OP-ED: What you need to know about the Covid-19 test

We know that the best thing to do to curb the spread of coronavirus is to continue testing to identify and isolate people in a timely way. This is how countries like South Korea and China got the virus under control — and are now seeing some of the consistently lowest rates of new cases. 

There is a lot of confusion and panic among us when it comes to testing and, even more so, what test results mean. All over the world, there have been reports of people getting different results from different labs for the Covid-19 test, or results that do not match the symptoms people are experiencing. All of this — combined with how our everyday lives are already disrupted — is undoubtedly overwhelming. 

The science is not perfect

It is important to acknowledge and understand that the science of diagnostic tests is not perfect, especially for a new virus like SARS-CoV-2, the virus that causes Covid-19. No test is 100% accurate even at the best labs in the world, and like any other diagnostic test, the RT-PCR tests for Covid-19 may show some discrepancies in its results. 

There is a chance that someone will have the virus but will test negative (false negative) or, less likely, will not have the virus but still test positive (false positive). As an immunologist with 30 years of experience working in laboratories, I understand the frustration that this can cause — and I hope to share what I know and help clear up confusion that many Bangladeshis are feeling. 

What counts as false-positive and false-negative?

Positive results mean that the laboratory machines detect genes of the coronavirus but this alone is not enough to determine whether a patient is infected. That’s because contracting the virus and having it cause Covid-19 disease depends on how much of the virus is in your body (called “viral load”) and an individual’s ability to clear the virus naturally. FDA guidelines state: “Laboratory test results should always be considered in the context of clinical observations and epidemiological data in making a final diagnosis and patient management decisions.”

Lab professionals have to look at the clinical correlation with patient history and other diagnostic information to determine the patient’s infection status. We do know, however, that there is a very small chance that a test can give a false-positive result — so if you test positive, you should definitely treat it as so, and take the necessary precautions. 

On the other hand, a false negative happens when a test says someone does not have a condition when they actually do. Negative results do not preclude SARS-CoV-2 infection, nor should they be used as the sole basis for patient management decisions. Negative results must be combined with clinical observations, patient history, and epidemiological information to determine the patient infection status. A review of global data regarding the accuracy of Covid-19 tests showed false-negative rates of between 2% and 29%. One report found that even a week after infection, one in five people who had the virus had a negative test result.

Why do false-positive and false-negative results happen?

Whether or not you could get a false negative or positive rate depends on many factors, including the time between exposure and getting tested. 

For example, if you are tested too soon, your body may not have enough of the virus yet, which could cause a negative result one day, and a positive result the next. Studies estimate that it takes about five days for most people to develop symptoms once they’re exposed, and almost all people who develop symptoms do so within about 11 days.  

Ideally, samples should be collected near the time that symptoms appear to achieve the highest likelihood that a true negative will be negative and true positive will be positive. Samples being stored too long could also give out false results since samples taken from patients have limited stability over time. If extended storage, transport, or handling causes a long delay before the sample is tested, it can be harder to detect the virus, leading to a false-negative result. Patients who are infected but not yet symptomatic may have false-negative test results, as may those whose symptoms are waning. 

A false-positive test result could arise from RT-PCR test with low specificity. Specificity is based on the ability of the test to recognize the unique genetic sequence of SARS-CoV-2 (the virus that causes Covid-19) and not recognize other virus sequences. A test that is 100% specific means all healthy individuals are correctly identified as healthy. 

A recent article in BMJ calculates that a test specificity of 95% could generate a 1% chance of a false positive result. Most tests used these days, however, have specificities of 98%-100% and chances of false positives are very unlikely. 

Because many people carrying Covid-19 are asymptomatic, in many cases, when they test positive, they may doubt the result; but because the false positive rate is quite low, this result should be taken seriously and discussed with your doctor. It is also possible to test positive one day and negative the next day — this does not necessarily mean the first test was a false positive; it might mean that the virus has passed through your body already.

How am I supposed to take correct action if I don’t know whether my test is a false negative or false positive?

A single negative test should not be used to rule out infection; it is a piece of the puzzle that doctors use to help you make decisions about your health. For example, if you have symptoms consistent with Covid-19 or recently travelled to a Covid hotspot, a doctor may still recommend isolating or taking certain protective measures — even if you test negative. 

The chances of a false positive are very low — and if your swab test comes back positive, then your doctor will work with you to determine the best next steps based on your medical history, travel history, and symptoms. 

While not a silver bullet, the CDC and WHO and global health community strongly advise that diagnostic testing is still one of the most important ways we can prevent the spread of Covid-19. The best way to manage your symptoms or prevent further spreading the virus is for you to get tested and then talk with your doctor about what the results mean for you.  

