Bad science Medicine Pseudoscience Quackery Skepticism/critical thinking

Casedemic: The latest COVID-19 conspiracy theory to downplay the severity of the pandemic

Antivaccine activists and pandemic minimizers Del Bigtree and Joe Mercola are promoting the myth of the “casedemic” that claims that the massive increase in COVID-19 cases being reported is an artifact of increased PCR testing and false positives due to too sensitive a threshold to the test. As they have done for vaccines and vaccine-preventable diseases many times before, they are vastly simplifying and exaggerating a scientific controversy to cast doubt on the scope and deadliness of the pandemic.

Ever since the COVID-19 pandemic reared its ugly head in China and then made its way to Europe and the rest of the world, conspiracy theorists have had a field day. Whether it was the idea that the 5G rollout in Wuhan, China somehow sparked or accelerated the COVID-19 outbreaks that evolved into the pandemic, that the influenza vaccine makes you more susceptible to COVID-19, or that COVID-19 was bioengineered in a laboratory and thus the pandemic is really a “plandemic” designed to yes, aliens!—could exploit the population and its resources), conspiracy theories have been flowing fast and furious since early this year. Meanwhile, antivaxxers rapidly formed an unholy alliance with antimaskers, COVID-19 pandemic minimizers and deniers, and others opposing public health mandates to control the spread of SARS-CoV-2, the coronavirus that causes COVID-19 (including QAnon believers!) while infusing that movement with antivaccine pseudoscience and conspiracy theories and launching a pre-emptive disinformation war against COVID-19 vaccines. Antivax leader and propagandist Robert F. Kennedy, Jr has gone all-in on COVID-19 minimization/denial, and Del Bigtree, who made the antivaccine propaganda film VAXXED with Andrew Wakefield, has urged his listeners to “catch this cold” in order to build up herd immunity among the “healthy,” because, to him, COVID-19 is not dangerous except to those who deserve to be endangered, specifically those with chronic conditions due to overeating, lack of exercise, excess drink, and the like. It was blaming the victim at its most blatant, very typical of antivaccine activists.

This brings me to the latest propaganda line being promoted by COVID-19 deniers and antivaxxers, that of the “casedemic”.

What is the “casedemic”?

What is a “casedemic”? Earlier this month, über-quack tycoon (worth over $100 million!) Joseph Mercola, DO published an article entitled “Asymptomatic ‘Casedemic’ Is a Perpetuation of Needless Fear“. Amusingly, Mercola prominently lists his article as having been “fact-checked”, to which I can only respond: “Fact-checked? You keep using that word. I do not think it means what you think it means.”

Casedemic and The Princess Bride

Before I deconstruct Mercola’s claims, let’s take a moment to consider why “casedemic” has been a buzzword among COVID-19 deniers and antivaxxers lately. COVID-19 is spreading out of control throughout huge swaths of the US, with the number of (known) cases hitting 13 million and the number of deaths well surpassing a quarter of a million. Hospitalizations are climbing, and in large areas of the US, hospitals and the healthcare system are straining under the load of caring for so many COVID-19 patients. The situation is only getting worse, with hospitals in half the states facing massive staffing shortages, especially shortages of ICU nurses. In the face of such empirical numbers, it’s difficult to deny how severe the COVID-19 pandemic currently is in the US; that is, unless you find a way to redefine your terms. Enter the “casedemic”, in which antivaxxers and COVID-19 deniers try to claim that what we are seeing is an epidemic of positive tests, not of real disease, hence the term. Indeed, if you do a search of the term “casedemic”, you’ll find articles from the usual COVID-19 denying suspects arguing that the now-exponential increase in COVID-19 cases is not due to real disease, but rather an artifact of wider testing.

Basically, “casedemic” is just a new name for an old COVID-19 denier trope, that increased testing explains the pandemic and that COVID-19 is not dangerous. Indeed, a Google Trends search shows that the term didn’t show up as Google searches until early August, but I’ve been as yet unable to figure out who coined the word:

Casedemic trend

The earliest example in which the term “casedemic” was used appears to have been in this Tweet:
Yes, the “Fat Emperor” really is that ignorant of science.

I think that might be the first instance of “casedemic” and that Ivor Cummins might well have been the person who coined the term, but I really don’t know for sure. Ivor Cummins, for those unfamiliar with him, is an engineer who decided he knew more about nutrition and health than actual, you know, nutritionists and physicians and had established himself as a nutrition quack under the title “Fat Emperor” long before COVID-19. Once the pandemic hit, he rapidly pivoted to become a COVID-19 grifter and has become hugely influential among the COVID-19 denial crowd. His shtick has been pretty much this, to claim that COVID-19 numbers are being vastly inflated due to increased testing and that it’s not that dangerous. Given how large an influence he’s become and how many of his videos minimizing COVID-19, spreading antimask propaganda, and decrying “lockdowns,” Cummins definitely rates a post of his own someday soon, and I’ve been meaning to do one discussing his pseudoscience about diet and COVID-10, but today is not the day for it.

Here’s where antivaxxers glom on. After all, if COVID-19 is not dangerous, particularly if it’s not more dangerous than the flu, if the pandemic is really a “casedemic” that is an artifact of increased testing for coronavirus, then there’s no need for masking, no need for social distancing, no need for public health interventions such as restricting activities known to be sources of spread (such as indoor dining at restaurants and having those who can work from home do so), and, above all, no need for a vaccine.

Now let’s get back to Mercola. Mercola relies largely on a video by Del Bigtree. (It’s always a bad idea to use such an unreliable source, but if there’s one thing that Bigtree is skilled at, it’s crafting science-denying and antivaccine propaganda that sounds convincing to people who are not well versed in the relevant sciences.) I’m not going to embed it or link to it; it’s in the article if you really want to subject yourself to 23 minutes of Bigtree’s rambling. It also amuses me when someone who knows nothing about PCR pontificates about PCR, the way that Bigtree and Mercola do.

