Our Pandemic Options

[AUFAN78 3,894]

I think our Covid task force members started telling us to wear masks too late. Just an opinion.

https://www.politico.com/news/2020/03/31/fauci-mask-recommendation-coronavirus-157476

[Grumps 3,704]

21 hours ago, homersapien said:

Our problem with tests are currently, 1) not enough of them,  2) too slow.

(Accuracy is another issue that can be factored in, but as long as we have enough, fast tests, you can work around that.)

We need to spend "billions" (whatever it takes) on 1 and 2.  And we should have started doing that months ago.

 

Can you consider even the theory that if the test isn't going to change action that needs to be taken then perhaps the test isn't necessary at all?

[homersapien 11,362]

45 minutes ago, Grumps said:

Can you consider even the theory that if the test isn't going to change action that needs to be taken then perhaps the test isn't necessary at all?

Adequate numbers of fast tests would allow for immediate quarantining of infected persons, which is the only way to stop the spread without a vaccine.  Inadequate numbers of slow tests can't  do that. 

So, are you suggesting - as your "theory" - that infected people will refuse to act (quarantine themselves)? 

If so, then yes, it's pointless to have adequate, fast tests. 

But from a semantics standpoint, assuming the goal is to reduce the spread of the virus, testing is still "necessary". That's scientific fact.  Americans being too dumb to take advantage of it wouldn't change that fact.

I don't accept your theory that Americans - as a whole - are that dumb. Maybe 25 - 30% of them might be.  (Coincidentally, about the same as Trump's core support. )

 

[Grumps 3,704]

10 minutes ago, homersapien said:

Adequate numbers of fast tests would allow for immediate quarantining of infected persons, which is the only way to stop the spread without a vaccine.  Inadequate numbers of slow tests can't  do that. 

So, are you suggesting - as your "theory" - that infected people will refuse to act (quarantine themselves)? 

If so, then yes, it's pointless to have adequate, fast tests. 

But from a semantics standpoint, assuming the goal is to reduce the spread of the virus, testing is still "necessary". That's scientific fact.  Americans being too dumb to take advantage of it wouldn't change that fact.

I don't accept your theory that Americans - as a whole - are that dumb. Maybe 25 - 30% of them might be.  (Coincidentally, about the same as Trump's core support. )

 

I am personally aware of probably a dozen or more people who have tested positive and were asymptomatic and did not isolate themselves. 

My theory is that the tests are being used to try to change people's behavior, not to serve as a basis for treatment plan. I believe that even people who test positive and do not isolate themselves will not pose much a risk to others if they socially distance and wear a mask and wash their hands. I believe that we, as a country, are not getting much value for our billions of dollars being spent on testing. I also don't believe that increasing testing, or spending on testing, is going to change the value of the testing.

[homersapien 11,362]

2 hours ago, Grumps said:

I am personally aware of probably a dozen or more people who have tested positive and were asymptomatic and did not isolate themselves. 

My theory is that the tests are being used to try to change people's behavior, not to serve as a basis for treatment plan. I believe that even people who test positive and do not isolate themselves will not pose much a risk to others if they socially distance and wear a mask and wash their hands. I believe that we, as a country, are not getting much value for our billions of dollars being spent on testing. I also don't believe that increasing testing, or spending on testing, is going to change the value of the testing.

"Well, we do know that every country in the world that has gotten on top of COVID-19 has done it based on a plan that makes testing effective and ubiquitous for their populations and particularly those in need, and then ties testing and test results to isolation and quarantine efforts that can help reduce the chain of transmission."

 

Excerpt from:

https://www.pbs.org/newshour/show/why-the-u-s-still-doesnt-have-control-of-covid-19-6-months-after-pandemic-began

Why the U.S. still doesn’t have control of COVID-19, 6 months after pandemic began

 

[savorytiger 182]

6 hours ago, Grumps said:

I am personally aware of probably a dozen or more people who have tested positive and were asymptomatic and did not isolate themselves. 

I've seen this brought up a few times in this forum a few times (that asymptomatic people are less likely to transmit the virus), and it's likely to be correct. The main issue is that people may assume that they asymptomatic when in fact they are presymptomatic. If you end up having symptoms 3 days later, that means you were probably infectious the entire time. So...if you get a positive test, self isolate until you are sure you are truly asymptomatic.

https://www.statnews.com/2020/06/09/who-comments-asymptomatic-spread-covid-19/

[Grumps 3,704]

10 hours ago, savorytiger said:

I've seen this brought up a few times in this forum a few times (that asymptomatic people are less likely to transmit the virus), and it's likely to be correct. The main issue is that people may assume that they asymptomatic when in fact they are presymptomatic. If you end up having symptoms 3 days later, that means you were probably infectious the entire time. So...if you get a positive test, self isolate until you are sure you are truly asymptomatic.

https://www.statnews.com/2020/06/09/who-comments-asymptomatic-spread-covid-19/

Thanks for the advice. The purpose of my comment was to point out that obtaining a positive test doesn't mean that people will isolate. I still contend that spending billions on testing that does not alter the treatment plan one bit is at least cause for close scrutiny.

