6 ms·

Because the US is doing nearly zero surveillance testing, we don't know what we don't know. Maybe there's community transmission right now beyond these two cas

Because the US is doing nearly zero surveillance testing, we don't know what we don't know. Maybe there's community transmission right now beyond these two cases and we don't know because we're only testing people returning from China or from the cruise ship.

bcrosby95 7y ago
Yes. California is monitoring 8,400 people for corona virus. They currently have 200 test kits. https://sanfrancisco.cbslocal.com/2020/02/27/gov-newsom-coronavirus-testing-kits-shortage/ https://sanfrancisco.cbslocal.com/2020/02/27/gov-newsom-coro...
- kuprel 7y ago
  I read that a CT scan outperforms the lab test at detecting it
  - frisco 7y ago
    CT scans involve a lot of ionizing radiation. Definitely something to be avoided unless necessary.
    - ridgeguy 7y ago
      According to [1], a chest CT scan rad dose ranges from 4 to 18 milliSieverts. Annual background dose is ~3 milliSv. [2] states that a 100 mSv dose would increase risk of cancer by 0.5% (5/1000). [1] https://www.health.harvard.edu/cancer/radiation-risk-from-medical-imaging https://www.health.harvard.edu/cancer/radiation-risk-from-me... [2] https://www.scientificamerican.com/article/air-travel-exposes-you-to-radiation-how-much-health-risk-comes-with-it/ https://www.scientificamerican.com/article/air-travel-expose...
      - hcknwscommenter 7y ago
        You cannot compare an annual background dose to the dose received in a CT scan. Similarly, the 100 mSv dose of your reference number 2 is an inappropriate comparison because it is spread out over time compared to a CT scan. Your premise is like saying, walking puts an impact of .8 J on my foot. I walk 10,000 steps a day. 10,000*.8 is 8,000 J. A bullet produces an impact of 168 J when fired from a .22 rifle into a human body. Therefore walking is much more dangerous than a bullet from a rifle.
        ridgeguy 7y ago
        What you suggest seems plausible, but I can't immediately calculate, for example, DNA repair rate vs. X-ray photon flux and cross-sections. Can you point me to something that confirms incidence or severity of radiation-induced disease depends on flux rather than dose? Tnx.
        Retric 7y ago
        Sun burns are known to significantly increase cancer risks vs similar exposure over longer periods. Sun burns are rather similar to accuse radiation poisoning suggesting similar issues.
        hcknwscommenter 7y ago
        Both dose and flux matter.
        carterehsmith 7y ago
        Above, there is a link to a report from Harvard Medical School, that claims otherwise. Maybe they are wrong, but a post on HN is not exactly a credible refutation.
        hcknwscommenter 7y ago
        And yet, this Harvard Medical School link (not a report, not peer reviewed, but whatevs) clearly states that one CT scan of 4 to 18 mSV increases cancer risk by 0.7%, which is higher than the increase of 0.5% from 100 mSV exposure over a greater period of time. So, no. The Harvard Medical School link does not refute in any way my point. In fact, it supports my point.
      - onlyrealcuzzo 7y ago
        0.5% absolute points or by 0.5%? Chance of cancer is already really low. Multiplying it by 1.005 doesn't make much of a difference. Adding 0.5% does.
    - ineedasername 7y ago
      Wouldn't tracking a virus like this be such a necessary situation?
  - carbocation 7y ago
    A CT scan is not an appropriate screening test for COVID-19. Also, that paper will have no clinical impact. Thread: https://twitter.com/drlukeor/status/1233547995192279040?s=21 https://twitter.com/drlukeor/status/1233547995192279040?s=21
    - carbocation 7y ago
      Follow-up from the American College of Radiology: https://www.acr.org/Advocacy-and-Economics/ACR-Position-Statements/Recommendations-for-Chest-Radiography-and-CT-for-Suspected-COVID19-Infection https://www.acr.org/Advocacy-and-Economics/ACR-Position-Stat... "CT should not be used to screen for or as a first-line test to diagnose COVID-19"
  - zachguo 7y ago
    The latest guidelines published by the Chinese CDC claimed so too, a CT scan is required, and RT-PCR tests have to be applied multiple times before claiming a patient is cured.
