
The Doctor Who Helped Defeat Smallpox Explains What's Coming - ajaviaad
https://www.wired.com/story/coronavirus-interview-larry-brilliant-smallpox-epidemiologist/#intcid=recommendations_wired-homepage-right-rail-popular_d00a3648-f912-49b3-9b8a-f82ade2ecbd5_popular4-1
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no_gravity
From what I read in this article and other sources, performing more tests
seems to be a very promising approach to get this pandemic under control.

The number of positive tests and death rates are published every day on all
channels. I wish the number of performed tests would be also published daily.
What gets measured gets managed.

I wonder what limits the number of tests that can be performed. How much would
it cost to ramp up testing capabilities so that every person with symptoms can
be tested? How much to increase it to a level that everyone can be tested?

~~~
Amygaz
It's not a question of cost at this point. It's a question of availability of
reagents and consumables, materials to make those, and time it takes to ramp
up. The supply chain is like a supertanker.

At first we didn't have enough test, but that ramped up quickly, then we
didn't have enough RNA extraction reagent, now we don't have enough swabs, and
soon is the collection media that will be missing.

There has been a call for more protective equipement. But as the situation
gets worst, beds space, ventilator, and then staff are going to be the
bottleneck.

If you google you'll find stories of people helping their local hospital by 3D
printing parts for for respirators, and swabs. There's nothing cost effective
about that, it's not fast, but it gets the job done. If you were to scale
that, you would be competing for the same materials than manufacturers using
injection molding or plastic dipping are.

~~~
tonetheman
We do not have tests.

[https://covidtracking.com/data/](https://covidtracking.com/data/)

We have tested 150K people.

We have 327M people in the US, we have tested 0.00046% of the population.

We do not have tests.

~~~
sp332
Yeah but about HALF of those tests were done in the last TWO days! Capacity is
coming online very rapidly now and while we are starting from behind, we will
not be so short on tests for long. Roche alone is shipping 400,000 tests per
week and Abbot Labs is on track to perform one million tests per week in the
next couple of weeks. [https://arstechnica.com/tech-policy/2020/03/america-is-
final...](https://arstechnica.com/tech-policy/2020/03/america-is-finally-
testing-for-coronavirus-in-significant-volumes/)

~~~
shalmanese
The important number is the ratio of tests:true case count. You need ~1000 -
10,000X tests/case to do true contact tracing because you want to a) blanket
the country with tests and test every single suspected case even if 99% of
them end up not being COVID 19 and b) proactively quarantine every person that
a positive person has come into contact with and then test each of those
people every single day for 14 days until they come up negative. If a single
of those people come up positive, then you want to proactively quarantine all
the people THAT person came into contact with, rinse and repeat.

It's great that tests are finally ramping up but the growth in testing can
never exceed the growth in cases if cases are doubling every finite number of
days. The choices are a severe lockdown where R < 0.5 until the true case
count drops to near 0, a non-severe lockdown where R ~1.2 - 1.8 (Hubei's
lockdown had an R of 1.3 in the early days until they figured out centralized
quarantine could bring it down to 0.4) and you just continue the lockdown
indefinitely, or "herd immunity" where R stays at 2.4 until pretty much
everyone in the country gets sick.

Once you get your true case load down below your test load, then you can think
about using non-pharmaceutical interventions (universal masking, universal
temperature screening, mandatory hand washing when entering into a gathering
space etc.) along with rigorous contact tracing to ensure that any future
outbreaks remain small and contained.

~~~
sp332
I agree with wanted to blanket the country in tests, but you don't need 1000
tests to do contact tracing for one person, even normally, let alone during
social distancing.

You don't need to test people every day for 14 days.

~~~
shalmanese
You do because as soon as that person is confirmed positive, then you need to
contact trace and quarantine that person's contacts. Every day that goes
between a confirmed positive and a contact trace, the more that person's
contacts are walking around, spreading it asymptomatically and making the
cluster even more out of control.

------
throwaway_pdp09
This is bad. I've been graphing the exp curve for Italy, UK and USA and the
USA curve is fearsomely steep. Italy has more cases now but the USA is growing
fastest and _looks like_ it will match Italy's on ~March 28th (looking at the
most recent 10 points, see below)

The rate of growth in the USA, extrapolated, is just huge. Looking at the
whole curve it does not match an exponential well, I think the early part is
skewing it. If we take the last 10 data points, they fall very well onto the
curves for all 3 countries, and that curve for the USA is horrific. I'm not an
epidemiologist nor statistican so it would be irresponsible to put my
predicted figures here, but christ, if I'm right the US is going to be reeling
in just a few day.

