COVID-19

Joseph P. Crawford M.D., F.A.C.S

Video Transcript

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Good afternoon. My name is Dr. Joseph Crawford with Advanced Urology. I'm here today as a husband and a father of two as well as a member of the Treasure Coast community to talk about the COVID pandemic here in the Treasure Coast. I'd like to start with a couple questions. Do you feel safe? Do you feel safe for yourself and your family? Is it safe to socialize? Is it safe for businesses to return to their normal activities? Will it be safe for your children or grandchildren to return to school and participate in group events? We may disagree about the details of the pandemic. But we won't disagree that if we don't know the extent of the disease, we can't have a plan forward to emerge and reengage. Specifically we need to know where this infection is in our community. Who's had it, who's been an asymptomatic carrier, who's recovered and may have immunity. We don't know these things. Without testing, we won't know these things. In other words, we don't know what we don't know, the current serum antibody tests are not perfect, but they're very, very accurate. They have a high degree of sensitivity as well as knowing specifically that is the COVID virus that we're testing for. For a simple blood test that takes eight to 10 minutes, and it's covered by insurance. I think the benefits are obvious. So what are my recommendations for my family, my friends and for the community at large. First, make sure you're using good personal protection equipment, social distancing, and most importantly, your common sense. If someone's ill make sure that they're isolated, and away from others. If their condition worsens, seek medical advice early rather than late. Two, if you're in a high risk group, first responders help care workers personnel that work in facilities that have confined populations of patients or human population, make sure you have the serum antibody test to know if you've been exposed as well as if what you've been doing has protected you. Thirdly, make sure you avail yourself of the best information. Usually that comes from the CDC, the Centers for Disease Control, they give almost daily updates of what we know about the virus, what we know about the infections where it's spreading, and what are the best recommendations for care. I want to thank you for listening and I'll be talking to you next week when we explore the new information that's available as it develops.

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Video Transcript

Good afternoon. This is Dr. Joseph Crawford again with Advanced Urology Associates talking about our COVID pandemic. This is number two in our series of public service announcements. And I encourage you to listen to our previous service announcement about the overview of the pandemic. Today, we're going to talk about something that I think is vitally important in order to get us to safely reengage. That is, why do we do antibody testing, and why do I think it's so important for the general population? As you know, there's been a resurgence of COVID infection in Florida up to 8000 cases a day we've had people that have been tested previously that were negative and because of increasing social interaction, now have been exposed to someone who was positive and now have to worry about whether it's going to be safe for them and their families to go to work socially re engage. So why do we do antibody testing? Well, antibody testing gives us a view of previous infections. If you've been exposed, has your social distancing, your PPE's been effective, or have you been exposed either because you've become ill, or because you are a carrier of the virus and are asymptomatic. Secondly, it gives us a very good idea in terms of our high risk population, where the individuals are in confined spaces, nursing homes, ACLFs, even in our presence, those individuals are at higher risk. Thirdly, those individuals that work in those environments certainly have a higher risk and we need to know are they safe, have they been exposed? Next, we really need to know about: are you protected? We can't tell about individual protection with antibodies. But certainly, if you develop antibodies, we need to know it because that may provide an indication of future protection against the second wave. We know that people who've had the disease, up to 4% of those individuals have had COVID infection, will get it again. We also need to know about immunity in terms of vaccines. Are we going to have a vaccine? Will these antibodies that we develop, are they going to be beneficial? Are they going to be neutralizing antibodies that can neutralize the infection? We also need to know about contact tracing. Antibodies let us know where people have been exposed, who we need to contact to make sure that the people they've been in contact are safe, and gives us a roadmap of where the disease is in our community. We've all heard the word herd immunity. We need to know how much or what percentage of our population in our community has been exposed. We know that several weeks ago, it was a three or 4%. Before herd immunity takes effect in our area it has to be 50-55% so we really need a snapshot of where we are with the pandemic. Is it going to be safe for us to reengage in the community? Is it going to be safe for our children to go back to school? If we don't look at our administrators, our staff and our teachers, we're not going to be able to say those schools are safe. The American Pediatric Association that says it's vitally important that in the Fall, that we have students in school in the facilities. Well, we need to make sure that not only the teachers, staff and administrators are safe, but we need to make sure that the students are safe. I think antibody testing fits these rules very critically. Finally, antibody testing will also give us an idea of those individuals that have been exposed to the disease and may develop significant antibody titers or amounts of antibody present, that they can donate their plasma and be plasma donors. This can be life saving for those individuals with COVID-19 that are hospitalized with significant respiratory difficulties or are on ventilators. So I think it's obvious that we need to have a strategy to test for antibodies in the high risk patients down to the general population that want to reengage in both work as well as school. I hope this has provided an insight in terms of why antibody testing is so important and why. At Advanced Urology, we're actively engaged in testing our first responders, those who work in nursing homes and ACLFs healthcare workers, as well as our elderly. I look forward to talking to you next week, on another subject with COVID-19

