COVID-19 Update, Monday August 10th

False positives, 5 million, children and cabbage.

1. We have discussed previously that we have some testing issues, and while most of our focus has been on false negatives, false positives are also an issue. In fact, the FDA issued a formal warning to a test producer, BD in early July regarding their high false positive rate (3%). Three percent false positives is far below the 30-65% false negatives we have seen in some tests, but it remains an issue and is a major factor in why physician’s judgment and expertise is so critical to this process. Every test (all laboratory tests not just COVID tests) have a sensitivity and specificity rating. These ratings tell us how often the test gets it right. Conversely it gives us an idea of how often we can expect a false positive or a false negative. Normally, tests undergo a very stringent validation process during which they prove that rating before getting FDA approval. But these aren’t normal times. Under the EUA many of these requirements were waived in an effort to get tests to the market quickly. False positives are most commonly seen in people who are not sick but are being tested for other reasons, such as to return to work or as part of a standard monitoring process. Factors (other than just the quality of the test) that can impact the results include when in the cycle of infection you test, the quality of the sample, errors by the person performing the test, and the type or brand of the test.

For those concerned that false positives are inflating the numbers there are some important things to note: 1) these are generally caught during a retest and not counted, 2) false positives occur in less that 5% of all testing, even if they were to be incorrectly counted, those will be easily offset in the numbers by the 30-65% of false negatives. 3) healthcare providers, public health providers and epidemiologists all understand sensitivity and specificity, testing anomalies, the fluid nature of the numbers etc. so none of this is new or unexpected. And for those concerned retesting inflates the testing numbers you can be assured that is not how it works. Tests are counted by the person tested not by the number of tests they received. This is just another reason we lean on the expertise of healthcare providers to use their clinical judgment.

2. The United States hit 5 million cases over the weekend. It took 17 days to get from 4 million to 5 million which is fast, but 3 days slower than the progression from 3 million to 4, let’s celebrate that small victory.

3. 97,000 children tested positive in the last two weeks of July according to a report published by the American Academy of Pediatrics. That is a 40% increase. These numbers are based on state testing and their definition of “child” which appears to vary from state to state with some states cutting off their counts at age 14 and at least one state (Alabama) including people up to age 24 (so as to include college students). 86 children have died since May. In related news, MMWR reports there has been a rise in MIS-C cases with 570 cases and ten deaths reported as of August 6th. MIS-C generally develops roughly 4 weeks after exposure to COVID and includes shock, cardiac involvement, and inflammation. Hospitalization rates among children remain low at only 8 per 100k requiring hospital intervention compared to 164.5 per 100k among adults. However, of those children who do require hospitalization, one in three require the ICU.

I have heard many people point to nations that have reopened schools without seeing a rise in cases so I wanted to speak to that briefly. Those nations did so with very stringent prevention measures in place such as required masks, desks moved 6 feet apart and partitions between desks, just to mention a few. In places that did not do so, they have seen increased numbers as a result (Israel, France, Australia). To be fair, Israel had stringent mask rules when they started but summer hit and AC issues happened, they allowed the children to remove their masks because it was so hot. Then their numbers jumped, and school closings were necessary. When we make decisions regarding the best courses of actions it is wise to look at other countries and see what they did – but it would be foolish to ignore culture or protocol as part of that. No school in the world with outbreak numbers as high as ours has reopened with masks optional and without social distancing and “been fine.” All of those who reopened and have done well have had low numbers in the area and strict mask requirements and distancing etc.

4. Johns Hopkins Coronavirus Resource Center is suggesting that eating cabbage and cucumber could reduce your risk of dying from COVID. They believe (this has not yet been scientifically proven via rigorous testing) Cabbage consumption (1 gram per day) could reduce mortality by 13.6% and cucumbers by 15.7%. So, stop drinking hand-sanitizer and eat your veggies instead. Can’t hurt, might help.

FINAL THOUGHTS: A new week begins, and we have a chance to begin anew. Listen to your body this week. Hear your thoughts and acknowledge them. It’s ok to not be ok. Stress, uncertainty, grief, and loneliness are very real. You may not even know you aren’t ok until you have an unexpected emotional response to something. Listen to your body. Take care of it. Tend to your emotional well-being. Reach out for help when you need it. Don’t pretend to be ok if you aren’t. Hold each other up. We are walking through this together, and the journey is long and worrisome. Some days you will be carrying others and some days you need to be carried. Be strong enough to admit when you need to be carried and kind enough to carry others when they need it.

1918 Picture: they were making homemade masks even then.