Labcorb has announced that they will begin outpatient serology (antibody) testing for Covid-19 on Monday April 27. Your physician will be able to order the test, and lab cord phlebotomy offices will be able to draw it.
We all want this test, I would argue we all need this test, so be prepared for long waits.
This is a major step in controlling this infection, and will help in getting things back to normal, whatever this ‘new normal’ they keep talking about is going to be.
Well, let’s hope antibodies do in fact turn out to mean what we hope they mean. WHO issued a warning last evening concerning current state of knowledge:
The World Health Organization has warned governments against issuing “immunity passports” to allow people who show antibodies for coronavirus to return to work. As leaders across the world turn their focus to reopening their economies after weeks of social restrictions designed to contain the pandemic, many have been hoping to deploy some form of certificate system allowing people deemed immune to travel and work. But in a scientific brief published on Friday evening, the WHO cautioned against such plans, citing a lack of proof that anyone could be definitively labelled immune from the deadly virus. “There is currently no evidence that people who have recovered from Covid-19 and have antibodies are protected from a second infection,” the WHO said. Chile last week became the first country to announce plans to give “health passports” to recovered Covid-19 patients, allowing them to go back to work, Reuters reported. Germany and the UK have also considered taking a similar approach to help ease the strains on economies suffering their sharpest contractions in decades. However the WHO said there is not yet enough evidence to guarantee that such measures would work, and that there are no studies on whether the presence of antibodies indicates immunity in humans. It said giving people who have antibodies special rights to travel or work “may therefore increase the risks of continued transmission”.
Reports of 51 patients in South Korea who tested positive after apparently recovering from the virus, as well as cases of reinfections in Japan and China, have raised concerns of scientists’ understanding of Covid-19 immunity. The WHO also cautioned on the accuracy of antibody tests used to determine immunity and the risk of confusing Covid-19 antibodies with those for other coronaviruses, including four viruses that cause the common cold.
Seropositive testing puts you in a rather good position re risk of infections. Sure, you can take the complete opposite approach but that makes no sense based on what we know about viral immunity when the specific agent can be identified by PCR testing.
The additional ‘good news’ is that the infectious mortality rate is roughly the same as the flu. And, yes, I would offer the argument that we destroyed the economy over a bug with the same infectious mortality rate as the average ‘flu’ at around 0.133%. I took the numbers from seropositivity in NY and the Stanford study and then took the last three years of flu mortality data. Baylor Dallas area have two ICU spots taken by Covid patients. I might not be up to date on this.
So . . .
True - You / I don’t want it. Yes, protect the high risk.
Exposure to the virus has roughly the same mortality as the flu.
Advanced age and comorbidity increase morbidity and mortality in roughly the same way as flu.
I would like to know my status. I wouldn’t pay money to know or go out of my way to get tested but I’d add that to my next set of labs from Labcor or whomever.
Case mortality is 2-5%. Those are the ones who show up for care.
I would agree that much is still not know about serology testing, including does the presence of antibody imply immunity (and that’s not known) and for how long (again not known). However, I think most would accept that presence of antibody indicates presence of disease, and as of now we really don’t have a good idea of prevalence due to mild or asymptomatic illness. In the absence of a true idea of prevalence, I would argue that it is difficult to calculate overall mortality rates for comparison to influenza. My understanding is most believe Covid-19 is a worse illness than influenza. For example, during a typical flu season ( around Christmas and New Years here ) the ICU will fill up with elderly people with influenza, and some of them die. What we usually don’t see, is 8 or 10 people dying from the same nursing home. I think you would agree that you would hear about it if that were to happen. It seems to be happening fairly frequently with Covid-19. I grant that vaccination and some treatment (oseltamivir (Tamiflu), zanamivir (Relenza), peramivir (Rapivab) or baloxavir (Xofluza)) may play a big role in that. Obviously, we do not have that for Covid-19 currently.
Your point ( or at least what I interpreted as your point ) that the damage to our society from social distancing outweighs the benefit of saving lives (100,000 ?) is one each of us must answer for ourselves. We can express our belief the next time we go to the polls. I personally believe that saving lives is more important. Our economy will recover, we will get through this. Dead people don’t come back (yes, I am not a zombie genre fan!). I also believe that widespread illness can be very disruptive to our society as well.
I am reminded of what Dr. Birx said which was something along the lines of ‘if we all look back on this and think it was quite unnecessary, it will have worked quite well’. As bad as it has been here (CDC lists 50,439 deaths), it was worse in Spain and Italy. They locked down their societies as well and it seems to be getting better. I truly fear what the result is going to be in poorer places such as Africa. One thing that may help them is the fact where life expectancy is low there are fewer elderly people that clearly are at more risk.