Edit: @mnl below has pointed out that infection is not an exponential but on
the whole a logistics curve (s-shaped curve
[https://en.wikipedia.org/wiki/Logistic_function](https://en.wikipedia.org/wiki/Logistic_function)).
He is correct. However in early stages I believe an exponential MAY be a
decent approximation (and I'm reading up on it now). However, the inflection
in the 'S' (where new infections would start to slow down) would be expected
to be at far higher figures than those I'm looking at - a few tens of
thousands of reported infections per country currently - and it's not even
close to that (populations of multiple millions in each country).

~~~
cowsandmilk
> the USA curve is fearsomely steep

This analysis is difficult because it is related to testing capacity. We all
know testing capacity was limited early on. It remains limited, but is
growing. The faster capacity grows, the steeper the curve will be. Want to
have a less steep curve? Lower the amount of testing.

In another comment, you claim looking at the curves leaves out politics
completely, but it doesn't. Any politician can make the situation look worse
on the curve, but better serve their people, by increasing testing. They can
also make their curve look better, but do worse for their people, by claiming
their state is unable to purchase tests. This can be a very political game.

~~~
notahacker
Yep. Ventilator usage [if available] and deaths are more reliable indicators,
but they're also lagging ones [and even deaths aren't entirely consistently
measured since many of the most severely affected patients exhibit
comorbities, and many nations don't test the dead]

~~~
paganel
> deaths are more reliable indicators

They are more reliable than the simple number of cases but in the Italian
province of Bergamo (and I suppose in neighbouring Brescia, too) lots of
people have started dying before the ambulance even arrives at their homes.
Those people will not show up on the official statistics of covid victims, at
least not now.

A similar thing had started happening in Wuhan once the situation had become
really dire, and the closest valid indicator people could find was to look at
the number of incinerators and how busy they were (mostly looking at the
number, because the incinerators were busy 24/7 anyway).

------
yread
165M deaths actually sounds plausible for covid19, if it overwhelms health
care in India and developing world countries...

~~~
yotamoron
And how many deaths would a greater-then-the-great-despresison depression will
cause?

~~~
mrfusion
Yes. No one is asking this question.

~~~
bsaul
That, IMHO is the point that was only implicitely made by the original article
: massive testing lets you keep the economy at least partially work, because
you know who can go to work safely and who can't.

I really hope someone makes a deep study of the decisions that were taken
regarding testing facilities in the various european countries, because i have
the feeling, at least here in france, that doctors gave up a little too fast
on that option (and i still don't understand why)

------
DoreenMichele
_Is there in any way a brighter side to this?_

Something I talk about a fair amount: It's incredibly hard to measure what
didn't happen but should have. Humans are really bad at that, and
understandably so.

If we had adopted a lot of the practices being advocated currently and avoided
the epidemic, no one would know or believe we had accomplished anything.
Having a pandemic and defeating it is the only way humanity can know and
understand with confidence that we need to make a lot of changes to make life
work with so many billions of people on the planet.

I have a serious medical condition. I've gotten off all drugs. I know what my
life is supposed to look like because I know what my condition is supposed to
do. Other people have what I have. I know the typical prognosis.

Yet I have no credibility. I've been mocked and attacked and dismissed online
for years because other people cannot see that I've done anything and don't
believe I have. Other people can't see what I see and it makes me look to them
like a loon suffering hallucinations, not a visionary that people ought to
listen to.

I once had someone email me and tell me "I give my child the sea salt and
coconut oil you've recommended, and he's in the ER less, but he's not on fewer
drugs."

She meant he still was on the same amount of maintenance drugs as before. She
wasn't really recognizing that fewer ER visits meant fewer rounds of
antibiotics, steroids and similar.

The child was taking less medication, but the mother couldn't quite manage to
count the drugs that weren't happening. In her mind, it would only count if
her child could reduce his maintenance drugs.

There are a lot of things I hope we change. But the reality is that without a
pandemic, no one would believe those changes actually provide germ control and
actually matter to the functioning of the world. People would just find the
restrictions annoying and pointless and would rebel against it.

You are only going to get compliance when enough people have been burned that
change seems less onerous than not changing. That's basically how humans
always handle things.

It's frustrating. I wish it weren't so.

But people don't change everything at great cost to avoid disaster based on
predictions and models. We make those changes because we got burned in actual
fact, not in theory, and we don't want to go back.

