The Coronavirus Testing Paradox | Talking Points Memo

The main driver of the conflicting thoughts isn’t actually a conflicting thought.

New York would love to be able to test everyone, every day (after all, just because you’re clear today doesn’t mean you are tomorrow).

But there’s a lack of both tests and the ability to process them.

When the availability of tests finally started ramping up last week, it promptly overwhelmed the capacity of laboratories to process them, creating massive backlogs of over a week.

With backlogs like that, if you’re asymptomatic, you’ll either be basically in the clear anyway, or have gotten sick and sought treatment, regardless of the results.

Once capacity for testing and testing supplies even out over time, you’ll see the official advice change and become mass-testing.

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“Local context is all important. In New York City, today, you should not get tested if you have mild symptoms.”

The reason, he said, is that the health care systems in places like New York, Los Angeles and Seattle are about to be overwhelmed by a wave of people seriously ill from COVID-19.

Catch 22…meanwhile, someone more concern about Wallstreet $$$ is toying with the herd immunity/KAG (Killing Geriatric Americans) are ok is going to complicate finding the epicenter in the US!

Oops…I meant
KAG = Killing American Geriatrics

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This bizarre idea, given what we know about this bug, that we should only test people who display symptoms, is a mistake, one driven by Trump’s failure to rally the federal government to obtain testing kits. They’re, once again, telling us “by the end of this week.” We heard that in late February.

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It’s a manufactured dilemma to justify incompetence.

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It’s not manufactured, it’s a real constraint, we’re two months behind where we should be in ramping up, that’s all on trump.

Laboratories aren’t going to sit around on tons of excess equipment, personnel or capacity in normal times, that would be bad business.

Which is why we’re supposed to have a government that can invest in big stockpiles for emergencies, since they aren’t concerned about quarterly profits. Sadly, we get a government who cares more about tax cuts for billionaires…

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No disagreement. I know the problem is real but it’s been treated as something normal. That shouldn’t be the case so many weeks into the outbreak. It’s a result of incompetence.

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That is totally true.

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This is a cascade failure, pure and simple. COVID-19 was coming to the US no matter what. The result could have been anywhere on a 1-10 scale depending on how much planning was done and the quality of that plan’s execution.

But there was no plan, except Trump’s PR step of halting flights from China, which he either wrongly thought would be enough, or more likely enough for a later PR strategy. And while a pandemic was a common model for disaster response planning, they didn’t do it and figured they’d just take their chances and wing it.

Early testing deployment probably would have reduced the economic impact because those who contracted the virus could be isolated while those found negative without contact could go about their business, perhaps with reduced activity. There would still be some economic slowing, but nothing like what we’ll have now. But Trump didn’t want testing widely deployed because then the numbers would go up, the market would go down, and he’d lose the PR battle anyway. His administration was not prepared, and Trump had already shot his mouth off too much to turn back.

Now, Trump and his minions are ready to march us all off to battle the virus on our own in hopes of saving the economy only in tatters because of his administration’s lack of planning and execution, and his own PR efforts to minimize the risk. It won’t work because hardly anybody would choose to sign up for this war. Some people may ignore the risks, or flaunt them like Trump does, or decide they are better off accepting the risk to themselves and others out of desperation to survive economically.

But it comes back to that cascade failure. Trump’s incompetence and ego and self-interest and utter lack of concern for anyone else’s life and health gave us this disaster. No wonder he’s willing to gamble our lives and livelihoods to attempt to prove he was right all along. He’ll claim it either way, so he can count me OUT.

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I wish I could like that 1000 times.

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I am hopeful that there are CDC epidemiologists in China, and, particularly in South Korea right now. In fact, all over the world. It would be helpful to be gathering as much data on their testing protocols, and follow-up testing in the population, both those who were confirmed COVID-19 cases, and those were tested negative. Are they doing serological tests (blood tests) after the fact? At what intervals? The world is one big laboratory right now. The quicker we learn about the natural history of this disease, the better will be our ability to manage the disease, treat, and protect (vaccinate) in the future.

