While the pandemic has taken much longer than anticipated earlier, testing for the Coronavirus infection has been significantly increasing. At Health Patrol, we have been getting queries on how to interpret the results and whether a negative antigen test means the person is free to roam around without a mask or any other safety measures. The answer is a big NO. While getting tested for COVID-19 is one of the ways to safeguard yourself and your close contacts from the virus, a negative test does not entirely mean that you are not infected by COVID-19 or that you are safe from it.
The right sample at the right time from the right anatomical site with the proper precautions is crucial in prompt and accurate diagnosis of COVID-19. The potential vulnerabilities include pre-analytical issues such as problems in identification, inappropriate or inadequate collection, handling, maintenance of the cold chain during transport, fluctuation in storage temperature, presence of interfering substances, manual errors, and sample contamination. There are various analytical issues like testing outside the diagnostic window, active viral recombination, inadequately validated assays, and instrument malfunctioning. Post-analytical vulnerabilities like errors and delay in reporting should be noted.
A negative result comes up when a diagnostic test isn’t able to detect sizeable load after repeated cycle testing in a given time (24-48 hours post sample collection and testing). On the other hand, even if the test picks up a fragment of the virus, it means the person is positive for coronavirus. So, a negative result just means that either the immune system cleared up when the blood sample was taken, or the virus was not present at the time the sample was taken. No one test is 100% accurate, or sensitive right now and experts believe that taking the tests lightly, or ‘interpreting’ the results wrongly can make matters worse.
A person with a negative RT-PCR result at initial testing, with a subsequent positive test result, is considered as a false-negative diagnosis. Clinical practice guidelines and consensus statements recommend repeated RT-PCR testing to confirm a clinical diagnosis, especially in the presence of symptoms associated with COVID-19. Researchers have suggested that these failures in SARS-CoV-2 detection are related to multiple preanalytical and analytical factors, such as lack of standardization for specimen collection, delays or poor storage conditions before arrival in the laboratory, the use of inadequately validated assays, contamination during the procedure, insufficient viral specimens and load, the incubation period of the disease, and the presence of mutations that escape detection or PCR inhibitors.
Antigen tests can show up inaccurate or false results. Sometimes, people who test negative for COVID-19 on an antigen test are asked to go for a repeat test to confirm results. With RT-PCR tests, the risk might be rare but still exists. Health Patrol had carried a detailed coverage on this.
Diagnostic errors and lapses can also lead to wrong results. According to experts, right now, during the pandemic, false-negative rates could be as high as 30%. Even getting the test done too early can show incorrect results because the Coronavirus has an incubation time of 5-12 days or in some cases, even longer. Now if that person gets tested too early after the exposure, he may neither show clear signs of the infection, nor have a positive COVID test result, therefore the chances of transmission multiply in such cases.
If you think you have been exposed to the virus or a COVID positive person, it is best for you and everyone around you to wait in isolation for 5-6 days (the average incubation period, which can be as long as 14 days) and then go for testing. It is also important to note that even a negative result does not mean that you are not infectious, and are therefore, still at risk for COVID-19.
Therefore, all COVID prevention measures should be in check including face masks, safe distancing, sanitation and good hygiene practices.
Dos and don’ts for vacay activities
It is not a one size fits all when it comes to vacations or holidays because every family has a different demographic – some may have small kids who need to be taken to a washroom very often, some may have elderly who cannot sit too long during road trips. Therefore, every family should decide based on their own family size, needs and facilities. Traveling will inevitably lead to exposures to unvaccinated kids and adults. But the risk will be decided based on the extent of that exposure.
Masks reduce transmission and have been proven to be an effective tool with vaccination. Wearing a mask indoors and in public spaces further cuts down on risk considerably.
Before you travel:
- Get your RTPCR test done
- Wear a mask covering your nose and mouth at all times when you are in public places or around individuals that cannot maintain a safe distance of 6 feet away from you.
- Avoid crowds and stay at least 6 feet/2 meters from anyone who you do not know personally with their health history.
- Wash your hands often or use hand sanitizer (with at least 60% alcohol).
When you return from your vacation:
- If you see any signs of COVID, get tested and isolate yourself from other family members as well.
- Even if you test negative, stay home and self-quarantine for the full 7 days.
- If you don’t get tested, stay home and self-quarantine for 10 days after travel.
- Self-monitor for COVID-19 symptoms; isolate and get tested if you develop symptoms.
It hasn’t affected kids till now – it won’t affect them ever
Schools reopening across the globe has brought about a sense of panic in some parents and a sense of confidence in others because vaccination for children is yet to come and unvaccinated children are both at direct risk for COVID as well as at risk of transmitting the virus to others.
