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You are here: Home / Anderson On Health Insurance / Test to get out

Test to get out

by David Anderson|  September 1, 20208:42 am| 80 Comments

This post is in: Anderson On Health Insurance, COVID-19 Coronavirus

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Last week, my sister gave birth to her son.

Mom and son are doing well.  He is adorable and asleep most of the time.  His big sister is not 100% on board with the alien that her parents brought home.

My parents live about 45 minutes away from their newest grandchild.  Both of my parents are at high risk of extremely negative consequences if they are infected with COVID.  They have been extremely cautious about interactions and social engagement over the past six months.  It helps that they live in Massachusetts where testing is common and community prevalence is low.  Both of my parents were very determined to safely hold their grandson and play with their youngest granddaughter.

They had a plan.

On Saturday morning, they went to a walk-up testing clinic.  They paid cash for a screening test.  Things got stuck up their nose.  Twenty minutes later, they were both cleared as unlikely to be positive and even less likely to be infectious.  Three minutes later, they were both in the Kia and driving down 495.   The testing cost them a good chunk of their discretionary funds for August but seeing their grandkids is highly valued.

An hour later, my dad was having a complicated tea party with his granddaughter and my mom was holding her grandson.  A bit after that, my mom was in a parade with a dozen stuff animals and my dad was holding his grandson.  My sister’s house was a bubble of confirmed no positives/no infectivity.  There were hugs.  There were dance parties led by an over-active three year old who knew exactly what she wanted even if the big people were not listening to her!  There were cookies.  It was a moment of near normality.

Testing is the way out.  Massive, widespread, common and cheap testing that is accurate enough where we have a good deal of confidence that a negative is a true negative even if a positive is likely to be a positive is the way out.  If people are able to test several times a week with results that are returned by the end of a cup of coffee, then 95% of normal, December 2019 expectations based, life can resume as long as people who don’t get negative results isolate until confirmatory diagnostic testing can sort false positives into true negatives and likely positives.

If we are confident that typical interactions of a day aren’t going to lead to infections of a disease that has immediate short run probabilities of high morbidity and mortality and significant unknown long run consequences, people will be out and about.  Widespread testing is a way to achieve that goal even as we are also working on multiple separate tracks for vaccination, therapeutics and behavioral modifications such as masks.

 

 

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Reader Interactions

80Comments

  1. 1.

    germy

    September 1, 2020 at 8:46 am

    The testing cost them a good chunk of their discretionary fnuds for the month of August

    What kind of country is this?

  2. 2.

    arrieve

    September 1, 2020 at 8:46 am

    I’m so glad your parents were able to have this visit. More testing is just common sense, if there was any to be found in this shitshow of a response. I don’t understand why the concept that controlling the virus has to come BEFORE re-opening schools and businesses is so hard to understand for so many people.

  3. 3.

    bbleh

    September 1, 2020 at 8:50 am

    @germy: Exactly.  Clinics and labs are overcharging wildly for testing — it’s basically blackmail.  States and local governments don’t have the money.  And the federal government is sitting on its hands.

    Business and a Republican president, working together to make you poor AND sick!  Nice job, Republicans!

  4. 4.

    SiubhanDuinne

    September 1, 2020 at 9:07 am

    Mazel tov on the latest addition to your family! It’s great that your folks got to hold and put some love on their new grandson, and play with his big sister!
    But how insane a world country this is when people have to pay out the nose to get swabbed up the nose, just so they can do something lovely and normal.

  5. 5.

    Mary G

    September 1, 2020 at 9:10 am

    Congratulations to the happy grandparents and to you on the new nephew. If we can get Democrats elected I have faith that Joe Biden will finally do what needs to be done. I hope. Of course 27% of America won’t cooperate.

  6. 6.

    Auntie Anne

    September 1, 2020 at 9:10 am

    THIS.  If we’d used our lockdown time to ramp up a federal testing strategy, we could have had a more normal summer.  I am so angry about what little the government has done – all of it badly – that I would crawl over broken glass to vote in November.  ALL of the deaths and pain are on the Republicans.

  7. 7.

    sdhays

    September 1, 2020 at 9:18 am

    We’re grappling with this same issue. My parents live 900 miles away. They had been visiting every 3 months or so to see their grandson, who is just now 1.5 years old. They usually fly in. They were last here in February, and it’s hard just doing Zoom calls.

    They recently brought up driving out to see us. 900 miles is a long drive, and my mother in particular doesn’t do well on long drives. They’ve done that drive a couple times before and had decided not to do it again. But COVID seems to be forcing our hand. We of course want to see them (and have some non-parent time again), but I don’t know what’s safe. You can’t drive for 12+ hours and not stop anywhere. It would be better if they felt like they could stop at a hotel. And we’ve been pretty hermit-like, but will my parents be as safe in Northern Virginia as they are in downstate Illinois? Will they be safer?

    I don’t even know what to suggest.

