"The Problem with Case Counting"

[KitKatastrophe]

www.bmj.com/content/370/bmj.m3374.full

Interesting article from British Medical Journal.
From what I understand of it there are issues with people testing "positive" and counted as a "case" even though they may only have a tiny fragment of RNA, and thus are asymptomatic and not infectious. Should this be counted as a "case"?

In the past an illness would be diagnosed by looking at symptoms and then ordering an appropriate test, not mass testing.

It appears that the virus is becoming more endemic in the population. If it had been this way at the beginning, then our response would have been very different (we might not have even noticed it was there!). Perhaps we should move away from binary positive/negative test results to something a bit more nuanced.

Bothers me too. I guess cases are being monitored as early sentinels for future hospitalisations and deaths - those are the actual problems to avoid. Deaths & hospitalisations are still at very low levels, even in the whackamole lockdown areas of UK. Doesn't seem like deaths/hosptlsns have spiked in a lot of places, maybe USA though.

Advising individuals if the RNA volume is so low as to be non-infectious might work, or might lead to telling people in the very early stages of the disease that they're fine, when they are not.

If there are only a higher proportion of asymptomatic cases being found, then the cases will level off. The issue is that asymptomatic in some cases can infect vulnerable people, it just takes a few weeks to filter through society. Look up Spain and France for rising hospital admissions weeks after cases started rising. There is a problem with leaving this disease to spread, that it becomes very hard to stop that spread at a specific point. It's important to suppress it in any area where cases are rising; that may be inconvenient, but will lead to less deaths in that specific community.

" Deaths & hospitalisations are still at very low levels, even in the whackamole lockdown areas of UK"

Trafford is reportedly starting to experience a small rise in admissions. Cases in most of the hotspots don't seem to be consistently falling either.

Beginning to think it could still be weeks before they can be lifted, and the impact of schools opening won't be seen for a few weeks either so might be longer😩

BBC reporting today that there’s been an increase of 20% in testing in last 4 weeks and only 0.4 % increase in positivity so no suggestion of second wave

1/5 in over 50’s supposed to 1/3 being over 80 last time

Almost all asymptomatic and who wouldn’t have been found earlier

Admissions are not rising here or abroad - certainly nowhere near the level they did months ago

On sky news last night they compared now to March and it said at current levels to reach anywhere near March figures itd take 3 years!

So second wave isn’t a certainty tho I think some on Mumsnet are almost running their hands for one

In March, there is every chance that there were millions of infections in the community, leading to the hospitalisation and death rate. At that point covid had been spreading for months without any restrictions and given that the majority of infected people will have thought they just had a cold or other innocuous virus, they will have been going to work and school ill and spreading it around in large numbers.

If (and it is still an if) being infected confers immunity, even short term, then all those millions of infected people won't get infected again any time soon, so infection stops dead with them. There may not be herd immunity but there's likely be high levels of general immunity.

March was the worst case scenario - an infectious disease, deadly to some people (but not most), widely spread in the community. Just being aware and modifying behaviour in relatively small ways (no big community events, some distancing) makes a huge difference. Add to that the high levels of immunity and the virus may bubble along but it won't really have the chance to get out of control.

Actually @Vinoonasunnyday that's incorrect, hospitalisations are increasing significantly in France and Spain as well as Argentina and a raft of other countries where infections have gone up. Typically hospitalisations run 3-6 weeks behind upticks in infection, that's what was seen before.

@TheDailyCarbuncle - I'd like to believe you're correct and the UK measures are sufficient. That relies on recent infection increases only being from the larger gatherings allowed (and illegally held) on the continent, it's possible but not certain.