11 ms·

Is there any particular reason the US is testing so few people? They've only tested 445 people in the entire country so far[0], which is a tiny number for such

by m-i-l 7y ago

Is there any particular reason the US is testing so few people? They've only tested 445 people in the entire country so far[0], which is a tiny number for such a large country (contrast e.g. with the much smaller UK which has tested 7,690 people[1])? Wasn't that one of the lessons from Italy - the numbers of confirmed cases seemed to shoot up from 21 Feb mainly because that's when they started testing. [0] https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html [1] https://www.gov.uk/guidance/coronavirus-covid-19-information-for-the-public https://www.gov.uk/guidance/coronavirus-covid-19-information...

alttab 7y ago
There's no reason to test if there aren't any confirmed cases. You can't confirm a case unless you test... And thus, how we find it now is bursting clusters with illnesses that can't be hidden by "flu." By then it's too late. Seems like the only way to contain it is do blanket nationwide testing every day and quickly contain anyone who tests positive, for like 6 months.
- claudeganon 7y ago
  This isn’t true. Containing the spread through mass testing would allow us to more appropriately measure the response and direct resources accordingly. Every epidemiologist I’ve read says the lack of testing is a very concerning in terms of our ability to address and respond to the pandemic.
- ryanmercer 7y ago
  >There's no reason to test if there aren't any confirmed cases. There's no reason to test when there isn't a high confidence that the person has the virus. Especially when the test costs something north of $3,000 and even with good insurance only a fraction of it is being paid for based on numerous Reddit threads and a news article [0] puts a specific patient's bill at: >$3,270 two weeks after his test. He will be responsible for $1,400 of that bill. A Forbes article [1] two weeks ago even states: >The cost of testing include the costs of test kits, labor, and sample processing. In some cases, storage and delivery costs would need to be added. It’s unclear what the costs of the test kits are, or ancillary items, as CDC and others haven’t revealed figures. For the sake of argument, let’s say that on the low end of the scale each test, including ancillary items such as labor and sample processing, costs $250, and at the high end it’s $1,500. [0] - https://www.independent.co.uk/news/world/americas/coronavirus-test-medical-bill-china-us-miami-osmel-martinez-azcue-a9358146.html?amp&utm_source=reddit.com https://www.independent.co.uk/news/world/americas/coronaviru... [1] - https://www.forbes.com/sites/joshuacohen/2020/02/12/testing-for-covid-19-in-all-patients-with-unexplained-pneumonia-is-probably-not-cost-effective/#6dae42895c33 https://www.forbes.com/sites/joshuacohen/2020/02/12/testing-...
  - pmoriarty 7y ago
    You have to balance that cost against the cost of not containing this outbreak, which is likely to be far, far more than that, not just in money but in lives. It's also critically important to act quickly, as it's at the early stages when this outbreak has a chance to be stopped. If we keep waiting until it's obvious that there's a large outbreak in the US it may be way too late. You don't have to test everyone in the US, or even anyone who has a cough, but everyone with severe symptoms of the disease should have been tested, regardless of whether they've recently been to China or had contacts with people who had.
  - dTal 7y ago
    Never a more frightening instance of "penny wise, pound foolish". "Oh heavens no, we can't afford to preventatively test for a virulent new lethal pathogen that has already brought one of the world's largest economies to a total standstill - it costs literally dozens of dollars!"
    - londons_explore 7y ago
      The patient who pays for the test gains nothing from the results. The country gains from the results, but isn't offering to pay. If I had been to China and got ill when returning to the US, I would not be getting tested - the test wouldn't help my chance of survival, and would just cost me money and time.
      - DanBC 7y ago
        > The patient who pays for the test gains nothing from the results. The patient who is tested negative gets their life back, and can stop self isolating immediately. The self isolation protocol is pretty intense. https://www.gov.uk/government/publications/wuhan-novel-coronavirus-self-isolation-for-patients-undergoing-testing/advice-sheet-home-isolation https://www.gov.uk/government/publications/wuhan-novel-coron...
