We do not yet have testing “takeoff”

Comments

Testing still takes manpower to administer so that could be a bottleneck.

Lots of unemployed people. Manpower should not be a problem. Training can be a bottleneck, but these are easily predicted and addressed.

This has been driving me crazy for the last few days. We really need an order of magnitude increase in testing though, so even if it were marching up 10-20K a day that would not actually be so reassuring. Nevertheless, the lack of testing in California is in a solid fourth place for historic US government failure after the federal government, states that are not sheltering in place, and states that told residents to shelter in place long after California.

Sheltering works without testing. That is kind of the big take-away for the last week.

Another one is that "can't smell anything" is not a terrible test. It might beat some of the worst clinical tests.

Michael Lewis is promoting a sense of smell self-reporting site that might be useful.

But then yes, in coming weeks we are going to need logistics for testing 3.7 million square miles, 330 million people. Without a national healthcare. Without any kind of standard for last-mile delivery.

The Koreans had it easy, with a national health care system tied to a national ID.

The Michael Lewis article is here.

More on how how South Korea did it:

"Mass testing and strict quarantine measures allowed South Korea to slow the outbreak without shutting down cities and banning travel."

Trumptards might get salty that South Korea succeeded without travel bans but unlike the freedom they so detest, South Korea shows the world how to do the job while keeping as much liberty in tact as possible. You just keep an eye on high risk targets like travelers from hot spots, you don't need mass surveillance. They went 100% into testing, quarantining any positives, and they acted swiftly. Masks, gloves, and social distancing should take care of the rest.

https://asia.nikkei.com/Spotlight/Caixin/In-Depth-Why-South-Korea-is-winning-the-coronavirus-battle

South Korea benefited from being essentially an island nation with a single infection vector (the church). Their experience just doesn't generalize, which is why *no* other nation (except a couple of islands) has come close.

OMG, you don't think South Koreans travel for any reason other than church?

In 2019 South Korea actually had 17 million foreign visitors.

https://en.m.wikipedia.org/wiki/Tourism_in_South_Korea#Arrival

Stop the handwaving already.

We know the course of transmission in South Korea. People need to be kept aware when someone's distorting the facts for political reasons.

Also, citing Wikipedia for irrelevant trivia is prior's shtick.

"Also, citing Wikipedia for irrelevant trivia is prior's shtick."

To be fair, while it was not directly relevant it was at least somewhat relevant and anonymous did't follow up with a wall of copy pasted text. So, not really as bad as prior.

And to directly answer the point anonymous is trying to make, South Korea has far fewer points of entry than the US or Europe does. They have 4 major international airports, no major passenger trains coming into the country and 2? major ferry ports.

They did things far better than any North American or European country did, but they also had some significant natural advantages.

A useful metric might be travel/population ratio, if anyone wants to bother.

17m visitors to a country of 52m looks high as a first pass, not counting outgoing and returning citizens ..

I think that South Korea has the largest numbers of foreign nationals in China, not counting Taiwan.

It still is vastly easier when you have no land borders and exceedingly few entrepots.

If we look at nations that have successfully avoided exponential growth in Covid cases the list is: Taiwan, S. Korea, maybe Singapore, maybe Japan, and then a bunch of tiny island states.

Europe has failed to contain it. As has South Africa. As have many other nations.

The whacky church was lucky for South Korea. Like with Washington state, you had an early hit on the radar, it was in an easy to trace location, and it lead to earlier measures being taken.

There is a lot that has been done wrong here, and I fault a lot of my usual suspects - the petty bureaucrats who run healthcare. But very few places have managed to do much more than increase the doubling time by a day or two.

If this were a simple case of failed leadership, then how exactly is it that it has occurred in Italy, Spain, France, Germany, The UK, Brazil, Russia, Saudi Arabia, and a host of other places as well?

If South Korea's success were generalizable with facts on the ground back in January, then some mainland state would have done it.

As is, I suspect the big variable was that east Asian states got crazy scared by SARS and built up a lot of social and real infrastructure to deal with it. Other places, having not built out those capabilities, got pretty uniformly shellacked. The time to fight this pandemic was back in 2018, yet everyone was more concerned about the petty antics of Trump, the economic costs of hard or soft Brexit, the yellow vests, Justin Trudeau's blackfacing, and other politically salient debates. Kudos to east Asia for taking the responsibility of governing more seriously than elsewhere, but let's not pretend that these are anything other than systemic failures, mostly brought on by the voters not caring.

Or in the specific case of South Korea, it is the last nation that still credibly expects to be subject to ABC warfare, and is thus prepared at a level last seen anywhere else at the height of the Cold War.

If this were a simple case of failed leadership, then how exactly is it that it has occurred in Italy, Spain, France, Germany, The UK, Brazil, Russia, Saudi Arabia, and a host of other places as well?

Some of these are not like the others.

Deducting Yemen, the Arabian peninsula has a resident population of 54 million, greater than that of Spain and just 10% shy of Italy's. The 1st case was detected on 29 January, about 9 days after the first case was detected in the United States and prior to the first case being detected in Spain. The number of coronavirus deaths to date on the peninsula is 36. The first case detected in Russia was found on 31 January. There have been 30 deaths to date.

Your examples lack all the Chinese provinces outside of Hubei that are as well as can be given the circumstances. They are not tiny little islands and in fact share borders with and conduct trade with Hubei. As another counterexample, the UK is an island they are struggling a bit here, I mean even the Prime Minster is infected.

