Greetings Everyone! And Happy Birthday to my wife, Jess!
I may look like a Crusading duck, but I’m just playing it safe as I prepare to perform a test in the parking lot. We test outdoors to minimize exposure to the building and our staff. We have a tent to deal with whatever weather conditions we might face. We have also performed urgent office visits in the parking lot and are starting to perform phone visits for routine follow-ups as the social distancing continues.
In speaking to colleagues at the hospital, the beginning of this week was a little quieter. Calls to my office for testing are not surging. We are all readying for a possible increase in cases in the county, but we are hopeful that our efforts in distancing decreases the case load. There are models hinting at a promising shift downward in fatalities and the possibility that the death total nationwide could come in below 100K.
Did you know that 2.8 million people die in America every year? That comes out to almost 8000 deaths per day. It’s helpful to keep that in mind when viewing some of the statistics. It keeps it in context. For example, nearly 2000 Americans yesterday died from suspected COVID. The number of deaths in NYC from COVID was over 700 yesterday. The typical number of deaths from NYC in any given non-pandemic day is around 500.
Testing: What We are Learning
I want to discuss some of the challenges we as a scientific community are finding with testing and the direction this points us. Imagine yourself walking out of the mobile rapid-testing unit after being told you have a negative COVID test. Your anosmia and fever and shortness of breath must be from something else? We find most likely you still have COVID with this presentation, even with a negative test. And, you might as well know that we don’t have reliable rapid tests or mobile testing centers. In the early days of this pandemic I bought into the idea that a lot of testing is the only way. Only then can you know who gets reassurance and who needs extra attention. It helps identify who needs to be quarantined. Accurate, accessible, and fast testing would be our #1 tool.
It has been a big disappointment to not have adequate testing in this state and across the country. Now we are facing the fact that testing with the RT PCR swab isn’t straight forward at all. Recently local experts estimate the nasal swab test has a least a 30% false negative rate. This means 30% of the people with COVID will test negative. Take the example of a woman hospitalized with symptoms typical of COVID who tested negative two times before she tested positive on a third try. We don’t have a gold standard which can tell us definitely whether or not the virus is present and against which we can compare PCR results to know how well it performs. This is a problem. Isn’t it fair to wonder whether the test could claim the presence of infection when it’s not there? We have no way of knowing. Last week MA Public Health officials made a precautionary visit to Fairview Commons Nursing Home to screen all of the residents, and five turned up positive. None were symptomatic. We treat them as all true positives of course- and isolate them, but we don’t know exactly what to make of it.
This also begs the question of how you can have large numbers of people with the virus who don’t even know it and a minority with symptoms so severe that doctors have no chance of saving them, even if they were the only patient in the whole hospital. There are rumors of information from China that there may be different strains of the virus, one mild and one causing the severe form of illness. This seems intuitively possible with this range of illness, but needs more study.
The blood test for antibodies will clear it all up, right? Wrong. We can look for evidence in the blood that a person has been exposed to coronavirus by checking for circulating antibodies to coronavirus. The problem is they don’t seem to be able to distinguish between a prior infection with the run-of-the-mill common-cold-causing coronaviruses and this novel one. And to make things more confused consider the example of a group of people with positive nasal swabs who had negative blood tests (undetectable antibody levels). This turned up in the data from a lab on a recent sample set we helped acquire. We love to have it black and white, but it’s not. We love for it to be simple, but it’s not. Coronavirus relating to the global outbreak is defying the rules. Again.
In 2003 there was a SARS coronavirus worldwide outbreak that wasn’t as widespread as COVD-19. At the time a front line microbiologist noted, “we are finding some of the best-characterized cases are negative for the virus. So, it’s puzzling. As is the fact the amounts of virus we are finding, when we find it, are very small–only detectable by very sensitive PCR.” Sound familiar?
Tests in one large sample back then “failed to spot a targeted virus in 30% to 50% of infected patients.” Sounds very familiar. This was attributed to inaccurate testing methods, not the absence of the virus. This sounds identical to today. The 2003 news cycles also sound identical: from wet market discussions to impinging on individual freedoms for the common good.
What is going on? Well, a good scientist will assume nothing. She won’t let the expected outcome frame the results she’s seeing. She won’t get frustrated nor will she stay disappointed too long. She’ll see the phenomena exactly for what they are and will strive to learn what the data is truly saying. This clearly isn’t an open and shut case. There is something here to be learned, about COVID-19, about infection in general, about human nature. A good scientist plays dumb and opens to the truth.
Remember the Whole
Certainly, the virus and the host must not be viewed in a vacuum. The NY Times reported this week that air pollution is linked to higher death rates with COVID. This is a huge step. This novel illness must be viewed in the context of the host’s environment, both internal (preexisting conditions) and external (toxins in the environment). There is an article included here from 2003 which talks about industrial toxins and virology in the contest of the SARS outbreak.
There is a line in the article from a cutting-edge biochemist named Howard Urnovitz, who views SARS virus as human genes rearranged by pollution stress: “I do not see a virus. I see a unique and complete rearrangement of genomic elements. For example, when I look at what is believed to be the gene sequence coding for the spike protein of this coronavirus, I see a complicated gene rearrangement of a region of human chromosome. As I did in our studies of Gulf War Syndrome, when I see gene rearrangements like this, I immediately search for an associated catastrophic environmental event that could have caused such genomic rearrangement.” The author’s conclusion is that SARS epidemics correspond strongly with such “catastrophic environmental events.” The link between toxins and virology is extremely promising, in my opinion. 5G is frequently mentioned as a novel environmental toxin that hasn’t been studied at all but is theorized to be much worse than existing EMF exposures.
We have to think outside the box. Innovation never comes from the majority, status quo does. Wrestling with dissenting opinions is critical. There’s no such thing as one medicine that is good for everyone. Optimal health never comes from the top down, which is generally one size fits all. Healthcare is best individualized and personalized. Be informed. Take your health into your own hands. If you follow the standard American diet, you will live with higher risks. A plant-based diet will help you detoxify. Eat greens every day this week if you want to take one thing away from this bulletin. If toxins correlate to viral problems, then let’s detoxify naturally with smart and safe dietary measures- green smoothie, anyone? Re-commit to a low sugar diet. Live cleanly. It’s potent.
The other area for detox is not giving in to fear. With knowledge, fear fades. With mindfulness, calm expands.
“Each morning we are born again. What we do today is what matters most.” Buddha
It’s always been true that every day has something brand new to it, something that has never been seen or felt before. This holds true for today but seems amplified a millionfold. The whole world has one thing on its collective mind. Researchers, doctors, manufacturers, citizens are united in concentrating efforts to come through the pandemic intact. Let’s protect against being burdened with lasting limitations. Let’s keep as a goal to have advancement come out of it too.
Let me know if we can be of support in any way,
Dr Cooney and staff