In another lengthy, rambling article this time by Robinson Meyer and Alexis C. Madrigal at Atlantic about SARS-CoV-2 testing, they argue for mass daily testing:
So here is what May 2021 could look like: Vaccines are rolling out. You haven’t gotten your dose yet, but you are no longer social distancing. When your daughter walks into her classroom, she briefly removes her mask and spits into a plastic bag; so do all the other children and the teacher. The bag is then driven across three states and delivered to the nearest Ginkgo processing facility. When you arrive at work, you spit into a plastic cup, then step outside to drink coffee. In 15 minutes, you get a text: You passed your daily screen and may proceed into the office. You still wear your mask at your desk, and you try to avoid common areas, but local infection levels are down in the single digits. That night, you and your family meet your parents at a restaurant, and before you proceed inside, you all take another contagiousness test. It’s normal, now, to see the little cups of saliva and saline solution, each holding a strip of color-changing paper, sitting on tables near the entrance of every public place. And before you fall asleep, you get a text message from the school district. Nobody in your daughter’s class tested positive this morning—instruction can happen in person tomorrow.
I honestly don’t think they’ve thought the plan through sufficiently. Even paper strip tests require materials and entail labor costs. And then there’s the disposal costs. The scale they’re talking about would be unprecedented.
As I’ve mentioned before, a majority of pharmaceutical company executives don’t believe that a vaccine will be available in spring 2021—they see the earliest likely delivery as fall of 2021.
Unless the test is failsafe in the sense that it produces zero false positive responses, it is daunting to think of the lawsuits that would inevitably be filed. It would be a full employment program for plaintiff’s attorneys and a nightmare for employers, school districts, and retailers.
And how in the world would the testing regime be enforced? If, on the other side of the coin, the tests produce lots of false negatives, it would in all likelihood be ignored after a while. Employers, school districts, and retailers would just stop administering them. We have ample evidence that local authorities are unwilling to enforce mask-wearing.
Speaking of Covid. The issues are never as easy as portrayed. I’m unaware of the state being able to deny doctor-patient decisions for off label prescribing. And yet they are. Don’t expect Fauci to actually answer any of the questions contained in the linked letter. Money and politics. Lives? Pfffft.
https://www.zerohedge.com/medical/doctors-pen-open-letter-fauci-regarding-use-hydroxychloroquine-treating-covid-19
I’m glad you posted that letter, Drew. I read it this morning and find it very compelling. However, there will be at least one poster who will discredit it, primarily because it was published in Zerohedge versus, let’s say, the NYT or Washington Post.
Jan
What he doesn’t, or refuses, to understand is that the website is mostly an aggregator. Further, you take the data and the arguments on their face, not appeal to authority.
The ultimate point is that the issue isn’t cut and dried, and doctors finding success shouldn’t be dictated to by government employees almost certainly with an agenda.
Actually, I will discredit it because of their claims. II will make fun of it because people are reading a gold bug site to get their medical “facts”. Seriously, if I want to learn stuff about Covid I should go to zero hedge? Sigh. Anyway, just for the record, I dont think of the NYT or WaPo as medical journals either.)
Anyway, there is way too much to go over and their questions are repetitious so lets just do three things, though I am gold to address any particular issues. First, if they think HCQ works then they need to publish studies. There are an awful lot of small retrospective studies showing HCQ works. I think that I have read most of them. Most with p values just barely significant, ie less that 0.05. We know those are pretty useless. Random chance is way too likely to account for the results. This is also true for the small retrospective studies which show HCQ does not work. The larger studies which claim to show it works are retrospective and flawed. People keep citing the Henry Ford, Michigan study even though it is seriously flawed. So do a study and back up what at this point is just a belief.
Second, the HCQ supporters keep saying the drug needs to given within 5-7 days of onset of symptoms. That was done in every study published. Lots of hospitals, I would wager most (all of the ones I communicate with used it), gave HCQ in the first couple months. People tend together admitted within a couple of days of symptom onset. HCQ is a pill. Its not dialysis or plasmapheresis. You just write and order and an hour later the pt has the pill. So this is nonsense.
What we dont have a good study on is prophylaxis. If you are already taking it and have an exposure are you less likely to get Covid?
Third, HCQ has been used pretty safely on lots of people, but lets remember who used it. Malaria is a young person’s disease. Most of it is in Africa where they dont have large populations of older people. Younger people dont generally have heart disease and that is the population we are worried about. No one has tried handing out HCQ to large numbers of old people.
