Active COVID-19 cases in North Dakota have increased dramatically over the past few weeks and that is driving public policy decisions at the state and local level. Decisions affecting schools, businesses, everyone. But public policy should be based on facts not fear, and to get the facts there are still some important questions that need be answered.
First, let me be clear. This pandemic is real and COVID-19 poses a serious threat, especially to the elderly and vulnerable individuals with underlying health conditions.
We now have well over 2,000 active cases in North Dakota. There is some good news, hospitalizations as a percentage of active cases are down significantly. This shows that the vulnerable population is being protected while active cases increase among the younger and generally healthier population.
However, whether a person has symptoms or not, each positive test result has a ripple effect. Under the North Dakota Department of Health’s guidelines for schools, a student identified as a close contact with an active COVID-19 individual should stay home for 14 days. That student should then be tested after 7 – 10 days and if positive the student should stay home for 10 days. The student’s family then would begin the 14 day stay home cycle, and on it goes.
Last week an entire kindergarten class was quarantined in Thompson, ND, after one of the students tested positive. Including siblings and parents of those 24 kindergartners, that is a lot of people impacted in just one small North Dakota town.
All of this is to say that each positive COVID-19 test has significant, far-reaching, impacts. We should at least be sure what a positive test result actually means.
An August 29, 2020, report in the New York Times raised some important questions about the testing process for the most common COVID-19 test. The report looked at the process in New York, Massachusetts and Nevada, and concluded that 90% of the positive cases did not contain enough virus for the individual to be contagious. That seems significant.
Without getting into the full detail (the Times article is worth the read), each sample from the common PCR test is amplified in the lab to determine if the virus is present. The amplification cycles, or cycle threshold, in the states reviewed was 40. The experts interviewed for the report said the cycle threshold should be 30 and if that were the case 90% of the prior positive results would be negative.
The Times report quotes a Dr. Mina, “Tests with thresholds so high may detect not just live virus but also genetic fragments, leftovers from infection that pose no particular risk — akin to finding a hair in a room long after a person has left.”
You can’t get blood from a turnip they say, but magnify the tissue sample 40 times and you might get a positive test.
I do not know the cycle threshold for PCR tests in North Dakota, or if the cycle threshold has been changed lately, but hopefully, policy makers and medical professionals have that information before using the increase in active cases to justify further restrictions on schools, businesses and individuals.