admin COVID-19

Covid testing for travel: FAQs

1. Do I need a PCR or antigen test to travel? The rules are subject to change at any time so check with the government website of the country you are traveling to and get up-to-date advice before booking your test. Here are some  useful links:

 

2. Are Atlantic Clinic Covid tests valid for travel? Yes, our tests satisfy the requirements of the World Health Organization for sensitivity and specificity for travel abroad.

3. Will I get a certificate? You will be given a certificate in English either by email in pdf form or we can print off a hard copy for you.

4. If there is any problem with my certificate is there someone I can talk to about it? Yes, there is somebody available to resolve any problems 24 hours a day: call the clinic number +34 952 81 7425

 

 

admin COVID-19

Covid Vaccination for ex-pats and foreigners


Even if you are not registered in the Andalucian Health Service you can now receive the Covid vaccine. Here’s how:

  1. Download the application form in Spanish by clicking here.
  2. We have provided a translation in English below.
  3. Fill out the form and take it to your nearest health centre (Ambulatorio). See below.
  4. Remember to bring your identification document (eg passport).
  5. Once entered onto their database you will be contacted when it is time for your vaccine.

Translation of application form (in red)

Finding your nearest health center

  1. You can search for a health center near to you by clicking here 

The site is in Spanish, but an example of a search for health centers in Marbella is shown below.

 

 

 

 

Dr. Anthony Crichton-Smith- GP

admin COVID-19, Vaccines

Covid-19 vaccination for foreign residents in Andalucia

If you are a foreigner residing in Andalucia you are eligible for Covid vaccines even if you are not currently registered with the Andalucia Social Security health system. 

You will need to first ensure that you are empadronado or registered as a resident in the town hall for a minimum of 3 months, and obtain a certificate of empadronamiento (which is valid for 3 months). 

If you are a pensioner you will need the document S1 from your home country.

With these documents, and your passport and residence document you can obtain a tarjeta sanitaria or health card from your local ambulatorio (health centre). You will then be included in the vaccination programme and will be contacted (usually by phone) when your appointment is due.

The Junta de Andalucia (the regional government) recommends contacting the consulate of your country of origin for further advice on how to be included in the vaccination programme.

 

I am not a resident in Spain, can I get vaccinated here?

At present non-residents are not being offered vaccination. 

 

How safe is the vaccine?

To date more than 150 million doses of the vaccine have been given worldwide, and side effects have been very closely monitored.

The usual side effects common to most vaccines have been identified. These are generally mild such as a sore arm, tiredness, headache or aching joints for a few days. The very rare occurrence of a serious allergic reaction (anaphylaxis) is also a feature of all vaccines. No long-term complications have been reported.

 

Can I be vaccinated privately?

At present, the vaccines are exclusively controlled by the Andalucian Social Security health system and cannot be obtained elsewhere in Spain. 

During this season’s influenza vaccine program the flu vaccine was initially only available only through the Andalucia Social Security health system and later on was also made available through some private clinics.  

So far we have no information as to whether the same policy may be applied to Covid-19 vaccines. In the light of this it is recommended to have the vaccine through the Social Security health system if you are eligible. Should the situation change you will be alerted via this blog or by email if you are included on our waiting list.

 

Can I choose which vaccine I have?

Vaccines are given according to availability at the time, and you cannot choose. 

 

I have had Covid-19 infection. Do I still need the vaccine?

Most people who have had the infection will probably have some immunity for at least 8-10 months although it is not yet known if it may last longer. There have also been cases of reinfection after having recovered from the illness, so immunity is not guaranteed.

It is very likely that vaccination will provide a better and longer lasting protection than the infection itself and vaccination in these people seems to be equally safe.

