LEARNING TO LIVE WITH COVID 19

by envtam-admin | Jun 13, 2020 | CoVid

LIVING WITH COVID — 19

The virus is not going away anytime soon so we have to adjust how we live in order to cope.

By Allan Maynard – June 12, 2020

We have been living with the CoVid-19 virus for over 6 months now and it is still a mystery in many ways. While governments around the world are looking at ways to open up their economies, the scientific community is urging caution and trying its best to keep current with developments. New information is published almost daily – in what many are calling ‘fast science’. Unfortunately, scientists are also having to battle misinformation and wishful thinking coming from some political leaders along with wacky conspiracy theories that are multiplied through social medial platforms – (see previous article on this web site). 

The CoVid-19 pandemic presents one of the clearest examples in modern history regarding the critical need for evidence-based decision-making. In terms of leadership around the response to this pandemic, we are witnessing first-hand – the good, the bad and the ugly. And leadership is critical. Some areas are now benefitting from flattened coronavirus curves. Meanwhile, parts of the US, India, Russia and Latin America are still recording thousands of new cases every day. The first wave of the coronavirus is not over. If anything close to this trend continues, we have to wonder what the threshold will be for many areas to reinstate stay-at-home orders and close businesses again, just as they are starting to reopen. 

The future shape of the pandemic will be decided by informed leadership, human action in the form of social distancing and hygiene, testing and other traditional methods of disease control, but also gaining more knowledge around several unanswered questions about the nature of the virus itself. 

WE KNOW WHAT WORKS TO LIMIT INFECTION RATES — For countries that implemented highly effective interventions such as testing and contact tracing, this first wave of coronavirus cases may be the last they experience, at least for some time. For one example, New Zealand, has managed to virtually eradicate the virus, acting early to implement a lock down and installing robust systems to monitor outbreaks. The country will likely be able to avoid future waves until a vaccine arrives.

Countries with small populations and isolated geography such as New Zealand and Australia may be able to pull this off. South Korea and Taiwan also provide examples whereby virus detection and suppression systems may be advanced enough to smother any future outbreaks. But this will be extremely difficult for most countries, especially those with large populations and porous borders.

We have been fortunate to have such good leadership in BC. We are successfully entering the first phase of re-opening and the numbers of new cases are falling significantly. Moreover we were able to avoid overwhelming our medical facilities. So again – early intervention, science based leadership, adequate testing and contact tracing proved successful. It is worth looking at some numbers (from June 11, 2020) for BC, Canada, USA, Washington State (as this is closest to BC) and New Zealand as mentioned above.

            M – million

We can see how successful New Zealand has been even though it is an isolated country and had some advance warning. However it is clear that strong and effective leadership, made the difference. That applies to BC as well. The messaging has been factually constant, consistent, and considerate of people’s concerns. In the messaging, kindness to one another was constantly emphasized and most BC residents have cooperated without reservation.  

To further re-enforce this message of what works is a large study recently published in “Nature” concerning 11 European countries. The authors state the following: “We estimate that, across all 11 countries, between 12 and 15 million individuals have been infected with SARS-CoV-2 up to 4^th May, representing between 3.2% and 4.0% of the population. Our results show that major non-pharmaceutical interventions and lockdown in particular have had a large effect on reducing transmission. Continued intervention should be considered to keep transmission of SARS-CoV-2 under control.”

UNDERSTANDING TRANSMISSION – From the early days of this pandemic, the experts have recommended wearing masks, staying at least six feet away from others, washing hands frequently and avoiding crowded spaces. What they’re really saying is: Try to minimize the amount of virus we encounter. It’s likely that a small amount of virus particles will not make us sick as our immune system would react and vanquish the invaders.

But how much virus is needed for an infection to take root? What is the minimum effective dose? A precise answer is impossible, because it’s difficult to capture the moment of infection. 

Not surprisingly, the current body of knowledge is clear that the worst-case scenario for outbreaks have occurred in care homes, cruise ships, prisons, factories, places of worships, large office settings and more – all as a result of people indoors and in close quarters, for a period of time. One oft-quoted case was a choir practice in Washington State wherein one infected person spread the virus to 87 percent of the choir members – with 2 members dying. Recently, in BC Provincial health officer Dr. Bonnie Henry revealed the isolation of an outbreak that erupted as a result of a family dinner inside (and outside) a residence. Of the 30 people at the gathering, 15 have become infected. 

