Is there any particular reason the US is testing so few people? They've only tested 445 people in the entire country so far[0], which is a tiny number for such a large country (contrast e.g. with the much smaller UK which has tested 7,690 people[1])? Wasn't that one of the lessons from Italy - the numbers of confirmed cases seemed to shoot up from 21 Feb mainly because that's when they started testing.
The test-kit that the CDC sent to local labs had a faulty reagent, so all test requests have to be sent back to the CDC.[0]
Local labs could develop or purchase their own test kits, but during an a public health emergency, they must get FDA authorization before launching such a test.[1]
This seems to me like a giant institutional and bureaucratic screw up.
In all seriousness, why should a non-invasive diagnostic test require any sort of approval (particularly during an outbreak)? This is just RT-PCR if I understand correctly - there's nothing particularly novel going on here. Just publish the primer sequences and let the biotech industry handle things.
Edit: Oh hey they did publish an RT-PCR protocol [1] plus sequences, [2] along with a disclaimer not to use them directly on human subjects. This is just silly (IMO).
> These procedures and/or reagents derived thereof are intended to be used for the purposes of respiratory virus surveillance and research. The procedures and reagents derived thereof may not be used directly in human subjects.
My understanding is that it’s based on a law from several decades ago, when it was difficult to get your hands on a sequencer, that was meant to help empower the CDC once some kind of pandemic was declared in order to get tests out faster. Now that sequencers are commonplace, the same law instead of speeding up the deployment of these tests now slows them down.
>FDA regulates test kits but generally lab developed tests, which are designed and used in single lab, can be offered without FDA review. When HHS declares Public Health Emergency and issues declaration to support EUAs, labs must seek FDA authorization before launching new test.
Normally they can be done without approval, but there is a special regulation on the books that activates when the department of health and human services declares a public health emergency.
Because government bureaucracies cease to function in their original task and become only concerned with their preservation. It’s a lesson that happens over and over and we selectively ignore it.
Remember this folks when voting for people who advocate for a greater role of bureaucratic control of our lives.
Taken literally, you are correct and you advocate good advice - to remember this and presumably weigh it among the pros and cons. However, your phrasing could be interpreted to have a subtext suggesting less bureaucracy is always better.
There's no way to criticize any bureaucracy without having a subtext that less bureaucracy is always better, if the mere implication that less bureaucracy would have prevented the problem is enough to conjure that subtext in the minds of the readers.
Why do we always measure burocracy as an "amount" (something of which there can be "less" or "more"). Surely there can be unnecessary, pointless, frustrating, harmful, nerve-wracking acts burocracy which can require more or less time to be performed. But isn't the real measure we should have one about quality of the outcome and balancing that against any effort endured by the populace?
> Why do we always measure burocracy as an "amount" (something of which there can be "less" or "more").
Because large bureaucracies only ever get modified in the aggregate.
You have a bureaucracy that imposes 500,000 rules. If you want to know which are worth it, you have to evaluate each of the rules individually, because some may be worth it and others not.
Really evaluating 500,000 separate rules would take a large staff multiple lifetimes, so you still have to decide whether the bureaucracy as a whole is doing net good or net harm in order to determine whether it should be suspended for the years it will take to evaluate all the rules.
But by the time you finish the evaluation, years have passed since you started and the facts on the ground may have changed, or new rules proposed, so the evaluations are stale before they're completed and you have to start over.
It leaves you with only the systemic question of whether large bureaucracies are a net positive force as an institution. The answer could reasonably be no.
But notice that the answer is also related to the size. Because if the bureaucracy is smaller, you can finish the evaluation sooner, possibly soon enough that the evaluation results are still relevant by the time you finish. Having fewer rules allows you to have better rules, because the fewer you have the more time and other resources you have to make sure each is doing more good than harm.
> There's no way to criticize any bureaucracy without having a subtext that less bureaucracy is always better, if the mere implication that less bureaucracy would have prevented the problem is enough to conjure that subtext in the minds of the readers.
I would agree it is impossible to prevent all potential misunderstanding when writing for a large audience, but various methods can make this kind of misunderstanding less likely:
- Emphasize qualifiers like "some", "most", "often", "sometimes", "not all", "many", etc.
- Anticipate and explicitly disclaim possible misinterpretations
- Acknowledge valid counter arguments
- Be very precise and explicit about our intended mentioning
As opposed to corporate bureaucracies? If you think the free market magically makes everything efficient and free of politics and bureaucracy, try spending some time in a big company.
Remember this folks when voting for people who advocate for privatizing or de-regulating industries.
Corporate bureaucracies can absolutely be just as terrible. But the problem isn't that a bureaucracy exists, it's that there is a law requiring the approval of a specific bureaucracy.
If a corporate bureaucracy is slow and inefficient, that sucks, but it creates an opportunity for somebody else to be less slow and less inefficient. If a government bureaucracy is slow and inefficient, can you start your own and go into competition with them?
Well, the result of the diagnostic test could cause harm (panic, unnecessary treatment, people not quarantined when they should be) if it was not accurate enough, but they should probably fast track something given the circumstances.
You know what causes greater panic? An outbreak that only to the attention of the media when corpses start piling up at the hospital, all because an undetected cluster wasn't identified when it was starting.
> In all seriousness, why should a non-invasive diagnostic test require any sort of approval (particularly during an outbreak)?
To make sure it's a reliable test with known error bars to avoid false positives and negatives. If your data is garbage who cares how quickly you get it?
^^ This is exactly the answer! The positive predictive value of a test changes based on the prevalence of the disease in the population. With rare conditions, you can end up with way more false positives than actual positives, which can cause actual harm to people.
"Outbreak" and "Contagion" both depict mass outbreaks of deadly viruses, and the social impacts of implementing last-ditch control efforts. There's a certain point where panic about an epidemic is more damaging than the epidemic itself, and I worry we're approaching that point with coronavirus. When everybody is freaking out is exactly when we need to enforce good public health practice, not throw it by the wayside and go full wild west.
when you conduct the assay you are handling a known pathogen
doing that without proper training equipment and expertise should be discouraged, even if it isnt the original intent of the restriction it does seem to reduce a possible avenue of amplification of the problem
The thing is, you're already dealing with a patient that might be infected and medical testing labs already process potentially infectious samples on a daily basis.
The CDC has actually issued official guidance regarding Coronavirus biosafety. [1] Other than discouraging unnecessary culturing of the virus, BSL-2 (a fairly common setup) is the main recommendation.
Medical testing is very, very murky. There was a time a routine medical test for me came back, indicating I possibly had Lupus. It turns out; this test has a false positive rate of about 5%.
I am a white male, and the rate for lupus for my group is astronomically low. The rate for the worst group (black females) is like 500 in 100,000. There's some evidence the rate around white males might be six times lower.
Had I known any of this at the time, or had my doctor explained it, I wouldn't have spent weeks worrying.
The fact is, medical tests just update the probability you're sick or well. And this is why they have to be well understood.
I had a problem a couple years ago where my test showed that I had hypothyroidism. My doctor wanted to immediately put me on sythetic thyroid hormone to adjust this. The problem is that I'm thin, athletic, and have no other indicators for risk of hypothyroidism.
I said no to the doctor, and had them do another test, which said I was just fine.
The story is not so remarkable: there is no harm from taking synthetic thyroid hormone, and your TSH is monitored while taking it such that I think the mistake would have been discovered later.
>there is no harm from taking synthetic thyroid hormone
Where are you getting this crazy idea? Have you ever known anyone who took it? I have two relatives (not biological) on synthroid and even small changes in doses have massive effects on their metabolism, tiredness, etc. Taking thyroid hormone when you don't need it is not harmless, just like any drug or hormone.
there's a particularly sad story about HIV testing, which is told as a cautionary tale to medical students: during the HIV outbreak, the tests had something like a 2% false positive rate. the result letter made the mistake of telling patients there was only a 2% chance the test was wrong. people committed suicide after discovering their test came back positive.
but they neglected conditional probability. so many people were being tested that the probability they had HIV was much lower than 98%. they changed the letters to say "inconclusive" instead of "positive" and had them take the test again, which reduced the needless suicides.
From reports, the Chinese tests have fairly high false negatives, but they’re still deploying them en masse because catching as much as is possible better than not catching anything at all. I’ve seen nothing on false positives.
Yeah at the end of the day it seems by far the best outcome. I'm just thinking there may be some sort of red tape surrounding the liability aspects of that outcome. Like maybe there's a waiver of liability for passing a sick person off as healthy, except it only applies to such and such equipment, etc. I'm just using my imagination here, I have no experience in the medical industry.
If you're using an officially published primer sequence? Possible (due to supplier or user error), but _highly_ unlikely. We're pretty good at molecular biology at this point.
I'm not talking about making an entire test kit, but rather labs with existing RT-PCR abilities (ie the vast majority of molecular biology labs) having the appropriate primers and probes synthesized by the standard (non-clinical) vendors that they order from every day.
>a disclaimer not to use them directly on human subjects. This is just silly (IMO).
this is because if you truly understand the materials present in the assay kit, you can, with a well stocked genetics laboratory, begin recombinant proceedures
That... doesn't make any sense. What does the ability to run recombinant procedures (however ill advised doing so might be) have to do with running an assay on a human sample for diagnostic (as opposed to research) purposes?
To be perfectly clear:
* The CDC has already made an RT-PCR protocol plus associated primer and probe sequences publicly available.
* BSL-2 labs that do cell culture and employ viral vectors for transfection [1] are quite common in academia.
there are structural conformations that are not indicated-
you must exploit a biological system that will create a functional virion-
before you do that , if you understand genodynamics of the sequence you can start making good guesses about where to change the sequence in what way-
this can be because you want attenuation of the virus with an extreme degree of control-
this is how you make a recombinant product that is not as damaging to the host and produces a strong antigenic signal to the immune system this means you have a vaccine-
of course this is also a dualpotential technology so it could be used for evil and weaponized, so we want to have some inspection regarding who has these opportunities
Are you saying that if i had the test for corona, and then a bunch of knowhow and some wizbang machines I could start making the virus? I was always terrible at biology.
you could create an mRNA and arrange the proper signaling and delivery [hopefully] and do something very risky like try to biohack an adaptive immune response into a vaccination
I think you've misunderstood. The CDC page I linked provides a diagnostic protocol for testing samples for presence of the virus. The disclaimer explicitly forbids using the protocol as a diagnostic test in a medical setting, reminding the reader that it is not approved for such use and is to be used for research purposes only. That's the silly part - industrial biotech oligos are _more_ than reliable enough for human diagnostic testing during an active crisis.
its not about reliability its about being vetted into the process, rather than have a bunch of randos doing things and making a bunch of reporting noise.
there is a form if you want to see about trying to help out:
A bunch of randos? You mean trained lab technicians with extensive experience running RT-PCR assays on a regular basis? You mean biotech vendors that already synthesize ultra high purity custom oligos? https://www.genewiz.com/en/Public/Services/Oligo
It's quite possible I've missed some crucial piece of information about why this wouldn't work. So far though, I've seen no reasonable explanation as to why we need specially approved kits at this point. These are standard reagents and standard techniques; the lack of widespread rapid testing in the US is bureaucratic in nature, not technical.
>the lack of widespread rapid testing in the US is bureaucratic in nature, not technical.
that is the thing right there-
the federal government has OCD when it comes to a lot of things its not that you dont have a reputation as a professional, its that you/we dont have a rep with them until they check us out.
+ if you want a kit use form [1]
if you think the kit is somehow deficient goto form [2]
This isn’t true. Containing the spread through mass testing would allow us to more appropriately measure the response and direct resources accordingly. Every epidemiologist I’ve read says the lack of testing is a very concerning in terms of our ability to address and respond to the pandemic.
>There's no reason to test if there aren't any confirmed cases.
There's no reason to test when there isn't a high confidence that the person has the virus. Especially when the test costs something north of $3,000 and even with good insurance only a fraction of it is being paid for based on numerous Reddit threads and a news article [0] puts a specific patient's bill at:
>$3,270 two weeks after his test. He will be responsible for $1,400 of that bill.
