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Frequent, rapid testing could turn national Covid-19 tide within weeks (colorado.edu)
39 points by chewdatgenie 1 day ago | hide | past | favorite | 56 comments

Wasn't this the White House strategy? They were doing daily rapid antigen tests, and have had several outbreaks.

It seems that even extremely frequent testing isn’t enough to prevent outbreaks without any other precautions. False negatives are too common.

The problem with testing is that a negative test today does not prevent you from catching the virus tomorrow. All you have to do is be in contact with someone who has it.

So you can't just test. You also need to avoid contact with other people, unless they have also tested negative. The White House clearly was not doing that. Even if they had, the tests are not totally reliable.

Given the number of people who come and go from the White House on a regular basis, it's kind of a surprise they didn't have an outbreak earlier than they did.

They also haven’t been following basic safety protocols. Further, we learnt when Trump had COVID that they were actually not even testing Trump on a regular basis. That’s probably also true of other members of the administration.


Whether you want to blame the CCP, WHO or the White House, the reality is that corona is highly contagious and everybody will get it, mask or not.

It was the job of the CDC to create a vaccine after SARS-1 in 2002/2003, and they failed to either fund or develop one.

There is very little any politician can do once a virus is endemic, as it is in the US, especially with 50 states.

As an example that's comparable to the US situation overall, Toronto did everything right including testing from Day One, yet they've reported 100,000 cases and are doing a hard lockdown:


This has been obvious for months -- Romer has been yelling from the rooftops about it -- and yet no major western govt save the Brits have attempted to even try this strategy. Madness.

> and yet no major western govt save the Brits have attempted to even try this strategy.

The per-capita death rate in the UK is one of the worst in the world for this pandemic, and it's higher than the USA's. And they are now into a second lockdown. Whatever their strategy is, it's not working well at all.

Because the more effective and proven strategy is to simply pay businesses and people to lockdown.

It has been effectively eliminated in both Australia and NZ this way. And the impact to the economy is significant but it's turning out to be far less severe than the rest of the world and their on/off again strategy.

> simply pay businesses and people to lockdown

This is anything but simple. Vast majority of businesses and people will not be supported if indefinite lockdown continues. The hidden costs of bankrolling an entire country for an indefinite period is much greater than the cost to deploy a persistent, scalable testing framework. The latter is also an investment into the future as this will not be the last pandemic.

No. It's very simple. You just keep paying people until the lockdown is over.

Again this isn't some hypothetical exercise. Australia and NZ have just done this and now have basically eliminated COVID-19.

As opposed to manufacturing and distributing 100s of millions of tests each week which is very much an unproven exercise.

I'll believe it is simple when you specify how much money is needed and where it comes from to do that.

In the US you just need to look at the COVID-19 bills that are tied up in Congress for an idea of the money needed i.e. ~ 2-5 trillion.

And you can fund it exactly the same way you did for the GFC (print money) or WW2 (war bonds).

But compare it to the cost of the US bouncing in/out of lockdowns for the next 9-12 months.

Sounds like a terrible idea.

Australia and NZ are not America. This is the same mistake Elon made when he suggested the US would have 0 new cases by this past April; the US is not China. The differences are actually so big that comparisons are dangerously misleading.

The problem in the US is that you cant pay people enough to change their minds about the politics. They would be, and many in fact are, millionaires and they would still refuse the test. Even if it meant jail time.

These solutions simply don't work in America.

> entire country for an indefinite period

it's not indefinite - it's just long enough to cut down unknown transmission to a managable number for contact tracing to kick in. Then public health measures like masking up and distancing is effective enough afterwards.

Businesses cannot stand uncertainty - a on-off lockdown that they cannot predict is the worst, because they cannot make investment decisions with this sort of huge uncertainty.

China moved on from lockdowns over 6 months ago. They switched to citywide testing with 5:1 and then 10:1 pooled PCR tests in May and then recently switched to pooled rapid antigen testing. With the current testing methodology, they place one sample on a test strip, wait to see if there's a color change, and if not, they'll put a subsequent sample on. You can use a single antigen test for up to 10 people and patients get their results while at the testing site.

