A Third Solution(paulbuchheit.blogspot.com)
paulbuchheit.blogspot.com
A Third Solution
https://paulbuchheit.blogspot.com/2020/04/a-third-solution.html
530 comments
Hi, Walker here, one of the PreDxion co-founders. Up until recently we've been focused on developing our technogy as a point of care biosensor for us in patients experiencing dysfunctional immune responses (e.g., sepsis, ARDS, and the immune responses induced by certain cancer immumotherapies).
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.
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.
It’s critical to not underestimate the non-technical steps here, in terms of how do you deploy at scale, convince venues to install, deal with throughput rates, tie results to individuals, etc. All solvable, but it’s important to think about those sooner rather than later.
I have some experience on the security side here and how to deploy technologies like this at scale... happy to help (my email is in bio).
Yup, lets look at the actual and physical supply chain of “at scale” to be tackled to succeed.
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)
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)
What TRL are you at for the original POC test, and what TRL are you at for viral detection? Any published papers for viral detection?
Are TRLs usually used outside of government R&D related things? If they got an SBIR I guess they'd be familiar with the technology, but I'm only familiar with it because of DoD funding applications and stuff, it's not terminology I've seen used in the private sector too much. Maybe it is, I'm curious to know if that's the case. I've usually only heard stages of tech development discussed in terms of preclinical, clinical stage, and other regulatory frameworks rather than tech readiness level necessarily.
I’ve seen TRLs used in tech transfer offices and engineering departments in academia; NIH and NSF (usually associated with SBIR programs) as well as the DoE; in medical device and pharma manufacturing; and in life science VC groups. In private companies and VCs I’ve heard it used most in management and BD contexts. I think TRLs can provide a useful second axis to the more common clinical or regulatory development staging.
Agreed. TRL (tech readiness level) isn't something commonly used outside government.
Right, I think we’ve probably missed boat on developing new diagnostic methods for Sars-CoV2.
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...
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...
I'm not familiar with the acronym PSM. Can you expand?
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
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
Sorry, typo. I meant SPR (surface plasmon resonance).
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.
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.
We've developed something NGS-based we call SwabSeq. You can find out more here: https://www.notion.so/Octant-SwabSeq-Testing-9eb80e793d7e463...
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.
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.
Oh, nvmd. I just saw you wanted a $1/run. Something ONT based perhaps.
Wouldn't many of the non-technical hurdles be reduced in the current situation? FDA approval steps for example have been relaxed for potential treatments. It's not my area, but I'm just curious what makes it so impossible or unlikely.
Hi,
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!
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!
Quotes from the article:
“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.
“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.
Reminds me of that access control system in the movie Gattaca, where you had to give a blood sample ;-)
https://i.pinimg.com/736x/ac/aa/b0/acaab01e6647159309f680844...
https://i.pinimg.com/736x/ac/aa/b0/acaab01e6647159309f680844...
An easy fix would be to require that all saliva samples are disposed of into the same container, mixing all samples of all tested persons.
Or you do the test yourself, and just show the already-completed test to the guy at the office door, and keep the test hardware, just like you currently show but keep an ID badge.
Sure, some people could fake the test, but for this approach to work, all that matters is that most people don't fake it.
Sure, some people could fake the test, but for this approach to work, all that matters is that most people don't fake it.
Perhaps, but if you think about how systems like this work today, for example scanning ID at the entrance to a nightclub or bar.
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.
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.
The swab could be ok, but I’d get really annoyed if entering any place required me to wait around for 10 minutes.
My Millennium Prize challenge for those clamoring to reopen the economy is: How do you reopen Disneyland? (I think Disneyland was even referenced in the article.)
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.
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.
Waiting in line for a venue can easily take 20-30 minutes. So why not deploy this to places like this. You get the test done while waiting in line at no extra time cost to you. So you wouldn't even be waiting 10 min to get in. That's already something you do.
At attractions and large events, maybe an app (or just a database linked to some sort of ID) to prove a person has passed the screening that day (or recently enough), so it doesn't all need to be done at the attraction/event itself?
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.
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.
This isn't a unique idea. This is the mainstream view. Everyone knows we need more testing and that testing is the only way to effectively ease distancing rules. That was a pretty extensive writeup to say what we've been hearing from all rational information outlets for a month.
I have not found any mainstream sources that advocate screening everyone every day (which is very different from simply doing "more testing"). Would love some pointers if I'm wrong.
Paul Romer, an economist at NYU, has been advocating for testing millions of people a day for a few weeks. He is co-author of a piece in The Atlantic, "Without More Tests, America Can’t Reopen", https://www.theatlantic.com/ideas/archive/2020/04/were-testi...
Googling for "romer covid 19" should turn up a lot of news sources covering the notion of testing millions of people a day.
Googling for "romer covid 19" should turn up a lot of news sources covering the notion of testing millions of people a day.
Yes, he is the best I've found. This proposal is still at least an order of magnitude more testing though :) (on the order of 100 million tests/day, not 1 million tests/day)
Romer has called for as much as 30 million tests a day, which I think was based on some simplistic modeling. I think he was targeting everyone in the US being tested every two weeks. I think the two approaches are similar: let's test lots of people all the time, however many X million tests a day that is, so that we can quickly isolate and treat them. People are spreading it before they know they have it, so let's just test everyone all the time and not wait until they have symptoms.
Paul Romer is also a recipient of the Nobel Prize in Economics.
> I have not found any mainstream sources that advocate screening everyone every day
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.
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.
If this concept would work in principle, covid could be reduced to scaling testing capacity. My impression is that estimates about achievable testing capacity don't assume a most-important-short-term-problem-of-mankind priority and resource allocation.
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.
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.
The concept for restarting the German football league involves daily testing of all players. So the idea is indeed widespread, but often enough just impractical for the numbers of tests required.
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.
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.
I would expect where there's a large enough economic incentive, and wealthy-enough private group (say, the NFL, MLB, etc) who wouldn't need to wait for government policy or supply, we will see daily testing of their 'employees' so that they can get back to operating. May not be any fans in a live setting, but better than nothing.
> screening everyone every day (which is very different from simply doing "more testing").
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
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
I think governor Cuomo was saying he'd love to test every day if he could, but just doesn't have the capacity. Edit: as a side note he put out a call for companies that can help with testing saying that NY state might be willing to invest to bring things to scale. I believe he already wanted FDA approved tests but there's an opportunity there to work directly with a government to implement this sort of thing.
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.
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.
Gov Cuomo should call up Gov Pritzger. Illinois recognized the challenge of testing supplies and asked the state universities to solve the problem. They have. Illinois is reporting a lot more positive cases in the past week because they keep increasing the number of daily tests. I believe that today was well over 12000 tests in Illinois. Anyone who feels like getting tested is now allowed to get a test.
New York has done more tests and more tests per capita than any other state per latest numbers - the reason for more tests isn't just to test people who want it, it's to run large random tests, require tests before visiting nursing homes, get an accurate picture of the infection rate, etc. We're testing more per capita than most countries in the world and it's still not enough. We've tested approximately 4 times as many people with only about a 50% higher population than Illinois and it's still not enough.
https://www.politico.com/interactives/2020/coronavirus-testi...
https://www.politico.com/interactives/2020/coronavirus-testi...
Sorry, I wasn't clear. Illinois has built out their own manufacturing supply chain and testing facilities. They are self-sufficient. If New York wants to scale up testing and has money to invest in doing so, they should look at how Illinois managed to make that happen.
This is maddening reading this thread. What is the reason for a federal gov't but to coordinate such cooperation? It goes back to creation of the "United States"! (this is hypothetical question, not one i expect you to answer)
Honestly, at this point I wouldn't be surprised if New York has tested more people per capita than all the comparably-sized countries in the world. There's a few countries which have beaten them, but it's generally small ones like Iceland.
Christian Drosten (German virologist, one of the most prominent experts here) has been advocating daily testing of medical workers.
This is a slightly easier situation, since you can trust them to swab themselves, and the logistics for collecting samples is already in place.
Can you trust them to swab themselves if their livelihoods depend on them attending work? The testing is only one component there I think.
In Germany, and generally in Europe, yes.
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
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
Every single country that has had any success containing the virus, including the origin country of China, has had rigorous continuous testing to contain the spread. It's hard to find a country with success containing the outbreak that doesn't do constant ubiquitous testing.
I suggested testing everyone every month about a month ago. This is a conservative testing frequency that would almost certainly put r0 under 1. Everyone every day is an overkill - why not everyone 4 times a day? What's the rationale for it other than it sounds good?
Because going out every day and knowing you are not infected feels pretty good?
Isn't this a minor upgrade on what the authorities did in Wuhan? They squashed the disease at the epicenter, faster than the tail-off in Italy, and a lot of it was massive screening and isolation of anyone showing symptoms, or with a high temperature (1), or testing positive, or anyone in contact with those.
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...
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...
You won’t be able to scale your solution before a vaccine is out, rendering your entire solution useless unfortunately.
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.
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.
> You won’t be able to scale your solution before a vaccine is out
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.
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.
I have advocated it. Allegedly everyone who comes close to Trump gets swabbed and rapid tested on the Abbott machine.
How does your device detect viruses? Is it based on a protein or the RNA or what?
How does your device detect viruses? Is it based on a protein or the RNA or what?
Everyone says "we need more testing", but there's actually very little discussion of how that testing would translate into lower transmission. I'm skeptical any program less aggressive than the one proposed here would get R0 < 1.
Testing by itself does nothing to reduce transmission. What it does do, though, is give you the opportunity to identify infected people and isolate them. And if you can identify and isolate them early enough in the course of their illness, you can prevent them from infecting many other people, and that’s what reduces transmission.
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.
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.
Right, but I haven't seen anything to suggest our current testing plans will be universal or frequent enough to really solve this. So testing more is certainly better than not testing, but without constant testing of non-sick people it's not really going to help much.
"Quantity has a quality all it's own"
"Quantity has a quality all it's own"
The article specifically is about a solution which would enable enormous amounts of people for cheap, so you can do universal tests.
Exactly. More testing is good, but actually stopping pandemic will require orders of magnitude more testing, which in turn requires a different approach to testing because the current way we do testing can't scale.
I mean in theory if you had a perfectly accurate test and everyone got tested before coming into contact with others, that gives you an R0 of 0. How close we can get to that standard is obviously very debatable, but simple logic tells us that it certainly could push the R0 below 1 given some (unknown) threshold of test accuracy and compliance.
Is it because the discussion isn't needed? Anyone who is of moderate intelligence and thinks for a few seconds can see the next logical step. I don't know pb and he might be wonderful and original etc, but I have to agree with the original comment - this is just miles from an original idea. The constraint is tests, not ideas of what to do when we have simple/fast/abundant testing available.... "A third solution" makes it seem like it's... an original idea.
