7 ms·

The thing that will restore trust: Clear and transparent daily reporting of comprehensive contact-tracing results.

by ISL 6y ago

pmoriarty 6y ago
You don't even need to contact trace if everyone gets tested every day.[1] The most promising plan I've heard along these lines is detailed in a recent episode of This Week in Virology.[2] This is possible, practical, and affordable. The technology for fast pregnancy-test style tests for COVID-19 exists right now, and they could cost as little as $1 per test. The reason these tests aren't being used yet is because of the FDA's misguided requirements for extremely high sensitivity for COVID-19 tests. If these requirements could be relaxed to allow lower-sensitivity tests, then these tests could go out on the market... or, better yet, the government could take over and ensure everyone gets tested with these tests every day for $1 a test. Even a more limited plan of testing everyone in just highly affected areas would be way better than what we've got now. [1] - People could, for instance, get tested each morning, and be required to present their daily test results upon arriving at work (or even online, from home, before they start their commute). If they test positive, they just stay home for a couple of weeks and then go back to work when they test negative again. People at work will have confidence all their colleagues (and virtually everyone else out and about) have tested negative. [2] - Starting at about 6'20" in to episode 640: https://www.microbe.tv/twiv/twiv-640/ https://www.microbe.tv/twiv/twiv-640/
- sp332 6y ago
  Testing everyone every day seems unrealistic in the near term. New York's test latency is up to 7 days, which is already beyond the median time for symptoms to appear. Contact tracing would let potentially-affected people quarantine and wait for their test results while other people keep going out. Increasing the number of tests quickly would probably make the latency longer.
  - tylerhou 6y ago
    The test described in the podcast give results back nearly instantly. They are just less sensitive than currently approved tests, but according to the podcast that doesn't matter too much for various reasons.
- ImaCake 6y ago
  I want to quickly plug TWIV here. It is an incredible podcast. I have listened to it for several years, along with its sister podcasts, and have found it incredible useful as a professional scientists and also just for the wonderful stories. The science they discuss is always good. During COVID they have really stepped up to provide clear and well grounded information to their listeners about the pandemic. Every friday they have been releasing an episode where a doctor on the front lines of the NY pandemic has given a medical update on symptoms and treatments. Invaluable information!
- morsch 6y ago
  > The technology for fast pregnancy-test style tests for COVID-19 exists right now, and they could cost as little as $1 per test. Antibody tests or antigen tests? I'm aware of that style of tests for the former but not the latter. You need the latter to do what you describe.
  - wittyreference 6y ago
    We can do fast, pregnancy-test-style serology now. BD is pushing one to market. 15min turn-around time. The problem is that their % positive agreement is too low (<90%), and their % negative agreement is based on the PCR benchmark which already churns out a false negative rate of roundabout 30%. And even their positives are only reasonably reliable (<90%) during peak symptoms. If you're pre, post, or low symptomaticity, its accuracy isnt even characterized (but believed to be low.) Given all of the above, hyping them up is ... well, ignorant of all of the above, one hopes.
    - glaugh 6y ago
      Can you add a citation for the false positives number? The Abbott Labs test false positive rate was 0.02%, which seems totally acceptable to me https://www.statnews.com/2020/05/15/fda-says-abbotts-5-minute-covid-19-test-may-miss-infected-patients/ https://www.statnews.com/2020/05/15/fda-says-abbotts-5-minut... On the other side of the equation, Mina’s point (see paper in my other comment) is that with frequent enough testing, the math of the epidemiology indicates that the sensitivity does not need to be terribly high to have a huge impact on the trajectory of the pandemic Edit: I see now that you were talking about antibodies, not antigens, sorry
      - wittyreference 6y ago
        https://www.bd.com/documents/brochures/microbiology-solutions/IDS_469-WW-0420_BD_Veritor_SARS-CoV-2_BR_EN.pdf https://www.bd.com/documents/brochures/microbiology-solution... The low %positive agreement generates false negatives, though, not false positives. False positives, for this context, would be fine.
    - 6y ago
- salakotolu 6y ago
  > People could, for instance, get tested each morning, and be required to present their daily test results upon arriving at work I don't think test turnaround time is this quick in the U.S.
  - pmoriarty 6y ago
    Only because they're using the wrong type of tests.
- fxtentacle 6y ago
  If your test has a 5% false positive rate, which is considered normal, then you'll be misdiagnosed as sick on average once per month. That seems not too helpful.
  - glaugh 6y ago
    Abbott Labs FP rate was stated as 0.02% https://www.statnews.com/2020/05/15/fda-says-abbotts-5-minute-covid-19-test-may-miss-infected-patients/ https://www.statnews.com/2020/05/15/fda-says-abbotts-5-minut...
  - pmoriarty 6y ago
    If you're testing every day, the false positives and false negatives will wash out after another test or two. The more you test, the more confidence you can have in multiple consistent test results.
- _jal 6y ago
  > You don't even need to contact trace if everyone gets tested every day If you have a factory capable putting out 350M tests/day (let's not even get in to logistics or the next steps), please hang out your shingle. If not, then perhaps considering plans within the realm of possibility is a better use of time.
  - glaugh 6y ago
    Paper: https://www.medrxiv.org/content/10.1101/2020.06.22.20136309v2.full.pdf+html https://www.medrxiv.org/content/10.1101/2020.06.22.20136309v... Op ed: https://www.nytimes.com/2020/07/03/opinion/coronavirus-tests.html https://www.nytimes.com/2020/07/03/opinion/coronavirus-tests... This isn’t like PCR testing. It’s closer to insulin testing, in terms of the expense and difficulty of creation of the tests (and the means of interpreting the results). 350M is well within the range of possibility. And the reward to having a reopened economy and significantly reduced death toll could justify very large investment.