    - TuringNYC 7y ago
      Any idea why a chest X-ray cannot be used, as is for TB?
- jvanderbot 7y ago
  The CDC is targetting routine bedside testing of COVID19 like we have for flu. It will take "months". Surveillance testing is enhanced by this. Recently an attempt to broaden testing ran into issues, now resolved. I expect test numbers to increase sharply. Monitoring those who are most likely vectors makes sense. https://abcnews.go.com/Politics/cdc-moves-rapidly-expand-covid-19-testing-capabilities/story?id=69286537 https://abcnews.go.com/Politics/cdc-moves-rapidly-expand-cov...
justinzollars 7y ago
Oh there is. These two cases have no known contacts.
sterlind 7y ago
What is the CDC actually doing? Presumably they've deployed a team to Santa Clara to deploy test kits, review hospital admissions and help construct isolation units? Or hopefully soon? Is there a site tracking the response of CDC and public health departments to this emerging pandemic?
- marcinzm 7y ago
  According to this reddit post the CDC won't even test you unless you're so sick that you need hospitalization even if you were in a country with an outbreak AND have flu symptoms: https://www.reddit.com/r/nyc/comments/fayko1/my_covid19_story_brooklyn/ https://www.reddit.com/r/nyc/comments/fayko1/my_covid19_stor... So it seems what the CDC is doing is trying to minimize the number of confirmed cases to make things look better.
  - kevin_thibedeau 7y ago
    China: Suppress the disclosure of damaging facts. USA: Suppress the creation of damaging facts.
    - brewdad 7y ago
      USA: Lower interest rates and the corporate tax rates to save the stock market. Pretend coronavirus is fake news.
    - blackrock 7y ago
      USA: Promote Alternative Facts
  - deleted 7y ago
    [deleted]
  - electriclove 7y ago
    Meanwhile, Hong Kong is able to test dogs (https://www.businessinsider.com/coronavirus-dog-isolated-test-no-sign-animals-can-be-infected-2020-2 https://www.businessinsider.com/coronavirus-dog-isolated-tes...) and Singapore is able to provide detailed updates to the public (https://www.moh.gov.sg/news-highlights/details/four-more-cases-discharged-three-new-cases-of-covid-19-infection-confirmed https://www.moh.gov.sg/news-highlights/details/four-more-cas...)
diogenescynic 7y ago
Trump is already claiming Coronavirus is a democrat hoax. We have the worst possible leadership when we need it the most.
ineedasername 7y ago
I don't think community transfer is a "maybe". If two people have been infected without any link to known cases, there must be at least one single person that links known cases to the two new infections. That can't really be debated. And what are the chances there is only one? And they only infected two more people, won't infect anyone else, and those two people didn't infect anyone before being quarantined? I think this thing is in the wild now.
- cstejerean 7y ago
  It seems the odds are high there is more than 1 because if there is only one there would be something in common between these two recent community cases. But from what I’ve seen there’s nothing linking these two together which means there are at least two distinct groups in California at the moment in which community infections are happening.
  - chiefalchemist 7y ago
    The past whereabouts of these people is self-reported, correct? It certainly possible that they're not being completely transparent. The simple solution? Take their phone geo records and see where and when there's an intersection. I'm not dismissing the possiblity of a threat; only how accurate self-reported data is known to be.
- claudeganon 7y ago
  There’s now a third case of unknown origin in Oregon, so it’s confirmed: https://www.washingtonpost.com/world/2020/02/28/coronavirus-live-updates/ https://www.washingtonpost.com/world/2020/02/28/coronavirus-...
  - pbourke 7y ago
    And possibly one in the Seattle metro area - there is an 8pm PT presser with King, Snohomish and Washington State Public Health officials this evening. https://twitter.com/passantino/status/1233587757198405632?s=21 https://twitter.com/passantino/status/1233587757198405632?s=...
clumsysmurf 7y ago
