May 17, 2020 at 7:11 pm #202602
When I was pretty young we use to give the sidewalks to our town medical doctors as a sign of respect, because we loved them and we knew what they were doing and we appreciated their works and sacrifice. At present, there are places where they want to kill the doctors and the nurses and blame everything on them, but they believe in the prescription given by any politicianMay 18, 2020 at 12:29 am #202597Dave BParticipant
Unfortunately Alan this is a load of bollocks.
It is called data-mining
Most of America has yet to be affected.
The hardest hit has been north east coast eg New York and New York State
Which has twice the population of Sweden
Per capita with covid deaths there are about 1000 per million which is the highest in the world for a population of over 10 million sort of thing.
You will spend for ever comparing one country to another but probably a good match for Sweden as regards population density would be something close to home eg Scotland
Stockholme has a population of 1 million, 1.5 million or 2.5 million depending on how you define it eg city metropolitan are or district.
That is a bit bigger or approximately the same as Glasgow
The Scottish covid death data is split into confirmed and confirmed and suspected.
Which generate per million death rates of about 350 or 450.
The upper figure is above Sweden the lower about the same.
Although this is all intensely irritating as I keep get dragged back into this fantasy world and false metric [eg measuring covid] that I don’t believe in.
It stopped or crashed in New York shortly after several 20-30% of population immunology testing surveys.
you might to check my numbers I have just rushed through tha a bit quick
I must admit I getting really bored with this and I am learning absolutely nothing here at all.May 18, 2020 at 12:29 am #202631robbo203ParticipantHow can we control subsequent surges of Covid-19 without accurate testing? How can we find plasma donors who have been infected, if the antibody testing is similarly shoddy as the tests for acute infection? Medscape article on the problem follows.***************************************
COVID-19 Test Results: Don’t Discount Clinical Intuition
<p class=”yiv6380061908ydpe499e55ameta-author”>Heather Boerner</p>
<p class=”yiv6380061908ydpe499e55ameta-date”>May 16, 2020</p>
Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.
Recently, a patient arrived at the UC San Diego Health medical center with what are now classic symptoms of COVID-19: a history of coughs, pneumonia, and severe respiratory distress that required immediate intubation.
What he didn’t have was a positive SARS-CoV-2 test — neither the first nor the second time clinicians swabbed the back of his throat. SARS-CoV-2 is the virus that causes COVID-19.
“The two negative tests didn’t convince anybody,” said Davey Smith, MD, a virologist and chief of the division of infectious diseases and global public health at UC San Diego School of Medicine. It was only on the third test, when they sampled fluid from a bronchial wash, that they were able to find the virus.
Smith’s patient is not alone. Though almost all experts agree that broad testing for SARS-CoV-2 will be critical to understanding, containing, and eventually treating COVID-19, the effort is hampered by limitations of current tests.
The tests today, experts say, are so new that it’s unclear how reliable they are. Anecdotally, clinicians report false negative rates of anywhere from 2% to 30%, depending on what part of the body is being tested and what means they are using to get a sample, as well as epidemiological and clinical factors.
And the US Food and Drug Administration issued an alert earlier this week warning of false negatives with one of the most commonly used tests, Abbott Labs’ ID NOW rapid test for COVID-19.
Data published earlier this week in the Annals of Internal Medicine show that test accuracy varies widely over the course of the disease in a mixed population of inpatients and outpatients. On the day symptoms appear, the median false negative rate was 38%. That figure dropped to 20% on the third day after symptom onset, but climbed again to 66% about 2 weeks later.
But test results should only be part of the picture. The key is clinical suspicion informed by all the above factors, said Joshua Metlay, MD, PhD, chief of the division of internal medicine at Massachusetts General Hospital, and coauthor of a series of articles on clinical decision-making in the Annals of Internal Medicine.
“How we treat patients is going to depend on understanding this concept,” Metlay told Medscape Medical News. “It isn’t one number. It’s actually much more complicated and very nuanced.” If clinicians don’t understand that, he added, “We’re really going to make mistakes about how to use all these negative tests.”
<b>When Hope Outstrips Reason</b>
A positive SARS-CoV-2 test sets off a cascade of actions, in and out of clinical settings: In patients with symptoms, it triggers a set of protocols, as recommended by the National Institutes of Health and individual hospitals, around use of personal protective equipment (PPE) for staff, whether patients are placed in rooms with others or singly, and specific treatment choices, such as which ventilator protocol to use. By contrast, a negative test, in an ideal situation, should lead a clinician to keep looking for a causative agent or underlying problem. Quality care, in other words, relies on accurate diagnosis.
In patients without symptoms, a positive test means suggesting quarantine and isolation for two weeks, said Colin West, MD, PhD, professor of medicine and biostatistics at the Mayo Clinic in Rochester, Minnesota.
