Formerly DT: COVID-19 - Featuring Lots of Politics, now CR because political talk not going away

[Iceman 2639]

43 minutes ago, Dahobbs said:

I have no idea what you're talking about, and per usual, neither do you.

the doomsayers are wrong as fuck.

 

You do know...or you are still in denial.

[Brisketexan 104590]

Well, we’re all due for some connection to a COVID death. An old friend’s father just died. Yeah, he was 81, but still. Not a close connection, and I sure hope that’s as close as it gets.

[Message Board User 12389]

 

[Anastasis 23394]

1 hour ago, dcar00 said:

I can only imagine that Fauci has more information than just that trial for him to make a statement like that.

I don't. 

[Bevo 13526]

1 hour ago, Liquor and Poker said:

I think that was the drug my kids had to have for the first two or three years after birth.  Near to ten grand a shot.

Probably, it was developed by Medimmune if memory serves. A company I worked with was considering development of a fully humanized version but I talked them out of it.

[Bevo 13526]

26 minutes ago, Brisketexan said:

Well, we’re all due for some connection to a COVID death. An old friend’s father just died. Yeah, he was 81, but still. Not a close connection, and I sure hope that’s as close as it gets.

A family friend and his wife died from Covid in Savannah awhile back. A few weeks before their death, my mom was considering going on a trip to NY with them but decided against it because of the pandemic.

[justhookit 4178]

Received the email from my mom’s San Antonio doctor today regarding his testing numbers (if you haven’t read my previous posts he is antibody testing ALL of his patients). Spoilered because it’s extremely longcat but it’s really interesting. Sitting down to a late meal now but I’ll read through it more thoroughly later.

Spoiler

Dear Patients,

 

What a difference a week makes. In spite of Covid-19, it was nice to see so many of you this past week. I am honored to serve each of you, and it's a privilege to be your doctor. Last week my office administered antibody tests to over 900 people.This letter is to explain the different immune responses to Covid-19, recap the results of our office's testing results, and explain in more detail why I am a firm believer in antibody testing.

 

 

The immune system acts the same way in 98 percent of the population. When you are exposed to a virus, your body immediately starts to make antibodies. The body makes two antibodies in response to every viral or bacterial infection: IgM and IgG.The same process occurs each time your body experiences an infection.

 

 

The IgM antibody is the first antibody produced by the body and its production peaks at 7 days. After 14 days the production of IgM has stopped and its presence in your bloodstream is diminished. In most people, IgM antibodies are undetectable 30 to 45 days following exposure to a virus.

 

 

Approximately 14 days following exposure to a virus, the body begins to produce the IgG antibody. Production of IgG continues to increase and hits a peak at roughly 30 days after viral exposure.  IgG is the antibody that is with you forever.  If your body were to encounter the same virus, IgG is the antibody that is rushed into production upon re-exposure.  It is your body's targeted, virus-specific immune response to an infection.  The IgG antibody is the golden ticket, as I said to many of you.  It is not a perfect immunity, but it is a more rapid and robust response from your immune system if you are subsequently exposed to Covid-19.

 

 

For those who tested IgM positive, your result indicates that at some point in the last 5-10 days you were exposed to the Covid-19 virus.  Your body has identified the virus and has started to make antibodies to it.  The CDC currently recommends that anyone who is exposed should self-quarantine for 14 days.  Given what we know about the timeline for the body to begin producing IgM antibodies, my recommendation to those patients is self-quarantine for 10 days.  That is in keeping with the CDC guidelines. For patients who tested IgM positive, please continue checking in regularly so we can provide the best care possible.

 

 

For those who tested IgM positive and IgG positive, your result indicates that you are further along in your body's immune response to the disease.  Your exposure was at least 14-30 days ago.  Enough time has passed that your body is able to start producing IgG, but within a timeframe that IgM antibodies are still detectable in the blood.  My recommendation to these patients is to self-quarantine for 5 more days, in an abundance of caution, to prevent the spread of the disease.

 

 

For those who were simply IgG positive, your result indicates that you were most likely exposed to Covid-19 30-45 days ago.  You are no longer symptomatic or contagious.  You have had the disease and have developed a degree of immunity to it.  If you were to be re-infected by Covid-19, your immune system will be ready to fight it.

 

 

Approximately 70% of the patients who tested positive for the IgG antibody had experienced moderate symptoms of this disease in the previous 30-45 days. About 30% of the IgG positive patients did not report any notable symptoms, or indicated conditions so mild one couldn't guess at the virus being present.  The mild symptoms included a moderate headache and fatigue.

 

 

PCR (the nasal swab test) is the standard of care used by the CDC and WHO to determine whether a person is Covid-19 positive or negative. It takes 3-5 days to get the results from a PCR test.  I have been testing people for the last 6 weeks and have formed some impressions about PCR testing.  As to its accuracy, I have had 5 patients for whom I made a clinical diagnosis of Covid-19, though they tested negative by PCR.  These patients presented with every classic symptom: high fever, cough, shortness of breath, severe fatigue, and body aches.  After making my clinical assessment, I treated those patients with hydroxychloroquine. Upon performing an antibody test on those 5 PCR-negative patients, all were IgM and IgG positive, indicating exposure to the virus and a developing immune response.  12 other patients who tested PCR-positive were also IgM and IgG positive.  100% of my patients who were seriously sick with Covid-19 have tested positive for antibodies.

 

 

Based on my observations, studies I have read, and clinical knowledge, I believe that there is a false-negative in PCR testing in roughly 1 out of every 5 cases.  That error ratio is present even when the patient is severely sick and the virus is everywhere in their body.  When the patient is only mildly sick or not displaying any symptoms of illness, the amount of virus present in their nose is so low, it is unlikely to get a positive PCR result.  I tested roughly 20% of my asymptomatic patients who were IgM positive.  As of this morning, 90% of them were PCR negative, meaning no virus could be found by nasal swab.  Some might conclude that means the antibody test is wrong; I wholeheartedly disagree.  I believe that the patient is not sick enough to produce the virus everywhere in the body, and the nasal swab simply isn't collecting mucous that is infectious.  There is some merit to the thinking that the patient isn't contagious in that scenario.  If the Covid-19 virus is not present in your nasal cavity or oral cavity, then you are not discharging it everywhere.  Given how many unknowns there are with this disease, I have opted to urge caution and have asked that everyone who is IgM positive stay quarantined for 10 days- even if you are asymptomatic.

 

 

After working with the antibody test for the past 10 days, and in light of research studies done by Stanford University, and in New York, and Los Angeles, I believe it to be 85% reliable.  I am attaching links to four articles in this email which I have found informative.  Please read them.  Given our current constraints, a perfect test is not possible.  We have to work with what we have been given.  Using the antibody test, I found clusters of positive results in the same family, in keeping with expectations for a contagious virus.  For example, if a mother has the illness, one or two other people in the household likely have it or have had it.  One positive test is significant, but in a family cluster an additional positive test validates the first test, and a third positive test increases the validity of the other two tests.  Covid-19 follows a contact, respiratory droplet, secretory disease process so one would expect it to spread within a household.

