I guess it's a YC17 company. The founders are Caroline Landau, Tim Cornell, Walker McHugh. From 2016: Landau was an MBA candidate, the other two founders have biomedical research/medical backgrounds:
Walker McHugh, Co-Founder, PreDxion Bio / Biomedical engineering candidate, University of Michigan
Dr. Tim Cornell, Co-Founder, PreDxion Bio / Pediatric Critical Care Physician, University of Michigan
At least until recently, the company focused on making diagnostics for immune disorders (microkine) for CAR-T patients which I can't find much detail on. I don't know if it's related to the SPR-based tests mentioned in the pb post.
They received a government business grant (SBIR) in 2018 and have some VC funding.
It looks like this post demonstrates their pivot to a specific infectious disease, and from a hospital provider setting to a public setting.
As an ex-advisor to a successful (in bio) VC fund, this is not something I would really spend a lot of time considering. There are too many non-technical hurdles that would need to be jumped before this was widespread, popular, effective, and profitable.
The technical implementation of a viral detection assay is much simiplier to implement than our quantitative, multiplexed small MW biomarker sensors... But there are certainly many other hurdles that remain as you point out as well as the additional biological uncertainty that remind around SARS-CoV-2 it's infectious course as well as our bodies subsequent immune responses.
There are certainly many hurdles left to be tackled but that's exactly what we're working towards.
And i am wishing them success, and my brother is the director of the VA for the entire state of Alaska, an Airforce Colonel (commander, tenth medical wing) and ive personally built/designed/commissioned 10+ hospitals (el camino, sf general, sequoia, nome, and more)
((All on the tech implementation and design side))
Anything i could contribute i would.
(My creds can be freely confirmed)
In particular, this method appears to be antibody based? (Which has accuracy issues) and uses SPR, which may involve some technical risk.
However, I think there’s mileage in developing methods now for the next pandemic. My personal interest is in developing programmable qPCR-like systems . So that kits can be deployed ahead of time, and then programmed to a specific target as required. If anyone is interested in discussing diagnostic approaches, please get in touch.
Are you familiar with the work of Dr. Chui at UCSF? His group has done some really cool work using mNGS to detect/diagnose emerging/rare infections in critically-ill patients with refractory encephalopathy
I’ve worked at a number of NGS platform companies developing new sequencing approaches. The problem is that sequencing is still expensive at the per-run level. It’s possible to be cost competitive with qPCR if you multiplex samples. But this isn’t ideal.
It would be interesting to create a small/cheap sequencer which could be applied to point-of-care/at-home testing. However, most of the money has gone after attacking the market leader (Illumina) on a cost-per-base, rather than cost-per-run.
A 1USD per-run sequencer would be interesting. But I’ve not seen anything that will hit that target in development. If anyone reading this is developing such a system, let me know, I’d love to get involved.
The idea of a programmable qPCR system is to add some of the versatility of sequencing to qPCR.
You can get to $1/sample; but need >1000 samples/run at least to get to that cost level. Could run 10k/day without automation; likely a lot more (100k-1MM) with automation.
I would love to hear about your advisor role experiences with VC funds. Would you be up for a short chat/call? My email can be found in my profile.
Background: Chemistry/Startups, looking what to do next with my life.
“It’s easy to fall into dystopian visions of the future — a world shut down by one virus after another”
“It doesn’t have to be that way. ..... Ubiquitous screening is the key.”
The approach is interesting and the possibility of eliminating large scale spread of covid, flu and others is attractive.
However the idea of requiring a saliva swab from every visitor to an office or event has the potential to create an equally terrifying dystopian future where those samples are used to collect and use other data (DNA for example).
How long before screening companies offers to provide free screening and access control systems in return for anonymised data?
This kind of solution needs to have very well thought out privacy rules supported by strong and enforceable legislation to protect the individuals rights.
Sure, some people could fake the test, but for this approach to work, all that matters is that most people don't fake it.
One way something like this is likely to be implemented is by validating a ticket or access card/token with a saliva swab. This is just too easy and attractive an opportunity for data collection to be passed up by some operators with business models that monetise the data as a revenue source.
That's a giant social space people would be clamoring to go to. But given Disneyland's mystique and raison d'etre, the logistics right now are impossible.
I don't know how viable the solution proposed here actually is. The skeptics here raise some good points.
But if this solution turned out to be proven, I expect Disneyland would be one of the first places where it was deployed at scale. If we trusted the technology, I'm pretty sure both you and I would be happy to wait 10 minutes to get in. A free COVID screen as part of your price of admission. (It's interesting to consider how they would handle people who failed the screening. A balloon and hauled away in a cheerful corporate van? Maybe Disney starts running COVID resort sanitoriums?)
I also imagine Disney is one of the few organizations out there that could get the queuing sorted out. And I suspect that would be as important as anything. Once perfected, it could serve as a model for others.
For this purpose the screening would probably have to be carried out at locations that could confirm the sample came from the right person at the right time.
Googling for "romer covid 19" should turn up a lot of news sources covering the notion of testing millions of people a day.
That's because we currently aren't capable of testing everyone who is obviously sick just once. If we got there, we wouldn't even be close to being capable of testing key personnel (like health care workers). If we got there we wouldn't even be close to being able to test everyone once. If we got there we wouldn't even be close to being able to test everyone every day.
You haven't heard any advocating for OR against it because it is so far from achievable that it isn't worth considering.
The linked article suggests a novel and much cheaper test, which would be great. But even if that didn't work out, what scale could possibly be feasible with existing tests? Pre-shortage, an RT-PCR seemed to be much cheaper than a missed day of work.
