I’ve been incredibly fortunate to work on frontlines of coronavirus (COVID) response, both as a clinician and as a grantmaker supporting our foundation’s Diagnostic Excellence Initiative.
When I worked in the emergency department early on in the COVID pandemic, the most acute challenge I experienced was due to limitations in diagnostic testing capacity. Clinicians had to ration and prioritize who got tested for COVID. Each test had to be approved by the county department of public health and required submitting a sample to an outside lab, with an average of turn-around time of 5-7 days.
In late March and early April, I cared for patients with symptoms and findings that were very concerning for COVID infection. But more often than not, I was unable to test these patients because they were not sick enough to be hospitalized nor did they meet a very narrow criteria for testing, such as recent travel to China, South Korea or Iran. I sent these patients back into their homes and into our communities with a prayer and a one-page handout encouraging them to wash their hands frequently and to avoid contact with others.
While diagnostic testing for coronavirus has become much more accessible in the United States in recent months, the current crisis underlines the critical importance of diagnostic excellence – defined as diagnosis that is timely, accurate, cost-efficient and convenient. In the absence of effective therapies or a vaccine, timely and accurate diagnosis is the primary tool we have to combat the spread of infection. Countries like South Korea who were able to quickly ramp up diagnostic testing were much more successful at flattening their curve. Unfortunately, the United States is a counterpoint to that, resulting in a catastrophic loss of life and dramatic public health measures that have shaken the foundation of our economy and re-written the basic rules of social engagement.
However, in order to meet the yawning gap of diagnostic capacity, tremendous ingenuity and innovation is emerging from the private sector, academia and the public. These efforts have the potential to open new fronts in diagnosis and accelerate current trends. First, we are seeing significant changes in where a diagnosis takes place, moving away from the traditional settings of hospitals and clinics and into people’s homes through web-based triage systems, telemedicine and home testing. We are also seeing the use of new devices like internet-connected thermometers and wearable sensors being repurposed for diagnosis – these new adaptations are helping identify emerging “hot spots” throughout the country and are also being studied as early-warning systems for patients infected with coronavirus.
During World War II, Winston Churchill stated “never let a good crisis go to waste.” In that vein, during a time that has often been likened to a “war with a silent enemy,” the Moore Foundation’s Diagnostic Excellence Initiative is exploring new areas of grantmaking in response to the pandemic. For example, the Moore Foundation made a grant to the Foundation for Innovative New Diagnostics (FIND) to support the independent evaluation of new COVID diagnostic tests. Our team is also supporting several data infrastructure projects that will enable the rapid collection of clinical data from hospitalized COVID patients, aggregated from multiple health care systems. We hope that rapid analysis of these large databases will enable researchers to derive clinical insight from real-world evidence, informing best practices for the diagnosis and management of COVID patients.
The recent innovations and trends we’re witnessing in diagnosis also inspire us to consider the future of diagnosis, likely to be transformed in the next 10 to 20 years. The current coronavirus crisis has piqued our curiosity and pushes us to challenge the current paradigm of diagnosis – rethinking what a diagnosis is, where it should take place, how the process should unfold, who should be involved in the diagnostic process and when a diagnosis is best rendered. The Moore Foundation remains committed to advancing diagnosis both in the current crisis and beyond. As a clinician, I look forward to caring for patients when diagnostic excellence is the norm.
Daniel Yang, M.D. is a program officer for the Gordon and Betty Moore Foundation’s Diagnostic Excellence Initiative. He is also a practicing hospitalist and a board-certified internal medicine physician.