I’ve been wondering about this:
Early in the pandemic, the United States had an undertesting problem. Now we are overtesting those who are immune and asymptomatic. A person with immunity to the coronavirus will fight off an infection. But during and after the person’s exposure to the virus, it’s common for a low number of virus particles to be detectable in the nose. In medicine, we call this virus a “colonizer” — a pathogen that does not cause illness or spread the illness. It’s an incidental finding. But in today’s world of routine coronavirus testing of vaccinated people, these positive tests are inflating the number of positive cases in a misleading way.
[…] The Centers for Disease Control and Prevention has officially decreed that fully vaccinated people should not be tested for the coronavirus in the absence of symptoms. That’s because immunity works. Mounting evidence has demonstrated an extremely low risk of asymptomatic transmission by vaccinated people.
The piece uses the example of Israel, which has an 85% vaccination rate, where there are positive test results but both cases and hospitalizations have plummeted after the population was vaccinated.
But in communities and regions where vaccination rates are high, we should be rethinking our definition of a covid-19 “case.” When we’re dealing with a vaccinated person, what we call a “case” is often instead the detection of a virus warded off by antibody and T cell immunity. (This can be true even for the delta variant, highly transmissible though it may be.) Even dead viral particles can be detected by a PCR test. This pandemic has consistently required us to rethink the meaning of the data and shift our strategy accordingly. When it comes to immune people who are asymptomatic, it’s time for us to do it again.
This was written by two well-credentialed infectious disease specialists. The actionable suggestion in the piece is that the level of viral load be used to discriminate between “colonizer” positive results and positive tests that indicate the possibility of transmission.
Cervantes
I agree with this but be warned: fully vaccinated people can and often do get symptomatic infections, and let me tell you, what the experts call a “mild” case is not necessarily mild from the subject’s point of view. I was fully vaccinated in March. Two weeks ago, I suddenly developed the most wracking, horrific bone dry cough I’ve ever had. I could barely get an inhalation in edgewise. My head hurt, my eyeballs hurt, my scalp felt like it was coming off, my neck hurt and my whole body hurt. I didn’t eat anything for 36 hours and when i tried to force myself food tasted weird and disgusting. I was so knocked out I could barely get off the couch to take a leak. It took me a good ten days to get my wind back and my stamina. And my only risk behavior was trips to the grocery store and the post office. Also, obviously, I never got tested and my case was never reported or counted. I’ll bet there are a whole lot of them like me. I’ve talked to physician friends, and there is no other plausible explanation for those symptoms. I had a so-called “mild”case of Covid-19. Fauci isn’t lying, I wasn’t hospitalized and I didn’t die, but you do not want that.
Matt McIrvin
I read an article months ago arguing that we needed to be testing differently: there are rapid tests that can detect the level of virus in the nose sufficient to actually spread COVID–which usually only exists for a couple of days even in an infected person (though I don’t know how delta affects this). Screen people with those tests daily, and it would eliminate the need for long quarantines, and also avoid picking up a lot of breakthrough “positives” that are not actually dangerous while finding the ones who are. Just not testing vaccinated people seems like too blunt a change, given what we know now.
MJS
This makes sense to me. At some point we’re going to have to completely trust this vaccine, just as we completely trust other vaccines. Testing asymptomatic vaccinated people, and reporting positive cases, serves to confuse the issue, as does over promising what the vaccine actually does (i.e. significantly reduces, but doesn’t eliminate, your chances of getting Covid; virtually eliminates your chances of dying if you do get it).
randy khan
If you want to see this in action, check out the New York Yankees. (Let me start by saying that I never have any sympathy for the Yankees, including in this case, because, well, they’re the Yankees.) MLB tests a lot – if not every day, pretty close, and regardless of whether you’re vaccinated. The Yankees have had two “outbreaks” this year even though the vast majority of the team and its staff is vaccinated, but nearly everyone who tested positive had no symptoms.
Four Seasons Total Landscaping mistermix
@Matt McIrvin: Yes, the antigen tests were used widely around here in schools during the school year since they weren’t as invasive as the PCR test and could be read from a card in 15 minutes. They should be available in stores (like pregnancy tests) at a low, subsidized price.
Han
So this hits me a little personally right now. Last week I was informed that someone I was in a meeting with two days previously became symptomatic and tested positive the next day. They were vaccinated, as am I. I was refused a covid test as I’ve been vaccinated. But I have two kids at home that are too young for the vaccine, and we’ve been told since the beginning that you can be contagious before being symptomatic, and can even be contagious if you never develop symptoms. Why in these circumstances should I not be allowed to be tested? I ended up spending the last week masking up in my own home, just to be sure I wouldn’t pass it on to my vulnerable children.
