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Cancer Blood Work Tests and Coronavirus

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Published on April 27, 2020

Key Takeaways

During the coronavirus crisis, many cancer patients have questions and concerns about getting their blood tests for monitoring disease progression. Many also want to know which coronavirus test to get and when.

Are there issues with standard monitoring tests coming from a different lab than usual? How reliable are the tests to make sound treatment decisions? What might dosing look like for the coronavirus vaccine after it becomes available?

Two notable laboratory science experts Dr. Susan Leclair and Dr. Jim Griffith, from the UMass Center for Molecular Diagnostics, joined us to share their knowledge about lab tests. Watch as they answer audience questions about blood testing and infection surveillance, platelet counts, coronavirus antibodies in plasma, how much lab tests can vary from lab to lab, and more.

Although this is a sponsored program, Patient Power maintains editorial control and is solely responsible for the content of this program.


[Due to extreme load on our website and Zoom platform, viewers may experience a time delay between the audio and video of the interview - please note the transcript can be read below.]

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Transcript | Cancer Blood Work Tests and Coronavirus

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Recorded on April 24, 2020

Andrew Schorr:
Greetings from Southern California. I'm Andrew Schorr with Patient Power. Thank you so much to our sponsors today Pharmacyclics and Janssen for supporting this very important program. We're joined by two of my favorite guests. We've been skirting around in this Internet world getting everybody connected, but there is Dr. Susan Leclair, laboratory science expert who’s been with us on Patient Power many times. And her husband who's also a Professor of Laboratory Science, Dr. Jim Griffith. Thanks to both of you for joining us from Dartmouth, Massachusetts. Did I get it right, Susan and Jim?

Dr. Leclair:
You did.

Andrew Schorr:
Okay. Thank you. We have many questions. Let me talk about what this program is about. So many of us, and I have to silence my phone here, many of us are blood cancer patients, but not everybody. But we have various conditions or a loved one, and we're used to getting regular blood testing often at the same place on a certain frequency, same lab. Susan has been on many programs talking about that, being important if we can. So now we're in a new situation. And so what about now?

And then we hear about virus testing. And we should say that Jim is an infectious disease laboratory science expert. And so we're going to talk to him about virus testing, we're going to talk about antibody testing. Now, many people—Susan and Jim—have sent in questions, and we're going to go through those as many as we can. I have some off the bat. So Susan and Jim, are you ready to go?

Dr. Griffith:
Ready.

Andrew Schorr:
Okay. Here's the one that I was alluding to, for me and many people who are patients who get regular blood testing. So I always go to the university clinic and I get a test often before I see my doctor, and they run it through some testing equipment there, and within an hour, there's my doctor's appointment. And it's probably always the same lab, the same equipment, maybe it's the same chemo pathologist that looks at it. I know that there's some consistency.
 
So in the many webinars we've been doing with cancer specialists over the last few weeks, they said, well, whether you're in a clinical trial or you're not, but if you get regular testing, we're often having people not come to the maybe the big hospital, but go to a Quest lab or a LabCorp lab in their town. Or a clinic right around the corner from them, so they don't have to travel so much, but we can get the data. And then other people are being told by their doctor, well, yeah, you get the test every month or every week or every two weeks or whatever. But you know what, we don't have to keep to that same schedule. So Susan, can you comment on consistency of results and frequency, because all of this is anxiety-producing for us?

Dr. Leclair:
Okay. The first thing I have to ask is, who are you? Are you a person who has been pretty stable in your disease? So that if you've got CLL, your white count has been about the same, plus or minus over the past six months, ditto for your hemoglobin and hematocrit and platelets. So you're in a good place. You can probably stretch out the frequency of your laboratory tests, because your past history suggests that maybe you don't need tests every two weeks or four weeks or whatever the current thing is.
 
Talk it over with your physician and I'll bet you there's a good chance it'll be all right, let's skip every third one or every second one. If on the other hand, things are moving. No, you're not sure if you're going into remission, you're not sure if things are stable, well, then you're probably going to have them as frequently.

Andrew Schorr:
Like low platelets. I mean, people don't want to bleed...

Dr. Leclair:
...right. But if you know that for the last six months, you've had 40,000 platelets, and you don't seem to be bleeding, maybe you can talk to your physician about skipping the next CBC. On the other hand, we have 40,000 platelets and everybody is different with these numbers. And yes, you have nosebleeds or, yes, you've had a problem with getting a scratch to stop bleeding, or you shaved in that nick is still oozing. Well, then my guess is that your physician is going to want it more frequently. So it really depends on what your level of stabilization is, and how comfortable the two of you are with that level. 

