Showing posts with label testing. Show all posts
Showing posts with label testing. Show all posts

Monday, July 20, 2020

Scaredy Cats


President Trump recently “joked” about the best way to reduce the number of new coronavirus cases would be to reduce virus testing. There is no doubt that our testing has expanded almost ten-fold since our last pandemic peak in April. However, the number of new cases are only roughly twice what they were in April. This comparison has a wrinkle ... tests for antibodies done back then ... in two places in California and one in New York State suggested the real (asymptomatic) cases were 10 to even 40 times higher (pick 10) ... which, given our testing capability back then, our April peak could have been, in reality, as much as five times higher (10/2) than our current peak. In other words, our current “Covid spike” is a convenient fiction ... being used for political advantage.

This possible conclusion is borne out by also looking at coronavirus deaths during the same period (see:Washington Post Numbers) which are down to a third of what they were back then. Thus, new deaths are better relative to new case by a factor of 6 (down by 3 x up by 2). Now we have better virus treatments that should account for some of this difference ... but, there seems no doubt that most of the increase in new cases today can be attributed to better and more extensive testing  ... now totaling over 48 million ... the best in the world (other than China’s questionable numbers). And it should thus be the number of new deaths ... not the number of new cases ... that should be the better metric when measuring progress in combating this pandemic.

But why might Trump suggest, even in jest, that testing should be reduced? Because the Democrats and their media pals are focusing on the current fallacious “spike” in new cases to panic states into re-closing their economies and not opening their schools ... both of which would dampen Trump’s re-election chances in November.

Human nature being what it is ... if enough scaredy cats believe that President Trump’s policies are putting them at greater risk, they will be less inclined to keep him in office ... even though he might be doing what is right for our country. What is that old saw? “Perception is reality.”

STAND UP FOR AMERICA!

Sunday, July 12, 2020

Perplexed


None of this makes any sense. Looking at the latest COVID-19 statistics leaves me scratching my head. Before we go any further, please, dear reader, inspect the graphs of new cases and new deaths in the United States as per WaPo ... see: Washington Post Stastics.

You should immediately notice that we are currently living through a spike in new cases ... twice what they were in April at their height ... yet hospitalizations, ICU COVID admission and deaths are all substantially lower than at that previous peak. How can this be? There are a number of possible answers. Let me deal with new cases and new deaths separately:

New Cases
- It is certainly possible that our poor testing capacity and reliability back in April considerably undercounted the new cases. Now with more and better testing, our number of new cases are closer to reality.
- Most of the current increase in new cases are occurring in our South and Southwest. This might have something to do with American ex-patriots returning from Mexico and other Central and South American hot spots for treatment here at home.
- Yes, the economic reopening of many states has caused many more group gatherings ... which might be upping the virus spread. But then so must have been the weeks of racial protests, rioting and looting.
- Changing measurements. For some stupid reason, possibly political, the criteria for measuring new cases has become considerably more liberal ... inflating case counts. Read the following explanation of this shift from a previous blog: Fudge ... including the inbedded Conservative Treehouse hyperlink.

New Deaths
This new deaths statistic has, until most recently, showed a remarkable divergence from the number of new cases ... even after an appropriate lag of two or three weeks. This can be the result of a few factors:
- After being embarrassed by the huge number of such deaths occurring in nursing homes in New York, Pennsylvania and Massachusetts, the governors of  all the states have instituted remedial measures to correct this problem.
- Many more of the current new cases must be younger people ... who have a much lower morbidity likelihood profile.
- One cannot discount the new therapeutics that have been developed to treat COVID ... as well as the improvements coming from the medical treatment learning curve.
- Nonetheless, we are beginning to see new deaths creep up. I am at a loss to explain this ... other than the obvious result in the spike in new cases ... or a new way of classifying such deaths ... or maybe even political bias insinuating itself in. See also the following explanation found on a site displaying such data:
Criteria for reporting deaths has changed in some states and cities, and numbers in this story may fluctuate as jurisdictions adjust their counting and reporting procedures. For instance, in mid-April, New York City added more than 3,700 deaths of people who were presumed to have the coronavirus but were never tested, and New Jersey added more than 1,800 on June 25.


Sunday, May 24, 2020

Today’s Poser

L.A. Mayor Garcetti and public health officials

Is it at all possible that some local politicians and public health officials are using lockdowns and other draconian unconstitutional restrictions to cover for the fact that they are lazy and/or incapable ... and do not want to do the hard work of targeted testing, hot spot identification, effective isolation, contact tracing, virus spread analysis, medical resource allocation and effective communication?


(This is clearly the case with de Blasio in NYC.)

