Testing participation vs. testing capacity

This paper argues that testing participation –and not testing capacity–is the biggest obstacle to a successful “test and isolate”-strategy, as recently proposed by Paul Romer. If 𝑅0=2.5,at least 60percentof a population needs to participate in a testing program to make it theoretically possible to achieve an effective reproduction rate for the whole population,𝑅′′, below 1. I also argue that Paul Romer’s assumption about quarantine length is problematic,because it implicitly assumes that an infected and tested person is quarantined during the entire duration of the illness. With more realistic assumptions, where the fraction of the illness duration that is spent in quarantine depends on the test frequency, at least 80percentof the population must participate to keep 𝑅0′′<1, even if participants in the test program are tested every five days.Comprehensive testing,as proposed by Romer,is probably still a very cost-effective means of reducing the reproduction rate of the infection compared to mandatory lockdown policies, but it seems less promising than he suggests.How-ever, comprehensive testing might also reduce voluntary social distancing in a non-cost-effective way because testing and isolating infected individuals decreases the risk of infection for an individual if social distancing is not practiced.

Here is the full paper by Jonas Herby.

Comments

It is not testing that is critical to make it theoretically possible to achieve an effective reproduction rate for the whole population,𝑅′′, below 1. It is an effective tracing/isolation capacity. Tests by themselves are close to meaningless unless basic principles concerning the stopping of contagious disease spread are not followed are consistently applied.

Not meaningless if there's a 4k Euro = $4.4k USD fine associated with not quarantining when told you are infected and you are put on notice you are infected. They had such steep fines in Greece and it worked. And for 'unaware' or 'involuntary' breaking of the law, such as failure to maintain social distancing / refusing to wear a mask, you hit people with a 100E/$110 fine. People respond to incentives. Even dumb people.

4k Euro equals improved testing for those those who were a mask, but when fines are so low that the incentives point in the direction of defecting against albino llamas.

'defecting against albino llamas' creates a sublime dadaesque vision in the reader.

If you fine people who does not quarentIne, how do you persuade people to be tested then? Would you take that test?

I agree that quatenrining is important. In my model (and Romer's) we assume that people quarentIne, if tested positive.

Defecating against albino llamas

Such a fine is already the law in most US states where lockdown orders are in effect. Such a fine is _also_ in effect for people who _aren't_ sick.

It has been enforced within epsilon of zero times. If a pre-existing law that already implements what you're asking for has been unable to be enforced, why do you think this is a practical solution?

The degree of compliance is part of the calculation as to the degree of stringency of the anti-infection measures that need to be applied. Suppression on all transmission before herd immunity is achieved is probably not a reasonable goal. As pointed out from the beginning, the goal is to hold the rate of new cases below the capacity of the health care system to deliver life-saving interventions.

Does anybody have a link on demonstrated individual immunity yet?

The last I heard was the doctors involved were optimistic, but were not ready to guarantee.

Apparently we are still at the "new COVID-19 study raises immunity hopes" stage.

That is good, but I don't believe policy should be built on hope!

https://thehill.com/policy/healthcare/public-global-health/496660-new-covid-study-raises-immunity-hopes-for-recovered

The reliance on an average figure for Ro makes all of this analysis useless: if 95 percent of the population are sitting in their basement watching Netflix and have an Ro – 0.1 and 5 percent are party animals with an Ro = 20, the average Ro is going to be > 1 which suggests you should be testing and isolating the party animals at much lower cost and time. Add in some discriminating on the basis of infectibility likelihood, age, race (maybe), co-morbidity possibilities, geographical factors etc and the probable figures and potential costs come way down – albeit you will have a wider probability distribution of outcomes.

Even assuming that average R is 2.5 is ridiculous. Until there’s a vaccine, you would have to force people together at gunpoint to get R back to that level. Post lockdown, average R will be closer to 1 than to 2.5 for a very long time. Any analysis that ignores this and treats R as some immutable property of the virus is too far away from reality to be of much use.

I think I see this similarly. It would be bad if it's true, but we know that in the real world regions have turned their growth rate negative.

If it is not some combination of change in behavior and testing and isolation, what is it?

https://www.cnn.com/2020/05/05/asia/hong-kong-coronavirus-recovery-intl-hnk/index.html

What would even compel someone to go get a COVID test unless they have strong symptoms? And if you do have strong symptoms, you're either going to the hospital or staying at home until you get better. Doubly so if you need to get a doctors referral first rather than simply showing up.