A Forbes article [1] two weeks ago even states:
>The cost of testing include the costs of test kits, labor, and sample processing. In some cases, storage and delivery costs would need to be added. It’s unclear what the costs of the test kits are, or ancillary items, as CDC and others haven’t revealed figures. For the sake of argument, let’s say that on the low end of the scale each test, including ancillary items such as labor and sample processing, costs $250, and at the high end it’s $1,500.
You have to balance that cost against the cost of not containing this outbreak, which is likely to be far, far more than that, not just in money but in lives.
It's also critically important to act quickly, as it's at the early stages when this outbreak has a chance to be stopped. If we keep waiting until it's obvious that there's a large outbreak in the US it may be way too late.
You don't have to test everyone in the US, or even anyone who has a cough, but everyone with severe symptoms of the disease should have been tested, regardless of whether they've recently been to China or had contacts with people who had.
Never a more frightening instance of "penny wise, pound foolish".
"Oh heavens no, we can't afford to preventatively test for a virulent new lethal pathogen that has already brought one of the world's largest economies to a total standstill - it costs literally dozens of dollars!"
The patient who pays for the test gains nothing from the results.
The country gains from the results, but isn't offering to pay.
If I had been to China and got ill when returning to the US, I would not be getting tested - the test wouldn't help my chance of survival, and would just cost me money and time.
Yeah, I think the actual answer is that the number of tests on that page is not even remotely up to date, and the CDC has more important issues on its plate than updating it. As I understand it the UK testing criteria are very similar to the CDC's and also require travel to an affected country or contact with a confirmed case: https://www.gov.uk/government/publications/wuhan-novel-coron... The government here is just starting to roll out more general testing of the population to selected cities, but so is the CDC over in the US, and in both cases it's intended more to detect widespread spreading than to catch every individual case.
It's just probably not the most important thing to keep it continously updated on their website. The actual numbers aren't a secret or anything; there's a more up-to-date figure in the MMWR report on their website a couple of days ago, as well as the one just announced. (Though the MMWR figure only counts CDC tests, and apparently other laboratories have finally started carrying out their own tests in the US, including I believe some in California. That means there's probably not a single definite, up-to-date total for the number of tests anymore.)
A counterpoint - testing like this takes resources, and creates a backlog for other more pressing tests for patients. I mentioned this in another comment, but if I have a patient with pneumonia, I'm more than likely going to treat it the same way regardless of what the test shows me. Getting samples from everyone takes resources that lots of hospitals don't really have.
Maybe you could get a backlog going that can test for COVID-19, when the lab's RT-PCR machines are underutilized, even after the patient leaves, so that we can get as much data as we can.
But wouldn't you need to isolate pneumonia patient if they confirmed to have COVID-19? Also, curious, would you be more inclined to use some of the medicine that other countries claimed to be effective against COVID-19? Like Remdesivir and chloroquine?
In addition, at least until the outbreak becomes an uncontrolled epidemic in the US, you'd want to trace the contacts of any person confirmed to be infected with COVID-19 in order to try to try to stop the spread of the disease.
How do we know that testing for Coronavirus creates a backlog? I don't have enough information to say how the system works, but I imagine a nurse takes an additional blood test, and then someone sends that test to the CDC. The CDC tests the blood, and sends a response to the hospital.
I am curious to know more about the actual process.
There's a bureaucratic 'Catch-22' in each regulatory agency's rules for allowing emergency testing, & apparently no one willing to exercise the authority to break the logjam. See for example the unwound details in this thread (which is reporting roughly the same things as Dr. Gottlieb, just without the diplomatic mollycoddling of his former agency):
Yes. The tests are sufficiently unreliable that if there is no specific reason to believe that a particular person has been exposed, the results are just noise.
Please remember that public health organizations have over 150 years of experience with how to make the most effective use of existing resources to limit health challenges. This is a complicated optimization problem and the people doing it aren't stupid. It is better to ask why they do what they do than to assume that what they are doing makes no sense.
The problem in such cases is the prior. If a false positive is 10%, 1%, 0.1% or 0.01% makes a huge difference. With 0.01% and two different tests, you will get a false positive in every 100'000'000 tests. Testing twice solves many of the issues. It also gives information about the sensitivity and specificity of a test.
> With 0.01% and two different tests, you will get a false positive in every 100'000'000 tests.
That doesn't sound right to me (i.e. only the case if false positive distributions are independent and uncorrelated, which seems unlikely), but I don't know enough about statistics and epidemiology to dispute it.
We messed up a bunch of the first ones and we don’t really have centralized capacity to manufacture the tests at scale because of our privatized, outsourced healthcare system, we’re being prevented from using overseas ones (the senator from Hawaii is publicly begging Japan for tests), the CDC and other responsible agencies are in disarray from GOP gutting and malfeasance.
If tested I have to assume the patient will be charged for it, which depending on their insurance could easily be a cost of thousands of dollars if they are in a hospital or ER. We are going to experience a situation where sick people don't get tested and continue to infect others because health care is too expensive. The cost of health care is very much going to exacerbate this situation.
Administration officials just refused to commit to making a tax payer funded vaccine affordable.
This is what end game capitalism in health care looks like.
As a South Korean citizen it is jarring that other countries including the US and Japan isn't really trying to test people. Japan has people that died due to COVID-19 and they don't know how it was spread - the US didn't even test everyone that came from Diamond Princess! Why aren't those countries tracking down how the viruses are being spread?
I don't like conspiracy theories, but seriously it looks like they are trying to lessen the numbers on the paper instead of really trying to find the patients. Compare the numbers that the countries are testing[0], US is less than a thousand and Japan is about 1300.
Edit: Just for people who are curious in how things are working in South Korea, we test everyone who has: pneumonia symptoms, or has been in the same place with already discovered patients for free - and anyone who is concerned can test with about $100 - which is refunded if one turns out to be positive. We track every COVID-19 patient's routes and test everyone who was in the same place; which means that the government (mostly) knows exactly how the virus is being spread. Based on data that was announced 10 hours ago[1] (we announce data and roadmap twice every day), we have tested 66,652 people with 1,766 cases found, and currently 25,568 tests are on-going. 1,727 people are being quarantined, and 26 people have fully recovered from COVID-19.
Second Edit: Okay, I'm not really skilled in English; if this felt like bragging how South Korea is well handling this situation, that is not my intent - we have a lot of complaints of how the government should handle this. My intent was asking why the US/Japan is not doing at least this much, considering that both countries are much powerful & richer than Korea. Both countries are basically the Korea's wannabe-countries; and everybody here is pretty shocked (literally - there is a lot of news/SNS posts/internet memes on how Japan/US is handling the situation) that they aren't doing well.
>As a South Korean citizen it is jarring that other countries including the US and Japan isn't really trying to test people.
It's apparently quite expensive here. Federal minimum wage is $7.25 an hour, while one reported cost [0] for the test is:
>$3,270 two weeks after his test. He will be responsible for $1,400 of that bill.
That's almost 10% of my annual gross before insurance and I have almost 14 years at my job. For someone working a minimum wage job that's more than 11 week's gross income. I imagine they are limiting the number of tests on people that could have any number of other things and waiting for symptoms to strongly point towards the virus due to the simple fact that the tests cost so much. If a patient can't pay, whatever hospital has to carry that cost for potentially years before the patient can repay them (or not get paid at all if it pushes someone to bankruptcy).
Until the government sets aside money to subsidize the tests, I imagine the testing rates will remain low.
Looks like we can add healthcare reform to the list of potential geopolitical consequences to this virus. Time to see if the U.S. medical establishment is really as dire as many claim online.
If what you're saying is true about prices, there really will be a full blown outbreak if people can't afford to be tested. I presume some sort of emergency order will be given Nationwide to make testing available for free.
> Looks like we can add healthcare reform to the list of potential geopolitical consequences to this virus.
Only if someone takes action, which will likely only happen with public outcry, which will also only likely happen if a whole lot of people die or at least a few celebrities. I'd wager money against it.
> Only if someone takes action, which will likely only happen with public outcry, which will also only likely happen if a whole lot of people die or at least a few celebrities.
I think your ultimate conclusion is far too cynical and pessimistic.
The popularity of universal healthcare just in the last 15 years has gone from "herpes" to "acceptable as long as it is a business-driven solution that doesn't rock the boat too much" to "you're disqualified from running for the Democratic nomination for the presidency if this isn't at the heart of your campaign". It polls extremely well on a bipartisan basis, and why shouldn't it? Insurance companies are almost unanimously loathed.
Seventy+ percent popularity for healthcare reform plus the possibility of a national crisis that could stretch our systems to the breaking point, damage the economy, and cause individual spending? This could be the push that finally brings a national health system to the US.
At this point, people around the world are getting testing, treatment, and hospitalization that costs little or nothing. In the US, the health secretary is strongly implying that people will have to pay for vaccines and care.
I have to expect that Americans will wonder how it can be that the world's richest country, a superpower, with supposedly the best health care in the world, is also the only country in which people go bankrupt just trying to stay alive during a pandemic.
Hmm, I’m not really familiar with US’s medical system... so some questions:
* Does that mean someone who gets minimum wage (which probably doesn’t have an additional health insurance except for a default one) needs to pay for $1400 to test? (If true, that’s insane - why does the government only take cares of $1700 and not something like $3000?)
* Does people who come from Wuhan/other places where COVID-19 is spreading (lets say an american that comes from Daegu - the district with the most patients in Korea) also have to pay the high price to be tested?
The healthcare system in the US is a shameful mess, but for someone that makes minimum wage they'll likely be on Medicaid, which is one of the US government's health programs. It's complicated, but likely in that case a person getting a blood test won't have to pay anywhere near the $3000 or $1700 amount. It'd probably be free, but I say probably because it's possible that your blood test gets sent to a lab that isn't Medicaid approved and who pays for it gets complicated at that point.
In the example case given from the article, that person likely made too much money to qualify for Medicaid, so they probably have a bad health insurance plan that has a high deductible. Which is why they're getting stuck with a huge bill for something that really shouldn't cost anywhere near $3000.
Anyone that pretends that the way the US health care system functions right now is good is either lying or an idiot.
Edit: As another person pointed out, to complicate things even more every state has a different implementation of Medicaid. If you're in one of those states that believes your poverty is your own fault, you probably have no health coverage at all.
> in that case a person getting a blood test won't have to pay anywhere near the $3000 or $1700 amount. It'd probably be free
Oh, that’s much, much more assuring to know. Looks like
> Anyone that pretends that the way the US health care system functions right now is good is either lying or an idiot.
Looks like the general consensus of HN agrees; I hope the US decides to overhaul the healthcare system to provide better care if everything I’m hearing in this thread is true, it’s a topic that’s saddening to hear about.
Someone making the federal minimum wage working full time makes $15,080 a year. For an individual to be eligible for Medicaid, they have to make (for 2019) less than $17236.20 a year (138% * Federal Policy Level $12,490). So yes, in states that don't have a higher minimum wage, they would just barely be covered, but millions of people making minimum wage in states that have raised the minimum wage or making just above minimum wage are not covered by Medicaid. In such a case, it's better to make less money by working less rather than lose that insurance because Medicaid is great insurance while what is available at such jobs is likely garbage.
And of course, there are the asshole states that did not expand Medicaid coverage. In those states, people making such little money are fucked. The ACA may help with discounts but I doubt any reasonable insurance can be had. Hell, I can't find decent insurance through the ACA in my state and I'm willing to pay anything. Super fucked up. I totally agree that people who defend this system are assholes or idiots. No other way around it.
Yup, this is super important to note too. You could make minimum wage in your state -- and likely live in a state with an overall higher cost of living -- but still not qualify for Medicaid because the low wages you make aren't low enough. It's awful.
All the sibling comments touch on valid points. I'm going to try and summarize them for clarity.
- The US has a few nationalized (single-payer) insurance programs... TriCare for military, Medicare for retirees, and Medicaid for the indigent.
- Obtaining Medicaid is not easy - you have to be truly indigent in many states (it's federally funded, but states manage their own programs)
- Everybody else is left to buy their own insurance policy. Sometimes this is partially funded by an employer, but not always.
- Due to the high cost of insurance (and health care in general), many plans have very high copays and deductibles.
So, even with an average health instance policy, a person could be stuck with the full cost of that test because of a deductible. In the past, I've had deductibles as high as $5000/individual, $12,000/family (note: I don't know, we're back on a PPO with a $2000 deductible).
