Coronavirus testing (1 Viewer)

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dtc

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What is the deal with the tests?

Seems like I'm reading we are processing 30% fewer tests this week than last and we've never been testing anywhere near what we should have been.

What happened to the drive-thru testing and all that and why in this nation are we having a hard time putting our hands on freaking cotton swabs?

I find it terribly unnerving to know we haven't been able to test as well as Korea or really anywhere yet.

What gives?
 

not2rich

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Not in my book.

Im also worried that we will repeat our testing errors with antibody testing. We need to be getting that up to speed for widespread testing like yesterday.

This administration‘s lack of attention to testing just baffles me.
It's all about shifting blame.

Ramping up testing production and supply capability, much less the manpower to do it, is tedious, difficult, logistically nightmarish work. And also uniquely within the power of the Fed. govt. to address from the top down.

Instead, Trump is telling the states they're on their own, not just with the guidelines but testing and basically everything else.

What he really wants, and the only thing he really wants, is to make grand "reopening pronouncements," hold daily political commercials disguised as press conferences, and either take credit (for doing basically nothing) if things go okay or cast blame if things don't in the hopes that most voters won't hold him accountable come November.
 

UncleTrvlingJim

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Of course more testing is better. Arguments that our testing is adequate, despite what health care workers in the trenches are saying, seem to me to have no real purpose other than to defend the Trump WH and the Federal failure in this regard for partisan reasons.
I'm trying to be as objective as possible about this. So, I'm trying to figure out the overall arguments being made, and at this point, I'm not interested in assigning blame if it is indeed warranted (and I do think we will need to do a full accounting of our process and figure out what could be done better and if people screwed up, then there needs to be some sort of accountability).

So, I can argue that there is a decreasing marginal utility to testing past a certain point, and when you get to that point, then you might want to shift resources to something with more marginal utility. Or even if there's value in testing resources and energy is better spent at some other aspect... is that what is being argued?

It just seems to me that we don't have enough data about COVID-19, which makes decision making really hard, and we need to rely more probabilistic reasoning than quantitative data. So to me, more testing seems like something we should want.
 

not2rich

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I'm trying to be as objective as possible about this. So, I'm trying to figure out the overall arguments being made, and at this point, I'm not interested in assigning blame if it is indeed warranted (and I do think we will need to do a full accounting of our process and figure out what could be done better and if people screwed up, then there needs to be some sort of accountability).

So, I can argue that there is a decreasing marginal utility to testing past a certain point, and when you get to that point, then you might want to shift resources to something with more marginal utility. Or even if there's value in testing resources and energy is better spent at some other aspect... is that what is being argued?

It just seems to me that we don't have enough data about COVID-19, which makes decision making really hard, and we need to rely more probabilistic reasoning than quantitative data. So to me, more testing seems like something we should want.
As far as assigning blame, I'll be the first to acknowledge that I do indeed blame Trump and his administration. For that matter I blame China as well. Unlike some, I am capable of holding both thoughts in my head.

But I'm just an average citizen. What's troubling is the obvious blame game going on at the highest levels of government, rather than - I don't know - maybe trying to get us through this crisis?

I agree testing would have been MORE useful early, but it's just as important now. It's just now that we need to do a much higher level of testing because the infection has spread so much. But we need more information on the degree of actual spread, not just to learn about the virus characteristics, but so that we can do a much better job of identifying and trying to isolate the infected from spreading further.

At this point, it seems to me that the Federal strategy is "herd immunity," but that's IMO based on suspect reasoning and evidence forming a premise that this "isn't so bad" (because if they're wrong, this is going to backfire disastrously) and "reopening" the economy is a safe bet (never mind that "reopening" too soon may wreck the economy even worse). If that's the plan, it is what it is, but I doubt it is based on good scientific analysis so much as saving Trump's re-election chances.
 
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dtc

dtc

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Of course more testing is better. Arguments that our testing is adequate, despite what health care workers in the trenches are saying, seem to me to have no real purpose other than to defend the Trump WH and the Federal failure in this regard for partisan reasons.
Today was my birthday and I spent an hour or two on the phone with family and friends and in a zoom virtual get together. Over the course of those discussions all three of the doctors involved said you can't get tested unless you have symptoms and that we are nowhere near the point where we should be. One did suggest a couple more weeks should let us know if our area is good to start back to normal as long as we have travel restrictions in place that limit visitors from coming.

