A Third Solution
paulbuchheit.blogspot.com
paulbuchheit.blogspot.com
I guess it's a YC17 company. The founders are Caroline Landau, Tim Cornell, Walker McHugh. From 2016: Landau was an MBA candidate, the other two founders have biomedical research/medical backgrounds: Walker McHugh, Co-Founder, PreDxion Bio / Biomedical engineering candidate, University of Michigan Dr. Tim Cornell, Co-Founder, PreDxion Bio / Pediatric Critical Care Physician, University of Michigan (https://www.hbs.edu/openforum/openforum.hbs.org/goto/challen...)
At least until recently, the company focused on making diagnostics for immune disorders (microkine) for CAR-T patients which I can't find much detail on. I don't know if it's related to the SPR-based tests mentioned in the pb post.
They received a government business grant (SBIR) in 2018 and have some VC funding.
It looks like this post demonstrates their pivot to a specific infectious disease, and from a hospital provider setting to a public setting.
As an ex-advisor to a successful (in bio) VC fund, this is not something I would really spend a lot of time considering. There are too many non-technical hurdles that would need to be jumped before this was widespread, popular, effective, and profitable.
In particular, this method appears to be antibody based? (Which has accuracy issues) and uses SPR, which may involve some technical risk.
However, I think there’s mileage in developing methods now for the next pandemic. My personal interest is in developing programmable qPCR-like systems [1]. So that kits can be deployed ahead of time, and then programmed to a specific target as required. If anyone is interested in discussing diagnostic approaches, please get in touch.
[1] http://41j.com/blog/2020/03/thoughts-on-a-new-approach-to-vi...
Are you familiar with the work of Dr. Chui at UCSF? His group has done some really cool work using mNGS to detect/diagnose emerging/rare infections in critically-ill patients with refractory encephalopathy
I’ve worked at a number of NGS platform companies developing new sequencing approaches. The problem is that sequencing is still expensive at the per-run level. It’s possible to be cost competitive with qPCR if you multiplex samples. But this isn’t ideal.
It would be interesting to create a small/cheap sequencer which could be applied to point-of-care/at-home testing. However, most of the money has gone after attacking the market leader (Illumina) on a cost-per-base, rather than cost-per-run.
A 1USD per-run sequencer would be interesting. But I’ve not seen anything that will hit that target in development. If anyone reading this is developing such a system, let me know, I’d love to get involved.
The idea of a programmable qPCR system is to add some of the versatility of sequencing to qPCR.
You can get to $1/sample; but need >1000 samples/run at least to get to that cost level. Could run 10k/day without automation; likely a lot more (100k-1MM) with automation.
The technical implementation of a viral detection assay is much simiplier to implement than our quantitative, multiplexed small MW biomarker sensors... But there are certainly many other hurdles that remain as you point out as well as the additional biological uncertainty that remind around SARS-CoV-2 it's infectious course as well as our bodies subsequent immune responses.
There are certainly many hurdles left to be tackled but that's exactly what we're working towards.
And i am wishing them success, and my brother is the director of the VA for the entire state of Alaska, an Airforce Colonel (commander, tenth medical wing) and ive personally built/designed/commissioned 10+ hospitals (el camino, sf general, sequoia, nome, and more)
((All on the tech implementation and design side))
Anything i could contribute i would.
(My creds can be freely confirmed)
I would love to hear about your advisor role experiences with VC funds. Would you be up for a short chat/call? My email can be found in my profile.
Background: Chemistry/Startups, looking what to do next with my life.
Cheers!
“It’s easy to fall into dystopian visions of the future — a world shut down by one virus after another”
“It doesn’t have to be that way. ..... Ubiquitous screening is the key.”
The approach is interesting and the possibility of eliminating large scale spread of covid, flu and others is attractive.
However the idea of requiring a saliva swab from every visitor to an office or event has the potential to create an equally terrifying dystopian future where those samples are used to collect and use other data (DNA for example).
How long before screening companies offers to provide free screening and access control systems in return for anonymised data?
This kind of solution needs to have very well thought out privacy rules supported by strong and enforceable legislation to protect the individuals rights.
One way something like this is likely to be implemented is by validating a ticket or access card/token with a saliva swab. This is just too easy and attractive an opportunity for data collection to be passed up by some operators with business models that monetise the data as a revenue source.
Sure, some people could fake the test, but for this approach to work, all that matters is that most people don't fake it.
https://i.pinimg.com/736x/ac/aa/b0/acaab01e6647159309f680844...
That's a giant social space people would be clamoring to go to. But given Disneyland's mystique and raison d'etre, the logistics right now are impossible.
I don't know how viable the solution proposed here actually is. The skeptics here raise some good points.
But if this solution turned out to be proven, I expect Disneyland would be one of the first places where it was deployed at scale. If we trusted the technology, I'm pretty sure both you and I would be happy to wait 10 minutes to get in. A free COVID screen as part of your price of admission. (It's interesting to consider how they would handle people who failed the screening. A balloon and hauled away in a cheerful corporate van? Maybe Disney starts running COVID resort sanitoriums?)
I also imagine Disney is one of the few organizations out there that could get the queuing sorted out. And I suspect that would be as important as anything. Once perfected, it could serve as a model for others.
For this purpose the screening would probably have to be carried out at locations that could confirm the sample came from the right person at the right time.
Googling for "romer covid 19" should turn up a lot of news sources covering the notion of testing millions of people a day.
IIRC, mainstream objections tend to come from concerns of false positives, since that becomes a bigger problem with this frequent level of testing and could prove a huge disruption if you end up with too many quarantine still, or so many that testing positive becomes essentially meaningless in terms of telling you whether you have the disease or not if you test positive.
https://www.politico.com/interactives/2020/coronavirus-testi...
That's because we currently aren't capable of testing everyone who is obviously sick just once. If we got there, we wouldn't even be close to being capable of testing key personnel (like health care workers). If we got there we wouldn't even be close to being able to test everyone once. If we got there we wouldn't even be close to being able to test everyone every day.
You haven't heard any advocating for OR against it because it is so far from achievable that it isn't worth considering.
The linked article suggests a novel and much cheaper test, which would be great. But even if that didn't work out, what scale could possibly be feasible with existing tests? Pre-shortage, an RT-PCR seemed to be much cheaper than a missed day of work.
Testing a few hundred people daily would be doable, as Germany has relatively good testing capacity - probably one main reason for the overall better handling of the pandemic so far. But the concept still gets critisized, as this would mean a fast track to testing for the players while parts of the population don't have equal access to testing.
For the whole population, it would be a good first step to be test really everyone who has any assumptions of symptoms and some time later, everyone in contact. And perhaps a biweekly test for the general population.
That seems like the logical conclusion of "more testing" to me. If we could, why wouldn't we?
3blue1brown on YouTube did an analysis which similarly shows that fast quarantining is the best way to mitigate the virus: https://www.youtube.com/watch?v=gxAaO2rsdIs
How does your device detect viruses? Is it based on a protein or the RNA or what?
Johnson and Johnson have already started scaling their vaccine and plan to have 1 billion doses available by January 2021. If their vaccine is approved, it will be an instant solution and better than testing everyone every day.
Moderna has also started the process of scaling their solution as well but J&J have a head start and a known platform.
Why not? Scaling a test is a completely separate exercise to scaling a vaccine, and it has the advantage that multiple proven working tests exit now, they just need to be scaled. Both can be done, by different people.
You might also find that having a vaccine and a test is better than having just a vaccine.
> If their vaccine is approved
Multiple vaccines are in development. This is not a situation where we should stop doing X now because Y _might_ happen in 8 months or more time. None of the vaccines are guaranteed to be ready and working and scaled at any given date. None of them.
That's demonstrably false. There are numerous prominent examples in fact.
Taiwan is not doing a high rate of testing at all, they're most certainly not doing constant ubiquitous testing. Their per capita test rate is 1/7 that of the US.
Singapore and South Korea are not doing constant ubiquitous testing. The US has already tested at a higher rate than South Korea and will pass Singapore shortly given the continued ramp in US testing. Both are held up as marvels of virus containment.
Japan has barely done any testing. They're seeing a small spike in cases now, however they were not earlier (this is four plus months after the outbreak began and Japan is next to China). Their deaths from Covid are commonly 1/50 to 1/150 the per capita rate of the US and other higher outbreak nations, while doing 1/10 to 1/15 the testing. The only explanation is either that they're covering up ten thousand deaths, or the other non-testing approaches they've utilized work well. Compare Japan to Germany on Covid deaths - again, despite Japan being next to China - and then look at the testing rates. Now explain that.
Finland is testing below the US rate and has contained the outbreak to a stellar degree. That's because Helsinki is colder than Stockholm and Copenhagen. The same reason Moscow didn't get slammed until more recently as the weather began to warm up. There are other factors that impact the spread of the virus, including the rate of social activity and high temperatures (over ~60F / ~15.5C). We know this from several studies that have proven the role of temperature in the spread of SARS and SARS-CoV-2; as well as understanding how the spread benefits from greater social activity (which doesn't occur at the same rate in super cold climates).
Greece has a very low number of Covid deaths and no evidence of serious outbreak this entire time. Their testing rate is 1/3 that of the US. And they're wedged between Turkey and Italy. Much like southern Italy, they've been heavily shielded by their climate. Nobody wants to talk about this of course, it's the Mexico / Texas / San Diego / Baghdad / Lagos effect in action.
Iraq isn't seeing any consequential outbreak, thanks to its climate. Whereas Iran right next door got smashed, because Tehran has an entirely different climate from Baghdad.
Thailand and Vietnam are both testing at a very low rate, and there has been zero evidence of serious outbreaks in either country, despite the proximity to China. That's thanks to their hotter climates.
Nigeria is barely testing at all, with zero evidence of a consequential outbreak there. No crushing of their healthcare system with cases or deaths; no huge spike in deaths, hospitalizations or ICU cases. There are numerous countries across Africa seeing similar low outbreak results, with very little testing.
Colombia isn't seeing a consequential outbreak, their testing rate is super low. They're not seeing a healthcare crush either. They've contained it so far without a high rate of testing.
India and Pakistan were supposed to get buried by SARS-CoV-2 cases. It hasn't happened, week after week goes by and the predictions continue to fail to come true. They're barely doing any testing at all. There's zero evidence in either country of a massive outbreak or crushing number of ICU cases swamping their healthcare systems. It's because of how hot their cities are. I've yet to see a single other good explanation for why India isn't buried in Covid deaths by now. India isn't seeing the virus hit for the same reason Africa hasn't.
Egypt is barely doing any testing. Cairo should have millions of cases of the virus and a huge number of deaths by now. They should have 20,000 dead people from Covid at this point just in Cairo. Where is it? The Cairo metro has 20 million people. It's not far from Italy, Turkey, or Iran. Guess what? It's very hot in Cairo.
And if you want to see a belligerent demonstration of the climate impact in action: tell me that Florida has been dramatically more responsible in their behavior than Belgium has (or France, or Italy, or Spain, or the UK, or the Netherlands, or Switzerland), to warrant having a per capita Covid mortality rate 1/12th that of Belgium. If Florida had New York's climate, Florida would have 20k Covid deaths by now. Instead they have a mere 1,066 (and Florida has a lot of old people) despite doing almost everything wrong.
Being off work for such should not result in severe reduction in income unless your income was already high; at least that is the case here in Norway where laid off personnel get 80% of their normal salary up to a limit that is above average salary.
Edit: typos
If "it happened and it worked" isn't "mainstream" then I don't know what is.
1) https://www.bloomberg.com/news/features/2020-04-23/wuhan-s-r...
The two solutions that are being debated now are (1) staying in lockdown until a vaccine or treatment is available, and (2) reopening and attempting to manage the spread using existing protocols/ideas (relatively low amounts of testing, quarantining after a period of infectiousness, some form of contact tracing, lots of finger crossing). At least, that's generally what I hear being debated: reopen or not, or when to reopen.
The post suggests that if we had quantitatively much more testing, we could pick a qualitatively different third solution -- namely, reopen pretty freely and realistically control the spread.
