
What's the point of a Covid-19 test that takes 19 days for results? - finphil
https://www.buzzfeednews.com/article/davidmack/coronavirus-testing-delays-backlog
======
endymi0n
It‘s so sad to watch, but compared to any other developed and affluent nation
(and with equal time to prepare), the US is a complete shitshow at this point.

The complete lack of leadership and resulting power vacuum resulted in
valuable time lost bickering, blaming and thumb twiddling that could have gone
towards preventing the second wave. This is a community spread at this stage
and another hundred thousand people are all but guaranteed to die. It‘s
mindblowing.

Here in Germany, I‘m getting my test results within 3 days via SMS (usually
same-day for positive results) and can enter it into an app to warn others.

Everybody wears a mask indoors and nobody but a very small minority complains.
Social distancing is enforced by usually friendly police which the people
mostly trusts to do its job.

It‘s just so sad to see how personal „freedom to choose“ turned into the
achilles heel of one of the formerly greatest nations on Earth.

~~~
jquery
No, that’s just yellow journalism. The USA is doing just fine thank you. The
“second wave” is the whole point of flattening the curve, as long as hospitals
aren’t overwhelmed, our response is successful.

Look at our respective stock markets for a more accurate view of the
situation. They’re tracking very close, even adjusting for currency float. The
USA is nowhere near falling apart.

~~~
hurrdurr2
Ahh yes. The stock market is doing great hence we are fine.

I'm sure our president and his sycophants also completely believe this.

------
tzs
For the cases given as examples in the article, from Georgia and Texas, even
if they got prompt test results both those states are doing badly at contact
tracing which further exacerbates the situation.

Georgia is currently tracing just 7% of contacts. They were in the 7-9% range
from mid May to early June, then fell slowly to about 4%, then briefly in late
June got up to 19%, and then immediately went into decline back down to 7%.

Texas is doing 6%. They were at 19% in mid May, rising to 42% near the end of
May, fell to 25% in early to mid June, jumped to 33% by June 11, and then have
been on a decline down to the current 6%.

Experts say this needs to be 90% withing 48 hours of infection.

California peaked at 39% in mid May and has followed roughly a declining
sawtooth since then, currently at 22%.

Florida is just 3%. They peaked at 40% at the start of June and went steadily
down hill since then. They curve looks like a capacitor discharge curve.

The only states that currently either have enough contact tracers or have
planned expansions that will get them enough are: Alaska, Hawaii, South
Dakota, and everything north or east of Pennsylvania except for Rhode Island,
.

Of those, all but New Jersey, Massachusetts, Alaska, and Hawaii currently have
sufficient contact tracers on hand.

The remaining ~40 states do not have enough and do not plan to get enough.

A state needs 5-15 tracers per daily positive test. Georgia has 0.33, Texas
0.31, California 1.07, and Florida 0.15. Compare to New York at 13.75.
(Missouri and Alabama are tied for the worst here, at a paltry 0.08).

Reading between the lines, I think that several states hired enough to handle
the load near the end of lockdown, with perhaps some room to spare for a minor
raise as they reopened. When the rise was faster than they anticipated, they
failed to slow down reopening or to boost their budget for contract tracing.

Above data from [https://testandtrace.com/](https://testandtrace.com/) and
[https://covidactnow.org/](https://covidactnow.org/)

~~~
makomk
No amount of budget-boosting would be enough to keep up with exponential
growth. If they hired enough people to cope with the contact tracing load near
the end of lockdown plus a little bit of an increase, and then the increase
was faster than expected, that sounds like a pretty clear sign that contact
tracing is not a workable solution. (Which is, as I understand it, pretty much
what we'd expect. Contact tracing has not conventionally been seen as even
remotely viable for a respiratory disease like this one.)

~~~
irrational
I thought contact tracing was exactly how countries like South Korea kept
their numbers so low?

~~~
SpicyLemonZest
It's unclear. Rates in South Korea are rising, and they've generally used
somewhat broad shutdowns in addition to contact tracing. (For example, when
there were positive cases found in Seoul bars, they closed all the bars in the
city for weeks.)

------
birken
If you want to be incredibly angry at the ineffectiveness of the current
testing regime that we as a country are heavily investing in, listen to this
episode of the This Week In Virology podcast:

[https://www.microbe.tv/twiv/twiv-640/](https://www.microbe.tv/twiv/twiv-640/)
[TWiV 640: Test often, fast turnaround, with Michael Mina]

The way to beat the pandemic is to have cheap, disposable instant tests that
anybody can take in their homes, everyday, to see if they have a large amount
of virus in their system. These instant tests will not have the sensitivity or
specificity of the PCR style test, but it doesn't matter. The PCR style test
can test for levels of virus that are _billions_ or _trillions_ times smaller
than necessary, yet we disqualify other types of tests because they aren't as
accurate as the PCR tests. So we set an impossible standard that all other
tests, no matter how practically useful they could be, fail to reach.

We all could have cheap, _accurate enough_ instant tests, but do not because
they aren't as accurate as a test that is ridiculously accurate but takes so
long to get results at scale it becomes completely ineffective. It's complete
madness.

