Presymptomatic transmission - Printable Version

Presymptomatic transmission - Printable Version

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Presymptomatic transmission - BostonCard - 04-02-2020

https://www.cdc.gov/mmwr/volumes/69/wr/mm6914e1.htm?s_cid=mm6914e1_w

this is the sort of work you can do with good contact tracing, he says, wistfully.

BC

RE: Presymptomatic transmission - Goose - 04-03-2020

(04-02-2020, 09:10 PM)BostonCard Wrote: https://www.cdc.gov/mmwr/volumes/69/wr/mm6914e1.htm?s_cid=mm6914e1_w

this is the sort of work you can do with good contact tracing, he says, wistfully.

BC

Yes, and we didn't have that at the start of this pandemic. As I have been saying, I don't see much evidence we are trying to build such a capability either. Is it just that I am unaware, or is it really true that essentially nothing is being done? It is difficult to do "on the fly", but if we aren't even trying, is the plan to wait until California is down to 1 case a day, which maybe we can trace down before we start relaxing shelter in place?

RE: Presymptomatic transmission - 2006alum - 04-03-2020

(04-03-2020, 08:14 AM)Goose Wrote:
(04-02-2020, 09:10 PM)BostonCard Wrote: https://www.cdc.gov/mmwr/volumes/69/wr/mm6914e1.htm?s_cid=mm6914e1_w

this is the sort of work you can do with good contact tracing, he says, wistfully.

BC

Yes, and we didn't have that at the start of this pandemic. As I have been saying, I don't see much evidence we are trying to build such a capability either. Is it just that I am unaware, or is it really true that essentially nothing is being done? It is difficult to do "on the fly", but if we aren't even trying, is the plan to wait until California is down to 1 case a day, which maybe we can trace down before we start relaxing shelter in place?

This is why I keep Chicken Littling. I am astounded by how little effort seems to be going into this. I am very loosely involved in volunteering with a non-profit/community-leader led effort to get this going in CA, but there's almost no indication that significant effort is happening at the national level to coordinate among/between state and local public health leaders.

ETA: Here's one way we can all help out:

[tweet]https://twitter.com/larrybrilliant/status/1245790730502561793?s=20[/tweet]

It takes 15 seconds to report your status. They ask you to give your phone number so that they can remind you daily.

RE: Presymptomatic transmission - BostonCard - 04-03-2020

Here's another one, which is more local:

https://www.engadget.com/2020-03-31-ucsf-app-citizen-science-covid-19.html

BV

RE: Presymptomatic transmission - Farm93 - 04-03-2020

CA will be ready for a careful return by removing the stay-at-home order before most states thanks to Governor Newsom's willingness to be the first state to do more than POTUS indicated was needed.

However, I suspect what will happen is the State of California will not release their stay at home order until there is much better set of Coronavirus testing available and potentially test for antibodies too.

USA should have had strong testing and tracing in January and February per the USA's pandemic playbook (see Singapore, Korea and Japan), but would be crazy to go through March and April with stay-at-home and then not have strong testing or tracing for May and June. CA is far too open to the rest of the USA with some states that never implemented stay-at-home to just go back to mere social distancing without testing.

RE: Presymptomatic transmission - M T - 04-03-2020

The article that BC posted is a more formal write-up on what's been known for some time. On March 17, I quoted a report from March 13 that indicated presymptomatic transmission. As I recall, there were multiple articles at that time that indicated the same thing. The earliest report in BC's article is January, so it has probably been recognized since at least early February.

The Public Health Department for each county is the agency responsible for dealing with these things, but obviously they aren't budgeted or staffed with the people it takes to do this. I don't have any idea if there are any resources (people) at the county level that can be diverted to this.

Ok, bump it up to the state. Again, there's someone at the state that deals with public health issues, but again, they don't have the staff. At least at the state level, there is the National Guard that can be activated. I'm not sure they have enough manpower to do this. I believe Califronia's governor has mentioned the National Guard for purposes such as distributing food. I think the state (at least for California) probably has the budget and staff (normally assigned to a wide range of other duties (all of which are important): Child Protective Services, Driver's Licenses, ....) that could be tasked for this.

Bump it up another level to the federal level, and you've got a similar issue as the state. Everyone has important jobs to do. So, who do you call? What organizations have the manpower, the organization, the skills, to do this tracking at the county level?

I have suggested that census workers be retasked to this. They may be a drop in the bucket as far as manpower, but they are often locality-focused, probably are trained to deal with people, and their regular task, while important, is not time critical.

I also think the National Guard can contribute to this effort. I think the border patrol & ICE can be retasked. Perhaps some military troops can be deployed to do this, but they (and the National Guard) may be better used in other ways. IRS workers?

What about the other direction? Can any group at the city level be retasked? Police - maybe some if crime really has fallen off. I'm not sure what else.

What about a nationwide work force from the unemployed? There are literally millions of people that would probably love to have a paying job doing this. This is a WPA type effort. The bureaucracy required to set this up is mind-boggling, but it was done in the 1930s. There are issues about privacy that will be of concern. Unfortunately the potential for scammers to portray themselves as part of this workforce is tangible.

