Wednesday, February 9, 2022

The COVID-19 Looking Ahead Episode

Episode 68

Speaker 1 (00:04):
Coming to you from Beaumont, this is your House Call.
Dr, Nick Gilpin (00:15):
As cases and hospitalizations fall in Michigan and around the country, you might get the feeling that Omicron is behind us. But what does the data say? What can we learn from this most recent surge? And what comes next for us? While some places consider relaxing their restrictions, we're bringing together our team of COVID experts to discuss what to expect next as we move beyond the fourth wave of COVID.
Dr, Nick Gilpin (00:45):
Hello and welcome to the Beaumont House Call podcast. I'm Dr. Nick Gilpin. My goal is to help you and your family live a smarter, healthier life. Today's conversation is about the most recent fourth surge thanks to Omicron. We have our house call podcast co-host, Dr. Ahsa Shajahan here.
Dr. Ahsa Shajahan (01:00):
Hello, hello.
Dr, Nick Gilpin (01:01):
Good to have you here. We also have Dr. Justin Skrzynski. He's one of our trusted voices on COVID. Justin has taken care of hundreds, maybe thousands, of COVID patients at the Beaumont Royal Oak campus. He's also helped get the word out on safe care for the community. Hi, Justin.
Dr. Skrzynski (01:17):
Dr, Nick Gilpin (01:18):
Good to have you here also. Great to have all of us here. Let's go ahead and get started. Lots to discuss. First things first. I'm going to put my timestamp on this information. I think that's important. It is mid-February 2022. Cases are declining all around us, around the state, around the country, but we're still in a place where transmission is quite high. The community positivity rate I think at this point in the county where we're sitting right now is about 18%. Justin, first to you. What are you seeing right now at the hospitals?
Dr. Skrzynski (01:50):
Right now, it's looking a lot better. If you look at the case numbers that we have at Royal Oak and also systemwide, we're looking at perhaps even as low as a quarter of the COVID patients that we had at the... Absolutely, absolutely. I think it's important to note, too, that a lot of the patients are less sick. You keep hearing that in the news, that Omicron is less deadly. Still deadly. Again, it's a percent chance. In terms of the percent chance that someone's going to progress to one of the worst outcomes, it's much lower. But it was well said that a lot of these patients are here with COVID as opposed to from COVID, so lot of incidental cases.
Dr, Nick Gilpin (02:25):
Really good point. I think I'd like to get into that maybe in the podcast at some point and talk about that, because that's been an interesting nuance of the data that we've been sharing with the public.
Dr. Ahsa Shajahan (02:36):
Justin, in terms of the people that are admitted with COVID, is it still the unvaccinated at a higher rate than those that are vaccinated?
Dr. Skrzynski (02:45):
Absolutely. Absolutely. If you look at the people that we're most concerned about, it's still the same group that we were most concerned about from the beginning. So chronically ill, overweight. Immunosuppression, so our transplant patients get hit especially hard. You might take a look at the numbers and say, well, that's a high number of breakthrough cases. So if you look at the vaccinated people that we have, and we can certainly drill down into that, but upwards of something like 40% breakthrough cases. One might take a look at that and say, well, that's awfully high. But I can tell you right now that in terms of the people who are here for COVID, so in terms of the people that are sick and in the hospital specifically for COVID, that's the majority of those. The vast majority of the sick cases are going to be unvaccinated.
Dr, Nick Gilpin (03:25):
Maybe we should talk about this now. I think we've teed it up pretty well. This is a very frequent question that we get on the socials. People see those numbers and they use this as evidence that maybe the vaccines aren't working the way that they should. I think we want to dispel that rumor. We want to really try to put that to bed.
Dr, Nick Gilpin (03:43):
The other question is why can't we get at that exact number? We're seeing 40% or so approximately of people in our hospitals with COVID. They're testing positive, they've been vaccinated, but they may not necessarily be there for COVID. They might be there surgery or for a sprained ankle or something else. Why can't we really pin that number down better? Well, I think the answer is because it's hard. Because you have to root through these charts one at a time and look at what these people are actually in the hospital for, and that takes time and that takes resources.
