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I wouldn’t be surprised if a lot of people testing negative don’t even know which test they had and what that means for them.
An example of a best practice CDC recommends the following (U)
“Employees undergoing testing should receive clear information on:
the manufacturer and name of the test, the type of test, the purpose of the test, the reliability of the test, any limitations associated with the test, who will pay for the test, and how the test will be performed, and
how to understand what the results mean, actions associated with negative or positive results, who will receive the results, how the results may be used, and any consequences for declining to be tested.”
Let’s assume you’re just worried and have a choice between rapid, 15-minute tests and a PCR tests. Which should you get?
At the end of this POST see “Considerations for who should get tested?” and the link to the CDC CORONAVIRUS SELF-CHECKER
To read Posts 1-55 in chronological order, highlight and click on
The TV news shows very long lines of people in their cars, in line for Coronavirus testing. Is this “panic” testing, that is a rush to get tested without knowing which test is being given and is it the right one at the right time?
As part of my recent annual physical I had a Coronavirus test – SARS COV2 S1/S2 AB IGG. It was negative.
From “googling” I found that:
“Results are for the detection of SARS CoV-2 antibodies. IgG antibodies to SARS-CoV-2 are generally detectable in blood several days after initial infection, although the duration of time antibodies are present post-infection is not well characterized. Individuals may have detectable virus present for several weeks following seroconversion…
Negative results do not preclude acute SARS-CoV-2 infection. If acute infection is suspected, direct testing for SARSCoV-2 is necessary.
False positive results for LIAISON® SARS-CoV-2 S1/S2 IgG may occur due to cross-reactivity from pre-existing antibodies or other possible causes.” (A)
So the negative result didn’t give me any useful information. Best I could tell is I had no antibodies.
Next I tried to sort this all out….
“During a “town hall” in the White House Rose Garden aired on Thursday, the president was asked about the outbreak that’s resulted in the deaths of at least 221,000 Americans.
“With COVID, is there anything that you think you could have done differently, if you had a mulligan or a do-over of the way you handled it, what would it be?” asked Eric Bolling, the moderator for the pre-taped Sinclair Broadcasting Network event.
“Not much,” Trump shot back.
“Look, it’s all over the world, you have a lot of great leaders, a lot of smart people it’s all over the world,” he said, adding: “It came out of China. China should have stopped it.”” (R)
“President Donald Trump’s COVID-19 diagnosis is raising fresh questions about the White House’s strategy for testing and containing the virus for a president whose cavalier attitude about the coronavirus has persisted since it landed on American shores…
The Trump administration has increasingly pinned its coronavirus testing strategy for the nation on antigen tests, which do not need a traditional lab for processing and quickly return results to patients. But the results are less accurate than those of the slower PCR tests.
An early Abbott test used by the White House was plagued with problems, with multiple researchers finding that it was less accurate than rival companies’ tests in picking up positive cases. But the new antigen test the White House is using has not been independently evaluated for accuracy and reliability. Moreover, the Trump administration recently shipped antigen tests from Abbott and other manufacturers to thousands of nursing homes to test residents and staff.
Testing “isn’t a ‘get out of jail free card,’” said Dr. Alan Wells, medical director of clinical labs at the University of Pittsburgh Medical Center and creator of its test for the novel coronavirus. In general, antigen tests can miss up to half the cases that are detected by polymerase chain reaction tests, depending on the population of patients tested, he said.”” (B)
“In a flurry of memos released this week and last, the White House physician, Dr. Sean Conley, stated that President Trump no longer posed a transmission risk to others — an assessment, he noted, that was largely precipitated by the results of a bevy of “advanced diagnostics.” The declarations have helped clear Mr. Trump to return to the campaign trail, including a town-hall-style event hosted by NBC News on Thursday evening.
Outside experts have also said that Mr. Trump, who reportedly began feeling sick about two weeks ago, is probably no longer infectious. But most have based such assessments on the trajectory of the president’s symptoms — not the results of his tests.
There exists no test that can definitively determine whether someone who caught the coronavirus is still contagious. “We do not have a test for cure, and we do not have a test for infectiousness,” said Omai Garner, a clinical microbiologist at the University of California, Los Angeles.
Experts have criticized the administration’s overreliance on tests to keep the coronavirus out of Mr. Trump’s inner circle. Now, they said, the White House appears to be leaning too heavily on tests to break the president out of isolation.
Not all coronavirus tests are designed to detect the same parts of the virus. And a negative on one test does not necessarily guarantee a negative on another.
“We don’t just look at these tests in the context of ‘Coronavirus, yes or no,’” said Karissa Culbreath, a clinical microbiologist at TriCore Reference Laboratories in New Mexico. “Each test looks for a different aspect of the virus.”..
Guidelines published by the Centers for Disease Control and Prevention stipulate that symptoms — not test results — should be the primary motivator for ending a person’s isolation. People with mild or moderate Covid-19 should isolate for least 10 days after their symptoms start. That timeline could extend up to 20 days if their symptoms are severe.”(K)
“With nine days until Election Day, the White House again faces the coronavirus in its ranks.
Two top advisers to Vice President Pence have tested positive for the virus in recent days, as Pence — who tested negative on Saturday and Sunday — crisscrosses the country for rallies in swing states as he and President Trump fight to win reelection.
Marc Short, Pence’s chief of staff, tested positive for the coronavirus on Saturday.
Marty Obst, a Pence political adviser, has also tested positive for the virus, according to a person familiar with the matter who asked for anonymity on Sunday to discuss Obst’s health.
The White House says Pence will continue to campaign. He is expected to travel to North Carolina for a rally on Sunday. His wife, Karen, who also tested negative for the coronavirus on Sunday, is slated to travel to the state for a campaign event on Monday.
Short did not travel with Pence on Saturday to rallies in Lakeland and Tallahassee, Fla. Spokesman Devin O’Malley said Short “began quarantine” on Saturday and was “assisting in the contact tracing process.” Aides deemed to have had close contact with Short were pulled from the trip before departure, White House reporters who traveled with Pence were later told.
But Pence — who is considered to have had close contact with his most senior adviser — decided to “maintain his schedule in accordance with the CDC guidelines for essential personnel,” O’Malley said in a statement, noting that Pence had consulted with White House physicians.
The Centers for Disease Control and Prevention’s guidelines for essential workers who have had close contact with an infected person include wearing a mask for 14 days “at all times while in the workplace.”
Pence did not wear a mask at his outdoor rally.” (P)
“White House chief of staff Mark Meadows said Sunday that the US is “not going to control” the coronavirus pandemic, as cases surge across the country and nearly 225,000 Americans have died from the virus.
“We are not going to control the pandemic. We are going to control the fact that we get vaccines, therapeutics and other mitigation areas,” Meadows told CNN’s Jake Tapper on “State of the Union.”
At least 5 people in Pence’s orbit, including chief of staff Marc Short, are positive for coronavirus
Pressed by Tapper on why the US isn’t going to get the pandemic under control, Meadows said: “Because it is a contagious virus just like the flu.” He added that the Trump administration is “making efforts to contain it.”…
“What we need to do is make sure that we have the proper mitigation factors, whether it’s therapies or vaccines or treatments to make sure that people don’t die from this,” Meadows said.” (Q)
“There are two different types of tests – diagnostic tests and antibody tests.
A diagnostic test can show if you have an active coronavirus infection and should take steps to quarantine or isolate yourself from others. Currently there are two types of diagnostic tests which detect the virus – molecular tests, such as RT-PCR tests, that detect the virus’s genetic material, and antigen tests that detect specific proteins on the surface of the virus.
An antibody test looks for antibodies that are made by your immune system in response to a threat, such as a specific virus. Antibodies can help fight infections. Antibodies can take several days or weeks to develop after you have an infection and may stay in your blood for several weeks or more after recovery. Because of this, antibody tests should not be used to diagnose an active coronavirus infection. At this time researchers do not know if the presence of antibodies means that you are immune to the coronavirus in the future.” (C)
“How are COVID-19 tests used?
The RT-PCR, antigen, and other tests that are being developed to detect the presence of the virus can be used for diagnostic, screening, or surveillance purposes. Diagnostic tests are focused on the experience, needs, and history of a single individual and are often used for those with COVID-19 symptoms.
Diagnostic tests may also be used to detect the virus in people without symptoms (asymptomatic individuals), typically after exposure to an infected individual. When applied to a population without regard to exposure history, the tests are considered screening or surveillance tests, which are essential tools in controlling the virus’s spread. The Food and Drug Administration (FDA) has issued standards for when each of these terms should be used and the acceptable levels of sensitivity and specificity for each.
Diagnostic tests are intended to determine with a high level of confidence whether an individual is currently infected with the virus. These tests could be used for individuals who are suspected of having COVID-19 because of their symptoms, asymptomatic individuals who have been exposed to a confirmed case of COVID-19, or individuals in particularly high-risk groups who have participated in large gatherings. Diagnostic tests must demonstrate high sensitivity and high specificity, because the intent is to use those results to make treatment decisions or quarantine recommendations for individuals. Diagnostic tests may be ordered by a health care provider or obtained directly by an individual. Diagnostic tests must be run in a lab that has been certified by the Centers for Medicare & Medicaid Services to be able to run high-complexity tests.
