EAllusion wrote:https://www.nytimes.com/2020/03/10/us/coronavirus-testing-delays.html
This story seems “drag them from their offices” level bad. I guess hope it isn’t true?
I tried to read the actual story, but I hit a paywall. But I read the authors TL/DR on Twitter, as well as Trevor and the Seattle Flu Study’s response to the article. There are good reasons why letting someone home brew a test kit that hasn’t been vetted diagnose people for a disease without their informed consent is a bad idea. This looks terrible because the test kit successfully caught a patient. But if it had ended up with a high rate of false positives or false negatives, the newspaper story would be very different.
Trevor and the Seattle flu study are working with both agencies to make use of their data for surveillance, and both describe the relationship as positive. But here’s the problem we’re wrestling with right now: every potential case of flu right now is a potential case of COVID-19. Doctors offices and medical clinics aren’t set up to safely test for COVID. So integrating testing into our existing flu surveillance networks is not a simple problem. The CDC had a plan for that, that appears to have been scrapped once Pence’s task force started pushing “test kits for all” as if it was a magic wand.
Where people are seeing nefarious motives, I’m seeing a cascade of institutional breakdown under stress. It’s remarkably similar to Crichton’s Jurassic Park. You have a known risk, virus getting into the general population, and you have a number of systems set up to stop that. But the systems are complex and interrelated, which means that, it is likely that unforeseen circumstances will result in those systems having the opposite of the intended effect.
Based on what I’ve read obsessively over the past few weeks, there is a fair amount of unwarranted hysteria over the issue of testing in the media and among the US population. Since the beginning, WHO has defined “suspect persons” i.e., individuals who should be investigated, including testing. The CDC’s term for the same folks is Persons Under Investigation. The CDC has currently abandoned any attempt to define PUI, punting to “your doctor.” What is the current WHO definition of suspect case? It’s the same definition the CDC was using before it punted: investigate (test) people who either show symptoms and have traveled in countries experiencing an outbreak or have had close contact with a case informed by testing. Or, have symptoms bad enough to require hospitalization and have had other causes ruled out. WHO does not recommend testing folks with mild symptoms on an patient by patient basis. We should still be testing these suspect cases. We are testing the hospitalized cases. But when the CDC punted, it left doctors no guidance on which patients with mild symptoms should be tested. It also left doctors and clinics with no guidance on how doctors and clinics can create a safe environment for testing patients with mild symptoms that minimizes the risk of infecting health care workers and doctors. On the ground here, it was chaos.
I’ve gotta run. I need to do my regular weekly shopping. The governor implemented our first mandatory closures, WHO said the P word, and it’s looking increasingly like our school district will move to online instruction next week. I want to get my regular shopping done before the next wave of panic buying.
But some numbers and questions to chew on. South Korea, with all of its widespread testing, has tested .4% of its population. It’s population density is 40x that off the US. What percentage of its identified cases has it found through drive in clinics as opposed to contact tracing members of the religious sect who spread the disease? What were the pier capital stocks of PPE in South Korea at the start of the outbreak compared to the US. What is the effect of using PPE for testing on the availability of PPE to protect medical personnel who treat hospitalized patients? What is South Korea doing with the data from mass testing and what is the evidence that it is actually saving lives?
Stay healthy and create slack.