Faith in Quick Test Leads to Epidemic That Wasn’t - Politics | PoFo

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New York Times

Faith in Quick Test Leads to Epidemic That Wasn’t

Dr. Brooke Herndon, an internist at Dartmouth-Hitchcock Medical Center, could not stop coughing. For two weeks starting in mid-April last Faith in Quick Test Leads to Epidemic That Wasn’tyear, she coughed, seemingly nonstop, followed by another week when she coughed sporadically, annoying, she said, everyone who worked with her.

Before long, Dr. Kathryn Kirkland, an infectious disease specialist at Dartmouth, had a chilling thought: Could she be seeing the start of a whooping cough epidemic? By late April, other health care workers at the hospital were coughing, and severe, intractable coughing is a whooping cough hallmark. And if it was whooping cough, the epidemic had to be contained immediately because the disease could be deadly to babies in the hospital and could lead to pneumonia in the frail and vulnerable adult patients there.

It was the start of a bizarre episode at the medical center: the story of the epidemic that wasn’t.

For months, nearly everyone involved thought the medical center had had a huge whooping cough outbreak, with extensive ramifications. Nearly 1,000 health care workers at the hospital in Lebanon, N.H., were given a preliminary test and furloughed from work until their results were in; 142 people, including Dr. Herndon, were told they appeared to have the disease; and thousands were given antibiotics and a vaccine for protection. Hospital beds were taken out of commission, including some in intensive care.

Then, about eight months later, health care workers were dumbfounded to receive an e-mail message from the hospital administration informing them that the whole thing was a false alarm.

Not a single case of whooping cough was confirmed with the definitive test, growing the bacterium, Bordetella pertussis, in the laboratory. Instead, it appears the health care workers probably were afflicted with ordinary respiratory diseases like the common cold.

Now, as they look back on the episode, epidemiologists and infectious disease specialists say the problem was that they placed too much faith in a quick and highly sensitive molecular test that led them astray.

Infectious disease experts say such tests are coming into increasing use and may be the only way to get a quick answer in diagnosing diseases like whooping cough, Legionnaire’s, bird flu, tuberculosis and SARS, and deciding whether an epidemic is under way.

There are no national data on pseudo-epidemics caused by an overreliance on such molecular tests, said Dr. Trish M. Perl, an epidemiologist at Johns Hopkins and past president of the Society of Health Care Epidemiologists of America. But, she said, pseudo-epidemics happen all the time. The Dartmouth case may have been one the largest, but it was by no means an exception, she said.

There was a similar whooping cough scare at Children’s Hospital in Boston last fall that involved 36 adults and 2 children. Definitive tests, though, did not find pertussis.

“It’s a problem; we know it’s a problem,” Dr. Perl said. “My guess is that what happened at Dartmouth is going to become more common.”

Many of the new molecular tests are quick but technically demanding, and each laboratory may do them in its own way. These tests, called “home brews,” are not commercially available, and there are no good estimates of their error rates. But their very sensitivity makes false positives likely, and when hundreds or thousands of people are tested, as occurred at Dartmouth, false positives can make it seem like there is an epidemic.

“You’re in a little bit of no man’s land,” with the new molecular tests, said Dr. Mark Perkins, an infectious disease specialist and chief scientific officer at the Foundation for Innovative New Diagnostics, a nonprofit foundation supported by the Bill and Melinda Gates Foundation. “All bets are off on exact performance.”

Of course, that leads to the question of why rely on them at all. “At face value, obviously they shouldn’t be doing it,” Dr. Perl said. But, she said, often when answers are needed and an organism like the pertussis bacterium is finicky and hard to grow in a laboratory, “you don’t have great options.”

Waiting to see if the bacteria grow can take weeks, but the quick molecular test can be wrong. “It’s almost like you’re trying to pick the least of two evils,” Dr. Perl said.

At Dartmouth the decision was to use a test, P.C.R., for polymerase chain reaction. It is a molecular test that, until recently, was confined to molecular biology laboratories.

“That’s kind of what’s happening,” said Dr. Kathryn Edwards, an infectious disease specialist and professor of pediatrics at Vanderbilt University. “That’s the reality out there. We are trying to figure out how to use methods that have been the purview of bench scientists.”

The Dartmouth whooping cough story shows what can ensue.

To say the episode was disruptive was an understatement, said Dr. Elizabeth Talbot, deputy state epidemiologist for the New Hampshire Department of Health and Human Services.

“You cannot imagine,” Dr. Talbot said. “I had a feeling at the time that this gave us a shadow of a hint of what it might be like during a pandemic flu epidemic.”