Based on the article, it seems crazy to test people who are asymptomatic, yet the call for more testing is to be able to test more asymptomatic people.

[savorytiger 182]

3 hours ago, Grumps said:

Thanks for the advice. The purpose of my comment was to point out that obtaining a positive test doesn't mean that people will isolate. I still contend that spending billions on testing that does not alter the treatment plan one bit is at least cause for close scrutiny.

Based on the article, it seems crazy to test people who are asymptomatic, yet the call for more testing is to be able to test more asymptomatic people.

There's too much unknown about the virus right now, and the only way to find out is to actually test people.  We're all just spitballing how many people are truly asymptomatic, how many just have mild symptoms, the likelyhood of asymptomatic people to spread the virus, etc. It may feel like a waste to try to contain something that may only have a 1% chance of happening (completely made up chance for an asymptomatic person to spread the virus), but given large enough numbers of such cases, you end up with a lot of sick people.

You're right that some people do not self isolate, but that's an issue of education. That people fail to execute public safety measures isn't a sign that those measures shouldn't exist.  From the article:

Quote

Some studies, however, have estimated that people without symptoms (whether truly asymptomatic or presymptomatic) could be responsible for up to half of the spread, which is why the virus has been so difficult to contain.

Anyway, we're mostly arguing with our intuitions here, so I'm not trying to get you to change your mind. Understanding that getting more testing is not a crazy stance would be good step though.

[Grumps 3,704]

7 hours ago, savorytiger said:

There's too much unknown about the virus right now, and the only way to find out is to actually test people.  We're all just spitballing how many people are truly asymptomatic, how many just have mild symptoms, the likelyhood of asymptomatic people to spread the virus, etc. It may feel like a waste to try to contain something that may only have a 1% chance of happening (completely made up chance for an asymptomatic person to spread the virus), but given large enough numbers of such cases, you end up with a lot of sick people.

You're right that some people do not self isolate, but that's an issue of education. That people fail to execute public safety measures isn't a sign that those measures shouldn't exist.  From the article:

Anyway, we're mostly arguing with our intuitions here, so I'm not trying to get you to change your mind. Understanding that getting more testing is not a crazy stance would be good step though.

When I said "crazy" I said that based on the article it seems crazy to test the asymptomatic. That's all. I find it fascinating how often people won't even consider information that goes against their intuition.

Do you know of any other medical conditions that the U.S. spends billions on for which there is no treatment and where the results of the test don't change the recommended treatment plan?

 

[savorytiger 182]

3 hours ago, Grumps said:

When I said "crazy" I said that based on the article it seems crazy to test the asymptomatic. That's all. I find it fascinating how often people won't even consider information that goes against their intuition.

Do you know of any other medical conditions that the U.S. spends billions on for which there is no treatment and where the results of the test don't change the recommended treatment plan?

Again, up to half of the spread may come from asymptomatic or presymptomatic people, which means testing could make a huge difference. I'm not focused on those who can get by with just isolation and rest. The money is spent for those who would experience permanent damage (which isn't talked about at all on this board), just die, or may need medical intervention to have a chance. Halving the spread could make the difference between an area getting overwhelmed, to having enough healthcare capacity to heal anyone who could be healed. Our poor testing capabilities and early reopening means certain states like Texas and Florida need all the help they can get.

[McLoofus 35,182]

10 hours ago, Grumps said:

the results of the test don't change the recommended treatment plan

You keep saying this, despite it being patently wrong. It's strange.

 

10 hours ago, Grumps said:

I find it fascinating how often people won't even consider information that goes against their intuition.

It's something, isn't it?

[Grumps 3,704]

27 minutes ago, McLoofus said:

You keep saying this, despite it being patently wrong. It's strange.

 

It's something, isn't it?

So you are saying this is patently wrong:

Person with symptoms with positive test: Stay home. Wear mask if out. Wash hands. Social Distance.

Person with symptoms with negative test: Stay home. Wear mask if out. Wash hands. Social Distance.

Person without symptoms with positive test: Stay home. Wear mask if out. Wash hands. Social Distance.

Person without symptoms with negative test: Stay home. Wear mask if out. Wash hands. Social Distance.

