What’s the deal with antibody tests?

Up until two weeks ago we had just a few COVID patients in total in my hospital and none in the ICU. For a few months we had quietly slipped back to our usual routine. We were caring for those sick with heart attacks, severe infections, drug overdoses, and other sundry calamities that can befall the human body and land someone in the ICU.

Then everything changed in just a few days.

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Vaccine joy and winter sorrow

He was a lonely older man without any living family. He came into the hospital with severe COVID but, after several days, stabilized. He wasn’t getting better and he wasn’t getting worse. We had given him all the standard treatments and were hopeful that he would improve. Then, as is often the case with COVID-19, he rapidly deteriorated over the course of a day and ended up on life support.

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The burning embers

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She was only in her 30s. She only had mild diabetes. She developed a cough, aches and fever about a week prior to when I saw her. Many of her coworkers had recently tested positive for COVID-19 and she tested positive as well. Gradually she noticed difficulty breathing prompting her to come to the hospital where she had low oxygen levels and was promptly admitted. She was not in long when she worsened further and was transferred to the ICU. When I saw here she was requiring a lot of oxygen and her lab work did not look good. We gave her all the standard treatments – decadron, remdesevir, convalescent plasma, and lovenox – and she stabilized for several days. She was still requiring high levels of oxygen and using CPAP at night but she was not getting worse. In fact there were some signs of improvement.

I have a clear memory of kneeling down next to her as she sat in the chair in her room. She was calm but I could see the fear behind her eyes. She was struggling to maintain control in the face of her situation. I had to nearly scream to be heard over the buzz of the negative pressure generator and my PAPR, “You’re stable and you’ll start getting better soon,” I told her. The minute I said it I could see the tension ease on her face and feel it ease in myself as well.

That was the last thing I said to her.

That night she stood up to use the commode and her oxygen dropped precipitously. This had happened before but she had always recovered in a few moments. This time she didn’t. She lost consciousness, her pulse slowed, and then her heart stopped beating. CPR was started and fortunately the team was able to resuscitate her quickly and placed her on a ventilator. Things got much more difficult from there. We induced a medical coma and paralyzed her to reduce her oxygen usage. We put her in a special bed that rotates her to keep her face down and improve blood flow in the lungs. We did everything possible with the ventilator to keep her oxygen up. She stabilized somewhat but if she was manipulated or turned on her back her oxygen would quickly drop to life threatening levels. We had nothing more we can do for her. Our only option was to transport her to a special center to hook her up to a heart lung bypass machine called ECMO.

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Why COVID-19 is political (IMHO)

What would you say is strongest single predictor of behavior and attitudes towards COVID-19? What factor makes it most likely that someone will follow masking and social distancing guideline?

You would be considered reasonable if you answered that those with the greatest risk of dying would be the most cautious. You would be wrong. You would be considered a rational thinker if you answered that healthcare workers that are confronted with the sick and dying from COVID-19 would have the strongest emotional response motivating them to extra caution. You’d be wrong. You would not be thought crazy if you answered that those with more education would be more careful because they have more of an understanding of the complicated factors at play. Again, you’d be wrong.

Race? Wrong. Gender? Wrong. Employment status? Wrong.

The single strongest predictor of behaviors and attitudes towards COVID-19 is political affiliation.

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What Should I Do With My Test Results?

When I was growing up watching sports there used to be a segment on Monday Night Football entitled “You Make the Call”. The audience would be shown a specific play that required referee intervention. We would then be asked to play pretend referee and decide if it was a touchdown, a penalty, or some other point of rules contention concluding with the phrase “You make the call”. The game would cut to commercial and a lively debate would usually ensue. When the commercials were over they would show the play in slow motion and give you the correct call. I thought it would be a good idea to do a COVID-19 version of “You Make the Call”. I’ll give you the scenario and you can decide how you would respond if you were the doctor.

He woke up in the morning with a bit of a headache. It was not that bad and he hadn’t slept much so he attributed the headache to sleep deprivation. His throat was a bit scratchy but he had allergies every fall and this was typical for him. He decided to get tested to be safe. His rapid antigen test was positive and he is calling to ask you what he should do. What would you tell him to do?

