If a new global viral outbreak is declared – and judging by some credible warnings, this is not too far off – its official status as “pandemic” will be determined through metrics and tools very similar to those used for Covid-19. Now that we have sufficient data available, especially data from 2020 uncluttered by the effects of vaccines, we should evaluate those metrics and tools to see how well they served us and whether they should be reused, adjusted or possibly abandoned. This is of obvious importance since the declaration of a pandemic and global emergency is, in addition to the actual disease effects, costly on all levels and disrupts virtually every aspect of modern life.
While many things elevated the Covid-19 pandemic from mere disease into world-altering narrative – statistics and models, media hype, the visuals of masking and social distancing, lockdowns, hospital utilization, peculiar treatments – the narrative largely rested on two basic metrics. These were cases, determining the scale of the outbreak, and deaths, driving public understanding of its severity. These in turn were measured predominantly by two tools: PCR testing and death certificates, respectively.
Those are the “Meat & Potato” of the Covid-19 pandemic. They are the two essential ingredients and their use (or misuse) provides a base recipe for moving a future viral outbreak into the category of pandemic. Accordingly, they are prime subjects of a post-mortem analysis.
“In Ontario, we use PCR as the gold standard of testing for Covid-19 because it is able to successfully detect tiny amounts of the virus (sensitivity) with a low chance for error (accuracy) compared to other types of lab tests.” So said Jonathan Gubbay, a medical microbiologist with Public Health Ontario (PHO), in an online explainer the ministry published in February 2021. This was a typical expression of how public health organizations around the world explained the polymerize chain reaction (PCR) test to the public. And the public had no reason to disbelieve its accuracy and reliability.
Gubbay did not give the PCR technology quite enough credit, however. It can detect not only tiny amounts of virus but tiny amounts of virus parts, right down to molecules. PCR was an amazing invention, for which Kary Mullis, the eccentric American biochemist and writer who developed the process while working at a private company, was recognized through the Nobel Prize in Chemistry in 1993. PCR revolutionized the field of molecular biology and genomics by enabling efficient DNA/RNA amplification. It became fundamental to many procedures used in genetic testing and biomedical research, including analysis of ancient DNA samples, criminal forensics, tissue typing (vital for organ transplants) and many others.
It would be fascinating to hear Mullis’ opinion on the “gold standard” in the context of today’s PCR application. Sadly, he died in 2019 just before the Covid-19 disaster was announced. Mullis had previously sounded a cautionary note, however, saying that, “With PCR, if you do it well, you can find almost anything in anybody.” In particular, he warned, “It does not tell you that you are sick.” While he was speaking in the context of HIV, his observation casts doubt on (or at least raises the possible limitations of) PCR-based diagnosis for any virus, including SARS-CoV-2.
But why would there be even a slight controversy for such an amazing technology, without which such achievements as the Human Genome Project would be hardly possible? Addressing this requires understanding the issue of what it means to diagnose someone as “sick” with Covid-19.
Read the full op-ed at www.c2cjournal.ca.
