When can we test everyone?
52 points by jeremyw 5 years ago | 48 comments- nostromo 5 years agoWhat we need now is antibody testing, not testing for Covid-19.
All the antibody studies in the US so far are showing that antibodies are present in at least an order of magnitude greater number of people than the official number of people with Covid-19.
This has huge implications for our response. Given this new data, LA is suggesting [1] that ~5% of the population of LA has already developed antibodies, which would mean the fatality rate may be as low as 0.10-0.20%. (For comparison, the seasonal flu is 0.05%-0.10%.)
Knowing if this is really the case for the entire nation would have huge implications for our response.
1. https://www.facebook.com/countyofla/videos/537241533852930/
- matwood 5 years agoThe existing antibody studies have come under scrutiny for a multitude of reasons. One, the samples were not randomized. Two, the tests are not very accurate. Three, we are still unsure what level of antibodies will confer immunity if at all.
Also, a raw fatality rate is useless in a vacuum. NYC has had a lot of deaths and if wasn't for the shelter in place, hospitals may have been completely overwhelmed. Fatality rate be damned.
Finally, comparing COVID-19 to the seasonal flu is simply incorrect in nearly all instances. For example, the seasonal flu fatality rate is likely much lower than listed because of how many cases never get counted. In order to even think about comparing the two, we would also need proper antibody studies done for the season flu in prior years and not just either presented cases or estimates.
Edit - added links to some information
https://sciencebasedmedicine.org/no-covid-19-is-not-just-a-b...
https://www.sciencemag.org/news/2020/04/antibody-surveys-sug...
- throwawayiionqz 5 years agoNumber of deaths in NYC divided by total population is 15,000/8,000,000. This already puts the fatality rate at at least 0.2.
But the consequences are far from over and the number of deaths will keep climbing, so your "fatality rate may be as low as 0.10-0.20%" is completely off the mark.
edit: I am sorry if my tone was interpreted as confrontational. I otherwise agree with the parent's post that we need much more antibody testing.
- nostromo 5 years agoFeel free to take it up with the Stanford researchers and the LA county health commissioner. I'm simply sharing their reports.
- throwawayiionqz 5 years agoI am simply trying to slow the spread of non-sensical numbers. The total population divided by number of deaths provide a factual lower bound and arguing against that is not sensible.
Flaws in the Stanford study has already been highlighted extensively, see for instance https://statmodeling.stat.columbia.edu/2020/04/19/fatal-flaw... and the insightful comments. The issue is not to take it up with the authors but whether the authors might listen and take back what they claimed on popular political TV shows. [1]
- ltbarcly3 5 years agoYou are taking their preliminary, non-peer reviewed data and making poorly founded arguments on top of them.
- 5 years ago
- throwawayiionqz 5 years ago
- nostromo 5 years ago
- bosswipe 5 years agoThose LA and Santa Clara studies have come under intense criticism. From other data it looks like the number is closer to .5% than .1%.
- jonny_eh 5 years agoWhich is still a far cry from the 4% mortality rate predicted in March.
- jonny_eh 5 years ago
- brazzy 5 years ago> All the antibody studies in the US so far are showing that antibodies are present in at least an order of magnitude greater number of people than the official number of people with Covid-19.
These results may not be accurate either, though. At least some antibody tests give false positives for antibodies to other Coronavirus strains.
- gnulinux 5 years agoNY study shows fatality rate can be between 0.5% to 1%. I don't think 0.1% to 0.2% is likely.
- faitswulff 5 years agoAdditionally, we need to find out how long antibodies confer immunity for.
- wonderwonder 5 years agoWe still dont know if the antibodies confer any sort of short / long term immunity at all. For all we know we could get the virus, fight it off and get it again. Rinse and repeat. While all data is useful there is still so much we don't know that hampers us from putting this data to use.
General lack of testing though is going to severely hamper our response to this. Overall unfortunately the federal government has failed to rise to the occasion.
- ltbarcly3 5 years agoWe also know that mortality rates have jumped up well beyond what is being reported in official covid mortality, with no other reasonable explanation apart from Covid.
https://theweek.com/speedreads/910226/excess-mortality-data-...
Frankly, it's just wishful thinking to cherry pick the highest estimate for the number of people who have been infected, and the lowest estimate for the number of deaths.
- ta1771 5 years agoAre we able to test for all 8 strains at once?
- matwood 5 years ago
- jameslevy 5 years agoAre there different tests for antibodies vs. active infections? Or is it just that if you have symptoms and antibodies, that means you have an active infection? For example, many of us who want to see family, etc. at some point may want to test to make sure we're not currently contagious, even if we don't have any symptoms. If we have antibodies and no symptoms, that doesn't necessarily imply that we're not currently contagious.
