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?
 

JimEverett

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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.
I don't disagree at all with what you are saying. I guess maybe - although I am not sure about this - you could say I am arguing from a personal point-of-view while your point is a more social point of view. Because I certainly see the value of having more tests for reasons you are saying. But at the same time, why should I (and others like me) waste my time sitting in a car line and risk (even if the risk is slight) infection to take a test when I feel fine?

Take my area - where they are offering free drive-in testing. The number of people who have been tested as having the virus constitute less than one fifteenth of a percent of people in the 2m+ metro Nashville area. There is no overwhelming of hospitals, there are not hundreds or thousands of additional deaths (that might be undetected cases). Certainly, some sort of more widespread testing for the virus wouldn't hurt - but I don't see much value in it for this area for determining if and when we should open up. For my county - we have been in a partial shutdown since MAy 6 and a full one from a week later. The metro area itself was largely shut down a little over a month ago. I don't know exactly what all that means - as in are we doing a good job of identifying cases early and then the infected obey quarantine, or did the shut-down stop the spread, or
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.
I guess the way I would put it is that in a perfect scenario we would want everyone tested - but it is not perfect, obviously. I will use my area as an example: I live in a suburban county of Nashville - a metro area of just over 2 million people. Currently the number of people identified as having the virus is roughly a fifteenth of 1% of the metro population. In my county itself the rate is the same - just under a fifteenth of 1%. The county and other counties offer free testing at various sites - open to all. But, it takes a long time and, as I mentioned earlier, you are going to an area that more than likely has symptomatic people - thus, you are putting yourself at greater risk even if that risk is slight. And what is the payoff if you are not showing any symptoms? For some people it is peace of mind, there could certainly be other reasons for others, but I think most people see little payoff.
And more to the point of testing as way to tell us when to reopen: More testing certainly wouldn't;t hurt, but what will it really show? PErticularly in an area like mine where there is little confirmed outbreak and the hospitals are not being overrun and there is not a huge increase in deaths (meaning the virus does not appear to be running around here undetected in a lot of people). We are a month and half off from when my county went on partial lockdown, and over a month from when almost all of the metro area went on lockdown. An increase of testing right now appears to me to lend little insight into the number of people who have had the virus in the region. Although I cannot argue against the idea that more information the better, it seems that singling out universal testing, or close to it, as a way to determine when to open up, or even to get the virus under control in a region like mine - and most of the country for that matter - seems weird to me.
 
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UncleTrvlingJim

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I don't disagree at all with what you are saying. I guess maybe - although I am not sure about this - you could say I am arguing from a personal point-of-view while your point is a more social point of view. Because I certainly see the value of having more tests for reasons you are saying. But at the same time, why should I (and others like me) waste my time sitting in a car line and risk (even if the risk is slight) infection to take a test when I feel fine?

Take my area - where they are offering free drive-in testing. The number of people who have been tested as having the virus constitute less than one fifteenth of a percent of people in the 2m+ metro Nashville area. There is no overwhelming of hospitals, there are not hundreds or thousands of additional deaths (that might be undetected cases). Certainly, some sort of more widespread testing for the virus wouldn't hurt - but I don't see much value in it for this area for determining if and when we should open up. For my county - we have been in a partial shutdown since MAy 6 and a full one from a week later. The metro area itself was largely shut down a little over a month ago. I don't know exactly what all that means - as in are we doing a good job of identifying cases early and then the infected obey quarantine, or did the shut-down stop the spread, or

I guess the way I would put it is that in a perfect scenario we would want everyone tested - but it is not perfect, obviously. I will use my area as an example: I live in a suburban county of Nashville - a metro area of just over 2 million people. Currently the number of people identified as having the virus is roughly a fifteenth of 1% of the metro population. In my county itself the rate is the same - just under a fifteenth of 1%. The county and other counties offer free testing at various sites - open to all. But, it takes a long time and, as I mentioned earlier, you are going to an area that more than likely has symptomatic people - thus, you are putting yourself at greater risk even if that risk is slight. And what is the payoff if you are not showing any symptoms? For some people it is peace of mind, there could certainly be other reasons for others, but I think most people see little payoff.
And more to the point of testing as way to tell us when to reopen: More testing certainly wouldn't;t hurt, but what will it really show? PErticularly in an area like mine where there is little confirmed outbreak and the hospitals are not being overrun and there is not a huge increase in deaths (meaning the virus does not appear to be running around here undetected in a lot of people). We are a month and half off from when my county went on partial lockdown, and over a month from when almost all of the metro area went on lockdown. An increase of testing right now appears to me to lend little insight into the number of people who have had the virus in the region. Although I cannot argue against the idea that more information the better, it seems that singling out universal testing, or close to it, as a way to determine when to open up, or even to get the virus under control in a region like mine - and most of the country for that matter - seems weird to me.
OK, I think I need to refine my argument a bit.

