It is absolutely insane that we are so limited in this capacity, months after we knew we would need it. It is so limited and dire that we are barely able to provide for our own healthcare workers.

I really hope that after this is over, we have the political strength to diagnose the problems and deal with them. However I fear that the current regime will prevent any such correction because of fear that they could blamed, and the extreme dictator-like narcissism that prevents any corrections because it would mean admitting imperfection.

> as a measure of lowering healthcare worker exposure and reducing use of limited personal protective equipment supplies.

It's not about test availability, but rather exposure of healthcare workers and use of PPE. If you're already in the hospital people will be wearing PPE if they can get it.

Now that NY has gotten to this point PPE seems to be the bottleneck.

It is absolutely about test availability.

Nations such as S. Korea are doing considerable and widespread testing and are able to protect their healthcare workers.

And S. Korea is not on lockdown and they have suppressed their outbreak.

Given that we're not going for 'herd immunity' in the short term, the only alternative is widespread testing, forced isolation and excessive testing of those with a recent history of contact of those who turn up positive.

This will take coordination, moreover, it will take fairly comprehensive testing.

I'm not sure if the USA is geared to do this. Maybe a few states, but not the others, which then creates problems.

If those $20 testing kits are available in volume, enough people will able to 'test themselves' and that will serve as a really good '1st pass filter' for the regular medical testing systems.

It is absolutely insane that we are so limited in this capacity, months after we knew we would need it.

1. According to Gov. Cuomo [0] New York is now testing more per capita than any place else including China or South Korea.

2. This comment [1] illuminates a bit the point about not getting tested by your healthcare provider.

[0] Around 11:30 https://www.ny1.com/nyc/all-boroughs/coronavirus-blog/2020/0...

[1] https://www.reddit.com/r/nyc/comments/fmb6p5/just_had_a_sobe...

We are going to need to massively scale up that testing; per capita tests is not a terribly relevant metric. The best measure is: can we test everybody who needs it?

All around the country, many (most?) people with symptoms are being denied any form of testing. We need to go beyond that to massive testing of even asymptomatic people that have come into contact with people who have tested positive.

The healthcare workers are thinking about how to best help the people under their care, with severely limited resources. And for them, testing doesn't matter unless it changes treatment. But there are other reasons to test.

What the rest of our leaders need to be thinning is how to engage a strategy to contain the broader spread and let people return to normal life, safely, as soon as possible.

South Korea has shown us one way, massive testing:

https://twitter.com/trvrb/status/1240444836982878213?s=21

https://www.reuters.com/article/us-health-coronavirus-testin...

The other ways or get there will be some sort of antiviral treatment or vaccine, but those will not be fast.

"According to Gov. Cuomo [0] New York is now testing more per capita than any place else including China or South Korea"

No - this is not accurate. Both your statement and the statement by Cuomo are not true.

As of last Wednesday, S Korea has done 295 000 people, of ~50M. [1]

As of yesterday, NY has done 45,437 tests for ~20M people.

So Cuomo's statement is looking a little Trumpish, I'm not accusing him of lying, but he's spreading false information which happens to make him look good, he needs to be more accurate.

Also - your statement misinterprets his - the NYC statement says 'any other state' - not 'any other place'. Canada is testing a little bit more widespread than NY, surely there are others.

So NYC is acting, but there's no 'cutting edge' or 'exceptional' response in America of anything right now. S. Korea, Taiwan, Singapore are looking like 'world leaders' here, granted, they have different kinds of systems entirely.

It's possible that some of their other social artifacts, such as 'basic face masks' might actually be responsible for reducing spread. Since 'lockdown' in North America the spread has continued unabated, and in S. Korea, there's no lock-down and they have it under control (though they are doing more testing as well).

There might possibly be something very specific about the spread of the virus that we don't understand, which if we were to be able to focus on, we could be more effective.

[1] https://fortune.com/2020/03/19/coronavirus-south-korea-test-...

