Frequent, rapid testing could turn national Covid-19 tide within weeks
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So you can't just test. You also need to avoid contact with other people, unless they have also tested negative. The White House clearly was not doing that. Even if they had, the tests are not totally reliable.
Given the number of people who come and go from the White House on a regular basis, it's kind of a surprise they didn't have an outbreak earlier than they did.
It has been effectively eliminated in both Australia and NZ this way. And the impact to the economy is significant but it's turning out to be far less severe than the rest of the world and their on/off again strategy.
This is anything but simple. Vast majority of businesses and people will not be supported if indefinite lockdown continues. The hidden costs of bankrolling an entire country for an indefinite period is much greater than the cost to deploy a persistent, scalable testing framework. The latter is also an investment into the future as this will not be the last pandemic.
Again this isn't some hypothetical exercise. Australia and NZ have just done this and now have basically eliminated COVID-19.
As opposed to manufacturing and distributing 100s of millions of tests each week which is very much an unproven exercise.
And you can fund it exactly the same way you did for the GFC (print money) or WW2 (war bonds).
But compare it to the cost of the US bouncing in/out of lockdowns for the next 9-12 months.
The problem in the US is that you cant pay people enough to change their minds about the politics. They would be, and many in fact are, millionaires and they would still refuse the test. Even if it meant jail time.
These solutions simply don't work in America.
it's not indefinite - it's just long enough to cut down unknown transmission to a managable number for contact tracing to kick in. Then public health measures like masking up and distancing is effective enough afterwards.
Businesses cannot stand uncertainty - a on-off lockdown that they cannot predict is the worst, because they cannot make investment decisions with this sort of huge uncertainty.
Not exactly an order of magnitude difference in population but yet there is a massive difference in the strategies and polices they've deployed. And now UK is a complete mess heading into winter and Australia has effective elimination.
Of course it might help that Australia is actually heading into summer.
Also in many places in Australia it was eliminated well before winter.
From tomorrow we no longer have to wear masks outside unless it gets crowded such that you cannot maintain physical distancing!
If the US or UK wants to, they can certainly make the same sort of lockdown. There are costs to it, but the leadership being incompetent at actually leading, is a bigger roadblock over the cost.
The UK is doing about as well as similarly populous countries nearby. Which is to say, not well at all.
The per-capita death rate in the UK is one of the worst in the world for this pandemic, and it's higher than the USA's. And they are now into a second lockdown. Whatever their strategy is, it's not working well at all.
https://covid.cornell.edu/testing/dashboard/
Their case-positivity rate is ~100x lower than many places in the United States.
We're in a much more suburban area than Ithaca, so that probably plays a factor.
Also, by the time you get your test results, you have been positive and spreading.
I get tested on Monday mornings, got a call Thursday night telling me not to come in on Friday. What good did that do?
Every bit helps. Perfection is the enemy of good. Rather test weekly than never. Rather test daily than weekly. Why not hourly or every 15 minutes though? Have to have a balance somewhere.
What good does it do to get a test and have results 2 hours later, if you spread the virus in that 2 hours? Better than spreading it for 2 weeks! But it still allows for it to spread. Something is way better than nothing.
One need not catch every case in order to make the epidemic burn out. One needs to reduce the number of transmissions/case below one. As we begin to win, contact-tracing becomes increasingly effective. When multiple-contact tracers can focus on a single known case, it is possible to really dig in and track cases effectively.
It's because the system as a whole is balanced on a critical threshold. It's like water boils at 101°C and condenses at 99°C.
The point is to reduce R below 1. When R > 1 the disease gets almost everywhere eventually. When R < 1 the disease fades away and most people don't get infected.
Currently R is above 1, but it's not a lot above 1. (We're lucky. There are other diseases where it's much higher.)
So even if you have been spreading on those 4 days, you are not spreading from days 5 onwards. That might be 10 days less spreading.
You are not giving it to large numbers of people in those 4 days either. As a spreader, you're adding risk to others, but only 1 or 2 will get it directly from you probably.
When you isolate on day 5, that's a reduction in the amount of spreading and it reduces R. When your traces also isolate from your day 5, that's a further reduction in the amount of spreading and R. That's recursive, if their traces also isolate, it's a further reduction, etc.
Altogether, if everyone follows these changes, there's a reasonable prospect of R falling below 1 enough for the disease to fade out. Because it's close enough to 1 already, that behaviour can make a significant difference.
