a) During the early stages of the pandemic there was serious under-testing, non-serious cases were not counted
b) A treatment protocol has been established, dexamethasone, Vitamin D and antihistaminics like cimetidine are actually helpful
c) Death is a lagging indicator, it takes about a week to become symptomatic, another week to see if you need to be hospizalized, and another week to see if you will likely die, If you are meant to die you die around the end of week 4.
Confirmed PCR cases (can someone from France confirm or disprove this? Is the government only using swabs + PCR?) are a problem, because they keep on piling but you lose track of who's infectious.
You have very large, almost inflated case numbers, but (in the absence of symptoms) you don't know if those people are still spreading the virus or had it and are recovering.
That's because, if you are positive at a PCR test and without any symptom you may:
- Have not yet developed symptoms, and are infectious
- Have no symptoms, and are infectious
- Have cleared the virus, and are no longer infectious
Viral RNA can last in the throat for weeks in some cases (and it's not unique to this virus). That is why you can't detect the virus just with this test in absence of anything else (and the British Medical Journal wrote about this recently: advice to the doctors on how to interpret tests).
The New England Journal of Medicine argued for far more frequent antigen testing as a way to keep track of cases that are important to isolate, that is, the ones that are infectious[1].
My country did the same mistake (also using serological tests to assess positivity and infectiousness, a stupid mistake that just increased the backlog of tests) and of course tracing blew up.
EDIT: You can voice your disagreement instead of downvoting.
No, that's not what I meant. I meant that a positive PCR test without any symptoms can't tell you if:
- you're about to have the disease (presymptomatic)
- you have the disease (asymptomatic)
- you already cleared the virus
You might be infectious, but you don't know. And given the time window of infectiousness, delays in testing can give you a "positive, please isolate" notice when it's too late, and you potentially have spread the virus to others without knowing.
OTOH, antigen tests detect virus proteins (with far lower sensitivity), so it's far more likely that you have an active infection if you are positive.
Masks do very little in open spaces. We still don't have the data but I think a large part of infections is happening at home were prophylactic measures are highly impractical and impossible to enforce.
We probably would have been able to control better the pandemic if students (of all ages) didn't go back to school, the assumption being that students are acting as silent spreaders (due to the low morbidity in young people), reaches home and multiplies easily there.
But our societies are not prepared to handle this scenario so we were stuck between a rock and a hard place. Preparation between the first wave and the second wave has been also pretty poor.
I wonder then why many countries enforce them in open spaces. Note, this meant as a honest question.
> We still don't have the data but I think a large part of infections is happening at home were prophylactic measures are highly impractical and impossible to enforce.
Some research on current evidence was published in Science last month[1]. With the exception of some specific "job related" events (like meat packing plants) or public gatherings, most of the transmission is in fact in the household.
> the assumption being that students are acting as silent spreaders (due to the low morbidity in young people), reaches home and multiplies easily there.
I've seen this a few times, but as far as I can see the current data are absolutely inconsistent. And the largest contact tracing study from India (recently published) was done with closed schools, so no information from there either.
> I wonder then why many countries enforce them in open spaces. Note, this meant as a honest question.
Well, first off, I’m not sure that many countries have. But for those who do, I suspect a big part of the motivation is initial high rates of people claiming they forgot their mask when they get to the shop and insisting they be let in anyway.
On top of my head, France is one, Spain too, and Italy as well.
> I suspect a big part of the motivation is initial high rates of people claiming they forgot their mask when they get to the shop and insisting they be let in anyway.
As far as I can tell, no shop here (Italy) will let you inside if you don't have a mask. At least in my town shopkeepers enforce this.
> I wonder then why many countries enforce them in open spaces. Note, this meant as a honest question.
I think it's just simple to enforce and has very limited downside. We want people wearing them in public closed spaces because that's were they help the most and we don't necessarily care if they were them outside but the inconvenience of doing so is fairly minor. So the simplest way to enforce this is if everyone has to wear them to go outside of their home.
> Some research on current evidence was published in Science last month[1]. With the exception of some specific "job related" events (like meat packing plants) or public gatherings, most of the transmission is in fact in the household.
Thanks for the article.
> I've seen this a few times, but as far as I can see the current data are absolutely inconsistent. And the largest contact tracing study from India (recently published) was done with closed schools, so no information from there either.
