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Coronavirus and You - Page 242

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Any and all updates regarding the COVID-19 will need a source provided. Please do your part in helping us to keep this thread maintainable and under control.

It is YOUR responsibility to fully read through the sources that you link, and you MUST provide a brief summary explaining what the source is about. Do not expect other people to do the work for you.

Conspiracy theories and fear mongering will absolutely not be tolerated in this thread. Expect harsh mod actions if you try to incite fear needlessly.

This is not a politics thread! You are allowed to post information regarding politics if it's related to the coronavirus, but do NOT discuss politics in here.

Added a disclaimer on page 662. Many need to post better.
WombaT
Profile Blog Joined May 2010
Northern Ireland26092 Posts
August 26 2020 22:06 GMT
#4821
On August 27 2020 05:46 Mohdoo wrote:
Show nested quote +
On August 27 2020 04:34 aseq wrote:
On August 27 2020 03:20 Mohdoo wrote:
For anyone else who is either black or hispanic:

Looking at statistics showing POC die from covid more, is anyone else assuming it is just because we tend to be loud, less educated and hang out in large groups? black and hispanic people aren't entirely the same, but in my experience, both groups have qualities that would make covid way, way worse.

to clarify:

loud: everyone is way more infectious because the louder you speak, you shoot wayyyyyy more particles out

less educated: don't understand mask science or infection stuff well enough to buy into it

large groups: higher % chance to get it, and generally also means cramped spaces, which means higher total viral load per person.

With all the current BLM stuff going on, hope this doesn't rub people the wrong way, but I think any of these could be factors, though impossible to know which one contributes most. Also, take into account that quality of life standard is a bit lower on average, more POC will be living in apartments as opposed to detached houses, and will use shared elevators/stairs and front doors (Covid in Singapore pretty much only showed in immigrant worker's housing, for example).


I think just directly being poor contributes, but black and hispanic culture is also just totally different when it comes to socializing. POC families and events are just a lot more boisterous. And I wouldn't say that is a bad thing, just different. Well, it definitely is a bad thing for covid, but not otherwise.

TBH I think it is also a reason Italy and Spain went so crazy. But Spain and Italy as countries in general have less education and and less money. And so I am saying when you take the cultural component of American POC, then add the fact that they will also suffer due to education and money making those problems worse, it is easy to see this as a matter of behavior rather than genetics. Some diseases harm certain races more than others, but what I am saying is that I think this all comes down to behavior, where it is understood that both culture and economic/education status impact behavior.

Being poor > other factors, IMO anyway. As a really, really underemployed and poor human myself. You’re considerably more likely to work a job with inadequate provisions in terms of protection, you’re more likely to be needing public transport and all sorts of factors that draw you into proximity to others. You’re more likely to be having to rent a place with a bunch of other strangers too.

As I said PoC in the UK still show disproportionate Covid outcomes, including communities that in general are less boisterous in their behaviour and are quite reserved. East Asians, your Chinese/Japanese/Koreans etc (Asian to a Brit means the Indian subcontinent tend to buck that trend but culturally they wear masks even in non-pandemic times too.

Indeed the UK overtook the likes of Italy and Spain on all sorts of negative metrics a fair while ago, and I’d say we’re a considerably less tactile culture than those.

Again, too many variables. Plenty more women in certain professions like nursing, care homes etc. I’d be curious if there are gender disparities if you account for different employment patterns. I find women in general tend to be louder in most environments outside of bars (in pre-Covid normality men shout the place down when it’s late), and are more touchy in general.
'You'll always be the cuddly marsupial of my heart, despite the inherent flaws of your ancestry' - Squat
Lmui
Profile Joined November 2010
Canada6215 Posts
August 26 2020 22:21 GMT
#4822
Kinda a random anecdote:

https://www.reddit.com/r/hockey/comments/ih1rr6/jim_thomas_armstrong_said_20_percent_of_the_blues/

The St. Louis Blues had about 20% of the roster affected by Covid (Not inside the bubble, but prior to). I'm sure a study will follow up with professional sports later to follow up on how much conditioning/fitness is lost from a professional athlete who gets infected. Some of it will be the time off taken to recover, but some of it might have lasting effects. I guess we might see that next year at bootcamp, the infected might be significantly less fit than expected.
cLutZ
Profile Joined November 2010
United States19574 Posts
August 26 2020 22:22 GMT
#4823
There is no evidence of a gender disparity in the number infected, although men are much more likely to die if they contract C19. This is probably because men die earlier normally.
Freeeeeeedom
Mohdoo
Profile Joined August 2007
United States15725 Posts
August 26 2020 22:27 GMT
#4824
On August 27 2020 07:22 cLutZ wrote:
There is no evidence of a gender disparity in the number infected, although men are much more likely to die if they contract C19. This is probably because men die earlier normally.


