COVID-19 Serology Testing

The following information is from Dr. Brian Metzger, MD, MPH on the current state of COVID-19 serology testing. Dr. Metzger is a member of the Austin Public Health COVID-19 Expert Advisory Panel and the infectious disease consultant to the Travis Medical Society ED/EMS Advisory Committee.

There is a growing concern about the current offering of serology testing for SARS-CoV-2, the virus responsible for COVID-19.

What is serology testing?

With the use of a blood sample, it can identify antibodies produced against the virus. Serology testing is different from molecular testing, which is used to diagnose active infection by detection of genetic material of the virus. As we have seen, this is typically done by a nasopharyngeal swab. Soon, serology testing will be used in the following ways:

  • To help determine the prevalence of SARS-CoV-2 in the population
  • Identify individuals in the community who are immune
  • Help delineate the phase of the infection (recent past vs. distant past)
  • Identify donors for therapeutic plasms
  • Possibly help with return-to-work decisions

Serology testing can identify whether antibodies are being made and which type of antibody. The most common serology testing involves identification of IgM and IgG antibodies.

  • IgM is the first antibody made following infection. This means that early after infection, only IgM will be present at detectable levels.
  • IgG antibodies follow several days later. At this phase, both IgM and IgG will be present at detectable levels.
  • IgM antibody production will begin to decrease, leaving IgG as the only detectable antibody.

What do we know about SARS-CoV-2 serology testing?

  • Approximately 50% of patients are seropositive for IgM by day 7 after symptom onset.
  • Close to 100% of patients are seropositive for IgM and approximately 50% are positive for IgG by day 14 after symptom onset.

Serology testing should never be used to make a diagnosis of active COVID-19 since antibody production is not present at detectable levels until several days after the onset of symptoms. Only molecular testing should be used to make the diagnosis of active COVID-19.

Serology testing is currently in development. As of April 14, 2020, the US Food and Drug Administration (FDA) has granted emergency use authorization (EUA) to one antibody test for the detection of SARS-CoV-2. In other words, there are no FDA-approved serology tests yet.

There is no telling the accuracy of serology tests that do not proceed through FDA emergency review authorization. We want to avoid the following consequences by waiting for more serology tests to complete the FDA EUA process:

  • A negative result may be a result of a test being insensitive to detecting SARS-CoV-2 antibodies.
  • A positive result may be a result of the presence of cross-reactivity with antibodies to more common, non-SARS-CoV-2 strains of coronavirus.
  • A false negative result can be a missed opportunity to make a diagnosis.
  • A false positive result can lead to misinformation that a patient is no longer susceptible to SARS-CoV-2 infection, resulting in discontinuation of social distancing measures and other means of protecting themselves from infection.

The good news is that there will be several serology tests that will have completed the FDA EUA process over the next few weeks. These tests will be more reliable since there will have been a review of their data, including the sensitivity (the ability to correctly identify all patients with the virus) and specificity (the ability to correctly identify all patients who do not have the virus) of the test. Serology testing will play a significant role in the COVID-19 pandemic, however that role is not now, and not with currently available serology testing.

At this point, we are not recommending serology testing in our office. As always, we are committed to updating our patients with the most recent information regarding this pandemic.

Workout Wednesday RESCHEDULED to Thursday this week at 6PM!

Exercise is more important than ever during this pandemic, especially when it comes to reducing that funk so many of us are in right now. Physical activity improves mood and well-being and reduces stress and anxiety. You can also use exercise as a way to organize your day. Our daily lives can be more stressful when we do not have a schedule, and exercise can be an anchor.

This week we will be hosting a free yoga session on ZOOM. Download the app for free on any web browser or mobile device and click the link here at 6 PM tomorrow to join the workout.

Some of the proven benefits of yoga include: 

  • decreased stress
  • improved flexibility
  • improved respiration and vitality
  • protection from injury
  • increased muscle tone and strength
  • relief of anxiety
  • reduction of inflammation
  • improved sleep quality

Do not feel pressure to turn your microphone or video options on, as this is all about your health and healing during this time. If you have a question during the workout, please feel free to speak up! Please listen to your body and alter any pose as needed. If you need any personalized advice on how to change a position after the session, please contact me directly at info@partners-in-health.com.