~~~
jacquesm
Is there such a thing as an instant test on the market?

~~~
microcolonel
A company here in Canada tried to bring one to market, but I think it was
completely disapproved because it was not precise and specific enough, which
baffled me since I don't really see the downside of it being available even if
that's the case.

Yes, accuracy is a nice thing to have, but if you _aren 't tested at all_ you
are worse off. You can still follow precautions if you are negative on an
inaccurate test, but we can't afford to have everyone take the precautions
that those with positive tests should.

If the test is highly sensitive but biased toward false positives, that would
also be a useful form of test.

~~~
contravariant
If it's not specific enough a significant portion of the population will have
to go into quarantine for no obvious reason, and if it's no precise enough you
either need to keep the restrictions or let a significant portion of the
infected population move around with no precautions whatsoever.

I'm not sure why you're not seeing any problems with this.

~~~
phendrenad2
It doesn't have to lead to quarantine. Many people are running around acting
as though the virus is gone. Some are staying indoors with a cold thinking
they might have the virus. If they could self-test and make their own decision
about the risk of changing their behavior, it would help immensely.

------
pdog
Did this pervasive level of criticism, animosity, and negativity exist a
hundred years ago during the last serious pandemic? Every week there's some
new crisis.

It feels like the entire media is always trying to highlight the next systemic
failure. "This is wrong." "This failed." "We don't have enough ventilators."
"New York cases are surging." "California cases are surging." "We don't have
enough PPE." "We don't have hand sanitizer." "We don't have masks." "We don't
have enough tests."

Are things actually this consistently bad, or does the media magnify the
negative and ignore the positive developments (of which there are plenty)?

It's like the difference between acute inflammation (which is good for the
body when it's fighting an infection) and chronic inflammation (which causes a
lot of problems).

~~~
king_magic
I mean, in the United States, 149,324 deaths _is_ a systemic failure. Another
834 today, and the day isn't over. Do you not think that constitutes a massive
crisis?

~~~
pdog
That's my point. The Spanish flu killed 750,000 in the United States at a time
when the population was around 100 million. It was certainly a massive crisis.

What was the reporting like and how has it changed?

~~~
jussij
When talking about mortality rates I don't think it is easy to make a
comparison of these two virus.

Firstly, the medical technologies of 1918 were nothing like what we have
today.

For example, even though it would have been no help fighting Spanish Flu, wide
spread use of penicillin was still some 20 years, showing just how far behind
the medical system of that time really was.

That difference also shows up in things like life expectancy which back then
was in the low 50s where as today it is in the 70s.

Finally the two virus are very different.

One factor that made the Spanish Flu virus so deadly was it killed both young
and old.

If COVID-19 had the same _death profile_ I suspect we would be seeing those
same 750,000 totals.

~~~
pvaldes
All of that, plus a context of wartime

And this deathcount was for an event that extended for 16 months between 2918
and 1920. We are in the eight month of covid-19 still

~~~
pvaldes
2918... (LOL)

1918

------
jefftk
If tests are much more useful if they come back quickly, then first come first
served with huge queues is the exact wrong way to handle excessive demand.
Instead you should test the _newest_ round of specimens that you have ready,
and catch up on older ones if you can when you have a lull.

~~~
dmurray
That incentivizes gaming the system by getting multiple tests, though, and
hoping one will be lucky to be the newest batch.

If you can centralise test assignment enough to eliminate that, you can do
something smarter, like prioritising health workers, at-risk demographics and
those who are already asymptomatic. Assign any remaining capacity quasi-
randomly to get the best possible statistical data for your epidemiologists:
if your systems are that overwhelmed it's far too late for contact tracing to
be useful, but the data scientists may learn something.

Having inefficient assignment of test resources is a problem inherent to
privatised distributed healthcare that doesn't just go away if you solve the
financial side with Obamacare or the like.

------
CyanLite4
Thus the need for cheaper, quicker tests, even if the accuracy is t that
great. TWIV Podcast episode #640 covers this. $1 per day test that quickly
gives a result, but perhaps is only 50% accurate.