- Bombthecat 7y ago
  That's why it will keep spreading... Dammed is you do, Dammed if you don't..
  - deleted 7y ago
    [deleted]
claudeganon 7y ago
We messed up a bunch of the first ones and we don’t really have centralized capacity to manufacture the tests at scale because of our privatized, outsourced healthcare system, we’re being prevented from using overseas ones (the senator from Hawaii is publicly begging Japan for tests), the CDC and other responsible agencies are in disarray from GOP gutting and malfeasance. Take your pick.
devinhelton 7y ago
The test-kit that the CDC sent to local labs had a faulty reagent, so all test requests have to be sent back to the CDC.[0] Local labs could develop or purchase their own test kits, but during an a public health emergency, they must get FDA authorization before launching such a test.[1] This seems to me like a giant institutional and bureaucratic screw up. Hopefully the FDA may be finally getting its act together and fast-tracking approval of local tests: https://twitter.com/ScottGottliebMD/status/1233021681918193664 https://twitter.com/ScottGottliebMD/status/12330216819181936... [0] https://www.politico.com/news/2020/02/20/cdc-coronavirus-116529 https://www.politico.com/news/2020/02/20/cdc-coronavirus-116... [1] https://threadreaderapp.com/thread/1231944326827081729.html https://threadreaderapp.com/thread/1231944326827081729.html
- Reelin 7y ago
  In all seriousness, why should a non-invasive diagnostic test require any sort of approval (particularly during an outbreak)? This is just RT-PCR if I understand correctly - there's nothing particularly novel going on here. Just publish the primer sequences and let the biotech industry handle things. Edit: Oh hey they did publish an RT-PCR protocol [1] plus sequences, [2] along with a disclaimer not to use them directly on human subjects. This is just silly (IMO). > These procedures and/or reagents derived thereof are intended to be used for the purposes of respiratory virus surveillance and research. The procedures and reagents derived thereof may not be used directly in human subjects. [1] https://www.cdc.gov/coronavirus/2019-ncov/lab/rt-pcr-detection-instructions.html https://www.cdc.gov/coronavirus/2019-ncov/lab/rt-pcr-detecti... [2] https://www.cdc.gov/coronavirus/2019-ncov/lab/rt-pcr-panel-primer-probes.html https://www.cdc.gov/coronavirus/2019-ncov/lab/rt-pcr-panel-p...
  - orblivion 7y ago
    Maybe false negatives or even false positives could be a liability issue?
    - claudeganon 7y ago
      From reports, the Chinese tests have fairly high false negatives, but they’re still deploying them en masse because catching as much as is possible better than not catching anything at all. I’ve seen nothing on false positives.
gojomo 7y ago
There's a bureaucratic 'Catch-22' in each regulatory agency's rules for allowing emergency testing, & apparently no one willing to exercise the authority to break the logjam. See for example the unwound details in this thread (which is reporting roughly the same things as Dr. Gottlieb, just without the diplomatic mollycoddling of his former agency): https://twitter.com/random_eddie/status/1232075474966368256 https://twitter.com/random_eddie/status/1232075474966368256
epmaybe 7y ago
A counterpoint - testing like this takes resources, and creates a backlog for other more pressing tests for patients. I mentioned this in another comment, but if I have a patient with pneumonia, I'm more than likely going to treat it the same way regardless of what the test shows me. Getting samples from everyone takes resources that lots of hospitals don't really have. Maybe you could get a backlog going that can test for COVID-19, when the lab's RT-PCR machines are underutilized, even after the patient leaves, so that we can get as much data as we can.
- jerry1979 7y ago
  How do we know that testing for Coronavirus creates a backlog? I don't have enough information to say how the system works, but I imagine a nurse takes an additional blood test, and then someone sends that test to the CDC. The CDC tests the blood, and sends a response to the hospital. I am curious to know more about the actual process.
  - dillonmckay 7y ago
    I believe a test takes 6 hours, there is already a several day backlog, and the samples are sent via FedEx.
