Will writes:

Hello TWIVerse, 

I am a Captain/Paramedic for a large city north of Detroit (Kathy’s meteorological report is usually the same as mine).  I am in charge of Macomb County’s Hazardous Materials Response Team, and also teach paramedic curriculum to new students and continuing education credits to paramedics on the job. I began listening to TWIP after my son had a “crappy” encounter with a little parasite by the name of Cryptosporidium 5 yrs ago. I quickly became a fan of microbe.tv and have been using info from your podcasts to aid in my teaching ever since. 

I am concerned with a second wave and how the emergency response community will handle it. As with most HCPs, we were dealing with PPE shortages in the beginning of this pandemic. Now that grant money has alleviated this issue, we have turned our attention to focus on building a reliable testing regimen and preventing an outbreak within our department. I plan on utilizing UHG’s testing simulator to help accomplish this. Access to testing sites and the type of tests they use have been very unreliable and inconsistent. Here’s a breakdown of testing results for our 100 firefighter/paramedics. 

PCR or antigen positives since March = 12

Antibody positives since March = 9 (not all 12 went for the antibody test)

We have been using PCR for guidance on when someone can return to work. The NEJM paper on rethinking test sensitivity has made me reconsider that. We have one firefighter who was PCR positive with mild symptoms the last week in August. He went for PCR and serology tests last week as a part of Wayne State University Physician Group’s free testing site. Both of those tests came back positive.  He is currently asymptomatic.

Here are my questions for you and Dr. Griffin – 

– Is his current PCR positive test likely showing post-infectious shedding of RNA from the last week in August rather than a new infection? Possibly a false positive?

– Should he get an antigen test to rule this out? (2 negative PCRs 24hrs apart isn’t something the City will pay for)

– Can you provide resources for obtaining rapid testing equipment and supplies? 

We plan on moving to a higher frequency testing model, utilizing rapid tests in order to minimize false positives and unnecessary quarantine of our members. 

I would like to thank all of you for being such a reliable resource. TWIV has benefited our department by providing our medics with good information which has helped them cope with the COVID runs we are seeing daily. 

Your friend in science,

Captain William R Walker II, EMT-P/IC
Hazardous Materials Specialist/Rescue Specialist
Macomb County Hazmat Team Leader

Liping writes:

Dear TWiV,

The Chinese vaccines will soon be available to us at a very reasonable price (comparable to that of the flu vaccine). As we make the decision on whether or not to inject this thing, I’d like to seek your input.

My understanding is that this vaccine is a live attenuated vaccine, made with 1930s technology. Given the fact that coronavirus has multiple strategies to evade the immune system, I doubt the efficacy. What is your thoughts on that? Do you think US would make the vaccines available to the world once it is cleared by the FDA?

Also, regarding the current circumstances on COVID in China, seems that they really have this thing under control. But as the winter approaches, we will see how things change. My hunch is that there is gonna be a second wave of this thing here in China.

Best Regards,

Bai LIping

Leah writes:

Greetings, TWIVers!

I was so excited when you read my last limerick on your podcast, that I’ve been looking for just the right inspiration to send in another one.  It also gave me a great excuse to share your podcast with people I know by joking that I’m now a celebrated poet!  HA!

Listening to TWIV 674 this morning, I was intrigued by the article you discussed about the effect of the SARS-CoV-2 spike protein on neurons. So, without further ado, here is my question in the form of a limerick:

Since, in vitro, spike affects neuron cells,
And made rats not feel pain quite so well,
Might reducing pain in rat toes
be what’s going on in your nose?
Is this why folks with Covid can’t smell?

I appreciate you all so very much!  I love your thoughtfulness and commitment to cutting through all the nonsense bombarding our nation.

All the best,

Leah from Oak Ridge, TN

Barry writes:

Results Of Melbourne Mask Trial

Well it seems masks have worked incredibly well at reducing the spread of SARS CoV2 here in Melbourne.  Sure, there were a few small confounding factors that muddied the results a little bit.  

You may remember we were having 300 to 400 cases a day when masks were made mandatory in late July here in Melbourne and country Victoria, Australia.  To further set the scene, all other states were seemingly virus free or having single digit cases and we Victorians were a little upset at this state of affairs.  A border sign leading into Victoria was graffitied so it read COVIC instead of VICTORIA (very amusing).

