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Paradigm Shift Intervention Monitoring
Flawed Logic On Beta Coronavirus Transmission
In the 10 days before his illness onset, the patient had visited both Pakistan (from 16 December 2012 to 20 January 2013) and Saudi Arabia (from 20 to 28 January 2013). After hospital admission, his condition deteriorated and he was transferred for extracorporeal membrane oxygenation (ECMO) treatment on 5 February. He remains severely ill in intensive care.
The wide geographical distribution, the long intervals between cases and clusters, and the absence of evidence for mild or asymptomatic human infections which could maintain a chain of transmission between outbreaks, point to intermittent zoonotic transmission or an environmental source.
The above comments from the ECDC beta cornonavirus update provide additional detail on the latest confirmed betacornavirus case, and repeat their illogical analysis that cites the absence of mild cases as evidence against human to human transmission.
The absence of confirmed mild cases is evidence for a failed protocol, which leads to a lack of sensitivity required for the detection of mild cases. WHO has classified the cluster members who tested negative as probable cases, consistent with their symptoms and tight linkage to multiple lab confirmed cases.
Severe and fatal cases commonly have high viral loads and ready access to sampling of the lower respiratory tract leading to detection by assays which have limited sensitivity for milder cases. The above case was co-infected with H1N1pdm09 with associated severe breathing difficulties. The co-infection with a readily transmissible pandemic H1N1 influenza woudl facilitate human transmission.
The absence of the detection of mild cases signals a flawed protocol, which when coupled to the ECDC logic, produces a novel conclusion that remains hazardous to the world’s health.