CDC declined to test new coronavirus patient for days, California hospital says

https://thehill.com/policy/healthcare/484903-cdc-declined-to-test-new-coronavirus-patient-for-days-california-hospital

by pmoriarty • 6 years ago

386 384 6 years ago

thehill.com

DonHopkins• 6 years ago

They were too busy sending their thoughts and prayers to perform any scientific evidence based tests.

derefr• 6 years ago

Are you suggesting that the people in their PR department should be doing the tests?

Or, do you think that they shouldn’t have a PR department, and be solely composed of doctors? When a large point of their organization is to talk the public into doing things for their own safety?

Without sarcasm, now: people need to stop thinking of organizations as amorphous talent pools of generalist ubermenschen, where a “trivial” task would distract one of these do-it-all people from doing an “important” task. Maybe on HN, people forget that not everything’s a startup and not everyone’s a cofounder.

Big organizations like the CDC are composed of departments; each department is a separate talent pool. The PR department making (trite) announcements is not “getting in the way” of anyone receiving a shot. Likewise, the management of an organization changing hands doesn’t usually† “get in the way” of boots-on-the-ground doing their day-to-day jobs.

† Management can explicitly interfere by introducing hindering policies. But—especially with doctors—it’s been found many times that the people doing the work will just ignore dumb executive policies if they get in the way of treating patients. This is why there’s not much point in a “private hospital” attempting to run at a profit by cutting costs: the doctors won’t cooperate, and will just treat patients the way they would in a public hospital, using all the same interventions they were taught were best-practices in med school.

8note• 6 years ago

each of those departments do take funding, and when the Republicans cut your budget in half, id hope they mostly keep the doctors and keep very few from the PR department

jefurii• 6 years ago

I think the grandparent was referring to GOP politicians who tweet their "hopes and prayers" after every mass shooting instead of doing something effective to stop the epidemic of gun violence.

ajross• 6 years ago

And we thought only China was suppressing disease counts

I see from the downvotes that everyone thinks this is just a glib cheap shot. But the point is profound: no one wants to admit to this happening. Everyone in power[1], everywhere, still thinks this is "probably not going to be a big deal". So they deliberately avoid looking for those early cases, because they're sure they're just rare outliers. And that makes the eventual outbreak inevitable.

And it's happening here too.

[1] Also a lot of people not in power, like a distressingly large cohort of posters here who seem to be taking their cues from political sources.

bluetwo• 6 years ago

"You don't want to see panic." --Trump last night.

Yep. That's called denial.

throw443422• 6 years ago

It’s fascinating how universal “saving face” is.

shakna3• 6 years ago

“Since the patient did not fit the existing CDC criteria for COVID-19, a test was not immediately administered,” the statement added. “UC Davis Health does not control the testing process.”

That seems fair enough to me - testing is currently limited, and likely under high load.

The concern, rather, is this:

Experts raised concern that the CDC's narrow testing criteria could mean that there are more cases circulating among the general public that have not been identified.

The narrowed testing criteria hasn't managed to just exclude false positives (the intent) - it is now excluding positives that need to be caught.

bilekas6• 6 years ago

testing is currently limited, and likely under high load.

How can it be high load if its not being tested ?

approx 400 tests nationwide ? If thats high load, the CDC is in for a big shock soon I think.

shakna3• 6 years ago

They've distributed around 200 test kits, that can each run 700-800 individual tests. [0]

Unfortunately, a number of these kits have turned out to be faulty, a discovery only widely noticed a few days ago. [1]

It'll take time for them to redistribute the kits.

[0] https://www.cdc.gov/media/releases/2020/p0206-coronavirus-di...

[1] https://www.washingtonpost.com/health/2020/02/25/cdc-coronav...

chapium2• 6 years ago

Roll out accurate test kits _world_wide_. There is a very high load globally.

deweller2• 6 years ago

I can only imagine that there is a large amount of requests for COVID-19 tests from hospitals across the country right now. Without some kind of guidelines, the request for tests would overwhelm the current capacity and the most likely subjects would not be identified as soon. There has to be priorities.

I expect the CDC will update their testing criteria when it makes sense.

missosoup4• 6 years ago

There aren't any meaningful criteria. The symptoms look exactly like those of the regular flu, they just have a worse distribution of outcomes which manifest long into the infection.

Just like China, the rest of the world does not have the capacity to test anywhere close to every suspected case. This is also why even good-faith stats are guaranteed to be underestimates. There are no easy answers here, individuals should look after their own wellbeing.

deweller2• 6 years ago

I think the criteria right now involves recent travel to China or being exposed to someone who was.

CDC initially declined because the patient, who had not recently traveled to countries with outbreaks or been in contact with someone with the virus, did not meet the testing criteria.

gnulinux4• 6 years ago

individuals should look after their own wellbeing.

I don't understand how I'm supposed to look after my wellbeing when I'm employed and need to go to work and need to be in close contact with hundreds of people. CDC should advise businesses and should advise everyone to WFH if they can. My boss didn't even hear about this at all, think about that for a second.

jbay808• 6 years ago

Regarding individuals looking after their own wellbeing...

It's very hard for a healthy person to make choices that will significantly increase the chances they stay healthy, short of a massive cost.

It's much easier for a sick person to make choices that will reduce the number of people they infect. And it is easier still for society to adjust certain expectations and incentives to help sick people take those actions. For example by not requiring them to go to work(!), especially via public transportation (!!), and ensuring that this is not overly economically burdensome for them.

An "individuals should look after their own wellbeing" attitude is a "healthy people are responsible for staying healthy" attitude. It suggests not creating any incentive for people who do fall ill to do anything to prevent the spread -- too late for me, I'm already sick, not much more I can do to look after my own wellbeing than taking the rush hour subway to the emergency room, I guess, and then go straight to work so that I can afford the treatment.

When the mathematics work out such that preventative measures taken by sick people are 100x more impactful than preventative measures taken by healthy people for a given expense, why wouldn't we try to encourage those measures to reduce transmission?

