A new approach to Covid-19 testing: Rapid Tests
August 17, 2020 1:55 PM Subscribe
How to test every American for Covid-19 everyday What's a rapid test? Existing technology using paper strips allows for contagious-COVID testing that is rapid and inexpensive. Research shows that if done properly, these testing protocols could drive down infections close to zero. Millions of these tests can easily be manufactured and distributed. At as low as $1 per test, you can take a test every day. Tests could be administered at the entrance to schools and offices, and some could be taken at home.
Rapid tests for contagiousness are currently not approved for Covid-19 testing, since they do not meet overly strict sensitivity requirements.Some people point out that rapid tests are less sensitive than PCR tests, meaning that they may sometimes fail to detect when the virus is present. Rapid tests are however very sensitive when it matters most — when your viral load is high enough that you are contagious. This, combined with their speed and ease of use, makes them ideal for routine public health screening. They’re also great for private at-home use, similar to a pregnancy test.
Research from Harvard and Yale shows that:
Turnaround time is far more important than sensitivity.
Frequency of testing is far more important than sensitivity.
A testing protocol with rapid tests can keep infections close to zero, even if the tests are less sensitive. A slower protocol cannot. The slower protocol PCR tests detect ultra-low levels of viral RNA that can exist in your system for days or weeks after you have stopped being contagious. While this is useful for clinical diagnosis, it is not useful for public health screening. More importantly, PCR tests can take several days to return results, which means that contagious people will get their results after it is too late. Rapid tests solve these problems. Much more in the link above including a highly informative article published in The Atlantic: The Plan That Could Give Us Our Lives Back and sample letters to send your governor and congressional representatives.
Rapid tests for contagiousness are currently not approved for Covid-19 testing, since they do not meet overly strict sensitivity requirements.Some people point out that rapid tests are less sensitive than PCR tests, meaning that they may sometimes fail to detect when the virus is present. Rapid tests are however very sensitive when it matters most — when your viral load is high enough that you are contagious. This, combined with their speed and ease of use, makes them ideal for routine public health screening. They’re also great for private at-home use, similar to a pregnancy test.
Research from Harvard and Yale shows that:
Turnaround time is far more important than sensitivity.
Frequency of testing is far more important than sensitivity.
A testing protocol with rapid tests can keep infections close to zero, even if the tests are less sensitive. A slower protocol cannot. The slower protocol PCR tests detect ultra-low levels of viral RNA that can exist in your system for days or weeks after you have stopped being contagious. While this is useful for clinical diagnosis, it is not useful for public health screening. More importantly, PCR tests can take several days to return results, which means that contagious people will get their results after it is too late. Rapid tests solve these problems. Much more in the link above including a highly informative article published in The Atlantic: The Plan That Could Give Us Our Lives Back and sample letters to send your governor and congressional representatives.
I heard that same interview on TWiV and it got me really excited and hopeful. MedCram has a good video about it with excerpts from the interview. TWiV has been collecting letters about rapid testing here. It's really exciting to see the concept gaining traction in the media.
posted by beandip at 2:25 PM on August 17, 2020 [4 favorites]
posted by beandip at 2:25 PM on August 17, 2020 [4 favorites]
For the curious, it looks like we're talking about a CRISPR-based lateral flow approach here.
I'm skeptical about scaling capacity (everyday testing for every American would require tens of billions, not millions of tests), but it's worth a try.
posted by mr_roboto at 2:25 PM on August 17, 2020 [5 favorites]
I'm skeptical about scaling capacity (everyday testing for every American would require tens of billions, not millions of tests), but it's worth a try.
posted by mr_roboto at 2:25 PM on August 17, 2020 [5 favorites]
The fact that speed is more important than sensitivity (per Larremore &al's model) is not unreasonable, and I definitely agree with the push to develop rapid and easy-to-administer tests.
However, I'm seeing a lot of assertions that this $1 paper-strip rapid test technology exists (mostly attributed to a startup called e25bio), but no peer-reviewed articles with numbers regarding its sensitivity relative to viral load -- numbers that are crucial to evaluating whether the break-even point of speed vs accuracy has been crossed. Where is the evidence that the technology exists* and would work in the manner that they assume (ie, would fall where their cartoon arrows/emojis are on the figure from the Larremore paper)?
We can't afford a Theranos-like debacle on this.
[*On preview: whatever it is is not the what's described in the CRISPR-based lateral flow paper, which requires much more than saliva & a $1 kit which you can use in your bathroom.]
posted by Westringia F. at 2:38 PM on August 17, 2020 [24 favorites]
However, I'm seeing a lot of assertions that this $1 paper-strip rapid test technology exists (mostly attributed to a startup called e25bio), but no peer-reviewed articles with numbers regarding its sensitivity relative to viral load -- numbers that are crucial to evaluating whether the break-even point of speed vs accuracy has been crossed. Where is the evidence that the technology exists* and would work in the manner that they assume (ie, would fall where their cartoon arrows/emojis are on the figure from the Larremore paper)?
We can't afford a Theranos-like debacle on this.
[*On preview: whatever it is is not the what's described in the CRISPR-based lateral flow paper, which requires much more than saliva & a $1 kit which you can use in your bathroom.]
posted by Westringia F. at 2:38 PM on August 17, 2020 [24 favorites]
I'll take Things That Should Have Been Done Months Ago for one hundred, please Alex.
posted by krisjohn at 2:41 PM on August 17, 2020 [19 favorites]
posted by krisjohn at 2:41 PM on August 17, 2020 [19 favorites]
Lots of coulds, shoulds, and woulds in that Atlantic article...and no mention of the NBA? I overheard the TV in the last couple of days talking about how they had their own test they paid to be developed?
There is no FDA-approved device, at present, that will let 10 kids safely spit into one vial. We should have federally backed development and fast regulatory approval for that kind of device, Kelly said.
I think I see where this is going.
posted by rhizome at 2:49 PM on August 17, 2020 [3 favorites]
There is no FDA-approved device, at present, that will let 10 kids safely spit into one vial. We should have federally backed development and fast regulatory approval for that kind of device, Kelly said.
I think I see where this is going.
posted by rhizome at 2:49 PM on August 17, 2020 [3 favorites]
People really seem to want to our (America's) failure to deal with this pandemic to be a problem with a technology solution. A digital anonymized app, an RNA vaccine platform, a new test. Maybe something will just save us? Countries around the world are in single digit or low-double digit deaths with none of this.
Contact tracing, shutdown bars and dining in active areas, wear masks, hard shutdowns if in a severe outbreak, carefully prioritized reopening when we we're running close to zero. Don't threaten schools that remain closed. We could deal with this long before a novel test is developed and produced, and if we can do that we're in good shape. If we can't how are we going to administer and apply the information from a billions of results?
posted by mark k at 2:50 PM on August 17, 2020 [123 favorites]
Contact tracing, shutdown bars and dining in active areas, wear masks, hard shutdowns if in a severe outbreak, carefully prioritized reopening when we we're running close to zero. Don't threaten schools that remain closed. We could deal with this long before a novel test is developed and produced, and if we can do that we're in good shape. If we can't how are we going to administer and apply the information from a billions of results?
posted by mark k at 2:50 PM on August 17, 2020 [123 favorites]
whatever it is is not the what's described in the CRISPR-based lateral flow paper, which requires much more than saliva & a $1 kit which you can use in your bathroom.
It's frustrating that they don't talk about the technology at all. In a lot of the linked press pieces, Sherlock Biosciences and E25Bio are mentioned. I looks like Sherlock is working on a CRISPR-based test and E25 has a direct antigen test (I'm inherently skeptical of direct antigen tests for this application, but maybe?).
posted by mr_roboto at 2:59 PM on August 17, 2020 [2 favorites]
It's frustrating that they don't talk about the technology at all. In a lot of the linked press pieces, Sherlock Biosciences and E25Bio are mentioned. I looks like Sherlock is working on a CRISPR-based test and E25 has a direct antigen test (I'm inherently skeptical of direct antigen tests for this application, but maybe?).
posted by mr_roboto at 2:59 PM on August 17, 2020 [2 favorites]
problem with a technology solution
It's a slightly more acceptable way of saying a miracle will happen, but also companies will save us when the government failed.
posted by meowzilla at 3:09 PM on August 17, 2020 [16 favorites]
It's a slightly more acceptable way of saying a miracle will happen, but also companies will save us when the government failed.
posted by meowzilla at 3:09 PM on August 17, 2020 [16 favorites]
Yeeeeaaaahhh...no. the FDA will just give em a pass and tell them to self-regulate (like every other test co). We'll never know what the sensitivity and specificity are, or how uniform the qa will be. Testing theatre. No way to ever measure success.
posted by j_curiouser at 3:14 PM on August 17, 2020 [7 favorites]
posted by j_curiouser at 3:14 PM on August 17, 2020 [7 favorites]
The thing about a technology solution is, it would make it so much easier. A hope that there's an end in sight that this test could give, instead of an endless, miserable, guilty slog, punctuated by the constant loneliness and the message that it's not ending because you are not trying hard enough, you didn't wear your mask 100% of the time, you were unclean, you gave in to the desire for human company, you weak-willed, filthy, selfish monster.
That's why everyone wants it to be a technology solution.
posted by HypotheticalWoman at 3:20 PM on August 17, 2020 [28 favorites]
That's why everyone wants it to be a technology solution.
posted by HypotheticalWoman at 3:20 PM on August 17, 2020 [28 favorites]
The second Atlantic article has a lot more detail about the E25bio test, which they say is a spike protein antigen test, meaning it should only detect active virions, unlike PCR and other antigen tests that detect inactive virions as well--hence all the people who continue to test positive long after they should have cleared the infection.
On their webpage, E25bio says that they have partnered "with top academic Boston hospitals for scaled evaluation and production"
I'm not saying it wouldn't be a million times better to actually have a peer-reviewed study by now, but the concept is at least not preposterous.
posted by hydropsyche at 3:32 PM on August 17, 2020 [4 favorites]
On their webpage, E25bio says that they have partnered "with top academic Boston hospitals for scaled evaluation and production"
I'm not saying it wouldn't be a million times better to actually have a peer-reviewed study by now, but the concept is at least not preposterous.
posted by hydropsyche at 3:32 PM on August 17, 2020 [4 favorites]
The thing about a technology solution is, it would make it so much easier
Yes, this is what I call "The Facebook Solution," from FB's genetic reluctance to hire humans to do anything software can do (quality aside). Even so, technology still isn't going to cover people who do not believe there is a problem. There are certain US societal traits that almost ensure that we are fucked no matter what, and for a long time, mostly due to churches in one form (evangelical) or another (QAnon).