Europe didn't learn from the SARS epidemic while Asia did. Masks, gloves, social distancing and other habits that inhibit spread are completely lacking in Europe. These can be learned and will be learned the next time around. Parents will teach their children. People won't be mocked for wearing masks or for taking seriously "a little flu".

South Korea is a bit special because they flubbed SARS when it happened so they compensated for that with rapid testing. I think the conclusion you are drawing with the church is not the right one. It's not that South Korea was lucky because it was just that one church. No you have it backwards, because the government caught it early through contact tracing, they were able to contain it to just that church. That situation could easily have gone exponential had they not been so aggressive and effective. Seoul is one of the world's most dense cities.

"If South Korea's success were generalizable with facts on the ground back in January, then some mainland state would have done it."

That requires people outside of Asia actually understanding those facts. Nobody in the Western Hemisphere did because it wasn't in their immediate experience. I won't quote any leaders but everybody in the West played it down.

I worry that if people say you need to be an island or that you must do travel bans or shutdowns then the real lessons to be learned here will be lost and people will gravitate toward these extreme and costly measures as a first resort rather than as a last.

I know you're all bored, but you have to ask yourselves.

Is hand-waving really the most useful reaction in a crisis?

What exactly do you think you are doing?

I am talking about the changes we can and should make.

Moar national healthcare.

Specifically your post is an example of hand waving away the other sides argument. Furthermore, people countering your argument with logical arguments is Not hand waving.

I think you are slow on the uptake here.

I've been a fan of some kind (actually any kind, as in "pick one") of national healthcare.

Many of you have argued with me that we don't need it, health is personal responsibility, and besides current government programs (which you are constantly trying to cut) are more than enough.

Well, that has turn out to be pure bs.

A public health crisis is not the same as national healthcare. Maybe you could just avoid derailing another thread and stick to the topic.

That answer is literally the kind of hand-waving I'm talking about.

A national healthcare system is incredibly useful in a national crisis like a pandemic, because its focus, last mile delivery to every citizen, is exactly what you need.

Now, if you want to hand-wave this some more, describe your last-mile alternative. Remember, there are tens of millions of Americans without health insurance, and others worried that their poor health insurance will still break the bank.

What do you do? Say this is already the best of all possible worlds?

No you troll, i'm saying that you are attempting to derail a post with what you want to say versus the actual topic. Again!

You joined me, where I was already talking about just this:

"yes, in coming weeks we are going to need logistics for testing 3.7 million square miles, 330 million people. Without a national healthcare. Without any kind of standard for last-mile delivery.

The Koreans had it easy, with a national health care system tied to a national ID."

(You just think I'm "derailing" my own topic because I didn't go down the "but, but, Korea is special" primrose path.)

So since every other country has national healthcare, why are they all failing as badly or worse than the U.S.? Where is your evidence that national healthcare is what we need for a pandemic?

A necessary but not sufficient condition?

The problem with pandemics is that you want to get some minimum level of care out to everyone, to stem propagation. A universal system has part of that. They get out to everyone. It's then a question of whether they can meet the minimum performance standard.

A pure market system doesn't even try to reach everyone.

A mixed system, like ours, hopes with a wing and a prayer that our combination of for-profit, non-profit, and governmental programs will manage to reach anyone .. but without any integrated database to know if that even happens.

Yesterday, the total new Covid-19 deaths in twenty-nine of thirty-five OECD countries came to under 800. The U.S. alone had over 1000.

National healthcare doesn't seem to have helped anyone at all. It just doesn't seem to be a variable that matters.

Which sort of makes sense. What's it supposed to be doing exactly? Even if you have ample access to ventilators, which most national healthcare schemes don't have, 80% of the people who go on those ventilators are never coming off alive.

S. Korea could do nationwide testing, and track and trace.

Has anyone done that without "teh socialism?"

As many others have pointed out, South Korea got lucky in many respects, and it still seems to be getting out of control there.

Across the world and the full spectrum of healthcare systems, nothing "healthcare" really seems to have helped. Note that having a lot of ventilators might help delay your deaths relative to the recognition of the cases, but it's mostly just delay. You can see that as the South Korean and German death rates creep up towards the world average.

Being a police state may have helped China, although the evidence is increasing that those numbers were fraudulent. Travel bans bought time, but they came too late and were too leaky. Being an island is like a natural travel ban. Shelter-in-place seems to slow spread.

Other than that, nothing seems to have worked. We're basically waiting for effective therapies and a vaccine. Try not to get sick in the meantime.

"Korea is special" is such a bad answer. So bad I'm not even interested anymore.

And again, we face the contradiction. Many libertarians want "more testing" but they won't talk about how it is delivered at the last mile, to stem a pandemic.

I can explain it to you. I can't understand it for you.

South Korea had a SARS outbreak within a generation, so both the leaders and the population were ready to react promptly before it became a big problem.

South Korea had a testing system set up quickly. You can track and trace if you have lots of tests relative to cases.

Luck matters, too, because the footholds of the disease are related to where the rare super-spreaders happen to be. The start can be fast or slow. After a while growth becomes predictable because it's in enough people that large numbers take over.

The US health care system has a fetish for diagnostic tests, typically beyond what is rational on a QALY-per-dollar basis. If the US had gotten testing off the ground quickly, we could potentially have clamped down on the cases. It's too late for that, though.

Testing. More of the middle and lower classes of countries that have national healthcare get tested. There is also the advantage of better coordination during a pandemic. We don't want a repeat of the 50 US states trying to outbid each other for masks only to lose to foreign governments that got their act together.

Sure, that's why Europe is doing so well. Thanks for your helpful comment.

