Should I Get a Covid-19 Antibody Test?

So another super common question that our patients ask is whether or not to get a Covid-19 antibody test. My thoughts...

Well, first have to explore the reasons behind the testing.

If you are a confirmed positive Covid patient who has recovered and you hope to donate plasma, then you can consider the test. However, the quality of the test varies.  You can see here FDA's updated list of different tests being offered by different companies and how their performance varies. You would have to check what is being offered in your area.

If you are a confirmed positive Covid patient and hope to have antibodies so you don't get sick again, you may want to reconsider whether or not you really want this test.  First of all, the test may not be accurate and your result may be either:

• false-positive - tells you you have antibodies but really you don't, so you'd have a false sense of security
• false-negative - tells you you do not have antibodies but really you do

However, even if you do have a true positive antibody to Covid-19, there is not enough evidence to guarantee that you will not get re-infected. So from a practical point of view, regardless of the results, you still have to practice all the same social distancing guidelines as anyone else.

If you are not a confirmed positive Covid patient but think you had it, the same rules above apply.

I get it that a lot of people want to know if that terrible cold they had back in January or last November could have been Covid.  In fact, I want to know myself! However, I am personally waiting for more evidence to come out and for a more accurate test to be available in my area.  Based on the limited data I've seen so far from the antibody testing that our office has ordered, I do not have much confidence in the accuracy or value of that particular test. Plus, since it does not change the management of care or the advice we give, I find little use for it.

As always, contact your physician for a more in-depth discussion. You can find out more about antibody testing in your area and whether or not you are a candidate for it.

So what is the best way to prevent getting sick?

• practice social distancing (mask and 6 feet apart!)
• wash your hands frequently (avoid touching your face)
• get adequate sleep (sleep sleep sleep!)
• eat healthy (vegetables!)
• exercise (even if just 15min a day!)
• decrease stress (carve time for yourself daily)

Stay safe, everyone! It's beginning to look a lot like...

How Long To Quarantine? When to Covid test? It's Thanksgiving!

So I'm sure everybody is reading about the recent spike in Covid cases. From my experience, it truly just hit that second weekend in November when I was "the doc on-call" and it has been a domino effect ever since. Calls started to come in from patients requesting testing as well as from the lab reporting positives back to me.

Back in the summer, we may get requests for Covid tests because folks were traveling and needed a negative result so they can enter another state or fly to some exotic island getaway. Few scattered calls came during August and September when college students went back to campus and we saw a small spike in that age group then. However, about a week after Halloween and Election Day, requests for covid testing due to positive contact or symptoms started to pour in. What's more, a lot of these tests are coming back positive.

So the big question everyone asks is, "How long do I need to quarantine?" Especially with the holidays around the corner, everyone is trying to decide what to do about family gatherings and travel. I will attempt to summarize it here as I feel like I'm having this conversation multiple times a day and every single day for the last 3 weeks. However, there are two things to note:

1)  guidelines change constantly and the CDC is actually in the process of officially decreasing the length of quarantine after positive exposure

2)  everybody's health and situation is different, so definitely consult with your physician for individual guidance.

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Symptoms of Covid can include all or only some of the following... but the first three symptoms seem to be consistent with most of my patients who end up with positive results. Fever, cough, and shortness of breath only in the more severe cases but I haven't been seeing those symptoms in the younger folks as much.

• sore throat
• headache
• congestion
• body aches
• fever / chills
• cough
• loss of smell
• GI symptoms (diarrhea etc)

If you have symptoms or just don't feel good -> self-quarantine for 10 days starting from the first day of symptoms REGARDLESS of a positive or negative covid swab.

If you do not have symptoms but you were in close contact (unmasked and less than 6 ft apart) with a confirmed positive -> self-quarantine for 14 days starting from the first day of the last contact REGARDLESS of a positive or negative covid swab

Why regardless of results you might ask?  It is because there is a possibility for a false negative test or you just tested too early. There is a 14-day window from exposure to symptoms and during that period, even if you have no symptoms, you are potentially contagious. In fact, most folks who are getting tested because they were around someone else who now tested positive will tell you that the person who tested positive was not having symptoms at the time they were together.

CDC is considering shortening the 14 days to 10 days because it is hard for folks who feel well to stay quarantined, so they are hoping for more compliance if the time is shortened. Stay tuned.

Now if you insist on testing for covid then timing is important.

If you have symptoms ->  test on day 3 or 4 of symptoms

If you do not have symptoms ->  test around day 7 from the last day of close contact with a confirmed positive covid case

If you did not have close contact with a confirmed positive covid case and...

• yes symptoms ->  test on day 3 or 4 of symptoms
• no symptoms -> chances are your test will be negative and hard to interpret if by chance it is positive then quarantine 10 days from day of positive covid swab

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So for details and more specific counseling, you should seek out your physician.

Happy Holidays everyone! Stay safe and smart. Despite the crazy year... can you think of things to be thankful for?

Back to School in the Midst of Covid

Happy Labor Day!

Today is the day before our school year begins. As both a mom and a physician, I've been pondering a lot about the challenging endeavor to best educate the kids this fall. There are many blogs and articles about this out there so I don't want to rehash everything, but the main questions being asked include...

