COVID-19 (f/k/a "the Coronavirus")

[rocky_warrior]

Iran is a nightmare...

I mean, I don't think COVID-19 moved the needle much there...

[GooooMarquette]

I mean we're talking about collections here, not testing and results.  Just drive up, get swabbed, and you're out.  Samples get moved to a testing lab.  I don't see this being difficult.

Yes, but in the process of collecting and labeling samples, mistakes are made. In the normal clinic and hospital environments. Every day.

If you quickly move that process to a new environment, the rate of errors will almost certainly increase. How much is anyone's guess.

It may or may not be a hard stop by itself, but in any case it's a very real factor to consider while considering additional considerations like cost and such.

[rocky_warrior]

It may or may not be a hard stop by itself, but in any case it's a very real factor to consider while considering additional considerations like cost and such.

You've mentioned cost and the financial side a few times.  Thousands of dead would appear to be the bigger cost - both emotionally and financially - though may help SS and Medicaid/medicare #s.  Or perhaps you've already written them off (no hope).  Curious why else you seem to indicate cost and finances are a reason to not do testing.  You claim is it's cheaper not to test?

[mu03eng]

Explain China, South Korea, Japan, Singapore.

How did they get this under control?

The window narrows every day that we don't implement this sort of solution.  Should have been ramping up the moment that this left China's border.

What is your solution to deal with what is coming?  Let it happen?  Let all the people who are at risk, die?  Bad news, you're talking about letting hundreds of thousands of people die, probably more.  For starters, we have about one million hospital beds available in the US, and 65% of those are occupied with non-Covid19 patients.  Now we look at people with risk factors.  Obesity (99 mllion), kidney disease (30 million), COPD (16 million, low end)... I realize there is plenty of overlap in those numbers, but you get my point.  And no, I'm not saying they're all going to die.  But if we say 60% of the obese population contracts this, and we say only 5% die, we are still talking about just under 3 million people.  You're an engineer (presumably from your name), run the numbers.

What do you suggest?  I'm genuinely curious.

They went into full lock down, that approach can absolutely works(until rounds 2, 3, 4.... come around again). I'm extremely sceptical that we could execute such a plan in the US and that it's actually necessary.

We need to lower the infection curve but I don't think we need anything drastic to do that. Wash hands, if you feel unwell stay home, and if you are higher risk stay home as much as practical. We can

It is inevitable this virus will spread and it will kill, tragic but death is a part of life. I don't say this casually as my parents are high risk, my sons godfather is 42 and has Cystic fibrosis, and I have a 4 year old and a 9 month old. We aren't going to stop it and we aren't going to take mortality rate to zero. We try to limit the damage and slow the curve but given the current understanding of the virus it is no time to hit the panic button as some seem to advocate.

[GooooMarquette]

You've mentioned cost and the financial side a few times.  Thousands of dead would appear to be the bigger cost - both emotionally and financially - though may help SS and Medicaid/medicare #s.  Or perhaps you've already written them off (no hope).  Curious why else you seem to indicate cost and finances are a reason to not do testing.  You claim is it's cheaper not to test?

If low-risk symptomatic people follow the CDC guidelines and self-quarantine, it won't cause additional deaths. In fact, as I said above, keeping them away from clinics and hospitals full of higher-risk people might save lives.

And it would be cheaper.

Spending more money doesn't always lead to a better outcome.

[rocky_warrior]

If low-risk symptomatic people follow the CDC guidelines and self-quarantine, it won't cause additional deaths. In fact, as I said above, keeping them away from clinics and hospitals full of higher-risk people might save lives.

Ah. I think I understand, and see the difference in our thinking - which isn't that far apart. 

I think most people will press on and do their jobs/go to social gatherings *while* being sick (or "not that sick" as they might determine) unless we make testing super easy and free.  It's the American way.  You don't let a simple fever or cough stop you from being successful!

You think higher of the US public than I do.  That's all.

[GooooMarquette]

Ah. I think I understand, and see the difference in our thinking - which isn't that far apart. 

I think most people will press on and do their jobs/go to social gatherings *while* being sick (or "not that sick" as they might determine) unless we make testing super easy and free.  It's the American way.  You don't let a simple fever or cough stop you from being successful!

You think higher of the US public than I do.  That's all.

