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We’re Testing the Wrong People

theatlantic.com

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Re: We’re Testing the Wrong People

#81

Post by ctoth »

ctoth wrote: post #57
heraclius wrote: post #49

Earlier quoted context omitted.

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 w…

> But it can be held down to a manageable level.

So I think the word manageable is doing a lot of work here. Specifically, manageable to the hospitals, which is what I believe most people mean when they say this, does not do anything to manage consumer confidence. Which my entire question is about. How do I, as an individual consumer, feel confident enough in the systems set up to go back to some semblance of normal? Learning that my chance of getting infected from going to the grocery store has dropped from 20%? to... 5%? 1%? Whatever the risk is, it needs to be multiplied by the average number of places a normal consumer went to over a week before this outbreak. Which means that I'm still gonna get it eventually, just I might not block somebody else from getting a hospital bed. Which is obviously better than nothing! But I really think people are missing the human aspect of precisely what this entails.

Consider user stories. As a single mother do you still feel confident going out to get groceries knowing there's an n% chance of getting it and bringing it home to your kids? If you die there's no one else to look after them.

Re: We’re Testing the Wrong People

#82

Post by tptacek »

SpicyLemonZest wrote: post #55
jcranmer wrote: post #31

Earlier quoted context omitted.

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.

The authority of the state to impose broad quarantines has a history in our jurisprudence going all the way back to John Marshall. See, for instance, Gibbons v Ogden.

Re: We’re Testing the Wrong People

#83

Post by throwaway2048 »

ajross wrote: post #77
beamatronic wrote: post #39

Earlier quoted context omitted.

Keep in mind, we've learned so much. At the beginning there were some authorities (China, WHO) claiming there was no human-to-human transmission. It's too bad they would have ever made that statement, because I think people latched onto that and didn't let go of the idea.

> At the beginning there were some authorities (China, WHO) claiming there was no human-to-human transmission. I don't understand how this misconception persists. That is not what the WHO statement said. The statement was that the outbreak was not being sustained by community transmission, and that they believed (this was very early on) that the cases from the Wuhan market were all due to exposure to a single case or…

There is currently a big push to scapegoat the WHO as the cause of the pandemic.

Re: We’re Testing the Wrong People

#84

Post by user_50123890 »

jellicle wrote: post #69
ctoth wrote: post #57

Earlier quoted context omitted.

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 w…

Since this is infectious before symptoms show up, it's basically impossible to eliminate it entirely. But suppose A starts showing symptoms, tests positive. We can immediately notify B1, B2 and B3 that they need to quarantine, immediately. Before they start showing symptoms. And therefore we're cutting down on the time that they were infectious and spreading. Therefore generation C is only a couple of people instead…

Why would it be? China, South Korea, Hong Kong have all pretty much managed to lower their amounts of new cases down to basically zero, and their society is open for business albeit with social distancing and mandatory mask usage.

The trick is to NOT stop testing once your case count starts going down, instead give the test to everybody that wants one.

A few million spent on 99.9% negative tests daily > a few billion spent on the economy being shut off daily

Re: We’re Testing the Wrong People

#85

Post by SpicyLemonZest »

tptacek wrote: post #82
SpicyLemonZest wrote: post #55

Earlier quoted context omitted.

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.

The authority of the state to impose broad quarantines has a history in our jurisprudence going all the way back to John Marshall. See, for instance, Gibbons v Ogden.

"Quarantine" historically refers to segregation of people or populations who've been exposed to a disease from the general public. The idea of a general quarantine, where everyone is segregated from everyone else, was as far as I can tell invented out of whole cloth a few months ago.

Re: We’re Testing the Wrong People

#86

Post by ajross »

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…

> 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?

The goal isn't to "alert" infectious cases, it's to quarantine them so they don't create new infections. Even baring a legal order, someone who knows they are covid-positive is much more likely to stay home and away from others. That reduces the rate of spread, which is ultimate goal.

> but ... as the individual

It's not an individual level solution. There are no individual level solutions (except complete and total isolation I guess). Outbreaks are community events.

Re: We’re Testing the Wrong People

#87

Post by [deleted] »

munificent wrote: post #32

> Another promising pathway is to pool many tests and run them together. If a pooled sample tests negative, everyone in the pool is negative. If it is positive, the members of the pool can be tested individually. Well, it took a global pandemic, but we finally found a use for bloom filters!

[deleted]

Re: We’re Testing the Wrong People

#88

Post by cm2187 »

ajross wrote: post #79
cm2187 wrote: post #78

Earlier quoted context omitted.

The study I got these numbers from doesn't seem to classify asthma or obesity as a comorbidity. The largest ones are hypertension, diabetes, ischemic heart disease, atrial fibrilation, active cancer in past 5y, heart failure, COPD, dementia, stroke and chronic liver disease. Not familiar with all items in this list but some seem pretty serious.

So you think that stroke victims and retirees with dementia are just months from the grave? FWIW: I've personally been living with diagnosed atrial fibrilation for almost three decades. Diabetes is, literally, a lifelong illness for its sufferers. In fact, please cite me any of those factors which will reasonable by expected to kill you in months. Even heart failure and cancer patients tend to live years to decades w…

Of the people who died of this virus, yes, it is likely that a not insignificant percentage were in pretty bad shape. We are not talking about the whole population who have these comorbidities in the country.

Re: We’re Testing the Wrong People

#89

Post by tptacek »

SpicyLemonZest wrote: post #85
tptacek wrote: post #82

Earlier quoted context omitted.

The authority of the state to impose broad quarantines has a history in our jurisprudence going all the way back to John Marshall. See, for instance, Gibbons v Ogden.

"Quarantine" historically refers to segregation of people or populations who've been exposed to a disease from the general public. The idea of a general quarantine, where everyone is segregated from everyone else, was as far as I can tell invented out of whole cloth a few months ago.

Since there are literally laws on the books in many states that explicitly delegate this power, for this precise purpose, "invented out of whole cloth a few months ago" seems an extraordinary claim. Find a credible source?

When you do so, remember that the "lockdown" we're experiencing falls far short of a "general quarantine". You can in fact leave your house, and travel between states, free from pretty much any tracking or extra surveillance. Most of the police power being exercised falls under business regulation; where you're feeling the lockdown the most is likely in the fact that you have so few places to go right now.

Because it's easy to find sources discussing the legal controversy of general quarantines. But you'll notice they're mostly talking about the due process concerns of doing the equivalent of imprisoning people without trials, not closing the bars.

Re: We’re Testing the Wrong People

#90

Post by mjul »

polygotdomain wrote: post #71

I think this article is getting things out of order. The question right now shouldn't be who to test, but rather how do we increase the volume of testing. The article states that we should be running 500k tests a day, as if we're not simply because we choose not too. Right now we don't have the capacity and so we can't scale up at all. Why don't we have the capacity? Well the complete lack of coordination and leaders…

The Danish Serum Institute published an alternative workflow for testing without using the scarce reagent. Instead, they use an old method of heating the samples like boiling an egg.

See Fomsgaard and Rosenstierne’s preprint on medrxiv here:

https://www.medrxiv.org/content/10.1101/2020.03.27.20044495v...

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