COVID-19 Update: The Wave of Testing Options—What the Numbers Do and Do Not Tell Us

All right, it is great to be with everybody once again. And so the summary of this conversation basically is to help us. The point of this, to help us think more clearly about what's going on right now. There's a whole barrage of tests coming out right now. A lot of our representatives, as well as physicians at national level are saying testing is the answer, testing is the way without testing, we can't move forward. And so I want to briefly talk about the actual testing that's out there and what these things mean. A lot of people don't know what sensitivity and specificity are and how to even apply these to the test. What's a screening test? What's a surveillance test? These are all questions we need to think about. So the gist of this, if you want to skip to the end, the gist is the testing we have is not amazing and we can't use it to make the decisions we have to make. Now I just want to repeat the summary. If you stop here, the testing we have now will not allow us. It's not accurate enough to allow us to make decisions we actually have to make in real time. That's the point of this. So as we go through data and information, a couple points I want to make clear really quickly is we always have to check the source. There's so much stuff passing around that are being spread by news article outlets, news outlets, social media, and always look at the source. If someone's giving you reliable information, they should at least give you a few links, a few points to say, hey, this is where I'm getting some of the source. I know that this is not clinical research, so the expectation is not that every single solitary data point is cited, but there should be some form of citation. If not, you're kind of on your own. And so I just, I tend to apply all those or attach all those to these things wherever I put these. So just always look for that if you want more information. The other thing, before we get started is a Q and A. I probably will do a live Q and A about this. So think about the questions you have and start attaching them either on YouTube or wherever the social media you're looking at this is. And one of the reasons for that is a UK article which I've attached below, and it's basically bringing to question the death certificates, saying maybe twice as many people are dying from COVID 19 as are being reported. And death certificates, that's. I'm not going to talk about that here, but the significance of death certificates is Suspect. How is that done? That's something I'll probably talk about in the Q and A. But these are the kind of things we need to think about as people rewire and reprogram, how we're looking at things and redefine stuff. You know, we can't just mid track say we're not going to use testing anymore, we're going to use death certificates to prove what's going on when no one's even defined the testing is accurate. And that's really what we're dealing with here is this mishmash. And it's mainly being driven by the news media and news outlets, which is concerning. This should be something we talk about, we discuss in this community you go back to with your doctor, your family, with your representatives. We need to be involved with this. It can't just be higher ups or technicians or technocrats saying this is the way things are going. So will antibody testing change everything? Yes and no. There's a flood test out there right now. There's over 70 different tests out there. Every day I learn about a new one that has new utility. Many of these are coming from China. And it's really concerning because when you go and get a test from, you know, literally in our office, we just were able to start testing actually this upcoming week from LabCorp, meaning starting tomorrow, this is Sunday when I'm recording this. We just literally got that ability now through a major distributor of LabCorp. Also, Quest and Bioreference have just in the last week released testing. And these are the biggest lab organizations in the country. There are literally dozens of other small organizations that have testing. It's not validated. So every time you get a test, the question is, who's the manufacturer and how sensitive and specific is is the test. So I want to talk about the different kind of testings, surveillance versus diagnostic versus confirmatory testing, to help wrap your brain around these. So when people start talking about testing, you can start asking yourself, is this a surveillance test or is a diagnostic test or is it confirmatory test? So surveillance testing. The example I use for surveillance testing is Lyme antibody testing. It's about 50 to 90% sensitive. So it's not really good if someone comes into your office to make a diagnosis. It's more for surveillance. We do this antibody testing on random blood. This is basically what the CDC does. And we say, look, 25% of people, 30% of people have had this, you know, where I'm at in central Virginia, Chesterfield county, for example, does this on dogs. And about 25% of dogs in Chesterfield county test positive for having had Lyme disease. So it doesn't mean the dog currently has Lyme. It just means, hey, it's a pretty prevalent thing. So that's the use of surveillance testing. But the problem with them, they're not very. The sensitivity is not good enough to actually make a diagnosis. So what that means for Lyme disease, for example, is roughly 50% of cases, between 40 and 50% of cases that are later found to be positive. The initial antibody testing was negative. So this testing is not great for diagnosis. It's more for surveillance. Now, diagnostic tests, these are where their sensitivity is ranging in the 99% range, like an HIV antibody testing. So what that means is you do the test that's positive, given 