For this update, I’m going to bypass the long answers and try to explain things in a simple way.

What’s the deal with testing? Are rapid tests not accurate?

There are several rapid tests that test for antigen and antibody to Covid-19. They can be helpful when they are positive so people can know when to isolate/quarantine. The rapid tests are less accurate than the PCR tests. **It’s like a pregnancy test. If a pregnancy test is negative, you still want to check later to be sure, but if it’s positive–it is most likely a true positive and will not turn negative.

What about PCR tests? Are these better?

Yes, PCR testing is more accurate because it is looking for the genetic sequence specific to Sars-Cov2-19, aka Covid-19. You can lower the threshold for getting a positive test by running more cycles. Since it is looking at the specific genetic sequence; it’s the best one to confirm. These PCR tests were given mainly way up the nose (nasopharyngeal) in the Spring, but now studies are showing that saliva, oral, and nasal swabs have similar rates of detecting Covid-19. PCR testing can detect virus during the early and late infection periods, making them particularly useful.

I’m hearing 10 days and 14 days. Why the difference?

10 days refers to infectious period and 14 days refers to incubation period. After an exposure to a person who tested positive, quarantine for 14 days. If you yourself test positive, isolate for 10 days if you have symptoms plus 3 days of no respiratory symptoms (no fever, cough, etc.). If you are asymptomatic, then isolate for 10 days after you test positive. **These new guidelines reflect the findings that patients whose symptoms have resolved may still test positive after 10 days due to viral shedding of dead virus, but are likely NOT to be infectious. ***you cannot test out of isolation or quarantine. Again, you can’t test out of quarantine or isolation. ****The North Dakota state rule that recently stated that a healthcare worker who tested positive could return to work if not showing symptoms is ridiculous and dangerous. It shows that our healthcare system is stressed and overburdened, and when that happens, bad decisions are made.

I was at a party where someone I interacted with tested positive, when should I get tested?

Try to quarantine for as much as you can for at least 5-8 days before getting a PCR test to limit to the possibility of getting a false negative. If you are having symptoms, test as soon as possible.

I heard that the reason our number of cases is increasing so much is because we are doing much more testing?

No, just no. The percentage of testing is increasing and we should be testing more than we are currently. However, there is a higher percentage of cases that outpaces the increase in testing.

I concede that the number of cases is increasing and that it is not due to the increase in the number of tests being done. But, our death rates are less, doesn’t that mean it isn’t as bad as the media is portraying?

Again, no. Death rates are down because we now know how to treat a new virus that we didn’t have knowledge of before last year. The rates of hospitalizations are increasing. Deaths and hospitalizations usually lag 2 weeks behind. This also assumes that there aren’t other long term effects of covid such as fatigue, breathing issues, and neurological issues (brain fog, lack of smell and taste).

There is this thing called “The Great Barrington Declaration” that many doctors have signed saying we shouldn’t go on lockdown and that our pandemic response has been too strict. Could the idea of protecting the vulnerable via lockdown while leaving the rest of the country open work?

Trying to keep answers short here: Besides that it’s a logistical nightmare to try to implement, “protecting the vulnerable by locking them down” while the rest of the population is open as a way to achieve herd immunity doesn’t work without a vaccine. We don’t know how long immunity lasts, so if there is the possibility of reinfection or decreased immunity with time, then we would be in a perpetual cycle of people getting infected, getting better, and getting infected again.

Other reasons the proclamation doesn’t hold up:

1. The declaration was developed by a Free Market think tank, not scientists.

2. Example of Sweden doesn’t match up because Sweden as a culture is better at preventing mass casualties. A large part of the population lives alone and can isolate better, universities were shut down, Swedes have better access to healthcare than Americans, and they have banned gatherings of 50 or more since March. It’s not open the way people are claiming. Sweden had more deaths and just as much economic loss as surrounding countries.

3. The “protect the vulnerable” idea is almost impossible to do because not all elderly live in facilities. Sweden actually had the most deaths from eldercare facilities even though the facilities were in lockdown.

4. Who is considered vulnerable? Many Americans have risk factors such as high blood pressure, heart disease, diabetes, a BMI above 40 and are also our essential workers basically keeping our country running. The lower the income level is, the less likely it is that the person can work remotely or stay home. Removing these people from the workforce not only puts greater burden on those of lower socioeconomic status, but it presents a problem of who will work all the service jobs that we still depend on. **Instead of trying to do something BIG and GRAND that probably wouldn’t work, we should focus on those small things that do work: like wearing a mask, social distancing, and washing our hands.

Should I get the Covid-19 vaccine when it comes out?

Once a vaccine has gone through the rigorous safety protocols verified by independent groups of scientists, then YES, you should get the vaccine. It is our best way to achieve herd immunity and end this pandemic.

Why are vaccines our best way to get herd immunity?

Vaccines are able to immunize a large portion of our population in a short amount of time. The immunity of the population is on the same schedule. This leaves very few available hosts of the virus. **This works so much better if a majority of the population gets the vaccine (for those with concerns, please ask me or a doctor who is well informed and can answer your personalized questions. From a public health standpoint, advice is given for the whole population and I’d much rather have a conversation built on trust and not judgement if this worries you.)

It sounds like recommendations have changed since early Spring, is there a reason that doctors and public health officials are changing the rules so much?

This is an excellent question that absolutely no one has asked me. Yes, the reason that the recommendations have changed are because we have access to new information through countless studies done in the past year. As we learn and increase our knowledge, our recommendations change. Some of the recommendations were wrong, now that we know better, we do better.

What’s the worst case scenario/best case scenario for this pandemic?

The worst case scenario is that our number of cases, hospitalizations, and deaths will keep increasing and the healthcare/hospital infrastructure will collapse. A collapse type situation is one where there aren’t enough beds or staff to care for patients and people suffer needlessly.

The best case scenario is that people social distance, wear a mask, and wash their hands, so that we slow down the spread of the virus. A vaccine will help us get to herd immunity hopefully in the next year or two. We don’t have to go into perpetual “lockdown” but focus on areas that are hotspots and shut down small pockets accordingly. More testing would help us achieve this. A coordinated national response would greatly help with this. Best case is that scientists, Epidemiologists, Infectious Disease doctors, and public health officials become the experts that we all listen to and work together with to get our kids back in school safely, our businesses open safely, and on the other side of this pandemic with less suffering and damage.

Please remember to verify and ask a medical person you trust before you share information. If it seems too good to be true and requires no inconvenience, it’s probably not based in facts. Also, hold the line and check on your friends, neighbors, and family. The holidays are stressful even when the stress is good stress verses bad stress. Consider buying locally instead of a big chain to help your community. Reach out for help when you need it. Pretty much everyone needs help right now. Lastly, and on the risk of sounding like a never-ending broken record, “Be excellent to each other, wash your hands, and cover your face”.