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We’re Testing the Wrong People

theatlantic.com

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Re: We’re Testing the Wrong People

#51

Post by jeremyjh »

pmoriarty wrote: post #40

This was covered about a month ago in episode 595 of This Week in Virology [1], in answer to a listener question: Rich Condit: Garrett writes: The CDC guidelines are to test hospitalized patients and symptomatic health care workers first, and the symptomatic general public last. This seems backwards to me. Alan Dove: Yeah. I just had this conversation with my wife after she had some, I mentioned this before, she had…

We will never have enough testing capacity if this is not the policy objective. Right now no government leadership is working towards a goal of millions of tests per day. That is what this article is trying to change.

Re: We’re Testing the Wrong People

#52

Post by kd0amg »

munificent wrote: post #30
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…

I'm pretty sure GP means actual quarantine. We are not quarantining hundreds of millions. We are advising hundreds of millions to practice social distancing.

Re: We’re Testing the Wrong People

#53

Post by blueplanet200 »

exhilaration wrote: post #35
RandallBrown wrote: post #25

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.

Because we don't have enough tests. We could reopen the country if we could test enough people, but we're stuck. Even in New York and New Jersey, tests are still limited to symptomatic people because there isn't enough testing capacity.

It's a problem of limited resource allocation. The _point_ is that we have limited tests, so given limited supply why are we wasting the tests on those we think are sick. The limited supply could still be directed towards asymptomatic carriers. Wouldn't be testing everyone we want, but it's still more valuable than the allocation of tests right now.

Re: We’re Testing the Wrong People

#54

Post by dragonwriter »

raldi wrote: post #14
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.

> Non-covid diseases still require the use of PPE.

The PPE required for some COVID-19 symptoms in the absence of clear indication of a droplet/airborne transmissible condition are different than for COVID-19. You don't usually use droplet, much less airborne, protections for every patient presenting with a fever, or GI symptoms, or several of the other ways COVID-19 can present, but you must with the prevalence of COVID-19 until you can rule it out.

And it's even more critical to identify COVID-19 or it's absence in sick patients when part of your containment strategy involves segregating ftreatment facilities (part of the capacity surge has been in establishing either new COVID-19 specific facilities or new facilities to handle non-COVID-19 cases while existing capacity is dedicated to COVID-19.)

Re: We’re Testing the Wrong People

#55

Post by SpicyLemonZest »

jcranmer wrote: post #31
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.

Which constitutional requirements do you think are being violated? And if you're going to say first amendment, be sure to explain precisely why they wouldn't survive strict scrutiny. (And if you're not aware of the legal meaning of "strict scrutiny," then you are probably ignorant of what the Constitution has actually been held to mean by the authority that has the power to interpret it.)

Controlling a pandemic is certainly a compelling interest, but as far as I know no government has attempted to show that a general closure of businesses and churches is the least restrictive means that will achieve it. Many acknowledge that there are less restrictive means, and have a medium-term plan to move to those lesser restrictions, but say we shouldn't explore them right now because it's too dangerous.

Re: We’re Testing the Wrong People

#56

Post by losvedir »

I appreciate the HN title ("We're Testing the Wrong People") in contrast to the article title ("Without More Tests, America Can't Reopen"), even though it's usually against policy to have them be different.

But the HN title is actionable: if we can change our testing policy and deploy our tests more usefully, that's great to know and eminently achievable.

But "not testing enough" isn't really actionable. There's a shortage of tests because there's a shortage of the raw materials that goes into making the tests. The U.S. already has tested far and away more people than anyone else, and is second only behind Italy in tests per capita, and has a "positive test to test" rate roughly in line with (as low of a rate as) any other country's rate. See [0] and related charts.

"Just test more" isn't really useful at this point.

[0] https://ourworldindata.org/grapher/full-list-total-tests-for...

Re: We’re Testing the Wrong People

#57

Post by ctoth »

heraclius wrote: post #49
ctoth wrote: post #42

Maybe someone here can explain to me how this is supposed to work. Let's assume we have enough tests in the US to test every single person in the country every 3 days, and are contact tracing everyone with a smartphone, and providing smartphones to everyone without. Now, with all this in place, isn't the best we can do to alert people after they have already been exposed to the virus? It feels a bit like the safe sex…

The target is to ensure that each case infects no more than one additional person (‘R Each infected person will come into contact with some other people. Testing allows three things— - first, we can tell this person to stay at home and so stop them from infecting more people; - second, we can tell the people they have seen to stay at home with good contact-tracing, so that even if they get it they don’t spread it fur…

So I guess I'm still not seeing this. Can you give me a concrete idea of what this looks like? Let's assume that it is the middle of August and the food situation is still somehow stable, I install my contact tracing app, I get a clean test. Then what? If we miss one person, that one person can still infect an entire office building by coughing in an elevator. Because of the two week incubation period, those people will not know they're infected until at least a couple of days in, even assuming testing daily. We don't yet know how long a person can infect before testing positive, but this amount of time is most likely not 0. If this amount of time is less than 24 hours the person can still make it anywhere in the US by air. If any longer they can make it anywhere in the world. How do we not have constant low-level infection everywhere?

Re: We’re Testing the Wrong People

#58

Post by RandallBrown »

exhilaration wrote: post #35
RandallBrown wrote: post #25

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.

Because we don't have enough tests. We could reopen the country if we could test enough people, but we're stuck. Even in New York and New Jersey, tests are still limited to symptomatic people because there isn't enough testing capacity.

But what's the point of testing people that are already sick?

We don't treat Covid patients any differently than any other patients that develop pneumonia

Re: We’re Testing the Wrong People

#59

Post by dragonwriter »

empath75 wrote: post #38
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).

During a pandemic, it's more likely than not that any negative test on a symptomatic person is false. It's also quite likely that a positive test on an asymptomatic person is also false -- depending on how prevalent it is in the general population.

> During a pandemic, it's more likely than not that any negative test on a symptomatic person is false.

I don't think we've reached the point where COVID-19 is the leading cause of fever, much less GI symptoms, so unless you define “symptomatic” extremely narrowly (like, “in need of a ventilator”) that's probably not true in this pandemic at this time in the US.

Re: We’re Testing the Wrong People

#60

Post by jldugger »

awinter-py wrote: post #34

sampling bias debate reminds me of this stats legend from ww2: the USAF wanted to armor planes where the bullet holes were. statistician abe wald recommended armoring where the bullet holes weren't on the theory that those were the non-survivable hits can't interpret a statistic until you think about what's excluded from the sample

We don't really know that 'the USAF' wanted anything; that bit has the 'citation needed' flag set in wikipedia. The paper itself makes no comment on the presumed answer to the question, focusing mostly on mathematical models.

It certainly makes for a good drama though.

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