In practice people do not comply, and they lie sometimes (https://www.bbc.co.uk/news/world-australia-55011790). So R does not fall as effectively as it would if there was high compliance. But every bit of compliance helps reduce R.
When R is consistently < 1 due to social changes, regular testing and behaviour changes in response (even with days of delay), tracing, social distancing and masks and workplace changes and commute changes, etc. then we will find the disease fades away.
It looks unlikely this will happen until we have widespread vaccination in some countries (USA is one of the leading examples), but the more we reduce R meanwhile, the fewer people will die or get long covid in the end. And fewer here means in the millions.
This group will keep the virus alive no matter what, endangering not only themselves, but the rest of us.
ETA: Many downvotes, many upvotes. Downvoters: I would love to hear from you what you find objectionable.
In January of this year, there were a negligible amount of people in the US with Covid. Let's say now in November everyone gets tested every day, and you have an unbelievable compliance for self quarantining on positive results. It would never happen, but pretend it's 99.9% of people following the rules to "drive the virus towards elimination within weeks". Great, now you think you've beaten it back to where it came from.
How does this do anything other than reset the clock back to last January just in time for next January? As soon as everyone lowers their guard and goes back to normal, it's going to spread again. We need immunity from a vaccine or from it running its course to be done with this.
What am I missing? Are we going to setup nationwide contact tracing this time? Just a few visitors from other countries, and we're at it again.
I say this as someone that is fine complying with my states restrictions. I even think they are correct, if only as something to try. I'm just not seeing the end game here. :(
Of course this works out easy in a post. Good luck implementing it in real life. People violate quarantine if they can.
Or did you mean we're all going to do daily testing and contact tracing forever?
First, that alone would be HUGE progress.
"As soon as everyone lowers their guard and goes back to normal, it's going to spread again."
Yeah, but this time you're not going to have whining, tantrum-throwing, conspiracy-mongering, megalomaniacal, science-denying children in charge.
We've yet to see if they wind up being more competent and actually make a difference, but the chance to do proper contact tracing on the relatively few people that get infected will be there, and hopefully the country will take it more seriously the second time around.
I'm not hugely optimistic, but if they actually followed through and were competent in dealing with it this time, it could save millions of lives.
I think you greatly overestimate how politics plays into this. It never ends until we're immune.
You just keep testing people, and do isolation and contact tracing on the ones that get sick.
In the meantime, vaccines will start to roll out.
Curbing this pandemic is perfectly practical and within reach, given the will to do it.
So just do what we do in Australia and quarantine them in hotels.
If you manage it properly it can be highly effective.
Rapid testing and isolating (I doubt the US could "enforce" it but you have to give the benefit of doubt that a percentage of people do care for others and will isolate - FWIW, I've seen this happen in Oz where a large %-age of people did isolate) will reduce/delay the infection surge and give time for the healthcare system to recover from the second shock this year. In addition, with the EUAs in flight by Jan '21 (hopefully), this one-two punch should drastically cut both infections and deaths. Remember, in the world of exponentials, both increase and decrease are exponential.
I think it's optimistic to assume this could be used as an entry check for a restaurant.
A nitpick, but it deals with a pervasive idea that should be updated.
The virus will most likely never "run its course" to give us collective immunity without technological intervention.
That's because herd immunity is only known to have ever occurred as a result of deliberate vaccination, and even then it disappears in areas where vaccination stops. It has never been observed to occur naturally as a result of infection.
In other words, the "natural herd immunity solution" is simply not something most of the scientific community believes to be an option right now. Instead the prevailing theory is that if we let it "run its course" it would in fact continue circulating endlessly, gradually mutating.
Epidemiologists do perform calculations to estimate how natural herd immunity might arise, but it has never yet been observed to actually happen, and the calculations are intrinsically rather unreliable.
From "The false promise of herd immunity for COVID-19" (21st October 2020, https://www.nature.com/articles/d41586-020-02948-4):
> never before have we reached herd immunity via natural infection
Also maybe relevant, if herd immunity could occur naturally, then the calculations done around it lead to:
> proposals to largely let the virus run its course [...] could bring “untold death and suffering”
Literally if the vaccines were known to have side effects 10x worse than the worst side effects in history, it would still be orders of magnitude safer to give to those over 65 than not. https://www.cdc.gov/vaccinesafety/concerns/concerns-history....
IIRC, the EUA analysis is in flight (for a December timeframe) and that is to ascertain that the data is up to the mark and not to take what the companies have announced at face-value.