As I’m trying to dig out the problems with SARS-CoV-2 testing the United States, it’s become necessary for me to learn a bit about how the test works. I am not an expert in RNA analysis, but this is chemistry, which I do understand. I asked Stephen N. Floor, Assistant Professor in the Department of Cell and Tissue Biology at the University of California, San Francisco, some questions and to check my work. All errors and political content in this post are mine.
I am working from the CDC instructions for the kit and their information for laboratories using the kit.
From the point of view of the person being tested, samples are taken from their respiratory tract, which means having the interior of one’s mouth and nose swabbed and perhaps washed out. They might be asked to hack up some sputum.
The laboratory procedures are demanding, but standard for RNA and DNA work.
RNA is extracted from the patient’s samples. It appears to be the extractant for this step that is currently in short supply. The extractant may be TRIzol, a solution of phenol and guanidinium isothiocyanate, neither of which should be hard to supply.
A primer and standard are added to the prepared sample, which is then run through a PCR machine.
PCR stands for polymerase chain reaction, which is a method to make many copies of DNA. Because this virus is an RNA virus, its complementary DNA is produced, a dye is added that binds to the DNA, and the primer amplifies the SARS-CoV-2 selectively. Neither the virus RNA nor DNA is infectious, because they lack the rest of the virus.
The dye fluoresces, and the amount of fluorescence indicates how much DNA is produced. A control is added to give a known result, against which the SARS-CoV-2 result can be evaluated.
A test like this must be reliable – not too many false positive or negative results. False negatives are the more dangerous in this case, because they may result in an infected person moving about the community or a delay in treatment for a sick person. I haven’t been able to find statistics on false positive and negative rates for this test. The New York fact sheet has a short discussion of their effects.
If the sample from the patient is run through the procedure immediately, results can be available within several hours.
Despite administration promises, test kits continue to be in very limited supply, and the number of qualified laboratories and total tests small. (But numbers are all over the map, and the government doesn’t seem to be collecting them.) The reasons for this remain murky. It looks to me like a bad decision, possibly a number of bad decisions, were made early on, including not using the WHO kit and developing a kit to detect multiple coronaviruses rather than just SARS-CoV-2. This could be an organizational problem – I worked for an organization that felt it had to develop all its own computer codes, including payroll. That did not go well. Or it could be that Trump’s strong desire to deny the epidemic affected the judgement of people like Robert Redfield, CDC director.
People need to know if they’re infected so that they can observe quarantine or go about their business; doctors need to know so they can isolate patients and give them appropriate treatment; and we all need to know to understand the patterns of infection in society and take appropriate distancing measures. Right now, with so few tests, we have people self-quarantining, possibly without need, and people who don’t know they’re infected.
Also with PCR, the full genome of the virus can be sequenced, and that has been done in some cases. Trevor Bedford has an extremely informative Twitter account (@trvrb), where he explains what can be deduced about the spread of the virus from its genome.
The media need to ask better questions on the lack of tests, particularly of Redfield and Mike Pence:
- Who made the decisions on which test to use? Why did they make those decisions?
- The question on the decisions is the central one, but you might be able to get there by asking about the alleged shortages of materials. Why? Who are the suppliers? Why are they not in short supply in the countries that are testing?
My suspicion is that the shortages are a cover for protecting Trump’s delicate ego. That priority has to be dumped in favor of the health of Americans.
Update: And it looks like my suspicion is right. From NPR Fresh Air interview of Dan Diamond, a reporter for Politico:
But at the same time, Secretary Azar has not always given the president the worst-case scenario of what could happen. My understanding is he did not push to do aggressive additional testing in recent weeks, and that’s partly because more testing might have led to more cases being discovered of coronavirus outbreak, and the president had made clear – the lower the numbers on coronavirus, the better for the president, the better for his potential reelection this fall.
Bolding mine. There’s more in the interview, but this is the most direct indictment of the president.
Cross-posted at Nuclear Diner
Fair Economist
As I now understand it, the limitation on RNA extraction is that the approved test requires certain *particular* RNA extraction kits, which are limited. The CDC and the FDA have authority to allow other RNA extraction methodologies like the TRIZOL you mention, but they are not doing so.