I think calling it a third solution is totally fair. Whether it's a novel solution is separate.
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.
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.
Imo, those are the currently discussed solutions because of the lack of available testing. Ie, with the current constraints. It's akin to two people discussing how to use the budget of $1 million and a third saying "I have a third solution: Make the budget $100 million and do everything". Sure, it's not wrong, and it's different to the first two, but... who cares? Everyone kind of already knows if you have the $100 million you have a much better option.
I think the main point is that he's pointing toward a specific test being developed that is intended to facilitate greatly increased degrees of testing. It is of course generally understood that if we could test everyone daily (or even a large section of people regularly), it could allow the virus to be contained without such widespread distancing and shutdown measures.
> 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.
> 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.
Agree to that point. The German, French and other media repeat that idea in the past weeks.
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.
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.
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Testing isn't the only way.
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)
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)
(I'm no epidemiologist etc.)
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.
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.
The idea would be to isolate the vulnerable and let everyone else get it.
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...
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...
I really hope this works. Without some new testing technology, I just don't see how we can stop the spread of this disease. A month ago, the US did about 100,000 tests per day. Yesterday, the US did about 200,000 tests. Growth in testing started off as exponential but now it looks linear.[1] Even if testing capability doubled every month, it would take 8 months before we could test every American once a week. (200,000 * 2^8 == 51,200,000, which is 15% of the population.)
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...
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...
Making this worse, the final size of an epidemic can be estimated as not p=1-1/R0, but rather p=1-e^-R0 [1]. With this, those R0 estimates give a final infected population of 95%-~100%... we can't let herd immunity be the solution.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3506030/
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3506030/
> Even if testing capability doubled every month, it would take 8 months before we could test every American once a week.
At this point, I'd consider that a success.
At this point, I'd consider that a success.
The post refers to an alternative method of testing for COVID-19 based on surface plasmon resonance that would have significant advantages, but unfortunately it provides absolutely no real substantiation that the test exists or works. The link about surface plasmon resonance goes to a generic Wikipedia page, the link about saliva is a small scale study that was conducted on RT-PCR not surface plasmon resonance, and the actual link to the team goes to a nothing more than splash screen with the company logo on it.
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.
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.
Hi, Walker here, one of the PreDxion Bio co-founders. Heres a some more information on the technology underlying the test we are developing: https://pubmed.ncbi.nlm.nih.gov/25790830/.
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.
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.
I worked at Integrated Plasmonics in 2012–14, the major problem you will face is fluidics and sample handling not so much the sensor design. You should consider stochastic plasmonic features grown using dna self-assembly on the surface of a cmos sensor (lots more recent work on DNA-based plasmonic nanostructures). I worked on varieties of ways to characterize a chemical signal even from stochastically distributed plasmonic features by running calibration during manufacturing. We were able to use support vector regression to characterize known chemical reaction signals on a per sensor basis.
If you have to do that for every sensor the cost goes up a lot. Also, "stochastic plasmonic features" without knowing much more sounds like something that varies by time of day, wind currents in the lab, whether you hit it ten minutes ago with a socket wrench or didn't.
Thanks for engaging with the HN community. I'm a bit disappointed that the original article doesn't say if the author is associated with your company. At one point he says "We", but it's never clear. Did I miss something? Your comment doesn't address this issue at all. Investor? Employee?
Ethics are an important thing.
Ethics are an important thing.
What do you think of the article's claim that eliminating the cold virus would be a good thing? I think I read somewhere that early exposure to cold viruses reduces the chance of acute lymphoblastic leukemia, which makes me wary of trying to eliminate them completely...
There’s a lot of really interesting work left to be done in this area. In our company’s other life we’re involved in CAR-T research, which involves exploiting natural pathways in our immune systems to target them at cancer cells. It’s a super exciting area of research and is bleeding edge in terms of breakthrough therapies coming into the clinic. These therapies[0][1] cure upwards of 90% of what would otherwise be incurable cancers, but they also induce severe inflammatory responses (cytokine storm) which results in respiratory failure and neurological adverse events (that’s a nice clean clinical way of saying putting them in a coma).
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...
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...
Don't worry. We're not going to run out of cold viruses any time soon, and the pitch was hyperbolic in virtually every way.
OK, but what are you detecting? Antibodies? Viral proteins? RNA? The messages from Paul and your team have been contradictory. The message is confusing, and this makes people skeptical. It would be great if you could clarify the detection strategy.
He should also disclose any personal interest in it more clearly at the top of the article.
At this point all our personal interests are to stay virus free as long as possible, given what we don't know might kill us. I really don't care why he's speculating about the things he is. Many of the things we postulate may be proven wrong simply by waiting long enough to get more data - i.e. it's not always necessary to formulate a test for disproving an idea, sometimes they evaporate on their own. (Software features for example frequently meet their ends this way).
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 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 gathered the same thing. Basically the gist is, if we can develop a cheap, fast, and effective test for COVID-19 then we can test everywhere and re-open everything.
Hasn't that always been everyone's argument? That's the crux of Pueyo's "dance" [1], that as long as you've contained the initial outbreak, you can pretty much go back to normal if you track movement and have the capacity to test everyone who comes in contact with an infected person.
[1]: https://medium.com/@tomaspueyo/coronavirus-learning-how-to-d...
[1]: https://medium.com/@tomaspueyo/coronavirus-learning-how-to-d...
This has been one major argument. The others have been: "flatten the curve - just extend the time until everyone gets it" (obvious problem, exponential growth can't work that way), "shelter in place 'till a vaccine appears" (not very practical) and "it's really not that bad, there are so many asymptomatic carriers that in the end it's not actually worse than the flu after all or at least there's nothing we can do." (not that plausible, not appealing, non-fatal cases still much worse than the flu).
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.
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.
> "flatten the curve - just extend the time until everyone gets it" (obvious problem, exponential growth can't work that way)
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.
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.
The characteristic of exponential is that things tend to come all once. In the final double period, you get as many cases as all the other doubling periods combined.
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.
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.
""flatten the curve - just extend the time until everyone gets it" (obvious problem, exponential growth can't work that way)"
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.
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.
One goal is to flatten the curve so that we don't have exponential growth
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.
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.
Sure. Yes. Of course you can flatten a lot and still wind up overwhelmed. Or, you can flatten enough that you don't.
"Flatten the curve" and "shelter in place" aren't mutually exclusive with a necessity to ramp up testing or develop a vaccine, they are just things that laypeople can be doing in the mean time to mitigate the negative effects of the virus while those other solutions are prepared.
That post, which was very popular, immediately came to my mind too.
It also feels like the logical next step to the very widespread testing found in countries like South Korea.
It also feels like the logical next step to the very widespread testing found in countries like South Korea.
Is this what you're looking for? Scientists at NTNU St. Olav's Hospital has made a test that can check 150,000 patients per week for Corona infection [1]. (Yes, it's the same uni that used the USA as an example in warning students abroad against poorly developed health systems lol.) Already testing is a lot more frequent in Norway because of it, and they're cautiously re-opening some businesses and services, the first of which are kindergartens and hair dressers.
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...
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...
The relevant quote actually concerned the collective infrastructure in the US, including health insurance. The actual quality of care in the US is great, particarly for specialty cases... for the few that can comfortably pay for it.
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."
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."
Yeah but maybe we shouldn't. We have the technology to compartmentalise our society WAY more than it currently is, at relatively little cost. COVID-19 is a fantastic dress rehearsal for the next disease, which will be far scarier and will come relatively soon. Humanity is a monoculture and like all such, is very vulnerable to pathogens. We need to start building social distancing into our culture the same way we built protection for sex into our culture.
Ever since 2000, we've have a pandemic once every decade. The next one will occur soon, but it's not certain whether it'll be as scary as COVID-19.
> 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.
> 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.
> I should emphasize that what we need is physical-distancing, not social.
Good distinction. We should be focusing more on hygiene while finding ways to connect remotely with the people who are important to us.
Good distinction. We should be focusing more on hygiene while finding ways to connect remotely with the people who are important to us.
> 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.
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.
> FaceTime and Zoom have a significant cognitive load, too
Why the cogntive load would be lesser in a face to face conversation than digital assuming the internet connectivity is good ?
Why the cogntive load would be lesser in a face to face conversation than digital assuming the internet connectivity is good ?
I don't know why or how, but I can confirm that remote connections have a significantly higher cognitive load than in-person interactions. Perhaps it's the same reason as why talking on the phone while driving is much more dangerous than talking to the passenger in the seat next to you.
"We are for the most part more lonely when we go abroad among men than when we stay in our chambers."
- Henry David Thoreau
- Henry David Thoreau
According to my biochem-undergrad kid, surface plasmon resonance is a thing; it had come up in classes. "It's like doing an ELISA with no secondary antibody". Someone here will know what that means. I don't!
A regular ELISA/immunoassay is: surface->Ab->protein<-Ab+signal. In school these are taught as "sandwich-assays". Basically you have one antibody to bind your molecule of interest to your substrate, and then another second which binds the bound molecule... which has been bound to the surface. This second antibody is decorated with an enzyme which will do something fancy (color-change) or a fluorescent protein to light-up if we shoot it with a laser. SPR is a label-free approach which results in an optical response in real-time as molecules associate with the SPR sensor. Detection is then a function of how long you need to let things bind to the sensor before your ability to detect the signal optically.
Sounds like your undergrad kid has been paying attention in class...
Sounds like your undergrad kid has been paying attention in class...
It's a very sensitive detection technique that uses some cool properties of light. We used it 20+ years ago in grad school (they were very expensive machines that were extremely hard to master; everything from calibration to routine operation was significantly more challenging than most devices I worked with) and I think it has quite a history before that. Never heard of it being used for rapid detection in a public environment; my experience is that things that work in a lab setting often don't externally unless somebody comes up with a good technology improvement (think vacuum tubes -> transistors -> small radios).
Can confirm that. Source: Worked with SPR/OW spectrocopy many a time during my time in research.
It’s a thing, but doing a saliva test with limited sample prep (which you need to be beat PCR, otherwise you might as well just make more known to work qPCR machines) is not something anyone has accomplished with it for any virus. It’s a promising technology; but not for having a widely deployable test before we have boring old ELISA antigen tests. Which we have developed for plenty of viruses, and which some individual companies alone can manufacture at a rate of several per second with existing production capacity.
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.
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.
Test complexity (sample prep, test workflow) is a real challenge to achieving testing scales at orders of magnitude above what is presently available.
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.
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.
ELISA tests don’t need to be done at central lab facilities; there are plenty of machines on the market with varying levels of automation (and many already in hospitals, even in ones that aren’t particularly outstanding). I’m curious what barrier to scaling those with COVID (either by making more of these machines, or repurposing other test capacity) you’ve identified that makes bringing a totally new machine to market more attractive, from a scaling perspective.
> 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.
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.
