Why is there so much fuss about testing? What does it mean for our battle against COVID-19? What do the most commonly used Covid-19 tests reveal to us?

Notice: For important concepts related to Covid-19 disease and immunology please scroll down to the following heading: “Had We Known What We Know Now About Social Distancing…”

Read form the beginning, if you are interested in the history of medical board, licensure and college admission test preparation.

Beneatha: They talk so much about “test” these days. I wake up, I hear the word “test”, I dream “test” all night long (click) , and I wake up with the test ringing in my ears! Dr. E you’re Dr. Testbuster, aren’t you? You’re the one and the only Dr. Testbuster! Can’t you do something about it? The entire globe will owe you much if you do!

Dr. E: Your nightmare about the test is correct! I’m wondering if you might have been dreaming about the USMLE test though! Irrespective, I would love nothing more than seeing eradication of the USMLE and COMLEX exams for American medical students and COVID-19 virus for the humanity! Also, remember that I am specialized in busting the medical board tests and not the COVID’s! But wait a minute—maybe you say this because you believe that I’m the master of busting upcoming COVID-related questions on the USMLE and COMLEX exams!

Beneatha: Actually, I did!

Dr. E: Did I ever tell you that you are my most favorite protégée? Well, aren’t you happy hearing it firsthand from me!

Beneatha: You’ve always been like a godfather to me!

Lifelong Dr. E’s War Against Tests!

Dr. E: Are you ready for a confession? I know you love confessions! There is a history behind the “Testbuster”! When I started all this back in early 80’s, I was in the favor of busting the National medical boards exams altogether! Back then, I erroneously thought that by helping everyone to ace their exams, I could do it. It didn’t work that way–actually, my pioneering role placed the NBOME and NBME exams at the core of a rapidly growing industry that I never truly meant it to be that way. I must also confess that somewhere along the way I, myself, also got carried away, and forgot my original mission. Well, as they say, to err is human, but not learning from it, is stupidity.  I have an announcement to make for the entire medical board prep industry: “I let this beast out unintendedly, it plagued the whole world like COVID did”–I promise you that I will do my best to terminate or tame it myself!

Interestingly, and for the record; my original belief of helping everyone pass their medical board exams, as means for eliminating the board exams altogether materialized only for two exams. Would you like to hear about them? I tell you; they were not COMLEX and USMLE!

Beneatha: OMG Dr. E, I am all ears!

Eradication of an Agonizing Test!

Dr. E: Back in late 1980’s and early 1990’s I was approached by employees of the State of Michigan who were panicking about an agonizing civil service exam named “In-basket Mid-management”. At the time no state employee could have been allowed to get promotion to higher mid-management positions unless she or he had passed the exam. Well, I spent a countless number of hours in training myself and developing the first of its kind review book and curriculum together. My course was named “In-basket Mid-Management Test Preparation”. The success rate of my first few classes and trainees were astounding. The rumor of my program shook the entire State of Michigan. Most State employees who were opting for higher management positions took my 1-day prep workshops in the years that followed. Next, I was approached by several employees who were opting for another exam, the “Executive Civil Service In-basket Management Exam”. Individuals who were passing that exam, as you can tell were opting for much higher positions in the state departments. Well, as you can guess I also developed and served a more limited number of state employees who were opting for executive positions in the state of Michigan. To make the story short, I was the only one who developed and taught in-basket management prep courses in the world. After all, at the time my course was the only one of its own kind! The participation and success rate of my workshops were so astounding that in late 1990’s the test was eradicated and no longer offered by the civil service department.

Revelation

Interestingly, a few years ago, I had a conversation in dry sauna with one of my athletic club acquaintances whom I knew for so many years but never gotten to know much about his whereabouts. While we’ve been sweating crazily, we talked about our life stories. As it turned out, he was a retired state employee who used to be one of the higher echelons in the civil service department. He was astounded to hear that I was the person behind the entire inbasket mid-management exam prep ordeal. Meanwhile, I was thrilled to hear that the state of Michigan stopped offering that exam, because my course nullified the value of it as an assessment tool for promoting state employees to mid-management positions. 