> we're only testing people returning from China or from the cruise ship Missing from the discussion is the whole debacle around the HHS staff that was sent to check the repatriated American citizens from Wuhan, who had no protection, were not trained, and were released back into the general public without further monitoring.
- mc32 7y ago
  Like why didn't they send people who had a few years ago dealt with Ebola. It's not like we didn't have people who went over there to help or people who treated infected people stateside --granted Ebola transmission is different but you still need PPE, but people know the protocol in practice, not just reading about how to wear PPE.
  - deleted 7y ago
    [deleted]
  - deleted 7y ago
    [deleted]
  - joezydeco 7y ago
    Those people were fired by the Trump administration in 2018. https://www.snopes.com/fact-check/trump-fire-pandemic-team/ https://www.snopes.com/fact-check/trump-fire-pandemic-team/
    - JohnJamesRambo 7y ago
      It's like I'm living in a simulation or the movie Idiocracy and I desperately want out.
      - asdf21 7y ago
        Hope you have plenty of guns to kill the zombies
    - addicted 7y ago
kryogen1c 7y ago
Isnt this a good thing? Isnt the fact that 8% of the bay area is not dying an indication the diamond princess cmr is more accurate than iran or wuhan, which is to say this is a normal seasonal virus?
- deleted 7y ago
  [deleted]
- nostromo 7y ago
  In my non-epidemiologist view, yes, it's a good thing. The denominator for the ~1% mortality rate is obviously bigger than we realize -- which means the mortality rate is potentially a lot lower. There are cases like this one popping up, where people are asymptomatic (and even test negative) and are not getting sick, despite being infected: https://www.theguardian.com/world/2020/feb/22/coronavirus-asymptomatic-wuhan-woman-shows-why-outbreak-will-be-hard-to-stop https://www.theguardian.com/world/2020/feb/22/coronavirus-as...
GeekyBear 7y ago
The CDC had issues with quality control on the test kits that must be distributed before labs outside of CDC Atlanta can begin doing their own testing. https://www.cdc.gov/coronavirus/2019-ncov/about/testing.html https://www.cdc.gov/coronavirus/2019-ncov/about/testing.html The plan was always to expand testing, but you need a working test kit first. >Six public health labs in the US plan to start monitoring the general population for the new coronavirus this week. The Centers for Disease Control and Prevention (CDC) says that the risk of the virus still remains low for the general population. But activating the disease surveillance network will allow the CDC and other public health officials to find any undetected virus circulating through the country. https://www.theverge.com/2020/2/24/21147157/coronavirus-lab-surveillance-flu-cdc-virus-tracking-testing https://www.theverge.com/2020/2/24/21147157/coronavirus-lab-... Edited to add that according to Pro Publica the problem stems from the CDC trying to get a little too fancy. >The federal agency shunned the World Health Organization test guidelines used by other countries and set out to create a more complicated test of its own that could identify a range of similar viruses. https://www.propublica.org/article/cdc-coronavirus-covid-19-test https://www.propublica.org/article/cdc-coronavirus-covid-19-...
- onlyrealcuzzo 7y ago
  Why can't the CDC make a working test kit? After China, every other country seems to have been able to do it in like 2-3 days after a few cases were discovered.
  - Reelin 7y ago
    They can and did. The issues in the US are entirely bureaucratic in nature.
- zaroth 7y ago
  Apparently the CDC has screwed up the “test kit” in numerous ways. First, they made it needlessly complicated by trying to make it test for other SARS-like viruses, and those tests were flagging a large number of false positives. Secondly, labs that are developing their own tests to mirror the CDC are being prohibited from using them due to onerous and absurd requirements like demonstrating their test wouldn’t falsely identify MERS as COVID-19, when MERS samples are nearly impossible to obtain. https://www.propublica.org/article/cdc-coronavirus-covid-19-test https://www.propublica.org/article/cdc-coronavirus-covid-19-...

