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We’re Testing the Wrong People

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Re: We’re Testing the Wrong People

#121

Post by leereeves »

tptacek wrote: post #119
leereeves wrote: post #116

Earlier quoted context omitted.

"When they can be" is a strange way to refer to a universal shutdown of all jury trials in many jurisdictions, such as: https://www.ktvu.com/news/justice-delayed-california-courts-... What was perhaps acceptable as a temporary emergency measure is not acceptable as the new normal. The current measures are overly restrictive and cannot continue for two years. And while I don't care about religion myself, I understand…

I'm not sure why you'd expect me to respond to (let alone defend) an argument that nobody is making. Clearly things will not continue exactly as they have been for two years. If the same protective needs exist 2 years from now, the courts will have adapted. The churches, for whatever it's worth to you, already have. Regarding the courts: Ken White is a good source for what's actually happening.

My point is coronavirus will still be here in six months or two years.

So if we agree that less restrictive measures will be in place in the future, I would ask why such measures aren't also sufficient today?

I would argue that, given that this lockdown must end before we eliminate the virus, we should begin adapting and testing less restrictive measures as quickly as possible.

Re: We’re Testing the Wrong People

#122

Post by rechristened »

yason wrote: post #41
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 can lie too. What does it take for a death to be labelled as covid-19 death? That the person who died was merely tested positive, or do they do autopsies for all those who tested positive? How about covid-19 deaths that aren't counted as covid-19 deaths, for a reason or another? How about people dying less of regular influenza this year because of covid-19 and lockdowns? Even looking back at monthly 2020 death…

I believe, at least in New York, people are being counted as covid-19 deaths if they were in contact with someone who was diagnosed. They can count as a covid-19 death without ever being tested for it.

Re: We’re Testing the Wrong People

#123

Post by losvedir »

ajross wrote: post #65
losvedir wrote: post #56

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 sh…

> The U.S. [...] is second only behind Italy in tests per capita Where are you getting those numbers? I don't think that's correct. The Worldometer data may not be the best, but they have the US well down in the middle of the pack at ~13k tests/Mpop. Lots of large developed nations have the US beat by quite a bit, in fact. And Iceland is literally a full order of magnitude higher! In fact US testing policy has been l…

Oh, wow, that was my mistake. Thanks. I was getting the data from here [0], which for me had a lot of countries selected but not all of them. I didn't realize that it did not include by default a number of countries. When I include them all I see that the U.S. is in the middle of the pack.

[0] https://ourworldindata.org/grapher/full-list-cumulative-tota...

Re: We’re Testing the Wrong People

#124

Post by adrianmonk »

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…

I completely agree that increasing test capacity is the thing that blocks everything else, and we need to solve that first.

But in order to try to generate the political will and get the backing to make this happen, it helps to get the word out about the big picture of exactly why having so many tests is important.

New legislation is coming that provides some funding for testing, but out of $484 billion that it authorizes, only $25 billion in it for testing[0]. Meanwhile, a report from Harvard estimates that $50 to $300 billion will be needed[1]. So the amount of money made available so far is 1/2 to 1/12 of what one source has estimated that we need.

---

[0] https://www.cnbc.com/2020/04/21/coronavirus-senate-passes-48...

[1] See Appendix B starting on p. 42 of this PDF: https://ethics.harvard.edu/files/center-for-ethics/files/roa...

Re: We’re Testing the Wrong People

#125

Post by rechristened »

lostapathy wrote: post #99
adventured wrote: post #75

Earlier quoted context omitted.

> In tests/capita US is 42nd That requires that you compare the US to Iceland, Faeroe Islands, Falkland Islands, UAE, Malta, Gibraltar, Luxembourg, Bahrain, Estonia, San Marino, Cyprus, Isle of Man, Lithuania, Brunei, Qatar, Liechtenstein, Ireland, Latvia, Andorra, Channel Islands, Bermuda, Aruba. Nice try. Back on planet earth, here's the list of actual sane comparables that are in front of the US, in order: Italy,…

This shouldn't be getting downvoted. Many of the countries testing "more per capita" have a lower population than cities that many here on hacker news wouldn't even consider "real cities". Scaling testing in the Isle of Man above the US only takes a total of 1100 tests. Of course they are testing more per-capita than we are.

It's like saying that Saint Lucia has over 10 Nobel Prize laureates per million population but then finding out that the country has a population of 180,000 and that works out to 2 laureates in the country.