Gin & Tonic
The West African bureau chief of the WaPo reported that Senegal (per-capita income ~$3,000) can get you your test results in 4 hours.
Mary G
joel hanes
False negatives are the more dangerous in this case,
Not in Trump’s estimation.
A false positive adds to the number of confirmed cases, which His Orangeness is afraid will make him look bad.
I suspect that if we ever find out what really happened, we’ll learn that Trump insisted that the CDC slow-walk all testing because he thought he could bluff and gaslight his way through a pandemic, working the propaganda angle, suppressing the data, and overtly lying about conditions. It’s always worked for him before, and he doesn’t seem to be able to change much in the patterns of his behavior.
germy
Gin & Tonic
West of the Rockies
Some countries have had the ability to test in large numbers for weeks. The US could have adopted, produced, and used such tests. It chose not to because Trump and his cavalcade of morons refused to make it happen. May this prove to be the end of the Republican party.
Goku (aka Amerikan Baka)
Ohio Bans Mass Gatherings of Over 100 People
What’s the point if it excludes restaurants, offices, schools, grocery stores, retail stores?
Goku (aka Amerikan Baka)
@West of the Rockies:
There are WHO tests we could be using right now. Why the fuck aren’t we using them at least as a stop-gap measure?
joel hanes
@Goku (aka Amerikan Baka):
The most severe outbreaks in Washington and New York have centered on places where vulnerable people are crowded together, nursing homes in particular. In a couple Washington nursing homes, a substantial fraction of the staff has contracted COVID-19, with tremendous impact on the level of care available to the residents, even those uninfected. The infected staff have, in turn, tended to infect their families.
germy
germy
Roger Moore
@Fair Economist:
I would also guess that the labs are supposed to use a standardized commercial kit rather than making up the reagents themselves. There are good reasons to want to use a commercial kit- the companies can do the kind of QA/QC most labs can’t do themselves- but it seems like the kind of rule that needs to be waived in the event of a genuine emergency like we’re currently facing. As with the rest of the problems the we’ve had with testing, it’s hard to know if this is just a case of bureaucratic pettifogging, or if the people in charge are trying to slow down testing to keep Trump happy.
joel hanes
@Goku (aka Amerikan Baka):
Why the fuck aren’t we using them
Donald Trump is afraid of the effect on his “ratings” if we do, and irrationally hates relying on “foreign” things, and especially will not concede that the US ever needs or will need help from some other nation.
germy
Goku (aka Amerikan Baka)
@joel hanes:
Oh I completely agree about blocking visitors from nursing homes and such. I just don’t see how banning gatherings of more than 100 people in a single room and having restaurants, offices and retail stores being explicitly excluded from that list makes any sense in flattening the curve of community-spread and hospitalizations. I think the state will eventually have to do that tbh anyway
Mary G
gene108
@Goku (aka Amerikan Baka):
Dr. Action!!! That’s a fucking amazing name to have. Like a superhero.
*************************
There needs to be a balance between shutting down the entire economy, and everyone staying home, versus allowing people to go about their normal activities.
But banning gatherings of over 100 people is a good step. Lots of conventions, sporting events, etc. will be cancelled, thus reducing chances the disease gets transmitted
Edit: Also, not shutting it all down, will help with people’s anxiety over this pandemic. Having some normal activities, like grocery shopping, going to church, etc. will help people cope.
Mary G
Jay
Soprano2
Just got an e-mail, my choir rehearsal for tonight was cancelled! They’re going to be on spring break next week, so who knows what will be going on by then.
Roger Moore
@Goku (aka Amerikan Baka):
I can think of a couple of reasons. At least with retail stores, the people tend to be spread out over a lot of space, so some of the worries about crowding you face with most public gatherings don’t apply. The same is probably true of offices; people are surrounded by work space, so they aren’t at the same kind of close quarters. That said, I think restaurants- certainly restaurants with seating capacity over 100 people- are probably going to have to close down.
MattF
The lack of test kits is a scandal. Testing is the basis for figuring out what needs to be known both for individuals and for monitoring the disease spread— the fact that preparations for widespread free testing weren’t made 6 to 8 weeks ago Is a sign of absolute incompetence. No excuse for it. None.
