It has been awhile since I have posted and update-mostly because I have had nothing new to say. What follows is not new but a response to the many COVID19 related inquiries I have been receiving and an effort on my part to refresh, remind and reinforce. COVID19 is not going anywhere and I do not see any end in sight.
First the corona virus cannot survive without us-its human host. It may live for a brief time in the air and on the surfaces that surround us, but it cannot survive without being within us. We share it through breathing it in and occasionally transferring it from surfaces to our eyes, nose, or mouth. Most infections occur indoors within residences, offices, or other gatherings where people share the air they breathe for minutes to hours.
How to stop the virus. Deny it the opportunity to spread from person to person. It is that simple-HARD STOP. The virus does not care how healthy or unhealthy, fit or unfit, mindful or mindless you are. Its only admission ticket is that you breathe-HARD STOP.
OUR TESTING IN ITS PRESENT FORM SUCKS.
We do it because we have nothing better to offer and, in this case, something is better than nothing-barely.
PCR testing-nasal/oral swabs and saliva. A positive test is accurate essentially 100%. A positive test means that you have viral particles that can be detected and you are either infected and contagious or have been infected and may not be contagious. If you have symptoms you are contagious. If you are asymptomatic who knows. A negative test is highly problematic. The false negative rate for this testing in the real world may be as high as 30-40% meaning that a negative test may be wrong in 30 to 40 people out of 100. The accuracy of this test is highly dependent on the way it is administered, and the sample is handled and the timing of the testing. The ideal time to test is 4-5 days after known exposure or with symptoms. Same day, so called point of care tests, may be the least accurate of all and in some cases may not be any better than a coin toss. It is ironic to me that the most expensive out of pocket most convenient instant gratification test is/may be the least accurate test in this group. Oh well, I guess money can’t buy everything.
Serologic or Antibody Testing. More of my patients are talking about getting or having gotten antibody tests as if there is any value to this information. Perhaps there is a psychic value. The antibody testing where a low percentage of people are infected is worthless and may be inaccurate up to 50% of the time. I have already written about this in a prior update and nothing has changed other than more people want to spend their money for reasons that escape me. The test is inaccurate and even if correct the presence of antibodies specific for SARS-COV-2 does not guarantee immunity.
We have learned how to treat COVID19 better with the tools we have so that fewer people die who are sick enough to be hospitalized. We have learned how to prevent transmission from person to person based on personal behavior and PPE.
We hope that things will improve with medications and vaccines-hopefully soon