tag:theconversation.com,2011:/us/topics/medical-test-61337/articlesMedical test – The Conversation2024-02-05T13:30:15Ztag:theconversation.com,2011:article/2163412024-02-05T13:30:15Z2024-02-05T13:30:15ZWhat do your blood test results mean? A toxicologist explains the basics of how to interpret them<figure><img src="https://images.theconversation.com/files/570974/original/file-20240123-19-h34bd4.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2120%2C1414&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">From CBC to CMP and beyond, blood test panels provide essential information to health practitioners.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/workplace-of-laboratory-with-blood-tubes-samples-royalty-free-image/1389684965">angelp/iStock via Getty Images Plus</a></span></figcaption></figure><p>Your blood <a href="https://www.ncbi.nlm.nih.gov/books/NBK279392/">serves numerous roles</a> to maintain your health. To carry out these functions, blood contains a multitude of components, including red blood cells that transport oxygen, nutrients and hormones; white blood cells that remove waste products and support the immune system; plasma that regulates temperature; and platelets that help with clotting.</p>
<p>Within the blood are also numerous molecules formed as byproducts of normal biochemical functions. When these molecules indicate how your cells are responding to disease, injury or stress, scientists often refer to them as <a href="https://doi.org/10.1097/COH.0b013e32833ed177">biological markers, or biomarkers</a>. Thus, biomarkers in a blood sample can represent a snapshot of the current biochemical state of your body, and analyzing them can provide information about various aspects of your health.</p>
<p><a href="https://www.researchgate.net/profile/Brad-Reisfeld">As a toxicologist</a>, I study the effects of drugs and environmental contaminants on human health. As part of my work, I rely on various health-related biomarkers, many of which are measured using conventional blood tests.</p>
<p>Understanding what <a href="https://www.nhlbi.nih.gov/health/blood-tests">common blood tests</a> are intended to measure can help you better interpret the results. If you have results from a recent blood test handy, please follow along.</p>
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<figcaption><span class="caption">Blood samples go through several processing steps after they’re drawn.</span></figcaption>
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<h2>Normal blood test ranges</h2>
<p><a href="https://theconversation.com/how-do-blood-tests-work-medical-laboratory-scientists-explain-the-pathway-from-blood-draw-to-diagnosis-and-treatment-196874">Depending on the lab</a> that analyzed your sample, the results from your blood test may be broken down into individual tests or collections of <a href="https://www.testing.com/tests/chemistry-panels/">related tests called panels</a>. Results from these panels can allow a health care professional to recommend preventive care, detect potential diseases and monitor ongoing health conditions.</p>
<p>For each of the tests listed in your report, there will typically be a number corresponding to your test result and a <a href="https://www.testing.com/articles/laboratory-test-reference-ranges/">reference range or interval</a>. This range is essentially the upper and lower limits within which most healthy people’s test results are expected to fall.</p>
<p>Sometimes called a normal range, a reference interval is based on <a href="https://webstore.ansi.org/preview-pages/CLSI/preview_CLSI+C28-A3.pdf">statistical analyses</a> of tests from a large number of patients in a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4975205/">reference population</a>. Normal levels of some biomarkers are expected to vary across a group of people, depending on their age, sex, ethnicity and other attributes. </p>
<p>So, separate reference populations are often created from people with a particular attribute. For example, a reference population could comprise all women or all children. A patient’s test value can then be appropriately compared with results from the reference population that fits them best.</p>
<p>Reference intervals <a href="https://doi.org/10.1001/archinternmed.2007.131">vary from lab to lab</a> because each may use different testing methods or reference populations. This means you might not be able to compare your results with reference intervals from other labs. To determine how your test results compare with the normal range, you need to check the reference interval listed on your lab report.</p>
<p>If you have results for a given test from different labs, your clinician will likely focus on test trends relative to their reference intervals and not the numerical results themselves.</p>
<h2>Interpreting your blood test results</h2>
<p>There are <a href="https://kidshealth.org/en/parents/blood-test-types.html">numerous blood panels</a> intended to test specific aspects of your health. These include panels that look at the cellular components of your blood, biomarkers of kidney and liver function, and many more.</p>
<p>Rather than describe each panel, let’s look at a hypothetical case study that requires using several panels to diagnose a disease.</p>
<p>In this situation, a patient visits their health care provider for fatigue that has lasted several months. <a href="https://www.merckmanuals.com/professional/special-subjects/nonspecific-symptoms/fatigue">Numerous factors and disorders</a> can result in prolonged or chronic fatigue.</p>
<p>Based on a physical examination, other symptoms and medical history, the health practitioner suspects that the patient could be suffering from any of the following: anemia, an underactive thyroid or diabetes.</p>
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<a href="https://images.theconversation.com/files/570977/original/file-20240123-21-rfgobx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Close-up of a person holding gauze against the crook of their arm while another person holds up two heparin tubes of blood" src="https://images.theconversation.com/files/570977/original/file-20240123-21-rfgobx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/570977/original/file-20240123-21-rfgobx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/570977/original/file-20240123-21-rfgobx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/570977/original/file-20240123-21-rfgobx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/570977/original/file-20240123-21-rfgobx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/570977/original/file-20240123-21-rfgobx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/570977/original/file-20240123-21-rfgobx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Blood tests provide clinicians with more information to guide diagnoses and treatment decisions.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/female-nurse-holding-blood-collection-tubes-royalty-free-image/1463489972">FluxFactory/E+ via Getty Images</a></span>
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<p>Blood tests would help further narrow down the cause of fatigue.</p>
<p><a href="https://www.nhlbi.nih.gov/health/anemia">Anemia</a> is a condition involving reduced blood capacity to transport oxygen. This results from either lower than normal levels of red blood cells or a decrease in the quantity or quality of <a href="https://theconversation.com/why-do-we-bleed-a-hematologist-explains-how-the-body-prevents-blood-loss-after-injury-174581">hemoglobin</a>, the protein that allows these cells to transport oxygen. </p>
<p>A <a href="https://medlineplus.gov/lab-tests/complete-blood-count-cbc/">complete blood count panel</a> measures various components of the blood to provide a comprehensive overview of the cells that make it up. <a href="https://www.nhlbi.nih.gov/health/anemia/diagnosis">Low values</a> of red blood cell count, or RBC, hemoglobin, or Hb, and hematocrit, or HCT, would indicate that the patient is suffering from anemia.</p>
<p><a href="https://www.niddk.nih.gov/health-information/endocrine-diseases/hypothyroidism">Hypothyroidism</a> is a disorder in which the thyroid gland does not produce enough thyroid hormones. These include thyroid-stimulating hormone, or TSH, which stimulates the thyroid gland to release two other hormones: triiodothyronine, or T3, and thyroxine, or T4. The <a href="https://medlineplus.gov/thyroidtests.html">thyroid function panel</a> measures the levels of these hormones to assess thyroid-related health.</p>
<p><a href="https://www.cdc.gov/diabetes/basics/diabetes.html">Diabetes</a> is a disease that occurs when blood sugar levels are too high. Excessive glucose molecules in the bloodstream can bind to hemoglobin and form what’s called glycated hemoglobin, or HbA1c. A <a href="https://doi.org/10.4137/BMI.S38440">hemoglobin A1c test</a> measures the percentage of HbA1c present relative to the total amount of hemoglobin. This provides a history of glucose levels in the bloodstream over a period of about three months prior to the test.</p>
<p>Providing additional information is the <a href="https://medlineplus.gov/lab-tests/basic-metabolic-panel-bmp/">basic metabolic panel, or BMP</a>, which measures the amount various substances in your blood. These include:</p>
<ul>
<li>Glucose, a type of sugar that provides energy for your body and brain. Relevant to diabetes, the BMP measures the blood glucose levels at the time of the test.</li>
<li>Calcium, a mineral essential for proper functioning of your nerves, muscles and heart.</li>
<li>Creatinine, a byproduct of muscle activity.</li>
<li>Blood urea nitrogen, or BUN, the amount of the waste product urea your kidneys help remove from your blood. These indicate the status of a person’s metabolism, kidney health and electrolyte balance.</li>
</ul>
<p>With results from each of these panels, the health professional would assess the patient’s values relative to their reference intervals and determine which condition they most likely have.</p>
<p>Understanding the purpose of blood tests and how to interpret them can help patients partner with their health care providers and become more informed about their health.</p><img src="https://counter.theconversation.com/content/216341/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brad Reisfeld does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Your blood contains a wealth of information about the state of your health. Analyzing the levels of each component is an important part of diagnosis.Brad Reisfeld, Professor of Chemical and Biological Engineering, Biomedical Engineering, and Public Health, Colorado State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2133592023-09-18T20:03:42Z2023-09-18T20:03:42ZTests that diagnose diseases are less reliable than you’d expect. Here’s why<figure><img src="https://images.theconversation.com/files/548709/original/file-20230918-27-xhsztq.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3583%2C2376&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/OZcQIhidMTw">CDC / Unsplash</a></span></figcaption></figure><p>You feel unwell, and visit your doctor. They ask some questions and take some blood for testing; a few days later they call to say you have been diagnosed with a disease.</p>
<p>What are the chances you <em>actually have</em> the disease? For some common diagnostic tests, the answer is surprisingly low.</p>
<p>Few medical tests are 100% accurate. Part of the reason is that people are inherently variable, but many tests are also built on limited or biased samples of patients – and our own work has shown researchers may <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-023-03048-6">deliberately exaggerate</a> the effectiveness of new tests.</p>
<p>None of this means we should stop trusting diagnostic tests, but a better understanding of their strengths and weaknesses is essential if we want to use them wisely. </p>
<h2>People are variable</h2>
<p>An example of a widely used imperfect test is prostate-specific antigen (PSA) screening, which measures the level of a particular protein in the blood as an indicator of prostate cancer. </p>
<p>The test catches an estimated 93% of cancers – but it has a very high false positive rate, as around 80% of men with a positive result do not actually have cancer. For those in the 80%, the result <a href="https://theconversation.com/prostate-cancer-testing-has-the-bubble-burst-82260">creates unnecessary stress</a> and likely further testing including painful biopsies.</p>
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Read more:
<a href="https://theconversation.com/prostate-cancer-testing-has-the-bubble-burst-82260">Prostate cancer testing: has the bubble burst?</a>
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<p>Rapid antigen tests for COVID-19 are another widely used imperfect test. A <a href="https://www.cochrane.org/CD013705/INFECTN_how-accurate-are-rapid-antigen-tests-diagnosing-covid-19">review of these tests</a> found that, of people without symptoms but with a positive test result, only 52% actually had COVID. </p>