Anyway, I frequently say: “Just because something is working well is no reason to change it!”
I also think that most would expect that antibody would provide at least some degree of immunity in patients that recovered from illness so I believe serology testing will have value. How much I am not sure, that will depend on many factors including the sensitivity and specificity of the tests.
Agree with much of above. That’s what’s confusing. If the infectious mortality as per serology is not that bad then why are we seeing / hearing about how deadly it is? The best explanation I can come up with is that the ‘curve’ we all talk about is peaked as people all get it at once, resulting in what looks like a massacre. If we look at the total deaths so far this year, I believe that we are still below last year’s flu numbers, so IDK.
The saving lives thing is blown out of proportion. Nobody likes to see someone pass, but realize that Covid and the media is the extreme case of what we hear about each year when we listen to stories about how a heat wave killed 20 people this month. Look at the demographics of the victims.
If we are so fussed about ‘saving a single life’ then consider (many examples I can’t begin to list) the 55 mph speed limit - saved well over 10,000 lives per year. I think we hardly heard a peep from anyone when 55 went away. We know if we went back to 55 mph then we might even save 15k lives in 2020 and those lives would have a significantly different demographic profile than Covid patients.
I tend to think that the area under the curve will be the same in all scenarios but we can hope that something might change that. Improved therapy, more available care with time, vaccine (not likely) and other factors may help those at the tail end of the curve. We are clearly not overloading healthcare right now so perhaps we could try a week or two of 'back to normal, then go back to restriction and wait on the output of the system to determine its response.
Heavy immune activity early in infection seems to greatly reduce morbidity with respiratory viral illness. This is how the Spanish flu was eventually treated. Patients with early infection were given hyperthermic and other treatments like a week of malaria (!) to boost early immunity. This resulted in at least a 5x reduction in mortality and maybe more but I don’t recall exactly. Make me sad that I can’t go the the gym and sit in the sauna. I’d be doing it every day.
So I see where the CDC says this for a full year: The CDC estimates that as many as 56,000 people die from the flu or flu -like illness each year . SOURCES: National Institute of Allergy and Infectious Diseases: “Common Cold.”
And C-19 is credited with more than 54,000 in less than 4 months. How many times have you seen truckloads of bodies being carted to temporary morgues or stockpiled in refrigerated trucks? How can you compare those numbers and think it’s no big deal? The hospitals in major city hot spots have stopped all non-emergency surgeries and have still been overwhelmed in several instances. As bad as it has been in the NE cities, it may very well get worse as it comes to the smaller cities, towns and rural areas. All those smaller places have limited healthcare facilities because they rely on the larger cities to handle any unusual peaks. That system fails completely when there are peaks in both large regional and smaller community locations.
Covid-19 has another wicked feature … it doesn’t make you feel sick before you become a virus spreader. I am not familiar with any other highly contagious medical problem that behaves that way. At least the common flu has the courtesy to make you feel sick enough to want stay away from others about the same time you can be a spreader.
Another worry point is the possibility this really is a virus that came from bats. That’s important because bats have a much higher body temperature during their active hours than humans do. Human bodies try to kill viruses with elevated temperature (fever). A bat originated virus isn’t nearly as vulnerable to heat making it much harder for the human body to fight.
Given the disruption this virus has caused to date, do recognize that no one had any immunity to this when it showed up. To date in the US about 1 in 300 folks are known to have become infected. Covid-19 is still on the hunt for the remaining 299 of us.
Random sampling with antibody tests confirmed that the number is 1:5 in New York. I suspect similar testing in other major cities will find a similar trend. In California the state health department has been antibody testing blood stored in blood banks. They’ve found evidence that SARS-COV2 was circulating as far back as October. It seems a large part of that 299 have already been exposed and didn’t know it.
That’s why I said “known”. With testing as limited as it has been, there is a big “unknown”. My guess is that it is indeed higher in larger communities, especially those with higher percentage of international exposure. I have significant concern about what happens once it really goes wide in small town & rural areas. Albany, GA is a great example to date. Two funerals with significant community attendance and the county leapt to the highest per capita ratio in the US.
I have to keep reminding myself, that this is called novel corona virus. It’s only been around since about Christmas, well, okay October? maybe earlier? I feel comfortable saying it was not generally recognized as causing significant illness until sometime in December. It’s not May yet. We know a lot, but you cannot expect to be able to define many things such as mortality rate, does infection provide immunity and for how long, what is the degree of unrecognized illness? Is it seasonal?
What does seem to be clear is it causes significant morbidity in certain populations especially elderly, those with preexisting illness, black people (at least in the United States).
