- COVID Vaccine Hesitancy Widespread, Even Among Medical Professionals
- https://pdmj.org/Mask_Risks_Part1.pdf
- Johns Hopkins University Reveals Manipulated Covid Death Figures
- Former Pfizer VP: ‘No need for vaccines,’ ‘the pandemic is effectively over’
- WHO and Lancet investigations into pandemic’s origins lack independence and credibility
- Johns Hopkins Study Saying COVID-19 Has ‘Relatively No Effect on Deaths’ in U.S. Deleted After Publication
- Covid-19: politicisation, “corruption,” and … – The BMJ
- The Collective Suicide of the Liberal Class
Videos
WHO Says Covid-19 Asymptomatic Transmission Is ‘Very Rare’
Ivermectin is having a moment, due to Senate Homeland Security and Governmental Affairs Committee hearings:
Study of the Efficacy and Safety of Topical Ivermectin + IotaCarrageenan in the Prophylaxis against COVID-19 in Health Personnel Journal of Biomedical Research and Clinical Investigation. Submission to publication was one week; I conclude no peer review. n=220 health care workers. The statistics are above my pay-grade; here is the narrative:
In the present two clinical trias, the ethnic and age characteristics, previous health, personal protection measures, performance areas, work hours, and type of patients assisted were the same in each arm.
If we consider the following facts:
1) Drops and sprays are a major source of human-to-human transmission.
2) The sources mentioned above depend on different sizes of saliva droplets.
3) The contagion comes from symptomatic and asymptomatic patients.
4) The proportion of asymptomatic patients exceeds 30% of all cases.
5) The concentration of ivermectin and carrageenan is adequate in the nasal mucus and salivary glands.
6) The combined oral solution can offer double protection: on the one hand, it reduces the spread and, on the other hand, it reduces the viral load.
7) Both (ivermectin and carrageenan) are present in the international pharmacopoeia, and their use is widely accepted.
8) Their respective “off label” applications do not involve any risk.
9) Health Personnel are constantly at risk of contagion, thus locking down all their co-workers, and preventing the community from the access to appropriate health care.
We conclude that by using ivermectin in oral solution and carrageenan in nasal spray form, we are providing an inexpensive, safe and effective means to protect people from contagion and serious forms of the disease.
The Therapeutic Potential of Ivermectin For Covid-19: A Systematic Review of Mechanisms and Evidence(preprint) medRxiv. A review of the literature. Results: “Search keywords- “COVID-19 (and synonyms) AND ivermectin”- generated 86 articles on PubMed, 48 on medRvix and 37 on clinicaltrials.gov at the time of writing. Twelve of these were listed as completed clinical trials and of these, 8 were included as investigators had released results. Positive mortality benefit, reduced time to clinical recovery, reduced incidence of disease progression and decreased duration of hospital admission were reported in patients across all stages of clinical severity.”
The effect of early treatment with ivermectin on viral load, symptoms and humoral response in patients with mild COVID-19: a pilot, double-blind, placebo-controlled, randomized clinical trial (preprint) Research Square. From the Abstract: “Ivermectin inhibits the replication of SARS-CoV-2 in vitro at concentrations not readily achievable with currently approved doses. There is limited evidence to support its clinical use in COVID-19 patients. We conducted a Pilot, randomized, double-blind, placebo-controlled trial to determine the efficacy of a single dose of ivermectin to reduce the proportion of PCR positives, viral load at day 7 post treatment….Among patients with mild COVID-19 and no risk factors for severe disease receiving a single 400 mcg/kg dose of ivermectin within 48 hours of fever or cough onset there was no difference in the proportion of PCR positives. There was however a marked reduction of anosmia/hyposmia, a reduction of cough and a tendency to lower viral loads and lower IgG titers which warrants assessment in larger trials.”
A five day course of ivermectin for the treatment of COVID-19 may reduce the duration of illnessInternational Journal of Infectious Diseases. December 2. From the Abstract: “A 5-day course of ivermectin was found to be safe and effective in treating mild COVID-19 adult patients. Larger trials will be needed to confirm these preliminary findings.” Placebo-controlled study in hospital, n=72, Bangladesh.
White paper on Ivermectin as a potential therapy for COVID-19 Indian Journal of Tuberculosis. The Abstract: “A group of senior doctors with vast clinical experience met on 19th July’20 under the aegis of Academy of Advanced Medical Education. The panel looked at Ivermectin, one of the old molecule and evaluated it’s use in COVID 19 (Novel Coronavirus Disease 2019) management. After critical panel discussion, all the attending doctors came to a conclusion that Ivermectin can be a potential molecule for prophylaxis and treatment of people infected with Coronavirus, owing to its anti-viral properties coupled with effective cost, availability and good tolerability and safety.”
For The First Time, A US State Will Require Disclosure Of PCR ‘Cycle Threshold’ Data In COVID Tests
ZERO HEDGE, December 7, 2020
We have detailed the controversy surrounding America’s COVID “casedemic” and the misleading results of the PCR test and its amplification procedure in great detail over the past few months.
As a reminder, “cycle thresholds” (Ct) are the level at which widely used polymerase chain reaction (PCR) test can detect a sample of the COVID-19 virus. The higher the number of cycles, the lower the amount of viral load in the sample; the lower the cycles, the more prevalent the virus was in the original sample.
Numerous epidemiological experts have argued that cycle thresholds are an important metric by which patients, the public, and policymakers can make more informed decisions about how infectious and/or sick an individual with a positive COVID-19 test might be. However, as JustTheNews reports, health departments across the country are failing to collect that data.
Here are a few headlines from those experts and scientific studies:
- Experts compiled three datasets with officials from the states of Massachusetts, New York and Nevada that conclude:“Up to 90% of the people who tested positive did not carry a virus.”
- The Wadworth Center, a New York State laboratory, analyzed the results of its July tests at the request of the NYT: 794 positive tests with a Ct of 40: “With a Ct threshold of 35, approximately halfof these PCR tests would no longer be considered positive,” said the NYT.“And about 70% would no longer be considered positive with a Ct of 30! “
- An appeals court in Portugal hasruled that the PCR process is not a reliable test for Sars-Cov-2, and therefore any enforced quarantine based on those test results is unlawful.
- A new study from the Infectious Diseases Society of America, found that at 25 cycles of amplification, 70% of PCR test “positives” are not “cases” since the virus cannot be cultured, it’s dead.And by 35: 97% of the positives are non-clinical.
- PCR is not testing for disease, it’s testing for a specific RNA pattern and this is the key pivot. When you crank it up to 25, 70% of the positive results are not really “positives” in any clinical sense, since it cannot make you or anyone else sick
So, in summary, with regard to our current “casedemic”, positive tests as they are counted today do not indicate a “case” of anything. They indicate that viral RNA was found in a nasal swab. It may be enough to make you sick, but according to the New York Times and their experts, probably won’t. And certainly not sufficient replication of the virus to make anyone else sick. But you will be sent home for ten days anyway, even if you never have a sniffle. And this is the number the media breathlessly reports… and is used to fearmonger mask mandates and lockdowns nationwide…
All of which is background for an intriguing decision made by Florida’s Department of Health (and signed off on by Florida’s Republican Governor Ron deSantis).
For the first time in the history of the pandemic, a state will require that all labs in the state report the critical “cycle threshold” level of every COVID-19 test they perform.
All positive, negative and indeterminate COVID-19 laboratory results must be reported to FDOH via electronic laboratory reporting or by fax immediately. 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.
Full press release below:
So, why is Florida doing this? There appears to be three options:
1) Pro-Trump – Florida is attempting to pre-empt the Biden Team’s plan to slash the Ct used by labs for COVID “case” which will eliminate the false positives and show “cases” plunge “thanks to Biden’s mask/lockdown/vaccine-confidence” rules.