  8. 8.

    bluefoot

    September 1, 2020 at 9:19 am

    Half of my siblings couldn’t see my mother as she was dying of cancer in April because there was no testing.  The sister of one of my best friends waited for TEN DAYS for the result of her and her childrens’ test just a couple of weeks ago.  (Her husband caught COVID at work.)    I know many teachers and health care workers who haven’t been able to get tested, and have employers who insist on them coming into work even with symptoms.

    Testing here in the US is a farce, except for the people coming into contact w Trump, and professional sports players.

  9. 9.

    Capri

    September 1, 2020 at 9:20 am

    I sheltered in place and then drove from Indiana to Reno, Nevada so that I could spend time with my new grandson.  A huge hassle but worth it.  Around me, testing comes back in 7-10 days if you’re asymptomatic, so it’s not any help.

  10. 10.

    JPL

    September 1, 2020 at 9:28 am

    The country we live in is one that the HHS spends 250 million in advertising telling us everything is fine.

  11. 11.

    Aleta

    September 1, 2020 at 9:32 am

    @germy: It’s the kind where some make millions on protection.

  12. 12.

    Mel

    September 1, 2020 at 9:34 am

    The keys here are free/ cheap testing, availability of testing, and reliable testing.

    We are still pretty far from achieving those benchmarks, though. Too many of the available swab tests have an unacceptably high false negative rate, and the fact that many testing locations require a “drive up” process knocks anyone without a vehicle out of the picture.

    Add to that the fact that the expense of tests (even for copays) is out of the range of feasibility for many, and that  the CDC’s new “guidance” excludes many who should be tested, and testing is nothing short of a fiasco in most parts of the U.S.

    Still, testing needs to be the answer, at least until we have widely disseminated, safe and effective vaccines. We just have to do it properly, with tests that we can rely on, quick results, and enforceable quarantine and organized, effective contact tracing for any people testing positive.

    The question is how do we manage to do that in the current environment?

    (FYI, a former coworker had fever, diarrhea, gastrointestinal pain, and had been exposed to an infected person a week earlier. Three nasal swab tests [drive up pharmacy parking lot testing and also primary care setting] came back negative, but when he called his gastroenterologist, a rectal swab was performed and came back  positive, as did blood antibody testing. Covid-19 does not always roost just in the respiratory system…)

  13. 13.

    J.

    September 1, 2020 at 9:40 am

    Wait. I thought testing was covered by insurance. Can you please explain, David? Also, my mother, who lives in Cambridge, MA, had problems getting tested. She didn’t have symptoms, so was constantly told she couldn’t get tested. She went to a place where they said she could get tested, but there was a long line, and she didn’t want to bake in the sun for an hour. It took her around a month to finally get tested someplace and then several days to get the result. (She is in her 80s and healthy and wears a mask most of the time but travels and socializes and we and others had encouraged her to get tested, just in case.) This is not progress or good.

  14. 14.

    germy

    September 1, 2020 at 9:43 am

    As a former health insurance exec, I know how rich corporations rake in billions by blocking life-saving procedures, hiking premiums & now exploiting a public health emergency. I often get asked what folks can do to help expose, shame & stop these swindlers. Here's what: (1/4)

    — Wendell Potter (@wendellpotter) August 31, 2020

  15. 15.

    Edmund Dantes

    September 1, 2020 at 9:47 am

    It still wouldn’t work in this country. And David even mentions the reason why.

    Did everyone spot it?

    I’ll give you the paragraph.

    Testing is the way out.  Massive, widespread, common and cheap testing that is accurate enough where we have a good deal of confidence that a negative is a true negative even if a positive is likely to be a positive is the way out.  If people are able to test several times a week with results that are returned by the end of a cup of coffee, then 95% of normal, December 2019 expectations based, life can resume as long as people who don’t get negative results isolate until confirmatory diagnostic testing can sort false positives into true negatives and likely positives.

  16. 16.

    Amir Khalid

    September 1, 2020 at 9:49 am

    Is there a reason price controls on Covid-19 testing are not an option over there?

  17. 17.

    charlucklesWe

    September 1, 2020 at 9:54 am

    @sdhays:

    We pulled a 1700 mile road trip to bring the kids to their Grandmas for two weeks.  We ended up doing a lot of roadside breaks with a cooler and a bucket.

    I was really impressed with how corporate hotels are handing it.  Even in the midwest the larger chains were clearly taking it very seriously with strict mask requirements, room doors being closed and sealed with a “cleaned” sticker etc.  This was after two weeks of at home isolation and a nasal test.

    In fact, we felt really good about the road trip option except for the very last night.  We ended up at a chain hotel where unfortunately there was a large baseball tournament happening.  The staff was fantastic and doing all they could but with several hundred intoxicated jerks running around being asshats about the masks and distancing mandates it was just a mess.

  18. 18.

    Omnes Omnibus

    September 1, 2020 at 9:55 am

    @Edmund Dantes:  Say what you want to say. I don’t feel like play cynicism charades this morning.

    @Amir Khalid:  Until January, yeah.

