A Los Angeles County nursing home serology study raises fundamental questions about SARS-CoV-2 (includes comparison with New York City)
Two years ago, an acquaintance I’ll call Beth brought an interesting study to my attention. Its results should make any reasonable person who hasn’t already reconsidered the nature of SARS-CoV-2—and the testing associated with it—do so.
Overview of the Study
Published in 2021, Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus 2 Among Skilled Nursing Facility Residents and Staff Members – Los Angeles County, August – September 2020 (Malenfant et al) collected specimen from residents and staff in 24 private nursing homes owned by a single company. The study aimed to assess the number of SARS-CoV-2 infections that were previously “undetected” due to “asymptomatic infections” and “limited testing capacity” during the initial months of the pandemic declaration.1
The Department of Public Health (DPH) surveillance database was used to identify residents and staff who had previously tested positive for SARS-CoV-2. Serology results were analyzed to detect SARS-CoV-2 antibodies (IgG and/or IgM).
Results
Of 856 residents who provided serum, 346 (40%) had detectable SARS-CoV-2 antibodies; 199 (58%) of these residents did not have a documented prior positive SARS-CoV-2 PCR result.
Of 1806 staff members who provided serum, 447 (25%) had detectable SARS-CoV-2 antibodies; 353 (79%) did not have a documented prior positive SARS-CoV-2 PCR result.
Reacting to these results via email, Beth asked,
“If this disease is so deadly, why would 58% of the residents have tested positive for serology, but never tested positive on a PCR? How could it be so mild/asymptomatic in those age groups most vulnerable?”
Those are good questions.
What should we make of the relatively high percentage of nursing home residents for whom SARS-CoV-2 was not significant enough to produce a positive result on an overly sensitive, non-specific PCR test—despite being described as a virus that poses the greatest risk to the elderly and those with comorbidities?
All of the nursing homes had reported a COVID-19 outbreak before the study period. Isn’t it curious that this new virus triggered antibody production but neither a PCR-positive result nor, presumably, significant symptoms in nearly 60% of those who tested seropositive?
The 2,650 resident and staff participants with documented SARS-CoV-2 PCR test results had been tested 2–6 times. This suggests testing rate and availability were more than sufficient. ‘Persistent positivity’ on PCR tests is a documented phenomenon – and (apparently) an even bigger problem in the elderly (e.g., Howard-Jones et al, 2021), making the seroprevalence results even more remarkable.
Most (though not all) of the nursing homes recorded their first cases in March and April 2020, after the U.S. declared an emergency and began deploying tests. Presumably, these cases (i.e., positive tests) marked the ‘beginning’ of each facility’s reported outbreak, during which outbreak testing was conducted.2
Additionally, staff in these facilities had also been infected at high rates, according to the results—meaning residents were being cared for by individuals carrying the allegedly high-risk and purportedly transmissible pathogen. In short, there’s no good “excuse” for the high percentage of sero-positive/no record of PCR-positive individuals.
Is it possible the serology tests were overly sensitive, non-specific, and are, in any event, generally meaningless with respect to coronaviruses? Yes. (The same could be said—and has been said—about SARS-CoV-2 PCR tests and PCR testing as a diagnostic tool.)
Differentially Deadly?
Malenfant, et al don’t report the number of deaths (“COVID” or otherwise) in the facilities. However, federal data show no increase prior to the “15 Days to Slow the Spread” decree, which was followed by only a very modest rise and then a decline. The same is generally true of spring 2020 deaths in Los Angeles County hospital inpatient, as shown here. So, even if nursing home patients were transferred to hospitals in the spring and died there, it didn’t drive excess deaths in hospitals to high levels. The increase in December came as the COVID shot was being deployed.
Like L.A., most of New York City’s excess death in 2020 occurred in hospitals rather than in nursing homes but a comparison (below) is illustrative of the bi-coastal absurdities we’re expected to accept.
Some have proposed that different variants made their way from Wuhan to Iran, Italy, and New York City on one coast—and from Wuhan to cruise ships, military vessels, and Seattle/Los Angeles on the other. That defies common sense and sounds more like science fiction than science.3
Beth’s question remains: If “it” is so deadly, then why wasn’t it deadly?
The answer provided by this L.A. nursing home study is “because *it* wasn’t at all what we were told.”
Footnotes
- Note: I am repeating, not validating, the researchers’ assumptions. There is never a need to test people who don’t have symptoms, or to test anyone for anything unless it directs or changes the course of treatment. Whether testing of any kind is needed for treating most manifestations of respiratory illness is debatable. | “Testing shortage” is an oft-repeated canard about spring 2020. ↩︎
- Breakdown: “Among the 1340 resident participants, 704 (53%) provided both NP swab and serum specimen, 484 (36%) provided nasopharyngeal swab specimen alone, and 152 (11%) provided serum specimen alone. Among the 1965 staff member participants, 1674 (85%) provided both NP swab and serum specimens, 159 (8%) provided NP swab specimen alone, and 132 (7%) provided serum specimen alone.” ↩︎
- Sequencing identifies multiple early introductions of SARS-CoV-2 to the New York City region is one study which bolstered that notion. For discussion, see here . ↩︎
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