Screening tests are given to asymptomatic individuals for the purpose of making decisions based on that person’s test results. Examples of common uses of screening tests include testing everyone in a nursing home, testing students upon their arrival on a college campus, or requiring a negative test before admitting someone back to an office. In screening tests, all individuals are often told of their results and those individuals who test positive for the virus are typically asked to take additional steps to protect their health and those around them through quarantine or other actions.
Surveillance testing refers to broad, typically nonidentified testing of populations to inform public health actions. Examples of surveillance testing include assaying wastewater or surfaces to detect presence of the virus or testing a large number of people and looking at aggregate results to determine the prevalence of the virus in a community. In true surveillance testing, there is usually no intention to return individual results to those tested.” (D)
“How do medical researchers’ measure the accuracy of these tests?
In the realm of science, there are several ways to evaluate the reliability of tests. Some of the most common metrics are called “Accuracy”, “Precision”, “Sensitivity(Recall)”, and “Specificity”….
A confusion matrix is a table to classify if a single test was accurate or not. The table is split into four grids —
A test accurately predicts if a person has coronavirus (TP)
A test accurately predicts if the person doesn’t have the coronavirus (TN)
A test falsely predicts if a person has coronavirus (FP)
A test falsely predicts if a person doesn’t have coronavirus (FN)…
Accuracy
Simply, accuracy answers out of all the people in the sample, how many people’s tests showed a correct result?
Precision
Precision helps you answer, out of the people that tested positive, how many of those people actually had the coronavirus?
Sensitivity aka Recall
Sensitivity/Recall helps you answer, out of people that had coronavirus, how many of those people tested positive?
Specificity
Specificity helps you answer, how well do you want the test to correctly predict that a person DOES NOT have the coronavirus?
Summary
These are all important questions medical decision-makers have to ask themselves. I’m not sure if all medical tests can be perfect, so if you start seeing news about how these tests are not working correctly. Look back at this article and try to guess what the medical researcher tried to optimize for. If I were a doctor, I would think recall is the most important one even if we have to optimize that metric at the expense of falsely positives — false test results that tell some healthy people they have the coronavirus. Also, news articles will start reporting accuracy numbers. Make sure to understand how reliable these tests are by doing some research yourself.” (E)
“In the high-stakes world of coronavirus testing, one mistake has taken center stage: the dreaded false negative, wherein a test mistakenly deems an infected person to be virus-free.
These troublesome results, experts have said, can deprive a person of treatment and embolden them to mingle with others, hastening the spread of disease.
But false negatives are not the only errors bedeviling coronavirus diagnostics. False positives, which incorrectly identify a healthy person as infected by the virus, can have serious consequences as well, especially in places where the virus is scarce….
Some rapid tests, which forgo sophisticated laboratory equipment and can deliver results in under an hour, have been criticized for returning high numbers of false positives, especially when used to screen people without symptoms. Even laboratory tests that rely on a very reliable technique called polymerase chain reaction, or P.C.R., have been known to return the occasional false positive…
A positive result on a coronavirus test sets off a cascade of consequences. According to guidelines published by the Centers for Disease Control and Prevention, people who test positive should immediately isolate for at least 10 days after their symptoms start (if they experience symptoms at all).
That is 10 days spent away from friends and family, and 10 days of potential productivity in a school or workplace lost….
False positives can also be disastrous from a treatment standpoint, said Linoj Samuel, a clinical microbiologist at Henry Ford Health System in Detroit. People with the flu or Covid-19, for example, often show similar symptoms, but may only be tested for one of them at a time. If a patient is given an incorrect diagnosis of Covid-19, that person could be deprived of treatment that could alleviate their illness, or be given a costly therapy that does little to speed their recovery.” (T)
“At the end of August, the US Food and Drug Administration (FDA) granted emergency-use approval to a new credit-card-sized testing device for the coronavirus that costs US$5, gives results in 15 minutes and doesn’t require a laboratory or a machine for processing. The United States is spending $760 million on 150 million of these tests from health-care company Abbott Laboratories, headquartered in Abbott Park, Illinois, which plans to ramp up production to 50 million per month in October…
Antigen assays are much faster and cheaper than the gold-standard tests that detect viral RNA using a technique called the polymerase chain reaction (PCR). But antigen tests aren’t as sensitive as the PCR versions, which can pick up minuscule amounts of the SARS-CoV-2 virus that causes COVID-19…
The high-sensitivity PCR tests are almost 100% accurate in spotting infected people, when they are administered properly. But such tests generally require trained personnel, specific reagents and expensive machines that take hours to provide results…
A typical antigen test starts with a health-care professional swabbing the back of a person’s nose or throat — although companies are developing kits that use saliva samples, which are easier and safer to collect than a swab. The sample is then mixed with a solution that breaks the virus open and frees specific viral proteins. The mix is added to a paper strip that contains an antibody tailored to bind to these proteins, if they’re present in the solution. A positive test result can be detected either as a fluorescent glow or as a dark band on the paper strip.
Antigen tests give results in less than 30 minutes, don’t have to be processed in a lab and are cheap to produce. Yet that speed comes with a cost in sensitivity. Whereas a typical PCR test can detect a single molecule of RNA in a microlitre of solution, antigen tests need a sample to contain thousands — probably tens of thousands — of virus particles per microlitre to produce a positive result1. So, if a person has low amounts of virus in their body, the test might give a false-negative result.” (F)
“People are getting the results of coronavirus tests in the U.S. faster than they were in the spring, but testing still takes far too long to help with effective disease control measures such as contact tracing and quarantining, according to the results of a large national survey…
Among that group, the average wait time for results was 2.7 days in September, down from four days in April, the researchers found. In addition, the proportion of people getting their results back within 24 hours increased from 23% to 37%.
While that’s an improvement, the turnaround time is still “too slow in most cases to support a successful strategy of contact tracing,” and most people are still waiting far too long, the researchers wrote…
To keep outbreaks from occurring, people who are infected need to be contacted quickly, ideally within 24-36 hours to make sure they don’t infect other people and find out who they may have come into contact with so those people can be told to quarantine and get tested.
In fact, only 56% of those who tested positive were contacted by a health worker to get contact tracing information, the researchers found…
The average person who got tested in the August and September surveys was tested within 2.5 days and waited 3.7 days for the results of the test. That means it took a total of 6.2 days between deciding on a test and receiving results, the researchers wrote.
“So even with the improvement in results, people are waiting about week. And by that point much of the harm that could occur in spreading through that person’s social network has already occurred,” Lazer says. “What you want to do is cut that to within 24 hours to 36 hours.”” (G)
“After struggling to ramp up coronavirus testing, the U.S. can now screen several million people daily, thanks to a growing supply of rapid tests. But the boom comes with a new challenge: keeping track of the results.
All U.S. testing sites are legally required to report their results, positive and negative, to public health agencies. But state health officials say many rapid tests are going unreported, which means some new COVID-19 infections may not be counted.
And the situation could get worse, experts say. The federal government is shipping more than 100 million of the newest rapid tests to states for use in public schools, assisted living centres and other new testing sites.
“Schools certainly don’t have the capacity to report these tests,” said Dr. Jeffrey Engel of the Council of State and Territorial Epidemiologists. “If it’s done at all it’s likely going to be paper-based, very slow and incomplete.”
Early in the outbreak, nearly all U.S. testing relied on genetic tests that could only be developed at high-tech laboratories. Even under the best circumstances, people had to wait about two to three days to get results. Experts pushed for more “point-of-care” rapid testing that could be done in doctors offices, clinics and other sites to quickly find people who are infected, get them into quarantine and stop the spread…
Large hospitals and laboratories electronically feed their results to state health departments, but there is no standardized way to report the rapid tests that are often done elsewhere. And state officials have often been unable to track where these tests are being shipped and whether results are being reported…
One of the challenges to an accurate count: States have wildly different approaches. Some states lump all types of tests together in one report, some don’t tabulate the quick antigen tests at all and others don’t publicize their system. Because antigen tests are more prone to false negatives and sometimes require retesting, most health experts say they should be recorded and analyzed separately. Currently only 10 states do that and post the results online, according to the COVID Tracking Project.
The federal government is allocating the tests to states based on their population, rather than helping them develop a strategy based on the size and severity of their outbreaks.
“That’s just lazy” said Dr. Michael Mina of Harvard University. “Most states won’t have the expertise to figure out how to use these most appropriately.”
Instead, Mina said the federal government should direct the limited supplies to key hot spots around the country, driving down infections in the hardest-hit communities. Keeping tighter control would also ensure test results are quickly reported.” (H)
“President Trump heralded new rapid coronavirus tests on Monday as game changers — fast, cheap and easy to use. But his administration’s deployment of the new tests to nursing homes has been plagued by poor communication, false results and a frustrating lack of planning, state leaders say.
Health officials in several states say they have been allowed no say in where the new tests are being sent and sometimes don’t know which nursing homes will receive them until the night before a shipment arrives. That has left some facilities ill-trained in how to use the tests and what to do with results. And it may be contributing to false-positive test results — when people are identified as being infected but aren’t.
The lack of federal planning also has left states with no standardized way to capture results from the new tests and include them in daily counts of infections and tests. Consequently, as the rapid tests become more widely distributed, the data and dashboards being used each day to guide the nation’s coronavirus response are becoming more inaccurate.