Goku (aka Amerikan Baka)
@gene108:
Her name is pretty cool; it’s alliterative!
Yeah, you’re right. Obviously we don’t want to crater the economy immediately. I’m honestly surprise the Ohio state government has handled this as well as they have. I think they were behind the curve because of limited number of tests, but they’ve responded quite strongly once confirmed cases started being found
germy
https://screenrant.com/tom-hanks-rita-wilson-coronavirus-movies-impact-meaning
TS (the original)
@West of the Rockies:
I keep thinking as to what would be happening if Obama was the President
The world would have been watching & looking to the US for guidance. Just not happening any more.
Jay
@Goku (aka Amerikan Baka):
no money for employees to survive on if they are shut down.
Cheryl Rofer
@Roger Moore:
This is one of my questions. Supposedly a number of laboratories are developing their own tests, including university laboratories. I agree that one standardized kit should have better QA/QC, but I am not seeing that listed as an issue.
?BillinGlendaleCA
March Madness has been cancelled.
joel hanes
@Goku (aka Amerikan Baka):
People have to eat. An amazing number of people have living situations in which they cannot cook, or are not able to competently cook for themselves. Think about the people who live in hotels, for instance
SP123
They should make a hierarchy of testing facilities. Any academic lab can run this assay- I would guess in the Boston area there are at least a thousand labs that could. They’ll be less accurate but we’d have to determine statistically whether that is worse than having no tests at all. Positive results (“possible positives”) could be elevated to state testing (currently called “presumptive positives”) which then go to CDC (“confirmed positives”). Negatives could be run in duplicate with the greatly increased capacity available to reduce false negatives.
smintheus
The media should also be asking whether undocumented aliens can get tested without risking getting arrested by ICE.
Archon
@Mary G:
My confusion is, how could deliberately not sending out tests help his reelection prospects?
Splitting Image
@germy:
Tom Hanks is one of the good ones, as his statement shows. I wish him and his wife a speedy recovery.
joel hanes
@Cheryl Rofer:
The Medicine department of the University of Washington has developed their own test, and is using it whether the Trumpies like it or not.
https://www.modernhealthcare.com/providers/drive-through-covid-19-testing-launched-hospitals-parking-lots-garages
I think Stanford is nearly as feisty.
There’s one other facility, but I’ve forgotten …
bluefoot
@Goku (aka Amerikan Baka): That’s something I don’t understand either – the US CDC could have been manufacturing the WHO kits and developing its own in parallel. it’s not like the country lacks in molecular biology experience or capability.
Re the tests themselves: Standard PCR is easy. RT-PCR for RNA is a lot more finicky but straightforward for those who are trained.
It wouldn’t be clinically validated/actionable, but we could mobilize molecular biology labs across the country to do quick and dirty research-grade testing at large scale. Each lab would have its own false positive/false negative rate, but It would at least give us a sense of how widespread the virus is and how its spreading, at least in aggregate.
Goku (aka Amerikan Baka)
@Jay:
@joel hanes:
I guess I wasn’t thinking so much as shutting them down but more like requiring businesses to control how many people are in their buildings at any one time
gene108
@TS (the original):
Republicans would be screaming that everything Obama does, no matter how well thought out and planned, is totally inadequate, Pres. Obama is bungling the response, and putting the American public at risk.
If 2014 was any indication, the media would pile on the Obama Administration with right-wing talking points.
?BillinGlendaleCA
Disneyland and California Adventure are closing.
Jay
@smintheus:
ICE is already sweeping the hospitals and clinics.
Roger Moore
@Mary G:
Shit’s gettin’ real!
joel hanes
@Archon:
He thinks that increases in the official number of confirmed cases makes him look bad, and will negatively affect his “ratings”
And as long as Fox covers for him, and there are no corpses in the street, it might sorta work. I think this is what Putin is doing in Russia, and it’ll probably succeed there.