Women have more powerful immune systems which is why they suffer from autoimmune disorders than men. Potential reason why, not that I know for sure.
cLutZ
Profile Joined November 2010
United States19574 Posts
August 26 2020 22:50 GMT
#4825
On August 27 2020 07:27 Mohdoo wrote:
Show nested quote +
On August 27 2020 07:22 cLutZ wrote:
There is no evidence of a gender disparity in the number infected, although men are much more likely to die if they contract C19. This is probably because men die earlier normally.


Women have more powerful immune systems which is why they suffer from autoimmune disorders than men. Potential reason why, not that I know for sure.


People used to think Testosterone was immunosuppressive because it also is anti-inflammatory, but modern studies have not really found that. Its probably much more likely that the things that already traditionally lead to men dying earlier like high BP and other heart disease-related things.
Freeeeeeedom
Mohdoo
Profile Joined August 2007
United States15725 Posts
August 27 2020 00:09 GMT
#4826
CDC saying not to test non-symptomatic is so amazingly dangerous. How utterly stupid.
Gorsameth
Profile Joined April 2010
Netherlands21961 Posts
August 27 2020 00:21 GMT
#4827
On August 27 2020 09:09 Mohdoo wrote:
CDC saying not to test non-symptomatic is so amazingly dangerous. How utterly stupid.
Makes sense considering Trump's talk about less testing = less cases.
It ignores such insignificant forces as time, entropy, and death
cLutZ
Profile Joined November 2010
United States19574 Posts
August 27 2020 00:28 GMT
#4828
On August 27 2020 09:09 Mohdoo wrote:
CDC saying not to test non-symptomatic is so amazingly dangerous. How utterly stupid.


If you are talking about this guidance it seems reasonable. A major problem of the Covid tests is false positives and false. Thus, if you are testing large populations of people you generate a lot of noise.

This part seems particularly important.
If you have been in close contact (within 6 feet) of a person with a COVID-19 infection for at least 15 minutes but do not have symptoms:

You do not necessarily need a test unless you are a vulnerable individual or your health care provider or State or local public health officials recommend you take one.
A negative test does not mean you will not develop an infection from the close contact or contract an infection at a later time.
You should monitor yourself for symptoms. If you develop symptoms, you should evaluate yourself under the considerations set forth above.
You should strictly adhere to CDC mitigation protocols, especially if you are interacting with a vulnerable individual. You should adhere to CDC guidelines to protect vulnerable individuals with whom you live.

Freeeeeeedom
Mohdoo
Profile Joined August 2007
United States15725 Posts
Last Edited: 2020-08-27 01:12:35
August 27 2020 01:07 GMT
#4829
On August 27 2020 09:28 cLutZ wrote:
Show nested quote +
On August 27 2020 09:09 Mohdoo wrote:
CDC saying not to test non-symptomatic is so amazingly dangerous. How utterly stupid.


If you are talking about this guidance it seems reasonable. A major problem of the Covid tests is false positives and false. Thus, if you are testing large populations of people you generate a lot of noise.

This part seems particularly important.
Show nested quote +
If you have been in close contact (within 6 feet) of a person with a COVID-19 infection for at least 15 minutes but do not have symptoms:

You do not necessarily need a test unless you are a vulnerable individual or your health care provider or State or local public health officials recommend you take one.
A negative test does not mean you will not develop an infection from the close contact or contract an infection at a later time.
You should monitor yourself for symptoms. If you develop symptoms, you should evaluate yourself under the considerations set forth above.
You should strictly adhere to CDC mitigation protocols, especially if you are interacting with a vulnerable individual. You should adhere to CDC guidelines to protect vulnerable individuals with whom you live.



