> Through a secure cloud connection, the Ellume COVID-19 Home Test provides real time reporting of test results and critical data to health authorities, employers and educators, for efficient COVID-19 mapping. [1]
> Real-time reporting through secure, HIPAA compliant cloud connection [1]
My understanding is that a major hurdle was the FDA requiring test results be reported back to health authorities. Or at least there has been a lot of disagreement on the issue [2]. It's a bit unclear if the reporting via the app is 100% mandatory but I would bet on it sending at least something indicating positive/negative by default.
I'd expect the majority of the per unit cost to be the digital test reader and Bluetooth capability. I'm skeptical if this is anything more than a fancy camera + Bluetooth like digital pregnancy tests. [3]
I'm glad we are finally getting an at home test but I can not help but think that having cheaper and simpler antigen test strips available months ago would have been a better solution.
My understanding is that a major hurdle was the FDA requiring test results be reported back to health authorities. Or at least there has been a lot of disagreement on the issue [2]. It's a bit unclear if the reporting via the app is 100% mandatory but I would bet on it sending at least something indicating positive/negative by default.
This would be a dealbreaker for me. If I'm buying a test kit it's because I want to know, not because I want the world to know.
> I want to know, not because I want the world to know.
I understand this attitude, but just to be clear, the FDA != "the world". Their job is to protect the health of the pubic and work to mitigate the spread of a highly-contagious virus that will likely hit 2M global deaths in fairly short order. It's your choice not to take the test, but the reality is that if you've received medical care in the last 10 years, several parties probably already have access to that data. If your medical provider's EMR system uses cloud servers, then at least one of the big firms has access to it. And that's not even considering the possibility that your (anonymized) medical records haven't been sold to third parties for research purposes. Last year, outlets reported that Ascension Health, one of the largest healthcare providers in the US, was sharing medical data on millions of Americans with Google[0] without disclosure.
At least in this case, you're being informed before agreeing to service how your data is going to be used. We're largely losing that right in this world.
I would argue that a much more effective approach would be to incentivize and isolation. If you report (correctly) that you have a positive test, you stay home, and the government provides food and benefits for however long you should isolate. And your employer is forbidden from retaliating.
Isolating sucks, but it shouldn’t be more of a hardship than absolutely necessary.
"Someone on Instagram told me how to get a weeks worth of free food! Simply order this coronavirus test and then dip it in drain cleaner! It'll come out positive, and the government will send loadsa free stuff!"
The UK pays a £500 incentive to anyone who gets covid-19, and suddenly a lot more people started getting infected... If you're young and poor, it's a pretty sweet deal since the mortality and complications rate is so low for young people.
It is to stop the spread of the virus. Someone who is asymptomatic is the worst person you want out of the house. So you absolutely need to incentivise everyone who tests positive to remain indoors.
Why do people not grasp this? It’s quarantine 101.
A bad actor can breed a lot of cobras at relatively low risk to themselves. They can only give themselves one COVID infection, and it comes with a pretty high personal risk.
They only pay £500 if you're already on low income. Is there any basis to your claim that suddenly a lot more people started getting infected? It's my recollection that cases were already rising fast when this was announced.
I know 4 people who deliberately got infected to claim the £500. Three have been paid (one is stuck in paperwork hell). I know of two others who tried to, but despite their efforts couldn't get the test to come back positive.
"Their job is to protect the health of the pubic and work to mitigate the spread of a highly-contagious virus that will likely hit 2M global deaths in fairly short order. "
This is a good example of how heavy handed approach beats reasonable regulation. Somehow I should consent for cookies (which I don't even know what they do) on websites I explicitly visit but my consent not needed for collecting health data ?
Having a cheap and simple covid test will greatly help arrest the spread of COVID whether or not FDA gets that data. Having said that there might be some marginal benefit for FDA to have some data for which the FDA should incentivize users by asking them to give consent, offer discounts and promise anonymisation.
A lot of people will call me a Libertarian sshole for pointing this out, but remember a rogue admin like Trump weaponized various terrorism related programs to target large groups of immigrants. Later Miller used covid as a weapon against lot of immigrants effectively bringing entire immigration system to halt. Such collection of data will BE used against some undesirable groups in future and this is something people should fight against.
> Having said that there might be some marginal benefit for FDA to have some data for which the FDA should incentivize users by asking them to give consent, offer discounts and promise anonymisation.
If the executive branch (which the FDA falls under) is so far beyond reigning in that we have to resort to disabling an important functionality of government instead of improving the check on power (which is where I believe the focus should be), then why would you assume that they're being honest when they promise you that they're anonymizing your data? You're arguing that the executive branch is out of control but you're willing to trust them if they promise to anonymize the data they collect? That makes no sense to me.
If you're going to use the "rogue administration" argument, then how exactly does FDA, which falls under the executive branch, not fall into the same rogue behavior category?
How will one data point (did this person test positive?) be used against minority groups? I'm as skeptical of govt data collection as the next HNer, but I fail to see how this particular piece of information could be weaponized.
A positive test is reported to the FDA. DHS gets this information. It is determined the individual "exposed others to Coronavirus". A "common sense" remedy is applied like, say, prohibiting the individual from boarding airplanes.
Individual is now on a possibly secret "no fly list" with terrorist connotations.
Macro:
Minority groups are skeptical of the government because of historic abuse. They tend to take fewer tests. Majority groups trust the government because of being treated well historically. They tend to take more tests.
More cases are found in majority groups per capita because they took more tests per capita. Data shows more cases in majority areas. More resources are sent to majority areas. Minority areas are neglected and do not receive the resources they need. This perpetuates the experience of mistreatment and discourages future cooperation.
The chilling effect is real, and concern is reasonable on the part of individuals. Who wants to defend a group of bioterrorists anyway?
That went from a reasonable thing that might happen — you're temporarily prevented from boarding a plane while you are bearing a highly contagious, deadly illness that can spread to whoever you breath on — to... Now you're labeled a terrorist because you got sick? That seems like a pretty large leap. Especially since millions of Americans have already tested positive for COVID using the existing infrastructure (that reports to health authorities already) and none of this has happened. Why do you think having at-home tests will suddenly result in labeling every positive case a terrorist?
> Who wants to defend a group of bioterrorists anyway?
I feel like the main stretch of imagination here that I find difficult to believe is that everyone who contracts COVID (which will likely be millions more Americans) will be labeled a terrorist, because they took the test at home instead of at a doctor's office or testing site. The existing testing infrastructure that has tested millions upon millions of Americans, and found millions of positive cases, already reports to health authorities: why would having a more convenient test that does the same thing result in dystopian madness?
> That went from a reasonable thing that might happen — you're temporarily prevented from boarding a plane while you are bearing a highly contagious, deadly illness that can spread to whoever you breath on — to... Now you're labeled a terrorist because you got sick?
To be clear, I am not talking about temporarily preventing sick people from boarding planes. I'm talking about DHS drawing their own conclusions from FDA/medical data. The scare quotes on "common sense" were meant to point this out. Preventing infectious people from boarding a plane is reasonable. That means FDA may very well share data with DHS and feel perfectly fine about it. But how does DHS achieve this? Do they diligently maintain a list of diagnosed individuals and scrub names when those people are healthy? Or do they re-purpose an existing mechanism that has the desired immediate effect?
The "no fly list" also contains terrorism suspects. These lists existed before Covid and contain names of people who have never been suspected of wrongdoing but just share a name with someone who is, or not, who knows. These individuals still live with the consequences of being suspected terrorists.
> Why do you think having at-home tests will suddenly result in labeling every positive case a terrorist?
I didn't say this.
> I feel like the main stretch of imagination here that I find difficult to believe is that everyone who contracts COVID (which will likely be millions more Americans) will be labeled a terrorist,because they took the test at home instead of at a doctor's office or testing site.
I didn't say everyone. In fact my hypothetical constructs a situation where minorities are disproportionately placed on the lists. The macro outcomes lead to micro outcomes which lead to further macro outcomes. This is systemic bias.
Regarding the difference between home and on-site tests: is the home test data protected the same way as other tests? How many people have not been tested because they are afraid of a situation like my hypothetical?
Can LEO get a search warrant for your home, find the testing device and retrieve the results? What if they search your phone?
We don't know anything about the home test data. We don't even know if sharing it will be mandatory. If it were mandatory, I find it a little unlikely that it'll be treated massively differently than the existing COVID test data that is shared from current test sites such that DHS will start labeling people as terrorists for testing positive or that law enforcement will start kicking down people's doors if their test doesn't report back (I mean, imagine if the WiFi went out, or they ran out of data on their data plan?). Given how the lockdowns have been policed on private citizens — that is to say, extremely lightly if at all — I find it a bit far-fetched that at-home COVID tests are what will push us over the brink into fascist dystopia.
What you find far fetched is in fact commonplace in America in 2020. It is important that we acknowledge this and fight it. The people need to be able to trust the government in situations like this. Today, rightfully, some people do not.
