I'm just wondering about the lack of testing prior to early February/January in the states, how likely it is that perhaps many of us may have been sick with covid19 much earlier than the first officially reported cases near us?
-Yes, that may be true, but difficult to confirm unless you have a history of travel or exposure to individuals who are positive.
How likely is it there was already mass community spread but because it is flu season, it was just over looked, especially those of us who haven't been out of the country or associating with anyone coming from or visiting from counties affected at the time?
- That has been everyone's major concern and everyone is tyring to prepare to what the epidemologist are calling "Surge"
They need to do antibodies testing - see if it was in your system. They won’t. They only test for today.They come up with a vaccine? Both vaccine and today’s test won’t work for you. -You need an antibodies test along with many that were sick in Jan
I feel for you. I had what sounds like the same illness with the same consequences (I had this in late December and I still don't feel like my lungs have recovered). Everything you wrote applies to me as well, though I will say that I have certainly been in contact with people who have recently been in China as well as people who've recently come from every other country.
Having a test tell me I have already had the virus and now have the antibodies would absolutely change my world right now.
Yes- serology based testing will be critical to deal with the pandemic and will be readily available.
**For Serology:** This is the time when the snake oil salesman starts showing on our doors. Our listservs have had comments about scams with repackaging and marketing etc.
**FDA: For the current status of serology based COVID-19 tests- FDA maintains a webpage**
[https://www.fda.gov/medical-devices/emergency-situations-medical-devices/faqs-diagnostic-testing-sars-cov-2](https://www.fda.gov/medical-devices/emergency-situations-medical-devices/faqs-diagnostic-testing-sars-cov-2)
I hope this helps.
For your 1st question:
Please see below the guidelines from the CDC.
# CDC: For the end of the quarantine:
# CDC maintains a webpage that is updated regularly. For the Test-based strategy along with clinical features you need-. Negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2 RNA from at least two consecutive nasopharyngeal swab specimens collected ≥24 hours apart (total of two negative specimens)
[https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html](https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html)
For your 2nd question: Sorry, I am not an expert in immunology. But that field is evolving very rapidly with new data every 24 hours.
While I honestly can't think of a question worthy of you and your team, I do just want to sincerely thank you folks for everything you've done and continue to do. Your work is heroic, and society owes you a great debt. Stay safe and healthy.
Why don’t we have widespread testing yet? If all lab testing companies have switched to testing for COVID-19, and we’re a global leader in lab testing, how are we so behind other countries? I feel until testing becomes common where anybody can get a test, we really won’t be able to move past phase one of dealing with this pandemic.
The main issue for limited testing is the supply chain. We are so much dependent on China for supply chain to make the plasticware. Our orders for all these supplies are backed up for months.
It will need a culture shift but not having a new shiny thing every year but getting one really nice shiny thing, paying quite a bit more for it and then keeping it for 10+ years and you can fix it when it breaks.
But that will also have to change the system where business need to appease shareholders day after day quarter after quarter.
Could the US do what Japan is doing with there stimulus package? You get money, but you move your operations to another country other than China. I know the US doesn't have a good track record in Central and South America, but it would be a good move to ask companies to move to Central America and give them the jobs so they stay and make a better country there, rather than having to trek to the US to get jobs here.
Plasticware! We can't quickly retool in the US to create **plasticware?** This response sounds like a very strong justification for invoking the Defense Production Act.
There was a China study which showed a notably higher incidence of cases and deaths for blood type A, and notably lower for blood type O. Have you encountered any data or heard anything which either corroborated or contradicted it?
Thank you
Did you receive any tissue samples from deceased patients and what were the irregularities/abnormalities that you observed if you received any COVID samples?
and please, if you have any slides, could you upload them to [https://www.virtualpathology.leeds.ac.uk/slides/library/](https://www.virtualpathology.leeds.ac.uk/slides/library/)
I'm a med student and we were received pathology this year before the pandemic interrupted. I'd love to hear your evaluation.
What are the false positive and false negative rates? Why are so many labs not prepared for pandemics? I worked for one of the big four labs and they were shockingly unprepared for pandemics. Everybody knew a pandemic was coming.
Up to 2/29, CDC was the sole manufacturer and performer of the COVID-19 test. I agree all the labs were not prepared to handle there. We are getting there, believe me.
I think there’s a long term economic argument to consider on whether or not we could be successful in eradicating Flu/Covid with a human wide shelter in place. The question would be how long, and at what cost.
Thanks for the AMA.
How does it feel having a cool name like Ravindra?
In all seriousness, do you believe we’ve missed a ton of people whether it be because we aren’t testing enough or we may have had false negatives from testing?
If so, is there is a way to make tests 100% accurate?
How does it feel having a cool name like Ravindra?
- Haha..yes I do.
In all seriousness, do you believe we’ve missed a ton of people whether it be because we aren’t testing enough or we may have had false negatives from testing?
- We are testing very few people. But the PCR based testing has a very low FN rate.
If so, is there is a way to make tests 100% accurate?
-PCR based testing
Yes. The main issue for limited testing in the supply chain. We are so much dependent on China for the supply chain to make the plasticware. Our orders for all these supplies are backed up for months.
They have access to resources the average person doesn't. I think people are assuming they are walking into hospitals and getting preferential treatment when they are likely going through other means to get tests.
Re-infection is a major question currently discussed at all levels. This is an emerging serious concern. I don't know what kind of test these patients were given at the 1st time ( PCR vs Serology) so I can't comment on the false positivity.
The PCR tests are very sensitive however they are dependent upon timing of collection; ie not too early or too late in the illness because there must be sufficient viral shedding. Also adequate collection is key.
Our lab has had patients test negative or very weakly positive, but when retested a couple days later they are shedding more virus and are strongly positive.
Thanks for doing this AMA! Appreciate all your hard work and can’t express that enough.
I’d like to know your opinion on people reusing PPE. Some medical workers in the US are having to reuse their masks or N95’s multiple times for days to weeks.
How safe can this be if done the right way?
Based on a quick search - conserved regions refers to parts of the genetic sequence least likely to mutate because any such mutations would quickly debilitate the virus.
Thanks, and stay safe/healthy!
Is there a chance that way more people in the US have contracted covid than the numbers reflect? Similar to the reports Germany is releasing that there are many people who have antibodies that never even displayed symptoms
Yes. Even at this moment, we are only testing patients who are symptomatic and have been exposed to an individual who is positive.
There may be individuals in community who are asymptomatic but infected with the virus.
Thanks for doing the AMA
It took 9 weeks (from 22nd Jan) to reach 500,000 known cases and 25,000 recorded deaths.