Beneatha: OMG Dr. E, you’re like the tip of an iceberg! It seems that I have so far only glimpsed at the last quarter century of your professional life! I know that you were planning to delve into the issues related to the COVID’s testing today, but would you please tell me a little about other test prep curricula that you’ve developed since 1984? 

Dr. E: If you don’t mind, I will make it quick and only name them for you now! Prior to the year 2000, in addition to the national medical board exams I developed and taught several college admission, graduate, and professional degree prep programs for the following exams: NCLEX, EIT, MCAT, DAT, GRE, GMAT, SAT, ACT and a few more!

Beneatha: Wow! I’m so happy to have you as my mentor!

***********

Had We Known What We Know Now About Social Distancing…

Dr. E: Beneatha, how is your fiancé doing these days?

Beneatha: Travis is doing greatly! These days he works from our study room. His workload has actually increased since he became home-bound because of the COVID-19. I guess for software engineers and computer programmers any place can be a workplace as long as they have their laptops and a good internet connection! Thanks for asking about him though!

Dr. E: If my memory serves me well, I think you said that in February he went to New York City for a convention related to robotics, smart cars, or something on those lines!

Beneatha: It was the Thirty-fourth Annual Conference of Association for the Advancement of Artificial Intelligence. The acronym for it is AAAI, and it was held from February 7-12, 2020, in Midtown, New York!

Dr. E: Such a lovely memory!

Beneatha: I wish I would have said “you’re right!” but I am looking at a beautiful retractable souvenir pen that he brought back from the conference… the dates are printed on it!

Dr. E: Well, the fact you immediately looked at the right place for the information shows that you are quick and smart! I was thinking about what you told me sometime earlier about the chemistry of conference attendees.

Beneatha: Yes, I remember quite well! Travis told me he was impressed by the unprecedented number of attendees from east Asian countries. Apparently, people from those countries like to heavily invest in artificial intelligence education!

Dr. E: Did Travis notice a high number of Chinese participants?

Beneatha:  Actually, he told me that they had their travel ban at the time of the conference and some of the Chinese scientists who had to give presentations during the conference did theirs on-line or via Webinar.

Dr. E: Did he notice a high participation from Taiwan, Japan, and South Korea?

Beneatha: I think he did! Also, the morning after he came back, and while I was drinking coffee, I skimmed through a few conference brochures and publications that he left on the kitchen table, I was impressed by the sheer number of participating speakers and scholars with East Asian sounding names.

Dr. E: You and Travis are both young with many more learning years ahead of you. However, I believe that even if you guys fall in love with the pursuit of knowledge, at a point in your life you may realize that certain experiences may no longer be attainable for you!

Beneatha:  It’s odd to hear it from someone with the lifelong zest for longevity!

Dr. E:  Well, you must be realistic about what you’ll be able to yet learn even if you conquer the art of healthy longevity.

Beneatha:  I feel you’re about to reveal something that you’ve realized you may not be able to learn much about!

Dr. E:  At times, I regret that despite my utmost desire for learning about various cultures, my insights into the East Asian world has never gotten beyond a rudimentary familiarity with martial arts, yoga, and mysticism. When I hear names of people who live anywhere in the northern hemisphere, I can roughly identify their ethnic and family origin, and I can assign them to certain defined geographical locations. When it comes to east Asians, I’m totally at loss!

Beneatha:  Even for generations like mine who came long after yours, the East Asian world has been an untapped world. I think they started learning about us, our sociopolitical system, and cultural characteristics a long time before we got to the point of acknowledging their worlds. However, for the past 10 years or so I feel that we have been learning about their world at a much higher pace.

Dr. E:  There is so much humanity around us, to appreciate it better, all we need to do is to see instead of just looking. It is extremely easy to play the blame game because of the Covid-19 and categorically unleash our anger against all east Asians. This is like the whole world categorically blaming me, you and all Americans for diabetes type II that results from obesity and imposed on us because of the greed of our powerful multinational food industry. In my opinion the right way to look at this is to know that people at the other end of our world, in east Asia, are suffering as much through this pandemic as we are here. Incidentally, what is the term that describes biased, discriminatory, and irrational acts against entire people in the East Asian countries?

Beneatha:  Do you mean xenophobia?

