My thought on this is essentially the same thought I have about all the so-called research breakthroughs.
COVID-19 is a new virus. This does not mean that all this research is based on new ideas. While SARS-CoV-2 is new, there have been earlier emergent viruses that are similar, like SARS-CoV.
These earlier emergent viruses have been extensively studied by thousands of virologists. The spike proteins have been analyzed. The cleavage sites have been identified and studied. They have been tested extensively against all sorts of drugs including Hydroxychloroquine.
All these highly technical descriptions of chemical pathways are very impressive sounding. But very few of them are specific to COVID and many aren’t even specific to viruses.
A lot of them are just the general chemical imbalances that happen when you are sick from anything. That’s why the the clinical history of promising treatments that target these pathways frequently shows they have also be touted as promising treatments against non-viral illnesses like cancer and bacterial infections.
Viruses are pretty obdurate and there hasn’t been a lot of success in terms of cures - and effective treatments are usually multi-drug cocktails that attack across multiple avenues.
I’m not saying the new discovery is worthless, this information may prove useful in terms of developing a complex treatment. But I’m saying this article gives the impression that if researchers can find a substance that blocks this receptor site, then we will have a cure.
Viewed in the light of the history of the science of virus prevention and treatment, this is just unbelievably optimistic.
Note: Frequently when I “research the research“, I use a date limited search set to not display anything AFTER 1-1-2020.
This gives me a picture of the research done on the infection mechanism, or possible cure, or whatever, pre-COVID. This has shown me that a lot of stuff being presented as new really isn’t.
I don’t think that is necessarily the conclusion to be drawn at this point. See this letter co-signed by a large group of physicians:
Studies123 investigating the prevalence of myocarditis in patients with recent COVID-19 have found features of subclinical myocarditis on cardiac magnetic resonance (CMR) imaging in patients without symptoms. Some commentators have raised concern that COVID-19 may lead to frequent, serious long-term cardiac sequelae even among people who have had mild infection and are currently asymptomatic.
We wish to emphasize that the prevalence, clinical significance and long-term implications of CMR surrogates of myocardial injury on morbidity and mortality are unknown. Further, it is unclear if the elevated T1 and T2 flagged in these studies are clinically significant, particularly in isolation, if treatment is needed, and, if so, what the management should be. These important questions should inspire future prospective studies.
Nonetheless, these reports have attracted significant media coverage, at times amplified by speculation on possible clinical implications, thus generating substantial anxiety amongst members of the general public. As a result, we are aware that some individuals are seeking CMR testing despite the absence of cardiac symptoms. We believe that, given the preliminary nature and limitations of the current evidence, testing asymptomatic members of the general public after COVID-19 is not indicated outside of carefully planned and approved research studies with appropriate control groups.
It’s my layman’s understanding that acute myocarditis is a fairly regular occurrence with other common viruses. See this interview with Dr. Michael Ackerman, genetic cardiologist at the Mayo Clinic.
D.O.: Are there any other viruses that can cause myocarditis?
M.A.: Yes, there are. Long before coronavirus, there are over 20 viruses that have been implicated with the ability for this kind of heart damage that we call myocarditis. We know that almost half, around 40% to 50%, of all cardiac transplant recipients require transplants because of the damage done by myocarditis. It is a very important entity but it is one that has been around long before coronavirus. This virus is yet another virus with the capability of infecting the heart muscle and potentially damaging the heart muscle. It’s created even more anxiety during this COVID-19 pandemic.
D.O.: How does this apply to young and healthy athletes who don’t have pre-existing conditions?
M.A.: For those individuals who are asymptomatic or minimally symptomatic, this myocarditis thing is a non-issue. That’s because the virus hasn’t reached or done any damage to that viral infected person. It’s a very small number of otherwise healthy young people where the viral infection of SARS-CoV-2 is going to reach the heart, penetrate the heart, or do any measurable damage. Myocarditis taking center stage with athletes and discussing athletes risk is probably a bit overstated.
D.O.: What happens if an athlete gets SARS-CoV-2 myocarditis?
M.A.: If someone gets SARS-CoV-2 myocarditis, it’s potentially a big deal. But any other potential viral myocarditis is also a big deal. If there’s a substantial level of heart damage rendered, we could be talking (about) life-support devices and cardiac transplantation. That is so much the exception, rather than the rule in any myocarditis. This coming flu season, influenza can infect and damage the heart muscle. It’s really a matter of perspective and weighing everything in the balance.
I’d welcome any SDMB’s doctor’s thoughts on the issue.
