Latest COVID-19 articles focus on test accuracy, racial issues
Recent research offered differing estimates of the risk of false negatives in testing for SARS-CoV-2, and physicians urged action against racism and racial disparities.
Multiple recent articles looked at testing for SARS-CoV-2. One, published by Clinical Infectious Diseases on June 7, offered some information about the frequency of false negatives from reverse transcription polymerase chain reaction (RT-PCR) tests. The analysis was based on more than 23,000 tests processed by two academic health systems in California and Washington. More than 90% of the initial nasopharyngeal (NP) swab tests were negative, and most patients were not retested. However, 626 of the initially negative patients were retested within a week, and 3.5% had newly positive results. The authors noted that although the study was not designed to determine the true false-negative rate, the results “suggest that false negative NP SARS-CoV-2 RT-PCR results do occur, but potentially at a lower frequency than is currently believed.”
A perspective published by the New England Journal of Medicine on June 5 expressed concern about the possibility of false negatives, citing multiple studies to estimate that the sensitivity of available tests may be around 70%. The authors called for more information to be provided about tests' clinical sensitivity and specificity and warned that in the meantime, “clinicians should not trust unexpected negative results (i.e., assume a negative result is a ‘false negative’ in a person with typical symptoms and known exposure).”
Another study, published by CHEST on June 10, tried to identify factors that would predict a positive test result. It included more than 10,000 patients tested for SARS-CoV-2 by Cleveland Clinic, including 818 positive results in a development cohort and 290 in a validation cohort. The study found that in addition to known exposure to COVID-19, being male, African-American, or older was associated with a positive result. Positive results were less likely in those who had received a pneumococcal polysaccharide or influenza vaccine or who were taking melatonin, paroxetine, or carvedilol. The authors suggested that the results could be used to conserve testing resources when they are limited and also support further investigation of the effects of the identified drugs on COVID-19.
The latest episode of Annals on Call and recent articles in The BMJ and the Journal of the Royal Society of Medicine discuss racial disparities and the effects of COVID-19.
A perspective article published by the Journal of Hospital Medicine on June 5 described what it's like to be a black hospitalist in the midst of two pandemics—COVID-19 and racism. The author offers such advice as listen more than you talk, provide timely support, don't expect those affected to guide you through the problem, and understand the significance of inaction. “Along with the pain we all feel from the impact of COVID-19, this is the time to recognize that your African American colleagues, patients, and friends have been navigating another tenacious and far more destructive pandemic at the same time,” the article said. “Unlike COVID-19, this pandemic of racism is not ‘unprecedented.’ We have been here before. It's time we all grieve—and act—together.”
ACP issued a statement on May 29 expressing grave concern about discrimination, racism, harassment and violence, whether by police and other public authorities or by private individuals discriminating and committing violence against others because of their race or other characteristics.
Advice on protecting the mental health of all clinicians during the pandemic was offered by an Ideas and Opinions article published by Annals of Internal Medicine on June 9. It urges clinicians to look past the illness by connecting with patients and families, foster community among colleagues, promote vulnerability by acknowledging that clinicians are not superheroes, and establish boundaries and limitations, for example, by taking appropriate time off.
ACP has continued to lobby on behalf of physicians combating the pandemic, most recently advocating that insurers keep new flexibilities, including payments for telehealth and reprieve from prior authorization, in place after the public health emergency has ended.