[HN Gopher] A Third Solution
___________________________________________________________________
A Third Solution
Author : rafaelc
Score : 53 points
Date : 2020-04-24 22:12 UTC (47 minutes ago)
(HTM) web link (paulbuchheit.blogspot.com)
(TXT) w3m dump (paulbuchheit.blogspot.com)
| caymanjim wrote:
| This isn't a unique idea. This is the mainstream view. Everyone
| knows we need more testing and that testing is the only way to
| effectively ease distancing rules. That was a pretty extensive
| writeup to say what we've been hearing from all rational
| information outlets for a month.
| pb wrote:
| I have not found any mainstream sources that advocate screening
| everyone every day (which is very different from simply doing
| "more testing"). Would love some pointers if I'm wrong.
| gowld wrote:
| > (less than $1/test).
|
| How much less than $1? $6B/day is a lot of money.
| baggy_trough wrote:
| Not on the scale the world is blowing up wealth right now.
| ak39 wrote:
| It's a lot of money in toal. But if the costs could be are
| borne by the customer or service provider or employer
| equally or proportionally, then it is a viable alternative
| to complete shutdown of businesses.
| scott_s wrote:
| Paul Romer, an economist at NYU, has been advocating for
| testing millions of people a day for a few weeks. He is co-
| author of a piece in The Atlantic, "Without More Tests,
| America Can't Reopen",
| https://www.theatlantic.com/ideas/archive/2020/04/were-
| testi...
|
| Googling for "romer covid 19" should turn up a lot of news
| sources covering the notion of testing millions of people a
| day.
| vikramkr wrote:
| I think governor Cuomo was saying he'd love to test every day
| if he could, but just doesn't have the capacity. IIRC,
| mainstream objections tend to come from concerns of false
| positives, since that becomes a bigger problem with this
| frequent level of testing and could prove a huge disruption
| if you end up with too many quarantine still, or so many that
| testing positive becomes essentially meaningless in terms of
| telling you whether you have the disease or not if you test
| positive.
| [deleted]
| 762236 wrote:
| One way to achieve ubiquitous screening is for people to perform
| regular VO2max tests (loosely speaking; you can do submaximal
| exercises for this). You quickly figure out if you have a stress
| on your immune system (by watching various metrics), and there
| are sports-science papers showing this (because they use it to
| avoid overtraining, which also appears as a stress on the immune
| system). This is of course not easy to achieve with our current
| culture. It used to be that physical achievement was valued. Only
| a small fraction of society pushes against their VO2max in a
| regular way that can be measured and tracked to detect the
| immune-system stress. If people were to pursue this approach,
| they'd become a lot healthier in general.
| texasbigdata wrote:
| Your "sick" vo2 might be above my "healthy" vo2.
|
| So you first need to get 300 Americans on a max treadmill test
| to baseline, then.....
| tlb wrote:
| Doesn't a VO2max test take 20 minutes, plus a shower
| afterwards? That sounds significantly more expensive than
| collecting vials of saliva.
|
| Also, you'd definitely need to do those VO2max tests in
| separate, sealed rooms because infected people would be huffing
| out maximum virus.
| DrNuke wrote:
| Cheap & working saliva test would be such a tracking game changer
| that I am really hoping it works, so good luck!
| temac wrote:
| There are insanely high amount of speculation in there.
|
| To my knowledge no _significant_ amount of non droplet or hand-
| to-face contamination as been demonstrated out of medical
| contexts where aerosolization is more a problem, because of
| technical gestures and cares.
|
| Even the linked page supposed to serve as a reference is
| _completely_ speculative on the subject of the potential for the
| virus to be airborne: "In addition, it is possible that SARS-CoV
| might be spread more broadly through the air (airborne spread) or
| by other ways that are not now known."
|
| So yeah, it also has not been proven that airborne transmission
| does not happen. But there are no strong signs showing we should
| highly worry about that highly speculative subject. The _main_
| contamination paths are well-known: droplets, and hand-to-face.
| If you want to strongly reduce the rate, you must focus on that.
|
| > Even if we don't avoid the virus 100%, reducing it by 80% could
| be the difference between something mild and something life-
| threatening. This could be a reason why so many otherwise young
| and healthy doctors and nurses have been killed by this virus.
|
| Yeah, no. This is also completely speculative at this point.
| There is no strong technical reason for why it should be the
| case, given how viruses work... So not completely impossible, but
| short of real reasoning and evidences and studies, this is not a
| theory to particularly to focus on... ANYWAY, it is a good idea
| to avoid spreading the virus on all surfaces, but simply because
| this will statistically reduce the contamination rate (maybe
| without any impact on the severity for those who _will_ be
| contaminated)
|
| More generally, I'd like essays on that subject from people
| working in the medical field. And I'd _probably_ not like essays
| on CS from virologists and epidemiologists...
