Testing positive?
What does testing ‘positive for covid’ actually mean? PCR swab tests look for viral fragments of the SARS cov-2 virus. According to an article in the Journal of the American Medical Association -it is viral fragments – if you’re infected or have been infected up to six weeks ago and also if you have been exposed to the virus but remained asymptomatic, which is what happens to the majority of those testing positive. This is partly because the test is for viral fragments, not viable virus that can cause disease.
You will have seen that the number of positive PCR swab tests has gone up. However, it is absolutely critical to know how many tests are being run for the obvious reason that the more tests that are run in a population the more positive results will occur. In other words, if you live in a village of 100 people and test 10 people and find 1 positive result, then test everyone the following month and find 10 test positive this might be reported as cases increasing ten-fold when it is actually the same percentage testing positive. So, the first thing we need to know in any reporting of ‘positive cases’ is number of tests so you can say eg 10 in 100 test positive.
Then you have to deduct the false positives from the total tests. A ‘false positive’ is someone testing positive who isn’t actually infected in any way. According to an article in the Lancet medical journal last week the rate of false positives is between 0.8 and 4%. For the sake of an easy explanation let’s say it’s 1%. That means that, in our village of 100 people, if all are tested and 10 test positive, 1 will be a false positive and 9 will be real. If you have a high rate of overall infection in a population (such as our example village) the false positive rate doesn’t change things much eg 9 versus 10 actual cases.
But what if there were 2 positive tests in our village of 100 people? One would be real and one would a false positive – eg half are false. So, when there is a low rate of infection if you don’t take into account false positives, and also test a lot of people, you get scary and unrealistic reports. That’s what’s happening now in the UK which is why cases go up but death rates in ICUs really aren’t changing much at all. Here’s why.
Let’s expand our village of 100 people to a town of 100,000 and test them all. Suddenly you’re reporting 2,000 cases because 2% test positive! Shock, horror. But 1,000 are false positives (1%). With 1,000 ‘real’ that’s 1 in 1,000 people having been exposed to the virus, most of whom are asymptomatic. Those are small odds.
The big problem is that false positives are just not being factored in which is why I pay little attention to the scary statistics being presented in the media. As the Lancet article says ‘False-positive COVID-19 swab test results might be increasingly likely in the current epidemiological climate in the UK. Any diagnostic test result should be interpreted in the context of the ‘pretest’ probability of disease. For COVID-19, the pretest probability assessment includes symptoms, previous medical history of COVID-19 or presence of antibodies, any potential exposure to COVID-19, and likelihood of an alternative diagnosis.’
In other words, the only ultimate purpose of these tests is to predict how many people will get sick, critically ill or die, which is why I pay most attention to the accurately reported number of people admitted into Intensive Care Units (ICUs) and actual covid deaths in ICUs, not spurious reports of people dying with a positive PCR test result, eg probably dying with covid-19 viral fragments, some of whom are false positives anyway, but not dying because of covid-19. The vast majority of people dying of covid-19 are first admitted into an ICU. Almost every NHS worker in hospitals that I’ve spoken to says anyone who dies, often obvious not from covid19 infection or a cytokine storm, but having tested PCR positive is automatically registered as a ‘covid death’.
Now lets make this real by taking the first two weeks of September using government numbers. Over a million were tested (1,168,749) and 36,000 tested positive (35,951). This means that 3%, or 3 in a 100, tested positive. If false positives account for 1% then, with 1 million tests you’d get 10,000 false positives. This would mean that actual real positives is 26,000 not 36,000, in other words 2/3rds of what is being reported. That means that 26,000 out of a million actually test positive, which is 2.6% of those tested.
Critical covid hospitalisations and deaths
Much more relevant are the actual covid-19 deaths and, working backwards from this, the number of actual critical hospitalisations for covid-19. The reason I say this is that, with so many false positives, anyone going into hospital, eg having had a heart attack, who happened to test positive, possibly a false positive and possibly asymptomatic, may be notched up as ‘covid hospitalisation’ and, if they die, counted as a ‘covid death’. But this is misleading.
That’s why a figure I trust, and get every week from the Intensive Care National Audit Research Centre, is ICU admissions with covid-19, and consequent deaths. I wanted to wait four weeks from the time when PCR positive cases started to crank up (albeit because more tests are being run) because it can take up to 3 weeks from infection to end up in the critical phase of a ‘cytokine storm’ requiring ICU treatment and the average length of stay in ICU of those who die is between 4 and 9 days. So there’s a lag.
As of today, for the month of September, 527 critically ill people have been admitted into ICUs – 126 in the North West, 93 in the Midlands, 90 in the North East, 73 in London, 17 in Wales, 12 in the East of England, 12 in Northern Ireland, 17 in the South East and 5 in the South West. The first thing you’ll notice, as occurs with both flu and many diseases, is that the further North you live the worse the risk which makes one think of poor nutrition and possibly sun intensity being less, hence lack of vitamin DWhat it does: Helps maintain strong and healthy bones by retaining calcium. Deficiency Signs: Joint pain or stiffness, backache, tooth decay, muscle cramps, hair loss….. Two thirds of those admitted are in the more deprived areas of the country – that is poorer people who are also known to have worse nutritional status and higher levels of smoking.
