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Dr. Dean Mitchell and Dr. Angela Rasmussen, a virologist at Columbia University, discuss the differences in COVID-19 testing and which one is best for getting people back to work and children back to school on The Smartest Doctor in the Room podcast.

Hi, I’m your host, Dr. Dean Mitchell. I want to ask my listeners, don’t you wish you could get the best medical advice anywhere and anytime for free? Well, this podcast, The Smartest Doctor in the Room, we’re striving to do just that. We are into our six months of this COVID-19 pandemic. And everyone that I meet is tired and frustrated with how it’s changed our business and our social lives. And what every scientist seems to agree is that if we had an accurate way to test for the virus and trace the public, we would be on our way to quote, as they say, crushing this virus spread and be able to return to some degree of normality. The problem that I see, and I’m going to tell you a personal story of mine at some point, that right now there’s a whole lot of confusion about testing, like what tests are appropriate, which are accurate.

So today I’m really fortunate to have Dr. Angela Rasmussen, an Associate Research Scientist from Columbia University, to help us understand how these tests are being performed and more importantly, which tests are going to be appropriate for the proper situations. And I’m talking about going back to school, getting to go back on an airplane, meeting at social gatherings, people who want to have weddings or religious services, how should they be tested?


Podcast main points & discussion.

Dr. Mitchell: 

With that, it’s my pleasure to introduce Dr. Angela Rasmussen to the podcast.

Dr. Rasmussen:

Well, thank you so much for having me here. It’s really a pleasure to talk to your listeners and hopefully, I’ll live up to the standard of your other guests and be one of the smarter doctors in the room, if not the smartest.

PCR Test vs Rapid Test for COVID-19

Dr. Mitchell: 

Okay, we’re going to get right into it, Angela. And eventually also, I want to bring in own personal story I think I shared with you, which I think highlights this whole thing. So the public is hearing a lot about rapid point of care testing for COVID, which hardly anybody seems to be able to get. I think there’s only a few instruments in all of New York. I’ve been trying to get one. I’m supposed to get one the next two weeks. And they hear about the PCR testing. I mean, even now everybody who never knew any biology knows, “I’m getting the PCR test,” which is offered by the standard labs. But they can take sometimes up to a week to get the results. So can you explain a little bit, I guess in lay terms, the differences between the two tests, so the listeners can understand?

Dr. Rasmussen:

Yeah, absolutely. So a PCR test works on the principle that the virus has genetic material, as all things do and that you can detect this using an assay that is called polymerase chain reaction, or PCR. And what PCR does is it relies on the fact that our genetic material encodes specific sequences. Those sequences can be recognized by other pieces of DNA. And if you do that, with an enzyme that replicates DNA, you can amplify up a bunch of copies of a certain piece of DNA, or in this case, RNA. There’s actually a reverse transcriptase polymerase chain reaction test, or RTPCR because the genetic material of the virus is RNA.

Dr. Mitchell: 

Yeah. I think it’s an important point to bring out, right? Because sometimes it gets very confused for patients, because they may have heard about PCR before, which has to do with DNA. But the coronavirus that we’re dealing with now, like HIV, is an RNA virus. So that’s why you mentioned it’s reverse transcriptase polymerase reaction, correct?

Dr. Rasmussen:

That’s right. And basically the difference between that and a conventional PCR assay is you have to convert that RNA into DNA before you can amplify it using the DNA primers, which are the things that recognize a specific sequence.

Dr. Mitchell: 

Is it less accurate because it’s, again, you have to do that other step? I’m just curious and I hadn’t thought about this before.

Dr. Rasmussen:

It’s not. So with RTPCR you use an enzyme called reverse transcriptase. That’s actually from HIV. So out in the normal biological world for us, we can only make RNA from DNA. We can’t make DNA from RNA. HIV and retroviruses can do this thing that nothing else on the planet can do and that’s make DNA from RNA. So you use this enzyme, reverse transcriptase. It copies the RNA template of the virus genome with fidelity, so it’s the same copy and it turns it into DNA. And then you can go ahead and run a conventional PCR test on it. But just to make sure that it is very accurate, the type of RTPCR test that’s used for diagnosis is the TaqMan platform. So not only is it using the primers that tell it which sequence to amplify, there’s another sequence in the middle that’s called a probe to confirm that you’re getting an on target result rather than just amplifying things that the primers may not be specific for if there’s any cross-reactivity.

