Coronavirus sentences to ponder

From a reader email:

I work at a large health care system on the west coast and the communication we have gotten from leadership is that we are only allowed to test for COVID-19 after discussion with and approval of the appropriate regulatory agencies.

How can this persist?

Comments

What is the cost of the test? Often in hospitals, things need to be approved by administrators when they are expensive.

@Bill, @others - re-read the sentence fragment more carefully... the key word is "with and approval of the appropriate REGULATORY agencies".

Honest question -- Do these regulatory bodies also take cost into account.

Should regulators take the cost of a high rate of false positives resulting in thousands being confined with a few infected with COVID-19, like on the cruise ship, and then being infected with COVID-19, because the cost of isolating thousands of false positive patients in ways that ensures no transmission is too high?

Maybe there's a shortage of the test kits, and the CDC wants them used in a way that will provide accurate feedback on the progress of the epidemic, as opposed to, say, a map of wealthy hypochondriacs who have fake handicap parking plaques on their cars because doctors give them whatever they ask for.

How do we know anyone actually has the disease, maybe it's all just false positives on the test? Wouldn't that be embarrassing for us all. Or maybe your false positive thing is bs.

If you test too many people, you will get false positives. For instance, if we tested everyone in the US today and the test gives a false positive just 0.1% of the time, then we would have 3 hundred thousand people testing positive for the virus. This would swamp the number of people who actually have it.

Not saying that the situation here is great. But you can't just dismiss the false positive worry as "BS". False positives are a really serious issue.

P(A/B)= P (B/A) x P(A) / P(B) Learn it, love it, live it.

I guess there is another person using the name Bill. So you may be responding to the comment of a different person than you think. Which is alright, as you should be responding to the comment but not the name.

That said, my daughter, a pathologist, advises that the death rate for those her age and children is less than 1%, and that there aren’t enough ventilators in hospitals to serve everyone if it is severe and community spread.

She said there will be an allocation of ventilators based on some criteria including survivability and age.

Seems reasonable. Healthcare rationing is inevitable under any conceivable system. In the English NHS apparently the triage decisions will be made by "Three Wise Men" in each hospital i.e.a group of three "Consultants", as senior physicians and surgeons are titled.

Presumably a similar policy will be adopted in the Scottish, Welsh, and Northern Irish NHS hospitals.

"That said, my daughter, a pathologist, advises that the death rate for those her age and children is less than 1%,"

The death rate is actually much lower than 1%. It spikes once you get above age 50. Effectively, it's about as dangerous as the flu for patients younger than 40.

"Patients ages 10 to 19 were as likely to die as patients in their 30s, at just 0.2 percent. The study did not report any deaths in children younger than 10, who represented less than 1 percent of patients. "

https://thehill.com/changing-america/well-being/prevention-cures/485144-coronavirus-fatality-rates-vary-dramatically

0.2% for people under 30 is much more dangerous than a flu.

It depends on the context: A .2% fatality, or 2 per 1000 is is twice as high as .1% or 1 per 1000. But if you heard there was an expensive drug with bad side effects which would "halve" your death odds from 2% to 1%, would you take it? Personally, I am not going to suffer bad side effects to increase my odds by 1/1000th.

It is too early to know the death rate with any accuracy. And if you factor in the misinformation and secrecy of China it is likely that we know little to nothing about this virus yet. In 6 months we will have a handle on the death rate.

Well with the data we do have it looks bimodal. The death rate in Hubei is quite large but outside of Hubei (whether in China or not) is another much lower rate. It is possible that the officials there have no idea what they are doing. Guangdong (only a few provinces away) just had single digit number of deaths less than Italy while Hubei has the world's majority of deaths by far.

The figures to follow are presumably South Korea's.

South Korea has 16 deaths so far. Italy has 21. SK's excuse is that they are next door to ground zero. Maybe Italy is the incompetent one.

https://cnnphilippines.com/world/2020/2/29/south-korea-coronavirus-cases.html

https://www.theguardian.com/world/live/2020/feb/28/coronavirus-live-updates-latest-news-china-wuhan-stock-markets-update

I believe the high rates inside Hubei represent what happens if a health care system gets overwhelmed due to its high serious complication rate. Those complications are manageable, and lead to a death rate of under 1% if there are enough ventilators and ICU beds for everyone, but once you get enough people with serious complications that it overwhelms the ICU system, that rate spikes to 2-6% for the people who are not able to get intensive medical care. The rate goes up with age, and with the more co-morbidities that you have as well, such as existing heart and lung disease, smoking, diabetes, etc. The serious complication rate seems to be as high as 20% among people who show symptoms, with about half of those needing ventilators or heart lung bypass. The ACE2 receptors the SARS-Cov-2 virus use to enter the cells are found in the deeper parts of the lung, as well as the vascular and circulatory system, and small intestines, so it can cause a lot of complications all over. This thing is bad news for people in countries without a functional hospital and ICU system.