When I use a medical service, I usually receive a statement that lists retail prices for services rendered, negotiated fees (between MD and insurance), and sometimes an excess amount that I owe.
If the hospital is "out of network" (no contract between insurance and hospital), I could be due a larger chunk of the bill personally (up to 100%, depending on insurance plan). This is called "balance billing" - google will give you all sorts of insane results from $50,000 helicopter rides to entire hospital centers that don't work with a single insurance provider so they can bill whatever they want.
As noted elsewhere, it's a complete mess and embarrassment for one of the wealthiest nations on the planet.
That's crazy. But what I think is: considering that's an epidemic that is dangerous and quickly spreading, shouldn't the government just decide to test people coming from places with a lot of cases already? And pay for it?
We have a healthcare system that demands my wife goes into the doctors office when fully healthy during the midst of flu season with an unknown epidemic ongoing just to get a refill for the same maintenance meds she's been on for over 30 years. Simply because they haven't billed us anything for over 6 months.
These policies actively spread infection and expose a larger number of the population to infected people.
It gets worse. Many service workers in the US do not have sick leave or insurance. If you work in a restaurant, you can legally be fired without notice for taking off a shift to go to the doctor. Then, several states have virtually no tenant protection laws, so the landlord can start legal eviction proceedings just a few days after missing a single payment.
Awesome, so basically if someone suspects they are infected, they won't get tested because they can't pay, and they still need to go work at the restaurant, infecting everyone else.
Just wait until a walmart produce worker thinks it is a cold and decided that they cant afford the time off and comes to work and spreads it to thousands of people.
A couple years ago the current administration fired the entire pandemic response team and did not replace them. Just the other day he claimed this entire situation was no big deal and would fizzle out on its own. Assuming the administration would do anything that helps anyone is a poor assumption
The US medical system is a complete disaster. Basically, the government doesn't pay for anything; only private insurers do. And they try to avoid paying for as much as they can get away with. On top of that, the actual cost of care is far, far higher than in other developed nations for the same procedures, due to many systemic problems.
> Basically, the government doesn't pay for anything; only private insurers do
The US government does spend huge sums of money on healthcare.
Medicare and Medicaid are 21% and 16%, respectively, of total healthcare spending as of 2018. [0]
That's 37% of the total.
Given that total healthcare spending is about $11,172 per capita, that's $4,133.64 per capita. [0]
The UK spent £2,989 per person in 2017 in total. [1]
It's not correct to do so, but using today's GBP to USD exchange rate that's roughly $3850.
This puts US per capita government spending alone (keep in mind it's Federal + state) in the same ballpark as the UK's entire healthcare expenditure per capita.
> On top of that, the actual cost of care is far, far higher than in other developed nations for the same procedures, due to many systemic problems.
Sure is. This is a huge issue and IMO the issue to solve. But sadly, no candidate is really digging into why costs are so much higher outside of administrative overhead (which is real, but eliminating it doesn't solve the problem).
> Sure is. This is a huge issue and IMO the issue to solve. But sadly, no candidate is really digging into why costs are so much higher outside of administrative overhead (which is real, but eliminating it doesn't solve the problem).
Has anyone estimated the impact of costly lawsuits->higher professional insurance costs->higher prices->higher medical insurance prices vicious cycle ?
If you read more, I believe diagnostic testing comes out to 0.5% of GDP in the UK vs. 2% of GDP in the US, a far bigger effect than the difference in salaries.
So yes, there is some indication that lawsuits can lead to more tests and thus wildly higher testing costs.
I wonder if this is also leading to doctors to favoring newer medications that should be "the best" versus cheaper generics that would be more cost effective for a particular ailment.
Speaking of which, the way drug approvals and patents work also increases costs, and there are perhaps some small tweaks like permitting foreign first-world drug approvals to count in the US as well that might also help keep a lid on costs.
Sounds like a lot on first glance, but if you're young and lose a lifetime of income, or need a lifetime of assistance/follow-on care, due to negligence, it's a drop in the bucket.
"Basically, the government doesn't pay for anything; only private insurers do."
That's not true. Poor people can get Medicaid, old people can get Medicare, and there are also various other ways of getting one's health care expenses subsidized by the government if you're poor or have medical reasons for not being able to work.
Just to be clear:
I'm for 100% state-funded medical care, but it's simply not true that "the government doesn't pay for anything; only private insurers do". The government does pay for quite a lot, even if many people in the US don't qualify for such aid.
They absolutely should qualify for such aid, in my view, but my opinion doesn't change anything. Some people qualify, some don't, and the government does pay for some, and private insurance does not pay for absolutely everything in the US. These are just facts.
You're focused on the trees, not the forest. The prior commenter is right: Unless you are very poor (and get Medicaid) or old (and get Medicare), most Americans receive no government assistance for healthcare.
Tricare for active and retired military and their families. Whatever the Federal government does for health care which I assume is some kind of government-managed insurance pool. Not sure how state, county, and city workers are covered (might be through private plans, might vary state to state).
Lots and lots of people already have "government healthcare". Just not enough.
That's just false. The US federal government spends over $1,000,000,000,000 on healthcare per year. Only Social Security is a bigger expenditure. It's almost twice what it spends on the military. It's 8.5% of its humongous GDP. That's a larger percentage than most European countries. Germany's the only country I'm aware of where the government spends substantially more of the country's GDP on healthcare than the US.
It should be noted, however, for spending a much larger percentage of GDP they are still only providing coverage to about 1/5 of the population while most other countries you're discussing are covering 100% of the population.
The US is a disaster. Even if everyone in the country caught the virus, and 2% of the population died from it as a result, we'd still be in the same exact situation because there's a majority of people who believe that reality is biased and that some people need to suffer. There would be a huge part of the population who would see the lack of government response (due to a lack of funding and leadership) as a fundamental reason for why we should reduce the role of government influence in these situations.
What's crazy about this is that, by "saving money" on asking people to pay for their tests, people won't get tested, spreading it more, causing more deaths and cases. Which I think is more expensive than the tests...
Medicaid covers poor people and children, and is the largest single way people are covered in the entire U.S. It is managed by each state, with some federal subsidies.
Someone who makes the minimum wage, working full time, will make ~$22,000 per year, and that is above the income limit in my state. Therefore they will not qualify for state Medicaid. They will have to pay out of pocket for this test, whatever their private for-profit health care plan does not pay. And whether they get their own health care plan, or the employer pays some of it through an employer provided health care plan, depends on how many employees the company has. And in fact it's no longer compulsory that individuals even have a health care plan, the individual mandate no longer exists. And there is no such thing as an option to buy into a public plan, either Medicaid or Medicare (people over 65).
If this person worked part time instead, they'd actually be in a better position in terms of health care, where Medicaid would pretty much cover the cost of this test.
The government does not take care of anything. Almost all health insurance for working age adults is private - provided either by their employer or bought on a government run exchange. Among those private insurances, usually the insurance pays around 1/2 and the worker pays half. So you are stuck with a $1700 if you get tested.
Also minimum wage in the Us ranges from $7 to about $15 in very expensive areas. So depending on you let salary you are left with 2 choices
1. Get tested if you have a severe flu or cold like symptoms and not eat and pay rent for a few weeks.
2. Tough it out , wait a few days/weeks and hope it goes away.
Most minimum wage workers also don't have health insurance ( at least in my hometown area ), and that means they'd be in the hook for the entire amount.
From what I understand, under the so-called "Obamacare" legislation, everyone in the US has to have insurance, and if they can't afford it then it'll be subsidized to some extent by the government. You do have to be poor enough to qualify for such subsidies, though.
In the grand tradition of USA politics, that responsibility has almost entirely been abdicated to the states.
Some states took federal funding to expand Medicaid and make it available to anyone making 138% of the federal poverty line -- think around $35k annually for a family of four.
Others did not. Consider Texas: medicaid is available for children, pregnant women, adults caring for children, and a few other special groups (children transitioning out of foster care, certain disabilities, etc.) It is not something that is available for all Texans.
In Texas, a single parent caring for one child would have to make less than $103 per month to receive coverage.
"Poor enough" means you make less than ~$50,000 for a single person though. (Twice that for a family of four.) That puts you in the top 20% in the US and would be the top 10% in most of Europe.
It's up to 400% of the FPL and that only gets you a "credit", you're still liable for the premiums up to about 10% of your income. Plus any other "features" like deductibles, copays and coinsurance.
> If true, that’s insane - why does the government only take cares of $1700 and not something like $3000?)
Because a government that does healthcare is socialism that that's considered inherently evil by many.
And you're right: the healthcare system is absolutely insane.
If you can afford it (like I do), it's obviously world class in its medical abilities, but it's a disaster in terms of administrative overhead and its inability to serve the general population.
The funny thing is that a government doing healthcare is not socialism at all. It's just good stewardship over something that is too much of a temptation for the capitalists to handle properly because 'life is priceless'.
The individual in that article likely had reasonably good insurance, someone earning minimum wage likely would have insurance that would cover very little if anything and they'd likely owe the entire 3* amount.
The countries doing lots of testing are basically countries with socialized medicine, the cost is being passed on to the tax payers. For the United States you are responsible for your medical costs, if you are fortunate you have good insurance that will cover varying percentages of your medical insurance.
I have 'good' insurance, several years ago I required hospitalization and ended up incurring somewhere between 13 and 15k USD in bills for about 30 hours in the hospital and the ambulance ride. I ended up paying something like 12-13% of that. At a start I personally owed 100 USD for every single doctor that touched my case which ended up being 5 doctors if I recall correctly, only 3 of which I ever met. In this instance the hospital was very courteous and allowed me to set up a payment plan and repay them, interest free, over many months. I paid the debt off over a year and a half if I recall correctly.
They then wanted more blood over the next several days and had to see a primary care physician to get my medical leave paperwork filled out and those two things cost me another 200-300 USD after insurance.
> The individual in that article likely had reasonably good insurance, someone earning minimum wage likely would have insurance that would cover very little if anything and they'd likely owe the entire 3* amount.
That’s worser than I thought :-(
I was thinking that $1400 is too pricey to anybody — turns out that it was higher for people who don’t have insurance.
> For the United States you are responsible for your medical costs
Is this a culture/mind difference, or does everybody in the US doesn’t like this but has no time to fix it? Genuinely interested, as most people in our country almost everybody relies on only the default insurance — is this a cultural difference between the US(western world) and here? Are countries in the Europe similar?
>Is this a culture/mind difference, or does everybody in the US doesn’t like this but has no time to fix it?
This is just the way it is. We don't know anything else and when you start talking about changing it a lot of people lash out and can get quite heated.
Our government is not the best at managing things efficiently, socialized medicine means it gets paid via taxes, the medical and drug companies have lobbyists and can largely get away with setting whatever prices they want right now, etc.
Personally I'd be fairly hesitant to get on board with socialized medicine here in the United States purely for the fact I would fear it would be just as corrupt and I don't know if the increased taxes would be more than I pay for my insurance currently considering my employer pays more of the cost of my insurance than I do and I doubt that sudden savings would be passed on to me as increased pay.
> That’s worser than I thought :-( I was thinking that $1400 is too pricey to anybody — turns out that it was higher for people who don’t have insurance.
He's giving you false information, that's not actually true.
If you are poor you don't usually have a deductible in your insurance (because it's government subsidized), which means you are responsible for LESS of the bill, not more.
People have a lot of false views on US healthcare, mainly because it's a political issue, so people have a strong motivation to spin it one way or another.
One of our two parties is actively working to get rid of even the existing insurance programs for the poor (Medicaid) and elderly/disabled (Medicare). The people who support them would rather their fellow Americans die than to help them. This is the culture here. The other party is just now starting to think about providing people with insurance. It doesn't matter that there is huge support among the people to have proper insurance as you do and every other developed country in the world does. That's why things are the way they are. On the other hand though, we have just lowered business taxes and have no problem spending money on the military and other garbage while people suffer and die from lack of healthcare. Greatest country in the world.
They're worried about false negatives, if you test someone before they're showing severe symptoms, its best to go ahead and quarantine them, but we've seen to many cases where we clear people as negative and turns out they had it the whole time. The viral load needs to be high enough for the test to work.
Could you explain this logic a little more? Unless the false negative is something very high (do we know what it is?), I don't understand why identifying none is better than identifying some some, especially with an exponential spread.
