You can rank people by the likely benefit of testing them. Interestingly, it goes up as the square of the number of people they interact with daily. (Because their risk of having it increases, and also the number they are likely to spread it to.)
So you can allocate tests by sorting by (# of daily contacts in a closed space) ^ 2.
But as PB says, it should be practical to test everyone every day.
Curious to know how you are getting power of 2 exactly. Are you just saying it's some sort of power law growth and approximately 2, or is there an actual way of deriving it?
Wouldn't it also vary by percent of population without immunity, perhaps demographics in the underlying population, and other environmental things (weather?). Seems like a (useful) aproximation.
That's what I was about to answer. That's where squaring comes from, in this case. However, as others have noted, you could just sort by # of people contacted, since squaring just gives you larger numbers for no benefit in analysis here.
If we assume (key) that the probability of becoming infected is directly proportional to the number of people you interact with, and consider that the probability of spreading infection given that you are infected is obviously directly proportional to the number of people you interact with, the product gives a quadratic function:
[probability of becoming infected and spreading] = [probability of becoming infected] * [probability of spreading] ~ [people you meet]^2
In math and (especially) physics it is common to express "proportionality" laws usually with a symbol that looks like LaTeX \propto. So for instance the activity A of a radioactive sample is written A \propto e^(-t/T) where t is time and T is the mean lifetime of a single particle. For convenience \propto is often transliterated as ~ when typing. So that becomes
This isn't quite right. For one, the probability of being infected is not linear (it's capped at 1). If you do the math, the expected number of people you infect (given you are not infected) is roughly linear-ish.
Correct, it's not. But it is roughly linear in the limit of small numbers of people with a small constant probability of becoming infected per interaction. (This assumption becomes problematic when you see "clustering" of highly social people with other highly social people.)
To be specific, if P is the probability of becoming infected when interacting with a single person, then the probability of becoming infected after interacting with N people is 1-(1-P)^N = NP - O(N^2 P^2). It's easy to see that the limiting infection probability is 1 in this simplified model, and that if N*P < 1 you're looking at close-to-linear growth.
The article begins by stating that this is not like the flu, yet we know people die from complications or directly from the flu every year. And further, we're seeing more and more evidence of huge numbers of the population with antibodies, i.e. already infected and immune. We also have seen the damage that using ventilators have had due to misunderstanding how this virus starves the body of oxygen (through the blood, not like pneumonia). We should continue to focus on treatment and realize that treatment along with population immunity is the best way to handle it now. Waiting a year for a vaccine that may not work or rushing a poorly tested vaccine is not good.
It's not the flu because the infection fatality rate is almost certainly a lot higher, we have no vaccine, and no reliable treatments. Seasonal flu has (semi-reliable) vaccines and antivirals and is almost definitely significantly less deadly.
Look at the excess death statistics. There's no question that it's deadlier than seasonal flu, because the seasonal flu doesn't kill a 9/11s worth of New Yorkers above the usual death rate over several weeks. If the current rate wasn't slowing we'd be looking at a death toll multiple times higher than the seasonal flu.
About 20% of people in NYC showed a positive antibody test. That's not nearly enough for herd immunity and it's not enough to push the infection fatality rate as low as the flu's.
Is it actually excess deaths? So many deaths are being counted as covid-19 that it looks more like we have the same amount of total deaths by all causes and any other year
Solutions like this give me hope that we can actually return to something resembling normal life in the future. I hope Paul's got everything he needs in funding and resources to pursue all three of his goals.
Can we stop hyping blog posts by tech people writing about epidemiology and medicine? I'm shocked how much baseless speculation and misinformation is being shared on HN.
I tend to agree. Maybe medical people should start having opinions on software architecture after reading a few articles. They may have some fresh ideas. Or not?
I've worked in both fields. Few people who are experts in one of those fields can be useful in the opposite field, but there are some exceptionally productive individuals who are. Reading through Bucheit's article, he seems to fall into the 'wow, biology is really easy, you just have to do <X> and the problem is fixed' camp. In my experience, that does not correlate with a good understanding of how to produce a successful medical diagnostic.
I have told a lot of people who said this "Just do it yourself. I don't know how to just do it". It's so disrespectful. "Just convert everything to micro services written in Go and all your problems will go away".
He's not. He's hyping his biomedical startup which is trying to make a cheap plasmon covid test. Whether or not he's right, that's sort of right at the HN sweet spot for relevance.
Will it work? God I hope so, but it doesn't seem prudent to bet on it. We know several existing technologies for covid testing that will work. We know they can scale. We know how expensive they are. And while they aren't cheap, we know can afford it at the federal level.
That we still refuse to actually pull the trigger on mass testing and announce a program to fund and launch a universal covid testing regime is just infuriating.
I mean, I desperately hope that a magic bullet like this will pop up to save us. But we know how to beat this. We just won't.
HN is an internet watercooler. It exists for curious conversation. That inevitably includes speculation—that's what people do when they converse. The question is whether it's curious (thoughtful and fresh) or uncurious (reflexive and predictable).
People being wrong is also inevitable. We don't have a truth meter, and there's a ton of uncertainty on topics like this one anyhow. I don't think it would work to try to restrict discussion so that only authoritative opinions are allowed. This community would not tolerate that sort of restriction being put on it, and it would only convert to an argument-by-proxy about who should count as authoritative. The solution, if there is one, is to converse thoughtfully and respond to one another with accurate information where possible.
No, because they were right and the epidemiologists and medical people were wrong. Everyone kept telling us not to use masks except the tech people. There were all these lies:
* Doesn't work
* Too hard to train
* Shortages will happen
Literally all were wrong and they either knew it and misinformed everyone or didn't know it. So you can either drop the assumption of benevolence or competence.
The only guys who didn't listen to them, Taiwan, are doing fine despite every other risk factor being huge for them. It turns out some skills translate across domains. I'm not going to get a software engineer to perform a total knee replacement on me, but I think I'll listen to them on the crisis management: turns out they're better at it than the crisis managers.
> First of all, it’s not “just the flu”. It is something much more dangerous. Catching this virus is a bit like playing a round of Russian roulette. You’ll probably be fine, but you could end up dead
I think this is mischaracterizing it. People have to die eventually. One year of existence has a mortality rate of 1%. For a 75-84 year old individual it is nearly 5%. Above 85 it's 14%. [1]
The coronavirus infection fatality is likely around 0.5-1%, but it's heavily skewed towards older individuals. Younger people do die from it, but a very low rates. And young people die from other causes as well, the annual mortality rates for a 20-something is around 0.1%. Getting coronavirus for a 20-something or 30-something is roughly equivalent to the mortality rate of a few months of life.
Death is sad and terrible, but we don't shut down society because people die.
No analogy is perfect, but people need context to understand fatality rates, and see what risk is acceptable. Society doesn't have a goal of 0% death rates. We all accept some risk of death as a cost of continued existence.
New data is showing that the fatality rate from covid-19 is more like existing risk we were all previously exposed to in the course of our existence, and not like a second version of smallpox.
As you said, you gotta die of something. If the covid rate equals the regular rate, then the US death rate would effectively double if we simply did nothing.
That’s assuming no second order effects like a shortage of medical care making things worse.
> If the covid rate equals the regular rate, then the US death rate would effectively double if we simply did nothing.
For one year (or however long it takes to reach herd immunity -- and if longer, then death rates wouldn't double but increase much less). Assuming recovery confers significantly long lasting immunity, which I agree is not a trivial assumption (and one we don't know yet how reasonable).
Definitely not trivial, but -- in context -- means a reduction of life expectancy by less than one year. The US already lags Japan by 6; there's a lot that can be done to improve it by a year, with costs much lower than those currently spent to avoid reducing it by a year.
Correct, Covid-19 is not as bad as smallpox. But it's still bad. Focusing on fatality rates misses the infection rate. Two diseases with the same case fatality rate can kill widely different number of people if one is more infectious than the other. We have learned that SARS-CoV-2 is way more infectious than the flu, meaning that way more people are getting it. With way more cases, we have way more deaths. (And, of course, way more strain on the medical system.)
This more or less sums up my position. Thank you for stating it. I think the news media played a big role in amplifying the risk in a very uncertain early period that made people treat this differently from other risks that affect us and many of the arguments right now are happening because some poeple believe the goal of society is to reach 0% death rates.
An important thing to recognize is that the disease itself is not an existential threat (even smallpox wasn't; even the plague wasn't!), but our response to it skirts creating one.
We need to give the scientists and medical professionals and industry more time to figure out how best to prevent this. There are many reports of 40-50 day illnesses in young people due to not clearing the virus.
And the poorly named 'mild' case can be rough. It's (badly imo) defined as when a patient doesn't require hospital. It should be called moderate I think. [1]
This is not an analogy. It's just math - the risk of dying from COVID19 if you got it is comparable to the risk of dying this year all things other than COVID19 considered. (approx 0.1% in your twenties, approx 15% in your eighties).
If getting it confers lifelong immunity (a question that does not yet have a definite answer), that means getting it means you compressed the overall risks of two years into one[0], or reduced your life expectancy by one year.
Now, one year is a lot. But the difference in life expectancy between the US (78) and Japan (84) is already six times as much, so the lockdown in that context is about 6 times more expensive (per day, per person) than moving to Japan[1] would have been before COVID19, and no one would have preached the latter.
Here's a conundrum: you can (a) lock yourself at home for 6 months, likely losing your job, potentially keeping in touch through the internet; then come back to "normal" life. (b) give up 6 months of your life expectancy, but go back to your normal life tomorrow. That is, w.r.t life expectancy, you can pause for 6 months and keep those 6 months; or fast forward those 6 months (and thus lose them). Almost everyone I know would pick (b) if there aren't any exception circumstances such as terminal disease. But the western world at large chose (a).
[0] That's not exactly true - depending on some other model parameters; reduction of life expectancy by 6-9 months is more accurate.
[1] It's not guaranteed that moving to Japan would grant you Japanese life expectancy. It is also not guaranteed that the lockdown as practiced really buys you more than a year either.
That's a terrible analysis, for reasons well-covered all over HN and elsewhere.
This is a whole different thing from 'another flu'. We have to address it head-on. Throwing people (a million people?) under the bus is not going to fly, not politically and not morally.
> for reasons well-covered all over HN and elsewhere.
I've yet to see a compelling argument that LY or QALY analysis is the wrong approach.
> This is a whole different thing from 'another flu'. We have to address it head-on
It sounds like you're not actually offering any relevant response to the parent comment, but just repeating the taglines we all saw in the article.
> Throwing people (a million people?) under the bus is not going to fly, not politically and not morally.
Every political action has victims and beneficiaries. At the moment, we're hurting billions of people (almost the entire world population) to buy (on average) a few expected life-months for a very small section of the population.
Your model of "people dying is bad" is true but not sufficient to make rational decisions.
Every year around 3 or 4 million people die in America from a variety of causes. This is sad, but at some point, everyone has to die.
Data is showing that the infection fatality rate is around 0.5%-1%, and is concentrated in older people. [1] is one study, but there are many others. Given this data, it's clear that our current response is out of proportion with reality.
So if all of America (330 million) gets infected, and we’ve got a 1% fatality rate, that means deaths (3.3 million) would be up there with all the other things that kill us combined!
We hopefully would reach herd immunity far before that point, but even with herd immunity only requiring 70% of Americans to be infected, we're looking at over 2m fatalities. And that's not even counting the hospitalizations that will be over 20M.
What we need to hope for is an unlikely vaccine, or a therapeutic treatment to mitigate the worst of the diseases effects.
Alright so lets unpack this argument, because (1) this is a pretty extreme oversimplification, and (2) the unstated suggestion you make is to quite literally let millions of people die world-wide who wouldn't have otherwise:
> Data is showing that the infection fatality rate is around 0.5%-1%, and is concentrated in older people.
right, "old" (65+?) people are going to die anyway, lets just let them die sooner. How much sooner? Years? Decades? Does this really sound like a cogent counterargument to not letting people die?
Let's ignore the morality aspect of this, which I don't think is in your favor, to put it mildly. I don't really like people suggesting that millions of people should die because "this is sad, but at some point, everyone has to die." Yikes.
But lets pretend we live in a very nauseating reality where older people don't really matter very much. You should still want society shut down to prevent this spreading out of hand because this will easily and thoroughly overwhelm all of our healthcare resources, which will mean hundreds of thousands of people you actually do care about (i.e. non-older people) will also die from lack of medical care either from COVID, pre-existing medical conditions, new medical conditions, etc.
First, the .75% mortality rate is a one-time hit. It likely pulls some deaths forward, so the incremental death rate is maybe .5% in a single year. Again, this is terrible, and sad, but we should be mindful and accurate with numbers.
Second, people make lots of choices that increase their mortality risk by .5%. For example, lots of people eat at McDonald's on a regular basis, which certainly increases your lifetime mortality risk by .5%. And other people don't exercise at all. 30 minutes of jogging a day will lower your mortality by at least 1%, likely a lot more [1]. But we don't pass laws to force everyone to jog for 30 minutes a day.
With the new data, which is showing that mortality rates from covid-19 are not like smallpox 2.0, we should adjust our response to be more in line with responses to comparable risks.
Again, you realize debating the true value of the fatality rate is a bit silly when we already know healthcare systems will be overwhelmed (and have been overwhelmed already!!) if we hadn’t and don’t continue to manage this with severe measures? Do you agree with that statement? It doesn’t matter what the incremental mortality rate is. It doesn’t matter. We don’t know the true fatality rate, yes, but we do know it’s high enough that without severe restrictions on social life, healthcare systems will be overwhelmed, regardless of whether or not you think 1-2 million people dying from this vs 60,000 flu deaths is a big deal or not. Your argument was that our reaction is disproportionate, but it’s not disproportionate because if we don’t do this, healthcare resources will be overwhelmed and the economic damage could be severe in addition to the loss of life. Are you disagreeing with that?
> we already know healthcare systems will be overwhelmed (and have been overwhelmed already!!)
This isn't really true. It depends a lot on the state. The healthcare system in my area, California Bay Area, is completely underwhelmed. Here are some numbers from San Mateo:
If our goal is to flatten the curve to slightly below hospital capacity, current policy has flattened the curve way too much.
Current number suggest that only 1-3% of the Bay Area has been infected with covid-19. If you wan to get to 70% infection rate for herd immunity, it would take multiple years to get there at current rates.
> If our goal is to flatten the curve to slightly below hospital capacity, current policy has flattened the curve way too much.
Our goal is to simply avoid hospitals becoming inundated. How would it be possible to flatten the curve to "slightly below hospital capacity"? To do that we would need to know exact numbers on hospitalization rates from infections, have a testing capability that is far beyond what we currently can do, and then we would need to have fine-tuned control on peoples' behaviors and also never be wrong. We have too much ignorance about too many things to do this in a way that you would deem optimal. This is a disease that takes a median of 5 days to incubate, so as soon as we get something wrong (hint: we will get it wrong), it festers for 5 entire days before we know it, and then we're stuck with the consequences. The only rational choice is to take severe action and hope it's enough. It wasn't enough in Italy, it wasn't enough in NYC.
If you're saying that social distancing/lockdown policies are an "overreaction" because we still have ICU beds and ventilators, I think that's a pretty good sign. The entire point is to do something drastic now, and gradually ease distancing measures as it becomes safe to do so without causing additional large-scale outbreaks. As soon as we have the ability to contact-trace all new infections and can successfully contain outbreaks, we can start letting up.
As I pointed out elsewhere, you're ignoring that Covid-19 is highly infectious, meaning that lots of people get it. Low fatality rates with wildly infectious diseases still mean lots of people dieing.
Of course, as others point out, there's also the enormous strain on the hospital system. Which, I am very curious: are you not aware of what has been going on with the NYC hospitals? Or parts of Italy?
the CFR is only as low as 0.5-1% when there is adequate medical care and the population is otherwise healthy. in NYC the CFR for the 18-45 cohort is ~5%[1].
