lbeltrame

It would be nice to have actual trials that show that masks are effective at reducing transmission (transmission, not stuff like reduced droplet emission etc).

This BMJ blog post[1] argues (and I agree) that if we're able to make trials for drugs, why not for non-drug interventions? Note that it is not against such interventions, but suggests we do trials to better direct public policy.

[1] https://blogs.bmj.com/bmj/2020/08/28/margaret-mccartney-we-n...

They can shed viral RNA for weeks. Whether this means they are infectious is unknown, because the paper (not linked in TFA) did not attempt to test for live virus (cell culture infection).

Does anyone know if they only tested for RNA, or for live virus?

At this point in time it is absolutely unacceptable to assume that presence of viral RNA equates to infectious virus. Hence the question.

> If I read correctly the they're saying they found that children have higher viral loads in their respiratory tracts

As I wrote elsewhere in the comments, the researchers have equated the quantity of viral RNA with viral load. Studies in adults have shown that this is not always the case. There's no guarantee that there is active virus there (unless you try to infect cells with what you got from the swab).

The paper is at: https://www.jpeds.com/article/S0022-3476(20)31023-4/fulltext

I still feel a little sour about this result: mainly because it's "easier" to find data on adult patients, but children data are far harder to get.

So I feel this is a wasted opportunity.

This study does not prove that children are more infectious.

The paper only tested for viral RNA, not for infectious virus. Given that some people are clinically recovered but still have RNA in the throat, and that presence of viral RNA may not equate with live virus (see a Nature paper from two months ago), this is a rather severe limitation.

Note that they may as well be: but you can't infer this from these results.

From the methods:

> SARS-CoV-2 viral load quantification: SARS-CoV-2 RNA levels were quantified with a quantitative viral load assay using the US CDC 2019-nCoV_N1 primers and probe set as previously described(10).

RNA. This can mean that they have a higher viral load, but high level of viral RNA does not necessarily equate with live virus. Why didn't they try to infect Vero E6 cells with the swab samples? (My guess: lack of equipment). Given the day of sampling, it may be still related, but given studies in children are far and few between, this is an IMO glaring omission.

I checked the paper for cell cultures or in vitro assays for live virus, no dice.

I'm kind of disappointed. We're well into the pandemic and we still rely on the presence of RNA alone to infer infectiousness? Why didn't the reviewers ask for that?

That assumes that the population is homogeneous in susceptibility. Some people argue that it is not the case, and as such the threshold is lower.

I'd say, for now. The problem with a virus that's contagious like this one is that non-pharmaceutical interventions are just bandaids. The moment someone makes a mistake (and it might happen even in the best scenario, we're all humans), the virus might appear again in the community.

You need pharmacological means to fight it. Not necessarily vaccines, also drugs (which might be available earlier than a vaccine).

This doesn't mean there is no immunity.

First of all, from the paper itself:

> Since we could not perform additional virus-neutralization tests we cannot exclude the possibility that COVID-19 convalescent subjects produce other types of protective antibodies besides those inhibiting RBD-ACE2 binding.

Second: they took antibodies from serum, which would exclude mucosal responses (IgA), observed by other groups.

Third: There's the whole matter of T-cell immunity which is not touched by this paper at all.

The antibody-dependent enhancement test was done in vitro, so there is no guarantee it would happen in vivo. In fact, the authors say so themselves:

> However, studies are needed to investigate if antibody-mediated increases of RBD binding to ACE2 have a clinical relevance.

I'd add that a few vaccines in trial use the full-length spike protein, rather than just the so-called "receptor binding domain" (RBD; the part that binds to the ACE2 receptor), so more data are needed to see what is observed here has implications or not.

Personally, I'm still optimistic.

Interestingly, the perspective from an Italian citizen (myself) is quite different.

- The media does not mention success anywhere: they only scream loud where positive people are found, regardless of trends

- Relaxing rules about train occupancy for long-haul trains (currently forced at 50% capacity) was bound to happen last weekend. However, the health minister reversed the decision mere hours before it went into effect. Train companies, which had been preparing for the change in the past 15 days (including negotiating protocols) were forced to refund thousands of tickets

- The shutdown was unnecessarily harsh, there is still no clear evidence (aside modeling, so lots of caveats apply) that deaths were spared by the lockdown, and the economy was hit pretty hard

- The Italian government is also one which did the least to mitigate the economic damage of the lockdown, a clear contrast with its public statements ("we will", "we plan", etc.)

