AN IMPORTANT MESSAGE FROM OUR CHIEF MEDICAL OFFICER GREGG DENICOLA MD
Is this the real life?
Is this just fantasy?
Caught in a landslide; no escape from reality.
Freddie Mercury did not know his lyrics would be so prophetic when he wrote them 45 years ago. He asked two very poignant questions but never really answered them, unless you count Scaramouche, Galileo, or Figaro as an artistic reply.
We will use this blog to answer three common questions that have been popping up in our emails. (Disclaimer- these answers are based on solid facts, but ARE still opinions. Expert opinions may vary.)
1. I feel fine. But can I be an asymptomatic carrier? If so, when will I not be?
2. What’s the deal with the antibody tests? When can I get one? My employer wants me to have one before they let me return.
3. Are things getting even a LITTLE better? As CMO when do you feel it’s safe to end the quarantine?
1. If you have no symptoms, and an accurate IGM antibody or nasal PCR test shows a Covid19 infection, you are an asymptomatic carrier.
It doesn't matter if you had symptoms and now are resolved, or never had symptoms. A positive PCR swab is the gold standard to determine if you are contagious. It IS possible to have viral particles in your nose and NOT be contagious. We just don't know if you are or not. No test exists to determine that. An antibody test does NOT tell you if you are contagious.
Keep in mind COVID19 is also called SARS2-- SARS 1 began in China in 2002 and is also a coronavirus so we do have some precedent to which we can look back. Using data from previous SARS outbreaks from Asia and Europe, the virus hangs around for at least three weeks and possibly three months or longer. Can it last a year? Or...gasp...forever? Hopefully not, but we simply do not have the data to tell us that answer.
What if a person is a month out from having the infection but keeps testing positive? Assume they are contagious.
If you have symptoms, GET TESTED. If you have exposure, GET TESTED. If you are positive, KEEP GETTING TESTED. If you are positive, STAY ISOLATED.
Do not bother with an antibody test. Get a nasal PCR. Caduceus has ample tests as of this writing.
2. Antibody tests are available through almost every drive through location, even big box stores. Caduceus has them available. But beware of false promises. A quick “Antibody 101,” we receive two readings; IGM, which tells us if you've been infected recently and also an IGG which theoretically confirms immunity--that is, are you protected from a future infection, such as is the case with measles.
Looking at SARS data from a few years ago, only 55% of patients converted a positive swab to an IGM. So to tell of a recent infection, it is pretty lousy if this SARS is similar to the last one. But 99% DID convert the IGG by 90 days from infection. So the antibody test is not really useful until months after the infection appeared. Again…that’s IF this SARS is like previous SARS. (DISCLOSURE-I am quoting ONE study from China. We have no idea if this SARS2 is going to act like SARS1.)
We hear many employers "requiring" antibody tests before allowing staff to return to work. That logic is fine if all they care about is immunity, but to allow the employer to say they have a virus-free workplace they really need the PCR nasal swab. Also, IGG antibody may take months to show. We may want to rethink the value of antibody tests for now.
One reasonable time to check with an antibody test is for those who feel they may have had Covid 19 in December or January and are now recovered. A negative antibody screen now would essentially rule out that possibility.
There is little reason to have an antibody test at this time. A repeat nasal swab after symptoms have resolved is the gold standard. An antibody test 2-3 months from the infection would add reassurance the patients is both IMMUNE AND NON- CONTAGIOUS.
3. Globally and nationally, the numbers are stabilizing. Here in Orange County we are seeing less demand for testing and less positives per day. One obvious reason is we are seeing less infections in general. In fact, almost none. Usually this time of year we see:
- Strep throat--now? Nope.
- Hand foot and mouth? Nada.
- Roseola? Nix.
- Viral respiratory infections? Forget it.
- Stomach flu? Negatory.
And STD’s? Haven’t seen the requisite case of gonorrhea or chlamydia in months; monogamy and celibacy appears to have cured that--for now. Why? Because no one is coming in contact with anyone. Even housemates can’t spread something they can’t catch. We may have found the answer to cure all infections....life long quarantines.
As the number of new cases fall, we may see the social isolation loosening, and masks, and X’s on store floors, but we must be concerned about a "second wave" of Covid 19. Almost certainly we will have one. Until we have herd immunity, via a vaccine, the carriers will infect others.
So ending the quarantine?
If you want someone to diagnose and treat Covid 19, we’ve got this.For the cost/benefit analysis of effectiveness of loosening the quarantine, you'll need to ask our president, or governor, or Dr. Fauci, or Bill Gates. Maybe even Jake from State Farm. I'm thinking his guess is as good as anyone’s.
Gregg DeNicola MD
Chief Medical Officer
Caduceus Medical Group