5 ms·

If it's so easy to build a website. Why doesn't everyone scale to the size of Google?

joe_the_user 7y ago
Indeed given many lives lie in the balance, shouldn't there be something like a bootcamp get smart people up to speed on this quickly?
- omar_a1 7y ago
  I doubt it's the lab techs that are in short supply. It's probably the consumables and reagents that go into the test that are out of stock. Lab procedures scale pretty well (to an extent - not the scale of the pandemic). Lab work is often feast or famine in terms of sample volume. During normal times, spikes usually just means the folks running the assays will be particularly busy. With all that said, there's still a lot of specialized skills required to competently run these tests. You'd still need significant training if starting from nothing. But there are enough un/underemployed lab techs out there that finding more techs won't be the bottleneck.
mayneack 7y ago
My guess: non trivial to do it safely and non trivial to get accuracy rates you'd get from a professional lab. Doing all those things by hand also takes some time. Thinking back to my days in a lab at MIT, sample to PCR probably took a full day (rough approximation). Big labs can probably increase the parallelism a lot.
mcovalt 7y ago
I’d be curious to the answer to that too. I can think of quite a few reasons, but I’m sure there are nuances that are completely unknown to me. I’m more interested in the parent question at the moment. I know almost nothing about the subject matter. What are the blockers for deploying a simple virus test at the scale we need?
- bhaumik 7y ago
  Supply chain issues, for one. Eg. Not enough cotton swabs: https://www.politico.com/news/2020/03/16/coronavirus-testing-glitch-cotton-swabs-132692 https://www.politico.com/news/2020/03/16/coronavirus-testing...
  - hcknwscommenter 7y ago
    Seriously? There are approximately 1 Billion cotton swabs in this country (U.S.). This is not the issue. The issue is gross federal gov't incompetence.
    - Reelin 7y ago
      It's somewhat more nuanced than that. The currently approved swabs have limited availability, and indeed there are others (unapproved) that would work. However it seems you can't use just any - they have to consist of synthetic fiber, can't have a wooden shaft, and can't contain calcium alginate. This rules out many of the swabs that a healthcare facility might have on hand. (https://khn.org/news/as-coronavirus-testing-gears-up-specialized-swabs-running-out/ https://khn.org/news/as-coronavirus-testing-gears-up-special...)
  - makomk 7y ago
    Yeah, by a bit of absolutely terrible luck, the preferred swabs for this are produced by a factory in Lombardy, Italy. There are other manufacturers of swabs that could be used but they don't seem to have the production capacity.
- nkrumm 7y ago
  It boils down to people, logistics, and efficiency: Yes, we can produce the primers, develop the tests, ramp up the supply of RNA extraction kits, swabs, tips, etc. Individually easy, but together more challenging, especially when the entire world is also trying to acquire the same products. Yes, large, fast and high-scale instruments exist. But, they need to be set up and calibrated. They need adequate power, cooling, water, space, etc. The technicians need training. They need network interfaces, etc. Yes, it's a simple test. But there are still SO MANY steps needed to generate a result from a sample, and those take people. Just looking at the laboratory workflow: 1) Sample received in shipment -- unbox, scan manifest (if provided) 2) Unbag sample + requisition 3) Check sample label (usually handwritten) and verify accuracy to requisition (possibly handwritten). In an ideal case, orders are coming in as "interfaced orders" (meaning electronically) but many smaller clinics/hospitals will not have this. 4) Enter all demographics of the patient into laboratory system 5) Have second person verify the information 6) Re-bag and send sample to location in lab with test instrumentation 7) Technicians unbag, verify label + order accuracy 8) Decant sample from non-standardized tube sent to lab to standard tube used in lab 9) Scan into liquid handling robot... ...et cetera, et cetera As I will probably find out in the replies there are "solutions" to all of these problems, and many labs utilize them. However, to scale such a complex system so quickly means that there is no room for a "test environment", and all changes have to be made "in production". Even simple changes to the workflow require days of prep to communicate to all of the staff across three daily shifts-- you get the idea. source: i'm a laboratory medicine resident at the UW lab. We scaled from 0 to 3000 tests in 2 weeks and it's been an incredible all-hands effort.
tjoff 7y ago
Comparison is flawed. Getting demand is harder than scaling. In this case the demand already exist and the money to scale as well. In short, the question remains. If there is a will to scale, what is the holdup? People with experience?
- freepor 7y ago
  I mean if you transferred $500 billion to my bank account and said “clone Google” I would not get very far.
  - jimmaswell 7y ago
    Hire the right people with all that money and you could.
    - freepor 7y ago
      I wouldn’t be able to evaluate people well enough to hire the right ones.
      - harry8 7y ago
        That right there is the problem we face as a nation, Mr President.
      - astatine 7y ago
        That doesn't take away from the point that there probably exists a non-zero number of people who could convert $500B into something of the scale of Google.
  - grumple 7y ago
    You might not, but many of us are capable to developing the systems and features that are core to google's business, and for any parts we don't know, we know where to find the people we need.
    - 7y ago