Goku (aka Amerikan Baka)
@smintheus:
I’m worried about undocumented immigrants at detention camps as well. Conditions are reportedly already intolerable
germy
@Splitting Image: He’s portraying Colonel Tom Parker in the Elvis biopic. I didn’t know about the diabetes.
His statement: “To play things right, as is needed in the world right now” (I wonder if that’s a subtle dig at our current administration…)
Jay
@Archon:
keeps the numbers of cases down, keeps the death toll down,
a previous prediction earlier this week was 480,000 dead in the US. That however was based on Dumph and the Feds not wasting any more time and Faux News actually reporting facts,….
piratedan
just going to point out one thing here:
The thing is, the vast majority of the samples will NOT be collected at the facility that does the testing.
They will be collected at urgent care, physician offices, outpatient lab centers, ER’s and hospitals. They will be documented, labelled, charts updated and then placed into transport protocols to be picked up by couriers and then delivered to the testing facility (or even to other hospitals to be batched in with their samples that have been collected), where the process will repeat itself. Most of the public health facilities that I have dealt with have a 3-5 day turn around on doing results for just the regular flu virus, but with this being a public health issue, I imagine that they’ll be running samples 24/7 to improve turnaround time for notification on positive results but collecting, documenting, transport, unpacking and then running the samples all take time, so just understand, you may see a turnaround in 6-8 hours if you’re extremely fortunate to have caught everything at just the right time, I would suggest a day or two is much more likely.
Temper your expectations accordingly
Roger Moore
@joel hanes:
If you’re worried about keeping restaurants open so people can eat, they could be forced to change to delivery/carry-out only.
Martin
@Fair Economist: That is my understanding as well. This is an artificial supply chain problem. It’s why Cuomo (smartly) told the feds to fuck off that they would do their own thing.
I don’t know why CA hasn’t done the same (or maybe we have but it’s not been reported on). We have more public health infrastructure than the feds do and comparable expertise. Time to throw out the rulebook and go with practical solutions. A 95% accurate test is worse than a 99%, but way the fuck better than no test at all.
bluefoot
@SP123: I completely agree with this. There could be a benchtop assay with 2-3 primer pairs, pick appropriate cycle times to minimize false negatives, a positive with any primer pair elevates to CDC testing for confirmation; a positive with all three would be a presumptive positive.
germy
Satellite images show Iran building vast burial trenches for virus victims
Feathers
@Roger Moore: Apparently in Ireland restaurants are removing tables to get themselves below 100 capacity.
Roger Moore
@Archon:
Simple: if nobody knows there’s an epidemic, they can’t blame him for it. If COVID-19 is no worse than the flu, as Trump apparently believes, then all the excess deaths could just be passed off as an unusually bad flu season.
Goku (aka Amerikan Baka)
@joel hanes:
I sincerely doubt that. Even with a mortality rate of 1% this will touch millions of people’s lives. It sucks to say this, but we’ll probably know at least one person who gets sick and dies from this or at least know someone who’s loved ones will. This is something the public isn’t going to just forget about.
As time goes on, people are going to see just how inadequate Trump and the national GOP’s response to this is. He only won by slim margins in 2016. His base is incredibly vulnerable to this virus. You do the math
Edit: I take no satisfaction in this however. I wish the Admin was doing a better job
Martin
@?BillinGlendaleCA: Well, yeah, it’s raining.
Jay
@Goku (aka Amerikan Baka):
unfortunately, that’s not how businesses work.
A 100+ person restaurant will have models based on historic data forcasting seats occupied, $$$ spent per head, time occupied and then will schedule all staffing around thoses numbers, 2 to 3 weeks out.
Not making “bank” means no tips, layoffs, no money, and a big chunk of 100+ person venues is catered events.
?BillinGlendaleCA
@Martin: They’re closing on Friday until the end of the month.
gene108
@Archon:
He can brag on Twitter and at his rallies about how few COVID-19 cases are in the USA, because of his swift action on banning travel from China, and now the EU.
Really seems like the same operating principle for someone like Trump to overstate what he can offer to a potential customer. He did this with his Trump Soho property, while it was being built. He overstated to potential customers about the current occupancy rate, so they would feel better about buying and/or be willing to pay more or not ask for a discount.
