Category Archives: Health & Wellness

New Reporting Suggests Many Positive Coronavirus Cases May Not Be Contagious

Reporting by the New York Times last week highlighted a possible answer to the unique presentation of the coronavirus in human subjects.

Since March, most governmental steps have largely been based on the believed ever-present threat of asymptomatic spread of the virus. Information pouring in from across the globe during the rapidly developing situation created a bevy of responses to fears that were later alleviated or amended.

Americans stopped washing their groceries, landscapers were allowed to work and new evidence may suggest that pervasive asymptomatic spread may be next in line to be cooled by better evidence and understanding of the threats posed by covid-19.

Fears of asymptomatic spread in Germany began after an article was published and later retracted in the New England Journal of Medicine that highlighted spread from a Chinese visitor to the country. It later came to light that researchers had not spoken to the Chinese visitor directly regarding whether she had been experiencing symptoms. She had. The Germans interviewed by the researchers commented that they did not think she had been and the foundation for one of the greatest elements of our response was seeded: contagious asymptomatic spread.

This possibility was particularly frightening and caused states and nations across the globe to test with far greater sensitivity than would be the case with other viruses. It also spurred governmental orders for mandatory universal masking, self-quarantine, social distancing, school closures, statewide lockdowns and many other measures which have largely diverged from traditional viral mediation techniques; primarily, vaccinate & stay home if you are sick.

Instead, widespread belief that the virus could be carried unbeknownst to an individual, while still being contagious, has led to some of the most unique responses in modern history.

We’ve been using one type of data for everything, and that is just plus or minus — that’s all. We’re using that for clinical diagnostics, for public health, for policy decision-making. It’s really irresponsible, I think, to forgo the recognition that this is a quantitative issue.”

Dr. Michael Mina, Epidemiologist, Harvard T.H. Chan School of Public Health, New York Times

However, new reporting supports what some critics have been clamoring about since the spring, namely that PCR testing (the testing method responsible for the lion’s share of tests run in the U.S. and around the globe) has utilized a far greater sensitivity and lower viral threshold for diagnosing a positive test than may be useful for determining public policy.

French Epidemiologist Didier Raoult remarked last spring (further reading) that he believed an appropriate threshold of 33 was necessary to detect the virus at contagious levels. Instead, many states have opted for far more sensitive thresholds of 37 to 40. That may not seem like much to a layman, but in practice, these differences in sensitivity skew the number of active and even contagious cases by 40 to a staggering 90%.

In other words, if a state registered 100 positives tests, as little as 10 may be currently active or contagious level infections depending on that state’s chosen testing threshold. Though his assertions were dismissed nearly 6 months ago and his support for hydroxychloroquine became controversial as the Trump administration began to publicly support hopes of the drug being used in treatment, the tide seems to be turning his way.

These findings may explain several phenomenon surrounding our early speculation regarding the virus. First, it may suggest an answer to the question of why this virus appeared peculiarly unique in its ability to linger in the body and deliver positive tests weeks to even months after symptoms had subsided in some or never arrived in many others.

This may be a reason to take other recent news coverage of outbreaks on college campuses with a grain of salt as well. The assumption has been that these outbreaks stemmed from students’ return to campus after just a single week at college, but may in fact be casting a clearer picture of community infection from a month or more before kids returned to school.

In short, the tests may be so sensitive that they pick up trace amounts of the virus, even when subjects are neither sick, nor actually contagious. Furthermore, subjects may not be asymptomatic in spite of the virus, but because of such low viral loads that symptoms and contagious levels never develop. Thus, it may be that the long perceived uniqueness of Covid-19 is more of a feature than a bug, resulting from the way governments and public health officials have approached, tested and handled it from the onset.

In the case of other viruses, viral loads must be present in significant amounts to return a positive test. Positive tests in those cases often overlap very strongly with contagious levels of the given virus. It has been widely assumed, as witnessed in the measures undertaken by states across the country, that a positive Covid-19 test should be understood to mean that a person is contagious.

Protocols have recommended that the positive individual and those they have recently come in close contact with for 15-minutes or more should self-isolate for 14 days.

These elements of coronavirus response have, in turn, continued to drive fears of an invisible contagion, hitchhiking without symptoms in some and attacking with deadly brutality in others. While these presumptions have underscored the nationwide coronavirus response since the spring and “15 days to slow the spread” turned to 6 months of lockdowns, shutdowns, social distancing, masking and more, that mentality may be changing.