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If you’re in a hot spot and start showing symptoms, just ASSUME you have Covid and self isolate. As much as you can. Testing in that situation is actually useless other than as an admissions confirmation. When you’re there, being clear this morning doesn’t mean you’ll be clear tonight.

However, outside of the hot spots, THAT’S how you identify and isolate using basic epidemiological tools. And the most basic tool in preventing spread is testing. The lack of tests is absolutely unforgivable. It’s like fighting a fire, you concentrate your efforts on controlling the spread. It’s just that this fire is invisible.

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OT, but this gave me a much-needed smile…

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It is a huge scandal and am glad reporters are still covering it. Lock him up!

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Good. Burr is going to need that $1.7 million just for legal fees.

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The testing and post-testing analysis will make this virus much more visible to us (scientific, medical, and public health fields.):slightly_smiling_face:

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There is no paradox.

To explain, let’s refer to the solution written by Tomas Pueyo in Medium:

Here is the key graph:

You test when in the before-Hammer and the Dance stages of an outbreak.

You don’t bother testing during the Hammer stage (as all spare medical capacity and personnel must be dedicated to the rising caseload).

America is currently in the Hammer.

We need to increase test capacity rapidly to be prepared for the Dance, but the focus right now needs to be on Hospital capacity and #FlattenTheCurve.

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Mechanisms of immunity / current test (transcription) / tests coming online soon (antibody) / new research about reinfection.

https://www.medcram.com/courses/take/coronavirus-outbreak-symptoms-treatment/lessons/11244772-update-42-immunity-to-covid-19-and-is-reinfection-possible

The problem with this discussion about testing is that it assumes that the current RNA test for Covid-19 has a high sensitivity and specificity rate. In actual fact we do not know the sensitivity/specificity of the test because we don’t know the denominator, ie we don’t know how many cases there are in total in the population because asymptomatic cases are not counted. We know that in vitro testing of the RNA assay is good, but there is data to suggest that in real life application the false negative rate (a person with the disease testing negative) is quite high. Below is a link to a talk given by a physician and personal eye witness to the experience in Wuhan. At 7:11 he shows a slide of the data of testing of people who almost certainly had the disease yet tested negative. As an additional kick in the pants, there is a critical shortage of the special nasopharyngeal swabs necessary for the RNA test as the main supplier is located in northern Italy.

What will be a significant step forward is the upcoming deployment of a serology (antibody) test. This is a simple blood test. Such a test will tells us who and how many have had the infection and identify those asymptomatic cases.

https://players.brightcove.net/719220616001/default_default/index.html?videoId=6142578981001

It’s critical not to forget that the tension between devoting resources to testing, or to care, is an artifact of the U.S. government’s failed response. The Trump administration chose positively, for misconceived political reasons, to sit on its hands when it was still possible to roll out an effective test/notify contacts/isolate program. Trump still refuses to mobilize the government effectively to increase either testing resources, or care resources.

I recognize that in our given context this is an important debate. But let’s not forget that the context for our context, so to speak, is a failure of epic proportions on the part of the Trump administration, and a failure that is ongoing as you read this.

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I would really be interested in antibody testing because I suspect I might have gotten the coronavirus and recovered - but how would I know without testing? It would be nice to know if I had acquired immunity - and if I’d put anyone at risk.

At the end of January I flew to Florida for a wedding. One leg of the trip had me sitting in the back of the airplane - across the aisle from a Delta pilot on his way home after flying back from China. Less than 6 feet, obviously. He wasn’t showing any signs of illness, but he did say he’d spent about several days wearing face masks while in China.

Several days later after returning home I became ill with symptoms that might have been coronavirus - or the flu. I eventually recovered after a few days at home. This was weeks before there was any great concern in the U.S. - self-isolation was not the critical matter it has become now. While I largely stayed at home (I’m retired), I did have several contacts during that period.

I would like to have antibody testing to find out one way or another. It sounds like it’s going to be months before anything like that is available. So, I will have to take precautions like everyone else until then.

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