
CDC coronavirus testing decision likely to haunt nation for months to come - bookofjoe
https://khn.org/news/cdc-coronavirus-testing-decision-likely-to-haunt-nation-for-months-to-come/
======
processing
Getting the test was difficult enough here in California. A bigger problem
that isn't being discussed is the delay to get the results. I had a test
10-days ago and still do not have results. Obviously, still self-isolating.

The local health county department have taken over issuing the results.
Yesterday, after multiple calls they told me to call the hospital as they
don't have an answer. Was able to contact someone today at the hospital - they
told me to call the local health department again.

The city keeps issuing updates/running daily conferences with new data (more
than likely 1-2 weeks old).

If the US had enough tests at the start - we would probably still be seeing
similar data points in the news as the backend infrastructure of issuing
results is in no way able to handle the amount of cases as is.

~~~
belltaco
Heard a report of a test getting "lost".

[https://thebatesstudent.com/2020/03/23/jack-allard-16-is-
in-...](https://thebatesstudent.com/2020/03/23/jack-allard-16-is-in-critical-
condition-due-to-covid-19/)

~~~
processing
What a nightmare for him and his family. Hope he pulls through.

------
aazaa
The damage will be much longer lasting than this.

The Chinese bought the US precious weeks to prepare while it locked down vast
numbers of its own population.

The disaster could have been prevented through a vigorous testing/quarrantine
program in Washington and California.

At every step of the way the US either bungled testing, or actively
discouraged testing. It's been nothing but lies and mistakes from the start.

Like most American catastrophes, this one will only be slowly understood many
years after the fact. There will be Congressional investigations and fact
finding rituals.

In the end it will come down to three things:

1\. Pandemic preparedness was not taken seriously by the incoming
administration.

2\. Testing was screwed up from the start and never found its footing.

3\. The administration actively discouraged testing through both political
pressure (e.g. W. Virginia "doing a tremendous job") and rationing of tests.

~~~
asquabventured
I don't understand this mentality when other Western Nations are going through
the exact same thing.

Did the administration cause every other countries problems with containing
the virus too?

~~~
sd8f9iu
The US has been far behind other Western countries in testing:
[https://www.nytimes.com/interactive/2020/03/17/us/coronaviru...](https://www.nytimes.com/interactive/2020/03/17/us/coronavirus-
testing-data.html)

The per-capita chart is most notable. Other Western countries' responses
haven't been stellar either, but the US's is particularly flawed.

~~~
lurquer
[https://www.worldometers.info/coronavirus/](https://www.worldometers.info/coronavirus/)

US is 21st in per capita deaths (and falling... that is, it was 18th a couple
days ago.)

Spin all you want about testing and the like.

But, the fact remains that the US's medical system is doing a better job than
the other western countries.

Its striking that Italy, Spain, Netherlands, Switzerland, France, Belgium, UK,
Sweden, Denmark, and Austria have more per capita covid deaths than the US.
(Looks like Germany is about to be added to that list.)

I do not see how any rational and objective analysis could characterize the
US's response as 'particularly flawed'.

~~~
sd8f9iu
There is no sense in comparing per-capita deaths this early in the pandemic,
especially when the spread of the virus in the US trails a few weeks behind
that in Europe. Talk to me in a few months. Furthermore, per-capita figures
are meaningless when comparing areas of substantially different population
size and density (e.g. Austria, Switzerland) to the US. _I_ do not see how a
"rational and objective analysis" like yours can ignore these basic mitigating
factors when making such comparisons.

------
h2odragon
Where was the media in this? Lots of scare stories about potential pandemics
back to January, in the US media, but I dont recall much if any "the CDC is
fucking up / not testing" coverage.

Of course that kind of thing was probably being said in the froth of the
fringe and conspiracy theorists, but thats all "fake news" and unmentionable
now.

~~~
throwaway122378
On 1/24/20 the WHO said there’s no human to human transmission of covid-19

[https://twitter.com/WHO/status/1217043229427761152?s=20](https://twitter.com/WHO/status/1217043229427761152?s=20)

They are to blame as much as anyone else

~~~
mikeyouse
WHO isn't faultless, but that's a fairly misrepresentative version of what
that Tweet actually says..

"WHO said there's no human to human transmission" vs.

