Are We Quarantining the Wrong People for Too Long?

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If you follow this blog, you know that I often write about what I experience or find. This morning is yet another super big deal paper on COVID-19 that’s of the highest quality. It tells us that because of our bad PCR tests, we’re quarantining the wrong people for longer than they need to be. Let’s dig in.

The Concept of Viral Load and Shedding

You know from a past blog that PCR tests for COVID-19 are often finding minuscule amounts of dead virus genetic material, even when there is no live virus present in the patient. If the person actually has the novel coronavirus, they are showing up as positive long after they can actually infect someone else, as infecting someone would take the transmission of a live virus. Meaning that dead viral strands of RNA (what the PCR test detects) can’t infect others.

First some definitions, viral load means the amount of live virus in a patient. The idea is that patients with higher viral loads are more likely to infect others. Viral shedding is when the virus is excreted in things that we can all come in contact with like the water droplets in a sneeze.

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Why Do We Need this COVID Study Right Now?

You may have seen news stories about how the coronavirus can survive in patients for a long-time and that they may be able to spread it to others even after quarantine. You also probably people who have come in contact with someone who has COVID-19 who never get sick are told to quarantine for two weeks. Does any of this make sense?

The New Study

This research is a systemic review and meta-analysis, which if done properly, is the “King” of studies. Meaning it looks at the results of many different high-quality studies and identifies the overarching trends to make sure that many studies point in the same direction. For example, you might have 5 studies saying the sky is blue and one saying it’s green, so you would conclude that the balance of the evidence shows that the sky is really blue.

This study was published in the prestigious medical journal “The Lancet” and reviewed 79 studies on the SARS-CoV-2 virus that all researched the viral load and shedding in 5,340 patients. While our overly sensitive PCR tests found viral RNA present for weeks to months after someone had been infected, no study found that actual live virus survived in any patient beyond 9 days. In addition, these viral loads peaked at days 3-5, which is when patients would be most infectious. In addition, if the patient has no symptoms, then the viral clearance is quicker. 

New Recommendations

First, this study confirms what the one I blogged on last week discussed, which is that PCR tests are often positive when there is no live virus in the patient. So please read that blog to make sure you don’t get tagged as having COVID-19 when you actually have no significant amount of virus in your body. Again, you need to know the cycle threshold for the test, which should be under 30-35.

Here’s what we can now say based on this huge new study:

  • Quarantine should be no longer than 9 days and not the 10-14 days that is currently being recommended.
  • A lesser number of days should be needed for patients without symptoms but who have a legitimately PCR positive test, although this study couldn’t settle on that number.
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The New COVID Data

Based on the high-quality research now being published, here’s what we know (in addition to the above):

The upshot? As I’ve said, the science on COVID-19 is maturing now, so it’s time to begin focusing on what we know based on the high-quality studies now being published and ditch what we thought we knew.  In this case, it’s time to shorten these quarantines! Even cutting a day off the time people need to isolate will save in lost productivity and add hundreds of billions to the US and trillions to the world economy.

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References:

(1) Cevik M, et al. SARS-CoV-2, SARS-CoV, and MERS-CoV viral load dynamics, duration of viral shedding, and infectiousness: a systematic review and meta-analysis. The Lancet. November 19, 2020DOI:https://doi.org/10.1016/S2666-5247(20)30172-5

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