Posts Tagged ‘ covidtestingorangecounty ’

Quantitative Antibody FAQ's Orange County

By editor
November 24, 2021

Since the blog last week advising antibody counts to help predict vaccine failures, we have had many questions. Let’s answer a few now.

-Caduceus and PDQ Urgent Care and More can draw the counts during an office visit of any type or at their draw stations. Due to high demand, we have specific times we are drawing total antibody counts. They are as follows:

-Caduceus at the Packing House 18200 Yorba Linda Blvd. - 

  • Caduceus Family Physicians (Red Cross tent)- 8:30-5
  • Caduceus for Women and Caduceus 4 Kids (Candyland)- 8-5

-Yorba Linda PDQ Urgent Care & More 18220 Yorba Linda Boulevard, Suite 301-

  • Mon-Fri 8-8 Sat/Sun 9-5

-Orange PDQ Urgent Care & More 7630 E Chapman Ave, Suite B.-

  • Mon-Fri 8-8 Sat 9-3

-Irvine- Caduceus Jamboree and PDQ Urgent Care and More 19742 MacArthur Blvd. Ste 100-

  • Mon-Fri- 8-5

-Laguna Beach- Caduceus on Thalia 333 Thalia 

  • Mon-Fri 8-6 Sat 9-3

-If you are a registered Caduceus or PDQ patient, you do not need a doctor’s order. If not, a quick video visit will give the order. 

-The tests are sent to Labcorp, which uses a different system than Quest.  The readings for counts cannot be compared against the two. Our ranges are for Labcorp only.

-We are aware there are many different types of antibody tests at Quest, Labcorp, and other labs. Our recommendation is ONLY for the TOTAL antibody count through Labcorp. It is the best way for us to compare apples to apples.

-We have NO affiliation with Labcorp, and do NOT receive any type of financial reward to use them. They were the first to offer the test to our patients, and with thousands of their tests to study and review that we have ordered, we continue to use them. 

-If just the total antibody screen is ordered, and insurance doesn't pay, the cost has been $40-50 for most patients. Caduceus simply sends the blood to Labcorp, which bills the patient or insurance.  Caduceus is not liable or responsible for billing questions or disputes with Labcorp.

-What Caduceus data shows are that if the TOTAL count from Labcorp is over 400, it is highly unlikely you will contract Covid, and if you do it would be a mild case.
Almost all our positive PCR tests are in patients whose antibody counts are under 300, even if vaccinated or having recovered from Covid.
We are NOT making a scientific conclusion, simply sharing our data. 

• It is a reasonable assumption that keeping your antibody count over 400 will help protect you against contracting Covid. 

• If you are under 300, we advise a vaccination or a booster.

-From our data, it does not seem to matter how you get these antibodies. There are only two ways to have anti-Covid antibodies in your blood.
1. Recover from a Covid infection
2. Receive a Covid vaccine or booster

-We do not profess a strong opinion which antibodies are "better.” Our data tells us natural antibodies last longer in our patients than vaccine antibodies. But both fade in time, thus our advice to check antibody counts regularly.

-The experts seem to agree that high antibody counts are protective, but do not agree on the best values. We anxiously await their research to be published.  Until that time, we stand by our data to help guide our patients. 

