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Comment by tbenst | Hacker News Reader

Thanks for your efforts! Inspiring to see our broader community spring into action.

I was part of a volunteer team that tested 3400 people on Friday/Saturday in Santa Clara country for COVID-19 antibodies [1]. It took a team of 100+ volunteers 10 hours / day just to collect samples.

Stanford, for example, has plenty of automated testing capacity, and even reagents. IMHO, the limiting factors are not that we need new tests, but rather we need (1) lighter regulations (2) funding to buy supplies and (3) massive manpower to scale-up drive through testing

[1] https://www.stanforddaily.com/2020/04/04/stanford-researcher...

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Thank you for your efforts as well!

Sample collection and accessioning (accessioning is unpacking test tubes one by one and aliquoting them into plates in the lab) is definitely going to require a lot of manpower. I'm hopeful that patients "self swabbing" can help alleviate some of the manpower needs. (Self-swabs are not allowed currently under FDA guidance).

A self-swab surveillance program has been launched in Seattle: https://publichealthinsider.com/2020/03/23/introducing-scan-... .

Is self-swabbing allowed there because it's for research purpose, not clinical purpose? The program does tell users whether they test positive though.

My guess is that self-swabbing is allowed in the Seattle SCAN study because it is a research study. The SCAN study is super fascinating because it would be crazy unusual under normal times for a research study to return results back to patients; I'm very happy they are able to do that, and it speaks to the severity of this pandemic.

The FDA has recently made clear that no at-home self-collection tests are allowed (for now): https://www.fda.gov/medical-devices/emergency-situations-med...

> The FDA has recently made clear that no at-home self-collection tests are allowed

I think rightfully so. I was on a government video conference where a doctor showed the current CDC testing procedure, which involves stick a swab in the nose all the way to the back of the throat. They explained that the further the sample is taken from the lungs the less accurate it is.

For clarity, a 500-patient study in WA (not yet peer-reviewed) showing self-swabbing to be as effective as swabbing by health care workers has prompted FDA to allow patient to self-swab at clinics, just not at home: https://medcitynews.com/2020/03/fda-says-patients-can-self-a...

Totally false - self swabbing is likely to be pretty accurate - and given current approach of virtually no testing - a much better situation

> The SCAN study is super fascinating because it would be crazy unusual under normal times for a research study to return results back to patients; I'm very happy they are able to do that, and it speaks to the severity of this pandemic.

The Seattle Flu Study wasn't allowed to communicate back to patients but "By Feb. 25, Dr. Chu and her colleagues could not bear to wait any longer. They began performing coronavirus tests, without government approval. What came back confirmed their worst fear. They quickly had a positive test from a local teenager with no recent travel history." https://www.nytimes.com/2020/03/10/us/coronavirus-testing-de...

I'm glad to hear they're allowed to do the SCAN study!

The situation is similar in WA state, where the current bottleneck is specimen collection, as there is a shortage of swabs, vials, PPE and personnel. This results in large amount of existing lab capacity, such as at UW Virology labs, not being used. Skipping RNA extraction definitely helps with expanding lab capacity in places where that's the current bottleneck, but isn't the most pressing thing in WA.

The other bottleneck in WA is that the state's multimillion dollar, IBM-contracted data collection program can't keep up ingesting a few thousand records a day.

Yes - this has been falling over for the past week.

Yep, starting March 28 (or sooner).

That's just for public data reporting, so doesn't stop people from actually doing tests.

Just realtime analysis, which is also very important.

I find it incredible that no one has done these studies before issuing the lock down orders. Without knowing what the proportion of people who have been exposed but aren't sick any response is the wrong response.

If it turns out that it's already spread to most everybody lock downs are just a way to create more homelessness. If it turns out that the only people with the antibodies are the ones in the hospitals we need martial law.

Yes, if you google "coronavirus iceland" you'll see they've tested almost their entire population. They found 1586 confirmed cases, of whom only 6 died, which gives a fatality rate of 0.4%.

Turning this around, if we multiply confirmed deaths by 264, that gives us an estimate of how many cases there are. So, for example, with UK's death count of 6159 this means about 2.4% of the population is infected. Furthermore, on the Diamond Princess only 20% of the people onboard caught the virus under poorly quarantined conditions. So, to extrapolate even further, this would imply that over 12% of the UK population has already been exposed to SARS-CoV-2. This means that the UK should peak at about 50k deaths, without any protective measures.

In 2018, the UK had 50k deaths due to flu in excess of normal flu deaths.

https://www.telegraph.co.uk/news/2018/11/30/winter-deaths-hi...

Iceland has only tested 28,992 of its residents as April 6th, so that throws the rest of this conjecture out the window. (Although regardless the conjecture was probably not a great idea.)

https://covid.is/data

The point is Iceland has the best statistic on death rate due to comprehensive testing.