If you are going to say that it is more important for someone with a positive test to stay home then I would agree with you.

I realize that you are implying that I am not considering that the billions we have spent on testing is a great thing. My reply is that I have been discussing it long enough to convince most people that I have, in fact, considered it.

I will ask you the same question I asked earlier with one slight change:

Do you know of any other medical conditions that the U.S. spends billions on for which there is no treatment and where the results of the test don't significantly change the recommended treatment plan?

FYI: I am staying home and wearing a mask if out and am washing my hands and socially distancing. I am not trying to be argumentative. Believe it or not, I am just trying to make sense of the situation.

[McLoofus 35,182]

2 minutes ago, Grumps said:

So you are saying this is patently wrong:

Person with symptoms with positive test: Stay home. Wear mask if out. Wash hands. Social Distance.

Yes. If you are symptomatic and positive, then don't go out. Period. 

3 minutes ago, Grumps said:

Do you know of any other medical conditions that the U.S. spends billions on for which there is no treatment and where the results of the test don't significantly change the recommended treatment plan?

This is something that you're just saying over and over and I don't really think it's accurate.

[Grumps 3,704]

20 minutes ago, McLoofus said:

Yes. If you are symptomatic and positive, then don't go out. Period. 

This is something that you're just saying over and over and I don't really think it's accurate.

Okay thanks. My post said, "Stay home." Yours says "don't go out. Period." My argument is that is not enough difference to justify spending billions of dollars, but I am pretty sure we are not going to agree on it. Anyway, thanks for considering my opinion!

What about the first part of the question:

Do you know of any other medical conditions that the U.S. spends billions on for which there is no treatment?

[Mikey 16,575]

On 7/25/2020 at 3:54 PM, Grumps said:

Can you consider even the theory that if the test isn't going to change action that needs to be taken then perhaps the test isn't necessary at all?

I see no benefit (other than to researchers) to anyone getting tested unless they are showing symptoms or some unusual work or social situation requires them to be tested. I certainly wouldn't get tested without some compelling reason to do so.

 

[McLoofus 35,182]

6 minutes ago, Grumps said:

Okay thanks. My post said, "Stay home." Yours says "don't go out. Period." My argument is that is not enough difference to justify spending billions of dollars, but I am pretty sure we are not going to agree on it. Anyway, thanks for considering my opinion!

What about the first part of the question:

Do you know of any other medical conditions that the U.S. spends billions on for which there is no treatment?

Probably every deadly medical condition. Takes billions of dollars to identify vaccines and treatments. They've more or less succeeded with HIV. 

Also, you do know that most testing is offered privately, yes? 

[Gowebb11 9,314]

Strategies and protocols are only as good as they are consistently executed. More testing vs less testing, masks vs no masks, isolation vs herd immunity. It doesn’t matter when you are as divided as our populous is. Nations who have had the best success vs COVID have come together as a society and complied with scientific approaches. While we were making runs on toilet paper and guns. I’m convinced we cannot and will not reach a consensus on a unified strategy to combat this virus and will have this chaos to deal with for a long time. Very sad. 

[McLoofus 35,182]

1 minute ago, Gowebb11 said:

Strategies and protocols are only as good as they are consistently executed. More testing vs less testing, masks vs no masks, isolation vs herd immunity. It doesn’t matter when you are as divided as our populous is. Nations who have had the best success vs COVID have come together as a society and complied with scientific approaches. While we were making runs on toilet paper and guns. I’m convinced we cannot and will not reach a consensus on a unified strategy to combat this virus and will have this chaos to deal with for a long time. Very sad. 

It reminds me of a popular response to green initiatives: "Why should we cut emissions if China doesn't?"

Pretty scary how often "Because it's the right thing to do" fails to be a sufficient answer. 

[homersapien 11,362]

1 hour ago, Gowebb11 said:

Strategies and protocols are only as good as they are consistently executed. More testing vs less testing, masks vs no masks, isolation vs herd immunity. It doesn’t matter when you are as divided as our populous is. Nations who have had the best success vs COVID have come together as a society and complied with scientific approaches. While we were making runs on toilet paper and guns. I’m convinced we cannot and will not reach a consensus on a unified strategy to combat this virus and will have this chaos to deal with for a long time. Very sad. 

Well, it would certainly help it we had a president who offered a consistent message from the beginning instead of a narcissistic psychopath who looks at this as a personal affront to his political career so has politicized it from the very beginning (with assistance from Fox network).

And the irony is, if he had acted responsibly, he would be in a much better position politically. 