<p>Among people with COVID symptoms and a positive result, the accuracy of the tests rose to 89%. This shows how a test’s performance cannot be summarised by a single number and depends on individual context.</p>
<p>Why aren’t diagnostic tests perfect? One key reason is that people are variable. A high temperature for you, for example, might be perfectly normal for someone else. For blood tests, many extraneous factors can influence the results, such as the time of day or how recently you have eaten.</p>
<p>Even the ubiquitous blood pressure test <a href="https://www.ama-assn.org/delivering-care/hypertension/4-big-ways-bp-measurement-goes-wrong-and-how-tackle-them">can be inaccurate</a>. Results can vary depending on whether the cuff is a good fit for your arm, if you have your legs crossed, and if you’re talking when the test is done. </p>
<h2>Small samples and statistical skullduggery</h2>
<p>There’s an enormous amount of research on new diagnostic models. New models frequently make the headlines as “medical breakthroughs”, such as how your <a href="https://www.jpost.com/health-and-science/handwriting-assessment-can-be-used-for-early-detection-of-parkinsons-disease-325798">handwriting could detect Parkinson’s disease</a>, how your pharmacy loyalty card could <a href="https://www.theguardian.com/society/2023/jan/26/loyalty-card-data-could-help-spot-ovarian-cancer-cases-sooner">detect ovarian cancer earlier</a>, or how <a href="https://www.abdn.ac.uk/news/4602/">eye movements could detect schizophrenia</a>.</p>
<p>But living up to the headlines is often a different story.</p>
<p>Many diagnostic models are developed based on small sample sizes. <a href="https://www.bmj.com/content/332/7550/1127.long">A review</a> found half of diagnostic studies used just over 100 patients. It is hard to get a true picture of the accuracy of a diagnostic test from such small samples. </p>
<p>For accurate results, the patients who use the test should be similar to those who were used to develop the test. For example, the widely used Framingham Risk Score for identifying people at high risk of heart disease was developed in the United States and is known to <a href="https://pubmed.ncbi.nlm.nih.gov/28749178/">perform poorly</a> in Aboriginal and Torres Strait Islander people. </p>
<p>Similar disparities in accuracy have been found for “polygenic risk scores”. These combine information on thousands of genes to predict disease risk, but were developed in European populations and <a href="https://www.nature.com/articles/s41588-019-0379-x">perform poorly in non-European populations</a>. </p>
<p>Recently, we identified another important problem: researchers have exaggerated <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-023-03048-6">the accuracy of some models</a> to gain journal publications. </p>
<p>There are many ways to exaggerate the performance of a test, such as dropping hard-to-predict patients from the sample. Some tests are also not truly predictive, as they include information from the future, such as a <a href="https://www.statnews.com/2021/09/27/epic-sepsis-algorithm-antibiotics-model/">predictive model of infection</a> that includes whether the patient had been prescribed antibiotics.</p>
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<strong>
Read more:
<a href="https://theconversation.com/elizabeth-holmes-theranos-scandal-has-more-to-it-than-just-toxic-silicon-valley-culture-114102">Elizabeth Holmes: Theranos scandal has more to it than just toxic Silicon Valley culture</a>
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<p>Perhaps the most extreme example of exaggerating the power of a diagnostic test was the <a href="https://theconversation.com/elizabeth-holmes-theranos-scandal-has-more-to-it-than-just-toxic-silicon-valley-culture-114102">Theranos scandal</a>, in which a finger-prick blood test supposed to diagnose multiple health conditions attracted hundreds of millions of dollars from investors. This was too good to be true – and the mastermind has now been convicted of fraud. </p>
<h2>Big data can’t make tests perfect</h2>
<p>In the era of precision medicine and big data, it seems appealing to combine tens or hundreds of pieces of information about a patient – perhaps using machine learning or artificial intelligence – to provide highly accurate predictions. However, the promise is so far outstripping the reality. </p>
<p>One <a href="https://osf.io/preprints/4txc6/">study</a> estimated 80,000 new prediction models were published between 1995 and 2020. That’s around 250 new models every month. </p>
<p>Are these models transforming healthcare? We see no sign of it – and if they really were having a big impact, surely we wouldn’t need such a steady stream of new models. </p>
<p>For many diseases there are data problems that no amount of sophisticated modelling can fix, such as measurement errors or missing data that make accurate predictions impossible. </p>
<p>Some diseases or illnesses are likely inherently random, and involve complex chains of events which a patient cannot describe and no model could predict. Examples might include injuries or previous illnesses that happened to a patient decades ago, which they cannot recall and are not in their medical notes. </p>
<p>Diagnostic tests will never be perfect. Acknowledging their imperfections will enable doctors and their patients to have an informed discussion about what a result means – and most importantly, what to do next.</p><img src="https://counter.theconversation.com/content/213359/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many diagnostic tests are far from 100% accurate – and even in the era of big data and machine learning, they never will be.Adrian Barnett, Professor of Statistics, Queensland University of TechnologyNicole White, Senior Research Fellow - Statistics, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2073972023-07-11T12:28:48Z2023-07-11T12:28:48ZThe 21st Century Cures Act requires that patients receive medical results immediately – and new research shows patients prefer it that way<figure><img src="https://images.theconversation.com/files/534479/original/file-20230628-36173-rt3t82.jpg?ixlib=rb-1.1.0&rect=35%2C23%2C7904%2C5273&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The 21st Century Cures Act requires that test results be released to patients even before their health care provider has reviewed them. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/afro-american-healthcare-worker-discussing-medical-royalty-free-image/1386035203?phrase=patients+talking+to+doctor&adppopup=true">Natalia Gdovskaia/Moment via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em> </p>
<h2>The big idea</h2>
<p>Patients overwhelmingly prefer to see their medical test results online immediately, even if that means viewing results before discussing them with a health care professional. These are the <a href="http://doi.org/10.1001/jamanetworkopen.2023.3572">key findings</a> from our team’s recent study, published in JAMA Network Open. Importantly, this preference remains true for patients who received results with abnormal or potentially concerning findings.</p>
<p>We carried out this study to understand how patients are affected by new legislation to prevent <a href="https://www.healthit.gov/topic/information-blocking">information blocking</a> and provide patients complete access to all of their electronic health information. The <a href="https://www.fda.gov/regulatory-information/selected-amendments-fdc-act/21st-century-cures-act">21st Century Cures Act</a> became law in 2016 to improve access, exchange and use of electronic health information. The information-blocking exceptions, which went into effect in April 2021, codified provisions that required <a href="https://www.opennotes.org/onc-federal-rule/">nearly all electronic health information</a> – including medical test results – be made immediately available to patients once the results are ready. </p>
<p>Many <a href="https://doi.org/10.1016/j.amjsurg.2021.12.002">clinicians have worried</a> that this new access may cause undue emotional distress. Some patients have reported receiving news of cancer or other critical diagnoses at home <a href="https://www.nytimes.com/2022/10/03/well/live/medical-test-results-cures-act.html">without immediate access to their clinician</a>. For some, receiving bad news from a health care professional rather than in an online report may help to avoid misinterpretations and alleviate distress. </p>
<p>Others have argued that receiving bad news itself is worrying, regardless of how it is delivered. Many patients may prefer to receive bad news in the comfort of their own home, surrounded by friends and family, and with time to <a href="https://www.theguardian.com/commentisfree/2023/apr/03/journalist-henry-mcdonald-facts-online-medical-records">do their own research and prepare questions</a> to inform conversations with their clinician.</p>
<p>We surveyed more than 8,000 patients, from four medical centers, who received test results through online patient portals between April 2021 and April 2022. We asked participants about the types of tests they received, their reaction to the results, the effect of the result on their health and well-being and preferences for the release of future results.</p>
<p>We found that a staggering 96% of patients wished to continue receiving their medical results online as soon as the results become available. Most patients – 92.5% – who reviewed their results online reported that seeing the result made them feel the same or less worried about their health. About 7.5% of patients reported feeling more worried after reviewing their result, especially when the findings were abnormal. However, over 95% of patients who received results with abnormal findings still wished to continue to receive results online – even if their clinician had not yet seen the result.</p>
<p>This research builds upon our prior work from 2021, which <a href="http://doi.org/10.1001/jamanetworkopen.2021.29553">found a fourfold increase</a> in the number of sensitive results reviewed first by patients after they were released. </p>
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<figcaption><span class="caption">The 21st Century Cures Act transforms how patients and clinicians communicate and share information to improve health care.</span></figcaption>
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<h2>Why it matters</h2>
<p>A major goal of the 21st Century Cures Act was to improve how health information is shared and exchanged between health care organizations, patients and caregivers. The law does not specify how electronic information should be released to the patient. Health care organizations have widely chosen to comply with the Cures Act by releasing all information through patient portals.</p>
<p>Improved sharing of information benefits both patients and clinicians. Full access to personal health information allows patients to better manage their health care, remain informed about key treatment decisions and have more meaningful discussions with their clinicians.</p>
<p>Before the Cures Act, individual health care organizations could choose which information was made available online to the patient. Many organizations already <a href="https://doi.org/10.1093/jamiaopen/ooz039">shared results from common medical tests</a>. Health systems often delayed results that might cause distress, such as a new cancer diagnosis or an HIV test result, to give clinicians time to review and discuss the result with patients. Some organizations chose to withhold these sensitive test results from the patient portal altogether.</p>
<h2>What’s next</h2>
<p>Patient preferences around test results are highly complex and nuanced, especially when those results are sensitive ones. </p>
<p>One way that clinicians might prepare patients is to do pre-counseling or provide guidance at the time of ordering a test. Helping patients to understand the reason for the test, the possible results and steps for professional follow-up may help to anticipate and alleviate concerns before receiving a test result. </p>
<p>With the 21st Century Cures Act, the medical field is moving away from the paternalistic view that clinicians know best in favor of embracing empowered patients who take charge of their own care.</p><img src="https://counter.theconversation.com/content/207397/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The law requires medical test results be made available to patients even before a clinician has reviewed them.Bryan Steitz, Instructor in Biomedical Informatics, Vanderbilt UniversityCT Lin, Professor of Medicine, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1968742023-02-14T13:27:07Z2023-02-14T13:27:07ZHow do blood tests work? Medical laboratory scientists explain the pathway from blood draw to diagnosis and treatment<figure><img src="https://images.theconversation.com/files/509538/original/file-20230210-16-9ds3x9.jpg?ixlib=rb-1.1.0&rect=15%2C0%2C2101%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pathology analyzes bodily fluids and tissues using a variety of methods.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctor-manipulating-blood-plasma-tubes-green-royalty-free-image/1404395240">Alvaro Lavin/Moment via Getty Images</a></span></figcaption></figure><p>Medical laboratory testing is the heartbeat of medicine. It provides critical data for physicians to diagnose and treat disease, <a href="https://doi.org/10.1093/labmed/lmaa098">dating back thousands of years</a>. Unfortunately, laboratory medicine as a field is poorly understood by both the public and health care communities. </p>
