COVID-19NC: Unpacking The PCR

Nov 16, 2020

 North Carolina coronavirus cases dipped a bit on Monday after a week of steady increases including a record high of more than 3,000 on Friday.  Hospitalizations also hit a new high last week.  BPR’s Helen Chickering checks in with NC Health News Editor Rose Hoban  - with a close look at questions around one of the most common COVID tests. 

HC: Embracing the COVID dashboard is in transition at the time of this conversation. So we're not going to unpack metrics, but we did see a record number of new cases and hospitalizations. This week, the percent positive has been up over the 5% benchmark for some time and health secretary Dr. Mandy Cohen sounds concerned.

RH: This is, this is a scary time for this virus and how we're going to proceed. Now I will say the good news is that we're starting to see mortality creep down. And the other piece of good news is that younger people are getting this - so they're less likely to die. It's not unlikely and it's not impossible, but they're less likely to die than some of these older folks. But the more virus you have circulating in the community, the more likely it is that it's going to reach a vulnerable person. And what was interesting, I've been working on this story about what's happening in the ICU. And one of the folks I talked to made this incredible point, which is that there's so much neurological involvement with COVID, that when they do need to intubate someone, they're having to give them more sedation because they're so agitated from the neurological effects of this disease. So there's a lot going on with this disease - like it really is nothing to play with.

HC: I feel like this pandemic has so many angles and I've been meaning to ask you about testing specifically PCR testing, which has been in the news. And a few weeks ago, you ask about PCR testing during one of the coronavirus task force briefings. I want to know what you’ve learned.

 RH: Okay. So the PCR test, which is the test that most people have when they have the stuck, their nose, swab is a test that measures RNA, and it finds snippets of RNA from the virus in question that might be circulated - that might be in your nose. And one of the things that they do is they use chemicals to  “amplify the RNA”. And there was a piece in The New York Times in August that talked about the fact that you can do a lot of amplification and find a very small amount of RNA. And it seemed to indicate that the tests in the U S were being over amplified. And you could make the argument that that means that we're finding cases of COVID where there's not a lot of virus in people's noses that would then go on, be able to go out and spread and make someone sick.  And this has gotten a lot of traction in some quarters where people are saying, see, you know, most of these cases are false positives, which is not what the article was talking about. These are not false positives, but what they're saying is see, these are false positives. And so therefore we really are making much ado about nothing with the cases.

So, I had asked about that at the press conference and Dr. Cohen said something about they're following you sort of the manufacturer's recommendations for how to do the work.  I was able to talk to her one-on-one and did a follow-up question on this. And she said, you know, there's a bunch of things that, that need to be unpacked here. One is that a lot of times someone might go to get tested because they've been exposed. So maybe they're not even symptomatic. So they're going to have a very small amount of virus present. Maybe those people would go on to be infective, maybe not. So, you're finding a very small amount of virus.

HC: Yeah. And well, testing - that's just one part of the pandemic picture. I mean, people have died and people are in the hospital.

RH: The proof is in the pudding. Right? Right. Now we have 1400 people in the hospital. We have 4,700 people who've died. And we have hospitals around the state that are starting to signal to state leaders like, Ooh, we're worried. So it's not like, this is just all overblown. There is definitely a lot of virus out there and you could even make the case that we're still under testing, where there are still people out there who are largely asymptomatic, who are encountering folks, maybe their grandparents who are going to be more likely to get quite sick. And  then, you know, we're also not capturing every single case of COVID that's out there. So you know, it was, it's, it's an interesting question. I think it's kind of peripheral, but boy, it's getting a lot of traction from folks who are deniers of, of the pandemic.

About Rose Hoban: 

Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992 but transitioned to journalism after earning degrees in public health policy and journalism. She's reported on science, health policy and research in NC since 2005. Contact: editor at northcarolinahealthnews.org