This is exactly my second COVID-19 anniversary. I wouldn't have realized that without one of our infectious diseases fellows mentioning an email I had sent out near the start of this whole thing. I had no recollection of that but was able to search through my Sent box and found it. It was dated January 9, 2020, and basically said to keep a watch on this new coronavirus thing in China, but at least it didn't appear to be showing human-to-human transmission. How times have changed.
A lot has happened in the past week, and most of that you've probably already heard about. Stick to the CDC website as a primary resource. Today I'll focus on just one COVID-19 topic to direct you to new publications you may not have seen, plus detour with news about an unrelated infection.
Testing for SARS-CoV-2
This is getting more confusing with possible less sensitivity for omicron with some of the rapid antigen tests. I first want to mention a review article published this week that I strongly encourage all healthcare providers to read. It's available free without journal subscription. I realized while reading it that the information answers virtually all of the questions I receive from practitioners about testing. It also has great figures and tables.
Somewhat along the same lines is some new information about false positive rapid antigen testing, very helpful though it is based in pre-omicron times. Usually when we talk about rapid antigen tests we are more worried about false negatives, but false positives do occur usually at a low rate. The two take-home points from this article are that 1) if rates of disease are really low in a population (not the case now!) then at some point no matter how high the test specificity a positive test is more likely to be false than true; and 2) sometimes test errors occur due to a faulty batch of test kits.
I do think we'll get over this omicron hump eventually and back to a time when infection rates are low. We all need to keep pushing on until we get there. Thanks to all the healthcare providers who are working so hard to keep our kids safe.
A Bad Year for Rabies
Rabies infection is about as close to 100% fatal as one can get with any specific diagnosis. CDC just reported on 3 rabies cases, 2 adults and 1 child, in the US resulting from separate bat exposures in August 2021. All 3 had direct contact with bats, either bite or collision. All became ill within 3-7 weeks and died 2-3 weeks after symptom onset.
Worse than that are a couple of details about the individual cases. Two didn't realize they were at risk for rabies and did not seek care until they developed symptoms. The third was even more sad: the patient submitted the bat for testing, it tested positive, but the patient refused post-exposure prophylaxis because of "a long-standing fear of vaccines." I wonder how much the current vaccine hesitancy associated with COVID-19 influenced that decision.
These cases also serve to remind us we can't turn all of our attention to COVID-19. With such a great strain on healthcare providers and epidemiologic systems it is likely easier to overlook something new coming up, sort of like those few cases seeming to originate from an obscure market in China.