Cases Gone Wild

There are a number of issues with testing that can, and probably are, greatly affecting the current case numbers.

To understand the problem it first must be understood that "cases" are in effect, a positive PCR test result for the virus.

To date, the majority of patients with Covid-19 have been diagnosed using a laboratory test called PCR, which detects the virus’ genetic material (i.e., RNA) in clinical samples (e.g., nasal swabs). PCR is a very sensitive laboratory method – meaning it can detect minute amounts of viral RNA – and has been used for nearly 2 decades to diagnose a variety of infectious diseases, including influenza and strep throat. Despite being a rapid and inherently sensitive test, PCR has certain limitations that need to be carefully considered when interpreting the results.

Many of the problems with case counts are due to this testing method. Not that there is anything inherently wrong with the test itself, just that it has never been used on such a large scale and the results of the tests are being misinterpreted. At the beginning of the crisis here in the United States, initial problems with the the test kits resulted in limited numbers of tests being done. Tests were pretty much limited to persons who had been exposed to the virus, in the hospital with symptoms, those who were prescribed to receive a test by doctors, and health care providers. Although there was a shortage of tests, the practice of testing only "at risk" patients is not unusual. In fact this is the first time in history that we have ever considered testing the general public en-mass for any disease. what is being done is unprecedented. Without even going into the reported misreporting of results from this unprecedented testing there are some "built in" or if you wish, systemic problems that have nothing to do with human error. Below is a summary of some for those problems, some having to do with with the PCR testing some for other reasons.

1. Many states including the three most populous, California, Texas and Florida and almost all states now experiencing a surge in cases, count "specimens tested" as cases rather than "people tested." This undoubtedly leads to an inflated case numbers since a person could be tested more than once and could test positive more than once.

2. The PCR test is so sensitive that it will pick up even fragments of the virus' genetic materials. The tested genetic material may or may not be live, in other words there is no way the test shows whether a person testing positive is infectious. A positive test does not mean a person is contagious to others.

3. These fragments can remain in an individual for an undetermined period of time, from days to weeks, it is not known. This means that a person could receive a positive test result even if they had already recovered from the virus and were no longer contagious.

4. It is not known whether there is any pre-infection immunity to the virus therefore all planning for the virus by public health officials assumes there is none. However if there is pre-existing immunity to the virus, that person too could test positive for the virus given the sensitivity of and scale of PCR testing. From the CDC.

"The relative infectiousness of asymptomatic cases to symptomatic cases remains highly uncertain as asymptomatic cases are difficult to identify and transmission is difficult to observe and quantify. The estimates for relative infectiousness are assumptions based on studies of viral shedding dynamics....the current estimates are an assumption."

The CDC currently estimates that 40% of all cases are asymptomatic. It is possible that some portion perhaps all of these asymptomatic cases are either persons who have been tested and who have pre-existing immunity or recovered cases that were unaware of their mild infection. or do not report them. These problems, along with others are greatly affecting the case counts in the United States or anywhere else in the world where PCR testing is used.

It seems to me that this ought to be publicized so that the general public is aware of these issues rather than being fed a continuous diet of fear porn.

It seems that there would be a solution to this. Give every "asymptomatic" person with a positive viral test result an antibody test. If the person has no symptoms, and does not claim to have ever have had symptoms or recalls only mild symptoms, test them for antibodies. If a person tests positive for the virus and has produced antibodies to Covid-19, more good would be done for society than shutting down bars and gyms, not to mention schools.