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The MoA Week In Review – Open Thread 2020-92
Last week's posts at Moon of Alabama:
> It was a shock on arriving at the New York Times in 2004, as the paper’s movie editor, to realize that its editorial dynamic was essentially the reverse. By and large, talented reporters scrambled to match stories with what internally was often called “the narrative.” We were occasionally asked to map a narrative for our various beats a year in advance, square the plan with editors, then generate stories that fit the pre-designated line.
Reality usually had a way of intervening. But I knew one senior reporter who would play solitaire on his computer in the mornings, waiting for his editors to come through with marching orders. Once, in the Los Angeles bureau, I listened to a visiting National staff reporter tell a contact, more or less: “My editor needs someone to say such-and-such, could you say that?”
The bigger shock came on being told, at least twice, by Times editors who were describing the paper’s daily Page One meeting: “We set the agenda for the country in that room.” <
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Other issues:
Lebanon:
Syria:
Covid-19:
> As of August 11, 24 of Kansas’s 105 counties did not opt out of the state mandate or adopted their own mask mandate shortly before or after the state mandate was issued; 81 counties opted out of the state mandate, as permitted by state law, and did not adopt their own mask mandate. After the governor’s executive order, COVID-19 incidence (calculated as the 7-day rolling average number of new daily cases per 100,000 population) decreased (mean decrease of 0.08 cases per 100,000 per day; net decrease of 6%) among counties with a mask mandate (mandated counties) but continued to increase (mean increase of 0.11 cases per 100,000 per day; net increase of 100%) among counties without a mask mandate (nonmandated counties). <
Use as open thread …
There is evidence that asymptomatic transmission DOES NOT occur:
Post-lockdown SARS-CoV-2 nucleic acid screening in nearly ten million residents of Wuhan, China
Stringent COVID-19 control measures were imposed in Wuhan between January 23 and April 8, 2020. Estimates of the prevalence of infection following the release of restrictions could inform post-lockdown pandemic management. Here, we describe a city-wide SARS-CoV-2 nucleic acid screening programme between May 14 and June 1, 2020 in Wuhan. All city residents aged six years or older were eligible and 9,899,828 (92.9%) participated. No new symptomatic cases and 300 asymptomatic cases (detection rate 0.303/10,000, 95% CI 0.270–0.339/10,000) were identified. There were no positive tests amongst 1,174 close contacts of asymptomatic cases. 107 of 34,424 previously recovered COVID-19 patients tested positive again (re-positive rate 0.31%, 95% CI 0.423–0.574%). The prevalence of SARS-CoV-2 infection in Wuhan was therefore very low five to eight weeks after the end of lockdown.
my emphasis
This study comes supporting early (June 2020) official statements by WHO where:
We have a number of reports from countries who are doing very detailed contact tracing. They’re following asymptomatic cases, they’re following contacts and they’re not finding secondary transmission onward. It’s very rare and much of that is not published in the literature. From the papers that are published there’s one that came out from Singapore looking at a long-term care facility. There are some household transmission studies where you follow individuals over time and you look at the proportion of those that transmit onwards.We are constantly looking at this data and we’re trying to get more information from countries to truly answer this question. It still appears to be rare that an asymptomatic individual actually transmits onward.
(my emphasis) COVID-19 daily press briefing 08 June 2020 (~33m24) – transcript
There existing or not “asymptomatic transmission” is a key piece of information because there lies the fundamental justification for isolation measures imposed on asymptomatic individuals with positive rtPCR test results. Further, without asymptomatic transmission, general confinements can not be scientifically justified for the purposes of slowing down/flattening the curve as has been claimed.
This recenters the pandemic response where it should be all along: properly diagnosed cases.
It is very curious that no later than 24 hours, WHO, was backtracking on the original statements, letting us know that models [as opposed to actual epidemiological studies] suggest otherwise but since they were models they were not mentioned. I’ll chalk that up as excess zeal at best.
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The supplementary material the study published in Nature was also revealing in terms of the rtPCR testing protocol, which employed, following Chinese National Guidelines, Ct values of ~35/34 (ORF and N genes respectively) on average. This arcs back to the question that has been haunting us, why are these tests being threshold at such high Ct values. In the Chinese case there appears to be an explanation. As the very title of the study mentions, these are tests made for screening purposes not diagnostic.
The following is very enlightening, contrast the following case definitions:
The European Case definition for coronavirus disease 2019 (COVID-19), as of 29 May 2020
(…)
Diagnostic imaging criteria
Radiological evidence showing lesions compatible with COVID-19
Laboratory criteria
Detection of SARS-CoV-2 nucleic acid in a clinical specimen [2] [rtPCR test]
(…)
Case classification
- Possible case: Any person meeting the clinical criteria
- Probable case:
Any person meeting the clinical criteria with an epidemiological link
OR
Any person meeting the diagnostic criteria
- Confirmed case: Any person meeting the laboratory criteria [see above]
my emphasis
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The Chinese Diagnosis and definition of confirmed cases with COVID-19
Mild case
The clinical symptoms are mild and no pneumonia manifestations can be found in imaging.
Moderate case
Patients have symptoms such as fever and respiratory tract symptoms etc., and pneumonia manifestations can be seen in imaging.
Severe case
Patients who meet any of the following criteria: dyspnea or respiratory rate ≥30 breaths/min; oxygen saturation ≤93% at a rest state; arterial partial pressure of oxygen (PaO2)/oxygen concentration (FiO2) ≤300 mmHg. Patients with >50% lesions progression within 24 to 48 hours in lung imaging should be treated as severe cases.
Critical case
Patients who meet any of the following criteria: occurrence of respiratory failure requiring mechanical ventilation; presence of shock; other organ failure that requires monitoring and treatment in the Intensive Care Unit.[at this severity they apparently dispense with imaging]
Clinically-diagnosed cases
The clinically-diagnosed cases were only allowed for the cases in the Hubei Province for the period of February 9 to 19 based on the 5th edition of the Scheme released by the National Health Commission of China released on February 8 and abolished on February 19. A presumptive case was defined as meeting the following criteria: (1) recent travel history to Wuhan City or Hubei Province; or close contact with a confirmed or probable case; or cluster transmission; (2) fever and/or respiratory symptoms; (3) laboratory evidence of normal or decreased number of leukocytes and/or lymphopenia. Those presumptive cases with further radiographic evidence showing pneumonia but without a positive RT-PCR test result were defined as clinically-diagnosed cases.
my emphasis
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The take away: The Chinese rely on radiological imaging to confirm COVID-19 cases NOT on rtPCR tests which they limit for screening purposes, as opposed to the European which use radiological imaging to define a probable case and rtPCR testing to confirm. The Chinese rely on a tried and tested method for confirming diagnostic and the European rely fallible method generaly used for screening to confirm diagnostic.
This is absolutely absurd!
Posted by: Vasco da Gama | Nov 22 2020 22:51 utc | 58
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