Mystery in Wuhan: recovered coronavirus patients test negative then positive
npr.org
npr.org
https://www.nytimes.com/interactive/2020/03/27/world/europe/...
Because you hypothesize that they can rapidly learn new, not very distinctive patterns without much data?
Of course not! We've got half a million cases now, hundreds of thousands cases in hospitals, and hundreds of papers published in all the medical journals. So yeah, data is rich.
Regarding CT scans .. machine learning will be so much better than humans in classifying those once enough data is available... it‘s completely out of question for me as an ML researcher.
What I don't know and what the article doesn't seem to mention is if the false positive rates are known yet and if we have more or less than the expected number of 'reinfected'.
NPR reports that "under its newest COVID-19 prevention guidelines, China does not include in its overall daily count for total and for new cases those who retest positive after being released from medical care. China also does not include asymptomatic cases in case counts" (emphasis mine).
One of the Wuhan doctors interviewed for this article told NPR that "I have no idea why the authorities choose not to count asymptomatic cases in the official case count. I am baffled."
All doctors and individuals in China who were interviewed for the article "requested anonymity when speaking with NPR because those who have challenged the government's handling of the outbreak have been detained."
--
See also: https://www.theguardian.com/film/2020/mar/27/china-re-closes...
More importantly, it would seem that premature lifting of restrictions is done at our peril.
I think DNA and RNA research is severely lacking in most countries. In a few years we will look at this year as 1960ies of computer engineering.
Edit: source https://www.irozhlas.cz/zpravy-domov/ostrava-rychlotesty-kor...
> The Chinese Embassy in Spain said that the Bioeasy tests were not part of China's medical donations and that the firm didn't have a license to sell its products.
To the extent they mention test types at all, it is quotes from "February" or "a professor... by email" – nothing about these persons' tests.
Yet, the tests in use have some level of false-positive and false-negative. Some variants have had quite high error rates – which may still be acceptable for mass-screening, but not for understanding the course of a single person's infection status.
So, among many millions of people tested in China, a handful have had alternating results not correlated with their symptoms? Not a surprise, even with tiny test error rates, unless each contributing result to the "+/-/+" pattern was reconfirmed by multiple-tests/multiple-methods.
(Note this also suggests many accounts of 'asymptomatic cases' may just be false-positives who never had Covid-19.)
So why are the asymptomatic cases required to quarantine under medical observation for 14 days but not counted?
Probably the same reason for mandatory 14 day quarantine for inbound travelers, China has the capacity to ere on the side of caution and enforce it.
- I think we need to know a LOT more about the sensitivity, specificity, and accuracy of every test that's being deployed right now. I am 100% willing to believe that "testing negative and then positive" means "you have a pretty low viral load and our tests suck more than we're willing to admit out loud right now".
- I think we need to be very clear that there are two kinds of tests: "you have an active SARS-CoV-2 infection right now, and also "you have once had a SARS-CoV-2 infection in the semi-recent past". One tells you who needs care, one tells you who is at least temporarily immune we hope.
That is, the patients were observed clinically to have caught and recovered from the virus, yet the test shows no trace of the viral infection.
Both are possible and either mess it all up.
(Edit) added in general above due to valid points in the comments below
- you do them right
- your reagents are good
- the kit was assembled properly
- there's no contamination in the machines
- you got a good sample
- ...
The capability for a highly sensitive and accurate test in no way guarantees that a randomly sampled administration of that test is going to meet the high standard that the test may be capable of.
In 205 patients with proven COVID-19 [...] bronchoalveolar lavage fluid was positive in 14/15 (93%), sputum 75/104 (72%), nasal swabs 5/8 (63%), brush biopsy 6/13 (46%), pharyngeal swabs 126/398 (32%), feces 44/153 (29%), blood 3/307 (1%), and urine 0/72 (0%).
https://www.jwatch.org/na51116/2020/03/17/pharyngeal-and-nas...
> blood 3/307 (1%)
Why isn't their blood rotten with virus?
(Why are rodents more prevalent in the walls/crawlspaces of a dwelling, rather than the hallways?)
So it's spreading mucosally or through connective tissue?
To the extent an infected cell releases its "baby coronaviruses" into the blood stream, they find a hot, chemically active environment – which is already inhospitable to their continued survival – plus a relative dearth of the respiratory cell-walls they're optimized to enter, plus a growing number of hostile antibodies.
(I don't know if a coronavirus-hijacked cell can direct its fresh viruses one way or the other, but it'd probably prefer to do that if it could, and I can understand why viruses wouldn't persist long in blood compared to respiratory-membranes.)
The coronaviruses are definitely active in mucosal surfaces, and carried by mucus. I haven't seen anything about, nor do I think any activity is necessarily implied, in other connective tissues.
