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Comment by panarky | Hacker News Reader

Because the US is doing nearly zero surveillance testing, we don't know what we don't know.

Maybe there's community transmission right now beyond these two cases and we don't know because we're only testing people returning from China or from the cruise ship.

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I don't think community transfer is a "maybe". If two people have been infected without any link to known cases, there must be at least one single person that links known cases to the two new infections. That can't really be debated. And what are the chances there is only one? And they only infected two more people, won't infect anyone else, and those two people didn't infect anyone before being quarantined? I think this thing is in the wild now.

It seems the odds are high there is more than 1 because if there is only one there would be something in common between these two recent community cases. But from what I’ve seen there’s nothing linking these two together which means there are at least two distinct groups in California at the moment in which community infections are happening.

The past whereabouts of these people is self-reported, correct? It certainly possible that they're not being completely transparent. The simple solution? Take their phone geo records and see where and when there's an intersection.

I'm not dismissing the possiblity of a threat; only how accurate self-reported data is known to be.

There’s now a third case of unknown origin in Oregon, so it’s confirmed:

https://www.washingtonpost.com/world/2020/02/28/coronavirus-...

And possibly one in the Seattle metro area - there is an 8pm PT presser with King, Snohomish and Washington State Public Health officials this evening.

https://twitter.com/passantino/status/1233587757198405632?s=...

> we're only testing people returning from China or from the cruise ship

Missing from the discussion is the whole debacle around the HHS staff that was sent to check the repatriated American citizens from Wuhan, who had no protection, were not trained, and were released back into the general public without further monitoring.

Like why didn't they send people who had a few years ago dealt with Ebola. It's not like we didn't have people who went over there to help or people who treated infected people stateside --granted Ebola transmission is different but you still need PPE, but people know the protocol in practice, not just reading about how to wear PPE.

Those people were fired by the Trump administration in 2018.

https://www.snopes.com/fact-check/trump-fire-pandemic-team/

It's like I'm living in a simulation or the movie Idiocracy and I desperately want out.

Hope you have plenty of guns to kill the zombies

Not sure why you’re being downvoted because that’s the exactly correct answer.

The previous administration converted the highly successful infrastructure they built up while responding to the Ebola virus into permanent infrastructure which was quickly dismantled by the current administration.

Because any suggestion that somehow politics and politicians are directly responsible for bad shit gets instantly down voted to oblivion on HN.

It could be because he is misrepresenting the content of the article.

Quoting: "funding for the CDC’s global disease outbreak prevention efforts had been reduced by 80%, including funding for the agency’s efforts in China. But that was the result of the anticipated depletion of previously allotted funding, not a direct cut by the Trump administration.

Since January 2019, actual funding (vs. requested/proposed funding) is controlled by the House leadership of the opposition party.

how exactly is it controlled by the "House leadership of the opposition party." when bills need to pass the senate too, and the republicans are flat out refusing to pass anything.

All spending bills originate in the House.

This is discussed in the NYT:

https://www.nytimes.com/2020/02/27/us/politics/coronavirus-u...

It was in fact broken by the Times and it is an inside source talking to their reporter that we know it happened.

Actually the Washington Post broke the story (according to the AP).

According to the Washington Post, the people from the CDC who interacted with the quarantined patients all had full protective gear.

Allegedly there were social workers from HHS also sent to help assist who were not trained in how to don full gear and so were wearing just masks and gloves.

Note this all happened back at the end of January. So it seems unlikely that anyone was actually exposed, unless you think that there are HHS workers who got sick and it was kept out of the news.

> So it seems unlikely that anyone was actually exposed, unless you think that there are HHS workers who got sick and it was kept out of the news.

That doesn't follow, both because the incubation period is now thought to be as long as 28 days and because infected individuals can be asymptomatic.

Clinical Characteristics of Coronavirus Disease 2019 in China

A study of 1,099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in China through January 29, 2020.

"The median incubation period was 4 days (interquartile range, 2 to 7)."

New England Journal of Medicine, Feb 28, 2020

https://www.nejm.org/doi/full/10.1056/NEJMoa2002032

This is also in part because the White House fired the CDC Pandemic Response Unit and cut their funding in 2018.

I'm not saying I don't believe something was cut, but I can't find an official CDC reference to something called "pandemic response unit"

Edit: I found reference to various leadership positions that would help respond to a pandemic be eliminated or left vacant [0], though I think that says something a bit different (still bad though) than the entire US pandemic response capability, or "unit", being axed.

[0]https://www.snopes.com/fact-check/trump-fire-pandemic-team/

https://www.washingtonpost.com/news/to-your-health/wp/2018/0...

> The top White House official responsible for leading the U.S. response in the event of a deadly pandemic has left the administration, and the global health security team he oversaw has been disbanded under a reorganization by national security adviser John Bolton.