You can't really compare two sparsely populated islands at the "end" of the Earth to the US or Europe.

The density of cities in australia and NZ are somewhat similar to european cities. The sparseness of Aus and NS are because their population is concentrated in cities, and there are large land masses.

If the US or UK wants to, they can certainly make the same sort of lockdown. There are costs to it, but the leadership being incompetent at actually leading, is a bigger roadblock over the cost.

The US could never do it because the federal government does not have that authority. They have lacked leadership, but they were also uniquely positioned for a world of hurt going into this.

The UK is doing about as well as similarly populous countries nearby. Which is to say, not well at all.

UK has a population of 60 million. Australia is 25 million. Both are a set of islands.

Not exactly an order of magnitude difference in population but yet there is a massive difference in the strategies and polices they've deployed. And now UK is a complete mess heading into winter and Australia has effective elimination.

> And now UK is a complete mess heading into winter and Australia has effective elimination.

Of course it might help that Australia is actually heading into summer.

And it has been eliminated before the summer months.

Also in many places in Australia it was eliminated well before winter.

I am in the part of Australia that didn't eliminate it well before winter. But with 112 days of lock-down _during_ winter we certainly had the numbers come down dramatically and have had twenty-three days so far of no new infections or deaths.

From tomorrow we no longer have to wear masks outside unless it gets crowded such that you cannot maintain physical distancing!

The UK is also next to Europe and a travel and business hub for the world. Australia is next to nothing important and has far less travel to and from the rest of the world.

I think the US gov't is too mired down in ... well, problems ... to do anything this pragmatic, efficient and effective.

Cornell is testing ~everyone once a week. After an initial small flurry of cases, they've picked off 1-2 cases a day before they have a chance to enter the broader populace.


Their case-positivity rate is ~100x lower than many places in the United States.

I go to a university where we're doing something similar - weekly testing for everyone at minimum, 2x per week if you're high risk or live in a dorm with a communal bathroom. For the most part, we've been doing well, but recently we've had a small surge (~100 students in quarantine, about 4-10 cases per day, with about 4000 undergrads, only part of which are on campus at the moment).

We're in a much more suburban area than Ithaca, so that probably plays a factor.

The problem with testing once a week is there are four more days you can be positive on.

Also, by the time you get your test results, you have been positive and spreading.

I get tested on Monday mornings, got a call Thursday night telling me not to come in on Friday. What good did that do?

In most of the US, you'd just keep going to work until you felt sick, because you never got tested. If you were asymptomatic, you'd keep right on going to work.

One need not catch every case in order to make the epidemic burn out. One needs to reduce the number of transmissions/case below one. As we begin to win, contact-tracing becomes increasingly effective. When multiple-contact tracers can focus on a single known case, it is possible to really dig in and track cases effectively.

It does a lot of good. Every little intervention really helps, even if it's seems far from perfect.

It's because the system as a whole is balanced on a critical threshold. It's like water boils at 101°C and condenses at 99°C.

The point is to reduce R below 1. When R > 1 the disease gets almost everywhere eventually. When R < 1 the disease fades away and most people don't get infected.

Currently R is above 1, but it's not a lot above 1. (We're lucky. There are other diseases where it's much higher.)

So even if you have been spreading on those 4 days, you are not spreading from days 5 onwards. That might be 10 days less spreading.

You are not giving it to large numbers of people in those 4 days either. As a spreader, you're adding risk to others, but only 1 or 2 will get it directly from you probably.

When you isolate on day 5, that's a reduction in the amount of spreading and it reduces R. When your traces also isolate from your day 5, that's a further reduction in the amount of spreading and R. That's recursive, if their traces also isolate, it's a further reduction, etc.

Altogether, if everyone follows these changes, there's a reasonable prospect of R falling below 1 enough for the disease to fade out. Because it's close enough to 1 already, that behaviour can make a significant difference.

In practice people do not comply, and they lie sometimes (https://www.bbc.co.uk/news/world-australia-55011790). So R does not fall as effectively as it would if there was high compliance. But every bit of compliance helps reduce R.