I'm not so sure it's a huge issue. Like OP's quote says, testing wont change what you need to do to get better. You will be told to take the same actions regardless of if it's coronavirus, flu, or common cold. Even if we had unlimited tests, I would rather our medical professionals be focused on treating those who need it instead of testing those who only have mild symptoms.

> I'm not so sure it's a huge issue.

Have a read of /r/medicine, it absolutely is.

They're already making (probably split-second) choices between endangering themselves without PPE or leaving patients untreated, in countries that have a long, long road ahead.

PPE seems to be the primary equipment shortage, not ECMO/ventilators, though that's an issue too.

In NYC, PPE is running low now, ventilators will be all used in 5 days. The PPE crisis is coming first, but not by many days.

Sure, but an abundance of tests wont fix that.

We're talking about availability of PPE, not of test kits. There's a PPE shortage even without using it for more tests.

Aggressive testing earlier would have allowed people to be taken out of circulation, which would have limited its spread. That horse has left the barn, however.

Maybe. What would we have done, though? Tested everyone, even those without symptoms?

If your symptoms are mild enough to not need hospitalization, your instructions are the same regardless of if it's the coronavirus, flu, or common cold. Now they're just telling the general population to follow those instructions.

What really disappoints me is that people seem to think it's okay to ignore those instructions if it's not the coronavirus. One possible silver lining to this mess is that flu cases will probably be significantly reduced in the short term.

Actively tracing contacts and testing them would be the key thing. When one person is found to be infected, you figure out where they've been and who they've interacted with, so you can test those people. Any of those people test positive? They go into quarantine and you trace their contacts. That's how you slow and eventually break the spread. Note that contacts don't need to be symptomatic to be tested.

Instead we're effectively doing the opposite, which is testing IF AND ONLY IF you BOTH have symptoms AND can prove contact with a confirmed case. Which doesn't do much to stop transmission (it's too late at this point; you've already spread it), and certainly doesn't give an accurate picture of the prevalence or behavior of the disease.

Have any nations found success with that strategy? Could it be that we simply couldn't conduct that level of investigation fast enough at scale to be effective? And are the tests accurate enough for that approach to work?

It's my understanding that this is what South Korea, Hong Kong, and possibly Taiwan did (and are still doing). As well as China once they acknowledged the outbreak. (Which is not to condone China's methods of enforcing the quarantine.)

(EDIT: Found an article I saw the other day about this being done in an Italian town with the claim that the virus has been "eradicated" there as a consequence: https://www.theguardian.com/commentisfree/2020/mar/20/eradic...)

I'm just a lay observer of all this, not an authority. But my impression is that the U.S. could have done it effectively if a) the CDC test situation had not been borked and b) the federal govt had acknowledged the risk of epidemic (because I expect it's the CDC who has expertise in this tracing exercise, much more than state health departments).

As to whether it's too late, I honestly don't know. But it seems like it would be useful in controlling the epidemic regardless of its state.

The horse left that barn when we had a couple weeks of unknown spread in Washington state.

Yes, although it is possible to put the horse back in the barn with lockdown measures. And then IFF you have the extensive testing, those measures can be relaxed after a few weeks without cases exploding again.

So how long should it take to be able to create a reliable, sensitive and specific test , and then produce millions of such tests, for a virus which didn't exist in humans until 3-4 months ago?

A week? Two weeks tops? Once we have the viral genome sequence, which we've had for a looooong time, it's really easy to make a test.

Testing a new virus is not the difficulty! We've had all the info we needed for months, and the bottlenecks are not anything specific to SARS-COV-2. IDT, TWIST, and others can produce the specifics for this virus in no time.

What we are seeing is a massive logistical and organizational failure, driven right from the top of all of the organizations.

I dunno, how long did it take in South Korea?

South Korea and the US found their first covid positive case on the same day[0]. I can't understand how the richest nation in the world failed this hard at containing and controlling covid.

[0]https://www.reuters.com/article/us-health-coronavirus-testin...

