The US is probably a much larger vector than we realize. The testing rate is the lowest in the world and Americans travel like mad. Who knows how many undiagnosed Americans have been globe trotting over the last couple weeks?

And you have millions without basic access to healthcare, meaning they will go around untreated passing the virus along to their fellow citizens.

Also no statutory entitlement to sick pay, so many people will drag themselves into work because they can't afford to take time off.

And also unpredictable and variable (and delayed) medical bills for those who don't have great employer-provided healthcare (and even sometimes when they do).

The stories abound of a hospital visit with a magical bill that appears months later with some unpaid sum that's in the 4 digits. Everyone knows someone who this happened to - I happened to know a couple who received a 5-digit bill for a baby who died many many months later. Now, as a rational person you're not going to go to an ER willy nilly, and sometimes an ER is what you get pointed to by smaller medical centers.

The U.S. medical model doesn't work - for the group. It works - for the individual. I had superb eye surgery recently from a top world center and it was fully paid. But the viruses don't care if one of us can afford care, and the other can't, because the virus views us as a singular organism, and now we're all at risk. Which is exactly how the health system should begin viewing us.

Wait, I thought the standard refrain is American's never travel - we don't even have a passport to get aboard.

You have no idea :-(

Not really. Even though the US media has focused on the raw number of tests carried out for domestic political reasons and left a lot of people with the belief that the number of confirmed cases is basically just a function of the number of tests, Italy has been visibly struggling to test people. If you look at the percentage of tests that came out positive rather than the absolute numbers, it's obvious that Italy was only testing people who were very likely to have the disease, especially during and after the big spike in cases that got everyone's attention. It was in the very high single digits for quite a while, compared to the 3% that the CDC's old, very restrictive policy of only testing a handful of people very likely to have it There's other evidence that Italy's numbers were off too.

I'm particularly miffed about this because it seems to have spread to our shores and convinced a bunch of people that the reason the UK has lower numbers than Italy is because they're not testing people, to the point they're literally unable to believe that Italy has only tested twice as many patients for the coronavirus as the UK.

You sound correct about the hypocracy but as far as I can find out the normal tests are reported about 40-70% accurate (reports vary but my understanding is more near 40 than 70) in non-symptomatic people and around here they are thus only used and done twice if one has symptoms as even then they are not fool-proof. The test is thus pretty useless to perform on everybody as it gives too many false positives and too many false negatives to be useful to people with no symptoms. It would be a lot better though if they explained that. People here (Netherlands) are also complaining about not being tested before having symptoms or even after being admitted, as they assume the test will give them a yes/no answer which it won't.

This is incorrect. The sequence test has low false positive rate and higher false negative rate. The positive results alone are significant and informative from a policy perspective. Combined with other measurements like CT, the accuracy can be high.

CT for a virus? You can only see that something is inflamed. I mean you can guess the diagnosis, but that doesn't really increases my confidence in testing. If inflammation can be detected, you probably also have symptoms already. That aside, you should limit CTs if possible. And you won't be able to do mass scans anyway. So it is just for specific cases. MRTs could also help and are not as invasive, but maybe they don't show enough.

This Chinese paper compares the sensitivity of diagnosis with chest CT vs RT-PCR:

"In a series of 51 patients with chest CT and RT-PCR assay performed within 3 days, the sensitivity of CT for COVID-19 infection was 98% compared to RT-PCR sensitivity of 71% (p<.001)."

https://pubs.rsna.org/doi/10.1148/radiol.2020200432

Good to know about the positive rate. The media has not been very forthcoming with actual data an usually only quotes wide numbers. What I meant is that is test alone will not do the job perfectly and that is what people expect. Higher false negative rates is what bothers me as people generally think "oh I'm safe now" when that might not be the case. Considering they wait here with testing to after symptoms it would likely make the tests way more useful then to test everyone. It requires labs and those might also be stressed to a point of breaking if you start testing everyone (if that is even possible) for instance.

This is America 40 years after the neoliberal revolution.

https://www.youtube.com/watch?v=xhYJS80MgYA