Testing a few hundred people daily would be doable, as Germany has relatively good testing capacity - probably one main reason for the overall better handling of the pandemic so far. But the concept still gets critisized, as this would mean a fast track to testing for the players while parts of the population don't have equal access to testing.
For the whole population, it would be a good first step to be test really everyone who has any assumptions of symptoms and some time later, everyone in contact. And perhaps a biweekly test for the general population.
That seems like the logical conclusion of "more testing" to me. If we could, why wouldn't we?
3blue1brown on YouTube did an analysis which similarly shows that fast quarantining is the best way to mitigate the virus: https://www.youtube.com/watch?v=gxAaO2rsdIs
IIRC, mainstream objections tend to come from concerns of false positives, since that becomes a bigger problem with this frequent level of testing and could prove a huge disruption if you end up with too many quarantine still, or so many that testing positive becomes essentially meaningless in terms of telling you whether you have the disease or not if you test positive.
Being off work for such should not result in severe reduction in income unless your income was already high; at least that is the case here in Norway where laid off personnel get 80% of their normal salary up to a limit that is above average salary.
That's demonstrably false. There are numerous prominent examples in fact.
Taiwan is not doing a high rate of testing at all, they're most certainly not doing constant ubiquitous testing. Their per capita test rate is 1/7 that of the US.
Singapore and South Korea are not doing constant ubiquitous testing. The US has already tested at a higher rate than South Korea and will pass Singapore shortly given the continued ramp in US testing. Both are held up as marvels of virus containment.
Japan has barely done any testing. They're seeing a small spike in cases now, however they were not earlier (this is four plus months after the outbreak began and Japan is next to China). Their deaths from Covid are commonly 1/50 to 1/150 the per capita rate of the US and other higher outbreak nations, while doing 1/10 to 1/15 the testing. The only explanation is either that they're covering up ten thousand deaths, or the other non-testing approaches they've utilized work well. Compare Japan to Germany on Covid deaths - again, despite Japan being next to China - and then look at the testing rates. Now explain that.
Finland is testing below the US rate and has contained the outbreak to a stellar degree. That's because Helsinki is colder than Stockholm and Copenhagen. The same reason Moscow didn't get slammed until more recently as the weather began to warm up. There are other factors that impact the spread of the virus, including the rate of social activity and high temperatures (over ~60F / ~15.5C). We know this from several studies that have proven the role of temperature in the spread of SARS and SARS-CoV-2; as well as understanding how the spread benefits from greater social activity (which doesn't occur at the same rate in super cold climates).
Greece has a very low number of Covid deaths and no evidence of serious outbreak this entire time. Their testing rate is 1/3 that of the US. And they're wedged between Turkey and Italy. Much like southern Italy, they've been heavily shielded by their climate. Nobody wants to talk about this of course, it's the Mexico / Texas / San Diego / Baghdad / Lagos effect in action.
Iraq isn't seeing any consequential outbreak, thanks to its climate. Whereas Iran right next door got smashed, because Tehran has an entirely different climate from Baghdad.
Thailand and Vietnam are both testing at a very low rate, and there has been zero evidence of serious outbreaks in either country, despite the proximity to China. That's thanks to their hotter climates.
Nigeria is barely testing at all, with zero evidence of a consequential outbreak there. No crushing of their healthcare system with cases or deaths; no huge spike in deaths, hospitalizations or ICU cases. There are numerous countries across Africa seeing similar low outbreak results, with very little testing.
Colombia isn't seeing a consequential outbreak, their testing rate is super low. They're not seeing a healthcare crush either. They've contained it so far without a high rate of testing.
India and Pakistan were supposed to get buried by SARS-CoV-2 cases. It hasn't happened, week after week goes by and the predictions continue to fail to come true. They're barely doing any testing at all. There's zero evidence in either country of a massive outbreak or crushing number of ICU cases swamping their healthcare systems. It's because of how hot their cities are. I've yet to see a single other good explanation for why India isn't buried in Covid deaths by now. India isn't seeing the virus hit for the same reason Africa hasn't.
Egypt is barely doing any testing. Cairo should have millions of cases of the virus and a huge number of deaths by now. They should have 20,000 dead people from Covid at this point just in Cairo. Where is it? The Cairo metro has 20 million people. It's not far from Italy, Turkey, or Iran. Guess what? It's very hot in Cairo.
And if you want to see a belligerent demonstration of the climate impact in action: tell me that Florida has been dramatically more responsible in their behavior than Belgium has (or France, or Italy, or Spain, or the UK, or the Netherlands, or Switzerland), to warrant having a per capita Covid mortality rate 1/12th that of Belgium. If Florida had New York's climate, Florida would have 20k Covid deaths by now. Instead they have a mere 1,066 (and Florida has a lot of old people) despite doing almost everything wrong.
If "it happened and it worked" isn't "mainstream" then I don't know what is.
Johnson and Johnson have already started scaling their vaccine and plan to have 1 billion doses available by January 2021. If their vaccine is approved, it will be an instant solution and better than testing everyone every day.
Moderna has also started the process of scaling their solution as well but J&J have a head start and a known platform.
Why not? Scaling a test is a completely separate exercise to scaling a vaccine, and it has the advantage that multiple proven working tests exit now, they just need to be scaled. Both can be done, by different people.
You might also find that having a vaccine and a test is better than having just a vaccine.
> If their vaccine is approved
Multiple vaccines are in development. This is not a situation where we should stop doing X now because Y _might_ happen in 8 months or more time. None of the vaccines are guaranteed to be ready and working and scaled at any given date. None of them.
