Coronavirus

[Cigarbutt]

I checked my result from Monday's testing:  again, 'negative'.  I give up.  What do I need next, an antibody test?

Given the description of the symptoms and 'epidemiological' circumstances, the two negative results are not enough to completely rule out CV.
So, the idea is to behave as if the virus disease is present. Behaviors (altered or not) depend on various beliefs but information coming out of imperfect collective organizations whose recommendations are based at least on some level of trust and peer-reviewed processes suggests that at least self-quarantine versus others that are presumed to not have the disease is the minimal way to go. Further testing may not be helpful unless there is a specific reason. The above assumes a gradual process to recovery.

If there is a specific reason to know or simply want to know, the way to go is to obtain another test in another testing area in order to control for collection technique, different lab, different test (antigen vs PCR) with a slightly different sensitivity/specificity (false negative, false positive) profile in general and evolving according to stage of clinical presentation. Another possibility is to wait for at least 2 to 3 weeks and get an antibody test.

[Cigarbutt]

Senate hearing testimony by Dr. George Fareed, a Harvard MD with honors and more profile given below:
https://www.hsgac.senate.gov/imo/media/doc/Testimony-Fareed-2020-11-19.pdf
Since early March both in my Brawley clinic and Dr. Brian Tyson’s The All Valley Urgent Care Clinic in El Centro (where I also work), over 25,000 fearful people were screened, over two thousand four hundred were COVID-19 positive and we treated successfully many hundreds of the high risk and symptomatic ones.
And this doctor has excellent credentials:
http://www.ivcommunityfoundation.org/media/managed/npd2019/NPD_2019_Program.pdf
PHILANTHROPIST OF THE YEAR Dr. George Fareed
Dr.  George  Fareed  graduated  with  honors  from  Harvard  Medical  School  in 1970  and  has  been  practicing  medicine  for  49  years.  He  spent  the  first  20 years after graduation researching and teaching at Harvard and UCLA. He was Assistant  Professor at  HMS  from  1973-1976.  He  was  Associate  Professor  at UCLA  from  1976-1996.  He  received  the  Soma  Weiss  Award  for  his  DNA                research.  He  founded  International  Genetic  Engineering,  Inc. in 1980 and Advanced Antigens, Inc. in 1991, the same year he opened his medical practice in  Brawley,  CA.  And,  he  was  the  US  Davis  Cup  tennis  team  physician  for  20 years and worked at 38 team matches and the US Olympics in Sydney in 2000.  In  the  memorable  1995  Davis  Cup  final  against  Russia  in  Moscow,  he  helped Pete Sampras bounce back from grueling leg cramps. He has been recognized for his many accomplishments including the 2004..........
........
You can read his full profile in the link...but my point is:
Whenever I went to doctor for my family one question I always had was how many they treated and what was the result and the doctors credentials.  If a doctor tells me they treated hundreds of patients and all of them are doing well, that usually works for me to take that treatment.
Why should not be taken seriously for Covid and ignore these doctors?

Short answer: The person may be right.
Longer answer: This opinion shows the challenge when there are 'competing' schools of thought. When this issue becomes driven by 'us vs them', constructive discussions become difficult and often deviate from basic data, reasoning, weight of evidence etc. The opinion also shows the challenge related to balancing personal and collective responsibility.

For various reasons, i've been involved in self-regulatory ventures which included to limit or terminate certain activities or even careers. A basic principle involved to respect alternative ways to think but the burden of proof should lie on the person voicing unusual or contrary opinions. So far, the evidence for the use of hydroxychloroquine at any stage of CV remains unconvincing and a lot of what the emerging school of thought is doing is to focus on the container, not the content. When assessing specific cases, the following type of comment sometimes appeared: [the] "doctor tells me they treated hundreds of patients and all of them are doing well". This was typically a massive red flag.

[ERICOPOLY]

I checked my result from Monday's testing:  again, 'negative'.  I give up.  What do I need next, an antibody test?