CFR is a terrible metric - you should be using IFR. CFR is of course going to be much higher than the IFR, probably orders of magnitude higher.
IFR data hasn't been available until recently because you need A) randomized sampling and B) antibody tests, which have only just been rolled out.
The most up-to-date IFR data suggests that "0.5%" is actually an astoundingly high overestimate for any reasonable metric of "number of people who die from this", and that's before adjusting for the fact that the people who die were usually going to die soon anyway.
Using CFR to determine fatality rate of COVID is as effective as it would be for skydiving. If you only count people who go to hospital (because they're frightfully sick -- or splatted out of an aircraft) and compare that to those who walk out of hospital you're exhibiting massive adverse selection bias.
For H1N1 swine flu, CFR was between 0.1% and 5.1% depending on the country. The IFR was 0.02%.
For COVID it's between 0.07% and 15%. The IFR is probably in the lower quartile of the 0.1%-1% range. [1]
> Death is sad and terrible, but we don't shut down society because people die.
Yea, but COVID has the potential to kill a lot of people, quickly -- are you suggesting it's a bad idea to "shut down society" to keep our hospitals functioning? I get the point that the economic cost is severe and also comes with its own share of human cost, but we're talking about saving ~1-2 million people in the US alone by doing this. Several trillion dollars is still worth it...
$2 trillion is 10% of GDP or the losses in ~6 months of a lockdown resulting in 80% productivity (with the assumption that everything goes back to normal immediately after the shutdown, which it won't)
So it seems like a ~6 month lockdown is warranted if you crassly value saving a life from COVID at $1 million. That's not long enough for a vaccine.
Alternatively, working backwards, you need to value a life saved at $3-$4m each to make a 18-24 month lockdown worth it.
We’ve already got a “Value of Statistical Life” in the US, and it’s higher than that. So you could justify lockdown on that alone
EPA recommends that the central estimate of $7.4 million ($2006), updated to the year of the analysis, be used in all benefits analyses that seek to quantify mortality risk reduction benefits regardless of the age, income, or other population characteristics of the affected population
6 month lockdown doesn’t seem necessary, but a lockdown until it’s possible to do contact tracing and containment does seem necessary, either way this is something that easily warrants a drastic response because the potential cost is so high.
> we're talking about saving ~1-2 million people in the US alone by doing this. Several trillion dollars is still worth it...
No, we're not. 88% of people on ventilators in NYC don't survive (in a predictable pattern - 97.2% over age 65 don't for example). You might remember that just a couple of weeks ago, everyone was calling for more ventilators and every company with a workshop started building one -- because it was assumed (a) they would be needed, and (b) they would be very useful; neither is considered self evident truth (or truth at all) three weeks later.
There is no vaccine yet, and no medicine yet, and either may take a year or twenty (TTBOMK, no successful vaccine for the corona family was ever made, and not for lack of trying). Unless you assume a miracle, the assumption is everyone will get it -- and so far, our ability to significantly "save" people has not been demonstrated.
The only reasonable assumption right now is that everyone will get it, and while keeping the hospital system function is important in general, it makes little difference to those who get COVID19.
A more reasonable model is that we're avoiding a 6-8 month reduction in life expectancy, at a cost of (so far) 2 months of normal life. Whether it is worth it or not is not for me or you to decide and obviously depends on your point of view -- but it is clearly not self evident one way or another.
edit: someone is systematically downvoting all my posts on this thread. Whoeveer that is, I am not advocating for or against a course of action - I'm addressing the math. It is your right to downvote without explanation, but if you think I'm wrong, I would appreciate an explanation.
So would you be willing to roll the dice then for the sake of opening up society?
In fact, are you willing to die for it? If given the choice between dying of COVID-19 or shutting down society, you're saying that you personally would choose to die?
I'm bringing this up because the difference between this and other causes of death is that not only is this transmissible, but it also has knock-on effects that we currently have no clue about (see: blood clotting). If we don't do what we can to prevent this, it could become far worse than what we originally thought.
> If given the choice between dying of COVID-19 or shutting down society
Obviously shut down society, but that's not the choice that exists.
The choice in reality is an acceptable risk of death, or shut down society. Between those I pick the acceptable risk of death. We all make the same choice for many, many other situations.
No, what I'm directly asking you is: Are you willing to die to reopen society? I'm not asking you to to take an acceptable risk.
The reason why I bring this up is because when you argue for reopening society based on 'acceptable risk', you're not just risking your own life. You're asking other people who are at risk (ie people with asthma or other issues) to die for you.
Another round of fear porn. I really wish HN would tone this down, because these articles/blog posts do not actually help or offer new insights in any way.
This "Third Solution" has been offered all the way back in February. It suffers from the same lack of information around reinfection and spread rates as it did the first time around.
> If we were able to identify and quarantine everyone who is contagious, including those who are asymptomatic, then we could let everyone else out of lockdown and resume ordinary social and economic activity.
> Even with imperfect screening, if we are able to prevent 90% of disease transmission, then the virus’s reproductive number, or R0, will drop below one and the pandemic will quickly fade. There is no risk of reintroduction from the outside because any new outbreaks will quickly be caught and contained. If used consistently, there will be no second wave, ever.
I'm not sure this "test and release" strategy works unless absolutely everybody gets tested simultaneously.
Even if testing of the total population can be completed in a week (a highly ambitious timeframe), there's still time for people released on Day 1 to be reinfected by people who don't get tested until Day 6.
Then you have to go through who knows how many follow-up rounds of testing absolutely everybody not in quarantine to identify those people. When responding to new outbreaks involves re-testing large populations of people, you're going to run into many problems. Notification, compliance, testing fatigue, etc.
That's why I think testing at the door is the more straightforward way to start. We can reopen factories, office buildings, even shopping malls, but no one gets in without passing the screen.
What door? You mean my front door? I'm not letting anyone in, and I'm not leaving either. What are you going to do, call the cops to kick in the doors to test me?
But that just moves the compliance and logistics problem back one step. Who's doing this massive amount of testing? If it's the government, you'd need armies of workers spread out everywhere. If it's the owners of these buildings, who checks to ensure compliance?
Imagine trying to enforce this on every non-residential building in, say, NYC. It would be practically impossible.
> If it's the owners of these buildings, who checks to ensure compliance?
Who checks to make sure every restaurant follows the standards of cleanliness? They have inspectors who (theoretically) show up randomly, so it ensures most places comply voluntarily, because the cost of getting caught is very high.
A combination of random inspections and steep fines would solve the compliance problem.
Edit: I just had another idea. Offer cash rewards to people who can prove they they weren't tested when entering a public place (which the business pays for via fines). You'd have people running around trying to find missed testing for the cash reward.
To your point, many businesses and facilities implement safety measures because they fear civil liability for preventable damages. I don’t think that’s likely in this case but if you can get most businesses and facilities to be mostly compliant most of the time, that might be enough.
There are many that are. Don't people get rewards for reporting malfeasance to the SEC, or ADA violations? I'm sure I've read about that, as well as about how some people think it's a questionable system. But privatization of enforcement of some regulations is a thing.
Now imagine going out shopping, you’re stopped at the door, and you test positive. What happens then? The government puts you in a car and sends you... back to your apartment? Sounds like a dystopian nightmare, to be honest.
I'm weirded out by this binary thinking arguing against masks or testing. It's like the people who say that helmets don't prevent all injuries, which they conclude means one shouldn't be wearing one. Except that where helmets are only individual protection, measures against infection are affective at a population level, where you profit from others' actions.
we're in the middle of a pandemic. at some point you've got to accept that dystopia is here, and the dystopian things that are happening are realistic ways of dealing with the situtuation.
you can't reject solutions because they sound dystopian unless you've got better, non-dystopian solutions. and everybody has to stay in their homes at all times and all non-essential services are shut down is not a less dystopian solution.
Fair enough. But I hope that line of reasoning has limits. After all, it would be safer to send everyone by truck to a quarantine camp instead of back to their apartment where they might infect their neighbors in the lobby, wouldn’t it?
That's been proposed
in the northeast US (MA, NY, NJ, CT, RI). Hotels would be used for mandatory quarantine. Tests and contact tracing (manually, then smartphone) would determine who gets isolated.
The flu comes every year, and it’s not even a order of magnitude less fatal. Maybe COVID will come back every year too.
What “solution” are you looking for to solve this relatively small share of “death from natural causes” that we call COVID? How much damage should we inflict upon ourselves in this moral quandary?
How many people should die because we’re willing to spend trillions of dollars due to our innate fear of a virus rather than our innate fear of much much bigger problems, like poverty or starvation?
Why can we muster so much energy in this case, and so little on much bigger problems? My theory is that you can’t catch hunger on the subway, you can’t catch underprivilege from a doorknob, and you can’t catch climate change from shaking hands with constituents.
There’s a lot wrong with our planet, it’s too bad we’ll all go bankrupt and unemployed chasing such a trifling disease as COVID when there were actual real problems we could have solved with mountains of cash that large, rather that burning the cash in effigy for modest to no effect once COVID has run its course.
Can you please stop posting in the flamewar style to HN? This sort of rhetoric and polemic destroys curious conversation, which is what the site exists for.
It seemed in-kind with the “dystopia is here” rhetoric, but I understand answering in the same vein doesn’t make things better.
If I could still edit the comment, I would replace the first “you” with “we”, as none of the comment is meant to be directed personally at OP.
The dystopia we have is purely one of our own creation. One which TFA seems to not only welcome with open arms, but seeks to capitalize upon. It’s really quite sad.
There are two things that don't make sense to me about your original post.
One is that cash is not a resource. It's even less of a resource when it's not only not metal, but mostly not paper either.
The other is that the flu comparison doesn't make sense to me on multiple levels. Given deaths from COVID at the moment are nearly ten times flu on an annualized basis, given the partial shutdown, obviously they would be more than ten times without the shutdown...but what is even significant about exactly one order of magnitude?
I’m not quite sure what to say to “cash is not a resource”. Even if just a proxy for attention cash is obviously a resource. But really, cash in itself is a resource. $10 trillion dollars can do a lot of things if spent wisely. $10 trillion dollars can also be destroyed for practically no benefit at all.
I agree it’s not strictly $1 spent on A means $1 less to spend on B. But it’s at least true to some extent, and again, as a proxy for attention and willingness to enact change, it’s a valid measure.
So the flu comparison is because they are both respiratory illnesses which kill a lot of people. In the 2017-2018 season the flu killed 61,000 in the US. Hospitals in NYC were stretched very thin. Nobody really noticed. It wasn’t even declared a pandemic.
Obviously it’s impossible to say with certainty if we have seen 1/4th, 1/3rd, or 1/2 of the total deaths that we are going to see from this SARS-CoV-2. But I think nobody is currently out there claiming that we’ve only seen 1/10th of the total deaths from SARS-CoV-2 that we’ll get by the time it’s over. (SARS-CoV-3 is another story?)
“Ten times flu on an annualized basis...” So 50k times 4 is 200k. That’s not nearly 600k. Just trying to follow your math. If we’re halfway through now (IHME thinks we’re about 3/4 through) then we‘ll have seen in COVID the equivalent of two bad years of flu.
Orders of magnitude generally provide rough measures of classification and are a nice rule of thumb for telling if one thing is “radically different” than another thing. So, flu kills up to 650k globally per year. Maybe COVID will do roughly the same, maybe 2-3x, but I think at least we’ve long past the days of claims that COVID will kill 5 million worldwide are being tossed around. And it’s not because no one’s caught it and we just need to keep hunkered down. It’s because a massive number of people caught it and overall its just not that deadly.
If governments around the world had done their jobs and shared data and been truly prepared and with a little luck and a lot of hard work this whole thing perhaps could have been avoided by early and arduous contact tracing. That day is long behind us.
I worry that by now so much energy and ink has been spilled getting the country into lockdown, and people are so politically invested in it, and all the social pressure campaigns have ramped up to max,... that now as data finally emerges which demonstrate it was all a gross overreaction, we will be too slow to correct.
In the meantime 10s of millions have lost their jobs, perhaps millions have lost their businesses. A $1T deficit seems like a quaint memory (sorry grandkids!).
And it was all for, what, exactly? When herd immunity is the endpoint and the IHME hospitalization predictions were wrong by 10x... overbending the curve only causes suffering and does not save lives. Bending the curve too far into next winter could actually cost lives, which the CDC acknowledged earlier this week in a very roundabout way. And bending the curve at all only helps if additional medical treatment availability would have actually saved more lives, something which I have not seen a strong case for.
"$10 trillion dollars can also be destroyed for practically no benefit at all."
$10 trillion is probably over twice the (financial) cost of WWII adjusted for inflation. Having numbers of that size written down, deleted, moved around, doesn't mean we are suffering that level of loss.
As far as comparing covid to flu, I was talking about annualized daily deaths from covid, compared to a normal year of flu. That was deliberate. I'm saying, if it neither increases nor decreases from this point on, it's nearly ten times the rate in the long run.
You are comparing the total deaths from covid, assuming it declines and goes away in due time. That would be fine in a vacuum, but you're using the consequences of trying to stop it to argue the efforts to stop it are unnecessary. What is the point of this sophistry?
Not only you, but everyone who was recently within six feet of you as determined by contact tracing (manual now, bluetooth later). If you don't live alone, you go to a mandatory isolation center, possibly a designated hotel. Kids can be separated from parents.
It doesn’t need perfect compliance to push down the R0 significantly. Lockdowns in the US are mostly not being strictly enforced, but enough people are complying to have a major impact.
I think economic incentives are also fairly well aligned here. If tests are widespread, a significant segment of the market is likely to prefer locations that are testing to those that don’t, just like the market tends to prefer clean restaurants to unsanitary ones.
This test takes 10 minutes. That is probably still too long to implement at the doors for most places. It will end up creating a bottleneck of people waiting to enter the building and another avenue to spread the virus. Making the inside of the mall safe from the virus isn't going to matter if everyone is exposed to the virus while waiting in the 30 minute line to get into the mall.
The article is suggesting daily testing and used "testing at the door" as an example.
Wouldn't it stand to reason that you could be tested once per day, in the parking lot to a mall or some other shopping establishment, and thereafter _verify_ that you had been tested that day for the remainder of your commercial transactions?
Thinking in those terms, 10 minutes per day is not so great of an imposition. We could formalize it and create drive-through test centers where you drive up, spit into the tube, have a bar code on your phone scanned, and drive off. On your way to the mall you get a text message with your results. Everywhere else you visit that day scans your phone upon entry and confirms that you've been tested.
You can't just ignore people who don't travel by car. The hardest hit place in the country in New York City. Most New Yorkers don't own cars and many go months at a time without entering one. And even outside of cities, it is still classist to only allow people with cars to reenter society.
The system also becomes much more complex and requires a bigger infrastructure if you aren't literally testing people at the door. How do you verify someone has had a test today? In your bar code idea, can the bar code be faked? Is there some centralized database behind the system that tracks who tests positive? Is that database politically feasible? Some comments here are already objecting to that idea.
A solution that works outside of the vicinity of New York, would still allow at least 47 other states to open up.
As for checking who has a test, simply give colored stickers. If someone wants to “beat” the system, so be it. Social disapproval and common sense will keep most people honest.
New York City isn't the only place in which car ownership is low. What about Chicago, Philadelphia, San Francisco, Los Angeles, Boston, DC, etc? If your plan for reopening the nation doesn't include reopening our cities, it isn't a real plan for reopening the nation.
You need a plan for people who want to beat the system because they present a huge danger. The whole idea behind this system is to allow the people inside the secured bubble to return to normal behavior. They aren't going to be wearing masks, social distancing, or taking other precautionary measures. Therefore one person acting inappropriately could present a huge problem for the people on the inside. Keep in mind there are still people who think this entire thing is a conspiracy and that COVID-19 is no worse than the flu. You have to consider what happens with people like that who might not participate in this system in good faith.
I wouldn’t plan on reopening the nation, since it was never closed from the top down to begin with. Individual states, and in many cases cities and counties, made the decision and continue even now to enforce rules different from one another.
