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A Third Solution

paulbuchheit.blogspot.com

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Re: A Third Solution

#101

Post by dekhn »

Ididntdothis wrote: post #7
uhnuhnuhn wrote: post #5

Can we stop hyping blog posts by tech people writing about epidemiology and medicine? I'm shocked how much baseless speculation and misinformation is being shared on HN.

I tend to agree. Maybe medical people should start having opinions on software architecture after reading a few articles. They may have some fresh ideas. Or not?

I've worked in both fields. Few people who are experts in one of those fields can be useful in the opposite field, but there are some exceptionally productive individuals who are. Reading through Bucheit's article, he seems to fall into the 'wow, biology is really easy, you just have to do and the problem is fixed' camp. In my experience, that does not correlate with a good understanding of how to produce a successful medical diagnostic.

Re: A Third Solution

#102

Post by sandworm101 »

jawns wrote: post #11

> If we were able to identify and quarantine everyone who is contagious, including those who are asymptomatic, then we could let everyone else out of lockdown and resume ordinary social and economic activity. > Even with imperfect screening, if we are able to prevent 90% of disease transmission, then the virus’s reproductive number, or R0, will drop below one and the pandemic will quickly fade. There is no risk of re…

"Test and release" only works in science fiction. In the real world there is no absolute test that would enable practical test/catch-and-release processing of infected persons. From an epidemiological perspective, when applied to an entire population even tiny false negative rates will let countless infections slip through. False positive rates will see some people doomed to perpetual lockdown as, for whatever reason, they repeatedly test positive.

Setting aside the science of disease, the concept of government agents performing a test to determine one's ability to conduct basic civil liberties (movement, work, basic speech etc) is antithetical to liberal democracy. Such things were not contemplated at the height of the AIDS panic, or SARs, or ebola. It would take something far worse than COVID-19 to implement such a regime in the western world. COVID is a threat to our way of life, to our economies. It isn't an existential threat to the state let alone the species.

Re: A Third Solution

#103

Post by epicureanideal »

Let's hope this works, and if it does, that we use it for every other kind of disease as well. I'd sure like to never get the flu, or the common cold again, because we brought their R0 to near 0 also.

Re: A Third Solution

#104

Post by macintux »

chatmasta wrote: post #97
philwelch wrote: post #83

Earlier quoted context omitted.

The store does not permit you to enter and you are asked to go home and self-quarantine.

What if you infect someone on your way back?

You’re still in a much better position than we are today, where you’d infect several people in the store, and again the next day, and the next.

Re: A Third Solution

#105

Post by vikramkr »

stonogo wrote: post #88

Not only is it completely unrealistic at scale, the specific approach in the blog post is wildly impossible at all. It requires screeners to directly manipulate saliva samples; this is dangerous in a pandemic. The assays referred to (lazily) in a Google Scholar search are almost overwhelmingly antibody assays; this does not allow the screener to differentiate between "has COVID-19" and "had COVID-19". Also, there is…

I might be misreading your comment, but I don't think the blog is promoting antibody testing? It sounds like the blog is about a method of detecting viral particles directly, perhaps using an immunoassay based on the wiki for SPR, but not to test for antibodies directly.

And in terms of medical records laws, the regulatory environment has loosened so quickly with the advent of this virus that I'm sure regulators and legislators will be favorable to making it easier for the company if the test demonstrates the appropriate sensitivity and specificity in clinical trials. People are getting reimbursed for sending emails to patients, health visits done over zoom, would have been impossible to imagine this level of regulatory flexibility just six months ago.

Re: A Third Solution

#106

Post by greedo »

johnnyo wrote: post #42
marcell wrote: post #30

Earlier quoted context omitted.

Every year around 3 or 4 million people die in America from a variety of causes. This is sad, but at some point, everyone has to die. Data is showing that the infection fatality rate is around 0.5%-1%, and is concentrated in older people. [1] is one study, but there are many others. Given this data, it's clear that our current response is out of proportion with reality. [1] https://www.reddit.com/r/COVID19/comments/g…

So if all of America (330 million) gets infected, and we’ve got a 1% fatality rate, that means deaths (3.3 million) would be up there with all the other things that kill us combined!

