Antibodies Testing in Karachi Reveals COVID19 Exposure Runs in Double Digits
Antibodies testing of 7,000 adults in Karachi reveals that as many as 15% of them have already been exposed to COVID19 without experiencing symptoms, according to a study by Dr. Wajiha Javed, an epidemiologist and head of public health and research at Getz Pharma in Pakistan. This data raises the possibility that millions of Pakistanis may have already been exposed to coronavirus. It takes at least 40% of the population to be exposed to build herd immunity. This may be the only way to normalcy unless there is a vaccine available sooner.
Human Immune Response:
Human body naturally produces antibodies to fight viruses of various kinds, including the coronavirus. Presence of antibodies in a person confirms that he or she has been exposed to a virus regardless of symptoms. Serology tests can detect body's immune response to even a low-level viral load. Such an immune response also occurs to a vaccine which does not make you sick but helps build immunity. More low level exposure to viruses in large numbers of people is in fact a good thing because it helps build herd immunity. However, the most vulnerable population such as the elderly must be isolated until herd immunity is achieved. It takes at least 40% of the population to be exposed to build herd immunity.
Getz Study:
Getz Pharma's Dr. Wajiha Javed told me in the latest update on her ongoing work that serology tests have so far been administered to 7,000 adults aged 18-65 over the last 6 weeks in Karachi. 15% of them have tested positive for COVID19 antibodies. People tested included those working for banks, restaurants, textile mills, factories, media and health care workers.
Antibody testing kits detect the response of the body rather than the virus or antigen itself. These tests do not have the issue of low viral load. Antibody tests can detect exposure to Covid-19 even in asymptomatic cases. Generally, antibody testing kits have a high level of accuracy, especially on sequential testing. The kit Getz Pharma has been using has a sensitivity (the ability to correctly detect positive cases) of 95.3% and specificity (the ability to correctly detect negative cases) of 98.7% for IgG, and the sensitivity is 86.48% and specificity is 95.18% for IgM, according to Dr. Wajiha Javed.
Asymptomatic Carriers:
Over 90% of those who tested positive in Karachi did not have any symptoms or had only mild symptoms, Dr. Wajiha Javed recently wrote in Dawn newspaper. But some were infectious and they were spreading the virus to others. Because of their non-existent or mild symptoms, they had not reached out to a PCR testing facility to get tested for Covid-19, and were only incidentally picked out for the antibody test during Getz's study. This data raises the possibility that millions of Pakistanis may have already been exposed to coronavirus.
Summary:
As many as 15% of Karachi adults have been exposed to COVID19 with over 90% of them showing no symptoms, according to a Getz Pharma study in Pakistan. People tested included those working for banks, restaurants, textile mills, factories, media and health care workers. Human body naturally produces antibodies to fight viruses of various kinds, including the coronavirus. Presence of antibodies in a person confirms that he or she has been exposed to a virus regardless of symptoms. It can even detect body's immune response to a low-level viral load. Getz Pharma's antibodies test data suggests the possibility that millions of Pakistanis may have already been exposed to coronavirus. Such an immune response also occurs to a vaccine which does not make you sick but helps build immunity. More low level exposure to viruses in large numbers of people is in fact a good thing because it helps build herd immunity. This may be the only way to normalcy unless there is a vaccine available sooner.
Human Immune Response:
Human body naturally produces antibodies to fight viruses of various kinds, including the coronavirus. Presence of antibodies in a person confirms that he or she has been exposed to a virus regardless of symptoms. Serology tests can detect body's immune response to even a low-level viral load. Such an immune response also occurs to a vaccine which does not make you sick but helps build immunity. More low level exposure to viruses in large numbers of people is in fact a good thing because it helps build herd immunity. However, the most vulnerable population such as the elderly must be isolated until herd immunity is achieved. It takes at least 40% of the population to be exposed to build herd immunity.
 |
| Coronavirus Antibodies |
Getz Study:
Getz Pharma's Dr. Wajiha Javed told me in the latest update on her ongoing work that serology tests have so far been administered to 7,000 adults aged 18-65 over the last 6 weeks in Karachi. 15% of them have tested positive for COVID19 antibodies. People tested included those working for banks, restaurants, textile mills, factories, media and health care workers.
