An Update Regarding the Coronavirus 

Dr. Martin Dubravec

November 12, 2021

This information is being provided on a periodic basis for patients and others interested in updates regarding the Coronavirus (COVID-19, Sars-CoV-2).  Facts are provided.  My comments and opinions are listed separately.  The goal of these updates has been to help the community in keeping informed of issues regarding Coronavirus from a local medical perspective.  As a clinical immunologist, I believe it is vital that information be shared with regard to this important issue.  If you would like to receive this information via Email, feel free to Email us at aasc1234@protonmail.com.   The opinions expressed in this Email are that of Dr. Dubravec.  Good doctors can disagree. Readers are encouraged to seek as much information as possible regarding COVID-19.  Information in this Email is not intended as a replacement for diagnosis or treatment by your doctor. Nothing in this Email provides medical advice or any form of diagnosis or treatment. Medical decisions should be made by the patient’s physician.  All information provided here is for general informational purposes and is not medical advice to users.

Please note that we will no longer be using Facebook for posting these Emails.  We prefer an Email format for this information.

Fact:

Positive COVID tests in the state of Michigan rose in October, but not to the same degree as previous months.

Source

https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173—,00.html

Comment/Opinion:

If we are to assume that positive COVID test results are reflective of the COVID-19 cases in Michigan, we see a rise in cases has occurred and is coming down.  Hopefully, we will see this trend continue.  It is unclear whether or not this represents a new variant of COVID-19 (some call it a new subvariant or variants) or whether or not other factors may be playing a role. 

Fact:

Home tests (rapid antigen tests) for COVID-19 are now readily available.  Studies have shown a false negative rate of approximately 20-38%.

Sources:

https://www.cdc.gov/mmwr/volumes/70/wr/mm7003e3.htm

https://www.technologyreview.com/2021/05/04/1024450/at-home-covid-test-review-accuracy-binaxnow-lucira-ellume/

Comment/Opinion:

Testing for COVID-19 has been problematic from the start.  The first major testing that was done is called the PCR test (polymerase chain reaction test).  The PCR was never meant to diagnose disease; it was developed to look for evidence of a virus or bacteria by looking for pieces of genetic material (DNA or RNA).  Although this can give evidence of a possible infection, it does not mean that the virus or bacteria is actually there.  Furthermore, PCR testing is done based on cycle thresholds, which are sort of like magnifications on a telescope.  As you use more cycle thresholds, the ability to pick up smaller and smaller pieces of genetic material goes up, but your risk of picking up unrelated material also goes up.  For reasons not entirely known, the cycle thresholds in the United States have often been way above what many consider to be reasonable (reasonable being about 25 cycles, for example).  Therefore, with cycle thresholds of 40 or higher, the false positive rate could easily be significantly higher than the true positive rate.

The rapid home tests for COVID-19 look for non-genetic proteins that the virus produces.  This makes them much more readily able to give a quick result.  However, if someone is early in their illness, there may not be enough protein for the test to pick up (i.e., if the viral load is not yet high enough).  This would explain why many who believe they have COVID-19 may not have a positive test for a few days.

The bottom line is that decisions regarding the diagnosis of COVID-19 should not be based on a test alone.  As the saying goes, don’t treat the test; treat the patient.  Although testing can be a significant part of diagnosing and treating COVID-19, other factors often must play an important or more important role than simply a PCR or rapid antigen test.

Fact:  

New variants of COVID-19 continue to be found.

Source

https://www.ibtimes.com/4-new-covid-19-variants-found-nebraska-are-more-transmissible-considered-worrisome-3333972

Comment/Opinion:

New variants of viruses are common.  Some viruses tend to mutate and produce more variants than others.  The same can be said of bacteria; some bacteria mutate more readily than others.  At this time, it seems as if COVID-19 is tracking like many viruses – less lethal over time but possibly more contagious as new variants evolve.  Fortunately, new variants of COVID-19 seem to be less lethal.  Our office will continue to monitor this development.

Fact:

Recent recommendations for vaccinating children as young as 5 years of age for COVID-19 have not come without controversy.  The former Secretary of Health and Human Services and renowned pediatric neurosurgeon Dr. Ben Carson voiced concerns of vaccinating children for COVID-19.   

The recommendations for vaccination of children are based in part on data showing a 90.7% effectiveness in preventing COVID-19 at 7 days after being vaccinated.

The vaccine packet insert (an FDA-approved document giving detailed information of a drug or vaccine) states the following:

·         The recipient or their caregiver has the option to accept or refuse Pfizer-BioNTech COVID-19 Vaccine.

·         The significant known and potential risks and benefits of Pfizer-BioNTech COVID-19 Vaccine, and the extent to which such risks and benefits are unknown

Sources:

https://www.realclearpolitics.com/video/2021/10/31/ben_carson_no_reason_to_mandate_covid_vaccine_for_children.html

https://www.fda.gov/news-events/press-announcements/fda-authorizes-pfizer-biontech-covid-19-vaccine-emergency-use-children-5-through-11-years-age

http://labeling.pfizer.com/ShowLabeling.aspx?id=16073

Comment/Opinion:

Shared decision making between a doctor and the patient’s parent(s)/guardian should be the basis for deciding whether or not a child receives a vaccine.  This is clearly reflected in the package insert of the vaccine.  No parent should be pressured into giving their child a vaccine.  Parents should be encouraged to make as educated a decision as possible before giving vaccines of any kind to children.

[Posted by Lori DeVries]