None of their kids are going back to school this year. None of them would even consider it and the terms they used to describe our current ability to test ourselves were very much less than positive.
 

Beach Friends

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Is there a downside to over-testing?

I'm operating under the assumption that more data is better, and can lead to better decision making, and more testing will lead to better data. Is there a down-side to too much testing?
Toilet paper, hand sanitizer and bread. Even items that seem plentiful can become scarce if there is a run on them.

As I understand it, the supply of reagents needed for testing is low. So, if tomorrow we started announcing that a much broader range of people need to be tested then it could mean that we exhausted our supply of reagents (and I am sure other assets needed to collect and process the tests.

 

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If supplies of reagents or other materials necessary to conduct the tests is the issue, that would seem MUCH more of a problem for states than the Federal government (even if it is a problem for the Feds too).

Just my opinion, but a real leader might say: "Yes, we have a problem with testing because we don't have the supplies and ingredients to make enough of them, but we're working on solutions."

A marketing con man turned reality TV show star turned President who wants to avoid either leadership or responsibility at all costs says: "Testing is the responsibility of the states. DO YOUR JOB STATES!"
 

JimEverett

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Is there a downside to over-testing?

I'm operating under the assumption that more data is better, and can lead to better decision making, and more testing will lead to better data. Is there a down-side to too much testing?
Sure there is a downside.
I am not going to get tested if I have no symptoms. Why should I? The downside for me individually is that testing sites are far more likely to have people there who are symptomatic. Why would I want to go anywhere in the vicinity of a place that is going to have a higher proportion of people symptomatic?
 

UncleTrvlingJim

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Toilet paper, hand sanitizer and bread. Even items that seem plentiful can become scarce if there is a run on them.

As I understand it, the supply of reagents needed for testing is low. So, if tomorrow we started announcing that a much broader range of people need to be tested then it could mean that we exhausted our supply of reagents (and I am sure other assets needed to collect and process the tests.

Is that a downside to testing or problem with our supply chain? Wouldn't the answer be to start producing more reagents then?

Sure there is a downside.
I am not going to get tested if I have no symptoms. Why should I? The downside for me individually is that testing sites are far more likely to have people there who are symptomatic. Why would I want to go anywhere in the vicinity of a place that is going to have a higher proportion of people symptomatic?
I should have been more clear. Is there a downside for the government/policy makers to wanting more testing done?

As far as your individual concern, that's a cost-benefit analysis you'd have to make based on the probability that you would catch the virus at one of the testing facilities versus the probability that you are unknowingly carrying the virus and might infect someone you care about and possibly causing them harm. And I assume that would depend on factors on what testing sites are available, how they handle sanitation, procedures for waiting in line and so on, and then how often you come into contact with people have other risk factors, and how much you care about faceless people you don't know.

It just seems weird that people seem to be arguing against having more data which I think should lead to better decision making.

I see people saying that a lot of decisions being made are an overreaction. Why is that? The available data we had at the time says that the transmission rate is roughly 2 to 3. The hospitalization rate is around 10-15% and the mortality rate is 0.5 to 2%. So, what's the appropriate decision? We know the data is incomplete. Let's say that there's only a 30% chance that the above knowledge is correct (I obviously just made that number up), and let's say a 65% that the virus is less severe and 5% chance the virus is even more severe than the above. So, decision makers are looking at 30% chance of a 19 million people in hospitals over the next year and 2 million people dying. What's the correct course of action. Sure, the probability is not that high (although it is still significant), but the severity is devastating.

What decision do you make with lower probability but super high severity events? Would you want more data to give a tighter range of probabilities? Should we work to make sure we have that data? Is having that data earlier better or worse? And so on.

So right now, we know that among people who can get a test done about 20% test positive. These are either people who show symptoms or have been near someone who tested positive. So obviously this number is very high. Let's be generous and say about 2% of the population has already had gotten it instead of the 0.04% that is our current positive test. We're currently seeing what, 11,000 die per week right now? If the disease is more contagious than what we thought but less deadly (and I'll continue to be generous and assume that undiagnosed COVID deaths are not significantly higher than what we currently know - which seems to be to be unlikely, but whatever). If it's that contagious, we'd need a significantly higher percentage of the population to be immune before we reach herd immunity. So, we need to continue at this rate of 11,000 people dying per week until we get say 80% of the population infected, which means about 1.6 million dead. So, that isn't that much better. Let's say it's really contagious, and even less deadly, and already 5% of our population is infected. That's 640,000 dead. These aren't great numbers. Especially considering that the hospitalization rate is about 10 times the mortality rate.
 

