NORTHFIELD, Ill.—The College of American Pathologists (CAP), hosted on Tuesday, Sept 1, The Rapidly Changing COVID-19 Testing Landscape: Where We Are/Where We Are Going, the first in a series of virtual media briefings. Leading pathologists offered insights and straight talk on: the latest in testing and advocacy efforts; a new survey addressing Americans’ understanding of testing; where we are with testing as schools continue to reopen and athletes may or may not return to sport. The event was also streamed on Facebook Live.
To review the full session please visit: https://bit.ly/2YWrhJa.
“We know the testing environment changes daily,” said CAP President Patrick Godbey, MD, FCAP, laboratory director, Southeastern Pathology Associates and Southeast Georgia Health System. “As pathologists on the frontlines of testing, we are able to address today’s current challenges, advancements that have been made, and how vital testing is in all areas of life. We continue to advocate for all patients and members of our profession to ensure the best and most timely care and quality of diagnostic results.”
Moderator and panelist Valerie Fitzhugh, MD, FCAP, associate professor and chair (interim), Department of Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Department of Pathology and Laboratory Medicine, Rutgers Robert Wood Johnson Medical School opened up the forum and reinforced the CAP’s commitment to testing. “Just last week, the CDC and FDA amended testing guidelines,” she said. “As pathologists we stand firm on the importance of testing and certainly being tested if people think they have been exposed to someone who has the virus.”
Advances on the Testing Landscape
Bobbi Pritt, MD, FCAP, chair of the CAP’s Microbiology Committee, professor of Laboratory Medicine and Pathology; chair of the Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota addressed the rapidly changing testing environment. “There seem to be new tests coming out every week and sometimes every day,” she said.
Dr. Pritt expanded on all COVID-19 testing including the polymerase chain reaction (PCR or molecular) test to be used when someone may be currently infected; and serology or antibody tests that determine prior exposure to the virus. “Testing has become faster and more easily performed,” said Dr. Pritt. “In particular, antigen tests are simpler to conduct and less expensive. While not as sensitive as molecular tests, they may become more widely available given the demand on testing.”
She also addressed changes in specimen collection including nasal swabs versus saliva and the role of pool testing to help save on reagents. By taking small amounts of different patient specimens, pathologists can test the pooled specimen once, and report out any negative results, thus saving on reagents.
“If results are positive, then additional testing needs to be performed to determine which of the pooled specimens are actually positive,” added Dr. Pritt. “This technique has been used in other settings such as blood donor screening, but it has not been widely used for testing respiratory specimens, and thus the process is relatively manual. It is vital for the pathologist to determine whether pooled testing is appropriate for the individual setting and patient population.” Dr. Fitzhugh added that Rutgers University has developed a saliva test that has now been used widely and with great success.
When asked about what is new and on the horizon, Dr. Pritt added that specimen collection can now be done at home, where the patient collects his or her own nasal swab or saliva specimen and mails it to a qualified laboratory for testing. “This method allows patients to collect a specimen in the comfort of their own home, without the need to go to a health care facility. We anticipate that eventually the patient will be able to perform the test at home as well, much we as now do with home pregnancy tests.”
With the flu season around the corner, Dr. Pritt concluded that “we are continuing to develop the right strategies and ensure we have the right testing quantities. There are also tests that can detect multiple viruses in one test and I think we’ll see more of that this fall.”
Private and Public Partnerships Key to Success during Pandemic
Dr. Fitzhugh asked panelists to expand on current state and community initiatives, particularly in hot spot areas such as Texas and Georgia and even her own state of New Jersey.
Emily Volk, MD, MBA, FCAP, president-elect of the College of American Pathologists, senior vice president of clinical services, University Health System and assistant professor of Pathology and Laboratory Medicine, University of Texas Health, Long School of Medicine, San Antonio discussed a COVID-19 Community Response Coalition in San Antonio bringing together public and private laboratories. “This made a big difference in helping to fight the virus and determine appropriate protocols regarding return to work, school and sport,” She and Dr. Godbey reinforced the importance of multiple laboratory platforms running at the same time and reimagining how labs can most effectively address testing demands and reagent shortages.
“Rutgers University also used multiple platforms in our academic centers,” said Dr. Fitzhugh. “Additionally, our community affiliates used one to two platforms but had to utilize send out tests to provide the best results.” Rutgers also partnered with the New Jersey Department of Health to assist in testing.
