COVID-19 Shutdown Exit Strategy?

[Dtail]

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.

Big +1
That's all we hear is of the shutting down of travel which was good, but most other decisions were made too late.

 

[MRG]

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.

Another appears to be an aggressive launch of the testing. The sooner during the growth you attack the problem there may be an eighth or sixteenth as many infected people; you can isolate them. Does two things. You're further down the curve and you slow the exponential growth as you are weeding out the infectious group. Both flatten the growth. At least that's my thinking.

 

[ERD50]

Originally Posted by ERD50 View Post
See youbet's follow up posts.

-ERD50

So you’ve got nothing. .... .

Incorrect conclusion. You can't get there from here.

I referenced youbet's post because he addressed it. Why be redundant? It's not like I need to boost my post count or anything!

You have not answered the question - how did more testing in S Korea make a difference? What was the mechanism? How would that apply to the US? We hear generalities that "testing is good", fine. But if testing leads to confinement, and we are doing confinement, it may not make a big difference. You can't just claim that if their results were better, and they did more testing, that testing was the reason.

Another thing which I have not had time to investigate deeply - how many pathways did S Korea have versus the US? S Korea has a handful of I'ntl airports, some of them tiny, and then they border N Korea (not much movement there). The US has over a hundred I'ntl airports, and # 30 in volume in the US handles more than 2x the passenger's of S Korea's #5. Plus two large borders with countries that were not limiting travel as we were. So maybe, it was far easier to isolate the early infections than in the US?

Big +1
That's all we hear is of the shutting down of travel which was good, but most other decisions were made too late.

I'm not talking about any other decisions, nor am I making any judgements at all. I'm just challenging the view that more early testing in the USA would have had any significant impact. If you try to make this political, the thread will get shutdown. There's some good back/forth here, let's keep it open.

I'm not defending the lack of tests available in the US. I'm only questioning the idea that it would have made a big difference.

Nothing to be mad about. Facts are facts. Deal with them.


-ERD50

 

[aiken]

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

Agree completely. Testing opportunistically within clusters/hotspots makes sense. Widespread testing across 325MM people is unrealistic from a feasibility standpoint. It would be nice to have that macro data though...I suspect it would show a helluva lot of us have been exposed but are mildly symptomatic or asymptomatic.

 

[dixonge]

how did more testing in S Korea make a difference? What was the mechanism? How would that apply to the US?

<snip>

I'm just challenging the view that more early testing in the USA would have had any significant impact.

-ERD50

It's really not that difficult, frankly.

The answer is contained in the many articles linked in this thread. S. Korea had tests and testing stations and procedures available and ready before the number of cases grew too high. This provides for the ability to catch as many infected people as possible as early as possible. No, not by randomly going house to house. By setting up stations and directing citizens with symptoms to go get tested. All those who have symptoms were instructed to go home and isolate themselves until results were in. Those who are negative can go back to work. Those who are positive stay in isolation.

If those who test positive get worse, they can go to a hospital equipped to deal with them. By knowing that they were positive, the patient gets to the hospital sooner and the hospital doesn't have to wait on any tests. The treatments are specific and early, and this greatly reduces the death rate. LESS PEOPLE DIE. Really I don't know what other reason you would need...

The other scenario that can be covered is clusters, like the church. As soon as you find a 'spreader' you can isolate them, trace their contacts, and test all of them. You catch the spread and stop it cold.

None of this is possible once the number of cases outpaces your ability to trace contacts and becomes a general community infection, like seasonal flu. At that point, you are reduced to using 15th century techniques like closing the gates to the city. If you have tests and testing procedures in place early, you could avoid shutting down 75% of the economy.

 

[Independent]

Getting to the end of the lock down means testing for antibodies. We don't have a test yet, but I think there is good cause for optimism,

Florian Krammer, a virologist at the Icahn School of Medicine at Mount Sinai, and his colleagues posted a preprint yesterday describing a SARS-CoV-2 antibody test they have developed, and directions for replicating it. It’s one of the first such detailed protocols to be widely distributed, and the procedure is simple enough, he says, that other labs could easily scale it up “to screen a few thousand people a day,” and quickly amass more data on the accuracy and specificity of the test.

