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The Corona Files: What’s the story about Covid-19 testing?

Written by Joerg Steegmueller
The Corona Files: What’s the story about Covid-19 testing?

My Corona update last week was read by well over 10,000 people and the last “Dublin Event Guide (for Free Events)” with some Covid-19 related information was seen by over 120,000 people. :-O

So I got a good few questions since then and a recurring question is about testing. Many people want to know: What is available and how does it work? So this post focuses on the mechanics of the Virus test that detects Covid-19 while you have symptoms and it also gives some further information about the possibility to detect antibodies that show if you HAD the test.

All explanations in this post are accurate at the time of writing it (27 March 2020), but since all can and will change relatively fast in a few weeks, this post will most likely at least partially outdated.

Most details in this post are based on publicly available information from the SARS expert, German virologist Prof. Dr. Christian Drosten, where I speculate or add my opinion, I will make this obvious.

 

1) What tests are available?

The current test for the Coronavirus only tests the presence of the virus, not if you HAD Covid-19. So you need to be tested WHILE you have symptoms and you can’t find out if you already went through the illness and might now be immune.

The current test is very reliable in the first week of symptoms, but already in the second week it is not that reliable anymore and that might be the reason why lots of people get test cancellations after quite an initial wait. The test is called PCR test (PCR stands for Polymerase Chain Reaction). In this test the DNA of the Corona virus will be compared with the DNA of what is contained in the sample swab from the patient’s throat.

Antibody (or Antigen) tests are available in labs and will be available in the future to do at home, but currently the home-test kits are not sufficiently tested for their reliability. [Oddly the UK has bought already 3.5 mio antibody tests (www.telegraph.co.uk/news/2020/03/27/coronavirus-covid-19-home-test-kits/) without waiting for the reliability tests. The manufacturer claims a reliability of 98%, but clinical test are at very early stage.] This first version of Antibody test will test a small amount of blood that is taken from a finger-prick.

The antibody test that is carried out in a lab is called ELISA (or EIA) test, which stands for “Enzyme-Linked Immunosorbent Assay”. It will be available on a larger scale in about a month, but larger capacity needs to be built and ELISA machines are not available in big enough numbers yet.

Later (probably in a few months) an antibody test like a pregnancy test will be available and will be the simplest way of mass testing It’s use will be for people to see if they had Covid-19. That test method is called LFD, which stands for Lateral Flow Diagnostic.

2) Why is the current virus test only reliable in the first week?

Currently the Covid-19 illness starts in the throat and then the virus moves to the lungs. Symptoms are initially pain at the back of the throat and later a dry cough and/or pain in the chest. The test is reliable while the virus is in the throat and that is typically in the first week. After that, symptoms are still present for another week or so, but after the first week the virus has moved to the lungs and therefore can’t be detected reliably with a throat swab anymore. The virus might present in the lungs for another 2-3 weeks and it would still be possible to diagnose it by analysing the sputum (mucus that is coughed up when you have a lung-affecting inflammation), but that is usually not tested.
It would also be possible to still prove the presence of the virus reliably in the stool (a.k.a feces) after the first week, but the labs are currently focusing on test swabs only and are mostly not set up for stool tests.

3) Is there anything to confirm that I did have the Covid-19?

Yes, these test are the antibody (or antigen) tests and there is more information about them a bit further down.

4) How is the swab done for the test that will detect presence of the Coronavirus?

Your doctor take the specimen and there are test centres that specify on these tests and at the test centres you often carry out that test yourself. You are given a test kit and have to take the swab yourself. Once the swab is taken, it will have to be analysed in a lab before a result will be known.

To take the swab there are a few methods.
The most reliable and virologist-recommended method is through the nose. In this case the swab is pushed into your nose until you reach the back of the throat. This is very deep into your nose and the test is not very comfortable, you might even get some tears, but it is over in seconds. This demonstrates the “nasopharyngeal swab”: youtu.be/hXohAo1d6tk?t=35

The second method is to take a swab from the back of your throat. It has to be the very back, either left or right of that soft tissue that hangs from your palate (it is actually called “uvula”). This test is called oropharyngeal swab and is not as reliable as the nasopharyngeal swab.

For self-collection of the specimen, a combination of “anterior nares swab” which is at just inside the nostril (or sometimes “nasal mid-turbinate” swab, which is a bit deeper into the nose) and additionally a throat swab is sometimes used. In Ireland, this somewhat less reliable but easier do-able combined test is used and you can see a demonstration here www.youtube.com/watch?v=tfnWnHm8JxU

5) How long does it take to get the test results?