Dr. Mitchell: 

Okay. So what I want to try to summarize a little bit, because you’re getting a little technical, because you’re obviously a virologist and super knowledgeable in this, is that essentially this PCR tasks, because we tend to think of it and this is what I want to get to in a few minutes is like the super sensitive test. It takes those little bits of the RNA of, let’s say in this case, the coronavirus and it amplifies it so that it can be detected.

So you would think, I mean, again, and this would be my thinking when I would hear this and I’m sure for lay people, they’re like, “Wow.” So this is the test. We want to know who has very tiny amounts of the coronavirus because that’s going to be the answer. Okay. So with that in mind, let’s move now to point of care tests, which we rely on something different. Maybe you could explain.

Dr. Rasmussen:

Right. So there’s a few different strategies for this that are being used to develop these point of care tests for COVID. The main thing that they all have in common is that they’re rapid and you can get the results similar to doing a rapid flu test at your doctor’s. Maybe some of them might even be able to work like a pregnancy test that you could do at home where you are taking your own sample, you’re putting it on the test yourself, and then it’s giving you a result very quickly. And so there’s several strategies. Some of them use CRISPR, there’s one in development that uses CRISPR technology, which is another way of recognizing genetic material at specific sequences. Some of them are these lateral flow assays and some of them are antigen tests, which looked for viral proteins that are associated with the virus particle rather than the genetic material of the virus.

Dr. Mitchell: 

Right. That’s what I’m hearing. I think the two popular ones, like by Abbott Labs and Quidel, they are looking at what’s called the antigen. Right? And just so for the listeners, you’ve probably seen, if you’re watching television, they’re pictures of this coronavirus and you see these things that look like little spikes, which they call corona because it looks like, I guess like a crown. And is that what these tests are measuring there? They’re measuring the level of either the spike protein or something I think called the M protein in the viruses. That’s what they’re trying to measure. Obviously, the levels to see again, if somebody has been exposed.

Dr. Rasmussen:

That’s correct. So an antigen in old school where the word came from is something that binds an antibody. And in this case, the antigen is referring to the surface proteins on the virus particle itself. And that’s the S protein, which is also known as spike, cleverly named because as you pointed out, they look like spikes on the surface of the virus particle. There’s also the M protein, which is the membrane protein and the E protein, which is the envelope protein that’s in the layer of fat that’s around the virus particle. So any of those three things will be considered antigens and that’s what those antigen tests are detecting.

Dr. Mitchell: 

Just to go on this too quickly, because again, it gets very technical, but did you feel at this point too that one might be more important than another, if somebody tests positive on a spike protein versus the M protein? Because again, maybe it was a minor protein. It’s almost like Lyme disease. That’s what I was thinking about. With Lyme disease, people have become very familiar. There’s all these different, that’s a DNA test, what’s called Western blot, where they look at different patterns on the test. Do you have any strong feelings about if a particular company is putting out an S protein, M protein, envelope protein, that’s not as good as the spike protein? Is that important for somebody to know?

Dr. Rasmussen:

I don’t think it’s really important for somebody to know. It’s very different from Lyme disease. So a Western blot is actually a protein test as well, but a Lyme disease, the bacteria that causes it has many, many more protein antigens on its surface. So there’s many more things that you could potentially detect. With this, there’s only three proteins. And for any of those proteins, probably the majority of them will be designed for spike because spike is functionally important also in the virus’s ability to infect people. But as long as the manufacturer of such a test is validating it to make sure that it’s as sensitive as it can possibly be and reliable, then I think any of the surface antigens would be a fine target.

Dr. Mitchell’s Personal Story

Dr. Mitchell: 

All right. So we’re going to get into about this whole issue about what’s called qualitative, how much there is, I’m sorry, qualitative versus yes versus no, and quantitative. But I want to first share with the listeners my own personal story. I may have told you this, but I think it highlights the confusion that’s going on. So about two weeks ago, I was in my office and I got a call from a colleague that had asked me to do COVID-19 testing on him. He’s a doctor. He was going to Europe and his mom had passed away a few weeks ago and he wanted to pay his respects, with all the horrendous confusion going on. So he came to me and going to Europe, they were very strict. They wanted a 72 hour window to know that you were negative before they would let you supposedly get on the plane.

