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How the CDC’s restrictive testing guidelines hid the coronavirus epidemic

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Re: How the CDC’s restrictive testing guidelines hid the coronavirus epidemic

#271
post #161

Earlier quoted context omitted.

This is a failure of the executive branch. Congress did its job long ago. The executive branch already had the legal means it needed but the administration chose to abdicate its responsibility.

Do you have evidence that other politicians would have handled things significantly differently? As I said, the articles I found from the beginning of the crisis don't demonstrate that. Have you found any articles from, say, the beginning of February where politicians are calling for a much more robust response? The legislative branch certainly has the ability to act when they don't think the executive branch is up t…

State leadership stepped up while conservative media was echoing the president's narrative that that response was a liberal hoax. There's a stark difference between the standard response and how the president acted.

Re: How the CDC’s restrictive testing guidelines hid the coronavirus epidemic

#272

We have 330 million people in US. China has ramped their mask production to 200 million masks a day. Had US government had the foresight and common sense to contract mask manufacturers to even produce half of what China is producing - let’s say 100 million masks, we could have had enough for everyone to have a mask in 3-4 days. Universal masks for everyone (not only health care workers) together with hygiene protocol…

The problem is that the majority of masks manufactures are in China because that’s where the population regularly wears them for the simple flu.

Understandably the Chinese government would be unwilling to contract their strategic supply of manufacturing out when they need it for themselves.

Re: How the CDC’s restrictive testing guidelines hid the coronavirus epidemic

#273

Earlier quoted context omitted.

Absolutely. One of the worst consequences that we may have to deal with at the end of this is that public trust will go down. In the beginning our leaders failed to act on the guidance of the scientific and medical communities -- almost two months wasted. And now, our leaders are flailing around implementing policy that is not based on reliable data or scientific evidence. They've both failed to react and then when t…

Ioannidis had [a similar opinion article][0] published last week. It's worth reading [the rebuttal that followed][1] (as long as we're doing credentials: "Marc Lipsitch, D.Phil., is professor of epidemiology at the Harvard T.H. Chan School of Public Health and director of Harvard’s Center for Communicable Disease Dynamics." ): It agrees that the basic lack of good information is a failing and also certainly creates r…

I had read that rebuttal. The odd thing about it is as the author himself wrote, I'm not sure that Ioannidis is advocating inaction. Neither would I. Things must be done. It's that it's completely unclear that the "lockdown" stuff that is going to cause a new depression is actually worth it, or effective. And because lockdown is so vague, I mean not allowing people to go outside under threat of imprisonment and fines, or needing papers to travel somewhere. It may be an extreme overreaction, and I personally believe the cure would be worse than the disease. There are other things we can do.

Here's speculation based on data:

I can't help but see the demographics of those who are dying and come to the conclusion that this is not a threat to the general population in the direct sense. No one aged 0-9 has died worldwide to date. No one in Italy under 30 has died. Of those that have died in Italy, 88% had one or more serious comorbidities; only 12% can be directly attributed to COVID-19. It seems that this is killing people who are already sick or in fragile health; it just so happens that the elderly of course dominate those categories. Consider this: nearly 3,000,000 people die every year in the USA. How many of those who will die this year from COVID-19 will overlap with that 3,000,000? In other words, could it be that the excess mortality rate of COVID-19 when amortized over the next two years isn't actually that high? Does it make any sense to throw ourselves into a depression because of this? Remember, the effects of eceonomic downturns affect every single aspect of peoples lives including their health. If we do this wrong even more people may die or have significant, long lasting, hardship because of an ill-considered and potentially unnecessary intervention.

I read a paper this morning that suggested some things that I believe need more attention:

> For example, we are learning that hospitals might be the main Covid-19 carriers, as they are rapidly populated by infected patients, facilitating transmission to uninfected patients. Patients are transported by our regional system,1 which also contributes to spreading the disease as its ambulances and personnel rapidly become vectors. Health workers are asymptomatic carriers or sick without surveillance; some might die, including young people, which increases the stress of those on the front line.

>This disaster could be averted only by massive deployment of outreach services. Pandemic solutionsare required for the entire population, not only for hospitals. Home care and mobile clinics avoid unnecessary movements and release pressure from hospitals.2 Early oxygen therapy, pulse oximeters, and nutrition can be delivered to the homes of mildly ill and convalescent patients, setting up a broad surveillance system with adequate isolation and leveraging innovative telemedicine instruments. This approach would limit hospitalization to a focused target of disease severity, thereby decreasing contagion, protecting patients and health care workers, and minimizing consumption of protective equipment. In hospitals, protection of medical personnel should be prioritized. No compromise should be made on protocols; equipment must be available. Measures to prevent infection must be implemented massively, in all locations and including vehicles. We need dedicated Covid-19 hospital pavilions and operators, separated from virus-free areas.[0]

[0] https://catalyst.nejm.org/doi/pdf/10.1056/CAT.20.0080

Re: How the CDC’s restrictive testing guidelines hid the coronavirus epidemic

#274

Earlier quoted context omitted.

There was a paper that went by my Twitter feed yesterday about how dish towels tended to do better on the particulates the researchers were testing on than a t-shirt (or piece of silk, or double layer cotton shirt, or...). I agree about them being better than nothing and it'll be fairly dependent on aerosol size but you should probably prefer thicker clothes.

This website chose cotton t-shirts as the best combo https://smartairfilters.com/en/blog/diy-homemade-mask-protec... https://smartairfilters.com/en/blog/best-materials-make-diy-...

Dish towels and vacuum bags do a better job of filtering, but make breathing quite difficult. A simple cotton t-shirt material is fine. And there's no sign that double layers help; and they make it harder to breath as well.

