The Pandemic of PCR-Negative COVID-Like Illness

Disclaimer: I am not a medical doctor and this is not medical advice. My goal is to empower you with information. I will not take a position on whether you should or should not get vaccinated. Please make this decision yourself, consulting sources you trust, including a caring health care professional.

In late October, the CDC had circulated a headline that the COVID vaccines are more than five times as effective as natural immunity. I pointed out that the real story was the hint from this paper that there is a pandemic of PCR-negative “COVID-like illness” hospitalizations that is six times more common in fully vaccinated individuals than in naturally immune individuals.

They had taken a sample of over 200,000 people hospitalized for respiratory failure, pneumonia, trouble breathing, fever, vomiting, or diarrhea, and whittled this down to roughly 7,000 people who had at least two PCR tests more than three months apart who were either fully vaccinated but never-infected or previously infected but never-vaccinated. In this subgroup, 85% of the people were fully vaccinated and 94.4% of them tested negative for COVID.

The remarkable fact that 94.4% of the people hospitalized for COVID-like illness didn't have COVID should have been the biggest story. The vaccines could be 100% effective against “COVID,” but if all that means is making someone test negative while they are hospitalized for respiratory failure, it is completely meaningless.

What we didn't know at that time was whether the data looked similar in the big sample of over 200,000 hospitalizations. If they did, then we should have just ceased talking about “COVID” hospitalizations altogether because most hospitalizations for COVID-like illness would not be included in the numbers.

And now we have the bigger dataset. This week's MMWR provides further evidence for the pandemic of the PCR-negative COVID-like illness.

While the headline is that booster shots were highly effective during both delta and omicron and that “all unvaccinated persons should start vaccination as soon as possible,” we need not look far to see the elephant in the room.

The paper analyzed 222,772 encounters from emergency departments and urgent care centers and 87,904 hospitalizations from 259 hospitals between the end of August and the beginning of January.

Every single person in this study had COVID-like illness, defined as respiratory failure, pneumonia, dyspnea (trouble breathing), vomiting, fever, or diarrhea, and all of them had a PCR test within 14 days before or 3 days after admission. The study was looking at efficacy of mRNA vaccines, so anyone who had gotten the J&J shot was excluded.

Among 222,772 emergency room and urgent care visits for COVID-like illness, 76% tested negative for COVID.

Among 87,904 hospitalizations for COVID-like illness, 79% tested negative for COVID.

The first thing we can say is the vast majority of hospitalizations for COVID-like illness — almost 80% — test negative for COVID.

Among the ER and urgent care visits, the majority (53%) were in the vaccinated (combining partial and full). Among the hospitalizations, the majority (57%) were in the vaccinated (again, combining partial and full).

This study was designed to see whether vaccination status is associated with the likelihood of testing positive if one is sick, not the likelihood that one has gotten sick. As a result, it does not report the underlying vaccination rates in the populations from which the sick people in the study came.

According to Our World in Data, at the mid-point of this study on October 31, the ten states included had vaccination rates ranging from 54% to 75%. These are probably overestimates. They are based on CDC data, which may overestimate the percentage of people vaccinated by up to ten percentage points as a result of misclassifying booster shots as first shots and counting people as being vaccinated from one area when they drove in to get their shot from somewhere else. If we deduct ten percentage points from each state we get 44-65%. Subtracting the roughly 6.5% of vaccinated people who got the J&J from the proportion of vaccinated brings this to 41-61% vaccinated with mRNA vaccines. The 57% of hospitalizations for COVID-like illness that are among the vaccinated falls toward the lower, middle, or higher end of this range depending on how many adjustments we make. Thus, hospitalizations for COVID-like illness seem to fall roughly equally among the vaccinated and unvaccinated.

Deaths are not reported. As such, we have no idea if deaths from COVID-like illness also fall equally among the vaccinated and unvaccinated. We only know that hospitalizations seem to.

When we hear reports about COVID deaths, we have to ask, is this hiding 79% of the deaths from COVID-like illness?

No one is talking about the 79%. It is the pandemic of PCR-negative COVID-like illness.

Among those hospitalized for COVID-like illness, those vaccinated were far less likely to test positive for COVID. Calculating “vaccine efficacy” from this, a third shot of one of the mRNA vaccines was 94% effective against “COVID-19–associated hospitalizations” during the delta-dominant period and 90% effective during the omicron-dominant period.

But “efficacy” means that they helped you get a negative PCR test while you were hospitalized for respiratory failure or other symptoms of COVID-like illness.

The previous study of this sort had found that there were six times more fully vaccinated people hospitalized for COVID-like illness as naturally immune people. This seems to suggest that prior infection actually keeps you out of the hospital, while vaccination just makes you test negative.

What could explain why vaccinated people would be so much less likely to test positive when winding up in the hospital with the same symptoms? I can think of two reasons:

• Viral competition. The vaccines make you less likely to get COVID, so you get a different respiratory virus instead.

• Antibody-dependent enhancement. The vaccine makes an immune response so strong that you clear the viral RNA from your nose by the time you are tested, but you get a worse inflammatory reaction that gets you hospitalized with the same symptoms.

In order to begin grappling with this, we need to study the 79% of hospitalizations for COVID-like illness that test negative for COVID in greater detail.

What is causing these? A different virus? An inflammatory reaction to a rapidly cleared SARS-CoV-2 infection?

To begin studying this, we must first admit that it exists.

It is the pandemic that no one dare speak of: the pandemic of PCR-negative COVID-like illness.

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