So what I did in his case was I was going to get some good results with a saliva test that I think was being done out of Rutgers lab. So I brought him the saliva test and he did it. He spit into the tube and we sent it out and he was fine, whatever. He was just again doing this so he could go on the flight. So his flight was on a Friday. I think we did this on a Tuesday. So Wednesday comes, we don’t have any answer. Okay, I wasn’t too alarmed. I figured I’ll give them 24 hours. It would be nice looking back, but it’s okay, it didn’t. 48 hours later, we’re waiting, no answer. 72 hours later, we’re waiting, no answer. And now he’s getting ready to board on the flight and he was fine.

He’s healthy. I felt so bad. I said to him, “I cannot believe I don’t have a result for you.” And he wasn’t going to miss his flight because this was a very important thing. He says, “Oh look, I guess they’ll test me when I go over there, whatever.” So anyway, they let them go on the flight at that time. And the weekend comes, I’m back in my office on Tuesday morning, all of a sudden, my staff brings me a piece of paper with his name on it and it said COVID-19 detected. So now I’m losing sleep. Now I’m in a panic for various reasons. One, worried about my friend, my colleague, being sick. Two, I’m worried about he got on a plane with all these other people. Did he get all these other people sick? Then of course, I reflect back on myself, “Uh oh, now I’m doomed.

I had to get myself tested and who else did I infect? So It created a lot of chaos in a very short period of time. And I was trying to reach him. So I quickly got tested and we fortunately were able to get where they can do some nice positions, a very rapid and well-meaning or very rapid turnover. It was still a PCR test. It went to the lab. I fortunately came back 24 hours later, negative. So I was happy, but I still was extremely distressed about my colleague and friend. And I was trying to locate him in Europe. And it took me about two days and I got ahold of him and I was like, really in a panic. And I think, again, I’m going to have to break the news to him and et cetera. And he says to me, Dean, he goes, they tested me when I got off the plane here, they made me, they wouldn’t even let me into the country and I was negative.

So I was, huh. And I assume it was a point of care, rapid tests because they, they did it right on the spot there. They didn’t wait at all. So with all that going on and my head’s spinning, I saw your article you recorded in New York Times about this whole issue about how your PCR testing and how we’re going to get into how, it depends on the degree of cycle thresholds. So what do you make of all that? I guess the big question is, what tests should we be telling patients to get? So what’s the right test to do.

What is the Best COVID-19 Test?

Dr. Rasmussen:

So it’s going to be really dependent on the situation. And this is, this problem has come up because of two things. First of all, we don’t have enough testing. And second of all, we don’t have consistent enough testing, I guess. And third of all, so three things, third of all, we don’t have sufficient turnaround time for these tests. One of the issues with the PCR test, and it’s not really an issue, it depends on the circumstances and the context, but when you are getting a result, most of the PCR tests have been approved with an emergency use authorization from the FDA that emergency use authorization only allows for many of the tests to be either positive or negative. It doesn’t allow you to see whether your CT value is low or high, the CT value.

And this is where it’s up to scientists to do a better job of communicating these technical details, which is very challenging sometimes with the general public and with physicians.

Dr. Mitchell: 

I was petrified for everybody involved. But it’s really frightening. So that’s why the test can be a dangerous thing. Not being, I always tell patients you’re today, people can get their own labs on their phone, from their laboratory without haven’t talked to the doctor yet. And I said, you know what? It’s great to have access to that, but that’s a very dangerous thing because all of a sudden, you’ll see these abnormal is that you think you’re dying and you’re not.

Dr. Rasmussen:

That’s a huge issue. And it’s come up before with other types of tests. So for example, 23 and me, years ago, when they first came out, they were offering genetic testing for markers of disease, potentially. And people not understanding how to interpret that you have a snip that’s associated with Alzheimer’s or something doesn’t necessarily guarantee that you’re going to get Alzheimer’s. But without talking to somebody who can help you interpret that data, it can be very frightening. And certainly with the Theranos rapid testing, that was supposed to roll out testing direct to consumers, those tested and worked very well. And so people were getting very alarming test results. Some people with diabetes, for example, were getting bad blood sugar results. Some people were being diagnosed with diseases. They didn’t have other people were missing diagnoses for types of cancer that were coming back. So it can be very dangerous to get test results, just given to people, without giving them any context for what they mean.

