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This isn't a unique idea. This is the mainstream view. Everyone knows we need more testing and that testing is the only way to effectively ease distancing rules

This isn't a unique idea. This is the mainstream view. Everyone knows we need more testing and that testing is the only way to effectively ease distancing rules. That was a pretty extensive writeup to say what we've been hearing from all rational information outlets for a month.

pb 7y ago
I have not found any mainstream sources that advocate screening everyone every day (which is very different from simply doing "more testing"). Would love some pointers if I'm wrong.
- scott_s 7y ago
  Paul Romer, an economist at NYU, has been advocating for testing millions of people a day for a few weeks. He is co-author of a piece in The Atlantic, "Without More Tests, America Can’t Reopen", https://www.theatlantic.com/ideas/archive/2020/04/were-testing-the-wrong-people/610234/ https://www.theatlantic.com/ideas/archive/2020/04/were-testi... Googling for "romer covid 19" should turn up a lot of news sources covering the notion of testing millions of people a day.
  - pb 7y ago
    Yes, he is the best I've found. This proposal is still at least an order of magnitude more testing though :) (on the order of 100 million tests/day, not 1 million tests/day)
    - scott_s 7y ago
      Romer has called for as much as 30 million tests a day, which I think was based on some simplistic modeling. I think he was targeting everyone in the US being tested every two weeks. I think the two approaches are similar: let's test lots of people all the time, however many X million tests a day that is, so that we can quickly isolate and treat them. People are spreading it before they know they have it, so let's just test everyone all the time and not wait until they have symptoms.
      - dboreham 7y ago
        Basically like the porn industry.
        mantap 7y ago
        This is a really good analogy actually. The porn industry has higher risk for STDs but lower incidence than the general population.
  - CryptoPunk 7y ago
    Paul Romer is also a recipient of the Nobel Prize in Economics.
- vikramkr 7y ago
  I think governor Cuomo was saying he'd love to test every day if he could, but just doesn't have the capacity. Edit: as a side note he put out a call for companies that can help with testing saying that NY state might be willing to invest to bring things to scale. I believe he already wanted FDA approved tests but there's an opportunity there to work directly with a government to implement this sort of thing. IIRC, mainstream objections tend to come from concerns of false positives, since that becomes a bigger problem with this frequent level of testing and could prove a huge disruption if you end up with too many quarantine still, or so many that testing positive becomes essentially meaningless in terms of telling you whether you have the disease or not if you test positive.
  - OldHand2018 7y ago
    Gov Cuomo should call up Gov Pritzger. Illinois recognized the challenge of testing supplies and asked the state universities to solve the problem. They have. Illinois is reporting a lot more positive cases in the past week because they keep increasing the number of daily tests. I believe that today was well over 12000 tests in Illinois. Anyone who feels like getting tested is now allowed to get a test.
    - vikramkr 7y ago
      New York has done more tests and more tests per capita than any other state per latest numbers - the reason for more tests isn't just to test people who want it, it's to run large random tests, require tests before visiting nursing homes, get an accurate picture of the infection rate, etc. We're testing more per capita than most countries in the world and it's still not enough. We've tested approximately 4 times as many people with only about a 50% higher population than Illinois and it's still not enough. https://www.politico.com/interactives/2020/coronavirus-testing-by-state-chart-of-new-cases/ https://www.politico.com/interactives/2020/coronavirus-testi...
      - OldHand2018 7y ago
        Sorry, I wasn't clear. Illinois has built out their own manufacturing supply chain and testing facilities. They are self-sufficient. If New York wants to scale up testing and has money to invest in doing so, they should look at how Illinois managed to make that happen.
- mcherm 7y ago
  > I have not found any mainstream sources that advocate screening everyone every day That's because we currently aren't capable of testing everyone who is obviously sick just once. If we got there, we wouldn't even be close to being capable of testing key personnel (like health care workers). If we got there we wouldn't even be close to being able to test everyone once. If we got there we wouldn't even be close to being able to test everyone every day. You haven't heard any advocating for OR against it because it is so far from achievable that it isn't worth considering.
  - seb314 7y ago
    If this concept would work in principle, covid could be reduced to scaling testing capacity. My impression is that estimates about achievable testing capacity don't assume a most-important-short-term-problem-of-mankind priority and resource allocation. The linked article suggests a novel and much cheaper test, which would be great. But even if that didn't work out, what scale could possibly be feasible with existing tests? Pre-shortage, an RT-PCR seemed to be much cheaper than a missed day of work.