Dr. E:  Xenophobia is close, but it is not what I had in mind. I have a more descriptive term in mind. Xenophobia means dislike of or prejudice against people from other countries or races. The term that I have in mind is “Sinophobia”. It denotes biased, prejudicial, discriminatory, and at times violent acts against people of East Asian and Southeast Asian descent and appearance.

Beneatha:  I know that my generation is a lot more intolerant of racial and ethnic biases

Dr. E:  Well, we went so much in tangents that I almost forgot what I wanted to ask you and why we ended up here! 

Beneatha:  You were asking about the number of attendees from East Asian countries at Travis’s conference!

Dr. E:  Oh, I remember now, thanks! If I am not mistaken you recently told me that upon return from the conference, Travis came down with common cold symptoms!

Beneatha:  You are correct…oh, guess whose ears must have been ringing?

Dr. E:  Must be Travis!

Travis: Hello Dr. E!

Dr. E:  Hey Travis! I have been thinking about you lately! Do you have a few minutes to spare with us?

Travis: Love to, I’m on my lunch break!

It All Begins Like a Common Cold-Like Illness…

Dr. E:  I heard that you came down with common cold symptoms after you returned from your New York trip—I like to ask about your experience a little!

Travis: Love to help!

Dr. E:  Do you often come down with respiratory symptoms after air travelling?

Travis: Actually, I do! I can say this happens in 25 to 30% of all my air travels!

Dr. E:  I assume that it mostly happens after you return back home, correct?

Travis: How did you guess!

Dr. E:  Just an educated hunch based on my past experiences! I have my own physiological convictions for it…may be at a different occasion we can discuss it. Please tell me more about your experience!

Travis: I had to stay home for almost 10 to 11 days. Overall, it was like other common cold symptoms that I’ve always used to have in the past—fever, lack of energy, difficulty breathing, feeling of soreness in my throat and so on. The only striking thing was that it appeared to be a little more bothersome than most of similar illnesses that I’ve had in recent pasts.

Dr. E:  Beneatha! Did you also get it?

Beneatha: No, I didn’t! It was a little odd because every now and then when one of us gets common cold, the other one follows!

Travis: I’ve been worried that she may catch it, but she didn’t?

Dr. E:  I just don’t want to drag this out any longer–here is my concern: We now know that about 430,000 people have flown, non-stop from China to our country since China officially acknowledged the COVID-19’s outbreak on December 31. We now know that during January majority of these travelers flew to Los Angeles, San Francisco, New York, Chicago, Seattle, and Detroit. Also, certain reports suggest that thousands of these travelers have flown to US from Wuhan, the original epicenter of the COVID-19 epidemic. Here are my thoughts: What are the odds that you might have contracted COVID-19 and recovered from it? Also, what are the chances that Beneatha might have also contracted it but brushed it off or developed immunity against it?

Travis: Actually, Beneatha and I have talked about this issue!

Dr. E:  Here is an alarming piece of information for New Yorkers: What are the chances that many of the Chinese AAAI conference participants have flown to New York before January 30 and during the time that international airlines used to have their routine flights to and from China? After all this conference was a once-in-life-time opportunity for those Chinese scientists to visit US and mix their work and pleasure together. After all everybody loves New York (click please!)

Travis: Now that I think about it, what you say makes so much sense!

Dr. E:  Travis, how crowded was the conference center? Did you dine at any nearby Chinese restaurant?

Dr. E: Jampacked! I walked only once to a Chinese restaurant, a few blocks away from my hotel. It was so crowded that I decided to turn back to my hotel for dinner!

How Do I know If I Have Contracted and Recovered from Covid-19 Infection?

Beneatha: Now, that Travis and I both look healthy and free of symptoms, is there a way to figure out if we’ve contracted the COVID before and recovered from it or not?

Dr. E: You hit the nail on the head! That’s why we hear people talking so much about the “TEST”. The specific test that shows if either of you have been exposed or contracted COVID-19 is the serum antibody testing that as its names implies, needs a blood sample from you guys. Assuming that you had your blood drawn for antibody TESTING, what would you have liked your results to be; contracted and recovered from the COVID-19 or never exposed nor contracted the disease?

Beneatha: We’re thinking that we’d loved to have it and recovered from it, because it would have built our immunity against it! What’s alarming is the rumor that we’re going to have another outbreak in the Fall again.