2) Pro-Biden – Florida is beginning the ‘fake rescue’ plan outlined here (and above)
3) Pro-Science – Florida is the first state to actually pay attention to the real ‘science’ of PCR tests.
We hope, for the sake of Americans’ livelihoods it is Option 3 and the ‘casedemic’ will collapse on itself and allow we, the people to go back to some sense of normality.
AN EYEWITNESS ACCOUNT Of Gross Irregularities and Medical Incompetence in the Early Clinical Trials of AZT
By Lynn Gannett
2000
Please keep in mind that these two write-ups represent only the “tip of the iceberg,” and for everything that is recorded here, there are literally dozens of other examples that I could give. My information is NOT included in John Lauritsen’s book on AZT, simply because neither of us had heard of each other at that time (although I wish we had!). His book documents information related to the Phase II studies of AZT, whereas I was involved with the Phase III studies (ACTG 019). But it was all the same kinds of shocking nonsense, incompetence and fraud. In addition to ACTG 019 (which was the major study at that time), I also worked on other studies of AZT and ddI (ACTG 002, 016, 020, 081, 116, 117 and 118). Some of these studies included other drugs, such as pentamidine. I was somewhat young (and naive) at the time, and didn’t quite know what to make of what I was witnessing, or what to do with the information that I had documented, having NEVER witnessed anything even remotely similar. In fact, at that point in my life, I didn’t even realize that human beings were even CAPABLE of this kind of corrupt, insane, self-motivated behavior. If I had known then what I know now, I would have been much more persistent in my attempts to report this information to the NIH. I don’t even have a single letter – my communication with them was done entirely over the phone. Which means they could simply deny that these phone conversations ever took place. All I have to offer as evidence that I DID REPORT THIS TO THE NIH AND THEY DELIBERATELY IGNORED MY INFORMATION is my personal testimony, and some handwritten notes that I took at the time (this was in the Spring of 1990). I may be able to locate at least one witness who could corroborate my story (the NIH site monitor for Syracuse). But the way that I look at this is that it’s never too late to report this to the NIH, AGAIN. And the important thing is that I still have ALL of my original documents (an entire box full of material) which I tried to share with them in 1990. I have precise names, patient numbers, dates, lab values, memos, etc. I KNOW that my information is accurate, because I was so thorough and meticulous (not to mention HONEST) in my record-keeping. That’s why they hired me – I’m an extremely detail-oriented, “numbers” person. Thus, all of my information could, in theory, be verified by referring to the original research forms and NIH documents from that time period, which must still exist and (theoretically) could be obtained through the Freedom of Information Act. Ideally, my second attempts to report this could lead to a Congressional Investigation. That is certainly what I will be calling for. The seriousness of my allegations certainly warrants such an investigation. For the NIH to knowingly ignore serious and credible DOCUMENTED reports of gross scientific misconduct coming from someone working on the INSIDE of these trials – if that doesn’t constitute scientific “fraud,” I don’t know what does. Especially when we look at the real-life gruesome outcome of this deliberate refusal to even INVESTIGATE my allegations to see if there was any merit to them (along with all of the other glaringly obvious, telltale signs and warnings coming from around the globe, which were also ignored at that time) – all of this intentional “blindness” on the part of the NIH, the FDA, Burroughs Wellcome, etc., led to the unnecessary and unimaginable suffering of countless individuals (of both “HIV+” people and their loved ones), and the unnecessary deaths of (in my view) tens of thousands of people. This dreadful holocaust continues to this day. Parks Mankahlana, couldn’t have summed it up better when he said “…the profit takers who are benefiting from the scourge of HIV/AIDS will disappear to the affluent beaches of the world to enjoy wealth accumulated from humankind ravaged by a dreaded disease.” Knowing what I know “first hand” about AZT, and knowing how it should NEVER have received FDA approval under ANY circumstances, this is one of many reasons why I am especially grateful to the members of the Perth group, Peter Duesberg, John Lauritsen, Celia Farber, Anthony Brink and many others for the outstanding work that they have done in documenting the case against AZT. *** I was an eyewitness (and later a whistle-blower) to gross negligence and fraud in the Phase III clinical trials of AZT (1987 to 1990). I’ve been saying to people for years that AZT was NEVER proven to be safe or effective. From the particular studies in which I was involved, it would have been impossible to prove anything. The data was such a mess! I now realize that AZT is a deadly poison. All “AIDS drug” trials since that time have been based on the same flawed model. The big difference is that now there is even LESS meaningful oversight, and even MORE of an economic incentive for physicians to enroll patients. And recent drug trials have also been characterized by an absurdly brief follow-up period (24 or 36 weeks, for example), and effectiveness is often said to be determined by “surrogate markers” which have never been proven to relate to actual clinical health and/or increased survival. But, the early AZT studies were like the big “granddaddy” of all of this ensuing insanity! I did not know John Lauritsen at the time that he wrote his book, AZT: Poison by Prescription (1990), but I later told him that, if I had known him at that time, I could have given him several additional chapters for his book! In this book he meticulously documents serious fraud which took place at other participating hospitals (I was in Syracuse, NY), particularly at a hospital in Boston. When I first read John’s book, it was like reading my own autobiography! Talk about deja vu! In spite of what I witnessed, I was not aware, however, of the deeper problems within “AIDS science” until many years later. It was in 1997 that I first heard about the views of the “AIDS dissidents.” After educating myself regarding the many unexplained and nonscientific paradoxes and absurdities of the orthodox “HIV/AIDS” model, and after studying the alternative views proposed by the various “AIDS dissidents,” I started doing public speaking on this topic. I especially want to share my story with as many people as possible about the fraud which I witnessed firsthand in the early AZT trials. I always tell people that if the general public knew what I knew about AZT, this so-called “drug” would be banned immediately. *** My name is Lynn Gannett. As the Data Manager for the first two years and seven months of the NIH-sponsored AIDS clinical trials conducted at the Syracuse, New York, clinic (September 1987 to March 1990), my belief is that the data which came from the Syracuse site is ABSOLUTELY WORTHLESS! I would NEVER trust my health or my life to the results of this so-called “research” or in the hands of these so-called “medical professionals.” I can only speculate that if these things occurred at this site, that similar things may have and in all likelihood did occur at the other participating sites. The things that I witnessed at this clinic would HORRIFY any reasonable observer. The level of medical incompetence, unprofessionalism, unethical, dishonest, corrupt, illegal and immoral behavior was shocking and inexcusable. The data was so inaccurate and so full of holes that I often compare it to Swiss cheese. I felt like I was trapped in the middle of an awful movie about “mad scientists.” If there was a “rule” that could be broken – they broke it! The following examples outline some of the most egregious examples of what I witnessed: * The Principal Investigator, an MD, and the Study Coordinator, an RN, showed a huge interest in enrolling as many patients as possible on studies (which would entitle them to more money and perceived prestige) and showed little interest in the research itself – specifically in the integrity, accuracy and completeness of the data. * The Study Coordinator (and other medical staff responsible for study patients) often displayed a significant lack of understanding and unfamiliarity with the study protocols and important memos concerning their implementation – as though she had not even read them, or had totally misunderstood and misinterpreted them, even in instances pertaining to terminology and procedures FUNDAMENTAL to the protocol itself, often months after the study had been underway. e.g. In what I consider to have been the most serious, disturbing and grossly incompetent situation that I witnessed, which came dangerously close to resulting in death, and unquestionably resulted in extreme unnecessary suffering, PID #110434, a black, obese, diabetic, HIV+ female with a history of serious heart problems, experienced severe hematologic toxicity from the 081 study drug (AZT), which had progressed to a GRADE IV toxicity by week 24 and resulted in her coming