I'm not saying it wouldn't be a million times better to actually have a peer-reviewed study by now, but the concept is at least not preposterous.
No matter what results from any of this, any liability concerns (death, maiming) that emerge from a rushed testing process will take years to work their way through the courts anyway, and so are of no concern at the moment. There's an election in the offing and the president needs some credit to claim.
posted by rhizome at 3:38 PM on August 17, 2020 [6 favorites]
Yes, this is what I call "The Facebook Solution," from FB's genetic reluctance to hire humans to do anything software can do (quality aside). Even so, technology still isn't going to cover people who do not believe there is a problem. There are certain US societal traits that almost ensure that we are fucked no matter what, and for a long time, mostly due to churches in one form (evangelical) or another (QAnon).
I'm not saying it wouldn't be a million times better to actually have a peer-reviewed study by now, but the concept is at least not preposterous.
No matter what results from any of this, any liability concerns (death, maiming) that emerge from a rushed testing process will take years to work their way through the courts anyway, and so are of no concern at the moment. There's an election in the offing and the president needs some credit to claim.
posted by rhizome at 3:38 PM on August 17, 2020 [6 favorites]
I would be massively skeptical of anything appearing on the market in 2020. The rush to get results leaves me uneasy.
posted by Barbara Spitzer at 3:46 PM on August 17, 2020 [4 favorites]
posted by Barbara Spitzer at 3:46 PM on August 17, 2020 [4 favorites]
The thing about a technology solution is, it would make it so much easier
Yeah, it would, and wanting things to be easy is reasonable. However, in American culture by and large, we expect, nay demand that things be easy. Even more important, we expect that solutions require no personal sacrifice.
posted by Ickster at 4:03 PM on August 17, 2020 [1 favorite]
Yeah, it would, and wanting things to be easy is reasonable. However, in American culture by and large, we expect, nay demand that things be easy. Even more important, we expect that solutions require no personal sacrifice.
posted by Ickster at 4:03 PM on August 17, 2020 [1 favorite]
...we expect that solutions require no personal sacrifice.
I guess I find this a little triggering...having lost not just my job to C19 but, for the time being at least, my career (I worked in hospitality) and now no longer collecting the CARES supplement to pad out my meager unemployment benefits, I kind of feel like I've been making plenty of personal sacrifices these past few months (not just wearing a mask). So, yeah, a little 'deus ex technica' would be A-OK with me right now.
posted by Insert Clever Name Here at 4:27 PM on August 17, 2020 [56 favorites]
I guess I find this a little triggering...having lost not just my job to C19 but, for the time being at least, my career (I worked in hospitality) and now no longer collecting the CARES supplement to pad out my meager unemployment benefits, I kind of feel like I've been making plenty of personal sacrifices these past few months (not just wearing a mask). So, yeah, a little 'deus ex technica' would be A-OK with me right now.
posted by Insert Clever Name Here at 4:27 PM on August 17, 2020 [56 favorites]
A hope that there's an end in sight that this test could give, instead of an endless, miserable, guilty slog, punctuated by the constant loneliness and the message that it's not ending because you are not trying hard enough, you didn't wear your mask 100% of the time, you were unclean, you gave in to the desire for human company, you weak-willed, filthy, selfish monster.
Or alternately, it doesn't matter how much of a good boy/girl/whatever YOU are and you stay inside 24-7 for the next 2 years, everyone else is going to run around to bars indoors in crowds and you can't stop them from contaminating everyone else.
That's why everyone wants it to be a technology solution.
posted by jenfullmoon at 4:28 PM on August 17, 2020 [29 favorites]
Or alternately, it doesn't matter how much of a good boy/girl/whatever YOU are and you stay inside 24-7 for the next 2 years, everyone else is going to run around to bars indoors in crowds and you can't stop them from contaminating everyone else.
That's why everyone wants it to be a technology solution.
posted by jenfullmoon at 4:28 PM on August 17, 2020 [29 favorites]
[they] can't won't stop them from contaminating everyone else.
That's a policy choice, not an inevitability.
posted by j_curiouser at 4:32 PM on August 17, 2020 [3 favorites]
That's a policy choice, not an inevitability.
posted by j_curiouser at 4:32 PM on August 17, 2020 [3 favorites]
Mod note: folks let's maybe keep this focused on testing and not the larger social COVID issues we're all facing. There is a COVID megathread still.
posted by jessamyn (staff) at 4:34 PM on August 17, 2020 [10 favorites]
posted by jessamyn (staff) at 4:34 PM on August 17, 2020 [10 favorites]
deep sigh
I understand why so many of you are skeptical. Jaded even. And yes, we're all familiar with the pitfalls of seeking a tech solution to a social problem. But .. this is not that thing. I'm seriously disheartened that this is becoming a knee-jerk pile on.
...any liability concerns (death, maiming) that emerge from a rushed testing process...
The tests in question involve spitting on paper. Maybe if you drop the paper and then slip on it??
...Testing theatre. No way to ever measure success....
We have plenty of data. The push among scientists for rapid tests are a result of analyzing what we've been measuring. We know that people are contagious early on in the disease, and that there is a long tail where they have positive PCR results for the virus (ie. they shed genetic material from the virus) but they are not infectious. We know that sensitivity of the rapid tests overlaps with the time when people are contagious, but gives false negative results when people are PCR positive but no longer contagious, which is fine for screening purposes. Here is a report from the Korean CDC that discusses how people who are still PCR positive late in their illness are not contagious. And a New England Journal of Medicine article on PCR values over the course of illness. And check out the medcram video linked above to see how it's tied together to show the utility of rapid tests.
I know the feeling of looking out at people being irresponsible and thinking that what we really need is to close everything and make them sit in their houses and suffer without their bars and parties and whatnot. But please, people are dying from this. People are losing their housing. And here we have a legitimate solution, we just have to get governments to prioritize funding improving and manufacturing the rapid tests instead of chasing ever more accurate tests that tell you too late and for too much money that yeah, you had it and probably infected a bunch of other people.
The virologists, immunologists, and epidemiologists who actually understand this disease and understand how to interpret the science, who are being sidelined by the administration and who have been defunded by the administration, who are being ignored by administrators rushing to open schools, these are the scientists who have come around to this rapid testing idea and are trying to get governments to shift their priorities away from tests that can 100% tell you if you had the disease way too late for it to matter, and towards screening tests that can tell you if your kid can go to school today. All tech isn't techbro tech. Some is legit the awesome stuff the US used to be good at.
The reaction here feels like when people say an addict has to hit rock-bottom in order to be worthy of recovery. Like the US is so messed up it has to suffer even more before it can be redeemed. I get being angry but think about who the ones actually suffering before you make flippant statements like we expect that solutions require no personal sacrifice (on preview, what Insert Clever Name Here said) As an American living in Europe I can tell you that while the rampant toxic capitalism of the US does seriously need to get fixed, a lot of the issues of viral spread are human issues. Here in the Netherlands we were able to keep the virus at bay early on with quick closures, but things are opening up again and it's spreading among the young population that isn't getting tested enough. People are tired of the isolation and loss of income and it's going to be really difficult to close back down again. We're going to be playing whack-a-mole with this thing _all over the world_ until we have a rapid test solution deployed.
posted by antinomia at 4:35 PM on August 17, 2020 [132 favorites]
I understand why so many of you are skeptical. Jaded even. And yes, we're all familiar with the pitfalls of seeking a tech solution to a social problem. But .. this is not that thing. I'm seriously disheartened that this is becoming a knee-jerk pile on.
...any liability concerns (death, maiming) that emerge from a rushed testing process...
The tests in question involve spitting on paper. Maybe if you drop the paper and then slip on it??
...Testing theatre. No way to ever measure success....
We have plenty of data. The push among scientists for rapid tests are a result of analyzing what we've been measuring. We know that people are contagious early on in the disease, and that there is a long tail where they have positive PCR results for the virus (ie. they shed genetic material from the virus) but they are not infectious. We know that sensitivity of the rapid tests overlaps with the time when people are contagious, but gives false negative results when people are PCR positive but no longer contagious, which is fine for screening purposes. Here is a report from the Korean CDC that discusses how people who are still PCR positive late in their illness are not contagious. And a New England Journal of Medicine article on PCR values over the course of illness. And check out the medcram video linked above to see how it's tied together to show the utility of rapid tests.
I know the feeling of looking out at people being irresponsible and thinking that what we really need is to close everything and make them sit in their houses and suffer without their bars and parties and whatnot. But please, people are dying from this. People are losing their housing. And here we have a legitimate solution, we just have to get governments to prioritize funding improving and manufacturing the rapid tests instead of chasing ever more accurate tests that tell you too late and for too much money that yeah, you had it and probably infected a bunch of other people.
The virologists, immunologists, and epidemiologists who actually understand this disease and understand how to interpret the science, who are being sidelined by the administration and who have been defunded by the administration, who are being ignored by administrators rushing to open schools, these are the scientists who have come around to this rapid testing idea and are trying to get governments to shift their priorities away from tests that can 100% tell you if you had the disease way too late for it to matter, and towards screening tests that can tell you if your kid can go to school today. All tech isn't techbro tech. Some is legit the awesome stuff the US used to be good at.
The reaction here feels like when people say an addict has to hit rock-bottom in order to be worthy of recovery. Like the US is so messed up it has to suffer even more before it can be redeemed. I get being angry but think about who the ones actually suffering before you make flippant statements like we expect that solutions require no personal sacrifice (on preview, what Insert Clever Name Here said) As an American living in Europe I can tell you that while the rampant toxic capitalism of the US does seriously need to get fixed, a lot of the issues of viral spread are human issues. Here in the Netherlands we were able to keep the virus at bay early on with quick closures, but things are opening up again and it's spreading among the young population that isn't getting tested enough. People are tired of the isolation and loss of income and it's going to be really difficult to close back down again. We're going to be playing whack-a-mole with this thing _all over the world_ until we have a rapid test solution deployed.
posted by antinomia at 4:35 PM on August 17, 2020 [132 favorites]
This has a technological component, but isn't really a technological solution. Not sure why people are characterizing it that way. It would require a massive amount of social coordination, cooperation, and dare I say, governance, to get these tests manufactured, distributed, administered, and the subsequent required isolation of people who test positive to have any effect. Those things are the challenge. Not the testing technology.
posted by spudsilo at 4:37 PM on August 17, 2020 [25 favorites]
posted by spudsilo at 4:37 PM on August 17, 2020 [25 favorites]
how are we going to administer and apply the information from a billions of results?
