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#1 User is offline   MTP Reggie 

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Posted 24 March 2020 - 06:40 AM

Far more people in the U.S. have the coronavirus than you think
Marc Lipsitch
The Washington Post
Published 6:43 am EDT, Monday, March 23, 2020
Greenwich Time

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As an infectious disease epidemiologist who's worked on pandemics for two decades, I've talked in recent days to journalists and health officials around the United States and from halfway around the world about how to stop the coronavirus. They all have the same questions: How many tests do we need? How should we use tests? For each case we know about, how many more cases are out there? What's the best way to find undiagnosed cases? Should we do "active case finding," which involves testing everyone who is mildly ill, then isolating known cases and quarantining and isolating their contacts? Instead - or in addition - should we implement intense social distancing, close schools and take other similar measures?

Everyone asks the same important, interrelated questions. In one respect, the answer is the same for all of them: We must vastly expand our testing capacity. No country has controlled transmission effectively without massive testing capacity. The United States currently has a sliver of the capacity we need, which is only a tiny fraction of that available in other countries. South Korea has performed over 320,000 tests - almost one for every 150 people. That is 30 times the testing per capita that we have done in the United States. Exceptional teams are racing to solve testing bottlenecks at local and state levels (Massachusetts is just one example), filling the vacuum left by the complete absence of federal leadership. Regulatory and technical hurdles accounted for early delays. Now that we're past those, several shortages are getting in the way. We don't have enough protective equipment for testers, nor swabs for sampling or reagents to extract genetic material from the virus. We don't have enough physical test kits, or enough human power to run large-scale testing. The result is that we have no idea how many people are infected with the coronavirus, or how fast the virus is spreading.

For most of the other questions about strategy, the best answer depends on local conditions. Different parts of the world, and maybe even different parts of the country, are in very different situations. The best strategy depends critically on which stage of the outbreak you are in, how much testing is available. This is a subject infectious disease epidemiologists have been thinking about for years. My colleagues and I have been adapting our earlier peer-reviewed work to the present pandemic. One size does not fit all.

A few places - many of them islands, like Singapore and Taiwan - have so far kept the epidemic relatively under control. They found and tested most of the initial imported cases; they deployed a skilled public health workforce to isolate people with the virus and trace and quarantine their contacts; and they've managed to maintain a "containment" strategy to good effect. The same can be said of Hong Kong and New Zealand. Iceland has combined containment with massive testing of its population. So far, this strategy has worked, and in these places, it would be wise to keep to it unless evidence that it is failing starts to emerge.

Containment can work when there are few enough cases that the public health system is able to deal with them and their contacts, so that the workload is manageable, and when a large fraction of cases are tested and identified, so that preventing them from infecting anyone else dramatically reduces the total amount of transmission.

For jurisdictions like these, case-based interventions (isolation, contact tracing and quarantine) can be the centerpiece of the control strategy - because they are highly effective. It may be necessary to supplement these with broad social distancing measures, of the sort we have been emphasizing recently in the United States, to snuff out any unobserved chains of transmission that might get past public health authorities. Places like Singapore can afford to keep schools open - and more generally to impose less stringent social distancing measures - precisely because the case-based interventions are working.

But the situation in the United States right now is very different.

The feckless federal response created such delays in testing that most cases here are not being confirmed, even now. We don't know even approximately how many people are infected, but it's certainly more than the current count of more than 33,000 confirmed cases. Even though many places are reporting relatively small numbers of confirmed cases, this is not comforting. In many parts of the country, we are seeing rising numbers of flu-like illnesses that when tested, are not flu, and may well actually be covid-19 if only we could test them. Observations like this convince epidemiologists that the large majority of cases are undetected. Given the various shortages, testing capacity in the short term is limited. But at this point, it's not going to be possible to find and test all the cases that actually exist, even if we massively ramped up testing. Despite welcome improvements in testing across the country, finding and testing all the contacts of confirmed cases when the numbers are increasing this quickly wouldn't be feasible at the best of times - let alone now.