It’s how he works. Say what he has to, in order to close a deal. The deal he’s closing is to make sure his base doesn’t waver, in their unthinking support of him. Even if some of them end up dying, because of his actions.
dmsilev
@Martin:
The _true_ sign of the apocalypse.
gene108
@?BillinGlendaleCA:
Disney World’s still open, I think.
Feathers
This is an issue with the FDA in general. You can’t update anything. Worked with a team looking to do an app to increase meds compliance. The problem was that it couldn’t be looped into the FDA approval process because FDA approval mandates that no changes be made once a thing is approved. Apparently as currently defined, that means no bug fixes, no updates for new OS releases, etc. It also means all sorts of devices don’t get the normal silent upgrades that most non-medical equipment does, smoother finishes, a more ergonomic grip… Hard to tell if it’s a racket or necessary safety measures to rein in sleezy manufacturers.
TS (the original)
@gene108:
Everything comes back to the media aiding and abetting trump. Current article at WAPO – Hopes of bipartisan deal rise as White House, Democrats negotiate coronavirus relief package
No mention that Trump refuses to even talk with Nancy Pelosi & McConnell is sending the Senate on a break before considering any legislation.
WhatsMyNym
@germy:
Didn’t look like that to me. It just looked like they had used up space in one cemetery block and had started to prepare a few rows in the next.
?BillinGlendaleCA
@dmsilev: Indeed, we’ve had over 1/2 and inch of rain in the last 4 hours.
Elizabelle
Norwegian Air has laid off half its staff.
I hope that airline survives. It’s my favorite for getting to Europe inexpensively. Excellent passenger service, too
It’s taken a double blow, because a lot of its business was flying people home to their cruise ports. They have an interesting route system; saw the opportunity and kept picking up US routes as they became available.
Goku (aka Amerikan Baka)
@?BillinGlendaleCA:
I hope Disney World and Universal Studios in Orlando follow suit too. Florida has already had deaths
Martin
@germy: He developed diabetes when he added weight to play Captain Phillips. That changed the expectations for actors to add/drop weight for roles.
LuciaMia
Re: Tom Hanks. They went to Australia to film an Elvis bio-pic?
Gin & Tonic
My daughter, a union thug, just reported that MD public schools are closed March 16-27.
Martin
@dmsilev: Look, in SoCal we can stare down coronavirus, but rain, that’s when the real panic sets in.
Elizabelle
@LuciaMia: Director’s an Aussie. Baz Luhrman, of Moulin Rouge and I forget what else. Kind of over the top artistic type.
Jay
@Goku (aka Amerikan Baka):
unfortunately, some Americans get their news from News Corps, some Americans don’t consume news at all, they specialize in escapism, and some Americans consume Reich Wing Propaganda which is still alternating between Blame Nancy, Obama’s Fault, Fake News Hoax and Chinese Bioweapon Plot.
I am not convinced the “Masque of the Red Death” experience will change any of the so called hearts and minds inside the Reich Wing Bubble. I think they will double down.
Martin
@WhatsMyNym: Intelligence agencies look for mass burial. They’re trained specifically for that because it’s often evidence of war crimes, the scale of a civil war, etc. Mass graves are a political decision.
Feathers
In Egypt, Cairo is facing massive rainstorms and flooding. Because they don’t usually have this much rain, they will be shutting off water to the city to protect the pumping facilities and water treatment plants.
pluky
@bluefoot: bingo! I was a molecular biology undergrad (albeit eons ago). While the protocol is not trivial (the extraction solution is both caustic and toxic, and I’d need to be trained in the operation of a PCR machine), I have little doubt of my ability to do this.
Goku (aka Amerikan Baka)
@Jay:
It’s not just about changing hearts and minds. It’s sadly also about many members of his base getting killed off along with everyone else
narya
This is so infuriating. I’m home with what I assuming is a cold–I don’t have the contact or travel risk factors that I know of–but if a test were available I would do the responsible thing and make SURE that that’s what it is. Instead I’m sitting here chanting “It’s just a cold; it’s just a cold.”
