Some Morning Reflections

By October 22, 2020Commentary

Maybe if I do this in the morning I won’t get so worked up.  Let us step back for a minute and look big picture.  The virus has re-emerged to some extent in the northern temperate latitudes.  A number of European countries are seeing many more cases.  Partly this is a testing phenomenon.  The cases are overall less severe.  This may partly be better treatment, but again, it is due to testing finding “cases” that would have gone undetected in the spring, and to the front-loading phenomenon of CV-19 attacking the most frail first.  Why doesn’t there appear to be a similar resurgence in Asia?  It isn’t because of a different mitigation approach.  I believe it is likely because the virus was spreading there last fall and winter to a much greater extent than has been reported so that there is much slower transmission now.  And the population has much lower levels of obesity and other health issues that are associated with more severe disease.  But this is an interesting question for further research.

What we really should learn from the swell of cases is that there is some geographic-associated seasonality with the virus and that when it is in a favorable environment, it will spread.  Fortunately, it really isn’t a very lethal pathogen, particularly if we accurately attributed cause of death.  I don’t know how long this infection swell will last, but if it is like the other waves, it won’t be long.  I don’t know why it follows that pattern either.  For whatever reason, transmission slows dramatically after a relatively small number of people are infected in an area.  Of course, we may still be missing a lot of infections, so it could be many more people that we realize.  If the detection rate is still only 10%, as the CDC estimated in the spring, then in Minnesota we would now have over 1,250,000 people infected, or almost a fourth of the population.  That is clearly enough to significantly slow transmission.

Meanwhile, the lack of useful data is very harmful to the public and allows the media to feed hysteria.  Here is my list of the better data and presentation we need and are entitled to:

Infection Testing–give us the distribution of cycle numbers for PCR tests.  Tell us how many times a positive is confirmed with a follow-on test–how many times is the follow-on test negative.  Do a study to identify in real clinic practice the number of false positives and false negatives.  Do a study to culture positives and do your own association of cycle number with culture positivity.

Immune Response Testing–do very sensitive random antibody sampling and do sampling for T cell response, so we know what the true-prevalence is.  Also test for cross-reactive antibodies and T cells.

Cases–don’t just highlight cases “reported” on a day, the most prominent data should be the dates the specimens were collected, so that we have the true picture of cases on the date they were actually identified.  Anything else is misleading.

Contact tracing–tell us the exact results of contact tracing–show us age to age transmission numbers, show us where transmission is actually occurring, show us transmission patterns related to long-term care facilities.

Hospitalizations–in addition to daily admissions, give us daily census.  Give us discharges.  Give us length of stay.  Tell us how many hospitalizations were for reasons other than CV-19 and the infection was just identified in the hospital.  Tell us how many people acquired CV-19 in the hospital.  Tell us the cycle number threshold used by hospital labs.

Deaths–stop doing date reported presentation, only use date of death.  Tell us how many people died with advance directives, meaning they did not want care.  Give us the specifics on where CV-19 is on the death certificate, underlying cause of death, contributing cause of death?  Do a sampling study and chart review to determine how many people actually died because of CV-19.

All of these things I ask for are already done or have been done in other states or countries.  It isn’t hard and when you don’t do it, don’t be surprised that people like me infer some political reason.

 

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