30 March 2020 Blog Post: COVID-19 Recovery: What Do We Know?

One of Dr. Fauci’s quotes that may have been lost in yet another week of CDC mixed messaging and more Dr. Birx shuffling, is the following:

“But I feel really confident that if this virus acts like every other virus that we know, once you get infected, get better, clear the virus, then you’ll have immunity that will protect you against re-infection.” He continued, “So it’s never 100 percent, but I’d be willing to bet anything that people who recover are really protected against re-infection.”

At this writing, there are a number of patients both in our practice as well as around the country who have tested positive for coronavirus and have recovered or are on the road to doing so. This is good news, not only for them to have survived this infection, but also for our community as we now are blessed with individuals who are, for intent and purposes, immune. As Dr. Fauci said above, we cannot say that immunity is 100% but if #COVID-19 functions like other viruses (and evidence thus far shows that is does), then we can expect functional immunity. In fact, a study in monkeys that had been reexposed to COVID-19 after initial infection showed with no recurrence of COVID-19. (Link: https://www.biorxiv.org/…/2020.03.13.990226v1.full.pdf).

According to the CDC, the decision to discontinue home isolation, “should be made in the context of local circumstances. Options now include both 1) a time-since-illness-onset and time-since-recovery (non-test-based) strategy, and 2) a test-based strategy.” Obviously it would be hypocritical of me to at once criticize the CDC for their wavering guidance and then look to them for, well, guidance.

Fortunately there are other sources with more expertise and proven outcomes in reducing coronavirus spread and disease burden. The paragon of COVID-19 response thus far has been South Korea. They have had, to date, 9583 cases, 152 deaths (1.6%), 5033 released from isolation and 4398 remaining in isolation. They have performed 39141 tests with a 2.5% positive rate (to compare – at Santa Monica Primary Care we are at nearly 15% positive tests).

The following criteria clinical and testing are used by the Centers for Disease Control and Prevention of South Korea to release a confirmed patient from quarantine:

1. A person should not have a fever without the help of medicine and clinical symptoms should improve.
2. A person’s PCR tests – two tests performed with a 24 hour interval – should both display negative results to meet the testing criteria.
3. Confirmed patients who do not display symptoms are released from quarantine IF two tests performed on the seventh day after COVID-19 confirmation with a 24 hour interval both display negative results.
4. If the patient tests positive, another set of two tests with a 24 hour intervals at dates to be determined by physicians (e.g. day 10 or day 14 after testing positive) is performed. Quarantine will be lifted if the test results are both negative.
5. However, if a patient continues to be asymptomatic, quarantine will be lifted after three weeks of self-quarantine or isolation in a quarantine facility from the date of confirmation.
 
OK so how do we practically then lift quarantine restrictions for those who have had positive tests? The answer, as always, is testing. This means that every case of COVID-19 should have at least three tests and, at Santa Monica Primary Care, this is precisely what we intend to do. Test, test, test. There is no reason to create a new system when we can rely on the experience and expertise of others. We are an international community (in Los Angeles particularly) and should take stock in what our colleagues around the world are doing to effectively stop this pandemic in its tracks.

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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