PCR basics

I know PCR, which stands for “polymerase chain reaction” and is a highly sensitive technique to amplify tiny quantities of specific DNA sequences. (I’ve discussed PCR before in the context of its misuse by antivaccine advocates.) Before I drifted away from doing benchwork myself—as lab directors tend to do as time goes on—I had done literally thousands of PCR assays personally in my time as a lab rat, dating back to the 1990s, when PCR was new. I had done thousands of real time quantitative PCR assays as well. Even though it’s been a few years since I’ve personally done PCR, I know PCR. I’ve troubleshot more PCR reactions than I can remember. So, it was with a combination of amusement and disgust that I watched Bigtree and Mercola cherry pick facts about PCR and twist known problems with PCR testing into casting doubt on the reliability of all PCR testing for COVID-19.

This brings us back to Mercola:

As coronavirus testing takes place en masse across the U.S., many are questioning whether the tests are accurate enough to trust, especially in people who are asymptomatic. Positive reverse transcription polymerase chain reaction (RT-PCR) tests have several drawbacks that make mass testing problematic and rife for misleading fearmongering.

For starters, the PCR test is not designed to be used as a diagnostic tool as it cannot distinguish between inactive viruses and “live” or reproductive ones.1 This is a crucial point, since inactive and reproductive viruses are not interchangeable in terms of infectivity. If you have a nonreproductive virus in your body, you will not get sick and you cannot spread it to others.

It really irks me when a quack like Mercola lectures about a fact regarding a medical test or intervention as though scientists and physicians have never thought of it before! Here’s how reverse-transcriptase polymerase chain reaction (RT-PCR) works. Because COVID-19 is an RNA virus, in order to amplify part of its sequence, first the RNA has to be converted to DNA, which is done with an enzyme called reverse transcriptase, which reverse transcribes RNA to DNA. Then that DNA can be amplified using a standard PCR reaction, which uses two primers designed to match specific sequences on the target DNA sequence. Basically, two different primers (short stretches of DNA designed to be complementary to and thus bind to a sequence of interest, each of which are on opposite strands “aimed” at each other are mixed with the sample containing the DNA of interest and then run through different temperature steps. First is the denaturation step at 95° C, which guarantees that all the DNA of interest has been separated into its two complementary strands. Next, the temperature is dropped lower to allow the primers to bind to their complementary sequences (the annealing phase). This temperature can’t be too low, or nonspecific binding of primer to other DNA sequences that don’t exactly match will occur, leading to amplification of DNA other than the intended sequence. It can’t be too high either, or there won’t be enough binding. Next, comes the elongation phase, where the temperature is increased to 72° or thereabouts, which is near the optimal temperature for Taq polymerase to do its thing. Finally comes another denaturation phase, where the temperature is briefly boosted to 95° to separate the strands, after which the temperature is dropped again to the annealing temperature and the cycle begins anew. Because the number of copies of the target DNA sequence roughly doubles every cycle, after 30-40 cycles even single DNA copies can be detected. Here’s what it looks like in schematic form:

PCR basics diagram

There’s a variant of PCR known as real time quantitative PCR, in which each amplification cycle releases a fluorescent marker, whose signal can be quantified, thus showing the progress of the reaction with each cycle. Back in the old days, PCR was basically a yes-no test. You’d run the PCR reaction for a given number of cycles, and you either could or could not see a band on a DNA separation gel. With real time PCR, accurate quantification of the DNA target (or, in the case of RT-PCR, the RNA target) present is possible. For purposes of my discussion, you really don’t need to know the details other than to know that this is the case.

In any event, the greatest power of PCR also leads to the biggest pitfalls in its application. Basically, PCR is so sensitive that it’s very easy for a PCR reaction to amplify a contaminant or for the primers to anneal to sequences that are similar but not identical to the target sequence and thus amplify DNA other than the sequence of interest. Indeed, I’ve encountered all of these pitfalls and more. That is why controls are of the utmost importance. In the case of real time PCR, there are also artifacts (such as primer-dimers) that can generate signal without the target sequence. For example, there has to be a good negative control to let the researcher know that the chosen PCR conditions are not amplifying junk. Moreover, if you’ve designed your primers poorly or if you anneal at too low a temperature, you can get nonspecific binding and amplify sequences that you don’t want to. Overall, PCR can be a very tricky game, and it gets trickier the more cycles you use to amplify and the lower amounts of target sequence you are trying to amplify. PCR is an exponential amplification; small variations in early cycles can have enormous effects in later cycle, producing wide variation in results. Every scientist who’s ever done a significant amount of PCR knows these pitfalls and takes steps to avoid them. Mercola treats them as though no one knows about them and that describing them is some sort of “revelation” or “secret” that scientists are hiding from you.

Back to the “casedemic”.

Joe Mercola: Regurgitating disinformation about COVID-19

So let’s get to the primary claim that falls under the term “casedemic”:

In summary, the PCR swab collects RNA from your nasal cavity. This RNA is then reverse transcribed into DNA. However, because the genetic snippets are so tiny, they must be amplified to become discernible.

Each round of amplification is called a cycle, and the number of amplification cycles used by any given test or lab is called a cycle threshold. Amplification over 35 cycles is considered unreliable and scientifically unjustified. Some experts say nothing above 30 cycles should be used,3 yet Drosten tests and tests recommended by the World Health Organization are set to 45 cycles.4,5,6

When you go above 30 cycles, even insignificant sequences of viral DNA end up being magnified to the point that the test reads positive even if your viral load is extremely low or the virus is inactive and poses no threat to you or anyone else.

Isn’t that last part pretty much what I was saying above? See what I mean about quacks treating well-known problems with a medical test or intervention as a “revelation” of “secret knowledge” that “they” don’t want you to know about.

Yes, it is true that doing PCR on swab tests from the nasopharynx only tells you whether there is detectable SARS-CoV-2 RNA present in the specimen; it does not say whether that RNA comes from infectious virus or is causing a clinical infection. Yes, it is true that PCR picks up many asymptomatic cases, but it is also true that asymptomatic patients can still spread COVID-19, old WHO statements in June notwithstanding, which is why identifying these cases is important. It is also true that there has been a bit of controversy over what the appropriate PCR threshold count should be for COVID-19 testing, as well as that early in the pandemic PCR tests were a lot less reliable. (Just witness the CDC debacle when it tried designing its own PCR test for SARS-CoV-2.) However, now, nearly a year into the global pandemic and nearly ten months after the pandemic hit US shores, we have a lot more experience with these tests. More on that in a moment, but first let’s let Mercola have some more rope to hang himself with, scientifically speaking:

When labs use these excessive cycle thresholds, you end up with a far higher number of positive tests than you would otherwise. At present, and going back a number of months now, what we’re really dealing with is a “casedemic,”7,8 meaning an epidemic of false positives.

