On-Demand Testing Needed

Letter to the Editor from Dr. Ann A Kiessling:

Wilma is a social worker on a medical ward at a state hospital. The patient she helped on Thursday developed fever and sore throat on Friday and was tested for COVID19 “sometime over the week-end.” Wilma was notified of the patient’s positive COVID19 test result on Wednesday, five days after the onset of the patient’s symptoms.

Concerned that she was also infected and had infected her husband and her toddler son, Wilma immediately asked to be re-tested at Bedford Research Foundation. She had been tested a week prior because as a front-line health care worker, she was concerned about infecting her family, and was unable to be tested through her work. The first test at BRF was negative. The second test at BRF was positive.

Wilma is my daughter. I am the lab director at BRF. I watched the positive test appear on the qPCR instrument. It was more positive than the positive controls included in the test run. I called her cell phone and told her that her test was positive. “I know, Mom, I’m in bed, I’m exhausted.”

The state hospital has lost a front-line worker who may have also infected her husband and toddler because of testing delays. This is precisely the scenario that Governor Baker’s COVID 19 task force sought diligently to prevent by helping expedite private labs, like Bedford Research Foundation, to ramp up to hundreds of tests per day. That has now been accomplished, and independent labs like BRF are available for testing concerned persons, including store clerks and health care workers whose institutions don’t have sufficient capacity to test people without symptoms.

But another obstacle to COVID19 testing in the Commonwealth is an old public health law that testing by licensed laboratories can only be performed at the request of a physician. The Obama administration tried to eliminate this provision entirely, country-wide, in keeping with the Institute of Medicine recommendations of 20 years ago that persons should be able to request laboratory tests themselves. But the Commonwealth is one of a few states that has retained the provision that only physicians can order laboratory tests.

Easy access to testing is the most powerful tool available to stop the spread of SARS2. Direct access testing (DAT) can easily be passed by the Massachusetts Legislature immediately. This would be a major aid to the COVID19 pandemic.

Update April 21: Wilma and her family continue to get tested regularly and are recovering well.

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