We’re Testing the Wrong People • Hacker News Board

Re: We’re Testing the Wrong People

#11

Post by explorigin » Thu, Apr 23, 2020, 3:58 PM UTC

Trasmatta wrote: post #8

alex_young wrote: post #3

The only data that is somewhat reliable in this pandemic is COVID deaths. Testing the population that is very sick / dying is crucial to understanding the baseline for the worst part of the problem. Once you have that under control, and we are not nearly there yet, you have to get every first responder tested regularly so you can prevent them from spreading the disease and give them some assurance that coming to work…

I would say the number of hospitalizations is reliable as well. Those are the only two numbers I've really been paying attention to, because the number of total cases is really just a factor of testing, and doesn't yet give us an accurate picture of the situation.

I disagree. In order for a hospitalization to count, they have to have a positive test. First, we have to factor in test inaccuracy and then the fact that doctors are still triaging tests even if a patient has symptoms. These numbers can't be considered accurate until we have enough tests to test everyone in the waiting room indiscriminately.

Re: We’re Testing the Wrong People

#12

Post by gumby » Thu, Apr 23, 2020, 3:58 PM UTC

alex_young wrote: post #3

The only data that is somewhat reliable in this pandemic is COVID deaths. Testing the population that is very sick / dying is crucial to understanding the baseline for the worst part of the problem. Once you have that under control, and we are not nearly there yet, you have to get every first responder tested regularly so you can prevent them from spreading the disease and give them some assurance that coming to work…

> The only data that is somewhat reliable in this pandemic is COVID deaths.

I agree,, especially as you included the word “somewhat”. We have pretty good numbers on people who died in hospitals, but people who died at home appear to be seriously under counted.

Additionally, consequential deaths are currently invisible. These are people who died, say, ecause the coronavirus crowded out their access to hospitals. There’s been a drop in ER visits for things like heart conditions. Some of those people would have recovered fine anyway but some may have arterial blockage that will kill them. You don’t Want these numbers in the primary statistics (as they say nothing about control of the pandemic) but you do want these very hard to track numbers to understating future capacity planning, ethical procedures, and long term economic consequences.

Re: We’re Testing the Wrong People

#13

Post by vikramkr » Thu, Apr 23, 2020, 3:59 PM UTC

alex_young wrote: post #3

The only data that is somewhat reliable in this pandemic is COVID deaths. Testing the population that is very sick / dying is crucial to understanding the baseline for the worst part of the problem. Once you have that under control, and we are not nearly there yet, you have to get every first responder tested regularly so you can prevent them from spreading the disease and give them some assurance that coming to work…

Deaths is a lagging indicator though, so even if it's reliable it comes in a bit late to make any policy changes off of it, and nobody likes waiting for 3 weeks to a month after each little change to see how it's reflected in death rates. Maybe it's reliable in the statistical sense, but not reliable in the sense that a layperson or a politician would be able to rely on it to guide decision making.

Re: We’re Testing the Wrong People

#14

Post by raldi » Thu, Apr 23, 2020, 4:03 PM UTC

lokar wrote: post #4

This seems to ignore the importance of testing symptomatic people to rule out COVID (the most common outcome) so care givers can stop wasting PPE (which is is short supply).

Non-covid diseases still require the use of PPE. Also, PPE is much easier to produce than tests.

Re: We’re Testing the Wrong People

#15

Post by pjc50 » Thu, Apr 23, 2020, 4:05 PM UTC

alex_young wrote: post #3

The only data that is somewhat reliable in this pandemic is COVID deaths. Testing the population that is very sick / dying is crucial to understanding the baseline for the worst part of the problem. Once you have that under control, and we are not nearly there yet, you have to get every first responder tested regularly so you can prevent them from spreading the disease and give them some assurance that coming to work…

The countries that have fought it most effectively do so by contact tracing: whenever someone is found to have it, test everyone they've come into contact with recently.

This works best with really intrusive surveillance of mobile phone locations :(

Re: We’re Testing the Wrong People

#16

Post by greendave » Thu, Apr 23, 2020, 4:06 PM UTC

lokar wrote: post #4

This seems to ignore the importance of testing symptomatic people to rule out COVID (the most common outcome) so care givers can stop wasting PPE (which is is short supply).

That works up to a point, but test accuracy makes it risky to be too definitive in interpreting the results. For example the Abbott test appears to have a 15% false negative rate[1]. That's potentially a lot of infectious people who would incorrectly be ruled out.

[1] https://www.npr.org/sections/health-shots/2020/04/21/8387942...

Re: We’re Testing the Wrong People

#17

Post by kurthr » Thu, Apr 23, 2020, 4:07 PM UTC

alex_young wrote: post #3

The only data that is somewhat reliable in this pandemic is COVID deaths. Testing the population that is very sick / dying is crucial to understanding the baseline for the worst part of the problem. Once you have that under control, and we are not nearly there yet, you have to get every first responder tested regularly so you can prevent them from spreading the disease and give them some assurance that coming to work…

I disagree that only deaths are reliable, fully tested patient ICU load is both easily measurable, fairly well controlled, and lower latency (roughly 2-4 weeks shorter!). I do agree that testing the dying is useful although it presents its own statistical challenges (dying with after a car accident with COVID).

Re: We’re Testing the Wrong People

#18

Post by kjakm » Thu, Apr 23, 2020, 4:07 PM UTC

vikramkr wrote: post #13

alex_young wrote: post #3

The only data that is somewhat reliable in this pandemic is COVID deaths. Testing the population that is very sick / dying is crucial to understanding the baseline for the worst part of the problem. Once you have that under control, and we are not nearly there yet, you have to get every first responder tested regularly so you can prevent them from spreading the disease and give them some assurance that coming to work…

Deaths is a lagging indicator though, so even if it's reliable it comes in a bit late to make any policy changes off of it, and nobody likes waiting for 3 weeks to a month after each little change to see how it's reflected in death rates. Maybe it's reliable in the statistical sense, but not reliable in the sense that a layperson or a politician would be able to rely on it to guide decision making.

>> Maybe it's reliable in the statistical sense, but not reliable in the sense that a layperson or a politician would be able to rely on it to guide decision making.

This seems to be what we're relying on in the UK. Hospital admissions for Covid show a good/relatively quick estimate of how measures are working and then a few weeks later a reflection of that trend in deaths confirms it.

Re: We’re Testing the Wrong People

#19

Post by votepaunchy » Thu, Apr 23, 2020, 4:08 PM UTC

ryanobjc wrote: post #9

Since many states cannot deficit spend, the strategy of 'leaving it to the states' is a deliberate strategy of abdicating responsibility at the federal executive level. With a federal unitary executive disinterested in expanding testing, and no other backstop, we are left without a country-wide strategy. I'm thinking that we won't get out from under this shroud until we get a new president.

The only thing stopping states from deficit spending (selling bonds to pay for general obligations) are the states’ own rules. As we have seen, constitutional requirements are not an impediment in a pandemic.

Re: We’re Testing the Wrong People

#20

Post by bo1024 » Thu, Apr 23, 2020, 4:11 PM UTC

But the tests aren't perfect, so how to get actionable data from them isn't clear. We saw this with the flawed west coast studies. If a test has false positive or false negative rates even as high as 1%, and we run hundreds of thousands to millions of tests per day...that's thousands or tens of thousands wrongly quarantined for 14 days, and the same number who are contagious but told it's okay to go out.