Given the description of the symptoms and 'epidemiological' circumstances, the two negative results are not enough to completely rule out CV.
So, the idea is to behave as if the virus disease is present. Behaviors (altered or not) depend on various beliefs but information coming out of imperfect collective organizations whose recommendations are based at least on some level of trust and peer-reviewed processes suggests that at least self-quarantine versus others that are presumed to not have the disease is the minimal way to go. Further testing may not be helpful unless there is a specific reason. The above assumes a gradual process to recovery.

If there is a specific reason to know or simply want to know, the way to go is to obtain another test in another testing area in order to control for collection technique, different lab, different test (antigen vs PCR) with a slightly different sensitivity/specificity (false negative, false positive) profile in general and evolving according to stage of clinical presentation. Another possibility is to wait for at least 2 to 3 weeks and get an antibody test.

The sample from Monday's test, 4 days ago, was done at my primary care doctor's parking lot in Folsom by a gowned nurse who came out to my car's window to swab me (but only 1 nostril).  That swab was sent to the lab at Quest Diagnostics and my online Quest account is where I viewed the result last night.  The type of test was "SARS CoV 2 RNA(COVID 19), QUALITATIVE NAAT".  Another online resource says that test "includes RT-PCR or TMA".

Off hand, I don't know which lab or which type of test it was from the testing done last Thursday (now 8 days ago) when we both were tested by the same PA at Med-7 in Roseville. Both nostrils were swabbed and my wife's came back positive.  I don't have online access to the test -- they notified me of the result by phone.  It is not showing up in my Quest Diagnostics account, so I assume they didn't process it at a Quest lab.

[ERICOPOLY]

It sounds like most of you haven't had covid-19 yet in your household.  Just in case, I recommend adding a fingertip pulse oximeter and a blood pressure monitor to your first aid supplies.  Do you really want to be in a situation at home with covid and not knowing what your readings are? 

For a period of time yesterday evening I started feeling weak like I was experiencing blood loss and my saturation dropped to 94.  Then the weakness subsided and went back up to 97.  If anything, it gives you something interesting to monitor while you pass the time.

[Liberty]

It sounds like most of you haven't had covid-19 yet in your household.  Just in case, I recommend adding a fingertip pulse oximeter and a blood pressure monitor to your first aid supplies.  Do you really want to be in a situation at home with covid and not knowing what your readings are? 

For a period of time yesterday evening I started feeling weak like I was experiencing blood loss and my saturation dropped to 94.  Then the weakness subsided and went back up to 97.  If anything, it gives you something interesting to monitor while you pass the time.

Seconded on the pulse oximeter. very cheap. I got one in March and thankfully haven't had to use it much, but you never know...

[Cigarbutt]

The sample from Monday's test, 4 days ago, was done at my primary care doctor's parking lot in Folsom by a gowned nurse who came out to my car's window to swab me (but only 1 nostril).  That swab was sent to the lab at Quest Diagnostics and my online Quest account is where I viewed the result last night.  The type of test was "SARS CoV 2 RNA(COVID 19), QUALITATIVE NAAT".  Another online resource says that test "includes RT-PCR or TMA".
Off hand, I don't know which lab or which type of test it was from the testing done last Thursday (now 8 days ago) when we both were tested by the same PA at Med-7 in Roseville. Both nostrils were swabbed and my wife's came back positive.  I don't have online access to the test -- they notified me of the result by phone.  It is not showing up in my Quest Diagnostics account, so I assume they didn't process it at a Quest lab.

Practical follow-up
Going for an additional test may increase the odds of a negative disease state, if negative but certainty is hard to achieve here. And then, if the test is positive, there's always the possibility that it's a false positive. Also, being free of disease today does not mean free of disease tomorrow.
Statistical follow-up (just in case somebody is interested)
Just like in any decision making process (health-related, investment etc), what you want are sensitive and specific 'tests' that help you keep or reject hypotheses (or investment targets).