But because of the relatively high rate of false negatives, a negative test in an asymptomatic person can’t confer the kind of relief patients, the public, or policymakers would like it to, West said.
“People can’t relax their physical distancing, their handwashing, their surface hygiene, their mask-wearing” even with a negative test, he said, because they still could be carrying the virus.
“When hope outstrips reason, we sometimes prematurely pin our hopes on tests that aren’t as good as we want them to be,” said West, who wrote a perspective for Mayo Clinic Proceedings warning about the dangers of false negatives. “Smart clinicians all around the country are not believing the test results when their clinical suspicion is high enough.”
<b>Calculating Clinical Suspicion</b>
With false negative rates ranging from 3.2% in a cohort of seriously ill COVID-19 inpatients in New York City, to 66% in the mixed population in the Annals of Internal Medicine study, it’s understandable that clinicians might be skeptical of the results in front of them.
The first thing to understand, Metlay said, is that the sensitivity of the test isn’t the same as the rate of false negatives. Sensitivity only describes the absolute ability of a given test to detect SARS-CoV-2 when it’s present.
A false negative is a combination of the accuracy of the test itself and its handling, along with clinical symptomology, local epidemiology, and the individual behavior of the person in front of you.
“This is why people don’t usually report false negative rates as one number — because that number can only be calculated or interpreted in the context of the group that you’re talking about,” Metlay said. “Two hospitals could report completely different false negative rates and that’s completely reasonable. Even within the same hospital, the false negative rate in the clinic could be different than the false negative rate in the emergency room.”
That is to say, people showing up with symptoms in an emergency department should be met with a higher pre-test probability of having COVID-19 than well people who show up for drive-through testing, he said.
The same holds true for the background rate of COVID-19 in a community.
“If you get into a community where almost no one is infected and you tested everybody, your false-negative rates are going to be very low, because almost everybody there is negative,” he said. In Boston, where Metlay practices, the community rates of COVID-19 are substantial, so even those with mild symptoms might be met with higher suspicion of having SARS-CoV-2. And that’s even before the patient opens their mouth and explains where they’ve been or who they’ve been in contact with.
This helps explain why Rajesh Gandhi, MD, Metlay’s colleague at Mass General, said the inpatient false negative rate there is between 2% and 3%, while Smith from UC San Diego reported that their false negative rates are no more than 10% — or that unpublished data first reported by NPR found that the most commonly used, fastest turnaround tests also churned out 15% false negatives.
<b>No Gold Standard</b>
Another factor in all of this are the tests themselves. Back in March, Chinese researchers at Central South University in Changsha, Hunan province, lamented that “existing PCR methods have very good specificity but low sensitivity, meaning that negative test results cannot exclude the presence of SARS-CoV-2.”
PCR stands for polymerase chain reaction, a means of testing for viral genetic material, currently most commonly used in a nasopharyngeal swab.
But we don’t know how inaccurate the tests actually are, said Stephen Rawlings, MD, PhD, an infectious disease fellow at UC San Diego’s Center for AIDS Research, who has been helping to validate RT-PCR tests for SARS-CoV-2 since repatriated Americans were held in isolation at military bases starting in March.
For one thing, we have nothing to compare current tests with.
“To truly determine false negatives, you need a gold standard test, which is essentially as close to perfect as we can get,” Rawlings said. “But there just isn’t one yet for coronavirus.”
For another, the studies that have been done on the accuracy of the tests themselves are filled with flaws, said Mayo Clinic’s West.
Sensitivity estimates are usually based on testing the tests against people who they already know have COVID-19. But that’s a bias — you know what you’re looking for, West said. Without control groups or blinded testing, it’s impossible to get “good information about where these imperfections lie, or even the magnitude of those imperfections,” said West, who conducted a tweetorial on how to understand the accuracy of current RT-PCR tests.
A recent non-peer reviewed preprint meta-analysis of five COVID-19 studies comprising 957 patients found that the underlying poor quality of data made it impossible to judge how effective the tests in the nation’s labs are at all.
“We’re trying to have informed conversations about how good are these tests, and how helpful are they in ruling in or ruling out diagnosis, when the source literature is so poor,” West said.
This is where the Centers for Disease Control and Prevention should step in, according to UCSD’s Smith. Local labs are doing their best to validate tests on their own, but if they could send their results in a blinded way to the CDC, he’d have a lot more confidence in every test.
“We really need these panels to help with the quality assurance internally,” Smith said. “It’s not about the nasal swabs or not. It’s about the potential sources of error within the lab.”
<b>Human Error and Biological Process</b>
Now add in the human piece of gathering, transporting, and reading an RT-PCR test, said Daniel Griffin, MD, PhD, an infectious disease physician and associate research scientist in the department of biochemistry and molecular biophysics at Columbia University in New York City.