Research has shown (1) the distribution of ACE2 protein, the functional receptor for SARS-Cov and SARS-Cov-2 (2), to include various human organs (oral and nasal mucosa, nasopharynx, lung, stomach, small intestine, colon, skin, lymph nodes, thymus, bone marrow, spleen, liver, kidney, and brain) along with arterial and venous endothelial cells and arterial smooth muscle cells in all organs studied. And ACE2 mRNA has been found in virtually all organs. So there is definitely the potential for cells in the circulatory system binding viruses.
What may be significant here is the concentration of ACE2 protein in cell membranes. One Chinese analysis of a group of 170 Covid-19 fatalities(3) found half of the cases suffered from hypertension. ACE inhibitors are a class of medication prescribed for lowering blood pressure and according to models they increase the concentration of ACE2 protein in lower respiratory tract cells. Given that fatality results from respiratory distress originating in the lower respiratory tract and that not all cases progress to the lower respiratory tract it seems possible that the spread of the virus within the body may be related to concentration of ACE2 protein in cells. The disease progression would also support mucosal transport of the virus within individuals the same as between them.
(1) Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. https://www.ncbi.nlm.nih.gov/pubmed/15141377 (2) Structure, Function, and Antigenicity of the SARS-CoV-2 Spike Glycoprotein https://www.sciencedirect.com/science/article/pii/S009286742... (3) Controversial Study Links COVID-19 Severity to ACEIs and ARBs (Newsweek, March 24, 2020)
Saw reports that bronchoalveolar lavage (introducing and then suctioning out fluid from a branch of the lung) is better at picking up virus if it's present -- but it's much more time consuming, more invasive, and much less pleasant for the patient than sticking a swab up your nose. Not something you're going to do in a parking lot in a drive through testing center for someone only showing mild symptoms.
There are always compromises.
Wouldn't that imply there should be some of the virus in your lungs? Test accuracy aside, is the definition of "positive" even clear?
re-positive report: http://www.bjnews.com.cn/feature/2020/03/05/699575.html (2020/03/05)
expert stance: http://www.bjnews.com.cn/news/2020/03/12/702870.html (2020/03/12)
it's about lives and I don't think anyone believe in govt. lightly. so do you.
Big question is if the re-positives are infectious again. Doesn't seem to be plausible, but could be. It's a new virus with a different, stronger header.
We need to be more hesitant to praise their pandemic response
I'm not sure why, but the media seems so eager to accept the official CCP narrative and take the lack of clear dissent from within China to mean China should be held up as a model Nation worthy of praise while simultaneously ignoring all the restrictions and brutality that force silent those who otherwise might have much to complain about.
Deference to China by naive journalists and other useful idiots must be checked.
> Eschew flamebait. Don't introduce flamewar topics unless you have something genuinely new to say. Avoid unrelated controversies and generic tangents.
I don't many outside of China accepting everything the CCP is saying about coronavirus.
I do think it's probably worth waiting to evaluate until we have more real, verifiable numbers. Some of what people are saying is likely true. Some of it is likely not.
I think the majority of people in the US that have observed how they handle it see their approach as overly harsh.
I'm afraid we only see the chinese government's report and data on how the epidemic is spreading within China.
Firstly, exports are hard to lie about. Order something from alibaba yourself, or here’s some graphs: https://www.plex.com/blogs/china-potential-model-for-post-co...
Secondly, Trump would break that news if it were fact. Hiding 10’s of thousands of deaths and 100’s of thousands of very ill is extremely difficult in the modern world when relatives live overseas.
Thirdly, I believe that China can effectively enforce social barriers, restricting the spread of Covid19. It seems reasonable to believe they can control it, even though freer countries struggle.
Of course you can always come up with some conspirational theory, and I keep my eyes open for lies, but common sense says that China is doing OK.
By the fact that there are already reports of factories throughout the world that kept operating eventhough they were experiencing an outbreak of covid19 within their staff.
And let's be honest: no one places China in the top spots in rankings on safe working conditions and human rights.
Which is why I wrote: Secondly, Trump would break that news if it were fact. Hiding 10’s of thousands of deaths and 100’s of thousands of very ill is extremely difficult in the modern world when relatives live overseas.
This part is huge. When apartment complexes are already surrounded by walls with a couple gates, it's easier to control flow of people in and out. The infrastructure already in place (yes I know, hardy har har, chinese building walls, ok) actually helps a lot.
We've got family back on mainland who can't get in and out of their apartment complex without getting their temperature taken (both directions) and playing 20 questions with the guards about where they're going.
a) China keeps on exporting,
b) liars are caught and Trump didn't caught the Chinese regime lying,
c) The Chinese regime enforced quarantined effectively.
From these points, only the third has any relation with and impact in the outbreak of covid19 within China.
However, as the virus is reported to have an asymptomatic incubation period that can be as long as 2 to 3 weeks, and as there are reports from within China that show that covid19 can be transmitted at over 4 meters, then, as we have seen in Italy and Spain, the impact of this measure would only start to show with that much of a lag.
