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COVID-19 Update

by | Jun 17, 2020 | Blog, Health & Wellness

We haven’t posted an update about COVID-19 in a while because — well — there haven’t been many newsworthy changes in the science and medical situation surrounding COVID-19.  We’re still eagerly anticipating a vaccine, our communities are crawling out of hibernation, and we’re all grappling with how to stay safe.  We’ve tried, below, to distill the most common questions we’re getting here at the clinic into quick, easily digestible answers with sources cited as appropriate.  Of course, if you are a member and have more questions or what to talk about any one of these things, don’t hesitate to reach out to us directly!

Last update June 17, 2020

Timeline

  • When will this be over?
    • Nobody knows.
    • With the opening up of communities across the US, we’re seeing that cases are continuing to rise.
    • This will likely be “over” when a vaccine is created or when a vast majority of the population is infected and recovers (i.e. “herd immunity” is created).

 

Numbers

 

Testing

  • What, exactly, are we testing when we “test” for COVID-19?
    • There are two kinds of testing methods widely available and one that should be ready for primetime soon:
      • Molecular (PCR) testing: this test diagnoses active, current COVID-19 infection is accomplished by taking a nasopharyngeal swab through the opening of the nose or a nasopharyngeal aspirate (like a Netti pot or nasal saline rinse).  The sample is then sent to a lab to amplify and duplicate the virus’ nucleic acid sequence (its RNA) — if it’s present.
      • Antibody (IgG/IgM) testing: the test we’re currently using checks only for the IgG antibody, which turns positive approximately 10-14 days after a person is infected.  It is collected via blood sample and we’re using it to diagnose prior infections with COVID-19.
      • Antigen testing: the newest form of testing that is still rampling up.  This test looks for protein elements of the viral molecule (as opposed to the nucleic acid components as with the PCR testing) and will be used for diagnosing active, current cases of COVID-19 once it’s up and running.

 

Accessing testing

  • Where can I be tested?
      • At KCDPC: we have the ability to do both PCR and Antibody testing here at the clinic (see above for the difference between the two). 
        • The molecular PCR (nasal swab) testing that diagnoses active, current infection is $75 for the visit here at KCDPC; there is an additional cost incurred by the lab vendor that you can use your insurance to cover.  Anyone interested in getting tested must fill out this questionnaire; you’ll be able to schedule your visit and pay for the visit fee after filling this out.  
        • Antibody (IgG, blood draw) testing that diagnoses past infection can be done at least 14 days beyond the resolution of symptoms; there is an additional cost incurred by the lab vendor that you can use your insurance to cover.  
        • We believe (don’t know) that those who don’t have insurance will not be billed for these tests by the lab vendor.  
      • The state/local health departments are ramping up their ability to test (usually at no cost!) and but have some stipulations regarding who can be tested (i.e. symptoms, healthcare workers, exposures, etc.)
      • Different commercial entities are also starting to offer testing (cost will vary; check with them directly): 
  • Is the testing 100% accurate?
      • No test (i.e. no laboratory test) is 100% accurate.
      • For the molecular PCR test, a negative result may not mean that a person doesn’t have the virus.  It may just mean that we didn’t capture the virus when we swabbed the individual.  This is known as a false negative result
      • For the antibody test, a positive result of this test may indicate exposure to the virus that causes COVID-19, SARS-CoV-2 — or it may not. Positive results to antibody testing could also be due to past or present infection with other coronavirus strains.  (We’re in the weeds a bit here, but you could get a positive result from a past infection with others like coronavirus HKU1, NL63, OC43, or 229E). This is what’s known as a false positive result. 
      • Frustratingly, we cannot say if a positive is a true or false positive or if a negative is a false or true negative without doing serial testing or testing w/ an alternate modality. 
  • Does a positive test mean that I’m immune from getting COVID-19 again?
    • Maybe.  The relationship between having a positive result and immunity to SARS-CoV-2 has not yet been firmly established — while we hope that a positive antibody and/or PCR test means that you can’t get infected again, we just don’t know one way or another if people can get it again.