“This is data we need, and there’s just no way of capturing it,” Pennsylvania Health Secretary Rachel Levine said. “We need a reporting structure and not just hundreds of faxes being randomly sent from nursing homes and other facilities.”
Many states are trying to create their own way to capture and classify the new data. Epidemiologists say that piecemeal approach could result in differing data sets, making it harder to pinpoint where infections are growing most this winter when infections are expected to spike.
Fueling such problems, public health officials say, is the White House’s continued refusal to take responsibility for leading the country through the pandemic and to lay out an overarching strategy on testing, instead of repeatedly pushing that onus onto the states.
“It’s the utter lack of planning and guidance that’s creating problems,” said one state official, speaking on the condition of anonymity for fear that federal officials might retaliate by giving the state less aid. “Their approach is to just throw things over the fence to the states and to say, ‘Take this, and deal with the problem.’ ”…
Similarly, Giroir dismissed the lack of a standardized reporting system as a result of the administration moving swiftly to implement testing.
“If we wanted to get everything perfect, we would have waited months to do that. The important thing was to get these out to nursing homes now,” he said. “We’d rather save lives.”
On Monday, after receiving repeated complaints from state officials, the Trump administration said governors will be given more discretion to decide where future test shipments go…
Adding to the confusion, state officials say shipments have arrived with little guidance for those facilities about the circumstances in which the antigen tests can be used most effectively.
“There’s been little national guidance to say, ‘These are the best places to use them, this is what you do under various circumstances if you get positives and this is how to report the data,’ ” said Michael Fraser, chief executive of the Association of State and Territorial Health Officials, which represents state health departments. “We are still waiting to reach consensus on when and where health departments should use these tests.”..
That problem is likely to grow as the new rapid tests become more widely used in schools, doctor’s offices, workplaces and private businesses. Some states don’t report positive antigen test results, resulting in an incomplete portrait of the disease’s spread. Others have begun to categorize them as “probable” rather than confirmed infections.
Companies are developing antigen tests people can take at home. If they become widely available, Americans could administer the test themselves weekly or even daily, experts say. That could be a powerful weapon to stop transmission. But it would be a nightmare for recording data if a nationally standardized system is not established.
Without that data, the country would be flying blind as it navigates later stages of the pandemic, experts say…” (I)
“Twice a week, students at Williams College in Williamstown, Mass., go to a parking garage to blow their noses…
Once the testing site closes each day, Rita Coppola-Wallace , Williams’s executive director of planning, design and construction, gathers the bounty—up to 1,100 test tubes—and loads them into a waiting car. The samples are whisked off to Cambridge, Mass., 150 miles away, and processed alongside tens of thousands of others overnight at the Broad Institute of MIT and Harvard, a biomedical and genomics research center.
A primary reason many colleges in Massachusetts, New York, Maine and Vermont have experienced few coronavirus outbreaks this fall has been frequent, widespread testing. At 108 colleges and universities, that testing is being done within a carefully orchestrated system run by the Broad Institute.
The testing, along with strict, state-level quarantine orders and low levels of community spread in the region, has helped keep infection rates at schools working with Broad below 0.2%.” (J)
“However, Mara Aspinall, a biomedical diagnostics professor at Arizona State University’s College of Health Solutions, makes the case that the U.S. cannot break the chain of transmission if the coronavirus outpaces public health efforts.
What’s needed is a “paradigm shift from exquisitely accurate-but-slow tests to fast-and-good enough to quarantine,” she said. “Slow and accurate works for clinical management, but this virus is a sprinter not a marathoner. We need fast and frequent tests just to keep up.”
That approach has been endorsed by top U.S. health officials, including National Institutes of Health Director Francis Collins and federal testing czar Brett Giroir.
Earlier this month, FDA granted emergency use authorization to BD’s rapid, point-of-care coronavirus antigen test, making it only the second such diagnostic to receive a nod from the regulatory agency… (K)
When it comes to diagnostic testing, “easy, fast, and cheap” is also what the Rockefeller Foundation is advocating to bring tests to the U.S. market at a national scale needed to effectively respond to the pandemic. The organization envisions point-of-care antigen tests costing $5 to $10 per test, with same-day test results for schools and workplaces, and even faster turnaround times for mobile testing in communities.
“Today the country conducts almost zero such [screening] tests, and we need at least 25 million per week for schools, health facilities, and essential workers to function safely,” wrote Rajiv Shah, president of the Rockefeller Foundation, in the organization’s proposed national testing plan.
The U.S. will need at least another $75 billion in federal funding for testing to reach the plan’s goal of 30 million tests per week by October, including at least 25 million fast, inexpensive antigen tests for asymptomatic Americans, according to the Rockefeller Foundation…
However, the Rockefeller Foundation argues that despite testing advancements such as sample pooling, the commercial labs “cannot come close to fulfilling the nation’s screening test needs.”
Lab tests “aren’t convenient, simple, or inexpensive enough to use at the scale needed,” the report says, calling for a ramp-up in antigen testing in schools, offices and beyond.
The Rockefeller Foundation also believes it is critical for the U.S. to look beyond commercial laboratories such as LabCorp and Quest that are overwhelmed and tap the testing resources of other underutilized labs, recruiting academic and other labs.
However, time is of the essence, according to Shah. “We will soon enter a new cold and flu season with potentially 100 million cases of flu-like symptoms that stand to overwhelm our current testing capacity.”” (L)
Michael mina is a professor of epidemiology at Harvard, where he studies the diagnostic testing of infectious diseases. He has watched, with disgust and disbelief, as the United States has struggled for months to obtain enough tests to fight the coronavirus. In January, he assured a newspaper reporter that he had “absolute faith” in the ability of the Centers for Disease Control and Prevention to contain the virus. By early March, that conviction was in crisis. “The incompetence has really exceeded what anyone would expect,” he told The New York Times. His astonishment has only intensified since…
Why has testing failed so completely? By the end of March, Mina had identified a culprit: “There’s little ability for a central command unit to pool all the resources from around the country,” he said at a Harvard event. “We have no way to centralize things in this country short of declaring martial law.” It took several more months for him to find a solution to this problem, which is to circumvent it altogether. In the past several weeks, he has become an evangelist for a total revolution in how the U.S. controls the pandemic. Instead of restructuring daily life around the American way of testing, he argues, the country should build testing into the American way of life.
The wand that will accomplish this feat is a thin paper strip, no longer than a finger. It is a coronavirus test. Mina says that the U.S. should mass-produce these inexpensive and relatively insensitive tests—unlike other methods, they require only a saliva sample—in quantities of tens of millions a day. These tests, which can deliver a result in 15 minutes or less, should then become a ubiquitous part of daily life. Before anyone enters a school or an office, a movie theater or a Walmart, they must take one of these tests. Test negative, and you may enter the public space. Test positive, and you are sent home. In other words: Mina wants to test nearly everyone, nearly every day…
We must out-volume the virus, and what will matter is not the strength of any one individual ship, but the strength of the system it is part of. When the FDA regulates tests, though, it looks at the sensitivity and specificity of a single test—how well the test identifies illness in an individual—not at how the test is part of a testing regimen meant to protect society. For this reason, Mina proposes that the FDA make room for the CDC or the NIH to oversee the use of contagiousness tests. “I think the CDC could potentially create a certification process really simply. They are the public-health agency, and could say, ‘We will evaluate different manufacturers. None of these will be fully regulated by law, but here are the ones you should or should not choose.’”” (M)
The AAMC noted in July 2020, as daily cases were falling, that the United States would need to test at least 2.3 million people per day to decrease the rate of positive tests below 3%.3 Our failure to contain the spread of the virus in the first several months of the pandemic has resulted in a much higher number of tests needed now. The AAMC’s assertion that a pandemic response currently requires 9 million people per day to be tested represents an estimation of the need for immediate testing in the categories below…
Up to 800,000 diagnostic tests are needed for:
Each person who is symptomatic.
Close contacts of every positive case identified (whether symptomatic or asymptomatic).
Over 8 million screening tests are needed for:
Every person who enters a health care facility for an inpatient admission or outpatient surgery.
Routine testing of all health care providers in hospital settings.
Routine testing of first responders (law enforcement officers, paramedics, and EMTs).
Strategic sampling of residents in nursing homes and assisted living facilities.
Strategic sampling of incarcerated individuals.
Strategic sampling of residents and staff in homeless shelters.
Routine testing of every K-12 teacher.
Strategic sampling of K-12 students.
Strategic sampling of college and university students, faculty, and staff.
This is not an exhaustive list of the categories of individuals that should be routinely tested. Additional testing is needed for other essential workers and individuals such as contact tracers, delivery and retail personnel, employees of agricultural and meatpacking businesses, and public transportation employees…
Any testing approach must make a clear distinction between the number of tests needed to determine whether a specific person has COVID-19 for purposes of making further recommendations about that person’s health (diagnostic testing) and the number of tests needed to not only test asymptomatic individuals suspected of being exposed but also to test large numbers of people on a routine basis through screening and surveillance testing. As vaccination increases, those tests may shift to antibody testing to measure population-level immunity levels.
Strategic use of testing technologies means using the most appropriate tests for each purpose. In general, the more important it is to get accurate results for a single test, the more sensitive a test should be. Such tests are often, but not always, more costly and resource-intensive to run. The use of highly sensitive tests for surveillance purposes or less accurate tests for diagnostic or critical screening purposes could be misdirecting resources and could have negative impacts on individual or public health.” (N)
Fast at-home coronavirus tests could help bring the United States’ surging outbreak under control — if companies developing the tests can convince regulators that the public can be trusted to use them correctly.