Matt McIrvin
One of the authors, Monica Gandhi, has been all-in on reopening in-person schools, and came under fire a while back for using stats on suicide and remote schooling in a way that psychologists thought was misleading. It makes me wonder if her prior preference for reopening is influencing these statements.
Enhanced Voting Techniques
I was under the impression that someone with a vaccine can be infected and be transmissible, jut their systems would be mild.
henrythefifth
We’re vaccinated, but our kids are to young to be. My wife was ill last week and got tested (turned out to be something else). But there are a lot of people like us. People love to forget how many unvaccinated kids are out there, whose vaccinated parents want to protect them (and will get the kids vaxed when possible).
bbleh
Reminds me of the early debate over the infectious process (droplets vs aerosol) and preventive measures (masks, cleaning of surfaces): as our understanding of the disease — which let us remember didn’t exist more than about a year and a half ago — deepens, our classifications and procedures changed accordingly. It’s frankly amazing that we have come as far and as fast as we have.
But forget about trying to communicate this level of nuance to the public. At least a third of them simply don’t want to hear any of it: about all they’ll do with the information is say something hilariously dumb like “see this just shows that scientists don’t know anything.” And even if the majority could understand it, a media complex focused squarely on entertainment won’t bother to try to explain it: far easier to “explore the controversy,” and far better for ratings to shriek about rising case numbers.
I am genuinely worried about what’s gonna happen when colds-and-flu season rolls around.
Unique uid
My personal take on this would be the effect of a trip to Canada … as I understand, you are supposed to test negative within 48 hours of being at the border. I’m mostly just getting tested because they want it, but understand it will “inflate “ the test numbers.
And if I have a harmless colony, would need to change trip plans.
Related: I am confused by the headlines about the US border being closed until August 19. Does that mean if you go To CA on the 10th, you can’t come back until after the 19th. The articles never seem to cover that.
dr. bloor
You can find useful ways to differentiate the nature of positive test results, as suggested, but you can’t really “overtest.” Information is always a good thing, better if used properly.
Han
@Matt McIrvin: And the other author wrote an opinion article for the WSJ back in February saying we would have herd immunity by April. Why should we listen to these people again?
randy khan
@Enhanced Voting Techniques:
In a small number of cases, yes, people do get the disease.
However, there’s a difference between having detectable levels of virus in your nose (where the test swabs are taken, and also the first place where the virus goes) and actually having the disease. Your immune system takes a couple of days to wipe out the virus once you get it in your nose, so you’ll test positive during that time.
ant
I got my 1st shot in April, then 2nd a month later.
Two weeks after I got sick. Sinus congestion for about 5 days, a cough for about 3 weeks, in bed for 1.5 days.
Pretty mild cold, all in all. Don’t know if it was covid. And I did give it to my husband (also vaccinated), who had same symptoms manifest 3 days after me.
I’m thinking that vaccinated people can infect others. And if I am wrong about that, it’s just a matter of time until it does.
And there are people like us who get sick but didn’t get tested.
Brachiator
I was just listening to the July 20 BBC Corona virus update. They noted that Israel had reported a 4 month high in new daily cases, going from almost none to 800 a day. And although they had rushed to vaccinate adults, younger people remain to get the vaccine.
Matt McIrvin
@Enhanced Voting Techniques: Hard for me to believe someone like Cervantes up top wouldn’t have been capable of infecting people just before the symptoms really hit. The problem is teasing them out from the people who would test positive on PCR but never be capable of infecting anyone.
Alex
@Han: Exactly– we don’t know whether people are truly asymptomatic or just presymptomatic until after they are contagious. And we do know vaccinated people can transmit, even to other vaccinated people. Viral loads are higher and faster with Delta. The only way to find out if asymptomatic vaccinated people can transmit is to identify them through testing and test their contacts. That’s why it’s premature to call for reduced testing of vaccinated people.
Maybe it won’t matter as much once everyone has a shot, but even then there will be millions of immune compromised people. All the messaging has been about whether vaccinated people themselves will be protected from severe illness, but many of us care about infecting others, including our children.
Brachiator
@Matt McIrvin:
Some conservatives have been pushing the lie that deaths from suicide and other causes exceed the number of deaths from Covid-19, so we should all relax, avoid lockdowns and just let the virus run loose.
Cameron
I thought Makary was a surgery professor, not an infectious disease specialist.
