COVID-19 Shutdown Exit Strategy?

[Fermion]

The main focus now should be respirator production and emergency hospital conversion, not testing.

Companies that make these respirators should be running 24 shifts now and getting priority on supplier deliveries for the materials they need.

Converting a hotel to a hospital is not incredibly difficult and can be done in weeks if the government is sufficiently motivated.

 

[Dtail]

YUP. Mine also.

+2 but it is fairly transparent why.
Kind of like a quarterback throwing a 90 yard touchdown, but throws 4 interceptions to lose the game.

 

[MichaelB]

But it seems many people are acting as if we had more testing capability, we would have had far fewer deaths to date. I just don't see any evidence or pathway for that to be the case.

I believe those jumping on the bandwagon of criticizing the lack of testing are motivated by other reasons. I'll stop there.

The daily press briefing just said that there have been 195K tests under the Federal program, with ~19K positive. Seems like a lot of tests to find the 10% that are positive. Note the 195K does not include all the individual hospitals' lab tests.

The coronavirus is contagious even when the infected individuals are asymptomatic, and early symptoms resemble other illnesses, such as the seasonal flu. Large scale testing is the only way to identify infected people and take action to isolate them. What is the alternative?

No one is saying earlier testing would have led to fewer deaths. That's a red herring. What is clear is large scale testing has been one of the critical factors in all the countries that have slowed the progression, such as S Korea and China. By itself, it doesn't help, but as one component of a coordinated approach, it has shown benefits.

 

[Freedom56]

Right now we are in day one in a statewide stay at home order. In Los Angeles country they are only testing those who will require treatment to change their outcome. The ones that show up with mild symptoms are told to isolate and are subject to followup. This alleviates some of the demand for test kits that are in shortage and also isolates people with COVID-19, Influenza, or the common cold. New York is also adopting this policy. In any case it was a good idea to issue the stay at home order to limit the spread.

Until there is a vaccine, this will likely be the protocol going forward.

 

[Midpack]

Right, which is why I included that statement.

But it seems many people are acting as if we had more testing capability, we would have had far fewer deaths to date. I just don't see any evidence or pathway for that to be the case.

I believe those jumping on the bandwagon of criticizing the lack of testing are motivated by other reasons. I'll stop there.

-ERD50

Testing made a huge difference in South Korea’s results, and they didn’t have to resort to quarantines and lockdowns like the US and many other countries have or are already in the midst of. Any health professional will tell you the more they can identify who’s infected and who isn’t, the easier it is to manage. And that extends to closing businesses. We’re all on lockdown because we don’t know who to avoid until it’s too late.

If you don’t think South Korea’s testing strategy had an effect, how do you explain their results to date?

Amid these dire trends, South Korea has emerged as a sign of hope and a model to emulate. The country of 50 million appears to have greatly slowed its epidemic; it reported only 74 new cases today, down from 909 at its peak on 29 February. And it has done so without locking down entire cities or taking some of the other authoritarian measures that helped China bring its epidemic under control. “South Korea is a democratic republic, we feel a lockdown is not a reasonable choice,” says Kim Woo-Joo, an infectious disease specialist at Korea University. South Korea’s success may hold lessons for other countries—and also a warning: Even after driving case numbers down, the country is braced for a resurgence.

 

[ERD50]

Symptoms for COVID-19 are not showing up in some people until up to 14 days after they are infected. The longer people go carrying the virus without symptoms the more likely they are to infect other people. Early testing would help to identify people who are contagious even if they are asymptomatic, especially if they have been in close contact with other people who are infected.

But we clearly don’t have enough tests to do this, so it’s a moot point for now.

But look at my numbers a few posts back. What would testing 5/1000 (like the model, South Korea) has done?

You hardly catch anyone, and you have to assume that some of the untested are infected. It barely changes anything at all. If my thinking is wrong, please show where I go astray.

-ERD50

 

[MichaelB]

But look at my numbers a few posts back. What would testing 5/1000 (like the model, South Korea) has done?

You hardly catch anyone, and you have to assume that some of the untested are infected. It barely changes anything at all. If my thinking is wrong, please show where I go astray.

-ERD50

What do you suggest should have been done?