Lots of labs are working on this. The article says some tests are already available on a limited basis. This is the first I've seen about a test that could scale up rapidly. We need, literally, tens of millions of antibody tests.

We hope that most people exposed to the virus get no symptoms or very mild symptoms, but they do produce antibodies that will give them immunity for at least a year. That is the end game. If we're lucky, we'll get herd immunity before we get a vaccine.

We need to find those people and tell them they can safely go back to work and school.

(Of course, I can't guarantee they exist. We have to have an antibody test to determine whether they do.)

https://www.sciencemag.org/news/202...es-could-show-true-scale-coronavirus-pandemic

 

[donheff]

It's really not that difficult, frankly.

The answer is contained in the many articles linked in this thread. S. Korea had tests and testing stations and procedures available and ready before the number of cases grew too high. This provides for the ability to catch as many infected people as possible as early as possible. No, not by randomly going house to house. By setting up stations and directing citizens with symptoms to go get tested. All those who have symptoms were instructed to go home and isolate themselves until results were in. Those who are negative can go back to work. Those who are positive stay in isolation.

If those who test positive get worse, they can go to a hospital equipped to deal with them. By knowing that they were positive, the patient gets to the hospital sooner and the hospital doesn't have to wait on any tests. The treatments are specific and early, and this greatly reduces the death rate. LESS PEOPLE DIE. Really I don't know what other reason you would need...

The other scenario that can be covered is clusters, like the church. As soon as you find a 'spreader' you can isolate them, trace their contacts, and test all of them. You catch the spread and stop it cold.

None of this is possible once the number of cases outpaces your ability to trace contacts and becomes a general community infection, like seasonal flu. At that point, you are reduced to using 15th century techniques like closing the gates to the city. If you have tests and testing procedures in place early, you could avoid shutting down 75% of the economy.

+1. The Japanese article I referenced in post #18 lays this out in detail. I doubt we would have achieved ROK’s results even if we had done better with testing. But the article explains with you can do with quick testing of suspected victims, fencing off positives, and rapid contact testing. I think Korea’s results with a relatively small percent of the population being tested demonstrates precisely how a good testing regimen can help. But that’s fodder for the post mortum. For now we have no choice but to rely on social isolation.

 

[ERD50]

It's really not that difficult, frankly.

The answer is contained in the many articles linked in this thread. S. Korea had tests and testing stations and procedures available and ready before the number of cases grew too high. This provides for the ability to catch as many infected people as possible as early as possible. No, not by randomly going house to house. ....

OK, but I do think some people in this thread aren't getting that. They seem to think we are going to test everyone and sort them out.

But I also think it's not that easy either. As I mentioned, there are difference between US and S Korea. The number of entry points, and the population primarily. It seems S Korea had known clusters to test. I think (would need to do more research to verify), that by the time anyone would have been motivated to test, we already had 'intrusions'. I don't think we were as isolated as S Korea was.

Ahhh, here we go:

https://www.nejm.org/doi/full/10.1056/NEJMoa2001191

On January 19, 2020, a 35-year-old man presented to an urgent care clinic in Snohomish County, Washington, with a 4-day history of cough and subjective fever. On checking into the clinic, the patient put on a mask in the waiting room. After waiting approximately 20 minutes, he was taken into an examination room and underwent evaluation by a provider. He disclosed that he had returned to Washington State on January 15 after traveling to visit family in Wuhan, China. The patient stated that he had seen a health alert from the U.S. Centers for Disease Control and Prevention (CDC) about the novel coronavirus outbreak in China and, because of his symptoms and recent travel, decided to see a health care provider.

Apart from a history of hypertriglyceridemia, the patient was an otherwise healthy nonsmoker. The physical examination revealed a body temperature of 37.2°C, blood pressure of 134/87 mm Hg, pulse of 110 beats per minute, respiratory rate of 16 breaths per minute, and oxygen saturation of 96% while the patient was breathing ambient air. Lung auscultation revealed rhonchi, and chest radiography was performed, which was reported as showing no abnormalities (Figure 1). A rapid nucleic acid amplification test (NAAT) for influenza A and B was negative. A nasopharyngeal swab specimen was obtained and sent for detection of viral respiratory pathogens by NAAT; this was reported back within 48 hours as negative for all pathogens tested, including influenza A and B, parainfluenza, respiratory syncytial virus, rhinovirus, adenovirus, and four common coronavirus strains known to cause illness in humans (HKU1, NL63, 229E, and OC43).

