OT: Article on why testing for COVID19 in the US has been a debacle (and other notes)
https://thedispatch.com/p/timeline-the-regulationsand-regulatorsthat
Here's a good article that explains why the US has tested so few (although that seems to be getting up to speed finally).
The FDA made it near impossible for labs to make testing kits BECAUSE of their emergency declaration. Then, they put all their eggs into one basket with a CDC test, which had a bunch of problems and was essentially unusable. And there's no good reason why they didn't just use the WHO tests.
Here's an update on the COVID19 mortality rate in Korea, which is likely the country closest to the true mortality rate because they've done the most testing.
https://twitter.com/iampaulkerry/status/1240811385660903431?s=20
After jumping up and down a bit in the beginning, it settled low but has been rising consistently and hasn't tapered off yet. It's at 1.1% as of now. The initial infected in Korea were largely young, so this is likely due to more elderly people getting infected and/or the disease running its course more fully. Reminder that the seasonal flu's mortality rate is about 0.1%.
And I'll just make a couple other remarks since I have the OP mic and you can't stop me, which you can TL;DR. It's still really early to tell how bad it can be and which countries have had the best response, besides obvious comparisons like Korea did a much better job than Italy (tracking is at least as important as testing). Italy probably got hammered with a mix of indifference until it was too late, the oldest median age population in the world, a lot of smokers, and pretty bad air pollution in northern Italy. Having said that, Japan is the 2nd oldest population and also has lots of smokers (you can still smoke in bars there! even some spots in restaurants), and also doesn't have the cleanest air in the world. While cases ramped up in Korea, testing languished in Japan and many Japanese were worried there was a coming disaster, but it hasn't materialized. Things are certainly going to get worse in the US, but urban sprawl, car ownership, and low smoking rates may help. I wonder how much is just plain luck as well. It's not entirely accurate to say China had a ton of cases. Wuhan and the surrounding provinces had a lot, but there are many provinces in China with tens of millions of people each that barely had any cases. As of a couple days ago, about 75% of all cases in Korea were in Daegu. This is largely because of a cult that had some super spreaders who had just come back from meetings in Wuhan and were very much uncooperative with authorities (avoiding testing, not telling about their contacts). New cases have dropped off dramatically since about a week ago.
March 22nd, 2020 at 12:15 PM ^
China has a billion citizens, the worst air pollution in the world, and an absurdly high rate of smokers, they had patient zero, their first cases were in November, and 5 months later they've largely cleared the hump. I don't really see it taking a year to a year and a half for it to run its course in the united states.
March 21st, 2020 at 10:57 AM ^
Freep article today on small colleges:
Yup. I've felt this was all but inevitable in the US since a month or so ago. I live in Korea, so I've been keeping up on a lot of the news since it blew up in Wuhan. I was actually in Italy earlier this winter and left just before it got bad (February 21st). It was pretty clear it was highly contagious. Combine that with modern-age mass travel and almost literally the worst possible response the US could possibly muster (denial from leadership and regulatory agencies screwing up massively), and you didn't have to be a doctor or epidemiologist to see things looked bad. I don't think it will be quite as bad as Italy if only because of the demographic stuff I mentioned. Weather-wise, it's a good thing this is happening now and not in November.
Football season is still a long ways away! I have hope.
I thought that this was inevitable in the US once it was clear back in January that it wasn't contained to China. Thus our poor performance at getting test kits ready and serious restrictions in place is more inexcusable. Also that we thought checking for fevers would be enough at airports for the longest time despite the fact that some people might not be showing symptoms yet and other people like the one Chinese tourist to France simply took medication to lower her temperature. This whole response from the national government on down to the states and cities has been asinine to protect the economy while hoping it just disappears on its own.
Italy had elected leaders criticizing our mild travel restrictions to and from Wuhan as xenophobic, which denied the science behind virus spread. The mayor of Florence was also encouraging people to hug Chinese tourists as late as February. It doesn't surprise me that Italy is struggling the most in Europe when you throw in the demographics and other factors that you mentioned.
They should use football as a public motivator....
If you want football in September, stay at home and keep your distance America!
Blast that through the media and we’ll be golden.
Although, “stay at home and keep your distance will help you get your job back” maybe be a better slogan.
March 21st, 2020 at 12:10 PM ^
If you want football in September, stay at home and keep your distance America!
Really? I feel like the opposite is true. Stay home and this flattens the curve, which means it goes on longer. If you want to shorten the time span and get it over with quicker you'd need to make everyone get it ASAP so it runs its course faster.