For various reasons, there has always been rampant distrust in the Bangladeshi health care system, and now in the face of Covid-19, it continues to expand exponentially. To ensure that labs are providing the highest standards of care and accuracy of their lab results that patients can trust, they should participate in External Quality Assessment (EQA). 

It is an essential aspect of any laboratory operation and is designed to monitor laboratory performance. Ideally, all labs should go through the process of getting international accreditation, including from the College of American Pathologists — the leading international organization advancing excellence in laboratory medicine. 

Praava is going through the process of accreditation from the College of American Pathologists and has been participating in Randox International Quality Assessment Scheme, or RIQAS, the world’s largest external quality assessment (EQA) scheme since November 2018 with an average accuracy score of 99.9%. 

We strongly encourage all other labs to do this as well to hold all of us accountable and ensure all Bangladeshis have access to the highest standard of world-class health care. 

Since the first case of Covid-19 in December 2019 in Wuhan, China, the novel coronavirus has rapidly spread across the world and has been continuing to gravely impact our lives. Globally, medical and scientific communities are learning new things about this virus almost daily. And the brightest minds are at work researching new medicines, treatment plans, and researching vaccines, to help fight this new virus. 

New tools

As we continue to learn more about the virus and develop new tools to detect, treat, and prevent it, we have to accept this new normal and continue seeking out testing — as well as social distancing as much as possible and taking all precautionary measures, to ensure that we are not being the cause behind further transmission of this novel coronavirus. 

This article was published in Dhaka Tribune authored by Praava Health’s Senior Lab Director Dr. Zaheed Husain, Retired Faculty, Department of Medicine, Harvard Medical School, and Retired Senior Scientist, Division of Medicine, Beth Israel Hospital, Boston.

Diabetes care during COVID-19

People with diabetes are not more likely to get COVID-19 than the general population. The risk of getting very sick from COVID-19 is likely to be lower if diabetes is well-managed.

COVID-19 is usually a mild disease and around 98% of people affected survive. Most cases (80%) are mild (showing only minimal flu-like symptoms) and people can recover at home. Some cases (around 14%) are severe and very few (around 5%) can result in critical illness. Some people have no symptoms or only mild symptoms of a common cold. In others, COVID-19 can lead to serious problems, like pneumonia or even death. This is more common in people who have other health problems, those with cardiovascular disease, chronic lung disease and hypertension. People with diabetes are among those high-risk categories that can have serious illness if they get the virus.

Everyone with diabetes, including those with type 1, type 2 and gestational (diabetes in pregnancy), is at risk of developing a severe illness if they get coronavirus, but the way it affects can vary from person to person. So, when you have diabetes, being ill can make your blood sugar go all over the place. Your body tries to fight the illness by releasing stored glucose (sugar) into your bloodstream to give you energy. But your body cannot produce insulin to cope with this, so your blood sugars rise. Your body is working overtime to fight the illness, making it harder to manage your diabetes (high sugar). This means you are more at risk of having serious blood sugar highs and lows, as well as longer-term problems with your eyes, feet and other areas of your body.

It is recommended that people with diabetes plan ahead of time what to do before they get ill. This includes having the contact information of their doctor at hand and making sure to have an adequate stock of medications (tablets and/or insulin, or both) and supplies (as glucometer) for monitoring blood glucose at home, so that they do not need to leave the house if they fall ill. Diabetic patients should practice the ‘sick day rules’ recommended for any stressful situation to improve their diabetes decompensation. Sick day rules for people with diabetes include keeping hydrated, monitoring blood glucose and temperature, and if you are on insulin, also monitoring ketone bodies and follow the doctor’s recommendations.

Finally, in response to the COVID-19, governments in many countries including Bangladesh have restricted the movement of their citizens, confining them to their homes. Regular physical activity is of great benefit to the general population and even more for people living with diabetes. Daily light exercise is recommended at home rather than going outside.

This article was published in The Daily Star authored by Dr. Pronob Choudhury, Praava Health’s Consultant on Diabetes, Rheumatology, and Family Medicine.

The immunity puzzle during COVID-19: jigsaw pieces for our immune system

As the pandemic stretches on, our online feed is overflowing with “quick fixes” to boost our immunity. Sadly, the sources for such solutions are often unclear and may thus be misleading. The “Clinical Dietician” world has also responded but with nutritional guidelines based on scientific research and unprecedented worldwide cooperation. These guidelines could thus help improve our understanding of how to build immunity better for the long term.

Nutrition does boost immunity but what I have to tell my patients is that the link is complicated. It is impacted by the multi-functional interactions of our cells, organs, tissues and molecular build in dealing with our environmental pathogens. Stress, obesity, age, genetics and time of the day can also affect it. Balanced eating, regular physical exercises and quality sleep often go hand in hand to reinforce immunity.

