Tag Archives: Coronavirus

Sweden’s Pandemic Policy: Arguably Best Practice

14 Monday Nov 2022

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When Covid-19 began its awful worldwide spread in early 2020, the Swedes made an early decision that ultimately proved to be as protective of human life as anything chosen from the policy menu elsewhere. Sweden decided to focus on approaches for which there was evidence of efficacy in containing respiratory pandemics, not mere assertions by public health authorities (or anyone else) that stringent non-pharmaceutical interventions (NPIs) were necessary or superior.

The Swedish Rationale

The following appeared in an article in Stuff in late April, 2020,

“Professor Johan Giesecke, who first recruited [Sweden’s State epidemiologist Anders] Tegnell during his own time as state epidemiologist, used a rare interview last week to argue that the Swedish people would respond better to more sensible measures. He blasted the sort of lockdowns imposed in Britain and Australia and warned a second wave would be inevitable once the measures are eased. ‘… when you start looking around at the measures being taken by different countries, you find very few of them have a shred of evidence-base,’ he said.

Giesecke, who has served as the first Chief Scientist of the European Centre for Disease Control and has been advising the Swedish Government during the pandemic, told the UnHerd website there was “almost no science” behind border closures and school closures and social distancing and said he looked forward to reviewing the course of the disease in a year’s time.”

Giesecke was of the opinion that there would ultimately be little difference in Covid mortality across countries with different pandemic policies. Therefore, the least disruptive approach was to be preferred. That meant allowing people to go about their business, disseminating information to the public regarding symptoms and hygiene, and attempting to protect the most vulnerable segments of the population. Giesecke said:

“I don’t think you can stop it. It’s spreading. It will roll over Europe no matter what you do.”

He was right. Sweden had a large number of early Covid deaths primarily due to its large elderly population as well as its difficulty in crafting effective health messages for foreign-speaking immigrants residing in crowded enclaves. Nevertheless, two years later, Sweden has posted extremely good results in terms of excess deaths during the pandemic.

Excess Deaths

Excess deaths, or deaths relative to projections based on historical averages, are a better metric than Covid deaths (per million) for cross-country or jurisdictional comparisons. Among other reasons, the latter are subject to significant variations in methods of determining cause of death. Moreover, there was a huge disparity between excess deaths and Covid deaths during the pandemic, and the gap is still growing:

Excess deaths varied widely across countries, as illustrated by the left-hand side of the following chart:

Interestingly, most of the lowest excess death percentages were in Nordic countries, but especially Sweden and Norway. That might be surprising in terms of high Nordic latitudes, which may have created something of a disadvantage in terms of sun exposure and potentially low vitamin D levels. Norway enacted more stringent public policies during the pandemic than Sweden. Globally, however, lockdown measures showed no systematic advantage in terms of excess deaths. Notably, the U.S. did quite poorly in terms of excess deaths at 8X the Swedish rate,

Covid Deaths

The right-hand side of the chart above shows that Sweden experienced a significant number of Covid deaths per million residents. The figure still compares reasonably well internationally, despite the country’s fairly advanced age demographics. Most Covid deaths occurred in the elderly and especially in care settings. Like other places, that is where the bulk of Sweden’s Covid deaths occurred. Note that U.S. Covid deaths per million were more than 50% higher than in Sweden.

NPIs Are Often Deadly

Perhaps a more important reason to emphasize excess deaths over Covid deaths is that public policy itself had disastrous consequences in many countries. In particular, strict NPIs like lockdowns, including school and business closures, can undermine public health in significant ways. That includes the inevitably poor consequences of deferred health care, the more rapid spread of Covid within home environments, the physical and psychological stress from loss of livelihood, and the toll of isolation, including increased use of alcohol and drugs, less exercise, and binge eating. Isolation is particularly hard on the elderly and led to an increase in “deaths of despair” during the pandemic. These were the kinds of maladjustments caused by lockdowns that led to greater excess deaths. Sweden avoided much of that by eschewing stringent NPIs, and Iceland is sometimes cited as a similar case.