Sure, you can view that as a variant of the "reopen" option, but in my mind reopening feels very different with a realistic way to isolate people before they've had a chance to spread it very far. It's proactive vs reactive. If we fully reopen with even 2 orders of magnitude more testing than we're currently doing, it's just going to be a matter of closing back up wherever it gets out of hand. In practice, the openness will fluctuate, things will be spread out over time, politicians will continue to do the exact wrong things, and lots of people will continue to die.
In short: (1) stay in lockdown until vaccine/treatment, (2) reopen without a strategy, (3) reopen with a strategy.
Given that it appears people with COVID-19 can shed the disease for many days before showing any symptoms, if your goal is to pinch off outbreaks before they become outbreaks, frequent, universal testing is the only way to get there.
"Quantity has a quality all it's own"
> This test gives results in ten minutes using a small amount of saliva which is taken into a disposable tube and then run through a scanner.
> We’re planning to start operating the first scanner within a month. If all goes well, there will be millions of scanners deployed by this fall, ensuring that every school and essential business can reopen while remaining safe and virus-free.
One of the oldest and largest biomedical institutes, the Robert Koch Institute in Germany, recently had a few press releases, urging for tests for at least ALL respiratory tract infections.
What one of the leading experts, Prof. Drosten, also mentioned is that current (PCR) tests have considerable false positives. The effect of such FP at large scale can hardly be estimated.
I really hope that you are able to find a solution and can bring up a scalable and reliable solution, after the promises. If not, there will only remain the impression that this could be a Silicon Valley type of talk the walk, as people heard it from other companies in the past.
Some people just advocate for isolating the elderly and having everyone else mingle.
The life expectancy loss from just letting it run its course would be less than a tenth of the life expectancy difference between the second and third wealth quartiles in the USA. And if we aren't worried about that difference, then why are we imposing a quality of life reduction that's much larger than the quality of life difference between those two quartiles for a much smaller gain in life expectancy? (similarly the economic costs of bringing the lowest quartile up a year or two would be much lower than the cost of this lockdown)
Because that's a terrible idea that doesn't make any sense. I understand the logic and why it's tempting, and I've even read some of the evidence supposedly backing it up. I find it thoroughly unconvincing.
I won't address the moral side, just the practical.
The virus disproportionately effects the elderly, yes, but far from exclusively. We have seen the non-elderly death rates with distancing in effect. If we could confidently say that >70% of the non-elderly population already had the virus, then this might make some sense. But since at the moment we cannot say that, then this is a method for quickly getting to >90% of the population, and killing off an unknown but far from trivial percentage of us.
Also, I have seen some evidence that the magnitude of symptoms is partly dependent on the degree of exposure. If that is the case, I really really do not want to be sitting between two infectious people in a movie theater or sports arena. But this would be commonplace with the whole "let's just sacrifice the elderly" approach.
As a society we have shown time and time again that we only care about "disasters", not the continuous but far greater and less expensively solved losses. Nuclear power vs coal, air plane accidents vs car accidents, the life expectancy reduction of poverty vs COVID-19...
It only took a couple of months for 20% of New Yorkers to get infected.[2] If we assume that half the population will get this disease over the next two years, and we assume an infection fatality rate of 0.3%, that's around 500,000 deaths. (328,000,000 * 0.5 * 0.003 == 492,000). Those are optimistic projections. The IFR is likely higher and the R0 is somewhere between 3 and 9[3], so that means at somewhere between 60% and 90% of the population needs to be infected before we get herd immunity.[4]
Unless there are radical improvements in testing and/or treatment, I think we'll end up with at least 500,000 deaths in the US. That would mean we're about 10% of the way through this catastrophe. So strap in, it's gonna be a long ride.
1. https://twitter.com/COVID19Tracking/status/12538071759457443...
2. https://twitter.com/NYGovCuomo/status/1253353516803993600
3. https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article
4. For the relationship between R0 and herd immunity, see figure 2 of this paper: https://academic.oup.com/cid/article-pdf/52/7/911/847338/cir...
At this point, I'd consider that a success.
If there is substance to this then it would be massively in Paul's (and the company's) interest to better link to that in both the post and the company web site. At the moment, it looks like at worst vaporware or at best, something so early stage it's years out from viability.
I just found out about Covid Toes. What will come tomorrow?
And now, a shameless plug for a next-day delivered PPE from Amazon built from a full faced snorkel, a vacuum filter and a 3D printed adapter I designed: https://3dprint.nih.gov/discover/3dpx-013899. There's a video too, which shows a bit cheaper version's assembly: https://www.youtube.com/watch?v=wydRpFpQD4I
I haven't been into an indoor shared space without it on for almost 3 weeks. You probably shouldn't use Gorilla Tape on it, because it might off gas something. Try surgical tape.
I’m glad more money is being put towards research in this tech (I used to study plasmonics from the physics side), I don’t think it’ll make a difference for COVID specifically before it’s too late to matter.
We should hopefully have boring old ELISA antigen tests shortly, thanks to Abbott and many of the other folks we've all heard from. The real challenge is scaling testing beyond what can be reasonably implemented from central lab facilities.
The SPR machines I’m familiar with are not inexpensive. Are there machines appropriate for these tests that are less expensive such that it could be rolled out widely? Sample cost is low, but a warehouse shift change of several thousand people isn’t going to need only one machine for screening as the load on the machines will be very bursty.
Sounds like your undergrad kid has been paying attention in class...
Unfortunately, up until about a month ago us like many folks, were blissfully minding our business developing a rapid point of care cytokine detection platform for use in monitoring patients experiencing certain immune responses following cancer immunothereapies, you can read more here: https://pubmed.ncbi.nlm.nih.gov/31597044/.
Currently, we are very much focused on techical/clinical validation. We will have many more details to share on our approach, the technology, as we continue to move things forward.
The holy grail would be real-time targeted therapeutics to modulate our immune systems up and down in response to various cues. We’re a long way off from that but it’s an idea that’s beginning to get wider acceptance in the medical community. [0] - https://www.novartis.us/sites/www.novartis.us/files/kymriah.... [1] - https://www.gilead.com/-/media/files/pdfs/medicines/oncology...
Ethics are an important thing.
I'm not so sure about this!
[1]: https://medium.com/@tomaspueyo/coronavirus-learning-how-to-d...
It also feels like the logical next step to the very widespread testing found in countries like South Korea.
I think this is the best position, however but it still needs to be argued for since it's not the only position.
Edit: Also, it looks like the US has plateaued at this point but in a situation with a fairly dysfunctional testing arrangement. It is going to be hard to argue for people to sit tight until tests are in place so I'm not terribly optimistic.
Huh? One goal is to flatten the curve so that we don't have exponential growth. Another is to flatten the curve so much that, even if might still be exponential growth, the growth is slow enough for our health care systems to absorb the peak.
The aim of mitigating measures is reducing the growth rate of the disease. But the mechanism of the disease is that you generally have a basic situation where X people infect at time t results R*X people at time t+1. That's fundamentally exponential process (even though you can extra factors, the process doesn't change 'till you get close to having infected everyone). If we can make R small enough, this become exponential decay, a good thing but still an exponential process. But when you do exponential growth. you have a doubling and on the last double, you get more cases than all the cases combines. So the peak is just MUCH higher than the rest of the curve and you can "flatten" a lot and still wind-up overwhelmed in the end if the growth process continues.
Just to nitpick a little here, it's more like "flatten the curve - stretch the time while everyone gets it, so we don't overwhelm hospitals". Even with exponential growth, you would rather deal with it over a longer period than have a massive spike where all services are overwhelmed.
Which is to say, you can stretch out exponential growth a lot and still not have enough. If you exponential growth from 1,000 to 1,000,000 cases over a year, the last month will overwhelm your services entirely and constitute the bulk of both cases and death.
There's a reason all those early graphs showed parabolas, not actual exponential curves, you can't even give plausible visual representation of this process, because it isn't plausible.
> We need to start building social distancing into our culture the same way we built protection for sex into our culture.
While I agree with the general gist of your comment, I should emphasize that what we need is physical-distancing, not social. Humans are social beings at core, and depriving them of social interactions is as deadly as the virus itself. What we should be practicing more than ever before is washing our hands, minding our coughs, and in general, being responsible to the society. The individualistic lifestyle - which is pretty much dominant in the West - shouldn't stop us from caring about our community as a whole and our duties towards other people. Technology can only help us get so far; the rest depends on how much we - as responsible social beings - take care of ourselves and each other.
Good distinction. We should be focusing more on hygiene while finding ways to connect remotely with the people who are important to us.
Good stop-gap, but not remotely viable long-term. Humans aren't made for isolation, even if video calls help take the edge off soon. FaceTime and Zoom have a significant cognitive load, too. As long as we're talking about how society should adapt to this sort of risk, we can't just go to living in individual hermetic pods with internet connections. The mental health cost will be monstrous.
Why the cogntive load would be lesser in a face to face conversation than digital assuming the internet connectivity is good ?
- Henry David Thoreau
The Norwegian health authorities also published an app that can be voluntarily downloaded, that tracks and warns about infected, while also collecting research data for future use. [2] The app has garnered some criticism for leaking user data, and for discharging the battery too quickly. The retort is that it's of course voluntary and anonymous, and that it's actually tracking less data than Facebook or Google.
[1]: https://norwegianscitechnews.com/2020/04/from-thousands-of-t...
[2]: Norwegian language source: https://www.fhi.no/nyheter/2020/ny-app-fra-folkehelseinstitu...
Relevant part of their tweet:
"This applies if you are staying in a country with poorly developed health services and infrastructure and/or collective infrastructure, for example the USA. The same applies if you do not have health insurance."
As well as a message, now apparently removed but archived by others, on their website:
"This also applies for countries with poorly developed collective infrastructure, for example the USA, where it can be difficult to get transport to the airport if you don’t have a car. The same applies if you don’t have health insurance."
So you can allocate tests by sorting by (# of daily contacts in a closed space) ^ 2.
But as PB says, it should be practical to test everyone every day.
Edit: I’m not sure I interpreted the original statement correctly.
[probability of becoming infected and spreading] = [probability of becoming infected] * [probability of spreading] ~ [people you meet]^2
probability of spreading = a * n probability of infected = b * n
where: a,b = some blackbox function for spreading/infection ratio? n = number of people you meet
Assuming both are independent events we get:
p = a * b * n^2
I can see how we get n^2 with that. The way I'm using a, and b seems clumsy though, is there a better way?
p_catch ~ n
p_spread ~ n
p_relay = p_spread * p_catch ~ n^2.
Correct, it's not. But it is roughly linear in the limit of small numbers of people with a small constant probability of becoming infected per interaction. (This assumption becomes problematic when you see "clustering" of highly social people with other highly social people.)
To be specific, if P is the probability of becoming infected when interacting with a single person, then the probability of becoming infected after interacting with N people is 1-(1-P)^N = NP - O(N^2 P^2). It's easy to see that the limiting infection probability is 1 in this simplified model, and that if N*P < 1 you're looking at close-to-linear growth.
> Even with imperfect screening, if we are able to prevent 90% of disease transmission, then the virus’s reproductive number, or R0, will drop below one and the pandemic will quickly fade. There is no risk of reintroduction from the outside because any new outbreaks will quickly be caught and contained. If used consistently, there will be no second wave, ever.
I'm not sure this "test and release" strategy works unless absolutely everybody gets tested simultaneously.
Even if testing of the total population can be completed in a week (a highly ambitious timeframe), there's still time for people released on Day 1 to be reinfected by people who don't get tested until Day 6.
Then you have to go through who knows how many follow-up rounds of testing absolutely everybody not in quarantine to identify those people. When responding to new outbreaks involves re-testing large populations of people, you're going to run into many problems. Notification, compliance, testing fatigue, etc.
Sounds like a logistical nightmare.
Imagine trying to enforce this on every non-residential building in, say, NYC. It would be practically impossible.
Who checks to make sure every restaurant follows the standards of cleanliness? They have inspectors who (theoretically) show up randomly, so it ensures most places comply voluntarily, because the cost of getting caught is very high.
A combination of random inspections and steep fines would solve the compliance problem.