“Basically, I tell my patients that unless you feel like they were trying to biopsy your brain, it wasn’t done correctly,” he said. And the less well done the test, the less likely the results will be reliable.
But even if all that is correct, there’s one more hurdle: What part of the body should be sampled and at what point in the illness? A viewpoint published in JAMA earlier this month synthesized known data on the accuracy of different tests at different points in the disease process.
For instance, it shows that within the first week of exposure before symptoms and in the first week of symptoms, nasopharyngeal swabs are most accurate. But by the end of week 2 of symptoms, bronchoalveolar lavage/sputum is most accurate.
This conforms to what clinicians report anecdotally. The number of copies of the virus in the nose and pharynx is highest in the early days infection, just like the flu, said Columbia University’s Griffin. And that may mean the RT-PCR tests of the nose and pharynx work best in the first few days of infection — when patients still have mild or moderate symptoms.
“If you do the test that first day or so when you’re sick, you’re going to have pretty good sensitivity” with nasopharyngeal swabs, said Griffin, who often provides COVID-19 updates on the podcast “This Week in Virology.”
“The interesting thing is, when people get admitted to the hospital, now they’ve been feeling crummy for a week or more,” he said. “Now it’s day 13 or day 14, and now the virus is actually starting to get to a lower level of activity” in the upper respiratory tract.
And that means, said Griffin, “there’s not as much virus around” the nose and pharynx to test.
That’s when UC San Diego’s Rawlings said they’ve found that passing a catheter through the tracheal tube of someone who’s already intubated can “often find [the virus] there at very high levels.”
This may explain the phenomenon that Smith described, as well as what Neera Ahuja, MD, of Stanford University, said in a “Medicine and the Machine” podcast recently, that “this virus actually moves from proximal upper airway nasal-pharyngeal down to the lower lungs.”
“If you catch it in a stage where it’s already progressed, you may have a false negative,” she said.
<b>Using Clinical Judgment</b>
It’s a lot to take in for a single clinician interpreting a single test result. The good news is that clinicians are literally trained for this, said Carlos del Rio, MD, of Emory University and coauthor with Gandhi of a recent article on mild or moderate COVID-19.
“We as clinicians use our brains,” he said. “We don’t say, ‘Oh the person doesn’t have the disease’ — we use the test in the context of our clinical expertise.”
So clinicians should ask: Are the patients sick themselves? What are their symptoms? Have they traveled to or from COVID-19-endemic areas recently? Have they been in touch with someone they know has COVID-19? Have they been practicing physical distancing, mask-wearing, and other protective behaviors? said Metlay.
They may even want to consider other questions, said Gregorio Millett, MPH, vice president and director of public policy at the American Foundation for AIDS Research (amfAR). Millett and colleagues have unpublished data showing that although disproportionately black counties account for just 22% of US counties overall, they make up 52% of counties with COVID-19 cases and 58% of counties with COVID-19 deaths. In those communities, lack of insurance and living in crowded households were associated with increased risk for acquiring COVID-19 — opening another potential data point to consider in those communities.
The bottom line is that “nobody can integrate all this math in their head every single time” they see a patient, Metlay said. Still, keeping all these factors in mind will help clinicians look at that negative result with clear eyes.
“This,” he said, “is what helps people not get tricked by these tests.”May 18, 2020 at 8:27 am #202645Dave CheshamParticipant
“I must admit I getting really bored with this…..”
You’re not the only one! Tell me though, who has largely been responsible for keeping the pot boiling?May 18, 2020 at 9:23 am #202646Bijou DrainsParticipant
“ I am learning absolutely nothing here at all.”
For once you’ve said something I can agree withMay 18, 2020 at 11:17 am #202647
“I must admit I getting really bored with this and I am learning absolutely nothing here at all.”
I think there are some very important social ramifications to the pandemic yet we appear to be concentrating upon the narrow medical pathology aspect of it on this forum.
We seem to be failing to make known the politico-economic connections, changes in social relationships.
There has been some negative consequences such as the strengthening of nationalism and populist calls for protectionism and de-globalisation, while paradoxically, there is a growing identification that humanity goes beyond national divisions and we have just as many calls for international cooperation and collaboration
I’m not doing the issue justice with such a brief passing comment, and I don’t think we as a world socialism movement have focussed as much as we could have on the different post-pandemic world scenarios.
We don’t seem to have a consistent coherent message to push that is clear and simple that brings the attention towards the case for socialism.
I may be wrong so tell me what we should be doing more of and perhaps i might learn something which is a positive contribution to the campaign for socialism.May 18, 2020 at 2:15 pm #202650ALBParticipant
Actually there is no longer a lockdown in England. Everybody can now leave their house as often as they like and travel in their car to Land’s End or the border with Scotland if they want.