Now, obviously people do go a get tested, but what is the motivation?

Testing isn’t even the issue. Aside from antibody testing, of course.

We don’t need massive testing capacity. We hypothetically would need “anyone symptomatic has their contacts traced and quarantined, including everyone in their apartment complex and anyone who’s come within 15 feet of them in the last 15 days.” Which is irrelevant now since we’re all quarantined anyways.

And this will never happen in the West to any real degree regardless, so it’s angels on a pin.

You should really learn to distinguish between the theory in your head what happens in the real world.

"we’re all quarantined anyways"

Ask a hell of a lot of front-line workers.

316 million people under shelter in place orders. Are you functionally illiterate or just an idiot?

That number is going to go down a lot in the next month. And of those 316 million many are essential workers who never stopped working.

Not to mention those AR-15 wielding protesters,

if i need one to get into my bldg at work or into Yankee Stadium i'll take one and pay for it myself

Bingo. If you tell businesses they can get back to work if their workers are tested regularly, they will gladly pay for most of this.

Finland, Germany, Portugal, Australia, New Zealand, Iceland, Norway

Are you trying to say there is some link between these countries and testing capacity? Quarantining? What these countries have to do with each other is not obvious. Actually I from what I can see there responses and the severity of their outbreaks has varied drastically. Germany ,for example, had a fairly substantial outbreak, so it seems odd that they would be used as an example when they did so much worse than their neighbors.

The paper is pointing out what is unstated about testing: it relates only to a point in time. I've been advising ambulatory surgery centers (ASCs) about protocols they should follow now that they are -re-opening. One issue is whether testing is required, in particular testing of patients. I tell them no, because testing only relates to a point in time: the day and time of the test. What I emphasize is the adoption of protocols that will identify if the patient is at high risk of infection. This means questioning the patient, both at the time the patient is scheduled and at the time the patient presents at the ASC, not only about whether the patient has been tested for or diagnosed with the virus, but also whether the patient has had symptoms of the virus, whether any family member, friend, or contact has had symptoms of or been diagnosed with the virus, whether the patient has recently traveled or been in contact with someone who recently traveled, etc. If the patient answers yes to two or more questions, especially symptoms and contact/travel, she is at high risk and should be re-scheduled. Testing is not the end all and be all, it can't be, not unless everyone is tested on a daily basis, which is unrealistic. Identifying those at high risk cannot be based solely on a test, but has to be based on common sense and due diligence.

Ah yes, the latest scheme touted by the smart people and Democrat governors to tighten their grip on the peasants. Our local Fuhrer, Herr Wolf, wants a CV task force to prowl about the commonwealth determining “are you, or have you ever been”. A dopey idea, to keep the masses in thrall.

I’ve been saying this for a while now. A good chunk of the population will simply not comply to mass testing, and possibly even contact tracing.

Re: A good chuck of the population will simply not comply to mass testing

Yeah, it's so hard to spit in a cup, have your nose or throat swabbed.

I feel your pain.

Snark won’t change the facts. We will eventually reopen without widespread testing. Because the state budgets are rapidly approaching a cliff.

Ha Ha. You see you ridiculous your comments are when someone points how absurd they are: that people will not comply testing.

Next, you changed the tune: Oh, we will now open because state governments will feel the pain.

What's next in the lineup of confusion.

Expect to get more of what you call Snark for making silly statement unsupported by facts.

If people aren’t complying with lockdowns, then its pretty reasonable that people won’t comply with testing.

You’ve provided no facts to the contrary, just chestpuffery that you’re swab worthy.

By making assertions you cannot support, you really hurt yourself because I am able to respond to your assertion with facts, underscoring how bad your initial comments were.

As an example, here is a survey showing strong support for willingness to be tested:

"Widespread, voluntary testing to control the spread of the novel coronavirus COVID-19 should be successful because a strong majority of people are willing to be tested, University of Wyoming researchers say.

A survey of 1,000 people conducted by UW economist Linda Thunstrom and her colleagues in the UW College of Business found that 70 percent were willing to be tested for COVID-19 at no cost -- even if a positive result means they must self-isolate for 14 days.