> _Preliminary investigations conducted by the Chinese authorities have found
> no clear evidence of human-to-human transmission of the novel #coronavirus
> (2019-nCoV) identified in #Wuhan, #China._

~~~
throwaway122378
It was 1/23/20\. Wuhan was under lockdown but there was _no_ clear evidence of
human to human transfer? Cmon

~~~
mikeyouse
That tweet was from ten days before the lockdown, based on evidence gathered
prior to that. The first death from the disease was 3 days prior to the WHO
tweet and Chinese researchers had only identified the specific virus 6 days
prior:

[https://www.nytimes.com/2020/01/08/health/china-pneumonia-
ou...](https://www.nytimes.com/2020/01/08/health/china-pneumonia-outbreak-
virus.html)

That very same day the WHO was recommending handwashing / avoiding close
contact with anyone with flu-like symptoms / and avoiding wet markets and
close contact with animals (since the largest known source of infection was
the market in Wuhan):

[https://twitter.com/WHO/status/1216754859292184577](https://twitter.com/WHO/status/1216754859292184577)

It's hard to lay any blame on the WHO for not taking the virus seriously
enough in the first days of the outbreak when major politicians were still
dismissing it two months later.

~~~
throwaway122378
Your source for that is China _itself_?

------
partiallypro
CDC and FDA having strict rules on who could test is vastly more important
than the CDC botching its own tests, imo. The Seattle Flu Study had proof of
community spread in January from their own testing, and the CDC and FDA told
them to stop testing because it was against the law (per a NYT article.)

------
Gatsky
The problem is a global lack of preparation for a pandemic of this nature,
despite multiple warning shots in the last couple of decades. The problem is
incompetent, complacent government, and the political processes which enable
it, and lately, even reward it.

Blaming the CDC seems pointless. There are any number of institutions which
could have done better. The thing is you don't want to be relying on
everything going right in a crisis.

~~~
BLKNSLVR
> The problem is incompetent, complacent government, and the political
> processes which enable it, and lately, even reward it.

Whilst I entirely agree with this statement, I actually doubt that any
political party that stood on a platform of pandemic-preparedness, and the
budgetary spending required for such, would have been voted into Government
anyway.

We, the people, have been voting for that which we believe to advantage us as
individuals based on the political rhetoric / media spin we're turning in to.

We, the people, get the Governments we deserve.

~~~
dbbk
In one of Hillary Clinton's books she talks about how she would have
dramatically scaled up US preparedness for pandemics. I don't believe she
explicitly ran on it for her platform though. (Which makes sense as it's not
something ordinary people think about.)

------
tunesmith
This whole line of analysis has confused me. The CDC tests, while flawed, were
never very numerous, right? Is the contention that if these early tests had
worked, they actually would have been sufficient to protect the entire nation?

It's seemed to me the problem has more been that we haven't stockpiled
supplies over the past few years like South Korea did.

~~~
Leary
The CDC produced 160,000 tests that were defective. Meanwhile, the FDA did not
allow anyone other than the CDC to test for coronavirus. That is the reason
why the US was weeks behind on testing.

~~~
rocky1138
I don't doubt you, but I'd love it if you posted links to sources for the
defective tests and the fact that the FDA didn't allow anyone but the CDC to
test.

~~~
cr1895
[https://www.newyorker.com/news/news-desk/what-went-wrong-
wit...](https://www.newyorker.com/news/news-desk/what-went-wrong-with-
coronavirus-testing-in-the-us)

------
sitkack
Anyone with a table top PCR machine could have been running tests. CDC/FDA
were actively preventing folks from doing their own tests.

~~~
andbberger
Yup they shut down the folks in washington after they started getting positive
results!!

------
jeffdavis
We need to look forward here. It's way too early for a retrospective.

And let's have some humility here. No matter what such a retrospective shows,
it's pretty hard to learn any real lessons from this kind of thing. We will
almost certainly just overfit our institutions to fight the next coronavirus;
I doubt we will better at handling crises in general.

It's still possible that the US will have a reasonable outcome. Let's do what
we can to make that happen and make use of our advantages. More cars and less
public transport may make physical distancing more effective.

------
GeekyBear
One of the issues is that the initial CDC test was overly complicated.

>On Wednesday, under pressure from health experts and public officials, the
CDC and the FDA told labs they no longer had to worry about the portion of the
test intended “for the universal detection of SARS-like coronaviruses.” After
three weeks of struggle, they could now use the test purely to check for the
presence of COVID-19.

[https://www.propublica.org/article/cdc-coronavirus-
covid-19-...](https://www.propublica.org/article/cdc-coronavirus-
covid-19-test)

------
rilindo
Months? This is going to haunt the US for decades.

------
DocSavage
I'm also surprised that there isn't more talk about the sensitivity of the
standard nasopharyngeal swab + RT-PCR. When the FDA approved it, they showed
it's extremely accurate... if you use swabs saturated with the virus at
various concentrations. Then I read about the poor (70-80%) sensitivity in the
real-world, which isn't suprising considering you (1) have variably expert
technique in positioning swabs into uncomfortable body spaces, and (2) apply
it to people at various stages of the disease with low viral shedding
initially and also at end stages. Apparently you can swab two different areas
and may raise your sensitivity 10% to 85%.

So if you are "negative" with say a 80% sensitivity, that leaves a lot of room
for actually infected people to think they are in the clear. There's a reason
why screening tests need to be highly accurate. I'm all in favor of at least
recognizing the positives and quarantining them, but with a high R0 disease,
the false negatives could be a problem.