- didericis 5 years agoYes, there are two types of tests. PCR tests check for active infections, whereas antibody tests check for immunity (For that strain of the virus at least). Antibody tests are only just starting to be done now, and not on a wide scale. It is currently unknown how long the antibodies last, but having antibodies does not mean you have an active infection.
Info sourced from here: https://youtu.be/kgzFAdYwYLM
- smacktoward 5 years agoYes. To see if someone has an active infection, you want an antigen test. To see if someone had an active infection in the past, you want an antibody test. More info at https://www.cnet.com/how-to/coronavirus-testing-what-to-know...
- maxerickson 5 years agoYes, the tests are different.
The tests that look for the virus are probably more accurate than the antibody tests, at least right now.
- dba7dba 5 years agoI have read that S. Korea's disease control center has not approved antibody tests because antibody tests are not accurate enough.
Multiple S. Korean companies submitted test kits for coronavirus for approval, and not all were approved because of insufficient accuracy.
Mainly antibody tests.
- dba7dba 5 years ago
- didericis 5 years ago
- ltbarcly3 5 years agoTesting is only really useful for a handful of things:
- Identifying people who are carriers so they can be isolated
- Contact tracing (pointless at the moment, there are hundreds of thousands of people in the US who are infected)
- Ruling out other diseases or conditions that are treatable
Testing basically doesn't help anyone who has covid, it helps the people they would have spread it to if you can prevent that spread. There is no treatment for covid whatsoever, knowing you have it doesn't help you live longer or become healthy sooner. Knowing you don't have it, if you are already sick, might help if that lets them invest in further testing or treatments for other, non-covid, conditions.
Testing is easy to point at, but at the moment more testing would have limited impact. Even if we were to test everyone in the US, it would have to be done in a relatively short window of time to allow for a significant impact, and it's unlikely that there will be enough testing capacity to use this strategy before we reach saturation levels of infection. If they test me today and I'm negative, then they test you in 6 weeks, what does that get you and me? I was very likely infected in the meantime. This could be used socially like an negative AIDS test, except instead of a few months or years the validity of a test as a social currency is about a week, making it more or less useless as a way to avoid being infected.
- didericis 5 years agoThe biggest benefit would come from antibody testing.
If we could end social isolation for people who have antibodies, which is probably a very large number of people, that’d be a big win.
- dawnerd 5 years agoThat could be dangerous - especially if things like theme parks open up. People without antibodies might risk getting infected just so they can go out and "have fun".
- didericis 5 years agoThat risk already exists.
I think we need to be realistic about containment. A full lockdown until a vaccine is released is the safest option, but it isn’t a sustainable strategy.
The main thing we should focus on is keeping high risk people away from people likely to have active infections, determining hotspots/where to increase/maintain blanket lockdowns, and detecting people with active infections early/getting them to self isolate when they’re just getting sick.
If someone really wants to expose themselves, there isn’t much you can do to stop them short of martial law, which starts a feedback loop of escalating civil unrest. I think you’re likely to have more success keeping people worried about being infected away from people who either don’t care or have antibodies than keeping all the people that want to go out indoors for a year.
- didericis 5 years ago
- ltbarcly3 5 years agoI agree, once they have data to support that antibodies prevent reinfection at a level that would be contagious.
- didericis 5 years agoThat data currently exists, although I’m not sure how definitive it is. A study was conducted where infected monkeys were exposed, which triggered detectable antibodies, and then exposed again. The monkeys did not show signs of the virus upon secondary exposure. I believe the biggest open question is the longevity of those antibodies and whether or not the virus mutates rapidly enough to eventually make the antibodies ineffective. Information comes from this video: https://youtu.be/kgzFAdYwYLM
- didericis 5 years ago
- dawnerd 5 years ago
- pdonis 5 years ago> There is no treatment for covid whatsoever
I don't know where you are getting that from. There is no treatment that guarantees a cure, but there are certainly treatments that have helped some number of people. And testing of people who have symptoms is an integral part of how the health care system decides where to put its resources.
- ltbarcly3 5 years ago> there are certainly treatments that have helped some number of people
This is simply an unsupported false assertion.
Name one treatment that is used for a person with a positive covid test that would be in any respect different from someone with the same symptoms and no test.
- pdonis 5 years ago> This is simply an unsupported false assertion.
Oh, please. There are plenty of confirmed cases of COVID-19 (confirmed by serological testing for the virus itself) that have responded well to a number of treatments.
If you were to say that there is no generally approved treatment protocol (i.e., a guideline that all health organizations agree upon), that would be true. Individual health care providers are having to develop treatment regimes on their own at this point. But the claim you made was much stronger than that.
> Name one treatment that is used for a person with a positive covid test that would be in any respect different from someone with the same symptoms and no test.
Without any test at all you don't even know if the person's respiratory illness is bacterial or viral, so you don't know whether or not antibiotics are indicated.