And, in a surprise to the researchers, people who are most likely to widely spread COVID-19 -- extraverts, younger people and others who meet more people in their daily lives -- expressed the highest level of willingness to be tested.

“Our results are encouraging. They imply that voluntary testing may succeed in targeting those who generate the largest social benefits from self-isolation if infected, which strengthens the case for widespread COVID-19 testing,” the UW economists wrote in an article that has been accepted for publication by the journal Behavioral Public Policy.

Joining Thunstrom in the research were UW graduate student Madison Ashworth, of Star Valley; Professors Jason Shogren and David Finnoff; and Assistant Professor Stephen Newbold, all in the UW College of Business. The paper may be viewed here." https://www.uwyo.edu/uw/news/2020/05/uw-study-finds-willingness-to-participate-in-widespread-covid-19-testing.html

You make my day.

Now, its your turn to support your claim that the public will not comply with mass testing. Polling results preferred.

From your own article: "While widespread, random testing is not yet available in the current COVID-19 pandemic..."

So the poll is about a testing regime that doesn't exist. 70% of the population is 231 mil tests. And that's a one time test. Mass testing requires repeated testing. The number of tests simply doesn't exist, and the 70% rate does not meet the 80% from the article above to reduce R to less than 1.

As I said, the states will have reopened before this pie in the sky testing regime is ever built and implemented.

From Steve Levitt and Paul Romer, two people who don't dabble in fantastical thinking:

"Making testing free and easily accessible is a good first step, but even then, compliance is likely to be low. Can we really expect a person who feels healthy to voluntarily go to a doctor’s office or pharmacy to be tested every week, likely waiting in line with people who have COVID symptoms, especially if he or she has tested negative on every other occasion?"

"Nonetheless, it is pure fantasy to believe that the amount of testing required will happen absent strong incentives. Now is the time to be putting those incentives into place."

https://www.usatoday.com/story/opinion/2020/04/30/coronavirus-tests-quarantines-incentives-can-make-it-work-column/3048508001/

Not surprised that you failed to quote the rest of the article, where the authors suggested for subsidies for those who tested positive so they could be isolated from those around them. That doesn't support the assertion that a good chunk will not want to be tested.

Look at countries with ample testing capacity and the willingness of persons to be tested. They have been willing to be tested, and countries with adequate testing have reduced the infection rate. Go to Johns Hopkins site for the data for other countries.

No country larger than the US, population-wise, has accomplished more testing per capita. The absolute number of tests really, really matters. The production capacity does not support testing in the hundreds of millions REPEATEDLY in the US alone, let alone for the entire globe.

Ha Ha Ha.

Notice how you qualified the opening line:

"No country larger than the US...."

Do you work for the Trump press office?

It's an appropriate qualifier, as the larger the country the more tests it will need. Tests that don't currently exist to test the entire population.

Not a hard concept to understand, unless you are being willfully dishonest.

Let's be real, you consider squawking "testing" like a mentally deficient parrot to b rising to the occasion. Mass testing ain't happening, boomer. Deal with it.

You again are unable to respond when I pointed out your qualifier. Why didn't you just say: All third world countries with populations equal to or higher than the US....rather than "No country larger than the US"

You've changed your story again: first you said no one would want to be tested. You were challenged and failed to support the claim, and I responded with survey evidence to the contrary.

Now, you change your story: Well, we don't have testing, so whether they are willing or not, it doesn't matter.

Yes, it is true that the Administration massively f*cked up getting testing underway, and that, unfortunately, we have to have protocols that limit testing, and that because we don't have adequate (as other countries have had) we have to use other methods to limit transmission, including social controls.

But, you know what: You said a good chunk of the population would not comply with mast testing.

Now, you slither away from your unsupported and unsupportable assertion.

You can't hide under a rock when all your comments above have been there for others to read.

"first you said no one would want to be tested."

Citation, please.

"Well, we don't have testing"

Accurate statement, and completely relevant to the discussion. People claiming to be willing to be tested is not enough.

"You said a good chunk of the population would not comply with mast testing."

I'd consider 30% to be a good chunk. Especially in light of Herby's calculation that 80% compliance is needed to drive R under 1. YMMV.

