COVID-19: Maybe More Contagious — But Far Less Deadly

One of the earliest alerts that the COVID-19 virus was not the death sentence that most scientists in the mainstream made it out to be was by Stanford School of Medicine professor, Dr. John Ioannidis. He is ranked by Google Scholar as “one of the world’s 100 most-cited scientists” and is the publisher of more than a thousand studies.

Dr. Ioannidis looked at one of the first places of known infection, the Diamond Princess cruise ship, that was quarantined by Japanese officials on February 4. 700 passengers and crew were infected and 9 died.

By examining the demographic make-up of those infected on-board, Dr. Ioannidis concluded that the fatality rate in the U.S. would be nowhere near the early predictions of one to two million deaths. He thought at worst it would be comparable to annual influenza deaths.

He also found many of the early predictions and studies were less scientific than they were ideological or political. He says these biases formed their underlying assumptions. He called the pandemic “the perfect storm of that quest for very urgent, spectacular, exciting, apocalyptic results.”

The World Health Organization (WHO) said in early March that the case-fatality rate would be nearly 3.5%. This and other such dire predictions by so-called “experts” caused the president and nearly all governors to literally shut down most of the nation’s commerce.

Those in government claim their mitigation efforts deserve all the credit for likely reducing the national deaths to less than one-tenth of one percent of the population.  But others, including some of the country’s top scientists, say there may be other factors to consider. Some physicians, like Dr. Ioannidis, are actually saying government-enforced “social-distancing” and “stay-at-home” orders are actually harming our ability to defeat the damage caused by COVID-19.

Though states like New York and New Jersey have been hit particularly hard by the virus, other states have not experienced anywhere near the number of cases nor deaths that were originally predicted.

The tri-state region of New Jersey-New York-Connecticut is one of the most impacted regions in the world. Comparing just this area with other countries, the region would easily rank No. 1 with the most deaths per capita.

The risk to the nation’s health, great though it may be, must now begin to take a back seat to the enormous economic danger of a continued shutdown. At the very least, we need more facts and likely less fear. And one of the facts is that the virus is not the threat to those of working age that we have been led to believe.

For example in North Carolina, one of the states that provides both case and death statistics based on age, the death rate (as of May 6) for those under 65 is 0.7% of verified cases or just 6 per one million population. For those fortunate enough to eventually go back to work, the risk of death driving to work in an auto accident is considerably higher than succumbing to the virus.

COVID-19 may have also been quietly infecting people here in the U.S. earlier than originally thought. New autopsy results have indicated that two California women had the virus in their system when they died in February before the CDC said the disease was community spread.

Northeastern University has estimated that by mid-February there were more than 600 infections that went undetected in the San Francisco and New York City areas. Boston and Chicago had over 100. More recent research indicates that as many as 50% of those who have (or had) the virus are asymptomatic and another 40% had mild symptoms. And yet about 4 out of every 5 (likely symptomatic) Americans who have been tested for the virus don’t have it.

At least six studies around the U.S. have preliminarily shown that the coronavirus is far more contagious but decidedly less deadly than previous thought. It appears especially less deadly to those under 65. In fact, for kids and young adults (under age 25), influenza appears to be considerably more of a threat. Young kids are vulnerable to influenza but parents have little to fear of losing their children to this virus. Thus far in 2020, the flu has killed 9 times as many kids under 15 as COVID-19 has. (Note: As of  May 6, North Carolina had zero percentage deaths for anyone under 25.)

What is becoming the most sought out test — for those not currently sick but who may have had COVID-like symptoms at some point during the last four months — is a serology test. This examines a person’s blood for immune proteins and antibodies that indicate a person has been exposed to the virus in the past and these antibodies may provide some immunity to new infection, though not as yet guaranteed.

In a surprising move the Food and Drug Administration has not demanded test makers get its blessing before putting their test kits on the market (though it has officially approved Cellex and a number of others). This has good and bad implications. First, this decision has resulted in dozens of test makers getting their tests immediately out to consumers. Second, the quality of many of these early tests may be dubious.