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Video Transcript

Good afternoon. I'm Dr. Joseph Crawford with Advanced Urology and like to continue another segment on the COVID-19 pandemic. Today I'd like to talk about the big picture. Right now we know that if we don't practice the key steps to be able to wear a mask, use social distancing, test for the antibodies, as well as use isolation for those who've had the virus or may spread the virus, we will have difficulties with more shutdowns, reinfections, and even deaths. it'll be very difficult to control this wildfire known as the COVID-19 pandemic. Why is this important? Well, because up to 4% of individuals will have a recurrent infection. Up to 20% of individuals will have chronic debility and diseases associated with the virus such as asthma, cardiac difficulties, and chronic pulmonary difficulties. These problems can be lifelong and have serious implications for those individuals so affected. This mask, distancing, testing and isolation plan answers many key questions that we need to know if we're going to be able to emerge successfully from this infection. Who has it? How do they get it? What can we do to help treat, control, and prevent the virus? When can we reengage? these answers can only be obtained by a plan that helps us ride this wave, rather than get pummeled by a second wave and it's mutations. In this war against the virus I ask you to be use your best efforts to use a mask when you're not at home. Make sure that you use social distancing and PPE, go ahead and get the antibody test to see if you've been exposed and what your protection might be. And finally, isolate those who are ill or have come in contact with those who've had COVID or you suspect may have had COVID. I want to thank you for listening today. And I look forward to talking to you next week about another aspect of the COVID-19 infections.

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Video Transcript

Good afternoon. I'm Dr. Joseph Crawford with Advanced Urology and today we're going to continue our series on the COVID pandemic. Where are we? Where are we going to go? What I like to call the crystal ball view of the COVID pandemic in Florida. If you listen to different radio stations, TV stations, or even look at the news, where the governor of Georgia is suing the mayor of Atlanta, over wearing masks, you know that there is a variety of different opinions about how should we emerge? How can we restart our educational and our economic systems? We need a path forward. Well, as you've heard in the past, I strongly believe in antibody testing, not that it tells us about an individual and their COVID safety, but rather, it gives us an idea about the COVID exposure, about the safety of groups of people. Whether they are naive or unexposed to the COVID virus, and if it's safe for them as a group to get together and restart our educational system, that means testing our administrators, our staff and our teachers. And if they're negative, we know they haven't been exposed to the COVID virus. If they're positive, certainly we can test them for the virus on two separate tests. If they're negative on both subsequent tests, we know they were exposed to the COVID virus, but they don't have the virus itself. They're over that and they probably have antibodies. If we test our staff, our teachers, as well as our administrators, we know that the environment is safe. If we test our students using a sputum test for antigen or virus, we know that they are safe. Well if the students are safe and we know their environment and the teachers, staff and administrators are safe, we know we can restart our educational system with a minimum of risk. And that's what this is all about. Looking at risk, no tests, no pathway is going to be perfect. But if we can make it as safe for our educational system, as well as our economic system to restart, then we've got a chance to raise ourselves out of this catastrophe that has been the COVID infection. If by example, we use the educational system and it works, then why not extend that to the gyms, the bars, the restaurants, or even the football stadiums to look at where we stand and making sure that those individuals who that attend those events or participate in those activities are safe. I think this is our best way to reemerge from this COVID virus and the pandemic. Other countries around the United States are doing so and I think we need to take the steps to reinvigorate our educational and our economic system so we can get back to normal way of life. I want to thank you for listening and I look forward to speaking to you next week with regards to other issues on the COVID pandemic.

