IS IT BETTER TO HAVE HAD COVID-19 & SURVIVED THAN TO HAVE NEVER HAD IT ALL?

 

It is less than a week since I posted this, however, in the interim, there has been a report of two cases of reinfection. It is still not much when we consider the 26 million recorded infections, still, it needs to be considered. Read the summary at read the summary  https://blogs.jwatch.org/hiv-id-observations/index.php/cases-of-sars-cov-2-reinfection-highlight-the-limitations-and-the-mysteries-of-our-immune-system/2020/08/30/?query=C19&cid=DM98059_NEJM_Registered_Users_and_InActive&bid=253773475

Even as an oral pathologist with no clinical worries of tooth cutting, aerosol contamination, and the like I am not untouched by the challenges that the dental profession is facing each day due to the increasing number of Covid-19 cases. Possibly like every other dentist, I have all the relevant updates delivered to my mailbox each day.

Yesterday an interesting one caught my eye, a letter to the editor of NEJM “Saliva or Nasopharyngeal Swab Specimens for Detection of SARS-CoV-2” by Wyllie, Ann L., et al. They report findings of their recent study on the effectiveness of the salivary sample in the diagnosis of COVID- 19 infection. Significantly the study found saliva to be at the very least as useful as nasopharyngeal swab specimens for quantitative reverse- transcriptase PCR detection of Covid-19. The authors highlighted the importance of saliva as the test sample, negating the need for trained personnel involvement, and exposure. 

https://www.nejm.org/doi/full/10.1056/NEJMc2016359

From a dental viewpoint, it is noteworthy that :

• Asymptomatic patient’s saliva carried a recoverable number of virus copies.
• The overall virus count and percentage of cases where the virus could be recovered were higher in saliva than the nasopharyngeal swabs, up to 10 days after the infection.
• The salivary recovery of virus copies was more consistent throughout the clinical course of the disease. 

The authors relate some of the finding of higher salivary virus counts and overall recovery rates to the inherent ease of salivary sample collection in comparison to the nasopharyngeal specimen collection—an explanation that is no doubt, logical and valid.  

Nonetheless, when we combine all the findings, it seems fair to surmise that SARS-CoV-2 RNA is consistently found in the saliva of both asymptomatic and symptomatic patients.

While reading this article, the statement that the level of Covid-19 RNA decreased after the onset of symptom in both salivary and nasopharyngeal specimens caught my attention and aroused my curiosity. A few search entries in google and I was at the CDC website with exciting updates,

·       Concentrations of virus RNA in upper respiratory specimens declines after onset of symptoms.

·       COVID-19 replication-competent the virus has not been recovered following symptom onset in mild to moderate cases after 10 days and 10-20 days in severe cases.

·       High-risk household and hospital contacts did not develop the infection if their exposure to a case-patient started 6 days or more after the case patient’s illness onset.

·       Currently, six months after the emergence of SARS-CoV-2, there have been no confirmed cases of SARS-CoV-2 reinfection.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html#key-findings

 So, in summary, current data has shown recovery of virus copies from the saliva of asymptomatic patients, and those with early symptoms. The virus then reduces in numbers and disappearing after ten days in those with mild and moderate symptoms, and 20 days in those with severe symptoms.

It seems that the safest bet is to treat patients who were infected and recovered.

Considering we are now resigned that for the foreseeable future the entire population remains at risk and an eventual infection is almost inevitable, COVID -19 tests may become the first test, where testing positive becomes a requirement before any treatment.   

AND So it may come to pass that  - Tis better to have had COVID & survived than to have never had it at all…

These are unprecedented times indeed!!