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To PCR or Antigen Test?-that is the question
With many people relying on at home rapid antigen tests to be able to safely gather with family members and attend events, it’s important to know just how far these tests go at helping us assess risk. There is a range of variability in the sensitivities of these rapid home tests especially when it comes to the omicron variant. Sensitivity refers to the ability of a test to accurately give a positive result in someone who is infected with the virus. Numbers for these rapid antigen tests have ranged with some studies showing sensitivity as low as 44% in asymptomatic individuals and an overall sensitivity of 65% and others showing sensitivity of roughly 92% in symptomatic individuals and 78% in asymptomatic individuals. The accuracy of these tests as discussed in the studies does depend on whether one is symptomatic or not (with symptomatic being more accurate) and of course at what point in the course of the illness one is being tested. That being said, there is some utility to rapid antigen tests.
A rapid antigen test detects a protein on one of the spikes of the coronavirus and is less sensitive overall than a PCR test because it takes more viral particles for it to reveal a positive result. A rapid antigen test may be best used if one is trying to determine if still infectious and a risk to others. It is unclear at this point how much viral load one needs to carry in order to be considered infectious, but if the rapid antigen test is positive, the result should be trusted. The timing of when to take the test is important though since you may not have a high enough amount of virus to be detected if you test too early after exposure (which is why PCR would be better early on) so if asymptomatic after a known exposure, testing with a rapid antigen test around day 3-5 and again at day 5-7 since exposure would be more accurate.
A PCR test also known as a reverse transcription-polymerase chain reaction test can pick up small amounts of viral genetic material. The test then amplifies the genetic material, making it a very sensitive test. However, because it reveals positivity even when there’s a small amount of virus, it can actually stay positive for many weeks after one is infected even if one may no longer be “infectious.” An appropriate time to take a PCR test is when one has had a known exposure to someone with COVID-19 or is experiencing symptoms. Since initial studies suggested that the 1-2 days before symptom onset and 2-3 days after symptom onset may be when one is the most infectious, it is important to opt for a PCR test because it may detect the virus earlier than a rapid antigen test, which is not as sensitive. That being said, a recent Japanese study found that viral loads for omicron were highest at days 3-6 after symptom onset, which also calls into question the shortened quarantine guidelines put out by the CDC.
Of course, it’s important to recognize that access to affordable testing is a major obstacle for many. This is why we need to ensure that everyone has access to free testing and delivery of these tests is equitable. For more information about specific rapid tests and their sensitivity, refer to the links below.
https://pubmed.ncbi.nlm.nih.gov/34242764/
https://www.cdc.gov/mmwr/volumes/70/wr/mm7003e3.htm
https://www.nytimes.com/article/at-home-covid-tests-accuracy.html?ref=oembed
https://www.health.harvard.edu/diseases-and-conditions/if-youve-been-exposed-to-the-coronavirus
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2783099
https://www.niid.go.jp/niid/en/2019-ncov-e/10884-covid19-66-en.html
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Austin outdoors: the top hiking trails to visit
Since moving to Dallas, I’ve been to Austin several times and each time it feels like I’m visiting a completely different city. Either Austin seems to transform its image quickly or I’m always discovering novel sights and activities. The restaurant scene, the live music, the shopping, the overall feel of the city and the many Austin outdoor adventures that await are endless. I could go on about all the things I love about Austin, but I’ll save that for future blog posts.
On our last trip, we chose to focus on exploring some of the surrounding Austin-area hikes and get a better feel for the Austin outdoors. Having stayed in the city many times before, we chose this time to stay somewhat on the outskirts at a lake house on Lake Austin. We picked the location because it was easier to get to a few of the hiking areas I had scoped out online, but also easy to get to the center of the city for other outings.
We planned to visit Lady Bird Lake Trail, McKinney Falls, Hamilton Greenbelt Trail and Hamilton Pool Preserve. Now I use the term “hiking” loosely as we had a baby in tow and there’s only so much terrain we can cover (or rather my husband can handle when carrying him in a hiking backpack). Some of these spots allow for leisurely strolls and all of them have the option of taking easier trails.