Dr. Ahsa Shajahan (04:18):
I think also, the definition of vaccinated is still the two vaccines. I think that many people have been over their six months to five months of being vaccinated and their immunity is waning. And so when you say that there are people that are vaccinated that are getting hospitalized, it's difficult to tell, or like you said, to look through and say, hey, were they boosted? How long ago did they have their vaccination? Because many people will say, "I've been vaccinated," but they were vaccinated almost a year ago. That makes me wonder a lot too, especially in the outpatient setting. When people say, "I'm good. I'm vaccinated." I always ask, "When was your last vaccination?" And the fact that, just like with other illnesses like the flu, you have to get re-vaccinated to have that protection.
Dr, Nick Gilpin (05:03):
Couple points. I think one is we're pivoting away from this language of fully vaccinated and we're pivoting to a new term, which is up to date. Because you could have gotten your two dose mRNA series just recently and you would technically be up to date. You're not yet eligible for a booster, but you are up to date. You're protected.
Dr, Nick Gilpin (05:23):
The other point, let's use an example. Let's take a patient who comes to the hospital with severe abdominal pain and has appendicitis. They're in the emergency room. We're at a place right now where because COVID numbers are so high, we're testing everybody that comes to our facilities. This person gets a COVID test and they test positive. Now, upon further questioning, we might elicit the story that I had a sore throat and a runny nose a week ago and I lost my taste and smell. How do I categorize this person? Does this person have COVID? Yes, I would argue they do. They just had symptoms a week ago and they tested positive. Is that person here for COVID related reasons? No, they're not. So what bucket do I put that person into? They're vaccinated, they have COVID, they're here for other reasons. We're seeing a lot of this.
Dr. Ahsa Shajahan (06:16):
I think just really having that determination of hospitalized with the admission of COVID as opposed to, as you said, coincidentally also having COVID. That'll probably give us better numbers of what's going on. But not to say, though, with the hospitalizations being down, it's great, and the severity being down, it's great. It seems like with Omicron as well, it's more upper respiratory than lower respiratory, so people are not getting intubated as they were with Delta. But I feel like in the outpatient setting, I felt like everybody had COVID for a while. There was a point, probably up to about two weeks ago, where every single patient was there for COVID. It was really funny to me because people would say, "I think I might have strep throat. My throat's just scratchy. I feel a little bit down. Can I come in for a strep test?" And I'm immediately saying, "You probably have COVID."
Dr, Nick Gilpin (07:08):
Dr. Ahsa Shajahan (07:09):
It's probably COVID. And there's always this, "Well, I don't think it is." I'm like, "I think it is." And then lo and behold, I'll get another call the next day. "Oh, Doc. It's positive for COVID." So I do think that it was very prominent in our communities and many people were getting it regardless of vaccination status. But the important thing was, as we mentioned, the fact that people were not getting hospitalized as much and not being in the ICUs, not being intubated, and the death rates not being nearly as high.
Dr, Nick Gilpin (07:40):
Agree. I think now we're in a place where, by virtue of vaccination or by virtue of having had COVID, the collective number of us that has been exposed to COVID has gone up significantly. And so societally speaking, we're all getting some collective immunity. This will hopefully carry us through to whatever may come next.
Dr. Ahsa Shajahan (08:01):
You know what? You know how we were talking earlier, and you mentioned the previous pandemic that you were reading about in the Washington Post? So with everyone getting COVID and immunity being higher through vaccination or natural immunity, where do you think we are? Are we at the endemic point? I'd love to hear both of your thoughts on that.
Dr, Nick Gilpin (08:25):
Almost. I don't think we're all the way there yet. I think endemic, it's good to talk about endemic too, because I think a lot of people look at endemic like it's a goal, like this is the end of the rainbow. I think we've got to really frame this in proper terms. Endemic means that it's everywhere and its uniform in terms of its transmission. It may have a seasonality to it.