Question for your daughter. Will doctors like herself show up to work and actually treat patients who have the corona virus? Or will they call in sick?

Her husband is an ER doc and she and her family expect that they may get it. She will show up, as will her husband. In fact, as the head of the department, he often pulls long hours if there are no shows from sickness.

Just like in any profession, there are norms and social pressure, particularly if another member of your team bails.

I wonder though about the old doc who is about to retire.

There's been a bit of a regulatory snafu around Coronavirus testing plus a batch of bad reagents in the official CDC testing kit which was the only one people were supposed to be using. So testing resources in the US are very limited right now even though this is the sort of test a large hospital could put together in a week.

Here's the former FDA commissioner explaining the problem a month ago: https://twitter.com/ScottGottliebMD/status/1224042220665307137

"this is the sort of test a large hospital could put together in a week" - really? Typically, such tests take years to develop, and to do so with good sensitivity and specificity isn't easy. And I think both sensitivity and specificity are important.

Also, see https://twitter.com/ecapobianco/status/1232090332654903296

Exactly.

It all depends upon having the right testing hardware to do RT-PCR tests. This is not like a simple test strip. We are talking about 20K$ machines.

It's called the unitary executive: if the president is the sole possessor of executive power, the president is solely responsible for the exercise of executive power. You asked for it, you got it.

This has nothing to do with Trump. This is at the discretion of the CDC. This has been going on for weeks and has been reported on.

This has to do the apocalyptic, catastrophic merge of novel coronavirus with Trump Derangement Syndrome.

As long as your willing to admit to yourself and others you have it and laugh at yourself, then it's not really a serious condition.

I fell your pain.

Tragically, you will endue four more years of Trump Triumphant before (God forbid) a Dem (Bernie! will be too old and he has a bad ticker) can wreck the economy and our way of life with the nude green eel (cost to each household $75,000 year-one and $40,000 yearly thereafter); pay off your student loans; make college free for all; pay your rationed health care for all; etc.

Correct, only when there is positive news on anything, it has everything to do with Trump, as he often tweets.

It has everything to do with Trump. He's the boss of the CDC. His inability to contain this thing is costing him bigly.

Deaths in the US have doubled! to zero.

Washington is in the United states.

No...Its not a MAGA voting state. So WA is not part of real America for MAGA RINOs....so it does not count.

We have leadership that likes to act like dictators. Lord Cheto has declared by fiat that there is no crisis.

Note: he then placed his little bitch in charge of it all so that when things go south he has a single person to blame and throw under the bus.

Would it be fair to say that of all the children conceived in the alley behind the Woodjnicky Waffle House, you are the smartest?

Fair. I regret that comment. Still mad about the response to this tho.

I also work in healthcare on the west coast. I am pretty sure that this restriction is because there is a limited number of Corona virus tests available at this time. My understanding is that this currently stands at 2,000 in the state of California.if everybody did the test who wanted to, both providers and patients,it would quickly deplete those available for those who really should be tested. it seems to me that this is a very reasonable form of rationing as we gear up to produce more tests.

No, it's because the existing test produces too many false positives. The test developed in DC where the globalist one world government WHO guidance was apparently rejected.

Maybe the WHO test violated some US patent application, eg IP theft!

> this currently stands at 2,000 in the state of California

Would you believe only 200??

https://www.statnews.com/2020/02/27/a-single-coronavirus-case-exposes-a-bigger-problem-the-scope-of-undetected-u-s-spread-is-unknown/

"California Gov. Gavin Newsom was critical of the testing debacle in a press conference on Thursday. His state (California) has only 200 kits to test for the new coronavirus, he said."

