Coronavirus Pandemic Update 54: COVID-19 Antibody vs. PCR Testing; When to Relax Social Distancing?

Production of COVID-19 antibody test kits are ramping up - there are over 70 companies producing them. Antibody tests could be one of the keys to eventually easing social distancing restrictions and allowing schools and businesses to re-open. Unfortunately, only one antibody test is FDA approved at this time, and the approval of each company will take some time. Dr. Seheult illustrates how antibody tests and PCR-RT tests for COVID-19 work on the cellular level, and he discusses potential coronavirus vaccine challenges.

Links referenced in this video:

Speaker: Roger Seheult, MD
Board Certified in Internal Medicine, Pulmonary Disease, Critical Care, and Sleep Medicine.

MedCram medical videos are for medical education and exam preparation, and NOT intended to replace recommendations from your doctor.
#COVID19 #SARSCoV2 #Coronavirus

[Medcram]

At our website, you can view all of our videos and CLEAR explanations of over 60 medical topics. We also offer CME/CEUs for medical professionals, medical programs, hospitals, and institutions.
All links referenced in this video are in the video description. Quick links to our previous updates on the coronavirus pandemic:

[edoray]

I'd much rather watch one of these than all the network news combined. I've been watching since Pandemic Update #1 and wouldn't miss one. I've watched #35 7 times now, following all the links. I just wish the people that we've put in charge would take the time to watch them also. Clear & concise, as it should be. Thank you so much for what you're doing.

[floobertuber]

I recently retired from a 30-year career in computer science, networking, and software development. But if I had seen videos like this back in the late '80s when I was an undergrad, there's a damn good chance I would have abandoned that entirely, and switched to a Medical educational track. FASCINATING, USEFUL, AND FANTASTIC MATERIAL, ROGER! KEEP UP THE GOOD WORK! I have zero doubt you're influencing numerous young people to pursue a Med/STEM career.

[saritananda]

Everyone should start watching this channel instead of the lame news channels that give nothing but fear and anxiety. This channel is so comforting in the gloomy days

[matthewblanchard]

I just want to say how much I appreciate the hard work you do to disseminate this knowledge to us. You have a very pleasant voice and a keen sense of articulation both verbally and thought process-wise. Thank you Dr. Seheult!

[stevenveltrie]

You give out more info in 17-20 minutes that the networks do in a week.Keep it up.

[vincef]

When a woman helps you catch 200 pill-bugs, you just KNOW she's a keeper!

[wherecar]

These are excellent. They also help with the unknowns in turn helps people cope with education and knowledge, thus leads to less anxiety.

[jeeyunsohn]

I have been watching the Korean news and they are seeing numbers of patient that have been treated already for the virus and are coming back to hospital with symptoms and testing positive again. some are speculating that it might be "reactivation" rather than reinfection. This worries me as the people that have recovered from the virus may be out in the public and can act as asymptomatic carriers again.

[scientia_potentia_est]

Thanks so much Dr. Seheult for these daily updates! As a scientist (immunologist, PhD student) is nice to hear proper scientific explanations behind the latest updates and discussing the latest clinical evidence, calmly and rationally! Just some thoughts: it would have been nice to clarify the difference (and mathematical definition) between diagnostic test sensitivity (probability of true positive detection; the higher the percent sensitivity the lower the number of false negatives) and specificity (probability of true negatives detection; the higher the percentage specificity the lower the number of false positives).
It's important to make the distinction, since, for example, a lot of the serological tests out there have ~90-93% sensitivity (a bit worse than nucleic acid testing but not far) but near 100% specificity. This means that these tests, even though only ~90-03% efficient at detecting true positive antibodies in those previously exposed and recovered from CoVID-19, are still very good at detecting true negatives (many are near 100%): Worse case scenario, even if the test comes out with a false negative (and the person has developed immunity due to previous exposure), and that person can't return to normal life (i.e. intensivist returning to the ICU), no biggie, that will only happen ~93% of the time. However, at least there's a very low chance that a person will test false positive (i.e. test falsely indicates immunity against the virus when in fact the person has not developed antibodies against SARS-CoV2) and goes out to be exposed due to erroneous testing results.


Also, while it's true that as of 4/14/20 there are no at-home test kits available, there's quick progress being made. Scanwell Health (develop at-home test kits for UTIs, pregnancy test kits, etc.) and Lemonaid (telehealth company) are the closest companies to getting FDA's EUA for an at-home test kit. The kit was used in China (not as at-home but administered in clinics) around Wuhan in the hardest-hit regions where there were severe nucleic acid test kit shortages.
Here are the sources:


Interestingly, North Carolina's state legislature approved a $100, 000 study at Wake Forest Baptist Health for 1, 000 at-home test kits from Scanwell to monitor a group of selected study subjects each month (NC senator hopeful the data can be used to determine quarantine measures in the state).

Also, BD & Biomedomics have gotten approval for a point-of-care 30-min capillary or venous blood serological tets kit in the USA that's already currently in use along with a few others (this one seems to be the most compact and quickest test kit that I've seen in use so far)


So, it seems that there's more serious thought and effort (at the federal level from biotech companies capital investment) being put towards serological testing. Hopefully the data will at least allow epidemiologists and immunologist/microbiologist researchers have a better understanding of the prevalence of the disease after all the data comes through by the end of this whole pandemic. Although, I honestly remain somewhat skeptic about the reliability of the data from serological testing in informing authorities about quarantine measures.

[ghostcityshelton]

Once again thank you for all that you do for us and for saving lives.
💖Stay safe💖

[alfascorpi]

Thank you Dr. Seheult! You can explain these processes so clearly, it is easy to follow, luckily I have a masters degree in biology so I understand a lot, but nevertheless thumbs up for clarity!

