CV🦠News, Week of August 10, 2020 – The Village Doctor

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CV🦠News, Week of August 10, 2020

 

Political greetings, TVD friends,

In a word: Kamala!

In a few more words: read, talk, learn, get involved, VOTE!

NOTE: CV🦠News is a labor of love. If you enjoy reading this, please share widely! Was this forwarded to you by a friend? Please subscribe here.

WHERE CAN I GET TESTED LOCALLY FOR COVID-19?

NOTE: There continues to be an increased demand for COVID-19 testing locally and wait times can be up to 3 – 4 days for a test, 4 – 7 days for results at all facilities.

**We recommend the options starred below for their combination of relative convenience and reliability. We are actively monitoring testing options for more availability and will be adding to this area as soon as we have reliable information.

**Stanford Express Care — Video appointment prior to drive-through test.

How: Register online through MyHealth if not already a MyHealth patient. To schedule your appointment through MyHealth, go to ‘Appointments,’ ‘Make Appointment’ and select ‘Express Care,’ or download their App for iOS or Android. To schedule over the phone, call (650) 736-5211. Having a primary care physician at Stanford is not required.

Where: Drive-through testing sites are located in Palo Alto, San Jose and Emeryville. Hours: 9AM to 7PM.

Who: Children and adults. Asymptomatic or symptomatic.

Note: Priority is given to those who are symptomatic or were exposed to confirmed or suspected COVID contacts.

**LabCorp Pixel — An at-home test, self-ordered and self-collected test, this is convenient and has a fairly quick turn-around. 

How: Order online through the link above, filling out the questionnaire. The kit is mailed FedEx Express (next day), picked up from your home by FedEx Express to send back next-day (not available to send back over the weekend), and results have been taking 36 – 72 hours after arrival back at their lab. We found the whole process to take only about 15 minutes of total coordination time (ordering, collecting specimen, calling for pick-up).

Where: A self-collected kit at your home

Who: Adults (over age 18), symptomatic or asymptomatic but live or work in a high-risk environment (defined as ‘communal,’ meaning you come within 6 feet of multiple people throughout the day). 

**The IV Doc COVID PCR testing in the comfort of your own home. Quick video appointment with a physician prior to home visit by RN to obtain the PCR test (via AccessMedical).  

How: Similar to The IV Doc’s services delivering IV fluids, one calls to make an appointment (844-843-4836). Currently appointments are scheduled out by about a day.  Same-day appointments may be available for an added fee. Results back in 24 – 48 hours (best if ordered Monday through Thursday, as they slow down over the weekend). The physician calls the patient with results. Cost: $599.

Where: From the comfort of your own home.

Who: Adults (18 and over).

Project Baseline — Drive-through test (no video visit or doctor’s order required).  Working with the county public health system through Google’s company Verily.  Drive-through testing options in Redwood City and San Mateo, appointments can be scheduled online 48-72 hours in advance, and results take 3-4 days.

How: Schedule online through the Project Baseline website. Select a nearby location — in our experience San Mateo is often unavailable (they cap at 500 tests/day), but San Jose often is.

Where: Locations throughout CA and several other states.

Who: Adults (age 18 or older). Asymptomatic or symptomatic.

Santa Clara County Testing — Drive-through test (no video visit or doctor’s order required), but backed up by about 2 weeks as of 8/12/20.  

How: Schedule online here.

Where: Multiple sites located in Santa Clara, San Jose, and Morgan Hill.  

Who: Children and adults who DO NOT have symptoms of COVID-19; ASYMPTOMATIC patients only. Residency in Santa Clara County is not required.

Dignity | GoHealth Urgent Care — Video appointment prior to drive-through test.  These appointments often book up with no available slots online.

How: Visit their Website to schedule a video visit.

Who: Children and adults, symptomatic and asymptomatic.

Where: Testing sites in Redwood City, San Bruno, San Francisco, Mill Valley, Oakland.

Note: GoHealth uses the Abbott point-of-care test which has significantly less sensitivity than the tests listed above. This means higher false negatives. However, results are available within an hour. Priority is given to those who are symptomatic or were exposed to confirmed or suspected COVID contacts.

Color Genomics / SF.Gov — Free testing for those who live or work in San Francisco, using Color Genomics. This is part of a COVID response group which offers multiple test sites around the city. 