"Now, you slither away"

Haven't gone anywhere. No slithering at all.
I've challenged you to show your work on how we'll get mass testing accomplished. Bumpkus, except a cite to a U of Wyoming poll. Solid work.

Go read your own comments again.

I cite to your comments above as my assertion of what you said, and what I responded to. You can't change what you said, even though, when you are confronted with evidence, you do not respond with evidence when challenged, change the story to we don't have testing.

Keep slithering.

Anyone can read your comments above and my reply with information.

I never said no one would want to be tested. You resorted to lying and got caught. And you hand waive away all of my points about testing. Because you found one poll .

Dishonest, fearful, and stupid is no way to go through life.

I'll give you five points and the right to go home early if you can identify the person who said:

"I’ve been saying this for a while now. A good chunk of the population will simply not comply to mass testing, and possibly even contact tracing."

Apparently. you forgot what you said. oops, I guess I gave it away and you are not eligible for the contest.

Keep on slithering.

Which I did say. And as I pointed out, 90+ million people (30% according to YOUR poll) seems to me like a good chunk.

But you really accused me of saying this:
"You've changed your story again: first you said no one would want to be tested."

Which is a total lie that you are incapable of owning up to.

You changed it. Refer to comment in reply above. First, it was a good chunk will not comply. Then, when the Wyoming survey discredited that you said: Oh, there is not enough testing. Now, you say: well, a chunk is what I say a good chunk is, as if you are god.

As for the poll, that is quite high, and without requirements of testing if you came in contact with a covid person.

But, the reader doesn't need polls to tell you what others like you think:

The reader can simply ask him or herself: would you take the test if if were readily available, or if you knew you were in contact with a covid person or were told to you by a contact tracer that you were.

Simple.

I changed nothing. You claimed I aid no one would take the test. A complete lie from a obviously dishonest person.

I did indeed say that 30%, aka 90 million, is indeed a good chunk. I also said YMMV, meaning if you don't consider that a good chunk, that's your decision.

I also pointed out that the authors of a mass testing scheme think it is unrealistic to believe that everyone would comply with testing. Why don't you go pick a nonsensical fight with Romer and Levitt?

I've answered this above and below, providing data in support from Kaiser and Wyoming and foreign states which offer testing. People can read the comments above and below.

Get tested.

In addition, nowhere in your poll does it show willingness for repeated testing. A requirement for the mass testing that Romer and others have proposed.

It appears you are willfully ignorant of what it would take to get to the level of testing suggested. Instead, you resort to a small poll and lying through your teeth on what I've said.

All replies to this comment have been given above. I will not repeat myself as you have.

So, to recap, an architect of one of the mass testing schemes admits it is fantasy to believe people will voluntarily get tested without strong incentives. In addition, we have nowhere near the amount of tests to accomplish the test strategy (simply because that amount of tests doesn't exist currently), nor do we have the infrastructure to conduct the tests.

Meanwhile, we're staring at 15% UE and rising, and record state and federal deficits. But yeah, since you cited a U of Wyoming poll of 1000 people, I totally believe we can wait around for all of the above to fall into place.

So funny.
You summarize yourself and say:
To recap.

Only old tires get recapped.
Your arguments are flat
and
No amount of recapping--or restating, misquoting, failing to support with evidence,
Can Ignore the voluntary and large scale testing that has occurred in other countries or the reader's own willingness to be tested.

Are you now arguing we have enough tests to conduct mass testing? If so, then where's that demand you speak of?

Keep digging, you sad, fearful boomer.

I guess you gave up on your previous argument and switched to a new one. First, it was a good chunk would not voluntarily be tested and now it is they can't be tested.

Because there aren't tens of millions of tests sitting around waiting to be used. You seem to be completely and totally ignorant of that basic fact.

Non compliance is only one of the arguments against these pie in the sky mass testing schemes.

Any time you want to draw out the logistics of testing millions per day (the actual number suggested by experts) let us all know. And try to tell us of any nations that have accomplished the feat of testing even 1 million a day, since you are so apt at pointing to other countries, while being completely ignorant of scale.

See comment below with additional survey evidence; see comments above.

"We will eventually reopen without widespread testing. Because the state budgets are rapidly approaching a cliff."

Is that working as designed for the do-nothings?

By do nothings do you mean the states that are actually reopening? Because that certainly seems like doing something instead of crying for more tests.

