If this is verified then what the hell are we locked down for?

[Leongsam]

Roseland Hospital phlebotomist: 30% of those tested have coronavirus antibody
Business

By Staff reports | Apr 9, 2020

Those seeking to be tested for the coronavirus line up outside Roseland Community Hospital.


A phlebotomist working at Roseland Community Hospital said Thursday that 30% to 50% of patients tested for the coronavirus have antibodies while only around 10% to 20% of those tested have the active virus.

Sumaya Owaynat, a phlebotomy technician, said she tests between 400 and 600 patients on an average day in the parking lot at Roseland Community Hospital. Drive-thru testing is from 9 a.m. to noon and 1 to 4 p.m. each day. However, the hospital has a limited number of tests they can give per day.

Owaynat said the number of patients coming through the testing center who appear to have already had coronavirus and gotten over it is far greater than those who currently have the disease.

Sumaya Owaynat

“A lot of people have high antibodies, which means they had the coronavirus but they don’t have it anymore and their bodies built the antibodies,” Owaynat told Chicago City Wire.

Antibodies in the bloodstream reveal that a person has already had the coronavirus and may be immune to contracting the virus again.

If accurate, this means the spread of the virus may have been underway in the Roseland community - and the state and country as a whole - prior to the issuance of stay at home orders and widespread business closures in mid-March which have crippled the national economy.

In addition, those who show signs of already having had the illness should be able to re-enter society -- albeit with some modified social distancing measures in place -- rather than sheltering at home as they are no longer in danger. Of those who contract the coronavirus, around 25 percent may be asymptomatic.

A recent study of 1,000 people in the Heinsberg District of Bonn, Germany found that 15% of the population had contracted the virus, many unknowingly and without symptoms.

Of those, only 0.37% died from COVID-19, a figure much lower than those previously cited.


In fact, Dr. Anthony Fauci recently decreased his projection of the number of deaths nationwide from the virus to 60,000 from the 100,000 he predicted just last week.


Labs have been ramping up production of antibody tests in recent days, and some are saying the testing will hasten the end of the crisis and help restore the economy and quality of life to the country at large.


Abbott Labs in particular, which developed a five-minute testing kit, is stepping up efforts to roll out more antibody testing kits.


Many are calling for the kits to be shipped to homes around the country to determine if people have already had the virus or not. Those receiving a positive result would be deemed safe to re-engage in the workforce as well as assist in efforts to help those most negatively affected by the virus.


Roseland Community Hospital, located on the far south side of Chicago, has 138 beds serving a majority minority population with over 96% of the community’s residents identifying as African-American.


In recent days, the White House has sounded the alarm saying early data show the black population is being affected to a higher degree by the virus.

 

[Leongsam]

@nayr69sg Please provide a professional medical opinion. Will pay you for it.

 

[syed putra]

So the question now is, how will the world get back on its feet. Who will start first? which airline will resume first flight? Did these airlines hedge their fuel prices when they were grounded?

 

[nayr69sg]

@nayr69sg Please provide a professional medical opinion. Will pay you for it.

I dont have much else to add to this article by way of opinion.

It does seem that the virus is highly infective. And infection rates are very very high.

The problem with the current mode of testing which is to only test for the presence of the virus in the patient is that it will NOT pick up somebody who has got the virus and beaten it.

Hence it is possible that a very large portion of the population already has had the virus and are already done with it.

You need to do both tests. Test for presence of virus and the IgM and IgG tests for active infection and immunity to have a better picture of what stage the patient is at. Having the serology ie Ig tests is also a check against false negatives with the virus test. All tests carry a failure rate.

There is a concept of specificity vs sensitivity in all tests.

A highly specific test has higher false negatives. In other words if the test is positive it is very likely to be correct. However if the test is negative you may not trust that it is a true negative.

Highly sensitive tests are the opposite. If the test is negative it is likely true. While positive tests could be false positives.

The covid 19 viral PCR test is highly specific. Which means there are many false negatives. This is why doctors say if you have symptoms you might as well assume you are positive.

Another way of looking at specificity and sensitivity is you use highly sensitive tests to exclude that you have an illness. While you use highly specific tests to confirm that you have an illness.

The way forward for the world is to do the antibody and viral PCR tests for everyone together. It can let you know if someone has never had any contact with covid19 or has had covid 19 and is fighting covid 19 currently.