Oxford Stringency Index

I should note here, and this is a digression, that the most commonly used summary measure of policy “stringency” is not especially trustworthy. That measure is an index produced by Oxford University that is available on the Our World In Data web site. Joakim Book documented troubling issues with this index in late 2020, after changes in the index’s weightings dramatically altered its levels for Nordic countries. As Book said at that time:

“Until sometime recently, Sweden, which most media coverage couldn’t get enough of reporting, was the least stringent of all the Nordics. Life was freer, pandemic restrictions were less invasive, and policy responses less strong; this aligned with Nordic people’s experience on the ground.”

Again, Sweden relied on voluntary action to limit the spread of the virus, including encouragement of hygiene, social distancing, and avoiding public transportation when possible. Book was careful to note that “Sweden did not ‘do nothing’”, but it’s policies were less stringent than its Nordic neighbors in several ways. While Sweden had the same restrictions on arrivals from outside the European Economic Area as the rest of the EU, it did not impose quarantines, testing requirements, or other restrictions on travelers or on internal movements. Sweden’s school closures were short-lived, and its masking policies were liberal. The late-2020 changes in the Oxford Stringency Index, Book said, simply did not “pass the most rudimentary sniff test”.

Economic Stability

Sweden’s economy performed relatively well during the pandemic. The growth path of real GDP was smoother than most countries that succumbed to the excessive precautions of lockdowns. However, Norway’s economy appears to have been the most stable of those shown on the chart, at least in terms of real output, though it did suffer a spike in unemployment.

The Bottom Line

The big lesson is that Sweden’s “light touch” during the pandemic proved to be at least as effective, if not more so, than comparatively stringent policies imposed elsewhere. Covid deaths were sure to occur, but widespread non-Covid excess deaths were unanticipated by many countries practicing stringent intervention. That lack of foresight is best understood as a consequence of blind panic among public health “experts” and other policymakers, who too often are rewarded for misguided demonstrations that they have “done something”. Those actions failed to stop the spread in any systematic sense, but they managed to do great damage to other aspects of public health. Furthermore, they undermined economic well being and the cause of freedom. Johan Giesecke was right to be skeptical of those claiming they could contain the virus through NPIs, though he never anticipated the full extent to which aggressive interventions would prove deadly.

Scary New Variant or Omicrommon Cold?

08 Wednesday Dec 2021

Posted by in Coronavirus, Pandemic, Uncategorized

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The political motives behind the naming of the Covid Omicron variant might prove to be a huge irony. The Greek letter Xi was skipped by the World Health Organization (WHO), undoubtedly to avoid any symbolic association between Covid and the Chinese dictator Xi Jinping. After all, he’s probably determined to bury discussion of the leak at the Wuhan lab that was the probable cause of this whole mess. The WHO was happy to provide cover. The irony is that the Omicron variant might well bring on a more gentle phase of the pandemic if early indications can be trusted. But in that case, my guess is Chairman Xi wouldn’t have appreciated the twist even if WHO had called it the Xi variant.

The Omicron variant was identified in the Gauteng Province of South Africa and announced by national health authorities on November 24th. The earliest known sample was taken on November 9th. The variant was subsequently diagnosed in a number of other countries, including the U.S. It has a large number of mutations, and initial reports indicated that the variant was spreading extremely fast, having suddenly outcompeted other variants to account for the majority of new cases in South Africa. It is apparently highly contagious. Moreover, Omicron has been diagnosed among the vaccinated as well as those having immunity from prior infections, which is usually more effective and durable than vaccination. Thus, it is said to have “immune escape” properties. Scary indeed!

However, Omicron seems to have been around much longer than suggested by its initial diagnosis in late November (and see this link for an extreme view). Cases in a number of countries show that it is already global; the lags involved in diagnosis as well as earlier contacts with spreaders suggest that Omicron’s origin could have been as early as late September. That means the spread has not been quite as fast as the first alarming reports suggested.

The reported symptoms of the Omicron variant have been quite mild, with fatigue being the most noteworthy. Omicron appears to have taken one mutation from the common cold, which, like Covid-19, is a type of coronavirus. And while there has been a surge in hospitalized cases in South Africa, most of these are said to be “incidental”. That is, these patients were admitted for other problems but happened to test positive for the Omicron variant. As we’ve seen throughout the pandemic, the data is not always reliable.

