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Comment by makomk | Hacker News Reader

No amount of budget-boosting would be enough to keep up with exponential growth. If they hired enough people to cope with the contact tracing load near the end of lockdown plus a little bit of an increase, and then the increase was faster than expected, that sounds like a pretty clear sign that contact tracing is not a workable solution. (Which is, as I understand it, pretty much what we'd expect. Contact tracing has not conventionally been seen as even remotely viable for a respiratory disease like this one.)

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Contact tracing has not conventionally been seen as even remotely viable for a respiratory disease like this one.

Source needed. It is, for example, what we used successfully to stop SARS from doing what COVID-19 has done.

But you have to get levels low enough first.

The US response is the worst of all worlds. We do enough to trash our economy but not enough to keep the disease from its inevitable march.

SARS is both much more deadly than COVID-19 and less infectious (in particular, people didn't seem to spread it prior to developing symptoms). Both of those things make contact tracing far more viable - the high hospitalization and death rate means that outbreaks could be detected really promptly and reliably because people turned up in hospitals with symptoms, and the fact it spread less effectively made it easy to track down the other people in the outbreak and quarantine them. On the other hand, COVID-19 is similar enough to the flu that contact tracing it should be even more futile than trying to contain the flu via contact tracing.

Also, if the things that worked successfully to stop SARS from doing what COVID-19 has done worked for it as well, then it would have been stopped just like SARS. All the western countries like the US, UK, Italy (I think), etc did SARS-style contact tracing starting really early on. It just didn't work this time around. There's not a huge amount of media coverage of this because it doesn't fit the narrative, but you should be able to find some.

They are still doing contact tracing, and even doubling down on it

to be fair, if nothing had been done, it is pretty likely that the surge of deaths would have trashed the economy just as well.

Not that I disagree that the US response has been among the worst .. and the bar is pretty low with only a handful of countries (like south korea and Taiwan) having been able to promptly adopt effective strategies.

I'll posit that political will counts double because you need everyone behind you to contact trace, both the agencies and the populace. It's not just budget.

Anecdote. An acquaintance is a disease export working for NIH near DC who also does contract tracing in the field. Sometimes their contact with the public includes death threats, refusals to cooperate, and even been spit on. They are good people trying to prevent more illness. Some of the public has been coached that the doctors are taking their jobs, closing employers, etc.

Leadership needs to get everyone behind the same spear so we can snuff this out quickly.

We're not going to snuff this out quickly regardless of whether people cooperate with contact tracers. SARS-CoV-2 will become the fifth circulating endemic coronavirus in the worldwide human population (plus some animals). Eradicating it has become effectively impossible, and not even the development of a vaccine will change that.

It's concerning to me to see this downvoted. As far as I know, almost every health official on the planet believes the virus can't be eradicated at this point, even in the countries that have kept it heavily suppressed. The long-term goal is to get it under control in the same way as tuberculosis.

Or, if we're lucky, the common cold. Harmless virus strains are usually more successful than ones that prompt their hosts to isolate themselves.

Absolutely not viable as the sole mitigation, but when rates are very low it is a useful tool in keeping them low.

Apart from all the places that are doing it successfully of course which you have for some reason ignored.

Government officials, unfortunately, have to pursue policies that work in the specific area they're responsible for. If contact tracing isn't effective in their area, they have to respond to that - it's unproductive for them to say it should in principle work based on what other governments have seen.

It’s not the physical locations that are making a difference. It’s the people and policies working together that make social distancing and contract tracing etc effective or not.

The physical location matters a lot as well. Geographical barriers like oceans and mountains do a lot to reduce transmission across borders; getting domestic cases under control won’t help much if new ones keep getting imported.

This is particularly important for metro areas that span multiple local jurisdictions: a single authority can’t do significantly better (or worse) than its neighbors, so they have to act in concert with each other. Ruling by committee is inevitably slower than by fiat, which makes it harder to handle highly dynamic situations.

Local jurisdictions within a city should have little to no control over policies in a pandemic like this. Giving them that control rather than operating at a higher level is idiotic. China was relatively successful because they sacrificed the economy of Wuhan early, but acting even sooner could have completely contained the virus and prevented the pandemic.