Dr. Mitchell: 

Well, so what’s going to happen with this. They want massive testing, and I really want to get into the nitty gritty of this, that, again, all these people are getting on flights, I get this is my personal experience now, shouldn’t they be having rapid testing? It’s actually, like you said, it won’t pick up that fine small amounts, a genetic material of the virus, but that could be dead virus. So not infectious virus. So isn’t the rapid testing. If we have more availability the way to go, I mean, to get back to normality. You know what I’m saying?

Dr. Rasmussen:

So here’s the deal. And let me back up a little bit, just to explain the CT thing. So what that means is cycle threshold, and that has to do with how the PCR test works. So the PCR test amplifies that piece of DNA that it’s detecting by doing what’s called the cycle. It’s a thermal cycle where it changes temperature and over time copies, accumulate after that cycle. So there’s a fluorescent molecule that glows basically, if that passes a certain point, a certain intensity of the fluorescence that’s, what’s called the cycle threshold and what cycle the PCR is on when it passes that point is the CT value. So if you have a low CT value, that means that you hit that threshold sooner, which means that you had more RNA from the virus to start with. If you have a high CT value, that means that you had way less of the virus to start with. And so it takes longer to get to a cycle where you’re going to meet that threshold.

Dr. Mitchell: 

So people will ask, I want to make this clear. So people will say, well, it doesn’t matter. You have it, You have it whether you have a lower amount, but it does matter. And I think what you brought out, what’s been brought out in the New York times. And one of your colleagues, Dr. Mina at the Harvard School of Health said, a lot of these thresholds are set for pretty high, like 37 to 40. And he feels it should be 35. Is too, even too high. So it sounds like, and then I think was a quote or two, I mean, this blew me away. And I know you mentioned mind-blowing statistics in here.

One reports that 90% of the people tested in New York, Massachusetts, and Nevada tested positive with barely any virus. This is worse.

Dr. Rasmussen:

So, so this is where the problem comes into play. And this is where rapid testing could also help. So that the nice thing about the PCR assay is, it is exquisitely sensitive. So if you just got exposed and you know, there’s a two-week incubation period for this virus, you just got exposed. Theoretically, let’s say you get tested every day and you get a rapid turnaround time for that test. You could detect being infected very, very early, and you could be treated sooner, which I’m sure as a physician, there are many circumstances in medicine where the earlier you treat somebody for a condition, they have the better.

So, that’s one advantage of the sensitivity of the PCR tests. But a disadvantage is that it’s been shown now pretty clearly that a number of people recover completely recovered from COVID can shed viral RNA long after they are producing any infectious virus. So a very sensitive test can also be misleading if you’ve never been tested before. If you don’t know that you had COVID before you get that test back, it says positive. You don’t know what that means in terms of, have you recovered? Are you just getting sick? What’s the doodle.

Dr. Mitchell: 

This is a huge, huge problem. Like, there’s this thing of it this way? Because again, as you say, they’re not giving you, they’re giving you a qualitative, not quantitative response. So let’s just say somebody was infected with COVID in March. And they said, okay, quarantine for three weeks, let’s really be safe. We don’t want anybody getting infected and you go back and you’re tested again. And you’re positive. Oh, with this piece, you how to go, you can’t come back to work yet. Then two, three months later, four months later, you’re tested again, depending on what this cycle threshold is, they’re still positive. Don’t come back to work.

And you’re walking around like, you’re this contagious person in which you’re not, it sounds like we really need to know this cycle threshold, especially, or, like in any of the lab where we know, what is the titer, what is the quantitative issue, right? Because you mentioned somebody was in your lab and you are, whatever, and you’re in charge, right? Nobody’s coming to my virality lab that’s sick with COVID and a person tested positive. We say, okay, look quarantine for three weeks. They say, I’m feeling okay, come back. Whatever three weeks later, you test them again with the PCR, they’re still positive. Would you let him back into the lab?