There is no centralized analysis required because these tests are designed to be done at home or at schools/workplaces. (Think pregnancy test but they use saliva.) You test before you leave the house or at the door of your office/school. If it's positive you go/stay home and isolate. If it's negative you go in and everything is normal. Repeat daily.
The only problem is the more centralized they are (deployed at schools/jobs rather than homes) the higher the chance people end up needing to line up for them. But hey, we're sending kids back to school now so, at least this way they would only be exposing others briefly in the line and then sent home instead of spending the whole rest of the day passing it around.
The Abbott ID now test works like this -- but it uses a nasal swab. You put the swab in a toaster-sized machine and within some number of minutes you have the result. Several companies are trying to make things even easier to deploy. There's one (SalivaDirect I think) that has eliminated the tubes for collection since those are difficult to deal with, as just one example. That's the sort of thing that folks are trying to get more funding for and more general deployment of.
posted by antinomia at 4:54 PM on August 17, 2020 [9 favorites]
There is no centralized analysis required because these tests are designed to be done at home or at schools/workplaces. (Think pregnancy test but they use saliva.) You test before you leave the house or at the door of your office/school. If it's positive you go/stay home and isolate. If it's negative you go in and everything is normal. Repeat daily.
The only problem is the more centralized they are (deployed at schools/jobs rather than homes) the higher the chance people end up needing to line up for them. But hey, we're sending kids back to school now so, at least this way they would only be exposing others briefly in the line and then sent home instead of spending the whole rest of the day passing it around.
The Abbott ID now test works like this -- but it uses a nasal swab. You put the swab in a toaster-sized machine and within some number of minutes you have the result. Several companies are trying to make things even easier to deploy. There's one (SalivaDirect I think) that has eliminated the tubes for collection since those are difficult to deal with, as just one example. That's the sort of thing that folks are trying to get more funding for and more general deployment of.
posted by antinomia at 4:54 PM on August 17, 2020 [9 favorites]
Those things are the challenge. Not the testing technology.
A test that takes 1d to return results, costs $100 and requires a large machine basically prohibits daily at-site testing by definition. Even if you nationalize the supply chain the time problems still remain with RT-QPCR tests. Coordination and compliance are still issues, but better technology in this case would help.
posted by benzenedream at 5:04 PM on August 17, 2020 [5 favorites]
A test that takes 1d to return results, costs $100 and requires a large machine basically prohibits daily at-site testing by definition. Even if you nationalize the supply chain the time problems still remain with RT-QPCR tests. Coordination and compliance are still issues, but better technology in this case would help.
posted by benzenedream at 5:04 PM on August 17, 2020 [5 favorites]
know the feeling of looking out at people being irresponsible and thinking that what we really need is to close everything and make them sit in their houses and suffer without their bars and parties and whatnot. But please, people are dying from this. People are losing their housing. And here we have a legitimate solution
We've had a legitimate solution from early in this crisis, that would stop people dying from this much sooner than deploying some new testing scheme and hoping that this time there will be voluntarily compliance. The implication that the proven solution isn't legitimate but we'll have one soon is the source of my frustration with the framing of almost all of these discussions. It should be discussed in "last mile" terms, how do we get from 10 deaths per day to zero, but people just want to skip over the step ahead of us now.
posted by mark k at 5:09 PM on August 17, 2020 [6 favorites]
We've had a legitimate solution from early in this crisis, that would stop people dying from this much sooner than deploying some new testing scheme and hoping that this time there will be voluntarily compliance. The implication that the proven solution isn't legitimate but we'll have one soon is the source of my frustration with the framing of almost all of these discussions. It should be discussed in "last mile" terms, how do we get from 10 deaths per day to zero, but people just want to skip over the step ahead of us now.
posted by mark k at 5:09 PM on August 17, 2020 [6 favorites]
We've had a legitimate solution from early in this crisis, that would stop people dying from this much sooner than deploying some new testing scheme and hoping that this time there will be voluntarily compliance.
What is the legitimate solution? (Not a snarky question). So far the only thing I've seen that has really worked is Chinese style forced quarantines, and even those required things like food runners and coordinated food delivery to prevent market transmission. Do you mean nationwide 95-100% lockdowns for 6 weeks?
posted by benzenedream at 5:25 PM on August 17, 2020 [6 favorites]
What is the legitimate solution? (Not a snarky question). So far the only thing I've seen that has really worked is Chinese style forced quarantines, and even those required things like food runners and coordinated food delivery to prevent market transmission. Do you mean nationwide 95-100% lockdowns for 6 weeks?
posted by benzenedream at 5:25 PM on August 17, 2020 [6 favorites]
I'm very very curious what the adoption rate for rapid testing would be among hardcore conservatives and other COVID-skeptics. My hypothesis is better than we think it would be, because tests can be done in the privacy of one's home and never have to be discussed with others. Rapid testing like this would be very different than requiring masks - by walking around without a mask, you are literally signalling your public allegiance to your political and social affiliations and to don a mask would be to reject those affiliations or have them reject you. So you might end up with a lot of folks who are willing to test in private and shout loudly about how COVID is overblown in public.
posted by WidgetAlley at 5:30 PM on August 17, 2020 [6 favorites]
posted by WidgetAlley at 5:30 PM on August 17, 2020 [6 favorites]
You test before you leave the house or at the door of your office/school. If it's positive you go/stay home and isolate. If it's negative you go in and everything is normal.
I think at this point any plan has to assume that there will be a significant percentage of people who would read off a positive test and continue to head out; whether out of distrust of the test, economic pressure, "But I have an appointment and I can't disappoint", or many other reasons. (To say nothing of various reports of groups talking over deliberately trying to spread it for ideological reasons)
So in order to plan properly, assume ~1/3 of people testing positive will continue to head out into the world, and the Congressional plan to extend immunity to companies for infection passes.
What do we do then?
posted by CrystalDave at 5:31 PM on August 17, 2020 [7 favorites]
I think at this point any plan has to assume that there will be a significant percentage of people who would read off a positive test and continue to head out; whether out of distrust of the test, economic pressure, "But I have an appointment and I can't disappoint", or many other reasons. (To say nothing of various reports of groups talking over deliberately trying to spread it for ideological reasons)
So in order to plan properly, assume ~1/3 of people testing positive will continue to head out into the world, and the Congressional plan to extend immunity to companies for infection passes.
What do we do then?
posted by CrystalDave at 5:31 PM on August 17, 2020 [7 favorites]
Either we never get out of this crisis, or we manage to move past it despite the people who refuse to take on the personal sacrifice they ought to. Given those options, I'm all for trying solutions to move us forward. I'm also glad to continue to invite people into more responsible behavior, but any step towards diminishing spread is progress.
posted by meinvt at 5:49 PM on August 17, 2020 [6 favorites]
posted by meinvt at 5:49 PM on August 17, 2020 [6 favorites]
Has any of their data gone through peer review? What does Dr. Fauci think? I don't work in infectious disease but I know quite a few people who do and they aren't talking about this. I'll ask them as soon as I can but it's odd that something so promising hasn't gotten any attention from experts — but maybe I'm just out of the loop.
I desperately want this to work, but I'm having some cognitive dissonance between that and "neither the experts I follow nor the ones I know are even addressing this."
posted by Tehhund at 5:52 PM on August 17, 2020 [2 favorites]
I desperately want this to work, but I'm having some cognitive dissonance between that and "neither the experts I follow nor the ones I know are even addressing this."
posted by Tehhund at 5:52 PM on August 17, 2020 [2 favorites]
Checked in with a ID friend. They are cautiously excited about this: https://covidtrackerct.com/about-salivadirect/ - not an individual test, but a method for labs to us common reagents to do rapid saliva tests. It has already received an Emergency Use Authorization from the US FDA.
But they've never head of this paper strip business. I'll keep asking.
posted by Tehhund at 6:23 PM on August 17, 2020 [4 favorites]
But they've never head of this paper strip business. I'll keep asking.
posted by Tehhund at 6:23 PM on August 17, 2020 [4 favorites]
So in order to plan properly, assume ~1/3 of people testing positive will continue to head out into the world, and the Congressional plan to extend immunity to companies for infection passes.
What do we do then?
You celebrate the fact that the other two-thirds will stay home and save tens of thousands of lives. Solutions do not require perfection to be useful.
posted by JackFlash at 7:01 PM on August 17, 2020 [28 favorites]
What do we do then?
You celebrate the fact that the other two-thirds will stay home and save tens of thousands of lives. Solutions do not require perfection to be useful.
posted by JackFlash at 7:01 PM on August 17, 2020 [28 favorites]
If they didn’t get a positive test, 3/3 of them would have gone out anyway?
posted by capnsue at 7:25 PM on August 17, 2020 [1 favorite]
posted by capnsue at 7:25 PM on August 17, 2020 [1 favorite]
"By walking around without a mask, you are literally signalling your public allegiance to your political and social affiliations and to don a mask would be to reject those affiliations or have them reject you."
Wearing a mask did not have to be political, until hardcore conservatives decided that safety = weakness and that their beer belly bodies would just Chuck Norris the virus. I 100% expect that any sort of rapid testing would be met by the same jabbering that they apply to needle exchange programs, sex education, and other basic harm-mitigation public health measures.
(I meant to type handwringing not jabbering, but on further consideration, autocorrect is, well, correct.)
posted by basalganglia at 7:31 PM on August 17, 2020 [4 favorites]
Wearing a mask did not have to be political, until hardcore conservatives decided that safety = weakness and that their beer belly bodies would just Chuck Norris the virus. I 100% expect that any sort of rapid testing would be met by the same jabbering that they apply to needle exchange programs, sex education, and other basic harm-mitigation public health measures.
(I meant to type handwringing not jabbering, but on further consideration, autocorrect is, well, correct.)
posted by basalganglia at 7:31 PM on August 17, 2020 [4 favorites]
I think the value of the rapid test is public rapid testing, so you can find positive cases fast and isolate them.
Even with the PCR test, the Victorian (Australia) govt found to their horror, that people were still going to work with symptoms, even knowing they were positive for COVID! news link so they brought in a payment for people without sick leave. And have the army and police door knocking to check on home quarantine.
