Coronavirus Chronicles — The Limits of Testing

Back in April, writer Nate Silver made the sensible argument that “the number of COVID-19 cases is not a very useful indicator of anything — unless you also know something about how tests are being conducted.” He speaks of incomplete data, which conceals systemic and logistical problems that are too easily ignored.

For instance, in far too many locations, the medical personnel are being run ragged. Testing gets done as part of the triage process, to determine who needs immediate help the most. Silver points out that the frontline people are not focusing on the creation of a “comprehensive dataset for epidemiologists and statisticians to study.” They are a bit too busy trying to make sure that patients are discharged to home rather than the morgue.

And yet, the resulting numbers are not regarded as best guesses, or as sincere but possibly incomplete efforts, but as gospel carved in stone, with several types of experts eager to provide interpretation. So, what kinds of problems are we letting ourselves in for by tolerating this much slack? Silver wrote,

A country where the case count is increasing because it’s doing more testing, for instance, might actually be getting its epidemic under control. Alternatively, in a country where the reported number of new cases is declining, the situation could actually be getting worse, either because its system is too overwhelmed to do adequate testing or because it’s ramping down on testing for PR reasons.

Yes, the author “went there.” The public relations angle, or spin, is always an important, if unwelcome, part of the news-scape. When spokespeople have ego-inflating authority, and jobs from which they could be fired or unelected, they do not always adhere strictly to the truth. What is the use of hiding from that reality?

But leaving unworthy motives aside, it appears possible to deduce many different conclusions from what are, perhaps, too easily accepted statistics. For instance, here is a fairly mind-blowing bit of news from Imperial College London scholars, who guess that…

[…] the true number of people who had been infected with the coronavirus in the U.K. as of March 30 was somewhere between 800,000 and 3.7 million — as compared to a reported case count through that date of just 22,141.

That estimate, if accurate, would differ from the official count by several orders of magnitude. And, no matter what kind of testing is done, the individual benefit is not enough. This personal matter needs to also be a public health matter. People demand answers from science but resist providing the information needed. A large part of the value of testing is lost unless the accurate and complete numbers are passed along to trained statisticians who know how to extract meaning from them.

Your responses and feedback are welcome!

Source: “Coronavirus Case Counts Are Meaningless,” FiveThirtyEight.com, 04/04/21
Image by Delaware National Guard/Public Domain

Coronavirus Chronicles — Changing Demographics

Generally, in discussions of the COVID pandemic, people like to cite statistics. The big unspoken truth about the statistics, in this particular case, is that they are likely to be highly unreliable, for a stunning array of reasons. This explains how a journalist could report…

So far, 30 million people in the United States have had a confirmed SARS-CoV-2 infection, although the real (unmeasured) number is perhaps as high as 100 million.

If the margin for error can be so enormous in an advanced country like the U.S., imagine the numerical chaos being generated in the rest of the world. Still, Zeynep Tufekci wrote of carefully conducted studies that show “a very low rate of reinfection for this coronavirus: less than 1 percent.” She specified that a large number of subjects were routinely tested, symptoms or no symptoms. If the investigators are to grasp what is going on, that is important…

[…] so we know that vaccines prevented not just symptomatic illness — the vaccine-efficacy rate reported in the trials — but any infection. As expected, those people retain some level of immunity for a substantial amount of time. It’s hard to know exactly how long, because the virus is so new…

That was written back in March, before the Delta variant became a thing, and since then, the whole coronavirus landscape has shifted. In May, the Centers for Disease Control issued recommendations, noting that…

[…] a growing body of evidence suggests that fully vaccinated people are less likely to have asymptomatic infection or transmit SARS-CoV-2 to others. How long vaccine protection lasts and how much vaccines protect against emerging SARS-CoV-2 variants are still under investigation.

In some quarters, the belief was that people who had a SARS-CoV-2 infection attained good natural immunity, and so should not be vaccinated, because the doses were more urgently needed by others, which is reasonable. But at the same time, some experts were saying that protection is strongest for those who are vaccinated, even if they had recovered from the virus and presumably had natural immunity.

Also, there have also been reports of “Long COVID” patients being vaccinated and experiencing improvement, but again, this was before Delta really hit its stride, so the thinking continued to evolve. In the same time frame, for the Miami Herald, Ben Conrack reported that…

[…] the virus continues to circulate throughout Florida, sending increasingly younger people to the hospital at rates that are among the highest in the country.

Hospitals were increasingly occupied by COVID victims in their 30s and 40s, replacing the geriatric patients the medical personnel had become accustomed to. Conrack wrote,

The younger skew for hospitalized COVID patients also follows an earlier rise in COVID cases for working-age people in late March. Public health experts tied that rise in infections to Spring Break tourism.

