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A Third Solution

paulbuchheit.blogspot.com

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Re: A Third Solution

#181

Post by pb »

arcticbull wrote: post #134

> This could be a reason why so many otherwise young and healthy doctors and nurses have been killed by this virus. This isn't well supported by data. In the sense that (a) young people just aren't particularly affected any more so than with the flu (old and sick people of course are much worse off) and (b) in Italy's data, no health professionals under the age of 49 died. There have been some deaths outside Italy bu…

Perhaps you should contact these medical residents to remind them that they'll be "just fine": https://www.aamc.org/news-insights/terrifying-privilege-resi...

I also see a fair number of younger people on this list: https://www.medscape.com/viewarticle/927976

Re: A Third Solution

#182

Post by tln »

pb wrote: post #143
adpirz wrote: post #138

Earlier quoted context omitted.

Assuming everything goes to plan, how will these be staffed and manufactured at scale?

It's a fully automated solution, like an airport kiosk or a subway turnstile. Maybe I need to make that more clear?

How far along is development?

Re: A Third Solution

#183

Post by vikramkr »

predxionbio wrote: post #173
vikramkr wrote: post #127

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 se…

0) From a clinical perspective this is data we are generating on an on going basis. Analytically this is a largely a function of the characteristics of the affinity, specificity of the capture molecule used to capture the target (viral particle). As you point out EUA gives opportunities to launch sooner... But it's still critical to validate technogies both internally and externally probably to a greater extent than…

Thanks for your reply! Makes sense with regards to the specificity and sensitivity. Are those more scalable supply chains ones that expose you to risk with international suppliers? My understanding, at least from what we've been hearing from our governor's press conferences (so take it with a big political grain of salt obviously), is that while we have high throughput machines capable of large numbers of tests, the reagent supply chains all go back to china leaving domestic companires reliant on international trade negotiations to be able to get the inputs they need to scale. Is that a valid type of concern and are there concerns that even if it's technologically easily scalable, the political and operational logistics of relying on third parties with different incentives could negate that advantage? I don't knwo how valid a concern that is, but that's the narrative we keep hearing here.

Re: A Third Solution

#184

Post by [deleted] »

s0rce wrote: post #164
IdoRA wrote: post #61

I’m having difficulty understanding why SPR would be more scalable than LFAs for this type of frequent screening? And what does the ROC look like for this startup’s SPR assay? Frankly, I don’t understand how this test is supposed to work, and I’ve used a Biacore! It might be helpful to have a technical explanation available, for domain experts to evaluate.

There didn't seem to be any details at all. Is there some sort of functionalized surface that specifically binds the virus, if so what molecule/chemistry, how? edit: this is all I found about the company: https://www.sbir.gov/sbirsearch/detail/1564207 https://innovation.medicine.umich.edu/portfolio_post/sepsis-...

[deleted]

Re: A Third Solution

#185

Post by usaar333 »

rossjudson wrote: post #129

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 dange…

> The latest on the COVID-19 R0 is a median of 5.7

Pet peeve of mine: R0 is not a property of a virus; it's a property of a virus in a certain environment. 5.7 is the estimate for covid-19 in Wuhan, a dense environment. It is nowhere close to that in the vast majority of the United States -- estimates are > Antibody testing appears to be showing infection rates are a lot higher than previously thought as well. > 2) "it might not be as dangerous as we thought".

The more reliable ones are about what we did think on both points, at least for those who rely on Imperial College's models (https://www.thelancet.com/journals/laninf/article/PIIS1473-3...)

> "there's no way to stop it"

Contact tracing is enough to keep r < 1. If we keep this thing at under 20 cases/million/day for the next few years until there's a vaccine, I think we can go about our lives.

Re: A Third Solution

#186

Post by slg »

condiment wrote: post #148
slg wrote: post #93

Earlier quoted context omitted.

This test takes 10 minutes. That is probably still too long to implement at the doors for most places. It will end up creating a bottleneck of people waiting to enter the building and another avenue to spread the virus. Making the inside of the mall safe from the virus isn't going to matter if everyone is exposed to the virus while waiting in the 30 minute line to get into the mall.