For vulnerable groups, such reinforcements are now crucial, especially amongst those aged 65 and above, with underlying health conditions, such as asthma, chronic obstructive pulmonary disease (COPD), diabetes, heart disease, chronic kidney and liver disease or who are immunosuppressed. Based on existing research, specific vitamins and minerals in our food intake can target such vulnerabilities individually or synergistically which I refer to in more detail below. 

Insufficient dietary intake of micronutrients such as vitamins and minerals can compromise immune functions and increase the overall risk of infection. The micronutrients which are pivotal for strengthening the immune system are vitamins A, C, D, E, B2 (riboflavin), B6 (pyridoxine), B12 (cobalamin) and B9 (folic acid) and minerals iron, selenium, zinc, magnesium and copper- these are found in a variety of foods as shown below and should be part of a healthy balanced diet. Individuals should not take extra supplements without consulting a doctor or dietitian.

Vitamins

VitaminPurposeFood SourcesContext 
AInsufficient amount in our diet increases susceptibility to a range of infections.Preformed – Animal foods such as liver and fat portions of dairy foods(milk, cheese, butter), egg yolk and fish. Provitamin A and β-Carotene– Dark yellow, red, green and orange pigment in plants such as carrots, spinach, pumpkin, tomatoes, broccoli. Should be taken with 3g of fat (e.g. oil, ghee, butter) to be absorbed properly.Cooking helps release the vitamin from plants making them available for absorption.
B2/ riboflavinFirst-line host immune response against invading pathogens; helps iron absorption.Milk and cheese.70% B2 will be lost by exposure to sunlight.
B6/ pyridoxineHelps in the production of antibodies and immune cells.Whole grains (brown flour and rice, oats), pulses (chickpeas, lentils dry beans) and legumes (green beans and peas, soybeans), bananas, potatoes and meat (poultry). 
B9/ folic acidMaintain the balance of the immune system and increase resistance to infections.Dark green leafy vegetables (spinach, cabbage, cauliflower, broccoli), citrus fruits (oranges), tomatoes, cantaloupe and legumes (green beans and peas, soybeans). Some cereals and bread are fortified with folic acid.Folate absorption depends on its source with only 50% being absorbed from plant sources. Older people are unable to absorb enough due to low gastric acid therefore intake should be more
B12/  cobalaminModulates immunity against viruses and bacteria.Only in animal food – meat, poultry, fish, milk, eggs and cheese.Individuals who are vegan or have low gastric acid levels (older population) are unable to meet daily requirements.
C/ ascorbic acidReduces risk, severity and duration of upper and lower respiratory tract infections.Requirements increase during infections.Citrus fruits (oranges and lemons), sweet potatoes, guava, strawberries, mangoes, papaya, capsicum, broccoli.Can be easily destroyed by heat, light and action of oxygen in the air. Cook for a limited amount of time.
DReduces risk of respiratory tract viral infections, therefore, improving immune functions.‘The sunshine vitamin’, as its source is the sunlight. Only a few other natural sources such as fish liver oils and egg yolks (only small amounts). Sources can be oily fish like trout and freshwater river carps.Staying indoors in a lockdown can deprive us of the daily requirements of sunlight. It is recommended to take a supplement of 10 mcg = 400 IU (International Units). The recommended daily amount of vitamin D is 400 IU for children up to age 12 months, 600 IU for ages 1 to 70 years, and 800 IU for people over 70.
EPotent antioxidant modulating host immune functions.Vegetable oils (canola, sunflower, safflower) and lower amounts in olive oil and corn oil. Also nuts (peanuts, hazelnuts and almonds), green vegetables (spinach and broccoli), sunflower seeds. Some breakfast cereals, spreads and fruit juices are fortified with vitamin E.Benefits the elderly, may reduce the risk of upper respiratory tract infections.

