I want to rant, but will try to be rational

By Kevin Roche

Updated with one important point–the same person could easily repeatedly be a “case” under our current testing approach. I should retitle my research summary series “coldmonomania” lives forever.  I try not to get wound up.  A couple of nites ago I went on a Twitter rant.  Tonight I am going to rant here, but in a rational way, if possible.  Our policy just gets stupider and crazier.  No one learns anything.  Our experts are not expert in anything except political messaging and it is bad communication at that.  It is like people are incapable of remembering the simplest, most basic relevant information and applying rational, obvious logic to those facts as they exist in our situation.  We need less testing not more.  Yet everyone is talking about testing everybody all the time.  Soon there will be no one left to do any work anywhere.

Here is the true situation.  This is basic, basic information, anyone who claims to understand anything about viruses and their interaction with humans should know this:

1.  I have explained this repeatedly, if you look in the presentation I have posted links to a couple of times (search YouTube or the blog, should still be up), I even have a visual I use to help people understand.  Nothing short of wrapping your head in multiple layers of saran wrap will stop you from being exposed to a widespread circulating respiratory virus.  Nothing.  “Exposure” means you inhale some of the virus into your upper respiratory tract–your nose and mouth.  There has been some suggestion eyes may count too, not clear from the research I recall.

2.  The virus has one and one only purpose, like any virus. It wants to replicate.  It does that by getting inside a human cell, hijacking the protein-making machinery and making more copies of itself, which then exit the cell to continue the process.  When you are exposed, you become “infected” if and only if the virus gets inside one or more cells and begins that replication cycle.

3.  A person is “infectious” if and only if either a) virus that they originally inhaled is exhaled, without infecting the person according to the above definition, which would be rare but could occur, or b) far more likely, they become infected, the virus replicates and the replicated virus is exhaled, coughed, sneezed or otherwise exits the person.  (Some research suggested fecal transfer or other methods, I am dubious.)  That expelled virus is then available for some time to infect other humans.  As a side note, we still have no idea of the minimal “dose” necessary to infect a person, or the variability in susceptibility among individuals to different doses.  It may not take many virions to do the job, which is one reason masks don’t work worth a crap, or social distancing or any other of our nonsense suppression of spread measures.  This failure to be effective is further explained by our inability to fully identify how and how long the virus travels and is viable.  By now it should be apparent to everyone that the virus has a travel and survival capability beyond whatever we are imagining.

4.  Identifying truly infectious people and stopping them from infecting anyone else appears to be an obvious strategy to limit the spread of the virus, if you think that is an important goal, which I believe is at least arguable.  It assumes, however, that you can accurately identify infectious persons before they are infectious.  Even leaving aside issues about asymptomatic or presymptomatic spread, that is not a truly feasible possibility.  It would require the absurd extreme, although some nut-case experts advocate this, of testing everyone, and I mean everyone, multiple times a day with exquisitely accurate tests, which don’t exist, and forcing them to isolate until they have a negative test, or just forcing everyone, tested or not, to have zero contact with anyone, ever.  I am not sure even the latter course of action is effective, given what I said at the end of point 3 above.   Obviously ends the notion of a functioning society.  China has tried something like this and it works so well that they have to try it again, and again, and again, and again.  See also Australia.

4.  A PCR or other similar test, i.e., the rapid antigen tests (but not a culture test) is “dumb”.  It has no idea what it is finding– it just attempts to see if there is a match to the chemical sequences used in the test’s primer.  It does not know if it is detecting whole virus, fragments of a virus, virus that is capable of replicating, virus that is the result of replication in a human cell; it just says I found a match.  So these tests do not with certainty tell you that a person is either infected or infectious.  You might infer that from the amount of virus you detect with the test, but you do not know.  These tests also have varying accuracy issues–levels of false negatives, false positives, “low” positives which don’t identify infected or infectious people, and so on, and these accuracy issues vary with the actual prevalence of the virus in the population.  So we are relying on a tool which has limited value for its intended purpose.

5.  When a person is exposed and the virus attempts an infection, various aspects of our immune system react, hopefully.  There is large variability in individuals’ immune systems, some due to factors like age, some genetic, some due to varying prior exposure to pathogens and so on.  This variability plays a role in a person’s susceptibility to any infection.  Some immune responses are quite crude–a sneeze, a cough, make a lot of mucus so you spit or blow your nose.  Some are generalized chemical ones–aspects of the immune system that alert and respond to any perceived foreign substance.  Some of these generalized ones are semi-specific to chemical sequences common to many bacteria or viruses.  And most importantly, some are quite specific to a pathogen, because the pathogen has been encountered before.  This latter is generally referred to as adaptive immunity.

