Testing?

[Overtaxed]

You know, I have a question that I've not yet seen really answered in any of the media outlets. Lots of people are saying, in some way, "more testing is the answer" to help us get back to work and get this thing under control. Some combo of testing and contract tracing is often held up as the "path forward" until we get a vaccine/treatment.

My question is simple. Why? How does this help? So you test everyone in the US and get a real incidence report. But the tests take time to complete, by the time they are done, some of the people who tested positive are through the infectious stage, and, more worrisome, some of those who tested negative are now infected and contagious. I'm a numbers/statistics guy, so that part of my brain would love the data that would come from this kind of very widespread testing, but.. I'm just not sure how it helps the situation without a "Star Trek level" test (point a magic wand at someone, tells you if they are infected or not, and you do it to everyone as the enter the public every day; that would be very useful, but that's science fiction, it doesn't exist for basically any disease we've ever encountered).

It just seems to me that this "testing" talk track now is kind of a distraction, there's no way we can even imagine to get the level of testing required (and also, IMHO, no earthly way everyone going to the office is going to submit to a blood test every day on their way in the door), and, even if we could, I'm not sure what it does other than give us really good/interesting data about the spread of the virus.

The much better/more workable answer to me seems to be obvious; instead of ramping up testing and developing more rapid tests, ramp up production of N95 masks. We know these stop the virus and they are in critically short supply and I know, for me personally, I'd feel a lot better being in public with a group of people wearing N95's than with a group of people who all said "we were tested yesterday" without effective PPE. Great, you were tested yesterday morning, but where have you been since then, who have you interacted with? The moment you step into "public" your status is no longer assured because while you tested negative 5 mins ago, you may no longer be negative right now.

Now for a bit of rant, this appears to me to be something that I'm seeing a lot of (over the past few years) in my industry (IT). It's a "data fascination/data fixation" that lots of companies seem to fall into. We build these massive data repos, data lakes, apply all kinds of ML/AI to massage the data, build dashboards of the data collection, and then... What question are you trying to answer? To which we get blank stares. Or, "how are you going to alter your company behavior based on this massive amount of info", again, blank stares. I understand why it's happening, companies like Google have made billions of dollars from "data" and the allure of that business model is strong, but Google/Amazon (and others, of course) aren't the "typical" company, most companies are producing/delivering a service that, frankly, isn't all that "data focused", the data isn't the value, the service it provides is the value. I did a job years ago for GE, helping them build systems to collect data from jet engines (and then, just to buzzword it up, dropping it into a data lake, then running it all though ML). For those who don't know, modern jet engines produce TONS of data every second, so this was a rather sizable ordeal; and, like most of these projects, as the data started to stream in, only then did someone say "What are we trying to do here"? Extend service intervals, HA, see, this thing does have use! Pushing all that data, we could figure out if we should change this bearing in 10,000 or 15,000 hours. My eyes lit up, that seemed like a great use of the technology. Well, 2 headed ending to this story; first was, it didn't matter what the data said, the engine overhaul and bearing replacements were mandated by the FAA. It could have said 100,000 hours, wouldn't have mattered, they had to change them at 10,000. And the other side of the ugly end here, as we collected this data and started to make predictions, we started to talk to the people who were working on/maintaining the engines and told them "the machine says we can go 15,000 hours instead of 10K on this part, does that sound reasonable to you" to which they answered "No, not at all, you could go 100K on that bearing, it comes out at 10K looking like it went in, it's completely unstressed in the engine, bathed in oil the entire time and we really shouldn't be changing them at all except for the fact that it's mandated by the FAA'. <face palm>

[bertschb]

Great, you were tested yesterday morning, but where have you been since then, who have you interacted with? The moment you step into "public" your status is no longer assured because while you tested negative 5 mins ago, you may no longer be negative right now.

Bingo! The people that want the lockdown (and the accompanying economic damage) are just looking for ways to delay reopening. They know the "we need more testing" mantra will extend the lockdown so that's their narrative right now. Their strategy will change as testing continues to ramp up.