- Schools were never reopened, talks about the "safety" in schools are reaching honestly hard to believe proposals (like wheeled desks). One month or so left before reopening them, there is no policy nor clear indication on what to do.

- Government models on the epidemic were completely off: the worst-case scenario predicted 150,000 Italians needing ICU care by the end of June, and while it was widely publicized, the actual report was secret, was somehow leaked around, and was full of large epidemiological errors

- A state of emergency was continued despite the absence of one (ICU use and hospitalization are in the lower figures)

- Thousands of people that recovered are still being held by the fact that they require two consecutive negative tests, and sometimes the delays are up to months

- Italy voted with Europe in allowing certain countries to enter the Schengen area with no quarantine, yet immediately reversed the decision locally, forbidding anyone from entering without "proper reasons" and with a quarantine of 14 days. At the same time, "special flights" carrying citizens from Bangladesh arrived without quarantining (I'm guessing it was part of some agreement on workers), and guess what, some of those people tested positive afterwards

- There's quite a lot of debate on how to consider a person positive to the test. At this point, people positive to IgG tests are counted as having the virus (however, evidence shows that IgG appear at least one week after symptom onset and peak much later, hence these people are not infectious)

- The scientific committee often makes "threats" to the population in case the advice isn't followed, despite having no authority to do so (that belongs to the government: they are only advisors).

FTR, note that this is modeling, not experimental evidence.

I'd love to see actual, hard experimental evidence on aerosol transmission (the latest Nature paper on it doesn't qualify: only part of the samples were actually used to test viral replication in cells, and only part of them actually had detectable virus).

Yes, but the easiness it spreads does not equate to the same frequency of long-lasting damage.

In fact, given so many cases are missed (bloodstream antibody tests don't catch those with T-cell responses, and mucosal antibodies aren't detected by those tests, either) I would not be surprised if those with complications are a minority (of extreme clinical importance, mind you) of the total cases.

My point is not much as to downplay the seriousness of these side effects, but rather that we have become more aware of them due to "information overload", because many other diseases can have these complications. IOW, this is not a magic disease (sometimes the press almost paints SARS-CoV-2 as something out of this world...).

> Aside from Deaths, Covid can cause permanent organ damage.

So can other diseases we live with, we're just not that exposed to them through the press. Certain diseases can cause heart failure; bacterial pneumonia, even if treated, can have effects that last for months if not a year or more; some viral infections can cause all sorts of bad side effects, including cytokine storms.

This including the recent interview with someone who had a lot of their fingers amputated due to cardiovascular complications from infections: this also happens to quite a few who have type 2 diabetes (due to neuropathy).

A lot of treatable diseases can have long lasting, sometimes even crippling effects in life. Many people just don't know because it's not told around.

This virus is no different from them.

> I don't think it's an accident at all that science uses its own thick jargon instead of a simple approachable vocabulary.

At least in my field of research, such views are held by few, if any. This is, IMO, an extremely bad faith argument. I think many in the field would love if the right information got out - even if incomplete, or with many unknowns.

At least that would spare us by the media getting things totally wrong and pushing disinformation on people (and that's a bipartisan problem).

However, this can lead to problematic outcomes, like WHO's tweet on immunity, which is absolutely bonkers from a biological perspective (and that was retracted, thankfully).

Appeal to authority may work, but authority can fail. And when that happens, the trust is lost.

> So what's your solution?

Telling things how they are, for a start, at least for the mainstream press. No matter if they go against one's narrative. We're not talking about politics or differing views, we're talking about scientific findings.

> You cannot bring openness and flexibility to a conversation with manipulative people.

That's how science is: open discourse. If you go for absolutes, eventually there are going to be contradictions, which will likely hamper getting important messages across. In my country, due to this, trust in scientific people is actually lowering, according to polls.

Honestly, thinking about winning against this virus with non pharmaceutical interventions is not sustainable on the long run. We need pharmacological means: drugs and vaccines.

I don't agree with your statement. The matter has become so polarized that both sides are actually lying about the data.

Just a few weeks ago, the Guardian quoted a study on Nature saying that asymptomatics were more infectious than symptomatic people. Except that the paper did not state anything like that, and even warned against using the results for policy reasons.

On the same camp, a Wired article saying that "the press must watch on science" to avoid pushing untested vaccines on the population, yet omitting the fact that some side effects of the Moderna vaccine were on a dose no longer used for trials.

