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Testing Testing 1-2-3

By editor
July 16, 2020

COVID 19...Testing…Testing...Testing… 1-2-3    
 
For my fellow baseball fans, this is a good time to recall the beloved Yogi Berra who told a post-game interviewer after a bad loss...
 
"We made too many wrong mistakes."
 
That sums up my viewpoint on our response to the Covid pandemic, both nationally and here in California. I have been purposely apolitical during the crises, and deflected blame, preferring to look ahead, not behind. Yet it is clear Yogi is right---both political parties have made too many wrong mistakes. 

If our elected leaders had pushed for universal testing early on (as we have advocated) many of the lockdowns and closures could have been avoided. 

We have been dealing with the nightmare that is Covid for four months, although it feels like four years. And in those four short months, we are learning so much every day.  When I look back and see what little we understood last St. Patrick’s Day, and then look at our current state-of-the-art, what we have mastered bears sharing here.
 
What I read on social media and here on mainstream media is so misleading, it’s actually frightening.

  • The swabs are part of a conspiracy to pay the hospitals more and are being falsified.
  • The antibody tests are inaccurate and IgG does not give you immunity.
  • Someone sent a swab dipped in a cup of coffee and it came out positive.
  • Only get tested if you are deathly ill.
  • Get tested daily to be safe. 
  • Someone's uncle can arrange for a swab to come back in two hours for $1500 cash.

Schiznick. All of it. 
Let’s deal with the bare facts.
 
If you follow Caduceus and PDQ you know our mantra... TEST.TEST.TEST.
and our slogan…

KNOW IF YOU’RE CONTAGIOUS
KNOW IF YOUR IMMUNE
 
CONTAGIOUS?  DO I HAVE COVID?
To find out if you are contagious or infected, you need a test for the virus. The gold standard is the PCR Swab.Things are changing there. At first, it was a long skinny wire that doubled as a brain biopsy. In the last six weeks, the labs are giving us a shorter swab, with equal accuracy. It is NOT just a Q-tip, its fibers pick up more mucosa and the virus is now known to reside primarily in the lower part of the nostrils. 
 
The problem is time. A finite number of testing machines are in play.  With the recent huge demand, swabs must wait their turn. So a 3-5 day wait has morphed into a 7- 10 day wait for results. For some people, that simply is too long.
 
Enter the newer "quickie" tests. Some are self-serve. Some use oral swabbing. Some do not need a doctor’s order. Many urgent cares offer them, as do the drive-up centers sponsored by local governments and large companies like CVS. And the results can be same day or one day. One catch----way too many (IMO) false negatives. Up to 20 % in some trials. These tests may be acceptable if the airline or your job just wants a negative test, and you feel great. But if you want to KNOW you REALLY are negative, I advise against the quickie tests. 
 
The companies that sell the quickie tests even warn you to repeat all negative quickie swabs with the PCR--which will take 7-10 days. So the only people who really benefit from the quickie tests are those that feel great but the airline, Hawaii, or job wants a test that was done in the last three days.  If you hear about a new test that is very accurate and results take less than a day, avoid it. That test does not yet exist.

IMMUNE? 

To find out if you are immune, you need the antibody test. For both IgM and IgG. 

IgM=you've had it. 

IgG=you’re immune.

IgM comes first, about 4-12 weeks after you are infected. It does NOT confer immunity.

IgG DOES confer immunity, but takes months to turn positive. We do not know how long the IgG stays on to protect you.  Maybe three months. Maybe three years. IgG from SARS 1 (in 2002) only hung around 4-6 months. The hope is your IgG will protect you until early 2021 when a vaccine is available.
 
So why do people on social and mainstream media keep insisting they are not accurate? If you are one of them and read this, PLEASE send me your source. If they aren't accurate I need to know NOW!!  Because all respected data says IgG confers Covid immunity.

Our tests come from labs in the USA. They are ready the same day. Almost no false positives and about 5% false negatives. Uses a finger stick.

We will soon announce we have obtained for our patients a newer more sensitive, moderate/high complexity, laboratory grade antibody test.  It is not necessarily more accurate, but does pick up the antibody earlier. 
 
We have had one patient IgG positive and then swabbed positive, but he had swabbed positive a month earlier. So far no one has been IgG positive and THEN contracted Covid. Not only in our practice, but in the literature. Again -if you read of anyone IgG positive later contracting Covid, please email me; that would be big news to the medical community. Good news...so far ALL of our Covid positive patients eventually turn antibody positive, confirming the accuracy.
 
