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Comment by deweller | Hacker News Reader

I can only imagine that there is a large amount of requests for COVID-19 tests from hospitals across the country right now. Without some kind of guidelines, the request for tests would overwhelm the current capacity and the most likely subjects would not be identified as soon. There has to be priorities.

I expect the CDC will update their testing criteria when it makes sense.

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Italy has managed to do an order of magnitude more tests than the US, which may be part of the reason there are so many cases recorded there.

A number of non-political positions haven't been filled in teams that should have been handling the response in the US:

https://www.nbcnews.com/health/health-news/trump-cuts-nation...

And the CDC has been having problems with tests:

https://www.washingtonpost.com/health/2020/02/25/cdc-coronav...

One big reason there are so many recorded cases in Italy is that they managed to screw up and not only failed to test someone until 36 hours after the third time they sought medical care, they also failed to practice proper infection control when handling that case. So it's been spreading through their medical system like wildfire and seeding infections to other countries.

It seems that nearly all countries have screwed up their handling of this outbreak in the early stages.

But at least now they're testing, and doing so way more than the US has been doing. They deserve praise for that, and the US needs to ramp up their testing a hundred-fold!

Yeah, the first person to die in Italy was from a tiny little town that's kind of out of the way. It's not the kind of busy, international spot where you'd expect to find an initial outbreak of this kind of thing.

I used to ride my bike through it pretty much every weekend.

https://en.wikipedia.org/wiki/V%C3%B2

To give the benefit of the doubt to the CDC, it appears that the RT-PCR test has been only about 70% sensitive in China. CT scans actually exceeded the RT-PCR tests in sensitivity. Here's the latest in an informative series of videos.[1]

So, it makes sense that shotgun testing would miss a lot of cases and might not be considered worth it. However, I agree that the CDC still seems to be slow to act, especially given how people like to laud the U.S. for being so advanced. Truth is, we've let institutional decay, neglect, and politics drag us behind relative to other first world countries.

1. https://www.youtube.com/watch?v=xQwfuJgJ9lo

There aren't any meaningful criteria. The symptoms look exactly like those of the regular flu, they just have a worse distribution of outcomes which manifest long into the infection.

Just like China, the rest of the world does not have the capacity to test anywhere close to every suspected case. This is also why even good-faith stats are guaranteed to be underestimates. There are no easy answers here, individuals should look after their own wellbeing.

I think the criteria right now involves recent travel to China or being exposed to someone who was.

> CDC initially declined because the patient, who had not recently traveled to countries with outbreaks or been in contact with someone with the virus, did not meet the testing criteria.

That's a poor heuristic which has already been contradicted by a number of cases outside of china aka local spread aka the criterion which transitions this from an epidemic to a pandemic.

I'm pretty sure the criteria has since changed, the story was talking about a request from Feb 19.

You would think so, but they haven’t yet! https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-crite...

> individuals should look after their own wellbeing.

I don't understand how I'm supposed to look after my wellbeing when I'm employed and need to go to work and need to be in close contact with hundreds of people. CDC should advise businesses and should advise everyone to WFH if they can. My boss didn't even hear about this at all, think about that for a second.

Don't rely on CDC. Don't rely on external parties. You are responsible for your health not your government.

If you're in a high risk category (old, history of chronic cough, cardiovascular issues, etc) then you should consider self isolating even at the cost of your job if WFH is not an option.

As China and Korea have demonstrated, this quickly becomes a problem much larger than the authorities are resourced to handle. At that point your health is in your hands and your hands only.

My company seems to be consistently behind the edge data with regards to policy.

For instance, self isolation is still 14 days. This isn't enough. They are also restricting isolation and travel only to "affected areas of Italy" instead of all of Italy.

It boggles my mind that people say "the risk is low" and "we don't know how to contain it or where these cases are coming from" in the same presser.

14 days is still probably enough. There are scattered reports of people staying asymptomatic for longer, but they're hard to confirm (maybe you weren't actually exposed at the start) and certainly very rare. The goal of self-isolation is to severely reduce transmission, not to make it 100% impossible.

People say the risk is low because it's probably good on net if the cases are coming from everywhere; it would indicate that the visible clusters where people die a lot are anomalies, and most cases aren't that bad. The worst case scenario is that containment is impossible but it really hasn't spread widely yet.