Minerals

Mineral typePurposeFood SourcesContext
IronProduces immune cells that attack foreign bacteria in the body. Non-Heme Iron: spinach and legumes  Heme Iron: fish, poultry, eggs  Heme iron improves the absorption of non-heme iron, so its deficiency in diets should be monitored. Also, an acidic environment increases iron absorption (iron taken with vitamin C) while severe infection depresses it.
ZincEven a marginal zinc deficiency can impact immunity as it leads to increased diarrhoea and respiratory morbidity.Sources can be seafood (shellfish-lobster, crab and oysters), meat, lamb, leafy and root vegetables, pumpkin seeds, eggs and milk.Zinc is better absorbed from animal protein than plant protein. Zinc supplements can interfere with iron and copper absorption and vice versa. Older individuals with optimum zinc status have greater resistance to infections and less need for antibiotics. Excessive zinc intake, especially from supplements, can lead to a suppressed immune system.
SeleniumAn integral part of antioxidants that protects the cell and lipid membrane from oxidative damage. Selenium influences the innate and acute immune systems. Selenium partners with vitamin E.Meat and meat products, fish, poultry, eggs and Brazil nuts.Lacto-ova vegetarians and vegans may be at risk of deficiency.
MagnesiumSome functions of the immune system are dependent on magnesium.Almonds, cashew nuts, green vegetables and spinach, pulses (beans, red, green, yellow and brown lentils, peas), whole grain cereals (wheat, corn, barley, oats, rye and millet).Deficiency associated with cardiac arrhythmias and cardiac arrest.
CopperEssential for optimal innate immune function.Liver, seafood, nuts and seeds.a deficiency increases susceptibility to bacterial infection.
Probiotics (live microflora) and prebiotics‘Desirable’ bacteria benefiting the gastrointestinal tract by promoting the proliferation of good bacteria and limiting the development of harmful bacteria preventing the colonisation of pathogens. Prebiotics – Bananas, onions and garlic. Dietary sources of probiotics can be cultured milk and yogurt, cheese, pickled cabbage and tempeh.Probiotics may be effective in treating infectious diarrhoea. Individuals with compromised immune function should not use probiotics without medical supervision. Accurate information regarding the dosage and requirements and safety of particular supplements are still uncertain.

Dietary considerations for COVID-19 positive patients at home

  1. Optimization of nutritional status: Energy and protein need individually adjusted according to body weight, age, disease status, energy expenditure, and tolerance to reduce the risk of complications.
  2. High calorie and high protein diets are important for patients with COVID-19 to protect against the breakdown of muscles. Try eating 6 times a day every 2-3 hours. Protein intake of at least 75-100 grams from sources that include meat, fish, poultry, eggs, milk, and yoghurt.
  3. Hydration: 2-3 liters of fluids per day (2-4 ounces every 15 minutes). Fever is associated with excess loss of fluid which may lead to dehydration. Caution should be used for individuals who have fluid restrictions.
  4. Proper nutrition adjusted on an individual basis can help reduce carbon dioxide levels and improve breathing (high fat and low carbohydrate diet).
  5. Supplementation with vitamins and minerals: vitamins A, B, C, and D, also omega-3 polyunsaturated fatty acids, as well as selenium, zinc, and iron should be considered in the assessment of micronutrients in COVID-19 patients.
  6. Physical activity: For people in quarantine, every day > 30 min or every second day > 1h exercise is recommended to maintain fitness, mental health, muscle mass, and thus energy expenditure and body composition.
  7. Oral nutritional supplements or enteral feeding should be considered for people whose nutritional needs cannot be met orally.

This article was published in The Daily Star authored by Tazreen Yusuf Mallick, Praava Health’s Nutritionist. She also worked in the NHS, United Kingdom as a registered clinical dietician.

How to Take Care of a COVID-19 Patient at Home

There are many ways to support a COVID-19 positive Patient at home and also keep the rest of the family members safe and healthy. Praava Health’s Senior Family Doctor, Dr. Paramita Karim, shares how to support and take care of a COVID-19 positive Patient at home

According to international guidelines, a Patient, regardless of whether they have symptoms, should be placed in a well-ventilated single room, away from other members in the house to prevent the spread of the virus and be cared for by a family member who is in good health, with no previous health conditions. Caregivers should always wear masks when interacting with the Patient and wash hands with soap after every interaction. The Patient should also wear a mask as much as possible.

It is very important for the Patient to stay isolated. This means eating in separate rooms and not sharing any personal items, including dishes, glasses, bedding, or electronics, such as cell phones.

It is essential for both the COVID-19 positive Patient and family members to monitor their health closely. Pay close attention to changes in temperature and shortness of breath and report any changes to your doctor. If you or anyone in your household have trouble breathing, seek immediate medical attention.

If you or your loved ones want to talk to a doctor, you can book a video consultation with one of Praava’s family doctors. Or if you think you require testing, or if advised by your doctor, we are also doing COVID-19 testing for our Patients and you can book a COVID-19 test online.   

Praava Health partners with Bangladesh Government to launch Plasma Network

The Bangladesh government has recently launched a plasma network titled “Shohojoddha” to facilitate the collection and distribution of plasma from patients who recovered from COVID-19 in Bangladesh. Praava Health is excited to be a partner of this initiative, along with several other private and public healthcare and service providers.  