We're still not sure how liability plays out in the courts in terms of going out into the community while potentially infected. From a legal standpoint, it's probably better to just not know, than to know and be on the hook for something.
Again, that's from a personal, legal liability standpoint. Not at all from a public health standpoint or a moral/ethical standpoint.
Thanks for asking this question. There is nothing "minority" about this, every group needs same protection and no one should be targeted. A reasonable person can not even guess how evil the government can get.
- Trump wanted to target certain folks with work authorizations. There was no legal way for him do end the program easily. So he insisted they are a threat to national security. Then he demanded they submit their biometric data every time they want to renew they authorization/visa (note that DHS or State Dept. already have their biometric data). Then all they had to do was to reduce work force in the biometric collection centers. As a consequence now the processing of these visas/work authorizations can take upto 18 months. Which effectively forces these people out of jobs. This is being done in the name of protecting Americans from terrorism.
There are number of ways this health data can be weaponized against immigrations or minorities.
- A rogue administration can classify infected immigrants as a public threat. (If that sounds a stretch remember kids from Iran are already a public threat, and children of Indian H1B holders have to submit their fingerprints every 3 years to ensure they are not public threats).
- If you ever have lied on any form about your covid infection or knowledge about it, but government data suggests you had covid during that time and you knew about it, that can be considered "bad moral character" and you naturalization can be denied or even revoked.
- Imagine a poor neighborhood where a particular "undesirable" group lives and a lot of people there test positive, now government can engage in propaganda that this evil group is spreading COVID.
Secondly, trust the creative ability of people like Stephen Miller to come up with more wide ranging excuses.
Sheesh, it seems like you would be against everything just because the information can be used for bad things... To use your logic (at least how I'm interpreting it), we should also abolish driver licenses as well, because look, there's a database of people! With addresses, etc!
And that would be a bad idea because untrained drivers may cause injury to others. The same logic applies to disease tracking, we have to know because someone might harm someone else. It's being measured so we know if prevention methods like lockdowns and masks are working. And just like a driver's license is not something you can volunteer to have (or not), neither should the knowledge of your virus status be optional.
Imagine running a country and being asked "So, how is your country coping with the virus?", and answering "I don't know, we don't have the numbers."...
> that would be a bad idea because untrained drivers may cause injury to others
One can always justify more government power and more government micromanagement of people's lives by claiming it will prevent some hypothetical harm. Here in the United States we're not supposed to accept that.
> Imagine running a country
Imagine having a country where no one person or small group of people gets to "run" things--where, instead, every adult citizen is assumed to be responsible for their own life and their own actions, and to suffer appropriate consequences if they cause harm to someone else. Where nobody is allowed to just declare by fiat what everyone else has to do or can't do. Where collective action is done by reasonable people persuading other reasonable people that a particular course of action is best for all, not by some people just dictating to everyone else what the "right" thing to do is.
The United States of America is supposed to be that kind of country.
Geez, you can fantasize all you want but that's not what we currently have. As Donald Rumsfeld said (I think he's a war criminal but at least what he said here makes sense): "You go to war with the army you have, not the army you might want or wish to have at a later time."
And governing by ignoring reality is not effective governing, sure you can say "Everyone has to be emancipated and be masters of their own fate!", but again that's not what we have right now, people are dying now. You can't just say "well, in the ideal USA, we just need to inform them how to protect themselves and they'll follow those 'suggestions', so that's what we'll do." because this is not the ideal world and people are too uninformed or have too many self-interests to listen.
> A lot of people will call me a Libertarian [a]sshole [...]
If you want to to force unusable fantasy world rules in this current world, well...
> If you're saying otherwise, you're insanely delusional, but well, that's probably how you see me.
My question to you is simple: do you see yourself as capable of managing your own life and being responsible for your own actions? I certainly see myself that way. My belief is that most Americans do too, so I assume you do as well. And if you do, then you are insanely delusional to be talking as though people need someone else, whether it's the government or "experts" or whatever, to tell them how to manage their lives.
Perhaps I'm wrong in my belief. Perhaps you honestly think that you yourself are not capable of managing your own life and being responsible for your own actions. Perhaps most Americans are like you and not me.
If you in fact don't think you're capable of managing your own life and being responsible for your own actions, then I have another simple question for you: who else do you expect to do it? If you expect our politicians and other so-called "elites" to do it, then once again, you're the one who's insanely delusional, not me. If you honestly don't think you're capable of managing your own life and being responsible for your own actions, my strong advice to you is to learn how, quickly, because otherwise you are putting your life in the hands of people who cannot be trusted with it.
I suppose there is one other possibility: that you think you, yourself, are capable of managing your own life and being responsible for your own actions, but you don't think most other Americans are (presumably including me). If so, once more, you're insanely delusional, unless you have very, very strong evidence that you are that much more capable of managing your own life and taking responsibility for your own actions than most other Americans.
Ever heard of Dunning-Kruger? Geez. Subjective opinion of one's self can be vastly different to the objective truth.
I wonder what drunk driving stats currently look like, despite harsh laws against them. These are people who believe "I'm fine to drive" and disregard the health of others when they get on the road. Imagine if in your magical world there are no drunk driving laws, because hey, let's trust everyone to be capable blah blah blah. On that topic, substance abuse.. but hey "my body, my problem?" right? Except substance abusers become a problem when they commit crimes against other people so they can get their fix, and when they fall over in public and start foaming in the mouth needing the ambulance. (Not familiar with the libertarian cult ideology, does one need a fat credit card before the ambulance start treating one's self?).
Whatever magical believe you have about those capabilities, yeah, most people in the world don't have them to the degree of perfection you think you have. Should I study more to advance my career? Yes. Should I have a better work-life balance? Yes. Am I doing those things? No, instead I'm spending time responding to crackpots on the Internet.
So yeah, trying to govern a society with your (IMO idiotic) assumptions is a stupid idea, because it's a society we don't have. Should we just cancel all drink driivng laws because we should assume right now that everyone will be responsible and not drink drive? To expand that, should we cancel all police because we can assume everyone will be responsible citizens and not commit crimes against others? What a genius idea. /s
If people just don't test because they don't want to give info to the government, that's not an information gain for the government, it's just a loss for everybody else.
This is why we here in the US call it a free country. It is very different from the democratic freedoms of other countries. We founded this nation because of misuse of government power. You should always be skeptical of government oversight. Our constitution was written by very bright people who understood that mob rule and government overreach are very easy to fall into. Think of how phishing attempts sometimes use your emotions/anxieties against you, “Urgent, this is your boss, I need your email and PW to log in.”
The same fear mongering has been used to shut down schools across the US when there is little statistical evidence showing spread occurs in schools. Many other nations know this and kids are still going to school. This is a prime example of when government overreach is entirely misguided and political.
Edit: Thank goodness we still have free speech here. I fear many of our freedoms can easily be eradicated by the, “saving just one life,” argument.
Edit edit: Also not trying to be too inflammatory but China has all the data in the world and they fudged the numbers they sent out. We already have entirely data driven societies and you can ask Hong Kong how much they wanted it.
Normally I care more about privacy than other people, and for a lot of illnesses I'd find this more than understandable, but for this pandemic, I don't understand your sentiment. Not only has it already infected over 74M people and killed 1.5M of them (and counting...) from all walks of society (hardly making you unique!), but by sharing 1 bit of information about yourself, you can help others avoid that fate. What exactly is so scary about the FDA knowing if you had COVID that terrifies you and trumps (no pun intended) everything else?
It seems to me that the point of mandatory reporting is to impose quarantining by force on people who wouldn't otherwise have done it. But if the test itself is not mandatory, then it defeats the purpose.
i.e. If I have the choice between taking the test or not, and I know the test is going to report me if my result is positive, leading to consequences I see as negative, then I can just choose not to take the test.
If I see the consequences of a positive test (quarantine, isolation, etc.) as necessary then I would just do it voluntarily and the government wouldn't need to step in.
If it was consensual I wouldn't have an issue with it. The fact that I'm not being given a choice means I'll just avoid taking the test. Consent matters.
I mean... you understand why it's not consensual here, right? It's not because they're trying to use your data for marketing purposes, it's because they need it to address public health. When you send your kids to school (if you have any, or hypothetically) and they ask for the immunization records, do you refuse to tell them and decide to home-school instead, because you don't like mandatory things? Does the context not matter at all?
Yep, here’s the language from the FDA’s approval letter [0]:
“ Test results from your product will be automatically reported to relevant public health authorities, via your product’s software application (app), in accordance with local, state, and federal requirements, using appropriate LOINC and SNOMED codes, as defined by the “Laboratory In Vitro Diagnostics (LIVD) Test Code Mapping for SARS-CoV-2 Tests” provided by the Centers for Disease Control and Prevention (CDC).”
For anyone else wondering about the benefits/downsides of the various tests (why do one that takes multiple days when you can do that takes 15 minutes?), the FDA has a pretty good page on this subject:
The tests that swab your nose or throat and take multiple days are called "molecular" tests and are considered highly accurate. They use controlled heating and cooling cycles to convert the virus' RNA to DNA, which can be detected by specialized lab technique after binding probes to it.
