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Coronavirus

Started by bacardiandlime, January 30, 2020, 03:20:28 PM

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Hegemony

There's a report on the difficulty of getting tested here:

https://www.theguardian.com/world/2020/mar/03/coronavirus-washington-state-deaths-testing

"One potential sufferer in the state, Jeannette Jameson, 61, a criminal defense lawyer, told the Guardian that she had been sick for about a month when her doctor suggested she go to an emergency room to be tested for the virus. On Monday, Jameson went to Providence hospital in Everett, Washington, and after waiting for over two hours near dozens of other sick people, she was escorted to a chair in the hallway, separated from other patients with respiratory symptoms by carpeted wall partitions. Jameson said she never saw a doctor, and after testing negative for flu and being given a chest X-ray, she was discharged with papers that said she had "some non-specific respiratory virus", along with prescriptions for ibuprofen and acetaminophen. When she asked why she wasn't given a test for coronavirus, she said that a nurse practitioner told her she could only get tested if she was admitted to the hospital with severe symptoms. After the flu test results came back and Jameson asked about the coronavirus test, she said the registered nurse practitioner told her: "You should be glad you don't have influenza because that's worse than coronavirus.""

Among the maddening things about this are that they didn't tell her upfront that they would refuse to test her for COVID-19; that they put her in a situation where she could infect numerous others; and that they undoubtedly charged her an arm and a leg for this inconclusive waste of time.

Meanwhile someone I know had a son who flew from Milan to Newark, has a cough and a virus, and nobody at Newark Airport tested him or even seemed to be aware that there might be an issue.

All of this is just making me, and everyone, more skeptical when they announce things like: "We have only 90 coronavirus patients in the U.S." What they really mean is that among the very limited number they tested, they found 90.

mythbuster

So I caught up with my colleagues who run various hospital Micro labs last night, as well as several colleagues who head the Microbiology section of the State Health Department lab. They are all exhausted. The state lab has now been cleared to do initial testing for the virus. Those that come up positive are "presumptive positive" and the samples will be forwarded to the CDC for confirmation.
   The FDA has also put in extreme streamlining for private hospitals to develop their own in house tests with approval in as little as 48 hours. However, the development of the test will take several weeks before you can ask the FDA for the quick approval.
   I will reiterate. The reason that it is so hard to get tested is because there is no one agreed upon test. Apparently there is one diagnostic company that has a general coronavirus test, but you need special equipment and it costs over $100 per sample to run. The test the CDC is distributing to State labs is a PCR based test, which means that they all should have the equipment and supplies should be relatively cheap and not coming from China.
   The general agreement of the group was that this virus has likely been in circulation for much longer than we realize. This is in part because many people just have common cold intensity symptoms.
   So stories like Hegemony's don't surprise me. It's likely that the hospital had no real way to test for this, and so ruling out flu was the next best idea.
 

Caracal

Quote from: Hegemony on March 04, 2020, 09:02:33 AM

All of this is just making me, and everyone, more skeptical when they announce things like: "We have only 90 coronavirus patients in the U.S." What they really mean is that among the very limited number they tested, they found 90.

Well nobody is actually saying there are only 90 cases. That isn't what the CDC is saying. They are saying there are outbreaks and they expect to find more cases. But yes, the lack of testing, which hopefully is quickly starting to change, is a real problem and shows that some things went really wrong. Some of these people, maybe most of them, don't have Coronavirus, but we can't have any idea of what is happening until we get more tests. It is also really, really not helping with the the anxiety and fear going around.

Hegemony

Well, the article does say "a nurse practitioner told her she could only get tested if she was admitted to the hospital with severe symptoms." So that suggests that there was a test available. If they have few tests, I can understand why they would test only the most severe cases. Other countries seem to have many more tests at their disposal, which doesn't speak well to our ability to keep up. The lack of coordination is also worrying. There are multiple reports of doctors advising sick people to do things that other healthcare agencies refuse to do — as in this case, where a doctor told her to go to the emergency room for a test, and the emergency room then refused to test her. If there were clear directives about this, and the initial doctor had known them, they could have spared a possibly contagious person sitting near other sick people in the emergency room for several hours. And people flying in from Milan is a prime source of spread of the virus — many of the UK cases are from precisely that. So what's our policy on people flying in from Milan? Test them? Ask them to self-isolate without a test? Ignore them and figure the virus will spread anyway?  Let's get some policy decided and publicized, whatever it is.