If you are unable to join us for this workout, there are many free online resources available! Yoga instructor, Adriene, hosts a YouTube channel called Yoga with Adriene that offers an online community of over 6 million subscribers. She publishes free Yoga Videos and has a library of over 500 free videos and growing. Click here to access her website for more information!

Stay healthy and keep active everyone! 

Your personal fitness coach,

Alyssa

Stay Home Order Extended and Face Masks Required: Update on COVID-19

The city of Austin’s Stay Home – Work Safe Order has been extended through May 8, 2020 by Mayor Steve Adler and Travis County Judge Sarah Eckhardt. This Order requires residents to stay at home, except for essential activities and essential businesses to prevent further spread of COVID-19. In addition, the Order now requires the public to wear fabric face coverings when conducting essential activities or work.

Examples of Essential Activities as defined in the order include:

  • Health and safety: obtaining healthcare, emergency services, medical supplies, or medications
  • Necessary supplies and services: obtaining groceries and prepared take-out food, liquor stores, pet food, and supplies necessary for staying at home
  • Outdoor activity and services: engaging in individual outdoor activity, such as walking (includes your pet), hiking, biking or running provided that individuals maintain at least 6 feet of social distancing
  • Essential work and services: performing work at an essential business defined in the Order, which includes all services needed to ensure the continuing operation of critical infrastructure to maintain the health, safety, and welfare of the public
  • Care for others: caring for a family member, the elderly, minors, dependents, persons with disabilities, or other vulnerable persons in another household

Examples of Non-Essential Activities include:

  • Social gatherings regardless of the number of people together who do not reside in the same household
  • Indoor/outdoor on-site restaurant dining
  • Visiting bars, entertainment venues
  • Exercising at gyms and fitness centers

Face Covering Information: The city now requires all individuals to wear a fabric face covering when leaving their residences, along with physical distancing. This is due to the findings consistent with the Centers for Disease Control (CDC) and Austin-Travis County Health Authority that a significant percentage of individuals with COVID-19 do not have any symptoms. An infected person can also transmit the virus to others before showing any symptoms. The covering of one’s nose and mouth when outside their home or residence is necessary to help prevent the spread of COVID-19. Keep in mind that when you wear your face covering, you are protecting other individuals, and when others wear their face coverings, they are protecting you. This is not meant to be a substitute for maintaining the 6-feet social distancing guidelines and hand washing, as these remain vital steps to slow the spread of the virus. Medical grade (N95) and surgical masks should be reserved and used only by medical professionals and first responders. Please see this flyer for how to make your own cloth face covering, or see this video for easy instructions. Parents and guardians of children under the age of 10 are responsible for appropriately masking children when outside of their residence.

All individuals over the age of 10 must wear some form of covering over their nose and mouth, such as a homemade mask, scarf, bandanna or handkerchief when:

  • Entering into or inside of any building open to the public (including medical offices)
  • Using public transportation, taxis, or ride shares
  • Pumping gas
  • Outside and 6 feet of social distancing cannot be consistently maintained between the person and individuals outside of their household

Cloth face coverings should:

  • Fit snugly, but comfortably against the side of the face
  • Be secured with ties or ear loops
  • Include multiple layers of fabric
  • Allow for breathing without restriction
  • Be able to be laundered and machine dried without damage or change to shape

Face coverings are not required when:

  • Riding in a personal vehicle
  • Alone in a separate single space
  • In the presence only of other members of their household or residence
  • Doing so poses a greater mental or physical health, safety or security risk such as anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the cover without assistance
  • Eating

What Else Can We Do?

