COVID-19 testing for providers: Leading by example

To the Editor:

This may sound like a broken record, but hospitals around the country are short-staffed and healthcare workers are paying the price [1]. An emergency medicine physician colleague at another institution recently confided that she felt terrible because she had to call in backup for a number of days while her COVID test was pending. Another had mild cold symptoms but needed a negative COVID test before working. When he called the hospital employee health COVID line, he was told to get testing in the community, which also took days. No rapid testing was available for employees and turn-around time was at least 48 h. If some healthcare workers are still having trouble achieving fast, accurate tests months into this pandemic, it means we are even further behind in the community. Indeed, Anthony Fauci recently said in an interview we need to “flood the system with tests” [2]. Healthcare institutions in the United States should be leading by example for their own employees. While we have made great progress in the United States, it begs the question, why has the United States lagged so far behind in testing strategies and capacity?

As the pandemic wears on, vaccine approval and increased access to accurate rapid testing offers a glimpse of hope, while simultaneously reminding us that our national response seems patchwork compared to other nations. To appropriately respond to the influx of COVID patients, access to testing for providers is critical this winter. Hospitals will likely continue to require negative COVID tests for symptomatic workers given incomplete vaccination rates, evolving understanding of vaccine efficacy, and COVID mutations that have been detected. Efficient testing has been and remains a critical issue for this pandemic and future outbreaks, and there is much to learn from the approach of other nations.

While testing capacity is often raised as an issue, testing turnaround time is an equally critical issue. Other countries have proven it can be done. In South Korea, rapid test turnaround for healthcare workers was thought to have been an important component to their low COVID infection rate despite a large outbreak in Daegu [3]. Switzerland and the Netherlands have also prioritized rapid testing of healthcare workers as part of their COVID strategy [4]. Although rapid antigen tests have a higher false negative rate compared to RT-PCR tests, it is still thought to be a good option during the symptomatic period of infection, making it a good option for symptomatic healthcare providers [5]. Increased access to quicker turnaround RT-PCR tests is another viable option.

In smaller communities, such as workers in a hospital, batched testing has been offered as a possible solution. Instead of each sample being tested separately, samples are batched together and only tested separately if there is a positive sample in the larger group. Batched testing only makes sense with low disease prevalence and has been used to some degree of success China, Germany, Israel and others. This method saves resources and allows for large numbers of tests to result faster. It may not be the holy grail for controlling community spread in higher prevalence areas, but may be useful for surveillance or symptomatic testing in hospital or nursing home workers [6]. Novel rapid tests such as saliva testing make this approach even more plausible [7]. While this has been suggested for months, its implementation has lagged.

We know testing works. On a larger scale, countries such as Germany and the United Kingdom have recently pivoted to distributing large amounts of rapid tests among segments of its population to better control COVID outbreaks. China, South Korea, Singapore and others successfully employed this strategy earlier in the pandemic.

It is old news that healthcare workers are at high risk for contracting COVID-19, with the CDC reporting over 100,000 healthcare workers infected between February and July 2020 alone [8]. COVID vaccination efforts offer us hope, but as we enter the winter viral season with COVID cases surging to record numbers in the United States, fast test results remain an imperative component to our ability to mitigate COVID. This is especially true for healthcare workers experiencing infectious symptoms who need to be tested for COVID-19 before returning to work. Continued improvement of testing capacity is key to fighting COVID and will help us in future outbreaks – both among healthcare workers and in our community at large.

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