While there is currently no treatment for COVID-19, patients who have recovered have antibodies in their blood plasma that help fight infection. Direct transfusion of blood plasma from recovered patients can be used to treat severe COVID-19 patients.

The network was designed to connect plasma donors with patients who require them for treatment. Once a donor registers with Shohojoddha, COVID-19 positive patients requiring plasma can search for a match and collect plasma for treatment when required. The network can help to track the status of donors and receiving patients, and also provide information to those looking for plasma for themselves or their loved ones.

Other healthcare and service providers who are part of this initiative are Dhaka Medical College (DMC), Bangabandhu Sheikh Mujib Medical University (BSMMU), United Hospital, Universal Hospital, MIST, e-Cab, Pulse Health, OIwel, Grey, Bangladesh Super Market Owners’ Association, Pathao, Shohoz, Ayat Foundation, BAGDOOM, and Chaldal.

If you are looking for plasma for yourself or a loved one, you can call +880906771166 or look up www.shohojoddha.com and www.facebook.com:BDshohojoddha for further information.

Praava is Here for You: Know the Facts on COVID-19 from our Doctors

Educating ourselves on the correct information regarding COVID-19 is crucial to help fight the illness and spread further transmission and also panic. We know it’s hard for you to get correct information as there is rapidly changing information online. To help you, we have the latest updates for you, debunking some of the most common myths about the coronavirus. 

I am coughing or sneezing. I must have coronavirus.

You can suspect to have coronavirus if you have symptoms such as fever, cough, and shortness of breath, plus any of the below:

  • Recent travel history abroad
  • Close contact with a person who may have recently returned from abroad
  • Visiting a healthcare facility or lab where coronavirus Patients are being cared for

Any face covering can protect me from COVID-19

According to the US Centers for Disease Control:

  • It is recommended you wear a cloth face covering or homemade mask everytime you go out especially in public settings such as grocery stores or pharmacies 
  • Facemasks are in short supply and they should only be saved and worn by caregivers

My children are at high risk of getting COVID-19

Based on available evidence, children do not appear to be at higher risk for COVID-19 than adults. While some children and infants have been sick with COVID-19, adults make up most of the known cases to date.

I can get coronavirus through food

No, there is no such evidence as of yet. Experience with other coronaviruses like SARS and MERS suggests that people do not get infected through food.

Eating chicken or eggs cause Coronavirus

No, there is no such evidence as of yet. The coronavirus is not known to spread directly through poultry products but experts say it can be a good option to have only properly cooked or well-done meat.

Warm weather stops the outbreak of COVID-19

It is not yet known whether weather and temperature impact the spread of COVID-19. There is much more to learn about the transmissibility, severity, and other features associated with COVID-19, and investigations are ongoing.

Antibiotics help treat COVID-19

No, antibiotics do not work against viruses like COVID-19. They only work against bacteria. The new coronavirus is a virus and so antibiotics should not be used as a means of prevention or treatment.

Pneumonia vaccines protect against COVID-19

This is not true. Vaccines against pneumonia, or any other illness, do not provide protection against COVID-19.

COVID-19 can be transmitted through mosquito bites

To date, there is no evidence to suggest that COVID-19 can be transmitted by mosquitos. 

Eating garlic helps prevent infection with the new coronavirus

Garlic is a healthy food that may have some antimicrobial properties. However, there is no evidence from the current outbreak that eating garlic has protected people from the new coronavirus.

COVID-19 affects older people more than younger people

People of all ages can be infected by the coronavirus. Older people and people with pre-existing medical conditions (such as asthma, diabetes, heart disease) appear to be more vulnerable to becoming severely ill with the virus.

What You Need To Know About Different Types of COVID-19 Testing

What are the types of COVID-19 tests?
Nasal or oral swab

This is the most common type of test available to determine positive cases of COVID-19. It uses polymerase chain reaction (PCR) testing. Sample is collected by a medical professional using a swab, similar to a Q-tip, to collect mucus from your nasopharyngeal or oropharyngeal passages— located deep inside your nasal and oral cavities in the back of your throat. PCR testing works by directly detecting the presence of the virus, instead of the presence of the body’s immune response or antibodies. However, preliminary data suggest that PCR testing may have a high false-negative reporting rate (up to 30%), which means those who actually have the virus may wrongly receive a negative test result. However, most of the false negative results are due to improper nasal swab application.

Blood test
This type of test looks for antibodies, which are specific blood proteins created by your immune system when it comes into contact with a foreign invader. Antibody testing is the only way to detect if you have previously been exposed to the virus.