Andrew Schorr:
I think you're right, the two of you. Because I think us patients, we freak out. I worry about my platelets. Somebody else, like we have with some of our MPN patients, they could have red cells or platelets that are through the roof. Mine are 70 something thousand and I worry about the trend. Okay. So what about where you get the test? Because the doctors are saying, well, yeah, you can usually come to the university hospital, but that's down the highway. I know you don't want to travel. So what about that going someplace else and the equipment being consistent?

Dr. Leclair:
Well, the equipment can have variations to it, and can have variations in methods. So there's the possibility that they won't be as close in relation to each other as they would if you went to the same facility. But it shouldn't be that much. Like, if your hemoglobin is supposed to be and has been running, let's say 9.8 to 10.5. Sounds good. Then if you go to another facility at about the same time of day, that still stays put, and at about the same level of hydration, than instead of bouncing between, say 9.8 and 10.5, this lab might give you a 9.5 or 10.6. They'll be close enough so that your physician should be able to think, wait a minute, this is a different lab. I've got to extend those ranges just a bit to accommodate those differences.

Andrew Schorr:
Okay. All right. You can understand why this is anxiety-producing for us.

Dr. Leclair:
Yes.

Andrew Schorr:
We did have one of the patients write me and she said I went to a Quest lab, this is one of these laboratory commercial labs, where you can go, and she went in, she said there was nobody there. She went in, she was in and out in five minutes. So it can happen where some people say sometimes that the big university hospital or big clinic, it takes a lot longer...

Dr. Leclair:
...and the length of exposure that you have inside the facility. So one option would be bring somebody with you to whichever one you choose to go to. Have them go in, you sit in the car, have them go in, do all the paperwork. And when someone calls your name, because it's time for you to go get your specimen collected, then that person calls you on the phone and says, in here now. And so what you've done is you've eliminated that chance or that time was sitting there in the waiting room worrying. You can worry in the car. But you know the car doesn't have anything, because you've been in it all this time. So you can just then run into the lab, get the testing done and leave.

Andrew Schorr:
Okay. So let me just go over—I mean, the situation is going to vary. We have people with us now who could have low neutrophils, and we're really worried about infection, not just COVID, but bacterial infections. They're really worried about that. Maybe they've had chemo and your neutrophils have gone down? Do they need some shot or something to boost them up? So that's kind of an important question, where are they now? They maybe be getting very regular testing.
 
Then we have other people like me with more chronic cancer, like a blood cancer, who've been getting tests for years. And what you're saying is, don't stress out if instead of getting tested every month, it's six weeks or whatever, and that's a discussion with our doctor. And if we have to go to a different lab, don't stress out about that because the doctor can factor for that.

Dr. Leclair:
They should be able to, yes. Because they're going to be receiving this in a different format, because it's coming from a different lab. So even if they didn't know you chose to do that, they will be aware of it because the formats are different.

Andrew Schorr:
So Jim has been a PhD for a long, long time in laboratory science. That's how Susan and Jim know each other, actually. So Jim, we're hearing about virus testing for the coronavirus. Okay. And we've been hearing about a different ways too. But basically, we've heard about swabs, we keep hearing about swabs. We also hear about the reliability of the test. So you've been following all this? Where are we now with if we're able to get a test? First of all, what is it showing or not? And how reliable is it?

Dr. Griffith:
There are two groups of tests. One group where you're looking for the actual presence of the coronavirus in this case. That's one way you need to swab. That has to be transported to the lab, and then a nucleic acid test is done in the lab looking directly for the virus. Now, one of the problems with it, well, one of the elements of that is that you're looking to see if you have the virus.
 
These tests are only good while the virus is there, and you have to have enough of the virus for the test to find them. The other kinds of tests are the antibody tests, and these are looking for, these are usually blood tests, these are looking to see if you had the virus. And since then, you made an antibody response, of course, you have to be immunocompetent enough to make an antibody response. And coronaviruses in this particular kit—Many viruses are great. They have protein covering, they stimulate your immune system, you make an antibody response, and we can find evidence of that years later.
 
