Cataclysm, Dichotomy, and Disease

Why is COVID-19 completely out of control again in Iowa?

Three factors –

1) The derecho temporarily displaced many and forced an increase in social mobility. This is apparent in mobility data as well as disease and hospitalization surges.

2) College students went back to campuses. Hundreds had infection on arrival, hundreds more were exposed in bars, parties, and various other gatherings hence the Governor’s new restrictions in 6 counties.

3) School transmission is already having an impact. Students and teachers are being quarantined, and even with small numbers of cases disease spreads easily in a COVID-19 naïve population.

There were almost 1,400 new cases in a single day this week.

It is important to note, hospitalizations have increased and deaths are rising as well. Since the beginning of the outbreak, more than roughly 5,000 Iowans were hospitalized and over 1,000 have died. We’re only six months into this.

Mask dichotomy

With the issuance of new restrictions, there is clearly a problem at hand. Yes, there is a precarious balance between the desires of many to maintain personal freedoms, but friends, we’re in a PANDEMIC. Is the mask really going to hurt you? Is it really THAT inconvenient? Besides being NOBLE and protecting others, the mask does offer you some protection too. Of all the things – forced closure, staying at home, mandatory testing, etc. putting a piece of fabric over your face for a few months seems pretty minor. You wear a seatbelt. You drink fluoridated water. You eat meat inspected by the USDA. There are a multitude of subconscious protections in your everyday life safeguarding your health thanks to public health. Public health doesn’t make stuff up for fun. Interventions are based on science.

Put on your dang mask. Even masks are not enough to contain disease right now. We will have to close things again which has already started. HUGE kudos to those who already make this a regular habit.

Why are case counts through the roof?!

The state did make a case counting adjustment and added antigen test results. That has been accounted for and there is truly more disease.

What is the antigen test?

Antigen AKA rapid or point of care tests look specifically for viral antigens in the body. These tests have strong “specificity”, meaning they react well when the actual pathogen is present. BUT, these tests can sometimes miss infections if not enough antigen is present. Therefore, you are more likely to receive a false negative than a false positive with this test.

In tracking other diseases, rapid tests are sometimes used with symptom and/or exposure criteria to identify cases. Use of this test will help detect cases, though the PCR test is more reliable.

What is the PCR test?

The PCR test (polymerase chain reaction) basically amplifies or creates millions of copies of viral DNA, if present, to determine whether a person is infected. The PCR test is very “specific” and “sensitive”, meaning it is good at finding the right virus when the virus is present in the body.

Laboratories performing PCR operate at a higher level of standards which means specimens have to be sent to these labs and testing can take some time. It’s tough to ramp up PCR testing capacity, though it is the best test we have for COVID-19.

Final note

No more on hydroxychloroquine. It’s not authorized for use in France. There is no global pharmaceutical conspiracy. It doesn’t drive down death rates. You should not take HCQ to prevent disease. You should not take HCQ to treat disease. You should not take HCQ with antibiotics. Don’t eat these green eggs and ham unless you want cardiac arrhythmia.

As always, article references and resources are in the blog. Hang in there, folks. I know we’re all super tired and stressed, but this will end eventually.

References:

HCQ meta analysis - https://www.medrxiv.org/content/10.1101/2020.05.14.20101774v3

Iowa reporting site - https://coronavirus.iowa.gov/pages/case-counts

Iowa case reporting change - https://www.kcci.com/article/iowa-department-of-public-health-august-28-coronavirus-update/33832815

Mask efficacy studies - https://wwwnc.cdc.gov/eid/article/26/10/20-0948_article

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