    - jerry1979 7y ago
      Would you happen to know it that takes 6 hours on the CDC's side or 6 hours in the doctor's office?
- gnulinux 7y ago
  But wouldn't you need to isolate pneumonia patient if they confirmed to have COVID-19? Also, curious, would you be more inclined to use some of the medicine that other countries claimed to be effective against COVID-19? Like Remdesivir and chloroquine?
  - pmoriarty 7y ago
    In addition, at least until the outbreak becomes an uncontrolled epidemic in the US, you'd want to trace the contacts of any person confirmed to be infected with COVID-19 in order to try to try to stop the spread of the disease.
MiguelVieira 7y ago
The latest word from the CDC is that they’ve run 3,625 tests and that the testing capacity should double soon.
- makomk 7y ago
  Yeah, I think the actual answer is that the number of tests on that page is not even remotely up to date, and the CDC has more important issues on its plate than updating it. As I understand it the UK testing criteria are very similar to the CDC's and also require travel to an affected country or contact with a confirmed case: https://www.gov.uk/government/publications/wuhan-novel-coronavirus-initial-investigation-of-possible-cases/investigation-and-initial-clinical-management-of-possible-cases-of-wuhan-novel-coronavirus-wn-cov-infection https://www.gov.uk/government/publications/wuhan-novel-coron... The government here is just starting to roll out more general testing of the population to selected cities, but so is the CDC over in the US, and in both cases it's intended more to detect widespread spreading than to catch every individual case.
  - avindroth 7y ago
    Why would it not be in CDC's interest to update the number of tests?
    - makomk 7y ago
      It's just probably not the most important thing to keep it continously updated on their website. The actual numbers aren't a secret or anything; there's a more up-to-date figure in the MMWR report on their website a couple of days ago, as well as the one just announced. (Though the MMWR figure only counts CDC tests, and apparently other laboratories have finally started carrying out their own tests in the US, including I believe some in California. That means there's probably not a single definite, up-to-date total for the number of tests anymore.)
btilly 7y ago
Yes. The tests are sufficiently unreliable that if there is no specific reason to believe that a particular person has been exposed, the results are just noise. See https://towardsdatascience.com/statistics-and-unreliable-tests-coronavirus-is-difficult-to-contain-e113b5c0967c https://towardsdatascience.com/statistics-and-unreliable-tes... for an analysis using Bayesian statistics that demonstrates why you would pre-filter who you give the test to, and why you shouldn't necessarily trust the test results after. Please remember that public health organizations have over 150 years of experience with how to make the most effective use of existing resources to limit health challenges. This is a complicated optimization problem and the people doing it aren't stupid. It is better to ask why they do what they do than to assume that what they are doing makes no sense.
- xorfish 7y ago
  The problem in such cases is the prior. If a false positive is 10%, 1%, 0.1% or 0.01% makes a huge difference. With 0.01% and two different tests, you will get a false positive in every 100'000'000 tests. Testing twice solves many of the issues. It also gives information about the sensitivity and specificity of a test.
  - wahern 7y ago
    > With 0.01% and two different tests, you will get a false positive in every 100'000'000 tests. That doesn't sound right to me (i.e. only the case if false positive distributions are independent and uncorrelated, which seems unlikely), but I don't know enough about statistics and epidemiology to dispute it.
wonderwonder 7y ago
If tested I have to assume the patient will be charged for it, which depending on their insurance could easily be a cost of thousands of dollars if they are in a hospital or ER. We are going to experience a situation where sick people don't get tested and continue to infect others because health care is too expensive. The cost of health care is very much going to exacerbate this situation. Administration officials just refused to commit to making a tax payer funded vaccine affordable. This is what end game capitalism in health care looks like.

