Testing and Contact Tracing - What Do We Need?

[Midpack]

Anyone else really tired of the nonstop non-specific reporting on testing - we have enough versus not enough - without anyone saying anything about what IS enough! What does more of that accomplish? Most of the reports I’ve seen on testing have been useless, only spurring confusion (and partisanship).

And I’ve yet to see anything specific on contact tracing, how many people have any idea what it entails, and who’s going to to do it?

After reading many useless reports, I found this - but when will journalists actually quantify what’s needed and how to work toward it? Stop wasting time with vague information.

The US has so far tested about 3.3m people, about 1% of its population. Per capita, that is small compared with several countries including Germany and South Korea. Iceland has tested people at 10 times the US rate.

Daily testing has flattened out and is now hovering around 150,000 tests a day – vastly below the level that would be needed to detect localized pockets of disease as the economy reopens. Most alarmingly, the number of tests carried out by commercial labs has actually plummeted in recent days due to shortages in test samples, leaving the labs sitting idle.

Estimates vary on how much testing will be needed, but they are all substantially greater than present provision. Even at the lower end, as posited by the former commissioner of the US Food and Drug Administration Scott Gottlieb, some 2m to 3m tests a day are recommended – up to three times the current level.

Harvard’s Safra Center for Ethics argues that is too few. It calls for tens of millions of tests every day, way beyond existing capacity.

As the Johns Hopkins plan makes clear, diagnostic testing is only the start. It must be combined with relentless detective work, called “contact tracing”, to track down anyone who has come into contact with an infected person and who might need quarantining to stop the virus spreading again.

The Johns Hopkins plan envisages a nationwide army of 100,000 contact tracers. “That might sound eye-popping, but it’s reasonable and may be a low estimate,” Cicero said, pointing out that in Wuhan, China, the authorities employed a workforce three times the size per capita.

https://www.theguardian.com/us-news...ond-historic-failure-of-leadership-from-trump

 

[audreyh1]

There is a severe shortage of swabs which has created a big testing bottleneck. The FDA is in the process of approving some synthetic swabs that can be produced much more rapidly. https://www.statnews.com/2020/04/16/fda-changes-coronavirus-testing-swabs/

Contact tracing will require a large number of people. The economies that have been able to shutdown far less or almost not at all, have invested heavily in testing and contact tracing to contain spread.

 

[ivinsfan]

oh my gosh, what kind of bubble do the JH people live in? 100,000 contact tracers and it's "reasonable and a low estimate" Where do they come up with stuff?

I still don't know what widespread testing will accomplish. I haven't left my farm in 5 weeks except for 3 food pickups (in the trunk) at Walmart. and haven't seen anyone but my DH..what could possible be accomplished by testing the two of us..I had a nephew in ND, who was literally a third degree contact...first and only positive test a family member of a coworker. they then called all coworkers, then called my nephew who was a room mate of an uninfected coworker...the only positive test in the entire group was the family member of the coworker. MY DN was told to quarantine. How many degrees of separation is reasonable going forward.

 

[Midpack]

oh my gosh, what kind of bubble do the JH people live in? 100,000 contact tracers and it's "reasonable and a low estimate" Where do they come up with stuff?

I still don't know what widespread testing will accomplish. I haven't left my farm in 5 weeks except for 3 food pickups (in the trunk) at Walmart. and haven't seen anyone but my DH..what could possible be accomplished by testing the two of us..I had a nephew in ND, who was literally a third degree contact...first and only positive test a family member of a coworker. they then called all coworkers, then called my nephew who was a room mate of an uninfected coworker...the only positive test in the entire group was the family member of the coworker. MY DN was told to quarantine. How many degrees of separation is reasonable going forward.

What’s been the substantial difference in (per capita or otherwise) coronavirus cases and deaths for the US versus South Korea, Germany, Taiwan, Hong Kong, and Singapore? Testing has been a part of their relative success.

And no one is suggesting we need to test everyone everywhere, that would be 327 million tests.

What’s your suggestion regarding testing protocol and/or contact tracing?