<p><a href="https://asm.org/Articles/2021/October/Using-Laboratory-Medicine-to-Support-Direct-Patien">Laboratory medicine</a>, also known as clinical pathology, is one of two main branches of pathology, or the study of the causes and effects of disease. Pathology covers many <a href="https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=85&contentid=P00955">laboratory areas</a>, such as blood banking and microbiology. Clinical pathology diagnoses a disease through laboratory analysis of body fluids such as blood, urine, feces and saliva. The other branch of pathology, <a href="https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/anatomical-pathology">anatomic pathology</a>, diagnoses a disease by examining body tissues.</p>
<p>We are <a href="https://scholar.google.com/citations?user=8XtvOZ8AAAAJ&hl=en">public health</a> and <a href="https://www.rushu.rush.edu/faculty/nicholas-moore-ms-mlsascpcm">medical laboratory</a> scientists who specialize in microbiology and infectious diseases. There are a lot of steps between when your doctor orders a blood test to establishing a diagnosis. From the bedside to the lab bench, here’s how laboratory testing works.</p>
<h2>It all starts with a specimen</h2>
<p>When you see a doctor, sometimes a physical exam and detailed medical history are enough for them to make a diagnosis, offer recommendations or prescribe medications for your condition. There are many instances, however, where your doctor may need additional information to make an accurate diagnosis. This information is often obtained from procedures like <a href="https://medlineplus.gov/ency/article/007451.htm">imaging scans</a> or <a href="https://doi.org/10.1309/LM4O4L0HHUTWWUDD">blood tests</a>.</p>
<p>The first step involves getting your blood drawn through a practice known as <a href="https://www.webmd.com/a-to-z-guides/what-is-phlebotomy">phlebotomy</a>. A health care professional, typically a phlebotomist or a nurse, inserts a needle into a vein to collect a blood specimen. </p>
<p>Multiple tubes of blood may be needed, as certain tests are only performed using certain types of blood specimens. For example, one test commonly used to <a href="https://www.nhlbi.nih.gov/health/anemia">diagnose anemia</a> requires blood to be collected in a chemical that prevents the blood from clotting. Patients being evaluated for a <a href="https://www.nhlbi.nih.gov/health/clotting-disorders">clotting disorder</a>, on the other hand, often have their blood collected in a tube containing another anticoagulant.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/509533/original/file-20230210-15-axvazu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Array of blood test tubes in a rack" src="https://images.theconversation.com/files/509533/original/file-20230210-15-axvazu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/509533/original/file-20230210-15-axvazu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/509533/original/file-20230210-15-axvazu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/509533/original/file-20230210-15-axvazu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/509533/original/file-20230210-15-axvazu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/509533/original/file-20230210-15-axvazu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/509533/original/file-20230210-15-axvazu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Different tests require different types of blood specimens.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/rack-with-tubes-blood-samples-from-patients-for-royalty-free-image/1446655782">angelp/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<h2>Testing pathways</h2>
<p>Specimens then make their way to a clinical laboratory. Laboratories can be found within hospitals, reference labs or physician offices, or they can be located in a public health setting such as the Centers for Disease Control and Prevention or a state public health laboratory. In 2021, there were <a href="https://www.bls.gov/ooh/healthcare/clinical-laboratory-technologists-and-technicians.htm#tab-1">more than 329,000 laboratory professionals</a> working in the U.S. in <a href="https://www.cms.gov/regulations-and-guidance/legislation/clia#">more than 320,000 federally regulated laboratories</a>. An estimated <a href="https://www.cdc.gov/csels/dls/strengthening-clinical-labs.html">14 billion laboratory tests</a> are ordered annually in the U.S., on top of <a href="https://www.worldometers.info/coronavirus/#countries">over 1 billon COVID-19 tests</a> during the pandemic. With such a large volume of specimens to test and examine, various sections of a laboratory are automated. </p>
<p>Laboratory tests examine the biological, chemical and physical properties of the cells and molecules that make up a blood specimen. The first step is often to centrifuge a blood specimen into separate components. This divides the sample into one portion that contains solid components, such as cells, and another that contains liquid components and dissolved solutes, known as serum or plasma.</p>
<p>Analyzing the serum or plasma portion of a blood specimen measures the levels of different substances within the body. One of the most common is your blood sugar, or glucose concentration. For the doctors of <a href="https://www.cdc.gov/csels/dls/strengthening-clinical-labs.html">more than 37 million Americans with diabetes</a>, knowing how high their patient’s blood glucose is helps them establish a new diagnosis or ensure their condition is under control.</p>
<p>If your doctor suspects you have an infection, they will collect specimens to test for the presence of a pathogen. For example, they might collect a throat swab for strep throat or a urine sample for a urinary tract infection. Scientists incubate these samples to screen any organisms that grow and resemble pathogens of interest. They may perform additional testing to identify the microbe. Once an organism is identified, the <a href="https://deepdive.tips/index.php/2022/12/01/putting-a-face-on-clinical-laboratory-sciences-w-dr-rodney-rohde/">medical laboratory professional</a> can then test a variety of antimicrobial agents against it to inform your doctor what the best treatment would be against your infection.</p>
<h2>Evolution of medical laboratory testing</h2>
<p>The <a href="https://doi.org/10.1093/clinchem/43.1.174">first hospital clinical laboratory in the U.S.</a> was established in 1894. Some of the methods <a href="https://deepdive.tips/index.php/2022/12/01/putting-a-face-on-clinical-laboratory-sciences-w-dr-rodney-rohde/">laboratory professionals</a> use to analyze samples have been in use for over a century. </p>
<p>One such staple, the <a href="https://www.ncbi.nlm.nih.gov/books/NBK562156/">Gram stain</a>, was introduced in 1882. It uses two different dyes and exploits differences in the bacterial cell wall to discriminate between two different groups of bacteria. This helps lab scientists identify the correct antimicrobial therapy to use against an infection.</p>
<p>Another commonly used technology, the <a href="https://doi.org/10.1002/cyto.a.24505">Coulter Principle</a>, was developed in the 1940s to identify and sort individual cells based on physical size and resistance to an electrical current. Medical laboratory professionals routinely use this technique to conduct <a href="https://medlineplus.gov/lab-tests/complete-blood-count-cbc/">complete blood count</a> tests, which measure unusual increases or decreases in the number of different types of blood cells that could provide insights into a disease or condition, such as cancer or sickle cell anemia.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/510360/original/file-20230215-28-e6jp0p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Medical laboratory professional holding blood tube" src="https://images.theconversation.com/files/510360/original/file-20230215-28-e6jp0p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/510360/original/file-20230215-28-e6jp0p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/510360/original/file-20230215-28-e6jp0p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/510360/original/file-20230215-28-e6jp0p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/510360/original/file-20230215-28-e6jp0p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/510360/original/file-20230215-28-e6jp0p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/510360/original/file-20230215-28-e6jp0p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Medical laboratory professionals use different techniques to analyze samples.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/feamle-scientist-preparing-a-blood-sample-for-royalty-free-image/1023297260">Westend61/Getty Images</a></span>
</figcaption>
</figure>
<p>In 1986, scientists devised the <a href="https://www.nobelprize.org/prizes/chemistry/1993/mullis/facts/">Nobel Prize-winning</a> <a href="https://www.ncbi.nlm.nih.gov/probe/docs/techpcr/">polymerase chain reaction</a> method to amplify, or rapidly produce, multiple copies of the DNA of a pathogen present within a sample. PCR is widely used to diagnose infections, identify genetic disorders and monitor cancer progression.</p>
<p>An explosion of modern laboratory tools to research and diagnose disease followed PCR. To name a few of these cutting-edge tools, <a href="https://doi.org/10.1038/labinvest.2014.156">matrix-assisted laser desorption ionization, or MALDI</a>, is one of the most commonly used techniques to identify microbes that are difficult or impossible to culture. Genome editing and <a href="https://medlineplus.gov/genetics/understanding/genomicresearch/genomeediting/">CRISPR-Cas9</a> give scientists the ability to change an organism’s DNA, aiding in <a href="https://doi.org/10.1016/j.biopha.2021.111487">identifying pathogens and detecting dysfunctional genes</a> by adding, removing or altering genes of interest. <a href="https://theconversation.com/genomic-sequencing-heres-how-researchers-identify-omicron-and-other-covid-19-variants-172935">Next-generation sequencing</a> has become a powerful modern tool to determine the sequence of the genetic material in biological samples and has been extensively used to <a href="https://doi.org/10.3390%2Fijms12117861">identify variants</a> and wastewater surveillance of pathogens like the virus that causes COVID-19.</p>
<h2>Challenges and solutions</h2>
<p>One of the most critical challenges in laboratory medicine is <a href="https://doi.org/10.1309/LM4O4L0HHUTWWUDD">understanding and interpreting test results</a>, because errors can occur throughout the testing process. Specimens must be properly collected and transported to the lab for accurate results. Likewise, at-home tests need to be properly stored. Clinicians and patients need to take into account the chances of false positive or negative results by considering the <a href="https://theconversation.com/coronavirus-tests-are-pretty-accurate-but-far-from-perfect-136671">limitations of the test</a> alongside the patient’s individual case.</p>
<p>Collaboration between clinicians and medical laboratory professionals could help <a href="https://www.elsevier.com/connect/preventing-diagnostic-errors-by-uniting-the-clinical-laboratory-with-direct-patient-care">reduce errors</a> in diagnosis and treatment. Laboratory data can and often is extremely useful to patient care, but a holistic approach that takes into account a patient’s medical history, genetics and health habits, among other factors, is necessary for an accurate diagnosis and treatment. While powerful, a laboratory result should not be used in isolation. Clear and accurate communication on laboratory testing is critical for effective patient care.</p>