by m-i-l 7y ago

alttab 7y ago

There's no reason to test if there aren't any confirmed cases. You can't confirm a case unless you test... And thus, how we find it now is bursting clusters with illnesses that can't be hidden by "flu." By then it's too late. Seems like the only way to contain it is do blanket nationwide testing every day and quickly contain anyone who tests positive, for like 6 months.

claudeganon 7y ago
This isn’t true. Containing the spread through mass testing would allow us to more appropriately measure the response and direct resources accordingly. Every epidemiologist I’ve read says the lack of testing is a very concerning in terms of our ability to address and respond to the pandemic.
ryanmercer 7y ago
>There's no reason to test if there aren't any confirmed cases. There's no reason to test when there isn't a high confidence that the person has the virus. Especially when the test costs something north of $3,000 and even with good insurance only a fraction of it is being paid for based on numerous Reddit threads and a news article [0] puts a specific patient's bill at: >$3,270 two weeks after his test. He will be responsible for $1,400 of that bill. A Forbes article [1] two weeks ago even states: >The cost of testing include the costs of test kits, labor, and sample processing. In some cases, storage and delivery costs would need to be added. It’s unclear what the costs of the test kits are, or ancillary items, as CDC and others haven’t revealed figures. For the sake of argument, let’s say that on the low end of the scale each test, including ancillary items such as labor and sample processing, costs $250, and at the high end it’s $1,500. [0] - https://www.independent.co.uk/news/world/americas/coronavirus-test-medical-bill-china-us-miami-osmel-martinez-azcue-a9358146.html?amp&utm_source=reddit.com https://www.independent.co.uk/news/world/americas/coronaviru... [1] - https://www.forbes.com/sites/joshuacohen/2020/02/12/testing-for-covid-19-in-all-patients-with-unexplained-pneumonia-is-probably-not-cost-effective/#6dae42895c33 https://www.forbes.com/sites/joshuacohen/2020/02/12/testing-...
- pmoriarty 7y ago
  You have to balance that cost against the cost of not containing this outbreak, which is likely to be far, far more than that, not just in money but in lives. It's also critically important to act quickly, as it's at the early stages when this outbreak has a chance to be stopped. If we keep waiting until it's obvious that there's a large outbreak in the US it may be way too late. You don't have to test everyone in the US, or even anyone who has a cough, but everyone with severe symptoms of the disease should have been tested, regardless of whether they've recently been to China or had contacts with people who had.
- dTal 7y ago
  Never a more frightening instance of "penny wise, pound foolish". "Oh heavens no, we can't afford to preventatively test for a virulent new lethal pathogen that has already brought one of the world's largest economies to a total standstill - it costs literally dozens of dollars!"
  - londons_explore 7y ago
    The patient who pays for the test gains nothing from the results. The country gains from the results, but isn't offering to pay. If I had been to China and got ill when returning to the US, I would not be getting tested - the test wouldn't help my chance of survival, and would just cost me money and time.
    - DanBC 7y ago
      > The patient who pays for the test gains nothing from the results. The patient who is tested negative gets their life back, and can stop self isolating immediately. The self isolation protocol is pretty intense. https://www.gov.uk/government/publications/wuhan-novel-coronavirus-self-isolation-for-patients-undergoing-testing/advice-sheet-home-isolation https://www.gov.uk/government/publications/wuhan-novel-coron...
Bombthecat 7y ago
That's why it will keep spreading... Dammed is you do, Dammed if you don't..
- deleted 7y ago
  [deleted]

claudeganon 7y ago

We messed up a bunch of the first ones and we don’t really have centralized capacity to manufacture the tests at scale because of our privatized, outsourced healthcare system, we’re being prevented from using overseas ones (the senator from Hawaii is publicly begging Japan for tests), the CDC and other responsible agencies are in disarray from GOP gutting and malfeasance. Take your pick.

devinhelton 7y ago

The test-kit that the CDC sent to local labs had a faulty reagent, so all test requests have to be sent back to the CDC.[0] Local labs could develop or purchase their own test kits, but during an a public health emergency, they must get FDA authorization before launching such a test.[1] This seems to me like a giant institutional and bureaucratic screw up. Hopefully the FDA may be finally getting its act together and fast-tracking approval of local tests: https://twitter.com/ScottGottliebMD/status/1233021681918193664 https://twitter.com/ScottGottliebMD/status/12330216819181936... [0] https://www.politico.com/news/2020/02/20/cdc-coronavirus-116529 https://www.politico.com/news/2020/02/20/cdc-coronavirus-116... [1] https://threadreaderapp.com/thread/1231944326827081729.html https://threadreaderapp.com/thread/1231944326827081729.html

Reelin 7y ago
In all seriousness, why should a non-invasive diagnostic test require any sort of approval (particularly during an outbreak)? This is just RT-PCR if I understand correctly - there's nothing particularly novel going on here. Just publish the primer sequences and let the biotech industry handle things. Edit: Oh hey they did publish an RT-PCR protocol [1] plus sequences, [2] along with a disclaimer not to use them directly on human subjects. This is just silly (IMO). > These procedures and/or reagents derived thereof are intended to be used for the purposes of respiratory virus surveillance and research. The procedures and reagents derived thereof may not be used directly in human subjects. [1] https://www.cdc.gov/coronavirus/2019-ncov/lab/rt-pcr-detection-instructions.html https://www.cdc.gov/coronavirus/2019-ncov/lab/rt-pcr-detecti... [2] https://www.cdc.gov/coronavirus/2019-ncov/lab/rt-pcr-panel-primer-probes.html https://www.cdc.gov/coronavirus/2019-ncov/lab/rt-pcr-panel-p...
- orblivion 7y ago
  Maybe false negatives or even false positives could be a liability issue?
  - claudeganon 7y ago
    From reports, the Chinese tests have fairly high false negatives, but they’re still deploying them en masse because catching as much as is possible better than not catching anything at all. I’ve seen nothing on false positives.

gojomo 7y ago

There's a bureaucratic 'Catch-22' in each regulatory agency's rules for allowing emergency testing, & apparently no one willing to exercise the authority to break the logjam. See for example the unwound details in this thread (which is reporting roughly the same things as Dr. Gottlieb, just without the diplomatic mollycoddling of his former agency): https://twitter.com/random_eddie/status/1232075474966368256 https://twitter.com/random_eddie/status/1232075474966368256

epmaybe 7y ago

A counterpoint - testing like this takes resources, and creates a backlog for other more pressing tests for patients. I mentioned this in another comment, but if I have a patient with pneumonia, I'm more than likely going to treat it the same way regardless of what the test shows me. Getting samples from everyone takes resources that lots of hospitals don't really have. Maybe you could get a backlog going that can test for COVID-19, when the lab's RT-PCR machines are underutilized, even after the patient leaves, so that we can get as much data as we can.