 

The Wall Street Journal asked experts basic questions about the value of antibody tests:

Q: What is an antibody test? How is it different from a diagnostic test?
A: Diagnostic tests tell you whether you are infected with Covid-19. They are molecular tests that detect the presence of the genetic material from the virus, says David Walt, a professor of pathology at Harvard Medical School and Brigham and Women’s Hospital in Boston. They typically use a nasopharyngeal swab that is pushed way back into the nose to get a sample of your mucus.
Antibody tests take a sample of your blood to test your immune response to the infection to see if your body has produced antibodies. They don’t detect active infections but tell you if you were previously infected with the virus.

Q: What is an antibody?
A: Any antibody is a protein produced by the immune system, designed to bind to particular proteins on the virus. Once the antibodies bind with the virus proteins, they ideally trigger a process to neutralize the virus and remove it from the body according to Dr. Walt.

Q: Are there different types of antibodies?
A: Yes. In a typical immune response, the first class of antibodies produced is called IgM, or immunoglobulin M. Next, the body produces IgG, which is better able to recognize and target the specific virus. The body also produces IgA, which is usually found in higher amounts on mucus-membrane surfaces says Gregory Storch, a professor of pediatrics at Washington University in St. Louis.
Dr. Storch says IgM is transient and typically isn’t detectable after a few months. IgG is detectable for much longer and is probably the most useful to measure.

Q: If I have antibodies to the virus that causes Covid-19, does that mean I’m protected from getting it again? If so, for how long?
A: We don’t know. “Just because people have an antibody response to this virus does not mean that they are protected against being reinfected,” says Dr. Walt.
Marc Jenkins, director of the Center for Immunology at the University of Minnesota Medical School, says the assumption is that the presence of antibodies provides some level of protection and could last a few years.
The question is, how many antibodies do you need? Different people make different amounts of antibodies based on their genetics and other factors, including how intense their viral infection was.
It is possible that people with milder infections-or who are asymptomatic-may not develop as many antibodies and may have less protection from the next infection, he says.
“Most likely, people who have recovered from Covid-19 with antibodies in their bloodstream will be immune for months or one to two years,” says David Reich, president of Mount Sinai Hospital in New York.

Q: How reliable are antibody tests?
A: There was a huge concern about the quality of the first group of antibody tests that hit the market about a month ago, says Amy Karger, an assistant professor in laboratory medicine and pathology at the University of Minnesota Medical School.

Q: Do antibody tests have high false positive or false negative rates?
A: Depending on the test, they can. Test makers try to balance specificity with sensitivity. A highly specific test will exclude false positives but might be less sensitive and miss some positives. If a test is very sensitive, it may pick up a signal in people not really infected.

 

With now over 120 companies pushing their own serology tests, other non-governmental organizations are conducting their own studies of these tests to determine their reliability, which can vary significantly.

A joint project of the University of California, Berkeley and UC San Francisco has chosen a dozen of these test kits to examine for both their accuracy in finding antibodies in those who recovered from COVID-19 (sensitivity) along with ensuring the tests don’t show “false positives” or indicating antibodies exist when they really don’t (specificity). That could give the person a false sense of immunity from the virus.

Those who led the study were Dr. Patrick Hsu of Berkeley, Dr. Alex Marson, associate professor of microbiology and immunology at UCSF, Dr. Caryn Bern, professor of epidemiology and biostatistics at UCSF and Dr. Jeffrey Whitman, clinical fellow of pathology at UCSF.

The researchers thought the results of their tests were important enough to publish them online in advance of peer review or submission to a medical journal.

They tested these dozen kits using approximately 300 blood samples: 108 of these were presumed to not contain COVID-19 antibodies as they were obtained prior to July 2018. The rest of the samples came from COVID-19 patients in the San Francisco area and about 50 samples from patients who had tested positive for viruses other than COVID-19.

The main problem for the researchers was the lack of a “gold standard” test to measure the others against. It means tests were scored on a “relative” basis, or how they perform relative to each other.

The team was encourage by the results though. “There are multiple tests that have specificities greater than 95%. So, there is some reason for guarded optimism,” Dr. Marson said. There were a few of the tests that had specificity rates over 98%.