Thursday, May 14, 2020

Headlines


Trump deems farmworkers ‘essential’ but doesn’t make safety rules mandatory

Coronavirus live updates: Hotspots flare up in South East, grocery costs jump the most in 46 years

Virtual Dr. Fauci warns nation slow down or die ...No school in fall ...

Romney trashes USA on testing

Pelosi unveils $3 trillion coronavirus relief plan

Dr. Anthony Fauci warns Congress re-opening risks more outbreaks and backfiring on local communities

COVID-19 expert: ‘It won’t slow down until it hits 60-70% ...

No vaccine guaranteed — ever!

Testing czar predicts U.S. can conduct up to 50M coronavirus tests per month by fall

Supreme Court justices appear divided in arguments over Trump tax records

NIH chief sees likely need for multiple vaccines ...

U.N. Officials: Lockdowns could trigger global famine

Wednesday, May 13, 2020

Want vs. Need


Trump says we have the most coronavirus testing in the world and anyone who “wants” a test can get one ... whereas his medical experts say anyone who “needs” a test can get one. Of course the media Trump-haters (and they are rife) jump on these semantic differences and argue:

- Even if we are doing by far the most absolute testing globally, on a per capita basis, we are not the leaders in the world since a number of countries  ... Canada, Italy, Germany, etc. ... lead us. Both assertions are relevant but Trump is again a liar because the second assertion is not true. Isn’t this called “moving the goal posts?” We are a wide country with many areas devoid of this virus ... however, in our hot spots like New York,New Jersey and Massachusetts testing leads every country in the world ... on a per capita basis.

- Insofar as the difference between those who “want” or “need” a test. This is again an indication of the media putting Trump in a lose-lose situation. Clearly, everyone in America may want a test every other day. This creates an impossible metric that could never be met ... ever. So, there must be a filter on who gets tested ... and this is where the word “need” comes in. As far as I am concerned, when Trump says “want,” he really understands that there must be a smudged or “need” in this semantic.

Bottom line: if you can’t defeat Trump with logic, try demagogery!

Friday, May 01, 2020

Headlines


NCAA proposes letting college athletes get paid for endorsements

US GDP shrank 4.8% during the first quarter amid biggest contraction since the financial crisis

U.S. deaths 58,611 ...

Poll: Trump net approval on coronavirus response hits new low

Gilead says remdesivir data shows encouraging signs against coronavirus

Pending home sales shrank nearly 21% in March, but Realtors claim prices will hold up

Medication shortages next crisis ...

Report: FoxNews severs ties with Diamond & Silk

‘Criminal incompetence’: Outrage after de Blasio breaks up crowded Orthodox Jewish funeral

Coronavirus testing chief says ‘no way on Earth’ US can test 5 million a day

Despite McConnell comment, states can’t go bankrupt, only default ...

Iran warns U.S. Navy in the Persian Gulf: Get ready for a ‘hand slap in the face’

Thursday, April 23, 2020

Dillinger


Many coronavirus testing advocates claim that the objective of such testing should be around 1% positives ... to show that there is sufficient testing coverage. Currently, the country is running at about 18% positives ... meaning we might have to expand testing by a factor of at least 5x or even higher. Is this ambitious objective sensible ... or counter-intuitive?

Although Congress just appropriated enough money ($25 billion) to test everyone in the United States once, this still might not be enough ... particularly when many people may need to be tested repeatedly.

It would seem to this observer that giving a test to someone where the results are 99% negative is a tremendous waste of resources that should be reserved for those of a higher probability of a positive result ... those with one or more symptoms. This is particularly questionable when a person with a negative test may catch COVID-19 the very next day ... and perhaps we could save the taxpayer say $20 billion?

What did John Dillinger say? “I rob banks because that is where the money is.”

Wednesday, April 22, 2020

Obvious Truth


Congress appropriating $25 billion for coronavirus testing is obviously gross overkill. This represents about $75 per person for everyone in the United States ... man, woman, child and otherwise. If you, kind reader, don’t think that there will be gigantic graft and waste associated with this Christmas tree ornament, you would believe Nancy Pelosi doesn’t relish ice cream.

Friday, March 20, 2020

The Solution?


President Trump has not ... at least for the nonce ... criticize the CDC ... probably because he needs them to perform well dealing with  this Wuhan virus epidemic. But the early screwups there with our testing apparatus has clearly set us back in our virus battle by a least a month ... see: Propublica Story.

However, particularly by partnering with the private sector, the Trump administration has apparently squeaked through this bottleneck as testing has ramped up dramatically. And as a result, the number of cases, particularly in New York, has soared. This is not a bad thing. This is good thing for now we can isolate these infected people without totally shutting down our whole economy ... mimicking the South Korea model of dealing with this pandemic ... not the Wuhan solution of a total shutdown  ... see: Yahoo News Article.