IgM antibodies indicate a recent infection and the person is fighting it. IgG means they have passed the initial infection and have immunity already.

Disclaimer I have not studied the IgG and IgM patterns with covid 19. I am using general immunology principles.

There are some viruses that have more complicated serology patterns eg Hepatitis B with anti HBs antiHBe HBsAg HBe Ag etc.

The countries that can start doing antibody serology testing for their entire population will be able to get back to normal faster.

 

[Leongsam]

I dont have much else to add to this article by way of opinion.

It does seem that the virus is highly infective. And infection rates are very very high.

The problem with the current mode of testing which is to only test for the presence of the virus in the patient is that it will NOT pick up somebody who has got the virus and beaten it.

Hence it is possible that a very large portion of the population already has had the virus and are already done with it.

You need to do both tests. Test for presence of virus and the IgM and IgG tests for active infection and immunity to have a better picture of what stage the patient is at. Having the serology ie Ig tests is also a check against false negatives with the virus test. All tests carry a failure rate.

There is a concept of specificity vs sensitivity in all tests.

A highly specific test has higher false negatives. In other words if the test is positive it is very likely to be correct. However if the test is negative you may not trust that it is a true negative.

Highly sensitive tests are the opposite. If the test is negative it is likely true. While positive tests could be false positives.

The covid 19 viral PCR test is highly specific. Which means there are many false negatives. This is why doctors say if you have symptoms you might as well assume you are positive.

Another way of looking at specificity and sensitivity is you use highly sensitive tests to exclude that you have an illness. While you use highly specific tests to confirm that you have an illness.

The way forward for the world is to do the antibody and viral PCR tests for everyone together. It can let you know if someone has never had any contact with covid19 or has had covid 19 and is fighting covid 19 currently.

IgM antibodies indicate a recent infection and the person is fighting it. IgG means they have passed the initial infection and have immunity already.

Disclaimer I have not studied the IgG and IgM patterns with covid 19. I am using general immunology principles.

There are some viruses that have more complicated serology patterns eg Hepatitis B with anti HBs antiHBe HBsAg HBe Ag etc.

The countries that can start doing antibody serology testing for their entire population will be able to get back to normal faster.

Send me the bill. I will pay via paypal account. Discount for fellow ex sinkie who is struggling at the moment because of covid shutdown.

 

[Leongsam]

Roseland Hospital phlebotomist: 30% of those tested have coronavirus antibody
Business

By Staff reports | Apr 9, 2020

Those seeking to be tested for the coronavirus line up outside Roseland Community Hospital.


A phlebotomist working at Roseland Community Hospital said Thursday that 30% to 50% of patients tested for the coronavirus have antibodies while only around 10% to 20% of those tested have the active virus.

Sumaya Owaynat, a phlebotomy technician, said she tests between 400 and 600 patients on an average day in the parking lot at Roseland Community Hospital. Drive-thru testing is from 9 a.m. to noon and 1 to 4 p.m. each day. However, the hospital has a limited number of tests they can give per day.

Owaynat said the number of patients coming through the testing center who appear to have already had coronavirus and gotten over it is far greater than those who currently have the disease.

Sumaya Owaynat

“A lot of people have high antibodies, which means they had the coronavirus but they don’t have it anymore and their bodies built the antibodies,” Owaynat told Chicago City Wire.

Antibodies in the bloodstream reveal that a person has already had the coronavirus and may be immune to contracting the virus again.

If accurate, this means the spread of the virus may have been underway in the Roseland community - and the state and country as a whole - prior to the issuance of stay at home orders and widespread business closures in mid-March which have crippled the national economy.

In addition, those who show signs of already having had the illness should be able to re-enter society -- albeit with some modified social distancing measures in place -- rather than sheltering at home as they are no longer in danger. Of those who contract the coronavirus, around 25 percent may be asymptomatic.

A recent study of 1,000 people in the Heinsberg District of Bonn, Germany found that 15% of the population had contracted the virus, many unknowingly and without symptoms.

Of those, only 0.37% died from COVID-19, a figure much lower than those previously cited.


In fact, Dr. Anthony Fauci recently decreased his projection of the number of deaths nationwide from the virus to 60,000 from the 100,000 he predicted just last week.


Labs have been ramping up production of antibody tests in recent days, and some are saying the testing will hasten the end of the crisis and help restore the economy and quality of life to the country at large.


