Tag Archives: Covid-19

Welcome to the world of the physician


In a sense, the uncertainty about hematologic complications of the pandemic vaccines is good in that it is a real teaching moment for the public about what docs confront every day — balancing risk vs. reward. 

No drug is without side effects.  No surgery is without complications.  It is good to see the public  wrestle with these things.  

For a very good explanation of what those complications are and the risks and rewards of taking the vaccines please see — 

https://blogs.sciencemag.org/pipeline/archives/2021/04/14/vaccine-side-effects-q-and-a

Even more interesting are the 139 comments found at the end of  the article.  Some are from experts, some are from frightened lay people; as always there are people with an ax to grind.  As is usually the case in medicine, the data are not clear cut and sometimes contradictory.  As is always the case more data would be helpful, is desired and rarely available.  What is particularly interesting to me is the way some very knowledgable people wrestle with the data, interpreting the same data differently.  Welcome to the real world. 

On a more positive note, a friend who teaches at Hopkins sent me the a copy of the eMail below, with permission to share it.  This provides lots of excellent data on the protective effects of vaccination in a  group of people with a fairly high risk of exposure to the virus,  working at a major medical center where lots of very sick COVID-19 patients are being treated. 

35,000 were vaccinated.  Nonetheless 51 became infected at a time of maximum protection (5 weeks or more after the first shot), demonstrating that the vaccine isn’t 100% protective.  But no one ever claimed that it was.

 But only 2 of the 51 required hospitalization.  So the vaccine is effective in preventing serious illness from the virus (2/35,000).  So who cares if the other 49 had the symptoms of the flu.  They don’t and you shouldn’t.  The number of hematologic complications wasn’t stated. There were two at most, as they always result in hospitalization.  

To the Johns Hopkins Medicine community

 

Dear Colleagues,

 

As we continue to monitor COVID-19 infection and vaccination trends at Johns Hopkins Medicine (JHM), we want to share some data about the incidence of infection among JHM personnel following partial and full vaccination.

 

You are considered fully vaccinated, per the Centers for Disease Control and Prevention, two weeks or more after receiving the second dose of a two-dose COVID-19 vaccine regimen and two weeks or more after receiving a one-dose COVID-19 vaccine regimen. This is when the body has had a chance to produce the antibodies and immune response that protect against infection. Before this time, if you have started the vaccination series, you are considered partially vaccinated and you do not yet have the full amount of protection the vaccination provides against infection. While full vaccination has been found to be highly effective at preventing COVID-19, infection (the incidence is very low) is still possible even after being fully vaccinated.

 

We are monitoring the situation to determine how often infection seems to occur after partial or full vaccination, and the severity of those infections.

 

As of April 12, 2021, of the nearly 35,000 employees who were fully vaccinated (14 days or more after a second dose), 51 employees (0.14% of those who have been fully vaccinated) had tested positive for COVID-19. This demonstrates that SARS-CoV-2 infection is possible even after full vaccination, and it highlights the importance of continuing to practice basic infection prevention precautions after full vaccination. The good news is that acquiring COVID-19 after full vaccination appears to be relatively rare and, among these 51 cases, only two were severe enough to require hospitalization. This shows that the COVID-19 vaccine is highly protective against severe disease, hospitalization and death. If you have not yet been vaccinated, please schedule your appointment as soon as you can to protect yourself and others.

 

 

Is the virus still within you? Will it cause trouble?

Let’s say you’ve recovered from a bout with COVID-19. Is the virus still with you? Could it come back and cause trouble? Given the data in a recent paper [ Nature vol. 591 pp. 639 – 644 ’21 ] — https://www.nature.com/articles/s41586-021-03207-w.pdf, it’s quite possible.

But first a story about my grandmother.  She was born somewhere around the Baltic Sea in 1880 and came to America in 1893.  She died of undiagnosed (hence untreated) miliary Tuberculosis in a University Hospital in 1967.  Just about everyone in Europe in the 1880s was exposed to TB and just like SARS-CoV-2 many if not most were asymptomatic.  Their lungs walled off the organism in something called a Gohn complex — https://en.wikipedia.org/wiki/Ghon%27s_complex.  The organism didn’t die — and probably broke out of the complex as my grandmother aged and her immune system got weaker and weaker.  It is very unlikely that she picked it up by exposure in the 1960’s.  As they say TB is forgotten but not gone.  