There is now a growing concern that the recent protests in cities around the world will also cause spikes in infection rates. Especially worrying is the use of tear gas, which makes people cough whilst in close proximity to one another. There are also major concerns about the prospect of political rallies related to the upcoming election in the US. The first one – an indoor event, is planned for June 19^th in Tulsa, Oklahoma. This plan goes against all scientific advice, as it’s likely to produce a virus fog within the facility. The organizers know this and in fact those planning to attend the rally will be required to indemnify the Trump campaign and others involved in the event so they will not be able to sue if they contract coronavirus.

The Achilles Heal – in understanding transmission is the fact that people who are asymptomatic or pre-symptomatic are nonetheless spreaders of the virus. For example, one study published  (early June) in the Annals of Internal Medicine suggested asymptomatic people seem to account for 40 to 45 percent of CoVid 19 infections and they can transmit the virus to others for an extended period of time. Another study found 23 percent of transmissions in Shenzhen, China were from asymptomatic people. Also, a study published in Nature found people shed the virus most when their symptoms are mild (likely pre-symptomatic).

Apart from avoiding crowded indoor spaces, most experts are now claiming the most effective protocols are to practise good hygiene and to wear masks.   Even if masks don’t fully shield us from droplets loaded with virus, they can cut down the amount we receive, and perhaps bring it below the infectious dose.

SO MUCH MORE TO LEARN – There is so much more to learn about the CoVid 19.  It is reassuring to know that there are significant research undertakings on many fronts and in many countries that should provide better tests, drug therapies, a clear understanding of immunity and hopefully an eventual vaccine. All this will take time. Some points:

• Immunity — Recent data shows that fewer than 10% of populations in countries studied have developed the antibodies that would be evidence of having caught the virus and, in theory, becoming immune for at least a short time. That also means the vast majority of populations remain susceptible.

• Immunity – There is not yet a clear understanding of immunity to the CoVid 19. Resistance to some earlier discovered coronaviruses has been thought to fade within a year. This could be a concern with respect to a vaccine if the resulting immunity is short-lived. 

• By age – CoVid-19 is definitely a disease of the elderly. Recent analysis is showing that the chance of a person over 75 dying from this disease is 10,000 times likely than it is for a 15 year old. 

• Children – Emerging evidence suggests children are not significant transmitters of Covid-19. These data, coupled with the enormous adverse impacts of continuing closures, argue for reopening schools by fall of 2020. Of about 400,000 Covid-19 deaths worldwide, only about two-dozen children are known to have died. Moreover reports of serious complications among young people are statistically rare and, if detected early, most afflicted youths recover within weeks. It is hoped that more will be learned from the recent partial reopening of schools in many locations that can thereby help to aid in decisions for a more widespread opening. 

• Drug Therapies – Trials are now under way for a number of antiviral drugs that were developed to deal with other diseases but are now being repurposed in the hope that they can be used to tackle Covid-19. Results are expected in a few months. If successful, some of these could help cut death rates. It should also be noted that hydroxyl-cholorquine, despite the very strangely hyped promotion by President Trump appears to be an unlikely therapy and may even cause heart issues when used. 

• Vaccines – the holy-grail – At last count there are over 100 initiatives around the world to develop a successful and effective vaccine. With testing underway on five short-listed experimental vaccines in China and four in the United States, the race to produce a vaccine for Covid-19 has taken on political dimensions that echo jockeying for technological dominance during the Cold War. Moreover – both countries are also taking huge financial risks to scale up production of possible vaccines even before they know any are safe and effective — a gambit to ensure their citizens won’t have to wait. “We’re going to start manufacturing doses of the vaccines way before we even know that the vaccine works,” Anthony S. Fauci said in an interview with the Journal of the American Medical Association. Most experts agree though – the prospect of a vaccine is IF – not WHEN. They also predict that it will be at least another year away. But who knows, perhaps with so much effort worldwide, it could come sooner. We can only hope. 

• Seasonality – Most influenzas spread more easily in the winter because the virus is thought to prefer dry air over humidity, and because people in cold environments spend more time indoors and close to each other. Existing coronaviruses (common cold) also follow seasonal patterns. If this coronavirus behaves in the same way – and there is not yet strong evidence that it does – we could see some improvements at least in the Northern Hemisphere. However these is significant information to contradict this hypothesis. CoVid 19 infections are increasing in many warm climates – such as Brazil, Texas and Arizona. The point is, the vast majority of people around the world are still susceptible. 