There are a number of delays in the process. The first problem is the delay in getting a test appointment. This has nothing to do with the test method, but with the organisation of the test procedure. Since there are sooo many people that currently need to get tested either because they have symptoms or because they think they have symptoms, this can take days or more than a week. And as explained above, once a week has passed and the test is less reliable, it could easily happen that your test gets cancelled. Why? Well, if your Covid-19 illness was serious, you might be in hospital already and if it wasn’t serious, it is not really necessary to check if you had it or not…especially because the reliability of lower than in the first week.

Once a test has been carried out, the specimen will need to be brought to the lab, it needs to be loaded into a machine and then after the test in the PCR test machine has started, a result is known in about 2.5 hours. But now the information has to be recorded and then needs to be communicated back to you. You can see that this is a long-ish process. If there weren’t so many people to be tested, you should have a result in about 1-2 days, but with so many tests that are queuing up, it can take 4-5 days until you find out the results.

6) Will mass testing happen?

Yes and no! It doesn’t make sense to mass test for the virus because the test has to happen in the first week of symptoms. But after the current serious Covid-19 situation is over, it will be quite relevant for yourself and to know if “herd immunity” has been achieved to check if you HAD been infected.
That’s where the antibody test will come in and since you will be available to self-test at some time, it will definitely make sense to come to a situation where you can buy that test for a low cost and then we will have a sort of mass test. However, the test results will most likely not be sent back to a central register.

7) How does that antibody test work?

Eventually it will be quite simple and fast: You will get a bit of blood from a finger-prick, then you put the drop of blood on a carrier, put a drop of another substance on it and after 15 minutes it will tell you if there are antibodies in your blood.

There are already tests available on eBay, but many are from Asia and are not tested for reliability.

Antibodies are created right from the beginning of the infection, but they are small in numbers. After a week, however, there is a good number of antibodies and that number increases in the next 2-3 weeks to a significant number. So once a reliable test is available (in 2-3 months maybe, the UK claims in about 1 week :-O ), you can do it on your own in a months.

Until then there is an option to do the “ELISA” test that I mentioned above. But ELISA tests are still lab based and therefore your GP needs to send in the blood sample.

Can antibody tests be done in any different way even earlier? Yes, a lab can already test if antibodies are in you blood. But this is a relatively complicated test and therefore is not a high priority at the moment where labs are flooded with the virus tests. The lab-based antibody test is called “Immunofluorescence test” in case you need to talk to a doctor about it.

8) You mention “herd immunity” again. Can you explain again?

Herd immunity is a situation where there is so much immunity in the “herd” of people that the virus can’t easily spread any further. Herd immunity requires that approximately 60-70% of people in society are immune.

9) Once I am immune against the Coronavirus, does that mean I can’t get it anymore?

Yes, as it looks at the moment, immunity against the Coronavirus is achieved once you had Covid-19. Unfortunately, though, viruses can mutate and therefore immunity against the current Coronavirus doesn’t mean that if a mutated Coronavirus will come back at some point in the future you will be immune against that next NEW Coronavirus. A lot of things are not clear yet regarding immunity and more research has to be done, but this is the situation that virologists expect at the moment.

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All this information is gathered based on information available from official channels or from expert virologists. However, there is a possibility that I misunderstood something. If you think that something in the above post might not be correct, please let me know before 27 April 2020. After that, I will not change the post anymore, but instead you should assume that the information above is “historic”. ;-)

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The Corona Files: Social Distancing & Lock Down

Written by Joerg Steegmueller
The Corona Files: Social Distancing & Lock Down
Sobering Statistics

The Corona Virus is continuing its rampage!

At the time of writing this, there have been 271,620 infections with 87,363 recovered. And sadly 11,280 people have died. That is more than 57 (!!) Ryanair plane loads full of people and imagine how shocked we would be if only ONE plane crashed.

Risk Group or Not: Prevent!

So in actual numbers it is terrifying and a lot of us have started to feel quite anxious or at least concerned about the impact that the virus could have on our own life. It is still the case that the majority of fatalities are in an older age group and/or with people that have some underlying illnesses, but there are plenty of young people that have heart issues or asthma or other circulatory problems that could be badly affected.

If you are in a higher risk group, stay away from other people and wash your hands really well when you have touched items outside in areas where potentially infected people have been and don’t touch your face until you have washed the hands.

With these steps, you will drastically reduce the risk! You will not have to wear a mask, but if you feel safer with a mask or a scarf, then wear it. Fear and anxiety is a bad thing and it doesn’t make sense to suffer it just because you don’t want to be seen with a mask.

