6 ms·

> If we were able to identify and quarantine everyone who is contagious, including those who are asymptomatic, then we could let everyone else out of lockdown a

• pb 7y ago
  It's daily screening for exactly that reason. Is there something I should change to make that more clear?
  • jawns 7y ago
    But how realistic is daily screening on a wide scale? You're going to face major issues with compliance.
    • pb 7y ago
      That's why I think testing at the door is the more straightforward way to start. We can reopen factories, office buildings, even shopping malls, but no one gets in without passing the screen.
      • xyzzyz 7y ago
        What door? You mean my front door? I'm not letting anyone in, and I'm not leaving either. What are you going to do, call the cops to kick in the doors to test me?
        • pb 7y ago
          No, I mean the door to the office building, shopping mall, or other place where groups of people gather and potentially transmit the virus.
      • LiquidSky 7y ago
        But that just moves the compliance and logistics problem back one step. Who's doing this massive amount of testing? If it's the government, you'd need armies of workers spread out everywhere. If it's the owners of these buildings, who checks to ensure compliance? Imagine trying to enforce this on every non-residential building in, say, NYC. It would be practically impossible.
        • jedberg 7y ago
          > If it's the owners of these buildings, who checks to ensure compliance? Who checks to make sure every restaurant follows the standards of cleanliness? They have inspectors who (theoretically) show up randomly, so it ensures most places comply voluntarily, because the cost of getting caught is very high. A combination of random inspections and steep fines would solve the compliance problem. Edit: I just had another idea. Offer cash rewards to people who can prove they they weren't tested when entering a public place (which the business pays for via fines). You'd have people running around trying to find missed testing for the cash reward.
          • philwelch 7y ago
            To your point, many businesses and facilities implement safety measures because they fear civil liability for preventable damages. I don’t think that’s likely in this case but if you can get most businesses and facilities to be mostly compliant most of the time, that might be enough.
  • rguzman 7y ago
    it is pretty clear, but the conclusion of the parent is still pretty strong: > Sounds like a logistical nightmare.
    • tlb 7y ago
      Making most people a coffee every day also seems like a logistical nightmare. But we built that infrastructure.
      • perl4ever 7y ago
        Using coffee as an example, there's enormous diversity in how people make it and what (mostly unnecessary) resources they put in.
• JoeAltmaier 7y ago
  Straw-man. Many scenarios exist to get most of the benefits without resorting to 'everybody simultaneously'. E.g. 'test and release' where only folks who've been tested are 'released' into the public. Track outbreaks and retest those cohorts thoroughly. And so on.
• pdonis 7y ago
  > I'm not sure this "test and release" strategy works unless absolutely everybody gets tested simultaneously. They don't all have to get tested literally simultaneously; but the "release" part of the strategy can't start until the "test" part has covered everybody, or at least close enough to "everybody" that the difference doesn't matter. Note that that's how the strategy is stated in what you quote: if we can identify everyone who is contagious, then we can release everyone else. The "if" has to be complete before the "then" starts; that's what "if"-"then" means.
  • jawns 7y ago
    But contagious status is not fixed. If you test someone, they're negative, but despite sheltering in place they pick up the virus while at a necessary doctor's appointment, then their status changes. Granted, frequent follow-up tests might identify that change, but daily tests of a sufficiently large portion of the population have a number of challenges beyond just access to the tests.
    • korantu 7y ago
      The difference here is that you test everyone entering a certain location, not everyone in general. This is much easier, and allows testing to be focused on most needed areas. In effect, if you only go to the groceries once a week, you will be tested once a week. If you go back to office, you will be tested every day. The more you interact with people the more you get tested to keep the interactions safe
• vikramkr 7y ago
  Compliance is tough. And my main concern would be false positives- if we are screening more people more frequently, we would have a lower expected percent of true positives, and even a small false positive rate could lead to significant overdiagnosis and disruption. The more often the test the more stringent that requirement. I dont know much about the testing method described in the article, but I wonder if it has unique characteristics beyond ease of administration to support that broad use case
  • tlb 7y ago
    A reasonable policy is to go home when the machine at the door to your office gives a positive result. Then get a more specific PCR test, and maybe come back to work. So the cost of a false positive can be one lost day. The false positive rate of lockdowns is 100%.
    • tempestn 7y ago
      Exactly. While this plan would certainly result in some disruption, it would be a lot less than the current status quo. And you can't really compare it to simply "opening back up" without a plan like this, because the simple fact is that even without government-enforced lockdowns, many (perhaps most) people won't return to a normal level of activity if they don't feel safe doing so.
      • clairity 7y ago
        > “...because the simple fact is that even without government-enforced lockdowns, many (perhaps most) people won't return to a normal level of activity if they don't feel safe doing so.“ you’re underestimating the pain that many americans are feeling after just a few weeks of (soft) lockdown. it’s not that people want to be unsafe, it’s that their livelihoods are in grave danger if the lockdowns last for months. many people are willing to take some risk now that the pandemic hasn’t turned out to be plague-levels of badness that some initially feared. few people are economically secure enough to say ‘no’ to opening back up sooner rather than later.