Which brings me to the Nature paper.  At first I thought it was great and very optimistic.  Some 87 people from New York City who had symptomatic SARS-CoV-2 infection (proven by finding the viral genome using RT-PCR technique).  The authors studied the antibody responses at an average of 1.3 and 6.2 months after infection.  Although the antibody levels dropped (which always happens) they changed so they bound the virus more tightly.  This is called affinity maturation — https://en.wikipedia.org/wiki/Affinity_maturation.  

So that’s good? 

No that’s bad because it implies that the protein stimulating affinity maturation is still around. The authors note the persistent antigenic stimulation of the immune system is possible because an “antigen trapped in the form of immune complexes on follicular dendritic cells .. . . . can be long-lived, because follicular dendritic cells do not internalize immune complexes”.  

Well maybe, but the paper gives evidence for another mechanism of antigen persistence (which I find more persuasive). 14 of the people had intestinal biopsies for appropriate clinical indications (see Table 7 in the supplementary information of the article). In some of the biopsies they detect viral antigen in some of the enterocytes (cells which line the inside of the gut) — I’m assuming the antigen is the viral spike protein, but it’s hard to find exactly what it is. 

This is quite bad, as the lifetime of the enterocyte is 5 days.  This means that the antigen is being continually produced, which means that the mRNA for the antigen is being continually produced, which in turn means that the viral genome is still around.  The mean lifetime of cellular mRNAs is 10 hours although some hang around for days, however I doubt that the mRNA responsible for the viral antigen had lasted for 2.8 to 5.7 months which is the time after clinical infection when the biopsies were done. 

So it is possible, that like TB in the Gohn complex, the immune system has fought the virus to a draw, but that the intact organism could be still present.  As in my grandmother, it is possible that the virus will reappear as the immune system weakens with age (something that happens in all of us). 

In that case we wouldl have recrudescence not reinfection. 

PS:  My grandmother came to this country at age 13 alone and speaking no English.  Every time I feel sad at what the pandemic has put us all through, I think of that generation.  

PPS: When she got sick, I wanted to put her in the hospital where I was an intern, but our family GP (Dr. Richard A. Gove) told me taking care of my own family was a very bad idea and put her elsewhere.  I doubt that I’d have made the diagnosis, or that anyone at our hospital would have. 

PPPS:  I don’t know if they still do autopsies, but I was always able to get one after I’d tell families of the deceased about my grandmother.  It meant that my wife and I and our two little kids were all screened for TB. 

PPPPS — a friend brought up the following — Eleanor Roosevelt, who was thought to have aplastic anemia, was treated with prednisone and later found to have died of military tuberculous, probably the recurrence of tb acquired some 4 decades earlier.

 

 

 

A non-coercive way to get people to accept vaccination for the pandemic virus

Many people are afraid of being vaccinated (for anything, not just the pandemic flu). Yelling at them won’t help. Calling them stupid won’t help. You can’t pass a law to coerce them, but here’s a law that would likely convince them that it is a good idea.

Can you think of it?

I’m not sure if congress could do it, or whether it would have to be done state by state.

Just require all death certificates for people dying with COVID-19 to state whether they’d been vaccinated or not. Certainly now all of the deaths will be in unvaccinated people, but as time passes (say 3 – 6 months) and 95% of them remain in the unvaccinated (as studies of the vaccine have shown) and 1/3 to half of the population is vaccinated, people will take notice.

I don’t know any legislators, but maybe you do, and you should suggest it to them.

DON’T TOUCH YOUR MASK !!!

I am fortunate enough to have a beautiful reservoir within a half mile of my house. Over the years in the 3.5 mile circumferential stroll it requires I’ve seen 3 black bears, 20 or so American Eagles, Swans, Mergansers, deer, chipmunks and 20 billion Canada geese.

I don’t wear a mask when I’m out there, because at most I’ll see 100 or so people during the walk. Everyone is very good about social distancing and actual propinquity lasts a few seconds at most when we’re walking in opposite directions. About 80% are wearing masks, or at least have them around their neck. Those wearing them around their neck grab them and cover their mouth and (sometimes) their noses.

This is a terrible mistake. The only way the pandemic virus can cause you serious trouble is if it gets to your mouth, nose or eyes. It will never get through your skin. Unless you carefully washed your hands before leaving for the reservoir, you might have it on the skin of your hands. Do not give it a free ride to your mask where it will happily reside getting a shot at entry every time you inhale.

Amazingly, this is not generally known, and people seem genuinely surprised when I tell them this. Most of them thank me.

Places like the reservoir are among the few where you don’t need to wear a mask. So protect yourself if you wear one, and don’t touch it.