  19. 19.

    germy

    September 1, 2020 at 9:55 am

    @Amir Khalid:  Politicians take donations from people who don’t want price controls.

    Some of the politicians spend hours on the phone asking for those donations.

  20. 20.

    Cheryl Rofer

    September 1, 2020 at 9:55 am

    @Amir Khalid: Price controls can be invoked as part of the Defense Production Act, which Trump continues to ignore.

  21. 21.

    TaMara (HFG)

    September 1, 2020 at 9:55 am

    Having spent the last month immersed, once again, in the health care system of one of the richest countries in the world, I was reminded how completely fucked up our system is.

    Grateful that surgery was available to save my dad. But now we worry – will the flight-for-life bankrupt my parents (and was it necessary – ambulance time vs. flight were almost identical once all was said and done). And post-stroke treatment is an eye-opener on how healthcare/insurance has just gotten worse since the last time I had to deal with a serious illness.

    Trying to get tested before a necessary trip to make sure my very ill mom was taken care of was a joke. The questions they asked before I could see my dad in rehab, equally laughable. I now know 5 people who have had covid, of all of them, only one had a fever and that manifested after they were too sick to even get out of bed.

    Should healthcare be a priority in the coming Biden administration? Absolutely – and we know it would be so easy to emulate an existing program working for other developed societies. But that’s not going to happen.

    So it’s probably going to suck all the oxygen out of legislation that should be focused on the climate crisis, which is going to make the pandemic look like a minor inconvenience by comparison.

    WASF

  22. 22.

    David Anderson

    September 1, 2020 at 9:57 am

    @J.: Will do a post on this tomorrow (writing a white paper that touches on this a lot right now)

    3 different types of testing regimes:

    a) Diagnostic — used to rule-in or rule out COVID under the direction and advice of a trained medical professional (TMP)  — this is covered by insurance

    b) Screening — not under the advice of a TMP and not being conducted on the basis of reasonable probability of exposure.  CARES ACT does not require insurers to pay

    c) Surveillance — used for public health decision making to understand pandemic contours in a region and shape public policy.

    My parents took an almost perfect definition of a Screening test.

  23. 23.

    germy

    September 1, 2020 at 10:04 am

    My colonoscopy was $587 AFTER insurance. And sometime you have to fight like hell to get certain screenings covered because the recommended age. These blanket “go get tested” messages ring hollow as hell in a country where people cannot afford it.

    — Breya M. Johnson (@TheBlackLayers) August 29, 2020

  24. 24.

    Omnes Omnibus

    September 1, 2020 at 10:07 am

    @David Anderson: Makes me think….  If I were a primary care physician, I might get yelled at by insurance companies for sending people for diagnostic testing at the drop of a hat.

  25. 25.

    randy khan

    September 1, 2020 at 10:08 am

    Not to worry – The Trump team now includes someone who has figured out herd immunity.  He’s entirely willing to break a few eggs to make a reelection omelet.

  26. 26.

    Edmund Dantes

    September 1, 2020 at 10:14 am

    @Omnes Omnibus: not cynicism. Empirical fact of the selfish idiots in this country. The type that would vote to re-elect Trump.

    There are stories all over, including on the  comments section of this blog, of people with known positive results still going out and visiting others (including vulnerable populations) when they knew they were sick.

  27. 27.

    Mel

    September 1, 2020 at 10:17 am

    @germy: This.

    Love it how a “screening colonoscopy” is “free”, unless they find anything at all (a polyp that needs to be removed, etc.), and then suddenly the (yes, very important and very necessary) free screening that insurers mercilessly nag you to get is no longer considered “free” or a “screening”.

    These are the types of loopholes that bankrupt people on the edge, and prevent people from seeking necessary care, all the while allowing insurers to comply with the letter of the law but not the intent of the law.

  28. 28.

    The Moar You Know

    September 1, 2020 at 10:19 am

    I don’t even know what to suggest.

    @sdhays: In all seriousness: rent an RV large enough to sleep in, with a good bathroom.

    I would not stay in a hotel for anything right now. At the best of times, all but the ultra-high end ones had sketchy sanitation. These are not the best of times.

  29. 29.

    Omnes Omnibus

    September 1, 2020 at 10:22 am

    @Edmund Dantes: And yet there are shitloads of people who could live a much more normal life if quick, accurate, and inexpensive testing were available.

  30. 30.

    PAM Dirac

    September 1, 2020 at 10:22 am

    @David Anderson:

     

    3 different types of testing regimes:

    I had just noticed this the other day regarding the web page with all the FDA EUA for diagnostics. Almost all of them have the phrase “individuals suspected of COVID-19 by their healthcare provider”. That includes the Abbott $5 test on a card. I didn’t bother to go though the almost 200 EUAs but it sure is sobering to realize that most COVID tests haven’t been authorized for the screening setting even on an emergency basis.

  31. 31.

    The Moar You Know

    September 1, 2020 at 10:23 am

    Another issue to be addressed with widespread testing is quarantine with teeth in it.  One of the four co-workers of mine who tested positive went out while waiting for their test results, knowing they were likely ill.  That’s a crime on the books already in most places.  It needs to start being enforced.

