Importance of properly diagnosing COVID-19 vs influenza to offer therapeutics.
Peter Salgo, MD: Jason, you were talking about the importance of making the distinction between flu and COVID-19, especially now that we have some therapies that are specific for COVID-19. At this point, with vaccination being where it is and flu not necessarily being as high, how important is it to make that distinction?
Jason Gallagher, PharmD: It’s critical. I’ll put it this way: It will be critical again as flu comes back. I’s still critical for COVID-19 because we’re not doing a great job of using the few therapies we have for outpatients. The monoclonal antibodies, which are a pain to set up the logistics to administer, but they’re set up in many places, and yet they’re being underutilized. It’s important that we do this testing to find these patients. Some places have done a good job of it. I don’t think it’s the majority by any stretch, but there are health care systems that do surveillance of all the positive COVID-19 tests that are done and then reach out to the patients who meet certain criteria for one of these monoclonal antibodies. That’s an amazing program. That’s not the norm, though. The first thing you need is to know that the person is positive.
Peter Salgo, MD: Did you want to say something?
William Schaffner, MD: I just wanted to emphasize that Jason is describing the program at Vanderbilt [University]. I would encourage others to think about this because we reach out to people who are COVID-19–positive, see if they fulfill the criteria for being in a high-risk group, and then invite them in for monoclonal antibody therapy whether they’ve been vaccinated or not. We have the impression that we have reduced the occurrence of severe disease by intervening early with monoclonal antibody with these high-risk patients.
Peter Salgo, MD: You can take the obverse of all of this. Let’s say you’ve got a symptomatic patient, that patient gets tested for COVID-19 and it’s negative. With these symptoms, should the assumption then be that they have the flu, or do you need to test for the flu?
Jason Gallagher, PharmD: We should be testing. We’re not going to know that flu is back until we start looking for it. With the availability of inexpensive, rapid, and easy-to-do tests, I don’t think we have a good reason to not do it.
Peter Salgo, MD: How important is it to get these tests back in real time? I know that the selling point—not economically, but in terms of patient acceptance—is you’re going to know quickly as opposed to what it used to take, which was about a day for the PCR [polymerase chain reaction] test. Is this important, George?
George Loukatos, MD: Absolutely. It’s very important. Not only for initiating the proper therapy, but for instituting the correct quarantine protocols and increasing compliance. A patient doesn’t want to take a test and get a result 14 days later, like they were initially with the PCR COVID-19 tests.
Peter Salgo, MD: I remember that.
George Loukatos, MD: It’s pointless to do the test at that point. At this point, we’re not reinforcing their reliance, or, what’s the word I’m looking for? Their—
Jason Gallagher, PharmD: Faith?
George Loukatos, MD: Yes, and their confidence.
Peter Salgo, MD: I wouldn’t worry too much about that word searching, George. It happens to all of us eventually.
George Loukatos, MD: Getting test results quickly is important so we’re not losing their confidence in the system when we tell them we’re going to run this test but it’s going to be clinically irrelevant by the time we get the results. We’re just going to keep our fingers crossed in the meantime and hope for the best. As a clinician, I want to get the right diagnosis and start the appropriate therapy. Now that we have therapies for COVID-19, even if it’s just starting somebody on Tamiflu, I want to know that. It’s important to start it early. Forty-eight hours is our window. It’s incredibly important. Hopefully, now that tests are more available, we’ll do better with that than we did the first go-around.
Peter Salgo, MD: If I could give you a test that would be reliable, easy to use, and available, what is the best venue for it? Is it in the PCP [primary care provider] office, urgent care center, pharmacy, or free-standing clinic? Where would you put it, George?
George Loukatos, MD: Everywhere. Because with the situation we’re in, all our clinics, urgent care centers, and emergency departments are stressed. We’re seeing triple the volume that we normally see. It needs to be available everywhere so that patients can figure out, “OK, I can get in here in an hour. It’s going to take me 5 hours there. I’m going to go here,” rather than trying to funnel everybody to 1 place.
Peter Salgo, MD: It’s unfair to criticize the way testing is being done compared with early on. You reminded me of the Paleolithic Era of COVID-19 testing—which wasn’t all that long ago—where it was a week or 2 to get a result. Now you’re going to get it within 24 hours in almost all circumstances, and yet we want to do better. It sounds to me like you’re all saying that faster is better and more available is better. How fast is fast enough?
Jason Gallagher, PharmD: Fast must be the same visit, truthfully.
Peter Salgo, MD: Really?
Jason Gallagher, PharmD: It depends on what the reason is. If it’s about quarantining a patient, you can tell them to do that and then tomorrow we’ll know. That’s 1 thing. It’s annoying, but it’s not a big hazard. But when it comes to effective therapies, as George was alluding to with oseltamivir with flu or monoclonal antibodies with COVID-19, you need to know soon. Because after the patient starts making their own antibodies for COVID-19, the therapy is probably worthless. For oseltamivir, once the virus starts coming down on its own, you’ve missed your window of opportunity to have the patient feel better faster. So it needs to be fast.
Peter Salgo, MD: I want to thank all of you out there for watching this Contagion® Peer Exchange. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming Peer Exchange segments and other great content right in your in-box.
Transcript edited for clarity.