[1] https://news.sky.com/story/coronavirus-south-korea-uses-driv...
[2] https://www.nytimes.com/2020/03/07/us/coronavirus-nursing-ho...
The original CDC batch became tainted but were more accurate...unfortunately the CDC version was also giving false positives and didn't meet QC. To make matters worse CDC rules required very stringent guidelines for approval from third parties and states. Most of that has been lifted (I think this is what Trump was referring to when he said he was lifting something from the Obama admin, though I don't think it started with him. But who knows because Trump is often full of bluster.)
Here are a few articles about it.
https://www.livescience.com/coronavirus-testing-kits-flawed....
https://www.bbc.com/news/health-51491763
https://www.propublica.org/article/cdc-coronavirus-covid-19-...
I wish people would stop pointing to South Korea and China as the paradigm of how this should be treated. It's entirely possible that the "drive thru" model with relatively inaccurate kits could make things worse. There isn't much point in producing millions of tests if they are no more accurate than a coin flip and can take up to 8 times to properly diagnose someone. Not to say the US hasn't bungled this and wasted some precious time.
The one thing, I'm pretty confused about at this point is how this has spread so quickly in Italy.
The infection is at the lung while the swabs are done to the upper respiratory tract. There will be misses no matter how good the kits are.
I can't see any easy way to get that info from your description. Can you give an actual link?
That is the thing. This discussion started around whether the CDC should have created their test and the claim was the CDC's actions were a response to the inaccuracy of the WHO test. But part of the accuracy of any test is whether the virus in a location at all - if the virus is, say, only in a person's lungs, any test will have trouble using blood or spit.
The infection is at the lung while the swabs are done to the upper respiratory tract.
I’m not aware of evidence that the CDC designed primers are any better, and have read anecdotal evidence that they fail basic QA tests in open source design software used for this sort of thing.
This was compounded by bad regulations which hamstrung local labs from doing their own testing.
I don't think the German test was any more inaccurate BTW.
The "livescience" link is a confusing story which seems to be talking about the US, CDC test: Last week, the CDC had begun to ship about 200 testing kits to labs across the U.S. and 200 more to over 30 other countries so that more facilities could conduct testing for the new coronavirus.... The CDC is working closely with the states to correct the issues in the testing kits, Messonnier said.
The BBC link is about the WHO test, says no one knows what is going on but gives multiple possible explanations:
One possible explanation is the tests are accurate and the patients do not have coronavirus at the time of testing
Alternatively, there could be a problem with the way the tests are being conducted... There has also been some discussion about whether doctors testing the back of the throat are looking in the wrong place.
A final option is the RT-PCR test for the new coronavirus is based on flawed science.... if there is a poor match between the primer and the virus in the patient, then an infected patient could get a negative result.
Use > or " or *
> One possible explanation is the tests are accurate and the patients do not have coronavirus at the time of testing
> Alternatively, there could be a problem with the way the tests are being conducted... There has also been some discussion about whether doctors testing the back of the throat are looking in the wrong place.
> A final option is the RT-PCR test for the new coronavirus is based on flawed science.... if there is a poor match between the primer and the virus in the patient, then an infected patient could get a negative result.
2) Some article point to the main vector in Italy being patient left in a hospital for 36 hour before being diagnosed and treated. This allowed the disease to spread in the community where testing was not being done - kind of like the US.
3) The Chinese test may indeed might have had problems at various points (your first link is rather anecdotal, hardly proves the test was a "coin flip". Other posters note your links don't back your arguments). The American test had even more problems and still hasn't ramped up to strong production. Making tests is hard, it seems. The CDC's "your test has problems and we know we can do better" attitude looks misguided in retrospect.
4) It seems like you're doing a bunch of speculation with little evidence. I suggest you look at infection and mortality as a basis for thinking about what country is doing well or badly. [1]
That's misleading. Korea has the highest active case ratio of any of the hardest hit countries. The flip side of the lowest CFR coin is that Korea also has by far the lowest recovery rate of any of those countries.
You need to wait for the active cases to turn into deaths or recoveries.
From JHU CSSE:
South Korea
Confirmed: 7,382
Deaths: 50
Recovered: 118
Existing: 7,214
If you're just looking at recovery rate (also misleading), Iran seems much better than Korea:
Iran
Confirmed: 6,566
Deaths: 194
Recovered: 2,134
Existing: 4,238
In all other measure, South Korea is doing well. Avoiding death is much unambiguous a measure.
