12 ms·

Thanks for your efforts! Inspiring to see our broader community spring into action. I was part of a volunteer team that tested 3400 people on Friday/Saturday i

by tbenst 7y ago

Thanks for your efforts! Inspiring to see our broader community spring into action. I was part of a volunteer team that tested 3400 people on Friday/Saturday in Santa Clara country for COVID-19 antibodies [1]. It took a team of 100+ volunteers 10 hours / day just to collect samples. Stanford, for example, has plenty of automated testing capacity, and even reagents. IMHO, the limiting factors are not that we need new tests, but rather we need (1) lighter regulations (2) funding to buy supplies and (3) massive manpower to scale-up drive through testing [1] https://www.stanforddaily.com/2020/04/04/stanford-researchers-test-3200-people-for-covid-19-antibodies https://www.stanforddaily.com/2020/04/04/stanford-researcher...

dvdt 7y ago
Thank you for your efforts as well! Sample collection and accessioning (accessioning is unpacking test tubes one by one and aliquoting them into plates in the lab) is definitely going to require a lot of manpower. I'm hopeful that patients "self swabbing" can help alleviate some of the manpower needs. (Self-swabs are not allowed currently under FDA guidance).
- sgw928 7y ago
  A self-swab surveillance program has been launched in Seattle: https://publichealthinsider.com/2020/03/23/introducing-scan-the-greater-seattle-coronavirus-assessment-network/ https://publichealthinsider.com/2020/03/23/introducing-scan-... . Is self-swabbing allowed there because it's for research purpose, not clinical purpose? The program does tell users whether they test positive though.
  - dvdt 7y ago
    My guess is that self-swabbing is allowed in the Seattle SCAN study because it is a research study. The SCAN study is super fascinating because it would be crazy unusual under normal times for a research study to return results back to patients; I'm very happy they are able to do that, and it speaks to the severity of this pandemic. The FDA has recently made clear that no at-home self-collection tests are allowed (for now): https://www.fda.gov/medical-devices/emergency-situations-medical-devices/faqs-diagnostic-testing-sars-cov-2 https://www.fda.gov/medical-devices/emergency-situations-med...
    - mike_d 7y ago
      > The FDA has recently made clear that no at-home self-collection tests are allowed I think rightfully so. I was on a government video conference where a doctor showed the current CDC testing procedure, which involves stick a swab in the nose all the way to the back of the throat. They explained that the further the sample is taken from the lungs the less accurate it is.
      - sgw928 7y ago
        For clarity, a 500-patient study in WA (not yet peer-reviewed) showing self-swabbing to be as effective as swabbing by health care workers has prompted FDA to allow patient to self-swab at clinics, just not at home: https://medcitynews.com/2020/03/fda-says-patients-can-self-administer-covid-19-tests-but-not-at-home/ https://medcitynews.com/2020/03/fda-says-patients-can-self-a...
      - anon102010 7y ago
        Totally false - self swabbing is likely to be pretty accurate - and given current approach of virtually no testing - a much better situation
    - Maxious 7y ago
      > The SCAN study is super fascinating because it would be crazy unusual under normal times for a research study to return results back to patients; I'm very happy they are able to do that, and it speaks to the severity of this pandemic. The Seattle Flu Study wasn't allowed to communicate back to patients but "By Feb. 25, Dr. Chu and her colleagues could not bear to wait any longer. They began performing coronavirus tests, without government approval. What came back confirmed their worst fear. They quickly had a positive test from a local teenager with no recent travel history." https://www.nytimes.com/2020/03/10/us/coronavirus-testing-delays.html https://www.nytimes.com/2020/03/10/us/coronavirus-testing-de... I'm glad to hear they're allowed to do the SCAN study!
sgw928 7y ago
The situation is similar in WA state, where the current bottleneck is specimen collection, as there is a shortage of swabs, vials, PPE and personnel. This results in large amount of existing lab capacity, such as at UW Virology labs, not being used. Skipping RNA extraction definitely helps with expanding lab capacity in places where that's the current bottleneck, but isn't the most pressing thing in WA.
- loeg 7y ago
  The other bottleneck in WA is that the state's multimillion dollar, IBM-contracted data collection program can't keep up ingesting a few thousand records a day.
  - kitteh 7y ago
    Yes - this has been falling over for the past week.
    - loeg 7y ago
      Yep, starting March 28 (or sooner).
  - sgw928 7y ago
    That's just for public data reporting, so doesn't stop people from actually doing tests.
    - loeg 7y ago
      Just realtime analysis, which is also very important.
buzzkillington 7y ago
I find it incredible that no one has done these studies before issuing the lock down orders. Without knowing what the proportion of people who have been exposed but aren't sick any response is the wrong response. If it turns out that it's already spread to most everybody lock downs are just a way to create more homelessness. If it turns out that the only people with the antibodies are the ones in the hospitals we need martial law.
- yters 7y ago
  Yes, if you google "coronavirus iceland" you'll see they've tested almost their entire population. They found 1586 confirmed cases, of whom only 6 died, which gives a fatality rate of 0.4%. Turning this around, if we multiply confirmed deaths by 264, that gives us an estimate of how many cases there are. So, for example, with UK's death count of 6159 this means about 2.4% of the population is infected. Furthermore, on the Diamond Princess only 20% of the people onboard caught the virus under poorly quarantined conditions. So, to extrapolate even further, this would imply that over 12% of the UK population has already been exposed to SARS-CoV-2. This means that the UK should peak at about 50k deaths, without any protective measures. In 2018, the UK had 50k deaths due to flu in excess of normal flu deaths. https://www.telegraph.co.uk/news/2018/11/30/winter-deaths-hit-highest-level-40-years-experts-blame-ineffective/ https://www.telegraph.co.uk/news/2018/11/30/winter-deaths-hi...
  - JamisonM 7y ago
    Iceland has only tested 28,992 of its residents as April 6th, so that throws the rest of this conjecture out the window. (Although regardless the conjecture was probably not a great idea.) https://covid.is/data https://covid.is/data
    - yters 7y ago
      The point is Iceland has the best statistic on death rate due to comprehensive testing.
      - 7y ago

by tbenst 7y ago

dvdt 7y ago

Thank you for your efforts as well! Sample collection and accessioning (accessioning is unpacking test tubes one by one and aliquoting them into plates in the lab) is definitely going to require a lot of manpower. I'm hopeful that patients "self swabbing" can help alleviate some of the manpower needs. (Self-swabs are not allowed currently under FDA guidance).

