A Head Full of Coronavirus Research, Part 23

Our briefers just follow the same script every time.  Cases are rising, we are still seeing the effects of Labor Day and school openings, cases are up in children, our neighboring states have increased transmission.  What is rising is testing.  We have no information on the qualitative results of testing.  We have no information on tests by age group.  But I would bet that we are doing a lot more testing of younger people, we are doing a lot more testing of everyone.  By now we all know what occurs next–false and low positives.  Give us the data.

Now here was an interesting piece of data–last year we had over 4000 flu hospitalizations.  Gee, with this terrible CV-19 epidemic, we are at about 7700 supposed hospitalizations.  If we counted flu hospitalizations the same way–test every patient for flu virus and treat every inpatient with the virus as a flu hospitalization, we would have 20,000 flu hospitalizations, or more.  This epidemic looks comparatively bad only because of the way we are handling data, and that is unprecedented.

The PCR testing problems are making big waves, here is the New England Journal of Medicine, probably the preeminent medical journal in the US, saying we need to reconsider what we are doing with PCR testing.  (NEJM Article)   The article points out that use of a test needs to be done in the context of the purpose of the testing program.  Instead of being focused on finding some minute evidence of virus, we should be focused on finding infectious people in time to prevent them from spreading the disease.  (I would dispute even that, most infections simply are irrelevant, we should be focused on infections which might be transmitted to vulnerable people.  Among a student population, for example, the likelihood of that is about zero.)  The authors identify speed to results and low cost as key to this kind of testing program.  PCR testing doesn’t meet these criteria.  They also mentioned the lack of infectiousness implied by most PCR test results, and the subsequent unnecessary quarantining of people.  They recommend widespread use of antigen tests and a massive testing program.  While I obviously agree with their critiques of PCR testing, their proposed solution is absurd.  This simply is not that deadly or widespread a disease (as opposed to a “case”)  to justify that kind of testing.  It only feeds hysteria, adds expense and distracts from more serious problems, like the increasing toll among the population’s health from suppression measures.

The mask mandate has made no difference in cases in Minnesota.  The level of mask wearing in a locale makes no difference in cases.  At the bottom of an updated version of this post (I am dependent on others to incorporate charts, tables, etc. into WordPress) will be a screen shot of a tweet translating a story on masks in Switzerland.  The essence of the story is that some districts in Switzerland mandated masks and others didn’t.  No difference in cases, in fact cases rose in districts with mask mandates as well as those without them.

As you know, I am fascinated with transmission issues and the level of uncertainty around that subject.  This paper from Russia talks about aerosols.  (Medrxiv Paper)   They discuss the general propagation of viruses by aerosols and on dust particles.  Apparently many viruses can be airborne for a while on these particles and travel around corners, up and down stairs, etc.  The authors conducted experiments and built models.  They believe that aerosols can be suspended indoors for some time.  They say that a mask won’t stop those fine particles.  They also note that items like air conditioning which only speed up air flow, could actually make the problem worse.

This study is on antibody durability.  As readers know, there has been controversy about how long antibodies to CV-19 may last.  Some of the issue may be due to the test used.  In this paper the authors used a very sensitive assay and found that antibodies persisted for at least 20 weeks.  (Medrxiv Paper)   Using three different tests on over 800 CV-19 and healthy patient samples, they found good performance of the assays and strong antibody response.  While antibody levels did decline over time, as is typical in viral illnesses, they always remained detectable, indicating presence of a sentinel population.

And this article discusses a specific type of T cell that is responsible for responding to bacteria and participating in viral defenses.   (Science Article)    In moderate and severe CV-19 disease, these T cells appear to decline substantially, weakening the immune response to the virus.  Another piece of the puzzle around severe disease.