COVID-19 Update 7/22: New Testing Options, Latest Numbers, Vaccines, and Your Questions

A lot changes in one week with COVID-19. This week, there's a new rapid COVID-19 test and an at-home testing kit now widely available. We've also learned more about the percent positivity rate, the three leading vaccine options, and more. Dr. Steven Bishop covered all that and answered your questions in this week's COVID-19 update. 

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Testing Availability & Testing Options

One new option for testing has come on the market, an antigen rapid test. In Virginia, BetterMed urgent care is offering this new test, as well as the PCR test and the antibody test. These rapid tests should give you results back in the same day. CVS is also continuing to do drive-up testing, but they may be a little backed up. 

One additional option is something called Pixel, a product of LabCorp. It came out a few months ago and initially was only available to healthcare professionals and first responders, but they've now expanded it to be available to everyone. It is essentially an at-home version of the nasal swab test. You order the test via their website, inputting your insurance information, and they mail you a test to take at home and mail back. 

Virginia Department of Health COVID-19 Numbers

One interesting thing learned this week related to the testing numbers provided by the Virginia Department of Health on their COVID-19 dashboard. One of the numbers they provide is the percent positive rate, which many of us, myself included, assumed this was a rough proxy of community prevalence. Turns out, that's not accurate.

The percent positivity is a metric used by VDH to determine whether the state has sufficient testing capacity, not prevalence, because of the way the data is calculated. They do not exclude multiple tests, so if one person is tested multiple times, that's counted as multiple tests, but really only one person. Additionally, the data does not represent a random sample of the population. Because of the way that metric is determined, it should not be considered a reflection of the prevalence of the virus in the community. 

For example, today the percent positivity rate is 8.4%. That does not mean that 8.4% of the population has or has had the virus. We want to keep that number under 10%, so we know we have sufficient testing capacity so that we know we can test everyone who needs to be tested. 

Vaccines in the News

It looks like a number of companies are making progress in developing a vaccine. There are three in particular that are promising — one from Phizer, one from Moderna, and one from AstraZeneca. They all have been found to work in developing the neutralizing antibodies we're looking for. That's the good news. 

Two of the vaccines, the ones based on the mRNA technology, which is brand new technology for vaccine development, appear to be successful in making antibodies. The problem is, because its new technology, we do not know what the side effect profile is or will be. The couple trials we've seen before, these two vaccines in particular have a fairly high rate of negative side effects. The Phizer one that was released this week, about 70% of the patients in one of the test arms had a fever of over 100.4 degrees. Same thing with Moderna, where 40-50% of the patients had side effects.

Now, these side effects are not life threatening, limited, and tended to fade away after a few days. And they were more severe at higher doses and in the second dose. So, that is good. I wouldn't say the vaccines are dangerous. But they seem to have a fairly high rate of side effects. The Moderna vaccine is going to start a 30,000-person trial with recruitment set to start July 27.

I am a little worried about the side effect profile of these two vaccines in particular, because we have a very hard time already getting everybody to take a regular flu shot every year, which has minimal to no side effects. I'm concerned we might have a hard time convincing people to take these vaccines. 

The other vaccine being developed by AstraZeneca is what's called a viral vector vaccine, which is technology that has been around a lot longer. It seems to have a much better side effect profile. If this one can produce antibodies AND have a low side effect profile, then that is the best case scenario.

Hopefully, they are all proven safe, because the best thing would be to have multiple vaccines to make sure we have enough supply for everyone who needs one. 

Your Questions, Answered. 

• Is anyone in Virginia using Thermo Fisher Scientific for testing? Hearing out of CT the test results are very inaccurate.
  
  I have not heard anyone in Virginia using that. Most people in Virginia that I'm aware of are either using the Abbott machines, BioFire machines, Quidel machines, or their own internally developed machines. 
• Are the significance of the side effects similar to the side effects of the shingrix vaccine? That vaccine has significant side effects, too. 
  
  It's similar, in terms of a lot of people with shingrix develop a really sore arm, have a low-grade fever, etc. From what I'm seeing from the data from the COVID vaccines is that more people are having side effects. 
  
  
• Why isn't there more focus on overall, metabolic health? Knowing your Vitamin D level, getting your blood sugar under control along with cholesterol seems to be helpful in overall immune support.
  
  Yes! Great question. We've been focusing on that heavily. That's my primary role as Director of Wellness. Improving your health is the key to maximizing your resilience to the virus. But, that's a complicated thing to do for a lot of folks and it takes time to change habits and lifestyles. We strongly advocate for that and are working hard on that. We'll talk more about metabolic health and COVID-19 outcomes next week. 
  
  
• What is the accuracy of the tests being used in VA? I,  too, was concerned about the inaccuracy of some tests.
  
  Quick lowdown on this. If its a PCR or antigen test, meaning its looking for some element of the virus in your system at that moment, if its positive, it is very accurate. It's almost never wrong. If its negative, you can trust it a little bit, but you can't be reassured completely that it is truly negative. The tests are just not accurate in that way. What's that called is they are not very "sensitive" tests. 
  
  Antibodies are a little different. If you have an IgG antibody, that's both "sensitive" and "specific." If its positive, you can trust it. If its negative, you can trust it. 
  