When R is consistently < 1 due to social changes, regular testing and behaviour changes in response (even with days of delay), tracing, social distancing and masks and workplace changes and commute changes, etc. then we will find the disease fades away.

It looks unlikely this will happen until we have widespread vaccination in some countries (USA is one of the leading examples), but the more we reduce R meanwhile, the fewer people will die or get long covid in the end. And fewer here means in the millions.

Agreed, but what good did it do? It prevented you from further spreading the virus more than if you had not got the call.

Every bit helps. Perfection is the enemy of good. Rather test weekly than never. Rather test daily than weekly. Why not hourly or every 15 minutes though? Have to have a balance somewhere.

What good does it do to get a test and have results 2 hours later, if you spread the virus in that 2 hours? Better than spreading it for 2 weeks! But it still allows for it to spread. Something is way better than nothing.

It won't turn the tide, because there is a huge population in the US which, as an expression of political identity, will refuse to get tested — or wear masks or take any other precautions for that matter.

This group will keep the virus alive no matter what, endangering not only themselves, but the rest of us.

ETA: Many downvotes, many upvotes. Downvoters: I would love to hear from you what you find objectionable.

These tests have a very high false negative rate. Before a test you have about a 13% chance of having covid. After a negative test it's about 11%. It doesn't seem plausible that's enough to make a big difference.

I would love for this whole thing to end as much as anyone, but I don't see how this gets anything back to normal.

In January of this year, there were a negligible amount of people in the US with Covid. Let's say now in November everyone gets tested every day, and you have an unbelievable compliance for self quarantining on positive results. It would never happen, but pretend it's 99.9% of people following the rules to "drive the virus towards elimination within weeks". Great, now you think you've beaten it back to where it came from.

How does this do anything other than reset the clock back to last January just in time for next January? As soon as everyone lowers their guard and goes back to normal, it's going to spread again. We need immunity from a vaccine or from it running its course to be done with this.

What am I missing? Are we going to setup nationwide contact tracing this time? Just a few visitors from other countries, and we're at it again.

Agree this won't get everything back to normal but think of it as an equivalent of "defence-in-depth" of info sec.

Rapid testing and isolating (I doubt the US could "enforce" it but you have to give the benefit of doubt that a percentage of people do care for others and will isolate - FWIW, I've seen this happen in Oz where a large %-age of people did isolate) will reduce/delay the infection surge and give time for the healthcare system to recover from the second shock this year. In addition, with the EUAs in flight by Jan '21 (hopefully), this one-two punch should drastically cut both infections and deaths. Remember, in the world of exponentials, both increase and decrease are exponential.

> Just a few visitors from other countries, and we're at it again

So just do what we do in Australia and quarantine them in hotels.

If you manage it properly it can be highly effective.

Australia's borders are oceans. It's a different thing altogether.


> americans start throwing hissy fits

well there's your problem. People are unwilling to make the least bit of self-sacrifice for a common cause.

And it's not even that big of a sacrifice - it's just staying in a hotel for 2 weeks, and not leaving! I'm like WTF why is it such a big deal?

"How does this do anything other than reset the clock back to last January just in time for next January?"

First, that alone would be HUGE progress.

"As soon as everyone lowers their guard and goes back to normal, it's going to spread again."

Yeah, but this time you're not going to have whining, tantrum-throwing, conspiracy-mongering, megalomaniacal, science-denying children in charge.

We've yet to see if they wind up being more competent and actually make a difference, but the chance to do proper contact tracing on the relatively few people that get infected will be there, and hopefully the country will take it more seriously the second time around.

I'm not hugely optimistic, but if they actually followed through and were competent in dealing with it this time, it could save millions of lives.

And then what? We're going to impose 2 week quarantines on every flight into the US? Have a dedicated branch of the CDC perform contact tracing on everyone who crosses the borders?

I think you greatly overestimate how politics plays into this. It never ends until we're immune.


You just keep testing people, and do isolation and contact tracing on the ones that get sick.