The article is suggesting daily testing and used "testing at the door" as an example. Wouldn't it stand to reason that you could be tested once per day, in the parking lot to a mall or some other shopping establishment, and thereafter _verify_ that you had been tested that day for the remainder of your commercial transactions? Thinking in those terms, 10 minutes per day is not so great of an imposition. We could form…

You can't just ignore people who don't travel by car. The hardest hit place in the country in New York City. Most New Yorkers don't own cars and many go months at a time without entering one. And even outside of cities, it is still classist to only allow people with cars to reenter society.

The system also becomes much more complex and requires a bigger infrastructure if you aren't literally testing people at the door. How do you verify someone has had a test today? In your bar code idea, can the bar code be faked? Is there some centralized database behind the system that tracks who tests positive? Is that database politically feasible? Some comments here are already objecting to that idea.

Re: A Third Solution

#187

Post by arcticbull »

pb wrote: post #181
arcticbull wrote: post #134

> This could be a reason why so many otherwise young and healthy doctors and nurses have been killed by this virus. This isn't well supported by data. In the sense that (a) young people just aren't particularly affected any more so than with the flu (old and sick people of course are much worse off) and (b) in Italy's data, no health professionals under the age of 49 died. There have been some deaths outside Italy bu…

Perhaps you should contact these medical residents to remind them that they'll be "just fine": https://www.aamc.org/news-insights/terrifying-privilege-resi... I also see a fair number of younger people on this list: https://www.medscape.com/viewarticle/927976

Again, I suggest you look at the data instead of responding emotionally. We need to allow the data to guide us.

I'm skeptical of the Medscape list, since it appears to be the product of a Google form. I'm not saying it's wrong, but I chose not to use it as my primary source because unlike the government data I provided, it's unclear how or if it's being verified.

Re: A Third Solution

#188

Post by renewiltord »

Mikeb85 wrote: post #132
newacct583 wrote: post #112

Earlier quoted context omitted.

Not to quibble too much with most of your criticism, but this one seems minor and trivially solved: > this does not allow the screener to differentiate between "has COVID-19" and "had COVID-19" As a policy matter, this doesn't rule out the use of the test in a pandemic management protocol at all, it just changes how it needs to be administered. For example it might require that people who are antibody-positive have a…

> people who are antibody-positive have a standardized note confirming recovery How do you prove recovery if you were never proven sick first? As an example, I had all the symptoms of Covid in late February, the same severity many people in my age group described, yet was never tested since our health authority dropped the ball and claimed community transmission wasn't a thing back then. If I tested positive for anti…

Test positive. Wait 14 days. Now you're positive clean.

Re: A Third Solution

#189

Post by philwelch »

clairity wrote: post #161
philwelch wrote: post #147

Earlier quoted context omitted.

That doesn’t really make sense. If you’re driving too fast, even with perfect focus you could hit someone or something before your normal reaction time could recognize and avoid it.

you’re missing the second half of the random chance argument. you could also have driven right past a collision that would have happened at a slower speed.

That makes no sense. The “collision that would have happened at a slower speed” wouldn’t happen at a slower speed because you’d see it coming in time to react and avoid it.

Re: A Third Solution

#190

Post by not_a_moth »

maxerickson wrote: post #172
not_a_moth wrote: post #160

A fourth way: We throw as many resources as we can at sampling undiagnosed populations, like the recent NYC study that suggests 20% of the city (10% of the state) has antibodies already. We could get real confidence that it's safe enough to return to normal, acceping that COVID is a new disease that's just going to be around, the 5th coronavirus that we deal with seasonally.

The arithmetic on that is ~1 million early deaths in the US. The screening in the article would cost billions of dollars. If it worked, we could then reuse the infrastructure to kill the flu. And then start on the colds.

> The arithmetic on that is ~1 million early deaths in the US.

Sorry that's baseless histeria. We can easily think through how healthy people go back to normal (exponentially lower fatality rate than elderly/sick), while vulnerable take more precaution, how then getting to 60% of population gives us herd immunity which grinds R0 to a halt. Then a vaccine arrives in 18 months. Not to mention heat/humidity/summer is being shown to slow the disease from recent studies.

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