Here is my only comment on the election–it is embarrassing to live in a country that conducts elections like a third-world nation, no standardization, no rigor in process and security. Completely unacceptable, unless you like seeing rife fraud and abuse of the process, which serves no one well and accelerates the cynicism about our democracy.
More about the disheartening spread of the virus at the day’s coronavirus briefing. One notable item was the continued aimless ramp up of testing with no assessment of either false positive or false negative rates or any showing that doing all this testing is having any effect on transmission. Supposedly the point is to be able to contact trace and get both the index case to isolate and any contacts who might be positive. It simply isn’t making any difference in stopping the spread. The saliva testing which is really being ramped up, is particularly prone to inaccurate results. The media tried to stir up fear about ICU capacity. I said this repeatedly in the spring, if you don’t know hospitals, you don’t understand that there is nothing magical about an ICU bed, especially if you aren’t doing ventilation, which is being avoided now. High rates of ICU capacity and of general hospital bed use are very common, the hospital industry has been pushed to limit expensive excess capacity.
Again the officials were strangely non-threatening. My interpretation is that one of two things is occurring. One is that they know that the IB intends to enact some additional unpleasant and unnecessary lockdown measure shortly, with the rationale being supposed fear of hospital capacity limitations. And I am sure those measures will work just as well as the previous ones–lockdowns, the LTC battle plan, masks, testing and contact tracing. And I have a sense, which I will caution is just a sense and could be wrong, that this will of course occur as we actually are likely near to the peak of the case surge. I base that in part on the length of the prior surges and in part on the numbers of cases, which suggest that in many places, transmission has to slow. The second option is that the IB and crew miraculously came to their senses and decided that the current spread isn’t that dangerous, all things considered, and the wisest option might be to let it burn out, and it will, while doing whatever can be done to protect the most vulnerable. As I said, I consider that to be solely wishful thinking on my part.
Big dump of research in the last two days on the preprint server, so I am doing my usual mid-week scramble to catch up. Just going off on a random ramble through a lot research.
The British Medical Journal observes that perhaps we should be a little more thoughtful about mitigation of spread actions, since they appear to cause other health care and system problems. Really, you are just figuring that out now. (BMJ Article) The economic damage is always accompanied by worsening health, particularly among the poor. They list a variety of harms from terrorizing the population into missing needed care. Just reading them should make a sane politician change course. But the politicians haven’t listened so far and aren’t likely to start now.
And of course what we are doing to children is the most disgraceful aspect of the epidemic response. This paper examined mental health issues among children in the Netherlands during the epidemic and found very large increases in anxiety, depression and other concerns. (Medrxiv Paper)
Another paper on tests. This one assessed performance of a specific antigen test. (Medrxiv Paper) Antigen tests have become more popular because they are faster and cheaper than PCR. But they can still have issues. The test was more accurate in symptomatic than asymptomatic persons and in people with higher viral loads, who are more likely to be infectious. This study found good performance at accurately telling people that they were negative when they actually were, but not so good for telling people they were positive when they actually were. Just what we need, more false positives.
People still are trying to figure out the meteorological factors associated with transmission. This study focused on absolute humidity, or how much moisture is in the air. (Medrxiv Paper) The researchers used mobility data and absolute humidity measurements in every US county to ascertain associations. The counties were divided into ten groups by humidity results. There was a significant negative effect of rising humidity on cases, especially in spring through July. The Midwest, the West and the Northeast tended to have the lowest absolute humidity and therefore saw the biggest negative effect. Mobility increases were associated with increases in cases.
The first of a couple of T cell studies. The design of the first study was creative. (Medrxiv Paper) The authors identified a prospective cohort of over 2800 hospital, police and fire workers in the UK. Only 150 or so were known to have had an infection. T cell counts for responsiveness to spike, nucleocapsid and membrane proteins were assessed. Those with the highest counts also were more likely to have antibodies, indicating actual CV-19 infection. 20 of the uninfected cohort ultimately developed CV-19 infection and they all had low T cell counts. None of the persons with high T cell counts developed an infection. A number of people who had no evidence of prior CV-19 infection had high T cell response, which could be from prior seasonal CV infections. Older people tended to have fewer T cells than younger ones.
This is another paper looking at T cell responses to infection. The authors found that there are T cells responsive to a particular section of the nucleocapsid protein that appear capable of recognizing multiple mutations in that region. (Medrxiv Paper) This is good news. Not good news, although somewhat unrelated, is that Denmark has found a dangerous mutation in the virus causing mink infections. You will recall that all the more lethal coronavirus variations have jumped from animals to humans. I was not being far-fetched when I have said that aggressive suppression efforts could lead to more troublesome strains of CV-19.
Another study trying to identify factors associated with cases and deaths across countries. (Medrxiv Paper) An aging population and fewer hospital beds per capita are associated with higher fatality rates, while degree of urbanization is associated with more cases. One quibble is that they use case fatality rate without any attempt to adjust for testing variation.
This study from Poland examines over 16,000 cases and finds very low severe disease and death rates among those under 40. The rate of household transmission appeared to be about 8% for the youngest cohort, age 19 and under and about 17% for those 80 and over. (Medrxiv Paper)