image title

'From Bench to Bedside in the COVID-19 Era'

The next COVID-19 health talk will take place at noon, Thursday, Oct. 22.
The best way to deal with COVID-19? Don't get it. (Prevention is key.)
September 18, 2020

College of Health Solutions kicks off fall series with talk about COVID-19 testing, clinical care

In the latest installment of Health Talks: COVID-19 Series, the Arizona State University College of Health Solutions’ series of talks on issues related to the COVID-19 pandemic, moderator Matthew Scotch, an associate professor of biomedical informatics, welcomed Executive Director of the Biodesign Institute Joshua LaBaer and Professor David Sklar to discuss everything from the recent history and development of human coronaviruses to the current diagnostic challenges and methods of combating COVID-19.

The health talks are free, available for continuing education credit and open to anyone seeking information and knowledge while navigating the current health crisis. The COVID-19 series in particular is offered virtually and features experts from a variety of backgrounds on topics including causes of the virus, how scientists use biomedical data to make data-driven decisions and how to maintain well-being and health while sheltering at home.

The next talk in the series, “Health Information and Misinformation During COVID-19: What Can We Believe?” will take place at noon, Thursday, Oct. 22, and will feature Clinical Assistant Professor Swapna Reddy, Managing Director of the Cronkite School’s News Co/Lab Kristy Roschke, and Dr. Quinn Snyder, an emergency medicine physician at Banner Desert Medical Center.

On Thursday, Sept. 17, the day of the talk titled “From Bench to Bedside in the COVID-19 Era: The Role of Testing in Clinical Care and Public Health Surveillance,” Scotch noted in his introduction that the state of Arizona reported about 1,700 new cases of the virus, according to the Arizona Republic.

“(That) represents an increase from the downward trends that we’ve seen over the last few weeks,” he said.

LaBaer was the first to present, beginning with a brief history of human coronaviruses, which began with mild to moderate upper-respiratory tract illnesses in the 1960s, followed by the emergence of SARS in 2002, MERS in 2012 and now SARS-CoV-2.

“I always say that this virus won the virulent virus trifecta, because it has three characteristics that make it such a devastating virus for humankind,” LaBaer said of SARS-CoV-2.

Those characteristics are: severity, spread and stealthiness. Severity because of its high morbidity and mortality rate (10 times worse than the flu); spread because it is capable of airborne transmission; and stealth because the peak of infectivity is when the individual is still presymptomatic.

Currently, two types of tests exist for the coronavirus: the qPCR test for viral RNA, which determines whether someone is presently infected, and the antibody test, which determines whether someone had past exposure to the virus.

As early as March, LaBaer and researchers at ASU’s Biodesign Institute began meeting to develop a system for testing for the virus at the university. At that time, there were very few tests being done in the state of Arizona – only about a couple hundred nasal swab tests, according to a poll they conducted with hospitals.

“We realized as a university, we were uniquely capable of setting up this sort of operation, because we had the skill sets, we had the technology. … We know how to do this, let’s do it,” LaBaer said.

Today, ASU Biodesign’s Clinical Testing Lab runs more than 4,000 tests a day, with plans to expand to 16,000 per day. Much of that is possible because researchers there were the first in the state to develop and offer saliva-based testing to the public, greatly expediting the testing process.

Biodesign researchers are also conducting contact tracing and have made a website available to the public that tracks epidemiological data for the state.

“A lot of people regard our site as one of most reliable sites for providing data about the pandemic in the state of Arizona, and we’re quite proud of that,” LaBaer said.

Much of Sklar’s presentation focused on the challenges physicians are facing in diagnosing and treating the virus.

“This disease, as well as being very new and complex and interesting, has a variety of clinical implications,” he said. “Unfortunately, the clinical information is just getting almost overwhelming in terms of keeping up with it.”

Reasons for that range from the variety of symptoms to the unpredictable nature of its progression. The majority of cases, 81%, are mild; 14% are severe; and 5% are critical – the problem is there is no way to predict who will be among the 81% and who will be among the 5%.

The difficulty associated with diagnosing the virus based on a physical exam alone underscores the importance of the kind of testing being done by the Biodesign Institute and other organizations, Sklar said.

As far as treatment, there are some things that seem to remain consistently effective, such as hydration, and the use of steroids seems to be promising at the moment. However, Sklar said, “What I’m telling you today may not be true tomorrow.”

That has been the case with ventilators, used heavily and often at the beginning of the pandemic, health care workers are now finding that they can sometimes worsen the situation by causing injury to the lungs.

“Vaccination, of course, is the million dollar question,” Sklar said. “Will we have a vaccine? Most likely, we will. What will it cost? We don’t know. Who will have access? Most likely it will be people either in the health care provider group or people who are at highest risk. Will it be safe? That’s again, one of the million dollar questions."