Abbott Labs in particular, which developed a five-minute testing kit, is stepping up efforts to roll out more antibody testing kits.


Many are calling for the kits to be shipped to homes around the country to determine if people have already had the virus or not. Those receiving a positive result would be deemed safe to re-engage in the workforce as well as assist in efforts to help those most negatively affected by the virus.


Roseland Community Hospital, located on the far south side of Chicago, has 138 beds serving a majority minority population with over 96% of the community’s residents identifying as African-American.


In recent days, the White House has sounded the alarm saying early data show the black population is being affected to a higher degree by the virus.

Apart from the accuracy of the tests don't the numbers, even if they are somewhat inaccurate, indicate that the number that have already been infected is an order of 10x or more higher than the confirmed case numbers?

 

[nayr69sg]

Send me the bill. I will pay via paypal account. Discount for fellow ex sinkie who is struggling at the moment because of covid shutdown.

No lah. Why would I charge you?

Just curious boss, those bros who have "asset" rank how did they get it? They made donations to the site?

 

[nayr69sg]

Apart from the accuracy of the tests don't the numbers, even if they are somewhat inaccurate, indicate that the number that have already been infected is an order of 10x or more higher than the confirmed case numbers?

The problem is these serology tests are quite new and no one also knows the accuracy of the results.

So more tests need to be done in general to get more data. Is it all false positives? Even the serology tests can have false positives and negatives.

 

[Leongsam]

No lah. Why would I charge you?

Just curious boss, those bros who have "asset" rank how did they get it? They made donations to the site?

To be honest I don't know.

The whole database was imported from vbulletin to xenforo and because the vbulletin rep system and the xenforo system are not the same a lot was lost in translation.

It would take me weeks to sort it out so I have just left things as they are.

 

[nayr69sg]

The colleague I mentioned who called sick and couldn't do his telemedicine on monday and Tuesday just shared that he is admitted to hospital for pneumonia!

I mean gotta be really sick if canr even do telephone calls.

His covid 19 test is negative. They might test him again


Another example of possible false negative from a highly specific covid19 PCR test.

 

[Leongsam]

The problem is these serology tests are quite new and no one also knows the accuracy of the results.

So more tests need to be done in general to get more data. Is it all false positives? Even the serology tests can have false positives and negatives.

Sounds like those guys in the other forum who went for Herpes 1 & 2 testing and ended up even more confused than ever. The results are not black and white. There is a wide expanse of grey where the test results can be interpreted any way you want.

 

[nayr69sg]

To be honest I don't know.

The whole database was imported from vbulletin to xenforo and because the vbulletin rep system and the xenforo system are not the same a lot was lost in translation.

It would take me weeks to sort it out so I have just left things as they are.

Oh I see. Ok. Haha!

 

[Asterix]

What the hell is a phlebotomist?

Someone whose job is to inspect and analyse bottoms

 

[nayr69sg]

Sounds like those guys in the other forum who went for Herpes 1 & 2 testing and ended up even more confused than ever. The results are not black and white. There is a wide expanse of grey where the test results can be interpreted any way you want.

Yeah this herpes testing is for IgG.

It is NOT for active virus.

So in the absence of symptoms who would do IgM? No right?

People say I want to test for herpes. Ok we do IgG.

If negative we say ok no symptoms? Means unlikely you are infected now. IgG negative? Means you have never got it. Means you virgin to herpes lah.

If IgG positive means you had it. But no symptoms now? Means unlikely you will be infective to your partner now. But try explaining to the partner. They will say wah lau my partner test positive for herpes leh!

That's why I do NOT do that test unless specifically requested. What for?

If you have no symptoms you are negative. If you have then you are positive and shouldn't screw around.

 

[Leongsam]

The problem is these serology tests are quite new and no one also knows the accuracy of the results.

So more tests need to be done in general to get more data. Is it all false positives? Even the serology tests can have false positives and negatives.

From the other forum:

OK let's talk about HSV testing. You PMed me a question but I thought it would be better to answer it here and share the info with everyone.

There are 2 groups of patients who carry HSV.

Group 1 - symptomatic patients
To make the diagnosis in these patients is really straightforward. It could be purely clinical i.e. you look at the blisters/ulcers and immediately you know it is HSV because it looks exactly like what is shown in textbooks. If you are still not sure or you want to know which type it is, you swab the base of the ulcer/blister and send it to the lab for a HSV PCR test. This has largely replaced viral culture tests we used to do which were highly non-sensitive.

