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Comment by alexandercrohde | Hacker News Reader

It's inaccurate because the US is not testing people with symptoms who certainly would have been tested in other countries.

South Korea has performed over 100,000 tests. NYC has performed ~ 35. [1]

I'm really curious what possible reason there could be for that. Regardless, there is no reason to believe "tested cases" is going to give a remotely accurate picture of "actual cases."

1. https://www1.nyc.gov/site/doh/health/health-topics/coronavir...

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> I'm really curious what possible reason there could be for that.

It's right in the page you linked:

> If you are experiencing fever, cough or shortness of breath, and traveled to an area where COVID-19 is spreading, call or go to your health care provider. Your provider will work with the Health Department to determine if you need COVID-19 testing.

Right now, the city is only testing symptomatic people that have been outside the country recently to one of the five nations with widespread cases, and people in direct contact with confirmed cases in the city. It's a (possibly too) conservative rationale, but it is a rationale.

You can't realistically track "actual cases" accurately anyways. For example, people might not go to the hospital. This is a well known challenge with population estimation e.g. domestic violence numbers)

What you seem to be getting at is that a) this chart doesn't display the total number of tested cases and b) external reports of number of tested cases point to very low number of tests in the US

But that's not a reporting problem, it's a risk/cost analysis problem by the part of the responders. Yes, you could in theory test everyone in the country every two weeks, but it would arguably be very wasteful and impractical to do so, so CDC/hospitals/etc need to figure out what is the right balance as the epidemic unfolds. Whether they are doing a good job is indeed debatable, I agree.

This is just a straw man. No one is suggesting that they test everyone in the US, but at the level that epidemiologists and the WHO says is absolutely necessary to understand and respond to the spread of the disease.

That they’re not doing testing at anywhere near the necessary levels, while countries like South Korea are, is not “debatable,” but evidence of their failure.

Also your supposition about tracking actual cases is false. Singapore has significantly curbed the spread of the disease by doing extensive contract traces, testing, and quarantines.

It's not a straw man, the spectrum goes from no testing to testing everyone, and _measuring_ "actual cases" accurately (especially after community transmission stage) requires one to be on the latter end of the spectrum. I did say that it's unrealistic to go that far, and you're right that more aggressive testing will obviously lead to better visibility. My point merely was that the rationale for not ramping up testing to the wazoo could be attributed to risk/cost analysis. Incidentally, that might even explain why Singapore with a population half the size of Wuhan's would be able to respond more elastically than the US with a ~300M population and high levels of bureaucracy and government fragmentation.

Btw, I should clarify that when I said the word "debatable", I was using an euphemism.

What is this evidence of this “risk/cost analysis” you keep alluding to? Frontline staff are describing dangerous, chaotic circumstances in hospitals because testing is being delayed:

https://www.latimes.com/science/story/2020-03-06/chaos-at-ho...

If the US isn’t deploying anywhere near the response of countries with demonstrably curbed spreads in places like Seattle and California, what do you think, explicitly, justifies this? You can’t keep appealing to some greater wisdom without providing some concrete example of it.

I'm not comparing what one country is doing in relation to others. I'm saying that the CDC has their own criteria of what cases qualify for tests. They're not going just wake up one morning and say "yep let's ramp up to 300M test kits because people in the web are up in arms", that's not how it works. They look at the data they have then decide what to do. That's what risk/cost analysis is.

What you seem to be missing from my point is that things take time to do and larger bureaucratic institutions move slower. While the CDC hasn't formally stated the reasons for delays in test ramp up, it's entirely plausible that they're slow to update their analyses, recommendations and action plans because of broken telephones/bureaucracy/politics/etc. If, as the rumors go, the CDC arm needs money to make test kits but the president says "nah can't be that bad", then yeah you can bet things are gonna move very slow.

With all this said, I'm not sure why you are using the word "justify", as if the involved parties are naughty kids to be spanked. I'm not very interested in armchair judgment.