Not sure how much more explicit that 2018 WaPo article can be.

From what I can tell though, that was more of an oversight team at the NSC level though, not the actual CDC folks or HHS folks that would really be dealing with this stuff. Again, I'm not saying that isn't bad, but it's not the same as saying the "pandemic response unit" was disbanded, which doesn't seem to be the official name of any actual unit, and it's a phrase that seems to imply that all of our pandemic response capabilities were dismantled. They weren't.

Was that part of the CDC or part of the NSC?

Yes. California is monitoring 8,400 people for corona virus. They currently have 200 test kits.

https://sanfrancisco.cbslocal.com/2020/02/27/gov-newsom-coro...

I read that a CT scan outperforms the lab test at detecting it

CT scans involve a lot of ionizing radiation. Definitely something to be avoided unless necessary.

According to [1], a chest CT scan rad dose ranges from 4 to 18 milliSieverts. Annual background dose is ~3 milliSv. [2] states that a 100 mSv dose would increase risk of cancer by 0.5% (5/1000).

[1] https://www.health.harvard.edu/cancer/radiation-risk-from-me...

[2] https://www.scientificamerican.com/article/air-travel-expose...

You cannot compare an annual background dose to the dose received in a CT scan. Similarly, the 100 mSv dose of your reference number 2 is an inappropriate comparison because it is spread out over time compared to a CT scan. Your premise is like saying, walking puts an impact of .8 J on my foot. I walk 10,000 steps a day. 10,000*.8 is 8,000 J. A bullet produces an impact of 168 J when fired from a .22 rifle into a human body. Therefore walking is much more dangerous than a bullet from a rifle.

What you suggest seems plausible, but I can't immediately calculate, for example, DNA repair rate vs. X-ray photon flux and cross-sections. Can you point me to something that confirms incidence or severity of radiation-induced disease depends on flux rather than dose? Tnx.

Sun burns are known to significantly increase cancer risks vs similar exposure over longer periods. Sun burns are rather similar to accuse radiation poisoning suggesting similar issues.

Both dose and flux matter.

Above, there is a link to a report from Harvard Medical School, that claims otherwise.

Maybe they are wrong, but a post on HN is not exactly a credible refutation.

And yet, this Harvard Medical School link (not a report, not peer reviewed, but whatevs) clearly states that one CT scan of 4 to 18 mSV increases cancer risk by 0.7%, which is higher than the increase of 0.5% from 100 mSV exposure over a greater period of time. So, no. The Harvard Medical School link does not refute in any way my point. In fact, it supports my point.

The Sievert unit is based upon the Gray unit of radiation dose, but it also includes a weighting factor for the type of biological tissue that is exposed to radiation. You can also read up on the linear no-threshold model of radiation exposure for more information. In terms of cancer risk, radiation doses on a range from 1 mSv to 100 mSv can definitely be compared, regardless of the duration of the exposure. There is a range of higher doses e.g. above 1 Gy that would cause acute radiation syndrome if received all at once, where different biological effects would predominate.

0.5% absolute points or by 0.5%? Chance of cancer is already really low. Multiplying it by 1.005 doesn't make much of a difference. Adding 0.5% does.

Wouldn't tracking a virus like this be such a necessary situation?

A CT scan is not an appropriate screening test for COVID-19.

Also, that paper will have no clinical impact. Thread: https://twitter.com/drlukeor/status/1233547995192279040?s=21

Follow-up from the American College of Radiology: https://www.acr.org/Advocacy-and-Economics/ACR-Position-Stat...

"CT should not be used to screen for or as a first-line test to diagnose COVID-19"

The latest guidelines published by the Chinese CDC claimed so too, a CT scan is required, and RT-PCR tests have to be applied multiple times before claiming a patient is cured.

Any idea why a chest X-ray cannot be used, as is for TB?

The CDC is targetting routine bedside testing of COVID19 like we have for flu. It will take "months". Surveillance testing is enhanced by this. Recently an attempt to broaden testing ran into issues, now resolved. I expect test numbers to increase sharply. Monitoring those who are most likely vectors makes sense.

https://abcnews.go.com/Politics/cdc-moves-rapidly-expand-cov...

What is the CDC actually doing? Presumably they've deployed a team to Santa Clara to deploy test kits, review hospital admissions and help construct isolation units? Or hopefully soon?

Is there a site tracking the response of CDC and public health departments to this emerging pandemic?

According to this reddit post the CDC won't even test you unless you're so sick that you need hospitalization even if you were in a country with an outbreak AND have flu symptoms:

https://www.reddit.com/r/nyc/comments/fayko1/my_covid19_stor...

So it seems what the CDC is doing is trying to minimize the number of confirmed cases to make things look better.

