Last day of my western sojourn. So far, no disasters. Mask wearing in Rapid City is about one-third or less of the level in the Twin Cities. Even less elsewhere. Don’t understand why the area isn’t inundated in cases. Of course parts of the media are trying to lie about that. When I return, I am going to write up a five-state analysis of testing levels, cases, etc. over the last couple of months. I already know what it says because I have looked at the numbers. It is a swell at most. And it may already be receding. Where will the panic come from next?
An important study in the ongoing testing discussion. This paper compares PCR and antigen testing with culture positivity and infectiousness. (Medrxiv Paper) The authors indicate that PCR testing is incapable of distinguishing viable virus from fragments, but that antigen testing results track the natural course of infection and avoid that issue. Comparing the two tests on 38 PCR positive samples, the researchers found that the antigen test treated as positive almost all the true viable virus samples found positive by PCR, but not the PCR positives which did not culture viable virus. The population prevalence for the overall study was 11%, the positive predictive value of the antigen test was 90% and for the PCR test only 74%. That is a lot of false positives. Sounds to me like we should be switching to antigen testing. Oh, but that might not facilitate panic.
Another in a series of studies finding lower population immunity levels resulting from heterogeneity. (Medrxiv Paper) The factors they included were studied at a county level and included variability in contacts, susceptibility, infectiousness and resistance to infection, which included assumptions about levels of cross-reactive T cells. They found population immunity levels varying from 34% to 47.5%. I will say again that these are much more sophisticated models than the ones relied on by people like Dr. Fauci and Dr. Osterholm, who disgracefully have allowed themselves to become woefully out-of-date and stubbornly anachronistic in regard to the research. This paper is very understandable and worth a read.
Speaking of pre-existing T cell response, this author examines whether they may have an effect on mortality. (Medrxiv Paper) The author purports to correlate levels of T cell response from prior CV infections to mortality and notes the importance of this finding for population immunity considerations. However, due to the limited number of T cell surveys, only five countries could be compared and relatively limited data for each country exists. I believe pre-existing response is important to consider but we need more and larger surveys.
Another couple of articles in the Journal of the American Medical Association discussing the need to open schools and the damage being done to low-income children in particular by how they have been treated during the epidemic. (JAMA Article) (JAMA Article) Both cover ground well trod by this blog before, but it is a good trend that so many people are speaking out about this harm.
Here is one thing you won’t hear the state talking about–how much damage the lockdowns have done and are doing to the health system. Here in Minnesota, one of our largest systems is laying off 900 workers, closing 16 out of 56 clinics, shutting one hospital for good and cutting services at others. (Hosp. Article) I am sure that really improves access and quality of care. But hey, those providers and clinics were probably giving care to non-CV-19 patients, who don’t count.
This is a lengthy Google doc with a variety of issues discussed by several noted researchers. (Google Doc) Useful information. Note that there is a strong inference that aerosol transmission is significant. While the authors present information that clearly shows a mask isn’t going to be effective at preventing aerosol transmission, they still insist that wearing a mask is important. If you have the time, the document is worth reading. And if you want even more, you can watch this video workshop from the National Academies of Science and Medicine. (Video)
And another study on airborne transmission. (Science Article) Again, these authors note that aerosol, or small particle transmission, is probably predominant. Still avoiding the obvious conclusion regarding masks.
This paper identifies risk factors related to CV-19 infection. (Medrxiv Paper) The study starts out with a serious flaw because it assumes that dividing the apparent fatality rate in a country by the apparent case rate in a country gives a valid comparable mortality number. That ignores the known and wide variation in testing policies and in antibody survey results. They then attempt to correlate infection and mortality rates with various factors, but the earlier noted flaw leads to warped conclusions like age having less to do with mortality than any other study suggests. They also claim to find that obesity and other pre-existing disease is not correlated with mortality. A disappointing study.