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Increased new COVID-19 positive RT-PCR cases set records in US, with hospitals overflowing. Deaths so far have lagged behind due to better treatment. Failure of direction from the top has led to a shambolic response.

2020-11-03
sars-cov-2 virions by EM: NIAID

Today is the end of Election Season, so here is a post about the future that has nothing to do with who wins the election. I haven’t posted about this before because it seemed obvious, but I can’t hold back anymore: records are being set every week now of new COVID-19 positive RT-PCR tests. Hospital cases are following right behind, but deaths so far have not increased as much as before.

One problem not noted in the official new case totals is that, increasingly, cases are being diagnosed by rapid tests. Many of these rapid tests are not being officially recorded, making the record increases even more consequential. Rapid tests are performed onsite or nearby, and they are taking place at urgent care centers and doctor’s offices that are not accustomed to informing the appropriate authorities about positive test results.

The rapid tests are also subject to abuse, in that people without symptoms are being tested– a use not intended by the test makers and likely to be false-negative in cases that have low virus loads. Apparently, asymptomatic individuals can have relatively light infections with fewer viruses being shed– resulting in a lower antigen signal.

The RT-PCR test is supremely sensitive– so much so that it is being accused of being “false-positive” when tiny amounts of virus are detected. The rapid virus tests are not nearly as sensitive, and can miss infections with small virus loads; this is particularly a problem in asymptomatic people. The rapid test is very helpful, but overall direction of the rapid effort should have included full instructions that it’s use should be limited to symptomatic people. This is increasingly evident: a failure of direction from the top has led to sincere but mis-directed efforts to find cases and failure to follow-up with contact tracing.

One example of official failure that I can’t help mentioning is that of a woman who died on an airplane in flight. She was middle-aged, obese, and had asthma; she did not know that she had COVID-19. She experienced increasing respiratory distress in-flight and had an intensive cardiopulmonary resuscitation attempt by a stewardess. The flight was diverted and the dead patient removed, but the diagnosis of COVID-19 was not made until she was autopsied two days later.

Most of the people exposed to her were not informed, and contact tracing was not done. It took three months for all of the people involved to learn of this case. From July 24 until mid-October, when the case was published in the newspaper, no attempts at full notification were performed. This was a failure of federal government agencies, initiated by a lack of overall direction by the administration from the top.

To return to the present: increases in new cases are being followed by increases in hospital admissions, resulting in record numbers of inpatients. These patients are overloading hospitals in places like Denver, Colorado, Salt Lake City, Utah, Boise, Idaho, and Bismarck, North Dakota. Hospitals are talking about transferring patients to places with greater intensive care unit capacity.

By the end of this year, hospitals may have been overloaded, and temporary field hospitals are being set up to handle the overflow. The hospital crush that was seen in New York City in the spring is being seen now in the rural Midwest, West, and Southwest.

The death rates have fallen far behind the new case rates because it now looks like doctors have gotten much better at treating serious cases. Fewer patients are being put on ventilators; more people are getting dexamethasone, which by itself reduces death rates by a third; patients are being turned to prone positions to improve oxygen exchange; and many refinements have resulted in improved survival rates in hospital.

Another problem which has not received enough attention is the plight of people who were not in critical condition during their acute infection but are left with serious after-effects. The rate of “long COVID” has been estimated at 5 to 10% of symptomatic cases. This represents a huge number of people when you take 8 million total positive test results in the last ten months: 400,000 to 800,000 people with persistent symptoms and at least a hundred thousand of them disabled, for a year or possibly permanently. They look like a new generation of myalgic encephalitis/chronic fatigue syndrome.

The virus is coming back in places that were hard hit last spring, but that experienced a remission in the summer: mostly the Northeast.

Places like Connecticut and Massachusetts that had almost eliminated new cases are seeing dramatic increases, doubling the rates from a month ago– although the rates then were so low that even twice as much is not overwhelming.

Everyone is saying that it looks like it is going to be a hard winter. Even Deborah Birx, MD, coordinator of the administration’s shambolic coronavirus task force, was said to have privately issued a warning about the winter. No public confirmation of the warning has been given, presumably because the White House doesn’t want people to know and would rather have rampant rumors spreading around among those who don’t believe the official lies.

Instead, the current president has threatened to “fire” the most trusted scientist working for the government: Anthony Fauci, MD. Dr. Fauci is said to have a 64% approval rating, versus the president’s 36% rating– so an unpopular president would be firing a popular scientist: not a good look. Of course, it is next to impossible for the president to directly fire him because of his Civil Service protections, but he has been eating away at those protections day by day.

No references today: I’m taking a holiday because today is the end of the Election Season. (Besides, it has all been reported by the big newspapers ad nauseam.) Tomorrow comes the real test of democracy: can the people wait for a full count of all the votes, or will they be sucked under by the violent bloviations of a narcissist completely without scruples?

I’m betting that, despite intensive exclamations of “vote rigging”, “fraud”, and “fake news”, the current president will see the winds blowing against him, including expressions of disgust by a few Republicans, and admit defeat (as he has in the past, in the face of intense public outcries.) Then he will make every effort to destroy the government on his way out the door, even pouring glue into the locks before he slams the front door.

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