Week 37 – coronavirus update – FAQ, vaccine update, and “Will someone please remove hydroxychloroquine from the discussions?”

FAQ about testing, contagion, and the illness:

Who should be tested? Anyone with exposure to someone with known COVID-19 or anyone with a respiratory illness.

When should you be tested? As soon as you know you have been exposed to someone with a positive test or proven COVID-19 illness or develop symptoms suspicious for COVID-19.

What about the rapid test versus the 3-day nasal swab? If the rapid test is positive, then that result can be believed, and you have contracted the virus. If the rapid test is negative, you may still have the illness and a nasal swab test should be performed. The nasal swab test is 95-100% positive in those with the virus in their nose and those with the illness.

What if you don’t have symptoms but want to know if you have the virus? if you have no symptoms, we are referring people to UC Health Hospital off Lucent Boulevard in Highlands Ranch. Please call the office to pick up an order for the test. If you have symptoms, UC Health will test you without an order. At the time of this post, their turn-around is 2-3 days.

We have limited quantities of test kits at the office and have reserved those tests for patients of my practice with symptoms. We do drive-by testing in the parking lot at the office for those with suspected symptoms, so please call ahead to ensure we have test kits available.

How long after I get exposed to someone with COVID-19, am I at risk for getting sick with COVID-19? The vast majority of people get sick within 7 days after exposure, but occasionally individuals may get sick 10-14 days later.

How likely am I to get COVID-19 after exposure? It depends on your age. Although it is not completely worked out yet, it seems as little as 25% of people in their 20’s and over 80% of those over age 65.

What should I do if I get sick with COVID-like symptoms? Call your Primary Care Physician. If you are one of my patients, call the office or me directly. We will arrange for testing, and I will likely start you on steroids and antibiotics, pending the results of your testing. We will stay in touch daily through the illness to help with the decision of whether you need to go to the hospital.

How long should I quarantine after being exposed to someone with COVID-19? For 7 days or until your nasal swab test returns negative. If you get sick, you need to quarantine two weeks more after the onset of your first symptoms.

What if I get exposed to someone with COVID-19, but don’t get sick? Am I still contagious to others? Yes. You can be contagious up to 7 days after exposure even if you do not get sick.

Studies testing people who test positive for the virus but do not get sick show that the virus can stay in their nose and throat up to 7 days without that person becoming ill. That is why at least a 7 day quarantine is needed after testing positive or with a known exposure.

If I test positive for the virus but don’t get sick, am I immune against getting it later? We don’t yet know the answer to that question. There is debate about the so-called asymptomatic infection, where people are purported to have an infection without symptoms. The validity of this condition and its potential consequences is debated. At the present time, I have been advising people that if you test positive but do not become ill with COVID-19, you are not immune to getting it with repeated exposure.

We do know that 100% of people with COVID-19 develop significant amount of antibodies that appears to be protective from re-infection.

Out of well over 55 million people proven to have COVID-19 in the world, the number of reported cases of recurrent infection is less than 5.

If I get sick with COVID-19, how long am I contagious? 10-14 days after the first symptoms.

What if I think I had COVID-19 but did not get tested? The antibody test currently available turns positive in 100% of people who have COVID-19 three weeks after the onset of your symptoms. You must wait at least 3 weeks after the onset of your illness to be tested in order for the test to be accurate.

IF you did not have an illness consistent with COVID-19 but want to know if you are immune to the SARS-CoV2 virus, there is only research-level testing available. This testing is currently reserved for research and vaccine trials and not the general public.

I had a bad cold for 3-5 days. I had COVID. If you are in your 20’s, then it is possible you had it. If you are over age 50, it is highly unlikely that you had COVID. For almost everyone over age 50, COVID-19 is a bad illness and not a few days of cold symptoms.

Getting the antibody test is the only way at present to answer the question whether you had it or not. Unfortunately it has to be interpreted carefully, because it is not as accurate as we would like.

More vaccine updates:

As expected another vaccine announcement has come forth. Moderna, who has a similar vaccine to Pfizer, came out and said their vaccine is “highly effective”, reporting 94+% effective. Here’s the link about the Moderna vaccine interim report.

The Pfizer study had 95 cases of COVID-19 out of about 22,000 people in the placebo group and 5 cases of COVID-19 out of 22,000 in the treatment group.

The Moderna study had 94 cases out of about 16,500 in the placebo group and 4 out of 16,500 in the treatment group. These are very small numbers on which to make decisions.

Both vaccines are a two-shot series given 28 days apart. Both have low temperature storage needs that may impact transport and availability outside of facilities able to maintain storage temperatures of -20 F or lower.

The statisticians say this is clinically significant and the results are not likely due to chance. However there are still important questions to be answered like:

1. Who will administer the vaccine? and how will they get it?
2. How long will the immunity last?
3. Are there any long term complications?
4. If you get the vaccine, do you still have to practice all the current precautions? If yes, then for how long after getting the vaccine?
5. Can life return to “normal” after getting the vaccine? If so, when?
6. Can one now travel internationally if you get the vaccine? If so, when?
7. Will the vaccines be mandated? or is there personal choice?
8. Will social events be allowed only for people who have gotten the vaccine?
9. What about all the people who have gotten COVID-19? Do they need the vaccine?

I’m sure application to the FDA for early release under the EUA (Emergency Use Act) is underway.

Hydroxychloroquine

The National Institute of Health (NIH) recently confirmed the lack of effectiveness of hydroxychloroquine in COVID-19.

Regardless what you read on the internet, there is still overwhelming and high quality research that confirms the lack of effectiveness of this drug in COVID-19.