RLNC COVID-19 #7
As of April 27, 2020 every state is currently using COVID-19 diagnostic testing. However, this does not necessarily equate to wide-scale availability of testing or scientifically proven accuracy of all types of testing.
Testing in Florida
Testing information, as in where to obtain a test – can be located through this website and through your own County’s Health Department, and of course, a number of physicians’ offices and clinics.
Recently, Governor Ron DeSantis directed the Florida State Surgeon General Dr. Scott Rivkees to allow licensed pharmacists in Florida to administer COVID-19 tests on an emergency temporary basis. This should help improve access to testing once more tests are available.
Types of Testing
Molecular Tests look for signs of active infection. This is taken using a cotton swab that goes up the nose far back into the throat. It undergoes polymerase chain reaction (PCR) test, which detects signs of the virus’s genetic material.
Serological Tests detect antibodies that the body produces to fight the virus. Antibodies are present in anyone who has recovered from COVID-19. These tests require a blood sample. These types of test are particularly useful for detecting cases of infection with no or mild symptoms.
Testing has been difficult or impossible due to technical difficulties in initial kits, shortages in swabs, reagents and other parts of test kits. Private labs and companies are developing new tests to detect the virus.
There has been much in the news about the shortage of swabs. As a result, and to increase the availability of testing, on April 16, 2020, the FDA announced that it would allow a broader range of swabs to be used in testing, including some made of polyester that is far easier to manufacture for widespread use. Ultimately, experts believe that this will make the swabs accessible and available, even for home testing.
The material used in the swab can affect testing. The tests work by growing large amounts of the virus using a reaction called the polymerase chain reaction or PCR which copies the specific DNA of the sample. This larger amount of virus allows scientists to study it in more detail. Cotton swabs do not work because the cotton, as a plant, has its own DNA. Currently the swabs are made of nylon or foam. This expansion of allowable materials should help with the shortages of tests.
Another helpful step taken by the FDA includes the guidance that a sample can now be collected by circling the swab in the nose rather than sticking a much longer swab much deeper into the nasal cavity, a very uncomfortable procedure which means that the healthcare provider must be wearing full protective gear. In addition, the FDA now says a patient instead of a healthcare professional can do the swab. Further, instead of needing to be stored in transport media, a special solution that tends to be in short supply, the FDA says it can be stored in saline solution, which is more readily available.
FDA granted emergency clearance to the first in home test for the coronavirus. LabCorp will be selling this test, which is a nasal swab kit, easily completed at home. Patients will swab their own nose using a testing kit sent by the company and will mail it back in an insulated package. This test will be available in most states but will require a doctor’s order.
LabCorp has said that it would make the tests first available to health care workers and emergency workers who may have been exposed or have symptoms and that they would be available to consumers in the coming weeks.
Recently reported COVID-19 Symptoms
Aside from the usual cough and fever, most of us have heard about the unusual COVID-19 symptoms that people are experiencing such as loss of sense of smell and/or taste. There have been recent reports about some additional unusual symptoms associated with COVID-19, one of which is COVID toes. COVID toes are purple, swollen toes sometimes with blisters that look as if they have been frostbitten.
The so-called COVID toes are typically painful to touch and could have a hot burning sensation, Dr. Ebbing Lautenbach, chief of infectious disease at the University of Pennsylvania’s School of Medicine, told USA Today. This is a manifestation that occurs early on in the disease, meaning you have this first, then you progress. Sometimes this might be your first clue that you have COVID-19 when you don’t have any other symptoms. Dr. Lautenbach says that for some people that symptom disappears in a week or so without showing any additional symptoms, for others they come down with serious respiratory problems.
In order to track whether the toe lesions are a true indicator of COVID-19, the Academy of Dermatology has launched a registry to track all the dermatological effects that COVID-19 patients are experiencing.
According to Dr. Esther Freeman, a dermatologist and epidemiologist at Massachusetts General Hospital and Harvard Medical School faculty member, there are 3 general theories about COVID toes. Some experts think it is a sign of general inflammation in the body while others think the virus is inflaming the walls of the blood vessels causing a condition called vasculitis. The third theory is that the lesions are caused by blood clots in the vessels in the skin. It is thought that blood clots may be a complication of the virus. With the novelty of the virus, so much is new and useful data is only now being collected.
Welcome to Romano Law Nurse Corner
We are Susan Ramsey and Amie Goldberg, both practicing attorneys and nurses here at the Romano Law Group. Here is a little more about each of us:
Susan Ramsey is both an attorney and an RN. Ms. Ramsey’s professional experience began as a Registered Nurse in the Intensive Care Unit at Yale New Haven Hospital. While pursuing her Bachelor’s Degree, she was a counselor with the New Haven Rape Crisis Program. During her time with the Program, Ms. Ramsey counseled sexual assault survivors and performed seminars for local police departments, universities, and high schools. During her time working as a registered nurse, Ms. Ramsey decided to attend law school. Ms. Ramsey graduated from CUNY Law School, and has practiced law in several different State and Federal Courts. She is a Florida Heath Care Risk Manager and a member of the Palm Beach County Sober Home Task Force. Ms. Ramsey actively litigates cases involving catastrophic injuries and wrongful death on behalf of survivors, cases include injuries suffered by victims of professional negligence, product liability and medical negligence.
Amie Goldberg is both an attorney and a certified APRN. After completing a Bachelor of Arts Degree at Whittier College, Ms. Goldberg attended nursing school at Emory University. Ms. Goldberg’s professional experience started as a Registered Nurse at Egleston Children’s Hospital taking care of children with congenital heart disease. After a few years, she continued working in all areas of the hospital while attending Kennesaw State University on weekends in order to get her Master’s Degree in Nursing with a specialty of Primary Care Nurse Practitioner/Family Nurse Practitioner. During her time as an APRN, Ms. Goldberg decided to attend law school at St. Thomas University in Miami, Florida. Since graduating, she has mainly practiced in the areas of personal injury and worker’s compensation, fighting for the rights of injured people. Since joining the Romano Law Group, Ms. Goldberg has been the Director of the Opioid Litigation Project. Ms. Goldberg also practices in the area of medical malpractice and nursing home negligence, bringing an inside perspective and knowledge to help get justice for our clients.