How does your device detect viruses? Is it based on a protein or the RNA or what?
Given that it appears people with COVID-19 can shed the disease for many days before showing any symptoms, if your goal is to pinch off outbreaks before they become outbreaks, frequent, universal testing is the only way to get there.
"Quantity has a quality all it's own"
The two solutions that are being debated now are (1) staying in lockdown until a vaccine or treatment is available, and (2) reopening and attempting to manage the spread using existing protocols/ideas (relatively low amounts of testing, quarantining after a period of infectiousness, some form of contact tracing, lots of finger crossing). At least, that's generally what I hear being debated: reopen or not, or when to reopen.
The post suggests that if we had quantitatively much more testing, we could pick a qualitatively different third solution -- namely, reopen pretty freely and realistically control the spread.
Sure, you can view that as a variant of the "reopen" option, but in my mind reopening feels very different with a realistic way to isolate people before they've had a chance to spread it very far. It's proactive vs reactive. If we fully reopen with even 2 orders of magnitude more testing than we're currently doing, it's just going to be a matter of closing back up wherever it gets out of hand. In practice, the openness will fluctuate, things will be spread out over time, politicians will continue to do the exact wrong things, and lots of people will continue to die.
In short: (1) stay in lockdown until vaccine/treatment, (2) reopen without a strategy, (3) reopen with a strategy.
> This test gives results in ten minutes using a small amount of saliva which is taken into a disposable tube and then run through a scanner.
> We’re planning to start operating the first scanner within a month. If all goes well, there will be millions of scanners deployed by this fall, ensuring that every school and essential business can reopen while remaining safe and virus-free.
One of the oldest and largest biomedical institutes, the Robert Koch Institute in Germany, recently had a few press releases, urging for tests for at least ALL respiratory tract infections.
What one of the leading experts, Prof. Drosten, also mentioned is that current (PCR) tests have considerable false positives. The effect of such FP at large scale can hardly be estimated.
I really hope that you are able to find a solution and can bring up a scalable and reliable solution, after the promises. If not, there will only remain the impression that this could be a Silicon Valley type of talk the walk, as people heard it from other companies in the past.
Some people just advocate for isolating the elderly and having everyone else mingle.
The life expectancy loss from just letting it run its course would be less than a tenth of the life expectancy difference between the second and third wealth quartiles in the USA. And if we aren't worried about that difference, then why are we imposing a quality of life reduction that's much larger than the quality of life difference between those two quartiles for a much smaller gain in life expectancy? (similarly the economic costs of bringing the lowest quartile up a year or two would be much lower than the cost of this lockdown)
Because that's a terrible idea that doesn't make any sense. I understand the logic and why it's tempting, and I've even read some of the evidence supposedly backing it up. I find it thoroughly unconvincing.
I won't address the moral side, just the practical.
The virus disproportionately effects the elderly, yes, but far from exclusively. We have seen the non-elderly death rates with distancing in effect. If we could confidently say that >70% of the non-elderly population already had the virus, then this might make some sense. But since at the moment we cannot say that, then this is a method for quickly getting to >90% of the population, and killing off an unknown but far from trivial percentage of us.
Also, I have seen some evidence that the magnitude of symptoms is partly dependent on the degree of exposure. If that is the case, I really really do not want to be sitting between two infectious people in a movie theater or sports arena. But this would be commonplace with the whole "let's just sacrifice the elderly" approach.
As a society we have shown time and time again that we only care about "disasters", not the continuous but far greater and less expensively solved losses. Nuclear power vs coal, air plane accidents vs car accidents, the life expectancy reduction of poverty vs COVID-19...
It only took a couple of months for 20% of New Yorkers to get infected. If we assume that half the population will get this disease over the next two years, and we assume an infection fatality rate of 0.3%, that's around 500,000 deaths. (328,000,000 * 0.5 * 0.003 == 492,000). Those are optimistic projections. The IFR is likely higher and the R0 is somewhere between 3 and 9, so that means at somewhere between 60% and 90% of the population needs to be infected before we get herd immunity.
Unless there are radical improvements in testing and/or treatment, I think we'll end up with at least 500,000 deaths in the US. That would mean we're about 10% of the way through this catastrophe. So strap in, it's gonna be a long ride.
4. For the relationship between R0 and herd immunity, see figure 2 of this paper: https://academic.oup.com/cid/article-pdf/52/7/911/847338/cir...
At this point, I'd consider that a success.
If there is substance to this then it would be massively in Paul's (and the company's) interest to better link to that in both the post and the company web site. At the moment, it looks like at worst vaporware or at best, something so early stage it's years out from viability.
Unfortunately, up until about a month ago us like many folks, were blissfully minding our business developing a rapid point of care cytokine detection platform for use in monitoring patients experiencing certain immune responses following cancer immunothereapies, you can read more here: https://pubmed.ncbi.nlm.nih.gov/31597044/.
Currently, we are very much focused on techical/clinical validation. We will have many more details to share on our approach, the technology, as we continue to move things forward.
Ethics are an important thing.
The holy grail would be real-time targeted therapeutics to modulate our immune systems up and down in response to various cues. We’re a long way off from that but it’s an idea that’s beginning to get wider acceptance in the medical community.
 - https://www.novartis.us/sites/www.novartis.us/files/kymriah....
 - https://www.gilead.com/-/media/files/pdfs/medicines/oncology...
I just found out about Covid Toes. What will come tomorrow?
