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This map seems effectively useless in the US, given absence of meaningful testing. Frontline nurses, treating COVID-19 patients, are having their tests stonewal

This map seems effectively useless in the US, given absence of meaningful testing. Frontline nurses, treating COVID-19 patients, are having their tests stonewalled and delayed by the CDC: https://act.nationalnursesunited.org/page/-/files/graphics/NU-Quarantine-RN-press-conf-statement.pdf https://act.nationalnursesunited.org/page/-/files/graphics/N... I’ve seen multiple people referencing it to prove the absence of real threat in the US, which seems beyond absurd at this point.

deleted 7y ago
[deleted]
everybodyknows 7y ago
Thanks for the link -- great insight to facts on the ground. Next link to snap may be hospitals in cash-flow crisis, like this one: https://www.nationalnursesunited.org/press/nurses-threatened-daly-city-hospital-closure-poses-significant-threat-public-amidst-growing https://www.nationalnursesunited.org/press/nurses-threatened... And here's why it was already so close to the edge: https://www.latimes.com/business/la-fi-verity-health-bankruptcy-20180831-story.html https://www.latimes.com/business/la-fi-verity-health-bankrup...
wahern 7y ago
The problem with wide scale testing is that it makes the CFR incomparable to seasonal flu or previous outbreaks. CFR is by definition deaths/confirmed cases. It's not a measure of infection lethality or mortality rate, even though that's what most of us think it is and what we're most curious about. For crisis management and planning, you want a CFR that is comparable to something like the seasonal flu or previous outbreaks. "Confirmed" cases of respiratory illnesses are roughly equivalent to the number of people who present to a hospital with severe respiratory symptoms, minus the base rate. We don't go out and run an assay for any person suspected of having the flu, for example, especially not asymptomatic people. If you do that for SARS-CoV-2, the number of "confirmed" cases will sky rocket and the CFR will drop. But that lower CFR can't be meaningfully compared to anything else, and is pretty much useless except as a curiosity. So it's understandable that the CDC isn't keen on widespread testing; it'll ruin the data, or at least ruin the characteristics of the data most important for crisis management. What matters now from a public health perspective is knowing whether SARS-CoV-2 is circulating. If you know it's circulating in an area, then you should just assume any respiratory illness is a SARS-CoV-2 and quarantine. Test if and only if it becomes severe and you need to know the cause for treatment.[1] You can calculate a more accurate and consistent CFR later by subtracting the base rate of presented respiratory infections from the outbreak rate. Identifying a local outbreak does request testing, but the major problem there was a temporary problem with getting assay kits out. But going forward, it doesn't help to test people who aren't presenting with severe symptoms. At least, it doesn't help from an epidemiological perspective. [1] However, SARS-CoV-2 causes primary viral pneumonia. By contrast, severe symptoms from seasonal flu are caused by secondary, bacterial pneumonia. There's not much that can be done for the former; for the latter you can prescribe antibiotics. So for severe cases it might just make sense to prescribe antibiotics, which would be benign for the viral infection (COVID-19) and even possibly a prophylactic for secondary bacterial pneumonia. In other words, in terms of treating a severely ill patient with a clear case of pneumonia, positive or negative COVID-19 identification might not provide any benefit.
- claudeganon 7y ago
  Nothing about what the CDC is doing is “understandable.” They’re stonewalling and delaying frontline responders testing puts the healthcare system more at risk of being overwhelmed and we’ve already seen cases of large numbers of nursing staff having to be quarantined once retroactive exposure was determined. There was also not a “temporary delay” with the kits, there is still nowhere near the necessary testing capacity and they’re throwing out absurd, false numbers like “1 million test kits” that then have to be walked back. And the whole absence of testing is because they rejected the WHO’s test kit and donations of them! We could have began testing immediately. I’m not sure where you’re getting all this nonsense about the absence of testing being “good for the data”. Every epidemiologist I’ve seen is saying the exact opposite, e.g.: Michael Mina, Asst Professor of Epidemiology & Immunology & physician @ Harvard School of Public Health/Medicine > 1 in 6 positive samples in China were asymptomatic and choice was made to not report those. This information is crucial for epidemiological modeling and developing appropriate mitigating strategies. Reporting all positives as symptomatic or not should be standard reporting. https://twitter.com/michaelmina_lab/status/1234355620557545473 https://twitter.com/michaelmina_lab/status/12343556205575454... Why are epidemiologists saying that testing and reporting asymptomatic cases is necessary for responding appropriately, counter to what you claim?
  - wahern 7y ago
    What value does knowing the total number of asymptomatic cases provide today? Such data is doubtlessly invaluable for studying the virus, but it's unnecessary today for managing the outbreak. Yes, the data can help us more accurately estimate the rate of infections, but that'll take months or years to pin down to the precision that such fine-grained data promises. In the mean time, you can roughly determine the spread of impactful cases by the change in number of presentations of respiratory infections, just as we've done for decades. You characterize what they're doing as stonewalling, but I'm charactering it as prioritizing. The biggest priority is collecting data on severe cases, and generally following established protocol to minimize unforced errors. The number of asymptomatic cases doesn't help you figure out how many ventilators you might need, at least not in a timely manner. The middle of an epidemic is not the time to revolutionize the practice and science of medicine. If you don't think things through carefully--i.e. the impact of false negatives and false positives of assay kits--you can easily fsck things up. Researchers want data, but the primary concern right now is juggling medical resources and finding treatments. More data is not always helpful, especially data not directly relevant to the present task. You're also assuming that hospitals and doctors are itching to run assay kits on every suspected case. Why, because some nurse's complaints went viral on social media? To out-do Singapore? Because "more data"? Doctors not interested in running millions of assay kits aren't going to be the ones complaining, not unless you forced them to run the tests. An assay result won't change the way you treat a patient with characteristic signs of a severe respiratory infection in the middle of a global SARS outbreak.