bcrosby95 7y ago

Yes. California is monitoring 8,400 people for corona virus. They currently have 200 test kits. https://sanfrancisco.cbslocal.com/2020/02/27/gov-newsom-coronavirus-testing-kits-shortage/ https://sanfrancisco.cbslocal.com/2020/02/27/gov-newsom-coro...

kuprel 7y ago
I read that a CT scan outperforms the lab test at detecting it
- frisco 7y ago
  CT scans involve a lot of ionizing radiation. Definitely something to be avoided unless necessary.
  - ridgeguy 7y ago
    According to [1], a chest CT scan rad dose ranges from 4 to 18 milliSieverts. Annual background dose is ~3 milliSv. [2] states that a 100 mSv dose would increase risk of cancer by 0.5% (5/1000). [1] https://www.health.harvard.edu/cancer/radiation-risk-from-medical-imaging https://www.health.harvard.edu/cancer/radiation-risk-from-me... [2] https://www.scientificamerican.com/article/air-travel-exposes-you-to-radiation-how-much-health-risk-comes-with-it/ https://www.scientificamerican.com/article/air-travel-expose...
    - hcknwscommenter 7y ago
      You cannot compare an annual background dose to the dose received in a CT scan. Similarly, the 100 mSv dose of your reference number 2 is an inappropriate comparison because it is spread out over time compared to a CT scan. Your premise is like saying, walking puts an impact of .8 J on my foot. I walk 10,000 steps a day. 10,000*.8 is 8,000 J. A bullet produces an impact of 168 J when fired from a .22 rifle into a human body. Therefore walking is much more dangerous than a bullet from a rifle.
      - ridgeguy 7y ago
        What you suggest seems plausible, but I can't immediately calculate, for example, DNA repair rate vs. X-ray photon flux and cross-sections. Can you point me to something that confirms incidence or severity of radiation-induced disease depends on flux rather than dose? Tnx.
        Retric 7y ago
        Sun burns are known to significantly increase cancer risks vs similar exposure over longer periods. Sun burns are rather similar to accuse radiation poisoning suggesting similar issues.
        hcknwscommenter 7y ago
        Both dose and flux matter.
      - carterehsmith 7y ago
        Above, there is a link to a report from Harvard Medical School, that claims otherwise. Maybe they are wrong, but a post on HN is not exactly a credible refutation.
        hcknwscommenter 7y ago
        And yet, this Harvard Medical School link (not a report, not peer reviewed, but whatevs) clearly states that one CT scan of 4 to 18 mSV increases cancer risk by 0.7%, which is higher than the increase of 0.5% from 100 mSV exposure over a greater period of time. So, no. The Harvard Medical School link does not refute in any way my point. In fact, it supports my point.
    - onlyrealcuzzo 7y ago
      0.5% absolute points or by 0.5%? Chance of cancer is already really low. Multiplying it by 1.005 doesn't make much of a difference. Adding 0.5% does.
  - ineedasername 7y ago
    Wouldn't tracking a virus like this be such a necessary situation?
- carbocation 7y ago
  A CT scan is not an appropriate screening test for COVID-19. Also, that paper will have no clinical impact. Thread: https://twitter.com/drlukeor/status/1233547995192279040?s=21 https://twitter.com/drlukeor/status/1233547995192279040?s=21
  - carbocation 7y ago
    Follow-up from the American College of Radiology: https://www.acr.org/Advocacy-and-Economics/ACR-Position-Statements/Recommendations-for-Chest-Radiography-and-CT-for-Suspected-COVID19-Infection https://www.acr.org/Advocacy-and-Economics/ACR-Position-Stat... "CT should not be used to screen for or as a first-line test to diagnose COVID-19"
- zachguo 7y ago
  The latest guidelines published by the Chinese CDC claimed so too, a CT scan is required, and RT-PCR tests have to be applied multiple times before claiming a patient is cured.
  - TuringNYC 7y ago
    Any idea why a chest X-ray cannot be used, as is for TB?
jvanderbot 7y ago
The CDC is targetting routine bedside testing of COVID19 like we have for flu. It will take "months". Surveillance testing is enhanced by this. Recently an attempt to broaden testing ran into issues, now resolved. I expect test numbers to increase sharply. Monitoring those who are most likely vectors makes sense. https://abcnews.go.com/Politics/cdc-moves-rapidly-expand-covid-19-testing-capabilities/story?id=69286537 https://abcnews.go.com/Politics/cdc-moves-rapidly-expand-cov...