  - _ph_ 7y ago
    The concept for restarting the German football league involves daily testing of all players. So the idea is indeed widespread, but often enough just impractical for the numbers of tests required. Testing a few hundred people daily would be doable, as Germany has relatively good testing capacity - probably one main reason for the overall better handling of the pandemic so far. But the concept still gets critisized, as this would mean a fast track to testing for the players while parts of the population don't have equal access to testing. For the whole population, it would be a good first step to be test really everyone who has any assumptions of symptoms and some time later, everyone in contact. And perhaps a biweekly test for the general population.
    - gdilla 7y ago
      I would expect where there's a large enough economic incentive, and wealthy-enough private group (say, the NFL, MLB, etc) who wouldn't need to wait for government policy or supply, we will see daily testing of their 'employees' so that they can get back to operating. May not be any fans in a live setting, but better than nothing.
- shawnz 7y ago
  > screening everyone every day (which is very different from simply doing "more testing"). That seems like the logical conclusion of "more testing" to me. If we could, why wouldn't we? 3blue1brown on YouTube did an analysis which similarly shows that fast quarantining is the best way to mitigate the virus: https://www.youtube.com/watch?v=gxAaO2rsdIs https://www.youtube.com/watch?v=gxAaO2rsdIs
- cameldrv 7y ago
  I have advocated it. Allegedly everyone who comes close to Trump gets swabbed and rapid tested on the Abbott machine. How does your device detect viruses? Is it based on a protein or the RNA or what?
- remote_phone 7y ago
  You won’t be able to scale your solution before a vaccine is out, rendering your entire solution useless unfortunately. Johnson and Johnson have already started scaling their vaccine and plan to have 1 billion doses available by January 2021. If their vaccine is approved, it will be an instant solution and better than testing everyone every day. Moderna has also started the process of scaling their solution as well but J&J have a head start and a known platform.
  - SideburnsOfDoom 7y ago
    > You won’t be able to scale your solution before a vaccine is out Why not? Scaling a test is a completely separate exercise to scaling a vaccine, and it has the advantage that multiple proven working tests exit now, they just need to be scaled. Both can be done, by different people. You might also find that having a vaccine and a test is better than having just a vaccine. > If their vaccine is approved Multiple vaccines are in development. This is not a situation where we should stop doing X now because Y _might_ happen in 8 months or more time. None of the vaccines are guaranteed to be ready and working and scaled at any given date. None of them.
- Larrikin 7y ago
  Every single country that has had any success containing the virus, including the origin country of China, has had rigorous continuous testing to contain the spread. It's hard to find a country with success containing the outbreak that doesn't do constant ubiquitous testing.
  - adventured 7y ago
    > Every single country that has had any success containing the virus ... has had rigorous continuous testing to contain the spread That's demonstrably false. There are numerous prominent examples in fact. Taiwan is not doing a high rate of testing at all, they're most certainly not doing constant ubiquitous testing. Their per capita test rate is 1/7 that of the US. Singapore and South Korea are not doing constant ubiquitous testing. The US has already tested at a higher rate than South Korea and will pass Singapore shortly given the continued ramp in US testing. Both are held up as marvels of virus containment. Japan has barely done any testing. They're seeing a small spike in cases now, however they were not earlier (this is four plus months after the outbreak began and Japan is next to China). Their deaths from Covid are commonly 1/50 to 1/150 the per capita rate of the US and other higher outbreak nations, while doing 1/10 to 1/15 the testing. The only explanation is either that they're covering up ten thousand deaths, or the other non-testing approaches they've utilized work well. Compare Japan to Germany on Covid deaths - again, despite Japan being next to China - and then look at the testing rates. Now explain that. Finland is testing below the US rate and has contained the outbreak to a stellar degree. That's because Helsinki is colder than Stockholm and Copenhagen. The same reason Moscow didn't get slammed until more recently as the weather began to warm up. There are other factors that impact the spread of the virus, including the rate of social activity and high temperatures (over ~60F / ~15.5C). We know this from several studies that have proven the role of temperature in the spread of SARS and SARS-CoV-2; as well as understanding how the spread benefits