 

[ERD50]

Testing made a huge difference in South Korea’s results, and they didn’t have to resort to quarantines and lockdowns like the US and many other countries have or are already in the midst of. Any health professional will tell you the more they can identify who’s infected and who isn’t, the easier it is to manage. And that extends to closing businesses. We’re all on lockdown because we don’t know who to avoid until it’s too late.
Testing made a huge difference in South Korea’s results, and they didn’t have to resort to quarantines and lockdowns like the US and many other countries have or are already in the midst of.

Well, the US is in the early stages, so I think it's hard to come to any conclusions one way or the other. My gut feeling is that the restrictions we are putting in place have a good chance of keeping this from getting as bad as it might have been, regardless of testing.

Also from that article, it sounds like that even without a formal lock down, they had good compliance:

Still, the numbers of new cases have dropped the past 2 weeks, aided by voluntary social distancing, both in the Daegu-Gyeongbuk region and nationwide. The government advised people to wear masks, wash their hands, avoid crowds and meetings, work remotely, and to join online religious services instead of going to churches. Those with fevers or respiratory illnesses are urged to stay home and watch their symptoms for 3 to 4 days. “People were shocked by the Shincheonji cluster,” Chun says, which boosted compliance. Less than 1 month after Case 31 emerged, “The cluster is coming under control,” Oh says.

As far as I can tell from these reports, I think the S Korea testing was focused on suspected clusters. And maybe that helped, but it doesn't require huge number of test kits. And I also think people here are thinking that general testing would help, but again, the 5/1000 type numbers I outlined just don't seem to indicate a way for that to work. We need isolation either way.

-ERD50

 

[ERD50]

What do you suggest should have been done?

I'm only pointing out that I just don't see where the US relative lack of testing to date would have made a significant difference.

What we should or shouldn't do beyond that is a different subject. So since you quoted me about the effect of testing to date, what do you think about that? Did you find an error in my numbers, or in my thought process?

As I said though, I think some degree of isolation is warranted, with or without testing. We are doing what we can, and we need to be flexible, and attack on all fronts.

-ERD50

 

[MichaelB]

I'm only pointing out that I just don't see where the US relative lack of testing to date would have made a significant difference.

What we should or shouldn't do beyond that is a different subject. So since you quoted me about the effect of testing to date, what do you think about that? Did you find an error in my numbers, or in my thought process?

As I said though, I think some degree of isolation is warranted, with or without testing. We are doing what we can, and we need to be flexible, and attack on all fronts.

-ERD50

If testing is part of the protocol for a comprehensive approach to deal with the pandemic, then less testing earlier in the cycle would mean an opportunity to slow the progression was missed.

 

[Midpack]

If testing is part of the protocol for a comprehensive approach to deal with the pandemic, then less testing earlier in the cycle would mean an opportunity to slow the progression was missed.

+1. Hard to believe anyone would argue otherwise. Ask ANY health professional. Quarantines and lockdowns are an inferior approach causing more substantial economic damage. We’re going to see that sooner than we think.

 

[ERD50]

If testing is part of the protocol for a comprehensive approach to deal with the pandemic, then less testing earlier in the cycle would mean an opportunity to slow the progression was missed.

But what opportunity, specifically, would have been missed that would have made a significant difference? What would we have done differently? What would the mechanism be? I already gave numbers, what would change, wouldn't we need to isolate in any case, or as I asked before, do you see an error in my numbers?

It just seems to me this focus on lack of testing kits early on is a bit of a red herring or scape-goating, maybe by those who want to blame someone, or something?

We can call it a missed opportunity, I'd say that's a fact. But is it a missed opportunity that would have made a significant difference? That's what matters. And I think it may be distracting attention from things that do matter.

-ERD50

 

[ERD50]

+1. Hard to believe anyone would argue otherwise. Ask ANY health professional. Quarantines and lockdowns are an inferior approach causing more substantial economic damage. We’re going to see that sooner than we think.

But this is just repetition. What would be done differently?

-erd50

 

[Midpack]

But this is just repetition. What would be done differently?

-erd50

Again, how do you explain South Korea’s trajectory and results to date? I’ve read through all their actions. They had better results and less disruption than we’re already experiencing. Please explain how if testing wasn’t significant.

 

[youbet]

Symptoms for COVID-19 are not showing up in some people until up to 14 days after they are infected. The longer people go carrying the virus without symptoms the more likely they are to infect other people. Early testing would help to identify people who are contagious even if they are asymptomatic, especially if they have been in close contact with other people who are infected.

But we clearly don’t have enough tests to do this, so it’s a moot point for now.