~~~
gitgudnubs
If the reproduction rate is 10, and you catch 70% of cases, then the effective
reproduction rate will be closer to 3. Since even the highest estimates of the
basic reproduction number are only about 4, a test that's 75% accurate means
an effective reproduction rate closer to 1.

Are you aware of the difference between 4^x and 1^x?

~~~
DocSavage
Since you are being snarky:

Are you aware that the sensitivity quoted was mostly in symptomatic and
hospitalized patients and not those in the very earliest stages who could also
be shedding less virus?

Are you aware that each false negative can infect N others, some of whom might
have also been previously tested, and also be greenlit to deal with high-risk
populations like nursing homes?

Are you aware that your 4^x vs 1^x comparison assumes that in that chain
everyone is tested, which is not even close to the case now.

~~~
gitgudnubs
My favorite game.

Are you aware that the test can be improved by training medical personnel on
sampling technique?

Are you aware that tests will, as a general rule, improve?

Are you aware that the majority of people understand the difference between
70% and 100% accurate?

Are you aware that public policy was affected by poor data on the spread?

Are you aware that it's far easier to successfully test [nearly] everyone in
the chain when the number of cases is small, like it would have been when this
test was initially available?

The _only_ way this can be contained is through massive lockdowns. If tests
were performed _as soon as possible_, then there's a good chance we could have
done a good job containing it through contact tracing. Even if that weren't
the case, it would have given our medical system several extra weeks to
prepare for the case load. It would have given our politicians better data to
enact policies.

~~~
DocSavage
So after you try to belittle me about not understanding 4^x vs 1^x, you are
now talking about future efforts, hopes how an entire medical community can be
retrained, etc. Let's stay focused on the real world and not some hypothetical
past where we were like South Korea. None of your comments apply to a 1^x
spread in the current system since we aren't testing many people, and in hot
spots, we aren't testing hardly anyone outside those in hospitals.

Here's where we agree. We agree that the only way this can be contained is
massive lockdowns, and I believe this particularly true in the face of
unreliable and unavailable testing. I also think it has to be coordinated
across the country to prevent constant reseeding. We agree that testing
_everyone_ would've been good, particularly in the containment phase, but that
ship has sailed.

My original point is that under the _current_ system where we are occasionally
testing the public at large, and also using swab RT-PCR just after suspected
infected contact (way before symptoms like Pence, etc), the variable
sensitivity is troubling.

~~~
gitgudnubs
It's like talking to a brick wall. Medical technology is approximately
monotonically increasing, so it's absurd to think the test we cobble together
in the first month won't be improved upon. The CDC FUCKED UP. I expect careers
to be finished. I want a criminal investigation, just in case of corruption,
and I hope some people lose their license.

But even in the current environment, testing is important. It guides public
policy, and it helps doctors triage patients in serious condition. It still
helps to limit the spread, and will do so even more when testing overtakes the
infection rate (aided by lockdowns). If testing improves, then it could cut
weeks off a global lockdown, because the long tail will die that much faster.

Not everyone is a neckbeard with a programming job who can live in a basement
for two weeks without a single human contact, so anything that helps
extinguish this disease helps. Now if you'll excuse me, I should go shave.

~~~
DocSavage
> It's like talking to a brick wall.

Yes, it certainly is. Did I ever say we shouldn't test? Did I ever argue
testing couldn't be improved? Suggest you argue points that were actually put
forth instead of using straw men arguments. Re-read the last line of my
original post. I'm all in favor of trying to find positive cases.

~~~
gitgudnubs
Brick. Wall.

>Re-read the last line of my original post.

Still wrong. Reread the second to last line of your original post.

>There's a reason why screening tests need to be highly accurate.

They don't. That's the point. It doesn't need to be 99.9% accurate unless the
disease is so aggressive that you're all dead anyway.