~~~
Stevvo
I've lost count of the amount of times I've been tested, and it never took
more than 15 minutes. There are plenty of quick and cheap tests out there.

~~~
jader201
Curious, if you can explain without going into any sensitive details:

1) Why are you getting tested so often?

2) Where/how are are you getting tested and getting quick results?

~~~
oneplane
I'm not the person you asked, but I also get tested often and quickly due to
some work on physical access controls.

Often being: once a week. Not considered often compared to physical contact
workers, but considered often compared to work-from-home workers. Heck, even
considered often compared to the entire continent of North America.

Quickly being: drive-in test or walk-in test that is done in 5 minutes,
results within 3 days, usually within 24h, either by SMS text message or phone
call (depending on the test center).

Test center appointments are generally divided based on proximity, there are 4
test centers nearby for me (4 kilometres to max 30 kilometres -- sadly the one
closest is usually queued up full for 1 or 2 days). So far my experience has
been that they are very efficient; a lot of open space, about 6 people
physically there at the most, testing room is about the size of a shipping
container, one person doing the tests, one person observing/checking/entering
data. The most efficient one was actually in a parking lot next to the
hospital that also has a lab where they do mass testing. There is space for
about 30 cars, but they regulate the appointments in a way that even when some
people come early only 4 cars are there. Half the spaces are blocked/crossed
out, entry and exit are made using ramps and zigzags (if that makes sense) so
they are very accessible but also naturally prompt people to keep their
distance (aside from the stickers/billboards all over the place). Because it's
a single-direction flow for both cars and people and the people flow exit ends
where the car parking flow starts you never run in to anyone getting in or
out.

------
threatripper
There is _some_ value in knowing that you had it even after the fact. Having a
positive PCR test is way better than a positive antibody test. This knowledge
means that it is unlikely that you will get it again soon. (Though, we don't
have very good data on that. It will take some time till we know how long
immunity lasts and how well it works.)

For test and trace to suppress the epidemic you'd want to have results before
people become infectious to chase the infection chain quicker than it spreads.
That means contact identification and test results in the order of 1-2 days
(the faster the better but with peak about 3-8 days after infection you want
to be on the lower end). Right now this strategy is not feasible since there
are just too many cases coming in. Therefore this calls for a hard lockdown
until the case rate is manageable again. Since the lockdown is not going to
happen it will continue to spread till the hot zones burn out. Getting to herd
immunity without overloading the hospitals is unlikely and would probably take
years. Therefore overloading the hospitals is inevitable now. The difference
between hospitals overloaded by a factor 3, 10, 100 does not seem so very big
since you can't care for most patients anyways. Overloading heavily on the
other hand has the advantage that it might be over soon and you are done with
it (or maybe not, we don't know how long lasting immunity is and how many
people will have serious health problems afterwards). So in summary: We are
probably beyond the point of no return and whatever happens will happen. I
wish you all and your loved ones good health and good luck.

~~~
acqq
> Having a positive PCR test is way better than a positive antibody test. This
> knowledge means that it is unlikely that you will get it again soon.

I believe positive “antibody” test could hint to some chance of faring better
“next time”.

But even that is still not clear.

------
natrik
I find it interesting how daily new deaths in Sweden seem to have levelled off
to a low level. Of course there could be a second wave in the fall, but I
think Sweden might have reached the low herd immunity threshold.

[https://www.worldometers.info/coronavirus/country/sweden/](https://www.worldometers.info/coronavirus/country/sweden/)

~~~
Marsymars
What I'm wondering is why it seems to have levelled off despite case numbers
being wildly different in different regions of Sweden. Are people's habits
different, leading to very different thresholds for herd immunity? Are
reported case numbers off? Something else?

~~~
usaar333
In lower density areas, you'll have fewer contacts, so "herd immunity" numbers
(with some interventions) are lower

------
sneak
The point is that if they administered tests daily at the daily capacity for
testing (24h result turnaround) then many people who want to be tested would
be turned away, and become aware immediately of the testing bottlenecks.

It’s a form of bufferbloat.

I sometimes wonder how many fewer USians would have died in this pandemic had
it occurred outside of an election year.

