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Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by rubidium on Monday March 30, 2020 @05:51AM (#22726516)
Ask HN: Has any study been done doing a random sampling of a population using an antibody immunity test? It seems the natural next step given we have such a test.

Until we do that, I feel like we have no idea of the actual infection rate and population immunity.

Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by fsh on Monday March 30, 2020 @06:56AM (#22726888)
Probably the false-positive rate of antibody tests would be a big problem as long as only a small fraction of the population is infected. From what I've read, the specificity of such tests is way worse than for RNA-based tests.
Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by ImaCake on Monday March 30, 2020 @07:08AM (#22726947)
Last I checked they had a roughly 10% false positive rate. So if 1 in 1000 people were infected but you tested all 1000 with an antibody assay, you would get 100 positives, and probably one of them is actually infected. Basically useless for mass screening. The gold standard RT-PCR assay has basically zero false positives, but requires experienced personnel and expensive reagents to do en-mass.
Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by tullatulla on Monday March 30, 2020 @09:41AM (#22727914)
Pharmact lateral flow test had zero false positives among 126 negative samples as far as I can see:

https://www.nature.com/articles/d41587-020-00010-2

https://pharmact.eu/

Don't know if this would show immunity though.

Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by ImaCake on Thursday April 02, 2020 @01:20AM (#22756443)
>100% Konformitatsrate (Spezifitatsrate) fur 126 Negativkontrollen mit nicht mit SARS-CoV-2 akut oder vorher infizierten Probanden.

Heh, well that's great news. It's an antibody test so it would tell you who has had antibodies against the virus and thus who is probably immune to it.

Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by foobarian on Monday March 30, 2020 @09:40AM (#22727905)
I keep seeing news articles along the lines of "People getting reinfected" "In 5% of cases recovered patients tested positive for COVID-10 2 months later" "Asymptomatic individuals test positive for COVID anyway" Yeah very mysterious indeed :)
Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by rjsw on Monday March 30, 2020 @09:53AM (#22727993)
Why would you think that people couldn't get reinfected ?

The virus won't just bounce off your skin after one has got into you. If it is present everywhere in the environment then you will keep getting infected, maybe faster than your immune system can deal with it.

The end point to aim for in terms of immunity is that your immune system can deal with any level of viral load in the future without you becoming ill. Maybe combined with prophylactic drugs that help prevent the virus reproducing as fast within you.

Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by vikramkr on Monday March 30, 2020 @09:02AM (#22727661)
But we wouldn't pick up any of the people who are now immune right?
Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by ImaCake on Tuesday March 31, 2020 @02:39AM (#22735387)
The RTPCR will only work for those with viral RNA in them. So those with active infections. The antibody test won't work until the host produces antibodies against the virus (except for false positives). So yeah, the antibody test will detect those who are immune, or at least have antibodies against Covid-19 whereas the RT-PCR will not.
Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by xorfish on Monday March 30, 2020 @10:15AM (#22728160)
This will be important information in a few months when countries have lowered the new detected cases and the lift of harsh measures is considered. So there is still some time to get the data. At the current moment, they are not important for the decisions.

However I want to caution anyone to expect a large proportion of the population to test positive in these tests.

We know that South Korea was able to contain the spread before a significant proportion of the population was infected. A important part of the strategy was contact tracing. For contact tracing to work, you need to detect at least 1-1/R of cases. If we assume that other measures such as masks and limited social distancing pushed R down to 2 and assume they were able to trace 100% of contacts, then we still have only twice as many that are infected. If nobody of the cases that are still ongoing dies, we look at a lower bound of the IFR of 0.8%.

Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by nostrebored on Monday March 30, 2020 @10:35AM (#22728328)
How can you say this? If it's significantly more infectious than we thought, that will obviously influence public policy as the r_0 will be radically decreased
Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by xorfish on Monday March 30, 2020 @10:54AM (#22728491)
The number of people that are infected doesn't tell you that much about R0. You can get R0 from the increase in daily new deaths and the generation time between infections, given that the quality of care stays constant.

Serological tests will tell you something about the early outbreak and how many cases where not detected and how high the infected fatality ratio really is.

I have seen many people that still believe that the IFR is in the range of an average flu. With the data from South Korea, we can put a number at what we can expect the IFR to be if we make some optimistic assumptions.