Given the patient’s travel history, the local and state health departments were immediately notified. Together with the urgent care clinician, the Washington Department of Health notified the CDC Emergency Operations Center. Although the patient reported that he had not spent time at the Huanan seafood market and reported no known contact with ill persons during his travel to China, CDC staff concurred with the need to test the patient for 2019-nCoV on the basis of current CDC “persons under investigation” case definitions.8 Specimens were collected in accordance with CDC guidance and included serum and nasopharyngeal and oropharyngeal swab specimens. After specimen collection, the patient was discharged to home isolation with active monitoring by the local health department.

On January 20, 2020, the CDC confirmed that the patient’s nasopharyngeal and oropharyngeal swabs tested positive for 2019-nCoV by real-time reverse-transcriptase–polymerase-chain-reaction (rRT-PCR) assay. In coordination with CDC subject-matter experts, state and local health officials, emergency medical services, and hospital leadership and staff, the patient was admitted to an airborne-isolation unit at Providence Regional Medical Center for clinical observation, with health care workers following CDC recommendations for contact, droplet, and airborne precautions with eye protection.9

So from the very start, the very first patient, the test was available, results in a day, and guess what - the action was similar - isolation before the test, isolation after the test (more stringent after though - but would it make a difference? Just how contagious is this, if everyone in contact knows to take care?).

So sure, with a positive test, they can be more proactive in tracing his path. But did we really not have enough tests for this sort of targeted testing? I don't know, have not dug that deep yet. But it wouldn't be a lot of tests for that level, so there may have well been enough. TBD for now.

...

None of this is possible once the number of cases outpaces your ability to trace contacts and becomes a general community infection, like seasonal flu. At that point, you are reduced to using 15th century techniques like closing the gates to the city. If you have tests and testing procedures in place early, you could avoid shutting down 75% of the economy.

I'm thinking we were soon past that point anyhow. Will try to research some more later, maybe I'm wrong about that.

-ERD50

 

[USGrant1962]

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.

Enough political talking point BS. This has been totally debunked and you keep repeating/linking it.

The WHO does not offer virus test kits/protocols to first world countries and never has. Their test kit are for sale to countries that don't have capabilities to devise/manufacture them. Basically Africa and South America.

WHO never offered it to the U.S., and the U.S. never declined it. It has never offered this service to the U.S. for any outbreak.

 

[ERD50]

The US declining the WHO test package was a significant mistake.

Well, I don't think snopes is as un-biased as they once were (gotta get those clicks, baby!), but here you go:

https://www.snopes.com/fact-check/us-coronavirus-test/

...WHO told PolitiFact that the organization had never discussed providing testing kits to the United States, and The Washington Post reported that it’s typical, historically, for the U.S. to develop its own methods under such circumstances:

China developed its own test. Leading laboratories in Germany published their own version, which was adopted by the World Health Organization. Many countries, including the United States, developed their own tests.

The traditional U.S. strategy for devising new diagnostic tests starts with the CDC. That is supposed to ensure new tests are accurate and reliable,

-ERD50

 

[USGrant1962]

And Politifact, after a debate regurgitated it:

https://www.politifact.com/factchec...falsely-says-trump-administration-rejected-w/

And sorry I was a little hot but this politically driven misinformation is doing a lot of damage, IMHO.

 

[Midpack]

Enough political talking point BS. This has been totally debunked and you keep repeating/linking it.

The WHO does not offer virus test kits/protocols to first world countries and never has. Their test kit are for sale to countries that don't have capabilities to devise/manufacture them. Basically Africa and South America.

WHO never offered it to the U.S., and the U.S. never declined it. It has never offered this service to the U.S. for any outbreak.

Fair enough. I read it in this thread, linked by another member, in a seemingly reasonable article (Politico IIRC).