Several firms are vying to be the first to market a test that Americans could buy over the counter with results delivered in minutes at a bedside or a breakfast table. That could allow people to screen themselves before heading to the office or school, relieving pressure on overburdened testing laboratories and quickly identifying new infections.
But concerns about the tests’ reliability, how consumers might react to their results and how public health departments will track them have slowed their development.
Companies formulating such tests say they won’t seek emergency authorization from the Food and Drug Administration until later this year or early next — in part because the agency wants them to prove that adults of different ages, education levels and English proficiency can successfully use their products.
Public health experts say FDA’s caution is warranted, because a test that’s unreliable or hard to use could help the virus spread. There is also a risk that many people will interpret a negative result as an all-clear; in reality, even the best test will produce some false negatives. And even a true negative does not guarantee that a person is not in the early stages of infection.
“If this was a disease that only impacted the individual, then it wouldn’t be such a problem,” said Georges Benjamin, executive director of the American Public Health Association. “The problem is that there will be a cohort of people who will take the test, find out that they are presumably negative, but they really weren’t, and go out and infect other people.”
A false negative result could be especially dangerous if “people use it to decide whether to go to parties,” said Heather Pierce, senior director for science policy at the Association of American Medical Colleges. “You’ve got infected people feeling like they have a passport to not engage in the other public health measures that we need to suppress the virus.”
False positive results are also a concern, because some people could isolate for up to two weeks, missing work or school for no reason. But that risk could be lowered with follow-up lab-based testing, and pales in comparison to at-home tests’ potential to prevent Covid-19 spread, said HHS testing czar Brett Giroir…
The agency said in July that any at-home test should be able to diagnose at least 90 percent of infections in people with and without symptoms, and should have a false positive rate of 1 percent or less. Companies must also prove to regulators that people will be able to perform the test on their own, without help from a health professional, and provide consumers clear information about when to use the tests and how to interpret the results…
FDA’s willingness to be flexible is welcome, but not enough, says Michael Mina, an epidemiologist at the Harvard T.H. Chan School of Public Health and a leading advocate for frequent, rapid testing. Mina says that at-home coronavirus testing should be used for surveillance — to detect new clusters of infection — but people should not rely solely on these tests to make medical decisions.
“We really need to have the FDA start to have a little bit of imagination with regard to how these tests are being evaluated,” Mina said. “We continue to see the FDA only approve tests through a clinical diagnostic lens.”
He said that positive results from at-home tests should be confirmed with a second test that uses a different approach to detect the virus — reducing the risk of false positives that could erode public confidence in at-home testing.
Another challenge for test developers is how to ensure results from at-home screening reach state and local health departments.
Automatic electronic reporting of results to public health authorities when an at-home test is run would be ideal, according to Mara Aspinall, a professor of biomedical diagnostics at Arizona State University. “We need to focus on as quickly as possible having that interconnectivity so that we can get an accurate count of both positives and negatives from these tests,” she said….(O)
Considerations for who should get tested (S)
People who have symptoms of COVID-19
People who have had close contact (within 6 feet of an infected person for a total of 15 minutes or more) with someone with confirmed COVID-19.
People who have been asked or referred to get testing by their healthcare provider, local
external icon or state health department.
Not everyone needs to be tested. If you do get tested, you should self-quarantine/isolate at home pending test results and follow the advice of your health care provider or a public health professional.
Coronavirus Self-Checker
Coronavirus Self-Checker is a tool to help you make decisions on when to seek testing and appropriate medical care.
Take steps to protect yourself
Whether you test positive or negative for COVID-19, you should take preventive measures to protect yourself and others.
How to get a viral test
A viral test checks samples to find out if you are currently infected with COVID-19. The time it takes to process these tests can vary.
You can visit your state or local health department’s website to look for the latest local information on testing.
If you have symptoms of COVID-19 and want to get tested, call your healthcare provider first.
If you have symptoms of COVID-19 and are not tested, it is important to stay home. Find out what to do if you are sick.
What to do after a viral test
To get your test result, please check with the group that performed your test, such as your healthcare provider or health department. How long it will take to get your test results depends on the test used.
If you test positive for COVID-19, know what protective steps to take if you are sick.
Most people have mild COVID-19 illness and can recover at home without medical care. Contact your healthcare provider if your symptoms are getting worse or if you have questions about your health.
If you test negative for COVID-19, you probably were not infected at the time your sample was collected. This does not mean you will not get sick:
A negative test result only means that you did not have COVID-19 at the time of testing or that your sample was collected too early in your infection.
You could also be exposed to COVID-19 after the test and then get infected and spread the virus to others.
If you have symptoms later, you may need another test to determine if you are infected with the virus that causes COVID-19.
Coronavirus Self-Checker
Updated Sept. 10, 2020
The Coronavirus Self-Checker is an interactive clinical assessment tool that will assist individuals ages 13 and older, and parents and caregivers of children ages 2 to 12 on deciding when to seek testing or medical care if they suspect they or someone they know has contracted COVID-19 or has come into close contact with someone who has COVID-19.
The online, mobile-friendly tool asks a series of questions, and based on the user’s responses, provides recommended actions and resources.
To get to the Coronavirus Self-Checker highlight and click on
PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”
PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”
PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)
PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….
PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 6. February 18, 2020. Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””
PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.
PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”
PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”
Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.
PART 11. March 5, 2020. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”
Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”
Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”
PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”
PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.
PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT
PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.” “New York’s private and public hospitals unite to manage patient load and share resources.
PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.
PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”
POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”
POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)
POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.
POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”
POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”
POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…
POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.
PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!
POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….
Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”? “ If Fauci didn’t exist, we’d have to invent him.”
POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!
POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..” While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”
POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..
POST 37. June 8, 2020. CORONAVIRUS. When “crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it.”
POST 38. July 15, 2020. CORONAVIRUS. Some Lessons Learned, or not. AdventHealth CEO Terry Shaw: I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” (M)
POST 39. July, 23,2020. CORONAVIRUS. A Tale of Two Cities. Seattle becomes New York (rolls back reopening) while New York becomes Seattle (moves to partial phase 4 reopening)
POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”
POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”
POST 44. September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”
POST 45. September 9, 2020. CORONAVIRUS. Trump on Fauci. ‘You inherit a lot of people, and you have some you love, some you don’t. I like him. I don’t agree with him that often but I like him.’
POST 46. September 17, 2020. CORONAVIRUS. “Bill Gates used to think of the US Food and Drug Administration as the world’s premier public-health authority. Not anymore. And he doesn’t trust the Centers for Disease Control and Protection either….”
POST 47. September 24, 2020. CORONAVIRUS. “Perry N. Halkitis, dean of the School of Public Health at Rutgers University…called New York City’s 35 percent rate for eliciting contacts “very bad.” “For each person, you should be in touch with 75 percent of their contacts within a day,” he said”
POST 48. October 1, 2020. “…you can actually control the outbreak if you do the nonpharmaceutical interventions (social distancing and masks). In the United States we haven’t done them. We haven’t adhered to them; we’ve played with them.” (A)
POST 49. October 4, 2020. CORONAVIRUS. RAPID RESPONSE. “The possibility that the president and his White House entourage were traveling superspreaders is a nightmare scenario for officials in Minnesota, Ohio, New Jersey and Pennsylvania…”
POST 50. October 6, 2020. CORONAVIRUS. Monday October 5th will go down as one of the most fraught chapters in the history of American public Health (and national security).
POST 51. October 12, 2020. Rather than a hodge-podge of Emergency Use Authorizations, off-label “experimentation”, right-to-try arguments, and “politicized” compassionate use approvals maybe we need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).
POST 52. October 18, 2020. ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018
POST 54. October 22, 2020. CORONAVIRUS. POST 54A. New Jersey’s Coronavirus response, led by Governor Murphy and Commissioner of Health Persichilli started with accelerated A+ traditional, evidence-based Public Health practices, developed over years of experience with seasonal flu, swine flu, Zika, and Ebola.
POST 55. October 26, 2020. CORONAVIRUS. The Testing Conundrum: “ It’s thus very possible to be antigen negative but P.C.R. positive, while still harboring the virus in the body..”
TWITTER @jonathan_metsch FACEBOOK Jonathan M. Metsch LINKEDIN Jonathan Metsch
#CoronavirusTracker #CoronavirusRapidResponse
Followed by:
– immediate adherence to ever-evolving CDC and FDA guidelines.
– rapid implementation of Lessons Learned from the preceding New York experience.
– a mobile app, in collaboration with New York and Pennsylvania, that notifies users when they have been exposed to another user who has tested positive for COVID-19.
– and every day 24/7 working with hospitals and nursing homes to make sure preparedness for the next surge is at the highest level.
______________________________________________
On the radio this morning, former Governor Christie acknowledged his lapse in mask wearing during debate preparation in the White House. Everyone in the prep group tested negative before each meeting but everyone in the group contracted Coved-19. Governor Christie then unnecessarily spent seven days in the ICU.