Indeed given many lives lie in the balance, shouldn't there be something like a bootcamp get smart people up to speed on this quickly?

omar_a1 7y ago
I doubt it's the lab techs that are in short supply. It's probably the consumables and reagents that go into the test that are out of stock. Lab procedures scale pretty well (to an extent - not the scale of the pandemic). Lab work is often feast or famine in terms of sample volume. During normal times, spikes usually just means the folks running the assays will be particularly busy. With all that said, there's still a lot of specialized skills required to competently run these tests. You'd still need significant training if starting from nothing. But there are enough un/underemployed lab techs out there that finding more techs won't be the bottleneck.

mayneack 7y ago

My guess: non trivial to do it safely and non trivial to get accuracy rates you'd get from a professional lab. Doing all those things by hand also takes some time. Thinking back to my days in a lab at MIT, sample to PCR probably took a full day (rough approximation). Big labs can probably increase the parallelism a lot.

mcovalt 7y ago

I’d be curious to the answer to that too. I can think of quite a few reasons, but I’m sure there are nuances that are completely unknown to me. I’m more interested in the parent question at the moment. I know almost nothing about the subject matter. What are the blockers for deploying a simple virus test at the scale we need?

bhaumik 7y ago
Supply chain issues, for one. Eg. Not enough cotton swabs: https://www.politico.com/news/2020/03/16/coronavirus-testing-glitch-cotton-swabs-132692 https://www.politico.com/news/2020/03/16/coronavirus-testing...
- hcknwscommenter 7y ago
  Seriously? There are approximately 1 Billion cotton swabs in this country (U.S.). This is not the issue. The issue is gross federal gov't incompetence.
  - Reelin 7y ago
    It's somewhat more nuanced than that. The currently approved swabs have limited availability, and indeed there are others (unapproved) that would work. However it seems you can't use just any - they have to consist of synthetic fiber, can't have a wooden shaft, and can't contain calcium alginate. This rules out many of the swabs that a healthcare facility might have on hand. (https://khn.org/news/as-coronavirus-testing-gears-up-specialized-swabs-running-out/ https://khn.org/news/as-coronavirus-testing-gears-up-special...)
- makomk 7y ago
  Yeah, by a bit of absolutely terrible luck, the preferred swabs for this are produced by a factory in Lombardy, Italy. There are other manufacturers of swabs that could be used but they don't seem to have the production capacity.
nkrumm 7y ago
It boils down to people, logistics, and efficiency: Yes, we can produce the primers, develop the tests, ramp up the supply of RNA extraction kits, swabs, tips, etc. Individually easy, but together more challenging, especially when the entire world is also trying to acquire the same products. Yes, large, fast and high-scale instruments exist. But, they need to be set up and calibrated. They need adequate power, cooling, water, space, etc. The technicians need training. They need network interfaces, etc. Yes, it's a simple test. But there are still SO MANY steps needed to generate a result from a sample, and those take people. Just looking at the laboratory workflow: 1) Sample received in shipment -- unbox, scan manifest (if provided) 2) Unbag sample + requisition 3) Check sample label (usually handwritten) and verify accuracy to requisition (possibly handwritten). In an ideal case, orders are coming in as "interfaced orders" (meaning electronically) but many smaller clinics/hospitals will not have this. 4) Enter all demographics of the patient into laboratory system 5) Have second person verify the information 6) Re-bag and send sample to location in lab with test instrumentation 7) Technicians unbag, verify label + order accuracy 8) Decant sample from non-standardized tube sent to lab to standard tube used in lab 9) Scan into liquid handling robot... ...et cetera, et cetera As I will probably find out in the replies there are "solutions" to all of these problems, and many labs utilize them. However, to scale such a complex system so quickly means that there is no room for a "test environment", and all changes have to be made "in production". Even simple changes to the workflow require days of prep to communicate to all of the staff across three daily shifts-- you get the idea. source: i'm a laboratory medicine resident at the UW lab. We scaled from 0 to 3000 tests in 2 weeks and it's been an incredible all-hands effort.

tjoff 7y ago

Comparison is flawed. Getting demand is harder than scaling. In this case the demand already exist and the money to scale as well. In short, the question remains. If there is a will to scale, what is the holdup? People with experience?

freepor 7y ago
I mean if you transferred $500 billion to my bank account and said “clone Google” I would not get very far.
- jimmaswell 7y ago
  Hire the right people with all that money and you could.
  - freepor 7y ago
    I wouldn’t be able to evaluate people well enough to hire the right ones.
    - harry8 7y ago
      That right there is the problem we face as a nation, Mr President.
    - astatine 7y ago
      That doesn't take away from the point that there probably exists a non-zero number of people who could convert $500B into something of the scale of Google.
- grumple 7y ago
  You might not, but many of us are capable to developing the systems and features that are core to google's business, and for any parts we don't know, we know where to find the people we need.
  - 7y ago