Summer wave of dementia deaths adds thousands to pandemic’s deadly toll – The US CDC is seeing an unexplained twenty-percent increase in deaths attributed to dementia/Alzheimer’s. It’s not clear whether this is due to undiagnosed COVID, disruptions in care attributable to staffing and other nursing home problems, lack of social contact with the outside world, or some combination of these and/or other factors.
Good going! I’m imagining the world – which is to say, science – is already now and certainly in the future will be learning much about the virus from the Herculean efforts being undertaken there.
One thing I’ve been wondering about – and I wrote one of the papers there but got no reply – is how many false positives they are receiving from all those tests, and how they are handling them. This seems like such an open question all around the world, with many jurisdictions perhaps not being in a place to even try to figure it out, so you’d think this would be another valuable data point to come from New Zealand. Are you hearing anything on this from following the news there? I imagine they are very carefully double-checking everything before they fully confirm a case? Would love to learn about their methodology. I recognize it might not be applicable to every other situation, but would still be interesting to learn about.
While false positives do occur, false negatives are much more prevalent for all three types of testing methods. So if the numbers get skewed, they’re probably too low. This is can be a problem because it gives people a false sense of security. They may go out and infect someone thinking that they are not contagious.
Interesting. Thanks for the link. I can’t say that this part inspires confidence!
What about accuracy? False negatives — that is, a test that says you don’t have the virus when you actually do have the virus — may occur. The reported rate of false negatives is as low as 2% and as high as 37%. The reported rate of false positives — that is, a test that says you have the virus when you actually do not — is 5% or lower.
Yikes. I’ve come across a number of other sources, though, that guess on rates like 99.5% for sensitivity and 98+% for specificity. But of course, and getting perhaps to what you said about false negatives, those accuracy rates are for conditions where the only source of error is the test itself, I’d imagine? If you get a bad swab, I guess that throws it all out the window.
I just wonder how well these issues are being addressed (if they do matter). Given how many people must be working, worldwide, on the hundreds and hundreds of thousands of tests each and every day (millions? tens of millions?), you’d have to think there is a pretty good sized margin of error.
If you’re lucky enough to live in a place like NZ, this isn’t an issue because they are keeping such close tabs on the virus.
In places that are not controlling or keeping tabs on the virus, like the US, the test positivity rate is what alerts authorities to a large amount of undetected community spread. Eventually, people start dying which, if not properly being tested for the virus, translates to excess deaths and discrepancies as discussed in another thread.
When San Antonio cases started surging in June, the test positivity rate went from 4% to eventually 24%. That means there was covid all over the place. Who knows what our real numbers were? All we know is that our hospitals were filling up. We probably have people who died of “pneumonia” who really died of covid.
But, really, false negatives is a much, much smaller problem than insufficient testing. That’s what the US has.
Do you think there is any chance the prevalence was well below 24%? How much chance do you think there is that it was significantly above 24%? Any chance it could have been double that number? (If so, would present testing capabilities really much matter?)
RE: False results -
Everybody coming into the country is sent to a quarantine facility for 14 days.
They are tested for the virus on day 3 and day 12
I hven’t been monitoring closely, but haven’t heard anything about false results.
Recalling highschool biology, and combining it with my rudimentary math skills, I’m not worried about false positives - we have the contact tracing capacity and quarantine setup to manage this.
It would be false negatives that are the concern -
while: chance of being infected x chance of false negative x chance of false negative may be low,
this may be what eventually causes another full scale community outbreak here.
And I would also need to add - it absolutely galls me everytime I hear about our “church cluster”.
I’m very much biased against any sort of organised religion and when hearing about the spread of a disease from a Church service it just fucks me off.
And this may be more suited to the politics thread - but my greatest hope is that Biden whacks Trump hard on stats from the virus - citing countries like NZ an South Korea where our test to positive ratio is so low, deaths are low etc etc and just absolutely crush him with simple stats.
I might be misunderstanding your question but test positivity means, in this case, that 24% of the tests came back positive. That means that only people who clearly have symptoms were getting tested. This is particularly true since many people may wait until their viral load drops to undetectable levels but they still be contagious and definitely had covid.
Think about it. Covid has a range of symptoms which could point to anything. Yet 24% of people were testing positive. Remember, there will be more false negatives than positives. And probably only a fraction of people were going in to get tested. So the real number is much larger. In certain regions of the US, where there is little control of the virus and testing is minimal, an outbreak probably has much more cases circulating than what is reported. I’ve seen estimates anywhere from 5-11X more when numbers overload testing and contact tracing.
Right, that’s what I’m getting at. If the positivity rate was that high, what do you think that says about the prevalence of the virus in the community at large. I do not know enough about the situation on the ground in San Antonio to guess how many people were getting tested, how likely those people were to be experiencing symptoms, and so on. I just know that 24% seems really high!