People suffering as precarious workers under late stage capitalism have to decide whether they are going to put food on the table or risk COVID spread, and we need to support them.
posted by freethefeet at 7:31 PM on August 17, 2020 [11 favorites]
Even with the PCR test, the Victorian (Australia) govt found to their horror, that people were still going to work with symptoms, even knowing they were positive for COVID! news link so they brought in a payment for people without sick leave. And have the army and police door knocking to check on home quarantine.
People suffering as precarious workers under late stage capitalism have to decide whether they are going to put food on the table or risk COVID spread, and we need to support them.
posted by freethefeet at 7:31 PM on August 17, 2020 [11 favorites]
If you have Ebola, you are in the submarine and not going anywhere because Laws and Rules and Public Safety and Theoretically wanting to stay alive. Covid? Freedom. Despite your victims.
At what death rate do we cross a line and save the victims?
Now? Now would be good. Enforce quarantine.
posted by j_curiouser at 7:46 PM on August 17, 2020 [1 favorite]
At what death rate do we cross a line and save the victims?
Now? Now would be good. Enforce quarantine.
posted by j_curiouser at 7:46 PM on August 17, 2020 [1 favorite]
(and pay people to stay home)
posted by j_curiouser at 7:46 PM on August 17, 2020 [3 favorites]
posted by j_curiouser at 7:46 PM on August 17, 2020 [3 favorites]
When the world is upside-down with COVID, I'm happy to link to an ESPN article about testing.
The NBA is taking a lead in identifying & funding development of fast + cheap testing. Over nearly a month in the "bubble" near Orlando, 22 NBA teams (+staff) have reported ZERO positive tests. Apparently a key aspect of this is the saliva-direct tests mentioned by Tehhund above.
Relevant quote from enterprising scientists involved:
All props to Adam Silver & NBPA, who clearly have worked together to facilitate this experiment in public health. And a hat tip to my grandpa and the cigarette-smoke clouded Rotary meetings he dragged me to, with a bunch of grey-hairs who might recognize this business model -- "this saves our butts, it must be good for everyone else!" 2020, here I am, nostalgic for old-school, pre-Reagan Republicanism...
posted by Theophrastus Johnson at 7:58 PM on August 17, 2020 [12 favorites]
The NBA is taking a lead in identifying & funding development of fast + cheap testing. Over nearly a month in the "bubble" near Orlando, 22 NBA teams (+staff) have reported ZERO positive tests. Apparently a key aspect of this is the saliva-direct tests mentioned by Tehhund above.
Relevant quote from enterprising scientists involved:
"My goal is not to test athletes," Grubaugh said. "That's not my target population. My target population is everybody. There were concerns about partnering with the NBA when all these other people need testing. But the simple answer ended up being the NBA was going to do all this testing anyway, so why not partner with them and try to create something for everyone?"It's a very matter-of-fact article written by the fantastic NBA reporter Zach Lowe. Although missing some of the snappy writing of Lowe's weekly columns, it alludes to the trade-offs made (less certainty for individual tests, but far greater speed due to not extracting RNA of samples). Overall, it paints a picture of a testing model with a successful sample (the NBA bubble) and the potential to scale nation-wide (hello FDA approval!).
All props to Adam Silver & NBPA, who clearly have worked together to facilitate this experiment in public health. And a hat tip to my grandpa and the cigarette-smoke clouded Rotary meetings he dragged me to, with a bunch of grey-hairs who might recognize this business model -- "this saves our butts, it must be good for everyone else!" 2020, here I am, nostalgic for old-school, pre-Reagan Republicanism...
posted by Theophrastus Johnson at 7:58 PM on August 17, 2020 [12 favorites]
(and pay people to stay home)
Better yet, pay them to stay in one of the many empty hotels with free wifi, Netflix, HBO, iPad and delivered meals.
Quarantine at home is a joke. You just infect your family who then go out and infect others.
posted by JackFlash at 8:12 PM on August 17, 2020 [14 favorites]
Better yet, pay them to stay in one of the many empty hotels with free wifi, Netflix, HBO, iPad and delivered meals.
Quarantine at home is a joke. You just infect your family who then go out and infect others.
posted by JackFlash at 8:12 PM on August 17, 2020 [14 favorites]
Hey, Tehhund, if you get the chance, could you ask your friends about E25Bio's other rapid diagnostic test (it's an OTC finger-prick blood draw, not a saliva sample) for dengue, chikungunya, and Zika? E25 is the small start-up, founded in September 2018, mentioned in the "Plan" article at The Atlantic, which isn't paywalled; from the article: Some experts worry that at-home tests will have a much lower accuracy rate than advertised. Laboratory tests are conducted by professionals on machines they are familiar with, but amateurs will conduct at-home tests, which risks introducing errors not captured by official ratings or even imagined by regulators. & “I think we’re the only company in North America that has developed a spike antigen test,” Bobby Brooke Herrera, e25’s co-founder and chief executive, told us. [Antibody vs antigen testing for COVID-19]
E25Bio Receives a Pair of Grant Awards to Expand Coronavirus and Arbovirus Testing (Businesswire, Aug. 13, 2020) E25Bio, rapid diagnostic innovators, announces award funding of $4.14M from the Bill & Melinda Gates Foundation and $1.68M from the NIH’s Small Business Innovation Research (SBIR) program. [...] The foundation’s grant will help E25Bio continue research and development on its rapid COVID-19 test, generate a coronavirus monoclonal antibody repository for future diagnostic efforts, and develop its mobile app to track and map disease data in real-time to provide the public with tools for informed decision-making around pandemic prevention. [...]
The grant supports the company’s prior and current work in developing rapid diagnostic tests for dengue, Zika, and chikungunya viruses; in April the Colombian regulatory agency, INVIMA, approved the company’s first product, Dengue SimPlexTM, for sale in the country. E25Bio is now preparing to launch Dengue SimPlexTM and expand upon their diagnostic portfolio.[...]“Infectious disease surveillance should prioritize affordability, accessibility, and sample to result time, especially during outbreak scenarios such as the COVID-19 pandemic,” said Dr. Bobby Brooke Herrera, co-founder and CEO of E25Bio. “Our platform has enabled development of low-cost, paper-based rapid tests for COVID-19, Zika and other outbreak diseases that can be self-administered across entire communities in the United States and beyond.
Dr. Herrera also serves as the company's chief science officer, and was named to the Forbes 30 Under 30 – Healthcare 2020 list last December. “Dr. Bosch isolated monoclonal antibodies for Dengue, Zika and Chikungunya to produce rapid point-of-care tests,” Herrera said. “She recruited me to co-found the company with her in 2018, which is funded by venture capitalists and a grant from the National Institutes of Health. The company is interested in producing monoclonal antibodies to be utilized in the development of point-of-care, affordable tests for highly infectious diseases. With a few drops of blood, you can get diagnostic results in five –10 minutes.” (NMSU alum among Forbes 2020 ‘30 under 30’ list of healthcare entrepreneurs, Las Cruces Sun News, Dec. 7, 2019) An interview with cE25Bio's CTO, Dr. Irene Bosch.
posted by Iris Gambol at 8:24 PM on August 17, 2020 [1 favorite]
E25Bio Receives a Pair of Grant Awards to Expand Coronavirus and Arbovirus Testing (Businesswire, Aug. 13, 2020) E25Bio, rapid diagnostic innovators, announces award funding of $4.14M from the Bill & Melinda Gates Foundation and $1.68M from the NIH’s Small Business Innovation Research (SBIR) program. [...] The foundation’s grant will help E25Bio continue research and development on its rapid COVID-19 test, generate a coronavirus monoclonal antibody repository for future diagnostic efforts, and develop its mobile app to track and map disease data in real-time to provide the public with tools for informed decision-making around pandemic prevention. [...]
The grant supports the company’s prior and current work in developing rapid diagnostic tests for dengue, Zika, and chikungunya viruses; in April the Colombian regulatory agency, INVIMA, approved the company’s first product, Dengue SimPlexTM, for sale in the country. E25Bio is now preparing to launch Dengue SimPlexTM and expand upon their diagnostic portfolio.[...]“Infectious disease surveillance should prioritize affordability, accessibility, and sample to result time, especially during outbreak scenarios such as the COVID-19 pandemic,” said Dr. Bobby Brooke Herrera, co-founder and CEO of E25Bio. “Our platform has enabled development of low-cost, paper-based rapid tests for COVID-19, Zika and other outbreak diseases that can be self-administered across entire communities in the United States and beyond.
Dr. Herrera also serves as the company's chief science officer, and was named to the Forbes 30 Under 30 – Healthcare 2020 list last December. “Dr. Bosch isolated monoclonal antibodies for Dengue, Zika and Chikungunya to produce rapid point-of-care tests,” Herrera said. “She recruited me to co-found the company with her in 2018, which is funded by venture capitalists and a grant from the National Institutes of Health. The company is interested in producing monoclonal antibodies to be utilized in the development of point-of-care, affordable tests for highly infectious diseases. With a few drops of blood, you can get diagnostic results in five –10 minutes.” (NMSU alum among Forbes 2020 ‘30 under 30’ list of healthcare entrepreneurs, Las Cruces Sun News, Dec. 7, 2019) An interview with cE25Bio's CTO, Dr. Irene Bosch.
posted by Iris Gambol at 8:24 PM on August 17, 2020 [1 favorite]
I hadn't seen my 81 year old mother in five months. We both hard quarantined for two weeks just so I could go home and hug her and spend a few days with her. Intellectually I know the risk is very low, but for the next two weeks I'm going to be worried that I've inadvertently given her a death sentence. Rapid test? Bring it on.
posted by Preserver at 8:31 PM on August 17, 2020 [15 favorites]
posted by Preserver at 8:31 PM on August 17, 2020 [15 favorites]
What is the legitimate solution?
Yes, basically I mean tighter lockdowns for six to eight weeks, with aggressive contact tracing and response to local outbreaks maintained after that. We might have different definitions of a "legitimate solution" because outside China this has worked--in many cases with more lenient rules than I've lived with here--sufficiently in Europe, South Korea and other places to get the death rates 95% to 99% lower per capita than we have here in the States.
I'm not disputing this is a valid tool at some point if we get it going. It would certainly change my risk assessment about, say, going to the gym if everyone was tested at the door. Which would be great. But we're leaving a lot of options on the table already.
posted by mark k at 8:41 PM on August 17, 2020 [2 favorites]
Yes, basically I mean tighter lockdowns for six to eight weeks, with aggressive contact tracing and response to local outbreaks maintained after that. We might have different definitions of a "legitimate solution" because outside China this has worked--in many cases with more lenient rules than I've lived with here--sufficiently in Europe, South Korea and other places to get the death rates 95% to 99% lower per capita than we have here in the States.
