For hospital patients. At my hospital it is 3 days or so. Excruciatingly long given the fact that HCQ is being reserved for confirmed cases only. Others experiences?

Just spoke to a doc in Conroe. Sent one to hospital for test on Monday with classic case.. Results came back yesterday.

We've been told to expect 3 days minimum. Taking 3-4. All this talk about having a rapid swab available soon, we haven't seen it yet.

My dad cant even get a test. He was known to be exposed to it, has all of the classic symptoms and his doctor is as certain as a doctor could be. But since he is not requiring hospitalization they will not even test him. Told him to go the ER if he has trouble breathing.

Burnet County.

Agsalaska, how are you doing? (Not trying to hi-jack the thread).

agsalaska said:

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My dad cant even get a test. He was known to be exposed to it, has all of the classic symptoms and his doctor is as certain as a doctor could be. But since he is not requiring hospitalization they will not even test him. Told him to go the ER if he has trouble breathing.

Burnet County.

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From what I'm hearing this is a pretty common story.

This can be both good and bad news:

Bad news: Test availability is egregiously behind. Blame to go around everywhere. A lot of people likely have it but aren't 100% sure.

Good news: This likely means only the "worst case" people are getting tested which means that the percentage of people with just mild symptoms are likely higher than being reported.

Also sorry to hear about your dad.

Do you know what type of test is typically used to test for COVID-19? ELISA, PCR, AGID, other? Assay type may play a role in turnaround type.

We can get one back in 3 hours if we need to. Average time right now for a routine test is about 36 hours. BUMC in Dallas.

Would need to know the specifics on the primers, product size, and PCR machine settings for the reaction, but PCR for small bp products take a few hours, 1/2 day at most. That's in the research setting. We use PCR quite a bit in our lab.

There may be different quality control steps that are required for clinical diagnostics vs. research applications: replication of runs, assay validation and QC after X number of runs, etc. that slow things down some. I'm not familiar with regulatory aspects of diagnostic PCR.

rRT-PCR

We are getting hit up POC IgM and IgG antibody claiming high sensitivity and specificity(suspect as hell). Requires lab to be high complexity and negatives to go out for confirmation. No CPT code yet.

That's my understanding

There is some information about the tests that have been given emergency use authorizations
https://www.fda.gov/medical-devices/emergency-situations-medical-devices/emergency-use-authorizations

If you drill down you get to such things as this:

https://www.fda.gov/media/135847/download

I have no expertise in this stuff.

There is some information about the CDC's assays.
I spent a little bit of time on Wikipedia trying to understand the basics
https://www.cdc.gov/coronavirus/2019-ncov/lab/rt-pcr-panel-primer-probes.html

Variations amongst the different fields in regards to terminology. We don't use rRT-PCR as it's not a clear description of a technique IMO.

We use qPCR for real-time PCR because it's actually quantitative, that's what the "q" is for. RT-PCR for reverse-transcription PCR, which is first making cDNA from an RNA sample, then performing PCR on that cDNA and running that product on a gel. It's not technically quantitative, although back in the day people would use densitometers and try to measure the intensity of the bands, but that process is prone to a lot of error.

We may get other opinions on terminology from others that are in different fields.

Through LabCorp it seems it is taking at least 5 days for the swabs to come back where I am. We were told it would only take 3 days but they that isn't happening.

Quest does have a test that they can do with a 24 hour turnaround time but it is quite expensive.

dr_boogs said:

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Do you know what type of test is typically used to test for COVID-19? ELISA, PCR, AGID, other? Assay type may play a role in turnaround type.

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RTPCR

CPL got us results in about 36 hours but I have only sent 3 swans to them

Marcus Aurelius said:

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For hospital patients. At my hospital it is 3 days or so. Excruciatingly long given the fact that HCQ is being reserved for confirmed cases only. Others experiences?

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A nurse friend of mine was tested Thursday and will have results tomorrow, Saturday.

Another friends previously healthy 27 year old daughter who is a nurse is in ICU right now awaiting results but let's face it, she has it. 3 days on her test turn around.

Catag94 said:

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Agsalaska, how are you doing? (Not trying to hi-jack the thread).