As a household, you can plan and make decisions now that will protect you and your family during this pandemic. Along with following all current guidelines, the CDC and the Travis County Medical Society recommend the following to ensure that your household is prepared:

  • Stay up-to-date about local COVID-19 activity from public health officials (please see our COVID-19 page for more information).
  • Create a list of local organizations you and your household can contact in case you need access to information, healthcare services, support, and resources.
  • Create an emergency contact list including family, friends, neighbors, carpool drivers, healthcare providers, teachers, employers, the local public health department, and other community resources.
  • Plan ways to care for those who might be at greater risk for serious complications.
  • Take everyday preventive steps (see here for more information) and watch for symptoms. Stay home and speak to your healthcare provider if you develop a fever, cough, or shortness of breath. If you develop emergency warning signs for COVID-19 (trouble breathing, persistent pain or pressure in the chest, new confusion or inability to arouse, bluish lips or face) seek medical attention immediately.
  • Choose a room in your home that can be used to separate sick household members from those who are healthy. Identify a separate bathroom as well, if possible. Learn how to care for someone with COVID-19 at home.
  • Prepare for possible illness. Most people who contract COVID-19 will have mild illness not requiring hospitalization. Should anyone in your household need hospitalization, it is important to write down vital health information ahead of time. Take the time now to write down your health history and include any legal documents, such as power of attorney and medical directives. Bring this information to the hospital in the case of hospitalization. A convenient form developed by the Travis County Medical Society can be filled out.
  • Take care of the emotional and mental health of your household members. Outbreaks can be stressful for adults and children, and children respond differently to stressful situations than adults. Talk with your children about the current situation, try to stay calm, and reassure them that they are safe.

As we are all experiencing, the pandemic has changed our daily lives and since we’ve never dealt with anything like this before, we are all learning as we go. The most important goal is to avoid a large number of people needing hospitalization at the same time, raising the possibility that health care resources will not be adequate to care for everyone. We must all do our part to slow the spread of COVID-19 to prevent this from happening. Enormous efforts in Central Texas alone are underway to manage the effects of COVID-19 on our health care system and our economy. From the words of the Travis County Medical Society, “This pandemic will pass, and life will return to normal. Some things may change. But rest assured, Austin will still be weird, and a great place to live.”

 

Workout Wednesday at 7PM: Circuit Training

Join the movement with us this week for Workout Wednesdays!

This week we will be hosting a free AMRAP (As Many Reps As Possible) Circuit Training session on ZOOM. Download the app for free on any web browser or mobile device and click the link here at 7 PM Wednesday to join the workout.

ZOOM ID: 626-748-173

For this week’s workout, you will need small dumbbells for arm exercises. All other exercises are weight-based and incorporate your body through movement to create resistance. If you do not own dumbbells, you can alternate with other household objects at this time such as water bottles or laundry detergent.

The coronavirus has changed daily life around the world in so many ways: the way we shop, the way we work, the way we socialize, and yes, the way we exercise. If you usually work out, or if you are craving more activity now that the globe is on lockdown, you might be wondering, where and how can do accomplish this?

Exercise is more important than ever during this pandemic, especially when it comes to reducing that funk so many of us are in right now. Physical activity improves mood and well-being and reduces stress and anxiety.

You can also use exercise as a way to organize your day. Our daily lives can be more stressful when we do not have a schedule, and exercise can be an anchor.

Do not feel pressure to turn your microphone or video options on, as this is all about your health and healing during this time. If you have a question during the workout, please feel free to speak up! Please listen to your body and alter any exercise as needed. If you need any personalized advice on how to change a position after the session, please contact me directly at info@partners-in-health.com.

Your personal fitness coach,

Alyssa

Update on COVID-19

With the evolution of the outbreak, our understanding of the transmission of COVID-19 virus continues to improve daily. Recent findings of the CDC suggest that this virus has the ability to transmit far easier than the flu, making it probably about three times as infectious as the flu.

Transmission of COVID-19

By definition from the WHO, a symptomatic COVID-19 case is a case who has developed signs and symptoms compatible with COVID-19 virus infection. Symptomatic transmission refers to transmission from a person while they are experiencing symptoms. COVID-19 is primarily transmitted from symptomatic people to others who are in close contact through respiratory droplets, by direct contact with infected people, or by contact with contaminated objects and surfaces.

