Dr. Pissed Off: I’m done cautioning patients
COVID-19 hospitalizations in the South Bay have remained relatively constant since the July 4 surge. Chart by Bernard Wong (SubliminalMachines.com)
People are idiots.
An older patient told me he and his wife were taking their three young grandkids to Catalina on their sailboat. The grandkids live in Northern California in a county the size of Orange County with a population the size of Manhattan Beach. The entire county has eight active COVID-19 cases, no COVID-19 hospitalizations and no COVID-19 deaths.
I didn’t say a thing, which the patient interpreted as approval. Three kids and their mom driving 800 miles down Highway 5, to spend four days with the grandparents on a boat not much bigger than the mom’s SUV. Where’s the risk in that?
A few days later the patient told me the son-in-law put the kibosh on the trip. He works for the county and the county has an aggressive COVID-19 tracing program. He didn’t want to risk getting fired, among other concerns.
The patient noticed my smug smile when he told me the trip was off. He asked why I hadn’t cautioned him.
I didn’t caution him because I’m done cautioning patients. I’ve already told them what they need to do to stop the plague. Deny it the opportunity to spread from person to person. The coronavirus cannot survive without a human host. A hard stop. It’s that simple. The virus does not care how healthy or unhealthy, fit or unfit, mindful or mindless you are. Its only admission ticket is that you breathe.
Get used to it. COVID-19 is not going anywhere anytime soon.
Part of the reason is our testing sucks. We do it because we have nothing better to offer and, something is better than nothing — barely.
PCR testing — nasal/oral swabs and saliva: A positive test is accurate essentially 100 percent of the time. A positive test means you have viral particles that can be detected and you are either infected and contagious or have been infected and may not be contagious. If you have symptoms you are contagious. If you are asymptomatic who knows.
A negative test is problematic. The false negative rate for this testing may be as high as 30 to 40 percent. The accuracy of this test is highly dependent on the way it is administered, how the sample is handled and timing. The ideal time to test is four to five days after known exposure, or with symptoms. Same day — so called point of care tests — may be the least accurate of all and in some cases may not be any better than a coin toss.
Serologic or antibody testing: More of my patients are talking about getting antibody tests. It is ironic to me that the most expensive, most convenient, instant gratification test may be the least accurate test in this group. Oh well, I guess money can’t buy everything. Perhaps there is a psychic value, or maybe the money would be better spent consulting a psychic. The antibody testing in a population where a low percentage of people are infected is worthless and may be inaccurate up to 50 percent of the time. Even if correct, the presence of antibodies specific for SARS-COV-2 does not guarantee immunity.
We have learned how to treat COVID-19 better, so fewer people die who are sick enough to be hospitalized. We have learned how to prevent transmission from person to person based on personal behavior and PPE.
Things will improve with medications and vaccines. Hopefully soon.
Until then, don’t be an idiot. ER
Charts by Bernard Wong (SubliminalMachines.com)
Beach City cases on decline since July 4 surge
Newly confirmed cases of COVID-19 have been declining in the three Beach Cities since the mid July spike, which has been attributed to Fourth of July social gatherings. Manhattan Beach’s decline in new cases has been steady. Hermosa Beach’s and Redondo Beach’s decline in new cases were reversed in early August. But Bernard Wong of Subliminal Machines, who compiled the city dashboards from Los Angeles County Health Department data, said the early August increases are attributable to a “dump” of test results, which had been backed up. The three Beach Cities also saw improvement in the number of days it takes for new cases to double. In late July cases were doubling approximately every 25 days. As of August 16, the Manhattan case count was doubling every 35 days, Hermosa’s every 45 days and Redondo’s every 40 days. Source: Bernard Wong (Subliminalmachines.com). Los Angeles County Dept. of Health