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From: Zack Mansdorf <mansdorfz**At_Symbol_Here**BELLSOUTH.NET>
Subject: Re: [DCHAS-L] [EXTERNAL] Re: [DCHAS-L] Ask Dr. Safety: Recovery and Contingency - A Virtual Symposium Wednesday Evening April 15th
Date: Apr 15, 2020 15:04 UTC
Reply-To:
ACS Division of Chemical Health and Safety
Risking life and limb, I will once more go into the breech.
There has been a tremendous emphasis on testing and some very hopeful developments (e.g., the salvia test). Many have pointed out that while we have done more tests than anybody else, but we have not done more on a per capita basis. This is in part due to our regulatory system where whatever testing we do must be reliable and accurate (while not so much in some other countries). There is some indication this (false negative) may have led to what some are calling reinfections.
Dr. Hall can weigh in, but the normal course is to test symptomatic persons. We will never be in a position to test everyone (320 million) and unless you need it and are very sick or becoming very sick, it does not change anything for those with mild symptoms. More importantly, what does a negative test do. I could test negative on Tuesday and become infected on Wednesday and then infect others the following week. Are we suggesting daily testing?
Persons who are symptomatic or thought to have the disease definitely should be absolutely tested.
I think our ultimate salivation will be a combination of smart public health and the immuno-assay.
Stay safe and well
Zack
From: ACS Division of Chemical Health and Safety <DCHAS-L**At_Symbol_Here**PRINCETON.EDU> On Behalf Of Alan Hall
Sent: Wednesday, April 15, 2020 10:01 AM
To: DCHAS-L**At_Symbol_Here**PRINCETON.EDU
Subject: Re: [DCHAS-L] [EXTERNAL] Re: [DCHAS-L] Ask Dr. Safety: Recovery and Contingency - A Virtual Symposium Wednesday Evening April 15th
Et al,
What I have yet to see so far are the positive and negative predictive values for any available tests. I'm doing a literature search on this issue today, but limited internet bandwidth at least where I live is seriously hampering this effort. There is also the emerging issue of re-infection which certainly has implications for return-to-work status.
If I come up with anything relevant, I'll share it with the group.
Alan
Alan H. Hall, MD
Medical Toxicologist
On Wed, Apr 15, 2020 at 7:15 AM Stefanie Gangano <stefanie.gangano**At_Symbol_Here**gmail.com> wrote:
Saying we have "tested more people in this country than any other country" is not helpful. The truth is, we have tested less than 1% of our population. We cannot expect people to go back to work, school, socializing, etc, until we know who is a carrier and potential infector versus who isn't.
The temperature screening will catch the really low-hanging fruit of those who are actively sick and showing fever symptoms. It will not catch anyone who is shedding virus before or after having symptoms, or shedding without showing any symptoms at all. I just saw a case today of a woman who was "presumptive COVID-19 positive" (because she couldn't get a test while showing symptoms), who tested positive for COVID-19 4 weeks post-symptoms!
This virus is not behaving according to other viruses we have dealt with. And all the information is not even known yet. We must remain super-vigilant in using all the protective gear we can when dealing with other people.
Stefanie Gangano
From: Frazier, Alicia S
Sent: Tuesday, April 14, 2020 3:05 PM
To: DCHAS-L**At_Symbol_Here**princeton.edu
Subject: Re: [DCHAS-L] [EXTERNAL] Re: [DCHAS-L] Ask Dr. Safety: Recovery and Contingency - A Virtual Symposium Wednesday Evening April 15th
Some people can not realize that they have a low grade temp because they don't feel cruddy until later, if at all. They may just think that they are tired, stressed or generally run down. In fact some of those folks that classified as asymptomatic, might be better classified as mildly symptomatic.
Have you considered having the person use the thermometer while the screening person is maintaining the 6 ft distance? The screening person could then come and read the thermometer after the incoming person sets it down. In that case all that would need to be done is the screening person would need gloves and appropriate disinfectant wipes to clean the thermometers and other touched surfaces. If that would logistically work?
Alicia Frazier
From: ACS Division of Chemical Health and Safety <DCHAS-L**At_Symbol_Here**PRINCETON.EDU> On Behalf Of Zack Mansdorf
Sent: Friday, April 10, 2020 3:26 PM
To: DCHAS-L**At_Symbol_Here**PRINCETON.EDU
Subject: [EXTERNAL] Re: [DCHAS-L] Ask Dr. Safety: Recovery and Contingency - A Virtual Symposium Wednesday Evening April 15th
Monna:
First, we actually have tested more people than any other country in the world. Some of the testing in some countries (such as China) had poor reliability. Antibodies normally indicate that you are over the infection if you are walking around versus being treated and I am not aware of any test for "shedding". Tests for having the infection would not make sense if you have no symptoms (it is not practical to test 320 million people). Having a negative test on Tuesday, means you do not have the virus on Tuesday. Maybe you get it Wednesday.
Zack
From: ACS Division of Chemical Health and Safety <DCHAS-L**At_Symbol_Here**PRINCETON.EDU> On Behalf Of Monona Rossol
Sent: Friday, April 10, 2020 2:38 PM
To: DCHAS-L**At_Symbol_Here**PRINCETON.EDU
Subject: Re: [DCHAS-L] Ask Dr. Safety: Recovery and Contingency - A Virtual Symposium Wednesday Evening April 15th
Gee, how about we test people? There are tests for shedding, tests for anitbodies (doesn't mean you still aren't shedding) and tests for just plain having the virus. We see a lot more testing in other countries. You can't fix what you can't track. Monona
-----Original Message-----
To: DCHAS-L**At_Symbol_Here**PRINCETON.EDU
Sent: Fri, Apr 10, 2020 11:33 am
Subject: Re: [DCHAS-L] Ask Dr. Safety: Recovery and Contingency - A Virtual Symposium Wednesday Evening April 15thWhile it is true that perhaps as much as 50% or those infected are asymptomatic, what else can be done as a screen in the absence of a readily available quick turn-around test for the virus or antibodies?
Temperature screening was more effective with SARS-1 since it looked like the asymptomatic were not infectious.
At least a temperature screen will identify _some_ of those infected. These days, the perfect cannot be the enemy of the "sort-of OK."
Peter Zavon, CIH
Penfield, NY
PZAVON**At_Symbol_Here**Rochester.rr.com
From: ACS Division of Chemical Health and Safety <DCHAS-L**At_Symbol_Here**PRINCETON.EDU> On Behalf Of Monona Rossol
Sent: Thursday, April 9, 2020 10:04 PM
To: DCHAS-L**At_Symbol_Here**PRINCETON.EDU
Subject: Re: [DCHAS-L] Ask Dr. Safety: Recovery and Contingency - A Virtual Symposium Wednesday Evening April 15th