~~~
makomk
I don't think there's any need for a deliberate conspiracy here; hard capping
the number of tests at exactly the daily capacity would require quite
complicated real-time feedback between the multiple sites taking samples and
the labs processing them, and would be worse in that it couldn't prioritize
cases which need test results most urgently. This problem isn't unique to the
US either; back when the press in other countries was pointing to Germany's
testing program as proof their country was falling behind, I even had a
conversation with a German on here who was convinced their testing was the
failure because of similar delays.

~~~
maxerickson
People would be mad about it, but it would be reasonably straightforward to
discard samples that were not urgent (so that testing for urgent samples
remained prompt and available).

There also seem to be some utilization problems. Some folks I know got tested
after 1 person had enough symptoms. The person with symptoms got sampled
several days before 3 other people and got their result last, probably because
of which lab was used.

------
tunesmith
Even in a place like Oregon which seems fairly well managed, we have major
test shortages. It just seems to me that the _first_ benchmark should be if we
have enough test availability (some combo of more tests and less infections)
to be able to get results with 24 hours of symptoms, so we can effectively
contact trace. If we don't have that, then all this Phase1 Phase2 stuff just
means that you're increasing the epidemic. But here in Oregon, all the
counties are in Phase1 or Phase2, none of them are in the "Baseline" lockdown
phase. Shouldn't we all be in the Baseline phase until we have enough test
availability?

I'm betting there's a good answer, like maybe the amount of test availability
Oregon has is dependent on the rest of the nation. Like, if our epidemic goes
down 90%, maybe our test availability will go down 90% anyway because other
states will get further prioritized.

But anyway, it seems like that should be the basic standard nationwide. Lock
it down until you can get test results within 24 hours, and then only slowly
open it up while proving you can keep that test availability - if you can't,
freeze or go back.

------
tammer
I work for a big institution that includes a massively funded hospital
network. I don’t actually work for the medical part of the institution. I am
technically deemed an essential worker because we have servers on-site.

Recently I had some minor symptoms and wanted to get a test. By going through
my employer’s employee testing process I

    
    
      A) got a test scheduled for the same day I called
      B) got my negative result under 12 hours later
    

This was a transformative moment for me in recognizing that there is an
intentional, and centralized project to stress testing capacity in the United
States. There is no shortage of materials or staff, just funding for lab
capacity. This is an incredibly solvable problem that our leaders are choosing
not to solve.

I truly believe the future historical narrative of this moment will cast our
elected leaders as the orchestrators of mass genocide. It’s hard to consider
living, breathing, contemporary people who hold esteemed positions to be on
the level of evil as historical Nazis. But as time passes and we consider the
impact their choices are having, it will both become easier to cast them in
such a light, and to question the passivity of a population that accepts their
decisions. It has never been more clear to me how such atrocities can happen
and at the same time become normalized.

~~~
asdf333
so you are saying that test results are intentionally being delayed?

i am not a fan of this administration and feel there is plenty of blame to go
around but i would love for more insight on why you think there is some
intentional malice happening...

~~~
xenospn
Virus stats make the people at the top look bad. More testing - more accurate
stats. More accurate stats - more outraged people. So they delay.

------
wyattpeak
While a wait time of 19 days is much too long, the connection drawn by the
article to the CDC recommended 2-week quarantine ("That’s five days longer
than the quarantine period of two weeks recommended by the CDC") is spurious.
That's the time in which the virus is expected to present, not the point at
which it's okay to leave your home regardless.

From the CDC article which they link right there, "[q]uarantine helps prevent
spread of disease that can occur before a person knows they are sick or if
they are infected with the virus without feeling symptoms."

------
kingkawn
Delayed test results are a nightmare that will guaranteed plunge us
exponentially deeper into the mess we’re in in the US

------
flukus
What's the point of testing at all in places that aren't taking steps to
reduce the spread?

Testing isn't the goal, it's data to use for an informed response. If the
response isn't going to come it's just a morbid and useless statistic.

~~~
SpicyLemonZest
Even in places that are willing to accept some amount of spread, testing
allows people to make informed decisions before doing particularly risky
things. I have friends who for example take a test just before visiting their
grandparents - if we lived in an area with week-long turnarounds, they
wouldn't be able to do that, and would have to choose between a significant
risk of infecting them or leaving them isolated for months on end.

------
dboreham
Because the official government policy is "just deal with it" and proper
testing isn't compatible with that policy. Essentially the test is a fobbing
off measure.

------
ex3ndr
Sorry but i didn't get claims about lack of public investing in healthcare.

Why when i am already paying like 500$/mo for insurance and making one
physical in a year at most. Also during this physical i asked about help with
my panic attacks and was told "well we don't have capacity at all for this,
you will wait for ~month for your visit and it won't be useful since they are
not going to have enough time to look at you". And this visit would be paid.