justinzollars 7y ago

Oh there is. These two cases have no known contacts.

sterlind 7y ago

What is the CDC actually doing? Presumably they've deployed a team to Santa Clara to deploy test kits, review hospital admissions and help construct isolation units? Or hopefully soon? Is there a site tracking the response of CDC and public health departments to this emerging pandemic?

marcinzm 7y ago
According to this reddit post the CDC won't even test you unless you're so sick that you need hospitalization even if you were in a country with an outbreak AND have flu symptoms: https://www.reddit.com/r/nyc/comments/fayko1/my_covid19_story_brooklyn/ https://www.reddit.com/r/nyc/comments/fayko1/my_covid19_stor... So it seems what the CDC is doing is trying to minimize the number of confirmed cases to make things look better.
- kevin_thibedeau 7y ago
  China: Suppress the disclosure of damaging facts. USA: Suppress the creation of damaging facts.
  - brewdad 7y ago
    USA: Lower interest rates and the corporate tax rates to save the stock market. Pretend coronavirus is fake news.
  - blackrock 7y ago
    USA: Promote Alternative Facts
- deleted 7y ago
  [deleted]
- electriclove 7y ago
  Meanwhile, Hong Kong is able to test dogs (https://www.businessinsider.com/coronavirus-dog-isolated-test-no-sign-animals-can-be-infected-2020-2 https://www.businessinsider.com/coronavirus-dog-isolated-tes...) and Singapore is able to provide detailed updates to the public (https://www.moh.gov.sg/news-highlights/details/four-more-cases-discharged-three-new-cases-of-covid-19-infection-confirmed https://www.moh.gov.sg/news-highlights/details/four-more-cas...)

diogenescynic 7y ago

Trump is already claiming Coronavirus is a democrat hoax. We have the worst possible leadership when we need it the most.

ineedasername 7y ago

I don't think community transfer is a "maybe". If two people have been infected without any link to known cases, there must be at least one single person that links known cases to the two new infections. That can't really be debated. And what are the chances there is only one? And they only infected two more people, won't infect anyone else, and those two people didn't infect anyone before being quarantined? I think this thing is in the wild now.

cstejerean 7y ago
It seems the odds are high there is more than 1 because if there is only one there would be something in common between these two recent community cases. But from what I’ve seen there’s nothing linking these two together which means there are at least two distinct groups in California at the moment in which community infections are happening.
- chiefalchemist 7y ago
  The past whereabouts of these people is self-reported, correct? It certainly possible that they're not being completely transparent. The simple solution? Take their phone geo records and see where and when there's an intersection. I'm not dismissing the possiblity of a threat; only how accurate self-reported data is known to be.
claudeganon 7y ago
There’s now a third case of unknown origin in Oregon, so it’s confirmed: https://www.washingtonpost.com/world/2020/02/28/coronavirus-live-updates/ https://www.washingtonpost.com/world/2020/02/28/coronavirus-...
- pbourke 7y ago
  And possibly one in the Seattle metro area - there is an 8pm PT presser with King, Snohomish and Washington State Public Health officials this evening. https://twitter.com/passantino/status/1233587757198405632?s=21 https://twitter.com/passantino/status/1233587757198405632?s=...

