5 ms·

CDC reviewing ‘stunning’ universal testing results from Boston homeless shelter

53 points by g42gregory 7y ago

JMTQp8lwXL 7y ago
> “It tells you, you don’t know who’s at risk. You don’t know what you need to do to contain the virus if you don’t actually have the details or facts,” said Marty Martinez, Boston’s chief of Health and Human Services. Plans to reopen states are conditioned on testing, but how long --and will we ever-- have enough testing data (among the general population, not just those showing symptoms) to make the informed decision? If we can't get the cotton swabs, the reagents, with the ability to test nationwide at scale, health policy experts will not be positioned to green light re-opening.
- cmurf 7y ago
  Well to do folks can work from home, or not work from vacation homes, have all their needs delivered, and not catch this thing. All the "essential" people will catch it and some will die, and the well off will consider this very cheap, good, proper, and mandatory for economic reasons. It's hardly worse than the exploitation for profit of the tobacco industry. Known for decades it would maim and kill, but millions invested in, were shareholders, were owners. And they've never been sanctioned. This will be no different. The lower class will take one for the team, again, for the greater good of society so that the better classes can live with minimal inconvenience. By all rights, essential workers should quit. But they have a boot on their head: landlords and debts. It's economic coercion.
  - WalterBright 7y ago
    It's been well known for over a century that smoking is a slow poison. The well off smoked as much or more than the not so well off. My dad, who went to high school in the 1930's, said they were known as "coffin nails" then. Any doctor who cut open a smoker knew what smoking did to the lungs.
  - eddieplan9 7y ago
    That's a very cynical view. Doctors are by no means lower class. Most if not all of them can quit, and are not subject to "economic coercion". Yet almost of them choose to work and overwork. I am not an "essential" and am working from home, but I donate and try to help my local community, and if I am called to help in other ways, I will. And no, I don't actively invest in tobacco.
    - gizmo686 7y ago
      Many doctors have a substantial amount of debt from med school that they took on with the assumption of having a doctor's income.
- SpicyLemonZest 7y ago
  I think there's a common misunderstanding here. The value of testing is that it enables effective contact tracing. (Ideally, you want quick and regular tests for every identified contact, so that if they do have it they can be isolated before they start coughing.) There's no data-driven strategy to compute how safe it is to open up - that's determined subjectively based on general trends.
- HarryHirsch 7y ago
  Soon there'll be a different kind of pressure. The Smithfield pork processing plant in Sioux Falls, SD is closed because of 500 coronavirus cases amongst the employees. Several other plants are idled now because they are downstream of the South Dakota plant. This is a cut of 5 % of the pork supply in the United States. Several Tyson chicken processing plants in Georgia also have coronavirus outbreaks. Everyone thought that food shortages due to the COVID-19 pandemic were a very remote possibility, but it seems they are coming, and the government can't permit that. Food riots are precursors to revolutions.
dboreham 7y ago
Transmission via asymptotic carriers isn't a new thing. It's been known for months (e.g. the analysis of the first cluster in Germany) and is one of the main reasons this virus is so problematic.
jennyyang 7y ago
Those appear to be just PCR tests that tell you if the person has an active infection or not. Those that are negative should get a serology test to see if they were previously infected. The combination of both of those tests would be a true indication of how far this has spread. Of course, given how infectious this virus is, it's no wonder that half have been infected in the last 1-2 weeks at the shelter. There's probably little to no safety measures in place to help isolate homeless people at that shelter, so it would spread like wildfire.
- SpicyLemonZest 7y ago
  Yeah, it seems like it spreads to everyone in every nursing home it hits, so it'd be shocking to see it fail to spread in a homeless shelter.
  - threeseed 7y ago
    In a nursing home I would've expected nurses to be transmitting COVID-19 between patients. But merely having a lot of people in a room be enough for widespread transmission is a bit of a wake up call. I can't understand how given that you could ever open up bars, restaurants etc.
    - SpicyLemonZest 7y ago
      Well, a lot of people in a room for at least 8 hours, and unless this is a one-day shelter probably iterated over quite a while. I don't think this suggests a story where you sit in a restaurant for 2 hours and then everyone's infected; there's only been one report of a case like that, and multiple contact tracing reports from other countries where a carrier only infected a few other people in their bus or restaurant.
stefan_ 7y ago
The CNN article has a picture of what a Boston homeless shelter looks like: https://cdn.cnn.com/cnnnext/dam/assets/200417103746-01-pine-street-homeless-shelter-boston-2018-exlarge-169.jpg https://cdn.cnn.com/cnnnext/dam/assets/200417103746-01-pine-... So yeah, it's a bunch of tightly packed beds. One or two asymptomatic carriers can probably infect hundreds in just a night.
wutbrodo 7y ago
I wonder what the age breakdown was of those tested. It seems like there have been a couple of (very preliminary) indications that prevalence may be higher (and thus case severity lower) than we thought. It's probably too early to be optimistic, but I'm looking forward to getting more and more cases with better population samples than "people who think they have it", to get a better sense of what the rate of symptoms is.
adventured 7y ago