I think we are at a point where I need to ask: what is your technical background? To what extent have you conducted research on viruses? You said testing too many people with a noisy test makes more noise. That is perhaps among the most blatantly incorrect things you have said in this thread. You appear to not have a technical background, but you speak as if you know about this topic.

We have seen numerous studies that show whether you are old or young, there are many people with extremely high viral concentrations in their nose and throat. That means those people can spread it, because as air passes by the virus, the virus hops along and is able to travel on particles/droplets. Let me reiterate: you do not need to show symptoms to be infectious. You do not need to cough to pass the virus. Simply speaking is sufficient. Saying a negative tests doesn't always mean someone isn't infected is a simple matter of existence. That is a really poor attempt to discredit testing. That is true for every single test ever made.

Since one of the best things about testing is signaling people to quarantine, we absolutely must continue to test non-symptomatic people. It is dangerous not to.
bloooargh
Profile Joined May 2012
United States28 Posts
August 27 2020 01:48 GMT
#4830
Looking carefully at the points cLutZ quoted, the advice seems more carefully tailored than I previously thought... to deflate the case numbers.

The rest of the advice seems to be the same instructions they give to asymptomatic people with a positive test result: Self-isolate, watch for symptoms, tell vulnerable people if you've been in contact with them.

It's like somebody actually had the cognitive chutzpah to ask, "how can we cook the case numbers without causing any real harm to the population?"
IT COMPILED!!! SHIP IT!!!
Amui
Profile Blog Joined August 2010
Canada10567 Posts
August 27 2020 02:19 GMT
#4831
On August 27 2020 10:48 bloooargh wrote:
Looking carefully at the points cLutZ quoted, the advice seems more carefully tailored than I previously thought... to deflate the case numbers.

The rest of the advice seems to be the same instructions they give to asymptomatic people with a positive test result: Self-isolate, watch for symptoms, tell vulnerable people if you've been in contact with them.

It's like somebody actually had the cognitive chutzpah to ask, "how can we cook the case numbers without causing any real harm to the population?"

The harm is very real. Many employers will give or are required to give sick leave in case of a positive Covid test, but are not required to do so in cases of suspected exposure. People are going to go in to work in cases of suspected exposure without testing and while possibly asymptomatic simply because they can't afford to take the days unpaid.
Porouscloud - NA LoL
Mohdoo
Profile Joined August 2007
United States15725 Posts
August 27 2020 03:12 GMT
#4832
On August 27 2020 10:48 bloooargh wrote:
Looking carefully at the points cLutZ quoted, the advice seems more carefully tailored than I previously thought... to deflate the case numbers.

The rest of the advice seems to be the same instructions they give to asymptomatic people with a positive test result: Self-isolate, watch for symptoms, tell vulnerable people if you've been in contact with them.

It's like somebody actually had the cognitive chutzpah to ask, "how can we cook the case numbers without causing any real harm to the population?"

There is huge harm because people who don’t show symptoms can spread Covid. If people aren’t tested they likely won’t quarantine if they have no symptoms
cLutZ
Profile Joined November 2010
United States19574 Posts
Last Edited: 2020-08-27 04:05:21
August 27 2020 03:15 GMT
#4833
On August 27 2020 10:07 Mohdoo wrote:
Show nested quote +
On August 27 2020 09:28 cLutZ wrote:
On August 27 2020 09:09 Mohdoo wrote:
CDC saying not to test non-symptomatic is so amazingly dangerous. How utterly stupid.


If you are talking about this guidance it seems reasonable. A major problem of the Covid tests is false positives and false. Thus, if you are testing large populations of people you generate a lot of noise.

This part seems particularly important.
If you have been in close contact (within 6 feet) of a person with a COVID-19 infection for at least 15 minutes but do not have symptoms:

You do not necessarily need a test unless you are a vulnerable individual or your health care provider or State or local public health officials recommend you take one.
A negative test does not mean you will not develop an infection from the close contact or contract an infection at a later time.
You should monitor yourself for symptoms. If you develop symptoms, you should evaluate yourself under the considerations set forth above.
You should strictly adhere to CDC mitigation protocols, especially if you are interacting with a vulnerable individual. You should adhere to CDC guidelines to protect vulnerable individuals with whom you live.