US pneumonia rates are under very close scrutiny. There is no spike of pneumonia anywhere currently, which means there is likely no huge cluster of 1000s of people infected. That's why it's low risk as in chances of catching COVID-19 is very low. But this doesn't mean they will be able to contain it.

> US pneumonia rates are under very close scrutiny

Do you have a source for that? I know that there is a nationwide flu surveillance system run by CDC, and it has indicated that most states are at or near peak - is that what you’re referring to?

Too right! Low risk and unknown risk are very different things.

Excuse me, what the hell?

Korea has so far tested 66,652 cases. All under government supervision. Local governments are barging into churches of those damned Sincheonji cultists responsible for the outbreak, in order to obtain the list of church members. Police force is tracking down cultists who failed to respond.

Of course, not all is well, and some critics are arguing we should have blocked people coming from China, which is something only the government can do, by the way.

Seriously, Korea is a living demonstration how the government is absolutely critical in controlling an epidemic. I'm tired of this fetishization of "individual responsibility" with no basis in reality.

Can we refrain from any unfounded hate on a religious group? It's not confirmed that they have some anything malicious, and even so it does nothing to help further solving the problem.

Their comment does not seem to be particularly hateful against the religious group for it's religion, but it's behavior in hiding sick members' identities and increasing transmission rates.

It's already becoming well known that that particular church sect is linked to the start of the disease in South Korea: https://www.npr.org/sections/goatsandsoda/2020/02/24/8089147...

I think the problem is identifying the behavior as a problem characteristic of the church or sect. This seems like victim blaming to me, especially when there have been there are countless mistakes being made across nations, religions, and organizations.

An alternative framing, which I believe to be more productive, is for the entire community to take ownership. "we messed up, we need to do better"

At a time like this, we need to partisanship aside and and focus on solutions, not blame. There will be plenty of time for a post-mortem after the crisis has passed.

In normal cases I would agree: e.g., I'm very much against the xenophobia shown by some Koreans against Chinese (and now, vice versa, it seems -_-). Unfortunately, this Sincheonji cult is something special.

I'm sure they didn't intentionally contract coronavirus, but once they did, their behavior went so far into gross stupidity territory that it's hard to distinguish from malice. Even after all national news blared for several days that hundreds were infected by their mass gathering, many of these cultists are still hiding their identity, not responding to authorities, and most infuriatingly, they are still going on about with their business, spreading disease everywhere.

A few hours ago it was revealed that a worker at Daegu Airport was Sincheonji cultist, he went to the Sincheonji meeting on 2/16 and kept working between 2/17-2/21, well after the news broke out on 2/18, and now he was diagnosed positive. Some 25k people were estimated to pass through Daegu airport during these days. WTF.

That sounds like abhorrent and stupid behavior, but I'm still unclear on how it is specific to their cult. Do they not believe in viruses or something? Do we see other people in society working while ill or hiding their identities? Has this been seen in China or other locations?

I don't claim to have all the details, but worry that some group is being scapegoated while a larger problem is being ignored.

The NPR article in particular was pretty bad [1].

>Critics say the disease may have spread within the church quickly because of the way that it worships. "Shincheonji followers hold services sitting on the floor, without any chairs," packed together "like bean sprouts,"

> "A bigger problem is that they shout out 'amen' after every sentence the pastor utters, pretty much every few seconds. And they do that at the top of their lungs,"

[1] https://www.npr.org/sections/goatsandsoda/2020/02/24/8089147...

Eh, in case you misunderstood the passage, "like bean sprouts" is not some kind of racist(-ish) metaphor: it's a common Korean expression to describe a place packed with people, like rush hour subways.

I guess NPR shouldn't have used the expression literally.

I just felt the whole article was undermined by the focus on religious nonconformity. It will be interesting to see how the subject is white Protestants passing the virus at church and work. I doubt their religion will be framed as the problem.

The religious aspect also obstructs the more interesting questions of privacy

Both government and individual responsibility are critical and necessary to controlling the outbreak.

The government can not wash your hands for you, or preemptively tell if you becoming sick.

I don't see how reminding people of their individual responsibility is detrimental to a government response.

There are not enough ICU beds or even hospital beds in the country to care for the infected during a major outbreak. The quality of treatment declines exponentially during outbreaks, to the point where it's worse than just holing up at home and some OTC medicines.

Every individual is ultimately responsible for their own safety, security, and wellbeing. The government isn't a protective loving parent that will go out of its way to care for you as an individual when infra and institutions become overloaded.