Heathen

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I read this when I woke up today. Not sure if it makes me feel better or worse about the whole situation, considering it's more or less known people can quickly get the virus again after the 'all clear'.

Where i live it seems you cannot get tested if you do not exhibit certain symptoms. I have none but do want to get tested before i visit my family in a few weeks.

 

UncleTrvlingJim

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I read this when I woke up today. Not sure if it makes me feel better or worse about the whole situation, considering it's more or less known people can quickly get the virus again after the 'all clear'.

Where i live it seems you cannot get tested if you do not exhibit certain symptoms. I have none but do want to get tested before i visit my family in a few weeks.

It would be mostly good news, in that obviously the mortality and hospitalization rates would be far lower. I think it would mean a much shorter crisis, but a much sharper spike if we relax measures... so instead of say 2 million deaths and 20 million hospitalizations over the next year, it will be something like 150,000 deaths and 1 million hospitalizations, but instead of that occuring over a year it will happen over a couple of months, and the chances of meaningful herd immunity diminishes until a very high percentage of the population has already gotten it.

I think.
 

Beach Friends

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It would be mostly good news, in that obviously the mortality and hospitalization rates would be far lower. I think it would mean a much shorter crisis, but a much sharper spike if we relax measures... so instead of say 2 million deaths and 20 million hospitalizations over the next year, it will be something like 150,000 deaths and 1 million hospitalizations, but instead of that occuring over a year it will happen over a couple of months, and the chances of meaningful herd immunity diminishes until a very high percentage of the population has already gotten it.

I think.
The guy who headed up the Sanford study had a couple of takeaways, some good news and some bad. The good news is that the study indicates that the mortality rate is much lower than originally thought. The bad news is that he doesn't believe eradication is going to be possible as it is far too widespread for that. We are going to have to learn to live with this virus.

The idea that we can hide from this virus until it is safe to come out is just not realistic. The best we can do is try to ensure that our health system will not be overwhelmed, but we are going to continue to have new infections and there will be more deaths associated with the virus and that is definitely going to be true if we do not learn to distinguish those dying with the virus from those dying of the virus.
 

JimEverett

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It just seems weird that people seem to be arguing against having more data which I think should lead to better decision making.
People on this board?
I know things can easily get misconstrued on a message board, but I don't think anyone is arguing against testing. This thread started out as some sort of hyperbolic rant as to why the U.S. is the worst in the world at testing - it is not.
I think it then went on to whether we are testing "enough." I feel like most people are like me - we don't live in a place where there is a large outbreak and we are showing no symptoms. Absolutely no reason we should test, and that covers the overwhelming majority of people in this country.

EDIT - last sentence should have added some sort of caveat about a personal reason for someone to test.
 
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UncleTrvlingJim

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The guy who headed up the Sanford study had a couple of takeaways, some good news and some bad. The good news is that the study indicates that the mortality rate is much lower than originally thought. The bad news is that he doesn't believe eradication is going to be possible as it is far too widespread for that. We are going to have to learn to live with this virus.

The idea that we can hide from this virus until it is safe to come out is just not realistic. The best we can do is try to ensure that our health system will not be overwhelmed, but we are going to continue to have new infections and there will be more deaths associated with the virus and that is definitely going to be true if we do not learn to distinguish those dying with the virus from those dying of the virus.
I feel like you're arguing against a strawman in that I don't think anyone here or anyone at a national level is arguing for trying to hide from the virus. I believe we're all arguing that we need to be able to mitigate it to the point where our healthcare system is not overwhelmed. I'm not confident we're at that point, largely b/c I don't think we have enough data to determine that yet.

We've seen if you wait too long to lock down area, the virus quickly ramps up and overwhelms local hospital systems. Do you think we have the infrastructure in place to predict where the next hotspot is going to be and lock it down before it becomes a problem? And do you think we have the infrastructure in place to quickly ramp up capacity in localized outbreaks if we're too late to prevent it?
 