Leary• 6 years ago

Why is their capacity in the hundreds and not in the thousands

mattkrause• 6 years ago

"I'm a businessperson, I don't like having thousands of people around when you don't need them," Trump said.

jboggan• 6 years ago

It would have made sense weeks ago. They are either dangerously incompetent or intentionally pushing this under the rug to forestall panic and buy themselves time to secure PPE and supply lines for critical medical infrastructure. I tend towards the latter explanation. Having a travel requirement to Wuhan or China to obtain testing was clearly insufficient weeks ago and they've done nothing to change that.

giarc2• 6 years ago

I work in this field and I agree. In my province, we had someone call into our health advisory line and request testing as they had been "at a party with an Asian looking person that was coughing." We have to draw the line somewhere.

PeterisP• 6 years ago

Sure, the line has to be drawn somewhere, but currently the line was drawn so that it denied testing a person who is already intubated for days with matching xrays - that's not the proper place to draw the line.

pmoriarty12• 6 years ago

Why is the CDC only managing to do orders of magnitude less testing than South Korea?

Also, let's remember that Trump recently tried to get the CDC's budget cut nearly in half.

Think about this for a second.

The US has not been taking this outbreak nearly seriously enough.

davidw3• 6 years ago

Italy has managed to do an order of magnitude more tests than the US, which may be part of the reason there are so many cases recorded there.

A number of non-political positions haven't been filled in teams that should have been handling the response in the US:

https://www.nbcnews.com/health/health-news/trump-cuts-nation...

And the CDC has been having problems with tests:

https://www.washingtonpost.com/health/2020/02/25/cdc-coronav...

makomk4• 6 years ago

One big reason there are so many recorded cases in Italy is that they managed to screw up and not only failed to test someone until 36 hours after the third time they sought medical care, they also failed to practice proper infection control when handling that case. So it's been spreading through their medical system like wildfire and seeding infections to other countries.

notabee• 6 years ago

To give the benefit of the doubt to the CDC, it appears that the RT-PCR test has been only about 70% sensitive in China. CT scans actually exceeded the RT-PCR tests in sensitivity. Here's the latest in an informative series of videos.[1]

So, it makes sense that shotgun testing would miss a lot of cases and might not be considered worth it. However, I agree that the CDC still seems to be slow to act, especially given how people like to laud the U.S. for being so advanced. Truth is, we've let institutional decay, neglect, and politics drag us behind relative to other first world countries.

1. https://www.youtube.com/watch?v=xQwfuJgJ9lo

gdubs4• 6 years ago

I would think “when it makes sense” would be before transmission of unknown origin, not after.

What people are looking for is an explanation as to why other countries are testing more vigorously, and the CDC so far has not.

Why not start random sampling among flu-like cases two weeks ago? Start in areas of high risk, move the circle out slowly.

pmoriarty12• 6 years ago

South Korea tested more people for COVID-19 in one day than all the testing the CDC has done to date.

DyslexicAtheist2• 6 years ago

+4000 tests within a couple of hours in which they identified another 70 cases: https://twitter.com/DrEricDing/status/1231972534612119557

US total tests so far: 445 (source: https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html)

jbattle• 6 years ago

The numbers on that page are over a month old

* This table represents cases detected and tested in the United States through U.S. public health surveillance systems since January 21, 2020.

refurb2• 6 years ago

The Centers for Disease Control and Prevention (CDC) initially declined to test a California patient for coronavirus because of narrow testing criteria, delaying the identification of a new possibly pivotal case, according to officials at the hospital treating the patient.

Seems pretty reasonable to me.

There are limited resources for doing the Corona virus test. If the CDC tested everyone who got a fever, they'd have a massive backlog.

The risk is reasonable if any suspected case is quarantined.

godtoldmetodoit• 6 years ago

Current capacity is 500 tests a day from what I've read. That seems awfully low to me, other countries are testing thousands with a much lower population.

We need to get these tests rolling out in larger numbers ASAP.

chabes• 6 years ago

Why would other countries have enough resources for testing while the US does not?

jmull2• 6 years ago

If the CDC tested everyone who got a fever, they'd have a massive backlog.

The problem with that argument is that's not what anyone was asking for. The patient went through an extensive triage before doctors identified a significant risk of coronavirus and requested a test. The CDC overrode that judgement.

Note that amount of CDC resources directed toward coronavirus so far is minuscule, so we should be no where near their capacity to respond.

In the face of a burgeoning pandemic where there are many cases with uncertain origins, it doesn't make sense to override the medical judgement of the doctors on the ground because the case has an uncertain origin.

refurb2• 6 years ago

The point is, the CDC came up with guidelines on when it’s appropriate to test a patient and this patient didn’t qualify until 4 days later.

That shouldn’t surprise anyone that they do this.

bilekas6• 6 years ago

What the hell is wrong with the CDC right now ?

[s]It just seems to be ran like a startup or something. Jesus.[/s]

How can more people not be outraged by the govmnt lack of readiness?

tristanj3• 6 years ago

The Trump admin fired much of the CDC pandemic response team in 2018 to cut costs. https://www.snopes.com/fact-check/trump-fire-pandemic-team/

In 2018, the Trump administration fired the government’s entire pandemic response chain of command, including the White House management infrastructure. https://foreignpolicy.com/2020/01/31/coronavirus-china-trump...