It can seem very discouraging indeed to face the prospect of having to deal with this pandemic for an undetermined period of time. However there’s a degree of hope with respect to drug therapies and vaccines. Moreover we know what we must do to control and even contain this virus. We are learning to take the needed intervention measures and yet still return to some semblance of normality. We should in time be able to safely open schools, do some limited local travel, have small groups visitors in our homes and most importantly see loved ones that we have been separated from. However, we must be prudent to note that most of society is still susceptible. Thus – a return to political rallies, major sporting events, concerts, extensive air travel, cruising, and hosting large gatherings, will (or should) not be considered for some time. Our elected leaders must recognize this reality and adhere to the advice coming from the medical experts. As we can see from the numbers presented in the table above – leadership and societal cooperation make the difference. 

COVID 19 – MYTHS LIES AND PROFOUND BULLSHIT

by envtam-admin | May 18, 2020 | CoVid

COVID 19 – MYTHS, LIES AND PROFOUND BULLSHIT

Allan Maynard, May 18, 2020

The CoVid 19 pandemic presents one of the clearest examples in modern history regarding the critical need for evidence based decision-making. Unfortunately, the presentation of scientific evidence has often been undermined by deadly denial (see paper – on this web site – Deny Delay Deadly), misinformation about the consequences of such denial and even outright wacky conspiracy theories.  As citizens and voters, we need to be vigilant in seeking out the truth by using trusted sources. 

Wacky Conspiracies 

A documentary-style video called ‘Plandemic: The Hidden Agenda Behind COVID-19′ has been removed by social media platforms after peddling potentially dangerous conspiracy theories about the coronavirus pandemic. The documentary features a Dr. Mikovits’, a discredited scientist who states that the coronavirus pandemic was planned. In the video, she claims that the virus was created in a laboratory, that wearing masks actually makes people sick, and that flu vaccines increase people’s odds of contracting COVID-19. No medical or scientific evidence exists to support any of Mikovits’ claims in the video.

An even more whacky conspiracy claims that the pandemic is really caused by the rollout of 5G (high speed -5th Generation Cellular) networks around the world.  Despite there being no scientific links, a number of 5G towers have been set on fire. The 5G conspiracies make no sense whatsoever. The virus is spreading in countries without access to 5G – in other words – the correlation falls apart.

It is indeed a head-scratcher to understand the motivations for such nonsense let alone fathom how these wacky theories gain traction – but they do. And with social media, the false information spreads quickly. Our willingness to share content without thinking is exploited to spread various forms of disinformation.

Lacking Leadership 

It does not help when we have world leaders also peddling misinformation. When the President of the United States promotes unproven drug therapies and even muses about injecting sanitizing chemicals to kill the virus, the implications are worrying. The scientific community is understandably growing increasingly frustrated. This frustration boiled over when, on May 16, the Lancet, perhaps the preeminent international medical journal, took an unprecedented step and published a front page editorial calling on the US administration to properly recognize science and even concluded by stating “Americans must put a president in the White House come January, 2021, who will understand that public health should not be guided by partisan politics.”

The lack of evidence-based leadership in the USA, the UK, Russia, China, Brazil and others has resulted in enhanced infection rates in these and other countries. For example, Brazil, led by a full-on anti-science president, now has more CoVid cases than China. The United States accounts for about 4.25% of the world’s population, but currently has about 29% of the confirmed deaths from the disease.

Information Disorder

What we are dealing with here is a pandemic of information disorder.  It has sprouted a whole new area of investigation in how lies originate and spread. Generally, the language commonly used to discuss misinformation problems can be too simplistic. Effective research and interventions require clear definitions, yet many people use the problematic phrase “fake news.” Used by politicians around the world to attack a free press, the term is dangerous. Recent research shows that audiences increasingly connect it with the mainstream media. It is often used as a catchall to describe things that are not the same, including lies, rumours, hoaxes, misinformation, conspiracies and propaganda, but it also papers over nuance and complexity.

The 3 main categories of untruths is well presented in a paper by Clare Wardle in Scientific American entitled “Misinformation Has Created A New World Disorder” The following schematic is from this article.

Most of what we are dealing with in the context of the science associated with CoVid 19 crisis and in the push back against climate change science is mainly that overlapping area in the circles of misinformation and disinformation. 

Understanding the motives for the lies

For the most part, the misinformation and disinformation can be understood in terms of the motives of those initiating the falsehoods. Withstanding the wacky conspiracy theories the motivations regarding the falsehoods by politicians are not all that difficult to discern. 

Initially – the motivations were all about money. The denial or initial downplaying of the CoVid crisis by a number of leaders (USA, UK, Russia, China, Brazil, Italy and more) is well documented and for certain linked to a determination to protect markets. See paper on this web site – Denial, Delay, Deadly. Of course we all know now that the denial strategy backfired.

