A Head Full of Coronavirus Research, Part 46

A bunch of pretty quick hit summaries.  But here is the quote of the day, from CS Lewis in 1958, expressing concerns about technocratic government planning and controlling our lives.  Sound applicable to today?

“the new oligarchy must more and more base its claim to plan us on its claim to knowledge. If we are to be mothered, mother must know best. This means they must increasingly rely on the advice of scientists, till in the end the politicians proper become merely the scientists’ puppets. Technocracy is the form to which a planned society must tend. Now I dread specialists in power because they are specialists speaking outside their special subjects. Let scientists tell us about sciences. But government involves questions about the good for man, and justice, and what things are worth having at what price; and on these a scientific training gives a man’s opinion no added value. Let the doctor tell me I shall die unless I do so-and-so; but whether life is worth having on those terms is no more a question for him than for any other man. … On just the same ground I dread government in the name of science. That is how tyrannies come in. In every age the men who want us under their thumb, if they have any sense, will put forward the particular pretension which the hopes and fears of that age render most potent. They ‘cash in’. It has been magic, it has been Christianity. Now it will certainly be science.”

First up, more on cycle number for PCR tests and the likelihood of finding infectious virus.  (CID Paper)   The researchers took samples from 195 patients with varying disease severity and cultured the virus.  Positive cultures only occurred in samples with cycle numbers equal to or under 32.  The mean time from symptom onset to culture positivity was 4.5 days.  Inpatients were substantially more likely to have viable virus than outpatients.  One more very good reason not to use cycle numbers above the low 30s as an indication of infectiousness.

More interesting research on viral loads.  (Medrxiv Paper)   The researchers examined over 840,000 PCR test results in the UK from an ongoing random longitudinal survey of households.  Of all the tests, only 1892 of which were positive.  Lower cycle numbers were found in those with symptoms at the time of testing.   A trend toward lower cycle numbers in positive results was correlated with subsequent increases in cases, suggesting a role of higher viral loads.  Cycle numbers under 30 were rarely associated with symptoms.  The authors also noted a very real concern about false positives in such a low prevalence environment.  Using a PCR test with more than one gene appeared to improve identification of true positives.

This is a study of household transmission patterns in Ontario, Canada.  (Medrxiv Paper)  There were 26,152 cases residing in 21,226 households.  Health care workers had lower risk of transmission.  Men were more likely to have secondary transmission.  Larger households were also more likely to experience secondary transmission.  There typically was only one event of secondary transmission per household.  There was far less household transmission in cases where children 19 and under were the index case.  There was basically no evidence of significant transmission from younger people to older ones.

The CDC has a paper on hospitalizations among health care workers.  (CDC Paper)   About 6% of all hospitalizations were among these people, which is not surprising since they obviously can have high levels of contact, but is surprising because they also use masks, other protective equipment and should understand risks better than most people.  About 36% were nurses, about 90% had an underlying condition, and obesity was fairly prevalent.  Median length of stay was four days.  A high percent received an investigational treatment, probably mostly remdesivir.  4% died.

Here is a general website you can visit that is cumulating all the costs of lockdowns.  The price in the third world in terms of starvation and disease is horrifying. It is aptly called “The Price of Panic”.   (Lockdown Harms)

Another study on the effect of terrorizing the population on receipt of health care.  (JAMA Article)  Weekly hospitalization rates for a hospital system in New York were compared for the prime epidemic period compared to two earlier years.  Non CV-19 hospitalizations dropped significantly, by almost a third.  Most of these were for pretty significant conditions, suggesting missed care.

And this study looked at trends in emergency room use from two health systems.  (JAMA Article)  They looked at visits for 5 true medical emergencies, including heart attack, stroke and ectopic pregnancy.  There was a 39% drop in visits for heart attacks at one system and a 26% decline at the other.  Most of the other conditions showed similar declines.  Meanwhile, looking at excess deaths at home, only half are accounted for by CV-19.  The combination of excess death and place of death data is pretty convincing in demonstrating that people are dying at home rather than seek treatment for very serious conditions.

This paper presents mortality trends in Norway and Sweden before and during the epidemic.  (SSRN Paper)   Mortality trends in the prior five years and during the epidemic were studied.  Sweden had significantly greater CV-19 mortality than did Norway, but also had had less mortality during the prior year, especially among the older people who represent most CV-19 deaths.  Sweden’s mortality also declined after the epidemic wave, suggesting mortality displacement.  In total, over the study period there were not significant differences in mortality between the two countries, which had very different strategies toward the epidemic.  The authors suggest that this means less restrictive measures could be taken without changes in total mortality over time.