Lots of people seem to be using cell phones on the walk, which is even worse, should they contain the virus, as contact is much more prolonged than a simple mask adjustment. How many people clean their cellphones?

One happy point now that winter is almost on us in these parts. The crucial spike protein of the virus (which is how it gets into your cells) deteriorates and becomes nonInfectious after storage for a week at 4 centigrade (about 40 F). What an overnight chill does for it is anyone’s guess. This is from a non-peer reviewed preprint — https://www.biorxiv.org/content/10.1101/2020.07.12.199588v1

The Public Service of President Trump

The number of new cases of COVID-19 is likely to significantly drop in the the coming months and we have President Trump to thank for that

Why? Because people don’t respond to abstract facts and exhortations given by people they don’t know. They do respond to particular examples.

The fact that Trump and Co. disparaged masks, and then came down with the virus will be far more convincing, than any pronouncements from Dr. Fauci or various mayors, governors, congressmen or senators.

I saw this many times in practice.

An example.

Neurologists treat migraine headaches. It is well known that migraines are triggered by stress. When someone was having a bout of several migraines under the stress of divorce, illness, finances you name it, I’d tell them this, but I could see they didn’t believe me.

So I’d say let me tell you about my wife’s migraines. She’s had them even before I met her when she was 19. And as is typical of migraine, they became less frequent and less severe as she got older.

So she had gone 18 months without one, until the afternoon that she found out that our 12 year old son, had a bone tumor in his ankle which would need surgery. Immediately, I could see the patient had bought in the particular what I’d just told them in the abstract.

I think the populace is presently saying to themselves. Maybe we ought to wear masks and only be around people wearing them. Look what happened to Trump and the Senators.

Addendum 5 October:

A sardonic friend (and retired ambassador) responded as follows

“Thanks for helping me appreciate President Trump’s public service.

The potential benefits of this style of leadership seem almost without limit.

Think, for example, of how the President could affect automotive safety if he were to demonstrate the perils of driving a car over a cliff.

Regards”

XXXX

If I were a billionaire

If I were a billionaire I’d fund the following research study immediately.  Where ?  Not Research Triangle Park, the Acela corridor or the Bay Area but Sturgis South Dakota.  Why?

Spend 11 minutes of your time looking at the following video — https://www.youtube.com/watch?v=aNIEOCFGr3s&feature=emb_rel_end%3Chttps://nam02.safelinks.protection.outlook.com/?

The 80th Annual Sturgis Motorcycle Rally began there 9 August. It is expected to attract between 250,000 and 500,000 people and last 10 days.  Masks are not required and the video shows that very few are wearing them.  Note the rather close seating for eating and drinking, the stores and restaurants with low ceilings and long horizontal extent (and rather poor ventilation)  I’m sure the actual event will have far closer human contact than shown as the video was shot when the festival was about to begin.

You’d never get an experiment like this to pass an institutional review board, but there it is for the taking  Mr. Billionaire.

Spend some of that cash getting vans to Sturgis and offer free COVID-19 testing (both antibody testing and genome testing) to any one wanting it.  This is an independent bunch, so all you ask is that they stay in touch and let you know how they’re doing in the weeks and months ahead.   Tell them, they’ll hear the results after the 19th when the festival ends if they want, so they’ll need a way for you to contact them.

Probably most will not divulge information about themselves, but you will  surely find some cooperative people.  So ask them to tell you about age, sex, medical conditions.  Offer to do a BMI for them.  Have your staff eyeball their ethnicity, rather than ask.  Since you are funding the study, you’l be able to keep the information completely private.

The study will tell us a huge amount about transmission, susceptibility, clinical course etc. etc.  You don’t need another house or mistress.  Take that cash and do something for humanity.

Of course, the population isn’t representative.  Almost entirely white, very few people over 70 or under 15 (please spend 11 minutes of your time looking at the video.  The level of obesity and smoking  is impressive).

Of course there will be ethical concerns.  Suppose you find someone shedding the virus — do you contact them?  Probably best to wait a few a weeks before testing.   This is a naturalistic study after all and you’re a billionaire not a doc.

Hurry there are just 7 more days to go.

 

 

New York City Covid-19 cases spiked today. Stock market futures tank

22 June:  A private testing firm (Legkoverny Testing) today reported 10,000 newly found Covid-19 cases in New York City today. Stock market futures immediately tanked.  They had been going around the Bronx for several weeks offering free antibody testing to anyone wanting it.  Some 30,000 residents took up the offer.