Dr. Rasmussen:

Probably I would. If they had a positive COVID test before and they were symptomatic. And so that’s one reason why people have largely stopped doing this return to work testing because of that very issue. And in some cases, so, some of these tests while the patients and what’s entered into the electronic medical record is positive or negative. In some cases, depending on where it’s done, including at Columbia, the physician will actually get, at least for patients admitted to the hospital, they actually will get the CT value. A person in the CLIA lab at Columbia told me that that has been useful in terms of triaging patients and understanding where people might be at during the infection. That can be useful information. Now, granted, that is information for patients that are being hospitalized. So they’re already symptomatic.

COVID Throughout the Country & Identifying COVID Early

Dr. Rasmussen:

And right now we have transmission throughout a lot of the country that is increasing again. We have high levels of community transmission in certain places. And the way to get rid of that, to get that transmission down, is to identify people early on, as early as possible, so you can isolate them and prevent them from infecting other people. And the only way to really do that, since this virus causes such a huge range of different disease presentations, is to screen people frequently.

So the PCR tests wouldn’t be an issue in terms of its sensitivity, if people were able to get PCR tests a few times a week. Then you would know if you know you were negative and then you turned positive, like it looks like you might’ve just gotten infected. But if we’re just testing people effectively, cross-sectionally when they need to travel, when they are able to get it to return to work, things like that, we don’t have any idea what their testing history has been, so it’s very difficult to distinguish those early cases that you do want to find from those people who have recovered and are probably not contagious.

Dr. Mitchell: 

So it sounds like we really want the point of care. If that was really widely available, you would love to have it yourself, I’m sure at Columbia. I know I’d want to have it in my office. I am sure there are businesses that would say, “Hey look, wouldn’t it be great for schools?” Can you imagine if, I don’t know, Sunday night, Monday morning, they were able, within reason do a questionnaire on kids. Did you travel somewhere? Was anybody sick near you? And you can even parcel out and say, “Well look, anybody who answers yes to any of these, we’ve got to do a rapid test, to really make some normalcy again.

Dr. Rasmussen:

I think that would be great. And I think it would be even better. And so let me back up really quickly. One of the principles that Michael Mina and others have used to argue for these rapid tests is that even though they are less sensitive, which has been one of the reasons why people say, no, we should stick with the PCR test, is that maybe you don’t need to detect these very low levels of virus. So you only really need to worry about it, if somebody is going to be shedding enough virus, that it would be detected by one of these tests and those people might be able to transmit it to others.

I think the best thing possible would be to have this type of point of care testing but also have something that’s more like a pregnancy test where people could test themselves before going to work, for example. Like with a pregnancy test, if you test positive, you’re not going to be like, “Oh, well I guess I’ll just go about my day then. Chances are, if you get a pregnancy test, that’s positive, you’re going to call your doctor, is going to be the next thing to do. So you would have that test confirmed anyways, probably with a PCR test.

So I think that there really is a place, there needs to be a place for this type of testing. It’s another tool that we need in our surveillance toolkit to try to identify cases and isolate them as soon as possible because that’s really the only way we’re going to get this under control.

How Important is The Amount of Exposure to COVID-19?

Dr. Mitchell: 

You’ve helped me segue to a perfect thing that I want to talk to you about right now and even when we’re talking about the rapid test, like with pregnancy. Now with pregnancy, you’re never a little bit pregnant. You are pregnant or you’re not. But what’s interesting is with infectious disease, you sometimes can be a little sick versus a lot of sick.

And I want to ask you this really interesting question. I was thinking about a lot before we were going to do this interview today. How important is dosage? I mean, if somebody is exposed to small amounts of coronavirus, let’s just say they walked into an elevator where somebody had an active coronavirus and they got just a little bit of, I don’t know, a few hundred particles, let’s say, if even that much. Can you be exposed to something like that and obviously not get sick? I mean, how does that work with viruses?

I’m always fascinated because with HIV, again I trained in the HIV epidemic and I remember I was so petrified of getting needle sticks, whatever. I mean, if somebody had a little bit of HIV, I mean, isn’t that going to replicate and take over? I mean, does dosage matter in these viruses and the way you contract it?

Dr. Rasmussen:

Dosage matters a lot.

