Doing the Right Thing at the Right Time

Today’s article in the Los Angeles Times titled, “Coronavirus tests are hard to get — unless you have money, fame and the right doctor” raises ethical, moral, and scientific questions relative to what is fair, equitable and supportive of population health practices during this historic COVID 19 crisis.

According to the piece, for $250, some doctors are providing an unapproved cheek-swab test for the virus to be administered at home.  The tests are being offered for purchase even if patients show no symptoms or have no other reason to fear they were infected, even though there is no guideline advising testing these patients particularly given the well documented lack of access to adequate testing throughout the county and nation. The Centers for Disease Control and Prevention guidelines prioritize testing for people who have COVID-19 symptoms and are hospitalized; have compromised immune systems or other factors that put them at high risk; or recently traveled to countries with major outbreaks or had close contact with someone who has the virus. These guidelines are informed by the availability of testing.

Furthermore, the Food and Drug Administration on Friday publicly warned that it has not authorized any at-home tests for COVID-19, the disease caused by the novel coronavirus. Blood antibody tests can indicate only if a person has had the virus, whereas the CDC-approved nasal swab tests can detect a current infection. 

At this critical time around the globe, across the US and here in Los Angeles,  where as of today, 536 cases and seven deaths have been attributed to COVID 19 as reported by the Los Angeles County Department of Public Health, it is essential that we, as providers of care, simply do the right thing.  For 149 years, the LA County Medical Association has promoted policies that help further equitable access to healthcare. During a pandemic, this commitment is more important than ever. COVID-19 spares nobody, and in a time where our resources are clearly limited, particularly in regards to access to testing, it is particularly important for us to adhere to evidence based guidelines that take into account the big picture in the treatment of all Angelinos. 

Morally, testing access should not favor any one group over another, but scientifically this is the case as well. The measures we are taking must be universally implemented to stand a chance of mitigating the crisis caused by this highly contagious disease. Social distancing is ineffective without broad participation. Similarly, testing is entirely ineffective without a consistently implemented testing strategy. Now more than ever, physicians must stand together and fight this disease together. Physicians that unscrupulously bend the rules for favor are part of the problem, not part of the solution in a time when we need all hands on deck.

I applaud State Sen. Dr. Richard Pan, who strongly criticized physicians who are seeking to profit from the crisis but I would take this denouncement a step further:  In Barcelona, Spain, each night at 8 PM, the citizens of this historic city publicly applaud physicians, nurses and emergency response personnel for their work, their commitment and their sacrifice while we have some, though a small minority, who subscribe to an entirely different compass, putting profit over people.