Frequent, and repeated testing of the currently non-symptomatic is how the NFL is playing.
Frequent, and repeated testing of the currently non-symptomatic is how Duke University is open to some on-campus, in-person instruction.
Frequent, and repeated testing of the currently non-symptomatic is the way out once we get the supply chain resolved.
I was part of a team that made this argument in a recent Rockefeller Foundation funded work: We built off the work by the Larremore Lab on the trade-offs between test sensitivity, turn around time and cadence.
There are a wide array of options to get significant reduction in (R), the reproductive rate.
Right now, the US R rate is about 1.0 nationally with regional Rs not above 1.5. Any R above 1 implies that the disease is spreading. Any R below 1 implies that the number of new cases is shrinking. The closer the the sub-1.0 R is to zero, the faster the disease spread shrinks.
The good news is that a 60% reduction in R anywhere in the country brings local R under 1.0.
In some areas, six weeks of a 60% reduction in R from the current level effectively stomps the virus out of local community spread. In other parts of the country, a 60% reduction means a long, slow slog of a decline.
We don’t, in general, need to get 90%+ R reductions for the general population. We just need 30%-40%-50%-60% reductions and then hold those for a few months. We can do that.
The big constraint right now is logistics. We estimated that a risk based testing strategy for just public schools and nursing homes+ residential care facilities based on late August prevalence would need 190 million tests per month. We don’t have that. We won’t have that number for a while. However, increasing the testing supply to start crushing local spread to reduce prevalence and thus testing needs is a potential strategy.
We have ways out. A fully integrated approach of testing, broad community surveillance through COVID-like Illness syndromic surveillance and sewage monitoring, mask wearing when out and about, and interaction management so that as many of a limited number of interactions occur in well-ventilated areas is a way out.
WaterGirl
The University of Illinois that’s doing the twice a week testing for everyone wrote over two weeks ago to say that some people weren’t following the rules and they were going to have to shut down if undergrads didn’t straighten up and fly right.
It’s been over two weeks since then and they haven’t closed and face said it was turning around so I agree with you that frequent testing of everyone is how we turn this around.
Betty
Couldn’t you just cry? This was obvious early on. Without testing, you simply do not know where the virus is. So many lives lost with more to come. Tragic.
Cheryl Rofer
We have to do everything, but testing is the biggest right now.
The cool thing about the calculations is, like those you’ve presented here, is that none of the interventions have to be perfect, but each adds to reducing the spread. So masks are still required, even when we have adequate testing. And a vaccine will help more.
What would also help is an administration that is committed to reducing R and keeping people healthy. 40 more days in the wilderness.
WaterGirl
Apropos of nothing except Covid today’s the first day of early voting where I live. I got here 30 minutes early and there is already a line forming Inside the gymnasium. There are never lines here ever.
so that’s good! Except I’m not gonna stand in a line inside the building.
So I’m in my car and I’ll wait 45 minutes or so till early on the early people are done and then hope it’s not like this all day.
edit: it’s Almost entirely older people, so I don’t know if that’s good or bad.
David Anderson
@WaterGirl: Every additional, incremental early vote removes variance from the system. High variance is the only chance for a candidate who is currently behind. A day where nothing changes but more people vote is a very good day for the Biden campaign even if everyone who is voting is an a priori highly likely voter.
Matt McIrvin
None of this will ever happen as long as the people in charge equate sickness with weakness and think strong people can’t get COVID.
Walker
We had some clusters at the start. But we are doing twice a week testing and are aggressively quarantining every single positive in the campus hotel (I got quite a few official letters that first week about students that would have to have virtual instruction for two weeks). It seems we have it under control now.
Benw
High school me never ever thought I’d say this: Please please please test us more! MORE TESTING!!
Mike J
@Cheryl Rofer: Having multiple ways to lower risk all working together is probably a better way to go about it in the long run than waiting on a 100% effective vaccine that will never happen.
The down side politically is the anti-maskers (rightly) point out that wearing a mask isn’t 100% and (wrongly) conclude that means it’s worthless.
Mart
I have looked at this from many angles, all the best angles actually, and I can’t figure how all that testing will help us achieve herd mentality.
