Testing and Contact Tracing - What Do We Need?

[Go-NoGo]

Abbott Labs seems to be holding the key for testing:
https://www.cnbc.com/2020/04/16/abbott-abt-earnings-q1-2020.html

Abbott has launched three coronavirus tests in the United States, including a rapid test that produces results in as little as five minutes and the newly released test that shows if a person has antibodies against the virus. Ford told investors that the company is selling its new antibody test at the same price as its influenza tests.

The company is working with CVS Health to get its tests “outside of the hospital” and into places like urgent-care clinics and nursing homes, Ford said. “Our first phase was to roll this out to ensure the front-line workers were tested and protected. As we start to ramp up manufacturing ... we’ll start to implement those actions into the month of May into June.”

Ford said the company is also working on a fourth diagnostic test for the coronavirus: A “lateral flow” blood test that can provide a diagnosis even more quickly.

“This will allow us to scale up to numbers much more significant,” he said. “This falls in our ability to look at mass testing for the general population. They are on time now and they are almost there.”

 

[fh2000]

Taiwan is a unique case. They had the first case early February and promptly banned travelers from China. Today, they have only 398 cases with 6 death.

This is a country 80 miles off Chinese coast, with 24 million population (not recognized by UN, and was rejected by WHO thanks to China, and with no official means to acquire enough information about COVID-19), but still acted early and is able to fend off the virus so far. They have not locked down any cities. Citizens are free to conduct business or travel within the island. There are some restrictions: masks are required everywhere, temperature taking before getting in every bus, train, restaurant, public places; each school takes temperature of each student in the morning.

Their local government structure is copied from Japan. There is an elected mayor. Underneath, there are about 50-100 regions, each with an elected supervisor (volunteer role, no salary) who oversees about 100-200 families. Each is supported by many local volunteers.

Their jobs are assisting the families: help remind parents to register kids for school, immunization; help remind male adults to register serving the military; assist family with hardship in the event of disaster; assist low income and bring them food; AND act as contact/tracing volunteers.

So, the country already have an army of volunteers to serve as contact/tracing. When each COVID-19 case was identified, the Health and Welfare Ministry, will find out normally about 100-300 people that the person has contact with for the last 14 days. The list is distributed to all the country to all cities and all region offices. These people are first being tested, and then told to quarantine at home for 14 days. If anyone is found positive, their tree of contact people is then further generated, and so on. To date, there are more than 60,000 people are being quarantined at home. Any small amber is doused quickly.

The local supervisors and their volunteers update their whiteboard list each time when a new case is identified and contact list is given. Three times a day, a volunteer would call each contact at home asking if any symptoms surfaced, and also serve as tracking if the contact person has left their home. If found violation of quarantine, a steep fine is issued ($30,000 US dollars, more than a year's worth of pay for average person).

To date, majority of the cases were brought in by repatriated citizens coming from Europe or US. There is no evidence of community spread so far. The Health and Welfare Minister is a doctor by trade. He serves as the head of task force and holds a daily briefing.

So, they shielded their country early, and prevented community spread with their contact/tracing method. The biggest worry is what happens if there is community spread. The whole country has only about 1100 ventilators.

I don't know how we in US will have to do to conduct the level of contact/tracing to be effective. There is no such foundation in the society like they do in Taiwan. New army of volunteers will need to be recruited to make those calls to each contact. Will they be effective to identify each potential carrier and isolate them?

 

[Chuckanut]

Nor should be listening to those few with with an excess of opinion or bravado but with zero scientific or medical knowledge on which to base them/it.

+1

Psychologists, so I am told, have long wondered why the people who sound the most certain on a subject and thus can be the most convincing are often those who know the least. And those in the know usually sound rather uncertain at times as though they were ignorant.

This conundrum is a prime example of the Dunning-Kruger effect. Certain people over estimate their own cognitive abilities. Or to put it more in layman's terms - some people are so stupid, they don't know they are stupid.

IMHO, many of the talking heads and expert news analysts we see on TV these days are excellent examples of Dunning-Kruger.

 

[ivinsfan]

You’re right, I’m wrong there. I was conflating aggressively getting on testing early (as SK, Germany, HK, Singapore and Taiwan) versus numbers of tests. Hard to keep facts straight for me at least.

