What Is A Covid-19 Case?

What Is A Covid-19 Case?

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00:00
yeah that's right the breaks are off and i'm talking about covet again [Music] who would have thought we'd be asking this question at this stage of the global covert 19 situation in today's video i'm going to explore some often overlooked fundamental issues it can be surprising when we scratch beneath the surface and go back to some basic scientific principles minor misunderstandings of these principles can magnify
00:31
dramatically and manifest in all sorts of unexpected ways i've got a few interesting recent developments to discuss too so make sure you watch till the end first of all we need to be clear that a case is not the same as a clinical diagnosis let's go to the medical dictionary to get these definitions right in general a clinical diagnosis refers to a diagnosis based on signs symptoms and laboratory findings during life now the definition of a case can mean instance of disease in the narrower
01:02
clinical sense but in the wider epidemiological sense it simply means the standard criteria for categorizing an individual as a case while defining cases can certainly help us understand and manage disease outbreaks we need to be careful when applying case definitions for example if the criteria is too broad or non-specific this can result in too much meaningless data so how do we make a clinical diagnosis of covert 19
01:32
if we search around the who website even though it talks about symptoms and testing it doesn't appear that there are any formal diagnostic criteria for the disease although they do state a molecular test is used to confirm an active infection and polymerase chain reaction pcr is the most commonly used molecular test you can check out my video here to see the possible problems with using pcr tests for diagnostic purposes and what do the ever trustworthy cochrane group have to say back in july they performed a literature
02:04
review with regards to signs and symptoms used to diagnose covert 19 and concluded the following based on currently available data neither absence nor presence of signs or symptoms are accurate enough to rule in or rule out disease it's now almost a year into the situation and as far as i am aware we are not much further ahead in this area in summary we don't seem to have standardized clinical diagnostic criteria for coping 19 outside of the pcr test signs
02:35
symptoms and other investigations may be recorded but they are not required virus isolation is similarly not required what about a case definition for covet 19 the who website states that a confirmed covert 19 case is a person with laboratory confirmation of covert 19 infection irrespective of clinical signs and symptoms dr claus kermline pointed out the problem with defining cases this way in my recent interview with him he
03:06
described it as a pcr pandemic additionally a case is technically whatever a health authority says it is so it can change over time and make comparisons of data meaningless useful conclusions can only be drawn when the case definition is consistent and we take into account what it is we are actually defining we are in a strange situation where in most instances a case can be determined solely by a positive pcr test and the clinical diagnosis is also
03:38
solely determined by a positive pcr test you will notice that the requirement of disease is conspicuous by its absence this is still technically valid under the definition of case keeping in mind that this can be loosely defined but in this setting it should be made clear that the covert cases refer only to people that had a positive pcr test nothing more than that it introduces significant issues when a standalone pcr test is used through the clinical diagnosis of covert 19
04:09
as it becomes disconnected from the concept of disease but wait there's more it is typical in medical and health matters to have some idea of the false positive rate for a test for example a pregnancy test would be considered a false positive if there was no actual pregnancy in the setting of a positive pregnancy test but the way the covert 19 pcr tests are being used in the population by definition there can be no concept of false positives and as i've discussed in a previous
04:40
video i'm not talking about false positive rates reported for sars kobe 2 pcr tests from a single isolate in a laboratory setting i'm talking about using the pcr tests in the population at large just to throw another spanner in the works i'd like to give the microphone to our old friend dr fauci now unlike some of us pcr skeptics dr vaachi believes a pcr test is a valid way to confirm covert 19 but in this interview he admits that the concept of a positive test is not that simple again a good question
05:11
and what is now sort of evolving into a bit of a standard that if you get a cycle threshold of 35 or more that the chances of it being replication competent are minuscule so that if somebody and you know we do we have patience and it's very frustrating for the patients as well as for the physicians somebody comes in and they repeat their pcr and it's like 37
05:41
cycle threshold but you never if you almost never can culture virus from a 37 threshold cycle so i think if somebody does come in with 37 38 even 36 you got to say you know it's just it's just dead nucleotides period the new york times subsequently reported that the limit for most covert 19 pcr tests in the us is 37 to 40 cycles in europe labs also work with up to 40 cycles here in new zealand an official
06:13
information act request has revealed that labs are typically running 40 cycles didn't even dr fauci just say those cycle thresholds are too high that is echoed by the times article which reports harvard epidemiologist dr michael mina is saying he would set the figure at 30 or even less indeed even less was suggested by a clinical infectious disease journal study these results demonstrate that infectivity is significantly reduced when rt pcr ct values are greater than
06:43
24 for every one unit increase in ct the odds ratio for infectivity decreased by 32 percent the difference between 24 cycles and 30 cycles let alone 40 cycles is enormous it's literally exponential even if the critics dismiss all of the concerns we raised with case definition and clinical diagnosis criteria and maintain a pcr test as the only requirement to detect covert 19
07:13
hasn't a crucial variable being introduced regarding cycle numbers if that's the case surely the pcr proponents have been carefully collating cycle data it seems no the times article goes on to state officials at some state labs said the cdc had not asked them to note threshold values or to share them with contact tracing organizations how did we get into this mess with pcr cycle thresholds the article goes on to state the food and drug administration said in an email statement that it does not specify
07:43
the cycle threshold ranges used to determine who is positive and that commercial manufacturers and laboratories set their own you can draw your own conclusions there in fact the original corman drosten covert pcr test first published in january 2020 has led to much of the confusion because it was woolly around definitions and standard operating procedures with regards to this paper on november 26 a consortium of health professionals and scientists sent a retraction request letter to euro surveillance
08:14
they documented numerous problems with the drosten paper it is possible that some of the technical issues relating to the laboratory techniques may be resolved but to me they identified the following key issues the number of pcr cycles to be used was not specified and there was no definition of what defines a positive or negative result the pcr test cannot discriminate between the whole virus in viral fragments a positive test cannot be equated to infection with a virus
08:44
i.e it has no clinical relevance corman and josten failed to disclose their affiliations with the commercial test laboratory labour berlin which is involved in pcr testing in any case it seems that when it comes to covert 19 we still don't have many sound principles behind either case definition or clinical diagnosis and is this a major problem yeah it's gonna be a problem there's gonna be a problem for them i was having a conversation about this recently with dr simon thornley public health physician at the university of auckland
09:16
dr thornley directed me to an article in the bmj discussing the implications of how we classify conditions i'd encourage you to have a look at the article which i've linked in the description it explains the different ways in which over-diagnosis can occur especially by over-detection or over-definition the authors state that while the forms of over-diagnosis differ the consequences are the same diagnoses that ultimately cause more harm than benefit is there any hope
09:47
that the covert situation is going to be resolved anytime soon that i cannot say that there have been some fascinating developments recently four german tourists who were illegally quarantined in portugal on the basis of a cobra 19 pcr test have won a landmark court case the judges in the lisbon court of appeal delivered some decisive rulings including in view of current scientific evidence this test shows itself to be unable to determine beyond reasonable doubt that such positivity
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corresponds in fact to the infection of a person by the sars kobe 2 virus and the test's reliability depend on the number of cycles used it's sad that we are needing court cases to point out the shortfalls of the pcr test that perhaps it's one of the only ways forward when politicians and health institutions seem unable to follow the science keep the conversation going in the comments section and as always i'm grateful to be made aware of new information you may discover in your own research to help sustain my
10:49
channel in this time of censorship please support my work on subscribe star link is in the description

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