[HN Gopher] LabCorp's at-home Covid-19 test kit is the first to ...
___________________________________________________________________
LabCorp's at-home Covid-19 test kit is the first to be authorized
by the FDA
Author : jbegley
Score : 132 points
Date : 2020-04-21 13:37 UTC (9 hours ago)
(HTM) web link (techcrunch.com)
(TXT) w3m dump (techcrunch.com)
| dznodes wrote:
| I thought Theranos had those 5 years ago.
| btian wrote:
| Theranos is a fraud
| [deleted]
| LinuxBender wrote:
| Does "At Home" mean at home, or send the kit from your home to
| their lab? It looks like I have to ship my DNA to them. That is
| not "at home".
|
| LabCorp has been hacked enough times for me to stay far away from
| them. I was also not impressed with their Lab setup. I had to
| help other customers input their sensitive data into LabCorp's
| Kiosk systems because their 2 employees were overloaded. I am
| happy I left before giving them my data.
|
| No thanks.
| vl wrote:
| You send your DNA to someone every time you post an envelope.
| LabCorp is the largest provider doing tests, when you are
| tested at hospital for example, most likely they will send your
| sample to them, so there is no difference with doing it at
| home.
| SparkyMcUnicorn wrote:
| The first paragraph mentions it's just a collection kit. Comes
| with a shipping label.
| drcode wrote:
| Yeah, I'm hoping we'll see serology tests soon that truly are
| 100% "at home", operating through a test strip. They already
| have had these tests available in China and other countries
| since February, but since the US is apparently a third world
| country in 2020 we will be lucky to see these tests before
| 2021.
| chki wrote:
| Actually those test strips tests are basically useless at the
| moment because they have way too many false positives. But I
| think there is some interesting work, so maybe we will see
| these tests at some point in an accurate form which would be
| extremely helpful.
| [deleted]
| techdevangelist wrote:
| What is the expectation people will actually get the swab far
| enough back to collect a meaningful sample? Having been on the
| receiving end of a nasal collected flu test, it was a pretty deep
| probing. I'm kind of doubtful most people can do it to themself
| properly without some prompting to 'go deeper'.
| James_Henry wrote:
| There's evidence that for Covid-19 it's not necessary to go as
| far back as people have been going. There's also evidence that
| self-collection works well. The FDA has acknowledged this
| before and allowed self-collection with physician oversight
| before they allowed this test.
| MikeAmelung wrote:
| Where is this evidence? How does this square with the
| evidence that RT-PCR tests are already coming back falsely
| negative, probably due to missing the virus while swabbing?
| Pardon me for being skeptical, but this is all from the same
| people who have bungled this every step of the way.
| cbhl wrote:
| I'm having trouble finding the actual study, but
| UnitedHealth Group, working with the Bill & Melinda Gates
| Foundation, Quest Diagnostics, and the University of
| Washington did a study on the efficacy of self-swabbing.
|
| https://techcrunch.com/2020/03/25/study-behind-updated-
| fda-g...
| James_Henry wrote:
| I found the paper. I haven't read through it so I can't say
| if it is actually any good, but it is good enough that the
| FDA changed their recommendations because of it (that might
| not mean much, of course).
|
| https://www.medrxiv.org/content/10.1101/2020.04.01.20050005
| v...
| MikeAmelung wrote:
| Thanks for tracking it down. Doesn't seem to be any
| problem with accepting their results that it's almost as
| good as a nasopharyngeal swab, so you won't see me
| complaining about it again.
| takeda wrote:
| Not really an evidence, but looks like their instructions
| explicitly say to not insert it deep:
| https://www.pixel.labcorp.com/covid-19-sample-collection
| biased_coin wrote:
| Prompting to 'go deeper' could potentially be done over a video
| call. I hope LabCorp does some sort of beta testing to know how
| well people do with instructions.
| James_Henry wrote:
| https://www.fda.gov/medical-devices/emergency-situations-
| med...
|
| The FDA doesn't think it is necessary to go that deep.
| throwaway55554 wrote:
| Put a mark on the swab, put a rubber band around the mark on
| the swab and say it has to go back that far. Have a test for
| adults and another for children.
|
| But, the video from the actual labcorp website someone else
| posted shows it does not actually have to go very deep.
| edoceo wrote:
| Even adult noses are different sizes, the depth is a relative
| measure.
