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1) China and Korea have effectively treated the virus, infections in both those areas have been declining. And Korea now is effectively the lowest fatality rate for any of the effected countries which points to excellent surveillance and treatment. I darn well intent to keep pointing to this.

2) Some article point to the main vector in Italy being patient left in a hospital for 36 hour before being diagnosed and treated. This allowed the disease to spread in the community where testing was not being done - kind of like the US.

3) The Chinese test may indeed might have had problems at various points (your first link is rather anecdotal, hardly proves the test was a "coin flip". Other posters note your links don't back your arguments). The American test had even more problems and still hasn't ramped up to strong production. Making tests is hard, it seems. The CDC's "your test has problems and we know we can do better" attitude looks misguided in retrospect.

4) It seems like you're doing a bunch of speculation with little evidence. I suggest you look at infection and mortality as a basis for thinking about what country is doing well or badly. [1]

[1] https://covid19info.live/

> And Korea now is effectively the lowest fatality rate for any of the effected countries which points to excellent surveillance and treatment. I darn well intent to keep pointing to this.

That's misleading. Korea has the highest active case ratio of any of the hardest hit countries. The flip side of the lowest CFR coin is that Korea also has by far the lowest recovery rate of any of those countries.

You need to wait for the active cases to turn into deaths or recoveries.

From JHU CSSE:

South Korea

Confirmed: 7,382

Deaths: 50

Recovered: 118

Existing: 7,214

If you're just looking at recovery rate (also misleading), Iran seems much better than Korea:

Iran

Confirmed: 6,566

Deaths: 194

Recovered: 2,134

Existing: 4,238

I don't know what the criteria for recovery is. My impression is there isn't much of a international standard and so the inter-country comparisons aren't that useful. Iran might have a higher recovery rate but that might be more an artifact of how they measure this.

In all other measure, South Korea is doing well. Avoiding death is much unambiguous a measure.

Edit: Yes, because Korea has experienced an exponential increase in cases, most cases in Korea are "new" but this is true for most other countries - though countries where they only find cases by people dying might be different but not in a good way.

Edit2: Also, it is true that Korea's lower mortality is likely partly a product of Korea's widely testing and finding asymptomatic carriers. But this is also a good thing since it allows Korea to get these people to quarantine and lower the transmission rate, hence the declining rate of infection there.

Numbers per country in general are really hard to evaluate as there is no standard for anything.

Confirmed cases: heavily dependent on tested people. 1500 in US vs 100k in S. Korea makes the comparison useless. Also, who is tested? In Italy they started testing only symptomatic people after a while. China has changed the parameters a few times in these last weeks.

Deaths: are all deceased people tested?

Recoveries: what constitutes as a recovery? Highly variable on a per country basis.

I wonder if WHO has published some standards.

> Edit: Yes, because Korea has experienced an exponential increase in cases, most cases in Korea are "new" but this is true for most other countries - though countries where they only find cases by people dying might be different but not in a good way.

That is the whole point of my comment. There are many countries that would appear to be even better than Korea by your naive interpretation of CFR. Germany, India, Russia, Brazil, Iceland, Mexico, and many other countries have 0% CFR. That just means that like in Korea, the infected haven't had time enough to die.

Once again, "You need to wait for the active cases to turn into deaths or recoveries."

The difference is countries widely affected by the virus; Italy and Iran. They too have exponential grow of cases and would logically lots of new cases.

Sure, countries that don't enough cases shouldn't be compared but countries with an equivalent growth pattern make sense to compare. At the same time, we can look at the total outside China fetal rate and that's about 2%, which again Korea is doing notably better than. All of this is in context of most infection being new, all of it.

Sure, CFR may not be the final rate one sees but that doesn't mean it doesn't give significant information about what's happening.

The point I've been arguing is that the Korean strategy involves finding asymptomatic cases and preventing these becoming more symptomatic cases by quarantining them, getting those exposed tested and so-forth.

One possibility is this means more of those they find are not seriously ill and won't become seriously ill and this reduces the overall CFR, which can be seen in a comparison to other nations with equivalent numbers of infections. This makes sense to me but can indeed only be verified once this whole horrible scenario plays out.

> All of this is in context of most infection being new, all of it.

No. The average time to die after infection is 28 days. Korea has been testing aggressively, and 28 days ago had fewer than 50 cases, despite finding cases earlier in their development. These other countries found cases who were already infected longer. That's why they have more deaths but also why they have more recoveries. You cannot gauge effectiveness of treatment until you've given the treated time to recover or die.

> This makes sense to me but can indeed only be verified once this whole horrible scenario plays out.