Edit: I just had another idea. Offer cash rewards to people who can prove they they weren't tested when entering a public place (which the business pays for via fines). You'd have people running around trying to find missed testing for the cash reward.
you can't reject solutions because they sound dystopian unless you've got better, non-dystopian solutions. and everybody has to stay in their homes at all times and all non-essential services are shut down is not a less dystopian solution.
What “solution” are you looking for to solve this relatively small share of “death from natural causes” that we call COVID? How much damage should we inflict upon ourselves in this moral quandary?
How many people should die because we’re willing to spend trillions of dollars due to our innate fear of a virus rather than our innate fear of much much bigger problems, like poverty or starvation?
Why can we muster so much energy in this case, and so little on much bigger problems? My theory is that you can’t catch hunger on the subway, you can’t catch underprivilege from a doorknob, and you can’t catch climate change from shaking hands with constituents.
There’s a lot wrong with our planet, it’s too bad we’ll all go bankrupt and unemployed chasing such a trifling disease as COVID when there were actual real problems we could have solved with mountains of cash that large, rather that burning the cash in effigy for modest to no effect once COVID has run its course.
If I could still edit the comment, I would replace the first “you” with “we”, as none of the comment is meant to be directed personally at OP.
The dystopia we have is purely one of our own creation. One which TFA seems to not only welcome with open arms, but seeks to capitalize upon. It’s really quite sad.
One is that cash is not a resource. It's even less of a resource when it's not only not metal, but mostly not paper either.
The other is that the flu comparison doesn't make sense to me on multiple levels. Given deaths from COVID at the moment are nearly ten times flu on an annualized basis, given the partial shutdown, obviously they would be more than ten times without the shutdown...but what is even significant about exactly one order of magnitude?
I’m not quite sure what to say to “cash is not a resource”. Even if just a proxy for attention cash is obviously a resource. But really, cash in itself is a resource. $10 trillion dollars can do a lot of things if spent wisely. $10 trillion dollars can also be destroyed for practically no benefit at all.
I agree it’s not strictly $1 spent on A means $1 less to spend on B. But it’s at least true to some extent, and again, as a proxy for attention and willingness to enact change, it’s a valid measure.
So the flu comparison is because they are both respiratory illnesses which kill a lot of people. In the 2017-2018 season the flu killed 61,000 in the US. Hospitals in NYC were stretched very thin. Nobody really noticed. It wasn’t even declared a pandemic.
Obviously it’s impossible to say with certainty if we have seen 1/4th, 1/3rd, or 1/2 of the total deaths that we are going to see from this SARS-CoV-2. But I think nobody is currently out there claiming that we’ve only seen 1/10th of the total deaths from SARS-CoV-2 that we’ll get by the time it’s over. (SARS-CoV-3 is another story?)
“Ten times flu on an annualized basis...” So 50k times 4 is 200k. That’s not nearly 600k. Just trying to follow your math. If we’re halfway through now (IHME thinks we’re about 3/4 through) then we‘ll have seen in COVID the equivalent of two bad years of flu.
Orders of magnitude generally provide rough measures of classification and are a nice rule of thumb for telling if one thing is “radically different” than another thing. So, flu kills up to 650k globally per year. Maybe COVID will do roughly the same, maybe 2-3x, but I think at least we’ve long past the days of claims that COVID will kill 5 million worldwide are being tossed around. And it’s not because no one’s caught it and we just need to keep hunkered down. It’s because a massive number of people caught it and overall its just not that deadly.
If governments around the world had done their jobs and shared data and been truly prepared and with a little luck and a lot of hard work this whole thing perhaps could have been avoided by early and arduous contact tracing. That day is long behind us.
I worry that by now so much energy and ink has been spilled getting the country into lockdown, and people are so politically invested in it, and all the social pressure campaigns have ramped up to max,... that now as data finally emerges which demonstrate it was all a gross overreaction, we will be too slow to correct.
In the meantime 10s of millions have lost their jobs, perhaps millions have lost their businesses. A $1T deficit seems like a quaint memory (sorry grandkids!).
And it was all for, what, exactly? When herd immunity is the endpoint and the IHME hospitalization predictions were wrong by 10x... overbending the curve only causes suffering and does not save lives. Bending the curve too far into next winter could actually cost lives, which the CDC acknowledged earlier this week in a very roundabout way. And bending the curve at all only helps if additional medical treatment availability would have actually saved more lives, something which I have not seen a strong case for.
$10 trillion is probably over twice the (financial) cost of WWII adjusted for inflation. Having numbers of that size written down, deleted, moved around, doesn't mean we are suffering that level of loss.
As far as comparing covid to flu, I was talking about annualized daily deaths from covid, compared to a normal year of flu. That was deliberate. I'm saying, if it neither increases nor decreases from this point on, it's nearly ten times the rate in the long run.
You are comparing the total deaths from covid, assuming it declines and goes away in due time. That would be fine in a vacuum, but you're using the consequences of trying to stop it to argue the efforts to stop it are unnecessary. What is the point of this sophistry?
https://www.wbur.org/commonhealth/2020/04/03/contact-tracing...
Now is the time to express opinions on these "proposals"..
I think economic incentives are also fairly well aligned here. If tests are widespread, a significant segment of the market is likely to prefer locations that are testing to those that don’t, just like the market tends to prefer clean restaurants to unsanitary ones.
Wouldn't it stand to reason that you could be tested once per day, in the parking lot to a mall or some other shopping establishment, and thereafter _verify_ that you had been tested that day for the remainder of your commercial transactions?
Thinking in those terms, 10 minutes per day is not so great of an imposition. We could formalize it and create drive-through test centers where you drive up, spit into the tube, have a bar code on your phone scanned, and drive off. On your way to the mall you get a text message with your results. Everywhere else you visit that day scans your phone upon entry and confirms that you've been tested.
The system also becomes much more complex and requires a bigger infrastructure if you aren't literally testing people at the door. How do you verify someone has had a test today? In your bar code idea, can the bar code be faked? Is there some centralized database behind the system that tracks who tests positive? Is that database politically feasible? Some comments here are already objecting to that idea.
As for checking who has a test, simply give colored stickers. If someone wants to “beat” the system, so be it. Social disapproval and common sense will keep most people honest.
You need a plan for people who want to beat the system because they present a huge danger. The whole idea behind this system is to allow the people inside the secured bubble to return to normal behavior. They aren't going to be wearing masks, social distancing, or taking other precautionary measures. Therefore one person acting inappropriately could present a huge problem for the people on the inside. Keep in mind there are still people who think this entire thing is a conspiracy and that COVID-19 is no worse than the flu. You have to consider what happens with people like that who might not participate in this system in good faith.
Hawaii is an island, thousands of miles away from the rest of the USA, so why shouldn’t it open on a different schedule?
Even China, ground zero for the crisis, close and reopened different providences, districts, and even neighborhoods independently.
Could you protect a food processing plant with this method? Yes. Does it cover testing in LA? No. Does LA need food and other shipments? Yeah they do.
No lines to spread the disease, and better throughput if you're testing many cars simultaneously rather than whoever is at the front of the line. (Although I suppose many people could be tested near the front of the line too.)
The cheap flight was what made this epidemic a pandemic.
We can continue lockdown until everyone who has got it has recovered and is no longer infected. This is a matter of weeks and we are mostly there.
Once we get to no new cases per week for a couple of weeks then we can end the lockdown and get on with our lives.
To prevent reinfection then anyone that flies in gets quarantined unless they come from a plague free country. The same applies to other border crossings, e.g. ferries and roads.
This approach works with rabies in the UK and with other historical plagues. No widespread daily testing is needed this way just the health service testing we have now.
This approach is the only realistic option using what we can do now. However there is little talk of quarantine being used for those that fly. Quarantine means forty days.
> Sounds like a logistical nightmare.
E.g. 'test and release' where only folks who've been tested are 'released' into the public. Track outbreaks and retest those cohorts thoroughly. And so on.
They don't all have to get tested literally simultaneously; but the "release" part of the strategy can't start until the "test" part has covered everybody, or at least close enough to "everybody" that the difference doesn't matter. Note that that's how the strategy is stated in what you quote: if we can identify everyone who is contagious, then we can release everyone else. The "if" has to be complete before the "then" starts; that's what "if"-"then" means.
The false positive rate of lockdowns is 100%.
you’re underestimating the pain that many americans are feeling after just a few weeks of (soft) lockdown. it’s not that people want to be unsafe, it’s that their livelihoods are in grave danger if the lockdowns last for months. many people are willing to take some risk now that the pandemic hasn’t turned out to be plague-levels of badness that some initially feared. few people are economically secure enough to say ‘no’ to opening back up sooner rather than later.
Without expressing an opinion of my own, how can you write as though from a twilight zone without causal relationships?
I mean, you, or anyone, can doubt that the lockdown is necessary. You might be right!
But you must acknowledge and challenge the causal connection between the lockdown and "not plague levels of badness". Comments that just ignore the possibility creep me out, because I can't imagine what the writer is thinking, except maybe "wishing will make it so".
If that were true lockdowns would make absolutely no difference in R0. Clearly, they do make a difference.
- A false positive means that a test shows someone is infected when they are not. For most tests that's somewhere between 0.1% and 2%.
- Lockdown means everyone stays at home. Different from PB's plan, where only people with a recent positive test stay home.
- R0 (technically Re) is the expected number of people each newly infected person spreads it to.
When I say a lockdown has a false positive rate of 100%, it means a lockdown is the same as if you tested everyone but the test always (100%) reported positive, so everyone had to stay home every day.
The point I am making is that some of the people who are on lockdown are truly positive for the virus. That’s why it works. They don’t have the opportunity to spread it outside their habitation unit.
^or whatever the true number ends up being
I suspect relying on people to test themselves daily without mandating it would do a reasonable job, but I have no idea if it would be enough.
Edit: typo.
But during an outbreak, the ability to roll that kind of thing out, especially in workplaces with vulnerable populations (like senior care homes and hospitals) or necessarily close working conditions (like restaurant kitchens or some factories) could certainly be a game-changer. And that just seems entirely reasonable to me. There's a outbreak happening, so in order to enter [place where transmission would likely occur] you have to be tested first. If found to be infected, you must isolate. Otherwise, you'd be knowingly exposing others, which already isn't something considered acceptable.
So to me this simply looks like an effective use of existing powers in this situation. I'm not sure how it would slide down a slippery slope. The government decides to keep doing virus screening? I mean, I doubt they would incur the cost, but if they do, good! Maybe as Paul mentioned, we could significantly knock down cold and flu as well. If people are worried about infringing on the rights of people with viruses to live normally, I would ask what about the rights of others not to be infected by them? That besides the fact that if these measures are effective very few people will be getting sick in the first place.
When is the pandemic over? When does the pervasive testing stop? The argument can - and will - be made that "unless we keep testing until the end of the human race, you will all die tomorrow of a horrible virus-ridden death."
I don't particulary mind doing pervasive testing for awhile. I would desperately not want to live in a world where I could not feed my family unless I give into it.
When we stop seeing non-trivial numbers of test results. The idea that governments want to spend billions on mandatory virus testing outside every building until the end of the human race out of some Orwellian enjoyment of inconveniencing people is not supported by evidence. Even China isn't doing this. Back in the real world, even the SARS vaccination research programmes, which cost relatively little and inconvenienced nobody, were shut down when SARS stopped circulating and the even keeping a few scientists employed as part of a pandemic task force looking out for the future was a step too far for the US govt.
Setting aside the science of disease, the concept of government agents performing a test to determine one's ability to conduct basic civil liberties (movement, work, basic speech etc) is antithetical to liberal democracy. Such things were not contemplated at the height of the AIDS panic, or SARs, or ebola. It would take something far worse than COVID-19 to implement such a regime in the western world. COVID is a threat to our way of life, to our economies. It isn't an existential threat to the state let alone the species.
Can you guarantee that a healthy person who gets this 3 times doesn't have a 100% fatality rate (i.e. it gets worse each time?)
Can you guarantee asymptomatic people don't become sterile? (Not saying they do, but if they did this would be an existential crisis and lead to our extinction after a generation).
