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Testing, Antibodies, Mask Etiquette and More! Joseph Gastaldo, MD, answers your burning questions about COVID-19

COVID-19 is a routine fact of life now. And while you may finally be getting used to wearing your mask and hearing statistics on the news, you probably still have a lot of questions.

We definitely did, as did many of our social followers! So, we sat down with OhioHealth’s system medical director of Infectious Diseases Joseph Gastaldo, MD, during a recent Facebook Live event to get some answers.

Note: If you want to hear Dr. Gastaldo’s answers to our questions, we’ve provided time stamps in our story, to help you find the answer in the video above.

As you read on, keep in mind that this information shouldn’t replace the advice of your doctor. If you have additional questions, visit the Centers for Disease Control and Prevention COVID-19 website.

What types of COVID-19 testing options are available right now? (00:57)

Currently, there are three tests that we use for diagnosing COVID-19 or identifying if someone has already had it. There is a genetic test, an antibody test and an antigen test.

Genetic tests measure pieces of nucleic acids. In our cells, we have DNA and RNA. Genetic tests measure pieces of RNA that are unique to the SARS-CoV-2 virus, which is the virus that causes COVID-19.

Antibody tests are blood tests that can suggest that someone previously had COVID-19. When people get infections (most infections), their immune system will make a specific type of protein called an antibody. This antibody develops in most people who become infected with SARS-CoV-2, making this test useful in the situation that someone is recovering or has possibly recovered from COVID-19.

Antigen tests measure a protein that’s either on the surface of the virus or inside the virus. This test is similar to genetic tests, because it also checks respiratory system samples (such as nasal, oral or saliva swabs) to determine if a patient has COVID-19. This is the same test that was in the news recently, due to Gov. Mike DeWine having it done.

What does getting a COVID-19 test involve? (02:58)

An antibody test is just a blood draw. The genetic tests typically involve either a nasal pharyngeal swab or an oral pharyngeal swab. A nasal pharyngeal swab is typically the best test to do with the best sensitivity. An oral pharyngeal swab, or throat swab, is also a good test to do, but it has less sensitivity. OhioHealth conducts both of these forms of testing. Other testing locations may do swabs in different ways. A few examples of different types of swabs are a mid-turbinate swab, which is done by inserting a swab halfway up your nose, and saliva testing, which we’re still in the process of understanding. All of these types of swabs are trying to test for genetic material or an antigen.

Is it possible to get false-positive results from genetic and antigen COVID-19 tests? (04:15)

Yes, you can have false positives with both tests. A false positive occurs when your test result is positive or detectable, but you don’t have the infection.

If you receive a false-positive result from a genetic test with the PCR (polymerase chain reaction) or Abbott ID NOW, it’s a processing error. This means that something happened in the laboratory, for example, a test with a negative result was contaminated with a test that had a positive result. It doesn’t take much for that to happen.

Antigen testing can result in false positives for the same reason as genetic testing. However, antigen testing can also have false positives because some of the antigens and proteins that are detected can cross-react with coronaviruses that cause the common cold.

Why would I want to get an antibody test if I don’t have COVID-19 anymore? (06:40)

When people get infected with SARS-CoV-2, they develop 60 different antibodies. Developing this many antibodies is common with many infections. You don’t just develop one antibody; you develop a family of different antibodies.

When antibody tests first came out, there were more than 70 of them and they all measured different antibodies. This has helped those in medicine learn that if you have an antibody like the measles, you have protection and immunity to measles. We can’t say that yet with COVID-19 because we don’t know the meaning of each antibody.

If somebody has recovered from COVID-19 and they get an antibody titer done, that antibody titer can be interpreted to say, “Given your history, exposure, travel and many other reasons, this antibody test is diagnostic for you having COVID-19.” Thus, having an antibody test after you recover from COVID-19 may help researchers who are looking to prove certain antibodies provide protection against COVID-19.