How: Schedule online here.

Where: Multiple sites in SF.

Who: Asymptomatic testing for those who live or work in SF.

PAMF and Kaiser — Established primary care patients at PAMF or Kaiser can be tested at their specific drive-through locations with approval by a visit with their PAMF or Kaiser primary care physician.

SHOULD I GET A FLU SHOT DURING COVID? AND IF SO, WHEN?

Yes, this flu season it is extremely important to get your flu shot and best to do it earlier in the fall rather than waiting. In fact, you can expect a strong campaign from public health officers and physicians to increase flu vaccine rates and decrease the spread of influenza this winter. This year, vaccine manufacturers will be producing 190 million doses (an increase of 20 million from years prior) and hopefully, vaccine rates will be higher than 50%, which they unfortunately have not been in the past. Manufacturers currently have the ability to make more if needed during the season, but that could change if a COVID vaccine is approved as there will be more competition for supplies at that point.

Preliminary CDC data for last flu season (October 2019-May 2020), showed that the flu was a factor in 18 million visits to health providers in the US and resulted in 410,000 hospitalizations and around 64,000 deaths. Getting a flu shot may help prevent influenza altogether, or at least lessen the symptoms, and thus will likely decrease visits to urgent care and the ER, lessening the burden on the healthcare system and preventing co-mingling of flu patients and COVID patients. The 2019-2020 US flu vaccine was 40% effective on average — meaning that it reduced the chances by 40% that someone exposed to the virus had symptoms severe enough to visit a doctor or hospital. That 40% effectiveness is generally what they expect and was better than the 2 prior seasons. The vaccine also of course helps prevent people who may only have mild illness from spreading the flu to those at higher risk of severe disease (babies, older people and those with compromised immune systems.) 

Many, but not all, symptoms of flu are similar to those of COVID, including fever, chills, cough, sore throat, muscle or body aches, headaches and fatigue. Given the similarities, it’s likely that some people who normally wouldn’t require a doctor’s visit for the flu will be encouraged to see a physician or go to the emergency room for flu-like symptoms. There is also concern that having both diseases at the same time could be dangerous, as Dr. Ashish Jha (Director of Harvard Global Health Institute) says, “We don’t know yet whether that could compound either illness, but why take the risk?”  

So, get your flu shot as soon as it is available to you! We should be getting our supply delivered to The Village Doctor in early to mid-September and will let our patients know how to schedule safe vaccine appointments as soon as the shots are available. There will also be vaccines available at pharmacies, supermarkets and presumably drive-up clinics will be available elsewhere given that many people who normally get vaccines through their employers may not be able to do so this year. Remember that it takes about two weeks after getting the shot to develop full immunity, so earlier is best this year.

WHAT IS CORONAVIRUS “IMMUNITY TESTING”? SHOULD I GET TESTED?  

Immunity tests, also called “serology” or “antibody tests,” detect novel coronavirus antibodies (IgM, IgG) that the body makes in response to COVID-19 infection. Antibody tests are designed to identify whether you have been exposed to the virus by testing a blood sample from a vein (ELISA) or from a finger prick (“lateral flow”) test. Both operate on the same principle, detecting the presence of  IgM or IgG antibodies in a patient’s blood by binding them to reactive molecules that show up as a visual positive or negative result. While the ELISA-based tests require going to a lab to have your blood drawn and some processing time, results tell you the quantity of IgG and IgM antibodies made in response to infection. Lateral flow tests could potentially offer a simpler “yes or no” test at home or in the doctor’s office, showing a positive or negative result with the presence or absence of a band (think of a home pregnancy test).  

The problem with both kinds of tests is the rate of false-positives. Lateral flow tests have wildly variable false-positive and false-negative results, and are not recommended. Even the more accurate ELISA tests have surprisingly variable manufacturer-reported rates of false-positives, from zero to 9.4%, but few have been independently verified. In an insightful article for The Atlantic, Ed Yong uses one of these tests as an insightful example: “it claims to correctly identify people with those antibodies 93.8 percent of the time. By contrast, it identifies phantom antibodies in 4.4 percent of people who don’t have them. That false-positive rate sounds acceptably low. It’s not. Let’s assume 5 percent of the U.S. has been infected so far. Among 1,000 people, the test would correctly identify antibodies in 47 of the 50 people who had them. But it would also wrongly spot antibodies in 42 of the 950 people without them. The number of true positives and false positives would be almost equal. In this scenario, if you were told you had coronavirus antibodies, your odds of actually having them would be little better than a coin toss.”  

