COVID topic vol 2

[jacob]

Surely Elon Musk is smart enough to know what a false positive is when it comes to diagnostics. Otherwise he should read this: https://en.wikipedia.org/wiki/Sensitivi ... pecificity Claiming shenanigans when there's a perfectly valid mathematical reason that has been discussed for weeks only makes him look bad/irresponsible while serving as conspiracy fodder for the innumerate. Once the piss is in the pool, it's hard to get out again. The original viral tweets tend to be retweeted orders of magnitude more than the eventual retraction insofar there ever is one. One should therefore be extremely careful about verifying before posting on twitter. It's unfortunate that it's often the other way around.

And yes, the rapid tests are not fantastically accurate. They don't need to be. It's sacrificing accuracy for time. In terms of population behavior, it's better to be 80% sure immediately than to wait 5-10 days to be 99% sure. This is a known problem: https://www.fda.gov/medical-devices/let ... laboratory

[ertyu]

He is, unfortunately, also smart enough to know that people who are changing their mobility patterns due to covid don't buy teslas...

[Ego]

And yes, the rapid tests are not fantastically accurate. They don't need to be.

The results of these "tests" have caused schools to be closed and businesses to be bankrupted. Families are not permitted to meet for Thanksgiving. People are seriously considering going back into full lockdown because of the explosion of positives. An entire generation of young people were - if they were following the rules - not supposed to date people outside of their immediate circle for nearly an entire year. They don't need to be accurate?

This from a NYTimes investigation.
https://www.nytimes.com/2020/10/07/heal ... homes.html

Among 39 positive antigen test results from both BD and Quidel, 23 were found by P.C.R. to be negative — an error rate of nearly 60 percent.

At what point can we say that a test is not a test?

[jacob]

Think of the rapid tests as a kind of short term vaccine to take R0 below 1 as sick (true positives) and possibly sick (false positives) people but nobody else (true and false negatives and the untested) self-quarantine for 14 days. It's a more targeted way controlling the spread than 100% lockdowns or 100% mask compliance which have proven unpossible.

PS: We already did the long economy vs health debate in the other COVID thread. I don't see any reason to repeat it in this one. People's positions seem firmly entrenched and the situation hasn't changed materially since widespread vaccination is still several months in the future. We'll just end up getting angry at each other again over things we have no control over anyway.

[Ego]

Perhaps I am the only one who didn't know that the rapid test results were this wildly inaccurate.

[mooretrees]

Not all rapid tests are the same. There are dozens of manufacturers and types of tests. We do two types of rapid tests in my little hospital system, one is more accurate than the other, I think 99% for the PCR test versus 85% for the lateral flow test (basically like a preg test).

Another fundamental issue with any testing is the quality of the specimen. Which is why some specimens must be collected by nurses/clinicians, that's supposed to increase the odds of a quality specimen. So, it's not only about the actual testing platform.

[nomadscientist]

Rapid testing does not meet its potential without centralised quarantine, which would be authoritarian (unlike banning society indefinitely... OK sorry, I'll shut up...).

With mass testing and centralised quarantine, could be possible to eliminate the disease from after a successful lockdown, which at one point was considered to be the plan by some.

[classical_Liberal]

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[nomadscientist]

Escalating mandatory testing plus escalating mandatory sub-lab testing (temperature measurements etc.) following by immediate mandatory centralised quarantine would be effective - and was effective in several Asian countries. It doesn't need to catch every person immediately, only enough people quickly enough that R0 is pushed below 1.0. Keep it up long enough combined with entry restrictions and the virus is gone.

The Western approach is as half hearted as other Western policies on this virus which is to offer testing and then do nothing based on the result. So, we eliminate spread by conscientious worriers - the people least likely to spread it anyway.

[7Wannabe5]

@c_L:

Yes, so why not everybody wear a mask along with shoes and a shirt? OTOH, it does seem to be primarily spreading through overlapping “safe” social pods at this point. The last survey I saw indicated that 35% intend to carry on with BAU Thanksgiving. Humans...

[classical_Liberal]

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[jacob]

@CL (mostly) - Since I'm mostly in favor of individual actionality, the other solution is to get one's hands on a P100 respirator and add an altruistic [Filti] exhalation filter as discussed here viewtopic.php?p=220307#p220307 and here viewtopic.php?p=220316#p220316 which can be done for about $50 w/o supply constraints at this point. This way those of us who don't want to get sick can pay the price of looking like Darth Vader when we venture out in public and those who are willing to chance it can take their chances and partake in BAU thanksgiving. This is a solution I can easily accept given the darker aspects of my soul.

My main question, however, is how the health care professionals feel about this in general. I keep reading about doctors and nurses who are tired of bearing the brunt of the consequences of this, but perhaps this is just reporting-bias: Frustrated comments along the lines of someday not showing up for work anymore. About having to put in high levels of stress/overtime because people can't be bothered to take simple precautions. I'd expect anyone going into the care professions to have a substantially higher tolerance for "the karmic consequences of willful ignorance" than I do, but I wonder to which degree society is perhaps asking too much given that there's material personal risk in terms of getting infected and paying a personal price?

The more general question is of course how regular non-professionals who are likely to need hospital services feel about it---since I don't (I spend on average 30 mins in a hospital per decade) I can only speculate---and in particular how this might drive the conversation if it's not already doing so in terms of which side people fall on this issue.