Antibody testing kits detect the response of the body rather than the virus or antigen itself. These tests do not have the issue of low viral load. Antibody tests can detect exposure to Covid-19 even in asymptomatic cases. Generally, antibody testing kits have a high level of accuracy, especially on sequential testing. The kit Getz Pharma has been using has a sensitivity (the ability to correctly detect positive cases) of 95.3% and specificity (the ability to correctly detect negative cases) of 98.7% for IgG, and the sensitivity is 86.48% and specificity is 95.18% for IgM, according to Dr. Wajiha Javed.
 |
| Pakistan COVID19 Death Rate Among The World's Lowest. Source: Our World in Data |
Asymptomatic Carriers:
Over 90% of those who tested positive in Karachi did not have any symptoms or had only mild symptoms, Dr. Wajiha Javed recently wrote in Dawn newspaper. But some were infectious and they were spreading the virus to others. Because of their non-existent or mild symptoms, they had not reached out to a PCR testing facility to get tested for Covid-19, and were only incidentally picked out for the antibody test during Getz's study. This data raises the possibility that millions of Pakistanis may have already been exposed to coronavirus.
Summary:
As many as 15% of Karachi adults have been exposed to COVID19 with over 90% of them showing no symptoms, according to a Getz Pharma study in Pakistan. People tested included those working for banks, restaurants, textile mills, factories, media and health care workers. Human body naturally produces antibodies to fight viruses of various kinds, including the coronavirus. Presence of antibodies in a person confirms that he or she has been exposed to a virus regardless of symptoms. It can even detect body's immune response to a low-level viral load. Getz Pharma's antibodies test data suggests the possibility that millions of Pakistanis may have already been exposed to coronavirus. Such an immune response also occurs to a vaccine which does not make you sick but helps build immunity. More low level exposure to viruses in large numbers of people is in fact a good thing because it helps build herd immunity. This may be the only way to normalcy unless there is a vaccine available sooner.
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Comments
Geneva, June 6 (IANS) The World Health Organization (WHO) said that as the COVID-19 cases were growing at an alarming rate in South Asia, there were risks of an explosion of the virus in the densely-populated region.
"Particularly in South Asia, not just in India, but in Bangladesh and in Pakistan and other countries in South Asia with large dense populations, the disease has not exploded, but there is always the risk of that happening," Michael Ryan, Executive Director of the WHO Health Emergencies Program, said during a press conference here on Friday.
"And as the disease generates and gets a foothold in communities, it can accelerate at anytime," he added.
"The number of cases in India has been going up by an average of a third per week, so probably the doubling time of the epidemic in India is about three weeks at this stage.
"So the direction of travel of the epidemic is not exponential, but it is still growing," he said.
Ryan said the measures taken in India "certainly had an impact in dampening transmission, and as India, as in other large countries open up and as people begin to move again, there''s always a risk of the disease bouncing back up".
"I think the important thing is to really keep track of the the growth rate, the doubling time of the virus and make sure that that doesn''t get worse," said WHO''s chief scientist Soumya Swaminathan.
As India is a "heterogeneous and huge country with very densely populated cities", Swaminathan said it''s important to wear face coverings.
As of Saturday, India has reported over 2.3 lakh COVID-19 cases, surpassing Italy. It is now in the sixth position with the highest number of infections in the world.
According to the Health Ministry, there were a total of 6,642 deaths.
After India, Pakistan is the worst affected in South Asia with 89,249 COVID-19 cases, and 1,935 fatalities.
Bangladesh follows in the third position with 60,391 infections and 811 deaths, according to the Johns Hopkins University.
With 18,969 cases and 309 deaths, Afghanistan is currently in the fourth position.
Nepal has reported 2,912 cases and 11 deaths, followed by Maldives 1,883 cases with seven deaths; and Sri Lanka with 1,801 cases and 11 deaths.