from greater social activity (which doesn't occur at the same rate in super cold climates). Greece has a very low number of Covid deaths and no evidence of serious outbreak this entire time. Their testing rate is 1/3 that of the US. And they're wedged between Turkey and Italy. Much like southern Italy, they've been heavily shielded by their climate. Nobody wants to talk about this of course, it's the Mexico / Texas / San Diego / Baghdad / Lagos effect in action. Iraq isn't seeing any consequential outbreak, thanks to its climate. Whereas Iran right next door got smashed, because Tehran has an entirely different climate from Baghdad. Thailand and Vietnam are both testing at a very low rate, and there has been zero evidence of serious outbreaks in either country, despite the proximity to China. That's thanks to their hotter climates. Nigeria is barely testing at all, with zero evidence of a consequential outbreak there. No crushing of their healthcare system with cases or deaths; no huge spike in deaths, hospitalizations or ICU cases. There are numerous countries across Africa seeing similar low outbreak results, with very little testing. Colombia isn't seeing a consequential outbreak, their testing rate is super low. They're not seeing a healthcare crush either. They've contained it so far without a high rate of testing. India and Pakistan were supposed to get buried by SARS-CoV-2 cases. It hasn't happened, week after week goes by and the predictions continue to fail to come true. They're barely doing any testing at all. There's zero evidence in either country of a massive outbreak or crushing number of ICU cases swamping their healthcare systems. It's because of how hot their cities are. I've yet to see a single other good explanation for why India isn't buried in Covid deaths by now. India isn't seeing the virus hit for the same reason Africa hasn't. Egypt is barely doing any testing. Cairo should have millions of cases of the virus and a huge number of deaths by now. They should have 20,000 dead people from Covid at this point just in Cairo. Where is it? The Cairo metro has 20 million people. It's not far from Italy, Turkey, or Iran. Guess what? It's very hot in Cairo. And if you want to see a belligerent demonstration of the climate impact in action: tell me that Florida has been dramatically more responsible in their behavior than Belgium has (or France, or Italy, or Spain, or the UK, or the Netherlands, or Switzerland), to warrant having a per capita Covid mortality rate 1/12th that of Belgium. If Florida had New York's climate, Florida would have 20k Covid deaths by now. Instead they have a mere 1,066 (and Florida has a lot of old people) despite doing almost everything wrong.
- danohuiginn 7y ago
  Christian Drosten (German virologist, one of the most prominent experts here) has been advocating daily testing of medical workers. This is a slightly easier situation, since you can trust them to swab themselves, and the logistics for collecting samples is already in place.
  - Aeolun 7y ago
    Can you trust them to swab themselves if their livelihoods depend on them attending work? The testing is only one component there I think.
    - kwhitefoot 7y ago
      In Germany, and generally in Europe, yes. Being off work for such should not result in severe reduction in income unless your income was already high; at least that is the case here in Norway where laid off personnel get 80% of their normal salary up to a limit that is above average salary. Edit: typos
- RivieraKid 7y ago
  I suggested testing everyone every month about a month ago. This is a conservative testing frequency that would almost certainly put r0 under 1. Everyone every day is an overkill - why not everyone 4 times a day? What's the rationale for it other than it sounds good?
  - Aeolun 7y ago
    Because going out every day and knowing you are not infected feels pretty good?
- SideburnsOfDoom 7y ago
  Isn't this a minor upgrade on what the authorities did in Wuhan? They squashed the disease at the epicenter, faster than the tail-off in Italy, and a lot of it was massive screening and isolation of anyone showing symptoms, or with a high temperature (1), or testing positive, or anyone in contact with those. If "it happened and it worked" isn't "mainstream" then I don't know what is. 1) https://www.bloomberg.com/news/features/2020-04-23/wuhan-s-return-to-life-temperature-checks-and-constant-anxiety https://www.bloomberg.com/news/features/2020-04-23/wuhan-s-r...
deleted 7y ago
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ahupp 7y ago
Everyone says "we need more testing", but there's actually very little discussion of how that testing would translate into lower transmission. I'm skeptical any program less aggressive than the one proposed here would get R0 < 1.
- pb 7y ago
  Exactly. More testing is good, but actually stopping pandemic will require orders of magnitude more testing, which in turn requires a different approach to testing because the current way we do testing can't scale.
- danielmarkbruce 7y ago
  Is it because the discussion isn't needed? Anyone who is of moderate intelligence and thinks for a few seconds can see the next logical step. I don't know pb and he might be wonderful and original etc, but I have to agree with the original comment - this is just miles from an original idea. The constraint is tests, not ideas of what to do when we have simple/fast/abundant testing available.... "A third solution" makes it seem like it's... an original idea.