In New Zealand we have done 880,000 tests* and have 1,809 cases
So about 1 in 500 positive?
Or 0.2%
Again - it flabbergasts me when you can get a positivity rate above 10%.
Here - anybody that tests positive ALL of their close contacts are also tested. That alone would be more than 10 people (even if none of them are infected)
How can anybody possibly be doing any sort of contact tracing with those sorts of positivity rates?
Seems to me - we may need to change the slogan for US from “The Land of the Free” to “The Land of the Ostrich”
I’m not sure if “tests” means people or actual tests
Person gets a positive test: its treated as a positive and the person goes into self-isolation.
Contact tracing starts: close contacts are asked to self-isolate and tested, casual contacts are notified and if symptomatic asked to come in for a test
The initial person is retested: if positive again then they are moved into managed isolation (or appropriate arrangements made.) If negative then they are retested again to make sure and if it comes back negative again the case is closed.
The Director General of Health Dr Bloomfield said that the Americold outbreak followed a very predictable pattern: and I suspect that any positive tests outside of that pattern (like the Wellington or Christchurch false positives) would get more scrutiny than those within.
Since I’m back in the thread I thought it would be interesting to look back over the last month just to give an overview of the outbreak and the NZ Government’s response.
Before the outbreak New Zealand had gone 100 days Covid-free: and we had gotten a bit complacent. Testing was at an all-time low since the start of the pandemic: outside of managed isolation my understanding was that the day before the index case there were less than 20 tests done on the day.
So it was very fortunate (and we are forever thankful) that the index case decided to get a test on the 10th of August. This was the start of the Americold cluster. Americold had a cool store in Mt Wellington where the index case worked. As of today how that person got infected is still a mystery. There is no genomic or epidemiological link to any past cases or any cases on the border. They are 99% sure it didn’t come in through the cool store. They checked the ports, they checked the airline crews. Nada.
Once the outbreak got detected NZ went back to their alert levels. Auckland went to Alert Level 3 and for the first time the police put up checkpoints to stop people getting into and out of the city. The rest of the country went to Alert Level 2. We learnt from Victoria’s mistake: we went for a regional lockdown instead of trying to lockdown streets and buildings. And we didn’t wait to introduce those measures, we pretty much introduced them over the course of 48 hours.
The system showed that it was capable of being ramped up substantially, in a way that would have been impossible back in March. The contact tracing teams were organised by the Regional Health Boards and included both Maori and Pacifica representation which was crucial as the initial outbreak was in South Auckland, an area dominated by these two communities. The labs worked overnight to get results back in 48 hours (any positive cases found in the lab were “flagged” and fast-tracked). If people returned a positive test both them and the people in their immediate bubble were moved to managed isolation: this reduced the risk of other people getting infected, but also reduced the burden of those at risk having to look after a person with Covid-19.
The first big wrinkle happened when a case was found to have been infected while travelling on a bus. This lead to a compulsory mask mandate on public transport nationwide: a mandate that is likely to continue even when the country drops back to Level 1.
The second big wrinkle was a subcluster, linked back to the Mount Roskill Evangelical Church. Members of the church allegedly held meetings over lockdown, then allegedly weren’t entirely co-operative with health officials with contact tracing, which lead to a subcluster of new infections. This subcluster lead to a “long tail” of infections that extended the Alert Levels (Auckland is now at Level 2.5, which allows travel but still limits group size, the rest of the country is at Level 2) that hopefully we will have finally stamped out. Its been 3 days with no new community cases. Hopefully today will be day 4.
But the outbreak has shaken (me at least) out of my complacency. I didn’t use the app before the new outbreak. But I now use it everywhere I go. I didn’t own a mask. We now have a set of disposable masks ready to go and I have my own custom crimson mask that I wear places to “look cool.” When we drop back to Level 1 next week nobody wants to go back to Level 2 or 3 again. So I’ll play my part.
I guess I’m not explaining myself well. The positivity rate is used to indicate the prevalence of the virus in the community at large relative to actual cases. When you have a high positivity rate, you have a lot of undetected covid in the community.
So I started figuring that for every new case that day, there may be 5-10 more out there. Some of those may already be quarantining themselves or they’re in the hospital. But maybe half of those are roaming around and possibly infecting people.
Twenty four % is not at all high compared to some places in the US at certain times. Some have reached over 80% positivity. My in-laws live in Oklahoma and I remember looking about at their rates. They had an 80% positivity rate in March-April. That means there were tons more cases. Even now, they’re reporting a lot of pneumonia deaths. My husbands, aunt had a friend who just died of pneumonia. I wouldn’t be surprised if it was really covid.