Baud
@ant: I’ve been sick without being tested. Symptoms more like traditional illnesses than Covid. I’m not going to get tested simply because I’m congested during allergy season.
scav
Even if the “over”tested vaccinated people don’t personally get very sick, their test results still legitimately reflect that they came into contact with the disease and picked up virus. Seems to adequately measure the prevalence of the disease circulating. Measuring severity of cases would require different sort of data (hospitalizations, days off work / out of school, purchases of medication, etc).
Matt McIrvin
@Brachiator: Yeah, Gandhi wasn’t saying that, but she did argue that the COVID risk in a school with vaccinated staff was low enough that the psychological danger of keeping kids out outweighed it, and she used child/teenage suicides during the pandemic as evidence.
And that may be. The trouble was that, as I understand it (and if I recall correctly), the suicide stats actually are ambiguous and odd once you dig into the details. There was no elevated level of suicides early in the pandemic when essentially all schools in the US were shut down. Then there was an increase later on, but only among girls… and it was during the period when a lot of school districts had actually reopened, so it wasn’t clear that these were even in places that were still shut down. It’s even possible that reopening (under weird pandemic conditions!) was actually responsible.
Villago Delenda Est
Meh, what do infectious disease experts know about infectious diseases? Why don’t we talk about REAL experts, like say Clay Higgins, a state representative in Louisiana? Or Jared Kushner? Or, dare I say it, Fucker Swanson Snarlson?
MisterForkbeard
@henrythefifth: My kids just attended a ‘birthday party’ for their cousin, all of whom are 6 or under. We showed up really early (okayed with my brother first), stayed outside and stayed masked, and left before all the other kids and adults arrived.
We’re taking a lot of precautions with our kids, and it always bugs me when people talk about letting the unvaccinated run amok because they’re “only hurting themselves”.
Dennis
No, this is just the latest stab by the same people who’ve been saying “we need to open up” all along. It is the more intellectually respectable version of Trump saying “STOP THE TESTING…more testing means more cases.”
While there may be some noise in the testing, the case count rise accurately predicted the clockwork-like lagging cycle of large rise in hospital admissions and, now, death.
It is probably true that the death rate will be not as bad this time around, because vax rates are high among seniors now and hospital admissions are skewing younger than before. But we know there are bad outcomes that don’t result in death.
Cervantes
Yes, I certainly would have been infectious shortly before and during my acute symptomatic period. Fortunately I only had contact with people who have either been vaccinated or actually had the disease. Going out and getting tested obviously would have been pointless and just put other people at risk. As I say, claims that experiences like mine are rare really can’t be supported by evidence — most of them won’t be observed by epidemiologists.
scav
da Est: Eh. Even REAL Medical Experts can have and push political agendas and even real medical experts can be be waylaid by interesting theoretical minutia while missing practical points.
Ella in New Mexico
As a provider in primary care, I’ve been wanting to climb a tower every time the news reports on “this group or that group tested positive” when some organization like the Yankees was just doing daily work screenings. What it’s doing is actually reinforcing the anti-vax crowd’s assertion the vaccines are not only going to put Intel microchips in your body, change your DNA and make people around you sterile they don’t even work so why bother to get one.
No one should be counting OR reporting fully vaccinated, asymptomatic people as “testing positive.” We stopped testing patient’s who had had COVID last year as a way to clear them to go back to work for just this very reason: virus particles that are destroyed by your immune system won’t make anyone sick.
@Cervantes: I’m sorry to hear you were so sick, it totally sucks. But I really wish you’d been able to get tested to confirm you actually caught COVID-19 because really, you don’t know that that’s what you had now.
I’m almost 60 and I can tell you I’ve probably had 5 infections in my adulthood with symptoms exactly like the ones you describe. At least 2-3 were during traditional flu season, one in which I was fully vaccinated for influenza. The other two were during the late spring or summer, and I have no idea what the hell I caught but I was out of commission for at least a week, and two before I felt normal again. Coulda been COVID had I had the same symptoms this past year.
Kent
“Closed” means different things. The US border has never been closed to US Citizens returning from abroad for any reason. But it has been closed to tourists coming from overseas. The US-Canada border has never been closed for people who are traveling for a long list of discretionary reasons from work to medical treatment to things like funerals. It has just been closed to discretionary travel like tourism.
Kent
Exactly. I’m not sure who all these vaccinated people are who are testing positive. But I’m guessing some of it is due to contact tracing. I teach at a HS and every time there is a student who tests positive they contact trace all the students who have had contact and they get tested. We keep rigid seating charts so the school administration can quickly trace all the close contacts of that student and have them tested. So a lot of symptom-free kids are getting tested and some do test positive. It is most definitely useful information.