What are antibodies?
Antibodies are infection-fighting proteins created by our immune system in response to the characteristics of the infectious agent. Over the course of an infection, our immune system produces different types of antibodies including IgM, which develops early in the immune response, and IgG, which develops later. Because antibodies to a virus are only produced once someone has been exposed to the virus (or to a vaccine, which doesn’t yet exist for COVID-19), the presence of antibodies to a virus is a solid indicator that an individual has been infected. 

What is an antibody test? 
The antibody test is a serology test which measures the amounts of antibodies or proteins present in the blood when the body is responding to a specific infection. However, unlike molecular tests for SARS-CoV-2, antibody tests are more useful as tools for gauzing proportions of the population exposed to the virus. Currently, antibody testing is mistake-prone and clinically unverified and should not be used as sole test for diagnosis. 

What is the difference between IgM antibodies and IgG antibodies? 
IgM antibodies are produced by the body during an active infection, while IgG antibodies come later and typically signal the infection has passed. 

IgG antibodies may also indicate immunity, or resistance to reinfection with the same virus, which is the case for certain other viral diseases such as measles, hepatitis A and polio. It is not yet known whether IgG antibodies are indicative of immunity to COVID-19, but research is ongoing.

How does COVID-19 antibody testing work?
For COVID-19 antibody testing, there are three different subclasses of antibodies that can be used including immunoglobulin A (IgA), immunoglobulin (IgG), and immunoglobulin M (IgM). 

The COVID-19 antibody test works by detecting whether the specific types of antibodies in your blood match those that correlate with the SARS-CoV-2 antigen, the virus responsible for COVID-19. If both IgM and IgG antibodies are still present in your system, it means that you have recently been exposed. If you only have IgG antibodies, it means it’s likely been over two weeks since you were infected. If you don’t exhibit any symptoms for more than 72 hours, it means (likely) you have an inactive infection which is no longer contagious.

A negative antibody result does not rule out SARS-CoV-2 infection, especially in individuals who have been exposed to COVID-19 positive patients. Further testing with a molecular test should be considered to rule out infection. 

Positive results may be due to past or present infection with non-SARS-CoV-2 coronavirus strains, such as coronavirus (eg. HKU1, NL63, OC43, or 229E). 

While the presence of antibodies doesn’t necessarily prevent future infections, they can reduce the severity of future infections of the current COVID-19 strain.

What are “point-of-care” antibody tests? 
Handheld “point-of-care” test kits only require a sample of blood from a pricked finger and results can be produced within minutes. There are over 100 versions of this kind of test being offered globally, and the accuracy of these kits is highly variable. This led the World Health Organization to recommend against using them except for research purposes.

How is antibody testing different from PCR tests?
PCR testing for COVID-19 involves detecting presence of viral nucleic acid or protein and determine whether an active virus is present. On the other hand, antibody testing (also called serology testing) is done with blood samples, looking for evidence of the body’s immune response to the virus. 

An individual’s exposure to a foreign pathogen results in the white blood cells ability to ‘learn’ about it and make antibodies to neutralize it. So, an antibody positive to SARS-CoV-2 result means 1) exposure to SARS-CoV-2 at some point in the past and 2) presence of an immune system robust enough to launch an antibody-forming immune response.

The blood tests check for specific iterations of Immunoglobulin-M (IgM) and Immunoglobulin-G, (IgG), that are created by the immune system in response to Covid-19.

How long does it take to generate these antibodies?
Sufficient data related to antibodies against SARS-CoV2 is currently lacking. While IgM is created quickly as part of the body’s response to infection and dissipates soon, IgG stays in the body and represents memory of past exposure to the virus. Some reports suggest most healthy people start making antibodies 11 to 14 days after symptoms first appear. 

A recent report from China, published in Nature Medicine, suggests that most patients developed SARS-CoV-2 specific antibodies within two to three weeks of their first symptoms. In this study patients developed IgM antibodies starting from day 7 and IgG antibodies after 2 – 3 weeks.

What are the potential benefits of antibody testing?
It can help in detection of PCR-negative cases in patients having other symptoms and also help in identification of people who can be convalescent plasma donors. Antibody testing can guide epidemiologic studies to determine disease prevalence in a community and can also assist in verification of vaccine response in vaccination programs.

What are the potential drawbacks of antibody testing?
Antibody testing’s false negative results can lead to missing carriers of the virus, due to either the fact that individuals have not developed antibodies yet or that the test is inaccurate.

False positivity also risks giving the wrong impression of immune protection, due to either cross-reactivity of antibody with common cold coronaviruses (e.g. HKU1, NL63, OC43, 229E) or a non-specific antibody.

Why should individuals know their antibody status?
The test will let individuals know their antibody status which can tell them if they have been exposed to the virus or if their bodies have cleared the virus. It is critical to understand their own health and slowing spread of the virus. 