<p><em>A photo was replaced to more accurately reflect medical laboratory work</em></p><img src="https://counter.theconversation.com/content/196874/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rodney E. Rohde has received funding from the American Society of Clinical Pathologists, American Society for Clinical Laboratory Science, U.S. Department of Labor (OSHA), and other public and private entities/foundations. Rohde is affiliated with ASCP, ASCLS, ASM, and serves on several scientific advisory boards. See <a href="https://rodneyerohde.wp.txstate.edu/service/">https://rodneyerohde.wp.txstate.edu/service/</a>.</span></em></p><p class="fine-print"><em><span>Nicholas Moore previously received funding from Abbott Molecular, bioMerieux, and Cepheid for contracted research work related to the development of laboratory assays. Funds were paid directly to Rush University. Nicholas Moore is a volunteer with the American Society for Clinical Laboratory Science, the American Society for Clinical Pathology, the American Society for Microbiology, and the Clinical and Laboratory Standards Institute. He is a member of the editorial board of Clinical Microbiology Reviews and BMC Infectious Diseases.</span></em></p>Lab testing provides doctors with essential information to help them diagnose and treat disease. Here’s what happens behind the scenes after you roll up your sleeve for a blood draw.Rodney E. Rohde, Regents' Professor of Clinical Laboratory Science, Texas State UniversityNicholas Moore, Associate Professor of Medical Laboratory Science, Rush UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1762422022-02-23T21:19:51Z2022-02-23T21:19:51ZTips for navigating an emergency department visit: Who you’ll see, what to ask and why it matters<figure><img src="https://images.theconversation.com/files/445346/original/file-20220209-15-iayomf.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C3967%2C2967&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Paramedics and ambulances spill out of the Emergency ramp at Michael Garron Hospital in Toronto.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Frank Gunn</span></span></figcaption></figure><p>The emergency department (ED) can be a stressful and confusing place for individuals who are sick or injured. During the pandemic, with many hospitals not permitting friends or family to accompany ED patients, being alone may exacerbate the uncertainty, fear and anxiety patients may experience about things like waiting times, undergoing tests or medical prognoses.</p>
<p>Research shows that <a href="http://doi.org/10.1136/emermed-2011-200451">almost half of all patients leave the hospital with a poor understanding of their ED visit</a>. As doctors who see the consequences of poor communication, let us break down what is going on in the ED and give you the knowledge and tools to empower you to have a smoother experience. </p>
<h2>The emergency department explained</h2>
<p>In the ED, some patients arrive by themselves (or get dropped off by family), some disembark from an ambulance and some are transferred from other hospitals. To decide the order of patient care, clinicians use a decision-making tool called the <a href="https://ctas-phctas.ca/">Canadian Emergency Department Triage and Acuity Scale</a> (CTAS). The CTAS is used instead of a first-come, first-served system. </p>
<p>The CTAS sorts patients based on severity of the illness or injury. A score of 1 suggests an imminent risk of dying or severe disability within minutes without treatment (for example, serious car accident or stroke). A score of 5 suggests that the outcome of the medical issue will not change whether treatment is delivered now or in a few hours. </p>
<p>A patient’s movement around the ED, from waiting location to treatment room to investigation area, is based on the presenting illness and CTAS. Patients wait for the room with the best resources for their condition. For example, a plaster room is the best place to make a cast for a broken ankle, but does not have the heart monitor equipment for diagnosing or treating a heart attack. </p>
<p>These factors help explain why certain patients seem to leave the waiting room faster than others. </p>
<h2>People in the ED</h2>
<p>The people working in the ED include clinicians such as doctors, nurses and social workers, and non-clinical staff such as clerks, porters and housekeepers. The number and types of staff will depend on the size of hospital. Each team member has a defined role and scope of practice, resulting in a roughly predictable sequence in which patients will see each staff member. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/447239/original/file-20220218-17-t26q1y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Medical staff wearing gowns, caps and face masks with two figures in the foreground seen from behind" src="https://images.theconversation.com/files/447239/original/file-20220218-17-t26q1y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/447239/original/file-20220218-17-t26q1y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447239/original/file-20220218-17-t26q1y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447239/original/file-20220218-17-t26q1y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447239/original/file-20220218-17-t26q1y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447239/original/file-20220218-17-t26q1y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447239/original/file-20220218-17-t26q1y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A patient is brought into a resuscitation bay in the emergency department at the Health Sciences Centre in Winnipeg. Patients are brought to the treatment area best suited for their health issue.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Mikaela MacKenzie</span></span>
</figcaption>
</figure>
<p>A patient entering the ED usually has their information collected by a clerk first, followed by a preliminary assessment by the triage paramedic or nurse. They may then be seen by another professional for a test or procedure like an X-ray. They may be monitored and treated by a nurse through much of this time, and seen by a physician. Before leaving the ED, a social worker or patient navigator may be seen as well.</p>
<p>Sometimes clinicians come and go over time, depending on whether they are waiting for results of tests or responses to treatment, so visits can differ in length. Recognizing the different roles of each employee, and different timelines, can help patients understand the process of diagnosis and treatment. </p>
<h2>Why understanding your ED visit matters</h2>
<p>To minimize feelings of being overwhelmed, and improve overall quality of care, patients should understand what happens in the ED. Patients may understand their diagnosis, but often have less comprehension of the <a href="https://doi.org/10.1016/j.annemergmed.2008.05.016">followup plan</a>. For example, approximately five to 10 per cent of patients do not fill their ED medications as <a href="https://doi.org/10.1016/j.annemergmed.2013.02.002">prescribed</a> and many do not follow up with recommended <a href="http://doi.org/10.1017/S1481803500012410">medical appointments</a>. </p>
<figure class="align-center ">
<img alt="Paramedics wheeling a patient on a gurney draped in orange in a crowded hospital corridor" src="https://images.theconversation.com/files/447241/original/file-20220218-27-yyuwmm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/447241/original/file-20220218-27-yyuwmm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=427&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447241/original/file-20220218-27-yyuwmm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=427&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447241/original/file-20220218-27-yyuwmm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=427&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447241/original/file-20220218-27-yyuwmm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=537&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447241/original/file-20220218-27-yyuwmm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=537&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447241/original/file-20220218-27-yyuwmm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=537&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In the emergency department, some patients arrive by themselves, some disembark by ambulance and some are transferred from other hospitals.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span>
</figcaption>
</figure>
<p>This is partially due to a lack of understanding of their ED visit, and results in more returns to the ED and greater likelihood of hospitalization, <a href="http://doi.org/10.1097/PTS.0b013e31820c7678">especially for older adults</a>.</p>
<p>Certain factors put patients at higher risk for leaving the ED without sufficient knowledge. These include hearing or vision challenges, cognitive impairment or altered cognition (for example, from intoxication or severe illness), <a href="https://doi.org/10.1016/j.annemergmed.2011.10.023">speaking a primary language different than the one spoken in the ED, as well as having difficulty reading or a lack of knowledge about the health-care system or health issues</a>.</p>
<h2>What you can do</h2>
<p>While the health care system needs to do its part to improve the ED experience and clearly communicate, there are evidence-based strategies that can empower patients in their own care. </p>
<ul>
<li>Have a list of your medications, allergies and medical conditions on hand, saved on a phone or in a wallet. It is beneficial to be as prepared as possible. Think about the questions you want to ask: What is the goal of the visit? Who will help you keep track of the recommendations? Preparing in advance can speed up the process and provide information to the health-care team. </li>
</ul>
<figure class="align-center ">
<img alt="A hospital worker is seen through the glass entrance doors of an emergency department" src="https://images.theconversation.com/files/447243/original/file-20220218-21-i4xr96.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/447243/original/file-20220218-21-i4xr96.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=391&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447243/original/file-20220218-21-i4xr96.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=391&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447243/original/file-20220218-21-i4xr96.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=391&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447243/original/file-20220218-21-i4xr96.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=492&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447243/original/file-20220218-21-i4xr96.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=492&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447243/original/file-20220218-21-i4xr96.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=492&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Being knowledgeable and prepared to advocate for yourself can make the next emergency department visit easier and less stressful.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Jonathan Hayward</span></span>
</figcaption>
</figure>
<ul>
<li><p>For older people, those with mobility or sensory challenges and those who are very unwell, a family member of caregiver may call the hospital and ask to speak to a nurse or doctor to relay or receive this information if their loved one is unable to do so. </p></li>
<li><p>On discharge, the patient should ask for clear written instructions. <a href="https://doi.org/10.1016/S0196-0644(95)70112-5">Short, concise</a> and in plain language is preferred over long medical summaries. <a href="http://doi.org/10.1002/14651858.CD003716">Written is generally better than verbal instructions</a>. </p></li>
<li><p>Repeat the discharge and followup instructions with the nurse or physician to check for accuracy. If the information and next steps are overwhelming, ask to speak to a discharge planning nurse or care navigator who can help smooth the transition from ED to home. </p></li>
<li><p>If the patient and/or loved ones see barriers to being able to follow through with a suggested care plan (such as an inability to afford medication, get to a pharmacy or swallow pills), these barriers should be brought to the ED team’s attention. It is better to address these proactively than to leave a condition under-treated. </p></li>
<li><p>If you are not feeling better, or are getting worse, return to the ED. Ask about return precautions: symptoms to watch for that should prompt a return to the ED. Going back may give ED staff a chance to see your symptoms at a different stage, which may result in a different course of action.</p></li>
</ul>
<p>In terms of what to ask, <a href="http://doi.org/10.1136/bmjoq-2021-001419">research has shown that it’s helpful</a> for patients to record a few important points:</p>
<ul>
<li> Date of ED visit and main diagnosis</li>
<li> Medication details (dose, purpose and how long to take)</li>
<li> Any doctors to follow up with, when and how to contact</li>
<li> Symptoms that should lead to immediate return to the ED</li>
</ul>
<p>Being knowledgeable and prepared to self-advocate can not only make the next ED visit easier and less stressful for you or your loved one, but can also help ensure you leave with the information you need.</p><img src="https://counter.theconversation.com/content/176242/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jasmine Mah is an Internal Medicine resident with Nova Scotia Health and receives scholarships supporting her PhD research from the Department of Medicine at Dalhousie University, Dalhousie Medical Research Foundation, Dr. Patrick Madore Foundation, Alzheimer Society of Nova Scotia and the Pierre Elliott Trudeau Foundation. She is part of the Canadian Consortium on Neurodegeneration in Aging (CCNA) Team 14, which investigates how multi-morbidity, frailty and social context modify risk of dementia and patterns of disease expression. The CCNA receives funding from the Canadian Institutes of Health Research (CNA-137794) and partner organizations (<a href="http://www.ccna-ccnv.ca">www.ccna-ccnv.ca</a>). The affiliations/funders had no input into any aspect of this subject or article.