I don't believe any country has come close to the 100% of population testing this would call for.

 

[Gumby]

If we had early, comprehensive and rapid testing, it would have been possible to contact trace and isolate only the infected and their contacts. You would not need to isolate everyone in the country and the economic impact would be much smaller. Here's a hypothetical:

Suppose at time t=0, there were 10 actual infections in the country. Assume a doubling time of 6 days. Assume each victim has 10 contacts. Now assume one of two scenarios:

Case 1: At time=0, we had comprehensive testing and identified 8 of the 10. Those people are isolated, as are their contacts. 88 people isolated. Eventually, they clear the virus (a small number die). 2 infected people are is undetected and the disease spreads from them. After 30 days (5 doublings), there are now 64 infected people. Still not so many that you can't trace contacts and, in effect, ring-fence them. That requires isolating 704 people. And note, your comprehensive testing probably will catch some of these new infections as theyoccur and continue to knock down the spread.

Case 2. At time t=0, you have a very limited and narrow testing regime, so you only catch 1 of the 10 infections. You isolate that person and his ten contacts. But there are still 9 people out there spreading the virus. After 30 days, there are now 288 infected and you would need to trace and isolate 3168 people. And you may not even catch all those 288 new infections, because your testing regime is poor.


As you can see the numbers quickly get far beyond the ability to trace and isolate. Then the only possible response is to isolate everyone, at great harm to the economy. That's why it makes a difference.

 

[youbet]

If we had early, comprehensive and rapid testing, it would have been possible to contact trace and isolate only the infected and their contacts.

While what you say sounds true, even if we had 100's of millions of test kits available, how would we administer and process all those tests within the incubation period? No country has come even remotely close to that, including South Korea.

If you were able to test a far larger number than we have so far, say 10 million, that would leave well over 300 million untested and the infected, but symptom-free, within that group would still be circulating and infecting others. We'd still have to get into shutting things down and social distancing to contain things.

South Korea has tested a very small fraction of their population, but a higher fraction than us. They've had more information to use to formulate their shut-downs, quaranteins, social distancinging, etc., and a MUCH more compliant population to control. But they did use isolation as their key tool, and not just isolation of people closely associated with people who tested infected.

If by " early, comprehensive and rapid testing" you mean 100% testing of the population within a very short period of time, then I agree with you. We could then have forcefully isolated the infected leaving everyone else free to go about their business. Less that 100% testing, and without comprehensive isolation/distancing, would only result in a reshaping of the spread timeline.

 

[Jerry1]

I see a lot of mentions of S. Korea, but one key factor I think people are missing is that S. Korea controlled the spread *without* locking down cities or businesses. Testing/isolation/quarantine + social distancing. That's it. And, frankly, that is the now obvious approach. That is the system to emulate. It avoids the problem this thread is addressing of how to know when to remove the lockdowns. Easiest to do when you never locked anything down to begin with.

Lots of things that *all* countries need to fix to make sure future pandemics don't cause the entire world to shut down.

S. Korea - Secret to its Success

Agreed. I still haven’t seen an explanation why S Korea could come up with all the testing they needed and the US is still floundering on testing.

https://www.politico.com/news/2020/03/06/coronavirus-testing-failure-123166

I agree. It's clear in my mind that testing is the key. When we can test quickly, we can isolate smaller numbers quicker. As has been said, not likely to eradicate the virus that way, but at least control it. That will get people back to work and IMO is what is the key to the exit process.

 

[Gumby]

While what you say sounds true, even if we had 100's of millions of test kits available, how would be administer and process all those tests within the incubation period? No country has come even remotely close to that, including South Korea.

If you were able to test a far larger number than we have so far, say 10 million, that would leave well over 300 million untested and the infected, but symptom-free, within that group would still be circulating and infecting others. We'd still have to get into shutting things down and social distancing to contain things.

South Korea has tested a very small fraction of their population, but a higher fraction than us. They've had more information to use to formulate their shut-downs, quaranteins, social distancinging, etc., and a MUCH more compliant population to control.

You don't just randomly test people; you try to be more intelligent in guiding your test efforts. You would start with areas that had more potential contact with China, e.g. people coming from overseas in the last X number of days and people who have been in contact with them. Also test the people that work in "gateway" locations, like the TSA agents. i.e.- places where you are more likely to find infection. The old lady who lives way out in the country in Iowa and has not been in contact with anyone in weeks does not need to be tested, at least initially.