I guess we’re seeing how much harder it is get on the testing/contact tracing bandwagon later. But I don’t see how we reopen and contain this at manageable levels without more testing and contact tracing.

I don’t doubt we need way more testing, I haven’t heard a single healthcare professional state otherwise. I’m just sick of talking heads saying we’re not doing enough testing - without also saying what they think we need. Are we 2X off, 10X, 100X or what? Without quantifying, it’s just mindless partisanship.

How should we get it done then? And some professionals disagree on the amount of tests needed..it's well and good to say more testing is required when there is no single plan in place

Seems like a vicious circle. What level of testing would you be satisfied with?

 

[Midpack]

How should we get it done then? And some professionals disagree on the amount of tests needed..it's well and good to say more testing is required when there is no single plan in place

Seems like a vicious circle. What level of testing would you be satisfied with?

I gather you've forgotten the OP, and the central point regarding journalism?

 

[aiken]

Guarantee they are already working on it, as well as building protocols to integrate with Uber, AirBnB, etc., (ie monetize it).

Somehow that doesn't give me a warm and fuzzy feeling.

 

[harllee]

If we are going to start reopening businesses like restaurants, salons, barbers, etc, shouldn't the employees of those places be tested on a periodic basis--say every couple of weeks? I would be more likely to go to a restaurant to eat if I knew all the employees tested negative every 2 weeks. If schools are going to reopen I think all school employees should test negative every 2 weeks.

The other place that needs frequent testing is all doctors, hospitals, assisted living, nursing homes, etc. Those people should probably be tested weekly.

I found the Iceland study very interesting--instead of closing down the country they are testing a large portion of the population and doing detailed tracing. Iceland found that almost 50% of those that tested positive had no symptoms.

If the U.S. is going to reopen soon we need alot more testing and I think it should be done systematically and all those that will be working with the public should test negative every 2 weeks. Testing will cost alot but it will be cheaper than having every one out of work.

Our country has done great things--put a man on the moon, etc. Surely we can figure out this testing thing.

 

[anethum]

Comparisons with S. Korea, Germany, & Taiwan concerning the number of tests per capita relative to the US fail to account for the fact all 3 of those countries got a handle on testing & contact tracing before the number of infected got out of hand, unlike in the US. Also, besides the raw numbers, it is important to look at when the tests were taking place relative to how much the virus had spread in each country.

I don't think it's difficult to understand how testing and contact tracing would work and would be feasible.

First, ample testing for anyone presenting with symptoms needs to be available throughout the country, and the testing needs to give reliable results within minutes.

Second, contact tracing should immediately commence for all who tested positive. Those contacts need to immediately quarantine for 2 weeks. If antibody tests become readily available, that could potentially limit the number of people subjected to quarantine measures as a result of contact tracing.

This cannot feasibly be implemented countrywide or even regionally, however, until the number of new cases is brought down to much lower levels than the US has at present. This can hopefully happen with the existing partial shutdown and adherence to social distancing measures in effect. We lost valuable time which allowed the virus to spread rampantly. That is why controlling the further spread of the virus is so much more difficult now.

 

[aiken]

You can do contact tracing in smaller, rural areas...or where clusters have been identified (nursing homes, etc). But for widespread contact tracing...no way. The genie is out of the bottle. Imagine trying to do that in NY/MI/CA/FL.



The real testing need is antibody samples across a representative sample of the population to see the degree of true morbidity. Jay Bhattacharya is advocating that and he makes more sense than anyone I've heard on this topic. That would give us a better estimate of the denominator...how many people have had the disease and it's cleared their body. His point is...if the actual mortality rate is around the seasonal flu, or a bit higher, it argues for reopening the economy (his early data confirms this). If it's really 3-4%, then you have a different calculus. Right now we don't know...and we're trying to make decisions by flying blind.

 

[Midpack]

Comparisons with S. Korea, Germany, & Taiwan concerning the number of tests per capita relative to the US fail to account for the fact all 3 of those countries got a handle on testing & contact tracing before the number of infected got out of hand, unlike in the US. Also, besides the raw numbers, it is important to look at when the tests were taking place relative to how much the virus had spread in each country.

I don't think it's difficult to understand how testing and contact tracing would work and would be feasible.

First, ample testing for anyone presenting with symptoms needs to be available throughout the country, and the testing needs to give reliable results within minutes.