I have no problem with testing in general. I'd like to know if my wife and I have been infected just out of curiosity. But, that won't change our behavior at all. If the test results indicate I haven't been infected, I'll still need to stay home if I want to avoid infection and I'll still need to wear a mask in public to avoid getting infected. And as you say, as soon as I'm near anybody else, or get gas, or bring groceries or a package into my home, or get my mail (etc, etc, etc) I'd need to get retested.

The test results are literally only good at the moment the test was conducted.

[Jerryr]

It seems that daily testing has become routine for everyone entering the Whitehouse I guess the administration feels it has value.

I expect mask wearing at the Whitehouse and General public areas will be the norm until a vaccine is developed, distributed and everyone is inoculated.

[Overtaxed]

Bingo! The people that want the lockdown (and the accompanying economic damage) are just looking for ways to delay reopening. They know the "we need more testing" mantra will extend the lockdown so that's their narrative right now. Their strategy will change as testing continues to ramp up.

I'm not sure I agree that this is a way to delay opening, but, the rest, I do agree. I'm just not sure why the message isn't "more PPE", that would serve the same goal (delay reopening) and makes a lot more sense. Perhaps it's a "softball", "if we can just test everyone" as the first talk track which then turns into "you need to wear N95's in public because it's too widespread". IDK. I'd be a LOT more interested in going out again with an N95 mask on (and others wearing them as well) than going out in public with people who got tests "recently" (a week ago, a few weeks ago, etc). I'm just not sure the American public is ready for the reality of "we're going to need to wear masks for a long time", and perhaps that's the issue?

No matter the intent, I'd MUCH rather we ramp up our ability to make masks vs our ability to make tests. Tests give us data/statistics, interesting, but not so helpful if you're the one who tests positive. N95's actually prevent infection, a much more worthwhile goal IMHO.

It seems that daily testing has become routine for everyone entering the Whitehorse. I guess the administration feels it has value.

I do see the value in that and would agree, if done daily on your way into the office, it would provide significant protection. But I just don't see that happening. And we'd need to do that at every "choke point" (airports, public trans, Walmart, etc). A mask seems a lot easier/more likely to succeed.

[Wicked ace]

You know, I have a question that I've not yet seen really answered in any of the media outlets. Lots of people are saying, in some way, "more testing is the answer" to help us get back to work and get this thing under control. Some combo of testing and contract tracing is often held up as the "path forward" until we get a vaccine/treatment.

My question is simple. Why? How does this help? So you test everyone in the US and get a real incidence report. But the tests take time to complete, by the time they are done, some of the people who tested positive are through the infectious stage, and, more worrisome, some of those who tested negative are now infected and contagious. I'm a numbers/statistics guy, so that part of my brain would love the data that would come from this kind of very widespread testing, but.. I'm just not sure how it helps the situation without a "Star Trek level" test (point a magic wand at someone, tells you if they are infected or not, and you do it to everyone as the enter the public every day; that would be very useful, but that's science fiction, it doesn't exist for basically any disease we've ever encountered).

It just seems to me that this "testing" talk track now is kind of a distraction, there's no way we can even imagine to get the level of testing required (and also, IMHO, no earthly way everyone going to the office is going to submit to a blood test every day on their way in the door), and, even if we could, I'm not sure what it does other than give us really good/interesting data about the spread of the virus.

The much better/more workable answer to me seems to be obvious; instead of ramping up testing and developing more rapid tests, ramp up production of N95 masks. We know these stop the virus and they are in critically short supply and I know, for me personally, I'd feel a lot better being in public with a group of people wearing N95's than with a group of people who all said "we were tested yesterday" without effective PPE. Great, you were tested yesterday morning, but where have you been since then, who have you interacted with? The moment you step into "public" your status is no longer assured because while you tested negative 5 mins ago, you may no longer be negative right now.

