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We’re Testing the Wrong People

theatlantic.com

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Re: We’re Testing the Wrong People

#91

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.

Re: We’re Testing the Wrong People

#92
post #89

Earlier quoted context omitted.

"Quarantine" historically refers to segregation of people or populations who've been exposed to a disease from the general public. The idea of a general quarantine, where everyone is segregated from everyone else, was as far as I can tell invented out of whole cloth a few months ago.

Since there are literally laws on the books in many states that explicitly delegate this power, for this precise purpose, "invented out of whole cloth a few months ago" seems an extraordinary claim. Find a credible source? When you do so, remember that the "lockdown" we're experiencing falls far short of a "general quarantine". You can in fact leave your house, and travel between states, free from pretty much any tra…

Closing the bars, and the churches, gun stores, courthouses...

This lockdown is infringing on pretty much all our Constitutional rights, across the board.

Re: We’re Testing the Wrong People

#93
post #77

Earlier quoted context omitted.

Keep in mind, we've learned so much. At the beginning there were some authorities (China, WHO) claiming there was no human-to-human transmission. It's too bad they would have ever made that statement, because I think people latched onto that and didn't let go of the idea.

> At the beginning there were some authorities (China, WHO) claiming there was no human-to-human transmission. I don't understand how this misconception persists. That is not what the WHO statement said. The statement was that the outbreak was not being sustained by community transmission, and that they believed (this was very early on) that the cases from the Wuhan market were all due to exposure to a single case or…

https://twitter.com/who/status/1217043229427761152?lang=en

Re: We’re Testing the Wrong People

#94

I appreciate the HN title ("We're Testing the Wrong People") in contrast to the article title ("Without More Tests, America Can't Reopen"), even though it's usually against policy to have them be different. But the HN title is actionable: if we can change our testing policy and deploy our tests more usefully, that's great to know and eminently achievable. But "not testing enough" isn't really actionable. There's a sh…

In tests/capita US is 42nd. https://www.worldometers.info/coronavirus/#countries

Sometimes, I feel like concepts such as these need to be translated into terms the average hackernews reader will understand.

Let's say your key metric you're trying to maintain or improve is P50 request latency. Its relatively easy to exhibit an acceptable P50 to 10 users, from 1 VM. Its actually harder to deliver the same P50 to 100 users, from 10 VMs. Even harder for 1000 users and 100 VMs, snd so on. You run into previously fine bottlenecks you didn't know existed. Issues which were invisible at ten users become cascading failures at thousands.

It just keeps getting harder the more users you add, even though you're adding proportionally more underlying VMs. There is no end to how difficult it gets, until eventually, it becomes impossible.

Testing is a problem with difficulty that scales with population size. Of the top ten countries by population size, there are only two countries that have higher testing per capita than the US: Russia and China. Those three countries are pretty close; no one else, anywhere in the top ten, is remotely close to the US, Russia, and China.

(Kind of funny how the top two testers in the top 10 countries by population are dictatorships, who have every reason to maintain a strong, powerful image. Funny how it works out like that, isn't it? Do you believe their numbers?)

I run the fastest website on the planet. No one but my mom visits it, but its still the fastest. Lithuania (the world's top daily tester per capita yesterday) is that website. The US is, uh, lets say Google. Should you bemoan Google for taking longer to load?

Re: We’re Testing the Wrong People

#95
post #77

Earlier quoted context omitted.

Keep in mind, we've learned so much. At the beginning there were some authorities (China, WHO) claiming there was no human-to-human transmission. It's too bad they would have ever made that statement, because I think people latched onto that and didn't let go of the idea.

> At the beginning there were some authorities (China, WHO) claiming there was no human-to-human transmission. I don't understand how this misconception persists. That is not what the WHO statement said. The statement was that the outbreak was not being sustained by community transmission, and that they believed (this was very early on) that the cases from the Wuhan market were all due to exposure to a single case or…

It was extremely irresponsible for them to make statements about community transmission without any solid facts.

Edit: by default we should ASSUME community transmission

Re: We’re Testing the Wrong People

#96

Earlier quoted context omitted.

Because we don't have enough tests. We could reopen the country if we could test enough people, but we're stuck. Even in New York and New Jersey, tests are still limited to symptomatic people because there isn't enough testing capacity.

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

The point is to catch as many infected people as possible with limited available resources. When someone is found to have the virus, then contact tracing is used to identify even more infected people and to shut down local outbreaks asap. Only a minority of people with mild symptoms actually have the virus.

Re: We’re Testing the Wrong People

#97

I think this article is getting things out of order. The question right now shouldn't be who to test, but rather how do we increase the volume of testing. The article states that we should be running 500k tests a day, as if we're not simply because we choose not too. Right now we don't have the capacity and so we can't scale up at all. Why don't we have the capacity? Well the complete lack of coordination and leaders…

There's, frankly, probably not enough reagents and consumables on the planet for the US to achieve 500k tests a day. As far as I know no country anywhere has managed this level of testing. Germany - who've been doing the best at testing lately - have been stuck at about 50,000 tests a day for a few weeks now, maybe even decreasing slightly. If you take into account the difference in population, that's only the equivalent of the US doing 200,000 tests a day - and of course scaling up to a larger population is harder. That doesn't stop the American press making it sound like not achieving those 500,000 tests a day is the result of some uniquely American political failing though.

Re: We’re Testing the Wrong People

#98

> Another promising pathway is to pool many tests and run them together. If a pooled sample tests negative, everyone in the pool is negative. If it is positive, the members of the pool can be tested individually. Well, it took a global pandemic, but we finally found a use for bloom filters!

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

Re: We’re Testing the Wrong People

#99

Earlier quoted context omitted.

In tests/capita US is 42nd. https://www.worldometers.info/coronavirus/#countries

> In tests/capita US is 42nd That requires that you compare the US to Iceland, Faeroe Islands, Falkland Islands, UAE, Malta, Gibraltar, Luxembourg, Bahrain, Estonia, San Marino, Cyprus, Isle of Man, Lithuania, Brunei, Qatar, Liechtenstein, Ireland, Latvia, Andorra, Channel Islands, Bermuda, Aruba. Nice try. Back on planet earth, here's the list of actual sane comparables that are in front of the US, in order: Italy,…

This shouldn't be getting downvoted.

Many of the countries testing "more per capita" have a lower population than cities that many here on hacker news wouldn't even consider "real cities". Scaling testing in the Isle of Man above the US only takes a total of 1100 tests. Of course they are testing more per-capita than we are.

Re: We’re Testing the Wrong People

#100
post #36

> Another promising pathway is to pool many tests and run them together. If a pooled sample tests negative, everyone in the pool is negative. If it is positive, the members of the pool can be tested individually. Well, it took a global pandemic, but we finally found a use for bloom filters!

This idea is called group testing [0] and has been used by the army for quite a while. It is also a well-studied problem in information theory as a (useful) basic model and we know optimal solutions to it. What is surprising is that group testing tells us that we can actually do better : the specific construction you pinpoint the people who come up positive, without needing to have a test for each person [1] and this…

germany has been doing this for a while now
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