Jason Gallagher, PharmD: I don’t think there are yet that combine the two. There are obviously the separate ones that are available. But I like Bill’s point. I want to come back to it really quickly. We keep saying this, but speed matters. And if there’s anything I’ve learned to appreciate through COVID-19, it might be that. Since the virus replication peaks so early, and we don’t usually get our therapies into patients that quickly, with tests that are either at home or at urgent care, in a pharmacy, or in a physician’s office, that can be done as therapies for various viruses emerge—there are several in the pipeline for COVID-19 that can be given easily with a prescription pad and a pharmacy visit—the expediency of the whole process works together. Find, diagnose, and treat all at once.

When you think about it, it’s better than what we do for a lot of bacterial infectious diseases, because at the time that we’re prescribing or recommending antibiotics, you’re guessing at what they have. You’re giving this empiricism. With viruses, the issue has always been when you get to the patient. If we expand our testing to find them, then we’ll be able to do that and possibly augment the effectiveness of our drugs.

Peter Salgo, MD: As someone who started out in this field a long time ago, we’re discussing a novel virus no one had ever seen before, identifying some therapies available, testing available, and within about a year, a test you can do at a practitioner’s office that doesn’t need a machine. You read it and it gives you all of this information. This is a brave new world. If I were able to go back in time—I won’t tell you how far back because it’s embarrassing—and tell myself this is coming, I’m not sure I would have believed it, Bill. What do you think, George?

George Loukatos, MD: I agree. It restores some faith in our process with how much we’ve been able to do. When we look back and all shake our heads as to the dire situation we were in going into this winter, it’s one of the positives. I can’t tell you how frustrating it was at the beginning to not be able to get testing. The reason my urgent care centers became so successful is we were able to find a laboratory that was able to turn our tests around within 48 hours. Suddenly the whole community was coming to us.

Speed matters. Not just for the clinician, but also for the patient. And not just in getting them an answer, but in their compliance with their treatment. It doesn’t do a whole lot of good to tell a patient, “I need you to start these antibiotics right away,” or “I need you to start this Tamiflu right away,” or “We need you to go get monoclonal antibodies,” when it took you 5 days to come up with a diagnosis. It doesn’t give them a sense of urgency.

Peter Salgo, MD: Right. The only time I ever heard of Tamiflu being given absolutely perfectly was when somebody brought a patient up to our OR [operating room] who had been tested and went through a procedure. Then all of us in the OR got a call. “The test just came back positive. You might want to start Tamiflu now.” We got it before testing and before we were sick. I don’t know if the patient got it, too. I don’t think she got sick, either. But in point of fact, that’s the only time, which emphasizes that early warning, speed, and accuracy are all important. It’s good stuff.

Jason Gallagher, PharmD: Yes. I have a similar anecdote. My daughter had flu. She tested positive. We were both on Tamiflu.

Peter Salgo, MD: And you survived.

Jason Gallagher, PharmD: That’s when it works.

Peter Salgo, MD: It works best.

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Transcript edited for clarity.