COVID-19 Antigen tests missed 90% of asymptomatic cases in this prospective volunteer trial of over 5000 volunteers by a Massachusetts group, Soni et al. https://www.acpjournals.org/doi/10.7326/M23-0385
Consider that in context with the report I shared previously on a breath testing device https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(23)00149-4/fulltext
An impressive study from Augusto et al https://www.nature.com/articles/s41586-023-06331-x with commentary in Nature here: https://www.nature.com/articles/d41586-023-02318-w “found a link between asymptomatic infection and an HLA mutation carried by about 10% of the study’s population. People with the mutated gene were twice as likely to remain asymptomatic as were people without it; people with two copies of the gene were eight times as likely.”
For this update I want to directly quote Katelyn Jetelina “Your Local Epidemiologist” in total, on lessons learned from COVID-19, published a few days ago. I think it’s a very thoughtful and worthwhile piece.
Lessons I learned:
· The three most important words: I don’t know.
· Approach novel threats with humility. Man this stupid virus gave us some surprises.
· Approach populations with humility. Helicoptering in is not the same thing as stakeholder engagement.
· There are only tough and tougher policy decisions during an emergency. Many decisions were leaps of faith. Schools were a great example.
· Public-private partnerships are critical: Operation Warp Speed. Google mobility data. CVS/Walgreens and vaccine distribution. Antigen tests and USPS. Contact tracing. Wastewater. Public health was brought to a new level.
· Humans don’t like being reminded of their vulnerabilities. It brings out a lot of hate and anger.
· We can do hard things: 91% of Americans 12+ years have the primary COVID-19 vaccine series. That’s absolutely huge.
· Public health is inherently political. Policy isn’t just based on science but also culture, psychology, politics, and values. A lot of the time we agree on data, but we value different priorities.
· Using public health as a partisan pawn, though, will cost lives. Using masks (or lack thereof) as a tribal symbol is a prime example.
· Scientific communication. Oh, where do I begin? This deserves its own YLE post.
Things I got wrong:
Hindsight is 20/20. But there is a difference between being wrong vs. being off because of limited knowledge at the time. There are things I need to be better at in the future, regardless of the rapidly changing evidence. Here are some examples:
· Noise. I initially dismissed lab spillover theory because of the messenger (Trump) and because it was wrapped up in other conspiracy theories. I’m getting better at dealing with noise, but not perfect.
· Feasibility. I strongly supported CDC’s recommendation on masking under 5 years old, but I ultimately think the WHO got this right (mask over 5 years old). Families were kicked off flights because toddlers wouldn’t wear a mask without crying. I felt for those parents. I was that parent. Feasibility is a big part of public health adherence.
· Being partisan. I fell for the partisan bait many times. This isn’t how we build new foundations of trust.
· Being sloppy, like not vetting sources carefully enough or leaving an ACIP meeting early and sending millions the wrong recommendation. (I’m still embarrassed.)
Things I hope you learned:
· Science is ever evolving. It never stops.
· A healthy population is a healthy economy. These interests are not competing, but rather complementary.
· Inequality is so very apparent in health and well-being.
· It’s really easy to forget how bad and scary it was. Revisionism is real and can happen unconsciously.
· When public health works, it’s invisible. But there are a ton of people working their butts off. As the Peace Corps say: It’s the toughest job you’ll ever love.
· Public health is a cycle of panic and neglect. We need to stop this. Supporting public health is just words unless it’s backed up with funding.
Bottom line
The pandemic made us move at incredible speed; we were bound to make mistakes. But, as Jonathan Mann said during the HIV era, “At the time of plague we did not flee; we did not hide; and we did not separate”. Here’s to learning, adapting, and being better prepared for tomorrow.
Other outbreak news from Airfinity’s service which sifts and verifies international literature and media:
In Cyprus there have been some 300,000 cases of feline coronavirus, but so far no evidence of any transmission to humans.
Nigeria continues to have high rates of Lassa fever with nearly 1000 cases and 170 deaths.
Somalia’s cholera outbreak finally appears to be in decline.
Florida health officials reported a new case of malaria on Tuesday, bringing the total number of locally acquired malaria infections in the U.S. to eight since May. These cases are the first to be acquired in the U.S. in 20 years.
And Okinawa Japan is being watched because of high COVID-19 hospital admission numbers there, surpassing their winter wave – probably driven by XBB variant, a large pool of susceptible people (time since last wave) and a large public holiday — it’s been about six months since their last wave (source YLE).
The 17th US report just out from the COVID modelling hub (comprising 9 modelling teams) is interesting. It concludes:
“For the range of scenarios considered, weekly hospitalizations and deaths are likely to stay within last year’s range, and unlikely to hit Delta or Omicron peaks. Further, weekly hospitalizations are likely to remain at low or medium community transmission levels and unlikely to reach high transmission levels (>20 weekly hospitalizations per 100,000), as defined by the CDC.”
From their scenarios the deaths per year range between 122,000 (best case) and 209,000 (worst case) deaths annually. Influenza deaths in the US have typically ranged around 20,000 to 50,000 per year. https://covid19scenariomodelinghub.org/
On disinsection (insecticide application for aircraft to prevent vector importation) - here is the definitive WHO document, updated Feb 2021 https://www.who.int/publications/i/item/9789240014459
It covers pesticide products, types of application/equipment, and procedures including amount of spray required. The big change is that the “”Blocks away” disinsection has gone and so has the “Top of descent” – both of these involved spraying while people are in the cabin which is always disliked. The main methods now are residual disinsection, pre-embarkation (before passengers board) and in some cases pre-departure.
David Powell
IATA Medical Advisor