One of the latest findings confirmed that up to 25% of individuals in the US that are infected remain asymptomatic. What does it mean to be asymptomatic? According to the WHO, an asymptomatic person is someone who is infected with COVID-19 and does not develop symptoms. Asymptomatic transmission refers to transmission of the virus from a person, who does not develop symptoms. Even though these individuals are asymptomatic, they do contribute to transmission.

The incubation period for COVID-19, which is the time between exposure to the virus (becoming infected) and symptom onset, is on average 5-6 days. However, incubation period can be up to 14 days. This period is also known as the “pre-symptomatic” period. Pre-symptomatic transmission refers to transmission of the virus from a person, who has not yet developed symptoms. Studies show that people can test positive for COVID-19 1-3 days before they develop symptoms. It is possible for people infected with COVID-19 to transmit the virus before any significant symptoms develop. This helps explain how rapidly the virus continues to spread across the country, because we have individuals who are transmitting the virus 48-72 hours before they become symptomatic.

New face mask recommendations?

Due to recent studies that strongly suggest the virus is possibly transmitted by simply speaking, the CDC recommends the community use of cloth masks as an additional public health measure people can take to prevent the spread of the virus to those around them, especially for pre-symptomatic and asymptomatic individuals. Cloth masks include the use of bandannas, scarves, and homemade masks (click here for suggestions on easy DIY masks at little to no cost). This does not include buying surgical masks or N95s, as this recommendation is not meant to take away availability of masks from health care providers on the front lines. It is important to keep in mind that is in addition to social distancing and practicing good hand-washing hygiene, and not a replacement.

As Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, stated, social distancing is a powerful weapon. With the social distancing guidelines extended until April 30th, we urge our patients to stay home. When you have to be in the public, distance yourself at least 6 feet away from people and wear your masks. As always, we will be here to keep you up to date with the evolving situation.

Introducing Workout Wednesdays – Tomorrow at 7PM!

The coronavirus has changed daily life around the world in so many ways: the way we shop, the way we work, the way we socialize, and yes, the way we exercise. If you usually work out, or if you are craving more activity now that the globe is on lockdown, you might be wondering, where and how can do accomplish this?

Exercise is more important than ever during this pandemic, especially when it comes to reducing that funk so many of us are in right now. Physical activity improves mood and well-being and reduces stress and anxiety.

You can also use exercise as a way to organize your day. Our daily lives can be more stressful when we do not have a schedule, and exercise can be an anchor.

Join the movement with us on our new Workout Wednesdays!

This week we will be hosting a free yoga session on ZOOM. Download the app for free on any web browser or mobile device and click the link here at 7 PM tomorrow to join the workout.

Do not feel pressure to turn your microphone or video options on, as this is all about your health and healing during this time. If you have a question during the workout, please feel free to speak up! Please listen to your body and alter any pose as needed. If you need any personalized advice on how to change a position after the session, please contact me directly at info@partners-in-health.com.

Your personal fitness coach,

Alyssa

Things to do at Home While in Quarantine

So you’re stuck at home and self-isolating during the coronavirus pandemic. What is there to do?

There are plenty of ways to pass the time — and many of them are free or cost-effective.

*Click links for direct access to each recommendation* 
  • PuzzlesNot only are jigsaw puzzles fun to do, but they are excellent for brain training too. Working a puzzle helps develop your abilities to sequence, reason, analyze, deduce, logical thought processes and problem solving skills. It’s a great way to engage with others, while engaging your brain!

  • Reading (create a virtual book club) – Reading is another great way to keep your brain active while at home. Numerous studies have shown the many ways reading benefits your brain, including mental stimulation, stress reduction, enhanced social skills, vocabulary expansion, memory improvement, improved brain connectivity and function, and better sleep. Thanks to technology, book clubs can be held virtually through multiple platforms, including threads, online groups, and video chat. Pick a book for you and your family or friends to read and discuss it for even further engagement. Click here for 6 books written by Austin authors.