I'm not disputing this is a valid tool at some point if we get it going. It would certainly change my risk assessment about, say, going to the gym if everyone was tested at the door. Which would be great. But we're leaving a lot of options on the table already.
posted by mark k at 8:41 PM on August 17, 2020 [2 favorites]
Tehhund: What does Dr. Fauci think?
TWiV host Racaniello asked about it July 17 during Fauci's appearance on episode 641, circa 36:44. Dr. Fauci responded enthusiastically:
posted by 20 year lurk at 9:38 PM on August 17, 2020 [8 favorites]
TWiV host Racaniello asked about it July 17 during Fauci's appearance on episode 641, circa 36:44. Dr. Fauci responded enthusiastically:
Something along that line is really what is needed, is something that you could essentially do as many tests as you want; it's instantaneous, you get the answer, bingo you're done. I mean, we really do need that. I mean, it would alleviate a lot of anxiety, number one. And number two, it would be an important public health tool. I mean, if you could do that, before you send a group together into a class or a group together into a factory to work, I mean, how great would that be knowing that at that given moment everybody was negative?Discussion continued a bit, but without too much more detail.
posted by 20 year lurk at 9:38 PM on August 17, 2020 [8 favorites]
I'd do rapid testing on my own every day before work (I'm somehow "essential"), I'd do rapid testing with any event I attended. I'd want to know more about accuracy before I'd go sit in a movie theater for 2 hours with recirculated air even with masks on and distancing, but if that raised a movie price a bit and the test was fairly accurate, I'd do it before walking into the theater. Not sure about indoor restaurants yet even with distancing.
But heck yeah, rapid testing. We've been needing this. This 3-7-10 day test result thing has been useless except for gathering data.
posted by hippybear at 10:21 PM on August 17, 2020 [6 favorites]
But heck yeah, rapid testing. We've been needing this. This 3-7-10 day test result thing has been useless except for gathering data.
posted by hippybear at 10:21 PM on August 17, 2020 [6 favorites]
I'm skeptical about scaling capacity (everyday testing for every American would require tens of billions, not millions of tests), but it's worth a try.
Even if we implemented existing rapid test technology, and only for medical workers and schools, imagine the difference that would make?
posted by latkes at 10:29 PM on August 17, 2020 [4 favorites]
Even if we implemented existing rapid test technology, and only for medical workers and schools, imagine the difference that would make?
posted by latkes at 10:29 PM on August 17, 2020 [4 favorites]
Oh man, weird stoned brain late night passing thought MeFiMusic challenge: write a song about being in line for a movie and having your test come back positive.
posted by hippybear at 10:51 PM on August 17, 2020 [2 favorites]
posted by hippybear at 10:51 PM on August 17, 2020 [2 favorites]
I mean, how great would that be knowing that at that given moment everybody was negative?
Ok. Sure, with *real* FDA approval and public numbers and ongoing QA checks from an outside authority with enough juice to halt use if it even begins to look dodgy.
And hotelquarentinepay-enforce every. single. positive. person. Stipend like 1.1x what they make, tax free.
posted by j_curiouser at 11:43 PM on August 17, 2020 [2 favorites]
Ok. Sure, with *real* FDA approval and public numbers and ongoing QA checks from an outside authority with enough juice to halt use if it even begins to look dodgy.
And hotelquarentinepay-enforce every. single. positive. person. Stipend like 1.1x what they make, tax free.
posted by j_curiouser at 11:43 PM on August 17, 2020 [2 favorites]
Even if we implemented existing rapid test technology, and only for medical workers and schools, imagine the difference that would make?
posted by latkes at 10:29 PM on August 17
Yeah as a medical worker I came here to say this. I absolutely understand and agree that there should have been and should be more hard quarantine, and I am 10000% behind any responsibility and assistance the government and social organizations and society at large may suddenly decide to pursue.
But I run a PACE site, an HMO and clinic for low income seniors. No matter how responsible greater society gets, I still have staff who still need to treat patients and be in each other’s company, in person. At no point has anyone stepped up and said “we’ll book out a hotel for months so you can hard quarantine”. We are running testing but it is obviously slow and expensive and a logistical nightmare to decide what to do with slow and expensive results.
I know people are skeptical that this could result in a society-wide change and that’s fair, but it would be a stone cold game changer at my work. It would solve so many problems. And in terms of mortality? If rapid cheap testing was available and paid for for nursing homes and senior living settings you bet your ass the national rates would plummet. Nearly half of the fatalities have been in nursing homes alone; it’s an absolute war zone out here. There have been unimaginable personal sacrifices.
Just because this wouldn’t save all lives or your life or better fit the social contract doesn’t mean that we do not need better technologies to save the lives of the seniors and their frontline workers who have been dying in the trenches out here. We are trying our hardest. We need more help.
posted by skookumsaurus rex at 3:06 AM on August 18, 2020 [54 favorites]
posted by latkes at 10:29 PM on August 17
Yeah as a medical worker I came here to say this. I absolutely understand and agree that there should have been and should be more hard quarantine, and I am 10000% behind any responsibility and assistance the government and social organizations and society at large may suddenly decide to pursue.
But I run a PACE site, an HMO and clinic for low income seniors. No matter how responsible greater society gets, I still have staff who still need to treat patients and be in each other’s company, in person. At no point has anyone stepped up and said “we’ll book out a hotel for months so you can hard quarantine”. We are running testing but it is obviously slow and expensive and a logistical nightmare to decide what to do with slow and expensive results.
I know people are skeptical that this could result in a society-wide change and that’s fair, but it would be a stone cold game changer at my work. It would solve so many problems. And in terms of mortality? If rapid cheap testing was available and paid for for nursing homes and senior living settings you bet your ass the national rates would plummet. Nearly half of the fatalities have been in nursing homes alone; it’s an absolute war zone out here. There have been unimaginable personal sacrifices.
Just because this wouldn’t save all lives or your life or better fit the social contract doesn’t mean that we do not need better technologies to save the lives of the seniors and their frontline workers who have been dying in the trenches out here. We are trying our hardest. We need more help.
posted by skookumsaurus rex at 3:06 AM on August 18, 2020 [54 favorites]
And look, I know I am on a soapbox here, but if you want to see the human cost of the virus up close, even now, all you have to do is look at the drawer filling up with my staff’s bereavement requests and medical absences. They are all Black Detroiters and even those who have not developed symptoms have spent this year burying their families. I sure would love a $1 rapid test and to stop filling that damn drawer.
posted by skookumsaurus rex at 3:29 AM on August 18, 2020 [37 favorites]
posted by skookumsaurus rex at 3:29 AM on August 18, 2020 [37 favorites]
The knee jerk skepticism I’m seeing in this thread reminds me of zealots ranting about how condoms can’t guarantee safety. I am sure those folks mean well, or at least some do. I am also sure that on net, their commitment to purity kills people.
I am scared as hell about vaccines being rushed through, and every single article I see suggesting it fills me with rage. We have so much on the line societally with vaccines, and I don’t want us to do to ourselves what we did to Pakistan. But I am super excited about rapid covid tests. That test-trace-isolate soapbox all the epidemiologists have been on — we have been stymied by the first step. We can catch more sick people by applying a flawed test to everyone several times a week than we can with the current regime, which does not test enough people, does not get results back fast enough, and may not actually be possible to scale up. Last week I saw a really nice and fun lecture by Carl Bergstrom on the math — to my chagrin it’s been taken down so I removed the link. But yes, real scientists working on covid related problems (I am not) are excited about this.
There are absolutely still social problems around Covid that this type of technology doesn’t solve. We’re still America and we are ingenious at inventing stupid ways to fuck ourselves. But I think anti-science reactionaries are one of those cultural misfeatures, and I hope these tests get some traction.
posted by eirias at 4:45 AM on August 18, 2020 [18 favorites]
I am scared as hell about vaccines being rushed through, and every single article I see suggesting it fills me with rage. We have so much on the line societally with vaccines, and I don’t want us to do to ourselves what we did to Pakistan. But I am super excited about rapid covid tests. That test-trace-isolate soapbox all the epidemiologists have been on — we have been stymied by the first step. We can catch more sick people by applying a flawed test to everyone several times a week than we can with the current regime, which does not test enough people, does not get results back fast enough, and may not actually be possible to scale up. Last week I saw a really nice and fun lecture by Carl Bergstrom on the math — to my chagrin it’s been taken down so I removed the link. But yes, real scientists working on covid related problems (I am not) are excited about this.
There are absolutely still social problems around Covid that this type of technology doesn’t solve. We’re still America and we are ingenious at inventing stupid ways to fuck ourselves. But I think anti-science reactionaries are one of those cultural misfeatures, and I hope these tests get some traction.
posted by eirias at 4:45 AM on August 18, 2020 [18 favorites]
If you have Ebola, you are in the submarine and not going anywhere because Laws and Rules and Public Safety and Theoretically wanting to stay alive.
But in this case it was a much smaller population, certainly non-trumpist, with some public health information, but still the families brought the body back to their house and everyone touched the body, the main form of transmission. Societal norms are really hard to modify.
I don't see why the efforts for testing and vaccine trials are not bigger and more extensive, one of the problems with stage III looks to be a shortage of non-white volunteers. Use emergency government funding to spin up a corp going door to door canvassing for good subjects. (sorry so many derails in the covid world)
posted by sammyo at 5:37 AM on August 18, 2020 [1 favorite]
But in this case it was a much smaller population, certainly non-trumpist, with some public health information, but still the families brought the body back to their house and everyone touched the body, the main form of transmission. Societal norms are really hard to modify.
I don't see why the efforts for testing and vaccine trials are not bigger and more extensive, one of the problems with stage III looks to be a shortage of non-white volunteers. Use emergency government funding to spin up a corp going door to door canvassing for good subjects. (sorry so many derails in the covid world)
posted by sammyo at 5:37 AM on August 18, 2020 [1 favorite]
First, an apology: I got all excited last night about being able to ask experts and report back, and I forgot that I used to talk to ID specialists regularly before 1) we moved and 2) SARS-CoV-2 hit. So I’m only able to ask one person who is more involved in treatment than diagnosis, so I won’t be the font of knowledge that I hoped.