into the emergency room with “severe shortness of breath, fatigue and weakness,” and required her to be hospitalized for a total of five days. BECAUSE NO ONE, DOCTOR OR NURSE, SHOWED ANY RESPONSIBILITY FOR, KNOWLEDGE OF, INTEREST IN OR RECOGNITION OF THE IMPORTANCE OF THE EXPLICITLY-DEFINED TOXICITY (ADVERSE REACTION) AND DOSE MANAGEMENT STEPS AND PROCEDURES OUTLINED IN THE PROTOCOL, instead of being taken OFF the AZT due to the Grade IV toxicity, her dose was reduced from 1000 mg/day to 500 mg/day, in complete violation of protocol requirements which explicitly require DISCONTINUATION of study drug. Additionally, early Grade I and Grade II toxicities should have indicated the need for interim lab monitoring of Hemoglobin, especially with this patient’s complicated medical history, but instead this patient had NO lab work performed between week 20 (13DEC89) and week 24 (10JAN90), even though she was in for a pentamidine treatment on 20DEC89 and could have easily had a blood sample drawn. At some point during this time interval, her original medical chart was “lost,” never to be found again, requiring a new chart to be made up, which subsequently obviously lacked significant information concerning her medical history. I was shocked, outraged and horrified when this whole situation occurred, and documented this gross medical incompetence and blatant violation of protocol requirements as carefully as I could because I wanted everything to be ON RECORD so that no one could later deny it or cover it up. (See attached memo dated 01FEB90 and lab flow chart showing toxicity progression.) * Patients were ROUTINELY enrolled who failed to meet eligibility requirements, especially when it came to specific required lab values and test ranges (i.e., within the required number of days prior to enrollment). There are many, many examples. Below are a few (also see attached 05OCT89 list of 081 screening lab eligibility failures): e.g. In the most blatant example, PID #110264C, a female partner of an HIV+ male, was enrolled on study 019 and took study drug for THREE weeks before it was discovered that she was actually HIV NEGATIVE! (The Elisa came back as a false positive but the Western Blot came back negative.) The test results date predated her enrollment on study date. She was also on oral contraceptives at the time, another eligibility violation. E.g. You might think that this would be the last time a patient would be enrolled without an HIV+ test result “in hand” – not so. PID #110316’s HIV+ test results are dated 06JAN89, ONE MONTH AFTER his enrollment date (05DEC88)! e.g. Other patients had been routinely enrolled without HIV+ test results documentation available, often based simply on referrals from other physicians. An example is PID #110153H, a referral patient from Binghamton who, to my knowledge, has no HIV+ test results in his chart TO THIS DAY! After a year or two of my repeated requests to the Study Coordinator for this information, she finally obtained a LETTER ONLY from the referring physician “verifying” his HIV+ status, who also apparently had no supporting documentation. * There were COUNTLESS unreported (meaning unreported on the research forms) diagnoses, opportunistic infections, symptoms, concomitant medications, and adverse reactions. Except for “symptoms” (which were asked for at every visit), these significant things (which each REQUIRE reporting) should have been reported on one of several “as needed” or optional case report forms used to track this information – an extra step which was rarely taken. I often observed, as did the RTI (Research Triangle Institute) site monitors, this unreported information recorded or mentioned in the patient’s regular medical chart. E.g. From the 22JUN89 site monitor’s report: “Of the six protocol 002 charts which were reviewed for the first critical event verification, four reported death as the first event even though at least one OI [opportunistic infection] has preceded the death. These OI’s were not reported. In another instance, it was impossible to determine what had happened to the patient between the time of randomization and death because the records were missing.” * Incorrect lab tests were ROUTINELY ordered (either required labs omitted or unrequired labs ordered by mistake), and the wrong prescriptions were ROUTINELY written (for example, 1200 mg/day instead of 1000 mg/day). When I questioned these and other similar mistakes, I would be chastised by the Principal Investigator and/or Study Coordinator for being too “nit picky” or for inappropriately questioning someone’s medical “expertise” since I did not have (nor did my position require) a medical degree. * Medical lab results were ROUTINELY transcribed incorrectly onto the research forms by the Study Coordinator (who I suspect may have dyslexia – at the very least, she does not have the “detail-oriented” type of mind necessary for this type of research position). * Syracuse had an unusually high and excessive rate of “no shows” (often meaning “not even scheduled to begin with”) and “not dones” compared to the other clinics. * On a regular basis, I would have to REPEATEDLY request data from the Study Coordinator, and we routinely missed deadlines. E.g. There was one group of approximately 90 (!) forms which were “missing” for over a year and a half. When these forms were eventually “found,” mostly blank, the Study Coordinator filled in much of the information with, in most cases, no supporting documentation or progress notes in the charts. I have always believed that this data was just “fudged” or made up, because there would have been no other written record of these things (such as vital signs). * Informed consent forms were ROUTINELY backdated, sometimes weeks or even months after enrollment. E.g. In at least one instance, a patient was asked to sign (and did sign, along with the Principal Investigator and Study Coordinator) an informed consent form for the WRONG study (PID #110076A signed an informed consent for study 116 but was being enrolled on study 117). * The Principal Investigator and Study Coordinator displayed such open hostility and contempt toward the site monitors that there was a high turnover (4 different site monitors in a 3-year period). These site monitors could have easily uncovered this corruption if they had done their jobs carefully (which the first 3, at least, did NOT do) and over an extended period of time. * On March 21, 1990, after attempting unsuccessfully for over one year to address and resolve these SERIOUS issues with the Principal Investigator and Study Coordinator, and after watching in horror as the situation worsened severely with the implementation of the DDI studies (see attached memo dated 19MAR90), and after being retaliated against in many vicious and mean-spirited ways by both the Principal Investigator and Study Coordinator merely for repeatedly raising these issues and insisting on some type of corrective action, I felt compelled, in good conscience, to resign my position as Data Manager and immediately report this critical situation to the RTI site monitor. E.g. After reporting this to the site monitor, she checked with her boss, who in turn checked with her boss, and the decision was made to launch a “special audit and investigation” of the Syracuse site by the program office. I was asked to mail copies of all of my documentation supporting my claims to the site monitor. In a 27MAR90, 1:40 PM, phone call, the site monitor told me that her boss “never heard of anything of this magnitude,” and referred to the situation as “uncharted waters.” E.g. In a 27MAR90, 4:00 PM (later that same afternoon), phone call with Carolyn Fassi, who called me from NIH on behalf of Dr. Kantz, she thanked me for bringing these issues to their attention and said it would be unnecessary for me to forward copies of my documentation to the site monitor or to NIH. She also stated that they “can’t act directly” based on my claims or supporting documentation, that they would “keep a close eye” on the Syracuse site, that they “won’t use my information against the site or me,” and ended by saying that he (Dr. Kantz) “may not even need to call me, except to clarify something.” In other words, “don’t call us, we’ll call you.” I never received a call from their office or anyone else associated with these studies again.
Service Members Can Request Religious Exemptions for Mandated Vaccines. Here’s How.
The military has a 4-step formal process for requesting a religious exemption. If the exemption is denied, there is also a process for overturning the decision.
By
Children’s Health Defense, November 30, 2020
The Department of Defense (DOD) Instruction 1300.17, “Religious Liberties in the Military Services,” conveys support for religious beliefs in the following statement:
“In accordance with Section 533(a)(1) of Public Law 112-239, as amended, the DOD components will accommodate individual expressions of sincerely held beliefs (conscience, moral principles or religious beliefs) which do not have an adverse impact on military readiness, unit cohesion, good order and discipline, or health and safety. A service member’s expression of such beliefs may not, in so far as practicable, be used as the basis of any adverse personnel action, discrimination, or denial of promotion, schooling, training, or assignment.”