But there’s no doubt in my mind S Korea’s relative success was due in part to how they used testing in their overall effort to contain Covid-19.

 

[ERD50]

Since this thread is about the exit strategy, maybe it's time to move on from whether early testing was a factor or not? That's history at this point, what's done (or not done) is done (or not) - and it might lead to getting the thread shut down. Maybe take it to a new thread, if you feel you still have something to say on that?

I'll just re-iterate that I think after a bit of time, we can get smarter and more focused with the lock-downs. I would think that defined groups could get together, like a construction group, if they normally only interface within that group, and don't interface with people outside that group. And testing within that group might be a good use of limited tests?

Suppliers could drop off at a designated area and not inter-mingle. Controls like that.

Keeping at least some people working would ease the economic issues, might help a few restaurants if they deliver to that site. And I think the risk would be small, with reasonable controls in place.

-ERD50

 

[Toocold]

Here is the most obvious difference between the US/Europe and the Asian countries. In Asia, they are told to wear masks regardless of your situation. In the US, we are told to not wear masks due to the short supply and it is reserved only for health workers. And people who wear masks are ridiculed because you are hoarding them. All things equal which countries will have a slower ramp-up of virus infection?

Perhaps in addition to all the things the US is doing, everybody should be required to wear a mask so that we can flatten the curve? That would be a viable exit strategy.

 

[Ready]

Here is the most obvious difference between the US/Europe and the Asian countries. In Asia, they are told to wear masks regardless of your situation. In the US, we are told to not wear masks due to the short supply and it is reserved only for health workers. And people who wear masks are ridiculed because you are hoarding them. All things equal which countries will have a slower ramp-up of virus infection?

Perhaps in addition to all the things the US is doing, everybody should be required to wear a mask so that we can flatten the curve? That would be a viable exit strategy.

If we had been more prepared for this pandemic we would have plenty of masks available for everyone. But at the moment we don’t even have enough for the ER workers to wear masks while treating COVID-19 patients.

But I do agree that we would be better off if we all wore masks when leaving the home, especially in hard hit areas like New York City.

 

[copyright1997reloaded]

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.

I'm not here to argue the test/no test discussion, this is only an periphery observation. Given the situation in China and the fact that there were already cases in Washington State, WHY did the hospital not ASSUME the patient was contagious? Instead, they moved him from floor to floor and allowed visitors. We already KNEW on Jan 21 that someone in Washington state had the virus, and that by 2/5/20 there were confirmed cases in six states (Washington, California, Arizona, Mass, Wisconsin, Illinois). By March 1 (the date of the first case in NY), there were CONFIRMED cases in eleven other states (besides NY).

Instead, they put out this in NY:

“Despite this development, New Yorkers remain at low risk for contracting COVID-19,” Barbot added. “As we confront this emerging outbreak, we need to separate facts from fear, and guard against stigma and panic.”

Source: https://www.amny.com/health/two-new-suspected-coronavirus-cases-reported-in-new-york-city/

My point is that by that time medical personal should have been treating ER cases with fever/respiratory distress as a*ASSUMED* COVID19 until proven differently. I *KNOW* I was at that time.

 

[Independent]

Since this thread is about the exit strategy, maybe it's time to move on from whether early testing was a factor or not?

And, the exit strategy is not about active virus testing, it is about antibody testing.

 

[Chuckanut]

I'll just re-iterate that I think after a bit of time, we can get smarter and more focused with the lock-downs. I would think that defined groups could get together, like a construction group, if they normally only interface within that group, and don't interface with people outside that group. And testing within that group might be a good use of limited tests?

+1

I agree.

We need to be working on how we can sustain the fight against CV-19. Shutting down the economy is not a sustainable strategy.

Each group will have to do what works best for them while not allowing the disease to go back to unlimited spreading. Maybe restaurants could use only 1/2 their capacity, making sure the tables and chairs are wiped down after every use? I don't know. But this shutdown can't last much past a month or there will be other health problems caused by massive unemployment - depression, lack of medical resources, civil disorder, etc.

I have never heard a Dr advocate poverty as a cure for illness.

 

[youbet]

And sorry I was a little hot but this politically driven misinformation is doing a lot of damage, IMHO.