And now, a shameless plug for a next-day delivered PPE from Amazon built from a full faced snorkel, a vacuum filter and a 3D printed adapter I designed: https://3dprint.nih.gov/discover/3dpx-013899. There's a video too, which shows a bit cheaper version's assembly: https://www.youtube.com/watch?v=wydRpFpQD4I
I haven't been into an indoor shared space without it on for almost 3 weeks. You probably shouldn't use Gorilla Tape on it, because it might off gas something. Try surgical tape.
I think this is the best position, however but it still needs to be argued for since it's not the only position.
Edit: Also, it looks like the US has plateaued at this point but in a situation with a fairly dysfunctional testing arrangement. It is going to be hard to argue for people to sit tight until tests are in place so I'm not terribly optimistic.
Just to nitpick a little here, it's more like "flatten the curve - stretch the time while everyone gets it, so we don't overwhelm hospitals". Even with exponential growth, you would rather deal with it over a longer period than have a massive spike where all services are overwhelmed.
Which is to say, you can stretch out exponential growth a lot and still not have enough. If you exponential growth from 1,000 to 1,000,000 cases over a year, the last month will overwhelm your services entirely and constitute the bulk of both cases and death.
There's a reason all those early graphs showed parabolas, not actual exponential curves, you can't even give plausible visual representation of this process, because it isn't plausible.
Huh? One goal is to flatten the curve so that we don't have exponential growth. Another is to flatten the curve so much that, even if might still be exponential growth, the growth is slow enough for our health care systems to absorb the peak.
The aim of mitigating measures is reducing the growth rate of the disease. But the mechanism of the disease is that you generally have a basic situation where X people infect at time t results R*X people at time t+1. That's fundamentally exponential process (even though you can extra factors, the process doesn't change 'till you get close to having infected everyone). If we can make R small enough, this become exponential decay, a good thing but still an exponential process. But when you do exponential growth. you have a doubling and on the last double, you get more cases than all the cases combines. So the peak is just MUCH higher than the rest of the curve and you can "flatten" a lot and still wind-up overwhelmed in the end if the growth process continues.
It also feels like the logical next step to the very widespread testing found in countries like South Korea.
The Norwegian health authorities also published an app that can be voluntarily downloaded, that tracks and warns about infected, while also collecting research data for future use.  The app has garnered some criticism for leaking user data, and for discharging the battery too quickly. The retort is that it's of course voluntary and anonymous, and that it's actually tracking less data than Facebook or Google.
: Norwegian language source: https://www.fhi.no/nyheter/2020/ny-app-fra-folkehelseinstitu...
Relevant part of their tweet:
"This applies if you are staying in a country with poorly developed health services and infrastructure and/or collective infrastructure, for example the USA. The same applies if you do not have health insurance."
As well as a message, now apparently removed but archived by others, on their website:
"This also applies for countries with poorly developed collective infrastructure, for example the USA, where it can be difficult to get transport to the airport if you don’t have a car. The same applies if you don’t have health insurance."
> We need to start building social distancing into our culture the same way we built protection for sex into our culture.
While I agree with the general gist of your comment, I should emphasize that what we need is physical-distancing, not social. Humans are social beings at core, and depriving them of social interactions is as deadly as the virus itself. What we should be practicing more than ever before is washing our hands, minding our coughs, and in general, being responsible to the society. The individualistic lifestyle - which is pretty much dominant in the West - shouldn't stop us from caring about our community as a whole and our duties towards other people. Technology can only help us get so far; the rest depends on how much we - as responsible social beings - take care of ourselves and each other.
Good distinction. We should be focusing more on hygiene while finding ways to connect remotely with the people who are important to us.
Good stop-gap, but not remotely viable long-term. Humans aren't made for isolation, even if video calls help take the edge off soon. FaceTime and Zoom have a significant cognitive load, too. As long as we're talking about how society should adapt to this sort of risk, we can't just go to living in individual hermetic pods with internet connections. The mental health cost will be monstrous.
Why the cogntive load would be lesser in a face to face conversation than digital assuming the internet connectivity is good ?
- Henry David Thoreau
Sounds like your undergrad kid has been paying attention in class...
I’m glad more money is being put towards research in this tech (I used to study plasmonics from the physics side), I don’t think it’ll make a difference for COVID specifically before it’s too late to matter.
We should hopefully have boring old ELISA antigen tests shortly, thanks to Abbott and many of the other folks we've all heard from. The real challenge is scaling testing beyond what can be reasonably implemented from central lab facilities.
The SPR machines I’m familiar with are not inexpensive. Are there machines appropriate for these tests that are less expensive such that it could be rolled out widely? Sample cost is low, but a warehouse shift change of several thousand people isn’t going to need only one machine for screening as the load on the machines will be very bursty.
I'm not so sure about this!
So you can allocate tests by sorting by (# of daily contacts in a closed space) ^ 2.
But as PB says, it should be practical to test everyone every day.
[probability of becoming infected and spreading] = [probability of becoming infected] * [probability of spreading] ~ [people you meet]^2
probability of spreading = a * n
probability of infected = b * n
a,b = some blackbox function for spreading/infection ratio?
n = number of people you meet
Assuming both are independent events we get:
p = a * b * n^2
I can see how we get n^2 with that. The way I'm using a, and b seems clumsy though, is there a better way?
p_catch ~ n
p_spread ~ n
p_relay = p_spread * p_catch ~ n^2.
Correct, it's not. But it is roughly linear in the limit of small numbers of people with a small constant probability of becoming infected per interaction. (This assumption becomes problematic when you see "clustering" of highly social people with other highly social people.)