In an interview with the New York Times, Dr. Michael Mina, an epidemiologist at the Harvard T.H. Chan School of Public Health, explained, “We’ve been using one type of data for everything, and that is just plus or minus — that’s all. We’re using that for clinical diagnostics, for public health, for policy decision-making.” Dr. Mina continued by explaining that a yes or no is insufficient given the sensitivity of our PCR testing for coronavirus and suggests that the viral load is far more important than our response has suggested. “It’s really irresponsible, I think, to forgo the recognition that this is a quantitative issue.”

These findings come on the heels of information released from the CDC that details just a 6% rate of covid-19 fatality death certificates listing covid-19 singularly under cause of death and an average of an additional 2.6 underlying causes of death among the other 94% of cases. While many cases certainly developed additional comorbidities as a result of covid-19 infections, specifically pneumonia, the average of 2.6 additional causes of death per case and a median fatality age in line with normal United States life expectancy at 78 years old, data is increasingly supporting the belief that the virus poses far less risk of fatal infection to those without significant health issues or of an advanced age.

While some critics may see this as justification for their long-held skepticism, these trends appear to be a positive swing in our understanding of the virus and that is something we should all welcome.

Governor Whitmer Names ‘Racism’ a Public Health Crisis

The governor has announced an update to last month’s press conference, which forecast her administration’s moves to combat systemic racism within the health field.

The argument made in that press conference detailed disparities between healthcare outcomes and illness across racial lines. The prescription given at the time was to require training in racial sensitivity as part of continuing education mandates. The move drew criticism from some in the healthcare field, who saw the comments as an attack on their integrity and overlooked other explanations for incongruities between racial groups.

“We must confront systemic racism head on so we can create a more equitable and just Michigan.”

Governor Gretchen Whitmer

A month later, the Whitmer administration once again took the podium and the state’s attention, amid the coronavirus pandemic, to announce a further development in their push. The governor officially named “racism” to be a public health emergency.

“We must confront systemic racism head on so we can create a more equitable and just Michigan,” Whitmer explained. Her order also establishes a Black Leadership Advisory Council, which will be filled by 16 applicants from around Michigan. Applications are due August 19.

Governor Whitmer Announces Stricter Statewide Guidelines

Governor Gretchen Whitmer announced at 9pm via Twitter on Tuesday night that she would be expanding and re-upping various restrictions in the mitten state as a response to what she claims has been a recent spike in cases.

“I’ve said this from the start — these are difficult decisions, but I will do what is necessary to protect the brave men and women on the front lines, avoid overwhelming our healthcare system, and save lives,” Whitmer tweeted on Tuesday night.

Her most recent order rolls back indoor gatherings to 10 or fewer people in a state-wide restriction that much of the progress that had been made towards opening the state. Other restrictions that have pertained to much of the state’s restaurants and taprooms will now also be extended to areas of northern Michigan, which had been largely open in recent weeks.

The full text of the press release is below for your review.

FOR IMMEDIATE RELEASE

LANSING, Mich. – Today, Governor Gretchen Whitmer signed Executive Order 2020-160 and Executive Order 2020-161, amending Michigan’s Safe Start Order and issuing revised workplace safeguards. Under the Safe Start Order, starting July 31, 2020, statewide indoor gatherings will be limited to 10 people and bars will be closed for indoor service across the state, including in Regions 6 and 8.

“As we see COVID-19 cases continue to rise, Michiganders cannot afford to drop our guard. We must take every step possible to saave lives, protect the brave men and women on the front lines, and avoid overwhelming our healthcare system while we continue to combat COVID-19,” said Governor Whitmer. “After seeing a resurgence in cases connected to social gatherings across the state, we must further limit gatherings for the health of our community and economy. By taking these strong actions, we will be better positioned to get our children back into classrooms and avoid a potentially devastating second wave.”   

COVID-19’s resurgence is closely associated with super-spreading events at large social gatherings, often attended by young people. An outbreak at a Lansing bar has resulted in 187 infections; more than 50 cases have been linked to a single house party in Saline; and a sandbar party at Torch Lake over the July 4 weekend led to at least 43 confirmed cases. Therefore, Executive Order 2020-160 limits statewide indoor gatherings to 10 people or less and, across most of the state, limits outdoor gatherings to 100. (The outdoor gathering limits will remain at 250 in Regions 6 and 8.)  