Hawaii is an island, thousands of miles away from the rest of the USA, so why shouldn’t it open on a different schedule?
Even China, ground zero for the crisis, close and reopened different providences, districts, and even neighborhoods independently.
You could probably use an app or just get their mobile phone number. It seems likely to me based on reading a lot of case studies that this virus is largely spread through talking, yelling, and singing. If we tell people not to talk for 10 minutes while they wait for their result, it could work if you could get people to comply.
Frankly this is the idea that a software guy comes up with. It’s like you translated the idea of checking every API request for malicious payload to a real-world situation and left out the 99.997% of the parts that make the problem hard. It’s like assuming the existence of a teleporter.
Paul, I posted this is part of another comment also, but for places like shopping malls, testers could also test people while they're in the parking lot.
No lines to spread the disease, and better throughput if you're testing many cars simultaneously rather than whoever is at the front of the line. (Although I suppose many people could be tested near the front of the line too.)
The cheap flight was what made this epidemic a pandemic.
We can continue lockdown until everyone who has got it has recovered and is no longer infected. This is a matter of weeks and we are mostly there.
Once we get to no new cases per week for a couple of weeks then we can end the lockdown and get on with our lives.
To prevent reinfection then anyone that flies in gets quarantined unless they come from a plague free country. The same applies to other border crossings, e.g. ferries and roads.
This approach works with rabies in the UK and with other historical plagues. No widespread daily testing is needed this way just the health service testing we have now.
This approach is the only realistic option using what we can do now. However there is little talk of quarantine being used for those that fly. Quarantine means forty days.
Straw-man. Many scenarios exist to get most of the benefits without resorting to 'everybody simultaneously'.
E.g. 'test and release' where only folks who've been tested are 'released' into the public. Track outbreaks and retest those cohorts thoroughly. And so on.
> I'm not sure this "test and release" strategy works unless absolutely everybody gets tested simultaneously.
They don't all have to get tested literally simultaneously; but the "release" part of the strategy can't start until the "test" part has covered everybody, or at least close enough to "everybody" that the difference doesn't matter. Note that that's how the strategy is stated in what you quote: if we can identify everyone who is contagious, then we can release everyone else. The "if" has to be complete before the "then" starts; that's what "if"-"then" means.
But contagious status is not fixed. If you test someone, they're negative, but despite sheltering in place they pick up the virus while at a necessary doctor's appointment, then their status changes. Granted, frequent follow-up tests might identify that change, but daily tests of a sufficiently large portion of the population have a number of challenges beyond just access to the tests.
The difference here is that you test everyone entering a certain location, not everyone in general. This is much easier, and allows testing to be focused on most needed areas. In effect, if you only go to the groceries once a week, you will be tested once a week. If you go back to office, you will be tested every day. The more you interact with people the more you get tested to keep the interactions safe
Compliance is tough. And my main concern would be false positives- if we are screening more people more frequently, we would have a lower expected percent of true positives, and even a small false positive rate could lead to significant overdiagnosis and disruption. The more often the test the more stringent that requirement. I dont know much about the testing method described in the article, but I wonder if it has unique characteristics beyond ease of administration to support that broad use case
A reasonable policy is to go home when the machine at the door to your office gives a positive result. Then get a more specific PCR test, and maybe come back to work. So the cost of a false positive can be one lost day.
Exactly. While this plan would certainly result in some disruption, it would be a lot less than the current status quo. And you can't really compare it to simply "opening back up" without a plan like this, because the simple fact is that even without government-enforced lockdowns, many (perhaps most) people won't return to a normal level of activity if they don't feel safe doing so.
> “...because the simple fact is that even without government-enforced lockdowns, many (perhaps most) people won't return to a normal level of activity if they don't feel safe doing so.“
you’re underestimating the pain that many americans are feeling after just a few weeks of (soft) lockdown. it’s not that people want to be unsafe, it’s that their livelihoods are in grave danger if the lockdowns last for months. many people are willing to take some risk now that the pandemic hasn’t turned out to be plague-levels of badness that some initially feared. few people are economically secure enough to say ‘no’ to opening back up sooner rather than later.
"many people are willing to take some risk now that the pandemic hasn’t turned out to be plague-levels of badness that some initially feared"
Without expressing an opinion of my own, how can you write as though from a twilight zone without causal relationships?
I mean, you, or anyone, can doubt that the lockdown is necessary. You might be right!
But you must acknowledge and challenge the causal connection between the lockdown and "not plague levels of badness". Comments that just ignore the possibility creep me out, because I can't imagine what the writer is thinking, except maybe "wishing will make it so".
I don't follow your reasoning. Maybe we use a term differently? Here's how I understand them:
- A false positive means that a test shows someone is infected when they are not. For most tests that's somewhere between 0.1% and 2%.
- Lockdown means everyone stays at home. Different from PB's plan, where only people with a recent positive test stay home.
- R0 (technically Re) is the expected number of people each newly infected person spreads it to.
When I say a lockdown has a false positive rate of 100%, it means a lockdown is the same as if you tested everyone but the test always (100%) reported positive, so everyone had to stay home every day.
Re is a different number based on what proportion of the population is immune. Here we are talking about R0.
The point I am making is that some of the people who are on lockdown are truly positive for the virus. That’s why it works. They don’t have the opportunity to spread it outside their habitation unit.
Not trying to show bravado or anything, just pointing out that I and probably others feel this way; I would fight tooth and nail against pervasive, mandatory "test and release" policies on humans (and the necessary concomitant growth of the surveillance state). The second-order social and political effects of such a policy would be disastrous - orders of magnitude worse, in the long run, than the population-level health effects of this virus. People anticipating these effects would probably be prone to civil disobedience, making the logistical nightmare even worse than what you would get with a fully passive and compliant population.
This position truly baffles me. I can understand people who have reservations about tracking everyone with phone apps to do more effective contact tracing. But objecting to widespread, low-cost testing for virus infection as an extension of the surveillance state? I don't even know how to argue against that because it simply doesn't make any sense to me. Right now the population is clamoring for more widespread and effective testing. Why would people rebel against it? You think people would prefer to remain locked down, or to sacrifice 0.5-1%^ of the population, than be regularly tested for infection? Why?
I think it's the mandatory part that's rankling centimeter, and I see their point. Once you give powers to the state in an emergency situation it's really hard to roll them back. See the PATRIOT act for example.
Is there a way to effectively get universal compliance without implicitly granting permanent new powers to violate civil liberties?
I suspect relying on people to test themselves daily without mandating it would do a reasonable job, but I have no idea if it would be enough.
I'm not sure new state powers would be required. The state already can (and does and should) compel people who are known to be infected to be quarantined, or at least self-isolated. As far as testing, companies can already require employees to be tested as a requirement to work. A lot of companies already do drug testing of employees, something I actually don't agree with in most cases, but it's already a norm. In normal times they likely won't have sufficient incentive to do virus testing though, and so probably wouldn't given the cost.
But during an outbreak, the ability to roll that kind of thing out, especially in workplaces with vulnerable populations (like senior care homes and hospitals) or necessarily close working conditions (like restaurant kitchens or some factories) could certainly be a game-changer. And that just seems entirely reasonable to me. There's a outbreak happening, so in order to enter [place where transmission would likely occur] you have to be tested first. If found to be infected, you must isolate. Otherwise, you'd be knowingly exposing others, which already isn't something considered acceptable.
So to me this simply looks like an effective use of existing powers in this situation. I'm not sure how it would slide down a slippery slope. The government decides to keep doing virus screening? I mean, I doubt they would incur the cost, but if they do, good! Maybe as Paul mentioned, we could significantly knock down cold and flu as well. If people are worried about infringing on the rights of people with viruses to live normally, I would ask what about the rights of others not to be infected by them? That besides the fact that if these measures are effective very few people will be getting sick in the first place.
When is the pandemic over? When does the pervasive testing stop? The argument can - and will - be made that "unless we keep testing until the end of the human race, you will all die tomorrow of a horrible virus-ridden death."
I don't particulary mind doing pervasive testing for awhile. I would desperately not want to live in a world where I could not feed my family unless I give into it.
> When is the pandemic over? When does the pervasive testing stop?
When we stop seeing non-trivial numbers of test results. The idea that governments want to spend billions on mandatory virus testing outside every building until the end of the human race out of some Orwellian enjoyment of inconveniencing people is not supported by evidence. Even China isn't doing this.
Back in the real world, even the SARS vaccination research programmes, which cost relatively little and inconvenienced nobody, were shut down when SARS stopped circulating and the even keeping a few scientists employed as part of a pandemic task force looking out for the future was a step too far for the US govt.
"Test and release" only works in science fiction. In the real world there is no absolute test that would enable practical test/catch-and-release processing of infected persons. From an epidemiological perspective, when applied to an entire population even tiny false negative rates will let countless infections slip through. False positive rates will see some people doomed to perpetual lockdown as, for whatever reason, they repeatedly test positive.
Setting aside the science of disease, the concept of government agents performing a test to determine one's ability to conduct basic civil liberties (movement, work, basic speech etc) is antithetical to liberal democracy. Such things were not contemplated at the height of the AIDS panic, or SARs, or ebola. It would take something far worse than COVID-19 to implement such a regime in the western world. COVID is a threat to our way of life, to our economies. It isn't an existential threat to the state let alone the species.
Can you guarantee that a healthy person who gets this 3 times doesn't have a 100% fatality rate (i.e. it gets worse each time?)
Can you guarantee asymptomatic people don't become sterile? (Not saying they do, but if they did this would be an existential crisis and lead to our extinction after a generation).
Can you guarantee asymptomatic people still won't have lung damage permanently? (some asymptomatics athletic types have shown severe decline in lung abilities following covid19).
SARs was bad, but was wiped out so it's moot, AIDS is easier to avoid -don't have sex. ebola I think isn't as viral, and has been mostly contained, iirc they may have a vaccine launched or soon will and better treatments -- it's never gone full global like this.
Covid-19's problem is it's severe viralness and r0. It spreads and keeps on spreading, and there's a ton we don't know about how bad having had it will be to even those with minor cases. until we know for sure on all these factors, the more we can quell it the better.
These are part of worst case scenarios that are not published openly. We need more data, and until then the responsible actions are taken by almost all govs.
>> (some asymptomatics athletic types have shown severe decline in lung abilities following covid19)
Which is 100% normal for any pneumonia. I myself once had a bad lung infection (on my back for over a week). It took months before I could swim laps as fast as I did before. That's not anything special. Infections always have secondary medium-to-long term impacts.
Did you have trouble breathing when you had the pneumonia? These are cases of people with 0 or low # of symptoms, and only knew they tested positive of the virus. I'd imagine they just didn't realize they were sick, and then they eventually start feeling fatigue and run down when doing 'normal' things even after the virus passing their system.
ACE2 is in high concentration in the testes too, could this cause fertility issues? Sure it'd be good for the environment but a lot of couples really do want and enjoy their children or to have some someday.
It'd be nice to know as much as possible before we open the flood gates.
> I'm not sure this "test and release" strategy works unless absolutely everybody gets tested simultaneously.
This is misunderstanding exactly the text you are quoting. The goal with epidemic management is NOT to seek out and destroy every last case of the disease.
All we need to do is reduce the spread rate so the exponent in the equation goes from above one to below one. At that point, the outbreak will shrink over time on its own. Critically, new/undetected outbreaks with an R0<1 won't get purchase and grow, because they can't.
At that point, the population is "safe". Individuals aren't, people might still get sick randomly. But this isn't a policy for individual safety per se.
This isn't a unique idea. This is the mainstream view. Everyone knows we need more testing and that testing is the only way to effectively ease distancing rules. That was a pretty extensive writeup to say what we've been hearing from all rational information outlets for a month.
I have not found any mainstream sources that advocate screening everyone every day (which is very different from simply doing "more testing"). Would love some pointers if I'm wrong.
Paul Romer, an economist at NYU, has been advocating for testing millions of people a day for a few weeks. He is co-author of a piece in The Atlantic, "Without More Tests, America Can’t Reopen", https://www.theatlantic.com/ideas/archive/2020/04/were-testi...
Googling for "romer covid 19" should turn up a lot of news sources covering the notion of testing millions of people a day.
Yes, he is the best I've found. This proposal is still at least an order of magnitude more testing though :) (on the order of 100 million tests/day, not 1 million tests/day)
Romer has called for as much as 30 million tests a day, which I think was based on some simplistic modeling. I think he was targeting everyone in the US being tested every two weeks. I think the two approaches are similar: let's test lots of people all the time, however many X million tests a day that is, so that we can quickly isolate and treat them. People are spreading it before they know they have it, so let's just test everyone all the time and not wait until they have symptoms.
I think governor Cuomo was saying he'd love to test every day if he could, but just doesn't have the capacity. Edit: as a side note he put out a call for companies that can help with testing saying that NY state might be willing to invest to bring things to scale. I believe he already wanted FDA approved tests but there's an opportunity there to work directly with a government to implement this sort of thing.
IIRC, mainstream objections tend to come from concerns of false positives, since that becomes a bigger problem with this frequent level of testing and could prove a huge disruption if you end up with too many quarantine still, or so many that testing positive becomes essentially meaningless in terms of telling you whether you have the disease or not if you test positive.
Gov Cuomo should call up Gov Pritzger. Illinois recognized the challenge of testing supplies and asked the state universities to solve the problem. They have. Illinois is reporting a lot more positive cases in the past week because they keep increasing the number of daily tests. I believe that today was well over 12000 tests in Illinois. Anyone who feels like getting tested is now allowed to get a test.
New York has done more tests and more tests per capita than any other state per latest numbers - the reason for more tests isn't just to test people who want it, it's to run large random tests, require tests before visiting nursing homes, get an accurate picture of the infection rate, etc. We're testing more per capita than most countries in the world and it's still not enough. We've tested approximately 4 times as many people with only about a 50% higher population than Illinois and it's still not enough.
Sorry, I wasn't clear. Illinois has built out their own manufacturing supply chain and testing facilities. They are self-sufficient. If New York wants to scale up testing and has money to invest in doing so, they should look at how Illinois managed to make that happen.
This is maddening reading this thread. What is the reason for a federal gov't but to coordinate such cooperation? It goes back to creation of the "United States"! (this is hypothetical question, not one i expect you to answer)
Honestly, at this point I wouldn't be surprised if New York has tested more people per capita than all the comparably-sized countries in the world. There's a few countries which have beaten them, but it's generally small ones like Iceland.
> I have not found any mainstream sources that advocate screening everyone every day
That's because we currently aren't capable of testing everyone who is obviously sick just once. If we got there, we wouldn't even be close to being capable of testing key personnel (like health care workers). If we got there we wouldn't even be close to being able to test everyone once. If we got there we wouldn't even be close to being able to test everyone every day.
You haven't heard any advocating for OR against it because it is so far from achievable that it isn't worth considering.
If this concept would work in principle, covid could be reduced to scaling testing capacity. My impression is that estimates about achievable testing capacity don't assume a most-important-short-term-problem-of-mankind priority and resource allocation.
The linked article suggests a novel and much cheaper test, which would be great. But even if that didn't work out, what scale could possibly be feasible with existing tests? Pre-shortage, an RT-PCR seemed to be much cheaper than a missed day of work.
The concept for restarting the German football league involves daily testing of all players. So the idea is indeed widespread, but often enough just impractical for the numbers of tests required.
Testing a few hundred people daily would be doable, as Germany has relatively good testing capacity - probably one main reason for the overall better handling of the pandemic so far. But the concept still gets critisized, as this would mean a fast track to testing for the players while parts of the population don't have equal access to testing.
For the whole population, it would be a good first step to be test really everyone who has any assumptions of symptoms and some time later, everyone in contact. And perhaps a biweekly test for the general population.
I would expect where there's a large enough economic incentive, and wealthy-enough private group (say, the NFL, MLB, etc) who wouldn't need to wait for government policy or supply, we will see daily testing of their 'employees' so that they can get back to operating. May not be any fans in a live setting, but better than nothing.
