Jason C. Gallagher, PharmD, FCCP, FIDP, FIDSA, BCPS

 What advice do you have for community clinicians and pharmacists for controlling the flu coming up alongside COVID-19? What do you think people should simply do proactively?

 That almost becomes a simple question. Control is an illusion, right? But if there’s any way to do it, the answer is clear: vaccination. The vaccines for COVID-19 are phenomenally effective overall. There are going to be breakthroughs. They’re quite publicized when it occurs, but overall, they’re still very effective and have been effective through the different variants. That’s an important message that’s getting lost. I’m very happy to hear that vaccine uptake has been taken up in the south somewhat, because I often hear people saying that the vaccine isn’t going to work against the delta variant because of some mixed media message. That’s not true. Vaccinate, vaccinate, and vaccinate are the 3 most important things when it comes to controlling these diseases.

Of course Jason is right. Because this is going out to a professional community, I would emphasize that being vaccinated ourselves against COVID-19 and influenza are professional and ethical responsibilities. It’s a patient safety issue. And you should make sure that everyone in your practice setting, whatever it is, also gets vaccinated against both COVID-19 and influenza. Do the best you can to model that behavior for your patients and, of course, for the benefits for yourself.

 That’s what motivated me early on to get the vaccine. I was worried about myself. But as a physician, I felt I had a responsibility to the patients I saw. I got vaccinated to give my patients the best shot I could at them not getting COVID-19 from me. Jason, you said something I like because it reminds me of a quote from Einstein. You said vaccination may be an illusion.

 Control is an illusion. That’s it. Einstein once said that reality is an illusion, but it’s a very convincing one.

 I wouldn’t know if he’s right or not.

 Well, by definition. I liked that. In the little time that we have remaining, I want to ask each of you to give us a last thought. Something you’d like to sum up and leave us with to give us a sense of where we are and where you think we’re going. George, we’ll start with you.

 The 1 thing the pandemic has taught us, and the recurring theme through this conversation, is that we’re in a state of flux and we’re doing the best we can to stay ahead of the curve, whether it’s influenza, COVID-19, or any other type of infectious disease process. The recurring theme is that as clinicians, as part of the medical community, we need to do our best to educate ourselves and stay ahead of the information curve so we can properly educate the public and maintain their confidence.

It’s important for us to be open and say, “This is our best guess right now. I’m not telling you that this is absolute, but this is what we know from the data that we’ve had and the data we’ve accumulated. These are my recommendations based on that.” Let them know that you’ve done your research and are staying ahead of things so that they’re confident, whether it’s convincing someone to take a vaccine, educating them about the importance to quarantine, or just how to care for their family and aftercare. It’s important to stay up to date on those things. That’s where our focus needs to be.

George gave my little talk. I will emphasize with slightly different words that, as he was saying, the only constant is change. We’re still writing the textbook for COVID-19. We’ll have to stay up to date with what’s happening because COVID-19 is likely to throw us a few more curveballs down the road. But COVID-19 is not the only respiratory disease. We’ve been talking about influenza. Influenza will soon be upon us, and influenza vaccination season comes before flu season. We’re going to have to vaccinate our patients with flu vaccine also.

 OK. I’m going to give you the last word, Jason. Go for it.

 Thank you. It’s interesting how similar our concluding thoughts are. To me, infectious diseases teach humility, and COVID-19 has been a big educator. So much has changed. With some of the messaging that people get, they’re looking for absolutes, and we have to be careful and straightforward and say, “This is what I think based on this. It may change if something else happens.” I didn’t have the summer called right. I thought we’d have a great summer and a pretty bumpy fall. Then delta came by and changed so much. Going forward, we’re definitely better informed with better tools and better therapies than we were, but we can’t say what tomorrow is going to bring.

 I want to thank all of you for being here. We’re going to revisit this, obviously. As all of you pointed out, this is a topic that keeps changing. The virus keeps changing. Our response to both the flu and COVID-19 keeps changing. And our therapeutics keep changing. If I heard all of you correctly, it seems to me that the more we understand, we have different effective pathways for dealing with each virus. That it makes it even more important to figure out which virus we’re dealing with. Do that effectively, cost-efficiently, and quickly so that we can get the therapy underway while it still has a chance of making a significant clinical difference. With that, maybe we’ve got a shot.

We’re already doing better than many people thought we ever would. I used to say that a viral disease is a real problem but that we’re not going to get anywhere. That was a generation ago. Pterodactyls were flying through the sky at that time. That’s no more. Things are better. Therapeutics are better. Diagnosis is key, and getting the right diagnosis for the right virus—for the right therapeutic—is also key. This has been very educational for me.