Perhaps I do. But if people won't voluntarily self-quarantine, I don't see huge numbers getting a test that might lead to a forced quarantine. Like you said:  the American way is not to let a fever and cough prevent people from doing whatever the hell they want to do.

Anyway, we can agree to disagree. But my position has been, and will likely continue to be, that people should follow the CDC recommendations.

[rocky_warrior]

Anyway, we can agree to disagree.

But, we don't have to.  I think we 100% agree.

people should follow the CDC recommendations.

100% agree.  That would help a bunch.

I don't see huge numbers getting a test that might lead to a forced quarantine.

100% agree.  Which is why we should eat as much Arbys as possible before they go bankrupt.

[GooooMarquette]

100% agree.  Which is why we should eat as much Arbys as possible before they go bankrupt.

Just for my edification, what are the six steps from Arby's to Kevin Bacon?

[Benny B]

You think higher of the US public than I do.  That's all.

Well of course everyone is less high than you.  Literally. 

[forgetful]

One other point about quickly setting up a drive-through system: when you quickly take a process out of its usual environment, you raise the risk for errors. We already know that samples occasionally get mishandled, contaminated or mislabeled in the normal clinic and hospital environment. It is quite possible that a hastily designed drive-through system would increase the error rate.

So there's the cost, but also the quality challenge due to a quick change in logistics.

These are pretty simple experiments. Most biochemistry labs in the US can easily run these assays, and can do them with far higher accuracy and throughput than many of the official labs.

It would be no problem whatsoever to set up drive through testing, with high accuracy and higher throughput. The problem is the US has regulations on who can do clinical testing and who can report clinical results. That is the barrier, regulations, not any logistical issues or accuracy.

Also, these regular biochemistry labs could run these samples for on the order of around $15-20 a sample, not the over $2k that they are currently charging people

[rocky_warrior]

Just for my edification, what are the six steps from Arby's to Kevin Bacon?

Only 2 steps required for Arbys.  Ving Rhames is the voice of Arbys, he was in Dave with Faith Prince who was in Picture Perfect with...well...you know who.

[GooooMarquette]

These are pretty simple experiments. Most biochemistry labs in the US can easily run these assays, and can do them with far higher accuracy and throughput than many of the official labs.

It would be no problem whatsoever to set up drive through testing, with high accuracy and higher throughput. The problem is the US has regulations on who can do clinical testing and who can report clinical results. That is the barrier, regulations, not any logistical issues or accuracy.

You are right about the complexities at the interface between clinical and research testing (I have had head-scratching conversations with FDA about that exact topic)...but that isn't what I'm talking about.

I'm talking about simple, straightforward purely clinical testing. Even in that relatively straightforward setting, errors are made in the handling and labeling of specimens. They aren't frequent, but they happen. If you add new logistical processes to the mix, the error rate is bound to go up. So I disagree with your comment that there aren't problems in terms of logistics or accurate reporting. There are.

[rocky_warrior]

Hah, this is rich, now china can blame everyone else...

https://www.reuters.com/article/us-health-coronavirus-china/chinas-new-coronavirus-cases-rise-on-infections-from-abroad-idUSKBN20Y03W

[forgetful]

You are right about the complexities at the interface between clinical and research testing (I have had head-scratching conversations with FDA about that exact topic)...but that isn't what I'm talking about.

I'm talking about simple, straightforward purely clinical testing. Even in that relatively straightforward setting, errors are made in the handling and labeling of specimens. They aren't frequent, but they happen. If you add new logistical processes to the mix, the error rate is bound to go up. So I disagree with your comment that there aren't problems in terms of logistics or accurate reporting. There are.

The problems with handling labeling etc., are largely from many hands being involved in collecting, labeling, transporting, preparing, and then testing the samples.

The drive through, high-throughput system would limit that. It would have a person collecting samples, providing them to the person who prepares and tests on site. It would be vastly faster, and since it has fewer hands in the mix, would have far less errors.

We are doing this in the most moronic, cumbersome, and inefficient way nearly imaginable.

[GooooMarquette]

The problems with handling labeling etc., are largely from many hands being involved in collecting, labeling, transporting, preparing, and then testing the samples.

The drive through, high-throughput system would limit that. It would have a person collecting samples, providing them to the person who prepares and tests on site. It would be vastly faster, and since it has fewer hands in the mix, would have far less errors.