All of the components in the military have a similar process for various religious accommodations, including vaccine exemptions. The Army’s religious accommodation request process, which takes 30 – 60 days, is outlined step-by-step in Army Regulation 600-20 (AR600-20) Appendix P-2:
“Immunizations. Immunization requirements for Soldiers are described in AR 40–562. Soldiers whose religious practices conflict with immunization requirements may request an exemption through command channels, from company or immediate commander through battalion, brigade, division and General Court-Martial Convening Authority (GCMCA) commanders to the surgeon general (TSG). TSG is the only approval or disapproval authority for immunization accommodation requests.”
To apply for a religious exemption, the service member must complete four documents. The first is a personal memorandum that includes identity information, establishes the religious belief that is contrary to immunization and lists the specific vaccines requested for exemption.
An additional letter from a supportive religious leader is optional, but the service member is not required to prove the tenets of his religion. The service member’s memorandum should also explain how the requested religious accommodation will not interfere with military readiness, unit cohesion, good order and discipline, health and safety. According to AR600-20:
“(1) Requests for religious exemption must include name, rank, MOS/branch and a description of the religious tenet or belief contrary to immunization. Other documentation, such as letters from a religious leader, is optional but may assist commanders evaluating the request.”
The second required document is a DA4856 counseling form summarizing an interview between the chaplain, unit commander and service member on the request for religious accommodation. This counseling form documents the reasons for the religious exemption, the lack of burden on military readiness and acknowledgement of the terms of revocation under imminent risk conditions. According to AR600-20:
“(2) The commander will arrange an in-person or telephonic interview between the requestor and the assigned unit chaplain or other chaplain determined by the senior chaplain present. The chaplain must provide a memorandum that summarizes this interview and addresses the religious basis and sincerity of the soldier’s request. The chaplain is not required to recommend approval or disapproval, but may do so. Memorandums from other chaplains or religious leaders may accompany the request as optional attachments, but do not meet the requirement for interview by the assigned unit chaplain or one determined by the senior chaplain present.”
The third required document is a counseling form documenting a discussion with a healthcare provider and the service member on the risks of disease, and benefits and risks of vaccines. According to AR600-20:
“(3) A licensed healthcare provider must counsel the applicant. The healthcare provider should ensure that the applicant is making an informed decision and should address, at a minimum, the following: (a) specific information about the diseases concerned; (b) specific vaccine information including benefits and risks; and (c) potential risks of infection incurred by unimmunized individuals.”
The fourth required document is a DA4856 counseling form on which the commander and service member explain the career impact of a religious exemption to vaccines, with a recommendation in favor or denial of the request. According to AR600-20:
“(4) The applicant’s immediate commander must counsel the applicant and recommend approval or denial of the exemption request. The commander must counsel that noncompliance with immunization requirements may adversely impact deployability, assignment or international travel, and that the exemption may be revoked under imminent risk conditions. The commander’s recommendation will address the factors of military necessity described in paragraph 5–6a.”
Once the packet containing all of the forms is submitted, the review process will include the following, according to AR600-20:
“(5) Commanders will forward exemption requests through command channels to TSG) TSG will approve or disapprove the requested exemption, and return the decision to the soldier’s commander through command channels.
“(6) TSG may authorize exemptions for the career of a soldier (subject to revocation), or issue a single, specific exemption, or may disapprove the request. If TSG disapproves a requested exemption and the soldier still refuses the immunization, paragraph 5–4g(2) applies.”
If the process results in a denial of request, the service member has right to appeal, right to legal counsel, options to file a complaint with Equal Opportunity or Inspector General for discrimination based on religious beliefs and freedom to contact their elected representatives or senators for an inquiry. If the request for exemption is ultimately denied, and the service member refuses vaccination, the soldier may face Uniform Code of Military Justice disciplinary action or request separation from the military.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the views of Children’s Health Defense.
PAM LONG IS GRADUATE OF USMA AT WEST POINT AND IS AN ARMY VETERAN OF THE MEDICAL SERVICE CORPS.
RT-PCR Test to Detect SARS-CoV-2 Reveals 10 Major Scientific Flaws at the Molecular and Methodological Level: Consequences for False Positive Results
CORMAN-DROSTEN REVIEW REPORT
CURATED BY AN INTERNATIONAL CONSORTIUM OF SCIENTISTS IN LIFE SCIENCES
Review report Corman-Drosten et al. Eurosurveillance 2020
November 27, 2020https://cormandrostenreview.com/report/?fbclid=IwAR0sSncAmhHhhwzQ21ODbrVgEtYZ0zfZDkG9ZGqRFGQocXDNM8KW7YBd41A
This extensive review report has been officially submitted to Eurosurveillance editorial board on 27th November 2020 via their submission-portal, enclosed to this review report is a retraction request letter, signed by all the main & co-authors. First and last listed names are the first and second main authors. All names in between are co-authors.
External peer review of the RTPCR test to detect SARS-CoV-2 reveals 10 major scientific flaws at the molecular and methodological level: consequences for false positive results.
Pieter Borger(1), Bobby Rajesh Malhotra(2) , Michael Yeadon(3) , Clare Craig(4), Kevin McKernan(5) , Klaus Steger(6) , Paul McSheehy(7) , Lidiya Angelova(8), Fabio Franchi(9), Thomas Binder(10), Henrik Ullrich(11) , Makoto Ohashi(12), Stefano Scoglio(13), Marjolein Doesburg-van Kleffens(14), Dorothea Gilbert(15), Rainer Klement(16), Ruth Schruefer(17), Berber W. Pieksma(18), Jan Bonte(19), Bruno H. Dalle Carbonare(20), Kevin P. Corbett(21), Ulrike Kämmerer(22)
ABSTRACT
In the publication entitled “Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR” (Eurosurveillance 25(8) 2020) the authors present a diagnostic workflow and RT-qPCR protocol for detection and diagnostics of 2019-nCoV (now known as SARS-CoV-2), which they claim to be validated, as well as being a robust diagnostic methodology for use in public-health laboratory settings.
In light of all the consequences resulting from this very publication for societies worldwide, a group of independent researchers performed a point-by-point review of the aforesaid publication in which 1) all components of the presented test design were cross checked, 2) the RT-qPCR protocol-recommendations were assessed w.r.t. good laboratory practice, and 3) parameters examined against relevant scientific literature covering the field.
The published RT-qPCR protocol for detection and diagnostics of 2019-nCoV and the manuscript suffer from numerous technical and scientific errors, including insufficient primer design, a problematic and insufficient RT-qPCR protocol, and the absence of an accurate test validation. Neither the presented test nor the manuscript itself fulfils the requirements for an acceptable scientific publication. Further, serious conflicts of interest of the authors are not mentioned. Finally, the very short timescale between submission and acceptance of the publication (24 hours) signifies that a systematic peer review process was either not performed here, or of problematic poor quality. We provide compelling evidence of several scientific inadequacies, errors and flaws.
Considering the scientific and methodological blemishes presented here, we are confident that the editorial board of Eurosurveillance has no other choice but to retract the publication.
CONCISE REVIEW REPORT
This paper will show numerous serious flaws in the Corman-Drosten paper, the significance of which has led to worldwide misdiagnosis of infections attributed to SARS-CoV-2 and associated with the disease COVID-19. We are confronted with stringent lockdowns which have destroyed many people’s lives and livelihoods, limited access to education and these imposed restrictions by governments around the world are a direct attack on people’s basic rights and their personal freedoms, resulting in collateral damage for entire economies on a global scale.
There are ten fatal problems with the Corman-Drosten paper which we will outline and explain in greater detail in the following sections.