  - pmoriarty 6y ago
    "If you have a factory capable putting out 350M tests/day (let's not even get in to logistics or the next steps), please hang out your shingle." From the above mentioned TWiV podcast[1]: "Take every manufacturing company that knows how to print paper, adapt their tools to print monoclonal antibodies on to those sheets and just start slicing it up and shipping it out. It's as easy as that, I mean, you know, I'm simplifying it a bit, but..." And, as the host of TWiV said in an earlier podcast[2]: "It's not undoable. If this were World War 2, you would figure out a way to do it! This is war. This is World War C19. I don't accept excuses. I got a letter from a laboratory person who said 'You have no idea what it takes to develop and execute a test, how many people, how much this and how much that..' and I said 'You're missing the point. You gotta try. You can't say why you can't do it. This is war. Let's do it!" In fact, I believe he's actually understating the point. This disease has the potential to kill more Americans than died in all of the wars its ever been in combined, if it hasn't already. The stakes are enormous. Let's get it done. [1] - from about 32 minutes in to podcast 640 - https://www.microbe.tv/twiv/twiv-640/ https://www.microbe.tv/twiv/twiv-640/ [2] - from about 1 hour, 47 minutes in to podcast 638 - https://www.microbe.tv/twiv/twiv-638/ https://www.microbe.tv/twiv/twiv-638/
sorenn111 6y ago
With a disease that has such uncertainty over its spread, its long term effects, and its recovery, I think it's silly to be certain about what will restore trust and how this will play out. to your suggestion, what is a contact tracing result look like? anonymized -> 53 persons tested positive today who had near contact with 204 persons? how does that restore trust? I can't imagine you meant non anonymized.
- creaghpatr 6y ago
  > With a disease that has such uncertainty over its spread, its long term effects, and its recovery, I think it's silly to be certain about what will restore trust and how this will play out. I see this comment a lot among friends and family, I call it ‘Blank-Checking’ because you can use it to basically shut down any argument, no questions asked.
  - tux1968 6y ago
    Well since the discussion is about what it will take to convince people it's safe to go back to work, any proposed strategy will have to deal with that tendency.
- ISL 6y ago
  A sample template that I believe would go a long way to restoring trust: "Thursday in King County, contact tracers tracked cases from 301 of the 672 new cases identified Wednesday. They contacted and referred 5,000 people for quarantine and testing. Tuesday's contact tracing efforts identified 15% of the cases reported Wednesday, up from 5% a week ago. The number of contact tracers working in King County will expand from 300 to 1500 in the coming week. We continue to see a high volume of cases associated with the Home Depot on Aurora, the Wallingford QFC, and UW's fraternity row. If you have been to any of these places within the last two weeks, we encourage you to seek testing immediately. Testing is free, takes less than two minutes, and wait-times are less than ten minutes at most testing sites across Seattle. For more information, visit covid.seattle.gov or call 206-555-1212. Your assistance is deeply appreciated. The sooner we can contact-trace every case, the sooner we can stop the COVID-19 outbreak and return to life as normal." As daily reporting of this sort becomes part of the rhythm of life, it will both build trust and point the way for the community and government to reach to ~90%+ contact-tracing coverage. When full contact-tracing coverage is achieved, the case count can begin to drop rapidly. This fight can be won. Winning saves lives.
blumomo 6y ago
Trust will be restored when the data concerning death rates will be truthfully collected reported. The real numbers are so low that in my eyes there’s no for contact-tracing but a truthful management and interpretation of death rates, which are, again, very low.
- hilbertseries 6y ago
  Can you expand a little bit on why you think the official numbers are inaccurate. Last time I checked excess mortality this year was either equal or more than the reported covid deaths.
  - blumomo 6y ago
    No, I won’t do that work for you. Get some serious numbers for yourself and see.
x87678r 6y ago
The contact tracing in US is non-existant. My town has tracers but they dont seem to do much. Our neighbour was positive but wasn't even asked where she went. BTW has any country with good contact tracing posted any details about where most people get infected? I can't believe we're 6 months into this and still don't know if grocery shopping is risky or not. In the US I read all the updates but still dont know who is getting infected or where.
- fxtentacle 6y ago
  In Germany, the consensus is that indoor 15+ minutes is risky. So outdoor farmers market, beach, takeaway are all fine. But for supermarkets, everyone has to wear a mask to keep the air safe to breathe. Smear infection appears highly unlikely. So grocery shopping can be both risky or safe, depending on whether it's inside or outside and whether people wear masks or not. Accordingly, most infections occur at private parties, in indoor restaurants, and in crowded factories, like meat processing plants.
- salakotolu 6y ago
  This. I doubt the human capital required would make any financial sense for many companies. Digital contact tracing, on the other hand, is also a bust. I wrote a 10 min post on it - https://tolusnotes.com/state-of-digital-contact-tracing-in-the-united-states/ https://tolusnotes.com/state-of-digital-contact-tracing-in-t...
- tunesmith 6y ago
  Here in Oregon, the latest update was that they had fallen under the 95% benchmark for contact tracing. I don't know the details on what that 95% measures. Also, they mentioned that while in the past, most case counts were from breakouts, that has changed. Now most case counts are "sporadic" cases, meaning no known infection source. The implication is that it's just out there in the general public now. Oregon also currently has lousy test availability, at least as of a couple of days ago. One person I know seeking a test was basically denied - they couldn't even get scheduled. Something about too many tests being sent from Oregon to California and Arizona.
- sp332 6y ago
Ar-Curunir 6y ago
No amount of contact-tracing can make believe that jobs that pay a pittance are worth risking one's life for.
- ISL 6y ago
  Contact tracing is the way to allow individual citizens to accurately assess which jobs are risky.

