DC Primary Care

04/09/2020

COVID-19 Testing

There are several different types of tests available for screening COVID-19. Four of them will be discussed here.

The nasopharyngeal swab detects SARS-CoV-2 (aka COVID-19) RNA by reverse-transcription polymerase chain reaction (RT-PCR). This test detects presence of current infection. The sample needs to be sent to a lab to be processed. The testing does not take long, but the labs have been overwhelmed with volume. The average turnaround time has been 5-7 days in the DC area.

Abbott received emergency use authorization (EUA) from the FDA for the Abbott RealTime SARS-CoV-2 assay. EUA means that the testing did not undergo the full degree of standard testing before FDA approval. The sensitivity and specificity of the tests are not yet known. We do not know how many false negatives or false positives the test yields. The test uses a nasal or oral viral swab. The test works by identifying the RNA of the virus then amplifying the RNA until there is enough for detection. This is a qualitative test run through Abbott’s m2000 RealTime system that identifies the presence of current infection. Contrary to the name, the sample must be sent to a certified lab for testing. The results are not immediate.

A week after getting EUA approval for the above test, Abbott developed the ID NOW COVID-19 test which is a point-of-care test that yields results in 15 minutes. The ID NOW system has FDA approval for Influenza A&B, Strep A, and respiratory syncytial virus (RSV) testing. It now has EUA by the FDA for COVID-19 testing. The test uses a nasal or oral viral swab and works by amplifying the RNA for detection and determines the presence of current infection.

Henry Schein has developed the point-of-care Standard Q COVID IgM/IgG Rapid test. It is a pinprick blood test that looks for antibodies and delivers results in 15 minutes. IgM antibodies fight active infections. As the infections subsides, our bodies make IgG memory antibodies. Detection of IgG indicates history of exposure. The test is a qualitative test that gives a yes or no answer to whether you were at some point exposed to COVID-19. It cannot determine when the exposure occurred or the level of antibody protection. Similar to the Abbott tests, it only has emergency use authorization from the FDA which leaves room to question the accuracy of the test. Nevertheless, the key to controlling spread of infection is knowledge of infection.

There are other companies developing testing, but the ones discussed here have already become available.

04/02/2020

BCG is an old vaccine with minimal side effects. It was given to children in India to help protect against tuberculosis. It is interesting that India with its large population living in small spaces does not have a high death rate from COVID-19. It would be amazing if this research trial shows beneficial results.

Scientists launch trial of bacillus Calmette-Guérin, a vaccine made of living bacteria, to protect health care workers at risk of COVID-19 infection

03/31/2020

COVID-19
Pregnancy

Very little information is available regarding COVID-19 during pregnancy. In a study of 18 women with suspected or confirmed COVID-19 pneumonia, there was no transmission of the virus to the newborn.

Two neonatal cases have been documented. In one case the baby was diagnosed positive on day 17 of life. The mother and another caregiver were both diagnosed with COVID-19. In the other case with a COVID-19 positive mother from Wuhan, China, the baby was diagnosed 36 hours after birth. The source of transmission was unknown. The mother wore a N95 mask during delivery and had no contact with the baby after birth. Testing of cord blood and placenta were negative for COVID-19. In this case, the baby was born in Wuhan Tongji Hospital which had high exposure risk. Regardless, we cannot definitively conclude that there was no vertical transmission.

03/30/2020

When to discontinue home isolation?

Since there is a nationwide shortage of testing kits, many people have been instructed to self-quarantine under the presumption of active COVID-19 infection. Isolation can be discontinued if the following occur:
• No fever for 72 hours (without the use of medication)
• Improvement in cough and shortness of breath in 72 hours
• 7 days have passed since the onset of symptoms

Individuals with laboratory-confirmed COVID-19 who do not have ANY symptoms may discontinue home isolation 7 days after testing positive.

03/27/2020

COVID-19
Spectrum of Illness

COVID-19 has similar symptoms to the common cold, influenza, and allergies. The primary symptoms are fever, cough, and shortness breath. The spectrum of symptoms ranges from mild upper respiratory symptoms of runny nose to critical ICU hospitalization.

Data from the Chinese Center for Disease Control and Prevention estimates:

• 81% mild – no symptoms to mild pneumonia
• 14% severe – shortness of breath, decline in oxygen levels, pneumonia
• 5% critical – respiratory failure, shock, multiorgan decline

The fatality rate has ranged across the world from 1-6%.
Most of the fatal cases have occurred in persons with advanced age or underlying medical comorbidities like heart disease, diabetes, chronic lung disease, hypertension and cancer. The Chinese CDC reported fatality rates of 8% among those aged 70-79 and 15% among those older than age 80.

Symptomatic infection in children appears to be uncommon. China reported

03/26/2020

COVID-19
Transmission

How likely is it that you are going to get coronavirus?

The viral RNA levels appear to be higher soon after symptoms start compared with later in the illness. Risk for transmitting the infection to someone else is presumably higher in the early stages of the disease. Additional data is needed to confirm this hypothesis.

Cases of transmission from asymptomatic individuals have been reported, but we do not know to what extent. The incubation period for COVID-19 is 14 days. The median time to develop symptoms is 4 days after exposure.

COVID-19 has similar symptoms to the common cold, influenza, and allergies. The primary symptoms are fever, cough, and shortness breath.

03/25/2020

COVID-19
General information

Coronaviruses are classified under the Nidovirales order. Viruses mutate. This is why there is a new influenza vaccine every year. These viruses have the largest known viral RNA genomes. Community-acquired coronaviruses are ubiquitous and are often the cause of the common cold. However, coronaviruses are only one of the many viruses that can cause the common cold.

The novel coronavirus that was first identified in Wuhan, China in late 2019 is known as COVID-19. The route of transmission is through direct contact with infected secretion or large aerosol droplets. The virus is released in respiratory droplets when a person with infection coughs, sneezes, or talks. Infection can occur if the virus makes contact with the mucus membranes of another person. Infection can occur if a person touches an infected surface and then touches their eyes, nose or mouth. Droplets typically do not travel more than six feet and do not linger in the air. However, given the current uncertainty regarding transmission mechanisms, airborne precautions (do not breath the same air) are recommended in some countries. The United States currently recommends respiratory droplet precautions.

03/25/2020

During this difficult period, I am committed to being available to my patients. Our office remains open for patients who need routine and acute medical care. We are taking every precaution in maintaining the safety of our patients and staff. I am now offering telemedicine appointments as well. It is a HIPAA compliant form of communication.

I am starting to write posts on COVID-19, so my patients can have accurate information. I cannot stress the importance of staying at home.