There's the contention. The goal is exponential decay, and the only scalable
method is to reduce the reproduction rate. Even if you don't drop below 1, a
smaller exponential still grows exponentially slower.

~~~
DocSavage
Screening tests need to be highly accurate OR you need to be fully aware and
manage the fallout from false negatives, which is the point I'm making. First,
screening tests have costs, that's why many diseases don't have screening
tests. It's what's drummed into us in medical school. Sometimes the medical
community backs away from a screening test like has been done in many areas
with prostate exams. The cost/benefit isn't worth it. One cost in the COVID
case is use of PPE, health care worker time, and test availability hence why
CA is backing away from broad testing to triage tests to in-hospital use.
Another cost is the possible grouping of symptomatic patients together as they
wait for tests. Sure, if rollout can be perfect this isn't a problem, but
medicine is about what happens in the real world where delivery is not
perfect. By the way, NYC and CA medical community is saying the cost/benefit
isn't good enough for broad COVID screening at this time. I'm sure you know
better because you know the math of disease spread and are completely unable
to grok other reasons why'd they do that.

Second and less talked about, there are consequences of a false negative
population which is NOT handled appropriately -- like not letting people know
if they test negative they STILL should stay away from high-risk population or
take precautions like you still could be infected. That directive has been
circulated a little but most people I've seen don't know that. The news
reporters don't ask Pence about serial tests. They seem satisfied he had one
negative test.

Once again, and I don't know how many times I have to say this, I'm not
against widespread testing of the current RT-PCR swab, particularly if we had
lots of tests, didn't have PPE shortages in the area, and guidance was given
to all those receiving results. Your contention that accuracy doesn't matter
is incorrect. It matters because false negatives matter and it's great to do
testing to decrease the spread, which is pretty obvious, but you absolutely
need additional management depending on accuracy. Like not setting the
standard of working with high-risk patients as a single negative test. They
need to be tested serially and hopefully get a more accurate test for nursing
home workers in future. Like not assuming Pence isn't spreading disease
because of a single negative test. He could be one of the many asymptomatic
infected. This has been my point for this entire thread. I'll leave you to
argue something different.

------
justforyou
Admittedly, America dropped the ball, tripped over it, and broke it's nose.

However, lets not forget that the WHO was also wildly irreaponsible by not
declaring this a pandemic sooner.

~~~
funcDropShadow
How have they been "wildly irresponsible"? Placing a label on the whole crisis
is a rather symbolic act. Important was and is to spread the available
knowledge, tests, and know-how.

~~~
mardifoufs
But saying that there was no proof for human to human transmission [0] in mid
January when china was already going ramping up containement efforts was
negligent imo. They were the only international observers on the ground and
it's hard for the rest of the world to prepare itself when they tell you that
you basically don't have to.

They shouldn't have just relayed whatever early study came out that was most
likely trying to play down what was happening there. And if you add up their
mysterious 'typos' and their other efforts to please/appease the Chinese
government, the WHO comes out of this with little credibility left

[0]
[https://twitter.com/WHO/status/1217043229427761152?s=20](https://twitter.com/WHO/status/1217043229427761152?s=20)

~~~
rovolo
I've embedded the tweet in wikipedia's timeline of events (I've trimmed the
events).

[https://en.wikipedia.org/wiki/Timeline_of_the_2019%E2%80%932...](https://en.wikipedia.org/wiki/Timeline_of_the_2019%E2%80%9320_coronavirus_pandemic_in_November_2019_%E2%80%93_January_2020#15_January)

31 December

On 31 December 2019, China contacts the WHO and informs them of "cases of
pneumonia of unknown etiology (unknown cause) detected in Wuhan"[37]

2 January

On 2 January, 41 admitted hospital patients in Wuhan, China, were confirmed to
have contracted (laboratory-confirmed) the 2019-nCoV (Novel coronavirus); 27
(66%) patients had direct exposure to Huanan Seafood Wholesale Market.

6 January

On Monday, 6 January, the Wuhan health authorities announced they continued
seeking the cause but had so far ruled out influenza, avian influenza,
adenovirus, and coronaviruses SARS and MERS as the respiratory pathogen that
had infected 59 people as of 5 January.[52]

9 January

The WHO confirmed that the novel coronavirus had been isolated from one person
who had been hospitalised.

11–12 January

In China, more than 700 close contacts of the 41 confirmed cases, including
more than 400 healthcare workers, had been monitored, with no new cases
reported in China since 5 January.[36][50][63][71] The WHO published initial
guidance on travel advice, testing in the laboratory and medical
investigation.

14 January

World Health Organization (WHO) @WHO Preliminary investigations conducted by
the Chinese authorities have found no clear evidence of human-to-human
transmission of the novel #coronavirus (2019-nCoV) identified in #Wuhan,
#China.

14 January

On 14 January, two of the 41 confirmed cases in Wuhan were reported to include
a married couple, raising the possibility of human-to-human
transmission.[74][75]

On 14 January, Maria Van Kerkhove, acting head of WHO's emerging diseases unit
said that there had been limited human-to-human transmission of the
coronavirus, mainly small clusters in families, adding that "it is very clear
right now that we have no sustained human-to-human transmission"

18 January

The Wuhan City government held an annual banquet in the Baibuting community
celebrating the Chinese New Year with forty thousand families in attendance
despite the officials' knowledge of the spread of the Wuhan coronavirus. They
shared meals, plates and ate together.

