I do think something that confuses people, or at least me, is that nobody ever seems to directly address social guidelines. Everything (at least in America) is spoken of entirely in relations to business, but I think there are a lot of people that simply want guidance on if/when/how they can socialize with their friends and family, and some of the general frustration and anger across the country comes from poor efforts at addressing that directly.

Most states are now testing 5-10x the number of people that they did in April. Arizona has tested 111,000 people and they want to test another 60,000 people in the next three weeks. There is zero chance their counted cases will go down - even if the actual number is decreasing. Having that 14-day decline is essentially incentivizing states to reduce their testing if they want to open up - which is a terrible idea. What states should do is rely on other indicators on a slow re-opening, but keep testing like crazy. This way we could still isolate certain counties/cities if there is a bigger outbreak there. I'm thankful there isn't a requirement to follow the Gottlieb plan or people would just reduce testing to apparent healthy people and call everything great.

Speaking of SW Georgia, this sobering article was came out by the AP:

https://apnews.com/b2a2add19ce7f4f75f42b29331034706

One of the most frightening lines was this one:


SW Georgia is one of the places where hospitals were overrun. There is a story about an older married couple with health issues who got sick in a few days of each other. The hospital was packed, so the husband was told to go to a hospital an hour south and then the wife was told to go to a hospital an hour north. They both have since died.

I feel like banging my head against a wall. Are you even reading?

"positive tests as a percent of total tests"

Opening up testing makes that % decrease as you start testing people without symptoms.

So, basically, you want states to go test a bunch of healthy people and then open up? Because that's what you are basically incentivizing.

I'd rather keep testing sick and healthy and get a better idea of what is really out there- but not sit in some state of paralyzed shelter in place until August/September when maybe you get "lucky" and hit an inside straight on cases per tested. IMO, we have tested so few people that hospitalization rates/beds are the only real way to know how things are. Even if we quadrupled the testing number by August in most states, we would still have tested less than 10% of the population. This 14-day thing on an insignificant sample seems pointless.

That would be far better than just randomly opening up because they feel it's time. Also that would provide some good numbers of asymptomatic infection rates - if they only tested healthy people, which no state will limit it to. Regardless, it's a massive incentive to increase testing.

Btw, once a state 'opens up' based on no plan at all they are really not going to have much of an incentive to test more. Because no Governor is going to want data to show they were completely wrong, especially if they went against White House guidelines.

No, all it does is incentivize you to test until you hit a magic number (that is basically meaningless) and then stop. We shouldn't have anything reliant on testing and should always incentivize more testing (no matter the results).

Using testing rates to determine safety is like having Brady, Rodgers, Blake Bortles and Nathan Peterman all throw one pass in a pitch black practice facility - then say whomever completes that pass to an unseen WR is the best QB in the NFL.

Do you really think healthy people are going to go in and pay to get tested to help the state get their numbers up?

I don't even know what that argument is

If we're relying on testing people who can pay, doesn't that generally leave the poor (who are probably the most vulnerable) out of the equation?

That could lead to us believing that we're more virus free than we actually are.

By incentivizing increased testing. Seems like a win to me. There is no incentive to test more once you open up in opposition to the WH guidelines - why have the numbers show you were wrong.


It's a way to argue against having any semi-objective plan for reopening at all is what I'm seeing.

Most likely so. Though, better than nothing. It's not perfect, but I don't want to minimize the benefits of increased testing, even if it is mostly from a higher socio-economic level. The asymptomatic amount of infection is one of the scary parts.

I just don't see how any logical person could rely on testing numbers at this point. The sample is so infinitesimal that you don't get any real data. You can convince me the death numbers are more usable, but the actual count of cases has no real significance.

Hopefully this is not some kind of revelation for you

Yeah, you're right, just fuck it, why test at all?

Let's just leave it all to chance and hope for the best

I guess I naively thought there was some good old fashioned random sampling testing going on.

If not then the numbers are kind of useless.

What good would that be for determining whether it’s wise to reopen though? Seems like it'd be no more real info than we have now.

At this point we're talking about "Hey, let's open up because it'll help me in November!" vs. "Hey, let's open up because we've manipulated the data to make it look like a wise choice!" Both suck.

I don't have problem with the act of testing and think we should be doing it in orders of magnitude higher ASAP. My issue is using the 2% of each state we've tested as some kind of massive yardstick on progress in returning back. It's just not enough data.

It is unfortunate that we didn't test a lot more back in April, but it is what it is. We are now forced to use other methods to determine when it is safe for a transition back (with numerous safety precautions and restrictions). It would be great if we even had 10% of each state tested, but we don't and won't anytime soon.