Martin
@Archon: He has gotten here by compressing the news cycle to 48 hours. He doesn’t plan 3 moves ahead. He addresses the problem in front of him and doesn’t consider the consequences, figuring he can adapt to them when they come.
He doesn’t understand that 38 deaths today could be worse than 15,000 flu fatalities because of the fear the public has that it’ll turn into 150,000 deaths. And that plays out over a longer time horizon than he has the attention span for. He’s the guy tasked with running a marathon that would go into a full sprint for the first 50 meters and then be out of gas for the next 26 miles.
WhatsMyNym
@Martin: Still not convinced.
Bill Arnold
For those looking for something else to boost their chances against COVID-19, consider vitamin D supplements, unless young and in the sun a lot. There’s quite a bit of dispute over the last couple of decades (or more) on vitamin D and respiratory infections, but this team’s metanalyses (this is just one) are enough to convince me that vitamin D deficiency is a bad idea. (Note that they note substantial heterogeneity of results.) Note that this is in general; it is possible that it does not apply to SARS-CoV-2 infections.
Vitamin D supplementation to prevent acute respiratory infections (JANUARY 2019, pdf)
We also showed that vitamin D had greater protective effects when it was given daily or weekly to people with the lowest vitamin D levels: the risk of having at least one ARI was reduced from 60% to 32% in these individuals
Also make sure you get enough zinc.
Zinc – Fact Sheet for Health Professionals
RDA is 8mg for female adults, 11mg for male adults. Max 40mg/40mg female/male.
(also, Contribution of Selected Vitamins and Trace Elements to Immune Function (2007, abstract only))
Jay
@Martin:
and Shia, unlike many Sunnis, venerate their dead. Graves are personal, familial, and religious, and can become shrines over time.
Mass graves are a bad sign unseen since the Iran- Iraq War.
Elizabelle
@narya:
Hugs.Fist bump. Keep hydrated and wash those hands. (And moisturize.) Hope it is just a garden variety cold or whatever.Martin
@narya: Same here. Daughter has all of the symptoms but the fever hasn’t shown up at all. So, we’re home. Not sure what else to do.
Eunicecycle
@Jay: I saw an article out of Scranton PA that ICE went in all Rambo and took out a patient being treated for a lung ailment. They should be barred from hospitals for sure.
trollhattan
@Jay:
Technically, they’re not getting news from Newscorp. (Such an ironic name.)
Uncle Cosmo
@Roger Moore: My favorite restaurant in Baltimore’s Little Italy had been struggling for a couple of years. We were aware it was on the market but it was still a shock when it was sold & closed its doors on 15 January.
Poor timing for the buyers, you’d think, if they intended to continue as a restaurant (still unclear). But perhaps worse timing for the sellers, who chose to exit the restaurant business and focus on what had become over the last few years a fast-growing sideline: Guided tours of Italy. Mannaggia!
Jay
@Goku (aka Amerikan Baka):
just a guess, but Possum Holler is going to have many more dead from insulin unaffordability, bad meth, suicide and opioids, than Covid19.
the Gated Communities might lose the odd Aunt, cook, maid, gardener, but they will be pretty much okay, money counts for a lot when it comes to triage or pandemics in the US.
I doubt, despite their wilful ignorance, that the MAGAt’s and Deplorables will be as hard hit as Urban Blue Zones.
At less than 300,000 people in total in the Dakotas, they won’t even notice 5000 are missing until mid summer and the smell wafts over, and it won’t effect their electoral votes one little bit.
bluefoot
@pluky: It’s been years since I’ve been in the lab, but I was a molecular biologist for years. I’m currently in Boston, and there must be hundreds of idle thermocyclers for real-time and qPCR with all the biotech companies (incl mine) having everyone work from home, and the universities shut down. I would totally volunteer to work late shift isolating RNA and running assays.
The hardest part would be logistics – collecting and barcoding samples, setting up a LIMS or something to track samples to plate location to result to reporting. Though the LIMS is something any medium-throughput genomics lab has already. What we’d really be lacking is positive and negative controls in sufficient quantity. And primers. But all that synthesis could be scaled up and dispersed to universities and biopharma companies to run assays, WWII-style. While all that is scaling up, we could be training people like you or me to run assays.