 

 

So, where do we go from here?  I am in the process of procuring more tests, which will allow me to retest all of the IgM positive patients in 2 weeks.  It is my hope that the vast majority of those will have converted to IgG.  The best news from testing last week is that roughly 7% of those tested were IgG positive, meaning they had been exposed to Covid-19, and had done very well.  That is a higher percentage than we would have expected to see.  Those who are IgG positive can go back to work without fear of exposing other people to Covid-19.  I retested by PCR (nasal swab) many of the IgG patient population, and all PCR tests were negative, meaning no virus was found in the nasal cavity. This patient population also has the ability to fight this virus if they are re-infected.

 

 

Additionally, I found that roughly 15% of the patients tested have the IgM antibody, indicating a current infection.  The majority of the IgM positive population were experiencing mild to no symptoms (roughly 85%). The most common mild disease symptoms were headache and fatigue, with some body aches.

 

 

Notably, many more people in our community have had exposure to this disease than we anticipated and are still doing great.  My results fall in line with the studies conducted at Stanford, USC and New York.  However, the antibody tests I administered last week were not random subjects.  We tested a small, focused geographic area, and we were looking at family clusters of viral contagion and therefore, our percentages of co-infection were higher.

 

 

Even with that distinction, the denominator in our equation is drastically changed, bringing the mortality ratio closer to what we see with flu.  The fact has not changed that Covid-19 has killed 59,000 people in less than 7 weeks in the US. But it does mean that a lot more people have had this disease and survived.  As of April 29, 2020, the mortality rate in the US was 5.6%.  This number is reached by taking the entire known infected population (1,038,000) and dividing by the total number of known deaths (59,000).

 

 

The mortality rate will drastically drop as the known infected population increases. If we were to use the results of last week's testing, and included the 10% of the population that has undetected IgM antibodies in the known infected number (the denominator), the mortality ratio drops to 0.18%.

 

 

Data makes it possible for us to move forward as a country.  We absolutely flattened the curve by quarantining and self-isolating, and as a result we did not overwhelm the hospital system as has happened in New York.  Covid-19 is a moving target and my views are evolving and changing every day.  I don't get it right all the time and I will make mistakes, but I am attempting to present the most current and correct data to my patients.  I am daily seeking to understand this virus and provide my patients the best care possible.  Please continue hand washing, physical distancing, in addition to wearing your masks to prevent the spread of this novel virus. I have attached a summary of the results from the Antibody testing conducted last week.

 

 

I am so proud of my staff.  They all worked tirelessly and conscientiously last week. Between April 17-24 we tested just shy of 900 patients and their loved ones and friends.  I have never seen such dedication and hard work.  I also have to thank Meredith for her constant support and making her guest appearance.  I couldn't do what we did without them. 

 

 

Stay healthy and safe,

 

 

Dr. Scott Campbell

Dr. Alan Merin

Kimberly Laswell

 

 

https://www.nytimes.com/2020/04/24/health/coronavirus-antibody-tests.html

 

 

https://www.sciencemag.org/news/2020/04/antibody-surveys-suggesting-vast-undercount-coronavirus-infections-may-be-unreliable

 

 

https://thehill.com/changing-america/resilience/smart-cities/493859-antibody-study-suggests-more-people-in-la-county?amp

 

 

https://www.dropbox.com/s/cd1628cau09288a/SARS-CoV-2_Serology_Manuscript.pdf?dl=0

 

Dr. Campbell tested 862 patients over the course of 4 days, recording the results for both IgM and IgG antibody tests.

 

 

The COVID-19 virus is a novel corona virus, meaning it is new to humans and therefore there is no existing immunity. The disease stages reflected by the results of the antibody test can be visualized in this highly simplified sketch:

 

 

Summary of recorded results:

	#	Percentages
Total Patients	862
Total Groups	491
Avg Group Size	2
Vulnerable (IgM & IgG Negative)	573	66.47%
Early (IgM Positive)	174	20.19%
Recovering (IgM & IgG Positive)	51	5.92%
Past (IgM Negative & IgG Positive)	64	7.42%

 

Patients counted as Vulnerable in this table tested negative for both the COVID-19 IgM and IgG antibodies. There were 573 patients for who tested negative for both the IgM and IgG antibodies, so they were described as Vulnerable to new infection.

 

Patients who tested positive for IgM were described as Early, reflecting that their bodies were producing IgM antibodies to fight the infection, but had not yet begun producing the IgG antibodies for future protection from infection. 174 patients tested positive for IgM and negative for IgG.

 

Patients who tested positive for both IgM and IgG antibodies were described as Recovering, producing both antibodies to defeat the infection while also producing the antibodies required

 

for future protection for COVID-19 infection. 51 patients tested positive for both IgM and IgG antibodies.

 

Patients who tested negative for IgM antibodies and positive for IgG antibodies were described as Past. Their immune systems had defeated the virus in the past and were no longer producing the IgM antibodies for actively fighting the virus, and were producing only IgG antibodies for providing protection from future infection. 64 patients tested positive for IgG only, including 13 patients who were 60 years of age and above.

 

The tests are FDA Title IV validated. Two tests were used, and are manufactured by Syntron Bioresearch (Tiajin Bay Bioresearch DBA Syntron) and Hangzhou All Test Biotech Company. Syntron has a Positive Percent Agreement (PPA) of 89.4%. This means that any particular test is 89.4% accurate for a positive test reading. Applying this to these results yields a potential false positive count of 61, meaning as many as 61 patients with tests that read positive for IgM and/or IgG antibodies actually did not have these antibodies. That places a lower bound on the positive number of 289 - 61 = 228 patients who tested positive for the antibodies and have been exposed to the virus. Out of a total population of 862, that means the lower bound on infection, either present or past, is 26%. This number is completely dependent on the accuracy of the tests reflected in the PPA data provided by the manufacturer. The PPA value is less that the provided Negative Percent Agreement (NPA), so the lower value of the PPA was used for calculating both the False Positive and False Negative values.

 

A False Negative value means a test that returns no indication of either IgM or IgG antibodies for a person who is infected with COVID-19. There were 573 patients that returned tests with no response for either antibody, and with an accuracy of 89.4%, that yields 72 patients who could have been infected with COVID-19 despite a clear test. This would lower the number of Vulnerable patients, but would increase the number of patients already exposed to the virus, increasing the value above 289 and raising the percentage that had already been exposed to COVID-19.

 

The age distribution reflects Dr Campbell's patient demographics. The test results are distributed across all age ranges with no hospitalizations in Dr Campbell's patient population, despite the severe symptoms in older patients reported in other populations.

 

 

Age Range	Vulnerable	Early	Recovering	Past	Totals
0-9	1	1	1	0	3
10-19	82	12	3	12	109
20-29	68	13	4	8	93
30-39	67	16	5	6	94
40-49	10	0	0	1	11
50-59	112	33	17	15	177
60-69	80	31	7	7	125
70-79	69	19	5	5	98
80-89	7	1	0	1	9
90-99	0	0	0	0	0

 

Dr. Campbell's population does not reflect the general population. It self-selected for testing, reflected in the number of Groups or families (491) that were tested. This population is cared for by a private physician and therefore receives higher quality care. They are more engaged in their own health than the general population, and have fewer untreated underlying conditions. This population also travels more extensively that the general population. There was travel in the tested population recorded in February and March to every continent except Antarctica.

This means these results can not be projected onto the general population, either in Bexar County or nationally. It does indicate a much higher percentage of the population in the 78209 ZIP code has been exposed to the virus than expected based on the most common models with limited severe cases.