    If they’d come back into the workplace (we’ve made this REALLY clear to everyone) we would have fired them.

    I don’t know what you do with people like this short of throwing them into a wood chipper and fining their parents for having raised an amoral monster.

  32. 32.

    Ceci n est pas mon nym

    September 1, 2020 at 10:26 am

    Testing is the way out. Massive, widespread, common and cheap testing that is accurate enough where we have a good deal of confidence that a negative is a true negative even if a positive is likely to be a positive is the way out.

    We have had this conversation a number of times and come to the same conclusion.

    My wife and I are over 60 and so far manage to live our life entirely isolated in our cave. Routine (or non-routine) medical or dental care will probably be the thing that causes us to break our own personal lockdown eventually. My hair is just going to do whatever it’s going to do, it will just have to wait.

    We normally host the Thanksgiving. That is not happening. It will be via Zoom. The family agrees, nobody is going to feel like traveling let alone gathering by November. (I suggested carving the turkey and dropping bits of turkey and gravy into envelopes to mail to everybody, but that suggestion hasn’t been very enthusiastically received)

    Will we host Thanksgiving 2021? Will there be a Thanksgiving 2021? We pretty much agree with you, David. We will be with people when there is testing that can give us pretty good confidence that the people we are with are virus free. The dentist tells us they are routinely checking temperatures, but that is almost pointless due to the danger from asymptomatic carriers. Testing. Testing.

    So we are in our cave as a minimum until:

    • Biden wins and takes office
    • There is a national policy to fight the virus
    • Testing is widespread, cheap and reliable
    • We trust what the government is saying again
    • And possibly: we are vaccinated with a vaccine that we trust is tested and effective, which requires the first four points.
  33. 33.

    Another Scott

    September 1, 2020 at 10:26 am

    @sdhays: Maybe meet them halfway?  Dayton?  Cincinnati?

    Hotels are not busy now.  It should be easy to find one with one’s choices of rooms and not have to worry about crowding.

    One has to be careful anytime one leaves one’s home bubble, of course.

    Best of luck and stay safe!

    Cheers,
    Scott.

  34. 34.

    Jeffro

    September 1, 2020 at 10:27 am

    @Auntie Anne: yup

    Here’s the Post, back in May: We Could Be Back to Normal by July 4th (if only we’d ramp up on testing)

    Here it is September 1st, and we’re still nowhere close.  Still limping along, shut out from most of the rest of the world, kids not in school, two 9/11s per week from COVID.

    But then again what did we expect in Joe Biden’s America???

  35. 35.

    The Moar You Know

    September 1, 2020 at 10:28 am

    Is there a reason price controls on Covid-19 testing are not an option over there?

    @Amir Khalid:  something something liberal fascism

    In all seriousness, we don’t do price controls on anything in America, and anyone who tries will be smeared as a communist and hounded from office.  The last time we did was 48 years ago under Nixon in an attempt to fight inflation.  It will not happen again in my life, I suspect, even though WRT to drugs we desperately need it.

  36. 36.

    Ceci n est pas mon nym

    September 1, 2020 at 10:37 am

    @Cheryl Rofer: If he’s elected, he’ll take action and fix it. I have it on authority from the best sources.

    It brings to mind the scene from “O Brother, Where Art Thou?” where Pappy’s son suggests Pappy run on reform. “I’ll reform you, you soft-headed son of a bitch! How we gonna run on reform when we’re the damn incumbent!”

    Well, you all thought that was a joke, but Trump is such a political genius that he’s actually doing it! Checkmate, libs!!

  37. 37.

    randy khan

    September 1, 2020 at 10:40 am

    @The Moar You Know:

    Based on what we know about transmission, motels (the kinds with rooms that open to the air) probably are pretty safe for COVID-19, even the kind of sketchy ones.  (This is not to say the sketchy ones are safe in general.)  Hotels are less safe, but if you wear a mask any time but while you’re in your room they actually should be okay.  (And moderately-priced hotels that have individual heating/cooling units are better than hotels with central air.)  Transmission risk is highly dependent on exposure to other people, and it doesn’t appear that COVID-19 lives very long on surfaces.

  38. 38.

    sdhays

    September 1, 2020 at 11:18 am

    @charlucklesWe: Thanks, that’s good to know about the hotels.

  39. 39.

    sdhays

    September 1, 2020 at 11:20 am

    @The Moar You Know: That’s an interesting idea. Thanks.

  40. 40.

    Suzanne

    September 1, 2020 at 11:35 am

    @charlucklesWe: We drove from Phoenix to Pittsburgh, with children and pets, in May. It went surprisingly well. I stocked each of the two vehicles with a box of sanitizers, disinfecting wipes, gloves, masks, etc. (this was when we still thought fomite transmission was the big vector). We stayed at La Quintas each night because they take pets, and we got takeout and brought it to the room to eat. Social distanced the whole time without problems. We did have to stop at convenience stores to use the bathrooms, so we masked up and just did it as quickly as possible.