That is why I say that you should not expect that serological tests show that a large part of the population already had covid19 and that the IFR is much lower than we expect. They will show where exactly the IFR is.

Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by abraxas on Tuesday March 31, 2020 @12:59AM (#22735041)
Or even the Infection Fatality Rate. The only way to stop fumbling in the dark is to get a random representative sample tested. It’s not impossible there is a dark pool of great numbers of present and past infections that are causing people to overreact .
Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by fabian2k on Monday March 30, 2020 @07:20AM (#22727026)
They're planning to do exactly that in some (probably many) countries. But the antibody tests are just being developed and might be ready in the next weeks for larger scales. But you need to do this properly to get a representative sample, which takes a bit of time.
Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by rubidium on Monday March 30, 2020 @09:10AM (#22727709)
Who is planning to do that? Any info available on that?

I understand the need for a proper study, just surprised we're not seeing more on this.

Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by Agathos on Monday March 30, 2020 @11:19AM (#22728689)
Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by evandijk70 on Monday March 30, 2020 @09:40AM (#22727904)
The Dutch blood bank, Sanquin, is currently running a study now for 10,000 blood donors, to see if the Netherlands is close to achieving 'herd immunity'
Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by phaemon on Monday March 30, 2020 @06:01AM (#22726571)
As an alternative point of view: who cares?

We know for a fact that ICUs are being overloaded with cases and morgues are overwhelmed with the dead. Arguing over exact figures is like quibbling over your exact velocity as you're falling off a cliff.

Finding some prettier numbers won't change the reality of the situation, no matter how convincingly you argue your case.

Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by vikramkr on Monday March 30, 2020 @09:06AM (#22727679)
3 blue one brown had a great video on exponential growth that detailed how a 10% difference in the numbers is the difference between being halfway there and having orders of magnitude to go.

As I'm sure you're aware, the point of the numbers isn't to change the reality of the situation, it's to understand what that reality is. And the people that care are epidemiologists and leaders with decades of experience fighting pandemic after pandemic. You know, people that know what they're talking about? Might be worth trying to spend time actually learning how the people that are spending day and night trying to save your life and the lives of your loved ones do their work before dismissing them as useless.

https://youtu.be/Kas0tIxDvrg

Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by rubidium on Monday March 30, 2020 @06:24AM (#22726688)
An alternative to your alternative: science and medicine still work. Let's try and make it better. The better we understand our situation the better we can react appropriately.

Yes, it's really bad in a few places right now. It looks like it's going to be really bad in a lot more places in the next 15-20 days. How _long_ will it be really bad for and for how _many_ people will it be really bad are important questions to understand.

Don't let the dire situation make you irrational.

Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by phaemon on Monday March 30, 2020 @06:56AM (#22726890)
I'm not being irrational; you are. I accept what I'm seeing as the reality of the situation. You appear to be looking for numbers that will tell you things are different to the observed reality. That's my point.
Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by Lewton on Monday March 30, 2020 @07:04AM (#22726933)
You don't KNOW what the reality of the situation is right now without knowing how many people are actually infected
Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by creato on Monday March 30, 2020 @08:41AM (#22727531)
If many more people are infected with mild symptoms than currently thought, that could have large implications for how long economic shutdowns need to last.
Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by easytiger on Tuesday March 31, 2020 @01:10AM (#22735076)
Well it's currently thought as many as 50% don't develop symptoms for the duration of the infection (and likely aren't necessarily a big infection risk) based on studies in Italy. 90% only very mild symptoms.
Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by rimliu on Monday March 30, 2020 @07:07AM (#22726943)
The observed reality where? Bergamo? South Korea?
Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by VBprogrammer on Monday March 30, 2020 @08:29AM (#22727451)
The situation in South Korea is clearly an outlier. Even knowing exactly the steps which have drastically slowed the growth of the virus in South Korea is about as useful as knowing last week's lottery numbers at this point.
Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by easytiger on Tuesday March 31, 2020 @01:17AM (#22735102)
It's not an outlier. Germany has even lower numbers despite doing even less than Korea.

Italy and the UK book the death of anyone who died testing positive as a covid19 death. The UK won't release any figures beyond that. Not even hospitalisation data. Studies in Italy show fewer than 15% of those deaths might be specifically caused by it.