If I do have COVID-19 antibodies, does that mean my blood or plasma could help other patients? (08:15)

What we currently think is if you have a detectable antibody, you probably have some immunity. However, we don’t know for how long. People who have recovered from COVID-19 produce a family of different antibodies. Some of those antibodies are neutralizing and do offer some protection.

If you have recovered from COVID-19 and you’ve produced those antibodies, you can go to the Red Cross and donate your blood or plasma. Based on your blood type, they’re able to give it to people in the hospital who are sick with COVID-19. This is known as convalescent plasma therapy. OhioHealth is one health system performing this therapy because of our involvement in a registry with the Mayo Clinic, which is administered through the Red Cross.

What is the proper way to take care of my face mask when taking it off and putting it back on? (10:14)

You should start off with a clean, laundered face mask every day. You want to inspect your face mask to make sure it’s not soiled or has holes in it. When you put a clean face mask on, you want to do everything you can to keep it clean. A general recommendation is to sanitize your hands each time you put on your face mask or take it off. This will lessen the potential of anything on your hands contaminating your mask.

What should I do if my mask just doesn’t fit right? (13:29)

When you put your face mask on, it’s important to note that the loops are fine to touch. If you’re wearing a surgical mask, the blue part should be on the outside. You want to try to protect this area and keep it clean. Avoid touching this area with your hands.

Overall, face masks need to cover your nose, mouth and chin. Make sure you pinch the mask at the bridge of your nose, in order to create a good seal. If you need to adjust your mask while you’re wearing it, make sure to only grab the areas where the strings are attached.

What should I do if wearing a mask gives me a headache or causes discomfort? (15:36)

A lot of it has to do with finding a mask that you’re comfortable in. There are a lot of mask options out there, so you just have to experiment until you find a mask that works for you. There are also a few other reasons why your mask may be bothering you. For example, being dehydrated makes wearing a mask more uncomfortable. Or, if you have claustrophobia, a mask can make you feel anxious. A lot of mask discomfort can be tied to not being used to wearing one, so practice and finding a comfortable mask for you are key.

Are neck gaiters truly not helpful, as Duke University’s recent study claimed? (17:10)

It depends on what material the gaiter is made of. Most gaiters are made of nylon, which is the same material pantyhose is made of. Therefore, I’m going to use pantyhose as an example. Gaiters are essentially pantyhose, just a little bit thicker. When you stretch out pantyhose, a lot of small holes appear, which allow air to go through them. This is not a quality you want in a mask. To avoid this, look for a mask that has a lot of fibers in it. These different layers act as shields and barriers against viruses and other things. So, the best materials for masks are organic substances like paper, cotton or even a cotton polyester blend. However, items like pure polyester pantyhose or stretchable gaiters have a lot of holes in them, which greatly decreases their ability to protect you.

If I’m wearing a face mask, do I still need to be six feet away from somebody else? (18:50)

Yes, you do. The six-feet distance is based on droplet studies that were done eons ago. This means there has been enough time for people to learn it, making six feet a good rule of thumb. However, eight feet is better than six feet, and 10 feet is better than eight feet. But no matter the distance, you still need to wear a mask. If you’re inside, this applies even more so, due to the air ventilation. Wearing a mask, social distancing and hand hygiene work synergistically.

When is it appropriate to take off my mask in public? (19:52)

What I think about when I want to take my mask off is, are there people around me and am I outside? Outside is better than inside, as far as safety goes. If you are walking outside a building, and there’s nobody else around you, it’s safe to take your mask off. But if you are walking out of a grocery store with a lot of people around you, it’s not safe to take off your mask.

Since many symptoms of allergies and COVID-19 are similar, how can I tell the difference? (21:19)

The big thing that I tell patients and providers is, ask yourself whether it is a new symptom that can’t be explained. For example, I have allergies and will have symptoms until the first frost. I’ve lived with my allergies for a long time and I feel comfortable knowing what my symptoms are. So, when we talk about some of the vague symptoms for COVID-19, we always want to ask the patient if it’s a new symptom for them. If the answer is yes, the patient needs to be evaluated for COVID-19.