 

[Grumps 3,704]

I agree with you about how our POTUS should act. I am pretty sure that we disagree as to how "we the people" should act. We could choose to work together for the good of the country  until Trump is gone, but that won't happen, will it?

[McLoofus 35,182]

Okay. Here's a real world scenario that, hopefully, can be understood by all. My daughter's summer camp just closed for two weeks because somebody, out of 150 or so kids and counselors, tested positive. Because of HIPAA, we of course have no idea who that kid or counselor was. And because testing isn't widely available with fast results, they just have to shut the whole thing down rather than test everyone and let all the clean people come back. So that means my wife now has to work from home the next two weeks while caring for a 5 year old. My family is very lucky that that's an option for us. A lot of people have their kids there because they have no other options for childcare. Some of them literally might lose their jobs over this.

Now project that across every elementary, middle, high and secondary school campus across the nation. Imagine how many similar closures there will be, how many childcare lurches there will be, how many kids will be sent to inadequate home situations... when, instead, regular testing of everyone would ensure that only the sick go home and it's business as usual for everyone else.

Surely this can penetrate even abnormally high bone density?

[Grumps 3,704]

It would be awesome and incredibly useful if widely available and very rapid testing was available. That would provide really useful and valuable information. Decisions could be made with such information that could help many people. I sure hope that happens, but as far as I know, that type of testing does not exist in quantities sufficient to help us yet.

On a completely separate note, if the only testing that we have widely available takes 5-10 days to come back, then is there any reason to test people who do not have symptoms?

[McLoofus 35,182]

24 minutes ago, Grumps said:

as far as I know, that type of testing does not exist in quantities sufficient to help us yet.

If there were only a resource that we could exchange for the research, production and distribution necessary to make that happen. 

25 minutes ago, Grumps said:

if the only testing that we have widely available takes 5-10 days to come back, then is there any reason to test people who do not have symptoms?

It would be useful as a sort of reverse contact tracing. It would let you know that you have the antibodies, even though they're not worth as much as we'd hoped. It would be worth other things. It would let you know that, yes, you do need to sit your ass in your house for the next week and have anything you need dropped off at your doorstep. 

But yes, the most important thing other than responsible personal behavior is more, faster, more accurate testing nationwide. I'm not really sure how or why that remains cloudy for literally a single person in this country at this point. As others have said, such testing exists in other countries. Which means it should exist here, but there's been a catastrophic failure of leadership. 

[Grumps 3,704]

Much of the confusion that keeps happening is that, as most of you probably know, there are several different types of tests. On TV the everyone says, "We need more tests! We need more tests!" The politicians and news media don't specify what tests we need more of. Most of the tests being done outside of hospitals are RNA tests to check to see if someone currently has the disease and therefore, is likely to be contagious. Those tests take 2-10 days to get back, depending on who is processing the tests. Even many nursing homes in Alabama are having to do these tests that have a long wait time for results.

There are some very fast RNA tests that give results in 1/2 hour or less. Those tests are mostly done in hospitals and a few urgent care clinics. Those tests would be great to have widely available. 

The antibody tests are completely different and only tell if someone has been exposed to the COVID-19 virus and has developed antibodies and should therefore be immune to the virus. I do not think that it is recommended for people to get antibody testing at this point because no one knows yet the significance of having antibodies. Some say that the immunity goes away after a short period of time.

If anyone thinks that we need to do more testing, it would be helpful to specify what type of testing we need more of.

For example, it is my understanding that all students who go back to Auburn this fall will be tested prior to starting classes. If they all get an RNA test, then the test only tells them if they are positive at the time of the test. If it takes 3-4 days for the test to come back, no one knows if the student has become positive since the test was obtained or if he/she will get COVID the next week.

[McLoofus 35,182]

I can hear the response now. Don't care. 

Quote

Countries that have successfully contained their outbreaks have empowered scientists to lead the response. But when Jared Kushner set out in March to solve the diagnostic-testing crisis, his efforts began not with public health experts but with bankers and billionaires. They saw themselves as the “A-team of people who get s*** done,” as one participant proclaimed in a March Politico article.

Kushner’s brain trust included Adam Boehler, his summer college roommate who now serves as chief executive officer of the newly created U.S. International Development Finance Corporation, a government development bank that makes loans overseas. Other group members included Nat Turner, the cofounder and CEO of Flatiron Health, which works to improve cancer treatment and research.

A Morgan Stanley banker with no notable health care experience, Jason Yeung took a leave of absence to join the task force. Along the way, the group reached out for advice to billionaires, such as Silicon Valley investor Marc Andreessen.

