By Kevin Roche
We are all prone to a variety of thinking biases, including looking only for evidence that supports our pre-conceived notions. This is particularly the case among those who are trying to convince us all that coronavirus is the bubonic plague and we must all give up everything that makes life worth living and encase ourselves in concrete until every coronavirus, and maybe every other virus or bacteria on the earth, is wiped out. Here are two studies that have been widely misused and mis-interpreted, I believe intentionally, to make us think it is worse that we could possibly believe.
The first relates to viral loads in children, and has been used by people to suggest, oh my God, we have to keep the schools closed. (JAMA Article) Please note that once again, the authors are a little disingenous in what they did. They said that closing schools precluded a real understanding of children as a source of transmission, but all around the world schools were kept open or re-opened and the evidence from those countries is unequivocal in regard to children’s limited role in transmission. The authors examined test swabs from 46 tested persons under age 5, 51 aged 5 to 17 and 48 adults 18 to 65. Supposedly their results found more virus in the upper respiratory tract of the 5 and under age group than the other two groups. They interpreted this to mean that we have to be careful about transmission by school age children. Under five is not school age. The day care studies, including in Minnesota, show basically zero transmission in children in day care. They excluded asymptomatic cases from the study. Why? Especially if that is the majority of cases in children. They only tested for viral RNA, which has nothing to do with infectiousness, you have to culture to determine that. Every study around the world finds children to be a very limited source of transmission. Oh, and there was no correlation between symptoms and amount of virus. Garbage again, in terms of the conclusion the authors tried to push.
The second relates to an outbreak at a youth camp in Georgia and has been used to suggest that, oh my God, we have to keep the schools closed. You see the pattern. (CDC Report) A training session for staff was held June 17-20, and the camp was scheduled for June 21 to 27 so over a month ago. 138 trainees and 120 staff were at the training session and the staff stayed and 363 campers and three more senior staff arrived for the actual camp. 31 cabins, varying in size were used. The campers, trainees and staff were required to have a negative test within 12 days of arriving at the camp. Most recommended precautions were taken, except that extra ventilation may not have been used in the cabins and masks were not required for campers, although some may have worn them, and cloth masks were required for staff. Activities, horror of all horrors, included “vigorous singing”. On June 23rd, 2 days after the camp opened, a staff member reported symptoms, left the camp and tested positive the next day. The camp was promptly closed.
In all 597 Georgia residents attended the camp as staff, trainees, or campers. There were some out-of-state attendees. Subsequent reported testing of 344 attendees found that 260 were positive, but due to the fact that negative results were often not reported in Georgia, it is likely that the remaining 253 attendees were tested, but had negative tests, so the positive rate was 44%. Of 136 people on whom symptom data was available, 26% had no symptoms and the rest were mild. I am guessing that the remaining 124 people for whom there wasn’t symptom data were asymptomatic, as would be typical in this age group. For the tested group, 51% of those ages 6 to 10 were positive, 44% aged 11-17 were positive, and 33% aged 18 to 21 were positive. The largest cabins had the highest positive rates. Staff had the highest positive rates at 56%. Recall that staff had to wear masks.
Any hospitalizations that were going to occur, would have occurred by now among this group. There is no mention of them in the report, so I don’t think they did happen. The authors note that they could not assess individual adherence to things like wearing masks among the campers. So what do we know about this situation? One thing we know is that it is not like school–students attending elementary and secondary schools are there for 6 to 8 hours; they don’t live there and they aren’t in the close contact implied by having as many as 30 people in a cabin. The second thing we know is that it wasn’t a camper who had the first illness, it was a staff member and given that people had negative tests before showing up, the staff member must have been negative at most 5 days before showing up at the camp. So it is likely that this person picked up the virus between the test and coming to camp. We also don’t know that this person was the index case, they very well could have picked it up from another person. We are given no information about the tracing of the chain of transmission. Given the usual chains of transmission, it would be most likely that an adult staff member brought the virus to the camp, or that multiple people brought it, having picked it up between their pre-camp test and coming to the camp. False negatives also do occur. As it always does, once in a confined setting, the virus spread efficiently. But with the resulting infections, as far as we are told, being exclusively asymptomatic and mild illness. Any more serious illness would have been reported by the time of this report. But the most important thing to realize is that this is not like a school situation and that we don’t know the exact chains of transmission. Among the children, was it child to child, or was it largely from adult to child, as other studies have found.