If you have tested to rule out bacterial infection, that still leaves different possible viral illnesses that have different expected responses to different antiviral drugs, so you need to test further to know which drug is the most likely to help.
For COVID-19 there is also HCL thrown into the mix.
- lurker458 5 years agobloodthinners to prevent clots.
- pdonis 5 years ago
- ltbarcly3 5 years ago
- didericis 5 years ago
- ttcbj 5 years agoFWIW, I think this is a useful idea. But I think it would be more helpful if you clearly explained why you choose those stats and rethought what you are trying to say. I personally care about "When can I feel safe going out?" Testing is just a means to that end.
* I would lead with the % of the population tested (not the total) and make it in the last 7 days, since I really care how likely they are to detect a current outbreak.
* I think to be really useful, it needs to be localized by county, since what I really care about is how likely I am to get infected, and that means I are about testing in my area.
* I would go with the positive rate in the last 7 days. It's important to explain that a high positive rate indicates they are probably only testing people with symptoms, and so they are probably missing lots of infectious asymptomatic cases.
* Then, I think I would drop the recent growth rate in testing, because I suspect that the growth rate is not going to grow consistently, and also that testing growth will be unevenly distributed. I am skeptical that it is meaningful to try to predict when testing will achieve specific milestones.
- klipt 5 years agoWhy would you want to test "everyone"?
For epidemiological purposes, you only need a statistically valid sample, which is much smaller than "everyone".
For medical purposes, you only need to test people who are sick, which is hopefully also much smaller than "everyone".
- ketamine__ 5 years agoAsymptomatic carriers of the virus can self-isolate. Contact tracing can be done at that point as well.
- alistairSH 5 years agoFor medical purposes, you don't even need to test the sick. We don't have treatments available at this time, so the course of treatment doesn't current vary. IE, if you have COVID-like symptoms and are moved to the ICU, the course of treatment is the same with or without a positive test.
I've seen it argued that instead of testing the sick (as we currently do), we should be testing individuals who are "high touch" and likely to infect others (even lacking symptoms). Medical staff, first responders. Pharmacy and grocery employees. Bus drivers. Etc. I don't know enough to argue this is a better approach.
- smacktoward 5 years agoSince an infected person can be contagious for days before showing any symptoms, it'd be ideal if we could regularly test everybody, regardless of whether or not they are currently symptomatic. That way we could get them isolated early, which would prevent them from infecting X other people before they even realize they're sick, as well as cutting down on the number of contacts they've had that would need to be traced.
- smacktoward 5 years ago
- poidos 5 years agoAren’t asymptomatic carriers a big part of the problem? That is, it seems like testing everyone (instead of just testing folks that are sick) enables us to find asymptomatic carriers and isolate them much sooner than (if) they start showing symptoms.
- BurningFrog 5 years agoYou absolutely need to get infected people without symptoms out of infecting people! They don't "get sick", so testing is the only way.
That seems to be the main way this is spreading.
- lbeltrame 5 years agoPeople with antibodies (assuming the test works and is specific enough) may have cleared the infection already and they may enjoy (temporary?) immunity enough for them to resume a part of their activities in a lockdown.
The other goal, as others have said, is to isolate, and contact trace the infected. And I add, early detection might also help with treatment, since the scant evidence so far suggests that pharmacological interventions that target the virus might be more effective early on during the infection.
- maxerickson 5 years agoThe idea is that testing everyone who has a fair chance of being infections makes suppression more effective.
If the goal is to just have everyone get it, but over a longer period of time, it doesn't matter a lot. But that's a shitty goal.
- didericis 5 years agoThis level of isolation can’t be sustained for the year or so it’s going to take until a vaccine is created.
Testing for active infections will help identify people who should self isolate to slow the spread, which is good, but we also should be determining who has antibodies and is able to end self isolation. We need to release some of the social pressure building up and allow people who are ok to go out again to do so.
- didericis 5 years ago
- ketamine__ 5 years ago
- JohnTHaller 5 years agoWe don't have anywhere near enough tests. We also don't know how many tests are actually available or will become available as the administration has repeatedly thrown out incorrect numbers without coming anywhere close to them.
- bhobs 5 years ago>everyone
In the us.
Nice.
- Waterluvian 5 years agoI'm not upset but indeed, you get reminded daily that you're not American because of sites like this.
- slap 5 years agoI knew it would be US-specific by the website name...
- ecmascript 5 years agoAs a european I immedietly suspected this before clicking the link. Was not disappointed.
This is very funny.
- davidw 5 years agoOTOH, most of Europe is probably ahead of the US. Italy and Germany are certainly doing a lot more tests per capita. So I guess it's not so bad...
- RandallBrown 5 years agoAnd parts of the US are ahead of Italy and Germany.
- RandallBrown 5 years ago
- davidw 5 years ago
- Waterluvian 5 years ago