Can you guarantee asymptomatic people still won't have lung damage permanently? (some asymptomatics athletic types have shown severe decline in lung abilities following covid19).
SARs was bad, but was wiped out so it's moot, AIDS is easier to avoid -don't have sex. ebola I think isn't as viral, and has been mostly contained, iirc they may have a vaccine launched or soon will and better treatments -- it's never gone full global like this.
Covid-19's problem is it's severe viralness and r0. It spreads and keeps on spreading, and there's a ton we don't know about how bad having had it will be to even those with minor cases. until we know for sure on all these factors, the more we can quell it the better.
Which is 100% normal for any pneumonia. I myself once had a bad lung infection (on my back for over a week). It took months before I could swim laps as fast as I did before. That's not anything special. Infections always have secondary medium-to-long term impacts.
ACE2 is in high concentration in the testes too, could this cause fertility issues? Sure it'd be good for the environment but a lot of couples really do want and enjoy their children or to have some someday.
It'd be nice to know as much as possible before we open the flood gates.
This is misunderstanding exactly the text you are quoting. The goal with epidemic management is NOT to seek out and destroy every last case of the disease.
All we need to do is reduce the spread rate so the exponent in the equation goes from above one to below one. At that point, the outbreak will shrink over time on its own. Critically, new/undetected outbreaks with an R0<1 won't get purchase and grow, because they can't.
At that point, the population is "safe". Individuals aren't, people might still get sick randomly. But this isn't a policy for individual safety per se.
And now they are pretty much back to normal while much of the world is still at a standstill.
The sad thing is that basically nobody else did, among major players. Even other countries in the area (i.e. Japan and China) just went “phew!” after SARS and didn’t substantially review their response strategies. Which is how China was caught napping, Japan is still fundamentally in denial, and everyone else got their asses handed to them by covid19.
Napping is not the word for that.
0) Sensitivity/specificity: Any data yet on what the sensitivity and specificity of this form of test for SARS-COV-2 will be? And, is work in characterizing all of that far enough along that we can expect to see emergency authorization by the FDA and scale up happening sooner rather than later?
1) Reagent supply: The biggest problem with PCR tests and all seems to have been reagent shortages and supply chains dependent on manufacturers not able to scale. Assuming the test is approved, are there any operational advantages to this approach in terms of securing reagents to overcome that problem?
Thanks for the fascinating read!
1) great question. Our approach is novel which allows us to tap into new supply chains that are inherently more scalable (think semi-conductor Fab) but the trade off is execution risk.
This is one of the implementations we're actually developing. One of the challenges with the implementation of testing on this scale is not necessarily on the technology/assay but on implementation. How do you reasonably test millions of folks each and every day, or said another way actually get millions of nasal swabs, saliva, etc on 384 well plate?
I think our ultimate approach is much more akin, albeit with a bit more sensor voodoo magic, to a at home pregnancy test than 384-well plate qPCR tests at central labs.
“While saliva has shown promise for SARS-CoV-2 detection, very few studies have directly compared it to the current gold standard, nasopharyngeal (NP) swab. So, we compared NP and saliva samples from COVID-19 patients and self-collected samples from asymptomatic healthcare workers”
“COVID-19 patients: SARS-CoV-2 detection from saliva is comparable to (or better than!) NP swabs and more consistent over time ...”
“Plus, the detection of SARS-CoV-2 from the saliva of two asymptomatic healthcare workers (...and counting!) who tested negative from their NP swabs suggests that saliva could be a viable alternative for identifying mild or subclinical infections.”
https://twitter.com/awyllie13/status/1252996627217801218?s=2...
[1] https://businesssearch.sos.ca.gov/Document/RetrievePDF?Id=04...
[2] https://jlabs.jnjinnovation.com/locations/jlabs-ssf
[3] https://jlabs.jnjinnovation.com/JLABSNavigator#/location/Bay...
I'm working with a team that has a test that detects proteins associated with covid. It works like a pregnancy test and does not need a special scanner. Would love to discuss further.
Is your protein test able to detect as soon as people become contagious? That's where a lot of ideas fail, but I think getting R0 < 1 likely requires it.
Maybe something like this is what set the stage for the common cold wiping out the aliens in War of the Worlds.
We don’t actually know that yet.
We could get real confidence that it's safe enough to return to normal, acceping that COVID is a new disease that's just going to be around, the 5th coronavirus that we deal with seasonally.
The screening in the article would cost billions of dollars.
If it worked, we could then reuse the infrastructure to kill the flu. And then start on the colds.
Sorry that's baseless histeria. We can easily think through how healthy people go back to normal (exponentially lower fatality rate than elderly/sick), while vulnerable take more precaution, how then getting to 60% of population gives us herd immunity which grinds R0 to a halt. Then a vaccine arrives in 18 months. Not to mention heat/humidity/summer is being shown to slow the disease from recent studies.
10000/(0.1 * (20 million)) = 0.005
Arithmetic to scale that to ~60% of the US:
0.005 * 0.6 * 330 million = 990000
Of course that is hugely sensitive to the assumptions about the overall infection rate in New York and the immunity factor, but like I said, the arithmetic on what you said leads to ~1 million early deaths.
Add in supposed summer slow down and before we get a vaccine the numbers could be 10x less
There are 12k cases in Singapore and 12 deaths because they almost exclusively tested foreign worker dormitories, healthy working people (and the 12 are all elderly).
All evidence so far is that a small fraction of people sick enough to be in the ICU end up with some sort of non-lung organ involvement. The vast majority (>99.98%) of young (<50 years), healthy people don't end up in the hospital at all, let alone the ICU.
https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidvi...
If this is the best you can do, you're grasping at straws.
In the show the disease is used as a classist thing or something. Anyways, its bacterial not viral, and they discover than antibiotics were never discovered so the Professor scrapes some fungus off some trash and takes it and is cured.
Love the Sliders reference. I might stream that all weekend.
B) Testing for O2 levels using already cheap + widely available pulse oximeters is probably an insufficient but necessary measure.
Does this approach bypass the reagent shortages ?
What are the specificity / sensitivity metrics ?
We've just begun our clinical testing so don't have specificity/sensitivity metrics yet, but will be sharing them when they're available.
Sorry for being cynical -- I just feel suspicious of this particular tired mindset to addressing complex public health and social issues, ones that intersect with (and aggravate) many other pre-existing social dilemmas. There are a thousand other ways to look at this that don't involve a small cornered market, I just doubt the entrepreneurial mind knows how to parse for it on its own. When you have a hammer...
Wake me up when someone's talking about this sort of thing amongst members of a consortium building open patents, not from some guy with plain-as-day zero-to-one ambitions. I'll root for someone who sees the interlocking opportunities, not someone who speaks about personal aspirations to "wipe out COVID-19" in 2020
Frankly, I don’t understand how this test is supposed to work, and I’ve used a Biacore! It might be helpful to have a technical explanation available, for domain experts to evaluate.
edit: this is all I found about the company:
https://www.sbir.gov/sbirsearch/detail/1564207
https://innovation.medicine.umich.edu/portfolio_post/sepsis-...
This is dangerously wrong.
If you reduce R0 below 1, you may stop community spread. You will not eradicate it however, unless this is done globally for a prolonged period of time with no error. This cannot be done with the proposed solution.
We can (probably) stop this from hurting the vulnerable population while we find a long term solution like an inoculation, but we cannot just skip that and call everything good after some period of low / no new cases in a region.
There will always be animal reservoirs of this.
For that reason, and those you outlined, we could achieve the flawless techno-totalitarian state that so many well-intentioned citizens are practically begging for, and we would still be screwed.
The only stable long-term solution is widespread exposure; ie how humanity has dealt with pretty much every other global pandemic we’ve been encountered with.
Thus why those who are trying to demonize the concept of “herd immunity” and make it a dirty word are playing a very dangerous game.
https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article
This means herd immunity kicks in at 82% of the population.
Antibody testing appears to be showing infection rates are a lot higher than previously thought as well.
Both of those things together mean that 1) "there's no way to stop it" 2) "it might not be as dangerous as we thought".
But who knows, right? There's a ton of science that needs to be done to find out what's really going on. Large-scale, accurate, randomized testing will hopefully fill out the data picture.
Because the US has an awful medical system where access to care comes through your job, it seems to me that more people will die (from non-virus causes) than from the economic damage than from the virus itself.
I guess we'll know more in a few years.
Pet peeve of mine: R0 is not a property of a virus; it's a property of a virus in a certain environment. 5.7 is the estimate for covid-19 in Wuhan, a dense environment. It is nowhere close to that in the vast majority of the United States -- estimates are <3 in say Seattle or Norcal.
> Antibody testing appears to be showing infection rates are a lot higher than previously thought as well. > 2) "it might not be as dangerous as we thought".
The more reliable ones are about what we did think on both points, at least for those who rely on Imperial College's models (https://www.thelancet.com/journals/laninf/article/PIIS1473-3...)
> "there's no way to stop it"
Contact tracing is enough to keep r < 1. If we keep this thing at under 20 cases/million/day for the next few years until there's a vaccine, I think we can go about our lives.
in certain urban cores. herd immunity requires well mixed populations
1. https://finance.yahoo.com/news/orasure-technologies-receives...
2. https://www.politico.com/states/new-jersey/story/2020/04/23/...
As this isn't always possible and mistakes are made, testing is indeed the other important part of fighting any spreadable disease. The comparison of the Covid-19 infections across different countries show clearly, how effective strict testing is. Any technology, which allows for frequent, wide-range testing is a big help in fighting diseases. If you could run a test when you are like feeling like getting a cold, the common cold and the flu would become much rarer diseases. (Especially if the west picks up the asian habit on wearing face masks, when you have the flu or a cold).
HIV could be erradicated quickly, if there was even a yearly test of the whole population and anyone tested positive would get treated with the antiviral medicine which already exists for quite a while. Once treated, the virus count decreases rapidly and there is very little risk of spreading the virus, especially when taking minimal precautions.
All above of course require for the tests to be available to literally everyone. So this should be a state run function, where you can get tested without any question asked about possible health insurance and also certain treatments should be given free of any charge.
If you want my opinion, the right way to approach this is using the consumable tests to maximum effect for mass viral surveillance by contact group hierarchies. For instance, pool an entire school district on a single test, and then hunt down positives by school then class etc. There won’t be enough tests to find every case. That’s okay; others in contact are suspect anyway even if their test would have been negative at that time. The contact group discovery is simple too: cell tower data (civil liberties notwithstanding).
This is pretty obvious, but it doesn’t work because our medical system is set up to charge individuals, and the highest priority will always be hospital admittances. This does little for the patient, but does protect others in the hospital.
Paul advocates daily saliva-based testing, but as an intermediary imperfect, but "better than nothing" measure, what are the benefits and drawbacks of requiring people entering public shared spaces to have their body temperatures taken via handheld temperature guns or infrared monitors, a measure that's already taking place in much East Asia (Greater China, Japan, Korea, etc.) in public shared spaces like malls, restaurants, office buildings? My understanding is that these methods are not as accurate as direct thermometers or Paul's saliva-based test; nonetheless, they would detect a good portion of mildly symptomatic people and also have the benefit of externally signaling to the populace to continue "sheltering-in-place" if they have a fever.
Is there any issue with supply chains? Or is there scientific evidence disproving the effectiveness of this precautionary measure that's already in place in so many regions that have already seemed to have crested the first wave of the pandemic?
What’s the costs/benefits versus the temperature gun method already being used in Asia?
I fear that “perfect” or “near-perfect” solutions such as daily saliva testing would be potentially unrealistic for widespread rollout in an effective amount of time. Could we perhaps consider prioritize the superior daily testing solutions for high-priority environments like first responders and hospitals and nurses while reserving the “less-than-perfect” solutions such as what’s being done in Asia for environments with other essential workers, at least until scale-up hurdles can be surmounted?
It would be nice if they could figure out a recycling system — or at least make sure the vials are made of somewhat environmentally neutral glass — out of the gate, rather than have another problem to solve after there are millions of these out there
If you’re a numerate person you’ll know it’s very unlikely you’ll lose a leg to corona virus. People argue that the fear is needed to keep people accepting quarantine but I’d submit that honesty is the best policy. We need to find a way to make honesty work.
