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Coronavirus Blood Tests May Bring a Reckoning

(AP Photo/Rich Pedroncelli, Pool)

Antibody testing will soon clarify how many have contracted COVID-19, and its real mortality rate. Those results could determine who survives the political fallout.

In Gangelt, a small German town near the Dutch border that had been hard-hit by COVID-19, virologists recently completed a local study in which they set out to test the blood of approximately 80% of the population (~1000 people) for the presence of SARS-CoV-2 antibodies. Their results gave the world its first glimpse into how far the virus has spread, relative to its death count.

Much more data will soon come from around the world as the necessary antibody blood tests are approved, verified, and made widely available. That data—and, particularly, the mortality rate that is calculated therefrom—can be expected to directly impact the future careers of many American public figures.

Until very recently, the only test that has been available has been the RT-PCR test (Reverse Transcription Polymerase Chain Reaction; also called “PCR”) of mucosal swabs, wherein advanced genetic techniques are used to amplify and detect the presence of minute viral genetic material (RNA) in samples. The test, which is rarely used on asymptomatic people, is not very accurate and completely misses people who have already recovered from the infection and no longer have the virus in their bodies. If millions of people have been exposed to the virus and recovered, this test could miss them all.

The blood antibody (“serology”) tests recently approved in the United States by the FDA will identify who has ever been infected—not just those who are actively infected. This is accomplished by checking for the presence of antibodies typically produced by the immune systems of infectees. (Some antibodies, called “IgM” type, can even tell us if the infection is recent.) The virus can be long gone from the body, but the antibodies in the blood remain; serology tests detect those antibodies.

In the coming days and weeks, blood antibody testing will be performed on a representative sample of the U.S. population, after which we will finally have a reliable estimate of the number of people exposed to COVID-19 since it first appeared: its prevalence. That number is going to be vitally important. The higher the prevalence number, the lower will be the calculated mortality (aka “fatality”) rate of COVID-19.

The mortality rate formula is: [the number of deaths from COVID-19] divided by [the total number of COVID-19 cases].

The mortality rate for the seasonal flu is widely considered to be 0.1%. (I.e., one out of every 1,000 flu infectees dies.) If the mortality rate for COVID-19 turns out to be significantly higher than that 0.1%, the politicians who shut down the world’s economy, threw millions out of work and disrupted life as we know it, will be able to claim that they were justified in their actions. They will survive politically.

The results from Gangelt, however, are not encouraging for the lockdown crowd. That study found that about 15% of the population at that time had been exposed to COVID-19 (either currently active or in the past). Using that data, the morality rate for the town at that time was calculated to be 0.37%. Note that Gangelt was impacted early in the pandemic, when they were wholly unprepared, and that may have pushed up their mortality rate at that time.

Until results are available from sufficient blood antibody testing in the U.S., there is no way to know how many Americans have already been exposed to the COVID-19 virus. The Gangelt data is the best information we have at the moment. If those findings are applied to the U.S. (and since weeks have passed since those tests were done, the spread of the virus in the U.S. could actually be significantly wider), that would mean that approximately 49 million Americans have been exposed to the SARS-CoV-2 virus to date (15%). As of April 18, there have been 31,217 confirmed COVID-19 deaths in the U.S., with an additional 4,226 “probables.” (The numbers may be inflated by overdiagnosis, but that is a different issue.) Plugging these numbers into the formula gives an overall mortality rate of between 0.06% (1 per 1,666 cases) and 0.07% (1 per 1,428 cases)—little more than one-half that of the seasonal flu.

That didn’t happen, unfortunately. But Dr. Ioannidis’ analysis is still useful now in that it predicted a mortality rate range of 0.05% to 1%. The results for the U.S. using the Gangelt study’s findings are in range.

It is important to note that none of this is certain yet. However, there is some corroboration of the Gangelt conclusions in The Atlantic’s COVID Tracking Project report, which found that about 20% of Americans test positive for SARS-CoV-2, regardless of location and symptoms (described as the “test-positivity rate” for the United States). It seems the mortality rate for COVID-19 might actually be less than 0.05%.

