There are two ways to classify an acute respiratory illness: by symptoms (syndrome) or by a causative agent, or a combination of the two. A syndrome is used because there is no reason to look for a causative agent. Most cases of acute respiratory diseases are caused by viruses. They resolve on their own. We can use remedies to alleviate or mask symptoms.1 Antivirals are hard to develop so we do not have many antiviral treatments. The ones we have are not very effective. We can treat complications of viral respiratory illnesses, which are often caused by bacteria. We use antibiotics to kill bacteria.2 We are decent at supportive treatment of those who suffer a complicated course of illness until they recover or die, if there is no healing left within them.
Diagnosis by a causative agent arose with the development of technology to detect a pathogen, a microbe that caused an illness. Before 2020 we rarely tested for a causative agent when a patient with some respiratory symptoms came to the doctor. A diagnosis was subjective, based on the opinion of the diagnosing physician. The same set of symptoms could be diagnosed as a common cold or seasonal allergies. A patient was tested only if there was a suspicion there may be an antiviral treatment available (as in the case with influenza) or a patient in the hospital was sick enough and not showing any improvement with current treatment. There are hundreds of viruses out there that cause the same symptoms. We test for a handful.
The emergence of SARS-CoV-2 virus (acronym for severe acute respiratory syndrome coronavirus 2)3 and availability of a method to test for the presence of minute fragments of the virus4 in a person made diagnosis by the causative agent imperative in context of (bio)politics and public health epidemiological or data seeking quest.5 The presence of viral fragments (a positive test) does not mean a person is sick if he has no symptoms. In 2020 a positive polymerase chain reaction test (PCR-test) became a diagnosis, COVID-19 ( an acronym for coronavirus disease of 2019), regardless of symptoms or their severity.6
Before 2020 nobody tested healthy people without any symptoms of respiratory illness for any microbes to diagnose them with a disease they did not have.7 You had to be sick to have a diagnosis. Any test by itself had no meaning. A physician would attempt to relate the findings of any test to your condition to see if you were sick and if the disease you had warranted any further action.8
Availability of genomic sequence testing made it possible to detect viral mutations and say what variant of SARS-CoV-2 makes people sick currently in a community.9 This is a public health surveillance tool that is not used to diagnose individual cases of illness. When public health authorities announced for no good reason that this or that variant was circulating in a community, the public took it upon themselves to create a subset of COVID-19 “diagnoses” - Alpha, Beta, Gamma, Delta, Omicron…10
When a public health agency declares that Omicron is prevalent in your community, when you are sick, it is impossible to tell what variant caused your illness, if you tested positive for COVID.11 When you are tested, no genomic sequence is done on your swab sample, unless it is pooled for community surveillance testing. You will not know if it was. It serves no purpose for any practical reason on the ground. You can say that you got sick when Omicron was prevalent in your community. It is a true statement.12 You cannot claim Omicron variant of SARS-CoV-2 caused your illness or that you had Omicron. It would not be a true statement, unless someone ran a test to confirm it for you.
Before the advent of testing, any disease was diagnosed for the purpose of treatment by the constellation of symptoms. Symptom onset, their combination, and severity would define a diagnosis. It gave a vague prognosis of the duration of an illness, often adjusted for the individual patient based on his current state of health and age. Common terms were acute upper respiratory infection, influenza, pharyngitis, acute bronchitis, allergic rhinitis, etc. Colloquially we may call these illnesses a cold, the flu, sore throat, or allergies. We add descriptors like “mild” or “severe” to help others understand what a fellow man feels.
Testing technology allowed us to know that one and the same course of illness and presentation of it in a patient as manifested in symptoms can be caused by many different viruses (or other species of microbes). A patient with symptoms of a cold can be infected by a rhinovirus, coronavirus, adenovirus, respiratory syncytial virus, paraninflueza, influenza, bocavirus, metapneumovirus, or enterovirus. In addition, there are other viruses we are not aware of, cannot or do not test for. A patient with the symptoms of the colloquial flu can be infected with exact same virus as the one experiencing a cold. The difference between a cold and the colloquial flu used to be the course of illness, severity of symptoms, and their duration. The Great Influenza of 2018-2020 was so severe and unusual that it was mistaken for dengue, cholera, or typhoid. How a virus manifests itself for us to see with our eyes or feel it in our bodies varies.