                                         Disease
                                 Y                       N
                      Y         a                        b
Test result
                      N         c                        d

Where false negatives come is from the sensitivity aspect (a/a+c). Specificity is (d/d+b). That's the disease perspective. Another instructing aspect is the predictive value (test) perspective. Positive predictive value = a/a+b. Negative predictive value = d/d+c.
So for a disease (or an investment) you want high sensitivity and high specificity tests for screening and high positive and negative predictive value on results to help delineate where the value is within the selected group.
This may seem dry and irrelevant but it's quite useful (people do it all the time without realizing it) when, for instance, you meet people for the first time. You may ask them if they like sports to screen and then calibrate by asking if they enjoy rugby.
By repeating the exact same test, you increase the odds for more precision but repeating the exact same test carries the same statistical limitations.
----
On the home oximetry.
i've been following an interesting company that offers home services for people affected by chronic lung conditions. i think it is becoming increasingly overvalued (i may be wrong) and think that they wrongly focus on the equipment rather than the services side at this point although this may be related to how insurers deal with 'product' under present conditions. Anyways, they have the potential to provide, in real time, online monitoring of different parameters including oximetry in order to timely intervene and likely reduce complications, hospitalizations etc
It's still unclear if the introduction of home oximetry would be cost effective on a large scale (for Covid-19 or otherwise) but, from an individual point of view, it's a reasonable option. There are smart watch options which are becoming interesting. Also, there are places where the idea is being tested.
https://www.bmj.com/content/371/bmj.m4151
One characteristic of Covid (not unique but quite representative) has been the combination of a relatively comfortable person with unusually low oxygen saturation levels at the initial measure. These people were often clinical ticking bombs with very real and rapid deterioration shortly thereafter so the idea to detect a significant and relatively asymptomatic aspect is an interesting feature. The oxygen saturation to oxygen concentration (pressure) curve is interesting and offers valuable lessons for other disciplines.



A very interesting feature happens when saturation reaches around and below 90%. This is related to a long evolutionary process meant to facilitate efficient oxygen unloading in peripheral tissues but has the side effect that the slope change around 90% can have sudden and disastrous consequences when it becomes systemic in the main circulation.
i've seen this this play out many times (ages ago it seems) when making money around securities entering or leaving financial distress as the cost of capital has historically been quite volatile during these transitions. Of course, i've become increasingly confused as the changing slope concept has existed for centuries and has recently become irrelevant with firms entering financial distress no longer submitted to this natural law. In fact, in parallel to the Covid spread in 2020, firms entering financial distress often had access to lower cost of capital options!? i continue to wonder if historical easy money conditions have anything to do with this. It seems it's the same concept that Mr. Minsky used to elaborate his unstable stability concept.

Anyways, home oximetry seems like a good and reliable idea if you're into self-monitoring. It is probably a better tool than home blood pressure monitoring. Home blood pressure devices are known to be quite imprecise. If you take it under standardized circumstances (ie once a day before breakfast), it may offer a reliable documentation of the underlying efficacy of non-pharma or pharma changes that are introduced. With blood pressure, there's the white coat syndrome aspect which basically means that your blood pressure may rise simply because you have reasons to believe that it should be, or needs to be, measured.

[ERICOPOLY]

With blood pressure, there's the white coat syndrome aspect which basically means that your blood pressure may rise simply because you have reasons to believe that it should be, or needs to be, measured.

My wife gets anxiety in a clinical setting and her self-administered-at-home blood pressure reading is far lower than what the nurse or doctor will see.

I took her into the Mercy Hospital ER a couple of days ago when her blood pressure dropped to 84/57 with a pulse of 91.  The triage nurse then took her blood pressure and it was way back up again.  This happens to my wife a lot, but she's never had a reading THIS low.  What the hospital should have done, but didn't, is lay her down on a bed in a quiet room alone with a machine periodically measuring her pressure every 5 minutes. 