Iceland may have the best statistic on their death rate from this virus, but these things are not static and depend on a zillion factors (slight exaggeration).

It is close to the other country with a lot of testing, South Korea.

I think the real point is that your original claim was a small sample that you were extrapolating wildly from turns out to be 10x smaller than you claimed.

Furthermore you are focusing on a tiny portion of available data instead of all that is available.

Given that New York State has 4,000+ deaths your "model" would indicate that 1MM residents have COVID-19? So if it rips through the remaining 19MM residents in the course of a few weeks the result will only be 80k deaths? And of course the healthcare system won't break down?

Also you said that the Diamond Princess only had a 20% infection rate but the Greg Mortimer is reporting a 60% infection rate. Seems like you've got a lot of facts wrong on the first pass, IDK.

It seems that 'all available' would diminish the signal of Iceland's good stat. What we really want is 'all good stats'. I think only South Korea is the other country with extensive testing.

According to my model NYC should only have a max of 13.5k deaths, without any mitigation.

Based on the Greg Mortimer stat, this bumps up to 41k for NYC.

It doesn't seem to pass just a basic level of consistency with present experience to believe that with no mitigation New York would only have 13.5k deaths when they already have 5.5k+ (and we know many more that have not and maybe will never be confirmed).

Even the idea of 41k at this point beggars belief, they are already well over capacity with some mitigation and the bodies are literally piling up.

I find it hard to wrap my head around the logic here.

My thought is since this is a new virus it will spread faster, and hit peak sooner. Also, those who are most affected are a small portion of the whole population, which will again imply faster time to peak.

> I think only South Korea is the other country with extensive testing.

South Korea has tested a tiny fraction of their total population, because the testing is largely targeted via contact tracing.

It isn't about proportion of population, but whether they are only testing people already admitted at the hospital, which will drive the estimate up, or testing the wider population, driving the estimate down. SK is doing the latter through contact tracing.

Bergamo had an 0.4% of it's population die in excess of usual in March and no one believes that 100% of the population was infected. Which would put the UK at 240,000.

From your own link: "The failings contributed to the worst flu season for seven years, with 15,000 deaths from the virus, around twice the average figure, and the worst NHS performance on record."

Not 50,000.

Sorry, I misread. This doc says (look at last couple pages) the 2014/2015 and 2017/2018 seasons had over 25k deaths from flu.

https://assets.publishing.service.gov.uk/government/uploads/...

So my calculation shows cov2 is about twice as bad as a strong flu, with no preventative measures. If we hit the 20k or less with preventative measures that the Imperial model predicts, this will be on par with regular flu season.

At any rate, much less than the 200k+ deaths originally predicted by the Imperial model and that pushed the UK to lockdown.

Something to consider: https://twitter.com/ScottGottliebMD/status/12501803096032870...

These studies were done well in advance. Every bit of research we have about the 1918 Influenza points to social isolation being the only effective way to combat a pandemic.

Please provide the doi for the articles which tell us the prevalence of covid-19 in the general population.

South Korea shows that test and trace works just as good or better than lockdowns. Which is why our failure to get high testing rates early on is such an utter travesty.

South Korea does not "tell" us any of that. The government did not force a lockdown, but massive voluntary social distancing occurred anyway.

That’s not a lockdown, though. Voluntary behavior change is much better (than having to force a lockdown) if you can manage it.

Your comment, unfortunately, won’t be appreciated by lemmings until the unemployment rate is 45% and hundreds of thousands are dying from disease and starvation.

Maybe so, but please don't post unsubstantive comments here.

The lock-downs are because we don't have the tests and we don't have these studies, and still won't, for weeks or months to come. They're being run as fast as possible but there's a lot we don't know about this disease. In the meanwhile, people are getting sick and dying.

We can disagree on whether a lockdown causes the least amount of societal distress compared to some of the other options, we can argue on when we would personally chose to enact lockdown. We could even try and work out what it would take to prevent people losing their homes and dying. $2000/month UBI seems like it might help.

But seriously, doing anything at all is wrong? And the only right response is to do nothing? No ordering more PPE, no preparing for a surge, no rebalancing shifts so the contagion doesn't take out the police force/navy/healthcare workers/etc?

Saying that any possible response is wrong seems like pretending the problem will go away if we pretend it doesn't exist. Which is really hard to do while people are dying.

No response is response too. It would be incredible to done such massive studies before antibodies tests existed and organizations were able to do them on mass scale.

What they had at the time were models (which predicted asymptomatic cases) and information on how it looks like in countries that did not done measures soon enough. Even as China lied and made their numbers smaller then the were, enough was known publically and even more by secret services.

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