Remember, in medical terminology, when used accurately, a “case” refers to someone who has symptoms of a disease. By erroneously reporting positive tests as “cases,” the pandemic appears magnitudes worse than it actually is.

Hilariously, reference #7 is not a scientific paper. It’s an article from PJ Media, the right-wing propaganda “news” network, and is basically a rant against Joe Biden that, amusingly, self-references another article in PJ Media that quotes a New York Times article without actually linking to it. What did the article say? Basically, the NYT looked at a bunch of PCR tests done by one lab, the Wadsworth Center (a New York State lab) and identified 872 positive tests in July, positives that were based on a threshold of 40 cycles. They found that with a cutoff of 35, about 43% of those tests would no longer have qualified as positive and that about 63% would no longer have been judged positive if the cycles were limited to 30. Interestingly, this NYT article was published in late August, but I have yet to see any peer-reviewed publication on it. The only possibly relevant publication I could find from the Wadsworth Center reported its evaluation of the NeuMoDx™ SARS-CoV-2 assay, performed on a NeuMoDx molecular system, a rapid, fully automated, qualitative real-time RT-PCR diagnostic test with throughput of up to 288 tests in an 8 hour shift. The article concluded that this automated system had a similar sensitivity and specificity to the CDC assay. So this does sound rather odd, but in reality way too much is being made of this single survey by a newspaper and not published in the peer-reviewed medical literature.

As for the second “reference”, it’s to an article published on the website of that medical conspiracy theorist group disguised as a medical professional organization, the Association of American Physicians and Surgeons (AAPS), which is known for its antivaccine views, denial of climate science, and all manner of conspiracy theories. (AAPS even published an article by Andrew Wakefield predicting a “mass extinction” due to the MMR vaccine. I kid you not.) Hilariously, even the AAPS acknowledges that “coronavirus is not a pseudo-epidemic” and that “thousands have died”, even as it speculates that the ‘dreaded “second wave” might be a surge of false positive tests that are inevitable in mass screenings of healthy persons’. Of course, AAPS fails to mention that hospitalizations and deaths are also rising rapidly, which would definitely go against the latest COVID-19 wave being a “casedemic”.

Why, though? Why would governments, scientists, physicians, and public health officials who’ve dedicated their lives to combatting infectious disease want to do this? I bet you know where this is going:

“The goal is to keep you scared, isolated and demoralized for a purpose,” says PJ Media.9 “Only a beaten nation would stand for what comes next.” And that next step is a reset of America as you know it, with the UN’s one-world Agenda 2030 at the helm.

Mercola even links to an article of his from three weeks ago called “The Great Reset“, in which he posits that the COVID-19 pandemic is being used as a pretext for the “Great Reset”, whose purpose is to “usher in a tech-driven dystopia free of democratic controls” and create a “new ‘social contract’ that ties you to it through an electronic ID linked to your bank account and health records, and a ‘social credit’ ID that will dictate every facet of your life.” Because of course it is. And, to Mercola and his fellow conspiracy mongers, COVID-19 PCR testing is a primary tool in achieving that end by creating a “casedemic” of illusory COVID-19 cases.

There’s just one problem. Actually, there are several.

The problem with the “casedemic” conspiracy theory

Anyone who’s done PCR knows that cranking up the number of cycles does indeed increase the chances of amplifying a contaminant or a sequence that is similar, but not identical, to the intended target sequence. (Again, it amuses me how cranks like Joe Mercola treat this long known issue with PCR as though it were some sort of astounding revelation that scientists have never thought about much before.) Is it a potential problem that PCR tests might be too sensitive for their intended purpose, namely screening for COVID-19 infection? Yes. However, as is almost always the case in these situations, the COVID-19 denialist cranks and conspiracy theorists have latched on to a problem and amplified it far out of proportion to its significance, all in order to cast doubt on the entire process of COVID-19 screening. Gideon M-K, a.k.a. the Health Nerd, pointed this out a couple of weeks ago, which seems to be when this whole “casedemic” thing started to percolate up onto social media in a way not seen since August:

Here’s what he points out:

As cases of COVID-19 skyrocket across Europe and the United States, a new myth has emerged to add to our ever-increasing list of coronavirus-related nonsense. The idea is that the current massive epidemic in Europe and elsewhere is not an issue, because this is a ‘casedemic’ — an increase in cases without any concomitant increase in sickness or deaths.

Basically, it’s another way of saying that the pandemic is over, from people who’ve been saying that it was over every month since March.

Thing is, this new piece of disinformation is simply factually inaccurate, and is driven by a simple misunderstanding: that the second wave of COVID-19 was dramatically different to the first. In fact, the two waves are much more alike than you’d imagine, because the disease probably hasn’t changed enormously in the last 6 months or so no matter how much we wish that it has.

In other words, while the number of cases that are appearing positive now seems far higher than at the start of the year, in fact what we know is that we missed a huge proportion of cases back in March and actually it’s more than likely that the current wave looks very similar to the first.

This, again, is not a new observation. Early in the pandemic, scientists pointed out that, due to the massive shortage of COVID-19 tests that led to, in essence, rationing in which only those who were hospitalized or had severe symptoms were tested (and sometimes not even they were always tested), huge numbers of milder cases were being missed. Many were the public health officials who predicted that, as more testing became available, the apparent infection fatality rate (IFR, the percent who have the infection and die, whether symptomatic or not) would decline as more mild and asymptomatic cases that weren’t being detected before started being detected.

To demonstrate this, the Health Nerd did a clever back calculation based on the number of deaths per time period, correcting for age, to extrapolate what the IFR would have been early in the pandemic if we were doing as many tests then as we are now and found:

Suddenly, the difference disappears! Indeed, it looks like the first wave might have even been a bit BIGGER than the second. This makes perfect sense when you consider that, at least in the United States, the number of tests being done each week in March was in the hundreds of thousands, and limited mostly to people who were being hospitalized for COVID-19. So we missed almost everyone with a mild infection, and cannot have picked up the millions of cases that almost certainly existed at the time.

