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Comment by majormajor | Hacker News Reader

> The US cannot do testing and tracing because they waited too late.

"Cannot"? Why wouldn't it just require a much bigger effort?

I've been flabbergasted by the lack of wartime thinking this whole time in the US. We know how to mobilize things and build logistical supply chains, why can't we apply that to a in-country medical battle?

Not only did the US governments (at all levels) demonstrate incompetence early, we've now given up on even trying to be competent.

That bodes poorly for future events.

If you're a person who can work from home and isolate, or just someone who's not scared because you think your personal odds are good, then it burning through the rest of population faster is better than it burning through more slowly, which is the best most of the country had gotten through their restrictions. But wow... what a low standard for our country.

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This is, i think, the root of people's anger toward the police right now. The ruling class can't seem to do anything but stomp on the people they hold power over.

> "Cannot"? Why wouldn't it just require a much bigger effort?

Corona is basically endemic in the US. You can test nursing homes and airport arrivals, and do followup testing on a small population. You cannot test 320 million people, and do followup weekly testing on them.

Perhaps you're inspired by the success in NZ or Taiwan. The US has a totally different situation.

You seem to think that "doing something" is better than nothing. Again, that's false hope in this case. Herd immunity is the only logical result in this case.

But hope is not a strategy.

I would compare the US response to corona in 2020 to the English and French appeasement of Germany in the 1930's. Denial of reality resulted in the total destruction of Europe in WW2, not much different to the health and financial results of corona.

This isn't "hope" that I'm expressing. This is me saying that *if we never try, we'll never succeed, at ANYTHING, not just at this.

You're convinced hard equals impossible. Which is definitely part of why the US is so incompetent when it comes to this (or healthcare in general). People don't care that we suck.

I just find that sad and horrifying.

Let's say you take NYC, where the cases have been tailing off, and you implement a massive contract tracing effort there. MASSIVE. Maybe it doesn't save the whole country. Maybe it doesn't even prevent inbound infections from spreading very well.

But it's also a hell of a lot of practice for the next time we need to accomplish something big.

Walk back.

Look at the hapless response to Hurricane Maria. You see any difference between that and the hapless response to Covid19? I don't. Hurricane Katrina? Ditto.

Consider the need to replace the year old train tunnels that service New York. Nope can't do it.

California needs to build a high speed rail system to deal with increased commuter and air traffic? Watch people get into a rage at the idea.

The US healthcare system is completely out of control. Costs twice what other countries systems cost, with worse outcomes and large numbers of unserved people. Lots of countries have systems that work. But reform is impossible.

The underlying cause here isn't technical. It's nihilist ideology.

I and a lot of folks won’t submit to contact tracing. So it is infeasible in more ways than one.

Sorry if this seems rude, it's not meant to be, I'm genuinely curious.

I understand (and support) opposition to contact tracing by badly designed technological solutions, but what is your argument against manual contact tracing? (actually asking people one-on-one who they've been in contact with if they test positive to Covid-19)

I'm just after your reasoning. I promise I won't deride your decision in any way (and I hope others refrain from doing so as well). People react differently in extreme situations, and I try to be aware of as many different reactions as possible, and possibly try to understand the reasons for those reactions.

A substantial part of the US population will not cooperate.

Yes, but why? It may be a valid reason, but I don't know what it is.

In case you didn't see the riots last week, many US people don't trust the police. If somebody knocks on your door, how do you know what their real motive is?

Are they there for contact tracing, to serve a warrant, to tip off ICE, or to plant something?

After all, the CIA used vaccines as a ruse to hunt Bin Laden.

I don't think police does contact tracing - usually it's the civil employees of the "hygiene office".

Lack of confidence in government and authority is my guess?

Basically, the government takes way more information than it is entitled to already. And then doesn't secure it. Look up snowden leaks, opm breach, etc etc. Rereading the 4th Amendment might be helpful as background as well.

This does happen (manual contact tracing) — at least it did when I had COVID-19 in March.

Contract testing is no go in the US, herd immunity is not realistic. It’s open up as much as we can and wait for vaccine. Is not going to be good if there is a second wave.

I think South Korea, Hong king and Singapore already had second wave.

South Korea, Hong Kong and Singapore haven't even had a real first wave yet. They're at 5 deaths per million, that's nothing.

