COVID-19 Update from Dr. Smith: 5/04/20

Each day during the COVID-19 crisis, Dr. Craig Smith, Chair of the Department of Surgery, sends an update to faculty and staff about pandemic response and priorities. Stay up to date with us.

Dear Colleagues,

Our colleagues at NYU Langone Health sent a blast email recently addressing FAQs about in-person appointments.  It is characteristically well done—direct, clear, and concise.  For example, they state “All NYU Langone providers and staff have been tested for COVID-19….”  Direct, clear, and concise…but “All,” as in 100.00%?  Perhaps they have proof, to which I would immediately yield, with apologies.  If not, their statement might still be defensible within the bounds of truth-in-advertising (not a high bar).  But I quibble; they are attempting to address an important concern in the minds of patients that no one should ignore.

It is hard for anyone to summarize in a single sentence how testing makes an environment Covid secure.  “Tested” is intended to imply that all providers and staff are either “negative,” or that any risk associated with positivity has been ameliorated through awareness.  Both implications could be valid and important sources of confidence to patients, but “tested” is almost meaningless without knowing which test or tests were done, and when.  A negative swab PCR is highly accurate for excluding infection on that day, but not the next day, or the days following.  Serologic testing for antibody is confounded by a wide array of testing options with highly variable accuracy.  Even using the most reliable ELISA assays, absence of antibody does not exclude active, transmissible infection.  Presence of antibody doesn’t assure immunity, and doesn’t guarantee absence of transmissible infection without a simultaneous negative swab PCR.  A suite of PCRs and serologies done at carefully designed intervals yields critical epidemiologic information, but doesn’t guarantee that someone so studied can’t transmit the coronavirus on a given day by falling through a crack in testing.  Unfortunately, testing is much more important for our body of knowledge, and for the herd, than it is for any one individual seeking protection from another individual.

How should we educate patients on testing, and what is the right message?  My oversimplified generalities in the previous paragraph illustrate how hard it is for explanation to equal the impact of eleven declarative words, as in the NYU Langone statement.  Yet testing of providers and staff is guaranteed to be a frequently asked question.  Testing definitely has a role to play in delivering the safest possible care.  Any FAQ answer must be accurate; advertising puffs may be fair play in commerce, but not in a pandemic.  Ideally, the answer should increase confidence more than it increases confusion, which is easier said than done.  What CU/NYP should do is above my pay grade.  My humble suggestion to everyone in the Department of Surgery is to enroll in the ARMOR study, if you’re eligible.  That will get you tested thoughtfully and comprehensively, and will contribute to knowledge.  If you’re not eligible, call WHS and arrange testing through them.  Under any circumstances, the second half of the NYU Langone sentence is the real money shot:  “All [providers and staff] wear masks and other appropriate protective equipment.”  To add “and wash their hands” would rest their case.

I suspect that the pressures of restarting the world, particularly the economic pressures, will lead us occasionally to forget that more has united us than divides us.  Churchill had experience.  “There is only one thing worse than fighting with allies, and that is fighting without them.”

Craig R. Smith, MD
Chair, Department of Surgery
Surgeon-in-Chief, NYP/CUIMC

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