Coronavirus: What questions do you have?

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cwbullet

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Today was a challenging day. We had a small bump in infections within the system. I have confirmed after 6 weeks that there is a hockey stick-shaped curve every weekend. I wonder if COVID limits itself to causing infections and deaths during the workweek or does GA Public Health take the weekends off. I think we all know the answer.
 

Peartree

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Full production usually follows as long at the 10K is somewhat of a good sample of the population.
And then, assuming that a viable vaccine was tested and approved by the FDA today, how long would it take to manufacture/produce, distribute, and inoculate 300 million Americans and several billion people worldwide? A year? Three years?
 

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I read that AB tests miss the mark 50% of the time. What good are these tests?
That is the first real question that must be answered followed by "how the heck do we use it?".

  1. Not all AB tests are the same. The best are Abbott and Roche at the time and they score far better than that. They are in the 90s. The problem with the news areticles on this is they look at 70+ test and lump them together with a generalized, sensationalized quote that is clickbait. Talk to a medical professional about whether they recommend testing. I was tested and I am negative. I tested myself as a part of media engagement to show we had the testing and even I was will to be tested.
  2. AB test is not there to test for an active infection. It must be drawn in the right window of time to indicate a prior infection and "potential immunity".
This are the answers. You must know which test they are running to know if it is better than 50%. If not, you might be one of the unlucky to get on that is far worse than 50%,
 

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“AB test is not there to test for an active infection. It must be drawn in the right window of time to indicate a prior infection and "potential immunity".

What is the right window?

Thanks
 

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“AB test is not there to test for an active infection. It must be drawn in the right window of time to indicate a prior infection and "potential immunity".

What is the right window?

Thanks
Good question - about 14 days for IgG which provides the bets information.
 

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Chuck, I haven't seen good metrics regarding how many "recovered" people will have persistent or permanent problems due to COVID-19.

For example, a quick scan of worldometers for the US shows that there have been a bit more than 1,758k cases, of which 102k+ died and 494k+ "recovered."

What percent of these recovered (presumably, no longer needing hospital care and no longer infectious) people have serious complications that will impact them for a while or perhaps permanently such as decreased respiratory capacity, problems due to clots, or other issues.

Certainly the situation is evolving, but is there a best guess so far?
 

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Chuck, I haven't seen good metrics regarding how many "recovered" people will have persistent or permanent problems due to COVID-19.

For example, a quick scan of worldometers for the US shows that there have been a bit more than 1,758k cases, of which 102k+ died and 494k+ "recovered."

What percent of these recovered (presumably, no longer needing hospital care and no longer infectious) people have serious complications that will impact them for a while or perhaps permanently such as decreased respiratory capacity, problems due to clots, or other issues.

Certainly the situation is evolving, but is there a best guess so far?
The information I am seeing indicates long term complications are rare and usually almost only occur is hospitalized.
 

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Today was a challenging day. We had a small bump in infections within the system. I have confirmed after 6 weeks that there is a hockey stick-shaped curve every weekend. I wonder if COVID limits itself to causing infections and deaths during the workweek or does GA Public Health take the weekends off. I think we all know the answer.
There has been a weekly cyclic pattern in the figures from the start from what I have seen. I suspect it relates to the amount of testing and/or analysis done on the weekend, thus seeing the amount of cases ramp down over the weekend and early in the week, then ramping back up again for later in the week.
 

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There has been a weekly cyclic pattern in the figures from the start from what I have seen. I suspect it relates to the amount of testing and/or analysis done on the weekend, thus seeing the amount of cases ramp down over the weekend and early in the week, then ramping back up again for later in the week.
Many county health departments don't report figures over the weekend so they are made up once the work week resumes.
 

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That is true in GA and I have graphs to prove it.
 

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We just had 2 guys at work test positive!

Sadly we are not allowed to wear masks at work.

I was within 6 feet of one of these guys, but for less than 10 minutes.

Just wondering do I need to wait for symptoms before seeking a test?
 

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We just had 2 guys at work test positive!

Sadly we are not allowed to wear masks at work.

I was within 6 feet of one of these guys, but for less than 10 minutes.

Just wondering do I need to wait for symptoms before seeking a test?
I would talk to a provider. I will tell you that the test is more sensitive (less false negatives) if you are symptomatic. A clinician needs to judge your risk. If the risk is high enough, we recommend quarantine and testing.
 

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Another day: we had to test a large number of folks who a local public health official felt were of high risk due to close contact. I previously screen 5 as being high risk. The other 40 screen low but "they must be tested". Four of the five I screened were positive. Of the remaining "large number", zero tested positive. Talk about a major whiff. My question now is based on 60-70% sensitivity, how many are a false negative?
 

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Another day: we had to test a large number of folks who a local public health official felt were of high risk due to close contact. I previously screen 5 as being high risk. The other 40 screen low but "they must be tested". Four of the five I screened were positive. Of the remaining "large number", zero tested positive. Talk about a major whiff. My question now is based on 60-70% sensitivity, how many are a false negative?
I had a telemedicine appointment with my internist/PCP this week. He said they were now doing COVID-19 antibody testing that was 99% accurate, "best on the market." Didn't ask about the brand/methodology, as I have zero desire to confirm my current negative status that I'm 100% positive about. So the question is, why would I even ever want to voluntarily do an antibody test (even if it is 99% accurate, which I question)? If I exhibit symptoms, then I call my doctor and get advice. Beyond that, why do I care?
 

