I would like to note that we are seeing slight case rises in a number of southern states just around the time we would expect to based on last year’s surge in those states. Some of those areas have low vaccination rates which could lead to greater increases in cases. So far, the case increases haven’t caused much in the way of hospitalizations or deaths. And while some people attribute the increase to the Delta variant, I believe that is erroneous; we would have seen that increase regardless of the predominant strain. Seasonality is real, don’t know the exact formula, but it is real.
I want to make a brief comment also on vaccinations and vaccine hesitancy. There is a myth that Republican men, especially in rural areas, are the primary holdouts. That is not true, the groups with the lowest vaccination rates are African-Americans and young, healthy people. Make up whatever reason you want for that but it isn’t lack of access, with all the “equity” bullshit baked into vaccination drives. And the distrust of government caused by the abysmal response to the epidemic, the failure to be honest and transparent with data and to represent the research accurately, coupled with a sensationalizing media that harps on every potential issue with the vaccines while at the same time trying to guilt those who then have some hesitation; that distrust is the real driver of the stalling of vaccinations. So the governments have no one but themselves to blame.
And speaking of distrust of unsupported government mandates, the American College of Physicians issued its sixth update on its review of the evidence to support masking, and guess what, still no evidence of clear benefit. (ACP Article)
When I put together that presentation on the epidemic, I tried to show people the micro and the macro view and help them understand how they fit together. At the micro level I tried to explain that people are constantly encountering pathogens and fragments of pathogens and that if you tested them at any particular time, you might get a positive result but it wouldn’t mean they were infected in the sense of harboring replicating virus. Here is a study from Germany in which a soccer team was tested regularly, identifying a number of asymptomatic infections. About 10% of these individuals did not develop an antibody immune response indicating that the “positive” test was just picking up transient virus or fragments in their respiratory tract. (Medrxiv Paper)
And this paper supports the finding that people vary widely in their viral loads and infectiousness, probably due to varying immune response. (Medrxiv Paper). The researchers did daily testing of 60 people with both symptomatic and asymptomatic CV-19 for two weeks. Viral loads peaked in saliva before it did in nasal passages. There was a 30-fold variation in viral load across individuals and the authors believe the results help explain the super- spreader phenomenon. Over 15% of those tested had only minor, inconsistent levels of virus, again indicating the over-sensitivity of PCR testing. There was no meaningful difference in B117 and other strains, again supporting the notion that these variants are not more transmissible. On around 7% of all tests a positive PCR test was not matched with a positive viral culture. In fact, the average person appeared to have viable virus for only a few days, far fewer than the 10 or 14 used for a quarantine period.
This study from China traced the first set of cases with the Delta variant in the country. According to the paper viral loads at first positive test were 1000 times higher than in the original CV-19 strain, but I wonder if front-loading, or the susceptibility of the most vulnerable, is the reason. (Medrxiv Paper). And if viral loads are highest early on, then greatly enhanced testing programs may also be responsible. Another side note is that cycle numbers above 30 never found viable virus by culture.
Here is another study on the actual prevalence of infections in the US. (JID Article). A national random sample was used and over 4500 persons responded. The study covered the period through October 2020 and estimated national prevalence at 12%, which at that time would yield a detection rate of only 17% of infections being found and reported. So actual prevalence was 6 times that reported.
And a paper from Sweden suggesting again that relatively low levels of infection prevalence may substantially slow transmission, most likely because a high percent of the population already has effective immune defenses against CV-19. (Medrxiv Paper).
This paper notes the obvious, the terror campaign reduced a lot of hospital use, often for necessary care. (SD Paper)