If one is clever, one can use SPR to interrogate a surface: monitor the surface and you can “see” the surface changing when stuff is sticking to it. If you have something with specific binding properties on that surface, like an antibody (as is used in an ELISA), with some additional effort you can maybe have an assay that detects something binding to that antibody.
And it's a public kiosk that you spit in?
I'm not so sure about this!
I'm not so sure about this!
You can rank people by the likely benefit of testing them. Interestingly, it goes up as the square of the number of people they interact with daily. (Because their risk of having it increases, and also the number they are likely to spread it to.)
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.
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.
Curious to know how you are getting power of 2 exactly. Are you just saying it's some sort of power law growth and approximately 2, or is there an actual way of deriving it?
If we assume (key) that the probability of becoming infected is directly proportional to the number of people you interact with, and consider that the probability of spreading infection given that you are infected is obviously directly proportional to the number of people you interact with, the product gives a quadratic function:
[probability of becoming infected and spreading] = [probability of becoming infected] * [probability of spreading] ~ [people you meet]^2
[probability of becoming infected and spreading] = [probability of becoming infected] * [probability of spreading] ~ [people you meet]^2
Okay so something like:
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?
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?
In math and (especially) physics it is common to express "proportionality" laws usually with a symbol that looks like LaTeX \propto. So for instance the activity A of a radioactive sample is written A \propto e^(-t/T) where t is time and T is the mean lifetime of a single particle. For convenience \propto is often transliterated as ~ when typing. So that becomes
p_catch ~ n
p_spread ~ n
p_relay = p_spread * p_catch ~ n^2.
p_catch ~ n
p_spread ~ n
p_relay = p_spread * p_catch ~ n^2.
Thanks, that's a much clearer way to think of it.
[deleted]
This isn't quite right. For one, the probability of being infected is not linear (it's capped at 1). If you do the math, the expected number of people you infect (given you are not infected) is roughly linear-ish.
> the probability of being infected is not linear
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.
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.
Wouldn't it also vary by percent of population without immunity, perhaps demographics in the underlying population, and other environmental things (weather?). Seems like a (useful) aproximation.
If you have N nodes and completely connect the nodes, there are O(N^2) edges. This comes from the formula for the sum(1...N).
Edit: I’m not sure I interpreted the original statement correctly.
Edit: I’m not sure I interpreted the original statement correctly.
That's what I was about to answer. That's where squaring comes from, in this case. However, as others have noted, you could just sort by # of people contacted, since squaring just gives you larger numbers for no benefit in analysis here.
Since squaring is a monotone transform over nonnegative numbers, why not just sort by (# of daily contacts in a closed space)?
> If we were able to identify and quarantine everyone who is contagious, including those who are asymptomatic, then we could let everyone else out of lockdown and resume ordinary social and economic activity.
> 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.
> 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.
It's daily screening for exactly that reason. Is there something I should change to make that more clear?
But how realistic is daily screening on a wide scale? You're going to face major issues with compliance.
That's why I think testing at the door is the more straightforward way to start. We can reopen factories, office buildings, even shopping malls, but no one gets in without passing the screen.
This test takes 10 minutes. That is probably still too long to implement at the doors for most places. It will end up creating a bottleneck of people waiting to enter the building and another avenue to spread the virus. Making the inside of the mall safe from the virus isn't going to matter if everyone is exposed to the virus while waiting in the 30 minute line to get into the mall.
The article is suggesting daily testing and used "testing at the door" as an example.
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.
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.
You can't just ignore people who don't travel by car. The hardest hit place in the country in New York City. Most New Yorkers don't own cars and many go months at a time without entering one. And even outside of cities, it is still classist to only allow people with cars to reenter society.
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.
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.
A solution that works outside of the vicinity of New York, would still allow at least 47 other states to open up.
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.
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.
New York City isn't the only place in which car ownership is low. What about Chicago, Philadelphia, San Francisco, Los Angeles, Boston, DC, etc? If your plan for reopening the nation doesn't include reopening our cities, it isn't a real plan for reopening the nation.
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.
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.
I wouldn’t plan on reopening the nation, since it was never closed from the top down to begin with. Individual states, and in many cases cities and counties, made the decision and continue even now to enforce rules different from one another.
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.
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.
that also doesn't mean that if you come up with a plan that only partially works you stop working on it. Perfect is the enemy of good.
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.
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.
You could probably use an app or just get their mobile phone number. It seems likely to me based on reading a lot of case studies that this virus is largely spread through talking, yelling, and singing. If we tell people not to talk for 10 minutes while they wait for their result, it could work if you could get people to comply.
But that just moves the compliance and logistics problem back one step. Who's doing this massive amount of testing? If it's the government, you'd need armies of workers spread out everywhere. If it's the owners of these buildings, who checks to ensure compliance?
Imagine trying to enforce this on every non-residential building in, say, NYC. It would be practically impossible.
Imagine trying to enforce this on every non-residential building in, say, NYC. It would be practically impossible.
> If it's the owners of these buildings, who checks to ensure compliance?
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.
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.
To your point, many businesses and facilities implement safety measures because they fear civil liability for preventable damages. I don’t think that’s likely in this case but if you can get most businesses and facilities to be mostly compliant most of the time, that might be enough.
There are many unlawful activities that could be solved with cash rewards for people reporting said activities.
There are many that are. Don't people get rewards for reporting malfeasance to the SEC, or ADA violations? I'm sure I've read about that, as well as about how some people think it's a questionable system. But privatization of enforcement of some regulations is a thing.
For this to work I think you would need a much stricter compliance than what is enforced in restaurant cleanliness.
It doesn't have to be good enough to catch all cases immediately, just good enough that isolated outbreaks can't sustain themselves.
It doesn’t need perfect compliance to push down the R0 significantly. Lockdowns in the US are mostly not being strictly enforced, but enough people are complying to have a major impact.
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.
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.
Now imagine going out shopping, you’re stopped at the door, and you test positive. What happens then? The government puts you in a car and sends you... back to your apartment? Sounds like a dystopian nightmare, to be honest.
we're in the middle of a pandemic. at some point you've got to accept that dystopia is here, and the dystopian things that are happening are realistic ways of dealing with the situtuation.
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.
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.
Fair enough. But I hope that line of reasoning has limits. After all, it would be safer to send everyone by truck to a quarantine camp instead of back to their apartment where they might infect their neighbors in the lobby, wouldn’t it?
That's actually how China handled it. If you test positive, you don't go home - you go to a facility to be quarantined and treated if necessary.
That's been proposed
in the northeast US (MA, NY, NJ, CT, RI). Hotels would be used for mandatory quarantine. Tests and contact tracing (manually, then smartphone) would determine who gets isolated.
The flu comes every year, and it’s not even a order of magnitude less fatal. Maybe COVID will come back every year too.
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.
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.
Can you please stop posting in the flamewar style to HN? This sort of rhetoric and polemic destroys curious conversation, which is what the site exists for.
https://news.ycombinator.com/newsguidelines.html
https://news.ycombinator.com/newsguidelines.html
It seemed in-kind with the “dystopia is here” rhetoric, but I understand answering in the same vein doesn’t make things better.
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.
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.
There are two things that don't make sense to me about your original post.
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?
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?
Thanks for the feedback!
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.
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.
The store does not permit you to enter and you are asked to go home and self-quarantine.
What if you infect someone on your way back?
You’re still in a much better position than we are today, where you’d infect several people in the store, and again the next day, and the next.
I'm weirded out by this binary thinking arguing against masks or testing. It's like the people who say that helmets don't prevent all injuries, which they conclude means one shouldn't be wearing one. Except that where helmets are only individual protection, measures against infection are affective at a population level, where you profit from others' actions.
You are handed a free mask that serves as warning people to give you space, and you are simultaneously logged as being infected with the CDC.
Not only you, but everyone who was recently within six feet of you as determined by contact tracing (manual now, bluetooth later). If you don't live alone, you go to a mandatory isolation center, possibly a designated hotel. Kids can be separated from parents.
https://www.wbur.org/commonhealth/2020/04/03/contact-tracing...
Now is the time to express opinions on these "proposals"..
https://www.wbur.org/commonhealth/2020/04/03/contact-tracing...
Now is the time to express opinions on these "proposals"..
How about the doors being to planes?
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.
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.
Paul, I posted this is part of another comment also, but for places like shopping malls, testers could also test people while they're in the parking lot.
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.)
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.)
Frankly this is the idea that a software guy comes up with. It’s like you translated the idea of checking every API request for malicious payload to a real-world situation and left out the 99.997% of the parts that make the problem hard. It’s like assuming the existence of a teleporter.
What door? You mean my front door? I'm not letting anyone in, and I'm not leaving either. What are you going to do, call the cops to kick in the doors to test me?
No, I mean the door to the office building, shopping mall, or other place where groups of people gather and potentially transmit the virus.
it is pretty clear, but the conclusion of the parent is still pretty strong:
> Sounds like a logistical nightmare.
> Sounds like a logistical nightmare.
> I'm not sure this "test and release" strategy works unless absolutely everybody gets tested simultaneously.
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.
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.
Compliance is tough. And my main concern would be false positives- if we are screening more people more frequently, we would have a lower expected percent of true positives, and even a small false positive rate could lead to significant overdiagnosis and disruption. The more often the test the more stringent that requirement. I dont know much about the testing method described in the article, but I wonder if it has unique characteristics beyond ease of administration to support that broad use case
A reasonable policy is to go home when the machine at the door to your office gives a positive result. Then get a more specific PCR test, and maybe come back to work. So the cost of a false positive can be one lost day.
The false positive rate of lockdowns is 100%.
The false positive rate of lockdowns is 100%.
Exactly. While this plan would certainly result in some disruption, it would be a lot less than the current status quo. And you can't really compare it to simply "opening back up" without a plan like this, because the simple fact is that even without government-enforced lockdowns, many (perhaps most) people won't return to a normal level of activity if they don't feel safe doing so.
> “...because the simple fact is that even without government-enforced lockdowns, many (perhaps most) people won't return to a normal level of activity if they don't feel safe doing so.“
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.
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.
"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"
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".
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".
All the more reason why extensive testing, allowing them to go back to work safely, would be great!
s/willing/forced
> The false positive rate of lockdowns is 100%.
If that were true lockdowns would make absolutely no difference in R0. Clearly, they do make a difference.
If that were true lockdowns would make absolutely no difference in R0. Clearly, they do make a difference.
I don't follow your reasoning. Maybe we use a term differently? Here's how I understand them:
- 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.
- 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.
Re is a different number based on what proportion of the population is immune. Here we are talking about R0.
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.
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.
> I'm not sure this "test and release" strategy works unless absolutely everybody gets tested simultaneously.
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.
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.
