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> COVID19 Notes from the Medical Director

2019 Novel Coronavirus (COVID-19)
Notes from the Medical Director

Photo of Dr Klepack

William Klepack, M.D. is the Medical Director of the Tompkins County Health Department. This page collects information that is essential for a complete understanding of how the coronavirus and COVID-19 disease impacts our community and its members.
 



Be sure to keep early childhood vaccination schedule on track (5/13/20)

I remember Meningitis as a devastating and too often fatal disease of children in the early years of my career as a doctor. We at the Tompkins County Health Department urge you to not let your babies and children get behind in their vaccinations during this time of coronavirus. The vaccinations given in the early years protect against many devastating types of meningitis and other serious and life-threatening infectious diseases. Even in this time of coronavirus concern keep your child’s vaccinations up-to-date. Don’t get behind. Please make an appointment with your doctor today.


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Antibody blood tests for COVID-19 as compared to Swab tests for COVID-19 virus (4/24/20)

A blood test for COVID-19 is as different from a Swab test for the virus as a photograph of a person is from seeing them face to face.

The blood test detects the body’s memory of having seen the virus. The Swab test picks up molecules of the virus itself from your nose and throat.

The blood test tells us that, at some time, your body had the virus. The Swab test shows the virus is still in and on you, and you are contagious to others around you. If your blood test is positive, you may or may not still have the virus. The blood test alone cannot tell you this important detail. Only the Swab test can tell you if you are contagious.

As of right now, the blood test cannot tell you for certain if you are immune to (protected from) COVID-19. We hope that a positive blood test means you are immune; but studies are just being done on this and it is too soon to say. If you are immune, the blood test does not tell us how long you will be immune. Again, studies are just getting underway that will answer this question. It will take months or perhaps a year for an answer. So, don’t let your guard down. A positive blood test does NOT mean you can afford to stop social distancing, hand washing, wearing masks and all the other important measures that have helped control this pandemic.

A negative Swab test does give some assurance that you are free of the virus. But, not 100% assurance since false negatives can occur in a small percentage of people. So, if you have a negative test and you do not have COVID symptoms but later develop them, or have a negative test but then your symptoms persist or get worse, you need to be retested.

On the other hand, a positive Swab test is highly reliable and shows you are contagious and that your symptoms (if any) are due to COVID. If your test is positive and you have no symptoms, you are still contagious. You should isolate yourself (see our video on isolation and quarantine) and get advice from your healthcare practitioner.

Some people who are infected with COVID-19 are interested in donating their blood to the Red Cross or a medical center for the purpose of it being used in the treatment of severely ill, hospitalized COVID patients. In that case, the COVID blood test is used to determine if you have enough antibodies (the body’s chemical way of remembering infection) to do any good. This use of the blood test is almost the only one that is useful currently.

So, to summarize: You are much more likely to need a COVID-19 Swab test than a blood test. A Swab test for COVID virus allows you to “see” the virus in and on your body “face to face.” The blood tests are like looking at its photograph – you do not know where it is right now or if it is even alive in and on your body.

We need a lot more studies and the good science that will come from them to answer many of the questions that we now have about blood testing and the finer details regarding how COVID-19 behaves.


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Medications and coronavirus (COVID-19): Know the Risks Before Taking Any Medications (4/15/2020)

As of this writing there are no medications that are proven to work against the COVID-19, unfortunately.

However, there is much said about some medications and some supplements by prominent political officials, marketers of supplements and the press. They usually miss making a very important point.

If medications and supplements did not have adverse effects, we could take them freely with no fear of harm in hopes they might help. (The only bad effect would be on our wallet.) But they all do have adverse effects and they are often serious ones. Medications and supplements should only be used when your situation is severe enough that taking these risks is justified.

Let’s take the drug being talked about the most, hydroxychloroquine. Its adverse effects include:

  • Irreversible eye damage to the retina
  • Decrease in kidney function
  • Life-threatening and fatal heart effects (atrioventricular block, pulmonary hypertension, sick sinus syndrome or other cardiac complications). The drug often prolongs the QT? interval which can lead to ventricular arrhythmias and torsades de pointes? which are life threatening.
  • Psoriasis and porphyria are worsened
  • Muscle weakness and nerve damage are reported
  • Severe and dangerous drops in blood sugar
  • Digestive side effects and liver impacts
  • Rashes, some of which can be due to serious bodily reactions to the drug
  • In persons with already existing problems, it can worsen them.
  • It interacts with many other drugs such as for diabetes, seizure control, heart medications and cancer treatments.

Patients should be fully informed of the potential risks of the use of it, especially in pregnancy, during breast feeding and in children.  Risks in the elderly may be even greater due to aging effects on kidney function.

This is not the only drug or supplement with such a long list of adverse reactions. Most have such potential problems associated with them.
You should never accept the statements of anyone advising you to take a drug or supplement without first demanding proof. Your body is precious. It can easily be damaged.

  Reference: https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/009768s037s045s047lbl.pdf


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Pregnancy and Pregnancy Outcomes Regarding Coronavirus
Submitted as an Op-Ed to 14850.com, Apr 15, 2020

The data we currently have about pregnancy and COVID-19 is encouraging. The Cochrane database, a well-respected resource of reliable medical information, reports that a pregnant woman is no more susceptible to COVID-19 virus than anyone else; but, on the other hand, no less susceptible to coming down with it. The risk of severe illness appears to be the same as a non-pregnant woman. Continue to use social distancing, hand washing and all the other measures that are recommended.

Pregnancy outcomes seem to be minimally affected if one is mildly to moderately ill. However, severe illness does increase risk. In the 138 pregnancies reported, the baby’s birth weight was usually normal and, with rare exception, infection of the baby was not reported. (A second study of 38 women and babies published on March 24 confirms this). Of course, pregnancies and babies were still subject to the various troubles that can occur normally. For example, the information still shows the expected number of premature births and unfortunate outcomes. But, (so far) coronavirus is not showing itself to be a devastating issue except if you become severely ill.

Take all precautions against acquiring coronavirus. Advise your family and friends to do so as well and, if it you meet the criteria, get tested. Several international authorities are advising against people becoming pregnant until the coronavirus is past. A conversation with your personal physician is advised before planning a pregnancy. If you are already pregnant, as always, your obstetrical practitioner knows you best. Your health care should always be individualized.

Additional information: coronavirus.health.ny.gov/protecting-public-health-all-new-yorkers.


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