Legkoverny knew where to go to get these results. https://www.6sqft.com/new-york-covid-antibody-test-preliminary-results/ — communities of color in the Bronx where positive tests for the antibody occur in up to  50% of the population.

Fortunately, officials noted that a positive antibody test means that the individual had been infected and recovered, as all 30,000 or so weren’t on respirator in ICUs.  In fact they were walking around the streets of the city, and most had never been sick.

This sort of thing has not been noted by the mainstream press reporting an upsurge in Covid-19 cases.

Increasing the number of tests done daily will increase the number of  positive tests for cases.  Every state in the country has been increasing the number of tests done daily.

Now Covid-19 used to mean, clinical illness with the SARS-CoV-19, the pandemic virus.  It isn’t being reported that way now, just a positive antibody test for the virus appears to be enough

Here’s Florida’s weekly report of positive antibody tests for the week ending 19 June — http://ww11.doh.state.fl.us/comm/_partners/action/report_archive/serology/serology_latest.pdf.  200,000+ people were tested, and 8,627 were found positive which is nearly 1/3 of the total new cases for that week.

So if you want to know if the number of serious cases is increasing (which is  what we all would like to know), forget these these numbers, which are partly due to increased testing.  Concentrate on two statistics (assuming you can get them)

l. The daily death rate from the virus — even better a 7 day moving average as Georgia does

2. The number of cases currently in the hospital.

Not every state gives out this information, but Massachusetts does.

There will be a lot of egg on a lot of faces if easing the lockdown restrictions doesn’t cause an increase in illness and death, which is probably why the pandemic is being reported this way.

Also ignore daily spikes in the number of cases — this can be an artifact of the way cases filter in to state health departments.  For an early example of this please see  — https://luysii.wordpress.com/2020/05/28/data-cherry-picking-101/

Good luck

 

 

 

Data Cherry Picking 101

A friend sent me the following link — https://www.voanews.com/covid-19-pandemic/wisconsin-reports-its-highest-daily-increase-covid-19-cases.

It starts off like this — dates in parentheses added by me.

“Health officials in the midwestern U.S. state of Wisconsin reported a record number of new COVID-19 cases Thursday, (28 May) two weeks after the state Supreme Court struck down a state-wide stay-at-home order issued by the governor and enacted by the state health department.

The Wisconsin Department of Health Services reported 599 new known COVID-19 cases Wednesday, (27 May) with 22 known deaths, the highest recorded daily rise since the pandemic began. The department reports the state had more than 16,460 known cases and 539 known deaths as of Wednesday.”

Well that proves it, doesn’t it?   Removing restrictions has clearly  been a disaster.

No it doesn’t.  This is data cherry picking par excellence — one day’s cases — after a long holiday (Memorial Day)  weekend means nothing.  The ‘spike’ is an artifact of how cases are reported.

Here are the daily new COVID-19 cases from Massachusetts (which has relaxed nothing so far)
24 May 382
25 May 281
26 May 197
27 May 688 
 
QED

Do not forget that there are huge agendas at stake in how data is reported after loosening of the restrictions.  It shouldn’t be that way but it is.

Here are a few apocalyptic predictions about what would happen after Georgia lifted its restrictions 25 April.  Future predictions and definitive statements from these sources should be taken with a grain or more of salt.

From The Atlantic — “Georgia’s Experiment in Human Sacrifice — The state is about to find out how many people need to lose their lives to shore up the economy.” — https://www.theatlantic.com/health/archive/2020/04/why-georgia-reopening-coronavirus-pandemic/610882/

Watch the press

We are about to embark on a variety of social experiments, in removing the restrictions on our activities.  This will be accomplished many different ways, in many different locales (which is good, because if there ever was a country where one size does not fit all, it is the USA).  But beware of what you read about the effects. There are people who will be proved very wrong either way — if nothing happens, or if cases and deaths skyrocket.

It’s good to see that people are being explicit about their predictions.  Here are two, both of which can’t be right

https://www.theatlantic.com/health/archive/2020/04/why-georgia-reopening-coronavirus-pandemic/610882/ — Here’s how it begins —

Georgia’s Experiment in Human Sacrifice

https://www.theepochtimes.com/as-ccp-virus-brings-a-taste-of-fascism-trump-needs-to-end-us-overreaction_3330804.html

As CCP Virus Brings a Taste of Fascism, Trump Needs to End US Overreaction

Also beware of breathless reports of nothing happening in the first few days confirming that it was OK to lift restrictions, again because new cases will take a while to show up, and new deaths from the disease will take even longer.