But contagious status is not fixed. If you test someone, they're negative, but despite sheltering in place they pick up the virus while at a necessary doctor's appointment, then their status changes. Granted, frequent follow-up tests might identify that change, but daily tests of a sufficiently large portion of the population have a number of challenges beyond just access to the tests.
The difference here is that you test everyone entering a certain location, not everyone in general. This is much easier, and allows testing to be focused on most needed areas. In effect, if you only go to the groceries once a week, you will be tested once a week. If you go back to office, you will be tested every day. The more you interact with people the more you get tested to keep the interactions safe
Straw-man. Many scenarios exist to get most of the benefits without resorting to 'everybody simultaneously'.
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.
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.
Not trying to show bravado or anything, just pointing out that I and probably others feel this way; I would fight tooth and nail against pervasive, mandatory "test and release" policies on humans (and the necessary concomitant growth of the surveillance state). The second-order social and political effects of such a policy would be disastrous - orders of magnitude worse, in the long run, than the population-level health effects of this virus. People anticipating these effects would probably be prone to civil disobedience, making the logistical nightmare even worse than what you would get with a fully passive and compliant population.
This position truly baffles me. I can understand people who have reservations about tracking everyone with phone apps to do more effective contact tracing. But objecting to widespread, low-cost testing for virus infection as an extension of the surveillance state? I don't even know how to argue against that because it simply doesn't make any sense to me. Right now the population is clamoring for more widespread and effective testing. Why would people rebel against it? You think people would prefer to remain locked down, or to sacrifice 0.5-1%^ of the population, than be regularly tested for infection? Why?
^or whatever the true number ends up being
^or whatever the true number ends up being
I think it's the mandatory part that's rankling centimeter, and I see their point. Once you give powers to the state in an emergency situation it's really hard to roll them back. See the PATRIOT act for example.
Is there a way to effectively get universal compliance without implicitly granting permanent new powers to violate civil liberties?
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.
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.
I'm not sure new state powers would be required. The state already can (and does and should) compel people who are known to be infected to be quarantined, or at least self-isolated. As far as testing, companies can already require employees to be tested as a requirement to work. A lot of companies already do drug testing of employees, something I actually don't agree with in most cases, but it's already a norm. In normal times they likely won't have sufficient incentive to do virus testing though, and so probably wouldn't given the cost.
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.
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.
Ok, simple basic counterargument.
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 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 is the pandemic over? When does the pervasive testing stop?
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.
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.
Fair enough, I accept that premise. Let's revisit in like... 8 months.
You work at a hospital, you're required to get a flu shot. I don't know how long this has been the case, but I can say firsthand over a decade.
This is a decentralized proposal similar to going through a metal detector to enter a building.
"Test and release" only works in science fiction. In the real world there is no absolute test that would enable practical test/catch-and-release processing of infected persons. From an epidemiological perspective, when applied to an entire population even tiny false negative rates will let countless infections slip through. False positive rates will see some people doomed to perpetual lockdown as, for whatever reason, they repeatedly test positive.
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.
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 be sure it's not an existential threat?
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.
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.
>> (some asymptomatics athletic types have shown severe decline in lung abilities following covid19)
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.
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.
Did you have trouble breathing when you had the pneumonia? These are cases of people with 0 or low # of symptoms, and only knew they tested positive of the virus. I'd imagine they just didn't realize they were sick, and then they eventually start feeling fatigue and run down when doing 'normal' things even after the virus passing their system.
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.
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.
These are part of worst case scenarios that are not published openly. We need more data, and until then the responsible actions are taken by almost all govs.
This is essentially what South Korea did. Granted it was done in a different way but everyone was “tested.” I was there just as covid-19 was on the rise and every shop, every station, and every high traffic area had people set up with thermal guns. Shop staff were having their temps checked before their shifts started. Everyone was gloved and masked. And once they had a proper test in place it was made easily accessible — even set up drive through testing.
And now they are pretty much back to normal while much of the world is still at a standstill.
And now they are pretty much back to normal while much of the world is still at a standstill.
They learnt from the previous SARS bout, reportedly thanks to a number of political factors aligning properly.
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.
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.
China had dispatched detachments of specialists to evaluate the unknown disease in mid December. They knew they were facing a new coronavirus ala SARS end of December and started closing Wuhan then other provinces in January. Not the chill lockdown like Europe, real lockdown where they close all transports, scan all citizens at checkpoints and have the police beatup people going out without masks.
Napping is not the word for that.
Napping is not the word for that.
But of course you need to package it as an unique, never seen before, game changing solution and write a blog post about it. He’s shilling his startup
Really interesting read and sounds like it could be a game changer for testing - I know in NY we've been clamoring for increased testing for a while to help us reopen. I've got two questions I'm curious about:
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!
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!
0) From a clinical perspective this is data we are generating on an on going basis. Analytically this is a largely a function of the characteristics of the affinity, specificity of the capture molecule used to capture the target (viral particle). As you point out EUA gives opportunities to launch sooner... But it's still critical to validate technogies both internally and externally probably to a greater extent than the de minimus EUA reqs
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.
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.
Thanks for your reply! Makes sense with regards to the specificity and sensitivity. Are those more scalable supply chains ones that expose you to risk with international suppliers? My understanding, at least from what we've been hearing from our governor's press conferences (so take it with a big political grain of salt obviously), is that while we have high throughput machines capable of large numbers of tests, the reagent supply chains all go back to china leaving domestic companires reliant on international trade negotiations to be able to get the inputs they need to scale. Is that a valid type of concern and are there concerns that even if it's technologically easily scalable, the political and operational logistics of relying on third parties with different incentives could negate that advantage? I don't knwo how valid a concern that is, but that's the narrative we keep hearing here.
I think we're up against many of the same challenges everyone else (Roche, Abbott, et al.) is up against. At the end of the day if we could all wave a magic wand and fix supply chains we would. Technically, we (the collective diagnostics hive-mind) know how to detect viruses. We haven't yet figured out how to deploy these technologies on scales orders of magnitude above our baseline implementations.
How is chip fabrication is more scalable than plastic 384-well plates and cotton swabs? Nothing shy of a home pregnancy test is more scalable than qPCR.
Great question.
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.
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.
OK well, having used a Biacore perhaps two decades ago, I'll just have to imagine your "magic" must be pretty good to compete with plastic multiwell plates and cotton on a stick.
50 or 100 sites, each with say a few dozen liquid handling robots. Let’s say each site runs 200 plates per day.. doesn’t seem unreasonable. The only hard parts are the funding and regulatory requirements.
You're getting downvoted but I think it's a fair question actually. I'd assumed they were referring to tapping into non-stressed supply chains. What you mention is valid though and something I'm curious about as well. Are the consumables reliant on chip fabrication? I don't think PCR machines themselves are scalable, maybe chips are more scalable than the optics systems for qPCR, but a valid point about whether the consumables are more scalable as well.
Tests are R&D in Norway that could test entire population in 2-3 weeks. It's developed to scale, so may improve. It's coming and soon, though there will be a ramp-up.
A very recent Yale study suggests promises for saliva-based detection:
“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...
“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...
They're in a "startup incubator" for bio firms in South San Francisco.[1][2] The incubator is run by a unit of Johnson and Johnson. Multiple companies (51 are listed, but some may no longer be there) share 30,000 square feet of workspace there. "We welcome new resident companies with the infrastructure and tools they need to get up and running on day one. This capital efficient model takes time and investment out of the equation—eliminating the normal setup typically required of a startup."
[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...
[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...
PB, can you elaborate on which other possible answers you've found for fast, easy, and abundant tests?
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.
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.
I'd love to hear more! Part of the reason I put this out is to encourage other people with technology for fast, easy, cheap testing come forward.
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.
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.
Solutions like this give me hope that we can actually return to something resembling normal life in the future. I hope Paul's got everything he needs in funding and resources to pursue all three of his goals.
I hope everyone has noticed that if this approach could wipe out COVID-19 it could wipe out influenza and even the common cold.
Imagine how naive our immune systems would become. It could have unpredictable effects, like increasing the rate of novel zoonotic disease transmissions.
Maybe something like this is what set the stage for the common cold wiping out the aliens in War of the Worlds.
Maybe something like this is what set the stage for the common cold wiping out the aliens in War of the Worlds.
We would still be exposed to a wide variety of diseases even if there were no more common cold viruses floating around. The common cold viruses haven’t helped us deal with COVID-19 :(
> The common cold viruses haven’t helped us deal with COVID-19
We don’t actually know that yet.
We don’t actually know that yet.
[deleted]
A fourth way: We throw as many resources as we can at sampling undiagnosed populations, like the recent NYC study that suggests 20% of the city (10% of the state) has antibodies already.
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.
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 arithmetic on that is ~1 million early deaths in the US.
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.
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.
> The arithmetic on that is ~1 million early deaths in the US.
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.
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.
New York (state) deaths per infection assuming ~10% overall spread:
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.
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.
No, if elderly/vulnerable continue precaution, more like range(.001 - .0001) x .6 x 330 million = 20k - 200k 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).
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).
I like how you're ignoring the organ damage in even younger survivors like it's rosacea or something.
Cite something -- anything -- legitimate that points long-term organ damage in young, otherwise healthy people. Newspaper anecdotes don't count.
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...
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...
https://www.washingtonpost.com/health/2020/04/24/strokes-cor... (TL, DR: NEJM next week)
Right. So a day after you make your comment implying lots of young people are experiencing long-term organ damage, the WaPo discusses an as-yet-unpublished paper discussing a small number of stroke victims who may or may not have been influenced by this virus.
If this is the best you can do, you're grasping at straws.
If this is the best you can do, you're grasping at straws.
I like how you're pulling the fear card instead of contributing to a real discussion
There is an episode of Sliders (Fever, Season 1, Episode 3), where they slide into a world affected by an infection with no cure, and scanners have been placed at the entrance to every store to detect if you have it.
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.
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.
I remember that episode!
Love the Sliders reference. I might stream that all weekend.
Love the Sliders reference. I might stream that all weekend.
Cheap & working saliva test would be such a tracking game changer that I am really hoping it works, so good luck!
A) Does he have any financial interest in PreDxion Bio? This sounds like another smaller startup claiming bullshit.
B) Testing for O2 levels using already cheap + widely available pulse oximeters is probably an insufficient but necessary measure.
B) Testing for O2 levels using already cheap + widely available pulse oximeters is probably an insufficient but necessary measure.
Thank you Paul. Two questions :
Does this approach bypass the reagent shortages ?
What are the specificity / sensitivity metrics ?
Does this approach bypass the reagent shortages ?
What are the specificity / sensitivity metrics ?
Couple of things at play here. First is we are developing a non-PCR based viral detection test. Many of the molecular tests approved rely on many of the same ancillary components (RNA extraction kits, flocked nasal swabs, viral transport media) as well as instrument systems. What we are developing is a non-molecular based test to directly detect SARS-CoV-2 particles in fluids, specifically saliva.
