Boris Mendelevich: you don't need a test to recover from coronavirus

The State Duma deputy and doctor explained that the results of the PCR test for coronavirus depend on the quantity and packaging of the biomaterial

At the end of last week, the number of cases of COVID-19 registered in Tatarstan exceeded 10,000: as of November 27, another 83 patients were officially diagnosed — a total of 10,083 officially infected. “Officially infected” is not a clumsy turn of speech, but a statement of the fact that the real number of cases is unknown, and the results of testing for coronavirus are often unreliable. Realnoe Vremya found out whether it makes sense to get tested for coronavirus, where the opposite results of tests from the same citizens come from, and how to take biomaterial so that your PCR test is as reliable as possible.

Diagnosis as in roulette

Boris Mendelevich, State Duma Deputy from Tatarstan, member of the Health Protection Committee, says that every day he receives more and more questions from voters on a somewhat unusual topic for a parliamentarian — a purely medical one. Many people wonder how much you can trust the results of tests for COVID-19, if they can be taken at intervals of one day three times — and each time the result may differ from the previous one.

For example, one of the readers of Realnoe Vremya — Sergey A. told our correspondent that he was taken with a high temperature and a full set of Covid-19 symptoms to an infectious hospital, had a CT scan, found 30% lung damage, prescribed medications — again according to the Covid-19 standard, and was released home to be treated on an outpatient basis. A swab was taken, and the next day they reported that the PCR test result was negative. A couple of days later, his wife came down with the same symptoms. Now both are being treated by the same scheme, the diagnosis is pneumonia, but they do not officially have a coronavirus. What is more, the wife was not even taken a swab. They were not included in the statistics of the pandemic, and judging by the posts in social networks, there are a huge number of them.

Do not drink, do not smoke, do not chew gum

“Many scientists claim that the results of tests for COVID-19 are reliable from 60% to 95% of cases. However, the result can be affected by many different factors: both the actions of a person before taking the material, and the manipulations of the specialist taking the biomaterial," warns Mendelevich.

The reasons why PCR tests give unreliable results, according to the interlocutor of Realnoe Vremya, are two: the incorrect sampling of biomaterial and the sampling of biomaterial from a person who was not warned how to properly prepare for the test:

“The medical worker needs to follow a clear algorithm of actions," says Mendelevich. “According to the recommendations of the ministry of healthcare, the doctor should take a swab from the oropharynx and nasopharynx. When taking a swab, the sterility of test tubes and probes is important, and the medical worker must wear gloves. To correctly take a swab from the throat, it is needed, without touching the cheeks and tongue, to run the probe along its back wall. When taking samples from the nose, the probe is inserted into the nostril for 2-3 cm. And the one who takes the test should understand that the results depend on their actions or inaction, as well as proper preparation. For example, experts recommend not eating, drinking, smoking, brushing the teeth, or rinsing the mouth for three hours immediately before taking the test. You should also refrain from using chewing gum. A nasal swab is uninformative if the patient has previously blown the nose or washed it, if the swab is taken with a shallow insertion into the nasal passages.”

And do not take Arbidol

Realnoe Vremya asked the press service of the Tatarstan ministry of healthcare about how biomaterial is sampled for PCR tests in state medical institutions, how instruct patients and medical workers are instructed. The response will be published upon receipt.

Rimma Gizatullina, the director general of the Biomed medical and diagnostic centre, told how this happens in the institution she runs:

“We have special requirements that we fulfill. First of all, we collect biomaterial only from those who do not have signs of viral respiratory infections and fever. Those who are really ill, take the test in a state medical institution. Besides, 7-10 days before sampling, the patient should not take antiviral drugs. After all, it often happens that people drop Grippferon or Arbidol into their nose for several days, and then go to take the test on the third or fourth day. We can't check and we believe if they tell us: “I haven't taken anything.” But to ensure accuracy, this rule must be observed.

According to Gizatullina, on the eve of the test, one should not use remedies for a sore throat, or the means for refreshing the oral cavity. After the medications, the analysis will not show the true picture. And for three to four hours before the test, you should not eat, or drink tea and coffee:

“What we are looking for is washed out of the mucosa.

“Is it also unrecommended to brush your teeth in the morning?" the correspondent of the publication specified.

“Since we take swabs after 2 p.m., you can brush your teeth in the morning. During this time, some kind of environment will still appear on the mucosa.

Also, as confirmed by Biomed CEO, much depends on the qualifications of the employee who carries out the sampling:

“Before giving the go-ahead for these manipulations to our nurses, they are trained by the chief doctor, with videos — from how to put on a protective suit, to how to pack the biomaterial. A lot depends on this, too. On how the biomaterial was taken. For example, there should be a triple package, and cooling elements are used. These are the requirements of preanalytics — if something is violated, the results will be unreliable.

The results of the analysis depend even on the amount of biomaterial, added Rimma Gizatullina.

You don't need a test to recover

When asked whether the flow of patients who want to take the PCR test in Biomed is now large, the CEO replied: it doubled compared to March. It has grown at the expense of vacationers returning from Turkey and at the expense of those who have had viral respiratory infections and did not take tests in the polyclinic at their place of residence but want to make sure that they do not have coronavirus infection. According to her, “asymptomatic patients” periodically have positive results.

“The results of the PCR test for the treatment of COVID-19 are not of fundamental importance," says Boris Mendelevich. “No one yet knows what this virus is — too little time has passed since its appearance, it has not been studied. And the test is significant from an epidemiological point of view, when deciding whether isolation is necessary. And the question of how to treat is decided by the clinical diagnosis made by the doctor. And the doctor treats, but since there is no medicine for the coronavirus itself, the doctor treats the symptoms, what he sees.

Indeed, as the above-mentioned Sergey A. told Realnoe Vremya, he was treated (with a negative test result for COVID-19) exactly by the same scheme as those who tested positive.

So it is no coincidence that back in April, the Russian ministry of healthcare allowed doctors to diagnose COVID-19 without laboratory confirmation — according to the clinical picture.

Another thing, says Boris Mendelevich, is that doctors do not have the right to discharge patients diagnosed with COVID-19 at the end of treatment from the hospital until they take a PCR test (and it is negative).

But if a person officially had viral respiratory infections or flu, this is not necessary and employers do not have the right to demand test results from the employee and not allow him to work without them.

“Another thing is that there are responsible employers who periodically send employees for testing on a paid basis and pay them for it because they take care that the virus does not spread in the team," said Mendelevich. “For example, State Duma deputies, since meetings are held in the hall and the risk of infection is high, take tests weekly in this way. But the employer has no right to demand an employee to take a paid test!”

By Inna Serova

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