"I have saying this is going to be bad, real bad, for about a month here and it's now happening."
You have some strange obsession with constantly making predictions and patting yourself on the back when you're right. Of course you quickly forget when you're wrong... I remember you made about 100 posts about how Shea would definitely not get immediate eligibility, with your only reasoning being that the NCAA hates Michigan.
Totally agree, bad habit on my part and one I need to break. Sometimes right and sometimes wrong so why don't we make this one count?
Let's have an unbiased third party, someone we both trust, open a PayPal account. We both fund it for whatever amount you're willing to bet. If there's a football season this fall he gives you the money and if it's cancelled I get it.
How much you want to wager on this one?
I wasn't even saying you're wrong about this. I'm not sure what will happen.
i'll hold the money. i suggest at least a $100K wager by each of you. sound good? great.
March 21st, 2020 at 10:02 AM ^
You can invest that at 0% and make... oh, never mind
March 21st, 2020 at 10:44 AM ^
You were the guy I had in mind.
Health care system load seems to be the real story. I am curious if the people coming to NYC hospitals is the same as here in Michigan, meaning they are descending on the hospitals out of fear and to be tested. If the actual people needing ICU care is overloading hospitals already, but if it is a lot of worried people seeking testing, etc. then that would be concerning. So far in the US, hospitals have not run out of ICU beds anywhere as far as I know. Would be interested to know if that is already happening in NYC.
March 21st, 2020 at 11:06 AM ^
According to friends of mine who work in the ER, here in SE Michigan we’re starting to get strained. There’s been a surge of patients in Oakland and Wayne and a lot of ventilators are getting used.
March 21st, 2020 at 11:15 AM ^
Everybody is running to the ER. It is really a problem. Fear mongering adds to that.
This virus is not just spreading now.iy has been inn Michigan for months. We just started testing. Now the hospitals have seen a big uptick in cases?
March 21st, 2020 at 11:36 AM ^
OK, you apparently need to be educated about this.
When a patient comes to the hospital, they evaluate them and determine what level of care they need. They don't just send people to the ICU willy-nilly. You don't get sent there unless you're very ill, possibly in danger of dying. We are seeing a surge of all kinds of patients, including those in severe condition.
And no, it probably hasn't been in Michigan that long, considering the first known case in the world was three months ago. Most of the admitted patients have clearly been infected recently.
March 21st, 2020 at 11:57 AM ^
Admission to the hospital and admission to ICU are two different things.
Every physician I know has been telling me it is already here for a while. Epidemiologists estimated 100k people had it worldwide long ago. The Ohio HHS director thought over 100k in Ohio had it before they began testing. Everybody agrees it spread s quickly and widely. Everybody knows it would have need to be here long ago to be so widespread even in Michigan. Half the NBA already has it and lots of political leaders and famous people. It has been in Michigan for a long time. There cannot be any dispute about that. OOldflu cultures have come back positive for it too.
The only thing new so far is testing. Oh and the news papers reporting on the number of confirmed cases.
March 21st, 2020 at 12:55 PM ^
Admission to the hospital and admission to ICU are two different things.
Yes, I know this. My friends in the ER are telling me that ICU admissions are increasing rapidly (as are regular hospital admissions). This has zero to do with "fear-mongering" - it's fact.
I'm not sure how the state of Ohio arrived at that figure. A lot of estimates about the number of infected don't make sense. One in five confirmed cases leads to hospitalization - this has consistently held true across different countries. If there were a ton of unknown cases 1-2 months ago, we'd have had a flood of people with flu symptoms that were testing negative for flu, but that didn't happen. Hospitalization rates were typical for winter months.
Now, we should have been testing earlier, for sure, to help us understand the spread and concentration of the virus.
March 21st, 2020 at 11:31 AM ^
Definitely have to prepare. They have been preparing for weeks in Seattle. All is covered so far.
I read the head of anesthesiology at a hospital hit hard in northern Italy said they have enough ICU beds, just need more ventilators and PPE.
We are not going to run out of beds, but we should prep for anything.
Italy has more beds per capita than here. Italy has run out of beds in the highly affected areas. Take off the rose colored glasses. Actual new cases per day in Wuhan were 5x what they could measure at the time they locked down and the peak was 2 weeks later at 10X new cases per day. And China had orders of magnitude more testing compared to here.
NY locked down not until 3000 new cases per day which is about 8X compared to China. You can do the math. Health care will be crushed in NY and cases could reach 30X new per day.
