COVID-19 rapid antibody testing

The tests everyone originally talked about getting were those that tested for the presence or absence of the virus that causes COVID-19. It was helpful at the beginning of this pandemic if you were symptomatic and your doctor needed to confirm your diagnosis for the most appropriate treatment. Or confirming your diagnosis might get you into a trial for an an experimental treatment.

But now that we may be moving back out into the community, we need a bit more information. Antibody testing provides more data than the typical PCR (polymerase chain reaction) tests that check for the presence of the coronavirus’ genetic material. As the video below explains, antibody testing can check for non-exposure, recent or current exposure and immunity.

Depending on the presence or absence of immunoglobulin M or immunoglobulin G in your blood, you can learn a lot about a person! Rather than repeating it all here, check out the video below to learn about the following four topics. First, are rapid antibody tests approved by the FDA or not? Second, how does antibody testing work? Third, how do the tests actually work? And fourth, how can antibody tests be used when reopening clinics and treating patients?

Video explaining COVID-19 rapid antibody testing

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post COVID-19 rapid antibody testing and you first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Why San Francisco is ready to reopen for business

As I discussed here previously, San Francisco has had fewer COVID-19 deaths than most large cities in the country. The city benefited from the early institution of shelter-in-place orders. Additionally, the large number of tech workers in the area began working remotely even earlier in the month of March. These early social distancing recommendations are having far reaching benefits in San Francisco.

There were only 12 COVID-19+ inpatients at all three Sutter Health CPMC San Francisco  hospitals as of Friday, April 10th. Clearly, not every city has these same low rates of inpatient admissions for patients with the coronavirus. And that’s why the decision to reopen for business or relax the shelter-in-place orders are not a national-level decision. These decisions are necessary on a local and regional basis, when appropriate, in coordination with state decision makers.

Because there are so few COVID-19+ inpatients in San Francisco, that means the hospital has the capacity to accept more of these patients if necessary. But it also means hospitals can start performing elective procedures again. With beds available, we can reassure every patient they will have a bed if needed.

Concerning news for San Francisco

While San Francisco is controlling the outbreak with social distancing, there is a potential problem on the horizon. On April 10th, public health officials announced that 70 people at San Francisco’s largest homeless shelter were found to be COVID-19 positive.

At this time, it remains to be seen if this will lead to the surge that has yet to materialize.

Benchmarks before reopening businesses

Based on the roadmap to reopening issued by former FDA commissioner Scott Gottlieb, there are four benchmarks before we can move to the next phase (Phase II) of this crisis. In his words, the current quarantine and shelter at home is Phase I. Now that we have 1) a reduction of patients needing inpatient medical care over the course of 14 days (one incubation period) and 2) hospitals in the area can safely treat all patients requiring hospitalization, San Francsico satisfies two of his four milestones at this moment.

The third and fourth benchmarks include widespread testing along with active monitoring and tracing of all confirmed cases. This is possible to implement over the remaining days in April.

On a case by case basis, doctor’s offices can join the city and other lab testing facilities in providing rapid testing capabilities to our citizens. My office is receiving delivery this week of antibody testing kits. These rapid blood testing kits can determine if one of my patients has 1) not been exposed to the virus, 2) was recently exposed and does not have full immunity yet or 3) they’ve been exposed and now has full immunity. If any patients test positive, but not yet immune, in our office, they will be sent home or to the hospital depending on symptomatology and they will be reported to the CDC.

The last requirement to move on to Phase II, contact tracing, will be available by the end of April. This includes the notification of an individual via smartphone if they’ve been near someone else that has since tested positive for the virus. By tracking this information, affected individuals can be monitored, sent home, isolated or seek out treatment. The technology to accomplish this is being provided by both Apple and Google. The software or API (application programming interface) they’re building for health department apps will have interoperability between both iPhone and Android.

Guidelines when reopening businesses

According to Gottlieb, in Phase II, the majority of schools, universities, and businesses can reopen. The truth is, many governors are leaning towards leaving schools closed for the rest of the school year. But working from home, when feasible, should continue. And he suggests gatherings be no more than 50 people at a time.