A possible low mortality rate was predicted by Stanford’s Dr. John P.A. Ioannidis in his early analysis of the pandemic, which should have served as a beacon of understanding to all those rushing to shut down the economy. That didn’t happen, unfortunately. But Dr. Ioannidis’ analysis is still useful now in that it predicted a mortality rate range of 0.05% to 1%. The results for the U.S. using the Gangelt study’s findings are in range.

If it turns out that 0.05% to 0.07% is a correct approximation of the actual mortality rate for COVID-19, the politicians who shut down the economy—and the doctors and experts who advised them—will pay a heavy price for their mistakes. It is hard to imagine any such politician ever winning another election; attacks from the opposition will be ferocious.

Some may argue that lockdown proponents only acted on the information they had at the time. This would be false. Many warned that country-wide lockdowns were a vast overreaction. In addition to Dr. Ioannidis’ clear and early warning (above), here’s another, and another, and another. (Here is my early piece on the subject, and its follow-up.)

Some facts: the only way to protect the most vulnerable individuals from a viral pandemic for which there is no current vaccine is to sequester them until the danger passes. Danger passes only when most of the population is immune (“most” is currently estimated to be 60% but could range up if the infectivity of the virus turns out to be higher than currently estimated). That immunity in the population can happen either naturally, through exposure to the virus, or via vaccination. If you effectively sequester virtually everyone in the country, as we have in the U.S., natural immunity in the population becomes impossible. The virus cannot spread, so neither can immunity to it. And effective vaccination is years away (more on that below).

Therefore, the widespread early lockdowns implemented in places like California, Ohio, Missouri, Texas, Minnesota, Utah, North Carolina and many other states—where there has never been any significant surge of COVID-19 cases, and nothing approaching healthcare system overload—were never necessary or advisable. (Note: Most of these states have already passed their peaks of COVID-19 cases, yet the lockdowns remain.) The result has been an insufficient level of population immunity. And if the coming blood antibody studies indicate that COVID-19’s mortality rate is approximately equal to the flu’s (or possibly lower), those early closures will be correctly characterized as catastrophic mistakes of epic proportions.

It is also important to note that the early lockdowns may not save any lives in the end. They may, in fact, have the opposite effect, with some of the most vulnerable people losing their lives unnecessarily. Here’s why: Had the highest-risk group been quarantined while everyone else was allowed to build immunity to the virus, as nature normally works, those vulnerable individuals would have eventually been released into a world in which most people were already immune and, therefore, incapable of transmitting the virus. They would have been reasonably safe. Now, because of the early lockdowns, those high-risk individuals will find that relatively few of the people around them are immune, putting them in constant danger of infection.

To avoid that unfortunate eventuality, the most vulnerable people will have to be sequestered long after everyone else is released. In other words, we will need to finally do what we should have done from the beginning: sequester only high-risk people while allowing everyone else to build immunity. That is the only way to make the world safe for everyone at this time.

Finally, lest you think that a vaccine will come and save the day: There has never been a successful coronavirus vaccine, despite the presence of these pathogens in our midst for decades, and two prior epidemics (SARS and MERS). The only coronavirus vaccine ever tested was given to cats and failed miserably, sickening them rather than protecting them. Barring a dramatic and historic scientific breakthrough, the fastest a vaccine can be made and properly tested is two years. It might be five years. It might be never. And even after one is made and tests well, it would take about one full year to distribute it widely enough for it to work. Any way you look at it, the time frame for an effective vaccine—if it exists at all—is almost certainly too long to rely on.

A political reckoning is coming. If COVID-19’s mortality rate turns out to be high, people who locked down the world will have a ready explanation for their actions when the inevitable studies and investigations come. If that rate is low—in the range of the flu’s 0.1%—there will be hell to pay.