We've just begun our clinical testing so don't have specificity/sensitivity metrics yet, but will be sharing them when they're available.
We've just begun our clinical testing so don't have specificity/sensitivity metrics yet, but will be sharing them when they're available.
Paul, is there anything HN readers can do to help with this?
Ah, of course. We create a new type of [patentable] ubiquitous technology and sell our way out of this. Leave it to the entrepreneurial mind...
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
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
I’m having difficulty understanding why SPR would be more scalable than LFAs for this type of frequent screening? And what does the ROC look like for this startup’s SPR assay?
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.
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.
There didn't seem to be any details at all. Is there some sort of functionalized surface that specifically binds the virus, if so what molecule/chemistry, how?
edit: this is all I found about the company:
https://www.sbir.gov/sbirsearch/detail/1564207
https://innovation.medicine.umich.edu/portfolio_post/sepsis-...
edit: this is all I found about the company:
https://www.sbir.gov/sbirsearch/detail/1564207
https://innovation.medicine.umich.edu/portfolio_post/sepsis-...
[deleted]
Good sleuthing! As you suspect we functionalize the our sensor surface to specifically bind the virus. We've partnered with a therapeutics company developing highly specific monoclonal mAbs against SARS-CoV-2 which we leverage in our diagnostic platform.
> 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.
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.
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.
Also remember this is literally a virus that emerged from animals in the first place (zoonotic transmission).
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.
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.
I really feel like we're spitting into the wind. There are very few who agree with this position.
The latest on the COVID-19 R0 is a median of 5.7, up from the previously thought range of 2.2 - 2.7.
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.
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.
> The latest on the COVID-19 R0 is a median of 5.7
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.
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.
> infection rates are a lot higher
in certain urban cores. herd immunity requires well mixed populations
in certain urban cores. herd immunity requires well mixed populations
Not sure if I'm missing something, isn't Saliva based testing almost/basically here?
1. https://finance.yahoo.com/news/orasure-technologies-receives...
2. https://www.politico.com/states/new-jersey/story/2020/04/23/...
1. https://finance.yahoo.com/news/orasure-technologies-receives...
2. https://www.politico.com/states/new-jersey/story/2020/04/23/...
After the whole Theranos debacle, I'm most curious how due diligence was done on this team and their technology.
The most important thing was mentioned at the top of that article: there is a very effective thing everyone can do right now and does not require any technology: keep your distance. Stay at home, if you can, and in the public, keep distances. Face masks are an important help in this distancing, as there are always situations, where you can't quite maintain the "safe" 2m distance. If we all kept perfect distancing, the virus would be erradicated in 4-8 weeks.
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.
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.
There’s not enough consumable tests, and there is currently no installed base of surface plasmon resonance machines, nor any of the other myriad types of constant-monitoring systems that have actually been proven to work for many years now in high-risk facilities (I developed some for the government 15 years ago and it wasn’t new).
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.
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.
An honest query by a non-medical professional as I'm sincerely curious...
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?
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?
Thermometers are better than nothing, but unlikely to stop the spread because of asymptomatic transmission (easy to catch the virus from someone who doesn't have a fever). This is why I think directly detecting the virus is essential.
In a best-case scenario, what is the timeline for testing, widescale manufacture, and rollout including “last mile” education to end users for the saliva tests? Is it achievable within a quarter? 2020? Beyond?
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?
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?
The fast gun like IR thermometers are not very accurate. And can be fooled. In one case an infected person took fever reducing medicine specifically so that they would be allowed on a plane where the temperature was checked on boarding.
My assumption would be that high accuracy solutions such as PCR testing or even the saliva testing that Paul is suggesting would be ideal, but potentially difficult to effectively rollout in a widespread manner. While IR thermometers are not very accurate, are they on a whole accurate enough to effectively screen out a sufficient number of people to reduce the R-factor viral spread below 1.0? Again, I’m not a medical professional, but shouldn’t we be biasing towards processes already being used by the multiple regions that have seemed to have successfully managed to reduce the viral spread below 1.0 first before seeking new solutions?
I’m sure this is the last of their concerns, but the word “disposable” and “daily” immediately made me think, “great, more garbage.”
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
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
This is not a third solution... It's the first ever thought of. But impractical, very expensive, and therefore, unrealistic.
An inadvertant Masterclass on how to convince a non-technical audience to invest in a tech startup.
- Take a huge and important problem
- Show the current challenges/lack of solutions
- Propose a 'radical' alternative
- Lend credence to the competency of the team
- 'How world can be saved'
- Imply the resultant victory
And critically, ensure there aren't really enough details to evaluate the proposal.
...
Profit
It’s a cool solution but I don’t like the fear mongering at the beginning. Reminds me of this (0)
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...
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...
Most of the statements in this article are false or exaggerated. There are no studies to back them up. These are just personal believes born out of fear.
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.
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 can't we reflexively refute things if they are wrong?
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.
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 it’s worth a shot. Around the world, countries will use different strategies long-term, and the best strategies will be employed by all others, eventually. If cheap and extensive testing works as a means of reducing infections, then the world will be better off for it. Rest assured, studies will be done, but before they can be done, funding has to be ensured. And that‘s what I see this article try to do.
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.
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.
Any examples? It really reads like common sense to me.
Sounds like the start of a plan. My questions would be around those 10 minutes at the entry door. What do we do with people? How are they connected to the test? How do we keep separation between people? How do we grant access after the passed test? What happens to those around if someone is +ve?
Maybe it can be accompanied with an app which would send you test result so you don't have to literally queue. And then use the result to enter the building.
This is a solution that could work provided we have a rapid on the spot test. David States has recently proposed exactly such a test and apparently his company is woking on developing it [1].
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.
1. https://twitter.com/statesdj/status/1253794887062958081
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.
1. https://twitter.com/statesdj/status/1253794887062958081
I'm in a medium income country, Thailand and they do quite well testing people they think at risk and if you have it the government pays the costs of quarantine / treatment / some lost income. It works well. I don't see why similar won't work in poorer countries. They use regular PCR but a better test would just make things better I guess.
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.
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.
The correlation is between countries who were harder hit with SARS. They were better prepared for this outbreak.
But it's also a good deal of luck. Test and tracing works until you miss enough people that you get controlled community spread.
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 not sure I believe that Vietnam has had zero deaths.
How many tests is Thailand doing per day?
How many tests is Thailand doing per day?
[deleted]
> 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. The virus is about the same size as the particles in cigarette smoke (though it would usually be part of a larger droplet), so I find it helpful to imagine a smoker exhaling smoke, and what it would take to avoid inhaling too much of that second-hand smoke.
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?
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?
The virus can travel through droplets and other large particles, so you definitely have to watch out for people sneezing etc. around you. There isn't any consensus, however, for whether it is airborne or not, i.e. whether it can be in regular exhaled air. Of course you should take precautions regardless.
Yes
I'm tired of reading that it spreads through the air and so we should avoid indoor spaces where we share air. It spreads through droplets large enough for the gravity to pull them down relatively fast.
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.
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.
How sure are we?
https://www.sciencedirect.com/science/article/pii/S016041202...
https://www.sciencedirect.com/science/article/pii/S016041202...
All studies that point to it being airborne are from medical setting or are misrepresented in the media. For example there's a new one that circulates abbreviated to "air conditioned restaurants make SARS-CoV-19 airborne".
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.
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.
Let's hope this works, and if it does, that we use it for every other kind of disease as well. I'd sure like to never get the flu, or the common cold again, because we brought their R0 to near 0 also.
Unless we have a fool-proof self test kit that is so cheap to mass produce and distribute so everyone can use it every morning by simply dropping saliva and the result is available within 5 minutes while the probability of false-negative/false-positive are practically zero, A Third Solution the linked article suggested never happens.
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.
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.
Prediction: no test development will be faster than the spread of the disease so when tests are easily available many or most densely populated areas will be at over 50% immunity.
>over 50% immunity. //
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.
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.
Yes - I’m only talking a about Covid. This can definitely be interesting for Covid-31 though.
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.
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.
I think the ubiquitous testing is the right approach, but I don't think we need a new test. Any test that requires a machine is going to be a severe bottleneck in testing.
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.
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.
Someone would be infected and contagious for awhile before developing antibodies though.
I agree that reliable antibody tests will be a help to policymakers in how they model the continued stay-at-home posture and begin to open things back up.
I think the jury is still out on 1. The persistence of the antibody response post-infection and 2. the neutralization/protection afforded by these antibodies.
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.
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.
I tried to order some of those off Alibaba in feb. The current ones never took off because they don't work very well, I think.
Not only is it completely unrealistic at scale, the specific approach in the blog post is wildly impossible at all.
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.
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.
The saliva stays inside the tube for that very reason. The test specifically identifies the virus, not the antibodies, again for the reason you identify.
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.
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.
Assuming everything goes to plan, how will these be staffed and manufactured at scale?
It's a fully automated solution, like an airport kiosk or a subway turnstile. Maybe I need to make that more clear?
Yes, I didn't get that from the essay. It's a fully automated scanner that can be operated by the person being tested?
How far along is development?
People hop over subway turnstiles all the time. It would have to be more secure than that to make me feel safe once I'm inside.
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.
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.
I might be misreading your comment, but I don't think the blog is promoting antibody testing? It sounds like the blog is about a method of detecting viral particles directly, perhaps using an immunoassay based on the wiki for SPR, but not to test for antibodies directly.
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.
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.
A shopping mall could have screeners at literally every entrance, and there are sometimes dozens of entrances at a shopping mall.
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.
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.
Not to quibble too much with most of your criticism, but this one seems minor and trivially solved:
> 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.
> 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.
> people who are antibody-positive have a standardized note confirming recovery
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.
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.
There are different subtypes of antibodies that you test, some that emerge early in infection and others that emerge later. The current understanding is that the later emerging antibodies being positive generally indicates that you are not only recovered but also immune from the virus and can donate your own convalescent plasma to be used as a drug for people with the infection. If you test positive for early antibodies you are assumed to still be undergoing the course of the infection.
Test positive. Wait 14 days. Now you're positive clean.
Also test igg instead of igm, and data suggests igg is more reliable anyway
And is someone going to verify I waited 14 days? Also, why should I have to if I already am clean?
> And is someone going to verify I waited 14 days?
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.
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.
I also don't think this particular test is an antibody test? It seems that this test detects viral particles based on:
"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)
"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)
I mean, my reaction is certainly on the "let us know when you start scaling out a quite accurate test" side of things, but I don't understand the point of declaring that it can't work.
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.
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.
People don't even observe yield signs reliably. You think everyone on earth is going to suddenly obey testing requirements?
If there's a fast, accurate, cheap test, I don't think compliance is going to be a big issue.
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.
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.
> antibody assays; this does not allow the screener to differentiate between "has COVID-19" and "had COVID-19"
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.