One thing I think that people don’t understand always. So in theory, if I took a single infectious virus particle and put it onto a plate of susceptible cells, those cells would probably get infected. There would be cell death, the virus would amplify, I’d be able to detect it. But in the real world, that’s not really what happens. And there’s a concept of minimum infectious dose that you do need to be exposed to, in order to become infected. And with this virus with SARS coronavirus 2, that has to do with both the route by which you’re infected by, as well as the dose that you are being exposed to.

So most of these infections, let’s just talk about the respiratory route, since that is probably the major route of transmission. You have to be exposed to enough virus, that it can get past all the barriers in your respiratory tract, that are designed to protect you from respiratory pathogens. So there’s mucus, there are cilia that move the mucus around. You have nose hairs, you have physical barriers to viruses getting in.

Some of that will depend on you as well. So the virus’ receptor, when it binds to get into the cell, using the spike protein, is a protein called ACE-2. People have different amounts of ACE-2 in different parts of the respiratory tract and that can vary a lot from person to person. So how much receptor is there for the virus to actually hook on to?

And then you have to get enough virus in there to be able to antagonize or evade the host immune response because when cells are exposed to viruses, they can recognize that or sense that and they begin to creating these proteins that are called interferons. And interferons put the cells around it, as well as the cell that is detected the virus into an antiviral state. They start expressing all these genes that can interfere with virus replication, which is how interferon got its name. So you have to get exposed to enough virus to sort of overcome all of these different barriers. What we don’t know for this virus is how much virus that actually is.

Dr. Mitchell: 

Okay. I want to make sure I’m understanding clearly because this is fascinating to me. So let’s say you are exposed to what did we determine as small amount of virus. Essentially your own body will take some mucus, whatever and just rid it of the body. Then as long as it’s not really forming an attack wall into your system, you can be exposed to small amounts and you will not show an immune response, you will not become infected, whatever.

Nasal Swab Test vs Saliva Testing

Dr. Mitchell: 

Now, with the testing also, let me ask you if you have any thoughts or preferences. Obviously there’s the nasal pharynx, that deep, what we call brain tickler test, which everybody really hates. Because obviously you could do a nasal swab, not a deep. And right now there’s also saliva. Do you have any preference?

We don’t want that thing multiple times a week, stuck up my nose. Do you have to go as deep? I mean, isn’t the virus even in the anterior part of the nose or the throat. What’s the differences here?

Dr. Rasmussen:

So this is one real problem. One of the nice things about the saliva test is that saliva is kind of everywhere in your oral pharynx and so some of that can get up into your nasal pharynx and of course your nasal pharynx drains into your mouth, as anybody who has had post-nasal drip knows. So certainly stuff from the nasal pharynx can get into the oral cavity and be detected within saliva. So I think that’s probably the easiest.

Certainly the nasal pharyngeal swabs go deeper and might get more of the tissues that are likely to be infected. And while that’s good in terms of sensitivity, there’s a lot of difference from one test to the next, in that situation because everybody’s nasal pharyngeal cavity is shaped a little differently. Sometimes it depends on the person who’s actually doing the test. And I’ve certainly talked to people who’ve had huge operator dependent differences in their nasal pharyngeal swab experience.

Dr. Mitchell: 

Is this true too, I’ve heard they said that people’s noses, not to get cosmetic or racial but different configurations of your nose make you more prone to getting infected or not. Is that true?

Dr. Rasmussen:

Yeah. And these aren’t really racial differences. There are differences from person to person that we all have different shapes, faces. We all have unique physical features. We have unique fingerprints. We have unique patterns of our vasculature in our retinas and we have differently shaped nasal pharyngeal, cavities and sinuses. So all of that can play a role in the consistency of nasal pharyngeal swabs and they’re not necessarily very consistent. But from just an ease of sampling standpoint, certainly nasal swabs that you could do yourself, just by basically sticking a Q-Tip into your nostril or a saliva sample, which is basically spitting into a tube, those things are certainly a lot easier than having a medical provider perform a nasal pharyngeal swab.

Dr. Mitchell: 

So at this point, would you have a problem recommending those saying, “Okay, look, you don’t have to do the nasal pharyngeal one. You could do the nasal. You can do the saliva?”