  - sfink 7y ago
    I think calling it a third solution is totally fair. Whether it's a novel solution is separate. The two solutions that are being debated now are (1) staying in lockdown until a vaccine or treatment is available, and (2) reopening and attempting to manage the spread using existing protocols/ideas (relatively low amounts of testing, quarantining after a period of infectiousness, some form of contact tracing, lots of finger crossing). At least, that's generally what I hear being debated: reopen or not, or when to reopen. The post suggests that if we had quantitatively much more testing, we could pick a qualitatively different third solution -- namely, reopen pretty freely and realistically control the spread. Sure, you can view that as a variant of the "reopen" option, but in my mind reopening feels very different with a realistic way to isolate people before they've had a chance to spread it very far. It's proactive vs reactive. If we fully reopen with even 2 orders of magnitude more testing than we're currently doing, it's just going to be a matter of closing back up wherever it gets out of hand. In practice, the openness will fluctuate, things will be spread out over time, politicians will continue to do the exact wrong things, and lots of people will continue to die. In short: (1) stay in lockdown until vaccine/treatment, (2) reopen without a strategy, (3) reopen with a strategy.
tempestn 7y ago
I think the main point is that he's pointing toward a specific test being developed that is intended to facilitate greatly increased degrees of testing. It is of course generally understood that if we could test everyone daily (or even a large section of people regularly), it could allow the virus to be contained without such widespread distancing and shutdown measures. > This test gives results in ten minutes using a small amount of saliva which is taken into a disposable tube and then run through a scanner. > We’re planning to start operating the first scanner within a month. If all goes well, there will be millions of scanners deployed by this fall, ensuring that every school and essential business can reopen while remaining safe and virus-free.
jetaim 7y ago
Agree to that point. The German, French and other media repeat that idea in the past weeks. One of the oldest and largest biomedical institutes, the Robert Koch Institute in Germany, recently had a few press releases, urging for tests for at least ALL respiratory tract infections. What one of the leading experts, Prof. Drosten, also mentioned is that current (PCR) tests have considerable false positives. The effect of such FP at large scale can hardly be estimated. I really hope that you are able to find a solution and can bring up a scalable and reliable solution, after the promises. If not, there will only remain the impression that this could be a Silicon Valley type of talk the walk, as people heard it from other companies in the past.
concordDance 7y ago
Testing isn't the only way. Some people just advocate for isolating the elderly and having everyone else mingle. The life expectancy loss from just letting it run its course would be less than a tenth of the life expectancy difference between the second and third wealth quartiles in the USA. And if we aren't worried about that difference, then why are we imposing a quality of life reduction that's much larger than the quality of life difference between those two quartiles for a much smaller gain in life expectancy? (similarly the economic costs of bringing the lowest quartile up a year or two would be much lower than the cost of this lockdown)
- sfink 7y ago
  (I'm no epidemiologist etc.) Because that's a terrible idea that doesn't make any sense. I understand the logic and why it's tempting, and I've even read some of the evidence supposedly backing it up. I find it thoroughly unconvincing. I won't address the moral side, just the practical. The virus disproportionately effects the elderly, yes, but far from exclusively. We have seen the non-elderly death rates with distancing in effect. If we could confidently say that >70% of the non-elderly population already had the virus, then this might make some sense. But since at the moment we cannot say that, then this is a method for quickly getting to >90% of the population, and killing off an unknown but far from trivial percentage of us. Also, I have seen some evidence that the magnitude of symptoms is partly dependent on the degree of exposure. If that is the case, I really really do not want to be sitting between two infectious people in a movie theater or sports arena. But this would be commonplace with the whole "let's just sacrifice the elderly" approach.
  - concordDance 7y ago
    The idea would be to isolate the vulnerable and let everyone else get it. As a society we have shown time and time again that we only care about "disasters", not the continuous but far greater and less expensively solved losses. Nuclear power vs coal, air plane accidents vs car accidents, the life expectancy reduction of poverty vs COVID-19...