Caduceus Medical Group/PDQ Urgent Care and More strives to be the best partner we can be to our loyal patients. We are honored to be helping blaze the trail in providing the newest and most accurate tests available. Soon, we will offer two types of antibody-(quickie/accurate and overnight/more accurate.) We are planning to offer two types of diagnostic swabs...both the PCR (very accurate, seven day turnaround) as well as a type of quickie (one day turnaround, less accurate).
 
As far as who needs what, and how often, here are the current Caduceus guidelines:
 

  • You have never had it, and no symptoms- do both swab and antibody.  We advise repeating monthly (no video visit required for repeat testing) if you are working, going out, or traveling.  It is less essential for regular testing if you are homebound. 
  • You recently swabbed positive for Covid---retest weekly until clear.  Then test monthly for antibody until IgG positive.
  • IgM positive, IgG negative...test monthly until IgG positive.
  • IgG positive…test every three months to ensure immunity. Stop when vaccine available. 

 
What about the posts stating "only test if you have symptoms?"  
 
Hooey. Poppycock. Horsefeathers.
 
Caduceus/PDQ does NOT require symptoms to be tested. We advocate EVERYONE should know if they are contagious and immune. By frequent testing, we will all know just that.
 
Why? 

How did China, Spain, New Zealand, Denmark finally reopen? Bingo! Universal testing. 

In some provinces of China, the government went door-to-door offering free tests. 

Denmark had a policy to test every willing citizen at no charge--and THEN offered them a digital "passport" to show they were free of the virus as of the date of their test. This was used to allow travel, certain jobs, and general reassurance of friends and family. 

And Spain? This is a quote from an article from Reuters on APRIL 6---at the peak of the high death rate:  "Spain is planning to widen coronavirus testing to include people without symptoms as a first step towards slowly easing a lockdown in the nation with the second highest death toll from the global pandemic." Guess what happened to the number of cases? Exactly!
 
Recently, with employers and traveling requiring swabs, we are finding up to 30% of our positive swabs show NO symptoms. So to require symptoms to be tested is missing a large reservoir of contagious people. It is a common-and deadly policy.
 
Our diligent staff work tirelessly to commit to our patients we will not run out of either swabs or antibody tests, and will test curbside daily as many people that can squeezed into one day. We do not require only Caduceus patients to be tested by us. We gladly swab all people, even from Kaiser, St. Jude, St. Joes, Memorial Care, and Hoag. 

How do we keep acquiring enough tests to have done this for four months now?

Sometimes it involves putting unmarked bills in a paper bag behind the palm tree in exchange for enough swabs...well ok, not exactly (but close to it). It shouldn't be that hard. Whatever the cost to produce adequate testing, it is less expensive than the devastation of closing down our economy.
 
Covid testing is definitely not a profit center. But -as Spike Lee would say—“it’s doing the right thing.”
 
Only by universal testing, and REPEAT testing, can we begin to tame this fast moving, lung eating, deadly virus. 
 
CONCLUSIONS 

  • If you know you are contagious, strictly quarantine yourself until you are documented not contagious.
  • If you are not immune, avoid close contacts, confined spaces, and crowds. (And wear masks, wash hands…the whole bit)
  • Staunchly consider putting yourself and your family (and workplace) on a monthly testing program until the numbers fall, or a vaccine is approved. Even….no wait...ESPECIALLY if you have no symptoms! 
  • When testing, avoid "quickie" tests and sacrifice speed for the best accuracy available.
  • If you have tested positive for Covid, or are IgM positive, antibody test monthly until your IgG becomes positive. It will.

Be aware of the massive demand for testing as cases surge. Expect a delay for a video visit, results of swabs, as well as phones and chat lines. We pledge to offer all of our patients daily video visits and curbside testing. No one will be turned away, which may intensify the delay. We thank you in advance for your understanding. 

KNOW IF YOU’RE CONTAGIOUS
KNOW IF YOU'RE IMMUNE


Let’s conclude with one more Yogi wisdom. One day at Shea stadium, streakers ran naked across the outfield. The reporters later asked Yogi (who was managing the Mets that day) if they were male or female streakers. With a puzzled look, Yogi answered....

 “I don’t know. They had bags over their heads.” 

Don't wear a bag over your head. 

Get tested.

Gregg Denicola MD
Chief Medical Officer 
Caduceus Medical Group

To make an appointment for a video visit from your phone for Covid-19 diagnostic swab and/or antibody or any other urgent or non-urgent medical needs including your annual physical, please email our appointments team at videovisits@caduceusmedicalgroup.com.
 
If you own a business and are interested in more information about our on-site corporate Covid-19 testing program for your employees, please email us at support@caduceusmedicalgroup.com.

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