The more we get community testing out into the world, the faster we can help slow the spread of the disease. Knowing who and who has not mounted an antibody response is critical to our understanding of disease progression.

By Dr. Zaheed Husain, Ph.D.

Q&A with Dr. Zaheed Husain: Remdesivir May or May Not Be A Silver Bullet

What is Remdesivir?

Remdesivir is an investigational drug that has not been approved by any regulatory authority, and the safety and efficacy of remdesivir for the treatment of COVID-19 are not yet known. It has broad antiviral action against several viruses including the coronaviruses that was earlier developed against the Ebola virus in 2014 but did not do well in large clinical trials.

Is Remdesivir Food and Drug Administration (FDA) approved? 

The Food and Drug Administration (FDA) approved an ‘emergency use authorization’ (EUA) for Remdesivir only. This means it can be prescribed for hospitalized patients infected with the coronavirus. 

Is Remdesivir effective in treating COVID-19? 

Remdesivir has shown to be relatively effective in treating COVID-19 patients to the extent it shortens the duration of the symptoms. According to a National Institutes of Health announcement, in a randomized clinical trial “remdesivir was better than placebo from the perspective of the primary endpoint, time to recovery.” Patients receiving remdesivir had a 31% faster time to recovery than those receiving placebo. The median time to recovery was 11 days for patients treated with remdesivir compared with 15 days for those who received placebo. The time to recovery was defined as the time when patients were well enough to leave the hospital or could return to normal activity levels. 

Is Remdesivir the answer to the coronavirus or can it cure coronavirus?

In short – no. The same day the FDA announcement came out, a study by Chinese researchers published in The Lancet found remdesivir did not perform better than a placebo in seriously ill COVID-19 patients. This dampened the excitement about remdesivir and expectations that it could be the “silver bullet” against COVID-19. Scientists and clinicians have questioned the validity of changing the approval criteria midway through the trial and have also questioned the lack of statistical significance in survival advantages between treated and placebo groups.  Former Harvard Professor and HIV treatment pioneer Bill Haseltine has expressed concerns about the premature approval without release of all the data, pointing out that remdesivir has significant adverse effects and wondered if the decision had economic, political, or geopolitical reasons. 

Which company originally manufactured Remdesivir? 

US-based biopharmaceutical company Gilead Sciences, Inc. manufactures Remdesivir. The company has accelerated production of the drug since January and has 1.5 million doses, to date.

Is Remdesivir available in Bangladesh? 

Eskayef Pharmaceuticals, one of the leading drug manufacturing companies of the country, has successfully produced Remdesivir. In early May 2020, the Directorate General of Drug Administration permitted six companies to produce the drug and they are Beximco, Incepta, Eskayef (SK-F) Square, Beacon, and Healthcare. These companies currently have approval to manufacture but have not started distribution of the drug yet. 

How is the drug taken?

Remdesivir is administered intravenously to patients, meaning it needs to be injected. 

Can it be bought at a pharmacy?

The pharmaceutical companies in Bangladesh can initially supply the drug to the hospitals that have been permitted to treat COVID-19. It will not be available in pharmacies since it needs to be administered intravenously.

How much will it cost? 

A single dose of remdesivir will be priced at Tk 5,500, according to officials of the Directorate General of Drug Administration and the pharmaceutical companies. 

When can remdesivir be available for use in Bangladesh?

The DG of the Directorate General of Drug Administration Major General Mahbubur Rahman, informed the press that Bangladesh is likely to begin using remdesivir by May 20

How to Stay Healthy & Connected While Social Distancing

As the COVID-19 pandemic continues and more cases are being reported daily in Bangladesh, we must take all necessary precautions to keep ourselves, our families, and our community safe. The most important thing to do now is to stay indoors and practice social distancing, if you can. This sudden change in our day-to-day life can lead to us experiencing feelings such as fear, depression, anxiety, or loneliness. It is also extremely important to stay healthy and connected during these trying times and so, here are a few tips on how to achieve that:

