I'm at least glad the Berlin police did something about it. And if there were kids in strollers whose parents were determined to expose them to a deadly disease, they might need foster care, who knows.
This post is long, sorry, but it all seemed worth noting.
In the link to the first NYT article below, I have quoted at more length than usual because it seemed important. Unfortunately, it was not highlighted anywhere on their main website, only buried several clicks inside among a lot of other coronavirus stuff.
Its conclusion that the U.S. needs to set a lower level of sensitivity for PCR tests, and standardize the reporting of the amount of viral load shown by any test, in order not to categorize people as positive when they have too little of the virus to be contagious,
made sense to me. But I was shocked to see that the topic has evidently only recently begun to be discussed.
The second NYT article below, about Dr. Fauci, was also not even listed on the main page of that disappointing website. (And don't even ask about their often infuriating app. I have spent over a week now trying to contact a human being to fix a stupid login bug in it.)
But it too was quite interesting to me, both for the glimpse of how the White House under Mark Meadows has tried to shield Trump from expert medical advice,
and for several links to podcasts and other useful reference sources.
* * *Your Coronavirus Test Is Positive. Maybe It Shouldn’t Be.
The usual diagnostic tests may simply be too sensitive and too slow to contain the spread of the virus. ...
* * *
Some of the nation’s leading public health experts are raising a new concern in the endless debate over coronavirus testing in the United States: The standard tests are diagnosing huge numbers of people who may be carrying relatively insignificant amounts of the virus.
Most of these people are not likely to be contagious, and identifying them may contribute to bottlenecks that prevent those who are contagious from being found in time. But researchers say the solution is not to test less, or to skip testing people without symptoms, as recently suggested by the Centers for Disease Control and Prevention.
Instead, new data underscore the need for more widespread use of rapid tests, even if they are less sensitive.
“The decision not to test asymptomatic people is just really backward,” said Dr. Michael Mina, an epidemiologist at the Harvard T.H. Chan School of Public Health, referring to the C.D.C. recommendation.
“In fact, we should be ramping up testing of all different people,” he said, “but we have to do it through whole different mechanisms.”
In what may be a step in this direction, the Trump administration announced on Thursday that it would purchase 150 million rapid tests.
The most widely used diagnostic test for the new coronavirus, called a PCR test, provides a simple yes-no answer to the question of whether a patient is infected.
But similar PCR tests for other viruses do offer some sense of how contagious an infected patient may be: The results may include a rough estimate of the amount of virus in the patient’s body.
We’ve been using one type of data for everything, and that is just plus or minus — that’s all,” Dr. Mina said. “We’re using that for clinical diagnostics, for public health, for policy decision-making.”
But yes-no isn’t good enough, he added. It’s the amount of virus that should dictate the infected patient’s next steps. “It’s really irresponsible, I think, to forgo the recognition that this is a quantitative issue,” Dr. Mina said.
The PCR test amplifies genetic matter from the virus in cycles; the fewer cycles required, the greater the amount of virus, or viral load, in the sample. The greater the viral load, the more likely the patient is to be contagious.
This number of amplification cycles needed to find the virus, called the cycle threshold, is never included in the results sent to doctors and coronavirus patients, although it could tell them how infectious the patients are.
In three sets of testing data that include cycle thresholds, compiled by officials in Massachusetts, New York and Nevada, up to 90 percent of people testing positive carried barely any virus, a review by The Times found.
One solution would be to adjust the cycle threshold used now to decide that a patient is infected. Most tests set the limit at 40, a few at 37. This means that you are positive for the coronavirus if the test process required up to 40 cycles, or 37, to detect the virus.
Tests with thresholds so high may detect not just live virus but also genetic fragments, leftovers from infection that pose no particular risk — akin to finding a hair in a room long after a person has left, Dr. Mina said.
Any test with a cycle threshold above 35 is too sensitive, agreed Juliet Morrison, a virologist at the University of California, Riverside. “I’m shocked that people would think that 40 could represent a positive,” she said.
A more reasonable cutoff would be 30 to 35, she added. Dr. Mina said he would set the figure at 30, or even less. Those changes would mean the amount of genetic material in a patient’s sample would have to be 100-fold to 1,000-fold that of the current standard for the test to return a positive result — at least, one worth acting on.
The Food and Drug Administration said in an emailed statement that it does not specify the cycle threshold ranges used to determine who is positive, and that “commercial manufacturersand laboratories set their own.”
The Centers for Disease Control and Prevention said it is examining the use of cycle threshold measures “for policy decisions.” The agency said it would need to collaborate with the F.D.A. and with device manufacturers to ensure the measures “can be used properly and with assurance that we know what they mean.”
The C.D.C.’s own calculations suggest that it is extremely difficult to detect any live virus in a sample above a threshold of 33 cycles. Officials at some state labs said the C.D.C. had not asked them to note threshold values or to share them with contact-tracing organizations. ...