This can be verified today by the lower number of recoveries.

> These other countries found cases who were already infected longer. That's why they have more deaths but also why they have more recoveries.

Yeah, and as I already noted, this situation MEANS that these other countries are failing to control the infection because they are finding infections late, which is going to mean more deaths later.

> You cannot gauge effectiveness of treatment until you've given the treated time to recover or die.

Sure, I shouldn't imply Korea does just better treatment rather than that the treatment/test combination regime of Korea seems like the superior model relative to other countries and I think have mostly said that. We can see notably that the infection rate in Korea has dropped off markedly in the last few days.

> this situation MEANS that these other countries are failing to control the infection

I never disputed that.

> Sure, I shouldn't imply Korea does just better treatment

You didn't imply that. You stated explicitly that Korea does better treatment when that statement is based on a gross misunderstanding of CFR data and said you were going to spread that misinformation. ("I darn well intent [sic] to keep pointing to this.") That's the only thing that I took issue with.

> We can see notably that the infection rate in Korea has dropped off markedly in the last few days.

That has nothing to do with fatality rate.

Fine, what I should have said for absolute clarity is:

"China and Korea have effectively dealt with the virus, infections in both those areas have been declining. And Korea now is effectively the lowest fatality rate for any of the effected countries which points to excellent surveillance and adequate treatment."

Instead of: "China and Korea have effectively treated the virus, infections in both those areas have been declining. And Korea now is effectively the lowest fatality rate for any of the effected countries which points to excellent surveillance and treatment."

But this isn't big change. Moreover, I think Korean model - ie, lots of testing - looks good in total and I think I've made clear that's what I advocate.

I would note in China's case, with infections declining everywhere, the fatality rate outside Hubei is fairly low also.

> And Korea now is effectively the lowest fatality rate for any of the effected countries which points to excellent surveillance and adequate treatment."

No, it doesn't. All it points to is that the cases are still active and have not had a chance to die. You cannot draw any other conclusions from that fatality data.

> I would note in China's case, with infections declining everywhere, the fatality rate outside Hubei is fairly low also.

For exactly the same reason. These infections are newer and have not had a chance to die. With each update, the CFR outside Hubei has increased, as expected.

> I think Korean model - ie, lots of testing - looks good in total

I agree that more testing is better. Why do you keep bringing this up? It has nothing to do with the fatality rate.

I agree that more testing is better. Why do you keep bringing this up? It has nothing to do with the fatality rate.

TL; DR; Without sufficient testing, hospitals get overwhelmed and death rate skyrockets. Is this "irrelevant".

...

My Gawd, you are the one who launched the massive detour on fatality rates. The topic of my first comment and topic of the OP was test, now like three days ago. You chimed in several posts down with the argument about immediate death rates not being final death, which I indeed didn't make my clear enough but which wasn't crucial to my point, which was and is about testing and related, about the Korean model being other countries should look to. I guess should say that Korean being at least adequate comes from my reading of press reports on Korea and not just statistical values but gruesomely technical do we want to get.

The thing is, I said from the start and I've clarified above, the fatality rate is an important proxy for how well a given country or area is doing as a combination of treatment and testing (but mostly testing). The infection rate is exponential everywhere the infection is not aggressively controlled so a high mortality rate means the country finding infection only having dying people walk in the doors of hospitals.

In that time, we've seen Italy, with a higher mortality rate spike in infections and mortality, now with 10x the death toll of Korea. And yes, as expected, the mortality rate in Korea is inching up but the infect rate is now steadily declining and it seems clear the total deaths there are going to be much less than Italy.

Yes, TESTING is my primary interest and advocating the Korean model related to that. The thing is that a look at the situation in Korea shows that the whole of society has mobilized, testing and treatment has been reorganized for the particular problems COVID presents - there are regular hospitals and COVID hospitals (or some equivalent).

> Without sufficient testing, hospitals get overwhelmed and death rate skyrockets. Is this "irrelevant".

It is irrelevant to the narrow question of whether the data show that Korea has reduced the fatality rate, which is the point being argued. Deaths from heart disease are irrelevant to the same discussion.

> My Gawd, you are the one who launched the massive detour on fatality rates.

It is not a detour. It is the single point being argued. You made an erroneous claim together with a statement that you intend to repeat it. I corrected that claim to prevent you from repeating it. When discussing that correction, it doesn't matter if you also made correct claims like that 2+2=4.

The links you posted don't back up your summary.