Second, contact tracing should immediately commence for all who tested positive. Those contacts need to immediately quarantine for 2 weeks. If antibody tests become readily available, that could potentially limit the number of people subjected to quarantine measures as a result of contact tracing.

This cannot feasibly be implemented countrywide or even regionally, however, until the number of new cases is brought down to much lower levels than the US has at present. This can hopefully happen with the existing partial shutdown and adherence to social distancing measures in effect. We lost valuable time which allowed the virus to spread rampantly. That is why controlling the further spread of the virus is so much more difficult now.

Agreed. I acknowledged that in post #29, but it's OK to repeat. Again, the extent of testing and tracing needed in the US will be far greater now that we've let coronavirus become so widespread, than had we acted earlier like the countries mentioned. A very expensive lesson in lives and $ lost.

You’re right, I’m wrong there. I was conflating aggressively getting on testing early (as SK, Germany, HK, Singapore and Taiwan) versus numbers of tests. Hard to keep facts straight for me at least.

I guess we’re seeing how much harder it is get on the testing/contact tracing bandwagon later. But I don’t see how we reopen and contain this at manageable levels without more testing and contact tracing.

I don’t doubt we need way more testing, I haven’t heard a single healthcare professional state otherwise. I’m just sick of talking heads saying we’re not doing enough testing - without also saying what they think we need. Are we 2X off, 10X, 100X or what? Without quantifying, it’s just mindless partisanship.

 

[ivinsfan]

I gather you've forgotten the OP, and the central point regarding journalism?

If the OP was meant to be a rant about modern uninformed journalism, I'm on board with that. ...to be fair the journalists can't report what they don't know, but perhaps they could tone some of it down...

 

[Gumby]

Interesting article about the contact tracing effort currently underway in Connecticut.

https://www.ctinsider.com/news/coro...tatewide-contact-tracing-to-warn-15208955.php

 

[Midpack]

Interesting article about the contact tracing effort currently underway in Connecticut.

https://www.ctinsider.com/news/coro...tatewide-contact-tracing-to-warn-15208955.php

Can’t read it, paywall or AdBlock but I’m all for all efforts at efficient available testing and contact tracing. Contact tracing methods are well documented.

 

[blueskyk]

I’m wondering about something I think Dr. Birx referred to in a recent briefing. I THINK she said something about antigen testing being a means of “sentinel” testing in a population. That is, one would understand the prevalence of the virus based on those who had already been infected (with X portion asymptomatic or such mild symptoms it was unrecognized).

Theoretically this would not be a test that had to be endlessly repeated. I’m surprised it’s so hard to find information on this idea of sentinel testing but maybe I’m not looking in the right places. Like info on parametric testing, not necessarily of the thing itself (in the absence of sufficient availability and practicality), but of things that are indicators infection is on the rise. Perhaps the existing nationwide flu reporting system is part of this strategy.

I’d love to see a clever graphic that brings together all these elements of “monitoring”.

 

[Midpack]

Another reason it’s essential we have adequate testing and contract tracing. Germany, Italy, South Korea and others that have handled the coronavirus better than most countries, are seeing early signs of second waves BUT they’re not letting it get out of hand. Seems crucial IMO.

https://youtu.be/DsWPXWpJaJQ

I hope we’re watching and learning from every country that’s further along the curve and trying to reopen, I don’t hear much about it but that doesn’t mean it’s not happening...

 

[donheff]

I’m wondering about something I think Dr. Birx referred to in a recent briefing. I THINK she said something about antigen testing being a means of “sentinel” testing in a population. That is, one would understand the prevalence of the virus based on those who had already been infected (with X portion asymptomatic or such mild symptoms it was unrecognized).

Theoretically this would not be a test that had to be endlessly repeated. I’m surprised it’s so hard to find information on this idea of sentinel testing but maybe I’m not looking in the right places.

Or, I may be inferring an inaccurate interpretation of “sentinel”.

I have read multiple conflicting reports about these tests. From, they are good enough to get a general idea of what is going on; to, they are inaccurate so whether false positives exceed true positives depends on the real underlying prevalence in the population. A researcher did a test of volunteers in Santa Clara County California and asserts that there are 50 to 85 times more infected people in the population than are confirmed positive but if the test is throwing off 4-5% false positives... Bolinas California is going to test the entire (small) population but, again, how accurate are the tests?. There are allegedly multiple surveys under way. Lots of reports floating around. We will eventually hear from Fauci and company.

