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Horowitz: Florida leads nation in pushing accuracy and transparency of COVID-19 testing

Op-ed

Sunshine indeed

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Which state will provide Americans as much transparency and due process as Portugal does before forcibly locking them down? It appears that Florida is leading the way in bringing sunlight to the process of PCR testing, which is being used as the formative tool inducing forced quarantines.

It's been nearly three months since the New York Times discovered that a large percentage of the positive tests being reported in this country are only at trace levels and are not infectious. The paper reported that most labs were using 35-40 RNA amplifications, known as "cycle thresholds" (CTs), in order to detect traces of the virus. Most research shows that any virus that is captured only through a CT level above 25, and certainly above 30, is very likely to be a false or meaningless positive. This is why a Portuguese judge recently ruled that any positive test that used more than 25 cycle thresholds is not reliable and cannot be used to force quarantine.

Each cycle threshold doubles the level of amplification of the previous CT. Thus, a CT of 40 is 1,024 times the amplification of a CT level of 30 (210 =1,024) and 32,768 times that of a CT of 25 (215=32,768). Clearly, not all positive results are equal, and knowing the CT level of your positive result is of utmost importance. A friend of mine had her daughter forcibly removed from school for two weeks because my friend tested positive with no symptoms when she gave birth in the hospital. Shouldn't she know if her case is really at a level that can be cultured as a live infection or not? If not, not only was her daughter's life gratuitously disrupted, but all her friends were needlessly locked down too.

Thanks to the leadership of Gov. Ron DeSantis (R), Florida appears to be the first state that will begin quantifying CT levels and possibly adjusting policy based on the results. On Dec. 4, Florida became the first state to mandate that testing labs report the cycle thresholds of each COVID test.

"All positive, negative and indeterminate COVID-19 laboratory results must be reported to FDOH via electronic laboratory reporting or by fax immediately," ordered the Florida Department of Health in a new memorandum to testing centers first posted online by the Alachua Chronicle. "This includes all COVID-19 test types – polymerase chain reaction (PCR), other RNA, antigen and antibody results. Cycle threshold (CT) values and their reference ranges, as applicable, must be reported by laboratories to FDOH via electronic laboratory reporting or by fax immediately."

It's unclear at this point whether the DeSantis administration plans to change quarantine policies based on the disclosure of CT values, but the first step toward readjusting those policies is to gather such information. Knowing what percentage of positive cases are detected only at levels that are likely dead viral RNA is a vital tool in tracking the epidemiological trends of the virus.

The enormity of consequence from such a decision cannot be overstated. A recent analysis of 29 existing studies conducted by Oxford University researchers found that "the evidence is increasingly pointing to the probability of culturing live virus being related to the amount of viral RNA in the specimen and, therefore, inversely related to the cycle threshold." They observed two published studies that showed "the odds of live virus culture reduced by approximately 33% for every one unit increase in Ct."

This is why they concluded that given that "complete live viruses are necessary for transmission, not the fragments identified by PCR," it's advisable that accurate CT levels coupled with actual symptoms in the patient "should be used to define the reliability of PCR for assessing infectious potential." On the other hand, they concluded that positive results from those "with high cycle threshold are unlikely to have infectious potential."

Consider all the children who often don't have any symptoms but test positive and are taken out of school. Now, consider all those who are supposedly exposed to that asymptomatic child who are taken out of school for two weeks. Shouldn't we try to determine whether those children actually have infectious potential, especially when we have found very little spread from children in school?

The consequences of unscientific quarantine of children are devastating. According to the Washington Post, failure rates in math and English among low-income household children in Montgomery County, Maryland, rose sixfold this year. In St. Paul, Minnesota, nearly 40% of high school students have received failing grades so far this year. Yet, Maryland Governor "Lockdown" Larry Hogan and Minnesota Governor Tim Walz continue to ignore the science about CT levels in testing and the lack of spread among children.

If every state were to track cycle thresholds, we would actually be able to better target the quarantine and contact tracing (to the extent it's even constitutional) to those who actually have live infectious potential. We'd also be able to determine once and for all if there is meaningful spread among asymptomatic individuals.

Why would we continue to indiscriminately lock down an entire society and chase our tail tracing a virus with millions of positive cases that aren't really infectious? That strategy hasn't worked in containing the virus and has only worked to destroy our lives. Then again, this was never about following the science. This was always about control. And the more the public is in the dark about what is and is not a danger for spreading the virus, the more the politicians can categorically shut us down.
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