We worry that patients who receive a positive antibody test could feel more comfortable being less careful with social distancing, compromising protection of at-risk loved ones or themselves.  

With all of this in mind, if you are interested in knowing whether you have positive antibodies to COVID-19, these options seem best right now:

Stanford serology test: You need an order from your doctor for this test and it is drawn at a Stanford lab draw center. Give us a call or email us if you are a patient of ours and interested in serology testing and we can discuss.

Quest Diagnostics serology test: You can order this yourself and schedule online for an appointment at a Quest Diagnostics lab draw site.

LabCorp serology test: You can order this yourself and schedule online for an appointment at a LabCorp lab draw site.

 CAN YOU BE IMMUNE TO COVID-19?

 While we all hope that making it through one COVID infection means we are “safe,” we do not yet know if, or for how long, immunity may last. Successfully fighting a virus involves much more than antibody levels. There is an “innate immune system” response and an “adaptive immune system” response, which orchestrates specialized T-cells and memory cells, messenger cells, signaling molecules, and much more. The immune system is impressively complex but as Ed Yong writes: Immunology is where intuition goes to die. “Crucially, researchers still don’t know how much protection the leftover antibodies, T-cells, and memory cells might offer against COVID-19, or even how to measure that.”  

In July, a team from King’s College London showed that many patients lose substantial amounts of their coronavirus-neutralizing antibodies after just a few months. Another study in June from a team in China, found similar results. Both raised the alarm that people could be infected repeatedly or even that a vaccine might not provide long-term protection. But, Yong writes, “many of the immunologists I spoke with weren’t too concerned, because — and reassuringly this time — the immune system is really complicated. A decline in antibody levels over time is expected. Antibody quantity is not the only thing that matters, the “quality” of the antibody is just as important. Quality might mean where on the virus it attaches or how well it sticks. Many people who recover from COVID-19 have low levels of neutralizing antibodies, but some of them neutralize very well.

Research on other coronavirus may help inform how long protective immunity lasts. For the severe ones, like MERS and the original SARS, it lasted at least a couple of years. For milder ones that cause the common cold, it disappears within a year. It is reasonable to guess COVID immunity will lie between those extremes, but we just don’t have the answer yet.  

HOPE AND GRACE

If you have made it this far, time for a reward, something to lighten your day, and acknowledge the human spirit. Find some escape, or perhaps even inspiration, in this collection of works and perspectives gathered from around the world. Please contact me directly if you have come across something that has lifted your heart today.  Dr. Eric Weiss

Although certainly still uplifting (perhaps even more than usual!), and fit for a King (sorry 😊),  this week’s two entries are more local. Please join me in celebrating, and supporting, both Bob and Dottie King of King Philanthropies, and the (virtual!) Kings Mountain Art Fair.

King Philanthropies has seeded MIT’s Abdul Latif Jameel Poverty Action Lab (J-PAL) with a $25M grant which will launch a new initiative to solve problems at the nexus of climate change and global poverty. Over the next decade, the King Climate Action Initiative (K-CAI) intends to help improve the lives of at least 25 million people hard hit by poverty and climate change. Wow. Thank you Bob and Dottie for truly working on changing the world for the better.

Kings Mountain Art Fair – For 56 years, every Labor Day weekend, a magical event has occurred in the redwood forest above Woodside. This year, planning for the Kings Mountain Art Fair has evolved and adapted to meet the challenges of the current times. The Fair will be going virtual in order to raise money for the Kings Mountain Volunteer Fire Brigade and local Kings Mountain Elementary School and to support the independent artists who are struggling in this difficult time. Please learn more here, or register for this year’s virtual event here! There will also be more information in next week’s newsletter.

Again, CV🦠News is a labor of love. If you enjoy reading this, please share widely! Was this forwarded to you by a friend? Please subscribe here.

*****

Yours, in health and resilience,

Eric and the TVD MD team…