I admit I am not an epidemiologist, but claiming that an epidemic was just stopped on it's tracks almost instantly has little to no credibility. For that to be even remotely realistic, there needed to be zero asymptomatic carriers from one day to another.
To add insult to injury, the Chinese government reported that the only new covid19 cases experienced within China came from foreigners who imported the disease.
I'm sure the measures imposed by the Chinese regime has a profound impact on the epidemic, but none of the official reports appear to have any credibility whatsoever. A disease with a 1 to 3 week incubation period does not stop spreading or killing people from one day to the other. What does stop immediately is how you chose to report the data, specially counting the dead.
https://twitter.com/KenDilanianNBC/status/124324375891486310...
I think it's been interesting wave. When the cases first started, China got blasted. As it hit the US, Administration political opponents have criticized the US response, but many have gone to the point of praising China's response and forgetting about China's actions in December/January.
China also deserves criticism; its initial response was dysfunctional in some ways (albeit somewhat different ways than the United States dysfunctional response). Fortunately, as you say, it's been blasted in some discussion.
But recognition of ways in which its response has been respectable is less the mark of someone "carrying water" and more part of the process of learning things and having our political institutions learn things.
It’s a sad mix of propaganda and temporary faith in a shaky globally supply chain.
https://www.bloomberg.com/news/articles/2019-03-08/china-s-g...
https://time.com/5811222/wuhan-coronavirus-death-toll/
etc
Why should any respectable journalist quote their statistics about COVID and conclude how effective their response was without mentioning that they've been known to fabricate statistics? Let alone calling them a 'Global Leader' in response. I've not seen this qualification mentioned once with respect to China's stats on this virus.
No one really cared that much because manipulation, risk, and uncertainty is baked into financial equations no matter what the country or government. Now that we're talking about lives, it's harder to dismiss.
I don't see it frequently in writing, but the majority of TV and podcast reporting from news sites has the disclaimer. And there's enough China bad articles out there that I feel like this is implicitly assumed.
Either way, no one trusts Chinese stats, including the Chinese public themselves, and the Chinese government most of all. The ability to collect accurate statistics when there's so many different development levels country-wide simply isn't there. For example, China doesn't use GDP internally, they use LKI, LiKeQiang Index which aggregates a value from measurable indicators like freight cargo volume, electric consumption, bank loans. There's also TSF, Total Social Financing. They can still be gamed, but physically (running empty trains), but much harder to fake via submitting fake excel sheets to central government. Chinese GDP is basically a back of the napkin estimate to appease foreign investors, it's also used to set growth targets instead of reflecting it. Most of the mainstream western reporting on Chinese GDP does not understand this. It's well understood among China watchers. The most comprehensive study on Chinese GDP so far, by CSIS, suggested China was under reporting their GDP.
As for stacked urns in Wuhan, the city is still under quarantine so urns would not be picked up. Also necessary to account for other sources of death. The article quotes 56K cremations in Q4 2019, so a few thousands urns especially as restock doesn't seem atypical. Like LKI, it's an useful oblique indicator, but should be considered in other context. If there's mass death, enough to measurably affect hysterical people in quarantine, it would be on Chinese social media which would leak to China watchers. There's many expats and Chinese people with VPNs, things that affect the public on a mass scale inevitably leaps over the firewall, it's not opaque like politburo politics. People need to stop looking at Chinese numbers and instead extrapolate from oblique indicators. When expats in China talk about things returning to normal, when Chinese diaspora aren't mourning about sick or dead family members en-mass, then you can assume that reflects ground reality.
Fully agreed on that particular point, that is commendable
Now, I suspect you wouldn't agree with that perspective either. But it's definitely not praise for China.
As far as the article to which it links... that's all factual stuff. The PRC absolutely has exported a ton of PPE equipment and assigned a bunch of well-documented medical personnel to hot regions. That's good, as far as it goes. It doesn't say anything about what they're doing inside the PRC, but it absolutely is helpful that they're doing it externally.
And historically, that was always one of the core roles played by America. So in perspective it's sort of notable, no?
You're contracting yourself and just being argumentative. The whole context is their international assistance work, and there is nothing but praise in that article. Meanwhile the article just brushes aside their initial deceit which greatly magnified the problem.
I genuinely thought you were talking about the tweet about the article being the praise. The article was just facts. Facts, to borrow a phrase, don't care about your feelings.
I think it's just false negatives.
https://www.bloomberg.com/news/articles/2020-03-27/stacks-of...
China is likely hiding the real numbers for unknown reasons
After a month of lockdown, the number of backlogged urns should be over 18000.
Article is intentionally misleading, burying the “normal” stats that way.
Original here: https://archive.md/g1BDx#selection-2503.0-2507.171
I'd like to know what the downvotes are? Because everything here is factually true.