Hacker News Reader

I think there is a more reasonable explanation why they are not testing you. Simply because they wouldn’t do anything with that information anyway. If the test is positive they’ll send you home to quarantine telling you to call back if your fever worsens. If the test would show negative, they’d tell you, guess what; “please call back if your fever worsens, and stay in quarantine anyway”.

So the information doesn’t really matter.

In Sweden once they change tactics from trying to track each and every case, and who they might have gotten it from etc, to a a strategy more about just accepting that it’s spreading and trying to limit the spread in general, and protect the weak. Then they also stopped doing testing here.

Unless you are in a risk group, the test doesn’t really make a difference.

> So the information doesn’t really matter.

It would matter to me. If I know I have it, I would stay at home and have somebody else do shopping and leave stuff in front of the door. If I dont know that, I do shopping by myself.

Having it or not is also difference between whether one can join one of those programs where young people shop for elderly and leave stuff in front of the door. Of course the caution must be taken with everyone, but also those with confirmed case are out.

It makes difference for people who still have to go to work.

Even official expectations on people with corronavirus are different then on others.

I tend to agree with you, I would like to know as well. But consider this: if it is cold or flu - would you want to risk your health being more prone to the infection while your immune system fights another virus, or bringing more people into the same situation in circumstances like these?

If it is cold of flu, when it passed, it passed. 7 days and you are fine. Corona is can get better and become worst and take weeks. So it is still a difference.

Is it a fact that corona in general takes long to get better from? Thats not what Ive heard/read. Unless you are unlucky and get pneumonia.

I'm always wary of any strategy that is fine with having less information. Of course cost of information is never zero but in this case the actual cost of tests is relatively low.

The cost as in “COGS + markup” may be low but the opportunity cost (cost of not doing a test when it is more important) might be higher when the supply of tests and lab time is limited. While it is absolutely important to ramp up both, it is a different story.

^^^^^^^

This, right here. The entire world is struggling to get enough testing supplies. Testing somebody who's experiencing mild symptoms takes away from testing cases that are much more important - because part of what is happening right now is that everybody with a light fever is all "I GOT THE COVIDS" and wants a test.

Fact of the matter: We don't have enough tests, worldwide. We can't produce them fast enough. We need to triage.

Yes, but it is also true that the number of available tests is increasing rapidly, and also is partly in response to government demand.

If the the available number increased to the level where everyone with symptoms could be tested, would you favor doing so? and do you think that governments should push til enough tests are available to do that?

Late reply, but yes to the former, with the caveat that it's contingent on sensitivity and specificity. (I.e. false negatives/positives)

Probably yes to the latter, unless it takes away resources we need more urgently elsewhere.

But really, what we need to do is depress the count of infected people to a point where it's even feasible to test everybody with symptoms.

Even if we rolled out testing to a point where we can test 1M/day (I think it's 200K/day right now?), it'd take a year to test all of the US. If we're in flu-prevalence territory, that's only 19M, and so suddenly much more doable.

And at that level, we need the ability to both test anybody with symptoms and to conduct random samplings of asymptomatic people, because without that, we couldn't lift shelter-in-place until we have a vaccine. That's... a tad long.

So, more tests, plus suppression doing its job. And it'd be lovely if our government would push to get anything done, really. They've wasted 8 weeks by now, at least. Coordinated response is allowed to kick in any day, by my book.

Cost isn’t zero though. Have a lot of people with mild symptoms come in puts strain on health care, and increases the risk that important health care workers get the affliction.

If the test could be done yourself, at home, then I would agree with you.

If you know how much the general spread is, and how often it requires different sorts of treatment (or is asymptomatic), you can plan your mitigations and restrictions much more effectively.

You don't need to know, the immediate doctor telling you to wait and see at home doesn't need to know, but the government absolutely needs to know.

> Unless you are in a risk group, the test doesn’t really make a difference.

If the test is positive, you can self-quarantine and notify everyone you've been in contact with that they need testing. Then any one of those people that tests positive can do the same thing, etc. etc.

If you don't do any testing, you end up with a bunch of positive but asymptomatic carriers wandering around unknowingly infecting other people.

South Korea is taking this approach and they seem to be doing a lot better than most other countries.

Indeed and it probably makes much of the difference why active cases in Korea have kind of leveled off while in Europe they are growing about 25%/day. And just a reminder that's 800x a month.

Is it possible for the number of cases counted to go up simply because more testing is occurring, while the number of people with the virus has leveled off?

Jup, but they are already at their test capacity so they already need to priorize who is beeing tested.

So unless you have the lab infrastructure in place already (I don't know how it is in Japan), you can't really invent it out of thin air in the midst of a crisis.

