It's just a test

I heard this startling story from a patient the other day: "I got a phone call...telling me my COVID-19 test came back positive.  But I never had the test done, I told the caller.  I checked in and completed the paperwork, but I left because the wait was too long.  They never [actually] tested me."

Incredibly, the caller didn't believe my patient.  "No," she insisted, "I am sorry...your test results were positive."  Worse, I suspect that these bogus "results" were sent to the state data bank that reports "new cases" to the CDC.  One more error in the Johns Hopkins numbers that most of the media rely on.

I have read numerous other accounts similar to this on social media.  They never seemed credible until several of my own patients reported directly to me that this is exactly what had happened to them.  Then a member of my office staff reported the same experience.  Concerns about the accuracy of the multitude of COVID-19 tests being used are commonplace and with good reason.  But now the issue of ghost tests calls into further question the validity of the whole testing process itself. 

Why would COVID-19 results be fabricated?  Is it a simple clerical error?  Are financial incentives being given for increased testing productivity?  Is politics at play — the more tests administered, the better the bureaucrats in charge look? 

But here's the important thing: if we can't get the basics right, and if the numbers are wrong, how can we expect the experts to make the best possible public policy decisions for the country?  We can't, and we can end up doing things that are actually inimical to the well-being of the people of this country!

Another real-life story: One of my patients owns a business in the city of Long Beach, California.  An employee of his, with whom he had direct contact, tested positive for COVID-19.  As a result, he decided to get himself tested.  So he drove to a COVID-19 testing center.  The Sofia rapid nasal test was used at this site.  This testing system uses an immunofluorescence-based assay.  To my patient's consternation, he, too, tested positive.  All of a sudden, he faced a cascade of unpleasant but necessary decisions including the cancelation of a long anticipated golf trip to Bandon Dunes, Oregon.  The next day, he took his wife to the same testing center; he also figured he would have himself retested just to be sure.  Naturally, both he and his wife tested negative for the virus this time. 

So which of the tests is correct? he wanted to know.  Both my patient and his spouse had no symptoms.  We are taught in medical school to treat the patient, not test results.  So no treatment was instituted.  But I wanted to know whether my patient's positive test from the day before had been reported.

Many of my patients who test positive go back and retest — sometimes multiple times until they get a negative result that conforms with how they feel.  They do this for a variety of reasons: legitimate concern about being contagious mixed with paranoia, return to work policies of their employers, and lack of confidence in any single test, to name a few. 

It has been reported that in a number of states, a patient testing positive three times over a couple weeks is listed as three positive tests in the central data bank.  Could this be in part why we have seen the number of cases escalate?  More positive tests lead to more multiple testing of a single patient.  What if I test positive while on a trip to a different state and then test positive when I come home?  Are my results counted twice, with each state registering a new case?  If the basic data begin to be suspect, how can you trust the effectiveness of the public policy on which they are based?

Image: USAF.

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