ORIGINAL: geofflambert
Not knowing is a problem. Not testing is not an answer to that problem. Random testing could at least provide us with scientific wild-ass guesses but we're not even doing that. The testing we are doing is ad hoc and incomplete. New York recently added thousands of deaths as being "likely" related to the coronavirus. "Flattening the curve" buys us time, but only if we actually do something with that time, like produce more tests by a factor of 1,000 or more. Just waiting until everyone eventually is infected and the survivors may or may not be immune before we start the world turning again is not an answer. If you're telling me that we just can't test everyone, you're telling me we didn't vaccinate virtually everyone against smallpox or that we really didn't almost eliminate polio. When we go to our doctors our medical record is checked to make sure our vaccinations are up-top-date. We regularly get tested for things like colon polyps and prostate problems. This will all get to be routine eventually. The problem we have to fix is getting to where it's routine sooner, way sooner than we're going at the current pace. We need to get to the place where any doctor anywhere can order tests and get them in a timely fashion from LabCorp or wherever. Diagnosis ---> treatment. Modellers are trying to model what is actually happening. Critics are checking that modelling against invalid data. What's the use in that?
Not knowing *what* is a problem? Not knowing *when* is a problem? You have to be specific here mate.
In your examples, our current (and most other states/countries' programs from what I understand) testing program will not realistically address the examples you cite. Certainly not as an real time interventional strategy. Our focus to measure more of a population-who has the virus right now-must continue to be intentionally biased in order to identify the virus where it needs to be identified first-clinically sick people.
To date, we have tested a little over 1% of the population of this country. By the way, more than South Korea on a per capita basis. Many European countries have tested twice the per capita rate we have, but are no closer to solving their problem.
At this stage its a
disease problem and a
mortality problem, not a 'is the virus in our country?' problem. Testing someone today that's clinically symptomatic will yield you results in maybe 24-48 hours. Probably longer in some states with a backlog. But that information doesn't solve the problem. Disease progression in an individual won't stop while the test is being processed. Every responsible public health office globally is saying the same thing about people that are sick-tested or no-'if you're sick, stay home and distance yourself from others' and so forth.
But a sick person who clinically deteriorates day-to-day isn't impacted by the progression of the testing procedure or even the results of the test. It's real-time irrelevant or clinically inactionable. Those that are sick enough to go to the hospital will be treated regardless of their testing status based upon presumptive diagnoses. The test does little to alter the time flow of a patient.
Someone who is sick and personally sequesters themselves-the best advice for people that are sick-is doing all they can at that point to stem the flow of the epidemic. If they deteriorate then they're going to the hospital no matter what the test results say. Positive test-they'll go to the hospital if they start getting really sick. Negative test-they're going to the hospital if they get really sick. "Pending" test-they're going to the hospital if they get really sick. Positive test and they're holding their own-they're staying home, per guidelines. Negative test and they're holding their own-they're staying home, per guidelines. Pending test and they're holding their own-they're staying home, per guidelines. The presence or absence of a viral test doesn't change the clinical outcome.
There is some benefit for those frontline hospital workers knowing ahead of time who is a confirmed COVID-19 case when they come in the door. They can probably be immediately triaged to the respiratory disease ward, which is hopefully sequestered from the rest of inpatient care. But they don't have to be tested
apriori in order to get the same supportive care they would get test or no test.
Demanding 'more testing!' for the virus (e.g., PCR testing) from the general populace doesn't matter for stemming the epidemic curve. And (with the exception of the triage example above) it hardly matters for the clinical patient outcome.
All that aside, I do think extrapolation of 'attack rate' data can help clarify a population's probable prevalance or at least get closer to ground truth. But that sort of testing isn't being done anywhere that I can think of. But that's another post for later.
; Julia Child