Yet, epidemiologists say, one of the most troubling aspects of the pseudo-epidemic is that all the decisions seemed so sensible at the time.

Dr. Katrina Kretsinger, a medical epidemiologist at the federal Centers for Disease Control and Prevention, who worked on the case along with her colleague Dr. Manisha Patel, does not fault the Dartmouth doctors.

“The issue was not that they overreacted or did anything inappropriate at all,” Dr. Kretsinger said. Instead, it is that there is often is no way to decide early on whether an epidemic is under way.

Before the 1940s when a pertussis vaccine for children was introduced, whooping cough was a leading cause of death in young children. The vaccine led to an 80 percent drop in the disease’s incidence, but did not completely eliminate it. That is because the vaccine’s effectiveness wanes after about a decade, and although there is now a new vaccine for adolescents and adults, it is only starting to come into use. Whooping cough, Dr. Kretsinger said, is still a concern.

The disease got its name from its most salient feature: Patients may cough and cough and cough until they have to gasp for breath, making a sound like a whoop. The coughing can last so long that one of the common names for whooping cough was the 100-day cough, Dr. Talbot said.

But neither coughing long and hard nor even whooping is unique to pertussis infections, and many people with whooping cough have symptoms that like those of common cold: a runny nose or an ordinary cough.

“Almost everything about the clinical presentation of pertussis, especially early pertussis, is not very specific,” Dr. Kirkland said.

That was the first problem in deciding whether there was an epidemic at Dartmouth.

The second was with P.C.R., the quick test to diagnose the disease, Dr. Kretsinger said.

With pertussis, she said, “there are probably 100 different P.C.R. protocols and methods being used throughout the country,” and it is unclear how often any of them are accurate. “We have had a number of outbreaks where we believe that despite the presence of P.C.R.-positive results, the disease was not pertussis,” Dr. Kretsinger added.

At Dartmouth, when the first suspect pertussis cases emerged and the P.C.R. test showed pertussis, doctors believed it. The results seem completely consistent with the patients’ symptoms.

“That’s how the whole thing got started,” Dr. Kirkland said. Then the doctors decided to test people who did not have severe coughing.

“Because we had cases we thought were pertussis and because we had vulnerable patients at the hospital, we lowered our threshold,” she said. Anyone who had a cough got a P.C.R. test, and so did anyone with a runny nose who worked with high-risk patients like infants.

“That’s how we ended up with 134 suspect cases,” Dr. Kirkland said. And that, she added, was why 1,445 health care workers ended up taking antibiotics and 4,524 health care workers at the hospital, or 72 percent of all the health care workers there, were immunized against whooping cough in a matter of days.

“If we had stopped there, I think we all would have agreed that we had had an outbreak of pertussis and that we had controlled it,” Dr. Kirkland said.

But epidemiologists at the hospital and working for the States of New Hampshire and Vermont decided to take extra steps to confirm that what they were seeing really was pertussis.

The Dartmouth doctors sent samples from 27 patients they thought had pertussis to the state health departments and the Centers for Disease Control. There, scientists tried to grow the bacteria, a process that can take weeks. Finally, they had their answer: There was no pertussis in any of the samples.

“We thought, Well, that’s odd,” Dr. Kirkland said. “Maybe it’s the timing of the culturing, maybe it’s a transport problem. Why don’t we try serological testing? Certainly, after a pertussis infection, a person should develop antibodies to the bacteria.”

They could only get suitable blood samples from 39 patients — the others had gotten the vaccine which itself elicits pertussis antibodies. But when the Centers for Disease Control tested those 39 samples, its scientists reported that only one showed increases in antibody levels indicative of pertussis.

The disease center did additional tests too, including molecular tests to look for features of the pertussis bacteria. Its scientists also did additional P.C.R. tests on samples from 116 of the 134 people who were thought to have whooping cough. Only one P.C.R. was positive, but other tests did not show that that person was infected with pertussis bacteria. The disease center also interviewed patients in depth to see what their symptoms were and how they evolved.

“It was going on for months,” Dr. Kirkland said. But in the end, the conclusion was clear: There was no pertussis epidemic.

“We were all somewhat surprised,” Dr. Kirkland said, “and we were left in a very frustrating situation about what to do when the next outbreak comes.”

Dr. Cathy A. Petti, an infectious disease specialist at the University of Utah, said the story had one clear lesson.

“The big message is that every lab is vulnerable to having false positives,” Dr. Petti said. “No single test result is absolute and that is even more important with a test result based on P.C.R.”

As for Dr. Herndon, though, she now knows she is off the hook.

“I thought I might have caused the epidemic,” she said.