To be clear, any person known to have covid-19 should, of course, be isolated to avoid onward transmission. But this strategy alone - and the tracing and quarantine of contacts that is central to Singapore or Taiwan's strategy - is inadequate to the problem we are already facing in the United States. It's just a matter of numbers. If we only know about 1 in 10 cases, then even perfectly effective interventions on known cases can block only 10 percent of transmission. More likely in the United States, we know about an even lower proportion.

For this reason, states and localities around the country are starting to apply social distancing, a set of policies that can be effective without knowing who is infected or infectious. Implementation around the country has been widely variable, with shelter-in-place orders in multiple sites and minimal interventions to date in others. Intense social distancing must be the centerpiece of our strategy for now. There are reasonable concerns about how long this can continue, but these are no excuse for avoiding urgent action now to prevent an already bad situation becoming worse.

(snip)


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#2 User is offline   Taggart Transcontinental 

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Posted 24 March 2020 - 07:41 AM

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Exceptional teams are racing to solve testing bottlenecks at local and state levels (Massachusetts is just one example), filling the vacuum left by the complete absence of federal leadership.

Here is the dishonesty right here. Claims that the "federal leadership" means Trump. Not at all the case. The problem is with the FDA and the CDC leadership which are hiding behind the bottleneck of it's regulations as a means to protect themselves.
https://www.technolo...avirus-testing/

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Case in point: FDA rules initially prevented state and commercial labs from developing their own coronavirus diagnostic tests, even if they could develop coronavirus PCR primers on their own. So when the only available test suddenly turned out to be bunk, no one could actually say what primer sets worked.


So we have rules in place that during a normal situation would protect us but in a critical situation they block people from being proactive. Don't sound like a capitalist system does it? Sounds more like a top down autocratic system where some people control the actions of most people.


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The CDC and FDA reversed course and lifted this rule on February 29, and commercial and academic labs are now allowed to participate. “Lots of people are working on this, and we’re on the phone all the time with each other comparing notes,” says Jerome. “At least in our hands, it seems that some of the CDC primers work better than others, some of the WHO primer sets look really good, and some from academic groups look great also.”


Gee I wonder WHO gave the order to stop this nonsense? Oh that's right the POTUS did when he stated "incorrectly" that testing would expand. Apparently the lackey's hadn't been told but the POTUS directed it in a meeting. SO the media ran out and contradicted the POTUS initially and now more labs are testing than before.


From this article:


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We don't have enough protective equipment for testers, nor swabs for sampling or reagents to extract genetic material from the virus.


Right now the FDA is holding back supplies, this was in this article here:

https://www.redstate...0/03/23/804818/

More bureaucracy gone mad.


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At this very moment, stockpiles of masks, hand sanitizer, and other supplies are sitting in warehouses waiting for FDA inspectors to get around to them. Where other nations are expediting these deliveries, trusting proven suppliers in their deliveries, the FDA has resorted to its favorite fetish: bureaucratic lethargy.

The problem here is not simply that the FDA is insisting that its box-checking comes before exigent needs of public health, but also that the agency doesn’t have enough inspectors to get the job done quickly.

I spoke to one significant medical supplier who talked to me on the condition of anonymity, for fear of FDA retaliation. In one location on the Pacific coast, this supplier has had more than 20 pallets of coronavirus-specific medical supplies waiting in a warehouse for five days. Yes, five days.At another depot in the south-central United States, this same supplier has had 500,000 level-three or level-four masks sitting in a warehouse for two days now. They expect the FDA delays to continue indefinitely.



More deep state incompetence. More lives threatened or lost. This is the danger of allowing unaccountable people control our nation. This isn't a failing of Trump or the people at the top level, it's a failure of middle management to ask the right questions to those in power, these things could be waived rather easily if the POTUS and Pence knew about them. It is impossible for a leader to know all the needs of the led. That's why marxism fails. El Supreme leader cannot know everything, nor can he be everywhere. So the system falls down because it breeds corruption. We are seeing a similar vein here, people protecting their turf and denying people to move equipment forward. The only way to fix this is to bring the problem to light. Like roaches they will scurry away, when the light is shined on them.



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#3 User is offline   Ticked@TinselTown 

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Posted 24 March 2020 - 05:26 PM

It's the Farrah Fawcett shampoo commercial all over again...
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