Gregg DeNicola MD
Caduceus Medical Group, PDQ Urgent Care & More, PDQ Telehealth

Antibody Quantitative Testing- Orange County CMO Covid Blog

By editor
November 19, 2021

In a world that keeps on pushin' me around  
I'll stand my ground 
And I won't back down. 
Tom Petty 
Let’s present the actual real-life case of a Caduceus married couple I will call Donald and Daisy.  (It’s real except their names of course.) 
They are both in their 60’s. 
Both were vaccinated in Feb/March (the brand isn't important). Being fully vaccinated, they assumed they were safe to travel to the Caribbean in late September. 
They needed to show proof of vaccination, which of course they had. 
They were gone two weeks, returning early October.  
On their second day at home they both began coughing. Coming to our Caduceus drive through curbside testing, they both tested positive for Covid in Mid-October. Daisy was moderately sick for two weeks.  Donald developed Covid pneumonia and was hospitalized and is still on home oxygen.  But both survived, thank God. 
Daisy's antibody level on diagnosis? 269. 
And Donald's?  27. 
What happened? Easy. The antibodies produced by the vaccine faded. Went away. Disappeared.   
In Donald's case, it was as if he wasn't vaccinated at all.  
Donald had "Mouse Called " Caduceus in mid-September asking if it was ok to travel. We advised to have an antibody count. They declined due to a busy schedule. Had they checked the levels BEFORE the trip they could have had boosters or perhaps postponed the trip. 
We continue to advocate for regular antibody level testing. When we began offering this in early summer, it was purely data gathering. But now, after several thousand tests, we can tell you our findings, and make reasonable assumptions. 
A disclaimer--we will be simply giving you data from our own Caduceus patients. We will not draw scientific conclusions. We won't claim proof or speculate on data from other groups. 
For example, if I tell you the street corner by my house has intersecting traffic stopping when the signal light is red, every day I drive by it, I'm just giving you factual data. I am NOT concluding red lights prevent accidents. That's for the statisticians and scientists to do their thing.  
Yet, it IS a reasonable assumption. But it's not valid proof. All I can say with certainty is all traffic stops at the red light by my house.  
So, Mr. Petty I am taking your advice.  
I’ll stand my ground. 
At Caduceus we have been advocating to check antibody levels monthly, since that appears to be an accurate way of telling if you are protected. 
Antibodies work.  
No matter how you get them- vaccine or natural. Whether Moderna is better than J&J or a vaccine is better than natural isn't the point. It doesn't matter. What DOES matter is how high your antibody count is. At least that's a reasonable assumption based on our numbers. 
Over 400, good shape. 
Under 300, beware---mask, avoid large gatherings, and get vaccinated and/or get a booster. 
300-400 appears to be the dreaded gray zone. 
More data to chew on; if the antibody count is over 400, we have had ONE symptomatic  Covid infection. Mind you, some patients do not allow us to check their antibody level when they are first diagnosed, but that is what our data is telling us. 
What about an antibody level under 300? Dozens of new cases. In fact, ALL but one of our new Covid cases who had been vaccinated had levels under 300. 
Again, I caution that this is just Caduceus data. It has not been analyzed by a Chi square, confidence interval, or signed off by Dr. Fauci. 
And there IS good data from our medical researchers showing a definite link to high antibody levels and Covid protection.  
However, a recent JAMA article called antibody testing a "flawed science.”  They acknowledged high levels appeared to be protective, but the exact thresholds were still in question. We agree. That is why we give our data here, without making a conclusion. 
About six months ago I made a prediction- we will reach herd immunity by Halloween. I rarely make predictions, since I feel NO ONE can look into the future. Yet in this case I had a good feeling. 
Since both Caduceus and California are experiencing a surge in new cases, it’s easy to say---I was wrong. But was I?  
I'd say yes and no. 
Explanation- People think herd immunity is having Covid go away. 
Not at all. 
Herd immunity occurs when a significant portion of a population is immune to an infectious disease, thereby limiting disease spread. For those who are not immune, they are indirectly protected because the ongoing disease spread is small.  
With herd immunity, masks, social distancing and even showing proof of vaccines should all go back to normal- whatever that was. 
In California, our numbers tell us 2/3 of adults are vaccinated. And another 20% have had Covid but not yet vaccinated. That's 86% protected, and we are thus at herd immunity.  So I was right, and you can pay me your losing bets when next see me. 
But wait. Cases are RISING. Especially in states with the HIGHEST vaccination rate. Pretzel logic, right? (That's for you, Steely Dan fans.) 
To explain we need to get three things straight. 
1. Vaccines work (by producing antibodies.) 
At Caduceus, 60% of our recent new Covid cases were in vaccinated people. That's right. Over half. So, do vaccines work or not? 
Answer: Vaccines do not prevent Covid infections. Look at Donald and Daisy -they were two of many vaccine failures.  Neither does having previous Covid infections.  
Now in fairness, the vaccines do trigger the antibodies. And a Covid infection also triggers antibodies. So how does that explain the lack of herd immunity? 