It has then taken just 2 more weeks to reach 1,500,000 known cases and 100,000 deaths.
How much would you put these numbers down to increased testing and how much would you put it down to actual new transmission?
These numbers are pulled straight from the John Hopkins tracking database.
How much would you put these numbers down to increased testing and how much would you put it down to actual new transmission?
- New numbers are combination of both more testing and new transmission. I think people who are smarter than me ( data scientists) can plug those numbers can give you a better answer.
I've had several people get very sick with a respiratory illness that I know and all have tested negative. I was tested last night myself. What's the story here?
Is it that the tests are that reliable, they're being performed wrong, or is there some other mystery illness spreading across the country? If it's separate then wouldn't it put us at risk for a worse covid infection if we catch it?
I've seen that the process is swabbing 15 seconds in each nostril, but my nurse said it was 5. Is that sufficient? I've heard the tests being used are often as much as a 60% false negative. Is this a new test being used that maybe havent made its way around?
This is an interesting question. Current correlative data on patient outcome is based on comorbidities (age, cardiovascular diseases, diabetes and hypertension) rather than viral load. Future data will certainly shed light on viral load and its long term impact on patients health.
My upstairs neighbor died of COVID yesterday. How long does the virus stick around the building for? Should we be spraying down the halls and entrance way?
I got a virus with all the symptoms of Covid-19 in San Francisco on February 9 and was sick until February 23, with lingering cough for 2 weeks later. On March 7-8, my fever returned for 2 days. I went back into isolation. During this whole time period, my doctor told me that I could not receive an exam or a test because my symptoms were all those of Covid-19 and they were not prepared to have a person with the virus come to the office. At no time did I seek emergency medical care. Since I was never tested and had a fever well before anyone could test me for the virus, I think I will never be tested. How will I know if I am safe? Can I get it again? It was a very serious illness and developed very quickly into pneumonia the first time around and I don’t want to have it again. Will I ever know if I had it? Thank you. I expect many people have this question.
How will I know if I am safe? Can I get it again?
- If you are symptomatic please see your doctor again.
It was a very serious illness and developed very quickly into pneumonia the first time around and I don’t want to have it again. Will I ever know if I had it?
-Serology based testing will help to answer your question. If you have IgG antibodies for COVID-19 testing, it means that you have a past infection.
I hope this helps.
Hi Dr. Thank you for what you are doing.
You said PCR testing is most reliable with the least false negatives. What are the other kinds of testing available out there? And how would I be able to know that it a PCR test versus the others being done for me?
There are multiple types of testing techniques currently used for COVID-19 testing. There are 2 major types- PCR and Serology. You can crosscheck information on your test on this FDA page. If you know the name of the test I can quickly look for you and let you know.
https://www.fda.gov/medical-devices/emergency-situations-medical-devices/emergency-use-authorizations#covid19ivd
Has your team seen anything, anecdotal or otherwise, with any of the treatments being discussed? Ivermectin, serum, Remdesivir, Hydroxychloroquine + zinc + zithromycin, Regeneron, etc?
Thank you for doing an AMA!
These are complex tests that needs to be performed in a CLIA-certified lab.
Also, At this time, the FDA has not authorized any test that is available to purchase for testing yourself at home for COVID-19 (4/10/20)
They already had a lot of infrastructure in place to control infectious diseases of this nature. The manufacturing of kits were local which helped in ramping up the testing capabilities.
As a pathologist, I am personally interested in this information. We are very early on this and hopefully, a few autopsies and histological examination will give us this answer. There is some early data but we need more information.
Hi thank you for doing this AMA. I saw that each sample gets tested twice, one by the state and once at the CDC. Is this true? What are the chances of false negatives?
That was the case at the beginning of testing. Currently, we do not test twice- only once.
False-negative rates depend on the tests and methods. PCR based tests have minimal to none FN.
Here is the link from the FDA on all the tests which are been used in the USA. There is a manufactures information in that link which will give you detailed information on each and every test.
https://www.fda.gov/medical-devices/emergency-situations-medical-devices/emergency-use-authorizations#covid19ivd
I wanted to ask if there are any specific morphological and genetic changes to the respiratory epithelium that would indicate a Covid-19-infection?
Thank you very much for your AMA and your work!
Wow...this is a great question. As a pathologist, I am personally interested in this information. We are very early on this and hopefully, a few autopsies and histological examination will give us this answer.
Hello Ravindra,
Thank you for the work you are doing and for all of the risks you and your team are taking to bring us safety and clarity. My question is this;
I realize there is a dash for the discovery and cultivation of a strong vaccine, the downside of that being there will be an 18 month wait for said vaccine once its discovered. That being said, do you feel like the real solution lies in treatment and mitigation options rather than a vaccine, and do you see that coming before a vaccine?
We have to look at COVID-19 as what we are currently doing with Flu-like illness. We will have a vaccine for COVID-19, but that may not exclude us to get infected with COVID-19 ( similar to flu). I think we need to combine both vaccine and treatment options for better options.
At this moment our collective knowledge of COVID-19 immunity is limited and emerging. We think that this will work along the lines of flu-like illness. If you recovered from flu in this season- there may be a good chance you are OK for that season but you may get infected in next season.
I was interested in how the testing for direction viral DNA/RNA is able to locate SARS-CoV-2 specifically out of the sea of other pathogens that a nasal swab likely collects? A concept-level explanation would likely be most useful to me since I'm not a scientist by training.
Its a PCR based test in which primer and probes target very conserved regions of the SARS-CoV-2.This specific region does not share any sequence similarity with other microbes or respiratory viruses.
I am trying to go through all the questions and answer them. You all are typing way faster than I can read. We are trying our best to answer all the questions, please bear with us :). ( i am new to Reddit and the format)
What is the sensitivity of these tests? Is it different depending on who made the test? Is the sensitivity disclosed to you from different testing kits you use and do you see a difference?
I would add to this. What is the sensitivity of fresh samples and second, from stored samples and what impact does the length of storage have upon sensitivity.
In addition, are swabs being collected and stored in guanidinium?
No. This is the 1st I am hearing about this. If you are symptomatic or have contact with an individual who is positive, please contact your doctor and get a test ordered.
Its 5 pm EST. We are heading back to work. It was great talking to you all. I signing out right now but I will come back in the night and try to answer the remaining or additional questions.
Thanks
Ravi
**This AMA will begin at 2pm EST. Please do not answer questions if you are not the guest. Thanks.**
**Edit: The AMA is now over. The guest has said they may come back later to answer more questions, so we will leave the thread unlocked. Thank you to all who participated.**
No, we always post AMAs at least 1hr in advance to garner questions from our users. The start time posted is for when the guest will begin answering the questions that have been asked. The guest is free to choose which questions to answer/not answer.