The thing that will restore trust: Clear and transparent daily reporting of comprehensive contact-tracing results.

by ISL 6y ago

The thing that will restore trust: Clear and transparent daily reporting of comprehensive contact-tracing results.

You don't even need to contact trace if everyone gets tested every day.[1] The most promising plan I've heard along these lines is detailed in a recent episode of This Week in Virology.[2] This is possible, practical, and affordable. The technology for fast pregnancy-test style tests for COVID-19 exists right now, and they could cost as little as $1 per test. The reason these tests aren't being used yet is because of the FDA's misguided requirements for extremely high sensitivity for COVID-19 tests. If these requirements could be relaxed to allow lower-sensitivity tests, then these tests could go out on the market... or, better yet, the government could take over and ensure everyone gets tested with these tests every day for $1 a test. Even a more limited plan of testing everyone in just highly affected areas would be way better than what we've got now. [1] - People could, for instance, get tested each morning, and be required to present their daily test results upon arriving at work (or even online, from home, before they start their commute). If they test positive, they just stay home for a couple of weeks and then go back to work when they test negative again. People at work will have confidence all their colleagues (and virtually everyone else out and about) have tested negative. [2] - Starting at about 6'20" in to episode 640: https://www.microbe.tv/twiv/twiv-640/ https://www.microbe.tv/twiv/twiv-640/