  
• If the percent positive on the VDH site isn't showing prevalence in the state, what is? 
  
  Nothing, unfortunately. There is not a good way of getting a fully accurate prevalence data set. Based on my understanding at this point, in order to get a truly accurate prevalence number (how many people have or have had an infection ever), you have to a random sampling of the population. So, we'd have to take a 1,000 random people in various counties and cities around Richmond and test them at random, whether they had symptoms or not, and see if they ever had the infection. And then based on that, we could get a fairly accurate prevalence percent. 
  
  But, we are not doing random sampling of large populations. We are only testing people who present for symptoms or have some reason to think they may have been exposed.
   
• How serious is the surge in cases in our region? It looks like new a Covid hospitalizations are rising in Maryland (I haven’t looked at Virginia’s data) but deaths from Covid not (yet) rising.
  
  This is a great question, because at this point, it looks like COVID-19 has become very regional. I have not looked at Maryland's data lately, but Virginia's data is interesting in this sense. We've definitely had an uptick of overall cases over the last couple of weeks.
  
  If you look at that data on a regional bases, say the Central Region, the Southwest, the Northwest, the Northern part of Virginia, and the Eastern part of Virginia, almost all of that increase in cases was driven by the Eastern portion of Virginia. And probably, frankly, because of people going to the beach and not social distancing enough. 
  
  Luckily, based on what I'm seeing, is most of those new cases are in the young and healthy, which is why we haven't seen an uptick in hospitalizations and deaths in Virginia, which continue on a nice downtrend (except for a slight uptick last week). 
  
  
• Help us again with the testing language. Kinds of Covid tests and antigen tests? How long are the results valid for?
  
  Yes, there are lots of different test types. An antigen tests looks for a viral protein or particle. A PCR test looks for the actual RNA or genetic material of the virus. And antibodies look for your body's response to the virus, so antibodies you've produced after exposure to the virus. There are two types of antibodies, one is called IgM and one is called IgG, that are being tested for. There is a whole slew of antibodies, but they are not related to COVID at this point.
  
  IgM will turn positive within a few days to a week after exposure, and that may stay positive for weeks to a couple of months. IgG is the long-term antibody that we hope will stay around for months or years, and that means you've had COVID in the past but are over it. That starts appearing around week two after exposure and hopefully stays for months of years. 
  
  
• Is there anyone capturing information on "long haulers" who contract COVID but just aren't recovering? Many of these people seem to have a form of dysautonomia or ME (I have POTS myself so am interested in this). I'm seeing more of these people show up in POTS forum so it's concerning to me as we really don't have good treatments for dysautonomia or ME.
  
  There definitely are people tracking this. For people who aren't familiar, POTS is a complex neurovascular disorder where people have trouble maintaining their blood pressure when they stand up and have issues with fainting, passing out, and increased heart rate, in addition to other issues. 
  
  It doesn't surprise me that people who are recovering from COVID have some of these symptoms is because of the nature of this virus. It attacks the vascular system in many people and the nerves of the vascular system, which act on your blood vessels to either constrict or relax them as you move around, sleep, etc. And the virus, because it attacks the vascular system, I can imagine in doing that the nerves are also damaged to a certain degree.
  
  So it makes sense that people are having dysautonomia symptoms after infection, even after "recovering" they still have some problems because nerve and vascular damage, like lung damage, does take time to heal. But people are tracking this and we should have more data in the coming months. 
  
  
• So then where do we get antibody testing? Do having antibodies mean we cannot catch COVID-19 then?
  
  You can get antibody testing from your physician's office (including PartnerMD) or a place like BetterMed or another urgent care facility offering them.
  
  We don't know yet if having antibodies prevents you from getting COVID-19. We hope so, and that's the goal of the vaccines. We think it's probably true, but we have to wait until the trials of the vaccine to know for sure. 
  
  
• Does the increase in positives indicate herd immunity is starting? 
  
  Maybe, and that's a maybe with a big asterisk. The problem is there is a lot of controversy over how many have to get infected to have herd immunity. I've seen everywhere from 15% to 85%. So, the short answer is I don't know and no one knows yet. We won't know we're getting herd immunity until after we've had it. It's one of those things where we won't know until we look back. 
  
  
• Could the uptick be because of the protesters?
  
  Certainly could be. It could also just be from people going on vacation. People being out and about doing their thing. We won't know. If we had lots and lots of contact tracers and people were doing a great job of interacting with the contact tracers, then we probably could sort out the exact cause of the surges. Barring that, we won't know for sure. 
  
  
• Does the IgG test indicate antibodies specific to COVID-19 or antibodies for any coronavirus?
  
  Great question. These are antibodies specific to SARS-COV2, which is COVID-19. They are not general coronavirus antibodies. They are antibodies specific to this strain. 
  
  
• Does any worthwhile contact tracing exist in Central Virginia? 
  I think so. I think they are trying to hire lots of contact tracers. What we don't know is if people are answering their questions. Even if we hire lots of contact tracers, like the VDH wants to, if when they call people, the people are not forthcoming and don't respond honestly, then even with tracers, it won't provide useful information. So, I don't know. That's probably inside information that the folks who work at VDH have.