CMO Corner- Covid Facts vs. Shiznit
“There was truth and there was untruth, and if you clung to the truth even against the whole world, you were not mad.”
In the novel 1984 (written in 1949) George Orwell predicted that technology would develop and allow corrupt governments to manipulate and spy on their population. In the book, the dangers of false information were warned of repeatedly.
In an earlier blog we played "Fact or Shiznit?" a true or false exercise regarding Covid myths. There was some constructive criticism of the blog, feeling we were "playing games" with a deadly disease.
So let’s clear up some false information out there; this time, no games.
We will tell you the Shiznit and then give you the facts.
The CDC and health departments say Covid positive patients are no longer contagious and can stop isolation after 10 days of no symptoms.
It is true that evidence exists suggesting the virus loses its penetrance after 10 days. No debate there. Yet it takes 7-21 days to re-swab negative once symptoms appear. Negative means no virus is found. Many infectious disease experts are showing evidence it’s safer to release a patient from isolation with a negative swab than just using the 10 days benchmark.
Let’s look closer at why the "10 day rule" is Shiznit.
Exhibit 1- For starters, the CDC states that there is evidence to release a patient at 10 days with no symptoms. Unfortunately, there has been insufficient time to do a broad scale prospective or double blinded study to show this definitively. That study will not be able to be published for many months. To allow a cessation of isolation in the middle of a pandemic is no time to be using "evidence exists" as your defense.
Exhibit 2- The European version of our CDC has gone on record that there is uncertainty about the requirement of a negative re-swab (also called "test-of-cure") although they also concede a 10 day wait is reasonable.
Exhibit 3- Johns Hopkins -a respected medical source- endorsed the CDC guidelines, yet also points out there is no way to tell if a swab positive test indicates an infectious or non-infectious virus. They also state a large number of Covid cases are spread by asymptomatic people who are swab negative.
So let's try to understand this---if you swab positive without symptoms, you may be able to spread the virus. But if you are positive 10 days after your last cough, you won’t spread the virus. At least "there is evidence" you won’t.
If this is how our health leaders are planning on stopping the virus, we have trouble. Right here in River City.
Fortunately, you have a choice.
TEST. TEST. TEST.
Reading the literature, what appears to be the "truth" is that the contagiousness is related to "viral load.” The higher your viral load when you contract the virus, the longer you are contagious after the infection. Since we have no way to measure viral load, the prudent course is to assume everyone has a high viral load.
Hence our advice is to swab negative prior to stopping your quarantine if you are positive.
So why are the health departments and CDC sticking with the 10 day advice?
In the spring, the CDC admitted the lack of tests in the country played a part in their position. They aren't saying that now.
Yet we know test availability has been a problem in our country, as well as Europe. But if that's the reason, just tell us. We can take it.
More facts to dispute the 10 day strategy---cases are raging both in the US and Europe. A large number--up to 40 % in some studies- are coming from asymptomatic people. If the 10 day rule was working, shouldn't we be seeing a DECREASE in new cases?
Would you go to a restaurant where the cook had a fever and swabbed positive 10 days ago, and is now flipping your burger?
Would you sit at a table at a wedding where the person next to you swabbed positive 11 days ago but stopped coughing ten days ago but did not re-swab?
Would you visit your elderly frail uncle if you had swabbed positive 10 days ago without knowing you are swab negative?
Of course not. And I suspect the head of the CDC wouldn't either.
CADUCEUS RECOMMENDS A NEGATIVE SWAB AFTER THE INITIAL POSITIVE SWAB IN A COVID INFECTION.
It may be 7 days, or 10, or 20.
Know if you're contagious.
And don't listen to the health department when they give you Shiznit.
If I feel sick between November and February, a Covid swab is sufficient. And a flu shot is optional.
It is very conceivable to have both the flu and Covid at the same. And if you have only one, it’s important to know which one it is. There is an antiviral medication for the flu.
Yet both during the last flu season as well as this one, many of our beloved patients balk at having both. Some say they are really only worried about Covid. They don't want two tests. Although covered by virtually all health plans, they bring up cost.
Since Covid and flu symptoms are quite similar, and this is the flu season, it is important to see if you have one, or the other, or heaven forbid both. The flu shot is more important this year than ever before. We cannot yet prevent Covid with a vaccine, but we can help prevent the flu and you really don't want to get both this winter.
CADUCEUS ADVISES BOTH A FLU SWAB AND A COVID SWAB FOR ANY FLU SYMPTOMS THIS FLU SEASON.
AND A FLU SHOT FOR ALL ITS PATIENTS.
“The best books… are those that tell you what you know already.”
George Orwell, 1984
Although this seems counterintuitive, it makes sense when you read Shiznit #3.
Newer saliva, rapid antigen, and self-administered swabs are accurate.
Yes; some studies do show a five percent false negative and positive rate for the saliva test, which is acceptable. However, those numbers have not been borne out by true randomized peer reviewed studies.