</span></em></p><p class="fine-print"><em><span>Melissa Andrew has received funding from Sanofi, GSK, Merck, Pfizer, Seqirus, Public Health Agency of Canada, Canadian Institutes of Health Research, and the Canadian Frailty Network, unrelated to the present article. She serves as a member of the Alzheimer Society of Nova Scotia Board of Directors and is part of the Canadian Consortium on Neurodegeneration in Aging (CCNA) Team 14, which investigates how multi-morbidity, frailty and social context modify risk of dementia and patterns of disease expression. The CCNA receives funding from the Canadian Institutes of Health Research (CNA-137794) and partner organizations (<a href="http://www.ccna-ccnv.ca">www.ccna-ccnv.ca</a>).</span></em></p>Almost half of patients have poor understanding of their emergency department visit. Being aware of how the emergency department works can give patients the tools to have a smoother experience.Jasmine Mah, MD (Internal Medicine Resident) & PhD candidate (Focus on Geriatrics), Dalhousie UniversityMelissa K. Andrew, Professor of Geriatric Medicine, Dalhousie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1318792020-05-07T12:23:33Z2020-05-07T12:23:33ZLasers could speed up coronavirus diagnostics<figure><img src="https://images.theconversation.com/files/332415/original/file-20200504-83775-t8zptn.gif?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A conceptual schematic of a laser-based method for identifying the coronavirus quickly.</span> <span class="attribution"><span class="source">Penn State University</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p><em>The Research Brief is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>The most common type of <a href="https://theconversation.com/how-does-the-coronavirus-test-work-5-questions-answered-133118">test</a> for the new coronavirus takes several hours and is uncomfortable; samples are obtained by sliding a swab into the nose or throat. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/332406/original/file-20200504-83745-ajkgp1.gif?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/332406/original/file-20200504-83745-ajkgp1.gif?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/332406/original/file-20200504-83745-ajkgp1.gif?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=703&fit=crop&dpr=1 600w, https://images.theconversation.com/files/332406/original/file-20200504-83745-ajkgp1.gif?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=703&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/332406/original/file-20200504-83745-ajkgp1.gif?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=703&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/332406/original/file-20200504-83745-ajkgp1.gif?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=883&fit=crop&dpr=1 754w, https://images.theconversation.com/files/332406/original/file-20200504-83745-ajkgp1.gif?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=883&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/332406/original/file-20200504-83745-ajkgp1.gif?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=883&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Shining a laser onto virus samples trapped in mesh of carbon nanotubes will produce a signature ‘reflection.’</span>
<span class="attribution"><span class="source">Penn State University</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>I am collaborating with other scientists, including <a href="https://scholar.google.com/citations?user=z7GMEIAAAAAJ&hl=en">Yin-Ting Yeh at Penn State</a>, <a href="https://scholar.google.com/citations?user=2_OASxMAAAAJ&hl=en">Elodie Ghedin at New York University</a>, <a href="https://scholar.google.com/citations?user=e2HHkukAAAAJ&hl=en">Shengxi Huang at Penn State</a> and <a href="https://scholar.google.com/citations?user=iTtzc1UAAAAJ&hl=es">Sharon X. Huang at Penn State</a>, on a diagnostic tool to rapidly trap and identify viruses using a laser beam and a detector. The team includes <a href="https://scholar.google.com/citations?user=tX4aXC0AAAAJ&hl=en">myself</a>, a physicist, as well virologists, engineers, chemists and data scientists. </p>
<h2>How we do the work</h2>
<p>Our <a href="https://doi.org/10.1073/pnas.1910113117">approach</a> uses a technique called <a href="https://www.sciencedirect.com/topics/neuroscience/raman-spectroscopy">Raman spectroscopy</a> to identify viruses by shining a light on a disposable cartridge that collects samples from oral cotton swabs or a person blowing through the device. Once a sample is collected, a spectrometer measures the interatomic vibrations that result from shining the light on the collected viruses. Each virus has its own signature vibrations, which act as a sort of optical fingerprint that can distinguish the coronavirus from, for example, the virus that causes influenza.</p>
<p>We could capture viruses from patients’ saliva taken with a swab or by a person blowing through a device, called a <a href="https://doi.org/10.1177/2211068216677820">microfluidic cartridge</a>. The air and liquid pass an array of <a href="https://www.nanowerk.com/nanotechnology/introduction/introduction_to_nanotechnology_22.php">carbon nanotubes</a>, cylinder-shape molecules used in different materials. </p>
<p>The diameters of the nanotubes are microscopic, between 10-60 nanometers. Because they are smaller than microbes – flu viruses range from 90-120 nanometers in diameter and coronaviruses range from 125-150nm in diameter – the pathogens collect on the carbon nanotubes. Once trapped by passing through the carbon nanotubes, the viruses can be optically identified by shining a laser on the sample. Shining the light on the carbon nanotubes and pathogens <a href="https://doi.org/10.1016/j.physrep.2004.10.006">creates a distinctive optical fingerprint</a>, or “Raman peaks.”</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/332410/original/file-20200504-83757-1l9ya9b.gif?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/332410/original/file-20200504-83757-1l9ya9b.gif?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/332410/original/file-20200504-83757-1l9ya9b.gif?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=304&fit=crop&dpr=1 600w, https://images.theconversation.com/files/332410/original/file-20200504-83757-1l9ya9b.gif?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=304&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/332410/original/file-20200504-83757-1l9ya9b.gif?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=304&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/332410/original/file-20200504-83757-1l9ya9b.gif?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=381&fit=crop&dpr=1 754w, https://images.theconversation.com/files/332410/original/file-20200504-83757-1l9ya9b.gif?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=381&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/332410/original/file-20200504-83757-1l9ya9b.gif?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=381&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">After being beamed with lasers, different microbes will give off radiation in different wavelengths that can be measured to identify the pathogen.</span>
<span class="attribution"><span class="source">Penn State University</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>After the laser shines on the trapped sample, machine learning algorithms identify the signature spectrum of the virus that results from the light that bounces off the virus particles. With the assistance of machine learning, the identification takes less than two minutes with an accuracy rate of up to 70% to 90%, comparable to state-of-the-art microbiology techniques.</p>
<h2>Why it matters</h2>
<p>Right now, the rapid and accurate detection of the novel coronavirus is of paramount importance. While Raman spectroscopy has the potential to be enormously helpful in identifying this virus, doctors can also use this technique to test for other illnesses, such as influenza. By identifying the virus easily, quickly and at the point of contact, Raman spectroscopy could significantly halt disease spread. </p>
<p>Compare that to our <a href="https://theconversation.com/how-does-the-coronavirus-test-work-5-questions-answered-133118">current methods of analyzing samples</a>; a process that is relatively slow, tedious, labor intensive and requires extensive scrutiny at laboratories. Early and rapid detection with this new device has the potential to save hundreds of thousands of lives every year. </p>
<h2>What other work is being done</h2>
<p>For the identification of viruses, <a href="https://theconversation.com/there-are-many-covid-19-tests-in-the-us-how-are-they-being-regulated-134783">existing technologies</a> do provide <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6988269/">relatively sensitive detection</a>. However, they take several hours and sometime days depending on the quality of the sample collected because low virus concentrations are very difficult to process and results in false negatives. </p>
<p>Unfortunately, both immune- and molecular-based methods, including <a href="https://www.thermofisher.com/us/en/home/life-science/protein-biology/protein-biology-learning-center/protein-biology-resource-library/pierce-protein-methods/overview-elisa.html">enzyme-linked immunosorbent assay</a> (<a href="http://www.epitopediagnostics.com/covid-19-elisa">ELISA</a>) and <a href="https://theconversation.com/on-the-front-lines-of-developing-a-test-for-the-coronavirus-133124">polymerase chain reaction</a> (PCR), require prior knowledge of the strains. Another technique known as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528456/">deep sequencing</a> is another promising new approach, but obtaining sufficient viral reads for it to work well depends on the quality of the sample and its preparation. Processing steps involve incorporating different benchtop equipment, reagents and technical expertise.