pb 7y ago

I have not found any mainstream sources that advocate screening everyone every day (which is very different from simply doing "more testing"). Would love some pointers if I'm wrong.

scott_s 7y ago
Paul Romer, an economist at NYU, has been advocating for testing millions of people a day for a few weeks. He is co-author of a piece in The Atlantic, "Without More Tests, America Can’t Reopen", https://www.theatlantic.com/ideas/archive/2020/04/were-testing-the-wrong-people/610234/ https://www.theatlantic.com/ideas/archive/2020/04/were-testi... Googling for "romer covid 19" should turn up a lot of news sources covering the notion of testing millions of people a day.
- pb 7y ago
  Yes, he is the best I've found. This proposal is still at least an order of magnitude more testing though :) (on the order of 100 million tests/day, not 1 million tests/day)
  - scott_s 7y ago
    Romer has called for as much as 30 million tests a day, which I think was based on some simplistic modeling. I think he was targeting everyone in the US being tested every two weeks. I think the two approaches are similar: let's test lots of people all the time, however many X million tests a day that is, so that we can quickly isolate and treat them. People are spreading it before they know they have it, so let's just test everyone all the time and not wait until they have symptoms.
    - dboreham 7y ago
      Basically like the porn industry.
      - mantap 7y ago
        This is a really good analogy actually. The porn industry has higher risk for STDs but lower incidence than the general population.
- CryptoPunk 7y ago
  Paul Romer is also a recipient of the Nobel Prize in Economics.
vikramkr 7y ago
I think governor Cuomo was saying he'd love to test every day if he could, but just doesn't have the capacity. Edit: as a side note he put out a call for companies that can help with testing saying that NY state might be willing to invest to bring things to scale. I believe he already wanted FDA approved tests but there's an opportunity there to work directly with a government to implement this sort of thing. IIRC, mainstream objections tend to come from concerns of false positives, since that becomes a bigger problem with this frequent level of testing and could prove a huge disruption if you end up with too many quarantine still, or so many that testing positive becomes essentially meaningless in terms of telling you whether you have the disease or not if you test positive.
- OldHand2018 7y ago
  Gov Cuomo should call up Gov Pritzger. Illinois recognized the challenge of testing supplies and asked the state universities to solve the problem. They have. Illinois is reporting a lot more positive cases in the past week because they keep increasing the number of daily tests. I believe that today was well over 12000 tests in Illinois. Anyone who feels like getting tested is now allowed to get a test.
  - vikramkr 7y ago
    New York has done more tests and more tests per capita than any other state per latest numbers - the reason for more tests isn't just to test people who want it, it's to run large random tests, require tests before visiting nursing homes, get an accurate picture of the infection rate, etc. We're testing more per capita than most countries in the world and it's still not enough. We've tested approximately 4 times as many people with only about a 50% higher population than Illinois and it's still not enough. https://www.politico.com/interactives/2020/coronavirus-testing-by-state-chart-of-new-cases/ https://www.politico.com/interactives/2020/coronavirus-testi...
    - OldHand2018 7y ago
      Sorry, I wasn't clear. Illinois has built out their own manufacturing supply chain and testing facilities. They are self-sufficient. If New York wants to scale up testing and has money to invest in doing so, they should look at how Illinois managed to make that happen.
mcherm 7y ago
> I have not found any mainstream sources that advocate screening everyone every day That's because we currently aren't capable of testing everyone who is obviously sick just once. If we got there, we wouldn't even be close to being capable of testing key personnel (like health care workers). If we got there we wouldn't even be close to being able to test everyone once. If we got there we wouldn't even be close to being able to test everyone every day. You haven't heard any advocating for OR against it because it is so far from achievable that it isn't worth considering.
- seb314 7y ago
  If this concept would work in principle, covid could be reduced to scaling testing capacity. My impression is that estimates about achievable testing capacity don't assume a most-important-short-term-problem-of-mankind priority and resource allocation. The linked article suggests a novel and much cheaper test, which would be great. But even if that didn't work out, what scale could possibly be feasible with existing tests? Pre-shortage, an RT-PCR seemed to be much cheaper than a missed day of work.