clumsysmurf 7y ago

> we're only testing people returning from China or from the cruise ship Missing from the discussion is the whole debacle around the HHS staff that was sent to check the repatriated American citizens from Wuhan, who had no protection, were not trained, and were released back into the general public without further monitoring.

mc32 7y ago
Like why didn't they send people who had a few years ago dealt with Ebola. It's not like we didn't have people who went over there to help or people who treated infected people stateside --granted Ebola transmission is different but you still need PPE, but people know the protocol in practice, not just reading about how to wear PPE.
- deleted 7y ago
  [deleted]
- deleted 7y ago
  [deleted]
- joezydeco 7y ago
  Those people were fired by the Trump administration in 2018. https://www.snopes.com/fact-check/trump-fire-pandemic-team/ https://www.snopes.com/fact-check/trump-fire-pandemic-team/
  - JohnJamesRambo 7y ago
    It's like I'm living in a simulation or the movie Idiocracy and I desperately want out.
    - asdf21 7y ago
      Hope you have plenty of guns to kill the zombies
  - addicted 7y ago

kryogen1c 7y ago

Isnt this a good thing? Isnt the fact that 8% of the bay area is not dying an indication the diamond princess cmr is more accurate than iran or wuhan, which is to say this is a normal seasonal virus?

deleted 7y ago
[deleted]
nostromo 7y ago
In my non-epidemiologist view, yes, it's a good thing. The denominator for the ~1% mortality rate is obviously bigger than we realize -- which means the mortality rate is potentially a lot lower. There are cases like this one popping up, where people are asymptomatic (and even test negative) and are not getting sick, despite being infected: https://www.theguardian.com/world/2020/feb/22/coronavirus-asymptomatic-wuhan-woman-shows-why-outbreak-will-be-hard-to-stop https://www.theguardian.com/world/2020/feb/22/coronavirus-as...

GeekyBear 7y ago

The CDC had issues with quality control on the test kits that must be distributed before labs outside of CDC Atlanta can begin doing their own testing. https://www.cdc.gov/coronavirus/2019-ncov/about/testing.html https://www.cdc.gov/coronavirus/2019-ncov/about/testing.html The plan was always to expand testing, but you need a working test kit first. >Six public health labs in the US plan to start monitoring the general population for the new coronavirus this week. The Centers for Disease Control and Prevention (CDC) says that the risk of the virus still remains low for the general population. But activating the disease surveillance network will allow the CDC and other public health officials to find any undetected virus circulating through the country. https://www.theverge.com/2020/2/24/21147157/coronavirus-lab-surveillance-flu-cdc-virus-tracking-testing https://www.theverge.com/2020/2/24/21147157/coronavirus-lab-... Edited to add that according to Pro Publica the problem stems from the CDC trying to get a little too fancy. >The federal agency shunned the World Health Organization test guidelines used by other countries and set out to create a more complicated test of its own that could identify a range of similar viruses. https://www.propublica.org/article/cdc-coronavirus-covid-19-test https://www.propublica.org/article/cdc-coronavirus-covid-19-...

onlyrealcuzzo 7y ago
Why can't the CDC make a working test kit? After China, every other country seems to have been able to do it in like 2-3 days after a few cases were discovered.
- Reelin 7y ago
  They can and did. The issues in the US are entirely bureaucratic in nature.
zaroth 7y ago
Apparently the CDC has screwed up the “test kit” in numerous ways. First, they made it needlessly complicated by trying to make it test for other SARS-like viruses, and those tests were flagging a large number of false positives. Secondly, labs that are developing their own tests to mirror the CDC are being prohibited from using them due to onerous and absurd requirements like demonstrating their test wouldn’t falsely identify MERS as COVID-19, when MERS samples are nearly impossible to obtain. https://www.propublica.org/article/cdc-coronavirus-covid-19-test https://www.propublica.org/article/cdc-coronavirus-covid-19-...