A Third Solution

I don't think this tracks.

What do you do if someone denies the test? You can deny them entry, but if they protest or decide to force the issue, then the police have to deal with it. Then if the police get sick, they have to self-quarantine, and what do you do when you don't have the power to enforce the test?

Even if we managed to dress up our entire police force in hazmat suits to reduce the risk of infection, they can still infect people out and around the building. Turning away someone doesn't mean we're reducing the R0, we're just moving someone that's infected around. Given that there are asymptomatic people (and a certain number of people that would likely claim the test is a false positive or fake), all we're really doing is encouraging more people to gather in a single location as a potential infection vector.

Let's assume next then that somehow we had an automated solution. All the doors to said buildings are locked unless you complete a saliva test to go through. Barring the huge logistical concerns, we're still dealing with potentially infected people spreading the virus on surfaces and areas that people are travelling to and from.

Tech isn't going to save us from COVID-19.

There's a bit of gish gallop and vitriol here.

First, the .75% mortality rate is a one-time hit. It likely pulls some deaths forward, so the incremental death rate is maybe .5% in a single year. Again, this is terrible, and sad, but we should be mindful and accurate with numbers.

Second, people make lots of choices that increase their mortality risk by .5%. For example, lots of people eat at McDonald's on a regular basis, which certainly increases your lifetime mortality risk by .5%. And other people don't exercise at all. 30 minutes of jogging a day will lower your mortality by at least 1%, likely a lot more [1]. But we don't pass laws to force everyone to jog for 30 minutes a day.

With the new data, which is showing that mortality rates from covid-19 are not like smallpox 2.0, we should adjust our response to be more in line with responses to comparable risks.

[1] https://www.theguardian.com/lifeandstyle/2019/nov/04/any-amo...

I'm not sure new state powers would be required. The state already can (and does and should) compel people who are known to be infected to be quarantined, or at least self-isolated. As far as testing, companies can already require employees to be tested as a requirement to work. A lot of companies already do drug testing of employees, something I actually don't agree with in most cases, but it's already a norm. In normal times they likely won't have sufficient incentive to do virus testing though, and so probably wouldn't given the cost.

But during an outbreak, the ability to roll that kind of thing out, especially in workplaces with vulnerable populations (like senior care homes and hospitals) or necessarily close working conditions (like restaurant kitchens or some factories) could certainly be a game-changer. And that just seems entirely reasonable to me. There's a outbreak happening, so in order to enter [place where transmission would likely occur] you have to be tested first. If found to be infected, you must isolate. Otherwise, you'd be knowingly exposing others, which already isn't something considered acceptable.

So to me this simply looks like an effective use of existing powers in this situation. I'm not sure how it would slide down a slippery slope. The government decides to keep doing virus screening? I mean, I doubt they would incur the cost, but if they do, good! Maybe as Paul mentioned, we could significantly knock down cold and flu as well. If people are worried about infringing on the rights of people with viruses to live normally, I would ask what about the rights of others not to be infected by them? That besides the fact that if these measures are effective very few people will be getting sick in the first place.

Really interesting read and sounds like it could be a game changer for testing - I know in NY we've been clamoring for increased testing for a while to help us reopen. I've got two questions I'm curious about:

0) Sensitivity/specificity: Any data yet on what the sensitivity and specificity of this form of test for SARS-COV-2 will be? And, is work in characterizing all of that far enough along that we can expect to see emergency authorization by the FDA and scale up happening sooner rather than later?

1) Reagent supply: The biggest problem with PCR tests and all seems to have been reagent shortages and supply chains dependent on manufacturers not able to scale. Assuming the test is approved, are there any operational advantages to this approach in terms of securing reagents to overcome that problem?

Thanks for the fascinating read!

The latest on the COVID-19 R0 is a median of 5.7, up from the previously thought range of 2.2 - 2.7.

https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article

This means herd immunity kicks in at 82% of the population.

Antibody testing appears to be showing infection rates are a lot higher than previously thought as well.

Both of those things together mean that 1) "there's no way to stop it" 2) "it might not be as dangerous as we thought".

But who knows, right? There's a ton of science that needs to be done to find out what's really going on. Large-scale, accurate, randomized testing will hopefully fill out the data picture.

Because the US has an awful medical system where access to care comes through your job, it seems to me that more people will die (from non-virus causes) than from the economic damage than from the virus itself.

I guess we'll know more in a few years.