Dr. David Wilkinson: Letters from the frontlines
For Steamboat Pilot & Today
The definition of failure is to keep treating this pandemic in the same way and expect different results. As a physician working in the emergency department, this is what has frustrated me the most as I have witnessed firsthand the tragedy unfold.
What if in the course of six to eight weeks Steamboat Springs could essentially be COVID-19 “controlled” … or the Steamboat Resort might be nearly COVID-19 free each and every day … that there is a path for restaurants to open and schools to return to teaching. There is a way for this to happen, and it is being done in countries around the world but it cannot yet be done legally in this country and that is part of the reason why our American experience with this virus is so dangerously different now.
At the end of this letter, I would ask you to contact your state and federal Senate and House representatives with this information and change the trajectory of this pandemic and in the process bring our country, our community and Northwest Colorado back to vitality.
The key to all of this in the immediate future is not vaccinations. It is rapid and inexpensive viral antigen testing that can be utilized multiple times each week, at home, to provide population-based results that can effectively manage this pandemic real time as the public health crisis that it is. This process is not without some confusion and controversy; however, at the end, I will reference an excellent and comprehensive YouTube medical web link to an internationally recognized Harvard Associate Professor MD/MPH, Dr. Michael Mina, who clearly describes the science behind using inexpensive (less than $10), rapid (10 to 20 minutes), at home COVID-19 antigen testing. In the end, if we really know who is infected — symptomatic or asymptomatic — we can stop the spread of this infection.
I will try to briefly explain this without too many complicating details. The details, however, are easily available in the below noted resource. And there are countless other scientific journals that substantiate this.
Currently, the only widely available testing in this country is PCR — polymerase chain reaction. This identifies coronavirus RNA and “magnifies” it for the testing process. It is very expensive ($100 to $1,000 or more), typically very slow (often and unpredictably, two to five days), rarely available emergently and very inconvenient (if you have had it done you know it is invasive, and it has to be done in an office or hospital setting). And in fact, unfortunately, if you had a negative test and just received the results three to five days later, you are not really safe to go to your Thanksgiving family dinner in three days, as you easily could have gotten infected in the interim and now have an asymptomatic infectious viral load.
An antigen test, which tests smaller viral proteins and often specifically the spike proteins, can be done at home with saliva or a self administered nasal swab, and it is inexpensive and fast as I have noted above. There are multiple international vendors available for this test. But it is only available in this country in a very limited fashion as a medical device test in an office or other medical setting. If this was allowed to be utilized appropriately, it could take place multiple times in a week, at home and then with the appropriate confirmational testing to allow surveillance monitoring of entire populations. And, it is a very, very good test when it is utilized in the appropriate fashion.
At the core of the confusion about these tests lies misunderstandings — even by well-intentioned medical providers — about the differences in the sensitivities between these tests and what that means to the identification of infected individuals, and more importantly, the public health approach to managing this.
If you can imagine a very narrow and steeply peaked bell-shaped curve, that is what the viral load looks like in your body after you are exposed and infected. If you have a little bit of virus you are not infectious. If you have more virus and it has multiplied, you are.
For a short period of time perhaps five to seven days after exposure depending on the viral load you were exposed to, you have very little virus. However over the next two to five days this quickly magnifies in a logarithmic fashion to significant viral loads. You are very infectious, but you may not have symptoms.
The CDC just recently acknowledged that perhaps greater than 50% of infections are transmitted by asymptomatic individuals, and perhaps overall, 40% to 50% of all infections are asymptomatic. Our “infection numbers” are absurdly inaccurate, and we can only speculate on the actual number of people who have been infected in this country. Some estimates are as high as 56 million …remember, we have 330 million at risk. Unless population-based testing takes place, all of those asymptomatic or mildly symptomatic infectious individuals would be missed and continue to infect. The infection, as it has, becomes uncontrollable.
Antigen testing, when conducted with a viral load present that is infectious is extremely sensitive and specific for COVID-19.
We are at war with this virus, and in an alarming reality of this war, there have been far too many deaths. Our country should immediately mobilize the necessary resources, specifically population-based antigen testing, that will cost billions to implement but save many trillions of dollars and countless lives, and open up the country again.
Vaccinations may be coming, but there are many questions about their ultimate and long-term efficacy, their distribution and population availability (who gets them and when do they get access). If the government and FDA directs it, antigen testing can be brought to scale quickly and effectively.
I cannot begin to speak on the complexities of these issues, but they are very understandable if you take the time. Please watch this video at https://www.youtube.com/watch?v=CjphzlV5DYo.
Write some letters. Have your doctors watch this. Let’s stop the failure and begin winning this war.
Dr. David Wilkinson is an emergency room physician at UCHealth Yampa Valley Medical Center.
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