Think of guns. To quote an old political argument...Guns don't kill people. Actually people don't kill people either.  
BULLETS kill people.  
Saying I am going to protect my house by buying a gun means nothing if you don't have bullets.  
To illustrate- Just ask Alec Baldwin. The gun didn't kill Halyna Hutchins. A bullet did. 
Now work with me on this analogy. What if bullets actually let’s say, melted after a while? Or turned into blanks? Some in three months, others in a year. You would not be able to defend yourself until you checked for this and then got MORE BULLETS!  Not more guns! 
So, in my weird analogy, the bullets are the ANTIBODIES. No bullets, no protection. Vaccine or not. Previous infection or not. 
2. The CDC says that those with natural antibodies are five times more likely to be hospitalized with a second Covid infection than those that are vaccinated. Yet at Caduceus, you want to guess how many new infections were in patients with natural antibodies over 400? 
One. 1. Uno. 
And that patient had no symptoms. She had a PCR in hopes of attending a friend’s wedding.  
What about "natural antibodies"? Our data show with a low viral load (mild case) natural antibodies last three-six months. But a high viral load (as in hospitalized and ICU patients)? OVER a year.  
Caduceus data would suggest you are much better off -i.e. have more antibodies- having been in the hospital in January than having the vaccine in January. 
So why is our experience so much different than the CDC’s? 
Well, many more people have had mild cases of Covid, i.e. low viral load. And this is word for word from the study: 
"The study only examined adults who had tested positive more than three months ago.” In other words, they stacked the deck against natural antibodies by picking patients whose antibody counts would be lower. No such restriction was placed on the vaccinated group, however. They also excluded the J&J vaccine! 
Could it be the CDC and others want to downplay the efficacy of natural antibodies so that more people will vaccinate?  (I am asking for a friend.)  
Now let’s address #3. 
"I have an immune system, thus do not need a vaccine," or in the case of Aaron Rodgers, "I bolstered my immune system using a technique championed by that famous immunologist Shailene Woodley.” 
The problem with that is that all your immune system does is produce antibodies AFTER the alarm goes off to your ADT alarm system.   
Once your body sends out the troops, Covid may have already made it into your lungs (speaking from personal experience). Having a "good “immune system doesn’t mean you have anti-Covid antibodies already in the house waiting to attack the Covid perpetrators as soon as they enter your nose.  
But wait----is there any way we CAN have the troops already there--waiting to neutralize (kill) the infamous spike protein without needing to first send an alert to your immune system? 
Can we Have antibodies ALREADY in our system -Designed to kill Covid right off! That'd be so cool if we can arrange that! 
But how? OMG, I know! Take a vaccine -it produces anti-Covid antibodies!   Or actually recover from Covid and let those antibodies you sent out hang around and protect you from a second Covid infection. 
This is immunology 101. Taught accurately in every high school, college, and medical school in the country for decades. But for some reason, between politics, and stupidity, antibodies are not recognized as what is needed for herd immunity. Or to get into a venue for that matter. 
In some diseases, antibodies (either vaccine or natural) last a long time...maybe even a lifetime such as Measles and Chicken Pox. 
In other cases, maybe five-ten years, such as Tetanus. And in other viruses only one year---like the annual flu vaccine we take.  
Here is what we have found at Caduceus.  
Vaccine antibodies last 3-10 months. 
Moderna- 6-10. 
Pfizer- 4-9. 
J&J- 3-6. 
Then they are gone. As in- you have NO antibodies once they disappear. 
This is how previously vaccinated people are getting Covid now. If they were vaccinated in early 2021, there is a good chance their antibody count is low or zero. 
Here's the irony. To get into a concert tonight at the Performing Arts Center, I must show my proof of vaccination. But if I was vaccinated in the spring, there is a good chance I'm NOT immune. Yet I am welcomed into the venue. 
But if I bring my trusty antibody count I do every month showing tons of good anti Covid antibodies (from BOTH my infection plus my vaccine), I would be banished to return home. Although I am VERY protected.  
For this I blame our leaders and giant organizations such as the CDC and WHO for not doing the simple research that will prove this.  
To summarize:  
1. Antibodies work. Whether from vaccines or natural immunity. 
2. Having no or low antibodies puts you at high risk of contracting Covid. No matter if you have been vaccinated or had a previous Covid infection. 
3. We advise all Caduceus patients to check their antibody counts every four-six weeks, regardless of vaccination status or past Covid infection, at least until we do reach herd immunity. 
I advise to not get hung up on whether you need a booster. Or if you had J&J in March. Or if you have natural immunity from your Covid infection in 2020. Or if it’s safe to travel if you’ve had the vaccine. 
Just check your antibodies.  
If your count is under 300, we advise full vaccination, including receiving boosters as needed. 
Caduceus can draw your antibody level anywhere they draw blood. Most insurance covers this; if not the cost is reasonable. No visit is needed if you are a registered Caduceus patient. To discuss the findings with a doctor, a video visit can be easily arranged from the comfort of your home or office. 
We won't back down. 

Gregg DeNicola MD
Caduceus Medical Group, PDQ Urgent Care & More, PDQ Telehealth

So What Now Orange County...Covid PCR, Antibody, Vaccine FAQ's

By editor
February 18, 2021

Sometimes, trends change just because that's what trends do....think -popcorn ceilings. We like them (ok, our parents liked them) then we don't - and prefer a different trend. 

Other times, the new trend is due to a change in circumstances---think -gas powered SUV’s replaced by electric cars as being in vogue to reduce carbon footprints as well as avoiding gas stations.

Let’s revisit 1953 and the film The Wild One.  Pogo sticks were featured and before you could say Tutti Frutti Ice Cream, Pogo sticks were all the rage. For those unfamiliar with the 20th Century, a pogo stick was a device for jumping off the ground in a standing position, consisting of a pole with a handle at the top and footrests near the bottom, and a spring located somewhere along the pole. Ok, I agree it sounds underwhelming, but if you were a ten year old in a housing tract in the Eisenhower 50's, and had a Pogo Stick, you were “King of the Neighborhood.”

 Yet, by 1960, Pogo sticks started rusting in the back of the garage next to the linseed green linoleum leftover from the kitchen floor remodel. (Yes, another trend that didn't last; thank God!) Although Pogo sticks still had a lot going for them, in 1958, the Wham-O Corporation started production of a plastic hoop, inspired by a bamboo exercise hoop popular in Australia. To use it, you pretended you were doing the Hula with the hoop around your waist....a Hula Hoop! This began one of the largest fads America has seen, before or after.

They were much less expensive than Pogo sticks. And anyone, from a kindergartener, to an adolescent, to a teen, and even Mom and Dad--heck, even Grandma and Grandpa, had their own Hula Hoop. They could be used to exercise, have endurance contests, and- once you learned the trick- even toss it away, and it would "walk" itself back to you.

Sometimes, a new fancy needs a little boost-especially when it can improve the health and well-being of our community. That is where today’s blog comes in.

In 2020, testing for Covid was all the rage---we promoted it here with the “TEST TEST TEST” mantra. And it became more and more essential as the numbers rose toward the last three months of the year.

We had the rapid test. The gold standard PCR test. The saliva test. The expedited test, all with different accuracies, prices, and difficulty in finding somewhere to do it.

At Caduceus and PDQ we were militant about getting enough tests for our patients, not requiring symptoms to test, and demanding a test of cure (a negative test after a positive one) to be cleared.

