Dr. Stuart Weiss, FACEP, FAAP, CBCP

July 27, 2020
Today’s topics: New CoViD-19 test may be the solution, Moderna vaccine in Phase 3, Baptist revivals, Baseball anyone, CoviD-19 numbers
There will NOT be a Friday call this week.

New CoViD-19 tests. Are they the solution we’ve been waiting for?

There has been considerable talk recently about the Lateral Flow Immunochromatographic Assay or lateral flow test, for short. I watched a particularly good 17 minute video summary about this on MedCram and This Week in Virology had an in-depth discussion last week. People are very excited about this type of test because it does not require any specialized or costly machines to process it. The test processes the sample itself. One of the most common lateral flow tests you may be familiar with already are home pregnancy tests. The test is designed to confirm the presence or absence of a target substance. In this case, it would be a protein from either the surface of the SARS-CoV-2 virus or its genetic material. The test has a positive line which turns color when the target substance is present and a control line which turns positive to show that the test worked properly. So if we go back to the pregnancy test, that test has a control line which always turns color and a second line which only turns color when human chorionic gonadotropin or hCG is present. If there is hCG , then the person is pregnancy and they can read that with the naked eye looking for two lines. This same technology can be used to detect SARS-CoV-2 virus. Basically, a swab from the nose would be placed into a cardboard tube and chemical inside would breakdown any virus from the swab exposing the critical virus protein. The test detector substance would attached itself to that specific viral protein if present, and cause a color reaction to happen turning the test line a specific color. If no viral protein is present, the test line would stay white. The control line would change color showing that the test ran correctly. So after 15 minutes, you would have a positive or negative. The great part is that it doesn’t require expensive equipment. And the even greater part is that these could be made pretty inexpensively. Millions of these tests could be printed and ready to go. This will be a game changer. The ability for everyone to get a rapid cheap test done frequently would allow universities to reopen and theater to resume. Audiences could come back knowing that they were CoViD-19 free (or almost free). Special events could resume, marathon races. This is not sometime far away, companies are currently working on this exact type of test. There was an article on CNBC two weeks ago talking about 3M partnering with MIT to develop their version of this test. Even more exciting is a company that told me that they expect their version of this test to be available in the middle of August. They are currently undergoing testing to determine the sensitivity of the test. So that leads me to the downside of these cheaper faster tests. Their sensitivity is lower than the gold standard RT-PCR test. In fact, it might be much lower but that may not actually matter much. Right now, many people do not get tested and for those that do get tested, they can wait 5-10 days to get the results. That makes the test almost useless because they can be spreading virus for a week before finding out that they should stay at home. Few people that I know are following the guidance that says if you get a test, you should assume you are positive and stay home until you get the negative results. But if everyone can do an inexpensive test daily or a few times a week, then even if the test is not as sensitive, we will be much better off because we will pick up so many more positive tests. In addition, all tests are compared to the “gold standard” which is RT-PCR but that test is extremely sensitive and picks up fragments of virus genetic material even when there is no active virus left. Some people continue to have virus fragments hang around for weeks after they have antibodies and symptoms have resolved. RT-PCR may remain positive long after they are no longer infectious. We don’t really care if these people are RT-PCR positive if they are not infectious any longer. So perhaps, we are using a test that is way too sensitive and expensive for our needs. I am very excited about the possibilities of lateral flow assays. I can’t wait to see the results of the testing going on now. I am looking forward to bringing this test to our clients to allow them to safely reopen their venues and bring back live performances and concerts and EDM festivals and movie theaters. I don’t want to get too excited because the study results could be disappointing but I can’t help myself and I’m smiling a bit more today than I was yesterday. Moderna enters Phase 3 of vaccine development Today, Moderna began a large phase three vaccine trial with 30,000 volunteers. This is the fastest phase three trial to start in history. Half of the recipients will receive two doses of vaccine 28 days apart and the other half will get placebo. The people giving the shots and the participants will not know if they got real vaccine or salt water. They will be looking to see whether the vaccine prevents patients from getting really sick with CoViD-19 or catching the SARS-CoV-2 virus at all. Several other vaccines will enter phase three trials soon. Globally, there are 27 CoViD-19 vaccines trials happening now. Its still not a good idea to get close and sing your heart out A church revival at the Warrior Creek Missionary Baptist church in Alabama last week resulted in 40 members catching coronavirus including the pastor. Baptist revivals are usually week long events featuring a guest evangelist. This one started on Wednesday and was cancelled on Thursday night when one of the members tested positive. Now practically the entire church is sick. Will we have Baseball this season? According to ESPN, 13 members of the Miami Marlins have tested positive for CoViD-19. This happened with only 92 games on the books. The Marlins played in Atlanta and then went on to a three game series in Philadelphia and were slated to go on to play the Orioles in Miami when their games were canceled due to SARS-CoV-2. Hopefully the outbreak will be confirmed to the Marlins but only time will tell. I will miss baseball if we don’t have it this year. Numbers continue to get worse Over the weekend, 22 states broke their own case number records. With increasing case numbers and increasing hospitalizations, the death rates have continued to rise as well. California and Florida have passed New York in the number of cases and continue to rise. Be well and take care of yourself. There are storm clouds on the horizon. –Dr. Stu