Anyone else a little freaked out that the military has put a permanent ban on anybody who has ever had the virus from joining the Armed Services? What exactly do they know?

You can still join if you get a waiver.

Looks like it is only those who have been hospitalized. And you can still get a medical waiver if you can prove you're healthy.

Doesn't seem like a big deal. They flag stuff like asthma. And with how it appears to cause permanent lung damage to those who have the most serious cases, they're likely just being cautious.

I've heard of a couple, but mostly not AFAIK

It would likely give a lot more information on asymptomatic infection rates. At this point, we don't know a ton about that.

There have been a few. But with lack of testing available it was hard to justify sampling 40,000 people when people going to a hospital couldn't even get a test

100% agree here. By the way, here's an exhaustive list of nations who have done one test per each ten people:

Faroe Islands
Iceland
UAE
Falkland Islands

No major industrialized nations are better than 1 in 20. So waiting for it to get to that kind of level is IMO a pipe dream.

How does a state or country increase their testing beyond those who are actively seeking it out because they are sick or have been exposed?

I talked a while ago here about an Idaho non-profit that is offering testing, and antibody testing, to anyone who wants it. It's covered by insurance, you can pay out of pocket, or there was some talk of a subsidy if you couldn't afford it - no idea how that played out. They got some people (I went! negative on antibodies, damn it), but nobody else I know was excited to run down to a hospital parking lot and wait in line to do that on their time off.

(Results of the first batch of testing was 3.1% positive COVID tests out of 1,598, and 1.75% positive antibody test out of 1,946). And those antibody tests were people who thought they may have had it. So the numbers are very low here. Leaving us very vulnerable to a second wave, presumably more so that those who here hit harder/weren't restrictive enough earlier).

I would be more concerned with insurance companies using it as a pre-existing condition.

Guess it depends on where you are. In Illinois it is still tough to get tested. Usually have to be real sick to get one.

As for how to test more people, you do it by testing those who might have been exposed. So if your wife tests positive, everyone in the house gets tested. People who were around her get tested. That hopefully stops the spread there.

The White House is using WordPress??

They built a COVID-19 "mathematical analysis" in Excel, what do you expect?

This + routine testing (every week f.e) in Retirement/nursing homes (both employees and inhabitants), medical personnel of all sort both in hospitals, doctors offices or mobile services. Or 'designated' contacts of people in care-settings.

PCR testing is not an adequate tool to use for some sort of "let's randomly test as much as possible", it is a tool to identify either likely infected (symptoms or contacts with known infected) and to stop outbreaks before they take hold and ideally catch quite a few possible spreaders before they do so in vulnerable closed settings. And no, doing it won't prevent that totally, but lowers the odds by a lot as well as the size of Clusters.

For all that you not only need tests and labs but local authorities to organize that and do that contact tracing. The goal should be that each of those local Teams is in a position to actually do this. As soon as they can't you again loose track of developments and are flying totally blind. On the other hand there is currently no way to do that in many areas in the US, because you need to actually get low enough to start this on decent footing otherwise all you can hope for is a bit if damage controll. Testing isn't the magic bullet to replace hygiene measures (keep a distance, wear a mask, limit capacity, limit contacts) that you need to do when opening, it is a suporting measure (the more you find, the more you Quarantine and thus break a chain of infections) and a warning system for when to restrict some things again (to at least then be able to make an informed decision).

It really is not realistic to come close to catching every case, but that does not mean that finding 1 in 4/5 isn't helping a lot more than 1/10. Especially entering winter. In essence this was the difference in February/early march between Germany, Austria, Norway or Portugal vs Spain, Italy or the UK in terms is hitting/missing the break point.

But all that also relies on a fast return, so testing more but waiting longer on results is not good as well.

Got it. I thought we were speaking specifically about the decision to reopen. Sure, it’s good to get that info, but it’s not part of the metrics. So, point being, I really do think we’re stuck with either:
—gaming the tests to make it look like the metrics have been achieved
—waiting an absurd amount of time for them to come down as we continue to increase testing for the next several months
—coming up with entirely different metrics like number of deaths (and then fighting over what constitutes a COVID19 death)
—Leroy Jenkins

Options 1&2 suck. Option 3 ain’t happenin’.

Leroy isn’t the hero we want, but he’s pretty much what 2020 deserves. *shurg*

Yeah, i really fail to see it working as way to get the curve down. It is an important tool important to keep it down once you get there by brute force measures... (Which many countries managed)
Again, in Germany the estimate is about 1k cases can be actually traced and managed per day (goal is to increase that, of course). And then you get ever closer to those 1k being a larger % of actual infected because you break chains of infections. 1k traced might mean 2-3k real infections, 1.5k (of which 500 ger pushed to the next day) over time might mean 1.5 are really 10+.
1k would be the equivalent of 4 or 5 in the US under similar testing patterns.