 

[ivinsfan]

What’s been the substantial difference in (per capita or otherwise) results for the US versus South Korea, Germany, Taiwan, Hong Kong, and Singapore? And no one is suggesting we need to test everyone everywhere, that would be 327 million tests.

I don't know... because as you say there are many reports and so many stats, how would one even begin to figure that out...

I keep coming back to the fact our state is restricting testing to certain high risk groups and high exposure people(i.e. health care). On any given day around 93-94% of the COVID tests come back negative. Some days a couple % higher and some days a couple % lower but long term its about 95% negative.

 

[Gumby]

oh my gosh, what kind of bubble do the JH people live in? 100,000 contact tracers and it's "reasonable and a low estimate" Where do they come up with stuff?

I still don't know what widespread testing will accomplish. I haven't left my farm in 5 weeks except for 3 food pickups (in the trunk) at Walmart. and haven't seen anyone but my DH..what could possible be accomplished by testing the two of us..I had a nephew in ND, who was literally a third degree contact...first and only positive test a family member of a coworker. they then called all coworkers, then called my nephew who was a room mate of an uninfected coworker...the only positive test in the entire group was the family member of the coworker. MY DN was told to quarantine. How many degrees of separation is reasonable going forward.

I think it is fairly obvious that you and people like you would be among the last to be tested. Where more robust testing and tracing would be important are the areas where people live cheek by jowl, such as NYC.

 

[Midpack]

I don't know... because as you say there are many reports and so many stats, how would one even begin to figure that out...

I keep coming back to the fact our state is restricting testing to certain high risk groups and high exposure people(i.e. health care). On any given day around 93-94% of the COVID tests come back negative. Some days a couple % higher and some days a couple % lower but long term its about 95% negative.

If we don’t get a handle on who’s infected and in contact with, we’re all susceptible.

Again, what’s your suggestion if you don’t want to model what’s been more successful in a half dozen other countries? Stay at home until there’s a vaccine? Open up and hope for the best?

 

[ivinsfan]

I think it is fairly obvious that you and people like you would be among the last to be tested. Where more robust testing and tracing would be important are the areas where people live cheek by jowl, such as NYC.

That's already happening as I couldn't get a test here if I wanted one...certainly when our borders and air travel resume I'd put people transiting from one locale to another on a testing protocol. But that brings it's own set of questions.

Through testing China is seeing new clusters coming in through Russia...that kind of testing probably should be a priority.

 

[ivinsfan]

If we don’t get a handle on who’s infected and in contact with, we’re all susceptible.

Again, what’s your suggestion if you don’t want to model what’s been more successful in a half dozen other countries? Stay at home until there’s a vaccine? Open up and hope for the best?

Your reading something into my posts that isn't intended. I was asking people's opinion as to how we would actually implement contact tracing and how many degrees of contact would be needed to be useful.

How do we even get 100K contact tracing workers up and running? It's kind of liking the testing thing. Some portion of things needed for tests always seems to be missing either the tests, or the swabs, or the regent needed or the lab capacity.

I'd love it if there was a simple answer here ...

If you have to test a limited number of people and restrict it to the sick, the high risk and the greatly exposed ( medical people), is is not useful info that well over 90% test negative?

I'm not against widespread testing, certainly it would be useful but I would say we aren't there yet...and a test is just a snapshot in time of one person on one day...

 

[Bir48die]

Your reading something into my posts that isn't intended. I was asking people's opinion as to how we would actually implement contact tracing and how many degrees of contact would be needed to be useful.



How do we even get 100K contact tracing workers up and running? It's kind of liking the testing thing. Some portion of things needed for tests always seems to be missing either the tests, or the swabs, or the regent needed or the lab capacity.



I'd love it if there was a simple answer here ...

Bunch it with the census and bang! you kill two birds with one stone

 

[ivinsfan]

Even the census is off schedule this year

 

[Rianne]

I keep forgetting it's been ~5 weeks since we even took this virus seriously. Suddenly, everyone and their brother is a medical expert citing various articles, studies, interviews and documentaries. I'm #1 guilty here. Heck, we just got back from SPI 7 weeks ago. Feels like an eternity. It took me a year to get tested for an unusual lump I had. Was cancer.