Coronaviruses are not so good. Some of them do, but most of them do not stimulate very good antibody responses or immune responses. And so that is part of the problem with the antibody test. They're quick, much less expensive, but they have problems of sensitivity and specificity, and all of that kind of thing. And the fact that we might do a test on you, you did have the virus at one point, but we're not finding the antibody because you didn't make it. It might not be time, you didn't have enough time to make the antibody, or you didn't make a very good antibody or not enough for this test to show it.

Andrew Schorr:
For those of us who have been immunocompromised, will we produce, let's say when there's a vaccine and we haven't gotten to that, but someday when there's a vaccine, will we produce antibodies that are enough?

Dr. Griffith:
Well, the CDC has been recommending extra dose influenza vaccines for senior citizens for a number of years. So if you're going to go get your annual flu shot, and you identify that you're blank years old, your physician may actually prescribe this senior citizen shot, which is exactly what you were suggesting. It's got a little more stuff in it intended to stimulate a little more of an immune response.
 
In the case that you're talking about, yourself, that same logic would apply, yes, if we have a coronavirus vaccine. Possibly you might get two of them, or a double dose or however that might be done, and then hopefully you'll make antibodies. But then remember, that coronaviruses different from influenza viruses, coronaviruses are not very good at stimulating immune responses in anyone. I give you an example, 4 of the 200 viruses that cause the common cold are coronaviruses, four of them.
 
One of them we do make antibodies too, but they only last a few months. So we don't have a vaccine yet for this, but when we do have a vaccine and part of that 12 months or 18 months or 2 years or however long it will take to test out this vaccine, of which there are 70 being worked on in the world, part of that testing is to see if they work. Do they stimulate an immune response? And if they do, is the immune response protective? Does it keep you from getting the influenza virus down the road?
 
Well, we're going to be looking for that same thing for coronaviruses. First of all, do immunocompetent patients, mount an immune response, and then secondly, does it work? In your case there’s the third thing of if you're not significantly immunocompetent, will the coronavirus vaccine work at all? And it might, we don't know yet.

Andrew Schorr:
Okay. One other line of questioning and then I want to just start buzzing through the great questions we've been getting from people is, we've seen on TV people in New York and other places where a lot of people have had the coronavirus and COVID-19. Fortunately, most but certainly not all have recovered, and these wonderful people are donating their blood and they're making plasma to try to pool the antibodies, and then that could be used to help other people. And that's a great thing.
 
My question is, some of us get immunoglobulin, because we're somewhat immunocompromised. Myeloma patients, CLL patients, maybe people with other cancers as well. I get it every month. And my understanding is it's been made from pooled plasma, and it's helping me avoid pneumonia and other bacterial infections, for sure, but maybe some viruses. Theoretically, will what's happening with plasma from coronavirus antibodies get into that so that someday we'll have immunoglobulin that will protect us from COVID-19?

Dr. Griffith:
Well, immunoglobulin that's a great place to start because it has pre-formed antibodies, that would be the idea. And that it's protecting you, because the antibodies are already there. You don't have to make them, they're already there. The problem with how immunoglobulin that you're describing is made is that as you suggested, it is pooled. So let's say that the pooled immunoglobulin that you're going to get, in fact, may have plasma from patients who survived coronavirus. Well, that's cool.
 
However, the number of people in the world who have had or will have had coronavirus, is minuscule, is a tiny, tiny percentage of people. Something like four-tenths of a percent or 2 or 3 percent at maximum. And we're guessing at how many people have ever had—there have been some suggestions that the data from China, we missed half of the people. They said they had 87,000 cases, probably missed half, because there are people who had coronavirus and were never symptomatic. They might have made antibodies, but they were never symptomatic. So they might have donated. So we don't know.
 
However, even for all of those, the number of people who will have been exposed to this virus, of which this virus is only about four months old, in its entire history, four months, so the number of people who will have been exposed to this virus is minuscule. Therefore, in the pool that goes into the plasma that you're getting, the number of patients who donated plasma that have coronavirus antibodies will likely be minuscule.
 
As time goes on, however, a year from now, two years from now, five years from now, that number is probably going to go up, because I think a lot of people in the world will eventually be exposed to this virus. So long-term, maybe, short-term, I doubt it. The second problem is that there is this notion going around of patients receiving convalescent plasma or hyperimmune plasma. In that case, we're taking a unit of plasma from a patient who's a definite coronavirus survivor, and we're going to give it to you. One unit from a coronavirus survivor can satisfy the need of three patients who don't have antibodies.
 