Her primary care doctor has measured her low blood pressure using that method, and tells her to eat pickles and put salt on her food to manage it.  If not, she gets dizzy.

[Spekulatius]

With blood pressure, there's the white coat syndrome aspect which basically means that your blood pressure may rise simply because you have reasons to believe that it should be, or needs to be, measured.

My wife gets anxiety in a clinical setting and her self-administered-at-home blood pressure reading is far lower than what the nurse or doctor will see.

I took her into the Mercy Hospital ER a couple of days ago when her blood pressure dropped to 84/57 with a pulse of 91.  The triage nurse then took her blood pressure and it was way back up again.  This happens to my wife a lot, but she's never had a reading THIS low.  What the hospital should have done, but didn't, is lay her down on a bed in a quiet room alone with a machine periodically measuring her pressure every 5 minutes. 

Her primary care doctor has measured her low blood pressure using that method, and tells her to eat pickles and put salt on her food to manage it.  If not, she gets dizzy.

My mom get‘s crazy high blood pressure readings when she goes to her doctor for checkups. Then when she his home, it’s back to normal. She has some problems with heart arrhythmia lately, but her doc thinks the high readings SRE due to anxiety - I guess it’s the white cost Syndrome that cigarbutt  mentioned.

As for false negative COVID-19 tests that’s a problem at hospitals my wife works. Every patient get‘s tested but some test negative even though it looks like they have COVID-19- Then they retest the next day and they sometimes test positive. That means that everyone who with them Better gets a test too because they wear different PPE and follow different procedures based the first negative test result. Crazy.

[ERICOPOLY]

The test results from the hospital say that she came in presenting with a cough.  She never told them that, she hasn't coughed a single time during this entire episode.  Do they just make things up in hospitals?

Before bringing her to the ER, I called the hospital to ask what the procedure is for checkin.  Do we call from the parking lot, etc...  They told me to just bring her in the front door of the ER and register at the desk.  We do so and just inside the front door we tell a greeter that we both have covid-9 and she says it's okay for both of us to come to the front desk to register.

THEN they tell us to sit in the FLU section.  Are you kidding?  Seating my wife with a positive covid-19 test next to the people they think have the flu, and on purpose?

Finally, someone on staff tells me that I need to leave because there is a new hospital policy for NO VISITORS for covid patients.  Yet they didn't tell the person at the front door or the phone operator who I spoke to.

[Gregmal]

If the "pandemic" has taught us anything it is that the bureaucrats dont know what they are doing, ever, and the scientists need to stay in the labs and stick to research; nothing more. Letting these people make decisions and policy has been a disaster. Almost every position they've taken, they've at some point also taken the exact opposite position. Wear masks, dont wear masks. Stay home! Actually most covid transmissions occur at home! Remdesivir works. Oh actually it doesnt. Hospitals putting people on ventilators....oops, ventilators make it worse! The scientists and medical professionals have certainly come out of this thing looking quite poor. And then they wonder why people dont "listen to the science"...

My wife had to got to the hospital for a standard procedure a couple weeks ago....they make this whole big to-do about temperature checks and processing everything and make us wait several hours to do basic check in stuff and get her one of the rapid tests. I ended up just asking, "you've spent 2+ hours dicking around and making us wait...what if she tests positive for covid? Do you not take her or something". And I was floored by the response. "Oh no, then we just take extra precautions but proceed as normal"...What!?! LOL Why TF wouldn't you just take these precautions, with everyone who comes in, to begin with? My wife's family, almost all of the women are nurses. And the stories about the hospitals, big ones at that, running around clueless or winging it, making mistakes all over the place, etc....its insane. I've long maintained that the only way I'll ever know if I've had covid is if I end up in the ICU or dead. Because barring being in that type of condition, I'd imagine I'd just suck it up like I would with any other cold or flu...and get on with my life. No need to take chances or incorporate these people into the equation unless absolutely desperate and necessary.