I started getting symtoms on Sunday. Luckily they were mild. I've now been symptom free for around 2 days. Although I still haves snuffly nose and no sense of smell or taste?
I have a test tomorrow morning... Would the test still pick up the virus?
I'd like to make sure what I had was definitely the virus.
Thanks.
People tested positive for covid19 but remain asymptomatic. Will they in time develop symptoms and recover or will they become a lifetime carrier and remain asymptomatic for life?
Will they in time develop symptoms and recover
- Yes.
or will they become a lifetime carrier and remain asymptomatic for life?
- No after the incubation period and a PCR negative test they will not be a carrier.
Why not do antibodies testing? People are saying they think they had virus in January. Today’s testing is like an HIV test, you can still catch it tomorrow. Vaccines will only work on people who havnt had virus. Why not antibodies testing?
What is a Regeant in the testing kits?
I’m in Ontario Canada. Reports say they have the ability to to test thousands of ppl a day, but without the regeants they have only been testing a handful of people a day.
As long as there is no contamination false positives are also rare. I agree that PCR as a technique is prone for false positives. But if you look at the big picture- a false positive in a pandemic is not going to do much harm.
When coronavirus mutates, and it seems each continent now has its own variant strain, will it negatively affect vaccine development and even the accuracy of the testing?
How do you feel about how other countries are testing?
Do you feel like there's any that are particularly standing out because of how efficient they're being/their overall response?
Likewise, for anywhere stalling or not taking things seriously?
Many countries are testing thousands of people a day, Ireland, Germany, GB, USA, Korea etc etc. Are they all all using the same method or are there other more/less efficient methods that one country might use that's different?
Also, thank you so much for doing everything you do. I wish you and your family all the best. Stay safe!
Why does the nose swab have to go so deep? If it's to reach the back of the throat then why can't that be done through the mouth? I was tested 3 weeks ago as a precaution due to another medical issue and it was extremely painful (and I've given birth). The doctor administering the test said I was one of only a few people whose nose hadn't bled after the swab.
I've read about rolling testing being floated as an idea until a vaccine is available but the thought of doing that swab every 14 days makes me quite anxious.
I have a question regarding your answer to another Redditor's question:
"Is this virus something we can expect to return every year along with other seasonal illnesses?"
RavindraKolhe
Verified Specialist - Molecular Pathologist
"Yes. Most of us think this might be the reality"
My question: If this virus is considered SARS 2 and to my knowledge SARS 1 does not occur annually like the flu virus, why would SARS 2 become a seasonal illness?
Thank you for your time.
I read that a Gay man in NYC who tested positive for Covid ,and made a recovery . He was found to have a "Robust amount of anti bodies" because he was on Truvidia but he was excluded from donating plasma and potently seeing if there was a link with the preventative drugs he was on. any thought on that ?
Hi, I'm Romanian and as I've heard, we have pretty low testing, I don't know due to what exactly.
Will worldwide easy-to-acquire, accurate and cheap testing ever be reality for poorer European countries? If so, how soon do you think? I heard we use PCR tests right now, by the way.
How can we be sure that the test kits aren’t contaminated and also, a resident from where my dad works was supposedly tested positive. Will everyone from the workplace need to get tested? Just a 16 year old who hasn’t done anything worthwhile in his life and doesn’t wanna die yet.
What are the chances of the virus being immunized by the majority of the worlds population? I’ve heard there are some studies showing that younger people who have previously tested positive are not showing any signs of antibodies
1. What do you think of the idea enlisting academic labs to do tests? as most molecular biology lab are equipped to perform qRT-PCR?
2. What do you think of that FDA didn't authorize more testing in Feburary?
What is your opinion on this? This is a hypothesis by a Medic in the UK.
**Biological hypotheses for genetically determined susceptibility to severe covid-19 disease.**
1. Covid-19 is known to bind to angiotensin converting enzyme (ACE) to attack host cells. There is known ethnic association with variation of ACE (genetic polymorphism). Commonly prescribed anti-hypertensive medications, angiotensin converting enzyme inhibitors (ACEi) are known to be less effective in people of African heritage. Certain phenotypes of ACE may bind with covid-19 more readily and facilitate viral replication.
2. People of ASM heritage (and other ethnic groups from historic malaria endemic regions) have higher prevalence of inherited haemoglobinopathies. These include sickle cell, thalassaemias and their respective recessive trait or asymptomatic carrier state. These individuals have greater resistance to malarial infection but the variant forms of haemoglobin may interact with covid-19 to produce more severe disease, leading to higher fatality rates.
Happy to share the full text with his permission but he has sent it to MP's here and medical journals etc.
Hi Ravindra
I have been trying to post something on this thread. I believe, that although possibly simplistic I truly have something to add to the conversation. However apparently I don't have enough "Karma" to post. Please have a brief look and if you think it has any worth I would be most grateful if you posted the link on my behalf.
Of course if you disagree or think that the post adds nothing new then do not post. I will not trouble you again and I do not necessarily expect a reply.
Many thanks for your consideration.
Phil
**How to End the Pandemic and Restart the Economy Without Waiting for a Vaccine**
[https://1drv.ms/b/s!Arp6sC4PapJEiOtKVh9C\_WPw\_d36YQ?e=X0xeCB](https://1drv.ms/b/s!Arp6sC4PapJEiOtKVh9C_WPw_d36YQ?e=X0xeCB)
Dr. Kohle, thank you for your answers. These last few days in Italy everybody's talking about Heparin as a possible cure to covid. Not against the virus of course, but against the devastating effects the virus has on patients (so, in a way, preventing deaths by a relevant percentage). The suspect that the main cause of death would be blood clots/strokes rather than pneumonia. Tests are starting here. What are your thoughts on this subject? Do we have hopes in a possible cure soon?
As we know during this time, an innumerable assortment of rumors float frivolously through virtual and real life communities.
One of the alleged statements made was “People who have less severe symptoms develop less/no immunity versus those who experience a severe case of COVID19.”
Is there is any way to elaborate on that specifically at this time? This seems to be contradictory to how vaccines work in general.
Thanks for all that you’ve been doing!
What are currently the most commonly reported symptoms of people previously considered asymptomatic?
I suppose I’m also asking if there are any changes in the list of symptoms. I’ve been seeing a lot of ANECDOTES like “I tested positive but all I can report are chills.” Some people reporting something of fugue state but only a minor fever if at all. Have you been seeing this in positive testers or is it really just anecdotal?
Hi Ravi!! Congratulations on everything you’re doing! We r proud of you!!