| dang wrote:
| Can you please make your substantive points without swipes?
| Controversial threads tend to devolve into people swiping at
| each other, and emotions run especially high in a crisis.
|
| I don't think there's any reason to exclude an article on the
| basis of who wrote it. Articles should be excluded because
| they're off topic or bad. In fact, essays on CS from
| virologists would likely be of high interest to this community.
|
| Besides that generic argument, which has become a bit of a
| shallow dismissal in these threads, there's the fact that pb is
| writing about a project he's personally involved in and hasn't
| been discussed here before. It's understandable if there's
| interest in that.
| FrojoS wrote:
| > Yeah, no. This is also completely speculative at this point.
| There is no strong technical reason for why it should be the
| case, given how viruses work...
|
| Yes it is. If the initial amount of virus exposure is low, the
| immune system has more time to react.
| roywiggins wrote:
| I've heard from virologists that the amount of virus you're
| exposed to does matter. A gallonful of virus can quickly
| overwhelm the immune system, a small amount can take long
| enough to grow that your immune system can ramp up to deal with
| it before it overwhelms. It's like someone releasing one
| breeding pair of rats in your attic vs 100.
|
| I don't have a cite, it was from the "This Week in Virology"
| podcast.
| tlb wrote:
| You can rank people by the likely benefit of testing them.
| Interestingly, it goes up as the square of the number of people
| they interact with daily. (Because their risk of having it
| increases, and also the number they are likely to spread it to.)
|
| So you can allocate tests by sorting by (# of daily contacts in a
| closed space) ^ 2.
|
| But as PB says, it should be practical to test everyone every
| day.
| saeranv wrote:
| Curious to know how you are getting power of 2 exactly. Are you
| just saying it's some sort of power law growth and
| approximately 2, or is there an actual way of deriving it?
| texasbigdata wrote:
| Wouldn't it also vary by percent of population without
| immunity, perhaps demographics in the underlying population,
| and other environmental things (weather?). Seems like a
| (useful) aproximation.
| tonyarkles wrote:
| If you have N nodes and completely connect the nodes, there
| are O(N^2) edges. This comes from the formula for the
| sum(1...N).
|
| Edit: I'm not sure I interpreted the original statement
| correctly.
| triyambakam wrote:
| The article begins by stating that this is not like the flu, yet
| we know people die from complications or directly from the flu
| every year. And further, we're seeing more and more evidence of
| huge numbers of the population with antibodies, i.e. already
| infected and immune. We also have seen the damage that using
| ventilators have had due to misunderstanding how this virus
| starves the body of oxygen (through the blood, not like
| pneumonia). We should continue to focus on treatment and realize
| that treatment along with population immunity is the best way to
| handle it now. Waiting a year for a vaccine that may not work or
| rushing a poorly tested vaccine is not good.
| roywiggins wrote:
| It's not the flu because the infection fatality rate is almost
| certainly a lot higher, we have no vaccine, and no reliable
| treatments. Seasonal flu has (semi-reliable) vaccines and
| antivirals and is almost definitely significantly less deadly.
|
| Look at the excess death statistics. There's no question that
| it's deadlier than seasonal flu, because the seasonal flu
| doesn't kill a 9/11s worth of New Yorkers _above the usual
| death rate_ over several weeks. If the current rate wasn 't
| slowing we'd be looking at a death toll multiple times higher
| than the seasonal flu.
|
| About 20% of people in NYC showed a positive antibody test.
| That's not nearly enough for herd immunity and it's not enough
| to push the infection fatality rate as low as the flu's.
| darkerside wrote:
| Solutions like this give me hope that we can actually return to
| something resembling normal life in the future. I hope Paul's got
| everything he needs in funding and resources to pursue all three
| of his goals.
| uhnuhnuhn wrote:
| Can we stop hyping blog posts by tech people writing about
| epidemiology and medicine? I'm shocked how much baseless
| speculation and misinformation is being shared on HN.
| dang wrote:
| HN is an internet watercooler. It exists for curious
| conversation. That inevitably includes speculation--that's what
| people do when they converse. The question is whether it's
| curious (thoughtful and fresh) or uncurious (reflexive and
| predictable).
|
| People being wrong is also inevitable. We don't have a truth
| meter, and there's a ton of uncertainty on topics like this one
| anyhow. I don't think it would work to try to restrict
| discussion so that only authoritative opinions are allowed.