The most stunning testing result is the recent Stanford blood study in Santa Clara showing that potentially 50 times as many people have been infected with Covid as previously thought. We might already have 50 million Americans that have had Covid before another couple weeks is up. Of course the media won't cover this story widely, as it won't sell properly, there isn't enough sensationalism. It lowers panic (it would mean the Covid mortality rate is radically lower than previously feared, even versus common low estimates), rather than raising panic. It's crazy that the US isn't putting a lot of manufacturing and money behind doing widespread blood testing to see how common Covid actually is. This should have been done a month plus ago. Based on deaths, 10-15% of NYC probably has already had it at this point and if so, we need to know that asap. I've been talking about this for months now, it's not a premise requiring any kind of specialized knowledge to grasp (obvious question: how widespread is the virus), and I've yet to see any media interest in it despite how blatantly obvious it is. It's almost like there is some interest in ensuring we don't find out how far Covid has already spread. The first thing they should have figured out, is the last thing they're apparently going to figure out.
- skybrian 7y ago
  The Santa Clara study has gotten a fair bit of press and attention but it's not clear whether the results will hold up. The antibody test is new and they're assuming very few false positives, and it's a non-random study (recruitment via Facebook). Here's some more criticism: https://medium.com/@balajis/peer-review-of-covid-19-antibody-seroprevalence-in-santa-clara-county-california-1f6382258c25 https://medium.com/@balajis/peer-review-of-covid-19-antibody...
  - sergiotapia 7y ago
    1. That's just one persons opinion. Don't treat it as fact. 2. Read the comments in that article for some counter-points. The point is, this can't go on and thank god we're opening up everything again.
  - adventured 7y ago
    It's why we should be doing massively increased blood testing and test manufacturing to resolve that question. For the last few months it has been the single most important question and they're putting very few resources behind trying to answer it. We can't test blood properly? Of course we could. They are choosing not to, is the actual context. It's a large mistake. How many infections have you already had? How widespread is it really? No answer, no attempt to answer at scale. At its best, it's immense incompetence in action by the authorities in charge of dealing with this mess.
elihu 7y ago
Some possibilities: the number of asymptomatic carriers is higher than expected, these people were mostly infected at the same time and just haven't shown symptoms yet, these people were infected by a less severe variant of SARS-CoV2, the tests are simply incorrect, or the inhabitants of that homeless shelter are in some way non-representative of the population in general (e.g. they're all in their mid-20's). They imply that those asymptomatic cases didn't all stay asymptomatic and that one was hospitalized, so I'm guessing the most likely explanation is just that most of them were infected around the same time, and the test just caught them before they started to show symptoms.
- swsieber 7y ago
  And another: The infection is far more widespread than previously believed because a larger percentage of people are asymptomatic than previously believed.
  - kyleee 7y ago
    That's mentioned in the first setnence of the comment you are replying to
    - swsieber 7y ago
      Wow. So it is. I guess I skimmed over that and missed it on multiple rereadings. Dang.
- kragen 7y ago
  I hadn't thought of that possibility. I'd thought that maybe the people with severe symptoms had gone to the hospital instead of the shelter.
- ImprovedSilence 7y ago
  I would love to see a follow up on their symptoms in 2-3 weeks. Not sure we'll ever see that info though, follow ups don't seem to sell eyeballs these days..
dang 7y ago
https://news.ycombinator.com/item?id=22880335 https://news.ycombinator.com/item?id=22880335
threeseed 7y ago
I am actually surprised people aren't more concerned about the long term effects of COVID-19. We have seen patients who got through it but were left with persistent neurological effects i.e. loss of smell, heart damage, weakened immune systems etc. If people are asymptotic but have reduced life expectancy then that is a really big problem. Especially if we are talking about just letting COVID-19 basically run wild through healthy people.
- Fjolsvith 7y ago
  > We have seen patients who got through it but were left with persistent neurological effects i.e. loss of smell, heart damage, weakened immune systems etc. Not a significant percentage of patients by any means.
  - orwin 7y ago
    Lasting lungs damage is expected in ~5% of hospitalized cases (not counting ICU/reanimation protocol cases) in eastern France. I'd says it is a significant percentage. We will need to wait a couple month to be sure it is irreversible (pulmonary fibrosis are irreversible for the moment, as we can't chirurgically extract damaged lung tissue yet) and also the extent of this damage. A young lady got asthma for the first time in her life last sunday, asthma that did not left her at least until wednesday (when my cousin told me about it, no news since). As nurses and doctors there now can afford to take vacation now (two-day vacations are vacations when you're working everyday since early march), they will probably have some time to start evaluating the non-deadly damages sometime soon.
    - Fjolsvith 7y ago
      > A young lady got asthma for the first time in her life last sunday, asthma that did not left her at least until wednesday (when my cousin told me about it, no news since). Anecdotal. While you say lasting lung damage is expected, you also say that a couple of months are needed to be able to prove the expectation.
- gremlinsinc 7y ago
aazaa 7y ago
These articles really need to state what kind of testing was done: RNA or serological. Very different conclusions if 50% test positive for one vs. the other.
smileypete 7y ago
Probably better off on the street in the open air, than a 'shelter' full of asymptomatic COVID cases...