China: Suppress the disclosure of damaging facts.

USA: Suppress the creation of damaging facts.

USA: Lower interest rates and the corporate tax rates to save the stock market. Pretend coronavirus is fake news.

USA: Promote Alternative Facts

Meanwhile, Hong Kong is able to test dogs (https://www.businessinsider.com/coronavirus-dog-isolated-tes...) and Singapore is able to provide detailed updates to the public (https://www.moh.gov.sg/news-highlights/details/four-more-cas...)

Never attribute to malice that which can be adequately explained by stupidity.

The CDC has seemed relatively dysfunctional in these outbreaks to me before. During Ebola, there were only a few concurrent (maybe just 1) cases of Ebola in the country. At the same time as the CDC was having news conferences and the CDC experts were presumably in meetings, the handful of nurses doing the actual care for one of the only ebola patients in the country were left completely alone by the CDC:

"After days of asking, Pham said, the nurses were given hazmat suits. She said all the decisions to upgrade the protective gear and precautions were made by the nurses “on the fly.”

Sadly, one of the nurses caught Ebola.

http://res.dallasnews.com/interactives/nina-pham/

Except the government learned from the Ebola outbreak, improved its response and setup infrastructure to handle future such scenarios based on their learning. The current administration dismantled that entire infrastructure.

So while it may not have been malice, there is a very straight line to be drawn from the actions of a couple of years ago and the inept handling of the situation today.

Nothing.

The POTUS just said this was a "democratic hoax." After appointing someone to deal with it.

It's beyond politics at this point. Trump can't run the country, and because of his policies, our response is limited and ineffective.

You have a citation for that quotation? Looks fake.

https://www.cnbc.com/2020/02/28/trump-says-the-coronavirus-i...

The quote they use is so decontextualized I had to go find another source to figure out what he actually said. It's pretty clear he's saying the Democrats' criticisms of his administrations response to coronavirus is "the new hoax", not the virus threat itself.

I had to watch the actual rally where he said the words. Article after article uses the decontextualized "the new hoax", or simply "hoax", and most even editorialize that he's claiming there's no threat from the virus.

This sort of thing is what gives Trump credibility when he accuses the media of "fake news".

He's literally saying that the Democrats are politicizing it and that it's a hoax.

The moment that the numbers take a turn for a worse (and they will, because we are not at all prepared for this and are doing nothing to prepare) he'll call them fake, made up and continue down the line of a democratic hoax.

He's doing the exact same thing he did during Hurricane Maria and I would hope that people would learn quickly from the way he's behaved in the past.

Without context your can't tell. He obviously doesn't believe coronavirus is a hoax, so it appears what he said is the Democrats attacks on unpreparedness is "their new hoax". The full comment is:

Now the Democrats are politicizing the coronavirus. They have no clue, they can't even count their votes in Iowa. This is their new hoax

When he says the coronavirus is a hoax, he's explicitly referring to the numbers and the people infected. Because again, he's already done this exact same plan before!

At that point it does not matter if he believes the coronavirus is fake or if he believes that the virus is a complete non-issue because the end result is the same.

When who says? Trump? Because he's never said that coronavirus is a hoax, at least not from what I can find. Certainly not in the decontextualized quote being talked about now.

This is just the typical way that Trump is misquoted. Drop a word here or there, ignore the context, and you have another great headline.

A staffer telling Trump “this is their new ‘hoax’” has a readily understandable meaning which is not even remotely calling Coronavirus itself a hoax.

Pompeo won’t say that the coronavirus is not a hoax.

https://mobile.twitter.com/owillis/status/123341176640054067...

It appears more like he refused to entertain Rep. Ted Lieu's mischaracterization of something that Mick Mulvaney said.

Really? Seems pretty in-character for him.

Sadly legit.

https://thehill.com/homenews/campaign/485245-trump-hits-demo...

"The Democrats are politicizing the coronavirus," he told the crowd in North Charleston.

"One of my people came up to me and said, 'Mr. President they tried to beat you on Russia, Russia, Russia. That didn't work out too well," Trump said. "They tried the impeachment hoax."

"This is their new hoax," he said, apparently referring to Democrats' criticism of the official coronavirus response.

Trump, who opened the rally by declaring the "fake news just doesn't get it," accused the press of being "in hysteria mode" in its coverage of the virus.

The CDC had issues with quality control on the test kits that must be distributed before labs outside of CDC Atlanta can begin doing their own testing.

https://www.cdc.gov/coronavirus/2019-ncov/about/testing.html

The plan was always to expand testing, but you need a working test kit first.

>Six public health labs in the US plan to start monitoring the general population for the new coronavirus this week. The Centers for Disease Control and Prevention (CDC) says that the risk of the virus still remains low for the general population. But activating the disease surveillance network will allow the CDC and other public health officials to find any undetected virus circulating through the country.

https://www.theverge.com/2020/2/24/21147157/coronavirus-lab-...