- _ph_ 7y ago
  The concept for restarting the German football league involves daily testing of all players. So the idea is indeed widespread, but often enough just impractical for the numbers of tests required. Testing a few hundred people daily would be doable, as Germany has relatively good testing capacity - probably one main reason for the overall better handling of the pandemic so far. But the concept still gets critisized, as this would mean a fast track to testing for the players while parts of the population don't have equal access to testing. For the whole population, it would be a good first step to be test really everyone who has any assumptions of symptoms and some time later, everyone in contact. And perhaps a biweekly test for the general population.
  - gdilla 7y ago
    I would expect where there's a large enough economic incentive, and wealthy-enough private group (say, the NFL, MLB, etc) who wouldn't need to wait for government policy or supply, we will see daily testing of their 'employees' so that they can get back to operating. May not be any fans in a live setting, but better than nothing.
shawnz 7y ago
> screening everyone every day (which is very different from simply doing "more testing"). That seems like the logical conclusion of "more testing" to me. If we could, why wouldn't we? 3blue1brown on YouTube did an analysis which similarly shows that fast quarantining is the best way to mitigate the virus: https://www.youtube.com/watch?v=gxAaO2rsdIs https://www.youtube.com/watch?v=gxAaO2rsdIs
cameldrv 7y ago
I have advocated it. Allegedly everyone who comes close to Trump gets swabbed and rapid tested on the Abbott machine. How does your device detect viruses? Is it based on a protein or the RNA or what?
remote_phone 7y ago
You won’t be able to scale your solution before a vaccine is out, rendering your entire solution useless unfortunately. Johnson and Johnson have already started scaling their vaccine and plan to have 1 billion doses available by January 2021. If their vaccine is approved, it will be an instant solution and better than testing everyone every day. Moderna has also started the process of scaling their solution as well but J&J have a head start and a known platform.
- SideburnsOfDoom 7y ago
  > You won’t be able to scale your solution before a vaccine is out Why not? Scaling a test is a completely separate exercise to scaling a vaccine, and it has the advantage that multiple proven working tests exit now, they just need to be scaled. Both can be done, by different people. You might also find that having a vaccine and a test is better than having just a vaccine. > If their vaccine is approved Multiple vaccines are in development. This is not a situation where we should stop doing X now because Y _might_ happen in 8 months or more time. None of the vaccines are guaranteed to be ready and working and scaled at any given date. None of them.
Larrikin 7y ago
Every single country that has had any success containing the virus, including the origin country of China, has had rigorous continuous testing to contain the spread. It's hard to find a country with success containing the outbreak that doesn't do constant ubiquitous testing.
- adventured 7y ago
  > Every single country that has had any success containing the virus ... has had rigorous continuous testing to contain the spread That's demonstrably false. There are numerous prominent examples in fact. Taiwan is not doing a high rate of testing at all, they're most certainly not doing constant ubiquitous testing. Their per capita test rate is 1/7 that of the US. Singapore and South Korea are not doing constant ubiquitous testing. The US has already tested at a higher rate than South Korea and will pass Singapore shortly given the continued ramp in US testing. Both are held up as marvels of virus containment. Japan has barely done any testing. They're seeing a small spike in cases now, however they were not earlier (this is four plus months after the outbreak began and Japan is next to China). Their deaths from Covid are commonly 1/50 to 1/150 the per capita rate of the US and other higher outbreak nations, while doing 1/10 to 1/15 the testing. The only explanation is either that they're covering up ten thousand deaths, or the other non-testing approaches they've utilized work well. Compare Japan to Germany on Covid deaths - again, despite Japan being next to China - and then look at the testing rates. Now explain that. Finland is testing below the US rate and has contained the outbreak to a stellar degree. That's because Helsinki is colder than Stockholm and Copenhagen. The same reason Moscow didn't get