
CDC reviewing ‘stunning’ universal testing results from Boston homeless shelter - g42gregory
https://www.boston25news.com/news/cdc-reviewing-stunning-universal-testing-results-boston-homeless-shelter/Z253TFBO6RG4HCUAARBO4YWO64/
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dang
[https://news.ycombinator.com/item?id=22880335](https://news.ycombinator.com/item?id=22880335)

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elihu
Some possibilities: the number of asymptomatic carriers is higher than
expected, these people were mostly infected at the same time and just haven't
shown symptoms yet, these people were infected by a less severe variant of
SARS-CoV2, the tests are simply incorrect, or the inhabitants of that homeless
shelter are in some way non-representative of the population in general (e.g.
they're all in their mid-20's).

They imply that those asymptomatic cases didn't all stay asymptomatic and that
one was hospitalized, so I'm guessing the most likely explanation is just that
most of them were infected around the same time, and the test just caught them
before they started to show symptoms.

~~~
ImprovedSilence
I would love to see a follow up on their symptoms in 2-3 weeks. Not sure we'll
ever see that info though, follow ups don't seem to sell eyeballs these days..

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officialjunk
italy did this in a small town, testing weekly, by week three 80+% showed
symptoms, and concluded they would all eventually show symptoms.

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stefan_
The CNN article has a picture of what a Boston homeless shelter looks like:

[https://cdn.cnn.com/cnnnext/dam/assets/200417103746-01-pine-...](https://cdn.cnn.com/cnnnext/dam/assets/200417103746-01-pine-
street-homeless-shelter-boston-2018-exlarge-169.jpg)

So yeah, it's a bunch of tightly packed beds. One or two asymptomatic carriers
can probably infect hundreds in just a night.

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jennyyang
Those appear to be just PCR tests that tell you if the person has an active
infection or not. Those that are negative should get a serology test to see if
they were previously infected. The combination of both of those tests would be
a true indication of how far this has spread.

Of course, given how infectious this virus is, it's no wonder that half have
been infected in the last 1-2 weeks at the shelter. There's probably little to
no safety measures in place to help isolate homeless people at that shelter,
so it would spread like wildfire.

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SpicyLemonZest
Yeah, it seems like it spreads to everyone in every nursing home it hits, so
it'd be shocking to see it fail to spread in a homeless shelter.

~~~
threeseed
In a nursing home I would've expected nurses to be transmitting COVID-19
between patients.

But merely having a lot of people in a room be enough for widespread
transmission is a bit of a wake up call. I can't understand how given that you
could ever open up bars, restaurants etc.

~~~
SpicyLemonZest
Well, a lot of people in a room for at least 8 hours, and unless this is a
one-day shelter probably iterated over quite a while. I don't think this
suggests a story where you sit in a restaurant for 2 hours and then everyone's
infected; there's only been one report of a case like that, and multiple
contact tracing reports from other countries where a carrier only infected a
few other people in their bus or restaurant.

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dboreham
Transmission via asymptotic carriers isn't a new thing. It's been known for
months (e.g. the analysis of the first cluster in Germany) and is one of the
main reasons this virus is so problematic.

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threeseed
I am actually surprised people aren't more concerned about the long term
effects of COVID-19.

We have seen patients who got through it but were left with persistent
neurological effects i.e. loss of smell, heart damage, weakened immune systems
etc.

If people are asymptotic but have reduced life expectancy then that is a
really big problem. Especially if we are talking about just letting COVID-19
basically run wild through healthy people.

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Fjolsvith
> We have seen patients who got through it but were left with persistent
> neurological effects i.e. loss of smell, heart damage, weakened immune
> systems etc.

Not a significant percentage of patients by any means.

~~~
orwin
Lasting lungs damage is expected in ~5% of hospitalized cases (not counting
ICU/reanimation protocol cases) in eastern France. I'd says it is a
significant percentage. We will need to wait a couple month to be sure it is
irreversible (pulmonary fibrosis are irreversible for the moment, as we can't
chirurgically extract damaged lung tissue yet) and also the extent of this
damage.

A young lady got asthma for the first time in her life last sunday, asthma
that did not left her at least until wednesday (when my cousin told me about
it, no news since). As nurses and doctors there now can afford to take
vacation now (two-day vacations are vacations when you're working everyday
since early march), they will probably have some time to start evaluating the
non-deadly damages sometime soon.

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Fjolsvith
> A young lady got asthma for the first time in her life last sunday, asthma
> that did not left her at least until wednesday (when my cousin told me about
> it, no news since).

Anecdotal. While you say lasting lung damage is expected, you also say that a
couple of months are needed to be able to prove the expectation.

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JMTQp8lwXL
> “It tells you, you don’t know who’s at risk. You don’t know what you need to
> do to contain the virus if you don’t actually have the details or facts,”
> said Marty Martinez, Boston’s chief of Health and Human Services.