But you have to use the power structures that were in place pre-epidemic, and lots of them stop at arbitrary boundaries where the modern cities don’t. In the US, health policy is generally handled at the state level, but you’ve got places like the DC metro area where the city effectively spans both Federal land and parts of two states.

I am saying polices are the reason why some areas failed. Saying this is how things are done is justification for failing policies, but it doesn’t mean they actually work.

The CDC was specifically created because diseases need a nationwide response, the US simply failed.

> No amount of budget-boosting would be enough to keep up with exponential growth.

Right now it would take an atomic mushroom cloud and/or the military in the streets to keep people at home for an extended period of time. And even then we would see 3-6 weeks of exponential rise in case numbers because testing is just so far behind and you will have tons of follow-up cases.

Yeah, 161K per million and 53.2 million tests is "so far behind". You should diversify your news intake at this point.

The United States is well on track to becoming the most tested large country in the world, and its testing rate is already the highest among large countries: https://ourworldindata.org/grapher/daily-tests-per-thousand-...

This discussion thread is in response to an article called "What's the point of Covid-19 test that takes 19 days for results?" If the contents are to be believed, that seems pretty far behind to me...

The title makes it sound like a significant fraction of them are taking this long, which is simply not true. The article takes a few anecdotes and makes it sound like it's like that in every case. Then the article predictably shits on Trump, whose (verifiably true) statements that the US leads the world in testing throughput at the moment it is unable to refute with facts, so it uses the aforementioned anecdotes to make it seem like this doesn't matter, tacking on a few more anecdotes and opinions towards the end.

This is why the press is not trustworthy.

It seems that for non-proirity cases, Quest is saying that it now takes 7 days or more for results to come in. This is ~125k of the daily tests performed in the US. Of course, based on this information alone, there's no telling how other labs are doing on test result turnaround times. I will also say, for what it's worth, that personally when I was tested a few days ago it took less than 24 hours to get results, and I doubt I was a priority case. But I also didn't go to a federally funded testing site.

1.https://newsroom.questdiagnostics.com/COVIDTestingUpdates

Daily testing numbers aren't really important except as they compare to daily new cases. Countries that have already controlled the spread of Covid (many Asian nations, NZ, a lo of Europe at this point) don't need to do many tests because they have few cases. And on that metric, the US is doing worse than all of Europe and all of Asia except maybe Japan.

We sit just between Nigeria and India, but well ahead of Brazil and Mexico.

More concretely, 0.5% of the tests in Germany, the UK, and Italy are positive. For us, between 8 and 9% are positive. So to do the same level of testing per-case, we need to do 15x as many tests as we have been.

https://ourworldindata.org/grapher/covid-19-daily-tests-vs-d...

If they "aren't important", we should shut down testing. The "new cases" will drop like a rock then. /s

That was Trump's original plan, yes.

The point is that as a nation we don't get brownie points for handling the outbreak so badly that we need to do things that other nations do not.

No one but the US (or Brazil or India, perhaps) has any business having the most tests per day, and few other nations have the need for a significant number of tests per capita, because cases per capita are so low that it's not worth it.

> That was Trump's original plan, yes.

That's why I have to qualify my sarcasm with /s on this site, including my post above: the population density is too high. /s Trump sarcastically suggested it, but there never was such a "plan". Nor could there be one: the president of the United States does not have the authority to shut down (mostly private) testing.

I thought contact tracing was exactly how countries like South Korea kept their numbers so low?

It's unclear. Rates in South Korea are rising, and they've generally used somewhat broad shutdowns in addition to contact tracing. (For example, when there were positive cases found in Seoul bars, they closed all the bars in the city for weeks.)

contact tracing + massive testing.

It is unclear to me why this wasn't doable in more countries but this has been one of the very few winning strategies. (not trying to be malicious here, I admit that I don't know the logistics of large scale testing and why it wasn't applicable to more countries).

Well, that and an actually effective isolation program.

With minimal budget and used in isolation, this is what you get. It is viable when used with other (strict) measures.

it seems that it is viable up to a specific scale, and we're already past that scale.

Honestly, my imagination fails to come up with a remotely plausible math model of containment, say in CA, of further spread from the current 400K (4M after the CDC 10x multiplier with the most being unaware of being a carrier) cases in 40M population.

It’s hard to fault what you are saying - with over 2 million active cases in the US it’s a truely massive task to contemplate.

https://www.worldometers.info/coronavirus/

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