The perils and pitfalls of RATs, Failures of public health, Immunology of Long Covid and more

Plus a whole bunch of really depressing but incredibly useful information

Photo by Annie Spratt on Unsplash

You can’t actually “move on from covid.” You can either (a) control it and contain it via problem solving, science, teamwork OR (b) you can give up on yourself and your community. When people say they are moving on they are choosing (b).

The messaging by pub health, minimizers are intended to persuade people and falsely remove the feelings of guilt and responsibility so that more people choose (b).

-Babel Fish

Welcome to the latest issue of the Covid-Is-Not-Over Newsletter! It’s great to be back after a nice summer break. The break ended up being a bit longer than I anticipated, but sometimes taking a little extra time and getting some good mental and physical rest is the best plan. I probably won’t get back to a weekly schedule until September, but we’ll see how that works out. There’s lots of interesting stuff in the pipeline!  Next up I plan to collect some commentary about the recent series of articles on Accountability for Canada’s Covid-19 Response in The BMJ. 

This time around we’re pretty lightly themed. If there’s thing I’d like people to take away from this issue, it’s that people need to be very careful when relying on Covid Rapid Antigen Tests (RATs). From the very beginning, we’ve all sort of assumed that they were pretty accurate. But, as we can see from some of today’s readings, that’s not really the case anymore. I really like this video from the now-disbanded Ontario Covid Science Table which explains a more accurate sample collection method with oral and nasal swabbing. 

I hope that those articles about RATs will be particularly useful in helping all our networks and contacts that they shouldn’t just rely on one test on the first day of symptoms as the definitive word on whether or not they have Covid. 

Of course, in our intensely gaslit and denialist stage of the pandemic, no one even seems to feel the need to test for a disease when they are being told that they can ignore Covid. After all, the Canadian government may end up trashing tens of millions of tests if no one wants them. There is hope, however, as new kinds of rapid tests are being developed that rely on exhaled breath or in the air of any room.

It all feels like we’re stuck in the worst possible science fictional dystopia, with waves of a still dangerous pandemic competing with climate catastrophe and surging fascism.

It’s tough times for those who are truly paying attention. As a reward for those of you who are persistent and dedicated enough to make it to the bottom of the list, I have a quick little musical balm. 

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Study: At-Home Rapid COVID Tests May Miss Many Infections by Emily Velasco / Caltech

"Generally, we saw that most people have virus first appear in their throat and in saliva, and then, sometimes days later, in their nose," says Alexander Viloria Winnett, biology graduate student and study co-author. "Actually, each sample type from a single person follows its own distinct rise and fall of viral load, so it makes a big difference which sample type is used for testing."

At the beginning of the pandemic, the gold standard for testing was the deep nasal swab (PCR test) administered by a medical professional, which is highly sensitive and accurate but uncomfortable for many people and slower to provide results. As the pandemic progressed, people more and more relied on at-home nasal rapid antigen tests, which can be performed without the assistance of a medical professional and provide results in as little as 15 minutes.

However, in their study, the Caltech researchers found that most people showed a delay of several days between when the virus first appeared in the throat or saliva and when it appeared in the nose. Importantly, 15 of the 17 study participants had high and presumably infectious levels of virus for at least a day prior to getting a positive antigen test.

"In one individual, levels of virus in throat swabs were extremely high and presumably infectious for almost two weeks while nasal-swab viral loads were undetectable or remained so low they would have been detected only by a highly sensitive PCR test," says Natasha Shelby, the Caltech COVID-19 study's administrator and a co-author on the paper. "This individual never tested positive on her daily rapid antigen tests."

Shelby says antigen tests have two major limitations: "First, they only test for virus in the nose, even though the SARS-CoV-2 virus is known to be in the mouth, and, in fact, numerous studies show it often shows up in the mouth days before the nose. Second, these rapid tests have low sensitivity, which means they require a lot of virus to indicate a positive result. People assume that these tests will be positive when people are infectious, but we now know from numerous studies that this is not always true."

Repeat testing with a rapid antigen test may be required to rule out SARS-CoV-2 infection by American College of Physicians / MedicalXpress

A prospective cohort study has found that repeat testing in 48-hour intervals with a rapid antigen test (Ag-RDT) may be required to rule out SARS-CoV-2 infection. This means that people testing for SARS-CoV-2 should exercise caution in public settings despite an initial negative result if they suspect they may be infected or have been exposed. The findings are published in Annals of Internal Medicine.

Rapid COVID tests miss 90% of asymptomatic cases / Nature

Rapid antigen tests are much more reliable at detecting COVID-19 in people with symptoms than in those without, finds the largest study to compare home rapid tests with gold-standard PCR tests. …

More than 150 participants tested positive for SARS-CoV-2 on PCR tests. On the day of infection onset, rapid tests detected almost 60% of infected participants who had COVID-19 symptoms, but only 10% of those who didn’t. However, repeating the test 3 times, 48 hours apart, led to detection of infections in 75% of asymptomatic participants. Two tests conducted 48-hours apart identified 92% of symptomatic participants.

Reminder: this video from the now-disbanded Ontario Covid Science Table explains a more accurate sample collection method for conventional RATs using oral and nasal swabbing. 

If public health is not there to protect the vulnerable, then why bother? by Christopher Leighton / Healthy Debate

The Ford government has offered little in the way of proof it considered the detailed, evidence-based analyses prepared and presented by senior experts at Public Health Ontario (PHO), Ontario COVID-19 Advisory Science Table Members and even a Senior Ministry of Health Branch Director. During a time of increasing contagiousness and immune evasion of the circulating Omicron variants, and when less than 37 per cent of children had completed a primary series of vaccinations, the Ontario government ignored calls to strengthen public health measures.