So the Trump “15-day” solution to this problem is emerging from the fog of war. That is — suppress economic activity until we fix the CDC’s testing f-up ... and use the power of the Federal Reserve Bank and the federal purse to ease the financial pain of this slowdown. Then, as our testing and medical solutions ramp up (such as the anti-malaria drugs), isolate those identified virus cases ... which enables the reawakening of much of our economic machinery. The economic ramp-up will depend upon where in this 15-day window we can confidently say we have an arm-lock on the COVID-19 contagion.

Why hasn’t Trump fully communicated this approach? Well, for one, he can’t rely on the media to candidly report on these steps. And secondly, plenty of things can go wrong in this approach. His administration needs to be nimble under these circumstances ... and change tactics if necessary.

The COVID-19 Dilemma


The following was a carom shot from a reader which was originally composed by a director of the Foundation for Economic Education. Good stuff:

It's possible for a disease or a trauma to kill you, not by direct injury to a particular organ, but by triggering a massive non-specific over-reaction by the immune system that causes inflammation in several vital organs all at once.  Systemic Inflammatory Response Syndrome.   It seems like an apt description of what COVID-19 has done to the US economy.  

There seem to be two approaches to the government's response to the COVID-19 situation:  (i) the targeted approach where they do aggressive investigation to figure out who's sick and then quarantine those people and (ii) the brute-force approach where they say, let's not do widespread testing, let's quarantine everybody and bring the whole economy to a halt.

The first was adopted by advanced Asian countries who chose to learn the lessons of SARS and H1N1, such as South Korea, Taiwan, Hong Kong, and Singapore.  



The second approach was adopted by China and many western countries.

As best I can tell, the main reason the US has chosen the second approach is that the CDC and the FDA didn't think it was important to put local health authorities in a position to conduct widespread testing in a timely manner.

I could be wrong in some of the details, but here's the gist of what I've gotten from a news sources across the political spectrum:

(1)  Once the genetics of the virus were mapped, the WHO came up with a model formula for a test, which many countries went ahead with, but it wasn't good enough for the CDC.  US laboratories were not allowed to use their own test formulas.  Labs around the world produced over a million tests while the US produced zero.

(2)  When they finally came up with their own formula, after weeks of work, the CDC permitted laboratories to produce tests, but prohibited them from using their tests until they got approval from the FDA.  The FDA, in turn, imposed standards on the labs that included a demonstration that their tests wouldn't produce false positives for pathogens that haven't been in circulation for years, so much so that it was difficult even to obtain samples of them to run the trials.  Under intense pressure as these news stories got out, the FDA recently relented, so now they have a saner standard and will grant provisional certifications, conditioned on submitting paperwork within 15 days. 

(3)  Even if they had the test kits, labs and clinical facilities were prohibited from testing patients who didn't meet all the indicia set forth by the CDC.  The authorities in Seattle discovered their outbreak only because a lab went ahead and tested people they weren't supposed to, and without waiting for the FDA approval.  The response of the CDC and the FDA was to tell the local authorities that they should order this rogue laboratory to cease and desist.


(4)  Meanwhile, the test kits produced by the CDC had to be recalled because local health officials found that they were generating too many false positives.   (If CDC had been subject to FDA certification, they would have been rejected!)   The CDC produced a second version and distributed it, but as recently as this week, local health officials were complaining that the kits were incomplete.  "Like getting a printer with no ink."

Hence, no option to take approach #1.

My suspicion is that this kind of bureaucratic obsession with maintaining control by checking boxes is a culture that's unaffacted by occasional changes of administration in Washington.  What was the CDC doing in all the years following SARS and H1N1?   If it wasn't their job to study the lessons learned by the advanced countries in Asia from dealing with those outbreaks, you have to ask, what exactly is their job?


Flu stats:

Interesting point of view and well articulated.

One data point I feel alarming comes from a study done by some Swiss researchers, reported in last week's Economist magazine.  They looked at data from Hubei, the province in China with the worst outbreak of the virus.  Among younger people, the fatality rate was less than 1%, but for people 80+ ( a cohort with which some of us have some familiarity) the fatality rate was 18%.

