Coronavirus Update (May 19th, 2020)

We are now two months into New York State on PAUSE, and while several regions have met the metrics for entering Phase 1 of returning to normalcy, here on Long Island we have at least one more week before we have an opportunity to do so as well.  You can track progress for all the metrics used on the governor’s website. Assuming there are no setbacks, we are looking at entering Phase 1 here on Long Island in one week.  It will take a minimum of two months for Long Island to enter the fourth and final phase of reopening.  It is that final phase that includes schools.  In the spirit of keeping it simple, it means there is a fighting chance that schools will open on time in the fall.

Antibody testing has continued to be a hot topic.  We are bombarded with messages recommending testing on media outlets.  At this time however, we do not agree with their message.  There is a time and a place for all types of diagnostic tests.  One expectation for all testing is that the information provided by the result means something with respect to what your next step forward is.  For example, if you have fever and a sore throat for three days, a positive strep test leads to the recommendation of taking an antibiotic to treat the condition while a negative strep test leads to a recommendation of supportive care.  When you are randomly testing for any purpose you run up the costs of care (how do you like the cost of your health insurance premium?) and create situations of confusion or poor decisions due to false positive, false negatives, or simply not understanding what the result means.

So, what are reasons to get antibody testing?  There are a couple valid reasons for testing at this time:

  1. You are pretty sure you had COVID-19 and wish to donate plasma to help others. If that is the case, please check out the FDA site on how to do such.
  2. You are participating in a research study that is trying to address prevalence of individuals with antibodies

There is a tipping point for the purpose of antibody testing however where we would recommend that everyone be tested, specifically if and when it is shown that having antibodies denotes you are immune.  Should antibodies be shown to indicate you are immune, it permits selective vaccination (should one be developed), selective quarantining if there are further surges in number of folks falling ill, and ability to staff facilities knowing that the staff is not likely to harbor the disease without symptoms to name just a few.

As a quick segue into discussing vaccinations, it is important to understand that it is not just about testing for antibodies that recognize a virus.  It is about testing for antibodies that can either neutralize (prevent virus from infecting a cell) or antibodies that recognize antigens (proteins) on infected cells and target them for destruction by T-cells (part of our immune system).   As an analogy, if you send a blindfolded person to the aisle in the grocery store that contains various products, they could identify rather easily cans versus cardboard packaged products.  Asking them to find a can of chicken soup though would require something additional such as braille labels.  That is where we are at now with antibody testing – we can find the can, just don’t know what is in it.  So again, wait for a test that means something other than “hey, I had COVID-19.”

Vaccine development is well underway for COVID-19 at this point.  Yesterday, it was announced that one of the companies working on such a vaccine had positive early results.  Specifically, Moderna (partnering with the NIH), announced that in their Phase 1 trial demonstrated that 8 out of a few dozen study participants had measurable antibodies.  Let’s assume that they work out dosing of the vaccine and get all the participants to have measurable antibodies.  What does that mean?  Nothing yet.  The real question that needs to be answered is whether these participants can get infected with COVID-19 or whether they are immune.   Animal trials on vaccines have started to yield hope that this may be the case, but the study is small (about a dozen mice and rhesus macaques).  You have to start somewhere, but creating a vaccine is not easy, and likely still quite a bit away from being a reality.  A thank you to Dr. Sherrye Glaser for sharing the animal trial with us.

Last major topic of the day is a quick update on Kawasaki Disease and its relation to COVID-19 in children.  Per the World Health Organization (WHO), there are currently more than 4 million confirmed cases of COVID-19-19 worldwide that have resulted in 285,000 deaths.  Currently, there are at most a few hundred reported cases of Kawasaki Disease in children that are of possible relation to COVID-19-19.  Keeping in mind that there are likely far more than 4 million cases of COVID-19-19 as not everyone has been tested, Kawasaki Disease is not a common consequence of infection.  Still anxious?  Keep in mind that Kawasaki Disease is not a new illness.  Per the CDC website, in 2000 there were 4248 hospitalizations for Kawasaki Disease and in 2009 there were 5447 hospitalizations.  If you assume that 4500 is an average year for the condition, you would expect 375 hospitalizations each month for Kawasaki Disease.  And lastly, just for your amusement is a nice paper discussing Novel Coronavirus and Kawasaki Disease.  The study demonstrated an association based on 11 children with Kawasaki along with 22 control subjects.  Spoiler alert, the paper is from 2005.  Keeping it simple again, and not belittling the condition, this is nothing new to be alarmed about.

Hope you all have a great week!