We’re Testing the Wrong People • Hacker News Board

Re: We’re Testing the Wrong People

#21

Post by ziga » Thu, Apr 23, 2020, 4:16 PM UTC

vikramkr wrote: post #2

The article mentioned using bar-coding to run pooled tests - that sounds really interesting. Anyone know if there's a link to a paper on that? The article doesn't link to anything on that unfortunately but that sounds really interesting. I'm trying to visualize how that works with qpcr, where the barcode is attached and where the primers bind (and presuambly after amplification you sanger them to read the barcode?).

Here’s a paper from the Broad Institute: https://www.biorxiv.org/content/10.1101/2020.04.06.025635v1

Re: We’re Testing the Wrong People

#22

Post by obelos » Thu, Apr 23, 2020, 4:17 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.

And even in states that can deficit spend, it seems like their efforts are stymied by the lack of the federal executive being unwilling/unable to manage supply lines. Congress handing money to university research hospitals is a necessary component to the TTSI strategy, but it will result in very little unless the executive branch steps in to coordinate access to the raw materials for these tests.

Re: We’re Testing the Wrong People

#23

Post by SlowRobotAhead » Thu, Apr 23, 2020, 4:21 PM UTC

votepaunchy wrote: post #19

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.

> As we have seen, constitutional requirements are not an impediment in a pandemic

Agreed. It’ll be interesting to see the 1A cases that come out of this though. There is only so much tolerance to freedom of religion, right to peaceful assembly, and right to petition the government that people will accept. Of course, if there was even a single issue with freedom of press there would be nonstop coverage from the very same.

I’m pro-self-quarantine but I can recognize the issue with ticketing people who went to a drive in church service, or walking alone, or playing outside with their kids. I haven’t see “THE” case that could go to Supreme Court, but I wonder if it’s out there.

Re: We’re Testing the Wrong People

#24

Post by Retric » Thu, Apr 23, 2020, 4:21 PM UTC

explorigin wrote: post #11

Trasmatta wrote: post #8

Earlier quoted context omitted.

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.

We have enough tests to cover people who are candidates for ventilators or have similarly severe symptoms. That’s still a lagging indicator, but not nearly as delayed as deaths.

Re: We’re Testing the Wrong People

#25

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

I've been saying this since the beginning of this whole thing.

I don't understand why we haven't focused all of our testing on people that aren't sick so we can catch the asymptomatic cases that are out in the world spreading it to everyone.

Re: We’re Testing the Wrong People

#26

Post by markrages » Thu, Apr 23, 2020, 4:24 PM UTC

gumby wrote: post #12

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…

You can get part of that with excess death rates. From the weeks overall deaths subtract the average death rate for this week in past years. That should give both people who died at home and consequential deaths.

Re: We’re Testing the Wrong People

#27

Post by ceejayoz » Thu, Apr 23, 2020, 4:26 PM UTC

markrages wrote: post #26

gumby wrote: post #12

Earlier quoted context omitted.

> 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…

You can get part of that with excess death rates. From the weeks overall deaths subtract the average death rate for this week in past years. That should give both people who died at home and consequential deaths.

The NYT has been analyzing that.

https://www.nytimes.com/interactive/2020/04/21/world/coronav...

Re: We’re Testing the Wrong People

#28

Post by sesuximo » Thu, Apr 23, 2020, 4:26 PM UTC

bo1024 wrote: post #20

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.

Isn't that better than quarantining everyone?

Re: We’re Testing the Wrong People

#29

Post by chasd00 » Thu, Apr 23, 2020, 4:30 PM UTC

SlowRobotAhead wrote: post #23

votepaunchy wrote: post #19

Earlier quoted context omitted.

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.

> As we have seen, constitutional requirements are not an impediment in a pandemic Agreed. It’ll be interesting to see the 1A cases that come out of this though. There is only so much tolerance to freedom of religion, right to peaceful assembly, and right to petition the government that people will accept. Of course, if there was even a single issue with freedom of press there would be nonstop coverage from the very…

i'm both impressed and worried over the level of compliance from the American people. It's good that everyone is working together to "flatten the curve" however it's also worrisome how willing citizens are to do throw their rights out the window. I'm sure many politicians are rubbing their chins right now wondering if the rights of the people even matter anymore.

Re: We’re Testing the Wrong People

#30

Post by munificent » Thu, Apr 23, 2020, 4:38 PM UTC

bo1024 wrote: post #20

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.

We are currently quarantining about 300 million here in the US, so tens of thousands would be a massive improvement.

The way to think about this is: who do we need to test so we can start un-quarantining people.

The goal is not to find out who has it because right now, we are essentially behaving as if the entire US population is infected. The goal is to efficiently determine who is very unlikely to have it so that those people can start incrementally returning to normal life.

It's not worth testing symptomatic people: they've already "failed" one test in that we at least know they have symptoms. Simply continue to treat them as infected.