    It really was okay. If you take precautions and keep interactions short, you can do it.

  41. 41.

    artem1s

    September 1, 2020 at 11:41 am

    this is why federal oversight is so important. we had the Cleveland Clinic convert a massive part of one of their buildings to treat critical care patients and then they torn it all down again, because they put it up too soon for when the real wave hit Ohio, and they had to have it down again for starting up classes. If they had some direction, they and the rest of the research healthcare nonprofits and universities could have been converted to testing facilities and actually provided no or low cost testing to most residents of the state.  but DeWine was too afraid of the gun humpers to cancel football and mandate state wide testing protocols before he reopened the schools.

    Too bad we have to wait for Biden’s team to get up and running before we can actually have a well run testing and tracing program in place anywhere in this country.  I think he should just start on Nov 4 and tell the cabinet to get on board or turn in their resignations and face criminal charges for negligent homicide come January.

    going outside and spitting and cursing now

    spit AND curse

  42. 42.

    Suzanne

    September 1, 2020 at 11:44 am

    @randy khan:

    (And moderately-priced hotels that have individual heating/cooling units are better than hotels with central air.) 

    There is no evidence of this that I have seen from my mechanical engineer colleagues. “Central air”, by which you mean a large multi-zone air handler, usually has significant filtration on it. And even though air is usually returned to the handler, it is mixed with a certain amount of outside air. I will point out that most hospitals have large air handlers and transmission in hospitals has come way, way down since this pandemic began. Infections of this type, and evidence continues to reveal, mostly come from close and sustained contact between people sharing space.

  43. 43.

    phein61

    September 1, 2020 at 11:47 am

    @Auntie Anne:   We could all be doing what the University of Illinois is doing in Champaign-Urbana.   My wife and son are tested twice a week, informed of the results by app, and have to have negative results to get into any buildings on campus (they have bouncers at doors, too).

    There’s only one reason that we aren’t.

  44. 44.

    Suzanne

    September 1, 2020 at 11:49 am

    @artem1s:

    we had the Cleveland Clinic convert a massive part of one of their buildings to treat critical care patients and then they torn it all down again, because they put it up too soon for when the real wave hit Ohio 

    I was actually a part of Cleveland Clinic’s surge planning effort. It was always intended to be for non-COVID patients, so that critical patients could use the actual hospital resources. It was taken down because those non-COVID patients didn’t materialize. That “field hospital” never saw a single patient, and it’s because it wasn’t needed.

    They are not unique here. The USS Comfort, and the “surge hospitals” built in stadiums….. saw next to no patients.

  45. 45.

    Suzanne

    September 1, 2020 at 11:54 am

    I will also note that now that we know that COVID is overwhelmingly spread through respiratory droplets and not via fomites, it is a VERY good thing that those “field hospitals” didn’t see COVID patients. Those places would become nothing but essentially “gas chambers”.

    Hospitals got away from shared patient rooms and open wards and went to single patient rooms for exactly this reason. It is much more resource-intensive, but it works. Separate spaces save lives.

  46. 46.

    trollhattan

    September 1, 2020 at 11:57 am

    Testing is the way out. Massive, widespread, common and cheap testing that is accurate enough where we have a good deal of confidence that a negative is a true negative even if a positive is likely to be a positive is the way out.

    Agree. Kiddo begins week two of her college experience (experiment) with across-the-board testing every seven days–sounds like similar/the same 20-minute turnaround. IDK what portion of class time is in person and how they’re finagling the details. She’s also keeping up a training regimen while they can’t have formal training, due to all form of sportsball being pushed back to spring.
    None of that happens without relentless testing, and proper response for any positives.

  47. 47.

    VeniceRiley

    September 1, 2020 at 12:00 pm

    I had just noticed this the other day regarding the web page with all the FDA EUA for diagnostics. Almost all of them have the phrase “individuals suspected of COVID-19 by their healthcare provider”. That includes the Abbott $5 test on a card. I didn’t bother to go though the almost 200 EUAs but it sure is sobering to realize that most COVID tests haven’t been authorized for the screening setting even on an emergency basis.

    Another issue to be addressed with widespread testing is quarantine with teeth in it. One of the four co-workers of mine who tested positive went out while waiting for their test results, knowing they were likely ill

    So wait. I thought the gubmint ordered 150million of the Abbot $5 card tests for … IDK, schools and such? The FDA needs to get off their duffs on this. We aren’t getting back to normal until travel is also back to normal. And no way am I getting on a plane full of selfish aholes who prioritize their own convenience over the health of everyone on board. We need before flight clearances. Nor would I go to school or indoors resto or theater or …
    So. Agreed. We need to get moving on testing for everyone! And we need it yesterday. And we need some cheap drugs EUA approved … pills or inhalers … that prevent or at least prevent severity, until vaccines are available. This dawdling for all the infected not hospitalized is insane.

  48. 48.