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Do Masks Work or Not?

“My friend told me that masks only work half the time and that there’s no difference between wearing them and not wearing them.”

This was an unsolicited outburst from my 10-year-old daughter the other day. She was quoting a girl in her class. I was not entirely concerned with the opinion of the preadolescent but was concerned about where this gross misinformation was coming from. While I didn’t investigate, I assume that this child did not do an exhaustive search of the latest literature on the effectiveness of face coverings in preventing COVID-19. This would mean that she was parroting something she heard from an adult. While I again did not investigate, I assume that this adult did not do an exhaustive search of the latest literature on the effectiveness of face coverings in preventing COVID-19 either. As is the case for many things these days, lack of knowledge is not an obstacle to the vehement expression of opinion. You only need to read an online article to form a strong and unwavering opinion of anything.

But since the question is floating around out there I thought I would give an updated answer to the question that just doesn’t seem to want to die: Do masks work or not?

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Is COVID testing reliable?

“We have had multiple family members with vague symptoms all of whom tested negative but the father is COVID positive. He then had a follow up test that was negative. Is this sufficient to clear him to go back to school?”

How about this one:

A person had congestion and achiness Monday. The next day she tested negative. She felt a bit better over the next few days but not back to normal (she was also running on very little sleep). A week later her symptoms started up again and were more severe. She is now recovering over the past few days. She has no known exposure. Do you think the negative test on day two clears her and her husband? Technically, she would be 10 days since the start of the second round of symptoms by next weekend but, if this is a second illness and is covid, her husband would not be.
Should she be tested today? Does that then put her and her husband into the questionable awaiting result group?

How would you answer? At best, if you’re wrong and say everyone is clear you could expose an entire school or community and lead to schools shutting down, more people stuck in quarantine, and great financial hardship. At worst, you could be the cause of serious illness or perhaps people dying.

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Why are we acting so crazy if people aren’t really dying from this!?!

“We are informing you that one student in 7th grade tested positive for Covid and a second 7th grade student is symptomatic and waiting for test results.  All students in 7th grade are considered “exposed” due to the student testing positive and they will need to remain quarantined at home through Friday, September 18th.” And thus it starts.

It took just over a week of schooling before the above message came by email. My 7th grader is now in quarantine. Fortunately she is not sick and wasn’t in close proximity to the infected kids (as far as she knows) so she didn’t likely get infected. Since there were a few kids who tested positive they sent the entire grade home. Unfortunately the news has put our house is in a minor state of turmoil. I know every other 7th grade family has had their lives unsettled as much or more than ours. For many it is much more than an inconvenience.

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The long-term damage from COVID you’re not hearing about

It is certainly important to give children responsibility as they grow up. Chores are more than just a means to keep the house in order, they are a means of teaching children the importance of contributing to the family, of giving up their present desires for a higher goal. While this is all wonderful for parenting books and magazine articles it generally ignores a major problem with children, especially smaller ones, performing these essential household duties – they’re typically not very good at them. This was our first problem.

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Maybe you can get COVID twice

Our national 6-month coronaversary has arrived. It’s now been 6 months since our world turned upside down. The world is not the same place it was in January, a statement that is as obvious as it is disconcerting. It’s funny how something can seem like it was just yesterday and a lifetime ago at the same time. I think this summarizes the past 6 months:

  • Do you get the coronavirus from Mexican beer?
  • Where’s Wuhan?
  • There’s no toilet paper!
  • There’s nowhere to get tested.
  • You don’t need to wear a mask.
  • Fauci is our savior!
  • Hydroxychloroquine will save us all! Anyone who disagrees is part of the conspiracy.
  • Fauci doesn’t know anything!
  • You can inject clorox?
  • Everyone needs to wear a mask!
  • You can’t tell me to wear a mask!
  • Does anyone remember sports?
  • It’s all gone, let’s open up the bars and restaurants!
  • We shouldn’t have done that.
  • I’m getting a puppy!
  • I shouldn’t have done that.
  • Opening up schools is irresponsible unless it’s not.
  • I need an air hug.
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