Late Breaking News
As this article was being finalized, a preliminary report out of Stanford University was released wherein a representative random sample of residents of Santa Clara County, California, were tested for the presence of SARS-CoV-2 antibodies. The study found that the number of people who have been exposed to the virus in that area was between 50 and 85 times the number of known confirmed COVID-19 cases in the same area. This is the first such data we have from the U.S. If these findings are widely applied, the total number of Americans who have been exposed to SARS-Cov-2 (and are, therefore, presumed immune to it now) would be between 34.5 million and 58.7 million. Given that the count of COVID-19 deaths as of April 15 (the endpoint of the study) was 32,458, that calculates to a mortality rate between .05% and 0.09%. Once again, we see a mortality rate result that is lower than the 0.1% of seasonal influenza, possibly by half.

Did we just let our elected officials shut down our world over a viral illness that is less dangerous, less lethal, less worrisome than the common flu? The definitive answer will arrive in a matter of days. If it’s “yes,” the backlash is likely to be fearsome.

Joshua Leichtberg, M.D. is a medical doctor specializing in internal medicine and is based in Southern California.

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Abe
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Abe

Except there’s no guarantee individuals will retain immunity for any amount of time. If this coronavirus is like other coronaviruses then we’ll only retain immunity for less than a year, potentially only a few months. Unrestrained, and as infectious as this disease is, we could see a much higher mortality rate as this thing washed back and forwards through the nation overwhelming hospitals. You’re assuming that since hospitals haven’t already been overwhelmed that would continue to be the case. Simply put: mortality rate is a function of number of severe cases and hospitals’ ability to treat them. It’s far too early to make the claims you’re making here. Add to the above that many of the serologic tests have notoriously high rates of false positives and very low accuracy, which makes it likely we’ll derive the wrong conclusion from any of these studies.

Josh
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Josh

It’s easy to say that the information we have is incomplete, because it must be incomplete when dealing with a brand new virus. We must use the best data we have, which this article enumerates. As for how long immunity to other coronavirus infections lasts, here’s a study published by the NIH about the SARS epidemic which found that immunity lasted 2-3 years: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851497/ . Many hospitals are now in danger of going broke because they’re so empty. It’s pretty ridiculous to say they’re in danger of overload now. Could it happen? Always possible, of course. That’s why we have to continue to track the progress of the pandemic over time, and lock down if it looks like real overload is coming. Main question: When you have incomplete data, but the data you do have points to a mild illness with a mortality rate roughly equal to the flu’s, do you shut down the entire economy, throwing millions into poverty and despair, or do you wait until the data clearly… Read more »

Sam
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Sam

I want to be just like Dr. Josh when I graduate from college and medical school. He has the courage to say what he thinks and not buy the dogma of what everyone else is saying. What a courageous doctor

A A
Guest
A A

I’m surprised by the simple minded analysis. While I’m sure many, including the esteemed physician wrote this piece, would be pleased to call the shutdown a “mistake” if the mortality rate proves to be low, surely politicians should not assume the best case and fail to prepare for the worst case. The only “mistake” here would be failing to reopen the economy if, in fact, the data supports a low mortality (and hospitalization) rate.

Josh
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Josh

Politicians should have been very, very wary of shutting down the economy of the whole United States and throwing millions out of work and into poverty — which itself causes many problems, including increased deaths that could easily outnumber those of COVID-19 — if they had incomplete information. If these lockdowns are to be considered reasonable, then those same politicians could (and arguably should) make it illegal to buy soft drinks and sugary breakfast cereals (diabetes deaths are estimated at 1.6 MILLION/year in the U.S. alone), make the speed limit 10 or 15 MPH (38,000 traffic deaths per year), bring back Prohibition (alcohol deaths/year = 88,000) and take all kinds of other (ridiculous) actions to stop any number of other life-destroying threats. They would be entitled to treat the American public like children, as they have. Sweden got it right. They advised their people on basic precautions, but did not shut down their economy. We got it completely wrong, and more evidence about that will continue to pour in from… Read more »