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COVID-19 HEADLINES FOR TODAY

Coronavirus update for July 27, 2020 World Wide Updates World’s largest COVID-19 vaccine study begins in US with 30,000 volunteers Germany must keep daily cases “well under 500” to keep coronavirus under control, official says Mexico says death toll rose 55% for March-June amid outbreak Hong Kong will fine people $645 for not wearing masks amid coronavirus surge Brazil’s Bolsonaro returns to work after testing negative for Covid-19 Governments with quick, honest Covid-19 responses should be praised, WHO official says Vietnam reports 11 new locally transmitted Covid-19 cases linked to hospital Several Middle East countries will reimpose restrictions as Eid holiday approaches Thursday will mark 6 months since Covid-19 was declared a public health emergency of international concern Covid-19 “has shown what humans are capable of,” WHO director-general says  Thousands of health care workers are testing vaccines in Sao Paulo’s vast human petri dish Singapore passes 50,000 cases, reporting 469 infections Monday Gold prices spike as investors hunt for safe havens Germany will require coronavirus tests for travelers returning from high-risk areas The president of Brazil’s Superior Court of Justice tests positive for Covid-19 China agrees to help build temporary hospital in Hong Kong, as city confirms record new cases 80,000 tourists to be evacuated from Vietnamese city due to fresh coronavirus cases  WHO warns of an “acceleration” of Covid-19 cases in Africa Tour operator calls for “regionalized policy” on UK quarantine Germany warns of new spike in Covid-19 infections as it tries to contain large farm outbreak  After U-turning on Spain, UK is monitoring Germany and France travel bridges closely France reaches same daily level of cases as when lockdown began easing, says health minister South Korea records 25 new Covid-19 cases China reports its highest number of local Covid-19 infections since March India reports nearly 50,000 new Covid-19 cases in highest single-day spike Japan reports nearly 840 new Covid-19 cases as country grapples with spike Australian state of Victoria records 532 new cases, in worst day of pandemic so far Mexico reports more than 46,000 coronavirus cases and 4,500 deaths in one week Brazil tops 2.4 million coronavirus cases, 5 months after first reported case Spanish hotels offer to pay for guests’ coronavirus tests Total Cases Worldwide: 16,597,238 Total Deaths Worldwide: 655,119 Total Recovered: 10,137,818 US Updates US stocks finish higher Trump says governors should be opening up states Oklahoma reports more than 1,400 new Covid-19 cases Trump wears mask while touring vaccine lab facility Coronavirus cases surge in California’s Central Valley with state’s highest infection rate Major League Baseball commissioner has not discussed canceling season with owners Robert O’Brien, Trump’s national security adviser, tests positive for COVID-19, the highest ranking official to get coronavirus Miami Beach mayor blames Florida governor for “unconstrained growth” of Covid-19 New Jersey gym owners arrested after defying court order to shut down ‘Rogue’ Trump adviser Peter Navarro says he has no regrets for deriding Dr. Fauci over coronavirus ’They are in danger of losing their licenses’: Cuomo warns as more N.Y. bars and restaurants violated COVID-19 guidelines One in 50 Florida residents have tested positive for COVID-19 as death toll nears 6,000 Sewage to be tested in Maine to determine prevalence of virus Google staffers won’t return to offices until at least July 2021 due to coronavirus 24 lifeguards test positive for coronavirus on New Jersey’s Long Beach Island MAAC cancels fall sports season citing the Covid-19 pandemic More than 1,200 new Covid-19 cases reported in South Carolina The Minnesota Vikings’ infection control officer has tested positive for Covid-19 Staples will require all customers wear masks in stores NCAA says fall sports other than football can play 50% of games this season New Jersey continues to see multiple Covid-19 outbreaks linked to gatherings of young people National Hockey League says no players have tested positive for Covid-19 Dick’s Sporting Goods & Target will close stores on Thanksgiving Day Pennsylvania reports more than 800 new Covid-19 cases Two MLB games postponed due to coronavirus San Diego is allowing gyms and churches to reopen outdoors to keep people employed, mayor says Military coronavirus cases increase by more than 1,000 Patients across 89 sites will be part of Phase 3 Moderna vaccine trial, Fauci says Miami Marlins home opener canceled due to Covid-19 positive tests, per reports Senate Republicans expected to release their $1 trillion stimulus proposal today The first Phase 3 trial of a coronavirus vaccine in the US has begun Another inmate dies in San Quentin, marking 17 total deaths in the California prison Notre Dame withdraws as host of first presidential debate due to coronavirus concerns Kentucky will close bars and limit indoor dining, governor says Total US cases: 4,421,831 Total US deaths: 150,241 Total Recovered: 2,100,624 Total Tested in US: 51,491,494 Total cases in CA: 463,975Total deaths in CA: 8,475 Total cases in NY: 440,391Total deaths in NY: 32,705 Total cases in FL: 432,747Total deaths in FL: 5,933 Total cases in TX: 399,307Total deaths in TX: 5,178

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