Conspiracy makes zero sense, what would be accomplished?
I'm going with a large bureaucracy reacting slowly, which is also hampered by being staffed according to political alignment rather than by the best candidates.
As a fellow South Korean, I should point out that the case of SK is very unique and probably can't be reproduced.
1. SK used to be under a dictatorship (until 1987 democratization) and as a result its administrative power is still far-reaching.
When the Shincheonji (SCJ hereafter) church in Daegu was revealed to be a very problematic cohort, essentially every SCJ follower in Daegu was contacted for check-up, to the point that some hiding SCJ follower was tracked via police power (!). Not that SCJ's behavior is acceptable, but SK government has too much information to track individuals when deemed necessary. It is really a lucky coincidence that the current government doesn't try to do too much bad thing with that power.
2. Unlike other countries, many, if not most, infections in SK can be readily tracked to a single cohort (SCJ followers) and that makes the containment look still viable.
Okay, I actually disagree as the prevalent (and secretive) nature of the SCJ makes the containment impossible at this stage. I believe the SK government knows that too but continues the containment as a last resort (that is, better than not trying at all). Combined with strong administrative power and pretty stable diagnostic capacity, this "last" resort can be extended much further. It is not necessarily a bad thing though because a big pile of data resulting from lots of tests will be useful later anyway.
3. There is no other incentive for countries to test every (pseudo)patient.
It is now clear that only some---mostly already vulnerable---COVID-19 patients develop severe symptoms and most can be recovered without too much hassle. Sending every patient to the hospital is a significant burden to the domestic medical system and eventually only severe patients would have to be sent. Having this information, countries can skip the investigative phase (in this case, thankfully done by China and SK) and simply execute the eventual strategy.
The eventual strategy also has a side effect of the smaller number of reported patients. It would be a conspiracy theory that this is a motivating factor for most other countries, but it is compelling as a side effect of what they have to eventually do anyway. WHO had to accept Japan's absurd claim that the "international conveyance" is not a part of Japan because they needed Japan to at least report proper numbers. I don't think Japan is in the unique position in this regard. Even SK would be doing the same unless SK is between two highly impacted countries...
Don't the costs get even worse if you are positive - or actually, higher while you wait for results?
I mean, you are supposed to self-quarantine while waiting, which means no pay for that period. If you are positive after the result, there is more quarantine. More time without pay.
You can let the bill go to collections if they don't require upfront payment, but few can go 2-6 weeks without pay at all. People need to eat.
My recommendation is don't create conspiracy theories when the easiest explanation is incompetence.
You'd be surprised - even though most businesses are fast at reacting to global events and responding accordingly, the US government is notoriously slow. The US hasn't faced or reacted to a serious pandemic before (the swine flu in 2009 was largely considered part of flu season).
> even though most businesses are fast at reacting to global events and responding accordingly
Citation needed. I wont declare the govt to respond quickly, but the incentives, experiences, and expertise at companies dont tell me they are likely to respond in the best way. Some, certainly. Many? Maybe. Most? Prove it.
Sorry, meant to convey an anecdotal tone, not a factual one. I won't modify the original but when I wrote it I was thinking about the stock market's quick reaction.
My wife's grandparents are in Korea so I'm so happy they're taking this seriously. Her grandma smokes a lot and already has a bad cough, so I feel like she'd be particularly vulnerable.
That's not a very good conspiracy theory, because ultimately more people will get infected and the numbers will be worse because of "lessening the numbers on paper".
It wasn't passive aggressive. And the issue was not a grammatical error, it was a logical error that I don't believe the governments in question would make.
I was pointing out that a conspiracy that will obviously collapse under its own weight as infections obviously increase is not a good conspiracy. (not to insult the theory, just the premise such a theory would describe).
Countries deliberately underreporting infections early on simply doesn't make sense except perhaps for China, before it spread beyond its borders, hoping to keep a lid on things.
Now that it's starting to spread in other countries, it's too late to pretend like it won't continue to get at least somewhat larger. Any numbers you falsify today will look bad tomorrow, clearly. Which is what China found out. Which is why I don't think such a conspiracy theory holds water.
> The truth is, no nation has a good answer to this new virus.
Yeah, that's true. Nobody is doing well, and South Korea is also having an outbreak as well.
> Get off your high horse.
I'm not here to brag about my country, I have enough problems with the current government here. What I'm asking is the reason why the US and Japan gov is doing nothing.
> Pres. Mun Jaein failed to put stops on people flowing in from China
AFAIK, Korea and Japan boyh banned people from coming from the Wuhan-district; they didn't ban everyone from China - which makes the three countries the same level. Also, AFAIK no Chinese people occurred secondary infection, every infection case was from a Korean citizen that came from China - which means blocking the Chinese wouldn't have helped.
> Handing out masks and doing drive-in clinics are just a publicity stunt in S.Korea to look like they're controlling the spread.
So, you think masks/fast tests are ineffective and they can't help controlling the spread?
> Don't just give me numbers, give me info how those numbers were acquired.
What info do you think isn't provided yet?
Edit: Got feedback that the US did ban every Chinese (not just from Wuhan), so removed the inaccurate mention.
>> AFAIK no Chinese people occurred secondary infection
I've seen reports this has happened, but the medical reporting is saying the person(s) may not have completely recovered before showing signs of the infection again. I saw two interviews with doctors who related the infection has ups and downs and while someone may have been feeling better - they might have thought they were over it, when in fact, they really weren't.
The reporting on this is all over the map and most of the stuff I've read is pretty tentative in what they actually know and can document as fact.
American here. Get off your own high horse - you're embarrassing us. The US response needs to get better, fast. We're lucky that we've been relatively isolated so far. But if we don't learn from the experiences of other countries closer to the source, we're wasting that good luck.
The US did quarantine and test arrivals from Diamond Princess. Those who showed no symptoms have been sent home afaik and are under self-quarantine for a couple weeks.
It is ironic that South Koreans would be worried about Americans and Japanese given the state of corona in SK.
The implication is that the number of confirmed patients in South Korea is so high exactly because the SK government actually tests ~3000 to 5000 potential carriers every day. The government is putting huge amounts of resources into tracking everyone who may have gotten in contact with confirmed patients, the vast majority of whom turned out to be part of some secret cult [1]. They even have drive-through stations where people can get tested in minutes. It's free to get tested and, if you're confirmed to have the virus, your hospital bill is entirely on the government.
I personally find that South Koreans are overreacting, but you can't really deny that their efforts to track the virus far eclipse those of Americans and/or Japanese. The people sitting in the White House don't really seem to care at all. Abe seems to only care about the coming Olympics (I mean, just look at how he handled the Diamond Princess situation).
In the short term, I keep finding myself asking: if people fear this new virus so much, shouldn't they also fear the flu virus every year?
In the long term, I believe we're going to see more cases of novel viruses spreading around the world as global warming unleashes dormant viruses. High density urban planning and new viruses is not a good combo. We'll probably need to drastically change our lifestyles to really combat future global epidemics.
> shouldn't they also fear the flu virus every year?
Why is it that people need to be told the same thing over and over again?
Never mind: (1) the R0 [1] of this virus is somewhere between 3-4 and that of the flu virus is closer to 1, that means that you can have a lot more cases, and quite fast. (2) the flu virus has a mortality around 0.1%, this virus is somewhere between 2-3% [2]. (3) the chances of severe complications (pneumonia) with lasting damage are about 20% once infected.
This has nothing to do with global warming or 'dormant viruses', it is an example of Zoonosis [3] , a pathogen crossing the 'some animal' -> humans species barrier.
If this were a start-up you'd all recognize that it is positioned quite well to scale up, 'go viral', so to speak, no growth hacking required. Investors would be tripping over each other trying to get in on the ground floor, success almost guaranteed.
You're probably correct and I understand your frustration. I was just coming from a more personal perspective. If I contract the corona virus, it'd be probably no different than contracting the flu, because I'm young, healthy, and I have easy access to healthcare (since I'm working). A lot of people with the virus reportedly do not even have any symptoms.
Regarding global warming, again, you're right that this virus is an example of zoonosis. I was more talking about the potential for additional novel viruses spreading around the globe.
> If I contract the corona virus, it'd be probably no different than contracting the flu, because I'm young, healthy, and I have easy access to healthcare (since I'm working).
That depends. The virus doesn't really care that you're young, healthy and have easy access to healthcare.
Yes, age is a factor, but you being young doesn't stop you from spreading it to those you love who may not be young, healthy and have easy access to healthcare.
That easy access to healthcare is predicated on a system that is not yet overloaded with cases in the 'critical' and 'serious' category.
It's all bell curves. So your personal perspective can (and will) shift as this thing develops.
"if people fear this new virus so much, shouldn't they also fear the flu virus every year?"
People should definitely be more concerned than they are about the flu every year.
Way fewer people would die from the flu every year if more people took it seriously and got vaccinated. Some people get vaccinated, but not nearly enough. Also, every year many people continue going in to work (even if they can take sick leave) when they feel sick. That spreads the disease and increases the risk that other people will die.
Fortunately people are starting to wake up to the risks of COVID-19, and will probably change their habits (by washing their hands more and staying home when they're sick) to make the spread of both diseases less likely. Unfortunately, after the outbreak is over they'll probably go back to business as usual in respect to the regular flu.
> It is ironic that South Koreans would be worried about Americans and Japanese given the state of corona in SK.
The government is doing so much more to control the spread of the virus in South Korea. As such I can reasonably trust that the number produced by South Korean is trustworthy. The same thing cannot be said for the Japanese or U.S. government. The Japanese have an incentive to under report numbers because they've prepared many years for the olympics and don't want it to be cancelled.
I'd rather a government overreact than be complacent and baselessly optimistic and do nothing.
> The US did quarantine and test arrivals from Diamond Princess. Those who showed no symptoms have been sent home afaik and are under self-quarantine for a couple weeks.
Hmm, what we heard was that the US only tested people who had symptoms, and people who didn’t wasn’t under quarantine. Looks like people thinks that self-quarantine disqualified as quarantine; they were worried that people can spread the virus while getting to their homes. Maybe this probably isn’t that much a big problem in US compared to Korea where public transport is less used?
> Hmm, what we heard was that the US only tested people who had symptoms.
Which is a crap shoot to begin with since the symptoms are fever, coughing and shortness of breath. A lot of the original patients were misdiagnosed as just having pneumonia since it has the same symptoms.
There's still a TON of misinformation out there as well. Just like in the Times today where they said in one sentence:
Yet the patient tested positive, and may be the first person to be infected through community spread in the United States, the Centers for Disease Control and Prevention said Wednesday.
So then, they don't know where he got it then? Wow, that must be serious, right? But wait, this is the VERY NEXT PARAGRAPH:
C.D.C. officials said it was possible the patient was exposed to a returning traveler who was infected.
They first say its the first patient who was infected through community spread, then back off the very next sentence to say its actually possible he was infected by someone else? I'm not sure how this type of reporting is helping anything, other than by spreading fear, which during an epidemic is exactly what you don't want.
From the point of view of the patient you don't 'just' have pneumonia. It's a pretty heavy thing to go through and may cause lasting damage to your lung capacity and ability to deal with future infections, the only upside is you can't spread it around.
It's a kakistocracy. The conspiracy is the spread of incompetency to paper over the mental illness of a malignant narcissist. It is better that the VPOTUS is taking charge of this, he's one of the few senior officials who isn't temporary, acting, unconfirmed, or insane. But conveniently, if everything goes to hell, the narcissist has someone to shift the blame to. And the only reason why someone accused you of bragging is classic "whataboutism" to deflect from your question, you can just ignore that nonsense. By the way, at least SK successfully impeached and removed its corrupt president from office. It's called taking responsibility and keeping power with the people.
In the U.S. we're papering over incompetency, corruption, and mental illness as much as possible. What will be the CDC version of Clownstick's NOAA Sharpie incident? I'm supremely confident there will be an equivalent of ordering scientists to lie to the American public, because that's what he does. It isn't a conspiracy, it's incompetency. And it is contagious. Defending incompetency is itself incompetent.
It's instances like this that reveal that the system is a joke. I don't know how people can witness the incompetence of entire nations and then have faith that the government will do the right thing given more money and more responsibility.
