Here I thought the best early warning system we have about a developing epidemic is poop.
In fact, according to this Massachusetts General Hospital study, the best early warning system we could have about a developing epidemic is Google for poop.
Previous research linked increased Google searches for gastrointestinal symptoms to influenza outbreaks. The MGH doctors naturally wondered if the same could be true for COVID-19. Is there a correlation between an increase in the number of locals seeking information online about loss of appetite, diarrhea and ageusia (i.e. loss of taste) and a spike in COVID cases?
Correlation peaked about three to four weeks after Google searches began to rise, meaning an increase in relevant searches could give health authorities a nearly a month’s warning that a wave is approaching.
However, there is an obvious wrinkle: the search term that was most strongly related to a later outbreak was, as you can imagine, loss of taste. This is probably the most characteristic symptom of the virus, now well known to many Americans. It was not well known in the first weeks of the pandemic, however, the period MGH focused on for its study. If an epidemic were to occur somewhere in America today, how many people who suddenly lost their taste would bother to Google that term for more information, and how many, now educated on the telltale signs of COVID, would simply conclude that they have it?
While there are now fewer searches for ageusia than in March, the search trends may still be illuminating. “Loss of appetite,” a much less characteristic symptom, was also highly correlated with the New York outbreak this spring.
The MGH study is the good news of today’s COVID. Another study, this one in India, is the bad news. One of the reasons the FDA’s decision to clear convalescent plasma for emergency use under Trump pressure has been controversial is that the US currently has no randomized clinical data showing that plasma transfusions actually help people. just infected to heal. Some doctors have argued that the benefits are still too hypothetical to justify approving a procedure that carries any risk. Worse still, as plasma is now cleared for emergency use, it will be difficult to find American volunteers for a clinical trial. Why would anyone want to participate in a study where they could get a placebo when they could get plasma in a course of hospital care?
However, Indian doctors * conducted * a clinical trial on plasma. Verdict: It’s a failure, at least in patients with moderate COVID attacks.
Results from the PLACID study indicate that there was no difference in 28-day mortality or progression to severe disease among moderately ill COVID-19 patients treated with CP along with BSC [basic standard of care] compared to the BSC alone. Furthermore, there were no differences in outcomes between study participants who received CPs with detectable NAb titers versus BSC alone; o between those who receive CPs with NAb titres greater than or equal to 1:80 and those who receive BSC only. CP therapy was associated with greater resolution of symptoms such as shortness of breath and fatigue on day 7. PC use was also associated with reduced FiO2 requirements on days 3 and 5 but not in the duration of respiratory support. There was a higher rate of negative viral RNA conversion on day 7 after enrollment in the intervention arm. However, it did not demonstrate anti-inflammatory properties as no difference in the levels of inflammatory markers such as ferritin, CRP, D-dimer or LDH could be detected between the two arms.
The report goes on to state that even smaller studies in China and the Netherlands found no benefit from plasma. Why didn’t it work? The study authors note that patients tended to have more antibodies in their systems than the plasma donated by the healed patients (!), Which could be due to the demographics of who is most likely to become a donor. “[A]n the vast majority of donors were only mildly ill, young survivors, “they say; their theory is that people who had had more severe cases of the disease were reluctant to go back to the hospital to donate blood for fear of reinfection. It is true that people with mild cases are more likely to donate, and while it is also true that people with mild cases have fewer antibodies in their system, then an infusion of their plasma may not do much good for someone who is struggling with the disease and the production of large volumes of antibodies themselves.