CDC to cut by 80 percent efforts to prevent global disease outbreak (2018): https://www.washingtonpost.com/news/to-your-health/wp/2018/0...

creaghpatr3• 6 years ago

This is partisan misinformation: https://apnews.com/d36d6c4de29f4d04beda3db00cb46104

alistairSH7• 6 years ago

Typical GOP play - Defund the programs in question until they can no longer function, use that as proof that government is inept, defund further. Repeat until program/agency/government collapses, then privatize the whole thing at great personal profit.

creaghpatr3• 6 years ago

This is misinformation https://apnews.com/d36d6c4de29f4d04beda3db00cb46104

Brain_Thief• 6 years ago

The problem is that the American public elected a reality television show host who can barely string a coherent sentence together as president. Since expertise, honesty, and competence represent direct threats to the administration (e.g., decorated military whistleblowers, career foreign service workers, etc.), the administration has steadily removed such people from critical positions in an attempt to stifle internal resistance to its behavior. A side effect of this type of purging is that we now have a reduced capacity to respond to complex geopolitical and natural threats. Hopefully the hard reality of a pandemic shakes some folks out of the propaganda bubble before too much damage is done.

ouid• 6 years ago

Confirmation bias is a stronger effect than that.

m-i-l• 6 years ago

Is there any particular reason the US is testing so few people? They've only tested 445 people in the entire country so far[0], which is a tiny number for such a large country (contrast e.g. with the much smaller UK which has tested 7,690 people[1])? Wasn't that one of the lessons from Italy - the numbers of confirmed cases seemed to shoot up from 21 Feb mainly because that's when they started testing.

[0] https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html

[1] https://www.gov.uk/guidance/coronavirus-covid-19-information...

alttab2• 6 years ago

There's no reason to test if there aren't any confirmed cases. You can't confirm a case unless you test...

And thus, how we find it now is bursting clusters with illnesses that can't be hidden by "flu." By then it's too late.

Seems like the only way to contain it is do blanket nationwide testing every day and quickly contain anyone who tests positive, for like 6 months.

claudeganon3• 6 years ago

This isn’t true. Containing the spread through mass testing would allow us to more appropriately measure the response and direct resources accordingly. Every epidemiologist I’ve read says the lack of testing is a very concerning in terms of our ability to address and respond to the pandemic.

ryanmercer4• 6 years ago

There's no reason to test if there aren't any confirmed cases.

There's no reason to test when there isn't a high confidence that the person has the virus. Especially when the test costs something north of $3,000 and even with good insurance only a fraction of it is being paid for based on numerous Reddit threads and a news article [0] puts a specific patient's bill at:

$3,270 two weeks after his test. He will be responsible for $1,400 of that bill.

A Forbes article [1] two weeks ago even states:

The cost of testing include the costs of test kits, labor, and sample processing. In some cases, storage and delivery costs would need to be added. It’s unclear what the costs of the test kits are, or ancillary items, as CDC and others haven’t revealed figures. For the sake of argument, let’s say that on the low end of the scale each test, including ancillary items such as labor and sample processing, costs $250, and at the high end it’s $1,500.

[0] https://www.independent.co.uk/news/world/americas/coronaviru...

[1] https://www.forbes.com/sites/joshuacohen/2020/02/12/testing-...

Bombthecat2• 6 years ago

That's why it will keep spreading... Dammed is you do, Dammed if you don't..

claudeganon3• 6 years ago

We messed up a bunch of the first ones and we don’t really have centralized capacity to manufacture the tests at scale because of our privatized, outsourced healthcare system, we’re being prevented from using overseas ones (the senator from Hawaii is publicly begging Japan for tests), the CDC and other responsible agencies are in disarray from GOP gutting and malfeasance.

Take your pick.

devinhelton• 6 years ago

The test-kit that the CDC sent to local labs had a faulty reagent, so all test requests have to be sent back to the CDC.[0]

Local labs could develop or purchase their own test kits, but during an a public health emergency, they must get FDA authorization before launching such a test.[1]

This seems to me like a giant institutional and bureaucratic screw up.

Hopefully the FDA may be finally getting its act together and fast-tracking approval of local tests: https://twitter.com/ScottGottliebMD/status/12330216819181936...

[0] https://www.politico.com/news/2020/02/20/cdc-coronavirus-116...

[1] https://threadreaderapp.com/thread/1231944326827081729.html

Reelin10• 6 years ago

In all seriousness, why should a non-invasive diagnostic test require any sort of approval (particularly during an outbreak)? This is just RT-PCR if I understand correctly - there's nothing particularly novel going on here. Just publish the primer sequences and let the biotech industry handle things.

Edit: Oh hey they did publish an RT-PCR protocol [1] plus sequences, [2] along with a disclaimer not to use them directly on human subjects. This is just silly (IMO).

These procedures and/or reagents derived thereof are intended to be used for the purposes of respiratory virus surveillance and research. The procedures and reagents derived thereof may not be used directly in human subjects.

[1] https://www.cdc.gov/coronavirus/2019-ncov/lab/rt-pcr-detecti...

[2] https://www.cdc.gov/coronavirus/2019-ncov/lab/rt-pcr-panel-p...

tozeur• 6 years ago

Reagent

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gojomo• 6 years ago

There's a bureaucratic 'Catch-22' in each regulatory agency's rules for allowing emergency testing, & apparently no one willing to exercise the authority to break the logjam. See for example the unwound details in this thread (which is reporting roughly the same things as Dr. Gottlieb, just without the diplomatic mollycoddling of his former agency):

https://twitter.com/random_eddie/status/1232075474966368256

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epmaybe• 6 years ago

A counterpoint - testing like this takes resources, and creates a backlog for other more pressing tests for patients. I mentioned this in another comment, but if I have a patient with pneumonia, I'm more than likely going to treat it the same way regardless of what the test shows me. Getting samples from everyone takes resources that lots of hospitals don't really have.

Maybe you could get a backlog going that can test for COVID-19, when the lab's RT-PCR machines are underutilized, even after the patient leaves, so that we can get as much data as we can.

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jerry19792• 6 years ago

How do we know that testing for Coronavirus creates a backlog? I don't have enough information to say how the system works, but I imagine a nurse takes an additional blood test, and then someone sends that test to the CDC. The CDC tests the blood, and sends a response to the hospital.

I am curious to know more about the actual process.

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gnulinux4• 6 years ago

But wouldn't you need to isolate pneumonia patient if they confirmed to have COVID-19? Also, curious, would you be more inclined to use some of the medicine that other countries claimed to be effective against COVID-19? Like Remdesivir and chloroquine?