slammed until more recently as the weather began to warm up. There are other factors that impact the spread of the virus, including the rate of social activity and high temperatures (over ~60F / ~15.5C). We know this from several studies that have proven the role of temperature in the spread of SARS and SARS-CoV-2; as well as understanding how the spread benefits from greater social activity (which doesn't occur at the same rate in super cold climates). Greece has a very low number of Covid deaths and no evidence of serious outbreak this entire time. Their testing rate is 1/3 that of the US. And they're wedged between Turkey and Italy. Much like southern Italy, they've been heavily shielded by their climate. Nobody wants to talk about this of course, it's the Mexico / Texas / San Diego / Baghdad / Lagos effect in action. Iraq isn't seeing any consequential outbreak, thanks to its climate. Whereas Iran right next door got smashed, because Tehran has an entirely different climate from Baghdad. Thailand and Vietnam are both testing at a very low rate, and there has been zero evidence of serious outbreaks in either country, despite the proximity to China. That's thanks to their hotter climates. Nigeria is barely testing at all, with zero evidence of a consequential outbreak there. No crushing of their healthcare system with cases or deaths; no huge spike in deaths, hospitalizations or ICU cases. There are numerous countries across Africa seeing similar low outbreak results, with very little testing. Colombia isn't seeing a consequential outbreak, their testing rate is super low. They're not seeing a healthcare crush either. They've contained it so far without a high rate of testing. India and Pakistan were supposed to get buried by SARS-CoV-2 cases. It hasn't happened, week after week goes by and the predictions continue to fail to come true. They're barely doing any testing at all. There's zero evidence in either country of a massive outbreak or crushing number of ICU cases swamping their healthcare systems. It's because of how hot their cities are. I've yet to see a single other good explanation for why India isn't buried in Covid deaths by now. India isn't seeing the virus hit for the same reason Africa hasn't. Egypt is barely doing any testing. Cairo should have millions of cases of the virus and a huge number of deaths by now. They should have 20,000 dead people from Covid at this point just in Cairo. Where is it? The Cairo metro has 20 million people. It's not far from Italy, Turkey, or Iran. Guess what? It's very hot in Cairo. And if you want to see a belligerent demonstration of the climate impact in action: tell me that Florida has been dramatically more responsible in their behavior than Belgium has (or France, or Italy, or Spain, or the UK, or the Netherlands, or Switzerland), to warrant having a per capita Covid mortality rate 1/12th that of Belgium. If Florida had New York's climate, Florida would have 20k Covid deaths by now. Instead they have a mere 1,066 (and Florida has a lot of old people) despite doing almost everything wrong.
danohuiginn 7y ago
Christian Drosten (German virologist, one of the most prominent experts here) has been advocating daily testing of medical workers. This is a slightly easier situation, since you can trust them to swab themselves, and the logistics for collecting samples is already in place.
- Aeolun 7y ago
  Can you trust them to swab themselves if their livelihoods depend on them attending work? The testing is only one component there I think.
  - kwhitefoot 7y ago
    In Germany, and generally in Europe, yes. Being off work for such should not result in severe reduction in income unless your income was already high; at least that is the case here in Norway where laid off personnel get 80% of their normal salary up to a limit that is above average salary. Edit: typos
RivieraKid 7y ago
I suggested testing everyone every month about a month ago. This is a conservative testing frequency that would almost certainly put r0 under 1. Everyone every day is an overkill - why not everyone 4 times a day? What's the rationale for it other than it sounds good?
- Aeolun 7y ago
  Because going out every day and knowing you are not infected feels pretty good?
SideburnsOfDoom 7y ago
Isn't this a minor upgrade on what the authorities did in Wuhan? They squashed the disease at the epicenter, faster than the tail-off in Italy, and a lot of it was massive screening and isolation of anyone showing symptoms, or with a high temperature (1), or testing positive, or anyone in contact with those. If "it happened and it worked" isn't "mainstream" then I don't know what is. 1) https://www.bloomberg.com/news/features/2020-04-23/wuhan-s-return-to-life-temperature-checks-and-constant-anxiety https://www.bloomberg.com/news/features/2020-04-23/wuhan-s-r...