I think we are at a point where I need to ask: what is your technical background? To what extent have you conducted research on viruses? You said testing too many people with a noisy test makes more noise. That is perhaps among the most blatantly incorrect things you have said in this thread. You appear to not have a technical background, but you speak as if you know about this topic.

We have seen numerous studies that show whether you are old or young, there are many people with extremely high viral concentrations in their nose and throat. That means those people can spread it, because as air passes by the virus, the virus hops along and is able to travel on particles/droplets. Let me reiterate: you do not need to show symptoms to be infectious. You do not need to cough to pass the virus. Simply speaking is sufficient. Saying a negative tests doesn't always mean someone isn't infected is a simple matter of existence. That is a really poor attempt to discredit testing. That is true for every single test ever made.

Since one of the best things about testing is signaling people to quarantine, we absolutely must continue to test non-symptomatic people. It is dangerous not to.



My technical background is in biomedical engineering where my specific work was with VADs, so I'm not an expert on this particular test. But in hospital work you generally learn that you need to watch out for both type 1 and type 2 errors, and both come into play with C-19 if you are testing asymptomatic people (not that you universally should not test asymptomatic people, its a judgement call as to when you should as I'll try to explain).

In their explanation (which I bolded) they explicitly warn about type 2 errors, that being false negative tests for people who actually have the disease. The risk with this is that if someone is exposed, and you test them, then it comes back negative, they will act like they don't have the virus and not monitor for symptoms or self-quarantine (I am currently doing so because I was at the hospital, even though I had a negative test).

They aren't explicitly discussing type 1 errors, false positives, but this is also a big problem for some tests, and C19 testing seems to have a significant level of this. This is why indiscriminate mammograms cause a lot of problems, as another example. Its fine to be indiscriminately testing so long as C19 has high prevalence in the population because you will mostly getting signal, but as it % of prevalence drops false positives will start dominating the statistics (as we saw with the NFL players example). According to this false positives are less than 5%, however this chart makes me suspect false positivity is more like 1%. What this means, is that if your state has a positive test rate of around that mark, most of your positives are actually false.

Overall, seeing the 2nd chart, I agree with you that their judgement call is likely wrong at least for the states on the right hand side. False positivity is not a worry for those states, but if your %positive rate is <1% you probably need to re-evaulate procedures. You can use Bayes theorem to estimate what the "target" positive rate should be and test more/less based on this. Lets say you dont want more than 50% of positive results to be false positives. If you assume the false positive rate is 1% (and for simplicity say no false negatives), then your target is for 2% of results to be positive or more.

So if %false positive is <1% this call is too early, but it is a call you eventually make. The less accurate you think tests are, the sooner you make it.
Freeeeeeedom
Amui
Profile Blog Joined August 2010
Canada10567 Posts
August 27 2020 04:35 GMT
#4834
I'm a bit curious as to how the false positive rate for the NFL would be so high as to dominate the real positives. Are they using a methodology that doesn't retest?

Looking at F1 for example, they're running an international event, with several thousand personnel across several countries, and minimal, if any false postives.

A false negative would definitely be worse, but based on the @F1Media account, they've done the following tests

2/4997
0/1461
1/3909
[1]/5127 (retested postive)
0/5467
1/2847
Porouscloud - NA LoL
Acrofales
Profile Joined August 2010
Spain18129 Posts
August 27 2020 06:29 GMT
#4835
On August 27 2020 12:15 cLutZ wrote:
Show nested quote +
On August 27 2020 10:07 Mohdoo wrote:
On August 27 2020 09:28 cLutZ wrote:
On August 27 2020 09:09 Mohdoo wrote:
CDC saying not to test non-symptomatic is so amazingly dangerous. How utterly stupid.


If you are talking about this guidance it seems reasonable. A major problem of the Covid tests is false positives and false. Thus, if you are testing large populations of people you generate a lot of noise.