The current guidelines in Spain recommend vaccination for those who have had Covid-19 infection (and do not have any contraindications) with the following conditions:

  1. Anyone over 55 yrs should receive the normal vaccination scheme after they have recovered from the Covid infection and at least 14 days from the start of the illness.
  2. Anyone in a high risk group such as health care professionals, carers of vulnerable people etc should receive the normal vaccination scheme after they have recovered from the Covid infection and at least 14 days from the start of the illness. 
  3. Those aged 55 or less (even if they have risk factors) need only 1 dose which should be delayed until 6 months after the diagnosis of the infection.

 

Once vaccinated do I still need to take precautions?

It is not yet known if vaccinated people could still become infected without symptoms and unknowingly pass on that infection to others. 

It is also not known if new variants of the Covid-19 virus could cause illness in those already vaccinated. For these reasons the same precautions should be followed as for those unvaccinated.

 

Does the vaccine protect against the new UK variant of the virus?

Based on the data available so far, the currently used vaccines are effective against this and other strains that are commonly circulating in Europe

 

After I get vaccinated will Covid-19 tests show up positive?

The PCR and antigen tests will not show positive due to the vaccine (but could be positive due to a new infection).

Antibody tests may show positive and indicate a state of immunity. The ELISA  antibody is recommended in this case. Click here for more information about Covid-19 tests

 

I suffer from allergies. Can I have the vaccine?

The only absolute contraindication (must never be given) to the Pfizer, Moderna and AstraZeneca vaccines is a previous history of severe allergic reaction (e.g. anaphylaxis) to a component of that vaccine.

Examples are allergy to; polyethylene glycol (in the Pfizer and Moderna vaccines), and polysorbate (in the AstraZeneca vaccine).

A relative contraindication is giving the vaccine during pregnancy (that is to say the vaccine should be avoided, but in special circumstances may be given). This is not due to any known problems in pregnancy, but rather to a lack of sufficient data to be sure it is safe. Those at high risk of Covid-19 may be offered the vaccine after discussion with their doctor.

It is no contraindication (can be safely given) in the case of;

  1. Allergies to different components of other vaccines which are not present in the Covid-19 vaccine. 
  2. Food, animal, insect, environmental, latex or other allergies.

 

 

 

 

Dr. Anthony Crichton-Smith- GP

 

admin COVID-19

Surviving Covid at home

What to do if you have Covid 19 at home?

Having just been through the experience with all my family, here are my tips on staying safe:

  1. Isolation. Once someone in the family is suspected or diagnosed with Covid that person and all close contacts must isolate. Ideally this means confining an infected person to 1 room with a separate bathroom and leaving meals outside the door for collection. Dirty plates must we washed with care, and any waste put in 2 plastic bags before being disposed of.
  1. Test the rest of the household even if they have no symptoms. PCR test picks up the disease earliest, or an Antigen testing which is cheaper and faster. Check with your doctor which is most suitable according to your circumstances. If you all end up positive, at least you no longer have the chore of 1 or more family members confined to a room.
  1. Prepare. The first few days are often relatively mild, so use this time to order supplies on-line, ask a friend to bring round medication like Paracetamol or Ibuprofen, do any reorganization for work like setting up a home office. Any deliveries of course must be left at the entrance with no contact with the occupants.
  1. Medical equipment. Especially if anybody is at risk because of age or other health problems make sure you have an infra-red thermometer (contactless), and I recommend a blood pressure monitor (upper arm, not wrist) and pulse oximeter. You can buy these from pharmacies or on-line. Don’t rely on phone apps or smart watches, which may not be reliable enough. With these 3 pieces of kit and video access to your doctor you can do a pretty effective monitoring of everybody’s health. 
  1. Day 5 deterioration. It is common for patients to feel worse around day 5 to 7. If you have some meals already prepared/frozen you will be glad not to have to cook.
  1. Symptom relief. 
    1. Paracetamol or Ibuprofen is best for fever and muscle and joint aches and pains.
    2. Cough: Try honey (if over 1 year old) or if distressing, a codeine based cough medication may be helpful, on the advice of your doctor. Avoid sleeping on your back if possible.
    3. Keep well hydrated. It is easy to forget to drink if you are sleeping most of the time. Your urine should be pale in colour. If dark, you may be dehydrated.
  1. Monitor. Those at risk or who deteriorate need close watching. The warning signs that indicate medical advice may be needed are shown in the table below. Green values are reassuringly acceptable.  The more abnormal readings there are, and the closer to the red end, the more serious the situation may be. An isolated abnormal reading can be repeated to see if it persists. Take into account the general trend. If things are getting progressively worse contact your doctor. Don’t delay or think you will wait until the morning because sometimes changes happen fast. It is a good idea to have a written record of your readings to send to him. Another important warning sign is any confusion or reduced level of consciousness.
Hi risk Low risk Hi risk
Breaths/min at rest <9 9-11 12-20 21-24 >24
Oxygen % at rest <92 92-93 94-95 >95
Temp. ºC <35.1 35.1-36 36.1-38.0 38.1-39 39.1-40 >40
Blood pressure (upper reading) <91 91-100 101-110 111-140 141-180 181-220 >220
Heart rate/min. <41 41-50 51-90 91-110 111-130 >130
This table is just for guidance and only applies to patients 16 years or older. It is not a substitute for medical advice
  1. What about antibiotics, Ivermectin, steroids, antivirals…..?
    1. Many patients feel a pressure to do something more active to fight the infection and request all kinds of treatments they may have read about “just in case”. For patients not needing admission to hospital there is at present (Jan 2021) no good evidence to support giving these medications as a preventative or treatment for Covid 19. It is important to be guided by the science and not by wishful thinking based on inadequate evidence.
    2. Vitamin D deficiency has been linked with poorer outcomes in Covid 19 infections. That doesn’t mean that taking extra vitamin D will help you if you are not deficient, but it is a good idea to ensure you have enough. Diet and sunshine are natural sources or supplement if your doctor advises.
  1. Ending isolation. If all goes well you can end your isolation if the following conditions are met (for Spain):
    1. At least 7 days have passed since a positive test or since the last contact with a positive Covid person
    2. AND you have been at least 3 days with no fever without taking any fever-lowering medication (eg. Paracetamol or Ibuprofen).
    3. AND your symptoms have significantly improved.
  1. Retest. If you want to confirm that you are no longer infectious (especially for example if you will be in contact with vulnerable people) ask for an IGG ELISA antibody test. If positive, you have developed antibodies and are not contagious, irrespective of your IGM or PCR result. 

Equally valid is a negative PCR test. But even if the PCR shows positive you may still be in the clear: ask for the cycle threshold  (ct or umbral de ciclos). If above a certain value it means the viral load is too low to be contagious.

 


 

 

 

 

Dr. Anthony Crichton-Smith- GP

admin COVID-19

Covid antigen / flu test combined.

The laboratory at Atlantic Clinic has acquired a new clever piece of kit that will test for Covid antigen and influenza antigen on the same sample, and at the same price as the original Covid antigen test (45 euros, 45 euros on weekend/out of hours).
The results are ready as quickly as 15 minutes (sometimes a little longer when there is a heavy workload).
This is especially useful over the winter months of the flu season when it may be difficult to distinguish between the 2 types of infection.

Book a test

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admin COVID-19

Same-day PCR test

Atlantic Clinic has just acquired the latest PCR equipment which can give a same day result.

 

Our prices for Covid 19 tests have also fallen:

-Same-day PCR: 85 €

–Antigen test (nose swab) 15 mins: 45€

–Antigen test on weekends/ out of hours (nose swab) 15 mins: 45€

–ELISA antibody test (blood sample) same day: 95€

 

Book a test

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To find which test is best for you click here.