While grocery stores and convenience stores can limit the number of people that come in at once, this is a more complicated decision for restaurants and bars. Many restaurants can continue delivery through DoorDash, Caviar, Postmates and UberEats. And I suppose dine-in restaurants can operate at 50% capacity where some social distancing is possible.

However, most restaurants operate on a thin margin. Being in a situation wherein their expenses/payroll are at pre-pandemic levels, but the restaurant is generating half the revenue may be untenable and impractical. It will also be interesting to review the numbers, when available, if restaurants whose business model is not meant for delivery and take out only, are generating enough revenue.

When it comes to bars, is there any scenario where they can reopen during Phase II? Bars seem to be less conducive to social distancing and more likely for patrons to be in close proximity to one another. Can a bar operate at 50% capacity? This may be a decision for a later phase.

Having realistic expectations

It’s critically important the public understands it’s not realistic to expect no one to get sick during the process of relaxing social distancing protocols. We just have to minimize the number of people that get sick at any one time. That’s what flattening the curve is all about.

We should not frame the question as, if we stop social distancing too soon, will people die? Unfortunately, it’s inevitable that as home quarantines are lifted, more people will die. More people will contract COVID-19, some will require admission to the hospital, and a few of those people will then go to the ICU and succumb to the virus. That’s unavoidable to some extent.

The right question is, how to do we relax social distancing, lockdowns and quarantines in such a way as to reduce the possibility of a spike in new infections that overwhelms the healthcare system? Just as flattening the curve was the goal at the beginning and in the midst of this crisis, flattening the curve is still the goal as we start to return to a more normal (but definitely not normal) way of life.

A phased return to “business as usual” is necessary. But only in areas that are ready based on the four benchmarks above. With contact tracing and rapid immunity testing, businesses can reopen. And as time goes on and new data becomes available, more test-proven immune employees will be able to return to work. We can eventually gather in successive waves of 50, 100, or a 1000 people. And then one day, we’ll be able to attend an NFL game. One day.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post America has to reopen for business… but not at the same time first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Many theories abound as to why COVID-19 deaths are lower in San Francisco. This article in USA Today reviews several of them. But before reviewing the possible reasons, we should also be clear that it’s not time to celebrate just yet. The city, state and nation are still in the throes of this pandemic. However, if the current trends in San Francisco hold true, there is a great deal to learn for the future.

Why COVID-19 deaths are lower in San Francisco?

San Francisco infamously instituted a shelter-in-place order on Monday, March 16th. This was the first city in the nation to do so. The idea was so novel to the American public that most were unfamiliar with the phrase. The entire state of California followed suit on March 19th. It’s accepted as conventional wisdom that staying home and isolating is very effective in reducing spread. This epidemiological recommendation bore fruit in San Francisco.

But even before March 16th, the tech companies in the Bay Area, with many of the residents living in San Francisco proper, told their employees to start working from home. While working from home may not be an option in many parts of the country, tech jobs in the Bay Area, and everywhere, are inherently conducive to working remotely. This pre-emptive, unofficial shelter in place was also very helpful in slowing the spread of COVID-19.

Aside from telling folks to stay inside or social distance when they’re out, ensuring they isolate themselves is another matter. There were certainly instances when SF residents were out and not social distancing. But these instances were the exception rather than the rule. Which leads to the other potential reason why COVID-19 deaths are lower in San Francisco.

San Francisco is home base to many delivery services. Aside from New York City, no city is so saturated with food or grocery delivery service options. This is another potential factor in adherence to the shelter in place orders. It’s just plain easier to stay home! Want any variety of cuisine? Call DoorDash, PostMates, UberEats or Caviar. With so many Lyft and Uber drivers available but without traditional rideshare customers, they’re available to deliver food or groceries. Anyone that has ordered food delivery prior to the COVID pandemic knows, it always took at least an hour to get your food. Since the shelter in place designation was instituted, delivery can be measured in minutes rather than hours.

