April 16, 2020 #5 blog: 

COVID-19 battle: Health or Wealth?
Today, President Trump is expected to spell out when to “open up the US.”  Two impending priorities demand a battle: Health or wealth? Which is more precedent now? Contagious COVID-19 infection causing overload of hospital capacities and resources and death; or, economical suffocation due to unemployment increasing by the day.

For the medical personnel like myself, it is obviously health over wealth but to perhaps a majority of Americans, immediate needs such as shelter, food and clothes to wear are becoming more significant, even though we as a nation then gamble and play the odds of prolonging the contagious virus. 

There are a number of issues we need to sort out during the pandemic in my humble opinion. As news media said, “we are in this together” fighting the silent and deadly enemy. And because this virus is novel, no one can predict, and prepare for the best scenario when unknowns are stacked against our odds. This was manifested by unpreparedness in our most powerful country and medical experts. Medicine is truly practiced at this time.

1. Americans are saying we need more robust testing.

Here are the current estimated numbers:

Region	Total population	# infected cases	% infection	# Death	% Death
CA	40 million	27,226	0.07%	893	0.002%
US	328.2 million	657,230	0.2%	29,908	0.009%

– The deaths out of the total number tested is not a true percentage of the death rate caused by coronavirus. It is easy to mistakenly calculate as such.

– These statistics are not the actual numbers because testing is done only in the high risk people where COVID-19 infections are suspected following specific guidelines.

– Even in the current ER admission, unless met with specific symptoms and signs, nasal swab test is not being done.

– Drive-thru testing sites are open in many areas but one needs to have high risk criteria such as immunosuppressed states, diabetics, high blood pressures, etc.

– Even doctors and nurses and health care allies are not given the option for testing because we simply do not have availability of test kits and labs to run the test.

• No tests currently conducted are “FDA approved.” 
  – No sensitivity and specificity studies are done; if the test result is negative, it does not necessarily mean one did not get infected. 
  – Sensitivity of nasal swab which is a PCR method (most common) and it is expected to have a 70% accuracy rate, which means 3 out of 10 tests may be a false negative result. 
  – Each test requires Sensitivity and Specificity analysis. Sensitivity test is the ability of a test to correctly identify those with the disease (true positive rate). Specificity test is the ability of the test to correctly identify those without the disease (true negative rate).
• Many labs including commercial, individual hospital labs, and government labs are currently coming out with new rapid tests. None are FDA approved. Each lab test has different sensitivity and specificity rates. There is no national standard check point to validate the accuracy of the test given from each site.

• Blood testing for antibodies against COVID-19 is the newest and entirely different test that Dr. Fauci talked about. The US FDA recently granted an “emergency use authorization” for this test. In Italy, politicians want to use antibody status to determine which people will get back to work. This test will be able to detect those “asymptomatic COVID-19 infected people” and it has a potential to reveal the true % of coronavirus infection rate. However, in order to do that, we will need to test all people. In the US, a collaborative multiyear project is underway which aims to provide a prevalence of nationwide antibody. The first phase is to collect samples fromblood donors in 6 major urban areas. This will be in combination of 3 national surveys of donors, supported by CDC in this fall and in the fall of 2021. Notice that this study involves blood donors, not entire regional areas, state or the US. How can we ever find out the true infection rate from these data?

• The antibody test has many presumptions.
• Influenza (flu), poliovirus and Varicella-Zoster (chicken pox) infections induce antibodies and not only tells who was infected, but provide protection that will be near universal, and have long-lasting resistance. Vaccines against these also provide a life time protection against re-infection. The immunity is permanent.
• HIV infected people will often have large amounts of antibodies but it does nothing to prevent or clear the disease.
• Hep B vaccine, Mumps, Measles, Rubella and Closterium (bacteria) which causes botulism need to have regular booster shots even if antibodies are detected in blood.  
• The presence of coronavirus antibodies may not bring a long-lasting resistance as chicken pox. At this early stage of understanding, we simply do not know yet what it takes to be effectively protected from this infection, how long do coronavirus antibodies remain in the blood and do they protect against re-infection.

• Do we really know how long asymptomatic coronavirus infected persons can actively transmit to others? It is recommended to be quarantined for 14 days (some say 10 days) but do we really know after these 14 days, it is contagious-free?
• It is estimated that we will eventually have approximately 5% of the population in the nation to be infected which means 95% are free of infection, and needing vaccine. If we are thinking about re-opening the economy, wouldn’t it make sense to send the people to work who are not infected?
• In some profession such as medicine, the majority may be exposed to COVID-19. If COVID-19 or antibody test results are positive, does that mean they cannot go back to work and for how long? Who then will remain in the hospital to attend to the sick?

• COVID-19 Vaccine in works.
• As of 4/8/20, there are 115 vaccine candidates and 73 are currently at exploratory or preclinical stages. Even though the scale and speed of the global vaccine research and development is at the highest focus, there is an indication that vaccine could be available in early 2021 (which is a disappointing timeline). To expedite the process, tremendous funding, strong international coordination and cooperation between vaccine developers, regulators, policymakers, public health bodies and government are needed.
• Here is the summary of current vaccines in the pipeline:
  

• Current potential treatment: Recent JAMA paper is included for your review:

Go to Jamanetwork.com,

Pharmacologic Treatment for Coronavirus Disease 2019 (COVID-19) by James M. Sanders. 

If China indeed had spilled out COVID-19 from Wuhan Lab (albeit accidently), surely, they should have antidote for this virus and the time to release it is now. 

After I spilled out my thoughts regarding COVID-19 which is all gloomy (I am sorry), I want to say I look for my comfort and peace in God who is called The Son of Man, The First and the Last, The living One, The Son of God, The faithful and true witness, the Lion of the tribe of Judah, the Heir of David’s throne, Lamb, Shepherd, Christ, the Word of God, King of all kings, Lord of all lords, the Alpha and Omega, the Beginning and the End, the bright morning star, Rock of Ages, Redeemer, Bread of Heaven, Living water, our sure foundation, good, fairest of ten thousand, Savior, Mediator, our Advocate, Almighty, the stone the builders rejected, wonderful counselor, friend of sinners, great physician, Anointed one, healer of broken hearts, prince of peace, blessed hope, our atonement, mighty fortress, shelter, the narrow gate, Lord of grace, God of all comfort, Word of life, Rose of Sharon, lily of the valley, Glorious, Immanuel, Living word, chief cornerstone, Creator, Ancient of Days, the eternal One, finisher of our faith, resurrection and life, the way, the truth and the life, everlasting Father, captain of the Lord’s army, strong tower, Yahweh, our defender, our friend, our comforter, the One who prays for us, the Most High Priest, and the most High…

These are just a few names and references for Jesus whom I trust, worship and give thanks to. It is indeed a miracle that we each have breaths today and live life as a gift from God.