Experts Weigh In

 

Our infectious disease experts answer your questions! Do you have a question for our experts? Send us your questions!

  • Duke is planning on offering an antibody test.
  • At this time, the laboratory is validating the test for use. Part of the validation is to establish how the test can be used.
  • Duke will not offer the test unless we can clearly define its clinical utility.
  • Currently we do not recommend antibody testing in the care of an individual patient or to diagnose COVID. Antibody tests should not be used to diagnose COVID in a patient with new infectious respiratory symptoms. It is not a replacement for the PCR-based COVID test.

  • The efficacy of broad scale antibody testing is not clear at this time and is therefore not recommended.
  • In fact, there are more questions than answers when it comes to antibody testing:
    • First, we do not know if a positive antibody test means a patient actually had COVID-19 infection.
      • False-positive tests are likely to occur in areas with a low community prevalence of disease.
      • False positive tests may also happen if there is cross-reactivity between the SARS-2-CoV antibodies and other “common-cold” coronavirus antibodies.
    • Second, we do not know if a negative antibody test means that a patient did not have COVID-19 infection.
      • False-negative tests may occur if the tests are performed too early in the disease course, if the patient had a very mild infection or if the patient did not mount an immune response.
    • Finally, we do not yet know the duration of immunity following COVID-19 infection, or if it provides any protection at all against future infection. Therefore, it is not clear at this time if a true positive antibody test means an individual is immune to recurrent COVID-19 infection.
  • Antibody testing may ultimately have a broader public health utility in determining the overall proportion of the population who may have been infected with COVID-19 and help inform a vaccination strategy.

A mask provides barrier protection. Wearing a mask contains droplets that come from the nose and mouth during speaking. It also contains most droplets generated from a sneeze or a cough. We call this source control. When everyone wears a mask, it provides source control for all and decreases the risk of transmission when people cannot be 6 feet apart. All masks are not created equal. By now you have seen many varieties, some of which have a higher filtration capacity. Here is a helpful resource.

When you recover from an infection like COVID-19, your immune system makes antibodies to recognize and fight the same infection in the future. These antibodies remain in your blood. You can have a blood test to determine if your body has built up antibodies against that infection. If your infection is active, your blood may not contain enough antibodies yet to be detected. Antibodies usually form 1 to 3 weeks after an infection starts. Antibody tests should NOT be used to diagnose an active infection.

If you have symptoms of COVID-19, you need a COVID-19 test, NOT a COVID-19 antibody test. Contact your healthcare provider for additional information if you have symptoms of COVID-19. Follow COVID-19 prevention guidelines.

Airlines are taking precautions to prevent travelers from acquiring COVID-19 during their flights by requiring everyone to wear masks, increasing environmental cleaning, and physically distancing with no middle seat occupant (no more figuring out who gets the arm rests! Obviously middle seat gets both ). If you must travel for personal reasons, you should think about the entire journey including how you can safely travel from point A to point B and how you can stay safe while you are away. Some tips for reducing your risk of acquiring COVID during travel include:

  1. Do not travel if you are sick with even mild symptoms.
  2. Be mindful of maintaining physical distance as much as possible within the airport and other common spaces.
  3. Add a face shield to your personal protective equipment outfit to further mitigate risk. This is especially helpful if you are traveling to a location where masking isn’t commonplace. A face shield will protect your eyes and face from droplet spray from unmasked individuals and protect your mask from getting contaminated.
  4. Bring hand sanitizer and use it frequently.
  5. Continue to avoid touching your face and eyes with unclean hands.
  6. If you plan to stay with family or friends, understand this places everyone at increased risk for infecting one another. You can mitigate this risk somewhat by masking all the time while in common spaces of the house/space, increasing environmental cleaning of high-touch surfaces in the house/space, and increasing hand hygiene. When eating together try to maintain physical distance and perform hand hygiene frequently. If you develop symptoms immediately isolate from everyone else and seek testing.

Here is a nice article on how to reduce risk for common activities.

Notes: This week’s question is complex. Rather than being a single person’s response, the response pulls from a few people who we reached out to for information on this question. We also gather some resources to reference.

Short answer: Only under extraordinary circumstances. While there are documented cases of enforcement activities at health care facilities, we were unable to identify any publicly disclosed enforcement activities since a March 18, 2020 ICE announcement on COVID.

The North Carolina Just Center has compiled videos in Spanish that address two points:

https://www.ncjustice.org/projects/immigrant-refugee-rights/project-resources/public-charge-rule/

  • Do not travel if you are sick with even mild symptoms.
  • “First, ICE (Immigration and Customs Enforcement) has announced that it will not conduct any immigration enforcement activities “at or near health care facilities, such as hospitals, doctors’ offices, accredited health clinics, and emergent or urgent care facilities, except in the most extraordinary of circumstances. Individuals should not avoid seeking medical care because they fear civil immigration enforcement.”
  • Second, USCIS (U.S. Citizenship and Immigration Services) has announced that it will not consider it negatively if an immigrant gets testing, treatment or preventative care for COVID-19, or coronavirus when considering whether an immigrant can be considered a “public charge.” USCIS encourages all immigrants to seek out testing, treatment, and preventative care (including vaccines, if one becomes available) without any negative effect on a future green card application.”

 

We need to acknowledge that the fear of ICE enforcement at a hospital during the COVID-19 pandemic is not unfounded. On March 12, 2020, an adult male was arrested by ICE in a hospital in Scranton, Pennsylvania. Here are two stories about that event:

That event was before the March 18, 2020 announcement from ICE: https://www.ice.gov/news/releases/updated-ice-statement-covid-19#wcm-sur....

 

Unfortunately, we could not find much in terms of how health systems respond if ICE violated the policy above and did conduct enforcement activities in health care systems. Atrium health in Charlotte has made a public statement (https://atriumhealth.org/dailydose/2020/04/09/correcting-the-myths-of-covid19) that we have shared with leaders at Duke Health to emulate:

“Atrium Health will not share patients’ immigration status. As COVID-19 is a public health concern, names of those testing positive have to be submitted to the health department to measure and control infection rates, but all information submitted is protected. Patients will not be referred to authorities if they are undocumented. Hospitals are considered sensitive locations, and according to the U.S. Immigration and Customs Enforcement’s (ICE) most recent statement, “ICE will not carry out enforcement operations at or near health care facilities, such as hospitals, doctors’ offices, accredited health clinics, and emergent or urgent care facilities.” For anyone with additional questions or concerns seeking support or information confidentially, please call the Charlotte Center for Legal Advocacy’s main line: 704-376-1600. Spanish-speaking representatives are available at 800-247-1931. Atrium Health partners with the Charlotte Center for Legal Advocacy through a grant-funded program to provide free legal aid to those in need.”

Duke Health does have a similar medical-legal partnership to support families in Durham: https://law.duke.edu/partnershipforfamilies/.

For additional resources: