Dr. Pugh’s News

For those that are interested in COVID-19 status in Austin, the Travis Co. Medical Society, UT/Dell Medical School and Austin Public Health (APH) gave docs an update this week.

Numbers: As of Saturday, the US has over 929,000 cases (over 700,000 more cases than the next country) and over 53,000 deaths (more than double the next country). Since only 1.5% of the population has been tested, this case count is lower than the real number. Many deaths at home are not being tested or autopsied, so these death counts are also significantly underestimated. Travis Co. has 1396 cases, Williamson Co. has 211 (other surrounding counties are less than Williamson). At the beginning of cases in Austin, UT developed some predictive models that showed how many cases we would have depending on how strictly people practiced social distancing. The best-case scenario was if people could reduce their daily contacts by 90%. This would prevent hospitals from becoming overwhelmed. Because Austin is filled with (mostly) awesome people, we have met and even exceeded this model. The number of cases was doubling every 2-4 days at the beginning of the outbreak, and now it is doubling every 14 days (standing ovation for everyone who has been staying home!). Our hospital capacity is better than we expected at this point. If we exceed capacity, there are plans in place to significantly expand our bed capacity. But since we are not overwhelmed, hospitals will now be able to start doing elective surgeries provided they do not deplete PPE and a certain percentage of hospital space will continue to be reserved for COVID patients. There are many patients waiting to have their cancers taken out or something biopsied, and I’m sure they will be relieved to be able to get this done.

Since residents are encountering so fewer people, it is making contact tracing much easier. This is really important. When the first cases were diagnosed, APH had to track down 100 + contacts for every positive case. Now, most positive cases are coming into contact with only a handful of people. This is using a lot less APH manpower and makes it easier to identify clusters of people at risk. They are aggressively testing clusters and nursing homes to try and identify cases early and limit the spread. As the restrictions relax, the plan is to “cocoon” nursing homes, the elderly, and others at high risk. The only asymptomatic people they are testing are people in these clusters. Asymptomatic testing does not make sense for everyone since the number of cases in our area is still relatively low. If the swab is negative, it doesn’t reliably rule out infection, because it could be positive the next day. If you are exposed, you would have to test every day of the 14 day incubation period to figure out when the infection started and no one is going to want to have a swab stuck WAY up in their nose every day!

Testing: We are dreaming of the day we have a fingerstick test that can diagnose you early in the illness. However, this may remain a dream. IgM antibodies, (the ones that are detectable first). aren’t detectable until 7-10 days into the infection. By this time, someone could be critically ill. If you test too early, it may be negative and you may be misled into thinking you were not infected with COVID-19. But, if a person had been sick for 10+ days and the test is negative, this would indicate they likely had another infection and not COVID-19. Because of cross-reactivity, a positive test could be COVID-19 or one of the four other common coronaviruses which cause the basic common cold. So the nasal swab is still the only reliable way to specifically diagnose COVID-19 infection (and it is by no means a perfect test). If you were sick a couple of months ago, IgM antibodies will be gone, so you would need an IgG antibody test. It also has the cross-reactivity issue, so we cannot reliably tell you if you had COVID-19 if it is positive. We do not want to give people a false sense of security if they have a positive test and make them think they are immune. Currently, these tests are being used for patients who had a positive nasal swab so we can tell if they are now immune and can be plasma donors. There are a lot of clinics advertising their antibody tests. Only a couple of tests are FDA approved and these brands are being used in hospitals, so most of these tests have not been validated. The reliability is questionable, and I think we need to be incredibly careful that we are using the best testing possible. For now, the most reliable test early in infection is still the nasal swab. APH now has free testing available to anyone with symptoms. Go to AustinTexas.gov/COVID19 to begin the enrollment to see if you are eligible for testing. Of note, they do NOT notify your doctor if your results are positive, so please notify your doctor so they can give you personal recommendations on care.

I also want to address the recent WHO statement regarding immunity after infection. Some of the headlines made it sound like you will not be immune if you get COVID-19, but that is misleading. There were some reports out of South Korea that they were seeing patients get reinfected. However, it is most likely that they were detecting either a reactivation of the virus still in the system or viral particles that were no longer infectious. The WHO statement is simply saying we do not know if, or how long, people will be immune after infection. It could be 1 month, 1 year, or even lifelong. There are a lot of things we still do not know, but we are learning more every day. The more time we can give our doctors and scientists to figure out this nasty virus and how to treat it, the more equipped we will be to fight it. So even though our numbers are fairly low, this isn’t the time to throw the doors wide open. In the words of APH, we should just crack the window open a little at first and proceed with caution. Please continue to be careful. If you think these measures were not worth it, I assure you that things would have been disastrous if we had allowed everyone to come here for SXSW and not put these restrictions in place. We are still at risk for having big spikes in cases. Yes, we need to let businesses reopen and let people get back to work, but wear your masks, wash your hands, keep your distance and do NOT be in groups. And remember, your mask doesn’t work if it’s not over your mouth and nose. And don’t touch the front of it after you put it on. I want to see you all at a concert and a football game ASAP, so keep up the good work Austin!!!!

If you read all of this, thank you! And look forward to the next installment of Pugh’s diary very soon.


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