 

Summary: Between 26% and 34% of Dr Campbell's patients have been exposed to the COVID- 19 virus, with no hospitalizations or ICU stays, even for patients in the High Risk category over 60 years of age.

 

[justhookit 4178]

Here’s the plaintext. Also keep in mind this is from Alamo  Heights and a bunch of people traveled over spring break and many to Colorado ski resorts so the numbers are going to skew high.

Spoiler

Dear Patients,

 

What a difference a week makes. In spite of Covid-19, it was nice to see so many of you this past week. I am honored to serve each of you, and it's a privilege to be your doctor. Last week my office administered antibody tests to over 900 people.This letter is to explain the different immune responses to Covid-19, recap the results of our office's testing results, and explain in more detail why I am a firm believer in antibody testing.

 

The immune system acts the same way in 98 percent of the population. When you are exposed to a virus, your body immediately starts to make antibodies. The body makes two antibodies in response to every viral or bacterial infection: IgM and IgG.The same process occurs each time your body experiences an infection.

 

The IgM antibody is the first antibody produced by the body and its production peaks at 7 days. After 14 days the production of IgM has stopped and its presence in your bloodstream is diminished. In most people, IgM antibodies are undetectable 30 to 45 days following exposure to a virus.

 

Approximately 14 days following exposure to a virus, the body begins to produce the IgG antibody. Production of IgG continues to increase and hits a peak at roughly 30 days after viral exposure.  IgG is the antibody that is with you forever.  If your body were to encounter the same virus, IgG is the antibody that is rushed into production upon re-exposure.  It is your body's targeted, virus-specific immune response to an infection.  The IgG antibody is the golden ticket, as I said to many of you.  It is not a perfect immunity, but it is a more rapid and robust response from your immune system if you are subsequently exposed to Covid-19.

 

For those who tested IgM positive, your result indicates that at some point in the last 5-10 days you were exposed to the Covid-19 virus.  Your body has identified the virus and has started to make antibodies to it.  The CDC currently recommends that anyone who is exposed should self-quarantine for 14 days.  Given what we know about the timeline for the body to begin producing IgM antibodies, my recommendation to those patients is self-quarantine for 10 days.  That is in keeping with the CDC guidelines. For patients who tested IgM positive, please continue checking in regularly so we can provide the best care possible.

 

For those who tested IgM positive and IgG positive, your result indicates that you are further along in your body's immune response to the disease.  Your exposure was at least 14-30 days ago.  Enough time has passed that your body is able to start producing IgG, but within a timeframe that IgM antibodies are still detectable in the blood.  My recommendation to these patients is to self-quarantine for 5 more days, in an abundance of caution, to prevent the spread of the disease.

 

For those who were simply IgG positive, your result indicates that you were most likely exposed to Covid-19 30-45 days ago.  You are no longer symptomatic or contagious.  You have had the disease and have developed a degree of immunity to it.  If you were to be re-infected by Covid-19, your immune system will be ready to fight it.

 

Approximately 70% of the patients who tested positive for the IgG antibody had experienced moderate symptoms of this disease in the previous 30-45 days. About 30% of the IgG positive patients did not report any notable symptoms, or indicated conditions so mild one couldn't guess at the virus being present.  The mild symptoms included a moderate headache and fatigue.

 

PCR (the nasal swab test) is the standard of care used by the CDC and WHO to determine whether a person is Covid-19 positive or negative. It takes 3-5 days to get the results from a PCR test.  I have been testing people for the last 6 weeks and have formed some impressions about PCR testing.  As to its accuracy, I have had 5 patients for whom I made a clinical diagnosis of Covid-19, though they tested negative by PCR.  These patients presented with every classic symptom: high fever, cough, shortness of breath, severe fatigue, and body aches.  After making my clinical assessment, I treated those patients with hydroxychloroquine. Upon performing an antibody test on those 5 PCR-negative patients, all were IgM and IgG positive, indicating exposure to the virus and a developing immune response.  12 other patients who tested PCR-positive were also IgM and IgG positive.  100% of my patients who were seriously sick with Covid-19 have tested positive for antibodies.

 

Based on my observations, studies I have read, and clinical knowledge, I believe that there is a false-negative in PCR testing in roughly 1 out of every 5 cases.  That error ratio is present even when the patient is severely sick and the virus is everywhere in their body.  When the patient is only mildly sick or not displaying any symptoms of illness, the amount of virus present in their nose is so low, it is unlikely to get a positive PCR result.  I tested roughly 20% of my asymptomatic patients who were IgM positive.  As of this morning, 90% of them were PCR negative, meaning no virus could be found by nasal swab.  Some might conclude that means the antibody test is wrong; I wholeheartedly disagree.  I believe that the patient is not sick enough to produce the virus everywhere in the body, and the nasal swab simply isn't collecting mucous that is infectious.  There is some merit to the thinking that the patient isn't contagious in that scenario.  If the Covid-19 virus is not present in your nasal cavity or oral cavity, then you are not discharging it everywhere.  Given how many unknowns there are with this disease, I have opted to urge caution and have asked that everyone who is IgM positive stay quarantined for 10 days- even if you are asymptomatic.

 

After working with the antibody test for the past 10 days, and in light of research studies done by Stanford University, and in New York, and Los Angeles, I believe it to be 85% reliable.  I am attaching links to four articles in this email which I have found informative.  Please read them.  Given our current constraints, a perfect test is not possible.  We have to work with what we have been given.  Using the antibody test, I found clusters of positive results in the same family, in keeping with expectations for a contagious virus.  For example, if a mother has the illness, one or two other people in the household likely have it or have had it.  One positive test is significant, but in a family cluster an additional positive test validates the first test, and a third positive test increases the validity of the other two tests.  Covid-19 follows a contact, respiratory droplet, secretory disease process so one would expect it to spread within a household.

 

So, where do we go from here?  I am in the process of procuring more tests, which will allow me to retest all of the IgM positive patients in 2 weeks.  It is my hope that the vast majority of those will have converted to IgG.  The best news from testing last week is that roughly 7% of those tested were IgG positive, meaning they had been exposed to Covid-19, and had done very well.  That is a higher percentage than we would have expected to see.  Those who are IgG positive can go back to work without fear of exposing other people to Covid-19.  I retested by PCR (nasal swab) many of the IgG patient population, and all PCR tests were negative, meaning no virus was found in the nasal cavity. This patient population also has the ability to fight this virus if they are re-infected.

 

Additionally, I found that roughly 15% of the patients tested have the IgM antibody, indicating a current infection.  The majority of the IgM positive population were experiencing mild to no symptoms (roughly 85%). The most common mild disease symptoms were headache and fatigue, with some body aches.

 

Notably, many more people in our community have had exposure to this disease than we anticipated and are still doing great.  My results fall in line with the studies conducted at Stanford, USC and New York.  However, the antibody tests I administered last week were not random subjects.  We tested a small, focused geographic area, and we were looking at family clusters of viral contagion and therefore, our percentages of co-infection were higher.

 

Even with that distinction, the denominator in our equation is drastically changed, bringing the mortality ratio closer to what we see with flu.  The fact has not changed that Covid-19 has killed 59,000 people in less than 7 weeks in the US. But it does mean that a lot more people have had this disease and survived.  As of April 29, 2020, the mortality rate in the US was 5.6%.  This number is reached by taking the entire known infected population (1,038,000) and dividing by the total number of known deaths (59,000).