I can only imagine that there is a large amount of requests for COVID-19 tests from hospitals across the country right now. Without some kind of guidelines, the request for tests would overwhelm the current capacity and the most likely subjects would not be identified as soon. There has to be priorities.
I expect the CDC will update their testing criteria when it makes sense.
To give the benefit of the doubt to the CDC, it appears that the RT-PCR test has been only about 70% sensitive in China. CT scans actually exceeded the RT-PCR tests in sensitivity. Here's the latest in an informative series of videos.[1]
So, it makes sense that shotgun testing would miss a lot of cases and might not be considered worth it. However, I agree that the CDC still seems to be slow to act, especially given how people like to laud the U.S. for being so advanced. Truth is, we've let institutional decay, neglect, and politics drag us behind relative to other first world countries.
One big reason there are so many recorded cases in Italy is that they managed to screw up and not only failed to test someone until 36 hours after the third time they sought medical care, they also failed to practice proper infection control when handling that case. So it's been spreading through their medical system like wildfire and seeding infections to other countries.
It seems that nearly all countries have screwed up their handling of this outbreak in the early stages.
But at least now they're testing, and doing so way more than the US has been doing. They deserve praise for that, and the US needs to ramp up their testing a hundred-fold!
Yeah, the first person to die in Italy was from a tiny little town that's kind of out of the way. It's not the kind of busy, international spot where you'd expect to find an initial outbreak of this kind of thing.
I used to ride my bike through it pretty much every weekend.
There aren't any meaningful criteria. The symptoms look exactly like those of the regular flu, they just have a worse distribution of outcomes which manifest long into the infection.
Just like China, the rest of the world does not have the capacity to test anywhere close to every suspected case. This is also why even good-faith stats are guaranteed to be underestimates. There are no easy answers here, individuals should look after their own wellbeing.
> individuals should look after their own wellbeing.
I don't understand how I'm supposed to look after my wellbeing when I'm employed and need to go to work and need to be in close contact with hundreds of people. CDC should advise businesses and should advise everyone to WFH if they can. My boss didn't even hear about this at all, think about that for a second.
3. Practice not touching your face. In particular eyes, mouth, nose
4. Keep distance from people. Aim for 1.5 feet. Double that if person coughing or sneezing
5. Don’t shake hands
6. Avoid large gatherings
7. If sick, take sick days
8. Watch out for objects many touch but which are infrequently cleaned. Doorknobs, pens, elevator buttons, etc. Using your elbow or sleeve is better than your hand. Once community spread starts, wear gloves.
More here. If everyone did the above the R0 would drop.
One problem I suspect we'll see is that the sick people most exposed to others won't take sick days, because they don't get paid sick leave.
There are a lot of hourly workers in the service economy that don't get sick time, and they still need to pay their bills. I'm not personally worried about the people in my office since I can avoid close contact. I'm worried about the people stocking shelves at grocery stores and pharmacies, working checkout counters and the like.
I'm also going to start refusing to handle objects handled by multiple people, such as the signature stylus in credit card checkout terminals.
door handles are also a problem
mandatory retrofit of every public door with automatic opener or at least push bar (use elbow or hip) would also help.
There's a thousand things society could do (have done) to systemically reduce R0 of most everything contagious...
I originally had it at 1.5 meters, then reread the article and saw the author listed 1.5 feet.
Personally I’d staying about a meter away from people at least. Can anyone comment of 1.5 feet is fine though? I’m assuming the author knows more than me.
IDK how it translates to contraction, but from a quick Google search coughing travels 6m, sneezing travels 8m, and the droplets stay suspended for 10min.
One of my main concerns is food prepared or handled by people who might be sick.
I can wash my hands and certain food, but other food that I eat (like a sandwich, bread, all sorts of prepared food) can't be washed by me before I eat it.
If someone sick coughed on their hands and then made that food for me, I'm screwed.
Maybe this will cause a number of people in the US to question our culture of "shut up and work, work, work" that encourages people to suppress humanity, vulnerability, and illness in the name of making their bosses more wealthy.
Poor people, who get poor health care, have poor sanitation, and are malnurished have poor immune systems as a result, and because of that become disease reservoirs.
They need to be lifted out of poverty if we are ever going to have a more healthy society as a whole and decrease the likelihood of future epidemics.
I disagree. You don't need to fix unrelated problems somewhere else to start making people's lives better today. It can be read cynically as a stalling tactic for no progress to be made.
The phenomenon I describe happens on a good day in the US, with no epidemics. Sick people go to work because their bosses don't tolerate otherwise. Sick kids go to school because their parents can't miss work to take care of them. A lot of people (not me, I am much more fortunate) cannot take any such breaks to take care of ordinary life situations because a lesser paycheck or lost job for completely legal bullshit reasons drowns them, gets them behind on tight living expenses.
These issues exist independent of coronavirus, when things are going "well".
I haven't even gotten into how these conditions feed back into stress, mental illness, other health conditions like obesity that are not aided by stress, all self re-enforcing.
If all parties wanted to fix this, we could, even without lifting those people out of poverty.
It's not unrelated. Poverty is one of the key components of why epidemics like this take hold and spread to the rest of society.
Working to eliminate poverty world-wide will go a long way to making us all healthier.
That said, I agree that people should get more sick-leave and be allowed to work from home more, if they can do their job from home, and be allowed to go home to take care of their family if they need to.
These things and lifting people out of poverty are not mutually exclusive, and improving the one will help improve the other.
Let me put it this way. In your understanding, why are people who are working constantly and cannot take breaks from work in poverty? They aren't unemployed. They are working themselves to death. Such a situation would be ridiculous in, say, the midcentury postwar boom, where working people were generally ok. Today a lot of people in that category are squeezed, overworked, overstressed, and find themselves in a very destructive cycle. You say we need to fix the "poverty" part of it, but I think perhaps a more accurate telling is that poverty is a symptom of people being exploited, undervalued, and not being paid in proportion to their contribution to the bottom line. Meanwhile executive pay and "shareholder value" metrics are doing well.
And by the way, there are plenty of middle class people who are accurately described by my statements, you don't need to be in poverty to get there.
Don't rely on CDC. Don't rely on external parties. You are responsible for your health not your government.
If you're in a high risk category (old, history of chronic cough, cardiovascular issues, etc) then you should consider self isolating even at the cost of your job if WFH is not an option.
As China and Korea have demonstrated, this quickly becomes a problem much larger than the authorities are resourced to handle. At that point your health is in your hands and your hands only.
Korea has so far tested 66,652 cases. All under government supervision. Local governments are barging into churches of those damned Sincheonji cultists responsible for the outbreak, in order to obtain the list of church members. Police force is tracking down cultists who failed to respond.
Of course, not all is well, and some critics are arguing we should have blocked people coming from China, which is something only the government can do, by the way.
Seriously, Korea is a living demonstration how the government is absolutely critical in controlling an epidemic. I'm tired of this fetishization of "individual responsibility" with no basis in reality.
There are not enough ICU beds or even hospital beds in the country to care for the infected during a major outbreak. The quality of treatment declines exponentially during outbreaks, to the point where it's worse than just holing up at home and some OTC medicines.
Every individual is ultimately responsible for their own safety, security, and wellbeing. The government isn't a protective loving parent that will go out of its way to care for you as an individual when infra and institutions become overloaded.
Can we refrain from any unfounded hate on a religious group? It's not confirmed that they have some anything malicious, and even so it does nothing to help further solving the problem.
Their comment does not seem to be particularly hateful against the religious group for it's religion, but it's behavior in hiding sick members' identities and increasing transmission rates.
I think the problem is identifying the behavior as a problem characteristic of the church or sect. This seems like victim blaming to me, especially when there have been there are countless mistakes being made across nations, religions, and organizations.
An alternative framing, which I believe to be more productive, is for the entire community to take ownership. "we messed up, we need to do better"
At a time like this, we need to partisanship aside and and focus on solutions, not blame. There will be plenty of time for a post-mortem after the crisis has passed.
In normal cases I would agree: e.g., I'm very much against the xenophobia shown by some Koreans against Chinese (and now, vice versa, it seems -_-). Unfortunately, this Sincheonji cult is something special.
I'm sure they didn't intentionally contract coronavirus, but once they did, their behavior went so far into gross stupidity territory that it's hard to distinguish from malice. Even after all national news blared for several days that hundreds were infected by their mass gathering, many of these cultists are still hiding their identity, not responding to authorities, and most infuriatingly, they are still going on about with their business, spreading disease everywhere.
A few hours ago it was revealed that a worker at Daegu Airport was Sincheonji cultist, he went to the Sincheonji meeting on 2/16 and kept working between 2/17-2/21, well after the news broke out on 2/18, and now he was diagnosed positive. Some 25k people were estimated to pass through Daegu airport during these days. WTF.
That sounds like abhorrent and stupid behavior, but I'm still unclear on how it is specific to their cult. Do they not believe in viruses or something? Do we see other people in society working while ill or hiding their identities? Has this been seen in China or other locations?
I don't claim to have all the details, but worry that some group is being scapegoated while a larger problem is being ignored.
The NPR article in particular was pretty bad [1].
>Critics say the disease may have spread within the church quickly because of the way that it worships. "Shincheonji followers hold services sitting on the floor, without any chairs," packed together "like bean sprouts,"
> "A bigger problem is that they shout out 'amen' after every sentence the pastor utters, pretty much every few seconds. And they do that at the top of their lungs,"
Eh, in case you misunderstood the passage, "like bean sprouts" is not some kind of racist(-ish) metaphor: it's a common Korean expression to describe a place packed with people, like rush hour subways.
I guess NPR shouldn't have used the expression literally.
I just felt the whole article was undermined by the focus on religious nonconformity.
It will be interesting to see how the subject is white Protestants passing the virus at church and work. I doubt their religion will be framed as the problem.
The religious aspect also obstructs the more interesting questions of privacy
My company seems to be consistently behind the edge data with regards to policy.
For instance, self isolation is still 14 days. This isn't enough. They are also restricting isolation and travel only to "affected areas of Italy" instead of all of Italy.
It boggles my mind that people say "the risk is low" and "we don't know how to contain it or where these cases are coming from" in the same presser.
14 days is still probably enough. There are scattered reports of people staying asymptomatic for longer, but they're hard to confirm (maybe you weren't actually exposed at the start) and certainly very rare. The goal of self-isolation is to severely reduce transmission, not to make it 100% impossible.
People say the risk is low because it's probably good on net if the cases are coming from everywhere; it would indicate that the visible clusters where people die a lot are anomalies, and most cases aren't that bad. The worst case scenario is that containment is impossible but it really hasn't spread widely yet.
US pneumonia rates are under very close scrutiny. There is no spike of pneumonia anywhere currently, which means there is likely no huge cluster of 1000s of people infected. That's why it's low risk as in chances of catching COVID-19 is very low. But this doesn't mean they will be able to contain it.
> US pneumonia rates are under very close scrutiny
Do you have a source for that? I know that there is a nationwide flu surveillance system run by CDC, and it has indicated that most states are at or near peak - is that what you’re referring to?
> I don't understand how I'm supposed to look after my wellbeing when I'm employed and need to go to work and need to be in close contact with hundreds of people.
This sucks, no doubt, and you have my sincere sympathies. This is a problem that many, many people will be facing. It's a lot like any other natural disaster--there's really not much to be done but carry on as best we can.
CDC messaging is tough. It needs to be enough to get people to do what can be done (which is not a lot), but not enough to spark irrational silliness (some of which we're seeing right here).
Regarding individuals looking after their own wellbeing...
It's very hard for a healthy person to make choices that will significantly increase the chances they stay healthy, short of a massive cost.
It's much easier for a sick person to make choices that will reduce the number of people they infect. And it is easier still for society to adjust certain expectations and incentives to help sick people take those actions. For example by not requiring them to go to work(!), especially via public transportation (!!), and ensuring that this is not overly economically burdensome for them.
An "individuals should look after their own wellbeing" attitude is a "healthy people are responsible for staying healthy" attitude. It suggests not creating any incentive for people who do fall ill to do anything to prevent the spread -- too late for me, I'm already sick, not much more I can do to look after my own wellbeing than taking the rush hour subway to the emergency room, I guess, and then go straight to work so that I can afford the treatment.