So that's one for three. And there's a minuscule number of people who have this, even though it's affecting society widely. That's the next problem. Third problem, there is no way, we have no organized registry of any kind anywhere in the world to track down these survivors and get them to donate plasma. So the hyper-immunoglobulin, that maybe down the road, but that's not going to be a solution now. Pooled plasma, my guess is by the number of people that have had it, that's a few years down the road that it might benefit you.

Andrew Schorr:
Okay. We got a question on exactly what you're talking about. I don't know if this is for you or Susan, but somebody just wrote in. They said their son as the antibodies for the virus. I have high-risk chronic lymphocytic leukemia, CLL. Can I have his plasma transfused to me for my protection? She said she already gets his platelets. So that's one to one, if you will, could that happen just like, they say if you're having a surgery, your family members donate blood to help with the supply. I don't know if it necessarily goes to you, but they contribute. What about here? Jim, do you know?

Dr. Griffith:
That scenario would solve a lot of the problems with donated plasma. When you're donating plasma from a survivor to someone who you are trying to help, it has to be processed, you have to make sure it's the same blood type and all that. So if this patient is already receiving platelets from her son, then all those problems have been solved. So that's good. The fact that her son may have antibodies, which he may, we just don't know, and we don't know how good they are, that's also a good thing. So I would say in her case, there's a chance that it might work. It might be good.

Andrew Schorr:
Susan, so people are asking a number of questions about testing. So you've talked for previously just about blood testing, be hydrated, this and that. Again, wherever you get the test, people want to have accurate values. So any recap you want to tell us whether we go to the local lab, whether we go to where our doctor's office where we always would drive to just so we can still have as much consistency as possible.

Dr. Leclair:
Sure. You hit the right word, it's consistent. If before you drive to the medical center, which is an hour away, you have a good breakfast because it's going to be an hour away. Then have a good breakfast, wait 45 minutes, and then go to the nearest drawing station that might be available to you. So you want to keep that time and that hydration level. You're going to be a little bit nervous anyways the first time, because you don't know where the parking is and you don't know how to get in, and all of the rest of that foolishness. But try and keep it exactly the same way you do it all the time. If anything else, it will make you feel more in control to know that that's exactly what you're doing.

Andrew Schorr:
Okay. We should mention that there may be situations where your doctor arranges for a home healthcare nurse to go to your house. Taking precautions, of course. So we'll see where this goes, where that has happened. So we're a little freaked out about going to the hospital or the big clinic now because we know that, particularly a major hospital if you were in New York, but now Boston, Louisiana, Detroit, and it's going to be other places around the country.
 
I've been hearing from Indianapolis and Los Angeles, wherever, is you don't want to be there. So what precautions would you say? I've heard that the hospitals are really working hard, like for cancer patients coming back, to have them go to a different place. Are either of you familiar with that?

Dr. Leclair:
Well, we live in Massachusetts, so I can give you some information about how Massachusetts who often thinks that they're Boston and nowhere else is doing this. So I'll give you the Boston hospital view. The majority of the hospitals that are taking in patients who are COVID-concerned, let's put it that way, whether they're positive or negative, have segregated off a different entrance and a different activity place. You want to call it perhaps the potential coronavirus emergency room. And then they will have another entrance in another area that is segregated off for everyone else.
 
It's not just the people who are listening to this today. Yesterday, several administrators from hospitals and several physicians went on the television to say, look, we've got room, we've got people that are available, do not stay home if you think you're having a heart attack. Do not stay home if you think you're having a stroke. We have capacity that we have set aside just for you. And the majority of major centers across the country have done that. They have managed to segregate space for the non-infectious concerned patients and the corona concerned patients. So don't worry about that.
 
I would also make use of the telephone. I know that sounds at this point, kind of silly, but, before you leave for that two-hour drive to the medical center, call the clinic. Ask them how far behind are they? If they're behind a half an hour delay, you're leaving in a half an hour. If they're going to be okay, then move along. When you park your car, give them another call, see what's going on. And then, if I were you, and I was really concerned about this, I would be in gloves and a mask.

Andrew Schorr:
Well, Susan, I would ask another question that is, do I need to come to you or is there a facility I could go to that's near my house?

Dr. Leclair:
If you're just using standard blood test, the metabolic panel, the electrophoresis, the CBC, the standard warhorses of the laboratory, then you can go anywhere. Because everybody will have the capacity to collect that and transport it someplace else correctly. The question you're going to have to ask is, if you want to know about genetic screenings of a particular mutation, you might want to call that drawing station and ask, does your facility; does Quest, does LabCorp, does whatever the private lab, do they do that test? Yes or no?
 
