Medical Discussion of Coronavirus

[fatlittlepig]

I obtained an antibody test, it was negative for IgM or IgG antibodies.

[Peds]

I obtained an antibody test, it was negative for IgM or IgG antibodies.

Did you have reason to believe otherwise?

[G]

Did you have reason to believe otherwise?

you mean aside from the petri dish of the Bay?

FLP, bummer...I am rooting for all of us.

[Max Power]

I think the issue was that the healthcare system was going to collapse, like in Italy, and that workers were going to stop showing up to work anyway, just as teachers did.

Happy you are delighted to sacrifice your elders; I am not. Hopefully you deal only with kids or pregnant women. Notably, though there have been many serious cases among young people and essential workers. Do they not matter, either?

Of course everyone matters... you can't make it into a straw man. Nobody is sacrificing anyone. Nobody is going to get this COVID or any other disease on purpose, and nobody is going to give it to anyone else on purpose. I simply said no society in history would choose its young and healthy over its seniors.

The 'serious cases' among health, safety, and other workers - and young or middle age people in general - is terribly overblown, and we all know it. The stats are above... this thing can VERY rarely pose a serious threat to people under retirement age barring morbid obesity. Refer to the CDC study of 10k health care workers. Other US and international cohorts on UpToDate and similar all echo the same. The death % and hospitalized % will nose dive as more testing occurs, just like H1N1 or MERS or SARS rates did. COVID's USA and overall worldwide mortality percentage is going to be well under 1% and total body counts way under what was predicted by doom and gloomers. Those who succumb to COVID19 were basically beyond help since they were mostly drain-circling to begin with. Sad but true. Will there be rare exceptions? Sure. Do you make policy based on outliers? Nope.

I totally get not wanting to overload the system, but we created an entirely new problem by largely ignoring all other conditions in order to be myopic with a fetish for Corona. Bad move. Hospitals are NOT overloaded for the most part... nearly all have vents, ICU, etc available to greater degree than they usually do back in peak flu season annually. What they now don't have is revenue or the ability to help the 99% who haven't gotten Corona but are getting silent MI, CVA, etc at home due to missed Rx and missed appts. Warnings of a high current importance of public health tactics of hygiene, distance, and other common sense flu season stuff like not attending work sick and senior wearing mask or isolating would have sufficed fine for COVID19.... as if did in other nations.

However we handle it, we will see shutdown resulting in more and more people running out of their meds due to finances and lack of access, more and more folks going depressed and much worse psych, nobody doing screen tests or labs or cleanings, etc. It is like no more service checks or new filters or oil changes or tire rotations or spark plug swaps for American health... works fine, until it doesn't. That is the entire reasoning for all of the evidence-based specialty and primary care guidelines we are now neglecting. You always see a bit of that stuff with people running out of Rx and being non-compliant with screenings and f/u (and it makes for severe admits and big problems later), but now it will start to be a ton with essentially zero preventative care for medical, dental, optho, podiatry, PT, social work, etc etc etc. Time will tell. It already is.

[fatlittlepig]

Did you have reason to believe otherwise?

1. I'm an inpatient physician
2. I'm a human, and no one knows the true incidence of SARS-COV-2

[redsand]

I obtained an antibody test, it was negative for IgM or IgG antibodies.

Is the test specific for SARS-CoV-2 and would not cross-react with antibodies to coronaviruses that would be ineffective for SARS-CoV-2?

It seems like all the discussion in the news and during press conferences about antibody testing neglects to discuss the level of certainty a positive antibody test result would demonstrate previous infection with SARS-CoV-2.

[fatlittlepig]

I don't think the article said this was all the healthcare people who have it. I think everyone has been operating under the assumption that the prevalence is many, many times higher than what we think. I think it was Santa Clara County, California who just recently estimated that 50-85 times more people have or have had COVID-19 than the numbers have confirmed. I mainly shared because I'm hoping it will add some grounded reality to those who are incredibly fearful of catching it and dying from it. I know several people in real life who have an irrational fear and I'm sure there's probably several on here, too.

I don't think being fearful of an efficiently transmissable airborne pathogen without knowing what genetic factors predisposes people to morbidity and mortality is irrational. It's very rational.

[fatlittlepig]

Is the test specific for SARS-CoV-2 and would not cross-react with antibodies to coronaviruses that would be ineffective for SARS-CoV-2?

It seems like all the discussion in the news and during press conferences about antibody testing neglects to discuss the level of certainty a positive antibody test result would demonstrate previous infection with SARS-CoV-2.