53 points by g42gregory 7y ago

> “It tells you, you don’t know who’s at risk. You don’t know what you need to do to contain the virus if you don’t actually have the details or facts,” said Marty Martinez, Boston’s chief of Health and Human Services. Plans to reopen states are conditioned on testing, but how long --and will we ever-- have enough testing data (among the general population, not just those showing symptoms) to make the informed decision? If we can't get the cotton swabs, the reagents, with the ability to test nationwide at scale, health policy experts will not be positioned to green light re-opening.

cmurf 7y ago
Well to do folks can work from home, or not work from vacation homes, have all their needs delivered, and not catch this thing. All the "essential" people will catch it and some will die, and the well off will consider this very cheap, good, proper, and mandatory for economic reasons. It's hardly worse than the exploitation for profit of the tobacco industry. Known for decades it would maim and kill, but millions invested in, were shareholders, were owners. And they've never been sanctioned. This will be no different. The lower class will take one for the team, again, for the greater good of society so that the better classes can live with minimal inconvenience. By all rights, essential workers should quit. But they have a boot on their head: landlords and debts. It's economic coercion.
- WalterBright 7y ago
  It's been well known for over a century that smoking is a slow poison. The well off smoked as much or more than the not so well off. My dad, who went to high school in the 1930's, said they were known as "coffin nails" then. Any doctor who cut open a smoker knew what smoking did to the lungs.
- eddieplan9 7y ago
  That's a very cynical view. Doctors are by no means lower class. Most if not all of them can quit, and are not subject to "economic coercion". Yet almost of them choose to work and overwork. I am not an "essential" and am working from home, but I donate and try to help my local community, and if I am called to help in other ways, I will. And no, I don't actively invest in tobacco.
  - gizmo686 7y ago
    Many doctors have a substantial amount of debt from med school that they took on with the assumption of having a doctor's income.
SpicyLemonZest 7y ago
I think there's a common misunderstanding here. The value of testing is that it enables effective contact tracing. (Ideally, you want quick and regular tests for every identified contact, so that if they do have it they can be isolated before they start coughing.) There's no data-driven strategy to compute how safe it is to open up - that's determined subjectively based on general trends.
HarryHirsch 7y ago
Soon there'll be a different kind of pressure. The Smithfield pork processing plant in Sioux Falls, SD is closed because of 500 coronavirus cases amongst the employees. Several other plants are idled now because they are downstream of the South Dakota plant. This is a cut of 5 % of the pork supply in the United States. Several Tyson chicken processing plants in Georgia also have coronavirus outbreaks. Everyone thought that food shortages due to the COVID-19 pandemic were a very remote possibility, but it seems they are coming, and the government can't permit that. Food riots are precursors to revolutions.