The first and major issue is that the novel Coronavirus SARS-CoV-2 (in the publication named 2019-nCoV and in February 2020 named SARS-CoV-2 by an international consortium of virus experts) is based on in silico (theoretical) sequences, supplied by a laboratory in China [1], because at the time neither control material of infectious (“live”) or inactivated SARS-CoV-2 nor isolated genomic RNA of the virus was available to the authors. To date no validation has been performed by the authorship based on isolated SARS-CoV-2 viruses or full length RNA thereof. According to Corman et al.:
“We aimed to develop and deploy robust diagnostic methodology for use in public health laboratory settings without having virus material available.” [1]
The focus here should be placed upon the two stated aims: a) development and b) deployment of a diagnostic test for use in public health laboratory settings. These aims are not achievable without having any actual virus material available (e.g. for determining the infectious viral load). In any case, only a protocol with maximal accuracy can be the mandatory and primary goal in any scenario-outcome of this magnitude. Critical viral load determination is mandatory information, and it is in Christian Drosten’s group responsibility to perform these experiments and provide the crucial data.
Nevertheless these in silico sequences were used to develop a RT-PCR test methodology to identify the aforesaid virus. This model was based on the assumption that the novel virus is very similar to SARS-CoV from 2003 as both are beta-coronaviruses.
The PCR test was therefore designed using the genomic sequence of SARS-CoV as a control material for the Sarbeco component; we know this from our personal email-communication with [2] one of the co-authors of the Corman-Drosten paper. This method to model SARS-CoV-2 was described in the Corman-Drosten paper as follows:
“the establishment and validation of a diagnostic workflow for 2019-nCoV screening and specific confirmation, designed in absence of available virus isolates or original patient specimens. Design and validation were enabled by the close genetic relatedness to the 2003 SARS-CoV, and aided by the use of synthetic nucleic acid technology.”
The Reverse Transcription-Polymerase Chain Reaction (RT-PCR) is an important biomolecular technology to rapidly detect rare RNA fragments, which are known in advance. In the first step, RNA molecules present in the sample are reverse transcribed to yield cDNA. The cDNA is then amplified in the polymerase chain reaction using a specific primer pair and a thermostable DNA polymerase enzyme. The technology is highly sensitive and its detection limit is theoretically 1 molecule of cDNA. The specificity of the PCR is highly influenced by biomolecular design errors.
What is important when designing an RT-PCR Test and the quantitative RT-qPCR test described in the Corman-Drosten publication?
1. The primers and probes:
- a) the concentration of primers and probes must be of optimal range
(100-200 nM)
b) must be specific to the target-gene you want to amplify
c) must have an optimal percentage of GC content relative to the total nitrogenous bases (minimum 40%, maximum 60%)
d) for virus diagnostics at least 3 primer pairs must detect 3 viral genes (preferably as far apart as possible in the viral genome)
2. The temperature at which all reactions take place:
- a) DNA melting temperature (>92°)
b) DNA amplification temperature (TaqPol specific)
c) Tm; the annealing temperature (the temperature at which the primers and probes reach the target binding/detachment, not to exceed 2 ̊C per primer pair). Tm heavily depends on GC content of the primers
3. The number of amplification cycles (less than 35; preferably 25-30 cycles);
In case of virus detection, >35 cycles only detects signals which do not correlate with infectious virus as determined by isolation in cell culture [reviewed in 2]; if someone is tested by PCR as positive when a threshold of 35 cycles or higher is used (as is the case in most laboratories in Europe & the US), the probability that said person is actually infected is less than 3%, the probability that said result is a false positive is 97% [reviewed in 3]
4. Molecular biological validations; amplified PCR products must be validated either by running the products in a gel with a DNA ruler, or by direct DNA sequencing
5. Positive and negative controls should be specified to confirm/refute specific virus detection
6. There should be a Standard Operational Procedure (SOP) available
SOP unequivocally specifies the above parameters, so that all laboratories are able to set up the exact same test conditions. To have a validated universal SOP is essential, because it enables the comparison of data within and between countries.
MINOR CONCERNS WITH THE CORMAN-DROSTEN PAPER
- In Table 1 of the Corman-Drosten paper, different abbreviations are stated – “nM” is specified, “nm” isn’t. Further in regards to correct nomenclature, nm means “nanometer” therefore nm should read nM here.
- It is the general consensus to write genetic sequences always in the 5’-3’ direction, including the reverse primers. It is highly unusual to do alignment with reverse complementary writing of the primer sequence as the authors did in figure 2 of the Corman-Drosten paper. Here, in addition, a wobble base is marked as “y” without description of the bases the Y stands for.
- Two misleading pitfalls in the Corman-Drosten paper are that their Table 1 does not include Tm-values (annealing-temperature values), neither does it show GC-values (number of G and C in the sequences as %-value of total bases).
MAJOR CONCERNS WITH THE CORMAN-DROSTEN PAPER
A) BACKGROUND
The authors introduce the background for their scientific work as: “The ongoing outbreak of the recently emerged novel coronavirus (2019-nCoV) poses a challenge for public health laboratories as virus isolates are unavailable while there is growing evidence that the outbreak is more widespread than initially thought, and international spread through travelers does already occur”.
According to BBC News [4] and Google Statistics [5] there were 6 deaths world-wide on January 21st 2020 – the day when the manuscript was submitted. Why did the authors assume a challenge for public health laboratories while there was no substantial evidence at that time to indicate that the outbreak was more widespread than initially thought?
As an aim the authors declared to develop and deploy robust diagnostic methodology for use in public health laboratory settings without having virus material available. Further, they acknowledge that “The present study demonstrates the enormous response capacity achieved through coordination of academic and public laboratories in national and European research networks.”
B) METHODS AND RESULTS
1. Primer & Probe Design
1a) Erroneous primer concentrations
Reliable and accurate PCR-test protocols are normally designed using between 100 nM and 200 nM per primer [7]. In the Corman-Drosten paper, we observe unusually high and varying primer concentrations for several primers (table 1). For the RdRp_SARSr-F and RdRp_SARSr-R primer pairs, 600 nM and 800 nM are described, respectively. Similarly, for the N_Sarbeco_F and N_Sarbeco_R primer set, they advise 600 nM and 800 nM, respectively [1].
It should be clear that these concentrations are far too high to be optimal for specific amplifications of target genes. There exists no specified reason to use these extremely high concentrations of primers in this protocol. Rather, these concentrations lead to increased unspecific binding and PCR product amplification.
Table1: Primers and probes (adapted from Corman-Drosten paper; erroneous primer concentrations are highlighted)
1b) Unspecified (“Wobbly”) primer and probe sequences
To obtain reproducible and comparable results, it is essential to distinctively define the primer pairs. In the Corman-Drosten paper we observed six unspecified positions, indicated by the letters R, W, M and S (Table 2). The letter W means that at this position there can be either an A or a T; R signifies there can be either a G or an A; M indicates that the position may either be an A or a C; the letter S indicates there can be either a G or a C on this position.
This high number of variants not only is unusual, but it also is highly confusing for laboratories. These six unspecified positions could easily result in the design of several different alternative primer sequences which do not relate to SARS-CoV-2 (2 distinct RdRp_SARSr_F primers + 8 distinct RdRp_SARS_P1 probes + 4 distinct RdRp_SARSr_R). The design variations will inevitably lead to results that are not even SARS CoV-2 related.Therefore, the confusing unspecific description in the Corman-Drosten paper is not suitable as a Standard Operational Protocol. These unspecified positions should have been designed unequivocally.
These wobbly sequences have already created a source of concern in the field and resulted in a Letter to the Editor authored by Pillonel et al. [8] regarding blatant errors in the described sequences. These errors are self-evident in the Corman et al. supplement as well.
Table 2: Primers and probes (adapted from Corman-Drosten paper; unspecified (“Wobbly”) nucleotides in the primers are highlighted)
The WHO-protocol (Figure 1), which directly derives from the Corman-Drosten paper, concludes that in order to confirm the presence of SARS-CoV-2, two control genes (the E-and the RdRp-genes) must be identified in the assay. It should be noted, that the RdPd-gene has one uncertain position (“wobbly”) in the forward-primer (R=G/A), two uncertain positions in the reverse-primer (R=G/A; S=G/C) and it has three uncertain positions in the RdRp-probe (W=A/T; R=G/A; M=A/C). So, two different forward primers, four different reverse primers, and eight distinct probes can be synthesized for the RdPd-gene. Together, there are 64 possible combinations of primers and probes!