WaterGirl
@Dennis: That was my reaction, also. Even if vaccinated people are asymptomatic, it seems very useful to know what % of people are coming into enough contact with the virus for it to show up in testing.
Jackie
@bbleh: I still clean surfaces – after all, aerosols do drift downward – as anyone spraying aerosols can attest.
Roger Moore
@bbleh:
An important point with all this stuff is that the initial versions of tests tend to be based more on the available sensitivity of the test than biological meaning. When they developed the test, they decided to look for any virus that could be detected reliably by PCR. That could be dead virus, it could be so little virus that it’s not enough to cause an infection in practice. When the test was developed, we didn’t know much about it, so it made sense to run the test that way. We now need to adjust the sensitivity of the test to match what we know about the biology of SARS-CoV-2 rather than what we know about PCR.
FWIW, this reminds me of some of the stuff with Olympic drug testing. For naturally occurring substances like testosterone, the test has to look at a level that theoretically shouldn’t be naturally present. But for synthetic drugs, like many other anabolic steroids, the only limit on what is against the rules is what the tests can detect. This is why athletes can get in trouble for consuming supplements or food that is incidentally tainted: the test will detect levels of the drug that are of no practical significance.
debbie
@ant:
I quickly ran in and out of an uncrowded food store and had a sore throat 48 hours later. Still got a bit of one two weeks later. I’m not concerned about COVID, but I do think all other kinds of microbes have spent the past year and a half making themselves more catchable. ??♀️
Roger Moore
@Brachiator:
I wonder how much of the problem in Israel is also that the Palestinians aren’t vaccinated at nearly the same rate as Israelis, but there’s still enough contact between them to spread virus.
Baud
Congrats to the Philippines for their first gold medal ever.
Enhanced Voting Techniques
@Matt McIrvin: Isn’t this why taking our temperature is so important? The fever is when someone is most infectious.
Roger Moore
@Alex:
One thing that would make a lot of sense is to do a followup test for viable virus in vaccinated people. PCR is a great, very sensitive test, but it’s not the be-all, end-all solution. An actual viral culture would help to understand if we’re seeing an actual infection or just some dead viral pieces.
Baud
@Baud:
Matt McIrvin
@Enhanced Voting Techniques: I could be wrong but I got the impression that many infectious people with COVID never develop a fever at all, or develop it after the period when they’re most infectious–my impression was that the temperature checks are mostly theater.
Brachiator
@Roger Moore:
Good question. There was an old Guardian story noting that 100,000 Palestinians with work permits were to be vaccinated starting in March, but few other stories about this issue.
Matt McIrvin
@Roger Moore: That might be some of it, but also Israel has a much younger population than the US; a considerably larger fraction of the population is kids underage for vaccination (and they only started vaccinating kids in the 12-15 group later than we did).
Even so, their current outbreak is not nearly as bad even as the one in the UK (so far).
Roger Moore
@Matt McIrvin:
My employer stopped doing the temperature checks a while back because they said the science didn’t support it. The biggest thing about COVID is that people are maximally contagious before they develop symptoms, including fever. That’s why testing is so critical; by the time they have a fever, it’s too late.
Wvng
A number of studies over the past year suggest that many asymptomatic cases and carriers had previous infections by non covid19 corona viruses and were protected through cross reactivity in T cell immunity. I have not seen any data on the possibility of vaccinated individuals becoming infected asymptomatically and spreading disease. The possibility of that suggests masking would be prudent.
Cervantes
No, this was nothing like influenza, which I’ve had a few times in my youth. No congestion, the cough was absolutely bone dry. Also, the specific symptoms only lasted about 36 hours, suggesting the vaccine had primed my immune system to respond quickly, just not quickly enough.
david
I’m not one for making too many demands. BUT, if I get in bad shape and I’m laid up in a hospital… don’t bring a goddamn horse into my room and have him tower over my ailing body. A kitty or puppy is fine, but ixnay on the Death Horse.
Le Comte de Monte Cristo, fka Edmund Dantes
@Han:
Lie.
rikyrah
Benjy Sarlin (@BenjySarlin) tweeted at 9:03 AM on Mon, Jul 26, 2021:
Trump strongly implied to supporters this month that it will hurt Biden politically if they don’t get vaccinated. But many R’s see other side of it: Getting branded the anti-vax party leaves them vulnerable to backlash from ~70% of adults who already are https://t.co/vZ7SV8TY00
(https://twitter.com/BenjySarlin/status/1419659722874097664?s=03)
J R in WV
@Matt McIrvin:
I suspect this is mostly true. The hospital where our family doctor’s offices are now just interviews people before issuing a pass. They used to take temperatures before issuing a pass to people with appointments.