A report just out from one ICU finds that all their ICU patients have abnormally low vitamin CWhat it does: Strengthens immune system – fights infections. Makes collagen, keeping bones, skin and joints firm and strong. Antioxidant, detoxifying pollutants and protecting against… levels, but those who don’t survive have much lower levels, many below the level that diagnoses scurvy. By the way, the vast majority of people who get scurvy and don’t survive die from pneumonia which is effectively what is happening in covid-19 fatalities, according to an article in the British Medical Journal
All have borderline low levels of vitamin D, but there’s no difference between survivors and non-survivors. (More on this below.) This concurs with what you’d expect in more deprived areas of the UK, especially further north.
The good news is that there’s no steady increase in admissions across September, as has been seen with positive PCR cases (largely due to more testing). It’s stayed much the same in the last two weeks. Of those 527 admissions, roughly a third (167) have been discharged from critical care so there’s 232 left as of the end of last month. 44 people have died in ICUs. That is 8% of ICU patients compared to the average in the first wave of around 40% of those admitted dying. This is also good news because it suggests treatment has got better. (There will be a bit of a delay here since those who don’t survive spend on average of 9 days in ICUs so we’ll have to wait to see how this figure levels out.)
Now compare this to the PCR test results, the purpose of which is to predict critically ill patients, deaths and NHS overwhelm. With 2.6% estimated positive infection rate, albeit most asymptomatic, and about 50 million adults in the UK (only one immune-compromised child under age 14 has died so I’ve used the adult population) you’d expect 1.3 million people in the UK to be actually positive for this virus right now. With 527 (call it 500) critically ill that’s an estimated conversion rate from positive test to critically ill of 0.04%. With 44 deaths (call it 50) that means that the conversion rate from positive PCR test to death is 0.003%. Or 3 in a million which means a 1 in 333,333 chance of dying if covid positive and a 1 in a million chance of dying from covid for the general population (eg 50 deaths in 50 million). Let’s assume deaths increase ten fold over the months to come and everything else stays the same these are still very small odds, and all based on the same treatment. These odds are way less than your chances of being run over by a bus.
Better treatment
All of this assumes there’s no better treatment. In case you didn’t know, the way to avoid fatality from covid-19 is now well established. No-one is dying from the virus – they die from the immune system’s over-reaction to dead viral particles, called a cytokine storm which is what happens in sepsis. At this critical phase, which is what’s happening to most people being admitted into ICUs, it is essential to combine vitamin C, steroids and anti-coagulants and, ideally, intravenously. In the first wave almost no ICUs in the UK were up to speed. However, there’s been a lot of sharing of learnings and I hope more ICUs will start using this combo when a cytokine storm is kicking in. The Chelsea and Westminster ICU are using 2g of intravenous vitamin C every 12 hours = 4g a day. They reported 29% mortality, compared to 42% mortality as the national average in the first wave, using only 2g a day but have doubled the dose going forward. In the US a number of hospitals are using 12g a day and reporting under 6% mortality and essentially no deaths in anyone under 85 and, for those over 85, only in those with a pre-existing end stage disease. (see https://covid19criticalcare.com/ for more on this.)
ICUs have woken up to the need for steroids (adrenal-like steroid hormones). The UK dexamethasone (steroid) study, which hit the headlines in June, is the only proven disease modifying treatment against covid-19 that saves lives so far. However, in studies on sepsis, a similar cytokine storm reaction, the steroid drug methylprednisolone works better.
Under physiological stress, such as a viral attack or a mass of alien viral particles, the adrenal cortex should release both vitamin C (yes, it’s stored in the adrenals and released into the bloodstream raising blood levels as much as twenty-fold making vitamin C, by definition, a hormone) and cortisolCortisol has been nicknamed ‘the stress hormone’ as it is released in higher levels during the body’s flight or fight response to stress. Levels of… but, in the absence of vitamin C the cortisol doesn’t work so well, hence you need both delivered into the blood intravenously to provide a continuous supply. ICUs that have tested covid-19 patients report that those who don’t survive have such low, and often undetectable levels of vitamin C to fulfil the diagnostic criteria for scurvy, the treatment of which is intravenous vitamin C (see below).
ICU covid patients tested have pre-scurvy
It is a no brainer to test critically ill people entering ICUs for vitamin C and D but this isn’t happening. However, last week the first ICU (in Colorado) published its results of testing a group of 21 patients, 10 of which did not survive. All had low vitamin C levels, but those who died had really low vitamin C levels, some below the level that diagnoses severe deficiency known as scurvy. You should have at least 50µmol/l in your serum – the clear part of the blood. But these patients, as a whole, had only 22µmol/l of serum vitamin C, less than half of what is considered normal. Those that died averaged only 15µmol/l. Outright scurvy is diagnosed by a vitamin C level below 11.4µmol/l so we can say all those who died had pre-scurvy and many had scurvy. This doesn’t surprise me since vitamin C levels are known to fall away precipitously during viral infection, sepsis and cytokine storms, hence the need for 1 gram an hour of oral vitamin C and perhaps half this if given intravenously. The big misunderstanding is that, while the RDA (80mg) of vitamin C, which is about an orange or lemon’s worth, raise blood levels to a normal and healthy level in people not infected, when virally infected it is well established that several grams of vitamin C are needed to get blood levels back to normal.
