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NEJM on Covid-19, Testing and the Economy

RenoCon

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I will forever wear a mask on an airplane (though, with recent improvements, this environment is considerably less contagious than it once was.) However, I am inclined to believe that much of the draconian measures that have been taken in regards to Covid-19 have done more harm than good.

This highly technical article from the New England Journal of Medicine raises some questions that I don't believe they intended:

"The Centers for Disease Control and Prevention (CDC) estimated in June 2020 that there were 10 times as many Covid-19 cases in the United States as had been detected. In other words, despite very high analytic sensitivity of the diagnostic tests deployed for surveillance, today’s testing regimens have at best only 10% sensitivity to detect infections and are failing as Covid filters.

.. such low counts could imply either an early- or a late-stage infection, the long duration of the RNA-positive tail suggests that most infected people are being identified after the infectious period has passed. Crucially for the economy, it also means that thousands of people are being sent to 10-day quarantines after positive RNA tests despite having already passed the transmissible stage of infection." (my emphasis)


If there are "10 times as many Covid-19 cases in the United States as had been detected" aren't we that much closer to heard immunity? If there are "10 times as many cases" than our current screening methods can identify then isn't the death rate considerably less, perhaps one 10th of current estimates? I can assure you that hospitalized patients diagnosed with Covid 19 and dying from Covid-19 are not recieving the simple screening tests. Rather, that diagnosis is made using more sensitive and specific tests, not "surveillance" testing. (I suspect many of these diagnosis are simply made on a clinical basis further inflating the rate of hospitalization/death attributed to Covid-19.)

The last sentence above seems to give away the farm. "Crucially for the economy, it also means that thousands of people are being sent to 10-day quarantines after positive RNA tests despite having already passed the transmissible stage of infection." The NEJM is usually far left when it comes to public health policy. (I gave up my subscription years ago after they supported the ACA and other politically left health policies. And resumed it to stay in touch after retiring.) For the NEJM to consider the "economy" in developing health policy is an unusual concept.

Stay safe out there. Wear a mask when appropriate, wash your hands and use good common sense. I do not think we need to continue to destroy the economy, disrupt education for our children or create other unintended adverse consequences to accomplish this goal.
 
I will forever wear a mask on an airplane (though, with recent improvements, this environment is considerably less contagious than it once was.) However, I am inclined to believe that much of the draconian measures that have been taken in regards to Covid-19 have done more harm than good.

This highly technical article from the New England Journal of Medicine raises some questions that I don't believe they intended:

"The Centers for Disease Control and Prevention (CDC) estimated in June 2020 that there were 10 times as many Covid-19 cases in the United States as had been detected. In other words, despite very high analytic sensitivity of the diagnostic tests deployed for surveillance, today’s testing regimens have at best only 10% sensitivity to detect infections and are failing as Covid filters.

.. such low counts could imply either an early- or a late-stage infection, the long duration of the RNA-positive tail suggests that most infected people are being identified after the infectious period has passed. Crucially for the economy, it also means that thousands of people are being sent to 10-day quarantines after positive RNA tests despite having already passed the transmissible stage of infection." (my emphasis)


If there are "10 times as many Covid-19 cases in the United States as had been detected" aren't we that much closer to heard immunity? If there are "10 times as many cases" than our current screening methods can identify then isn't the death rate considerably less, perhaps one 10th of current estimates? I can assure you that hospitalized patients diagnosed with Covid 19 and dying from Covid-19 are not recieving the simple screening tests. Rather, that diagnosis is made using more sensitive and specific tests, not "surveillance" testing. (I suspect many of these diagnosis are simply made on a clinical basis further inflating the rate of hospitalization/death attributed to Covid-19.)

The last sentence above seems to give away the farm. "Crucially for the economy, it also means that thousands of people are being sent to 10-day quarantines after positive RNA tests despite having already passed the transmissible stage of infection." The NEJM is usually far left when it comes to public health policy. (I gave up my subscription years ago after they supported the ACA and other politically left health policies. And resumed it to stay in touch after retiring.) For the NEJM to consider the "economy" in developing health policy is an unusual concept.

Stay safe out there. Wear a mask when appropriate, wash your hands and use good common sense. I do not think we need to continue to destroy the economy, disrupt education for our children or create other unintended adverse consequences to accomplish this goal.
The claim of 10% testing efficacy strikes me as an erroneous deduction. If the number of infected is really 10X higher than known, it's likely a great many of those were never tested at all or didn't even know they had the disease.
 
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