You won’t be able to scale your solution before a vaccine is out, rendering your entire solution useless unfortunately.
Johnson and Johnson have already started scaling their vaccine and plan to have 1 billion doses available by January 2021. If their vaccine is approved, it will be an instant solution and better than testing everyone every day.
Moderna has also started the process of scaling their solution as well but J&J have a head start and a known platform.
> You won’t be able to scale your solution before a vaccine is out
Why not? Scaling a test is a completely separate exercise to scaling a vaccine, and it has the advantage that multiple proven working tests exit now, they just need to be scaled. Both can be done, by different people.
You might also find that having a vaccine and a test is better than having just a vaccine.
> If their vaccine is approved
Multiple vaccines are in development. This is not a situation where we should stop doing X now because Y _might_ happen in 8 months or more time. None of the vaccines are guaranteed to be ready and working and scaled at any given date. None of them.
Every single country that has had any success containing the virus, including the origin country of China, has had rigorous continuous testing to contain the spread. It's hard to find a country with success containing the outbreak that doesn't do constant ubiquitous testing.
> Every single country that has had any success containing the virus ... has had rigorous continuous testing to contain the spread
That's demonstrably false. There are numerous prominent examples in fact.
Taiwan is not doing a high rate of testing at all, they're most certainly not doing constant ubiquitous testing. Their per capita test rate is 1/7 that of the US.
Singapore and South Korea are not doing constant ubiquitous testing. The US has already tested at a higher rate than South Korea and will pass Singapore shortly given the continued ramp in US testing. Both are held up as marvels of virus containment.
Japan has barely done any testing. They're seeing a small spike in cases now, however they were not earlier (this is four plus months after the outbreak began and Japan is next to China). Their deaths from Covid are commonly 1/50 to 1/150 the per capita rate of the US and other higher outbreak nations, while doing 1/10 to 1/15 the testing. The only explanation is either that they're covering up ten thousand deaths, or the other non-testing approaches they've utilized work well. Compare Japan to Germany on Covid deaths - again, despite Japan being next to China - and then look at the testing rates. Now explain that.
Finland is testing below the US rate and has contained the outbreak to a stellar degree. That's because Helsinki is colder than Stockholm and Copenhagen. The same reason Moscow didn't get slammed until more recently as the weather began to warm up. There are other factors that impact the spread of the virus, including the rate of social activity and high temperatures (over ~60F / ~15.5C). We know this from several studies that have proven the role of temperature in the spread of SARS and SARS-CoV-2; as well as understanding how the spread benefits from greater social activity (which doesn't occur at the same rate in super cold climates).
Greece has a very low number of Covid deaths and no evidence of serious outbreak this entire time. Their testing rate is 1/3 that of the US. And they're wedged between Turkey and Italy. Much like southern Italy, they've been heavily shielded by their climate. Nobody wants to talk about this of course, it's the Mexico / Texas / San Diego / Baghdad / Lagos effect in action.
Iraq isn't seeing any consequential outbreak, thanks to its climate. Whereas Iran right next door got smashed, because Tehran has an entirely different climate from Baghdad.
Thailand and Vietnam are both testing at a very low rate, and there has been zero evidence of serious outbreaks in either country, despite the proximity to China. That's thanks to their hotter climates.
Nigeria is barely testing at all, with zero evidence of a consequential outbreak there. No crushing of their healthcare system with cases or deaths; no huge spike in deaths, hospitalizations or ICU cases. There are numerous countries across Africa seeing similar low outbreak results, with very little testing.
Colombia isn't seeing a consequential outbreak, their testing rate is super low. They're not seeing a healthcare crush either. They've contained it so far without a high rate of testing.
India and Pakistan were supposed to get buried by SARS-CoV-2 cases. It hasn't happened, week after week goes by and the predictions continue to fail to come true. They're barely doing any testing at all. There's zero evidence in either country of a massive outbreak or crushing number of ICU cases swamping their healthcare systems. It's because of how hot their cities are. I've yet to see a single other good explanation for why India isn't buried in Covid deaths by now. India isn't seeing the virus hit for the same reason Africa hasn't.
Egypt is barely doing any testing. Cairo should have millions of cases of the virus and a huge number of deaths by now. They should have 20,000 dead people from Covid at this point just in Cairo. Where is it? Th...
Christian Drosten (German virologist, one of the most prominent experts here) has been advocating daily testing of medical workers.
This is a slightly easier situation, since you can trust them to swab themselves, and the logistics for collecting samples is already in place.
Being off work for such should not result in severe reduction in income unless your income was already high; at least that is the case here in Norway where laid off personnel get 80% of their normal salary up to a limit that is above average salary.
I suggested testing everyone every month about a month ago. This is a conservative testing frequency that would almost certainly put r0 under 1. Everyone every day is an overkill - why not everyone 4 times a day? What's the rationale for it other than it sounds good?
Isn't this a minor upgrade on what the authorities did in Wuhan? They squashed the disease at the epicenter, faster than the tail-off in Italy, and a lot of it was massive screening and isolation of anyone showing symptoms, or with a high temperature (1), or testing positive, or anyone in contact with those.
If "it happened and it worked" isn't "mainstream" then I don't know what is.
Everyone says "we need more testing", but there's actually very little discussion of how that testing would translate into lower transmission. I'm skeptical any program less aggressive than the one proposed here would get R0 < 1.
Exactly. More testing is good, but actually stopping pandemic will require orders of magnitude more testing, which in turn requires a different approach to testing because the current way we do testing can't scale.
Is it because the discussion isn't needed? Anyone who is of moderate intelligence and thinks for a few seconds can see the next logical step. I don't know pb and he might be wonderful and original etc, but I have to agree with the original comment - this is just miles from an original idea. The constraint is tests, not ideas of what to do when we have simple/fast/abundant testing available.... "A third solution" makes it seem like it's... an original idea.
I think calling it a third solution is totally fair. Whether it's a novel solution is separate.
The two solutions that are being debated now are (1) staying in lockdown until a vaccine or treatment is available, and (2) reopening and attempting to manage the spread using existing protocols/ideas (relatively low amounts of testing, quarantining after a period of infectiousness, some form of contact tracing, lots of finger crossing). At least, that's generally what I hear being debated: reopen or not, or when to reopen.
The post suggests that if we had quantitatively much more testing, we could pick a qualitatively different third solution -- namely, reopen pretty freely and realistically control the spread.
Sure, you can view that as a variant of the "reopen" option, but in my mind reopening feels very different with a realistic way to isolate people before they've had a chance to spread it very far. It's proactive vs reactive. If we fully reopen with even 2 orders of magnitude more testing than we're currently doing, it's just going to be a matter of closing back up wherever it gets out of hand. In practice, the openness will fluctuate, things will be spread out over time, politicians will continue to do the exact wrong things, and lots of people will continue to die.
In short: (1) stay in lockdown until vaccine/treatment, (2) reopen without a strategy, (3) reopen with a strategy.
Imo, those are the currently discussed solutions because of the lack of available testing. Ie, with the current constraints. It's akin to two people discussing how to use the budget of $1 million and a third saying "I have a third solution: Make the budget $100 million and do everything". Sure, it's not wrong, and it's different to the first two, but... who cares? Everyone kind of already knows if you have the $100 million you have a much better option.
I mean in theory if you had a perfectly accurate test and everyone got tested before coming into contact with others, that gives you an R0 of 0. How close we can get to that standard is obviously very debatable, but simple logic tells us that it certainly could push the R0 below 1 given some (unknown) threshold of test accuracy and compliance.
Testing by itself does nothing to reduce transmission. What it does do, though, is give you the opportunity to identify infected people and isolate them. And if you can identify and isolate them early enough in the course of their illness, you can prevent them from infecting many other people, and that’s what reduces transmission.
Given that it appears people with COVID-19 can shed the disease for many days before showing any symptoms, if your goal is to pinch off outbreaks before they become outbreaks, frequent, universal testing is the only way to get there.
Right, but I haven't seen anything to suggest our current testing plans will be universal or frequent enough to really solve this. So testing more is certainly better than not testing, but without constant testing of non-sick people it's not really going to help much.
I think the main point is that he's pointing toward a specific test being developed that is intended to facilitate greatly increased degrees of testing. It is of course generally understood that if we could test everyone daily (or even a large section of people regularly), it could allow the virus to be contained without such widespread distancing and shutdown measures.
> This test gives results in ten minutes using a small amount of saliva which is taken into a disposable tube and then run through a scanner.
> We’re planning to start operating the first scanner within a month. If all goes well, there will be millions of scanners deployed by this fall, ensuring that every school and essential business can reopen while remaining safe and virus-free.
Agree to that point. The German, French and other media repeat that idea in the past weeks.
One of the oldest and largest biomedical institutes, the Robert Koch Institute in Germany, recently had a few press releases, urging for tests for at least ALL respiratory tract infections.
What one of the leading experts, Prof. Drosten, also mentioned is that current (PCR) tests have considerable false positives. The effect of such FP at large scale can hardly be estimated.
I really hope that you are able to find a solution and can bring up a scalable and reliable solution, after the promises. If not, there will only remain the impression that this could be a Silicon Valley type of talk the walk, as people heard it from other companies in the past.
Some people just advocate for isolating the elderly and having everyone else mingle.
The life expectancy loss from just letting it run its course would be less than a tenth of the life expectancy difference between the second and third wealth quartiles in the USA. And if we aren't worried about that difference, then why are we imposing a quality of life reduction that's much larger than the quality of life difference between those two quartiles for a much smaller gain in life expectancy? (similarly the economic costs of bringing the lowest quartile up a year or two would be much lower than the cost of this lockdown)
Because that's a terrible idea that doesn't make any sense. I understand the logic and why it's tempting, and I've even read some of the evidence supposedly backing it up. I find it thoroughly unconvincing.
I won't address the moral side, just the practical.
The virus disproportionately effects the elderly, yes, but far from exclusively. We have seen the non-elderly death rates with distancing in effect. If we could confidently say that >70% of the non-elderly population already had the virus, then this might make some sense. But since at the moment we cannot say that, then this is a method for quickly getting to >90% of the population, and killing off an unknown but far from trivial percentage of us.
Also, I have seen some evidence that the magnitude of symptoms is partly dependent on the degree of exposure. If that is the case, I really really do not want to be sitting between two infectious people in a movie theater or sports arena. But this would be commonplace with the whole "let's just sacrifice the elderly" approach.
The idea would be to isolate the vulnerable and let everyone else get it.
As a society we have shown time and time again that we only care about "disasters", not the continuous but far greater and less expensively solved losses. Nuclear power vs coal, air plane accidents vs car accidents, the life expectancy reduction of poverty vs COVID-19...
One way to achieve ubiquitous screening is for people to perform regular VO2max tests (loosely speaking; you can do submaximal exercises for this). You quickly figure out if you have a stress on your immune system (by watching various metrics), and there are sports-science papers showing this (because they use it to avoid overtraining, which also appears as a stress on the immune system). This is of course not easy to achieve with our current culture. It used to be that physical achievement was valued. Only a small fraction of society pushes against their VO2max in a regular way that can be measured and tracked to detect the immune-system stress. If people were to pursue this approach, they'd become a lot healthier in general.
This seems like something that would detect symptomatic patients only, I haven't heard of any research showing that patients would see lowered oxygen saturation in the early stages of infection.
So for people who are going to get sick it would trigger too late, letting them spread the infection for days until this test catches it; and all the many infected people who will never develop any symptoms (perhaps up to a half of infected according to the Iceland tests?) would never 'fail' this test, but still go on infecting other people.
You wouldn't pay attention to oxygen saturation, and I'm not sure if you can even use that as a metric. Generally this involves heart-rate variability, heart-rate recovery, etc. This detects the stress on the immune system, which is detectable soon after your body starts dealing with an illness. If the asymptomatic case has a stress on the immune system, which it likely does, then this test will detect it (so it actually isn't asymptomatic in a strict sense). It won't be able to tell you that it is Covid 19, but it can be used as guidance to behave as if you have the asymptomatic case. You could even just look at your performance: a significant drop in output means your body is unhappy about something. Imagine running/biking/swimming/etc at full capacity when you have a cold: you can't.
There are insanely high amount of speculation in there.
To my knowledge no significant amount of non droplet or hand-to-face contamination as been demonstrated out of medical contexts where aerosolization is more a problem, because of technical gestures and cares.
Even the linked page supposed to serve as a reference is completely speculative on the subject of the potential for the virus to be airborne: "In addition, it is possible that SARS-CoV might be spread more broadly through the air (airborne spread) or by other ways that are not now known."
So yeah, it also has not been proven that airborne transmission does not happen. But there are no strong signs showing we should highly worry about that highly speculative subject. The main contamination paths are well-known: droplets, and hand-to-face. If you want to strongly reduce the rate, you must focus on that.
> Even if we don’t avoid the virus 100%, reducing it by 80% could be the difference between something mild and something life-threatening. This could be a reason why so many otherwise young and healthy doctors and nurses have been killed by this virus.
Yeah, no. This is also completely speculative at this point. There is no strong technical reason for why it should be the case, given how viruses work... So not completely impossible, but short of real reasoning and evidences and studies, this is not a theory to particularly to focus on... ANYWAY, it is a good idea to avoid spreading the virus on all surfaces, but simply because this will statistically reduce the contamination rate (maybe without any impact on the severity for those who will be contaminated)
More generally, I'd like essays on that subject from people working in the medical field. And I'd probably not like essays on CS from virologists and epidemiologists...
Can you please make your substantive points without swipes? Controversial threads tend to devolve into people swiping at each other, and emotions run especially high in a crisis.
I don't think there's any reason to exclude an article on the basis of who wrote it. Articles should be excluded because they're off topic, bad, or uninteresting. Essays on CS from virologists would likely be of high interest to this community.
Besides that generic argument, which has become a bit of a shallow dismissal lately, there's the fact that pb is writing about a project he's personally involved in and which hasn't been discussed here before. It's understandable if there's interest in that.
> Yeah, no. This is also completely speculative at this point. There is no strong technical reason for why it should be the case, given how viruses work...
Yes it is. If the initial amount of virus exposure is low, the immune system has more time to react.
I've heard from virologists that the amount of virus you're exposed to does matter. A gallonful of virus can quickly overwhelm the immune system, a small amount can take long enough to grow that your immune system can ramp up to deal with it before it overwhelms. It's like someone releasing one breeding pair of rats in your attic vs 100.
I don't have a cite, it was from the "This Week in Virology" podcast.
I also heard a number going around suggesting that an early group of people hospitalized and killed were Ear, Nose and Throat doctors, who obviously would have been exposed to an almost comically large amount of the virus.
Giving someone a little bit of smallpox was a known immunization method before modern methods were invented. You'd still get sick, but less sick, and you'd wind up immune.
It's a lot of money in toal. But if the costs could be are borne by the customer or service provider or employer equally or proportionally, then it is a viable alternative to complete shutdown of businesses.
(The total cost of 50c drinking straws or coffee cups daily is also in the billions but we don't see it that way.)
The USA could pay 6B/day for over a year of the current stimulus package. And that would be paying for the whole world. For the Netherlands it’s a similar amount (for a year) as what we just put in one airline. So it’s peanuts. Employers could Easily pay this for staff, people could pay it for events, etc.
This is a pleasant thought, but we can't even get most people to obey speed limits most days, even though it's far easier and we know it would save large numbers of lives.
strictly speaking, speed in and of itself isn’t the primary problem, it’s distracted driving in its many forms. speed only makes the severity of those accidents greater.
That doesn’t really make sense. If you’re driving too fast, even with perfect focus you could hit someone or something before your normal reaction time could recognize and avoid it.
you’re missing the second half of the random chance argument. you could also have driven right past a collision that would have happened at a slower speed.
That makes no sense. The “collision that would have happened at a slower speed” wouldn’t happen at a slower speed because you’d see it coming in time to react and avoid it.