sp332 6y ago
Testing everyone every day seems unrealistic in the near term. New York's test latency is up to 7 days, which is already beyond the median time for symptoms to appear. Contact tracing would let potentially-affected people quarantine and wait for their test results while other people keep going out. Increasing the number of tests quickly would probably make the latency longer.
- tylerhou 6y ago
  The test described in the podcast give results back nearly instantly. They are just less sensitive than currently approved tests, but according to the podcast that doesn't matter too much for various reasons.
ImaCake 6y ago
I want to quickly plug TWIV here. It is an incredible podcast. I have listened to it for several years, along with its sister podcasts, and have found it incredible useful as a professional scientists and also just for the wonderful stories. The science they discuss is always good. During COVID they have really stepped up to provide clear and well grounded information to their listeners about the pandemic. Every friday they have been releasing an episode where a doctor on the front lines of the NY pandemic has given a medical update on symptoms and treatments. Invaluable information!
morsch 6y ago
> The technology for fast pregnancy-test style tests for COVID-19 exists right now, and they could cost as little as $1 per test. Antibody tests or antigen tests? I'm aware of that style of tests for the former but not the latter. You need the latter to do what you describe.
- wittyreference 6y ago
  We can do fast, pregnancy-test-style serology now. BD is pushing one to market. 15min turn-around time. The problem is that their % positive agreement is too low (<90%), and their % negative agreement is based on the PCR benchmark which already churns out a false negative rate of roundabout 30%. And even their positives are only reasonably reliable (<90%) during peak symptoms. If you're pre, post, or low symptomaticity, its accuracy isnt even characterized (but believed to be low.) Given all of the above, hyping them up is ... well, ignorant of all of the above, one hopes.
  - glaugh 6y ago
    Can you add a citation for the false positives number? The Abbott Labs test false positive rate was 0.02%, which seems totally acceptable to me https://www.statnews.com/2020/05/15/fda-says-abbotts-5-minute-covid-19-test-may-miss-infected-patients/ https://www.statnews.com/2020/05/15/fda-says-abbotts-5-minut... On the other side of the equation, Mina’s point (see paper in my other comment) is that with frequent enough testing, the math of the epidemiology indicates that the sensitivity does not need to be terribly high to have a huge impact on the trajectory of the pandemic Edit: I see now that you were talking about antibodies, not antigens, sorry
    - wittyreference 6y ago
      https://www.bd.com/documents/brochures/microbiology-solutions/IDS_469-WW-0420_BD_Veritor_SARS-CoV-2_BR_EN.pdf https://www.bd.com/documents/brochures/microbiology-solution... The low %positive agreement generates false negatives, though, not false positives. False positives, for this context, would be fine.
  - 6y ago
salakotolu 6y ago
> People could, for instance, get tested each morning, and be required to present their daily test results upon arriving at work I don't think test turnaround time is this quick in the U.S.
- pmoriarty 6y ago
  Only because they're using the wrong type of tests.
fxtentacle 6y ago
If your test has a 5% false positive rate, which is considered normal, then you'll be misdiagnosed as sick on average once per month. That seems not too helpful.
- glaugh 6y ago
  Abbott Labs FP rate was stated as 0.02% https://www.statnews.com/2020/05/15/fda-says-abbotts-5-minute-covid-19-test-may-miss-infected-patients/ https://www.statnews.com/2020/05/15/fda-says-abbotts-5-minut...
- pmoriarty 6y ago
  If you're testing every day, the false positives and false negatives will wash out after another test or two. The more you test, the more confidence you can have in multiple consistent test results.
_jal 6y ago
> You don't even need to contact trace if everyone gets tested every day If you have a factory capable putting out 350M tests/day (let's not even get in to logistics or the next steps), please hang out your shingle. If not, then perhaps considering plans within the realm of possibility is a better use of time.
- glaugh 6y ago
  Paper: https://www.medrxiv.org/content/10.1101/2020.06.22.20136309v2.full.pdf+html https://www.medrxiv.org/content/10.1101/2020.06.22.20136309v... Op ed: https://www.nytimes.com/2020/07/03/opinion/coronavirus-tests.html https://www.nytimes.com/2020/07/03/opinion/coronavirus-tests... This isn’t like PCR testing. It’s closer to insulin testing, in terms of the expense and difficulty of creation of the tests (and the means of interpreting the results). 350M is well within the range of possibility. And the reward to having a reopened economy and significantly reduced death toll could justify very large investment.
- pmoriarty 6y ago
  "If you have a factory capable putting out 350M tests/day (let's not even get in to logistics or the next steps), please hang out your shingle." From the above mentioned TWiV podcast[1]: "Take every manufacturing company that knows how to print paper, adapt their tools to print monoclonal antibodies on to those sheets and just start slicing it up and shipping it out. It's as easy as that, I mean, you know, I'm simplifying it a bit, but..." And, as the host of TWiV said in an earlier podcast[2]: "It's not undoable. If this were World War 2, you would figure out a way to do it! This is war. This is World War C19. I don't accept excuses. I got a letter from a laboratory person who said 'You have no idea what it takes to develop and execute a test, how many people, how much this and how much that..' and I said 'You're missing the point. You gotta try. You can't say why you can't do it. This is war. Let's do it!" In fact, I believe he's actually understating the point. This disease has the potential to kill more Americans than died in all of the wars its ever been in combined, if it hasn't already. The stakes are enormous. Let's get it done. [1] - from about 32 minutes in to podcast 640 - https://www.microbe.tv/twiv/twiv-640/ https://www.microbe.tv/twiv/twiv-640/ [2] - from about 1 hour, 47 minutes in to podcast 638 - https://www.microbe.tv/twiv/twiv-638/ https://www.microbe.tv/twiv/twiv-638/

sorenn111 6y ago

With a disease that has such uncertainty over its spread, its long term effects, and its recovery, I think it's silly to be certain about what will restore trust and how this will play out. to your suggestion, what is a contact tracing result look like? anonymized -> 53 persons tested positive today who had near contact with 204 persons? how does that restore trust? I can't imagine you meant non anonymized.