| jacobriis wrote:
| You only need to swab the edge of your nostril for this test.
|
| https://www.pixel.labcorp.com/covid-19-sample-collection
| clumsysmurf wrote:
| It was my understanding, that its easy to get false negatives
| with this kind of test because the virus moves down the
| respiratory track as time goes on. Too early, its not
| sensitive enough. Too late, nothing there. It has to be in a
| specific window of opportunity. Can somebody jump in and
| correct me if I am wrong?
| fspeech wrote:
| It is now thought that the virus can also infect cells in
| the nose. Cough and nasal discharge could also bring virus
| from deeper parts of the body to the nasal passage.
| LatteLazy wrote:
| I think they're just assuming you will pay 119USD (Plus tax and
| shipping) for a box because coronavirus. What you do with it
| after your transaction clears really isn't their concern...
| tomohawk wrote:
| Found this:
|
| https://www.fda.gov/media/136151/download
|
| > Negative results do not preclude SARS-CoV-2 infection and
| should not be used as the sole basis for patient management
| decisions. Negative results must be combined with clinical
| observations, patient history, and epidemiological information.
|
| Here's a brief article that explains why observed symptoms are
| more important than a test:
|
| https://asiatimes.com/2020/04/how-accurate-are-coronavirus-t...
| FootballMuse wrote:
| So if I get one of these tests, and it comes back negative, what
| does that mean?
| vl wrote:
| This test is mostly useless anyway: you need to administer it
| at the narrow window when you have covid for it to be
| effective. This implies that you have to keep it on hand, ie it
| can be too late to order it when you have symptoms since it can
| be delivered too late to detect anything. Then you have to wait
| for results for many days once you send it - so it's useless
| for guiding your action during the time you have symptoms.
|
| If you administer the test when you don't have symptoms it
| useless as well since most likely you will miss the window.
| SketchySeaBeast wrote:
| That'll you need more testing through the rest of the pandemic
| until it's either over or you come back positive.
| FootballMuse wrote:
| Sounds like a positive test would be a relief then.
| gweinberg wrote:
| Yes. The best situation to be in is to have been through it
| and be immune.
|
| For those of us who aren't showing symptoms and aren't at
| high risk for exposure, there's no point in testing us
| unless the test becomes super cheap.
| macintux wrote:
| > The best situation to be in is to have been through it
| and be immune.
|
| I think the jury's still out on the odds of achieving
| even temporary immunity after having caught it.
| grandmczeb wrote:
| All current evidence says infection confers temporary
| immunity to the vast majority of people infected. It's
| not clear how long immunity lasts, but it's most likely
| on the order of years. And even if you lose immunity, the
| reinfection will likely be more mild.
|
| https://www.wsj.com/articles/does-covid-19-infection-
| equal-i...
| finaliteration wrote:
| I'd say it's a relief if you test positive and then 14 days
| pass and you experience no or mild symptoms. But I know for
| me, personally, I'd be a nervous wreck during that period
| waiting for the symptoms to come (but I also have an
| underlying respiratory condition so that's a big part of my
| anxiety).
| SketchySeaBeast wrote:
| My concern here is why did you pay over $100 when you
| felt fine? How often would someone sample themselves
| without symptoms?
| TylerE wrote:
| Even that is no guarantee. Some of the passengers on that
| cruise ship became symptomatic weeks later.
| tunesmith wrote:
| Not sure why you would take it if asymptomatic (assuming you
| aren't an essential health worker), unless you were told to
| either as part of a random sample study, or because a contact
| tracing effort told you you were at risk.
|
| If you take it while symptomatic, I believe the sensitivity is
| improved, so if it comes back negative, you can be pretty
| assured that you just have a regular cold, right?
| MikeAmelung wrote:
| As a childhood sufferer of semi-regular strep throat infections,
| I have a hard time believing people are going to willingly jam
| the swab back to where it needs to go. To me, it seems like this
| will just generate false negatives.
| needle0 wrote:
| So this has you take a sample and ship it to their lab. How is
| this going to deal with the risk of biohazard for parcel delivery
| personnel?
| pwg wrote:
| Likely something like how this at home mail in test handles
| those exact same risks:
|
| https://www.cologuardtest.com/
|
| The sample is sealed inside a heavy grade plastic container
| with a screw top lid.
