On-Site Diagnostic Testing During COVID-19 Can Help Determine the Severity of the Viral Infection and Set the Course for Treatment
“The goal when treating nursing home and assisted living patients is to avoid sending them to the hospital. You don’t want elderly people to go to the hospital if they don’t have to. When they do, they often end up contracting other illnesses or facing other issues. The last thing you want to do when you’re an older person is end up in the hospital, it often doesn’t end well. Especially during the COVID-19 pandemic.” – Dr. Jonathan Luchs, MD FACR, Chief Medical Officer
The typical risks of transferring residents to a hospital, such as falls, contracting diseases, disorientation, and days of recuperation, are all exacerbated during a pandemic. That’s why it’s so important to know what you can do to treat residents at your facility while continuing to provide them quality medical care and appropriate diagnostic testing.
If there is a resident in a nursing home or assisted living facility who is presenting with lung symptoms such as shortness of breath or clinical signs and symptoms of pneumonia then a chest -ray, as it has been performed in the past, is still a recommended test to evaluate the lungs.
If the chest x-ray is positive for pneumonia then, in the setting of this present COVID-19 pandemic, it should be included in the differential diagnosis. Therefore, the clinical staff will use the tools they have to evaluate this patient such as any prior exposure to COVID-19 and/or use of swab PCR test to evaluate for COVID-19.
If a patient is already determined to have COVID-19 symptoms or has tested positive for the virus, then a chest x-ray can help determine the severity of lung involvement without needing to transport the resident to the hospital.
Chest x-ray findings tend to have a 1-3 day delay in findings when compared to the patients clinical findings. Therefore the clinical signs and symptoms are very important. If the chest x-ray is negative then a short interval follow up chest x-ray (1-3 days) might be helpful and might then show radiographic findings of pneumonia.
Another option to determine lung involvement if it is not showing up on a chest x-ray is to perform a portable lung ultrasound.
“A lung ultrasound is a great documented tool. It is something done in the ICUs for years, more cost effective than doing chest CTs, and can be performed at an assisted living facility. Lung ultrasound has also proven to be very helpful in COVID-19 patients. If you have a patient who is COVID positive and the chest x-ray is normal, then you can do an ultrasound and you can see if there is any involvement in the lung that may not yet show up on an x-ray.” – Dr. Jonathan Luchs
It takes a while for a viral infection to show up on an x-ray because you need a decent amount of lung infection to actually see it on the x-ray. However, on an ultrasound you don’t need much progression of the infection for it to be seen. Lung ultrasounds are a quick, inexpensive, and portable method for determining the location and severity of the infection in COVID-19 patients.
Benefits of Portable Diagnostic Testing: Less Risk, Better Directive of Care
Keeping residents at your facility doesn’t mean you need to sacrifice quality medical care and procedures, such as x-ray and ultrasound. Your physicians can monitor patients remotely through proper diagnostic testing, which allows for a more precise treatment plan, less risk of spreading the virus through unnecessary exposure, and potentially the justification for acquiring more COVID-19 swab tests for your facility.
Justification for Increased Testing
If your facility is having trouble accessing COVID-19 swab tests, performing chest x-rays or lung ultrasounds on symptomatic residents is a step to prove that the patient has viral pneumonia. COVID-19, being a virus, presents similarly to other viral pneumonias. These diagnostic tests can’t specifically say whether or not a resident has COVID-19, but they can help justify doing a swab test. If you are in a state or community where it is difficult to get swab tests, and the patient is proven to have a viral pneumonia, this could help justify getting access to those tests.
Less Risk of Exposure
Portable chest x-rays and lung ultrasounds are recommended as opposed to bringing a patient into a facility and performing these tests in an ultrasound or x-ray room. It is easier to clean and sanitize a portable unit and a portable plate as opposed to cleaning an entire room. When you try to sterilize a room, you’re not only sterilizing the equipment, you also have to decontaminate the air. It can take up to an hour for the air to recirculate and make it safe for the next patient. This causes huge lag time in-between patients, where a portable test is done in the resident’s room, which decreases the risk for that person and those around them.
Logistically, an in-facility portable chest x-ray or ultrasound also allows for multiple patients to be seen right away. All they need to do is clean the actual machine, without worrying about the table, the gowns, the sheets, or even the air possibly transmitting the disease to others.
Precise Treatment Plan and Monitoring
The purpose of performing portable chest x-rays and lung ultrasounds is to have a better directive of care as a result of a clearer understanding of the patient’s lung involvement. The lung is the most common place that the infection sits in the body, especially for the elderly. However, the virus can also be located in other parts of the body. So, having correct information provided from a lung ultrasound or chest x-ray allows the physician to be better informed when following the progress of the virus in a patient’s body.
If a radiologist sees evidence of pneumonia on a lung ultrasound and not a chest x-ray, then the radiologist knows that this patient does have lung involvement and the clinical team is able to follow the progress of that patient more closely. This means triaging the patient into a more severe infection category, rather than potentially misdiagnosing them as COVID-positive with no symptoms or lung involvement.
“What we are aiming for is a precise treatment plan, and a better ability to follow the progression and, hopefully, the resolution of the disease. If it is progressing, then the patient will need to go to the hospital. If it is resolving, then we can afford to keep patients at home where they are comfortable and have less risk of spreading the virus to others.” – Dr. Jonathan Luchs