April 8 (UPI) -- Shortages in testing kits for COVID-19 have not only led to confusion about who has the virus, but who has recovered from it, experts say.
The lack of tests adds complication to decisions on releasing people from the hospital or home quarantine, allowing first responders to return to work and even whether patients participating in clinical trials have actually recovered from the disease.
As a result, at least in some cases, doctors are measuring clinical signs of disease to determine recovery -- mostly because rapid testing is not widely available.
The lack of testing could also complicate clinical trials, such as the ongoing series of blood plasma trials expanded Friday by the U.S. Food and Drug Administration across the country, because patients must be recovered from COVID-19 before participating.
"At this time while we are still prioritizing testing for inpatients and patients at high-risk for severe disease, in order to determine whether a patient is recovered, we have to rely on a patient's symptoms," Dr. Michael Chang, pediatric infectious disease specialist with McGovern Medical School at UTHealth and UT Physicians, told UPI. "One interesting question though is if a patient is asymptomatic, would they still test positive? At this moment, we don't know the answer to this question."
With first responders, healthcare workers and those in other "essential" occupations -- staff at a supermarkets, for example -- getting first priority, clinicians treating patients with COVID-19 have had to use other approaches.
"The availability of testing varies from state to state, from hospital to hospital," Dr. Raj Dasgupta, a pulmonolgist and critical care medicine specialist at Keck School of Medicine of the University of Southern California, told UPI. "It's improving, and we are seeing more rapid tests, where we can get results in minutes instead of days. But many places are struggling to identify who's infected, much less who has recovered from infection."
Without a test, a COVID-19 patients must go at least three days without fever, after treatment with fever-reducing medications has been stopped, and improvement in respiratory symptoms -- like coughing and shortness of breath -- in order to be declared recovered, according to the U.S. Centers for Disease Control and Prevention.
Because coughs can linger for days, or even weeks, after infection has cleared, most clinicians are relying on fever as a measure of illness and recovery, Dasgupta said. "Fever is the most objective measure, and we can measure it ourselves and it is easy to measure," he said.
In the absence of a test, even with temperature, Dasgupta said healthcare professionals are making a judgement based on physical health and consideration for a person's potential to pass the virus to somebody else.
Testing, however, is ideal.
"Testing is used by some to 'clear' patients if they need to return to a congregate setting that might cause increased cases if there was still any transmission," said Dr. Susan Bleasdale, medical director of infection prevention at the University of Illinois Hospital and associate professor of clinical medicine at the University of Illinois at Chicago College of Medicine.
"For those that are essential workers, it is really important to make sure you are clear of infection before returning so you don't have further cases and decrease capacity of your staff to maintain essential services, like healthcare or grocery services," Bleasdale added.
Dasgupta said he's aware of some hospitals that have allowed staff to return to work after suspected COVID-19 infection without being tested because of shortages in doctors and nurses in various parts of the country.
Similarly, testing is a fundamental part of testing use of blood plasma for COVID-19 treatment. Houston Methodist, which on March 28 became one of the first hospitals in the United States to try the approach, ramped up its trial over the weekend.
Ten recovered patients participating at Houston Methodist have donated plasma, and more donations are scheduled for next week, a spokeswoman told UPI. The trial there is accepting patients that have been both treated and tested at any of the facility's affiliated hospitals, she said.
Although assessment for potential plasma donors is centered around a blood test -- to ensure their immune system has produced antibodies against COVID-19 -- evaluation of those potentially on the road to recovery from the disease has placed additional strain on the already-overwhelmed testing capacity in the United States.
"In some cases, people should wait until they have a negative test -- primarily immuno-compromised people," Chang said. "For most people though, and those without close high-risk contacts, following the recovery of fever and symptoms should be okay."