Paul Buchheit: A Possible Third Solution to End the Pandemic | Hacker News Reader

Paul Buchheit: A Possible Third Solution to End the Pandemic

paulbuchheit.blogspot.com

20 pointsaxiomdata31618 comments

Longform article from a few days ago (August 2020), almost seems like a followup to Paul's April blog.

https://www.theatlantic.com/health/archive/2020/08/how-to-te...

Michael Mina is promoting self-administered daily lateral flow [1] paper strip tests while Paul’s startup PreDxion Bio [2] is working on a SPR [3] device which I think is an alternative to Isothermal PCR devices like the Abbott ID.Now and the Canadian exclusive Spartan Cube.

I think Michael Mina’s core contribution is mapping the PCR Cycle Threshold (CT) value to transmissible viral load (CT < 24).

Rapid tests need to be benchmarked against samples with CT values of 24 or less. Paper tests meet this benchmark.

[1] https://en.m.wikipedia.org/wiki/Lateral_flow_test

[2] https://www.predxionbio.com/

[3] https://en.m.wikipedia.org/wiki/Surface_plasmon_resonance

“Friday, April 24, 2020”

“If all goes well, there will be millions of scanners deployed by this fall”

Ageing well…

UIUC is going to test all students twice a week, and has the capacity to run 10,000 tests per day. I wish other institutions would copy their methodology and build upon it.

Our pocket computers should have the necessary sensors to dynamically test for all kinds of diseases.

Deluseional pipedream disguised as information.

Let's make a test for heart disease we can take every day. Let's make a test for cancer to spot the first mutated cell. Let's invent a time machine to fix it all.

There are three solutions, but not yours.

1. Open everything as long as the curve is flattened to rush to herd immunity. This was the plan. Why did it change?

2. Wait 2 years for a cure.

3. Allow willing participants to get the virus to make vaccine tests better. It will be cured in 2 months. We allow people to sign up for war and risk their lives. Do the same with science.

Number 3 makes me wonder: Do you think they have a lack of patients?! Why would we need any extra for testing?

You could do things like see if they can catch it from touch. Or 3 meters social distancing.

Then when they get it you can do further tests, tracking everything from day of conception.

All with top notch the best hospital care, so their risk would be similar overall as being in the community.

I'd do it for fun, even without extra hospital care.

Millions will die because of University ethics committees.

[OT] I really like the Interrobang ‽I wish keyboards had it.

“Millions will die because of University ethics committees.”

Uh-huh.

https://www.cdc.gov/tuskegee/timeline.htm

I did wonder which of the two cliche examples would be pulled out ;)

Also everything by Milgram, Pavlov, Zimbardo, Jane Elliott, Ron Jones, My favourite - Schachter and Singer (Misattribution of arousal)

Basically anything classical you read about on HN about psychology no longer passes ethics.

“cliche examples”

Well that’s certainly a perspective.

Interrobang ‽ has bad readability, in my opinion. Perhaps a capital letter P with a dot underneath would be better. I found many letters with "DOT BELOW" in charmap, but no "P".:

ḄḅḌḍḤḥḲḳḶḷṂṃṆṇṚṛṢṣṬṭṾṿẈẉẒẓ

It makes absolutely no sense to me, that there would be some characters with dots below, but not others, even of the latin alphabet. What?! Why?!

I argue #1 is still the _only_ realistic plan. And it hasn't changed, it's proceeding, whether we want it or not. Other countries which managed to "beat" the virus will join the rest later this fall. I hope they stockpiled enough PPE in the meanwhile. It ain't over until it's over. The virus is now endemic - it's not going anywhere. The only way out, besides a vaccine, which may or may not work, is to get the virus and acquire immunity (or die). People are just scared to admit it.

> This was the plan.

I'm starting to suspect that the real plan was killing as many poor people as possible, explaining the mass baths and stupid advices (cleaning masks with gasoline, go away and enjoy your tear gas, or drink poisons to poison the virus, and so...)

> Why did it change?

Because this plan leads to healthcare system collapsing as collateral damage, and this is an universal fear in all countries. If it collapses people that otherwise would recover, will die by lack of medical resources.

And because it failed. After all those months we still are far from herd immunity, even if we had sacrificed thousands of elders in the way.

> the best cure for any disease is to avoid the disease.

That ship was sailed, for several reasons, and specially for some countries.

We may have already reached herd immunity in some locations, like northern Italy, NYC, etc - the places hardest hit so far, with many other places such as southern Florida on the way.

This would be due to T-cell immunity conferred by prior coronavirus exposure, measured to exist in as much as 50% of the sample populations in replicated studies, lasting for up to 17 years. This is not reflected in the B-cell antibody tests being done.

This also helps explain why different regions of the world were impacted differently - they had different histories of coronavirus exposures.

Refer to https://www.nature.com/articles/s41586-020-2598-9

If we are reached herd immunity, why we have even more new cases than ever?. Herd immunity means that disease is unable to spread anymore, we can see that this is clearly not happening. Anybody can see this.

What we are seeing in reality is a patched distribution or a model in mosaic, a case studied in ecology. Models predict in this case an infinite cycle of conquest and retreat that fits much better.

The science around the evolution of this pandemic is still up in the air, but it's not as crazy an idea as you think, here's an article talking about herd immunity in some NYC neighborhoods, without regard to t-cells [0]

I agree that herd immunity, whenever it manifests, would be patchy. NYC is not the same as other cities in NY state as far as exposure, or all the small towns and rural areas in between, etc.

I thought the paper on t-cells was interesting, in that the patchiness of covid impact around the world could partially be explained by prior coronavirus exposure, which would be expected to vary by region.

[0] https://www.marketwatch.com/story/have-you-herd-new-york-mig...

The tests (LFA strips that basically work like pregnancy strips) were first developed back in February and have been modeled to be accurate enough with daily (and up to 3 day) testing to stop transmission in its tracks.

Development has been slow on rapid tests since the FDA seems to not understand tests primarily for surveillance shouldn’t need to meet guidelines for diagnostic testing.

For those interested in reading the preprint on the modeling:

Larremore, Daniel B, Bryan Wilder, Evan Lester, Soraya Shehata, James M Burke, James A Hay, Milind Tambe, Michael J Mina, and Roy Parker. “Test Sensitivity Is Secondary to Frequency and Turnaround Time for COVID-19 Surveillance.” Preprint. Infectious Diseases (except HIV/AIDS), June 25, 2020. https://doi.org/10.1101/2020.06.22.20136309.

For nasal/saliva antigen point of need rapid tests, there are at least 4 different kinds being sold commercially outside of the US currently. The Indian MyLab Pathocatch is $6/test. For those interested in reading more about rapid testing, I’ve been putting together a document here: https://www.notion.so/lhl/COVID19-Preventing-Spread-and-Tran...

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