IANS – COVID-19

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It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so. ~ Mark Twain

When George Gershwin composed the song It Ain’t Necessarily So, he was onto something. I’d love to have a nickel for everything I was taught or told or just accepted as fact in the course of my life. From food preservation to gardening to animal husbandry to medicine to finance, there have been a lot more ‘not-so’ things than ‘so’ things. A while back I did a post on not needing to waterbath jams and jellies; I got more than 200 comments corroborating my “not-so” position. At which point it occurred to me there are lots of other not-so things out there, and shazaam, I had an ongoing blog topic. Here’s the latest “it ain’t necessarily so” (IANS). It’s a two-parter, because there is a lot of ground to cover.

Now here’s a topic that provides fertile ground for an IANS blog. The amount of misinformation, disinformation and downright lies spreading about the coronavirus pandemic is mind-boggling. It’s not surprising. We’re having to study this thing as we go along, which means theories about what it does and how it works are constantly coming and going. It’s politicized to the hilt – in a badly divided country that means people will take positions based on party preference rather than science, facts or common sense. People are scared and willing to grasp at the outlandish if it means not having to jettison long-held beliefs. There’s money to be made from vaccines and treatments – enter Big Pharma. On the other end of the scale, the economic damage is huge. Having said all that, here are what I consider to be some IANS issues. Warning: my position on these could change in the future as more information comes in.

Getting COVID-19 is No Big Deal

Think so? Spend some time with a few patients or listen to what the healthcare workers on the front lines are telling you. Some people are getting very, very sick – and there’s no good way to tell ahead of time who those people will be. Even the young and healthy can die from this stuff: children, teens, young adults. Yes, it does look as though the elderly and immune-compromised are more likely to die. But in California, for example, the fastest-growing group of positive COVID tests is coming from the 18 to 49 year-old group. And some seniors in their 90s or over 100 have survived.

You Get Sick, But You’re Fine After You Recover

You wish. There is increasing evidence, both anecdotal and from case studies and research, that COVID-19 can cause significant damage to the heart, lungs, kidneys and brain. There are also reports of neurological damage and syndromes similar to polio. I haven’t seen anything specific about liver damage, but I’d say odds are high. We don’t know enough to say yet whether this damage is permanent. Recovery can take months and many people suffer relapses.

Kids and Teens Don’t Have to Worry About COVID-19

Kids (including newborns) can catch this virus, as can teens. While it looks as though most don’t get very sick and recover quickly, a few develop a condition called multisystem inflammatory syndrome in children (MIS-C) or pediatric multisystem inflammatory syndrome (PMIS). These kids get very sick indeed. Kids with conditions like asthma (about 7.5% of the pediatric population) are more likely to have complications. And kids especially can be asymptomatic carriers, increasing the risk of everyone around them. There are some indications that younger people, who have stronger immune systems than the elderly, may be more likely to develop deadly cytokine storms. Cytokine storms in young, healthy adults are thought to be the reason why the mortality rate of the 1918 flu pandemic was so high, especially in the military.

COVID Tests Are Accurate

It depends. There are a number of different tests out there, but they basically fall into one of two groups. The first is the PCR, or polymerase chain reaction test. It can identify the actual RNA of coronavirus. If the test says it’s positive, odds are pretty high it’s accurate. A negative test, however, is not nearly so conclusive. First, the timing of collection matters. Getting tested in the first three days of infection nearly always results in a negative. Testing between five and eight days after symptoms appear seems to be more accurate. Second, the technique of the person doing the collection matters, as is true for nearly all human-collected specimens. The reported false negative rate is about 30-40%, meaning of every three tests, one is a false negative.