 

The mortality rate will drastically drop as the known infected population increases. If we were to use the results of last week's testing, and included the 10% of the population that has undetected IgM antibodies in the known infected number (the denominator), the mortality ratio drops to 0.18%.

 

Data makes it possible for us to move forward as a country.  We absolutely flattened the curve by quarantining and self-isolating, and as a result we did not overwhelm the hospital system as has happened in New York.  Covid-19 is a moving target and my views are evolving and changing every day.  I don't get it right all the time and I will make mistakes, but I am attempting to present the most current and correct data to my patients.  I am daily seeking to understand this virus and provide my patients the best care possible.  Please continue hand washing, physical distancing, in addition to wearing your masks to prevent the spread of this novel virus. I have attached a summary of the results from the Antibody testing conducted last week.

 

I am so proud of my staff.  They all worked tirelessly and conscientiously last week. Between April 17-24 we tested just shy of 900 patients and their loved ones and friends.  I have never seen such dedication and hard work.  I also have to thank Meredith for her constant support and making her guest appearance.  I couldn't do what we did without them. 

 

Stay healthy and safe,

 

Dr. Scott Campbell

Dr. Alan Merin

Kimberly Laswell

 

https://www.nytimes.com/2020/04/24/health/coronavirus-antibody-tests.html

 

https://www.sciencemag.org/news/2020/04/antibody-surveys-suggesting-vast-undercount-coronavirus-infections-may-be-unreliable

 

https://thehill.com/changing-america/resilience/smart-cities/493859-antibody-study-suggests-more-people-in-la-county?amp

 

https://www.dropbox.com/s/cd1628cau09288a/SARS-CoV-2_Serology_Manuscript.pdf?dl=0

 

Dr. Campbell tested 862 patients over the course of 4 days, recording the results for both IgM and IgG antibody tests.

 

 

The COVID-19 virus is a novel corona virus, meaning it is new to humans and therefore there is no existing immunity. The disease stages reflected by the results of the antibody test can be visualized in this highly simplified sketch:

 

 

Summary of recorded results:

 

#

Percentages

Total Patients

862

 

Total Groups

491

 

Avg Group Size

2

 

Vulnerable (IgM & IgG Negative)

573

66.47%

Early (IgM Positive)

174

20.19%

Recovering (IgM & IgG Positive)

51

5.92%

Past (IgM Negative & IgG Positive)

64

7.42%

 

Patients counted as Vulnerable in this table tested negative for both the COVID-19 IgM and IgG antibodies. There were 573 patients for who tested negative for both the IgM and IgG antibodies, so they were described as Vulnerable to new infection.

 

Patients who tested positive for IgM were described as Early, reflecting that their bodies were producing IgM antibodies to fight the infection, but had not yet begun producing the IgG antibodies for future protection from infection. 174 patients tested positive for IgM and negative for IgG.

 

Patients who tested positive for both IgM and IgG antibodies were described as Recovering, producing both antibodies to defeat the infection while also producing the antibodies required

 

for future protection for COVID-19 infection. 51 patients tested positive for both IgM and IgG antibodies.

 

Patients who tested negative for IgM antibodies and positive for IgG antibodies were described as Past. Their immune systems had defeated the virus in the past and were no longer producing the IgM antibodies for actively fighting the virus, and were producing only IgG antibodies for providing protection from future infection. 64 patients tested positive for IgG only, including 13 patients who were 60 years of age and above.

 

The tests are FDA Title IV validated. Two tests were used, and are manufactured by Syntron Bioresearch (Tiajin Bay Bioresearch DBA Syntron) and Hangzhou All Test Biotech Company. Syntron has a Positive Percent Agreement (PPA) of 89.4%. This means that any particular test is 89.4% accurate for a positive test reading. Applying this to these results yields a potential false positive count of 61, meaning as many as 61 patients with tests that read positive for IgM and/or IgG antibodies actually did not have these antibodies. That places a lower bound on the positive number of 289 - 61 = 228 patients who tested positive for the antibodies and have been exposed to the virus. Out of a total population of 862, that means the lower bound on infection, either present or past, is 26%. This number is completely dependent on the accuracy of the tests reflected in the PPA data provided by the manufacturer. The PPA value is less that the provided Negative Percent Agreement (NPA), so the lower value of the PPA was used for calculating both the False Positive and False Negative values.

 

A False Negative value means a test that returns no indication of either IgM or IgG antibodies for a person who is infected with COVID-19. There were 573 patients that returned tests with no response for either antibody, and with an accuracy of 89.4%, that yields 72 patients who could have been infected with COVID-19 despite a clear test. This would lower the number of Vulnerable patients, but would increase the number of patients already exposed to the virus, increasing the value above 289 and raising the percentage that had already been exposed to COVID-19.

 

The age distribution reflects Dr Campbell's patient demographics. The test results are distributed across all age ranges with no hospitalizations in Dr Campbell's patient population, despite the severe symptoms in older patients reported in other populations.

 

 

Age Range

Vulnerable

Early

Recovering

Past

Totals

0-9

1

1

1

0

3

10-19

82

12

3

12

109

20-29

68

13

4

8

93

30-39

67

16

5

6

94

40-49

10

0

0

1

11

50-59

112

33

17

15

177

60-69

80

31

7

7

125

70-79

69

19

5

5

98

80-89

7

1

0

1

9

90-99

0

0

0

0

0

 

Dr. Campbell's population does not reflect the general population. It self-selected for testing, reflected in the number of Groups or families (491) that were tested. This population is cared for by a private physician and therefore receives higher quality care. They are more engaged in their own health than the general population, and have fewer untreated underlying conditions. This population also travels more extensively that the general population. There was travel in the tested population recorded in February and March to every continent except Antarctica.

This means these results can not be projected onto the general population, either in Bexar County or nationally. It does indicate a much higher percentage of the population in the 78209 ZIP code has been exposed to the virus than expected based on the most common models with limited severe cases.

 

Summary: Between 26% and 34% of Dr Campbell's patients have been exposed to the COVID- 19 virus, with no hospitalizations or ICU stays, even for patients in the High Risk category over 60 years of age.

 

[babysdaddy 2718]

 

I watched my wife get a covid test a few days ago and it was not that. Her eyes watered a bit but nothing like that

[babysdaddy 2718]

 

I watched my wife get a covid test a few days ago and it was not that. Her eyes watered a bit but nothing like that

[MNLonghornFUKM 8799]

 

Im scared of the test more than the covid

[MNLonghornFUKM 8799]

Thanks for the update hook it...even tho I’m still pissed you called me a dumbfuck, 30% of antibodies is huge.

[gmr548 16503]

Fighting a virus with a genetically designed virus.  

Definitely how we start an apocalypse movie.

[justhookit 4178]

 

4 minutes ago, MNLonghornFUKM said:

Thanks for the update hook it...even tho I’m still pissed you called me a dumbfuck, 30% of antibodies is huge.

Ha, no worries I think anyone not in Texas is a dumbfuck. I’m doing some other stuff right now so have only skimmed it, but I don’t think that was what it said. Regardless looks like pretty good news.

[ChiTownDoc 21098]

1 hour ago, Dr. Beeper said:

Ticketless Travel with SWA. Bitches better allow me to chew tobacco.  

There you go, old friend. 