 

Antibody Studies

At least six serology studies using FDA-approved antibody tests in the U.S. have all shown that the virus has infected far more people than the current positive case numbers indicate.

Among the most publicized studies were those conducted in Santa Clara County in California, Miami-Dade County in Florida and the New York City area.

The seroprevalence study of Santa Clara County by a team of scientists from Stanford University was released in mid-April.

Drs. Jay Bhattacharya and Eran Bendavid led a team (co-authored by Dr. Ioannidis) that collected 3,300 blood samples over 2 days.

Based on the results of the antibody tests on these samples, the researchers estimated, after adjusting for demographics, it is likely that between 2.5% and 4.2% of the county’s population (which includes San Jose, the state’s third largest city) had been infected.

This range of infection stunned the medical community. It said that the actual number of people infected were as many as 50 to 85 times the number of confirmed cases in the county.

In responding to considerable subsequent criticism, Dr. Ioannidis and his colleagues openly admitted that this study and its extrapolation weren’t “bulletproof.” They invited it to be examined by others. But Dr. Ioannidis also expressed confidence that their study will hold up well when reviewed.

If the Stanford team is correct, 50 times more infections would mean that as many as 80,000 residents had previously contracted the virus, most of whom didn’t know it. It would also indicate that the fatality rate would be enormously lower than using the reported COVID-19 positive cases as the denominator. It would be closer to a “normal” seasonal influenza rate of 0.1% to 0.2%.

The authors now argue that economy-destroying lockdowns may not be necessary at all.

Drs. Bhattacharya and Bendavid teamed up with Neeraj Sood, an expert on health policy at the University of Southern California to conduct a similar study in Los Angeles County. Those results produced an estimate of 4.1% of the people in L.A. County being infected at some point in the recent past. This would translate to 28 to 55 times more than case reports.

A University of Miami study published its preliminary results about the antibody prevalence of the population of Miami-Dade County in the Miami Herald on April 24.

Researchers tested approximately 1,400 residents and found that 6% had antibodies. About half claimed no previous symptoms in the 14-17 days prior to the tests.

The Miami-Herald reported: (“)UM researchers used statistical methods to account for the limitations of the antibody test, which is known to generate some false positive results. The researchers say they are 95% certain that the true amount of infection lies between 4.4% and 7.9% of the population, with 6% representing the best estimate.”

This means that there have been 165,000 estimated infections in the county (low end of 123,000 to high end of 221,000).

The New England Journal of Medicine published a serology study of tests in the greater New York City area. The study examined 215 women entering two hospitals between March 22 and April 4. Shockingly, 15% had been previously infected.

A far broader study collected 3,000 blood samples from people at 40 sites in 19 counties according to Governor Andrew Cuomo. About 70% of the testing occurred in the areas of Westchester, NYC and Long Island. New York’s health commissioner said the test was reliable and had been approved by the FDA.

The New York Times reported that Cuomo said the infection rate varied from a high of 21.2% in New York City to 16.7% on Long Island to just 3.6% upstate. He added, “These are people who were infected and who developed the antibodies to fight the infection. They had the virus, they developed the antibodies and they are now ‘recovered’.”

Cuomo said a statewide infection rate of 13.9% would equate to millions more having carried the disease than previously believed. It would also take the COVID-19 death rate down to about 0.5%.

This study does have serious caveats. It was “only” a sample of 3,000 and who were never tested for COVID-19 but it does agree with the other studies previously mentioned.

Similar results are now being discovered around the world. In places like Robbio, Italy the infection rate is estimated to be 30 times the reported cases; 10 times in Iceland, 27 times in Denmark.

In Germany on April 9, virologist Hendrik Streeck of the University of Bonn announced his preliminary results of a study conducted in Heinsburg, a region in Germany. He tested 500 people and found antibodies in 14% of those tested. This would indicate the COVID-19 had a fatality rate of 0.37% there.

Sweden never even closed its economy and has similar death rates to those that embarked on a total shutdown.