When the mathematics work out such that preventative measures taken by sick people are 100x more impactful than preventative measures taken by healthy people for a given expense, why wouldn't we try to encourage those measures to reduce transmission?
I think the criteria right now involves recent travel to China or being exposed to someone who was.
> CDC initially declined because the patient, who had not recently traveled to countries with outbreaks or been in contact with someone with the virus, did not meet the testing criteria.
That's a poor heuristic which has already been contradicted by a number of cases outside of china aka local spread aka the criterion which transitions this from an epidemic to a pandemic.
It would have made sense weeks ago. They are either dangerously incompetent or intentionally pushing this under the rug to forestall panic and buy themselves time to secure PPE and supply lines for critical medical infrastructure. I tend towards the latter explanation. Having a travel requirement to Wuhan or China to obtain testing was clearly insufficient weeks ago and they've done nothing to change that.
I work in this field and I agree. In my province, we had someone call into our health advisory line and request testing as they had been "at a party with an Asian looking person that was coughing." We have to draw the line somewhere.
Sure, the line has to be drawn somewhere, but currently the line was drawn so that it denied testing a person who is already intubated for days with matching xrays - that's not the proper place to draw the line.
Intubated with ground glass opacities on xray? Probably 25-50% of patients in all ICU's around the world match that criteria. This patient had no travel history and no known sick contacts, the line was appropriate for that patient. Sure they were wrong, but in public health, you known you will be wrong sometimes. It's a balancing act.
Flying into LAX from Asia last week, I had expected to spend a few hours at the airport before officially entering, but alas, it was worryingly expedient only being asked “did I travel to China in the last weeks?”
I came japan -> SF on 2/1 (prior to major outbreaks) but they didn’t have temperature scanners, no one asked if I’d been to China, and with the mobile passport app I was through immigration in <30 seconds. Kind of crazy.
At this point, the voluntary self-quarantines if you came from China (ex-Hubei) aren't even defensible for health (as opposed to political) reasons. Or at least they aren't defensible if you believe we also shouldn't be quarantining people coming from S. Korea, Italy, or Iran. [In Koreas' case I'm seriously surprised no CDC self-quarantine rules have been issued]
China is ground zero and as far as anyone knows has 3+ orders of magnitude more cases than any other nation. Turning this into a political or identity political game will be our undoing.
It is statistically prudent to focus on monitoring of and restriction of movement for Chinese Nationals. I would expect the same if the virus broke out in the U.S. and you bet your ass China would have shut down travel just as soon. This is not xenophobia, it is prudence; the fact that the infection currently aligns along national and racial lines is incidental to the steps that we must take as a nation to avoid the chaos that is gripping China.
Hubei is ground zero. China has locked the province down and other provinces are doing better than South Korea, Italy or Iran at this point. The ban was justified weeks ago - less so now.
Why is South Korea, etc. not under similar travel restrictions?
China has not been forthcoming as to the true scale of the epidemic. It has spread far past Hubei and is not likely under the degree of control that they claim - it is simply impossible to mobilize the manpower and resources required in such a short time. It is possible for both political reasons and containment to play a role in the ban.
Meanwhile the outbreak in SK has just started in earnest and as a democratic nation with ostensibly more relaxed freedom of speech and close government cooperation, as well as local U.S. bases, there is less uncertainty regarding the status of spread in SK which places less of a priority on closing off travel. Still, if the virus continues to spread you can expect that travel to be restricted as well.
In any case, shaming officials for xenophobia is absolutely inapropriate in this time of crisis. All travel restrictions are going to line up by national and racial lines, because national borders do as well. You can't keep your borders open during a pandemic in order to preserve political correctness.
I never argued it was xenophobia - it's that geopolitical factors (S. Korea strong ally; China rival) are heavily influencing this decision.
I definitely agree that the numbers are being less massaged in Korea than China, but there's a questions of how off they can be.
> . Still, if the virus continues to spread you can expect that travel to be restricted as well.
S. Korea has 1700 cases and 13 deaths from Covid-19 at this point. On the day the US issued its travel ban on China (Jan 31), China had 12k cases and and 259 deaths. China has 25x the population, meaning S. Korea is already more infected than China (going by official numbers) when the ban was issued on China -- and in particular, almost certainly more infected than China outside Hubei.
More to the point, it is not credible at this point that the spread/person in China (esp. outside Hubei) is faster than Korea (Chinese citizens have been quarantining themselves for weeks now). I am far more worried about a random traveler today coming from S. Korea than say a tier-1 Chinese city (Shanghai, Beijing) - we're talking a 10x risk multiplier realistically - but we aren't even recommending self-quarantines for visitors from Korea.
Note that Israel (which has less geopolitical opinions on East Asia) has bans on basically all of East Asia.
> “Since the patient did not fit the existing CDC criteria for COVID-19, a test was not immediately administered,” the statement added. “UC Davis Health does not control the testing process.”
That seems fair enough to me - testing is currently limited, and likely under high load.
The concern, rather, is this:
> Experts raised concern that the CDC's narrow testing criteria could mean that there are more cases circulating among the general public that have not been identified.
The narrowed testing criteria hasn't managed to just exclude false positives (the intent) - it is now excluding positives that need to be caught.
I'm actually a bit puzzled by this. This is RT-PCR based, so why can't off the shelf lab supplies be used? Oligo synthesis commonly has next day turnaround at this point, so primers can't be the issue... Is this purely a regulatory bottleneck?
> The test kit has not been FDA cleared or approved, however distribution and use of the test kits follows the U.S. Food and Drug Administration (FDA) February 4, 2020, issuance of an Emergency Use Authorization (EUA). The tests are being shipped through the International Reagent Resource (IRR), a CDC-established mechanism that distributes laboratory reagents domestically and globally.
> Is this purely a regulatory bottleneck?
That seems likely. It needs to be shipped through a particular resource, under particular constraints that lie outside the norm:
> The CDC 2019-Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel was developed for qualified domestic public health laboratories to detect SARS-CoV-2. The U.S. Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) on February 4, 2020, to enable emergency use of the test kit in the United States. CDC has produced EUA and Research Use Only (RUO) test kits that are now available to order by domestic and international public health partners through IRR.
Interesting read. It doesn't explain though why "the people in charge" haven't issued a blanket authorization by now for basic RT-PCR based diagnostics using a particular primer sequence at facilities meeting some minimum criteria.
Other countries have managed to authorize and implement drive-thru testing stations [1] by now; it really seems like we're demonstrating our ineptitude here.
The FDA is a big slow bureaucracy. Also, all of their incentives are to block new things. If they approve a new medical treatment or diagnostic that ends up harming people, they'll get tons of bad publicity and the individuals who approved it could lose their jobs. If they block things, few seem to notice (see everyone in this thread talking about CDC funding being cut).
For example: The FDA took a decade longer than the rest of the world to approve the first beta-blocker (timolol). That caused around 100,000 deaths. The FDA is also the reason why epipens are so expensive (along with countless other generic drugs).[1]
That said, it looks like they'll approve a standard covid19 test soon.[2]
Perhaps a basic question, but what is actually required to test for COVID-19? I've seen mentions of "testing kits", but what's actually in them? For comparison, US medical facilities regularly test for any number of viruses and can essentially turn them around indefinitely. Is this because they know they'll continue to need to test for them, so they are well-stocked in the test kits?
nit, but it's an actually amplifying the RNA (it's an RNA, not DNA based virus), using RT-PCR (which basically converts the RNA into complementary DNA -- and then amplifying DNA)
In 1990's I worked on the software for an automated NASBA amp. These were mostly sold into the market for HIV testing. They are a lot more productive than 25/day/tech. Is PCR the only way to test for this virus? Are patents standing between us and alternatives?
The machines and reagents are super common. The critical missing element is the primer, a short sequence of nucleotides telling the PCR (gene copier) what sequence to copy
Gene synthesis companies are probably ramping production of these primers now. It’s a logistics issue to send them to the labs, but tiny quantities are needed so the packages are gonna be small, with cold chain shipping I think.
We (molecular biologists) have a dearth of tools for affordable label-free testing, so you basically have to know what you’re looking for before you can look. Bad problem to have. this could be improved with sequencers from Illumina / Roche / Oxford Nanopore but need $$ for that
I've been turning this around in my head for the past few days. If things keep getting worse (and there's no signs they'll get better soon) I'll bring it up with my co-founders. Seems silly to worry too much, but on the other hand, what is the upside if we are all on our computers 99.99% of the time anyway?
No I’m talking about people in the CDC specifically. They should have fast trAcked this but they did the opposite and let it spread. They hurt us, they didn’t help us.
The Centers for Disease Control and Prevention (CDC) initially declined to test a California patient for coronavirus because of narrow testing criteria, delaying the identification of a new possibly pivotal case, according to officials at the hospital treating the patient.
Seems pretty reasonable to me.
There are limited resources for doing the Corona virus test. If the CDC tested everyone who got a fever, they'd have a massive backlog.
The risk is reasonable if any suspected case is quarantined.
Current capacity is 500 tests a day from what I've read. That seems awfully low to me, other countries are testing thousands with a much lower population.
We need to get these tests rolling out in larger numbers ASAP.
> If the CDC tested everyone who got a fever, they'd have a massive backlog.
The problem with that argument is that's not what anyone was asking for. The patient went through an extensive triage before doctors identified a significant risk of coronavirus and requested a test. The CDC overrode that judgement.
Note that amount of CDC resources directed toward coronavirus so far is minuscule, so we should be no where near their capacity to respond.
In the face of a burgeoning pandemic where there are many cases with uncertain origins, it doesn't make sense to override the medical judgement of the doctors on the ground because the case has an uncertain origin.
Guidelines would be ok but these weren't guidelines so much as inflexible rules.
Surprise doesn't really have anything to do with it. We want the CDC to take the coronavirus seriously and disregarding doctors working directly with coronavirus patients is not taking it seriously.
No, I’m not new here... My comment was directed at the user I was directly replying to, who said “if CDC tested everyone with a fever, blah blah blah...” I’m more or less asking the previous commenter why they think it’s reasonable for the US to not be widely testing for this globally contagious infectious disease when other countries seem to have no problem.
No offense, but I remember couple weeks ago, people in here are keep mention that China gov lying about the truth/numbers etc.
By saying that, I am not argue fro the China gov. The Wuhan gov actually tried to hide something in the very early days, until the central gov noticed this.
I just feel this's interesting..
---
Disclaimer: I am Chinese work in US. I don't agree everything China is doing, but also don't like people blindly hate it.
It has been mentioned in a number of threads that there are likely a significant number of underreported cases, e.g. John Hopkins study. However, if cases are underreported and it is implied that these are more mild cases, would that mean that these more mild cases are less likely to infect others? I ask this because if there's a hidden but significant fraction of cases, it seems to be beyond the scope of nearly every quarantine (i.e. asymptomatic people going about their day) and if the transmission rate is equal I would think we would see a lot of uncontrolled spreading. Perhaps Italy and South Korea are an example of this, although I would've imagined far more Western countries with deep distributed infections if are so many high transmission, light or asymptomatic carriers around.
Concurrent to this, I am surprised the original dozen set of infections in the US seemed to have not infected nearly anyone else, assuming close contacts were appropriately monitored.
In China, where the overwhelming amount of cases in the John Hopkins study came from, deaths were also likely to have been underreported or miscategorized as not being caused by COVID-19.
We're not sure to what extent that has happened, but it could also alter estimates of disease mortality rates for the worse.
UC Davis is 20 minutes from the capital of California, the largest state in the union. Davis Medical, one of the top-5 hospitals in the state, has specialists in 150 fields, and is the referral center for 33 counties. It took them 3 days to get a Covid test.
And we thought only China was suppressing disease counts
I see from the downvotes that everyone thinks this is just a glib cheap shot. But the point is profound: no one wants to admit to this happening. Everyone in power[1], everywhere, still thinks this is "probably not going to be a big deal". So they deliberately avoid looking for those early cases, because they're sure they're just rare outliers. And that makes the eventual outbreak inevitable.
And it's happening here too.
[1] Also a lot of people not in power, like a distressingly large cohort of posters here who seem to be taking their cues from political sources.
