Hoochabald5

Me too. The following is a mini rant but I need to put it out there. I’m trying to shout this from the roof tops but I get the 500 yard stare.

I think the key is to quickly fix our testing system.

There are currently way too many steps / gates to pass / interactions to have / opportunities to spread or catch the virus / just to find out if you covid. It’s nuts. South Korea (SK) has none of this.

So when I hear the problem with testing is that there is a lack of test kits, I want to pull my hair out.

The solution isn’t necessarily test kits but a need to get people testing resources fast (drive thru, Over the Counter in home test kits - like a pregnancy test for covid, doesn’t matter).

Eliminate all this red tape.

Here is the current process simplified. Remember you have sick, elderly stressed people doing this! This process takes weeks for those who are successful enough to get through it.

1a) Make appointment to see provider to get screened for testing. May take days.

Or

1b) Access telemedicine to see provider.

2) Wait days for appointment with provider or hours and hours in an online waiting room for telemedicine provider (scanned a bunch of sites and saw many providers had upwards of 30-40 patients in their q).

(This is why people go to ERs by the way. Takes way too long just to see a doctor. Other people give up.)

3) See your provider for screening. Provider uses any combination of cdc, state and/or local guidance for reference criterion. Too constraining, too subjective, not adapting to the science.

4) Provider makes determination as to whether or not you meet the criterion (subjective). Totally subjective and very frustrating if you are denied. You waited so long.

5) Then the provider must seek approval of state / local health authorities for covid testing authorization. Why?

6) Once the provider receives that authorization, you are referred to another provider who will collect your specimen. Sometimes this can be done at the point of care, most times you need to go to another provider. Really?

7) Make an appointment with the second provider. Wait for appointment.

8) Travel to second provider. Wait.

9) Second provider collects your specimen.

10) Second provider mails / transports your specimen to designated lab (state, local or private lab.)

10) Specimen goes into a lab backlog. Some labs have very large backlogs.

11) Lab processes and results your specimen.

12) Lab sends results to provider.

13) Provider contacts patient with test result.

Why can’t we jump right to step 13. Test person and provide immediate result.

Without doing this you have no idea what’s going on. You can’t answer those mortality rate questions, you don’t know if your containment strategy is working, you put sick people through hell, you need to lock down the entire country for the next year as you need to assume the worst case scenario.

We can’t figure this out? I have no pull. But I know the process as I work in the industry. Too many special interests guarding it as it represents billions of dollars of revenue. Unfortunately it’ll cost countless lives.

Rant over.

Testing like this works

Thank you!

How many mortality rates are there?

I’ve seen people cherry picking the data to either say we are overreacting or under reacting. Ive seen well respected epidemiologists say this is a gross mortality rate of .5%. I’ve seen numbers as high as 10%. It all depends on the denominator and assumptions of course but I’m losing the forest through the trees. I also realize these are gross numbers which need to be stratified. Just need a 101. What number do you use? Specifically what percentage of the population will catch this? 70%? Of that, what percentage will be asymptomatic versus symptomatic? Is it 80/20, 50/50? Assuming the mortality rate only applies to symptomatic, what percentage of that group will die? Take NYC for example. What do the models currently show.

I’m asking you impossible questions and I would seriously need to write a 20 page paper just to state all of the assumptions, etc. I’m only looking for rules of thumb. Politics are starting to skew the numbers - dependent upon what agenda folks have. I just want plan old boring empiricism.

Thank you!

Exactly! Plus there are ranges in the date of initial incubation to death. I’ve read papers where it can go from 25 days total to 47 days. Of that 10 days in the hospital. Horrible source but if you scroll through Twitter so many seem to be an the initial onset of symptoms or have been experiencing them for a few days. Large number complain of lung pain / weird feeling in chest. They (most) don’t meet cdc criterion for testing. So if this group is any indication of what’s to come, and going with the higher number (37 days till hospitalization) we should see the first wave next week. This will last for a month or two and come down assuming everyday stays in place. Again, we have no idea who is presently in the q who have yet to be admitted. My fear is that this number is extraordinarily high. Such a vicious virus. I feel all of my responses are so inadequate - we just don’t know if this will be Armageddon, really bad, bad but manageable, etc. anyone who claims to know this, well they are not being totally truthful.

Thank you so much for your work. You have an impossible job. Unsolicited advice. Err on the side of worst case given our lack of testing / Italy. You’ll be forgiven for being conservative. Downplaying the risk based on incomplete data (which I’ve seen some do by cherry picking data, not taking the trouble to analyze this and admit they just don’t know for sure, that’s irresponsible.)