99% chance of having this disease. And there are some things like hiv, this is not good enough for. There are other things that this is good enough for. You know, so it depends on what disease entity you're looking at. If you're looking at giving someone the diagnosis of hiv, for example, which means a lifelong medications, lifelong surveillance, lifelong lab testing, then you want to be better than 99% sensitive. That's where a confirmatory test, like a western block comes into play. And it's 99.99. It's actually just be two nines here sensitive. Which means if you test, if you have a group of a thousand people with hiv, maybe one of them, this test will be negative in it if they have it. So you want something that's really, really accurate for that kind of disease. So let's look at COVID 19 testing. What do we have out there where the sensitivity ranges from 67 to 93%. I was actually looking at a lab this past weekend that a patient actually forwarded on to us. Our friend and my wife reviewed and forwarded on to me, and I've been looking at it. We're getting lots of great information, by the way, from people out there. So keep it coming. A lot of it's stuff I've already seen, but, you know, I learn from patients. That's the practice of medicine. It's not just me reading articles and stuff. It's me not just learning, working with patients and on patients, that's actually learning from patients. And that, I think, in my humble opinion, is a good practitioner doesn't just learn on their own. They learn from their patients, with their patients, through their patients. And that's a really important key here. But Anyway, specificity is 93%. Now, does this look more like a surveillance Test, A diagnostic test or confirmatory test. Okay. Well, it really depends on the accuracy of test. If you could get the COVID 19 testing sensitivity at 99%, which is one test I'm looking at, that may actually have. That I'm not going to talk about yet. That might be for our Q and A. Absolutely. But for what we have now, what we're deploying now, which is just IGM testing. No, it's surveillance quality testing, which means if you come in and that's, that's. I think that's part of the problem is people are coming in testing negative, negative, positive. It's like, yes, these are surveillance tests meant to be tested on millions of people. Like what went on New York, for those of you been following. We talked about this last week, New York did some testing and looked at up to 22% of New Yorkers may have had this already. And I think it was 17% of people in New York State have already been infected. In my opinion, that's actually good because that means New York is not quite 40% of the way to herd immunity. That's actually good for New York. But that testing, which was IgM antibody testing, was deployed appropriately, not to diagnose, but to look for the prevalence as a surveillance test. I think the point here is that interpretation depends on multiple things, including the local environment. If you're in an area where there's tons of people with the disease, surveillance test is a great idea. If it's not super accurate, if you're in an area, say a rural America, where maybe 0.0%, 0.2% of people have disease, then this kind of surveillance test is not going to be super accurate because it's more likely to be falsely positive than truly positive. And so interpretation depends not only on the test itself, its accuracy, but where the population you're using. That's something else people aren't talking about. The testing in New York City is going to vary widely in its utility compared to Santa Clara, California, which has a lower prevalence versus Richmond, Virginia or wherever you're living. So disease surveillance, that's the point of that. So the point is that the testing we have is surveillance. And is that the kind of test we can use to now make national policy recommendations like, let's stay close through the summer? I mean, probably not. No, we need testing to make those kind of, that level of a decision. We need testing that is super accurate. If we're going to say 320 million people need to stay locked down, I want a test that's Better than it's right. More than half the time, more than 80% of the time. I want that test that's just like if someone's a mom will tell a patient they have HIV, I want that to be 99.99% accurate. If I'm telling the country to shut down and no one can work, you might lose your house and your job and we might have social unrest. I want the testing I'm using to base that decision on to be really, really accurate, not a coin flip. I think that's kind of where we're at. So the point is we need to use what we got, Use it and use the data we have, interpret it and move forward. But anyway, so disease surveillance, the CDC since March has been looking at the prevalence, suggesting that. Yeah, so this I just want to go through. Yeah, sorry, lost my train of thought there. I want to go through the disease surveillance real quickly and look at the progression with the testing we've been having. Okay, so initially the cdc, you know, this was back in March, the city was saying the prevalence in the United states was maybe 10 to 20 times more than we thought. I read a couple articles that said 50 times maybe, but this was all hypothesis, it wasn't validated. So it was just kind of undercurrents. But the significance of that was that if our mortality rates are being reported at that point in time were 2 and a half to 4 to 5% due to lack of data, then maybe the mortality rates were really 0.6%. And if the mortality rate of a death of an illness is 12% or 10%, you can make much different health policy decisions. If the mortality rate is 0.6% or 0.1%, or from some of the California data, 0.06% mortality rate. And we've got that data now coming out