Why do people believe COVID-19 conspiracy theories?
As conspiracy theories about COVID-19 take root in the United States, understanding the psychological foundations of conspiracy beliefs is increasingly critical. Our research shows that beliefs in two popular variants of COVID-19 conspiracy theory are the joint product of the psychological predispositions 1) to reject information coming from experts and other authority figures and 2) to view major events as the product of conspiracies, as well as partisan and ideological motivations. The psychological foundations of conspiracy beliefs have implications for the development of strategies designed to curtail their negative consequences.

How widespread are beliefs about COVID-19 conspiracy theories?
What psychological, social, and political factors explain COVID-19 conspiracy beliefs?
Can partisanship and cues from partisan leaders, such as the president, increase misinformation about COVID-19?

Using a representative survey of U.S. adults fielded March 17-19, 2020 (n=2,023), we examine the prevalence and correlates of beliefs in two conspiracy theories about COVID-19.

29% of respondents agree that the threat of COVID-19 has been exaggerated to damage President Trump; 31% agree that the virus was purposefully created and spread.

The strongest predictors of beliefs in these ideas are a psychological predisposition to reject expert information and accounts of major events (denialism), a psychological predisposition to view major events as the product of conspiracy theories (conspiracy thinking), and partisan and ideological motivations.

Support for Donald Trump is strongly related to the belief that the COVID-19 threat has been exaggerated, even when accounting for partisanship and ideology. This relationship is strongest among people who regularly pay attention to politics. We surmise that Trump supporters adopted this belief in response to the President’s early messaging about the virus.
Belief that the virus was spread on purpose is most related to conspiracy thinking and is only slightly more concentrated among self-identified Republicans and conservatives than Democrats and liberals. This is likely a consequence of the fact that only a few, less salient partisan elites have endorsed this theory.

Conspiracy beliefs – especially those regarding science, medicine, and health-related topics – are widespread (Oliver and Wood 2014) and capable of prompting people to eschew appropriate health-related behaviors (Jolley and Douglas 2014). These (in)actions can result in negative societal consequences that reach beyond the individual conspiracy believer (e.g., failing to vaccinate one’s children can contribute to a resurgence in once eradicated diseases). A primary step in any initiative to correct harmful beliefs is to understand their characteristics and sources. If we understand who believes in conspiracy theories and misinformation about COVID-19 and why they hold such beliefs, we can better inform strategies to mitigate the harmful effects of the beliefs.

We find that the psychological predisposition to reject expert, authoritative information (denialism), the tendency to view major social and political events as the product of conspiracies (conspiracy thinking), and partisan motivations are the strongest explanatory factors behind COVID-19 conspiracy beliefs. Because two of these factors – conspiracy thinking and denialism – are founded in a deep distrust of experts and authority figures (e.g., scientists, political leaders), correction of misinformed and conspiratorial beliefs among individuals who exhibit high levels of conspiracy thinking and denialism is likely to be difficult. Conspiracy theorists and denialists are simply unlikely to accept corrective information coming from experts. This link between conspiracy thinking and misinformation has been highlighted as a potential reason for the observed failure of corrective strategies in several health-related cases (Carey, et al. 2020).

Despite this difficulty, it is not altogether impossible to limit the negative effects of misinformation and conspiracy theories, especially when the third factor – partisanship – can be mobilized in this effort. We identify three strategies for overcoming these negative effects. First, we might aim to limit the spread of, or exposure to, misinformation and conspiracy theories in the first place, or attempt to “pre-bunk” the dubious claims at the center of such ideas. These strategies take the perspective that our efforts should be as focused on prevention as they are on treatment, and recent efforts in this vein have proven successful despite legal and practical complications with impeding the communication of certain types of ideas (Roozenbeek, van der Linden and Nygren 2020).

Second, future work might employ existing knowledge about the correlates of conspiracy thinking and denialism to construct new strategies for limiting the effects of these predispositions on subsequent beliefs. For example, Douglas and colleagues (2017, 538) find that both conspiracy thinking and specific conspiracy beliefs are oftentimes the product of “epistemic (e.g., the desire for understanding, accuracy, and subjective certainty), existential (e.g., the desire for control and security), and social (e.g., the desire to maintain a positive image of the self or group)” motivations. If, then, we can generate preventive and corrective strategies that reduce uncertainty, increase perceived control, or promote a positive self-image, for example, we may be able to limit the power of people’s predispositions to construct conspiratorial accounts of major events or deny expert information (Nyhan and Reifler 2019).