The truth is that neoliberal ideology all around the globe did its best to make hospitals and health systems "more economic" by cutting (at the time) unneeded capacities, without any real concern about the resillience of the system as a whole. This is (aside from timing and culture) where you see the main difference between nations today. This is e.g. why Spain decided the privatization of their hospitals was a grave mistake.

Thank you!

There is a HUGE cost to "shelter-in-place". People's businesses and jobs depend on customers going out and using their services, and without customers, they won't have jobs, business will fail, and people will get hurt, and die. (Hopefully fewer now that Trump's doing a bail out.)

Shelter-in-place may be the right thing to do, now that that containment has failed, because people will get hurt and die otherwise, but containment wasn't doomed to failure from the start. It's wrong to frame it that way. It's like running for the bus. You don't have to run as fast as a bus can possibly, you only have to run fast enough to catch it before it leaves the bus stop.

Containment isn't supposed to last forever, it lasts as long as it lasts. It absolutely required far more aggressive action to be successful, and one of those was testing. Which we dropped the ball on.

You should not be giving medical advice. 3% of people with no fever who test positive end up needing ITU admission. Deterioration can be sudden after the first week.

You’re right. I’ll edit it. Edit: I cannot edit it:(

Did you even read the article? The article points out that identifying those infected and isolating them from those who are not reduces infection and also increases the number of those that get better.

The results of the individual test might have limited use to the individual.

But the idea that the information won't be used is nonsense. It's invaluable for the overall response. We have only the vaguest of ideas how many people (in the U.S.) are infected. The more information we have about cases with few or no symptoms, the more we can understand the spread and take appropriate measures (that will also be more obviously justified, countering people who claim overreaction).

More accurate information about symptoms would also help individual people:

- help them understand that they can feel fine and still be getting other people sick

- help them have an accurate picture of contracting the disease, instead of leaving it to nightmares

There's no universe where having more information about the situation would not be better.

In my experience, government/businesses/schools have been slow to close without confirmed test results. If you don't get the tests, no one is going to pull the trigger on quarantining. That is frustrating to me.

Isn't it the case that most countries in the world don't have enough tests, it seems only South Korea does. I live in Switzerland and they are also restricting tests to higher risk groups, and people with worse conditions (which is a bit grim, how dead do I need to be before I can get a test?)

Either it's due to Olympics, or just logistics. Will the Olympics even happen if Japan is declared "OK" but many guest nations still have sick people?

I would guess their criteria for testing is people who could develop into a critical situation quickly because the tests are not 100 percent reliable and they are slow.

They were talking about having a televised only Olympics which might work if there were enough countries with athletes willing to fly to Japan.

It's not really about how bad your symptoms get before you can get tested. It's about WHERE you are.

Coronavirus is a virus after all, just like the flu, there is no medication. You can only treat the symptoms, but not the virus itself (as opposed to a bacterial infection where you can attack the bacteria with antibiotics).

So with these undeniable facts it's fairly simple, if your symptoms are so mild that you can cure it out at home without special medical equipment like a ventilator, then you don't need testing. You just have to self isolate yourself for two weeks, get over it and afterwards you are fine and not contagious, so no way of further transmission and therefore no need to test.

If however you develop severe symptopms and need hospitalisation, then they have to test you so they know if they need to isolate you in hospital away from other patiens and protect staff or if you can get a bed amongst everyone else. That is really the only reason.

Your treatment in or outside hospital does not change at all whether you have breathing difficulties because of COVID-19 or any other influenza.

So that is it.

Don't know why this is downvoted. Doctors can't treat the virus but only the symptoms, even for the flu.

From a public health perspective, if you have any symptoms, be it covid-19 or flu, just isolate yourself for the health of others.

It's downvoted because it's dangerous and uninformed medical advice.

You can treat flu (influenza) with osetalmivir. People with mild symptoms can still be at risk, further testing is needed [1]

Please just phone your emergency line if you suspect you may have it.

[1]https://news.ycombinator.com/item?id=22610265

Would not the influenza vaccine be better than using osetalmivir?

These serve different purposes.

If you are already infected, a vaccine is not useful.

But regardless, there is no approved treatment for COVID.

Gilead's new antiviral looks promising, and the Chloroquine/Azithromycin combo looks promising, too, but the first isn't approved for any use yet, and the second is an uncertain off-label use, so in either case, you aren't going to get those treatments unless the alternative is likely death, if you can get them them at all.

If you know you have the covid virus, then you know you have a disease that is far more dangerous than the standard flu, and so you need to take much more stringent measures to prevent others from being infected. You also need to have to health dept trace out all the people you may have infected already.

Capacity of testing is a major issue, and as cases increase, turn around goes down. Tests have to be used where they will be useful and influence management.

The symptoms you describe are very similar to those articulated by these two CoV patients who were aboard the Diamond Princess cruise ship which docked in Japan.