“Interestingly, The Centers for Disease Control and Prevention has broadened the definition of what it means to be a “close contact” of a person with COVID-19.Previous language defined a close contact as someone who spent at least 15 minutes within 6 feet of a person with a confirmed case. The CDC now defines a close contact as someone who was within 6 feet of an infected person for a total of 15 minutes or more over a 24-hour period.” (J)
By comparison, Governor Murphy self-quarantined after contact with a staff member tested positive for COVID-19.
‘Dr. Scott Gottlieb is warning that the United States is about “a week away from seeing a rapid acceleration in cases” of Covid-19 as the number of coronavirus infections and hospitalizations surge.
In an interview on CNBC’s “The News with Shepard Smith” on Monday evening, the former FDA chief in the Trump administration said the country no longer has any pandemic backstops.
“The summer was a backstop, of sorts, to the spring surge, and we have no therapeutic backstop,” Gottlieb said. “The fall and winter season is when this coronavirus is going to want to spread.”
Echoing similar comments from Dr. Anthony Fauci, the nation’s top infectious disease expert, Gottlieb said the holiday season and family gatherings are especially precarious for the spread of coronavirus because that’s when people let their guard down.” (A)
“Dr. Francis Collins, director of the National Institutes of Health, says “it was all sadly somewhat predictable.”
Hospitalizations are up in more than 40 states. The rising number of cases has not led to a corresponding rise in the number of deaths — yet.
But Collins tells NPR’s Steve Inskeep on Morning Edition that an increase in the number of fatalities will soon follow, as it has previously when cases and hospitalizations went up.
“All of this, I’m afraid, happens because we have not succeeded in this country in introducing really effective public health measures, those simple things that we all could be doing,” he says. “Wear your mask, keep that 6-foot distance and don’t congregate indoors whatever you do, and wash your hands. It’s so simple. And yet people are tired of it. And yet the virus is not tired of us.”” (B)
“U.S. Surgeon General Jerome Adams said Wednesday that a “herd immunity” approach to combating COVID-19 could “lead to many complications/deaths.”
Adams posted the comment on his official Twitter account, along with a link to a recent article from The Journal of the American Medical Association entitled “What is Herd Immunity?”
“The summary: Large numbers of people would need to be infected to achieve herd immunity without a vaccine; this could overwhelm health care systems and lead to many complications/deaths,” Adams tweeted. “So far, there is no example of a large-scale successful intentional infection-based herd immunity strategy.”
Instead, Adams urged people to “wear masks,” “wash hands” and “watch distances.”
The surgeon general’s comments come after the White House embraced a controversial declaration by a group of scientists calling for an approach that relies on “herd immunity.”” (C)
“A frustrated and at times foul-mouthed President Donald Trump claimed on a campaign call that people are tired of hearing about the deadly pandemic which has killed more than 215,000 Americans and trashed Dr. Anthony Fauci as a “disaster” who has been around for “500 years.”
Referring to Fauci and other health officials as “idiots,” Trump declared the country ready to move on from the health disaster, even as cases are again spiking and medical experts warn the worst may be yet to come.
Baselessly claiming that if Fauci was in charge more than half a million people would be dead in the United States, Trump portrayed the recommendations offered by his own administration to mitigate spread of the disease as a burdensome annoyance.
“People are tired of Covid. I have the biggest rallies I’ve ever had, and we have Covid,” Trump said, phoning into a call with campaign staff from his namesake hotel in Las Vegas, where he spent two nights amid a western campaign swing. “People are saying whatever. Just leave us alone. They’re tired of it. People are tired of hearing Fauci and all these idiots.”
“Fauci is a nice guy,” Trump went on. “He’s been here for 500 years.”” (D)
“Hospitals across the United States are starting to buckle from a resurgence of COVID-19 cases, with several states setting records for the number of people hospitalized and leaders scrambling to find extra beds and staff. New highs in cases have been reported in states big and small — from Idaho to Ohio — in recent days.
The rise in cases and hospitalizations was alarming to medical experts.
Around the world, disease trackers have seen a pattern: First, the number of cases rises, then hospitalizations and finally there are increases in deaths. Seeing hospitals struggling is alarming because it may already be too late to stop a crippling surge.
“By the time we see hospitalizations rise, it means we’re really struggling,” said Saskia Popescu, an epidemiologist at George Mason University.”” (E)
“Coronavirus cases in New Jersey, an early epicenter of the pandemic, are on the rise again, doubling over the last month to an average of more than 900 new positive tests a day, a worrisome reversal of fortune for a state that had driven transmission rates to some of the nation’s lowest levels.
After an outbreak several weeks ago in a heavily Orthodox Jewish town near the Jersey Shore, cases are now rising in counties across the state, driven, officials say, by indoor gatherings.
The state’s health commissioner has said there are signs of “widespread community spread” for the first time since New Jersey successfully slowed the spread of a virus that has claimed the lives of more than 16,000 residents. A small, densely packed state, New Jersey has the highest virus fatality rate in the country…/..
State government and hospital officials said they have stockpiled months’ worth of masks, gowns and gloves — the critical personal protective equipment, or PPE, that was in short supply early in the pandemic — and are amassing medications to treat COVID-19 patients. Some acute-care facilities are signing advance contracts with staffing agencies in case they need to supplement their existing workforce…
State Health Commissioner Judy Persichilli said Monday that her team holds daily calls with hospital leaders to check on bed capacity and other resources, including staff — a protocol that has continued, unabated, since the pandemic began.
“We’ve never stopped working with the hospitals. We never considered the (first) wave to be over,” she said. “It’s an everyday event. We’re working with the hospitals and preparing with them every step of the way.”
The state DOH worked with the hospital association to create a database for all providers to report their PPE capacity; the department also requires hospitals to keep 90 days’ worth of surge-level supplies in stock, according to a spokesperson. Persichilli said the state is also stockpiling protective gear and some medicines — in particular Remdesivir, which appears to benefit some patients.
“My anticipation is that our biggest struggle will be staffing as we experience community spread,” Persichilli said Monday as she urged the public to keep up with infection control measures. “People that work in hospitals and in long-term care facilities also are members of a community.”
“These are very valuable individuals that we need, but if they fall ill, backup will be difficult … because every other state in the nation is having the same difficulties we’re having,” she said. In the spring, other states then relatively spared by the pandemic sent backup staff to help New Jersey.” (F)
“It’s no longer just a few hotspot counties causing the virus to spread in New Jersey. The problem is now widespread, from north Jersey to south.
But experts say a second wave is here.
“This is not something we didn’t expect. We expected a second wave to happen in the fall. But the question is how bad it gets. That means peak, and how quickly we get to that peak,” said Dr. Shereef Elnahal, president and CEO of University Hospital, Newark.
Dr. Elnahal says the hospital is already nearly at capacity with non-COVID patients. Now the COVID hospitalizations are increasing again.
“Signs are pointing that this is about to get worse,” Dr. Elnahal told CBS2’s John Dias. “When you start to hit levels of 3 or 4% positivity, you can expect even more admissions. And most concerningly, John, we did have one COVID-19 death last week for the first time in many weeks.”
“The other patients will have to delay their care even more,” Dr. Elnahal added….
New Jersey and Connecticut now technically qualify for the Tri-State travel advisory list, where travelers from states with rising infection rates must quarantine for two weeks.” (G)
“As the coronavirus races across the country, it has reached every corner of a nursing home in Kansas, infecting all 62 residents inside. There are so few hospital beds available in North Dakota that patients sick with the virus are being ferried by ambulance to facilities 100 miles away. And in Ohio, more people are hospitalized with the virus than at any other time during the pandemic.
After weeks of warnings that cases were again on the rise, a third surge of coronavirus infection has firmly taken hold in the United States. The nation is averaging 59,000 new cases a day, the most since the beginning of August, and the country is on pace to record the most new daily cases of the entire pandemic in the coming days.
But if earlier surges were defined by acute and concentrated outbreaks — in the Northeast this spring, and in the South during the summer — the virus is now simmering at a worrisome level across nearly the entire country. Colorado, Illinois, Kentucky, Michigan, Montana, New Mexico, North Dakota, Ohio, South Dakota, Utah, Wisconsin and Wyoming each set seven-day case records on Tuesday. Even New Jersey, once a model for bringing the virus under control, has seen cases double over the past month…
The latest wave threatens to be the worst of the pandemic yet, coming as cooler weather is forcing people indoors and as many Americans report feeling exhausted by months of restrictions. Unlike earlier waves, which were met with shutdown orders and mask mandates, the country has shown little appetite for widespread new restrictions…
The newest surge sets the stage for a grueling winter that will test the discipline of many Americans who have spent warmer months gathering in parks and eating outdoors, where the virus is known to spread less easily. At the current rate of growth, new daily confirmed cases could soon surpass 75,687, the record set on July 16.
The rising case count has so far not translated to increased deaths: About 700 people are dying on average each day, a high but steady rate. So far, more than 220,000 Americans have died from the virus.
The latest developments represent a serious new level of spread. Deaths are considered a lagging indicator of new infection, and experts believe the daily toll is likely to rise in the coming months. Nationwide, hospitalizations, the most accurate gauge of how many people are currently sick from the virus, are already trending upward, at a pace slightly lower than new infections.” (H)
“On Tuesday, local health authorities issued an emergency stay-at-home order for the campus in Ann Arbor, Mich., mostly restricting undergraduates to their residences unless they’re getting food, doing an essential job or going to class.
