The Focus on ‘Cases,’ Not COVID Deaths is a Trick

Written by Andy Rowlands on September 14, 2020. Posted in Current News

The Centre for Evidence Based-Medicine at Oxford University has posted the following article, When is Covid, Covid? (September 11, 2020).

For clarity, it should be remembered that Professor Carl Heneghan is Director of the Centre for Evidence-Based Medicine & Director of Studies for the Evidence-Based Health Care Programme, and it was his work at the CEBM that forced the government to revise its method of counting deaths, so that only people dying within 28 days of a positive test were counted as having died from the virus.

The article starts by saying:

We are constantly following the tally of Covid-19 cases. But one question won’t go away: when is Covid-19 actually Covid-19?

Covid-19 was first identified as a severe disease-causing atypical pneumonia, accompanied by fever, cough and sometimes a range of other symptoms. The clinical features of the 41 patients infected with 2019 novel coronavirus in Wuhan included pneumonia with abnormal findings on chest CT. The agent was identified as SARS-CoV-2. 

Testing by RT-PCR has been globally implemented to identify RNA sequences thought to be unique to SARS-CoV-2. Worldwide case numbers are based on the reporting of the presence or absence of small RNA sequences of the SARS-CoV-2 genome. (Emphasis added)

Thought to be unique? But presumably then not proven to be.

The article continues:

Some diseases can be diagnosed based on a test alone; most diseases, however, are defined by the cluster of symptoms and signs, in addition to test results. A recent review found that a single symptom or sign could not accurately diagnose COVID-19. (Emphasis added)

A highly cited rapid review guideline defined a suspected case as a patient with any of two of the following clinical features: fever, imaging features of pneumonia, normal or reduced white blood cell count, or reduced lymphocyte count in the early stages of the disease onset. A confirmed case was defined as positive for the 2019-nCoV by the real-time PCR test for nucleic acid in respiratory or blood samples. 

Disease control agencies and the World Health Organisation have produced guidance for diagnosing Covid-19. We looked up case definitions, and copied them into a table to compare them.

The table can be seen here: docs.google.com

The article then mentions how various organisations and countries define the virus characteristics and testing methods. For the purposes of this article, I use only data for the UK, USA & EU.

It says:

WHO

• A suspect case has clinical symptoms of respiratory disease, perhaps with other associated presentations. 
• A probable case is a suspect case for whom laboratory testing was inconclusive or not possible. 
• A confirmed case is “A person with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms.” (Emphasis in original)

Thus, a positive laboratory test – type of test not specified here – trumps all else. We were not able to find WHO guidance on how PCR tests should be interpreted, specifically in relation to cycle count or viral load. (Emphasis added)

European Union

For the European Centres for Disease Control (ECDC), a case may be defined from clinical symptoms, or from radiology, or from “detection of SARS-CoV-2 nucleic acid in a clinical specimen” alone.

• Possible cases if diagnosed from clinical criteria, 
• Probable if diagnosed from clinical and epidemiological criteria, 
• Confirmed in “any person meeting the laboratory criteria”. (Emphasis in original)

So, again, a positive laboratory test is more important than clinical diagnoses, and again, we were unable to find guidance on how laboratory tests should be applied and interpreted, particularly in PCR in relation to cycle count and viral load. (Emphasis added)

USA

The US Centers for Disease Control (CDC) states 

• Probable case meets clinical criteria and epidemiological evidence, or has presumptive laboratory evidence with either clinical or epidemiological evidence, or has Covid-19 or SARS-CoV-2 on the death certificate as a cause or significant contributor to death.
• Confirmed case “Meets confirmatory laboratory evidence”. (Emphasis in original)

No information is given on interpreting PCR tests in relation to cycle count thresholds or viral load. Again, it looks as though a PCR test trumps clinical diagnoses. (Emphasis added)

UK 

The UK government guidance on diagnosis is based on clinical symptoms. Testing (not specified) is recommended for cases who are well enough to remain in the community. No guidance is given as to how to interpret such a test or any actions that should be taken consequent to the test results. Thus, new cases in the UK could reasonably be thought to mean cases diagnosed by clinical symptoms. (Emphasis in original)

The methodology for counting cases states the following:

“If a person has both a negative and a positive test, then only their positive test will be counted. If a person is tested as positive under both pillar 1 and pillar 2, then only the first positive case is counted.” (Emphasis added)

Only positive test results are counted, negative ones are ignored.

It continues:

An asymptomatic person who tested positive could have two confirmatory negative tests, but would still count as a confirmed case. In Wales, data is deduplicated on 42-day episodes; if someone is tested twice, 43 days apart, they will be included in the case count measure twice. (Emphasis added)

The latest guidance states that ‘positive test results at the limit of detection that occur early in the cycle of infection are important as these represent individuals who may go on to transmit infection.’ The guidance asks laboratories to ‘determine the threshold for a positive result at the limit of detection based on the in-use assay,’ without stating what the threshold should be. If necessary, the laboratory should request a repeat sample; again this advice is given without a threshold to guide when to do the repeat test. (Emphasis added)

What is the case definition being used for clusters of UK cases being reported currently?

We deduce that a reported “case” is most probably simply the result of a positive PCR test. The new guidance is meaningless unless it provides a clear threshold for the limits of detection. For many whose test turns up positive, there may be nothing recorded about any clinical symptoms. (Emphasis added)

The definition of suspected cases resembles what we would normally expect for making a diagnosis based on a set of clinical criteria. This is, however, discarded when it comes to a confirmatory diagnosis and replaced by a single PCR test result. However, there is no guidance providing details on the specific RNA sequences required by testing, a threshold for the test result and the need for confirmatory testing. It is therefore not clear to us what constitutes a positive result.

Currently, any person meeting the laboratory criteria is a confirmed case. Yet, a case definition should be a set of standard criteria for classifying whether a person has a certain disease, syndrome, or other health condition.

The PCR test positivity counts should include a standardized threshold level of detection, and at a minimum, the recording of the presence or absence of symptoms. As a disease, the COVID-19 case definition should constitute a disorder that produces a specific set of symptoms and signs. The in-hospital case definition should, therefore, record the CT lung findings and associated blood tests. 

Only when an international standard is agreed upon will we be able to make comparisons, and answer the question of when is Covid, Covid?

You see now how the focus on tests and cases rather than deaths is making people think this ‘pandemic’ is much worse than it really is, and rising cases is being used to justify continued and increasing restrictions. Negative tests are ignored if there was a positive test, and some positive tests are double-counted.

We have to wonder why this apparently deliberate deception revealed by the CEBM is being perpetrated across the world, and for what end, though I think many readers can probably guess.

About the author: Andy Rowlands is a British Principia Scientific International researcher, writer and editor who co-edited the new climate science book, ‘The Sky Dragon Slayers: Victory Lap‘

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