It has become obvious that the Country as well as our County needs to step forward out of the shadows of the unknown and restart our lives safely. Our mission is to provide information and reassurance to the Treasure Coast community through the provision of Covid-19 antibody testing as necessary. The purpose of this presentation is to provide some of the basic background information that you will need to understand the importance of the pandemic and our response.

What is COVID-19?

COVID-19 is a highly contagious virus that invades the cells of an individual’s respiratory tract.
Multiple organ injury may result due to an individual's specific body response to COVID-19.
Symptoms of infection range from asymptomatic to severe and life-threatening
- Why? Symptoms are based on your body’s reaction to the virus, as well as your body’s ability to trigger an overwhelming defense response.
How is COVID-19 contracted?
- Physical contact with your hands and face after encountering the virus
- Being in close proximity with an individual that has been infected with the virus
- Bodily fluids, such as respiratory and nasal secretions
Because COVID-19 may be contracted in various ways, using personal protective equipment (i.e. masks and gloves) and practicing social distancing will reduce your chance of contracting the virus.

What We Currently Know About COVID-19

COVID-19 is known as a “novel” virus which means we have not seen a disease like this before.
- Currently, COVID-19 is being thoroughly studied so its weaknesses can be understood, and effective treatments can be developed.
COVID-19 can be present and go undetected in our community far earlier than other common viruses.
- Because COVID-19 affects individuals differently, many may contract the virus but not experience any symptoms at all.
- Individuals in our community that have contracted the virus without experiencing symptoms are known as asymptomatic carriers.
Asymptomatic carriers can spread the virus without knowing which increases the chance of infection, among others.
It is expected that up to 20% of those who have been infected with COVID-19 will have subsequent respiratory diseases.

COVID-19 Definitions: COVID-19 Actively Ill: Those who are Infected with the virus and have symptoms. Asymptomatic Carriers: Those who have been infected with the virus and can transmit the virus, but have no symptoms. Presumptive Immunity: Those who have been exposed to the virus and are not infectious but have developed protective antibodies against the virus. COVID-19 Naïve: Those who have never been exposed to the virus, have no protective antibodies and can be subsequently infected in the future.

Why Our Lab

The Rationale for Utilizing the Laboratory at AUAF for COVID-19 Testing

This antibody test helps identify those individuals who have had a COVID-19 infection as well as those who may have been exposed to the virus and became an asymptomatic carrier.
This serology evaluation determines individual immunity and identifies those who can safely reengage in social and work activities.
We need to determine the safety of our community especially those in confined-population facilities who were at an increased risk such as nursing homes, adult care facilities, prison and jail populations together with their correctional staff. This will give our first-line responders the confidence to continue their vital work and by extension, the community will have reassurance that it is safe to reengage at an appropriate time.
We can begin to define the future social and medical strategies that would be appropriate for our community. We expect up to 20% of those who have been COVID-19 infections to have subsequent respiratory diseases. This has broad implications for the overall health and safety of our community.
Using serology results for the COVID-19, we can concentrate our contact-tracing of infection in our community and determine who are asymptomatic carriers.
This test gives us the ability to identify convalescent plasma donors. This may be lifesaving for those who have severe COVID-19 infections or re infections.
Our COVID-19 antibody evaluation will provide information on the efficacy of future vaccines and their ability to produce protective neutralizing antibodies.

Why Our Lab

It has become obvious that the country, as well as our county, needs to step forward out of the shadows of the unknown and restart our lives safely. Our initiative is to provide information and reassurance to the Treasure Coast community through provision of COVID-19 antibody testing to anyone seeking testing. Advanced Urology Associates of Florida (AUAF)’s clinical laboratory is certified by federal (Clinical Laboratory Improvements Act (CLIA)) standards as a laboratory authorized to perform COVID-19 antibody testing, as well as COVID-19 “High complexity” nucleic acid (RNA) testing using state of the art PCR technology to identify current infectious status.

