SARS-CoV-2 detection

Pooled saliva samples for COVID-19 surveillance programme

Update: Characteristics of Health Care Personnel with COVID-19 -United States