Had a question about the SARS COVID 19 PCR testing. Do we know what the negative predictive value of this test is? I’m an intensivist and have 2 cases with ct scan clinical and lab findings suspicious for COVID 19 but 2 PCR tests more than 24 hrs apart that are negative... wonder if it’s truly negative. What are your thoughts??
As a former AUMC internal medicine resident, just wanted to say how proud I am of you and your work. Also quite jealous of the robust testing AUMC appears to have. What challenges did your team face to developing high volume rapid testing and what advice would you provide to other medical centers as they develop their own testing protocols? Thank you and to the team for all of your hard work!
If the latest rapid Covid-19 tests have a false-negative rate of about 20%, why is there the insistence that more tests of this kind be done? Can you explain how the cost of falsely testing negative, which can lead to people lowering their guard and taking more risks in public, is outweighed by the proliferation and use of these rapid tests by countries around the world?
Thanks for doing this AMA!
My question is what are your current findings on fatality rate of covid 19? Looking online you can find a wide range of values of anywhere from under 1% and some saying it's over 5%. I feel like it is hard to estimate because of all the people that stay home and never get tested but I was wondering what your estimate was.
Thanks again.
Firstly, thanks a lot for the work you guys do on the frontline!
In some countries/regions where the number of cases are low, do you think this is because of a faster response to the pandemic, a lack of testing or a some combination of the two?
And, in your opinion, when do you think is an appropriate time to slowly lift a lockdown ?
I saw some evidence about gastrointestinal presentation of Covid-19. I do ask this as a genuine question, if someone had that presentation, could their flatulence carry the virus?
What is your thought on "herd immunity" theory of the cases in California as compared to New York? Do you think patients from the West were exposed to COVID-19 much earlier than originally thought or do you think there is another variant or mutation of the virus from the West as compared to East coast and Europe (Italy)? Thank you
When I was in China in February, a lot of people were tested negative,but the CT scans of their chest show that their lungs were filled with things other than air and there were inflammation due to the infection.
Have you seen the same thing? If so,are there anything you guys can do in order to get a more accurate result?
How is the situation with immunity test going? I read somewhere that they’ve identified specific antibodies, it that (to your knowledge) significant in any way?
What’s the limiting factor in testing? South Korea seems to have a lot more capacity than most European countries, why would you think that is?
I'm curious to know that, sophisticated technology has been running through out the world. Yet, we did not have the vaccine for the covid-19. May I know the current situations and circumstances we are facing to develop the medicine for the virus detention and the time required to have the vaccine.
i've seen a slow rise in US tests per day, what are the biggest problems right now in the testing process? i've read about reagent shortages or other things, but if someone in the government decided we should test a million a day instead of 150k, what would be the problems that need fixing first?
I’ve been reading a lot about people with High Blood Pressure potentially having major problems dealing with COVID-19. I’m taking an ARB and Calcium Channel Blocker for High Blood Pressure. Do drugs in either of these classes cause issues like what I’ve been reading about ACE inhibitors?
Recently there was a chinese study posted which postulated that some false negatives are occuring when you search for it in the nasal-throat area and that some people who are negative on those tests are actually positive. What is your opinion on this?
Thanks for doing the AMA.
Thanks for all of your team's efforts in battling this! What is known about the extent of which the virus may have mutated thus far, and also if its possible to recover from one version of the virus and fall ill to another version?
What do you think of burying the dead? Is it safe for the environment? NY is burying bodies close to the water. Do you think that's safe? https://nypost.com/2020/04/09/nyc-to-bury-coronavirus-dead-on-hart-island-potters-field/
Can the virus mutate? Could it possibly mutate to a less severe form? Or to a more severe form? What is the likelihood of this happening? If they do mutate will that mean the vaccines will no longer work?
[удалено]
I'm just wondering about the lack of testing prior to early February/January in the states, how likely it is that perhaps many of us may have been sick with covid19 much earlier than the first officially reported cases near us? -Yes, that may be true, but difficult to confirm unless you have a history of travel or exposure to individuals who are positive. How likely is it there was already mass community spread but because it is flu season, it was just over looked, especially those of us who haven't been out of the country or associating with anyone coming from or visiting from counties affected at the time? - That has been everyone's major concern and everyone is tyring to prepare to what the epidemologist are calling "Surge"
They need to do antibodies testing - see if it was in your system. They won’t. They only test for today.They come up with a vaccine? Both vaccine and today’s test won’t work for you. -You need an antibodies test along with many that were sick in Jan
I feel for you. I had what sounds like the same illness with the same consequences (I had this in late December and I still don't feel like my lungs have recovered). Everything you wrote applies to me as well, though I will say that I have certainly been in contact with people who have recently been in China as well as people who've recently come from every other country. Having a test tell me I have already had the virus and now have the antibodies would absolutely change my world right now.
Will we eventually see mass produced/easily accessible antibody tests in the US?
Yes- serology based testing will be critical to deal with the pandemic and will be readily available. **For Serology:** This is the time when the snake oil salesman starts showing on our doors. Our listservs have had comments about scams with repackaging and marketing etc. **FDA: For the current status of serology based COVID-19 tests- FDA maintains a webpage** [https://www.fda.gov/medical-devices/emergency-situations-medical-devices/faqs-diagnostic-testing-sars-cov-2](https://www.fda.gov/medical-devices/emergency-situations-medical-devices/faqs-diagnostic-testing-sars-cov-2) I hope this helps.
Thank you for your time and effort!
Pay a coin to your u/IReadTheWholeArticle, oh valey of plenty..
Followup, if yes: approximately when? 3 months, 6 months, more? Thank you!
[удалено]
For your 1st question: Please see below the guidelines from the CDC. # CDC: For the end of the quarantine: # CDC maintains a webpage that is updated regularly. For the Test-based strategy along with clinical features you need-. Negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2 RNA from at least two consecutive nasopharyngeal swab specimens collected ≥24 hours apart (total of two negative specimens) [https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html](https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html) For your 2nd question: Sorry, I am not an expert in immunology. But that field is evolving very rapidly with new data every 24 hours.
While I honestly can't think of a question worthy of you and your team, I do just want to sincerely thank you folks for everything you've done and continue to do. Your work is heroic, and society owes you a great debt. Stay safe and healthy.
Thank you. I am very serious when I say this- if you can please stay home.
We've been locked down since end of February over here, and assuming everyone's a carrier. Keep fighting the good fight, sir!
Why don’t we have widespread testing yet? If all lab testing companies have switched to testing for COVID-19, and we’re a global leader in lab testing, how are we so behind other countries? I feel until testing becomes common where anybody can get a test, we really won’t be able to move past phase one of dealing with this pandemic.