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Final thoughts from experts on controlling COVID-19 and influenza.

Final Thoughts on COVID-19 and Flu

 There’s been a lot of public education about the COVID-19 vaccine. In my limited sample, it seems that there’s less public education about getting tested and the value of making the distinction between the flu—which wasn’t a problem for most of last year—and COVID-19. How can all of us—physicians and pharmacists—encourage people to get tested if they’re symptomatic, George? Particularly in light of the fact that we previously told them not to get tested. How do we fix this?

 That’s been 1 of the biggest challenges because even there, the recommendations have changed. How long do we wait from exposure? At first, we had people running in saying, “My sister’s brother’s cousin has COVID-19. I need a test.” It took us awhile to develop our protocols of needing to wait 5 days after exposure to get an accurate result. If we’re testing you 2 days after exposure, we could get a false negative, along with the public health implications of giving that patient the information of, “You’re negative. You’re good.” No, you’re not. You need to remain quarantined.

We have spent the last year and a half developing those protocols and trying to educate ourselves. It’s a constant process. As far as getting that information to our colleagues, I can’t tell you how many Facebook pages, Facebook groups, and blogs I’m following that I wasn’t before, because I’m certainly not on the front line or the cutting edge of the technology and research. I’m relying on other people to give me my information as well.

 Do we have to resort to what’s known as—I hate this phrase—influencers? Is that what we need to do? Maybe it’s a good idea.

 I don’t like that term either. But I prolifically use Twitter, and I’ll put a brief plug there. There’s a section of it that is hell, and there’s a section of it that’s useful. When something comes out that’s new and influencing—I guess influencers—that’s honestly the first place I see it. I check the veracity of what’s said. It’s interesting. Social media can be used in some pretty awful ways, but it can also be used in some helpful ones to help practitioners keep up to date.

 George, do you think people are aware of the fact that the therapies for the flu and COVID-19 are different and that testing for both makes sense?

 I do. In general, there’s been enough education that people understand that there’s maybe not so much for COVID-19. For COVID-19, the message may still be, “Unless you’re in the hospital, we can’t really do anything for you,” because monoclonal antibody treatments have been around for only a few months, at least in my area. That message is still getting out there. But in general, people understand the importance of getting tested. There’s going to be a subsegment of the population that’s going to form their opinions, and no matter how big a brick you hit them with over the head, they’re not going to change their opinion. But in general, the public has done a pretty good job of keeping themselves informed and complying with CDC [Centers for Disease Control and Prevention] recommendations, their doctor’s instructions, and public health measures that we’ve tried to institute.

 I can tell you what I hear from patients all the time. I’m sure you hear the same thing. “If I go in the hospital, I’m going to die. If I go in the hospital, I’m told that they shouldn’t intubate me because that will cause me to die. My grandmother walked into the hospital, and I never saw her again.” So why test? What’s the point? This is all just a big fantasy, right? We can’t do anything. How do you combat that? We can do something.

There’s really good information, and it’s getting out there. We’ve learned so much. My colleagues who are intensivists about how to recognize these patients understand the pathophysiology of the virus and what it does to the body, anticipate those changes, and make the appropriate therapeutic decisions. The team members here at Vanderbilt University [School of Medicine] are somewhat cocky. They think that no place in the country provides better care than they can for patients admitted to their intensive care units. I suspect their colleagues across the country have similar feelings about their own units, because we’ve really gotten better. People are leaving our intensive care units and our hospitals vertical, whereas they used to leave horizontal. We’ve made big strides in those directions.

 It’s huge. We had 2 physicians in the early days of the pandemic who wound up on ECMO [extracorporeal membrane oxygenation]. They both left the hospital and are back at work. That was a miracle back then. I suspect not so much now. Now we’ve got pathways to deal with this that we didn’t have a year ago. I’m not sure that message is getting out. What do you think, Jason?

 It’s tougher. I don’t think people realize that we’ve gotten better in our therapeutics overall. That’s a good point. But it’s also important for them to know that they aren’t great. We have gotten better. Outcomes have improved, and a lot of them are not pharmacological. The early emphasis of intubating early to protect the patient’s airway has changed to intubating later, because it’s a different disease from what people were used to seeing. I don’t want people to think, “It’s OK. If I get to the hospital, I’ll be all right.” We have gotten better at keeping people alive, and the outcomes are better overall. One day, we’ll sit there and do a dissection of it all and say what was responsible for what. But we’re still not stellar, to be quite honest.