Bhutan has registered 48 cases with no fatalities.
Government responses should focus on detecting and isolating infected people with symptoms, the World Health Organization said.
https://www.cnbc.com/2020/06/08/asymptomatic-coronavirus-patients-arent-spreading-new-infections-who-says.html
Coronavirus patients without symptoms aren’t driving the spread of the virus, World Health Organization officials said Monday, casting doubt on concerns by some researchers that the disease could be difficult to contain due to asymptomatic infections.
Some people, particularly young and otherwise healthy individuals, who are infected by the coronavirus never develop symptoms or only develop mild symptoms. Others might not develop symptoms until days after they were actually infected.
Preliminary evidence from the earliest outbreaks indicated that the virus could spread from person-to-person contact, even if the carrier didn’t have symptoms. But WHO officials now say that while asymptomatic spread can occur, it is not the main way it’s being transmitted.
“From the data we have, it still seems to be rare that an asymptomatic person actually transmits onward to a secondary individual,” Dr. Maria Van Kerkhove, head of WHO’s emerging diseases and zoonosis unit, said at a news briefing from the United Nations agency’s Geneva headquarters. “It’s very rare.”
Government responses should focus on detecting and isolating infected people with symptoms, and tracking anyone who might have come into contact with them, Van Kerkhove said. She acknowledged that some studies have indicated asymptomatic or presymptomatic spread in nursing homes and in household settings.
More research and data are needed to “truly answer” the question of whether the coronavirus can spread widely through asymptomatic carriers, Van Kerkhove added.
“We have a number of reports from countries who are doing very detailed contact tracing,” she said. “They’re following asymptomatic cases. They’re following contacts. And they’re not finding secondary transmission onward. It’s very rare.”
If asymptomatic spread proves to not be a main driver of coronavirus transmission, the policy implications could be tremendous. A report from the U.S. Centers for Disease Control and Prevention published on April 1 cited the “potential for presymptomatic transmission” as a reason for the importance of social distancing.
“These findings also suggest that to control the pandemic, it might not be enough for only persons with symptoms to limit their contact with others because persons without symptoms might transmit infection,” the CDC study said.
To be sure, asymptomatic and presymptomatic spread of the virus appears to still be happening, Van Kerkhove said but remains rare. That finding has important implications for how to screen for the virus and limit its spread.
“What we really want to be focused on is following the symptomatic cases,” Van Kerkhove said. “If we actually followed all of the symptomatic cases, isolated those cases, followed the contacts and quarantined those contacts, we would drastically reduce” the outbreak.
WHO calls for new lockdowns in Pakistan
The World Health Organization has told Pakistan it should implement “intermittent” lockdowns to counter a surge in coronavirus infections that has come as the country loosens restrictions, an official said Tuesday.
Since the start of Pakistan’s outbreak in March, Prime Minister Imran Khan opposed a nationwide lockdown of the sort seen elsewhere, arguing the impoverished country could not afford it, AFP reports.
Pakistan #pharma industry growing fast. #Pakistan’s domestic #pharmaceutical firms sales have grown 13.1% CAGR in last 4 years, outperforming multinational companies (MNCs), which saw global growth of 9.34% CAGR, according to global industry group IQVIA. https://www.thenews.com.pk/print/681143-pakistan-s-domestic-pharmaceuticals-growing-faster-than-mncs
Emerging faster than the MNCs, the local pharmaceutical companies’ quarterly revenues surged to Rs320 billion till March 31, 2020 compared with Rs195.75 billion as of March 31, 2016. Similarly, MNCs increased their quarterly market size to Rs143.2 billion by the end of the first quarter of 2020 as against Rs100.2 billion in Q12016.
IQVIA is a global provider of information, innovative technology solutions and contract research services with operations in more than 100 countries.