May be AHA shouldn't limit number of doctors educated to make it available to
public? Money is clearly not an issue.

~~~
acdha
Spending is not synonymous with investment. Around half of your money is going
to middlemen - think about how many people have full time jobs deciding what
to charge, coding it, shipping invoices around, etc. not to mention trying to
figure out how to profit as much as possible? How much goes to emergency care
because preventative care is not covered and healthy lifestyles are actively
discouraged by public policy?

None of that is going to medical professionals, infrastructure, or research.
We pay considerably more than anyone else per-capita but that’s waste: as far
as outcomes go we rank much lower than our peers.

This is also interesting when you compare tax rates: Americans pay taxes +
insurance at a combined rate around “expensive” countries like Denmark but we
don’t get anywhere near as much for our money.

~~~
learc83
You’re right! Only about 20% of healthcare spending goes to physicians and
half of that does to practice expenses like malpractice insurance. So even
forcing physicians to work for free wouldn’t do very much to lower healthcare
prices.

------
saluki
Not only the time frame but it seems like all the tests have significant false
+ and false - results.

I don't see any benefit from being tested at this time.

I definitely don't want to spread the virus if I'm positive or be around
people who are positive and can spread it to me but the time frame and false
+/\- results, testing doesn't seem viable to provide any actionable knowledge.

I think we'll see the limits of what testing can do to prevent the spread of
the virus with the start of NFL training camp/season.

~~~
aaronblohowiak
the roche antibody test has high specificity and sensitivity

~~~
adolph
Without knowing the base rate for a community isn’t specificity and
sensitivity like a numerator without a denominator?

“Roche’s SARS-CoV2 antibody test, which has a specificity greater than 99.8%
and 100% sensitivity3 (14 Days post-PCR confirmation), can help assess
patients’ immune response to the virus.”

[https://www.roche.com/media/releases/med-
cor-2020-05-03.htm](https://www.roche.com/media/releases/med-
cor-2020-05-03.htm)

~~~
nradov
Roche validated the test using stored blood samples from before the pandemic
started, when the base rate was 0.

------
vinniejames
What percentage of the current population has already been infected?

What is the latest death rate of confirmed cases?

------
Animats
" So I said to my people, 'Slow the testing down, please.'".

Mission accomplished.

------
abalaji
Incremental improvement

------
yalogin
We are in this mess fully because of trump. It’s unfortunate we have a
president that has no empathy for people and is constantly fanning the
conspiracy theories as he also doesn’t believe in science. But finally he
seems to have realize it’s bad for him so he might actually try to listen to
his scientists for a day or two.

Given people are already so predisposed to their theories not sure how many
people actually will listen without a full lockdown. Also it’s highly unlikely
the red states will lockdown ahead of the election and go against trump. We
are in a real mess. The pessimist in me is thinking we will probably have to
really solve it after the election it if trump wins probably never until we
get a vaccine.

------
mensetmanusman
This will not get resolved because both major parties have decided America
isn’t worth saving (because the other party exists).

------
dehrmann
Without contact tracing, there's an argument that tests don't give you much
actionable information. If you're sick, you'll (hopefully) self-quarentine
anyway. If you're sick enough to go to the hospital, you'll go anyway and be
presumed to have covid. If you feel healthy, unless you're being tested
because of your job, you probably aren't going to get tested.

The case that's somewhat interesting is the one in article where someone might
have gotten people sick at a party.

~~~
vharuck
The tests helped my wife make a decision. She and I slept through most of one
weekend (very unusual) and had mild congestion and headaches. However, calling
off work for two weeks would've been difficult for her. She works at a daycare
where staff have been leaving one after another. And the daycare doesn't give
paid sick days. (I still insisted she stay home until the results came in 2
days later). We had to go with likelihood of being a spreader instead of
getting to play it safe.

------
at_a_remove
Clearly, the reporter didn't really want the question answered because three
points come to mind, immediately.

1) Testing of corpses and blood samples thereof. The CDC recently changed its
guidelines for cause of death determination to be "if it looks like COVID,
just mark it down as COVID." Being able to test corpses, who are in no rush,
could help more accurately pin down mortality rates.

2) Knowing that you are not likely to catch it again, or, alternately, are
still at risk. Yes, I know there's some debate as to whether or not you can
catch it again due to declining antibodies. I am not believing that at
current.

3) Being able to use antibodies cultivated from patients who have recovered in
those who are currently quite ill. That's a common enough concept, cheaper
than cultivating monoclonal antibodies.

Boom, three right there. How hard was that?