Okay I will try to give you some credit here and let you answer this the best of your ability:

Why is opening, and bringing more cases, more important than driving cases to zero?

Sticking the swab up your nose or down your throat is a medical procedure, and they all entail risks.

Until they come up with a simple saliva test that is common and accurate then there will be very few tests.

Oh, give me a break.

You are a grown person afraid of a swab.

People are lining up in cars to get tested. It's not the lack of public demand for testing, but rather the lack of supply coupled with protocols which limit testing.

No wise man has the power to reason away. The stupid is strong with this commenter, “Bill”.

When commenters fail to support with evidence or are not logical expect someone who is not afraid to speak up and challenge them.

I'm not afraid and am happy to rise to the challenge.

Bring it on.

If you think strutting around a message board is rising to the occasion, you’re more senile than I thought.

If your argument is that there won’t be non compliance with testing, than make it. As I said before, I believe it’ll be a moot point because states will have reopened by then.

I don't what you think and I will not be deterred from responding to foolish statements.

I have challenged your assertions above, challenged you to provide evidence in response to my evidence of widespread support for testing and a willingness to participate. You have not posted any evidence and have only proceeded with ad hominem.

Was it a foolish statement when Romer and Levitt conceded that test compliance would be low?

The Wyoming survey and study answer the question. They speculated that people would not want to stand in line at the doctors office to be tested and that would lower the compliance. They had no data. The real gist of the comment was thatThey were arguing that if you tested positive there should be payments for people to isolate separately and not with others, and that the costs of testing programs were much lower than other mitigation efforts.

There is also Kaiser Foundation survey data that say "There has been discussion about the developments of a potential at-home testing kit for coronavirus with possible public availability. Seven in ten (72%) say they are either “very likely” or “somewhat likely” to use a coronavirus testing kit that they could do at their home and then send to a lab to find out if they have the virus. Unlike contact tracing apps, majorities across age groups and partisans say they are likely to use in-home testing kits." https://www.kff.org/global-health-policy/issue-brief/kff-health-tracking-poll-late-april-2020/ This is without mandatory testing that could arise if an exposed person refused to be tested, such as a clerk in a grocery store, if the employer demanded it as a condition for serving the public.

They’ll gladly comply if a negative test in the last two weeks is required to go back to work or go to a public venue.

Vitamin D, really a precursor hormone was shown to be a partial defense against the covid. I got interested. Vitamin D is a way to feed the white cells with cholesterol on the body surface, a free food idea. Vitamin D has been around since the almost beginning of cell development. It is a taco truck. runs on the outside of our skin. Furry animals lick their fur and lie in the sun, UV rays convert the food to Vitamin D. We quit licking fur when we wore clothes. Vitamin D deficiency has previously been linked to macrophage flare ups. Skin absorbs the stuff, so fur is a later adaption that we dispensed with. Cold weather is a lot like a skin infection. What is the advantage of eating free food we collect? In math, it is entanglement, getting an estimate of finite N, the density of the biostuff in the environment. This is inrormation about how much white cell density we need on the skin, an important metric for the B cell system. It is a boundary condition, and white cells are not infinite bandwidth.

Yet again, the three coloring of a beach ball. The surface has to everywhere maintain equal concentrations of three groups, food, B cell and T cell; I call them. It i energy driven, it operates non adiabatically, it is a stuck ratio. Eating from the surface of the organism is cheap food for the white cells, they will optimize a that fixed point. Then they cause the beach ball to become oddly shaped, to maximize the free food.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5491340/

It has been suggested that modernization and westernization have led to vitamin D deficiency among world population. Since, the majority of the population spends time indoors away from sun exposure, leading to vitamin D deficiency [21, 27].

The role of vitamin D in asthma is not yet clear. Few cross-sectional surveys had suggested a probable link between asthma and vitamin D [27-28]. Studies have concluded that decreased level of serum 25(OH)D is correlated with an increased prevalence, hospitalization, and increased emergency visits along with declined lung function and increased airway hyper-responsiveness in asthmatic children [27, 29]. Clinical trials conducted in recent times have shown the protective influence of vitamin D supplementation among asthmatic patients [30-32]. In addition, increased intake of vitamin D during pregnancy has an influence on asthma in children and adults [33-34].

