June 22, 2020
Coronavirus Testing and You
- The things to be most aware of are proximity to others, and surfaces that could easily be contaminated by droplets.
- There are ten steps in the section on hand washing.
- There will be a test.
I stumbled across a nifty little class in which one can learn how to administer tests for COVID-19. It is free, quick, and easy to follow. There is no certification given, the stated purpose is for those who may need to help with testing under the supervision of qualified medical personnel.
We begin with a disclaimer: the gist of which is this is no substitute for medical knowledge and supervision by a medical professional. The purpose of the course is to potentially provide extra hands for testing, rather than additional minds for diagnosis. The course is given and was developed by Dr. Jaimie Nguyen whose credentials are numerous as are her accomplishments.
The class is accessible and brief, so we’ll just hit the high points, starting with the learning objectives:
- Understanding symptoms and how the coronavirus spreads
- Know standard precautions for preventing transmission
- The how, why, and when of testing
- Handling, transport, etc. of test kits
There was information on how the virus spreads, most of which I want to believe is common knowledge by now. The things to be most aware of are proximity to others, and surfaces that could easily be contaminated by droplets. Sharing phones, for example, would clearly be a risky choice. In spite of the concerns regarding pre-symptomatic spread, testing is recommended only for those who are symptomatic, especially if they are in a high-risk category. We learn that most cases inflict only mild to moderate symptoms. While this is good news for those infected, unfortunately it also provided an excuse for some not to take precautions seriously.
For obvious reasons, the hygiene protocols are as important as the test administration itself. Hands are to be washed between each patient, before donning PPE, and after removing PPE. All PPE should be disposable, with the possible exception of face shields (these are worn in addition to masks.) Reusable face shields are available, and if these are used, they need to be thoroughly sanitized between each patient. Basically, it is to be expected that preparation and cleanup between patients will be far more time consuming for the administrator than procuring samples.
It is recommended that jewelry be removed before hand washing. And it was thrilling to know that an expert recommends using a paper towel to turn the faucet on and off if it is not automatic. Validation is a heady thing. There are ten steps in the section on hand washing. Does it take you ten steps to wash your hands? Ask yourself why not.
What to wear: A mask snugged over the bridge of your nose. A gown that will be tied behind the neck and around the waist. Gloves that cover the cuffs of the gown. A face shield if available.
As for the testing itself, as we know, there are tests available from multiple manufactures. Therefore, rule number one is read the instructions. Rule number two is, follow them exactly. It is explained that improper specimen collection can render a test inaccurate. While this is common knowledge among health care workers, the possibility of laypeople being called on to assist with administration does seem likely.
Test kits may differ between manufacturers, but the basic components are swabs (nasal and/or oral) and transport tubes (for tests that will be sent into a lab, which is the focus of this class.) The laboratory tests are more accurate than the rapid result tests, but of course will not be what is needed if we move forward with point of sale testing. We learn that it is important to explain to the patient what is happening; this makes sense in light of the fact that the swab will be going in all the way to the throat, which seems especially alarming if the nasal route is being taken.
Label, label, label.
There’s no point in performing good sampling if diligent track isn’t kept of which sample came from which person.
We are walked through a diagram and instructed on how to perform the swabbing. Because of the somewhat technical nature, we will just say for now that the test administrator must be prepared to stick something up someone’s else’s nose for at least 5 seconds. Observing the oropharyngeal swab, I could not help but consider consequences of triggering a stranger’s gag reflex. Although not specifically mentioned, it is impossible not to draw the conclusion that avoiding that would be in everybody’s best interests.
There is a section on storage and transport. This goes into temperatures, how soon the specimens must be shipped, and reiterates the need for proper labeling.
When ready to remove PPE (and again, this is after each patient) remember that the basic trick is not to touch the exposed part of things while you take them off. Gowns and gloves come off inside out. The mask should be removed by the ties. It shouldn’t be touched with bare hands and the outside should definitely not be allowed to touch your face. Face shields must be cleaned if reusable. Sanitize the testing area. Wash your hands. Yes, again.
For those who are interested, the class is accessible here.
There will be a quiz. I passed. Ok, I got an A.