Executive Order 2020-160 also orders that bars in every region, including those in regions 6 and 8, must close for indoor service if they earn more than 70% of their gross receipts from sales of alcoholic beverages.  

Under the governor’s orders, Detroit casinos will also be allowed to open on August 5, but their occupancy will be limited to 15% capacity. Casinos must also, among other things, conduct a daily entry screening protocol for customers and employees, temperature screening. Casinos must require patrons to wear a face covering, except while eating or drinking or for identification purposes. 

Executive Order 2020-160 will rescind Executive Orders 2020-110, 2020-115, 2020-120, 2020-133, and 2020-143.  

Information around this outbreak is changing rapidly. The latest information is available at Michigan.gov/Coronavirus and CDC.gov/Coronavirus.  

To view Executive Order 2020-160 and Executive Order 2020-161, click the links below: 

Coronavirus Antibody Testing Provides Hope as Mortality Rate Appears Lower than Early Indications

The potential for hope might seem misplaced as the world faces down the start of another month battling the novel coronavirus.

It may be hard to understand the full context of how far we have come in the last several months. Our newsfeeds and televisions have seen a steady flow of articles, opinion pieces and news conferences detailing the latest information and data surrounding this worldwide pandemic.

In March, early models out of the Imperial College London forecasted a grim scenario for the United States of 2.2 million dead. As we began to digest images and data out of Italy and China, Americans became increasingly concerned that fatality rates for the infected might be 10% or more and an underlying concern that some unknown number could carry the virus undetected led governments around the world to take sweeping action on a scale not seen by the modern world.

Toilet paper, cleaning products, hand sanitizer, bread, meat, rice, beans and other assorted grocery products disappeared from shelves. Americans were told masks were unnecessary. Then they were told masks were mandatory for anyone without a medical exemption. Businesses and workers, told to stay home, waited anxiously for unemployment checks to arrive. Some are still waiting.

All these unknowns and more have left Americans stranded in a sea of confusion, as well as political & social division, with available data offering little solace. The confirmed positive tests and fatalities linked to the virus have given Americans little room for hope or positivity in the weeks since America’s first outbreaks. Projected mortality rates based solely on confirmed infections and presumptive fatalities have continued to paint a grim picture of numbers as high as 10% or more in some regions.

In the weeks since, death estimates have been revised from millions to hundreds of thousands and now hover around 75,000 by August. Despite this reassuring trend, the countless tragic stories pouring in from around the country maintain the concerns of many politicians and constituents about the veracity of the coronavirus and the disease it causes, Covid-19.

The concerns of citizens, desperate for the economy to reopen and those still grappling with the apocalyptic view presented by mounting presumptive fatality & confirmed infection totals may be granted a reprieve in the coming weeks as the tide of data coming in begins to take a reassuring turn.

Antibody testing in several places in the United States and around the world is beginning to shed light on many of the coronavirus’ darkest corners. Most recently, extensive testing has been compiled in New York, Boston (Chelsea) and Miami-Dade County. Other testing was also completed in two separate California studies (Santa Clara/Stanford & LA County/USC). While numbers are not exhaustive, they do give us the clear indication that our infection totals, and thus previous estimates of the virus’ mortality, are off by some degree. In fact, if recent findings are remotely accurate, conservative estimates put infection totals off by a factor of 15-20x depending on the region of the country.

While that news might be shocking and perhaps even terrifying, there is reason for optimism. As the picture of the infection denominator comes into view and a more accurate depiction of infection spread is known, the rate of deaths per infection necessarily falls. That change in data means significant reductions in estimates of the coronavirus’ mortality rate.

In the University of Miami study, researchers determined with reasonable probability through antibody testing that infection rates were anywhere between 12-22x higher than the county’s confirmed total of approximately 11,500. The findings led the team reach a median rate of 16.5x more infections than recorded through previous testing. The data, in effect, would cause Miami-Dade county’s infection totals to jump to just under 190,000. With that change in estimated infections, the mortality rate of Miami-Dade county would plummet from 2.6% to .16% of those infected with the virus. So while early fears regarding the virus’ ability to be carried with little to no symptoms provided serious cause for concern, the prevalence of those relatively unaffected by the virus may have skewed the earliest available data towards the most ill carriers by well over an order of magnitude.

