As usual, an observation or two first. I don’t know what happened somewhere around the start of October, but the state really accelerated its CV-19 death reporting. There is now very little lag between the state’s reporting and it showing up on the CDC site. And deaths are not being added more than three weeks back at the CDC site. This is a dramatic change especially from late spring and summer, when deaths were routinely being added months back. Why the change? Maybe a desire to keep deaths looking as high as possible before the election. Maybe a desire to get them cleared now, so they aren’t reporting a large backlog when they claim success from their wonderful responses to the epidemic. Don’t want to be paranoid, but with the messaging mentality of this administration, have to think those are possible explanations. And meanwhile, as the answers to Scott Johnson indicated, they are slowing processing of other death certificates.
The active case analysis continues to show turnaround was in the November 7 to 10 area. If you look at the active case curve, and I will have an update in the next couple of days, taking out the sawtooth weekend effect, it is a purely classical unmitigated epidemic curve. Go back to the Minnesota model and you will see this curve in the version with no attempts to slow spread. CV-19 doesn’t care what we do to slow transmission when we are in that narrow environmental niche it seems to thrive in. I am going to wait another week or and give myself a gentle pat on the back for oh-so-tentatively calling the peak. Very courageous of me.
And go to the table of cases by specimen collection date and look at Thanksgiving, the 26th. Couldn’t have a clearer demonstration of the effect of testing on cases. Somehow, no one got sick or felt sick on Thanksgiving. Look at that, over a week out now and less than 200 cases.
More and more evidence coming out on the health harms caused by the media and political campaign of CV-19 terror. The media should be held liable for these damages. Here is a study from the Journal of the American Medical Association finding that children’s appendicitis treatment has been delayed, causing far more serious consequences than if treatment were sought promptly. The primary reason for the delays was fear of coming to the hospital during the epidemic. (JAMA Article)
More good news that Governor Walz, other Governors and the media can take responsibility for. Cardiac arrests for drug overdoses were up very substantially, from 50% to 100% more, during the epidemic, according to data from emergency services activations. (JAMA Article)
A very interesting study from Korea, sent to me by a reader, regarding indoor transmission in a restaurant. (Korea Study) The authors supposedly traced transmission from an index case sitting about 15 and 20 feet, respectively, from two infectees, one who had only a five minute exposure and one about a 20 minute exposure. The air flow in the restaurant was in the direction from infector to infectees. It is unlikely this was large or medium size droplet transmission, it almost certainly had to be aerosolized, although the authors leave open the possibility of larger droplets.
A paper written largely by CEBM authors again covers the extent to which PCR tests actually reveal viable virus and indicate that a person may be infectious. (CID Article) The researchers reviewed 29 studies, which collectively led to the conclusion that there is a strong inverse relationship between PCR test cycle number and likelihood of presence of actual viable virus. Higher cycle numbers rarely find viable virus. In addition, viable virus is rarely found is specimens beyond 8 days from symptom onset. The authors strongly suggest that anyone doing PCR testing must validate the correlation between cycle number and viable virus for the test.
And thanks to an answer to a Scott Johnson question, I found this very illuminating article on hospitalizations in Minnesota. (MM Article) The research covered medical review of 3751 hospitalizations in the spring and early summer. A number of things will catch your eye. 30% ended up in a ICU, probably because of excess use of mechanical ventilation, which would not occur now. 30% came from congregate care settings, very disproportionate to cases overall. 78% had at least one underlying health condition. Median length of stay was 5 days. Median length of stay in the ICU was 29 days, which is astounding. Median days from symptom onset to hospitalization was 6 days. 11% of cases had no symptoms on admission, which means they weren’t admitted for CV-19 but tested positive on admission. The largest subset of these was pregnant women. The state has to give us the data on patients who either are first tested and are positive for CV-19 when admitted for another reason and those who acquire CV-19 in the hospital. 13% died while hospitalized. The median age of those who died was 74. As the article notes, this number would have been even higher except for the presence of advance directives in very old persons.