The alternative is people losing trust in science the more they’re misled.
In the event his solution isn’t a available soon, What do you think of a solution like this? (1)
(0) https://mobile.twitter.com/billmaher/status/1251350310045413...
(1) https://thehill.com/opinion/healthcare/494034-the-data-are-i...
Computer engineers like him should be shamed in public for speaking so confident about things they have not been trained.
We, as society, should point the finger at such frauds.
Why does it have to be shaming so often these days?
We need fringe opinion, we need new ideas. And new ideas on average means: bad ideas. Still need the process for the one brilliant one among all the bad.
We should encourage people thinking out loud, and accept that this is a process. Including people with bigger-than-life personality, including lunatics who might hit onto something by accident, including amateurs. Please allow creativity again, especially in times of need.
Sharing your thinking isn't misinformation. We don't need other grownups protected from mistaken thinking, because you yourself aren't the only one who can spot it.
I think condemning professionals for looking into other domains is not conducive to scientific discourse. The silo-ing of domains that has developed in recent decades IMO leads to local optima.
The major problem with all self-testing and isolation strategies is getting population buy in and what to do about poor countries.
It is difficult to get population buy in if the economic cost of being positive is high (which it would be for many). If people have to isolate for weeks then it will be difficult to get the working poor to test and/or quarantine themselves if positive. This virus is so infectious that even a small percentage of people not voluntarily participating is a problem. It might be possible to overcome this issue via some rewards (say a cash payment), but this would need to be carefully structured to not encourage people to infect themselves and/or fraud.
A daily test is unlikely to be viable for most poor countries in the world. I am not sure how we would overcome this problem outside of a cheap vaccine.
It's odd that there seems a negative correlation between country wealth and how well they are doing with covid eg. Vietnam zero deaths, UK & USA a mess.
How many tests is Thailand doing per day?
But it's also a good deal of luck. Test and tracing works until you miss enough people that you get controlled community spread.
I just got back from a bike ride and I went through an area where a lot of homeless hang out. I could strongly smell urine and smoke while I was waiting at a stop light under a bridge. Do I need to be concerned that I just exposed myself?
It's not measles, you can't contract it by breathing the same air someone infected did unless you're in a medical setting and AGP is performed on someone who's infected. If it was airborne, masks that aren't fitted wouldn't protect anyone: they wouldn't prevent absorbing nor would they prevent spreading.
https://www.sciencedirect.com/science/article/pii/S016041202...
Comment + source: https://twitter.com/alicesim/status/1254057546333241346
As for your source: it misrepresents SARS as airborne in the same way most other publications of this ilk do: by taking examples from medical setting and extrapolating from that. It even admits the setting but keeps the general "airborne" label for the sake of argument.
> SARS-CoV-1, did spread in the air. This was reported in several studies and retrospectively explained the pathway of transmission in Hong Kong’s Prince of Wales Hospital
Yes, this virus can become airborne if aerosol generating procedure is performed on an infected patient. But 1) you don't intubate people in restaurants, and 2) that's why PPE is so important for medical staff, because they do operate in conditions in which this virus can become airborne. That's also why you can't visit people in hospitals any more.
You can't do contact tracing of airborne infection that is this contagious. Measles hover in the room for hours after spraying and you can't trace down everyone who was doing groceries across 5h in your local market (I'm glad we have vaccine for measles). But you can do tracking and isolation of SARS-CoV-19 patients. Why? Because droplets are pulled down to surfaces and are no longer dangerous within seconds to minutes after spraying. But they do stay on surfaces, that's why hand hygiene is so important.
There are 7 billion humans in the world. Even the very low probability of false-negative lead to millions of infected people go outside, or millions of healthy people rushed to the hospital for detailed test every day.
As you say "the" disease I assume you mean Covid19, not just a future disease. AFAIAA is not been shown that recovered (or long-term asymptomatic) cases are immune and there's some suggestion that at least a few people don't have immunity after recovery. I think I'd stick with "at 50% infection rate".
But then if at 50% infection rate you've had 0.2% death rate (seems to be about the right order for confirmed deaths+anticipated numbers of not confirmed {ie excess deaths during the period of the diseases spread}, in UK) then testing might save huge numbers of deaths.
The death rate in the second half of the population I'd expect to be higher, they include those with pre-existing conditions (including the more elderly) who isolated early, testing of the caregivers and families will be very important.
Testing and contact tracing will indeed save lots of lives, I’m just not optimistic about <$1 “daily tests for everyone” within the relevant time frame of this pandemic.
Far better to use one of the antibody test strips. Prick your finger to get blood, or spit some saliva on a strip and you know in 5 minutes if you have antibodies.
Just keep testing everyone on a regular basis, and once they test positive, they are quarantined for 14 days. After that, they are assumed to be immune.
The development of antibodies requires either a vaccine or you to be infected. The rate of antibody protection in populations is certainly rising, but to get to meaningful levels of herd-immunity it would require all of us to get infected, lets say ~70%+ (obviously problematic), or rapid and major strides to be made in vaccination.
Anecdotally, significant therapeutic, vaccination and diagnostic approaches are required to effectively respond to COVID-19. Its been incredible to be a part of such a widespread, organized movement within both the healthcare and tech communities as we collectively mobilize to respond.
It requires screeners to directly manipulate saliva samples; this is dangerous in a pandemic. The assays referred to (lazily) in a Google Scholar search are almost overwhelmingly antibody assays; this does not allow the screener to differentiate between "has COVID-19" and "had COVID-19". Also, there is no evidence that the described test actually exists.
Finally, maybe irrelevantly, there is no way in hell you're going to get people at large to stand around for two hours a week waiting for test results. Ten minutes for a screening whenever you try to enter a public building; that's ten minutes to get into work, and we'll say ten minutes to get into another place each day. "But wait," I hear you say, "you only need to be screened once per day, and the first place can share that data with the next place." This plan was constructed by someone who is unfamiliar with medical records laws.
This is no "third solution." It's an engaging thought experiment, but it's just too far away from reality to get here from there.
And in terms of medical records laws, the regulatory environment has loosened so quickly with the advent of this virus that I'm sure regulators and legislators will be favorable to making it easier for the company if the test demonstrates the appropriate sensitivity and specificity in clinical trials. People are getting reimbursed for sending emails to patients, health visits done over zoom, would have been impossible to imagine this level of regulatory flexibility just six months ago.
> this does not allow the screener to differentiate between "has COVID-19" and "had COVID-19"
As a policy matter, this doesn't rule out the use of the test in a pandemic management protocol at all, it just changes how it needs to be administered. For example it might require that people who are antibody-positive have a standardized note confirming recovery (in Contagion, this was a cute electronic bracelet).
The critical requirement is that we detect unknown positives, and this test would do that.
"The most proven and ready to scale technology is based on surface plasmon resonance. It’s able to detect even a very small number of viral particles, which is very important because we want to detect everyone who is contagious"
(6th paragraph in the "A third solution" paragraph)
How do you prove recovery if you were never proven sick first?
As an example, I had all the symptoms of Covid in late February, the same severity many people in my age group described, yet was never tested since our health authority dropped the ball and claimed community transmission wasn't a thing back then.
If I tested positive for antibodies, would I get treated like someone newly infected? The only way to prove recovery is to prove you have antibodies and don't have the virus, so we'd essentially have to test every single member of society.
Sure, good idea.
> Also, why should I have to if I already am clean?
Oh, you don't have to. You can just stay at home like now.
Even then, traffic might be reduced, but it would be enough traffic for something like regular life to resume. Some businesses would be able to survive, even if not all.
* IDEA *
They could also do checks in the parking lot of any business. You drive up, someone comes out to start the process and marks down your license plate. After 10 minutes they return to your car and tell you your results.
This way nobody is standing in long lines possibly spreading the disease to each other. And it scales well to large numbers of people being tested simultaneously.
There would be a lag time of 10 minutes, but throughput would be nearly the same as before COVID.
Currently most public buildings are closed, so adding ten minutes is a big improvement relative to that. Also, it probably took them more than ten minutes to drive to work, so I don't think it's completely implausible.
You could have security guards with masks at every entrance. But if even one person with COVID-19 gets past security, you could start an outbreak.
Especially based on assumptions.
The petty whinging in your third paragraph is basically ridiculous. Imagine, waiting 10 or 20 minutes a day for a few months to help save millions of life-years.
There will be a few people who have some issue with regular testing, the vast majority of people will be happy to have a tool that works.
It does if it's an IgM test - IgM is only around during the illness. However, it takes a while to come up, so it can't tell you if someone is presymptomatic, at which point they are highly infectious.
That said, I have some serious doubts about the particular mechanism being used here being ready for $1/test within say the next year or two. It’s been studied for a few decades and while there has been some promising progress, this would be the first saliva viral antigen test using this technology. It seems a bit like trying to solve global warming by bringing fusion generators to market. I have doubts it will be deployable before a vaccine, let alone more conventional and boring antigen rapid diagnostic tests that we have developed for a wide array of viruses.
I've seen posts of using drones to detect 'sick' people... could they create a drone w/ some sort of scanner and microscope that could actually detect covid19 in the air?
Imagine if it could spot it on surfaces, air, etc...might be a bit dystopian, but at least it'd have a further reach than voluntary testing enmasse.
Well, the comparison is a bit unfair, recent studies [1] give : P(death | infected) = 0.05% overall which is order of magnitude less than Russian's roulette where P(death | play) = 16%
With probability a number between 0 and 1, percentage is between 0 and 100.
From the study in your source [1] the P(death|infected) = 0.005 And Russian roulette P(death | play) = 0.16
In percentages:
Covid19 - IFR = 0.5%, Russian roulette = 16%
From this calculation based on the recent New York antibody study [2] the average IFR across all age groups is 1.31%. (0 + 0.017 + 0.067 + 0.13 + 0.45 + 1.26 + 3.16 + 5.4)/8 = 1.31%
This is a much higher IFR than flu or H1N1 (IFR was 0.02% in 2009, 65 times less).
[1] https://hal-pasteur.archives-ouvertes.fr/pasteur-02548181 "We find 2.6% of infected individuals are hospitalized and 0.53% die"
[2] https://www.reddit.com/r/COVID19/comments/g6pqsr/nysnyc_anti... 0-19 ~= 0%; 20-29 = 0.017%; 30-39 = 0.067%.; 40-49 = 0.13%; 50-59 = 0.45%; 60-69 = 1.26%; 70-79 = 3.16%; 80+ = 5.4%;
Thanks for the correction and the new study link.
Tom Fulp had a bigger impact on my childhood than most - <3 newgrounds. Good Times.
What do you do if someone denies the test? You can deny them entry, but if they protest or decide to force the issue, then the police have to deal with it. Then if the police get sick, they have to self-quarantine, and what do you do when you don't have the power to enforce the test?
Even if we managed to dress up our entire police force in hazmat suits to reduce the risk of infection, they can still infect people out and around the building. Turning away someone doesn't mean we're reducing the R0, we're just moving someone that's infected around. Given that there are asymptomatic people (and a certain number of people that would likely claim the test is a false positive or fake), all we're really doing is encouraging more people to gather in a single location as a potential infection vector.
Let's assume next then that somehow we had an automated solution. All the doors to said buildings are locked unless you complete a saliva test to go through. Barring the huge logistical concerns, we're still dealing with potentially infected people spreading the virus on surfaces and areas that people are travelling to and from.
Tech isn't going to save us from COVID-19.
archive.vn/NzNRO
If you 're doing contact tracing right, you should need to test very few people per million every day. If you need to do a lot of testing, you ve probably already lost and will be forced to shutdown again. The solution is probably the second: antivirals.
OTOH i wonder what's the effectiveness of optical-based methods to detect viral particles: https://phys.org/news/2006-11-laser-nanotechnology-rapidly-v...
For example, I cannot just tell my boss, I am working from home, even though in my case there is no problem. Even if he allows, the company policy might not. (Although I am lucky I live in a sane country and we have that policy now.)
Or in Czechia, now everyone wears a mask (since it is mandatory). It became a norm in like 2 days, one day almost nobody had them (and people felt that wearing them makes you look sick), the next day they became mandatory in public transport, and the day after everybody had them.