It comes down to the fact that the US is not testing enough people to make ANY sort of assessment, other than that COVID-19 exists here. In South Korea, they have tested enough of their population to make reasonable, even statistically accurate extrapolations. In the US, we may as well not be testing. It does no good at the rate we are doing it. The CDC done fucked up with their initial testing policy, which was likely chosen because they knew that the number of testing kits would bottleneck them to only testing world travellers. This was likely caused by a lack of funding and infrastructure (staff), which is quite clearly caused by our president deciding to fire the people who know how to handle pandemics.

This is almost certainly getting cause and effect backwards. That is, South Korea has been testing a large number of people because there were a large number of likely cases to test, mainly due to that one cult inadvertantly spreading the coronavirus to so many people. You can see this in the number of tests that turn out positive: it's hovering somewhere around 4% in South Korea and slowly dropping now they've got through the really likely targets, but was in the high single digits earlier. Back when the CDC was only testing the most likely cases, their number was around 3%. A lot of the media reporting on this is dubious and might lead people to believe that the US had South Korea-level numbers all along and just wasn't spotting them due to not testing, but that's unlikely.

CDC’s lackluster response is absolutely confounding. One could suspect political involvement, but I can’t see who would stand to benefit.

The market and the current administration both benefit from a low count of confirmed cases. The administration has already been criticized for repeatedly attempting to slash the CDC budget[1] and terminating the epidemic response team[2]. Trump also keeps attempting to downplay the severity of the virus so it would not be a good look if the true spread of the disease was widely known. Knowledge of the spread would also probably trigger more panic selling in the markets which the current administration also tries to avoid as much as possible.

[1]: https://abcnews.go.com/Politics/trump-cut-cdcs-budget-democr...

[2]: https://www.washingtonpost.com/news/to-your-health/wp/2018/0...

That just doesn’t make sense to me. Uncontained, this disease will grow exponentially until tens of millions are infected at once, and it eventually burns itself out. But by then, the disaster will be obvious and we will have the same result. Only with more casualties.

Certainly anyone who had that sort of ulterior motive would understand this.

Making sense is not a priority for this administration.

I predict Trump administration will underreport the numbers and use the courts to hold up transparency reports and audits until after the election.

They’re already refusing to test people, and I’m guessing they’ll start to blame the flu and/or fake news at some point.

They’ll probably somehow exceed my expectations, and come up with even more cynical tactics than this. For instance, I’ve seen users in other forums blame liberal china lovers for bringing the disease to the US. I wonder if they’re paid trolls or not.

Wasn't the CDC budget cut drastically by the current administration? You reap what you sow.

Well Congress is the ones who actually pass the budget so no?

No, the budget was not cut.

Nope this was misinformation sowed for political purposes: https://apnews.com/d36d6c4de29f4d04beda3db00cb46104

The budget proposal included cuts to it, though, and some of the response teams that were in place in the government were cut.

https://www.snopes.com/fact-check/trump-fire-pandemic-team/

And yet that's not what you insinuated. There were no cuts no matter how you characterize it-your source confirms that. Certainly no "reaping" what was "sowed".

You're responding to me, not the author of the 'reaping' comment.

I'm responding to both, the cuts you mention never took place so it's a bad faith accusation.

Maybe I'm just not reading this right, but the right column is all red. Doesn't red mean "smaller than last year"?

https://www.cdc.gov/budget/documents/fy2020/fy-2020-detail-t...

Why would you have any confidence with CDC?

Go browse through the weekly bulletins from 2003 regarding the SARS 'epidemic' in the US. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5218a2.htm

You'll read of the hundreds of 'confirmed' and 'probsble' cases and dire warnings and the like.

Then, when the dust settles and years pass, the CDC reluctantly admits the following: ------ In the United States, only eight people had laboratory evidence of SARS-CoV infection. All of these people had traveled to other parts of the world where SARS was spreading. SARS did not spread more widely in the community in the United States. https://www.cdc.gov/sars/about/fs-sars.html#outbreak ----

And China may have tested every one in Wuhan, which has almost the same population as New York.

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