He further predicts, based on what’s happened before, that hospitalizations and deaths will increase, because when a lot more people test positive for COVID-19, a lot more people will be hospitalized even if only a relatively small percent of the total infections get that sick, and, eventually, a lot of those people will die, even if the total is “only” less than 1% of the total infection rate. There’s just a lag of several weeks for the virus to do its work, for people to die, and for the deaths to be reported.

Ian Mackay, virologist and adjunct Associate Professor at the University of Queensland had another way of putting it, namely More testing shows more iceberg. Like the Health Nerd, Mackay emphasizes that, early in the pandemic, there was a massive shortage of testing kits:

One thing is pretty clear: laboratories and biotechnology companies worldwide were unprepared for the scale of a pandemic. This wasn’t a slow-moving SARS-CoV or a poorly transmitting MERS-CoV. This was a fast-moving, fully armed, well-equipped, respiratory virus. Labs couldn’t keep pace. And even though test development was super-quick, the fuel to feed and power what those tests needed, quickly became scarce.

Despite the lab challenges posed by Ebola virus epidemics in Africa just a few years ago, and Zika virus epidemics across the world, testing wasn’t ready enough for pandemic 2020. In today’s world, a pandemic was always going to mean using real-time PCR-based tools to detect the virus. These were the most sensitive tests we had. Also, we didn’t have a better tool because no replacement had hit the mainstream. Despite the recurring promise of new platforms pitched during recent outbreaks and epidemics, PCR hasn’t faced a mainstream challenger since its real-time iteration hit the brights [sic] lights in 2009.

The analogy is simple. Early in the pandemic, we were only detecting the “tip of the iceberg” of COVID-19 cases. With more testing, we’re now seeing more of the iceberg, namely the part that lies “below the water,” so to speak, and wasn’t detected in March and April because not enough people were being tested and a lot of cases were going undiagnosed and undetected.

More importantly, though, to counter the claim of a “casedemic”, using PCR to detect a virus is more complicated than someone like Mercola lets on. It depends on so many things, not the least of which is sample collection, which can result in a high degree of variability in detectable RNA in a person’s sample. As cranks ignore that complexity, Mackay shares my amusement at how cranks portray a certain observation as such an amazing revelation:

Look, I fully agree that the later (higher number) the threshold cycle (CT “cycle number”) of the RT-PCR result, the less target RNA is present at the start of the reaction. That RNA is a surrogate marker for the amount of virus but not an actual measure because PCR methods can’t tell you a virus is infectious.

People are very chuffed to have learned this fact in 2020 by the way. You can tell because they say so. A lot. But despite their newfound out-of-context knowledge they actually know very little about what they’re talking about.

See what I mean? Yes, Mr. Bigtree and “Dr.” Mercola, real scientists who do PCR are laughing at you.

In any event, Mackay cites a study from Eurosurveillance that highlights the variability in PCR results, as well as the “gold standard” test of demonstrating the ability of virus from an isolate to be able to infect appropriate cells in cell culture, pointing out, based on the result reported that from among 5/60 (8.3%) of patient samples with a CT greater than 35, infectious virus was still present:

The figure shows that if you were to blindly and ignorantly rely on single CT values to proclaim lack of infectious risk – let’s say 35 or greater – you would miss people who were still shedding infectious virus.

If you surveyed more labs with expertise in cell culture and virus isolation and labs that could get hold of fresh samples and samples from the actual site of virus replication, I’m sure you could find even later CTs. You can also find labs who can’t isolate virus from samples with CTs this late. This biological variability means we need to step back from these stupid single number cut-offs.

Precisely. Setting the threshold count (CT) cutoff on a PCR test is a balancing act, in which you balance the increased sensitivity of using a higher CT and more amplification cycles as your cutoff and the attendant possibility of more false positives associated with that more sensitive cutoff against the possibility of missing a lot more cases of real infection if you use a lower CT. Another way of looking at it is this. If there were so many false positives, then PCR reactions all over the world should be generating them in huge numbers now. But:

Mackay points to the example of Australia, which currently has no reported local transmission of SARS-CoV-2, noting that “Australia’s COVID-19 cases right now are almost exclusively in quarantine hotels and among Aussies returning, or special-purpose travellers visiting, from a world on fire” and that Australia has “had a few clusters spin out from quarantine but they’ve–so far–been squished dead in weeks to months.” He further notes that Australia’s testing rate hasn’t fallen below 20,000/day since June. He then notes:

All that testing provides a good number of opportunities for those so-called false-positive PCR results to show up in our daily reported numbers. Surely more testing should mean a steady flow of false positives if these conspiracies are correct? And others love to add that it should be even more of a problem in a low prevalence setting. Australia certainly fits that bill. Plus, we’re testing mostly sick people but also asymptomatic and presymptomatic people.

But lo and behold there is no steady stream of false positives. We don’t have an issue because once again, this is an over-oxygenated amateur conspiracy theory and not an actual issue.

Local context also matters. For example, in a situation in which the disease being tested for is present at low prevalence (say, less than 2% of the population), even a test that is very specific and sensitive can produce a lot of false positives compared to “true” positives. I won’t go into the gory details (if you want discussions of sensitivity, specificity, and positive and negative predictive values, go here, here, and here), can lead to a lower positive predictive value (PPV), which is the likelihood, given a positive test, that there really is disease present. To put it simply (but hopefully not simplistically), the lower the prevalence of a disease, the lower the positive predictive value of a test for that disease, even a good one, is likely to be, because even low rates of false positivity will be high (half, equal, or even greater) compared to the actual prevalence of the disease in the population.