Re: We’re Testing the Wrong People

#126

Post by opo »

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

>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

It wasn't quite that simple, but the story has a gem of truth. As this article quotes Stephen Stigler (son of George Stigler who worked with Abraham Wald):

>..."The military was inclined to provide protection for those parts that on returning planes showed the most hits. Wald assumed, on good evidence, that hits in combat were uniformly distributed over the planes. It follows that hits on the more vulnerable parts were less likely to be found on returning planes than hits on the less vulnerable parts, since planes receiving hits on the more vulnerable parts were less likely to return to provide data. From these premises, he devised methods for estimating vulnerability of various parts."

http://www.ams.org/publicoutreach/feature-column/fc-2016-06

This paper goes into detail for those interested in statistics:

https://people.ucsc.edu/~msmangel/Wald.pdf

Re: We’re Testing the Wrong People

#127

Post by scott00 »

godtoldmetodoit wrote: post #44
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.

I've been wondering why there hasn't been more programs to test representative samples of individuals, just like a political poll. If I was in a Governor's or Mayor's shoes right now and I know there aren't enough resources to test everyone, I'd want some data like that to work with to make policy decisions. While you are in the process of opening things back up, you keep a close eye on your daily/weekly representati…

The confidence intervals are wide enough it wouldn't be very useful. If you sample 1000 people and get 0 positives, the 95% confidence interval is 0% - 0.36%. If you're the governor of Illinois, with a population of 12.67 million people, that upper bound equates to 45,612 people: far, far too many to handle with contact tracing and isolation. So you need to look to other metrics to make the decision about whether to issue or revoke a stay at home order.

So what are they looking at? Basically, if they have any evidence of community transmission, they need to issue the order or keep it in place. That means that if there are too many symptomatic people to even attempt contact tracing, you're not even close. Once you're low enough you can do contact tracing, you wait until you have a handful at most of symptomatic people you can't trace back to a known case. Until then, all you can do is keep the stay at home order in place, buy/beg/borrow/steal ventilators and PPE, and build testing and contact tracing capacity.

Re: We’re Testing the Wrong People

#128

Post by Marsymars »

013a wrote: post #94
theaeolist wrote: post #62

Earlier quoted context omitted.

In tests/capita US is 42nd. https://www.worldometers.info/coronavirus/#countries

Sometimes, I feel like concepts such as these need to be translated into terms the average hackernews reader will understand. Let's say your key metric you're trying to maintain or improve is P50 request latency. Its relatively easy to exhibit an acceptable P50 to 10 users, from 1 VM. Its actually harder to deliver the same P50 to 100 users, from 10 VMs. Even harder for 1000 users and 100 VMs, snd so on. You run into…

Tests don't need to scale with population size of the country - many countries have healthcare that's not administered at the national level.

Re: We’re Testing the Wrong People

#129

Post by Marsymars »

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.

There are places with single-digit positive test rates, that would require a 90%+ false negative rate, which, as far as we know, is not the case.

Re: We’re Testing the Wrong People

#130

Post by polygotdomain »

adrianmonk wrote: post #124
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…

I completely agree that increasing test capacity is the thing that blocks everything else, and we need to solve that first. But in order to try to generate the political will and get the backing to make this happen, it helps to get the word out about the big picture of exactly why having so many tests is important. New legislation is coming that provides some funding for testing, but out of $484 billion that it autho…

The political will should be fewer American lives lost. Politicians are framing this about the economy and states rights and other BS as a way to distract the public from the fact that people have died because we didn't act soon enough and decisively enough.

I also don't think we need to get the word out about how testing is important. People are cooped up in their homes precisely because we don't know who has it and who doesn't. Testing could resolve that.

I have little faith in the legislation from Washington for many reasons. The primary one being that before the crisis, during it, and at this very moment there is a lack of acknowledgment of the actual scale of this pandemic. Even worse a large part of the legislature fails to take this seriously, thus making the scale of the issue a secondary problem. What's been passed so far has already missed the mark as far as funding testing and properly ensuring that those who need the money get it. Instead, big business gets "relief" with little oversight, which given the past actions of this administration clearly isn't just by accident.

The reality is that testing is still significantly behind and efforts to increase testing won't make the news cycles. I strongly doubt that we'd be able to scale up quickly enough to make a meaningful dent in this anymore than strictly following stay at home orders. Unfortunately even that is too much to ask us to do as a society it seems.

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