Aaron Hartman, MD, answers COVID-19 questions about antibody testing (EU test shows ~90% sensitivity; Abbott test rolling out to Richmond urgent cares), hydroxychloroquine dosing (5-day course with azithromycin and zinc, requires EKG monitoring for QT risk), and who needs hospital care. About 80% recover without treatment; obesity increases complications 2 to 4 times.
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All right, everybody. So this is going to be a Q and A session, just answering some questions. If your question is not answered here, just remember you can ask these in the comments section on Facebook and Instagram. We're compiling those. Some of the questions are already being answered in previous videos as ones keep on popping up. We'll try to keep on addressing what people feel is important as well as put new information out there. So this is just a quick Q and A session. So antibody testing. People have been asking about antibody testing which is not currently available in the United States. The hope is that will be available by the summertime. Once it is available, people can start getting tested to find out who has already had this infection. Maybe we'll find out. 11.8% of people have already had it, according to that recent study I referred to from Italy. Who knows, but that's going to be helpful. Now, the problem with the antibody testing is currently the one where that's out in Europe that's getting ready to get introduced has a 90% sensitivity, meaning that 10% of people who've been sick will be falsely negative. So what does that mean? It means if we test 100 people who've had the infection, 10 people who have had it will test negative. So what you have to remember is no test is 100%. There's no test that has 100% sensitivity and specificity. What does that mean? If you have the disease, the test will be positive. If you don't have the disease, the test will be negative. That's what those words mean. Abbott Labs is actually a test that's coming out currently. It's being made available to urgent care centers and the Richmond area. Hopefully our office will have it in the next two weeks. I know a lot of people are hearing about this and they're like, hey, have you got this test yet? It's available right now to urgent care in the Central Richmond area. BetterMed has actually hooked up with the Virginia Department of Health, and actually they have several sites around the state where they're providing testing for COVID 19. When I'm hearing from patients, it's taking three to four days to get the test back. But that's a private organization that's hooking up with the Virginia Department of Health to make that testing available. That's where you have to find out what's going on in your local environment to know what's going on so you can figure out where to get tested if you have symptoms. Lots of questions about hydroxychloroquine. There's an article shared which we'll probably reshare below because we've getting lots of questions. I've already used this medication with several really sick patients. I think the big thing about hydroxychloroquine is first it's been around for a long time. I use it with some of my patients with lupus. Some of my patients have been out for years. And the use for COVID 19 is literally for five days. It's a very short duration. So I think it's gonna be very, very safe. Azithromycin, which is used with the hydroxychloroquine, another medication that we use all the time with a Z Pak, very safe. Concern with combining these two together is that might cause a cardiac arrhythmia via prolonged QT interval syndrome, which your physician can do an EKG and figure out if you have issues with that. The thing is, you have to remember you have to take the hydroxychloroquine with zinc. What hydroxychloroquine is doing is getting zinc into the cells. If you don't, if you have low zinc levels, the hydroxychloroquine is not going to have the quote unquote bang for the buck that you're looking for. But we also have to realize that this is not a panacea for everybody. 80% of people who get sick will get well. Regardless of what we want to do, we want to find the 5% in the ICUs in the hospital, which will be outside of my realm of expertise. That's going to be with the intensivists and the critical care specialists. It's more in the 15% that will need health care action admission. Can I prevent that if I see those people on an outpatient basis? And that's where working with a skilled practitioner can be helpful. Someone who says, hey, like my one patient I saw this past week who didn't go to the hospital had pneumonia, had fever, had a fast heart rate, oxygen level was a little bit low, but refused to go to the hospital. So I'm like, look, you need to be in the hospital, let me treat you. And three days later he was doing much, much better. That's a situation where I'm. If someone just has a cold or a cough or is concerned, this is not an anti anxiety medication. This is not a panic medication. There's other medications for that. We need to reserve this for the sick because if we make a run on this like we did on toilet paper and face masks, it won't be available for the 5%. If they don't get it, it might be life altering. Or the 15% that will be entering the healthcare into the hospital world. Maybe if we can make that a lower number, that we can have a massive impact on this disease. So the current criteria, the ones we're looking at, if you're over 60 years of age and you have one to two comorbidities, don't forget obesity is a comorbidity as well. If your body mass index is over 30, you have a multiple two to four fold increased risk for complications of this disease. In addition to high blood pressure diabetes. If you're less than 60 and you have multiple comorbidities as well, this is something to think about. You want to make sure you're doing lab testing with it. It's not just taking the drug. It's also checking your lactate level, your CBC, checking blood tests for heart failure like an NT pro, BNP comp, chest X ray, sed rate, cardiac enzymes. Those are the tests I've been doing in my office to help me determine if I'm doing the right thing. This is not a medication for the weak at heart to use referring to practitioners. You have to be comfortable taking care of patients who have heart failure, who've had a heart attack and respiratory distress on an outpatient basis. If not, you need to send these people to the hospital. So other things people have asked me about, there's a University of Pennsylvania had a very interesting potential vaccine they're studying right now. Very excited to see what happens with this. I'm not going to say too much about it. I will attach the article below. Lots of promise, but it's a little preliminary. I did do a video about a week ago talking about studies and data and validity. Just refer back to that. This is one of those things that was published in actually a newspaper, not a research journal article. But it did link back to the original research in that article which I've attached below. It's a little too early to say, but it's very promising. So questions I have, you know, people ask me questions. What questions I have. Why are there only 1200 deaths in Germany out of 91,000 cases? We don't know. Why is this disease so bad in New York City and not in Los Angeles? I have some theories, but ultimately we don't know why. In Stockholm, Sweden are 1/3 of all the elderly care units people have testing positive for COVID 19 in Stockholm, 1/3 of all basically elderly home patients have this. Yet the disease is still said to be early in Sweden. I would think it's pretty advanced if one third of elderly and long term care facilities have this. How do we differentiate those who are going to die from COVID 19 versus those who died with COVID 19 from other causes? So there's a controversy right now. If you basically die for heart attack, stroke, pneumonia, whatever, and you happen to test positive for COVID 19, we're assuming that's the cause of death. Pretty good assumption. But are we 100% sure that I don't know, I don't know, I don't know how many questions I don't know. Four times I have theories. But ultimately you're going to see a lot of theories floating around about these and other things. Make sure you get reliable sources of information. If someone says, I know I'm 100% sure about this, then I would just, you know, step back. I defer to what Socrates said in the Phaedo when he was before the the Greek Council when he was accused of perverting the youth. And his defense was, you all claim to know and yet do not know. I know I do not know. And I say I do not know, therefore I'm the only wise one among you. And many, many times in my career I kind of pull to that where I know enough to know that I just don't know. Some people don't know enough to know that they don't know. If that resonates with you, good. That's just a healthy level of skepticism. It doesn't disable you. It means you look farther, you study more, you work harder, you look for more resources. The lack of knowledge is not an excuse for inactivity. It's supposed to drive us to dive deeper and look more. And that's what's done in my life. If you're working with a good practitioner, it's what's going to do with their professional career as well. Anyway, hope this has been helpful. Continue to post questions below. We'll continue to try to answer them again, like us on Facebook, Instagram, Follow us. Give us five stars. That will allow this information to be more available to other people. So hopefully this can help as many people as possible. Y' all take care. Have a great weekend.
