May 14, 2020 Corona Update

Beginning tomorrow you will be able to get you hair coiffed in Maryland, by appointment only.  This is good news as we are all looking a bit ragged after 2 months of inadequate grooming.   Maryland is still listed as a state with increasing, rather than decreasing cases, but hospitalizations and deaths have been trending down in the state of over the last week.

Overall, deaths and hospitalizations are trending down nationally, but new hotspots in rural areas emerge almost every day, usually related to prisons or meat processing plants.  In Trousdale, Tennessee, 1 out of every 7 people in the town are infected, so your odds are just worse than Russian Roulette  of coming in contact with an infected person when you go to the Walmart for some frozen pizza .

We have received many inquiries about testing, and I wanted to provide some information on this today.  Testing falls into three categories:  1) testing for viral RNA, 2) testing for proteins contained in the virus itself, this is also known as an antigen test and 3) testing for viral antibodies, descriptions below

A.  Viral RNA testing performed from nasal swab or saliva shows whether someone is shedding virus. They may be symptomatic or asymptomatic.  Three popular forms of Viral RNA testing are listed:

  1. RNA PCR testing:   this is the standard type of test performed by a nasal swab which detects sequences of viral RNA.  These tests are mostly performed by major labs, (Quest, Lab Corp) and results currently take 1-3 days to come back.  This is likely the most accurate form of testing to detect active viral particles in the nose or mouth. 
  2. Abbot Rapid Testing:  the ID Now machine uses viral RNA amplification to identify the COVID virus and produces results in about 15 minutes.  The accuracy of this test has come under scrutiny and this issue may render this test obsolete in the near future.
  3. Cepheid Gene Expert:  this also works off of nasal swabs and looks for multiple sequences of RNA specific to the Corona Virus.  The accuracy is thought to be much higher than the Abbot test and it takes about 45 minutes to complete. This technology has the highest chance of becoming a stable in the workplace because of its accuracy and short turnaround time

B. Antigen Testing:  Tests for protein of the virus instead of RNA, similar to a test for strep throat.  This test is accurate and rapid.  It is useful to tell whether a symptomatic person with a fever and a cough has COVID.  It is not useful to test an asymptomatic population and It does not necessarily tell if someone is contagious. Benton Dickinson makes a rapid antigen assay that should find itself in doctors’ offices within a few months

C. Antibody testing:  this is now a widely available blood test from reputable labs (as well as fly by night operations) that looks for an antibody to the virus in someone who has been previously infected.  How long does it take to produce antibodies after infection?  How accurate is the test?  If you have antibodies are you immune?  These are excellent questions.  Unfortunately, no one at this point has good answers to these questions.  If you were sick with an illness with symptoms of COVID and you get a positive antibody test 4 weeks later there is a good chance that this is accurate and that you have some immunity to the disease.  

To get an idea of how testing can be used effectively,  we need to look no further than the Whitehouse,  which has not necessarily advocated wide spread testing for the public, but is in fact practicing meticulous testing in their own shop.   Just this week, two employees in close proximity to the President were diagnosed as asymptomatic carriers of COVID with the Abbot ID Now testing device.  Since all employees are tested every day, the minute these tests became positive, the employees were whisked away to undisclosed location to drink Clorox or immerse in a hydroxychloroquine hot tub. 

Imagine if your workplace or doctor’s office or assisted living home functioned this way.  Imagine a dentist’s office which has now been given the all clear to begin elective procedures, could perform a test prior to a teeth cleaning.  Negative test, much lower probability of an infectious patient. Positive test – we’ll be doing that teeth cleaning in August, after a Spic and Span rinse. 

Hopefully, the future for us mortals will look more like the Whitehouse (at least in regard to the availability of testing.) Accurate and rapid tests in the workplace performed regularly would give us a sense of security that our coworkers are not infected. These tests will not be perfect, but they should markedly reduce our vulnerability to the infection.  

Now on to some Housekeeping

We are planning on resuming a more robust schedule in June and many of you have appointments.  To keep our work environment safe for everyone we suggest that you follow these guidelines. 

  1. We request that you wear masks in our office, our employees will do the same.
  2. If you have upper respiratory symptoms or a fever, please contact us the day before your appointment.  We will either see you in your car, prescribe medications by phone, or can arrange a video appointment.  This will reduce the chance of exposure in our office
  3. Come in the office to sign in for your appointment.  In most cases we will take you back to an exam room immediately.
  4. If there are more than 5 people in the waiting room, put your cell phone number on the sign in sheet, and go outside, and we will call you promptly when a room is available.  (Hopefully, this will not be necessary but just in case)
  5. To avoid patients congregating at the desk for discharge appointments, etc., we will either try to schedule you for follow-up while you are in the exam room,  or you can call Maria to schedule your next appointment. 
  6. Copays will be billed, don’t worry about paying this at the time of your appointment. 

One day we will look back at this and laugh.  Like in 50 years. 

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