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COVID-19 Supporting Your Practice

COVID-19: How Important is Point-of-Care Testing?

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One of the key weapons in the fight against any pandemic is effective testing. Knowing who is or has been infected by COVID-19 is vital information that allows us to track the spread of the virus and adjust public healthcare measures accordingly. With the recent release of the first point-of-care test products into the market, healthcare providers, including dental practitioners, are wondering when these tests will be available and at what cost.

Dr. Aaron Burry, Public Dental Health Specialist and Associate Director Professional Affairs CDA, explains to Chiraz Guessaier of CDA why there is such an interest in point-of-care testing and how it differs from laboratory testing.

He talks about the costs and what the Canadian provinces are currently doing about the provision of point of care testing.

Will point of care testing be available in Canada any time soon? And is there a place for it in the dental office?

We hope you you find the conversation helpful. We welcome your thoughts, questions and/or suggestions about this post and other topics. Leave a comment in the box below or send us your feedback by email.

Until next time!
Chiraz Guessaier, CDA Oasis Manager

Full Conversation (7.51")

23 Comments

  1. Terry Farquhar April 15, 2020

    Has there been any discussion regarding sensitivity and specificity of these point of care tests versus laboratory tests? What is the predictive value of these tests?

    Reply
    1. CDA Oasis April 15, 2020

      Hello Terry,
      Thank you for reaching out and leaving your comment. I have sent it to Dr. Burry and I will get back to you as soon as I have a response.
      Chiraz
      CDA Oasis.

  2. Douglas Hamilton April 15, 2020

    I spoke to the manufacturer, Spartan Bioscience. They indicate 95% sensitivity and specificity. The cost is too high for us at this time, but at a lower range of cost, this could be useful in the late pandemic cycle. If we can do point of care testing, we can determine the safe patients and go ahead with treatment.

    This could be a service paid for by Government and provided by dental offices. It is clear that broad based community testing combined with contact tracing, is necessary to get society back to work. Dentists could provide the skilled labor force to engage this testing in their offices and report to Government. Once a patient is verified virus free, we could do our dentistry. So, we open the office, put our people back to work, treat our patients and at the same time provide broad based community testing.

    We know our patient base and can even do some early contact tracing, for the patients shown to be covid-19 positive. We would get our workers off salary support, so the program would cost very little, by virtue of the savings in salaries. We currently are an un-utilized skilled labor force. We can contribute.

    Perhaps this idea can be brought to Government. Dentists can get the economy open for business by doing the testing. We are a ready and available work force.

    Reply
    1. Eugenie MacKay April 16, 2020

      Well said.
      Without point of care testing I do not see how we can return to work to provide routine and elective dental care safely. I think you highlighted an extremely important point which is that subsidizing point of care testing in dental offices would be significantly lower than what we are paying people to stay home.
      I think that difficult times tend to lead to innovation and I hope we will see many more point of care testing devices become available quickly so that we can return to some sense of normalcy.

      1. Douglas Hamilton April 16, 2020

        Indeed, the Canadian Government has just signed an agreement with Spartan Bioscience, to deploy their new RNA testing technology here in Canada. They are buying thousands of units and test kits. So, why cannot they go to Dental offices?

        This system is 95% in specificity and sensitivity. It gives results in 30-60 minutes, and soon to deliver in just 30 minutes. The Abbot Laboratory test machine called ID Now gives a 15 minute result, with the same accuracy. So we can deploy this technology.

    2. Zak April 20, 2020

      In my office 9 people are working all together every day for 5 days a week( before the pandemics). So, based on your suggestion, all of us should get tested everyday first in the morning before our day starts ( and all the patients) since social distancing is not possible Inside the office and we have to make sure everyday non of us is infected . How is that possible? Testing all the staff and doctors everyday?

  3. Ali Farahani April 15, 2020

    Thank you for interview. I listened to it twice and still don’t understand the difference between point of care and lab testing as both were mentioned in this video to test for virus.
    There has to be an obvious difference between the tests and that difference (not including cost) is not clear to me. Why should we be interested in POC testing vs lab?