Now for a bit of rant, this appears to me to be something that I'm seeing a lot of (over the past few years) in my industry (IT). It's a "data fascination/data fixation" that lots of companies seem to fall into. We build these massive data repos, data lakes, apply all kinds of ML/AI to massage the data, build dashboards of the data collection, and then... What question are you trying to answer? To which we get blank stares. Or, "how are you going to alter your company behavior based on this massive amount of info", again, blank stares. I understand why it's happening, companies like Google have made billions of dollars from "data" and the allure of that business model is strong, but Google/Amazon (and others, of course) aren't the "typical" company, most companies are producing/delivering a service that, frankly, isn't all that "data focused", the data isn't the value, the service it provides is the value. I did a job years ago for GE, helping them build systems to collect data from jet engines (and then, just to buzzword it up, dropping it into a data lake, then running it all though ML). For those who don't know, modern jet engines produce TONS of data every second, so this was a rather sizable ordeal; and, like most of these projects, as the data started to stream in, only then did someone say "What are we trying to do here"? Extend service intervals, HA, see, this thing does have use! Pushing all that data, we could figure out if we should change this bearing in 10,000 or 15,000 hours. My eyes lit up, that seemed like a great use of the technology. Well, 2 headed ending to this story; first was, it didn't matter what the data said, the engine overhaul and bearing replacements were mandated by the FAA. It could have said 100,000 hours, wouldn't have mattered, they had to change them at 10,000. And the other side of the ugly end here, as we collected this data and started to make predictions, we started to talk to the people who were working on/maintaining the engines and told them "the machine says we can go 15,000 hours instead of 10K on this part, does that sound reasonable to you" to which they answered "No, not at all, you could go 100K on that bearing, it comes out at 10K looking like it went in, it's completely unstressed in the engine, bathed in oil the entire time and we really shouldn't be changing them at all except for the fact that it's mandated by the FAA'. <face palm>

If I may.....I think you miss the point and are discrediting the messengers or at least some of them. I'll concede it is in bits and pieces mostly because it seems to be beaten down or ignored by certain entities. But all the same it is there if you follow the bread crumbs.
The increase of testing and tracing is to identify more (quantity) infected persons by sampling to prevent spreading disease. Instead of doing only highly suspect cases to confirm, by looking for asymptomatic and infected persons, weeding them out if you may, have them quarantine or in treatment then following their steps to identify and test others that may be exposed and on (take a look at the link you posted yesterday as an example of spread). Also constant monitoring for "at risk" groups or persons, like myself, to begin treatment before the virus starts to do damage. In a previous post I put up a link to an explanation of what the virus does to the lungs and respiratory system. Many who have gone seeking treatment are already well into the infection cycle because the symptoms are gradual over days. This way more people who are not infected could move about, go to work or interact in daily life with some confidence in their fellow man. I also realize a test is only as good as it is reliable, timely and in a moment. Go back out into the population and you may be once again at risk.
My rant...... Personally I think I have a long way to go and if I need to sit tight for a bit to insure that, it is what I'll do. Also realizing the thought that somebody else's life could unwittingly be in my hands doesn't sit well with me. What I saw in war was enough.
You would think that after what transpired in a house that is painted white that there would be a move to step up more comprehensive and reliable testing and tracing regimen. I don't see how a rant about protecting one individual and rigorous screening and now, finally use of PPE that is not available to all is acceptable.
And I'll put this in as well. Sweden tried 'herd immunity" and found that the cost in lives is high. I myself can't put a price nor would want to make a decision knowing others would die because of it. I empathize and commend the governors that stand their ground and make the hard decisions. I understand people have bills, rent, mortgages, car payments but it seems to me many have gotten fat or lax because of the bounty of the last ten years of growth so are in some ways or instances acting spoiled. And now I'll shut up before it spills over.

[backtrack2015]

State and local officials have been trying to drive a car with all the windows painted black. The current testing is equivalent to scraping the paint off a small portion of the rear window. They can see what they hit about a block behind the car. Widely available rapid testing that could detect the early stages of infection would be equivalent to scraping off the paint on the rear window and the side windows. Suddenly they'd know they just hit a mailbox instead of waiting two or three weeks to find out. Wider use of our current tests, sufficient for low-level random sampling of the population, could scrape all the paint off the rear window and possibly some of the rear side windows. Again, faster policy response to whatever is seen out the window.

