
A Third Solution - rafaelc
https://paulbuchheit.blogspot.com/2020/04/a-third-solution.html
======
dekhn
I was curious about the company that's being touted in this post so I did a
little searching. The website doesn't seem to have much on it.

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...](https://www.hbs.edu/openforum/openforum.hbs.org/goto/challenge/health-
acceleration-challenge-2016/predxion-bio-faster-results-saving-lives.html))

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.

~~~
predxionbio
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.

~~~
icinnamon
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).

~~~
samstave
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)

------
lrpublic
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.

~~~
manmal
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.

~~~
londons_explore
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.

------
caymanjim
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.

~~~
pb
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.

~~~
scott_s
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...](https://www.theatlantic.com/ideas/archive/2020/04/were-testing-the-
wrong-people/610234/)

Googling for "romer covid 19" should turn up a lot of news sources covering
the notion of testing millions of people a day.

~~~
pb
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)

~~~
scott_s
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.

~~~
dboreham
Basically like the porn industry.

~~~
mantap
This is a really good analogy actually. The porn industry has higher risk for
STDs but lower incidence than the general population.

------
ggreer
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...](https://twitter.com/COVID19Tracking/status/1253807175945744391)

2\.
[https://twitter.com/NYGovCuomo/status/1253353516803993600](https://twitter.com/NYGovCuomo/status/1253353516803993600)

3\.
[https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article](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...](https://academic.oup.com/cid/article-
pdf/52/7/911/847338/cir007.pdf)

~~~
ChaseT
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/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3506030/)

------
zmmmmm
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.

~~~
predxionbio
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/](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/](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.

~~~
klipt
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...

~~~
predxionbio
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....](https://www.novartis.us/sites/www.novartis.us/files/kymriah.pdf)
[1] -
[https://www.gilead.com/-/media/files/pdfs/medicines/oncology...](https://www.gilead.com/-/media/files/pdfs/medicines/oncology/yescarta/yescarta-
pi.pdf)

------
tlb
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.

~~~
saeranv
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?

~~~
scythe
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

~~~
saeranv
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?

~~~
scythe
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.

~~~
saeranv
Thanks, that's a much clearer way to think of it.

------
jawns
> 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.

~~~
pb
It's daily screening for exactly that reason. Is there something I should
change to make that more clear?

~~~
jawns
But how realistic is daily screening on a wide scale? You're going to face
major issues with compliance.

~~~
pb
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.

~~~
LiquidSky
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.

~~~
chatmasta
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.

~~~
notatoad
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.

~~~
chatmasta
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?

~~~
ceejayoz
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.

~~~
walterbell
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.

------
distantaidenn
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.

~~~
toyg
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.

~~~
user5994461
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.

------
vikramkr
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!

~~~
predxionbio
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.

~~~
lvs
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.

~~~
predxionbio
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.

~~~
lvs
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.

------
nopinsight
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...](https://twitter.com/awyllie13/status/1252996627217801218?s=20)

------
Animats
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...](https://businesssearch.sos.ca.gov/Document/RetrievePDF?Id=04265673-26160052)

[2] [https://jlabs.jnjinnovation.com/locations/jlabs-
ssf](https://jlabs.jnjinnovation.com/locations/jlabs-ssf)

[3]
[https://jlabs.jnjinnovation.com/JLABSNavigator#/location/Bay...](https://jlabs.jnjinnovation.com/JLABSNavigator#/location/Bay%20Area%20-%20SSF)

------
husein10
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.

~~~
pb
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.

------
darkerside
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.

------
danieltillett
I hope everyone has noticed that if this approach could wipe out COVID-19 it
could wipe out influenza and even the common cold.

~~~
krrrh
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.

~~~
danieltillett
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 :(

~~~
krrrh
> The common cold viruses haven’t helped us deal with COVID-19

We don’t actually know that yet.

------
not_a_moth
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.

~~~
maxerickson
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.

~~~
not_a_moth
> 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.