We hopefully would reach herd immunity far before that point, but even with herd immunity only requiring 70% of Americans to be infected, we're looking at over 2m fatalities. And that's not even counting the hospitalizations that will be over 20M.

What we need to hope for is an unlikely vaccine, or a therapeutic treatment to mitigate the worst of the diseases effects.

Re: A Third Solution

#107

Post by arcticbull »

rguzman wrote: post #20
marcell wrote: post #6

> First of all, it’s not “just the flu”. It is something much more dangerous. Catching this virus is a bit like playing a round of Russian roulette. You’ll probably be fine, but you could end up dead I think this is mischaracterizing it. People have to die eventually. One year of existence has a mortality rate of 1%. For a 75-84 year old individual it is nearly 5%. Above 85 it's 14%. [1] The coronavirus infection fat…

the CFR is only as low as 0.5-1% when there is adequate medical care and the population is otherwise healthy. in NYC the CFR for the 18-45 cohort is ~5%[1]. [1]: https://www.worldometers.info/coronavirus/coronavirus-age-se...

Using CFR to determine fatality rate of COVID is as effective as it would be for skydiving. If you only count people who go to hospital (because they're frightfully sick -- or splatted out of an aircraft) and compare that to those who walk out of hospital you're exhibiting massive adverse selection bias.

For H1N1 swine flu, CFR was between 0.1% and 5.1% depending on the country. The IFR was 0.02%.

For COVID it's between 0.07% and 15%. The IFR is probably in the lower quartile of the 0.1%-1% range. [1]

[1] http://cebm.net/oxford-covid-19-evidence-service/

Re: A Third Solution

#108

Post by freepor »

pb wrote: post #38
jawns wrote: post #24

Earlier quoted context omitted.

But how realistic is daily screening on a wide scale? You're going to face major issues with compliance.

That's why I think testing at the door is the more straightforward way to start. We can reopen factories, office buildings, even shopping malls, but no one gets in without passing the screen.

Frankly this is the idea that a software guy comes up with. It’s like you translated the idea of checking every API request for malicious payload to a real-world situation and left out the 99.997% of the parts that make the problem hard. It’s like assuming the existence of a teleporter.

Re: A Third Solution

#109

Post by jhauris »

tempestn wrote: post #77
centimeter wrote: post #54

Earlier quoted context omitted.

Not trying to show bravado or anything, just pointing out that I and probably others feel this way; I would fight tooth and nail against pervasive, mandatory "test and release" policies on humans (and the necessary concomitant growth of the surveillance state). The second-order social and political effects of such a policy would be disastrous - orders of magnitude worse, in the long run, than the population-level hea…

This position truly baffles me. I can understand people who have reservations about tracking everyone with phone apps to do more effective contact tracing. But objecting to widespread, low-cost testing for virus infection as an extension of the surveillance state? I don't even know how to argue against that because it simply doesn't make any sense to me. Right now the population is clamoring for more widespread and e…

I think it's the mandatory part that's rankling centimeter, and I see their point. Once you give powers to the state in an emergency situation it's really hard to roll them back. See the PATRIOT act for example. Is there a way to effectively get universal compliance without implicitly granting permanent new powers to violate civil liberties?

I suspect relying on people to test themselves daily without mandating it would do a reasonable job, but I have no idea if it would be enough.

Edit: typo.

Re: A Third Solution

#110

Post by macintux »

arcticbull wrote: post #98

> First of all, it’s not “just the flu”. It is something much more dangerous. It is for some demographics, not all. It's safer than the flu for young folks, especially the under 10's which the flu hits pretty hard. For some it's worse, especially over 70s. > Catching this virus is a bit like playing a round of Russian roulette. You’ll probably be fine, but you could end up dead. Also true of the flu. Yes, even for th…

But unlike the flu there’s significant spread from asymptotic people, so the young are walking time bombs.
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