There are over 70 different companies who have antibody tests. Most are lateral flow assays which are impregnated with recombinant SARS-2 virus antigen (Nucleocapsid shell or spike protein antigen) bound to colloidal gold. The Anti-human IgM and Anti-Human IgG lines will light up if your blood has anti SARS-2 antibodies. My understanding is the viral antigen used should be specific for novel coronavirus as opposed to the other 4 coronaviruses (which cause the common cold), but the antibodies tests have a false positive rate. I think that is why the US government is having a hard time, because for screening the general population a sensitivity and specificity between 95-99% is fine, but if you are using them to tell someone they are clear to return to work, it may not be specific enough (I believe you may need a more specialized quantitative antibody test, which of course would be much more costly and not necessary a POC test.)

[StarTrekDoc]

Most these serology are 90% sens and 98% spec that are being approved or in the pipeline for FDA approval.

This translate to a The PPV of most of these tests with a prevalence of 1% is low -- 15-20%. If the Santa Clara county prevalence rate holds true to the general population overall, then PPV gets better to the 50/50 range --. That's assuming a IgG conveys a 100% immunity --- which is a stretch too at this time.

So until prevalence jumps into the 10% range, will a PPV of 80% is reached and having COVID+ teams as frontline HCW to seniors and response teams may become somewhat viable.

Seniors will be stay-at-home orders with strict social distancing and masking until vaccine. When with IgG+ HCW, until that prevalence rate really goes up; I'm not letting anyone close to my elderly at-risk parents.

[Tangler]

I obtained an antibody test, it was negative for IgM or IgG antibodies.

Sorry FLP, I would be pretty sad if I was negative, even though we don't know what it means in terms of immunity. Some Ig seems better than no Ig, but I am just a caveman anesthesiologist, so what do I know?!

[White.Beard.Doc]

I obtained an antibody test, it was negative for IgM or IgG antibodies.

The lateral flow assays, like the one you used, are reportedly quite inaccurate. Did you source this assay from China? Is it one of the many that have not been FDA reviewed? The Cellex lateral flow assay is reported as the only lateral flow assay that the FDA has approved.

The elisa assay is quantitative and supposed to be much more accurate. LabCorp is working on getting the elisa quantitative assay up and running shortly. I feel like I would much rather have that test in contrast to a lateral flow assay.

I also wonder if viral mutation since the Chinese outbreak has an effect on the lateral flow antibody assays coming out of China. The reports are that the strain in the US is different and comes mostly from Europe.

[Lordosis]

Of course everyone matters... you can't make it into a straw man. Nobody is sacrificing anyone. Nobody is going to get this COVID or any other disease on purpose, and nobody is going to give it to anyone else on purpose. I simply said no society in history would choose its young and healthy over its seniors.

The 'serious cases' among health, safety, and other workers - and young or middle age people in general - is terribly overblown, and we all know it. The stats are above... this thing can VERY rarely pose a serious threat to people under retirement age barring morbid obesity. Refer to the CDC study of 10k health care workers. Other US and international cohorts on UpToDate and similar all echo the same. The death % and hospitalized % will nose dive as more testing occurs, just like H1N1 or MERS or SARS rates did. COVID's USA and overall worldwide mortality percentage is going to be well under 1% and total body counts way under what was predicted by doom and gloomers. Those who succumb to COVID19 were basically beyond help since they were mostly drain-circling to begin with. Sad but true. Will there be rare exceptions? Sure. Do you make policy based on outliers? Nope.

I totally get not wanting to overload the system, but we created an entirely new problem by largely ignoring all other conditions in order to be myopic with a fetish for Corona. Bad move. Hospitals are NOT overloaded for the most part... nearly all have vents, ICU, etc available to greater degree than they usually do back in peak flu season annually. What they now don't have is revenue or the ability to help the 99% who haven't gotten Corona but are getting silent MI, CVA, etc at home due to missed Rx and missed appts. Warnings of a high current importance of public health tactics of hygiene, distance, and other common sense flu season stuff like not attending work sick and senior wearing mask or isolating would have sufficed fine for COVID19.... as if did in other nations.

However we handle it, we will see shutdown resulting in more and more people running out of their meds due to finances and lack of access, more and more folks going depressed and much worse psych, nobody doing screen tests or labs or cleanings, etc. It is like no more service checks or new filters or oil changes or tire rotations or spark plug swaps for American health... works fine, until it doesn't. That is the entire reasoning for all of the evidence-based specialty and primary care guidelines we are now neglecting. You always see a bit of that stuff with people running out of Rx and being non-compliant with screenings and f/u (and it makes for severe admits and big problems later), but now it will start to be a ton with essentially zero preventative care for medical, dental, optho, podiatry, PT, social work, etc etc etc. Time will tell. It already is.