Dr, Nick Gilpin (08:50):
Endemic does not necessarily mean good. There's lots of examples of terrible things in history that were endemic, or even to this day that are endemic. Malaria is endemic in Africa. Doesn't mean you want to go out and get malaria. So I think just separating some of that.
Dr, Nick Gilpin (09:06):
Are we moving into maybe a more sort of seasonal look to COVID? I think we could be. But again, I'm so bad at making predictions. We got to also remember that with so many of us collectively unvaccinated and unexposed, the community is still ripe for new variants to emerge, and then we could all be susceptible again at some point.
Dr. Skrzynski (09:29):
Absolutely. I think it's important not to just hand wave it. I think a lot of the popular conception is that, well, everyone had Omicron, so that's it. We're done. Between vaccination, between natural immunity, we've got enough exposure that this is it. I don't think that's true because it raises a couple important questions. One is, do we care about the numbers? I think to say that this is truly endemic means that we don't care care so much about diagnosing every COVID case, we don't care so much about isolating, and we're clearly not to that point yet. I think a lot of people have this notion that Omicron is less severe and that COVID will inevitably become less severe, which is not necessarily true. There's a lot of viruses that do have that tendency, and we can certainly talk about at that. But if you look at Delta, for instance, Delta was very tenacious, very deadly, and that was downstream. That was-
Dr, Nick Gilpin (10:22):
Worse what came before it.
Dr. Skrzynski (10:24):
Exactly, exactly. Also, if you look at Omicron, right now, in order to generate another huge surge, you'd probably need a variant which is significantly different than Omicron. Considering how much natural immunity, how much vaccination, you'd probably have to have a significantly different variant in order to generate a new surge. If you look at how quickly we saw Omicron as a variant of interest and then how quickly became the dominant variant, that was a very short period of time. That's a month. So that just shows that all the predictions that you can make, we can make predictions based on the best available evidence, but at the same of time, these things can change very quickly.
Dr, Nick Gilpin (10:58):
Excellent points.
Dr. Ahsa Shajahan (11:00):
I feel a new empathy towards the weathermen because they're always predicting the weather, and sometimes they get it right and sometimes they get it wrong, and it's just based on the science. One of my friends actually is a meteorologist and he was like, "Now you get where I'm coming from." And I definitely do.
Dr. Ahsa Shajahan (11:19):
But one thing I wanted to bring up, too, in terms of oftentimes when we look at the pandemic, we are looking at it from the lens of the United States and the fact that we've got boosters, we have about 64% of our population is vaccinated. But the pandemic has to do with the entire world. I think that variants emerge when the virus is not controlled, and there's still a lot of places around the world that are not controlled. For example, in India, 52% of the population is vaccinated, but less than 1% has received a booster. If you look at South Africa, 28% of the country is vaccinated, only 28%. And again, less than 1% is boosted. And then you look at it country like Kenya, only 11% is vaccinated and less than 1% is boosted. When you're looking here in the United States, only 27% of us are boosted.
Dr. Ahsa Shajahan (12:12):
So again, as long as this virus is able to replicate and get on different hosts, this is going to continue to get more and more variants. Just because things are looking better here, you can end up getting a really bad variant that might come out of a country that is less vaccinated. So I think we have to look at the endemic point from a global level and not so much just from the lens of the United States.
Dr. Skrzynski (12:36):
100% agree. We do live in a global community now. You saw how fast COVID dispersed from its original places. And you look at the two variants that we have that have caused an incredible amount of mortality in this country, that being Delta and Omicron. Those originated in the areas that you just mentioned, the very under vaccinated areas.
Dr, Nick Gilpin (12:56):
Let's pivot to... Well, I guess we're already there. Let's talk a little bit more about Omicron and the new variant. It's not yet considered a variant of concern, but it is a new thing, and that's this Omicron sub variant called BA.2 Some people are calling it stealth Omicron. So it's a stealth variant because certain tests don't detect it as Omicron. It looks a little bit different to certain tests. I don't want to get super in the weeds on that. The tests do still work. But it is distinct from Omicron. So let's talk a little bit about that. So BA.2, several additional mutations, right?
