Santa Barbara Doctors ExtraCare – May 2020 Newsletter

May 2020 ExtraCare Newsletter

COVID Update-viral shedding and antibodies

As the weeks go on we continue to learn more about the characteristics of the SARS0CoV-2 virus and its sequela. As I combed through the multitude of scientific publications this past month two jumped out at me that I wanted to share.

The first was a study in China published in Clinical Infectious Diseases that followed 56 COVID-19 patients (median age 55; 61% men) with mild-moderate infection. They obtained throat or deep nasal cavity specimens and performed RT-PCR assays to detect virus.

The rate of positive results was highest at week one (100%), followed by 89.3%, 66.1%, 32.1%, 5.4% and 0% at weeks two, three, four, five and six, respectively.

This study suggests the presence of viral RNA for up to six weeks after symptom onset. However, additional studies have not been able to culture live virus beyond 14 days suggesting that these positive PCR tests may be picking up remnants of viral RNA.

In other words, detecting viral RNA via PCR does not necessarily mean that infectious virus is present.

This is the rationale behind the current CDC Symptom-based strategy back to work recommendations which allow return to work if:

• At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,
• At least 10 days have passed since symptoms first appeared

The antibody response begins generally 1-2 weeks after symptom onset, with IgM antibodies (early antibodies) forming first and quickly disappearing and IgG antibodies (late antibodies) starting a bit later and persisting.

The antibody issue is one that I wanted to try to clear up for you, because there is so much information out there that even I can’t keep it all straight.

The WHO released a scientific brief a few weeks ago stating that there is currently no evidence to suggest that people who recover from COVID-19 and have antibodies are protected against reinfection with the illness. While this is technically true, there are no studies to date proving immunity to COVID-19 with antibodies, there is data to support this concept with many other viruses including SARS-CoV-1. In addition, it is believed that the few cases of people retesting positive on a RT-PCR after previously testing negative, is probably a result of the detection of residual viral RNA, not active virus.

Thus, I personally believe that antibody testing is important when trying to determine one’s susceptibility to this virus. I don’t advocate this testing as an “immunity passport” as some have called it, but do believe that individuals who carry antibodies likely have some degree of defense against reinfection with the virus.

This being said, the next question remains which is the best test to use?

This is where, I believe, the FDA has done us a disservice by relaxing it’s standards for releasing antibody testing under the emergency use authorization act. This has opened the floodgates and saturated the market with hundreds of antibody tests, but currently, there are only 12 COVID-19 antibody tests approved by the FDA. Many of you have been sending me emails and notices received by various companies offering antibody tests with fingerstick blood, even home testing kits. I urge you not to purchase those as most of them are not approved by the FDA and the sensitivity and specificity of the tests are unknown. In addition, a fingerstick test relies on an adequate sample collection, which often falls short, especially with a non-trained processor.

I have been holding off on sending this email, waiting for our laboratory kits to arrive. Unfortunately, we have not yet received our shipment of antibody test kits but we expect delivery by early next week. We have ordered FDA approved test kits distributed by Hardy Diagnostics. They have a reported sensitivity of 99% for IgG and 96% for IgM antibodies and specificity of 99%. We will be drawing blood samples and using spun down serum to run the tests, ensuring adequate specimen sampling.

As soon as these kits arrive and we have completed our validation studies we can offer them to our patients. It is our hope that those who suffered from a viral illness anytime between January to the present get tested first. We will be adding COVID-19 antibody testing to our annual physical blood panel moving forward and will of course have this testing available to all of our patients if needed.

It is important to know that antibody testing is not intended to diagnose acute disease. Our policy remains that if you suspect that you have COVID infection, phone our office and schedule a telehealth visit. We can then assess you and order PCR testing if appropriate.

During these trying times it is more important than ever to consider the emotional elements of wellness. These 7 tips can help reset your mind:

1.  Stay connected: Utilize your community and maintain relationships!  Covid isolation does NOT mean emotional isolation.  Study after study supports the importance of relationships during stressful moments.  This can be done with phone calls, video chats, email, or the old fashioned letter.  Now is the perfect time to reach out to friends or family to remind them you care.
2. Structure your day: Waking up with the alarm and planning short term goals throughout the day or week will create a sense of accomplishment.  When life is set to pause it can create a sense of stagnation; humans are inherently goal driven.
3. Re-visit your hobbies: Make a list of things you used to love to do.  This is an important reminder in and out of isolation because emotional wellness suffers when chores become overwhelming.  Making time for even ONE thing that you love to do each day will make you smile.
4. Eat right: I truly believe in the connection between healthy dieting with healthy living.  Now that you’ve gotten the munchies out of the way with the early quarantine, there’s no better time to focus on a diet plan.  Meal prepping ensures compliance, and purchasing fruits and vegetables either online or through farmers market suppliers, helps the local community and can become a fun, creative hobby.
5. Exercise! At least 30 minutes a day; this is life’s natural serotonin kick.  It honestly doesn’t matter what you do as long as you get your heart rate up and have fun doing it.  Exercising can help your mind, body, and spirit.
6. Smile: to your loved ones, and smile to strangers.  Everyone’s stressed and hurting in some way, and everyone can use an emotional pick-me-up.  This is even more pronounced now.  Smiling has been shown to raise endorphins in the brain and lower blood pressure, heart rate, and stress levels.
7. Dream: We all speculate what the “new norm” will be and too often migrate to pessimism.  Catch yourself and reset your mind.    We live in Santa Barbara.  We have each other.  And life is pretty amazing.

Copyright © 2021 Barbara A. Hrach M.D. FACP, All rights reserved. You are receiving this email because you are an ExtraCare patient of Barbara A. Hrach, M.D., FACP.

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