jerry1979 7y ago
How do we know that testing for Coronavirus creates a backlog? I don't have enough information to say how the system works, but I imagine a nurse takes an additional blood test, and then someone sends that test to the CDC. The CDC tests the blood, and sends a response to the hospital. I am curious to know more about the actual process.
- dillonmckay 7y ago
  I believe a test takes 6 hours, there is already a several day backlog, and the samples are sent via FedEx.
  - jerry1979 7y ago
    Would you happen to know it that takes 6 hours on the CDC's side or 6 hours in the doctor's office?
gnulinux 7y ago
But wouldn't you need to isolate pneumonia patient if they confirmed to have COVID-19? Also, curious, would you be more inclined to use some of the medicine that other countries claimed to be effective against COVID-19? Like Remdesivir and chloroquine?
- pmoriarty 7y ago
  In addition, at least until the outbreak becomes an uncontrolled epidemic in the US, you'd want to trace the contacts of any person confirmed to be infected with COVID-19 in order to try to try to stop the spread of the disease.

MiguelVieira 7y ago

The latest word from the CDC is that they’ve run 3,625 tests and that the testing capacity should double soon.

makomk 7y ago
Yeah, I think the actual answer is that the number of tests on that page is not even remotely up to date, and the CDC has more important issues on its plate than updating it. As I understand it the UK testing criteria are very similar to the CDC's and also require travel to an affected country or contact with a confirmed case: https://www.gov.uk/government/publications/wuhan-novel-coronavirus-initial-investigation-of-possible-cases/investigation-and-initial-clinical-management-of-possible-cases-of-wuhan-novel-coronavirus-wn-cov-infection https://www.gov.uk/government/publications/wuhan-novel-coron... The government here is just starting to roll out more general testing of the population to selected cities, but so is the CDC over in the US, and in both cases it's intended more to detect widespread spreading than to catch every individual case.
- avindroth 7y ago
  Why would it not be in CDC's interest to update the number of tests?
  - makomk 7y ago
    It's just probably not the most important thing to keep it continously updated on their website. The actual numbers aren't a secret or anything; there's a more up-to-date figure in the MMWR report on their website a couple of days ago, as well as the one just announced. (Though the MMWR figure only counts CDC tests, and apparently other laboratories have finally started carrying out their own tests in the US, including I believe some in California. That means there's probably not a single definite, up-to-date total for the number of tests anymore.)

btilly 7y ago

Yes. The tests are sufficiently unreliable that if there is no specific reason to believe that a particular person has been exposed, the results are just noise. See https://towardsdatascience.com/statistics-and-unreliable-tests-coronavirus-is-difficult-to-contain-e113b5c0967c https://towardsdatascience.com/statistics-and-unreliable-tes... for an analysis using Bayesian statistics that demonstrates why you would pre-filter who you give the test to, and why you shouldn't necessarily trust the test results after. Please remember that public health organizations have over 150 years of experience with how to make the most effective use of existing resources to limit health challenges. This is a complicated optimization problem and the people doing it aren't stupid. It is better to ask why they do what they do than to assume that what they are doing makes no sense.

xorfish 7y ago
The problem in such cases is the prior. If a false positive is 10%, 1%, 0.1% or 0.01% makes a huge difference. With 0.01% and two different tests, you will get a false positive in every 100'000'000 tests. Testing twice solves many of the issues. It also gives information about the sensitivity and specificity of a test.
- wahern 7y ago
  > With 0.01% and two different tests, you will get a false positive in every 100'000'000 tests. That doesn't sound right to me (i.e. only the case if false positive distributions are independent and uncorrelated, which seems unlikely), but I don't know enough about statistics and epidemiology to dispute it.

wonderwonder 7y ago

If tested I have to assume the patient will be charged for it, which depending on their insurance could easily be a cost of thousands of dollars if they are in a hospital or ER. We are going to experience a situation where sick people don't get tested and continue to infect others because health care is too expensive. The cost of health care is very much going to exacerbate this situation. Administration officials just refused to commit to making a tax payer funded vaccine affordable. This is what end game capitalism in health care looks like.