from different parts of the country. And I think the one interpretive parts of that is this disease looks different in different parts of the country. And that kind of makes sense. A city with the rail, with subways, where people are packed into non ventilated tubes on top of each other. When you have, you know, 2.2 million people in a city proper and maybe 8 or 9 million people in a, in a metropolitan area, the disease is going to look much, much different there than is in the Allegheny or rural area of Virginia or the East Coast. Anyway, so, so Iceland, then we came over to Iceland, got new data. Look, Iceland, maybe 50% of people in Iceland were asymptomatic. Now we're. That's more well known information here now in the United States, but we learned about that mid last month. We also Learned that maybe 0.8% of Icelandic people were infected recently a couple weeks ago. I'm losing track of time by the way, because COVID 19, 247 all day, every day. It kind of gets you after a while. So anyway, if some of my dates roll off as I'm going by the floor to see my pants, I do apologize. Anyway. Chelsea, Massachusetts. One third of people were testing up there positive for disease. There's a homeless shelter up there as well. It showed 34% were positive from previous infections. So maybe in Boston replaced Massachusetts. Almost a third of people already have this. If that's the case, if we're using 50, 60, 70% as our numbers for herd immunity, maybe the public policy for Boston is going to be radically different than the public policy for Georgia because the incidence is different. If you're, if you're almost at herd immunity sheltering place doesn't make much sense. Santa Clara came out the blood banks looking at anywhere from 2.5 to 4% testing positive. And the interesting thing about the Santa Clara data, excuse me, is that the fatality rate with that then went down to 0.2%. Now you have to realize all this testing is disease surveillance. Remember we talked about up here and we'll go back up here, the different kind of testing. Where'd I go here? Surveillance. I'm gonna put the little error here. Surveillance versus diagnostic versus confirmatory. This is all surveillance data. Okay. Keep that in the back of your head. LA county, those interesting LA county with their testing. The mortality rate is less than 0.6%. The flying new York City this past week had some really revealing data. This is a great, great surveillance test. This is like what we need to be doing here in Virginia. Wherever you're at, this is what needs to be happening. Every state we take a random sample of people, you test them. There's 19.4 million people in the state, 2.7 New York City proper, and the state prevalence was 13.9% and the city surveillance was 21%. That is a crazy statistic to think about that almost one out of five people in New York City have had this. But that puts the case fatality rate down at 0.72% in our Italy, the state, the region that is our Lombardy, which would be New York City property, or Italy, which would be New York State, has a mortality of 0.72% based on the most recent data before it was estimated at 11% again, this is surveillance information. This is great. I think this changes how we look at stuff. But the testing we're using. You can't use this test, though, to determine if people can be reintroduced to society because it's a surveillance test, it's not a diagnostic test. And I think that's my point. My point is now all the talk is what, what determines if people can get back in to get back to work? We're going to do get certificates, we're going to do testing. You can't use surveillance testing. That's wrong. Almost, maybe half the time or a third of the time, determine whether or not I go back to work. Now, I'm a physician. I've been working the whole time. I've not had a break, actually. I've been wearing scrubs the whole time, wearing my face masks the whole time. So, you know, actually, I'm looking forward to a break, actually. But the point is that the testing we have is not what people are saying it is. Point. What's the point of this? When do we have enough? The point is, what's the question? The question is, when do we have enough data to act? And when there's enough data, act. From a public health perspective, do we have enough data now to make decisions? I think yes. There's been suspicions that this is not as deadly as we thought. Still bad. I mean, still people are still dying from it. I mean, at 0.6% mortality, it's still worse than the flu, which is usually about 0.1%, but it's not going to ravage our society. Now we're at the point now that the disease is not as bad as we thought. Maybe the cure is worse than the disease. Maybe a shutting down our shuttering the economy. Hospitals are going out of business now. You know, hospitals are going bankrupt. There are hospital systems where they're cutting physicians pay, laying off people. I mean, literally, we're saying, oh, the healthcare system are our heroes and the janitors and people cleaning up our heroes and the grocery stores that are staying over, these are our heroes. What's like literally, if you're having these hospital systems shut down, maybe the. Maybe we're at the stage that the treatment's worse than the cure. I don't know. But these are things we need to start discussing among ourselves and talking to our representatives about and getting them to get in line with the most recent data. Not making actions based on data from a month ago or six weeks ago or two months ago, because things are moving quickly. What else does this Also mean it means one size cannot fit all. What you do in LA county, you can't do New York City. We need to make our responses specific and unique to the individual regions of the country. Virginia will not do what Georgia is doing. I'm from