In one Yale study, saliva testing was MORE accurate than nasal swabs. Number of patients tested? 76.
Yet, another study from South America showed the saliva tests had more false negatives than nasal swabs. It was just published in the journal "The Scientist.”
Sample size? 776 subjects.
The fact is for a study to be credible, there must be THOUSANDS of subjects. Different races, ages, and other demographics. Better yet, make that TENS OF THOUSANDS of subjects, with the testing done blinded.
Saliva tests are far from proving themselves.
The rapid antigen tests are still running around a 10-20% false negative rate. No real improvement has been seen here, and the data keeps getting more accurate.
Nonetheless, our most popular test to do at a patient’s request is the rapid “while-you-wait” test. Even if they have to pay for it.
Many patients are seeking the test where you do your own swab, mail it in and wait for the result. I am confused as to the logic.
First, there is user error. A timid patient will not swab as accurately as a trained professional. Then we are relying on the US mail, whereas a curbside PCR test is no charge - back in a day or two- and very accurate.
As Mr. Orwell said...”the best book is the one that tells you what you already know.”
You already know the PCR test is the best. Don't fall for the slick sales pitch for rapid tests. Don't be tempted by saliva tests. At least wait until more studies can confirm their accuracy.
CADUCEUS ADVISES THE CURBSIDE NASAL SWAB VIA PCR TO DETERMINE THE PRESENCE OF COVID. AVOID SALIVA TESTS, RAPID TESTS, AND SELF ADMINISTERED TESTS.
This is too important to take a short cut. A possible fatal shortcut.
Once I recover from Covid, I am out of the woods, just like getting over the flu.
Beware of post-Covid Syndrome, or as we call it-“PCS.”
This is being described in the literature, but the data here is only from our own patients....our sample size is the 600 plus patients we have treated from the start of their infection until turning swab negative.
The scenario is becoming more common and more disturbing. You have exposure or a fever. You go curbside for the swab and it does come back positive.
You start in our treatment program. Meds. Pulmonary hygiene. Bedrest. Isolation.
10 days later, you feel better and swab negative. All is great---right?
A few weeks later, you feel more fatigue. Your cough returns and you can’t walk up the stairs. Your sense of smell, which never totally came back, goes away entirely.
You may actually feel sicker a month after you "recover" than you did while you had Covid.
Sounds like a nightmare, right? Welcome to the “Wonderful World of Covid,” the virus that is writing its own rules.
For our patients, about 15% of our more recent cases qualify as having “PCS.”
Average age of “PCS” is 45.
First and most common of PCS is by far fatigue. Very bad fatigue.
And it’s more likely if they did not practice strict bedrest when they were fighting Covid initially.
Most worrisome and bothersome are the symptoms revolves around the lungs-- Shortness of breath. Cough. Air Hunger. Poor exertion. Mucus.
For lung symptoms, we use Budesonide, Albuterol, and Decadron if necessary. We follow pulse-ox frequently, and encourage incentive spirometry and pulmonary hygiene. Unfortunately, some cases have not improved even after several months.
We pray it's treatable.
And prepare for it being permanent.
For other symptoms, e.g. the lack of taste/smell, muscle and joint aches, headaches and palpitations, TOT (Tincture of Time), bedrest, and plenty of fluids appear to be helping.
We have seen new cases of significant hypertension appear shortly after Covid recovery. These cases require medication and the long term prognosis is unknown.
“PCS” is becoming a true disease and deserves more research and alertness on the doctor’s part.
Nationally, new diagnoses of autoimmune diseases post-covid (Hashimoto’s, Lupus, and Sjogren’s) have been noted, but we have not seen that at Caduceus---yet.
CADUCEUS ADVISES CONTACTING YOUR COVID DOCTOR IF YOU HAVE NEW OR PERSISTENT SYMPTOMS AFTER YOU TEST NEGATIVE FOR COVID. TREATMENTS CAN HELP.
You all know the drill.
- Know if you're contagious---get swabbed before any social gathering and insist the others do the same.
- Have swabs regularly---every two weeks if you are out and about or working.
- Get regular antibody tests to see if you're immune.
- Wear your masks.
- Stay as far away from others as situations allow.
Locally, statewide, nationally, and globally--cases are skyrocketing. One of the solutions is more testing, not less. We are happy to help provide that curbside for you.
Still not sold on testing?
We offer a complimentary online assessment that is actually kind of fun to take on our website. Go to caduceusmedicalgroup.com or pdqurgentcareandmore.com and hover over the “Individual Covid-19 Testing” button and choose the drop down “Are You Actively Contagious with Covid-19?” It only takes about ten minutes and a staff member will contact you with your results within 24 hours.
Consider taking that test to determine your risk level.
Do mandatory masks and testing take away our freedoms? Let’s again look to the novel 1984 and the words of Mr. Orwell.
“The choice for mankind lies between freedom and happiness- and for the great bulk of mankind, happiness is better.”
Gregg DeNicola MD
Chief Medical Officer
Caduceus Medical Group
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