What is clear after a test for coronavirus infection does not mean all is clear, apparently. No one who has COVID-19 and then recovers ensures that it will not attack again. That’s the unsettling news that came out of South Korea, a country that is widely regarded as the most successful – and transparent – overcoming the threat of a pandemic against its people and economy.
In briefing earlier this week, Jeong Eun-kyeong, director general of the Korea Centers for Disease Control and Prevention, said that 51 people who were previously thought to be fully recovered were positive again shortly after they left quarantine. Jeong said the virus might have been “reactivated” in a certain way since then in the CDC’s assessment too soon after their recovery so that they had been infected again.
“We are conducting a comprehensive study on this,” Jeong said. “There are many cases when a patient during treatment will test negative one day and another positive.” But the CDC “emphasizes reactivation as a possible cause.”
There is reason for concern, but not concern, according to various analysts.
“When you test hundreds of thousands of cases, you get a number.“
– Ogan Gurel
“The possibility of false negatives is very real,” Dr. Ogan Gurel, who came to Korea nine years ago was armed with a medical degree from Columbia to teach and conduct research after serving at the Massachusetts General Hospital affiliated with Harvard in Boston.
“Think about how the test is done,” he said. “You put a cotton swab in your nose and spin it.” Even if done correctly, the procedure “is not always guaranteed to take the virus.” In addition, “storage, transportation, etc. Samples can create negative results – many experts think this might be the problem.”
Clearly the CDC will look at the problem very carefully because it carries out new tests that are more complicated than “reactivated” patients.
At the very least, uncertainty makes Koreans nervous, wondering if the efficiency praised by the country in warding off disease really works well. “This is very erratic, we have to be extra careful,” said Chang Sung-eun, an office worker who stayed at home during the pandemic. “Mistakes don’t happen often, but nobody knows.”
“The most frightening scenario is mutations – changes in the nature of the virus.“
Gurel cites estimates that “false negatives occur in only one percent of cases” but observes, “When you test hundreds of thousands of cases, you get several numbers.”
Korean CDC figure showed that on April 9, South Korea, with a population of around 52 million people, had tested 494,711, of whom 10,423 were confirmed to have the disease, while 204 had died.
For comparison, as of this writing New York City alone, with a population of 8.5 million, has had more than 4,500 deaths.
Another aspect of the problem, said Gurel, is that “everyone’s immune system is different.”
If failing testing is the main reason why no one can be absolutely sure not to get down with bugs, or have recovered at least to the extent that they are no longer contagious, other unclear factors also play a role. . Unfortunately, this may be increasingly important over the years, even assuming scientists make vaccines.
The most frightening scenario is mutations – changes in the nature of the virus. In other words, the tension created by a team of scientists and doctors can turn into a different variety that is just as deadly.
“There are indeed frequent mutations,” Gurel said. “It is very important for us to carry out genome studies of viruses and patients and to correlate these genetic studies with clinical results.”
Such grueling research will “help us understand exactly why some people get serious illnesses while others are quite mild,” he continued. “Ensuring which parts of the virus mutate and are conserved will help in designing an effective vaccine that will concentrate on areas of the virus that generally do not mutate.”
Then, Gurel said, there was the problem of “immune failure over time with an unsustainable antibody response.” People who suffer from measles or chickenpox, for example, can usually depend on some level of immunity for the rest of their lives.
But that’s not the problem with all viruses, with the common cold is a good example. “We know that there is no vaccine and it often recurs in people,” he said, and “about 15 percent of ordinary flu cases are caused by mild varieties of coronavirus.”
Like the common cold virus, he said, coronavirus “can make immune responses that are less strong in some people.” Bottom line: “There may be some concern about the limited immune response becoming possible with this new coronavirus.”
Gurel rejected, however, the theory that coronaviruses might be latent in a person’s system, escaping detection until it develops as a disease in the way of HIV, herpes or hepatitis. COVID-19, he said, did not have “such latency.”
In seeking healing, Gurel warned against taking President Donald Trump’s advice and trying hydroxychloroquine, an anti-malaria drug. Trump asked, “What’s the loss?” said Gurel, repeating Trump’s line. “There are serious side effects,” including blindness in some cases.
Gurel offers some suggestions that Trump might want to consider: “We must be open to evaluating such therapies but still applying some degree of rigidity to avoid complications of tragedy.”
For comparison, Gurel noted that victims of the Spanish flu, a disease that killed 40 million worldwide in 1918-1919, used high-dose aspirin to reduce fever. There are, he said, “theories that high levels of aspirin contribute to outcomes” – high numbers of deaths.
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