It's perfectly reasonable, and what I'd expect, unless they happen to have an in-house kit (and even then it might be reasonable). I ran a very very large hospital microbiology facility during a different outbreak (the swine-origin H1N1). Until the FDA EUA was out, the only way to test samples was at the state lab, and even then, I could do it because I had PCR equipment but other labs couldn't. The state lab was SLAMMED and backlogged so they had to keep updating the case definition that they'd test -- limiting it either to persons with a higher than normal possibility of infection or persons in pretty serious medical jeopardy since after all supportive care is supportive care. It didn't help that everyone was panicky and trying to pull strings to get their smaple sent in -- basically it they'd had their druthers every other ER patient of any kind would've had a sample needlessly sent out, so in order to handle the most urgent cases the staties HAD to limit samples. It was a nightmare because as the workload grew the case definition kept tightening and quite often the doc had out-of-date -- like a couple hours old -- information about what could be sent, so, you needed to have some kind of central authority in the system to check with (who was me).

Sure, they brought more surge capacity online, and things eased up. But for a little while they have to tightly restrict samples.

+1, highly informative. Thank you for the post!

Thanks. This is a real time test of the communication channels and ability to respond to an ever changing situation.

You can't make it better. All you can do is not make it worse.

In BC, http://www.bccdc.ca/about/news-stories/stories/2020/information-on-novel-coronavirus

7 cases,1425 tests on 1012 people. Is that the proportion that US testing is finding?

Outside of repatriated Americans in quarantine on military bases, the total number of cases in the US is......

1

I think all the cases are people coming from affected areas. One was from Iran. Lots of Asian traffic coming into Vancouver.

https://www.wbur.org/commonhealth/2020/02/03/novel-coronavirus-explainer-massachusetts-impact

The Massachusetts case is just confined to his apartment awaiting two consecutive clear tests, isn't he? I understand some large groups have been sent to military bases, but not all cases?

The caveat here is that most possible cases are not tested. In other words, we can hope we have identified all the cases, but we probably haven't.

If this is like the common influenza, there are people who have minor symptoms but go on with their lives, and some end up with pneumonia and require serious medical interventions. And everything in between. Essentially they will only be testing people who show up in hospital with symptoms. What percentage of the cases does that represent? I don't think it is possible to know.

Travelers from Wuhan were quarantined. All International travelers should be quarantined immediately for 2-3 weeks.

There’s a decent chance this virus could never take off in the US, and hopefully a germaphobic and xenophobic President might actually do it.

Unfortunately for reasons I cannot possibly fathom the entire left wing media apparatus is calling for immediate free movement across borders from everywhere in the world to the US.

Vox, Nytimes, Atlantic, TNR, Jacobin, CNN, MSNBC, ABC et al are pushing every day about how quarantines or border restrictions are immoral and bad.

What....the f?

Immoral, no. But quite possibly too late or too leaky to do any good.

> the total number of cases in the US is ...... 1

The test protocol seems to be sweeping the potential COVID19 cases under the influenza carpet.

https://thehill.com/changing-america/well-being/prevention-cures/483167-cdc-says-testing-for-covid-19-will-begin-in-five

"In a Friday update, the U.S. Centers for Disease Control and Prevention (CDC) said that it will begin testing for the coronavirus, now named COVID-19, in five separate states. The idea, Messonnier says, is to test people for COVID-19 if they test negative for influenza.

Here is the testing criteria. https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/health-professionals/national-case-definition.html

The BC labs now don't have to send samples to Winnipeg for verification.

Again this is interesting, watching how long it takes for the basic infrastructure of a response takes to set up.

"How can this persist?"

I've always assumed the CDC was very professional, but they have been making a lot of mistakes regarding the coronavirus. Bad reagents in test kits, extremely slow testing, stringent requirements that resulted in the CA patient not being test for over a week, despite repeated hospital requests.

Clearly, Obummer destroyed American competence in his 8 years even more than anyone knew. After getting rid of the CDC deadwood in 3 years, it is clear that Trump needs four more years to make the CDC great again.

The TDS infected Washington Post keeps publishing propaganda. Only those deranged with TDS could give any credence to such trash fake news.

- The White House official charged with leading the U.S. response to deadly pandemics left nearly two years ago as his global health security team was disbanded. Federal funding for preventing and mitigating the spread of infectious disease has been repeatedly threatened since President Trump’s election.

Despite the mounting threat of a coronavirus outbreak in the United States, Trump said he has no regrets about those actions and that expertise and resources can be quickly ramped up to meet the current needs.

Former federal officials and public-health experts argue that an effective response to a epidemiological crisis demands sustained planning and investment. While the administration’s response to coronavirus has been criticized in recent weeks as slow and disjointed, people in and outside the White House have warned for years that the nation is ill prepared for a dangerous pandemic. -

Fascinating.