Tests like this 15 min one are called "antigen" tests and are still accurate/helpful, but are known to produce more false negatives and false positives compared to molecular.
"Tests like this 15 min one are called "antigen" tests and are still accurate/helpful, but are known to produce more false negatives and false positives compared to molecular."
On a large scale, the wrong results from such tests don't matter if you test people often enough (say, every day). If you get a wrong result one day, it'll probably be corrected in the next day or two with more tests.
If there was a massive government initiative to manufacture such tests and subsidize them so that everyone got them every day this pandemic could be effectively halted in very short order, even without a vaccine.
Almost 6 months ago, the This Week in Virology podcast went in to great detail about this plan, starting at about 6'20" in to episode 640:
On a large scale, the wrong results from such tests don't matter if you test people often enough
That assumes that for each test it is a sort of dice roll on whether or not there will be a false result. It might be that something about the individual person's biochemistry or health history (like prior exposure to a different corona strain) is the cause of the false result. If that's the case, then people who receive a false result on this type of test will tend to always receive false results, and testing more often won't help much.
Its the viral load, or the amount of virus, mainly. Most people have a large viral load when they are the most infectious, especially in the nose and throat. Testing daily would ensure that you know immediately when you're highly infectious.
A recent check of the rapid test used in the UK is that its largely unaware of the virus if the necessary PCR cycles are > 25, gets it right half of the time for CT between 20 and 25 and it gets very good if viral load is large enough to be detected by < 20 cycles. Other rapid tests are AFAIK somewhat better.
The main problem that most (western) countries failed to solve is to remove reasons to not take a test and not to self-isolate, and that's primarily inability to get proper support WRT work / monetary situation while self-isolating.
Make it easier for people to self-isolate than not to, and people will do it.
They can simply use a different test. It'd be much more resource efficient to use the rapid tests on those for whom it works as intended and use PCR (molecular) tests for those who get false positives every time.
I have friend who has a colleague who always produces a false pos. antibody test. They know it, they still test him. (At this point basically to make sure the test does something at all.)
After all, every kind of proactive/preventive measure helps a bit to keep a group/family/workplace safe.
Yep, if we can distinguish between who it does and does not work as intended. How do you verify a false positive? By performing a better test, but then you have to do it for everyone and we're back to square one. However I agree with other comments that even with false results, it's still very useful, just that frequent testing won't necessarily overcome all false results.
Sure I'd be worried about false negatives. Identifying the infected to allow them to isolate is the reason for it. I'm not worried about false positives because there is little harm done in having someone isolate uneccessarily. Much more harm is possible by keeping an infected person, who now thinks they're fine, out in public.
These assays are very skewed toward producing false positives.
Exactly for this reason.
It's not perfect. PCR can miss the early stages of the infection too.
These are just signals.
Luckily we know that viral load is the factor for transmission rate (infectiousness). So even if someone is (false) negative, but has symptoms, should self-quarantine.
The governments of Slovakia and of the Bozen province in Italy both organized an antigen testing of their whole population over the course of a weekend (Slovakia did this two times, two weeks apart). From what I can see both attempts were largely unsuccessful in sensibly reducing the spread of Covid, even temporarily.
Testing the whole population of Bozen with antigen tests yielded way less positive results than expected, so the feeling was that the tests were just not as sensitive as advertised.
The antigen test also seems to be ineffective at detecting igg antibodies months after infection due to their half life and very few non clinically researched focused tests for t or b cells seem to have been carried out anywhere
In Bozen they mass-tested 65% of the population over the course of 3 days.
They were getting 540 positive PCR tests every 100k people a week in the week before the mass screening; the latter yielded 900 positive antigen results every 100k people; they got 435 positive PCR tests every 100k people in the week after the screening.
This 20% reduction in positive PCR tests seems mostly due to the lockdown, given that the week before the mass screening the reduction had been even greater, 32%.
According to that TWiV episode, such tests could cost just $1.
So, according to your estimates of 2 billion tests per week, that would make for $2 billion per week, not $60 billion per week.
As for shipping, the tests need not be shipped via USPS nor need they be shipped individually to every person.
They might be locally manufactured, there could be centralized distribution locations, and people could stock up for a month's or a year's worth of tests at one time, greatly reducing shipping costs (assuming enough tests could be made, of course).
The tests could also be at the very least targeted at locations where there are a lot of infections, further reducing how many tests would need to be manufactured and used.
You wouldn't be delivering 1 test per person per day. You'd deliver a month's worth for a whole household. There's about 52 million households divided by 30 days = 1.7 million packages per day. A 1% increase. I wonder how much of an increase in shipping Christmas is.
Okay, now do the math on loaves of bread that manage to make it into homes. Or rolls of toilet paper. If the price really could be down to $1 per test, and manufacturing capacity exists (or could be made to exist), the market would figure out a way to get these tests in enough places to be massively effective. And the government could even fill in some gaps.
As with everything else, the market would simultaneously have offerings with higher prices and offerings with lower prices. There's not just one price.
The scale is enormous but so is the scale of actions we did take. Billions of dollars in aid to individuals and aid/loans to businesses. Government funding for operation warpspeed to develop vaccines. High unemployment and a reduced economy for months as the pandemic continued.
I bet some companies are working on a repeatable device that runs / re-runs tests. Think of it like a thermometer - you can reuse it as often as you like and get results in seconds.
Of course that doesn't exist yet, but it would solve all the problems you mention.
I'm sure. However the previous comment was lamenting that the government didn't do this for us at the beginning. Even If the test existed (it didn't), and had the money to do so (which is also huge), scaling manufacturing is a real challenge, mailing to 128m households is a huge challenge.
There's no need to mail tests to each individual end user.
The tests could be manufactured locally and picked up in bulk by the end users from centralized locations.
But even if they did have to be mailed to the end users in the hundreds of millions, that's not exactly an insurmountable challenge.
Just a little while ago hundreds of millions of people got mailed ballots and plenty of other information so they could vote in the Presidential Election. That's not to mention all the junk mail each of us gets every single day.
Look at the massive effort put in to the Manhattan Project and the Space Race. There's no reason the government couldn't have done something like that for mass testing, and saved hundreds of thousands of lives and trillions of dollars.
One cannot be certain why, but perhaps it is due to the fact that the prior qualifications of this individual were:
1. Operating some mixed-use buildings in New York, and casinos in Atlantic City purchased through extensive family loans
2. Owning and operating a few golf courses
3. Licensing their name to some adult learning courses that were later revealed to be scams
4. Being the star of a reality TV show
Without passing any sort of judgement on this person, they were completely unqualified to orchestrate anything anywhere near the complexity of the Manhattan Project or Space Race.
They were unable to even prioritize and orchestrate the allocation of adequate PPE to healthcare facilities, as well as adequate testing capacity for 50% of Americans to be tested on a monthly basis let-alone daily.
Again, no judgement on this individual, but they were totally unprepared and unwilling to manage the crisis and their failure to act likely hamstrung any meaningful attempt to coordinate the type of effort you are describing, which would have required federal buy-in.
The test is very good at detecting the virus if you have a high viral load. Waiting a day and doing another test means that the low-level infection you missed yesterday has had another day to replicate, making it easier to detect.
You're also probably much more infectious when the virus is at levels that are detectible by the antigen tests, so even if you miss it when it's at a low level, as long as you detect it when you get really infectious it can help lower your chances of transmitting it.
> If there was a massive government initiative to manufacture such tests and subsidize them so that everyone got them every day this pandemic could be effectively halted in very short order, even without a vaccine.
Absolutely, except that people need to be willing to take the tests. Here in Austria they did a round of free mass testing. The plan was to test the whole population, however only 17% of eligible people showed up. They just don't care.
In fact, acquaintances asked me "why did you get tested if you didn't have any symptoms?? don't you have anything better to do with your time?".
For the next round of mass testing they are considering paying people €50 just to show up!
"In fact, acquaintances asked me "why did you get tested if you didn't have any symptoms? don't you have anything better to do?"."
This is a simple matter of educating the public.
The government has done this effectively in, say, wartime, when the importance of acting a certain way (ex. "Loose Lips Sink Ships") is emphasized.
You can get nearly everyone on board if the government is competent, on the same side of the issue, and determined.
Sadly, in the US we have bickering, incompetent, and ignorant government officials which are often making things worse by ignoring the science or acting directly contrary to it.
You need both good leadership and good support. The sense of unity should extend to an actual implementation of unity as well: monetary support for people while they self-isolate would go a long way, for example.
Unfortunately I'm afraid that at this point its way too late. The window has moved and the new accepted normal seems to be lots of people dying from the virus. Due to privacy protection those people are also largely invisible to the majority of the population, except for their loved ones - an abstract number. There is also a general sense that "testing doesn't work" - even more so accentuated by the repeated insistence of various medical professionals that rapid tests are "not reliable" (which misses the point - they are not for diagnosis but they're a good infection control tool) and a focus on the vaccines.