I think a big problem for the US is the big distances which protected some areas from the worst early but also puts them on an entirely different trajectory now than NY or NJ.

What could be a game changer are 'instant' tests working on spit and are somewhat similarly intuitive as pregnancy tests. Which won't be available tomorrow, but is very likely going to be available soonish. Mass production needs to be figured out, but especially for people in contact with elderly people (by profession or privately) this would be huge as a safety net. Which is what it should be used for first and foremost ...
Because that way a higher number of cases in younger people is less of a Problem. Not no problem, but for the big picture not a neck breaker.

Partially it is. These states are going balls to the wall to reopen (Leroy Jenkins-ing it as you say). I think having them have some measurable metrics is good. Some states are going to game it, because that's just who their Governors are. I think a bunch would take it seriously. But even the states that game it, we can perhaps get some usable information from them. While testing isn't being done in necessarily a random statistical sample to extrapolate, it can be a good tool to see how things are looking - enough for a decent statistical sample for a certain socio-economic group I guess (and you don't need all that much for that - see how political polling is done). IIRC, about 19+ states are doing a statistically significant amount of testing for their state population, including most Southern states (including both Carolinas) - at least as of the end of April.

Is the alternative, like you said, wait for a neighboring state to reopen and see how many die in 2 weeks? Or just throw caution to the wind? (because as I noted, why would those states continue to test at any real level outside of hospitals if they did that)

Is anybody (CDC ?) 'curating' the data from testing on a national level btw ? I know the Institute in charge here keeps detailed statistics on a ton of stuff including certain professions or when a case actually showed symptoms vs. when they were tested etc. If anybody is interested:

https://www.rki.de/DE/Content/InfAZ/...ublicationFile

RKI - Coronavirus SARS-CoV-2 - Archiv der Situationsberichte des Robert Koch-Instituts zu COVID-19 (ab 4.3.2020)

(Not always the same stats/graphs every day and those are only a small portion, basically the easier ones for the public and available in german and english, lots more only in german like where the tests were done between doctors offices, tracing or hospitals etc)

:withstupid:

Seems like the best way forward has always been to test better, show that even though the infection rate is high, the death rate is actually low, and we have a way to manage both by tracking people who are infected. That would elevate the numbers, but would've helped us get to a place where a majority of the population would feel comfortable going out and adhering to the regulations.

Instead, we're basically still guessing. While the stay at home orders have helped reduce the load on hospitals, we don't know whether we're in a good place to be out. We should have an educated guess by now.

I've seen a couple of theories on that online. The first is that they're treating it a bit like childhood asthma as it's a respiratory disease and that's not a disqualifier but makes it pretty hard to get in. Second theory I've seen is that they don't want to take on the medical liability for the services or the VA. Of course, the whole "military knows (or strongly suspects) something we don't about it" is quite popular, as well, and that one's a bit more scary. Then again, there were a number of gnarly aftereffects from SARS.

SI

I know the feds aren't the answer but I don't get why at least a couple states or even cities haven't done their own random sampling because you really don't need large numbers to get a better idea. I heard about one in Boston where 32% of people in Chelsea tested positive, there was a plan for a test of a larger number (2000?) across more neighborhoods and... crickets. (Now Brookline says it will partner with MGH to test 200 asymptomatic first responders and 400 residents. Brookline Plans Randomized COVID-19 Antibody Testing Of Residents – CBS Boston )

Plus you see weird stories like the shockingly high numbers who test positive in a homeless shelter Coronavirus: CDC reviewing ‘stunning’ universal testing results from Boston homeless shelter or jails Ohio’s Marion prison reveals coronavirus challenges behind bars. None is easy. All are urgent - cleveland.com , the even more shocking number who show no symptoms, and the follow up focusing on what actually happens to this random sampling who got it is again minimal. This article at least has some stats (and says 11 deaths later in it), but as unfortunate it is it exploded in prisons, this seems like a perfect place to get some better data and extrapolate it and it's barely covered by the media.
Also (unsurprisingly), thanks New York! https://www.nytimes.com/2020/05/07/u...-outbreak.html

Just had a two hour conversation. With one of my oldest friends who stopped by. We social distanced around my pool table.

He has a daughter same age as my daughter so they've spent a lot of nights together at both houses and she considers him dad 2. So she was hanging out in the basement with us guys and even shot a game.

We were both confused and talking about why we both aren't worried at all about the virus, yet totally respect it and social distance (mostly - tonight excluded i suppose) etc. Just that we hsve zero fear for our safety despite fearing for our family.