In this comment Prior_Approval, a fired public relations employee of GMU (fired for either sexual harassment or sexual assault), attempts to pin his possible Corona-Chan infection in SW Germany on President Trump.

Germany is of course exploding in Corona-chan cases and Trump has literally nothing to do with them.

Germany has quarantined 1,000 people and has open borders. Also, soon to have 3.7 million refugees from Turkey!

Apparently you're right, Germany has open borders. I recently took a train from Basel to Freiburg am Briesgau and back and no one ever asked to see my passport. (I am not a EU national with the right of free movement, but it doesn't matter, if I were one they should have ascertained that I was one by looking at my passport.)

Interesting to see how a childish vendetta continues to develop, especially as even you know that your current claims about firing are simply made up, compared to your previous claims of the grounds.

Are you really so desperate for attention?

None of those things are indicative of a failure of professionalism. It might just be failure to produce resources that cannot be produced at all.

Sure, but South Korea, China & Japan are all making thousands of tests at this point. The CDC is supposed to be World Class.

"The CDC is supposed to be World Class."

Supposed by whom?

I bet those Chinese made tests are garbage.

it's a problem that also could lead to an overestimate of the fatality rate and of the serious cases.
Because it's costly and time consuming/inconvenient to test ,mostly very serious cases are tested. The mild cases are ignored and not tallied.

It will persist until the Chinese gear up to manufacture whatever America needs. After all, nothing beats the benefit of American consumers paying the lowest possible cost and enjoying all the benefits of globalization.

Thank you for pointing that, sir. We should demand more from our leaders.

The CDC test kit released last week turned out to not produce reliable results in half the States which used it. Last report I heard several days ago was no one knew why some State labs were able to get the test kit to work.
https://www.propublica.org/article/cdc-coronavirus-covid-19-test

Do you want lots and lots of false positives so you need to care for/monitor people who are not infected with COVID-19.

Or will you group them with actual COVID-19 patients and thus infect them with COVID-19?

I see no evidence of free market capitalists delivering superior cheaper faster COVID-19 tests to say Africa, Asian, or Europe which are free of the incompetent US government regulation, so the question is who do you trust? The Trump government run testing kit, the globalist WHO, or maybe Elizabeth Holmes?

So much TDS in the comments.

You are right, of course. Just imagine that a Democrat was in charge - the stock market would be tanking, for example, and people would probably believe that this virus will be a problem in the future, instead of it going away with warm weather.

Prior’s even less coherent than usual today.

Not to worry. Pence is on the case. When he wants you to know something you will know it. Not before.

Who is his technical advisor? Pence doing politics/face time with the boss + someone at Fauchi's level of competence evaluating evidence and figuring out what to do could work fine. Pence with incompetent technical advisors won't know what to do even if he is capable of getting things done.

Sorry, Thiago, but Il Piccolo Duce Bolsonaro's top-down fascist approach isn't doing any better: "Within 24 hours, the number of suspected cases jumped to 132, from 20, and government authorities said they expect the number to reach 300." https://cumberlink.com/news/world/brazil-coronavirus-worry-emerges-with-new-suspected-cases/article_8249bfec-e3a5-51bc-b9b9-545a7f66416b.html

It's a triage problem, right?

You can wish for more testing capacity, but without that wish, the testing capacity must be allocated for maximum benefit.

I noted in an earlier comment that if you *think* you have a new and effective test, you have to test it against something to be sure. If you try to use the CDC's in-house test as the gold standard .. you can only do your QC testing at the cost of live patients.

Not a good situation at all, but I don't see a magic bullet.

Of course, if Korea really is doing like 10,000 tests per day with few false positives, that's another story.

Then it is a serious question of why we can't too.

The Koreans can't know they have "few false positives", nor can they determine the numbers of false negatives on the fly. You can really only determine the reliability of the testing procedure in a controlled study, which isn't being run by anyone at this point.

Being fairly familiar with the test that is being attempted, I wouldn't guess you could have done a controlled study of the test's reliability in less than 3 or 4 months, and you certainly would then have to devote time to optimizing it.

you can compare the negatives results that turns positive after 2nd or 3rd testing.
why repeat a test if 1st and 2nd negative?
you repeat it if your pneumonia negative for all common viral and bacterial cultures ... w serial chest ct w ground glass opacities

Basically, we are now in the first stage of a pandemic, not the first stage of containing a new disease. Testing grows increasingly less relevant as the number of cases grows. Many people were on vacation in Italy over the last couple of weeks, enjoying skiing and carnival. The number of confirmed cases in the rest of Europe that can be traced back to Italy means that the next stage of handling a pandemic is rapidly approaching. Which explains why European governments are already planning and talking about school closings and cancelling public events. There is already a shrinking benefit to testing everyone with a fever to see whether they have the flu, a cold or corona.