Many best practices can be done in that context:

1. Wash your hands frequently

2. Especially wash your hands before eating

3. Practice not touching your face. In particular eyes, mouth, nose

4. Keep distance from people. Aim for 1.5 feet. Double that if person coughing or sneezing

5. Don’t shake hands

6. Avoid large gatherings

7. If sick, take sick days

8. Watch out for objects many touch but which are infrequently cleaned. Doorknobs, pens, elevator buttons, etc. Using your elbow or sleeve is better than your hand. Once community spread starts, wear gloves.

More here. If everyone did the above the R0 would drop.

https://foreignpolicy.com/2020/01/25/wuhan-coronavirus-safet...

One of my main concerns is food prepared or handled by people who might be sick.

I can wash my hands and certain food, but other food that I eat (like a sandwich, bread, all sorts of prepared food) can't be washed by me before I eat it.

If someone sick coughed on their hands and then made that food for me, I'm screwed.

Am unsure how much food can spread covid. But, one way to prepare is to take stock of your eating, and minimize prepared food.

Eg pack sandwiches in a lunchbox rather than buy one.

You perhaps can’t eliminate it all. But this is a risk reduction game, rather than a perfection game. Taking low impact precautions goes a long way.

One problem I suspect we'll see is that the sick people most exposed to others won't take sick days, because they don't get paid sick leave.

There are a lot of hourly workers in the service economy that don't get sick time, and they still need to pay their bills. I'm not personally worried about the people in my office since I can avoid close contact. I'm worried about the people stocking shelves at grocery stores and pharmacies, working checkout counters and the like.

It’s a real concern. But keeping your distance, washing your hands, and not touching your face will nonetheless greatly reduce risk.

Maintaining a decent (though not extreme) amount of supplies at home will also help you avoid shopping at time of greatest spread.

I say “not extreme” as hoarding can cause problems on its own. Basically just forward your own purchases a couple weeks.

These same people also are less likely to have health insurance. The US is particularly vulnerable to something like this.

great list

I'd edit the 1.5 feet to 1.5 meters

I'm also going to start refusing to handle objects handled by multiple people, such as the signature stylus in credit card checkout terminals.

door handles are also a problem

mandatory retrofit of every public door with automatic opener or at least push bar (use elbow or hip) would also help. There's a thousand things society could do (have done) to systemically reduce R0 of most everything contagious...

I originally had it at 1.5 meters, then reread the article and saw the author listed 1.5 feet.

Personally I’d staying about a meter away from people at least. Can anyone comment of 1.5 feet is fine though? I’m assuming the author knows more than me.

IDK how it translates to contraction, but from a quick Google search coughing travels 6m, sneezing travels 8m, and the droplets stay suspended for 10min.

What gloves would you recommend, that are effective but "blend in"?

When it gets to that point I think people will just use medical gloves.

Non-disposable gloves aren’t great. They’ll soon become an infection vector.

I wouldn’t worry about gloves until outbreaks happen.

Protection that looks silly is protection you will wait too long to start using, that's my philosophy anyway.

Fair enough. Anyway, disposable medical gloves are the ones you want. The article I linked has some guidelines on their use.

> 4. Keep distance from people. Aim for 1.5 feet. Double that if person coughing or sneezing

If someone is coughing or sneezing I'm going to shoot for much farther that three feet.

Maybe this will cause a number of people in the US to question our culture of "shut up and work, work, work" that encourages people to suppress humanity, vulnerability, and illness in the name of making their bosses more wealthy.

Nah.

There's more to it than that.

Poor people, who get poor health care, have poor sanitation, and are malnurished have poor immune systems as a result, and because of that become disease reservoirs.

They need to be lifted out of poverty if we are ever going to have a more healthy society as a whole and decrease the likelihood of future epidemics.

I disagree. You don't need to fix unrelated problems somewhere else to start making people's lives better today. It can be read cynically as a stalling tactic for no progress to be made.

The phenomenon I describe happens on a good day in the US, with no epidemics. Sick people go to work because their bosses don't tolerate otherwise. Sick kids go to school because their parents can't miss work to take care of them. A lot of people (not me, I am much more fortunate) cannot take any such breaks to take care of ordinary life situations because a lesser paycheck or lost job for completely legal bullshit reasons drowns them, gets them behind on tight living expenses.