To be specific, if P is the probability of becoming infected when interacting with a single person, then the probability of becoming infected after interacting with N people is 1-(1-P)^N = NP - O(N^2 P^2). It's easy to see that the limiting infection probability is 1 in this simplified model, and that if N*P < 1 you're looking at close-to-linear growth.
Edit: I’m not sure I interpreted the original statement correctly.
> Even with imperfect screening, if we are able to prevent 90% of disease transmission, then the virus’s reproductive number, or R0, will drop below one and the pandemic will quickly fade. There is no risk of reintroduction from the outside because any new outbreaks will quickly be caught and contained. If used consistently, there will be no second wave, ever.
I'm not sure this "test and release" strategy works unless absolutely everybody gets tested simultaneously.
Even if testing of the total population can be completed in a week (a highly ambitious timeframe), there's still time for people released on Day 1 to be reinfected by people who don't get tested until Day 6.
Then you have to go through who knows how many follow-up rounds of testing absolutely everybody not in quarantine to identify those people. When responding to new outbreaks involves re-testing large populations of people, you're going to run into many problems. Notification, compliance, testing fatigue, etc.
Sounds like a logistical nightmare.
Wouldn't it stand to reason that you could be tested once per day, in the parking lot to a mall or some other shopping establishment, and thereafter _verify_ that you had been tested that day for the remainder of your commercial transactions?
Thinking in those terms, 10 minutes per day is not so great of an imposition. We could formalize it and create drive-through test centers where you drive up, spit into the tube, have a bar code on your phone scanned, and drive off. On your way to the mall you get a text message with your results. Everywhere else you visit that day scans your phone upon entry and confirms that you've been tested.
The system also becomes much more complex and requires a bigger infrastructure if you aren't literally testing people at the door. How do you verify someone has had a test today? In your bar code idea, can the bar code be faked? Is there some centralized database behind the system that tracks who tests positive? Is that database politically feasible? Some comments here are already objecting to that idea.
As for checking who has a test, simply give colored stickers. If someone wants to “beat” the system, so be it. Social disapproval and common sense will keep most people honest.
You need a plan for people who want to beat the system because they present a huge danger. The whole idea behind this system is to allow the people inside the secured bubble to return to normal behavior. They aren't going to be wearing masks, social distancing, or taking other precautionary measures. Therefore one person acting inappropriately could present a huge problem for the people on the inside. Keep in mind there are still people who think this entire thing is a conspiracy and that COVID-19 is no worse than the flu. You have to consider what happens with people like that who might not participate in this system in good faith.
Hawaii is an island, thousands of miles away from the rest of the USA, so why shouldn’t it open on a different schedule?
Even China, ground zero for the crisis, close and reopened different providences, districts, and even neighborhoods independently.
Could you protect a food processing plant with this method? Yes. Does it cover testing in LA? No. Does LA need food and other shipments? Yeah they do.
Imagine trying to enforce this on every non-residential building in, say, NYC. It would be practically impossible.
Who checks to make sure every restaurant follows the standards of cleanliness? They have inspectors who (theoretically) show up randomly, so it ensures most places comply voluntarily, because the cost of getting caught is very high.
A combination of random inspections and steep fines would solve the compliance problem.
Edit: I just had another idea. Offer cash rewards to people who can prove they they weren't tested when entering a public place (which the business pays for via fines). You'd have people running around trying to find missed testing for the cash reward.
I think economic incentives are also fairly well aligned here. If tests are widespread, a significant segment of the market is likely to prefer locations that are testing to those that don’t, just like the market tends to prefer clean restaurants to unsanitary ones.
you can't reject solutions because they sound dystopian unless you've got better, non-dystopian solutions. and everybody has to stay in their homes at all times and all non-essential services are shut down is not a less dystopian solution.
What “solution” are you looking for to solve this relatively small share of “death from natural causes” that we call COVID? How much damage should we inflict upon ourselves in this moral quandary?
How many people should die because we’re willing to spend trillions of dollars due to our innate fear of a virus rather than our innate fear of much much bigger problems, like poverty or starvation?
Why can we muster so much energy in this case, and so little on much bigger problems? My theory is that you can’t catch hunger on the subway, you can’t catch underprivilege from a doorknob, and you can’t catch climate change from shaking hands with constituents.
There’s a lot wrong with our planet, it’s too bad we’ll all go bankrupt and unemployed chasing such a trifling disease as COVID when there were actual real problems we could have solved with mountains of cash that large, rather that burning the cash in effigy for modest to no effect once COVID has run its course.
If I could still edit the comment, I would replace the first “you” with “we”, as none of the comment is meant to be directed personally at OP.
The dystopia we have is purely one of our own creation. One which TFA seems to not only welcome with open arms, but seeks to capitalize upon. It’s really quite sad.
One is that cash is not a resource. It's even less of a resource when it's not only not metal, but mostly not paper either.
The other is that the flu comparison doesn't make sense to me on multiple levels. Given deaths from COVID at the moment are nearly ten times flu on an annualized basis, given the partial shutdown, obviously they would be more than ten times without the shutdown...but what is even significant about exactly one order of magnitude?
I’m not quite sure what to say to “cash is not a resource”. Even if just a proxy for attention cash is obviously a resource. But really, cash in itself is a resource. $10 trillion dollars can do a lot of things if spent wisely. $10 trillion dollars can also be destroyed for practically no benefit at all.
I agree it’s not strictly $1 spent on A means $1 less to spend on B. But it’s at least true to some extent, and again, as a proxy for attention and willingness to enact change, it’s a valid measure.
So the flu comparison is because they are both respiratory illnesses which kill a lot of people. In the 2017-2018 season the flu killed 61,000 in the US. Hospitals in NYC were stretched very thin. Nobody really noticed. It wasn’t even declared a pandemic.