6.  Adaptive immunity results from an intial infection and the body’s effort to fight that infection.  Certain immune cells are capable of recognizing the chemical sequence of the pathogen, and then develop a “memory” for that sequence.  The B cells that produce antibodies have this capability and another class of cells called T cells does as well.  Typically after an acute infection, some level of circulating antibodies to the pathogen also exists.  On attempted reinfection, those circulating antibodies and memory cells aid in a quick response to repel the invader.  Some of these antibodies and cells may exist in the upper respiratory tract.  This is a highly simplified depiction of the immune system–it is amazingly complex and has many components that are marshalled to defeat infection.  Vaccination is merely an attempt to prompt the body to develop the same “memory” for a pathogen, without having to go through the risk of an actual infection.  (Note also that many aspects of serious disease after infection are actually the result of an overly aggressive immune response.)

7.  Respiratory viruses, as noted above, only want to replicate.  If you try to stop them from replicating, they have a sophisticated enough replication machinery that they regularly make errors in replication–the chemical sequence changes. Enough sequence changes or changes in the right place, for example, where the virus binds to a cell, and an initial effective adaptive immune response may be rendered less effective.  While some people say that the more replication opportunities a virus has the more likely it is too mutate, I think that ignores the basic laws of evolution, which operate among viruses as well as humans.  The harder you make it for a virus to replicate, the more likely a mutation which restores its ability to infect and replicate will be favored.  Along with allowing more replication may come changes which make disease more or less severe.  The virus really only cares about being able to replicate.

8.  So where are we?  You have a widespread, easily transmissible respiratory virus.  Exposure can’t really be stopped.  You breathe in the virus.  If you have been infected or vaccinated, you should have some immune response, but it takes time, unless you have exceptionally strong responses right in the upper respiratory tract that almost immediately prevent or limit infection.  I characterize adaptive immunity as a rapid reaction force.  It can’t stop exposure, it can limit infection and clear it before serious disease ensues. But it takes a little time for the memory cells to recognize the pathogen and call headquarters to get the antibodies and T cells and other components out to repel the invader.  And what do we see now, we see lots of vaxed and prior infected persons who are exposed and if tested at the right moment, they will be “positive”. These “cases” or “infections”, however, are generally cleared rapidly, without serious clinical consequences and usually with no significant symptoms.

9.  And why is the amount of testing we currently do stupid and increasing testing to an even higher level stupider?  Because obviously the more you test, the more you find “positives” in people who are exposed, but not infected or infectious, or if they are, have only mild cases.  The same person, as in Groundhog Day, could easily repeatedly be exposed and test positive.  We could see an infinite number of reinfectons and repeat breakthrough infections. And now we are telling anyone who is positive to isolate for some time–don’t go to work, don’t go to school.  And we are telling contacts of these people to do the same, even if they don’t have a positive test themselves.  So we have tons of people who aren’t working, including health care workers at a time when we are worried about capacity and resources.  We have people we think they have a disease because they have a positive test so they go to the ER or urgent care or their doctor and want treatment, for nothing in almost every case, for a cold in some cases.  This further strains health care resources and limits access to care for people who are really sick with CV-19 or more likely, with heart disease, hypertension, diabetes, etc.  We are making people anxious for nothing.  And now we are calling even more hospitalizations and deaths CV-19 ones because lots of people are just incidentally positive for the virus.

10.  And here is the biggest problem–we are creating a loop we never get out of.  There are four current circulating coronaviruses which tend to be seasonal and have been around for a long time.  If you three years ago randomly swabbed and tested people to find what was in their nose or saliva, you would find large percents of people with coronavirus, rhinovirus, adenovirus, influenza virus, and so on.  Omicron is destined, I believe, to become one of these circulating coronaviruses.  It is always going to be there and if we keep testing for it, we will find it and the idiots, and there really is no other word to describe them, who run our public health response, will keep trying to limit spread by these futile and damaging suppression of spread efforts.  We will never get out of this, because the virus isn’t going away.  And we are wasting our time and resources trying to stop a cold.

11.  I made this point on Twitter.  Omicron is CV-19’s offer of a truce.  The virus wants to replicate.  It is now saying, let me replicate and I won’t do much damage at all.  Omicron apparently is less dangerous than influenza, which would seem orders of magnitude worse than we think it is if we tested for and attributed hospitalizations and deaths to it like we do for CV-19.  If we have any sense, we accept the truce.  If we don’t, there is a risk that something worse arises as a result of our suppression efforts.

12.  So my prescription for current epidemic policy is a) stop testing so much.  Only test people who are seriously symptomatic.  No routine testing for health care, work or school.  b) stop routine isolation.  If you are really sick, whatever it is, stay home.  c) stop reporting. Period.  Stop reporting any CV-19 events.  Out of sight, out of mind.  d) if you are going to report anything, be complete and accurate.  Give cycle number distributions, test for false and low positives, tell the real reason for hospitalizations and deaths.  e) if any measures to limit spread are undertaken, create and show the public a full accounting of the benefits and costs.  The measures so far have done immense damage, much greater than the virus itself.  All policy measures must reflect this accounting and then the public can decide if the measure is worth the cost.

That is the rant for the evening.