Dr. Ahsa Shajahan (13:34):
37 some mutations.
Dr, Nick Gilpin (13:36):
Even put it separate from the original Omicron variant, BA.1. BA.2 may be more transmissible than BA.1, the thing that came before it, but it does not appear to be causing more severe disease, so that's a good thing. BA.1, at least as of this morning when I looked at the data, is still by far the most dominant strain. So the original Omicron is still the dominant strain, making up more than 96% of COVID across the country. BA.2 is slowly rising. When you look at the CDC data tracker, which is a great way to find this in real time, BA.2 went from nothing to about 3% to 4% in the last week or so, so it is climbing.
Dr. Ahsa Shajahan (14:18):
You know what's interesting about that? There was a study done in Denmark that stated that they found that BA.2 was 1.5 times more transmissible than BA.1. I'm thinking that Omicron, the original, let's call it that, was so transmissible that if you got something that's even more so, then it should be everywhere very soon. So the question comes up, is there some immunity if you've had BA.1 to BA.2? I don't know.
Dr, Nick Gilpin (14:43):
The answer seems to be yes. So the currently available vaccines do seem to provide some protection against BA.2, just like they did for BA.1. Having had the original Omicron, Omicron classic, does seem to provide some protection against getting BA.2. So will BA.2 get a foothold in places where Omicron has already blown through the population? Hard to say. Maybe not. Because if so many people have already been exposed to what came before it, it may not get as much of a foothold.
Dr, Nick Gilpin (15:13):
So I guess to bring it on home, what does this mean, guys? Does this mean anything for us? Do we care? What should we do about BA.2 now that it's starting to rise? What do you think?
Dr. Ahsa Shajahan (15:25):
I think it's still more of the same. I feel like every COVID podcast is the same bread and butter of getting vaccinated, making sure you're up to date on your vaccination. So if it's been more than five months since your last vaccine, it's probably a good idea to get vaccinated again. Also, I'm a proponent for masking. I still think that masking in crowded areas or indoor places or in places that you may not have high vaccination rates is still the best way to protect yourself. And of course, the hand washing and social distancing is needed. So that's my take.
Dr. Skrzynski (16:00):
I agree. I agree. I think in terms of not just COVID, because right now you're looking at Omicron. You're saying, well, now we're talking about the original Omicron versus the original COVID. You really wonder how many steps do you have to take until you really end up with a new virus at this point. When people point to the vaccine and they say, "Well, it's not holding up as well against Omicron," or they point to testing and saying, "Well, there's some evidence that things like antigen tests may not be as effective." Well, you're almost dealing with a different virus at this point. I think moving forward, the adaptability is going to be key in terms of societally, our willingness to do things like masking, our willingness to be adaptable in terms of whether or not we're going to shut down large venues or get rid of indoor dining, and on a flexible basis.
Dr. Skrzynski (16:48):
I think that if you look at the flu, for instance, that was the classic. Where did all the flu cases go? Turns out that if you take measures against one contagious respiratory virus, turns out that you prevent many respiratory viruses that are contagious. So it's not just Omicron. We live in a very crowded society, we live in a very international society. In order to prevent these sort of issues in the future, I think the adaptability is what we have to take out of this.
Dr. Ahsa Shajahan (17:17):
I love that. Adaptability is key, because I think the situation is we're all tired. People are tired. Many of my patients are asking me, when can we stop masking? Is that ever going to be a reality? Is that the future? Are we going to be able to see each other's faces and not have to have a mask hanging from your car rear view mirror? My answer to that is that I think definitely in the future, I think we will be able to unmask. But I think at this point in time, we're just coming down from Omicron, and I'm not sure if it's the best thing to let your guard down just yet. What do you guys think?