The label of a syndrome readily evokes the implied severity of illness as most people have experienced or observed it. Words correspond to something in reality. The causative agent of illness or modern diagnosis by it lacks this clarity. To claim that “a cold is less precise than symptomatic rhinovirus infection” is to fail to acknowledge that we seek diagnosis not for accurate classification purpose of its etiology but to consider treatment.13 Symptomatic rhinovirus infection can range from sniffles to death rattle. Which one is it?14
The reality of a disease and a microbe alike is not what the public imagines. Neither disease nor microbe are clearly defined or static in the precision model of diagnostics today. We do not live in a single dimension un-reality on freeze. A microbe may colonize, but not infect (cause illness) thus failing to meet the criteria for the definition of a pathogen. A combination of man (we call him a host) in his totality of past history and present state,15 a microbe in its totality of past history and present state, and the environment (conditions here and now) - result in some outcome from benign, to positive, or negative (what we call disease, when a microbe becomes a pathogen).16 A tight correlation between a pathogen and symptoms does not exist. There is no way to predict how this man here and now will experience illness by extrapolating from population statistics to him.
There is an abyss between population research, an abstract disease description extracted from the context of time and place,17 how it is relayed to the public and experts alike for simplicity of understanding, and the reality of this man and this illness here and now. 18
Plastic diagnosis COVID-19 means nothing. SARS-CoV-2 manifests itself in reality as a range of conditions from no symptoms to death and everything in between. Diagnosis expressed as a syndrome communicates more than diagnosis by the causative agent.
Further Reading
Accad, Michel . What’s a diagnosis about? COVID-19 and beyond. Alert and Oriented. May, 2020.
Bethge, Philip; Elger, Katrin et al. The Swine Flu Panic of 2009. Reconstruction of Mass Hysteria. The Spiegel, December 3, 2010.
Msoond. A Flu by any Other Name. Illnesses we think of as "flu" caused by variety of respiratory pathogens. Substack, November 13, 2021.
Poerksen, Uwe . Plastic Words. The Tyranny of a Modular Language. The Pennsylvania State University Press, 1988.
Pradeu, Thomas . Philosophy of Immunology. Cambridge University Press, 2019.
Stupak, Howard D. What was rebranded as “COVID” has always just been a variation of Influenza-Like-Illness (ILI). Medium, June 30, 2022.
Masking symptoms is most effective in spreading disease. You think you are well enough to wander around, make money, travel, etc. Nobody can tell you are sick, thus they see no reason to stay away from you. It works GREAT!
We are losing this fight to antibiotic resistant bacteria. By no means we must stop. Fight till death we shall.
It can be argued this name is a misnomer, a wrong or inaccurate name. We like lofty terminology. It is our problem. We are so sedated by lethargy of how we live, we seek excitement or pick a fight where there is none. Most cases of “COVID-19” are not severe.
Polymerase chain reaction (PCR) test is performed by repeatedly replicating viral material in the sample until we can detect it. The number of cycles before the virus is detectable is known as the cycle threshold (Ct). The more you spin it, the higher the chance you will find it. A positive test with a high Ct value may indicate a test from someone who had a very small amount of detectable viral RNA on their initial swab, and may not be infectious or have ongoing active infection. The exact relationship between Ct value and how it correlated to a person’s ability to infect others is still being researched, and interpreting these results depends on the clinical context. This is where a physician with brains, not protocols, comes in.
It is hard to tell if epidemiologists collected data for the sake of data or for something of practical use. Regardless, we all suffered as the result of their curiosity.