Mudbrush
I’m an RN who takes care of covid patients every week. I’ve never been offered a covid test; if I develop symptoms, I am to self quarantine & seek testing & care from my primary care provider. Quarantine time comes out of my vacation & sick days. I dream of the day when the US starts to give a darn about it’s frontline workers.
zhena gogolia
@Cheryl Rofer:
40 days in the wilderness indeed.
He spends his days golfing, watching TV, babbling to his cult. Anything but doing his fucking job.
zhena gogolia
@Mudbrush:
That is disgusting.
Our university is doing testing and so far, so good, we’re still open, but it is enormously expensive and we are undergoing painful financial consequences across the board.
ETA: Which is why his “it affects almost nobody” speech enrages me so much. Beyond the 200,000 dead and millions seriously ill, we are ALL affected to greater or lesser degree.
bluefoot
@Mudbrush: My sister is a doctor and it’s the same for her. Which is ridiculous. I’ve heard the same from a lot of different frontline workers (healthcare workers of all sorts, staff at hospitals, teachers, people working at grocery stores, etc.) All this “heroes” lip service crap – as they say, talk is cheap, whisky costs money. Instead the federal govt diverts money to buying toys for the military and for fireworks.
ETA: Some of the healthcare workers I know have had to pay for testing out of pocket AND can only get tested if they show symptoms EVEN IF they’ve been exposed or live with someone with COVID. WTF??
Ceci n est pas mon nym
It’s certainly a minimum requirement for our own comfort level. In the language of math, it’s a necessary condition. But not a sufficient one.
We’ve discussed this at length of course, what would it take for us to feel comfortable among a group of strangers. That means you have to trust them to not be exposing you.
When we get to widespread vaccination and I’m personally vaccinated with a vaccine I trust to be effective and we have frequent universal testing AND all the people around me are masked, then I will begin to feel like coming out of the cave. At least I’ll re-evaluate what the sufficient conditions are.
We were out a couple days ago, went to the CVS to get flu vaccines. It was frankly terrifying. This thing is turning me, a guy who used to get cabin fever after a couple of hours at home, into a full-fledged agoraphobe.
Margaret Imber
Look at the Covid dashboards for NESCAC (small New England) colleges. It can be done.
geg6
Here’s where we stand:
https://news.psu.edu/story/632726/2020/09/22/campus-life/922-covid-19-dashboard-updated-preliminary-results-weekend
Considering that we have 24 campuses, 81K undergrads, 15K grad students and 31K full-time employees, I’m thinking we’re doing okay. Would like to see more testing, but there does seem to be quite a bit of random testing of students happening based on the traffic in my campus’ health center. I was working with a student the other day on some aid issues when he got a message that he was chosen for random testing. So I know it’s happening, but I would still like to see more. I do know that all faculty and staff who are expected to be on campus were tested before the semester began. What I don’t know is how many of us have been tested since.
WaterGirl
@Mudbrush: I’m sorry. That’s so wrong.
Another Scott
Well said, but we’re living in Donnie’s America at the moment.
Until we have sensible leadership that is actually interested in getting the virus under control, then we won’t have enough testing. The last 9+ months have taught us that.
Masking, distancing, avoiding indoor spaces with others, is the way out until Biden’s team is running things because we’re not going to have enough testing before then. And, because of Donnie’s malevolent leadership, not for months afterwards either. (It takes time and money to spin up logistics and supply chains.)
It’s infuriating that we still don’t have enough testing, PPE, and all the rest.
Grr…
Larry Brilliant – if 80% of people wore masks 80% of the time…
Thanks.
Cheers,
Scott.
Old School
@WaterGirl:
I guess voting by older people can cut both ways. Older can skew conservative, but they are also more likely to be irritated by the campaign to sacrifice the seniors for the sake of the markets.
I saw a “Old Lives Matter” sign in front of a house down the road from me next to a Biden sign.
Hoodie
@Old School: @Matt McIrvin: Trump’s comment about “virtually nobody” getting Covid is revelatory. For him, no one exists outside of his bubble, and the same appears to be true for his followers. We seem to be going through an epidemic of narcissism that predates Covid. Constantly needing to reassure yourself that you’re strong – physically and/or mentally – is part of that syndrome. Everyone is dying, some just seem to be closer to it than others. Some of us have decided to hasten the death of others out of a thought that will make us stronger to somehow avoid or transcend death.
lowtechcyclist
David – does the private sector have sufficient economic reason to get us up to the level of testing we need, or will it take government action (e.g. Defense Production Act)?