Evidence from the researches concludes that asthma exacerbations and resistance to common therapies are some of the major challenges to reduce asthma-related morbidity and mortality [29-34]. Studies are suggestive in support of a role of vitamin D in both these aspects [29-34].

----

OK, here we have it. Vitamin D is free food for the white cells. What happens on the organism surface then food, B and T are all evenly matched? The white cells are well fed and do not eat skin. energy driven system well alter its interior to maintain that condition. It is the condition where every body gets a fair share of free food. Here is where he finite and infinte separate, Vitamin D fixes N, so at finitity i goes to somewhere close to N.

Long run effect? Of the B cell LH chains, there are five. A maximum use of UV energy would select for just one of these to be in the highest concentration. The four other chains would adapt in semi-repeatable fashion. The UV kills pathogens, gets them predigested. It would have been an evolutionary driver. A skin allergy, like poison oak, is a direct violation of the balance, a chemical that was not split up by UV. Obesity, rickets. Viruses sneak around the skin barrier. Notice the animals? they do sniff and reject, a neat trick in use of free energy.

That frequent testing would reduce social distancing by those found to have recovered is a good thing. the rebound effect depends on whether people are complying with social distancing/masking recommendations out of self interest or (properly) to reduce the risk of infecting othres.

It's probably best to test-pool all workers in each assisted living facility weekly. One test per facility required! If someone has it, disband the facility and give all seniors hydrochloroquine or remdesivir. One week max incubation time is still enough for those medications to keep down the viral load and inhibit the immune response phase.

yes, this point seems to be missed all the time... 60% is just not reasonable, and they need to be tested every single day

mass testing probably makes sense for high-risk pools like nursing homes and perhaps schools, i.e. places where the subjects are all in proximity for a long time daily (this apparently matters a lot both for COVID spread, but also for meeting the logistical challenges of testing them)

fortunately death rates may fall over coming months as treatment research matures... distressingly little sign the Very Serious People have noticed the astounding Vitamin D correlations, seems to have lost momentum pending further studies

80% of the deaths in Canada were in care homes. The huge political issue of the day in Ontario is that the Premier went to his summer home.

Sometimes civilizations become too stupid to survive.

https://www.frontpagemag.com/fpm/2020/05/did-lockdown-model-cause-half-coronavirus-deaths-daniel-greenfield/

Similar stupidity by that blowhard Cuomo led to many deaths in NY nursing homes.

https://www.nytimes.com/2020/05/07/us/new-york-city-coronavirus-outbreak.html

Cuomo should be impeached. He's done tremendous harm to New York and to the rest of the country.

Add Trump to that list. New Yorkers produce the most incompetent leaders. That's two crises in a row now for the Big Apple. I'm disappointed.

So let's review. We know this disease is hard. We know the testing is hard. We know that quarantine is hard. We are uncertain if herd immunity exists. But we know that Hong Kong has driven their new cases to zero.

So why don't we just do what they did?

Maybe herd immunity actually helped them, but we can be agnostic on that. We can just do what it seen to work.

Turn ourself into a city state that is smaller in size than Long Island?

Do you have a reason their method cannot scale?

Do you have a reason to believe it can?

Hong Kong testing 60% of pop=4.2 mil tests
US at 60% of pop=198 mil tests.

Hong Kong can test 50x more to get to the number if tests for the US to test once.

Sure I have a reason to think it can. The US is just many cities!

By the way RG, I think you have kind of become poster boy for "let's not try."

As far as I'm concerned, don't even.

And you are the poster boy for innumeracy and wishcasting.

If scale doesn’t matter than why are you just taking a national view? Why not propose global mass testing? This way global trade and travel can open up as well.

You have shown no math. You have just handwaved that we cannot reproduce Hong Kong methods because we're different.

What did someone say a few days ago? That it used to be Europe who said that it couldn't be done, and America who just did it?

They said that now it is America who says it can't be done, and Asia who just does it.

Case in point?

I did indeed show the math in the post above for the 60% population testing.

And you utterly ignore success stories that don’t involve testing like Japan.

You handwave away every and any reasonable logistical challenge or differences between countries.

You're an idiot if you do straight comparisons.

You first stated I showed no math, now you’re calling me an idiot for showing the math for a 60% test rate (from the article) for both the US and HK.