New Survey Sheds Light on Americans’ Knowledge of Testing
In August 2020, the CAP commissioned an Ipsos market research study with responses from 1,000 U.S. consumers (age 18 to 65) conducted online August 4-5 to determine their understanding, attitudes and perceptions of COVID-19 testing, the role of medical professionals and the primary sources of information they trust more. Dr. Volk provided highlights including:
- 91% believe getting test results that are easy to understand is very important.
- Nearly 2 out of 3 (65%) surveyed said they could use a better explanation of the different types of tests. Providing simple education on the advantages, disadvantages and accuracy rate for each test will help with decision making.
- 3 out of 4 (76%) people feel overloaded and find it difficult to keep up with changing information.
- 75% likely or very likely trust pathologists to provide reliable information and 85% claim to have an understanding of what pathologists do.
- Respondents trust medical professionals (57%) to provide that reliable information more than any other resource (though 73% get most of their news from the media).
- 24% have reported taken a COVID-19 test.
- The public’s understanding of tests aligns closely with their personal experiences with them: the PCR tests are most popular and understood.
- About half of those who have taken a COVID-19 test consulted with a medical professional after their results.
- Testing accuracy is important to consumers with 86 % percent of survey respondents wanting to get accurate results. Next important are results that are easy to understand (63%); results that are reported quickly (56%) and information on next steps after receiving results (54%).
- Nearly 4 in 5 American believe that a medical professional should explain COVID-19 results to each patient, a stark difference to the 50% of those tested who discussed their results with a medical professional.
Resource Guide for Parents with College-aged Children Returning to Campus and Sport
As colleges and universities continue to reopen, Dr. Volk also introduced the CAP’s new COVID Conversations resource guide for parents with college-aged children returning to campus and sport. “As a parent with a daughter in college, I have several concerns and wanted to know how students would be screened on campus, how would the school test students and how would they keep my daughter safe. The guide is designed as a conversation starter or to continue a conversation on school safety protocols including testing, physical distancing, travel, monitoring of symptoms and additional considerations.” Dr. Volk expanded on the types of questions and concerns a parent should have in addition to ensuring their own child’s insurance coverage.
Groundbreaking Advocacy and Educational Efforts
Dr. Godbey provided an overview of ongoing educational and advocacy efforts spearheaded by the CAP. His goal as president, he said, is to ensure increased supplies and reagents for testing at the local level. Highlights included:
- Results of a recent CAP survey among the directors of accredited laboratories regarding testing capabilities: while ramping up capacity 64% said they were still experiencing testing shortages and could not meet the local demand.
- The CAP’s recent letter to Congress and participation in a Health and Human Services (HHS) forum to address testing challenges and suggest protocols moving forward.
- It’s opposition to HHS laboratory penalty and unworkable data reporting requirements.
- How supply shortages and Medicare cuts may impact patient access to care and testing and affect not only the most vulnerable populations but the medical professionals who serve them—especially those hospitals in rural areas.
- Pathologists’ commitment to provide the best quality of care and to continually explore new platforms and ways to test effectively, efficiently, and safely.
The panelists further discussed testing reporting and shortages, testing in the right way and the benefit of rapid testing in particular to address mass testing needs. “These are all tools we have in our COVID-19 toolbox,” said Dr. Pritt. The panelists agreed that there are so many factors at the local level to determine what test is best to use in each respective community.
The session ended on a parental note when the group was asked about protocols at the high school level. “Know your community’s positivity rate to determine the risk of putting individuals in group settings,” said Dr. Volk. “These are tough decisions for parents to consider with regard to return to school and sport, opting for online learning, learning bubbles or collaborative efforts that allow children to socialize.” Dr. Fitzhugh suggested parents get actively involved with their local school board and ask questions to know what schools are doing to keep children safe.
“This forum will provide an opportunity for an interactive discussion on testing today, which remains so vital to Americans as we shape a new roadmap ahead,” concluded Dr. Godbey. “We look forward to continuing these conversations through future briefings and addressing topics of most concern to the health and safety of all Americans.”
About the College of American Pathologists
As the world’s largest organization of board-certified pathologists and leading provider of laboratory accreditation and proficiency testing programs, the College of American Pathologists (CAP) serves patients, pathologists, and the public by fostering and advocating excellence in the practice of pathology and laboratory medicine worldwide. As a 501(c)(6) membership organization, the CAP is the only entity representing pathologists with unrestricted advocacy capability and a political action committee, PathPAC. For more information, visit yourpathologist.org to watch pathologists at work and see the stories of the patients who trust them with their care. Read the CAP Annual Report.