It's all deck chairs on the Titanic and people are trying to score political points over it. "Look, my deck chair arrangement is nicer!"

The only thing that has worked is limiting mobility, and obviously that's not a great solution.

Tom T., you are rightfully being taken to task for ignoring the millions of travelers that traffic in and out of S. Korea. The UK is an island with lots of travelers too but it has much more infections and deaths than S. Korea even though S. Korea has tested more of its country than anybody else. How did you think Italy got infected? It wasn't from its land border with Switzerland or France was it? Testing for air travelers from risky parts of the world with quarantine is enough to do the trick and the least invasive. There is something to generalize here but you fail to see the obvious.

https://theworldnews.co/why-asias-new-coronavirus-controls-should-worry-the-world/ -

"South Korea, which has been praised globally for flattening the curve shortly after an early explosive peak in infections, initially required vacationers from some international locations to quarantine. This week it expanded the record to cover the entire world."

"China, Hong Kong, Singapore and Taiwan have merely shut their borders to just about all foreigners."

"Park has called for a complete entry ban on foreigners.

'It is time to make efforts to protect one another on a global level by practicing international social distancing,' he stated."

Those that smart will understand that freedom to move between countries will always come well behind ensuring freedom to move within a country.

Hawaii is now forcing any American citizen that arrives to quarantine themselves for two weeks. France has just announced there will be road blocks covering their road network (particularly the toll highways used by holidayers) over the Easter school holiday.

Pandemics also force the smart to recognize that movement within a country will always come well behind a locality trying to stop being exposed to a disease.

M, your website is fake news. Marvel at these bits of well-crafted English:

"South Korea has but to bar entrants from anyplace however the Hubei area of China."

"Park has known as for a complete entry ban on foreigners."

It got so dizzy reading it I thought I got the coronavirus. Even some of the sentences you quoted above aren't even grammatical.

It's a mirror of the same thing on NYT - https://www.nytimes.com/2020/03/31/world/asia/coronavirus-china-hong-kong-singapore-south-korea.html

I thought people would prefer a lack of paywall so grabbed the first mirror I could find, but it does seem like there are spelling mistakes from translating to a third language and translating back to English.

Doesn't change any of the substance tho. There's a mirror on MSN with the same content, without the spelling mistakes:

https://www.msn.com/en-us/news/world/why-asias-new-coronavirus-controls-should-worry-the-world/ar-BB11XSdu

that meme that south korea did not ban travel is not true
they did ban travel from wuhan

Maybe that is a pithy question for the libertarians. If you want a lot of testing, who do you see doing your last mile?

What is the "last mile" in testing someone? Isn't that a term from shipping? If you are talking about who will do the tests I would assume doctors or other healthcare professionals, what are you proposing?

Should "sure" answer that? Is he out pulling people from their cars and giving them nasal swabs?

Who should actually be doing the throat swabbing? How about the patients themselves? This has the obvious added advantage of no healthcare workers potentially being exposed.

What, you think the Q-Tip in the medicine cabinet is up to the challenge?

What? No, the kits would be delivered. Are you worrying about what might happen if all shipping services are all shut down? Then the backup plan would probably be to have them available for curbside pickup (and drop-off for the completed tests). The point is that we really don't need medical staff involved in the swabbing, shipping or test running.

Do me the favor of fully explaining your idea.

In the American system, who delivers kits to everyone, either nationally to everyone, or even in some sub-group like track-and-trace, or recent travelers?

This has nothing to do with nationalizing hospitals.

The bottlenecks are not the point of testing anyways, so your last mile makes no sense. It’s not the right term, it’s not the bottleneck, and it’s an off the wall take.

Literally nothing you’re saying is relevant.

It might be easier if you put forth an actual hypothesis:

Nationalized healthcare allowed countries x,y,z to do these things strictly because they were nationalized. You haven’t even tried.

I checked back in to see if you actually have a plan, and the answer is no.

You do not name which agency has the funds, the personnel, or the charter to carry out national testing, even if it is by mail.

I mean by mail is fine, but showing up without anyone in charge or actually doing it, is magic.

Most of your questions make absolutely no sense.

As it stands Walgreens and CVS are committed to ramping up drive through testing. That’s 20,000 potential locations, with a presence in all 50 states, PR, and the Virgin Islands.

The pharmacy chains have been transitioning to having onsite easy access outpatient clinics anyways.

Last mile delivery is .... not even remotely a relevant statistic here.

You never understood the "universal" part of universal.

You name anecdotes and pretend they are universal.

And seriously do you think "track and trace" means "hey, you could have gone to Walmart, what's the problem?"

The U.S. is still on the taxiway, not even the runway, if we are using Italy as a guide to a best case scenario in terms of response. And has the U.S. started post-mortality confirmation of infection like the Italians? The Germans don't do it, as they think that if there is any particular value to such testing, then blood samples from already buried cadavers should be adequate later. In northern Italy, cremation is how the hundreds of bodies a day are being handled (avoiding as much contact as possible between a likely still contagious body and the removal of any further danger by cremation). Germany still has regular burials - if very limited in terms of participants/practices.

Both countries use the same standards for counting covid19 fatalities, it is simply the Italians are using part of their testing capacity on the dead, unlike the Germans, who have the current luxury of a low death rate. worldometer - Deaths/1M pop Italy 218, U.S. 15, Germany 11

The current testing still only reveals people with active virus. It is sensitive, in that it can return positive for only one virus (assuming that virus makes it onto the swab). But I don't think it even gives a quantitative value of virus load.