~~~
selimthegrim
I like how you're ignoring the organ damage in even younger survivors like
it's rosacea or something.

~~~
timr
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...](https://www.cdc.gov/coronavirus/2019-ncov/covid-
data/covidview/index.html#hospitalizations)

~~~
selimthegrim
[https://www.washingtonpost.com/health/2020/04/24/strokes-
cor...](https://www.washingtonpost.com/health/2020/04/24/strokes-coronavirus-
young-patients/) (TL, DR: NEJM next week)

~~~
timr
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.

------
tolmasky
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.

~~~
johnedwards
I remember that episode!

Love the Sliders reference. I might stream that all weekend.

------
DrNuke
Cheap & working saliva test would be such a tracking game changer that I am
really hoping it works, so good luck!

------
sub7
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.

------
seafoam
Thank you Paul. Two questions :

Does this approach bypass the reagent shortages ?

What are the specificity / sensitivity metrics ?

~~~
predxionbio
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.

------
levpopov
Paul, is there anything HN readers can do to help with this?

------
patcon
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

------
IdoRA
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.

~~~
s0rce
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://www.sbir.gov/sbirsearch/detail/1564207)

[https://innovation.medicine.umich.edu/portfolio_post/sepsis-...](https://innovation.medicine.umich.edu/portfolio_post/sepsis-
risk-measurement-device/)

~~~
predxionbio
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.

------
alex_young
> 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.

~~~
__blockcipher__
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.

~~~
RonanTheGrey
I really feel like we're spitting into the wind. There are very few who agree
with this position.

------
rossjudson
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](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.

~~~
usaar333
> 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...](https://www.thelancet.com/journals/laninf/article/PIIS1473-3099\(20\)30243-7/fulltext))

> "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.

------
auston
Not sure if I'm missing something, isn't Saliva based testing almost/basically
here?

1\. [https://finance.yahoo.com/news/orasure-technologies-
receives...](https://finance.yahoo.com/news/orasure-technologies-receives-
barda-contract-100010049.html)

2\. [https://www.politico.com/states/new-
jersey/story/2020/04/23/...](https://www.politico.com/states/new-
jersey/story/2020/04/23/rutgers-saliva-based-covid-test-could-be-key-to-
unlocking-new-jerseys-economy-1279421)

------
thaumaturgy
After the whole Theranos debacle, I'm most curious how due diligence was done
on this team and their technology.

------
_ph_
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.

------
jl2718
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.

------
swang75
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?

~~~
pb
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.

~~~
swang75
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?

------
Eric_WVGG
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

------
martini333
This is not a third solution... It's the first ever thought of. But
impractical, very expensive, and therefore, unrealistic.

------
vadym909
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

~~~
lvs
And critically, ensure there aren't really enough details to evaluate the
proposal. ... Profit

------
mrfusion
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...](https://mobile.twitter.com/billmaher/status/1251350310045413377?s=20)

(1) [https://thehill.com/opinion/healthcare/494034-the-data-
are-i...](https://thehill.com/opinion/healthcare/494034-the-data-are-in-stop-
the-panic-and-end-the-total-isolation)

------
lorsting
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.

~~~
febeling
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.

------
stickhandle
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?

~~~
korantu
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.

------
danieltillett
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](https://twitter.com/statesdj/status/1253794887062958081)

~~~
tim333
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.

~~~
rhino369
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.

------
nickysielicki
> 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?

~~~
paxys
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.

------
DominikD
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.

~~~
buboard
How sure are we?

[https://www.sciencedirect.com/science/article/pii/S016041202...](https://www.sciencedirect.com/science/article/pii/S016041202031254X)

~~~
DominikD
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](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.

------
epicureanideal
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.

------
ezoe
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.

------
alkonaut
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.

~~~
pbhjpbhj
>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.

~~~
alkonaut
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.

------
refurb
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.

~~~
philwelch
Someone would be infected and contagious for awhile before developing
antibodies though.

~~~
refurb
True, but that's unavoidable with every test. Even PCR doesn't work until
you're body has produced enough viruses to be detected.

~~~
philwelch
Yeah, I think there's value in minimizing the period that someone is
contagious but still tests negative though.

------
stonogo
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.