Dr. Rasmussen:

Yeah. And I mean, I think people are moving in that direction. The other issue is that with the nasal pharyngeal swab, you need somebody trained to do it. And that means that they need to be wearing full PPE because they have to get right up in your face, right up into your business and it puts them at risk to collect the sample, whereas a nasal swab or a saliva sample, you could collect yourself and so there’s not that other person. We were even having problems earlier on in the pandemic, with the actual swabs that are used to collect the nasal pharyngeal samples. They’re a special kind of Q-Tip as the president once memorably said.

And Q-tip effective way and they have to be specially made you can’t just go to the drug store and get a Q-tip. You have to use one that’s sterile and it has to be specially made and so for all these things, it’s more resource intensive, it’s more personnel intensive and time intensive to collect a nasopharyngeal swab than those other methods. And just a lot of unhappy patients, because I mean, it’s not comfortable to get an NP swab.

Closing Statements

Dr. Mitchell: 

So we’ve had a great discussion, I am going to end with one last question I want to ask you, if you are appointed, Dr. Rasmussen the Czar for New York, where the country on how we should get life back to normal, what kind of testing, if the resources weren’t a problem, what would you lay the groundwork? Because again, assuming, maybe you get questions about this from parents say, when can my kids go back to school and I can feel safe. When can we go back to our jobs and our work? What testing would you like to see in place? You know, again, if money and resources were not a barrier.

Dr. Rasmussen:

With infinite resources and infinite money after I fired probably half the people on the coronavirus task force, at least the non-scientists who are politicizing things unnecessarily, I would probably implement some type of nationwide routine testing thing and whether that was PCR tests or rapid tests, certainly rapid at home tests would be the easiest to implement. But assuming, let’s say we don’t have any of those, like assuming that I had infinite resources to do as much PCR as I ever wanted, I would suggest at minimum testing people at least once a week, and then you would be able to distinguish those low virus having people, the people with high CT values, you would be able to tell where they were at in the course of their infection, you would be able to respond appropriately. You would be able to make more educated decisions about whether they might be capable of transmitting the virus to others or not.

So I would definitely, one of the first things I would do is make sure that there was adequate testing capacity as well as adequate surveillance. And that means testing everybody asymptomatic or symptomatic exposure to a confirmed case or not. I think one of the ways that we really get out of this is by relying on the epidemiological principles we know that work. Testing, identifying cases, isolating them, quarantining their contacts, testing those contacts, breaking chains of transmission. That’s always worked in the past and that’s what we really need to do to end this pandemic for us and make it safe for everybody to return to their normal lives.

Dr. Mitchell: 

You know, it’s true. You know what people forget and I’m sure, even in my lifetime, you forget we in my lifetime I trained during the AIDS epidemic and it was frightening, it was scary. You just didn’t think we’d see our way through it. And I’d have to say more than even just the medications, which would have been amazing because as they evolve was the education and the people taking the protective measures needed. They really have made that really marginalized and it made a minimal issue.

And our country in the world has recovered from many viruses is just a question of how long, and I agree with you a hundred percent. I think you’d be a great Czar because I think that if we really listened to the epidemiologists and did everything they said, we’d be back to a much more normal life faster than the way things are heading right now. So anyway, Dr. Angela Rasmussen, I want to thank you so much for taking the time educating me and the listeners. As I said, COVID testing can seem confusing at times, and there are all these tests out there, and I don’t want anybody to go into a panic if they get a positive test, get some more information, check with your doctor, and hopefully we’re going to all get through this together.

About the Author – Dr. Dean Mitchell, M.D.

Dr. Dean Mitchell, M.D.

Dr. Dean Mitchell M.D. is a Board-Certified and Immunologist based out of NYC. He graduated from the Sackler School of Medicine and completed training at the Robert Cooke Allergy Institute in New York City. He is also a Professor of Clinical Immunology at Touro College of Osteopathic Medicine, a fellow of the American Academy of Allergy, Asthma and Immunology, and the author of Allergy and Asthma Solution: The Ultimate Program for Reversing Your Symptoms One Drop at a Time. Dr. Dean Mitchell, M.D. has also been featured in The New York Times, The Huffington Post, Fitness Magazine, Dr. Oz and News NY 1. Dr. Mitchell also hosts the podcast The Smartest Doctor in the Room – a combination of a lively, personal and in-depth interview with top healthcare specialists.

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