[C-Man 27049]

1 hour ago, Dr. Beeper said:

Deadliest days don’t mean a great deal to me. Much more interested in new cases. 

Think it was the same story on the cases.

[C-Man 27049]

4 hours ago, bullzak said:

Still think this will be a game changer. I would think in general if this works it works across the spectrum of patients. 

Isn't the problem that ChiTownDoc brought up that it takes 20 plasma donations to treat one patient?

[ChiTownDoc 21098]

9 minutes ago, Dr. Beeper said:

At this point I am him. I am Rex Kramer, just as Surly has deemed South Austin’s mom to be one hell of a whore. Fuck it. I can’t wait to fly again and leave CovidSkoal droplets everywhere. 

LOL, I have no idea where the Dr. Beeper is Rex Kramer shit came from, but I had to break out one of Rex's all time stories when you set that up for me.  Apologies...

[TexasMan 10786]

 

[Kennythetiger 9334]

1 hour ago, Brisketexan said:

Well, we’re all due for some connection to a COVID death. An old friend’s father just died. Yeah, he was 81, but still. Not a close connection, and I sure hope that’s as close as it gets.

John Prine doesn’t count??  

[markstanco 12505]

I've been to China a dozen times. Saw on the news tonight that a car company called BYD is making masks for California at $5 a piece.

This company, byd, stands for Build Your Dream per my contractor in China. If you want an F150, they build it. Want a Cadillac? They build it. At a fraction of the cost. According to him his American made Cadillac cost nearly 250k. A real f150 or silverado costs around 150k.

Now, I don't know the numbers on vehicles and their associated costs in China but that is insane.

And somebody like the state of California dealing with a shady company like this is unprecedented.

[markstanco 12505]

I've been to China a dozen times. Saw on the news tonight that a car company called BYD is making masks for California at $5 a piece.

This company, byd, stands for Build Your Dream per my contractor in China. If you want an F150, they build it. Want a Cadillac? They build it. At a fraction of the cost. According to him his American made Cadillac cost nearly 250k. A real f150 or silverado costs around 150k.

Now, I don't know the numbers on vehicles and their associated costs in China but that is insane.

And somebody like the state of California dealing with a shady company like this is unprecedented.

[ChiTownDoc 21098]

9 minutes ago, C-Man said:

Isn't the problem that ChiTownDoc brought up that it takes 20 plasma donations to treat one patient?

Yes, that's what I was quoted.  And I have to assume that must be the issue or we would be seeing  a lot more of that type of treatment. 

Also I haven't given as many updates...I don't think it's healthy for me to eat/breath C19 talk 24/7...here's a quick note: 

I love the back and forth here.  Hell, I am mentally on the same team as those that are just yelling to be let loose.  But all the shit I'm seeing points to a long slog through the rest of 2020.  Hell, even if we open everything up, tons of people are going to stay home.  25-50% for restaurants doesn't allow for sustainability.  I wish I didn't have this fucking debbie downer mood, I really do.  

I also know IL had it's peak about 10 days ago and have heard that from several hospitals.  Here's the latest per Becker's:  https://www.beckershospitalreview.com/patient-flow/updated-covid-19-peak-dates-state-by-state.html?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_source=BHRE&utm_medium=email&oly_enc_id=7221B9683990F9B

Yet my dipshit governor is saying midMay.  I really hope this mess doesn't get more political than it already is.  

Best news I've heard in the past week or two?  The race for a vaccine - working in monkeys is actually fantastic news.  To me Remdesivir is needed and I'm happy it's helping but it's going to be used as an IV infusion for those needing hospitalization...even without Remdesivir we are doing a much better job getting patients better and keeping them off vents.  This med won't help us open up the economy and that's what I keep looking at.  Not to sound like a dick saying that...of course I care about those passing etc.  I don't feel the need to give those sob stories in this forum. 

[Pato del Muerto 52342]

Thought there was a camping thread but didn’t find it. Anyway, there will be no overnight camping at Wyoming state parks for out of state licensed vehicles this summer. 
will make for crowded BLM and National Forest spots if they allow it. 
 

in case anyone needed that information. 

[utee94 15745]

2 minutes ago, Pato del Muerto said:

Thought there was a camping thread but didn’t find it. Anyway, there will be no overnight camping at Wyoming state parks for out of state licensed vehicles this summer. 
will make for crowded BLM and National Forest spots if they allow it. 
 

in case anyone needed that information. 

 

[woohorn 1131]

I watched my wife get a covid test a few days ago and it was not that. Her eyes watered a bit but nothing like that

But she doesn't have any gag reflex if menory serves.

[woohorn 1131]

I watched my wife get a covid test a few days ago and it was not that. Her eyes watered a bit but nothing like that

But she doesn't have any gag reflex if menory serves.

[Eskimohorn 5613]

So we lock down the world for a year?  Twp years?  Three years?  How long?  How many trillions lost?  Business destroyed?  What is the end game?  Today, right now - there are no known vaccines for ANY corona virus.  A decade ago SARS rolled through. Still not vaccine.  The initial SIP was espoused as a flattening of the curve.  It's so flat now it's just a line.  Then it morphed into transmission, then vaccines, and it keeps dancing along.
Funny how when comparing demographics from either the right or the left with Sweden it suits their argument.  For those in favor of a greatly expanded welfare state, demographics are not mentioned, but when discussing COVID, it's a part of the discussion.  

How are we in any way like Sweden in health, culture, geography or demographics?

Achieving herd immunity status means minimum 70% infection rate? Do we agree?

Have to repeat myself because you want to discuss the same thing over and over again. Admitting you want to get 70% infected as quickly as possible doesn’t sound like a convincing strategy in the United States.

[atomheartbevo 89416]

https://www.cnn.com/2020/04/29/us/bodies-trucks-brooklyn-funeral-home/index.html

Quote

Four trucks containing as many as 60 bodies have been discovered outside a Brooklyn funeral home after someone reported fluids dripping from the trucks, a law enforcement official told CNN.

The Andrew Cleckley Funeral Home home was overwhelmed and ran out of room for bodies, which were awaiting cremation, and used the trucks for storage, a second law enforcement source said Wednesday.

At least one of the trucks was unrefrigerated, according to one law enforcement official. One source said the bodies were put on ice.

CNN reached out to the Andrew Cleckley Funeral Home, and someone who identified himself as the owner would not comment.

"They were like almost everyone doing their best to cope," one source said.

That's some movie-level stuff right there.

[atomheartbevo 89416]

San Antonio Zoo reopening for a drive-through experience, to help cover costs of animal care and employees

https://www.mysanantonio.com/news/local/article/San-Antonio-Zoo-will-reopen-for-one-of-a-kind-15234576.php

Quote

The San Antonio Zoo is still waiting for the green light to reopen after being closed due to the coronavirus pandemic, but in the meantime a new drive-thru alternative to see the animals will be launched this weekend.

Tim Morrow, the zoo's CEO, shared preliminary information on social media Wednesday afternoon. He called the new offer a "one-of-kind experience" which allows families to visit the zoo "from the comfort, safety and security of their own vehicle."

A video paired with the announcement shows a car driving through the wide pathways of the zoo where visitors usually walk.

Quote

The drive-thru tour will include a guided educational audio tour and curbside food and beverage options, the zoo said online.