I'm sympathetic to raising speed limits like any good Californian. But there's an asymmetry in the positions, in that more reaction time is universally better than less reaction time.
that’s not so self-evident. reaction time is a property of the driver, not the speed. slower speeds can lull drivers into slower reaction times, so it’s not so obviously asymmetrical. drunk drivers tend to drive slower than normal but have higher fatality crash rates, for example.
active driving and avoiding distractions (including drugs) are the difference makers, not speed limits. the reason people oppose this is because they want to treat driving like lounging by the pool, rather than operating machines that collectively kill a million people a year.
Allow me to ensure I understand your position. Overall, you believe that lower speed limits will result in more accidents?
I am certainly on the side of raising speed limits to 100 mph where possible. Or providing turbo lanes for "Class C+" drivers or something. But that's because I think I'm willing to make the trade-off in lives. Your opinion is more that we're making not a trade-off but costing ourselves both lives and speed?
no, i’m saying speed is largely beside the point when discussing saving lives in auto accidents. the critical behavior change we need is constant active driving, which is hard, but that’s what would make a meaningful difference, not lowering speed limits. people tend to drive as fast as conditions allow anyway.
Sure, but you work within the constraints you have. What we really need is a cure for all cancers but that doesn't exist just like no universal method for constant active driving exists. Given that, it's a pointless thing to bring up.
"Just have everyone be better at things" isn't a helpful alternative.
that’s a false equivalence. every driver has the ability to refrain from texting, talking on the phone, eating their breakfast, doing their makeup, reading the paper (yes, i’ve seen this), etc. and instead focus on scanning the road and their mirrors while actively controlling their car.
I'm talking about from the view of public health administration. There is no intervention available to us that will ensure a change in behaviour economically.
I’m having difficulty understanding why SPR would be more scalable than LFAs for this type of frequent screening? And what does the ROC look like for this startup’s SPR assay?
Frankly, I don’t understand how this test is supposed to work, and I’ve used a Biacore! It might be helpful to have a technical explanation available, for domain experts to evaluate.
There didn't seem to be any details at all. Is there some sort of functionalized surface that specifically binds the virus, if so what molecule/chemistry, how?
Good sleuthing! As you suspect we functionalize the our sensor surface to specifically bind the virus. We've partnered with a therapeutics company developing highly specific monoclonal mAbs against SARS-CoV-2 which we leverage in our diagnostic platform.
Couple of things at play here. First is we are developing a non-PCR based viral detection test. Many of the molecular tests approved rely on many of the same ancillary components (RNA extraction kits, flocked nasal swabs, viral transport media) as well as instrument systems. What we are developing is a non-molecular based test to directly detect SARS-CoV-2 particles in fluids, specifically saliva.
We've just begun our clinical testing so don't have specificity/sensitivity metrics yet, but will be sharing them when they're available.
"But we have not seen an urgent enough escalation in testing, isolation and contact tracing – which is the backbone of the response.
Social distancing measures can help to reduce transmission and enable health systems to cope.
Handwashing and coughing into your elbow can reduce the risk for yourself and others.
But on their own, they are not enough to extinguish this pandemic. It’s the combination that makes the difference.
As I keep saying, all countries must take a comprehensive approach.
But the most effective way to prevent infections and save lives is breaking the chains of transmission. And to do that, you must test and isolate.
You cannot fight a fire blindfolded. And we cannot stop this pandemic if we don’t know who is infected.
We have a simple message for all countries: test, test, test.
Test every suspected case.
If they test positive, isolate them and find out who they have been in close contact with up to 2 days before they developed symptoms, and test those people too."
This assumes that "economic activity will restart". Humans won't participate in dangerous activities. They may test the waters e.g. by ggoing to gyms, but as soon as a single case is found they 'll be scared back into their homes. It will happen even more so as the disease spreads and people learn about the death of someone they know. This will happen regardless of how much testing.
If you 're doing contact tracing right, you should need to test very few people per million every day. If you need to do a lot of testing, you ve probably already lost and will be forced to shutdown again. The solution is probably the second: antivirals.
If humans were so extremely risk averse that a single case is unacceptable, wouldn't we have naturally isolated ourselves without requiring lockdown orders?
No, because while many humans are risk averse, we also live in certain cultural circumstances that prevent us to make that decision unilaterally.
For example, I cannot just tell my boss, I am working from home, even though in my case there is no problem. Even if he allows, the company policy might not. (Although I am lucky I live in a sane country and we have that policy now.)
Or in Czechia, now everyone wears a mask (since it is mandatory). It became a norm in like 2 days, one day almost nobody had them (and people felt that wearing them makes you look sick), the next day they became mandatory in public transport, and the day after everybody had them.
There are other examples like that, where the peer pressure plays an important role (in preventing humans to make rational decisions).
PB, can you elaborate on which other possible answers you've found for fast, easy, and abundant tests?
I'm working with a team that has a test that detects proteins associated with covid. It works like a pregnancy test and does not need a special scanner. Would love to discuss further.
I'd love to hear more! Part of the reason I put this out is to encourage other people with technology for fast, easy, cheap testing come forward.
Is your protein test able to detect as soon as people become contagious? That's where a lot of ideas fail, but I think getting R0 < 1 likely requires it.
Not only is it completely unrealistic at scale, the specific approach in the blog post is wildly impossible at all.
It requires screeners to directly manipulate saliva samples; this is dangerous in a pandemic. The assays referred to (lazily) in a Google Scholar search are almost overwhelmingly antibody assays; this does not allow the screener to differentiate between "has COVID-19" and "had COVID-19". Also, there is no evidence that the described test actually exists.
Finally, maybe irrelevantly, there is no way in hell you're going to get people at large to stand around for two hours a week waiting for test results. Ten minutes for a screening whenever you try to enter a public building; that's ten minutes to get into work, and we'll say ten minutes to get into another place each day. "But wait," I hear you say, "you only need to be screened once per day, and the first place can share that data with the next place." This plan was constructed by someone who is unfamiliar with medical records laws.
This is no "third solution." It's an engaging thought experiment, but it's just too far away from reality to get here from there.
I might be misreading your comment, but I don't think the blog is promoting antibody testing? It sounds like the blog is about a method of detecting viral particles directly, perhaps using an immunoassay based on the wiki for SPR, but not to test for antibodies directly.
And in terms of medical records laws, the regulatory environment has loosened so quickly with the advent of this virus that I'm sure regulators and legislators will be favorable to making it easier for the company if the test demonstrates the appropriate sensitivity and specificity in clinical trials. People are getting reimbursed for sending emails to patients, health visits done over zoom, would have been impossible to imagine this level of regulatory flexibility just six months ago.
Not to quibble too much with most of your criticism, but this one seems minor and trivially solved:
> this does not allow the screener to differentiate between "has COVID-19" and "had COVID-19"
As a policy matter, this doesn't rule out the use of the test in a pandemic management protocol at all, it just changes how it needs to be administered. For example it might require that people who are antibody-positive have a standardized note confirming recovery (in Contagion, this was a cute electronic bracelet).
The critical requirement is that we detect unknown positives, and this test would do that.
I also don't think this particular test is an antibody test? It seems that this test detects viral particles based on:
"The most proven and ready to scale technology is based on surface plasmon resonance. It’s able to detect even a very small number of viral particles, which is very important because we want to detect everyone who is contagious"
(6th paragraph in the "A third solution" paragraph)
> people who are antibody-positive have a standardized note confirming recovery
How do you prove recovery if you were never proven sick first?
As an example, I had all the symptoms of Covid in late February, the same severity many people in my age group described, yet was never tested since our health authority dropped the ball and claimed community transmission wasn't a thing back then.
If I tested positive for antibodies, would I get treated like someone newly infected? The only way to prove recovery is to prove you have antibodies and don't have the virus, so we'd essentially have to test every single member of society.
There are different subtypes of antibodies that you test, some that emerge early in infection and others that emerge later. The current understanding is that the later emerging antibodies being positive generally indicates that you are not only recovered but also immune from the virus and can donate your own convalescent plasma to be used as a drug for people with the infection. If you test positive for early antibodies you are assumed to still be undergoing the course of the infection.
A shopping mall could have screeners at literally every entrance, and there are sometimes dozens of entrances at a shopping mall.
Even then, traffic might be reduced, but it would be enough traffic for something like regular life to resume. Some businesses would be able to survive, even if not all.
* IDEA *
They could also do checks in the parking lot of any business. You drive up, someone comes out to start the process and marks down your license plate. After 10 minutes they return to your car and tell you your results.
This way nobody is standing in long lines possibly spreading the disease to each other. And it scales well to large numbers of people being tested simultaneously.
There would be a lag time of 10 minutes, but throughput would be nearly the same as before COVID.
The saliva stays inside the tube for that very reason. The test specifically identifies the virus, not the antibodies, again for the reason you identify.
Currently most public buildings are closed, so adding ten minutes is a big improvement relative to that. Also, it probably took them more than ten minutes to drive to work, so I don't think it's completely implausible.
Some of the assays do appear to functionalize the surface to directly bind and detect viral particles. I have some familiarity with SPR but haven't used it and not to detect viruses (otherwise experienced with surface science).
I mean, my reaction is certainly on the "let us know when you start scaling out a quite accurate test" side of things, but I don't understand the point of declaring that it can't work.
Especially based on assumptions.
The petty whinging in your third paragraph is basically ridiculous. Imagine, waiting 10 or 20 minutes a day for a few months to help save millions of life-years.
> antibody assays; this does not allow the screener to differentiate between "has COVID-19" and "had COVID-19"
It does if it's an IgM test - IgM is only around during the illness. However, it takes a while to come up, so it can't tell you if someone is presymptomatic, at which point they are highly infectious.
What they’re describing is an antigen test, not an antibody test. It tests directly for part of the virus, not an immune response, so it’s more a replacement for the existing PCR testing.
That said, I have some serious doubts about the particular mechanism being used here being ready for $1/test within say the next year or two. It’s been studied for a few decades and while there has been some promising progress, this would be the first saliva viral antigen test using this technology. It seems a bit like trying to solve global warming by bringing fusion generators to market. I have doubts it will be deployable before a vaccine, let alone more conventional and boring antigen rapid diagnostic tests that we have developed for a wide array of viruses.
> First of all, it’s not “just the flu”. It is something much more dangerous.
It is for some demographics, not all. It's safer than the flu for young folks, especially the under 10's which the flu hits pretty hard. For some it's worse, especially over 70s.
> Catching this virus is a bit like playing a round of Russian roulette. You’ll probably be fine, but you could end up dead.
Also true of the flu. Yes, even for the seemingly young and healthy.
It's amazing how freaked out people are getting over this. All the data points to it being worse than the flu, but not drastically [1]. Certainly not "immunity checkpoints at all building entrances" worse, it's not ebola.
That doesn't really change anything. To the extent the vulnerable are holed up inside, everyone else is welcome to get it, display mild flu-like symptoms, and develop herd immunity.
Sweden isn’t proof of anything, please stop using it as though it is.
Your claim is that the vulnerable can be “holed up” while everyone else goes about their happy business. There is no such thing, and I challenge you to provide the details and success as measured by per-demographic death rates of any proof you may have.
The crux of the issue is this: Neither I nor the Swedes believe that you can keep this disease at bay by hiding indoors for a few months and then opening back up well in advance of a vaccine which appears to be the entire world's game plan. I think it's fair to say there won't be a vaccine for 12-18 months, and we're not as a society prepared to stay indoors for that long.
Not to mention even with complete lockdowns around the US we're somehow seeing 38,000 new cases per day. This is not winning. With an R0 of 2-5 a single new infected person post lockdown lifting is going to set the wildfire ablaze again. As China is showing us, if you lock down then re-open, you're just going to start playing whack-a-mole with rolling city-level lockdowns.
Even if we were to stay inside for months, the case the Swedes are making is that deaths are higher now than in locked down countries, but unlike locked down countries, the Swedes will have developed herd immunity in a few months, and will never be affected again.
This makes the temporary delta in death rates not a success for locked-down countries but rather a temporary deferral.
Sweden is proof of something, but it's not clear yet what. Somehow, their new case load is pretty flat, just like the US. [1]
Let's hope this works, and if it does, that we use it for every other kind of disease as well. I'd sure like to never get the flu, or the common cold again, because we brought their R0 to near 0 also.
What do you do if someone denies the test? You can deny them entry, but if they protest or decide to force the issue, then the police have to deal with it. Then if the police get sick, they have to self-quarantine, and what do you do when you don't have the power to enforce the test?
Even if we managed to dress up our entire police force in hazmat suits to reduce the risk of infection, they can still infect people out and around the building. Turning away someone doesn't mean we're reducing the R0, we're just moving someone that's infected around. Given that there are asymptomatic people (and a certain number of people that would likely claim the test is a false positive or fake), all we're really doing is encouraging more people to gather in a single location as a potential infection vector.
Let's assume next then that somehow we had an automated solution. All the doors to said buildings are locked unless you complete a saliva test to go through. Barring the huge logistical concerns, we're still dealing with potentially infected people spreading the virus on surfaces and areas that people are travelling to and from.
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[ 3.4 ms ] story [ 338 ms ] threadSo you can allocate tests by sorting by (# of daily contacts in a closed space) ^ 2.
But as PB says, it should be practical to test everyone every day.
Edit: I’m not sure I interpreted the original statement correctly.
[probability of becoming infected and spreading] = [probability of becoming infected] * [probability of spreading] ~ [people you meet]^2
probability of spreading = a * n probability of infected = b * n
where: a,b = some blackbox function for spreading/infection ratio? n = number of people you meet
Assuming both are independent events we get:
p = a * b * n^2
I can see how we get n^2 with that. The way I'm using a, and b seems clumsy though, is there a better way?
p_catch ~ n
p_spread ~ n
p_relay = p_spread * p_catch ~ n^2.
Correct, it's not. But it is roughly linear in the limit of small numbers of people with a small constant probability of becoming infected per interaction. (This assumption becomes problematic when you see "clustering" of highly social people with other highly social people.)
To be specific, if P is the probability of becoming infected when interacting with a single person, then the probability of becoming infected after interacting with N people is 1-(1-P)^N = NP - O(N^2 P^2). It's easy to see that the limiting infection probability is 1 in this simplified model, and that if N*P < 1 you're looking at close-to-linear growth.
Look at the excess death statistics. There's no question that it's deadlier than seasonal flu, because the seasonal flu doesn't kill a 9/11s worth of New Yorkers above the usual death rate over several weeks. If the current rate wasn't slowing we'd be looking at a death toll multiple times higher than the seasonal flu.
About 20% of people in NYC showed a positive antibody test. That's not nearly enough for herd immunity and it's not enough to push the infection fatality rate as low as the flu's.
https://www.nytimes.com/interactive/2020/04/10/upshot/corona...
I have told a lot of people who said this "Just do it yourself. I don't know how to just do it". It's so disrespectful. "Just convert everything to micro services written in Go and all your problems will go away".
Will it work? God I hope so, but it doesn't seem prudent to bet on it. We know several existing technologies for covid testing that will work. We know they can scale. We know how expensive they are. And while they aren't cheap, we know can afford it at the federal level.
That we still refuse to actually pull the trigger on mass testing and announce a program to fund and launch a universal covid testing regime is just infuriating.
I mean, I desperately hope that a magic bullet like this will pop up to save us. But we know how to beat this. We just won't.
People being wrong is also inevitable. We don't have a truth meter, and there's a ton of uncertainty on topics like this one anyhow. I don't think it would work to try to restrict discussion so that only authoritative opinions are allowed. This community would not tolerate that sort of restriction being put on it, and it would only convert to an argument-by-proxy about who should count as authoritative. The solution, if there is one, is to converse thoughtfully and respond to one another with accurate information where possible.
* Doesn't work
* Too hard to train
* Shortages will happen
Literally all were wrong and they either knew it and misinformed everyone or didn't know it. So you can either drop the assumption of benevolence or competence.