Anselm

A friend has posted a picture from an Iowa City grocery store.  A store sign says that they are limiting the amount of items you can buy in certain categories such as rice, Lysol, toilet paper, water and paper towels.
I am Dr. Thunderdome and I run Bartertown.

spork

It's terrible writing, used to obfuscate the fact that the authors actually have nothing to say.

Stockmann

Quote from: Hegemony on March 04, 2020, 09:02:33 AM
After the flu test results came back and Jameson asked about the coronavirus test, she said the registered nurse practitioner told her: "You should be glad you don't have influenza because that's worse than coronavirus."

The nurse was outright lying, of course - even by conservative estimates, the coronavirus has several times the fatality rate of ordinary seasonal flu (the worst-case estimates are over an order of mangnitude), and it's also more contagious. I guess the nurse was trying to be reassuring or something, but these sort of lies and false reassurance are exactly what feeds conspiracy theories, rumors, etc. If this had been a young child instead of a 61-year-old, the nurse would've probably been right, but it wasn't.


QuoteMeanwhile someone I know had a son who flew from Milan to Newark, has a cough and a virus, and nobody at Newark Airport tested him or even seemed to be aware that there might be an issue.

European airports aren't doing much, either (note that Italy didn't quarantine people being repatriated from China). Only in some Asian countries are airports checking people's temperature, etc.


QuoteAmong the maddening things about this are that they didn't tell her upfront that they would refuse to test her for COVID-19; that they put her in a situation where she could infect numerous others; and that they undoubtedly charged her an arm and a leg for this inconclusive waste of time.

Yep. Talking to a friend of mine, we both agreed that if we were in the US and suspected we had it we wouldn't go to a hospital unless it was immediately life-threatening bad, as we likely wouldn't get tested anyway and we would only get palliative care at best, so no point on spending several months' pay on it.
The Chinese and Japanese healthcare systems are looking very good on this, on the other hand. 

Caracal

Quote from: Stockmann on March 04, 2020, 01:34:21 PM

Yep. Talking to a friend of mine, we both agreed that if we were in the US and suspected we had it we wouldn't go to a hospital unless it was immediately life-threatening bad, as we likely wouldn't get tested anyway and we would only get palliative care at best, so no point on spending several months' pay on it.
The Chinese and Japanese healthcare systems are looking very good on this, on the other hand.

You aren't supposed to go to a hospital unless you have symptoms of pneumonia. In fact, if this gets worse it will be very important that mildly sick without a lot of risk factors stay home and don't contribute to the overwhelming of the medical system. They aren't admitting everyone who has this to hospitals in Japan and China either. The vast majority of people are just going to have some flu symptoms and then get better with no medical treatment. (Which isn't to say there aren't lots of people in high risk groups, or this isn't dangerous)  At the moment, there aren't any drugs to treat it, so there's no reason for people to be in a hospital unless they develop more severe symptoms and need supportive care.

Hegemony

In which case, it's important that there should be a consistent message across the healthcare system, instead of the woman's doctor explicitly telling to her go to the emergency room and get tested. When your doctor tells you to go to the emergency room, normally you tend to believe the doctor knows what they're talking about — after all, they're the one you're asking for advice.

Caracal

Quote from: Hegemony on March 04, 2020, 02:37:00 PM
In which case, it's important that there should be a consistent message across the healthcare system, instead of the woman's doctor explicitly telling to her go to the emergency room and get tested. When your doctor tells you to go to the emergency room, normally you tend to believe the doctor knows what they're talking about — after all, they're the one you're asking for advice.

Indeed. One really hopes that the CDC and local health departments are going to start doing a better job communicating to health care providers.

Stockmann

Quote from: Hegemony on March 04, 2020, 02:37:00 PM
In which case, it's important that there should be a consistent message across the healthcare system, instead of the woman's doctor explicitly telling to her go to the emergency room and get tested. When your doctor tells you to go to the emergency room, normally you tend to believe the doctor knows what they're talking about — after all, they're the one you're asking for advice.

This. Basically, what I meant was that in the US my friend and I wouldn't go to a hospital unless it was immediately life-threatening even if explicitly told to do so by a physician.
The US is well past the early, imported-cases-only stage, but in the early stages actually it makes sense to test, if you can, everyone with reasonable suspicion it could be coronavirus, screen travelers, etc to prolong the early, "easy" stage as much as possible.