It was refreshing to have someone else get your feelings and understand. But we were both confused. Then 16 year old sweet daughter chimes in.

Y'all both work high risk electric. You literally prepare to die if you mess up 10x a week. Y'all are over being scared of dieing. Me and Maddie are over being scared of y'all dieing. We used to cry to each other worried about y'all when we figured out what you do at like 10. Now we just hope it doesn't happen.

It was sobering to realize she had this fear and never shared it. And eye opening to realize she was right.

Don't know what that says about me but felt like sharing.
From the mouth of babes and such.

Bottoms up.

I think there's been a lot of concern that the serology tests right now produce too many false positives.

Indeed. A shot (and a prayer) for y'all - literally, FWIW.

chins down boys

With the newest good ones that is more an issue in areas with few cases. Say only 2-3% had it, than a 98/99 % rate of correct diagnosis is a problem (because quite conceivably from 500 tests you might find not 10 positives but 20 f.e.) but in total and clear hotspots that is somewhat negligible for academic purposes (!).

But personally i don't think these purely "how many had it" 'studies' are remotely useful, especially when they are random rather than representative/preplanned. Because at the end they do not really tell you much by itself other than how many had it in a very specific setting (,jail) or how many might (!) have had it in one town/zip code. Take the supermarket shoppers in NY which is simply flawed and really can't give you more than a very rough idea on it's own.
I mean, what exact use has that number, the jail number for any other setting ? Zero if you are honest.

So either you do big representative (not random !) studies on at least a big city level in multiple cities or countrywide with many criteria: demografic, social, racial etc spread of participants, big cities, small citis, rural, with many care homes, few care homes, high median age, low median age, many cases few cases etc). Or you use local studies to actually get Information: Like, how does it spread, who infects whome, who is sick when, what happens in households, what sort of jobs or habits di infected/uninfected have, how many antibodies are produced relative to symptoms/exposure etc, etc
And ideally you test those participants every week (both antibody and PCR) to get more than a mere snapshot from 10 days ago (antibodies take time to develop)

That then actually tells you sth about the disease and how it spreads that you can use for adjusting your strategy, but is not sth that you can whip up, do and analyse in a week.

The german study in Heinsberg has it's most relevant results not in their flawed IFR extrapolation (in essence they take one municipality with 7 deaths and end up guessing 1.8 mio in Germany were infected. Which is utter BS, because if 7,4 or 14 people in one little town die is highly random based on who gets infected or how/when they get treated There are similar sized and affected towns with 40 dead and much bigger ones with less).

But in analysing f.e. spread in households (the larger the household the lower the risk for each person. Highest in 2 persons, lowest with 4), relationship between exposure (a superspreading even at a local carnival session/party) and mild/bad cases or demografics of infections (children ARE infected at a similar rate).
And they are currently working on a fascinating analyses of that carnival session. Who sat where how long, who drank or didn't, who sang or didn't, who got sick when afterwards (or how sick) etc to figur out why who might have gotten infected or NOT infected.

The South Korean Prime Minister demostrating safety measures in a school cafeteria:

https://cdn.i-scmp.com/sites/default...770_170034.jpg

Meanwhile, westerners can't be bothered to bring themselves to make the sacrifice of wearing a bloody selfmade mask in select locations.(yes, obviously during meals the masks will come off ;) )

Everybody thinking the South Korean model would work in Europe/US is dreaming. Testing is only part of it, protection, consideration for others and a very, very close digital and analogue monitoring are other pillars.

They just had a single person presumably infect at least 12 already identified people in 3 different night clubs (more are expected as it has only been 4 days, but still that is insane to find these 12 starting from 1) and thinking about quarantining 1500 people.

Imagine a night club in the US or Europe being open right now and, say, 10 people with the virus (no symptoms or still before symptoms or even just not giving a fuck) visiting and spreading it to 50 more (to be conservative). How many infected would be identified 4 days later ? How many visitors would be identified ?

that's sure different from "a shot and a beer"

Hell, I'd even take consideration for others. It seems as soon as an inch is given, people take not just yards, but miles.

That safety measure inthe cafeteria is an instance where people who don't understand what it's like in person, creating something they think will help the situation. Sure, it's a great idea in theory, but he hasn't clearly been in a school cafeteria in a very long time. That might be fine at a college campus or a small school. No way does any school cafeteria have that much space, at least at the schools that I have been at and worked at.

He;s wearing a mask so he is already light years ahead of our leaders

Elementary school cafeteria's are the wild wild west. Average distance probably lucky to be 6 inches

In Oregon where my son went to school K-2 they eat lunch in the classroom. When we moved to NJ starting in 3rd grade they eat at the cafeteria here, he was like, WTF?