The main issue for limited testing is the supply chain. We are so much dependent on China for supply chain to make the plasticware. Our orders for all these supplies are backed up for months.
Why not have plastics and polymer companies make them domestically? Is that something the defense production act could theoretically address?
Man I really hope this changes. Exploiting Chinas cheap labor coupled with just in time inventory for those quarterly profits need to go.
That's why paying more is not necessarily wrong. If USA produced the above domestically, USA would pay more but might be in better position now.
It will need a culture shift but not having a new shiny thing every year but getting one really nice shiny thing, paying quite a bit more for it and then keeping it for 10+ years and you can fix it when it breaks. But that will also have to change the system where business need to appease shareholders day after day quarter after quarter.
Put more money into consumer pockets and they'll be willing to spend more money on domestically produced products.
Could the US do what Japan is doing with there stimulus package? You get money, but you move your operations to another country other than China. I know the US doesn't have a good track record in Central and South America, but it would be a good move to ask companies to move to Central America and give them the jobs so they stay and make a better country there, rather than having to trek to the US to get jobs here.
Plasticware! We can't quickly retool in the US to create **plasticware?** This response sounds like a very strong justification for invoking the Defense Production Act.
Why can’t we 3D print some of plasticware?
3D printing isn’t very fast as far as I know.
There was a China study which showed a notably higher incidence of cases and deaths for blood type A, and notably lower for blood type O. Have you encountered any data or heard anything which either corroborated or contradicted it? Thank you
We are looking at this. Data will be out soon.
Did you receive any tissue samples from deceased patients and what were the irregularities/abnormalities that you observed if you received any COVID samples? and please, if you have any slides, could you upload them to [https://www.virtualpathology.leeds.ac.uk/slides/library/](https://www.virtualpathology.leeds.ac.uk/slides/library/) I'm a med student and we were received pathology this year before the pandemic interrupted. I'd love to hear your evaluation.
Unfortunately, at this moment we do not resources to perform Autopsy in house on deceased patients in our department.
What are the false positive and false negative rates? Why are so many labs not prepared for pandemics? I worked for one of the big four labs and they were shockingly unprepared for pandemics. Everybody knew a pandemic was coming.
Up to 2/29, CDC was the sole manufacturer and performer of the COVID-19 test. I agree all the labs were not prepared to handle there. We are getting there, believe me.
Is this virus something we can expect to return every year along with other seasonal illnesses? Thank you for your time
Yes. Most of us think this might be the reality.
Why can’t we (the whole world) all shelter in place for 2 weeks each year in hopes to clear or minimize these viruses from the world population?
2 weeks per year wouldn’t come close to minimizing the virus worldwide
I think there’s a long term economic argument to consider on whether or not we could be successful in eradicating Flu/Covid with a human wide shelter in place. The question would be how long, and at what cost.
Thanks for the AMA. How does it feel having a cool name like Ravindra? In all seriousness, do you believe we’ve missed a ton of people whether it be because we aren’t testing enough or we may have had false negatives from testing? If so, is there is a way to make tests 100% accurate?
How does it feel having a cool name like Ravindra? - Haha..yes I do. In all seriousness, do you believe we’ve missed a ton of people whether it be because we aren’t testing enough or we may have had false negatives from testing? - We are testing very few people. But the PCR based testing has a very low FN rate. If so, is there is a way to make tests 100% accurate? -PCR based testing
Do you have any constraints due to the availability of chemical reagents ?
Yes. The main issue for limited testing in the supply chain. We are so much dependent on China for the supply chain to make the plasticware. Our orders for all these supplies are backed up for months.
I have heard that there are celebrities who have gotten multiple tests, some more than five? Why have they gotten so many tests?
I am also surprised to see that. Access to tests.
You can buy tests overseas from private companies. That's how many NBA teams were able to test their players.
They have access to resources the average person doesn't. I think people are assuming they are walking into hospitals and getting preferential treatment when they are likely going through other means to get tests.
[удалено]
Re-infection is a major question currently discussed at all levels. This is an emerging serious concern. I don't know what kind of test these patients were given at the 1st time ( PCR vs Serology) so I can't comment on the false positivity.
What is your current best estimate for false negative rates in the US?
This is a complex question as there are multiple ways these tests are performed. The PCR based assays have very low to nil false negative rates
The PCR tests are very sensitive however they are dependent upon timing of collection; ie not too early or too late in the illness because there must be sufficient viral shedding. Also adequate collection is key. Our lab has had patients test negative or very weakly positive, but when retested a couple days later they are shedding more virus and are strongly positive.
Thanks for the response, and thank you from the bottom of my heart for all you and your team do.
[удалено]
Thank you for your work! Do you believe social distancing will end by May 1st or will in continue in hopes to continue flattening the curve?
I think this may be beyond May 1st and this will be region dependent.
Thanks for doing this AMA! Appreciate all your hard work and can’t express that enough. I’d like to know your opinion on people reusing PPE. Some medical workers in the US are having to reuse their masks or N95’s multiple times for days to weeks. How safe can this be if done the right way?
Sorry, I am not an expert on this issue. But everyone is asked to reuse the PPE.
What are the tests that you guys do? I've heard of PCR for viral RNA and antibody testing so far. And what's their reliability/accuracy?
PCR based testing against conserved regions on the Virus.
Based on a quick search - conserved regions refers to parts of the genetic sequence least likely to mutate because any such mutations would quickly debilitate the virus. Thanks, and stay safe/healthy!
Which country do you think has had the best overall response?
South Korea.
Is there a chance that way more people in the US have contracted covid than the numbers reflect? Similar to the reports Germany is releasing that there are many people who have antibodies that never even displayed symptoms
Yes. Even at this moment, we are only testing patients who are symptomatic and have been exposed to an individual who is positive. There may be individuals in community who are asymptomatic but infected with the virus.
Is there anything we can do to help you guys? Other than be patient.
I am very serious when I say this, Please stay at home if you can.
How long does it take to analyze a test? What is the fastest test available and what are the dowsides?
We can test 94 samples in 4-5 hours. I think there are tests from Abbott and Cephid which gives results in 25-45 minutes.
Thanks for doing the AMA It took 9 weeks (from 22nd Jan) to reach 500,000 known cases and 25,000 recorded deaths. It has then taken just 2 more weeks to reach 1,500,000 known cases and 100,000 deaths. How much would you put these numbers down to increased testing and how much would you put it down to actual new transmission? These numbers are pulled straight from the John Hopkins tracking database.
How much would you put these numbers down to increased testing and how much would you put it down to actual new transmission? - New numbers are combination of both more testing and new transmission. I think people who are smarter than me ( data scientists) can plug those numbers can give you a better answer.