| This community would not tolerate that sort of restriction
| being put on it, and it would only lead to a worse argument
| about who should be considered authoritative anyhow. The
| solution, if there is one, is to converse thoughtfully and
| respond to one another with accurate information where
| possible.
| Ididntdothis wrote:
| I tend to agree. Maybe medical people should start having
| opinions on software architecture after reading a few articles.
| They may have some fresh ideas. Or not?
| newacct583 wrote:
| He's not. He's hyping his biomedical startup which is trying to
| make a cheap plasmon covid test. Whether or not he's right,
| that's sort of right at the HN sweet spot for relevance.
|
| Will it work? God I hope so, but it doesn't seem prudent to bet
| on it. We know several existing technologies for covid testing
| that will work. We know they can scale. We know how expensive
| they are. And while they aren't cheap, we know can afford it at
| the federal level.
|
| That we still refuse to actually pull the trigger on mass
| testing and announce a program to fund and launch a universal
| covid testing regime is just infuriating.
|
| I mean, I desperately hope that a magic bullet like this will
| pop up to save us. But we _know_ how to beat this. We just won
| 't.
| marcell wrote:
| > First of all, it's not "just the flu". It is something much
| more dangerous. Catching this virus is a bit like playing a round
| of Russian roulette. You'll probably be fine, but you could end
| up dead
|
| I think this is mischaracterizing it. People have to die
| eventually. One year of existence has a mortality rate of 1%. For
| a 75-84 year old individual it is nearly 5%. Above 85 it's 14%.
| [1]
|
| The coronavirus infection fatality is likely around 0.5-1%, but
| it's heavily skewed towards older individuals. Younger people do
| die from it, but a very low rates. And young people die from
| other causes as well, the annual mortality rates for a
| 20-something is around 0.1%. Getting coronavirus for a
| 20-something or 30-something is roughly equivalent to the
| mortality rate of a few months of life.
|
| Death is sad and terrible, but we don't shut down society because
| people die.
|
| [1] https://www.mdch.state.mi.us/osr/deaths/ageadjdxARS.asp
| JoeAltmaier wrote:
| That's a terrible analysis, for reasons well-covered all over
| HN and elsewhere.
|
| This is a whole different thing from 'another flu'. We have to
| address it head-on. Throwing people (a million people?) under
| the bus is not going to fly, not politically and not morally.
| centimeter wrote:
| > for reasons well-covered all over HN and elsewhere.
|
| I've yet to see a compelling argument that LY or QALY
| analysis is the wrong approach.
|
| > This is a whole different thing from 'another flu'. We have
| to address it head-on
|
| It sounds like you're not actually offering any relevant
| response to the parent comment, but just repeating the
| taglines we all saw in the article.
|
| > Throwing people (a million people?) under the bus is not
| going to fly, not politically and not morally.
|
| Every political action has victims and beneficiaries. At the
| moment, we're hurting billions of people (almost the entire
| world population) to buy (on average) a few expected life-
| months for a very small section of the population.
|
| Your model of "people dying is bad" is true but not
| sufficient to make rational decisions.
| JoeAltmaier wrote:
| Because, its well-covered all over HN and elsewhere. I
| suggest reading and thinking, before posting throw-away
| pseudo-analyses.
| marcell wrote:
| Every year around 3 or 4 million people die in America from a
| variety of causes. This is sad, but at some point, everyone
| has to die.
|
| Data is showing that the infection fatality rate is around
| 0.5%-1%, and is concentrated in older people. [1] is one
| study, but there are many others. Given this data, it's clear
| that our current response is out of proportion with reality.
|
| [1] https://www.reddit.com/r/COVID19/comments/g4tqvk/dutch_an
| tib...
| johnnyo wrote:
| So if all of America (330 million) gets infected, and we've
| got a 1% fatality rate, that means deaths (3.3 million)
| would be up there with all the other things that kill us
| combined!
| rguzman wrote:
| the CFR is only as low as 0.5-1% when there is adequate medical
| care and the population is otherwise healthy. in NYC the CFR
| for the 18-45 cohort is ~5%[1].
|
| [1]: https://www.worldometers.info/coronavirus/coronavirus-age-
| se...
| centimeter wrote:
| CFR is a terrible metric - you should be using IFR. CFR is of
| course going to be much higher than the IFR, probably orders
| of magnitude higher.
|
| IFR data hasn't been available until recently because you
| need A) randomized sampling and B) antibody tests, which have
| only just been rolled out.
|
| The most up-to-date IFR data suggests that "0.5%" is actually
| an astoundingly high _over_ estimate for any reasonable
| metric of "number of people who die from this", and that's
| _before_ adjusting for the fact that the people who die were
| usually going to die soon anyway.
