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Apr
29

When can we re-open?

That depends on when we:
a) can reliably tell people if they’ve been infected, and
b) know that those who have been infected are immune.
Let’s take these in order.
How do you know you’ve been infected with coronavirus?
Outside of the obvious – a positive test that shows the actual presence of the coronavirus, there has been much talk of “antibody” or “serology” tests. You may have seen articles like this one reporting that many more of us have been infected with the virus than we thought.

Not so fast…that assumes the tests used to verify exposure are accurate, ergo, the core issue is “are these antibody tests accurate?

First, there are over 120 antibody tests on the market – few if any vetted by the FDA to determine if the tests are accurate. And some have been shown to be pretty inaccurate, including $20 million worth of tests the UK bought from a Chinese supplier.

Credible research indicates some tests are accurate – and some aren’t.  A study conducted by UC-San Francisco and Cal Berkeley on a dozen of the tests indicates there are an alarming number of false positives – tests that show patients DO have antibodies, when in fact the patients don’t.  That means the tests indicated the patients were infected – when they may well not have been.

Here’s the key statement from the cite below: “a large proportion of those testing positive on an antibody test may not actually have had COVID-19 [emphasis added]” – and thus could be infected – and infect others – in the future.

The good news is the FDA has decided it will begin to “test the tests”; yet another example of the FDA’s new operating principle “Better late than never.

Second, there is no consensus as to the immunity of individuals previously infected with coronavirus to a re-infection. 

This from the actual study report cited above:

Importantly, we still do not know the extent to which positive results by serology reflect a protective immune response. Future functional studies are critical to determine whether specific antibody responses predict virus neutralization and protection against re-infection. Until this is established, conventional antibody assays should not be used as predictors of future infection risk [emphasis added]

What does this mean for you?

Until we know who’s been infected and if they are immune, “opening up” will be a crap shoot.

Scientific rigor is critical, and you MUST read critically. 


3 thoughts on “When can we re-open?”

  1. No test is 100% correct. The current Covid-19 test being used widely is 70% reliable for a negative result, so 30% of negatives could be positive. The US Healthcare system is providing the best care available to its patients in all settings. We set the standard for flexibility, resourcefulness and adaptability of our front line primary care physicians, ED physicians and the ICU specialists. The lives saved, and the patients whose disease process has been stopped precluding hospitalization is tremendous, also treatment to avoid an ICU admission or a dreaded intubation. We are far from coming to grips with this virus and maybe we will never come to grips with it and will just have to move on with life. Scientists are still dissecting the H1N1 and have little insight than what was originally learned during its initial pandemic and we still continue to have outbreaks every winter. Sometimes these viruses show us how little patience we have and what
    little understanding of our mortality and that truly everyday you wake up is a miracle and that we should live life accordingly and without fear.

    1. Hello Tony – thanks for your thoughts, always appreciate your comments.

      I’m a bit cautious about statements concerning accuracy and reliability. I assume you are referring to the RT-PCR test; I haven’t seen that specific data point so a cite would be helpful. From a statistical perspective, my understanding is there’s a lot to this – this piece provides a good perspective.

      Like most tests, the lower the viral or bacterial (or chemical or whatever you are testing for) load, the higher the false negative results. In this case, the earlier the test is given, the lower the viral load, the less reliable the test is.

      For antibody tests, my understanding is the problem is somewhat different – the false positive is the issue, and the lack of credibility of many current antibody tests coupled with the lack of involvement by the FDA is leading to significant confusion.

      Re the US healthcare system providing the best available care, I’m not able to find any analysis that validates that assumption. What is clear is the massive and catastrophic failure by the Trump Administration on many fronts is the main driver of the current health and economic disaster.

      be well Joe

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Joe Paduda is the principal of Health Strategy Associates

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