COVID-19 Update from Dr. Smith: 5/07/20

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,

As if employing a device from a cheesy screenplay, yesterday I dropped back and threw an interception, straight into the hands of countless readers who gently pointed out the 10-fold, decimal-point error in my incidence calculation. Not only is that far outside anything I could excuse under the heading of my “crude approximations,” it destroys the only semi-quantitative piece of my argument by implying there might be a 10-fold higher risk inside than outside. Even so, I stand by my more visceral concern that comparing the complexity and expense of mitigation to the density of data supporting it might be another 10-fold disparity. Fear >> Fact ⟹ superstition. Fortunately, all my questions were answered this morning when I heard on NPR “We know how to determine when it’s safe to reopen. It’s testing.” Without the slightly more nuanced discussion that followed, that comment would qualify as fake news. I would almost feel better if my calculation error wasn’t too pathetically inept to qualify as fake news. Exercising guile in defense of a lie is much more stimulating than admitting stupidity.
Speaking of testing, this is a good time to remind everyone in the Department that testing is much more easily available than previously, and CU/NYP are highly motivated to test all employees. There are two major pathways. I still encourage everyone to consider enrolling in the ARMOR trial if eligible. Or, contact WHS and testing will be arranged. To avoid reusing NPR’s lipstick I’ll also remind everyone that “testing” is not one thing. If you’re concerned about having Covid-19 infection, with or without symptoms, you want the PCR assay for viral nucleic acid, which is highly sensitive and specific. To determine whether you’ve had Covid-19 infection, with or without symptoms, you need an ELISA serologic assay for antibody. Antibody detection is less sensitive and specific than PCR for virus, especially with methods other than ELISA, and it won’t detect antibody for at least two weeks after infection. Whatever your results, prepare to feel a little disappointed in the clarity it brings to your life. There is still so much we don’t know. Particularly if you’re part of the ARMOR study, however, you will be contributing greatly to filling in the gaping voids in our knowledge. We were so confident, once upon a time! Back in March, while we were surging at a terrifying pace, a pulmonologist at a major center in Los Angeles informed the press “The majority of people, it’s not rocket science. They have a single organ failure—their lungs…we manage the lungs until the lungs hopefully calm down. That’s it. It’s pretty much supportive.” Ah, to be young and in love.

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

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