Edit: Yes, because Korea has experienced an exponential increase in cases, most cases in Korea are "new" but this is true for most other countries - though countries where they only find cases by people dying might be different but not in a good way.
Edit2: Also, it is true that Korea's lower mortality is likely partly a product of Korea's widely testing and finding asymptomatic carriers. But this is also a good thing since it allows Korea to get these people to quarantine and lower the transmission rate, hence the declining rate of infection there.
Confirmed cases: heavily dependent on tested people. 1500 in US vs 100k in S. Korea makes the comparison useless. Also, who is tested? In Italy they started testing only symptomatic people after a while. China has changed the parameters a few times in these last weeks.
Deaths: are all deceased people tested?
Recoveries: what constitutes as a recovery? Highly variable on a per country basis.
I wonder if WHO has published some standards.
That is the whole point of my comment. There are many countries that would appear to be even better than Korea by your naive interpretation of CFR. Germany, India, Russia, Brazil, Iceland, Mexico, and many other countries have 0% CFR. That just means that like in Korea, the infected haven't had time enough to die.
Once again, "You need to wait for the active cases to turn into deaths or recoveries."
Sure, countries that don't enough cases shouldn't be compared but countries with an equivalent growth pattern make sense to compare. At the same time, we can look at the total outside China fetal rate and that's about 2%, which again Korea is doing notably better than. All of this is in context of most infection being new, all of it.
Sure, CFR may not be the final rate one sees but that doesn't mean it doesn't give significant information about what's happening.
The point I've been arguing is that the Korean strategy involves finding asymptomatic cases and preventing these becoming more symptomatic cases by quarantining them, getting those exposed tested and so-forth.
One possibility is this means more of those they find are not seriously ill and won't become seriously ill and this reduces the overall CFR, which can be seen in a comparison to other nations with equivalent numbers of infections. This makes sense to me but can indeed only be verified once this whole horrible scenario plays out.
No. The average time to die after infection is 28 days. Korea has been testing aggressively, and 28 days ago had fewer than 50 cases, despite finding cases earlier in their development. These other countries found cases who were already infected longer. That's why they have more deaths but also why they have more recoveries. You cannot gauge effectiveness of treatment until you've given the treated time to recover or die.
> This makes sense to me but can indeed only be verified once this whole horrible scenario plays out.
This can be verified today by the lower number of recoveries.
Yeah, and as I already noted, this situation MEANS that these other countries are failing to control the infection because they are finding infections late, which is going to mean more deaths later.
> You cannot gauge effectiveness of treatment until you've given the treated time to recover or die.
Sure, I shouldn't imply Korea does just better treatment rather than that the treatment/test combination regime of Korea seems like the superior model relative to other countries and I think have mostly said that. We can see notably that the infection rate in Korea has dropped off markedly in the last few days.
I never disputed that.
> Sure, I shouldn't imply Korea does just better treatment
You didn't imply that. You stated explicitly that Korea does better treatment when that statement is based on a gross misunderstanding of CFR data and said you were going to spread that misinformation. ("I darn well intent [sic] to keep pointing to this.") That's the only thing that I took issue with.
> We can see notably that the infection rate in Korea has dropped off markedly in the last few days.
That has nothing to do with fatality rate.
"China and Korea have effectively dealt with the virus, infections in both those areas have been declining. And Korea now is effectively the lowest fatality rate for any of the effected countries which points to excellent surveillance and adequate treatment."
Instead of: "China and Korea have effectively treated the virus, infections in both those areas have been declining. And Korea now is effectively the lowest fatality rate for any of the effected countries which points to excellent surveillance and treatment."
But this isn't big change. Moreover, I think Korean model - ie, lots of testing - looks good in total and I think I've made clear that's what I advocate.
I would note in China's case, with infections declining everywhere, the fatality rate outside Hubei is fairly low also.
No, it doesn't. All it points to is that the cases are still active and have not had a chance to die. You cannot draw any other conclusions from that fatality data.
> I would note in China's case, with infections declining everywhere, the fatality rate outside Hubei is fairly low also.
For exactly the same reason. These infections are newer and have not had a chance to die. With each update, the CFR outside Hubei has increased, as expected.
> I think Korean model - ie, lots of testing - looks good in total
I agree that more testing is better. Why do you keep bringing this up? It has nothing to do with the fatality rate.
TL; DR; Without sufficient testing, hospitals get overwhelmed and death rate skyrockets. Is this "irrelevant".
...