Success for rapid tests is therefore highly unlikely at this point. Could have worked 3 or 4 months ago. Maybe if there are huge incentives to get tested and a large campaign to inform the public, it could work - but otherwise I doubt it.
It isn't just a matter of education. It's a matter of setting incentives as well. If the downside of getting tested when asymptomatic, and getting a positive result, is having to quarantine and losing two weeks of work then no level of education will get enough people to do that. If you also guarantee their wages, then that's different.
_The government has done this effectively in, say, wartime, when the importance of acting a certain way (ex. "Loose Lips Sink Ships") is emphasized._
That was a long time ago when the vast majority of media available to people was willing to go along with what the government told them was ok or not ok to print. Even if you got 90% of the media on board today, think of the number of Facebook clicks and thus fat stacks of ad revenue one media outlet could generate by just posting a couple of stories a week that "present another viewpoint" or "ask questions" about "the debate".
In funding our news via ad revenue we have turned all issues into a decision of Coke versus Pepsi and tossed any idea of a mutually-agreed upon reality out the door.
> "why did you get tested if you didn't have any symptoms? don't you have anything better to do?"
I mean, I've been known to use the blood pressure machines that drug stores make available mostly because I like the feeling of pressure on my arm. Maybe you didn't have anything better to do. People do lots of things.
With the current tests, that is the right answer. Unless the test results are quick, there really is no reason to test everyone. If there is a significant length of time between the test and the results then the people who have it will spread it while waiting for the results.
Fortunately, this doesn't appear to be a problem where I live. They're telling us not to get tested because too many people are getting tested without symptoms.
>If there was a massive government initiative to manufacture such tests and subsidize them so that everyone got them every day this pandemic could be effectively halted in very short order, even without a vaccine.
Provably false, since over the past 10 months we've seen people all along the way going to parties, restaurants, rallies, airline flights...all after having tested positive. Mooks and celebrities, it hasn't mattered.
Your false assumption is that strangers care whether anybody around them dies a painful and lonely death. That's before you even get to the practicality of isolating people who test positive, or to isolate themselves, especially among science disbelievers, Christian congregations, and 2nd Amendment activists.
That wouldn't have had the fancy electronics and cell phone app that force the user to show up in government statistics, though. It would just let the user know if they were infectious or not and act accordingly.
…which would be plenty of info for the primary endpoint of "saving lives".
The government's desire for a legible set of stats should take a backseat to the urgent need to inform people how to protect themselves. Let's help people save themselves by not making useful tools illegal. Pretty charts for bureaucracies can wait.
Yes, ideally that's what would happen. But it's hard for the FDA to approve any new medical device that's worse along a metric the FDA cares about than existing methods. Honestly, the FDA has basically never cared about price and availability before so I'm really surprised they're even letting this one through given that it's less sensitive than a standard PCR. Given how disastrous the FDA's (and CDC's) actions around testing were in February and March I'm relieved things are currently going as well as they are.
Yeah, it should be subsidized so its at least 10 times cheaper. $30 should be a pack of 10 rapid tests.
In addition there should be mechanisms to support people who are self-isolating that are sufficient so that its equally easy to self-isolate as it is not to self-isolate
> On a large scale, the wrong results from such tests don't matter if you test people often enough (say, every day).
But is anyone going to be getting the test every day? Particularly when it apparently costs $30. At that price, once is fine but nobody is going to be doing it over and over; they'll just treat whatever result they get (positive or negative) as binding.
The functional part of the test, the piece of paper that lines appear on, is less than $0.10 a piece. It is mass manufactured, you could mail people a hundred test strips. You could reuse the $1 plastic housing. What do you think people are doing in other countries? This is a failure of leadership.
As a citizen of another country, I'm not aware of any country that is shipping tests to citizens at their homes. Maybe your numbers you quote are correct - there are other problems, like relying on people to report their positive test results and isolate. A lot of people would, but many also wouldn't, because they can't afford the loss of wages. You'd have to cover wages lost, or some percentage anyway, and that would mean requiring another test at a trusted facility, which increases the complexity again...
Maybe the concept would be workable, but it's also not a simple slam dunk, and again, I don't know that any country is doing anything like it.
$10 billion per month is far, far less than either 1) the economic losses of the pandemic to society, or 2) the amount of money the pandemic is costing the government. I have no knowledge on whether it's feasible, but if it significantly reduced the impact of the pandemic, the economic decision is easy.
"could we manufacture 10 billion of them a month?"
Yes, it could be done.
According to that TWiV episode (which, again, I encourage everyone to listen to) the tests are very simple: just a piece of paper with some antibodies on it.
As for the $10 billion per month cost, from the TWiV episode (about 31 minutes in):
It just boggles my mind, the enormity of this problem. This is killing enormous numbers of people every day. It's costing the country trillions -- literally trillions of dollars. This should just be part of the national emergency.
It's one thing to make vaccines, it's one thing to make therapeutics, but these are things that necessarily take time. We have to wait to see what the efficacy is, we have to... it's really hard to make therapeutics. A diagnostic test should be a no-brainer. Make a $1 test. Get it to everyone. Change the way we view these things, and that should be completely being plowed through by the federal government.
We don't have to make 300 million of them overnight. We just have to focus them at the moment in places where the cases are worst... it's just astounding that we don't see a flurry of activity from the US Army...
I don't know who makes it, but take every manufacturing company that knows how to print paper, adapt their tools to print monocolonal antibodies on to those sheets and just start slicing it up and shipping it out. It's as easy as that.. well, you know, I'm simplifying it a bit but...
>Maybe a year ago this would have been worth it. But the resources should be used for mass vaccination instead.
Given that it will be at least 6-9 months before an appreciable fraction of the population can be vaccinated, frequent testing still makes a whole lot of sense.
As to the effort/expense, you'd think we'd be able to walk and chew gum at the same time, no?
>Given that it will be at least 6-9 months before an appreciable fraction of the population can be vaccinated, frequent testing still makes a whole lot of sense.
What makes you think we can ramp up production on these faster than that? You'd need a billion of them to test each America once every three months.
>As to the effort/expense, you'd think we'd be able to walk and chew gum at the same time, no?
Only if the resources used were entirely unrelated, which I doubt. Every public health offical's man-hour should be dedicated to setting up vaccination sites. Every medical manufacturing facility should be making vaccine components and accessories.
I very much doubt you could set up mass testing of asymptomatic people without making trade offs regarding resources for mass vaccinations.
Unfortunately, it seems a lot of people are afraid of getting vaccinated.
Those people, at the very least, should be getting tested.
Also, it's going to take a long time for even those who want to get vaccinated.
Finally, we don't know how long the immunity given by the vaccination will last. If it only lasts a couple of months people might need to get revaccinated again and again throughout the year, which will probably lead to even less people willing to be vaccinated.
So vaccines are very unlikely to be a complete solution by themselves.
I'm going to make an educated guess and say that there isn't a ton of overlap between people who will refuse a vaccine and people who will voluntarily submit to continuous testing.
Maybe I'm underestimating how fast they can ramp up production on these tests, but you'd need billions a month to just test everyone every week.
The tests that they used in Austria cost 7€ a piece, and apparently there are even tests available for 4€ (bulk price obviously)
A friend of mine recently ordered a pack of 25 tests for less than 200€ (he only had to check a box confirming that he was a medical professional). They test the kids with a throat swab every time before they visit their grandparents.
Frequent testing is absolutely feasible if you really want to.
I wouldn't have a problem with the testing at my school if they didn't basically forcefully evict you (and by forcefully, they just threaten you being a student there anymore if you don't leave) or tell you to go into quarantine housing. Which requires you cannot leave your apartment for 14 days. Period no exceptions. And they only give you 4 hours to do it. Even several people moving one person's stuff in 4 hours is absurd.
It's like these bureaucrats don't know human psychology. Youre essentially shaming people to a leper colony for a short time just to save face. It wouldn't be so bad if they just told you stay put. But the administration doesn't want to risk seeming incompetent so they heard the sheep in the way that's easiest for them.
>On a large scale, the wrong results from such tests don't matter if you test people often enough (say, every day). If you get a wrong result one day, it'll probably be corrected in the next day or two with more tests.
Huh?
Continuing to accumulate bad data just leads to a higher accumulation of error.
If you have a high percentage of false results and you continue to test over and over the data are still not reliable. How would you know which the correct results are?
Say you test 14 days in a row, over those 14 days you've experienced no symptoms, yet 6 tests showed positive and 8 showed negative.
Do you have any better idea after those 14 days of testing as to whether you've got covid or not?
If your choice is to test all the students monthly -- e.g. 3% of them per day -- with a molecular test that has a couple day turnaround... This works pretty much only well enough to detect rampant, uncontrolled spread, and will not break a transmission chain very often.
Or to test all the students weekly -- 14% per day -- with an antigen test that returns results in 30 minutes... Even if there's some false negatives, you'll still interrupt many transmission chains and effectively lower Rt.
