Objections to Prevention

It didn’t take long before the 1–2 shares of my post on testing to attract someone who had problems with what I said. They helpfully provided a rundown of the top objections I’ve heard to basic COVID-19 prevention strategies, which made it seem worthwhile to systematically address them.

After enthusiastic support in the comments from my mom and brother, I saw this:

Your graph needs alot more false results. They are testing until they get a positive result- as though a positive is what is desired. If this was a true epidemic, we wouldnt need test to prove it. There would be symptoms and dead bodies- not everyone coming into the hospital feeling fine but getting positive results. Mankind has survived with diseases and viruses for this long- becoming germaphobes and suffocating everyone with mask is not the answer! All this is doing is taking our freedoms away. I am appalled that you feel you need to “dumb” the concept down. Michael, you are not a parent. You are not feeling the real damage this is causing. Babies being taken away at birth, because of a false positive where the mother feels fine. Children not allowed in schools and being confined when this hasnt even effected children. You and Rachel really need to step back and get a different perspective. There are doctors out there with actual years behind them who see this for what it really is. Please stop spreading mask propaganda- it does nothing but bring everyone’s O2 down and bacteria into their lungs. My mom put a pulse ox on a 9 year old boy after putting his mask on… in less then a minute his O2 levels dropped below what they should be. I know you took pride in this post… but more is at stake then you could ever imagine. And while you dont have children to worry about their future.. I do!

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Now for the breakdown:

Your graph needs [a lot] more false results.

This may not have been clear, but the graph in the post is simply an illustration of how false positives and negatives interact with each other; it does not represent any actual data. I am not yet aware of any solid data on the sensitivity and specificity of SARS-CoV2 testing, unfortunately. The merits of different tests were discussed in a recent issue of Annals of Internal Medicine, while community utilization of the more rapid-result tests showed a low sensitivity (remember, that means a high false negative rate).^​1,2​

They are testing until they get a positive result- as though a positive is what is desired.

Here, I am one of “them,” and what I can say is that I reorder testing when I have someone who is clearly symptomatic, but tested negative. In these cases, the test doesn’t match what I am seeing in front of me, so I treat the patient based on what clinically makes sense and in the background, order a repeat test.

This is important: I believe I can speak for my colleagues as well when I say that we do not rerun the test for fun or because we “want” a specific result, but because the results are not making sense given the sick person in front of us. At the same time, we are also considering other things that could cause those symptoms—like cancer.

If this was a true epidemic, we wouldn’t need test to prove it. There would be symptoms and dead bodies- not everyone coming into the hospital feeling fine but getting positive results. Mankind has survived with diseases and viruses for this long- becoming germaphobes and suffocating everyone with mask is not the answer!

Here in San Diego County, 478 people have died.^​3​ These are not abstract numbers, these are actual human beings my friends and I take care of in the hospital. And we still have it easy: In New York, overwhelmed funeral homes are renting trucks to keep bodies on ice. As of July 19, 2020, the United States of America has reported over 140,000 deaths, even before any sort of long-term complications that might happen in the future. Dying from viruses is something we would like to think of as preventable, certainly in the US, and right now, it’s not.

All this is doing is taking our freedoms away.

When did it become freedom to contract and spread disease? I admit I have a hard time understanding how citizens of the country that rationed gasoline, meat, and butter have difficulty wearing a fabric mask.

Please stop spreading mask propaganda- it does nothing but bring everyone’s O2 down and bacteria into their lungs. My mom put a pulse ox on a 9 year old boy after putting his mask on… in less then a minute his O2 levels dropped below what they should be.

I find that instantaneous result a little surprising, especially given the variability in continuous pulse oximetry readings. Thankfully, I found some folks who were really interested in this question during the early part of the decade. There are indeed some small physiologic changes when wearing a mask, similar to how there are small physiologic change when we travel to higher altitude; however, in addition to having no impact on activity, the people being tested didn’t notice, even when they were wearing more restrictive N95 masks.^​4–6​ Our bodies are able to compensate pretty well, even under exercise conditions! Additionally, no one is being asked to wear masks continuously: kids (and adults) can be happily mask-free while at home. This includes outdoors, for those lucky enough to have yards.

The second part of this is the question of whether or not the small changes described above are worse than spreading an incapacitating if not outright deadly disease. After all, if masks don’t work, why bother being uncomfortable? I read the paper so you don’t have to: it turns out they’re likely to be effective.^​7​ In a meta-analysis of multiple different studies with a combined ten thousand people, wearing a mask can potentially drop the rate of transmission by 14%, from ~17% without masks to ~3% with them.^​7​ Physical distancing can drop it by 10%, with even stronger statistical numbers supporting that conclusion.^​7​ This is real-world data supporting what the computer modelers were saying back in April.^​8​

Michael, you are not a parent. You are not feeling the real damage this is causing. Babies being taken away at birth, because of a false positive where the mother feels fine. Children not allowed in schools and being confined when this hasnt even effected children. You and Rachel really need to step back and get a different perspective. There are doctors out there with actual years behind them who see this for what it really is…I know you took pride in this post… but more is at stake then you could ever imagine. And while you dont have children to worry about their future.. I do!

Anyone who is a parent should be especially concerned about Multisystem Inflammatory Syndrome in Children (MIS-C), a new disease presentation triggered by SARS-CoV2 infection that leads to progressive weakening, dilation, and aneurysms of the blood vessels close to the heart.^​9,10​ Similar to the process in the previously-described Kawasaki Disease (KD), this can result in sudden heart failure.^​11​ Thankfully we have been able to repurpose cutting-edge KD treatments which seem to be effective; however, there is still so much that is unknown, that the KD team at UCSD insists on being woken up at any hour of the night if a new MIS-C patient is suspected.^​9–12​

I have personally been involved in the diagnosis and treatment of multiple children with this disease. What is particularly concerning is that many of these children were completely asymptomatic during the initial infection and are only discovered when they develop symptoms of inflammation months later.^​10​ A proportion of patients are never positive on multiple forms of SARS-CoV-2 testing despite their hearts showing signs of injury.

Finally, there was this:

I am appalled that you feel you need to “dumb” the concept down.

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This article lost me…

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I am the first to say I have plenty of room for improvement, although currently I am at a loss as to the direction: it seems feedback on the level of detail is “mixed.”