Drive-thru zoo will be available May 1-3, from 10 a.m. to 5 p.m. Guests are encouraged to buy their admission — priced at $40 per car for non-pass holders and $30 for members — online. Annual pass holders and members will need to buy their admission on site.

There are some vehicle size limitations in place to ensure cars can journey through the zoo safely. The zoo says cars as big as the approximate size of a Chevy Tahoe should fit. Exact specifications are 198 inches long, 78 inches wide and 76 inches high.

It sold out, so they are going to extend it a few weeks into May.

[atomheartbevo 89416]

https://www.tampabay.com/news/health/2020/04/29/florida-medical-examiners-were-releasing-coronavirus-death-data-the-state-made-them-stop/

Quote

State officials have stopped releasing the list of coronavirus deaths being compiled by Florida’s medical examiners, which has at times shown a higher death toll than the state’s published count.

The list had previously been released in real time by the state Medical Examiners Commission. But earlier this month, after the Tampa Bay Times reported that the medical examiners’ death count was 10 percent higher than the figure released by the Florida Department of Health, state officials said the list needed to be reviewed and possibly redacted.

They’ve now been withholding it for nine days, without providing any of the information or specifying what they plan to remove.

Spoiler

Quote

Dr. Stephen Nelson, the chairman of the state Medical Examiners Commission, said the change in policy came after the state health department intervened.

The medical examiners’ list does not include names. But it provides demographic information, probable cause of death and case summaries with information about each person’s medical and travel history.

Nelson — who is also the medical examiner for Polk, Highlands and Hardee counties — said state officials told him they plan to remove causes of death and case descriptions. Without that information, the list is meaningless, he said.

Nelson said he believes the entirety of the list is public information — a stance supported by Florida public records experts.

“This is no different than any other public record we deal with,” Nelson said. “It’s paid for by taxpayer dollars and the taxpayers have a right to know.”

The health department acknowledged that it “participated in conference calls” with the Florida Department of Law Enforcement, which provides administrative support to the Medical Examiners Commission. The topic was “privacy concerns for the individuals that passed away related to COVID-19,” health department spokesman Alberto Moscoso said.

Moscoso said the health department didn’t provide a formal legal opinion.

The agency has attempted at least once to block information about deaths from COVID-19, the disease caused by the novel coronavirus, from becoming public.

 

Quote

Last month, it tried to persuade the medical examiner’s office in Miami-Dade County to restrict access to its death records, according to the Miami Herald and correspondence between the two agencies obtained by the Times.

 

Edited April 30, 2020 by atomheartbevo

[atomheartbevo 89416]

One positive thing.

https://www.kxan.com/news/coronavirus/gov-abbott-alcohol-to-go-could-stay-forever/

Quote

Texans taking advantage of the availability of alcohol for pickup and delivery may be able to do that indefinitely.

The Texas Alcoholic Beverage Commission indicated on its website that to-go sales may continue after restaurants are allowed to reopen in a limited capacity on Friday.

Fuck yeah Texas!

 

[Dennis Taylor 18706]

 

17 minutes ago, atomheartbevo said:

https://www.cnn.com/2020/04/29/us/bodies-trucks-brooklyn-funeral-home/index.html

That's some movie-level stuff right there.

From CNN? You don't say...

Edited April 30, 2020 by Dennis Taylor

[Pato del Muerto 52342]

Nm server borkage

Edited April 30, 2020 by Pato del Muerto

[AngryDragon 270]

..

Edited April 30, 2020 by AngryDragon
wrong forum

[Bevo 13526]

8 hours ago, Dahobbs said:

Not having a bad outbreak at the present time is a bad criteria to reopen. You want to have an ability, or at least the semblance of a plan, to avoid a bad outbreak once you reopen. Italy jumped from 50 (what Texas reported today according to worldometer) deaths a day to 800 in 2 weeks. There are enough cases here that it can quickly spiral out of control if we let it. 

Time for me to borrow a hundred grand from a fat-ass loan shark and spend it all on a stripper named Molly Mounds.

[Royalfan5 2348]

For your AM livestock report, fresh beef prices slowed their rise but are still moving higher with focus on reports that fast food is trying to secure as much grinding meat as possible, fresh pork is just about to $100 with freezer stocks getting drawn down more by non-traditional buyers. Doesn't seem like a lot of movement on the plant front but I've got guys able to ship steers for the first time in a month to Dodge City so hopefully that's a good sign. 

[atomheartbevo 89416]

11 hours ago, Dennis Taylor said:

From CNN? You don't say...

If you don’t like that, here are a few others

https://www.foxnews.com/us/dozens-of-bodies-found-u-haul-trucks-outside-nyc-funeral-home

https://www.nytimes.com/2020/04/29/nyregion/bodies-brooklyn-funeral-home-coronavirus.html

 

[Foosters 17730]

11 hours ago, Dennis Taylor said:

 

From CNN? You don't say...

You're saying it didn't happen or that finding 60 bodies decomposing in a truck isn't news?

[bigup2dahorns 3343]

[bigup2dahorns 3343]

Can Surly servers get an antibody test?

[bullzak 411]

The decomposing bodies thing is ghastly for a first world country. Shit. 

[BabaYaga 15210]

Hey SURLY.  Fix your damn servers!  Jesus Christ, had to pay attention in a ZOOM meeting earlier.  What the actual fuck.....

[Bevo 13526]

15 minutes ago, bigup2dahorns said:

Can Surly servers get an antibody test?

 

[BabaYaga 15210]

Scary stat I heard from an interview with a CA Sheriff (forget the area) - used to deal with a suicide a week +/-......now they are estimating close to 5/day.  That's bananas.  Now multiple that across the country.  

[NeverMarryAStripper 21781]

8 hours ago, Bevo said:

Time for me to borrow a hundred grand from a fat-ass loan shark and spend it all on a stripper named Molly Mounds.

Say hi to my ex for me

Edited April 30, 2020 by NeverMarryAStripper

[InkaUtexas 25506]

44 minutes ago, bigup2dahorns said:

 

With their fans leaving in the 3rd quarter the risk will be reduced right? 

[Royalfan5 2348]

So the packers showed some improvement today, cattle hit 80K for the first time this week, up 10% from yesterday, hogs are up about 22K from yesterday, about 10% better as well. Getting back towards 2/3rd of normal run rates. Still leaves a big hole but if we improve into the weekend the worst may be past there, still probably be hit and miss on certain cuts through to mid to late May. 

[justhookit 4178]

15 hours ago, justhookit said:

Received the email from my mom’s San Antonio doctor today regarding his testing numbers (if you haven’t read my previous posts he is antibody testing ALL of his patients). Spoilered because it’s extremely longcat but it’s really interesting. Sitting down to a late meal now but I’ll read through it more thoroughly later.

  Reveal hidden contents

Dear Patients,

 

What a difference a week makes. In spite of Covid-19, it was nice to see so many of you this past week. I am honored to serve each of you, and it's a privilege to be your doctor. Last week my office administered antibody tests to over 900 people.This letter is to explain the different immune responses to Covid-19, recap the results of our office's testing results, and explain in more detail why I am a firm believer in antibody testing.

 

 

The immune system acts the same way in 98 percent of the population. When you are exposed to a virus, your body immediately starts to make antibodies. The body makes two antibodies in response to every viral or bacterial infection: IgM and IgG.The same process occurs each time your body experiences an infection.