They may be right, they may be wrong, but at least we’re about to find out.

 

Addendum 1 May: If you have the time, please read Matt Taibbi’s latest article — https://taibbi.substack.com/p/temporary-coronavirus-censorship.
It shows just how invested the ‘don’t relax restrictions’ side is in having the experiment fail.  Toward the end of Taibbi’s article you’ll find a series of quotes in January from the same bunch showing why you shouldn’t worry about the coronavirus.  I wish I’d saved them.  I knew better, because I’d been closely following what was going on in China  since 1 Jan because I have a son, daughter-in-law and two grandchildren living in Hong Kong. Here’s a link to that old post of 27 January — https://luysii.wordpress.com/2020/01/27/what-to-do-about-the-wuhan-flu/

Here is the last post on the subject.  Good luck to us all

Gentlemen, place your bets

It’s time for us all to think like a doc who’s ordered a bunch of tests on a fairly sick patient.  The good ones don’t wait for them to come in and then figure out what to do.  They usually concentrate on the worst cases and make plans.

Before going any further, please read the following paragraph. I’m sorry to keep putting this in, but I don’t want to leave anyone behind. Finding the actual genome (RNA in this case) of a virus in an individual  is like seeing a real bear up close and personal.  This can do you some damage.  In contrast, antibodies to the virus are made by an individual who has been infected by the virus in the past.  Antibodies (proteins) and genomes (RNA) are completely different chemically.      Antibodies are like seeing the tracks of the bear without the bear itself. You can’t see tracks without the bear having been present at some point in the past.

Well we’re in that situation in the USA.  Based on many studies now (California, New York State, Prison systems) the number of people who’ve been exposed to the virus enough to develop their own antibodies to it, is anywhere from 10 – 100 times greater than the number of people in whom the viral genome has been found.  This means that the vast majority of infections with the new coronavirus are asymptomatic.

We’ll have a more accurate picture shortly, but what do you think will happen when New York State (and probably everyone else) repeats the test for antibodies in a few weeks?

Place your bets.

Once you have an antibody to a bug, you have it (at least for a few weeks to months).  This is not true for the elderly and my wife had to be re-vaccinated for measles so she doesn’t give it to our grandkids should she be exposed again.

So repeating the prevalence of antibody studies should show an increasing percentage of people with the antibodies.  The bets have to do with how much increase we will see.  Will NY go from 13% to 26% or higher?  The experience in nursing homes and the disaster in the Soldier’s Home in Holyoke MA, shows that in a vulnerable group the infection rate can explode — https://www.masslive.com/news/2020/04/coronavirus-at-holyoke-soldiers-home-additional-veteran-dies-infection-remains-stable-over-3-days.html. Out of 210 veterans living there 66 have died of COVID19 and 82 more have been infected (showing the genome), since the first case was discovered 21 March.

Showing the conflicting evidence docs have to deal with all the time — consider the prisoner studies — https://www.reuters.com/article/us-health-coronavirus-prisons-testing-in/in-four-u-s-state-prisons-nearly-3300-inmates-test-positive-for-coronavirus-96-without-symptoms-idUSKCN2270RX.

It isn’t clear which test was being used (viral genome or antibodies to the virus).  But this is a younger and healthier population.  Very surprisingly in four state prison systems — Arkansas, North Carolina, Ohio and Virginia — 96% of 3,277 inmates who tested positive for the coronavirus were asymptomatic.

So if healthy people won’t be made sick, what will happen when restrictions on activity (both personal and business) are lifted as they will be shortly?   You have two conflicting pieces of evidence to help you place your bets.  Fortunately the country has not adopted a one-size-fits-all approach, and lots of different experiments of nature will occur.

New York is the epicenter, with the most cases and very high population density.  Symptomatic cases appear to have stabilized even with a 10fold higher transmission rate (as measured by antibody prevalence) than that measured by finding the viral genome itself.

What would be your guidance here?

It’s time to pay our respects to Dr. Janeway who first focused on the innate immune system 30 years ago — https://en.wikipedia.org/wiki/Charles_Janeway.  Obviously if we had to wait the week or so for antibodies to develop to fight off infections, we’d all be dead.  The innate immune system is much older evolutionarily than antibodies and starts working immediately.  We are still finding out how complex it is. https://en.wikipedia.org/wiki/Innate_immune_system.

Like everything else, the innate immune system weakens with age, possibly explaining the difference in clinical outcome between the vets at the Soldier’s home and the prison inmates.