I intentionally phrased as being an assumption as I don't have the hard data to back it up yet. It's based on the spike of cases observed here in Europe after the return to schools, in Belgium (for example) the french-speaking side went to school one week before the dutch-speaking side of the country.The dutch-speaking side is lagging in cases for roughly that amount.
12 comments
[ 4.5 ms ] story [ 42.3 ms ] threadb) A treatment protocol has been established, dexamethasone, Vitamin D and antihistaminics like cimetidine are actually helpful
c) Death is a lagging indicator, it takes about a week to become symptomatic, another week to see if you need to be hospizalized, and another week to see if you will likely die, If you are meant to die you die around the end of week 4.
You have very large, almost inflated case numbers, but (in the absence of symptoms) you don't know if those people are still spreading the virus or had it and are recovering.
That's because, if you are positive at a PCR test and without any symptom you may:
- Have not yet developed symptoms, and are infectious
- Have no symptoms, and are infectious
- Have cleared the virus, and are no longer infectious
Viral RNA can last in the throat for weeks in some cases (and it's not unique to this virus). That is why you can't detect the virus just with this test in absence of anything else (and the British Medical Journal wrote about this recently: advice to the doctors on how to interpret tests).
The New England Journal of Medicine argued for far more frequent antigen testing as a way to keep track of cases that are important to isolate, that is, the ones that are infectious[1].
My country did the same mistake (also using serological tests to assess positivity and infectiousness, a stupid mistake that just increased the backlog of tests) and of course tracing blew up.
EDIT: You can voice your disagreement instead of downvoting.
[1] https://www.nejm.org/doi/full/10.1056/NEJMp2025631
Why do the test numbers keep on piling up?
- you're about to have the disease (presymptomatic)
- you have the disease (asymptomatic)
- you already cleared the virus
You might be infectious, but you don't know. And given the time window of infectiousness, delays in testing can give you a "positive, please isolate" notice when it's too late, and you potentially have spread the virus to others without knowing.
OTOH, antigen tests detect virus proteins (with far lower sensitivity), so it's far more likely that you have an active infection if you are positive.
https://i.redd.it/vfij6vxnobu51.png
We probably would have been able to control better the pandemic if students (of all ages) didn't go back to school, the assumption being that students are acting as silent spreaders (due to the low morbidity in young people), reaches home and multiplies easily there.
But our societies are not prepared to handle this scenario so we were stuck between a rock and a hard place. Preparation between the first wave and the second wave has been also pretty poor.
I wonder then why many countries enforce them in open spaces. Note, this meant as a honest question.
> We still don't have the data but I think a large part of infections is happening at home were prophylactic measures are highly impractical and impossible to enforce.
Some research on current evidence was published in Science last month[1]. With the exception of some specific "job related" events (like meat packing plants) or public gatherings, most of the transmission is in fact in the household.
> the assumption being that students are acting as silent spreaders (due to the low morbidity in young people), reaches home and multiplies easily there.
I've seen this a few times, but as far as I can see the current data are absolutely inconsistent. And the largest contact tracing study from India (recently published) was done with closed schools, so no information from there either.
[1] https://science.sciencemag.org/content/early/2020/09/29/scie...
Well, first off, I’m not sure that many countries have. But for those who do, I suspect a big part of the motivation is initial high rates of people claiming they forgot their mask when they get to the shop and insisting they be let in anyway.
> I suspect a big part of the motivation is initial high rates of people claiming they forgot their mask when they get to the shop and insisting they be let in anyway.
As far as I can tell, no shop here (Italy) will let you inside if you don't have a mask. At least in my town shopkeepers enforce this.
I think it's just simple to enforce and has very limited downside. We want people wearing them in public closed spaces because that's were they help the most and we don't necessarily care if they were them outside but the inconvenience of doing so is fairly minor. So the simplest way to enforce this is if everyone has to wear them to go outside of their home.
> Some research on current evidence was published in Science last month[1]. With the exception of some specific "job related" events (like meat packing plants) or public gatherings, most of the transmission is in fact in the household.
Thanks for the article.
> I've seen this a few times, but as far as I can see the current data are absolutely inconsistent. And the largest contact tracing study from India (recently published) was done with closed schools, so no information from there either.
I intentionally phrased as being an assumption as I don't have the hard data to back it up yet. It's based on the spike of cases observed here in Europe after the return to schools, in Belgium (for example) the french-speaking side went to school one week before the dutch-speaking side of the country.The dutch-speaking side is lagging in cases for roughly that amount.