IS OUR CO-19 TESTING STRATEGY ALL WRONG? (Guest Post - Boo Fagan
IS OUR CO-19 TESTING STRATEGY ALL WRONG? (Guess post from my friend and fellow Design Thinker Boo Fagan, with color commentary from me)
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I want to know why I hear doctors and nurses and politicians every day on the radio say “we don’t have enough tests. We need to reserve them for the sickest people.”
Our testing approach seems like it breaks all testing strategy logic used in any other context. In my work, you test in the area with the highest unknowns, where the unknown has the highest risk. And you don’t test where you already have directional data, hypotheses are strong and testing outcomes have very little impact. For some reason here we are doing the opposite.
If there are a limited number of tests, tests are precious. But we are using those tests on people who are already thinking and demonstrating that they are positive and testing exactly no-one who shows no symptoms. And the outcome of a test of someone exhibiting symptoms has essentially no impact on the systematic contagion risks because the person exhibiting symptoms will necessarily be put into home quarantine or a hospital bed away from other humans, test or no. The biggest risks to the spread of this disease are the unknown swaths of asymptomatic humans walking about without a clue that they are spreading it. As it turns out that is probably a large or even giant figure…
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(John K. Coyle addition here: CO-19 is 4 – 8 times more infectious than the flu, and 5 to 15 times more deadly, but those stats pale in comparison to the most deadly aspect: a 5 day asymptomatic incubation period (vs. 2 days for the flu) and ~25% asymptomatic rate (vs. 15% for the flu) for the whole long course of the illness of 2+ weeks. CO-19 hides in plain sight for longer than any other infectious disease. This is the REAL reason we have this lockdown across the planet – because we simply don’t know who has it… and the only way to do that would be a statistically significant randomized test across multiple geographies – which does not exist (or to test every single person on the planet - which is not feasible in any useful timeframe). There are only 2 efforts I am even aware of to try to understand it this way: A doctor in a town in Italy tested every resident. Nearly all the positives were asymptomatic and were quarantined. Less than a month later, the illness has been squelched. https://www.theguardian.com/commentisfree/2020/mar/20/eradicated-coronavirus-mass-testing-covid-19-italy-vo Stanford University is also conducting a test to understand the true penetration by studying those with antibodies that have recovered from the disease and start to get a clearer picture of the penetration for actual cases vs. tested cases.) https://www.stanforddaily.com/2020/04/04/stanford-researchers-test-3200-people-for-covid-19-antibodies/?fbclid=IwAR00UVP_y-AdJNWaSryete0NjapGQ3VVO4ZGGh-57Tth5O85GzXUjiprY-0
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The outcome of finding a positive in a sea of people without symptoms has a massive effect on whether they continue to spread the disease without know or go into isolation to protect others. So we are effectively throwing away our scarce supply of tests by double testing the lowest risk and leaving a massive blind spot where the highest risk lives (which is in the still-mobile asymptomatic carriers.)
(John K Coyle addition: Have symptoms? Unless you require hospitalization, assume that you have it, STAY HOME and self-quarantine! Why do you really need to know? Consider this… if you suspect you have it and then show up to a hospital to get tested, regardless of test outcome, you are contributing to the problem. If you are NOT carrying it, you just self-selected to enter the one locality in the world with the highest rate of infections (a hospital) putting yourself at increased risk. And if you DO have it, you just ran the risk of adding to the already crisis conditions at the hospital and infecting more of the most precious resources we have - the heroes of the front line at the hospital. As Samuel Jackson so elegantly put it in his bedtime story, "Stay.the fuck.at home")
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It makes sense that early in the pandemic when cases are sparse you test the sick cases that pop up in order to trace and isolate everyone who came in contact with that individual, (JKC - this was how Korea did it, but we are way too late for that now). It feels like we’re holding onto a latent approach for no apparent reason. Consider this: if you have 20 people - 10 sick and 10 healthy, but only five tests... We should call the sick positive. Just count them. And quarantine them. Then use the five tests on a randomized/representative group of the healthy, and start to model the patterns that emerge to predict who is likely sick among the healthy. As more tests emerge continue doing the same until you have a decent model for the ACTUAL number of cases in a given geography.
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(John K. Coyle addition: Here we are in the worst pandemic in modern history and 4 months in, we actually have no clue, within an order of magnitude (or more) of the number of actual cases. What if 10X as many people have it as tested? For the short term it doesn’t really matter – we know the trends for those needing hospitalization and the emergent health care crisis – that is the only thing that matters for the next few weeks. But, post-surge the policy decisions on when and how to loosen up have to be based on a real understanding of the actual penetration, the percent of people that have already had it and are (likely) immune that can resume work in public spaces, and how careful we need to be with the rest to manage infectious growth and not create an echo boom – or bomb. At some point, some pour soul (Dr. Fauci?) is going to have to take an actuarial view and say, "yes if we open up, X thousands will die, but due to the economic costs (which lead indirectly to deaths) it is the right thing to do." I wouldn't want to be that person - UGH...)
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Oh! Last thing. We need a super basic online platform and automated phone system for people to “raise their hands” if they have symptoms but are going to ride it out at home so that they can become a data point. And then we need a way for recovered people to identify themselves easily to others, because they essentially have superpowers now and we need to activate them. Something like those dumb plastic lanyards they give us at conventions or the vests that parking ticket cops wear, that are a distinct bright color to show others that they can safely interact/support healthcare or economic recovery efforts.
Also, people like us should form a coalition of private-sector experts/ citizens with various skill sets, to put ideas like the ones above together and send them to the CDC/State Governors as an input. The collective brainpower of all the individuals sitting at home helpless is just a stupidly huge untapped resource. John - you could spend more of your COVID data analysis time on solutions instead of debunking dirt information on social media (which is still super valuable, just not an impact at the scale that you can and should be contributing at). - Boo Fagan
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(John K. Coyle: anyone want to help me prepare future posts? I’d love to have a little Thinktank to run ideas through and we can simultaneously publish the outputs of our collective expertise. I’m happy to be the storytelling scribe and translate your genius for the laypeople… @davidtorgerson @elliotrawls @terryKarner @gregswinand @gregfanslow… who else?