Please excuse my literary style in the above question, I pray it is the effect of prolonged quarantine (or maybe the toxic effect of Antivirals? I have been meaning to check my QT interval) Sorry.

Dr Gary Joseph Ordog

I read your question with great interest and felt positive about the assumption that, over time, there will be people who have recovered and are now feeling sufficiently fit and have been shown to be antibody positive on a blood serum test.

As you suggested above, this group of individuals should be an ideal addition to the workforce on the front line, globally.

When the confirmatory COVID-19 serology test is able to be widely used, it may be apparent that there are more people who have overcome the virus than originally thought?

I realise that it will take time to produce a vaccine and more time for sufficient to be produced and administered, to generate a population who have immunity. I was wondering whether - as time progresses - those who have their own immunity after surviving COVID-19, in addition to those who have been vaccinated, will enhance the dropping of numbers of new cases as a result of herd immunity?

Thank you for a thought provoking question.

Dear Dr Gary Joseph Ordog

Hope you are well and did not need ventilatory support for a terrible experience of being a doctor as well a patient and recovering from the effects of COVID-19 as well as medications.

I could not understand your question, is it about:

1. When you as a patient would be able to resume your duty after a convalescent period on recovery from COVID-19? or

2. You are asking about the duration of immunity following COVID-19?

3. Or you are asking about effect on QT interval due to medications e.g. Hydroxychloroquine with or without Azithromycin that you received with some antivirals as part of your treatment?

Please have a look at the following link:

https://www.researchgate.net/post/Should_people_diagnosed_immune_by_a_reliable_SARS-CoV-2_specific_IgG_antibodies_test_be_allowed_to_work

Sorry, I am doing well, no illness. I was taking a glass of tonic water daily for possible prophylaxis. I was referring to the population in general, because most of us are still somewhat on isolation, and it would be nice to have the reliable serum antibody test that proved I/we are immune and can join society again.

Further consideration:

The disease COVID-19 is too Novel to have had a complete workup. Immense research is underway, but it needs some time to be published. Yes testing is the basis for much of the treatment and research. Koch's Postulate is important, but I think is unethical to give a disease to a human to test it, but there are cell cultures and animal models that are used in a secondary way. Of course, human cell cultures are about as close as we can get to testing it absolutely, and ethically. Yes, the PCR method is testing for the viral RNA only. The RNA has to be intact, but give no indication of the virus viability. Intact viral RNA may in fact, be inactivated, and so nonviable. A viability, culture or infectivity test is required. Again, requiring cell culturing or an animal model can be used. (As yet viruses are not classified as "life-forms" and so viability is a misnomer, for now, as this would indicate that they are considered to be "alive.")

PCR sensitivity depends on the presence of intact viral RNA, which has a lot to do with collection and sample types, host viral shedding, host immune responses, etc., thus giving the test sensitivity a wide range. Also, a good control method is needed and none of this is perfected yet. With the madness of the Pandemic, many companies and tests were pushed through, maybe without adequate controls and testing first, but it was an emergency situation, which should be rectified. The PCR should be extremely specific, as it should be relying on the exact RNA sequence for this specific virus. Again, in the rush to push tests to market, there may be confounding variables introduced, again which are being studied and rectified.

Again, the PCR method is not specifically to detect a "live virus" but only for the presence of its RNA. Viability testing is a totally different set of tests. I agree that the definition of virus should be changed to acknowledge it as a "life-form."

I agree that we have been exposed to many coronaviruses, over the years. Many animals and even plants can be infected with various types. Each though has its own unique nucleic acid sequence which can be recognized specifically by the PCR test. Again, that is specificity, not sensitivity.

When you say "80% false positives" you have to be comparing the PCR test to some other test. It is like comparing apples to oranges. For what the test is designed to do, that is detect the presence of intact SARS-Cov-2 viral RNA on the swab at that time and place, it is probably very accurate as to that fact, at that time and situation. But to say false positives for infectivity, for example, that is not what the test does. This test does not tell if the RNA is infectious or not. The swab can be negative for many reasons, wrong location, lack of viral shedding, etc. but these should not be considered false negatives, as the viral RNA was "missed."

The diagnosis of new cases and deaths due to the virus, have much more to do with the medical evaluation of signs and symptoms and other ancillary tests, than just the PCR swab. A patient may die of COVID-19, despite a negative PCR swab; the swab missed the virus, not transported properly, patient not excreting virus at the source or time, the RNA has been inactivated by the immune system, etc. Again, these are not considered false negatives, because the RNA was not present, so actually a true negative (even though they died of COVID-19)

Thank you for your consideration and support. Stay safe. July 01, 2020;

Gary Ordog, MD

White House's Birx and Fauci denies 'herd immunity' policy under consideration. September 02, 2020: White House Coronavirus Task Force coordinator, Dr. Deborah Birx, on Wednesday (September 02, 2020) dismissed the notion that the Trump administration was considering a strategy of allowing Americans to become infected with coronavirus in order to reach "herd immunity." "Neither I, nor anybody in the administration, is willing to sacrifice American lives for herd immunity. We'll get to herd immunity through a vaccine and that's the right way to do it," Dr. Birx told reporters during a briefing at St. Mary Mercy Hospital in Livonia, Michigan. Dr. Deborah Birx was responding to news reports that new White House pandemic adviser Scott Atlas, a physician who is a fellow at Stanford University's Hoover Institution, had advocated for the Trump administration to lift all social and business restrictions aimed at stopping infections from spreading. The United States, which has not had a coordinated federal-led response to the virus, has recorded more than 6 million COVID-19 cases and 185,000 deaths, both the highest in the world. The nation's top infectious disease expert, Dr. Anthony Fauci, told MSNBC on Wednesday that the White House was not using a "herd immunity" strategy and was relying on identification of COVID-19 cases, isolation and contact tracing. Once enough individuals have been infected and become immune, others are less likely to be infected, creating what health officials call "herd immunity." "I would not be here if the White House believed that herd immunity was an option for America," Dr. Deborah Birx, Chief of White house Coronavirus Panel said. Economic shutdowns and measures such as extensive testing and social distancing have curbed the virus' spread in many countries. Others, like Sweden, have attempted to let the outbreak run its course in the hopes of creating herd immunity. Sweden and the United States are both among the nations with the highest rate of coronavirus-related deaths per capita. President Donald Trump in August said Atlas was working with the White House on the coronavirus.

This response does not really fit into the longer description of the question, but is appropriate for the heading. I live in the UK, and there was a television news item last night featuring a senior nursing sister who had been a patient on the intensive care ward that she manages. She was being looked after by staff who she had been involved in employing.

Now she is back at work. A marvellous lady.

https://www.bbc.co.uk/news/uk-england-lincolnshire-54074423

Thank you.