Edited to add that according to Pro Publica the problem stems from the CDC trying to get a little too fancy.

>The federal agency shunned the World Health Organization test guidelines used by other countries and set out to create a more complicated test of its own that could identify a range of similar viruses.

https://www.propublica.org/article/cdc-coronavirus-covid-19-...

Why can't the CDC make a working test kit? After China, every other country seems to have been able to do it in like 2-3 days after a few cases were discovered.

They can and did. The issues in the US are entirely bureaucratic in nature.

Apparently the CDC has screwed up the “test kit” in numerous ways.

First, they made it needlessly complicated by trying to make it test for other SARS-like viruses, and those tests were flagging a large number of false positives.

Secondly, labs that are developing their own tests to mirror the CDC are being prohibited from using them due to onerous and absurd requirements like demonstrating their test wouldn’t falsely identify MERS as COVID-19, when MERS samples are nearly impossible to obtain.

https://www.propublica.org/article/cdc-coronavirus-covid-19-...

South Korea tested on the order of 10,000 people today alone and found roughly 300 positive cases. The USA has managed to test around 500 in the past two months.

I'm extremely concerned this isn't being treated with an appropriate level of hair on fire urgency. They said 2 weeks ago they were going to start expanded testing in 5 cities and they are still developing a testing procedure?

> I'm extremely concerned this isn't being treated with an appropriate level of hair on fire urgency.

Or, the actions are to be given more weight that the words. That is, perhaps the response is actually appreciate.

Let's recap: The CDC has made a couple statements. The POTUS has down played things. On the other hand, the mainstream media has pinned the sensationalism meter.

Fact: It's been a fairly active "traditional" flu season. Plenty have gotten sick. Plenty have died. Coverage? Zero. Comparison between the flu and this corona virus? Again, zero.

There's disconnected and mixed messages, and plenty of misinformation. I'm not dismissing the threat. Just the same the signal to noise ratio is ridiculous.

Full disclosure: I carry a lot of contempt for the mainstream media. My level of trust, close to zero. The coverge of this issue does more to deepen my mistrust more than gain it. Based on discussions I've had with peers, I'm not alone.

Your contempt leads you to falsehoods and further confusion. Put it away before it gets you hurt.

There is no comparison between flu and Corona. Deaths of non-immune compromised flu sufferers in the US are tiny (1 in my state, NYS, this whole season).

Corona appears to be at least 100 times as deadly as the flu for non-immune compromised, probably more, and there are so many unknowns (eg repeat sufferers).

There is no universe in which "POTUS has down played things" is anywhere near a rational distillation of the behavior of this administration.

Take the glasses off. Put away the contempt. Use your brain. Don't be a fool.

Outside of China...number of deaths?

One death for the common flu in all of NY this season? Nah. Not credible. NYC alone has more than one.

https://weather.com/health/cold-flu/news/2020-01-28-flu-more...

Is there a concern about corona? Possibly. Does the data and the media's depiction currently support the frenzy? No.

Fool? That funny because your data is wrong. I'm questioning you, you have no answers, and I'm the fool? That's not how it works here.

> The plan was always to expand testing, but you need a working test kit first.

I'd like to call out the fact that the impediments to testing in the US were and are entirely bureaucratic in nature.

The CDC publicly published a real-time RT-PCR protocol (including primer and probe sequences) at the end of January. Since that time, it has been entirely possible (from a technical standpoint) for any properly equipped lab to perform tests.

By properly equipped, I mean BSL-2 with a real-time RT-PCR machine - this in not at all an uncommon setup. Other types of PCR machines would require making appropriate modifications to the protocol, but any lab that already does such work will posses the required expertise (seriously, this stuff is _trivial_ by academic standards).

Entirely separate from technical ability to perform an assay is legal status with regard to testing human samples for diagnostic purposes. To that end, the FDA failed to approve any vendor-specific test kits in a timely manner. This is frankly ludicrous under the circumstances, as South Korea managed to approve and make available at least two different test kits in the same time frame - they even have drive-thru testing stations set up!

Oh there is. These two cases have no known contacts.

Isnt this a good thing? Isnt the fact that 8% of the bay area is not dying an indication the diamond princess cmr is more accurate than iran or wuhan, which is to say this is a normal seasonal virus?

In my non-epidemiologist view, yes, it's a good thing.

The denominator for the ~1% mortality rate is obviously bigger than we realize -- which means the mortality rate is potentially a lot lower.

There are cases like this one popping up, where people are asymptomatic (and even test negative) and are not getting sick, despite being infected:

https://www.theguardian.com/world/2020/feb/22/coronavirus-as...

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