It’s too early to draw definite conclusions, and this variant might prove to be more dangerous with time. In fact, some say that South Africa’s experience might not be representative because of its young population and high natural immunity. It also happens to be early summer there, when higher vitamin D levels help to boost immunity. So, there is a great deal of uncertainty about Omicron (and see here). Nevertheless, I’ll risk a jinx by momentarily contemplating an outcome that’s not terribly far-fetched.

Viruses mutate in ways that help ensure their survival: they must not kill too many of their hosts, which means the usual progression is toward less lethal variants. They may become more contagious, and new variants must be contagious enough to outcompete their ancestors. Viral interference can sometimes prevent multiple viruses from having a broad coexistence. That’s the likely phenomenon we witnessed when the Covid pandemic coincided with the virtual disappearance of the flu and other respiratory viruses. More to the point, it’s the same phenomenon that occurred when the Spanish Flu was eventually outcompeted by less deadly variants.

So it’s possible that a mild Omicron will put the pandemic behind us. If it proves to be as contagious and as mild as it appears thus far, it would likely displace Delta and other variants as the first phase of a new, endemic malady. That might even cut into the severity of the current seasonal wave. The Ethical Skeptic tweets thusly:

“So was Omicron an ultra fast-mutating magic terminator variant? A gift from God, or aliens…? … Or natural virility/genetic profile derived from a previous variant conferring immunity …”

That would be a wonderful outcome, but Omicron’s arrival in the northern hemisphere just as winter gets underway contributes to the uncertainty. It’s severity during the northern winter could be far worse than what we’ve seen in South Africa. We can hope this variant isn’t one truly deserving of Chairman Xi’s name.

Failed Health Education, In One Anecdote

28 Thursday Oct 2021

Posted by in Coronavirus, Public Health

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I’d just posted an article about the idiocy of masking outdoors, which included a call for an end to the confused public health messaging we’ve heard during the pandemic, when I witnessed something that made my eyes roll:

A fiftyish guy just ahead of me is wearing a mask, walking from the beach toward a public pavilion where there are restrooms. He is barefoot…. and he enters the men’s room and steps right up to the row of urinals. He leaves the restroom without washing his hands.

Perhaps he’s not quite Darwin Award material, but I ask: do you think this guy’s precautions against potential pathogens and disease vectors were well balanced? It’s not terribly uncommon to see “moisture” or even shallow puddles around public urinals. Don’t go barefoot! Wear flip-flops to the john, at the very least. And wash your hands when you’re done!

Amazingly, the only message related to health and hygiene that our friend has absorbed is to wear a useless mask. And he wears it at the beach! I’m sure he got around to adjusting his mask with unwashed hands at some point. I’ll cut him some slack for wearing a mask inside the restroom, but as my last post noted, that precaution is almost surely wasted effort.

Mask Truths and Signals

26 Tuesday Oct 2021

Posted by in Coronavirus, Public Health

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It’s been clear since the beginning of the pandemic that your chance of getting infected with COVID outside is close to zero. (Also see here). Yet I still see a few masked people on the beach, in the park, on balconies, and walking in the neighborhood. Given the negligible risk of contracting COVID outdoors, the marginal benefit of masking outdoors is infinitesimal. Likewise, the benefit of a mask to the sole occupant of a vehicle is about zilch. Okay, some individuals might forget to remove their masks after leaving a “high-risk” environment. Sure, maybe, but cloth masks really don’t stop the dispersion of fine aerosols anywhere, indoors or outdoors. Of course, the immune-compromised have a reasonable excuse to apply the precautionary principle, but generally not outside with good air quality.

The following link provides a list of mask studies, and meta-studies. Several describe randomized control trials (RCTs). They vary in context, but all of them reject the hypothesis that masks are protective. Positive evidence on mask efficacy is lacking in health care settings, in community settings, and in school settings, and the evidence shows that masks create “pronounced difficulties” for young children and “emotional interference” for school children of all ages. Here’s another article containing links to more studies demonstrating the inefficacy of masks. Also see here. And this article is not only an excellent summary of the research, but it also highlights the hypocrisy of the “follow the science” public health establishment with respect to RCTs. Compliance is not even at issue in many of these studies, though if you think masks matter, it is always an issue in practice. Even studies claiming that cloth masks of the type normally worn by the public are “effective” usually concede that a large percentage of fine aerosols get through the masks… containing millions of tiny particles. In indoor environments with poor ventilation, those aerosols remain suspended in the air for periods long enough to be inhaled by others. That, in fact, is why masks are ineffective at preventing transmission.