Jay
@trollhattan:
News (space) Corp, ( semi responsible media, aka, MSM), not NewsCorp, which I prefer to call either Faux News or the Reich Wing Media.
The MAGAt’s and Deplorables are inside of a propaganda bubble that even Dear Dear Grandmomma’s preventable death ain’t gonna pop.
Roger Moore
@Feathers:
The FDA is very conservative about this stuff because that’s what their experience teaches them. A good example is a recent case of drug pressure drugs being contaminated with nitrosoamines. The manufacturers changed their production methods to be more efficient, but in the process they introduced some new contaminants that they hadn’t considered when designing their purification strategy. The result was that lots of blood pressure medicine was contaminated with carcinogens. That kind of thing has taught the FDA that you need to test the exact procedure you’re going to be using, and any time you make even apparently minor changes you need to test to make sure they don’t cause unexpected problems down-stream. The net result is that the drug and medical device industry tends to be very conservative about making changes, even in products like health apps where a bug is just a hassle rather than a life-threatening event.
Fair Economist
@Feathers:
Back when I worked in regulatory affairs, I got all sorts of changes approved as “substantially equivalent” – even in cases where I knew for a fact they *weren’t* substantially equivalent. I always felt uncomfortable with those filings but I didn’t get to make the decisions.
.
Uncle Cosmo
Maybe, maybe not.
Suppose this stuff rips through the global population this spring, then again in the autumn through the winter, kills off that 1% (3.3M here, 70M worldwide), then effectively vanishes because everyone left has seroconverted (developed antibodies) as a result of exposure or vaccination.
(IMO that is the most likely outcome of the current pandemic: 12-24 months of significant disruption worldwide, but no drastic break with the past in behavior or culture after COVID-19 burns itself out. Most all changes in daily life will probably be quantitative rather than qualitative, e.e., an uptick in behaviors like social distancing.)
That’s pretty much what happened with the 1918 Spanish flu, and you’d think pretty much everyone in the US knew someone (or knew someone who knew someone) that died from it.
How much did the possible recurrence of a flu pandemic trouble the minds of Americans in the 1920s? I’ve seen very little evidence in the history & literature of the period that anyone thought much about it – except for public health officials, who probably spent a lot of sleepless nights worrying about it.
narya
@Elizabelle: Elbow bump? And I’ll be wearing a mask. Drinking fluids, taking vitamins (which I rarely do; current bottle has use-by date from 2015…), monitoring the fever, taking ibuprofen if it gets to 101.
Kent
Disney is not far from the Villages, the largest retirement community in North America with 51,000 oldsters in residence.
Kent
I spent a decade of my life writing environmental and fisheries regulations for NOAA (mostly regulating the big commercial fisheries in Alaska). On many occasions we issued “emergency regulations” that waived all kinds of procedures to get stuff done fast, like emergency closure of fishing areas for environmental and safety reasons. I processed some of them personally in less than 24 hours and even hand-delivered documents to the Federal Register myself via the METRO Red Line (from NOAA HQ in Silver Spring) to make them effective immediately upon “filing for public inspection with the Office of the Federal Register”
People who give a shit and are empowered to do so can move quickly. The problem is the lack of empowerment, not the lack of mechanisms to take emergency actions.
Little Dragon
@Fair Economist: I used to do a lot of these sorts of procedures and a kit made by a German company, Qiagen, is in short supply. Other companies make serviceable kits but Qiagen has been the gold standard for years. I can’t find a mention of what the bottleneck is but I’d guess it’s not the Trizol solution (Qiazol brand name in Qiagen’s kit) but instead may be the columns that come with the kit. The columns include a silica-based matrix which binds RNA under high salt conditions, can be washed, and then the “pure” RNA can be collected off the column by washing with a no salt solution. Qiagen’s formula is proprietary and works amazing well with great consistency. You can make a passable subsitute by simply grinding silicate glass into as fine a powder as possible but the results are meh. Other kits (one made by Roche, I think) are now being allowed but I think the basic principles are the same.