Where’s the evidence that COVID-19 deaths are lower in San Francisco?

The rising number of people testing positive is often the measure of the growing pandemic. But the more significant measure of illness is the number of hospital admissions. The COVID-19 positive patients requiring admission are the sickest and mostly likely to tax the healthcare system. The folks that test positive but are able to stay at home and recover without incident are not the focus of our healthcare resources.

As an active member of Sutter Health’s California Pacific Medical Center hospital staff, I receive updates everyday regarding the number of inpatients with COVID-19. The data includes both person’s under investigation (PUI) and test-positive, confirmed COVID-19 patients.

Thus far, the data over the last week and a half shows that the number of suspected COVID-19 and confirmed COVID-19 patients rose from 22 patients across all three Sutter hospitals in San Francisco, to a peak of 37 and then trended downwards to 22 suspected or confirmed patients as of Tuesday morning, April 7th.

Again, it’s too early to break out the champagne. But if this snapshot offers any optimism, the early actions by tech companies and government officials, and the relative ease with which to abide by those actions, has served San Francisco well.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Why COVID-19 deaths are lower in San Francisco (so far) first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Like everyone, I’ve been thinking a lot lately about COVID-19. What I’m realizing is that the changes in social etiquette and the rise of alternative business models and communication are here to stay, post COVID-19. For example, telemedicine, previously an “option” in healthcare, will finally have its day in the sun. Here’s a list of other “new normals” that apply to small businesses, families, and society as a whole.

Small Businesses

It’s a uniquely confusing time for small businesses. The question is what to do with  employees. Many business owners I’ve spoken to who have salaried employees with paid-time-off (PTO) benefits are in a quandary. How do you pay salaried employees if there is no revenue generation? And even if you let salaried employees go, you’ll still have to pay them for unused PTO, either voluntarily or required by law. Small businesses may have a rainy day fund. But it’s unusual they can cover months of salary without ongoing cash flow.

In the future, employers will have to rely on gig workers or hourly employees, rather than salaried employees. And they may be less willing to provide benefits such as PTO or sick leave. If job security further erodes in this country, states may mandate PTO and paid sick leave, as is the case in California in regards to paid sick leave.

While working from home was often seen as a perk, it was not really considered the default status of an employee. Employers will start to rely on shared employees working from home. This way, an employee that was previously a full time employee with one business, can be paid as a part time employee since they will be kept whole by receiving part time work when their employment is shared by multiple businesses.

Families

Rather than taking the chance on overcrowding in a restaurant or grocery store, more families will rely on delivery services. While services such as Postmates or DoorDash were having difficulty scaling in the past, the tipping point for their success has arrived. These services will expand and become more readily available in cities and suburbs across the country.

To facilitate this new business model, the former CEO of Uber started Cloud Kitchens. These are shared kitchens that cook food for delivery-only restaurants. Rather than being a brick and mortar restaurant, chefs or owners will produce their menu items for delivery only, and avoid the dine-in business altogether.

Society as a whole

Social distancing will be more pervasive than ever before. Will restaurants have to accommodate guests at half capacity? Will there be a demand for outdoor seating? Are you going to feel comfortable crowding into a bar? Walking sideways on your way to the bathroom or up to the bar to get a drink? Just as the fire marshals sets capacity limits on public spaces, the health department may implement additional restrictions.

On an even bigger scale, what about concerts or sporting events? Just as increased security screening was a result of 9/11, spectators will undergo infrared heat scanning for fever screening. And what about conferences or summer camp? Will everyone undergo a temperature check each morning?

But the most shocking change of all? The hand shake. Dating back to 5th century BC Greece, the hand shake is now a custom of our collective past. While epidemiologists deem the elbow bump as the most appropriate alternative during the pandemic, the fist bump or wave will become the custom de rigueur in a post COVID-19 society.

Sure, it’s possible some of these predictions will not hold true. But make no mistake, life will never be the same in this post COVID-19 world.

What other changes are here to stay? Comment below!

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Changes in a post COVID-19 society that are here to stay first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.