SARS-CoV-2 novel CORONAVIRUS is a nasty bug, no doubt about it. It’s the SINE QUA NON of the crisis we’re facing right now.

But, I’m NOT BLAMING THE VIRUS for the crisis.

Would I like to sweep up every last virus & toss them in a blast furnace?

Hell oui ! (pardon my French).🧵 The virus is just a teeny-weeny bag of itsy-bitsy pieces of RNA, just out there trying to get by.

Many people like to place a pile of blame onto the shoulders of our elected “LEADERS”. Leaders definitely could have done a lot better to consult, learn, teach and model.
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TEST POSITIVITY - My view.

Disclaimer: I'm not an epidemiologist nor statistician. This is my understanding of the topic.

A simple internet search will yield a LOT of explanations with good graphics so you might consider going that route if I don’t provide what you need.
… I am going to sacrifice brevity and density for clarity, so this could end up being a long thread. My apologies in advance. Someone who knows how might unroll this for us.

In my haste I won’t have diagrams or graphics so you’ll have to use your imagination at times.

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If feel like making a shocking statement, a bold prediction. One of those statements a person immortalizes in a tweet that others repost a couple months later and say “This didn’t age well”.

If you’ll bear with me I’ll explain what is swirling around in my head.

Here’s a hint: First, I should say that I don’t have any special access to information and I don’t really have any special skill in making predictions pertinent to the coronavirus pandemic in South Dakota. But it’s obvious I’ve been paying attention.

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What good is FREE, MASS CoV TESTING to anyone who wants a test ...

IF you don't plan to quarantine until result is returned?
IF you are asymptomatic and are not a close contact?
IF results take 3-5 business days (up to a week!)?
IF you won't isolate 10+ days if positive?
IF ... IF you are worried you might have COVID because you're sick or have had close contact with someone with COVID,

you MUST QUARANTINE until you receive the result otherwise the test does nothing to slow the spread. If you don't plan to quarantine why get the test?

I'm tired of the mask-debaters, anti-testers, herders and the like. I'm certain NOTHING will change their minds. People of that ideology, and it is an ideology, don't move to SD because they're welcome here, they are GROWN and nurtured here.

Many of them are my good friends.
... So...

If anyone wants to discuss the pandemic or has a legitimate question about how it spreads & how it does damage to the human body or economy, sure, I'll engage. We can start as far back in the basics of science as they want. I have all the patience in the world for that....

It is likely that HOSPITAL usage by COVID patients in South Dakota will become a hot topic in coming days & weeks.

Here are some questions that come to mind. It would be nice if media reps would consider pursuing this line of questioning at a press conf.

🧵 A short thread. It should be easy to put this one to rest:

The # of "currently hospitalized", per DoH, "MAY include out-of-state cases". Does that mean SOME or ALL non-SD residents receiving care in SD hospitals? Or non-SD residents residing in SD for college? Or SD residents in non-SD hosp?

I've noticed some confusion re discrepancies between # of CoV POSITIVES reported on a day & the # of POSITIVES for that same DATE on the TREND graph a couple days later.

I thought I could explain with a graphic. Unfortunately it became an uncontrolled, eye roll-worthy beast.
... At the top, imagine @SDDOH receives results in 2 batches each day, 1 in the morning and 1 in afternoon. The POS results will be tallied & presented on trend graph for that date 2 days later (to allow time to verify & add in results that might arrive shortly before midnight).

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SCIENCE - What is so great about science?

Science is like that NAIL you pounded into the wall a while back because you needed a place to HANG YOUR HAT.

Another Saturday morning THREAD (about “social” DISTANCING, and CONTACT TRACING).

… Imagine you’re moving into a new place. You thought you saw a closet by the front door but were so excited to sign the lease you didn't notice.

NP. You get your toolbox & grab a hammer & nail. You pound a big nail deep into a wall stud &, voila: a place to hang your hat.

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How can we make sense of this?

Contact tracing is supposed to identify/warn potential contacts of a CoV infected person. Risk times include 2 days before symptoms started until the person was isolated.

When do you think this person was tested?
Do you think they had symptoms?

Most following here are prob aware of news about UNC shutting down in-person undergrad classes due to a bunch of CoV clusters among students.

I can't help but wonder why this wasn't fully anticipated & why stronger measure weren't enacted to prevent.

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unc.live/3iVHtlr On-campus planning, rules & mitigation won't prevent students getting & spreading CoV infections if they engage in known, risky behavior off-campus.

As a parent of 3 college/grad students I accept one can only ask & expect so much, but I'm reminded of that "ass u me" saying.
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People who have recovered from COVID will presumably have blood full of antibodies against the virus. These folks can donate the liquid part of their blood, so-called CONVALESCENT PLASMA, so it can be given to someone fighting the infection.

Short THREAD

bit.ly/3kP5wnM The transfer of antibodies from one person to another via convalescent plasma transfusion is an old, tried and true treatment for many infectious diseases. It makes sense, and it works.