The second kind of test is a blood test, which looks for antibodies to the coronavirus. Timing is critically important with this one, as the test won’t pick up antibodies unless you are fully recovered, which is usually several weeks, at minimum, after symptoms appear. I could find only one independent study of the various tests out there to see which are the most accurate (there are a number on the market). Second, the antibody tests are not necessarily specific to coronavirus. They may show positive results because you have antibodies to the common cold (also a coronavirus) circulating in your blood stream. Third, no one knows whether these tests have any value, because we don’t know if immunity wanes or even if it protects you from another infection. Which leads me to…

My Test is Negative, So Everything’s Fine

If you are one of the 30-40% with a false negative test, you are spreading coronavirus hither, thither and yon. Not to mention that a negative test now does not mean you can’t catch it in the future. A negative test does not give you license to ignore prevention strategies that protect both you and others. By the way, at least in our area, the private labs are so overwhelmed that test results are not coming back for 10 to 13 days. So while you’re waiting, please self-isolate, especially if you have symptoms. By the time your results arrive, you could have infected dozens of other people.

Tests Help in Treating Coronavirus

Not really. Here are the problems:

  • The high false negative rate means that in too many cases, people whose symptoms clearly indicate they have COVID are sent home or untreated because the test is “negative.” I’ve mentioned the case I personally experienced in which the patient’s symptoms were overwhelmingly positive but the test was negative. The ER doctor dismissed the symptoms and the chest CT that showed the ground-glass opacity typical of a COVID infection. My granddaughter’s case was similar, although she was thankfully not nearly as sick.
  • Turnaround time for tests is so long (13 days in most cases for my area right now) that by the time you get results you’re well past the quarantine period. In many cases, you’re also well into the period when treatment is needed.
  • Treatment for COVID is mostly based on symptoms. If your oxygen level is low, for example, we use supplementary oxygen. Whether your test is positive or negative is pretty much a moot point. We don’t have any kind of a magic bullet – antibiotics don’t work unless the patient has a secondary bacterial infection. Medications like Remdesivir and Acyclovir may or may not be helpful – not enough information. The water is very muddy because of the potential money to be made and the intertwined political issues, which is skewing the data on which remedies are effective.
  • We don’t know what antibody tests mean. Does a high antibody level mean your body has successfully beaten back the disease or just that your immune system is still trying to combat the infection? If your antibody test is positive, do you have any kind of lasting immunity? If your antibody test is low, will it climb higher over time? Is a positive test truly a reflection of your response to COVID, or does it show a previous response to another coronavirus (like the common cold)?
  • Tests don’t tell us anything about your long-term prospects. I’ve seen a couple of reports that some experts believe a COVID infection confers short-term immunity – say six months. I don’t see any good, solid data to back that up. And since we’re just now getting to the six- to eight-month mark in this pandemic, I don’t see how anyone can make that kind of statement with any degree of certainty.
  • So what are tests good for? Well, they are useful for epidemiologists who are trying to study the pandemic. With enough testing, you can make some educated guesses about the overall infection rate and the rate at which the disease is spreading. Tests on people who die can help confirm the actual mortality rate. Testing can help to pinpoint the best times to collect specimens. To some extent, they may be useful for convincing the doubters that yes, Virginia, there really is a pandemic. Since positive test results are more accurate than negatives, they can help us catch the people who do have COVID but don’t have symptoms.

You Can Only Catch COVID Once

We don’t know for sure. Some people seem to develop a second infection weeks or months later. Many of these people test positive, but we don’t know if that’s because they still have the virus from the first time they got sick. And viruses mutate at the drop of the proverbial hat; it could be a mutation causing the second illness. Jury’s definitely still out on this one.

Take a Missouri Approach

Missouri is the “show me” state. The mental attitude of “you’ll have to prove it to me” is a good one. Use your common sense. When your experience or that of people you trust is contrary to accepted scientific wisdom or expert recommendations, odds are very high the scientific wisdom and the experts are out to lunch. Ask the old homicide lawyer’s question, “Cui bono?” Loosely translated as “Who benefits?” what it actually means is “To whose profit?” When big bucks, company survival or professional reputations are on the line, ethics quite often take a back seat. Circus entrepreneur PT Barnum is credited as the person who coined the sucker-born-every-minute rule. In fact, there’s no evidence that he did say it; however, there is some evidence that it was said about Barnum’s tactics, by a banker named David Hannum. Don’t be a sucker and remember: it ain’t necessarily so. (See Part II next week!)

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