Another dubious claim is that masks are responsible for virtually eliminating cases of influenza in 2020 and 2021. Again, to be charitable, masks are of very limited effectiveness in stopping viral transmission. Moreover, compliance has been weak at best, and areas without mask mandates have experienced the same plunge in flu cases as areas with mandates. A far more compelling explanation is that viral interference caused the steep reduction in flu incidence. The chance of being infected with more than one virus at a time is almost nil. Simply put, COVID outcompeted the flu.

Again, I grant that there are studies (though only a single randomized control trial out of India of which I’m aware) that have demonstrated significant protective effects. Even then, however, the mixed nature of this body of research does not support intrusive masking requirements.

Nevertheless, masks are still mandated in some jurisdictions. Those mandates usually don’t apply outdoors, however, and not in your own damn car! Mask mandates contribute to the general climate of fear surrounding COVID, which is wholly unjustified for most children and healthy working-age people. Public health messaging should focus on high-risk individuals: the elderly, the obese, and those having so-called comorbidities and compromised immune systems. Those groups have obvious reasons to be concerned about the virus. They have excuses to be germaphobic! Still, they are at little risk outdoors, the value of masks is doubtful, and breathing deep of fresh air is good for you in any case!

The incidence of COVID has declined substantially in many areas since early September, but the virus is now almost certainly endemic and is likely to return in seasonal waves. However, the Delta wave was far less deadly than earlier variants, a favorable trend many believe will continue. These charts from the UK posted by Michael Levitt demonstrate the improvement vividly. Perhaps the mask craze will fade away as the evidence accumulates.

The pandemic has been a moment of redemption for germaphobes, but no reasonable assessment of risk mitigation relative to the cost, inconvenience, discomfort, and psychological debasement of face jackets can prove their worth outdoors. Their value indoors is nearly as questionable. Yet there remains a stubborn reluctance by public health authorities to lift mask mandates. There are far too many individuals masking outdoors, and to be nice, perhaps it’s mere ignorance. But there are still a few would-be tyrants on Twitter presuming to shame others into joining this pathetic bit of theatre. I believe Anne Wheeler nailed it with this recent tweet:

“This is one of the first things you learn in OCD therapy – you don’t get to make people participate in your compulsions in order to lesson your own anxiety. It’s bizarre that it’s been turned into a virtue.”

There’s also no question that masks are still in vogue as a virtue signal in some circles, but a mask outdoors, especially, is increasingly viewed as a stupid-signal, and for good reason. I’ll continue to marvel at the irrationality of these masked alarmists, who just don’t understand how foolish they look. Give yourself permission to get some fresh air!

Bottom-Line Booster Shots

17 Saturday Apr 2021

Posted by in Coronavirus, Public Health, Vaccinations

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The barrage of precautionary COVID missives continues, and with a familiar “follow-the-money” twist. The CEOs of both Pfizer and Moderna say that booster shots are likely to be needed a year after initial administration of their COVID vaccines, and almost certainly every year thereafter. Of course, this message is for those who felt compelled to be vaccinated in the first place, whether out of concern for their own health, high-minded community spirit, fear of social ostracism, or fear of possible vaccine passport requirements. It’s probably also intended for those who acquired immunity through infection.

There are reasons to believe, however, that such a booster is unnecessary. This case was made a few days ago in a series of tweets by Dr. Monica Ghandi, an infectious disease expert and Professor of Medicine at UCSF. Ghandi says immunity from an infection or a vaccine can be expected to last much longer than a year, despite the diminished presence of antibodies. That’s because the immune system relies on other mechanisms to signal and produce new antibodies against specific pathogens when called upon.

So-called B cells actually produce antibodies. Another cell-type known as T cells act to signal or instruct B cells to do so, but so-called “killer” T cells destroy cells in the body that have already been infected. Dr. Ghandi’s point is that both B and T cells tend to have very long memories and are capable of conferring immunity for many years.