No apology necessary. In fact, forum members owe you a great big thanks. I don't think anyone here, even those who were repeating the inaccurate information, want the forum to be a vehicle for spreading politically motivated, inaccurate information.

Thanks.

 

[Toocold]

And sorry I was a little hot but this politically driven misinformation is doing a lot of damage, IMHO.

I couldn't agree more. I usually go to NPR, Reuters, and BBC for my news. I can't stand the news and the political divide we have right now. I usually listen to the source to make more own judgement.

 

[ERD50]

And, the exit strategy is not about active virus testing, it is about antibody testing.

I just read a bit about that. If I'm following you, the idea is that antibody testing would inform us of people who had the infection, and recovered (maybe w/o even being aware, just mild symptoms), and now have a good deal of immunity from it.

If that's where you are going, interesting. I guess we could start to put together teams of people who are now safer (no guarantee) from further exposure. Those people might be the front line in dealing with infected people. I guess maybe they could still be carriers, but that seems less likely if they aren't actively coughing/sneezing around other people (the main form of transmission, I think))?

Seems it would be a good start.

I got lots of hits searching for "covid-19 antibody tests", so I'll go take a look now.

-ERD50

 

[anethum]

This week-old ProPublica article explains how South Korea quickly developed and implemented testing, how multiple bad decisions in the US (many made by the CDC) resulted in significant delays (continuing to today) in getting accurate tests widely available, and a poor directive from the CDC concerning the criteria for who should be tested. One of the poor decisions was rather than using WHO's template for the test, the CDC foolishly decided to make a new test from scratch. And after they finally did that, the CDC test was sometimes giving faulty results.

https://www.propublica.org/article/...-testing-while-the-us-fell-dangerously-behind

It is ludicrous (and IMO politically motivated) to suggest that the testing failure in the US is not substantially responsible for the current disastrous situation in the US. And it's not about the number of people who needed to be tested, but rather about who should have been tested, tested just as early as South Koreans were tested, the accuracy of the test, the speed at which test results were returned, and what was done when a positive test was made.

I've mostly stayed away from this forum lately, but I logged on tonight and found myself reading this thread for the first time. I'm appalled at some of the posts.

 

[ERD50]

.... One of the poor decisions was rather than using WHO's template for the test, the CDC foolishly decided to make a new test from scratch. ....

You are holding South Korea up as a model, and claiming the CDC was "foolish to make their own test", yet...

https://www.theguardian.com/commentisfree/2020/mar/20/south-korea-rapid-intrusive-measures-covid-19

On 16 January, the South Korean biotech executive Chun Jong-yoon grasped the reality unfolding in China and directed his lab to work to stem the virus’s inevitable spread; within days, his team developed detection kits now in high demand around the world.

that's what SK did.

....

It is ludicrous (and IMO politically motivated) to suggest that the testing failure in the US is not substantially responsible for the current disastrous situation in the US. ...

And some might be of the opinion that blaming the current situation (is it disastrous? time will tell) on the test situation is politically motivated.

... I'm appalled at some of the posts.

Finally, some agreement.

-ERD50

 

[USGrant1962]

So now I'm thinking that the "15 days to slow the spread" that the Covid-19 task force is recommending might lead to the exit strategy. After 15 days (8 days from now I think, so starting April 1) if the infection/mortality curves have started to slow Dr. Fauci can begin relaxing some of the recommendation. Especially things like applying social distancing to businesses.

So instead of recommending "avoid eating or drinking in bars, restaurants..." the next 15 days should say "eat in restaurants that practice social distancing (tables 6 feet apart) and enhanced hygiene". And instead of "Avoid discretionary travel, shopping trips, and social visits" they could recommend "practice social distancing, and patronize businesses that do". Lastly, wider availability of surgical and N95 masks in a week or two might lead to a recommendation for, say, restaurant servers to wear masks.

I think that Federal leadership, based on bending the curves, might give the Governors and Mayors the cover they need to dig themselves out of the hole they have dug.

 

[Ready]

At some point we have to find a way to open schools again. Kids staying at home for weeks or months on end is very bad for everyone. I think that needs to happen before we worry about restaurants or movie theaters.