~~~
newacct583
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.

~~~
Mikeb85
> 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.

~~~
renewiltord
Test positive. Wait 14 days. Now you're positive clean.

~~~
Mikeb85
And is someone going to verify I waited 14 days? Also, why should I have to if
I already am clean?

~~~
renewiltord
> 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.

------
gremlinsinc
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.

------
repied
> 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/](https://death-proba-
website.appspot.com/)

~~~
evross
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](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...](https://www.reddit.com/r/COVID19/comments/g6pqsr/nysnyc_antibody_study_updates/foc1cbf/)
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%;

~~~
repied
> Covid19 - IFR = 0.5%, Russian roulette = 16%

Thanks for the correction and the new study link.

------
inglor
This really reminds me of the old Newgrounds stuff and the old Room game
[https://www.newgrounds.com/portal/view/547307](https://www.newgrounds.com/portal/view/547307)

Tom Fulp had a bigger impact on my childhood than most - <3 newgrounds. Good
Times.

------
fzeroracer
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.

------
sitkack
We need micro PCR machines built into our phones. They could basically test
for everything all the time.

~~~
sitkack
Also a FLIR selfie camera could monitor our temperature at random points
throughout the day.

------
known
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

------
buboard
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...](https://phys.org/news/2006-11-laser-nanotechnology-rapidly-
viruses.html)

~~~
SpicyLemonZest
If humans were so extremely risk averse that a single case is unacceptable,
wouldn't we have naturally isolated ourselves without requiring lockdown
orders?

~~~
js8
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).

------
davidwhodge
How can people help you succeed?

------
justnotworthit
> 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?

~~~
pb
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.

------
gorgoiler
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.

------
ajarmst
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.

------
_pmf_
> 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.

------
tmsh
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...](https://www.nsmedicaldevices.com/news/astrotech-
breathtest-1000-covid-19/)

------
jacquesm
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.

------
Kiro
> 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.

------
pugworthy
“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.

------
transfire
Or we could just have a mandatory global quarantine for two weeks. Not only
Covid, but all transmittable diseases would plummet.

------
fsh
Grandiose statements with zero technical details make this sound a lot like
"Theranos for Viruses".

------
flaque
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”?

~~~
predxionbio
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

~~~
flaque
Gotcha! Thank you!

------
known
Is it possible to create an artificial antibody in lab that can stimulate the
immune system?

------
dustinmoris
> 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.

~~~
apatters
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.)

~~~
dustinmoris
There is too much sense and logic and critical thinking in your response.
Brace yourself for the backlash! :)

~~~
apatters
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.

------
SomeoneFromCA
I absolutely agree with the point, and it goes 100% against to Sweden is
doing.

------
arcticbull
> 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...](http://webcache.googleusercontent.com/search?q=cache:6rohagxzQR4J:https://www.cebm.net/covid-19/global-
covid-19-case-fatality-rates/&client=safari&hl=en&gl=us&strip=1&vwsrc=0)

[2] Original data here in Italian:
[https://www.epicentro.iss.it/coronavirus/bollettino/Bolletti...](https://www.epicentro.iss.it/coronavirus/bollettino/Bollettino-
sorveglianza-integrata-COVID-19_26-marzo%202020.pdf)

~~~
thaumaturgy
"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...](https://www.worldometers.info/coronavirus/coronavirus-age-sex-
demographics/)

[2]:
[https://old.reddit.com/r/Coronavirus/comments/fj1owh/over_ha...](https://old.reddit.com/r/Coronavirus/comments/fj1owh/over_half_of_the_coronavirus_patients_in/)

[3]:
[https://old.reddit.com/r/Coronavirus/comments/fip9t9/france_...](https://old.reddit.com/r/Coronavirus/comments/fip9t9/france_300_cases_in_critical_state_50_of_them_are/)

[4]:
[https://old.reddit.com/r/Coronavirus/comments/fipavk/more_th...](https://old.reddit.com/r/Coronavirus/comments/fipavk/more_than_half_of_icu_patients_are_below_50yrs_of/)

[5]: [https://www.businessinsider.com/new-york-city-coronavirus-
ca...](https://www.businessinsider.com/new-york-city-coronavirus-cases-deaths-
hospitalizations-by-age-chart-2020-3)

~~~
arcticbull
> 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.

------
projektfu
Paul, have you partnered with an epidemiologist to produce a paper on the
method?