Athletics, though, are exempt — meaning that the Wolverines’ football team will keep preparing for a road game in Minnesota on Saturday and an Oct. 31 home opener against rival Michigan State University. Although the Michigan stadium won’t feature a large crowd, some officials worry that the home game will fuel new cases anyway because of Spartan fans who travel to Ann Arbor and Michigan supporters who gather for watch parties.” (I)
PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”
PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”
PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)
PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….
PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 6. February 18, 2020. Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””
PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.
PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”
PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”
Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.
PART 11. March 5, 2020. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”
Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”
Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”
PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”
PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.
PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT
PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.” “New York’s private and public hospitals unite to manage patient load and share resources.
PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.
PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”
POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”
POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)
POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.
POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”
POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”
POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…
POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.
PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!
POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….
Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”? “ If Fauci didn’t exist, we’d have to invent him.”
POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!
POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..” While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”
POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..
POST 37. June 8, 2020. CORONAVIRUS. When “crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it.”
POST 38. July 15, 2020. CORONAVIRUS. Some Lessons Learned, or not. AdventHealth CEO Terry Shaw: I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” (M)
POST 39. July, 23,2020. CORONAVIRUS. A Tale of Two Cities. Seattle becomes New York (rolls back reopening) while New York becomes Seattle (moves to partial phase 4 reopening)
POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”
POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”
POST 44. September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”
POST 45. September 9, 2020. CORONAVIRUS. Trump on Fauci. ‘You inherit a lot of people, and you have some you love, some you don’t. I like him. I don’t agree with him that often but I like him.’
POST 46. September 17, 2020. CORONAVIRUS. “Bill Gates used to think of the US Food and Drug Administration as the world’s premier public-health authority. Not anymore. And he doesn’t trust the Centers for Disease Control and Protection either….”
POST 47. September 24, 2020. CORONAVIRUS. “Perry N. Halkitis, dean of the School of Public Health at Rutgers University…called New York City’s 35 percent rate for eliciting contacts “very bad.” “For each person, you should be in touch with 75 percent of their contacts within a day,” he said”
POST 48. October 1, 2020. “…you can actually control the outbreak if you do the nonpharmaceutical interventions (social distancing and masks). In the United States we haven’t done them. We haven’t adhered to them; we’ve played with them.” (A)
POST 49. October 4, 2020. CORONAVIRUS. RAPID RESPONSE. “The possibility that the president and his White House entourage were traveling superspreaders is a nightmare scenario for officials in Minnesota, Ohio, New Jersey and Pennsylvania…”
POST 50. October 6, 2020. CORONAVIRUS. Monday October 5th will go down as one of the most fraught chapters in the history of American public Health (and national security).
POST 51. October 12, 2020. Rather than a hodge-podge of Emergency Use Authorizations, off-label “experimentation”, right-to-try arguments, and “politicized” compassionate use approvals maybe we need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).
POST 52. October 18, 2020. ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018
POST 54. October 22, 2020. CORONAVIRUS. “Hospitals across the USA are starting to buckle from a resurgence of COVID-19 cases…” ““U of Michigan hit with emergency stay-at-home order…. But the football team will play on..” (I)
TWITTER @jonathan_metsch FACEBOOK Jonathan M. Metsch LINKEDIN Jonathan Metsch
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“Letting the coronavirus rip through the U.S. population unchecked to infect as many people as possible to achieve so-called herd immunity would cause a lot of unnecessary deaths and the idea is “nonsense” and “dangerous,”…. (Dr. Anthony Fauci)
With “herd immunity” being introduced into the Coronavirus discussion I recalled that as a student in Epidemiology 101 at the UNC School of Public Health back in 1970 this was a descriptive term, and not used operationally.
“Herd immunity” was, and still is, an outcome where enough of the population gains immunity to a virus by vaccination that the viral threat burns itself out by lack of am easily available residual target population.
Now, as the third wave seems to be underway some are suggesting “herd immunity” as a tamping down strategy – let the young get it, while protecting those at risk, e.g., the elderly and those with pre-existing conditions.
But it doesn’t work that way. The young may get it asymptomatically but will still bring it home to those at risk who will get symptoms requiring treatment, leading to hospitals reaching their limits, not because of unavailability of beds and equipment, but due to staff shortages (health care workers get sick too!)
So it’s back to basics until there is a vaccine and advanced therapeutics – wearing masks, social distancing, hand hygiene and now “indoor safety”.
Here’s why!
but first….
to read POSTS 1-53 in chronological order, highlight and click on
POST 52. October 18, 2020. ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018
“But “herd-immunity strategy” is a contradiction in terms, in that herd immunity is the absence of a strategy. Herd immunity is an important public-health concept, developed and used to guide vaccination policy. It involves a calculation of the percentage of people in a population who would need to achieve immunity in order to prevent an outbreak. The same concept offers little such guidance during an ongoing pandemic without a vaccine. If it were a military strategy, it would mean letting the enemy tear through you until they stop because there’s no one left to attack.” (L)
“In late September, a Nobel Prize-winning economist emailed Dr. Scott W. Atlas, a White House coronavirus adviser, in what he saw as a last-ditch effort to persuade the Trump administration to embrace a dramatic increase in testing and isolating infected patients. The plan was designed to appeal to President Trump, who has complained that positive tests make his administration look bad and would not “generate any new confirmed cases.”
Dr. Atlas, a radiologist, told the economist, Paul Romer of New York University, that there was no need to do the sort of testing he was proposing.
“That’s not appropriate health care policy,” Dr. Atlas wrote.
Dr. Atlas went on to reference a theory that the virus can be arrested once a small percentage of the United States population contracts it. He said there was a “likelihood that only 25 or 20 percent of people need the infection,” an apparent reference to a threshold for so-called “herd immunity” that has been widely disputed by epidemiologists.
The call for more widespread testing and isolation, Dr. Atlas wrote, “is grossly misguided.”
The exchange highlights the resistance within the White House toward adopting a significantly expanded federal testing program, including efforts to isolate infected patients and track the people they have been in contact with, even as infections and deaths continue to rise nationwide. That resistance has become a sticking point in negotiations over a new economic stimulus package, with the administration and top Democrats disagreeing over the scope and setup of an expanded testing plan.
Many public health experts, and some economists like Mr. Romer, say that a far more sweeping testing program would save lives and boost the economy by helping as many Americans as possible learn quickly if they are sick — and then take steps to avoid spreading the virus.
Dr. Atlas and other administration officials playing influential roles in the government’s virus response effectively say the opposite: that more widespread testing would infringe on Americans’ privacy and hurt the economy, by keeping potentially infected workers who show no symptoms of the virus from reporting to their jobs.” (A)
“In an interview on Thursday, …..Dr Atlas said that the United States had a “massive” testing program over all, but that it should be used strategically to protect vulnerable populations, like nursing home residents — not young, healthy individuals who he said were at low risk of contracting the disease. He said that large-scale government test and isolate programs infringed on civil liberties, and that new research had persuaded him that herd immunity might be achieved once 20 or 40 percent of Americans are infected.
“The overwhelming majority of people who get this infection are not at high risk,” Dr. Atlas said in the interview. “And when you start seeking out and testing asymptomatic people, you are destroying the workforce.”…
Experts from a wide range of fields have repeatedly denounced the lack of testing in the United States. Despite Mr. Trump’s repeated affirmations that the country has done more testing than any other nation, researchers have noted that 991,000 or so tests done each day were still not enough to keep in check a virus that has infected more than eight million people nationwide. Tests can individually diagnose people who might unknowingly carrying the virus. At the population level, they can also help health officials monitor any spread and pinpoint and quash outbreaks before they spin out of control.
Others have cautioned against an overreliance on testing as a preventive measure, noting that, in the absence of standards like physical distancing and mask wearing, testing alone cannot fully contain a virus that spreads wherever people tend to gather, regardless of whether those infected are exhibiting symptoms.
“No testing scheme, no test is perfect. There will always be people who go undetected,” said Dr. David Dowdy, an infectious disease epidemiologist at Johns Hopkins University who has researched and written about herd immunity. “The best way to protect the most vulnerable is to reduce the amount of virus that’s in the population that can get through all of those testing schemes and cause destruction.”
Dr. Atlas’s position has been challenged by medical advisers around him who have backgrounds in infectious disease response, revealing a significant rift in the White House over the right approach. Dr. Deborah L. Birx, the White House’s coronavirus response coordinator, has pushed for aggressive, broad testing even among young and healthy people, often clashing with Dr. Atlas in meetings.
“I would always be happy if we had 100 percent of students tested weekly,” Dr. Birx said on Wednesday in an appearance at Penn State University, “because I think testing changes behavior.”
Dr. Atlas at one point influenced the administration’s efforts to install new Centers for Disease Control and Prevention guidance that said it was not necessary to test people without symptoms of Covid-19 even if they had been exposed to the virus, upsetting Dr. Birx and Dr. Robert R. Redfield, the C.D.C. director….
In his email, sent to Dr. Atlas’s personal account, Mr. Romer proposed additional testing and isolation efforts that could allow far more Americans to return to work and shopping, generating economic activity that would be 10 or 100 times larger than the cost of the testing program itself.” (B)
“The Great Barrington Declaration – As infectious disease epidemiologists and public health scientists we have grave concerns about the damaging physical and mental health impacts of the prevailing COVID-19 policies, and recommend an approach we call Focused Protection.
