Originally published: August 9 2020
I know there are many opinions on COVID-19. Trust me, I hear about them all day long. This email is not to debate the virus, but give you a bias-free set of statistics that you can use to compare to other sources you may be using.
Knowing how most people read an email, I have placed my take-home message at the top. For the details and support, read the full body of this email.
Take home message
- With few exceptions, most of the patients that tested positive had mild to moderate symptoms and recovered without the use of medication. We do not have a routine cocktail of therapies (HCQ, CBD, ZPACK, or STEROIDS) that we give a patient that tested positive. We do routinely recommend vitamin D, Vitamin C, and Zinc (all can be found in a basic multi-vitamin) to all patients, especially a person who has tested positive for SARs CoV 2.
- There are people that carry the virus and are unaware (asymptomatic). If you are going to be visiting a loved one that is considered to be high-risk, a test is reasonable.
- People with symptoms made up the majority of our positive tests and remains the main reason we recommend testing.
- Direct exposure to a positive patient made up the second-largest group of positive patients in our panel and showed a decent chance of becoming infected within one week after exposure. The longer, closer, and less protected, the more likely to see a positive conversion from exposure.
- The majority of positive patients cleared the virus in two weeks or less.
A few details about our testing system
Over the past month, we have been using a Quidel Sofia analyzer to run the FIA rapid COVID-19 test at Personal MD. There are a few differences between Flow Immune Assay (FIA) testing and Polymerase Chain Reaction (PCR) testing. The most significant difference is that PCR looks for the presence of the virus itself, where FIA testing looks for a specific antigen (protein) that attaches to the virus. It would be the equivalent of finding a person and finding a personal driver’s license. Finding the person (PCR) is much more reliable, however with rare exceptions, a driver’s license (FIA) is specific for an individual person.
Standard terms used in testing are sensitivity and specificity. Sensitivity is identifying a virus when it is present. Specificity provides confidence that what you found is genuinely what it represents. PCR is considered the best test available as it is the most specific and the most sensitive. However, FIA testing has been used for years and has a good track record of being trustworthy. FIA testing is commonly used in doctors’ offices to determine flu, strep, Lyme, and RSV.
The advantage of FIA over PCR is speed. FIA can produce results in a few minutes, where PCR takes anywhere from 2-20 days. The time difference is a vital part of identifying a positive COVID-19 person and isolating that person to limit the spread. As you will see below, it can be challenging to know when a person is infected with this virus, so using a screening tool like FIA can be invaluable.
We have found that there are three reasons people need to be tested for COVID-19.
First, a person has symptoms that have been associated with COVID-19.
Second, a person has been exposed to a person who tested positive for COVID-19.
Finally, a person needs to be screened for COVID-19 (traveling, going back to college, visiting a high-risk person, or getting cleared to be on a job site).
Ages: Our clients range from 11 years old to 91 years old.
Note: We did not differentiate by race, sex, economic status, or other unique qualities.
Three hundred tests were performed in July.
Seven tests were used to calibrate our machine and act as periodic controls throughout July.
Five tests were used to re-test a patient that was identified as being positive on our machine.
This leaves 288 unique individuals that were tested and included in our results.
We had 35 positive tests between the dates of July 5, 2020, and July 30, 2020.
Positivity rate: All clients: 35/288 = 12.15%
Out of the 288 patients, 68 were being screened, 94 were exposed, and 126 had at least one symptom.
Patients with symptoms (see details below)- 18 patients who tested positive out of 126 that had symptoms: 18/126 = 14.29%
Patients who were exposed no more than 10 days prior to being tested and had no symptoms- 13 positives out of 94 exposed individuals: 13/94 = 13.8%.
Finally, asymptomatic positives (people being screened to travel, go back to work, college, etc. and no symptoms and no known exposure)- 3 positives out of the 68 total people screened. 3/68 = 4.4%.
A word on symptoms
We used a questionnaire for patients to mark their symptoms. The number one complaint was a headache. The second was fatigue. And third was body aches. Other symptoms included cough, nausea, loss of taste, loss of smell, and fever (self-reported, not measured).
Before you start sending me emails
I am aware there are many ways to look at these values. Our results are being presented for general information only. We admittingly are not using the gold standard testing system (PCR), so the chance of false negatives (a negative result when the patient is actually positive) is undoubtedly there, which means our true values are likely higher than what we detected. However, the chance of false positives is doubtful considering the unique nature of the antigen the test can identify. If our test determines you are positive, you can be confident you are indeed positive. You have to have a high enough viral load with the unique antigen to trigger the test to read positive.
We have no need to be biased with our testing. We are merely screening clients that need to know if they are positive or negative. We do encourage people to wait until day 5 after known exposure to be tested but otherwise, we do not turn away a person who wants to be tested.
We take a person’s word on why they want a test by using a simple questionnaire. I am sure some people may not fully disclose their symptoms or exposure history.
Our results are purely objective. The machine we are using reads the results for us. A few tests on the market require a human to judge whether a test is positive or negative (like a traditional pregnancy test). I have used these tests in the past, and it can be difficult to interpret some of the results.
Testing too early and too late can be missed by our machine. In fact, we know testing in the first three days of exposure, and after the seventh day of the onset of symptoms is not a good fit for our machine. The false-negative rate is higher in these scenarios.
I suspect the true percent of positive tests is higher than what we observed as many of the clients we tested originally tested positive at an outside facility and used our test to be cleared to go back to work. This group of patients was counted as part of the asymptomatic group, which also dilutes our asymptomatic value.
How our patients have done
Our data demonstrate that over 96% of people cleared within 14 days of testing positive. With few exceptions, most of the patients that were positive that we encountered had mild symptoms (see above). This is heavily based on history as over two dozen of the clients we tested were originally diagnosed at an outside facility. Also, many people tested were not my personal patients and no follow-up was attempted.
Since March 1, 2020, a few unique cases have stood out. One of our patients (age 20) took 8 weeks to show a negative result, one of our clients (age 57) took 4 weeks, and one of our clients (age 46) took 3 weeks to test negative.
Since March 1, 20202, we have had three of my personal patients that required hospital support. A 34-year-old female that was treated and discharged from the emergency room. A 41-year old female that was hospitalized without ventilation support for three days. And a 45-year-old female that was hospitalized and required ventilation support for eleven days.
I will continue to share our test results with you as we collect more data.