Group 2 - asymptomatic patients
First of all you have to ask yourself and your patient the question "why the hell are you testing in the first place?". Let sleeping dogs lie and let the patient live his life in blissful ignorance.

But you absolutely have to know if you are infected or not if not you will go mad. That's fine.

You then have to rely on serologic tests. In other words, you have to test for HSV antibodies and not HSV virus. The problem with serologic tests is that they are extremely difficult to interpret. There is a lot of cross reaction. For example, most people carry HSV 1 and this may cause the HSV 2 results to become false positive. Even getting a chickenpox vaccine may cause the HSV serologic tests to become false positive.

So you want serologic tests that are as specific as possible. The Gold Standard is the Western Blot test. As far as I know, there is only 1 lab in the world that does this and they only do it for research purposes.

A good alternative is Type Specific Serologic Testing. I have personally called the labs in Singapore that I use for HSV serologic testing and they have told me that the tests that they do are TSST tests. I have my doubts but let's just take that at face value.

The labs use a cut off index value of anywhere from 0.80 to 1.1 to say a test is "positive" for HSV infection. I call bullshit on this. From the studies I have read, it should be > 3.50. So if you HSV IgG index reads > 3.50 you can more or less (99%) say that you have been infected with HSV.

The problem is when your reading comes back as 2.0 or 2.5 or 1.8 and you do not have any symptoms. Are you infected or not? Nobody knows. You can re-test in a few months to look for a SIGNIFICANT INCREASE in titer but most of the time, this does not help either. SIGNIFICANT INCREASE means it must rise above 3.50. If you go from 2.0 to 2.8, you are still none the wiser.

The other problem is the window period. This is the time from infection to when TESTS CAN PICK UP THE INFECTION. This is very different from saying WHEN THE BODY STARTS PRODUCING ANTIBODIES. The body starts to produce IgM antibodies (more on this later) as early as 3 weeks from infection. And IgG antibodies no later than 6 weeks form infection. Very frequently, IgG can be produced much earlier. So the doctor who informed you that the HSV IgG test at 28 days is "90% to 95%" accurate is absolutely correct. From the studies I have read, HSV IgG tests are accurate no later than 16 weeks from infection.

IgM is produced much earlier so some doctors use this test to detect an infection earlier. The problem with IgM is that is disappears very fast also. So it has very limited utility in diagnosis. Furthermore, IgM cannot differentiate between HSV 1 and 2.

Last thing: even if your HSV test came back positive, you don't know when you caught it anyway! Maybe your parents had cold sores and passed HSV 1 to you as a child. So now you test positive for HSV 1 and going to freak out when you have been living with it happily all your life? Maybe you caught HSV 2 from your 1st GF, been symptom free all this while and now you are going to freak out?

After knowing all this you still want to test?
Listen to good advice from everyone here. You have no symptoms. Leave it.
Live your life. Be happy.

 

[nayr69sg]

What the hell is a phlebotomist?

Someone whose job is to inspect and analyse bottoms

No it is someone who draws blood from patients veins or artery for tests.

Singapore during my time as houseman and MO dont have such workers. All done by Houseman.

 

[nayr69sg]

From the other forum:

OK let's talk about HSV testing. You PMed me a question but I thought it would be better to answer it here and share the info with everyone.

There are 2 groups of patients who carry HSV.

Group 1 - symptomatic patients
To make the diagnosis in these patients is really straightforward. It could be purely clinical i.e. you look at the blisters/ulcers and immediately you know it is HSV because it looks exactly like what is shown in textbooks. If you are still not sure or you want to know which type it is, you swab the base of the ulcer/blister and send it to the lab for a HSV PCR test. This has largely replaced viral culture tests we used to do which were highly non-sensitive.

Group 2 - asymptomatic patients
First of all you have to ask yourself and your patient the question "why the hell are you testing in the first place?". Let sleeping dogs lie and let the patient live his life in blissful ignorance.

But you absolutely have to know if you are infected or not if not you will go mad. That's fine.