The group’s collective lack of relevant experience was far from the only challenge it faced. The obstacles arrayed against any effective national testing effort included: limited laboratory capacity, supply shortages, huge discrepancies in employers’ abilities to cover testing costs for their employees, an enormous number of uninsured Americans, and a fragmented diagnostic-testing marketplace.

According to one participant, the group did not coordinate its work with a diagnostic-testing team at Health and Human Services, working under Admiral Brett Giroir, who was appointed as the nation’s “testing czar” on March 12. Kushner’s group was “in their own bubble,” said the participant. “Other agencies were in their own bubbles. The circles never overlapped.”

As it evolved, Kushner’s group called on the help of several top diagnostic-testing experts. Together, they worked around the clock, and through a forest of WhatsApp messages. The effort of the White House team was “apolitical,” said the participant, and undertaken “with the nation’s best interests in mind.”

Kushner’s team hammered out a detailed plan, which Vanity Fair obtained. It stated, “Current challenges that need to be resolved include uneven testing capacity and supplies throughout the US, both between and within regions, significant delays in reporting results (4-11 days), and national supply chain constraints, such as PPE, swabs, and certain testing reagents.”

 

The plan called for the federal government to coordinate distribution of test kits, so they could be surged to heavily affected areas, and oversee a national contact-tracing infrastructure. It also proposed lifting contract restrictions on where doctors and hospitals send tests, allowing any laboratory with capacity to test any sample. It proposed a massive scale-up of antibody testing to facilitate a return to work. It called for mandating that all COVID-19 test results from any kind of testing, taken anywhere, be reported to a national repository as well as to state and local health departments.

And it proposed establishing “a national Sentinel Surveillance System” with “real-time intelligence capabilities to understand leading indicators where hot spots are arising and where the risks are high vs. where people can get back to work.”

By early April, some who worked on the plan were given the strong impression that it would soon be shared with President Trump and announced by the White House. The plan, though imperfect, was a starting point. Simply working together as a nation on it “would have put us in a fundamentally different place,” said the participant.

But the effort ran headlong into shifting sentiment at the White House. Trusting his vaunted political instincts, President Trump had been downplaying concerns about the virus and spreading misinformation about it—efforts that were soon amplified by Republican elected officials and right-wing media figures. Worried about the stock market and his reelection prospects, Trump also feared that more testing would only lead to higher case counts and more bad publicity. Meanwhile, Dr. Deborah Birx, the White House’s coronavirus response coordinator, was reportedly sharing models with senior staff that optimistically—and erroneously, it would turn out—predicted the virus would soon fade away.

Against that background, the prospect of launching a large-scale national plan was losing favor, said one public health expert in frequent contact with the White House’s official coronavirus task force.

Most troubling of all, perhaps, was a sentiment the expert said a member of Kushner’s team expressed: that because the virus had hit blue states hardest, a national plan was unnecessary and would not make sense politically. “The political folks believed that because it was going to be relegated to Democratic states, that they could blame those governors, and that would be an effective political strategy,” said the expert.

That's the juicy part. As for the testing deniers:

Quote

Without systematic testing, “We might as well put duct tape over our eyes, cotton in our ears, and hide under the bed,” said Dr. Margaret Bourdeaux, research director for the Harvard Medical School Program in Global Public Policy.

Though President Trump likes to trumpet America’s sheer number of tests, that metric does not account for the speed of results or the response to them, said Dr. June-Ho Kim, a public health researcher at Ariadne Labs, a collaboration between Harvard’s T.H. Chan School of Public Health and Brigham and Women’s Hospital, who leads a team studying outlier countries with successful COVID-19 responses. “If you’re pedaling really hard and not going anywhere, it’s all for naught.”

 

With no bankable national plan, the effort to create one has fallen to a network of high-level civilians and nongovernmental organizations. The most visible effort is led by the Rockefeller Foundation and its soft-spoken president, Dr. Rajiv Shah. Focused and determinedly apolitical, Shah, 47, is now steering a widening and bipartisan coalition that includes three former FDA commissioners, a Nobel Prize–winning economist, a movie star, and 27 American cities, states, and tribal nations, all toward the far-reaching goal of getting to 30 million COVID-19 tests a week by autumn, up from the current rate of roughly 5.5 million a week.

“We know what has to be done: broad and ubiquitous testing tied to broad and effective contact tracing,” until a vaccine can be widely administered, Shah told Vanity Fair. “It takes about five minutes for anyone to understand that is the only path forward to reopening and recovering.” Without that, he said, “Our country is going to be stuck facing a series of rebound epidemics that are highly consequential in a really deleterious way.”

https://www.vanityfair.com/news/2020/07/how-jared-kushners-secret-testing-plan-went-poof-into-thin-air