What You Should Know About Coronavirus Tests

Stan Bunger
April 03, 2020 - 11:15 am
Drive-through testing site in Wolverhampton, England

Christopher Furlong/Getty Images

As we continue to navigate these unprecedented times, KCBS Radio is getting the answers to your questions about the coronavirus pandemic. 

Every morning, Monday-thru-Friday, at 9:20 a.m. we're doing an "Ask An Expert" segment. Each day, we'll focus on a different aspect of this situation. 

Today we discussed the medical options available for dealing with the virus. What drugs can be used, possible vaccine efforts and different forms of testing. 

KCBS Radio's Stan Bunger talked with Dr. Margaret Hamburg, former FDA Commissioner and former Health Commissioner of New York City. and posed some questioners from listeners to her. 

Q: Regarding the antibody test people have been talking about, isn’t it true that the body produces two antibodies spaced days apart? Since any antibody test must be for specificity and sensitivity, wouldn’t it be unwise to assume a test would prove you have immunity?

There are a couple different aspects to that question. The antibody test is an important test because it tells us about people who has been infected with the virus, but their body has mobilized to fight it off by creating antibodies. There are different types of antibodies. Your questioner is right, but the main thing is that it takes a little while for the antibodies to develop. But then the antibodies are your bodies’ way of protecting you against an infection. By doing an antibody test, we can learn about people who have been infected, no longer are actively infected, but have this evidence of an immune response.

In almost all cases, developing antibodies does give you some protection against reinfection and future infection. This is a novel virus we’re dealing with, so there’s a lot we don’t know. So we can’t say 100% for sure, but it’s a pretty good indicator that you’re going to have protection in many ways in the same way that a vaccine would give you protection. It will be important to get these antibody tests out there and in use. It will help us to know when health care workers and other first responders that have been infected can go back safely into the workplace.

It’s going to be important for all of us to be able to assess our status in thinking about how do we return over time back to a more normal life and into the workforce. The antibody test is very important. We always care about specificity and sensitivity of diagnostics no matter what kind of test it is. And it’s important that we continue to expand access to the tests that tell you if you’re actively infected. It’s also important that we continue to expand access to these new, more rapid and accessible, diagnostic tests as well.

Q: When is it absolutely necessary/mandatory versus highly recommended to wear a surgical mask for the common person? I’m a runner and would like to know if it’s necessary or recommended to wear a mask while I’m exercising outdoors. 

If you’re a healthcare worker taking care of infected patients or if you are infected yourself and are around others, you need a mask. Generally speaking, we don’t recommend that other people need to wear masks to protect themselves just out in the world. If you’re a runner, then wearing a mask is probably a huge inconvenience and not good for your breathing. But we are learning more about this virus, we are learning that people that are infected and asymptomatic can spread it and it may linger in the air a little bit more than we had realized.

That’s why you’re seeing new recommendations, not requirements, that people can consider wearing masks when they’re outside. But that doesn’t protect you, you can’t think you’re safe and can gather with friends. I think it’s about common sense. I would say to that runner I probably wouldn’t wear a mask because I’m short of breath when I’m running already and a mask would only make me sick.

Q: Why are we quarantining health care workers who test positive? If the worker is asymptomatic, or has a mild case and continues doing their job, aren’t they the perfect candidate to work with COVID-19 positive patients?

I think we want to make sure that people who are actively infected don’t expose others. While a healthcare worker might be working with an infected person already, there also working with many other health care workers and others that aren’t infected. We want to make sure that if you have infection you isolate yourself from your workplace and your family, if you’re at home, until you clear that virus and aren’t at risk of actively spreading disease to others.

Q: Does the pneumonia vaccination provide any resistance or protection against COVID-19?

Vaccines against flu or pneumonia don’t protect you against COVD-19,  but it’s good to be protected against other circulating infectious diseases in a community. COVID-19 has been occuring at the same time we’re having a flu season. It can confound the diagnosis, and also you can be more vulnerable to serious complications of COVID-19 if you have other medical complications or are immune compromised. I recommend that people routinely get flu vaccines, for example, and if you’re over a certain age the pneumonia vaccine as well. Not to protect you from COVID-19 infection, per se, but to make you healthier and disease-free so that you can combat other threats to your health.

Q: Why will it be possible to create a vaccine for the COVID-19 coronavirus when no such vaccine has been possible for the common cold coronavirus? What’s the difference between all these coronaviruses?

The coronaviruses are all in the same family, but each one is different. There hasn’t actually been a vaccine developed for SARS or MERS. There have been research efforts underway and we’re building on some of those now as we race to try to develop a vaccine against this novel coronavirus. Making vaccines isn’t always easy. It does take time. It takes good science, and it takes good technology to make the vaccine, scale it up, manufacture it, and get it to the people who need it. 

We are seeing a mobilization of science like we’ve never seen before in terms of the efforts both to find new drugs and a new vaccine against novel coronavirus. There have been important advances in science and technology over time that I think will get us more successfully to our goal of a vaccine and new therapeutics as we combat COVID-19.

Q: Do you have any idea if the severity of illness would have anything to do with how it was transmitted?

