Thursday, August 27, 2020

Cause, effect and the need to test for COVID-19 -- column of Aug. 27, 2020


A wise editor of mine used to say, “Wet streets don’t cause rain.”

John’s point, of course, was not to confuse cause and effect. I’ve thought about his warning often since President Donald Trump began his counter-narrative about coronavirus testing.

As the number of positive cases of COVID-19 soared this summer, Trump repeatedly blamed the tests for causing the cases.

Testing “makes us look bad,” he tweeted in June.

At the Tulsa rally a few days later, he said, “I said to my people, `Slow the testing down, please.’”

His aides tried to pass that remark off as a joke, but Trump said, “I don’t kid.”

“Cases, Cases, Cases! If we didn’t test so much and so successfully, we would have very few cases,” he tweeted in July.

And, he told reporters, “When you test you create cases.”

That’s all wrong. Pregnancy tests don’t create babies.

Not only the number of cases but the positivity rate – the percentage of tests coming back positive -- also soared in many places.

“A higher percent positive suggests higher transmission and that there are likely more people with coronavirus in the community who haven’t been tested yet,” the Johns Hopkins School of Public Health says, noting it may be a time to add restrictions to slow spread of the disease.

On Monday, the Centers for Disease Control and Prevention quietly posted new guidelines on its website that likely will sow confusion and discourage people from getting tested.

“If you have been in close contact (within 6 feet) of a person with a COVID-19 infection for at least 15 minutes but do not have symptoms, you do not necessarily need a test,” the latest guidance says.

Previously, the CDC urged all people who had come in close contact with an infected person to get tested.

The timing could not be worse. Hundreds of thousands of children and older students are going back to school and college. To keep them, their teachers and other essential workers safe, people need to know if they’re infected so they can self-isolate.

The new guidance cites as an exception “vulnerable” individuals and advises everyone to listen to health care providers and local public health officials.

“I’m dumbfounded by this recommendation,” Dr. Michael Osterholm, director of infectious diseases research at the University of Minnesota, said on CNN.

It may take four or five days for exposure to show up on a test, he said, but people still need to be tested.

Trump and everyone who comes near him at the White House are tested repeatedly. He doesn’t need to wear a mask, he says, because everyone gets a test.

Good for them. But what about the rest of us?

Admiral Brett Giroir, assistant secretary of Health and Human Services in charge of testing, denied Trump pressured the CDC and said the guidance had been updated to reflect “current evidence.” But he didn’t present any.

“All the docs” including Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, had signed off on the new guidelines at a meeting, Giroir said.

Not so, said Fauci. He had seen an earlier draft but wasn’t present when the final version was approved. He had a good excuse.

“I was under general anesthesia in the operating room and was not part of any discussion or deliberation regarding the new testing recommendations,” he told CNN. Fauci had surgery Aug. 20 for a polyp on his vocal cords.

“I am concerned about the interpretation of these recommendations and worried it will give people the incorrect assumption that asymptomatic spread is not of great concern. In fact, it is,” Fauci said.  

About 40% of COVID-19 cases are asymptomatic, the CDC estimates, and the chance of people with no symptoms infecting someone else is 75%. That’s why knowing who is infected and having them quarantine for two weeks is important.

Trump has consistently attacked his own health experts, pressuring the CDC to rewrite guidelines for opening schools and businesses and rushing at “warp speed” to have a vaccine by Nov. 3.

Everyone wants to live in the world again, and most of us rely on science for the facts. 
That means we need to know more – not less – about the coronavirus, who has it and how it works.

For now, wear a mask, wash your hands, keep your distance, stay home if you’re sick, and remember: Wet streets don’t cause rain.

©2020 Marsha Mercer. All rights reserved.

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