Your area seems to me to be a perfect example of a place that could potentially reopen now and have a somewhat normal environment provided you can keep ahead of the virus. The way I understand it, if a particular area has a very low infection rate, you can get away with just testing the people who've been in direct contact with someone who has the virus. And then you just do a local quarantine (those people who have been in direct contact with the infected person) until you can test everyone in that group. Some of this will require individuals volunteering to come in for testing when they know they've been in contact with someone, and some of it can be determined by that person's pattern of life (ie close their place of work until everyone is tested, or their church, etc).

You won't be able to stop the spread, but you can probably keep it slow.

As far as why a person would volunteer to be tested, it's going to depend on a number of factors. If you are asymptomatic, no one you know has been infected, and you haven't been in a place where there was an outbreak, then I agree, there is little need to be tested. But if the virus is starting to become widespread near you, or if you know you've been in direct contact with someone and you want to make sure you don't pass it on, then your personal incentive changes.

All this depends though on your local area being able to do a lot of testing of asymptomatic people (being able to test people the infected people have been in contact with). I'd imagine if you know that you've been working right next to someone who has come down with the disease you'd want to know if you are infected - because the chance of you having the disease has gone up and you'd probably want to make sure you get proper care early.
 

JimEverett

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OK, I think I need to refine my argument a bit.

Your area seems to me to be a perfect example of a place that could potentially reopen now and have a somewhat normal environment provided you can keep ahead of the virus. The way I understand it, if a particular area has a very low infection rate, you can get away with just testing the people who've been in direct contact with someone who has the virus. And then you just do a local quarantine (those people who have been in direct contact with the infected person) until you can test everyone in that group. Some of this will require individuals volunteering to come in for testing when they know they've been in contact with someone, and some of it can be determined by that person's pattern of life (ie close their place of work until everyone is tested, or their church, etc).

You won't be able to stop the spread, but you can probably keep it slow.

As far as why a person would volunteer to be tested, it's going to depend on a number of factors. If you are asymptomatic, no one you know has been infected, and you haven't been in a place where there was an outbreak, then I agree, there is little need to be tested. But if the virus is starting to become widespread near you, or if you know you've been in direct contact with someone and you want to make sure you don't pass it on, then your personal incentive changes.

All this depends though on your local area being able to do a lot of testing of asymptomatic people (being able to test people the infected people have been in contact with). I'd imagine if you know that you've been working right next to someone who has come down with the disease you'd want to know if you are infected - because the chance of you having the disease has gone up and you'd probably want to make sure you get proper care early.
Thanks for rephrasing. That makes sense, and I see your point now.
 

UncleTrvlingJim

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Thanks for rephrasing. That makes sense, and I see your point now.
Groovy.

Just because I find this interesting. In order for COVID-19 to be roughly equivalent to a very bad flu year (let's say 0.4% mortality rate), that would mean about 10,000,000 Americans (or about 3% of the population) would have already had to have gotten and recovered from it. And there are no significant numbers unreported deaths. That would make it remarkably contagious.

This also seems pretty unlikely, countries that are doing mass testing are estimating at most only 1% of their population has been infected.

Not impossible though.
 

Beach Friends

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Groovy.

Just because I find this interesting. In order for COVID-19 to be roughly equivalent to a very bad flu year (let's say 0.4% mortality rate), that would mean about 10,000,000 Americans (or about 3% of the population) would have already had to have gotten and recovered from it. And there are no significant numbers unreported deaths. That would make it remarkably contagious.

This also seems pretty unlikely, countries that are doing mass testing are estimating at most only 1% of their population has been infected.