This is wrong. Too false positive and people will start ignoring the results. Thats what happened in the current climate. You need consistently good days otherwise over the long haul people will distrust and ultimately not follow.
It isn't quite that bad, because the tests aren't independent. You end up with a few people who are disproportionately likely to test positive and can adjust appropriately your testing strategy for them.
And even if that wasn't the case-- you keep a few people home (them + close contacts) until followup molecular testing returns a negative. Yes, it's a big hassle-- you're "falsely" forcing 10% of the student body into remote learning, but probably better than remaining closed.
Yes. And then it’s not just one kid. It’s the entire class plus teacher. It would be a fire drill per day. And then they would need to take the tests every day until they are cleared. It’s not feasible.
As I understand it, these tests rarely produce a false positive, but often produce a false negative. So a positive test result on 6 occurrences is a much stronger signal than a negative result on 8 days. If you get a positive result from a rapid test, you should either self isolate or take a PCR test to confirm.
Think about what you would do if you wake up with cold or flu symptoms these days - there's a chance you don't have covid, but you still need to be extremely careful. These rapid tests should be thought of as a more effective version of the "do I have symptoms" test everybody does subconsciously every day.
Large scale testing is likely aimed at public health, where the goal is to lower Rt < 1. Missing some positives is tolerable. Also, the antigen tests are more sensitive when the person is most likely to be contagious.
With n multiple tests you are much more likely to approach the mean of positive results, which for an actually positive patient is (1-p1)n and for an actually negative patient is p2n, where p1 and p2 are false result probabilities. If p1, p2 << 1 then the means are sufficiently apart that you can compute the probability of getting your result (whatever that is) under the actual positive/negative scenario and one probability will be significantly higher than the other.
Assuming the tests are independent, which is unrealistic. If the antigen test is positive because it's cross-reacting to the common cold or because of something unique to you, then testing more tells you nothing.
It depends on the error rate of the test. If it's close to 50/50 then obviously the test is worthless. But these tests are much more reliable than that, so a population scale the wrong results will be corrected with more testing.
I don't have the analysis in front of me, but I encourage you to listen to that TWiV episode yourself and listen to the panel of virologists discussing this. They were initially skeptical also, but after questioning the plan's author they were eventually convinced and became excited because the plan could actually work.
Its not randomly unreliable but its significantly more unreliable when you have low viral load. (As it happens thats also when you're much less likely to be infectious)
There's a major difference. Antigen tests identify a protein of the virus, which can be detected only if you have infectious viruses in your respiratory tract.
Less sensitive, but highly useful in absence of symptoms, because you know that you need to isolate as you're infectious.
RNA tests take multiple hours, not days. 4-12 hours is usual, depending on how early in the batch you get swabbed and how often does given place run the tests. Haven't heard about someone waiting more than 24 hours in months, long gone are the problems from spring.
If they take days, it's pointing to insufficient testing capacity and/or infrastructure, not to property of the test.
Testing is starting to backlog again. We’re the fastest turnaround PCR public testing company and our turnarounds have crept up over 24 hours in the past two weeks. LabCorp and Quest are in the 5–7 day range in some places.
Also when thinking about accuracy, I think it's helpful to distinguish between testing for public health, and testing for medical diagnosis/treatment. Antigen tests tend to be cheaper and have better sensitivity when the person is most likely to be contagious, for example, which, likely make them more suited for public health-oriented frequent, mass-testing.
> The tests that swab your nose or throat and take multiple days are called "molecular" tests and are considered highly accurate
...
> Tests like this 15 min one are called "antigen" tests and are still accurate/helpful, but are known to produce more false negatives and false positives compared to molecular.
You are correct on "molecular" vs. "antigen" tests in regard to false negatives/positives, but you can't rely on whether or not a test swabs your nose to tell them apart. This newly approved test is indeed an anitgen test, but you collect your sample via nose swab.
Here are the accuracy numbers for this new test, in comparison to a laboratory RT-PCR test.
This test has a sensitivity of 96% and specificity of 100% for people with COVID symptoms, and 91% sensitivity and 96% specificity for asymptomatic people [1].
Sensitivity is how well a test identifies patients WITH the disease.
Specificity is how well a test identifies patients WITHOUT the disease.
For completeness, there is a third type of test, an "antibody" test. The molecular tests and the antigen tests try to answer the question "Do I have COVID right now?". The antibody tests try to answer the question "Have I had COVID in the past?".
Antibody tests typically involve taking a blood sample.
I'm hoping for a cheap, readily available antibody test. I've had enough COVID symptoms at various times over the last few months that it would not surprise me if I had had it, although I probably haven't.
I'm overweight and have high blood pressure and approaching retirement age, which on some vaccine distribution plans I've seen would get me fairly early access once the health care and elderly are taken care of. If I've already had COVID, though, I'm fine with waiting until it is generally available to all. An antibody test would help with that decision.
How common is this? Aside from the initial news that this happened I haven't heard much. Any studies looking at a larger scale?
Friend of mine got COVID, the health department told him he could get reinfected and to continue taking percautions. He was sick enough with it that he's taking the threat of reinfection seriously.
I have mixed feelings. It might undermine trust (already feeble in the U.S. across the board when it comes to both authority and science nowadays) if there are false results. When Musk tweeted his results of what I believe were antigen (and not PCR tests, which are more accurate), and showed contradictory results with a WTF attitude, that's an example of what we'll see more of. Musk is no shining example, but the messaging somehow needs to be "this is just a first line test, you should really rely on PCR test."
That last line seems too complex, as simple as it is, to relay via the news media and 'the public.'
A scenario where public health authorities don’t allow the public to have a test because the public might not understand how to interpret the results will likely undermine trust. It will solidify the belief that these authorities treat us like children, and their recommendations cannot be taken at face value. And that may be a more significant cost in the long run.
I sent them N95s in late Feb and they still don't really wear them (though at least they wear basic fabric masks). At first they told me 'those don't prevent covid - i heard might make it worse.' I tried to explain what n95 technically meant to no avail.
Yes. I think our public authorities - the ones we're told are scientific geniuses (the WHO, CDC) that we should all dutifully follow - said not to wear a mask, at least it was interpreted like that (what they actually said was, we don't recommend masks for the public).
As recently as two months ago I argued with a doctor (not my doctor, a person I met) that these guidelines were off, poor messaging and an outright mistake given the trust fallout. I was told, no no, when I was getting my license, they made us do specialized fitting and testing and even put down some fit information on a card (she showed me a card with details). I was confused, since N95s come in two sizes, regular and "small."
This is an example of an institutional/acedemic ivory tower needing a reality check if I ever saw one. How many people died because many people heard that masks were useless and even harmful? Nope, not red tie people or flat earthers, or whatever conspiratorialists du jour that enjoy mainstream press coverage; here, mainstream institutions are responsible for this.
My other problem with N95 fitting argument (as I've seen it made during the early days of the pandemic) is that there is a level that is "good enough" for most people.
Yes, if you want absolute certainty in a highly infectious environment like the hospital, when you're doing bronchoscopies or taking care of COVID patients, you'd want to get the fit absolutely perfect (especially if it takes key resources like Nurses / docs out of commission for several weeks).
But if you're just worried about everyday scenarios like sharing an elevator in my apartment building or going to a grocery store where people still seem to turn up with out masks (or worse, pretend bandanas are masks) or get on public transit, then getting some protection is good enough.
There was a Netflix documentary series on pandemic planning (in the works before COVID, but the timing was fortuitous). In it, there was a CDC/WHO expert who traveled around to various health authorities/districts/regions and trained them on how to deal with the public regarding a pandemic.
This expert did the professional version of a facepalm when she recounted the times when these health experts failed in their drills. She made it clear that the public will look to them as experts, so be clear, be informative, tell the truth, give actionable steps, etc. Because if these experts _don't_ do these things, the public will look elsewhere. And that "elsewhere" will likely be random yahoos on the internet. Doctors saying "wear a mask" will have greater overall benefits, even if people follow that advice BADLY.
I've argued with both a doctor and an aerospace engineer (her expertise was specifically in fluid flow) about how valves on masks significantly reduce their effects in transmission reduction. It amazed me how people who should be experts fought against basic information that is also easy to verify and should also be within their domain expertise
For what it's worth I have a degree in physics and used to work in rocketry and sim science so I'm not just some naive person arguing with a domain expert.
What I learned from this is that there's a lot going on besides facts. Social status and signaling matters a lot and the reason they were upset is because I upset that, even though it was in private. When we politicize and socialize things it's a double edged sword. It can get people to adopt strategies but can also add binders.
> what they actually said was, we don't recommend masks for the public
There is no reasonable explanation except that the misleading statements were intentional - there's no way they didn't notice how their statements were received. And infamously the US Surgeon General made a pretty clear statement with his "Don't buy masks" tweet.
> I was confused, since N95s come in two sizes, regular and "small."