UncleTrvlingJim

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People on this board?
I know things can easily get misconstrued on a message board, but I don't think anyone is arguing against testing. This thread started out as some sort of hyperbolic rant as to why the U.S. is the worst in the world at testing - it is not.
I think it then went on to whether we are testing "enough." I feel like most people are like me - we don't live in a place where there is a large outbreak and we are showing no symptoms. Absolutely no reason we should test, and that covers the overwhelming majority of people in this country.

EDIT - last sentence should have added some sort of caveat about a personal reason for someone to test.
So, I perceive this as being consistent with what I gather as your stance on global warming. It seems a somewhat reactive stance vs a proactive stance, and please forgive me if I misconstrue your positions.

I lean heavily towards risk mitigation and minimization (not avoidance) rather than any sort of maximization strategies (profit maximization, GDP growth maximization, etc). So generally when I see low probability but high consequence scenarios, it makes sense to me to put strategies in place to mitigate that risk, even at the cost of shaving off a bit of GDP, or whatever.

So, with regards to testing, I look at do we have enough data right now to make intelligent policy decisions? For me, to make an intelligent decision, I would want to know how infectious the disease is, what is the true hospitalization rate, and true mortality rate. I don't think we have that yet, do you?

The reason I would want to know that is it would guide how I would go about reopening the economy. If it is super infectious but not very high mortality, as Beach Friends seems to believe, then I think we don't need to worry about mass testing past the point we know that it is super infectious - and we use the lockdown time to ramp up hospital capacity to deal with the surge in people coming in, this means producing tons of PPE, figuring out a way to build temporary bed capacity in a quick manner whenever there is an outbreak, and figuring out how to stage ventilators to move to the next hotspot. I suppose some testing would still need to be done to help predict where the next hotspot will be.

If instead the data suggest that disease is what the current majority belief is - that it is pretty contagious (R0 of about 2-3) and a hospitalization rate 10% and mortality rate of about 1%, then it seems to me you'd want mass testing available - in order to perform localized lockdowns before it gets bad, and to do contact tracing.
 

Beach Friends

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I feel like you're arguing against a strawman in that I don't think anyone here or anyone at a national level is arguing for trying to hide from the virus. I believe we're all arguing that we need to be able to mitigate it to the point where our healthcare system is not overwhelmed. I'm not confident we're at that point, largely b/c I don't think we have enough data to determine that yet.

We've seen if you wait too long to lock down area, the virus quickly ramps up and overwhelms local hospital systems. Do you think we have the infrastructure in place to predict where the next hotspot is going to be and lock it down before it becomes a problem? And do you think we have the infrastructure in place to quickly ramp up capacity in localized outbreaks if we're too late to prevent it?
I wasn't arguing at all. Just adding to the discussion of what these new studies seem to show.

I don't know when is the ideal time to reopen. But, I think the questions you are asking are the proper questions. And those are not the same as questions with an eye toward riding this out until there is no more virus to be fearful of anymore.

I am just concerned that as a society we don't seem to have a common understanding of what the goal of the lockdown is. If we think we are over this we are definitely wrong. To the extent people think that we can afford to wait on reopening until it is completely safe to do so, that is also wrong.

We are going to continue to have deaths, and yes there will be spikes. We all know this, but watch everyone lose their minds and want to assign blame when it inevitably happens.

We have to take into account that the remedial actions we are taking have health effects too. A global depression is going to pretty damn tough on the health and well being of our citizens, but for developing countries (where there are black and brown people) it is going to be a catastrophe.
 

UncleTrvlingJim

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I wasn't arguing at all. Just adding to the discussion of what these new studies seem to show.

I don't know when is the ideal time to reopen. But, I think the questions you are asking are the proper questions. And those are not the same as questions with an eye toward riding this out until there is no more virus to be fearful of anymore.

I am just concerned that as a society we don't seem to have a common understanding of what the goal of the lockdown is. If we think we are over this we are definitely wrong. To the extent people think that we can afford to wait on reopening until it is completely safe to do so, that is also wrong.

We are going to continue to have deaths, and yes there will be spikes. We all know this, but watch everyone lose their minds and want to assign blame when it inevitably happens.

We have to take into account that the remedial actions we are taking have health effects too. A global depression is going to pretty damn tough on the health and well being of our citizens, but for developing countries (where there are black and brown people) it is going to be a catastrophe.
Well, this is boring, I agree with that.
 

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