Basically, yes, there are false positives on PCR testing, but false positives are not nearly as huge a problem as people like Del Bigtree and Joe Mercola want to lead you to believe, and, contrary to their portrayal of scientists, physicians, and public health officials as oblivious to this problem, all these people working to find science-based methods to slow the spread of COVID-19 and bring the pandemic under control do consider the potential for false positives and seek to find ways to account for them and reduce them. Also, when the PCR testing is done properly in the context of a larger public health effort, the overall process will make sure that the lab results are considered along with the epidemiological and clinical context. Similarly, because the issues with PCR tests are known, other tests are being increasingly used. Rapid antigen tests are less sensitive, but detect the actual proteins made by cells as a result of SARS-CoV-2 infection, something not seen from an inactive virus. Serum antibody tests, which detect antibody to SARS-CoV-2 in the blood made as a result of infection, can tell us who has recovered from infection (or been infected long enough to develop an antibody response).

COVID-19 science denial is basically no different from any other form of medical science denial that we’ve covered here. It uses the same techniques of distraction to produce disinformation. In this case, Bigtree and Mercola are latching on to a legitimate controversy over the minutiae of a lab test and vastly exaggerating the significance of the controversy and magnitude of the problems it causes in order to cast doubt on the very process of testing for the disease itself, which is their real purpose. They are not promoting better and more accurate COVID-19 testing, which is what we all want, especially physicians and scientists on the front lines fighting the pandemic. They are doing their best to deny that COVID-19 is as huge and deadly a problem as it actually is, because if COVID-19 really is that big a problem then it does, contrary to their views, justify massive public health interventions to decrease infection and death rates, and, ultimately, a mass vaccination program.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

59 replies on “Casedemic: The latest COVID-19 conspiracy theory to downplay the severity of the pandemic”

I regard that dismal NYT article as the single most destructive publication since the pandemic began. It was full of hand waving and lacking substance. I too have looked for anything published on these “retests” and could find nothing. There isn’t even any info on how much time passed between collection of the specimens and when the retests were done or how the specimens were stored. Properly deep frozen? Sitting in a fridge at 4 °C in viral transport medium?

I’ve seen that wretched article cited over and over, frequently with claims that 90% of PCR results are false positives. People who invariably pan “MSM” in favor of their “alternative” sources lapped that article up without question.

No one has been able to come up with a credible explanation for the source of SARS-CoV-2 viral “fragments” up the noses of people who have been tested. They all seem to think these fragments just appeared there. Yes, in some cases there may be nothing left from an infection but inactive virus. How many such cases are actually being counted? While it may be “wrong” to have people in that position isolate, is it wrong to count them as a case if they hadn’t been previously? If there is a very low number of copies of viable virus is it safe to assume that there won’t be more in a few days? No clinical evidence to support any of the “false positive” claims from anyone – including Fauci when he talked about “dead” nucleotides.

No one has been able to rationalize the supposed excessive number of cases identified with PCR with the still much higher estimates that have come from serological surveys, though it must be admitted that some of these surveys appear to have been total botch jobs from beginning to end. No one has been able to rationalize the vast oversensitivity with the fact that PCR has been reported to return up to around 20% “false” negatives – false because of issues with specimen collection depending very much on when the specimen was collected relative to the likely infection event (eg. someone told they might have been exposed, get tested next day, negative; several days hence, positive)

Many of the cranks are also fond of saying Mullis said PCR isn’t suitable for diagnostic purposes. There is a video of him, date unknown to me, talking about it. He is barely coherent.

Question for ORAC or anyone else familiar with current methods: From virtually everything I can find a swab for COVID-19 is put into typically 3 mL of viral transport medium. I have no feel for what that would mean in terms of dilution, but I wouldn’t be surprised if at least by a factor equivalent to 5 or 6 PCR cycles (i.e. dilution by a factor of 32 to 64). Is similar transport medium or other diluent common in research PCR with specimens not collected “remotely” from the lab? Does it matter?

“credible explanation for the source of SARS-CoV-2 viral “fragments” up the noses of people who have been tested”

The fragments are planted in building HVAC systems by agents of the deep state.

“dilution by a factor of 32 to 64”

PCR has a superficial resemblance to the preparation of homeopathic “remedies”, but operates in the reverse direction.

Yeah, the more I think about it since I composed the first version of this post a week ago, the more that NYT article pisses me off. A newspaper should have known better than to do a survey like that and just publishing it in the newspaper without any sort of peer review. This article has fueled a dozen antivax conspiracy theories and is the go-to source referenced “casedemic” conspiracy theorists to “prove” the “casedemic.”

So, an actual real live instance of #FakeNews pokes its head, and the world’s entire supply of paranoid fucknuts can’t suck it up fast enough. Flies on a turd. Observe my surprised face: ?

To remind you, the NYT also carried that problematic editorial by Peter Doshi and Eric Topol mischaracterizing Covid-19 vaccines trials and making incorrect statements about influenza vaccines.

They’ve done good work in many ways, but they’re certainly not perfect.

” doing their best to deny that COVID-19 is as huge and deadly a problem as it actually is..”
Exactly. All of the pseudoscientists I follow are guilty of at least part of this denialism ( in slightly different ways).

Is it all a means to keep the economy running at least partially so that they can sell their products, receive money for their “charities”, watch their investments in the market grow?
I wonder how much of alt med entrepreneurs’ fuming is fuelled by decreased sales? Do their charities get less contributions when customers are out of work due to closures?
I heard that there was a mass protest ( of several hundred!) in NY’s Union Square yesterday against shutdowns and Coleman’s followers ( V is for Vaccine/ Josh Bucky facebook) erected his signature signs all over the English speaking world ( UK, US, CN, AUS) this weekend to protest Covid vaccines
Funny but no news coverage of these events because I suppose the media is “bought and paid for”

Orac writes,

“It was blaming the victim…excess drink, and the like.”

MJD says,

The FDA writes, “Smoking cigarettes can leave you more vulnerable to respiratory illnesses such as COVID-19. Smoking cigarettes is known to cause heart and lung disease and people with underlying heart and lung problems may have increased risk for serious complications from COVID-19. Smoking can also cause inflammation and cell damage throughout the body, and can weaken your immune system, making it less able to fight off disease. There’s never been a better time to quit smoking. If you need resources to help you quit smoking, the FDA’s Every Try Counts campaign has supportive tips and tools to help you get closer to quitting for good.”,to%20fight%20off%20disease.

@ MJD,

Smokers should switch to nicotine patches to minimize scarring in lungs which would exacerbate the ‘ground glass opacity’ that indicates density in the lungs of covid patients (as well as other conditions; not just covid related).