20 January

On 20 January, after two medical staff were infected in Guangdong, China
announced that the virus was human-to-human transmissible.

------
PaulHoule
When they tried testing in NYC they got sick people to stand in line with
people who just think they might be sick, which causes the not sick people to
be sick.

~~~
sundvor
Yep, there's something that just screams "wake up and use your head" about
that. It happened in Australia as well. Have people just lost their ability to
think?

~~~
tlrobinson
I wonder how many people got sick while panic buying toilet paper.

~~~
nullc
AFAICT "panic buying toilet paper" is mostly constructed bullcrap arising from
the facts that:

* Essentially everyone needs toilet paper * Places don't stock that much so it sells out quickly when people pull forward their next week or two of purchases * toilet paper is extremely bulky so it makes for good pictures of loaded people (even when they just have one jumbo multipack) and empty aisles

In most of the pictures I've seen claiming to show "panic buying toilet paper"
showed each party with similar or less toilet paper than I purchase at
ordinary times (e.g. the big costco pack) for almost everyone in the frame.

Worse, the net effect of circulating these sorts of things shames people for
taking the actions they need to take to avoid continually going out.

------
Animats
From the New York Times:

"Peter Hotez, an eminent vaccine scientist at Baylor College of Medicine, told
me that he and his colleagues have a candidate vaccine for the coronavirus but
still haven’t been able to line up sufficient funding for clinical trials."[1]

This scientist was involved with developing a SARS vaccine. It never went to
full clinical testing because the disease disappeared before the vaccine was
ready. Hotez is also politically unpopular in some areas because he publicly
takes on the anti-vaxers over measles vaccination.

VCs: now there's an opportunity.

[1]
[http://archive.is/skGAe#selection-1219.0-1219.231](http://archive.is/skGAe#selection-1219.0-1219.231)

------
IggleSniggle
The CDC is still instructing healthcare providers NOT to test UNLESS a person
has either come into contact with a known COVID-19 carrier OR recently
traveled abroad. Otherwise, the guideline is "do not test."

I am married to a healthcare provider. Nevermind clinical judgement, context,
or an abundance of available tests. If you don't meet the above guidelines, my
spouse is being firmly instructed by the clinical practice manager to follow
the CDC guideline: do not test.

~~~
MikeAmelung
Someone needs to update your clinical practice manager with the info from 2
weeks ago:

[https://emergency.cdc.gov/han/2020/han00429.asp](https://emergency.cdc.gov/han/2020/han00429.asp)

~~~
IggleSniggle
Thanks for that, I'll be sure to pass along.

------
pengaru
To add insult to injury all those CDC-developed test kits nobody was using
because they were faulty actually were perfectly usable the whole time.

[https://www.businessinsider.com/cdc-coronavirus-testing-
erro...](https://www.businessinsider.com/cdc-coronavirus-testing-error-
resolved-by-throwing-away-reagent-2020-3)

------
dchyrdvh
We're witnessing the fall of the Roman Empire. CDC just implements the will of
healthcare bosses who want to take the most of it before this card house falls
apart. In the corporate world this is called the phase of creative
destruction.

------
panarky
Does anyone know actual facts about testing in the US?

Yes, the CDC's tests were flawed, but ...

1) Other countries don't have a problem testing millions of people, so why
doesn't the US use the same tests they do?

2) 3.5 weeks ago the Trump admin promised 1 million tests _that week_ with
many more to follow soon thereafter. After all this time they still haven't
materialized, so what happened to the million tests?

3) Is there any reliable data on tests given by day, by city or state in the
US today?

4) Is there some kind of struggle among different people or agencies in the US
government, some wanting more testing and others trying to suppress testing?

~~~
IggleSniggle
The CDC is still instructing healthcare providers NOT to test UNLESS a person
has either come into contact with a known COVID-19 carrier OR recently
traveled abroad. Otherwise, the guideline is "do not test."

I am married to a healthcare provider. Nevermind clinical judgement, context,
or an abundance of available tests. If you don't meet the above guidelines, my
spouse is being firmly instructed to follow the CDC guideline: do not test.

~~~
IggleSniggle
My spouse was being fed outdated information. Latest testing guideline is
here:

[https://emergency.cdc.gov/han/2020/han00429.asp](https://emergency.cdc.gov/han/2020/han00429.asp)

------
lurquer
How many deaths per capita for US versus other industrialized countries?

~~~
rovolo
Deaths per capita will be most important at the end of the pandemic. Right now
you're better off looking at case-fatality-rate, day over day rate of new
cases, and the current number of cases.

Right now the US is at 52K cases and ~650 deaths. That is ~1% fatal, but that
can decrease by more testing or increase because it takes time to die.
Currently 0.01% of the US has tested positive and 0.0002% of the US has died.
The worry is that those numbers double every 2-3 days and will cause an
unprecedented spike in the number of hospitalizations.