|
| The plastic container is sealed inside a heavy weight zip-lock
| bag already form fitted to the inside of the shipping box.
|
| The shipping box itself is quite sturdy.
|
| I suspect something similar for this new LabCorp test, just
| customized for a swab.
| stronglikedan wrote:
| It's no more risky than anything else an already infected
| person may ship, which is why the parcel delivery companies
| likely already have sufficient mitigation efforts in place.
| refurb wrote:
| How has 21 and Me been dealing with vials of saliva making it
| to their lab?
|
| Shipping biological hazards is a solved problem.
| mdszy wrote:
| Expecting profit during a catastrophe is exactly why the
| sitaution is as shit as it is right now.
| walkon wrote:
| Ok, why don't you make a test and sell it at cost?
| mdszy wrote:
| Corporations are not people.
| [deleted]
| Wowfunhappy wrote:
| But then, why would any company take the risk of developing a
| new test?
| mdszy wrote:
| If you can't see beyond monetary benefit when it comes to
| saving lives then I have news for you: you're a psycopath.
| sieabahlpark wrote:
| How do you stay in business long enough to be able to save
| future lives if you don't any money to do so in the first
| place.
|
| Should only billionaires and elite have their drugs?
|
| What your proposing isn't actually how the world works. Why
| don't you go out of your way to go get the same degree as
| them and make sure you make the bare minimum. Want to spend
| money on that new machine? Can't, you're only able to
| charge the cost it took to make the drug, and that new
| machine wasn't used so it's not in the price...
|
| Profits are about growing and expanding the business,
| generally a good thing.
| mdszy wrote:
| You really honestly believe that profits are used by
| these companies only for innovation, and billions of
| dollars aren't misappropriated to paying overinflated
| C-level salaries?
|
| Good one.
| whatshisface wrote:
| I think a reasonable calibration would be charity=good,
| usual behavior=usual, and active malice=bad. Having a
| return around the cost of capital is usual behavior, so I
| think complaining about a company profiting off a disaster
| by selling the product that they usually make is kind of
| like complaining about a person not giving to a food bank.
| pmiller2 wrote:
| "Usual behavior" should not be "usual" in such an
| extraordinary situation as a deadly pandemic. Your
| premise is flawed.
| whatshisface wrote:
| Because of the way our system works, you and I will pay
| that 10% in the form of taxes and insurance premiums. I
| for one, am glad to reward companies who are contributing
| to the solution for this crisis. Profit is the reward we
| give to companies for good behavior, and wouldn't you
| agree that companies who are making tests are behaving
| well?
| pmiller2 wrote:
| No, I do not agree that profit is the reward for good
| behavior, nor that companies attempting to profit off
| making the tests are behaving well. In fact, profit is
| often the reward for some very, very harmful behavior. I
| would say it is at least borderline sociopathic to
| conflate the profit motive with the desire to do good.
| Your premise is, again, flawed.
|
| I would be glad to pay for the tests through my taxes if
| it means people can get them now, for free.
| TheOtherHobbes wrote:
| The problem isn't the profit, it's the kinds of
| behaviours to which profit is allocated.
|
| If profit really was a reward for good behaviour, no one
| would have a problem with it. (Except bad actors.)
|
| In this situation, the goal is to get as many high
| quality tests out as possible.
|
| If this is truly a reliable and useful test and results
| are available quickly, then the ideal level of profit is
| one that maximises that result - i.e. a small profit on
| each kit to encourage volume sales.
|
| If the tests aren't reliable enough to be clinically
| useful and they're being sold to the public without a
| context (i.e. no information about what the result means
| in terms of changed behaviour or risk) then the kits
| should be banned for wasting everyone's time and money.
| pmiller2 wrote:
| If you want to split hairs, I don't have a problem with
| LabCorp profiting _per se_ from the test. I have a
| problem with the cost being a barrier to people getting
| it. If the government were to pay them cost + a small
| profit to offer it free at the point of delivery, I would
| have no issue.
|
| I have a philosophical problem with profit being the only
| motivation for producing the test, but that takes a
| backseat to practicality here.
| mdszy wrote:
| The current world situation is anything but usual.
| bigyikes wrote:
| Well that's just it, isn't it? We are talking about
| corporations, not people. A corporation is motivated by
| profit and is, in some loose sense, a "psychopath." Sure,
| corporations are composed of people, but your moral
| argument is a lot more complicated in relation to an
| aggregate of people instead of just an individual.