 But we’re moving in the right direction. It took us a long time with AIDS. We got there to a large degree, but we’re not there yet with COVID-19.

Encouraging testing of symptomatic COVID-19 or influenza patients and utilization of available therapeutics.

Encouraging Testing for Symptomatic COVID-19 or Flu Patients

 Let’s close this loop. We want to encourage the flu vaccine and COVID-19 vaccine. With all the information that’s been out there, people are getting overloaded. What’s the best way for clinicians, pharmacists—all of us at this point—to encourage people to get vaccinated? If this information hasn’t sunk in yet, do we have a chance, Bill?

 We do have a chance, and we’re a team. For example, the role of pharmacists in providing information and immunization has been growing over the last decade or so. Every pharmacist in school now actually gets more elaborate training about vaccines and their delivery than we do in medical schools. That’s a fact. So we have incredible partners as part of what we’ve come to call the immunization neighborhood. And of course, information is part of that. We’re getting better at the state level in collaborating with each other. I’ve been a passionate advocate and supporter of pharmacists being part of the team and physicians recognizing the importance of pharmacists, as well as our nursing partners, physician assistants, and everybody else. This is a team effort.

 Jason, I mentioned before we had our discussion that the single greatest advance in my ICU [intensive care unit] was pharmacists, PharmDs, doing rounds with us. Out in the real world, people see pharmacists far more than they see doctors. They go to the drug store all the time. They interface with pharmacists. Pharmacists seem to me to be the natural leaders to encourage vaccination and all of the good practices we’d like.

 I hope so. I say to our students all the time that the setting where pharmacists have to shine the most is in the community center. They see these semiglamorous—if you can say that—roles of infectious disease pharmacist and people in critical care and so forth, but the frontline practitioners are the ones in the community pharmacies. That has shined in the last year and a half, where pharmacies have delivered very high percentages of the COVID-19 vaccines. It’s gone beyond information providing and so forth. When patients are looking for sources of information, they’re going to go to people they trust. It’s not so important who that person is in the medical community, as long as they can find somebody.

 It’s important that you said, “In the medical community.” They’re not going to their congressmen and they’re not going to….

 Facebook, or some Facebook or YouTube video.

 But often they are, and then they can turn and go to Bob the pharmacist and ask, “Bob, have you seen this video?” He can say, “Yes, I have. But what it doesn’t say is that the mRNA vaccines, while they were only studied in this past year for patients, have been in development for 15 years,” and things like that. I love the term immunization neighborhood because it shows that anyone in that neighborhood can be that source of information.

 What you’re describing, both for clinicians on the MD and DO side and the pharmacy side, sounds a bit reactive to me. Somebody has to come in. Somebody has to talk to that pharmacist. What about outreach? We’re all quick to bash social media, YouTube, and bloggers. Shouldn’t we be out there reaching forward proactively?

 Yes, that’s a plus if it can be done. It’s interesting hearing you say that. I was listening to a podcast a couple of weeks ago. I don’t want to get into politics here, but a conservative blogger was speaking to a liberal blogger. The conservative guy was saying, “I think that pharmacies should be reaching out to their patients. They’re seeing these patients so frequently that this is an opportunity to reach out and encourage immunization.” I honestly hadn’t thought about that particular angle before. There’s always that balance of how aggressive someone is in advocacy. You can see it turned in the wrong way rather easily. But it’s important. The more facing forward practitioners doing it, the better.

 We need to reach out. If there’s a message that we believe is scientifically important and important to the public health, shouldn’t we be out there? Shouldn’t there be blogs from all of us? Shouldn’t there be YouTube videos from all of us saying what looks like the correct scientific approach here, George?

Yes. As an emergency [department] physician now having transitioned to the outpatient world, even as a clinician in general, I was always focused on keeping myself up to date for my patients on whatever particular type of case I was handling. Over the last year and a half, that has transitioned into where I feel like I’m becoming more of an expert in public health issues and doing a lot more outreach to educate my community. We do a 

 blog and informational sessions to try to get the correct information out there, because there’s so much incorrect information out there.

The other point I wanted to add to what you guys have said is that when we talk about what we can do, we need to first look internally to our own community, the medical community, to encourage our colleagues and come up with avenues to make it easy for people to stay up to date. Because one thing that the COVID-19 pandemic has taught us is that things are changing constantly, and it’s very important to stay up to date on the latest recommendations. A lot of the guys who have been practicing for years and doing the things they do haven’t been great about doing that. In some instances, they’re the ones propagating misinformation to their patients. We’ve got to support our own community and make it known and essential that we need to stay up to date. How do we make that easier for the guy who’s just punching the clock 9 to 5 in the family practice clinic?