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.
Some of the assays do appear to functionalize the surface to directly bind and detect viral particles. I have some familiarity with SPR but haven't used it and not to detect viruses (otherwise experienced with surface science).
What they’re describing is an antigen test, not an antibody test. It tests directly for part of the virus, not an immune response, so it’s more a replacement for the existing PCR testing.
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.
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 doubt people are going to want to do this everywhere they go. It's definitely good though to have more testing options.
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.
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.
> Catching this virus is a bit like playing a round of Russian roulette.
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%
[1] https://death-proba-website.appspot.com/
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%
[1] https://death-proba-website.appspot.com/
Russian roulette might be an unfair comparison, but it may only be one order of magnitude different to this virus IFR.
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%;
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%;
> Covid19 - IFR = 0.5%, Russian roulette = 16%
Thanks for the correction and the new study link.
Thanks for the correction and the new study link.
This really reminds me of the old Newgrounds stuff and the old Room game https://www.newgrounds.com/portal/view/547307
Tom Fulp had a bigger impact on my childhood than most - <3 newgrounds. Good Times.
Tom Fulp had a bigger impact on my childhood than most - <3 newgrounds. Good Times.
I don't think this tracks.
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.
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.
We need micro PCR machines built into our phones. They could basically test for everything all the time.
Also a FLIR selfie camera could monitor our temperature at random points throughout the day.
That would be sweet. Lead-time on this one is likely too long, however.
You may get a negative result if you’ve only had the coronavirus a short time. And it’s possible to get exposed and not develop antibodies. You may also get a “false positive” i.e. you have antibodies but had a different kind of virus e.g Hepatatis-B
archive.vn/NzNRO
archive.vn/NzNRO
This assumes that "economic activity will restart". Humans won't participate in dangerous activities. They may test the waters e.g. by ggoing to gyms, but as soon as a single case is found they 'll be scared back into their homes. It will happen even more so as the disease spreads and people learn about the death of someone they know. This will happen regardless of how much testing.
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...
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...
If humans were so extremely risk averse that a single case is unacceptable, wouldn't we have naturally isolated ourselves without requiring lockdown orders?
No, because while many humans are risk averse, we also live in certain cultural circumstances that prevent us to make that decision unilaterally.
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).
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).
they did not know how dangerous it is. i think attitudes will change everywhere
How can people help you succeed?
> With early detection, we can get the best known treatments
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?
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?
The best known treatment at the time the infection is detected. That can be as basic as rest and hydration, but hopefully we'll have something better down the line.
Assuming he's speaking in the more general sense, but who knows? he's an engineer and not an epidemiologist or a doctor.
If I test positive, do I need to go straight to hospital as a precaution? I’d like something constructive to happen to happen to me (and by Golden Rule extension, anyone else who shows up as a carrier) while everyone else is running away in fear and revulsion.
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.
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.
I don't particularly disagree with any of this, but as a society, we have a bad habit of assuming that people with an impressive record of innovation and expertise in one field should be treated as authoritative in others. At the very least, they should take their idea to people with sufficient expertise to evaluate it before using their notoriety to take it to the public. I think Elon Musk, Steve Jobs, Linus Pauling and any number of failed unicorn startups should have taught us some caution. I don't want to know what a famed early architect of social media thinks about this topic, at least not before a famed virologist, immunologist or public health practitioner comments on it first.
> t’s confusing to me that we’ve implemented harsh and expensive lockdown measures, but have been slow to implement a basic mask mandate.
That's what baffles me the most.
That's what baffles me the most.
If the proposed test takes 10 minutes, as Steve Jobs would say, that's not good enough. Try to make it work in 10 seconds. Like a breathalyzer. Add more liquid to the solution if necessary. I am not a doctor, but am just imagining TSA-style x-ray detectors that you walk through, while issued a disposable container to blow into, and put back into the large spinner machine.
A quick search actually reveals something:
https://www.nsmedicaldevices.com/news/astrotech-breathtest-1...
A quick search actually reveals something:
https://www.nsmedicaldevices.com/news/astrotech-breathtest-1...
[deleted]
If a test doesn't give a result in a few seconds the queues at the testing stations will become a perfect venue for spreading the virus.
> Unfortunately, I’m still seeing people at the supermarket with their mouths uncovered
In Sweden masks are so uncommon that you react when you see one.
In Sweden masks are so uncommon that you react when you see one.
“Ubiquitous daily screening” has this William Gibsonesque edge to it.
Add the idea that anyone who has already had it gets a pass and it sounds worse.
Add the idea that anyone who has already had it gets a pass and it sounds worse.
Or we could just have a mandatory global quarantine for two weeks. Not only Covid, but all transmittable diseases would plummet.
Grandiose statements with zero technical details make this sound a lot like "Theranos for Viruses".
I may have missed this, but how physically is this test done?
Is it “spit in a tube” or “swab the back of the throat”?
Is it “spit in a tube” or “swab the back of the throat”?
Hi there. We are developing a saliva (e.g., spit in tube) type test. There are a couple of reasons for this including:
- supply chain issues with flocked nasal swabs and viral transport media
- enable self-sampling limiting healthcare workers SARS-CoV-2 exposures and PPE utilization
Gotcha! Thank you!
Is it possible to create an artificial antibody in lab that can stimulate the immune system?
> It is my belief that the best cure for any disease is to avoid the disease.
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.
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.
The author doesn't understand the virus and makes many dubious statements about it.
> 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.)
> 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.)
There is too much sense and logic and critical thinking in your response. Brace yourself for the backlash! :)
Thanks! No witch hunts yet, but I don't think a lot of people saw the comment.
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.
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.
> just respect nature and how nature works and please live life like animals like us are meant to live. Freely.
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).
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).
I absolutely agree with the point, and it goes 100% against to Sweden is doing.
> This could be a reason why so many otherwise young and healthy doctors and nurses have been killed by this virus.
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...
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...
"Just fine" is really misleading.
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...
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...
The key piece is young and healthy. Very few people who are under 50 and don't have chronic health conditions have succumbed to Covid-19. A recent study of NYC patients [1] indicated that only 6.4% of hospitalizations (for all age groups!) were patients with zero co-morbidities.
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
[2]: https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm
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
[2]: https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm
> 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.
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.
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.
thaumaturgy(2)
While the young might rarely die, this illness is not something you want even if young. It can be pretty brutal and there is some evidence that it causes damage to lung even in the absence of symptoms.
> While the young might rarely die, this illness is not something you want even if young.
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.
[1] https://time.com/5816239/children-coronavirus/
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.
[1] https://time.com/5816239/children-coronavirus/
This paper found more than half of the asymptomatic patients had lung damage [1].
1. https://pubs.rsna.org/doi/10.1148/ryct.2020200110
1. https://pubs.rsna.org/doi/10.1148/ryct.2020200110
The Diamond Princess averaged (mean age, 62 years ± 16, range 25-93) years old. That's not the demographic we're discussing. We know they're way, way worse off than younger folks. I was also informed that the "73% asymptomatic" rate they quote in this article dwindled down to below 18%.
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.
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.
I was making the point that this disease is an issue for the young and it causes damage to the lungs even in the absence of symptoms. This is a serious disease that needs to be taken seriously.
> I was making the point that this disease is an issue for the young...
[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.
[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.
I am not sure the relevance of flu in children for the problem of COVID-19. The flu rarely causes serious illness in children and thankfully SARS-CoV-2 also rarely causes serious illness in children.
Well, this was all born out of the line in the post saying that young and healthy healthcare workers were dying. The data indicates that occasionally, they have, but overwhelmingly, the data indicates the statement is false. This continued on to an evaluation of "even if they don't die, they may have permanent lung injuries -- even if they show no symptoms" and I responded that I have not seen any data to indicate this is the case. I'm certainly open to it being true (it was for SARS-COV-1) but I have not seen any supporting evidence.
Perhaps you should contact these medical residents to remind them that they'll be "just fine": https://www.aamc.org/news-insights/terrifying-privilege-resi...
I also see a fair number of younger people on this list: https://www.medscape.com/viewarticle/927976
I also see a fair number of younger people on this list: https://www.medscape.com/viewarticle/927976
Again, I suggest you look at the data instead of responding emotionally. We need to allow the data to guide us.
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 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 agree that data is good, but the data you linked to seems to be for Italy only. Perhaps they had adequate PPE?
I'm kind of skeptical of the idea that the doctors and nurses in the United States are simply reacting out of irrational fear.
I'm kind of skeptical of the idea that the doctors and nurses in the United States are simply reacting out of irrational fear.
If I had to put myself in their shoes I would react out of panic too, if all of a sudden my day to day was flooded by cases of this new respiratory disease. Doctors and nurses suffer the same sort of adverse selection bias as CFR data: you're not counting the healthy. The doctors are only ever exposed to the sick, day in and day out, not to the healthy who don't walk through their doors. They're experiencing a concentration of the negative effects, orders of magnitude worse than what's happening outside the hospital.
that’s one of a number of misleading assumptions stemming from the core presumption that
> “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.
> “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.
There is plenty of data to come up with a viable solution.
The Proximity Solution:
https://medium.com/@dilip.dasilva/introducing-the-proximity-...
The Proximity Solution:
https://medium.com/@dilip.dasilva/introducing-the-proximity-...
You need a test in real time. Ten minutes for millions is gonna be hard to enforce them to sit and wait every day. I’m assuming you need to test them every day. You need a real time scanner and even that may or may not work depending the speed and invasivness of collecting before the actual scan.
major issue I have here is that once you put these turnstiles in they aren't coming back out. then they start scanning for other stuff and there goes your medical privacy.
> (less than $1/test).
How much less than $1? $6B/day is a lot of money.
How much less than $1? $6B/day is a lot of money.
It's a lot of money in toal. But if the costs could be are borne by the customer or service provider or employer equally or proportionally, then it is a viable alternative to complete shutdown of businesses.
(The total cost of 50c drinking straws or coffee cups daily is also in the billions but we don't see it that way.)
(The total cost of 50c drinking straws or coffee cups daily is also in the billions but we don't see it that way.)
The USA could pay 6B/day for over a year of the current stimulus package. And that would be paying for the whole world. For the Netherlands it’s a similar amount (for a year) as what we just put in one airline. So it’s peanuts. Employers could Easily pay this for staff, people could pay it for events, etc.
Not on the scale the world is blowing up wealth right now.
"First of all, it’s not “just the flu”. It is something much more dangerous. Catching this virus is a bit like playing a round of Russian roulette. You’ll probably be fine, but you could end up dead."
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.
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.
A blogspot/google blogger blog how quaint
I wonder if it could be possible to mix test samples to test several people at once? Like maybe take 10 or even 100 samples, mix them together, and the test shows positive if any of the 100 has the disease? In that case, the samples could be tested individually.
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.
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.