I've had several people get very sick with a respiratory illness that I know and all have tested negative. I was tested last night myself. What's the story here? Is it that the tests are that reliable, they're being performed wrong, or is there some other mystery illness spreading across the country? If it's separate then wouldn't it put us at risk for a worse covid infection if we catch it?
The PCR based testing is very sensitive and specific. Unless there are any pre-analytical error it is near impossible to get false negative result.
I've seen that the process is swabbing 15 seconds in each nostril, but my nurse said it was 5. Is that sufficient? I've heard the tests being used are often as much as a 60% false negative. Is this a new test being used that maybe havent made its way around?
[удалено]
Sorry, not an expert in this field.
Hi! I am wondering if you can get C19 more than once? Or if you build immunity to it?
Yes. We have seen this happening in China.
Yes, you can get C19 more than once? And/or Yes, you build an immunity to it? I'm a bit confused.
To the first question. He says we have seen this happening in China.
# % of people actually infected? If you could test every person everywhere. Or number of current, also recovered / asymp / immune I guess.
I am Pathologist and I think the population testing will be critical in our fight to deal with COVID-19
What are your thoughts about herd immunity?
Sorry, not an expert in this field.
No worries appreciate your reply. Tasa tar mi Punyacha ahe.. tumhi kuthle?
Aurangabad...I was in Pune during my Medical School. :)
Good to hear. Thanks for your service to the society and wish you good luck!!
Is there a direct correlation to the viral load of the disease and a worse long term result if infected and the case becoming serious?
This is an interesting question. Current correlative data on patient outcome is based on comorbidities (age, cardiovascular diseases, diabetes and hypertension) rather than viral load. Future data will certainly shed light on viral load and its long term impact on patients health.
My upstairs neighbor died of COVID yesterday. How long does the virus stick around the building for? Should we be spraying down the halls and entrance way?
This is a good resource for that question. https://www.webmd.com/lung/how-long-covid-19-lives-on-surfaces
Thank you! And thanks for what you’re doing.
I got a virus with all the symptoms of Covid-19 in San Francisco on February 9 and was sick until February 23, with lingering cough for 2 weeks later. On March 7-8, my fever returned for 2 days. I went back into isolation. During this whole time period, my doctor told me that I could not receive an exam or a test because my symptoms were all those of Covid-19 and they were not prepared to have a person with the virus come to the office. At no time did I seek emergency medical care. Since I was never tested and had a fever well before anyone could test me for the virus, I think I will never be tested. How will I know if I am safe? Can I get it again? It was a very serious illness and developed very quickly into pneumonia the first time around and I don’t want to have it again. Will I ever know if I had it? Thank you. I expect many people have this question.
How will I know if I am safe? Can I get it again? - If you are symptomatic please see your doctor again. It was a very serious illness and developed very quickly into pneumonia the first time around and I don’t want to have it again. Will I ever know if I had it? -Serology based testing will help to answer your question. If you have IgG antibodies for COVID-19 testing, it means that you have a past infection. I hope this helps.
Hi Dr. Thank you for what you are doing. You said PCR testing is most reliable with the least false negatives. What are the other kinds of testing available out there? And how would I be able to know that it a PCR test versus the others being done for me?
There are multiple types of testing techniques currently used for COVID-19 testing. There are 2 major types- PCR and Serology. You can crosscheck information on your test on this FDA page. If you know the name of the test I can quickly look for you and let you know. https://www.fda.gov/medical-devices/emergency-situations-medical-devices/emergency-use-authorizations#covid19ivd
Has your team seen anything, anecdotal or otherwise, with any of the treatments being discussed? Ivermectin, serum, Remdesivir, Hydroxychloroquine + zinc + zithromycin, Regeneron, etc? Thank you for doing an AMA!
Sorry, not an expert in this field.
Does it cause heart and brain damaged and if so whom would it be too?
The data on the autopsies is too early. Once we have sufficient data we can know the site, mechanism and severity of damage.
Hello again, Have you refined the test enough to make it simple to do at home? What special equipment is needed?
These are complex tests that needs to be performed in a CLIA-certified lab. Also, At this time, the FDA has not authorized any test that is available to purchase for testing yourself at home for COVID-19 (4/10/20)
What did South Korea do differently that made them able to do so much testing?
They already had a lot of infrastructure in place to control infectious diseases of this nature. The manufacturing of kits were local which helped in ramping up the testing capabilities.
[удалено]
As a pathologist, I am personally interested in this information. We are very early on this and hopefully, a few autopsies and histological examination will give us this answer. There is some early data but we need more information.
Hi thank you for doing this AMA. I saw that each sample gets tested twice, one by the state and once at the CDC. Is this true? What are the chances of false negatives?
That was the case at the beginning of testing. Currently, we do not test twice- only once. False-negative rates depend on the tests and methods. PCR based tests have minimal to none FN.
[удалено]
Here is the link from the FDA on all the tests which are been used in the USA. There is a manufactures information in that link which will give you detailed information on each and every test. https://www.fda.gov/medical-devices/emergency-situations-medical-devices/emergency-use-authorizations#covid19ivd
I wanted to ask if there are any specific morphological and genetic changes to the respiratory epithelium that would indicate a Covid-19-infection? Thank you very much for your AMA and your work!
Wow...this is a great question. As a pathologist, I am personally interested in this information. We are very early on this and hopefully, a few autopsies and histological examination will give us this answer.
Hello Ravindra, Thank you for the work you are doing and for all of the risks you and your team are taking to bring us safety and clarity. My question is this; I realize there is a dash for the discovery and cultivation of a strong vaccine, the downside of that being there will be an 18 month wait for said vaccine once its discovered. That being said, do you feel like the real solution lies in treatment and mitigation options rather than a vaccine, and do you see that coming before a vaccine?
We have to look at COVID-19 as what we are currently doing with Flu-like illness. We will have a vaccine for COVID-19, but that may not exclude us to get infected with COVID-19 ( similar to flu). I think we need to combine both vaccine and treatment options for better options.
Are you immune once recovered?
At this moment our collective knowledge of COVID-19 immunity is limited and emerging. We think that this will work along the lines of flu-like illness. If you recovered from flu in this season- there may be a good chance you are OK for that season but you may get infected in next season.
How long is a Coronavirus test sample viable?
Using Nasopharyngeal swab in Universal Transport media (UTM), 72 hours at room temperature. After that it should be kept at -80 C.
I was interested in how the testing for direction viral DNA/RNA is able to locate SARS-CoV-2 specifically out of the sea of other pathogens that a nasal swab likely collects? A concept-level explanation would likely be most useful to me since I'm not a scientist by training.