The coming test for anti-bodies will have real value in planning since it will reveal who has met and overcome the virus and who is still a possible future medical case. We are also learning who is likely to need medical attendance and who will just recover at home due to co-morbidities. Diabetes and pre-diabetes seem to be significant risk factors as is 30+ BMI for serious cases.

What's your source for only one virus making the test positive? Sounds too low, even with PCR, though I understand in theory that could be the case.

Source: am diagnostics professional, just not in ID (infectious disease).

The PCR testing is called 'reverse transciptase real-time PCR' or alternatively 'reverse transcriptase quantitative PCR', and the number of PCR cycles and thresholds gives a number (from 20 to 40+) called Ct.

While not reported (it is either positive or negative in terms of what the physician gets back) it is recorded, and thus can be used to calculate amount of virus.

Was looking at this JAMA paper here, with interesting data of sampling patients from different, um, places in the body over time. https://jamanetwork.com/journals/jama/fullarticle/2762997

+1, informative. Thanks!

Thanks Dale. Antidote to hand waving is real research. I wonder if you have an opinion about the lower threshold of detection of RT-qPCR as discussed above? Will 1 virus will yield a positive?
Also I have a bleg, does anyone have an article that reviews, in biochemical terms , what went wrong with the initial FDA analysis kits? I’ve heard it was ‘defective reagents’ but what reagents? The primers? Also I heard a shortage of RNA extraction kits? I’d like to know more about the mechanics of the analysis but am finding detailed information hard to come by.

The newly approved Abbott Labs 5 minute test doesn’t use PCR but a new amplification technique called LAMP, for loop mediated iso thermal amplification. Results +/- can be read by eye sometimes? Does it give an idea of viral load? Aren’t humans clever!

The virus test should just be thrown away at this point. It's use does not dictate the protocols used to treat patients and its only apparent use is to create wildly inaccurate statistics for scare headlines. If is were applied stochastically, then we might gain some insight into the spread of the virus.

The anti-body tests are the only real solution to getting back to normal. It will show who is immune (and later how long they stay immune) and allow a confident return to social activities and better healthcare.

+1

And from what I am hearing from friends and family around the country who have developed symptoms, this is what doctors are doing already. Example, 40 year old friend with no additional health concerns came down with fever and dry cough. Doctor advised not bothering to get tested but to rest, hydrate, and call back if condition worsened. Similar stories elsewhere.

It is not like "track and trace" was ever going to happen anyway. The whole testing fiasco is a tempest in a teapot. The quants want numbers but the numbers would never have been useful anyway and they numbers being reported tell us nothing.

It’s throwing the baby with the bath water. Because testing was lamely introduced it doesn’t make it useless. If the results come back timely ( < 6 hours in Korea) It still tells you who is infected and therefore what should be the course of action and how the infection is spreading.
Antibody tests are useful but not a panacea. They don’t show a result until up to 9 days after infection ( 5 days mean incubation + ~ 4 days of symptoms). They also have their own specificity/ sensitivity issues.
We need both.

Seroconversion May be a bit longer than 9 days but still shorter than HIV which can take 3-12 weeks. Good news.
https://www.medrxiv.org/content/10.1101/2020.03.02.20030189v1

Taking deaths and critical cases as hard data, as they're difficult to hide and fudge (UK being an exception), one can get a very rough estimation of the virus spread; with a ~2 week lag it takes the disease to progress.

Onboard Diamond Princess roughly 1/30 of the infected either passed away or are in critical condition. Average age of the passengers was at 69 years, so multiplying (critical + dead) * 30 gives you a lower bound.

Iceland's numbers, skewing young, indicate multiplication by 90, but many of the infected haven't had the disease long enough to develop critical symptoms. Korea's numbers suggest multiplication by 50. Guess: 50 as a multiplier for an upper bound.

Plugging in the numbers, 300k-500k people in the US had the virus 2 weeks ago. Even weaker guesswork: 2M-3.5M have it now.

I truly hope I'm totally off.

It suggests there are many countries whose confirmed cases today are a factor of 5 or worse from where they were...2 weeks ago.

No need to speculate.

Italy - cases/deaths March 17 - 31,506 - 2503 / April 1 110,574 - 13,115

Frances - cases/deaths March 17 - 6953 - 175 / April 1 42,022 - 4032

Seems like the data is not all that consistent, in part because things breakdown in a country experiencing the first wave of the pandemic. The Italians were unlucky in being the first country with broad viral community spread, which makes France a bit more relevant in looking how a country that had at least a bit of warning was able to deal with things. Poorly would be the simple summation. By the end of the first wave in the industrial world, the Italians may come out actually looking fairly good, particularly after accounting for a couple of fairly unique factors.

The Italians were unlucky in being the first country with broad viral community spread

....China? There were three months between first infection in Wuhan and Lombardy. Italy had at least a month to prepare. As did Germany and France.

Just like Japanese numbers need to have the Diamond Princess excluded, the Chinese numbers basically reflect a single region, and not an entire nation. There is no question that Italian community spread started in Lombardy, but unlike China, the Italians were completely unable to keep the disease basically contained in a single region while dealing rigourosly with it appearing anywhere else..

Of course the entire world had time to start preparing by late December. The French did poorly, but the Germans having their first case on 27 January seem to have prepared considerably better, at least looking at their current numbers not going into the extreme rise being seem in Italy, Spain, France, or the U.S.

"the Chinese numbers basically reflect a single region, and not an entire nation"

Hubei province has more people than Spain and is in the same neighborhood in terms of population numbers as the U.K., Italy, and South Korea.