If you are super healthy and could have a guarantee that there are no health issues that could require you to be put on a ventilator, it would be best for you and for society as a whole to get infected asap, then completely isolate until the symptoms are totally gone and afterwards be safe from the virus AND not have the risk of being a carrier anymore. Unfortunately, though there is no such 100% guarantee.

There is very good news about immunity: Research on monkeys has shown that immunity will be achieved after an initial infection and once immunity has been achieved, then the monkey who is a second time exposed to the virus will also not pass it on to others anymore. But this research has only been done on a small test group of monkeys and we don’t know either if us human beings react exactly the same as monkeys.

Social Distancing

So to protect the risk groups, the concept of “social distancing” has been developed. The name is very unfortunate, it should be physical distancing or spatial separation, because we don’t want to move away socially from our friends, colleagues and families. But for the rest of this post I will still – reluctantly – use the bad term.

The idea behind social distancing is perfectly expressed in the graph below by @garrywarshaw.

Image

By infecting less people initially, even the multiplication (or compound) effect of an infection chain a significant reduction of total number of infections can be achieved. This is the one and only reason for social distancing.

It does SLOW DOWN the spread of the virus. Social Distancing doesn’t stop it and it also doesn’t stop that we might get infected eventually. But a calculation by a university in the UK showed that just protecting the elderly (for example by locking them away) would not be enough. There would still be 8 times more hospital beds required than they have available.

With a drastic slow down on the other hand, the cases that need to be admitted to hospital will be looked after correctly. A lot of us will still have to get infected to achieve a immunisation (herd immunity) of a larger group of people. So our attitude to an infection has to change! Nobody wants to have a 2 week long bad flu wth the risk of a hospital stay and a low – but still higher than zero – risk of death, but if we accept that it is NOT the worst case scenario if we get infected.

Stigma of Infection

Right now, it seems as if people really think negatively of someone who gets infected. :-O I call that an “Infection Stigma” and it makes absolutely no sense. Getting infected doesn’t mean the person misbehaved, it also doesn’t mean the person is and will remain to be dangerous forever, it doesn’t mean that that person has done society a dis- service and it doesn’t mean that the person will probably die anyway. Not at all!!

The person will most likely survive; has helped society to reach herd immunity faster and does not pose a risk once the two weeks of symptoms are over.

So please stop stigmatising people who got infected by the virus and stop panicking over the possibility that you might get it.

Will we have a lock down?

Nobody wants a lock down really. A lock down means that nobody is allowed to leave the house or apartment anymore unless it is to go to work, to buy food or to go to a doctor.

A lock down is NOT needed where people stick to the social distancing rules. But where people don’t adhere these rules, the only other way to ensure that they stay away from each other is to force them to stay inside.

I saw some pictures from Spain, where a cyclist was fined for going on a training cycle on his own. Yes, he broke the existing law and that is what he was fined for. But the law that he broke didn’t help to improve the Corona virus situation in the slightest. He was NO danger to himself or anyone. In Bavaria in Germany where a moderate lock down is implemented from today, the rules have been created better: You are still allowed to go for a walk as long as it is on your own or only with the people that live with you.

I can understand why the Spanish government used their all-encompassing law, it is MUCH easier to control than a more differentiated law. But this whole situation could take quite some time and rules only make sense if they help improving the situation.

So what can we do in Ireland to avoid a lock down? Simple! Adhere to the Social Distancing rules!!

When will it all be over?

This is one of the most difficult questions to answer. Virologists think that in about 2-3 months it could be over…at least for now. The problem is that when winter returns, the virus could come back.

There is another possible scenario and that assumes that the limitations or restrictions to life are less severe (e.g. schools will restart for higher classes at some point and work will resume) in that case, the restrictions could be lifted then applied again, then lifted and applied again. Whenever the virus comes back the infections will be allowed to rise and then will be controlled through the application of restrictions again. In this on-off scenario, the whole Corona / Covid-19 issue could go on for around 2 years. :-O

I heard about faster tests and a vaccine. Is that true?

Yes and no! Faster tests are being developed at the moment. They will probably be very similar to a pregnancy test where you pee on a strip that tells you instantly through a colour change if you have the virus or not. This is not as easy as it sounds because it has to have a high reliability. But research is on the right path and will probably have a solution relatively soon. Then tests will have to start, which will take another bit. Until then we only have the relatively cumbersome lab test that checks the presence of the virus in a throat swab and – as far as I know – that also can detect antibodies as indicators that you had been infected.