As I understand it, if neither passes the fit test, you need a different brand or can't do work that requires one.
I think they were worried about a run on the masks that would jeopardize civil workers and medical personnel. But instead of phrasing it remotely like that, or a different tactic, they chose to lie. That's my explanation. Maybe a recording will leak or a document and we'll find out in a few decades.
We did not find evidence that surgical-type face masks are
effective in reducing laboratory-confirmed influenza
transmission, either when worn by infected persons (source
control) or by persons in the general community to reduce
their susceptibility
The problem is that it is very hard to assess the real effect of masks, because they are always a part of a broader range of measures. The infamous Danish study is rather inconclusive and there are no other trying to measure the direct effect.
I think a major problem is that "we don't recommend masks" too easily gets interpreted as "we recommend no masks", and we need new clear language to say the former (no position on masks) with no risk of misinterpretation (position against masks).
Edit: I misremembered the original advice. CDC specifically said masks were unnecessary. Obviously they didn't have the evidence to make that kind of assertion.
IDK about the WHO & CDC, but “the leading spokesperson on matters of public health in the federal government of the United States” (according to Wikipedia) did not have “no position on masks”. I’d quote him here, but his position was emphatic enough to technically break HN’s guidelines: https://nitter.net/Surgeon_General/status/123372578528393216...
I would take a step back from partisan politics for this issue, something people have a very tough time with even in the best of times. We should criticize all institutions when they're wrong on questions of public health.
You are right. CDC said in March "You do not need to wear a facemask unless you are caring for someone who is sick (and they are not able to wear a facemask)".
Honestly, if COVID has taught us anything, it's that people are on average should be treated as children, because it's pretty clear they aren't capable of rational decision making.
If by people you mean academic and institutional voices in power, then I fully agree. I'm only repeating my comment above for effect, here: the WHO and CDC said that masks were not recommended for the general public, and did more harm than good, and this only changed in June.
So from here, the issue is that common sense was shot down in favor of credentialism. I wore a mask starting in March because it was common sense, and I was given scientific arguments for not wearing them. Because, science. That I observed medical professionals wearing them, and east Asian citizens doing this for decades already, was irrelevant in the face of credentialed spokespeople from large organizations arguing that up was down and down was up.
So then the idea that people are children and should be treated as such becomes very elitist if taken like this.
You and me both, brother. Everyone I knew in my friend groups had their masks up. N95s and P100s we all had for California wildfire season. It was the perfect use of knowledge over argument from authority: we were all masked up and we knew we were right.
Other things people said:
* N95s have a short shelf-life. Complete bullshit. The real first POF is the elasticated band. If that's fine, your fit will probably be fine. We knew this wasn't true so my 10 year old masks were still legit.
* N95s require a lot of training for fit. The fit test is trivial to do. We knew this but lots of people on HN and authorities claimed this wasn't the case.
* N95s cannot be reused. This was highly likely to be nonsense. The virus doesn't survive on surfaces for very long and that was the high probability event. After all, viruses rarely mutate so that they're terrible in all ways. i.e. this virus likely behaves like other coronaviruses except for a few variations.
And of course those with our half-mask respirators printed our exhale valves and placed our P100s in them and were full protected.
There was a lot of misinformation going around by people who just didn't know very much and were very eager to sound authoritative. They were all about "sources" and "citations" that are just parrot views (i.e. single primary source, many secondary sources giving the impression of consensus).
People made fun of the tech industry for how they handled it, too. Techies (being coddled millennial snowflakes) shut down before any government, stopped business flights to/from China, and started working from home and wearing masks earlier.
Honestly, my biggest mistake was that I was one of the few in my group of friends who believed the US had competent bureaucrats and so I stayed in the market while my friends sold ahead of the crash. Welp.
CDC recommended masks be worn in public in Aril 2nd, just a couple weeks after the first US shutdowns. There were "only" about 8k total confirmed deaths in the US at that time. That was ~300k deaths ago.
They had it wrong for a few weeks, okay. But they changed their guidelines, and there was new data showing the efficacy of wearing masks(at least the combination of the masks and the social behavior they encourage), and they have stuck to those guidelines for nearly 8 months now.
I'm honestly amazed how long people are being hung up on that single, one-way change in guidelines during the early weeks. It's unfortunate the guidelines didn't come sooner. But looking at the timeline, where we were then, and where we are now.. The totality of it all.. IDK, it's weird seeing people constantly bringing it up and blaming public health official. Especially considering what the messaging from non-health public officials has been over the past 8 months and 300k deaths.
Well part of the topic in this long post and threads is trust in health authorities. I think it's rational and not unreasonable to criticize decisions that permanently damaged the trust.
Stuff was confusing as it was in April. I argued with people about masks then. Normal, rational people, who didn't see this update and sudden change of tune. The information noise level was high in those days, which didn't help.
Absolutely. The communication was worse than awful, and on top of that it wasn't even coordinated. Plus to make matters even worse instead of doing that all that the current US administration did was to issue gag orders to scientists.
Instead of organizing PPE distribution and informing people that it might come to mandatory mask wearing, the message was a very dumb "well, maybe, but really think of the shortage and well, it's a hard question". :/
Not just masks. Early projections (March / April) by supposedly reputable groups like IHME were wildly inaccurate. Even a cursory reading of their methods showed that they had no idea what they were doing. Oversimplifying a bit, they were fitting the CDF of a Gaussian to the cumulative deaths over time. Not a reasonable way of modeling exponential growth.
Nevertheless, IHME was kept in the spotlight by the government and media because they deemed the experts as an independent health research center at a reputable university. Their predictions drove many poor policy decisions, culminating in the infamous claim by Trump that the pandemic would be over soon after Easter. Many epidemiologists, statisticians, physicists, mathematicians etc. called their conclusions into question and built better models (mostly using SEIR / SEIS). It took several more months for IHME to improve their own model, but by then the damage was already done.
Shit, I wasn't even aware of that one. It is so spectacularly stupid I almost think it is a more logical explanation that it is an inside job, surely nobody can be that stupid, right? I mean I am just a computer programmer but I know what exponential growth is and what it looks like.
What was pretty obvious was there were two biases in play with masks. A science bias. And a credentialist bias.
Science bias leads you to come down hard that things that aren't proven are false. No hard proof double blind studies that masks work with covid19 means mask don't work.
Credentialist bias makes you assume people without are stupid and need to be tricked to do the right thing.
Plus as far as I'm aware there was no lying, it was a very wishy-washy diversion, woes about PPE shortage due to China shut down, and 5D chessing about trying to not worsen the shortage instead of giving a simple and clear answer, that "yes, they unquestionably help [healthcare workers use them for a reason!], but we'll be stockpiling every shipment for later".
My mum loves children and has raised me and my brother well and has been a part of the lives of countless children.
You know what she has never done that I can remember? Belittled them, talked down to them or not considered that they were _humans_ with their own goals and values. I can't say that she never lied to us (Santa Claus etc) and of course sometimes she would force us to got to bed or do homework or whatever, but it seems obvious that she genuinely cared at all times and she was happy when you were able to do something new or achieved something.
The vibe I have seen from those in power and their supporters have been one of arrogance and utter contempt bordering on hatred for the masses that won't blindly obey them. They have no interest in protecting the population, they are just there for the power.
I think Fauci did care, a few others probably did too, but the general tone on twitter, reddit and the media was one of contempt.
I vaguely follow a (real) conservative on twitter, and she was also pretty arrogant but obviously from the other side, so this is a bipartisan issue, I think.
This thing spreads whether there is “rational decision making” or not. In Nevada we have had a mask mandate since the summer, and our numbers are worse than most states, even those that are far less restrictive. When I go out in public, I see near-100% compliance with the mandate, so “rational decision making” isn’t the issue. Perhaps it’s that masks, unless combined with highly impractical protocols that nobody would follow even if imposed (not touching/using their cell phone after touching other things, wearing disposable gloves, etc), simply aren’t that effective.
Most of the spread are private gatherings of family and friends and in places where people neither wear a mask nor socially distance.
I think a mask is meaningless walking outside on the sidewalk; if virus particles survive past six feet and through wind then we have bigger problems ; no, the mask mandate makes sense in stores, workplace hallways and bathrooms, hair salons and stuff like that.
It's complex to tell people to wear a mask in specific situations so the authorities say to wear it all the time, which feels oppressive. It's complex to tell people not to hoard things so we lied and told the public masks weren't recommended until June.
Now the gloves thing is a mystery to me. Do people not have control over their hands? The virus doesn't enter the hands, it enters the face-holes, but the hands have to be close to the face-holes to enter, where they bind to receptors in the airways. The virus-facehole transit route exists even if you wear gloves.
A few months back I saw someone sitting outside, on a park bench, mask on chin while they ate a sandwich -- with their gloves.
Yeah, it can be the case that people are dumb-dumbs AND our institutions are awful at messaging strategy.
I think it’s masks without social distancing makes the mask less effective.
Unfortunately early on it was viewed as masks or social distance, with both competing for the top spot in the prevention hierarchy.