The only guys who didn't listen to them, Taiwan, are doing fine despite every other risk factor being huge for them. It turns out some skills translate across domains. I'm not going to get a software engineer to perform a total knee replacement on me, but I think I'll listen to them on the crisis management: turns out they're better at it than the crisis managers.
I think this is mischaracterizing it. People have to die eventually. One year of existence has a mortality rate of 1%. For a 75-84 year old individual it is nearly 5%. Above 85 it's 14%. [1]
The coronavirus infection fatality is likely around 0.5-1%, but it's heavily skewed towards older individuals. Younger people do die from it, but a very low rates. And young people die from other causes as well, the annual mortality rates for a 20-something is around 0.1%. Getting coronavirus for a 20-something or 30-something is roughly equivalent to the mortality rate of a few months of life.
Death is sad and terrible, but we don't shut down society because people die.
[1] https://www.mdch.state.mi.us/osr/deaths/ageadjdxARS.asp
New data is showing that the fatality rate from covid-19 is more like existing risk we were all previously exposed to in the course of our existence, and not like a second version of smallpox.
That’s assuming no second order effects like a shortage of medical care making things worse.
For one year (or however long it takes to reach herd immunity -- and if longer, then death rates wouldn't double but increase much less). Assuming recovery confers significantly long lasting immunity, which I agree is not a trivial assumption (and one we don't know yet how reasonable).
Definitely not trivial, but -- in context -- means a reduction of life expectancy by less than one year. The US already lags Japan by 6; there's a lot that can be done to improve it by a year, with costs much lower than those currently spent to avoid reducing it by a year.
An important thing to recognize is that the disease itself is not an existential threat (even smallpox wasn't; even the plague wasn't!), but our response to it skirts creating one.
We need to give the scientists and medical professionals and industry more time to figure out how best to prevent this. There are many reports of 40-50 day illnesses in young people due to not clearing the virus. And the poorly named 'mild' case can be rough. It's (badly imo) defined as when a patient doesn't require hospital. It should be called moderate I think. [1]
[1] https://www.businessinsider.com/what-coronavirus-mild-sympto...
In the US, it’s largely the things I listed.
If getting it confers lifelong immunity (a question that does not yet have a definite answer), that means getting it means you compressed the overall risks of two years into one[0], or reduced your life expectancy by one year.
Now, one year is a lot. But the difference in life expectancy between the US (78) and Japan (84) is already six times as much, so the lockdown in that context is about 6 times more expensive (per day, per person) than moving to Japan[1] would have been before COVID19, and no one would have preached the latter.
Here's a conundrum: you can (a) lock yourself at home for 6 months, likely losing your job, potentially keeping in touch through the internet; then come back to "normal" life. (b) give up 6 months of your life expectancy, but go back to your normal life tomorrow. That is, w.r.t life expectancy, you can pause for 6 months and keep those 6 months; or fast forward those 6 months (and thus lose them). Almost everyone I know would pick (b) if there aren't any exception circumstances such as terminal disease. But the western world at large chose (a).
[0] That's not exactly true - depending on some other model parameters; reduction of life expectancy by 6-9 months is more accurate.
[1] It's not guaranteed that moving to Japan would grant you Japanese life expectancy. It is also not guaranteed that the lockdown as practiced really buys you more than a year either.
This is a whole different thing from 'another flu'. We have to address it head-on. Throwing people (a million people?) under the bus is not going to fly, not politically and not morally.
I've yet to see a compelling argument that LY or QALY analysis is the wrong approach.
> This is a whole different thing from 'another flu'. We have to address it head-on
It sounds like you're not actually offering any relevant response to the parent comment, but just repeating the taglines we all saw in the article.
> Throwing people (a million people?) under the bus is not going to fly, not politically and not morally.
Every political action has victims and beneficiaries. At the moment, we're hurting billions of people (almost the entire world population) to buy (on average) a few expected life-months for a very small section of the population.
Your model of "people dying is bad" is true but not sufficient to make rational decisions.
Data is showing that the infection fatality rate is around 0.5%-1%, and is concentrated in older people. [1] is one study, but there are many others. Given this data, it's clear that our current response is out of proportion with reality.
[1] https://www.reddit.com/r/COVID19/comments/g4tqvk/dutch_antib...
What we need to hope for is an unlikely vaccine, or a therapeutic treatment to mitigate the worst of the diseases effects.
> Data is showing that the infection fatality rate is around 0.5%-1%, and is concentrated in older people.
right, "old" (65+?) people are going to die anyway, lets just let them die sooner. How much sooner? Years? Decades? Does this really sound like a cogent counterargument to not letting people die?
Let's ignore the morality aspect of this, which I don't think is in your favor, to put it mildly. I don't really like people suggesting that millions of people should die because "this is sad, but at some point, everyone has to die." Yikes.
But lets pretend we live in a very nauseating reality where older people don't really matter very much. You should still want society shut down to prevent this spreading out of hand because this will easily and thoroughly overwhelm all of our healthcare resources, which will mean hundreds of thousands of people you actually do care about (i.e. non-older people) will also die from lack of medical care either from COVID, pre-existing medical conditions, new medical conditions, etc.
First, the .75% mortality rate is a one-time hit. It likely pulls some deaths forward, so the incremental death rate is maybe .5% in a single year. Again, this is terrible, and sad, but we should be mindful and accurate with numbers.
Second, people make lots of choices that increase their mortality risk by .5%. For example, lots of people eat at McDonald's on a regular basis, which certainly increases your lifetime mortality risk by .5%. And other people don't exercise at all. 30 minutes of jogging a day will lower your mortality by at least 1%, likely a lot more [1]. But we don't pass laws to force everyone to jog for 30 minutes a day.
With the new data, which is showing that mortality rates from covid-19 are not like smallpox 2.0, we should adjust our response to be more in line with responses to comparable risks.
[1] https://www.theguardian.com/lifeandstyle/2019/nov/04/any-amo...
This isn't really true. It depends a lot on the state. The healthcare system in my area, California Bay Area, is completely underwhelmed. Here are some numbers from San Mateo:
(1) 40% of standard ICU beds are open
(2) 91% of ventilators are unused
(3) 91% of "surge beds" are unused
Source: https://www.smchealth.org/post/san-mateo-county-covid-19-dat...
If our goal is to flatten the curve to slightly below hospital capacity, current policy has flattened the curve way too much.
Current number suggest that only 1-3% of the Bay Area has been infected with covid-19. If you wan to get to 70% infection rate for herd immunity, it would take multiple years to get there at current rates.
Those numbers reflect a correct, working response. Sure the restrictions can be lifted, but carefully and balanced by changes in those stats.
Our goal is to simply avoid hospitals becoming inundated. How would it be possible to flatten the curve to "slightly below hospital capacity"? To do that we would need to know exact numbers on hospitalization rates from infections, have a testing capability that is far beyond what we currently can do, and then we would need to have fine-tuned control on peoples' behaviors and also never be wrong. We have too much ignorance about too many things to do this in a way that you would deem optimal. This is a disease that takes a median of 5 days to incubate, so as soon as we get something wrong (hint: we will get it wrong), it festers for 5 entire days before we know it, and then we're stuck with the consequences. The only rational choice is to take severe action and hope it's enough. It wasn't enough in Italy, it wasn't enough in NYC.
If you're saying that social distancing/lockdown policies are an "overreaction" because we still have ICU beds and ventilators, I think that's a pretty good sign. The entire point is to do something drastic now, and gradually ease distancing measures as it becomes safe to do so without causing additional large-scale outbreaks. As soon as we have the ability to contact-trace all new infections and can successfully contain outbreaks, we can start letting up.
Of course, as others point out, there's also the enormous strain on the hospital system. Which, I am very curious: are you not aware of what has been going on with the NYC hospitals? Or parts of Italy?
[1]: https://www.worldometers.info/coronavirus/coronavirus-age-se...
IFR data hasn't been available until recently because you need A) randomized sampling and B) antibody tests, which have only just been rolled out.
The most up-to-date IFR data suggests that "0.5%" is actually an astoundingly high overestimate for any reasonable metric of "number of people who die from this", and that's before adjusting for the fact that the people who die were usually going to die soon anyway.
12k deaths in NYC gives a pretty hard lower bound on IFR of 0.14%.
The IFR will end up higher than 0.5% if incidence in city is any lower than 27%, which seems very reasonably likely.
For H1N1 swine flu, CFR was between 0.1% and 5.1% depending on the country. The IFR was 0.02%.
For COVID it's between 0.07% and 15%. The IFR is probably in the lower quartile of the 0.1%-1% range. [1]
[1] http://cebm.net/oxford-covid-19-evidence-service/
Yea, but COVID has the potential to kill a lot of people, quickly -- are you suggesting it's a bad idea to "shut down society" to keep our hospitals functioning? I get the point that the economic cost is severe and also comes with its own share of human cost, but we're talking about saving ~1-2 million people in the US alone by doing this. Several trillion dollars is still worth it...
$2 trillion is 10% of GDP or the losses in ~6 months of a lockdown resulting in 80% productivity (with the assumption that everything goes back to normal immediately after the shutdown, which it won't)
So it seems like a ~6 month lockdown is warranted if you crassly value saving a life from COVID at $1 million. That's not long enough for a vaccine.
Alternatively, working backwards, you need to value a life saved at $3-$4m each to make a 18-24 month lockdown worth it.
EPA recommends that the central estimate of $7.4 million ($2006), updated to the year of the analysis, be used in all benefits analyses that seek to quantify mortality risk reduction benefits regardless of the age, income, or other population characteristics of the affected population
https://www.epa.gov/environmental-economics/mortality-risk-v...
No, we're not. 88% of people on ventilators in NYC don't survive (in a predictable pattern - 97.2% over age 65 don't for example). You might remember that just a couple of weeks ago, everyone was calling for more ventilators and every company with a workshop started building one -- because it was assumed (a) they would be needed, and (b) they would be very useful; neither is considered self evident truth (or truth at all) three weeks later.
There is no vaccine yet, and no medicine yet, and either may take a year or twenty (TTBOMK, no successful vaccine for the corona family was ever made, and not for lack of trying). Unless you assume a miracle, the assumption is everyone will get it -- and so far, our ability to significantly "save" people has not been demonstrated.
The only reasonable assumption right now is that everyone will get it, and while keeping the hospital system function is important in general, it makes little difference to those who get COVID19.
A more reasonable model is that we're avoiding a 6-8 month reduction in life expectancy, at a cost of (so far) 2 months of normal life. Whether it is worth it or not is not for me or you to decide and obviously depends on your point of view -- but it is clearly not self evident one way or another.
[0] https://www.washingtonpost.com/health/2020/04/22/coronavirus...
edit: someone is systematically downvoting all my posts on this thread. Whoeveer that is, I am not advocating for or against a course of action - I'm addressing the math. It is your right to downvote without explanation, but if you think I'm wrong, I would appreciate an explanation.
In fact, are you willing to die for it? If given the choice between dying of COVID-19 or shutting down society, you're saying that you personally would choose to die?
I'm bringing this up because the difference between this and other causes of death is that not only is this transmissible, but it also has knock-on effects that we currently have no clue about (see: blood clotting). If we don't do what we can to prevent this, it could become far worse than what we originally thought.
Obviously shut down society, but that's not the choice that exists.
The choice in reality is an acceptable risk of death, or shut down society. Between those I pick the acceptable risk of death. We all make the same choice for many, many other situations.
The reason why I bring this up is because when you argue for reopening society based on 'acceptable risk', you're not just risking your own life. You're asking other people who are at risk (ie people with asthma or other issues) to die for you.
This "Third Solution" has been offered all the way back in February. It suffers from the same lack of information around reinfection and spread rates as it did the first time around.
> Even with imperfect screening, if we are able to prevent 90% of disease transmission, then the virus’s reproductive number, or R0, will drop below one and the pandemic will quickly fade. There is no risk of reintroduction from the outside because any new outbreaks will quickly be caught and contained. If used consistently, there will be no second wave, ever.
I'm not sure this "test and release" strategy works unless absolutely everybody gets tested simultaneously.
Even if testing of the total population can be completed in a week (a highly ambitious timeframe), there's still time for people released on Day 1 to be reinfected by people who don't get tested until Day 6.
Then you have to go through who knows how many follow-up rounds of testing absolutely everybody not in quarantine to identify those people. When responding to new outbreaks involves re-testing large populations of people, you're going to run into many problems. Notification, compliance, testing fatigue, etc.
Sounds like a logistical nightmare.
Imagine trying to enforce this on every non-residential building in, say, NYC. It would be practically impossible.
Who checks to make sure every restaurant follows the standards of cleanliness? They have inspectors who (theoretically) show up randomly, so it ensures most places comply voluntarily, because the cost of getting caught is very high.
A combination of random inspections and steep fines would solve the compliance problem.
Edit: I just had another idea. Offer cash rewards to people who can prove they they weren't tested when entering a public place (which the business pays for via fines). You'd have people running around trying to find missed testing for the cash reward.
you can't reject solutions because they sound dystopian unless you've got better, non-dystopian solutions. and everybody has to stay in their homes at all times and all non-essential services are shut down is not a less dystopian solution.
What “solution” are you looking for to solve this relatively small share of “death from natural causes” that we call COVID? How much damage should we inflict upon ourselves in this moral quandary?
How many people should die because we’re willing to spend trillions of dollars due to our innate fear of a virus rather than our innate fear of much much bigger problems, like poverty or starvation?
Why can we muster so much energy in this case, and so little on much bigger problems? My theory is that you can’t catch hunger on the subway, you can’t catch underprivilege from a doorknob, and you can’t catch climate change from shaking hands with constituents.
There’s a lot wrong with our planet, it’s too bad we’ll all go bankrupt and unemployed chasing such a trifling disease as COVID when there were actual real problems we could have solved with mountains of cash that large, rather that burning the cash in effigy for modest to no effect once COVID has run its course.
https://news.ycombinator.com/newsguidelines.html
If I could still edit the comment, I would replace the first “you” with “we”, as none of the comment is meant to be directed personally at OP.
The dystopia we have is purely one of our own creation. One which TFA seems to not only welcome with open arms, but seeks to capitalize upon. It’s really quite sad.
One is that cash is not a resource. It's even less of a resource when it's not only not metal, but mostly not paper either.
The other is that the flu comparison doesn't make sense to me on multiple levels. Given deaths from COVID at the moment are nearly ten times flu on an annualized basis, given the partial shutdown, obviously they would be more than ten times without the shutdown...but what is even significant about exactly one order of magnitude?
I’m not quite sure what to say to “cash is not a resource”. Even if just a proxy for attention cash is obviously a resource. But really, cash in itself is a resource. $10 trillion dollars can do a lot of things if spent wisely. $10 trillion dollars can also be destroyed for practically no benefit at all.
I agree it’s not strictly $1 spent on A means $1 less to spend on B. But it’s at least true to some extent, and again, as a proxy for attention and willingness to enact change, it’s a valid measure.
So the flu comparison is because they are both respiratory illnesses which kill a lot of people. In the 2017-2018 season the flu killed 61,000 in the US. Hospitals in NYC were stretched very thin. Nobody really noticed. It wasn’t even declared a pandemic.
Obviously it’s impossible to say with certainty if we have seen 1/4th, 1/3rd, or 1/2 of the total deaths that we are going to see from this SARS-CoV-2. But I think nobody is currently out there claiming that we’ve only seen 1/10th of the total deaths from SARS-CoV-2 that we’ll get by the time it’s over. (SARS-CoV-3 is another story?)
“Ten times flu on an annualized basis...” So 50k times 4 is 200k. That’s not nearly 600k. Just trying to follow your math. If we’re halfway through now (IHME thinks we’re about 3/4 through) then we‘ll have seen in COVID the equivalent of two bad years of flu.
Orders of magnitude generally provide rough measures of classification and are a nice rule of thumb for telling if one thing is “radically different” than another thing. So, flu kills up to 650k globally per year. Maybe COVID will do roughly the same, maybe 2-3x, but I think at least we’ve long past the days of claims that COVID will kill 5 million worldwide are being tossed around. And it’s not because no one’s caught it and we just need to keep hunkered down. It’s because a massive number of people caught it and overall its just not that deadly.
