Dentists; Diabetes; Sensitivity of COVID-19 Antibody Tests (Lecture 72)
Welcome to another MedCram Covid-19 update. I wanted to take a look at India. We’ve got definitely rising total cases, and that’s because the number of daily new cases is also increasing. It also looks as though the daily new deaths in India are increasing. But despite that, the death rate is remaining relatively low and the recovery rate is relatively high.
If you look at the list of nations here where we have the United States at the top of this list at least in terms of total cases, we can see the total deaths per million population listed at 252. For India, we’re looking at around two deaths per million population. And even though India has more than three times the amount of people in this country, over a billion, the number of total tests is a fraction and the number of total tests that have been done in the United States. So it’s really unclear exactly what to make of those numbers.
Again, let’s look at Australia with the number of daily new cases, still very low. And this is important because Australia is headed into the winter season, and so we’ll see whether or not coronavirus makes a resurgence during that time.
Things have started to open up very slowly in the United States. We can see here that the daily new cases in the United States overall is slowly drifting down and the daily deaths are also seemingly taking a similar course, but we have to remember that what we do today is not going to show up in these statistics for at least another week or two. So, let’s keep vigilant.
In Sweden, we see that the daily new cases are slowly drifting down. And the daily death seem to be taking a similar course as well.
There was an article recently in the Business Insider titled “Texas reported its highest single day increase in new COVID-19 cases as restaurants, salons and cinemas open to the public”. If you read down here, it’s unclear exactly whether or not this is related to opening up or just more testing. Abbott, the governor of Texas, expects the number of new cases to continue to see increases as the state plans to increase the amount of testing in the most high-risk areas: nursing homes, meat-packing plants, and jails. And specifically these large cases that popped up here have to do with these meat–packing facilities in the Amarillo region of the panhandle of Texas. So again, we have to watch and wait and be vigilant.
There’s been a lot of discussion about the sensitivity and specificity of the antibody tests. And we’ve talked about antibody test before. These are blood tests, either finger pricks or sample that is sent off for a blood test to see whether or not you have the antibody against SARS-CoV2. Well, here’s an article that was just published on April 29th in the journal of clinical virology that was comparing the four different commercially available serological assays for their sensitivity and their specificity.
And again, I have no relationship with any of these companies, but in this study, they took 75 sera from patients testing positive or negative by SARS-CoV2 PCR to find whether or not this was specific or sensitive and they found the different companies. There is one called Euroimmun from Germany. There’s Epitope diagnostics from the United States. There’s Mikrogen from Germany and also Viramed from Germany. And they found that the sensitivity was 86.4%, 100%, 86.4% and 77.3% respectively and they found a specificity of 96.2%, 88.7%, 100% and 100% respectively.
Now remember if you have a high sensitivity and the test comes out negative then you can practically rule it out. On the other hand, if you have a high specificity and the test comes back positive, then you can practically rule it in. And you can see that the second one listed, the one from the United States, the Epitope had a 100% sensitivity and that the two last ones, Mikrogen, and Viramed from Germany, had 100% specificity. I will put a link in the description below.
Here’s another interesting article that was published on May 13 in diabetes research and clinical practice. And basically what it’s looking at is something called a hemoglobin (HbA1c), which is a measure of glycosylated hemoglobin. What happens here is as the blood sugar in someone’s body is elevated for a long period of time sugar gets attached to the hemoglobin molecule. In a sense, it’s glycolated and this can be measured.
Now, normally this number should be down to around five or six in somebody who does not have diabetes, but in somebody who does have diabetes and they have it uncontrolled, this number could go up to as high as 10 11 12 and even higher in some patients. And so somebody with an elevated hemoglobin A1c may have more oxidative stress and may have worse diabetes in terms of control.
通常这个数字在没有糖尿病的人中应该降至五到六个左右，但是在患有糖尿病并且他们无法控制的人中，这个数字可能会上升到10 11 12甚至更高。一些病人。因此，血红蛋白A1c升高的人在控制方面可能具有更大的氧化应激，并且糖尿病可能会恶化。
What this study seems to indicate is that what we imagine might be associated with hemoglobin A1c is truly the case. In other words, as the hemoglobin A1c goes up, the saturation of that patient goes down, which is not a good thing, serum ferritin levels, which are an indication of inflammation C-reactive protein, which is a indication of inflammation as well as the ESR or the erythrocyte sedimentation rate and fibrinogen, IL-6. All these things go up and are worse.
And they are directly correlated with hemoglobin A1c. They also noticed that hypercoagulability is also associated with an elevated hemoglobin A1c. Not only that but the mortality rate in these patients with COVID-19 is associated with that as well. And so the conclusion that they came up with is that the hemoglobin A1c level after hospital admission is helpful in assessing inflammation hypercoagulability and prognosis of COVID-19 patients.
I also want to draw your attention to this article that was published in Market Watch, regarding if you need to see a dentist and what happens if you are a dentist and you want to open up, what do you need to do to make sure that you’re complying with all the laws?
Well, this is a great article to take a look at because it goes through exactly what the issues are. The ADA is looking to the CDC for advice on exactly what needs to be done. And as of the printing of this article there really is not much from the CDC in terms of dentistry or dental visits.
For instance here, it says although dentist in 31 states are allowed to reopen and perform elective procedures, the CDC recommends dentists only provide emergency services. As it stands, the agency does not have any published protocol on how to safely offer non-emergency services. But even for emergency services the CDC says, “that if a surgical mask and a full face shield are not available, do not perform any emergency dental care. Refer the patient to a clinician who has the appropriate PPE.“
Of course, this is really important for a lot of dentist because they don’t want to have even one patient get COVID-19 from them. And that’s understandable, especially when you look at the history of HIV and how it was spread potentially back in 1993, when there was a New York Times article on this topic. And according to the story during the AIDS crisis, dentists were seen by some people as a mechanism for transmitting the deadly disease. We certainly don’t want a repeat of that.
Now because of this vacuum in terms of the American Dental Association and the CDC, a lot of dentists have been relying on groups composed of, for instance, New York city-based periodontists, oral surgeons and general dentists like the one here in the story because they need information on what they need to do to open up their dental office.
And as the article says there’s a number of people who are employed by dental offices and they are being furloughed or no longer employed and says here that the number of Americans working in dental offices has plunged by more than 53 percent since February.
And so there’s less patients coming in the dentist have to pay more money for the PPE that is going to keep them in business and keep their patients safe. And all at the same time, there’s going to be more and more patients that aren’t going to seek dental care. And as they say here in the article, “that’s the last thing I want to see,” he said. “They could easily cause an oral health crisis if everyone stops seeing their dentists.”
The mouth and the teeth are not detached from the body and when the teeth become inflamed, this leads to a number of problems. It can increase the risk of pneumonia and as we’ve already talked about oxidative stress is the result of infections and things of that nature. Coronary disease is connected with periodontal disease as well. So you can’t have good medical health unless you have good dental health as well.
And I believe a problem that we have in this country is that dentistry is seen as a luxury. I mean it’s carved out. There’s a different dental insurance plan. And it seems as though that decision makers feel that it’s not essential to have good dental health and while I know that the CDC have a lot of things on their hands, I really do hope that they come up with recommendations fairly quickly that they can give to the American Dental Association to get dental offices back open because if we wait for everyone have a toothache we’re waiting way too long. Thanks for joining us.
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