The only rule now is “social distancing”. You must stay 6 metres (the length of two supermarket trolleys as they are helpfully pointing out in case you don’t know what a metre is) apart from anyone else. But even this is unenforceable outside shops and workplaces, where it’s up to people’s sense of social responsibility. You’re not supposed to invite anyone into your house not even close relatives but, if what my neighbours on both sides do on a regular basis is anything to go by, this is widely ignored.May 18, 2020 at 2:50 pm #202651
The only medical solution for this situation is a vaccine and it does not exist at present, and there is not any proven treatment either, as soon as the vaccine be ready to be injected I would be the first one on the line to get one, and I do not care if the project has been financed by Soros, Bill Gates, by the Chinese, or the Russian or any other rich peoples, I do not follow conspiracist theories.
Peoples are going to continue getting infected and many peoples are going to continue dying, and many peoples are not going to follow medical instructions and they are going to get infected and they are going to infect others peoples including children.
Many leaders around the world are counting on the so-called herd immunity, but the thing about this Malthusian solution is that we are human beings we are not animals.
Some peoples are complaining because they can not go to a bar to have a drink, or to go to a restaurant to eat with their family members and friends or to go to their churches, but if they want to die it is their personal decision but their personal decision might affect the life of others peoples.
This virus besides affecting many human organs, it also affects the brain, and peoples are going to act in many crazy ways and they will try to infect others human beings by going to public places without the mask and spitting on others peoples faces. It has not been proven yet but they have found traces of coronavirus on men semen and the disease can be transmitted thru sexual contact, and it produces blood clots and peoples are losing arms, hands and legs due to gangrene.
There are COVID related deaths, but there are also non-covid related deaths. This society based on private medicine and production of profits is not prepared to handle this complicated situation, and nationalism and patriotism have also affected our life because we have placed our future in the hands of several nationalists leaders and we have separated ourselves from others human beings living in a different part of the world. This is a real mess, this is not the future that I wanted to leave to my children and my grandchildren, this society must be replaced by a new one immediately.
This disease is being used to spread racism, xenophobia, and confrontation among capitalists superpowers, and some retaliations might take place which will also affect the lives of millions of human beings, and the first ones who are going to be affected are the Asian peoplesMay 18, 2020 at 3:22 pm #202657
The fights between capitalists bandits affect the lives of many human beings. Peoples need these medical supplies but they are seating in a warehouse waiting for governmental approvalMay 18, 2020 at 10:12 pm #202668
As expected, as the pandemic recedes in the developed nations, the increased cases and deaths in the undeveloped and developing world drops from the media headlines.May 18, 2020 at 11:51 pm #202669
Science as an ideology?
“Ministers have been using the mantra of “following the science” as a “simple defence” to justify decision-making during the Covid-19 pandemic, Professor Brian Cox and that use of the defence had been masking “a whole area of debate” going on between advisers and politicians behind closed doors.
“I’ve seen instances of the phrase ‘we were following the science’ as a very simple defence to a difficult question,” said Cox, during a discussion held by the Science Media Centre. “The politicisation of science or scientific advice might deliver some short-term political advantages. It’s very tempting, I think, to blame the science if a decision is made which subsequently turns out to be suboptimal in some way. But, this will have, I think, have serious long-term consequences because it undermines public trust in science.”May 19, 2020 at 4:12 am #202670
In reality in this society, science is influenced by the bourgeoise ideology. As Engels wrote: Many scientists are materialists in their laboratory and metaphysical in their private lifeMay 19, 2020 at 6:04 am #202671
WHO under pressure and the politicalisation of COVID-19
Classic diversionary strategy…May 19, 2020 at 8:30 am #202673Dave BParticipant
<figure class=”wp-block-image size-large is-resized”><figcaption>Citizen Young rallies rallies his troops outside the now closed Tooting Broadway tube station</figcaption></figure>
I love getting emails from lefties who say they share my lockdown scepticism and can’t believe what a bunch of bed-wetters their fellow travellers are. But this is my favourite so far:
Just to say I’ve been a lifelong member of the Marxist revolutionary left and would definitely be on the other side of the barricades from Toby Young (except on Brexit). However, I will be making a donation to Lockdown Sceptics because it is a beacon of sanity in a sea of hysteria. I’ve just finished writing a piece against lockdown, which is even worse where I am (Scotland), and it will hopefully be published next week in a small scale online magazine.
Keep me posted, Comrade. I will link to your article on this siteMay 19, 2020 at 9:49 am #202674Dave CheshamParticipant
ACG Statement on the anti-lockdown so called “freedom picnics”
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