 

Prevention, spread and outbreaks

  • Aren’t most of the cases right now associated with outbreaks? 
      • Well, yes.  But remember: you’re one large gathering away from an outbreak.
      • We are seeing clusters of cases in situations where people are in close quarters for extended periods of time (i.e. in nursing homes, in meat processing plants, etc.).
  • How can I keep from catching COVID-19? 
      • The advice really hasn’t changed too too much:
        • Wash your hands after touching surfaces.
        • Avoid touching your face; wash your hands before and after you do.
        • Avoid those who are currently sick.
        • Avoid crowded environments.
        • Avoid areas with people outside of your “pandemic pod” in areas with poor air circulation (i.e. outdoors, for example, has better air circulation than indoors).
        • Avoid unnecessary physical contact with others. This is super sad and frustrating for humans (we’re social creatures, after all!) but is our reality for the time being.
  • What increases my risk of catching COVID-19?  What increases my risk of having severe illness if I get COVID-19?
      • While there is no black and white “this is safe; this isn’t” list, there are varying degrees of risk associated w/ many different behaviors and actions.
      • The following things increase your risk of either contracting COVID-19 or of having a worse disease course if you do contract it:
        • Leaving your house or inviting others in
        • Increased time spent in:
          • Indoor environments
          • Close proximity to others (i.e. closer than 6-10 feet)
          • Crowded environments
        • Close or prolonged interaction with people you don’t live with
        • Residing in a community with a higher number of cases
        • Older age
        • The use of certain medications and/or underlying conditions
        • Smoking
        • Skipping important vaccines like the flu or pneumococcal vaccine
      • If you can modify behaviors to avoid the above, do so.  (And do it in coordination with your doctor when it comes to medications, vaccines, and underlying health conditions!)
  • Do masks work?
      • Sorta yes. 
      • N95 masks (when properly fitted) filter out about 95% of pathogens and irritants.
      • Our homemade masks and surgical (ear-loop) masks aren’t as good as the N95 masks, but they can be quite helpful in decreasing the outward spread of something like a sneeze, cough, or overly-exuberant hello/song/point of emphasis.
  • Can COVID-19 be spread by touching surfaces with the virus on it?
  • Can COVID-19 be spread by those who don’t seem sick (i.e. by those who are “asymptomatic”)?
    • Yes.  Many people take a couple of days after getting infected to actually appear or feel sick.  In that time period, they can actively spread the illness.
    • A representative from the World Health Organization (the WHO) was recently quoted as saying that this was “very rare” — however, Maria Van Kerkhove (the WHO technical lead on COVID-19) was clarifying a technical point regarding the possibility of spread by people who are infected but never, ever develop symptoms. That situation is likely “very rare,” but we just don’t know how often it happens; we don’t know where to look for these people who are asymptomatic through the entire course of their infection.  (Makes sense, right?  If they don’t have symptoms, we don’t know to look for them.) It’s confusing, but the important point to remember is the one above — people can spread the virus in the window between when they’re infected and when they feel sick

 

Returning to work, shopping, and other activities

  • My employer wants me to return to work.  Should I? 
      • It depends.
      • This is by far the most confusing and unclear element of COVID-19 at this point, as any sort of interaction with other people will undoubtedly increase the risk of spread of SARS-CoV-2, the virus that causes COVID-19.
      • See the above section on prevention for some (kinda) practical tips on protecting yourself — we (as self-employed rebels here at Kansas City Direct Primary Care) recommend that you not rely on an employer to protect yourself and make sure you take as many steps as possible to feel comfortable in your work environment. 
        • If you do not feel comfortable at work and cannot take your own steps to adequately protect yourself, we’re not quite sure what to recommend. There is a very real balance between your financial/economic health and your physical health.  There are no easy answers here.
      • OSHA is traditionally the federal organization we look to for guidance on protecting workers from harm; they have released their recommendations here. 
  • I want my employees to return to work.  How can I protect them?
    • The CDC lays out guidance for employers to protect their workers here.
    • Not every employee will feel comfortable returning to work, and we here at the clinic struggle in providing guidance on this front.
      • See the above section on prevention for some (kinda) practical tips on mitigating risk for yourself and your employees.
    • We recommend seeking advice from your general counsel or HR management personnel on this matter, as there is no solid black <> white answer, and all solutions carry varying amounts of risk.
      • We’re always happy to talk through any specific situation you have arise at your business to see if we can help you lower the risk of transmission as much as possible, test employees, etc. 
      • We recommend Brian Huston, an attorney with OutrightHR, for anyone looking for help with employment issues related to COVID-19 or a return-to-work plan.