What are you talking about. Plenty of healthy people are getting real sick and even dying. I am in a relatively low impact area and I have about a dozen patients who tested positive. 4 hospitalized. 2 are still intubated. Both in their 50s. One guy intubated for over 3 weeks now yes he is obese and has well controlled DM but he was by no means circling the drain. He was likely planning on working another decade.

The other guy was in excellent health. Remote history of smoking. Nothing else. Not fat. No metabolic syndrome. Takes no meds. Normal guy with a normal job. Mid 50s. Scares the sh!t out of me.

It is a small sample size for sure but it can cause very significant morbidity and mortality in healthy folk. And we do not know what the common denominator is.

[CordMcNally]

I don't think being fearful of an efficiently transmissable airborne pathogen without knowing what genetic factors predisposes people to morbidity and mortality is irrational. It's very rational.

I feel sorry for the people who let such a small chance of something happening affect the way they live their life. I'm more worried about being shot by a patient or dying in a car wreck than I am from dying from COVID.

[Tangler]

Of course everyone matters... you can't make it into a straw man. Nobody is sacrificing anyone. Nobody is going to get this COVID or any other disease on purpose, and nobody is going to give it to anyone else on purpose. I simply said no society in history would choose its young and healthy over its seniors.

The 'serious cases' among health, safety, and other workers - and young or middle age people in general - is terribly overblown, and we all know it. The stats are above... this thing can VERY rarely pose a serious threat to people under retirement age barring morbid obesity. .

The point here doc: those people matter. The old and frail matter. The "few" heal care workers who get really sick matter.
All of my icus are full. We just opened more ICUs. We are using anesthesia ventilators.
Do you want us to run out of vents so you can "open things up"? Do you want an Italy like situation where we have to decide who gets a vent?
You say one minute that everyone matters, then you imply it is just like the flu, well the flu is not filling up my ICU in mid April.
I don't mean to argue with you. My brother (a general surgeon in a much smaller town) has many of your concerns about the economy and the small businesses and the loss of jobs etc. but he understands that if the virus is not controlled those people will not be able to make money despite the "opening" of things because people will not go out out of fear and opening a place back up costs money (prior discussions on utilities, supplies, workers salaries, and no one shows = worse than staying closed).

we are: 1. not running out of food 2. dying from lack of resources (we are the richest country in the world) and I think we need to keep it shut down until we get a very good plan for how to slowly open things up. We need some effective treatments and much better testing. We need to understand what the antibody tests mean in terms of "protection" and we need to protect the people who cannot protect themselves.

I know the stats, but I know a few young docs who needed intubation and one ecmo. I know that is unlikely and that a previously healthy person like me is probably going to be just fine, but I don't give a rats behind about not having screening colonoscopies or gyn exams or sporting events or open restaurants etc. right now. sorry. Don't care about that. That stuff can wait a few weeks. Also, people can get their meds, no one needs to come within 100 feet of a hospital to get meds, their kid can pick it up from CVS on the corner.

I am reassured by the stats, on health care workers but I also know: 1. this ain't the flu 2. people are dying 3. PPE supplies are terrible 4. Administrators care more about image and liability than workers 5. I will get through this but I will be pissed if they open things up and we get overwhelmed.

Would a massive increase in cases overwhelm us? Will we totally run out of PPE? Will I work with marginal / crappy PPE, we already sorta are.

Your Words like "Overblown, and VERY rarely pose a serious threat to people under retirement age"

Think a little about what you are saying.

Just reflect a little on what you are saying and imagine how you would feel if it was your medschool classmate who was put on ecmo. Would those words sit well with you?

How would you interpret those words in that situation? Not picking a fight here. It would be better to have you convinced then to have you as an enemy.

Young doc got off ecmo last week. Anesthesia doc in 40s Not obese.

[jhwkr542]

This will be the last time I say this: the POC serology tests are trash. If it's negative, you're likely negative. If it's positive, you're still probably negative. The new elisa assays on the chemistry lab immunoanalyzers are much better but in a low prevalence population, your PPV is still likely to be so low that a positive test isn't definitive proof you've been exposed. Serology testing will never be this near 100% sensitivity and specificity test. It's not like a molecular test or ion electrodes.