 

[brewer12345]

oh my gosh, what kind of bubble do the JH people live in? 100,000 contact tracers and it's "reasonable and a low estimate" Where do they come up with stuff?

I still don't know what widespread testing will accomplish. I haven't left my farm in 5 weeks except for 3 food pickups (in the trunk) at Walmart. and haven't seen anyone but my DH..what could possible be accomplished by testing the two of us..I had a nephew in ND, who was literally a third degree contact...first and only positive test a family member of a coworker. they then called all coworkers, then called my nephew who was a room mate of an uninfected coworker...the only positive test in the entire group was the family member of the coworker. MY DN was told to quarantine. How many degrees of separation is reasonable going forward.

It is probably OK if both of the people living in ND go back to work. Ditto WY. Elsewhere? We simply don't have the basic stuff we need to do that.

Its hard to understand what big cities are like if you are living an isolated life on a farm. You literally cannot stay away from other people and survive. It just isn't possible. I live in suburbia and I can only stay away from other people if I take care to do so.

Like you, I could not get tested for love nor money if I wanted to. My entire state about manages to do 1500 tests or so a day after a concerted effort to test as much as possible. This is despite the fact that we have a population pushing 6 million and have multiple clusters in ski resort towns and urban areas. My county is #2 in the state for confirmed cases and good luck getting a test.

Once you get testing capacity somewhere in the region of the minimum necessary, you will need the contact tracers to do something about positive tests. If you are going to have even a partial reopening, you will need to be able to quickly follow up on positives and do localized lockdowns and quarantines to prevent a wider spread. Hopefully we get an effective treatment sometime this year that A) we know how to manufacture and B) can be rapidly distributed widely to hospitals. Not seen anything like it yet.

 

[Midpack]

If we don’t get a handle on who’s infected and in contact with, we’re all susceptible.

Again, what’s your suggestion if you don’t want to model what’s been more successful in a half dozen other countries? Stay at home until there’s a vaccine? Open up and hope for the best?

Your reading something into my posts that isn't intended. I was asking people's opinion as to how we would actually implement contact tracing and how many degrees of contact would be needed to be useful.

I'm not against widespread testing, certainly it would be useful but I would say we aren't there yet...

You also questioned testing in your first post below, that’s what I’m asking about. Though now you’re for widespread testing? What’s your suggestion?

I still don't know what widespread testing will accomplish.

 

[misanman]

Any ideas of how often someone should get tested if the have a negative result? Every week? Once a month? Just wondering how all this testing would work.

 

[pacergal]

There is testing for active disease and testing for protective(hopefully) antibodies. This country is unable to accomplish either one on the level needed for adequate epidemiology /contact tracing and notification, IMHO.
The amount of tests/supplies/labs/personnel is something that needs to be done on the grand scale, States are not equipped to do this individually, it really needs to be co ordinated by the Federal government, again IMHO.
But I am only a random old Public Health RN, feeling a bit frustrated and b****y this morning, sorry for the rant.

 

[Rianne]

Any ideas of how often someone should get tested if the have a negative result? Every week? Once a month? Just wondering how all this testing would work.

Good point, and how much would that cost?

 

[brewer12345]

Good point, and how much would that cost?

Less than shutting down the economy.

Really, we don't need to test the population. What we need is the ability to test suspected cases and anyone they have been i contact with. We do not have that.

 

[ivinsfan]

You also questioned testing in your first post below, that’s what I’m asking about. Though now you’re for widespread testing? What’s your suggestion?

Have I said something to make you mad, you cut and pasted both my posts and bolded in red and in fact the edits you made discounted what I was trying to talk about. ...saying I'm not sure what it would accomplish isn't the same as saying I'm against it ... I thought we were discussing practicalities here... not that I was defending a PHD thesis.

Do you think getting a reliable antibodies test widely available would be more valuable then putting all that time and money into widespread testing?

I already said I don't know what the proper course going forward is, what do you think we should do?

 

[brewer12345]

Do you think getting a reliable antibodies test widely available would be more valuable then putting all that time and money into widespread testing?