Dr. David De La Zerda, of the Jackson Health System, noted that these younger patients might not die so readily, but they tended to be sick for three or four months. He told the reporter,

We have a bunch of post-COVID patients and they’re young but their lungs look like a pulmonary fibrosis. We have to start looking at transplants.

Your responses and feedback are welcome!

Source: “The Fourth Surge Is Upon Us. This Time, It’s Different,” TheAtlantic.com, 03/30/21
Source: “Interim Public Health Recommendations for Fully Vaccinated People,” CDC.gov, 05/28/21
Source: “Younger patients causing Florida to have among the highest COVID hospital rates in country,” MiamiHerald.com, 05/07/21
Image by Navy Medicine/Public Domain

Vaccines, Transmission, and Youth

For an unconscionably long time, plenty of people were in denial about COVID-19, and apparently, some still are. But eventually, word started to get around. Yes, adults who appear to be fit and healthy can contract the disease, and even children can get it. A hefty proportion of people suffer from “Long COVID” at this moment, and some of them are children and teens. Young people can definitely transmit the virus. To pretend otherwise is to assert that if swimmers pee in the pool, only the adult urine is unhygienic, which is just silly.

While fully vaccinated people can still have asymptomatic infections, and transmit SARS-CoV-2 to others, they are a lot less likely to do so than the unvaccinated population. All the thought leaders in the field, like Dr. Larry Brilliant, have affirmed that the Delta variant jumps from one person to another much more efficiently than the original brands of COVID-19. It is, in other words, fiercely contagious.

In February, the Centers for Disease Control and Prevention (CDC) said that mask mandates should not be lifted, which was announced on Valentine’s Day as a reminder of how we could show our love for humanity in general by continuing to be cautious about spreading the disease. The CDC said,

Continued adherence to social distancing and face coverings remains especially urgent given the risks posed by new coronavirus variants found to be more transmissible, and possibly more resistant to antibodies, than the original strain.

Early in April, the American Academy of Pediatrics and the Children’s Hospital Association announced that “more than 3.5 million children in the U.S. have tested positive for COVID-19 since the onset of the pandemic, representing 13.5% of all of the nation’s diagnosed infections.” That’s a lot of sick kids, considering that as of that date so many Americans still clung to the belief that children can neither catch nor transmit COVID.

At that point in time, the AAP recommended that anybody 16 years of age or older should be vaccinated, and went on to say,

Once approved, vaccine distribution and access should be supported for all children and adolescents, with particular attention to those disproportionately affected by the pandemic.

By then, both Pfizer and Moderna had started testing their product on children from six months to 12 years old, and Johnson & Johnson was testing its version on adolescents starting at 12. Particular attention was being paid to the potential impact of childhood obesity on children’s vaccine responsiveness.

The U.S. territory of Puerto Rico had cautiously reopened 100 of its 858 schools, with very minimalist hours (two days a week, morning only) and a limited student body (grades K through 3, plus high school seniors). In April, after only a month of revival, this truncated schedule was suspended again for at least two weeks.

(To be continued…)

Source: “Interim Public Health Recommendations for Fully Vaccinated People,” CDC.gov, 05/28/21
Source: “CDC chief warns it’s too soon in U.S. to lift COVID-19 mask mandates,” Reuters.com, 02/14/21
Source: “COVID-19 vaccines in children: Research to guide your news coverage,” JournalistsResource.org. 04/12/21
Source: “Puerto Rico will close schools amid Covid surge,” NBSNews.com, 04/09/21
Image by Jernej Furman/CC BY 2.0

Explainers, Rad and Bad

The previous post mentioned some doctors who face facts about the width and depth of the current global public health problem, and who are very active in fighting misinformation. There are also some disturbingly contrary professional voices out there. One is celebrity doctor Joseph Mercola, D.O. Some people place a lot of importance on the difference between osteopaths and MDs. The main difference is that osteopathy is more holistic in approach, and the practitioners are more “hands-on,” using techniques like spinal manipulation and massage therapy.

Traditionally, osteopaths tended to gravitate to the field of Primary Care (while MDs specialize), though that is less true nowadays. Philosophically, a larger percentage of osteopaths, as compared to MDs, tend to be mavericks of one sort or another.

Dr. Mercola has stirred up controversy before, but in February he attracted intense criticism by saying that the anti-COVID vaccines can “alter your genetic coding, turning you into a viral protein factory that has no off-switch.” This attracted attention to the hundreds of similar articles he has published since COVID came to town. Some call him the chief spreader of coronavirus misinformation online.

A whole different type of oddball

And then, there are the mavericks of another kind — those who serve the greater good with what is sometimes regarded as weirdness. Epidemiologist Larry Brilliant, M.D., who also has a Masters in Public Health, is described by journalist Steve Paulson as…

[…] the doctor who helped lead the United Nations campaign that eradicated smallpox, and for years he’s been warning about another pandemic that could kill millions of people.

