By my count, it is week 18 of restrictions imposed upon us by the COVID-19 pandemic. It feels like “the new normal” has set in. Here in Pennsylvania, all of the state is in the so-called “green” phase, where the remaining businesses have opened, and we can now go to bars and restaurants albeit with masks and appropriate distancing. Our case numbers per day continue to trend downward except in Allegheny County (Pittsburgh). There the numbers are slowly increasing.

There is been great concern about the surge in new coronavirus cases in multiple states. Florida for instance has seen a significant increase in new cases over the last several weeks. If you look at the long-term graph of cases per day however, this surge looks like the state’s first true peak. Deaths are on the rise there. Interestingly there are reports out of Florida that a significant number of sites had an 80-100% positivity rate (our positivity rate in April was around 27% which is typical). This sounds like there are testing issues in the Sunshine State.

Georgia, which up to now had been fairly quiet, has seen its own increase, but so far deaths are flat. Another hot spot, Texas, new cases, and deaths are continuing to rise at this point. This is mainly centered in the cities and much of Texas remains quiet.

I should point out that the Texas hotspots of Houston, El Paso, and Austin were the site of significant protesting/mayhem in previous weeks. This is also true of Miami, Seattle, and Portland Oregon, where cases are also rising.

My concern about this situation regards the data on which it is based. Because it appears there are serious problems with the acquisition and reporting of COVID testing that could lead to bad decisions down the road.

There have been several interesting articles published in the last several weeks. Several sources I’ve pointed out that state by state, reporting of new cases uses different methodology. The CDC and apparently some states report both positive PCR tests (swab test), and positive antibody tests (blood test) as new cases (I understand this is true in PA). This is problematic.

First off, PCR test, or polymerase chain reaction test looks for pieces of the coronavirus RNA. This RNA can be present on your mucous membranes whether you’ve been merely exposed to the virus but not infected. The test detects segments of RNA that can either represent either intact virus actively spreading, or fragments of virus successfully destroyed by your antibodies or T cells. So, it may report a failed infection as positive.

Also, it is important to remember that we are reporting positive tests, not positive patients. If the patient has a positive PCR test, and weeks later has a repeat study and it remains positive, then that’s counted as another positive test even though it’s on the same person. And again there is the thought that the positive PCR in that situation may reflect the presence of viral debris at the end of the infection. So any way you look at it, it is bad data.

The antibody test, as most people know is geared to discover whether someone has been infected in the past. If we count these positives in the same way we count the PCR, then we can give the false impression of additional viral spread occurring in real time when that is not necessarily a valid conclusion.

Also, the dynamics of testing have changed radically in the last 3 months. It used to be that you needed to have very specific symptoms and be in a high-risk group to obtain a nasal swab test. Now you can essentially obtain testing on a whim. Thus, it is likely that many more asymptomatic patients are being tested.

We do know that the uptick in cases has also involved a roughly 10 years shift in average age downward. This means that the average person exposed is likely much less vulnerable.

 So, if a younger patient tests positive by PCR but has no symptoms is this really an actual infection or an aborted one? These are questions I don’t think we really understand. But we still count them as positives.

So, it would appear that the actual impact of each additional positive coronavirus test in July may be different than one in early April.

Need evidence of this? There is recent data from the University of Pittsburgh suggesting that the recent strain of COVID being encountered is perhaps less virulent than previous sprains. They note that only 2% of people who test positive now require hospitalization. And only 0.2% of cases result in death, far lower than previous statistics. Given the different profile of patients getting tested this might actually have been true all along.

There is another thing to consider. When we locked things down in March, we had little to no knowledge of how to treat these patients. We had shortages of hospital beds, PPE’s and of course ventilators.

Now, 4 months later, the healthcare system has adequate supplies and additional expertise in the care of these patients. We figured out how to reprioritize and add additional patient care units and negative pressure rooms. New discoveries in therapeutics are reducing the severity of illness and shortening the length of admissions. We are far more ready and capable than we were in the spring.

I should mention the hydroxychloroquine study out of Henry Ford Hospital in Detroit. They studied patients hospitalized with COVID. In one leg of the study, the patients were treated with hydroxychloroquine alone. These were compared to patients but did not receive the drug. The mortality rate for those in the treatment arm was 13% as opposed to roughly 26% in the nontreatment arm. There were negligible cardiac difficulties, which is the main concern over the use of the drug. This is a peer-reviewed study, the first significant evidence for use of the drug. So it is likely we can finally add this medication to remdesivir, and dexamethasone in our anti-coronavirus armamentarium.

There is also emerging information that many people may well have had some degree of both antibody and T-cell immunity to this particular coronavirus based on previous exposure to the “common cold” coronavirus that we have all encountered for most of our lives. This virus may not be so “novel” as we have been told.

I guess what I really want to say is this: We need to be careful about how we react to these surges.  In places where the healthcare services start to become strained, then we need to react strongly to avoid further spread. But in places where the numbers merely go up without much impact, then we need to remain vigilant,. We need to protect the vulnerable, but continue to go about our business with precautions in place.

As I am a compliant soul, I will wear my mask and observe the CDC recommendations. I will respect the businesses I visit, and obey the rules so they will not be penalized by the state.

So I wrote the words above between Monday 7/13 and Wednesday afternoon 7/15. I just needed a punchy way to end it.

I get home and turn on the news only to find that his Majesty the Governor has reimposed lockdowns?… on the whole state? He has targeted the bar-restaurant trade which I suspect he views as a more frivolous business and the least defendable (tell that to the owners and employees).

There is no justification for this in the state’s own data. First off, cases were bound to kick up a bit when we went to green several weeks ago. Then there is the fact that the increases are limited to a few counties in the west. Remember the announcement above from UPMC?

So I went to the State’s own COVID Early Warning Dashboard. In Allegheny county, the PCR positivity rate is 7.9%. The percentage of ER visits related to COVID is 0.9%. Pittsburg has multiple very large hospitals. There are 80 patients admitted with COVID, only 9 on ventilators. All of this in the State epicenter.

I’m sorry, but this feels purely political. It is tyranny in the Commonwealth of Pennsylvania.

What do you think…punchy enough?