Sklar noted that there has always been some fear of and resistance to vaccines, even when their safety was fairly well-proven, such as measles vaccines. Those attitudes may be due to instances in the past, as with the swine flu vaccine, where some who received it experienced complications, though Sklar added that it was a very small number of people in that case.

During the Q&A portion of the talk, Professor Scott Leischow, College of Health Solutions director of clinical and translational science, asked whether continued improvements in managing symptoms would be sufficient enough to get society back to a state of normalcy while we wait for a vaccine.

“We really want to stop the spread; we don’t want to be operating at the level of managing symptoms,” LaBaer said, adding that prevention is key because of how much we still don’t know about the virus, including whether asymptomatic people can suffer long-term effects.

“The virus has not even been in the human population a full year yet, so long-term studies are impossible,” he continued. “But we do know there are plenty of viruses out there that can cause cancer over time, that can cause neurological disease over time, that can cause all kinds of long-term health sequelae … and we just simply don’t know in this case what getting this virus does. So the best thing you can say is — don’t get it.”

And the best way to not get it is to continue doing what we already have been: wearing masks, socially distancing, staying home and getting tested if your work or life circumstances require you to interact with the public often.

Top photo: Screenshot of Biodesign Institute Executive Director Joshua LaBaer's PowerPoint presentation for ASU's College of Health Solutions COVID-19 Health Talk series, featuring the faces of researchers at ASU Biodesign’s Clinical Testing Lab.

 
image title

The facts behind student misconceptions about COVID-19 testing and symptoms

September 18, 2020

As the world’s understanding of COVID-19 continues to develop, so too do questions and misconceptions about symptoms and testing. 

Ciara Harding, a junior studying microbiology in The College of Liberal Arts and Sciences, works with the Arizona Department of Health Services as a case investigator to assist individuals showing symptoms of the virus. Through her work and interactions with fellow Arizona State University students, she noticed a number of common misconceptions being shared about the virus and best practices for keeping the community safe.

We consulted with ASU Health Services and the staff at Educational Outreach and Student Services to address these misconceptions and other commonly asked questions.

Misconceptions

Misconception No. 1: A negative test means it’s fine to go to parties, travel, etc. 

The facts: A negative test is just a snapshot in time: It means the coronavirus was not active in your body (or that there wasn’t enough virus present yet; see Misconception No. 2) at the time of the test. It does not mean that you’re immune or that you haven’t been infected in the time since the test.

Even if you get a negative test result, you should continue to take steps to protect yourself and those around you: Wear a face covering, keep a physical distance of at least 6 feet from anyone you don’t live with, wash your hands often, and clean and disinfect frequently touched surfaces daily. Avoid large gatherings and unnecessary travel, and use extreme caution even in smaller gatherings.

Smaller gatherings are not automatically “safe,” either — you can contract the virus just as easily during a small gathering as you can at a large one. It’s best to use face coverings and social distancing with anyone you don’t live with.

Repeat: A negative test result is not permission to socialize with abandon. Continue to take precautions.

Misconception No. 2: A negative test means I’ll stay COVID-19 free all week. 

The facts: A negative test result only means that the test did not detect the virus on the day you took it. If the test was administered soon after you were exposed, there may not be enough virus in you for the test to catch yet. That’s how you might get a negative test result but develop symptoms a few days later.

According to the Centers for Disease Control, COVID-19 symptoms typically appear an average of five to six days after exposure, but could appear in as few as two days or as long as 14 days after exposure.

This is why test results are just a snapshot in time, and why it’s important to get regular, frequent tests. 

Negative test results don’t guarantee future protection or mean that you couldn’t have contracted the virus on the day of the test.

Misconception No. 3: Face coverings replace the need for physical distancing. 

The facts: Face coverings reduce but do not eliminate the possibility of virus transmission, so you still need to physically distance. There are several reasons for this: Not everyone wears a mask (Remember: Your face covering protects others, and their mask protects you), not everyone wears one correctly (it needs to completely cover the mouth AND the nose), and non-medical-grade masks aren’t going to catch all respiratory droplets.

The best strategy is combining both physical distancing and face coverings.

Misconception No. 4: If you test positive but feel fine, then you’re OK to not isolate. 

The facts: Even if you have no symptoms (asymptomatic), you are still contagious. You can still pass the virus to other people, even if you feel OK. And the person you pass it to may not be so lucky and may come down with severe symptoms or even die.

If you test positive — whether you live on or off campus — you should self-isolate for the period of time necessary per the Maricopa County Health Department guidance (currently minimum 10 days plus no fever and improving symptoms for 24 hours) and utilize no-contact food delivery. Students should contact ASU Health Services at 480-965-3349 for more information and assistance.

