COVID – Where we are and where we’re going

COVID-19 Vaccination Updates

Who is eligible?

Every resident over the age of 17 is eligible

COVID-19 Testing Information

The novel coronavirus SARS-CoV-2 (COVID) is a “new” form of the Coronavirus (which has been causing “colds” in humans for thousands of years).   At this time, we believe that humans first contracted this virus from bats used in China for food or medicinal purposes.

Why is it a problem?  Any time humans encounter a “new” virus, our bodies’ defense mechanisms (the immune system) need to identify the virus and, essentially, build a new antibody (called an IGM antibody) to destroy that virus.   That takes time and while the body is building those antibodies, the virus is reproducing and causing illness.   Once the IGM has done its job and killed the virus, the body then makes a different antibody (IGG) which “remembers” the virus so that you can mount a defense much more quickly the next time you encounter the virus.    IGG tends to remain in the system for an extended period of time (months to forever, depending on the antibody).   Humans have never “seen” this virus before, so everyone is starting out with no defense.   Furthermore, some people seem to have a violent reaction to this virus – almost like an allergic anaphylactic response some people have to peanuts or bee stings.   It is the body’s reaction to the virus, rather than the virus itself, which is causing the elevated mortality of this particular virus.

What about testing?   Early in the pandemic we were unable to test for the COVID-19 virus.   Eventually a test became available (in very limited numbers), but the results were being returned in 1-2 weeks, by which time most victims had either improved significantly or had deteriorated to the point where there was no longer a question as to what the problem was.   QwikCareMD, for example, was seeing 1000 patients per week and we were initially allocated 5 tests per week.   We had to limit testing to the CDC guidelines which we came to realize were not helpful.    Our initial tests for COVID-19 consisted of a culture which identified the virus itself (also know as an “antigen” test, since the virus is an antigen).   This was useful to identify an active COVID infection, whether or not the patient was symptomatic.   The biggest problem with this virus is that a large majority of people who are infected (80% in our practice) have no significant symptoms.   This does NOT mean that they can’t spread the virus to people who WILL get sick.   On the contrary, it makes our job that much more difficult because we have no idea who is infected and who is not.    Because of this, the only effective testing for this disease is widespread testing of symptomatic AND asymptomatic people, so that EVERYONE who is infected can be isolated to prevent the spread.

We now have available antibody testing for COVID.    Antibodies come in two major groups, IGM and IGG.   The IGM antibodies are the antibodies the body produces to actually fight the infection.   They rise early in the infection and disappear after the infection is gone.   The body then also produces IGG antibodies to “remember” the virus.   IGG carries a “blueprint” of the IGM antibody so that if the body sees COVID again, it can quickly build IGM antibodies – hopefully before there are enough viruses to cause illness.   This is what immunity is all about.

Antibody testing, therefore, tells you if you have been exposed to COVID-19 in the past.    We assume that if you have IGG antibodies you are at least partially immune to a repeat infection.    At this time we don’t know how effective that immunity is nor do we know how long it lasts.   Similar viral infections tend to lead to 1-2 years of relatively effective immunity. 

How do I get antibodies?   There are generally two ways to get IGG antibodies.   The first is by being infected by COVID-19.   The second is through being immunized against COVID-19.   Thus far we haven’t developed an effective COVID-19 immunization, but there are over 100 vaccines presently in development.    Some are in Phase 2 testing, none (as of early May) have reached Phase 3 testing.   We don’t expect an effective vaccine before the end of 2020 at best.   It may be significantly longer.

What is Herd Immunity and why do I care?   Herd immunity is our best defense against future pandemics from a given virus.   See the discussion on elementary epidemiology below for a more in-depth explanation.   The short answer is that the more people within the “herd” (world, country, state, city, neighborhood) who are immune to the virus, the less likely an epidemic or pandemic will occur if someone contracts the disease.    This is why immunization (when available) needs to be as universal as possible.   Not just to protect the immunized individuals, but also to increase the herd immunity and keep un-immunized people safe.

Epidemiology 101   There is a considerable amount of math involved in epidemiology (why epidemics happen and how to prevent them or make them less severe).    The important number to know is “1”.   Epidemiology revolves around the question “How many other people will the average “victim” infect before he is either cured or dead?”.   If that number, across the population, is more than 1, you will have an epidemic.   If it is less than 1, you won’t.

That number is called R0 in epidemiology.   It depends on several factors:

  1. How many susceptible people will the Victim come in contact with while he is infective
  2. How effective is the virus in infecting that contact.

Let’s say, for example, that the virus is 20% effective in causing an infection in a given contact and the average victim comes in contact with 10 people while he is infective.   That would mean that R0 would be 20% of 10 or 2.   Since R0 is 2, an epidemic is inevitable, unless you do something to prevent it.   What we have been doing so far is by decreasing the number of contacts through using masks, social distancing, etc.   That clearly brings down R0 , but not yet to below 1 in our country.   As more people become immune (by having been exposed to COVID or by being immunized with a vaccine), the number of SUSCEPTIBLE people decreases even if the number of contacts remains the same.   If our “herd immunity” was 90% in the above case, R0 would be decreased from 2 to 0.2 and an epidemic would be impossible.

So now what?  What we are doing with masks, “stay in place”, hand washing, and so forth is essentially waiting for an effective vaccine.    Some people will get infected with COVID-19.   Some of those people will get ill.   Some people will get very ill and some people will die.    Minimizing contacts (chances to spread the virus) will minimize those deaths until we can induce an artificial herd immunity through the use of an effective COVID vaccine.   In the meanwhile, get tested – as often as necessary.   Get an antibody test to see if you’ve already been infected.   If you get ill or have any reason to think you are infected, get an antigen (viral) test and, if positive, stay away from other people.