Texas just reopened in a big way, much more than advertised if we go by the traffic on the roads and the number of cars in parking lots. We won't know what that means for a few weeks as we wait for folks to get truly sick, get approved for testing (you have to be sick), and go get tested. If we had been testing sufficient enough to randomly sample folks in the population continuously, we could probably see the initial results in a matter of a week. We could then open even further or ratchet back before cases bloomed. Our testing right now is so abysmal that the Governor is effectively driving by monitoring the hospital utilization rate.

[Wicked ace]

state and local officials have been trying to drive a car with all the windows painted black. The current testing is equivalent to scraping the paint off a small portion of the rear window. They can see what they hit about a block behind the car. Widely available rapid testing that could detect the early stages of infection would be equivalent to scraping off the paint on the rear window and the side windows. Suddenly they'd know they just hit a mailbox instead of waiting two or three weeks to find out. Wider use of our current tests, sufficient for low-level random sampling of the population, could scrape all the paint off the rear window and possibly some of the rear side windows. Again, faster policy response to whatever is seen out the window.

Texas just reopened in a big way, much more than advertised if we go by the traffic on the roads and the number of cars in parking lots. We won't know what that means for a few weeks as we wait for folks to get truly sick, get approved for testing (you have to be sick), and go get tested. If we had been testing sufficient enough to randomly sample folks in the population continuously, we could probably see the initial results in a matter of a week. We could then open even further or ratchet back before cases bloomed. Our testing right now is so abysmal that the governor is effectively driving by monitoring the hospital utilization rate.

awesome analogy!

[Overtaxed]

Love to emoji Wicked.

I see what your saying, but let me ask a direct question. If the entire US was tested every week and people who were positive were "asked" to isolate for 2 weeks would you feel comfortable going out? How about if you could get 7 N95's for every member of your household, as could every other American? Which would make you more comfortable? Which do you think is more likely?

We have no mechanism in place to force people to test to be in public (nor should we, IMHO). We have no way to tell if the person your talking to was tested yesterday or 3 weeks ago, and no way to tell if that person, after they were tested was on a subway for 3 hours or went home and didn't see another soul. We also have no clue how to get that many tests out there, return results that rapidly or honestly, what to do with those results. Let's say, for example, they require you to test before you can board an airplane. Sounds good, right? You test positive, you have to go home. Well, OK, but what about the 150 people you walked by on your path through the airport? Are they all now banned from flying too? Because they very well might have it on them, and, if you do let them fly, when they get ready to come home, guess what? Some of them will test positive.

I'm not saying that testing is without value, scientists needs to understand the spread and build models to help limit it. It's useful to know how many are sick, where they are, and what the trends look like. I agree on all of that. But to "reopen", it seems like a MUCH better goal is, instead of spinning up testing, spin up production of masks until we can provide 7 N95's per person (one per day) every week. Require them in crowded settings. Under those conditions, if I absolutely needed to, I'd fly again (everyone wearing an N95 including me). "we've tested a lot" doesn't help me one iota when the guy sitting next to me on the plane was the one who was tested a week ago.

We could then open even further or ratchet back before cases bloomed.

How are cases not going to bloom? That's the thing, it seems like a lot of magical thinking here, if we just test enough, cases won't go up after we reopen. I don't see how those two things are related, if we reopen and people aren't wearing masks, it's going to "bloom"; we all pretty much know that (which is why states are talking about opening and then closing as needed). Yes, testing will let us see that faster than waiting for hospitalization numbers, that's true, but testing isn't going to stop the blooming, it's just going to let us know it's happening faster. Not that this is without value, it is; I'd just MUCH rather we focus on how we can provide enough PPE to prevent the blooms in the first place.

[Wicked ace]

Love to emoji Wicked.