Here's the appropriate level of threat response to the virus, as seen by other countries:
0-30 cases/day (covid is being imported in via travel)
- put temperature detection check points at airports for all passengers on international flights
- voluntary or enforced self-quarantine measures for those who have fever
- tighten or ban travel from certain areas of the world
30-100 cases/day (you've isolated individuals with covid in your population)
- put areas with confirmed COVID cases on high alert - hospitals in those areas should be required to check fever for COVID virus
- Follow up with patients who have COVID by tracking down and checking their recent social circles
100+ cases / day (containment, not prevention, becomes the main goal. There's groups who contracted the virus / the virus cannot be traced to an entry point)
- Put the entire region on high alert via policy - mandated work from home and limited social gatherings
- Suspend school and other high traffic institutions
- limit travel, request everyone to stay at home. Put up temperature checks / road blocks in major crowded areas.
- ask population to take extreme precautions with their health by washing hands and wearing masks. Wearing masks is an amazing marketing tool to get people to treat the pandemic seriously, even if it doesn't actually help limit the spread that much.
1000+ cases/day (treatment is the prioritization to limit deaths)
- build makeshift hospitals to anticipate the increase in load
- remove as much red tape as possible to allow immediate treatment of critical condition patients (approve funding, get the right tests, mobilize health professionals, allocate hazmat suits / quarantine spaces)
This implies that you are testing patients that have suspected corona symptoms and reporting them upwards.
The US should have been taking border protection more seriously, but it's probably already too late for that. COVID is likely to spread regardless of how much effort you put into border control now.
Typical GOP play - Defund the programs in question until they can no longer function, use that as proof that government is inept, defund further. Repeat until program/agency/government collapses, then privatize the whole thing at great personal profit.
I'm not sure why you're trying to spread fake news. The Trump admin absolutely made cuts to the CDC in 2018 and pushed out key officials.
> In May 2018, Trump ordered the NSC’s entire global health security unit shut down, calling for reassignment of Rear Adm. Timothy Ziemer and dissolution of his team inside the agency. The month before, then-White House National Security Advisor John Bolton pressured Ziemer’s DHS counterpart, Tom Bossert, to resign along with his team. Neither the NSC nor DHS epidemic teams have been replaced. The global health section of the CDC was so drastically cut in 2018 that much of its staff was laid off and the number of countries it was working in was reduced from 49 to merely 10. Meanwhile, throughout 2018, the U.S. Agency for International Development and its director, Mark Green, came repeatedly under fire from both the White House and Secretary of State Mike Pompeo. And though Congress has so far managed to block Trump administration plans to cut the U.S. Public Health Service Commissioned Corps by 40 percent, the disease-fighting cadres have steadily eroded as retiring officers go unreplaced.
Working in 49 countries is not the job of the CDC. They have a duty to exactly 1 country. Cutting the workload should help them stay focused on that 1 country.
It really is crazy for a US government agency to be supporting 49 countries. I hope this isn't typical. Imagine all the other agencies doing likewise. The EPA can stop pollution in France, Botswana, Finland, and 45 other countries. The Department of Education can regulate schools in Russia, Spain, Argentina, and 45 other countries.
That's just messed up. It's treating them as colonies.
The first portion of the CDC's mission statement suggests otherwise...
"CDC works 24/7 to protect America from health, safety and security threats, both foreign and in the U.S. Whether diseases start at home or abroad, are chronic or acute, curable or preventable, human error or deliberate attack, CDC fights disease and supports communities and citizens to do the same."
It isn't about fixing every problem abroad, or regulating any foreign nation's health agencies. It's about controlling/recognizing threats that start abroad before they spread to the US.
Does it work the other way too, or does only the US get stuck with this expense?
For example, maybe Poland could fund a disease-control effort in 49 different countries, including the USA.
The USA could expect about 48 countries to do likewise. We could have our diseases controlled by Slovakia, Ireland, Haiti, Singapore, South Sudan, Denmark, Laos, Pakistan, Chile, Peru, Ghana, Estonia, and dozens more.
Yes, other agencies fill similar roles abroad. The ECDC works across the EU, has partnerships with other states, and has an international relations component.
I suspect other nations do the same. It would be daft to ignore epidemics abroad.
Diseases don't exactly have a duty to one country. The best way to stop a pandemic is to control the spread, and controlling the spread means working with other countries.
The problem is that the American public elected a reality television show host who can barely string a coherent sentence together as president. Since expertise, honesty, and competence represent direct threats to the administration (e.g., decorated military whistleblowers, career foreign service workers, etc.), the administration has steadily removed such people from critical positions in an attempt to stifle internal resistance to its behavior. A side effect of this type of purging is that we now have a reduced capacity to respond to complex geopolitical and natural threats. Hopefully the hard reality of a pandemic shakes some folks out of the propaganda bubble before too much damage is done.
I strongly disagree. The articles I linked talk about 2018 budget cuts and eliminations that went through. The article you linked talk about proposed 2020 budget cuts, and how they came up at this week's democratic debate.
They are not the same issue. Taken from the FP article linked above:
>In the spring of 2018, the White House pushed Congress to cut funding for Obama-era disease security programs, proposing to eliminate $252 million in previously committed resources for rebuilding health systems in Ebola-ravaged Liberia, Sierra Leone, and Guinea. Under fire from both sides of the aisle, President Donald Trump dropped the proposal to eliminate Ebola funds a month later. But other White House efforts included reducing $15 billion in national health spending and cutting the global disease-fighting operational budgets of the CDC, NSC, DHS, and HHS. And the government’s $30 million Complex Crises Fund was eliminated.
>In May 2018, Trump ordered the NSC’s entire global health security unit shut down, calling for reassignment of Rear Adm. Timothy Ziemer and dissolution of his team inside the agency. The month before, then-White House National Security Advisor John Bolton pressured Ziemer’s DHS counterpart, Tom Bossert, to resign along with his team. Neither the NSC nor DHS epidemic teams have been replaced. The global health section of the CDC was so drastically cut in 2018 that much of its staff was laid off and the number of countries it was working in was reduced from 49 to merely 10. Meanwhile, throughout 2018, the U.S. Agency for International Development and its director, Mark Green, came repeatedly under fire from both the White House and Secretary of State Mike Pompeo. And though Congress has so far managed to block Trump administration plans to cut the U.S. Public Health Service Commissioned Corps by 40 percent, the disease-fighting cadres have steadily eroded as retiring officers go unreplaced.
In 2018, 80% of the staff working at the CDC global health section were let go because of Trump budget cuts.
From an on-the-ground perspective, most of the infrastructure is intact and the day-to-day works of the CDC is running as normal.
However, it seems like the top few officials have constantly been rotated, including now Mike Pence is in charge, meaning the ability to lead and organize mass response at a Federal level is handicapped.
I'm wondering if confirming COVID-19 with a test now matters much from the perspective of a patient and doctor. At this point, with public-to-public transmission known to be occurring, if an MD assesses a symptomatic patient and suspects COVID-19, they'd likely isolate the patient immediately.
Does the treatment regimen differ much between severe flu and COVID-19?
If any given country is declining to test for whatever reason, but the virus kills ~2% of those infected, wouldn't the mortality rate seem much higher than 2% in those countries?
(assuming testing uncovers cases post-homously and numbers are not suppressed outright)
I wonder sometimes about the future of the human species. I can't find an apparent reason for it other than cost and even that should not be an issue in this case. Ignorance is bliss and no one wants to cause panic?
That's the point. Just cutting down the military when you don't need it and scaling it back up "really quickly" when it's needed obviously does not work, just as it does not work to cut down the CDC and scale it back up "really quickly" when there's a pandemic incoming. Both institutions provide a significant part of their value by "standing by", so qualified personnel can spring into action quickly in case they are needed.
It's just that Trump obviously applies double standards here: while the military is fine to burn through billions without supplying immediate value (outside of that provided by its mere existence) for a large part of that money, the CDC as a civil organization is apparently not allowed do to the very same thing, even when it costs much less money in comparison. And that's what api obviously wanted to point out. I can't see too much satire in that.
That's the point, having a trained - equipped army at the ready costs money. One could save money by dissolving the army when it's not needed, but clearly you can't respond the same when it's suddenly needed.
The point was that the cost of saving money is effectiveness.
Clearly, this isn't always the case, there is a difference between bloat/overpricing/unnecessary spending vs cut backs that hinder operation ability.
That's the point. Trump is acting like he's running a hotel where the cleaning crew, janitors, concierge, etc are all easy to fill positions and easy to onboard, whereas getting qualified people for the CDC/military and onboarding them is not at all a simple task.
In addition to the CDC, the National Security Council position addressing global pandemic preparation and response was cut. Not to mention the whole of the national policy and especially the national security and foreign relations apparatus being the subject of multiple rounds of political, vanity-driven purges that have driven out expertise in favor of toadying.
I don't really see the problem here. If the government has cut all the staff needed to respond effectively to a pandemic threat, causing the pandemic to be far, far worse than it would have been otherwise, this is just a case of the voting public getting exactly what they voted for. As a wise Frenchman once wrote, "every nation gets the government it deserves". This should be a lesson to voters in every democratic country about the dangers of electing incompetents to run your nation's government.
Roughly half the country absolutely did vote for this President. Moreover, while the Electoral College system does give an edge to certain places, no one has ever made it a political issue to get this changed, so that means the majority is OK with the system remaining as-is. They've had well over 200 years to change it now...
> Moreover, while the Electoral College system does give an edge to certain places, no one has ever made it a political issue to get this changed,
Yes, they have, see the National Popular Vote movement. Also, it's not just the electoral college, it's also the Senate which is actually a bigger problem, and exacerbates the EC problem, and whose antidemocratic character is actually the one thing the Constitution prohibits altering permanently (the slave trade had a similar, but temporary, protection.)
Of course all the EC is protected against popular change by change mechanisms which distort power in the same direction as the distortion in the EC and Senate do.
> so that means the majority is OK with the system
No, what the actual failure to implement a change despite a substantial movement directed at it means is that the minority which is advantaged by the system and which has a veto over change because it's also advantaged by the mechanism which is necessary to use to change the system is okay with it.
> They've had well over 200 years to change it now...
No. They haven't; other people (facing similar barriers) may have, but even if failure to overcome those institutional barriers implied acceptance, the failure of people in the past wouldn't imply acceptance of the present majority.
> Roughly half the country absolutely did vote for this
I get that approximation is subjective, but I'm not sure 19% is what most (or even “roughly half”, even by your apparent standard, of) people would consider “roughly half”.
Roughly half of voters voted for this. Non-voters do not count in a democratic system. I'm not counting "people", I'm counting voters. Non-voters are quite simply irrelevant. If you don't make your voice heard, then you're implicitly allowing others to speak for you.
Substantially less than half the voters voted for it, while more than half voted for one specific alternative.
> Non-voters do not count in a democratic system.
They certainly count as part of the country. And, to the extent that they are nonvoters because they are systematically excluded rather than than voluntarily abstaining, the system isn't democratic to start with.
But, that aside, in any case, in a democratic system, an option with minority support in the electorate doesn't get selected over one supported by the majority, so I'm not sure why you are raising what happens in a democratic system to defend your argument, since it instead defeats it.
There was a fairly in depth FP article back in January about cuts to the pandemic response budget, as well as the elimination of the pandemic czar / team that was created in response to the last Ebola outbreak:
I predict the virus will persist in being unmoved by public opinion no matter how fake the news is.
With less confidence, I predict people who get sick, have friends and family get sick, and/or watch their 401k value drop 25% in a month will develop antibodies to certain types of fake news.
>With less confidence, I predict people who get sick, have friends and family get sick, and/or watch their 401k value drop 25% in a month will develop antibodies to certain types of fake news.
With 100% confidence, I predict those people will use all of the things you mention there to further increase the political divide and entrench their already solidified world and political views.
No, I don't think so. People can be extremely stubborn, yes, but sooner or later, reality is going to force them to make a change. No amount of stubbornness can change the laws of physics. Note that I am not claiming that things will get better for these stubborn people, in fact I'm claiming that things will get much, much worse for them when reality gives them a wake-up call, and there will be nothing they can do about it at that point because it'll be too late to fix things.
The right-wing media is already telling people that it's a bioweapon from China that is being used to attack the United States. Anyone saying differently will be attacked as a deep-state conspirator.
It's different when it's personal. It's easy to ignore talking heads on TV, because they're talking heads on TV. If you personally watch a parent die from coronavirus, there is no amount of spin that will erase that.