Roger Moore
@Uncle Cosmo:
I think the public health people were more focused on all the other epidemic diseases- polio, whooping cough, typhoid, measles, mumps, etc.- that were still running rampant through the population. The Spanish Flu was bigger in scale than those other epidemics, but epidemic disease was simply a fact of life back then. I think COVID-19 is likely to serve as a terrifying reminder to people today of just how dangerous contagious disease can be- a reminder that people in the age of the Spanish Flu didn’t need in the same way.
Soprano2
The second confirmed MO case of COVID-19 is in Greene County, where I live. Fuck…….
L85NJGT
How’d they fuck this up?
This is the Trump organization we’re talking about. Pretty good chance attempting to monetize the tests fucked it all up.
L85NJGT
PCR is reliant on viral load.
There are also blood antibody tests like that developed by Signapore’s Duke-NUS Medical School. Antibodies remain after the infection (this is how immunity to pathogens happens), and are good for determining who has had exposure when there is a variance in symptoms and course.
Anonymous At Work
@bluefoot: I spent time in a lab working near people running PCR. I learned more about how to curse that summer than I suspect 30 years with the Marines would teach.
And that’s each individual person. One at a time.
tony in san diego
@Mary G: Is that impeachable abuse of power?
Amir Khalid
@LuciaMia:
Director Baz Luhrmann prefers to film in his home country. He also shot his version of The Great Gatsby there.
Ruckus
@Archon:
Don’t try to make sense of or find logic in any thing about trump. His world does not have any sense other than he is the greatest human ever and anything that might detract from that is wrong and has to be shunned/destroyed. As for logic, he has no higher brain functionality. He has react and destroy as the closest thing to any kind/type of logic. And common sense? If that was actually common then more people would have some. What should be said is that people have are supposed to have some sense about the world and it’s function, the commonality of it all, how it works. But that is something that is commonly lacking in a large segment of any population.
ziggy
Regarding the restaurant situation–the market is going to shut them down when the situation is bad enough. Already in Seattle, 4% of restaurants have closed. Many well-known ones are struggling and it’s going to be an economic bloodbath soon. This is NOT because of regulations, it’s because people are choosing not to eat out. Same with many other face-to-face services.
The testing situation is driving me batty–now that everyone is working on it, why are more/faster tests not available? A friend of mine works in an office where someone tested positive. Many of her coworkers are sick and she is starting to get sick. No one has been able to get testing. So they are all on quarantine for weeks.
Another Scott
@ziggy:
USA!! USA!! USA!!
I guess I need to rustle up my pitchfork and torches. Who’s with me??
People are dying because Donnie told everyone he didn’t want to see or hear about big numbers.
Grr…
Cheers,
Scott.
Ruckus
@Roger Moore:
Very true. Everything could kill or disable you. OK that’s a bit over the top but not all that much. I knew/know 4 people that grew up with polio. I was 4 or 5 when the vaccine was first widely available. The entire family stood in line at a bank to get it. I remember watching them put one drop on a sugar cube and we each ate one. Wasn’t a vaccine for chickenpox until 1995 so a lot of people alive may have had it.
Wilhelm Cody
@West of the Rockies: In fact, the restrictions on early testing were done by the CDC and FDA with little input from the White House. This has been documented by the CDC and by Dr. Fauci’s comments on the strategy adopted. The formation of the Coronavirus task force led to reduced restrictions and even encouragement, allowing many testing laboratories and private companies to get emergency approval for tests. This change also freed up CDC resources from running tests to getting more tests approved.
As of today, at least two testing labs (Quest and Euofins) and Roche Diagnostics are providing services and kits for expanded testing. This is in addition to testing by many hospital and University testing labs using CDC-arranged kits. Kaiser Permanente in the San Francisco Bay Area now has a drive through service for those approved for testing after telephone conversation with physician at Kaiser.
The initial error was at combination of Not Invented Here Syndrome and a desire for absolute government control at the CDC and FDA. They are smart people and can do much but they did not initially take advantage of what had been done by the Chinese, WHO, Germany and others. Nor did they take advantage of the incredible resources available from testing laboratories and private diagnostic companies in the USA. Those errors have been corrected and testing options are expanding, we hope at a faster rate than the number of infected people in the USA.