There is no peak until the rate of spread R0 is 1 or less. That only happens if people are Isolated; you can test at scale like getting a coffee; 70% of the population vaccinated; or 70% of the population recovered and has immunity. Korea has texting like getting coffee so they could focus their lockdowns. They did many other things we are not doing. And they did it early. Our rates of growth, mostly due to NY not locking down last week, exceed Italy. So the only option now is a lock down. Don’t wait like NY and Italy. And as far as “do nothing”, do the math. 70% of 7 Billion. 1% die at a minimum but likely 8% in most places because we don't have the beds or ventilators.
March 21st, 2020 at 11:35 AM ^
The problem we have is the data is completely skewed due to "adverse selection" of who is getting the tests - early data was provided by those who were sick enough to get it because of scarcity of the tests and we don't know true number of infections. So, of course, the data looks bad if you're only testing people who needed to be in the hospital. I guarantee you if we could test everyone at the same time, this wouldn't seem as bad as it looks right now.
I'm NOT saying this is no big deal, but I am saying we have flawed data that makes it look a lot worse than it actually is. The more data we can get as time passes, the better the decisions we can make. I guarantee you this thing is ALL over the US and has been for months and no one really noticed it because it's only taking out the elderly and infirm at a slightly more aggressive rate than usual.
We lose 3,300,000 people in the US a year (275,000 a month) so losing an extra 279 people so far in the US wouldn't have been noticed unless we knew to look for it. If you look at Italy, 86% of deaths are 80+ years old with another 10% of deaths in the 70+ category. Those people are expected to be dying of SOMETHING at a higher than the normal population anyway.
Finally, some personal anecdotal evidence for the board - I have two family members overseas that are early 70s who tested positive. They are being treated with chloroquine and recovering at home. So far, so good with only side effect being they lost sense of taste and smell. But they're alive and out of the hospital.....
it is in fact possible for multiple things to be happening simultaneously:
1. Increasing testing is identifying more cases, so some of the increase is not related to spread
2. Because of limited testing, rates of severe impact are skewed
3. The virus is in fact spreading
and that three is significant enough not to be offset by 1 and 2.
Deaths and IC admissions are probably the best indicator of that. We still seem to be seeing an exponential increase in deaths which would worry me about your hypothesis. What would be interesting would be to look at unexplained deaths from respiratory illness in the US for January and February. If they were abnormally high compared to previous years then perhaps we were under reporting coronavirus deaths earlier so we aren’t seeing exponential growth. Since this doesn’t seem to be a particularly difficult idea, and since I presume the data exists, I presume (perhaps wrongly) that it or something like it has been done. Thus, absent some more evidence, your hypothesis seems to me to be wishful thinking,
I don't know...I feel certain I had this back in the third week of January as I spend a lot of time in Vail over the winter and it has become ground zero for this in Colorado. Worst flu of my life and it took out my wife and one of my kids (who never gets sick) for a solid 8 days and then had trouble with a nagging cough for two weeks after the fact.
Can't confirm it but I suspect that's what it was in hindsight.
All I know is the only data I feel is reliable is that coming out of Italy and then the Diamond Princess which was an almost perfect "lab like" environment. Everyone on there was healthy, most, if not all, were exposed to it and we only had 7 deaths out of 3,700 people.
https://www.sciencenews.org/article/coronavirus-outbreak-diamond-princess-cruise-ship-death-rate
March 21st, 2020 at 12:58 PM ^
Testing for Swing Flu was much easier. The doctor would have you open your mouth and say "oink".
Its like someone shouldnt have cut the Pandemic Response Team that would have had a plan forward when things like this happen, instead of figuring it out as we go.....
Lets not tiptoe around the issue. The reason we don't have tests is simply because Trump cut the person and team in charge of streamlining and coordinating the response to events like this. This isn't an unfounded political attack. Its a POLITICAL issue, so this is a political response.
Would have been responsible if leadership during Swine Flu would have taken a lesson and improved the healthcare infrastructure. Negligence.
Laughable, because thats exactly why it was created, except Obama made the team in response to Ebola not Swine Flu. They learned from the chaotic response to Ebola and decided something had to be done for the inevitable future pandemic down the road.
Swine flu was actually handled pretty darn well compared to how COVID-19 has been handled. You'd do well to actually read something factual that compares the two... Here's a hint, though - Fox News is no more factual than CNN... The only difference between the two is the political bias.
Sounds to me like you have been eating a few too many mushrooms that weren't morels. You really need to get your facts straights or keep them to yourself. Your comments have been proven 100% false by those on the actual pandemic team.
What did I say that was wrong or factually incorrect?