This is a teaching hospital, which appears to successfully shoot for state of the art, so I think state of the art no longer requires temperature testing. One question they don’t ask, which surprises me, is whether incoming patients are vaccinated… go figure!
rikyrah
@rikyrah:
Benjy Sarlin (@BenjySarlin) tweeted at 9:08 AM on Mon, Jul 26, 2021:
One added element @joshtpm gets at: vaccine resistance/hesitancy is overwhelmingly concentrated in younger age groups. ~90% of seniors have at least one shot and they’re the most reliable voters. So setting aside the health implications, anti-vax talk targets most marginal voters
(https://twitter.com/BenjySarlin/status/1419660913834139651?s=03)
Villago Delenda Est
@scav: Oh, I know that. I was just snarking on the stupidity of everyone to the right of Joe Biden.
Martin
So, datawise, you do want to test the vaccinated, but you want to report them separately. If you are trying to measure the transmission rate to determine if things are getting better or worse, you need both numbers, because a variant may increase transmission only among the unvaccinated, or it could be only among the vaccinated by breaking through immunity. Being vaccinated is a variable that you have to control for. This is stats 101 stuff.
Matt McIrvin
@rikyrah: I suspect most of the lower vaccination rate among Hispanic Americans is explained by them being younger on average.
dmsilev
California government, health workers must show proof of vaccination or be regularly tested
Yes yes, not called a mandate, but inching closer.
Matt McIrvin
It seems to me that the biggest problem with testing the vaccinated isn’t that they’re being tested, it’s that the results are reported as “positive/negative” with an arbitrary cutoff that isn’t even consistent from place to place, and probably catches a lot of benign cases. More information is good, but flattening it in this way isn’t.
Matt McIrvin
@Le Comte de Monte Cristo, fka Edmund Dantes: It shouldn’t be necessary!
Soprano2
@Enhanced Voting Techniques: Neither my husband or I ever had a fever when we had Covid. I took our temperatures multiple times a day, and we never spiked a fever. So it’s possible to have Covid with no fever at all.
Martin
@Matt McIrvin: Temperature checks are actually very useful. But you need to understand what they are designed to do.
What China figured out very early on, which the west refused to listen to because ‘LOL, white people’ was that it transmitted faster indoors, and was likely aerosol. The west said ‘no that’s impossible, some dude in the 1950s said so’, but China deals with infectious disease a LOT, and they know that the way you deal with this is a kind of statistical divide and conquer. Your goal is to get R0 below 1. It doesn’t matter HOW. Like, at all. And this is a statistical, not individual measure, so you solve it statistically.
Your best bet is to stack layered defenses, assume each layer has a statistical reduction, and with all layers together you may get under the line, if not, you’ll at least slow it way the fuck down so you can take time to measure it better and come up with better layers.
Temperature checks are an important layer. Do they have a lot of false positives and negatives? Sure. But that doesn’t matter – this is a statistical game, not an individual one. Temperature checks can be rolled out universally – every person who goes in a building has to get checked. We can’t afford a Covid test on that scale, but a temperature check is nearly instant, non-invasive, and has no marginal cost other than the labor of the person taking temps (not a problem when a pandemic has shut workplaces down). Sure, some infected people will get through, and some non-infected people will get turned away, but if only half of the positives are accurate, you’ve cut your R0 in half, half again with masks, half again with testing, etc. Suddenly your natural R0 of 6 is down to 0.75. You did it – you won the pandemic. Take away the temp checks, or the masks, or the tests and you’re at 1.5. You’re losing.
You need to layer your defenses. Temp checks not only provide a cheap and decent (if very flawed, but that’s okay) layer, if you expect masking to work, you need someone gatekeeping anyway, so why not have them add that extra bit.
Soprano2
I’m with you on this. It makes me crazy how the headlines make it seem like it’s useless to get vaccinated because you’ll just get Covid anyway. Few people listen to what comes after the beginning of a story that starts “Several fully vaccinated people tested positive for Covid today after blah blah blah blah”. My mom has had two Covid tests in a week because whatever is making her sick is a lot like Covid, but it’s definitely not Covid.
Ken
@dmsilev: I expect that once the vaccines get final use authorization, many public and private organizations will make vaccination mandatory.
Martin
@dmsilev: This will work better than people expect. I’m not sure well enough, but decently well.