If governments around the world had done their jobs and shared data and been truly prepared and with a little luck and a lot of hard work this whole thing perhaps could have been avoided by early and arduous contact tracing. That day is long behind us.
I worry that by now so much energy and ink has been spilled getting the country into lockdown, and people are so politically invested in it, and all the social pressure campaigns have ramped up to max,... that now as data finally emerges which demonstrate it was all a gross overreaction, we will be too slow to correct.
In the meantime 10s of millions have lost their jobs, perhaps millions have lost their businesses. A $1T deficit seems like a quaint memory (sorry grandkids!).
And it was all for, what, exactly? When herd immunity is the endpoint and the IHME hospitalization predictions were wrong by 10x... overbending the curve only causes suffering and does not save lives. Bending the curve too far into next winter could actually cost lives, which the CDC acknowledged earlier this week in a very roundabout way. And bending the curve at all only helps if additional medical treatment availability would have actually saved more lives, something which I have not seen a strong case for.
$10 trillion is probably over twice the (financial) cost of WWII adjusted for inflation. Having numbers of that size written down, deleted, moved around, doesn't mean we are suffering that level of loss.
As far as comparing covid to flu, I was talking about annualized daily deaths from covid, compared to a normal year of flu. That was deliberate. I'm saying, if it neither increases nor decreases from this point on, it's nearly ten times the rate in the long run.
You are comparing the total deaths from covid, assuming it declines and goes away in due time. That would be fine in a vacuum, but you're using the consequences of trying to stop it to argue the efforts to stop it are unnecessary. What is the point of this sophistry?
https://www.wbur.org/commonhealth/2020/04/03/contact-tracing...
Now is the time to express opinions on these "proposals"..
I think economic incentives are also fairly well aligned here. If tests are widespread, a significant segment of the market is likely to prefer locations that are testing to those that don’t, just like the market tends to prefer clean restaurants to unsanitary ones.
Wouldn't it stand to reason that you could be tested once per day, in the parking lot to a mall or some other shopping establishment, and thereafter _verify_ that you had been tested that day for the remainder of your commercial transactions?
Thinking in those terms, 10 minutes per day is not so great of an imposition. We could formalize it and create drive-through test centers where you drive up, spit into the tube, have a bar code on your phone scanned, and drive off. On your way to the mall you get a text message with your results. Everywhere else you visit that day scans your phone upon entry and confirms that you've been tested.
The system also becomes much more complex and requires a bigger infrastructure if you aren't literally testing people at the door. How do you verify someone has had a test today? In your bar code idea, can the bar code be faked? Is there some centralized database behind the system that tracks who tests positive? Is that database politically feasible? Some comments here are already objecting to that idea.
As for checking who has a test, simply give colored stickers. If someone wants to “beat” the system, so be it. Social disapproval and common sense will keep most people honest.
You need a plan for people who want to beat the system because they present a huge danger. The whole idea behind this system is to allow the people inside the secured bubble to return to normal behavior. They aren't going to be wearing masks, social distancing, or taking other precautionary measures. Therefore one person acting inappropriately could present a huge problem for the people on the inside. Keep in mind there are still people who think this entire thing is a conspiracy and that COVID-19 is no worse than the flu. You have to consider what happens with people like that who might not participate in this system in good faith.
Hawaii is an island, thousands of miles away from the rest of the USA, so why shouldn’t it open on a different schedule?
Even China, ground zero for the crisis, close and reopened different providences, districts, and even neighborhoods independently.
Could you protect a food processing plant with this method? Yes. Does it cover testing in LA? No. Does LA need food and other shipments? Yeah they do.
No lines to spread the disease, and better throughput if you're testing many cars simultaneously rather than whoever is at the front of the line. (Although I suppose many people could be tested near the front of the line too.)
The cheap flight was what made this epidemic a pandemic.
We can continue lockdown until everyone who has got it has recovered and is no longer infected. This is a matter of weeks and we are mostly there.
Once we get to no new cases per week for a couple of weeks then we can end the lockdown and get on with our lives.
To prevent reinfection then anyone that flies in gets quarantined unless they come from a plague free country. The same applies to other border crossings, e.g. ferries and roads.
This approach works with rabies in the UK and with other historical plagues. No widespread daily testing is needed this way just the health service testing we have now.
This approach is the only realistic option using what we can do now. However there is little talk of quarantine being used for those that fly. Quarantine means forty days.
> Sounds like a logistical nightmare.
E.g. 'test and release' where only folks who've been tested are 'released' into the public. Track outbreaks and retest those cohorts thoroughly. And so on.
They don't all have to get tested literally simultaneously; but the "release" part of the strategy can't start until the "test" part has covered everybody, or at least close enough to "everybody" that the difference doesn't matter. Note that that's how the strategy is stated in what you quote: if we can identify everyone who is contagious, then we can release everyone else. The "if" has to be complete before the "then" starts; that's what "if"-"then" means.
The false positive rate of lockdowns is 100%.
you’re underestimating the pain that many americans are feeling after just a few weeks of (soft) lockdown. it’s not that people want to be unsafe, it’s that their livelihoods are in grave danger if the lockdowns last for months. many people are willing to take some risk now that the pandemic hasn’t turned out to be plague-levels of badness that some initially feared. few people are economically secure enough to say ‘no’ to opening back up sooner rather than later.
Without expressing an opinion of my own, how can you write as though from a twilight zone without causal relationships?
I mean, you, or anyone, can doubt that the lockdown is necessary. You might be right!
But you must acknowledge and challenge the causal connection between the lockdown and "not plague levels of badness". Comments that just ignore the possibility creep me out, because I can't imagine what the writer is thinking, except maybe "wishing will make it so".
If that were true lockdowns would make absolutely no difference in R0. Clearly, they do make a difference.
- A false positive means that a test shows someone is infected when they are not. For most tests that's somewhere between 0.1% and 2%.
- Lockdown means everyone stays at home. Different from PB's plan, where only people with a recent positive test stay home.
- R0 (technically Re) is the expected number of people each newly infected person spreads it to.
When I say a lockdown has a false positive rate of 100%, it means a lockdown is the same as if you tested everyone but the test always (100%) reported positive, so everyone had to stay home every day.
The point I am making is that some of the people who are on lockdown are truly positive for the virus. That’s why it works. They don’t have the opportunity to spread it outside their habitation unit.
^or whatever the true number ends up being
I suspect relying on people to test themselves daily without mandating it would do a reasonable job, but I have no idea if it would be enough.
Edit: typo.
But during an outbreak, the ability to roll that kind of thing out, especially in workplaces with vulnerable populations (like senior care homes and hospitals) or necessarily close working conditions (like restaurant kitchens or some factories) could certainly be a game-changer. And that just seems entirely reasonable to me. There's a outbreak happening, so in order to enter [place where transmission would likely occur] you have to be tested first. If found to be infected, you must isolate. Otherwise, you'd be knowingly exposing others, which already isn't something considered acceptable.
So to me this simply looks like an effective use of existing powers in this situation. I'm not sure how it would slide down a slippery slope. The government decides to keep doing virus screening? I mean, I doubt they would incur the cost, but if they do, good! Maybe as Paul mentioned, we could significantly knock down cold and flu as well. If people are worried about infringing on the rights of people with viruses to live normally, I would ask what about the rights of others not to be infected by them? That besides the fact that if these measures are effective very few people will be getting sick in the first place.
When is the pandemic over? When does the pervasive testing stop? The argument can - and will - be made that "unless we keep testing until the end of the human race, you will all die tomorrow of a horrible virus-ridden death."
I don't particulary mind doing pervasive testing for awhile. I would desperately not want to live in a world where I could not feed my family unless I give into it.
When we stop seeing non-trivial numbers of test results. The idea that governments want to spend billions on mandatory virus testing outside every building until the end of the human race out of some Orwellian enjoyment of inconveniencing people is not supported by evidence. Even China isn't doing this. Back in the real world, even the SARS vaccination research programmes, which cost relatively little and inconvenienced nobody, were shut down when SARS stopped circulating and the even keeping a few scientists employed as part of a pandemic task force looking out for the future was a step too far for the US govt.
Setting aside the science of disease, the concept of government agents performing a test to determine one's ability to conduct basic civil liberties (movement, work, basic speech etc) is antithetical to liberal democracy. Such things were not contemplated at the height of the AIDS panic, or SARs, or ebola. It would take something far worse than COVID-19 to implement such a regime in the western world. COVID is a threat to our way of life, to our economies. It isn't an existential threat to the state let alone the species.
Can you guarantee that a healthy person who gets this 3 times doesn't have a 100% fatality rate (i.e. it gets worse each time?)
Can you guarantee asymptomatic people don't become sterile? (Not saying they do, but if they did this would be an existential crisis and lead to our extinction after a generation).
Can you guarantee asymptomatic people still won't have lung damage permanently? (some asymptomatics athletic types have shown severe decline in lung abilities following covid19).
SARs was bad, but was wiped out so it's moot, AIDS is easier to avoid -don't have sex. ebola I think isn't as viral, and has been mostly contained, iirc they may have a vaccine launched or soon will and better treatments -- it's never gone full global like this.
Covid-19's problem is it's severe viralness and r0. It spreads and keeps on spreading, and there's a ton we don't know about how bad having had it will be to even those with minor cases. until we know for sure on all these factors, the more we can quell it the better.
Which is 100% normal for any pneumonia. I myself once had a bad lung infection (on my back for over a week). It took months before I could swim laps as fast as I did before. That's not anything special. Infections always have secondary medium-to-long term impacts.
ACE2 is in high concentration in the testes too, could this cause fertility issues? Sure it'd be good for the environment but a lot of couples really do want and enjoy their children or to have some someday.
It'd be nice to know as much as possible before we open the flood gates.
This is misunderstanding exactly the text you are quoting. The goal with epidemic management is NOT to seek out and destroy every last case of the disease.
All we need to do is reduce the spread rate so the exponent in the equation goes from above one to below one. At that point, the outbreak will shrink over time on its own. Critically, new/undetected outbreaks with an R0<1 won't get purchase and grow, because they can't.
At that point, the population is "safe". Individuals aren't, people might still get sick randomly. But this isn't a policy for individual safety per se.
Googling for "romer covid 19" should turn up a lot of news sources covering the notion of testing millions of people a day.
IIRC, mainstream objections tend to come from concerns of false positives, since that becomes a bigger problem with this frequent level of testing and could prove a huge disruption if you end up with too many quarantine still, or so many that testing positive becomes essentially meaningless in terms of telling you whether you have the disease or not if you test positive.
https://www.politico.com/interactives/2020/coronavirus-testi...
That's because we currently aren't capable of testing everyone who is obviously sick just once. If we got there, we wouldn't even be close to being capable of testing key personnel (like health care workers). If we got there we wouldn't even be close to being able to test everyone once. If we got there we wouldn't even be close to being able to test everyone every day.
You haven't heard any advocating for OR against it because it is so far from achievable that it isn't worth considering.
The linked article suggests a novel and much cheaper test, which would be great. But even if that didn't work out, what scale could possibly be feasible with existing tests? Pre-shortage, an RT-PCR seemed to be much cheaper than a missed day of work.
Testing a few hundred people daily would be doable, as Germany has relatively good testing capacity - probably one main reason for the overall better handling of the pandemic so far. But the concept still gets critisized, as this would mean a fast track to testing for the players while parts of the population don't have equal access to testing.
For the whole population, it would be a good first step to be test really everyone who has any assumptions of symptoms and some time later, everyone in contact. And perhaps a biweekly test for the general population.
That seems like the logical conclusion of "more testing" to me. If we could, why wouldn't we?
3blue1brown on YouTube did an analysis which similarly shows that fast quarantining is the best way to mitigate the virus: https://www.youtube.com/watch?v=gxAaO2rsdIs
How does your device detect viruses? Is it based on a protein or the RNA or what?
Johnson and Johnson have already started scaling their vaccine and plan to have 1 billion doses available by January 2021. If their vaccine is approved, it will be an instant solution and better than testing everyone every day.
Moderna has also started the process of scaling their solution as well but J&J have a head start and a known platform.
Why not? Scaling a test is a completely separate exercise to scaling a vaccine, and it has the advantage that multiple proven working tests exit now, they just need to be scaled. Both can be done, by different people.
You might also find that having a vaccine and a test is better than having just a vaccine.
> If their vaccine is approved
Multiple vaccines are in development. This is not a situation where we should stop doing X now because Y _might_ happen in 8 months or more time. None of the vaccines are guaranteed to be ready and working and scaled at any given date. None of them.
That's demonstrably false. There are numerous prominent examples in fact.
Taiwan is not doing a high rate of testing at all, they're most certainly not doing constant ubiquitous testing. Their per capita test rate is 1/7 that of the US.
Singapore and South Korea are not doing constant ubiquitous testing. The US has already tested at a higher rate than South Korea and will pass Singapore shortly given the continued ramp in US testing. Both are held up as marvels of virus containment.
Japan has barely done any testing. They're seeing a small spike in cases now, however they were not earlier (this is four plus months after the outbreak began and Japan is next to China). Their deaths from Covid are commonly 1/50 to 1/150 the per capita rate of the US and other higher outbreak nations, while doing 1/10 to 1/15 the testing. The only explanation is either that they're covering up ten thousand deaths, or the other non-testing approaches they've utilized work well. Compare Japan to Germany on Covid deaths - again, despite Japan being next to China - and then look at the testing rates. Now explain that.
Finland is testing below the US rate and has contained the outbreak to a stellar degree. That's because Helsinki is colder than Stockholm and Copenhagen. The same reason Moscow didn't get slammed until more recently as the weather began to warm up. There are other factors that impact the spread of the virus, including the rate of social activity and high temperatures (over ~60F / ~15.5C). We know this from several studies that have proven the role of temperature in the spread of SARS and SARS-CoV-2; as well as understanding how the spread benefits from greater social activity (which doesn't occur at the same rate in super cold climates).
Greece has a very low number of Covid deaths and no evidence of serious outbreak this entire time. Their testing rate is 1/3 that of the US. And they're wedged between Turkey and Italy. Much like southern Italy, they've been heavily shielded by their climate. Nobody wants to talk about this of course, it's the Mexico / Texas / San Diego / Baghdad / Lagos effect in action.
Iraq isn't seeing any consequential outbreak, thanks to its climate. Whereas Iran right next door got smashed, because Tehran has an entirely different climate from Baghdad.
Thailand and Vietnam are both testing at a very low rate, and there has been zero evidence of serious outbreaks in either country, despite the proximity to China. That's thanks to their hotter climates.
Nigeria is barely testing at all, with zero evidence of a consequential outbreak there. No crushing of their healthcare system with cases or deaths; no huge spike in deaths, hospitalizations or ICU cases. There are numerous countries across Africa seeing similar low outbreak results, with very little testing.
Colombia isn't seeing a consequential outbreak, their testing rate is super low. They're not seeing a healthcare crush either. They've contained it so far without a high rate of testing.
India and Pakistan were supposed to get buried by SARS-CoV-2 cases. It hasn't happened, week after week goes by and the predictions continue to fail to come true. They're barely doing any testing at all. There's zero evidence in either country of a massive outbreak or crushing number of ICU cases swamping their healthcare systems. It's because of how hot their cities are. I've yet to see a single other good explanation for why India isn't buried in Covid deaths by now. India isn't seeing the virus hit for the same reason Africa hasn't.
Egypt is barely doing any testing. Cairo should have millions of cases of the virus and a huge number of deaths by now. They should have 20,000 dead people from Covid at this point just in Cairo. Where is it? Th...
Being off work for such should not result in severe reduction in income unless your income was already high; at least that is the case here in Norway where laid off personnel get 80% of their normal salary up to a limit that is above average salary.
Edit: typos
If "it happened and it worked" isn't "mainstream" then I don't know what is.