 

[anethum]

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.

If you're not satisfied with the reporting you've read, heard, or seen, then I suggest that you change your news sources. Excellent news sources do exist. You posted similar complaints concerning reporting on the ages of Covid-19 patients & victims.

I've been quite satisfied, for example, with the reporting on the coronavirus that The Washington Post has been doing. Here are 2 excellent articles that they've published during the past week. The first article is about problems at the CDC concerning testing. The second is about extensive damage to human organs other than the lungs, which doctors are finding in many Covid-19 patients.

These articles might be behind paywalls. Much of The Post's coronavirus reporting has been made available for free, but not everything. Sometimes, you get what you pay for.

https://www.washingtonpost.com/inve...7d3824-7139-11ea-aa80-c2470c6b2034_story.html
quote: "The failure by the Centers for Disease Control and Prevention to quickly produce a test kit for detecting the novel coronavirus was triggered by a glaring scientific breakdown at the CDC’s central laboratory complex in Atlanta, according to scientists with knowledge of the matter and a determination by federal regulators."


https://www.washingtonpost.com/heal...f71ee0-7db1-11ea-a3ee-13e1ae0a3571_story.html
quote: "But clinicians around the world are seeing evidence that suggests the virus also may be causing heart inflammation, acute kidney disease, neurological malfunction, blood clots, intestinal damage and liver problems."

quote: "Almost half the people hospitalized because of covid-19 have blood or protein in their urine, indicating early damage to their kidneys, said Alan Kliger, a nephrologist at the Yale School of Medicine who co-chairs a task force assisting dialysis patients who have covid-19."

 

[Midpack]

If you're not satisfied with the reporting you've read, heard, or seen, then I suggest that you change your news sources. Excellent news sources do exist. You posted similar complaints concerning reporting on the ages of Covid-19 patients & victims.

I've been quite satisfied, for example, with the reporting on the coronavirus that The Washington Post has been doing. Here are 2 excellent articles that they've published during the past week. The first article is about problems at the CDC concerning testing. The second is about extensive damage to human organs other than the lungs, which doctors are finding in many Covid-19 patients.

These articles might be behind paywalls. Much of The Post's coronavirus reporting has been made available for free, but not everything. Sometimes, you get what you pay for.

https://www.washingtonpost.com/inve...7d3824-7139-11ea-aa80-c2470c6b2034_story.html
quote: "The failure by the Centers for Disease Control and Prevention to quickly produce a test kit for detecting the novel coronavirus was triggered by a glaring scientific breakdown at the CDC’s central laboratory complex in Atlanta, according to scientists with knowledge of the matter and a determination by federal regulators."


https://www.washingtonpost.com/heal...f71ee0-7db1-11ea-a3ee-13e1ae0a3571_story.html
quote: "But clinicians around the world are seeing evidence that suggests the virus also may be causing heart inflammation, acute kidney disease, neurological malfunction, blood clots, intestinal damage and liver problems."

quote: "Almost half the people hospitalized because of covid-19 have blood or protein in their urine, indicating early damage to their kidneys, said Alan Kliger, a nephrologist at the Yale School of Medicine who co-chairs a task force assisting dialysis patients who have covid-19."

I am very selective about news sources, and I do consider WaPo a reliable source - that many don’t have access to if behind a paywall. Has WaPo addressed specific testing requirements or contract tracing WRT reopening? Or delineating coronavirus risk by age of underlying health? There are sources, I’ve provided several but it takes some digging. I’d think widespread specific understanding of risks, testing and contract tracing would be one of the more important topics while people are talking about reopening. If we don’t have those factors covered, a second wave seems likely - that could be devastating.

 

[USGrant1962]

...

I hope we’re watching and learning from every country that’s further along the curve and trying to reopen, I don’t hear much about it but that doesn’t mean it’s not happening...

