Coronavirus Testing

Coronavirus testing will help countries manage COVID-19 but will raise questions about how to counsel patients about their test results. The CDC’s Deputy Director for Infectious Diseases Jay Butler talks with JAMA Editor Howard Bauchner about what to advise healthy patients with positive tests, sick patients with negative test results, and more.

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• Coronavirus Resource page from the JAMA Network:

Topics covered in this interview:

What’s the most common test that’s currently available? (1:40)

Positive predictive value (PPV) of COVID-19 tests (2:29)

Data on sensitivity (3:05)

Do patients test positive early in the course of the disease when they are exhibiting a few minor symptoms like runny nose or cough? (4:03)

Is the expectation that if someone has symptoms, they’re likely to have a positive test? (4:50)

If someone with a runny nose, cough, fever tests negative, can they come back to work? (5:44)

If someone tests positive, how long should they stay home and when can they go back to work? (7:10)

Is there a minimum time period someone should be out of work or should they be relying on a negative test result? (9:59)

If someone tests negative, can they still shed the SARS-CoV-2 virus? (11:08)

What’s the recommendation about who should and shouldn’t be tested? (12:26)

Are any of the recommendations different for health care workers? (13:43)

Do health care workers, who previously tested positive, need to wait for a negative test before returning to work? (15:00)

What do we know about reinfection? (16:04)

Any new data on why younger children seem to be at low risk for the disease? (17:38)

What are the risks for women who are pregnant? (20:07)

What are the recommendations for health care workers who are pregnant? (21:08)

Can you talk about limiting the size of social gatherings? Where did the 50 person limit come from? (21:40)

The importance of community mitigation (24:00)

Any updates on treatments or therapies? Any updates on the use of NSAIDs? (25:53)

Any concerns about supply chain issues with regards to reagents for the tests? (27:41)

How viable is the virus on various surfaces? (29:16)

Any concerns patients taking ACE inhibitors and ARBs? (30:59)

General recommendations for people who are sick (32:03)

Can you summarize the current recommendations for people who test positive? (33:16)

The next two weeks are critical. Do you think we’ll flatten the curve? (34:52)

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47 Comments

salam95159

April 16, 2020

Informative and evidence based episode but it has no date.

Reply

Red MoonEagle

old info. why are we supposed to watch this NOW?!! and there is evidence you can test positive and be contagious for up to 49 days after showing symptoms!!!

Maria Torres

Test comes back neg because it's bunk.

ryan cole

Notice how the pcr sensitivity question was dodged. I have been doing antibody testing for 2 weeks now and am doing so serially. Notice how he mentions commercial labs and not private or community labs. Notice how he only mentions big pharmaceutical drugs and not the effective cheap hydroxychloroquine and zinc. Wonder where the funding for his organization arises. This is the biggest dodge interview. As a physician I find this underwhelming and informationally scant. You can do far better than this. Disingenuous.

Johnny Utah

Please explain to me how the test (specifically) gives a (positive) How many false positives are there ?

Hendrick Smit

Did anyone catch any useful answer on how reliable the tests are? What % of infected patients comes out as positive? 'Very high' doesn't cut it for me. And, interestingly, how much false positive is to be expected?

Brandy Dinsmore

Is an antibody test quicker to run (and more available) to find out if somebody had it then one that tells them if they have it now because it’s taking so long to get the results back.

Nada Jurinčić

Is this test positive in some other health conditions? Why there is not diagnostic photographies of Corona virus by electronic microscope into the cell? Dr Steiner did not take this prove as a scientific prove of virus.

Monica Friedman

Just received an email from a friend saying that the covid-19 (as with any upper respiratory virus can be killed in as little as 20 minutes in an at-home remedy, Spray moisture into nostrils; cover the back end of a hair dryer and blow hot air into nostrils for 5 minutes. rest. repeat. keep this up for 20 minutes. then stop. repeat the 20 minutes procedure an hour later.
Does this have merit?

Mmmm L

Testing only the people with symptoms means the “super spreaders” are still out free to spread more

iroulis

Wow such couched language.

dimitris koukios

Swab procedure shown (32.20) is nasal, NOT nasopharyngeal which would be the correct way to sample for coronavirus. Please JAMA correct it to prevent from false negatives.