A vaccine is also not too far away from being developed. But even when scientists found a vaccine, that doesn’t mean that you will be able to get it. Currently vaccines needs to go through a very long and expensive trial process, which could delay the availability for patients for another 12-18 months based on current regulatory rules. But maybe the rules will have to get changed so that at least health professionals can be vaccinated earlier. But there is a risk of severe side effects and politicians have to decide if they want to accept this risk (and insure the vaccination producer against it).

What should I do for now?

Three things:
1) Stay upbeat and positive by creating a new routine during the isolated living
2) Adhere to all Social Distancing rules and if necessary, obey the lock down.
3) Keep in close contact with people that live on their own, with elderly people and with anybody else who could do with your support. Isolation is a challenge for most people and we need to be there for each other to get through it. Be proactive with your friend. Don’t wait for them to tell you they need help, but contact them regularly to check if they need anything.

We all go through the same situation and a shared experience can pull people together and will provide the support needed so that everyone can get through it. If you are strong, provide the support and if you are challenged ask for support! Let’s help each other and be there for each other!!

 

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The Corona Files: An explainer

Written by Joerg Steegmueller
5 Comments
The Corona Files: An explainer

After the Coronavirus reached Italy and created havoc there, it was only a matter of time when it would arrive in Ireland and so it happened and – through visitors in Italy – the virus made it to our little island.

And like in most European countries the confusion was huge at first, the demands on politicians were massive and finally the Taoiseach had not other option but to also declare the closure of schools and universities and cultural institutions.

This is a completely unprecedented situation that nobody in this whole world has any experience with, so there is no real right or wrong yet and I think our politicians have done the best they could.

You might be very worried about this virus, so let me explain what one of the most eminent SARS experts in Germany, Virologist Prof. Dr. Christian Drosten, says about the Corona Virus /Covid-19, which has a lot of similarities to the SARS virus.

He explains that it is expected that nearly every one will get infected at some stage over the next few months. For kids, there seems to be an indication that they are only carriers and will not experience severe symptoms. Then there is the age 12-65 where the symptoms will be a general weakness, a persistent cough and – in most cases – a raised temperature. But after about 2 weeks all is over and they will recover. And then there is the groups of elderly people from 65 years of age. In this group it is expected that unfortunately up to 20 or 25% of infected people will die. The virus itself doesn’t kill, but the body (especially the circulatory system) will be so challenged after around 5 days with symptoms, that it will not be able to continue to work in weaker people or people with an pre-existing heart problem and a few other issues. They and younger people with other underlying health problems will be the people that need to be looked after in a hospital.

After the first phase, the Containment Phase, didn’t succeed and the virus could not be contained. We entered the Delay phase. In this phase the focus is on delaying the spread of the virus (not stopping it!). There is no way to stop it, but if all people that could get infected would get infected around the same time, the health system would collapse. (I saw a calculation that described that the UK, for example, would need over 1 million hospital bed if the spread couldn’t be delayed, but they only have 140,000 beds.) So currently they are ONLY trying to delay the infection.

The experts are expecting that the infections will continue until September or even longer. :-O And that nearly all of us will get infected at some time over this time. So all the current limitations, including school, university closures and closures of all cultural institutions will unlikely end on 29 March.

Most flu viruses don’t like the warmer weather, but it seems the Corona virus can handle it, so there is a high probability that the virus will not “disappear” over the summer and then come back in autumn/winter, but that it will stay with us.

In that case – and if it ha immunisation as a result – it would be positive for the healthy among us to get it early on, but the problem is that for a period of 2 weeks BEFORE you show any symptoms, you can already infect people. So this is the dangerous period during which you should stay away from all weak and elderly people.

No vaccines will be available until probably next year, so we can’t hope for that to sort the situation.

In general, try to stay upbeat and try not to panic. Prepare yourself mentally that this virus will be with us for quite some time (And we thought Brexit was an endless story!?) and that the current or some other social distancing rules will either stay in place or will come back again in a few weeks. Oh and stay healthy as much as possible so that you will get over it fast when the virus hits you.

And here is some advise on how to behave in the next few weeks or months:

1. An infected person would have to cough, sneeze or – and we all do that – spit while talking. The droplets fly through the air and would have to land on your face to infect you directly. If you keep a distance from the people you talk to, there is a good chance that the droplets fall on the ground and will be harmless for you.

2. If an infected person coughs into their hands and then touches a doorknob/tap/fridge door/steering wheel/shopping cart, they will leave the droplets there. The droplets are relatively sticky and can survive for up to 3 days and some surfaces and only approximately 3 hours on others. If you then touch that surface AND transfer the droplets to your eyes, nose or mouth you can also get infected. So, don’t touch your face and you are most likely fine.

