
Covid-19 at a homeless shelter in Boston: Implications for universal testing - stillsut
https://www.medrxiv.org/content/10.1101/2020.04.12.20059618v1
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jcp2fa
> Cough (7.5%), shortness of breath (1.4%), and fever (0.7%) were all uncommon
> among COVID-positive individuals

It seems the more important point here is that the majority of the COVID-
positive individuals were asymptomatic, putting another datapoint towards the
conclusion that there are orders of magnitude more people that have this
disease than have tested positive.

We need more studies to gather data on these asymptomatic cases if we want to
reopen the economy soon. Imagine if 10+% of the population already had COVID
and where immune, we'd be much closer to heard immunity than we currently
think.

~~~
jlmorton
We already have lots of data that says this is not true. For instance, on the
Diamond Princess, widespread testing of a confined group initially found many
asymptomatic infections, but the majority of those turned out to be pre-
symptomatic, not asymptomatic.

Longer term follow-up found ~25% of infections were asymptomatic.

In the US, we're now doing significant amounts of testing, but we're still
primarily testing only those with severe symptoms. Even limiting our sample to
people presenting with severe matching symptoms of COVID-19, we're finding
~20% PCR-positive for SARS-CoV-2.

Beyond that, we also have good evidence that the Basic Reproduction Number is
somewhere between 2-3. Given a seeding of cases in mid-to-late January, even
without social distancing measures, it would be unlikely to have 10% of the
population infected yet.

~~~
cgb223
> In the US, we're now doing significant amounts of testing, but we're still
> primarily testing only those with severe symptoms

Its not a significant amount of testing if we're only testing those with
severe symptoms

Here in SF at least there are scores of people I know who all were sick with a
"weird flu" at some point from February to now who would all kill for a test
to show that they have COVID immunity. These are people who could potentially
go back into society and do more work / enjoy their lives instead of being
shuttered inside with anxiety

It is currently _IMPOSSIBLE_ to get any kind of test to prove that

~~~
beamatronic
Go do the Stanford drive-through blood antibody tests. It takes five minutes
it’s free and they do it for everybody.

~~~
cgb223
Do you need any kind of doctors order for that or health insurance?

Like how does it work? Would love to go do that

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zadkey
(Regarding the Headline) Surely you mean 35% of homeless who were tested. We
can't say for certain that the sample is an exact representation of the
general population of the homeless in Boston.

"Upon observing a cluster of COVID-19 cases from a single large homeless
shelter in Boston, Boston Health Care for the Homeless Program conducted
symptom assessments and polymerase chain reaction (PCR) testing for SARS-CoV-2
among all guests residing at the shelter over a 2-day period. Of 408
participants, 147 (36.0%) were PCR-positive for SARS-CoV-2"

The key thing here is they tested people from one single homeless shelter. Is
this one homeless shelter in Boston representative of all homeless shelters in
Boston? There is not enough info in this article to make that assumption. Nor
is it enough information to make generalizations about the populations of the
homeless who do not live in shelters.

~~~
smallgovt
> We can't say for certain that the sample is an exact representation of the
> general population.

I actually think we can say for certain this is NOT a good representation of
the general population. The general population has not been living in close
quarters with multiple COVID positive people.

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rb808
Also 15% of pregnant Moms in NYC had the virus. This could already be much
more widely spread that people think.

[https://www.nbcnewyork.com/news/local/nyc-hospital-finds-
hig...](https://www.nbcnewyork.com/news/local/nyc-hospital-finds-high-
covid-19-infection-rate-but-few-symptoms-in-pregnant-women/2372863/)

~~~
drtillberg
The Boston Globe this morning ran an op-ed advocating testing a random sample
of residents to get a better sense of community-wide infection rates.[1] It's
_amazing_ that this needed to be stated in a major market newspaper four weeks
after most business and school was stopped due to the virus. Goverent is doing
some interesting things, random sampling apparently isn't one of them, for
reasons it's hard to understand.

[1]. [https://www.bostonglobe.com/2020/04/15/opinion/how-get-
bette...](https://www.bostonglobe.com/2020/04/15/opinion/how-get-better-
covid-19-infection-data-without-universal-testing/)

~~~
jandrese
Everybody knows this, but the US healthcare system was so unprepared for this
that there simply weren't (aren't) enough test kits around to do a proper
study. Even people who have the symptoms struggle to find a place that will
test them in some cities.

~~~
arcticfox
I like Step 0 of Paul Romer's proposal: "Stop testing people with symptoms.
Presume positive and isolate."

[https://twitter.com/paulmromer/status/1248712889705410560](https://twitter.com/paulmromer/status/1248712889705410560)

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kens
Regarding the title "Covid+", it seems that most people (even on the news)
don't care about the difference between SARS-CoV-2 (the virus) and COVID-19
(the disease). Is this distinction being abandoned? (I'm not trying to be
pedantic here; I'm just curious about the common usage.)

~~~
marcosdumay
Nobody ever cared. The names are confusing (the virus is named after the
disease, and the disease after the virus), and the virus name obtuse. The
obvious consequence is that nobody ever used the virus name, and never will.

The best you can hope for is for people to call it the "COVID19 virus".

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analog31
I certainly don't have a better read on the numbers than anybody else. But I
think that the rising number of reported cases and deaths is going to make it
harder and harder to think that there is a huge hidden pool of asymptomatic or
immune people in the population.

For instance as of today, the number of unreported to reported cases in the US
can't be more than about 500.

The time period when the disease could have been prevalent in the US can't
have been very long, because at its present level it kills about 15000 per
week -- a number that could not have gone unnoticed even a month ago.

Eventually, the curves of hopes, reported data, and reality will all have to
intersect, I just don't know where or when.

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downerending
As always, "compared to what?". If non-homeless, demographically matched, are
also around 35%, this might not mean much.

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hairytrog
A good dose of skepticism:
[https://swprs.org/contact/](https://swprs.org/contact/)

~~~
jshevek
Most of the links on that page are unrelated to COVID19. Three were related.
Are you recommending one of those three? Which?

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JulianMorrison
I really wish they'd tested inability to smell/taste as a symptom. I'd be
interested to see if it leads other symptoms.

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turbostyler
I'm surprised it's that low.