Third, evidence suggests that corrective strategies can be efficacious if other political and social ingredients of conspiracy beliefs can be mobilized to correct beliefs (e.g., Berinsky 2015). Partisan and ideological motivations – both of which underlie the COVID-19 conspiracy beliefs we examine here – are prime examples of such ingredients. Even though conspiracy thinking and denialism may lead one to reject the information and accounts of many experts and authority figures, partisanship supplies trusted authority figures in the form of co-partisan leaders. If, then, partisan identity can be activated and mobilized, it may prove capable of overriding the distrust at the center of conspiratorial and denialist tendencies. A central mechanism by which this mobilization can occur is elite cueing (Zaller 1992), and the motivated reasoning it engages (Miller, Saunders and Farhart 2016). When party leaders and media personalities promote conspiracy theories and misinformation, likeminded individuals exposed to this rhetoric are more likely to adopt those ideas (Swire, et al. 2017).

We present evidence below that cues from partisan elites are capable of fostering, rather than correcting, conspiracy beliefs. To see how, consider the political information environment in the U.S. in the early months of 2020. At the outset of the COVID-19 threat, President Trump referred to COVID-19 as “their [Democrats’] new hoax” (Rieder 2020), and repeatedly likened the threat to the common flu (Brooks 2020). This likely led his supporters to take COVID-19 less seriously – a proposition we find support for. Less visible Republican leaders, such as Senator Tom Cotton, hinted that the virus was a bioweapon (Stevenson 2020); this rhetoric, albeit to a lesser extent, also likely encouraged some Republicans to adopt related beliefs. Moreover, Fox News personalities and other right-wing media figures continue to cast aspersions on the threat of COVID-19, even going so far as to question whether hospitals are truly filled with infected patients (Peters 2020).

If cues from partisan elites are capable of inflaming conspiracy beliefs among likeminded supporters, they may also capable of reducing conspiracy beliefs and limiting their pernicious effects. In these instances, the distrust at the center of conspiracy thinking and denialism may be overridden by embracing the power of partisanship and conveying corrective information using likeminded political elites (Berinsky 2015, Benegal and Scruggs 2018). This strategy seems particularly promising in the case of COVID-19. Since our survey was fielded, Donald Trump has publicly acknowledged the threat in daily White House briefings – an action that seems to have made Republicans more concerned about the virus (Badger and Quealy 2020).

On the one hand, this provides suggestive evidence for the efficacy of corrective partisan cues; on the other, it suggests a potential limitation of our study. Our results – from a survey fielded in mid-March – provide but a snapshot of COVID-19 conspiracy beliefs in a continually developing sociopolitical context. Changes in the behavior of Donald Trump and other political leaders who previously hinted at the possibility of a conspiracy or who trafficked in misinformation may operate as a corrective cue of sorts, encouraging supporters to take the threat seriously and engage in preventive measures. This is especially the case as other facts – e.g., the toll on human life – become increasingly apparent and unassailable.

That said, we possess ample evidence that these and similar COVID-19 conspiracy theories continue to spread and generate negative societal consequences. For example, three weeks after our data was collected a train operator working at the Port of Los Angeles attempted to crash a train into a Navy hospital ship because he “wanted to bring attention to the government’s activities” regarding the COVID-19 response (Zaveri 2020). In the UK, people who allegedly believe that 5G cellular networks are the cause of COVID-19 set fire to multiple cell towers (Slotkin 2020). These events suggest that our findings and their implications may traverse the trappings of the particular conspiracy theories we queried and the timeline of data collection.

They also suggest some nuance to the strategy of correction via co-partisan sources. Even though many political leaders who once trafficked in misinformation about the virus have begun to take it seriously, few have explicitly and unequivocally disavowed the misinformation and conspiracy theories. Even co-partisan corrections to misinformation require more than simply changing the conversation or quietly changing course; rather, dubious information needs to be actively discredited for a “correction” to be effective. Moreover, some negative consequences of misinformation and conspiratorial rhetoric cannot fully be reversed (Thorson 2015). During health crises like the COVID-19 pandemic or measles outbreaks, post-hoc changes in beliefs are simply not as valuable as the preventive actions – social distancing, hand-washing, vaccinations – that are consequentially stymied by such misinformed beliefs in the early stages of a crisis.

Finding 1: COVID-19 conspiracy beliefs are widespread

We asked respondents to what extent they agreed with the ideas that the COVID-19 threat “has been exaggerated” or “purposely created and released.” While the distributions of responses in Figure 1 reveal that there are more individuals who generally disagree with the propositions than agree, levels of agreement are far from trivial. Indeed, over 29% of respondents agree that the threat posed by COVID-19 is being exaggerated, while more than 31% agree that virus was intentionally created and spread. Given the transmissibility of COVID-19, these beliefs are dangerous even if only a fraction of Americans succumbing to them ignore best practices, such as social distancing. ... -theories/
We're already well more than 2 weeks into the rise in cases, with no corresponding rise in deaths yet.