    David Anderson

    September 1, 2020 at 12:12 pm

    @VeniceRiley: Those tests are probably not going to be available until early October.

    Manufacturing pipelines are a pain in the ass and real.

  49. 49.

    Roger Moore

    September 1, 2020 at 12:14 pm

    @arrieve:

    I don’t understand why the concept that controlling the virus has to come BEFORE re-opening schools and businesses is so hard to understand for so many people.

    Because they have the patience of a four-year-old.  They want things to be open now, now, now, not in a few months when we have a good testing infrastructure in place.  Of course we could have had the virus under control now if people hadn’t been in such a damn hurry to reopen earlier, and if our toddler-brained excuse for a president had done his damn job and used his power to develop a real testing (and tracing and quarantining) infrastructure.

  50. 50.

    Ohio Mom

    September 1, 2020 at 12:15 pm

    If I was going on a long car trip, I might try to stay at little Bed and Breakfasts in private homes where the windows can be opened, providing lots of fresh air. If there are any that are still open for business.

    The idea that rooms with individual heating/cooling systems might be safer makes intuitive sense. Up until right now, always hated them because they are so noisy! It’s usually hard enough to fall sleep in a hotel room without that racket (I get why Bush II was reported to take his own pillow with him on tne road).

    I’d also check the Covidactnow.org site and plan which counties I’d avoid/stop in accordingly.

    But this is all theoretical for me, I’m not leaving my immediate vicinity for the foreseeable future.

  51. 51.

    patrick II

    September 1, 2020 at 12:21 pm

    A few weeks back I read a story (perhaps here at BJ) that as part of the NBA’s effort to start up their league again, they needed good testing.  So, they invested in what was at the time a promising test protocol, developed at a university, that needed only saliva to work at 90% accuracy.  The NBA said they were publishing the test protocols free and anyone could use them. Because the protocol is free to use and there is not the overhead of nurses or medical staff to take the saliva, the tests could be very inexpensive — in the area of $10 or $15.

    So, when I hear something like this, I get my hopes up, but really kind of expect nothing to happen. But it leads me to some questions/

    If you say you have a protocol, what does that mean?  A meta-language procedure that can be turned into code on various testing machines?  Or do I not understand what this type of protocol is at all?

    How diverse are the testing machines.  Do they all use the same operating system?  Is there a significant difference in their input and output mechanisms?  How difficult is it to take a protocol written in whatever high-level language and turn it into code onto various testing machines.

    What programming language is normally used to code the test machines?

    The basic thing I am curious about is the difficulty of starting with a protocol and physically making it widespread.

    And that’s not even to begin with the difficulties of logistics and the presence of existing contracts.

    It would be nice if we had a president with a plan.

  52. 52.

    J.

    September 1, 2020 at 12:24 pm

    @David Anderson: Thank you for the explanation. FYI my husband, who had no symptoms, was unable to get a Covid test here in CT this summer, but he was able to get an antibody test, which was covered by insurance. (We thought he might have had Covid back at the end of February, after attending a meeting of healthcare technology contractors in Dallas and getting sick.)

  53. 53.

    MazeDancer

    September 1, 2020 at 12:27 pm

    What a sweet, wonderful story, well told.

  54. 54.

    patrick II

    September 1, 2020 at 12:30 pm

    I finally got up the nerve to get a procedure done at a local hospital.  To get the procedure I had to get a covid test.  To get the covid test I had to sit in a waiting room with about forty people for about an hour.  We wore masks though.  I was confident going in I would be ok, less confident afterward.

  55. 55.

    joel hanes

    September 1, 2020 at 12:31 pm

    I had planned to live at least half of 2020 in Iowa, living with my 87-year-old mother and helping her out, but I was in California when February happened.

    I am waiting for an adequate testing regime to be available in Iowa.

    Unfortunately, Iowa under Republican governance has the worst infection rate in the nation, and a Republican-ideologically-correct privatized testing regime that has failed the state’s people.

  56. 56.

    Roger Moore

    September 1, 2020 at 12:31 pm

    @David Anderson:

    Manufacturing pipelines are a pain in the ass and real.

    And anything that needs to be done to serious quality specifications needs to be done very carefully indeed.  The last thing we want is tests with hidden manufacturing defects.

  57. 57.

    patrick II

    September 1, 2020 at 12:33 pm

    @David Anderson

    At #51 I asked questions about covid testing infrastructure.  Is there a site(s) that you know of that would be helpful in learning about that?

  58. 58.

    VeniceRiley

    September 1, 2020 at 12:35 pm

    @David Anderson:

     

    October is fine, considering.

    “Almost all of them have the phrase “individuals suspected of COVID-19 by their healthcare provider”. That includes the Abbott $5 test on a card.”

    This is the part that concerned me. We need the FDA to approve testing for anyone entering or attending a facility, plane or school! Not just the ‘suspected positive’ cohort they have currently approved.

  59. 59.