Not impossible though.
I have no doubt that there have been undiagnosed deaths. I also have no doubt that deaths have been wrongfully attributed to the virus. There is a difference between dying with the virus, and dying of the virus.

I have no idea with the "net" is.
 

MT15

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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?
So, I explained above one reason why a person who doesn’t show symptoms should be tested. Mostly to catch people who have been exposed but have not yet developed full blown disease and could infect people. If you can identify someone who is not yet aware they are ill, and get them to stay home, they will halt the spread. If you do that consistently, you don’t get exponentially rising death.

Also, if you are not so ill that you require medical care in an ED or Urgent Care, you would be tested without leaving your car at a drive through site. So chances of catching anything would be extremely low. You’re more at risk going to the grocery store. A lot more at risk.

Jim, to add to your point, nobody is testing people who don’t have symptoms at this point in time. We simply don’t have the supplies to do it. Your area is similar to mine in that we have prepared for a larger outbreak than we have seen so far. But we are not testing people who have been exposed, only those who are symptomatic. By the time someone is symptomatic it seems they have likely been contagious for a while and have likely contributed to an exponential curve.

Your area and mine have been spared so far, relatively speaking. But it’s not because of good testing and follow up on cases. Most likely it’s due to luck. We need to get the capacity to test everyone who wants a test and we aren’t even close to that. We need to have enough workers to do the contact tracing and follow up when a case is identified. I don’t see that happening either. We don’t have the manpower to do that.

Your area and mine still have a shot at containment rather then mitigation. But if things open up without the infrastructure to trace and test we will be at risk of an outbreak similar to what happened in NY. And we will then be in mitigation mode, where nobody wants to be.
 
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UncleTrvlingJim

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I have no doubt that there have been undiagnosed deaths. I also have no doubt that deaths have been wrongfully attributed to the virus. There is a difference between dying with the virus, and dying of the virus.

I have no idea with the "net" is.
I think that's something that will have to be determined post-facto. For example if normally x number of people die from diabetes per week, but now y number of people with both diabetes and covid-19 die per week and y number of people is greater than X, then the number of y-x is more directly attributable to covid-19 than diabetes.

But like all diseases, there's usually a multitude of factors that go into someone's mortality rate.
 

MT15

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I’ve seen some analyses of death rates in NYC already. They have really consistent stats on causes of death. I think I read that so many people were dying at home that their cause of death was listed as “cardiac arrest” simply because they were never tested.

Found it:

“The FDNY reported a nearly 400 percent increase in "cardiac arrest" home deaths in late March and early April, a spike that officials say is almost certainly driven by COVID-19, whether they were formally diagnosed or not.

Between March 20 and April 5, the department recorded nearly 2,200 such deaths, versus 450 in the same period last year, according to data it provided on Friday.”

From NBC, but it seems to have been widely reported.
 

Lapaz

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This isn't exactly about testing, but it isn't exactly political, so I'll post it here. We have only had about 20k new daily cases for about the last 3 days, even though states started opening about a week ago. Also, on 12 May, we had the 1st drop in active cases in a couple of months, but then they went up again on 13 May. I think these numbers reflect the pre-opening affect, because there is a lag between the spread and detection of that spread. I think it's unlikely that daily numbers will continue to stay this low due to the new openings, but it shows how close we were to a condition that would get the virus under control. I know states aren't opening without restrictions, so that should help slow the spread, but it seems inevitable that the virus will start spreading more quickly since things have loosened up. I hope I'm wrong, but I think by next week, we'll be back over 25k daily new cases and active cases will begin rising again. I think there is a fair chance that we will have to shut things down again until we can sustain a drop in daily cases.
 