Meryl Nass

very bad visual on nasal swab, please correct this to demonstrate proper technique to avoid collecting false negative results

SuperLeica1

I took a look through the list of nations with many Corona-cases. I found some nations standing out, small populations but many cases: fex. Qatar, Bahrain, Hong Kong and Macao. These are air-traffic hubs as well as trading hotspots. The travellers are well off and dwell in hi-tech offices/hotels. They ought not to contract; they´ve got everything cleaned around them, can take a shower anytime. The only "crook" I can find which is common to stylish airplanes, offices, hotel rooms and hospitals, is that they all have air condition. So, if the corona-virus can survive a ride through the ventilation, this might explain a part of this unexpectedly fast spread. A high pressure blow-through and liquor-drenched filters might do a part of the job?

James Armstrong

Social distancing is my motto for the next several months – glasses & N95 mask on for trips to grocery – hand sanitizer in the car for after leaving the store.

Eric Egeland

Great interview! The exchange of information in the interview format was very impactful. Keep up the good work, praying for all at the national policy level!

Patti Hardy

Great show. First person to give details about being sick. I’ve subscribed.

holisticpoet

Why do we have nothing but jokers running the country? This includes nearly all politicians and the heads of all the alphabet agencies. This corona virus will be gone by mid summer. They have no idea how many people have corona virus or how many people have died from it. They count whoever they want to get the numbers they are looking for to fool the people into believing that it will be the corona virus than ruined the economy instead of the policies of the central banks. This is when all the while they have been fleecing the public of all their hard earned wealth. Wake UP People!

kofthebaskervilles

Very impressive. This will be my go to site for updates and news.

Steve Slack

Far too lax concerning social gatherings. All non-essential gathering needs to cease completely. Only grocery, pharmacy, bank, and doctor visits that can't be delayed. That's it. No friends over, family visits, or the like. This is wartime. Celebrate after.

MNM Media

This guy should be and probably is a politician. For all his education he basically just regurgitated information from others. I expect more from the CDC.

Dynamic Disc Designs - Spine Education Models

Thank you both for taking the time to share your current knowledge with the world.

Seneca Nzallanute

It's early to say, of course, but is it possible from historical data with other coronavirus strains to infer whether there will be neurological sequelae to Covid-19 infection?

urinfamousr79

If i as a nurse stay home esp since we don't have access to enough PPE who takes care of the patients? the reason as you say most don't stay home during the flu season is just for that reason. We know in theory its best to stay home BUT if we all actually did that, every time we had flu like symptoms the hospitals would collapse and patients would go untreated. Most hospitals have staffing issues, you get 1 call out with just adequate staff can make a manageable night into a nightmare. This is why even my hospital has said even if we get exposed we will still be expected to come to work, and will not be tested despite exposure unless we show symptoms of illness. you better believe if hospitals get inundated with patients nurses/doctors will be asked to work sick, no one staying home in a pandemic cause you have the sniffles. ..

Vivian Oosthuizen

Nonsense children get the flu or colds in general 12 times a year why not this one

s w

34:57 he doesn't sound convinced to me. Ughh..

Glen Mayne

Typical CDC “don’t panic the ignorant masses” answers. He never answered the question of how many out of 100 tests of 100 sick people will have a positive test result. The prevailing answer to that question is that the accuracy of the RT-PCR is about 70% to 75%.

msndrstdwlf BB

Only a small percentage of people have died. We need widespread accurate testing.and guidelines to use for prevention and if positive proper medical treatment if necessary. We must contain this disease the best we can. The misleading info tRump submitted can cost human lives. We are each responsible to limit our individual exposure and prevention of its spread.

Checkered Flag Films

No mention of the difference between the WHO test kit and what's being used in America?

shqarthi

As of this moment, the CDC website is showing 4'255 tests performed by the CDC and 20'907 tests performed by US public health laboratories. It seems vastly insufficient. I hope they ramp it up very quickly. Is there anything the public at large can do to help free or increase resources to help in ramping up testing capacity? As an example, Italian newspapers today were talking about a private company 3d-printing respirator valves to help a local hospital.

kyjo72682

Slowing the epidemic is not enough. Spreading the impact seems like a valid strategy at first but look at the data! If we look at the situation in Italy they have some 25k confirmed cases right now. Lets say there's 100 times more total cases (an upper estimate, it's probably way less). This is like 4% of Italian population infected after 6-7 weeks. So, if the virus can wreak such a havoc now – when there's just a tiny percentage of population infected – what will happen with a more significant percentage? In my opinion even a slow epidemic will overwhelm the health care systems very soon. The only valid strategy is to stop the epidemic before it affects a significant portion of population.