There are other examples like that, where the peer pressure plays an important role (in preventing humans to make rational decisions).
From WHO: What is the treatment for the coronavirus disease? No pharmaceutical products have yet been shown to be safe and effective for the treatment of COVID-19.
What is the author referring to?
What happens when I reach the front of the line at Disneyworld, enter the testing booth, and the big red light flashes? Will Disney Corporation have a record of my identity at this point as well?
It’s all very challenging. There are chilling warnings from history of both the havoc caused by mass viral illness, and also of discrimination and ostracizing based on fear.
Ideally I’d want the test to be anonymous, private, and administered by me. Like taking my temperature or feeling for swollen neck glands. Hopefully we’ll get to that point in my lifetime.
That's what baffles me the most.
A quick search actually reveals something:
https://www.nsmedicaldevices.com/news/astrotech-breathtest-1...
In Sweden masks are so uncommon that you react when you see one.
Add the idea that anyone who has already had it gets a pass and it sounds worse.
Is it “spit in a tube” or “swab the back of the throat”?
That's not a cure. That is prevention.
> As such, I want to avoid ever catching this virus. I’m optimistic that we will eventually have a good vaccine, but until then I need to avoid those who are contagious.
Completely unrealistic. Same person would have said in 1918 that they want to avoid ever catching the flu. Maybe back then some HN users would think it sounds smart, but today we know it sounds just silly, because it's unrealistic, unnatural, against how life works and simply unnecessary.
Try your best to stay healthy, but please stop compromising life in ways which are completely unnatural because there is a possibility that your immune system has to do a bit of work. Our immune system has to work all the time, we are exposed to viruses all the time. This is how nature works. If there's a vaccine then yes let's all get it, like we should with other vaccines. Only a fool wouldn't get vaccinations, but until we have a vaccine let's just respect nature and how nature works and please live life like animals like us are meant to live. Freely.
> Catching this virus is a bit like playing a round of Russian roulette. You’ll probably be fine, but you could end up dead.
This is a poor analogy. In Russian roulette you have a 1 in 6 chance of getting a bullet in the head. The overall infection fatality rate of COVID-19 is under 1%, and the vast majority of fatalities are people with comorbidities.
It's more accurate to say that catching the virus is like Russian roulette only if you have a serious pre-existing condition.
> It is my belief that the best cure for any disease is to avoid the disease.
Avoiding the disease is not a cure. The only cure we have at this time is in fact the opposite: exposure and resulting immunity. This is the population level cure too; as immunity in the population grows, the reproduction rate of the virus declines.
There are still valid reasons for encouraging people to isolate and avoid infection. Like keeping the hospitals running, and minimizing the exposure of vulnerable individuals while the rest of us develop immunity. But curing the disease isn't a reason. And it also postpones the only true cure we have, which is the thing dying off due to herd immunity.
> The great challenge with avoiding this virus is that people with minimal symptoms are responsible for much, if not most, of the disease transmission.
This is true simply because people with minimal symptoms are most of the people who have it. So of course they represent the largest number of transmissions; they are the largest number of cases. Again, getting COVID-19 is not the same as Russian roulette, unless you're already sick.
> It appears that the virus travels through the air, so whenever possible, it’s important to avoid crowds of people or indoor spaces with shared air.
One authority after another has said that the main way this virus is transmitted is through respiratory droplets. Can it aerosolize? Yes. Can someone get sick from inhaling it in that aerosolized state? Probably yes. Is this a common form of transmission? Despite endless media coverage of studies in which the virus was deliberately aerosolized or found to be aerosolized, the answer is no. It is not. Neither the WHO nor the CDC has changed their view on this. Most transmission occurs at home or in tightly packed public transport.
There's no evidence that we need to avoid indoor spaces with shared air. There's an abundance of evidence that we should stay six feet away from each other and wear masks, wherever we are. (Since day one, all health authorities have acknowledged that wearing a mask reduces your risk of spreading the disease to other people.)
At the outset of the infection surge and subsequent lockdowns I was saying stuff like this and being crucified for it. We should have followed the Korean model from day one and in the US its existence was almost totally ignored. I have continued to say all these things and over time the lynch mobs seem to be dissipating. Hopefully we will see more level-headed critical thinking as the next step, which will lead to solutions.
Given a ridiculous argument like that, why do you get vaccinations? That's also unnatural and we're not meant to live like that, we're meant to die from certain diseases (your reasoning, not mine, if I understand you correctly).
This isn't well supported by data. In the sense that (a) young people just aren't particularly affected any more so than with the flu (old and sick people of course are much worse off) and (b) in Italy's data, no health professionals under the age of 49 died. There have been some deaths outside Italy but on average the trend mirrors the broader trend: if you're young and healthy, you're just fine. [1, 2]
I get that there's wide-spread panic, but we should allow the data to guide us where it exists. This isn't the time to spout off unsubstantiated fear-inducing commentary.
We need to keep our wits about us if we're going to tackle this effectively.
[1] Oxford CEBM, cached since it appears down: http://webcache.googleusercontent.com/search?q=cache:6rohagx...
[2] Original data here in Italian: https://www.epicentro.iss.it/coronavirus/bollettino/Bolletti...
To begin of course, you don't want any disease at any age.
Setting that aside it's pretty clear that you're less likely to die of COVID as a child than you are of the flu (which hits both young and old). Children are less likely to develop any meaningful symptoms in the first place, and if they do, they're less severe. Lots of ongoing research on this.
“The fact is that we are not seeing preponderance of severe [COVID-19] disease in young children, which is distinct from influenza...” [1]
> It can be pretty brutal...
Yup.
> ...and there is some evidence that it causes damage to lung even in the absence of symptoms.
[citation needed], specifically for children.
Your study also appears to indicate that the amount of damage is correlated to severity of the disease ("The CT severity score was higher in symptomatic cases than asymptomatic cases, particularly in the lower lobes"), which is demonstrably much lower in children.
It's also not clear this damage won't go away.
[citation needed]
> ... and it causes damage to the lungs even in the absence of symptoms.
The data you provided did not back up your assertion. I have not seen any data the backs up your assertion. If you have some, please do share it.
The data you provided suggested 73% of those folks were asymptomatic when in fact only 18% of them were upon further investigation. That brings into question all of their conclusions. Its interim conclusions suggest that there is a correlation between symptomaticity and severity (I mean, duh) and the articles I provided showed children exhibited milder symptoms.
> This is a serious disease that needs to be taken seriously.
Yes, it is, and it's not equally serious to everyone. It is less serious than the flu for children. This is substantiated fact. We can use this information to our advantage as we determine our next steps.
> “It is my belief that the best cure for any disease is to avoid the disease.”
on top of that, even assumptions about how to do that (avoid the disease) at scale are often mistaken. that’s a big credibility hurdle.
with that said, mass and frequent testing would be a method to quarantine the infected, and get treatment for the most vulnerable (like the elderly), faster (surveillance implications notwithstanding), which would drop R0 like a rock.
I also see a fair number of younger people on this list: https://www.medscape.com/viewarticle/927976
I'm skeptical of the Medscape list, since it appears to be the product of a Google form. I'm not saying it's wrong, but I chose not to use it as my primary source because unlike the government data I provided, it's unclear how or if it's being verified.
I'm kind of skeptical of the idea that the doctors and nurses in the United States are simply reacting out of irrational fear.
The 45 - 64 age group accounts for 23% of deaths currently [1]. There are widespread reports of high hospitalization rates for people under the age of 50 [2][3][4][5]. Unfortunately, most of the statistics being collected are focusing on official mortality rates, which leads people to see much higher numbers for "old" people and assume there's no impact for younger groups, which isn't true. ICU hospitalization is still a serious health care event, even if the probable outcome is much better.
Finally, please stop referring to what's going on as "panic". All things considered, most people have been remarkably calm. The only ones panicking seem to be the crazy attention-seekers blocking traffic.
[1]: https://www.worldometers.info/coronavirus/coronavirus-age-se...
[2]: https://old.reddit.com/r/Coronavirus/comments/fj1owh/over_ha...
[3]: https://old.reddit.com/r/Coronavirus/comments/fip9t9/france_...
[4]: https://old.reddit.com/r/Coronavirus/comments/fipavk/more_th...
[5]: https://www.businessinsider.com/new-york-city-coronavirus-ca...
Stopping the world is the panic button. 100% of the news cycle devoted to coverage. All schools shut down. It can be justified or unjustified but I think it's a stretch to call it anything but panic. I'd say the only ones who aren't panicking are the Swedes. A bold strategy, cotton, let's see if it pays off.
I would also argue that being aged 45-64 isn't exactly "young". The share of U.S. deaths for those under 45 is 2.8%. Under 35 is 0.89%. [2]
It's also important to point out that the percentage of deaths attributed to a given age bracket is not the same thing as your chance of dying of the disease. I don't think you were suggesting this, but just in case other people read these statistics and are alarmed, I wanted to mention it.
I'm not saying that Covid-19 isn't serious. But we have a good deal of data at this point that indicates that if you are young and healthy, you are very unlikely to die if you contract the disease.
[1]: https://jamanetwork.com/journals/jama/fullarticle/2765184
The Proximity Solution:
https://medium.com/@dilip.dasilva/introducing-the-proximity-...
How much less than $1? $6B/day is a lot of money.
(The total cost of 50c drinking straws or coffee cups daily is also in the billions but we don't see it that way.)
Whether this virus is more or less dangerous than the flu depends on who you are. For a child it's much less dangerous. This virus is not like Russian Roulette, the outcome of which is random and impossible to predict. It has a much greater likelihood of affecting certain groups than others. Flu is much more random. Like covid and most other respiratory illnesses, the flu is also transmitted by asymptomatic individuals.
Most of the motivating factoids presented in this article are false or misleading. Since the author's stated goal is to never become infected he should hide in a closet until the vaccine is ready.
Also I don't think the consensus is that only a vaccine can end the thread, or that it is necessarily much more dangerous than the flu. I know three people who died from the flu. And there are also cases of younger, healthy people dying from the flu, or people getting permanent health issues like inflammation of the heart.
This seems like a heavy application of The Copenhagen Interpretation of Ethics https://blog.jaibot.com/the-copenhagen-interpretation-of-eth...
1) Actually helped solve a problem we face with COVID without doing more harm than good, and
2) Did so in a way that didn’t trample civil liberties with invasive daily tests before allowing someone to leave their house.
Why not use an incentive system instead? You’d need a lot of work to design a good system but for example pay $100 for a positive test and proof that you isolated that day. (For proof of isolation maybe a system texts you at random times and asks for a picture of something in your house. Eg. 10:13am you get a text asking for a picture of a pillow.)
Please don’t critique the plan, I’m only offering it as an example of an alternative to having the national guard show up on your doorstep.
Strict constitutional scrutiny requires that the least disruptive action be taken to obtain the desired effect.
I think no would could possibly argue that widespread free testing would be a bad thing. It’s when it becomes mandatory that it becomes not only wrong, but unconstitutional.
> Again, the best cure for any disease is to avoid the disease.
Sure, if we're talking about HIV or HSV (any variant), then yes, the best cure is to avoid getting it in the first place.
Some diseases you don't really get a choice. When 21% of NYC has had a disease that has been spreading for only a few weeks in spite of extreme public safety measures (social distancing, shutdowns), you have to wonder if you can avoid getting it, for how long, and at what cost. If you don't get it now, how do you keep from getting it later? Eradication is typically a decades-long project. Vaccination is anywhere from a months-long project if you don't care about establishing vaccine safety to a multi-year effort -- enough to eradicate if you're serious about it and have a vaccine that can cope with mutation rate (probably not).
> Catching this virus is a bit like playing a round of Russian roulette. You’ll probably be fine, but you could end up dead.