    Reply
    1. Douglas Hamilton April 15, 2020

      Point of care tests would be done in your office with quick results. In some cases within an hour, 30 minutes and some claim 15 minute results. The degree of specificity and sensitivity would allow you to work confidently on a patient identified as Covid-19 free. Currently, the cost is relatively high, at about $100 per test, plus the cost of the test unit, which could be 5-7 thousand per unit.

      Lab tests are much less expensive and take a while, hours in the lab, so results could take days to receive. An in-office test would enable you to work, but not a lab test, as there is a lag time in which the patient may become infected.

  4. Ban El Bahrani April 15, 2020

    The point of care test would be a great asset to a dental clinic. I was thinking about this also and honestly I would not be safe without knowing the result. I think each patient should be tested before commencing treatment A lot of offices have open concept style and this would further minimize virus spread until a vaccine is found

    Reply
  5. Anonymous April 15, 2020

    Yes, this is the only way for us to start up before we have mass vaccinations. I just don’t believe we should wait 18 months with no dental treatments. In addition to swab point of care tests, we should also do serological test for antibodies, to show immunity for Covid19. The Government needs testing for both. That test gives results in 10 minutes and is low cost.

    We need to do both tests for each patient.

    Reply
  6. Olga Rodrigues April 15, 2020

    So, a patient presenting for a COE and requiring 7 restorative appointments will require 8 tests since there is no guarantee the pt will not get infected while in between appointments. Is that realistic?

    Reply
  7. Chris Bryant April 16, 2020

    I believe that it is important that clinicians see/understand the algorithm of how point of care tests and lab tests differ in their assignment of test outcomes and resulting patient status.This is especially important given the outcomes of false negatives and issues surrounding what “positive” means re: patient infectivity likelihood (active positive vs resolved infection).
    Clearly testing ability has huge benefits in a large (but shrinking over time) population of “negative” patients; it will be critical that we manage those testing “positive” wisely and ethically.

    Reply
    1. Douglas Hamilton April 16, 2020

      It is widely accepted that broad based community testing is required to locate new clusters of disease, and that early contact tracing is necessary. There currently is no infrastructure to accomplish this. Dental offices are an existing network of highly skilled workers, who are broadly dispersed and have intimate community relationships and knowledge. We are organized and are used to learning.

      In effect, we are the natural ready untapped labor force, capable of providing the testing infrastructure for the nation. We can test healthy populations and identify those needing quarantine. The country needs our contribution. We can do point-of-care testing for about half the population. This can be done quickly at very low cost, if we can treat those confirmed to be disease free. We can get back to work while providing the diagnostic testing services the government needs.

      As time goes on, the need for testing will diminish and finally end. Worry about this later. Right now we need testing, a lot of it. We are trained, organized available, competent, knowledgeable in PPE and sterile technique, are located broadly across the country. We have all the personal contacts and phone infrastructure.

      It is true that any patient treated will need to be tested and retested, so just organize as much treatment as you can in a single visit. In any case, we need not get to full treatment now. There is always a hierarchy of need, put off the full mouth rehab for better times. Just do simpler and more necessary treatments and preventive care for now.

      The cash flow will keep our businesses a float and provide a low-cost source of testing for public health planning and disease control. We can get our teams off of EI and thus save money for Government, if we can get back to billable procedures. The net cost to Government is therefore, very low.

      I hope Trudeau is listening. Perhaps the CDA can introduce this idea.

  8. Vasant Ramlaggan April 16, 2020

    Thanks for the great information on Spartan’s test! There has been similar talk in some study groups about it and the usefulness in dentistry. It seems to be too expensive currently for the dental community. Hopefully costs will go down with more test production.

    Reply
    1. Douglas Hamilton April 17, 2020

      Costs have to go down. I suggest the Government pay for the test units and test kits. With this subsidy, we could collect the data.