I see what your saying, but let me ask a direct question. If the entire US was tested every week and people who were positive were "asked" to isolate for 2 weeks would you feel comfortable going out? How about if you could get 7 N95's for every member of your household, as could every other American? Which would make you more comfortable? Which do you think is more likely?

It would but I will say that the methods Fauci and Birx are now quieted on of testing and contact tracing would be more effective if a plan were put in place that all would follow. Then not only discovery but prevention is addressed. Of course first off both would need to ramped up, a lot of time has been wasted in getting there. There is a lot of disinformation from a certain source about what is available and being done.
I'm of the opinion everyone should have access to proper PPE. I have and do wear an N95 mask when I go out. By dumb luck I grabbed a box of them before I retired in anticipation of a few messy home projects. I kept a few for myself and gave the remainder to my sister that works in a nursing home. Some places I avoid now just because of behavior I have seen when I was there previously.

We have no mechanism in place to force people to test to be in public (nor should we, IMHO). We have no way to tell if the person your talking to was tested yesterday or 3 weeks ago, and no way to tell if that person, after they were tested was on a subway for 3 hours or went home and didn't see another soul. We also have no clue how to get that many tests out there, return results that rapidly or honestly, what to do with those results. Let's say, for example, they require you to test before you can board an airplane. Sounds good, right? You test positive, you have to go home. Well, OK, but what about the 150 people you walked by on your path through the airport? Are they all now banned from flying too? Because they very well might have it on them, and, if you do let them fly, when they get ready to come home, guess what? Some of them will test positive.

First I'll refer you to the article you posted yesterday about dose and time, which myself having worked in the nuclear industry understand all too well. Different circumstances, same effect. This where we all need to pull together as society which begins with a unified message that distancing and face covers work along with respect for your fellow man. Flying is a recurring theme you have, I haven't flown commercial in 8 years and don't miss it. I don't see the airlines trying to come up with a plan to make things safe yet, they are still interested in selling seats or wanting to get propped up and because of that people will stay away.

I'm not saying that testing is without value, scientists needs to understand the spread and build models to help limit it. It's useful to know how many are sick, where they are, and what the trends look like. I agree on all of that. But to "reopen", it seems like a MUCH better goal is, instead of spinning up testing, spin up production of masks until we can provide 7 N95's per person (one per day) every week. Require them in crowded settings. Under those conditions, if I absolutely needed to, I'd fly again (everyone wearing an N95 including me). "we've tested a lot" doesn't help me one iota when the guy sitting next to me on the plane was the one who was tested a week ago.

I go back to testing / contact tracing as a method. Except for the plane, no arguments there!

[Overtaxed]

Flying is a recurring theme you have, I haven't flown commercial in 8 years and don't miss it.

Oh goodness, I don't miss it at all. I flew a ton for all my career, and haven't flown since Feb, and I don't miss it one second. I bring it up because it's a big industry and to a lot of people, a very important part of the economy. I just don't see it coming back anytime soon, but, what applies to flying applies to any "dense" activity. Public trans of any kind, for example (NYC, looking at you). Large events/gathering. Stuff like that, the stuff that's really "closed" right now (and needs to remain so, IMHO), "testing" isn't going to help there.

more effective if a plan were put in place that all would follow

Agreed, but, IMHO, also "magical thinking". You can't depend on others to do the "right thing" as evidenced by the millions of pictures of people flouting the rules. It would be nice if "do the right thing" would work, honestly, this would have been over months ago if that was a reliable way to deal with this. Masks work, we know they do, so much so that people will march into a room filled with COVID patients wearing one and not get sick. That's wonderful, and, I do agree, those marching into rooms of patients NEED those masks, I don't want to stop them from having them so I can go a "low risk" place. I want us BOTH to have them, that's a real plan that I can put into practice without "hoping" that other people do the right thing. They won't. It's just reality, even if most do, some won't and those "some" will infect those who do if they don't have protection.

In general, I think we're in agreement, I'm not trying to troll or pick a fight here, I just think that we should focus more on what "really works" (masks) rather than what "should work" (do the right thing) or gathering data in the hopes that we can use that data to do "something" that might work.