creaghpatr 6y ago
> With a disease that has such uncertainty over its spread, its long term effects, and its recovery, I think it's silly to be certain about what will restore trust and how this will play out. I see this comment a lot among friends and family, I call it ‘Blank-Checking’ because you can use it to basically shut down any argument, no questions asked.
- tux1968 6y ago
  Well since the discussion is about what it will take to convince people it's safe to go back to work, any proposed strategy will have to deal with that tendency.
ISL 6y ago
A sample template that I believe would go a long way to restoring trust: "Thursday in King County, contact tracers tracked cases from 301 of the 672 new cases identified Wednesday. They contacted and referred 5,000 people for quarantine and testing. Tuesday's contact tracing efforts identified 15% of the cases reported Wednesday, up from 5% a week ago. The number of contact tracers working in King County will expand from 300 to 1500 in the coming week. We continue to see a high volume of cases associated with the Home Depot on Aurora, the Wallingford QFC, and UW's fraternity row. If you have been to any of these places within the last two weeks, we encourage you to seek testing immediately. Testing is free, takes less than two minutes, and wait-times are less than ten minutes at most testing sites across Seattle. For more information, visit covid.seattle.gov or call 206-555-1212. Your assistance is deeply appreciated. The sooner we can contact-trace every case, the sooner we can stop the COVID-19 outbreak and return to life as normal." As daily reporting of this sort becomes part of the rhythm of life, it will both build trust and point the way for the community and government to reach to ~90%+ contact-tracing coverage. When full contact-tracing coverage is achieved, the case count can begin to drop rapidly. This fight can be won. Winning saves lives.

blumomo 6y ago

Trust will be restored when the data concerning death rates will be truthfully collected reported. The real numbers are so low that in my eyes there’s no for contact-tracing but a truthful management and interpretation of death rates, which are, again, very low.

hilbertseries 6y ago
Can you expand a little bit on why you think the official numbers are inaccurate. Last time I checked excess mortality this year was either equal or more than the reported covid deaths.
- blumomo 6y ago
  No, I won’t do that work for you. Get some serious numbers for yourself and see.

x87678r 6y ago

The contact tracing in US is non-existant. My town has tracers but they dont seem to do much. Our neighbour was positive but wasn't even asked where she went. BTW has any country with good contact tracing posted any details about where most people get infected? I can't believe we're 6 months into this and still don't know if grocery shopping is risky or not. In the US I read all the updates but still dont know who is getting infected or where.

fxtentacle 6y ago
In Germany, the consensus is that indoor 15+ minutes is risky. So outdoor farmers market, beach, takeaway are all fine. But for supermarkets, everyone has to wear a mask to keep the air safe to breathe. Smear infection appears highly unlikely. So grocery shopping can be both risky or safe, depending on whether it's inside or outside and whether people wear masks or not. Accordingly, most infections occur at private parties, in indoor restaurants, and in crowded factories, like meat processing plants.
salakotolu 6y ago
This. I doubt the human capital required would make any financial sense for many companies. Digital contact tracing, on the other hand, is also a bust. I wrote a 10 min post on it - https://tolusnotes.com/state-of-digital-contact-tracing-in-the-united-states/ https://tolusnotes.com/state-of-digital-contact-tracing-in-t...
tunesmith 6y ago
Here in Oregon, the latest update was that they had fallen under the 95% benchmark for contact tracing. I don't know the details on what that 95% measures. Also, they mentioned that while in the past, most case counts were from breakouts, that has changed. Now most case counts are "sporadic" cases, meaning no known infection source. The implication is that it's just out there in the general public now. Oregon also currently has lousy test availability, at least as of a couple of days ago. One person I know seeking a test was basically denied - they couldn't even get scheduled. Something about too many tests being sent from Oregon to California and Arizona.
sp332 6y ago

Ar-Curunir 6y ago

No amount of contact-tracing can make believe that jobs that pay a pittance are worth risking one's life for.

ISL 6y ago
Contact tracing is the way to allow individual citizens to accurately assess which jobs are risky.