The Corman-Drosten paper further identifies a third gene which, according to the WHO protocol, was not further validated and deemed unnecessary:
“Of note, the N gene assay also performed well but was not subjected to intensive further validation because it was slightly less sensitive.”
This was an unfortunate omission as it would be best to use all three gene PCRs as confirmatory assays, and this would have resulted in an almost sufficient virus RNA detection diagnostic tool protocol. Three confirmatory assay-steps would at least minimize-out errors & uncertainties at every fold-step in regards to “Wobbly”-spots. (Nonetheless, the protocol would still fall short of any “good laboratory practice”, when factoring in all the other design-errors).
As it stands, the N gene assay is regrettably neither proposed in the WHO-recommendation (Figure 1) as a mandatory and crucial third confirmatory step, nor is it emphasized in the Corman-Drosten paper as important optional reassurance “for a routine workflow” (Table 2).
Consequently, in nearly all test procedures worldwide, merely 2 primer matches were used instead of all three. This oversight renders the entire test-protocol useless with regards to delivering accurate test-results of real significance in an ongoing pandemic.
Figure 1: The N-Gene confirmatory-assay is neither emphasized as necessary third step in the official WHO Drosten-Corman protocol-recommendation below [8] nor is it required as a crucial step for higher test-accuracy in the Eurosurveillance publication.
1c) Erroneous GC-content (discussed in 2c, together with annealing temperature (Tm))
1d) Detection of viral genes
RT-PCR is not recommended for primary diagnostics of infection. This is why the RT-PCR Test used in clinical routine for detection of COVID-19 is not indicated for COVID-19 diagnosis on a regulatory basis.
“Clinicians need to recognize the enhanced accuracy and speed of the molecular diagnostic techniques for the diagnosis of infections, but also to understand their limitations. Laboratory results should always be interpreted in the context of the clinical presentation of the patient, and appropriate site, quality, and timing of specimen collection are required for reliable test results”. [9]
However, it may be used to help the physician’s differential diagnosis when he or she has to discriminate between different infections of the lung (Flu, Covid-19 and SARS have very similar symptoms). For a confirmative diagnosis of a specific virus, at least 3 specific primer pairs must be applied to detect 3 virus-specific genes. Preferably, these target genes should be located with the greatest distance possible in the viral genome (opposite ends included).
Although the Corman-Drosten paper describes 3 primers, these primers only cover roughly half of the virus’ genome. This is another factor that decreases specificity for detection of intact COVID-19 virus RNA and increases the quote of false positive test results.
Therefore, even if we obtain three positive signals (i.e. the three primer pairs give 3 different amplification products) in a sample, this does not prove the presence of a virus. A better primer design would have terminal primers on both ends of the viral genome. This is because the whole viral genome would be covered and three positive signals can better discriminate between a complete (and thus potentially infectious) virus and fragmented viral genomes (without infectious potency). In order to infer anything of significance about the infectivity of the virus, the Orf1 gene, which encodes the essential replicase enzyme of SARS-CoV viruses, should have been included as a target (Figure 2). The positioning of the targets in the region of the viral genome that is most heavily and variably transcribed is another weakness of the protocol.
Kim et al. demonstrate a highly variable 3’ expression of subgenomic RNA in Sars-CoV-2 [23]. These RNAs are actively monitored as signatures for asymptomatic and non-infectious patients [10]. It is highly questionable to screen a population of asymptomatic people with qPCR primers that have 6 base pairs primer-dimer on the 3 prime end of a primer (Figure 3).
Apparently the WHO recommends these primers. We tested all the wobble derivatives from the Corman-Drosten paper with Thermofisher’s primer dimer web tool [11]. The RdRp forward primer has 6bp 3prime homology with Sarbeco E Reverse. At high primer concentrations this is enough to create inaccuracies.
Of note: There is a perfect match of one of the N primers to a clinical pathogen (Pantoea), found in immuno-compromised patients. The reverse primer hits Pantoea as well but not in the same region (Figure 3).
These are severe design errors, since the test cannot discriminate between the whole virus and viral fragments. The test cannot be used as a diagnostic for SARS-viruses.
Figure 2: Relative positions of amplicon targets on the SARS coronavirus and the 2019 novel coronavirus genome. ORF: open reading frame; RdRp: RNA-dependent RNA polymerase. Numbers below amplicon are genome positions according to SARS-CoV, NC_004718 [1];
Figure 3: A test with Thermofischer’s primer dimer web tool reveals that the RdRp forward primer has a 6bp 3`prime homology with Sarbeco E Reverse (left box). Another test reveals that there is a perfect match for one of the N-primers to a clinical pathogen (Pantoea) found in immuno-compromised patients (right box).
2. Reaction temperatures
2a) DNA melting temperature (>92°).
Adequately addressed in the Corman-Drosten paper.
2b) DNA amplification temperature.
Adequately addressed in the Corman-Drosten paper.
2c) Erroneous GC-contents and Tm
The annealing-temperature determines at which temperature the primer attaches/detaches from the target sequence. For an efficient and specific amplification, GC content of primers should meet a minimum of 40% and a maximum of 60% amplification. As indicated in table 3, three of the primers described in the Corman-Drosten paper are not within the normal range for GC-content. Two primers (RdRp_SARSr_F and RdRp_SARSr_R) have unusual and very low GC-values of 28%-31% for all possible variants of wobble bases, whereas primer E_Sarbeco_F has a GC-value of 34.6% (Table 3 and second panel of Table 3).
It should be noted that the GC-content largely determines the binding to its specific target due to its three hydrogen bonds in base pairing. Thus, the lower the GC-content of the primer, the lower its binding-capability to its specific target gene sequence (i.e. the gene to be detected). This means for a target-sequence to be recognized we have to choose a temperature which is as close as possible to the actual annealing-temperature (best practise-value) for the primer not to detach again, while at the same time specifically selecting the target sequence.
If the Tm-value is very low, as observed for all wobbly-variants of the RdRp reverse primers, the primers can bind non-specifically to several targets, decreasing specificity and increasing potential false positive results.
The annealing temperature (Tm) is a crucial factor for the determination of the specificity/accuracy of the qPCR procedure and essential for evaluating the accuracy of qPCR-protocols. Best-practice recommendation: Both primers (forward and reverse) should have an almost similar value, preferably the identical value.
We used the freely available primer design software Primer-BLAST [12, 25] to evaluable the best-practise values for all primers used in the Corman-Drosten paper (Table 3). We attempted to find a Tm-value of 60° C, while similarly seeking the highest possible GC%-value for all primers. A maximal Tm difference of 2° C within primer pairs was considered acceptable. Testing the primer pairs specified in the Corman-Drosten paper, we observed a difference of 10° C with respect to the annealing temperature Tm for primer pair1 (RdRp_SARSr_F and RdRp_SARSr_R). This is a very serious error and makes the protocol useless as a specific diagnostic tool.
Additional testing demonstrated that only the primer pair designed to amplify the N-gene (N_Sarbeco_F and N_Sarbeco_R) reached the adequate standard to operate in a diagnostic test, since it has a sufficient GC-content and the Tm difference between the primers (N_Sarbeco_F and N_Sarbeco_R) is 1.85° C (below the crucial maximum of 2° C difference). Importantly, this is the gene which was neither tested in the virus samples (Table 2) nor emphasized as a confirmatory test. In addition to highly variable melting temperatures and degenerate sequences in these primers, there is another factor impacting specificity of the procedure: the dNTPs (0.4uM) are 2x higher than recommended for a highly specific amplification. There is additional magnesium sulphate added to the reaction as well. This procedure combined with a low annealing temperature can create non-specific amplifications. When additional magnesium is required for qPCR, specificity of the assay should be further scrutinized.