I am almost certainly in the minority, but I cannot avoid wondering if we in America have lost our collective mind.  We are bankrupting numerous small businesses by forcing them to close while not imposing a rent holiday, and imperiling airlines, hotels, service industries of all types, etc., etc., because of the supposedly dire threat of the Corona virus.  Do the facts warrant this degree of disruption?
  The outbreak began in Wuhan, China, on December 29, 2019. As of yesterday, March 15, the World Health Organization reports that out of the 7 billion or so people in the world there have been 153,517 confirmed cases of Covad-19, and 5,735 deaths. 
  According to the U.S. Center for Disease Control, in this country alone there were 35.5 million cases and 34,200 deaths in the 2019-19 flu season.  For the period October 1, 2019 thru March 7, 2020, the flu statistics indicate that this season’s totals will not differ significantly from the prior season and may be a bit worse.
  There is no question that Covad-19 can easily be spread.   Of the total confirmed Covad-19 cases, almost 53% (81,048) are in China.  The city of Wuhan was put on lockdown January 23, about three weeks or so after the first case was detected, but by February 1 there were 11,821 confirmed cases in China.  On February 15, the number had increased to 50,054, and two days later the confirmed cases had jumped over 40% to 70,635.  The earlier statistical increases were because of increased testing, and the February 17 jump was because the methodology of counting confirmed cases had changed.  The totals now included not just cases confirmed by lab tests but by clinical findings at treatment centers. 
  By March 1, the confirmed cases in China had reached 79,968 but only 1,053 have since been confirmed.  The lesson is clear:  a combination of isolating known cases, and careful hygiene and normal precautions by others will check the spread of the virus. 
  The experience of South Korea is a model.  It had its first confirmed case on January 20. Increase was slow until the last weeks of February when a large church congregation became a focal point of infection, and a hospital in another area also became a major source.   South Korea responded by a massive public testing program for the virus, coupled with public tracking of the movements of infected persons and limited restrictions on travel and public gatherings in affected areas, with some school closings or delayed semester starts.  Apart from the two areas that are the major contributors to the outbreak, most of South Korea is operating normally. 
  South Korea had a bad experience with the MERS outbreak in 2015 because of a lack of test kits.   Afterwards, the country approved rapid deployment of viral test kits, and now they are able to test more than 10,000 people a day, including at drive-thru roadside sites.  It has tested over 200,000 people, up to 10,000 a day.   As a result of this extensive testing, it furnishes the best data for evaluating the risk of a fatal result of a COVID-19 infection.  With 8,236 confirmed cases, and 75 deaths, the fatality rate is 0.91%.  The attachment to this memo shows how that risk is directly related to age, a feature COVID-19 shares with the flu where 75% of deaths in the 2018-19 flu season were people 65 or older.  What the attachment does not show is how many of the fatalities were persons with major preexisting health issues.  According to US CDC data, persons with such a condition are more that four times more likely to have a fatal case that those without such a condition.
 While it appears that the death rate for COVID-19 may be higher than for the flu, although the target age cohort may be similar, I am confident it will be much lower than current US statistics show and will be closer to those of South Korea.  Until we know how many people actually get COVID-19, which will be unknown until testing is orders of magnitude greater than at present, there is no way to determine that fact accurately.
 When I look at the available facts, the damage being done to our economy and social interactions by the draconic steps now in vogue, the statistics about flu, and see that South Korea has managed to control the virus without bringing millions of its citizens to the brink of bankruptcy, and watch the Wall Street traders have a feast because of the volatility caused by the actions taken and/or contemplated, I find myself wishing for a Maggie Thatcher who could inspire – or order -- the nation to keep cool and carry on.
 Obviously the elderly, and particularly those with existing health issues, would do well to avoid mingling with the public until the danger has abated.  For others, it seems to me that normal prudence and increased vigilance against contamination by use of soap, water, disinfectants, and avoidance of too close contact with others, should keep the risk to about what it is for the flu.  At the end of the day, we would survive as would so many of those whose livelihood will go under because of the panic let loose in the land.  At the very least, the policy ought to be to increase testing as fast as possible with a public commitment to return things to normal once a certain level of testing has been achieved, with draconian limitations continuing only in demonstrated COVID-19 hot spots.
Korean Statistics:
Classification
Cases
Fatal cases
Number
(%)
Number
(%)
Rate (%)
All
8,236
(100.0)
75
(100.0)
0.91
Sex
Male
3,169
(38.48)
41
(54.67)
1.29
Female
5,067
(61.52)
34
(45.33)
0.67
Age
Above 80
270
(3.28)
25
(33.33)
9.26
70–79
531
(6.45)
28
(37.33)
5.27
60–69
1,024
(12.43)
14
(18.67)
1.37
50–59
1,585
(19.24)
6
(8.00)
0.38
40–49
1,147
(13.93)
1
(1.33)
0.09
30–39
849
(10.31)
1
(1.33)
0.12
20–29
2,313
(28.08)
0
0.0
-
10–19
432
(5.25)
0
0.0
-
0–9
85
(1.03)
0
0.0
-
Data as of 2020/03/16 00:00 KST.