The truth is masks help, but no where near as much as social distancing. I also think this was a misfire of harm reduction vs prevention.
Stay home, and if you have to go out wear a mask was probably the right messaging. Along with masks are not fool proof and you can still get sick, so really minimize interactions.
Funny, I thought it taught us that trust in institutions has almost completely disappeared. They've squandered it for years, and now they're bewildered that people don't trust them when they cry "wolf" anymore.
This is far from a good thing, but I believe you've got the cause, or at least blame, mostly wrong.
Interestingly, right at the beginning of the crisis trust in the CDC was really high. Then, soon after, when it was revealed that the HHS and its minions had lied to people, trust plunged.
Interesting note? Right at the beginning of the crisis Republicans trusted the CDC more than Dems.
People don't like being lied to "for their own good" or whatever. This is the Red Cross Doughnut moment. It's over for trust in public health institutions.
ah man. good luck having long-term political success with this attitude. this is the sort of insanely condescending attitude that is partially responsible for the rise of right wing demagoguery.
I was going to say this isn't black and white, but that actually understates it. It's pretty black and white. There are many things that are not approved for medical usage because using them unsafely or incorrectly could result in problematic outcomes.
That said, I didn't see any information on the sensitivity of the test. Did I miss it?
* These kinds of at-home antigen tests are more likely to accurately test positive when the person is actually infectious. Yes, they do test negative when PCR can return positive, but (according to the doctor there) the PCR can often return positive when the person is no longer infectious.
* at-home tests could easily be produced now (with some government investment) for a couple of bucks apiece (possibly even less). The low price would allow the government to send some number of these to each household and suggest that they self-test twice a week which would be enough to catch people during the actual infectious period.
Musk later took two PCR tests which we conveniently heard nothing from him afterwards, so Im just assuming it came back positive and he just shut up to save face.
30 dollars for a rapid test is still too much. It needs to be something people do daily.
Meta: The amount of shit he gets for things he supposedly didn't do that he did, and supposedly did do that he didn't, is amazing. There's a lot of good reasons to criticize him (and most other humans), but people are remarkably bad at criticizing him for those things, and remarkably bad at not criticizing him for other things. It must be very frustrating to be a celebrity.
(you might have pressed "submit" before ending your message, I think you meant:) ...a lot to expect from someone in bad faith (or charitably, irresponsible) like musk.
After stirring the pot, someone in good faith with a huge platform, would have indeed kept this tweets well organized
I'm of the opinion that Musk was write to consider that a "wtf" result - but he could have done a much better of messaging why it was such a wtf.
If a cheap test gives independently random false negative results when administered multiple times to the same human, and doesn't give independently random false positive results at an appreciable rate (which is what I've been told about that test), the test is broken for no good reason.
Whoever designed it should have designed a testing protocol where you perform the test multiple times to drive the number of false negatives down - and clearly communicated that this was possible if you were looking for accurate test results. Yes, sometimes you aren't looking for accurate individual test results, e.g. if doing statistical studies, but how these tests are being used frequently you are.
It would be in line with pregnancy tests. You can do an at home test that gets results in a few minutes, but they always tell you that if you get a positive result you still need to verify it with your doctor and a blood test.
96% sensitivity rate for people with symptoms. 91% sensitivity rate without symptoms. Given the ramp of virus replication between the time that one is asymptomatic and when one is infectious (ie hours), this sensitivity rate is excellent for an at-home test.
Imagine if such a test had been available to everyone nine months ago. The pandemic could have been effectively ended.
Interesting, this seems much better than the "lateral-flow" tests that we've started using in the UK for mass community testing. Apparantly those are only detecting about 50% of positive cases (not sure what the symptomatic/asymptomatic breakdown is).
There is a math that you have to apply with the amount infected. Like a test that is %99 accurate for a disease that only happens %0.001 of the time will have high false negative or positive rate, which is somewhat unexpected result. More detail: https://www.lesswrong.com/posts/XTXWPQSEgoMkAupKt/an-intuiti...
Testing once per week is $4 per day, which definitely adds up. But if you do this testing staggered across a population, you interrupt a whole lot of transmission chains.
Not to mention a whole lot of the $30 is the disposable bluetooth scanner. If you wanted to do this kind of antigen test repeatedly at the population level you'd make different choices.
We in the US spent something like $7000/citizen on stimulus so far though, so $30/test gets you a lot of tests if it mitigates the economic effects of the virus.
Interestingly, the Lucira test was 100% sensitive for all samples that had a PCR CT value of < 37.5 (n=45). The CT value is the number of times that the PCR test has to amplify (i.e. make copies of) the genetic material in the sample before there was enough material that it produced a positive test result. A low CT value means that there is a lot of viral RNA present; a high CT value means the opposite.
A CT value of 37.5 is exceptionally high; it corresponds to about 10 copies of virus per microliter. Someone only becomes infectious (it's believed) when the copies per microliter is in the hundreds of thousands. PS don't quote me on the precise numbers here as I am trying to remember them and it's a bit fuzzy.
On the information sheet, they say that, "Lucira achieved a 94% positive percent agreement (PPA) and a 98% negative percent agreement (NPA)."
Positive agreement is the proportion of comparative/reference method positive results in which the test method result is positive.
Negative agreement is the proportion of comparative/reference method negative results in which the test method result is negative.
The Abbot rapid test is approved for use in the US, in fact I had it done on me this morning.
It has almost entirely been purchased by the government for distribution to the appropriate settings (mostly healthcare/long term care settings).
The Abbott ID Now is not authorized for use to detect asymptomatic spread. The machine was coming to market even before COVID and was developed to be an accurate rapid test for doctors offices and other appropriate places for diseases such as influenza. https://www.medtechdive.com/news/abbott-on-defense-id-now-co...
The White House used it for that purpose anyway, it seems to have been moderately effective for a while but they ended up having 3 super spreading events because of relying exclusively on the ID Now tests (used against directions) and without masking, social distancing, or ventilation/outdoors events.
I cannot find any pricing info, but I doubt that a Bluetooth enabled at-home virus test is $30. I would image that the consumables for one test would be $30/ea.
I may be off base here, but that seems like it's a bit too expensive for a lot of people. If you could price it at a subway ride or a slice of pizza ($3 ?) that would be better.
But I doubt they are trying to churn a profit here and that it costs as much because, well, it's expensive biochem.
In Europe, I did such a fast test with results in 10 minutes, with visual reading, like in pregnancy tests, so no Bluetooth.
The cost was less than $15, so if the Ellume test is double, then $15 would be just for the Bluetooth transceiver plus maybe a surcharge for the US market, as here all medical services are more expensive.
The following *PCR Vs Rapid Antigen" 7min YouTube video [1] is the best summary of the Michael Mina $Dollar-a-Day-Lick-a-Stick strategy that I've come across.
I find it fascinating how this seemingly simple idea has been received. We have this $30 test that wraps the paper strip antigen test in a disposable digital device that communicates via Bluetooth to a smartphone app, a $5 Abbott BinaxNOW [2] that wraps the paper strip in a folding card with a QR code that requires a technician, and the home Lucira test [3] that requires a prescription and a doctor to remotely monitor its application. We seem to be regulating for the lowest common denominator: those unable to follow a set of relatively complex instructions. I understand that the outcomes are more critical than furniture from Ikea or a cake recipe but still.
There is a market for things like digital pregnancy tests because they reduce the ambiguity and user errors but it also seems unfair to prevent availability for simpler tools for people who are capable of following instructions.
It seems to come down to marketing (messaging, packaging, and positioning). The Lick-a-Stick is not "a" test but a "test regiment" analogous to say a regiment of antibiotics. A positive test should be confirmed with second rapid antigen test and then an official PCR test if possible (or serum antibody tests after recovery). I think we should also refer to the paper antigen tests as "non amplified" compared to RT-PCR and RT-LAMP. The word "rapid" can apply to both styles and confuses the matter. Non amplified tests require active viral loads which is a feature not a bug (no pun intended).
I think there is also a technical aspect. There should be standardized samples that can be used to certify the operating range of any test. Compared to the allies response in WWII, the Western world seems to have lost the ability to 1. identify problems, and 2. attempt to solve the problem. I thought that C.P. Snow's Two-Cultures [4] was behind us but now I'm not so sure.
Can we get a better link/source? This Axios "article" doesn't have any of the details that the title of this post has (specifically ~$30 or 15min).
Maybe it's just the confusing layout but the "article" under the one linked [0] does appear to have this info in it so maybe the link should be changed to that?
I really hate it when news sites do this multi-article-page nonsense. It makes it so hard to link directly to information.
You have to break through a wall so you can approach the checkout counter from the wrong direction. But once you do it the cashier will give you $30 in "change" without you ever having paid!
Only problem is when you leave you end up back in the entrance to the store, until you die.
Hahaha, and here I thought my eyes were just playing tricks on me and I didn't look closer. I even saw the "-" and initially thought the same thing but then I, wrongly, assumed it was just the font and it was a subtle "~".