Then I pointed out Japan and of course you ignored that again.

I’ve even pointed put that the US has tested more per capita than HK.

No facts land with you.

That was absolutely not "math." Math would do some kind of conversion or scale to the US.

As I say, if you want to compare responses (testing rates or isolation or ability to pay or whatever) look at per capita figures.

I mean consider this statement:

"Hong Kong can test 50x more to get to the number if tests for the US to test once."

You are literally looking at the absolute costs for a large and small country!

Now go away.

Nowhere did I mention costs. You are resorting to making things up as usual.

The point was the sheer scale of tests needed. Romer says to test the entire population twice every two weeks.

That amount of tests doesn’t currently exist, a fact you continue to ignore.

If you don't imply costs, your argument makes even less sense.

I was being too generous?

Again, "tests" only matter per capita, and they are paid for per capita.

In the worst possible interpretation you are implicitly arguing that the US cannot do what Asia does, because Asia is rich and we are poor.

We are not poor, but what is your better argument here? Just some stupid claim that no one "big" can ever be "good?"

What even is your argument? On a per capita and real basis, we’ve tested more than Hong Kong. To implement Romer’s testing regime, we’d need way more tests than currently in existence, yet you are too innumerate to recognize this.

My argument is the same as it always was, that we should use successful countries as or model.

It's that simple, and it doesn't have to be any more specific at the top level.

It is SIMPLY let success guide us.

You opposed that because?

Japan's been pretty successful, yet you refuse to point to them as a model.

"When the state of emergency was extended, the government -- acknowledging public fatigue and the leveling-off of the epidemic -- decided to allow certain public facilities, including parks, libraries and museums, to reopen even in the 13 prefectures on condition that sufficient preventive steps against the virus are taken.

Like many other countries, however, Japan still faces a tough challenge to resume economic activities and stem the spread of the disease at the same time.

"We don't know when and where infections will increase," Nishimura said. "We will make sure measures against the virus are thoroughly in place as we pick up the pace of economic activities.""

I hope you don't think it was actually meaningful to compare the number of tests between large and small countries?

I read right past that, because it is meaningless. Large countries have more resources to do more tests. if you want to say something interesting talk about test per capita, and wealth per capita to pay for it.

The US has tested more per capita than Hong Kong.

Your strategy seems to be continually asking “ Why can’t we test more.” It never dawns on you that testing might not be the key variable.

I absolutely did not simply say why can't we cast more.

I didn't even try to characterize exactly what Hong Kong did.

I simply said if it works let's do it too.

Yet again, we’ve tested more than Hong Kong.

Do you honestly think "testing" is the only thing Hong Kong did to drive their new caseload to zero?

I don't know the answer to this, and a quick search didn't tell me..

Do we currently take the temperature of everyone trying to board a domestic flight?

I'm sure anyone interested can find their own link on what Hong Kong did, but for convenience:

https://www.sfgate.com/science/article/How-Hong-Kong-kept-COVID-19-at-bay-15254007.php

“As result, COVID-19 cases again fell dramatically. The last locally transmitted case occurred on April 19.
Despite the two outbreaks, city authorities have never issued an official stay-at-home order. People complied on their own.
“It has been a difficult few months for Hong Kong citizens. … The consensus of the Hong Kong citizen is the government has been slow and not proactive enough,” said Gabriel Choi, a family physician and president of the Hong Kong Medical Association, told Stat News. “The citizens did most of the work themselves.””

That's a weird cherry-pick, because we saw in the article that the HK government shut down a lot of businesses, fast compared to the US.

"Not proactive enough" means they should have closed more.

But on the other hand, mask-wearing might be a big part of it. It's probably why the CDC swung around to "make your own mask if you can't find one."

Or the article is of poor quality, because it also says this:

"Despite the two outbreaks, city authorities have never issued an official stay-at-home order. People complied on their own."

Dude!

That might tell us something useful. Don't make it fit into your framework. Keep an open mind.

Maybe that's what works. Maybe there are specific businesses that should be closed, and with that you don't need full on shelter in place.

That would be good news, right? But you don't want it to mean you can both not shelter and open any business, because that's not the demonstrated model for success.