I actually wrote this months ago I think that we would see a case spike, making it look worse, then no corresponding death spike, which would lead to the opposite.

Especially with a vaccine coming out, the people who doubled down on this for months at great detriment to other people are going to look pretty bad.
Wulfschilde wrote:
I actually wrote this months ago I think that we would see a case spike

That's the question though, is there really a spike in cases or is this all just a pseudo-epidemic caused by an overreliance on unreliable molecular tests? They're using the same kinds of molecular tests discussed in the article so a pseudo-epidemic is a distinct possibility.
Wulfschilde wrote:We're already well more than 2 weeks into the rise in cases, with no corresponding rise in deaths yet.

There are rising deaths. In absolute terms, deaths will always rise. So be aware of fake reporting. It's the rate of deaths that has stabilized and is falling on a confirmed case basis. In terms of fatality rates in confirmed cases in the US, Connecticut, New York and New Jersey are still have the highest fatality rates by far. Same with deaths per 1M population. Those numbers are pretty stable now.
Pfizer Science Chief: 'Government are using a Covid-19 test with undeclared false positive rates.'

with over 25 years of experience in drug discovery and development, Dr Yeadon has published over 40 original research articles and since 2011 has consulted to more than 20 biotechnology companies. Prior to consulting as an independent, he was Vice President and Chief Scientific Officer of the A&R Research Unit of Pfizer

In an interview last week Dr. Yeadon was asked:

“we are basing a government policy, an economic policy, a civil liberties policy, in terms of limiting people to six people in a meeting…all based on, what may well be, completely fake data on this coronavirus?”

Dr. Yeadon answered with a simple “yes.”

Dr. Yeadon said in the interview that, given the “shape” of all important indicators in a worldwide pandemic, such as hospitalizations, ICU utilization, and deaths, “the pandemic is fundamentally over.”

Yeadon said in the interview:

“Were it not for the test data that you get from the TV all the time, you would rightly conclude that the pandemic was over, as nothing much has happened. Of course people go to the hospital, moving into the autumn flu season…but there is no science to suggest a second wave should happen.”
Carl Heneghan - False positives is a really important issue

Carl Heneghan is a clinical epidemiologist with expertise in evidence-based medicine, research methods, and evidence synthesis.
He is Director of the NIHR SPCR Evidence Synthesis Working Group a collaboration of nine primary care departments across UK universities. He set up and directs the Oxford COVID Evidence Service, has over 400 peer-reviewed publications (current H Index 67); published 95 systematic reviews. He is Editor in Chief of BMJ Evidence-Based Medicine, and Editor of the Catalogue of Bias.

Director of CEBM & Programs in EBHC
Editor in Chief, BMJ EBM
NHS Urgent Care GP
NIHR Senior Investigator
It should be noted that once you've got false infections you can get false Covid deaths as well. Because when you're generating huge numbers of fake Covid cases some of those people will inevitably die from other causes.

We should not assume though that all the people at the centre of the medical industrial complex are stupid though. Oh no. Some of them are very clever and know exactly what they are doing. Mass false positive testing is only one part of their plan. Another is that they are deliberately trying to weaken the the west's populations disease resistance. They are deliberately trying to sabotage our development of immunity not just to Covid 19, but to all infectious deceases.

When Europeans arrived in the Americas, because of their very limited animal husbandry the indigenous Americans were incredibly vulnerable to old world diseases. When Europeans went to Africa, Europeans died, but when Europeans went to the Americas it was the Amerindians that died. When most of us decent people look back to these events we see a terrible human tragedy, but that's not how some of the people within Medical Health industrial complex see it. No they see money. They see a business opportunity.

What if you could have a huge population without properly developed immune systems like the Amerindians, but also rich like westerners capable of paying for an endless series of vaccines, medicines and medical treatments. By these lockdowns and social distancing they may have inflicted damage to some children's immune development that they will be hoping will leave them weakened, compromised and vulnerable for the rest of their lives.
Rancid wrote:@Sivad, even your boy Bill Gates say's death rates will drop significantly by the end of the year.

Where did he say that? If he did it's interesting in itself.
annatar1914 wrote:Where did he say that? If he did it's interesting in itself. ... -2020.html

He's mostly talking about advances in medicine though, not because of some natural thing happening. Though, corona viruses tend to mutate to become weaker, so the results of these new medical advances could be confounded with that. All that said, I'm sure researchers will be able to pick this all apart given enough time.
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