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MiguelVieira• 6 years ago

The latest word from the CDC is that they’ve run 3,625 tests and that the testing capacity should double soon.

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makomk4• 6 years ago

Yeah, I think the actual answer is that the number of tests on that page is not even remotely up to date, and the CDC has more important issues on its plate than updating it. As I understand it the UK testing criteria are very similar to the CDC's and also require travel to an affected country or contact with a confirmed case: https://www.gov.uk/government/publications/wuhan-novel-coron... The government here is just starting to roll out more general testing of the population to selected cities, but so is the CDC over in the US, and in both cases it's intended more to detect widespread spreading than to catch every individual case.

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btilly• 6 years ago

Yes. The tests are sufficiently unreliable that if there is no specific reason to believe that a particular person has been exposed, the results are just noise.

See https://towardsdatascience.com/statistics-and-unreliable-tes... for an analysis using Bayesian statistics that demonstrates why you would pre-filter who you give the test to, and why you shouldn't necessarily trust the test results after.

Please remember that public health organizations have over 150 years of experience with how to make the most effective use of existing resources to limit health challenges. This is a complicated optimization problem and the people doing it aren't stupid. It is better to ask why they do what they do than to assume that what they are doing makes no sense.

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xorfish• 6 years ago

The problem in such cases is the prior. If a false positive is 10%, 1%, 0.1% or 0.01% makes a huge difference. With 0.01% and two different tests, you will get a false positive in every 100'000'000 tests. Testing twice solves many of the issues. It also gives information about the sensitivity and specificity of a test.

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wonderwonder• 6 years ago

If tested I have to assume the patient will be charged for it, which depending on their insurance could easily be a cost of thousands of dollars if they are in a hospital or ER. We are going to experience a situation where sick people don't get tested and continue to infect others because health care is too expensive. The cost of health care is very much going to exacerbate this situation.

Administration officials just refused to commit to making a tax payer funded vaccine affordable.

This is what end game capitalism in health care looks like.

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bilekas6• 6 years ago

I've heard there are budget cuts being done, they've completely gutted the staff of the CDC.

Morons in charge seems to be a leading factor.

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bluGill2• 6 years ago

It is an election year. One says says Trump cut needless dead weight and there is still plenty of staff. The other side is going to play this crisis and call it a gutting.

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aaomidi• 6 years ago

Are you seriously arguing the cuts to CDCs budget is not needless?

Stop making politics a spectator sport. There's lives on the fucking line.

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bilekas6• 6 years ago

The other side is going to play this crisis

I would prefer to have more people looking into this than less.. The idea of err on the side of caution really does apply right now.

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jethro_tell3• 6 years ago

There's no sides here, and the particular reason for failure doesn't matter. This is a disease that will kill people. Letting people go untested out into the wild is not going to help.

People fuck up, that's what people do, leaders catch and acknowledge failure early and try to fix it. Unfortunately, at this point, people will die that didn't have to. And that's going to be because:

1. Tons of people weren't tested that should have been.

2. People can't afford to get a test because of the health insurance situation in this country.

Aggressive no cost testing would help, I'm sure trump is going to announce that here any minute for a problem that he doesn't think is real.

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blattimwind2• 6 years ago

Seeing global medical emergencies as a bipartisan battle for political capital has to be rooted in a truly fascinating world view.

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josephorjoe2• 6 years ago

I guess we'll find out how susceptible viruses are to propaganda, political spin, and troll farms...

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bilekas6• 6 years ago

Will it matter ? There will just be a barrage of BS about how the numbers are fake news, and how the media is being dramatic.

We've seen this all before and it's become so predictable.

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dragonwriter6• 6 years ago

In addition to the CDC, the National Security Council position addressing global pandemic preparation and response was cut. Not to mention the whole of the national policy and especially the national security and foreign relations apparatus being the subject of multiple rounds of political, vanity-driven purges that have driven out expertise in favor of toadying.

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magduf9• 6 years ago

I don't really see the problem here. If the government has cut all the staff needed to respond effectively to a pandemic threat, causing the pandemic to be far, far worse than it would have been otherwise, this is just a case of the voting public getting exactly what they voted for. As a wise Frenchman once wrote, "every nation gets the government it deserves". This should be a lesson to voters in every democratic country about the dangers of electing incompetents to run your nation's government.

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gdubs4• 6 years ago

There was a fairly in depth FP article back in January about cuts to the pandemic response budget, as well as the elimination of the pandemic czar / team that was created in response to the last Ebola outbreak:

https://foreignpolicy.com/2020/01/31/coronavirus-china-trump...

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randomfool• 6 years ago

STEIN: You’ve consistently called for enormous cuts to the CDC… Does this experience at all give you pause?
TRUMP: No…I’m a business person, I don’t like having thousands of people around when you don’t need them…we can get ‘em back really quickly.

https://twitter.com/ddiamond/status/1232829064194469893

This is not the correct approach for an organization responsible for early warnings and preparation.

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api• 6 years ago

Imagine the outcry if he applied that logic to the military. Just shut down the DOD. We can always raise a citizens' militia if anything bad happens.

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jacquesm7• 6 years ago

That's what you get when you put TV personalities that get off on the words 'you're fired' in charge of critical institutions.

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makomk4• 6 years ago

Apparently, that's partisan misinformation: https://apnews.com/d36d6c4de29f4d04beda3db00cb46104

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beepboopbeep• 6 years ago

https://www.nbcnews.com/health/health-news/trump-cuts-nation...

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robocat• 6 years ago

"In 2018, the Trump administration fired the government’s entire pandemic response chain of command, including the White House management infrastructure." isn't covered by your response...

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Spellman2• 6 years ago

As I mention elsewhere, both can be true.

The CDC itself isn't majorly affected and day-to-day operations can continue as normal following the standard playbook. Especially at the local and state level.

However, the Federal pandemic response teams have been gutted, positions not filled, and so we don't have the leadership to coordinate a nationwide response as new facts are discovered by the Executive Branch.