Why should I get tested for COVID-19 if I have no symptoms? (22:13)

The Ohio Department of Health has a testing priority matrix. We use the priority matrix as a guide for who to test based on our supply of testing materials. The lowest priority is asymptomatic testing. However, the reason we do it is to try to understand how many asymptomatic COVID-19 cases are out there.

What is the current thought on aerosolization of the COVID-19 virus? (23:50)

SARS-CoV-2 is predominantly spread through droplets. So, when we cough, sneeze, talk and sing, droplets are transmitted. Droplets typically don’t travel more than six feet. That being said, it is also now recognized in research and laboratory settings that COVID-19 can be spread through aerosols because there is no air ventilation. However, what happens in the lab often is very hard to replicate in real-world situations. One of the things you’re going to be hearing more, especially with kids going back to school and winter on its way, is you should be in rooms that are well-ventilated. If you’re in a room that’s well-ventilated in the setting of an aerosol transmission of COVID-19, that’s a safer environment to be in.

Is it OK to clean disposable masks with Clorox wipes and reuse them? (25:42)

I would be concerned about the chemicals in a Clorox wipe degrading the material the mask is made of. So no, I wouldn’t recommend doing that. I have cotton masks that I launder like regular clothes.

Is it okay to put my mask in a paper bag while I’m in my car? (26:17)

Yes, that’s okay. When you take your mask off, sanitize your hands first. Try to only touch the mask where the loops are attached. You want to store your mask in something that breathes, such as a paper bag or an envelope. This is because when we talk, moisture builds up inside our masks. A paper bag or envelope will allow this moisture to dry out. Do not store your mask in a plastic bag, as plastic bags don’t breathe and will trap moisture in your mask.

This graphic from the Ohio Department of Health breaks down the incidence of COVID-19 in different age groups through the past six months. Could you explain the graphic for us? (27:01)

Here we have statistics from the Ohio Department of Health, breaking down COVID-19 infection based on different age groups. For the month of March, people 0–19 year old represented 2.4% of those diagnosed with COVID-19, whereas people 50–59 and 60–69 were the biggest age groups with COVID-19.

You might have heard before that those most likely to have complications are older people, people with underlying health conditions and pregnant people. While this is true, it’s important to note that COVID-19 doesn’t discriminate. It can affect anybody, including adults and children who are healthy.

I also want to recognize that COVID-19 has brought a highlight to healthcare discrepancies that have always been there. Based on their percentage of the population, there is more sickness, illness and death associated with COVID-19 in the and Hispanic communities compared to Caucasian communities.

As you go through each month on the graphic, you can see that people mostly getting COVID-19 are getting younger. The No. 1 age category was 30–39 in May, then 20–29 for June, July and August. This showcases that in March, April and May, even though everything was closed down, we weren’t protecting those most vulnerable – the older population. Today we are doing a much better job protecting those age ranges. It shouldn’t surprise anyone that we are seeing higher case numbers in lower age groups in recent months. Businesses, bars and restaurants are open again. People are getting out and going to the zoo, they’re traveling and overall, they’re getting stuff done. With schools opening back up, I wouldn’t be surprised if we see more cases even in the 0–19 age range.

Beginning in August, the overall trends of newly positive patients have gone down. That’s a good thing. However, I don’t want to celebrate it, nor do I want people to see that and then assume they can be more relaxed with wearing a mask, having people over and going to parties. We still have to have our foot on the accelerator pedal in allowing us to protect each other.

This article is based off of a live interview conducted on Facebook on August 13, 2020. Due to the changing nature of COVID-19, some information might be dated. Always check with the CDC for the latest changing information concerning COVID-19. 

 

 

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