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Good man. Bored. Better than my dad. Haha.

In that situation what exactly is going to be done differently whether it's positive or negative test result?

BigOil said:

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In that situation what exactly is going to be done differently whether it's positive or negative test result?

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Not sure if your referring to my dad or the OP. But that's the thing. And that's exactly how the S&W nurse explained it when he called today.

Deal with it if you start having trouble breathing get here quickly.



By the way, how is the pup?

I live in Burnet County and there are supposedly no cases here; but i wonder how many suspected cases there may be? What region does your dad live?

Which is essentially my biggest issue with the reported cases. It's capped at the number of tests available, so it's essentially meaningless data.

There is definitely a case off of 4 between Burnet and MF.


And agree about the meaningless data. They are going to have to figure that stat out.

Question for you agsalaska. For you and your dad, how many days from exposure to first symptoms?

Pelayo said:

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rRT-PCR

We are getting hit up POC IgM and IgG antibody claiming high sensitivity and specificity(suspect as hell). Requires lab to be high complexity and negatives to go out for confirmation. No CPT code yet.

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U0001 for the PCR test.

Found this from Aetna, but applies to all payers.

U0001 - 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel should be used when specimens are sent to the CDC and CDC-approved local/state health department laboratories.
U0002 - 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC should be used when specimens are sent to commercial laboratories, e.g. Quest or LabCorp, and not to the CDC or CDC-approved local/state health department laboratories.
87635 - Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique. Use of code 87635 will help the labs to efficiently report and track testing services related to SARS-CoV-2 and will streamline the reporting and reimbursement for this test in the US.


This was released by our coders last week (BCBSLA.)

On Friday, Medicare released another COVID-19 lab code, U0002. See the attached updated 2020 2nd Quarter Code Updates.

U0002 is to be used by non-CDC labs. The only new ICD-10 CM code related to Coronavirus was reported on the first 2020 2nd Quarter Code Update, U07.1 COVID-19

Below are Medicare's guidelines for the diagnoses codes to use for healthcare encounters related to COVID-19. The ICD-10 CM codes below are established codes.

Exposure to COVID-19:
For cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation, it would appropriate to assign the codes, Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out.

For cases where there is an actual exposure to someone who is confirmed to have COVID-19, it would be appropriate to assign the code, Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.

For further information, if needed, please refer to the link below:

https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html

Catag94 said:

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Question for you agsalaska. For you and your dad, how many days from exposure to first symptoms?

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5

Excellent, thanks!

You are forgetting a critical step viral RNA isolation from the sample. This alone can take 2-3 hours depending on the method. Different labs have different methods (kits and suppliers). For a lot of the labs this is the rate limiting step and also they are in need of these isolation kits. We sent off an RNA isolation kit yesterday to try and help meet their demand.

Reverse transcriptase reaction 1 hr

qPCR 1-2 hr which includes the data analysis. Positives have to be matched to controls by determining the cycle number in which the DNA product was detected. This can also be a rate limiting step in terms of number of machines you have and their capacity. I've heard some testing centers only were equipped with a smaller machine (48 or sometimes even 16 well!) and a number of those wells must be used for controls.

So in total

RNA Isolation: 2 hr
RT Reaction: 1 hr
qPCR of cDNA products: 1-2 hr
Data Analysis: ? Another 1 hr

So there is no way to get the speed under half a day with these current tests. The process may be sped up with you had a robot to complete all the process at once, but I have not heard of many so people are completing all steps by hand, and they need more people. We are getting ready with a list of people who have experience and can run these protocols here to help out.

You also have to remember there is a backlog of tests that need to be processed. While it may only take half a day, there are a number of tests that may need be run in front of yours and that backlog is only growing. It's not just about "number of tests" that is in the news, but number of people and labs that can currently complete them.

I saw Cephid just received approval for their test. It is interesting as they use a point of care instrument with a quoted 45 minute test time. I believe sample prep is minimal. The limitation would be how many samples can be ran at a time. They quote 23k instrument placements so a nice capacity bump.

On call this weekend. Have 30 pts awaiting test!!!! Taking up to a week.