Lady Bird Lake Running Trail
Of course Lady Bird Lake Running Trail is probably the most popular trail in Austin as it’s in the heart of the city and encompasses a range of recreational activities, merging nature and urban life. There are a lot of different entry points to this trail (also called the Ann and Roy Butler Hike and Bike Trail) and each time I’ve visited I’ve taken a different path. Some people use the dirt path, some use the boardwalk and others do a combination. This is where you will see tons of paddleboarders and kayaks especially on the weekends. They also offer pilates classes on top of paddleboards! Lady Bird Lake Running Trail is one of my favorite Austin outdoor spots to visit.
Typically after completing a lap around the Lady Bird Lake Running Trail, we head to one of our favorite brunch spots such as the Well ATX! Make sure to check out Zilker Park and Barton Springs Pool while in the area as well! Barton Springs is fed from a natural spring and open all year round to swimmers.
Hamilton Greenbelt Trail
After spending the first day in the city, we drove to our airbnb on Lake Austin. Lake Austin is about a 30 minute drive from Austin and of course we had to stop to grab a latte from summer moon, a Texas Hill Country original. Well known for their special sweet cream called “moon milk” and their delicious coffee, summer moon has multiple drive-thru locations throughout hill country. We stayed at a beautiful home with lakeside views (views pictured below). The next morning, we drove about 30 minutes to Hamilton Greenbelt Trail to set out on a hike. The Hamilton Greenbelt Trail incorporates a diverse terrain with multiple paths and waterfalls one can chase. There are a lot of oak trees that shade the way if you don’t want to be in the sun. There is also a more “primitive trail,” which is a little rocky, but not very difficult.
After completing the Hamilton Greenbelt trail, we headed to lunch at the Oasis, a restaurant known as “the sunset capital of Texas.” The views here really are spectacular and worth taking in.
We spent the afternoon in Austin doing some shopping. We like to put out names down at one of our favorite Austin patio’s Perla’s while we shop around as there is often a long wait to get in. This seafood and oyster bar is an absolute must when visiting not only for the food, but the atmosphere and vibe.
McKinney Falls
The next morning, we drove to McKinney Falls. McKinney Falls is best known for its waterfalls and cypress trees. It surrounds Onion Creek and Williamson creek and people can be seen fishing or swimming in the creeks. Our visit here was short as we only walked to the McKinney Falls lower falls as it is a short walk from the parking lot. There is also a McKinney Falls upper falls path, but based on my reading it was more rugged and not as easily accessible.
Austin is only about a 20 minute drive from McKinney Falls so we spent the rest of the day walking around Austin with a stop at Mozart’s coffee, a coffee shop on Lake Austin. Something I just love about Austin is the plethora of places that boast lakeside views. For dinner we ventured to another favorite Austin patio, Aba restaurant. They have great quality mediterranean food and an eclectic drink menu, but the ambiance and scene is really the main draw of this place.
Hamilton Pool Preserve
On our last day, we planned to visit Hamilton Pool Preserve, the furthest drive we did from our airbnb at about 45 minutes. This was probably my favorite hike of the trip and the only hike that required reservations in advance. Hamilton Pool Preserve reservations can be made here. We were able to make Hamilton Pool Preserve reservations for a 9 AM slot the day before, but it was also a week day so reservations may be required earlier for a weekend. The Hamilton Pool Preserve contains a historic swimming hole where people can swim, but I would also check in advance if you’re looking to swim as there are dates when swimming is not allowed (determined by water temperature and bacteria level in the water). The hike to the pool is about 30 minutes from the parking lot and can be a little rugged at times, but overall feasible. It is a really pretty hike and the pool preserve itself is beautiful too.
After our visit to Hamilton Pool Preserve, we drove back to Dallas. On our drive back to Dallas, we stopped at Bidermen’s deli, a delicious Jewish-inspired deli for some bagels. As a New Yorker, I am always searching for the best bagels. I have yet to find a NY equivalent bagel in Texas, but this place is pretty good.