We are doing this in the most moronic, cumbersome, and inefficient way nearly imaginable.

You are overstating the feasibility and simplicity of doing PCR-based testing in the field with a near-zero error rate. You will become a very rich man if you can actually bring that to pass.

Godspeed.

[forgetful]

You are overstating the feasibility and simplicity of doing PCR-based testing in the field with a near-zero error rate. You will become a very rich man if you can actually bring that to pass.

Godspeed.

I do this. Including having worked on field-based PCR on a chip for rapid detection of pathogens at sea.

It's not complicated or difficult. In fact, there are multiple industries that intentionally do field-based studies to avoid errors, and problems due to transportation and samples changing hands.

[Hards Alumni]

You are overstating the feasibility and simplicity of doing PCR-based testing in the field with a near-zero error rate. You will become a very rich man if you can actually bring that to pass.

Godspeed.

So things are hard so we should not do them because we might make a mistake?

https://www.cbsnews.com/news/drive-thru-coronavirus-testing-facility-us-seattle-washington/

[Hards Alumni]

They went into full lock down, that approach can absolutely works(until rounds 2, 3, 4.... come around again). I'm extremely sceptical that we could execute such a plan in the US and that it's actually necessary.

We need to lower the infection curve but I don't think we need anything drastic to do that. Wash hands, if you feel unwell stay home, and if you are higher risk stay home as much as practical. We can

It is inevitable this virus will spread and it will kill, tragic but death is a part of life. I don't say this casually as my parents are high risk, my sons godfather is 42 and has Cystic fibrosis, and I have a 4 year old and a 9 month old. We aren't going to stop it and we aren't going to take mortality rate to zero. We try to limit the damage and slow the curve but given the current understanding of the virus it is no time to hit the panic button as some seem to advocate.

China went into lockdown.  South Korea did not.  I don't remember hearing Tokyo or anything about Japan reaching a total lockdown.  Though, to be fair, we haven't heard much out of Japan in a while anyway.

[GooooMarquette]

I do this quit regularly.

The in-lab part, or the logistical part of setting up large-scale systems for accurate collection, handling, labeling, transporting and reporting of results? Two very different animals, and in my experience the in-lab people routinely underestimate the complexity and potential error rates in the latter.

If you have a solution beyond the in-lab part, then by all means go ahead and show the rest of the medical community how it's done easily, on-site and with a low error rate.

[GooooMarquette]

So things are hard so we should not do them because we might make a mistake?

https://www.cbsnews.com/news/drive-thru-coronavirus-testing-facility-us-seattle-washington/

There's a huge difference between a few facilities where there's already a huge problem vs thousands of facilities in an enormous country. And that's in terms of costs, compliance and error rates.

[forgetful]

The in-lab part, or the logistical part of setting up large-scale systems for accurate collection, handling, labeling, transporting and reporting of results? Two very different animals, and in my experience the in-lab people routinely underestimate the complexity and potential error rates in the latter.

If you have a solution beyond the in-lab part, then by all means go ahead and show the rest of the medical community how it's done easily, on-site and with a low error rate.

Quite frankly, the medical community does not want things to change. They profit dramatically from the red-tape and hurdles.

Also, the MD's greatly overestimate the complexity of routine tests and the logistics of handling large numbers of samples and large sets of data. This in part stems from medical testing facilities often hiring poorly skilled technicians that don't care about their job.

There is no reason that even a small facility couldn't be running 5-10k tests a day. At that scale you could run these for $2 a sample, including labor for a highly skilled PhD level research technicians.

We haven't ran 10k tests nationwide yet.

We are going to have to agree to disagree on the feasibility of large scale testing and drive through facilities.

[Hards Alumni]

https://www.nytimes.com/2020/03/10/us/coronavirus-testing-delays.html#click=https://t.co/mlEjBJl96Q

[forgetful]

https://www.nytimes.com/2020/03/10/us/coronavirus-testing-delays.html#click=https://t.co/mlEjBJl96Q

Her lab probably tested close to as many samples as the rest of the nation, up until this week. Great story.

[GooooMarquette]

https://www.nytimes.com/2020/03/10/us/coronavirus-testing-delays.html#click=https://t.co/mlEjBJl96Q

That is a great story about what I agree was a big miss. Notably, it occurred where many lab-related regulatory blunders occur: the interface between research and clinical labs.

Regrettable.