• centimeter 7y ago
  Not trying to show bravado or anything, just pointing out that I and probably others feel this way; I would fight tooth and nail against pervasive, mandatory "test and release" policies on humans (and the necessary concomitant growth of the surveillance state). The second-order social and political effects of such a policy would be disastrous - orders of magnitude worse, in the long run, than the population-level health effects of this virus. People anticipating these effects would probably be prone to civil disobedience, making the logistical nightmare even worse than what you would get with a fully passive and compliant population.
  • tempestn 7y ago
    This position truly baffles me. I can understand people who have reservations about tracking everyone with phone apps to do more effective contact tracing. But objecting to widespread, low-cost testing for virus infection as an extension of the surveillance state? I don't even know how to argue against that because it simply doesn't make any sense to me. Right now the population is clamoring for more widespread and effective testing. Why would people rebel against it? You think people would prefer to remain locked down, or to sacrifice 0.5-1%^ of the population, than be regularly tested for infection? Why? ^or whatever the true number ends up being
    • jhauris 7y ago
      I think it's the mandatory part that's rankling centimeter, and I see their point. Once you give powers to the state in an emergency situation it's really hard to roll them back. See the PATRIOT act for example. Is there a way to effectively get universal compliance without implicitly granting permanent new powers to violate civil liberties? I suspect relying on people to test themselves daily without mandating it would do a reasonable job, but I have no idea if it would be enough. Edit: typo.
      • tempestn 7y ago
        I'm not sure new state powers would be required. The state already can (and does and should) compel people who are known to be infected to be quarantined, or at least self-isolated. As far as testing, companies can already require employees to be tested as a requirement to work. A lot of companies already do drug testing of employees, something I actually don't agree with in most cases, but it's already a norm. In normal times they likely won't have sufficient incentive to do virus testing though, and so probably wouldn't given the cost. But during an outbreak, the ability to roll that kind of thing out, especially in workplaces with vulnerable populations (like senior care homes and hospitals) or necessarily close working conditions (like restaurant kitchens or some factories) could certainly be a game-changer. And that just seems entirely reasonable to me. There's a outbreak happening, so in order to enter [place where transmission would likely occur] you have to be tested first. If found to be infected, you must isolate. Otherwise, you'd be knowingly exposing others, which already isn't something considered acceptable. So to me this simply looks like an effective use of existing powers in this situation. I'm not sure how it would slide down a slippery slope. The government decides to keep doing virus screening? I mean, I doubt they would incur the cost, but if they do, good! Maybe as Paul mentioned, we could significantly knock down cold and flu as well. If people are worried about infringing on the rights of people with viruses to live normally, I would ask what about the rights of others not to be infected by them? That besides the fact that if these measures are effective very few people will be getting sick in the first place.
• sandworm101 7y ago
  "Test and release" only works in science fiction. In the real world there is no absolute test that would enable practical test/catch-and-release processing of infected persons. From an epidemiological perspective, when applied to an entire population even tiny false negative rates will let countless infections slip through. False positive rates will see some people doomed to perpetual lockdown as, for whatever reason, they repeatedly test positive. Setting aside the science of disease, the concept of government agents performing a test to determine one's ability to conduct basic civil liberties (movement, work, basic speech etc) is antithetical to liberal democracy. Such things were not contemplated at the height of the AIDS panic, or SARs, or ebola. It would take something far worse than COVID-19 to implement such a regime in the western world. COVID is a threat to our way of life, to our economies. It isn't an existential threat to the state let alone the species.
  • gremlinsinc 7y ago
    Can you be sure it's not an existential threat? Can you guarantee that a healthy person who gets this 3 times doesn't have a 100% fatality rate (i.e. it gets worse each time?) Can you guarantee asymptomatic people don't become sterile? (Not saying they do, but if they did this would be an existential crisis and lead to our extinction after a generation). Can you guarantee asymptomatic people still won't have lung damage permanently? (some asymptomatics athletic types have shown severe decline in lung abilities following covid19). SARs was bad, but was wiped out so it's moot, AIDS is easier to avoid -don't have sex. ebola I think isn't as viral, and has been mostly contained, iirc they may have a vaccine launched or soon will and better treatments -- it's never gone full global like this. Covid-19's problem is it's severe viralness and r0. It spreads and keeps on spreading, and there's a ton we don't know about how bad having had it will be to even those with minor cases. until we know for sure on all these factors, the more we can quell it the better.
    • loopz 7y ago
      These are part of worst case scenarios that are not published openly. We need more data, and until then the responsible actions are taken by almost all govs.
• newacct583 7y ago
  > I'm not sure this "test and release" strategy works unless absolutely everybody gets tested simultaneously. This is misunderstanding exactly the text you are quoting. The goal with epidemic management is NOT to seek out and destroy every last case of the disease. All we need to do is reduce the spread rate so the exponent in the equation goes from above one to below one. At that point, the outbreak will shrink over time on its own. Critically, new/undetected outbreaks with an R0<1 won't get purchase and grow, because they can't. At that point, the population is "safe". Individuals aren't, people might still get sick randomly. But this isn't a policy for individual safety per se.