This global pandemic has disrupted the entire world and continues to affect every aspect of our lives. Unfortunately, we are not only facing the unseen and invisible disease but problems of our own making through poor policy and unregulated procedures. As a physician on the front line, I see many patients who have been exposed to the coronavirus and have tested many who have turned out to be positive. My experience is obtained through direct treatment of these patients as well as continued review and research of available data. In this article, I will try to give an overview of some key points to the virus, the spread, the testing and what can be done to prevent the spread.
Coronavirus SARS-CoV2 belongs to a family of viruses that have been around for a long time and has been typically associated with common cold symptoms. This new virus that is causing COVID-19 needs to be approached with humility because, while it may have similarities to other viruses, its behavior is not always typical. I have seen patients who are asymptomatic and can spread infection to those who are critically ill and at high risk of death. It is unclear why some patients are so ill, and others have no symptoms. We do understand how it is transmitted.
The virus is a respiratory illness that is spread through large droplets produced during talking, coughing, sneezing and other aerosol generating procedures. The virus has to get into a person’s eyes, nose, mouth and other mucus membranes. It does not appear to be waiting in the air, ready to pounce, like a hovering specter. The droplets tend to fall to the ground within three to six feet from the person. If the virus is on a surface, and a person touches that surface then touches their face, the virus can be transmitted. With this information, the prevention measures seem obvious. Regardless, the virus is quite transmissible, and it is up to us to prevent the spread through common sense means that will be discussed further.
When a person comes to the office, I have several options for testing them and it is important to know what those are and how to use them. One of the problems with the FDA granting emergency approval for so many tests is that the data is not fully validated, and several people are possibly taking advantage of this to offer testing for profit. The issue is not fully knowing how valid the testing is. All tests have false negative and false positive rates. This means a test could have a negative result, but the person actually has the disease and is not detected, or the test could be positive, but the patient does not have the disease. If decisions are being made on the results of a test and the patient thinks they do not have the disease but really do then the virus can continue to spread. The test must be accurate and reliable.
When evaluating patients for coronavirus, I look for current symptoms as well as exposure. As soon as they come in, my staff screens the patients for symptoms and if there is any hint of fever, cough, shortness of breath or other respiratory symptom, they are placed in an isolation room while I put on protective equipment to be able to evaluate them. It is so important for front line professionals to be as safe as possible and prevent spread. The concept of testing is either for current infection or past infection. If a patient is actively with virus, a PCR or polymerase chain reaction test is done to detect the presence of that virus by using a nasal swab, or similar throat swab to sample the secretions and send it to the lab where it is run through a system that will amplify the viral material if it is present. If no virus is present, then the test will be negative, and the person likely does not have the virus. Concerns with interpreting the results include assuming that the sample was done correctly to get enough virus on the swab and that the person was far along in the infection to have enough virus present to be picked up on the swab. It is not clear on how many days after infection a person will show positive and more data is needed to assess this infection rate. The other type of test is a blood sample to look for antibodies to the virus. Whenever an individual is infected with any disease, the body will activate the immune system to identify specific unique characteristics to that infection that will allow the body to attack the infection and hopefully remove it from the body. Unfortunately, the infection sometimes overwhelms the body and the immune system is not able to remove it. The initial antibodies formed are IgM and appear in acute infection, while the IgG antibodies appear more long term and show previous infection but are also necessary to prevent future infections. What is not fully known is when each of these antibodies appear and what the long-term immunity is. In typical infections, the IgM appears quickly and then disappears while the IgG becomes more permanent and long lasting. The hope is that the IgG will be long lasting and prevent further infection.
With that overview, it is necessary to understand that not all tests are equal and it would be quite concerning for someone to have a test reporting them negative but they have the infection and it was just not detected, or, that a person has antibodies that are not protective because it was a false positive. Antibody testing will be important in determining both how widespread the virus actually is and who may be less at risk. Regardless of those results, several steps still need to be taken to flatten the curve and decrease infection. If anyone is offering a test, especially for exorbitant amounts of money, make sure you fully know and understand if that test is even valid and you are not being taken advantage of. Also understand that having a negative test may not fully explain the state of infection and if you are at risk or clear of infection. Having a negative test will not protect you from future exposure and you can always be infected if you get exposed again.
With all of that information, how do we best protect ourselves from this virus and attempt to restore a more normal world. This will involve the basic concepts of testing, tracing and treating. We need to know who has the virus, who has been in contact with those persons infected and then treating infected people. The first and most important preventative tool is social distancing. Knowing that the virus spreads with close respiratory contact, keeping more than six feet from someone will drastically decrease the spread of the virus. Wearing a mask does not protect you from the virus but will help to prevent the spread to others. Washing your hands and using disinfectant, as well as not touching your face will decrease the chance of you getting sick. If the virus is on a surface and you touch it but wash your hands and disinfect then you are unlikely to get infected. Remember that what kills the virus in the environment does not work in the body While the virus can be killed by sunlight, bleach and other cleaning products, that does not mean it will work in the body. Once the virus gets inside the body, it hijacks the bodies machinery so it can reproduce. Bleach, sunlight and other products will not kill the virus in the body and will likely kill the person attempting to inject, ingest or introduce bleach and other products into the body. Please do not attempt that. It is astounding that I need to say that, but we do not need to study that issue at all. Please use common sense in regard to cleaning and other chemical products.
The most effective tool we have is to social distance and avoid close contact so that the virus will have nowhere to go. Paraphrasing Sun Tzu in the Art of War, if your enemy goes to ground, give them no ground to go to. If we stop the spread of the virus by being smart and not allowing it to transmit, then it will eventually die out. If we continue to ignore common sense measures and continue exposure to other people, then the virus will continue. If you are a non-essential worker and can stay home, then please do so. I risk my life every day to care for and treat patients, please do your part to stay away from others so we can end the pandemic as soon as possible. The virus has one purpose in life and that is to make more of itself. The pandemic will eventually end with a tremendous loss of life or a minimal loss of life. The difference is based on our actions that we take now. Please be safe, consult with your doctor for specific health related questions, be aware of the role of testing and what those results may mean, and continue social distancing to end the pandemic.