You can try predicting the number of deaths by looking at a semilog plot:
[https://www.ft.com/coronavirus-latest](https://www.ft.com/coronavirus-latest)

~~~
lurquer
US is 18th in deaths per capita.

(And falling.)

In a thread criticizing the US, it is odd that this simple fact isn't
mentioned. Or, alternatively, the importance of the fact is minimized.

(Even more odd that the US per capita death from covid is less than U.K.,
Netherlands, France, Sweden, Denmark and many other countries whose health-
care systems are routinely praised on this site.)

~~~
rovolo
Because the virus is spreading exponentially, the rankings for per-capita
cases/deaths are going to be highly dependent on how long the outbreak has
been going on in that area. Is the US's health care system worse than
Palestine, Honduras, Cuba, and Pakistan?

I see you're using
[https://www.worldometers.info/coronavirus/](https://www.worldometers.info/coronavirus/)
for your rankings. The per-capita rankings are very sensitive to small
populations. I think these 9 should be considered outliers:

San Marino (basically Italy): 21 deaths; Andorra: 3; Cayman Islands: 1;
Luxembourg: 9; Iceland: 2; Channel Islands: 1; Curaçao: 1; Norway (half the
pop of Sweden, but the cut-off has to be somewhere): 14; Slovenia: 6.

That leaves 10 places which I agree are currently doing worse in deaths per-
capita: Italy, Spain, Iran, France, Netherlands, Switzerland, Belgium, UK,
Denmark, Sweden; and 5 places doing roughly the same: Portugal, Austria,
Germany, Ecuador, Greece.

However, the number of deaths per-capita is doubling every 3 days in the US.
If we do 3 days worse then other countries, we'll pass Denmark and Sweden. A
week worse and we'll pass the UK. 10 days and we'll pass France, Netherlands,
Switzerland, and Belgium.

~~~
lurquer
>The per-capita rankings are very sensitive to small populations. I think
these 9 should be considered outliers:

I agree.

Time will tell about the final rankings.

But, the US health-care system is far more robust and creative than many of
these other systems.

Health-care COST is a legitimate debate. But, at the end of the day, when it
comes to care, you are generally far better off in a US hospital than one of
the others.

In any case, we shall see...

------
ccktlmazeltov
There are two ways to react to this:

* React to protect people, this is what Europe is doing.

* React to protect large businesses, this is what the US is doing by trying to prop up the market, lie to the citizens about the dangers, actively block testing.

------
waterhouse
The CDC screwing up wouldn't have been so bad without the FDA. I'm just going
to quote Scott Alexander here[1] (supporting links in original):

"No problem so bad overregulation can’t make it worse:

So far the government has bungled its coronavirus response pretty egregiously.

Most hospitals have the equipment in house to detect coronavirus. But the FDA
banned them from using it. They said all coronavirus tests needed FDA
approval, and refused to approve anything except the official test made by the
CDC.

Unfortunately, the official CDC test was defective. The test itself worked,
but one component in the test kit was broken. Most hospitals had their own
supply of this component and could have substituted it in, but the way the FDA
approved the CDC test banned them from doing this.

The CDC tried as hard as it could to fix their broken tests quickly, but they
weren’t able to do it fast enough to satisfy demand. In order to ration the
scarce tests, they mandated that hospitals only test people who had recently
been to China, or been in close contact with someone who had.

This was a disaster. For example, here’s a story from a person who traveled to
Japan, where the coronavirus is active. He came back to the US, started
developing symptoms, and went to a hospital. The hospital said since he hadn’t
been to China, they couldn’t test him, and _sent him home_ (he voluntarily
quarantined after discharge, so thanks).

But even worse, the policy ruled out by fiat ever being able to detect when
the epidemic spread to the US. So in mid-February, when a patient with no
history of travel to China came to a hospital in California with coronavirus
symptoms, the doctors had to ask the CDC for special permission to test. The
CDC dithered for four days before granting the permission, during which nobody
put any work into containing the disease. Finally the test came back positive
– after some health workers had already been infected.

There were many points where this could have been avoided. A better CDC could
have made tests that worked from the beginning, or ramped up production of
working tests faster, or come up with smarter criteria for rationing tests.
But it would have been even better to have a system where things don’t have to
go perfectly, and where a few mistakes don’t choke up the entire response to
an epidemic for weeks. If we hadn’t let our culture reach the point where
governments ban things by default and review at leisure, and where individual
iniative is frowned upon in favor of waiting for official permission to do the
right thing, we could have recovered from all of these mistakes. Hospitals
would have used their existing tests which they already have more than enough
of, doctors would have had permission to test suspicious cases at their
discretion, and we would have had a chance to catch infections early before
they could spread. If the government didn’t already regulate adrenaline,
buspirone, insulin, and genetic testing to the point of near-unavailability,
maybe people would have thought it was weirder, or raised more of a fuss, when
they started doing it for coronavirus tests.

If you don’t trust me, trust former FDA director Scott Gottleib, who explains
the situation here in an unusually candid communication from an ex-government
official talking about his former agency. His Twitter feed is a great source
of information in general.

And here’s a more careful analysis of some of the laws around diagnostic
testing and how they contributed to the current crisis. And by more careful, I
mean it ends with “Bottom line: the FDA is going to kill us all”."

[1] [https://slatestarcodex.com/2020/03/02/coronavirus-links-
spec...](https://slatestarcodex.com/2020/03/02/coronavirus-links-speculation-
open-thread/)

------
omgJustTest
This article does not mention the WHO offered tests to the US before the CDC
decided it should make its own[1]. This alone should have been enough to bring
impeachment charges against public officials, for criminal neglect.

If the WHO had proven these in China, and you have no other alternative, it
make sense to do both 1. buy tests you know are in active use and 2. make your
own tests if needed.

Someone at the CDC must have been asleep or was ignored. China was shut down
for weeks, the port of LA didnt have 25% of its normal volume in February and
the WHO was shipping tests to over 60 countries _at the end of February_.

EDIT#1: I also emailed Dr Fauci a full week before about the short sightedness
of allowing cruise ships to continue operating and while he was claiming "if
you are healthy, they are fine". His office returned my mail a few days ago
with a blanket "Dr Fauci is busy, and appreciates your comments" email.

EDIT#2: There is a more nuanced version of this discussion in the comments
below. It is technically not correct to say the "WHO offered the US tests",
the more technical distinction would be the "WHO supported leading research
from Berlin, and the CDC did not. This decision lead to a delay in tests that
did not have a higher number of false positives... (etc). The US generally has
resources to produce these tests, and would not rely on the WHO." Either way,
a test existed and the US could have chosen to take a more conservative stance
by adopting the research and producing its own simulatneously. The Chinese
economy was shutdown.

[1] [https://www.politico.com/news/2020/03/06/coronavirus-
testing...](https://www.politico.com/news/2020/03/06/coronavirus-testing-
failure-123166)