1) https://www.bloomberg.com/news/features/2020-04-23/wuhan-s-r...
The two solutions that are being debated now are (1) staying in lockdown until a vaccine or treatment is available, and (2) reopening and attempting to manage the spread using existing protocols/ideas (relatively low amounts of testing, quarantining after a period of infectiousness, some form of contact tracing, lots of finger crossing). At least, that's generally what I hear being debated: reopen or not, or when to reopen.
The post suggests that if we had quantitatively much more testing, we could pick a qualitatively different third solution -- namely, reopen pretty freely and realistically control the spread.
Sure, you can view that as a variant of the "reopen" option, but in my mind reopening feels very different with a realistic way to isolate people before they've had a chance to spread it very far. It's proactive vs reactive. If we fully reopen with even 2 orders of magnitude more testing than we're currently doing, it's just going to be a matter of closing back up wherever it gets out of hand. In practice, the openness will fluctuate, things will be spread out over time, politicians will continue to do the exact wrong things, and lots of people will continue to die.
In short: (1) stay in lockdown until vaccine/treatment, (2) reopen without a strategy, (3) reopen with a strategy.
Given that it appears people with COVID-19 can shed the disease for many days before showing any symptoms, if your goal is to pinch off outbreaks before they become outbreaks, frequent, universal testing is the only way to get there.
"Quantity has a quality all it's own"
> This test gives results in ten minutes using a small amount of saliva which is taken into a disposable tube and then run through a scanner.
> We’re planning to start operating the first scanner within a month. If all goes well, there will be millions of scanners deployed by this fall, ensuring that every school and essential business can reopen while remaining safe and virus-free.
One of the oldest and largest biomedical institutes, the Robert Koch Institute in Germany, recently had a few press releases, urging for tests for at least ALL respiratory tract infections.
What one of the leading experts, Prof. Drosten, also mentioned is that current (PCR) tests have considerable false positives. The effect of such FP at large scale can hardly be estimated.
I really hope that you are able to find a solution and can bring up a scalable and reliable solution, after the promises. If not, there will only remain the impression that this could be a Silicon Valley type of talk the walk, as people heard it from other companies in the past.
Some people just advocate for isolating the elderly and having everyone else mingle.
The life expectancy loss from just letting it run its course would be less than a tenth of the life expectancy difference between the second and third wealth quartiles in the USA. And if we aren't worried about that difference, then why are we imposing a quality of life reduction that's much larger than the quality of life difference between those two quartiles for a much smaller gain in life expectancy? (similarly the economic costs of bringing the lowest quartile up a year or two would be much lower than the cost of this lockdown)
Because that's a terrible idea that doesn't make any sense. I understand the logic and why it's tempting, and I've even read some of the evidence supposedly backing it up. I find it thoroughly unconvincing.
I won't address the moral side, just the practical.
The virus disproportionately effects the elderly, yes, but far from exclusively. We have seen the non-elderly death rates with distancing in effect. If we could confidently say that >70% of the non-elderly population already had the virus, then this might make some sense. But since at the moment we cannot say that, then this is a method for quickly getting to >90% of the population, and killing off an unknown but far from trivial percentage of us.
Also, I have seen some evidence that the magnitude of symptoms is partly dependent on the degree of exposure. If that is the case, I really really do not want to be sitting between two infectious people in a movie theater or sports arena. But this would be commonplace with the whole "let's just sacrifice the elderly" approach.
As a society we have shown time and time again that we only care about "disasters", not the continuous but far greater and less expensively solved losses. Nuclear power vs coal, air plane accidents vs car accidents, the life expectancy reduction of poverty vs COVID-19...
So you first need to get 300 Americans on a max treadmill test to baseline, then.....
Also, you'd definitely need to do those VO2max tests in separate, sealed rooms because infected people would be huffing out maximum virus.
I'll give my Garmin 645 credit for consistency day to day, though I have no idea how close it is to giving the correct value.
So for people who are going to get sick it would trigger too late, letting them spread the infection for days until this test catches it; and all the many infected people who will never develop any symptoms (perhaps up to a half of infected according to the Iceland tests?) would never 'fail' this test, but still go on infecting other people.
To my knowledge no significant amount of non droplet or hand-to-face contamination as been demonstrated out of medical contexts where aerosolization is more a problem, because of technical gestures and cares.
Even the linked page supposed to serve as a reference is completely speculative on the subject of the potential for the virus to be airborne: "In addition, it is possible that SARS-CoV might be spread more broadly through the air (airborne spread) or by other ways that are not now known."
So yeah, it also has not been proven that airborne transmission does not happen. But there are no strong signs showing we should highly worry about that highly speculative subject. The main contamination paths are well-known: droplets, and hand-to-face. If you want to strongly reduce the rate, you must focus on that.
> Even if we don’t avoid the virus 100%, reducing it by 80% could be the difference between something mild and something life-threatening. This could be a reason why so many otherwise young and healthy doctors and nurses have been killed by this virus.
Yeah, no. This is also completely speculative at this point. There is no strong technical reason for why it should be the case, given how viruses work... So not completely impossible, but short of real reasoning and evidences and studies, this is not a theory to particularly to focus on... ANYWAY, it is a good idea to avoid spreading the virus on all surfaces, but simply because this will statistically reduce the contamination rate (maybe without any impact on the severity for those who will be contaminated)
More generally, I'd like essays on that subject from people working in the medical field. And I'd probably not like essays on CS from virologists and epidemiologists...
I don't think there's any reason to exclude an article on the basis of who wrote it. Articles should be excluded because they're off topic, bad, or uninteresting. Essays on CS from virologists would likely be of high interest to this community.
Besides that generic argument, which has become a bit of a shallow dismissal lately, there's the fact that pb is writing about a project he's personally involved in and which hasn't been discussed here before. It's understandable if there's interest in that.
Yes it is. If the initial amount of virus exposure is low, the immune system has more time to react.
I don't have a cite, it was from the "This Week in Virology" podcast.
I also heard a number going around suggesting that an early group of people hospitalized and killed were Ear, Nose and Throat doctors, who obviously would have been exposed to an almost comically large amount of the virus.
Giving someone a little bit of smallpox was a known immunization method before modern methods were invented. You'd still get sick, but less sick, and you'd wind up immune.
https://en.m.wikipedia.org/wiki/Variolation
How much less than $1? $6B/day is a lot of money.
(The total cost of 50c drinking straws or coffee cups daily is also in the billions but we don't see it that way.)
Public spaces generally comply with these types of things because of the fear of getting caught by random inspections and steep fines and penalties.
active driving and avoiding distractions (including drugs) are the difference makers, not speed limits. the reason people oppose this is because they want to treat driving like lounging by the pool, rather than operating machines that collectively kill a million people a year.
I am certainly on the side of raising speed limits to 100 mph where possible. Or providing turbo lanes for "Class C+" drivers or something. But that's because I think I'm willing to make the trade-off in lives. Your opinion is more that we're making not a trade-off but costing ourselves both lives and speed?
"Just have everyone be better at things" isn't a helpful alternative.
We do have available to us the speed limit.
of course we do. you mentioned one yourself: “providing turbo lanes for ‘Class C+‘ drivers”. it’s only a matter of imagination to come up with others.
speed limits are poor proxies for what really impacts lives saved.
Speed kills.
Frankly, I don’t understand how this test is supposed to work, and I’ve used a Biacore! It might be helpful to have a technical explanation available, for domain experts to evaluate.
edit: this is all I found about the company:
https://www.sbir.gov/sbirsearch/detail/1564207
https://innovation.medicine.umich.edu/portfolio_post/sepsis-...
Does this approach bypass the reagent shortages ?
What are the specificity / sensitivity metrics ?
We've just begun our clinical testing so don't have specificity/sensitivity metrics yet, but will be sharing them when they're available.
https://www.who.int/dg/speeches/detail/who-director-general-...
"But we have not seen an urgent enough escalation in testing, isolation and contact tracing – which is the backbone of the response.
Social distancing measures can help to reduce transmission and enable health systems to cope.
Handwashing and coughing into your elbow can reduce the risk for yourself and others.
But on their own, they are not enough to extinguish this pandemic. It’s the combination that makes the difference.
As I keep saying, all countries must take a comprehensive approach.
But the most effective way to prevent infections and save lives is breaking the chains of transmission. And to do that, you must test and isolate.
You cannot fight a fire blindfolded. And we cannot stop this pandemic if we don’t know who is infected.
We have a simple message for all countries: test, test, test.
Test every suspected case.
If they test positive, isolate them and find out who they have been in close contact with up to 2 days before they developed symptoms, and test those people too."
If you 're doing contact tracing right, you should need to test very few people per million every day. If you need to do a lot of testing, you ve probably already lost and will be forced to shutdown again. The solution is probably the second: antivirals.
OTOH i wonder what's the effectiveness of optical-based methods to detect viral particles: https://phys.org/news/2006-11-laser-nanotechnology-rapidly-v...
For example, I cannot just tell my boss, I am working from home, even though in my case there is no problem. Even if he allows, the company policy might not. (Although I am lucky I live in a sane country and we have that policy now.)
Or in Czechia, now everyone wears a mask (since it is mandatory). It became a norm in like 2 days, one day almost nobody had them (and people felt that wearing them makes you look sick), the next day they became mandatory in public transport, and the day after everybody had them.
There are other examples like that, where the peer pressure plays an important role (in preventing humans to make rational decisions).
I'm working with a team that has a test that detects proteins associated with covid. It works like a pregnancy test and does not need a special scanner. Would love to discuss further.
Is your protein test able to detect as soon as people become contagious? That's where a lot of ideas fail, but I think getting R0 < 1 likely requires it.
It requires screeners to directly manipulate saliva samples; this is dangerous in a pandemic. The assays referred to (lazily) in a Google Scholar search are almost overwhelmingly antibody assays; this does not allow the screener to differentiate between "has COVID-19" and "had COVID-19". Also, there is no evidence that the described test actually exists.
Finally, maybe irrelevantly, there is no way in hell you're going to get people at large to stand around for two hours a week waiting for test results. Ten minutes for a screening whenever you try to enter a public building; that's ten minutes to get into work, and we'll say ten minutes to get into another place each day. "But wait," I hear you say, "you only need to be screened once per day, and the first place can share that data with the next place." This plan was constructed by someone who is unfamiliar with medical records laws.
This is no "third solution." It's an engaging thought experiment, but it's just too far away from reality to get here from there.
And in terms of medical records laws, the regulatory environment has loosened so quickly with the advent of this virus that I'm sure regulators and legislators will be favorable to making it easier for the company if the test demonstrates the appropriate sensitivity and specificity in clinical trials. People are getting reimbursed for sending emails to patients, health visits done over zoom, would have been impossible to imagine this level of regulatory flexibility just six months ago.
> this does not allow the screener to differentiate between "has COVID-19" and "had COVID-19"
As a policy matter, this doesn't rule out the use of the test in a pandemic management protocol at all, it just changes how it needs to be administered. For example it might require that people who are antibody-positive have a standardized note confirming recovery (in Contagion, this was a cute electronic bracelet).
The critical requirement is that we detect unknown positives, and this test would do that.
"The most proven and ready to scale technology is based on surface plasmon resonance. It’s able to detect even a very small number of viral particles, which is very important because we want to detect everyone who is contagious"
(6th paragraph in the "A third solution" paragraph)
How do you prove recovery if you were never proven sick first?
As an example, I had all the symptoms of Covid in late February, the same severity many people in my age group described, yet was never tested since our health authority dropped the ball and claimed community transmission wasn't a thing back then.
If I tested positive for antibodies, would I get treated like someone newly infected? The only way to prove recovery is to prove you have antibodies and don't have the virus, so we'd essentially have to test every single member of society.
Sure, good idea.
> Also, why should I have to if I already am clean?
Oh, you don't have to. You can just stay at home like now.
Even then, traffic might be reduced, but it would be enough traffic for something like regular life to resume. Some businesses would be able to survive, even if not all.
* IDEA *
They could also do checks in the parking lot of any business. You drive up, someone comes out to start the process and marks down your license plate. After 10 minutes they return to your car and tell you your results.
This way nobody is standing in long lines possibly spreading the disease to each other. And it scales well to large numbers of people being tested simultaneously.
There would be a lag time of 10 minutes, but throughput would be nearly the same as before COVID.
Currently most public buildings are closed, so adding ten minutes is a big improvement relative to that. Also, it probably took them more than ten minutes to drive to work, so I don't think it's completely implausible.
You could have security guards with masks at every entrance. But if even one person with COVID-19 gets past security, you could start an outbreak.
Especially based on assumptions.
The petty whinging in your third paragraph is basically ridiculous. Imagine, waiting 10 or 20 minutes a day for a few months to help save millions of life-years.
There will be a few people who have some issue with regular testing, the vast majority of people will be happy to have a tool that works.
It does if it's an IgM test - IgM is only around during the illness. However, it takes a while to come up, so it can't tell you if someone is presymptomatic, at which point they are highly infectious.
That said, I have some serious doubts about the particular mechanism being used here being ready for $1/test within say the next year or two. It’s been studied for a few decades and while there has been some promising progress, this would be the first saliva viral antigen test using this technology. It seems a bit like trying to solve global warming by bringing fusion generators to market. I have doubts it will be deployable before a vaccine, let alone more conventional and boring antigen rapid diagnostic tests that we have developed for a wide array of viruses.
It is for some demographics, not all. It's safer than the flu for young folks, especially the under 10's which the flu hits pretty hard. For some it's worse, especially over 70s.
> Catching this virus is a bit like playing a round of Russian roulette. You’ll probably be fine, but you could end up dead.
Also true of the flu. Yes, even for the seemingly young and healthy.
It's amazing how freaked out people are getting over this. All the data points to it being worse than the flu, but not drastically [1]. Certainly not "immunity checkpoints at all building entrances" worse, it's not ebola.
[1] http://cebm.net/oxford-covid-19-evidence-service/
As well you omit the size of the vulnerable - everyone who is obese, diabetic, hypertensive, or cardiovascular diseased, or immunocompromised.
The first is just a fantasy - no one has an actionable plan to do it. The second proves the size of the problem, which exacerbates the difficulty.
Your claim is that the vulnerable can be “holed up” while everyone else goes about their happy business. There is no such thing, and I challenge you to provide the details and success as measured by per-demographic death rates of any proof you may have.
Not to mention even with complete lockdowns around the US we're somehow seeing 38,000 new cases per day. This is not winning. With an R0 of 2-5 a single new infected person post lockdown lifting is going to set the wildfire ablaze again. As China is showing us, if you lock down then re-open, you're just going to start playing whack-a-mole with rolling city-level lockdowns.
Even if we were to stay inside for months, the case the Swedes are making is that deaths are higher now than in locked down countries, but unlike locked down countries, the Swedes will have developed herd immunity in a few months, and will never be affected again.
This makes the temporary delta in death rates not a success for locked-down countries but rather a temporary deferral.
Sweden is proof of something, but it's not clear yet what. Somehow, their new case load is pretty flat, just like the US. [1]
[1] https://aatishb.com/covidtrends/?location=Canada&location=Sw...
What do you do if someone denies the test? You can deny them entry, but if they protest or decide to force the issue, then the police have to deal with it. Then if the police get sick, they have to self-quarantine, and what do you do when you don't have the power to enforce the test?
Even if we managed to dress up our entire police force in hazmat suits to reduce the risk of infection, they can still infect people out and around the building. Turning away someone doesn't mean we're reducing the R0, we're just moving someone that's infected around. Given that there are asymptomatic people (and a certain number of people that would likely claim the test is a false positive or fake), all we're really doing is encouraging more people to gather in a single location as a potential infection vector.
Let's assume next then that somehow we had an automated solution. All the doors to said buildings are locked unless you complete a saliva test to go through. Barring the huge logistical concerns, we're still dealing with potentially infected people spreading the virus on surfaces and areas that people are travelling to and from.
Tech isn't going to save us from COVID-19.