People used the PCR to get back to work, travel, gain entrance to a family party, and even be reassured visiting the seniors in their lives. People would wait in their cars for hours, plead on Facebook for sites they could get a Covid test, TODAY!

Now, in 2021, it is still important to keep an eye on whether your contagious ---and by all means, check a PCR if you have symptoms of Covid. But we have a candidate for a new Covid fad--the forgotten antibody tests.

First, we must clear up one falsehood about Covid antibodies. They DO protect against catching Covid. Somewhere, social media picked up on the CDC’s and the WHO’s advice that said we weren't sure. But we are. Antibodies fight off Covid; period. How would a millennial type it?

Antibodies. Do. Work.

That's what antibodies do. It would be like saying, we aren't sure that blood carries oxygen, or the kidneys don't filter our blood... They work, well, because they are antibodies.

If they didn't, we just wasted trillions of dollars and time developing and giving vaccines. Because that's how the vaccine works; it stimulates Covid antibodies which in turn fight off the Covid virus.

But when we discuss commercially available antibody tests, we are talking about checking the antibodies we form after exposure or an infection. What about the antibodies we form from a vaccine? As they say in OZ, "That's a horse of a different color!"

The experts told us the antibodies from the vaccine are a different type of antibodies, which probably don't show up on normal antibody testing. So no need to check antibodies after a vaccine, right?

Well....a lot of people did anyway, and guess what? A lot of them have antibodies. What do we do with this info? No one has any idea.

At Caduceus, we have diagnosed over 3,000 patients with current or past Covid infections. Only ONE was diagnosed with a positive PCR swab with positive antibodies, but he had no symptoms. A new study in progress will show NO Covid infections with 11,000 patients with antibodies. We are not saying antibodies are 100% protective. However, looking at available data, it is highly unlikely you will contract Covid if you have Covid antibodies.

If you look it up, the CDC as well as all the major research centers in the US, will say something like-

"We don’t have enough information yet to say how protected someone might be from being infected if they have antibodies to the virus.”

That's fair. Also cowardly.

Sometimes you have to tell the Emperor he has no clothes on. 

We get many FAQ’s....I will post a few here and forewarn you we have the same answer for all of them...

Q: I have had Covid. Do I still need the vaccine?

A: Not sure.

You should definitely check for antibodies. If you have them, you may want to save the vaccine for those without antibodies.

It is apparent we have no idea if Mother Nature’s antibodies are "better" than vaccine antibodies.

In most other viruses, Mother Nature’s antibodies are always better--or at least as good- as vaccine induced antibodies.

Remember Chicken Pox? "Natural and wild" antibodies were much more protective than the vaccine.

But some studies are telling us the vaccine is more protective than simply testing positive for antibodies post-Covid.

Yours truly just had an antibody test, and I paid extra to get a "quantitative" number, and I was off the chart.

I have so many antibodies I swear I saw a couple crawl out of my ear last night. Am I going to get the vaccine?

Not sure.

I need more data, which will be forthcoming as more people get both natural antibodies as well as vaccine antibodies.

Q: I have had the vaccine. Do I need to check my antibodies?

A: Not sure.

It appears the vaccine may trigger antibodies not picked up by the conventional testing done by commercial labs. No "expert" has officially advised checking antibodies. The concern is you will test negative and conclude the vaccine failed, when in fact it worked perfectly; the antibodies just need a different test. Since we do not know how long the vaccine lasts, just stay tuned and the WHO/CDC/Dr. Fauci will let us know if and when we need a booster.

Q: How about Mother Nature’s antibodies? If I have them , how long will they last?

A: Not sure. (See a trend here?)

We have had patients lose IgG in a month. Others are still IgG strong seven months from their infection. The only way to know is “TEST TEST TEST.”

So do we have any specific advice for you?

You're darn tootin’. (Recovering from Covid, I saw a lot of old Westerns)

There is a 100% chance you fit into one of these five buckets. Follow along for your fortune…I mean advice...  feel free to pass it along to friends or family who may be in a different bucket.