After masks became a thing, and thankfully adherence was very high, case numbers…stubbornly and disappointingly continued to rise!  For the next two weeks they rose into the 400s and 500s.  I heard epidemiologists explain that the masks were working, it was just that there was a built-in latency in the case numbers.  Well ok, I thought, ok let’s wait and see.  I did wait and see, and…they rose into the high 500s and up to 600.  So we added a few more small additional measures on top of the mask-wearing…

All retail shops closed
5 kilometre radius travel restrictions from home.
Curfew from 8pm to 5am.
No gatherings in the home. 
No gatherings out of the home.
Limit of 1 hour for exercise outside.
Limit of 2 people from same household to be outside at once and then only for exercise.
Limit of 1 person per household per day for grocery shopping.
Other than work, only four other reasons to leave home (getting tested, getting medical attention, caregiving to others, grocery shopping)
Workers travelling outside 5km limit are required to have an employer-signed certificate that you are a permitted worker.

This was called Stage 4.

And then as you can probably already guess…cases continued to rise…for a short while anyway, up to a peak of 700 for one day in early August…and then, and then, they finally fell, in fact they plummeted.  From 700 to the low teens in less than two months.  We are now down to a 14 day average of 6 and in the last week it has been only 2.

It has been a hard gruelling lockdown but we had the other states of Australia to look to and help us; they sent us healthcare workers and contact tracers and test kits.  We used the lockdown to dramatically improve our own TETRIS but we are cautious in relying on it and we are done taking any chances.  Although Premier Dan Andrews has stated that we are not aiming for elimination of the virus in Victoria it does suspiciously look like we are aiming for such low numbers that a toddler with a toy phone could TETRIS this thing.

So whatever happened, however it happened, it worked, for now.  The masks worked and so did all those other things.  No idea by how much but the culture here in Melbourne feels different to the rest of Australia, like it has permanently changed.  At least we are having some fun with it too – can you guess who this is with her new mask on?

Emily writes:


First of all, thanks for all of the work you all do!  I enjoy listening to TWIV on my runs every week and I personally think you are the best source of information during the pandemic.  Your insights have guided several of our decisions, including keeping our kids home from school and learning online this fall.  

A few weeks ago, my kids and I were going to visit my parents and in-laws, who we haven’t seen for months,  so I decided to get a PCR test at our local drive-thru state testing facility because I felt it was the responsible thing to do before visiting older family members.  I was shocked when I tested positive. While I realize there certainly are theoretical possibilities, we haven’t been able to come up with any logical way I could have contracted the virus as none of us have had any close contact (or really any contact) with anyone except each other.   We work from home and my kids are doing virtual school.   I was completely asymptomatic and no one else in my house has been sick either.   I retested negative PCR 48 hours later.  

I found it interesting that public health had suggested my test could be a false positive, but when I followed up with my healthcare provider, I was told false positives really aren’t possible with PCRs.  After searching through Google, I found similar media outlets and articles saying the same thing – false negatives are an issue, but a positive means a positive.  However, I did run across this recent publication in the Lancet that suggests that false positives are rare, but possible: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600%2820%2930453-7/fulltext

I understand promoting the narrative of erring on the side of caution – we don’t want people assuming they had a false positive and then going out and infecting others if we acknowledge that false positives occur.  I also know there are conspiracy theories floating around out there regarding false positives, so I’m curious on your take on this issue.  I know there have been several well publicized events with the NFL where false positives have occurred, both with rapid tests and PCRs, so I find it interesting that there is so much conflicting information out there.  

I realize I may never know whether or not my positive was “real” or not…it doesn’t really change anything for me at this point, but it certainly caused a roller coaster of emotions for me from guilt to frustration to being grateful this ended up being a best case scenario outcome for my family and I if I truly was infected.  

Thanks again for all that you do!  

Emily from Iowa

Andrew writes:

Hi there, 6 month viewer of TWIV here.

I was an auto part analyst in Detroit before the bug. & I think there could be something I know that may be of good use for you guys.

Through my years of work & research, I have come to realize 2 things, car engineers A) need something that will not break during the 5 year 100k mile warranty period & B) they want the cheapest option that will fit this 0/low warranty requirement.

Ok now on masks

There are 0 washable filters that are deemed acceptable to filter enough fine particulates to protect the engine from damage. There is 1 well-known filter for being washable its called K&N But this filter needs oil (applied properly) after washing. Straight from the factory it still does not filter as well as paper.

Long story short paper works best as a filtration media. & I haven’t heard much about filtration quality from anyone anywhere but I have been way into it, actually for years. I actually think the filtration media needs more attention; but what the hell do I know I am just an auto parts guy in Detroit.