If these studies are close to being accurate, it would be great news. It would suggest that the majority of those who have contracted the virus never even knew they had it. The virus would be considerably more contagious but markedly less lethal.

And that the fatality rate would not justify the economic destruction of a continued mass shutdown.

The big question is whether these antibodies will provide partial or full immunity from future infections. Based on many years of virology science we ought to anticipate immunity for at least a year or more.

This virus has been especially hard on the elderly. Nearly 25% of all U.S. deaths from COVID-19 have been in nursing homes.

In New York City where about one-third of all U.S. deaths have occurred from COVID-19, those 75 and over have a fatality rare about 80 times that for those 18 to 45. And for those under 18, the death rate is 0 per 100,000.

Of the NYC fully investigated COVID-19 deaths so far, over 99% have had underlying illnesses. Obesity was the single greatest factor present in those infected with the virus requiring hospitalization.

The aforementioned Dr. Ioannidis and his wife, Dr. Despina Contopoulos-Ioannidis, an infectious-disease specialist also at Stanford, published a study stating that those under 65 without any underlying illnesses were only 0.7% of COVID-19 deaths in Italy and 1.8% in NYC.

Dr. Ioannidis commented, “Compared to almost any other cause of disease that I can think of, it’s really sparing young people. I’m not saying that the lives of 80-year-olds do not have value-they do, … but there’s far, far, far more . . . young people who commit suicide.”

In Pennsylvania, fully two-thirds of the state’s deaths have been to those in nursing homes.

Those of working age, though, have been left relatively unscathed. North Carolina has a fatality rate (so far) for those under 65 of just 6 per million population.

 

Policies going forward

Dr. Ioannidis, as expert as anyone on the subject, has expressed some strong and controversial opinions about the effectiveness of broad economic shutdowns and the “mitigation” efforts that have been so widely embraced by most government authorities nationally.

“It’s not that we have randomized 10 countries to go into lockdown and another 10 countries to remain relatively open and see what happens, and do that randomly. … Different prime ministers, different presidents, different task forces make decisions, they implement them in different sequences, at different times, in different phases of the epidemic, says Dr. Ioannidis.

There is virtually no place on earth that has the same conditions and same policies so it is very difficult, if not impossible to apply a uniform strategy to mitigate both the effects of the virus and the economic damage. Both are critically important.

Will these antibody tests show that we are moving toward what is called “herd immunity?” It’s certainly possible. Some nations like France, Italy and the U.K. are considering the use of serology tests to provide an “immunity passport,” allowing those who have been infected and possess antibodies to no longer be required to social-distance. Dr. Anthony Fauci has verified that the idea is currently being considered in the United States.

An under reported but enormous and growing health problem is due to America virtually shutting down medical care for life-saving tests and “elective” surgeries. As many governors declared health emergencies in their respective states, hospitals were instructed to stop “nonessential” treatments to ensure an adequate supply of beds and staffing would be available for the anticipated COVID-19 patient surge.

Most of the country never saw this deluge but “elective” procedures like mastectomies, pain-relieving (e.g., back and spine) surgeries along with cancer screenings and biopsies have been dangerously postponed. Some estimates claim half of all cancer patients have deferred chemotherapy treatments.

As many as 80% of brain surgery patients have had their procedures pushed back. Even transplant donations from living donors are off 85% from this period last year.

People are dying or likely will die because of COVID-19 concerns (panic?). We have essentially stopped care in its tracks for millions of Americans who may desperately need it.

Dr. Scott Atlas, Senior Fellow at Stanford University’s Hoover Institution and a former chief of neuroradiology at Stanford Medical Center, says that it would be beneficial if infected people would transmit the virus to others in low-risk groups to generate antibodies while simultaneously taking strong measures to protect the most vulnerable.

The current best case scenario is the virus isn’t as lethal (for the non-elderly) as initially believed and that a national “herd immunity” develops rapidly either by way of a new effective vaccine or the production of antibodies from people already infected. Widespread immunity along with effective treatments for difficult cases and enhanced mitigation for places like nursing homes would expedite the solid economic recovery that we now so desperately need.

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