Instead, it gradually withdrew them in overt opposition to expert guidance. While the CMOH strongly encouraged masking by the public, Moore introduced no measures of compliance monitoring and was himself soon observed at a highly public and televised function without a mask.

The immunology of long COVID by Daniel M. Altmann, Emily M. Whettlock, Siyi Liu, Deepa J. Arachchillage & Rosemary J. Boyton / Nature Reviews Immunology

The clinical definition of long COVID is still a work in progress. Already there is a tendency to draw a distinction between the familiar spectrum of persistent symptoms such as fatigue, breathlessness and neurocognitive impairment, on the one hand, and increased risk of overt ‘lifetime’ impacts such as increased risk of stroke, myocardial infarction, and types 1 and 2 diabetes, on the other. In the absence of clear mechanistic pathways, we argue that both sets of outcomes need to be considered within the framework of long COVID. If long COVID encompasses consequences of the infection beyond 4 weeks, then increased lifetime risk of neurological, cardiovascular, renal or metabolic disease events certainly qualify within the term ‘long’. The risk of new-onset autoimmunity as reported in health-care records following COVID-19 has been discussed above. The US Department of Veteran Affairs health record data sets were used in a series of papers on altered risk conferred by COVID-19 on a wide range of disease outcomes, often viewed as HR deduced from 1-year disease burden data. This finds an increased risk of dyslipidaemia across abnormal lipid outcomes, with a HR of 1.24. Analysis of cardiovascular outcomes found a HR of 1.52 for risk of stroke, 2.93 for pulmonary embolism, 5.38 for myocarditis and 1.49 for transient ischaemic attacks. For all diabetes across this data set, the HR was 1.4

A Patient’s Right to Masked Health Care Providers by  Katherine Macfarlane / Bill of Health

Health care facilities interested in ensuring that high-risk patients are treated by providers wearing masks could take the following steps. First, a facility might return to universal masking, ensuring that no patient must undertake the labor of negotiating masking with their doctor. Second, a facility could ask patients whether they want their health care providers to wear a mask on an intake form. The form would be returned to a receptionist who communicates the patient’s preference, using something as simple as a sticker affixed to the patient’s chart. A doctor who does not comply would be subject to whatever consequence the doctor would face for violating any other workplace rule.

Enforcing a health care provider’s duty to mask should not be left to patients. Masking is an inherently charged subject with the potential to create tension in the patient-physician relationship. That conflict may compromise quality of care or create or exacerbate a patient’s medical trauma. High-risk patients with disabilities have suffered enough.

"A Heightened Sense of Risk": A Covid FAQ with 300 Sources by Jessica Wildfire / OK Doomer

We answer the same questions over and over. We show the mounting evidence. We debunk myth after myth, only for them to resurrect. It can get tedious. Sometimes indifference can overwhelm us and make us question our sanity. That’s why last year I started keeping and organizing a list of sources. I use these sources when I need to convince someone to take Covid seriously.

Over the last year, my list has grown to nearly 300 sources. I’ve made categories and subcategories for Long Covid, masks, the immune system, and a list of other voices worth listening to.

I also decided to make an FAQ.

Here it is:

Flattening the Curve / The John Snow Project

Few seem to appreciate what a monumental shift in public health philosophy these events represent. The traditional goal of public health has been to promote public health by eliminating the disease burden that plagued humanity for much of its existence.

No longer. It has now been firmly established that human lives and health are not the priority as long as there is “capacity” in the healthcare system and we are not yet at the point where refrigeration trucks are needed because morgues and crematoria can no longer keep up. This shift in philosophy can be expected to have devastating consequences throughout healthcare and public health. Why should COVID-19 be special and why would anyone expect these practices to apply only to it?

We already see such impacts in many hospital systems around the world, where masking rules have been dropped and no precautions are taken to prevent COVID-19 positives from mixing with other patients, which will certainly cost innumerable lives of clinically vulnerable people suffering from non-COVID conditions. The rot will only spread from there, and standards of care will erode across the board. Why wouldn’t they if we have collectively decided that serious nosocomial infections are something we will just sweep under the rug from now on? And, of course, there will be more pandemics, and we have now established how we are not going to properly deal with them.

What SARS-CoV-2 Does to the Body (2nd Edition, July 2023) / Pandemic Accountability Index

Last November, we posted a compilation of over a hundred studies and articles on how the SARS-CoV-2 virus can harm the body. It’s been a little over six months since then, and a lot more research has been published since then. So, it’s long overdue to revisit our understanding of why it’s just so important to prevent infections from a deadly & disabling virus that has ended and upended the lives of millions around the world - in Europe alone, the WHO is saying that over 36 million are suffering from Long COVID disability, an umbrella term for numerous medical complications.

Those who have insisted that SARS-CoV-2 is relatively harmless or “mild,” or insisted that COVID-19 is “just a cold/flu,” should be forced to contend with the ever-growing mountain of scientific research that has emerged, as new discoveries continued to be researched to this day.

Political party affiliation linked to excess COVID deaths by Stephanie Soucheray / CIDRAP

The study looked at deaths in both Florida and Ohio during the first 22 months of the pandemic and found the overall excess death rate of Republican voters was 15% higher than that of Democrats. The gap widened further once COVID-19 vaccines were introduced. …

By looking at individual-level connections between political affiliations and excess deaths, the study highlights that the most significant divide occurred only after COVID-19 vaccines became widely available.

"The results suggest that well-documented differences in vaccination attitudes and reported uptake between Republican and Democratic voters may have been factors in the severity and trajectory of the pandemic," the authors wrote.

The Who has long been my favourite rock band and this recording from the Rolling Stones Rock and Roll Circus is perhaps their most ferocious live recording. And by extension, one of the most ferocious live recordings of all time. Enjoy!