Iris Gambol, I’ve got a followup question for you so I’ll send you a DM.
Finally, the first link in the post (www.rapidtests.org) links to this NYT piece: https://www.nytimes.com/2020/07/03/opinion/coronavirus-tests.html, which says
posted by Tehhund at 6:44 AM on August 18, 2020 [1 favorite]
Iris Gambol, I’ve got a followup question for you so I’ll send you a DM.
Finally, the first link in the post (www.rapidtests.org) links to this NYT piece: https://www.nytimes.com/2020/07/03/opinion/coronavirus-tests.html, which says
Once paper strips’ efficacy is definitively proved and they are cleared by the F.D.A., Congress can quickly authorize the production and distribution- this sounds like the kind of guarded excitement that most people in the thread are expressing: this would be great, once it passes muster. And I agree that the standards we use for "good enough" should be reevaluated given the ongoing crisis, but my governor and congresspeople are all really bad and I want them to stay the hell away from the FDA. So no, I won't be calling for politicians to lean on the FDA even though I think the FDA needs to take this seriously.
posted by Tehhund at 6:44 AM on August 18, 2020 [1 favorite]
We've got a real life experiment of how rapid testing intersects with human behavior going on this week here in Colorado. Sara Sawyer's lab in Boulder has been working non-stop since March developing and validating a saliva-based test (RT-LAMP, not the same as the lateral flow test strips discussed in the article), and CU Boulder is deploying it on every incoming undergrad to try to keep COVID out of the dorms, with recurring surveillance testing of asymptomatic members of the campus community. The test is super promising, even though I personally think there are too many holes in the human experiment, like not testing graduate TAs or RAs who teach undergrads.
posted by deludingmyself at 6:59 AM on August 18, 2020 [8 favorites]
posted by deludingmyself at 6:59 AM on August 18, 2020 [8 favorites]
One of the appeals of this approach is that it doesn't require you to solve all of society's problems at a stroke -- if I run a home daycare and enforce test on site upon arrival, I could care less if 5% of the parents are crazy Churchgoing mask deniers. I can keep covid out of my daycare and from getting to my elderly relatives who behave sensibly. The same logic applies to schools and teachers. You can keep the school from becoming a hotspot despite the 20% of people who DGAF.
At this point in the USA we are going to have so many smoldering embers and reservoirs I think it would take a military style lockdown to knock rates back to those controllable using standard test and trace strategies.
posted by benzenedream at 8:46 AM on August 18, 2020 [11 favorites]
At this point in the USA we are going to have so many smoldering embers and reservoirs I think it would take a military style lockdown to knock rates back to those controllable using standard test and trace strategies.
posted by benzenedream at 8:46 AM on August 18, 2020 [11 favorites]
I think a military style lock down in the US would have been very effective in the beginning if...we had a competent government running it. I agree that rapid testing would be the best thing we can do now to gatekeep what we need to have open and running. Geez, I'd feel better about the grocery store too if they could actually test their employees.
posted by tiny frying pan at 9:56 AM on August 18, 2020 [3 favorites]
posted by tiny frying pan at 9:56 AM on August 18, 2020 [3 favorites]
I'm not clear from the Atlantic article what rapid test hospitals are currently using.
posted by latkes at 10:00 AM on August 18, 2020
posted by latkes at 10:00 AM on August 18, 2020
I can keep covid out of my daycare and from getting to my elderly relatives who behave sensibly.
Well no, because this instant testing, even if perfect, still has a small gap between viral loads that can be transmitted and viral loads that can be detected.
This is a game of chance and attenuating probabilities. The hierarchy of controls from most effective to least effective is is:
Sadly, when it comes to older people, they have to multiply any possible risk by their additional risk factor of their age. Any back of the math calculations you pretty much have to multiply them by 20 for anyone over 60 and 30 for anyone over 70. A lot of them are probably taking way bigger a risk than they think they are. Thankfully my MIL and uncle in law is in complete isolation and my parents and grandmother are in a total green zone (0 community transmission for 100 days and locked up borders what what!)
The US being loathe to go towards any sort of elimination in the face of embers is causing them to basically smolder and occasionally catch fire. A lot of grandparents are going to die because of it.
posted by Your Childhood Pet Rock at 10:01 AM on August 18, 2020 [2 favorites]
Well no, because this instant testing, even if perfect, still has a small gap between viral loads that can be transmitted and viral loads that can be detected.
This is a game of chance and attenuating probabilities. The hierarchy of controls from most effective to least effective is is:
- Elimination (don't get near the hazard)
- Substitution (use something less hazardous)
- Engineering Controls (make sure people can't get to the hazard)
- Administrative Controls (change the behavior of people)
- PPE (personal protective equipment)
Sadly, when it comes to older people, they have to multiply any possible risk by their additional risk factor of their age. Any back of the math calculations you pretty much have to multiply them by 20 for anyone over 60 and 30 for anyone over 70. A lot of them are probably taking way bigger a risk than they think they are. Thankfully my MIL and uncle in law is in complete isolation and my parents and grandmother are in a total green zone (0 community transmission for 100 days and locked up borders what what!)
The US being loathe to go towards any sort of elimination in the face of embers is causing them to basically smolder and occasionally catch fire. A lot of grandparents are going to die because of it.
posted by Your Childhood Pet Rock at 10:01 AM on August 18, 2020 [2 favorites]
we can't abide a high false-negative rate, no matter our silver bullet wishes. it invalidates the entire concept. oversight.
posted by j_curiouser at 10:01 AM on August 18, 2020 [2 favorites]
posted by j_curiouser at 10:01 AM on August 18, 2020 [2 favorites]
False positives aren't a problem because it just means 14 day quarantine without a reason.
False negatives means possible silent transmission unabated which is far, far worse.
posted by Your Childhood Pet Rock at 10:10 AM on August 18, 2020 [4 favorites]
False negatives means possible silent transmission unabated which is far, far worse.
posted by Your Childhood Pet Rock at 10:10 AM on August 18, 2020 [4 favorites]
we can't abide a high false-negative rate, no matter our silver bullet wishes. it invalidates the entire concept. oversight.
It does not. If you give an infectious person even a 50% chance of being stopped before going into a high impact setting (factory floor, gym, school, church, etc.) then you've definitely reduced the average spread of infection. It is a statistical game, and you want to change the odds so they stop favoring the house, even if you can't win every hand.
You are also pretty much 100% guaranteed to catch a nascent cluster in one of those places *early* once spread has taken place, allowing better response.
My comments on this thread make it clear I'm not especially excited by this on its own, but no question it would make a positive impact.
posted by mark k at 10:18 AM on August 18, 2020 [17 favorites]
It does not. If you give an infectious person even a 50% chance of being stopped before going into a high impact setting (factory floor, gym, school, church, etc.) then you've definitely reduced the average spread of infection. It is a statistical game, and you want to change the odds so they stop favoring the house, even if you can't win every hand.
You are also pretty much 100% guaranteed to catch a nascent cluster in one of those places *early* once spread has taken place, allowing better response.
My comments on this thread make it clear I'm not especially excited by this on its own, but no question it would make a positive impact.
posted by mark k at 10:18 AM on August 18, 2020 [17 favorites]
WRT to false negative rate, the most important piece from the article and the talk is that most of those "false" negatives are false because of a low viral load, and insufficient virus in the sample. So they may be false from an absolute diagnostic sense, but are still giving you useful information about the public health risk of that person being in circulation.
If you have a very low viral load, you're generally not spreading the disease. That's the whole point - that these tests are about epidemiological and public health risk, not about high specificity individual diagnosis.
posted by mercredi at 10:25 AM on August 18, 2020 [9 favorites]
If you have a very low viral load, you're generally not spreading the disease. That's the whole point - that these tests are about epidemiological and public health risk, not about high specificity individual diagnosis.
posted by mercredi at 10:25 AM on August 18, 2020 [9 favorites]
If you have a very low viral load, you're generally not spreading the disease. That's the whole point - that these tests are about epidemiological and public health risk, not about high specificity individual diagnosis.
Except that the typical progression is for viral loads to grow over time and for transmission to be an ever more probable event.
posted by Your Childhood Pet Rock at 10:28 AM on August 18, 2020
Except that the typical progression is for viral loads to grow over time and for transmission to be an ever more probable event.
posted by Your Childhood Pet Rock at 10:28 AM on August 18, 2020
Except that the typical progression is for viral loads to grow over time and for transmission to be an ever more probable event.
Which is why you test every day, to catch that progression.
posted by JackFlash at 10:33 AM on August 18, 2020 [17 favorites]
Which is why you test every day, to catch that progression.
posted by JackFlash at 10:33 AM on August 18, 2020 [17 favorites]
As I said above I really want this to become available, but it really is worth thinking about whether the problems with this approach outweigh the benefits and learn how we can mitigate those problems to maximize benefits. The world isn't just "people who are doing maximum possible lockdown" vs "angry anti-maskers", the majority of people are somewhere in the middle mostly trying to muddle through but also sometimes grocery shopping and trying to keep precarious jobs. What will the impact be on that vast majority? I'm not a public health expert so I can't say.
Will the false positive rate cause some people to assume "I had it, I'm immune" and stop being so cautious? If so, does that happen frequently or rarely?
Will the test cause people to think "I tested negative this morning" and not be as cautious as they should that day? If it was a true negative they might go somewhere they shouldn't and become infected, and if it was a false negative they might go out and spread it. Does that happen frequently or rarely?
A few people have said this sort of strategy relies on people testing every day, can we rely on the general public to do that reliably? Is it still effective if on average people only test every other day?
Will politicians say "We have daily tests now, open up the schools, churches, and bars" ? Actually without a degree in public health or political science I can answer that: I assure you that the current administration will abuse this daily test in that way. Doesn't mean we can't have the test but we need to account for that sort of disinformation.
The general public, myself included, are not public health or infectious disease experts and that is a lot of uncertainty to ask people to navigate. I'm not saying we can't have these at-home tests. But there are lots of reasons for healthy skepticism, and it might be good for the makers to go through some kind of trial to make sure that making these strips widely available is a net benefit once you take into account how people actually use them. Or do whatever sort of data collection the FDA wants because they are the experts and I am not. I strongly suspect the answer would be yes, it's a net benefit, but a well-designed trial might help the broader deployment go better. So no, I won't be telling my representatives to lean on the FDA to speed up approval. I hope the experts at the FDA make the best possible decision, and since they are the experts I defer to them.
posted by Tehhund at 11:05 AM on August 18, 2020 [2 favorites]
Will the false positive rate cause some people to assume "I had it, I'm immune" and stop being so cautious? If so, does that happen frequently or rarely?