|
| Anyway, more tests are available than would be had LabCorp
| not existed, so seems like a win-win to me.
| formercoder wrote:
| Such a tough conversation. I want to think that these firms
| should do this research out of the goodness of their
| hearts, but i know that their employees want to go on
| vacation and send their kids to college. I believe in the
| invisible hand, and honestly don't know the solution to
| these healthcare problems. Maybe just raising taxes and
| paying for all research by the government, but then I worry
| about the inefficiencies therein.
| sethhochberg wrote:
| Personally I'd love to see someone explore the idea of
| incentives that heavily favor benefit corporations and/or
| employee-owned coops for commercial activity in direct
| support of human rights (assuming we're approaching the
| problem from a place where people agree access to
| healthcare, medicines, etc is a human right).
|
| People who do the incredibly valuable work of developing
| drugs shouldn't be forced to live a life of squalor, and
| can be compensated generously for the value and
| complexity of their work, but I think most people's
| objections to pharma companies as they typically exist
| today are centered around companies reporting substantial
| profits and conflated ideas about obligations to
| shareholders.
|
| Its a lot easier to feel good about a company reporting a
| profit if you're confident the company's governance
| structure ensures that profit is mostly lockboxed for
| future R&D instead of a shareholder dividend to people
| who may not even know their investment is funding
| medicine.
| formercoder wrote:
| Good ideas, but without distribution of profits how are
| these companies going to be capitalized? Maybe government
| owns the equity?
| nicoburns wrote:
| On the other hand, businesses in other industries that are
| not so beneficial to society will happily charge gob loads
| of money for their services. IMO giving these companies
| some profit is a good thing, so long as the money is made
| available so that everyone can afford the product, and so
| long as it doesn't stop or slow it's distribution.
| refurb wrote:
| Exactly. I'd love to ask all the people criticizing this to
| work for free for a few months because "it's the right thing
| to do in a crisis".
|
| I'm guessing there would be zero takers.
| wwweston wrote:
| Personally, I _would_ do (and have done) certain kinds of
| work without monetary compensation because I want to see it
| done, or because I think there 's some other upside.
|
| However, I probably wouldn't ask that of LabCorp in this
| circumstance, because what I want from institutions
| providing testing is scaling up while providing an
| effective product/service. Not getting revenue makes that
| considerably harder.
|
| Public subsidies might make a lot of sense, though,
| especially to the extent that everyone wins the
| broader/deeper test coverage is, but not everyone has a
| disposable $100.
| 1-more wrote:
| There's a structural limit to a market based economy that
| can only be overcome with central planning. This is it. We
| ran into it.
| TheOtherHobbes wrote:
| In fact quite a number of people are out there working for
| free because "it's the right thing to do in a crisis."
| Teever wrote:
| How have you been foregoing profit for your work during this
| calamitous time? Have you been laid off like many people or are
| you simply returning the cheques that your employer sends you?
|
| Personally I've been continuing to show up for work despite my
| employer not having sufficient funds to pay me but I understand
| that every situation is different.
| mdszy wrote:
| Existing within a system is not inherent endorsement of that
| system.
| mdszy wrote:
| Corporations are not people.
| claudeganon wrote:
| Profit != wages. A company profiting off a test is not the
| same as a worker being paid for their labor. Something being
| made at cost would price in the cost of labor, while profit
| is in excess of that (and all other expenses).
| ars wrote:
| So what you are saying is that everyone should work for
| minimum wage, and any wage in excess of that is profit?
| revnode wrote:
| I would say anything above your costs of living would be
| profit in a wage, no?
| dang wrote:
| Ok, but please don't post unsubstantive or flamebait comments
| to HN.
|
| We detached this subthread from
| https://news.ycombinator.com/item?id=22936488.
| TomatoTomato wrote:
| economic profit, gross profit, operating profit, or net profit?
| ianhawes wrote:
| > Pixel by LabCorp(tm) is not available in NY, NJ, MD, or RI due
| to restrictions on how laboratory tests may be ordered. Please
| talk with your healthcare provider about options for getting
| tested.
|
| Ah wonderful, so this rules out states accounting for 45% of the
| confirmed cases.