[jeffreyhortman]

Thanks Dr. Long for the day where you don't have to do this anymore. Your very appreciated.

[pamelaherrington]

November 2, 2019 I became suddenly ill and was hospitalized with sepsis. My blood pressure was 40/20, I was dizzy on standing and out of breath with two steps. For 3-4 weeks prior to this I had been running a low grade fever off and on and was feeling run down. I eat nutritiously and was was walking 2-7 miles almost daily until then.

I called for an ambulance about 10 p.m. that Saturday night. The prior Wednesday evening through Saturday morning I was having periodic muscle spasms in my back and had thought it was related to having broke my back a year previously. When I awoke Saturday morning my urinating was unusual and it was only symptom. I felt like I had a full bladder but wasn't having much output and thought maybe a kidney stone though I'd never had one and I've had two kidney infections in my 65 years and had none of the symptoms of one... only symptom was the odd urine output. By Saturday night...12 hours after awakening with this symptom I knew I couldn't put off medical help. When I arrived at the ER I was on the verge of a heart attack and my organs were shutting down. I wasn't frightened, but the ER staff was... I only requested giving me oxygen. I was in the ER with 3-5 staff members for the next 5-6 hours being worked on before going to ICU while they administered an IV medication to keep me from having an heart attack... then I was moved to a private room.

I was in the hospital for a week then did 10 days of outpatient IV antibiotic treatment.

The course of this illness I had behaved with every characteristic of this covid-19 virus. I gained a heart doctor, blood doctor, and kidney doctor, along with numerous doctor appointments and lab tests for 3-4 months.

I've never been that sick in my life and the doctors were incredulous how quickly it came on me and no symptoms other than what I mentioned above. I live in Terre Haute, Indiana and I only socialize with one friend, who one week after I came down with my illness, was hospitalized for over a week with breathing problems.

If I had the virus as early as November there are few places that could have been the source... I'm suspecting it was the Cambodian restaurant I dined at. They're menu choices include things like intestines and tripe and other exotic/foreign critters. The only other places I'd been were grocery shopping and Menards and discount stores and I only do this shopping twice a month. I usually use public transportation, but very infrequently.

My question is: If what I had was the virus would it be in any of the many blood samples I gave over the course of months getting my blood levels back to normal? Because my hemoglobin was so low the kidney doctor kept questioning me about irregular bleeding and I didn't experience that. I did a chemical stress test on my heart and they found no damage. It took a few months for my blood levels to come back to normal and was prescribed potassium and iron along with Corey and Lisinopril and 81mg aspirin. I had developed slightly high blood pressure about a year previous to this illness and am told I have emphazema, but don't really experience any breathing difficulties or mucus in my lungs. I do have sinus allergy problems with a lot of sinus drainage which only clears up by going to California... don't know why.... think it's pollens.

I would like to be put in touch with someone that is working on the study of this virus because if I and my friend had it in November in the U.S. it might benefit the study. My friend and I live in the same town but we went to different hospitals and received different treatments. My recovery was was miraculous and I can only attribute it to the excellent medical care I received upon arrival at the ER. They were surprised I didn't need to go on a ventilator and I didn't need a platelet transfusion. Any help you can provide me so I might be helpful while this experience is still fresh in my mind would be appreciated.

[xino_z]

I found this episode VERY encouraging. Hope you and your pillbug partner had a nice holiday.

[mariocosta]

Which drawing tool does the good doctor use?

[proverbsthirty-one]

Very interesting. Thank you for simplifying. Loved the rolly polly project example.

[jonathanweiner]

I Heard Mitchel Katz MD today on Jama Network. Today, there are 951 patients in the hospitals he manages in NY who are on ventilators, and 3000 more in the hospitals with covid. I was an intern in SF in 1987 and took care of the patients with AIDS/HIV. It was traumatic and a tragedy that I am now having intrusive memories of. The toll of this virus to patients and health care workers is immense. I feel so bad for those hospital workers in NY. Unless you have lived through it you can not imagine what it is like. I teared up again at the end of Dr. Katz's interview. Dr. J Weiner

[cindyjohnson]

Thank you again Dr Seheult for another very informative pod cast. I was able to watch your special last night, after the fact, and was very impressed. It seems that you and your team are more on top of the situation than Dr Fauci and Dr Birx.

I have a question, have you seen any research on the use of the Moringa plant? The plant contains all the essentials to treat CV 19 including Zinc and Qucerin. In the Philippines the Minister of Health is advising all residents the eat the plant daily.
Also, there is a major problem brewing in health care right now, causing a great divide in regards to the use of hydroxychloroquine. I'm a PharmD and belong to many Facebook groups discussing this drug. There is a huge amount of pharmacists who are so anti-President Trump (and anti-republican) and him suggesting that this is a good drug to use, they are adamant not to dispense this drug. The arguments are very heated. These pharmacists are insisting we must wait for proper clinical testing before they will dispense these medications. Since we are in a pandemic, and as your podcast pointed out, there is no time for proper double blind, placebo controlled trials.

They insist we must wait for a vaccine, that it's the only way to be safe. I am floored at a callous lack of empathy for our suffering patients over the hate of one man, when people are dying. This needs to be brought to the attention of the medical association. They are walking a fine line on their right of not dispensing based on some moral grounds.

This is not a time to continue this hatred and divide. This is a time to work and bring this country back together again. Your podcasts bring sanity back from the insane. Thank you very much!

[LemansSunset]

I’m glad your subscriber count is going up. You deserve it! Thank you for all you do!