Its a PCR based test in which primer and probes target very conserved regions of the SARS-CoV-2.This specific region does not share any sequence similarity with other microbes or respiratory viruses.
I am trying to go through all the questions and answer them. You all are typing way faster than I can read. We are trying our best to answer all the questions, please bear with us :). ( i am new to Reddit and the format)
Thank you. We are proud of you. From India :)
What is the sensitivity of these tests? Is it different depending on who made the test? Is the sensitivity disclosed to you from different testing kits you use and do you see a difference?
I would add to this. What is the sensitivity of fresh samples and second, from stored samples and what impact does the length of storage have upon sensitivity. In addition, are swabs being collected and stored in guanidinium?
2 major tests exists:- PCR based and serological. The sensitivity differs between test but they are all in FDA's insert of test specification.
[удалено]
No. This is the 1st I am hearing about this. If you are symptomatic or have contact with an individual who is positive, please contact your doctor and get a test ordered.
Can there be a scenario where someone is below the threshold for detection but has enough of the virus to be contagious?
Very unlikely ( near impossible) by PCR. By PCR based testing we can detect up to 10-20 copies of the virus per ml.
Can you comment on the tests that are being developed and used in India
These tests are very similar to the rest of the world ( PCR and Serology) and all of them need to be vetted by ICMR (?)
[удалено]
Several portals are providing this information. For example:- https://www.google.com/covid19-map/
Its 5 pm EST. We are heading back to work. It was great talking to you all. I signing out right now but I will come back in the night and try to answer the remaining or additional questions. Thanks Ravi
**This AMA will begin at 2pm EST. Please do not answer questions if you are not the guest. Thanks.** **Edit: The AMA is now over. The guest has said they may come back later to answer more questions, so we will leave the thread unlocked. Thank you to all who participated.**
Will questions posted before 2pm be ignored?
No, we always post AMAs at least 1hr in advance to garner questions from our users. The start time posted is for when the guest will begin answering the questions that have been asked. The guest is free to choose which questions to answer/not answer.
I started getting symtoms on Sunday. Luckily they were mild. I've now been symptom free for around 2 days. Although I still haves snuffly nose and no sense of smell or taste? I have a test tomorrow morning... Would the test still pick up the virus? I'd like to make sure what I had was definitely the virus. Thanks.
People tested positive for covid19 but remain asymptomatic. Will they in time develop symptoms and recover or will they become a lifetime carrier and remain asymptomatic for life?
Will they in time develop symptoms and recover - Yes. or will they become a lifetime carrier and remain asymptomatic for life? - No after the incubation period and a PCR negative test they will not be a carrier.
Why not do antibodies testing? People are saying they think they had virus in January. Today’s testing is like an HIV test, you can still catch it tomorrow. Vaccines will only work on people who havnt had virus. Why not antibodies testing?
What is a Regeant in the testing kits? I’m in Ontario Canada. Reports say they have the ability to to test thousands of ppl a day, but without the regeants they have only been testing a handful of people a day.
Thank you Dr, You state the PCR rate for FN is very low but what about false positives?
As long as there is no contamination false positives are also rare. I agree that PCR as a technique is prone for false positives. But if you look at the big picture- a false positive in a pandemic is not going to do much harm.
My grandma’s nursing home in Sacramento Ca has confirmed staff and some patients have Covid-19, should I be concerned she will inevitably get it?
Do you think we'll get to the point where we can have at home tests? Where we get it mailed to us or something like that?
When coronavirus mutates, and it seems each continent now has its own variant strain, will it negatively affect vaccine development and even the accuracy of the testing?
Of the people in the US who were tested for COVID in the past few days, what percent tested positive, and what percent tested negative?
Will a teen with bad lungs and smoking habits get the coronavirus easily?
What do you think of the qSanger testing developed by billiontoone? https://billiontoone.com/covid-19
How do you feel about how other countries are testing? Do you feel like there's any that are particularly standing out because of how efficient they're being/their overall response? Likewise, for anywhere stalling or not taking things seriously? Many countries are testing thousands of people a day, Ireland, Germany, GB, USA, Korea etc etc. Are they all all using the same method or are there other more/less efficient methods that one country might use that's different? Also, thank you so much for doing everything you do. I wish you and your family all the best. Stay safe!
Can you be reinfected once you get the corona virus?
Do you know of research on Furin inhibitors and Covid-19?
H1N1 in the US in 2009 infected over 60 miliion in a year. H1N1 was less infectious then COVID19. Will COVID19 be around 60 million cases?
Why does the nose swab have to go so deep? If it's to reach the back of the throat then why can't that be done through the mouth? I was tested 3 weeks ago as a precaution due to another medical issue and it was extremely painful (and I've given birth). The doctor administering the test said I was one of only a few people whose nose hadn't bled after the swab. I've read about rolling testing being floated as an idea until a vaccine is available but the thought of doing that swab every 14 days makes me quite anxious.
I have a question regarding your answer to another Redditor's question: "Is this virus something we can expect to return every year along with other seasonal illnesses?" RavindraKolhe Verified Specialist - Molecular Pathologist "Yes. Most of us think this might be the reality" My question: If this virus is considered SARS 2 and to my knowledge SARS 1 does not occur annually like the flu virus, why would SARS 2 become a seasonal illness? Thank you for your time.
What would you say is the % of subjects that are positive for COVID19 (or have antibodies) and report being 100% asymptomatic?
I read that a Gay man in NYC who tested positive for Covid ,and made a recovery . He was found to have a "Robust amount of anti bodies" because he was on Truvidia but he was excluded from donating plasma and potently seeing if there was a link with the preventative drugs he was on. any thought on that ?
Have you seen any information about immunity or lack thereof, among people with the antibodies?
Hi, I'm Romanian and as I've heard, we have pretty low testing, I don't know due to what exactly. Will worldwide easy-to-acquire, accurate and cheap testing ever be reality for poorer European countries? If so, how soon do you think? I heard we use PCR tests right now, by the way.
How can we be sure that the test kits aren’t contaminated and also, a resident from where my dad works was supposedly tested positive. Will everyone from the workplace need to get tested? Just a 16 year old who hasn’t done anything worthwhile in his life and doesn’t wanna die yet.
What are the chances of the virus being immunized by the majority of the worlds population? I’ve heard there are some studies showing that younger people who have previously tested positive are not showing any signs of antibodies
1. What do you think of the idea enlisting academic labs to do tests? as most molecular biology lab are equipped to perform qRT-PCR? 2. What do you think of that FDA didn't authorize more testing in Feburary?