Misconception No. 5: “No test results, no coronavirus.” 

The facts: Some people think self-isolation should begin only after a positive test result comes back; this is incorrect. If you know you have been exposed to someone who has COVID-19 or if you are experiencing symptoms, you should self-isolate immediately and not wait until you get a positive test result — you could be infecting others in the time you’re waiting on a test result. It’s not just about you.

Also, if you do have symptoms or know you have been exposed, you should utilize the drive-through options for getting an ASU saliva-based test if at all possible, in order to avoid exposing the testing staff.

Misconception No. 6: Young people are only experiencing minor symptoms.

The facts: Although many young people get only mild symptoms, others end up on respirators and a few have lost their lives to COVID-19. There’s no way to tell how an individual will fare, either; some people have mild symptoms that turn overnight into a need to be on a respirator.

Even if a person survives COVID-19, there can be serious, long-lasting damage to the body, such as heart damage and reduced lung capacity. Some people are also at risk of developing anxiety or post-traumatic stress syndrome after surviving the experience of being on a ventilator.

And again, it’s not just about you. You might have only mild symptoms, but you could pass it to someone who is not so lucky. Or they could pass it to an at-risk relative. 

Other common questions

Question: Which testing sites are open to the public?

Answer: The ASU community (current students and employees) have the choice of multiple on-campus locations for getting a test.

The locations for public testing — around both the Phoenix area and the state — are separate. A list of those sites can be found at https://azdhs.gov/preparedness/epidemiology-disease-control/infectious-disease-epidemiology/index.php#novel-coronavirus-saliva-testing.

Find links to register for a free saliva-based COVID-19 test — for both the public and the ASU community — at https://biodesign.asu.edu/research/clinical-testing/testing.

Q: What specifically happens when a student is required to quarantine — who notifies them, who checks on them and how often, how do they get university services, etc.?

A: A member of the ASU Health Services team will contact a student believed to be exposed to a person in the community who is positive for COVID-19. In that notification, they will be given information about how to quarantine, requirements, and how to get ongoing medical care or testing if they become symptomatic. They are also given contact information for the Dean of Students Office and ASU Housing (if a resident) to help with any logistical or personal issues during their quarantine (such as communication with professors or food delivery). Each student is assigned an “Engager” who checks in with them daily, or as often as the student would like. We ask the student what frequency of communication they would like from us.

Meals are provided to students in isolation and quarantine using meal swipes from their meal plan. Meals are delivered based upon the following schedule: 

Weekdays

  • Breakfast delivery: 8:30– 10:30 a.m.
  • Lunch delivery: 12–2 p.m.
  • Dinner delivery: 5–7 p.m.

Weekends

  • Brunch delivery: 11 a.m.– 1 p.m.
  • Dinner delivery: 5–7 p.m.

Q: Why aren’t students who test positive required to retest before ending isolation?

A: Studies have shown that those who have recovered from COVID-19 may have low levels of the virus in their bodies for up to three months. This means that if that person is retested within three months of initial infection, they may continue to have a positive test result, even though they are recovered and are not spreading COVID-19.

Because of that, the CDC is no longer recommending retesting for COVID-19 after a positive diagnosis until three months have passed from the date of the first positive test, since repeat testing may remain positive during that period of time. Instead, when a student has met county and state criteria for release (listed below), they can get cleared by ASU Health Services or provide a letter from an outside medical provider showing that they have met the criteria listed below.

To return to campus, students and employees must demonstrate that they have met the criteria set by the Maricopa County and state health departments:

  • At least 10 days since symptoms first appeared and

  • At least 24 hours with no fever without fever-reducing medication and

  • Symptoms have improved.

 Or if the individual never had symptoms:

  • 10 days since the date of first testing.

More information

  • Find more questions and answers on ASU's extensive and searchable coronavirus FAQ page.
  • Students, employees and the public can register for a test on the Biodesign Institute’s COVID-19 saliva testing website.
  • ASU Health Services has in-person and telehealth options. Call 480-965-3349 or visit https://eoss.asu.edu/health for more information.
  • ASU Counseling Services is offering mental health support services remotely and in person as needed. To reach a counselor or schedule an appointment, please call 480-965-6146. For students enrolled through ASU Online, counseling is available through 360 Life Services, a free, 24/7 counseling and crisis intervention service. Staff can be contacted at 833-223-9883 or visit https://goto.asuonline.asu.edu/360lifeservices.

Aaron Krasnow, associate vice president of Health and Counseling Services; Stefanie Schroeder, medical director, ASU Health Services; and Joan Sherwood, executive director, Educational Outreach and Student Services, contributed to this article.

Top photo by Deanna Dent/ASU Now