This Raman technique has been <a href="https://www.nature.com/articles/s41467-019-12898-9">recently developed to identify different bacteria</a>, thus demonstrating the technique is indeed novel and viable. </p>
<h2>What’s next</h2>
<p>We are applying for federal funds to demonstrate that this technology works for SARS-CoV-2, the virus that cause COVID-19, and then build reliable prototypes that can be scaled up for mass production and field deployment. We are also talking with several manufacturers and exploring ways to move the technology forward to help in the current crisis. </p>
<p>We have been successful in capturing human respiratory viruses from clinical samples using this technique. Eventually, we foresee this technology becoming available to anyone visiting their family doctor. Within two minutes, a person would know whether you have a respiratory virus by comparing the result of the spectroscopy test with other results in a database. In the future, this technology could be at hospitals, airports and inside commercial aircraft to avoid outbreaks. And the captured viruses, still viable, can be replicated to develop a vaccine. </p>
<p>[<em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklysmart">You can get our highlights each weekend</a>.]</p><img src="https://counter.theconversation.com/content/131879/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mauricio Terrones and Yin-Ting Yeh have developed an earlier technology capable of enriching viruses from clinical samples for their rapid identification using PCR and NGS. The detection limits of this technology is improved >100 times when compared to PCR (<a href="https://advances.sciencemag.org/content/2/10/e1601026">https://advances.sciencemag.org/content/2/10/e1601026</a>). This technology has been licensed to Virolock Technologies LLC (<a href="https://virolock.com/">https://virolock.com/</a>). The technology described in this article for the rapid optical identification using Raman spectroscopy and machine learning, has been disclosed and its patent is pending under Penn State University. The latter Raman technology has been performed with funds from the National Science Foundation’s Growing Convergence Research Big Idea (Grant # 1934977).
</span></em></p>A team of physicists, virologists and computer scientists are seeking to develop a coronavirus diagnostic tool that could deliver rapid results.Mauricio Terrones, Professor of Physics, Penn StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1362022020-04-21T12:47:15Z2020-04-21T12:47:15ZHow South Korea flattened the coronavirus curve with technology<figure><img src="https://images.theconversation.com/files/329242/original/file-20200420-152602-1j3h2eq.jpg?ixlib=rb-1.1.0&rect=17%2C185%2C3976%2C2473&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A sense of normalcy is returning to South Korea but the U.S. lacks the testing capacity and contact tracing system the country relies on.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Virus-Outbreak-South-Korea-Elections/91114bdc80a84e82b54849856435e43e/1/0">AP Photo/Ahn Young-joon</a></span></figcaption></figure><p>As countries around the world consider how best to reopen their countries, it’s worth considering how South Korea has been able to “<a href="https://theconversation.com/coronavirus-cases-are-growing-exponentially-heres-what-that-means-135181">flatten the curve</a>” and even hold parliamentary elections without resorting to lockdowns.</p>
<p>After seeing an initial spike in COVID-19 infections in February, South Korea implemented several measures to bring the disease’s <a href="https://www.npr.org/sections/goatsandsoda/2020/03/26/821688981/how-south-korea-reigned-in-the-outbreak-without-shutting-everything-down">spread under control</a>, a progression I’ve followed as a <a href="https://scholar.google.com/citations?user=xou_1u0AAAAJ&hl=en">researcher on public policy</a>. South Korea was able to lower the number of new infections from <a href="https://www.worldometers.info/coronavirus/country/south-korea/">851 on March 3 to 22 infections as of April 17</a> and the mortality rate from COVID-19 hovers <a href="https://www.worldometers.info/coronavirus/country/south-korea/">around 2%</a>. </p>
<p>Several measures contribute to <a href="https://www.brookings.edu/blog/techtank/2020/04/13/combating-covid-19-lessons-from-south-korea/">Korea’s success</a>, but two measures were critical in the country’s ability to flatten the curve: extensive testing for the disease and a national system for promptly and effectively tracking people infected with COVID-19. </p>
<h2>Testing and triage</h2>
<p>From the <a href="https://www.who.int/westernpacific/emergencies/2015-mers-outbreak">2015 MERS outbreak</a>, Korea learned that infection to medical staff sapped the ability to control the virus as infected citizens in hospitals turned them into hotspots for infection. As a result, at the onset of COVID-19 infection, the Korean government ensured that proper personal protective equipment was provided to avoid infection to the medical staff. It also created physically separated testing and treatment sites for health care workers.</p>
<p>Once safe testing and treatment facilities were secured, the government began testing for COVID-19 at massive scale – over <a href="https://www.cnbc.com/2020/04/07/coronavirus-south-korea-testing-could-flatten-pandemic-curve-in-us-areas.html">440,000 people</a> – which essentially covered all those with symptoms. People who test positive are quarantined in COVID-19 special units and treated. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/328927/original/file-20200419-152585-laj4ah.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/328927/original/file-20200419-152585-laj4ah.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/328927/original/file-20200419-152585-laj4ah.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=395&fit=crop&dpr=1 600w, https://images.theconversation.com/files/328927/original/file-20200419-152585-laj4ah.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=395&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/328927/original/file-20200419-152585-laj4ah.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=395&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/328927/original/file-20200419-152585-laj4ah.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=497&fit=crop&dpr=1 754w, https://images.theconversation.com/files/328927/original/file-20200419-152585-laj4ah.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=497&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/328927/original/file-20200419-152585-laj4ah.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=497&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">South Korea was able to hold a national election on April 15, because it has been successful in containing the spread of COVID-19.</span>
<span class="attribution"><span class="source">AP Photo/Lee Jin-man</span></span>
</figcaption>
</figure>
<p>South Korea focuses attention on treating people with severe symptoms and therefore less likelihood of recovery, rather than focusing on people with mild symptoms. This helped lower the mortality rate of COVID-19, as some of the most vulnerable populations with severe symptoms recovered. Countries focusing their effort on treating patients with a greater likelihood of survival may lead to a higher mortality rate as more vulnerable patients perish. </p>
<p>Extensive testing is a crucial step in identifying the state of the infection in the country – where the outbreaks are taking place, who is infected and who is not. This data then becomes a stepping stone for identifying any hotspots of infection in the country and to trace and identify the population that came in contact with those infected.</p>
<h2>COVID-19 contact tracing system with roots in MERS</h2>
<p>What distinguishes the Korean model in controlling COVID-19 is its ability to trace individuals diagnosed with the disease who may have come into contact with the infected individuals. It’s known as the <a href="https://www.reuters.com/article/us-health-coronavirus-southkorea-respons/ahead-of-the-curve-south-koreas-evolving-strategy-to-prevent-a-coronavirus-resurgence-idUSKCN21X0MO">COVID-19 Smart Management System (SMS)</a>.</p>
<p>South Korea’s Centers for Disease Control and Prevention (KCDC) runs the contact tracing system that uses <a href="http://m.molit.go.kr/viewer/skin/doc.html?fn=374f741a7cee499222a2ac204d1c2f2d&rs=/viewer/result/20200325">data from 28 organizations</a> such as National Police Agency, The Credit Finance Association, three smartphone companies, and 22 credit card companies to trace the movement of individuals with COVID-19. This system takes 10 minutes to analyze the movement of the infected individuals. For people who come in contact with an infected person, the KCDC informs the local public health center near the infected citizen’s residence and <a href="http://ncov.mohw.go.kr/en/">the health center sends the notification to them</a>. If they test positive, they are hospitalized at the COVID-19 special facilities. Those without symptoms are asked to remain self-quarantined for 14 days. </p>
<p>The legal basis for accessing such personal information was prepared after the 2015 MERS outbreak when the government learned that tracing the movement of infected individuals and people who came in contact with them is crucial. As a safety measure, only epidemic investigators at KCDC can access the location information and once the COVID-19 outbreak is over, the personal information used for the contact tracing will be purged.</p>
<p><iframe id="ESEmm" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/ESEmm/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Could the US emulate South Korea?</h2>
<p>South Korea’s model – relying on rapid testing availability, safe COVID-19 medical facilities and a government-run contact tracing system – helps avoid an authoritarian approach of shutting down an entire city as we have seen in China. A forced lockdown has democratic and human consequences of restricting individual freedom and stockpiling. It may have lasting consequences in the post-COVID-19 world such as the <a href="https://www.economist.com/leaders/2020/03/26/the-state-in-the-time-of-covid-19">abuse of political power and the threat to freedom through intrusive surveillance</a>.</p>
<p>Currently, the U.S. is considering re-opening the country or states out of concern over the economy. But without <a href="https://khn.org/news/its-not-over-until-its-over-5-things-to-know-about-hitting-the-covid-19-peak/">effective measures in place</a> to contain the virus, it <a href="https://www.nbcnews.com/politics/politics-news/governors-shrug-trump-s-reopening-plan-say-more-funds-testing-n1186476">may lead to exponential growth</a> in infection again.</p>
<p>Epidemiologists have said the key in defeating COVID-19 pandemic is in identifying <a href="https://www.statnews.com/2020/04/13/coronavirus-health-agencies-need-army-of-contact-tracers/">hotspots of infection and severing the vicious cycle of infection</a>. An effective contact tracing system is a crucial component in this approach and this can be potentially emulated in the U.S. </p>
<p>The U.S. has the necessary technology and data and the government could form a partnership with the relevant entities, such as credit card and telecommunications companies, law enforcement, health care, and other related public and private organizations to create a COVID-19 contact tracing system. With the help of such system, the government could identify the infected population and hotspots, trace and quarantine them for treatment in medical facilities that are, with government’s continued effort, supplied with the necessary PPE. </p>