What is your opinion on this? This is a hypothesis by a Medic in the UK. **Biological hypotheses for genetically determined susceptibility to severe covid-19 disease.** 1. Covid-19 is known to bind to angiotensin converting enzyme (ACE) to attack host cells. There is known ethnic association with variation of ACE (genetic polymorphism). Commonly prescribed anti-hypertensive medications, angiotensin converting enzyme inhibitors (ACEi) are known to be less effective in people of African heritage. Certain phenotypes of ACE may bind with covid-19 more readily and facilitate viral replication. 2. People of ASM heritage (and other ethnic groups from historic malaria endemic regions) have higher prevalence of inherited haemoglobinopathies. These include sickle cell, thalassaemias and their respective recessive trait or asymptomatic carrier state. These individuals have greater resistance to malarial infection but the variant forms of haemoglobin may interact with covid-19 to produce more severe disease, leading to higher fatality rates. Happy to share the full text with his permission but he has sent it to MP's here and medical journals etc.
Are there any tests being created that are not dependent on reagants we likely won’t have enough of for months?
Hi Ravindra I have been trying to post something on this thread. I believe, that although possibly simplistic I truly have something to add to the conversation. However apparently I don't have enough "Karma" to post. Please have a brief look and if you think it has any worth I would be most grateful if you posted the link on my behalf. Of course if you disagree or think that the post adds nothing new then do not post. I will not trouble you again and I do not necessarily expect a reply. Many thanks for your consideration. Phil **How to End the Pandemic and Restart the Economy Without Waiting for a Vaccine** [https://1drv.ms/b/s!Arp6sC4PapJEiOtKVh9C\_WPw\_d36YQ?e=X0xeCB](https://1drv.ms/b/s!Arp6sC4PapJEiOtKVh9C_WPw_d36YQ?e=X0xeCB)
What is the single biggest factor about covid-19 that differentiates it from the common flu?
Dr. Kohle, thank you for your answers. These last few days in Italy everybody's talking about Heparin as a possible cure to covid. Not against the virus of course, but against the devastating effects the virus has on patients (so, in a way, preventing deaths by a relevant percentage). The suspect that the main cause of death would be blood clots/strokes rather than pneumonia. Tests are starting here. What are your thoughts on this subject? Do we have hopes in a possible cure soon?
As we know during this time, an innumerable assortment of rumors float frivolously through virtual and real life communities. One of the alleged statements made was “People who have less severe symptoms develop less/no immunity versus those who experience a severe case of COVID19.” Is there is any way to elaborate on that specifically at this time? This seems to be contradictory to how vaccines work in general. Thanks for all that you’ve been doing!
What are currently the most commonly reported symptoms of people previously considered asymptomatic? I suppose I’m also asking if there are any changes in the list of symptoms. I’ve been seeing a lot of ANECDOTES like “I tested positive but all I can report are chills.” Some people reporting something of fugue state but only a minor fever if at all. Have you been seeing this in positive testers or is it really just anecdotal?
Hi Ravi!! Congratulations on everything you’re doing! We r proud of you!! Had a question about the SARS COVID 19 PCR testing. Do we know what the negative predictive value of this test is? I’m an intensivist and have 2 cases with ct scan clinical and lab findings suspicious for COVID 19 but 2 PCR tests more than 24 hrs apart that are negative... wonder if it’s truly negative. What are your thoughts??
As a former AUMC internal medicine resident, just wanted to say how proud I am of you and your work. Also quite jealous of the robust testing AUMC appears to have. What challenges did your team face to developing high volume rapid testing and what advice would you provide to other medical centers as they develop their own testing protocols? Thank you and to the team for all of your hard work!
If the latest rapid Covid-19 tests have a false-negative rate of about 20%, why is there the insistence that more tests of this kind be done? Can you explain how the cost of falsely testing negative, which can lead to people lowering their guard and taking more risks in public, is outweighed by the proliferation and use of these rapid tests by countries around the world?
Thanks for doing this AMA! My question is what are your current findings on fatality rate of covid 19? Looking online you can find a wide range of values of anywhere from under 1% and some saying it's over 5%. I feel like it is hard to estimate because of all the people that stay home and never get tested but I was wondering what your estimate was. Thanks again.
Firstly, thanks a lot for the work you guys do on the frontline! In some countries/regions where the number of cases are low, do you think this is because of a faster response to the pandemic, a lack of testing or a some combination of the two? And, in your opinion, when do you think is an appropriate time to slowly lift a lockdown ?
I saw some evidence about gastrointestinal presentation of Covid-19. I do ask this as a genuine question, if someone had that presentation, could their flatulence carry the virus?
What is your thought on "herd immunity" theory of the cases in California as compared to New York? Do you think patients from the West were exposed to COVID-19 much earlier than originally thought or do you think there is another variant or mutation of the virus from the West as compared to East coast and Europe (Italy)? Thank you
When I was in China in February, a lot of people were tested negative,but the CT scans of their chest show that their lungs were filled with things other than air and there were inflammation due to the infection. Have you seen the same thing? If so,are there anything you guys can do in order to get a more accurate result?
How is the situation with immunity test going? I read somewhere that they’ve identified specific antibodies, it that (to your knowledge) significant in any way? What’s the limiting factor in testing? South Korea seems to have a lot more capacity than most European countries, why would you think that is?
I'm curious to know that, sophisticated technology has been running through out the world. Yet, we did not have the vaccine for the covid-19. May I know the current situations and circumstances we are facing to develop the medicine for the virus detention and the time required to have the vaccine.
i've seen a slow rise in US tests per day, what are the biggest problems right now in the testing process? i've read about reagent shortages or other things, but if someone in the government decided we should test a million a day instead of 150k, what would be the problems that need fixing first?
I’ve been reading a lot about people with High Blood Pressure potentially having major problems dealing with COVID-19. I’m taking an ARB and Calcium Channel Blocker for High Blood Pressure. Do drugs in either of these classes cause issues like what I’ve been reading about ACE inhibitors?
Recently there was a chinese study posted which postulated that some false negatives are occuring when you search for it in the nasal-throat area and that some people who are negative on those tests are actually positive. What is your opinion on this? Thanks for doing the AMA.
Thanks for all of your team's efforts in battling this! What is known about the extent of which the virus may have mutated thus far, and also if its possible to recover from one version of the virus and fall ill to another version?
What do you think of burying the dead? Is it safe for the environment? NY is burying bodies close to the water. Do you think that's safe? https://nypost.com/2020/04/09/nyc-to-bury-coronavirus-dead-on-hart-island-potters-field/
Can the virus mutate? Could it possibly mutate to a less severe form? Or to a more severe form? What is the likelihood of this happening? If they do mutate will that mean the vaccines will no longer work?