Dr, Nick Gilpin (17:55):
Totally agree. I'm glad you both brought up masking because this has been getting a lot of attention lately. You're starting to see a lot of mask mandates get relaxed. A lot of discussion there. Asha, I like the way you put it. I think that we have to look at what's going on around us right now in the community. We have to say, wow, there's still a lot of COVID out there. Great news that cases are going down. But when you just take a snapshot of what the numbers are now, still incredibly high transmission, still a lot of COVID out there. Now is probably not the time to start peeling those masks off
Dr. Ahsa Shajahan (18:28):
Also, with this last surge, a lot of the patients who were in the outpatient setting, I was talking to many of my patients. Although they had more of a cough, cold, sore throat, maybe a little bit of fatigue, and they were feeling better. Many of them were working from home and were able to function. It's lingering a little bit longer, anecdotally. Patients are feeling 100%. A lot of people have lost their sense of taste and smell, and it's been months since it's come back. So there are some ramifications to getting COVID. Although people equate it more so to, oh, it's just a cold and you feel better in a couple days, it's not a big deal. That's not always the case for everybody. And then this chronic fatigue that seems to linger on for months is a problem.
Dr. Ahsa Shajahan (19:13):
I have one patient who, unfortunately, she got the original Alpha COVID, and then she ended up contracting Delta, and then now she has Omicron.
Dr, Nick Gilpin (19:26):
Dr. Ahsa Shajahan (19:26):
Yeah. I tell her that she's the COVID expert because she's had almost all of them. What she's been saying, though, is that although Omicron, she was not hospitalized. She was hospitalized for Delta. She was not hospitalized, she was at home, she felt like she was doing well. She's just so fatigued, and it's been over three weeks since she's been now testing negative. So again, I still say that you probably don't want to get COVID. Some people were saying, "Oh, just get Omicron and get it over with." I don't think that's probably a wise thing to do. There's still a lot of ramifications to getting the illness. We have to still stay safe, and the best way to do that is vaccination and masking.
Dr. Skrzynski (20:07):
To me, that's the most compelling reason to wear the mask, is you do don't want to get it. If you look at the downstream effects from COVID, even things like there's studies that show brain volume loss. Very dramatic things. Myocarditis. There's very profound and lasting issues that you can get from COVID. It's not a cold. If we do see that COVID does follow that trend of less virulence over time, if this turns into a cold, then yeah, there's really not much reason to count cases at that point if it doesn't result in hospitalizations, if it doesn't result in severe outcomes. But we're not there yet.
Dr. Ahsa Shajahan (20:43):
Dr, Nick Gilpin (20:44):
I want to share with you guys a piece of this article that I found from the New York Times. The title of the article is What We Can Learn From How the 1918 Pandemic Ended. This was published on January 31st and as I said, it was in the New York Times. I think it's apropos of the discussion we're having here because there's a lot of consensus out there in the community that cases are going down, let's get back to normal as fast as possible, let's get those masks off. So let me read you this short little snippet here.
Dr, Nick Gilpin (21:17):
Nearly all cities in the United States imposed restrictions during the pandemic's virulent second wave, which peaked in the fall of 1918. That winter, some cities reimposed controls when a third, though less deadly, wave struck. But virtually no city responded in 1920. People were weary of influenza and so were public officials. Newspapers were filled with frightening news about the virus, but no one cared. People at the time ignored this fourth wave. So did historians. Deaths returned to pre-pandemic levels in 1921, so a year later, and the virus mutated into ordinary seasonal influenza, but the world had moved on well before. Sound familiar?
Dr. Ahsa Shajahan (21:59):
Yeah, absolutely.
Dr, Nick Gilpin (22:00):
It really is. It's like we're living the past all over again.
Dr. Ahsa Shajahan (22:03):
History repeats itself. It's so interesting to see that we have precedence, in a sense. It's not necessarily COVID, but we have precedence of a pandemic, and yet behaviors are the same. I don't know. What is it that we can learn from that? What is it that we can do differently to maybe save more lives or have things get better?
Dr, Nick Gilpin (22:25):
I think one key difference that we have today versus 100 ago is that we have, I'd say, better record keeping, better ability to track what's going on around us. We can tell when cases are starting to rise, we can tell when hospitalizations are starting to rise. We have this early warning system. We also obviously have vaccines and treatments and things that are currently available and becoming more available and terms of oral antiviral treatments. So we have a lot more tools in our toolkit today than we did 100 years ago. But public perception seems to be exactly what it was 100 years ago. Crazy.