And on the other side, we have conspiracy theorists and "skeptics" which only quote part of the studies which benefit their agenda, such as reporting only the more optimistic bound for the infection fatality rate. Or those who only quote negative bits about vaccines.

And scientists (I'm one of them) are to blame, too. A lot of those reporting to the media gave predictions, talked in absolutes (at least speaking for my country). Few actually said "we don't know". I'm not aware of anyone saying "we got something wrong".

> Any credible sources that I could find say that protection correlation with SARS is not clearly established and antibody levels to SARS fall off between 2-3 years after infection.

It was T-cell immunity, not humoral immunity like with antibodies. Absence of antibodies != absence of immunity.

And here's the citation: https://www.nature.com/articles/s41586-020-2550-z

An organization that puts out a tweet (on immunity) that was, in the form it was written, totally void of any biological sense, doesn't rank much on my scale of worthiness.

On the seasonality: at a seminar on the epidemiology of this disease at my institution right today, the evidence on the impact of experimental factors was described as "inconsistent" but not enough to rule out one possibility or the other.

Ironically, a WHO staffer in Italy actually made a claim (or so the media said) about a "second wave" just two weeks ago.

I really don't understand why it is hard for many (not necessarily just the WHO) to say "we don't know".

I can say for sure on neural invasion because I found a paper describing the phenomenon from 2018, which described (IIRC, on hospitalized patients) neural invasions by "human coronavirus".

Took a while to dig through my post history, but here's the paper I mentioned:

https://www.frontiersin.org/articles/10.3389/fncel.2018.0038...

I doubt the virus is still around 2-3 months later in their bodies. These effects are likely due to the hyperinflammation triggered later on during the course of the disease, if I am to follow the mechanism described in the well-detailed paper in Cell from a few weeks ago.

The virus is still a coronavirus (neural invasion, also noted for SARS-CoV-2, is also a feature of regular coronaviruses). These effects, although possibly severe and worthy of concern, are second-order effects.

It is highly unlikely as the reports of "reinfections" only are by PCR-positive test (not stating the quantity of viral RNA found, either). But it could be as well that the immune system found and cleared the virus.

One would need to see if there's infectious virus in the throat before calling a "reinfection".

P.S. for the GP: you might have got repeated infections of different viruses which causes similar symptoms, because something like that was found for "reinfected" cases in South Korea. Asking for a proper test and a serological test (so you know if one of the past events was indeed due to a SARS-CoV-2 infection) as well would help.

That's why the pharmaceutical industry is not putting all eggs in the vaccine basket (but for the press, it is the only option available).

Therapies with monoclonal antibodies might handle this case, in particular, cocktails of antibodies (like Regeneron, Vir, and Sorrento are making) to reduce the risk of selecting resistant mutants (if you target multiple parts of the virus proteins, they'd have to mutate all together to gain resistance, which is a less likely event).

Do we need herd immunity? Note, I'm in favor of vaccination, but I don't understand why the press keeps on ignoring other pharmacological interventions that can potentially "downgrade" this disease to something far more manageable.

Instead, the press keeps on talking about the "miracle vaccine" which will come eventually.

No comment on the section on immunity. Sloppy reporting at best.

Most of them, were, IIRC, only "reported to" parliament. After reopening on May 4th, some of them were voted.

I admit I worded my post poorly: a state of emergency exists, but limiting constitutional rights is, AFAICS, only permitted through law.

"DPCM" are mere administrative acts, and a few people expert in the judicial system have raised objections about their use in this way (including the head of the constitutional court). In particular, the debate is whether they can or can't limit constitutional rights.

There's no such thing as a state of emergency, only the state of war. Anything else needs to go through the parliament, directly or indirectly.

By indirectly I mean something akin to the USA executive order, but agreed upon the cabinet, not the PM, then countersigned by the President, who can veto it. Then it lasts 60 days and must be confirmed by the parliament, or becomes void.

Keep in mind the constitution was written right after WW2, so the writers were carrying the scars of "emergency measures" going into dictatorship.

There are a few things that can be done by the health ministry, but nothing as big as a country wide lockdown.

de facto Italy did. None of the early acts went through the parliament, but were moves made by the PM alone.

Suspensions of rights in exceptional cases is granted only in the case of war, or by law (and that means going through the parliament).