Dear patients of SPCHC and Sun Peaks residents/guests,
Re: Covid-19 update
I realize it has been a while since I’ve written a community letter, but with Omicron things have been developing at such a pace it is hard to keep up. I think we all feel this. And yes, we are all exhausted by the whole situation.
First, as you are aware, Interior Health has basically stopped doing Covid testing along with contact tracing and instead are handing out ‘Rapid Home’ test kits. Our clinic is still doing standard PCR swabbing/testing on Monday, Wednesday and Friday, but have certain criteria.
These rapid tests have some bonuses but also limitations. First, like any test or procedure their accuracy is dependent on how it is used. It is crucial the test be done EXACTLY as the instructions direct. There are various tests out there, not just the IH ones, so make sure you read the instructions or, dare I say, watch a YouTube video on how you use your specific test. When the swab is in your nose it should feel uncomfortable and even make you feel like you may have to sneeze or cough. You will not get an adequate sample by ‘gently’ putting the swab up your nose and bringing it out!
(My cynical side would like to point out that many unvaccinated people seem to be relying on these tests now. Odd that they don’t trust mRNA technology but are willing to trust PCR technology to what end suits them best.)
Secondly, for the test to be positive, you need a certain number of viral particles in your nose (what is called viral load or viral shedding). If you do the test too early, in some cases within the first day of symptoms, the viral shedding may be too low for detection. If you have no symptoms, even if you have Covid, the sensitivity of many rapid tests to show positivity is only around 60%. If you have symptoms, the sensitivity is up in the 80 + % range.
Thirdly, if the test comes out positive, then assume you have Covid (as they are about 99% accurate or specific). What we call the ‘false positive’ rate (the test saying you are positive when in fact you are negative) is thus extremely low. Conversely, if you have symptoms and the test comes out negative, the ‘false negative rate’ (test says you are negative but in fact you are positive) can be around 90 – 95%. In other words, there is a 5 – 10% chance you actually do have Covid despite the test results. To make life simple, if you are symptomatic, assume you have Covid and isolate. Even if you don’t have Covid, you have some infectious disease and why would you want to spread that to co-workers and friends? There is a reason daycares and schools recommend children stay home when they have a ‘cough and cold’.
Fourthly, if you are positive and you isolate for the recommended 5 days, the question of doing another rapid test to ensure you are now ‘negative’ has come up. If you do test and it comes back negative, then you likely are no longer shedding virus and thus non-infectious. If the test comes back positive; you may just have lingering viral particles (which can last for weeks or even months) but there is no way to know if you are infectious. So, to err on the side of caution most authorities recommend isolating for another 5 days. So as far as ‘return to work’ is concerned, after 5 days I personally think being without symptoms is more important than a negative test. The caveat to that statement is that with many viral infections, including Covid, patients will often have what is called a ‘post viral cough’ which is that nagging dry hack. This is caused by post infectious inflammation in the airways and not from infection. That being said, if you return to work with a cough, expect people to look at you funny!
Lastly, regarding vaccines. Yes, I am still profoundly in favoUr of vaccines (and still not writing letters of exemption!) My concern is that there seems to be the public perception developing that Omicron is not that bad so why worry. You may have had Omicron yourself or known a friend and yes felt awful or the sniffles for a couple of days, then fine. However, across BC, Canada and worldwide, patients intubated in ICU beds range from 80 – 100% being unvaccinated people. If you are vaccinated, your chance of becoming seriously ill is greatly reduced. If you are unvaccinated your risk of needing hospitalization and even dying is still substantial. To reiterate, your risk of a serious side effect from a vaccine is much less than the effects of Covid.
Stay safe and please continue to wear masks and socially distance. Unfortunately, we are not out of this yet.
Sincerely,
Shane Barclay MD
Medical Director SPCHC