This amounts to an enormous missed opportunity to learn more about the disease, some experts said.
“It’s just kind of mind-blowing to me that people are not recording the C.T. values from all these tests — that they’re just returning a positive or a negative,” said Angela Rasmussen, a virologist at Columbia University in New York.
“It would be useful information to know[,] if somebody’s positive, whether they have a high viral load or a low viral load,” she added.
Officials at the Wadsworth Center, New York’s state lab, have access to C.T. values from tests they have processed, and analyzed their numbers at The Times’s request. In July, the lab identified 794 positive tests, based on a threshold of 40 cycles.
With a cutoff of 35, about half of those tests would no longer qualify as positive. About 70 percent would no longer be judged positive if the cycles were limited to 30.
In Massachusetts, from 85 to 90 percent of people who tested positive in July with a cycle threshold of 40 would have been deemed negative if the threshold were 30 cycles, Dr. Mina said. “I would say that none of those people should be contact-traced, not one,” he said.
Other experts informed of these numbers were stunned.
“I’m really shocked that it could be that high — the proportion of people with high C.T. value results,” said Dr. Ashish Jha, director of the Harvard Global Health Institute. “Boy, does it really change the way we need to be thinking about testing.”
The F.D.A. noted that people may have a low viral load when they are newly infected. A test with less sensitivity would miss these infections.
But that problem is easily solved, Dr. Mina said: “Test them again, six hours later or 15 hours later or whatever,” he said. A rapid test would find these patients quickly, even if it were less sensitive, because their viral loads would quickly rise.
PCR tests still have a role, he and other experts said. For example, their sensitivity is an asset when identifying newly infected people to enroll in clinical trials of drugs.
But with 20 percent or more of people testing positive for the virus in some parts of the country, Dr. Mina and other researchers are questioning the use of PCR tests as a frontline diagnostic tool.
People infected with the virus are most infectious from a day or two before symptoms appear till about five days after. But at the current testing rates, “you’re not going to be doing it frequently enough to have any chance of really capturing somebody in that window,” Dr. Mina added.https://www.nytimes.com/2020/08/29/health/cor...
* * *How Dr. Fauci Found Himself Talking to Julia Roberts, Lil Wayne and Just About Any Podcaster Who Asked ...
On March 15, as the novel coronavirus was beginning to surge in the United States, Dr. Anthony S. Fauci accomplished a rare Washington feat: He appeared on all five major Sunday talk shows.
But the White House worried that Dr. Fauci might upstage (and sometimes contradict) President Trump, and soon his media handlers were no longer approving his high-profile interview requests.
So Dr. Fauci found another way to get his message out: He said yes to pretty much every small offer that came his way: academic webinars, Instagram feeds and niche science podcasts, as well as a few celebrity interviews. ...
... it may be how he ended up with a polyp on his vocal cord. “Essentially I was talking all day without interruption for six months,” he wrote in an email message on Friday, the day after he had surgery to remove it. ...
The coronavirus pandemic has turned Dr. Fauci, a career government scientist first propelled into public view in the early years of the AIDS epidemic, into a genuine celebrity. There is now all manner of Fauci swag — Fauci socks, T-shirts, coffee mugs, buttons, stickers and masks. ...
That renown has pushed him into the higher echelons of media interest. Most people need a slot on a major show to have a better chance of reaching a huge audience. But reporters track all of Dr. Fauci’s appearances, however obscure. ...
Whether by design or not, Dr. Fauci has effectively circumvented efforts by the White House to mute him. Since Mark Meadows took over as chief of staff on March 31, White House communications officials have approved very few requests from major outlets. But there is no such review process for smaller ones, like the weekly podcast of the Journal of the American Medical Association ...
https://edhub.ama-assn.org/jn-learning/audio-... ? )
His appearances are widely watched by reporters from larger outlets, who then quote him in their news reports. ...
Our charts track Dr. Fauci’s broadcast appearances from March 1 to Aug. 20, the day of his operation. We included video and audio appearances listed on Dr. Fauci’s National Institutes of Health web page,
( https://www.niaid.nih.gov/news-events/directo... )
and others we uncovered through searches ...
Dr. Fauci has rarely appeared on CNN’s prime-time broadcasts, but he did grant an hourlong interview to “The Axe Files,”
( https://podcasts.apple.com/us/podcast/ep-396-... )
a CNN-backed podcast hosted by David Axelrod, who was a top adviser to President Obama. “Tony is the personification of the nagging reality that science presents,” Mr. Axelrod said. ...
Journalists with major news broadcasts are frustrated they can’t book Dr. Fauci during a public health emergency. ...
Yet Dr. Fauci’s accessibility is a boon for smaller outlets that can’t always book such a prominent guest. In July, Vincent Racaniello, a Columbia University professor and the co-host of a podcast, “This Week in Virology,” inquired about an interview. Dr. Fauci agreed almost immediately. ...