This part seems particularly important.
If you have been in close contact (within 6 feet) of a person with a COVID-19 infection for at least 15 minutes but do not have symptoms:

You do not necessarily need a test unless you are a vulnerable individual or your health care provider or State or local public health officials recommend you take one.
A negative test does not mean you will not develop an infection from the close contact or contract an infection at a later time.
You should monitor yourself for symptoms. If you develop symptoms, you should evaluate yourself under the considerations set forth above.
You should strictly adhere to CDC mitigation protocols, especially if you are interacting with a vulnerable individual. You should adhere to CDC guidelines to protect vulnerable individuals with whom you live.



I think we are at a point where I need to ask: what is your technical background? To what extent have you conducted research on viruses? You said testing too many people with a noisy test makes more noise. That is perhaps among the most blatantly incorrect things you have said in this thread. You appear to not have a technical background, but you speak as if you know about this topic.

We have seen numerous studies that show whether you are old or young, there are many people with extremely high viral concentrations in their nose and throat. That means those people can spread it, because as air passes by the virus, the virus hops along and is able to travel on particles/droplets. Let me reiterate: you do not need to show symptoms to be infectious. You do not need to cough to pass the virus. Simply speaking is sufficient. Saying a negative tests doesn't always mean someone isn't infected is a simple matter of existence. That is a really poor attempt to discredit testing. That is true for every single test ever made.

Since one of the best things about testing is signaling people to quarantine, we absolutely must continue to test non-symptomatic people. It is dangerous not to.



My technical background is in biomedical engineering where my specific work was with VADs, so I'm not an expert on this particular test. But in hospital work you generally learn that you need to watch out for both type 1 and type 2 errors, and both come into play with C-19 if you are testing asymptomatic people (not that you universally should not test asymptomatic people, its a judgement call as to when you should as I'll try to explain).

In their explanation (which I bolded) they explicitly warn about type 2 errors, that being false negative tests for people who actually have the disease. The risk with this is that if someone is exposed, and you test them, then it comes back negative, they will act like they don't have the virus and not monitor for symptoms or self-quarantine (I am currently doing so because I was at the hospital, even though I had a negative test).

They aren't explicitly discussing type 1 errors, false positives, but this is also a big problem for some tests, and C19 testing seems to have a significant level of this. This is why indiscriminate mammograms cause a lot of problems, as another example. Its fine to be indiscriminately testing so long as C19 has high prevalence in the population because you will mostly getting signal, but as it % of prevalence drops false positives will start dominating the statistics (as we saw with the NFL players example). According to this false positives are less than 5%, however this chart makes me suspect false positivity is more like 1%. What this means, is that if your state has a positive test rate of around that mark, most of your positives are actually false.

Overall, seeing the 2nd chart, I agree with you that their judgement call is likely wrong at least for the states on the right hand side. False positivity is not a worry for those states, but if your %positive rate is <1% you probably need to re-evaulate procedures. You can use Bayes theorem to estimate what the "target" positive rate should be and test more/less based on this. Lets say you dont want more than 50% of positive results to be false positives. If you assume the false positive rate is 1% (and for simplicity say no false negatives), then your target is for 2% of results to be positive or more.

So if %false positive is <1% this call is too early, but it is a call you eventually make. The less accurate you think tests are, the sooner you make it.


I think with Covid, we need to distinguish regions with a surge in cases and regions where there are currently few cases.

In the former, I would argue it is very harmful to deny tests to people who have been in touch with a confirmed Covid patient even though they have no symptoms themselves. You want to get ahead of the virus and the only way of doing this is by testing a lot and curbing the spread. If you don't do that, you will need drastic measures for the entire population. False positives are mostly irrelevant as having healthy people self quarantine is far less harmful in a surge than having sick people not self-quarantine. False negatives are a huge problem, but generally a test like this will be tuned for false negatives to be extremely rare (at the cost of more false positives).

Meanwhile in a place with very few cases, I agree with you that testing everyone is going to cause unnecessary fear and loss of work due to quarantining of false positives, and possibly even cause the spread to speed up as false positives will self-quarantine for 14 days and then think they are immune and become more reckless. Despite having never had Covid and not being immune.
Geisterkarle
Profile Blog Joined September 2008
Germany3257 Posts
August 27 2020 07:16 GMT
#4836
On August 27 2020 07:27 Mohdoo wrote:
Show nested quote +
On August 27 2020 07:22 cLutZ wrote:
There is no evidence of a gender disparity in the number infected, although men are much more likely to die if they contract C19. This is probably because men die earlier normally.


