Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the strain of coronavirus that causes coronavirus disease (COVID-19), is spread through human-to-human contact. 1 The World Health Organization declared COVID-19 a pandemic on March 11, 2020, and as of August 1, 2020, there were almost 5 million cases, with more than 52 million people who have been tested for SARS-CoV-2 (positivity rate of 10%) in the United States. 2-5 On February 4, 2020, the U.S. Health and Human Services (HHS) Secretary determined that COVID-19 posed significant public health threats, and multiple Emergency Use Authorizations (EUA) were subsequently issued by the Food and Drug Administration (FDA). 6 An EUA allows FDA to facilitate the availability of countermeasures more rapidly during a public health emergency, including for SARS-CoV-2 testing. Each in vitro diagnostic test requires an EUA for distribution unless developed by state laboratories. 7 Testing is 1 of the cornerstones of controlling the spread of infection. 8 There are currently 3 types of in vitro tests available for the detection of current or previous SARS-CoV-2 infection: (1) molecular-based (reverse transcription polymerase chain reaction), (2) antigen, and (3) serologic (antibody) tests. 9,10 Molecular-based tests identify the presence of viral RNA, and antigen tests detect the presence of the nucleocapsid protein antigen and are used to determine active infection. Serologic tests have been developed to identify the immune response to SARS-CoV-2 through the identification of antibodies. 9 Although the tests are detecting the presence of SARS-CoV-2, the tests are commonly called COVID-19 tests. The inadequate response of the United States to develop and distribute such tests left states initially with few options except for expedited vaccine and drug development and physical distancing. 11 With increasing demands to reopen the country and noncompliance with Centers for Disease Control and Prevention (CDC) recommendations to prevent infection, such as washing your hands, avoiding close contact, and covering your mouth and nose with a mask when around others, there is an even greater need now for expanded testing. 12 In addition, employees may be required to have a least 1 or even 2 negative tests for SARS-CoV-2 before returning to work, increasing testing demand. Evidence exists for the quality, safety, and effectiveness of pharmacist-administered Clinical Laboratory Improvement Amendments (CLIA)ewaived point-of-care (POC) tests for infectious diseases, including Streptococcal pharyngitis, influenza, Helibactor pylori, HIV, and hepatitis C. 13-16 In addition, pharmacists are already using POC devices to test for Streptococcal pharyngitis and influenza that are similar to the devices in use for SARS-CoV-2 testing. 14 In an analysis, Gubbins et al. 17 determined that POC testing in community-based pharmacies could benefit patients. Pharmacists are fundamental in the solution to expand SARS-CoV-2 testing in the United States because of their accessibility to patients...

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A consensus definition of ADE remains elusive at this time. Preliminary studies utilizing rapid diagnostic tests including matrix-assisted laser desorption/ionization time of flight (MALDI-TOF), procalcitonin, and other molecular techniques have demonstrated the potential to support ADE strategies. In the absence of evidence-based, highly specific ADE protocols, the likelihood that individual providers will make consistent, often challenging, decisions to de-escalate antibiotic therapy is low. Antimicrobial stewardship programs should support local physicians with ADE and develop innovative ways to integrate ADE into the broader construct of antimicrobial stewardship programs. The evolving field of rapid diagnostics has significant potential to improve ADE strategies, but more research is needed to fully realize this goal.

Table 1 ASP recommendations and team actions ASP recommendation, n (%) No change: 28 (41.2) Discontinue antibiotics: 16 (23.5) Decrease duration of antibiotics: 14 (20.6) Infectious Diseases consult: 5 (7.4) Deescalate therapy: 6 (8.8) Escalate therapy: 0 (0.0) Accepted recommendation, n (%) Yes: 45 (66.2) No: 23 (33.8) Action following ASP recommendation, n (%) No change: 40 (58.8) Discontinue antibiotics: 6 (8.8) Decrease duration of antibiotics: 9 (13.2) Infectious Diseases consult: 2 (2.9) Deescalate therapy: 7 (10.3) Escalate therapy: 4 (5.9) Time from test result to antibiotic change, h, mean (range) 13.5 (0.5-40) ASP, antimicrobial stewardship program.

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