COVID Testing

Rapid COVID Testing Update



Although I do have the Abbott ID NOW machine for rapid (15 minute) COVID-19 testing, the company is currently not able to supply us with test kits due to supply line issues associated with skyrocketing nationwide demand. They are ramping up production, and we hope to get more test kits soon. I can still do the standard PCR testing, with lab results in 24-48 hours in most cases.

If you want to be alerted as soon as the rapid tests are available, follow me on Instagram (@snotdoctor) for further updates, as well as other pediatric ENT topics!

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There are basically three types of COVID tests: antigen tests, antibody tests and molecular tests. Antibody tests shows evidence of past infection, but they are not recommended for clinical practice - they are mainly used for research and were used for screening recovered patients who were donating plasma. Antigen tests look for proteins on the surface of the virus. They are not considered reliable enough for preoperative screening, since they have a high rate of false negative results, and may miss contagious patients. Molecular tests look for RNA, the chemical that lets the virus reproduce - they include PCR tests that are sent to an outside lab (with results in 24-48 hours) and rapid molecular tests, that provide results in 15-30 minutes.

In my office, I offer PCR and rapid molecular testing. If you or your child is not sick but is getting tested for surveillance reasons (e.g. for travel or for surgery), it is important to confirm which test is needed. Some places (for example, the operating room at Mt. Sinai) will only accept the PCR test.
The rapid molecular testing unit in my office is the Abbott ID NOW machine, which is gives results in about 15 minutes. While no test is 100% accurate, this unit has been shown to be 95% sensitive during the first week of infection. It was accepted by New York State for testing out of quarantine, and it is acceptable to the Manhattan Surgery Center (where I do most of my operations) for preoperative clearance. Here is more detailed recent information about the test's accuracy.
All tests are dependent on the amount of virus being shed, and even the most sensitive lab tests can theoretically miss contagious patients either very early on in the infection or in early recovery. There are going to be clinical situations where a positive or negative rapid point of care test (like the ID NOW) needs to be followed up with a lab test, but that will be rare in my practice.

So what does this mean for testing, and when should you get this test in my office? Almost all of my surgical patients can be cleared with the ID Now, and there will be no issue of the results not being ready in time for surgery. I will do this as a routine part of my preoperative visit. These patients will come into the office with the same standard COVID-era precautions (masks, hand hygiene, etc..) used for my regular in-person consultations.

Patients who are symptomatic and may have COVID, and patients who are under quarantine due to travel or exposure to an infected contact need to be treated differently, to minimize the risk to my staff and other patients in the office. These protocols apply to both the standard PCR lab tests and the rapid ID NOW test. All patients coming in for this type of testing must register for an appointment ahead of time. Registration forms, payments and the scheduling of followup visits must all be done remotely by email or through my website. I am happy to spend as much time as necessary discussing things, but this discussion will be by telemedicine (e.g. FaceTime, Skype or telephone). The actual testing will be done outside of the office, either in a car or by the back entrance. You will be given specific directions and I will meet you as soon as possible to minimize your wait outside.
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There are basically three types of COVID tests: antigen tests, antibody tests and molecular tests. Antibody tests shows evidence of past infection, but they are not recommended for clinical practice - they are mainly used for research and were used for screening recovered patients who were donating plasma. Antigen tests look for proteins on the surface of the virus. They are not considered reliable enough for preoperative screening, since they have a high rate of false negative results, and may miss contagious patients. Molecular tests look for RNA, the chemical that lets the virus reproduce - they include PCR tests that are sent to an outside lab (with results in 24-48 hours) and rapid molecular tests, that provide results in 15-30 minutes.

In my office, I offer PCR and rapid molecular testing. If you or your child is not sick but is getting tested for surveillance reasons (e.g. for travel or for surgery), it is important to confirm which test is needed. Some places (for example, the operating room at Mt. Sinai) will only accept the PCR test.
The rapid molecular testing unit in my office is the Abbott ID NOW machine, which is gives results in about 15 minutes. While no test is 100% accurate, this unit has been shown to be 95% sensitive during the first week of infection. It was accepted by New York State for testing out of quarantine, and it is acceptable to the Manhattan Surgery Center (where I do most of my operations) for preoperative clearance. Here is more detailed recent information about the test's accuracy.
All tests are dependent on the amount of virus being shed, and even the most sensitive lab tests can theoretically miss contagious patients either very early on in the infection or in early recovery. There are going to be clinical situations where a positive or negative rapid point of care test (like the ID NOW) needs to be followed up with a lab test, but that will be rare in my practice.

So what does this mean for testing, and when should you get this test in my office? Almost all of my surgical patients can be cleared with the ID Now, and there will be no issue of the results not being ready in time for surgery. I will do this as a routine part of my preoperative visit. These patients will come into the office with the same standard COVID-era precautions (masks, hand hygiene, etc..) used for my regular in-person consultations.

Patients who are symptomatic and may have COVID, and patients who are under quarantine due to travel or exposure to an infected contact need to be treated differently, to minimize the risk to my staff and other patients in the office. These protocols apply to both the standard PCR lab tests and the rapid ID NOW test. All patients coming in for this type of testing must register for an appointment ahead of time. Registration forms, payments and the scheduling of followup visits must all be done remotely by email or through my website. I am happy to spend as much time as necessary discussing things, but this discussion will be by telemedicine (e.g. FaceTime, Skype or telephone). The actual testing will be done outside of the office, either in a car or by the back entrance. You will be given specific directions and I will meet you as soon as possible to minimize your wait outside.