Women have more powerful immune systems which is why they suffer from autoimmune disorders than men. Potential reason why, not that I know for sure.

There are a lot of diseases that have basically a sex difference in how they affect people! Also, because PoC are mentioned: Even that could be something!
I was looking up ALS because somewhere in my head I remember hearing that more women than man get ALS, but men are hit harder. And I stumbled across this line in the wiki:
In the United States, it is more common in white people than black people.

Don't know about the US part, but here is something that PoC have "better"...
Also I had the sexes turned around; it is more common in men not women!

Anyway...also about the testing:
Here in Germany my county (not CountRy!) changed the testing rules a few weeks (not months!) back, that everyone that wants to can test themself! Before that it was like you said: No symptoms? No test! Even if you were in proximity with a ill person; if you had no symptoms, the "rules" were to just go into quarantine for a week or two and "everything is fine"!
So while we can blame Trump and his administration for a lot of things. other countries have similar testing restrictions!
There can only be one Geisterkarle
Belisarius
Profile Joined November 2010
Australia6233 Posts
Last Edited: 2020-08-27 10:48:55
August 27 2020 10:33 GMT
#4837
An Australian state tested 20k people on Wednesday trying to chase down a suspected cluster, and got one positive case.

Your purported type 1 rate is greatly exaggerated.

https://www.abc.net.au/news/2020-08-26/coronavirus-queensland-new-case-forest-lake-cluster/12589540
+ Show Spoiler +
Deputy Premier Steven Miles said the most recent case was "already in quarantine and therefore not posing an ongoing infection risk to the community".

He thanked the 20,856 Queenslanders who were tested for COVID-19 in the past 24 hours.

"The highest number in a 24-hour period we have recorded throughout the pandemic," he said.

"To have just one of those return positive is fantastic news."
Neneu
Profile Joined September 2010
Norway492 Posts
Last Edited: 2020-08-27 10:40:48
August 27 2020 10:40 GMT
#4838
Just want to point out that with knowledge of the of the error rate, especially with associated data for symptoms and its type 1 and 2 error rate, you can calculate how much of the data you have is likely to be noise. So it doesn't affect the statistics that much really if done right. Type 2 error rate is quite bad when it comes to very infectious diseases which is why, I believe, they have weighted the tests to be have a heavy type 1 error compared to other regular tests, which is not really that big of a problem.

This is one of the reasons Norway didn't start testing everyone in general, but anyone who wanted to be tested were allowed to, during the summer. We were at 0.2% positive/test at that time, which had a strong amount of type 1 error, but the positive/test ratio weren't low enough for the type 1 error to become significant.

TLDR: Mass testing in locations where there is a significant positive/test ratio is not a problem. Mass testing in locations where the positive/test ratio is very, very low, could be a problem.
TheTenthDoc
Profile Blog Joined February 2011
United States9561 Posts
August 27 2020 20:32 GMT
#4839
On August 27 2020 15:29 Acrofales wrote:
Show nested quote +
On August 27 2020 12:15 cLutZ wrote:
On August 27 2020 10:07 Mohdoo wrote:
On August 27 2020 09:28 cLutZ wrote:
On August 27 2020 09:09 Mohdoo wrote:
CDC saying not to test non-symptomatic is so amazingly dangerous. How utterly stupid.


If you are talking about this guidance it seems reasonable. A major problem of the Covid tests is false positives and false. Thus, if you are testing large populations of people you generate a lot of noise.

This part seems particularly important.
If you have been in close contact (within 6 feet) of a person with a COVID-19 infection for at least 15 minutes but do not have symptoms:

You do not necessarily need a test unless you are a vulnerable individual or your health care provider or State or local public health officials recommend you take one.
A negative test does not mean you will not develop an infection from the close contact or contract an infection at a later time.
You should monitor yourself for symptoms. If you develop symptoms, you should evaluate yourself under the considerations set forth above.
You should strictly adhere to CDC mitigation protocols, especially if you are interacting with a vulnerable individual. You should adhere to CDC guidelines to protect vulnerable individuals with whom you live.