To book your appointment, please call 952 81 7425

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admin COVID-19

New Antigen test for Covid-19

This test has just become available in Spain and has several advantages

  1. Rapid: It is as fast as the rapid antibody test, and faster than the PCR test. The results are ready from about 20 minutes of taking the sample.
  2. Early detection: it can detect Covid-19 as early as 2 day after contact with an infected person, or as soon as symptoms appear until 5 days after symptoms start.
  3. Cheaper than the PCR test. It costs 50 (55€ on weekends/out of hours) euros.
  4. Accurate: Sensitivity is 80-94% and Specificity is >97%  (this satisfies the requirements for intenational travel certification).
  5. It is taken by a nose or throat swab.

Disadvantages

  1. The result becomes negative as the infection clears (after 5 days from the start of symptoms). This may be useful to indicate that a patient is no longer infectious, but it cannot indicate a previous infection (antibody tests are better for this). 

So, which test to have?

      1. To detect a previous infection the ELISA antibody test is the most accurate. A cheaper, faster, but less reliable alternative is the rapid antibody test.
      2. When a PCR test is required for travel or employment, or when cost and rapidity is not an issue the PCR is recommended. At present this is the most accurate method for diagnosing a current active infection
      3. When cost and speed are important the Antigen test is recommended. For example a child may be sent home from school, or an employee sent home from work with possible Covid-19 symptoms, or you have had contact with somebody who tested positive. This test can give a positive or negative result within minutes, allowing that person to either isolate or get back to school/work quickly.

Book a test

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admin COVID-19

How to interpret your Covid 19 antibody results

For Rapid antibody tests and ELISA tests the interpretation is the same.

The ELISA test is considered more reliable and also gives a quantitative figure of the amount of antibody (as opposed to a simple positive/negative result with the Rapid test).

There are 4 possible results:

  1. IgM negative, IgG negative.
    1. There is no evidence of current infection or previous infection.
    2. Remember that it takes a minimum of 4 days from the start of symptoms, or 7 days from exposure to the virus before the antibodies show up positive. This means that the antibody test cannot detect an infection in the initial stages.
    3. If there is a suspicion of recent infection in spite of this result a PCR or Antigen test can be done, or repeat the antibody test after a few days.
  1. IgM positive, IgG negative:
    1. This suggests infection in the early stages of the disease.
    2. The patient is infectious
    3. If the result does not coincide with the clinical picture (for example, if there are no symptoms) it could be a false positive. The result can be confirmed with a PCR test or, if the test was a Rapid antibody test, by doing an ELISA test, which is more reliable and uses a different method.
  1. IgM positive, IgG positive:
    1. This suggests infection in the intermediate stage of the disease.
    2. The patient is considered no longer infectious.
  1. IgM negative, IgG positive
    1. There is recovery from the disease and the patient is not infectious
    2. There may be some immunity to Covid-19, although it is not known yet to what extent and how long that immunity may last. Precautions should still be taken.

Book a test

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admin COVID-19

Covid-19 testing: which, when and why?

There are now 4 types of Covid-19 tests available at Atlantic Clinic: 

  1. PCR  ultra-fast
  2. Antigen test
  3. Rapid antibody tests for IgM and IgG
  4. ELISA antibody tests for IgM and IgG 

Confused?  Here’s what they mean:

 

1. PCR (polymerase chain reaction): 85€ 

This detects the presence of genetic material from the coronavirus.

How?  Swabs (like a long cotton bud) collect mucous from the back of the throat and nose.

Time for result: from 4 hours

When? The test shows positive early in the disease (within a day or so after symptoms begin).

Why? 

  1. To diagnose the illness in the early stages of the infection, or;
  2. For travel when a negative result is a requirement.

Limitations: 

a. After recovery the PCR may no longer be detectable so it is not so useful to diagnose a previous infection.

b. The PCR may persist for some time even after recovery because of residual genetic material leading to confusion over whether a patient is still contagious.

c. The test may be falsely negative if the sample is not taken correctly, or if the virus is not present in that part of the body (it may be only in the lungs, for example).

Book a test

 

2. Antigen test: 45€

45€ on weekends/out of hours

This detects the presence of the virus in an active infection.

How? A swab collects mucous from the back of the nose.

Time: about 20 minutes.