Dr. Fauci spoke on the podcast for 30 minutes, sharing his assessments of the latest science on Covid-19 and the strategies that various pharmaceutical companies were using to investigate vaccines. The audience for the 12-year-old “This Week in Virology” has been growing since the pandemic hit, but the Fauci episode has been its most popular one, with close to 100,000 combined podcast downloads and YouTube views.
He is keenly aware of his media profile; he knows, for instance, that the March 15 string of Sunday shows amounted to a “full Ginsburg.” (The reference is to William H. Ginsburg, a lawyer for Monica Lewinsky, who appeared on all five Sunday shows in 1998.)
But his inclination to say yes — and his friendships with prominent journalists — has sometimes gotten him in trouble, as it did when his friend Norah O’Donnell interviewed him for InStyle magazine. Dr. Fauci was photographed by his backyard pool wearing sunglasses — an image that did not sit well with Republicans, and one he now says he regrets. ...
His friends say he has overextended himself; Mr. Staley said he had lately been encouraging Dr. Fauci to “take an axe to his schedule.” The polyp surgery has done that for him. He can’t do extended interviews until September.https://www.nytimes.com/interactive/2020/08/2...Trump Program to Cover Uninsured Covid-19 Patients Falls Short of Promise
Some patients are still receiving staggering bills. Others don’t qualify because conditions other than Covid-19 were their primary diagnosis. ...
... care is supposed to be covered under a program Mr. Trump announced this spring as the coronavirus pandemic was taking hold — a time when millions of people were losing their health insurance and the administration was doubling down on trying to dismantle the Affordable Care Act, the law that had expanded coverage to more than 20 million people.
“This should alleviate any concern uninsured Americans may have about seeking the coronavirus treatment,” Mr. Trump said in April about the program, which is supposed to cover testing and treatment for uninsured people with Covid-19, using money from the federal coronavirus relief package passed by Congress.
The program has drawn little attention since, but a review by The New York Times of payments made through it, as well as interviews with hospital executives, patients and health policy researchers who have examined the payments, suggest the quickly concocted plan has not lived up to its promise. It has caused confusion at participating hospitals, which in some cases have mistakenly billed patients like Ms. Cortez who should be covered by it. Few patients seem to know the program exists, so they don’t question the charges. And some hospitals and other medical providers have chosen not to participate in the program,
( https://www.timesunion.com/news/article/Compa... )
which bars them from seeking any payment from patients whose bills they submit to it.
Large numbers of patients have also been disqualified because Covid-19 has to be the primary diagnosis for a case to be covered (unless the patient is pregnant). Since hospitalized Covid patients often have other serious medical conditions, many have other primary diagnoses. ...
Critics say the stopgap program is among the strongest evidence that Mr. Trump and his party have no vision for improving health coverage, and instead promote piecemeal solutions, even in a national health crisis. Mr. Trump had promised a plan to replace the Affordable Care Act by the beginning of August, but none has been announced and he and other Republicans barely mentioned health policy in their national convention last week. ...
The program has clearly paid what, in many cases, would be staggering and unaffordable bills for thousands of Covid-19 patients. In addition to hospital care, it covers outpatient visits, ambulance rides, medical equipment, skilled nursing home care and even future Covid vaccines for the uninsured, “subject to available funding.” It does not cover prescriptions once patients leave the hospital, or treatment of underlying chronic conditions that make many more vulnerable to the virus. ...
... the Kaiser Family Foundation, a nonpartisan research organization, has estimated that hospital costs alone for uninsured coronavirus patients could reach between $13.9 billion and $41.8 billion, far more than what the program has paid out so far. ...
Nationally, the total average charge for uninsured Covid- patients requiring a hospital stay is $73,300, according to FAIR Health, a health care cost database, although they may be able to negotiate a lower amount. ...
Despite its limitations, some hospital executives said they liked the program because it paid Medicare rates, which are considerably higher than those for Medicaid, the government health insurance program for the poor, or any normal funding they would receive for charity care.
“This was a really progressive policy we were really surprised by, frankly,” said Dr. Shereef Elnahal, the chief executive of University Hospital in Newark, N.J., which has received $8.2 million for treating 787 uninsured patients with Covid, about a third of its coronavirus patients. ...
The Trump administration has not said how much money it will ultimately allot for the Covid-19 program. It is a small part of the Provider Relief Fund, which totaled $175 billion to start but has been spent down to $60 billion. Most of that money has helped health care providers cover financial losses during the pandemic.
A spokeswoman for the Department of Health and Human Services said in an email that it had not set a limit on how much of the fund would be spent on covering uninsured costs. She said the agency had no plans to change the program to cover patients for whom Covid is a secondary diagnosis.https://www.nytimes.com/2020/08/29/health/Cov...