Coronavirus cases are mounting but deaths remain stable. Why?


Something rather odd is happening in the two Europeans nations worst hit by Covid-19. The UK and Italy have a rising number of cases but a stable and very low number of deaths, even weeks after the cases started rising again.

At the time of writing, the UK records 1750 new cases daily and one death in a population of 67 million. With a roughly similar population and an average of 602 cases a day, Italy has had just over four deaths a day over the last month. The ratio of cases to deaths is nowhere near what it was at the height of the pandemic. The other notable feature is a shift of cases to a younger population.

There can be several explanations for this trend. First, the viral agent may have mutated to a less virulent form. Although there are some published studies showing minor mutations, these are what you would expect from an RNA virus which is inherently unstable (think of the influenza viruses, which perpetually change their suits).

Second, we may have got better at dealing with Covid-19. Apart from dexamethasone in the small population admitted to intensive care units, there are no specific treatments for the disease, and as we are not observing a substantial increase in admissions or severity of the disease, this seems also an unlikely explanation.

Third, our preventive measures may have worked, only allowing new cases when lapses have occurred. If this were the case we would expect effectiveness against all forms of acute respiratory infections, like the winter illnesses. This has indeed happened in the Southern hemisphere, but the age shift does not fit with this theory.

A fourth possible and much more complex explanation is what we call the ‘reality problem’. There is rapidly accumulating evidence that the tests used worldwide to identify cases in a binary mode ‘Yes or No’ are being used in a simplistic and uncoordinated way. We have already explained the limits of polymerase chain reaction (PCR) to carry out mass testing.

PCR is a very sensitive test, which means that it detects the smallest fragments of the virus it is looking for by amplifying the sample millions of times. However, a fragment is not a whole virus, capable of replication and of infecting other human beings. It is a small part of the viral structure that the PCR primer is looking for, not the whole microorganism. Only whole viruses can infect us.

To avoid this dual reality and the dangers of isolating non-infectious people or whole communities we need an international effort to standardise testing, periodic calibration against culture or other recognised measures of infectiousness and strict laboratory protocols and procedures probably with a central licensing authority. A lot more work needs to be done to correlate cycle thresholds, patients’ characteristics and intelligence on virus circulation. Medicine and public health are about people, not printouts. US SPREAD GOOD NEWS!

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By Justgivemepositivenews Team