If you look at South Korea's population, they have 1/7th the pop of the United States but yet have 1/3rd the number of deaths. They are doing almost twice as bad as the U.S. in terms of deaths per million people.

There are so many ways to slice the raw data, each giving a different sound of how alarming it is. For example, if you look at just Washington state, it has roughly the same number of deaths of South Korea, with one seventh the population.

Exactly. It’s already done. Why there isn’t more or even any public outcry regarding the US/FDA refusing to use their testing kits/system is beyond me.

For those reading who may be reminded of a recent news story - There was never any refusal of purportedly offered test kits. The WHO confirmed that there was never such an offer or even availability and that the rumor was false.

https://www.politifact.com/factchecks/2020/mar/16/joe-biden/...

I’m not sure when the WHO reported that it did not have kits to offer, though they did state that many countries develop their own kits.

It still makes sense to ask why FDA only allowed CDC to develop a test, vs allowing all extant, validated tests and/or allowing private US tests.

This is not the same story or question. This is a derailing statement and should be removed.

Looks like they were on the ball and started developing their tests way back in January, when the virus's gene was first sequenced. I haven't been able to find a detailed timeline of their test production, though: https://www.aljazeera.com/news/2020/03/south-korea-coronavir...

SK reformed their pandemic response in 2015.

They were ready long before Covid-19 showed up.

https://www.propublica.org/article/how-south-korea-scaled-co...

How were their false negatives?

(Edit: typo: just noticed I accidentally wrote false positives instead of false negatives.)

Seems not to matter much given that they were able to get their cases under control

How have they established this has been due to testing rather than something else?

Testing and tracing are core parts of both SK's and Singapore's strategies who had cases in their countries and seem to have beaten it. I don't think we'll ever be able to proof with 100% certainty that their strategies worked because and it wasn't good luck or some other unknown factor, however it seems highly likely given the same strategy is working out well on two different places.

South Korean foreign minister believes it's testing that was key: https://www.bbc.com/news/av/world-asia-51897979/coronavirus-...

Singapore was hit hard by SARS. They adjusted their strategy and are successful with COVID-19. paper: https://academic.oup.com/jtm/advance-article/doi/10.1093/jtm...

Maybe they were just lucky, but if it was my decision, I'd put my money on the strategy that worked in those two countries and minimized cost in lives and economic impact.

Thanks for the links! To be clear, I'm not suggesting they had good luck or anything like that. I'm not even saying testing would be unhelpful (obviously it'd be helpful at least in some cases). I'm trying to figure out if there's more to the story, and if the effect testing itself is really as big as people imagine. Note that in the video she says testing is important because it minimizes further spread and quickly treats those found with the virus. But, for example, I'm hearing many Americans aren't exactly heeding the shelter-at-home orders. Would testing change that? And is there no other way to already change that without testing? Or for example, I'm hearing the US is running low on masks (not sure about other supplies) which I presume would harm patients' treatment. Would testing change that in any way? And like I mentioned elsewhere, the US can't legally just collect GPS data on everyone, and if we tried to put known cases on a map for everyone to look at, I'm not sure how well it would fly here. So are these going to be bigger obstacles to tracing even if we test people? Is testing really our biggest obstacle here?

I find these “devil’s advocate” perspectives a bit trying at times - yes testing would lead people to stay at home (since we could simply post a cop outside), yes testing would reduce PPE use (we would reduce transmission before a new case ever could walk in the ER door). You don’t need GPS data to do contact tracing.

Really, there’s no excuse for the abysmal US testing regime. We’re beyond a point where contact tracing is feasible, but there is no reason we had to get to this point.

Maybe instead of looking for excuses we should look at what they have done that can be applied to the US and Europe.

That's literally what I'm asking. What else did they do besides testing? My understanding is they've been aggressively quarantining people and tracing their contacts via phone GPS tracking, credit card data, and video surveillance [1], which is what really matters. Whereas in the US, they're telling people that testing them wouldn't change the health provider's response, which would be that the patient should self-quarantine if able. Now I don't like this fact, but I don't see why they would be lying about it. And if we assume they're not lying, then testing really would seem pointless. The problem here (as far as I can tell) seems to not be the presence or lack of testing, but the inability and/or unwillingness to provide the same kind of response in the US as in South Korea.