| astrophysician wrote:
| > Death is sad and terrible, but we don't shut down society
| because people die.
|
| Yea, but COVID has the potential to kill a lot of people,
| _quickly_ -- are you suggesting it 's a bad idea to "shut down
| society" to keep our hospitals functioning? I get the point
| that the economic cost is severe and also comes with its own
| share of human cost, but we're talking about saving _~1-2
| million people in the US alone_ by doing this. Several trillion
| dollars is still worth it...
| johnnyo wrote:
| The things that generally kill Americans (heart disease,
| cancer, car crashes, diabetes, etc) aren't contagious, so this
| is a bad analogy.
| marcell wrote:
| No analogy is perfect, but people need context to understand
| fatality rates, and see what risk is acceptable. Society
| doesn't have a goal of 0% death rates. We all accept some
| risk of death as a cost of continued existence.
|
| New data is showing that the fatality rate from covid-19 is
| more like existing risk we were all previously exposed to in
| the course of our existence, and not like a second version of
| smallpox.
| troughway wrote:
| Another round of fear porn. I really wish HN would tone this
| down, because these articles/blog posts do not actually help or
| offer new insights in any way.
|
| This "Third Solution" has been offered all the way back in
| February. It suffers from the same lack of information around
| reinfection and spread rates as it did the first time around.
| jawns wrote:
| > If we were able to identify and quarantine everyone who is
| contagious, including those who are asymptomatic, then we could
| let everyone else out of lockdown and resume ordinary social and
| economic activity.
|
| > Even with imperfect screening, if we are able to prevent 90% of
| disease transmission, then the virus's reproductive number, or
| R0, will drop below one and the pandemic will quickly fade. There
| is no risk of reintroduction from the outside because any new
| outbreaks will quickly be caught and contained. If used
| consistently, there will be no second wave, ever.
|
| I'm not sure this "test and release" strategy works unless
| absolutely everybody gets tested simultaneously.
|
| Even if testing of the total population can be completed in a
| week (a highly ambitious timeframe), there's still time for
| people released on Day 1 to be reinfected by people who don't get
| tested until Day 6.
|
| Then you have to go through who knows how many follow-up rounds
| of testing absolutely everybody not in quarantine to identify
| those people. When responding to new outbreaks involves re-
| testing large populations of people, you're going to run into
| many problems. Notification, compliance, testing fatigue, etc.
|
| Sounds like a logistical nightmare.
| pb wrote:
| It's daily screening for exactly that reason. Is there
| something I should change to make that more clear?
| jawns wrote:
| But how realistic is daily screening on a wide scale? You're
| going to face major issues with compliance.
| pb wrote:
| That's why I think testing at the door is the more
| straightforward way to start. We can reopen factories,
| office buildings, even shopping malls, but no one gets in
| without passing the screen.
| xyzzyz wrote:
| What door? You mean my front door? I'm not letting anyone
| in, and I'm not leaving either. What are you going to do,
| call the cops to kick in the doors to test me?
| rguzman wrote:
| it is pretty clear, but the conclusion of the parent is still
| pretty strong:
|
| > Sounds like a logistical nightmare.
| tlb wrote:
| Making most people a coffee every day also seems like a
| logistical nightmare. But we built that infrastructure.
| JoeAltmaier wrote:
| Straw-man. Many scenarios exist to get most of the benefits
| without resorting to 'everybody simultaneously'.
|
| E.g. 'test and release' where only folks who've been tested are
| 'released' into the public. Track outbreaks and retest those
| cohorts thoroughly. And so on.
| pdonis wrote:
| _> I 'm not sure this "test and release" strategy works unless
| absolutely everybody gets tested simultaneously._
|
| They don't all have to get tested literally simultaneously; but
| the "release" part of the strategy can't start until the "test"
| part has covered everybody, or at least close enough to
| "everybody" that the difference doesn't matter. Note that
| that's how the strategy is stated in what you quote: _if_ we
| can identify _everyone_ who is contagious, _then_ we can
| release everyone else. The "if" has to be complete before the
| "then" starts; that's what "if"-"then" means.
| vikramkr wrote:
| Compliance is tough. And my main concern would be false
| positives- if we are screening more people more frequently, we
| would have a lower expected percent of true positives, and even
| a small false positive rate could lead to significant
| overdiagnosis and disruption. The more often the test the more
| stringent that requirement. I dont know much about the testing
| method described in the article, but I wonder if it has unique
| characteristics beyond ease of administration to support that
| broad use case
___________________________________________________________________
(page generated 2020-04-24 23:00 UTC)