Elected officials have become one-trick ponies. All they know is locking people down for the sake of social distancing. That was a reasonable strategy when the outbreak began, before the disease and its treatment was understood, and in order to protect the health care system from overload. But now a different prescription is required, if leaders have the courage and wisdom to adapt. Here are three recommendations that will stop the damage being done in the name of “fighting Covid19.”
1. Do not prevent school children from training their immune systems.
Shutting schools and/or applying social distancing protocols to children are not only unnecessary, but harmful. Stopping normal social interaction among children takes away the exposure they need to develop immunity for future outbreaks. Donna L. Farber and Thomas Connors and Columbia University wrote Quarantine May Negatively Affect Kids’ Immune Systems. H/T Jeffrey Tucker at AIER (here). Excerpts in italics with my bolds.
During the Covid-19 pandemic, the world is unwittingly conducting what amounts to the largest immunological experiment in history on our own children. We have been keeping children inside, relentlessly sanitizing their living spaces and their hands and largely isolating them. In doing so, we have prevented large numbers of them from becoming infected or transmitting the virus. But in the course of social distancing to mitigate the spread, we may also be unintentionally inhibiting the proper development of children’s immune systems….Immunological memory and tolerance learned during childhood serves as the basis for immunity and health throughout adulthood.
[The article then continues and actually invokes the great taboo word of our age: exposure. It’s good. Exposure is good. It is necessary. It is needed. Not bad. Good.]
However, for memory T cells to become functionally mature, multiple exposures may be necessary, particularly for cells residing in tissues such as the lung and intestines, where we encounter numerous pathogens. These exposures typically and naturally occur during the everyday experiences of childhood — such as interactions with friends, teachers, trips to the playground, sports — all of which have been curtailed or shut down entirely during efforts to mitigate viral spread. As a result, we are altering the frequency, breadth and degree of exposures that are crucial for immune memory development.
[Okay, now it is time for the writer to invoke a bit of memorable scientific knowledge. It’s a beautiful paragraph with a stunning opening sentence.]
Failing to train our immune systems properly can have serious consequences. When laboratory mice raised in nearly sterile conditions were housed together in the same cage with pet mice raised in standard conditions, some of the laboratory mice succumbed to pathogens that the pet mice were able to fight off. Additional studies of the microbiome — the bacteria that normally inhabit our intestines and other sites — have shown that mice raised in germ-free conditions or in the presence of antibiotics had reduced and altered immune responses to many types of pathogens. These studies suggest that for establishing a healthy immune system, the more diverse and frequent the encounters with antigens, the better.
Summary: The kids are all right, let them get on with their lives for their own sakes.
2. Count people as cases only if they are sick from a viral load.
Public health officials need to stop confusing and scaring the public with positive PCR tests. As noted in previous posts here, PCR tests amplify a viral trace up to 35 or 40 doublings, which is too small a viral load to make the person sick or to transmit to others. The rapid tests now available do not amplify and the protocol now should be to do antigen tests on people with symptoms to identify actual patients needing treatment and isolation.
Background posts: COVID Fearmongering With ‘Cases’ of Perfectly Healthy People
Summary: The BinaxNOW test detects antigens — proteins unique to the virus that are usually detectable whenever there is an active infection.
3. Implement practical effective measures to protect the vulnerable nursing home residents and staff.
Kevin Pham, MD, explains in his essay If We’re Going to Control COVID, We Need to Make This Crucial Change. Excerpts in italics with my bolds.
According to an Associated Press report, there has been a four-fold rise in nursing home-related cases of COVID-19 since June. And CDC data shows there has been an increase of nearly 1,000 COVID-related deaths in nursing homes from September to October.
There are three ways for COVID-19 to enter a nursing home: 1.) through staff and faculty working at the facility, 2.) through visitors who enter the premises, and 3.) through forcing nursing homes to admit patients with active infections.
The disastrous effects of the latter policy is one reason that Gov. Andrew Cuomo’s New York has contributed a disproportionate share of American COVID-related deaths. Thankfully, his order was finally reversed in May.
The more recent increase in nursing home cases are likely a function of the former two ways that COVID enters a nursing home. This is where we need to focus our efforts, with refined policies.
Test nursing home visitors.
Current guidance from the Centers for Medicare and Medicaid Services restrict the number of visitors in ways that are lacking. The focus is temperature checks and screening questionnaires, as well as observing for signs or symptoms of illness.
This may have been reasonable early on in the pandemic, when any sort of a screen was better than no screen, but it’s insufficient now. We have had point-of-care testing for months now, and more recently, rapid antigen tests that require no special lab equipment, no specialized storage, not even refrigeration.
No effort should be spared in procuring what is needed to test everyone going into a nursing home, whether visitor or staff. Key to making this work: the FDA should lift restrictions requiring all tests to reviewed at a lab, so rapid tests that don’t need lab equipment can truly live up to their promise.
Stronger mitigation measures for nursing home staff.
It is likely that infected staff are driving the rise in cases, as visitations are relatively restricted. The AP report shows a proportionate increase in the number of staff cases and resident cases. This is naturally difficult to control because the staff live in the community and work in the nursing homes. Their job is vital.
The latest CMS guidance on staff testing frequency are intended to test often enough to detect cases early enough to stop transmissions, from staff to residents.
Clearly that hasn’t been enough. We need more targeted testing to detect early cases, and that has to be done every time someone leaves and reenters the nursing home. This may be difficult for some facilities, especially rural ones, that lack either financial or human resources, but again, no effort should be spared to enable nursing homes to test everyone going to visit or who works with our elders.
Ensuring a steady and abundant supply of tests is one solution, but nursing home leadership should consider providing for housing for staff for several days at a time to obviate the need to go into the community where there may be high levels of COVID-19. Such an isolation “bubble” was good enough for the National Basketball Association, so it ought to be good enough for older Americans.
If a facility cannot manage these steps on their own, they should receive help, post haste. Every mayor and governor should immediately ask nursing home leaders for their plans, and to identify any barriers. If helped is needed, they need to arrange for its provision.
Summary: The primary focus of our COVID response should center on helping those known to be most at risk from the virus—nursing homes, the elderly and the vulnerable, and those who work with them. Anything else, especially now, would be unconscionable.