Unfortunately I don't think it is any different. Parents have watched their children die from preventable diseases because they decided against vaccination and they still came out believing that they did the right thing.
People will just double down. The conspiracy will be that it's just an attempt by the government to get you to vaccinate or something.
Well I know 2 faimilies in PR that personally had deaths related to hurricane... and it didn't stop WH to say it was lie and they don't exist.
I think you undervalue this administration ability to spin. Did you watch President speech yesterday? Everything is wonderful, everything is great and Mike Pence in charge (with at best questionable history of handling crisises in his own state). If you believe we will have real death tolls from Corona and yet Trump will not spin it that into some form of good news (because more haven't died for example?) you haven't paid attention to politics long enough, I'm afraid.
I'm sorry if this sounds really callous, but this virus (like most flu-like diseases) is going to mostly kill elderly people and others in very poor health. The "side" that voted for Trump is probably going to be hit harder by this virus.
But pretending there wasn't problems with Clinton isn't going to help.
Trump would never have won against Obama for example, but against someone who sh#ts on their core voter base even he had a chance and now Republicans seems to be defending his every move like soccer fans defending their favorite team in spite of all their problems.
(Oh, and the Democrats keep defending Hillary despite all her craziness.)
Absolutely. Some 3,500 american citizens died during last PR hurricane devastation and that was barely covered in media. WH said its fake numbers and its not even 100 people that died. Trump is a genius at spinning things, so I would imagine if someone dies from Corona, it will be "fake news".
The CDC itself isn't majorly affected and day-to-day operations can continue as normal following the standard playbook. Especially at the local and state level.
However, the Federal pandemic response teams have been gutted, positions not filled, and so we don't have the leadership to coordinate a nationwide response as new facts are discovered by the Executive Branch.
"In 2018, the Trump administration fired the government’s entire pandemic response chain of command, including the White House management infrastructure." isn't covered by your response...
It is an election year. One says says Trump cut needless dead weight and there is still plenty of staff. The other side is going to play this crisis and call it a gutting.
There's no sides here, and the particular reason for failure doesn't matter. This is a disease that will kill people. Letting people go untested out into the wild is not going to help.
People fuck up, that's what people do, leaders catch and acknowledge failure early and try to fix it. Unfortunately, at this point, people will die that didn't have to. And that's going to be because:
1. Tons of people weren't tested that should have been.
2. People can't afford to get a test because of the health insurance situation in this country.
Aggressive no cost testing would help, I'm sure trump is going to announce that here any minute for a problem that he doesn't think is real.
I find your post really interesting and am having trouble unpacking it. It seems to me that there are many contradictions, but perhaps I missunderstood.
You say that there are no sides, but end by railing on trump.
You say that the reason for failure doesn't matter, but provide a list of reasons.
You claim that health insurance is the cause of no testing, when the article stated that the CDC refused to conduct or approve testing.
If you sentiment is that this is not the time to focus on partisanship, I wholeheartedly agree.
If you sentiment is we should be solution minded, I wholeheartedly agree.
The focus should be on determining what we can do NOW to save the most lives. There will be plenty of time later to assign blame and discuss long term fixes.
> You say that there are no sides, but end by railing on trump.
He means it's not a partisan thing. Trump is still the person calling the shots.
> You say that the reason for failure doesn't matter, but provide a list of reasons.
I think you're misunderstanding here on what the reasons he's referring to, which are why we're in this situation - those don't matter. The reasons that he provided are the reasons why this is an issue.
Agree on no sides, and it was heartening to hear Gabbard chide everyone for squabbling.
It appears that there simply aren't enough test kits available for wide-spread testing, so it's rational for CDC to try to use what they have wisely. It also appears that we'd be in that situation no matter who had won in 2016.
This is a failing on the CDC that reports to Trump. If you view this as a threat, this should be an easy problem for the US government to solve. The fact that it wasn't is the failing. And failure is on leadership.
Dont forget the problem of declaring people ilegal and pushing other population groups (drug addicts) with draconian measures into the underground, where they infect one another in horrible conditions, and make any quarantine impossible. If any measure should be take, then for the time of the epidemic, the ICE and similar agencys - should be frozzen or recommendered to the CDC, and a general amnesty for any illegal health related problem announced.Im certain that seems insane to some conservatives, but the other approach is self-sabotage on a titanic level.
I don't understand this argument, what if the CDC was actually overstaffed? Do you know? I have no idea...
Lives are always on the line when it comes to disease, but we have never placed an infinite value on human life. By your logic and morality, the CDC should receive additional funding and staffing until there are 0 deaths from disease every year, regardless of diminishing returns. What if increasing funding and staffing of the CDC by 100x reduced the incidence of flu-related deaths by 10%, would your justification mandate this?
To call the cuts "needless" and justify it by arguing that "there are lives on the line" is simply not a good argument unless you are willing to take the argument to its extreme conclusion. If instead what you are arguing is that you believe that the previous budget and staffing was at a correct figure, and that you believe that the increase in body count that will come as a result of the adjustment of that figure (which I doubt is knowable at this moment at time, or if it is even greater than 0) is not a worthwhile tradeoff, then that is a completely different argument.
Your entire premise is based on a basic logical fallacy. You absolutely do not have to take the argument to its extreme, and that is literally called an appeal to extremes.
The argument made was that cutting the CDC, and leadership related to global pandemics was probably a bad idea now that we may be experiencing one. Not that we should spend all of our money on the CDC regardless of returns.
But that's precisely my point. I'm not saying that you or the OP is actually arguing the extreme of the position, I'm saying that the argument that "cutting the budget is needless" because "lives are on the line" implies the extreme unless you are willing to accept that there is a correct amount of diminishing returns where we would agree that cuts to the budget were not needless, but justifiable, regardless of lives being on the line. So if we accept that we both agree that there is a figure where this tradeoff takes place, then what I'd like to know is why the previous figure was correct, and the figure post-cuts is not.
I'm not sure what side of the argument I'm ignoring, do you mind clarifying? I feel as though my argument is precisely predicated on adding additional considerations into the mix, rather than ignoring some component of the original point.
Maybe, but it's probably not like, say, ditch digging, where you round up some people with strong backs and hand them shovels and get to work. Probably takes time to ramp up. The time to do that was a few months back.
Put this in a more familiar context: say the CDC had just been rooted by a bunch of hackers. How much time would it take for Congress to cut a check versus setting up the organization structure, hiring highly-skilled in-demand people, getting them on-board and trained up with the environment, and letting them learn enough about the systems to start hardening them, etc.?
This kind of capacity takes years to develop even if you can cut it quickly.
Thanks for all the responses everyone - I understood this concept but failed to apply it here (where it most certainly does apply).
Dont know if anyone is still keeping tabs on this thread, but apparently Trump's "CDC budget cuts" are a falsehood. He proposed cuts but was overruled by congress. In fact, CDC received an increase in funding. See the following link:
> MIKE BLOOMBERG: “There’s nobody here to figure out what the hell we should be doing. And he’s defunded — he’s defunded Centers for Disease Control, CDC, so we don’t have the organization we need. This is a very serious thing.” — Democratic presidential debate Tuesday.
JOE BIDEN, comparing the Obama-Biden administration with now: “We increased the budget of the CDC. We increased the NIH budget. ... He’s wiped all that out. ... He cut the funding for the entire effort.”
THE FACTS: They’re both wrong to say the agencies have seen their money cut. Bloomberg is repeating the false allegation in a new ad that states the U.S. is unprepared for the virus because of “reckless cuts” to the CDC. Trump’s budgets have proposed cuts to public health, only to be overruled by Congress, where there’s strong bipartisan support for agencies such as the CDC and NIH. Instead, financing has increased.
It's going to be very late once people start dying. COVID-19 takes about 2 weeks to develop severe pneumonia. Once dozens of people start dying, assuming 1% fatality, there would be thousands of patients 2 weeks ago, spreading exponentially.
Is there any reason to believe the people Trump fired are useful to look into this, or are they just "middle management" overhead that would get in the way?
I haven't looked into the details. So far this entire thread has made me conclude nobody else has either - instead they are spinning it into good/bad trump while pretending to be neutral.
As european, don't count on Europe neither. Italians are already backing up in their statements as they clearly see they are the only fools that were willing to make any sacrifice to try to contain it.
Another instance of pathethic european leadership.
Ordinary flu killed some 80k americans last year. Covid-19 seems to be ~20x as deadly as the ordinary flu, and spreading at least as fast if not much more. So if it becomes endemic, embedded in the general population, just as flu is now - then the next flu season will have 1.6 million dead americans. Most people would consider that this is a large and undesireable result; that worrying about such a result is reasonable, and that it would be imperative to try and prevent it from happening if we can.
If everyone in the world were suddenly infected today and the onset would be, say, five days, the world would be in a mayhem in a week. The current fatality rate in countries such as Japan that doesn't have overloaded medical system, may seem low, but:
1) it's low because the system isn't overloaded. When overloaded, it starts to rise as the patients with heavy symptoms just die.
2) at a stage of a epidemic, it affects infra, which has feedback loop effects.
3) (for the sake of an argument) two percent of humanity is still 156 million people. A death sentence for 156 million people? That's harsh.
Indeed, overloaded medical system = high mortality.
To give a concrete example: recently there was a video report in Chinese state TV showing a heroic tag-team (doctors+nurses) doing 6 intubations per hour. Note: intubation is practically the last stage before you end up in a body bag.
That's a crazy number of intubations/hour for a single team. In such circumstances, you're guaranteed to get less-than-perfect recovery rate due to cross-infection.
China’s response in the beginning was exactly the same. Only people who had been to Wuhan seafood market and had fever got tested and we had testing kits shortages too.
But US have the advantage of hindsight. Why they are repeating Wuhan’s mistake is beyond me.
We have had the sequence of the COVID-19 for over a month. Are you guys, on hackernews, are telling me there isn't a single startup - not one - that could develop a more effective test to fill this gap? The virus when it comes, will not discriminate between Republican and Democrat. But developing a better test could save lives.
There are plenty of startups giving this a shot. There's a huge amount of money in being the first to develop a test or vaccine. Just look at the unbelievable growth in $CODX, $NVAX, $GILD, $MRNA, over the past week.
A quick Google shows:
Feb 16 - Israel races to find solutions for coronavirus [0]
Feb 17 - Corporate Japan rushes to devise quick coronavirus tests [1]
Feb 25 - Nanotechnology Startup Develops Quick-response Lateral-flow Test for Coronavirus [2]
Feb 26 - Biotech company Moderna says its coronavirus vaccine is ready for first tests [3]
Feb 26 - Novavax to Begin Clinical Testing of Coronavirus Vaccine by Late Spring [4]
Feb 27 - Drug companies race to test coronavirus vaccines
Are you suggesting that the people in their PR department should be doing the tests?
Or, do you think that they shouldn’t have a PR department, and be solely composed of doctors? When a large point of their organization is to talk the public into doing things for their own safety?
Without sarcasm, now: people need to stop thinking of organizations as amorphous talent pools of generalist ubermenschen, where a “trivial” task would distract one of these do-it-all people from doing an “important” task. Maybe on HN, people forget that not everything’s a startup and not everyone’s a cofounder.
Big organizations like the CDC are composed of departments; each department is a separate talent pool. The PR department making (trite) announcements is not “getting in the way” of anyone receiving a shot. Likewise, the management of an organization changing hands doesn’t usually† “get in the way” of boots-on-the-ground doing their day-to-day jobs.
† Management can explicitly interfere by introducing hindering policies. But—especially with doctors—it’s been found many times that the people doing the work will just ignore dumb executive policies if they get in the way of treating patients. This is why there’s not much point in a “private hospital” attempting to run at a profit by cutting costs: the doctors won’t cooperate, and will just treat patients the way they would in a public hospital, using all the same interventions they were taught were best-practices in med school.
I think the grandparent was referring to GOP politicians who tweet their "hopes and prayers" after every mass shooting instead of doing something effective to stop the epidemic of gun violence.
each of those departments do take funding, and when the Republicans cut your budget in half, id hope they mostly keep the doctors and keep very few from the PR department
[0] https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html
[1] https://www.gov.uk/guidance/coronavirus-covid-19-information...