What this is starting to do is make unvaccinated a larger work burden on the institution than the vaccinated. They need to be tracked, tests monitored, and so on. In the current environment, I being vaccinated are being burdened and tracked the same as as unvaccinated person. I create no more of a hassle to my supervisor than an unvaccinated person does, but this forces that to change. Differential burdens add up, which is why socially we add burdens to people of color, women, etc. as a way to keep the rest of society turned against them.
Martin
VA requiring all health workers be vaccinated. Guessing that’s the ballgame in the health industry. Everyone should feel free to follow suit.
JoyceH
You can buy home COVID tests now that give you results in 10-15 minutes – does anyone know how accurate they are?
And what do you folks think is going to be the course of the current surge? I saw a thing just today where one of our epidemiologists was saying the surge ought to peak in a couple weeks – based on the UK’s experience with the Delta variant. I found that questionable because, y’know – we are not the UK. They have a higher percentage of their population vaccinated, so their surge was pretty much entirely due to Delta. Ours is a combination of Delta, removing all the pandemic protocols, and a high number of unvaccinated. I was looking at those infection graphs by state, and Florida and Arkansas’s recent graphing is a straight line pointing up.
And hey, guess what’s coming up in a couple weeks? Sturgis!
Cermet
All data absolutely shows that very, very few vaccinated people that are known to be infected develop any significant Covid symptoms. The ‘break-throughs’ are less than 3% and most of those are likely immune compromised people. I have seen zero scientific evidence that has shown anyone vaccinated and asymptomatic can transmit Covid. Certainly possible because I am hardily versed in the field but not any published evidence that I’ve ever seen.
trollhattan
@dmsilev:
Yes! Believe me [where have I heard that before?] in the capital region this is a Big Fuckin’ Deal. State is the region’s #1 employer and the feds are right up there.
Ken
Virginia, or Veteran’s Administration?
Martin
@Ken: Veterans Administration. Great question!
Baud
@Martin:
germy
And they didn’t learn from last year’s fiasco?
JoyceH
@Ken:
Some private organizations aren’t waiting. Saw an article about a restaurant in Georgia that has announced they will only serve the vaccinated. They had a couple break-throughs on their staff and decided it’s just not worth it. And Georgia is under 40% vaccinated!
I think we’re going to be seeing a lot more of that.
Spanky
@germy: People who ride motorcycles without helmets aren’t real good at analyzing risk.
jl
@Matt McIrvin: Gandhi is extremely solid on infectious disease and the way, and how well, vaccines work. I agree that she has been very aggressive on reopening schools, and I agree that she has been very aggressive on interpretation of academic studies.
So, might be some truth in what you say. However, I agree with her based on the fact that a number of countries have been able to keep schools open through most of the pandemic, and have been more successful both at keeping health effects of covid an order of magnitude below the US, and better at keeping their economies open. Finland and Norway are two examples.
Also, some regional examples in US of very successful school reopenings with reasonable control measures for young kids
Edit: I disagree with Dr. Gandhi on a number of points, but I still recommend checking her twitter for good analysis and great links.
mrmoshpotato
@rikyrah:
Someone tell Benjy that the GQP branded themselves as the anti-vax, pro-COVID party over a year ago.
germy
(that’s not all they’re spreading)
Baud
@mrmoshpotato:
They weren’t antivax a year ago. They wouldn’t be as antivax now if Trump had won.
jl
@Matt McIrvin: Gandhi and her buddies have not consistently been asserting that suicides were up. I haven’t read every one of their twitter tweets, so maybe they slipped up when the sketchy data first came out.
What they’ve been emphasizing is that kids reporting depression and suicidal thoughts have increases, which I believe is true. Also, indicators of population mental health have been alarming: increases in alcohol abuse and drug overdoses.
Roger Moore
@germy:
Failing to learn from the past is now a core Republican value.
germy
@Roger Moore:
I guess that’s a form of freedom.
jl
@JoyceH: I’d check Michael Mina’s twitter. He is on a break now, but you can scroll down and get great info and links.
Rapid antigen tests are designed to determine whether you can infect other people, so it is useful for disease control; it is not a clinical diagnostic tests. Can cost at most a buck to make, ahd you get them free or at a buck in many other countries (not the outrages $25 charged in US). They work great for what they are intended to do. I think we need many more much cheaper here in US, along with $ for people who test positive and need to stay home for a week.
You take on in the morning, and if it’s positive, you stay home from work, go consult doctor to decide how to proceed from there.
NotMax
@Baud
No fan of Jack Webb I, but there’s got to be some Sgt. Joe Friday impersonators out there who could be featured in a series of public service spots.
