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Where we are today: COVID-19 Testing, Contact Tracing and the Vaccine Race

Editor’s Note: Watch the COVID-19 – Testing, Contact Tracing and the Vaccine Race panel here.

As a moderator participating in last week’s Virtual Allscripts Client Experience (ACE), I had the opportunity to speak with and hear from an incredible collection of industry thought leaders. We covered a broad array of topics together, and in the coming weeks, I’ll share my key takeaways from some of the most interesting conversations. I’ll start today by sharing what I learned from a panel on COVID-19 that discussed the timely topics of testing, contact tracing and vaccine development.

On October 6, I hosted a very impressive panel of experts who are working every day to help the country emerge from the pandemic. Dr. Marcus Plescia from the Association of State and Territorial Health Officers (ASTHO), Dr. Emily Gurley from the Johns Hopkins Bloomberg School of Public Health and Dr. Dave Swerdlow from Pfizer brought their years of experience to our conversation. They shared up-to-the-minute information with the audience and provided actionable guidance they could bring back to their care-delivery environments.

Here are a few key points that really grabbed my attention:

Dr. Plescia speaking on COVID-19 testing (4:35)

The antigen type of test delivers results quickly, which plays an important role in settings like nursing homes or schools where staff are going to be tested repeatedly and consistently. However, because antigen tests can still miss as many as 30% of cases, that repetition of testing is important to catch the patient’s illness as quickly as possible on a future date.

The gold standard test is the PCR test – while it takes longer to get results, it’s the most effective and accurate. PCR tests offer higher specificity, meaning fewer false positives and false negatives, which is why a positive antigen test is frequently followed by a PCR test to verify the results.

New tests are currently coming to market that will enable at-home COVID-19 testing.  As these tests become available on a much wider scale, it will change the entire approach of how we conduct and monitor testing overall.

“We’re really going to depend on all of you [speaking to Allscripts clients] who are involved in diagnosing and testing for COVID-19 to help us make sure we have good systems to report on COVID results,” Dr. Plescia said.

Recommended Reading: A National Decision Point (a report published by The Rockefeller Foundation)

Testing resource: TestingCommons.com (one-stop source for comprehensive information about COVID-19 tests worldwide)

Dr. Gurley speaking on contact tracing (20:09)

Two main characteristics define the impact of a contact tracing program: Completeness of information and the timing of testing and quarantine. The speed at which we find cases and act on them to isolate patients determines how effective those efforts are.

Right now, our programs in the United States are not as successful as they could be, for three main reasons:

  1. Lack of trust among the public (in the program, in the motives of those doing the tracing, in public health)
  2. Delays in testing and diagnosis
  3. People unconvinced in the need to isolate when exposed or diagnosed

Allscripts clients can play a key role in overcoming those barriers. They can build on the trust they already have with their patients to educate and set expectations, which will help normalize the process. They can also encourage people to seek testing very early when they have symptoms, and they should assertively encourage patients to isolate while they await results to be safe. (And if diagnosed, certainly to isolate immediately and thoroughly.)

“Getting in touch and being knowledgeable about your local public health response is really useful. Many public health departments have made materials available and have them translated into languages that may be useful. Pointing them to the right resources and having them available if you are seeing patients in real time is a great step to take,” Dr. Gurley said.

Recommended reading: A National Plan to Enable Comprehensive COVID-19 Case Finding and Contact Tracing in the US (published by Johns Hopkins and ASTHO)

Available contact tracing coursework.

Dr. Swerdlow speaking about Pfizer’s COVID-19 vaccine development (30:59)

The last several months have been a phenomenal, collaborative effort to address the pandemic, and companies have been testing many different approaches to vaccines – inactivated vs. weakened, protein subunit vs. virus-like particles, DNA vs. RNA.

Pfizer’s vaccine is a mRNA-based vaccine. There are benefits to this approach because you don’t need to use the organism itself, but rather its genetic sequence, which makes it a fast and safe model. When the mRNA is injected, the body recognizes it as it does the virus, as a foreign antigen, and sparks an immune response.Recognizing the urgency of the pandemic, Pfizer tested different permutations and with many populations in parallel (expected to total 45,000 volunteers), and results have shown a very successful immune response by day 28 (after two doses). Particularly noteworthy is that the volunteers who have received the vaccine have shown even more of a response than patients have demonstrated naturally after recovery from COVID-19.

Pfizer has taken unheard of steps to be transparent in the work toward this vaccine to address concerns about public trust, including sharing its blueprint for the vaccine work back in mid-September. The company is now working with numerous groups, including the WHO, the National Academies of Medicine and the ACIP at the CDC, to assess trial efficacy and safety.

Pfizer is using its manufacturing experience to produce as many doses as possible, even in an at-risk model that includes manufacturing millions of doses before FDA approval. Pfizer is selling the vaccine to the Federal government, which will determine who should get the dose (prioritization) and when. Each state, additionally, has to submit a plan by mid-October detailing how it will manage the local distribution, tracking and more.

“It’s true that we don’t know how long the natural immunity is, and we don’t know yet how long the immunity from the vaccine will be. We don’t know if you are going to need a booster dose a year or two years or three years after a vaccine. The virus is really just too new to have all the answers yet,” Dr. Swerdlow said.

Recommended reading: www.Pfizer.com/science/coronavirus/vaccine

https://www.cdc.gov/vaccines/acip/index.html

 

Editor’s Note: Watch the COVID-19 – Testing, Contact Tracing and the Vaccine Race panel here.

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