3. An infected person doesn’t show symptoms for up to 14 days, but can pass on the virus already. So we should be vigilant with regards to all people, not just obviously ill people. You will not get sick just by being in the same room with someone who is infected.

Adhere to this protocol:

◦ Don’t touch your face

◦ Wash hands surgeon style for at least 30 seconds after potential exposure to surfaces that others may have touched. You may think you know how to wash your hands, but you should STILL watch a video and get it right.

◦ Social distancing will decrease the risk of getting infected. Cancel unnecessary meetings, but confidently go to necessary engagements and then use the protocol above.

◦ Carry a large handkerchief at all times, even when you are not sick. Cough into it or at least cough into your elbow. Do not cough without covering your mouth.

◦ Wipe your phone down (at same time as washing hands)

◦ Wipe fridge door, taps, light switches, remote controls, keyboards etc

◦ Use a paper towel to open the door on the way out of a public toilet.

◦ Washing your hands with soap and water is sufficient. Anti-bacterial soap is NOT required. Hand sanitizer is NOT as efficient as soap, but can be used when no soap and water is available. Make sure that the hand sanitizer has 60+% of alcohol in it.

◦ Remember you have an immune system too. Even if the droplets manage to reach you, the virus still has to get past your immune system. So keep that healthy! Look after yourself and don’t run yourself down.

◦ Take care of your emotional self – fear, worry and anxiety wear you down

◦ If you do feel sick, immediately self-isolate, get tested and take directions from your health care provider.

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Amalgam in Tooth fillings: Harmless but DON’T use it?

Written by Joerg Steegmueller
Amalgam in Tooth fillings: Harmless but DON’T use it?

Last week a number of media outlets reported that EU had brought in a law that outlawed the use of Dental Amalgam for fillings for children under 15 and pregnant or breast feeding women. The law is from 2017 already, but it came into effect only on 01 July.

So what is Amalgam? Amalgam is compound for tooth fillings that contains Mercury. Mercury is highly toxic but for some odd reason it is allegedly harmless when in your mouth.

The Irish Times wrote in an article “Mercury is the only liquid metal and, while safe when used in dentistry, has been associated with incidents of poisoning, as in the Bay of Minamata in Japan where, in the 1950s and 1960s, a disfiguring disease was identified to be associated with industrial-scale mercury poisoning.”

So it’s safe, but causes poisoning!? How does that make sense?

The Irish Times continued and claimed that the change was part of the Government’s adherence to the Minamata Convention, a United Nations agreement dating from 2013, which aims to protect human health and the environment by reducing, or eliminating altogether, the use of the chemical element mercury.

But it might not surprise you that the Irish Government delayed the change until the very last moment and that it only did so because of a EU law change.

Interestingly Sweden, Norway, Denmark and Germany have banned or restricted use of amalgam already in 2011. But the Irish Government thought it was appropriate to allow the use for another 7 years! SEVEN!

Now why is this change happening? After all the Health Service Executive in Ireland said that the Amalgam compound was “a safe, reliable and durable filling material, and has been used successfully for over 100 years”. So something safe and perfect will be banned? Isn’t that odd? Bans are normally reserved for dangerous things, no?

Well, interestingly if you are older than 15 or not pregnant, you can currently still get Amalgam fillings DESPITE the fact that many other countries saw the need to ban it.

So is it dangerous or not? Dentists and Health Service Executive tell us that it is safe, but how could they not do that. It would imply that they were lying all along. The ban for children and pregnant women is a clear admission that it is NOT safe.

DON’T use it and tell your dentist that you do NOT want any Amalgam fillings added!

 

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Don’t get sick in Ireland!! – Disastrous Irish Health System

Written by Joerg Steegmueller
Don’t get sick in Ireland!! – Disastrous Irish Health System

What a shocker! RTE News told us Thursday that the number of people in Ireland who are on waiting lists to be treated or seen by a doctor has grown to a shocking number of over 707,000. This is an unbelievably huge number. 15% of the population of Ireland is waiting!! FIFTEEN percent!!

According to the Euro Health Consumer Index from 2017, the number of Irish patients waiting for surgery or an outpatient appointment is “abysmal”. They have concluded that Ireland has the WORST hospital waiting list in Europe.

It is not totally clear how RTE arrived at this number, but there is an Outpatient waiting list of 511,000 and an Inpatient waiting list of 78,000. There is planned procedure waiting list of 12,000 as well and adding all these up comes to around 600,000. so there are still 100,000 missing. But even if the waiting list was ONLY 600,000, that is still more than 12.5% of the population in Ireland.

If you are affected by this, check out the Cross Border Health Care Directive, this article in the Journal.ie outlines what it does.

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