Will the test cause people to think "I tested negative this morning" and not be as cautious as they should that day? If it was a true negative they might go somewhere they shouldn't and become infected, and if it was a false negative they might go out and spread it. Does that happen frequently or rarely?
A few people have said this sort of strategy relies on people testing every day, can we rely on the general public to do that reliably? Is it still effective if on average people only test every other day?
Will politicians say "We have daily tests now, open up the schools, churches, and bars" ? Actually without a degree in public health or political science I can answer that: I assure you that the current administration will abuse this daily test in that way. Doesn't mean we can't have the test but we need to account for that sort of disinformation.
The general public, myself included, are not public health or infectious disease experts and that is a lot of uncertainty to ask people to navigate. I'm not saying we can't have these at-home tests. But there are lots of reasons for healthy skepticism, and it might be good for the makers to go through some kind of trial to make sure that making these strips widely available is a net benefit once you take into account how people actually use them. Or do whatever sort of data collection the FDA wants because they are the experts and I am not. I strongly suspect the answer would be yes, it's a net benefit, but a well-designed trial might help the broader deployment go better. So no, I won't be telling my representatives to lean on the FDA to speed up approval. I hope the experts at the FDA make the best possible decision, and since they are the experts I defer to them.
posted by Tehhund at 11:05 AM on August 18, 2020 [2 favorites]
The Militias Against Masks (The New Yorker reporting from Michigan), in which a group partially funded by Betsy DeVos and initially founded as an anti-union right-to-work group connects with a bunch of racists to form the anti-lockdown movement.
posted by box at 11:08 AM on August 18, 2020 [2 favorites]
posted by box at 11:08 AM on August 18, 2020 [2 favorites]
The Militias Against Masks
It showed up in the "Full Moon Fever Dream" thread, but as a repost or sorts that article can be taken in tandem with "The Dudes Who Won't Wear Masks" from The Atlantic a couple months ago.
posted by rhizome at 12:04 PM on August 18, 2020
It showed up in the "Full Moon Fever Dream" thread, but as a repost or sorts that article can be taken in tandem with "The Dudes Who Won't Wear Masks" from The Atlantic a couple months ago.
posted by rhizome at 12:04 PM on August 18, 2020
I for one am just very angry and exhausted over the schooling issue. I cannot understand why schools have not been under the category of essential and kept open. We never closed grocery stores, hardware stores, gas stations, hospitals, and various other things. Yet schools were closed. Schools should have always been in this category of essential entity and prioritized over a variety of other things that somehow they seem to be behind currently.
posted by JenMarie at 12:51 PM on August 18, 2020
posted by JenMarie at 12:51 PM on August 18, 2020
I cannot understand why schools have not been under the category of essential and kept open.
Because they're perfect vectors for spreading covid. Stores are places that adults (who, in theory, can act like grown-ups and wear masks) go for minutes a week if they're reducing contact and not talking much. Schools are places that children, who can't be relied upon to make adult choices, go for ~30 hours/week, in relatively small, confined spaces with much denser population than the typical store, where at least one person has to be talking most of the time. Even if the idea that children aren't as likely to die from covid is true, an outbreak would lead to many adult infections in the homes of those children. Just read any of the umpteen articles written about the infamous Georgia high school. Having 30 people in a small room is a recipe for mass infections.
posted by Candleman at 1:47 PM on August 18, 2020 [24 favorites]
Because they're perfect vectors for spreading covid. Stores are places that adults (who, in theory, can act like grown-ups and wear masks) go for minutes a week if they're reducing contact and not talking much. Schools are places that children, who can't be relied upon to make adult choices, go for ~30 hours/week, in relatively small, confined spaces with much denser population than the typical store, where at least one person has to be talking most of the time. Even if the idea that children aren't as likely to die from covid is true, an outbreak would lead to many adult infections in the homes of those children. Just read any of the umpteen articles written about the infamous Georgia high school. Having 30 people in a small room is a recipe for mass infections.
posted by Candleman at 1:47 PM on August 18, 2020 [24 favorites]
> I for one am just very angry and exhausted over the schooling issue. I cannot understand why schools have not been under the category of essential and kept open
classroom environments are among the places most likely to spread coronavirus / produce superspreader events. basically the only thing that's more dangerous than teaching or learning in a classroom is singing in an enclosed space. like, a karaoke bar or a church choir practice is worse, but only barely. and if you're talking about k-12 schools rather than colleges, there's the additional facet that it is impossible to get a pack of kids to adhere to social distancing standards / keep adhering over time.
opening schools before the virus is suppressed — suppressed suppressed, such that new cases are vanishingly rare and such that whenever a case does pop up the contact tracers can do their jobs quickly and effectively — will result in plague, immediate plague, lots of plague, fast-spreading plague, plague that kills a bunch of kids, a bunch of teachers, a bunch of relatives, plague that will maim a bunch more, plague that will keep your kids stuck in the house all day every day until there's a vaccine. unless it puts them six feet under before we get that vaccine.
hopefully this helps you understand.
posted by Reclusive Novelist Thomas Pynchon at 1:56 PM on August 18, 2020 [20 favorites]
classroom environments are among the places most likely to spread coronavirus / produce superspreader events. basically the only thing that's more dangerous than teaching or learning in a classroom is singing in an enclosed space. like, a karaoke bar or a church choir practice is worse, but only barely. and if you're talking about k-12 schools rather than colleges, there's the additional facet that it is impossible to get a pack of kids to adhere to social distancing standards / keep adhering over time.
opening schools before the virus is suppressed — suppressed suppressed, such that new cases are vanishingly rare and such that whenever a case does pop up the contact tracers can do their jobs quickly and effectively — will result in plague, immediate plague, lots of plague, fast-spreading plague, plague that kills a bunch of kids, a bunch of teachers, a bunch of relatives, plague that will maim a bunch more, plague that will keep your kids stuck in the house all day every day until there's a vaccine. unless it puts them six feet under before we get that vaccine.
hopefully this helps you understand.
posted by Reclusive Novelist Thomas Pynchon at 1:56 PM on August 18, 2020 [20 favorites]
I cannot understand why schools have not been under the category of essential and kept open.
Candleman and Reclusive Novelist Thomas Pynchon covered this well, but I just want to re-iterate: it has been demonstrated many, many times that children are incredible vectors for respiratory infections. By protecting only children from infection, you reduce infections in the entire population by about three times. If you open schools, expect to triple the current COVID19 infection rate.
There are lots of great citations in the references of those papers, if you'd like more examples.
posted by agentofselection at 2:27 PM on August 18, 2020 [10 favorites]
Candleman and Reclusive Novelist Thomas Pynchon covered this well, but I just want to re-iterate: it has been demonstrated many, many times that children are incredible vectors for respiratory infections. By protecting only children from infection, you reduce infections in the entire population by about three times. If you open schools, expect to triple the current COVID19 infection rate.
There are lots of great citations in the references of those papers, if you'd like more examples.
posted by agentofselection at 2:27 PM on August 18, 2020 [10 favorites]
There were options besides having 30 kids in a classroom, including small groups fewer days a week and utilizing outdoor space. I don't think it's a matter of me misunderstanding, it is a matter of a lack of will to prioritize this specific thing.
posted by JenMarie at 2:48 PM on August 18, 2020
posted by JenMarie at 2:48 PM on August 18, 2020
Other countries have opened schools. It's a matter of the inadequate response to covid in the US, not that there's no way to safely open schools.
posted by JenMarie at 2:49 PM on August 18, 2020 [1 favorite]
posted by JenMarie at 2:49 PM on August 18, 2020 [1 favorite]
I cannot understand why schools have not been under the category of essential and kept open.
My kid's school was closed for one week. Since then, she has been learning remotely. It has not negatively affected her. Granted, that is not the case for all students. But, just because kids were not physically at school does not mean schools were closed.
posted by a non mouse, a cow herd at 2:51 PM on August 18, 2020 [4 favorites]
My kid's school was closed for one week. Since then, she has been learning remotely. It has not negatively affected her. Granted, that is not the case for all students. But, just because kids were not physically at school does not mean schools were closed.
posted by a non mouse, a cow herd at 2:51 PM on August 18, 2020 [4 favorites]
Other countries have open bars and churches, too, because their rates are low enough to justify those things. We don't live in those other countries. Closing schools has been the only part of our response that is adequate, frankly. I understand that it is enormously inconvenient, even to the point of financial ruin for many, but it is the only sane answer we have given our current infection rates.
posted by agentofselection at 2:53 PM on August 18, 2020 [10 favorites]
posted by agentofselection at 2:53 PM on August 18, 2020 [10 favorites]
because their rates are low enough to justify those things
Because they had an adequate federal response. And I am angry about our lack of response here in the US. That's the point I am making. It's not about inconvenience, which is a really dismissive thing to say. Many kids, a lot of whom have special needs like mine, are suffering enormously.
posted by JenMarie at 2:56 PM on August 18, 2020 [4 favorites]
Because they had an adequate federal response. And I am angry about our lack of response here in the US. That's the point I am making. It's not about inconvenience, which is a really dismissive thing to say. Many kids, a lot of whom have special needs like mine, are suffering enormously.
posted by JenMarie at 2:56 PM on August 18, 2020 [4 favorites]
JenMarie, I think what you mean to say is “I can’t believe we’ve bungled this so badly we can’t safely open schools.” Because that’s the situation.
posted by argybarg at 3:04 PM on August 18, 2020 [13 favorites]
posted by argybarg at 3:04 PM on August 18, 2020 [13 favorites]
I guess partly, but it doesn't encompass my anger that schools are farther down the list of what we are safely trying to reopen than other things. I do not perceive that schools are given the priority level they should be, because hey it's only families and kids suffering. And that suffering is often characterized as just an inconvenience or parents complaining. I've even seen teachers say things like they aren't willing to babysit so parents can work. But I value school far more than as merely babysitting. At any rate I'm frustrated and unhappy and don't feel like the schools are being prioritized the way they should be.
posted by JenMarie at 3:12 PM on August 18, 2020
posted by JenMarie at 3:12 PM on August 18, 2020
You are correct, I focused my comment on the needs of adults rather than those of children; my apologies for not thinking of special-needs children while composing it (not sarcasm).