 

 

The IgM antibody is the first antibody produced by the body and its production peaks at 7 days. After 14 days the production of IgM has stopped and its presence in your bloodstream is diminished. In most people, IgM antibodies are undetectable 30 to 45 days following exposure to a virus.

 

 

Approximately 14 days following exposure to a virus, the body begins to produce the IgG antibody. Production of IgG continues to increase and hits a peak at roughly 30 days after viral exposure.  IgG is the antibody that is with you forever.  If your body were to encounter the same virus, IgG is the antibody that is rushed into production upon re-exposure.  It is your body's targeted, virus-specific immune response to an infection.  The IgG antibody is the golden ticket, as I said to many of you.  It is not a perfect immunity, but it is a more rapid and robust response from your immune system if you are subsequently exposed to Covid-19.

 

 

For those who tested IgM positive, your result indicates that at some point in the last 5-10 days you were exposed to the Covid-19 virus.  Your body has identified the virus and has started to make antibodies to it.  The CDC currently recommends that anyone who is exposed should self-quarantine for 14 days.  Given what we know about the timeline for the body to begin producing IgM antibodies, my recommendation to those patients is self-quarantine for 10 days.  That is in keeping with the CDC guidelines. For patients who tested IgM positive, please continue checking in regularly so we can provide the best care possible.

 

 

For those who tested IgM positive and IgG positive, your result indicates that you are further along in your body's immune response to the disease.  Your exposure was at least 14-30 days ago.  Enough time has passed that your body is able to start producing IgG, but within a timeframe that IgM antibodies are still detectable in the blood.  My recommendation to these patients is to self-quarantine for 5 more days, in an abundance of caution, to prevent the spread of the disease.

 

 

For those who were simply IgG positive, your result indicates that you were most likely exposed to Covid-19 30-45 days ago.  You are no longer symptomatic or contagious.  You have had the disease and have developed a degree of immunity to it.  If you were to be re-infected by Covid-19, your immune system will be ready to fight it.

 

 

Approximately 70% of the patients who tested positive for the IgG antibody had experienced moderate symptoms of this disease in the previous 30-45 days. About 30% of the IgG positive patients did not report any notable symptoms, or indicated conditions so mild one couldn't guess at the virus being present.  The mild symptoms included a moderate headache and fatigue.

 

 

PCR (the nasal swab test) is the standard of care used by the CDC and WHO to determine whether a person is Covid-19 positive or negative. It takes 3-5 days to get the results from a PCR test.  I have been testing people for the last 6 weeks and have formed some impressions about PCR testing.  As to its accuracy, I have had 5 patients for whom I made a clinical diagnosis of Covid-19, though they tested negative by PCR.  These patients presented with every classic symptom: high fever, cough, shortness of breath, severe fatigue, and body aches.  After making my clinical assessment, I treated those patients with hydroxychloroquine. Upon performing an antibody test on those 5 PCR-negative patients, all were IgM and IgG positive, indicating exposure to the virus and a developing immune response.  12 other patients who tested PCR-positive were also IgM and IgG positive.  100% of my patients who were seriously sick with Covid-19 have tested positive for antibodies.

 

 

Based on my observations, studies I have read, and clinical knowledge, I believe that there is a false-negative in PCR testing in roughly 1 out of every 5 cases.  That error ratio is present even when the patient is severely sick and the virus is everywhere in their body.  When the patient is only mildly sick or not displaying any symptoms of illness, the amount of virus present in their nose is so low, it is unlikely to get a positive PCR result.  I tested roughly 20% of my asymptomatic patients who were IgM positive.  As of this morning, 90% of them were PCR negative, meaning no virus could be found by nasal swab.  Some might conclude that means the antibody test is wrong; I wholeheartedly disagree.  I believe that the patient is not sick enough to produce the virus everywhere in the body, and the nasal swab simply isn't collecting mucous that is infectious.  There is some merit to the thinking that the patient isn't contagious in that scenario.  If the Covid-19 virus is not present in your nasal cavity or oral cavity, then you are not discharging it everywhere.  Given how many unknowns there are with this disease, I have opted to urge caution and have asked that everyone who is IgM positive stay quarantined for 10 days- even if you are asymptomatic.

 

 

After working with the antibody test for the past 10 days, and in light of research studies done by Stanford University, and in New York, and Los Angeles, I believe it to be 85% reliable.  I am attaching links to four articles in this email which I have found informative.  Please read them.  Given our current constraints, a perfect test is not possible.  We have to work with what we have been given.  Using the antibody test, I found clusters of positive results in the same family, in keeping with expectations for a contagious virus.  For example, if a mother has the illness, one or two other people in the household likely have it or have had it.  One positive test is significant, but in a family cluster an additional positive test validates the first test, and a third positive test increases the validity of the other two tests.  Covid-19 follows a contact, respiratory droplet, secretory disease process so one would expect it to spread within a household.

 

 

So, where do we go from here?  I am in the process of procuring more tests, which will allow me to retest all of the IgM positive patients in 2 weeks.  It is my hope that the vast majority of those will have converted to IgG.  The best news from testing last week is that roughly 7% of those tested were IgG positive, meaning they had been exposed to Covid-19, and had done very well.  That is a higher percentage than we would have expected to see.  Those who are IgG positive can go back to work without fear of exposing other people to Covid-19.  I retested by PCR (nasal swab) many of the IgG patient population, and all PCR tests were negative, meaning no virus was found in the nasal cavity. This patient population also has the ability to fight this virus if they are re-infected.

 

 

Additionally, I found that roughly 15% of the patients tested have the IgM antibody, indicating a current infection.  The majority of the IgM positive population were experiencing mild to no symptoms (roughly 85%). The most common mild disease symptoms were headache and fatigue, with some body aches.

 

 

Notably, many more people in our community have had exposure to this disease than we anticipated and are still doing great.  My results fall in line with the studies conducted at Stanford, USC and New York.  However, the antibody tests I administered last week were not random subjects.  We tested a small, focused geographic area, and we were looking at family clusters of viral contagion and therefore, our percentages of co-infection were higher.

 

 

Even with that distinction, the denominator in our equation is drastically changed, bringing the mortality ratio closer to what we see with flu.  The fact has not changed that Covid-19 has killed 59,000 people in less than 7 weeks in the US. But it does mean that a lot more people have had this disease and survived.  As of April 29, 2020, the mortality rate in the US was 5.6%.  This number is reached by taking the entire known infected population (1,038,000) and dividing by the total number of known deaths (59,000).

 

 

The mortality rate will drastically drop as the known infected population increases. If we were to use the results of last week's testing, and included the 10% of the population that has undetected IgM antibodies in the known infected number (the denominator), the mortality ratio drops to 0.18%.

 

 

Data makes it possible for us to move forward as a country.  We absolutely flattened the curve by quarantining and self-isolating, and as a result we did not overwhelm the hospital system as has happened in New York.  Covid-19 is a moving target and my views are evolving and changing every day.  I don't get it right all the time and I will make mistakes, but I am attempting to present the most current and correct data to my patients.  I am daily seeking to understand this virus and provide my patients the best care possible.  Please continue hand washing, physical distancing, in addition to wearing your masks to prevent the spread of this novel virus. I have attached a summary of the results from the Antibody testing conducted last week.