If they don't do the test, can they transport it correctly to, I'm going to say your medical center, because that's where that's performed? So you can ask those questions beforehand and figure out what's going on. It may be that you have to go that two hours to the medical center, but maybe not.

Andrew Schorr:
Susan, one of the tests I get from time to time and other patients as well is IgA, IgG, IgM testing, I'm not even sure what it means. I know when I get the immunoglobulin, it helps. Does that number tell us anything about our immunity?

Dr. Leclair:
Absolutely. IgM is a type of antibody you make as the first response to an insult. Take a look at the common cold. You get the virus, it multiplies a while in you for like maybe two to three days before you begin that, oh my god, I think I'm coming down with a cold stage. The first three days you figure, I'm not too bad, this isn't going to be too bad, and then you plunge down to the, I think I'm going to die stage of a cold. And that's like days, say three through seven. Day eight, you realize you're not going to die from this cold. What has happened?
 
In the time between your first notice of the virus and day eight, nine-ish, you make IgM, that is your very first defense, antibody defense against your antigen, your bacteria, your virus. The problem is it is not very long lasting. It gets you going, you make it fast. It gets you going and it starts your process of defeating this cold. But about a week later you start making IgG. That's usually a longer term antibody and that's kind of the cleans up, gets everything finished, puts everything away and gives you a sense of some protection for a while. As Jim was saying, sometimes it's for life, sometimes not so long.
 
So IgA, which is the only one I didn't mention is one that protects your GI tract, your nose and your mouth. There are cells that line, every place that interacts with the outside world. You breathe in, it comes down to your throat, you eat, you drink, it comes into your throat, stuff goes down into your lungs, it goes down into your GI tract, there are cells that line that entire area. They produce IgA. They don't have to travel in the bloodstream to anywhere because all they're going to do is dump their antibodies directly out into the nasal sinuses or into your GI tract. So that too is an early responder to diseases.
 
So after M and A are early. One is bloodstream, one is more directly into the tissue proper, and G is long-term protection. So your physician gets a pretty good profile of how good you are.

Andrew Schorr:
But that's where we are with viruses, things that have been out. Now we got this thing that's like from outer space, Jim. So no matter what our IgG, IgM, IgA have been, does that mean anything related to the coronavirus version that we have now?

Dr. Griffith:
Well, if you have antibodies, and most of the tests that are available as antibody tests, they're looking for IgG, if you have antibodies, that's a good thing. And if the test shows up positive, then it does indicate, like the woman you were talking about earlier whose son has antibodies, that suggests that you were exposed, you did make an immune response as Susan was describing, and that's all good. What we don't know is how long those antibodies will last.
 
And again, they could be perfectly long lasting like influenza virus when you make antibodies to influenza virus, it lasts pretty good till the next time you encounter that influenza virus. What we don't know with coronavirus is, will these antibodies last and will they be protective? So it's not a bad situation. We just don't know. Four months old this virus is.

Andrew Schorr:
Right. But if I've been getting immunoglobulin, wasn't pooled with antibodies from coronavirus survivors, et cetera, I don't have any antibodies to that, right? I mean, my other IgG, IgM, IgA, that doesn't help. Does it?

Dr. Griffith:
Yes, you have bullets for the wrong war.

Andrew Schorr:
Oh, boy. Okay. Can I ask you a question about testing, Jim? So, first of all, we have a shortage of tests in the U.S. as we do this program now. And you've talked about the reliability of the test. But do we have any sense of who will get the test as it rolls out? I know we've been hearing about healthcare providers, but will vulnerable patients be able to be—Where will we be in the line? Do we know?

Dr. Griffith:
Well, it depends on the jurisdiction where the tests become available. I'm pretty sure that most people who are in control; a mayor, director of public health, governor of a state, I'm sure in most cases, they will try to direct the available testing to healthcare providers. Because this is a double whammy with them. If they aren't covered, aren't measured, aren't evaluated, then they get the virus, and they're out of the loop, which means they can't be there saving lives because they're sick themselves.
 
Plus, they contribute to the patient load of whatever hospital that was. So it's a double whammy. So we have to do them first. After we do the health care providers, that's a lot of tests, after we do that, then—I don't know who will decide if we continued to have a shortage of tests, will it be other first...