| hnburnsy wrote:
| Looks like New York and Maryland ban consumer initiated lab
| tests...
|
| https://www.technologyreview.com/2017/09/28/148899/as-consum...
| joncrane wrote:
| I remember when they banned 23andme in MD, I researched it and
| it turns out the health insurance companies successfully
| lobbied against it with the argument that information asymmetry
| may lead to loss of profits.
|
| I'm still salty and I think this is part of the same scenario.
|
| Having said that, I think Governor Hogan is one of the best
| governors out there wrt state level response to Covid. Right up
| there with Newsom and Cuomo.
| chimeracoder wrote:
| > Right up there with Newsom and Cuomo.
|
| Cuomo cut Medicaid funding by $6 billion _during_ the
| pandemic. He dragged his feet on issuing a stay-at-home order
| for a week after the city government had asked for one (the
| governor has the sole authority to authorize one in NY). San
| Francisco beat Cuomo to the punch by nearly a week, even
| though New York had been hit earlier and harder with COVID-19
| cases. Cuomo also fought against closing NYC schools even
| after the city and teachers were already on board with the
| idea. As a result of New York 's sluggish response, community
| spread of COVID-19 happened much more rapidly than it did in
| other urbanized areas of the country (most notably San
| Francisco), so hospitals were already overloaded even before
| the stay-at-home order had been issued. On top of that, Cuomo
| also expanded pretrial detention for nonviolent drug
| offenders during the pandemic, which puts even more people in
| unnecessary close contact.
| https://nymag.com/intelligencer/2020/04/cuomo-has-learned-
| no...
|
| As of today, 1 in 1000 New Yorkers who were alive a month ago
| are now dead. Cuomo might not be the only person responsible
| for the current situation in New York, but it's clear that
| things would be better in New York had Cuomo taken action
| instead of fighting public health officials at every turn.
| tomohawk wrote:
| Any idea what the false positive / false negative rate is?
| gshdg wrote:
| Yeah, haven't false negatives been a scourge of at-home testing
| kits released in other countries?
| WoodenChair wrote:
| Is there a possibility of us getting an FDA sanctioned OTC
| antibody test in the near future so we can find out if we already
| had the virus?
| James_Henry wrote:
| I'm sure it will come, but it looks like the FDA is waiting
| until the big companies ask for an EUA because they don't trust
| the startups (or the startups aren't able to do what LabCorp
| does?)
| zenyc wrote:
| We are working on this. I can't share more here but if you are
| interested and want to help, let me know how at
| zen[at]rapidcov[dot]com (dev, design, marketing, medical,
| partnerships, etc). We have our core team in place but we are
| planning to be bring on more people in the next few weeks.
|
| P.S. ignore the website, it's not the product.
| James_Henry wrote:
| What would make you different from the many many EUA antibody
| tests already on the market? How are you going to get yours
| approved for OTC at-home use?
| zenyc wrote:
| Originally, we tried to bring the existing antibody tests
| that can only be sold to medical practitioners. During that
| process, we engaged in conversations with the FDA to get
| approval and we asked them what their concerns are with at-
| home antibody test kits. Once they explained us, we went
| back to the drawing board and worked on a solution that
| would allow us to mitigate the FDA's concerns.
|
| We then proceeded to present our solution to the FDA. They
| were positive so we filed for our pre-EUA and now we are
| working with an FDA reviewer.
|
| I'm not going to pretend that our solution will end being
| approved. I have no idea since none of us (the three
| founders) have medical device experience. Nonetheless, we
| are willing to take a huge risk in terms of money and time,
| and at least know at the end that we gave it our best shot.
| pmiller2 wrote:
| There's one available in Richmond, CA for $125:
| https://www.sfgate.com/bayarea/article/COVID-19-antibody-tes...
| renewiltord wrote:
| It's $199 (+taxes).
| pmiller2 wrote:
| It literally says $125 in the opening paragraph of the
| article I linked. Do you have updated information?
| renewiltord wrote:
| Yes, the lab itself. https://app.acuityscheduling.com/sch
| edule.php?owner=19381748
| LatteLazy wrote:
| Before people get excited that the FDA approved something, how
| much testing have the FDA done on this product and how many other
| tests have they declined to authorize?
|
| Right now, FDA approved means about as much as Probably not
| immediately lethal.
