Testing, testing, testing.
It’s on our minds. We all wonder how testing will help us out of this coronavirus/COVID-19 crisis.
There are two types of COVID-19 tests to know about: nasal swabs and antibody blood tests.
The Nasal Swab Test
The nasal swab test can determine whether you are currently infected with COVID-19.
For those who have experienced the displeasure of a swab shoved deep into their nasal cavity, your respiratory secretions were tested for the presence of the COVID-19 virus.
A positive nasal swab test means that you are infected with COVID-19. A negative test means that you probably aren’t infected with COVID-19.
Unfortunately, some nasal swab tests have false-negative rates up to 30 percent. This means that many who test “negative” for COVID-19 may actually have the disease.
The Antibody Blood Test
An antibody blood test can determine whether you have already been infected by COVID-19.
This is called “antibody” or “serology” testing, and it tests to see if your immune system is producing specific IgM and IgG antibodies.
A positive antibody test indicates that you have immunity to COVID-19. A negative antibody test indicates that you do not have immunity to COVID-19, either because you haven’t been infected or your immune system has not built up immunity.
The first generation of antibody testing is just being introduced. It will take time to understand the reliability of these tests.
What Is an Antibody?
Antibodies are proteins made by your body that fight off germs.
What Is IgM?
IgM, also known as Immunoglobulin M, is an antibody produced by your immune system when your body is first exposed to a germ. Your IgM level will rise for a short period of time. Those levels will then begin to drop as your body produces a second antibody called IgG.
What Is IgG?
IgG, also known as Immunoglobulin G, is the antibody that will give you long-term protection.
IgG antibodies protect you against infection by “remembering” which germs you’ve been exposed to previously. If you have IgG antibodies for a specific germ and you are re-exposed to that germ, then your immune system knows to attack it.
Your doctor can test for IgG to figure out whether you’ve been infected by a specific virus.
We know that not every immune system is the same. While some people who get COVID-19 will develop a strong immune response and create IgG antibodies, others may not.
What Are the Benefits of Testing?
Doctors benefit from real-time, reliable tests in order to diagnose and treat their patients.
Testing is necessary for Public Health officials to determine the extent of illness across communities. Antibody testing will us identify who has already been infected and who has immunity to COVID-19. What has been accomplished in a few short weeks is just short of a medical miracle.
What Are Some Limitations of Testing?
While we want to break out of isolation, we are not there yet. Even after widespread testing is in place, we will still need to be patient.
We don’t know how accurate the first generation of antibody testing will be. We don’t know how long a person’s COVID-19 IgG immunity will last. We don’t know whether COVID-19 will mutate in a way that allows a person to be reinfected with a mutated viral strain.
It is going to take time to administer tests, collect data, administer more tests, crunch numbers and draw accurate scientific conclusions.
It is important to know the accuracy of our testing before making important public policy decisions, such as when to safely release “immune” workers back into the work force.
Is There a Chance That I Caught COVID-19 Last Fall?
We experienced a harsh cold and flu this past fall. Some wonder if their flu-like illness in November was really COVID-19. I have heard optimistic speculation that Californians may already be immune.
While I really, really wish this was true, I think it is highly unlikely. And this is why.
Californians would not have had immunity to COVID-19 in November. If COVID-19 had been circulating, the virus would have spread rapidly and our emergency rooms and intensive care units would have been overflowing with severe respiratory illness. There would have been unexplained deaths. Doctors would have noticed this.
Once antibody testing starts, we will have a better idea of how many Californians have already been sick and who has immunity. Until then, we all need to continue with strict distancing.
When Will Things Be Back to “Normal”?
I wish that I knew, but I don’t.
Unless the virus disappears with a change in seasons, we should expect some element of social distancing until a vaccine or an effective treatment is discovered. If it feels like your community has not yet been hit hard, then credit your neighbors for doing a great job of social distancing.
California implemented some drastic measures very early on, and I believe this helped to significantly delay the surge.
“Delay” is the key word. COVID-19 is here. Because of limited testing, our data is not robust. We should assume that the number of actual cases is greater than the reported number of positive tests. I don’t say this to create anxiety, but because it is important for us all to continue social distancing until more data can be collected.
Until we implement widespread diagnostic and antibody testing, we won’t have the data to know what our “curve” really looks like and where we truly are on that “curve.”
California has not hit its peak. Because of social distancing, we appear to be bending the curve to peak sometime in May or June.
Scientific data is coming. The better the data, the more accurate our models will be. We must be patient and follow the science.
The Good News
The good news for us is that other parts of the world are months ahead. We have the ability to incorporate their data and experience into our planning.
The State of California has announced that more widespread nasal testing is on its way. Antibody testing will be available soon. More testing means that more data is coming.
Our medical and scientific communities are united, collaborating and moving at light speed. Treatments and vaccines are actively being studied.
While it may feel like time, testing and treatments are moving slowly, they aren’t.
Seek Out the Silver Linings
Take this time to be present with your loved ones. Slow down. Be more mindful. Eat three meals together. Dust off the board games. Do puzzles. Enjoy family movie nights with popcorn. Laugh. Seek out silver linings and talk about them with your kids. You may never get another opportunity like this.
Turn off the 24/7 TV news coverage. The death tracker is anxiety-provoking. The back-and-forth banter sets us up with unrealistic expectations and timelines.
Let’s keep doing our part to flatten the curve by staying home and minimizing trips for shopping and errands.
Allow our expert scientists and epidemiologists the time they need to collect and sort through the data.
Together, we will follow a science-based path out of the COVID-19 crisis.
— Dr. Dan Brennan is a board-certified pediatrician at Sansum Clinic who thanks you for staying home to protect your tribe and help prevent the spread of COVID-19. Please contact Dr. Dan at 805.563.6211, firstname.lastname@example.org or visit www.sbpediatrics.com.