My Gawd, you are the one who launched the massive detour on fatality rates. The topic of my first comment and topic of the OP was test, now like three days ago. You chimed in several posts down with the argument about immediate death rates not being final death, which I indeed didn't make my clear enough but which wasn't crucial to my point, which was and is about testing and related, about the Korean model being other countries should look to. I guess should say that Korean being at least adequate comes from my reading of press reports on Korea and not just statistical values but gruesomely technical do we want to get.
The thing is, I said from the start and I've clarified above, the fatality rate is an important proxy for how well a given country or area is doing as a combination of treatment and testing (but mostly testing). The infection rate is exponential everywhere the infection is not aggressively controlled so a high mortality rate means the country finding infection only having dying people walk in the doors of hospitals.
In that time, we've seen Italy, with a higher mortality rate spike in infections and mortality, now with 10x the death toll of Korea. And yes, as expected, the mortality rate in Korea is inching up but the infect rate is now steadily declining and it seems clear the total deaths there are going to be much less than Italy.
Yes, TESTING is my primary interest and advocating the Korean model related to that. The thing is that a look at the situation in Korea shows that the whole of society has mobilized, testing and treatment has been reorganized for the particular problems COVID presents - there are regular hospitals and COVID hospitals (or some equivalent).
It is irrelevant to the narrow question of whether the data show that Korea has reduced the fatality rate, which is the point being argued. Deaths from heart disease are irrelevant to the same discussion.
> My Gawd, you are the one who launched the massive detour on fatality rates.
It is not a detour. It is the single point being argued. You made an erroneous claim together with a statement that you intend to repeat it. I corrected that claim to prevent you from repeating it. When discussing that correction, it doesn't matter if you also made correct claims like that 2+2=4.
Staying alone for 14 days in self imposed quarantine is a potential death sentence anyway for many in our JIT hand-to-mouth sectors of society.
https://www.washingtonpost.com/news/to-your-health/wp/2018/0...
No pandemic: What the hell do we pay you for.
Pandemic: What the hell do we pay you for.
He absolutely did dump everyone in the pandemic command chain in NSC/DHS, and then not replace them. https://www.snopes.com/fact-check/trump-fire-pandemic-team/
When recently asked about this and his proposals to defund the CDC by the press, he said in response “I’m a businessperson. I don’t like having thousands of people around when you don’t need them. When we need them, we can get them back very quickly.”
Could the CDC intentionally be avoiding increasing testing to avoid panic? If the numbers are to be believed, no matter what we'll see a sizable number of infected this year and risk losing many of the elderly.
This is the only logical explanation at this point. Or you can replace "avoid panic" with "avoid bad press for Trump".
Hanlon's razor: "Never attribute to malice that which is adequately explained by stupidity."
Also recall that incompetence in the CDC likely stems from politically-motivated firings and funding cuts in 2018.
I don't think you're wrong about the firings though.
Same is happening in South Korea, Italy, and other places.
There is a ton of research suggesting it's possible to reduce your risk of death by like 99%. There was metastudy on the front page of HN a couple days ago suggesting that vitamin D3 alone can reduce your risk of death by like 50% for those who are otherwise deficient.
The most recent Cochrane review on Vitamin C suggests that that alone can reduce your risk of death from pneumonia by like 80%.
Those aren't even the only things you can do before getting the virus. And once you get the virus there are like 6 different steps by which it kills you, and there are various things you can take to ameliorate what is happening at each step.
Viruses can replicate up to once a minute, so if you've already been letting it replicate inside you for a couple weeks before taking something to block viral replication then taking something to do that isn't going to do anything after the fact, but it's absolutely a misconception to say that there's nothing we can do for fighting viruses.
Not necessarily. You only get accurate numbers for deaths if you test deaths. Some countries reporting zero cases may have had deaths that will never be reported. The US likely has also had unreported deaths.
NPR had a story about genomics lab that repurposed some of it research equipment to provide some testing resources. Apparently about 70 other labs, including Gate's, did similar and provide backup resources. But a month delay seriously damaged the US response.
> But German researchers were devising their own test, which was quickly adopted by the World Health Organization for distribution around the world.
After the C.D.C.’s version turned out to be flawed, the agency continued to pursue it, despite the fact that another diagnostic test was already in wide use.
With F.D.A. approval, the agency could simply have embraced the test used by the W.H.O., Dr. Mina said. The government could do so even now.
“It’s just a very American approach to say, ‘We’re the U.S., the major U.S. public health lab, and we’re going to not follow the leader,’” Dr. Mina said.
https://www.nytimes.com/2020/03/02/health/coronavirus-testin...