When? The test shows positive as soon as symptoms start or at least 2 days after contact until 5 days after the symptoms start.

Why?

  1. To diagnose the illness in the early stages of the infection or;
  2. For travel when a negative Antigen test is required

Limitations

The result becomes negative as the infection clears (after about 5 days from the start of symptoms). This may be useful to indicate that a patient is no longer infectious, but it cannot indicate a previous infection (antibody tests are better for this).

Book a test

 

 

 

 3. Rapid antibody tests: 60€ 

This detects the presence of antibodies (the body’s defense against the virus) which are produced in response to the infection.

How? The sample is either a drop of blood from a finger prick or a blood sample taken from the vein. 

Time for the result: At Atlantic Clinic the result is ready the same day.

When? Antibodies take at least 7 days from infection or 4 days from the start of symptoms to show up. The IgM antibodies are seen first as the disease progresses. After recovery, the IgM disappears and IgG persists.

Why? 

  1. It is the quickest and cheapest test.
  2. It is most useful for those who have had no symptoms, or symptoms some time ago, (a minimum of 4 days) and would like to know if:
  •  You have had the disease in the past and have recovered, or;
  • You are currently infected and what stage of infectivity or recovery you are in.

Limitations

Not useful for diagnosis in the early stages of the disease (PCR is better). The test only gives a positive/negative result. Generally the ELISA test is preferred (see below).

Book a test

 

 

 

3. ELISA antibody test (enzyme-linked immunosorbent assay) 95€.

This also detects antibodies but uses more sophisticated techniques and needs skilled technicians. It is more accurate than the rapid test.

How?  A blood sample is taken from the vein. 

Time for result: At Atlantic Clinic the result are ready the same day.

When? As with the rapid test, the antibodies take at least 7 days from infection or 4 days from the start of symptoms to show up. 

Why? It is a more reliable test that the rapid antibody test. It gives a figure showing the amount of IgM and IgG (rather than a simple positive/negative result) which can indicate the degree of immunity. It can used to confirm a rapid antibody test result that is in doubt.

Limitations

  1. It is more expensive than the rapid antibody test and takes longer to get the results.
  2. Not useful for diagnosis in the early stages of the disease (PCR is better).

Book a test

 

 

How accurate are they?

The manufacturers quoted accuracy rates for the methods used at Atlantic Clinic are:

PCR:

Specificity and sensitivity 99.999%

Antigen test:

Specificity 100%, sensitivity: 85%, (this satisfies the requirements for international travel certification)

Rapid antibody test:

– IgM specificity 96% and sensitivity 85%

– IgG specificity 98% and sensitivity 93%

ELISA: 

– IgM specificity 97.5% and Sensitivity 82%

– IgG specificity 97.3% and sensitivity 91.2%

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admin COVID-19

How accurate is the Covid-19 rapid antibody test?

The antibody testing at Atlantic Clinic is currently using the Acro Biotech kit.

The American supplier quotes an accuracy rate for the 2 types of antibodies: 

IgM: 92.9% IgG: 98.6%*

However, there are some uncertainties at the moment:

  1. These figures are based on current information. New data is coming in all the time and may refine them.
  1. The usefulness of the test depends to a certain extent on the proportion of people within a given population that has the virus, which is at present unknown. No one knows how many people may have been infected but show no symptoms.
  1. Antibodies take at least 7 days after infection (or after 4 days of symptoms) to show up on the test, so it is not useful in the very early stages of an infection. In these circumstances, where active Covid-19 is suspected, the PCR test is better, which in Spain is normally done in hospitals.

Antibody testing is used to identify those who have been infected for at least 7 days, or have recovered from a previous illness (either with symptoms, or a “silent infection” which went unnoticed). 

*For the technically minded, accuracy is a function of:

Relative specificity IgM 96%

Relative sensitivity IgM 85%

Relative specificity IgG 98%

Relative sensitivity IgG 100%

 

 

Dr. Anthony Crichton-Smith- GP

 

 

 

 

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