Last, the three docs here are an orthopedic surgeon and 2 family doctors. None of these are likely to have significant contact with sick Covid pts. As I noted before, if you are working safely in your office it is a lot easier to make claims about Covid. This would be something to take a tiny bit more seriously if it came from some ID docs, critical care, hospitalists, ED, etc and/or someone who has studied and done research in the area. Please note that this letter hinges upon the work of one epidemiologist. Sure, it is possible that he is the only one who is correct and all of the other epidemiologists in the world are wrong, but not likely. Also, I actually read his letter. The guy thinks the Henry Ford study is a good study. He is clearly not making decisions based n science.
Steve
If you set zero infections as the needed result, then this wont work. If you just want to keep it down to manageable rates AND low enough that people are confident about going back to work, restaurants, school etc. you could certainly do something like this, assuming cheap tests. Do surveillance testing everywhere. If the positive rates goes above some trigger then follow this plan. Could work. It looks like saliva based tests are getting better and cheaper.
Steve
My mention of “zero” was in connection with false positives. The legal liability for barring someone from working, entering a store, or a child from coming into school on the basis of a false positive will be titanic.
Just mandating the test and the production of the materials for the test would not be enough. There would need to be a whole raft of shield laws which there is no prospect whatever of being enacted.
I am fairly confident that daily testing won’t do the magic trick of returning people back to work or school. For one; it does not work for anyone using public transit.
Second; if the choice between employers and employees is paying for the cost of a test everyday; with still a chance of catching it vs working from home, no test needed, no liability concerns; that’s an easy choice.
You could make the same argument for dine in vs ordering take-out.
“The legal liability for barring someone from working, entering a store, or a child from coming into school”
Wonder what PD thinks. I think that if a company decides to have daily testing and they have someone sit out for 2 weeks that will just be company policy and they wont be able to sue. Besides which if tests are cheap and frequent if someone tests positive they likely only miss a couple of days if it is false. Stores get to have no shoes no service policy so expect same to hold and same for schools. False negatives might be bigger issue, especially if you chose brand X rather than the slightly better test.
CO- I dont think people are entirely rational about testing. They trust them too much so I can see people going back.
Steve
I look at the ability to take HCQ plus zinc in the same light as what is allowed under The Right To Try Act – if a person chooses to take this anti viral medication, sign a waiver, and under a doctor’s care they should be able to do so.
Remedies come in many forms – some suffocating with trials and data, others can simply be classified as alternative choices. No matter how you attempt to belittle HCQ, Steve, it defies your lectures by the numerous physicians reporting successful outcomes in the US and all around the world. These doctors describe themselves as actively being on the front lines treating COVID. They also acknowledge it’s application is best at the onset of symptoms, contraindications are spelled out, and side effects are manageable should they appear.
Personally, my only concern about HCQ is the difficulty in finding it should I become sick with this virus.
The paper tests are estimated to be $5 per test, hope to get to $1. If you suspect the test result is inaccurate, take it again.
My wife and daughter are barred from working based upon a temperature checks and signing some sort of statement about not having a number of health conditions that seem pretty close to including basic cold and allergy symptoms. I don’t see any legal issue with extending that to a more accurate form of testing, so long as their are options available for more accuracy, if one things the results are inaccurate.
“I look at the ability to take HCQ plus zinc in the same light as what is allowed under The Right To Try Act”
The Right To Try Act is harmful to pts, and pretty stupid besides. Anyway, I dont see a need to sign a waiver. If people want to use it or a doctor order they should feel free to do so. That is what we do in my network. AFAICT that is what happens in most places.
” No matter how you attempt to belittle HCQ, Steve, it defies your lectures by the numerous physicians reporting successful outcomes in the US and all around the world. ”
I am trying not to belittle HCQ. What I want is for those people who claim they have success to publish their data. I know the numbers at our network and we have not had success with it. I read every paper I can find on HCQ and I have yet to see one that I owed consider a good study, which is also true of most of the studies that say it doesnt work.
“These doctors describe themselves as actively being on the front lines treating COVID.”
I have also described my self as better looking than a younger Sean Connery, but that doesnt make it true. It is certainly possible an orthopedic surgeon is actively dealing with Covid, but the odds are hugely against it. It is also incredibly noticeable that the specialties that deal most actively with Covid are not the ones claiming it works. That the people claiming it works have only found one epidemiologist to support their cause. Again, they can prove their claims by publishing.
Why is it belittling HCQ to point out that with Malaria it is being used for younger pts? Why is it belittling HCQ to note that most of us tried using HCQ within 5-7 days? Note that I also specifically pointed out that there is no good study on prophylaxis so it could work there and we wouldnt know. And then I try, but sometimes forget, to always add the caveat that it is still possible HCQ has some positive effects since even the high quality studies that show it doesnt work are few in number. I keep saying, and I mean it, that we need some large, prospective randomized studies. However, I would also note, that if you need that kind of study to show some positive effects the positive effects are likely small.
Steve