According to the World Health Organisation (WHO), data suggests that children under the age of 18 years represent about 8.5% of reported cases, with relatively few deaths compared to other age groups and usually mild disease. However, cases of critical illness have been reported. As with adults, pre-existing medical conditions have been suggested as a risk factor for severe disease and intensive care admission in children. Further studies are underway to assess the risk of infection in children and to better understand transmission in this age group.
Although research has shown that children develop severe disease from COVID-19 far less commonly than adults, and therefore, the risk of death due to severity of COVID-19 is also much lower in children. However, they are not immune. There are reports of children dying due to COVID-19. But even when children do not get seriously ill with COVID-19 or show symptoms, they can still transmit the virus to other children and adults. The rate of child-to-adult transmission of SARS-CoV-2 is roughly half the rate of adult-to-child transmission. So even when the risk is low for children, transmission to other unvaccinated kids and adults is still a serious concern.
Vaccination can help us tide over the third wave
The second wave is declining, although up to 30-40,000 daily new cases continue to be recorded. India is far from being a COVID-19 free nation. Moreover, the looming third wave and alerts released by different State heads to be prepared for a third wave or to make adequate arrangements for the third wave in terms of oxygen cylinders, beds, critical care wards, etc. has kept us all on our toes and inside homes for fear of expediting the arrival of the third wave.
Eminent virologist and retired professor (CMC Vellore), Dr. T Jacob John, in a recent media interview said if the Government can do justice to the vaccination, in terms of making it available in abundance and everywhere, even the unlikely probability of a third wave can be mitigated, adding that in other words, the third wave can be and must be prevented with vaccination. Dr. John also believes that the two strong waves of COVID-19 pandemic in India would have created high herd-immunity, which is why even a moderate level of vaccination will surely avert the third wave.
We should continue to follow physical distancing protocols and avoid crowding indoors or outdoors as much as possible.
Complete vaccinated individuals three times less likely to get COVID-19
In what comes as more evidence to back completing the (two-dose or one-dose) mandated course for vaccinations for COVID-19, a recent update published by the Imperial College London has shown that people who have received both doses of their coronavirus vaccine are three times less likely to get infected with COVID-19. These results from the 13th round of the Imperial-led REACT-1 study, a major coronavirus monitoring programme, are based on swab tests taken by almost 100,000 people in England between 24 June and 12 July.
According to their website, REACT (REal-time Assessment of Community Transmission) is a series of studies that are using home testing to improve the understanding of how the COVID-19 pandemic is progressing across England. This major research programme was commissioned by the Department of Health and Social Care (DHSC) and is being carried out by Imperial College London in partnership with Ipsos MORI and Imperial College Healthcare NHS Trust.
The analysis by Imperial College London and Ipsos MORI, which had almost 100,000 volunteers taking part in the study in England between June 24 and July 12, suggests that double vaccinated people are also less likely to pass on the virus to others. Results have also indicated that people who were fully vaccinated were less likely to be carriers of infection to pass the virus on to others, because they have a lower viral load on average and therefore shed less virus.
In his statement to the Press post release of study results, the UK Vaccines Minister Mr. Nadhim Zahawi also stated, “these results show the positive impact of the vaccination program with those who are double jabbed three times less likely than unvaccinated people to get the virus and less likely to pass on this awful disease to those around them”.
It is important to note that no vaccine has 100% efficacy but benefits outweigh the risks and therefore vaccination is an important step towards curbing the pandemic. Vaccination however, must also be complemented by COVID appropriate behavior.
Breastfeeding post vaccination can kill your baby
There isn’t any research to support this claim, and based on how vaccines work, there is no reason to believe that the vaccine could harm mom or baby. In fact studies support the fact that the vaccines are not excreted into the breast milk, but antibodies produced by mothers in response to the COVID-19 vaccine do — providing hope that breastfed babies might have some level of protection.
A report published in the journal Nature states that COVID-19 vaccines do not carry a risk of igniting an active infection and that they are extremely unlikely to cross into breast milk. The report further elaborates how the fragile messenger RNA used in the Pfizer–BioNTech and Moderna vaccines, is designed to break down so quickly that it should never leave the cells where it was injected. Therefore, it cannot get into the bloodstream and then the breast. In fact, experts believe none of the current vaccines will be excreted into breast milk.
The World Health Organisation (WHO) Strategic Advisory Group of Experts on Immunization (SAGE) Guidance also recommends that mothers continue to breastfeed after vaccination. The Centre for Disease Control (CDC) and the UK Joint Committee on Vaccination and Immunisation issued statements shortly after the first vaccines were authorized in both countries recommending COVID-19 vaccination for breastfeeding women.
Australia’s Department of Health has indicated that breastfeeding women can get an approved COVID-19 vaccine and don’t need to stop breastfeeding before or after.
Therefore, in conclusion, no safety concerns have been identified in lactating women who have been vaccinated. Women can continue to breastfeed pre and post COVID-19 vaccination.