“Get the vax, ma’am.”
Brachiator
@jl:
Drug overdoses leading to hospitalizations and death?
Show me some actual data. Ah. Here’s something from an AP story.
There’s no current evidence that more Americans started using drugs last year, Monnat said. Rather, the increased deaths most likely were people who had already been struggling with addiction. Some have told her research team that suspensions of evictions and extended unemployment benefits left them with more money than usual. And they said “when I have money, I stock up on my (drug) supply,” she said.
Overdose deaths are just one facet of what was overall the deadliest year in U.S. history. With about 378,000 deaths attributed to COVID-19, the nation saw more than 3.3 million deaths.
The Centers for Disease Control and Prevention reviewed death certificates to come up with the estimate for 2020 drug overdose deaths. The estimate of over 93,000 translates to an average of more than 250 deaths each day, or roughly 11 every hour.
rikyrah
Coming to a Government Employer Near You.
That’s right…bring down the hammer.
The Associated Press (@AP) tweeted at 1:00 PM on Mon, Jul 26, 2021:
BREAKING: California will require proof of COVID-19 vaccination or weekly testing for all state workers and health care employees.
New York City also says it will require its municipal workers to get vaccinated or face weekly COVID-19 tests. https://t.co/BhwhdyX83c
(https://twitter.com/AP/status/1419719251137552384?s=03)
germy
Oh God. Please don’t tell the Republicans
They’ve got enough “talking points” against our policies.
rikyrah
Kate Sullivan (@KateSullivanDC) tweeted at 1:32 PM on Mon, Jul 26, 2021:
The Department of Veterans Affairs will require many of its frontline health workers to be vaccinated, VA Secretary Denis McDonough announced today. It’s the first area of the federal government to require shots among some of its workers.
(https://twitter.com/KateSullivanDC/status/1419727319204352000?s=03)
Geminid
A friend told me that her wife, coach of a local university field hockey team, had been tested 56 times during the recent season. I don’t know how much the student atheletes were tested, but they all lived in the same dorm, and that dorm’s sewage was tested. The university and it’s atheletic department are well funded.
jl
I think commenters Martin and McIrivin are basically correct on where we are, though I am less sure we know much at all about it. I don’t think we know whether high vaccination areas have reached the herd immunity threshold or not. I think evidence is that they have certainly not reached a low disease herd immunity steady state (remember that after a place reaches herd immunity threshold, the stock of infected people need to burn off before steady state is reached). I think the kind of surges we’re getting in high vax areas are consistent with increasing activity due to end of lockdowns, but who knows for sure?
I think low vax areas are on their way to herd immunity threshold, sadly through continued spread of disease, and for placed like MS and LA, it may take a year or more at this rate, and even then need to hope that vax and natural immunity last several years (probably does, but we should have better control efforts in US, far past time we engaged in risky real world experiments).
StringOnAStick
Instead of constantly testing “everyone”, how about doing antibody tests on the vaccinated to make sure they have enough neutralizing antibodies, then excusing them from institutional testing mandates? At least that would provide some peace of mind to the vaccinated. It would seem like this should be done for anyone who is immunocompromised as well.
I wish we could get that for my husband, who has a form of chronic leukaemia but is rated as at stage zero currently (and hopefully for as long as possible). It would be really nice to know that he has an effective level of Covid antibodies from his Pfizer vaccination pair.
NotMax
@germy
One can eat only so many T-bones and own only so many Cadillacs.
//
Another Scott
(Haven’t read the comments yet – someone has probably already said the following better.)
We’ve known for a year or more that PCR tests are extremely sensitive and can detect virus fragments that cannot cause disease.
But the real question is – who is getting tested? Presumably it’s not people who have no reason to be tested. So, it’s either required (e.g. to be able to travel), or the person was exposed, or the person has symptoms. I doubt that there are many joy-riders out there who like having their brain tickled with a foot-long swab.
If someone is fully vaccinated and showing symptoms, then they should be tested (to try to rule-out a breakthrough infection). If they’re fully vaccinated and exposed but not showing symptoms, then PCR tests probably aren’t useful (but maybe antibody tests are – do they have enough antibodies to fight off an infection if they do have it?).
As always, a test exists in a context – what question are they trying to answer?
Thanks.
Cheers,
Scott.
Fair Economist
Ignoring possible infections of vaccinated people is highly irresponsible for 3 reasons:
First, (and this is a killer problem), you can’t distinguish between an asymptomatic infection and an infection that’s not symptomatic *yet*.