Obviously it’s impossible to say with certainty if we have seen 1/4th, 1/3rd, or 1/2 of the total deaths that we are going to see from this SARS-CoV-2. But I think nobody is currently out there claiming that we’ve only seen 1/10th of the total deaths from SARS-CoV-2 that we’ll get by the time it’s over. (SARS-CoV-3 is another story?)
“Ten times flu on an annualized basis...” So 50k times 4 is 200k. That’s not nearly 600k. Just trying to follow your math. If we’re halfway through now (IHME thinks we’re about 3/4 through) then we‘ll have seen in COVID the equivalent of two bad years of flu.
Orders of magnitude generally provide rough measures of classification and are a nice rule of thumb for telling if one thing is “radically different” than another thing. So, flu kills up to 650k globally per year. Maybe COVID will do roughly the same, maybe 2-3x, but I think at least we’ve long past the days of claims that COVID will kill 5 million worldwide are being tossed around. And it’s not because no one’s caught it and we just need to keep hunkered down. It’s because a massive number of people caught it and overall its just not that deadly.
If governments around the world had done their jobs and shared data and been truly prepared and with a little luck and a lot of hard work this whole thing perhaps could have been avoided by early and arduous contact tracing. That day is long behind us.
I worry that by now so much energy and ink has been spilled getting the country into lockdown, and people are so politically invested in it, and all the social pressure campaigns have ramped up to max,... that now as data finally emerges which demonstrate it was all a gross overreaction, we will be too slow to correct.
In the meantime 10s of millions have lost their jobs, perhaps millions have lost their businesses. A $1T deficit seems like a quaint memory (sorry grandkids!).
And it was all for, what, exactly? When herd immunity is the endpoint and the IHME hospitalization predictions were wrong by 10x... overbending the curve only causes suffering and does not save lives. Bending the curve too far into next winter could actually cost lives, which the CDC acknowledged earlier this week in a very roundabout way. And bending the curve at all only helps if additional medical treatment availability would have actually saved more lives, something which I have not seen a strong case for.
$10 trillion is probably over twice the (financial) cost of WWII adjusted for inflation. Having numbers of that size written down, deleted, moved around, doesn't mean we are suffering that level of loss.
As far as comparing covid to flu, I was talking about annualized daily deaths from covid, compared to a normal year of flu. That was deliberate. I'm saying, if it neither increases nor decreases from this point on, it's nearly ten times the rate in the long run.
You are comparing the total deaths from covid, assuming it declines and goes away in due time. That would be fine in a vacuum, but you're using the consequences of trying to stop it to argue the efforts to stop it are unnecessary. What is the point of this sophistry?
Now is the time to express opinions on these "proposals"..
The cheap flight was what made this epidemic a pandemic.
We can continue lockdown until everyone who has got it has recovered and is no longer infected. This is a matter of weeks and we are mostly there.
Once we get to no new cases per week for a couple of weeks then we can end the lockdown and get on with our lives.
To prevent reinfection then anyone that flies in gets quarantined unless they come from a plague free country. The same applies to other border crossings, e.g. ferries and roads.
This approach works with rabies in the UK and with other historical plagues. No widespread daily testing is needed this way just the health service testing we have now.
This approach is the only realistic option using what we can do now. However there is little talk of quarantine being used for those that fly. Quarantine means forty days.
No lines to spread the disease, and better throughput if you're testing many cars simultaneously rather than whoever is at the front of the line. (Although I suppose many people could be tested near the front of the line too.)
> Sounds like a logistical nightmare.
This is misunderstanding exactly the text you are quoting. The goal with epidemic management is NOT to seek out and destroy every last case of the disease.
All we need to do is reduce the spread rate so the exponent in the equation goes from above one to below one. At that point, the outbreak will shrink over time on its own. Critically, new/undetected outbreaks with an R0<1 won't get purchase and grow, because they can't.
At that point, the population is "safe". Individuals aren't, people might still get sick randomly. But this isn't a policy for individual safety per se.
The false positive rate of lockdowns is 100%.
you’re underestimating the pain that many americans are feeling after just a few weeks of (soft) lockdown. it’s not that people want to be unsafe, it’s that their livelihoods are in grave danger if the lockdowns last for months. many people are willing to take some risk now that the pandemic hasn’t turned out to be plague-levels of badness that some initially feared. few people are economically secure enough to say ‘no’ to opening back up sooner rather than later.
Without expressing an opinion of my own, how can you write as though from a twilight zone without causal relationships?
I mean, you, or anyone, can doubt that the lockdown is necessary. You might be right!
But you must acknowledge and challenge the causal connection between the lockdown and "not plague levels of badness". Comments that just ignore the possibility creep me out, because I can't imagine what the writer is thinking, except maybe "wishing will make it so".
If that were true lockdowns would make absolutely no difference in R0. Clearly, they do make a difference.
- A false positive means that a test shows someone is infected when they are not. For most tests that's somewhere between 0.1% and 2%.
- Lockdown means everyone stays at home. Different from PB's plan, where only people with a recent positive test stay home.
- R0 (technically Re) is the expected number of people each newly infected person spreads it to.
When I say a lockdown has a false positive rate of 100%, it means a lockdown is the same as if you tested everyone but the test always (100%) reported positive, so everyone had to stay home every day.
The point I am making is that some of the people who are on lockdown are truly positive for the virus. That’s why it works. They don’t have the opportunity to spread it outside their habitation unit.
