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Three important COVID-19 questions answered

By Gregg DeNicola, M.D., Caduceus Medical Group

Of all the questions I am receiving on COVID-19, I can narrow down the most important to three. 

--Do I have it? 

--Am I over it? 

--Am I contagious? 

It turns out even distinguished specialists are not in agreement. After all, no one had ever heard of COVID-19 three months ago. Doctors like pointing to peer reviewed data. In this case there is…well, none. That forces us to use logic, and a bit of faith we are making rational choices. Let’s answer those three questions using these principles. 

--We have come to the conclusion that the PCR test via nasal swab is the gold standard. It isn’t 100 percent. But it’s the best we have. It does take a few days to get the result, during which time you should stay isolated. But we have had at least six patients who tested negative on a “quick” test and allowed us to do the PCR – which was positive. The concern is more with false negatives than positives. This is too critical a disease to risk a false negative. 

It is clear that all “COVID-19 tests” are not equal. 

The inaccurate sense of safety from a false negative can lead to a life-threatening infection to those close to you if you spread it unknowingly. Same issue with the newer “antibody” screens. They test your immune response to the virus. But finding the virus itself is obviously preferred.

Moral: We advise avoiding all COVID-19 tests other than nasopharyngeal PCR swabs at this time. Ask prior to going to the testing center. They may be hard to find, but there are several centers here in Laguna offering them. 

--To “close” the case is tougher. Most of our re-swabs at one and two weeks post-diagnosis have remained positive. The experts are telling us to keep testing to at least four weeks out. This is where serum antibody tests are superior to PCR tests. If your body has mounted an antibody response to COVID-19, you may assume you are recovered if you have no symptoms. That means the infection has run its course, and you will not get it again. 

Unfortunately, we are having difficulty finding antibody tests on the market with the accuracy we feel is needed. At Caduceus, we prefer an antibody test to close your case. Absent one, a PCR swab also works. But do you need to stay isolated even if you have no symptoms until one of these tests show recovery?

The CDC says no. They ask for three days of no fever or symptoms, and one week from diagnosis. But using that criteria ignores our data that all cases still show active virus via PCR at one week. 

Moral:  We advise either an antibody or PCR test to show recovery prior to discontinuing isolation. Be patient. Wait for proof of immunity. If any disease begs for an accurate immunity, this is it. 

--Determining if you are contagious is the toughest job we have since no test can reliably tell us that. The PCR tells us if there is virus in your nose...but it is so sensitive, it may pick up viral fragments that are not contagious. You may be three weeks out from your diagnosis, feeling great with a positive PCR. Are you contagious? We just don’t know.

The antibody test? Tells us you are immune but not if you can pass it. Another virus, Hepatitis B, has some patients show immunity but they are active carriers for a lifetime. 

The experts are hoping to develop a test we use with HIV called a “viral load” – telling us both how bad it is, as well as how infectious. But that doesn’t exist now. 

Is it possible there will be “asymptomatic carriers” that can keep spreading COVID-19 for months or years? That is a question no doctor wants to have to answer. Including yours truly. We pray the answer is no.

Moral: There is no definite test to ensure you are not contagious. The best test we have now is the PCR swab. 

Fortunately, every day we analyze more data. And share it. And learn. Keep getting tested. More data means lives saved. 

Caduceus Medical Group is located at 333 Thalia St.

For more information, go to www.caduceusmedicalgroup.com or call (949) 499-0577.

 

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