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This isn't exactly about testing, but it isn't exactly political, so I'll post it here. We have only had about 20k new daily cases for about the last 3 days, even though states started opening about a week ago. Also, on 12 May, we had the 1st drop in active cases in a couple of months, but then they went up again on 13 May. I think these numbers reflect the pre-opening affect, because there is a lag between the spread and detection of that spread. I think it's unlikely that daily numbers will continue to stay this low due to the new openings, but it shows how close we were to a condition that would get the virus under control. I know states aren't opening without restrictions, so that should help slow the spread, but it seems inevitable that the virus will start spreading more quickly since things have loosened up. I hope I'm wrong, but I think by next week, we'll be back over 25k daily new cases and active cases will begin rising again. I think there is a fair chance that we will have to shut things down again until we can sustain a drop in daily cases.
I don't know if Alabama people are doing things differently than here in Mississippi, but when it was announced that almost everything would be opening back up in a couple of weeks, people started acting like it was all over. Yes, some people are still wearing masks, but the majority are not. Driving down the main road in Laurel, MS looks like a normal business day. The parking lots are full and there is tons of activity. Churches intend to reopen fully by the end of the month. I am just concerned that not enough people are taking the proper precautions and that a second surge of cases will be much more devastating than the first. I certainly hope I am wrong. I still have a job, thanks to the SBA loan program, but that would change if there is another shutdown in August or September.
 

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I don't know if Alabama people are doing things differently than here in Mississippi, but when it was announced that almost everything would be opening back up in a couple of weeks, people started acting like it was all over. Yes, some people are still wearing masks, but the majority are not. Driving down the main road in Laurel, MS looks like a normal business day. The parking lots are full and there is tons of activity. Churches intend to reopen fully by the end of the month. I am just concerned that not enough people are taking the proper precautions and that a second surge of cases will be much more devastating than the first. I certainly hope I am wrong. I still have a job, thanks to the SBA loan program, but that would change if there is another shutdown in August or September.
I can attest to this. Was on the Coast last week and pretty shocked that there seems to be very little if no one wearing masks at beaches, restaurants, bars etc. People are going to forget and when hardly anyone is being safe, it'll be a hotbed for this thing. Guess we could say that a few weeks or so after opening up is time enough to tell how much it'll spread as a result. I wish for the very best, but fear the worst.
 

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I can attest to this. Was on the Coast last week and pretty shocked that there seems to be very little if no one wearing masks at beaches, restaurants, bars etc. People are going to forget and when hardly anyone is being safe, it'll be a hotbed for this thing. Guess we could say that a few weeks or so after opening up is time enough to tell how much it'll spread as a result. I wish for the very best, but fear the worst.
I don’t think beaches are unsafe. If people are in and out of the water, they’ll essentially be washing off the virus. They can still shed by breathing and coughing, but whenever I go to the beach, I usually don’t get too close to others. I’ll sit in my beach chair a few feet away from others and typically not even facing others. Usually I’ll sit next to someone. Of course I will typically share things like coolers, balls, sunscreen bottles, etc, but with some simple precautions, the beach can be as safe as the parks, which people don’t object to.

Now I agree that restaurants and bars opening their indoor spaces is likely to become a problem. You have to take off your masks to eat or drink, so the virus will be shed in those environments.

I think most people are still being very cautious, but the minority that is not being cautious are visible and will cause the virus to start spreading quickly again. I think we will see the results within 2 weeks. Thankfully my office is not going to allow anyone to return until June. We should know by then if we have the virus under control.

PS: I know vane people seeking out hot people in bars may be surprised when they end up with literally hot people.
 

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Groovy.

Just because I find this interesting. In order for COVID-19 to be roughly equivalent to a very bad flu year (let's say 0.4% mortality rate), that would mean about 10,000,000 Americans (or about 3% of the population) would have already had to have gotten and recovered from it. And there are no significant numbers unreported deaths. That would make it remarkably contagious.

This also seems pretty unlikely, countries that are doing mass testing are estimating at most only 1% of their population has been infected.

Not impossible though.
We just do not know enough, imo. While I do hope the infection rate is far higher, it is way too early to say. And even though I hope its wrong, there is a chance having the virus and recovering does not mean you are immune, at least not after a set period of time.

I do wonder as well if people have immunity to the virus even before they are ever infected. A friend of mine got the virus back in mid-March. He lived in his house with wife and 4 kids for 4 or 5 days while showing symptoms and did not isolate himself in the house. No one else in his family ever tested positive despite being tested for it regularly over the course of 4 weeks. I don't think they have taken an antibody test. I actually know another person with an even bigger family that got the virus and no one else in the family has tested positive for it or is showing symptoms. But, I don't know the details on his case.
Just anecdotes and no doubt there are weird or seemingly weird situations involving anything. But just something I have thought about.
 