Dr. Ahsa Shajahan (22:59):
So talking about vaccines. Probably in the next week or so, I think we're going to have a vaccine availability for yet another group of people, kids six months to five years of age, many of my patients that are parents, some are thrilled and overjoyed and others are really skeptical and scared. I just wanted to open it up. Let's maybe talk a little bit about the possibility that this vaccine will be available for this new group, probably as soon as maybe even next week or next two weeks.
Dr, Nick Gilpin (23:35):
You got it. You read my mind. I have a couple of talking points here that I want to just get out. First of all, Pfizer submitted for EUA, emergency use authorization, for vaccines kids six months to five years. The dose that's administered to this population is about a 10th of the dose for adults, so obviously a much smaller dose. The FDA is going to be meeting, I think next week, to discuss and vote on this.
Dr. Ahsa Shajahan (23:59):
Next Tuesday.
Dr, Nick Gilpin (23:59):
So to your point, we could have a approval very soon. The preliminary data, so important point here, preliminary data for two doses of vaccines in this group, not that impressive. It did not show a robust immune response. But the company is planning on investigating a third dose, so this will probably be a three dose series at some point. It'll start off as a two dose series, and eventually likely become a three dose. No safety concerns, right?
Dr. Ahsa Shajahan (24:32):
But when you say that, basically what you're saying is that from the first dose, there is a good immune response, similar to what's seen in adults. But with the second dose, the immune response was not as high as it was for adults receiving the second dose.
Dr, Nick Gilpin (24:44):
Dr. Ahsa Shajahan (24:44):
So the speculation is that if there is a third dose, that perhaps the immunity would be higher. Do you think, then, that maybe the dosing might need to be increased as opposed to more vaccine? Because then getting a second dose... It's very confusing. Because getting a second dose of it doesn't amount to the right immune response. It makes people question. So I think people are going to be confused about what to do.
Dr, Nick Gilpin (25:09):
Fair question. I don't want to speculate because I was not a part of those trials. It could have been that they were trying to find the balance between effectiveness and safety, and so they were maybe erring on the side of a somewhat lower dose. Could they push the dose? Maybe. I'll leave it to the scientists to figure.
Dr. Ahsa Shajahan (25:27):
I would say, though, it doesn't seem like there's any really bad side effects that are different than what the adult population had, and if not, maybe even less. Definitely at least getting the first dose is important for that group. Again, as schools are starting to lift their mask mandates, vaccination is key in protecting your kids.
Dr. Skrzynski (25:46):
Absolutely. People are eager to point out that children are a very low risk group with COVID, but it's not a zero risk group. We saw with Omicron, we saw an increase in pediatric hospitalizations, which certainly raises a lot of red flags about Omicron. So if you're looking at something which is honestly a pretty much no cost protective measure for your children, which is vaccination, a lot of compelling reasons to go ahead and do that.
Dr, Nick Gilpin (26:13):
I'm going to invoke Dr. Paul Offit, who's a big peds infectious disease and big vaccine guy in this space. He's made some very good comments here, and I think I'm paraphrasing him, but what's the downside? Yeah, pediatric hospitalizations are up. They're still relatively low relative to adult hospitalizations with COVID. But getting vaccinated, no downside.
Dr. Skrzynski (26:37):
Absolutely. Now I think you can point to hundreds of millions of people who have received COVID vaccines. Granted, adults. But at the same time, I think the safety profile is there. Even now, if you look at the original study participants in things like the Pfizer trial, we're almost two years out from those people receiving these trial doses, so a very established track record. I think the people that point to this vaccine call it unproven or untested, as time goes on especially, very little to stand on.
