Dr. Steven Bishop returned to PartnerMD Live on Wednesday, April 22, to provide an update on COVID-19. He discussed the development, availability, and uncertainties of antibody testing; the latest models and projections; and what "reopening" the economy will look like to limit continued spread. He also answered questions from those watching. Read below for a recap, watch the full video for more information, and leave any additional questions you have in the comments.
- I read an article about cytokine storms. Does that change what we should be looking for on an individual basis with regard to who might be more likely to get hit harder by the virus? Or, does that change when doctors might recommend a patient with symptoms be sent to the hospital? Excellent question. Cytokines are a group of molecules that signal the body's immune system that a virus, or something else that shouldn't be there, has arrived. It recruits the white blood cells and whatever other processes the body uses to fight illness. A cytokine storm is when the body's response becomes over-excessive. The body mounts just a vigorous response that it does more harm than good. With regard to COVID-19, as far as I'm aware, there is no way to tell who this might happen to ahead of time.
- What is a good estimate of time that you’d consider “safe” if I test positive for antibodies? The most truthful and shortest answer is we have no idea right now. However, if you have what's called IgG antibodies, antibodies that your body makes after its been managing an infection for a couple weeks or more, that usually means you will have strong immunity to the virus that lasts at least months, if not years or a lifetime. But the immune response can be different for each virus.
- Is the antibody test considered definitively reliable? This is a loaded question, because there is almost no test in the medical profession, from a blood test to an imaging test to a physical exam, that can be considered definitively, 100% reliable. Pathology results like biopsies are probably the best, but there is some room in there for error. However, the antibody tests are quite good. "If I got an antibody test that came back positive, I would be reassured that it was accurate."
- Can keeping everyday inflammation down in the body help? What we have definitely learned about COVID-19 that people who have underlying conditions associated with inflammation do worse. People who are overweight, have diabetes, have chronic conditions that have an inflammatory component (chronic lung, COPD, asthma) have done worse. Anything that can be done to manage or prevent these conditions will be helpful.
- What's the difference between a D.O. and an M.D.? These are the two major classifications of doctor. There used to be a major difference, but in general, there is no practical difference at this point. Check out our article on the topic here.
- Have we refined the known symptoms of COVID-19? Are rashes a symptom? Yes, there are rashes with coronavirus. You may have seen reports of "corona toes" or "corona fingers," which have been reported in COVID-19 patients. This is likely due to small blood clots caused by the inflammation associated with the disease. Another prominent symptom that has been strongly associated with COVID-19 is the loss of taste and smell, in addition to fever, cough, and congestion.
- What is the advice for people who are immunosupressed? This is a decision you should make with the advice of your doctor, but for now, it is probably recommended to continue social distancing, take advantage of special hours at grocery stores, and wear a mask. If you're going to wear gloves, be aware that as soon as you touch something, those gloves could then be contaminated, so be sure to take them off and wash your hands.
Steve E. Bishop, M.D.
As a board-certified internist and concierge doctor in Richmond, VA, Dr. Steven Bishop is passionate about helping his patients improve their lives through better health. He helps healthy adults adjust their lifestyles as they age and helps patients with complex medical diseases manage and improve their health.