Now that the virus has spread around the world, the motivation for the spread of misinformation and disinformation is to distract and even cover-up mistakes that were made and also to offer optimism even though not backed up by science.  A few examples:

• The world cup of testing – an example of exaggeration. You would think in watching the news that testing rates is now an international competition. Donald Trump has falsely stated a number of times that the US has done more testing than any other country. His latest  – more than twice as much testing as all other countries combined. This is not even remotely true. Moreover, it’s irrelevant. The correct metric is tests per capita and the US is improving but still is not doing enough. (Some numbers – US – 36,000 tests per million population, Canada – about the same, Italy 50,000, Denmark – 80,000). Most scientists point to Denmark as the benchmark to attain or even exceed. 

• Miracle cures – an example of wishful thinking – Despite cautions by medical experts, there has been a dangerous promotion by many in politics citing so called evidence that malaria drugs can treat the CoVid virus. This caused a major run on supplies creating dangerous shortages in some countries. Results from a number of studies, including the first randomized controlled trial, are providing further evidence that the antimalarial drug hydroxychloroquine may not help COVID-19 patients and in fact can cause premature deaths from heart problems. 

• Origin of CoVid 19 – an example of the blame game. China and Russia initially blamed the USA. The Trump administration has continued to claim the virus came from a lab in Wuhan although it has recently backed off this stance. The evidence strongly suggests the source of the corona virus is bats. A new University of California study finds that bats have a fierce immune response to viral infections, which likely causes the viruses to replicate more rapidly. 

These are only 3 examples – there are many more especially in other crises such as climate change. It is disconcerting to see how these lies spread and even more so, how they are blindly believed. But, in many ways it’s not surprising. Social scientists and propagandists have long known that humans are wired to respond to emotional triggers and share misinformation if it reinforces existing beliefs and prejudices. The success of the purveyors of falsehoods also relies on people’s cognitive dissonance – when someone feels genuine mental discomfort when confronted with a view that upends their viewpoint or belief system. So – an alternative story winds up being believed even if lacking in facts. 

No government could have been completely ready for the pandemic, but taking the public for fools is destroying trust. The truth is out there if we are willing to dig – using fact-check sites, listening to medical experts and trusting our own instincts not be fooled by bullshit even if it appears profound.  

UPDATE ON TESTING FOR COVID 19

by envtam-admin | May 6, 2020 | CoVid

UPDATE ON TESTING FOR COVID-19
Allan Maynard – May 8th, 2020

There is a great deal of new information along with political noise about testing for the CoVid 19. For the past 6 weeks, almost all countries have been in various forms of lock-down; in some cases a complete shut down. Understandably there is desire by most citizens to be able to safely move past this phase and return to some sense of normality, however that may be defined for our post CoVid future. Most medical experts caution though, that the key to slowly re-opening our economies is to significantly ramp up testing, followed by quarantining those who test positive and additionally tracing and testing their contacts.

For most countries, the testing frequency is insufficient despite the statements of some politicians. Some examples – testing totals per 1000 citizens as of May 3rd, 2020 – Italy -34, Germany – 30, USA – 20, Canada – 22, South Korea – 12, France – 11. The South Korea numbers may seem low in comparison but that country was very quick to implement widespread testing, combined with combined with contact tracing and isolation which enabled the country to ‘flatten the curve’ (slow infection rates) much earlier than other countries. The USA had a slow start due to a defective test system but is now catching up. The UK also had a late start. Both countries have unfortunately, been following an infection trajectory comparable to Italy.

According to most medical experts, even though testing numbers increased through April, the numbers are still insufficient to allow a substantial opening of commerce. For instance – the USA has now conducted just over 6 million tests in total but the target should really closer to 1 million per day (about 10 times more than over the past 2.5 months). France is now conducting 700,000 tests per week. In the UK the target is 100,000 tests per day. Canada has set a goal of over 500,000 tests per week. It should be noted however that increased testing will not have the desired outcome unless it is accompanied by contact tracing and isolation. Moreover, herd immunity, an epidemiological concept that describes the state where a population is sufficiently immune, will not be possible until a vaccine is available – likely 1.5 years away at the earliest.

To meet the ever-increasing demand for more testing, research has expanded around the globe to produce more, better and faster tests. The latest count – there are over 60 forms of the viral swab PCR tests and over 130 forms of the antibody tests. Many of these have been introduced without undergoing full approval processes in the various countries. In the USA – the FDA provides an “Emergency Use Application (EMA)” for many of the new tests. This can be sensible in such dire situations as long as the tests’ performance characteristics are very carefully monitored.
So – how are the various tests performing?