 

 

I am so proud of my staff.  They all worked tirelessly and conscientiously last week. Between April 17-24 we tested just shy of 900 patients and their loved ones and friends.  I have never seen such dedication and hard work.  I also have to thank Meredith for her constant support and making her guest appearance.  I couldn't do what we did without them. 

 

 

Stay healthy and safe,

 

 

Dr. Scott Campbell

Dr. Alan Merin

Kimberly Laswell

 

 

https://www.nytimes.com/2020/04/24/health/coronavirus-antibody-tests.html

 

 

https://www.sciencemag.org/news/2020/04/antibody-surveys-suggesting-vast-undercount-coronavirus-infections-may-be-unreliable

 

 

https://thehill.com/changing-america/resilience/smart-cities/493859-antibody-study-suggests-more-people-in-la-county?amp

 

 

https://www.dropbox.com/s/cd1628cau09288a/SARS-CoV-2_Serology_Manuscript.pdf?dl=0

 

Dr. Campbell tested 862 patients over the course of 4 days, recording the results for both IgM and IgG antibody tests.

 

 

The COVID-19 virus is a novel corona virus, meaning it is new to humans and therefore there is no existing immunity. The disease stages reflected by the results of the antibody test can be visualized in this highly simplified sketch:

 

 

Summary of recorded results:

	#	Percentages
Total Patients	862
Total Groups	491
Avg Group Size	2
Vulnerable (IgM & IgG Negative)	573	66.47%
Early (IgM Positive)	174	20.19%
Recovering (IgM & IgG Positive)	51	5.92%
Past (IgM Negative & IgG Positive)	64	7.42%

 

Patients counted as Vulnerable in this table tested negative for both the COVID-19 IgM and IgG antibodies. There were 573 patients for who tested negative for both the IgM and IgG antibodies, so they were described as Vulnerable to new infection.

 

Patients who tested positive for IgM were described as Early, reflecting that their bodies were producing IgM antibodies to fight the infection, but had not yet begun producing the IgG antibodies for future protection from infection. 174 patients tested positive for IgM and negative for IgG.

 

Patients who tested positive for both IgM and IgG antibodies were described as Recovering, producing both antibodies to defeat the infection while also producing the antibodies required

 

for future protection for COVID-19 infection. 51 patients tested positive for both IgM and IgG antibodies.

 

Patients who tested negative for IgM antibodies and positive for IgG antibodies were described as Past. Their immune systems had defeated the virus in the past and were no longer producing the IgM antibodies for actively fighting the virus, and were producing only IgG antibodies for providing protection from future infection. 64 patients tested positive for IgG only, including 13 patients who were 60 years of age and above.

 

The tests are FDA Title IV validated. Two tests were used, and are manufactured by Syntron Bioresearch (Tiajin Bay Bioresearch DBA Syntron) and Hangzhou All Test Biotech Company. Syntron has a Positive Percent Agreement (PPA) of 89.4%. This means that any particular test is 89.4% accurate for a positive test reading. Applying this to these results yields a potential false positive count of 61, meaning as many as 61 patients with tests that read positive for IgM and/or IgG antibodies actually did not have these antibodies. That places a lower bound on the positive number of 289 - 61 = 228 patients who tested positive for the antibodies and have been exposed to the virus. Out of a total population of 862, that means the lower bound on infection, either present or past, is 26%. This number is completely dependent on the accuracy of the tests reflected in the PPA data provided by the manufacturer. The PPA value is less that the provided Negative Percent Agreement (NPA), so the lower value of the PPA was used for calculating both the False Positive and False Negative values.

 

A False Negative value means a test that returns no indication of either IgM or IgG antibodies for a person who is infected with COVID-19. There were 573 patients that returned tests with no response for either antibody, and with an accuracy of 89.4%, that yields 72 patients who could have been infected with COVID-19 despite a clear test. This would lower the number of Vulnerable patients, but would increase the number of patients already exposed to the virus, increasing the value above 289 and raising the percentage that had already been exposed to COVID-19.

 

The age distribution reflects Dr Campbell's patient demographics. The test results are distributed across all age ranges with no hospitalizations in Dr Campbell's patient population, despite the severe symptoms in older patients reported in other populations.

 

 

Age Range	Vulnerable	Early	Recovering	Past	Totals
0-9	1	1	1	0	3
10-19	82	12	3	12	109
20-29	68	13	4	8	93
30-39	67	16	5	6	94
40-49	10	0	0	1	11
50-59	112	33	17	15	177
60-69	80	31	7	7	125
70-79	69	19	5	5	98
80-89	7	1	0	1	9
90-99	0	0	0	0	0

 

Dr. Campbell's population does not reflect the general population. It self-selected for testing, reflected in the number of Groups or families (491) that were tested. This population is cared for by a private physician and therefore receives higher quality care. They are more engaged in their own health than the general population, and have fewer untreated underlying conditions. This population also travels more extensively that the general population. There was travel in the tested population recorded in February and March to every continent except Antarctica.

This means these results can not be projected onto the general population, either in Bexar County or nationally. It does indicate a much higher percentage of the population in the 78209 ZIP code has been exposed to the virus than expected based on the most common models with limited severe cases.

 

Summary: Between 26% and 34% of Dr Campbell's patients have been exposed to the COVID- 19 virus, with no hospitalizations or ICU stays, even for patients in the High Risk category over 60 years of age.

 

Ok, pulled some of the more interesting lines out for those that don’t want to read the whole thing. He has tested almost 900 patients so far.

“Summary: Between 26% and 34% of Dr Campbell's patients have been exposed to the COVID- 19 virus, with no hospitalizations or ICU stays, even for patients in the High Risk category over 60 years of age.”

“Approximately 70% of the patients who tested positive for the IgG antibody had experienced moderate symptoms of this disease in the previous 30-45 days. About 30% of the IgG positive patients did not report any notable symptoms, or indicated conditions so mild one couldn't guess at the virus being present.  The mild symptoms included a moderate headache and fatigue.”

“Based on my observations, studies I have read, and clinical knowledge, I believe that there is a false-negative in PCR testing in roughly 1 out of every 5 cases.  That error ratio is present even when the patient is severely sick and the virus is everywhere in their body.  When the patient is only mildly sick or not displaying any symptoms of illness, the amount of virus present in their nose is so low, it is unlikely to get a positive PCR result.  I tested roughly 20% of my asymptomatic patients who were IgM positive.  As of this morning, 90% of them were PCR negative, meaning no virus could be found by nasal swab.  Some might conclude that means the antibody test is wrong; I wholeheartedly disagree.  I believe that the patient is not sick enough to produce the virus everywhere in the body, and the nasal swab simply isn't collecting mucous that is infectious.  There is some merit to the thinking that the patient isn't contagious in that scenario.”

edit- well lost some other quotes and some thoughts because of website borkage. Fuck it I’m going to the beach. Hopefully later when surly is running right @Newdoc and @ChiTownDoc might have some insights. 

 

Edited April 30, 2020 by justhookit

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Universities starting to announce their plans to be open with students on-campus in the Fall:

Texas A&M, Texas Tech:

https://www.dallasnews.com/news/public-health/2020/04/30/texas-am-texas-tech-universities-plan-to-reopen-campuses-in-the-fall/

Baylor:

https://www.kxxv.com/hometown/mclennan-county/baylor-university-announces-plans-for-fall-semester-return-to-campus-for-faculty-and-staff