In almost every COVID-10 Task Force daily briefing Dr. Birx says they are doing exactly that

 

[sengsational]

I have read multiple conflicting reports about these tests. From, they are good enough to get a general idea of what is going on; to, they are inaccurate so whether false positives exceed true positives depends on the real underlying prevalence in the population. A researcher did a test of volunteers in Santa Clara County California and asserts that there are 50 to 85 times more infected people in the population than are confirmed positive but if the test is throwing off 4-5% false positives... Bolinas California is going to test the entire (small) population but, again, how accurate are the tests?. There are allegedly multiple surveys under way. Lots of reports floating around. We will eventually hear from Fauci and company.

The problem, I learned from the video below, is that as the fraction of true positives gets smaller and smaller, the test results mean less and less.


So, think about that, as it applies to sentinel testing. You draw a circle in the middle of Kansas (presuming very few true positives) and you test a random sample. You would think that would yield a valuable indication of the situation, but because the test is not perfect, the results are not very useful.

Numbers is hard, a wise man once said, and this is no exception.

This video, explains the phenomenon. And you can even download the spreadsheet and plug in your own numbers.

 

[donheff]

The problem, I learned from the video below, is that as the fraction of true positives gets smaller and smaller, the test results mean less and less.

Excellent. I follow Atia's blog but didn't catch this one. I went through this type of analysis when we implemented drug testing in the Federal government. Our population was expected to be low true positive so I worried about false reports. The test thresholds (for amount of drugs detected) were set very high so the labs argued they were in the 99.99 range for only detecting true positives but I was always skeptical.

 

[youbet]

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.

Agree, but....... We'll also need a change in culture. When I watched a lengthy documentary on CGTN regarding both the S Korean and the Chinese handling of COVID-19 to date, it was very clear that contact tracing came with enforceable, strict regulations regarding isolation, quarantining and such. Some of it seemed more like imprisonment since some of the folks involved didn't want to obey and were taken away kicking and screaming.

If/when we are able to implement a high enough level of testing and contact tracing, the required level of enforcement is going to be quite a shock to many people.

 

[MichaelB]

If we do implement a high level of testing and contact tracing, the required level of enforcement is going to be quite a shock to many people.

Exactly. I would add, those societies show a much greater tendency toward social conformity, which makes the isolation and tracking easier to implement. The US, OTOH, practices non-conformity as a virtue.

 

[Rianne]

The problem, I learned from the video below, is that as the fraction of true positives gets smaller and smaller, the test results mean less and less.


So, think about that, as it applies to sentinel testing. You draw a circle in the middle of Kansas (presuming very few true positives) and you test a random sample. You would think that would yield a valuable indication of the situation, but because the test is not perfect, the results are not very useful.

Numbers is hard, a wise man once said, and this is no exception.

This video, explains the phenomenon. And you can even download the spreadsheet and plug in your own numbers.

Not to belabor my point, testing is not accurate, when the U.S. has such a high pre existing rate of health issues, what comes first...Covid19 or pre existing condition as cause of death and/or cause of extreme reaction to the virus. Covid19 may set in motion the premature death rate of an already existing condition that may have been avoided. If testing for Covid19 is inaccurate, testing for the antibodies is more useful.


Edit: https://jamanetwork.com/journals/jama/fullarticle/2764954


"Unlike polymerase chain reaction (PCR) tests—also referred to as molecular or nucleic acid–based tests—antibody tests aren’t intended to identify active SARS-CoV-2 infections. Instead of detecting viral genetic material in throat or nasal swabs, antibody tests reveal markers of immune response—the IgM and IgG antibodies that for most people show up in blood more than a week after they start to feel sick, when symptoms may already be waning.
Serologic antibody tests not only can confirm suspected cases after the fact, they can also reveal who was infected and didn’t know it. Up to a quarter of people with SARS-CoV-2 infection may unwittingly spread the virus because they have mild or no symptoms."

 

[brewer12345]

Agree, but....... We'll also need a change in culture. When I watched a lengthy documentary on CGTN regarding both the S Korean and the Chinese handling of COVID-19 to date, it was very clear that contact tracing came with enforceable, strict regulations regarding isolation, quarantining and such. Some of it seemed more like imprisonment since some of the folks involved didn't want to obey and were taken away kicking and screaming.

If/when we are able to implement a high enough level of testing and contact tracing, the required level of enforcement is going to be quite a shock to many people.

A large fraction of the population will not put up with it. I would obey a quarantine, but if you plan on padlocking me in, you better bring the swat team.