ETA - the first case in New York was a lawyer in New Rochelle who turned out to be a "superspreader", infecting more than 50 other people.
He was admitted to the hospital with fever and breathing difficulty. He was not tested for COVID-19 until four days after admission. During that time, he was moved to two different floors of the hospital and handled by the staff with no special precautions. His family and friends and rabbi all came to visit him during those four days without any precautions. Early testing would sure have helped there.

 

[audreyh1]

Right, which is why I included that statement.

But it seems many people are acting as if we had more testing capability, we would have had far fewer deaths to date. I just don't see any evidence or pathway for that to be the case.

I believe those jumping on the bandwagon of criticizing the lack of testing are motivated by other reasons. I'll stop there.

-ERD50

I think there is a clear example in Washington at the Kirkland nursing home outbreak. It took a very, very long time to identify that it was a COVID-19 outbreak. By the time they finally tested some folks, many first responders had to be placed on quarantine and. Huge number of residents and staff had contracted the virus. Because there wasn’t a clear connection between the nursing home and a traveler from China, people didn’t consider that it might be a COVID-19 outbreak even though way more residents than normal were having to be transported to the hospital by first responders. Honestly, I think if it had been detected sooner, fewer people at the nursing home would have caught it because they could have moved early ill folks into isolation. Also, more of the first responders would have been protected.

There was a clue - I believe that the first US case traveler returned from China was in this general area of Washington. And they did comb through he contacts, and he was quarantined. But keeping a watch for any usual illness in the general area would have been wise. Some genetic testing indicated that the virus affecting the Kirkland residents did come from this first individual.

I think early testing and tracing and monitoring was key to early containment.

 

[ERD50]

Again, how do you explain South Korea’s trajectory and results to date? I’ve read through all their actions. They had better results and less disruption than we’re already experiencing. Please explain how if testing wasn’t significant.

See youbet's follow up posts.

-ERD50

 

[daylatedollarshort]

But this is just repetition. What would be done differently?

-erd50

I don't think you are missing anything, not at this point in time. You are just better at math problems than most people. With limited tests available, it doesn't help to only test the people that are 90% sure to have the virus, especially those where the treatment for their condition is the same whether they have the virus or not.

Some health officials have now also figured this out -
"Health officials in New York City and Los Angeles County are signaling a change in local strategy when it comes to coronavirus testing, recommending that doctors avoid testing patients except in cases where a test result would significantly change the course of treatment."
Source: CNN

 

[MichaelB]

South Korea has tested a very small fraction of their population, but a higher fraction than us. They've had more information to use to formulate their shut-downs, quaranteins, social distancinging, etc., and a MUCH more compliant population to control. But they did use isolation as their key tool, and not just isolation of people closely associated with people who tested infected.

If by " early, comprehensive and rapid testing" you mean 100% testing of the population within a very short period of time, then I agree with you. We could then have forcefully isolated the infected leaving everyone else free to go about their business. Less that 100% testing, and without comprehensive isolation/distancing, would only result in a reshaping of the spread timeline.

I think there’s been clear acknowledgment that large scale testing is one component of a comprehensive approach. Alone, it accomplishes little. Accompanied by other measures, it is intended to slow the progression. Even in the countries that appear to be ahead of the curve, it is early, so we don’t know for certain, but globally the public health profession believes this is the recommended approach.

 

[youbet]

I think there’s been clear acknowledgment that large scale testing is one component of a comprehensive approach. Alone, it accomplishes little. Accompanied by other measures, it is intended to slow the progression. Even in the countries that appear to be ahead of the curve, it is early, so we don’t know for certain, but globally the public health profession believes this is the recommended approach.

To help me understand, what do you mean by "large scale testing?" 0.1%? 1%? 10%? 99%?

Of course, more knowledge about what is going on with the infection, both within a single individual and within the population, is beneficial. Testing increases the knowledge base and I certainly support it. But what you do with the knowledge/data/information and how compliant the population is conforming with directives that is the key.

 

[Midpack]

See youbet's follow up posts.

-ERD50

So you’ve got nothing. youbet is focused on testing in much the same way you’ve been, without looking at the broader picture explaining how S Korea has managed better than others. It’s clear we could’ve slowed the spread sooner and lessened the economic impact we’ve put in motion. And we had the benefit of looking at China, S Korea, Iran and Italy who went before us and didn’t for the most part. The US declining the WHO test package was a significant mistake.