The US, by contrast, has rapidly increasing herd immunity. That's why the trend is going down despite less social distancing. And there has never been a working coronavirus vaccin, so the assumption there will be one for covid19 soon is unfounded optimism.

Trend is up for new cases and hospital beds in almost every single state that opened early. The only exception is Georgia which has been caught falsifying data more than once.

You have to torture the data pretty badly to come to that conclusion. In deaths per million those states have vastly outperformed and after the dust has settled they will still have way fewer deaths per million compared to those states where politicians panicked, issued full lockdowns, and sent covid patients to care homes.

As far as spread/death differences, population density was a clear multiplier, as would be expected. Policy effects weren’t seen in early days because there were no policy differences, just population density and global travel ones.

The rise differential now is the first good example of measurement of policy effects.

These are not political points, just data points.

What does population density mean? Number of people per household square footage? Number of people per household? Number of people per zipcode? City/rural? Population density is not a consistent predictor of covid19 spread by any of these measures, unless you also start taking other factors into account. Density matters "intuitively", but it's not borne out by the data.

> You're convinced hard equals impossible.

No I'm convinced it's pointless because herd immunity is inevitable and essentially free.

Testing somebody in the morning, then them going to the grocery store in the afternoon, is pointless.

Testing takes a significant amount of resources per test, which we don't have to do 300 million tests per week.

If you walk through the problem at this point, there is no solution for the US. Mother Nature won this time, and people like you are shouting into the wind.

Even if there was a vaccine tomorrow, there's enough anti-vaxxers that it won't be 100% applied. And it better be a free vaccine, because half the population is unemployed at this point and they're not paying $100 for non-essentials.

I've had covid. Will I be immune in 6months? 12? 18?

We don't know if herd immunity is even a thing.

So far it appears yes, you will be immune.

Forever? I've not read this anywhere yet.

"You cannot test 320 million people, and do followup weekly testing on them."

I mean, that is factually wrong. We could actually do that. It wouldn't even be that expensive. Of course, such a thing isn't really necessary. If everyone who wanted a test could get one without delay and get results back in hours, that would be sufficient to implement test and trace effectively.

Of course testing scales with the size of the country.

So do available resources. This go to argument that things that work in smaller countries don't work in the US is bizarre. It's used in all these discussions of how things that work in the EU couldn't possibly work in the US, even though the EU has a larger population.

Nobody is talking about the EU - we're talking about NZ and Taiwan.

New Zeland hasn't tested more per population size than the US or the EU. If the argument is scale the EU is a counter-example. If the argument is management there are literally dozens of countries that have managed things better than the US. NZ and Taiwan are just examples of where things were done particularly well, but there are plenty of others.

Mostly agree 100% with you, there is one caveat: you can’t restrict travel inside the USA, so it’s harder to keep things local.

For scale it clearly should scale, and there should be efficiencies you can find in bigger countries.

I suggest you watch the videos from the Seattle hospital involved with the first corona patient.

They emphasize that each test is expensive, involving PPE for the collector, the lab assistants, reagents and machine time.

Then there's the question of accuracy and retesting to verify a positive result ...

At this point in Europe we have private accredited labs doing tests for under 100€ on-site whenever there's an outbreak. Testing the entire US population once would cost ~30B$. Do it three times and spend 100B$ which would be incredible overtesting, and yet well below the other measures your congress has already passed in terms of cost.

Not enough labs, corona is too contagious to test only 3 or 4 times.

You're somehow assuming that doing things properly in the US requires a testing rate that's 1000x larger than everywhere else. I was just putting numbers to the absurd scale of testing everyone 3 times, which is far far beyond what is actually needed given examples of everywhere else.

The first corona patient is always going to be expensive. We had no testing infrastructure or really any best practices. We were unprepared in every way imaginable. Nowadays it doesn't have to be that way at all (and in fact it isn't that way). Watch videos of Korean drive through testing sites.

Did you just recently believe that herd immunity is the solution in the past month (or 2), or was it your ideal solution since January?

1) Since SF hospitalizations flatlined 2 months ago:

https://www.sccgov.org/sites/covid19/Pages/dashboard.aspx#ho...

2) Since it turned out the US can't do testing and tracing

The folks holding the power in the US don't appear to want there to be a pandemic, therefore it's just a bad flu. Out of sync with reality.

This is going to get rougher, I think.

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