Andrew Schorr:
...first responders.

Dr. Griffith:
Like people who work ambulances, certainly the elderly in nursing homes, almost 50 percent of the deaths of coronavirus in the United States have come from people who were in nursing homes. So maybe that's an area that you really have to find out. Do they or don't they? Nursing homes typically don't provide a lot of personal protective equipment for the staff that work there. So you kind of have to find out pretty quick. And then I would guess, I would hope that whoever is deciding would be looking at people who have risk factors, and that would include your blood cancer patients, other cancer patients. But I don't know.
 
That will that would be a good question to ask in your jurisdiction wherever you are, how are you going to decide? As long as we have a limited supply of tests, how are we deciding who gets tested? That's a good question to ask. And the answers will be different from jurisdiction to jurisdiction.

Andrew Schorr:
So somebody sent in a question and asked, "Well, what test should I get when it's available to me before I feel like I can open up my own life, knowing that we are, depending upon the cancer we've had, more or less vulnerable?"

Dr. Griffith:
Well, if the questioner has been self-isolating, following the rules, wearing a mask, not going out very much, not playing basketball with 10 other people, if they've been doing that kind of stuff, then that would suggest that it's been a while, two weeks, three weeks, four weeks, et cetera. So I would say the best test in that scenario would be the antibody test, because those patients are past the time when they would have had active viruses. So then you want to have an antibody test.
 
But as soon as you say that's the test I want to have, I want to start going out, I want to go back to work or I want to go to the mall or whenever those things open. But then you're faced with the other problem, is which antibody test? And you should be asking, what is the reliability of this test that I'm going to have? You want to know because some of them are pretty reliable and some are definitely not.

Esther Schorr:
Andrew, this is your producer. The clarification that's needed is, I believe, Jim, please clarify this, that there's some matching that needs to happen between the donor and the patient before considering giving her his plasma. She's not getting his platelets or any transfusions or infusions from him at this time.

Andrew Schorr:
But if she could, what has to happen?

Esther Schorr:
Right.

Andrew Schorr:
Okay. Thank you, Esther.

Dr. Griffith:
Esther, thank you. That's a completely different situation. In the first scenario, I was assuming and I said, all those problems have been worked out. But if they haven't, and the only advantage her son has is that he probably has plasma with antibodies in it. We're still guessing at that, then yes, you still have to match. That plasma has her son's entire defensive bullet holster. They're all in there, all the antibodies, all of the blood type stuff in there. There's all kinds of stuff in there. And you do have to do some matching to make sure that she could receive her son's plasma at all.

Andrew Schorr:
What advice would you give people just generally, as we are in this never-never land of availability of testing? Can we get a reliable viral test? Can we get more blood taken for an antibody test? How do we get our head on straight for this? How do we take a deep breath, any suggestions?

Dr. Leclair:
Well, I think talking to physician is probably one of the best places to start. Because each physician is doing exactly the same thing you are when he or she looks at his patients. Where are you? How are you? What are we looking forward to? What is the history of your condition? So the two of you can come to some kind of agreement because you can say to your physician, once every three months is fine for you, it's not fine for me. I have to have it more. Or, yes, I can deal with less frequent laboratory testing. So that's one thing that you can do.
 
Another thing that you can do is talk to them in terms of the availability of the coronavirus testing, whichever one, in a sense, tell them the truth, which I understand is kind of harder to do sometimes than some people might want. But I would want you to say to them, as Jim just mentioned, I've been really good. I've gone out less than once a week. No, I have never had in the last six weeks, I have not had one incidence of chest pain, or the one time I did it turned out to be heartburn and because of I didn't realize they were chili peppers and something. I didn't have any of the signs and symptoms.
 
Really do you need to test, either one of them? Because you've not had much your physician might say to you, okay, how about let's make a deal. We're going to go for the antibody test, but we're going to wait another three weeks. Because by then maybe the first initial avalanche of people requesting the test, people who are first responders, people who actually had signs and symptoms, they might be over with, and then we'll get you in on the very next wave of these.
 
So you can have a sense of, okay, that's good for me. That's good for the greater community. Let's go with that. So you could talk to your physician and figure that out. If you've never had any signs or symptoms of this and you don't know anybody that did, my guess is the antibody test is going to be your major choice of tests.

Andrew Schorr:
Okay. And somebody wrote in and said, should I insist that my family members be tested too?