It would be helpful, but not a silver bullet. We don't have such a test widely available and probably won't for months. Once we do, we don't know what the test id telling us other than who has been exposed. Nobody knows if you have partial or total immunity if you have been exposed.

 

[USGrant1962]

What’s been the substantial difference in (per capita or otherwise) coronavirus cases and deaths for the US versus South Korea, Germany, Taiwan, Hong Kong, and Singapore? Testing has been a part of their relative success.

And no one is suggesting we need to test everyone everywhere, that would be 327 million tests.

What’s your suggestion regarding testing protocol and/or contact tracing?

FWIW, the US has now passed South Korea and Taiwan in tests per million people according to: https://www.worldometers.info/coronavirus/#countries

Even Germany's ~20,000 tests per million people is only 2% tested (probably really <1% due to medical workers and infecteds getting tested multiple times).

 

[Chuckanut]

Anyone else really tired of the nonstop non-specific reporting on testing - we have enough versus not enough - without anyone saying anything about what IS enough! What does more of that accomplish? Most of the reports I’ve seen on testing have been useless, only spurring confusion (and partisanship).

+1

A few days ago I watched the entire White House CV19 press conference paying special attention to what the two Drs. and the CDC guy said. I pretty much discounted input from politicians. I actually felt better about our national situation for a while as it seems that somebody is getting a handle on this thing and focusing our efforts in a worthwhile direction.

Then, I watched the newscasts that told us about what when on in the press conference. Big Mistake. Either I have a terrible memory or the press can't report a news item accurately to save their lives (and reputations). Trivial useless generalities poured forth, leaving me wondering what in the world was going on. Then they tossed in anecdotal 'evidence' like a crying nurse who says she can't get tested for CV19 which, while very sad, is not necessarily reflective of what is happening nation wide, and did nothing to explain why she could not get tested. I wonder if they even bothered to verify her story?

It's pathetic.

On a local level we have one station that actually takes the time to visit places like a university medical centers that are being enlisted to help increase the number of tests being done daily. Imagine that!

 

[Rianne]

Less than shutting down the economy.

Really, we don't need to test the population. What we need is the ability to test suspected cases and anyone they have been i contact with. We do not have that.

I highlighted. One is most contagious before they have symptoms. Thus, we would have to test everyone. As symptoms get worse, the contagion goes down. The issue with this virus, that makes it different than other viruses, E bola (much more deadly) or swine flu or SARS is how quickly it passes from one to another. The contagion virus is in the nasal, upper respiratory system, which is more readily passed from person to person.
(My source is Dr. Peter Attia and his many interviews)

 

[ivinsfan]

It would be helpful, but not a silver bullet. We don't have such a test widely available and probably won't for months. Once we do, we don't know what the test id telling us other than who has been exposed. Nobody knows if you have partial or total immunity if you have been exposed.

The wildcard here is the percent of people who are infected but completely asymptomatic how would you catch them in a regular testing protocol, it seems like that could be a big number of people...a regular test is a snapshot of one day of one person.

 

[atmsmshr]

I would really like to see the USA do contact tracing. But I fear that will not happen for several reasons.

The community spread of the virus is everywhere and now has only reached a steady state that is too much to keep up with. Asymptomatic carriers will keep up the infection rate to some non-zero steady state level. When the states open their economies - that steady state level will increase in the second wave until (if) herd immunity kicks in. Too much to keep track of for contract tracing. Only a vaccine next year or herd immunity stops the pandemic.

The community spread of the virus is worldwide. Developing nations are going to make the USA infection rate look small. Poor countries with less social margin are going to completely lose hospitals, and other infrastructure such as supply chains for food. After seeing the stress in USA food chains, we are probably going to witness widespread famine in Africa and South America. Migrants in search of food will spread the virus in a third wave that will overwhelm borders of those countries that are successful with mitigation. Expats will bring the virus back home.

Contact tracers will have to deal with 'you are trampling my rights as an individual mentality' to not adhere to quarantine and spread the virus.

I hope to be wrong.

Sigh