“Researchers in more than 130 laboratories in 102 countries are constantly on the lookout for new flu pathogens. Entire careers and institutions, and a lot of money, depend on the outcomes of their work. "Sometimes you get the feeling that there is a whole industry almost waiting for a pandemic to occur," says flu expert Tom Jefferson , from an international health nonprofit called the Cochrane Collaboration.” (This is a quote from 2010)
A lot of slide and deliberate confusion in medicine comes from definition swindle, philosophical outlook warping, juking the stats, etc. It is a system with no coordinates. There used to be some.
Tuberculosis screening is an outlier. Selective testing was done only when something would change as a result - work clearance (many hospitals abandoned this practice), residential care facility placement for patients in high risk category as determined by screening.
This is Old School Medicine when a physician took a look at you in your living breathing body, examined you, and asked questions. A physician then would use his judgement (as in think!) based on his education, training, and experience to decide if and what kind of treatment you may need.
A computer data entry clerk steeped in Woke Medicine treats test results by applying algorithms and iProtocols to patients as invented on a computer screen as numbers and images unrelated to any body.
Scientists use special names used only in research (nomenclature) to name viral variants and indicate their lineage. Letters of the Greek Alphabet are used for communication with lay audience (e.g. Omicron* = B.1.1.529 (Pango lineage)). Public health officials declare that they track viral variants to understand if certain variants make people sicker, if more people get sick, and if current methods of viral detection as it correlates to illness work, if the current methods of prevention and treatment are effective for some declared or desired purpose (e.g. decrease in symptomatic illness, severe illness, transmission, hospitalization, or death).
Public health specialists track variants for mostly data collection for possible future use. We have tools therefore we do. Mostly, all of this activity makes people neurotic and sicker.
There are no diseases called Delta or Omicron. There is no “acute Omicron”. No matter what you will, wish, or want, and how you twist it around. Words have meaning. Concepts arise in context. Random wishful thinking has no place in scientific discourse or its practical application in what we used to call reality. It still exists. Without common language that relates to something that exists in reality, we cannot communicate anything of meaning.
The purpose of announcement of some variants is to instill fear. On July 7, 2022 Forbes published an article “Meet ‘Centaurus,’ the new ‘stealth Omicron.’It was just found in the U.S. and may escape immunity more than any other COVID strain” by Erin Prater. (Bless her little heart). Whatever will circulate means about the same for you as any other illness in the past for any man: you will either get sick or you won’t; you will see how you fare if you get sick, you will recover or you will die. There are but so many options and you can deal with each of them should it happen to you. Men before you did. You will too. There is no reason to bury yourself before your time. You job is to live here and now.
At any given time, there are many circulating viruses that cause the same symptoms. Dominance of one over all others in absence of testing does not mean that your sickness was caused by the dominant species or strain. How do we know? We can test and witness it.
How truth emerges is not the same in lay vs medical vs scientific epistemology. How we know what we know and what we call what.
Precise etiology of a cold becomes of interest if you seek high precision treatment for a virus that mutates quickly and has properties that are hard to impossible to target. Have fun!
What is the purpose of communication?
We spend too much time chasing what we have no control over (viruses), but fail to do something about what is in our power to control - ourselves and our environment. We spend all of our time digging a grave for ourselves deeper and deeper by denying reality and rejoicing in excellent metrics of the ever growing list of our misfortunes. We sit in ruin patting ourselves on the backs for the job well done.
Adopting an adversarial stance of a fight with everything around us has consequences. Much of scientific research rests on an arbitrary philosophical premise (pick a fight or build a market) wrapped in ideology of words. If you upset it, you can change direction of research and policy by creating a new research paradigm. We are stubborn and do not like to change our opinions or the direction of hell we are headed to. Hell is hot. Some like it hot. They think it is a vacation zone central.
Have we thought of getting along with anybody? Ever?
Time and place are important for population research. The context of family and individuals is pertinent for all of us.
Research fractures reality into tiny pieces in an attempt to put it together in a framework of metrics. What you read in a scientific publication is not reality. It is a feeble attempt to grasp it. We are failing at it.
I thought was an excellent explanation of an often misunderstood topic and put in terms non experts can readily understand, many thanks