  1. Follow a Daily Routine
    Whether you are working from home or have a lot of time in your hands, try to follow a daily routine from when you wake up until when you go to bed. While working from home, we can easily lose track of time and forget to take care of ourselves or even skip meals. Make sure to keep time aside for yourself and family and stick to allocated work hours. If you aren’t working from home and find yourself with a lot of time in hand, it is best you allocate different hours for different things during the day – whether watching a movie or catching up with friends on the phone. In either case, include activities such as exercise or yoga to ensure you stay fit, eating healthy, playing board games with your family members at home, and make them a part of your daily routine. 
  2. Connect with Family and Friends
    During this lockdown, most of us are spending more time at home with family members than we usually do. For those who aren’t around family, it is good to take time out to connect with family members over a video call – be it Facetime, Whatsapp video, or Facebook messenger – whatever your family is comfortable with. Similarly, reach out to friends. These are tough times and a phone or a video call to a friend can be a huge support to you and could help relieve stress, loneliness or any anxious feelings – and it will make them feel better too. On the other hand, spending a lot of time with family members, especially since we are not going out, can also be overwhelming. So keep aside some time for just yourself alone. It could be your time to read a book, meditate, or just simply some quiet time by yourself to find comfort in solitude. 
  3. Talk About Your Feelings and Ask for Help
    Not everyone likes to talk about their feelings or emotions but given the current predicament, it can be too much for us to process alone. Talk to those closest to you – be it a family member or a friend, and discuss what you are feeling or going through. It is normal for feelings of hopelessness and despair to arise during this time and being able to talk to someone about it can be incredibly helpful. If you think you need professional help, you can book an appointment with Praava’s counselors or psychotherapists by calling 10648, and they can talk to you remotely and help you navigate your emotions better. If you are worried about your employment and the future, talk to friends or mentors who you think can help to guide you accordingly and figure out future solutions.    
  4. Stay Positive
    It is always easier said than done when we ask someone to “stay positive!” but it is also imperative during this time for us to remain positive and not feel helpless. We need to be emotionally agile to adapt to this drastic change. If you are not comfortable with talking to your family, friends, or even asking for professional help, you can write down what you are feeling and maintain a journal just for you. It is always important to be in touch with your inner self while acknowledging and accepting the emotions you are experiencing. 
  5. Limit the News

It is important to know what is happening in your community and in the world, but too much news at this time could be exhausting. Try setting limits on how much news you watch and read. There may be members of your family who are constantly watching the news – advise them to limit how many hours they spend watching news on TV. It is not only good for their mental well-being but also yours. 

Originally published in Dhaka Tribune on 12 May 2020. 

Praava is Here for You: We’re Testing for COVID-19

We know that things have been difficult during this pandemic – and how difficult it has been to get tested for COVID-19. We are very happy to share that we are one of the only private labs that have started COVID-19 testing for our Patients.

If you or any of your loved ones think you are infected by the coronavirus and want to get tested, please call our hotline 10648, send a message to our Facebook Messenger, or book online for a testing appointment. (Charges apply.)

Home sample collection:

We are collecting nasopharyngeal and oropharyngeal samples (by nasal and oral swab) from home for testing. Patients with suspected COVID-19 will not be entering our facility to provide samples. Our teams doing COVID home sample collection maintain strict clinical protocols including wearing full personal protective equipment and other protective measures. This means that the team that goes to your house for sample collection for regular tests is not regularly exposed to the coronavirus or anyone infected with it.

Sample collection booths:

Our crowd controlled COVID sample collection booths with highly skilled professionals are spread across the city so that it is easy for you to access from your neighborhood. Below are the details of our booths:

Booths where you can walk-in and provide samples:

Mohammadpur

Address: Modina villa-3, Flat no-A1, House-09, Road-1, Char Rasta, Chadd Uddan, Mohammadpur, Dhaka-1207
Days: Every day 
Time: 11am – 6pm

Kuril 

Prescription Care
Address: Ka-62, Kuril Chowrasta, Kuril, Dhaka-1219
Days: Every day
Time: 10am – 5pm

Mirpur  

Address: 2-F, Road 7, Love Road, Mirpur 2, Dhaka
Days: Every day
Time: 11am – 6pm

Booths where you have to pre-book a slot by calling 10648 or book online:

Dhanmondi

Bangladesh Medical College and Hospital (BMCH)
Address: 14/A, BMCH Shondhani building, Dhanmondi
Days: Every day
Time: Based on booking slots

Niketon

Address: Niketon Society, Gate 2 in Gulshan-1
Days: Sunday, Tuesday, Thursday 
Time: Based on booking slots

Your safety is our top priority and we have taken the following measures to reduce your risk of exposure:

Health of Teams

Our teams doing home sample collection maintain strict clinical protocols including wearing full personal protective equipment and other protective measures. They are also checked daily for symptoms to ensure that they are healthy before they go to your home. 

Separate Teams for COVID-19 Testing

Additionally, our team that is collecting home samples for COVID-19 tests is separate from the team collecting samples for other routine tests. This means that the team that goes to your house for sample collection for regular tests is not regularly exposed to the coronavirus or anyone infected with it. 

Remember, you can check out our COVID-19 webpage to access all of Praava’s COVID-19 tools and resources.  

Meanwhile, stay indoors and stay safe! 

Thank you for trusting Praava Health. 

Remember, at Praava you are more than just a Patient, you are family.