You have not had Covid, not been exposed, nor had any Covid type symptoms over, say, the past year. You have not been vaccinated.

ADVICE- No antibody test necessary. Find a way to get a vaccine. Then just sit back and wait as we find out how long the vaccine lasts.


You were exposed to Covid--through a roommate-partner-coworker etc., at any time over the past year. I'm talking about a close exposure.

ADVICE- If the exposure is recent, start with a PCR swab. Otherwise, check your antibodies. You may be surprised to find out you are IgG positive. Then check your antibodies monthly through 2021 to confirm your (probable) immunity. If the IgG disappears, or your antibody test is negative, take the vaccine.


You have had Covid in the past year (but not currently).

ADVICE- Check your antibodies, now and monthly through 2021. Same logic. Since we do not know how long they will protect you, keep a close eye on them, and get vaccinated as soon as they disappear.


You currently have Covid, or have symptoms of Covid. You have a positive PCR swab.

ADVICE- Wait at least a month from when your symptoms started, then check your antibodies. Check your PCR regularly also, to be sure your clear of the virus. Check your antibodies monthly through 2021, using the same logic from Buckets 2 and 3.


You have been vaccinated (apply this advice even if you also are a member of Buckets 1-4).

ADVICE- Sit back, relax, and read this blog for advice as to a possible booster. Of course, still wear a mask, social distance, and avoid super spreader events. If your personality allows for it, you may want to check antibodies, but do not be concerned if they are negative, even after the vaccine.

PCR Covid testing?

That is SOOOO 2020.

In 2021, Let’s make antibody tests all the rage. It’s good data to know.

 Oh!  Also... as long as we are discussing fads, a Hula Hoop on Amazon goes for $29.99. Just in case you are feeling nostalgic.  (I swear my Mom got mine at Zody's for a dollar!)

Gregg DeNicola MD, Chief Medical Officer

PS. I again want to thank all of our loyal readers and patients for their prayers, cards, gifts, and messages of goodwill as I continue the slow recovery from a serious Covid pneumonia.

It is a slow daily fight, but I am getting slowly better, as the doctors predicted. If you are post-Covid yourself, you are aware of the danger of blood clots, long term lung damage, and a continuing cytokine storm to keep you alert.

It would be a lonely road if not for all the support, and I want to thank you from the bottom of my heart.

And yes, I still enjoy a shot of Kahlua.

CMO Covid Patient Bulletin Orange County December 2020

By editor
December 8, 2020

Special Bulletin-
We want to alert our Caduceus and PDQ patients to new developments regarding Covid ---the usual disclaimer-

These apply ONLY to our patients, other health systems may be experiencing different scenarios, or perhaps not reporting them.
1. New presentation of Covid
2. Testing shortage looming
3. New saliva testing update
4. News on vaccinations
5. How to reach us
1. New presentation of Covid
Like most of the country, we have had an explosion of new cases. So many that we have a difficult time to keep up with the pace. Our aggressive treatment program has been successful in reducing admissions, ventilators, and we are now at 1000 cases treated with no deaths. However, we postulate another mutation has occurred. 
For the past two weeks, a large percentage of new cases present with diarrhea as the only symptom. Because they have no fever, or respiratory symptoms, many patients feel it’s a bad burrito and do not seek care. The only other symptom they have is a definite fatigue, even the loss of taste/smell has been rare. Some of these patients do progress on to a full blown Covid picture, so it’s important to get tested if you experience a new onset diarrhea, DESPITE WHAT YOU MAY HAVE RECENTLY EATEN. 
Contact us for a telehealth visit at the first sign of diarrhea. Do not try to ride it out with some Kaopectate. Isolate immediately. 
2. Testing shortage-
As we have informed you previously, Caduceus does NOT run the tests ourselves, we swab and send them to a number of different labs to perform that function. The swabs themselves are NOT simply Q-tips , they are specialized swabs provided by the labs.
Due to the holiday rush, and the enormous increase in new cases, we have been warned by all labs that there may be a shortage of swabs, both PCR and rapid antigen. Although they cannot give us a time frame, we are hoping this is temporary until the “powers that be” can invest in more testing. 
We will be testing close contacts and symptomatic patients as a first priority. We will not routinely test for every positive antibody. We suggest waiting 10 days in between swabs for patients under active treatment. We ask private companies that have been requiring weekly tests on their staff to temporarily change that to every two weeks.
Do not hold off on testing if you need it. We have sufficient swabs currently. But we may have to begin rationing if swabs become harder to come by. This is true for ALL medical centers that are testing. Be prepared to find it more difficult to obtain testing without symptoms. Of course we will give priority to our own loyal patients. 
3. Saliva testing-
Just in the nick of time, it appears there has been improvements of the saliva tests for Covid. Recall we initially did not advise saliva tests due to the lack of good studies and the fact the virus appears to prefer the nasal cavity, leading to many false negatives.

