Read on Twitter
All right, everyone! We all ready for a good old-fashioned Saturday afternoon tweeter thread about coronavirus testing in upstate New York? Here we go!
1/?
1/?
Remember when there were barely any tests and the criteria for getting one were really strict and forced doctors and patients into tough choices? https://www.wxxinews.org/post/who-gets-tested-covid-19-test-shortages-force-county-make-choices
2/?
2/?
That's not the case anymore! The criteria are much wider. Now, anyone who's going to work in phase one of reopening, plus anyone who's been working in contact with the public, plus anyone who's had symptoms of COVID-19 even if they're part of a pre-existing condition, plus...
3/?
3/?
... plus anyone whose doctor wants them to get tested, qualifies for testing. But, in practice, several places said they'll test people even outside of those guidelines. "If you're curious, call us. We can probably get you in." https://www.wxxinews.org/post/how-get-tested-novel-coronavirus-and-its-antibodies-upstate-new-york
4/?
4/?
Both @ROCRegional and @UR_Med say they have excess capacity. They can run more diagnostic tests than they're receiving right now.
5/?
5/?
BUT! Now there's another kind of testing popping up in the county/region/state. Antibody testing. The goal of antibody testing is to determine if someone's already been exposed to the novel coronavirus.
How is this working for us in upstate NY? Read on!
6/?
How is this working for us in upstate NY? Read on!
6/?
These tests could be important! Maybe you're immune! Maybe you're one of the many people who had some symptoms over the last few months but didn't get tested because supplies were so limited. Now you want to know if you had the novel coronavirus!
Not. So. Fast.
7/?
Not. So. Fast.
7/?
Problem #1: No antibody test is currently approved by the @US_FDA. There's a wide range of issues with accuracy ( https://www.npr.org/sections/health-shots/2020/04/15/834497497/antibody-tests-for-coronavirus-can-miss-the-mark).
Problem #2: Even if your test is accurate, we don't know what it means ( https://www.npr.org/sections/coronavirus-live-updates/2020/04/25/844939777/no-evidence-that-recovered-covid-19-patients-are-immune-who-says).
8/?
Problem #2: Even if your test is accurate, we don't know what it means ( https://www.npr.org/sections/coronavirus-live-updates/2020/04/25/844939777/no-evidence-that-recovered-covid-19-patients-are-immune-who-says).
8/?
Into this thicket wades @HealthNYGov, which ran some antibody tests in Monroe County ( https://www.wxxinews.org/post/state-health-department-conducts-antibody-testing-east-avenue-wegmans) and other places in the Finger Lakes region last month, determining that ~2.6% of people in the region have antibodies ( https://www.governor.ny.gov/news/amid-ongoing-covid-19-pandemic-governor-cuomo-announces-results-completed-antibody-testing).
9/?
9/?
Shortly thereafter, a company called WellNow Urgent Care started offering antibody testing in Western New York ( https://www.wkbw.com/news/coronavirus/wellnow-urgent-care-to-provide-covid-19-testing-with-no-appointment-no-prescription) and then in the Finger Lakes ( https://www.rochesterfirst.com/coronavirus/well-now-urgent-care-offering-testing/) and other parts of upstate.
9/?
9/?
The company says these tests are "highly accurate." Follow along with me now on the saga of trying to verify that claim.
WellNow says its tests have 95% sensitivity & 96% specificity.
10/?
WellNow says its tests have 95% sensitivity & 96% specificity.
10/?
Sensitivity is a test's ability to correctly identify positive results. Specificity is a test's ability to correctly identify negatives.
So let's double-check those numbers with WellNow.
Well, we can't. WellNow doesn't actually run the tests. It just collects the samples.
11/?
So let's double-check those numbers with WellNow.
Well, we can't. WellNow doesn't actually run the tests. It just collects the samples.
11/?
WellNow sends the samples to @BostonHeartDX, which tests them for antibodies in a lab in Massachusetts.
Boston Heart says the same thing as WellNow about the accuracy of the tests. But again, there's no way to verify it.
12/?
Boston Heart says the same thing as WellNow about the accuracy of the tests. But again, there's no way to verify it.
12/?
There's no data available to the public, and Boston Heart won't say what test platform it's using or what the procedure is to get its results. "We don't release the platform name of our antibody test for competitive reasons," a spokesperson told me.
https://www.wxxinews.org/post/wild-west-coronavirus-antibody-testing-new-york
13/?
https://www.wxxinews.org/post/wild-west-coronavirus-antibody-testing-new-york
13/?
However, Boston Heart does say it's working with the FDA to get emergency use authorization for its test. So surely the FDA will share some data, right? I mean, there's a pretty compelling public health interest in knowing how reliable a coronavirus test is.
14/?
14/?
Nope. "The FDA is not able to discuss any applications we may or may not have received," a spokesperson there said.
So, where does that leave us? Well, doctors' offices I talked to across New York were pretty confused about where things stand on antibody tests.
15/?
So, where does that leave us? Well, doctors' offices I talked to across New York were pretty confused about where things stand on antibody tests.
15/?
Some doctors and clinic managers said they first heard that antibody testing was available near them from patients who called asking about it.
In the absence of federal, state or local guidance, primary care practices aren't at all sure what advice to give their patients.
16/?
In the absence of federal, state or local guidance, primary care practices aren't at all sure what advice to give their patients.
16/?
Insurance companies don't have a uniform policy on antibody tests either. The decision on whether to cover them is up to individual plans, a spokesperson for @NYHPA told me. Without insurance, the tests can be more than $200 out of pocket.
17/?
17/?
In separate conversations, administrators at two different upstate health care systems told me this looked like "a money grab." It's a test of unverifiable reliability and sensitivity that's not FDA-approved and might not tell us anything about immunity.
18/?
18/?
Those administrators, and several other chief medical officers/epidemiologists, said the tests very likely do have some utility at a population level. They can help determine how prevalent the virus is and how ready a region might be to reopen, for example.
19/?
19/?
But the way they're being offered right now? Not so good. "Testing individual people and telling them the results when we don’t really know what the results mean? That’s not where we should be right now. That can get very, very dangerous."
https://www.wxxinews.org/post/wild-west-coronavirus-antibody-testing-new-york
20/20
https://www.wxxinews.org/post/wild-west-coronavirus-antibody-testing-new-york
20/20