Dr. Ahsa Shajahan (27:07):
Now, thinking about kids and schools and keeping things as normal as possible, let's talk about this antigen test, because now antigen tests are available. The government has sent kids to people's homes if you ordered them. A lot of people are getting them for free. But it still gets a little confusing for people about the at home, which is the antigen test, versus the PCR. And then people are getting confused about, well, with Omicron, is it even detectable? Because you have a lot of false negatives. Let's talk about that.
Dr, Nick Gilpin (27:40):
Yeah, let's. First of all, I think if you lived through Omicron, then you realized that we had some testing challenges. Even still, I think. If you go back to around late December, testing was hard to get. In this neck of the woods, at least, if you wanted to get a COVID test, it was hard. You were waiting a few days.
Dr. Ahsa Shajahan (28:03):
I was texting you. Do you remember that?
Dr, Nick Gilpin (28:03):
I do remember that.
Dr. Ahsa Shajahan (28:03):
I was like, "Nick, I think I need a test."
Dr, Nick Gilpin (28:07):
It was hard. I had to get a COVID test at one point. On Christmas Eve, I was running out to a CVS pharmacy to get a COVID... It's not easy. So I'm glad that antigen testing and testing in general is more widely available, so that's a good thing. Now let's talk about how to use it. So first of all, I think the best use for any COVID test, generally speaking, is for the symptomatic population, correct?
Dr. Skrzynski (28:32):
Dr, Nick Gilpin (28:33):
They're useful for people who want to test because you've got symptoms. They can also be useful for testing if there's been a known exposure, a high risk exposure, a household exposure. Your husband or your wife has COVID, you want to get tested. I think there's a sweet spot for that. It's probably somewhere in the three-ish to five-ish day window after that exposure has occurred. That's probably going to be the right window to test.
Dr, Nick Gilpin (28:57):
Now, if you test positive with an antigen test, first of all, pause for a second. Rapid test. I want to away from this terminology because there's rapid PCR tests and there's rapid antigen tests. So if you tell me you got a rapid test, you really didn't tell me anything other than that the test was quick. I think with any test, if you test positive, PCR or antigen, treat it as the real deal, especially right now with what's going on in our community. There's a lot of COVID out there. If you test positive, I'm going to treat you as a true positive.
Dr, Nick Gilpin (29:30):
If you test negative and you don't have any known exposure that you're aware of or any symptoms, it's probably a true negative test. Now, you may want to confirm that. If it was an antigen test, you may want to confirm that with a PCR test. They're a little bit more sensitive. That's perfectly reasonable. We certainly have a lot of folks that do that. But if you test negative and you are having symptoms, so you've got that classic fever, chills, body aches, sore throat, runny nose, and you run out and you get a rapid antigen test and it's negative, I would recommend repeating the test because there's a discordance there. You have symptoms, but your test is negative. It's possible the test could be wrong or it's possible that it's just not detecting what you have yet, and it's perfectly okay to get a follow up test in that situation. Does that make sense?
Dr. Ahsa Shajahan (30:22):
Yeah. I tell my patients that if they have multiple antigen tests, test on day three of symptoms, and then if it's negative, then day four of symptoms, and if possible, on day five of symptoms. If you've got all three negative, then yeah, okay, maybe it's negative. It could be something else. But if you do have symptoms and your antigen's negative and you can get a PCR, then I would recommend to get to a PCR to confirm. It's really confusing for people. But like we said, I think the antigen test, which is the at home test, is a great thing for ruling in disease. So if it comes back positive, you don't have to go to an urgent care, you don't have to go to a pharmacy. You can do it right from home, and it's pretty easy to do.
Dr, Nick Gilpin (30:59):
It is. I want to get away from this idea of chasing a negative test. We're seeing a lot of this. People who test positive, they may have mild symptoms and they test positive, and they say, "Oh, I don't think this is COVID. I'm going to go get another test." They'll get one or two or three more tests, and then one of those tests happens to be negative and they're like, "See? I told you it was negative." No. If you have a positive test with any symptoms, even mild symptoms, treat it as a positive test and act accordingly.