 What do you think of this? To some degree, we’ve all been victims of our own success. With the antibiotic revolution, a whole generation of doctors came along who didn’t regard infectious diseases as that big of a problem anymore. You come in, we’ll give you some antibiotics, you go away, we’re good. But in fact, infectious diseases have a way of biting us, whether it was in my early career with AIDS, or things like swine flu, MERS [Middle East Respiratory Syndrome], and this pandemic. It comes back to bite you. It emphasizes something that my professors always taught me: the community is important. You can’t just sit in your office and do your examinations. You’re responsible for the community. How do we get that message out to our colleagues? You’re smiling, Bill.

 The infectious diseases impress that upon them. There’s no practicing doctor who doesn’t realize that what happens in their office has implications for what’s going on in the community, and what happens in the community has implications for what’s coming through the front door of their offices. If influenza doesn’t do it, COVID-19 certainly has nailed that concept home. There’s been more communication between public health and practicing doctors than there has been in a long time.

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The concept of the “immunization neighborhood” highlighting the importance of pharmacists in encouraging and administering vaccinations.

Encouraging the COVID-19 and Flu Vaccines

 Are there rapid tests other than the one we’ve been talking about for both flu and COVID-19?

 I don’t think there are yet that combine the two. There are obviously the separate ones that are available. But I like Bill’s point. I want to come back to it really quickly. We keep saying this, but speed matters. And if there’s anything I’ve learned to appreciate through COVID-19, it might be that. Since the virus replication peaks so early, and we don’t usually get our therapies into patients that quickly, with tests that are either at home or at urgent care, in a pharmacy, or in a physician’s office, that can be done as therapies for various viruses emerge—there are several in the pipeline for COVID-19 that can be given easily with a prescription pad and a pharmacy visit—the expediency of the whole process works together. Find, diagnose, and treat all at once.

When you think about it, it’s better than what we do for a lot of bacterial infectious diseases, because at the time that we’re prescribing or recommending antibiotics, you’re guessing at what they have. You’re giving this empiricism. With viruses, the issue has always been when you get to the patient. If we expand our testing to find them, then we’ll be able to do that and possibly augment the effectiveness of our drugs.

 As someone who started out in this field a long time ago, we’re discussing a novel virus no one had ever seen before, identifying some therapies available, testing available, and within about a year, a test you can do at a practitioner’s office that doesn’t need a machine. You read it and it gives you all of this information. This is a brave new world. If I were able to go back in time—I won’t tell you how far back because it’s embarrassing—and tell myself this is coming, I’m not sure I would have believed it, Bill. What do you think, George?

I agree. It restores some faith in our process with how much we’ve been able to do. When we look back and all shake our heads as to the dire situation we were in going into this winter, it’s one of the positives. I can’t tell you how frustrating it was at the beginning to not be able to get testing. The reason my urgent care centers became so successful is we were able to find a laboratory that was able to turn our tests around within 48 hours. Suddenly the whole community was coming to us.

Speed matters. Not just for the clinician, but also for the patient. And not just in getting them an answer, but in their compliance with their treatment. It doesn’t do a whole lot of good to tell a patient, “I need you to start these antibiotics right away,” or “I need you to start this Tamiflu right away,” or “We need you to go get monoclonal antibodies,” when it took you 5 days to come up with a diagnosis. It doesn’t give them a sense of urgency.

 Right. The only time I ever heard of Tamiflu being given absolutely perfectly was when somebody brought a patient up to our OR [operating room] who had been tested and went through a procedure. Then all of us in the OR got a call. “The test just came back positive. You might want to start Tamiflu now.” We got it before testing and before we were sick. I don’t know if the patient got it, too. I don’t think she got sick, either. But in point of fact, that’s the only time, which emphasizes that early warning, speed, and accuracy are all important. It’s good stuff.

 Yes. I have a similar anecdote. My daughter had flu. She tested positive. We were both on Tamiflu.

The importance of a rapid and accurate COVID-19 and influenza test.

Importance of a Rapid COVID-19 and Flu Test

 If you’re going to test separately for the flu and for COVID-19, you need 2 machines or 2 devices, right?

