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We’re Testing the Wrong People

theatlantic.com

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Re: We’re Testing the Wrong People

#131

Post by Marsymars »

kd0amg wrote: post #52
munificent wrote: post #30

Earlier quoted context omitted.

We are currently quarantining about 300 million here in the US, so tens of thousands would be a massive improvement. The way to think about this is: who do we need to test so we can start un -quarantining people. The goal is not to find out who has it because right now, we are essentially behaving as if the entire US population is infected. The goal is to efficiently determine who is very unlikely to have it so that…

I'm pretty sure GP means actual quarantine. We are not quarantining hundreds of millions. We are advising hundreds of millions to practice social distancing.

Depends on the circumstances. I live alone and work from home, so there's very little difference for me between the current situation and an indefinite quarantine.

Re: We’re Testing the Wrong People

#132

Post by tptacek »

leereeves wrote: post #121
tptacek wrote: post #119

Earlier quoted context omitted.

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.

Your argument is specious. I said that the measures in place 2 years from now won't be the same as the ones we have now, not that things will simply be "less restrictive". Maybe they will be, maybe they won't. The reason they aren't different now is that it takes time to adapt. The reason we don't simply reduce restrictions right now is that doing so will kill people.

Re: We’re Testing the Wrong People

#133

Post by bo1024 »

Marsymars wrote: post #131
kd0amg wrote: post #52

Earlier quoted context omitted.

I'm pretty sure GP means actual quarantine. We are not quarantining hundreds of millions. We are advising hundreds of millions to practice social distancing.

Depends on the circumstances. I live alone and work from home, so there's very little difference for me between the current situation and an indefinite quarantine.

For anyone who exercises daily, there's a really big difference!

Re: We’re Testing the Wrong People

#134

Post by uxp100 »

uxp100 wrote: post #64
RandallBrown wrote: post #58

Earlier quoted context omitted.

But what's the point of testing people that are already sick? We don't treat Covid patients any differently than any other patients that develop pneumonia

We often put covid and suspected covid in separate areas of the hospital from others, with a different staff.

kjust to be clear, this is just what friends have told me, this is the communal we, I do not work in a hospital.

Re: We’re Testing the Wrong People

#135

Post by bo1024 »

munificent wrote: post #30
bo1024 wrote: post #20

But the tests aren't perfect, so how to get actionable data from them isn't clear. We saw this with the flawed west coast studies. If a test has false positive or false negative rates even as high as 1%, and we run hundreds of thousands to millions of tests per day...that's thousands or tens of thousands wrongly quarantined for 14 days, and the same number who are contagious but told it's okay to go out.

We are currently quarantining about 300 million here in the US, so tens of thousands would be a massive improvement. The way to think about this is: who do we need to test so we can start un -quarantining people. The goal is not to find out who has it because right now, we are essentially behaving as if the entire US population is infected. The goal is to efficiently determine who is very unlikely to have it so that…

These are good points (though broad strokes). Mostly I'm just pointing out subtleties or challenges with this approach.

One difference is if a business re-opens and expects people to come in to work, the US probably needs legal protections so quarantined workers don't get fired or forced to come in illegally.

Re: We’re Testing the Wrong People

#136

Post by rovolo »

RandallBrown wrote: post #91
pmoriarty wrote: post #40

This was covered about a month ago in episode 595 of This Week in Virology [1], in answer to a listener question: Rich Condit: Garrett writes: The CDC guidelines are to test hospitalized patients and symptomatic health care workers first, and the symptomatic general public last. This seems backwards to me. Alan Dove: Yeah. I just had this conversation with my wife after she had some, I mentioned this before, she had…

But why test the people with the worst symptoms? People with bad symptoms aren't the one's going out into the world spreading the virus and the difference in treatment between a Covid and non-Covid patient (from what I've heard) is minimal.

A) You'll know which communities have infections. Many places are saying: "it's not bad here, why should we isolate?"

B) If you know that someone with bad symptoms has the virus, then you can go test everyone they contacted. You'll find more people who currently have mild or no symptoms.

Re: We’re Testing the Wrong People

#137

Post by eckesicle »

efavdb wrote: post #98
eckesicle wrote: post #46

Earlier quoted context omitted.

