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Data from Iceland suggest that roughly 89 to 94% of SARS-COV-2 infections (COVID-19) have gone undetected: BioRxiv. We are already behind the eight-ball on COVID-19 and the only way to catch up is with tests for everyone and a smartphone app.

2020-04-12

Coronavirus by Engin Akyurt via pixabay.com (open access)

(Nota bene: This is an enlargement of my last post, with a title altered to be more specific and a few new sentences at the beginning about the initial stages of the outbreak.  My statement about the size of the outbreak in China is merely speculation, but it is informed speculation.)

When COVID-19 was first detected in Hubei, China in late November or early December of 2019, it presented as an unusual outbreak of atypical viral pneumonia.  Patients with this disease presented with fever, dyspnea, cough, and chest pain.  They had negative tests for influenza, respiratory syncytial virus, and bacterial pneumonia, but their blood showed signs of raging infection: elevated C-reactive protein, abnormal white blood cell counts, and dropping oxygen saturation (blood oxygen levels).  Their chest CAT scans (computer-assisted tomography) showed a characteristic pattern of hazy, “ground-glass” opacities (areas of increased density) in the lungs, usually bilaterally (on both sides).  Some of these patients inexorably went downhill, stayed on the ventilator (a machine which pumps oxygenated air into the lungs through a tube inserted into the windpipe, while the patient is heavily sedated) for long periods of days and weeks, and developed multiple organ failure.  Their kidneys, livers, brains, muscles, and finally hearts, broke down.  Some of them died.

This was the picture of COVID-19 as it was presented to the world.  No-one seemed to realize that the infection was in most cases completely asymptomatic (without any symptoms of illness) or trivially symptomatic (with a runny nose or fatigue).  It was really looking at the tip of the iceberg to see the new virus as pneumonia.  Within three months, the virus spread around the world, leaping country borders and side-stepping quarantines.  It spread so fast that even our president was unprepared (although he later said that he had known it all along and was just making happy talk to keep people from panicking).  /s

The Chinese government, once they realized (unwillingly) that they had a potential pandemic on their hands, reacted with draconian severity.  Quarantines on patients were enforced by the police, who were used to keeping dissidents under close observation and applying all sorts of pressure to keep people under control.  Contacts of known cases were separated from their families and put into rudimentary holding cells repurposed from hotels and inns.  Eventually, the doctor who had sounded the warning about a new form of atypical pneumonia was vindicated– posthumously.

He received an official apology for being called in to a police station and being told to shut his face– unofficially arrested for making a case report– and the officials who oversaw his silencing were dismissed.  His relatives appreciated the gesture, but he had already died of COVID-19.  We can assume that he faced massive exposure to the virus in the course of his work and succumbed to an overwhelming infection.

Even now, the true scale of the epidemic in China is unknown.  Estimates of the actual number of patients involved have not been publicized, in part for fear of sounding alarmist.  The government still reports only clinical cases of the viral illness that require significant intervention as “positive for viral RNA” although it has reflexively quarantined anyone who comes in contact with known cases.  They do have a count of people known to be exposed and known to have tested positive, but they have not revealed these numbers.

While it is unfair to the rest of the world not to reveal the true figures for known infections, the Chinese have done the only thing that could have been effective against an infectious agent of this degree of “sneakiness”.   The Chinese system routinely violates civil liberties, but it is effective against an agent that “flies under the radar” in about 90% of cases.  I, personally, based on developments described below and in my last few posts, roughly estimate that the true case count in China is five to ten times as high as what has been officially reported.

A study published in BioRxiv on April 6 analyzes the reports from Iceland, where a community-wide voluntary random sampling program is underway.  These studies are based on two sample sets, as the abstract explains:

The criteria for testing within the Icelandic medical system, processed by the National University Hospital of Iceland (NUHI), have also been targeted at high-risk individuals, but additionally most Icelanders qualify for voluntary testing through the biopharmaceutical company deCODE genetics.

Based on these samples, the authors of the BioRxiv study analyzed the data and found that:

Our primary estimates for the fraction of infections that are undetected range from 88.7% to 93.6%.

This report and the reports from California described in my previous posts reinforce my impression that we are massively underestimating the rate of SARS-COV-2 spread through the community.  My own personal experience suggests that a wave of infections passed through our rural area in mid- to late-February, hitting medical staff at a community clinic through exposure to one or a few symptomatic patients before anyone realized what was happening.  Now the infection is reaching shut-ins and chronically ill people who are relatively isolated from the rest of the community.  These patients are the most susceptible to severe and overwhelming disease, and they will represent the largest percentage of deaths due to COVID-19.

Robust patients with inapparent disease who travel widely have spread the virus throughout the community; less than 10% of them have been detected.  Now the isolated patients will begin to fall ill, and they will be detected with much greater frequency.  More than 10% of them will die.

We need a massive rollout of blood antibody tests for everyone so those who have been infected and are now immune can go back to work.  We need a smartphone app, like so many other countries already have, so that susceptible people can avoid known cases, self-isolation can be monitored, and immune people can advertise that fact.  That is the way to get from behind the eight-ball.

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