Edit: I guess you could say he "re-organized the team" and spread it out to other agencies, which caused some of the leaders to quit, which Trump never re-hired, but just shifted the responsibilities to others.
March 21st, 2020 at 11:55 AM ^
Tigerd your statement us untrue. So far, ONE Trump appointee to the Pandemic team, I'll say it again, one single Trump appointee, wrote an Op-Ed for the Wapo where he disputed that the team had been disbanded, but without presenting any factual evidence to support his claims.
When a crisis takes place, some people point fingers and some people get to work on solutions.
To fix a crisis, you must identify why the crisis occurred.
I’ve been trying to write this in a clear concise format without too much emotion. Thanks!
Good thing you’re not in charge. Finger pointing should come AFTER the crisis is over. That can help mitigate a future crisis. It does NOTHING to help the current crisis. But let’s spend energy looking to place blame...
If only the person in charge would take your advice
That must be why our President is calling it the "Chinese Flu" and taking no responsibility for the cavalier way he handled the US response.
Because he's "working on solutions".
The people who deserve the most credit at the end of the day are state governments who took up the reins when the federal government failed, utterly, to respond appropriately to a pandemic.
Here here, we should look to great examples of that in the past, like the response of half of the country to Benghazi.
March 21st, 2020 at 10:30 AM ^
The Pandemic office was not cut- it was folded into another unit with zero reduction in staff positions. One can fairly debate whether the change streamlined reporting and conflicting bureaucracies, or hurt specific focus. There is no clear evidence that it altered our response, only speculation. It may have, it may not have. The overly simplified claims made by others is misleading.
March 21st, 2020 at 11:31 AM ^
The global health security office in the National Security Council could have been the interagency policy (and macro-response coordinator pending lead agency designation, which should be HHS). Instead we have dropped the ball on unity of command and coordinated, synchronized, effort. It is one reason you are seeing a merry go round of people at the podium at the White House explaining their takes, all shoulder to shoulder by the way, which is the poorest form of visual leadership I can imagine.
March 21st, 2020 at 11:23 AM ^
It's really too bad the regulations placed on the FDA by the Obama administration didn't limit the ability of the CDC to make better initial test.
March 21st, 2020 at 11:52 AM ^
ah the old “all regulations are bad” argument. All rules are bad. Must be the big governments fault. Guess what, there are many more highly regulated countries all over the world and many of them are handling this better than the US response. This isn’t about an overly bureaucratic system. It’s about gross incompetence at the highest level of our government, it’s about under investment to safeguard for this scenario because of policies focused on making government smaller, its about decades of sowing distrust in our institutions with a goal of dismantling them. As you sow, so shall you reap.
The system 1 brain processing that causes so many people to associate anything bad with governmental regulation is super frustrating.
Trump has been president for three years. He has changed plenty of regulations. If they were so bad, he should have fixed them. However ,why is it that when he was finally put under significant pressure to improve testing, they quickly found workarounds. Workarounds that could have been used in January.
March 21st, 2020 at 11:49 AM ^
Not a fan of Trumps but no country was prepared to test at the scale we needed to....you can be upset but lets be realistic too. No one has 3,000,000 tests for a unknown virus at the ready.
March 21st, 2020 at 12:10 PM ^
Fail to plan; plan to fail.
A way:
Maintain a national stockpile (an informed quantity, and maybe not 3 million at all if we get the next parts right);
Constantly encourage testing for better devices (for stockpile replenishment at a minimum); and
Identify and encourage the production base for expanded operations.
”Encourage” is a loose term. We could talk about how to incentivize this.
March 21st, 2020 at 12:55 PM ^
I don't how these tests come about but I still think it's too hard to have that many tests at the ready when you don't know what to test for.....maybe there's a way to do it, and if so, we need to be better prepared.
One outcome I hope to see out of this entire debacle is that we move some percentage of critical systems manufacturing home. Right now, 90% of our medical supplies from from overseas....25% or more of every medical product (device and medications) should be MANDATORY manufactured in the US so we can ramp up if needed instead of hoping other industries can lend us their facilities that aren't designed for this type of manufacturing in the first place.
Serious question: How do you stockpile tests for a novel virus?
You are correct in this case as this is a previously unknown vector, although the hardware protocols are often common (so there are some things that can be done ahead). Now that this is known quality there can be kits designed against it that might also be best cases against mutations. Flu vaccines work the same way - it is always worth getting inoculated in the fall but the serums are not completely predictive of new flu's in a given season.
I would add that the test kit encouragement is a parallel lane to threat research, which is a parallel to threat detection. All of that has to be synched (and resourced). Time for me to do my taxes, I suppose.