Second, there are a fair number of cases of asymptomatic vaccinated individuals transmitting disease. Perhaps that will turn out to be negligible on a population scale, but we don’t know that yet, and especially not for the higher infectivity variants spreading now.
Third, immunity via vaccine will fade, and we don’t currently know how fast. With the previous human coronavirus, reinfection become a reasonable possibility at 6 to 9 months after infection and returns to the baseline at about a year (note that baseline is still more resistant than for a never infected individual because essentially all adults have had all the existing coronaviruses).
In a year or so we *might* be able to disregard #2 and #3 if the data comes in right. We will never be able to disregard #1. At least where spread of COVID is a life-threatening issue (to elderly or immunocompromised, or those who can’t be vaccinated) continued testing is a moral responsibility. Even in other cases, testing might be appropriate – as exemplified by Cervantes’s experience.
mrmoshpotato
@Baud: Ok. But they definitely were on the side of the virus with their orange cult leader bellowing that it was a hoax to make him look bad.
jl
@Another Scott: Yes, I think you are on right track. The US testing approach continues to be a mess, and most places are sticking with very out of date protocols.
The think is that MOST vaccines DO NOT stop all viral reproduction after you get an effective exposure (one that gets some of the bug in the right place to start reproducing). In the lingo, most vaccines are not ‘sterilizing’ and they allow some viral colonization (local patch of infection that doesn’t spread). And the quality and reporting standards of PCR testing stink. The sensitivity of the tests are still not often reported, and no national quality control program to help labs produce consistent results (so, you can send standardized samples, with standardized protocol and get different results from different labs).
We don’t know what a lot of these positive tests for asymptomatic cases mean. We also only have crude estimates of how much long covid will result from asymptomatic and mild cases. Which is the reason that many clinical infectious disease docs and virologists who understand public health think that the CDC made a mistake in only monitoring cases that get hospitalized and wonder why the US still has not well designed population based surveillance system (like we do for whooping cough, dangerous staph infections and mumps).
The public health and CDC efforts have improved vastly during new administration. One example is big improvement in guidance for ventilation standards. But in some ways, the US still lags far behind other countries that have had more successful covid control efforts with more open economies, less economic and social damage, some with very little or no detectable total excess mortality so far in the epidemic.
jl
@Fair Economist: I mostly agree. I think you underestimate the uncertainty, so would say ‘we really don’t know’ for some of your assertions.
I would say that there is no excuse for ‘we really don’t know’ at this point. From an economic and risk management point of view, no excuse for taking unnecessary risks, and muddling along with so much substandard control efforts compared to more than a dozen much more successful countries.
I think good reason to believe that for vast majority of people, vaccine induced immunity will last at least several years. But we should have a very solid program to monitor that, and I don’t think we do.
Edit: First, ” (and this is a killer problem), you can’t distinguish between an asymptomatic infection and an infection that’s not symptomatic *yet*. ”
I totally agree. In lingo, we can’t or don’t have the programs, to distinguish between a nonsterilizing vaccine (which is now most vaccines work) shutting down colonization and an infection that spreads beyond site where virus first entered cells but has spread enough to be an infection that might cause damage, either to person infected (even if no or very mild symptoms) or through substantial risk or transmission.
Another Scott
@Baud: Wonderful!
Thanks.
Cheers,
Scott.
HIPAA violating hubby
Spousal had a relatively mild case pre-vaccine, got both rounds of the shot months back, and recently seems to have had another go. This time was milder but came with the telltale loss of smell. (How lucky can one gal be? Thanks, Delta!) Difference is mild cold-ish junk for about a week versus flu like junk for a couple. Even just for this unlucky outcome, the shot is a no-brainer.
So I get the testing recommendation, and this symptomatic case would have made sense just for data. But where’s the science on risk of spread on a symptomatic break-through case?
Princess Leia
@Brachiator:
Not to mention that we have so much Fentanyl out there right now that the harm reduction folks are distributing Fentanyl test strips to prevent overdoses. They thought at least half of the ODs were due to Fentanyl and not “suicides.”
quakerinabasement
All persons entering the US from overseas–including US citizens–have to show proof of a recent negative Covid test or certification from a physician of recovery from the disease.
https://www.cdc.gov/coronavirus/2019-ncov/travelers/testing-international-air-travelers.html#:~:text=On%20January%2012%2C%202021%2C%20CDC,airline%20before%20boarding%20the%20flight.
KrackenJack
@HIPAA violating hubby: Whoa! Now I’m an accessory! The BJ omerta may not be as strong as you hope.
WaterGirl
@Le Comte de Monte Cristo, fka Edmund Dantes: What is that supposed to mean?