Coming from both the left and right, and around the world, we have devoted our careers to protecting people. Current lockdown policies are producing devastating effects on short and long-term public health. The results (to name a few) include lower childhood vaccination rates, worsening cardiovascular disease outcomes, fewer cancer screenings and deteriorating mental health – leading to greater excess mortality in years to come, with the working class and younger members of society carrying the heaviest burden. Keeping students out of school is a grave injustice.
Keeping these measures in place until a vaccine is available will cause irreparable damage, with the underprivileged disproportionately harmed.
Fortunately, our understanding of the virus is growing. We know that vulnerability to death from COVID-19 is more than a thousand-fold higher in the old and infirm than the young. Indeed, for children, COVID-19 is less dangerous than many other harms, including influenza.
As immunity builds in the population, the risk of infection to all – including the vulnerable – falls. We know that all populations will eventually reach herd immunity – i.e. the point at which the rate of new infections is stable – and that this can be assisted by (but is not dependent upon) a vaccine. Our goal should therefore be to minimize mortality and social harm until we reach herd immunity.
The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection.
Adopting measures to protect the vulnerable should be the central aim of public health responses to COVID-19. By way of example, nursing homes should use staff with acquired immunity and perform frequent PCR testing of other staff and all visitors. Staff rotation should be minimized. Retired people living at home should have groceries and other essentials delivered to their home. When possible, they should meet family members outside rather than inside. A comprehensive and detailed list of measures, including approaches to multi-generational households, can be implemented, and is well within the scope and capability of public health professionals.
Those who are not vulnerable should immediately be allowed to resume life as normal. Simple hygiene measures, such as hand washing and staying home when sick should be practiced by everyone to reduce the herd immunity threshold. Schools and universities should be open for in-person teaching. Extracurricular activities, such as sports, should be resumed. Young low-risk adults should work normally, rather than from home. Restaurants and other businesses should open. Arts, music, sport and other cultural activities should resume. People who are more at risk may participate if they wish, while society as a whole enjoys the protection conferred upon the vulnerable by those who have built up herd immunity.” (C)
“Letting the coronavirus rip through the U.S. population unchecked to infect as many people as possible to achieve so-called herd immunity would cause a lot of unnecessary deaths and the idea is “nonsense” and “dangerous,” the nation’s top infectious disease expert said Thursday.
“I’ll tell you exactly how I feel about that,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said when asked about whether herd immunity is a viable strategy for the U.S. to adopt. “If you let infections rip as it were and say, ‘Let everybody get infected that’s going to be able to get infected and then we’ll have herd immunity.’ Quite frankly that is nonsense, and anybody who knows anything about epidemiology will tell you that that is nonsense and very dangerous,” Fauci told Yahoo News.
Herd immunity happens when enough of the population is immune to a disease, making it unlikely to spread and protecting the rest of the community, the Mayo Clinic says. It can be achieved through natural infection — when enough people are exposed to the disease and develop antibodies against it — and through vaccinations.
Most scientists think 60% to 80% of the population needs to be vaccinated or have natural antibodies to achieve herd immunity, global health experts say. However, the nation’s top health experts have said a majority of Americans remain susceptible to a coronavirus infection.
“With this idea of herd immunity, this is a phrase that’s used when you use vaccination. When you vaccinate a certain amount of the population to be able to protect the rest of the population that isn’t able to get that vaccine,” Maria Van Kerkhove, head of the World Health Organization’s emerging diseases and zoonosis unit, told CNN’s “New Day” on Thursday.
“Herd immunity as an approach by letting the virus circulate is dangerous, it leads to unnecessary cases and it leads to unnecessary deaths,” she said.
Despite those concerns, a senior White House official briefing reporters on a call Monday mentioned an online movement called the “Great Barrington Declaration,” which favors herd immunity, NBC News reported. Health and Human Services Secretary Alex Azar has previously said that herd immunity “is not the strategy of the U.S. government with regard to coronavirus.”..
“By the time you get to herd immunity you will have killed a lot of people that would’ve been avoidable,” he said.” (D)
“If you just let things rip and let the infection go — no masks, crowd, it doesn’t make any difference — that quite frankly,… is ridiculous because what that will do is that there will be so many people in the community that you can’t shelter, that you can’t protect, who are going to get sick and get serious consequences,” Fauci said. “So this idea that we have the power to protect the vulnerable is total nonsense, because history has shown that that’s not the case. And if you talk to anybody who has any experience in epidemiology and infectious diseases, they will tell you that that is risky and you’ll wind up with many more infections of vulnerable people, which will lead to hospitalizations and deaths. So I think that we just got to look that square in the eye and say it’s nonsense.”
During a briefing Monday, World Health Organization director-general Tedros Adhanom Ghebreyesus called herd immunity “scientifically and ethically problematic.
“Never in the history of public health has herd immunity been used as a strategy for responding to an outbreak, let alone a pandemic,” Tedros said.” (E)
“The authors of the Declaration — a trio of scientists from Harvard, Stanford, and Oxford, whose views, we should say, are outside the mainstream — call their approach “focused prevention.” The big idea is that we could let the virus spread among younger, healthier people, all the while making sure we protect older, more vulnerable people…
And yet there are ample reasons to fear that this “focused prevention” strategy of allowing the young and healthy to get sick to build population immunity to the virus would never work. And it could cause devastating unintended consequences….
Let’s count the reasons why.
1) Even if we could limit exposure to the people least likely to die of Covid-19, this group still can suffer immense consequences from the infection — like hospitalization, long-term symptoms, organ damage, missed work, and high medical bills. The long-term health consequences of the virus have barely been studied. When we expose younger, healthier people to the virus (on purpose!), we don’t know what the consequence of that will be down the road.
2) We have a lonnnnnngggggg way to go. There’s no one, perfect estimate of what percentage of the US population has already been infected by the virus. But, by all accounts, it’s nowhere near the figures needed for herd immunity to kick in. Overall, a new Lancet study — which drew its data from a sample of dialysis patients — suggests that fewer than 10 percent of people nationwide have been exposed to the virus. No one knows the exact threshold percentage for herd immunity to kick in for a meaningful way to help end the pandemic. But common estimates hover around 60 percent.
So far, there have been more than 200,000 deaths in the United States. There’s so much more potential for death if the virus spreads to true herd immunity levels. “The cost of herd immunity [through natural infection] is extraordinarily high,” Hanage says…
3) Scientists don’t know how long naturally acquired immunity to the virus lasts or how common reinfections might be. If immunity wanes and reinfections are common, then it will be all the more difficult to build up herd immunity in the country. In the spring, epidemiologists at Harvard sketched out the scenarios. If immunity lasts a couple of years or more, Covid-19 could fade in a few years’ time, per their analysis published in Science (much too long a time to begin with, if you ask me). If immunity wanes within a year, Covid-19 could make fierce annual comebacks until an effective vaccine is widely available.
At the same time, we don’t know how long immunity delivered via a vaccine would last. But, at least a vaccine would come without the cost of increased illnesses, hospitalizations, and long-term complications.
If immunity doesn’t last, “such a [focused prevention] strategy would not end the COVID-19 pandemic but result in recurrent epidemics, as was the case with numerous infectious diseases before the advent of vaccination,” the John Snow Memorandum says.
4) By letting the pandemic rage, we risk overshooting the herd immunity threshold. Once you hit the herd immunity threshold, it doesn’t mean the pandemic is over. After the threshold is reached, “all it means is that, on average, each infection causes less than one ongoing infection,” Hanage says. “That’s of limited use if you’ve already got a million people infected.” If each infection causes, on average, 0.8 new infections, the epidemic will slow. But 0.8 isn’t zero. If a million people are infected at the time herd immunity is reached, per Hanage’s example, those already infected people may infect 800,000 more.
There are a lot of other unknowns here, too. One is the type of immunity conferred by natural infection. “Immunity” is a catchall term that means many different things. It could mean true protection from getting infected with the virus a second time. Or it could mean reinfections are possible but less severe. You could, potentially, get infected a second time, never feel sick at all (thanks to a quick immune response), and still pass on the virus to another person.” (F)
“Experts from a wide range of fields have repeatedly denounced the lack of testing in the United States. Despite Mr. Trump’s repeated affirmations that the country has done more testing than any other nation, researchers have noted that 991,000 or so tests done each day were still not enough to keep in check a virus that has infected more than eight million people nationwide. Tests can individually diagnose people who might unknowingly carrying the virus. At the population level, they can also help health officials monitor any spread and pinpoint and quash outbreaks before they spin out of control.
Others have cautioned against an overreliance on testing as a preventive measure, noting that, in the absence of standards like physical distancing and mask wearing, testing alone cannot fully contain a virus that spreads wherever people tend to gather, regardless of whether those infected are exhibiting symptoms.
“No testing scheme, no test is perfect. There will always be people who go undetected,” said Dr. David Dowdy, an infectious disease epidemiologist at Johns Hopkins University who has researched and written about herd immunity. “The best way to protect the most vulnerable is to reduce the amount of virus that’s in the population that can get through all of those testing schemes and cause destruction.”