~~~
kiba
Can we stop threatening criminal negligence charge for every single mistakes
people make?

It's not going to improve performance in the next pandemic if people are
afraid of doing their job or engages in ass covering.

~~~
H8crilA
Uhm, yes, skin in the game?

Things generally don't improve because people get better. Things generally
improve because bad people/groups/corporations/ideas fail.

Way more people should be fired / tried / impeached. Need I remind you that
nobody went to jail over 2008? It does make the system more healthy. If you're
responsible for the health of some country _you better be scared_ , because
the consequences are dire, and your decisions are of utmost importance. I
_want_ that person to be on constant lookout for problems, bordering on
desperation.

~~~
Natsu
That's effectively the complete opposite of how to actually eliminate errors.
The way engineers do it involves depersonalizing it to get away from blame
games, assessing all contributing causes, doing proper risk modeling and
working to improve the systems so that they rely on human frailty as little as
possible.

Skin in the game is an easy concept we're all familiar with, but it generally
leads to adverse behavior like gaming the numbers instead of fixing the
problems.

See, e.g. [http://www.hazardcontrol.com/factsheets/principles/core-
prin...](http://www.hazardcontrol.com/factsheets/principles/core-principles)

\---

"Herein, the term “unsafe condition” is retained, but the term “unsafe act” is
rejected as historically leading to error or incomplete cause analysis.

Rather, inappropriate human actions or inactions of persons that contribute to
accidents (resulting from error or human nature associated with the common
relevant human factor capabilities and limitations of men and women) are
called “unsafe actions,” defined as unsafe system use methods and procedures,
without any initial implication of fault or blame."

~~~
H8crilA
I don't think the concept is easy for people to understand at all. It's just
darwinism really, but people think it's about punishment. Note that darwinism
doesn't just reject bad ideas, it has a rather high and variable false
positive rate. I.e. it's unfair, for example Ramanujan died prematurely
despite being a genius and a gift to his species. But it is overall also quite
effective.

If you can game the numbers there's no real skin in the game. And people do!
Just sell volatility ("everything will always be fine") regardless of the
conditions, it will work wonders, until you blow up. The difference is that if
you blow up your own money you cannot continue the game, whereas if you blow
other people's money - you can.

~~~
Natsu
You seem to believe that "skin in the game" guarantees the survival of the
fittest leaders. This is only true assuming that the selection criteria are
good ones and ones that cannot be cheated.