Pharma companies can manufacture antibodies (aka monoclonal antibodies) against CoV.

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Inpatient and Outpatient Deaths - Distinctions of Honor

South Dakota Dept of Health @SDDOH reports deaths among SD residents as either INPATIENT or OUTPATIENT.

The death location might seem academic but I think there’s something to it.

A rambling THREAD… I have no special info from DoH re location criteria but I suspect it’s fairly straightforward.

If you die while ADMITTED TO HOSPITAL then you are tallied as INPATIENT death.

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This South Dakota Dept of Education's @sddoe school reopening guidance. At first glance it looks like a lot of thought & work went into it. On deeper review it strikes me as extremely WEAK. No real guidance at all. Lots of "limit this", "consider that".

bit.ly/3h30dim I have not studied all the links yet. The one re mitigation in schools indicates that if there are cases in a school they should look for gaps in prevention strategies. Why not assume there will be cases and look for gaps NOW, implement them NOW to prevent the cases?

Reality check time. Maybe my expectations are too high.

I believe that South Dakota Dept of Health @SDDOH should have used their platform to educate & inform people in the state –locals & visitors alike– about the GROSSLY ILLOGICAL use of CoV ANTIBODY TESTING in Sturgis.

THREAD The @SDDOH EPIDEMIOLOGIST was asked about a vendor selling ANTIBODY testing at STURGIS rally. He said something to the effect of “NOT MY JOB to regulate the testing or results” and said it’s UP TO THE PEOPLE to ask questions. He said test should be given by healthcare pros.

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Coronavirus ANTIBODY TESTING IN STURGIS is likely to give FALSE or MISLEADING results to concerned bikers.

TLDR: If you arrived at the rally on Saturday 08 Aug & were exposed to CoV that day, you might have detectable IgM antibodies today, 13 Aug. MIGHT.

Let me explain…
THREAD When a person is infected with a new virus, a healthy immune system immediately gets to work to track down the infected cells, kill those cell, attack the virus, and set into motion the production of antibodies.

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I have become increasingly critical of South Dakota governor @govkrisinoem & Dept of Health @SDDOH & about how they’re managing SD response to CoV pandemic.

It’s easy to criticize from my comfortable chair, But WHAT WOULD I DO if I were in charge?

THE MOTHER OF ALL THREADS … The first thing I would do is acknowledge that the greatest, present threat to South Dakotans is the coronavirus pandemic. Controlling its spread is the key to safely opening businesses and schools, and getting closer to our new normal.

TPR vs. P-TPR
We've discussed TPR a lot but recently @SDDOH started reporting persons tested vs. tests used.

It's an important distinction, but which value should be used for calculation of POSITIVITY RATE?

I think there are good reasons to support either denominator.

THREAD At first I thought we should focus on PERSONS, not tests, but I'm not so sure.

If tests are used, as I advocate, to repeatedly test NH staff & other front-line workers one could argue each test (same person) does help assess status of disease in the community.

BUT...

Let’s discuss test positivity rate (TPR) again.

Review: TPR is the % of total RESULTS (+ & -) that are positive. I chose those words carefully as nowadays a batch of results presented one day might represent tests conducted over many preceding days.

It’s crude metric.

THREAD… TPR is influenced by testing practice in an area of interest.

For example, if tests only done on people with symptoms there is a high chance many will be positive. TPR will be high.

If tests only done as pre-op screening in people likely to be negative, TPR will be low.

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I don't want be labeled a fear-monger, but issue of reopening schools is heating up quickly as Sept approaches and it'll be messy.

I suppose it's good that some SD schools have delayed opening so nationwide experience can be factored in to ultimate plan. nytimes.com/2020/08/01/us/… If I were advising a large SD school district I would recommend embracing FULL, REMOTE LEARNING as the foundation for academic year 20-21. Get that planned to the best it can be, and only then add in-person experiences, first focusing on special needs of students and families.

What happened at Camp Judson, a nice church camp nestled in the Black Hills of Pennington Co., @southdakota ?

Apparently an outbreak of coronavirus infections has caused camp to temporarily close. LMK what you know.

What lessons can be learned re school opening?

(OLD photo.) I posted this link a while back but shared it with Camp Judson Facebook page this morning. It looks like there are no more youth camps scheduled this summer; maybe they can learn from experience & literature that the pandemic is real & worthy of attention. scientificamerican.com/article/how-su…

Should we focus on DEATHS as a measure of pandemic success in South Dakota?

Some say we’re doing fine because we have so few recorded COVID deaths among South Dakotans.

At what level would the death count be too high?

My sense is this is the WORST METRIC of SUCCESS.

THREAD... Not every COVID death is preventable but in theory, most are. If you don’t get infected you won’t get sick and you won’t die.

Success should be measured in how the coronavirus pandemic GOALS are enumerated, communicated, operationalized and executed by state and local officials.