(Edit: Wrong icon for thread.)

Now merge this with the CDC guidance for H1N1 cases, and think about what metrics we should be using...

https://www.cdc.gov/h1n1flu/reportingqa.htm

Quote:

---

Why did CDC stop reporting confirmed and probable 2009 H1N1 flu cases?

Individual case counts were kept early during the 2009 H1N1 outbreak when the 2009 H1N1 virus first emerged. As the outbreak expanded and became more widespread, individual case counts become increasingly impractical and not representative of the true extent of the outbreak. This is because only a small proportion of persons with respiratory illness are actually tested and confirmed for influenza (including 2009 H1N1) so the true benefit of keeping track of these numbers is questionable. In addition, the extensive spread of 2009 H1N1 flu within the United States made it extremely resource-intensive for states to count individual cases. On July 24, 2009, CDC discontinued reporting of individual cases of 2009 H1N1, but continued to track hospitalizations and deaths.

---

Yes. "Trace amounts", one might say.

Yep. We need to be focusing on identifying and treating people that are actually ill, not chasing ghosts with a singular focus on "cases".

If this is true this is like Dwights fire drill.

it wasn't all bad to have the PCRs be super sensitive at the beginning when we needed time and didn't understand the virus

but we've bought enough time now

Could this be what's driving the high rate of "asymptomatic" people?

Why am I not surprised ?

Driving up positives for what reason? Wasting resources and time, why would they do that?

Let me guess why.....

This needs to be addressed immediately

The European equivalent of the CDC considers anything above 35 cycles as needing confirmatory testing.

I'm pretty sure I posted exactly this from ethical skeptic on Monday and it got deleted as misinformation.

The small signal for this were those that got sick, got better and tested positive 3,4,5 weeks later. China and Italy both had situations like this.

How many cycles are we running here in Texas? Hospitalizations are dropping really fast and it's dang important that we know the real numbers of sick. Not the fake numbers used for fear Mongering.

I wish this would have been revealed months ago.

We've migrated from needing two negative PCRs after a confirmed COVID infection to a timeline to determine someone is no longer infected.

Right now we're seeing patients who are returning after a COVID infection for elective procedures.
If a patient is 20-90 days out from an initial positive test, we don't retest. The guidance from experts is that patients may continue to test positive, but they're not contagious. It's the same principle of what is being said here. There may be fragments of genetic material left in the nasopharynx from an infection, but it's not the same as shedding virus.

We're following this same protocol with employees now. Following an infection, once things have resolved and a certain time period has elapsed, they're cleared to come to work while wearing an N95 all of the time for the next 2 weeks.

I had a patient just the other day who got a nasopharyngeal test right before the new guidelines came out. They were 45 days out from their infection, which did not require hospitalization but was detected due to a hospitalization for something completely unrelated. They were coming for a procedure and their PCR was still positive. ID ruled them non-infectious and good to proceed for the reasons listed above.

SO , what I took from this is that in the US - we set a threshold on the test that gives a positive result when the patient isn't necessarily positive/ or contagious.


If how the US is doing is being compared to other countries who use a different standard - that appears to be a huge problem.


It seems the article made the argument that if we used a threshold of 30 instead of 40, that the number of actual positives would be about 85% less.


That is a game changer when comparing numbers.

How can we determine what other countries are using for their threshold?

Think about this.... CDC revised their isolation guidelines to 10 days from exposure (it was previously 14). Effectively most people are over it by day 10.

Now consider symptoms develop around day 5-7.

Here is the scenario...
you get unknowingly exposed at day 0. At day 5 you develop symptoms and decide you need to get tested. Maybe you have to wait a day to get testing, so they take the sample at day 6. With a three day turn around on the PCR test, you get the results on day 9... only, you already got over it and should be fine to go about your life on day 10, the day after you get your test result confirming you were sick.

Now, what happens if it is 5 day turn around or a week before you get your test result... well, now you have a positive result for an illness you had last week. At least you know it was COVID. clinically useless information, but good fear numbers.

docaggie said:

---

We've migrated from needing two negative PCRs after a confirmed COVID infection to a timeline to determine someone is no longer infected.

Right now we're seeing patients who are returning after a COVID infection for elective procedures.
If a patient is 20-90 days out from an initial positive test, we don't retest. The guidance from experts is that patients may continue to test positive, but they're not contagious. It's the same principle of what is being said here. There may be fragments of genetic material left in the nasopharynx from an infection, but it's not the same as shedding virus.

We're following this same protocol with employees now. Following an infection, once things have resolved and a certain time period has elapsed, they're cleared to come to work while wearing an N95 all of the time for the next 2 weeks.

I had a patient just the other day who got a nasopharyngeal test right before the new guidelines came out. They were 45 days out from their infection, which did not require hospitalization but was detected due to a hospitalization for something completely unrelated. They were coming for a procedure and their PCR was still positive. ID ruled them non-infectious and good to proceed for the reasons listed above.

---

There was that early scare back in March/April where subjects were testing positive after recovering and getting a negative test. I think it was in South Korea or Singapore. The media leaped to the you can be reinfected conclusion, but viral cultures showed they were not shedding live virus.

BiochemAg97 said:

---

I've wondered about the prevalence of virus present but not infected, especially in the context of flu.

---

Seasonality is interesting because it points to what we don't understand about common respiratory viruses. Take the Flu and the notion of "Herd Immunity" people have adopted. In the middle of August 2019 the population of Texas minus any mitigation measures had "herd immunity" to all the influenza strains. Someone could step off a plane at IAH from the Southern Hemisphere with a blossoming Flu case and they would not trigger a cascade of flu transmission. R(t) is essentially zero.

Yet 4 months or so later the same population will have a R(t) north of 1.0 and it will be spreading around sending people to the ER, ICU, etc. How do we account for that? What changed? And if the virus isn't spreading, where is it? It has to be resident somewhere in August. And as people were pointing out 40 years ago, jet travel wasn't changing the seasonal epidemic timing or patterns significantly.

This thread points to the ambiguity of testing for the presence of the virus by amplifying short protein segments unique to the virus and some control sub-segments. Assuming we can agree on the mechanics of how many amplification cycles is too many or not enough, we still have a larger question about what the presence of the virus sub-segments mean.

The simple idea is

virus segments present = live virus present = host infection = disease of some degree = host contagious = potential spread to non-immune population

Alas, we know this story isn't that simple for the Influenza strains and the accompanying Flu. And I'm not sure things are clarified if we say the "disease is seasonal, but the infection isn't."

Given that things aren't that clear with the more familiar Influenza/Flu, I guess we shouldn't be surprised when simple ideas don't work with SARS-CoV2/Covid-19.

But what is actually going on? Everyone likes a good Mystery. Unfortunately we are living in this one. Lives hang in the balance and Trillions of Dollars are at stake.

Hopefully "The Game is Afoot." Because as we turn the calendar page today, "Winter is Coming."