If the entire population and productive capability of North America and Europe was combined to fight the pandemic in Spain alone, it would also represent how China responded to the outbreak in Hubei province. One could say that China and India are in a class by themselves in many ways.

China had outbreaks of up to 1,000 people all over the country. Millions of people got out of Hubei in advance of the lockdown.

The testing numbers for the US may reflect greater testing in hospitals, but testing per capita is very low relative to other countries: and the 5 day moving average of reported cases is off the charts: https://coronavirus.jhu.edu/data/new-cases

Also, restrictive testing led to greater problemshttps://www.wsj.com/articles/how-the-cdcs-restrictive-testing-guidelines-hid-the-coronavirus-epidemic-11584882001

By the way, the covid tracking project data is here: https://covidtracking.com

On the point of testing per capita, the US is below Greece, so even though the graph above shows an increase, it is meaningless because it is not stated in per capita terms: https://www.nytimes.com/interactive/2020/03/17/us/coronavirus-testing-data.html

Here is more per capita testing data: https://ourworldindata.org/coronavirus-data

Sorry, but data from March 20 is meaningless at this point. Unless there is some updated link that I missed.

Completely meaningless. That's actually data from the day ending of March 19th. It records US testing at that point as 104K.

The US has vastly ramped up testing since then and is as of yesterday at: 1,169K tested

I guess you have difficulty reading charts, and looking at data or computing your own.

Total population of the United States is 327 million..
From JWatts unlinked data claim: 1.17 million tested.

Divide 1.17 million by 327 million: equals .0035 or .35% of the population.

Now, let me take you by the hand, and go back again to the tables showing percentage of population tested. March 20 was .31% Now go back and look at the tables again: we rank on par with the Philippines.

You never bothered to look at the data, to look at the charts, or even to look at the total population of the US .

Yes, Bill I did look at the data on the charts. It's clearly wrong. Because on March 19th the US has not tested 0.35% of its population.

What is your point, that the site has old data and some of it's either wrong for the time or is current but the chart is mislabeled with an old date?

The US is behind in testing, that's not News. It's not nearly as behind as it was 10-12 days ago, because we've increased our number of tested by 10 fold during that time period.

If you've got a current, better source, I'm certainly willing to look at it. But that data is clearly old/bad.

Actually the chart isn't incorrect.

(COVID-19 data as of 20 March: Total tests performed per million
people)

It shows that the US had tested 0.0314% on March 19th. (313.6 out of every 1 million)

Currently (as of yesterday) the US has tested roughly 0.35% of the population.

The data you are looking at Bill is old.

I have to laugh at you once more.

First, I was the one, not you, who pointed out in my 4th post above that the change was now ,035% using YOUR data and doing simple division.

JW, you have a problem.

Perhaps you can't divide. Perhaps you think .035% is not equivalent to what the Philippines the was testing.

Perhaps you expect persons not to follow the thread.

Defend .035%.

You can't.

Bill you got me. I can't defend 0.035%.

That's because the current figure (4/2 12:40) is:
1,179,589 tested

https://www.politico.com/interactives/2020/coronavirus-testing-by-state-chart-of-new-cases/

The current US population is: 331 million

1.18 / 331 = 0.356%

Bill, you really should double check your own math before saying things like: "Perhaps you can't divide. "

You didn't read above , where I said it was .35%. Quote: " Divide 1.17 million by 327 million: equals .0035 or .35% of the population. "

You knew that I had earlier said .35%.

So, defend .35%.

What bothers me about you is that you mindlessly defend incompetence and ignore facts.

So, here is one for today.

My wife emailed a friend living in a suburb of Detroit. She didn't respond, but her husband did. She has been running a fever and is sick. Called the doctor. Doctor took a regular flu test because covid tests are scarce. Doctor advised staying inside and treating it as covid because the only place to test is at the fairgrounds, where there was a 2 hour wait, and based on absence of some symptoms she could be refused.

You are something else.

Keep defending the indefensible and we will all die.

You go first.

The basic facts:
On March 19th the US had only tested 0.0314% of the population
As of April 2nd, the US has significantly boosted testing and has now tested 0.35% of the population.

Bill seems to be making some indecipherable argument at this point. At this point it feels like he is just trolling me. Everyone can read the math above.

I've got nothing left to say in this pointless argument.

Yeah, you give up after you're exposed for misleading, knowingly misquoting (I did say .35% above), denying, and refusing to answer why we are testing below the rate of the Philippines. And, whether .35% is adequate.

My comments are quite understandable, and that is why you cowardly refuse to defend .35%.

Shame on you for taking everyone's time and for your obfuscation and avoidance.

In other words, the Worldometer site for the USA is garbage, since the number of total cases shown is limited by the number of tests being done in the USA? Wonderful. We're screwed. No wonder there's not 'topping off', it's just a measurement error. More tests administered will reveal more US Covid-19 cases.

Keep your eye on deaths. New York state trails only Italy and Spain in per capita deaths as of today, and Italy and Spain are slowing compared to NY.

Ex-New York, US death rates are currently lower than Germany, tho there is some sense that the US has a longer fuse and will pass Germany without New York's help.

Through yesterday, Belgium had 828 dead, and still growing quickly. Similar-sized Illinois has 141 dead, also growing quickly, but from a much smaller base.

What's up with Michigan, though?

Automaker China connection? From what I hear, Detroit is being hit. This thing started among the jet-set, but if it takes hold in poor areas (fewer resources, more overcrowding, more underlying health conditions, more communal living and shared public spaces) it could get very ugly.

+1, Detroit county (Wayne) and the 3 surrounding counties are the hot spot in Michigan. Over 70% of the cases are in those 4 counties.