Plans to reopen states are conditioned on testing, but how long --and will we
ever-- have enough testing data (among the general population, not just those
showing symptoms) to make the informed decision?

If we can't get the cotton swabs, the reagents, with the ability to test
nationwide at scale, health policy experts will not be positioned to green
light re-opening.

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cmurf
Well to do folks can work from home, or not work from vacation homes, have all
their needs delivered, and not catch this thing. All the "essential" people
will catch it and some will die, and the well off will consider this very
cheap, good, proper, and mandatory for economic reasons.

It's hardly worse than the exploitation for profit of the tobacco industry.
Known for decades it would maim and kill, but millions invested in, were
shareholders, were owners. And they've never been sanctioned. This will be no
different. The lower class will take one for the team, again, for the greater
good of society so that the better classes can live with minimal
inconvenience.

By all rights, essential workers should quit. But they have a boot on their
head: landlords and debts. It's economic coercion.

~~~
eddieplan9
That's a very cynical view. Doctors are by no means lower class. Most if not
all of them can quit, and are not subject to "economic coercion". Yet almost
of them choose to work and overwork.

I am not an "essential" and am working from home, but I donate and try to help
my local community, and if I am called to help in other ways, I will.

And no, I don't actively invest in tobacco.

~~~
gizmo686
Many doctors have a substantial amount of debt from med school that they took
on with the assumption of having a doctor's income.

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wutbrodo
I wonder what the age breakdown was of those tested. It seems like there have
been a couple of (very preliminary) indications that prevalence may be higher
(and thus case severity lower) than we thought. It's probably too early to be
optimistic, but I'm looking forward to getting more and more cases with better
population samples than "people who think they have it", to get a better sense
of what the rate of symptoms is.

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aazaa
These articles really need to state what kind of testing was done: RNA or
serological.

Very different conclusions if 50% test positive for one vs. the other.

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smileypete
Probably better off on the street in the open air, than a 'shelter' full of
asymptomatic COVID cases...

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adventured
The most stunning testing result is the recent Stanford blood study in Santa
Clara showing that potentially 50 times as many people have been infected with
Covid as previously thought.

We might already have 50 million Americans that have had Covid before another
couple weeks is up.

Of course the media won't cover this story widely, as it won't sell properly,
there isn't enough sensationalism. It lowers panic (it would mean the Covid
mortality rate is radically lower than previously feared, even versus common
low estimates), rather than raising panic.

It's crazy that the US isn't putting a lot of manufacturing and money behind
doing widespread blood testing to see how common Covid actually is. This
should have been done a month plus ago. Based on deaths, 10-15% of NYC
probably has already had it at this point and if so, we need to know that
asap. I've been talking about this for months now, it's not a premise
requiring any kind of specialized knowledge to grasp (obvious question: how
widespread is the virus), and I've yet to see any media interest in it despite
how blatantly obvious it is.

It's almost like there is some interest in ensuring we don't find out how far
Covid has already spread. The first thing they should have figured out, is the
last thing they're apparently going to figure out.

~~~
skybrian
The Santa Clara study has gotten a fair bit of press and attention but it's
not clear whether the results will hold up. The antibody test is new and
they're assuming very few false positives, and it's a non-random study
(recruitment via Facebook).

Here's some more criticism: [https://medium.com/@balajis/peer-review-of-
covid-19-antibody...](https://medium.com/@balajis/peer-review-of-
covid-19-antibody-seroprevalence-in-santa-clara-county-
california-1f6382258c25)

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adventured
It's why we should be doing massively increased blood testing and test
manufacturing to resolve that question. For the last few months it has been
the single most important question and they're putting very few resources
behind trying to answer it.

We can't test blood properly? Of course we could. They are choosing not to, is
the actual context. It's a large mistake.

How many infections have you already had? How widespread is it really? No
answer, no attempt to answer at scale. At its best, it's immense incompetence
in action by the authorities in charge of dealing with this mess.

~~~
hcknwscommenter
You seem to conflate antibody testing with viral rna testing. The former is
somewhat difficult because you can't make the reagents necessary overnight,
and the reagents are unique for the virus. Essentially, you have to clone the
gene for an immunogenic portion of the virus (the spike protein most likely),
express it in a recombinant host (which may require extensive optimization),
purify it, and then validate that it properly detects blood of people who were
confirmed positive for viral RNA and then recovered. That all takes time, and
then you have to scale up manufacturing. In contrast, the the viral rna
(RT_PCR) test takes about a day to design and the reagents are synthesized
overnight and then you can run the test in the morning of the second day.
Scaling that up to 1 million viral RNA tests a day should add at most a month,
but our country already runs this number of tests a day if you count every
academic, research, hospital, and CLIA lab, so the manufacturing capacity
already exists.