While our experience with COVID-19 is short, long-lasting immunity has been proven against measles for up to 34 years, and for other SARS-type viruses for at least 17 years. Dr. Ghandi links to research showing that survivors of the 1918 flu pandemic were found to have active B cells against the virus 90 years later! The COVID vaccines cause the body to produce both B and T cells, and the T cells are protective against COVID variants.

A last point made by Dr. Ghandi is intended to dispel doubts some might harbor due to the relatively ineffectual nature of annual flu vaccines. The flu mutates much more aggressively than COVID, so the design of each year’s flu vaccine involves a limited and uncertain choice among recent strains. COVID mutates, but in a more stable way, so that vaccines and adaptive immunity tend to retain their effectiveness.

While I’m sure the pharmaceutical companies believe in the benefits of their vaccines, there are undoubtedly other motives behind the push for boosters. There is money to be made, and much of that money will be paid by governments eager to jump on the precautionary bandwagon, and who are likely to be very insensitive to price. In fact, the vaccine producers might well have encouraged those pushing vaccine passports to include annual booster requirements. This would be another unwelcome imposition. The very discussion of boosters gives government officials more running room for other draconian but ultimately ineffective mandates on behavior. And the booster recommendation gives additional cover to public health “experts” who refuse to acknowledge real tradeoffs between the stringency of non-pharmaceutical interventions, economic well being, and other dimensions of public health.

Hooray For Florida!

22 Monday Feb 2021

Posted by in Coronavirus, Public Health

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It’s been said that many of the so-called “heroes” of the COVID pandemic who’ve been celebrated by the media are actually villains, and perhaps Governor Andrew Cuomo of New York should top the list. He saw to it that retirement homes were seeded with infected patients by ordering them returned their care homes rather than admitted to hospitals. Deaths in these facilities mounted, and they mounted faster than Cuomo’s administration was willing to admit. But the media and even Democrat state legislators have begun to take note, which is practically a miracle!

It seems equally true that some vilified by the media for their COVID response are actually heroes. Governor Ron DeSantis of Florida might deserve top honors here. Having spent the last month in Florida, I can attest that the business and social environment here is quite open compared to my home state (despite the presence of a few freaked out northerners who can’t quite fathom how stupid they look wearing masks on the beach). Florida’s infections, hospitalizations, and deaths have been lower than in California, New York, and many other states where lockdown measures have been stringent. (The first chart below is just a little busy…)

As I’ve written for much of the past year, COVID is far more dangerous to the elderly than anyone else, particularly those with co-morbidities. It’s also true that blacks (and some other minorities) are more vulnerable than whites, but if we want to save more black lives, we’re still better off prioritizing the elderly than racial groups. DeSantis understands this, and Florida is among the leaders in vaccinating the elderly population. (States don’t report this data on a uniform basis):

This approach to saving lives is obvious, yet critics at outlets like NBC News insist that DeSantis must be pandering to the senior population in Florida. Well, one wouldn’t want to be responsive to voters who happen to face high mortality risks, right? Others such as horror writer Stephen King have jumped onboard to offer their bumbling public health expertise as well.

There were many experts and the usual collection of numbskulls on social media who were wrong about Florida. DeSantis handled the pandemic as it should have been handled elsewhere. But the propaganda to the contrary goes unabated. For example, this article is pathetic. Can these people be serious? Or are they really that stupid? This goes for the Biden Administration as well, which had entertained the notion of imposing federal travel restrictions on Florida!

The political attacks on Florida and its governor reveal the extent to which opponents wish to ignore the evidence in plain sight. The data on COVID outcomes put the lie to the narrative of a public health emergency requiring massive restrictions on personal liberty. We know those policies are powerless to control the course of the contagion. The pandemic, however, was the key to convincing the public to accept a more authoritarian role for government. It’s a blessing that not everyone bought in, and that there are places like Florida where you can still go about your business in approximate normalcy.

COVID Cases Decline Despite New Variants

19 Friday Feb 2021

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For weeks, even months, we’ve been hearing about dangerous new mutations of the coronavirus, and they’ve been identified in cases in the U.S. There’s a UK strain, a South African strain, a Brazilian strain, and still others, which differ in seemingly minor ways. Nevertheless, these variants are said to be more infectious. It’s also been reported that the South African and Brazilian strains might resist antibodies from prior infections from earlier strains.