We have been working on productizing this for the past couple of weeks. A bottle neck seems to be that it's not really possible to pool more than at most 32 patients at a time. It's an early work in progress but have a look: https://www.pcr-pooling.com

This is exciting. I've been following the idea for a month or so. Did you know that a group in Israel has tested the idea and found that it worked with the swab tests? I have a link on my notes below. I'll add your site to the reference list at the top tonight. https://github.com/EFavDB/pooling

Hi, Yes we are aware and have reached out to them. There are a few more studies out there. One from Stanford and one from Germany too. We're currently working to refine the software and also improve the presentation (there are some mistakes) and write a paper.

Re: We’re Testing the Wrong People

#138

Post by edmundsauto »

chasd00 wrote: post #29
SlowRobotAhead wrote: post #23

Earlier quoted context omitted.

> As we have seen, constitutional requirements are not an impediment in a pandemic Agreed. It’ll be interesting to see the 1A cases that come out of this though. There is only so much tolerance to freedom of religion, right to peaceful assembly, and right to petition the government that people will accept. Of course, if there was even a single issue with freedom of press there would be nonstop coverage from the very…

i'm both impressed and worried over the level of compliance from the American people. It's good that everyone is working together to "flatten the curve" however it's also worrisome how willing citizens are to do throw their rights out the window. I'm sure many politicians are rubbing their chins right now wondering if the rights of the people even matter anymore.

You are projecting that citizens are willing to throw their rights out the window. A more neutral perspective would be that people are willing to make sacrifices when they feel it's worth it. Also, people aren't "throwing their rights out the window" -- it's more like people are chilling them in the fridge for a small window of time. To prevent their friends, families, and countrymen from death.

(Also, it's not clear that America is all that compliant.)

Re: We’re Testing the Wrong People

#139

Post by DanBC »

tptacek wrote: post #106
leereeves wrote: post #92

Earlier quoted context omitted.

Closing the bars, and the churches, gun stores, courthouses... This lockdown is infringing on pretty much all our Constitutional rights, across the board.

It is if you assume your Constitutional rights are that that any citizen intuits from a casual reading of the Bill of Rights. It suffices in this context to point out that, if you're an American, you don't live in a country that operates on that principle; we've had centuries of jurisprudence that put the Bill of Rights into actual practice, and many of the principles routinely assumed to be violating the plain meani…

I agree with you, but you said this and I thought people may be interested in experiences from England about online court appearances.

> (Courts, for what it's worth, continue to function).

In England we split courts up, so we have a variety of criminal courts, courts of protection, family courts, etc.

Before Covid-19 they were all trying to "go digital", and were having mixed results. Now, because of Covid-19, they've just had to make it work somehow.

Here's some discussion from (the excellent) Transparency Project: http://www.transparencyproject.org.uk/remote-hearings-a-gulf...

They link to quite a few different blogs and comments, but I really want to highlight this one. It's from the courts of protection. http://www.transparencyproject.org.uk/remote-justice-a-famil...

Sarah's father had a stroke. He was taken to hospital. He started to refuse to eat or drink. The doctors decided he did not have mental capacity to make that choice, and so they fitted a nasogastric tube. He told his daughter that this was wrong, and he pulled out (!!!) his tube several times. They gave him a PEG tube, and he was eventually discharged to a nursing home. He wants the medical treatment (feeding) to stop; she wants what he wants; so now they go to the court to get an order. They lost the case.

This is, of course, a very distressing case for all involved. But this woman says that the informal nature of a skype case, with people's pets wandering in and out and people talking in a casual way to each other made it worse.

There's some sense that because Sarah wasn't in the same room as the judge and the lawyers that they didn't recognise her distress.

So, court cases are going ahead, but there's some considerable adjustment needed.

Also, they're not always going ahead. Here's a case about a form of child abuse (fabricated or induced illness). It's a really serious case, and the mother risks being separated from her child (or the child risks remaining with an abusive mother). The judge decided that this isn't a case that can be heard remotely. http://www.transparencyproject.org.uk/p-a-child-remote-heari...

Re: We’re Testing the Wrong People

#140

Post by DanBC »

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…

This is tricky to understand, but "all cause excess mortality" is pretty well understood by statisticians. They use it all the time for flu.

Here's one document from the UK that mentions the kind of testing they do to arrive at "deaths to flu" figures. They have international programmes to see what respiratory diseases are circulating, they test people who arrive in hospital for those, they know roughly how many people in the population they expect to die (because RTAs, cancer, heart disease, etc all stay sort of stable from one year to the next). They also do survey work to see if people have flu symptoms but haven't seen a doctor, and they can see how many people attend various healthcare settings for flu.

It's all a lot more complicated than "did someone write flu on a death certificate".

https://assets.publishing.service.gov.uk/government/uploads/...

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