It’s hard to place a bet when you’re wishing for the best possible outcome as are most of us. Some people are highly invested in the worst possible scenarios, particularly those who’ve predicted them.  My guess is that we won’t see a surge in fatal or symptomatic cases as things open up.  What’s yours?

Gentlemen, place your bets

It’s time for us all to think like a doc who’s ordered a bunch of tests on a fairly sick patient.  The good ones don’t wait for them to come in and then figure out what to do.  They usually concentrate on the worst cases and make plans.

Before going any further, please read the following paragraph. I’m sorry to keep putting this in, but I don’t want to leave anyone behind. Finding the actual genome (RNA in this case) of a virus in an individual  is like seeing a real bear up close and personal.  This can do you some damage.  In contrast, antibodies to the virus are made by an individual who has been infected by the virus in the past.  Antibodies (proteins) and genomes (RNA) are completely different chemically.      Antibodies are like seeing the tracks of the bear without the bear itself. You can’t see tracks without the bear having been present at some point in the past.

Well we’re in that situation in the USA.  Based on many studies now (California, New York State, Prison systems) the number of people who’ve been exposed to the virus enough to develop their own antibodies to it, is anywhere from 10 – 100 times greater than the number of people in whom the viral genome has been found.  This means that the vast majority of infections with the new coronavirus are asymptomatic.

We’ll have a more accurate picture shortly, but what do you think will happen when New York State (and probably everyone else) repeats the test for antibodies in a few weeks?

Place your bets.

Once you have an antibody to a bug, you have it (at least for a few weeks to months).  This is not true for the elderly and my wife had to be re-vaccinated for measles so she doesn’t give it to our grandkids should she be exposed again.

So repeating the prevalence of antibody studies should show an increasing percentage of people with the antibodies.  The bets have to do with how much increase we will see.  Will NY go from 13% to 26% or higher?  The experience in nursing homes and the disaster in the Soldier’s Home in Holyoke MA, shows that in a vulnerable group the infection rate can explode — https://www.masslive.com/news/2020/04/coronavirus-at-holyoke-soldiers-home-additional-veteran-dies-infection-remains-stable-over-3-days.html. Out of 210 veterans living there 66 have died of COVID19 and 82 more have been infected (showing the genome), since the first case was discovered 21 March.

Showing the conflicting evidence docs have to deal with all the time — consider the prisoner studies — https://www.reuters.com/article/us-health-coronavirus-prisons-testing-in/in-four-u-s-state-prisons-nearly-3300-inmates-test-positive-for-coronavirus-96-without-symptoms-idUSKCN2270RX.

It isn’t clear which test was being used (viral genome or antibodies to the virus).  But this is a younger and healthier population.  Very surprisingly in four state prison systems — Arkansas, North Carolina, Ohio and Virginia — 96% of 3,277 inmates who tested positive for the coronavirus were asymptomatic.

So if healthy people won’t be made sick, what will happen when restrictions on activity (both personal and business) are lifted as they will be shortly?   You have two conflicting pieces of evidence to help you place your bets.  Fortunately the country has not adopted a one-size-fits-all approach, and lots of different experiments of nature will occur.

New York is the epicenter, with the most cases and very high population density.  Symptomatic cases appear to have stabilized even with a 10fold higher transmission rate (as measured by antibody prevalence) than that measured by finding the viral genome itself.

What would be your guidance here?

It’s time to pay our respects to Dr. Janeway who first focused on the innate immune system 30 years ago — https://en.wikipedia.org/wiki/Charles_Janeway.  Obviously if we had to wait the week or so for antibodies to develop to fight off infections, we’d all be dead.  The innate immune system is much older evolutionarily than antibodies and starts working immediately.  We are still finding out how complex it is. https://en.wikipedia.org/wiki/Innate_immune_system.

Like everything else, the innate immune system weakens with age, possibly explaining the difference in clinical outcome between the vets at the Soldier’s home and the prison inmates.

It’s hard to place a bet when you’re wishing for the best possible outcome as are most of us. Some people are highly invested in the worst possible scenarios, particularly those who’ve predicted them.  My guess is that we won’t see a surge in fatal or symptomatic cases as things open up.  What’s yours?

Addendum 27 April ’20.  People who have predicted terrible things happening by opening up some of the restrictions have their egos and reputations involved if they are proved wrong.  So beware breathless reports of spikes in incidence, hospitalization, deaths occurring in the first few days after the restrictions are lifted.  Remember the mean incubation period is 5 days with a range of up to 11 days.