Dr. Leclair:
Again, how obedient have they been? I can tell you that with the exception of feeding the now migratory birds that are getting into our backyard now, Jim has not been out any place that I haven't been. He feeds the birds because you need a ladder to get to the bird feeders. So should I insist on him having a test? No. If I have someone who lives in my house who's a first responder, well, yeah. But they're going to get theirs anyways. If I know that I have a teenager whose version of self-isolation is not going out three times a day, but only seeing their friends once a day. Yes, I would insist on testing.

Andrew Schorr:
Jim, you mentioned all these tests that are being tried out. And the FDA is maybe blessing some but they're different, and we've also had a question of reliability. Is there anything the patient can know now, when they go to the doctor like Susan said, to know which test? Is like, what's the Cadillac test? What's the Rolls Royce test? What's the Tesla test? Whatever. That we can say that’s a quality one and both my doctor and I can rely on it. In other words, consumers and in testing, I can't even imagine that, but we could get there.

Dr. Griffith:
With as bumpy road as we have in coronavirus testing, every patient and every physician should be asking, because it's the lab that's doing the test, they should all be asking; all the patients and all the physicians should be asking, at what level of sensitivity and specificity is this test that you are performing? The actual one that you are performing. That's the key question. If sensitivity and specificity are in the 95 percent range, that's pretty good. That's going to deal with the false positives and false negatives.
 
As I mentioned earlier, some of the antibody tests out there have 40 percent false negatives. In my view, most physicians I think would conclude, that test is virtually useless. If you're going to have a chance encounter, you're going to have a brief encounter with your healthcare professional, ask that question. What is the sensitivity and specificity? What are the false positives and false negatives? Those should be known even with emergency use declaration by the FDA, which there are plenty of these tests out there that have that, which means they skipped a lot of the validation. They should at least have an answer to that.

Andrew Schorr:
So folks, if you remember that in your discussion with your doctor, Susan's urging you to have that on a lot of counts. What tests you need, when, et cetera. When we start to get to these antibody testing and viral testing, all that, specificity and sensitivity. You and your doctor can be confident that you're getting accurate information so you can make decisions. Okay. Go ahead.

Dr. Griffith:
The sensitivity is essentially, if all tests are looking for something, the sensitivity is, does the test find what it's looking for? That's the sensitivity. The specificity is, does it find anything it shouldn't find? For example, a lot of these antibody tests are also positive for other coronaviruses and other viruses. So it's two things, and the sensitivity and specificity if they are off will result in false positives or false negatives. So if you have one question to ask, that's what to ask.

Andrew Schorr:
Okay. So first of all, related to frequency of testing, talk to your doctor, talk to your doctor's nurse. I've been getting this testing, do I need it on the same schedule? Second of all is, are there other places maybe closer to home I could go and then call et cetera? Maybe they can help coordinate if it's needed, even in some cases, particularly if you had some disability, is there a home healthcare nurse or somebody who could do a blood draw safely for you? Okay. Then the next question is we get into viral testing and antibody testing. It sounds like the jury's still out. First of all, what is sensitive and specific? And what is reliable? And then when does it apply to us has cancer patients or family members, right?

Dr. Leclair:
One small thing because when you're moving around and changing where your drawing station is going to be, or if it's somebody who comes to your house, you might want to make sure that the specimen is labeled correctly. One of the problems that laboratories have frustratingly and insanely is when specimens come down to the laboratory and they're not labeled at all, or they're labeled partially like “Smith.” Well, according to both ethics and the law, all things that are incompletely labeled must be thrown away.
 
Now, you don't want me to throw away your blood, or at times I've actually seen this on bone marrow samples. So you don't want me to throw this stuff away. So if somebody is packing up their kit, whether it's in a phlebotomy station or in your home, you might want to check to find out if that specimen is completely labeled. First and last name, middle initial, your address, your age, and yes, the physician to whom you want me to send the report. Because nobody wins when those things are eliminated.

Andrew Schorr:
You two, Susan Leclair and Jim Griffith, are really the dynamic duo in helping us understand all these different tests, and where they can help us and where the limitations are in the evolving story. So of course, we'll have you back. But thank you so much. I love you guys and I know our audience does, too. I want to thank our sponsors for this very important community event, Pharmacyclics and Janssen, we're very grateful for them in supporting the community. Look for our webinars ongoing on very important topics. You can always send us comments and questions to comments@patientpower.info. I'm Andrew Schorr. Remember, knowledge can be the best medicine of all.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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