These issues exist independent of coronavirus, when things are going "well".

I haven't even gotten into how these conditions feed back into stress, mental illness, other health conditions like obesity that are not aided by stress, all self re-enforcing.

If all parties wanted to fix this, we could, even without lifting those people out of poverty.

It's not unrelated. Poverty is one of the key components of why epidemics like this take hold and spread to the rest of society.

Working to eliminate poverty world-wide will go a long way to making us all healthier.

That said, I agree that people should get more sick-leave and be allowed to work from home more, if they can do their job from home, and be allowed to go home to take care of their family if they need to.

These things and lifting people out of poverty are not mutually exclusive, and improving the one will help improve the other.

Let me put it this way. In your understanding, why are people who are working constantly and cannot take breaks from work in poverty? They aren't unemployed. They are working themselves to death. Such a situation would be ridiculous in, say, the midcentury postwar boom, where working people were generally ok. Today a lot of people in that category are squeezed, overworked, overstressed, and find themselves in a very destructive cycle. You say we need to fix the "poverty" part of it, but I think perhaps a more accurate telling is that poverty is a symptom of people being exploited, undervalued, and not being paid in proportion to their contribution to the bottom line. Meanwhile executive pay and "shareholder value" metrics are doing well.

And by the way, there are plenty of middle class people who are accurately described by my statements, you don't need to be in poverty to get there.

> I don't understand how I'm supposed to look after my wellbeing when I'm employed and need to go to work and need to be in close contact with hundreds of people.

This sucks, no doubt, and you have my sincere sympathies. This is a problem that many, many people will be facing. It's a lot like any other natural disaster--there's really not much to be done but carry on as best we can.

CDC messaging is tough. It needs to be enough to get people to do what can be done (which is not a lot), but not enough to spark irrational silliness (some of which we're seeing right here).

Regarding individuals looking after their own wellbeing...

It's very hard for a healthy person to make choices that will significantly increase the chances they stay healthy, short of a massive cost.

It's much easier for a sick person to make choices that will reduce the number of people they infect. And it is easier still for society to adjust certain expectations and incentives to help sick people take those actions. For example by not requiring them to go to work(!), especially via public transportation (!!), and ensuring that this is not overly economically burdensome for them.

An "individuals should look after their own wellbeing" attitude is a "healthy people are responsible for staying healthy" attitude. It suggests not creating any incentive for people who do fall ill to do anything to prevent the spread -- too late for me, I'm already sick, not much more I can do to look after my own wellbeing than taking the rush hour subway to the emergency room, I guess, and then go straight to work so that I can afford the treatment.

When the mathematics work out such that preventative measures taken by sick people are 100x more impactful than preventative measures taken by healthy people for a given expense, why wouldn't we try to encourage those measures to reduce transmission?

It would have made sense weeks ago. They are either dangerously incompetent or intentionally pushing this under the rug to forestall panic and buy themselves time to secure PPE and supply lines for critical medical infrastructure. I tend towards the latter explanation. Having a travel requirement to Wuhan or China to obtain testing was clearly insufficient weeks ago and they've done nothing to change that.

I work in this field and I agree. In my province, we had someone call into our health advisory line and request testing as they had been "at a party with an Asian looking person that was coughing." We have to draw the line somewhere.

Sure, the line has to be drawn somewhere, but currently the line was drawn so that it denied testing a person who is already intubated for days with matching xrays - that's not the proper place to draw the line.

Intubated with ground glass opacities on xray? Probably 25-50% of patients in all ICU's around the world match that criteria. This patient had no travel history and no known sick contacts, the line was appropriate for that patient. Sure they were wrong, but in public health, you known you will be wrong sometimes. It's a balancing act.

Why is their capacity in the hundreds and not in the thousands

"I'm a businessperson, I don't like having thousands of people around when you don't need them," Trump said.

I would think “when it makes sense” would be before transmission of unknown origin, not after.

What people are looking for is an explanation as to why other countries are testing more vigorously, and the CDC so far has not.

Why not start random sampling among flu-like cases two weeks ago? Start in areas of high risk, move the circle out slowly.

Why is the CDC only managing to do orders of magnitude less testing than South Korea?

Also, let's remember that Trump recently tried to get the CDC's budget cut nearly in half.

Think about this for a second.

The US has not been taking this outbreak nearly seriously enough.

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