 That also depends. As George was alluding to, the Abbott machine can do those as 2 tests. The same machine can do 2 tests, but there are 2 separate tests. There are some tests that can do both. One has become recently available that tests for COVID-19, flu A, and flu B on the same card. As we go into these merging seasons, that’s something that can be pretty useful.

 There’s a new test with a long name. Let me see if I can get this right: the Status COVID-19/Flu A&B rapid SARS-CoV-2/influenza A and B antigen panel test.

 Yes. It’s not alone in its ability to test for these pathogens. But it’s alone in its ability to do a simple 1 on a little card and get results fairly quickly, because it’s a rapid antigen test. The technology is pretty well known and being utilized to test for this combination of different viruses.

 Have you guys used this thing? What does it look like? How do you use it? What kind of results does it give you? How do you read it?

 We call it our combo flu and COVID-19 tests for short. But it’s become our mainstay test, especially as we’re going into fall and coming into flu season, because it’s easy to do—it’s 1 swab rather than multiple swabs—and it’s affordable. Basically, it’s collected like other COVID-19 tests. It’s a nasopharyngeal swab that’s mixed with an assay, and that’s put onto a basic chromatographic-type cartridge. After 10 minutes, it tells you whether you have flu A, flu B, or COVID-19.

 Yes, I’m sure you could. It’s very simple to use and very cost effective to me. I keep bringing it back to cost. But especially as a practicing person, you don’t want to order a $400 test on somebody in January when they haven’t met their deductible. Patients aren’t happy when they see a $400 bill for a flu test.

 In this age, everybody is worried about cost. Who’s paying for this? Is this test reimbursable? Is it covered?

 It is. It’s definitely covered by all our major insurers. The beauty of this test is that it’s affordable to the patient too, because rather than doing 3 separate tests, we’re doing 1 test. It’s lower cost for the patient, and it’s lower cost for me as far as getting my supply in through the door and managing my practice.

 Do you see the actual purchase or lease of this equipment being cost effective for PCPs [primary care providers] and clinics?

 The beauty of the test that we’re talking about is that there’s no equipment. It’s just the cartridge that comes in prepackaged kits. You don’t need a machine to run it.

 I see. I misunderstood. It’s just a reader. You just look at it.

 That’s impressive. I go back to a year ago: How far have we come? We had 2-week delays if you could get tests at all. Now you can go to your private practitioner, the rapid urgent care center, or a pharmacy and get the test. That’s dramatic, isn’t it?

 Yes. One of the areas that’s been underemphasized is how much better we’ve gotten at testing over the past year and a half. It’s crazy to think about how you couldn’t get tested last March and April because of the lack of availability, and now we’re talking about inexpensive antigen-based testing that can give you an answer in 15 minutes for multiple pathogens potentially available widely.

 This is very impressive. Before we go crazy on this thing, let’s get some science in here, because the test doesn’t make sense if it’s not any good. What about the sensitivity and specificity for COVID-19, flu A, and flu B? How do you compare all this? Does anybody have these numbers?

 The specificity is very good across the board with most antigen tests. We feel like when we get a positive result, we’re about 98% to 100% confident that it’s accurate, whether it’s flu or COVID-19. The sensitivity is more of a gray area, but all these tests that we’re using are in the low-to-mid-90% range as far as sensitivity. Even our false negative rates are getting pretty low. That’s not that far off from the PCR [polymerase chain reaction] test that we have to wait 24 to 72 hours for results. If there’s a 3% to 5% difference, how clinically relevant is that when you’re talking about a clinic that’s testing 60 or 70 patients a day?

 This is dramatic. Compare this with the test that requires testing readers. This doesn’t appear to be all that better or worse. It’s about the same, no? Unless I’m missing something.

 It’s essentially the same, so it’s a pretty amazing advance.

 Let me tie this up for a moment. You’ve got a visual reader, meaning you don’t need a machine. You use a sample, and 15 minutes later, you get an answer. And the answer is as reliable as we had a year ago with the other more cumbersome, far more expensive devices. Bill, where’s the problem here?

 I don’t see much of a problem. The advances in technology, which are extraordinary, will encourage more widespread testing which, as we’ve all been saying, we’re going to need in order to treat patients in the best way going forward as flu and other respiratory viruses hit on top of COVID-19.

 As we’ve been discussing, if COVID-19 is going to be part of our landscape forever in 1 form or another, like flu, we need to be able to test. As the price comes down and the speed goes up, this is all good, right?

 Yes. And I’ll take the hit for George and point out the importance of the price, because that’s what allows these things to be widespread. Without it being inexpensive, it won’t happen. In flu season, most years you can make a pretty reasonable clinical assumption based on symptoms, which you can’t do anymore with these 2 respiratory pathogens circulating, potentially at the same time. The testing is critical, and it’s cost that allows that.

