As of 02/28/2020, a second case of COVID-19 with an unknown origin has been confirmed in San Francisco County. These 2 confirmed cases are not linked to each other, nor do they have any known contacts with other known COVID-19 patients. They also do not have a history of travel to the high-risk areas and no known contacts with travelers to those areas. This is a significant development in the story of COVID-19 (AKA nCoV-2019) in the USA as it suggests that there is one or more undiagnosed person spreading the disease. This blog post will attempt to address some of the questions that comes up from this development.
Is the CDC completely retarded?
There has been backlash against the CDC (US Center for Disease Control) because of the COVID-19 testing criteria. As a practicing medical doctor in California, I have been privy to early information on how CDC recommends community physicians approach the COVID-19 issue. In short, the CDC wants doctors to only test clinical symptomatic patients that have “high risk” histories, such as travel to affected areas of China. This recommendation made sense at first, as testing capabilities were extremely limited in the beginning (late January) and the outbreak was pretty much contained in China. I thought the CDC’s recommendations made a lot of sense given the early situation of COVID-19 in late January.
As we know now, the person-to-person spread of the disease is occurring quite regularly. There was an explosion of cases in China. It is only a matter of time before the virus jumps away from the high-risk population (the Wuhanians) and begin spreading to other group of people who have no direct connection to China. Unfortunately, as the COVID-19 situation evolved, the CDC did not update their guidance on testing. In other words, you can have an actual patient getting sick from COVID-19, but no confirmation testing is done! This exact situation did happen in California! The UC David patient was so sick from COVID-19 (but not confirmed/diagnosed) on 2/19/2020. The UC Davis medical team requesting testing for coronavirus, but the CDC didn’t get doing so until 02/23/2020. The positive test returned on 02/26/2020. It took 7 whole days in a top-tier American hospital!
So it is understandable to see that the CDC may have made some mistakes. They are guilty of not updating their testing guidance with the evolving story of the COVID-19 situation. When it was clear that the virus is actively spreading from human to human, actively spreading away from the high-risk Wuhan area – the CDC did update its guidance to reflect the new situation.
Why not just test everyone?
There are not enough tests to go around. In America, the land of the plentiful, it is hard to imagine that there is a resource that we are limited to. Unfortunately, the COVID-19 testing protocol only has a certain capacity. That capacity cannot accommodate blanket testing for every sick patient that enters the hospital. Think of it this way, remember the UC David patient we discussed above. He was so sick that he had to be placed on a ventilator (machine breathing for him). Compare him to his fictional neighbor, someone with mild flu symptoms that is caught up in the COVID-19 hysteria. If we “wasted” a limited COVID-19 confirmation test on hysterical neighbor to soothe said person’s anxiety, UC David ventilator patient would have his testing delayed for a few days – and for the ventilator patient it may be the difference between life and death. As a society, we need to intelligently ration out the limited resource of COVID-19 testing, prioritizing tests to patients that will benefit the most (ie actually treating a medical problem) as opposed to “wasting” testing to appease another person’s COVID-19 anxiety. Bright side, we do live in “MAKE AMERICA GREAT” so I do think that testing capacity will only increase as time moves on.
Is there asymptomatic spread of COVID-19?
Yes and no, but technically no. I believe most transmission are from undiagnosed symptomatic patients. IE someone in the bus who is sick with COVID-19 but keeping it to himself at the expense of infecting others (such as our poor UC Davis ventilator patient). From the perspective of the UC Davis patient, he doesn’t know that the people in his surroundings have symptoms of the disease, so it seems like he caught it from an asymptomatic patient. So in a sense, practically you can get COVID from someone in your proximity that is not obviously sick. Based on how virus work, a person has to be “sick” with them and have “symptoms” for the virus to multiply enough to spread. A COVID-19 must have some symptoms to be contagious. So when you hear people claim “asymptomatic spread!” they mean you can pick it up from a COVID-19 infected who is hiding his symptoms, not from another perfectly healthy person.
What will happen in America?
The truth is no one knows. There is one caveat – that social media algorithms prioritize emotionally charged headlines, so the communications that will trend will likely be some kind of anxiety provoking narrative. That is just a bias introduced in social media. Truthfully no one really knows what will happen. COVID-19 can explode uncontrollably, just like how it did in China a few weeks ago (until they controlled it again, go China!) Or COVID-19 can just dry out, like liquid nitrogen exposed to room temperature. Speaking of drying out, Southern California was 86 degrees today… in February. It sure sucks for someone like me who like winter, but sucks even more for virus (such as COVID-19) which tend to go away with warmer seasons. I personally think that more scary cases will occur in America over the short-term, but ultimately the problem will be contained one way or another in the medium term. My investment accounts are counting on it!
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