They don't all have to get tested literally simultaneously; but the "release" part of the strategy can't start until the "test" part has covered everybody, or at least close enough to "everybody" that the difference doesn't matter. Note that that's how the strategy is stated in what you quote: if we can identify everyone who is contagious, then we can release everyone else. The "if" has to be complete before the "then" starts; that's what "if"-"then" means.
E.g. 'test and release' where only folks who've been tested are 'released' into the public. Track outbreaks and retest those cohorts thoroughly. And so on.
^or whatever the true number ends up being
I suspect relying on people to test themselves daily without mandating it would do a reasonable job, but I have no idea if it would be enough.
But during an outbreak, the ability to roll that kind of thing out, especially in workplaces with vulnerable populations (like senior care homes and hospitals) or necessarily close working conditions (like restaurant kitchens or some factories) could certainly be a game-changer. And that just seems entirely reasonable to me. There's a outbreak happening, so in order to enter [place where transmission would likely occur] you have to be tested first. If found to be infected, you must isolate. Otherwise, you'd be knowingly exposing others, which already isn't something considered acceptable.
So to me this simply looks like an effective use of existing powers in this situation. I'm not sure how it would slide down a slippery slope. The government decides to keep doing virus screening? I mean, I doubt they would incur the cost, but if they do, good! Maybe as Paul mentioned, we could significantly knock down cold and flu as well. If people are worried about infringing on the rights of people with viruses to live normally, I would ask what about the rights of others not to be infected by them? That besides the fact that if these measures are effective very few people will be getting sick in the first place.
When is the pandemic over? When does the pervasive testing stop? The argument can - and will - be made that "unless we keep testing until the end of the human race, you will all die tomorrow of a horrible virus-ridden death."
I don't particulary mind doing pervasive testing for awhile. I would desperately not want to live in a world where I could not feed my family unless I give into it.
When we stop seeing non-trivial numbers of test results. The idea that governments want to spend billions on mandatory virus testing outside every building until the end of the human race out of some Orwellian enjoyment of inconveniencing people is not supported by evidence. Even China isn't doing this.
Back in the real world, even the SARS vaccination research programmes, which cost relatively little and inconvenienced nobody, were shut down when SARS stopped circulating and the even keeping a few scientists employed as part of a pandemic task force looking out for the future was a step too far for the US govt.
Setting aside the science of disease, the concept of government agents performing a test to determine one's ability to conduct basic civil liberties (movement, work, basic speech etc) is antithetical to liberal democracy. Such things were not contemplated at the height of the AIDS panic, or SARs, or ebola. It would take something far worse than COVID-19 to implement such a regime in the western world. COVID is a threat to our way of life, to our economies. It isn't an existential threat to the state let alone the species.
Can you guarantee that a healthy person who gets this 3 times doesn't have a 100% fatality rate (i.e. it gets worse each time?)
Can you guarantee asymptomatic people don't become sterile? (Not saying they do, but if they did this would be an existential crisis and lead to our extinction after a generation).
Can you guarantee asymptomatic people still won't have lung damage permanently? (some asymptomatics athletic types have shown severe decline in lung abilities following covid19).
SARs was bad, but was wiped out so it's moot, AIDS is easier to avoid -don't have sex. ebola I think isn't as viral, and has been mostly contained, iirc they may have a vaccine launched or soon will and better treatments -- it's never gone full global like this.
Covid-19's problem is it's severe viralness and r0. It spreads and keeps on spreading, and there's a ton we don't know about how bad having had it will be to even those with minor cases. until we know for sure on all these factors, the more we can quell it the better.
Which is 100% normal for any pneumonia. I myself once had a bad lung infection (on my back for over a week). It took months before I could swim laps as fast as I did before. That's not anything special. Infections always have secondary medium-to-long term impacts.
ACE2 is in high concentration in the testes too, could this cause fertility issues? Sure it'd be good for the environment but a lot of couples really do want and enjoy their children or to have some someday.
It'd be nice to know as much as possible before we open the flood gates.
And now they are pretty much back to normal while much of the world is still at a standstill.
The sad thing is that basically nobody else did, among major players. Even other countries in the area (i.e. Japan and China) just went “phew!” after SARS and didn’t substantially review their response strategies. Which is how China was caught napping, Japan is still fundamentally in denial, and everyone else got their asses handed to them by covid19.
Napping is not the word for that.
Any data yet on what the sensitivity and specificity of this form of test for SARS-COV-2 will be? And, is work in characterizing all of that far enough along that we can expect to see emergency authorization by the FDA and scale up happening sooner rather than later?
1) Reagent supply:
The biggest problem with PCR tests and all seems to have been reagent shortages and supply chains dependent on manufacturers not able to scale. Assuming the test is approved, are there any operational advantages to this approach in terms of securing reagents to overcome that problem?
Thanks for the fascinating read!
1) great question. Our approach is novel which allows us to tap into new supply chains that are inherently more scalable (think semi-conductor Fab) but the trade off is execution risk.
This is one of the implementations we're actually developing. One of the challenges with the implementation of testing on this scale is not necessarily on the technology/assay but on implementation. How do you reasonably test millions of folks each and every day, or said another way actually get millions of nasal swabs, saliva, etc on 384 well plate?
I think our ultimate approach is much more akin, albeit with a bit more sensor voodoo magic, to a at home pregnancy test than 384-well plate qPCR tests at central labs.
“While saliva has shown promise for SARS-CoV-2 detection, very few studies have directly compared it to the current gold standard, nasopharyngeal (NP) swab. So, we compared NP and saliva samples from COVID-19 patients and self-collected samples from asymptomatic healthcare workers”
“COVID-19 patients: SARS-CoV-2 detection from saliva is comparable to (or better than!) NP swabs and more consistent over time ...”
