My last post was quite some time ago and I am pleased to be able to share some positive developments as well as some words of caution. Fortunately we are reaching a point where there is reason for optimism, however we are nowhere near the end of COVID despite the encouraging signs. This will be an abbreviated post to highlight things I believe to be important as we continue to deal with the pandemic.
Monoclonal Antibody Infusions
Monoclonal antibody infusion centers are now available for high risk patients who test positive for COVID. The criteria are based on age and underlying medical conditions. Research has shown monoclonal antibodies can reduce viral load and therefore prevent progression to severe disease. These infusions are typically given in outpatient infusion centers and are best given early after diagnosis/symptom onset. We are referring patients to have monoclonal antibody infusions when they meet criteria and the feedback I have received thus far has been extremely positive in terms of scheduling/getting the infusion treatment as well as improvement in symptoms.
“It’s Just Allergies”
In my experience a significant number of patients who test positive for COVID report their symptoms are very similar to their normal seasonal allergies/chronic sinus issues. Many patients with COVID never experience a fever. Many never lose taste or smell—or if they do it frequently occurs long after onset of other symptoms. As we are now getting into allergy season in North Texas, I would caution anyone who has what may seem extremely similar to their typical seasonal allergies: Get tested for COVID and isolate until you have a negative test result. Preferably a negative PCR test rather than (or in addition to) the rapid test.
PCR Test Turnaround Times
If you had a COVID test done last summer or early fall you may have waited a week or more to get your test results. Fortunately the PCR tests are being resulted far sooner at this point in time. At the time of this writing we are getting results same day more often than not, or by the end of the following day.
There is encouraging news on the vaccine front as we now have three approved vaccines and they are being distributed in larger numbers with more people being vaccinated day to day. We are still looking at a minimum of two to three months to have everyone vaccinated who chooses to vaccinate and this is based on number of vaccines anticipated to be available but not the logistics of getting them distributed and administered. I would encourage everyone to get the vaccine as soon as you have the opportunity to do so.
I will also mention, I have a small but growing number of patients who have been vaccinated and still test positive for COVID. To be clear the vaccine does not cause a “false positive test” and the patients I am referring to have all had minimal symptoms (or no symptoms whatsoever) if the vaccine was administered two or more weeks before their exposure/positive test. Even with the vaccine it is possible to become infected with COVID, however having been vaccinated will significantly reduce your risk of severe disease. I highlight this to emphasize the importance of still wearing a mask even if vaccinated—-specifically because you may be a carrier and capable of spreading the virus even if you are fully vaccinated and never have any symptoms whatsoever despite being COVID positive and contagious.
I would also mention there are situations where those who are fully vaccinated should be able to go without a mask around loved ones, so long as they have an understanding of the above.
“Do You Do The Nose Test? Throat Test? Blood Test?”
I continue to have patients ask these questions and there is understandably a level of confusion based on the different tests being offered. What matters most is not the method of collection, but which test specifically is being done:
PCR Test: PCR stands for “Polymerase Chain Reaction”. This test is sometimes also referred to as “RT-PCR” or “NAA” which stands for Nucleic Acid Amplification. This is the most accurate test available. Specimens typically are collected either via an oral swab (oropharyngeal swab, or “throat swab”), or a nasal swab which can be either an anterior nasal swab (only the nostril itself is swabbed) or nasopharyngeal (deeper into the nasopharynx and more unpleasant to have done as reported by most patients). Some PCR tests may be done on saliva alone without a swab but this is not a widely used method at this point in time.
Rapid Test (Antigen Test): Typically done through nasopharyngeal swab/anterior nasal swab. This test, if positive, is highly accurate. We do see a significant number of false negative results. The false negative rate is dependent on which test is being utilized as well as the pre test probability (how likely the person being tested is to have a positive COVID test). Generally I recommend a PCR test on anyone with a negative rapid test, if symptomatic or with significant exposure to confirmed or suspected positive.
Antibody Test: This test is typically done either by a finger stick or a venous blood draw. There are many different antibody tests available. This test is not typically used as a diagnostic test but rather to test for prior illness.
If you are symptomatic and/or have recent exposure to known or suspected COVID, I recommend having the PCR test if your rapid test is negative.
How Long Should We Wear Masks?
I believe it is premature to stop wearing masks indoors at this point in time, or outdoors for large gatherings without appropriate distancing. I am optimistic as we see more people being vaccinated we may be able to safely stop wearing masks within 6-8 weeks (best case), but this is speculative and we will have to follow trends on case rates as well as what percentage of our population has been vaccinated. I have concerns about Spring Break being another superspreader event—although not likely to the extent of Thanksgiving and Christmas given case rates declining. I would encourage everyone to continue to exercise caution, understanding we are all ready to be back to normal and we will hopefully get there relatively soon based on current trends and the latest news on vaccine availability.