Re: How the CDC’s restrictive testing guidelines hid the coronavirus epidemic

#275

I'm still trying to understand why Japan's numbers are so low. You can argue they aren't testing but if the infection rate is similar then the death rate should be similar was well regardless of testing or not. They aren't staying home. Restaurants, bars, and events are still open. Trains are still packed at rush hour. Festivals are still happening. They're planning on starting school in April. I can only see a few p…

> "I don't believe this one. Japanese might wear masks but not all of them wear masks and they are not N95 masks." This is a very western belief. Why do we continue to think that asians wearing masks are stupid? Most importantly, say masks prevent 50% of transmission, and the majority of transmission is via the air (highly plausible), then that would mean drastically less transmission. Even an N20 mask that reduces r…

A DIY mask made from a common cotton t-shirt is approximately N70. This article breaks down the effectiveness and breathability of different materials.

https://smartairfilters.com/en/blog/best-materials-make-diy-...

Re: How the CDC’s restrictive testing guidelines hid the coronavirus epidemic

#276
post #159
post #94

Earlier quoted context omitted.

Pretty much. We're seeing the result of institutional decay at every level. "In the middle of the 20th century, a cadre of credentialed experts was created to replace citizens. This was a mistake. The selection mechanism for entry into this cadre selects against bravery and original thinking. Experts should be consulted, but what use is an expert unwilling to consult on a grand vision? The American system of the 2020…

A few counterpoints: - The CDC (and the US Federal Government in particular) has been understaffed and underfunded for the entire duration of the Trump Administration; to expect the agency that's been gutted for 3 years to rise up to responding effectively to a pandemic seems a bit much. The CDC is not the Center for Pandemic Control; 99% of the time their goal is to optimize tests and 99% of diseases they work with…

Per your first point, you are incorrect. From the CDC About page:

* CDC is the nation’s health protection agency, working 24/7 to protect America from health and safety threats, both foreign and domestic. CDC increases the health security of our nation.*

“Protection” is active, not passive. So yes, they are the center for pandemic control.

And if you don’t like my wording, then check out this page [0] which is the homepage for the Deputy Director for Infectious Diseases (DDID). On that page it states that “he directed CDC’s 2009 H1N1 Pandemic Vaccine Task Force”.

Finally, this funding story has been denied [1] by the CDC itself.

So yes, someone dropped the ball. I’m not mad about that (it’s a complicated environment, etc), as much as I am mad that nobody will own up to it. That lack of responsibility is why I hate politics and Washington crap in general.

[0] - https://www.cdc.gov/about/leadership/leaders/oid.html [1] - https://www.factcheck.org/2020/03/false-claim-about-cdcs-glo...

Re: How the CDC’s restrictive testing guidelines hid the coronavirus epidemic

#277
post #242

Earlier quoted context omitted.

> test extensively You can't manage what you can't measure. To this date, I have seen no reliable data on how fast the disease spreads, or how dangerous it actually is. Testing only 'people with shortness of breath and high fever for more than 4 days' is so biased it's not even funny. There could be 10x or even 100x more people with milder symptoms that are never considered for testing. Reporting '10% of people teste…

There is extremely good data from South Korea where extensive testing is performed.

[deleted]

Re: How the CDC’s restrictive testing guidelines hid the coronavirus epidemic

#278

Earlier quoted context omitted.

Yes, it's terrible that politicians in the us at least were doing their utmost to say this isn't a real problem because they didn't want to hurt the stock market and impact their re-election changes. But there's another side to testing things to failure in the real world, people can die. There are vulnerable people of every stripe. Unlike me they may barely get enough food, barely be able to pay that apt that depends…

> Some stress testing is good, but how to do it without killing the vulnerable. Less stress, more often. I think regular random border closures or brief, targeted disruptions of small parts of supply chains would do wonders to curb over-JIT-ting of the economy, while not hurting too many people too much. That said, I worry it's too little - it doesn't address head-on the incentives that create vulnerable supply chain…

We do that (kindof) with airports every time there is a hurricane.

Somehow that needs to be woven into a bigger fabric.

I wonder if there is a way to create simultaneous small pains randomly.

For instance, a hurricane and a cell phone outage would really suck.

Re: How the CDC’s restrictive testing guidelines hid the coronavirus epidemic

#279

Earlier quoted context omitted.

Yeah maybe it'll be in place for next time. But this looks to be about a once in a century event. It happened in 1917 and happening now. I doubt we'll handle it better in 2115.

I don’t know about that. A lot of lessons were learned in the 1918 flu pandemic that were applied here. For example, I’ve seen the comparison between the Philadelphia and St Louis responses multiple times in how governments were reacting. I’m sure there will be lessons here too. The difference in response of between countries is one obvious comparison. But I think another lesson will be how the virus spread globally.…

I've seen the Philadelphia versus St. Louis response, and I guess that may have informed a couple of decisions. But I think we already knew large gatherings are bad when a pandemic is afoot.

Any other examples?

Re: How the CDC’s restrictive testing guidelines hid the coronavirus epidemic

#280

Earlier quoted context omitted.

This is so completely blowing this crisis out of proportion. I am so confused by the tenor of the discourse on HN. I expected more from this place.

Chernobyl was projected to kill millions. The top epidemiologists in the world projected in the most realistic scenarios that the death toll would have been in the millions prior to the quarantines. Both could have been prevented if people knew the truth well in advance of the crisis. Call it hyperbole, but the Spanish Flu killed millions because the public was not told the truth soon enough. We were likewise told th…

  because the public was not told the truth soon enough
Nobody knew the truth (as the "Spanish" moniker makes obvious). Germ theory itself was new, and viruses were unknown. In fact, a substantial effort to make a vaccine to combat the suspect bacteria resulted in actual deployment to thousands despite the fact that they had misidentified a bacterium as the culprit.
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