  • Solitary Walks/Runs/Bike Rides (with dogs)  – It is important to stay physically active. Even with the Stay-at-Home order, you are still allowed to be outdoors for individual activity. A 30-minute walk outside has many benefits, including burning calories, strengthening your heart, lowering your blood sugar, easing joint pain, boosting your immune function and energy. It can also improve your mood and it may help clear your head and help you think creatively. Other exercises can also include resistance bands and dumbbells, or stretching to work on your flexibility.

  • Fostering animalsAustin Pets Alive really needs fosters right now for dogs and cats! If you are not currently looking to adopt a pet, you can still help by taking in an animal and help to care for them until they find a permanent home. There are many health benefits of interacting with pets. Pets can increase opportunities to exercise, get outside, and socialize (even at 6 feet apart). Regular walking or playing with pets can decrease blood pressure, cholesterol levels, and triglyceride levels. Pets can help manage loneliness and depression by giving us companionship. Teaching a dog or cat new tricks is also another great way to past the time.

It doesn’t stop there, there are so many other things you can do to keep yourself and your brain active during this time. Check out these options and challenge yourself!

  • Video Games  
  • Painting by Numbers
  • Blog or journal
  • Spring Clean and organize (Watch Marie Kondo‘s Tidying Tips on Netflix)
  • Streaming TV (You can watch with your friends online with Netflix’s new Netflix Party feature)
  • Yoga 
  • Meditation (HeadSpace App)
  • Create To-Do Lists
  • Cook new recipes
  • Learn an instrument
  • Create a Duolingo account and learn a new language
  • Board Games
  • Crosswords, Sudoku, Word Search or other games on your phone
  • Knit or Crochet
  • Create a fort inside your home – a great option for kids!
  • Learn Origami
  • Create a scavenger hunt – another great option for kids!
  • Pray or watch church online
  • Learn how to macrame
  • Catch up on sleep
  • Call your family and friends!

Taking care of yourself, your friends, and your family can help you cope with stress. Helping others cope with their stress can also make your community stronger.

Update on COVID-19

Stay Home – Work Safe Order Effective 11:59 PM on March 24, 2020

Mayor Adler issued a stay-at-home order for the city of Austin. This new order states people may leave their residences only to perform “Essential Activities”, to work in or obtain services from an “Essential Business” ,”Essential Government Service”, or in “Critical Infrastructure”, or to engage in “Essential Travel”  or “Minimum Basic Operations”. Please read through the order to understand which activities are considered essential and which are not. These are steps that promote social distancing to help prevent the spread of COVID-19.

Potential COVID-19 Treatments?

There are currently no FDA-approved treatments or preventive vaccines for COVID-19. The Texas State Board of Pharmacy (TSBP) has placed restrictions for prescriptions of chloroquine, hydroxychloroquine, azithromycin and another anti-malarial drug, mefloquine due to the shortages of these drugs. Shortages of these drugs have a negative effect on patients who need it. At this time, physicians are not allowed to prescribe these medications without a clinical diagnosis. Please refer to this official document from the TSBP for more information.

Due to the shortage of azithromycin, we will prescribe this medication exclusively to patients who can only take this medication due to drug allergies.

Office Hours for Partners in Health

Our office hours will remain the same. We have postponed all routine appointments and we are currently not accepting walk-ins. All illnesses are first evaluated with a virtual visit, which include but are not limited to: phone call, text, email, FaceTime or video chat. For other general consultations, please contact our office by phone at (512) 453-3542 or by email at info@partners-in-health.com. Please remember that Dr. Rhodes is available to our patients outside of our office hours by directly contacting her cell phone or email.

To stay up to date with the most recent guidelines from the CDC, please visit this website.

We thank you for your continued cooperation to help prevent the spread of COVID-19.

One Week into Social Distancing: Update on COVID-19

What is social distancing? 