> On re-evaluation by the National Institute of Health, only 12 per cent of death certificates have shown a direct causality from coronavirus, while 88 per cent of patients who have died have at least one pre-morbidity - many had two or three,” he says.^

In fact the average comorbiditities is 2.7. mean age of death is 79.5 years. Median 80.5.

^ https://www.telegraph.co.uk/global-health/science-and-diseas...

Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by rimliu on Monday March 30, 2020 @08:37AM (#22727503)
Taiwan, Hong Kong. You can even say that Italy is an outlier too.
Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by rimliu on Monday March 30, 2020 @06:26AM (#22726698)
Everybody should care. The most important thing, knowing the situation would enormously help with shaping up the response. If 0.0005% of the population had COVID-19 would require different actions compared to a situation where 30% had it.

Not everywhere ICUS are being overloaded and morgues are overwhelmed with the dead. And ignorance was the first reason why it happened where that's the case. So anything that could decrease the ignorance should be met with open arms.

Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by phaemon on Monday March 30, 2020 @06:52AM (#22726869)
> If 0.0005% of the population had COVID-19

That's exactly what I mean. There is no scenario where that is the case. If your numbers tell you that, your numbers are wrong.

The actions are the same regardless: shut down everything except essential services, isolate everyone as much as possible, throw as many resources as possible at your health service. Even then, they will be overwhelmed at some point.

What numbers exactly would lead you to a different course of action, based on what we have already observed?

Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by rimliu on Monday March 30, 2020 @07:06AM (#22726937)
So, you did the testing and know the true numbers? How's that?
Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by phaemon on Monday March 30, 2020 @07:16AM (#22726997)
Because if the number was 0.0005% you wouldn't see ICUs and morgues overwhelmed (why don't you calculate how many people that is for your country?)

And, again, that's my point: you're asking why it can't be a ridiculously small number when it should be obvious from the reality of the situation that it isn't!

Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by rimliu on Monday March 30, 2020 @07:38AM (#22727145)
Sorry, you make zero sense. First of all, not everywhere are ICUS and morgues overwhelmed. Some towns in Italy and Spain are hit bad, South Korea manages it without even having lockdowns.

Second, and that's my point: you can have the same result with two very different scenarios: either a lot of people have/had it but in the vast majority of the cases it goes without symptoms at all. So when a big part of the population gets infected only then you start noticing "ICUs being overwhelmed". The second scenario is: it causes serious problems for a substantial part of the infected so even the small number of those who got the virus will flood the hospitals.

And those two scenarios require different responses.

Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by acqq on Monday March 30, 2020 @11:32AM (#22728794)
There was however a perfect environment which allowed us to have an idea of percentages:

https://www.eurosurveillance.org/content/10.2807/1560-7917.E...

And the percentage of really asymptotic cases is much lower than the most here expect.

All the tests in all the countries could be seen as the statistical sampling. The speed of the transmission is also known, and surely not fundamentally different than the speed of people needing hospital or dying -- the doubling time is nowhere faster than 2 days, and the typical is 3 days.

In short, it can't be expected that "already everybody has it" in the positive sense of "nothing will happen."

Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by saalweachter on Monday March 30, 2020 @12:10PM (#22729155)
I mean, as of today, 0.018% of Italy is known to have died from COVID-19. 0.0096% of the world has tested positive so far.

So the true numbers are definitely higher than 0.0005%.

Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by rcxdude on Monday March 30, 2020 @07:41AM (#22727164)
Because it makes a hell of a lot of difference if we are seeing those numbers in the ICU when 5% of the population is infected or 50% is infected. One means the situation is going to get way way worse in the future and one means we're probably nearing the peak now.
Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by nothrabannosir on Monday March 30, 2020 @06:13AM (#22726631)
People are talking doomsday scenarios, on this very forum. Getting some hard facts would really help temper the hysteria, or allow people to prep further appropriately.

We’re planning for more than the next three days here.

Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by phaemon on Monday March 30, 2020 @08:57AM (#22727641)
Actually, I've changed my mind. I still don't think an antibody test should be a prerequisite for current action, but I think it will be very useful for deciding what to do in a few weeks.
Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by Lewton on Monday March 30, 2020 @11:40AM (#22728867)
That's the point I was trying to make (quite clumsily, I agree). I hope I didn't give the impression that I expected the numbers to prove that we are overreacting. Having a reasonable idea of how many people have been infected will help when trying to avoid a second wave of infections
Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by Lewton on Monday March 30, 2020 @06:24AM (#22726689)
If you had a random sample from two weeks ago and one from today, you think this provides zero information on how to react now?
Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by phaemon on Monday March 30, 2020 @06:54AM (#22726878)
Yes, that's what I think. The actions two weeks ago were:

Shut down everything except essential services, isolate everyone as much as possible, throw as many resources as possible at your health service. Even then, they will be overwhelmed at some point.

The same actions apply today. What's changed?

Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by Lewton on Monday March 30, 2020 @07:03AM (#22726927)
Which country are you even talking about? If you think the US is literally doing everything they can, have you looked at what the lockdown in Italy looks like?

If you have random sampling from two weeks ago and today, you might find out that you won't have to go to the same extremes as italy, or you might find out that military should have been on the streets a week ago and putting them on the streets now is a good idea

Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by phaemon on Monday March 30, 2020 @07:11AM (#22726967)
I'm talking generally about all developed countries (I know what in many developing countries a lockdown will simply be impossible).

I certainly don't think the US has done everything it can. Quite the contrary - it's no surprise to me at all that it is now top of the leaderboard in recorded cases. The US had to go to at least the extremes of Italy, and it didn't, so you'll end up with many more deaths than you would otherwise have had.

The US could just have looked at what was actually happening in Europe to establish what it needed to do. Arguing over the numbers is exactly what caused the inaction in the first place.

Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by Lewton on Monday March 30, 2020 @07:29AM (#22727090)
Ok, then let's talk Europe. Denmark has been in a early and disciplined lockdown for 3 weeks. The amount of deaths per day seem to have stabilized. The Hospitals are not overrun

When should Denmark end the lockdown?

(And if Denmark had a random sampling from two weeks ago, and one from today, would they be better positioned to know when to end the lockdown or not?)

Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by phaemon on Monday March 30, 2020 @07:41AM (#22727166)
No, that's completely wrong. Denmark only had its first death 2 weeks ago (a single death) and one the following day. Over the last 3 days, it's had 31 deaths. The number of active cases is still shooting up. It's very early days for Denmark and things will get a lot worse before it gets better. I've no idea why you think anything has stabilised there.

Look at the graphs: https://www.worldometers.info/coronavirus/country/denmark/

Is it perhaps the change in daily new cases that's thrown you? Many countries have that drop and increase again as they change the way they're testing.

Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by Lewton on Monday March 30, 2020 @07:49AM (#22727208)
... Sigh. Ok then the cases in Denmark hasn't stabilized. How in the world does that change my point?

(but number of daily deaths have been linear for a week now, I don't know why you'd think that's not stable, but you're just completely proving my point by disagreeing with how stable the situation is in Denmark, how do you ACTUALLY know that it's not?)

Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by phaemon on Monday March 30, 2020 @08:46AM (#22727574)
Number of daily deaths for the last 3 days, as I mentioned before, was 31. The 3 days before that, 18. The 3 days before that 15. That is clearly increasing.

I know it's not from the statistics. Note I don't need to know the exact percentage of asymptomatic cases for this, or to know the correct course of action. Which was my point to start with. Perhaps you lost track of it?

Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by vonmoltke on Monday March 30, 2020 @09:20AM (#22727774)
So, what is it going to be in 3 days? 6 days? 9 days? Your view on the situation is purely reactionary. Having population-level data allows public health officials to proactively take steps to mitigate the current crisis and anticipate how much surge capacity they will actually need. Right now they can't do that, because even testing of symptomatic people is bottlenecked.

Being reactionary to a crisis like this is a very bad idea and will lead to it being worse than it needs to be.

Re:Covid-19 Sanity – Covid-19 papers from bioRxiv/medRxiv se... by watwut on Monday March 30, 2020 @10:51AM (#22728462)
I think that fear that people are on fishing expedition to find any numbers that could be twisted as optimistic and then use them for politics is not reactionary paranoia. That is exactly what was and is going on last weeks.

And phaemon is completely correct in saying that US has not done everything it can. It was the opposite - spinning situation in absurdly optimistic way until it became impossible to ignore.