• Is it important for children's mental health to interact in person with peers? yes

• Is it important to prevent the spread of Covid19 to protect the health of teachers and family members who may be more at risk?  yes

• Is it important to provide the resources for all children to have access to learning? yes

• Is it important to be sensitive to one another's fears and feelings and to be respectful, forgiving, and gracious? yes

The bottom line is that the rate of infection varies from state to state and even region to region here in the United States. Therefore, the decisions of how to do school are being made by local government and educators taking into account those basic questions and I'm sure many more. 

In our particular region, the numbers are currently low. Although we want to do everything to prevent those numbers from spiking back up to where they were in the spring, we also want to balance the benefits that would come from in-person learning to students and families. As a sort of compromise, our district is offering a choice for families to pick either 100% virtual learning or a hybrid model where two of the five days would be in person with social distancing measures in place. Again, not to rehash what all those measures are and the reasonings for them... I do want to give credit for the decision-makers because this is no easy task. No matter the final decision, there is sure to be those unhappy with the outcome.

We are promised that the model for virtual learning this fall will look different than it did in the spring. Well, we shall see.

So whether a family is choosing to go with the public school system with 100% virtual vs hybrid model or 100% in-person at a private school or 100% home school...  "Happy Back to School"!

Is Telemedicine Here to Stay?

I recently submitted an article to MIT's department of athletics in response to their request regarding alum's involvement in COVID-19. Life has been busy and with so many things going on in the news... it has been hard to find time to process, think, and blog. Honestly, by the end of the day, my brain just wants to vegetate. Well, here is what I sent them... I feel it summarizes life since March...

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Dr Ellen H Kim ’97 was a four year starter on MIT’s field hockey team during which they won their first ever New England Women’s Eight Conference Championship in 1994. She also made All-Conference team and the National Academic Squad her senior year and graduated with a degree in biology and a minor in music. She went on to receive her M.D. from Drexel University College of Medicine and then completed her residency in family medicine at the University of Pennsylvania, where she served as chief resident. Dr. Kim currently works in private practice at Wrightstown Family Medicine in Newtown, PA and is mom to four kids ages 6,9,10, and 12.

These last few months have been challenging, simultaneously transitioning a busy outpatient practice to essentially all telemedicine while managing four kids ages 6,8,10, and 12. Supervising their “distance learning” was a bit painful. Fortunately, my seventh grader was fairly independent, but the younger ones were easily distracted and needed more direction. The concern was not so much the volume or difficulty of the schoolwork, but so many hours in front of a screen affected their emotional lability and grumpiness. Keeping track of the different zoom calls was a whole other undertaking. My husband, Dr. Joseph Kim, MIT Class ’98, runs his own consulting and CME company, also had to work from home. Imagine the craziness of all six of us accessing our respective laptops and computers to participate in numerous zoom meetings throughout the day!

Our dining room turned into a temporary classroom for my kindergartner, third-grader, and fourth grader.

  

My seventh grader distance learning from her room.               

My fourth grader submitting homework online

My medical practice cares for a wide range of patients from newborns to great grandparents. We wanted to stay available and offer medical care and treatment to those who need it. However, it was necessary to protect the more vulnerable and not contribute to the spread of COVID-19 that was sweeping through our region. Many who live in our county either commute to New York City for work or have grown children who left the city to quarantine with their parents. There were also folks who returned from travel overseas or returned home from college, which all played a part in our rising infection rate.

Our office hosted a Friendsgiving luncheon for some of our patients in Nov.

At the end of March, the sudden surge of positive COVID-19 cases in our area resulted in schools emergently shutting down. We faced a similar urgency in our practice to separate the exposed with those not infected. During those early days, I recall the frustration of trying to help direct care when there were no concrete guidelines. Disappointed at the lack of testing availability, we felt somewhat helpless but pushed on to formulate treatment plans. We endeavored to help our patients and steer the course of their illness to recovery. Our goal was to ward off the need for emergency room visits which may ultimately result in hospitalization and even ICU admissions.

In order to prevent the healthy and especially the more vulnerable patients from contracting COVID-19, and to not be the vector of transmission ourselves, we converted our practice to mostly telehealth services online. Fortunately, we were able to do this without needing to ever close our doors. Of course, there were some bumps as we switched to conducting interviews virtually rather than face to face. The adjustment was both on our end as well as our patients’ end and it certainly took some getting used to.

At the end of the day, telemedicine provided us the ability to offer care to those needing routine maintenance for their medications and address new issues not related to the coronavirus, while also delivering care to those exposed and fighting COVID-19. It has been busy but rewarding to be able to meet needs. To avert hospital overload and to prevent medical staff burn out, it was crucial for us to help curve ER visits by treating sick patients from home. Telemedicine gave us the means to do so but we also had a physician available for in-office urgent cases that are not sickness related.

Information for COVID-19 constantly changes and recommendations still get revised as research and new data pours in. As primary care, our job is to filter out what is relevant and apply it to the care of our patients. This global pandemic is not yet over and although we are now seeing more patients face to face for in-office visits, telemedicine is still available. It is essential to have for those who may be more high risk, and convenient for those who do not need to come in person or those who have a hard time getting transportation. Some form of telemedicine will likely be here to stay even as the pandemic resolves. Given the way things look, that resolution may still take some time.

My little hockey player giving a virtual presentation about the sport to her class

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