Dr. Atlas’s position has been challenged by medical advisers around him who have backgrounds in infectious disease response, revealing a significant rift in the White House over the right approach. Dr. Deborah L. Birx, the White House’s coronavirus response coordinator, has pushed for aggressive, broad testing even among young and healthy people, often clashing with Dr. Atlas in meetings.
“I would always be happy if we had 100 percent of students tested weekly,” Dr. Birx said on Wednesday in an appearance at Penn State University, “because I think testing changes behavior.”
Dr. Atlas at one point influenced the administration’s efforts to install new Centers for Disease Control and Prevention guidance that said it was not necessary to test people without symptoms of Covid-19 even if they had been exposed to the virus, upsetting Dr. Birx and Dr. Robert R. Redfield, the C.D.C. director….
Mr. Romer said… “Atlas just responded in a way that just honestly made it seem like he was in over his head,” … (G)
“A group of 80 researchers warn that a so-called herd immunity approach to managing COVID-19 by allowing immunity to develop in low-risk populations while protecting the most vulnerable is “a dangerous fallacy unsupported by the scientific evidence”…
The open letter, referred to by its authors as the John Snow Memorandum, is published today by The Lancet. It is signed by 80 international researchers (as of publication) with expertise spanning public health, epidemiology, medicine, paediatrics, sociology, virology, infectious disease, health systems, psychology, psychiatry, health policy, and mathematical modelling [1]. The letter will also be launched during the 16th World Congress on Public Health programme 2020.
They state: “It is critical to act decisively and urgently. Effective measures that suppress and control transmission need to be implemented widely, and they must be supported by financial and social programmes that encourage community responses and address the inequities that have been amplified by the pandemic.”
“Continuing restrictions will probably be required in the short term, to reduce transmission and fix ineffective pandemic response systems, in order to prevent future lockdowns. The purpose of these restrictions is to effectively suppress SARS-CoV-2 infections to low levels that allow rapid detection of localised outbreaks and rapid response through efficient and comprehensive find, test, trace, isolate, and support systems so life can return to near-normal without the need for generalised restrictions. Protecting our economies is inextricably tied to controlling COVID-19. We must protect our workforce and avoid long-term uncertainty.”…
They explain that uncontrolled transmission in younger people risks significant ill-health and death across the whole population – with real-world evidence from many countries showing that it is not possible to restrict uncontrolled outbreaks to certain sections of society, and it being practically impossible and highly unethical to isolate large swathes of the population. Instead, they say that special efforts to protect the most vulnerable are essential, but must go hand-in-hand with multi-pronged population-level strategies…
The authors also warn that natural infection-based herd immunity approaches risk impacting the workforce as a whole and overwhelming the ability of healthcare systems to provide acute and routine care. They note that we still do not understand who might suffer from ‘long COVID’, and that herd immunity approaches place an unacceptable burden on healthcare workers, many of whom have died from COVID-19 or experienced trauma as a result of having to practise disaster medicine.
The letter concludes: “The evidence is very clear: controlling community spread of COVID-19 is the best way to protect our societies and economies until safe and effective vaccines and therapeutics arrive within the coming months. We cannot afford distractions that undermine an effective response; it is essential that we act urgently based on the evidence.” (H)
“THE JOHN SNOW MEMORANDUM
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected more than 35 million people globally, with more than 1 million deaths recorded by the World Health Organization as of Oct 12, 2020. As a second wave of COVID-19 affects Europe, and with winter approaching, we need clear communication about the risks posed by COVID-19 and effective strategies to combat them. Here, we share our view of the current evidence-based consensus on COVID-19….
In the initial phase of the pandemic, many countries instituted lockdowns (general population restrictions, including orders to stay at home and work from home) to slow the rapid spread of the virus. This was essential to reduce mortality(6),(7) prevent health-care services from being overwhelmed, and buy time to set up pandemic response systems to suppress transmission following lockdown. Although lockdowns have been disruptive, substantially affecting mental and physical health, and harming the economy, these effects have often been worse in countries that were not able to use the time during and after lockdown to establish effective pandemic control systems. In the absence of adequate provisions to manage the pandemic and its societal impacts, these countries have faced continuing restrictions.
This has understandably led to widespread demoralisation and diminishing trust. The arrival of a second wave and the realisation of the challenges ahead has led to renewed interest in a so-called herd immunity approach, which suggests allowing a large uncontrolled outbreak in the low-risk population while protecting the vulnerable. Proponents suggest this would lead to the development of infection-acquired population immunity in the low-risk population, which will eventually protect the vulnerable. This is a dangerous fallacy unsupported by scientific evidence….
We cannot afford distractions that undermine an effective response; it is essential that we act urgently based on the evidence.” (I)
Showdown: Great Barrington Declaration v John Snow Memorandum (J)
“The United States came into this crisis with enormous advantages. Along with tremendous manufacturing capacity, we have a biomedical research system that is the envy of the world. We have enormous expertise in public health, health policy, and basic biology and have consistently been able to turn that expertise into new therapies and preventive measures. And much of that national expertise resides in government institutions. Yet our leaders have largely chosen to ignore and even denigrate experts.
The response of our nation’s leaders has been consistently inadequate. The federal government has largely abandoned disease control to the states. Governors have varied in their responses, not so much by party as by competence. But whatever their competence, governors do not have the tools that Washington controls. Instead of using those tools, the federal government has undermined them. The Centers for Disease Control and Prevention, which was the world’s leading disease response organization, has been eviscerated and has suffered dramatic testing and policy failures. The National Institutes of Health have played a key role in vaccine development but have been excluded from much crucial government decision making. And the Food and Drug Administration has been shamefully politicized,3 appearing to respond to pressure from the administration rather than scientific evidence. Our current leaders have undercut trust in science and in government,4 causing damage that will certainly outlast them. Instead of relying on expertise, the administration has turned to uninformed “opinion leaders” and charlatans who obscure the truth and facilitate the promulgation of outright lies.” (K)
PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”
PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”
PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)
PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….
PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 6. February 18, 2020. Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””
PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.
PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”
PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”
Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.
PART 11. March 5, 2020. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”
Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”
Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”
PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”
PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.
PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT
PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.” “New York’s private and public hospitals unite to manage patient load and share resources.
PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.
PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”
POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”
POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)
POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.
POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”
POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”
POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…
POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.
PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!
POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….
Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”? “ If Fauci didn’t exist, we’d have to invent him.”
POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!
POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..” While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”
POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..
POST 37. June 8, 2020. CORONAVIRUS. When “crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it.”
POST 38. July 15, 2020. CORONAVIRUS. Some Lessons Learned, or not. AdventHealth CEO Terry Shaw: I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” (M)
POST 39. July, 23,2020. CORONAVIRUS. A Tale of Two Cities. Seattle becomes New York (rolls back reopening) while New York becomes Seattle (moves to partial phase 4 reopening)
POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”
POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”
POST 44. September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”
POST 45. September 9, 2020. CORONAVIRUS. Trump on Fauci. ‘You inherit a lot of people, and you have some you love, some you don’t. I like him. I don’t agree with him that often but I like him.’
POST 46. September 17, 2020. CORONAVIRUS. “Bill Gates used to think of the US Food and Drug Administration as the world’s premier public-health authority. Not anymore. And he doesn’t trust the Centers for Disease Control and Protection either….”
POST 47. September 24, 2020. CORONAVIRUS. “Perry N. Halkitis, dean of the School of Public Health at Rutgers University…called New York City’s 35 percent rate for eliciting contacts “very bad.” “For each person, you should be in touch with 75 percent of their contacts within a day,” he said”
POST 48. October 1, 2020. “…you can actually control the outbreak if you do the nonpharmaceutical interventions (social distancing and masks). In the United States we haven’t done them. We haven’t adhered to them; we’ve played with them.” (A)
POST 49. October 4, 2020. CORONAVIRUS. RAPID RESPONSE. “The possibility that the president and his White House entourage were traveling superspreaders is a nightmare scenario for officials in Minnesota, Ohio, New Jersey and Pennsylvania…”
POST 50. October 6, 2020. CORONAVIRUS. Monday October 5th will go down as one of the most fraught chapters in the history of American public Health (and national security).
POST 51. October 12, 2020. Rather than a hodge-podge of Emergency Use Authorizations, off-label “experimentation”, right-to-try arguments, and “politicized” compassionate use approvals maybe we need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).
POST 52. October 18, 2020. ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018
TWITTER @jonathan_metsch FACEBOOK Jonathan M. Metsch LINKEDIN Jonathan Metsch
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1.Former hospital prez says: Designate local Zika centers now. Medical experts do not know if, or where, or how much, or on what trajectory the Zika virus may spread across the United States.
4.Hospitals are developing their own Zika preparedness models. Compare the Central Florida and Johns Hopkins approaches! Which template makes more sense?
9.“Houston Braces for Another Brush With the Peril of Zika” *. But they are doing passive not active surveillance. IS YOU AREA’S HEALTH CARE SYSTEM PREPARED FOR A SURGE OF AN EMERGING VIRUS LIKE ZIKA?
25.“… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days….Boy, do we not have our act together.” — Bill Gates”.
29. Candida Auris. Is it ethical for the public not be notified about new “super bugs” in hospitals so they can decide whether or not to go to affected hospital
33. CANDIDA AURIS. “.. nursing facilities, and long-term hospitals, are…continuously cycling infected patients, or those who carry the germ, into hospitals and back again.”