[1] https://www.businessinsider.com/coronavirus-south-korea-spre...

I think the problem is bigger. We can't do now what SK is doing. They are tracing cases and aggressively quarantining everyone who tests positive. Obviously you cannot do that if you cannot test enough people to get a complete enough picture of the invected population. We also probably now have too many infected to make that strategy workable at this point, even if we had the tests, tracing probably would be the new bottleneck.

This great write-up suggests to shut everything down to get cases back to a manageable level and then move to the SK and Singaporean model: https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-th...

Strongly recommend the read.

I don't really think we disagree on the overall picture to be honest. I realize they're probably doing something (or I should say multiple things) right, and I realize the US has had organizational failures and such. I'm just not clear on what exactly having testing capability would let the US do that it otherwise cannot do right now, and I've yet to see a direct answer to this. If healthcare providers are saying that they'd just tell anyone who might have the disease stay home, then how does testing change the picture? Can't they do it already? Or is the idea that people would only obey this if they actually tested positive? And for tracing, can the US even use GPS etc. data the way South Korea can to trace their contacts, and invade people's privacy just like that? Would testing make that noticeably easier, compared to (I don't know, just thinking aloud) making medical providers report those that call about an illness so their contacts can be traced? etc.

I'm not so sure the tests are really the issue here. Were talking about breathing equipment for sick folks (anesthesiologists have proposed repurposing some of the equipment to aid in the shortage). We're talking about personal protective equipment, and the time/energy of the healthcare providers. At least in the case of simply having enough general use equipment for a pandemic, it's something that can be prepared for well in advance.

One Germany company managed in January https://www.bloomberg.com/news/articles/2020-03-12/a-berlin-...

It's about PPE. The time for testing was February. That ship has sailed. The disruptions to supply from Asia combined with the massive increase in demand in the US have resulted in widespread shortages of essential equipment.

If you're not sick enough to need hospitalization then don't go force somebody to waste PPE to tell you to go home and stay hydrated.

Honestly, it's amazing that we can do so much about a virus that didn't even exist 5 months ago. The tech angle of the history feels like an Start Trek episode.

I think the strategy has shifted in terms of just trying to get people tested. It's a pandemic. Now, we're just trying to figure out how make sure the health system can serve those who really need it.

https://www.latimes.com/california/story/2020-03-20/coronavi...

Are these official state tests or does that include commercial tests?

I believe the New York City Department of Health and Mental Hygiene has regulatory authority over healthcare providers within the City of New York.

Their 2020 Advisory #8 COVID-19 Update for New York City [1] directed towards healthcare providers states in the summary that "Outpatient testing must not be encouraged, promoted or advertised."

Additionally, "To preserve PPE for HCW providing medically necessary care for hospitalized patients, the NYC Health Department is directing healthcare facilities to IMMEDIATELY STOP TESTING NON-HOSPITALIZED PATIENTS FOR COVID-19 unless test results will impact the clinical management of the patient. In addition, do not test asymptomatic people, including HCWs or first responders. COVID-19 testing is only indicated for HOSPITALIZED PATIENTS."

[1] https://www1.nyc.gov/assets/doh/downloads/pdf/han/advisory/2...

Ok so that tells you how f* we are.

On the contrary, that tells us the NYC public health regulator is making logical choices in the face of systemic limitations.

F'd meaning they tested 10k people. The full impact hasn't peaked.

Thanks souterrain for the info.

On a side note, out of curiosity, would you happen to know how much the test costs in US?

Not sure, but Medicare (the U.S. federal public healthcare system which covers older patients and some others) will reimburse approximately $35 - $50 per test.

https://www.cms.gov/files/document/mac-covid-19-test-pricing...