I’d like to start by expanding on a theme from my last missive.   
I believe a vaccine is too risky given the dual pressures of needing to have it today and the complexity of getting something safe to market.  Developing safe treatments on the road to herd immunity is our best option moving forward.  Taking this a step further and assuming we are faced with the inevitable breakdown of social distancing, then recognition of susceptibles and access to immediate and effective treatment should be of paramount importance.  I hope to soon delve into what an effective treatment may look like.  The Remdesivir data available so far is absolutely underwhelming and Hydroxychloroquine has killed far more people than it has helped. 

Today I wanted to discuss some emerging data regarding who may be at increased risk for the complications of a Covid-19 infection.  We are aware of certain risk factors like age, obesity, diabetes, and hypertension but we may be getting a bit closer to stratifying those most at risk.  

We have focused on antibody (B-cell) development as a marker for immunity in Covid-19 and I think we are all hearing the common conundrums that we don’t know what level is needed or how long protective antibodies will last.  I had previously mentioned that I think we are inadequately evaluating immunes or partial immunes with this limited technology.  Unfortunately our inability to understand or quantitate T-cell memory function provides us with few options.

Data from Chinese studies demonstrates that patients who had lower starting T-cells were at increased risk of overwhelming disease.  Also by following T-cell number and class (T-cell subsets) and their cytokines (chemical messengers) during active disease provides the ability to predict who was at the most risk for severe infection.  Additionally looking at T-cell numbers relative to drug treatments may give us an idea what is working before we see a change in the clinical picture.

I mention this because I think this may have practical application for our community of Highland Personal Health patients.  A series of routine labs like a CBC (complete blood count), CRP (C-Reactive Protein) and LDH (Lactate Dehydrogenase) have been used with good predictive value so far in Covid-19 infections.  I also think that we can now include a T-cell subset to add an even more powerful tool in our assessment.  CBC, CRP, and LDH labs are quite inexpensive.  A T-cell subset is about $60 and Cytokine testing about $350 for a full complement of Cytokines.  I definitely think the cytokine panel is too expensive to be of practical use but for you over-achievers this kind of lab panel is a wealth of information.

It is unlikely we could get insurance to pay for the T-cell subset but CBC,CRP,and LDH will not be a problem.  In summary I would like to offer to our community of Highland Personal Health patients serum (blood testing) for those tests.  Cash price $75 for everything or $60 and we run the other labs through insurance if you have it.  

Please reach out to Janette and we will schedule you fore a blood draw. You will be seen upstairs and drawn to avoid any other exposure.  
Knowledge is power!
Warm Regards,
Dr. Nick