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COVID-19 Testing and Risk Stratification

Renslow Sherer, MD
Program Director

Director, International HIV Training Center
Professor of Medicine
Section of Infectious Diseases and Global Health
Department of Medicine
University of Chicago
Chicago, Illinois

Renslow Sherer, MD: unrestricted research grant: Gilead Sciences.

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Rasika Karnik, MS, MD

Assistant Professor
Division of Primary Care
Department of Internal Medicine
University of Chicago
Medical Director
Post-COVID Recovery Clinic
Chicago, Illinois

Rasika Karnik, MS, MD: consultant/advisor/speaker: Gilead Sciences.

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Released: December 20, 2022

Key Takeaways

  • Equitable access to SARS-CoV-2 testing is imperative to mitigate disease spread and to ensure adequate access to treatment.
  • COVID-19 treatment guidelines developed by the National Institutes of Health and the WHO are essential to patient care.

How do we ensure equitable access to SARS-CoV-2 testing?
Because people of all ages have been affected by the COVID-19 pandemic, every member of the population should have unencumbered access to SARS-CoV-2 testing. Testing is essential to reduce the spread of disease within a community and to reduce the risk of more severe disease and death among at-risk individuals.

A positive test is also necessary to determine eligibility for antiviral and monoclonal antibody treatments. In light of the recent surge of influenza and other upper respiratory viruses, correctly identifying treatable pathogens is crucial for directing care. Recent data suggest that antiviral treatment may reduce the risk of long COVID by approximately 25%. If we fail to aggressively promote and enable easy access to SARS-CoV-2 testing, we are sending the wrong public health messages, incorrectly implying that SARS-CoV-2 infection in any individual is inconsequential and that COVID-19 is no longer potentially serious or fatal in populations such as older adults, people with immunocompromise, pregnant people, and people with certain comorbidities. 

To create an infrastructure where both rapid antigen tests and polymerase chain reaction tests for SARS-CoV-2 are readily accessible, it is imperative to develop new venues for testing. Healthcare facilities offer COVID-19 testing as a screening or diagnostic tool, and free, regulated testing sites should continue to operate at hours that can accommodate various schedules, including evening and weekend hours. At-home rapid antigen tests are important for those with transportation barriers (eg, people with disabilities, residents in rural areas). Insurance companies should cover or subsidize the cost of at-home rapid antigen tests. Expanded testing opportunities at pharmacies, public schools, public libraries, and community clinics will further expand easy access to testing. [

Public health efforts to communicate the importance of testing need to be sensitive to variations in community literacy levels and language barriers. Engaging with local community organizations to create solutions that work best for their members is key. Providing up-to-date information—and in simple language with translation into multiple languages—also will promote testing. It is our shared responsibility to further expand the message of the value of ongoing SARS-CoV-2 testing of people with COVID-19 symptoms and with direct exposure to known infected individuals.

How do we approach patient-specific risk stratification for treatment?
There is growing public awareness of the groups at higher risk for severe COVID-19 and death, even among vaccinated individuals. This list is led by people older than 65 years of age, people with certain comorbidities (eg, diabetes, heart disease, cancer, advanced or untreated HIV), and pregnant people, as well as the approximately 3% of the US population with an immunocompromising condition.

We should build further on this knowledge by emphasizing that prompt treatment of COVID-19 can reduce the risk of hospitalization or death by up to 89%, with the largest benefit seen in unvaccinated patients.

The National Institutes of Health COVID-19 treatment guidelines identify which patients should be offered treatment, and they offer explicit guidance on the subtle distinctions among treatment options. The WHO’s Therapeutics and COVID-19: Living Guideline is another tool that advises on different therapeutic options for both outpatient and inpatient persons with COVID-19. Both resources offer current information and are updated regularly. 

To better advise which treatment a patient should receive when there are multiple options, healthcare professionals must weigh the treatment benefit vs the risks of drug interactions, tolerability, and feasibility of administration to facilitate the best shared decision-making situation. 

Your Thoughts?
How do you ensure that your patients receive access to SARS-CoV-2 testing when they are exposed to someone with or develop symptoms consistent with COVID-19? Join the conversation by leaving a comment below. 

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