Five Questions With: Rick Pescatore, DO, on COVID-19 Testing

Rick Pescatore, DO, FAAEM, is chief physician for the state of Delaware and has been featured on nationwide media outlets such as Larry King Now, MSNBC, and Business Insider for his insight on the COVID-19 crisis. He has garnered a particular expertise in COVID-19 testing.

EMS World: What is your current role with the state of Delaware?

Pescatore: I currently serve as chief physician in the Division of Public Health (DPH). I provide clinical insight and support for DPH and other state agencies and am fortunate to play a role addressing health concerns for populations throughout Delaware.

What does a typical day look like for you these days?

During the COVID-19 pandemic, my time is largely spent in the state health operations center addressing a variety of strategic and operational priorities. I am occasionally in the field providing on-site clinical guidance or performing time-sensitive lab validation work.

You are active on Twitter and routinely appear on news outlets discussing the pandemic. Do you view this outreach as an integral part of being a public health leader?

The confusion and misinformation surrounding COVID is nearly as significant a public health concern as the virus itself. It is critical that reliable, trusted information be disseminated to the general public. Utilizing social media is one of many routes through which we are able to narrow the communication gap between public health and the public and between patients and physicians.

What role do you see COVID-19 testing play as we continue into the summer? Are there particular testing modalities you feel are more pragmatic than others as we seek to scale the testing efforts to reach more Americans?

Testing is increasingly a smorgasbord of a variety of testing types, all of which have pros and cons that must be carefully weighed and understood within the context of the tested population. Early in the pandemic, shortages of PCR components—from collection kits to extraction reagents and more—drove more indirect approaches to testing. More recently we’ve seen a welcome explosion in the ability to extend molecular testing (PCR) across communities, from the infamous nasopharyngeal swab to newer modalities such as saliva testing.

As we move into the summer, I think we’ll see the establishment of high-volume universal testing sites (government-run), combined with increasing surveillance and testing through hospital partners, ambulatory care sites, primary care providers, federally qualified health centers, and more. Beyond that I am hopeful for point-of-care testing modalities that are in the pipeline, such as CRISPR and antigen testing strategies, which could be extremely helpful and allow for simpler logistics and faster decision-making.

Prehospital providers face dramatically different environments depending on their area of service. Some may be dealing exclusively with COVID-19-related cases, and others might rarely come into contact with a case. Do you feel the varying circumstances warrant an equally diverse approach to testing, depending on the environment in question?

Well said. Community-specific considerations—that is, an understanding of the community’s disease prevalence, where that community stands on the timeline of pandemic progression, as well as patient-specific factors—all contribute to the calculations necessary to make the best decisions regarding testing and nonpharmaceutical interventions.

Christopher Gaeta is a student at Swarthmore College.