COVID-19 Update from Dr. Smith: 4/18/20

Each day during the COVID-19 crisis, Dr. Craig Smith, Chair of the Department of Surgery, sends an update to faculty and staff about pandemic response and priorities. Stay up to date with us.

Dear Colleagues,

I will begin by amplifying an important announcement you should have received yesterday from NYP.  Serologic testing for antibody to the SARS-CoV-2 virus is now available for health care personnel.  Those eligible have been symptom-free more than 14 days after a confirmed infection, or after a “COVID-19-like illness,” and “were cleared to return to work” by WHS.  The statement implies that only those who contacted WHS and were excused from work are eligible.  Since a request for serologic testing can only be granted after a screening call to WHS, all eligibility ambiguities should be resolved in the WHS screening process.  Even if you’re not certain about your eligibility, call them.  While this sounds frustratingly narrow in scope, I assure you that NYP hopes to screen all health care workers as soon as possible.  I believe it’s worth waiting for the NYP ELISA assay to be expanded in scope.  It is ~99% specific and >80% sensitive 3-4 weeks after infection, significantly superior to the widely hyped quickie assays that are much less accurate and potentially misleading.

Unless you’ve been without power and internet, and don’t read, you will have heard about the serologic-testing study done by Stanford University investigators on 3300 people in Santa Clara County over April 3-4.  They concluded that there were 50 to 85-fold (!!) more cases in the County than had been detected by other diagnostic means (~1000 cases).  Please note that this manuscript is still undergoing peer review.  If even half-true, at the simplest level, this would greatly decrease the case fatality rate by greatly increasing the denominator.  It also implies an enormous pool of asymptomatic infections, which has very important implications for the level of herd immunity we may have already achieved.  The greater our herd immunity, the less we need to worry about epidemic surges after relaxation of mitigating measures.  That reassurance is qualified by how little we know about the immune response, particularly what level of protection coronavirus seropositivity conveys.  Nonetheless, this is potentially great news for reopening, which explains all the attention.

Formal planning for reopening CUIMC and the entire NYP system is moving fast.  I participated in a CU planning meeting yesterday, and another with NYP this morning.  The next round begins Monday morning and will intensify daily.  There will be bureaucracy to deal with, but the energy and motivation for achieving the larger goals is exceptionally high, which will help clear obstacles.  In contrast, preparing for the surge felt more like cleaning out the house of a recently deceased relative.  Something that must be done, there is some sense of achievement in all the empty rooms, but there is no joy in it.  We did all that, we staggered but didn’t fall, and what’s ahead is unarguably better than what’s behind.  My cardiothoracic surgery faculty have been working on a detailed outline for the path ahead, exchanging hundreds of emails over a few days.  One said, as an aside, “I can’t wait to touch heart.”  An innocent noun typo, and I know what he meant.  What all of you have done to reach this place on the path home has already touched mine.

Craig R. Smith, MD
Chair, Department of Surgery
Surgeon-in-Chief, NYP/CUIMC

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