Something like moron of the week, as multiple Governors berate and blame their citizens for cases surges, with absolutely no evidence of behavior change. Here is the champ. Gov. Steve Sisolak chastising Nevadans this week for their supposed responsibility for more cases: “I’m not going to come back in two weeks and say I’m going to give you another chance.” After the Governor then tested positive on Friday for CV-19: “You can take all the precautions that are possible and you can still contract the virus. I don’t know how I got it.” How about developing a little humility and acknowledging the limits of what can be done to stop spread.
Once more into the breach with a bunch of research summaries. Readers know how I feel about what is being done to children. I am not the only person by far who is distressed by our gutless caving to teachers’ unions and school administrators in being the only developed country in the world to deprive our children of a decent in-person education. This paper describes the likely increased death toll and years of live lost among young people because of school closures. (JAMA Article) The authors estimated that the school closures in 2020 would cause 5.5 million reduced years of life among school-children. Every month of missed or limited school means less educational attainment, which studies show isn’t recouped in later years. That lower educational attainment is associated with lower income and poorer health status. Guess which groups this falls most heavily on? Low-income and minority ones.
More on the unintended but predictable effects of lockdowns comes from Italy, where emergency room visits and percents of deaths at home were studied. (Medrxiv Paper) The comparable time period in 2020 and 2019 was analyzed and an enormous drop in ER visits and hospitalizations occurred. At the same time, deaths at home increased by 43% overall and by 77% for cancer, 80% for diabetes and 33% for cardiovascular conditions. Clearly people avoided care and died at home as a result.
This is a pretty important paper. Another study of adaptive immune response from the oft-studied epidemic in Vo, Italy, which was hard hit in the spring. (Medrxiv Paper) 2200 individuals were tested for CV-19 specific T cells and antibodies 60 days after the first wave. There were 70 PCR confirmed cases among this group. Among those cases 97% had a T cell response and 77% an antibody one. The strength of the T cell response was correlated with disease severity, but antibody response strength did not appear correlated. 45 additional likely cases who did not have a positive PCR test or a positive antibody response were identified by a positive T cell response. This again highlights the importance of the T cell response. And just doing some quick numbers, it would suggest that prevalence surveys that rely only on antibodies missed 71 cases among this group of 2200 individuals or 50% of all cases. The T cell test identified over twice as many cases as did the antibody test. So prevalence is likely higher than antibody surveys alone would suggest.
Another paper examines antibody prevalence in the US and Puerto Rico. (Medrxiv Paper) The authors were looking at an asymptomatic population. Over 100,000 blood samples from life insurance applicants were used up to late September. So not a truly random sample, but a large sample. Prevalence increased from 3.3% in May to 6.6% at the end of the period. The authors extrapolate this to 11 million cases, which I suggest is a low estimate, based on the study immediately above among other factors. The prevalence increase was greatest in the young and lowest in the old. Certain areas which had strong epidemic waves in the spring had slower prevalence growth over the summer.
And these researchers also looked at PCR testing, antibody prevalence and transmission risk factors in a contact tracing study. (Lancet Study) It comes from Singapore where authorities run a very tight ship in general and certainly have during the epidemic. All cases from the early part of the epidemic were contact traced and transmission chains among household and non-household contacts were tracked. 7770 close contacts of 1114 confirmed cases were included. A total of 182 secondary cases were confirmed. The transmission rate among household contacts was 5.9%, for non-household ones it was 1.3%, including work and social contacts. Serology testing revealed that PCR testing based on symptoms missed 62% of cases and that 36% of all cases were asymptomatic. Sharing a bedroom, a vehicle and talking to a case for longer that 30 minutes were associated with greater likelihood of transmission, but not sharing a meal or bathrooms. So keep those conversations short.
This paper comes from Canada and attempts to assess age-specific case fatality rates. (Medrxiv Paper) The authors used stored donated blood samples to determine antibody prevalence and compared those to identified cases and then generated infection fatality rates. You will note that the infection fatality rates have an incredibly large range which tells you the researchers have no real confidence in their results. In any event they estimate prevalence was about 6 times higher than detected infections. They estimate an overall infection fatality rate of .8% which is almost certainly very high. But as is obvious by just looking at the data, the age progression is tremendous, about zero risk for the young to very high risk in the old.
Interesting article in the Wall Street Journal about whether the recent case surge in Europe may have peaked and the extent to which renewed lockdowns may have contributed to the rollover. (WSJ Article)