Dr. Skrzynski (31:28):
I've had more than my share of patients who will say, "Test me again. I don't believe it." PCR especially, it's a lock and key mechanism. And so if it fits, that means that you have it. So in terms of the specificity, it's there for the PCR test. Also, I think it speaks to the threshold that we just need to have in terms of illness in the society. I think there's a mantra that if you feel good enough to get in your car, then you should go to work. That's got to change because. Especially if we are concerned about things like antigen testing and any possibility of a false negative, we have to be just especially that much more vigilant.
Dr, Nick Gilpin (32:09):
I want to also put in a quick word here about PCR testing. Something we have all seen in our practices is this prolonged test positivity with people who have a PCR positive. We saw this a lot when Delta came in December and then Omicron quickly followed in late December throughout January. We had a lot of people that had Delta back in late November, early December. We were PCR testing those people in January, and many of them had positive PCR tests. This is not a bug, it's a feature. So the test will, in many people, be positive for some weeks. Interpretation in those situations can be a little tricky. If you're having symptoms, again, I would probably treat this like it's COVID. There may a role here for antigen testing in these circumstances. It may actually, in some ways, be a little better because it doesn't seem to have that same problem with prolonged positivity in some circumstances. So be mindful of that. I'm glad we have more testing available.
Dr, Nick Gilpin (33:14):
So let's bring it on home. We've been talking for a little while here. Let's talk predictions and advice and what do we want to share with the community. So I think COVID is continuing its transition towards endemicity. Endemic does not necessarily mean good, and we touched on that. Justin, you mentioned this. The disease might become milder over time or it might not. That's not a guarantee. Just because things seem to be getting milder doesn't mean that trend will continue. We've been pushing hard on vaccinations and masks and staying safe, especially when community transmission is high. Doing your part. What other things do you guys want to share with the group?
Dr. Ahsa Shajahan (33:56):
I think you hit it all. Basically, we're still in the pandemic, yet there is a light at the end of the tunnel. Things seem to be getting better. People are not getting as sick. But I think there also has to do with the fact that many people are vaccinated. So I think my advice would be that if it's been over five months since your booster, really don't put it off. Get the booster and remain protected. That's what I would add.
Dr. Skrzynski (34:21):
I would also say that if you look at the mortality, the daily mortality from COVID is still exceptionally high. Upwards of 2,000 people a day are dying of COVID.
Dr. Ahsa Shajahan (34:30):
That's crazy.
Dr. Skrzynski (34:31):
It is, it is. You almost wouldn't know it if you went out and about in certain places. We see it at the hospital, and COVID care for a lot of it has been very compartmentalized, where it happens at the hospital, and it's out of sight and for many out of mind. But healthcare is not an inexhaustible resource either, and that's a separate podcast completely. But the idea, though, is that there is a light at the end of the tunnel. This is certainly not doom and gloom. But is just say that we're still in the middle of the storm, we see some blue sky in the distance, but it's not here yet. This is a time to really focus. If we do that, there's a lot of lives that we can save before this does blow over.
Dr, Nick Gilpin (35:16):
Agree. Pandemics do end. It will end. Let's try not to make the mistakes that we made as society back 100 years ago with influenza and try to keep our foot on the gas. Good talk, guys. I think that's all the information we have time for today. I want to thank Asha and Justin. Appreciate you guys.
Dr. Skrzynski (35:33):
Thank you.
Dr, Nick Gilpin (35:34):
I also want to remind our listeners to check out for all things COVID. And also, shameless plug here, to send your emails and your questions to us at We're going to sift through that mailbag and try to answer some of those questions in a future podcast.
Dr, Nick Gilpin (35:52):
I will wrap it up with this healthy thought. As we enter third year of the COVID-19 pandemic, we have collectively learned a lot about the virus and about the many ways to reduce transmission and keep ourselves safe. Let's not get complacent. Let's keep our foot on the gas. Let's make sure we're getting vaccinated and boosted if we're eligible. Let's wear those well fitting face masks out in public, get tested and stay home if we're not feeling well, and let's wash those hands often. Hopefully fewer surges and better days ahead if we all do our part.
Speaker 1 (36:30):
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