The "livescience" link is a confusing story which seems to be talking about the US, CDC test: Last week, the CDC had begun to ship about 200 testing kits to labs across the U.S. and 200 more to over 30 other countries so that more facilities could conduct testing for the new coronavirus.... The CDC is working closely with the states to correct the issues in the testing kits, Messonnier said.

The BBC link is about the WHO test, says no one knows what is going on but gives multiple possible explanations:

  One possible explanation is the tests are accurate and the patients do not have coronavirus at the time of testing

  Alternatively, there could be a problem with the way the tests are being conducted... There has also been some discussion about whether doctors testing the back of the throat are looking in the wrong place. 

  A final option is the RT-PCR test for the new coronavirus is based on flawed science....  if there is a poor match between the primer and the virus in the patient, then an infected patient could get a negative result.

The Propublica link is about the CDC test: The CDC designed a flawed test for COVID-19, then took weeks to figure out a fix so state and local labs could use it.

Don't use indentation for blockquotes. HN uses indentation for non-wrapped lines non-proportional font.

Use > or " or *

> One possible explanation is the tests are accurate and the patients do not have coronavirus at the time of testing

> Alternatively, there could be a problem with the way the tests are being conducted... There has also been some discussion about whether doctors testing the back of the throat are looking in the wrong place.

> A final option is the RT-PCR test for the new coronavirus is based on flawed science.... if there is a poor match between the primer and the virus in the patient, then an infected patient could get a negative result.

"Coin flip" would imply half of the people who don't have the disease will test positive. There is no evidence for that. It is a super inept analogy.

The infection is at the lung while the swabs are done to the upper respiratory tract. There will be misses no matter how good the kits are.

  The infection is at the lung while the swabs are done to the upper respiratory tract.

That's not particularly relevant, given that anal swabs are more accurate than oral swabs.

ACE2 receptors, through which the virus infects the cells, are highly expressed in parts of the lung and the digestive tract. They are not in the upper respiratory tract however. The accuracy of the swab test depends on the amount of viral material coughed up in the sputum.

The key point is in “basically” its a metaphor. The test kits have a 40% false positive and alternative test kits which may test using an entirely different method may improve this. If you think a 40% false positive is good I urge you to actually read the who guidelines which both state this information and recommend testing people multiple times over two weeks. Source is who technical guidelines for testing on their site.

A 40% false positive may be acceptable for purposes of quarantining, so long as the false negative rate is low and the percentage of healthy people being tested is relatively low. It'd be a bit like a bloom filter of quarantine. Can this person skip quarantine? Test says okay. Can this other person leave? Test says no, but that's not solid evidence that they have the disease.

It also has a large false negative, see the posts i replied to

Oh, well in that case, yeah, I agree, that's not very useful.

The key point is information (more precisely "mutual information"). A positive test gives you information that says you have it while a coin toss tells you nothing.

I’ve seen no evidence of this rate of false positives, only for false negatives (which is a problem across these tests for respiratory illnesses). What’s your source on the false positive rate?

Dismiss my claim on false positives, dont have source on that rn.

Then please edit your original comment to correct this false information.

Source is who technical guidelines for testing on their site.

I can't see any easy way to get that info from your description. Can you give an actual link?

https://www.who.int/emergencies/diseases/novel-coronavirus-2...

Start reading here: https://apps.who.int/iris/bitstream/handle/10665/330857/WHO-...

I'm not seeing any references to the accuracy or inaccuracy of the test. They mention a severe case that's negative should be re-tested and that samples from the lower respiratory tract are better.

That is the thing. This discussion started around whether the CDC should have created their test and the claim was the CDC's actions were a response to the inaccuracy of the WHO test. But part of the accuracy of any test is whether the virus in a location at all - if the virus is, say, only in a person's lungs, any test will have trouble using blood or spit.

That might be true about the accuracy of the other tests, but it's not the reason the CDC created their own. The reason, as I understand it, is simply that there was no WHO test when they started and there never would be unless some country got up off their ass and made one. As it happens Germany got their test finished first and the WHO used that, but the CDC were already well down the path of preparing and qualifying their own test for US use by that point and switching to the WHO one would mean abandoning that work and starting again.

The CDC appears to have made an over complicated test with the goal of being able to identify other SARS viruses beyond just COVID and screwed up the reagents in the process.

I’m not aware of evidence that the CDC designed primers are any better, and have read anecdotal evidence that they fail basic QA tests in open source design software used for this sort of thing.

This was compounded by bad regulations which hamstrung local labs from doing their own testing.

Are you certain this wasn't some form of NIH syndrome?

I don't think the German test was any more inaccurate BTW.

I believe they run the tests multiple times and get more accuracy from the repeated runs.