Falling Coronavirus Testing Numbers Obscures the Reality of the U.S. Pandemic

July was devastating in the U.S. After the country had appeared to flatten the curve in late spring, daily new cases of COVID-19 skyrocketed as the season turned, peaking at 20.5 per 100,000 people on July 18, according to data gathered by Johns Hopkins University (JHU). After some hemming and hawing, many local officials of…

Falling Coronavirus Testing Numbers Obscures the Reality of the U.S. Pandemic
new cases of COVID-19 skyrocketed as the season turned, peaking at 20.5 per 100,000 people on July 18, according to data gathered by Johns Hopkins University (JHU). After some hemming and hawing, many local officials of states seeing resurgences reinstated some of the restrictions, meant to limit the spread of the virus, which had previously been lifted. On the face of it, these decisions seemed to have paid off: Though the U.S. recently passed 5 million total confirmed cases, it took longer (17 days) to go from 4 million to 5 million than it did (15 days) to go from 3 million to 4 million. And in the past two weeks, the per-capita daily case rate in the U.S. has fallen by four—equal to a drop of about 13,100 new daily cases.

The reality, however, might not be so rosy. That’s because in that same time frame, testing for COVID-19 in the U.S. has also fallen at practically the same rate. A little over two weeks ago, about 820,000 new tests were being administered per day, according to the COVID Tracking Project. By Aug. 12, that had dropped to about 710,000:

As U.S. President Donald Trump gears up for the 2020 election cycle, he’s been keen to minimize the impact of COVID-19 under his watch, largely by latching on to any data or talking point that suggests the epidemic has been overblown by those he sees as his political enemies. His favorite: the only reason U.S. case numbers are up is because the country is testing more.

Here’s the thing: if more tests reveal more cases, that, on its own, does not mean a problem doesn’t exist. What would be needed to prove that is a trend showing that as we test more people, the share of positive tests fall. And yet, this has not been the reality at all. In fact, over the past two months, when testing rates increased, so did positive-result rates. And when testing rates fell…so did positive-result rates:

This is a bit complicated, but it’s important, so stay with me here. Most experts who have been watching the pandemic since the start believe that early on, we did not understand the full scale of the spread of the virus—because we were only testing those who got sick. But now we know that many people can contract the virus, show no symptoms whatsoever, then pass it on. When there’s a robust and accessible testing system, even these asymptomatic cases will be found and added to the numbers. But, as soon as testing becomes inaccessible again—which seems to be happening in the U.S. right now—we’re back to where we were before: probably missing cases left and right.

Read more: ‘It’s The Hunger Games for laboratories.’ Why some people are waiting weeks for their COVID-19 test results

As fall approaches, those in charge at every level—from elected federal officials responsible for the lives of millions to parents responsible for the lives of one or two—are going to have to make nearly impossible decisions about how to live in a post-pandemic, pre-vaccine world. Increased testing in the U.S. will be essential if we want these decisions to be even partially informed.

That might mean, as Dr. Ashish K. Jha, director of the Harvard Global Health Institute, has suggested, adding cheaper and more rapid types of testing to the overall mix (even if these types are less accurate than the expensive and tedious kinds). It might mean some use of “pooled testing,” which takes genetic samples from a bunch of people, combines them into a sort of mega-sample, which is what gets sent to testing. And given the Trump Administration’s clear disdain for testing—and resulting abdication of responsibility for maintaining a robust testing system—it might mean governors and mayors really stepping up on this issue, as the leaders of Louisiana, Maryland, Massachusetts, Michigan, Ohio and Virginia (three Democrat and three Republican) did recently when they banded together to buy three million tests.

It’s likely too early to tell for certain whether the U.S. is truly stabilizing, as the surface numbers appear to suggest. But declaring victory now, at a moment when many people can’t get tests or face nearly two-week delays for results is like turning off the lights and claiming you eradicated a cockroach infestation.

Source : Time More   

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An emerging link between the urinary microbiome and urinary incontinence

The discovery that the urinary tract has a microbiome analogous to the one in the digestive tract has led to research showing that in women with urinary incontinence, their urinary microbiome differs from those in women who do not have urinary incontinence. The post An emerging link between the urinary microbiome and urinary incontinence appeared first on Harvard Health Blog.

An emerging link between the urinary microbiome and urinary incontinence

Most people know that microorganisms live on our skin, and in other places in the body such as the digestive tract. However, traditional thinking and medical teaching was that there was no such microbiome in the urinary tract. Many people may still believe that urine is sterile.

Advanced detection methods such as enhanced urine cultures and DNA sequencing have shown that this is not true. These newer technologies have enabled identification of low levels of microorganisms that were not previously detected using conventional methods. This has revolutionized how we think about the urinary tract when it is both healthy and unwell, and has led to a paradigm shift as we recognize that the bladder, like other parts of the human body, is widely colonized by microorganisms.

Gaining insight into the urinary microbiome

The urinary microbiome has quickly become a hot topic of investigation, leading to a burgeoning collection of scientific literature in this area. Multiple scientific investigations have studied which microorganisms make up the urinary microbiome, and how changes in the microbiome may result in or be a result of disease.

Lactobacillus is the most common species of bacteria in the female urinary microbiome, but other bacteria including Streptococcus, Staphylococcus, Aerococcus, Gardnerella, and Bifidobacterium are also present. There’s evidence that the urinary microbiome changes with age. In addition, previous studies have shown that women with various urologic conditions, including overactive bladder and interstitial cystitis/bladder pain syndrome, have an altered urinary microbiome.

Study links urinary microbiome and urinary incontinence

In a recent publication in the American Journal of Obstetrics and Gynecology, researchers found that women with urinary incontinence — urine loss beyond one’s control — had different urinary microbiomes compared with continent women. The microbiomes differed not only in terms of the types of bacteria present, but also in terms of the diversity of species present. Furthermore, women who had stress urinary incontinence (urine loss with physical activity) had different urinary microbiomes compared to women who had urgency urinary incontinence (urine loss with a sudden desire to urinate).

In a sense, these findings are not surprising given that stress and urgency urinary incontinence have different underlying causes. Stress urinary incontinence is thought to be more of an anatomic problem (having to do with the structure of body parts), while urgency urinary incontinence is thought to be more of a physiologic one (how body parts function).

These study findings raise the question of whether differences in the urinary microbiome play a role in causing urinary incontinence, or are a consequence of these conditions — not unlike the chicken-and-egg conundrum. Further research is needed to better understand the connection.

A role for probiotics in treating urologic conditions?

These study findings may also prompt questions about whether probiotics have a role in managing urinary incontinence. However, most urinary microbiome studies to date are descriptive in nature, and have not looked into probiotic use for the treatment of most urologic conditions. However, there are some studies (like this one and this one) that suggest Lactobacillus-based probiotics may be effective in preventing urinary tract infections.

Emerging research about the urinary microbiome represents an important next step in our quest to increase the treatment options available to women with urinary incontinence and other urologic conditions.

The post An emerging link between the urinary microbiome and urinary incontinence appeared first on Harvard Health Blog.

Source : Harvard Health More   

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