| stronglikedan wrote:
| $119 [0], since it's not mentioned in the article.
|
| Also, not yet available to the masses:
|
| > With limited quantities of kits available, Pixel by LabCorp is
| currently prioritizing healthcare workers and first responders,
| consistent with guidance from the CDC. We plan to make kits more
| broadly available soon so please check back.
|
| [0]https://www.pixel.labcorp.com/
| fmakunbound wrote:
| Anyone know if that $119 at cost? LabCorp is going to make a
| killing of this crisis...
| malandrew wrote:
| Maybe, maybe not. Their other tests have almost no demand
| right now due to coronavirus. How much of a killing they make
| will depend on which tests have better margins.
| hbosch wrote:
| I believe LabCorp's Men's Health Test is relatively popular
| amongst guys looking to check their testosterone levels.
| The results can be taken to a "men's health physician", or
| a "bio-identical hormone physician", or whatever else they
| are called and used to justify legal hormone therapies
| (typically testosterone injections and/or estrogen-
| blockers). Common for bodybuilders, or even just dudes
| closing in on 60 who want to stay good at golf.
| stronglikedan wrote:
| Likely not "at cost", since a for-profit company should be
| expected to be making a profit, but probably close,
| considering the herculean effort to get these things to
| market, despite the red tape.
| three_seagrass wrote:
| The Labcorp Pixel covid kit is a mail-in sample swap for a
| PCR test. The variable cost is magnitudes lower than $119.
| James_Henry wrote:
| There is also the variable cost of the technician needed
| to run the machine, no?
| three_seagrass wrote:
| Lab techs will spend at _maximum_ a couple minutes on
| each test, if they are manually preparing and pipetting
| samples, as the majority of the test is automated on a
| PCR thermocycler. At $30 /hr that's $1/test in labor at
| most.
| foota wrote:
| Right, but isn't there capital costs associated with
| being able to run them?
| nikofeyn wrote:
| how does this help? if you can test at home, so what? how does
| that change anything? it's not being tracked, can you trust
| results, etc.
| gweinberg wrote:
| Saves the risk of infecting someone or being infected at a
| testing center. You don't want to be going near a hospital
| these days if you don't have to.
| KaiserPro wrote:
| Isn't it a notifiable disease? Wouldn't that put the onus on
| the testing company to report a positive test?
|
| I'm not sure how that works in the states.
| SkyPuncher wrote:
| It won't do much for most people - which is why healthcare
| workers and first responders are being prioritized.
|
| My wife is a doctor and cared for our county's first COVID-
| positive patient before he was formally diagnosed (took 11 days
| to get test results). She was on self-isolation for 3 weeks for
| late March/early April. Two weeks for the initial exposure, 1
| more week because of a low-grade fever. We're still not certain
| if she had it (I got symptoms about 5 days after she did)
| because it was extremely difficult to get her tested.
|
| The challenge now is monitoring her with likely exposure when
| she'll be working in-patient for the month of June. While these
| tests aren't perfect, they can give us some direction on how we
| need handle things at home. The price is reasonable enough that
| we can simply order the test for her directly without having to
| call 20 different people across 3 different hospital systems to
| get the sign-off on testing.
|
| A negative doesn't tell us much (as she could still have it),
| but a positive is a strong indication that she should be
| avoiding patient interactions and likely self-isolating at
| home.
| SketchySeaBeast wrote:
| > A negative doesn't tell us much (as she could still have
| it), but a positive is a strong indication that she should be
| avoiding patient interactions and likely self-isolating at
| home.
|
| Doesn't it only tell you if you should now be immune once
| your sickness is over? Otherwise you have to act like you
| have it if you have the symptoms regardless of the test.
| Avoiding patient interactions and self isolating should
| happen regardless, shouldn't it?
| ck2 wrote:
| Well, it's three months and 40,000 deaths late but it's a start.
|
| But there needs to be anonymous antibody testing at home like a
| pregnancy test.
|
| BTW also needs the post office properly funded and saved from
| bankruptcy. WTF are we bailing out cruise ships and not the post
| office?
| renewiltord wrote:
| Well considering it's been three months and 40k deaths and you
| have given us nothing, I'm going to go with the guy who gave me
| something.
| throwaway55554 wrote:
| Follow the money. Who do the CEOs of the cruise ships know that
| are in Congress?
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