How are the shortages of the polymerase chain reaction (PCR) tests affecting the number of tests your sites are conducting?

We are now more focused on cluster testing, utilizing our “strike teams.” This is a group of six to 24 staffers that deploys often within 12 hours and no more than 24. We are called by nursing homes, hospitals, restaurants, retail, construction and many locations with essential workers.

We are primarily using Clinical Lab of Hawaii and still get most tests in 24 hours. We continue to do 2,000 -3,000 test per week.

Are the tests a significant revenue stream for your practice? Specifically, how are the tests paid for, and what are the costs/profits per testing?

We make no money from testing. That is collected by the lab that bills for it based on insurance allowances. We are allowed to bill a collection fee which is small and barely covers the costs.

Also, in the earlier phases of tests, we conducted drive-through urgent-care services as allowed by law.

Overall, it is important to note how staff-intensive the process is to run testing, and I spare nothing on the type of PPE (personal protective equipment). I buy these selfless individuals who work for me the most expensive and safest gear.

What are the strengths, as well as any limitations, of the other tests you offer? How fast, and how accurate, are they?

We now offer the Quidel Rapid Antigen test on site and can have results in 15 minutes, and it is 97.6% accurate. We can process 500 tests per hour with the equipment we now have.

It is important to note that this is only accurate in the five- to six-day period when you are having active symptoms. Antibodies tests can be important to do in community epidemiological surveillance and will be very important to check immunity after a vaccine is available. Also important: This should be a serum blood draw and not a finger stick.

What new testing platforms in development now do you see as most promising?

The new sputum tests, which can be self-administered with results in 10 minutes, are going to be widely available by the end of the year and have specific use again in detecting COVID when you are actively shedding virus and the most contagious. Consider a test a parent can give their child in the morning to determine if a simple runny nose is COVID or a cold.

How do you see the chances of testing being deployed successfully in managing outbreaks in Hawaii? In the U.S.?

We need to increase our state’s testing to a minimum of 10,000 PCRs available daily in the state, providing 24-hour results. Without one-day results, contact tracing is much less effective, and infected and contagious individuals may not be quarantined.

Bonus thought

Any reaction to the current spikes in infections?

The current trend in infections throughout the state is very concerning, especially on Oahu. As of the past week, nearly 4% of all tests performed are positive for COVID on Oahu, and this increasing weekly.

This, epidemiologically coupled with the spikes, is predictive of more hospitalizations, ICU and ventilator use and fatalities in two weeks.

I am more concerned that the random nature of the positive tests means community spread is now out of our control as a state unless we learn from our past successes.

It is time to close the bars, and restaurants, initiate the work-from-home orders and return to no groups of more than two individuals.

We did this better than anyone in the country in March and April. Instead of crippling our economy into next year, one month or two cycles of infection will stop COVID and reduce our incidence and allow use to open safely with lessons learned.

THE BIO FILE

>> Title: President and founder of Premier Medical Group Hawaii; family physician in Hawaii since 1988; national medical director for COVID Response at PAE (pae.com), a government contractor with global projects, currently working domestically on testing in numerous states.

>> Born: Latrobe, Penn.

>> Family: Married, four children, ages 22, 24, 26, 28.

>> Experience: 34 years in the medical field, including 10 years in government health contracting, ranging from work with quarantine facilities to World Health Organization and Federal Emergency Management Agency training. Formerly national medical director for Spectrum Healthcare Services, the largest U.S. provider of government health service contracting.

>> Interests: Traveling and hiking and climbing in austere locations, and health-care volunteer work in underserved areas of the world or during disasters.

>> One more thing: I will spend time on the road as the COVID clinical operations U.S. and international lead for AMI Expeditionary Health, with teams in the Caribbean and throughout Africa. These groups did the Ebola response in Africa, so this is not new to them. We are about to launch testing and two quarantine facilities throughout the Navajo Nation, which I will be overseeing and training the trainers.

Asked by Vicki Viotti, Star-Advertiser