dboreham 7y ago

Transmission via asymptotic carriers isn't a new thing. It's been known for months (e.g. the analysis of the first cluster in Germany) and is one of the main reasons this virus is so problematic.

jennyyang 7y ago

Those appear to be just PCR tests that tell you if the person has an active infection or not. Those that are negative should get a serology test to see if they were previously infected. The combination of both of those tests would be a true indication of how far this has spread. Of course, given how infectious this virus is, it's no wonder that half have been infected in the last 1-2 weeks at the shelter. There's probably little to no safety measures in place to help isolate homeless people at that shelter, so it would spread like wildfire.

SpicyLemonZest 7y ago
Yeah, it seems like it spreads to everyone in every nursing home it hits, so it'd be shocking to see it fail to spread in a homeless shelter.
- threeseed 7y ago
  In a nursing home I would've expected nurses to be transmitting COVID-19 between patients. But merely having a lot of people in a room be enough for widespread transmission is a bit of a wake up call. I can't understand how given that you could ever open up bars, restaurants etc.
  - SpicyLemonZest 7y ago
    Well, a lot of people in a room for at least 8 hours, and unless this is a one-day shelter probably iterated over quite a while. I don't think this suggests a story where you sit in a restaurant for 2 hours and then everyone's infected; there's only been one report of a case like that, and multiple contact tracing reports from other countries where a carrier only infected a few other people in their bus or restaurant.

stefan_ 7y ago

The CNN article has a picture of what a Boston homeless shelter looks like: https://cdn.cnn.com/cnnnext/dam/assets/200417103746-01-pine-street-homeless-shelter-boston-2018-exlarge-169.jpg https://cdn.cnn.com/cnnnext/dam/assets/200417103746-01-pine-... So yeah, it's a bunch of tightly packed beds. One or two asymptomatic carriers can probably infect hundreds in just a night.

wutbrodo 7y ago

I wonder what the age breakdown was of those tested. It seems like there have been a couple of (very preliminary) indications that prevalence may be higher (and thus case severity lower) than we thought. It's probably too early to be optimistic, but I'm looking forward to getting more and more cases with better population samples than "people who think they have it", to get a better sense of what the rate of symptoms is.

adventured 7y ago

The most stunning testing result is the recent Stanford blood study in Santa Clara showing that potentially 50 times as many people have been infected with Covid as previously thought. We might already have 50 million Americans that have had Covid before another couple weeks is up. Of course the media won't cover this story widely, as it won't sell properly, there isn't enough sensationalism. It lowers panic (it would mean the Covid mortality rate is radically lower than previously feared, even versus common low estimates), rather than raising panic. It's crazy that the US isn't putting a lot of manufacturing and money behind doing widespread blood testing to see how common Covid actually is. This should have been done a month plus ago. Based on deaths, 10-15% of NYC probably has already had it at this point and if so, we need to know that asap. I've been talking about this for months now, it's not a premise requiring any kind of specialized knowledge to grasp (obvious question: how widespread is the virus), and I've yet to see any media interest in it despite how blatantly obvious it is. It's almost like there is some interest in ensuring we don't find out how far Covid has already spread. The first thing they should have figured out, is the last thing they're apparently going to figure out.

