
US admits 'failing' on testing, says Fauci - hhs
https://www.bbc.com/news/world-us-canada-51860529
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Reedx
Sounds like he's being too honest. Expect him to be replaced imminently.

Seriously, how are we so bad at this? We knew it was coming and South Korea
has been testing 10k/day since Feb, so it's clearly doable. We've done <10k
total! What in the world is going on with the tests?

~~~
pgrote
>What in the world is going on with the tests?

It appears the main driver has been lack of chemicals and in the beginning,
the cdc required tests to be sent to them. The states can now test on their
own.

[https://www.vox.com/science-and-
health/2020/3/12/21175034/co...](https://www.vox.com/science-and-
health/2020/3/12/21175034/coronavirus-covid-19-testing-usa)

~~~
beamatronic
There was a technical issue, and a policy issue.

~~~
belltaco
There was literally a policy not to allow states to use testing from other
countries. And also to restrict testing a lot, early on. Even India started
aggressively testing many travelers long before.

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snapetom
I have a hard time faulting the CDC for the response overall, but I just don't
understand why they decided to make their own test at the beginning. Was it
bravado? Did they think the 70% accuracy of the WHO test wasn't good enough?

If they didn't make their own test, they wouldn't have fubarred the
manufacturing, which would have given us more tests.

One of the CDC's main goals, if not the main goal in this, is to spread out
the panic. Given this goal, the fact that we're in flu season, _and_ the lack
of test kits, I can understand the stringent testing criteria. They choose the
best option in a bad situation, and I think they've done a pretty good job.
However, it seems like a lot of problems could have been avoided if they just
used the WHO tests.

~~~
surge
The test accuracy of the WHO test as far as I understood it was good if
someone was already experiencing symptoms once viral load was high enough. The
bigger issue was false negatives, people would get released from quarantine
measures, then spread it (like the cruise ship). They recommended anyone
within contact to self quarantine until symptoms had reached a point they
could get a definitive test. At this point testing early and coming up
negative doesn't mean anything, you should still stay quarantined and
continuously get retested, since a lot of people who tested negative were
found to have had it the whole time when symptoms present and were given the
all clear before.

In summary, the testing early doesn't change the decision tree, which is stay
quarantined for 14 days, until symptoms present or not, so little point was
seen to testing until then.

Problem is now, we can't track it, so everyone ideally should self quarantine
or limit as much as possible social interaction and get tested if they have
good reason to believe they've been exposed. Early testing will catch a lot of
people but not all, so it will slow the spread, so at this point the decision
tree changes and we need to start testing more, if nothing else to get a
sample to extrapolate the true spread of this thing.

~~~
snapetom
> In summary, the testing early doesn't change the decision tree, which is
> stay quarantined for 14 days, until symptoms present or not, so little point
> was seen to testing until then.

That makes a ton of sense. Thank you!

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pgrote
Admitting and identifying the problem is the first step.

The Cleveland Clinic just came out with an 8 hour test and hopefully this will
help the situation if they share the process.

[https://www.vox.com/science-and-
health/2020/3/12/21175034/co...](https://www.vox.com/science-and-
health/2020/3/12/21175034/coronavirus-covid-19-testing-usa)

~~~
throw7337
There is nothing secret about RNA testing. Any decent lab can synthetise its
own markers from a file downloaded from internet. It is like genetic research
is illegal in US or what.

~~~
tlb
Offering a diagnostic test without FDA approval is illegal, for good reason
(there would be companies far worse than Theranos) but clearly in an emergency
regulators need to adapt.

~~~
wbl
That's not true for tests developed in the lab they are used in.

~~~
vmh1928
In Arizona, Mayo Clinic, Sonora Quest Laboratories, and the Translational
Genomics Research Institute in Flagstaff are rolling out their own tests.
Official test kits from the CDC are in woefully short supply, under 200 right
now, and only being used for people showing significant symptoms. According to
a news article the new tests will use a technique similar to the CDC test
known as reverse transcription polymerase chain reaction, otherwise shortened
to RT-PCR

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astrophysician
What is the true/false negative/positive rate for these tests? I can't find
that online and I have tried.

If FPR is 10% and we test 100,000,000 people in the US but only 100,000 have
the disease right now, then assuming a TPR of 100% (and a FNR of 0%) we will
have 10,100,000 positive results = 101 x the number of people with COVID? How
is that useful?

Disclaimer: I am maybe an idiot.

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chvid
I thought this polymerase chain reaction test was something you could do at
any university hospital?

~~~
jfarlow
From a technical perspective, it is a simple test. Hard part is chain of
custody and sample integrity - controls, etc.

~~~
heyitsguay
Are there any differences for Covid-19 samples versus any of the other samples
such labs would be routinely testing though?

~~~
chromatin
Yes, it is RNA virus so it is an extra step that is not necessary in many
other PCR based clinical tests.

~~~
heyitsguay
Sure, I meant for the non-technical aspects that the previous poster mentioned
- chain of custody, sample integrity.

~~~
jfarlow
So the process used in this testing is so common that research labs and any
biochemistry lab in any college or high-school can run the test. But they
probably shouldn't because they have no practice nor experience providing a
diagnosis to a human - much less the strict statistical controls to interpret
their results reliably.

A clinical lab that is used to running these kinds of (very common) protocols
will see no difference in this protocol from others they commonly run (from a
chain of custody, sample integrity, etc. perspective), just with a slight
change to their reagents to specifically test for COVID. Their handling should
be no different.

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holri
Austria alone (8 Mio people) made to date more than 5000 tests, the US
11000....

~~~
elygre
Norway (5-ish million) did more than 10000.

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ajross
Realistically there is no "US" any more. Fauci is speaking for the NIAID, and
arguably for the scientific community within the CDC/NIH/HHS. The white house
certainly wouldn't be on board with this message, but as we saw last night
even the white house is inconsistent with its own policies in important ways.

But yes: we messed up. We weren't prepared to begin with, we rolled back a
bunch of existing preparedness work, when the disease arrived we turtled
instead of testing, and then we refused to scale the testing capability for
critical weeks. At this point it's too late. Better testing is still needed to
inform the hard public health decisions that will have to be made, but it's no
longer able to contain outbreaks that have grown orders of magnitude too
large.

~~~
MiroF
Absolutely. Was talking with a friend who was confused about why schools in
remote areas are being shut down - testing needs to be done just so people
realize that it's not just Washington or New York, this is pretty much
everywhere or imminently about to be everywhere in the United States.

~~~
chrisco255
Anyone want guess at how difficult it is to ramp up testing to a population of
320 million for a disease that didn't exist 4 months ago?

~~~
stevenwoo
Italy and South Korea managed to scale up widespread testing and their
economies are proportionately much smaller than the USA for their population.

~~~
rstupek
Italy is geographically half the size of Texas and South Korea is 1/7 the size
of Texas. It's considerably easier to do widespread testing when everyone
practically lives next to everyone else.

~~~
yongjik
This is the weirdest "US is special" argument. You can pack a hundred samples
(blood/swab/whatever) in a box and send it to whatever lab in a major US city,
in a matter of hours.

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esthermun
He can do the mea culpa later. Lets fix this asap!