Kyle Lamb has provided the following charts to put things in perspective:

Just to round things out, here is the trend in cases worldwide:

There is a great deal of concern about the new variants. A search for “COVID-19 variants” turns up plenty of scary articles. However, there is some evidence that the new variants are not as dangerous as alarmists contend. The resistance to specific antibodies does not necessarily imply resistance to protection by T-cells. As Youyang Gu points out, even if a new strain becomes “dominant”, that does not imply that cases will reverse their decline. This study indicates that the Pfizer vaccine is protective against both the UK and South African strains, and there is evidence that other vaccines offer adequate protection as well (and see here).

The charts demonstrate that the new strains haven’t arrested or reversed the declines in infections witnessed worldwide since early January. That doesn’t mean the mutations haven’t made a difference: perhaps the declines would have been faster in their absence. And we don’t know what the future will hold as the virus in various forms becomes endemic. Still, it’s reassuring to see that the increased transmissibility of the new strains hasn’t overcome factors that have contributed to the recent declines, which in all likelihood are related to increasing immunity in the population with a minor assist from vaccinations (thus far). As Lamb wryly notes about the recent declines in transmission: “Just saying”.

Long COVID: a Name For Post-Viral Syndrome

15 Friday Jan 2021

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I see references to “long COVID” or “long-haul COVID” almost every day. No, it’s not an extended COVID infection or an extra scary version of COVID. It’s about lingering or new symptoms after recovery from the infection. Reportedly, these symptoms range from fatigue or anxiety to joint pain. Sometimes they are rather unusual afflictions such as “COVID toes”, described as rashes or red spots on toes. Sebastian Rushworth notes that there is “no hard evidence that long COVID is a distinct entity”. It was essentially invented on social media by groups of individuals who connected to discuss various post-COVID symptoms. Rushworth says:

“The most common symptoms in people with long covid (defined in the study as still having symptoms after four weeks) were fatigue (98%) and intermittent headache (91%). … symptoms of long covid are extremely unspecific, so it is probable that long covid is actually a whole bunch of different things, of which I would think post-viral syndrome is likely a significant part.”

Post-viral syndrome should not be a big surprise, since COVID is, well, a virus! PVS can last for months and commonly has the following symptoms:

Those sound familiar. PVS symptoms are thought to be a consequence of the body’s effort to fight off a virus, including the lingering effects of a strong immune response and the inflammation it can induce. Such an immune response can lead to even greater problems for those with a genetic predisposition for autoimmune diseases like diabetes. It happens. But none of this is new or unique to COVID.

While PVS and autoimmune diseases are very real, the unbridled panic over COVID has led to a few false claims. “COVID toes” is one of them. Moreover, the pandemic precipitated an avalanche of poor-quality academic research, rushed in an effort to produce useful findings. Some of that research is implicated in the COVID myths we’ve heard. An example discussed at the last link is the incidence of heart inflammation or myocarditis in COVID patients. This was all over the media in the months leading up to the college football season, as young athletes were said to be vulnerable. In fact, it’s incidence among COVID patients is fairly rare, and it’s not unique to COVID.

COVID can be a nasty infection, primarily for the aged and those with pre-existing conditions, including obesity. PVS is an unfortunate reality for many patients. But “long-COViD” is merely a varied collection of post-viral symptoms. Many of them are vague and usually self-diagnosed. Long COVID is, as Rushworth says, “basically whatever the person who thinks they have it says it is.” That the media has promoted long COVID and its varied manifestations as something wholly new, including a few probable “imagifestations” (to coin a term), is one more example of the “panic porn” to which we’ve been subjected during the pandemic.

The Pernicious COVID PCR Test: Ditch It or Fix It

02 Wednesday Dec 2020

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We have a false-positive problem and even the New York Times noticed! The number of active COVID cases has been vastly exaggerated and still is, but there is more than one fix.

COVID PCR tests, which are designed to detect coronavirus RNA from a nasal swab, have a “specificity” of about 97%, and perhaps much less in the field. That means at least 3% of tests on uninfected subjects are falsely positive. But the total number of false positive tests can be as large or larger than the total number of true positives identified. Let’s say 3% of the tested population is truly infected. Then out of every 100 individuals tested, three individuals are actively infected and 97 are not. Yet about 3 of those 97 will test positive anyway! So in this example, for every true infection identified, the test also falsely flags an uninfected individual. The number of active infections is exaggerated by 100%.