Dr. E: Bravo! What you guys were wishing for is what I wish for anyone who is dear to me!

Beneatha: I must be unlucky because I didn’t get sick!

Dr. E: Wait-a-minute! What are the chances that you might have contracted COVID, but have had a very mild and practically unnoticeable bodily response to it? What are the chances that you might have contracted it but because of your mild symptoms you might have brushed it off as a mild allergy, fatigue, lack of energy, laziness, or depressed mood?

Beneatha: I have these symptoms almost every other day, LOL!

Travis: Me too!

Dr. E: Do you know what is the magic TEST result that should make you both ecstatic?

Travis: Um…Ig…positive IgM results!

Dr. E: Actually, positive IgG is something that you would have loved to have! Assuming that your symptoms have been due to COVID and not a viral cause of common cold such as rhinovirus or benign corona viruses, the only serological marker that proves you have already contracted and recovered from COVID-19, is a positive IgG antibody result!  

Travis: Why is it not possible for me to have positive IgM response?

Dr. E:  IgM in contrast to IgG has a short half-life. The…

Travis: Did you mean shelf life?

IgM, IgG, and Their Diagnostic Values

Dr. E:  No, I meant half-life! But it roughly means something like shelf life. IgM is the first antibody that our body produces. It stays in our blood only for a short time, and often at the time that IgG appears, it has either tapered off or is tapering off. The ideal time for identifying or catching IgM would be in the early days of infection, or soon after recovery from a mild COVID virus infections. Of course, as you can tell, neither of these scenarios are applicable to you. On the other hand, if both of you have positive IgG serologies, this shows that both of you must have contracted COVID and both have fully recovered from it. Of course, Travis, had apparent common cold-like symptoms for it, and Beneatha’s ailment must have been unnoticeable. Is this good news?

Beneatha: Yes!

Dr. E:  It is good news alright! As long as your overall health stays almost as it is now, high IgG titers indicate that you will be partially or fully immune against the next COVID virus attack. For some diseases, the IgGs that our body produces against them, stay practically in our blood forever and provide us with lifelong immunity. More importantly, if Beneatha becomes pregnant in the interim, those IgGs can be passed through her placenta and confer immunity in her womb, and for up to five to six months after your baby is born.

Beneatha: I’ve always wondered why we don’t get crazy about protecting our babies as much as we’re crazy for protecting ourselves against COVID.

Dr. E: You are correct! If you’ve had a disease and you’ve recovered from it, and if there are traces of IgG antibodies against them in your serum, you will pass along all of them to your baby. Theoretically, you must have antibodies in the form of IgG to a countess number of pathogens in your blood. This is the foundation of passive immunization that I’d rather leave discussion of that for another occasion. The only bothersome issue for epidemiologists and public health professionals is that this is altogether a new rascal with no historical record track. No one knows how long the IgG antibodies of those who have recovered from it will safeguard them against future COVID-19 infections even if the virus does not change its genetic make-up. There is one good news though–the entirety of humanity is focused on eradicating this rascal! Let us salute our scientists and medical professionals who are working on behalf of the entire humanity and hope for the best!

Breakthrough News: Actually, wait a minute! Earlier this morning I heard in the news that China has bioengineered and cloned COVID virus antibodies. China has about 20 years of experience with nasty Corona family viruses. What they’ve done, if true, is a milestone in our worldwide battle against COVID-19, and it can be a great gamechanger! Let us hope that this breakthrough product can soon be made available to people across the globe.

Beneatha: I see on the TV that in some countries they stop cars, and with cotton swabs take samples from nostrils or mouths of their drivers. What type of test is that?

Dr. E:  This test is by far the most commonly used test and identifies the genetic material of COVID-19, and it is known as COVID-19 RT-PCR test. This acronym stands for “real-time reverse transcription polymerase chain reaction (rRT-PCR) test”. It is used for qualitative detection of viral RNA. It has a fast turnaround of up to 6 hours. It identifies the viral particles, and as such it is the most accurate way of diagnosing the disease or positive cases. The value of this test is that it is the best available diagnostic test during early exposure of patients and before they break their symptoms or produce their serological (antibody) markers. Of course, as you can tell this test only is helpful during the early course of the disease and while the patients have symptoms of the disease.

