Image of hand in surgical glove Covid 19 antibody test kit

CMO Covid Corner


A quick visit to the archives for a new take on an old TV show…
 
Who can you trust for Covid-19 advice?
 
Not WHO
Nor FDA
Nor even the CDC blog…
 
Just little ol’ us…
We’re UNDERDOG!
 
At Caduceus, we are used to being an underdog. Our entire annual revenue would possibly fit in Kaiser’s petty cash fund.  Mammoth health “systems” in Orange County, like Providence and Memorial, are comparable to Costco’s size next to our little boutique practice.  And the government agencies in the above rhyme have billion dollar budgets with some of the greatest health care minds in the world.
 
Yet here we are in month nine of the worst pandemic in our lifetime, and no end in sight. Perhaps it’s time to listen to the “Underdog.”
 
Let’s look at what our prodigious health agencies have told us so far. FYI, all the data we publish forth comes from their own websites or newsletters.
 
WHO-
The World Health Organization is an agency of the United Nations. It is funded by its members. The top three financial contributors?

-The USA
-Bill Gates
-The UK

Despite it ravaging Asia and then Europe, the WHO did not proclaim Covid-19 a pandemic until March 11. We started curbside testing for flu and strep in February, and added Covid-19 tests on March 12.
 
They have not advised universal testing, only those with symptoms or close contacts.
They advise stopping a quarantine on a swab-positive case once symptoms have resolved.
They determined a positive swab without symptoms can be due to “prolonged viral shedding.”
They have told employers they “may” want to require a negative test before people return to work after infection. 

On April 24, they told the public that antibody tests showed no evidence of immunity. They now have reversed course on that position.

On June 7, they did not advise routine mask wearing. On June 8, they changed their position.

And what has their advice accomplished? Almost 300.000 NEW cases a day worldwide now, compared with fewer than 100,000 at the end of May. Perhaps tighter controls are in order?
 
FDA-
The Food and Drug Administration is a truly bipartisan part of the Federal Government, yet empowered through Congress. So, they both have their fingerprints on the crime scene here.

Let’s see…Plaquenil. It was given emergency approval for Covid-19 in March. In June, they revoked it. Now they say they won’t approve it, but a doctor is approved to use it in the hospital or a clinical trial setting. Keep in mind that once the FDA approves any drug for ANY condition, ANY doctor may use that drug for another indication “off label,” it’s done daily on thousands of drugs. It is not “illegal” to use Plaquenil for Covid-19. But trying to follow the FDA advice is like playing Whac-A-Mole.  
 
Let’s look at the Abbott “rapid test” for Covid-19…it was given emergency use authorization in the spring.  Then several academic centers found “adverse events” (translation-bad mistakes) with the test informing thousands of patients they were Covid negative when they were actually positive.Yet the FDA approval stood. They simply put out a “warning” of the high degree of false negatives.

And now, they have just approved a new “quickie” Abbott test, coming out in October with a better false negative rate. Ummm…according to Abbott….no academic center has tested it yet.  And the FDA still approved it. 

And the result?  Only PCR swab tests have data with acceptable false negative rates. FDA approval of “antigen” tests (i.e. quickie tests) have exposed thousands of Americans to Covid-19 unknowingly.

On the flip side, thousands of Covid-19 patients have improved with drugs such as Decadron, with no FDA approval
At least right now, FDA approval–or lack of it—appears to be of little importance.
 
CDC-
The Centers for Disease Control is a federal agency. If you want to trace how Covid-19 became out of control in the US, we can start here. The first confirmed case in the US was January 20.  Yet the CDC delayed widespread testing for over a month. Worse, CDC tests were found to be faulty, and investigations show the CDC did not follow their own protocols regarding pandemics. 

And although Caduceus was the first to start testing for Covid-19 in Orange County, we had to wait until March 12 because the CDC had not made tests available to the health care community until that date. It would be April before the testing was available to the general public. And even then, everyone was running out of tests. This debacle lay in the hands of the CDC.

This was definitely a pandemic prior to March 11. 

A US Department of Health and Human Services (HHS) investigation into the COVID-19 testing crisis is under way.
But that isn’t all; the CDC admitted they inflated results by combining IgM antibody results with positive PCR swabs. 
Even now, they admit they were wrong to not advise testing close contacts of known Covid-19 patients with no symptoms, and now do advise it…four months too late.

They also discourage a test of cure (re-swab) after a Covid-19 infection. It is easier to have a Michelin restaurant allow substitutions than have the CDC advise us to test.  And we shouldn’t forget the CDC website told us in the spring to only wear masks if social distancing was not possible.

And what has our federal agency designed to protect us accomplished? 
New cases in US March 30-19,000 
New cases in US August 30- 44,000. 

How is minimizing universal testing working out for you?
 
How about the White House Task Force—headed by Dr Fauci, under President Trump?
 
On February 29, WE WERE TOLD “NO NEED TO CHANGE WHAT WE ARE DOING” in regards to the large wave approaching. He has also flip flopped on the travel ban (first against it, then for it). He first spoke of masks being optional, and then changed his mind. The lockdown? First for it, then against it.  More flip flops than Labor Day in Laguna Beach. 
But this is truly a bipartisan gaffe; both Nancy Pelosi and Joe Biden downplayed the upcoming carnage in February when we needed a strong push to test from all of our leaders. 
 
We must mention our own Orange County Health Department leader Nichole Quick was forced to resign after death threats when she put out a mandatory mask order.  Her replacement understandably reversed the order. The job doesn’t pay enough to risk an execution.

When the state also passed a mandatory mask order, the Orange County Sheriff said he would refuse to enforce it.
Our own OC Health Department is calling our patients telling them no need to retest after an infection. As recently as last week, other health departments through the state are doing the same thing.

And Governor Newsom locking down, reopening, and then locking down again-without advising mandatory testing? 

How effective are our state leaders in getting this under control?
New cases in California March 25- 471
New cases August 25- 6,004

More testing anyone?
 
At Caduceus, we have been consistent with our message from Day One.

*Know if your contagious (PCR Swab) 
*Know if your immune (Antibody blood test)
*If your positive strictly quarantine until PCR swab is negative (Average 14 days) 
*Get tested bimonthly, or monthly depending on your risk and activity level

 
-Keep in mind the main three methods of transmission:
 1. Respiratory secretions (Wear a mask)
 2. Close contact with the virus (Social distance)
 3. Crowds (Hunker at home, avoid gatherings)
 
If our leaders had put forth–and enforced–such measures, our transmission rate would have plunged and lockdowns would have been unnecessary.

A few other facts…
Would reviewing Avian Flu help us with Covid-19?
This influenza is spread from infected birds, not bats. And does not wreak the havoc Covid-19 does. No help here.
 
How have airlines dealt with Covid-19?
Some block middle seats. Most require masks. Some upgraded their disinfecting policy. Most stopped serving meals. So far, little effect on the rate of Covid-19 spread has been noted. Nothing here to assist us either.
 
Is there an association between frogs and Covid-19? According to Ethos, a famed vet blog, It is neither considered likely that Covid-19 will be found in frogs nor as a cause of disease, nor that frogs function as a reservoir that allows spread to humans.

So, for extra credit, can we actually use Wally Cox’s monologue from the famed cartoon to adjourn?
 
Sure, easy:
Where can we best find Covid-19 advice?
 
Not bird
Nor plane
Nor even frog

Just little ol’ us
Heh Heh 
Underdog.
 
Gregg DeNicola MD
Chief Medical Officer
PDQ Urgent Care and More

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