There’s so much we still don’t know about this new virus. It’s hard to remember that we didn't even know about it a few months ago. We’re learning quickly. Part of what we don’t fully understand is why some people get infected and others don’t, as well as why some people go on to get severe disease and others may not even know that they’re infected. Certainly the amount of exposure to the virus, the timing of that exposure, your underlying vulnerable in terms of health, and maybe some genetic vulnerabilities, all make a difference in whether or not you’ll go on to be infected and/or have serious disease.

Q: Can hydroxychloroquine and maybe taking a Finnish sauna bath help to improve our innate immune system.

[laughs> I haven’t heard the Finnish sauna bath theory, I’ve heard a lot about hydroxychloroquine. That is a compound that has been used for many years as an antimalarial drug and also for the treatment of certain auto-immune diseases like Lupus and rheumatoid arthritis. It is a drug that we know has some toxicities in use, but it’s very beneficial for those conditions. We don’t yet know whether it works against COVID-19 in people.

It has been shown to have some activity in test tubes and in animal cells in a lab, but studies are being done right now to find out if it really works or not against COVID-19. It has been tried against other viruses in other outbreaks in recent years, and again it showed activity in a test tube and in the laboratory, but didn’t work in people. I think we all want to explore, we all hope that it will hold promise, but we need to study to know if it actually works and will provide benefit to patients?

Q: Are the bills dispensed by ATMs sanitized in any way? If not, how long should I wait before using them freely?

The truth is that money is pretty dirty, think about all the hands that it goes through. I think it is a good idea to treat money from an ATM as though it could be contaminated, as strange as that seems. I don’t know anything about what has been done with ATM machines in recent days in response to COVID-19, but studies have been done and show that it is good at carrying germs in many instances. I would handle it with gloves or a barrier when you get it out when you take home. If you live in a sunny place like the Bay Area, spread it out then flip it over, and then put it in your wallet and use it.

Q: What percentage of people who have severe enough conditions that they need a ventilator recover if they do get a ventilator?

There are a lot of unknowns unfortunately, as we’re just learning now, how to manage serious cases of COVID-19. We know that most people who get infected in fact do well, and that’s the good news. eight or nine out of 10 have mild disease, some asymptomatic, some a little bit more moderate in terms of severity. It’s a smaller percentage that has serious disease, a smaller percentage that require hospitalization, and of those who need the ventilator. You certainly don’t want to put anyone on a ventilator if they don’t need it, but one of the things that we still really don’t understand about this disease is that you can have a patient that’s doing pretty well and then suddenly…their breathing worsens, and then they really do need to get on a ventilator.

That’s why there's’ been so much focus on the need for ventilators, I don’t think we really understand what percentage of patients right now, in any given hospital, who’s going to need a ventilator. It’s partly dictated by their background level of illness, with patients that are more likely to have serious disease being also more likely to need a ventilator. But, like I said, some patients go from seeming pretty well to quickly needing a ventilator. The goal right now is to try to make sure that we have enough ventilators for the patients who need them, and to try to keep patients as well as possible that they don’t need a ventilator.

Q: Are the 3M Cool Flow 95 respirators that have an unfiltered exhaust valve inappropriate to donate to health care workers? It seems like these would protect the wearer, but not those that they’re caring for.

I don’t know specifically about that 3M respirator, I think that right now with a gap in the availability of respirators and masks for health care providers that many different strategies are being used and I would think that what you’re describing could offer protection. But I really have to say I don’t know the specifics of that particular respirator series, so I can’t be as helpful to that questioner as I would like.

Q: What’s going on with diagnostic testing?

Diagnostic testing unfortunately in our country did get off to a slow start. There were problems with the initial diagnostic tests that were developed and distributed. That set us back in terms of really understanding the nature and the scope of the outbreak in various regions of the county, and across the whole country, and certainly slowed our ability to be as fully prepared and responsive as we might have wished. Thankfully, we are seeing a very rapid upsing in the number of diagnostics that are going out into the health care system and out for use. We are seeing a range of diagnostics, and that’s a good thing.

As we talked about before, we need the diagnostics that tell you if you’re infected, but also the diagnostics that look at antibodies The advance, just recently, of being able to offer a rapid and accessible ‘point of care’ diagnostic is really important so that we can get answers more quickly and we can act on them, instead of the one to two day delays to get test results back, and I’m hearing even longer backlogs in some instances. We’re making progress we need to continue to push on that front, and we need to really be able to monitor where we stand with this unfolding outbreak, and we need to make sure that people who are infected manage their infection correctly and isolate themselves and get the health care that they need.

Q: Does wind have an effect on the spread of the virus?

I think the science here is really uncertain, but my guess is that wind probably helps it to dissipate. I think that opening a window, or being outside where it’s windy is probably beneficial.

Q: There’s so much information out there. How can people figure out who and what to trust?

There really is a lot of information, and for a couple different reasons. We are learning every day more and more about this novel coronavirus and the COVID-19 disease which it causes, with that comes a flood of new information. In addition, there’s a lot of misinformation out there. Some of it is well-meaning but incorrect, and some it is unfortunately not well-intentioned in products and other things that are being advertised offering fraudulent claims and sometimes cures.

I do recommend that people try to stay up with the most current info, but get their facts from trusted and reliable sources. The Centers for Disease Control website is a good one, as well as the FDA or National Institutes of Health websites. Also your local or state health department, and your medical professionals. It’s crucial to stay up to date, but it’s also crucial to be able to weed out the bad information so that you don’t inadvertently do something that isn’t actually beneficial to yourself or others.