The British "herd immunity" approach will be a total disaster. I hope they reconsider it very soon. For herd immunity to work there needs to be at least 70% of the population immunized. It's just not possible to achieve that number without massive loss of life and a collapse of health care systems. IMO it's not possible with a "slow" epidemic. It definitely isn't possible with uncontroled spreading..

biospheres

You got to get over this lackadaisical attitude …. this lame duck approach was used in 1918… moving into gross negligence that will knock this country back to the Middle Ages….then again what they don’t know won’t hurt them…..

Joseph Cillo, Jr.

Please adopt the treatment approach that the South Koreans are using, including chloroquine. You may not need a fancy and expensive new drug.

NoBoostNoParty

in the USA you have not yet understood that it is the asymptomatic people who infect hundreds, perhaps thousands, of people a day. In the next days I wish you more restrictive actions. You have no idea what this virus can do. Increase testing and quarantine. Good luck.

Sean Hogan

Did you see there is a 10 minute pricktest just released – made in Northern Ireland https://www.google.co.uk/amp/s/www.irishtimes.com/business/health-pharma/randox-ships-covid-19-test-kits-to-wuhan-hospitals-1.4190697%3fmode=amp

J Stasiak

You guys are unreal. The worst global public health crisis in over a century is raging right now and you are hedging and equivocating. Clear and resolute thinking to guide bold and decisive action is needed right now, not evasions and circumlocutions. As Patton said, a good solution vigorously applied now is superior to a perfect solution applied next week.

There is absolutely no excuse for not having a fully deployed PCR test for SARS-CoV-2 by now. Dr. Butler’s remark evading the fact that the US doesn’t even have sufficient reagents to be able to run these tests is stunning. Doesn’t this country have chemical engineers anymore? Why aren’t they working 24/7 on solving this impasse? We should be running a million PCR tests per day by now. China’s Draconian measures are clearly working and bought us precious time that was squandered. If we could have deployed a PCR test 3-4 weeks ago to allow us to see where SARS-COV-2 was replicating and contained those cases, we might have been able to avoid lockdowns and authoritarianism. Now, it looks like there is no other way. The American people are not going to well tolerate lockdowns and restrictions on their freedom of movement.

The red tape needs to be cut, the bureaucratic inertia must be overcome and the equivocations and evasions must cease immediately. If you guys can’t lead, then get out of the way and get someone who, beside being knowledgeable, is bold and decisive enough to take the required action and get things done. Making speeches and writing papers doesn’t cut it.

No Name

A lot of people I know in seasonal jobs go to work no matter how sick they are. Dr.s do you remember what it is like to make 400/week working 50/hour weeks

Ava Brida

Or maybe the Elite are getting tested rn? That is why many are negative!

Kris Drazek

How many test kits are available right now in the US? Are we going to start testing the symptomatic? Diverting to flu protocol until lung symptoms that require management with no diagnostics is insufficient.

jim occi

My guess (why kids are not as susceptible) is due to their thymus (says a non MD/immunologist)

Jude Attude

The SARS 1 didn't spare children…..as your guest says the flu doesn't either and yes it is really fascinating and perhaps a clue to the vaccine…

John Brown

When can we expect an antibody test? Isn't it essential to know who has had the virus and recovered, especially if the recovered are immune and can return to normal life?

Jim Cole

Sounds vague to me. I believe with this type of testing that they can give us any #s they need to justify tanks in the street. Seek Jesus and repent

Helen Garrett

We still do not have sufficient tests. An example is the following true story unfolding now:

A trainer was sent to a call center with 100 employees on a single floor with work stations 4' apart. He trained employees in groups of te. The trainer dppeared to be sick. An employee in one group came down with a cough but no fever five days later and went on vacation. His wife came down with a cough and fever. They went to visit the rife's family who all five became sick with cough and fever. Upon the end of the vacation the worker returned to work still coughing. His supervisor advised him to cough into his elbow. Nobody got tested.

Iris Hewlett

Waited too long to get serious about regulating chemicals and reagents used by labs. F failure to implembt Clia88 amendment Act for decades under high complex proficiency testing created this mess. HCFA failed, CMS failed, college if American Pathologists failed and State Department of Public Health failed.

hawaiiopihi

Excellent video! Thank you. Wish the regular media would conduct more of these interviews.

Jeanie Rides

B S A teacher in the Bay Area was tested and the whole school has to wait 5-7 days before 2500 people with children in this number NOT KNOW WTH WHETHER OR NOT ITS SARS COV-2 CDC IDIOTS LIARS FAUCI KNEW THIS VIRUS WAS COMING IN MID JANUARY WHY DID HE NOT GET THE USA PREPARED