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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

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.

missosoup 7y ago
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.
- deweller 7y ago
  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.
  - missosoup 7y ago
    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.
    - creaghpatr 7y ago
      I'm pretty sure the criteria has since changed, the story was talking about a request from Feb 19.
      - nilsbunger 7y ago
        You would think so, but they haven’t yet! https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-crite...
- gnulinux 7y ago
  > 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.
  - missosoup 7y ago
    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.
    - alttab 7y ago
      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.
      - SpicyLemonZest 7y ago
        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.
- jbay808 7y ago
  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?
Leary 7y ago
Why is their capacity in the hundreds and not in the thousands
- mattkrause 7y ago
  "I'm a businessperson, I don't like having thousands of people around when you don't need them," Trump said.
jboggan 7y ago
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.
giarc 7y ago
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.
- PeterisP 7y ago
  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.
  - giarc 7y ago
    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.
pmoriarty 7y ago
Why is the CDC only managing to do orders of magnitude less testing than South Korea? Also, let's remember that Trump recently tried to get the CDC's budget cut nearly in half. Think about this for a second. The US has not been taking this outbreak nearly seriously enough.
davidw 7y ago
Italy has managed to do an order of magnitude more tests than the US, which may be part of the reason there are so many cases recorded there. A number of non-political positions haven't been filled in teams that should have been handling the response in the US: https://www.nbcnews.com/health/health-news/trump-cuts-national-security-staff-may-hurt-coronavirus-response-say-n1143656 https://www.nbcnews.com/health/health-news/trump-cuts-nation... And the CDC has been having problems with tests: https://www.washingtonpost.com/health/2020/02/25/cdc-coronavirus-test/ https://www.washingtonpost.com/health/2020/02/25/cdc-coronav...
- makomk 7y ago
  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.
  - pmoriarty 7y ago
    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!
    - davidw 7y ago
      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. https://en.wikipedia.org/wiki/V%C3%B2 https://en.wikipedia.org/wiki/V%C3%B2
- notabee 7y ago
  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. 1. https://www.youtube.com/watch?v=xQwfuJgJ9lo https://www.youtube.com/watch?v=xQwfuJgJ9lo
gdubs 7y ago
I would think “when it makes sense” would be before transmission of unknown origin, not after. What people are looking for is an explanation as to why other countries are testing more vigorously, and the CDC so far has not. Why not start random sampling among flu-like cases two weeks ago? Start in areas of high risk, move the circle out slowly.

missosoup 7y ago

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.

deweller 7y ago
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.
- missosoup 7y ago
  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.
  - creaghpatr 7y ago
    I'm pretty sure the criteria has since changed, the story was talking about a request from Feb 19.
    - nilsbunger 7y ago
      You would think so, but they haven’t yet! https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-crite...
gnulinux 7y ago
> 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.
- missosoup 7y ago
  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.
  - alttab 7y ago
    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.
    - SpicyLemonZest 7y ago
      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.
jbay808 7y ago
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?

Leary 7y ago

Why is their capacity in the hundreds and not in the thousands

mattkrause 7y ago
"I'm a businessperson, I don't like having thousands of people around when you don't need them," Trump said.

jboggan 7y ago

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.

giarc 7y ago

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.

PeterisP 7y ago
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.
- giarc 7y ago
  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.

pmoriarty 7y ago

Why is the CDC only managing to do orders of magnitude less testing than South Korea? Also, let's remember that Trump recently tried to get the CDC's budget cut nearly in half. Think about this for a second. The US has not been taking this outbreak nearly seriously enough.

davidw 7y ago

Italy has managed to do an order of magnitude more tests than the US, which may be part of the reason there are so many cases recorded there. A number of non-political positions haven't been filled in teams that should have been handling the response in the US: https://www.nbcnews.com/health/health-news/trump-cuts-national-security-staff-may-hurt-coronavirus-response-say-n1143656 https://www.nbcnews.com/health/health-news/trump-cuts-nation... And the CDC has been having problems with tests: https://www.washingtonpost.com/health/2020/02/25/cdc-coronavirus-test/ https://www.washingtonpost.com/health/2020/02/25/cdc-coronav...

makomk 7y ago
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.
- pmoriarty 7y ago
  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!
  - davidw 7y ago
    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. https://en.wikipedia.org/wiki/V%C3%B2 https://en.wikipedia.org/wiki/V%C3%B2
notabee 7y ago
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. 1. https://www.youtube.com/watch?v=xQwfuJgJ9lo https://www.youtube.com/watch?v=xQwfuJgJ9lo

gdubs 7y ago

I would think “when it makes sense” would be before transmission of unknown origin, not after. What people are looking for is an explanation as to why other countries are testing more vigorously, and the CDC so far has not. Why not start random sampling among flu-like cases two weeks ago? Start in areas of high risk, move the circle out slowly.