The design errors described here are so severe that it is highly unlikely that specific amplification of SARS-CoV-2 genetic material will occur using the protocol of the Corman-Drosten paper.
Table 3: GC-content of the primers and probes (adapted from Corman-Drosten paper; aberrations from optimized GC-contents are highlighted. Second Panel shows a table-listing of all Primer-BLAST best practices values for all primers and probes used in the Corman-Drosten paper by Prof. Dr. Ulrike Kämmerer & her team
3. The number of amplification cycles
It should be noted that there is no mention anywhere in the Corman-Drosten paper of a test being positive or negative, or indeed what defines a positive or negative result. These types of virological diagnostic tests must be based on a SOP, including a validated and fixed number of PCR cycles (Ct value) after which a sample is deemed positive or negative. The maximum reasonably reliable Ct value is 30 cycles. Above a Ct of 35 cycles, rapidly increasing numbers of false positives must be expected .
PCR data evaluated as positive after a Ct value of 35 cycles are completely unreliable.
Citing Jaafar et al. 2020 [3]: “At Ct = 35, the value we used to report a positive result for PCR, <3% of cultures are positive.” In other words, there was no successful virus isolation of SARS-CoV-2 at those high Ct values.
Further, scientific studies show that only non-infectious (dead) viruses are detected with Ct values of 35 [22].
Between 30 and 35 there is a grey area, where a positive test cannot be established with certainty. This area should be excluded. Of course, one could perform 45 PCR cycles, as recommended in the Corman-Drosten WHO-protocol (Figure 4), but then you also have to define a reasonable Ct-value (which should not exceed 30). But an analytical result with a Ct value of 45 is scientifically and diagnostically absolutely meaningless (a reasonable Ct-value should not exceed 30). All this should be communicated very clearly. It is a significant mistake that the Corman-Drosten paper does not mention the maximum Ct value at which a sample can be unambiguously considered as a positive or a negative test-result. This important cycle threshold limit is also not specified in any follow-up submissions to date.
Figure 4: RT-PCR Kit recommendation in the official Corman-Drosten WHO-protocol [8]. Only a “Cycler”-value (cycles) is to be found without corresponding and scientifically reasonable Ct (Cutoff-value). This or any other cycles-value is nowhere to be found in the actual Corman-Drosten paper.
4. Biomolecular validations
To determine whether the amplified products are indeed SARS-CoV-2 genes, biomolecular validation of amplified PCR products is essential. For a diagnostic test, this validation is an absolute must.
Validation of PCR products should be performed by either running the PCR product in a 1% agarose-EtBr gel together with a size indicator (DNA ruler or DNA ladder) so that the size of the product can be estimated. The size must correspond to the calculated size of the amplification product. But it is even better to sequence the amplification product. The latter will give 100% certainty about the identity of the amplification product. Without molecular validation one can not be sure about the identity of the amplified PCR products. Considering the severe design errors described earlier, the amplified PCR products can be anything.
Also not mentioned in the Corman-Drosten paper is the case of small fragments of qPCR (around 100bp): It could be either 1,5% agarose gel or even an acrylamide gel.
The fact that these PCR products have not been validated at molecular level is another striking error of the protocol, making any test based upon it useless as a specific diagnostic tool to identify the SARS-CoV-2 virus.
5. Positive and negative controls to confirm/refute specific virus detection.
The unconfirmed assumption described in the Corman-Drosten paper is that SARS-CoV-2 is the only virus from the SARS-like beta-coronavirus group that currently causes infections in humans. The sequences on which their PCR method is based are in silico sequences, supplied by a laboratory in China [23], because at the time of development of the PCR test no control material of infectious (“live”) or inactivated SARS-CoV-2 was available to the authors. The PCR test was therefore designed using the sequence of the known SARS-CoV as a control material for the Sarbeco component (Dr. Meijer, co-author Corman-Drosten paper in an email exchange with Dr. Peter Borger) [2].
All individuals testing positive with the RT-PCR test, as described in the Corman-Drosten paper, are assumed to be positive for SARS-CoV-2 infections. There are three severe flaws in their assumption. First, a positive test for the RNA molecules described in the Corman-Drosten paper cannot be equated to “infection with a virus”. A positive RT-PCR test merely indicates the presence of viral RNA molecules. As demonstrated under point 1d (above), the Corman-Drosten test was not designed to detect the full-length virus, but only a fragment of the virus. We already concluded that this classifies the test as unsuitable as a diagnostic test
for SARS-virus infections.
Secondly and of major relevance, the functionality of the published RT-PCR Test was not demonstrated with the use of a positive control (isolated SARS-CoV-2 RNA) which is an essential scientific gold standard.
Third, the Corman-Drosten paper states:
“To show that the assays can detect other bat-associated SARS-related viruses, we used the E gene assay to test six bat-derived faecal samples available from Drexler et al. […] und Muth et al. […]. These virus-positive samples stemmed from European rhinolophid bats. Detection of these phylogenetic outliers within the SARS-related CoV clade suggests that all Asian viruses are likely to be detected. This would, theoretically, ensure broad sensitivity even in case of multiple independent acquisitions of variant viruses from an animal reservoir.”
This statement demonstrates that the E gene used in RT-PCR test, as described in the Corman-Drosten paper, is not specific to SARS-CoV-2.
The E gene primers also detect a broad spectrum of other SARS viruses.
The genome of the coronavirus is the largest of all RNA viruses that infect humans and they all have a very similar molecular structure. Still, SARS-CoV1 and SARS-CoV-2 have two highly specific genetic fingerprints, which set them apart from the other coronaviruses. First, a unique fingerprint-sequence (KTFPPTEPKKDKKKK) is present in the N-protein of SARS-CoV and SARS-CoV-2 [13,14,15]. Second, both SARS-CoV1 and SARS-CoV2 do not contain the HE protein, whereas all other coronaviruses possess this gene [13, 14]. So, in order to specifically detect a SARS-CoV1 and SARS-CoV-2 PCR product the above region in the N gene should have been chosen as the amplification target. A reliable diagnostic test should focus on this specific region in the N gene as a confirmatory test. The PCR for this N gene was not further validated nor recommended as a test gene by the Drosten-Corman paper, because of being “not so sensitive” with the SARS-CoV original probe [1].
Furthermore, the absence of the HE gene in both SARS-CoV1 and SARS-CoV-2 makes this gene the ideal negative control to exclude other coronaviruses. The Corman-Drosten paper does not contain this negative control, nor does it contain any other negative controls. The PCR test in the Corman-Drosten paper therefore contains neither a unique positive control nor a negative control to exclude the presence of other coronaviruses. This is another major design flaw which classifies the test as unsuitable for diagnosis.
6. Standard Operational Procedure (SOP) is not available
There should be a Standard Operational Procedure (SOP) available, which unequivocally specifies the above parameters, so that all laboratories are able to set up the identical same test conditions. To have a validated universal SOP is essential, because it facilitates data comparison within and between countries. It is very important to specify all primer parameters unequivocally. We note that this has not been done. Further, the Ct value to indicate when a sample should be considered positive or negative is not specified. It is also not specified when a sample is considered infected with SARS-CoV viruses. As shown above, the test cannot discern between virus and virus fragments, so the Ct value indicating positivity is crucially important. This Ct value should have been specified in the Standard Operational Procedure (SOP) and put on-line so that all laboratories carrying out this test have exactly the same boundary conditions. It points to flawed science that such an SOP does not exist. The laboratories are thus free to conduct the test as they consider appropriate, resulting in an enormous amount of variation. Laboratories all over Europe are left with a multitude of questions; which primers to order? which nucleotides to fill in the undefined places? which Tm value to choose? How many PCR cycles to run? At what Ct value is the sample positive? And when is it negative? And how many genes to test? Should all genes be tested, or just the E and RpRd gene as shown in Table 2 of the Corman-Drosten paper? Should the N gene be tested as well? And what is their negative control? What is their positive control?