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tlobes• 6 years ago

Flying into LAX from Asia last week, I had expected to spend a few hours at the airport before officially entering, but alas, it was worryingly expedient only being asked “did I travel to China in the last weeks?”

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jcriddle4• 6 years ago

Well I am glad nobody is going to lie. /S

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soared• 6 years ago

I came japan -> SF on 2/1 (prior to major outbreaks) but they didn’t have temperature scanners, no one asked if I’d been to China, and with the mobile passport app I was through immigration in <30 seconds. Kind of crazy.

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companyhen2• 6 years ago

What's the mobile passport app called? I have a global entry card, but just got it so I'm not too familiar with my options.

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usaar3334• 6 years ago

At this point, the voluntary self-quarantines if you came from China (ex-Hubei) aren't even defensible for health (as opposed to political) reasons. Or at least they aren't defensible if you believe we also shouldn't be quarantining people coming from S. Korea, Italy, or Iran. [In Koreas' case I'm seriously surprised no CDC self-quarantine rules have been issued]

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allovernow3• 6 years ago

China is ground zero and as far as anyone knows has 3+ orders of magnitude more cases than any other nation. Turning this into a political or identity political game will be our undoing.

It is statistically prudent to focus on monitoring of and restriction of movement for Chinese Nationals. I would expect the same if the virus broke out in the U.S. and you bet your ass China would have shut down travel just as soon. This is not xenophobia, it is prudence; the fact that the infection currently aligns along national and racial lines is incidental to the steps that we must take as a nation to avoid the chaos that is gripping China.

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the_watcher• 6 years ago

Perhaps a basic question, but what is actually required to test for COVID-19? I've seen mentions of "testing kits", but what's actually in them? For comparison, US medical facilities regularly test for any number of viruses and can essentially turn them around indefinitely. Is this because they know they'll continue to need to test for them, so they are well-stocked in the test kits?

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singularity2001• 6 years ago

The most sensitive test is polymerase chain reaction PCR, which multiplies tiny remnants of DNA of the virus

It can take up to a day to get results, a team of four can only do roughly about 100 tests per day

Then you have serology test, which checks for antibodies against the virus, The signal is strongest after the peak of the disease

The Koreans are working on tests which can be applied at home but I don’t know details

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thedance• 6 years ago

In 1990's I worked on the software for an automated NASBA amp. These were mostly sold into the market for HIV testing. They are a lot more productive than 25/day/tech. Is PCR the only way to test for this virus? Are patents standing between us and alternatives?

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usaar3334• 6 years ago

nit, but it's an actually amplifying the RNA (it's an RNA, not DNA based virus), using RT-PCR (which basically converts the RNA into complementary DNA -- and then amplifying DNA)

I'm not sure per se what the CDC does, but here's a good overview of a testing method: https://www.broadinstitute.org/files/publications/special/CO...

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bionhoward• 6 years ago

The machines and reagents are super common. The critical missing element is the primer, a short sequence of nucleotides telling the PCR (gene copier) what sequence to copy

Gene synthesis companies are probably ramping production of these primers now. It’s a logistics issue to send them to the labs, but tiny quantities are needed so the packages are gonna be small, with cold chain shipping I think.

We (molecular biologists) have a dearth of tools for affordable label-free testing, so you basically have to know what you’re looking for before you can look. Bad problem to have. this could be improved with sequencers from Illumina / Roche / Oxford Nanopore but need $$ for that

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moultano• 6 years ago

Folks, I think it's time for as many bay area workers as possible to WFH. Let's get ahead of this.

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alecco• 6 years ago

It's the time to shine for the technology sector. Helping the rest of the economy work online.

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dguaraglia• 6 years ago

I've been turning this around in my head for the past few days. If things keep getting worse (and there's no signs they'll get better soon) I'll bring it up with my co-founders. Seems silly to worry too much, but on the other hand, what is the upside if we are all on our computers 99.99% of the time anyway?

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pcr9103036• 6 years ago

As a South Korean citizen it is jarring that other countries including the US and Japan isn't really trying to test people. Japan has people that died due to COVID-19 and they don't know how it was spread - the US didn't even test everyone that came from Diamond Princess! Why aren't those countries tracking down how the viruses are being spread?

I don't like conspiracy theories, but seriously it looks like they are trying to lessen the numbers on the paper instead of really trying to find the patients. Compare the numbers that the countries are testing[0], US is less than a thousand and Japan is about 1300.

Edit: Just for people who are curious in how things are working in South Korea, we test everyone who has: pneumonia symptoms, or has been in the same place with already discovered patients for free - and anyone who is concerned can test with about $100 - which is refunded if one turns out to be positive. We track every COVID-19 patient's routes and test everyone who was in the same place; which means that the government (mostly) knows exactly how the virus is being spread. Based on data that was announced 10 hours ago[1] (we announce data and roadmap twice every day), we have tested 66,652 people with 1,766 cases found, and currently 25,568 tests are on-going. 1,727 people are being quarantined, and 26 people have fully recovered from COVID-19.

Second Edit: Okay, I'm not really skilled in English; if this felt like bragging how South Korea is well handling this situation, that is not my intent - we have a lot of complaints of how the government should handle this. My intent was asking why the US/Japan is not doing at least this much, considering that both countries are much powerful & richer than Korea. Both countries are basically the Korea's wannabe-countries; and everybody here is pretty shocked (literally - there is a lot of news/SNS posts/internet memes on how Japan/US is handling the situation) that they aren't doing well.

[0] https://i.imgur.com/BAROczt.jpg

[1] http://ncov.mohw.go.kr/tcmBoardView.do?brdId=&brdGubun=&data... (Korean, sorry :-()

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hadtodoit• 6 years ago

The US did quarantine and test arrivals from Diamond Princess. Those who showed no symptoms have been sent home afaik and are under self-quarantine for a couple weeks.

It is ironic that South Koreans would be worried about Americans and Japanese given the state of corona in SK.