[Lemon]

@Jacob There is certainly a non zero number of healthcare workers looking at quitting. There are always noises made about leaving in general and the surveys in the UK always give terrifying numbers like 1/3 of GPs thinking of leaving in 2-5 years. So far, that many haven't left. But COVID has focussed minds on this and those survey numbers have got worse. The UK does have worse shortages than the US, though the frustrations of work are similar but distinct.
Personally working in the middle of the chaos of the first wave at the time while out I would have flashes of anger at seeing people blatantly not adhering to advice. I was stressed, overworked, and sleep deprived at the time though reducing my tolerance for "the karmic consequences of willful ignorance" . It didn't really increase my quit thoughts. But anecdotally I have plenty of colleagues looking to either the exit or change in hours. Not to mention the extra mental health burden this has put on a lot of staff. Pretty scary numbers of PTSD and other mental health conditions if the surveys of front line are in any way accurate.
This wave I am more sanguine about partly because of a better working situation and partly having made (more) peace with the fact humans are going to human.

There is a really good interview by Chris Whitty in last weeks BMJ talking about how there is no 'good' option: here obviously UK focussed

[classical_Liberal]

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[Ego]

There is a really good interview by Chris Whitty in last weeks BMJ talking about how there is no 'good' option: here obviously UK focussed

Speaking of the BMJ. Apparently the editor is furious about the rapid tests and the "questionable logic of mass screening".

https://www.bmj.com/content/371/bmj.m4425

Now, a new example concerns the controversy over point-of-care antibody testing for covid-19.The prime minister’s Operation Moonshot depends on immediate and wide availability of accurate rapid diagnostic tests. It also depends on the questionable logic of mass screening—currently being trialled in Liverpool with a suboptimal PCR test.

The incident relates to research published this week by The BMJ, which finds that the government procured an antibody test that in real world tests falls well short of performance claims made by its manufacturers. Researchers from Public Health England and collaborating institutions sensibly pushed to publish their study findings before the government committed to buying a million of these tests but were blocked by the health department and the prime minister’s office.14 Why was it important to procure this product without due scrutiny? Prior publication of research on a preprint server or a government website is compatible with The BMJ’s publication policy. As if to prove a point, Public Health England then unsuccessfully attempted to block The BMJ’s press release about the research paper.

Politicians often claim to follow the science, but that is a misleading oversimplification. Science is rarely absolute. It rarely applies to every setting or every population. It doesn’t make sense to slavishly follow science or evidence. A better approach is for politicians, the publicly appointed decision makers, to be informed and guided by science when they decide policy for their public. But even that approach retains public and professional trust only if science is available for scrutiny and free of political interference, and if the system is transparent and not compromised by conflicts of interest.

[nomadscientist]

This works in Asian countries because a) it happened before widespread infection (hence exponentially increasing the number of people who need to isolate and comply)

Yes but in Europe we were there for several months in the summer and did nothing with that.

Also, our current approach to get back there is also a mass quarantine, just a far less effective one. Is it going to work? Why would it, if a much more effective quarantine would not work?

Do politicians/others in fact believe that the disease will somehow go into remission on its own and implement moderate lockdowns to be seen as doing something in the meantime? (imo plausible)

and b) cultural differences wrt to perceived individualism vs collectivism.

I am very skeptical that this is some iron constraint on Western societies. Who was it who carried out WWI with mass universal conscription armies? Not to mention the follow-on. Western societies have been very collectivist within living memory and demanded much more of their members than we are possibly contemplating now. I think we rather like to pat ourselves on the back about "individualism" when deep down we know the cause is really moral cowardice of our leaders combined with a probably much more limited state capacity than we had in previous generations. If we don't try to use it, maybe we can keep pretending it hasn't degraded.

[classical_Liberal]

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[Lemon]

@ego yes there have been concerns about procurement and affiliations of those in the system. Rapid tests are only good if sufficiently sensitive and specific. It also depends on the prevalence rate. But this concept along with positive predictive and negative predictive values is not something I think many politicians will get and when scrabbling around for any sort of solution I can see how such choices are made. I totally agree it should be transparent. But governments hate that.

Mass screening could help in theory but given uneven the PCR testing can be negative taken early enough on in the disease when you are still infective. The issue is how useful so actually a pilot in one of your worst effected cities seems to be to be a pretty reasonable thing to do.

[tonyedgecombe]

I don't think the drop in infection rates in Europe and the US over the summer had anything to do with policy.

It has definitely had an effect on Influenza, the CDC recently said it was down by 90% over the same period last year. Given that it seems likely that policy did affect covid as well.

[jennypenny]

Sorry, personal question ...

DS lives in SD and is flying home next weekend (for a couple of months). Since SD is such a shit show at the moment, his school has offered to test any student who wants one (on campus/free of charge) before going to home to family, which I think is a nice gesture. DS offered to get a test, but I'm wondering if it's worth it since he'll still have to fly home and could catch it en route, after the test. It's not the rapid test, it's the poke-your-brain test, so I don't want to make him take it if the results don't matter much. Any thoughts yay or nay? I want to have him tested after he gets home but you still need to show symptoms in my state to get a test. We have quarantine plans in place so I'm not worried about him infecting us. It's more that Thanksgiving is 6 days after he gets home and it would be nice if he could join us.