The protocol as described is unfortunately very vague and erroneous in its design that one can go in dozens of different directions. There does not appear to be any standardization nor an SOP, so it is not clear how this test can be implemented.
- Consequences of the errors described under 1-5: false positive results.
The RT-PCR test described in the Corman-Drosten paper contains so many molecular biological design errors (see 1-5) that it is not possible to obtain unambiguous results. It is inevitable that this test will generate a tremendous number of so-called “false positives”. The definition of false positives is a negative sample, which initially scores positive, but which is negative after retesting with the same test. False positives are erroneous positive test-results, i.e. negative samples that test positive. And this is indeed what is found in the Corman-Drosten paper. On page 6 of the manuscript PDF the authors demonstrate, that even under well-controlled laboratory conditions, a considerable percentage of false positives is generated with this test:
“In four individual test reactions, weak initial reactivity was seen however they were negative upon retesting with the same assay. These signals were not associated with any particular virus, and for each virus with which initial positive reactivity occurred, there were other samples that contained the same virus at a higher concentration but did not test positive. Given the results from the extensive technical qualification described above, it was concluded that this initial reactivity was not due to chemical instability of real-time PCR probes and most probably to handling issues caused by the rapid introduction of new diagnostic tests and controls during this evaluation study.” [1]
The first sentence of this excerpt is clear evidence that the PCR test described in the Corman-Drosten paper generates false positives. Even under the well-controlled conditions of the state-of-the-art Charité-laboratory, 4 out of 310 primary-tests are false positives per definition. Four negative samples initially tested positive, then were negative upon retesting. This is the classical example of a false positive. In this case the authors do not identify them as false positives, which is intellectually dishonest.
Another telltale observation in the excerpt above is that the authors explain the false positives away as “handling issues caused by the rapid introduction of new diagnostic tests”. Imagine the laboratories that have to introduce the test without all the necessary information normally described in an SOP.
8. The Corman-Drosten paper was not peer-reviewed
Before formal publication in a scholarly journal, scientific and medical articles are traditionally certified by “peer review.” In this process, the journal’s editors take advice from various experts (“referees”) who have assessed the paper and may identify weaknesses in its assumptions, methods, and conclusions. Typically a journal will only publish an article once the editors are satisfied that the authors have addressed referees’ concerns and that the data presented supports the conclusions drawn in the paper.” This process is as well described for Eurosurveillance [16].
The Corman-Drosten paper was submitted to Eurosurveillance on January 21st 2020 and accepted for publication on January 22nd 2020. On January 23rd 2020 the paper was online. On January 13th 2020 version 1-0 of the protocol was published at the official WHO website [17], updated on January 17th 2020 as document version 2-1 [18], even before the Corman-Drosten paper was published on January 23rd at Eurosurveillance.
Normally, peer review is a time-consuming process since at least two experts from the field have to critically read and comment on the submitted paper. In our opinion, this paper was not peer-reviewed. Twenty-four hours are simply not enough to carry out a thorough peer review. Our conclusion is supported by the fact that a tremendous number of very serious design flaws were found by us, which make the PCR test completely unsuitable as a diagnostic tool to identify the SARS-CoV-2 virus. Any molecular biologist familiar with RT-PCR design would have easily observed the grave errors present in the Corman-Drosten paper before the actual review process. We asked Eurosurveillance on October 26th 2020 to send us a copy of the peer review report. To date, we have not received this report and in a letter dated November 18th 2020, the ECDC as host for Eurosurveillance declined to provide access without providing substantial scientific reasons for their decision. On the contrary, they write that “disclosure would undermine the purpose of scientific investigations.” [24].
9. Authors as the editors
A final point is one of major concern. It turns out that two authors of the Corman-Drosten paper, Christian Drosten and Chantal Reusken, are also members of the editorial board of this journal [19]. Hence there is a severe conflict of interest which strengthens suspicions that the paper was not peer-reviewed. It has the appearance that the rapid publication was possible simply because the authors were also part of the editorial board at Eurosurveillance. This practice is categorized as compromising scientific integrity.
SUMMARY CATALOGUE OF ERRORS FOUND IN THE PAPER
The Corman-Drosten paper contains the following specific errors:
- There exists no specified reason to use these extremely high concentrations of primers in this protocol. The described concentrations lead to increased nonspecific bindings and PCR product amplifications, making the test unsuitable as a specific diagnostic tool to identify the SARS-CoV-2 virus.
- Six unspecified wobbly positions will introduce an enormous variability in the real world laboratory implementations of this test; the confusing nonspecific description in the Corman-Drosten paper is not suitable as a Standard Operational Protocol making the test unsuitable as a specific diagnostic tool to identify the SARS-CoV-2 virus.
- The test cannot discriminate between the whole virus and viral fragments. Therefore, the test cannot be used as a diagnostic for intact (infectious) viruses, making the test unsuitable as a specific diagnostic tool to identify the SARS-CoV-2 virus and make inferences about the presence of an infection.
- A difference of 10° C with respect to the annealing temperature Tm for primer pair1 (RdRp_SARSr_F and RdRp_SARSr_R) also makes the test unsuitable as a specific diagnostic tool to identify the SARS-CoV-2 virus.
- A severe error is the omission of a Ct value at which a sample is considered positive and negative. This Ct value is also not found in follow-up submissions making the test unsuitable as a specific diagnostic tool to identify the SARS-CoV-2 virus.
- The PCR products have not been validated at the molecular level. This fact makes the protocol useless as a specific diagnostic tool to identify the SARS-CoV-2 virus.
- The PCR test contains neither a unique positive control to evaluate its specificity for SARS-CoV-2 nor a negative control to exclude the presence of other coronaviruses, making the test unsuitable as a specific diagnostic tool to identify the SARS-CoV-2 virus.
- The test design in the Corman-Drosten paper is so vague and flawed that one can go in dozens of different directions; nothing is standardized and there is no SOP. This highly questions the scientific validity of the test and makes it unsuitable as a specific diagnostic tool to identify the SARS-CoV-2 virus.
- Most likely, the Corman-Drosten paper was not peer-reviewed making the test unsuitable as a specific diagnostic tool to identify the SARS-CoV-2 virus.
- We find severe conflicts of interest for at least four authors, in addition to the fact that two of the authors of the Corman-Drosten paper (Christian Drosten and Chantal Reusken) are members of the editorial board of Eurosurveillance. A conflict of interest was added on July 29 2020 (Olfert Landt is CEO of TIB-Molbiol; Marco Kaiser is senior researcher at GenExpress and serves as scientific advisor for TIB-Molbiol), that was not declared in the original version (and still is missing in the PubMed version); TIB-Molbiol is the company which was “the first” to produce PCR kits (Light Mix) based on the protocol published in the Corman-Drosten manuscript, and according to their own words, they distributed these PCR-test kits before the publication was even submitted [20]; further, Victor Corman & Christian Drosten failed to mention their second affiliation: the commercial test laboratory “Labor Berlin”. Both are responsible for the virus diagnostics there [21] and the company operates in the realm of real time PCR-testing.
In light of our re-examination of the test protocol to identify SARS-CoV-2 described in the Corman-Drosten paper we have identified concerning errors and inherent fallacies which render the SARS-CoV-2 PCR test useless.
CONCLUSION
The decision as to which test protocols are published and made widely available lies squarely in the hands of Eurosurveillance. A decision to recognise the errors apparent in the Corman-Drosten paper has the benefit to greatly minimise human cost and suffering going forward.
Is it not in the best interest of Eurosurveillance to retract this paper? Our conclusion is clear. In the face of all the tremendous PCR-protocol design flaws and errors described here, we conclude: There is not much of a choice left in the framework of scientific integrity and responsibility.
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