The inside of a digital pregnancy test is literally an analog test with two lines plus some cheap electronics to read the line. Having a digital readout that says "positive" or "negative" makes these tests easier to interpret, which is important given the stakes involved.
I assume that pairing the test with a phone was a compromise that cuts the need to put an LCD display on the test.
I guess it’s that, and to report the data to HHS, and to gather data for anonymization and resale as permitted by HIPAA/CLIA.
I want to read the privacy policy.
Edit:
Couldn’t find the app yet, here’s language that I think confirms from FDA [0]
“ Test results from your product will be automatically reported to relevant public health authorities, via your product’s software application (app), in accordance with local, state, and federal requirements, using appropriate LOINC and SNOMED codes, as defined by the “Laboratory In Vitro Diagnostics (LIVD) Test Code Mapping for SARS-CoV-2 Tests” provided by the Centers for Disease Control and Prevention (CDC).”
Anybody know when this will be available? I heard in a Shepard Smith segment that it'd be available "by summer". Who cares by then? We need it yesterday.
Are there tests for antibodies and what company makes them? I know there is uncertainty about reinfection but if I knew I had antibodies it would give me some peace of mind (even if that's a bit misleading, and of course I would still wear a mask).
In many areas you can get antibody testing on demand. I recently had it done in NY at the same time I had a PCR test. I think more people should get it just so we can cut down on the number of people who blithely say "I had a tickle in my throat six months ago so I probably had COVID".
This is great news. The thing I can't understand is, Ellume is an Australian company and somehow, the US has approved these rapid testing kits and Australia has not. Just seems strange and backwards to me.
Too little, too late, at least for OECD countries. We're already starting to manufacture and distribute vaccines; ramping up new testing & tracing infrastructure is likely to have very little impact now[0], and would not be worth committing any public resources to. This might be helpful for countries that are going to be on the end of the vaccination list, but even for developing nations this will be much more expensive than vaccines (at least one company has promised to sell to poor nations at cost, which IIRC is $3-4 per shot).
0 - Test & trace is both more valuable early in the pandemic because you can save more lives, but also because these techniques have an upper limit on how many cases the system can handle. Once sizeable chunks of the population have the disease, no test & trace system cat possibly keep up. If we'd had this months ago, we possibly could have stopped this pandemic in its tracks.
I remember seeing lines of cars on the news for people getting tests before Thanksgiving, and every clinic in my area being out of appointments for tests.
We knew people were going to see family for Thanksgiving, and people wanted to do be safe about it, but we didn't make it easy for them. I'll call out Fauci for not sounding the alarm on this one. He's mostly been preachy about what to do and what not to do. In September, he should have been pushing for cheap rapid tests behind the scenes. In November, he should have started saying "stay home if you can, but we know you're going to want to see family, so we made it super easy to get tested."
Fauci has basically been following the sex-ed abstinence script, and it's well-documented how well that works.
Please don't take HN threads into flamewar. We're here for curious conversation. The fact that emotions are high right now makes it more important, not less, to be careful about this.
But they're not in this case because you can't force someone to take the test. I don't like this attitude from the government that people can't be trusted to be responsible adults. Same as when Fauci lied about masks to save them for healthcare workers. Let people have anonymous tests if they want, and make sure there's financial and community support for them if they do test positive, but they don't need to phone home.
I'm probably visiting family for Christmas. I'm being cautious in the weeks leading up to it, but am I getting a test? No, and only because they're too hard to get. I'm not sitting in a drive-thru line for an hour for one, not even going out of my way for one. The at-home version is what I want, but I'd like to think I can be trusted to do the right thing with the results.
> this attitude from the government that people can't be trusted to be responsible adults
Have we been in the same country these past months?
In 1918, several American cities jailed people breaking quarantine or otherwise putting public health at risk. There has been zero such enforcement this time around. Public health powers are old, precedented and powerful. They are barely being used here.
I would support anonymizing the reporting. But requiring some kind of reporting is reasonable given the circumstances. There are too many people who would test positive and hide it, and that's a public health risk.
Those who would test positive and hide it are also those who would just not get tested in the first place. The only difference is they would know, so they might change their behavior.
The fact that you're linking to news coverage featuring numbers in the... dozens makes it seem like "barely" is justifiable in the context of populations of millions.
(It's certainly arguable that outside distanced activities shouldn't be the front lines of enforcement, but once you're infected you really are a risk to not even just any individual you happen by but anyone down the chain of infection.)
> Trillions of dollars of economic damages.
And if you assume that the damages came primarily from civil actions, then I guess that'd make sense.
The reality is that there was never an option to avoid economic damages once the epidemic was uncontained. The bulk of the impacts come from the threat of the illness itself. Where most people are avoiding economic and social activities, it's not because they're forced into it, it's because they regard the personal or social risk to be significant. Lift all restrictions and only some margin of people will dive back in and even many of those will do so selectively. The major thing that civil actions do is coordinate the possibility of effective healthy mitigations.
> Millions of lives will be lost due to the prioritization of the COVID over all else.
It is true that severe covid cases take up a lot of resources in the medical system and that could cost lives, but that's an argument for mitigating measures.
> My children can’t go to school.
I might be persuaded based on enough further commentary that it's crucial that your children get influences forming their critical thinking skills from outside the home, but I certainly wouldn't assume it on the basis of a single comment.
The goalposts just moved so far we’re not even on the same field.
>> In 1918, several American cities jailed people breaking quarantine or otherwise putting public health at risk.
And in 2020, several American cities did exactly the same. The link was my citation. Aside from millions of dollars in fines, and hundreds of thousands of small businesses forced shut to the point of financial ruin, yes, people have also been arrested.
>> Public health powers are old, precedented and powerful. They are barely being used here.
Now, the question wasn’t the necessity of the response, or the appropriateness of the response or even the effectiveness of the response.
My incredulity was simply with the characterization of the magnitude of the public health response. The magnitude of the public health response is unprecedentedly and undeniably massive. To say public health powers are barely being applied is wrong, but also unfair to all those who have been directly impacted.
Your opinion that people would be fearful enough of COVID that they wouldn’t have gone out anyway is highly speculative, belied by the data, but also besides the point.
I think your concluding paragraph is entirely inappropriate and against site guidelines. I suggest you delete it. More so, it’s just in bad taste. Two weeks ago an 11 year old shot themselves on a Zoom call. It’s just one of the most grievous examples of the mental health impact of school shutdowns, but the overall mental health of school age children has been broadly effected.
> And in 2020, several American cities did exactly the same.
Did they? In 1918, people were arrested for leaving their homes without masks on, regardless of whether they were known to be infected. In 1918 San Francisco, people were shot for leaving their homes without masks. A few people being arrested in 2020 for much more serious behavior — breaking quarantine while knowingly infected with COVID — is a pretty far cry from that.
That's not to say nothing happened; obviously there were lockdowns, and private businesses were forced to close or reduce occupancy for varying amounts of time depending on the state governments. But individual private citizens were extremely lightly policed in comparison.
People were not shot for leaving their homes without masks.
People were shot (innocent bystanders, in one case) during brawls that ensued after being confronted for not wearing masks.
I don't know if anyone died from those altercations in 1918, but at least one similar event unfolded in 2020 where a 73 year old man was shot and killed by police;
Your example seems quite different from 1918. In 1918, people were shot when police started a confrontation over their refusal to wear masks. In your example, a man who refused to wear a mask also started assaulting people at a store (because he was angry that they wouldn't service him without a mask), and the police were called only once the assaults started. Then he was shot — because he was assaulting people, not because he refused to wear a mask.
If you can be trusted to do the right thing — that is, report a positive result to relevant health authorities so they can do contact tracing, and self-quarantine for the duration of your illness — then having it automatically reported for you is a useful convenience.
If you can't be trusted to do the right thing — that is, if you're not going to report your positive test result — then automatic reporting is useful for society to handle that case, too.
I'm generally against mass data collection, especially from the government. But not in this case. Hiding a positive result is ethically indefensible. Even if you're feeling fine, interacting with you while you're positive may be a death sentence for others.
> Real-time reporting through secure, HIPAA compliant cloud connection [1]
My understanding is that a major hurdle was the FDA requiring test results be reported back to health authorities. Or at least there has been a lot of disagreement on the issue [2]. It's a bit unclear if the reporting via the app is 100% mandatory but I would bet on it sending at least something indicating positive/negative by default.
I'd expect the majority of the per unit cost to be the digital test reader and Bluetooth capability. I'm skeptical if this is anything more than a fancy camera + Bluetooth like digital pregnancy tests. [3]
I'm glad we are finally getting an at home test but I can not help but think that having cheaper and simpler antigen test strips available months ago would have been a better solution.
[1] https://www.ellumehealth.com/products/consumer-products/covi...
[2] https://www.nytimes.com/2020/09/06/health/coronavirus-rapid-...
[3] https://hackaday.com/2020/09/09/digital-pregnancy-tests-use-...