Here is their vlog on youtube. https://www.youtube.com/watch?v=H2E1t3yMXgE

The husband describes his experience with temperature and thermometers in the first 5 minutes. The similarity to your symptoms begins at ~ 5:00.

This whole video is worth an investment of 38 minutes. 5M+ views.

I would assume its because the number of people with similar symptoms far exceeds the capacity to test for covid-19. If the numbers in this article[1] are accurate there were around 2.23 million people who went to the doctor for flu related symptoms from January 21 to 27, 2019.

1. https://www.nippon.com/en/japan-data/h00386/japan-gripped-by...

Are you having issues with your smell/taste? A german virologist talked to symptomatic patients and found that most patients were stating that they lost smell/taste for days.

"Almost all infected people we interviewed, and this applies to a good two thirds, described a loss of smell and taste lasting several days."

https://www.faz.net/aktuell/gesellschaft/gesundheit/coronavi...

I have a terrible sense of smell to begin with. I always wonder what people with good senses of smell experience on a daily basis.

But I can generally taste things, so this is good to know.

Loss of taste is caused by loss of smell, is my understanding. That is consistent with the colds that cause significant nasal congestion causing a loss of the ability to smell and therefore taste as well.

I have read that a few of the "common cold" infections are also caused by different species of "corona virus" so this is perhaps not too surprising.

Sounds like the government is correctly rationing tests.

My sense is that the vast majority of the healthy population shouldn't get tested even if they might have the virus because the infrastructure doesn't support widespread testing (anywhere -- as far as I know). They should act as if they have the virus and stay home, rest, drink a lot of water, and take NSAIDs if the pain gets out of hand.

I've been sick since last week (much improved yesterday and today) and it could definitely be covid-19. But there's no point in trying to get tested. If I felt the symptoms were serious (significant difficulty breathing) then I'd go to an ER or call 911.

Also, 37.5 is a fairly low fever.

Note, France is warning against NSAIDs specifically for COVID-19.

https://www.theguardian.com/world/2020/mar/14/anti-inflammat...

In the Guardian article in the parent comment, the warning says that any anti-inflammatory drug may be a risk, not just NSAIDs. They include cortisone as an example of a drug to avoid, which is a non-NSAID anti-inflammatory.

Wouldn't that just leave steroids, which is generally never good idea to give when you have an infection as far as I know.

I think it's generally the case that taking pain killers isn't a fantastic idea when you have an infection. Of course, for mild infections there's little consequence, but in this case it might be best to avoid them. Just wrap up warm and stay hydrated.

current advice is: DON'T take NSAIDs (e.g. ibuprofen), which may cause complications due to interaction with immune system.

do take paracetamol

aka Tylenol (acetaminophen) in the USA. Consult your doctor. Not sure what this means for children, but this directive against NSAIDs is a really important development in treatment protocols for COVID-19.

Tylenol / acetaminophen is not an NSAID.

Grandparent was saying that paracetamol is a synonym for Tylenlol/acetaminophen

Paracetamol is the same compound as Acetaminophen, and is sold under the Tylenol brand in the US.

This is incorrect. Paracetamol, Tylenol etc are brand names for acetaminophen which is not NSAID. Ibuprofen, Naproxen, Aspirin are NSAIDs.

https://en.wikipedia.org/wiki/Nonsteroidal_anti-inflammatory...

I suspect the reason for fewer tests is, as many have pointed out, because of a lack of tests rather than overt political malfeasance. Note: Yesterday they performed 3.4k tests,[0] which is aprox 30% of the total tests to date in a single day. Tests are ramping up as supplies come online.

[0] https://covid19japan.com/

The government says they can perform around 7,500 test a day. However, the total number of tests are much lower than that. Please see the data below. https://toyokeizai.net/sp/visual/tko/covid19/en.html

3/17 is kind of an outlier, because there were too many tests for those who were in close contact with suspected carriers.

What would you change if you take the test and come positive?

Gut instinct:

- More likely to strictly adhere to the lockdown - Post recovery / quarantine period, if (big IF) you now have immunity and aren’t risking infecting others anymore, you could be more productive in the world.

- Helping others with their food/supplies/whatever. Heck, even spending more money on take out food which helps the economy.

The idea of building up a herd immunity seems to me to require knowing who has the immunity so we know when we have enough.

Get a blood test. If CRP raised and lymphopenic, likelihood of ARDS requiring ITU admission is higher. This can happen very quickly after the first week, so I'd put pressure on the doctor to keep me hospitalized.

> but I still have chest tightness and consistent coughing

Could be hayfever. 花粉症の時期が始まったからね。

If you're really desperate for a test go to the hospital and say you feel breathless. Dyspnoea is a subjective symptom but no doctor worth it's salt would just ignore it without investigating further.