Nicotine may be protective against cytokine storm but I can’t find that this has been pursued in research since around June.

You should obviously use cholinergic antagonist when there actually is a cytokine storm, not all the time.

Every scientist who’s ever done a significant amount of PCR knows these pitfalls and takes steps to avoid them. Mercola treats them as though no one knows about them and that describing them is some sort of “revelation” or “secret” that scientists are hiding from you.

Reminds me of some of PZ Myers’ comments on “physicists who think they understand biology”. Even without the blatantly self-serving FUD-dispersal of Mercola and Bigtree, there are a whole lot of comments about things to which the appropriate response is pretty much “Yes, what you propose is a simple and obvious solution. It’s so simple and obvious that we tried it a hundred years ago and found out that it didn’t work because the real world isn’t that simple.”

Yeah, I’ve complained about a certain two physicists thinking that they’ve “solved” cancer by considering a “theory” that cancer biologists considered a century ago and ultimately rejected because it didn’t fit the data and our emerging understanding of cancer.

Ooh, names?

Being clever is no guarantee of being smart. Often as not it just makes for more ingenious idiots.

A sadly familiar phenom. I suspect a broad streak of narcissism to go with that Dunning-Kruger. They’re just so incredibly proud of themselves for having thought of it First*. And nothing is going to take that achievement away.

One of the few benefits to getting old that I’ve found is learning to own a lifetime of errors, and in doing so get much better at anticipating my mistakes before I make them and thus [hopefully] avoid them entirely.

Not that such auto-correction can stop a true narcissist as they are, of course, Never Wrong. But for the rest of us: check your damn homework first. Saves a lot of public humiliation later on.

may not actually be first**

** or even close

I followed the corresponding article on SBM a lot, but I’ll add a couple thoughts here.

They are very much following the anti-vax playbook.

Focus on a minor, if not necessarily unimportant, problem and exaggerate its importance.

Ignore the larger and very real problem.

Impugn the medical and scientific community and anyone who disagrees with them.

False positives are a problem, but some of that is because we are using an exquisitely sensitive test (PCR) for a purpose it was not really designed for, public health screening and surveillance. I’ve gotten 3 Covid-19 tests in the last couple months. The first one in Texas was just before a holiday weekend and took 4-5 days to get me a result (all 3 negative). The next one in New Mexico I had to schedule a day or two in advance and it took 2-3 days to get a result. I tried to do another one a couple weeks later, but there were no openings available! So I got a third one when I returned to Texas. i had to do a video chat with a doctor to get the test scheduled, so it took a couple days to get the test. But they had switched to doing rapid antigen tests, so I got a call back that afternoon! I think they are doing a PCR backup test.

A quick check of Dallas County showed 3083 confirmed (PCR) and 220 probable (antigen) for Thursday, Friday, and Saturday. About 10% of their recent tests have been rapid antigen ones.

I also thought I’d do a quick, rough estimate of the CFR.

As of May 31, the U.S. showed 1,774,034 cases and 97,959 deaths for a CFR of 5.52%.
June 1 – Nov 29, we reported 11,183,396 cases and 154,126 deaths for a CFT of 1.378%.

I remember reading that one epidemiologist estimated that back in the early months (January – March?) there were about 10 infected people for every reported case. Recent serological surveys seem to show a ratio of about 4. But I attribute much of the reduction in CFR, and correspondingly the IFR, to doctors and hospitals learning how to manage cases, not being overwhelmed which may not last much longer, and some helpful treatments, especially the use of steroids for the inflammatory phase.

As of May 31, the U.S. showed 1,774,034 cases and 97,959 deaths for a CFR of 5.52%.
June 1 – Nov 29, we reported 11,183,396 cases and 154,126 deaths for a CFT of 1.378%.

This may also have something to do with the age demographic getting infected. The CFR in Australia at present is 3.3%. The spike in Victoria through July to October resulted in about 18,000 cases and just under 800 deaths for a CFR of a little over 4%. Just under 80% of the deaths were residents of nursing homes.

Thanks. That’s the other part of the “much” that I mentioned. I saw a table of age-based fatality rates. I think it was 0-24 extremely low, 25-44 was about 6-7 times higher. Then it went up by a factor of 3 for every 10 years of age.

In the U.S., the elderly are mainly sheltering in place. The nursing homes are getting better at limiting access and regular testing. I know one person who is currently in a skilled nursing facility. They get a couple positive cases about every other week. Employees are furloughed for isolation until they test negative. Residents who test positive are moved to another facility for treatment.

But the younger generation have returned to college and they and the 20’s crowd are getting stir crazy and finding ways to do their partying. That helped kickstart the current pick back in September-October.

On the plus side, the U.S. this morning is down to only a 3% 14 day case growth.

And Scott Atlas has left his job at the White House.

Australia is in the Southern Hemisphere & their June/July surge was likely associated with their flu vaccine campaign that started in April. Same with Brazil.

Just like how our November/December surge is associated with out flu vaccine campaign that started in September, along with the rest of the Northern first world .

Australia is in the Southern Hemisphere & their June/July surge was likely associated with their flu vaccine campaign that started in April. Same with Brazil.

What complete and utter nonsense.

The surge in June/July was only in one state: Victoria. It was caused by a failure of management of the hotel quarantine system – allowing security guards within the system to work 2 jobs and not testing them often enough. 99% of the cases were genetically tracked back to a single family that arrived from overseas and were quarantined at the Rydges Hotel.

The fact that the late June – early October “second wave” in Australia was largely confined to Victoria can again be clearly seen from the New cases section Australian Broadcasting Corporation’s Covid-19 stats page. It shows both the national daily case numbers and per state numbers. The Victorian case numbers overwhelm the numbers from all other states.

It’s hard to see how a successful national campaign to increase the numbers vaccinating against influenza could affect only one state. In fact, it really largely affected only one city, since there were few cases in that Victorian second wave outside Greater Melbourne..

It also causes a bit of a wry smile when American commentators try to paint Australia as having had large numbers of Covid cases. From the Worldometers by-country tables, The USA has had to date 42450 cases/million population, and 834 deaths/million, Australia has had 1,089 cases/million and 35 deaths/million. I wish that our numbers had been better (more like, say, New Zealand’s), but posts that try to imply that Australia has somehow done particularly badly, especially when compared to the US (or much of Europe), really don’t stand up to even brief scrutiny.