Why are there so many armchair quarterbacks in this thread spouting dismissive criticism? Paul already acknowledges that "success is far from guaranteed." If this works, great! If it doesn't, I don't think any of us are worse off...
This seems like a heavy application of The Copenhagen Interpretation of Ethics https://blog.jaibot.com/the-copenhagen-interpretation-of-eth...
This seems like a heavy application of The Copenhagen Interpretation of Ethics https://blog.jaibot.com/the-copenhagen-interpretation-of-eth...
Thanks for the link! A useful ethical-social concept with examples.
I’d be less inclined to offer negative opinions on someone making a product that helped manage COVID and financially benefiting from that product, if it;
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.
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.
I wonder why we always jump to the China approach of forcing people to do things.
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.
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.
You don't really need to pay. At the infectious disease place in Marseille they offered free tests, hundreds lined up to get tested and the the number of infections in community dropped dramatically.
Great point. I guess my thinking was to make sure folks could afford to isolate and increase compliance even more.
I think the key fact here is that tests were offered and people lined up and volunteered to take them.
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.
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.
Odd objections. We test people already with infrared thermometers but they miss many cases. This would be similar but work better.
[deleted]
The issue with testing particularly in the US is not at all about the availability of tests or their expense, it is almost entirely political. Political discussions can often be fraught but when it almost the sole reason we don't have adequate testing in the US. It has almost nothing to do with the lack of a technical solution.
The article proposes daily broad testing. I thought that is what governments were shooting for?
[deleted]
> It is my belief that the best cure for any disease is to avoid the disease.
> 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.
> 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.
TL;DR
Test, Test and Test
Test, Test and Test
I think it is a good idea to keep some interpretation of the stages of grief [0] in the back of your head while reading posts like these (especially now, related to SARS-CoV-2).
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.
[0] https://en.wikipedia.org/wiki/K%C3%BCbler-Ross_model
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.
[0] https://en.wikipedia.org/wiki/K%C3%BCbler-Ross_model
> Ctrl+f theranos no results
have we learned nothing?
have we learned nothing?
We have Trump claiming things like "we don't have a shortage of tests" and "everybody who needs a test gets a test" and "the US is testing more people than every other country combined". These are daily press conferences broadcast on a national level. Unfortunately, rational information outlets are covering this too.
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.
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.
This is badly written but very much in the correct direction.
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...
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...
“It is my belief that the best cure for any disease is to avoid the disease.”
https://m.imgur.com/dL807yM
https://m.imgur.com/dL807yM
I can't help feeling a bit uneased reading about computer science people doing salespitch for solving a world epidemic.
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.
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.
This appeal to authority always bothers me. Polymaths are capable of making bigger contributions in any field they involve themselves in than the average phD can in their own field of expertise. Look at Musk, Tesla, Von Neumann, Hughes, Da Vinci, Edison, Ben Franklin.
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.
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.
Science and technology has moved on significantly since the Da Vinci days and modern day “geniuses” like Musk surround themselves with experts in each field.
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.
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.
On average, sure. And that may be a rational reason for a busy investor to reject a pitch meeting, but that's never a reason to dismiss an idea once you've read it, or in a forum where there is no cost to that idea existing (such as HN).
It’s a reason enough to be skeptical. How often have you read on here someone saying “can’t you just do x y and z” to a problem that is grossly more complex than the commenter initially appreciates?
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.
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.
It's an excuse not to think. Now, if you feel that YOU are not qualified to evaluate the idea, that's a different story. Don't act on the idea until it comes from someone you trust. But that's no reason to tell others it's unworthy of their evaluation.
Citing Elon Musk in this context is definitely not making the point you think it’s making.
Why not? It doesn't matter if he's... Elon Musk. What he's accomplished in fields he wasn't trained in is significant. I think that makes OPs point just fine.
Unlike the other people in the list, Musk (and Huges) have never made a significant scientific discovery or invention.
He seems to have a rare skill for building large successful innovative companies with revolutionary products. Not sure if that’s below or above the level of accomplishment of the reference group.
Because Elon Musk has made a series of incorrect, misleading, and ignorant statements about the Coronavirus crisis in order to benefit himself personally.
Name one aeronautical engineer phD who deserves more credit for giving America the ability to put humans in space next month than Musk.
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.
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.
> Name one aeronautical engineer phD who deserves more credit for giving America the ability to put humans in space next month than Musk.
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.
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.
Marx was a bit further removed from day to day decisions on rocket architecture than Musk if I understand correctly.
Beware of congratulating yourself on spotting one fallacy (appeal to authority) while faceplanting into another (selection bias).
You do start to get a false feeling of invincibility after being validated so much in your actual field (even if it is largely due to being in the right place at the right time). Most one-hit wonders who manage to hit a homerun in the Valley with their web app who then end up trying to solve world hunger, etc. afterwards fail. I do have to hand it to Gates though (but he isn't a one-hit wonder).
Gates has the good sense of surrounding himself with deep expertise in everything he takes on.
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.
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.
It’s not really his solution though is it? WHO has been urging governments to “test test test” for months with the same argument. In fact, the UK government is currently being criticised for not testing enough. Other countries that test more have shown a lower death rate (Germany at one point, not sure of the figures today) at odds with neighbouring states. Between lockdown and waiting for a vaccine, this is the only other thing that’s been suggested that makes sense. It’s not like the author is recommending injections of bleach.
A huge proportion of capable autodidacts are coders. Especially those who go through grad school for STEM - the skill is invaluable.
So don't be so surprised, these aren't necessarily junior level devs at FAANG spouting off.
So don't be so surprised, these aren't necessarily junior level devs at FAANG spouting off.
There are junior level devs at FAANG that would otherwise would be either starting their own company or be considered senior level at most other startups/other companies -- often they are really bright engineers at the beginning of their career, the same age as Paul Bucheit when he created a certain web email client at a FAANG company as a junior engineer.
This is a pleasant thought, but we can't even get most people to obey speed limits most days, even though it's far easier and we know it would save large numbers of lives.
He's proposing scanning when you enter a public space.
Public spaces generally comply with these types of things because of the fear of getting caught by random inspections and steep fines and penalties.
Public spaces generally comply with these types of things because of the fear of getting caught by random inspections and steep fines and penalties.
That actually does sound a lot like the situation with speeding on freeways, at least in flyover country.
strictly speaking, speed in and of itself isn’t the primary problem, it’s distracted driving in its many forms. speed only makes the severity of those accidents greater.
That doesn’t really make sense. If you’re driving too fast, even with perfect focus you could hit someone or something before your normal reaction time could recognize and avoid it.
you’re missing the second half of the random chance argument. you could also have driven right past a collision that would have happened at a slower speed.
I'm sympathetic to raising speed limits like any good Californian. But there's an asymmetry in the positions, in that more reaction time is universally better than less reaction time.
that’s not so self-evident. reaction time is a property of the driver, not the speed. slower speeds can lull drivers into slower reaction times, so it’s not so obviously asymmetrical. drunk drivers tend to drive slower than normal but have higher fatality crash rates, for example.
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.
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.
Allow me to ensure I understand your position. Overall, you believe that lower speed limits will result in more accidents?
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?
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?
no, i’m saying speed is largely beside the point when discussing saving lives in auto accidents. the critical behavior change we need is constant active driving, which is hard, but that’s what would make a meaningful difference, not lowering speed limits. people tend to drive as fast as conditions allow anyway.
Sure, but you work within the constraints you have. What we really need is a cure for all cancers but that doesn't exist just like no universal method for constant active driving exists. Given that, it's a pointless thing to bring up.
"Just have everyone be better at things" isn't a helpful alternative.
"Just have everyone be better at things" isn't a helpful alternative.
that’s a false equivalence. every driver has the ability to refrain from texting, talking on the phone, eating their breakfast, doing their makeup, reading the paper (yes, i’ve seen this), etc. and instead focus on scanning the road and their mirrors while actively controlling their car.
I'm talking about from the view of public health administration. There is no intervention available to us that will ensure a change in behaviour economically.
We do have available to us the speed limit.
We do have available to us the speed limit.
> “There is no intervention available to us that will ensure a change in behaviour economically.”
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.
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.
That makes no sense. The “collision that would have happened at a slower speed” wouldn’t happen at a slower speed because you’d see it coming in time to react and avoid it.
just because you are driving slower doesn’t mean that a surprise event doesn’t happen faster than your reaction time.
[footage not found]
Speed kills.
Speed kills.
mehrdada(1)
Another round of fear porn. I really wish HN would tone this down, because these articles/blog posts do not actually help or offer new insights in any way.
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.
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.
Dr. Fauci explained very clearly and simply the problem with daily testing.
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.
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.
Can we stop hyping blog posts by tech people writing about epidemiology and medicine? I'm shocked how much baseless speculation and misinformation is being shared on HN.
He's not. He's hyping his biomedical startup which is trying to make a cheap plasmon covid test. Whether or not he's right, that's sort of right at the HN sweet spot for relevance.
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.
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.
Thanks for noticing this. It must be https://predxionbio.com/ (he really buried that part).
HN is an internet watercooler. It exists for curious conversation. That inevitably includes speculation—that's what people do when they converse. The question is whether it's curious (thoughtful and fresh) or uncurious (reflexive and predictable).
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.
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.
I tend to agree. Maybe medical people should start having opinions on software architecture after reading a few articles. They may have some fresh ideas. Or not?
I've worked in both fields. Few people who are experts in one of those fields can be useful in the opposite field, but there are some exceptionally productive individuals who are. Reading through Bucheit's article, he seems to fall into the 'wow, biology is really easy, you just have to do <X> and the problem is fixed' camp. In my experience, that does not correlate with a good understanding of how to produce a successful medical diagnostic.
"you just have to do <X>"
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".
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".
A fourth solution: force the boomers and vulnerable to retire. Let's bail them out. Let the young take control of the economy. Everybody wins.
A lot of fear mongering and FUD in this article.
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.
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.
There are insanely high amount of speculation in there.
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...
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've heard from virologists that the amount of virus you're exposed to does matter. A gallonful of virus can quickly overwhelm the immune system, a small amount can take long enough to grow that your immune system can ramp up to deal with it before it overwhelms. It's like someone releasing one breeding pair of rats in your attic vs 100.
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.
https://en.m.wikipedia.org/wiki/Variolation
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.
https://en.m.wikipedia.org/wiki/Variolation
Can you please make your substantive points without swipes? Controversial threads tend to devolve into people swiping at each other, and emotions run especially high in a crisis.
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.
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.
> 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...
Yes it is. If the initial amount of virus exposure is low, the immune system has more time to react.
Yes it is. If the initial amount of virus exposure is low, the immune system has more time to react.
> First of all, it’s not “just the flu”. It is something much more dangerous. Catching this virus is a bit like playing a round of Russian roulette. You’ll probably be fine, but you could end up dead
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.
