Encouraging testing of symptomatic COVID-19 or influenza patients and utilization of available therapeutics.
Peter Salgo, MD: 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?
George Loukatos, MD: 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.
Peter Salgo, MD: 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.
Jason Gallagher, PharmD: 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.
Peter Salgo, MD: 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?
George Loukatos, MD: 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.
Peter Salgo, MD: 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.
William Schaffner, MD: 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.
Peter Salgo, MD: 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?
Jason Gallagher, PharmD: 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.
Peter Salgo, MD: 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.
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Transcript edited for clarity.