    Roger Moore

    September 1, 2020 at 12:40 pm

    @patrick II:

    If you say you have a protocol, what does that mean? A meta-language procedure that can be turned into code on various testing machines? Or do I not understand what this type of protocol is at all?

    In scientific speak, a protocol is a detailed procedure to follow.  It will spell out exactly what reagents and equipment to use and then a step-by-step procedure.  It will also include a description of what positive and negative controls are necessary to get the quality of results you want.  In practice, it may include some degree of flexibility.  For example, it may let you use different brands of machine, with slightly different steps defined for each brand of RT-PCR machine.

  60. 60.

    Kirk Spencer

    September 1, 2020 at 12:48 pm

    I want cheap fast adequate testing for a selfish reason. I am one of the millions of non-healthcare essential workers. At my place of employment we use temperature screening daily because it’s what we have. Give us a test that we can afford to use daily as work is beginning and we’ll take it. Personally, given the way odds work I’d be happy with 60% accuracy, positive requires a better but slower follow up test. Because odds of someone false negative multiple days in a row is slim.

    But again that requires cheap.

  61. 61.

    trollhattan

    September 1, 2020 at 12:53 pm

    @Kirk Spencer:

    IMHO temp screening especially for populations that skew young is close to worthless and perhaps worse, lending a false sense of security. Since so many infected young people are asymptomatic you’ll only flag a fraction of those infected, even as they shed virus.

  62. 62.

    patrick II

    September 1, 2020 at 12:58 pm

    @Roger Moore:

    Thank you.

  63. 63.

    rikyrah

    September 1, 2020 at 1:01 pm

    I don’t know why, but I teared up reading this.

    Thank you for this post.

  64. 64.

    Matt McIrvin

    September 1, 2020 at 1:09 pm

    It helps that they live in Massachusetts where testing is common and community prevalence is low.

    Not as low as it should be, goddammit. If Baker had just delayed phase 2 by, say, four more weeks we’d be in so much better shape now.

    But the testing situation is a bright spot. After some delay, It’s ramping way up and at least some of the recent increase in detected cases probably is from increased test coverage. It feels like we’re running in place sometimes, though, and the school openings will probably make it worse.

  65. 65.

    burnspbesq

    September 1, 2020 at 1:23 pm

    One long-term takeaway from this pandemic, that has relatively little to do with the disease per se, is about the fragility of supply chains.

    There was never really a shortage of toilet paper; but when you couldn’t find it at your supermarket, there were rail cars of it piling up in the distribution centers of suppliers to commercial and industrial users. Nobody knew how to divert it from one channel to the other. Similar situation for a lot of food items; it’s like there is an impenetrable wall between grocery and Foodservice.

    And if you thought about buying a bicycle in the spring or early summer, you know what I’m talking about.

    We still have a lot to learn about making supply chains nimble. Will we learn it? Who the hell knows.

  66. 66.

    VeniceRiley

    September 1, 2020 at 1:31 pm

    @Kirk Spencer: I’m IN healthcare and temp screening + self report symptom survey is what we have as well. They’re going to start testing us, frontline senior care services first (once a month!) and then roll out to the rest of us. I mean, we run testing sites and it’s just infuriating that by now we do not have faster better cheaper testing available. What a fail.
    Mask. Wash. Social distance. haven’t seen my fiancé since February.

  67. 67.

    WaterGirl

    September 1, 2020 at 2:01 pm

    @VeniceRiley:

    haven’t seen my fiancé since February.

    That’s awful.

  68. 68.

    VeniceRiley

    September 1, 2020 at 2:06 pm

    @WaterGirl: Not counting WhatsApp! LOL but we should be married by now and she is already living alone (plus dogs) in our new awesome house on the other side of the world.

    Meanwhile, for hospitalized patients, I read good news and predict an EUA for this treatment currently in trial has very good outcomes:
    https://www.biospace.com/article/releases/humanigen-company-update/

    very cool because an IL-6 inhibitor in phase 3 crashed out today.

  69. 69.

    Another Scott

    September 1, 2020 at 2:12 pm

    @VeniceRiley: Thanks for the pointer.  That looks like genuine good news.

    Best of luck with the home front!  :-(  Things will get better.

    Cheers,
    Scott.

  70. 70.

    VeniceRiley

    September 1, 2020 at 2:22 pm

    @Another Scott:  thanks Scott. I’m cool for now. My roommate is going into hospital for neck surgery, and I was able to take a load off her mind by pre-paying 2 months rent and 100% of expected typical utilities, so she won’t have to worry about covering her bills while convalescing at her parents for care purposes. I’m glad to have a steady job while I wait this pandemic out. And now, if I catch it here at the clinic, I will have a safe space to quarantine. I just hope she doesn’t catch it in hospital.
    As for my fiancé I hope she doesn’t catch it at the prison.  they’ve isolated but aren’t masking or PPE unless transporting prisoners to hospital.

    In political news: Biden/Harris crushed it in Aug fundraising hitting record 300mil.

  71. 71.