Please remember that a curve flatting strategy only is intended to limit the rate of appearance of disease. It does not affect the number of people that get infected (the area under the curve). Containment, test, quarantine, contact trace, test, quarantine, repeat until a vaccination or other treatment is available, then ring vaccination. That will decrease the area under the curve. The problem was the rate of appearance of disease has been too great for containment to be practical (it takes a lot of people to do all that!). Hopefully, social distancing (otherwise known as a pain in the tush) will flatten the curve enough to make containment practical. The advent of more and better testing will be a factor in that. People’s behavior will play a large role as well. Remember covid parties? The one thing I am most confident of is we will get through this! It will bring heartache and tragedy to many people and families, but We will get through this! If we work together and act intelligently we will get through this quicker and with less heartache.
Another thought about comparing Covid-19 to influenza, influenza is a well known disease. We have treatments, we have vaccinations, we expect it during the flu season and prepare. There is immunity in the community (ha, that sounds funny to me, good, but funny). The flu virus mutates a lot (another unknown about Covid-19) which results in recurring infections with different strains, but the strains are not usually more pathogenic (exceptions, Spanish flu, swine flu, do occur).
Disease from the novel corona virus (SARS-CoV-2) is well, novel. None of the above things that exist for influenza exist for SARS-CoV-2. Not the least of which is immunity in the community (still love that).
SARS-CoV-2 seems to have evolved to be contagious, long incubation period, minimally symptomatic disease in some populations, but the main issue is the lack of immunity (essentially every that hasn’t had it). Perhaps one day when we have vaccinations, treatments, and more heard (opps, herd) immunity the mortality rate will match that of influenza. I honestly to not believe that to be the case today. As always, I realize that I could be wrong, and quite frankly, it won’t bother me at all.
You mentioned that we don’t know if Covid mutates. We should know that because corona viruses cause much of the “ccommon” cold. You kknow- the ones we’ve never developed a vaccine for because they change too much and weren’t deadly before this version. Will the new mutations still be as deadly? Only time will tell.
Shoot – I can remember having the cough that they are describing in years past. Just without any of the deadly symptoms.
Good point, you are absolutely correct. I should have said that we don’t know how big a role mutation will play in the course of this disease. Heck, if it hadn’t mutated we wouldn’t have the disease!
Interesting, a very Darwinian approach to a pandemic. There certainly is a balance between the societal impact of social distancing and the societal impact of a pandemic. I choose to disagree with this opinion, but I do believe that this argument can be made.
So much is still unknown about the infection rate, how/when the virus is transmitted, what factors lead to more severe symptoms, etc. … and yet people do “know” somehow that we need to re-open the economy. I need to talk to these folks before my next trip to Vegas.
A “pandemic” which, if the numbers are right, is no worse than the death rate from the common flu – that people die of every day. Yes, even otherwise-healthy 20 and 30-year-olds.
It’s a novelty and unknown, therefore Fear, Uncertainty, and Doubt drive people to do strange things.
I don’t remember seeing New York set up temporary morgues for the flu. But I don’t watch much news the past few years so I may have missed it.
if the numbers are right
What numbers? There is a dearth of data, because we are still lagging on testing. It’s kinda hard to make a definitive call about a rate of something when you have no idea of either the numerator or the denominator.
I agree that the numbers may be suspect, including the ones that I present in this post.
From this website: Stats of the State of New York
Total number of deaths in 2017 from the category flu/pneumonia - 4517 deaths
From this website: Provisional Death Counts for Coronavirus Disease 2019 (COVID-19)
I am not sure why numbers for New York and for New York City are presented separately
deaths from: /// //////// New York ///// New York City
Covid-19 //////// ////////// 4,283 ////////////////// 9,401
Covid plus pneumonia 2,228 //// ////////// 3,410
Flu /////////////////// /////// 187 ////////////////////////////// 792
note that this is data is from February 1,2020 to April 25,2020, not a full year.
I am guessing these numbers are from ICD10 codes from death certificates.
I cannot accept that Covid-19 is representative of a typical flu season.
Please note I found it hard to create a chart in this software, doesn’t seem to like white spaces.
I believe New York City data to be representative of what happens in the absence of social distancing in a large metropolitan area because the disease was out of control there prior to their social distancing (they were unfortunate in that they got it early like Wuhan, Italy, Spain and the nursing homes in Washington state, other places learned from their example). Certain other demographics such as less population density, older populations may make a significant difference.
Once again and as always, I realize that I could be wrong, and time will certainly tell.
Did you read the article? Watch the two one-hour-long videos? Those Docs have numbers, and the denominator is increasing far faster than the numerator. I believe they’ve probably got a representative sample[1].