deleted 7y ago

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ahupp 7y ago

Everyone says "we need more testing", but there's actually very little discussion of how that testing would translate into lower transmission. I'm skeptical any program less aggressive than the one proposed here would get R0 < 1.

pb 7y ago
Exactly. More testing is good, but actually stopping pandemic will require orders of magnitude more testing, which in turn requires a different approach to testing because the current way we do testing can't scale.
danielmarkbruce 7y ago
Is it because the discussion isn't needed? Anyone who is of moderate intelligence and thinks for a few seconds can see the next logical step. I don't know pb and he might be wonderful and original etc, but I have to agree with the original comment - this is just miles from an original idea. The constraint is tests, not ideas of what to do when we have simple/fast/abundant testing available.... "A third solution" makes it seem like it's... an original idea.
- sfink 7y ago
  I think calling it a third solution is totally fair. Whether it's a novel solution is separate. The two solutions that are being debated now are (1) staying in lockdown until a vaccine or treatment is available, and (2) reopening and attempting to manage the spread using existing protocols/ideas (relatively low amounts of testing, quarantining after a period of infectiousness, some form of contact tracing, lots of finger crossing). At least, that's generally what I hear being debated: reopen or not, or when to reopen. The post suggests that if we had quantitatively much more testing, we could pick a qualitatively different third solution -- namely, reopen pretty freely and realistically control the spread. Sure, you can view that as a variant of the "reopen" option, but in my mind reopening feels very different with a realistic way to isolate people before they've had a chance to spread it very far. It's proactive vs reactive. If we fully reopen with even 2 orders of magnitude more testing than we're currently doing, it's just going to be a matter of closing back up wherever it gets out of hand. In practice, the openness will fluctuate, things will be spread out over time, politicians will continue to do the exact wrong things, and lots of people will continue to die. In short: (1) stay in lockdown until vaccine/treatment, (2) reopen without a strategy, (3) reopen with a strategy.

tempestn 7y ago

I think the main point is that he's pointing toward a specific test being developed that is intended to facilitate greatly increased degrees of testing. It is of course generally understood that if we could test everyone daily (or even a large section of people regularly), it could allow the virus to be contained without such widespread distancing and shutdown measures. > This test gives results in ten minutes using a small amount of saliva which is taken into a disposable tube and then run through a scanner. > We’re planning to start operating the first scanner within a month. If all goes well, there will be millions of scanners deployed by this fall, ensuring that every school and essential business can reopen while remaining safe and virus-free.

jetaim 7y ago

Agree to that point. The German, French and other media repeat that idea in the past weeks. One of the oldest and largest biomedical institutes, the Robert Koch Institute in Germany, recently had a few press releases, urging for tests for at least ALL respiratory tract infections. What one of the leading experts, Prof. Drosten, also mentioned is that current (PCR) tests have considerable false positives. The effect of such FP at large scale can hardly be estimated. I really hope that you are able to find a solution and can bring up a scalable and reliable solution, after the promises. If not, there will only remain the impression that this could be a Silicon Valley type of talk the walk, as people heard it from other companies in the past.

concordDance 7y ago

Testing isn't the only way. Some people just advocate for isolating the elderly and having everyone else mingle. The life expectancy loss from just letting it run its course would be less than a tenth of the life expectancy difference between the second and third wealth quartiles in the USA. And if we aren't worried about that difference, then why are we imposing a quality of life reduction that's much larger than the quality of life difference between those two quartiles for a much smaller gain in life expectancy? (similarly the economic costs of bringing the lowest quartile up a year or two would be much lower than the cost of this lockdown)

sfink 7y ago
(I'm no epidemiologist etc.) Because that's a terrible idea that doesn't make any sense. I understand the logic and why it's tempting, and I've even read some of the evidence supposedly backing it up. I find it thoroughly unconvincing. I won't address the moral side, just the practical. The virus disproportionately effects the elderly, yes, but far from exclusively. We have seen the non-elderly death rates with distancing in effect. If we could confidently say that >70% of the non-elderly population already had the virus, then this might make some sense. But since at the moment we cannot say that, then this is a method for quickly getting to >90% of the population, and killing off an unknown but far from trivial percentage of us. Also, I have seen some evidence that the magnitude of symptoms is partly dependent on the degree of exposure. If that is the case, I really really do not want to be sitting between two infectious people in a movie theater or sports arena. But this would be commonplace with the whole "let's just sacrifice the elderly" approach.
- concordDance 7y ago
  The idea would be to isolate the vulnerable and let everyone else get it. As a society we have shown time and time again that we only care about "disasters", not the continuous but far greater and less expensively solved losses. Nuclear power vs coal, air plane accidents vs car accidents, the life expectancy reduction of poverty vs COVID-19...