But that's not really the case. Risk factors for covid-19 are fairly well understood at this point: old age, past history of pneumonia, obesity, and diabetes. That's not not-a-big-deal, but it's in the realm of the manageable: isolate those at risk. But stopping the progression of this virus through the population is clearly not an option at this point -- we long ago passed the point where that was feasible. We can only slow down the progression, and definitely not long enough to obtain a tested vaccine because that's well over a year away and might be closer to two years if anything goes wrong with the current candidates. In terms of morbidity rates, this thing is not that bad as it has not overwhelmed the U.S. healthcare system (a few hospitals, yes, but the vast majority are far from capacity), and some treatments are available.
So it's not clear that we need to slow covid-19's progression further, or that we could if we really wanted to. Transmission rates are just extremely high.
> With this test, we can screen for the virus at the entrances to buildings and other areas, much like we currently use metal detectors to screen for weapons. [...] Longer term, it can be used to safely reopen more crowded areas such as festivals, sporting events, and even Disneyland.
With... a test that... takes 10 minutes to run? Color me skeptical. By the time amusement parks get the go-ahead to reopen, covid-19 will have worked its way through well over 50% of the population. The way things are going, that's not too long from now, maybe two more months and NYC will be at 50% -- by the end of the year maybe most of the U.S. will be past 50%.
Covid-19 is just too infectious. We can't stop it.
Test, Test and Test
I don't want to say they are all wrong, but you tend to see the type of responses evolve as countries are further down the whole lockdown-process.
have we learned nothing?
Trump would rather pretend that we don't need more tests than admit to something the administration could do slightly better. I'm sure if we took the pulse of all Americans there would be a shockingly large number of people who didn't think testing was a big deal.
Screw Vaccines and Cures, if these could 'just' be found for Covid-19 then we wouldn't have any sickness in this world.
Work on both cheap and quick tests while we wait for the long, if even possible, timeframes of Vaccines and Cures.
So why aren't Bill Gates self swabs out yet? https://www.gatesfoundation.org/TheOptimist/Articles/coronav...
If a famous medical doctor was trying to convince me that his database product was really the best, while making grandiose statement, i think i'd be very very harsh with them.
However, I wouldn't limit this to being a "genius" thing -- there may actually be something significant to being able to apply knowledge and patterns in one or more field to a seemingly unrelated field, and people who tend to be interested enough to learn and think about a lot of different fields in depth have a better base of mental abstractions for inventing in a new field, even if they don't score ridiculously high on an IQ test.
Note that this is just a general rant -- re: the article, I don't think the pitch is particularly interesting or noteworthy.
He's quite involved with technical decisions. His social media behavior is irrelevant here -- this is about the ability to innovate outside of physics or economics, which is what he learned about in college.
Wait what? Despite the pandemic?
Why limit it to them? Without the Internet, there would have been no X.com, no PayPal, no billion dollar paycheck. If "funding" a large project is the equivalent of "being a scientific genius", I think we'll add a lot of geniuses to the books, and we should probably include every government official that makes decisions about funding large projects.
And really ... who deserves more credit for putting a man on the moon than Karl Marx? Without Marx no communism, without communism no Soviet Union, without SU no American fear of losing dominance, and without that no ambitious and well-funded space program.
On some topics you just have to accept that someone who has spent years of their live dedicated to a complex topic might actually be better placed to judge a solution than someone who specialises in an entirely unrelated field but happens to demonstrate a passing interest. Particularly when the topic is literally a matter of life or death.
A better stance would be to take such pitches as an interesting take but one which still requires peer review.
Edit: Remember when Musk tried to pitch a submarine to save those children stuck in a Thai cave and how local divers have to point out the passage ways were too narrow for even Musks child size sub? Being smart doesn’t mean you are equality qualified to resolve hard problems in other people’s fields.
So don't be so surprised, these aren't necessarily junior level devs at FAANG spouting off.
He was smart to avoid the typical tech guy hiring only a bunch of other tech guys to try and take on problems like hunger, global health, and education.
Public spaces generally comply with these types of things because of the fear of getting caught by random inspections and steep fines and penalties.
active driving and avoiding distractions (including drugs) are the difference makers, not speed limits. the reason people oppose this is because they want to treat driving like lounging by the pool, rather than operating machines that collectively kill a million people a year.
I am certainly on the side of raising speed limits to 100 mph where possible. Or providing turbo lanes for "Class C+" drivers or something. But that's because I think I'm willing to make the trade-off in lives. Your opinion is more that we're making not a trade-off but costing ourselves both lives and speed?
"Just have everyone be better at things" isn't a helpful alternative.
We do have available to us the speed limit.
of course we do. you mentioned one yourself: “providing turbo lanes for ‘Class C+‘ drivers”. it’s only a matter of imagination to come up with others.
speed limits are poor proxies for what really impacts lives saved.
Speed kills.
This "Third Solution" has been offered all the way back in February. It suffers from the same lack of information around reinfection and spread rates as it did the first time around.
Fauci’s background is in AIDS. It’s what he’s worked on his entire career. With AIDS, you can take a test, come back negative, and a year later if you haven’t done any at risk activities, you can be assured you are still negative. Not so with SARS-CoV-2.
With a virus as transmissible and prevalent as corona, you can test negative on Monday, and be shedding virus on Tuesday. A negative test gives you some confidence that you weren’t infected yesterday. It gives you no confidence that you weren’t exposed this morning.
The final nail in the proverbial Daily Testing coffin, even aside from the absurd logistical challenges, even aside from the civil rights issues of baring someone from leaving their home unless they wear a special colored armband, the biggest problem is that it just doesn’t work. The false positive rates on a test like this will be high enough that daily repeated testing will give the average uninfected person a 50% chance of testing positive by the end of the week. Don’t forget that we now have evidence that even a 14-day quarantine is insufficient, and that totally asymptomatic people can shed virus.
Ignoring that TFA is a sales pitch, which makes the whole thing rather nauseating, I hope that people will start taking a hard look at the absurdity of such a response, and perhaps not usher in a totalitarian regime with such open arms.
There’s certainly some sick irony involved in this post’s title. Gives me shivers.
I have told a lot of people who said this "Just do it yourself. I don't know how to just do it". It's so disrespectful. "Just convert everything to micro services written in Go and all your problems will go away".
Will it work? God I hope so, but it doesn't seem prudent to bet on it. We know several existing technologies for covid testing that will work. We know they can scale. We know how expensive they are. And while they aren't cheap, we know can afford it at the federal level.
That we still refuse to actually pull the trigger on mass testing and announce a program to fund and launch a universal covid testing regime is just infuriating.
I mean, I desperately hope that a magic bullet like this will pop up to save us. But we know how to beat this. We just won't.
People being wrong is also inevitable. We don't have a truth meter, and there's a ton of uncertainty on topics like this one anyhow. I don't think it would work to try to restrict discussion so that only authoritative opinions are allowed. This community would not tolerate that sort of restriction being put on it, and it would only convert to an argument-by-proxy about who should count as authoritative. The solution, if there is one, is to converse thoughtfully and respond to one another with accurate information where possible.
* Doesn't work
* Too hard to train
* Shortages will happen
Literally all were wrong and they either knew it and misinformed everyone or didn't know it. So you can either drop the assumption of benevolence or competence.
The only guys who didn't listen to them, Taiwan, are doing fine despite every other risk factor being huge for them. It turns out some skills translate across domains. I'm not going to get a software engineer to perform a total knee replacement on me, but I think I'll listen to them on the crisis management: turns out they're better at it than the crisis managers.
They say COVID is like Russian roulette.
LIFE is Russian roulette.
In the under 54 crowd Covid is no more deadly than the flu.
So any time you go outside during flu season you're playing Russian roulette?
The only people who need fear this bug are the over 54 crowd.
They need to remain quarantined until the vaccine is released or herd immunity is built up.
To my knowledge no significant amount of non droplet or hand-to-face contamination as been demonstrated out of medical contexts where aerosolization is more a problem, because of technical gestures and cares.
Even the linked page supposed to serve as a reference is completely speculative on the subject of the potential for the virus to be airborne: "In addition, it is possible that SARS-CoV might be spread more broadly through the air (airborne spread) or by other ways that are not now known."
So yeah, it also has not been proven that airborne transmission does not happen. But there are no strong signs showing we should highly worry about that highly speculative subject. The main contamination paths are well-known: droplets, and hand-to-face. If you want to strongly reduce the rate, you must focus on that.
> Even if we don’t avoid the virus 100%, reducing it by 80% could be the difference between something mild and something life-threatening. This could be a reason why so many otherwise young and healthy doctors and nurses have been killed by this virus.
Yeah, no. This is also completely speculative at this point. There is no strong technical reason for why it should be the case, given how viruses work... So not completely impossible, but short of real reasoning and evidences and studies, this is not a theory to particularly to focus on... ANYWAY, it is a good idea to avoid spreading the virus on all surfaces, but simply because this will statistically reduce the contamination rate (maybe without any impact on the severity for those who will be contaminated)
More generally, I'd like essays on that subject from people working in the medical field. And I'd probably not like essays on CS from virologists and epidemiologists...
I don't think there's any reason to exclude an article on the basis of who wrote it. Articles should be excluded because they're off topic, bad, or uninteresting. Essays on CS from virologists would likely be of high interest to this community.
Besides that generic argument, which has become a bit of a shallow dismissal lately, there's the fact that pb is writing about a project he's personally involved in and which hasn't been discussed here before. It's understandable if there's interest in that.
Yes it is. If the initial amount of virus exposure is low, the immune system has more time to react.
I don't have a cite, it was from the "This Week in Virology" podcast.
I also heard a number going around suggesting that an early group of people hospitalized and killed were Ear, Nose and Throat doctors, who obviously would have been exposed to an almost comically large amount of the virus.
Giving someone a little bit of smallpox was a known immunization method before modern methods were invented. You'd still get sick, but less sick, and you'd wind up immune.
I think this is mischaracterizing it. People have to die eventually. One year of existence has a mortality rate of 1%. For a 75-84 year old individual it is nearly 5%. Above 85 it's 14%. [1]
The coronavirus infection fatality is likely around 0.5-1%, but it's heavily skewed towards older individuals. Younger people do die from it, but a very low rates. And young people die from other causes as well, the annual mortality rates for a 20-something is around 0.1%. Getting coronavirus for a 20-something or 30-something is roughly equivalent to the mortality rate of a few months of life.
Death is sad and terrible, but we don't shut down society because people die.
New data is showing that the fatality rate from covid-19 is more like existing risk we were all previously exposed to in the course of our existence, and not like a second version of smallpox.
That’s assuming no second order effects like a shortage of medical care making things worse.
For one year (or however long it takes to reach herd immunity -- and if longer, then death rates wouldn't double but increase much less). Assuming recovery confers significantly long lasting immunity, which I agree is not a trivial assumption (and one we don't know yet how reasonable).
Definitely not trivial, but -- in context -- means a reduction of life expectancy by less than one year. The US already lags Japan by 6; there's a lot that can be done to improve it by a year, with costs much lower than those currently spent to avoid reducing it by a year.
An important thing to recognize is that the disease itself is not an existential threat (even smallpox wasn't; even the plague wasn't!), but our response to it skirts creating one.
We need to give the scientists and medical professionals and industry more time to figure out how best to prevent this. There are many reports of 40-50 day illnesses in young people due to not clearing the virus. And the poorly named 'mild' case can be rough. It's (badly imo) defined as when a patient doesn't require hospital. It should be called moderate I think. [1]
[1] https://www.businessinsider.com/what-coronavirus-mild-sympto...
Cardiovascular diseases 29.34%
Infectious and parasitic diseases 23.04%
Malignant neoplasms (cancers) 12.49%
Respiratory diseases 6.49%
Unintentional injuries * 6.23%
Perinatal conditions 4.32%
Digestive diseases 3.45%
Intentional injuries + 2.84%
Neuropsychiatric disorders 1.95%
Diabetes mellitus 1.73%
Diseases of the genitourinary system 1.49%
* includes car accidents
+ suicide, violence, war, etc.In the US, it’s largely the things I listed.
If getting it confers lifelong immunity (a question that does not yet have a definite answer), that means getting it means you compressed the overall risks of two years into one[0], or reduced your life expectancy by one year.
Now, one year is a lot. But the difference in life expectancy between the US (78) and Japan (84) is already six times as much, so the lockdown in that context is about 6 times more expensive (per day, per person) than moving to Japan[1] would have been before COVID19, and no one would have preached the latter.