I hope more ICUs will start testing, and sharing their findings because, with enough results we can see how statistically significant this is. For example, while age is a predictor of covid mortality risk, in this small group, if you adjusted for the confounding variable of vitamin C level, age did not predict outcome, but vitamin C level did. This suggests that older people have lower vitamin C status and this, not their age, puts them at increased risk. But this sort of supposition can only be tested with larger numbers.
Vitamin D levels were also low, but not exceptionally low in these patients (55.5µmol/l). Many GPs consider anything below 50 to be deficient while I recommend a higher 75µmol/l cut off point. There was no real difference in the vitamin D level of the survivors (53 µmol/l) compared to the non-survivors (57 µmol/l). This also doesn’t surprise me since vitamin D, while important for immunity, isn’t expended during viral attack in the way that vitamin C is. In other words, having higher and sufficient circulating vitamin D may help reduce your risk of serious infection, but it is unlikely to stop you dying from covid-19 if you’ve hit the cytokine storm phase. However, giving very high doses to those with vitamin D levels below 50µmol/l has speeded up recovery.
Protecting yourself from the inside with vitamin C, D and zinc
With high dose vitamin C, zincWhat it does: Component of over 200 enzymes in the body, essential for growth, important for healing, controls hormones, aids ability to cope with stress… and sufficient vitamin D then you are extremely unlikely to ever end up in hospital. The key is to take a loading dose of 2-5grams of vitamin C on first signs of infection, followed by 1 gram an hour, with eg 3mg of zinc, to achieve 20 grams of vitamin C and at least 60mg of zinc across 24 hours. Black elderberry may also help at this stage, but not in the later non-infectious ‘cytokine’ storm phase. Steroids will not help in the earlier ‘infectious’ stage either. If you haven’t already read Flu Fighters please do so, and share this information with your friends and family. Order your physical copy, kindle or audible version at https://www.patrickholford.com/flu-fighters
Protecting yourself from the outside with masks and social distancing
Masks are a good idea IF infection is around. My understanding of the studies is that this virus spreads rapidly, but closely, eg within 2 metres but not much outside of this. So, if you’re not that close to people sneezing ,sniffling and snuffling, or shouting or spitting, or unknowingly infected, masks may not be so essential. That’s why you wear a mask on entering a bar, but take them off when sitting with your family or group of close friends. HOWEVER the infectious period is two days before symptoms and 4 to 6 days from first symptoms so it’s hard to know if an asymptomatic person is in that infectious period. Technically there’s no need to both social distance AND wear a mask. So, if you’re 2 metres away from anyone on a train there’s not much point wearing a mask. To be safe, do both.
Vaccines
The reality is they’ll be none this winter that have been adequately safety tested. We have to wait and see if they work and are safe. The greatest risk is an immunological over-reaction, as has already occurred with the Oxford and Moderna vaccine. Since there’s very little actual covid infection around, hence waiting for those vaccinated to get exposed to judge if the vaccine protects them could take a very long time. A trial actually vaccinating, then infecting people with covid-19, is being proposed and currently undergoing the ethical approval process. Bear in mind that no coronavirus vaccine has ever worked before. Also, the best flu jabs have been something like 10% to 35% effective. Therefore, the chances of a vaccine being more effective in saving lives than getting your vitamin D level up, taking vitamin C and zinc if infected, and getting the proper treatment in ICUs, if needed, is very small indeed. However, these approaches are not mutually exclusive. In fact, they help each other. Vaccines are more effective in people with fully functioning immune systems. The biggest danger is that vaccines are rolled out, and adverse effects are rolled under the carpet, as happened with the last pandemic flu vaccine, as graphically illustrated in this short youtube film:
I hope that clarifies a few points. In my next 100% Health Newsletter (you can sign up here). I’ll be doing a full and up to date report on both vitamin C and vitamin D.
I’ve been working with a number of leading experts on a review of the scientific literature on vitamin C, colds, flu, sepsis/cytokine storm and covid-19 to share and present to UK health authorities. I’ll also share this through change.org/vitaminC4UK. Please sign up to our petition to get the UK government and NHS to take vitamin C seriously. If you are a doctor, nutritionist or nutritional therapist you’ll have an opportunity to sign this statement/review when it’s ready to give more weight to this statement.
Meanwhile, in case you haven’t seen it, my colleagues and I have published a review in the international Nutrient journal entitled ‘Could Vitamins Help in the Fight Against Covid-19?’. Here’s the link: https://www.mdpi.com/2072-6643/12/9/2550
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