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pcr9103036• 6 years ago

The US did quarantine and test arrivals from Diamond Princess. Those who showed no symptoms have been sent home afaik and are under self-quarantine for a couple weeks.

Hmm, what we heard was that the US only tested people who had symptoms, and people who didn’t wasn’t under quarantine. Looks like people thinks that self-quarantine disqualified as quarantine; they were worried that people can spread the virus while getting to their homes. Maybe this probably isn’t that much a big problem in US compared to Korea where public transport is less used?

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simmanian3• 6 years ago

The implication is that the number of confirmed patients in South Korea is so high exactly because the SK government actually tests ~3000 to 5000 potential carriers every day. The government is putting huge amounts of resources into tracking everyone who may have gotten in contact with confirmed patients, the vast majority of whom turned out to be part of some secret cult [1]. They even have drive-through stations where people can get tested in minutes. It's free to get tested and, if you're confirmed to have the virus, your hospital bill is entirely on the government.

I personally find that South Koreans are overreacting, but you can't really deny that their efforts to track the virus far eclipse those of Americans and/or Japanese. The people sitting in the White House don't really seem to care at all. Abe seems to only care about the coming Olympics (I mean, just look at how he handled the Diamond Princess situation).

[1] https://www.bbc.com/news/world-asia-51609840

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kccqzy• 6 years ago

It is ironic that South Koreans would be worried about Americans and Japanese given the state of corona in SK.

The government is doing so much more to control the spread of the virus in South Korea. As such I can reasonably trust that the number produced by South Korean is trustworthy. The same thing cannot be said for the Japanese or U.S. government. The Japanese have an incentive to under report numbers because they've prepared many years for the olympics and don't want it to be cancelled.

I'd rather a government overreact than be complacent and baselessly optimistic and do nothing.

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dang3• 6 years ago

Please don't cross into nationalistic flamewar on HN.

https://news.ycombinator.com/newsguidelines.html

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ryanmercer4• 6 years ago

As a South Korean citizen it is jarring that other countries including the US and Japan isn't really trying to test people.

It's apparently quite expensive here. Federal minimum wage is $7.25 an hour, while one reported cost [0] for the test is:

$3,270 two weeks after his test. He will be responsible for $1,400 of that bill.

That's almost 10% of my annual gross before insurance and I have almost 14 years at my job. For someone working a minimum wage job that's more than 11 week's gross income. I imagine they are limiting the number of tests on people that could have any number of other things and waiting for symptoms to strongly point towards the virus due to the simple fact that the tests cost so much. If a patient can't pay, whatever hospital has to carry that cost for potentially years before the patient can repay them (or not get paid at all if it pushes someone to bankruptcy).

Until the government sets aside money to subsidize the tests, I imagine the testing rates will remain low.

[0] https://www.independent.co.uk/news/world/americas/coronaviru...

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pcr9103036• 6 years ago

Hmm, I’m not really familiar with US’s medical system... so some questions:

* Does that mean someone who gets minimum wage (which probably doesn’t have an additional health insurance except for a default one) needs to pay for $1400 to test? (If true, that’s insane - why does the government only take cares of $1700 and not something like $3000?)

* Does people who come from Wuhan/other places where COVID-19 is spreading (lets say an american that comes from Daegu - the district with the most patients in Korea) also have to pay the high price to be tested?

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allovernow3• 6 years ago

Looks like we can add healthcare reform to the list of potential geopolitical consequences to this virus. Time to see if the U.S. medical establishment is really as dire as many claim online.

If what you're saying is true about prices, there really will be a full blown outbreak if people can't afford to be tested. I presume some sort of emergency order will be given Nationwide to make testing available for free.

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jacquesm7• 6 years ago

And that assumes you only need the one test.

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roywiggins• 6 years ago

And that was a flu test, not a coronavirus test.

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cmurf2• 6 years ago

It's a kakistocracy. The conspiracy is the spread of incompetency to paper over the mental illness of a malignant narcissist. It is better that the VPOTUS is taking charge of this, he's one of the few senior officials who isn't temporary, acting, unconfirmed, or insane. But conveniently, if everything goes to hell, the narcissist has someone to shift the blame to. And the only reason why someone accused you of bragging is classic "whataboutism" to deflect from your question, you can just ignore that nonsense. By the way, at least SK successfully impeached and removed its corrupt president from office. It's called taking responsibility and keeping power with the people.

In the U.S. we're papering over incompetency, corruption, and mental illness as much as possible. What will be the CDC version of Clownstick's NOAA Sharpie incident? I'm supremely confident there will be an equivalent of ordering scientists to lie to the American public, because that's what he does. It isn't a conspiracy, it's incompetency. And it is contagious. Defending incompetency is itself incompetent.

Edit: Oh look it's already happening. U.S. health officials can't make their own statements on the progression of Coronavirus, they have to clear their statements with Pence first. https://www.nytimes.com/2020/02/27/us/politics/us-coronaviru...

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dang3• 6 years ago

Please don't go back to old habits of breaking the HN guidelines.

https://news.ycombinator.com/newsguidelines.html

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Broken_Hippo2• 6 years ago

Don't the costs get even worse if you are positive - or actually, higher while you wait for results?

I mean, you are supposed to self-quarantine while waiting, which means no pay for that period. If you are positive after the result, there is more quarantine. More time without pay.

You can let the bill go to collections if they don't require upfront payment, but few can go 2-6 weeks without pay at all. People need to eat.

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petschge• 6 years ago

In civilized countries you are still payed if you are ordered into medically necessary quarantine. And you can not be fired for it either.

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cm2012• 6 years ago

My wife's grandparents are in Korea so I'm so happy they're taking this seriously. Her grandma smokes a lot and already has a bad cough, so I feel like she'd be particularly vulnerable.

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ravenstine• 6 years ago

It's instances like this that reveal that the system is a joke. I don't know how people can witness the incompetence of entire nations and then have faith that the government will do the right thing given more money and more responsibility.