Austin has something for everyone, but the Austin outdoors are Texas Hill Country’s best kept secret. It is truly a magnificent place with so many outdoor adventures that await!
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Coffee chat: which masks are best?
It has become increasingly important to upgrade our masks given how contagious the omciron variant is and the recent data suggesting the need to switch to high filtration masks, but which masks are worth investing in? The two most important features we look at our mask quality and mask fit. Studies have shown that the risk of infection increases within minutes for someone who is wearing a cloth or surgical mask compared to someone wearing a well fitted, high filtration mask where exposure would take hours before it became a threat. Of course, fit-tested National Institute for Occupational Safety and Health (NIOSH) approved N95 masks often used by healthcare workers offer the best protection overall, but even non-fit tested N95 masks offer more protection than any other mask. In a study by Lindsley et al. 2021, % outward and inward leakage was evaluated and time to infectious dose for an uninfected person was assessed with different types of masks. It was demonstrated that the N95 is superior to surgical masks, cloth masks and wearing no mask at all. Brosseau et al. 2020 assessed non-fit tested N95s and also arrived at favorable conclusions. For those who may not have access to N95s, KN95s and KF94s offer excellent protection. For specific mask recommendations, check out the mask nerd, Aaron Collins. As an engineer and expert in aerosol science, he does his own experiments looking at filtration efficiency (FE) of various masks and has great videos on youtube with detailed reviews (keep in mind experiments are done on his own face). I took a look at these and put together his top rated masks:
Bluna FaceFit Large KF94 with 99.1% FE
Mask Lab KF Style FFP2 with 98.3% FE
CleanTop Evergreen KF94 with 99.8% FE
LG Airwasher KF94 with 99.1% FE
For smaller faces, mask nerd recommends the BOTN Medium KF94 with 99.7% FE and Dr.Puri Medium KF94 with 98.7% FE
Powecom Black KN95 with 96.8%-98.9% FE
Arun External Nose Clip KN95 with 99.8% FE
With children going back to in person learning all over the country, many parents are wondering what masks are best to help keep their kids safe. @masknerd has a great youtube video that provides some guidance, but I would also add that the best mask for your children is the one they can keep on the longest. Here are the ones recommended by @masknerd:
Blue Tiger Kids KF94 with 99.4% FE
Bluna Kids KF94 with 98.8% FE
BOTN Kids KF94 with 99.3% FE
HappyLife Goodsay Youth KF94 with 99.3% FE
Now that we have established what kinds of masks are necessary to keep us well-protected, we should expect the government to increase production of these masks, make them widely available and free for all! #maskup #maskswork ##maskmandates #covid19 #doctorsofinstagram #physiciansofinstagram
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Why I started this blog
Hi! My name is Jessica and I’m a native New Yorker, currently living in Dallas, Texas where I work as a practicing neurologist. While I have many interests outside medicine including writing, reading, traveling and discovering new restaurants and coffee shops, the main impetus for starting this blog was to have a place to express my passion (and sometimes frustration) about social, political and health issues. When George Floyd was murdered and many people were expressing their outrage and showing solidarity with #Blacklivesmatter, I noticed that some influencers and those in the public sphere stayed silent or made half-hearted statements that did not add anything of value to the movement or the conversation. That irked me. Similarly, the COVID pandemic has affected us all yet, you wouldn’t know that looking at the social media accounts of some public figures. As someone in healthcare who has witnessed firsthand how COVID has affected patients and uprooted our hospital systems and also experienced the personal struggles of raising a baby and keeping my family safe, I felt it was important to be in the conversation. I decided to be more intentional about who I follow on social media and cleansed my social media of accounts that did not use their platform to advocate for social issues. I follow many accounts that are focused on food, fashion, travel, beauty etc. because those things are all parts of life, but I think we are all multi-faceted and can discuss where to get the best latte while also discussing topics like voter suppression. This may not be everyone’s cup of tea (or coffee) and that’s okay, but I hope we can move towards a space where more influencers and those in the public domain utilize social media to create change on deeper levels.