If the latter, we’re looking at January 20 + however long it takes to ramp up.
JustRuss
@Mudbrush: yep. I have a friend who’s an RN, treats Covid patience in very Red hot spot. Inadequate PPE, poor protocols to protect workers and patients, she had Covid months ago, getting a test was a time-consuming ordeal. It’s ridiculous, and horrifying.
David Anderson
@lowtechcyclist: Good question — I think on average, the motivation won’t be there as testing creates massive public externalities that aren’t paid for by the person being tested. We’ll see some entities motivated.
United Airlines is motivated in a specific use case:
https://www.usatoday.com/story/travel/airline-news/2020/09/24/united-airlines-introduces-covid-19-rapid-testing-program-hawaii/3515043001/
WaterGirl
@Hoodie: Except for his fucking brother!
edit: But since the dumpster’s development does not appear to have reached object permanence yet, I guess even that is understandable.
lowtechcyclist
@Mudbrush: @bluefoot: @JustRuss: This country has become so dysfunctional. This shit – testing, quarantine pay, etc. – shouldn’t be falling on you. It should be taken care of – by the hospitals, by the government, whoever.
The way this country is run sucks in so many ways, and it ain’t just Velveetamort. We’ve been headed this way for the past 40 years. If we win in November, we’re going to have to get serious about changing so many things starting in January.
Uncle Cosmo
But it’s a gym, right? High ceilings, reasonably strong air movement, windows near the ceiling that can (& should) be opened?
That’s about as minimally risky an indoor environment as can be found. With a good mask and an eye shield** and 6′ apart, you should be almost as safe as being en plein air.
** NB It seems that one of the routes of entry is via the eye orbs. If a full face shield is a problem, folks might want to buy one of those handyman-style eye-shields to cover that region even wearing glasses. Or if you have sunglasses that fully cover the eyes (wrap-arounds, or the ones the optometrist gives you after dilating your pupils), consider donning those & keeping them on until & unless you have to verify ID, then putting them right back on again.
Jay
@Uncle Cosmo:
you forgot the gloves, but otherwise yurp,
that is of course, if everybody else stays 6 feet away from you.
there probably is one hell of a market for shirts that say variations on “6 Feet, asshole” on the front and back.
Saw one that said “Please stay at least 6 feet away from this moving vehicle. Hows my driving? 1-800-608-2198.”
LongHairedWeirdo
@Betty: I couldn’t just cry, really. This is an issue for anger.
Look: the news media might be stupid, or forced to act stupidly, or some combination, but THIS IS NOT DIFFICULT. It really isn’t.
It would be one thing to cry, because people just don’t realize how important this is, but they *DO*. Trump is a moron, a ninny – not a nincompoop, that word is far too humorous sounding to be applied to an anthropomorphic black hole of hateful horror with a bad combover – an idiot, etc., but his advisers aren’t. Fox News isn’t peopled with idiots – it just plays that way on TV. The Republican Congresscritters aren’t all imbeciles, or, at least, many have staffers whose jobs it is to be not-an-imbecile.
We could cry because of the missed opportunity, and mourn, for sure, but please remember that Fox, and Republicans, are not blindly, stupidly, fumbling their way through a pandemic; they’re aiding and abetting a massive crime against the American people.
jl
Thanks for very important post. The initial forecasts re control of covid-19 were far too pessimistic. Like many other countries, there is a way out that allows life and the economy to proceed in a half-way normal fashion. What the US is doing is a choice, not necessity. We can be do it in a matter of a couple of months, and live with economic and social restrictions fare below what much of the US is facing now. And BTW, the Western European ‘resurgence’ is vastly overblown. Spain and France do have a serious problem. There are very earl signs of a new wave in 5 other countries, and we’ll see how they handle it. No one knows the implications of the vastly increased testing over last two months in terms of significance of new confirmed cases they are uncovering.
And doesn’t need to be expensive, countries in Africa, which at the outset of the pandemic many self-satisfied experts thought would be disasters, are doing far better than we are. And on a shoestring compared to us. Most of those countries are doing it with and GDP per capita of $4K to $15K per capita.