<p>At the citizen level, the practice of wearing masks and social distancing should be strongly encouraged to prevent infection while the government tries to flatten the curve. </p>
<p>Currently, there is a sense of normalcy returning to South Korea. No cities are under lockdown, the restaurants, <a href="http://www.koreaherald.com/view.php?ud=20200419000038">churches, bars, gyms and learning institutes are allowed to open</a> if they observe the government quarantine guidelines, trains and buses run on schedule, grocery stores are fully stocked, and the country just successfully held parliamentary elections in mid-April. Citizens wear masks and exercise social distancing at all times which helps preventing further infection. South Korea’s approach to COVID-19 with its focus on technology suggests a possible path for the U.S. in reopening the country without having to subject citizens to the coercive authority of the state and compromise our democratic ideal.</p>
<p>[<em>You need to understand the coronavirus pandemic, and we can help.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=upper-coronavirus-help">Read The Conversation’s newsletter</a>.]</p><img src="https://counter.theconversation.com/content/136202/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Ahn does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In addition to testing and special facilities for COVID-19 patients, the country’s government-run tracking system allows the health care system to identify infected people and their contacts.Michael Ahn, Associate Professor and MPA Graduate Program Director, UMass BostonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1357452020-04-07T07:56:50Z2020-04-07T07:56:50ZCoronavirus: how we’re creating a rapid test that could help halt the pandemic<figure><img src="https://images.theconversation.com/files/326004/original/file-20200407-110267-1r4pikx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Antibodies capturing a virus.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/virus-antibodies-close-microorganism-microscopic-organism-1304148580">ustas777777/Shutterstock</a></span></figcaption></figure><p>Testing has become <a href="https://www.weforum.org/agenda/2020/04/to-test-or-not-to-test-2-experts-explain-covid-19-testing/">central to the discussion</a> about how to best tackle the current coronavirus pandemic. The World Health Organization is recommending <a href="https://www.reuters.com/article/us-healthcare-coronavirus-who/test-test-test-who-chiefs-coronavirus-message-to-world-idUSKBN2132S4">frequent and broad testing</a> in order to identify exactly who has and hasn’t caught the virus and stop its spread by isolating the infected. </p>
<p>But the currently available tests don’t provide the kind of rapid result that is needed to isolate people before they can pass on the virus. This is especially true for healthcare staff and other people who need to keep working outside their homes but could be unwittingly transmitting the disease because they don’t realise they have it.</p>
<p>My colleagues and I are one of several groups of researchers around the world working to develop a rapid test for the virus that could solve this problem. Our goal is to produce a cheap, near-instant test kit that anyone can use, and we hope to have one ready later this year.</p>
<p>The <a href="https://theconversation.com/covid-19-tests-how-they-work-and-whats-in-development-134479">current test method</a> relies on looking for genetic evidence of the virus using the so-called polymerase chain reaction <a href="https://www.scientificamerican.com/article/heres-how-coronavirus-tests-work-and-who-offers-them/">(PCR) method</a>. This method is very sensitive and can diagnose infected patients even in the early phase of the disease. </p>
<p>But it typically takes at least three hours, including handling at the hospital, to produce a result. If a nurse or doctor is waiting three hours to find out if they are infected, that’s valuable time they could be using to treat patients – or time they may be infecting others. The workload and cost involved also mean the test can’t easily be used to carry out mass screening of the rest of the population.</p>
<p>Another option is to test patients’ blood for antibodies that the body creates to <a href="https://www.sciencemag.org/news/2020/03/new-blood-tests-antibodies-could-show-true-scale-coronavirus-pandemic">fight the virus</a>. This is cheaper and easier than the PCR method but the antibodies may not be detectable for up to a week after contracting the virus. That makes it good for estimating what percentage of people have had the disease but means it can miss newly infected patients. </p>
<p>All this means there is a clear need for a sensitive, rapid test that can identify the virus in a person within minutes, and that people can ideally use on themselves at home without a medical professional. The way my colleagues and I are working to produce such a test is to create our own antibodies that can catch the virus so we can directly identify its presence in a sample.</p>
<h2>Diagnostic antibodies</h2>
<p>Antibodies are proteins that bind in a highly targeted way with very specific structures on the surface of harmful microbes such as viruses. The antibodies can be attached to a particle that acts as a label and becomes easily detectable in the presence of the microbe.</p>
<p>These kind of diagnostic antibodies are typically generated by injecting part of a virus into a mouse. This essentially vaccinates it so that its immune system starts to produce antibodies against the virus. We can then isolate and cultivate the cells that produce these specific antibodies to <a href="https://www.scientificamerican.com/article/monoclonal-antibodies/">create our own unlimited supply</a>. </p>
<p>My university department has been developing a range of diagnostic antibodies for several years. A single mouse can produce millions of different antibodies and we specialise in developing very selective ways to screen a selection of antibody candidates. Our aim is to rapidly narrow them down to the few that are best at binding to the virus and not to other molecules.</p>
<p>In the case of the current coronavirus pandemic, we were initially contacted by a the clinical microbiology department of Odense University Hospital to see if we could help grow the virus for study. Given our expertise, it was natural for us to also start producing antibodies as a research tool. We are currently working hard at making and selecting antibodies, with the aim of producing a test for a second wave of the disease, which could well occur later this year. </p>
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<p>For the test to function, we also need a way to deliver a patient’s sample to the antibodies and quickly reveal if the virus is present. One solution is to use the so-called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4986465/">lateral flow technique</a> commonly used in over-the-counter pregnancy stick tests but other tests for viruses such as HIV <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC497609/">and influenza</a>. The patient’s sample flows down the test stick and is captured by a line of antibodies, which then become visible thanks to the coloured label particles.</p>
<p>In the past, these kinds of test haven’t been as accurate as the PCR method as they can produce more false positive results (indicating someone has the virus when, in fact, they don’t). We can minimise this problem by finding the most specific antibodies using the screening process mentioned above. Our aim is create a test with similar levels of sensitivity and accuracy to the <a href="https://www.medrxiv.org/content/10.1101/2020.02.25.20027755v2.full.pdf">current PCR based methods</a>. But people who test positive for the virus could also follow up with a PCR test to be sure. </p>
<p>Working with company BioPorto Diagnostics, we hope to have an approved version of the test kit is available within the second half of 2020. Our initial goal is to help hospital staff continue working while minimising the risk they are passing on the virus. In the longer term, we can even envision screening air passengers or people going to work or social events. This could mean the current lockdown measures could be lifted for some aspects of life because we would be able to quickly determine who was infected and who wasn’t.</p><img src="https://counter.theconversation.com/content/135745/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jonas Graversen works for University of Southern Denmark. </span></em></p>Using antibodies to trap the virus could create near-instant pregnancy test-style kits.Jonas Graversen, Associate Professor, Department of Molecular Medicine, University of Southern DenmarkLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1346032020-04-03T19:23:20Z2020-04-03T19:23:20ZCoronavirus case counts are going to go up – but that doesn’t mean social distancing is a bust<figure><img src="https://images.theconversation.com/files/325122/original/file-20200402-74878-besz38.jpg?ixlib=rb-1.1.0&rect=0%2C7%2C5049%2C3368&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Empty parking lots show social distancing’s costs. It could take time to see its benefits.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/empty-parking-lot-at-dusk-royalty-free-image/6552-000128?adppopup=true">Pete Starman/The Image Bank via Getty Images</a></span></figcaption></figure><p>The last few weeks have brought previously unimaginable changes to the lives of people throughout the United States. Americans everywhere are waking up to a new reality in which they can’t go to work or school outside the home and they have to stay six feet away from others. More than <a href="https://www.businessinsider.com/us-map-stay-at-home-orders-lockdowns-2020-3">80% of Americans</a> are under such stay-at-home orders.</p>
<p>People are also <a href="https://coronavirus.jhu.edu/map.html">seeing charts in the news</a> showing rapidly increasing case counts. This is likely to <a href="https://www.theguardian.com/world/2020/mar/24/us-may-become-centre-of-coronavirus-pandemic-who-says">continue to occur</a>. The United States <a href="https://coronavirus.jhu.edu/map.html">surpassed Italy and China</a> to have the most confirmed cases of any country.</p>
<p>Americans might begin to wonder if these social distancing measures are working if the case numbers keep climbing. The problem is that the number of <a href="https://www.nytimes.com/interactive/2020/04/01/us/coronavirus-covid-19-symptoms-data.html">reported cases is not the same as the number of people who are infected</a>. It takes time for people to develop symptoms, seek treatment and get tested and for the results to come back. So the effects of social distancing might not be obvious from the numbers for a while. As <a href="https://scholar.google.com/citations?user=RNembkwAAAAJ&hl=en">an epidemiologist at the University of Michigan</a>, I can assure you that staying at home is one of the most effective ways to <a href="https://theconversation.com/how-to-flatten-the-curve-of-coronavirus-a-mathematician-explains-133514">slow the spread of COVID-19</a>.</p>
<p>A key reason for the delay between people severely restricting their movements and a drop in the number of new cases is that COVID-19 can have a long incubation period, the time between getting infected and becoming sick. The average incubation period <a href="https://doi.org/10.7326/M20-0504">is around 5 days</a>, but it can be as long as 14 days or more. This means that a person infected before a stay-at-home order might not get diagnosed until days later.</p>
<h2>Testing for COVID-19</h2>