Orac: “…as is almost always the case in these situations, the COVID-19 denialist cranks and conspiracy theorists have latched on to a problem and amplified it far out of proportion to its significance”

As a crank claim is amplified through multiple news cycles, it rapidly reaches a threshold at which it is completely non-credible.

It is just a casedemic. There is no “second wave.” People need to get back a’cruisin’ because the industry is having to rely on billions in bailouts and that just makes them feel like moochers. People, do your part and get your ass back onto the Loafe Barges–

We know now where this is headed over the next few months. Hospitals will be taxed beyond capacity, spiking the death rate from COVID and delaying or canceling care for tens of thousands of others. There will be mobile morgues and mass graves and countless Zoom funerals and an entire generation of health-care workers with permanent emotional trauma. People will show up to the ER after car accidents and heart attacks and allergic reactions and die waiting.

Thx, Obama.

In the last two weeks, Australia has done 35000+ tests/day, but there have been fewer than 20 new cases/day reported. Even if all of those cases are false positives (which seems unlikely, but let’s allow it to show a point), that’s still only a about a 0.06% false positive rate. Again, the source is the Australian Broadcasting Corporation Web site.

See the “Tests versus new cases graph” in the linked page. There’s currently a strange data glitch for 30 Nov that messes up the scaling, but the rest of the graph is OK. You can also compare the “Tests, daily count” graph against the “New confirmed cases, daily count graph” near the top of the page. The cause of the data glitch is that for some reason about -8 million tests has been entered as the value for Nov 30!

Anyone would care to take a jab at this one???

We now know the virus doesn’t come from a Chinese lab. Nor poor pangolins. It’s Indian. If China says it’s India, it must be true. No?

Imperial Count or Royal Marquis (the guy had fairly fluid political affiliations – no gender fluidity but political fluidity…) Pierre-Simon de Laplace, who had such lofty ideals for statistics – whose birth he assisted – must be rolling in his grave. Eternal slumber seems to be a bitch.

Whist playing a pool game, is that the guy who asked, “do you want to hold my balls?” And I answered, “yes, please.” That guy? Fuck that guy. So didn’t deliver; sad.

My last post evaporated so I now wish to be crude.

Erotic is when u stroke yur dick with a feather; kinky is when you fuck a whole chicken. Or, so I am told. Merry Xmas.

It seems a stretch. It’s an unreviewed preprint and they will need good data to back it up.

Genetically, SARS-CoV-2 seems to go back a couple decades. But the closest genetic match is from a cave in southern China. It’s easy to see how people digging through piles of guano in the caves could get infected. Then it only takes someone traveling to the market in Wuhan to start spreading the infection.

People have been tracking bat-borne viruses from the Philippines to Malaysia to India. But I haven’t heard of a SARS-like virus being found.

They would need not just human blood samples, but a plausible zoonotic host.

Otherwise, it seems like just an exercise in finger pointing.

I know a bit about pcr as we use it diagnostically in my job. On an anti science/expert site it was stated that even the pcr designer said it was never meant to be used diagnostically and that every pcr machine was labelled thus. I literally only pointed out that none of our machines had any such label. Well! I was accused of being a so called expert, sheep, big pharma spokesman, government spokesman etc. Quite shocking. Not going back there.

I’ve been doing PCR for nearly 30 years going back to my days in graduate school back in the early 1990s, and I’ve never seen such a label on any of the PCR machines I’ve used. Certainly neither of the PCR machines in my lab have such a warning…

I’ve worked in both research environments and at a qPCR assay vendor, stuff not meant for cGMP diagnostic kits use has “Research Use Only” labels all over it.

The only difference is the paper trail and the supplier cost, it’s the same technology and reagents.

Those are the kits, though, right? The cranks claim these notices are all over the machines. Also, the COVID PCR test kits are approved for clinical use by the relevant regulatory bodies in the countries where they are used…

Oh, of course. Every conspiracy theory starts with an a fact before going through several layers of brain worms.

I’m happy I got out when I did, the EUA they got for SARS-COV-2 required a heroic effort from the quality people and that was with a Flu A/B/RSV assay already in the catalog to plagiarize from.

I have huge, epic respect for everyone who’s managed a filing with FDA right now. It’s a stonking great amount of work.

I’ve also got a tiny, tiny sigh from everyone who has non-COVID submissions waiting for FDA. Dog knows they’re swamped, but it’s been 6 months on my CBE30, please? (To non-pharma folks, it’s not one and done with FDA. You’re constantly updating them with every little change, and it all needs approval before you go ahead.)

The cranks claim these notices are all over the machines.

This is just the Kary Mullis routine over again.

This Week in Virology, episode 687 has Peter Hotez as a guest. It’s worth a listen. He has some interesting things to say about the state of science communication to the general public.

Definitely worthwhile: I especially liked PH’s appellation: the anti-science confederation, i.e., of political entities foreign and domestic, rightwing, health freedom, woo/ anti- vax.
I usually stick to the last two but his exploration of all of them merits thought..

Casedemic at the Bat
(with apologies to) Ernest Lawrence Thayer

The outlook wasn’t brilliant for the Wooville nine that day:
The score stood four to two, with but one inning more to play,
And then when Wakefield died at first, and Kennedy did the same,
A pall-like silence fell upon the patrons of the game.

A straggling few got up to go in deep despair. The rest
Clung to the hope which springs eternal in the human breast;
They thought, “If only Casedemic could but get a whack at that—
We’d put up even money now, with Casedemic at the bat.”

But Bigtree preceded Casedemic, as did also Joe Mercola,
And the former was a hoodoo, while the latter was a rake;
So upon that stricken multitude grim melancholy sat,
For there seemed but little chance of Casedemic getting to the bat.

But Bigtree let drive a single, to the wonderment of all,
And Mercola the much despisèd, tore the clicks off the ‘net;
And when the dust had lifted, and men saw what had occurred,
There was Joey safe at second and Del a-hugging third.