In the meantime, vaccines will start to roll out.

Curbing this pandemic is perfectly practical and within reach, given the will to do it.

This is my problem with most every success story so far. For how quickly this spreads where it spreads, and that it is a corona virus, I'm not seeing any panacea here.

I say this as someone that is fine complying with my states restrictions. I even think they are correct, if only as something to try. I'm just not seeing the end game here. :(

You need to get positives down to zero for two weeks before you declare success. Daily testing, with quarantine of any positives and then contact tracing two levels (everyone you contacted and then their contacts could get to zero quickly. But the quarantine step is required for every one to pull that off.

Of course this works out easy in a post. Good luck implementing it in real life. People violate quarantine if they can.

No, that's exactly my point. Even if it went according to your best possible plan, all you do is reset it back to Jan 2019.

Or did you mean we're all going to do daily testing and contact tracing forever?

I mean daily testing until we have two weeks of zero cases. Worldwide (or mandatory two weeks isolated quarantine at customs). This is what new Zealand did, so it is possible, but it is logically very hard for anyone not an isolated island.

Worldwide with quarantines from customs is virtually impossible. Customs can't stop human or cocaine trafficking from making it into the country, much less undocumented immigration. All you need is a half dozen sick people who are trying to hide from the authorities, and you're back to square one. Most countries are not islands.

Like I said, logistically impossible, but it would work.

> or from it running its course to be done with this.

A nitpick, but it deals with a pervasive idea that should be updated.

The virus will most likely never "run its course" to give us collective immunity without technological intervention.

That's because herd immunity is only known to have ever occurred as a result of deliberate vaccination, and even then it disappears in areas where vaccination stops. It has never been observed to occur naturally as a result of infection.

In other words, the "natural herd immunity solution" is simply not something most of the scientific community believes to be an option right now. Instead the prevailing theory is that if we let it "run its course" it would in fact continue circulating endlessly, gradually mutating.

Epidemiologists do perform calculations to estimate how natural herd immunity might arise, but it has never yet been observed to actually happen, and the calculations are intrinsically rather unreliable.

From "The false promise of herd immunity for COVID-19" (21st October 2020, https://www.nature.com/articles/d41586-020-02948-4):

> never before have we reached herd immunity via natural infection

Also maybe relevant, if herd immunity could occur naturally, then the calculations done around it lead to:

> proposals to largely let the virus run its course [...] could bring “untold death and suffering”

This is interesting, and I hadn't heard this about herd immunity before. However, I kind of imagine that at some point in history a lot of our ancestors died from things we don't even think of as more than nuisances now.

What you're missing is that a rapid test like this can be used as an entry check at restaurants and other public venues, allowing them to go back into business. Even if the vaccines turn out not to work for some reason, we can have our economy back, while limiting spread of the virus. It's not so much about getting people to fully self-quarantine, although that would be nice, as about eliminating super-spreader events.

I didn't see the turn around time in the article. Just something about "less sensitive test with results today".

I think it's optimistic to assume this could be used as an entry check for a restaurant.

I have read elsewhere about researchers at least trying to develop 15-minute tests. Not sure what the status of their work is, but some think it's possible -- and they're specifically targeting entry checks.

Well, that'd be fast enough for some venues. I'm still skeptical it'd work in practice.

At this point there are

There are over 6 vaccines that have very low expected downside (vaccines rarely have severe side effects and these have none found in thousands of tests)and are all expected to work (>90%). They are all currently banned (people who want them can't buy them legally), and the FDA is refusing to even discuss lifting the ban for 3 weeks. It seems odd to discuss anything other solution than letting people who want to take vaccines, take them.

Literally if the vaccines were known to have side effects 10x worse than the worst side effects in history, it would still be orders of magnitude safer to give to those over 65 than not. https://www.cdc.gov/vaccinesafety/concerns/concerns-history....

Banned? Perhaps you are under the impression that the data has been reviewed by the FDA?

IIRC, the EUA analysis is in flight (for a December timeframe) and that is to ascertain that the data is up to the mark and not to take what the companies have announced at face-value.

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