 Jason, as you implied, if it was the distinction without a difference, who’d care? But in fact, we do care, because the treatment pathways diverge.

 Exactly. One pathway puts you down some oral antivirals, the other 1 either watchful waiting or a potential monoclonal antibody. It allows us to get the right patients to that. It’s critical.

 Let me ask a crazy question. Are you sitting down for this? Can you foresee a day when you can get this test done at home? You get the test in the mail, or like a pregnancy test. You put a sample on.

 It’s already happening. There’s the BinaxNOW test. When you walk down the aisle in Walmart, you’ll see them sitting on the pharmacy shelf. They’re not the greatest test. Those are in the 70% range as far as sensitivity, so we don’t really use them. But the day has already come when an individual can walk into a pharmacy, pull something off the shelf, and go home and test themselves.

 But what about the Status test we’re talking about? Is this potentially useful for at-home testing?

 With the advances we’ve made in the last year and a half, I wouldn’t bet against it.

 It’s certainly possible. I don’t know that I want to do my own nasopharyngeal swab or rely on patients to do that. But if it becomes nasal, a bit of a different sample, then certainly. There’s nothing else technically difficult about it.

 Before my kids go back to school after breaks, I’ve got to swab them. Then they take the swab to school. I could see that. Prior to that, where it’s going to be in a place like a practitioner’s office, how do you see this being implemented in general practice? Does everybody who comes in with a fever get 1? It’s so cheap and easy. Bill, what do you think?

 All of us are developing our protocols. But as we’ve all been saying, we’re going to be testing an awful lot more this season than we have in the past. That will set the pattern going into the future. Not that we have to go down these various roads, but there are other respiratory viruses out there. We’re increasingly appreciating the importance of respiratory syncytial virus [RSV], in not only kids but adults. That can produce an influenza-like illness. Down the road, I see us getting tests that tell us about that as well. There are therapeutic agents and vaccines in the research pipeline for RSV too. This whole respiratory illness arena is expanding and will continue to expand going forward.

The Status™ COVID-19/Flu A&B - Rapid SARS-CoV-2/Influenza A+B Antigen Panel Test:  rapid testing for COVID-19, Flu A&B in one test. 

Status COVID-19/Flu A&B Rapid Test

 What are the options? Right now, if you want to be in the physician’s office, the PCP [primary care provider] office, or someplace where the patient trusts that the test will be done properly, and you’ll get the results, what are the rapid testing options for both COVID-19 and influenza, each of them separately? George, can you spell that out for us?

 There’s a pretty large plate you can choose from. We’ve gone through our own vetting process to find what’s most accurate as far as sensitivity and specificity, and what’s most affordable to the patient. But it starts with the conventional PCR [polymerase chain reaction] test for COVID-19 and PCR test and viral panel PCR test where you can get the flu, adenovirus, and every virus out there. Those tend to be very expensive, so we shy away from them at our urgent care centers.

Then they transition into the equipment-required tests, like the Abbott and the Sofia tests, which are molecular tests that you run through a machine. They’re typically around the same time line, 15 to 30 minutes from the time you swab the patient to when you get a result spit out to you. We’re most commonly using the basic chromatographic type, like a pregnancy test, where 1 line is negative and 2 lines is positive. As those tests have become more accurate, that’s where we’re leaning, at least for our low-risk patients. Every situation is different, as we alluded to. If you’ve got an octogenarian with a fever and you get a negative flu and COVID-19 test, I’m probably going to confirm with a PCR because I want to be able to initiate proper therapy on that person if they have 1 of those 2.

 But are those machines that you outlined, including the chromatographic tests, suitable for in-office, private practitioner, rapid care center use? Are they cost effective? What do they cost?

 That’s a good question, because the cost has come down significantly. When I started testing, we started using Abbott and had to sign a very large purchase agreement to even be considered to get some tests. The tests weren’t available unless you were willing to commit to a big purchase. Those were in the mid-$40 range per test. Now the tests are coming down to where you can get certain brands of antigen tests that are the chromatographic type for less than $10. The cost of testing has come down significantly. It’s been a big issue and a big plus for us. As they become more common, supply and demand has kicked in.

 I want to thank all of you for watching this 

Getting real time results when testing for COVID-19 and influenza.

Jason C. Gallagher, PharmD, FCCP, FIDP, FIDSA, BCPS

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