Then from five thousand throats and more there rose a lusty yell;
It rumbled through the valley, it rattled in the dell;
It pounded on the mountain and recoiled upon the flat,
For Casedemic, mighty Casedemic, was advancing to the bat.

There was ease in Casedemic’s manner as he stepped into his place;
There was pride in Casedemic’s bearing and a smile lit Casedemic’s face.
And when, responding to the cheers, he lightly doffed his hat,
No stranger in the crowd could doubt ’twas Casedemic at the bat.

Ten thousand eyes were on him as he rubbed his hands with dirt;
Five thousand tongues applauded when he wiped them on his shirt;
Then while the epidemiologist ground the data into his equip’,
Defiance flashed in Casedemic’s eye, a sneer curled Casedemic’s lip.

And now the p-value-covered data came hurtling through the air,
And Casedemic stood a-watching it in haughty grandeur there.
Close by the sturdy batsman the data unheeded sped—
“That ain’t my style,” said Casedemic. “Strike one!” the doctor said.

From the benches, black with people, there went up a muffled roar,
Like the beating of the storm-waves on a stern and distant shore;
“Kill him! Kill the doctor!” shouted someone on the stand;
And it’s likely they’d have killed him had not Casedemic raised his hand.

With a smile of CT charity great Casedemic’s visage shone;
He stilled the rising tumult; he bade the game go on;
He signaled to the epi’, and once more the empiric data flew;
But Casedemic still ignored it and the doctor said, “Strike two!”

“Fraud!” cried the maddened thousands, and echo answered “Fraud!”
But one scornful look from Casedemic and the audience was awed.
They saw his face grow stern and cold, they saw his muscles strain,
And they knew that Casedemic wouldn’t let that data go by again.

The sneer is gone from Casedemic’s lip, his teeth are clenched in hate,
He pounds with cruel violence his bat upon debate;
And now the epi’ holds the data, and now he lets it go,
And now the air is shattered by the force of Casedemic’s blow.

Oh, somewhere in this favored land the sun is shining bright,
The band is playing somewhere, and somewhere hearts are light;
And somewhere men are laughing, and somewhere children shout,
But there is no joy in Wooville—mighty Casedemic has struck out.

@ Chris Preston,

“What complete and utter nonsense.”

Oh yes; the Lothario Security Guard explanation. And Brazil?

I had a little birdie,
And it’s name was Enza
I opened up the window
And In Flew Enza!

Brazil COVID mortality started to rise March, as everywhere outside China. Only difference is that it did not go much down during summer..

the PCR test is not designed to be used as a diagnostic tool as it cannot distinguish between inactive viruses and “live” or reproductive ones.

Yes, it is true that doing PCR on swab tests from the nasopharynx only tells you whether there is detectable SARS-CoV-2 RNA present in the specimen; it does not say whether that RNA comes from infectious virus or is causing a clinical infection.

Just an instantaneous reaction. Coronavirus is a single stranded positive_sense RNA virus; if you detect coronavirus RNA in RT-PCR, it is by definition “active.” Inactive viruses have to be lysogens in the genome; meaning DNA form. RNA has a short half-life. You could control for DNA v. RNA in the sample with a trial not running the reverse transcription step. If you’re dealing with coronavirus RNA, you’re looking at an mRNA. That’s the business end of the knife if ribosomes are present.

Maybe this is said later and I’ve just missed it so far.


A word about humidity. This time of year, in this hemisphere, with so many central air and even more worthless glass covered decorative gas log displays it becomes hard to not dry the air out. The decorative ones even draws in dry outside air as it convects up the shoot and supplies no overall sensible heat at all — (no irradiated IR through the glass even). Do yourselves a favor and take off the glass and put tinfoil over the ‘chimney’ inlet. If one is worried about CO, then a cheap smoke/monoxide detector can be placed above. I have never seen a problem putting the flame indoors (the mass of gas burned== the mass of water vapor, for the win. also, I doubt virons would survive cycling through the heater). Naturally, if one has gas, the best option is for a ceramic element wall mounted burner designed for unvented use.

As it turns out,

(1) higher humidity slows droplet evaporation so that they stay bigger longer and might fall to the floor sooner.
(2) water vapor seems to supress virus’ ability to infect by breaking them in some way
(3) your respiratory tract fends them off better when somewhat NW moisty.

Taylor’s own interest in humidity began in 2013 when she was studying (PDF) how infections spread at a new hospital. Her research isolated just about every aspect of a hospital you could imagine, and she discovered a link between infection rates and humidity in patient rooms. In fact, it was the single biggest correlation she found.

Happy quanza, festivus, channucka, winter solstice deflorination festival, whatever. Stay moist and stay safe, yo.

I’ve been running my little humidifier at night, but I don’t feel like it’s doing much but making me cold.

Here’s the problem with humidity in hospitals in one word: Legionnaire’s. (Second word, mold.)

Well, it just doesn’t need to be ‘desert dry’. 45-60% should do ya a treat, and gas burner heaters as the vapor source eliminates both concerns.


Hmm. For most of my life, I thought that was related to tobacco mosaic virus — I thought I had learned that as a child off an episode of Quincy M.E. (Klugman) but I can’t find a reference. There must have been a show somewhere that gave me that idea; of course, viruses don’t replicate in swamp coolers — must have been one of those other ‘preachy’ shows where the message of the week was anti-smoking.

Hi Orac,
I know I’m not your favourite person , but if you are planning to discuss the ” the fat emporer” , perhaps you would consider discussing Dr Mike Yeadon ? His original arguments seemed quite reasonable , but now be is talking g about banning trials of Covid vaccines.

“a former Vice President and Chief Scientist of the company”

Things that make some go ‘hmmm’.

“The pandemic is effectively over and can easily be handled by a properly functioning NHS* (National Health Service). Accordingly, the country should immediately be permitted to get back to normal life.”

Things that make some go ‘Bwaaahaaaha’.

*nothing ‘properly functions’ in the US. There are no sad Maytag repairmen sitting around; never were.

I know, Dorit Reiss. I think I saw you doing a television conference the other day. Was that two vats of colored ‘slime’ on the counter?? Somebody has kids (I trust).

Yes, I have kids, and yes, we made colored slime. It was fun.

Not quite sure what to do with it now, though. Making cookies and buns is easier that way.

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