  9. Olga Rodrigues April 16, 2020

    Thank you for answering my concern, Mr. Hamilton. Do you think that, in case of approved point of care testing, dentists and all staff will need to test themselves daily, before starting the day? Also, there should be a universal consent form for patients/staff undergoing testing so they are aware where positive results will be submitted (e.g., public health, or MD). It would be nice if all provincial regulatory bodies would create such consent forms for us so we don’t have to worry about that part.

    Reply
    1. Douglas Hamilton April 17, 2020

      I am a dentist, just like you and we want our team, as well as patients to be safe. So, yes, I agree, we need to test team twice a week and every patient as they enter the office. As we learn about what immunity means, a positive antibody test may be enough to indicate no further testing is needed. For now, everyone gets tested regularly.

      As far as regulatory bodies go, yes, we need to set national and provincial guidelines for patient interactions, reporting, wavers, contact tracing protocols etc. All this has to come from Government.

      I am trying to communicate that a solution for widespread community testing needs, found in our labor pool. It is likely best done by dental offices, due to our expertise, patient contacts, communication infrastructure, availability and the low cost of roll out. Of course it also serves our professional and patients best interest, as it allows us to get back to work soon, with safety, while providing an essential public service of mass population testing.

    2. Olga Rodrigues April 17, 2020

      Indeed, it sounds like point of care testing is a win-win proposition for both the Government, patients and us. Between a future vaccine, special PPEs and point of care testing, the latter presents as the most reliable and safest option, and is also based on mutual respect.

      1. Douglas Hamilton April 18, 2020

        Keep your ear to the rail. This idea has legs and is now with the ADA and CDA.

  10. Jane Wrinch April 29, 2020

    Hello,
    What about the POC antibody tests sold by Abnova and Biosciences? There are other companies that sell these tests. Results in less than 15 minutes. Does anyone know the rate of false results with these tests? They are much more affordable ($10-20/test) than the tests discussed by Dr. Burry. Any comments would be most appreciated here.

    Reply
    1. Douglas Hamilton April 30, 2020

      Dentists could track both the presence of active virus and test for antigens, indicating pasts infection. This would also be reported to the authorities. The problem is that there were so many anatigen tests approved in the US with out verification. Many of them give false positives (50%), thus making them useless. We also still don’t know the meaning of a valid test showing a positive result, other than indicating experience with previous disease. The presence of previous infection and antibodies, has not been proven to confer immunity. The antigen tests have to first, be approved for use in Canada, where we are currently testing the validity of the test. We can then get access to test kits through the Government.

      Some of these tests give a positive result with non-SARS-COV 2 virus, thus false positive, also, a postive antigen test does not mean the patient is clear of virus. They could still be infectious, so you need to test for both antibodies and do a molecular RNA test for the presence of the active virus.

      It is the wild wild west out there. Anyone and his mother is selling product with no contols. We know about a lot of counterfeit n95 masks, so, I would be suspicious with suppliers, unless it is Government approved. As for actual testing, we still have to get regulatory approval to conduct them. Again, we come back to working with Government on this issue.

  11. CDA Oasis April 30, 2020

    Great conversation going on here 🙂 I would like to bring it to your attention that there are currently (as of April 30th, 2020) no approved point-of-care COVID-19 test kits. They are all authorized (vs. approved) by the FDA. Please visit our in-depth expert conversation on point-of-care tests through this link: http://oasisdiscussions.ca/2020/04/28/an-in-depth-look-at-covid-19-point-of-care-testing/

    Thank you again for leaving your insightful comments.
    Take care and stay safe!
    Chiraz, CDA Oasis

    Reply
    1. Douglas Hamilton May 1, 2020

      I understand that recent evidence does not support the accuracy of some of the tests for Covid 19, thus false negative results could poses a risk. It is wise to hold off on approval until testing confirms the adequacy of these testing modalities. The reliability of these tests should improve with time. The concept of POC testing has to remain in the range of measures applied to this problem, as technology catches up to Covid 19. If successful tests are possible, we all could use a machine in our office.

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