skybrian 7y ago
The Santa Clara study has gotten a fair bit of press and attention but it's not clear whether the results will hold up. The antibody test is new and they're assuming very few false positives, and it's a non-random study (recruitment via Facebook). Here's some more criticism: https://medium.com/@balajis/peer-review-of-covid-19-antibody-seroprevalence-in-santa-clara-county-california-1f6382258c25 https://medium.com/@balajis/peer-review-of-covid-19-antibody...
- sergiotapia 7y ago
  1. That's just one persons opinion. Don't treat it as fact. 2. Read the comments in that article for some counter-points. The point is, this can't go on and thank god we're opening up everything again.
- adventured 7y ago
  It's why we should be doing massively increased blood testing and test manufacturing to resolve that question. For the last few months it has been the single most important question and they're putting very few resources behind trying to answer it. We can't test blood properly? Of course we could. They are choosing not to, is the actual context. It's a large mistake. How many infections have you already had? How widespread is it really? No answer, no attempt to answer at scale. At its best, it's immense incompetence in action by the authorities in charge of dealing with this mess.

elihu 7y ago

Some possibilities: the number of asymptomatic carriers is higher than expected, these people were mostly infected at the same time and just haven't shown symptoms yet, these people were infected by a less severe variant of SARS-CoV2, the tests are simply incorrect, or the inhabitants of that homeless shelter are in some way non-representative of the population in general (e.g. they're all in their mid-20's). They imply that those asymptomatic cases didn't all stay asymptomatic and that one was hospitalized, so I'm guessing the most likely explanation is just that most of them were infected around the same time, and the test just caught them before they started to show symptoms.

swsieber 7y ago
And another: The infection is far more widespread than previously believed because a larger percentage of people are asymptomatic than previously believed.
- kyleee 7y ago
  That's mentioned in the first setnence of the comment you are replying to
  - swsieber 7y ago
    Wow. So it is. I guess I skimmed over that and missed it on multiple rereadings. Dang.
kragen 7y ago
I hadn't thought of that possibility. I'd thought that maybe the people with severe symptoms had gone to the hospital instead of the shelter.
ImprovedSilence 7y ago
I would love to see a follow up on their symptoms in 2-3 weeks. Not sure we'll ever see that info though, follow ups don't seem to sell eyeballs these days..

dang 7y ago

https://news.ycombinator.com/item?id=22880335 https://news.ycombinator.com/item?id=22880335

threeseed 7y ago

I am actually surprised people aren't more concerned about the long term effects of COVID-19. We have seen patients who got through it but were left with persistent neurological effects i.e. loss of smell, heart damage, weakened immune systems etc. If people are asymptotic but have reduced life expectancy then that is a really big problem. Especially if we are talking about just letting COVID-19 basically run wild through healthy people.

Fjolsvith 7y ago
> We have seen patients who got through it but were left with persistent neurological effects i.e. loss of smell, heart damage, weakened immune systems etc. Not a significant percentage of patients by any means.
- orwin 7y ago
  Lasting lungs damage is expected in ~5% of hospitalized cases (not counting ICU/reanimation protocol cases) in eastern France. I'd says it is a significant percentage. We will need to wait a couple month to be sure it is irreversible (pulmonary fibrosis are irreversible for the moment, as we can't chirurgically extract damaged lung tissue yet) and also the extent of this damage. A young lady got asthma for the first time in her life last sunday, asthma that did not left her at least until wednesday (when my cousin told me about it, no news since). As nurses and doctors there now can afford to take vacation now (two-day vacations are vacations when you're working everyday since early march), they will probably have some time to start evaluating the non-deadly damages sometime soon.
  - Fjolsvith 7y ago
    > A young lady got asthma for the first time in her life last sunday, asthma that did not left her at least until wednesday (when my cousin told me about it, no news since). Anecdotal. While you say lasting lung damage is expected, you also say that a couple of months are needed to be able to prove the expectation.
gremlinsinc 7y ago

aazaa 7y ago

These articles really need to state what kind of testing was done: RNA or serological. Very different conclusions if 50% test positive for one vs. the other.

smileypete 7y ago

Probably better off on the street in the open air, than a 'shelter' full of asymptomatic COVID cases...