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surge• 6 years ago

They're worried about false negatives, if you test someone before they're showing severe symptoms, its best to go ahead and quarantine them, but we've seen to many cases where we clear people as negative and turns out they had it the whole time. The viral load needs to be high enough for the test to work.

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nomel• 6 years ago

They're worried about false negatives,

Could you explain this logic a little more? Unless the false negative is something very high (do we know what it is?), I don't understand why identifying none is better than identifying some some, especially with an exponential spread.

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rconti2• 6 years ago

That's not a very good conspiracy theory, because ultimately more people will get infected and the numbers will be worse because of "lessening the numbers on paper".

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fierro• 6 years ago

not cool to passive aggressively "quote" a grammatically incorrect comment clearly made by an ESL commenter

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chapium2• 6 years ago

Conspiracy makes zero sense, what would be accomplished?

I'm going with a large bureaucracy reacting slowly, which is also hampered by being staffed according to political alignment rather than by the best candidates.

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p1esk• 6 years ago

Never attribute to malice that which is adequately explained by stupidity

- Hanlon’s razor

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throw443422• 6 years ago

Perhaps they want to save face?

Elections and the Olympics are coming up.

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spyckie23• 6 years ago

My recommendation is don't create conspiracy theories when the easiest explanation is incompetence.

You'd be surprised - even though most businesses are fast at reacting to global events and responding accordingly, the US government is notoriously slow. The US hasn't faced or reacted to a serious pandemic before (the swine flu in 2009 was largely considered part of flu season).

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ergothus• 6 years ago

even though most businesses are fast at reacting to global events and responding accordingly

Citation needed. I wont declare the govt to respond quickly, but the incentives, experiences, and expertise at companies dont tell me they are likely to respond in the best way. Some, certainly. Many? Maybe. Most? Prove it.

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lifthrasiir• 6 years ago

As a fellow South Korean, I should point out that the case of SK is very unique and probably can't be reproduced.

1. SK used to be under a dictatorship (until 1987 democratization) and as a result its administrative power is still far-reaching.

When the Shincheonji (SCJ hereafter) church in Daegu was revealed to be a very problematic cohort, essentially every SCJ follower in Daegu was contacted for check-up, to the point that some hiding SCJ follower was tracked via police power (!). Not that SCJ's behavior is acceptable, but SK government has too much information to track individuals when deemed necessary. It is really a lucky coincidence that the current government doesn't try to do too much bad thing with that power.

2. Unlike other countries, many, if not most, infections in SK can be readily tracked to a single cohort (SCJ followers) and that makes the containment look still viable.

Okay, I actually disagree as the prevalent (and secretive) nature of the SCJ makes the containment impossible at this stage. I believe the SK government knows that too but continues the containment as a last resort (that is, better than not trying at all). Combined with strong administrative power and pretty stable diagnostic capacity, this "last" resort can be extended much further. It is not necessarily a bad thing though because a big pile of data resulting from lots of tests will be useful later anyway.

3. There is no other incentive for countries to test every (pseudo)patient.

It is now clear that only some---mostly already vulnerable---COVID-19 patients develop severe symptoms and most can be recovered without too much hassle. Sending every patient to the hospital is a significant burden to the domestic medical system and eventually only severe patients would have to be sent. Having this information, countries can skip the investigative phase (in this case, thankfully done by China and SK) and simply execute the eventual strategy.

The eventual strategy also has a side effect of the smaller number of reported patients. It would be a conspiracy theory that this is a motivating factor for most other countries, but it is compelling as a side effect of what they have to eventually do anyway. WHO had to accept Japan's absurd claim that the "international conveyance" is not a part of Japan because they needed Japan to at least report proper numbers. I don't think Japan is in the unique position in this regard. Even SK would be doing the same unless SK is between two highly impacted countries...

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jfoster• 6 years ago

If any given country is declining to test for whatever reason, but the virus kills ~2% of those infected, wouldn't the mortality rate seem much higher than 2% in those countries?

(assuming testing uncovers cases post-homously and numbers are not suppressed outright)

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heavyset_go3• 6 years ago

I'm not aware of any country doing posthumous testing while there are many orders of magnitude more living and symptomatic people who need the tests.

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A4ET8a8uTh0• 6 years ago

I wonder sometimes about the future of the human species. I can't find an apparent reason for it other than cost and even that should not be an issue in this case. Ignorance is bliss and no one wants to cause panic?

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stanski• 6 years ago

Something something the blindness of a non-authoritarianism (Chinese version of The Atlantic).

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netheril962• 6 years ago

China’s response in the beginning was exactly the same. Only people who had been to Wuhan seafood market and had fever got tested and we had testing kits shortages too.

But US have the advantage of hindsight. Why they are repeating Wuhan’s mistake is beyond me.

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chrononaut• 6 years ago

It has been mentioned in a number of threads that there are likely a significant number of underreported cases, e.g. John Hopkins study. However, if cases are underreported and it is implied that these are more mild cases, would that mean that these more mild cases are less likely to infect others? I ask this because if there's a hidden but significant fraction of cases, it seems to be beyond the scope of nearly every quarantine (i.e. asymptomatic people going about their day) and if the transmission rate is equal I would think we would see a lot of uncontrolled spreading. Perhaps Italy and South Korea are an example of this, although I would've imagined far more Western countries with deep distributed infections if are so many high transmission, light or asymptomatic carriers around.

Concurrent to this, I am surprised the original dozen set of infections in the US seemed to have not infected nearly anyone else, assuming close contacts were appropriately monitored.

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netheril962• 6 years ago

This disease has a potentially long incubation period, and patients do not get severely ill without weeks of development.

You are not seeing an outbreak yet simply because it is still brewing, not because it isn’t there.

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pmoriarty12• 6 years ago

In China, where the overwhelming amount of cases in the John Hopkins study came from, deaths were also likely to have been underreported or miscategorized as not being caused by COVID-19.