sgw928 7y ago
A self-swab surveillance program has been launched in Seattle: https://publichealthinsider.com/2020/03/23/introducing-scan-the-greater-seattle-coronavirus-assessment-network/ https://publichealthinsider.com/2020/03/23/introducing-scan-... . Is self-swabbing allowed there because it's for research purpose, not clinical purpose? The program does tell users whether they test positive though.
- dvdt 7y ago
  My guess is that self-swabbing is allowed in the Seattle SCAN study because it is a research study. The SCAN study is super fascinating because it would be crazy unusual under normal times for a research study to return results back to patients; I'm very happy they are able to do that, and it speaks to the severity of this pandemic. The FDA has recently made clear that no at-home self-collection tests are allowed (for now): https://www.fda.gov/medical-devices/emergency-situations-medical-devices/faqs-diagnostic-testing-sars-cov-2 https://www.fda.gov/medical-devices/emergency-situations-med...
  - mike_d 7y ago
    > The FDA has recently made clear that no at-home self-collection tests are allowed I think rightfully so. I was on a government video conference where a doctor showed the current CDC testing procedure, which involves stick a swab in the nose all the way to the back of the throat. They explained that the further the sample is taken from the lungs the less accurate it is.
    - sgw928 7y ago
      For clarity, a 500-patient study in WA (not yet peer-reviewed) showing self-swabbing to be as effective as swabbing by health care workers has prompted FDA to allow patient to self-swab at clinics, just not at home: https://medcitynews.com/2020/03/fda-says-patients-can-self-administer-covid-19-tests-but-not-at-home/ https://medcitynews.com/2020/03/fda-says-patients-can-self-a...
    - anon102010 7y ago
      Totally false - self swabbing is likely to be pretty accurate - and given current approach of virtually no testing - a much better situation
  - Maxious 7y ago
    > The SCAN study is super fascinating because it would be crazy unusual under normal times for a research study to return results back to patients; I'm very happy they are able to do that, and it speaks to the severity of this pandemic. The Seattle Flu Study wasn't allowed to communicate back to patients but "By Feb. 25, Dr. Chu and her colleagues could not bear to wait any longer. They began performing coronavirus tests, without government approval. What came back confirmed their worst fear. They quickly had a positive test from a local teenager with no recent travel history." https://www.nytimes.com/2020/03/10/us/coronavirus-testing-delays.html https://www.nytimes.com/2020/03/10/us/coronavirus-testing-de... I'm glad to hear they're allowed to do the SCAN study!

sgw928 7y ago

The situation is similar in WA state, where the current bottleneck is specimen collection, as there is a shortage of swabs, vials, PPE and personnel. This results in large amount of existing lab capacity, such as at UW Virology labs, not being used. Skipping RNA extraction definitely helps with expanding lab capacity in places where that's the current bottleneck, but isn't the most pressing thing in WA.

loeg 7y ago
The other bottleneck in WA is that the state's multimillion dollar, IBM-contracted data collection program can't keep up ingesting a few thousand records a day.
- kitteh 7y ago
  Yes - this has been falling over for the past week.
  - loeg 7y ago
    Yep, starting March 28 (or sooner).
- sgw928 7y ago
  That's just for public data reporting, so doesn't stop people from actually doing tests.
  - loeg 7y ago
    Just realtime analysis, which is also very important.

buzzkillington 7y ago

I find it incredible that no one has done these studies before issuing the lock down orders. Without knowing what the proportion of people who have been exposed but aren't sick any response is the wrong response. If it turns out that it's already spread to most everybody lock downs are just a way to create more homelessness. If it turns out that the only people with the antibodies are the ones in the hospitals we need martial law.

yters 7y ago
Yes, if you google "coronavirus iceland" you'll see they've tested almost their entire population. They found 1586 confirmed cases, of whom only 6 died, which gives a fatality rate of 0.4%. Turning this around, if we multiply confirmed deaths by 264, that gives us an estimate of how many cases there are. So, for example, with UK's death count of 6159 this means about 2.4% of the population is infected. Furthermore, on the Diamond Princess only 20% of the people onboard caught the virus under poorly quarantined conditions. So, to extrapolate even further, this would imply that over 12% of the UK population has already been exposed to SARS-CoV-2. This means that the UK should peak at about 50k deaths, without any protective measures. In 2018, the UK had 50k deaths due to flu in excess of normal flu deaths. https://www.telegraph.co.uk/news/2018/11/30/winter-deaths-hit-highest-level-40-years-experts-blame-ineffective/ https://www.telegraph.co.uk/news/2018/11/30/winter-deaths-hi...
- JamisonM 7y ago
  Iceland has only tested 28,992 of its residents as April 6th, so that throws the rest of this conjecture out the window. (Although regardless the conjecture was probably not a great idea.) https://covid.is/data https://covid.is/data
  - yters 7y ago
    The point is Iceland has the best statistic on death rate due to comprehensive testing.
    - 7y ago