<p>Testing is another factor in the delay between the start of social distancing and seeing the results. Many Americans don’t even know if they’ve been infected with the new coronavirus – SARS-CoV-2. Though the United States is finally ramping up production of test kits in federal, state and private laboratories, there are <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html">stringent criteria on who can get tested</a>. Testing is mostly limited to people with symptoms, frontline health care workers and first responders, and older people. However, scientists have found <a href="https://wwwnc.cdc.gov/eid/article/26/6/20-0412_article">asymptomatic and presymptomatic transmission</a> of COVID-19. </p>
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<span class="caption">A nurse prepares a COVID-19 testing kit in Richardson, Texas.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Virus-Outbreak-Texas-Testing/cbb9dadc83044a6fa9a58b1981009b5a/22/0">AP Photo/Tony Gutierrez</a></span>
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<p>Asymptomatic spread <a href="https://theconversation.com/to-get-on-top-of-the-coronavirus-we-also-need-to-test-people-without-symptoms-134381">has probably contributed</a> to the explosive growth of COVID-19 in the United States. Overall, as restrictions on testing ease, case counts are going to rise because more people, including those with mild or no illness, will be able to get tested.</p>
<p>Finally, it’s important to note that current COVID-19 tests <a href="https://www.the-scientist.com/news-opinion/how-sars-cov-2-tests-work-and-whats-next-in-covid-19-diagnostics-67210">take 24 to 72 hours to generate a result</a>. Even in China, where testing is widely available, the average time <a href="https://mp.weixin.qq.com/s/UlBi-HX_rHPXa1qHA2bhdA">from the onset of symptoms to a diagnosis of COVID-19 is five days</a>. It takes one to three days to get test results because the tests discover whether the virus’s genetic material is present inside a patient’s body. This requires replicating the virus’s genome using specialized laboratory equipment. Scientists <a href="https://thepulse.org.au/2020/03/25/breakthrough-in-fight-against-covid-19-at-westmead-health-precinct/">are developing tests</a> that look for telltale signs of the patient’s immune system response to virus, and these blood tests should provide quicker results. </p>
<h2>Believing can help make it so</h2>
<p>Unfortunately, people will, for the next few weeks, <a href="https://covid19.healthdata.org/projections">see increasing case counts</a> even as they might be rigorously complying with government directives to avoid contact with other people. The lag time in reporting cases could make people feel that the actions they’re taking – staying at home and limiting in-person social interactions – aren’t working. </p>
<p>When people think that what they do works, they’re more likely to do it, a concept known as self-efficacy. It turns out to be <a href="https://doi.org/10.1002/9780470479216.corpsy0836">an important predictor of human behavior</a>. For example, people who expect to be able to quit smoking <a href="https://doi.org/10.1007/BF01204849">are more likely to quit</a>. As self-efficacy diminishes, people could become less motivated and relax their adherence to stay-at-home orders.</p>
<p>Experience from previous pandemics in the 21st century shows that people’s behaviors and attitudes change over the course of the outbreak. As the 2009 H1N1 pandemic progressed, people <a href="https://dx.doi.org/10.2105%2FAJPH.2011.300407">became less likely to want a vaccine</a> and to perceive themselves at risk. Researchers who conducted monthly interviews with Hong Kong residents over the course of the SARS outbreak found that people’s perceptions of the effectiveness of staying at home and avoiding going to work <a href="https://doi.org/10.1136/jech.57.11.864">decreased as the outbreak wore on</a>.</p>
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<p>If Americans see increases in case counts and believe that their own actions are ineffective, they might be less inclined to follow through on social distancing. This could lead to increased contact among people, which could make it more difficult to bring the pandemic under control. Hopefully widespread testing and faster test results will lead to a more accurate understanding of who is and is not infected with the disease, not unlike what <a href="https://theconversation.com/coronavirus-south-koreas-success-in-controlling-disease-is-due-to-its-acceptance-of-surveillance-134068">South Korea has accomplished</a> so far. In the meantime, Americans should not take an increase in COVID-19 cases to mean that their sacrifices aren’t worth sustaining.</p>
<p>[<em>Get facts about coronavirus and the latest research.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=upper-coronavirus-facts">Sign up for The Conversation’s newsletter.</a>]</p><img src="https://counter.theconversation.com/content/134603/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Abram Wagner receives funding from the National Institute Of Allergy And Infectious Diseases of the National Institutes of Health under Award Number K01AI137123</span></em></p>COVID-19 has a long incubation time, and testing can take days to get results. Don’t let continually rising case numbers make you give up on staying at home.Abram L. Wagner, Research Assistant Professor of Epidemiology, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1054302018-10-29T14:25:17Z2018-10-29T14:25:17ZDIY medical tests: why some are safer than others<figure><img src="https://images.theconversation.com/files/242014/original/file-20181024-48712-gbxf8k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">False positive results have raised questions about home pregnancy tests.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/myloonyland/389135805/in/photolist-Y6XDrQ-9BzazU-8TXFGT-8qiZAZ-fzTLhM-5RQPVt-2dXqUN-5xxxG2-6hpMpd-diUihm-qvQeo1-53M2cc-cLAxn3-39QEFe-q4ZXe6-URd7AS-XQGhW8-GFQcAp-33i9yu-rTZG2P-21avrnb-5e144b-78BcH2-C1eLK-9ECDDq-buyDqb-mdwvb-4V8Hns-7UqeGE-4nxPMJ-4YpvPV-4XHB6J-2gbrJr-5BLS1K-mgkid-9dzNz-4V8Hq1-4kgcKZ-Aoqw2-78Bdea-bkuvT-5FsaCj-J14MjY-cf9Qy-fxawZ-J6R3Th-6fCxrc-2AtHiL-DURup2-LJHhuN">flickr/Rebecca</a></span></figcaption></figure><p>Recent media reports revealed that digital home pregnancy tests being sold at leading pharmacies in <a href="https://www.businessinsider.co.za/clicks-digital-pregnancy-test-show-pregnant-for-water-2018-10">South Africa</a> and <a href="https://news.sky.com/story/58000-pregnancy-tests-sold-in-uk-recalled-11517254">the UK</a> were consistently giving false positive results. Both countries acted quickly. The home pregnancy kits, reportedly manufactured by a large international manufacturer were immediately <a href="https://ewn.co.za/2018/10/13/clicks-recalls-false-positive-pregnancy-test">recalled</a>.</p>
<p>The incident led to lots of questions being asked about home tests and what had gone wrong. These included whether the tests were well regulated and whether or not they were safe.</p>
<p>Home pregnancy tests measure the hormone human chorionic gonadotropin in the urine of pregnant women as early as seven to 10 days after conception. A false positive is rare but it can happen. The reasons are usually because the user didn’t follow the manufacturer’s instructions, the kits had expired or the user was on medication that affected the outcome. </p>
<p>In this case it’s clear that the device itself was at fault. </p>
<p>Home pregnancy kits are just one of a range of point-of-care medical diagnostic tests. These include tests used by health care professionals in a small clinic, hospital, or at a patient’s bedside as well as those sold over the counter and used at home by the patient themselves or a caregiver. </p>
<p>Diagnostic tests performed in rural clinics or at the bedside have huge advantages, and can result in improved clinical decisions and treatment. Consequently, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5746785/">the market</a> for point-of-care testing is expanding rapidly and is now worth billions of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204237/">dollars</a>. </p>
<p>One of the main challenges has been the quality and accuracy of the final results. To fix this, organisations such as the <a href="http://www.who.int/bulletin/volumes/95/9/16-187468/en/">World Health Organisation</a> and the <a href="http://www.ifbls.org/images/IFBLS_Documents/POCT.PDF">International Federation of Biomedical Scientists</a> have published guidelines for the validation and use of a range of tests, particularly those used by health care facilities.</p>
<p>But there are very few guidelines for over-the-counter diagnostic tests. And regulation is patchy – in South Africa as well as in other countries. So it’s not surprising that false results happen.</p>
<p>In the absence of proper regulation of over-the-counter medical tests, patients need to take extra care when using them. They need to follow the manufacturers instructions closely. But they also need to confirm the result at an accredited laboratory and consult with a health care practitioner. </p>
<p>And governments need to take action to improve regulations so that faulty kits don’t get sold. In South Africa this would require consultation with all role players and the expansion of the current regulations to include all home based tests being sold at retailers.</p>
<h2>A wide array of tests</h2>
<p>The demand for over-the-counter diagnostic tests, performed by patients themselves, is increasing. These include tests for pregnancy, glucose and HIV.</p>
<p>In 2017 the first home test kit for HIV became available in <a href="https://clicks.co.za/health/article-view/everything-you-need-to-know-about-hiv-self-testing">South Africa</a>. The kits were welcomed because they increased the number of individuals who could simultaneously know their status and present for early treatment. This could ultimately result in a reduction in the spread of the virus. </p>
<p>Guidelines for HIV home testing have been included in the South African <a href="http://sanac.org.za/wp-content/uploads/2017/05/NSP_FullDocument_FINAL.pdf">National Strategic Plan</a> for HIV, sexually transmitted infections and tuberculosis. The guidelines emphasise that test kits should be approved by a regulatory body similar to the Food and Drug Administration in the US and meet international quality standards. </p>
<p>In addition, the South African Health Products Regulatory Authority has published <a href="https://www.sahpra.org.za/documents/838804628.01_General_Guideline_Medical_Device_IVD_Aug15_v2_for_comment.pdf">regulations</a> covering medical devices and in vitro diagnostic medical devices. These include issues such as their importation, transportation, registration and manufacture. </p>
<p>But, with the exception of HIV, home test kits are not adequately monitored and managed.</p>
<h2>Where to next</h2>
<p>The era of individuals taking control of their own medical decisions is here to stay. Home based diagnostic tests should be accepted.</p>
<p>Although guidelines for HIV home testing have been developed, there are huge gaps when it comes to other testing kits. This includes pregnancy tests. Authorities in South Africa – and in other countries – should up their game and provide guidelines and regulations on the quality, training and use of all point-of-care testing.</p><img src="https://counter.theconversation.com/content/105430/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Glenda Mary Davison does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The increased demand for home-based diagnostic tests calls for stricter regulation.Glenda Mary Davison, Associate professor, Cape Peninsula University of TechnologyLicensed as Creative Commons – attribution, no derivatives.