[1] https://www.mdch.state.mi.us/osr/deaths/ageadjdxARS.asp
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.
[1] https://www.mdch.state.mi.us/osr/deaths/ageadjdxARS.asp
The things that generally kill Americans (heart disease, cancer, car crashes, diabetes, etc) aren’t contagious, so this is a bad analogy.
This is not an analogy. It's just math - the risk of dying from COVID19 if you got it is comparable to the risk of dying this year all things other than COVID19 considered. (approx 0.1% in your twenties, approx 15% in your eighties).
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.
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.
No analogy is perfect, but people need context to understand fatality rates, and see what risk is acceptable. Society doesn't have a goal of 0% death rates. We all accept some risk of death as a cost of continued existence.
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.
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.
Correct, Covid-19 is not as bad as smallpox. But it's still bad. Focusing on fatality rates misses the infection rate. Two diseases with the same case fatality rate can kill widely different number of people if one is more infectious than the other. We have learned that SARS-CoV-2 is way more infectious than the flu, meaning that way more people are getting it. With way more cases, we have way more deaths. (And, of course, way more strain on the medical system.)
The graphs on this page shows the situation for NY. It is clear that the risk can't be compared with 2009's H1N1. It's sobering. https://www.nytimes.com/interactive/2020/04/10/upshot/corona...
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...
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...
This more or less sums up my position. Thank you for stating it. I think the news media played a big role in amplifying the risk in a very uncertain early period that made people treat this differently from other risks that affect us and many of the arguments right now are happening because some poeple believe the goal of society is to reach 0% death rates.
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.
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.
As you said, you gotta die of something. If the covid rate equals the regular rate, then the US death rate would effectively double if we simply did nothing.
That’s assuming no second order effects like a shortage of medical care making things worse.
That’s assuming no second order effects like a shortage of medical care making things worse.
> If the covid rate equals the regular rate, then the US death rate would effectively double if we simply did nothing.
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.
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.
The numbers from Wikipedia are very different, many death are due to contagious illness https://en.wikipedia.org/wiki/List_of_causes_of_death_by_rat...
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.Those are world rates, not US rates.
In the US, it’s largely the things I listed.
In the US, it’s largely the things I listed.
the CFR is only as low as 0.5-1% when there is adequate medical care and the population is otherwise healthy. in NYC the CFR for the 18-45 cohort is ~5%[1].
[1]: https://www.worldometers.info/coronavirus/coronavirus-age-se...
[1]: https://www.worldometers.info/coronavirus/coronavirus-age-se...
CFR is a terrible metric - you should be using IFR. CFR is of course going to be much higher than the IFR, probably orders of magnitude higher.
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.
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.
> astoundingly high overestimate for any reasonable metric
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.
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.
Using CFR to determine fatality rate of COVID is as effective as it would be for skydiving. If you only count people who go to hospital (because they're frightfully sick -- or splatted out of an aircraft) and compare that to those who walk out of hospital you're exhibiting massive adverse selection bias.
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]
[1] http://cebm.net/oxford-covid-19-evidence-service/
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]
[1] http://cebm.net/oxford-covid-19-evidence-service/
> Death is sad and terrible, but we don't shut down society because people die.
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...
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...
> we're talking about saving ~1-2 million people in the US alone by doing this. Several trillion dollars is still worth it...
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.
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.
> 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.
$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.
We’ve already got a “Value of Statistical Life” in the US, and it’s higher than that. So you could justify lockdown on that alone
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...
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...
6 month lockdown doesn’t seem necessary, but a lockdown until it’s possible to do contact tracing and containment does seem necessary, either way this is something that easily warrants a drastic response because the potential cost is so high.
So would you be willing to roll the dice then for the sake of opening up society?
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.
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.
> If given the choice between dying of COVID-19 or shutting down society
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.
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.
No, what I'm directly asking you is: Are you willing to die to reopen society? I'm not asking you to to take an acceptable risk.
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.
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.
That's a terrible analysis, for reasons well-covered all over HN and elsewhere.
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.
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.
> for reasons well-covered all over HN and elsewhere.
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.
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.
Every year around 3 or 4 million people die in America from a variety of causes. This is sad, but at some point, everyone has to die.
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...
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...
Alright so lets unpack this argument, because (1) this is a pretty extreme oversimplification, and (2) the unstated suggestion you make is to quite literally let millions of people die world-wide who wouldn't have otherwise:
> 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.
> 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.
There's a bit of gish gallop and vitriol here.
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...
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...
Again, you realize debating the true value of the fatality rate is a bit silly when we already know healthcare systems will be overwhelmed (and have been overwhelmed already!!) if we hadn’t and don’t continue to manage this with severe measures? Do you agree with that statement? It doesn’t matter what the incremental mortality rate is. It doesn’t matter. We don’t know the true fatality rate, yes, but we do know it’s high enough that without severe restrictions on social life, healthcare systems will be overwhelmed, regardless of whether or not you think 1-2 million people dying from this vs 60,000 flu deaths is a big deal or not. Your argument was that our reaction is disproportionate, but it’s not disproportionate because if we don’t do this, healthcare resources will be overwhelmed and the economic damage could be severe in addition to the loss of life. Are you disagreeing with that?
> we already know healthcare systems will be overwhelmed (and have been overwhelmed already!!)
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.
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.
This changes in a day, if the lockdown were lifted. The number of needed ventilators etc could grow 10X in no time.
Those numbers reflect a correct, working response. Sure the restrictions can be lifted, but carefully and balanced by changes in those stats.
Those numbers reflect a correct, working response. Sure the restrictions can be lifted, but carefully and balanced by changes in those stats.
> If our goal is to flatten the curve to slightly below hospital capacity, current policy has flattened the curve way too much.
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.
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.
I can understand risk per time period, but what does "0.5% lifetime mortality risk" mean? Does my lifespan get 0.38 years shorter?
Yes, basically that. Your expected lifespan is lowered by 0.5%, which is around 0.38 years.
As I pointed out elsewhere, you're ignoring that Covid-19 is highly infectious, meaning that lots of people get it. Low fatality rates with wildly infectious diseases still mean lots of people dieing.
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?
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?
So if all of America (330 million) gets infected, and we’ve got a 1% fatality rate, that means deaths (3.3 million) would be up there with all the other things that kill us combined!
We hopefully would reach herd immunity far before that point, but even with herd immunity only requiring 70% of Americans to be infected, we're looking at over 2m fatalities. And that's not even counting the hospitalizations that will be over 20M.
What we need to hope for is an unlikely vaccine, or a therapeutic treatment to mitigate the worst of the diseases effects.
What we need to hope for is an unlikely vaccine, or a therapeutic treatment to mitigate the worst of the diseases effects.
The article begins by stating that this is not like the flu, yet we know people die from complications or directly from the flu every year. And further, we're seeing more and more evidence of huge numbers of the population with antibodies, i.e. already infected and immune. We also have seen the damage that using ventilators have had due to misunderstanding how this virus starves the body of oxygen (through the blood, not like pneumonia). We should continue to focus on treatment and realize that treatment along with population immunity is the best way to handle it now. Waiting a year for a vaccine that may not work or rushing a poorly tested vaccine is not good.
It's not the flu because the infection fatality rate is almost certainly a lot higher, we have no vaccine, and no reliable treatments. Seasonal flu has (semi-reliable) vaccines and antivirals and is almost definitely significantly less deadly.
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.
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.
Is it actually excess deaths? So many deaths are being counted as covid-19 that it looks more like we have the same amount of total deaths by all causes and any other year
Sure looks that way to me. The spike is larger than 9/11.
https://www.nytimes.com/interactive/2020/04/10/upshot/corona...
https://www.nytimes.com/interactive/2020/04/10/upshot/corona...
No, we definitely don't want a world in which government officials have little kiosks outside every business where they get to decide who has to be removed from society with no due process.
Soon you will realize, that the cost of keeping people alive times the growing number of new people on earth will be the thing that will kill us all.
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.
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.
One way to achieve ubiquitous screening is for people to perform regular VO2max tests (loosely speaking; you can do submaximal exercises for this). You quickly figure out if you have a stress on your immune system (by watching various metrics), and there are sports-science papers showing this (because they use it to avoid overtraining, which also appears as a stress on the immune system). This is of course not easy to achieve with our current culture. It used to be that physical achievement was valued. Only a small fraction of society pushes against their VO2max in a regular way that can be measured and tracked to detect the immune-system stress. If people were to pursue this approach, they'd become a lot healthier in general.
This seems like something that would detect symptomatic patients only, I haven't heard of any research showing that patients would see lowered oxygen saturation in the early stages of infection.
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.
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.
You wouldn't pay attention to oxygen saturation, and I'm not sure if you can even use that as a metric. Generally this involves heart-rate variability, heart-rate recovery, etc. This detects the stress on the immune system, which is detectable soon after your body starts dealing with an illness. If the asymptomatic case has a stress on the immune system, which it likely does, then this test will detect it (so it actually isn't asymptomatic in a strict sense). It won't be able to tell you that it is Covid 19, but it can be used as guidance to behave as if you have the asymptomatic case. You could even just look at your performance: a significant drop in output means your body is unhappy about something. Imagine running/biking/swimming/etc at full capacity when you have a cold: you can't.
Doesn't a VO2max test take 20 minutes, plus a shower afterwards? That sounds significantly more expensive than collecting vials of saliva.
Also, you'd definitely need to do those VO2max tests in separate, sealed rooms because infected people would be huffing out maximum virus.
Also, you'd definitely need to do those VO2max tests in separate, sealed rooms because infected people would be huffing out maximum virus.
Exercise watches claim to estimate it accurately.
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.
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.
Your "sick" vo2 might be above my "healthy" vo2.
So you first need to get 300 Americans on a max treadmill test to baseline, then.....
So you first need to get 300 Americans on a max treadmill test to baseline, then.....
> First of all, it’s not “just the flu”. It is something much more dangerous.
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.
[1] http://cebm.net/oxford-covid-19-evidence-service/
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.
[1] http://cebm.net/oxford-covid-19-evidence-service/
But unlike the flu there’s significant spread from asymptotic people, so the young are walking time bombs.
That doesn't really change anything. To the extent the vulnerable are holed up inside, everyone else is welcome to get it, display mild flu-like symptoms, and develop herd immunity.
You repeat the fantasy that the more vulnerable population is separable from the less vulnerable.
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.
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.
Again, as always, Sweden seems to be doing it just fine.
Sweden isn’t proof of anything, please stop using it as though it is.
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.
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.
The crux of the issue is this: Neither I nor the Swedes believe that you can keep this disease at bay by hiding indoors for a few months and then opening back up well in advance of a vaccine which appears to be the entire world's game plan. I think it's fair to say there won't be a vaccine for 12-18 months, and we're not as a society prepared to stay indoors for that long.
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...
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...
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.