Due to high rupee depreciation, overall industry growth in dollar terms in the first quarter of 2020 remained negative. In dollar terms, national companies witnessed CAGR of 2.41 percent in last four years compared with MNCs, which grew at a CAGR of negative 1.01 percent in the same period, the report said. The pharmaceuticals have remained functional during the Covid-19 pandemic and in fact registered growth.
Pakistan Economic Survey 2019-20 disclosed that the pace of contraction diminished in the pharmaceutical sector, as it registered 5.38 percent decline during July to March in FY2020 as compared to 8.66 percent decline in the corresponding period the previous year. Also, the pharmaceutical sector recorded the highest sales in March, while it fetched $1.3 million foreign direct investment (FDI) in April 2020. Analysts believe at the present growth rate the market size for pharmaceuticals would double in the next 10 years in Pakistan.
But the impact of the pandemic would be severe in the coming months, as the International Monetary Fund (IMF) has revised down its world GDP projections and now expects a contraction of 4.9 percent in 2020.
“Apart from the last three months, the next twelve months will also be very tough for the Pakistan economy,” said Taha Khan Javed, Head of Equities at Al Meezan Investment. “The outlook for Pakistan GDP is also precarious with growth for next fiscal year expected to be only 1-2 percent, much below the normal growth 3-5 percent we have seen in the past.”
Javed said few industries including the pharmaceuticals of the country could play a vital role in their capacity to help the national economy. He suggested the pharmaceutical industry to ramp up production capacity, and collaborate with international pharmaceutical companies to bring critical medicines in the country and eventually aim for joint venture investment of production facilities.
“The government should ensure that timely price increases are given to companies so that they have incentive to increase their investment instead of relying on only imported medicines,” he added.
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Medicine spending growth in the pharmerging markets
continues to slow compared to the past five years and
is projected to grow at 5–8% through 2023. Although
China, Brazil and India have the greatest medicine
spending within the pharmerging markets, Turkey,
Egypt and Pakistan are forecast to have the greatest
growth between 2019 and 2023 (see Exhibit 4).
Pharmerging market growth continues to derive
primarily from increasing per capita use, but some
markets are seeing wider uptake of newer medicines as
patients’ ability to afford their share of costs improves
with economic growth.
https://www.iqvia.com/-/media/iqvia/pdfs/institute-reports/the-global-use-of-medicine-in-2019-and-outlook-to-2023.pdf?_=1593882831247
On the flip side, manufacturers of consumer discretionary items such as automobiles did terribly. Kumar had grouped four companies under consumer discretionaries: the three car manufacturers Indus Motors, Honda Atlas, Pak Suzuki Motors, and Thal Ltd, which manufactures jute products. The total profits of all three fell by 39% to Rs2.9 billion.
Meanwhile consumer staples – which includes 13 companies such as Nestle, Packages, Pakistan Tobacco, Colgate, among others – saw profits remain more or less stagnant, with a growth of 1% YoY to Rs8.35 billion.
“Overall slowdown in economic activity and country-wide lockdown starting during the last week of Mar-2020 in the wake of COVID-19, resulted in lower consumers’ purchasing power,” noted Kumar.
The pandemic, it seems, forced consumers to pause and consider exactly what they were opening their wallets for. In the midst of pay cuts, lay-offs, and general job uncertainty, consumers decided this was the worst possible time to buy a car.
Food and cleaning products, or items that are manufactured by Nestle, Unilever or National Foods, are deemed more of a necessity, even though this sector saw an increase in overall prices. The same goes for pharmaceuticals, which are necessities that consumers will often cut back on other spending for in order to be able to continue to afford them. This holds particularly true during a climate of a global pandemic.
This is reflected in the sales numbers as well. Sales for discretionary items (at this point, we will just call it autos), declined by 32% YoY in the first quarter of 2020. But the sales of consumer staples and pharmaceuticals, saw an uptick of 8% YoY and 7% YoY, respectively.
“We believe, due to country wide lockdown amid COVID-19 outbreak, the overall sales of the consumer segment will be affected due to supply chain disruptions, wherein consumer discretionary firms are likely to take the hit most among others,” said Kumar.