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@Speaknoevil

You may not care nor need it. If you have no perceived benefit, there's no need for a invasive test.

As for me, I'd like one, but it would need a higher accuracy for an older exposure. Working around this disease and not always having the necessary PPE makes me curious. I never developed a fever, but did have a few other symptoms in my lower chest. It was most likely something else, but I would be curious for an antibody test. Just not curious enough to pay out of pocket.
 

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@Speaknoevil

You may not care nor need it. If you have no perceived benefit, there's no need for a invasive test.

As for me, I'd like one, but it would need a higher accuracy for an older exposure. Working around this disease and not always having the necessary PPE makes me curious. I never developed a fever, but did have a few other symptoms in my lower chest. It was most likely something else, but I would be curious for an antibody test. Just not curious enough to pay out of pocket.
Concur 100%. You are not sticking a 6-inch swab near my brain to test for something I could care less whether I have.
 

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Statistical question:

Ive heard .3% fatal rate (3/1000)

Is there a similar figure for "Recovered, but with lasting lung damage"?
 

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Chuck how are the saliva based tests coming along?
Still in FDA review last time I checked. As of this morning, you still have to get your brain tickled and risking puking on the Doc's shoes.

No, it does not go back to the brain, but it is darn deep.
 

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Statistical question:

Ive heard .3% fatal rate (3/1000)

Is there a similar figure for "Recovered, but with lasting lung damage"?
True long term lung damage will not be known for years. We will need time to evaluate. It is probably exceptionally rare. 1% or less.

The fatality rate based on statistical analysis is 0.3% - it could be 1% or it could 0.1%. We will not know for sure until there are much higher levels of AB testing with a much more reliable AB test. Some of them are pure crap.
 

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Update: We are starting to see a bump in cases from memorial day. Sunday's numbers were double what we normally expect.

I am beginning to believe this will end up being three crises. Of course, the first crisis is COVID. While stunned and reeling from the COVID-19 pandemic, we find ourselves embroiled in another crisis and protests. Although the masks seem to play into helping the protestors. I am worried that we will have a huge boost in infections from the lack of social distancing and travel of those supporting the Floyd family. The third crisis, unfortunately, is not new, but one that has reached a tipping point. The growing poverty in the country will be hurt further by both an extension of COVID and damage caused by protests. I am deeply concerned.
 

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Remember the video from the wild Lake of the Ozarks pool party over Memorial Day weekend? Well, someone there got sick that Sunday and has since tested positive.

I will keep my words to myself in order to remain family friendly.
 

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Montana has had very low numbers for quite a while. A couple weeks ago we had a spike of 7 or 8 following some travel. Then we had no new cases for several days. Yesterday, two adjoining counties (Big Horn and Yellowstone) had a huge number of new cases confirmed. I think I heard 41 new cases.
 

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Montana has had very low numbers for quite a while. A couple weeks ago we had a spike of 7 or 8 following some travel. Then we had no new cases for several days. Yesterday, two adjoining counties (Big Horn and Yellowstone) had a huge number of new cases confirmed. I think I heard 41 new cases.
We are experiencing moderately large increases in Georgia over the weekend. The largest number on a Sunday on nearly 6 weeks.
 

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Our hospital admissions with confirmed Covid cases have risen since more business have opened and some gatherings have resumed. We have also resumed more elective procedures causing our census to increase. We still have rooms available and the ED hasn't been flooded with patients where they are lined up in the halls, so I still remain cautiously optimistic.
 

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We are screening all patient prior to allowing them to come into the hospital in a tent. It will hopefully prevent the spread into our hospital. Only true emergencies bypass the tent.
 

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New data released in the news. A small isolated population of over 600 was brought into a controlled environment and tested for COVID. All were asymptomatic and 8 tested positive for COVID. They were separated into two cohorts: COVID and Non-COVID. The groups were separated by physical barriers (distance) and had separate facilities. No chance of contamination. After 14 days of strict quarantine, both groups were retested. Over 150 tested positive for COVID on the second test.

I cannot explain the results and it has me guessing but I am 100% certain this did not magically transport into the population. I have to think that the false-negative rate is so high that a few slipped through.
 

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How should we use the AB test?
You should discuss this with a public health official or medical provider. It really depends on the test and local prevalence.

There have not been formal guidelines at the national or local levels regarding how exactly these tests should be used but most local experts can suggest a strategy. And, in the absence of such guidelines, many people are anxious to get antibody testing. We have started in our local area.

The way I look at such tests is that they are a single tool in our toolbox. People develop IgG antibodies a week to 2 weeks into an infection and these are the most useful to mark a prior infection or immunity (not a guarantee of immunity). Antibody tests can support diagnostic tests in identifying prior infections. They also can be used for screening or public health surveillance. But, for all these purposes, antibody tests should not be the sole source of information for decision-making. As we learn more about the tests and what they're capable of, I think we'll be able to make some evidence-based guidelines to indicate who should be tested and what we should do with the results.

Locally, we are using them as surveillance and to gauge what some folks actually had. It is not a guarantee and it is sort of like sticking your finger up to gauge wind direction.
 
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