To start, a couple of pieces in regard to lockdown harms. The Lancet has a brief piece of research showing how alcohol abuse has increased and people who were abstinent fell off the wagon at an increased rate during the lockdown. (Lancet Article)
Cancer is being diagnosed at a much lower rate during the epidemic, again certainly due to scaring the crap out of people about seeking medical care. (JAMA Article) The authors compared newly diagnosed cancer during the epidemic compared to earlier periods for six common cancers. Overall, cancer diagnoses were down 46%, which is astonishing. Cancer hasn’t stopped. This means people are going to be diagnosed later and have worse outcomes.
Depressed yet, how about some missed care by children? These researchers looked at ER use by children during parts of March and April of this year versus the same time in 2019. (Medrxiv Paper) There was a 90% reduction in visits to the ER by children in this period. The children who did show up were younger, more likely to be admitted, more likely to come by ambulance and sicker. Since some patients likely represented coronavirus concerns, the fall in visits largely reflected other issues. Another example of missed care, and some, if not most, had to have been needed.
Okay, so some positive news, again on immune responses. (Medrxiv Paper) In this study the researchers were looking for mucosal antibodies to the spike, receptor binding and nucleocapsid proteins, as well as ones in the blood. For respiratory infections, the mucosal layers in the upper respiratory tract are the first lines of defense. They found persistent antibodies over a three plus month period in both the blood and the mucosal areas, and the levels were correlated. Antibodies appeared strongest in regard to the spike protein.
Next, a paper on viral load in asymptomatic versus symptomatic patients. (JAMA Paper) I don’t want to get too technical but the typical infection test relies upon some called a PCR process, that basically relates to how quickly virus RNA (changed to DNA in the test) increases. The faster it increases, the more virus and the higher the viral load, presumably. But also recall that these PCR tests are not only picking up live virus but viral fragments, and the test can’t tell the difference. So a positive test doesn’t tell you anything about infectiousness. These researchers from South Korea used 303 people being held in a community treatment center and compared viral loads among patients. 110 were initially asymptomatic and of these 21 developed symptoms during isolation. So 81% of patients stayed asymptomatic. PCR testing indicated that viral loads overall were similar initially but decreased faster for certain genes in asymptomatic patients and vice versa for other genes, but the authors believe the latter result was due to viral fragments. The authors also noted the limitation of not identifying live virus capable of replication.
Finally, who knows what the case fatality rate for coronavirus is, but a lot of people seem to care. As we explained early on, there is a massive denominator problem–no one has any idea how many people have really been infected. The authors in this paper tried to estimate a case fatality rate. (NBER Paper) The authors attempted to solve the denominator problem by using antibody prevalence studies from six locations to create a model of actual infections, and then apply that to other locations. They found, which everyone now knows, that the percent of people who are infected and subsequently die is heavily determined by age. Their numbers are for ages 34 and under, .01%; 35 to 44, .o4%; 45 to 54, .2%; 55 to 64, .7%; 65 to 74, 2.4%; 75 to 84, 8.9% and 85 plus, 36.8%. I think those are more realistic than what we often see, but still too high, especially based on recent trends.