THE PCR TEST FOR THE COVID 19 VIRUS – MAIN ISSUE – FALSE NEGATIVES. – As described in my earlier blog, the first type of test introduced worldwide, the polymerase chain reaction (PCR) test, diagnoses CoVid infections by analyzing virus material in mucous collected from the nose and/or back of the throat. The test then isolates the genetic components of the virus and converts it into DNA (Deoxyribonucleic acid). Then, using “polymerase enzymes”, the DNA is duplicated again and again so that there’s enough to be detected (if it is present at all). This process is known as “amplification.”

The inherent issue with this test is that the incidence of false negatives can be high. This makes sense. If a patient is tested too early in the disease, there may not be a sufficient viral load to be detectable. If a patient is tested later in the disease, the viral material is likely concentrated more in the lungs and trachea and thus may not be isolated.
Furthermore, there are now a number of more rapid PRC tests on the market without the same degree of amplification of the DNA. This may mean there is less genetic material within the test, for detection. There are now a number of studies underway or reported that show the incidence of false positives can be significant. In the early stages of the pandemic, Chinese scientists published a paper that found the false negative rate of some of the tests conducted at the Third People’s Hospital in Shenzhen, southern China, between Jan. 11 and Feb. 3, were as high as 40 percent.

More recent studies (University of Cleveland, Mayo Clinic) calculate a false positive rate of closer to 15% and stress the need for follow-up tests to reduce the health risk created by infected people mistakenly being told they are infection-free. This objective of repeated testing is hampered by the shortage of supplies needed to conduct the PCR tests. Many who should be re-tested or even initially tested, are not able to do so.

These problems may seem untenable but that is not the case. The PCR test is highly complex. The global developments to expand testing and speed up test results are impressive. The main point, the limitations of the test must be well understood and further assessed as we deal with the CoVid health crisis.

ANTIBODY TESTING – MAIN ISSUE IS FALSE POSITIVES – The second kind of test involves testing blood samples for the presence of antibodies to the virus. Antibodies are evidence of the body’s reaction to an infection. The presence of CoVid antibodies might then suggest that the person is now immune to the virus. It should be cautioned however, that the notion of immunity to the CoVid virus being acquired through infection is only, for now, an assumption based on past experience with other viruses. No scientific studies have confirmed this hypothesis yet. Nonetheless – serology testing for antibodies is a critical part of national testing programs.

Antibody testing is generally less complex and certainly more rapid that testing for the virus itself (the PCR test). In fact there are even test kits on the market that are similar to home pregnancy tests. Most kits however, involve the need for a blood sample to be collected with a finger prick, which is then analysed in a lab setting. However, as stated above most of the new tests on the market have bypassed the needed oversight.

The issue is that many of the new tests have a high rate of false positives. This makes sense given the many types of antibodies in our blood stream, with some, such as the common cold corona virus, very similar in structure to the CoVid virus. Of the 12 antibody tests that were studied by the CoVid testing project in the USA, one of the tests gave false positives more than 15% of the time, or in about one out of seven samples. Three other tests gave false positives more than 10% of the time.

It is a work in progress though and some of the larger firms (Roche, Abbot and others) seem to be close to getting full approval by organizations such as WHO, and the FDA. It seems likely that by June 2020, there will be more reliability in antibody testing.

NEW APPROACH – TESTING FOR COVID GENETIC MATERIAL IN BLOOD SAMPLES – In what could be a significant breakthrough is a blood-based test that will be able to detect the virus’s presence as early as 24 hours after infection – before people show symptoms and several days before a carrier is considered capable of spreading it to other people. In other words — around four days before current tests can detect the virus.

The test has emerged from a project set up by the US military’s Defense Advanced Research Projects Agency (Darpa) aimed at rapid diagnosis of germ or chemical warfare poisoning. It was hurriedly repurposed when the pandemic broke out. The new test is expected to be forwarded for emergency use approval (EUA) by the US Food and Drug Administration (FDA) in May 2020.

Like the viral test, the new blood test hunts for the virus’s RNA (Ribonucleic acid) — in this case it is messenger RNA (mRNA). “Target mRNA is part of the immune response to viral infection,” a Darpa representative said. The test needs about 1 ml of blood – thus blood collection would need to be done in a clinical setting. More will be known about this potential test by June 2020.

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In summary – testing for the CoVid virus is expanding in scope and the tests are improving in terms of their reliability. However the limitations of the tests must be fully considered in analysing data concerning infection rates and disease mitigation measures.