New York City antibody results paint a very similar picture. Testing done in America’s largest hotspot showed that as many as 1 in 5 have had the virus. Adjusting for this indicator means a full-scale reduction in the mortality rate to around .5%. While this rate is still considerably higher than the mortality we have come to accept with seasonal influenza outbreaks each year, it is important to note that it falls well below the reported mortality of a staggering 10.7%. That would put NYC’s official tally off by 21.5x the projected mortality according to previous testing for the virus.

New York Governor Andrew Cuomo announced on April 29 that 17.1% of FDNY/EMT and 10.5% of NYPD tested positive for antibodies to the virus. According to Cuomo, the entire downstate antibody average is 18%. Another test of NYC transit workers is also being conducted this week. The National Institute of Health has also recently announced a test of 10,000 healthy individuals to gauge possible antibody spread across the nation.

A much smaller scale study in the Chelsea neighborhood outside of Boston found 1 in 3 had antibodies for the virus. The neighborhood has been visibly hit by the virus with 39 fatalities and 712 confirmed cases, which totals just 2% of the population and 5.5% mortality rate. However, antibody indicators could point to the area being farther along the outbreak curve than previously believed and could mean that confirmed cases are off by a factor as high as 16x. That possibility means the viral mortality in Chelsea could drop from 5.5% to just .34%.

The approximate 15-20x factor of antibody indicators to confirmed cases in Miami-Dade, Chelsea and NYC has shown to be a consistent trend across the country and even in international studies.

This should come as no surprise, as data has been available for weeks giving glimpses at just how contagious and sneaky the virus can be. In a review of cruise ship outbreaks, the CDC determined that as many as 46.5% of positive tests were asymptomatic at time of testing. Available statistical models also led the CDC to suggest that the virus never developed symptoms of any kind in 17.9% of those infected. The CDC has estimated that approximately 25% of cases among the general population carry the virus asymptomatically. These numbers are even more staggering given the much higher than average median age of those embarking on cruises. Both numbers seem to support the growing evidence that the outbreak is far more widespread than testing has shown and gives substantial credence to the numbers coming out of ongoing antibody research.

Antibody testing, like the live viral testing going on around the globe, is not without its limitations. Early tests out of Oxford showed that there is a margin of error in both false positives and false negatives. To combat this, researchers have factored some amount of this into their findings by generating deriving the most conservative models from their findings and have got to work on formulating more specificity in future testing.

Despite these limitations, several researchers, speaking with Bloomberg News gave reasons to be optimistic. Natalie Dean, a biostatician with the University of Florida, explained, “The results change a lot depending on what assumptions you put in…I think there is value in getting an answer very quickly, even if it’s not exactly right. As long as it kind of gets us in a ballpark.”

John Ioannidis, professor of medicine and epidemiology with Stanford also supported this point. “No study, no matter how well done, will be able to give the definitive answer alone…But at last we have data, real data, because until now we have mostly relied on speculation.”

These antibody studies, coupled with testing of outbreaks among contained populations (Ohio Department of Rehabilitation & Correction, several cruise ships and the USS Theodore Roosevelt), show that mortality rates fall far below figures that were initially believed in the early days of the virus. Though each of the above contained populations are not representative samples of the general population, the statistics are encouraging when tested against results shown in antibody studies.

While some critics of the government response have pointed to potentially inflated death statistics being linked to the virus, it is becoming increasingly clear that infection totals being amended according to new data will have a bigger impact on our understanding of the risk of this virus to the public at large. It is clear the virus is a significant threat, but Americans should be encouraged that our most dire predictions and indicators of the deadliness of this illness fall far below what we previously believed.

“Trent Speaks” Coming to GR

Trent Podskalan is a motivational speaker from Grand Rapids and the founder of the podcast “Trent Speaks”.  He has had a passion for people and hearing their stories since senior year of high school when he became involved in a program called Peer Assisted Listeners (PALS). Since creating his podcast in February of 2018, Podskalan has had people on there to share their stories. It’s become an outlet for everyone to speak, including Podskalan himself.

“Vulnerability is the strength of our weakness.” Trent Podskalan

Podskalan said that while the most difficult part about his career has been starting, the far more rewarding part is the impact he has left and the people he has met along the way. When asked about where he anticipates this journey taking him, he said his goal is to “continue going to high schools and colleges and sharing (his) message with others…to show people it’s okay to not be okay and to be open about the struggles they may be experiencing”.

More information about Podskalan and his podcast and upcoming projects can be found at www.trentspeaks.com/trent-speaks.