State infection map here: https://tinyurl.com/rww5khp

"The high number of COVID-19 cases in Detroit and Wayne County tell the story of a community with a disproportionately poor population, with high rates of asthma, diabetes, heart disease and high blood pressure"

“Around 50% of people in Detroit are Medicaid eligible, and there are very few clinics that even take Medicaid,”

“And you have a situation where basic utilities are limited …”

https://www.freep.com/story/news/health/2020/03/26/michigan-detroit-coronavirus-testing-covid-19/2914611001/

At least in NY, where in a couple of days, basically no doctor will act like this one did. "The patient was breathing 60 times a minute and within seconds could no longer answer my questions. I rushed to grab a plastic gown. There were none left. But we needed a breathing tube fast, and putting one in even with gear on puts everyone around me at risk. I ran to the metal racks, grabbed a yellow patient gown and put it over my head. I looked down at my arms, exposed from the elbow down to my glove. Better than nothing. I threw one at the nurse and a co-resident and ran into the room.

We began to resuscitate the patient, pounding on her chest, inserting a breathing tube, pushing epinephrine, guiding a crash femoral venous line into her leg. Anything to keep her alive. This woman died in front of me and came back. I left my shift that day, walking past her distraught family standing on the curb worrying about their mother who was fine just hours earlier. She was hanging on by a thread. I held back tears, got in the car and drove away. Hours later, she died."

This is what has been going on in Madrid, and Milan, and Strasbourg for weeks, without anyone attempting to keep such a patient alive a few hours more at this point. It is what happens during this pandemic, and there is no escaping this horrible truth. The medical system collapses, and no longer wastes any effort on what have clearly become futile gestures.

Testing is used for a number of reasons, and is required, but it pales in significance to the actual results of having so many sick people appear at once. The proper discussion now turns to how people respond to such a collapse, and how to recognize that this sort heroic thinking is going to being drowned under the growing wave of sick people. "ER doctors are drilled on how to identify who is sick and not sick. She was sick — minutes from death if we didn’t help her." Even with help, she was simply hours from death. Like many thousands of Americans will be in the next days and weeks.

It is extremely difficult for any society to get ahead of what happens in viral time, not that the virus cares.

Well, if healthcare workers don't or can't make any difference, then the only there's left is god. Oh wait, church services are suspended.

Any libertarians found God during these trying times? It's usually what happens historically or are we too autistic and modern for Bronze Age fairy tales?

That's nice God caused this and now we should pray to him o make it all better.

One good thing about being a faithful Catholic is that we have thousands of years of greats to draw on (the communion of the Saints) in the face of these kinds of statements:

From two of my favorites on these topics (Augustine and Aquila’s):

Augustine says (Qq. 83,3): "No wise man is the cause of another man becoming worse. Now God surpasses all men in wisdom. Much less therefore is God the cause of man becoming worse; and when He is said to be the cause of a thing, He is said to will it." Therefore it is not by God's will that man becomes worse. Now it is clear that every evil makes a thing worse. Therefore God wills not evil things.

I answer that, Since the ratio of good is the ratio of appetibility, as said before (I:5:1), and since evil is opposed to good, it is impossible that any evil, as such, should be sought for by the appetite, either natural, or animal, or by the intellectual appetite which is the will. Nevertheless evil may be sought accidentally, so far as it accompanies a good, as appears in each of the appetites. For a natural agent intends not privation or corruption, but the form to which is annexed the privation of some other form, and the generation of one thing, which implies the corruption of another. Also when a lion kills a stag, his object is food, to obtain which the killing of the animal is only the means. Similarly the fornicator has merely pleasure for his object, and the deformity of sin is only an accompaniment. Now the evil that accompanies one good, is the privation of another good. Never therefore would evil be sought after, not even accidentally, unless the good that accompanies the evil were more desired than the good of which the evil is the privation. Now God wills no good more than He wills His own goodness; yet He wills one good more than another. Hence He in no way wills the evil of sin, which is the privation of right order towards the divine good. The evil of natural defect, or of punishment, He does will, by willing the good to which such evils are attached. Thus in willing justice He wills punishment; and in willing the preservation of the natural order, He wills some things to be naturally corrupted.

*Augustine and Aquinas...

Not in Florida or Texas, probably several other states too, which is a huge mistake.

Florida arrested a pastor for illegally holding service. No such luck in Texas.

https://www.usatoday.com/story/news/nation/2020/03/31/coronavirus-florida-megachurch-pastor-arrested-church-amid-orders/5093160002/

If you read the order they issued in FL yesterday, you'll see that "religious services" are the first enumerated type of "essential services" that are exempt.

Might be a county/state issue:

"Last week Hillsborough County issued an order directing residents to remain at home effective March 27 except for “essential services” — including trips to the grocery store, the doctor’s office and the pharmacy. The county’s list of “essential services” does not include attending church."

https://localnews8.com/news/2020/03/30/police-arrest-florida-pastor-for-holding-church-services-despite-stay-at-home-order/

Hopefully we're not going to make public policy decisions based on an anonymous anecdote from a troll.

Sadly, he uses a different handle every time now, so you can't use a filter to clean out his commentary.

Don't people here read the Washington Post? The link for that anecdote is https://www.washingtonpost.com/opinions/2020/04/01/if-you-could-see-my-hospital-you-would-know-horror-covid-19/ and the person that wrote it is Danielle Stansky, an emergency medicine resident physician in New York City.