My conscience tells me that I should talk a little more about how our immune system works to make more sense out of IgG and IgM antibodies. But I don’t want to baffle Travis with them!

Travis: Actually, this conversation was so interesting that I forgot that my lunch break is almost over. If you don’t mind, I will go back to my workstation. Thank you so much–goodbye!

Quick Review of Antibodies

Dr. E: Catch you down the road, Travis!

Okay Beneatha it’s only me and you, so here we go: Antibodies, also known as immunoglobulins, are products of our immune system against the assaults of bacteria, viruses, and other infectious agents. Our immune system develops a few classes of antibodies for each infectious agent that our body confronts. In particular, over millions of years it has become adept in producing them against the harmful components of each classic infectious agent. The two major antibody types among the five types that are our concern today are, IgM and IgG. Note that “Ig” stands for immunoglobulin (or as I said before, “antibody”).

Beneatha: Why don’t we make antibodies against a whole virus or a whole bacterium?

Dr. E: One simple answer is that even viruses that are the tiniest organisms that we know of, are much bigger than the antibodies that our body manufactures. But the most educated answer is that our immune system cares more about the so-called virulence factor or factors of each infectious agent. For the corona (crown) family of viruses one of the perceived virulence factors is their crown or if you wish the external ornaments, spikes, or clubs on them that are glycoprotein (sugary protein) molecules. These molecules bestow upon them their ability to adhere to the cells of our respiratory system–in our nose, mouth, trachea, bronchi, and lungs. After they attach to our cells, they infuse their nasty particles into our cells, infect them, use the energy machinery of our body to propagate and produce countless number of their nasty progenies that each is capable of infecting another cell. So, one way to knock down the corona is by removing its crown. A tyrant king with no crown is nobody and hurts no one!

Of course, as you can tell, there are so many other antibodies that our bodies make against each part of the corona viruses. To give you a simple example, suppose a virus is chopped into so many pieces–the spikes, the envelop proteins and genetic materials. If you recall we said earlier, the genetic building blocks of the Corona family is composed of ribonucleic acid molecules (RNA). Antibodies that our bodies produce against these sub-Corona 19 parts, will provide our body with the ability to mount defensive responses upon future encounters with same pathogen. Actually, our immune response begins with the first responders of our immune system–the so-called dendritic cells and macrophages. Note that macro means big, and phage means “devourer, engulfer or eater”. In other words, this is a big cell that eats and destroys the germs. The other cells, the dendritic cells, have numerous long octopus-like arms that allow them to efficiently find, grab, and engulf almost any invading germs. These cells are located at strategic points where the inner environment of our body is at risk of being breached. Where are these strategic locations? Under the surface of lung, gut, skin, etc. These cells are the ones who are first alerted that our body is breached. After they bring the invading pathogens into their bodies, they break them into smaller pieces, and then hand them to cells, called T-lymphocytes and B-lymphocytes in our immune system. The latter two cells work cooperatively in remembering the parts of the invading microorganisms and making antibodies against each and all their components in our future encounters with them. There is much to know about immunology. However, if I delve anymore into it, it may take us too far away from the crux of our current conversation.

Beneatha: The science of immunology is so fascinating. I know that you have made an awesome set of 17 videos that cover must-know medical immunology concepts from A to Z. Is there a way that I can watch them on my own time later?

Dr. E: Of course, you may! I have placed my entire medical immunology course on the YouTube. It has not been available to public until now. As a global support for medical students who are homebound, I think it is a great idea if I make them available to everyone now! I am confident that they will help you to ace all your immunology exam questions.  Just click on the link for the first video, below, watch it,  and the other 16 will follow sequentially:  https://www.youtube.com/watch?v=RqI7SbudfN8&t=124s

You may download a free PDF of the entire book by clicking on this link: https://nmrtestbuster.com/download/bare-minimum-immunology-online/

Beneatha: Thank you, thank you so much Dr. E. I will start on it tonight!

Dr. E: Well, before saying goodbye, can you tell me what is the only way that we can learn about how to eradicate this rascal from our planet? By doing…

Beneatha: Testing, testing, testing, and more testing!

Dr. E: Bravo! We are in this together (click and see)! Let us salute those who remind us why we need more testing…