This sounds tragically realistic.

For Europe, unfortunately it’s likely accurate.

For the US, it’s absolutely untrue at least as of today. The total cases outside of intentional repatriation is 1. One. Dude.

Ironically the travel ban might prove to be accidentally useful, as Nigeria and Iran are on the list.

Second case of domestic propagation in California.

Are you talking about the UMass student who came home from Wuhan, got sick, and went to the doctor? He wasn't intentionally repatriated.

As I understand it, also, he's sitting around in his apartment getting regular visits from a nurse. Good on him for being conscientious enough to get checked, but it's a case of "we're lucky" and not "we're good."

For the curious:

The current anonymous/Democrat position is open borders, let 100,000 migrants living in camps in Mexico into the US literally tomorrow, and override Trump’s restrictions and quarantines on travel.

The anonymous/democrat position is to remove all travel restrictions and restore flights. Seriously....this is what they’re pushing. Flights from Wuhan and Beijing and Tokyo with no quarantine. Flights from Lombardy and no quarantine. Flights from x...

🤔

You’d think even the Bernie Bolsheviks like anonymous would support not importing pandemics. Apparently being against disease is now Fascist.

Why do you do this?

I have never said that.

Oh, I thought you supported the Democrat Party candidates. Are you pro-Trump now?

This is the actual position of every Democrat party candidate for president, and in fact the Democrat party apparatus has been attacking Trump for quarantining travelers from both Wuhan and China in general.

Actually the Democrat party just won an Appellate court victory to let in 200,000 illegal immigrants from abroad; the expectation is the Supreme Court will stop it....

We’re at a weird point where the border restrictionists are actually correct. The anonymous response has been to challenge an order to keep potentially infected 200,000 migrants a month from permanently moving to the US.

200,000 illegal migrants from Corona centers, that’s the plan.

Ignoring most of this confused comment.

The comment above talks about spread from Italy. Do you think we have border controls against Italy?

Have you been drinking? Even for you, this is outlandishly obvious lying.

Serious question: So you treat someone the same if they have the flu or if they have the coronavirus? Even assuming it's a pandemic, do you give the flu patients drug A and the coronavirus patients drug B? If nothing else, you'd be more careful about contagion with the more virulent disease, wouldn't you?

Im not any kind of medical person, but there are influenza drugs which surely won't do anything to stop COVID-19. And I'm pretty sure if you look to have COVID-19 right now, you're going to be in an isolated room where nobody ever goes without mask, gown, and gloves; nobody's going to do that for the flu.

“How can this persist?” Because regulations are written to say “No,” and they are written by people who love the power of “No.”

"n the US, there’s always the risk of people not getting tested due to fear of medical bills. The Miami Herald reported that a man who had traveled to China and developed flu-like symptoms after returning home was charged $3,270 for diagnostic tests at the hospital (it turned out he had the flu). It’s easy to envision a scenario where many sick people avoid getting tested for Covid-19 because they fear what it’ll cost." Fix that.

For the same reason that nobody offers meat tested for mad-cow disease -- because the feds have forbidden it and nobody is in a position to defy them and get away with it.

weponder

the odd/crooked optics in a legal hearing when spanberger1 asks Pompeo questions but answers her own questions instead of allowing
Pompeo to answer the questions!
https://www.youtube.com/watch?v=OKifiMcnnek
1 university of virginia 50,000 American dollars/per anum

The tests aren't terribly reliable, resulting in lots of false negatives and probably a lot of false positives, too.

Few cases have been reported in Singapore. That's because the government is competent.

Few cases have been reported in the USA. That's because the government is incompetent.

This may well prove to be true.

That also means they are competent at lying to you, describe your confidence level in their numbers

My wife is a primary care physician with a very large west coast health system and they have provided no guidance on ordering COVID19 tests yet.

My son-in-law in Springfield, VA was refused a test when he went to the hospital yesterday with obvious flu-like symptoms.

Chickens coming home to roost, trump and his enablers have driven away experts and integrity...remind me what happened when you didn’t pay the piper

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