You may not want to make policy from anecdotes, but I certainly trust information from someone who is actually dealing with COVID19 compared to commenters here. At least she is risking her life to help others. Even if she has to put on a patient gown and leave her arms bare to do it.

I trust here more than the Washington post. At least some of the commentators here aren’t actively trying to lie to me.

Prior stated that: "Discussions about testing are no longer particularly relevant at this point in the pandemic"

Then he posts anecdotal data from NY. NY (NYC in particular) is in the middle of a crisis. But that doesn't mean that testing is useless in NY. And it certainly doesn't mean that testing across the United States isn't relevant because of the current state of the pandemic in NY.

Unfortunately you all are missing a key factor here: people are not utilizing the full testing capacity available because they don’t want a test. In other words, the disease is less widespread than you think and daily new infections are about to fall off a cliff. Check out your local testing location for availability, you won’t be disappointed.

This is not accurate - "daily new infections are about to fall off a cliff." The virus cares nothing about testing and confirmed case numbers.

Of course they make a difference, just not in all cases or circumstances, as that ER doctor will likely rapidly learn. Triage will definitely involve DNR orders and the (possibly unstated) reality that people over a certain age will only be offered palliative care as they die.
This has been true in Italy and France (I have seen no reports from Spain), and will undoubtedly be equally true in the U.S.

Age will be a major determinant in this process, as healthcare workers make a lot of difference for a 25 year old ICU patient, and very little difference for an 85 year old on a ventilator.

The spread theory is not yet elucidated, still all a speculation, so I add mine.

Phase two cases, the one NYC is dealing with, are all the cases spread in mass gatherings before the virus was well known.
Phase three are the cases where the virus has to opportunistically escape to smaller gatherings, the virus has been somewhat bottle up..
Phase one, the first phase were the international travelers.

My unit of account, for phase one, is eight hours at a mass gathering with one spreader, we have a number for that, we know that unit. Then I take the daily life of a New Yorker, break it up into chunks of that unit and let the rate churn out. I get that New York is there, they have about 30% immunity, either yesterday, today or tomorrow sometime. They should be about past the peak.

https://www.fresnobee.com/news/coronavirus/article241695671.html

First homeless patient tests positive for coronavirus in Fresno
---
One homeless camp is one mass gathering for eight hours a day each day. We have that number. This is the equivalent of a packed subway car for this ag valley of five million. Our spread rate is both slower and delayed, we do not have regular conventions, mass commuting on rail, or a strong restaurant sector.

So phase two is all the homeless camps spreading into central Fresno, almost certainly. Each homeless camp will be decimated. This will happen in LA. The two places are suburban car cultures, spread rate will be lower. NYC will suffer the sharpest, shortest peak of all.

And yet it's taken this long for a confirmed case to appear along the homeless. I guess I wonder if they pack as closely as you suggest (here in DC there seems to be a lot of separation among them), and they don't interact with the outside world all that much, particularly with local business shut down. Presumably they skew younger, too, and it's not clear whether the high rate of mental illness and substance abuse figures into virus susceptibility.

Costs will be lower, per capita, out here in this ag valley of Fresno. Our spread rate lower, the peak smoothed out, we do not need as much of a temporary surge in hospital beds. We need about 500 extra beds for about three months. That is a smaller logistics problem even though the total hospitalizations per capita remain the same.

It hasn't been in the headlines but there are explanations for this that have been buried in some of the reporting if you read closely enough. A month ago it was all about increasing testing because there seemed to be a chance for containment and the press needed something a scandal to fixate on. Now, it's not clear that containment is possible and the testing scandal is behind us. So now we're in a position where we have tests BUT:
1) administering tests takes time and resources...including the PPE that are now in very short supply...so providers are reluctant to test more than necessary.
2) the recommendations following a test are pretty much the same whether positive or negative...stay home unless symptoms become extreme

The limited testing is frustrating from a data perspective. We really don't know enough about the scope of what we're dealing with. How widespread is the virus? How deadly is it? How does one country or mitigation approach compare with others? But, on the front lines of care, where testing and treatment is being administered, these questions are secondary.

The idea of lockdown is that we drop the rate of viral spread low. Data out of WA suggests that R0 has been falling with these measures. If we can drop it low enough, then we can begin to test people and let them out of quarantine. It helps to know of those who are currently sick, who actually has Covid for later.

It particularly helps so that those symptomatic patients who just have the flu can be treated as far away from Covid patients as possible for now.

When we start to end containment, we will have cases that pop back up, if only those imported from countries that undertook no precautions or treatment (e.g. Turkmenistan). So eventually the hope is that we can let most people out of containment before they get exposed and then use testing to quarantine only those infected.

Administering tests is trivial in terms of time and resources within a hospital. The issue is that the results often don't come back for over a week. And the recommendations can be catastrophically different.

True story: A friends daughter got very ill, with high fever, cough, malaise. She was tested and admitted to the hospital. When she was at her sickest, the parents asked about experiment drugs, like hydroxycloroquine. However, they cannot be administered unless there is documentation of COVID-19 in the form of a positive test. Fortunately, she improved, and was released after 10 days. The test results still have not arrived.

The family doesn't know if they need to socially isolate, or be in strict quarantine. There are profound differences between "stay home" and quarantine.

For the test everyone crowd, can you explain how that will work? Is the belief that every American will voluntarily submit to testing? We are not a high trust, high compliance society (Germany, South Korea) , just look at how many folks are ignoring quarantine.

I am confused. South Korea was being praised for testing 15000 people per day, US is testing 100000 people per day. And Korea has roughly 15% of the US population. Thus, testing rates seem to be similar per capita, and the main difference seems to be that US started late, not that it is testing fewer people.