You then have to rely on serologic tests. In other words, you have to test for HSV antibodies and not HSV virus. The problem with serologic tests is that they are extremely difficult to interpret. There is a lot of cross reaction. For example, most people carry HSV 1 and this may cause the HSV 2 results to become false positive. Even getting a chickenpox vaccine may cause the HSV serologic tests to become false positive.

So you want serologic tests that are as specific as possible. The Gold Standard is the Western Blot test. As far as I know, there is only 1 lab in the world that does this and they only do it for research purposes.

A good alternative is Type Specific Serologic Testing. I have personally called the labs in Singapore that I use for HSV serologic testing and they have told me that the tests that they do are TSST tests. I have my doubts but let's just take that at face value.

The labs use a cut off index value of anywhere from 0.80 to 1.1 to say a test is "positive" for HSV infection. I call bullshit on this. From the studies I have read, it should be > 3.50. So if you HSV IgG index reads > 3.50 you can more or less (99%) say that you have been infected with HSV.

The problem is when your reading comes back as 2.0 or 2.5 or 1.8 and you do not have any symptoms. Are you infected or not? Nobody knows. You can re-test in a few months to look for a SIGNIFICANT INCREASE in titer but most of the time, this does not help either. SIGNIFICANT INCREASE means it must rise above 3.50. If you go from 2.0 to 2.8, you are still none the wiser.

The other problem is the window period. This is the time from infection to when TESTS CAN PICK UP THE INFECTION. This is very different from saying WHEN THE BODY STARTS PRODUCING ANTIBODIES. The body starts to produce IgM antibodies (more on this later) as early as 3 weeks from infection. And IgG antibodies no later than 6 weeks form infection. Very frequently, IgG can be produced much earlier. So the doctor who informed you that the HSV IgG test at 28 days is "90% to 95%" accurate is absolutely correct. From the studies I have read, HSV IgG tests are accurate no later than 16 weeks from infection.

IgM is produced much earlier so some doctors use this test to detect an infection earlier. The problem with IgM is that is disappears very fast also. So it has very limited utility in diagnosis. Furthermore, IgM cannot differentiate between HSV 1 and 2.

Last thing: even if your HSV test came back positive, you don't know when you caught it anyway! Maybe your parents had cold sores and passed HSV 1 to you as a child. So now you test positive for HSV 1 and going to freak out when you have been living with it happily all your life? Maybe you caught HSV 2 from your 1st GF, been symptom free all this while and now you are going to freak out?

After knowing all this you still want to test?
Listen to good advice from everyone here. You have no symptoms. Leave it.
Live your life. Be happy.

Wah who wrote that?

Another doctor on the forum?

 

[Leongsam]

Wah who wrote that?

Another doctor on the forum?

Yes the resident doctor there. I invited you to take up the post but you declined remember?

 

[Asterix]

Nowadays every Tom, Dick and Harry wants to be a virologist.

Truth be told, these “virologist” wannabes are actually “investors” who jumped in too early expecting a V shaped recovery like during the SARS epidemic. As events developed, they find themselves financially burned. Share price of a certain airline has dropped from 2 plus to 90 cents in a matter of days and dividends are sure to be reduced if not scrapped totally. High dividend yield argument for the “investment” also go kaput. The recent rally didn’t benefit this airline stock at all.

Now they are looking for any kind of evidence to support their opinion. This is called “confirmation bias” or something like that.

All this is unnecessary noise, unless you are really a virologist working to save the world. If you going through a divorce will you take your chances with a “general lawyer”, M&A specialist or one who specialises in getting the best deal for the husband/wife in a messy divorce?

 

[nayr69sg]

Yes the resident doctor there. I invited you to take up the post but you declined remember?

I do recall you asking me. I think I declined as I did not want to join the other forum. I remember now.

Anyway an example of a highly specific test is the urine pregnancy test. If the second line shows up it is positive and chances are extremely high that you are pregnant. It is looking for urine HCG. However if there is no second line does it mean you are definitely not pregnant? Nope.

An example of a highly sensitive test is the urine dipstick test. Very very often it will pick up trace blood or protein etc. Does it mean anything? Often doctor would say not sure. Need to do urine culture. Sometimes the dip may pick up positive nitrites. You only get nitrites if there is Ecoli in your urine. Breaks down urea to nitrites. But it can be a contaminated sample and if left in bottle long enough can also have false positive.

If the urine dip is totally negative chances you have a UTI is very very unlikely. Hence it is a test fo exclude illness.