I think we are at a point where I need to ask: what is your technical background? To what extent have you conducted research on viruses? You said testing too many people with a noisy test makes more noise. That is perhaps among the most blatantly incorrect things you have said in this thread. You appear to not have a technical background, but you speak as if you know about this topic.

We have seen numerous studies that show whether you are old or young, there are many people with extremely high viral concentrations in their nose and throat. That means those people can spread it, because as air passes by the virus, the virus hops along and is able to travel on particles/droplets. Let me reiterate: you do not need to show symptoms to be infectious. You do not need to cough to pass the virus. Simply speaking is sufficient. Saying a negative tests doesn't always mean someone isn't infected is a simple matter of existence. That is a really poor attempt to discredit testing. That is true for every single test ever made.

Since one of the best things about testing is signaling people to quarantine, we absolutely must continue to test non-symptomatic people. It is dangerous not to.



My technical background is in biomedical engineering where my specific work was with VADs, so I'm not an expert on this particular test. But in hospital work you generally learn that you need to watch out for both type 1 and type 2 errors, and both come into play with C-19 if you are testing asymptomatic people (not that you universally should not test asymptomatic people, its a judgement call as to when you should as I'll try to explain).

In their explanation (which I bolded) they explicitly warn about type 2 errors, that being false negative tests for people who actually have the disease. The risk with this is that if someone is exposed, and you test them, then it comes back negative, they will act like they don't have the virus and not monitor for symptoms or self-quarantine (I am currently doing so because I was at the hospital, even though I had a negative test).

They aren't explicitly discussing type 1 errors, false positives, but this is also a big problem for some tests, and C19 testing seems to have a significant level of this. This is why indiscriminate mammograms cause a lot of problems, as another example. Its fine to be indiscriminately testing so long as C19 has high prevalence in the population because you will mostly getting signal, but as it % of prevalence drops false positives will start dominating the statistics (as we saw with the NFL players example). According to this false positives are less than 5%, however this chart makes me suspect false positivity is more like 1%. What this means, is that if your state has a positive test rate of around that mark, most of your positives are actually false.

Overall, seeing the 2nd chart, I agree with you that their judgement call is likely wrong at least for the states on the right hand side. False positivity is not a worry for those states, but if your %positive rate is <1% you probably need to re-evaulate procedures. You can use Bayes theorem to estimate what the "target" positive rate should be and test more/less based on this. Lets say you dont want more than 50% of positive results to be false positives. If you assume the false positive rate is 1% (and for simplicity say no false negatives), then your target is for 2% of results to be positive or more.

So if %false positive is <1% this call is too early, but it is a call you eventually make. The less accurate you think tests are, the sooner you make it.


I think with Covid, we need to distinguish regions with a surge in cases and regions where there are currently few cases.

In the former, I would argue it is very harmful to deny tests to people who have been in touch with a confirmed Covid patient even though they have no symptoms themselves. You want to get ahead of the virus and the only way of doing this is by testing a lot and curbing the spread. If you don't do that, you will need drastic measures for the entire population. False positives are mostly irrelevant as having healthy people self quarantine is far less harmful in a surge than having sick people not self-quarantine. False negatives are a huge problem, but generally a test like this will be tuned for false negatives to be extremely rare (at the cost of more false positives).

Meanwhile in a place with very few cases, I agree with you that testing everyone is going to cause unnecessary fear and loss of work due to quarantining of false positives, and possibly even cause the spread to speed up as false positives will self-quarantine for 14 days and then think they are immune and become more reckless. Despite having never had Covid and not being immune.


Just make sure to take into account the relative values of true positives at different levels of community spread as well. The fewer cases there are in an area, the more valuable each true positive identified among asymptomatic individuals are from a contact tracing and spread preventing perspective. Meanwhile, the (negative) value of a single false positive seems fairly fixed.

That said, I'm not sure there's anywhere left in the United States where the number of cases is low enough for the really really huge rewards of identifying the positives to kick in. Maybe in some island areas or very isolated communities, but I sure hope none of them have ever been giving a shit about the CDC guidance.
JGwintworth
Profile Joined April 2018
United States18 Posts
August 27 2020 23:26 GMT
#4840
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