Centers for Disease Control (CDC) guidance has recommended that COVID-19 testing priority should be given to our first responders, including police and sheriffs’ departments, emergency transport/fire rescue, as well as our providers of healthcare services. By the very nature of their work our healthcare service workers and other first responder personnel are on the front line, and the performance of their duties may bring repeated and often prolonged exposure to those who are currently infectious. For the safety and peace of mind of all individuals, their families, co-workers, patrons, and the members of the public they serve, determination of antibody presence is valuable information to each of us. Antibody testing (and, where appropriate, determination of current infectious status) can provide valuable information to all of us as our local community and the nation attempts to restart and move forward with our lives. COVID-19 testing, in addition to practices of good health and hygiene, social distancing, and use of personal protective equipment will be among those tools that are recommended “best practices” for the foreseeable future, and likely until such time as an effective vaccine and broad-based vaccination program can reduce and better control the risks of COVID-19 infection. AUAF and its clinical laboratory will soon offer COVID-19 antibody and current infectious status testing to anyone seeking testing.

We as a community need reassurance regarding when and how it is safe to re-emerge, re-engage, and re-energize our lives and the life of our community. While we do not have all the answers, and where we are not likely to have an effective vaccination program soon, serology (blood) antibody testing (and current infectious status testing, as appropriate) will give each us a better idea of our own exposure and risk to others, who might be at lower risk of relapse or future infection, and the general prevalence of the virus or its antibodies in our community. This information will be vital to how and when we safely emerge from the pandemic locally, and will give all of us, including our first responders, vital re-assurance as we resume our respective missions during these challenging times.

Why are we so concerned about Isolating COVID-19?

We still have many unanswered questions regarding COVID-19, such as:
- Where did the virus start?
- Why did this virus start?
- What makes up COVID-19 that is different from other coronaviruses?
- What makes some of our older and younger patients more susceptible to the severe forms of the virus?
Currently, we do not have a definitive cure or “magic bullet” for COVID-19.
- Effective therapies for the infection are available.
While vaccine development is a major collaborative effort, involving academic, pharmacologic and research institutions, wide-spread availability of a safe and effective vaccine against this specific virus is months, if not longer, away.
So, what should we do while more research is being completed?
- Follow the Safety Task Forces recommendations (i.e. practice social distancing, using PPE, handwashing, etc.).
- Complete COVID-19 Antibody Testing to determine if individuals diagnosed with COVID-19 have developed antibodies, as well as identify those that have been exposed to the virus and became asymptomatic carriers.
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What is Antibody and Virus Testing?

COVID-19 Antibody Testing is used to determine if individuals diagnosed with COVID-19 have developed antibodies, as well as identify those that have been exposed to the virus and became asymptomatic carriers.
Nasal swab, sputum sample, or a saliva sample that tests for the COVID-19 virus DNA “RT-PCR”, The virus in those who have had symptoms of COVID-19 or have been in direct contact with COVID-19 infected patients.

Why is it important to test for COVID-19 Antibodies?

Those who have been diagnosed and recovered from the virus need to test for the presence of COVID-19 antibodies which will help determine their level of antibodies present in their body and protective status.
Goals of Antibody Testing
- To determine potential individual immunity to COVID-19
- To concentrate our contact-tracing of infection in our community and determine who are asymptomatic carriers
- To define future and social medical strategies that would be appropriate for our community
- To provide information of the efficacy of future vaccines and their ability to produce protective neutralizing antibodies
- To identify convalescent plasma donors
  - Plasma donations are essential as they may be lifesaving for those who have had severe COVID-19 infections or reinfections
- To determine the safety of our community, especially high risk first responders and confined population facilities (i.e. adult care facilities and jails/prisons including correctional staff)
- To identify those who can safely return to social and work activities

How will Antibody Testing work in our Community?

First, we will begin with the First Responders (Police, Sheriff, Corrections personnel, Fire/Rescue and Health Care workers).
- By the very nature of their work, these groups are on the front line and the performance of their duties may bring them in repeated and often prolonged exposure to those infected with or carrying the virus.
Second, we will test those who are at increased risk with other illnesses, age or the nature of their habitation.
Third, we will test those who anticipate close contact with others, based on their activities of daily living or anticipated future social, educational or community events.
Fourth, we will test the general population to evaluate the prevalence of the virus and the effectiveness of our instituted treatment and preventive measures.