Kron3007

Quote from: mythbuster on March 04, 2020, 09:24:29 AM
So I caught up with my colleagues who run various hospital Micro labs last night, as well as several colleagues who head the Microbiology section of the State Health Department lab. They are all exhausted. The state lab has now been cleared to do initial testing for the virus. Those that come up positive are "presumptive positive" and the samples will be forwarded to the CDC for confirmation.
   The FDA has also put in extreme streamlining for private hospitals to develop their own in house tests with approval in as little as 48 hours. However, the development of the test will take several weeks before you can ask the FDA for the quick approval.
   I will reiterate. The reason that it is so hard to get tested is because there is no one agreed upon test. Apparently there is one diagnostic company that has a general coronavirus test, but you need special equipment and it costs over $100 per sample to run. The test the CDC is distributing to State labs is a PCR based test, which means that they all should have the equipment and supplies should be relatively cheap and not coming from China.
   The general agreement of the group was that this virus has likely been in circulation for much longer than we realize. This is in part because many people just have common cold intensity symptoms.
   So stories like Hegemony's don't surprise me. It's likely that the hospital had no real way to test for this, and so ruling out flu was the next best idea.


All this just highlights the failure of the US response.  Other countries are testing thousands of people and have been for weeks.  They don't seem to be having any of these issues, or at least not to the same degree.  I just heard in BC and Ontario they are testing all patients that come to the hospital with flu like symptoms.  There is no reason that there should be a testing ssue in the US when Canada and so many other countries seem to be able to do it.

clean

QuoteThere is no reason that there should be a testing ssue in the US when Canada and so many other countries seem to be able to do it.

Well, others on this fora are mentioning that there is no ONE test, so the test used in the US (reported to cost $100 to run) is not likely the test that others are using. The accuracy of the different tests around the world is also an issue, I am sure!  In this or the other Cornavirus thread, there was discussion of the Diamond Princess.  For much of the quarantine period, even Japan was unable to test the entirety of the passengers and crew, at least in any timely fashion. 
"The Emperor is not as forgiving as I am"  Darth Vader

Treehugger

Quote from: Parasaurolophus on March 03, 2020, 07:05:46 AM
I was travelling last weekend, and it was amusing/a little sad to see how many people in all the airports were wearing various kinds of face mask (including some pretty heavy-duty painting masks).
`
There's no way they were all sick, which means they mistakenly think wearing a face mask will protect them.


It is my understanding that wearing a face mask will provide partial protection. Obviously, it doesn't cover your eyes and most of them are not airtight. However, if you are exposed, you will be exposed to less of the virus and viral load is important. In other words, it is literally better than nothing.

Treehugger

#104
Quote from: Caracal on March 04, 2020, 09:27:17 AM
Quote from: Hegemony on March 04, 2020, 09:02:33 AM

All of this is just making me, and everyone, more skeptical when they announce things like: "We have only 90 coronavirus patients in the U.S." What they really mean is that among the very limited number they tested, they found 90.

Well nobody is actually saying there are only 90 cases. That isn't what the CDC is saying. They are saying there are outbreaks and they expect to find more cases. But yes, the lack of testing, which hopefully is quickly starting to change, is a real problem and shows that some things went really wrong. Some of these people, maybe most of them, don't have Coronavirus, but we can't have any idea of what is happening until we get more tests. It is also really, really not helping with the the anxiety and fear going around.


Yes, I am sure most of them do not have the Coronavirus. If you take a look at the data for countries where there are known, serious outbreaks (https://www.worldometers.info/coronavirus/covid-19-testing/), countries where they are testing thousands and tens of thousands of people, you will see that the rate of positive tests is still pretty low. It is  a little more than 4% positive for South Korea. In Italy, the rate was only a little higher in spite of there being an obvious crisis with lots of people dying and them deciding to limit testing only to those with symptoms. In the UK, where they are also testing many, many people, they are finding a .2% positive rate.


My point is not that we shouldn't be testing more. We definitely should be. How else are we going to contain the outbreak if we don't test?

Instead, my point is that people from Washington or Oregon who have flu symptoms and are worried about not being tested are really most likely to not have coronavirus. Or, no more than 1 in 20 Twitter complainers actually have it.