And then it's no longer hypothetical. Then it's actually real and we aren't
running from Boogeymen. We're problem solving and dealing with actual reality.

Then you see real change.

~~~
ComputerGuru
I’m sorry, you sound like you’ve been through a lot, but what does this have
to do with the article, or even the sentence you excerpted?

~~~
soneca
I believe she is saying that the humanity will be better prepared to handle
threats after the pandemic. That's a brighter side to things.

~~~
DoreenMichele
Better prepared and _will know the value of it._

We already have remote work. It may have already reduced our vulnerability and
lessened the impact of this pandemic.

I'm not seeing that talked about. We have no means to measure how much worse
this pandemic would have been without remote work, without the internet,
without credit cards and PayPal and a zillion other things that already exist.

In most cases, we don't even try to measure the disasters that didn't happen.
That gets viewed as talking out your ass, basically.

------
bg24
Illiterate politicians can still survive if they keep competent people in
their surrounding. Our president pushed out the relevant people from national
security council, kept his own folks, and did not listen to anyone in January.

Four years of presidency tenure has it’s downsides.

------
nabla9
Francois Balloux Computational biologist, director of Genetics Institute at
UCL had interesting twitter post:
[https://twitter.com/BallouxFrancois/status/12388371580074475...](https://twitter.com/BallouxFrancois/status/1238837158007447558)

> Predictions from any model are only as good as the data that parametrised
> it. There are two major unknowns at this stage. (1) We don't know to what
> extent covid-19 transmission will be seasonal. (2) We don’t know if covid-19
> infection induces long-lasting immunity.

>How long immunity lasts for following covid-19 infection is the biggest
unknown. Comparison with other Coronaviridae suggests it may be relatively
short-lived (i.e. months). If this were to be confirmed, it would add to the
challenge of managing the pandemic.

>Short-lived immunisation would defeat both ‘flattening the curve’ and ‘herd
immunity’ approaches. Devising an effective strategy would be even more
challenging under low seasonal forcing. It would also considerably complicate
effective vaccination campaigns.

~~~
34679
Why don't we know the extent of seasonal transmission? At the very least, we
have data from areas that are in opposite seasons, even if we've yet to
collect data on the transition from one season to another. Can't we get some
insight from comparing the rate of transmission in Australia, where it's
summer, to the UK, where it's winter?

~~~
marcosdumay
This virus has spread just like you would expect it to if airplanes did not
exist (probably because most flights are short range). And it started at the
North Hemisphere.

The southern countries are all on the initial stages, and I doubt any one has
any reliable number for transmission speed, due to both test limits and low
numbers overall.

------
merricksb
Earlier discussion:

[https://news.ycombinator.com/item?id=22635225](https://news.ycombinator.com/item?id=22635225)

~~~
Amygaz
Thanks, except the discussion on this one are more relevant, to what is at
stake. The other started pretty quickly on pooping the media.

~~~
ethbro
As opposed to this one, which is starting with armchair statisticians
extrapolating curves without considering the nuances of the underlying data?

------
Dahoon
Most people (and most people who advice the public in the US) doesn't take
this serious enough.

One of the foremost experts in epidemiology in the US Michael T. Osterholm
said on Joe Rogan (AFAIKR) 6-12 months for the virus to go away, up to 5 years
for a vaccine and that it would return in China when people start behaving
normally again. This isn't something that will go away in a few weeks or
months.

In "Deadliest Enemy: Our War Against Killer Germs" he also predicted a Corona
virus coming from China.

In a months time the US will take the place of Italy and see the healthsystem
crash.

~~~
bamboozled
If you read the article, Dr Brilliant [sic] says 12-18 months most likely for
a vaccine?

------
steipete
Doctor Who?

------
yotamoron
Corona is killing a negligible % of the population, mostly very old and very
sick people (checkout the official data from the Italian health ministary -
average age of dead patiences is 79.5 years, all of them with severe
background illness, in a part of the country where 29% of the population is at
least 60 yeard old. Those are the facts.). If anyting, what we are
experiencing is not a corona pandemic but a massive, global hysteria pandemic
- much more dangerous.

~~~
throwaway_pdp09
> checkout the official data from the Italian health ministary

Post link plz

~~~
grouff
Here is something from somewhere from yesterday
[https://www.epicentro.iss.it/coronavirus/bollettino/Infograf...](https://www.epicentro.iss.it/coronavirus/bollettino/Infografica_20marzo%20ITA.pdf)