Can someone tell me what I am missing?

Korea has roughly 1/6 the population of the U.S., and many fewer cases at this point. So the South Koreans are likely catching most cases of transmission, and are still able to effectively trace and quarantine, which is the major initial reason for testing.

By this point, and according to Vice President Pence, the best case scenario for the U.S. is Italy - where tracing and quarantining is no longer part of their public health response. Testing still has value in various ways, but any particular emphasis on testing in the U.S. at this point is more or less misplaced.

South Korea was somewhat lucky/smart that were able to target their
testing/isolation strategy around the church members and trace their contacts

52% of their cases are from one religious sect but South Korea has also done a diligent job of testing and tracing the other 48%. Seoul right now has 488 confirmed cases, only 7 of which originate from the Shincheonji sect.

the church gave the epidemiologsts a good place to start & define the disease
Covid 19 didn't get mixed up with other uris &
masks problaby helped with limiting asymptomatic spread
south korea will likely be the model for how to handle the next pandemic (especially to study how they quikly ramped up their testing)
looks like the u.s. is gonna recommend masks soon

The hospital system was ill matched for the pandemic spread system, that is all. Hospitals were right to call for a sudden stop. In abstract tree we say the hospital , as a value chain, was relatively prime to the virus as a spreading process. Ill matched power spectrums. There was no way the hospital could make a department by department change and adapt, in essence. That would be an unobservable adaptation in the value chain. So the bulge in the tree trunk became quite visible to the hospital managers.

The adiabatic change, a node by node adaption of the structured queues in a hospital are supported by excess inventory, set aside for that. It has been eightyyears since they have seen a pandemic of this sudden magnitude. Abstract tree theory is very close to prime number theory, they are both about using approximations to avoid the work of generating a new prime when partitioning a new set.

Testing has been sporadic in count in TX due to weather. The big cities have hung their hat (probably for good reason) on drive thru testing, which is slower, harder or not realistic when the wind is blowing 30-40 mph and it's raining...which it has done in Dallas and Houston at least regularly over the last week and looks to continue for the next week.

There is definitely value in testing and testing early. Norway and Ireland are two countries on the periphery of Europe. Norway was aggressive about testing, Ireland laid back. On March 14, Norway had identified 1,254 cases and had 3 deaths. Ireland had identified 170 cases and had 2 deaths.

As of yesterday, Norway has seen 44 deaths, Ireland 85. We'll see where it goes, because Norway deaths are growing more slowly than Ireland, but this suggests early and aggressive testing can cut the death toll at least in half.

Covid-19 new deaths reached 1049 yesterday. Influenza and pneumonia claimed a daily average of 150 lives in 2017. Heart disease, the nation's #1 killer, claimed a daily average of 1000 lives in 2017.

I have stat of two elements.

The doorman spreading this stuff six weeks ago got it from the ER room on visiting his mom for other causes. The first ER nurse to return to work after virus remission was yesterday. That nurse, now immune, will slow the ER room from spreading it. The anti-bodies have covered the loop, chasing the virus.

The doormen will all soon be in remission, they were the first to catch and spread it. The virus is eating the easy clusters, the defenseless mass traveler in NYC. The parties and card games are gone, restaurants doing carry out. Blocked or immune.

An RT-PCR test is a snapshot in time. This stupid idea that you are going to test everybody and have a major impact on the course of this crisis is just that- stupid. I don't care how you try to do it, the logistics would require 1 to 2 months just to get a results that would would be irrelevant after the first week.

Seriously, have you seen the procedure for taking a sample? It isn't like the DNA cheek swabs you see on television crime programs- it is longer and more invasive. And have any of you people advocating mass testing thought about the people who take these samples? Do you really believe they are changing their gloves every time they take a new sample? If you do, I have swamp land for sale. It is all but certain that the testing sampling locations are major vectors for spread themselves.

The first advice given was always the only pragmatic kind- if you have flu-like symptoms, isolate yourself for at least 14 days.

The experience of South Korea says otherwise: https://www.cdc.go.kr/board/board.es?mid=a30402000000&bid=0030

Those results are without the lockdowns that have become the norm in much of the rest of the world.

Agreed. If you want people to go out and mingle, you need testing. Once you stop community spread, you can rely on tracing to sources.

When we have widespread community testing, the story will change once more from those who defend the decision of the President without examining what went wrong and why we are on a different path than those who tested early.

The testing horse might be out of the barn door at this point.

There was a critical window to act quickly and decisively and no Western country came close. The US fell flat on its face as to be expected.

Certainly we need to test randomly in geographic areas, and do antibody testing to get people back to work.

But track and trace is probably a done deal

Depends on facts on whether it is a done deal. And, if you can trace to a source, you can close off that source. Health departments are still doing contact tracking today.

And, Skeptical, you evidently don't know about the Oxford paper and digital contact tracing:

"Epidemic control with instant digital contact tracing
A mobile phone App can make contact tracing and notification instantaneous upon case confirmation. By keeping a temporary record of proximity events between individuals, it can immediately alert recent close contacts of diagnosed cases and prompt them to self-isolate."

Don't assume anything. People are developing digital contact tracing where you can identify those with whom you interacted so they can be alerted if you come down with covid.

When anti-body tests become more available, then, yes, testing mass numbers will make far more sense and the information gleaned far more useful since it isn't just a snapshot in time.

This is absurd. US already has more tests per day per million population than any country other than Italy. Of course more testing would be great, but you have to recognize practical volume constraints and be realistic.

https://ourworldindata.org/covid-testing

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