deleted 7y ago

[deleted]

everybodyknows 7y ago

Thanks for the link -- great insight to facts on the ground. Next link to snap may be hospitals in cash-flow crisis, like this one: https://www.nationalnursesunited.org/press/nurses-threatened-daly-city-hospital-closure-poses-significant-threat-public-amidst-growing https://www.nationalnursesunited.org/press/nurses-threatened... And here's why it was already so close to the edge: https://www.latimes.com/business/la-fi-verity-health-bankruptcy-20180831-story.html https://www.latimes.com/business/la-fi-verity-health-bankrup...

wahern 7y ago

The problem with wide scale testing is that it makes the CFR incomparable to seasonal flu or previous outbreaks. CFR is by definition deaths/confirmed cases. It's not a measure of infection lethality or mortality rate, even though that's what most of us think it is and what we're most curious about. For crisis management and planning, you want a CFR that is comparable to something like the seasonal flu or previous outbreaks. "Confirmed" cases of respiratory illnesses are roughly equivalent to the number of people who present to a hospital with severe respiratory symptoms, minus the base rate. We don't go out and run an assay for any person suspected of having the flu, for example, especially not asymptomatic people. If you do that for SARS-CoV-2, the number of "confirmed" cases will sky rocket and the CFR will drop. But that lower CFR can't be meaningfully compared to anything else, and is pretty much useless except as a curiosity. So it's understandable that the CDC isn't keen on widespread testing; it'll ruin the data, or at least ruin the characteristics of the data most important for crisis management. What matters now from a public health perspective is knowing whether SARS-CoV-2 is circulating. If you know it's circulating in an area, then you should just assume any respiratory illness is a SARS-CoV-2 and quarantine. Test if and only if it becomes severe and you need to know the cause for treatment.[1] You can calculate a more accurate and consistent CFR later by subtracting the base rate of presented respiratory infections from the outbreak rate. Identifying a local outbreak does request testing, but the major problem there was a temporary problem with getting assay kits out. But going forward, it doesn't help to test people who aren't presenting with severe symptoms. At least, it doesn't help from an epidemiological perspective. [1] However, SARS-CoV-2 causes primary viral pneumonia. By contrast, severe symptoms from seasonal flu are caused by secondary, bacterial pneumonia. There's not much that can be done for the former; for the latter you can prescribe antibiotics. So for severe cases it might just make sense to prescribe antibiotics, which would be benign for the viral infection (COVID-19) and even possibly a prophylactic for secondary bacterial pneumonia. In other words, in terms of treating a severely ill patient with a clear case of pneumonia, positive or negative COVID-19 identification might not provide any benefit.

claudeganon 7y ago
Nothing about what the CDC is doing is “understandable.” They’re stonewalling and delaying frontline responders testing puts the healthcare system more at risk of being overwhelmed and we’ve already seen cases of large numbers of nursing staff having to be quarantined once retroactive exposure was determined. There was also not a “temporary delay” with the kits, there is still nowhere near the necessary testing capacity and they’re throwing out absurd, false numbers like “1 million test kits” that then have to be walked back. And the whole absence of testing is because they rejected the WHO’s test kit and donations of them! We could have began testing immediately. I’m not sure where you’re getting all this nonsense about the absence of testing being “good for the data”. Every epidemiologist I’ve seen is saying the exact opposite, e.g.: Michael Mina, Asst Professor of Epidemiology & Immunology & physician @ Harvard School of Public Health/Medicine > 1 in 6 positive samples in China were asymptomatic and choice was made to not report those. This information is crucial for epidemiological modeling and developing appropriate mitigating strategies. Reporting all positives as symptomatic or not should be standard reporting. https://twitter.com/michaelmina_lab/status/1234355620557545473 https://twitter.com/michaelmina_lab/status/12343556205575454... Why are epidemiologists saying that testing and reporting asymptomatic cases is necessary for responding appropriately, counter to what you claim?
- wahern 7y ago
  What value does knowing the total number of asymptomatic cases provide today? Such data is doubtlessly invaluable for studying the virus, but it's unnecessary today for managing the outbreak. Yes, the data can help us more accurately estimate the rate of infections, but that'll take months or years to pin down to the precision that such fine-grained data promises. In the mean time, you can roughly determine the spread of impactful cases by the change in number of presentations of respiratory infections, just as we've done for decades. You characterize what they're doing as stonewalling, but I'm charactering it as prioritizing. The biggest priority is collecting data on severe cases, and generally following established protocol to minimize unforced errors. The number of asymptomatic cases doesn't help you figure out how many ventilators you might need, at least not in a timely manner. The middle of an epidemic is not the time to revolutionize the practice and science of medicine. If you don't think things through carefully--i.e. the impact of false negatives and false positives of assay kits--you can easily fsck things up. Researchers want data, but the primary concern right now is juggling medical resources and finding treatments. More data is not always helpful, especially data not directly relevant to the present task. You're also assuming that hospitals and doctors are itching to run assay kits on every suspected case. Why, because some nurse's complaints went viral on social media? To out-do Singapore? Because "more data"? Doctors not interested in running millions of assay kits aren't going to be the ones complaining, not unless you forced them to run the tests. An assay result won't change the way you treat a patient with characteristic signs of a severe respiratory infection in the middle of a global SARS outbreak.