Virginia, Central Virginia. Virginia will not do what New York is doing. We have to get local data that's actionable. Now, I don't know what our numbers are in Virginia because Virginia has not been testing that aggressively. We do have numbers, but they've not been put out there. So I can tell people with incidents in New York, as California has. New York has. We have data from other countries and that's where every state needs to respond. And whatever state you're living in, you need to go to your local representatives, your county representative. You know, if you're, you know, if you're in Palatine county, talk to your, your Palatine senator. If you're in Goochland, talk to your Goochland senator representative and say, look, we need to do this because it needs to be individual response. So what can we do? What can you do when you. What's our way forward? We need to have a public, the political policy. We need a public debate. This needs to be something that we discuss and then we get our representatives to represent. We have representatives, not overlords. We have representatives, not kings. Some of the things, it's some of the stuff you've been hearing about with grocery stores having aisles shut off because whatever is being sold in that aisle is not essential. But you can shop in this aisle, hearing stuff like that going on. States like Minnesota, other states, Michigan. It just makes you kind of wonder, like things are kind of crazy anyway when you talk about public policy and political debate. Prevention. So we've talked about prevention, sleep, you know, huge important nutrition, hugely important. These nutrients I've listed here, vitamin D, C, hydrotherapy, nac. There's so many things you can do to help boost your immune system so that when you get this, because personally I don't see the vaccine as the answer to our messiah, our savior, our hero, our rescuer is not going to be vaccine. If it's going to take 12 to 18 months for this to get out. We can't shut the entire economy down for a year. So what can you individually do to boost your immune system? Sleep is usually important. We've talked about that on past videos. Our survival guide talks about that. It's free for you to download on our website. Nutrition. We've talked about that on the survival guide as well. These are all Things we've talked about and we'll continue to talk about treatments. One thing I'd like to get into, I'd like to. I like the information and the social media stuff to calm down enough so I can actually talk about all the, all the drugs that are being studied. These are treatments. I've listed all the ones that I've looked at and seen so far, and many of these you've never heard of. Not a zoxamide. If you kind of go down here and see one right up, right below Sirolimus, right above Fativnomir, that's actually one. I did a research on using a parasitic anti. Parasitic for an antiviral, which that was actually a flu study. So these are, these are some things I'm very, very familiar with Tovaquone, which is something we use with our Lyme patients. But these are all the current treatments that are being studied. Point is, is that there's a lot of. If you. Okay, so one you want to prevent, right? Boom, hit the prevention, that's at 80%. But if you get sick, these are all the things we're working on for treatment that if you get hospitalized, you know, using, you know, tocolizumab, which some of you've heard the very, very bomb. I have a list of all the biologics. These are all the biologics that are being studied currently. Azithromycin, niazoxamide, all these drugs. Yes, hydroxychloroquine is still on the list because we'll talk about that later. But what I'd like to do is have enough time eventually to walk through some of these and talk about the research that's going on. Because I think it's helpful to know that actually there's a lot of stuff going on. If you get sick and if you get hospitalized, there are things they can do for you. Absolutely. You don't want to get intubated because, you know, 50%, 60%, depending on the data, what city, what state, what region, up to 9% mortality if you intubate it. But these, these are things we're looking at to prevent that proning when people get sick, having them on their stomach versus their back using permissive oxygen, positive airflow. There's so many things that are happening in this treatment area that I think if we knew about, we'd feel better about. But we're not hearing about treatment. We're only hearing about if you get this, you'll die and we have to stay at home. And it's more nuanced than that. It's more nuanced than stay at home or go out and die. I mean, literally, it's way, way more nuanced than that. I think if we knew that, we'd have a lot less trepidation and a lot less fear. So hopefully this was helpful. Again, follow us like us Share this information if you feel like it's helpful, I will attach the links to all this below. Share those as well with your friends. You know our website is a resource, whether it's nutritional guides, diet guides, books to read while you're hunkered at home. I think we put back out our initial podcast. We have some information there. Diet, lifestyle stuff. Start becoming active. Unfortunately, there's this thing called the COVID 20 and that's basically people are staying home, drinking, gaining 20 pounds. They're doing the exact opposite of what they should be doing to boost their immune system. Maybe turn the corner and start becoming more what can you do individually for your family, for your job, because you want a place to go back to work and then for your state, your locality, whatever ways you can move to get your representatives to represent and move forward. So again, follow us like us Share this if it was useful. Yeah. So hope you have a great day. Take care.