So first, let us look at the problem sector: autos. The overall slowdown in economic activity and country wide lockdowns, meant that sales took a hit. Foreseeing this, many such as Indus Motors and Honda Atlas sharply hiked their prices, in order to salvage some semblance of a profit. They should not have bothered: volumes witnessed a contraction of over 50% YoY, leading to a massive overall decline.
Of the three auto companies, Indus fared a little better, with its sales only declined by 20% YoY, compared to Honda Atlas’ 35% YoY fall, and Pak Suzuki’s abysmal 48% decline. According to the report, Indus also helped buoy the overall gross margins of this sector, which increased by 0.11 percentage points to 8.8%.
Now, to consumer staples. Much of the higher revenue in staples was actually driven by an increase in the prices of goods, as the rupee’s devaluation led to costs being passed on to consumers. There was also an increase in volumes compared to last year. Much of this growth in Kumar’s sample size was led by National Foods, which saw a 28% increase in sales compared to last year, and Unilever Pakistan Foods, which saw a 17% increase.
https://www.nytimes.com/2020/08/29/health/coronavirus-testing.html
Some of the nation’s leading public health experts are raising a new concern in the endless debate over coronavirus testing in the United States: The standard tests are diagnosing huge numbers of people who may be carrying relatively insignificant amounts of the virus.
Most of these people are not likely to be contagious, and identifying them may contribute to bottlenecks that prevent those who are contagious from being found in time. But researchers say the solution is not to test less, or to skip testing people without symptoms, as recently suggested by the Centers for Disease Control and Prevention.
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The PCR test amplifies genetic matter from the virus in cycles; the fewer cycles required, the greater the amount of virus, or viral load, in the sample. The greater the viral load, the more likely the patient is to be contagious.
This number of amplification cycles needed to find the virus, called the cycle threshold, is never included in the results sent to doctors and coronavirus patients, although it could tell them how infectious the patients are.
In three sets of testing data that include cycle thresholds, compiled by officials in Massachusetts, New York and Nevada, up to 90 percent of people testing positive carried barely any virus, a review by The Times found.
On Thursday, the United States recorded 45,604 new coronavirus cases, according to a database maintained by The Times. If the rates of contagiousness in Massachusetts and New York were to apply nationwide, then perhaps only 4,500 of those people may actually need to isolate and submit to contact tracing.
One solution would be to adjust the cycle threshold used now to decide that a patient is infected. Most tests set the limit at 40, a few at 37. This means that you are positive for the coronavirus if the test process required up to 40 cycles, or 37, to detect the virus.
Tests with thresholds so high may detect not just live virus but also genetic fragments, leftovers from infection that pose no particular risk — akin to finding a hair in a room long after a person has left, Dr. Mina said.
Any test with a cycle threshold above 35 is too sensitive, agreed Juliet Morrison, a virologist at the University of California, Riverside. “I’m shocked that people would think that 40 could represent a positive,” she said.
A more reasonable cutoff would be 30 to 35, she added. Dr. Mina said he would set the figure at 30, or even less. Those changes would mean the amount of genetic material in a patient’s sample would have to be 100-fold to 1,000-fold that of the current standard for the test to return a positive result — at least, one worth acting on.
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Instead, new data underscore the need for more widespread use of rapid tests, even if they are less sensitive.
“The decision not to test asymptomatic people is just really backward,” said Dr. Michael Mina, an epidemiologist at the Harvard T.H. Chan School of Public Health, referring to the C.D.C. recommendation.
“In fact, we should be ramping up testing of all different people,” he said, “but we have to do it through whole different mechanisms.”
In what may be a step in this direction, the Trump administration announced on Thursday that it would purchase 150 million rapid tests.
The most widely used diagnostic test for the new coronavirus, called a PCR test, provides a simple yes-no answer to the question of whether a patient is infected.
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But yes-no isn’t good enough, he added. It’s the amount of virus that should dictate the infected patient’s next steps. “It’s really irresponsible, I think, to forgo the recognition that this is a quantitative issue,” Dr. Mina said.