We have kept up with the studies and there may be new saliva tests that are a little more accurate than the rapid antigen test, but not as accurate as the PCR. If it passes our vetting, we will announce it via our website and social media, and begin using them quickly.
DO NOT fall for the “do it yourself” saliva tests. There are far too many errors with this. 
Consider saliva testing only once we have thoroughly investigated it for efficacy. Follow us on Facebook, Instagram, and check our websites daily for updates. 
4. Vaccination questions-
Hard to believe but we know about as much as you do from the news media. We have put in for an order, but that is just a formality. We have contacted the manufacturers directly, and their tersely worded responses are a bit disappointing. They basically say “no comment.”
Sources at higher levels have shared with us that both seniors and health care workers will come first.
But will it be no charge and administered by the government? 
No comment.

Will they sell it to doctors to give in their offices?
No comment.

Will it be the technology of messenger RNA developed by Pfizer and Moderna or will a more typical antibody vaccine being developed by other labs be offered?
No Comment.

Will it be mandatory?
No comment.
Will it really get us to herd immunity?
No comment.
Did we really ask the authorities all these questions?
No...oops I mean absolutely. Very frustrating.

Any rumors you hear about the vaccine are just that--rumors. Check with our social media and website for updates as we get them. Our past performance on Covid tells you Caduceus been on the cutting edge, and ahead of the game from the beginning. That will continue with the vaccine.
DO NOT sign up for, or pay money, or visit an unfamiliar medical office to get in line for the vaccine. There are many hoaxes and scams going around, and NO ONE can or should be taking any money from you at this time for the vaccine or for a waiting list.
5. How to reach us-

This last weekend, we had over 2,000 phone calls, mostly about Covid. It obviously overwhelmed our staff, and we apologize if your voice mails were not answered. We are still a local doctor owned small business and would need a staff of dozens of operators to handle what we are experiencing now.
Hands down the easiest way to reach is is via email, either the patient portal or Mouse Calls on our website for medical questions. We commit to a same day answer.  Our live chat feature on the websites or apps is a great way to make appointments for testing or any other appointments.
If you call and do not get an immediate answer, use the email or live chat options instead of calling again.
We would appreciate not leaving negative reviews on Yelp or Google saying we don't answer our phones. This is our first pandemic and we are really using every resource we have to serve our patients. We want to stay in business as much as all other small business owners. 
Steve Jobs said this as part of his Apple strategy, but it applies to us now more than ever...
Everyone here has the sense that right now is one of those moments when we are influencing the future. 
Gregg DeNicola MD
Chief Medical Officer
Caduceus Medical Group

CMO Corner- Covid Facts vs. Shiznit

By editor
November 10, 2020

“There was truth and there was untruth, and if you clung to the truth even against the whole world, you were not mad.”
George Orwell

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. 
Duly noted.
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. 
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. 
It may be 7 days, or 10, or 20. 
Know if you're contagious.
Don't assume. 
Don't guess.
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.

“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.
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.
Male/female -50/50
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.
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 or 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