As long as anyone is capable of gaming their numbers, it floods out honest
people in favor of cheaters. It's very powerful at selecting for whatever your
metrics are. When you have the wrong metrics or ones that can be cheated, it's
very powerful in an extremely bad way.

In addition, the general public and the media are absolutely not good at this,
or we would have far better leaders than we do.

------
ck2
"packed churches for easter" is pretty much round2 for haunting for months to
come.

This is like a massive IQ test for the country, we failed.

These "leaders" didn't self-anoint, they were put there and sustained.

------
watertom
When China announced they had a mystery virus, travel from China should have
been stopped.

When China locked down their country, travel from China should have been
stopped.

When community spread was detected in Washington state, the U.S. should have
been locked down.

Testing wasn't the problem.

~~~
tobltobs
> When community spread was detected in Washington state ... Testing wasn't
> the problem.

If you detect community spread without testing you are too late anyway.

~~~
watertom
Not for the rest of the country

~~~
tobltobs
You are two weeks behind with testing. There is no rest of the country
anymore.

------
ykevinator
People are blaming trump and while I'm no fan, the cdc is an embarrassment.
How many decades did they have to prepare for disease control?

~~~
TheSpiceIsLife
Didn't the Trump administration slash CDC funding?

This claims so:

[https://www.businessinsider.com.au/trump-cuts-programs-
respo...](https://www.businessinsider.com.au/trump-cuts-programs-responsible-
for-fighting-
coronavirus-2020-2?utm_source=markets&utm_medium=ingest&r=US&IR=T)

And here we have him saying "I'm a businessperson. I don't like having
thousands of people around when you don't need them," Trump said. "When we
need them, we can get them back very quickly."

[https://markets.businessinsider.com/news/stocks/trump-
defend...](https://markets.businessinsider.com/news/stocks/trump-defends-cuts-
cdc-budget-federal-government-hire-doctors-coronavirus-2020-2-1028946602?op=1)

~~~
wideasleep1
Not exactly. Again, 1 screen, but folks are seeing 2 different movies.

[https://www.factcheck.org/2020/03/dems-misconstrue-trump-
bud...](https://www.factcheck.org/2020/03/dems-misconstrue-trump-budget-
remarks/)

~~~
gdubs
Your link — which you’ve posted twice — doesn’t address the points being made.

It’s a _fact_ that the pandemic response team was cut, and it’s a _fact_ that
the White House budget proposal included cuts to the CDC.

1: [https://www.snopes.com/fact-check/trump-fire-pandemic-
team/](https://www.snopes.com/fact-check/trump-fire-pandemic-team/)

~~~
wideasleep1
You should read the factcheck.org link more carefully, as it details/addresses
these points, and also indicates congress indeed funded (they control the
purse, after all) the CDC, despite Trump's proposal.

------
bionhoward
I hate to be the “we should use metagenomics” guy but we should use
metagenomics:

[https://en.wikipedia.org/wiki/Metagenomics](https://en.wikipedia.org/wiki/Metagenomics)

~~~
stallmanite
Thanks for being that guy because now I just learned about something awesome
I’d not heard of.

------
tosser0001
I just don't see what good is going to come out of worrying about this right
now while the world is on fire. Everybody needs to be thinking about how to
help in the coming weeks, anything else is a waste of time and mental energy.

There will be plenty of time to analyze what went wrong with the initial
response when things calm down. This is just raising the level of angst
unnecessarily in my opinion.

~~~
jude-
If you want to come out of a lock-down without also causing the number of
cases to spike again, we'll need to implement a widespread test-and-trace
protocol similar to South Korea's. This requires _lots and lots_ of testing.

~~~
mbreese
If you want to come out of lock-down, you really need a different test... you
need a serological antibody test to tell if you've been exposed to the novel
coronavirus (and thus have immunity from re-infection [0]). The current test
can only tell you if you have an active infection. But before we can really
open things up again, we'll need to know who is still at risk, and that
requires the antibody test. There has been good progress in getting these
tests to work, but it's not quite ready for prime-time.

And it will still be quite a while before we have a vaccine which is the
ultimate goal.

[0] (assuming you can't be re-infected)

~~~
SketchySeaBeast
I mean, you're not wrong, if we can test for anti-bodies we can get a better
handle on this whole thing in 3 months, especially given the reportedly high
occurrence of mild or asymptomatic individuals. That'll give a sense of where
we are in total. But no way are we waiting for herd immunity before the
restrictions start to loosen.

We very much still need to be able to test for people that currently have it -
we're kind of starting from zero every time people come out of lock-down, so
we need to test for outbreaks before they happen.

------
throwaway122378
January 14, 2020- There is no human to human transmission of covid-19

[https://twitter.com/WHO/status/1217043229427761152?s=20](https://twitter.com/WHO/status/1217043229427761152?s=20)

WHO officials and their Chinese counterparts should be on trial.