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I don’t think beaches are unsafe. If people are in and out of the water, they’ll essentially be washing off the virus. They can still shed by breathing and coughing, but whenever I go to the beach, I usually don’t get too close to others. I’ll sit in my beach chair a few feet away from others and typically not even facing others. Usually I’ll sit next to someone. Of course I will typically share things like coolers, balls, sunscreen bottles, etc, but with some simple precautions, the beach can be as safe as the parks, which people don’t object to.

Now I agree that restaurants and bars opening their indoor spaces is likely to become a problem. You have to take off your masks to eat or drink, so the virus will be shed in those environments.

I think most people are still being very cautious, but the minority that is not being cautious are visible and will cause the virus to start spreading quickly again. I think we will see the results within 2 weeks. Thankfully my office is not going to allow anyone to return until June. We should know by then if we have the virus under control.

PS: I know vane people seeking out hot people in bars may be surprised when they end up with literally hot people.
I think being outdoors, wherever that may be, is the best thing people can do. Obviously mantain social distancing and other precautions. But fresh air, sunshine, and being disconnected from devices, t.v., and the news are great for physical and mental well-being.

My kids are becoming expert fisherman due to covid
 

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I think being outdoors, wherever that may be, is the best thing people can do. Obviously mantain social distancing and other precautions. But fresh air, sunshine, and being disconnected from devices, t.v., and the news are great for physical and mental well-being.

My kids are becoming expert fisherman due to covid
Just like everyone else, I've been cooped up at home except for the bi-weekly Walmart grocery pickup. However, I've ridden bikes with my kids and pretty much been outside every day. I even forced my teenage boy scout dropout son to sleep in a tent in the back yard. I know people in big cities that live close together don't have the luxury of a large back yard but I never took the stay at home orders to literally stay at home. I took it as staying away from other people. That being said, I agree that being outdoors is the best thing people can do to get through this.

Consequently, I rather enjoy the fact that daily I smell the sweet aroma of barbeque grilles going at all times during the day every day. As for fishing, I wondered if people were still taking boats out to fish. Fishing tends to be an activity that doesn't require a crowd.
 
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dtc

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We just do not know enough, imo. While I do hope the infection rate is far higher, it is way too early to say. And even though I hope its wrong, there is a chance having the virus and recovering does not mean you are immune, at least not after a set period of time.

I do wonder as well if people have immunity to the virus even before they are ever infected. A friend of mine got the virus back in mid-March. He lived in his house with wife and 4 kids for 4 or 5 days while showing symptoms and did not isolate himself in the house. No one else in his family ever tested positive despite being tested for it regularly over the course of 4 weeks. I don't think they have taken an antibody test. I actually know another person with an even bigger family that got the virus and no one else in the family has tested positive for it or is showing symptoms. But, I don't know the details on his case.
Just anecdotes and no doubt there are weird or seemingly weird situations involving anything. But just something I have thought about.
WHo gets it or not is a freaking mystery. Bad info, bad tests, bad stories being told, but confusing and odd.

There's a family of Menonite framers here and one of them got it a month ago. Didn't get tested until he was very sick and then none of the rest of the 12 people at his house took any precautions and only the youngest kid ever showed symptoms. When the kid was taken to the hospital she tested negative.

Makes no sense, but glad they're all ok now.
 

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WHo gets it or not is a freaking mystery. Bad info, bad tests, bad stories being told, but confusing and odd.

There's a family of Menonite framers here and one of them got it a month ago. Didn't get tested until he was very sick and then none of the rest of the 12 people at his house took any precautions and only the youngest kid ever showed symptoms. When the kid was taken to the hospital she tested negative.

Makes no sense, but glad they're all ok now.
The infectiousness seems to be all over the map, but that is hardly ever mentioned. When people say it has a R infectiousness rating of 2 to 3, they are lumping all of the strains together. I've heard there are multiple strains with varying degrees of infectiousness. I believe the North East primarily has a very infectious strain, but the west had a less infectious strain. If we could determine not only whether we're infected, but also which strain is in our area, and whether that is the less dangerous variety, then it would allow us to make more intelligent decisions. We're still working with limited information.
 

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I am curious as to how many members would get tested if they are not showing any symptoms and they have not been in contact with anyone that has got the virus.

Until they come up with a less invasive method I do not. Plus you would run the risk of getting sick being around people that are positive.
 

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