We're not sure to what extent that has happened, but it could also alter estimates of disease mortality rates for the worse.

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randyrand• 6 years ago

I’ve read that as a respiratory disease such as the flu it should die down in spring naturally. Is that true?

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gdubs4• 6 years ago

Well, I’d keep an eye on Singapore which has cases and is currently 88 degrees Fahrenheit and 70 miles from the equator.

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pugworthy• 6 years ago

It's showing up in Australia, which has a flu season typically from April – September.

Basically flu spikes in the local fall and winter because it is cold and dry then - two things that help the virus survive longer.

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heavyset_go3• 6 years ago

No, pneumonia is not the same thing as the flu.

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justinzollars2• 6 years ago

We have had the sequence of the COVID-19 for over a month. Are you guys, on hackernews, are telling me there isn't a single startup - not one - that could develop a more effective test to fill this gap? The virus when it comes, will not discriminate between Republican and Democrat. But developing a better test could save lives.

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CamelCaseName• 6 years ago

There are plenty of startups giving this a shot. There's a huge amount of money in being the first to develop a test or vaccine. Just look at the unbelievable growth in $CODX, $NVAX, $GILD, $MRNA, over the past week.

A quick Google shows:

Feb 16 - Israel races to find solutions for coronavirus [0]

Feb 17 - Corporate Japan rushes to devise quick coronavirus tests [1]

Feb 25 - Nanotechnology Startup Develops Quick-response Lateral-flow Test for Coronavirus [2]

Feb 26 - Biotech company Moderna says its coronavirus vaccine is ready for first tests [3]

Feb 26 - Novavax to Begin Clinical Testing of Coronavirus Vaccine by Late Spring [4]

Feb 27 - Drug companies race to test coronavirus vaccines

[0] https://www.israel21c.org/israel-races-to-find-solutions-for...

[1] https://asia.nikkei.com/Spotlight/Coronavirus/Corporate-Japa...

[2] https://statnano.com/news/67501/Nanotechnology-Startup-Devel...

[3] https://www.cnn.com/2020/02/25/business/moderna-coronavirus-...

[4] https://www.fool.com/investing/2020/02/26/novavax-plans-clin...

[5] https://www.cnn.com/2020/02/27/investing/coronavirus-vaccine...

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justinzollars2• 6 years ago

Thank you for this list! This is great

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remote_phone• 6 years ago

Everyone involved in the decision not to test the person should be removed from their position. End of story.

In a time of crisis we need the best people in control of important decisions not bureaucrats.

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ctww• 6 years ago

No offense, but I remember couple weeks ago, people in here are keep mention that China gov lying about the truth/numbers etc. By saying that, I am not argue fro the China gov. The Wuhan gov actually tried to hide something in the very early days, until the central gov noticed this.

I just feel this's interesting.. --- Disclaimer: I am Chinese work in US. I don't agree everything China is doing, but also don't like people blindly hate it.

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iagovar• 6 years ago

As european, don't count on Europe neither. Italians are already backing up in their statements as they clearly see they are the only fools that were willing to make any sacrifice to try to contain it.

Another instance of pathethic european leadership.

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Bombthecat2• 6 years ago

No, we just love money and no panic over everything else.

In cologne we went from 2 to 20 and probably hundreds of unknown. But nothing will be done...

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johnchristopher• 6 years ago

Another instance of pathethic european leadership.

Rather the absence of European leadership on health crisis management.

Which is to be expected since member states haven't defered that competence to the EU.

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dang3• 6 years ago

We detached this subthread from https://news.ycombinator.com/item?id=22434997.

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acoderhasnoname2• 6 years ago

the test result shows it is flu, why panic

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acoderhasnoname2• 6 years ago

The corona virus has to be tariffed before get into united state

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spyckie23• 6 years ago

Here's the appropriate level of threat response to the virus, as seen by other countries:

0-30 cases/day (covid is being imported in via travel)

- put temperature detection check points at airports for all passengers on international flights

- voluntary or enforced self-quarantine measures for those who have fever

- tighten or ban travel from certain areas of the world

30-100 cases/day (you've isolated individuals with covid in your population)

- put areas with confirmed COVID cases on high alert - hospitals in those areas should be required to check fever for COVID virus

- Follow up with patients who have COVID by tracking down and checking their recent social circles

100+ cases / day (containment, not prevention, becomes the main goal. There's groups who contracted the virus / the virus cannot be traced to an entry point)

- Put the entire region on high alert via policy - mandated work from home and limited social gatherings

- Suspend school and other high traffic institutions

- limit travel, request everyone to stay at home. Put up temperature checks / road blocks in major crowded areas.

- ask population to take extreme precautions with their health by washing hands and wearing masks. Wearing masks is an amazing marketing tool to get people to treat the pandemic seriously, even if it doesn't actually help limit the spread that much.

1000+ cases/day (treatment is the prioritization to limit deaths)

- build makeshift hospitals to anticipate the increase in load

- remove as much red tape as possible to allow immediate treatment of critical condition patients (approve funding, get the right tests, mobilize health professionals, allocate hazmat suits / quarantine spaces)

This implies that you are testing patients that have suspected corona symptoms and reporting them upwards.

The US should have been taking border protection more seriously, but it's probably already too late for that. COVID is likely to spread regardless of how much effort you put into border control now.

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mrandish• 6 years ago

I'm wondering if confirming COVID-19 with a test now matters much from the perspective of a patient and doctor. At this point, with public-to-public transmission known to be occurring, if an MD assesses a symptomatic patient and suspects COVID-19, they'd likely isolate the patient immediately.

Does the treatment regimen differ much between severe flu and COVID-19?

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8bitsrule• 6 years ago

UC Davis is 20 minutes from the capital of California, the largest state in the union. Davis Medical, one of the top-5 hospitals in the state, has specialists in 150 fields, and is the referral center for 33 counties. It took them 3 days to get a Covid test.

How long 'til we get serious?

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CDC declined to test new coronavirus patient for days, California hospital says

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