Dr. Brilliant was a brand-new doctor in San Francisco during the peace and love era, where he knew Ken Kesey, Timothy Leary, Wavy Gravy, and other icons of the time. With Stewart Brand, he co-founded The Well, one of the first online communities and arguably the most influential of them all.

After traveling on altruistic missions in various parts of the world, Dr. Brilliant visited the revered Hindu holy man Neem Karoli Baba (pictured above), who indicated that Dr. Brilliant should convince the United Nations to take him on as part of its smallpox eradication team. Paulson says,

Over the next few years he helped lead a team of 150,000 people from 170 countries […] to work together to wipe out the last traces of the deadly disease.

“I had the privilege of seeing the last case of smallpox,” Brilliant said. “A young girl named Rahima Banu had completed smallpox in October of 1975 and did not die. That was the last case in an unbroken chain of transmission of killer smallpox that went all the way back to Pharaoh Ramses and beyond, probably 10,000 years.”

This is why he is worth listening to on the subject of the current pandemic.

(To be continued…)

Your responses and feedback are welcome!

Source: “What kind of doctor is a D.O.?,” MayoClinic.org, undated
Source: “The Most Influential Spreader of Coronavirus Misinformation Online,” DNYUZ.com, 07/24/21
Source: The Hippie Doctor Who Helped Eradicate Smallpox,” ttbook.org, 03/27/20
Image by Ken Wieland/CC BY-SA 2.0

Coronavirus Chronicles — More Strange Notions

To some Americans, “compliance” is a dirty word, especially compliance with any rule, or even suggestion, related to preventing the spread of COVID-19. In various parts of the country, public officials who try to do the right thing are met with indifference, if not actual resistance, and even interference and obstructionism. For The New York Times, Noah Weiland wrote,

They are facing new heights of hostility, and new battles are looming over what safety measures schools and businesses should put in place in the fall, decisions the Centers for Disease Control and Prevention has said should be made in consultation with local health officials.

Many agencies and institutions that are meant to serve the public are operating with inadequate budgets and paltry support of other kinds.

A year and a half into the crisis, their battered departments are now struggling to contain the spread of the Delta variant with testing and contact tracing — the best resources, despite their limited reach, in the many places where vaccination rates remain low.

In Louisiana, Dr. Martha Whyte has been trying to save the children, whether obese or otherwise, from the virus — and their parents and grandparents too, along with their teachers and babysitters, and in general, everybody. In that neck of the woods only about 30% of the people have been vaccinated, which is a considerably lower proportion than the national average.

Dr. Whyte speaks at churches and calls on neighborhood residents, hoping to correct misconceptions and motivate people to want the shots. When interviewed by a reporter, she emphasizes the care taken by the team to respect people’s dignity and autonomy by offering a service that can be freely accepted or rejected. A canvasser does not pose intrusive questions like, “Have you had your COVID vaccination?”

“We don’t ask people that,” she said. “That’s not our business. We’re here to ask you, ‘Would you like to schedule a Covid vaccination?’”

Meet ECMO

The previous post mentioned a young man who was not vaccinated against COVID, and caught it in a concert hall crowd, and had to have a double lung transplant. This replacement surgery is usually preceded by a long period of ECMO treatment, which is essentially what laypersons call “life support.” Traditionally, the Extracorporeal Membrane Oxygenation machine does the work of the heart and lungs, keeping a patient alive during open-heart surgery.

Lately, some COVID patients have been maintained by these devices for months at a time. To administer the high-risk, last-ditch treatment requires a ton of expensive equipment and an entire team of intensely trained experts.

Dr. Cleavon Gilman is an emergency medicine physician who uses social media to bring awareness to this phenomenon. He speaks of the respiratory therapist who fell ill in January and spent months connected to an ECMO machine before finally undergoing a double lung transplant in July; the 43-year-old former bodybuilder who held the distinction of receiving Kentucky’s first double lung transplant; the 33-year-old (six months on ECMO, double lung transplant); the 17-year-old (five months on ECMO, double lung transplant)…

And yet, deniers continue to spread the lie that only the elderly and obese come down with the virus, never the young and fit. However, evidence to the contrary keeps on piling up. Young people do catch COVID, and they are getting younger all the time.

A short digression

The demand for gently used lungs is obviously increasing every day. Where will we find donors for all these double-lung transplants? Will the trend lead to an upswing in horrendous crimes, like people being kidnapped and killed to harvest their organs? What kind of monstrous future is being created here?

Your responses and feedback are welcome!

Source: “In Louisiana, Vaccine Misinformation Has Public Health Workers Feeling ‘Stuck’,” NYTimes.com, 07/25/21
Image by bobo615/CC BY 2.0