But again, it’s suspected to be much worse than that. The specificity of PCR tests depends on the number of DNA replications, or amplification cycles, to which a test sample is subjected. That process is illustrated through three cycles in the graphic above. It’s generally thought that 20 – 30 cycles is sufficient to pick-up DNA from a live virus infection. If a sample is subjected to more than 30 cycles, the likelihood that the test will detect insignificant dead fragments of the virus is increased. More than 35 cycles prompts real concern about the test’s reliability. But in the U.S., PCR tests are regularly subjected to upwards of 35 and even 40-plus cycles of amplification. This means the number of active cases is exaggerated, perhaps by several times. If you don’t believe me, just ask the great Dr. Anthony Fauci:

“It’s very frustrating for the patients as well as for the physicians … somebody comes in, and they repeat their PCR, and it’s like [a] 37 cycle threshold, but you almost never can culture virus from a 37 threshold cycle. So, I think if somebody does come in with 37, 38, even 36, you got to say, you know, it’s just dead nucleotides, period.“

Remember, the purpose of the test is to find active infections, but the window during which most COVID infections are active is fairly narrow, only for 10 – 15 days after the onset of symptoms, and often less; those individuals are infectious to others only up to about 10 days, and most tests lag behind the onset of symptoms. In fact, infected but asymptomatic individuals — a third or more of all those truly infected at any given time — are minimally infectious, if at all. So the window over which the test should be sensitive is fairly narrow, and many active infections are not infectious at all.

PCR tests are subject to a variety of other criticisms. Many of those are discussed in this external peer-review report on an early 2020 publication favorable to the tests. In addition to the many practical shortfalls of the test, the authors of the original paper are cited for conflicts of interest. And the original paper was accepted within 24 hours of submission to the journal Eurosurveillance (what a name!), which should raise eyebrows to anyone familiar with a typical journal review process.

The most obvious implication of all the false positives is that the COVID case numbers are exaggerated. The media and even public health officials have been very slow to catch onto this fact. As a result, their reaction has sown a panic among the public that active case numbers are spiraling out of control. In addition, false positives lead directly to mis-attribution of death: the CDC changed it’s guidelines in early April for attributing death to COVID (and only for COVID, not other causes of death). This, along with the vast increase in testing, means that false positives have led to an exaggeration of COVID as a cause of death. Even worse, false positives absorb scarce medical resources, as patients diagnosed with COVID require a high level of staffing and precaution, and the staff often requires isolation themselves.

Many have heard that Elon Musk tested positive twice in one day, and tested negative twice in the same day! The uncomfortable reality of a faulty test was recently recognized by an Appeals Court in Portugal, and we may see more litigation of this kind. The Court ruled in favor of four German tourists who were quarantined all summer after one of them tested positive. The Court said:

“In view of current scientific evidence, this test shows itself to be unable to determine beyond reasonable doubt that such positivity corresponds, in fact, to the infection of a person by the SARS-CoV-2 virus.” 

I don’t believe testing is a bad thing. The existence of diagnostic tests cannot be a bad thing. In fact, I have advocated for fast, cheap tests, even at the sacrifice of accuracy, so that individuals can test themselves at home repeatedly, if necessary. And fast, cheap tests exist, if only they would be approved by the FDA. Positive tests should always be followed-up immediately by additional testing, whether those are additional PCR tests, other molecular tests, or antigen tests. And as Brown University epidemiologist Andrew Bostom says, you should always ask for the cycle threshold used when you receive a positive result on a PCR test. If it’s above 30 and you feel okay, the test is probably not meaningful.

PCR tests are not ideal because repeat testing is time consuming and expensive, but PCR tests could be much better if the number of replication cycles was reduced to somewhere between 20 and 30. Like most flu and SARS viruses, COVID-19 is very dangerous to the aged and sick, so our resources should be focused on their safety. However, exaggerated case counts are a cause of unnecessary hysteria and cost, especially for a virus that is rather benign to most people.

COVID Trends and Flu Cases

05 Thursday Nov 2020

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Writing about COVID as a respite from election madness is very cold comfort, but here goes….