However, your initial comment did not read as being angry that our response was so inadequate that it caused the situation that schools couldn't be opened--it read as wondering why schools couldn't be open, given that businesses were open. I was responding to that comparison. I know that both adults and children are suffering because of school closures, but re-opening them would result in hundreds of thousands of deaths, so I am going to remain quite adamant in making sure that the epidemiological reasons for our current school closure requirements are clear.
posted by agentofselection at 3:13 PM on August 18, 2020 [5 favorites]
However, your initial comment did not read as being angry that our response was so inadequate that it caused the situation that schools couldn't be opened--it read as wondering why schools couldn't be open, given that businesses were open. I was responding to that comparison. I know that both adults and children are suffering because of school closures, but re-opening them would result in hundreds of thousands of deaths, so I am going to remain quite adamant in making sure that the epidemiological reasons for our current school closure requirements are clear.
posted by agentofselection at 3:13 PM on August 18, 2020 [5 favorites]
Okay, fair enough. I'm sure I didn't express myself as well as I could, and that reasonable people can have a difference of opinion.
posted by JenMarie at 3:15 PM on August 18, 2020 [1 favorite]
posted by JenMarie at 3:15 PM on August 18, 2020 [1 favorite]
I also agree that triage should have been done to say "which students will be permanently harmed by a gap in education?" and prioritize small group (pod) teaching as much as possible. I have heard some real horror stories from parents with special needs kids who have regressed during the pandemic and wiped out hard-won years of gains. (tl;dr - school closings did not have to be completely binary)
posted by benzenedream at 3:16 PM on August 18, 2020 [6 favorites]
posted by benzenedream at 3:16 PM on August 18, 2020 [6 favorites]
My kid's school was closed for one week. Since then, she has been learning remotely. It has not negatively affected her. Granted, that is not the case for all students. But, just because kids were not physically at school does not mean schools were closed.
Great. You are lucky, I am glad to hear this situation works for your student. But it doesn't work for mine, nor is it my responsibility to educate my child nor is it my child's fault that distance learning doesn't work for him. Read up on FAPE if you don't know what I mean. We will all benefit if we ensure children get a fair and appropriate education.
posted by JenMarie at 3:40 PM on August 18, 2020 [1 favorite]
Great. You are lucky, I am glad to hear this situation works for your student. But it doesn't work for mine, nor is it my responsibility to educate my child nor is it my child's fault that distance learning doesn't work for him. Read up on FAPE if you don't know what I mean. We will all benefit if we ensure children get a fair and appropriate education.
posted by JenMarie at 3:40 PM on August 18, 2020 [1 favorite]
Something that hasn't been mentioned is that not only is transmission less likely if a person has a very low viral load, dose appears to be (at least) strongly correlated with disease severity and, more speculatively, with the likelihood of long-term health impacts. A false negative (due to low viral load) is less of a risk with COVID-19 than with many other diseases.
With good rapid testing and enforced mask-wearing, we could get this thing under control. It's highly unfortunate that a significant fraction of the population is doing their level best to neuter our ability to use masks as a mitigation of risk.
posted by wierdo at 11:03 PM on August 18, 2020 [1 favorite]
With good rapid testing and enforced mask-wearing, we could get this thing under control. It's highly unfortunate that a significant fraction of the population is doing their level best to neuter our ability to use masks as a mitigation of risk.
posted by wierdo at 11:03 PM on August 18, 2020 [1 favorite]
UK is making interested noises. Says we're evaluating rapid tests, tests using saliva, and: Hancock’s aim is to have a system where anyone can tests themselves on a regular basis – potentially each day. Doesn't claim there's any overlap between the aspiration and our current lab evaluations.
posted by sourcejedi at 6:24 AM on August 19, 2020
posted by sourcejedi at 6:24 AM on August 19, 2020
Oh, and this was after an endorsement by Blair + ex-health secretary Hunt + William Hague.
Current reality is a little less rosy. We don't do regular testing of hospital staff, and the regular testing in care homes has floundered. We have not yet allowed testing to shorten quarantine or self-isolation.
posted by sourcejedi at 6:35 AM on August 19, 2020
Current reality is a little less rosy. We don't do regular testing of hospital staff, and the regular testing in care homes has floundered. We have not yet allowed testing to shorten quarantine or self-isolation.
posted by sourcejedi at 6:35 AM on August 19, 2020
The technology solution that's staring us in the face is smartphone-based contact tracing. The uniquely American twist to the pandemic is that everyone knows someone with the space for a bar in their backyard or basement. Keeping bars closed now, when everyone is fed up with the social isolation just means actual underground speakeasies serving alcohol aka indoor house party super-spreader events. We have to admit that events are happening, and are going to keep happening, and unfortunately there isn't a way to prevent that from happening in America. (Australia managed to control the spread by implementing Wuhan-style enforced lock downs but there simply isn't the will in the US.) Sober people (ostensibly) can stay 6-ft apart and wear a mask, but trying to get drunk people to stay 6-ft apart and wear a mask is an exercise in futility.
Since people are gonna be drinking anyway, especially during a pandemic, and a recession, and in the face of great uncertainty, and on the cusp of a presidential election, what's needed is to open the bars, but require patrons scan-in via phone app using the bluetooth-based contact tracing (PEPP-PT), or else face suspension of the venue's liquor license. You get around some of the privacy issues by only making it required at bars, and using bluetooth-based tracing gets around issues of using GPS-based tracking, with the point being to help a limited contact tracing corps be more effective.
This is imperfect, but perfect is the enemy of the good, and even done imperfectly, contact tracing can successfully drive Re (the local effective value calculated from a diseases' R0) down below 1, at which point the disease doesn't continue to spread and the pandemic can be controlled. For a disease like COVID-19 with an R0 of 2.5, it doesn't take too much to drive it down.
posted by fragmede at 11:26 AM on August 19, 2020
Since people are gonna be drinking anyway, especially during a pandemic, and a recession, and in the face of great uncertainty, and on the cusp of a presidential election, what's needed is to open the bars, but require patrons scan-in via phone app using the bluetooth-based contact tracing (PEPP-PT), or else face suspension of the venue's liquor license. You get around some of the privacy issues by only making it required at bars, and using bluetooth-based tracing gets around issues of using GPS-based tracking, with the point being to help a limited contact tracing corps be more effective.
This is imperfect, but perfect is the enemy of the good, and even done imperfectly, contact tracing can successfully drive Re (the local effective value calculated from a diseases' R0) down below 1, at which point the disease doesn't continue to spread and the pandemic can be controlled. For a disease like COVID-19 with an R0 of 2.5, it doesn't take too much to drive it down.
posted by fragmede at 11:26 AM on August 19, 2020
The complaint that not having the social structure of school "hurts the kids" is a bit of a feint. It only hurts kids for whom on-site school is the best option.
For those kids that are non social-typical (to borrow the concept from "neurotypical"), remote learning can be a boon. School was hell for me, and it was worse hell for the kids even lower than me on the social scale. Finally, we have a situation where the freaks, geeks, nerds, and other outcasts have an advantage, and once again, those same kids' needs are on the back burner to the needs of the cool kids.
Note: I'm not addressing the real problem of what to do with kids at home, and the real family issues stemming from remote learning. That is, indeed, a very tough problem. But OMG THE CHILDREN completely ignores the kids that are actually better served not being in a classroom setting.
posted by notsnot at 12:10 PM on August 19, 2020 [1 favorite]
For those kids that are non social-typical (to borrow the concept from "neurotypical"), remote learning can be a boon. School was hell for me, and it was worse hell for the kids even lower than me on the social scale. Finally, we have a situation where the freaks, geeks, nerds, and other outcasts have an advantage, and once again, those same kids' needs are on the back burner to the needs of the cool kids.
Note: I'm not addressing the real problem of what to do with kids at home, and the real family issues stemming from remote learning. That is, indeed, a very tough problem. But OMG THE CHILDREN completely ignores the kids that are actually better served not being in a classroom setting.
posted by notsnot at 12:10 PM on August 19, 2020 [1 favorite]
...plus, as traumatizing as remote learning may be, losing a classmate or teacher would represent orders of magnitude more trauma.
posted by notsnot at 12:13 PM on August 19, 2020 [1 favorite]
posted by notsnot at 12:13 PM on August 19, 2020 [1 favorite]
I agree we don't have the conditions we need for safe school openings, but it's a mistake to argue with parents on this.. I live in a region that made school all remote and it is hell for parents who either have to find a way to work from home and try to be teachers while they work or will be literally leaving their kids alone with an ipad or phone while they work. The bad guy here is our failed state. We should be yelling at governors and state and federal legislators to demand a real COVID response, but also direct payments to everyone to allow them to stay home, if that's what we're left with in the wake of no real COVID response. Teacher advocates and parents fighting each other, instead of parents and teachers marching on their state capitals to demand money and resources, is definitely the outcome Trump prefers here.
posted by latkes at 12:45 PM on August 19, 2020 [3 favorites]
posted by latkes at 12:45 PM on August 19, 2020 [3 favorites]
Finally, we have a situation where the freaks, geeks, nerds, and other outcasts have an advantage, and once again, those same kids' needs are on the back burner to the needs of the cool kids.
What are you referencing? How are their needs on the backburner? I am trying to understand.
OMG THE CHILDREN
What is this a response to? I think stating the specific stances you are arguing against instead of condensing to some kind of meme or whatever would help conversation.
posted by JenMarie at 2:59 PM on August 19, 2020 [2 favorites]
What are you referencing? How are their needs on the backburner? I am trying to understand.
OMG THE CHILDREN
What is this a response to? I think stating the specific stances you are arguing against instead of condensing to some kind of meme or whatever would help conversation.
posted by JenMarie at 2:59 PM on August 19, 2020 [2 favorites]
Testing free for all.
That's one? way of looking at it! "Skipping FDA approval" tells me there's going to be a simulacrum of a treatment or vaccine in the next, oh, 74½ days. And we're never going to hear the end of it.
posted by rhizome at 9:05 PM on August 19, 2020 [1 favorite]
That's one? way of looking at it! "Skipping FDA approval" tells me there's going to be a simulacrum of a treatment or vaccine in the next, oh, 74½ days. And we're never going to hear the end of it.
posted by rhizome at 9:05 PM on August 19, 2020 [1 favorite]
« Older Homemade Peanut Sauce That Was All Wrong But My... | Little Acorns Newer »
This thread has been archived and is closed to new comments
posted by benzenedream at 2:20 PM on August 17, 2020 [8 favorites]