According to the Centers for Disease Control and Prevention (CDC), social distancing means remaining out of congregate settings (crowded public places where close contact with others may occur, such as shopping centers, movie theaters, stadiums), avoiding mass gatherings, and maintaining distance (approximately 6 feet or 2 meters) from others when possible. These steps have been recommended in order to lessen one’s chances of catching COVID-19.

Other examples of social distancing that allows people to avoid larger crowds or crowded spaces include, but are not limited to:

  • Working from home instead of at the office
  • Closing schools or switching to online classes
  • Visiting loved ones by electronic devices instead of in person
  • Cancelling or postponing conferences and large meetings

Remember that social distancing is different from self-quarantine and isolation. People who have been exposed to COVID-19 and are at risk for coming down with it may practice self-quarantine. The CDC recommends that self-quarantine lasts 14 days. Self-quarantine involves washing your hands frequently and practicing standard hygiene, not sharing things like towels and utensils, staying at home, not having visitors, and staying at least 6 feet away from other people in your household. For people who are confirmed to have COVID-19 through testing, isolation is the recommendation. This means keeping people who are infected with a contagious illness away from those who are not infected. Isolation can take place at home, hospital, or a care facility. Special personal protective equipment (PPE) needs to be used to care for these patients in health care settings.

What is “flattening the curve?”

Coined by the CDC, this term refers to the implementation of protective practices to slow the rate of COVID-19 infection, in order to ensure that hospitals and health care facilities have enough room, supplies, and health care providers for all patients who need care. A large number of people becoming very sick over the course of a few days can potentially overwhelm a hospital or health care facility, as we have seen in other countries already. Too many people becoming severely ill with COVID-19 at the same time can result in a shortage of hospital beds, equipment, and providers.

On the contrary, if that same large number of people became sick at a slower rate, over the course of several weeks, the line on the graph would be a longer, flatter, curve. In this case, there is a better chance of the hospital being able to keep up with adequate supplies, beds, and health care providers to care for them.

At this time, our practice has decided to postpone appointments that are not urgent, including routine physicals. Other general consultations and illnesses will first be evaluated via a virtual visit, which includes, but is not limited to: phone call, text, FaceTime, or video chat. Our goal as a practice is to make sure our patients follow the practice of social distancing, and to stay at home as much as possible. This pandemic can be overwhelming, but every person can help slow down the spread of COVID-19. By doing your part, you can make a big difference to your health and the health of others around you.

 

A note to our patients regarding COVID-19

We are closely monitoring the Coronavirus (COVID-19) situation and following recommendations from the Centers for Disease Control and Prevention (CDC), World Health Organization, and the City of Austin.

At this time, we are postponing all events scheduled for this month until further notice. This includes the free skin check with Dr. Tyler Hollmig scheduled for March 25th and our “A Walk in the Park” event scheduled for March 29th.

At this time, all testing for patients who qualify are held at the public health labs. Please refer to this website: http://www.austintexas.gov/department/health for the Austin Public Health Department or call (512) 972-5555. If you are presenting with symptoms but are not able to get tested, please quarantine yourself for 14 days and until completely symptom-free.

In an effort to protect you, our medical team, and the general public, please do not go directly to your doctor’s office or the emergency department without calling first. A phone call will allow care teams to determine the best location for you to be evaluated. In some cases, phone calls may allow you to avoid an in-person evaluation, which helps minimize exposure to the public. If you are experiencing a medical emergency, such as severe shortness of breath, chest pain, or altered mental status, please call 911.
To keep yourself and others healthy:
  • Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Stay home when you are sick.
  • Cover your cough or sneeze with a tissue or bent elbow (if tissue is unavailable), then throw the tissue in the trash.
  • Avoid all non-essential travel.
  • Know the symptoms: fever, cough, shortness of breath
If you have an existing routine appointment scheduled, and are experiencing respiratory symptoms such as fever, cough, or shortness of breath, please call the office prior to the appointment to discuss how your care will best be served.

This is a rapidly evolving situation, and one that we are actively monitoring. We are ready to adjust as things progress, and we will keep our patients up to date throughout.