    KayInMD (formerly Kay (not the front-pager))

    September 1, 2020 at 2:41 pm

    My adult son, who lives with me, is upstairs waiting for results of a test he took yesterday. He has to text to make sure no one else is in the kitchen before he comes down, wearing a mask, to get something to eat. He doesn’t have a fever, just cold symptoms that are probably due to allergies, but our state is currently #5 in active cases per million so… No point taking chances. I’m sitting in my own kitchen wearing a mask. Such is the state of our healthcare system. I didn’t ask him if he had to pay for the test, or if his insurance covered it. He’s lying low.

    The irony is, he may already have had it, all the way back in early March when you could only get tested if you could prove you were directly exposed to someone who was actively sick and had tested positive. He was exposed to one of the first tree people in our state confirmed with the virus, she was already carrying the virus, but because she hadn’t yet been notified, it didn’t count and he wasn’t eligible for testing. He didn’t have what we thought of then as the classic signs of the virus, so we don’t know whether he had a lighter case or a really bad cold.

  72. 72.

    David Anderson

    September 1, 2020 at 2:50 pm

    @patrick II: Testing Commons by Arizona State University is a good spot;

    a Duke Margolis white paper has a brief bit on this

    https://healthpolicy.duke.edu/publications/legislative-and-regulatory-steps-national-covid-19-testing-strategy

    It is fairly opaque which is problematic.

  73. 73.

    Sab

    September 1, 2020 at 2:53 pm

    @KayInMD (formerly Kay (not the front-pager)): My husband is climbing the walls waiting for his test results. Slight fever end of last week. Got tested Sunday at CVS. He can’t quite figure out how to login to MyCharts (he has a MyCharts account through his insurer/hospital system, but apparently it doesn’t speak to MyChartsCVS. Ohio testing does seem to be sort of available for adults, at least if they are old. Results are supposed to be timely ( 2-4 days) for seniors with the computer skills to access them.

    I personally don’t think he has it, but I am laying low and keeping quiet because if he DOES have it he caught it from me because I do the shopping.

    I was hoping to do more during my retirement thank wash and fold face-masks and cotton gloves. I am enjoying the time to cook, and it shows at our waistlines.

  74. 74.

    JCNZee

    September 1, 2020 at 3:07 pm

    @VeniceRiley: Every word in your post was exhilarating!

  75. 75.

    JCNZee

    September 1, 2020 at 3:11 pm

    @VeniceRiley: (except for these words) “As for my fiancé I hope she doesn’t catch it at the prison. They’ve isolated but aren’t masking or PPE unless transporting prisoners to hospital.” Crossing fingers for her.

  76. 76.

    VeniceRiley

    September 1, 2020 at 3:16 pm

    @JCNZee: Thank you. At least she got promoted to a Governor. I was about snatch myself bald!

  77. 77.

    Sab

    September 1, 2020 at 3:23 pm

    Testing is so slow it isn’t all that useful. Thanksgiving is goimg to suck big-time this year. Bake pies wearing masks, then Zoomchat with the grandkids next door while they eat turkey and our pies and we tuck into our tiny chicken carcass. At least they are next door. We wave at them over the fence. We can feed chicken giblets to their dog.

    They are out and about more than we are comfortable with, but five half-siblings in four different households, plus cousins. How on earth do you socially distant and keep families intact and in touch.

  78. 78.

    randy khan

    September 1, 2020 at 4:08 pm

    @Suzanne:

    The problem with central air systems is not that they aren’t filtered going into the room – it’s that they push air through the room.  The now-classic example of transmission in a closed space for COVID-19 was a restaurant where the flow from the air vent went from a table with an infected person over several other tables, and people at the other tables got infected.

    That said, on reflection probably central air is no worse in an individual room than in-room units, given that it stays in the ducts from the chiller/heater to your room, so I’m probably wrong that it matters what kind of unit you have.

  79. 79.

    WaterGirl

    September 1, 2020 at 5:26 pm

    @VeniceRiley: I was running a backup on my laptop which took over 2 hours, so I am late getting back to this thread.

    I must have missed most of the backstory.  Where is halfway around the world?  Is your fiancé in prison :-) or working on a prison or working in a hospital that serves a prison?

    Inquiring minds want to know!  :-)

  80. 80.

    LongHairedWeirdo

    September 2, 2020 at 12:09 am

    @Capri: I saw Bill Gates discussing this, and pointing out that the incentives are wrong.

    Labs should be given a bonus if they turn a test around in under 24 hours; normal payments on day 2 (and maybe 3), and *greatly* reduced payments afterward, where after 4-5 days, payment drops to 0 (but they’re still obligated to provide the results). That would align the incentives properly – labs would push to be able to turn around all tests in under 24 hours, and announce they’re past capacity once they’re not sure they can complete all pending tests in 72 hours.

    Waiting 7 days for an asymptomatic test is all but useless; there’s no contact tracing possible, so all you might learn is that one person doesn’t have to stay in quarantine any longer. At 10 days – isn’t the guidance something like “10 days asymptomatic and you don’t need a negative test”?

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