Related to general measures needed:

Probably add Vitamin D supplementation to "potential tools to use carefully reopen the economy safely" (alongside masks, social distancing, etc) - https://medicalxpress.com/news/2020-05-vitamin-d-role-covid-mortality.html

Backman and his team were inspired to examine vitamin D levels after noticing unexplained differences in COVID-19 mortality rates from country to country. Some people hypothesized that differences in healthcare quality, age distributions in population, testing rates or different strains of the coronavirus might be responsible. But Backman remained skeptical.

"None of these factors appears to play a significant role," Backman said. "The healthcare system in northern Italy is one of the best in the world. Differences in mortality exist even if one looks across the same age group. And, while the restrictions on testing do indeed vary, the disparities in mortality still exist even when we looked at countries or populations for which similar testing rates apply.
"Instead, we saw a significant correlation with vitamin D deficiency," he said.

Fits with the pattern that Brits/people in Britain with progressively darker skin (and generally less of their ancestry from populations living in cloudy areas) tending to be more at risk, in cloudy Britain,
(https://twitter.com/rob_aldridge/status/1258292203346067456 - Africans most, Chinese least. Although there must be some other factors in play (possibly higher % face-to-face jobs where encountering lots of people, so more superspreading).

Fits as well with finding that urban areas in cloudy climes with significant 1st - 3rd gen non-European migration hit harder than everywhere else (although yes, of course not the only or even main factor), including patterning within UK and New York State.

Conversely, concerns of *current* spread in medical care system seem overblown - https://medicalxpress.com/news/2020-05-hospitals-safer-covid-.html - "The initial findings, published in correspondence to The Lancet, show that infection among healthcare workers at present is more likely to reflect general community transmission than exposure within a hospital."

Healthcare workers seem no more infected than general public at present.

However, this was not always so:

"Our research indicates that in the past 2-3 weeks, despite high numbers of patients with COVID-19 in our wards and intensive care units, rates of staff infection have fallen so much that it is unlikely the staff are being infected by patients.

It seems that healthcare workers got hit earlier than other labour demographics, and that's probably why the deaths we did see among them spiked relatively earlier.

Generally in the US, when you pay for a medical test, the org that does the test owns the data and tells the patient the results. There are hipaa restrictions on wider access. I'm not sure what legal exceptions have been carved out there.

So, everyone seems to discuss this as if the results are managed in some centralized way. But we read about meat packing plants arranging for tests and not even telling local health authorities what the summary results were. What good were those tests to the greater public?

Testing is just an act that uncovers some time sensitive data. We do not have much of a legal or operational framework for evaluating that data, or for then empowering authorities to act on that knowledge in any useful way. So, we are unprepared to do any of the downstream work that accomplishes anything.

This might be the first time Ive really appreciated HIPPA. It is kind of an interesting moment in that HIPPA, an obscure little understood law is one of the main obstacles to an unprecedented trammeling of the 4th amendment, among other things.

You might want to be a bit more ambivalent. Those rights protect your privacy, and they also prevent your country from doing the sorts of things that other countries have been successful at to protect you and your freedoms in this pandemic.

Because we have these rights, we also have limited the capacity of our government to be competent. Test, trace and isolate will almost certainly not work well enough.

In the end, it appears you still think maintaining 4th amendment protection is worth it, and you may be right. But it may mean we cannot mount a collective defense against this pandemic that works.

Yes, I am more worried about the people want to defeat the virus than I am of the virus.

> So, we are unprepared to do any of the downstream work that accomplishes anything.

Yes, HIPPA is a barrier to managing the spread of a virus. In fact, a lot of the privacy cultivated in the west is a barrier. SKorea made is easy for you to look on a map and see all the sick people around you. "Hey, honey, it looks like Mr. Cho that owns the market has tested positive. You can bet his kids have it. Avoid that market for the next few weeks..."

Much of the US doesn't even believe it's criminal if you knowingly give someone HIV. That's how insane our system has become. SKorea will secretly test you for HIV or any other disease they think might be in the public interest. And the gov is then made aware of the results.

Can you imagine the outrage if you gave a vial of blood at your annual physical and then a gov worker contacted you and said "You have HIV and TB, and we need you to come to this address for further processing. And by the way, we need your primary address so it can be correctly noted on the website."

https://www.unaids.org/en/resources/presscentre/featurestories/2017/june/20170622_korea

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