Sunday morning epi musings:
With the antigen home test we always knew that it might take two tests over two days to have good sensitivity. This was known and why the tests came in two packs. The message was "if you are sick, stay home, please test."
The message isn't changed, but anecdotally, these tests now seem less sensitive. I was recently exposed when someone who thought they were having allergies tested negative 2 days in a row, then the day after the bbq, that person tested positive. Then I developed allergy type symptoms. I isolated 5 days, tested negative 3 days in a row on sx days 3-5, and went out masked for the next 5.
Did I have COVID? Don't know. Had I been quite social before then? Yes. Did I hang out after with two friends who were also on (unrelated) COVID watch and also testing negative? Sure.
For over a year during the pandemic, I used to say to healthcare workers "COVID isn't the only thing your patient can have, but your patient almost certainly has COVID" in the context of respiratory infectious diagnosis. At first there were no other circulating RVs except rhinovirus. Then the masks started to come off, and there were other circulating pathogens, but they were still eclipsed by the hyper-contagious COVID variants. Now "almost certainly" is just "likely." COVID is still number one, but it isn't the only one.
Do the tests still work?
On Friday an Epi from the state suggested continuous testing for up to 6 days might be needed. I thought this was extremely absurd for the average person.
The current way of thinking, data supported, is that if you are testing antigen negative with good procedure, you are at least significantly less contagious, or likely not contagious. You don't have enough antigen you are just not shedding as much, or any, replication competent virus, particularly if you have some level of immunity (and almost everyone does now), particularly if you are on the recovery end of the illness, thus the idea of using antigens to clear early from isolation.
So did the viral antigen dynamics change vs the tests? Or is this a manifestation of antigen levels in people with significant immunity from vaccination/infection?
If there is a new way of thinking that we need to test for 6 days, it needs to be data supported. If the reasoning is that the antigen tests have severely degraded clinical sensitivity (ability to positively detect transmissible infection), then we need different tests (updated antigen or use PCR). Such a message is not being put forth outside of discussion on my state epidemiology call.
I've said this repeatedly, testing is hard and complex, even for the medical professional.
Hospitalizations are manageable. Staffing impacts are the primary. This is the end of the Deceleration Phase that Fauci described at the end of the Pandemic->Endemic transition.
Go out, enjoy a social summer, don't stress. You might get Rona, but you'll be OK. You won't get the pox, polios, marburg, yellow fever, or whatever else the 24 hour news cycle is yammering about. Stop stressing. Wash your hands. Wear a mask in crowded and poorly ventilated places. If you are stick, stay home. I still like antigens to clear COVID iso, especially if you are around the vulnerable.
/Sunday morning epidemiology musings
