Thursday May 28th The Coronet Diaries

YOU ARE HERE (PHOTO BY JOHN HAYNES)

BUT WHERE AM I ? WHERE ARE WE?

  1. A new phenomenon is creeping in when I talk to my ‘patients’. They are confused. Rather more than three people already this week have expressed reluctance to go outside their homes. They report feeling confused, anxious about what they can and cannot do. Let alone what they are allowed to do.
  2. A less conscious reason for this reluctance may be their fear that having once again taken back some agency and access to the wider environment it will, come the Autumn, be snatched away. The metaphor of the butterfly feels appropriate. The grub or virus crept into our lives. Now, we have grown used to cocoons. Dare we allow ourselves the dream of a butterfly… Or will that invisible worm that flies in the night return to destroy our crimson joy of health?
  3. I have decided not to make any decisions about where I will in the future be practising other than, when appropriate, in my home consulting room until January 2021, by which time we will know whether or not the virus has burnt out, or is just prepping up around the corner of the universe for a grand reprisal. And that is the question to which nobody, on either side of the lockdown/scientific debate yet has the answer. As with the origins of consciousness there are far more theories and opinions than answers. One can only hope the questions of immunity, and reprisal, will be quicker to solve than What/Where is the invisible seat or throne of Selfhood.
  4. I have just listened to a long interview with Professor Sunetra Gupta who is Professor of Theoretical Immunology at Oxford and whose views are in direct opposition to Professor Neil Ferguson and the Imperial group. Her arguments both convince and fail to convince. It is true that the virus seems to have attacked very specific groups of the population and it has proved – more than other pandemics so far that there is one outcome for the privileged and another for the economically deprived members of society. In almost any emergency scenario it is true that the elderly will be more vulnerable to death and accident. Likewise those suffering with serious underlying conditions. It is also true that nobody I know, not even my friends in New York, has had to face the tragedy of losing someone they love. I pray that scenario will continue. And yet thousands of other people are struck down in mourning and melancholia. Prof Gupta’s argument also rests on the hypothesis that a far larger section of the population was infected with the virus at the beginning of March before the public was cognisant of the dangers of the virus and lockdown had not begun. Her argument cannot be proved because of the absence of testing. The absence of reliable testing, despite Government protestation, continues and if anything many people who are not Key Workers will now, with threats of self-isolation, become less likely to seek out tests.
  5. It seems to me that in-spite of the hours now being devoted in the media to the importance of national testing it remains a fiasco. Many members of the public are reporting having driven to testing centres last week who are still waiting for their results over a week later. In relation to Prof Gupta’s statement about fifty percent of the London community already being immune, I would surely be one such candidate. At the beginning of March, when I was still working within a large communal building in the West End, and taking Ubers daily, I had to stop working with a feverish cold and persistent dry cough which disturbed my family as it sounded so unfamiliar.
  6. Yesterday, after less than thirty six hours, my doctor heard back from the laboratory that my antibodies test result was negative. ‘Dr Dan’ supplies the following information sheet. Such things as IMMUNITY PASSPORTS send a bit of a shiver down my spine.

IMMUNOLOGY
ANTI-SARS COV 2 IGG RESULT Negative

Understanding Antibodies

Antibodies are small proteins produced by the body in response to infection. They can bind to any invading pathogens such as bacteria or viruses and neutralise them, minimising the risk to the person. After infection, the body usually produces specific antibodies which have a memory for that infection, protecting us from being affected by the same pathogen again. A good example of this is chickenpox, where a single childhood infection gives almost all patients lifelong immunity from re-infection

There are several coronavirus tests on the market testing different antibodies, however the UK government approved Abbott & Roche products only test the IgG antibody, confirming whether we have been infected before, and have current immunity.  The scientific community is assuming that positive antibodies would be protective from re-infection as no-one has had Covid-19 more than once and antibodies do seem to persist in people after other similar Coronavirus infection for at least a few years, however long term data is unavailable as the infection only appeared in December 2019.

As more is learned about this, it is possible that schemes such as ‘immunity passports’ may be used to re-open society to those who have had the virus. If this is the case, it is likely that the Abbott IgG test result could be used towards such an immunity passport as it is currently approved by the UK government. 

Interpreting your result -IgG test

A negative result (Antibodies-not detected) indicates that you have not yet been infected with SARS CoV2, the virus which causes COVID-19, and have no immunity. The test is considered maximally accurate a minimum of 14 days following the onset of symptoms, so it is not advisable to use this test while acutely infected or within 2 weeks of exposure to a known case.

A positive result (Antibodies-detected) indicates that you have been infected with SARS CoV2, the virus which causes COVID-19 at some point more than two weeks ago. It cannot tell you when it was, or how severe a form of the illness you had. It also cannot tell you if you are still infectious, although if you are testing outside of the 14-day window then you are highly unlikely to be. 

As detailed above, there is currently no long-term data on immunity to COVID-19.  It is assumed that people with antibodies are immune from re-infection for a period of time however we do not know how long this will be and at present you must continue to follow national social isolation and distancing measures.

About the test

Our testing is undertaken by The Doctors Laboratory, one of the largest private healthcare laboratories in the country. The test is the Abbott SARS-CoV-2 IgG lab-based serology blood test.

Quoted data for the test indicate reliable results with 99.6% specificity and 100% sensitivity for patients tested 14 days after symptoms began. Practically this means that

  • The test is accurate for ‘positive’ patients 100% of the time, if tested more than 14 days after symptoms began – There are no false negatives
  • The test is 99.6% accurate for ‘negative’ patients, if tested more than 14 days after symptoms began. In other words, if 1000 COVID-19 negative patients were tested, 4 would test positive despite not having had the disease. 

All medical tests have margins of error, and the quoted data above indicate that the test is likely to perform very well and the results can be trusted. The UK government approved this test on 15thMay 2020.

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