~~~
projektfu
I guess the answer, as usual on these things, is no.

------
m3kw9
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.

------
celticninja
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.

------
gowld
> (less than $1/test).

How much less than $1? $6B/day is a lot of money.

~~~
ak39
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.)

------
bagacrap
"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.

------
stefankeys
A blogspot/google blogger blog how quaint

------
schnischna
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.

------
mastermojo
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...](https://blog.jaibot.com/the-copenhagen-interpretation-of-ethics/)

~~~
zaroth
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.

~~~
mrfusion
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.

~~~
tim333
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.

~~~
mrfusion
Great point. I guess my thinking was to make sure folks could afford to
isolate and increase compliance even more.

------
noobermin
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.

------
xivzgrev
The article proposes daily broad testing. I thought that is what governments
were shooting for?

------
cryptonector
> 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.

------
known
TL;DR

Test, Test and Test

------
smhg
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](https://en.wikipedia.org/wiki/K%C3%BCbler-Ross_model)

------
agentdrtran
> Ctrl+f theranos no results

have we learned nothing?

------
mastermojo
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.

------
aaron695
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...](https://www.gatesfoundation.org/TheOptimist/Articles/coronavirus-
interview-dan-wattendorf)

------
human
“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)

------
bsaul
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.

~~~
lend000
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.

~~~
CPLX
Citing Elon Musk in this context is definitely not making the point you think
it’s making.

~~~
post_below
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.

~~~
fsh
Unlike the other people in the list, Musk (and Huges) have never made a
significant scientific discovery or invention.

~~~
febeling
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.

------
downerending
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.

~~~
clairity
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.

~~~
philwelch
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.

~~~
clairity
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.

~~~
renewiltord
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.

~~~
clairity
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.

~~~
renewiltord
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?

~~~
clairity
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.

~~~
renewiltord
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.

~~~
clairity
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.

~~~
renewiltord
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.

~~~
clairity
> “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.

~~~
renewiltord
Fair enough.

------
troughway
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.

------
zaroth
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.

------
uhnuhnuhn
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.

~~~
newacct583
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.

~~~
dekhn
Thanks for noticing this. It must be
[https://predxionbio.com/](https://predxionbio.com/) (he really buried that
part).

------
esahione
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.

~~~
mkl
Younger people get it too, and some die. Not only that but many older or
vulnerable people live with or depend on younger people. Separation like you
suggest is simply impossible, and your misbelief that young people are
invulnerable is dangerous.

------
nickthemagicman
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.

------
temac
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...

~~~
roywiggins
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](https://en.m.wikipedia.org/wiki/Variolation)

------
marcell
> 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](https://www.mdch.state.mi.us/osr/deaths/ageadjdxARS.asp)

~~~
johnnyo
The things that generally kill Americans (heart disease, cancer, car crashes,
diabetes, etc) aren’t contagious, so this is a bad analogy.

~~~
marcell
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.

~~~
johnnyo
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.

~~~
beagle3
> 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.

------
triyambakam
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.

~~~
roywiggins
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.

~~~
triyambakam
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

~~~
roywiggins
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/coronavirus-
deaths-new-york-city.html)

------
vanniv
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.

------
danielovichdk
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.

------
762236
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.

~~~
PeterisP
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.

~~~
762236
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.

------
arcticbull
> 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/](http://cebm.net/oxford-covid-19-evidence-service/)

~~~
macintux
But unlike the flu there’s significant spread from asymptotic people, so the
young are walking time bombs.

~~~
arcticbull
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.

~~~
jhayward
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.

~~~
arcticbull
Again, as always, Sweden seems to be doing it just fine.

~~~
jhayward
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.

~~~
arcticbull
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...](https://aatishb.com/covidtrends/?location=Canada&location=Sweden&location=US&location=United+Kingdom)