“Plus, the detection of SARS-CoV-2 from the saliva of two asymptomatic healthcare workers (...and counting!) who tested negative from their NP swabs suggests that saliva could be a viable alternative for identifying mild or subclinical infections.”
I'm working with a team that has a test that detects proteins associated with covid. It works like a pregnancy test and does not need a special scanner. Would love to discuss further.
Is your protein test able to detect as soon as people become contagious? That's where a lot of ideas fail, but I think getting R0 < 1 likely requires it.
Maybe something like this is what set the stage for the common cold wiping out the aliens in War of the Worlds.
We don’t actually know that yet.
We could get real confidence that it's safe enough to return to normal, acceping that COVID is a new disease that's just going to be around, the 5th coronavirus that we deal with seasonally.
The screening in the article would cost billions of dollars.
If it worked, we could then reuse the infrastructure to kill the flu. And then start on the colds.
Sorry that's baseless histeria. We can easily think through how healthy people go back to normal (exponentially lower fatality rate than elderly/sick), while vulnerable take more precaution, how then getting to 60% of population gives us herd immunity which grinds R0 to a halt. Then a vaccine arrives in 18 months. Not to mention heat/humidity/summer is being shown to slow the disease from recent studies.
10000/(0.1 * (20 million)) = 0.005
Arithmetic to scale that to ~60% of the US:
0.005 * 0.6 * 330 million = 990000
Of course that is hugely sensitive to the assumptions about the overall infection rate in New York and the immunity factor, but like I said, the arithmetic on what you said leads to ~1 million early deaths.
Add in supposed summer slow down and before we get a vaccine the numbers could be 10x less
There are 12k cases in Singapore and 12 deaths because they almost exclusively tested foreign worker dormitories, healthy working people (and the 12 are all elderly).
All evidence so far is that a small fraction of people sick enough to be in the ICU end up with some sort of non-lung organ involvement. The vast majority (>99.98%) of young (<50 years), healthy people don't end up in the hospital at all, let alone the ICU.
If this is the best you can do, you're grasping at straws.
In the show the disease is used as a classist thing or something. Anyways, its bacterial not viral, and they discover than antibiotics were never discovered so the Professor scrapes some fungus off some trash and takes it and is cured.
Love the Sliders reference. I might stream that all weekend.
B) Testing for O2 levels using already cheap + widely available pulse oximeters is probably an insufficient but necessary measure.
Does this approach bypass the reagent shortages ?
What are the specificity / sensitivity metrics ?
We've just begun our clinical testing so don't have specificity/sensitivity metrics yet, but will be sharing them when they're available.
Sorry for being cynical -- I just feel suspicious of this particular tired mindset to addressing complex public health and social issues, ones that intersect with (and aggravate) many other pre-existing social dilemmas. There are a thousand other ways to look at this that don't involve a small cornered market, I just doubt the entrepreneurial mind knows how to parse for it on its own. When you have a hammer...
Wake me up when someone's talking about this sort of thing amongst members of a consortium building open patents, not from some guy with plain-as-day zero-to-one ambitions. I'll root for someone who sees the interlocking opportunities, not someone who speaks about personal aspirations to "wipe out COVID-19" in 2020
Frankly, I don’t understand how this test is supposed to work, and I’ve used a Biacore! It might be helpful to have a technical explanation available, for domain experts to evaluate.
edit: this is all I found about the company:
This is dangerously wrong.
If you reduce R0 below 1, you may stop community spread. You will not eradicate it however, unless this is done globally for a prolonged period of time with no error. This cannot be done with the proposed solution.
We can (probably) stop this from hurting the vulnerable population while we find a long term solution like an inoculation, but we cannot just skip that and call everything good after some period of low / no new cases in a region.
There will always be animal reservoirs of this.
For that reason, and those you outlined, we could achieve the flawless techno-totalitarian state that so many well-intentioned citizens are practically begging for, and we would still be screwed.
The only stable long-term solution is widespread exposure; ie how humanity has dealt with pretty much every other global pandemic we’ve been encountered with.
Thus why those who are trying to demonize the concept of “herd immunity” and make it a dirty word are playing a very dangerous game.
This means herd immunity kicks in at 82% of the population.
Antibody testing appears to be showing infection rates are a lot higher than previously thought as well.
Both of those things together mean that 1) "there's no way to stop it" 2) "it might not be as dangerous as we thought".
But who knows, right? There's a ton of science that needs to be done to find out what's really going on. Large-scale, accurate, randomized testing will hopefully fill out the data picture.
Because the US has an awful medical system where access to care comes through your job, it seems to me that more people will die (from non-virus causes) than from the economic damage than from the virus itself.
I guess we'll know more in a few years.
Pet peeve of mine: R0 is not a property of a virus; it's a property of a virus in a certain environment. 5.7 is the estimate for covid-19 in Wuhan, a dense environment. It is nowhere close to that in the vast majority of the United States -- estimates are <3 in say Seattle or Norcal.
> Antibody testing appears to be showing infection rates are a lot higher than previously thought as well.
> 2) "it might not be as dangerous as we thought".
The more reliable ones are about what we did think on both points, at least for those who rely on Imperial College's models (https://www.thelancet.com/journals/laninf/article/PIIS1473-3...)
> "there's no way to stop it"
Contact tracing is enough to keep r < 1. If we keep this thing at under 20 cases/million/day for the next few years until there's a vaccine, I think we can go about our lives.
in certain urban cores. herd immunity requires well mixed populations