COVID deaths in the U.S. still haven’t shown the kind of upward trend this fall that many had feared. It could happen, but it hasn’t yet. In the chart above, new cases are shown in brown (along with the rolling seven-day average), while deaths (on the right axis) are shown in blue. It’s been over six weeks since new case counts began to rise, but deaths have risen for about two weeks, and it’s been gradual relative to the first two waves. Either the average lag between diagnosis and death is much longer than earlier in the year, or the current “casedemic” is much less deadly, or perhaps both. It could change. And granted, this is national data; states in the midwest have had the strongest trends in cases, especially the upper midwest, as well as stronger trends in hospitalizations and deaths. Most of those areas had milder experiences with the virus in the spring and summer.

Lagged Reporting

What’s tricky about this is that both case reports and death reports in the chart above are significantly lagged. A COVID test might not take place until several days after infection (if at all), and sometimes not until hospitalization or death. Then the test result might not be known for several days. However, the greater availability of tests and faster turnaround time have almost certainly shortened that lag.

Deaths are reported with an even a greater delay, though you wouldn’t know it from listening to the media or some of the organizations that track these statistics, such as Johns Hopkins University and the COVID Tracking Project. Thus far, they only tell you what’s reported on a given day. This article from Rational Ground does a good job of explaining the issue and the distortion it causes in discerning trends.

Deaths by actual date-of-death

I’ve reported on the issue of lagged COVID deaths myself. The following graph from Justin Hart is a clear presentation of the reporting delays.

Reported deaths for the most recent week (10/24) are shown in dark blue, and those deaths were spread over a number of prior weeks. Actual deaths in a given week are represented by a “stack” of deaths reported later, in subsequent weeks. One word of caution: actual deaths in the most recent weeks are “provisional”, and more will be added in subsequent reporting weeks. Hence the steep drop off for the 10/17 and 10/24 reporting weeks.

Going back three or four weeks, it’s clear that actual deaths continued to decline into October. Unfortunately, that doesn’t tell us much about the recent trend or whether actual deaths have started to rise given the increase in new cases. I have seen a new weekly update with the deaths by actual date of death, but it is not “stacked” by reporting week. However, it does show a slight increase in the week of 10/10, the first weekly increase since the end of June. So perhaps we’ll see an uptick more in-line with the earlier lags between diagnosis and death, but that’s far from certain.

Another important point is that the number of deaths each week, and each day, are not as high as reported by the media and the popular tracking sites. How often have you heard “more than 1,000 people a day are dying”. That’s high even for weekly averages of reported deaths. As of three weeks ago, actual daily deaths were running at about 560. That’s still very high, but based on seroprevalence estimates (the actual number of infections from the presence of antibodies), the infection fatality keeps dropping toward levels that are comparable to the flu at ages less than 65.

Where is the flu?

Speaking of the flu, this chart from the World Health Organization is revealing: the flu appears to have virtually disappeared in 2020:

It’s still very early in the northern flu season, but the case count was very light this summer in the Southern Hemisphere. There are several possible explanations. One favored by the “lockdown crowd” is that mitigation efforts, including masks and social distancing, have curtailed the flu bug. Not just curtailed … quashed! If that’s true, it’s more than a little odd because the same measures have been so unsuccessful in curtailing COVID, which is transmitted the same way! Also, these measures vary widely around the globe, which weakens the explanation.

There are other, more likely explanations: perhaps the flu is being undercounted because COVID is being overcounted. False positive COVID tests might override the reporting of a few flu cases, but not all diagnoses are made via testing. Other respiratory diseases can be mistaken for the flu and vice versus, and they are now more likely to be diagnosed as COVID absent a test — and as the joke goes, the flu is now illegal! And another partial explanation: it is rare to be infected with two viruses at once. Thus, COVID is said to be “crowding out” the flu.

Waiting for data

There is other good news about transmission, treatment, and immunity, but I’ll devote another post to that, and I’ll wait for more data. For now, the “third wave” appears to be geographically distinct from the first two, as was the second wave from the first. This suggests a sort of herd immunity in areas that were hit more severely in earlier waves. But the best news is that COVID deaths, thus far this fall, are not showing much if any upward movement, and estimates of infection fatality rates continue to fall.