Here's a conundrum: you can (a) lock yourself at home for 6 months, likely losing your job, potentially keeping in touch through the internet; then come back to "normal" life. (b) give up 6 months of your life expectancy, but go back to your normal life tomorrow. That is, w.r.t life expectancy, you can pause for 6 months and keep those 6 months; or fast forward those 6 months (and thus lose them). Almost everyone I know would pick (b) if there aren't any exception circumstances such as terminal disease. But the western world at large chose (a).
[0] That's not exactly true - depending on some other model parameters; reduction of life expectancy by 6-9 months is more accurate.
[1] It's not guaranteed that moving to Japan would grant you Japanese life expectancy. It is also not guaranteed that the lockdown as practiced really buys you more than a year either.
This is a whole different thing from 'another flu'. We have to address it head-on. Throwing people (a million people?) under the bus is not going to fly, not politically and not morally.
I've yet to see a compelling argument that LY or QALY analysis is the wrong approach.
> This is a whole different thing from 'another flu'. We have to address it head-on
It sounds like you're not actually offering any relevant response to the parent comment, but just repeating the taglines we all saw in the article.
> Throwing people (a million people?) under the bus is not going to fly, not politically and not morally.
Every political action has victims and beneficiaries. At the moment, we're hurting billions of people (almost the entire world population) to buy (on average) a few expected life-months for a very small section of the population.
Your model of "people dying is bad" is true but not sufficient to make rational decisions.
Data is showing that the infection fatality rate is around 0.5%-1%, and is concentrated in older people. [1] is one study, but there are many others. Given this data, it's clear that our current response is out of proportion with reality.
[1] https://www.reddit.com/r/COVID19/comments/g4tqvk/dutch_antib...
What we need to hope for is an unlikely vaccine, or a therapeutic treatment to mitigate the worst of the diseases effects.
> Data is showing that the infection fatality rate is around 0.5%-1%, and is concentrated in older people.
right, "old" (65+?) people are going to die anyway, lets just let them die sooner. How much sooner? Years? Decades? Does this really sound like a cogent counterargument to not letting people die?
Let's ignore the morality aspect of this, which I don't think is in your favor, to put it mildly. I don't really like people suggesting that millions of people should die because "this is sad, but at some point, everyone has to die." Yikes.
But lets pretend we live in a very nauseating reality where older people don't really matter very much. You should still want society shut down to prevent this spreading out of hand because this will easily and thoroughly overwhelm all of our healthcare resources, which will mean hundreds of thousands of people you actually do care about (i.e. non-older people) will also die from lack of medical care either from COVID, pre-existing medical conditions, new medical conditions, etc.
First, the .75% mortality rate is a one-time hit. It likely pulls some deaths forward, so the incremental death rate is maybe .5% in a single year. Again, this is terrible, and sad, but we should be mindful and accurate with numbers.
Second, people make lots of choices that increase their mortality risk by .5%. For example, lots of people eat at McDonald's on a regular basis, which certainly increases your lifetime mortality risk by .5%. And other people don't exercise at all. 30 minutes of jogging a day will lower your mortality by at least 1%, likely a lot more [1]. But we don't pass laws to force everyone to jog for 30 minutes a day.
With the new data, which is showing that mortality rates from covid-19 are not like smallpox 2.0, we should adjust our response to be more in line with responses to comparable risks.
[1] https://www.theguardian.com/lifeandstyle/2019/nov/04/any-amo...
This isn't really true. It depends a lot on the state. The healthcare system in my area, California Bay Area, is completely underwhelmed. Here are some numbers from San Mateo:
(1) 40% of standard ICU beds are open
(2) 91% of ventilators are unused
(3) 91% of "surge beds" are unused
Source: https://www.smchealth.org/post/san-mateo-county-covid-19-dat...
If our goal is to flatten the curve to slightly below hospital capacity, current policy has flattened the curve way too much.
Current number suggest that only 1-3% of the Bay Area has been infected with covid-19. If you wan to get to 70% infection rate for herd immunity, it would take multiple years to get there at current rates.
Those numbers reflect a correct, working response. Sure the restrictions can be lifted, but carefully and balanced by changes in those stats.
Our goal is to simply avoid hospitals becoming inundated. How would it be possible to flatten the curve to "slightly below hospital capacity"? To do that we would need to know exact numbers on hospitalization rates from infections, have a testing capability that is far beyond what we currently can do, and then we would need to have fine-tuned control on peoples' behaviors and also never be wrong. We have too much ignorance about too many things to do this in a way that you would deem optimal. This is a disease that takes a median of 5 days to incubate, so as soon as we get something wrong (hint: we will get it wrong), it festers for 5 entire days before we know it, and then we're stuck with the consequences. The only rational choice is to take severe action and hope it's enough. It wasn't enough in Italy, it wasn't enough in NYC.
If you're saying that social distancing/lockdown policies are an "overreaction" because we still have ICU beds and ventilators, I think that's a pretty good sign. The entire point is to do something drastic now, and gradually ease distancing measures as it becomes safe to do so without causing additional large-scale outbreaks. As soon as we have the ability to contact-trace all new infections and can successfully contain outbreaks, we can start letting up.
Of course, as others point out, there's also the enormous strain on the hospital system. Which, I am very curious: are you not aware of what has been going on with the NYC hospitals? Or parts of Italy?
[1]: https://www.worldometers.info/coronavirus/coronavirus-age-se...
IFR data hasn't been available until recently because you need A) randomized sampling and B) antibody tests, which have only just been rolled out.
The most up-to-date IFR data suggests that "0.5%" is actually an astoundingly high overestimate for any reasonable metric of "number of people who die from this", and that's before adjusting for the fact that the people who die were usually going to die soon anyway.
12k deaths in NYC gives a pretty hard lower bound on IFR of 0.14%.
The IFR will end up higher than 0.5% if incidence in city is any lower than 27%, which seems very reasonably likely.
For H1N1 swine flu, CFR was between 0.1% and 5.1% depending on the country. The IFR was 0.02%.
For COVID it's between 0.07% and 15%. The IFR is probably in the lower quartile of the 0.1%-1% range. [1]
Yea, but COVID has the potential to kill a lot of people, quickly -- are you suggesting it's a bad idea to "shut down society" to keep our hospitals functioning? I get the point that the economic cost is severe and also comes with its own share of human cost, but we're talking about saving ~1-2 million people in the US alone by doing this. Several trillion dollars is still worth it...
$2 trillion is 10% of GDP or the losses in ~6 months of a lockdown resulting in 80% productivity (with the assumption that everything goes back to normal immediately after the shutdown, which it won't)
So it seems like a ~6 month lockdown is warranted if you crassly value saving a life from COVID at $1 million. That's not long enough for a vaccine.
Alternatively, working backwards, you need to value a life saved at $3-$4m each to make a 18-24 month lockdown worth it.
EPA recommends that the central estimate of $7.4 million ($2006), updated to the year of the analysis, be used in all benefits analyses that seek to quantify mortality risk reduction benefits regardless of the age, income, or other population characteristics of the affected population
https://www.epa.gov/environmental-economics/mortality-risk-v...
No, we're not. 88% of people on ventilators in NYC don't survive (in a predictable pattern - 97.2% over age 65 don't for example). You might remember that just a couple of weeks ago, everyone was calling for more ventilators and every company with a workshop started building one -- because it was assumed (a) they would be needed, and (b) they would be very useful; neither is considered self evident truth (or truth at all) three weeks later.
There is no vaccine yet, and no medicine yet, and either may take a year or twenty (TTBOMK, no successful vaccine for the corona family was ever made, and not for lack of trying). Unless you assume a miracle, the assumption is everyone will get it -- and so far, our ability to significantly "save" people has not been demonstrated.
The only reasonable assumption right now is that everyone will get it, and while keeping the hospital system function is important in general, it makes little difference to those who get COVID19.
A more reasonable model is that we're avoiding a 6-8 month reduction in life expectancy, at a cost of (so far) 2 months of normal life. Whether it is worth it or not is not for me or you to decide and obviously depends on your point of view -- but it is clearly not self evident one way or another.
[0] https://www.washingtonpost.com/health/2020/04/22/coronavirus...
edit: someone is systematically downvoting all my posts on this thread. Whoeveer that is, I am not advocating for or against a course of action - I'm addressing the math. It is your right to downvote without explanation, but if you think I'm wrong, I would appreciate an explanation.
In fact, are you willing to die for it? If given the choice between dying of COVID-19 or shutting down society, you're saying that you personally would choose to die?
I'm bringing this up because the difference between this and other causes of death is that not only is this transmissible, but it also has knock-on effects that we currently have no clue about (see: blood clotting). If we don't do what we can to prevent this, it could become far worse than what we originally thought.
Obviously shut down society, but that's not the choice that exists.
The choice in reality is an acceptable risk of death, or shut down society. Between those I pick the acceptable risk of death. We all make the same choice for many, many other situations.
The reason why I bring this up is because when you argue for reopening society based on 'acceptable risk', you're not just risking your own life. You're asking other people who are at risk (ie people with asthma or other issues) to die for you.
Look at the excess death statistics. There's no question that it's deadlier than seasonal flu, because the seasonal flu doesn't kill a 9/11s worth of New Yorkers above the usual death rate over several weeks. If the current rate wasn't slowing we'd be looking at a death toll multiple times higher than the seasonal flu.
About 20% of people in NYC showed a positive antibody test. That's not nearly enough for herd immunity and it's not enough to push the infection fatality rate as low as the flu's.
https://www.nytimes.com/interactive/2020/04/10/upshot/corona...
Fuck your third solution.
No one has been promised a long life nor a happy life. The gift of life is imminent, and you should aim for being well and in a good state until you cannot.
Nature is the only religion than you really need to respect and obey. The rest is just for fun.
Let the virus go. Let people go. We cannot act as god, it's unfair for everyone.
So you first need to get 300 Americans on a max treadmill test to baseline, then.....
Also, you'd definitely need to do those VO2max tests in separate, sealed rooms because infected people would be huffing out maximum virus.
I'll give my Garmin 645 credit for consistency day to day, though I have no idea how close it is to giving the correct value.
So for people who are going to get sick it would trigger too late, letting them spread the infection for days until this test catches it; and all the many infected people who will never develop any symptoms (perhaps up to a half of infected according to the Iceland tests?) would never 'fail' this test, but still go on infecting other people.
It is for some demographics, not all. It's safer than the flu for young folks, especially the under 10's which the flu hits pretty hard. For some it's worse, especially over 70s.
> Catching this virus is a bit like playing a round of Russian roulette. You’ll probably be fine, but you could end up dead.
Also true of the flu. Yes, even for the seemingly young and healthy.
It's amazing how freaked out people are getting over this. All the data points to it being worse than the flu, but not drastically [1]. Certainly not "immunity checkpoints at all building entrances" worse, it's not ebola.
As well you omit the size of the vulnerable - everyone who is obese, diabetic, hypertensive, or cardiovascular diseased, or immunocompromised.
The first is just a fantasy - no one has an actionable plan to do it. The second proves the size of the problem, which exacerbates the difficulty.
Your claim is that the vulnerable can be “holed up” while everyone else goes about their happy business. There is no such thing, and I challenge you to provide the details and success as measured by per-demographic death rates of any proof you may have.
Not to mention even with complete lockdowns around the US we're somehow seeing 38,000 new cases per day. This is not winning. With an R0 of 2-5 a single new infected person post lockdown lifting is going to set the wildfire ablaze again. As China is showing us, if you lock down then re-open, you're just going to start playing whack-a-mole with rolling city-level lockdowns.
Even if we were to stay inside for months, the case the Swedes are making is that deaths are higher now than in locked down countries, but unlike locked down countries, the Swedes will have developed herd immunity in a few months, and will never be affected again.
This makes the temporary delta in death rates not a success for locked-down countries but rather a temporary deferral.
Sweden is proof of something, but it's not clear yet what. Somehow, their new case load is pretty flat, just like the US. [1]
[1] https://aatishb.com/covidtrends/?location=Canada&location=Sw...