Whatever group of workers that do this, I hope they are tasked to work under the authority & responsibility of the various counties. Making a federal organization be in control seems to me to add a lot of heaviness at the top when you really want all the resources at the local levels. I'd rather it be a model like the National Guard working to support the counties' Public Health Departments.

Then there's the scale of this. Obviously NYC has to have a very large scale. Tuolomne County can probably get by without help (for now).

How to get appropriate staffing & pay for it? I don't know. One thought is for those who have recovered from the disease could be used to do interviewing of patients. An interesting thought is to encourage patients who aren't able to otherwise pay for their hospitalization to do this (but then, what if some don't agree? I wouldn't agree to withholding care, so that can't be the apple/stick)

That brings up another question (for another thread, not here). Hospitals are going to be burning money quickly. A lot of patients won't be able to pay (no insurance). Even if they do have insurance, do the insurance companies have the money for this (esp. with the stock market being much lower)? Will we see hospitals and/or insurance companies fail?

I still like a tech-based answer to getting much of the contact information, with little effort, and some loss of privacy (but each individual gets to make that choice, not have it handed down from some government entity). The so-called Singapore tracking app is one example.

RE: Presymptomatic transmission - M T - 04-03-2020

I thought I'd quote the full set of symptoms of some of the patients out of the presymptomatic article:

itchy throat, chills
sore throat, blocked nose
sore throat

How many people will get these & not recognize that this is COVID-19?

RE: Presymptomatic transmission - Leftcoast - 04-03-2020

"How many people will get these & not recognize that this is COVID-19?" - MT

Probably every hourly worker depending upon getting work hours to make his rent. To him/her those symptoms will look like every other flu he's had and worked through. Unfortunately that could be the guy standing next to us at the Safeway checkout line, standing next to us on an elevator or flipping our In-N-Out burgers.

I suspect our view of this crisis is overly grounded upon our personal curiosity plus frequent viewing of this Covid-19 forum and government trackers. That's not the reality for much of America.

RE: Presymptomatic transmission - oldalum - 04-03-2020

(04-03-2020, 11:28 AM)M T Wrote: On March 17, I quoted a report from March 13 that indicated presymptomatic transmission. As I recall, there were multiple articles at that time that indicated the same thing.

I posted this in this forum on March 5:

alarming report from Germany in this week's New England J of Medicine confirming transmission of infection early in its asymptomatic incubation period. Patient "1"(who had been infected by a then-asymptomatic index patient who had traveled to Germany from China) then infected another work colleague with whom he had contacts only the same day or the day after patient 1 himself became infected--and 3 or 4 days before patient 1 became symptomatic. If such early transmission soon after infection is common, it will spread quickly and widely.

article

RE: Presymptomatic transmission - Snorlax94 - 04-03-2020

(04-03-2020, 11:28 AM)M T Wrote: I still like a tech-based answer to getting much of the contact information, with little effort, and some loss of privacy (but each individual gets to make that choice, not have it handed down from some government entity). The so-called Singapore tracking app is one example.

YES THIS. Similar to many posters above, one of my frustrations (and apparently, Governor Newsom's) is that other states are not on lockdown. The Bay Area was the first in the nation to go on lockdown. Let's say the Bay Area and CA gets it under control by June 1. Then people start flying in from all over the country and from other countries, and it starts all over again. Then we will be the first to hammer again, and again.

IF we had widespread testing and contact tracing, this might work. But, well, I think many of us are similarly frustrated at this point.

I don't know what's in the Singapore App, but based on what I've read bout apps in Korea and China and how they're used, how about this for a technological solution: The Quarantine CA App. This idea is not about contact tracing, so it avoids many of the privacy issues -- it's just about enforcing quarantines or proving immunity.

There could be three levels: (1) Documented immunity, (2) Documented recent test (proving Negative), (3) Quarantined Recently, (4) Newcomer.

When the lockdown lifts, CA could block all new tourists, newly returning people (Category 4 - Newcomer) from entering any non-essential service. Two prove you were quarantined recently, you had to install an (intrusive) app for 14 days and PROVE you stayed at home for the 14 day quarantine. The app could constantly track your location, and you might, for example, take photos or receive calls to prove you are who you say you are, when you say you are there.

Similar to what I've read in China, when CA re-opens, we should block people from entering shopping malls, restaurants, and other non-essential locations until they prove they quarantined.
This would serve many purposes:
1) Protect CA from people flying in and re-spreading the disease
2) Increase compliance with the quarantine (you'll want to prove you've been home for 14+ days)
3) Discourage tourism to CA this summer+fall

We could have reciprocal agreements with other states so if you proved you quarantined for 14 days in say, Oregon, and drove down, CA might honor an Oregon post-quarantine person.

For urgent needs, someone could fly in and take a test at the airport and wait for a quicker clearance while at a quarantine airport hotel.

If the privacy issues could be dealt with, then known exposure could knock you back down to category 4 (let's say a co-worker or a child at your child's school tested positive). But this could be very hard to do due to privacy concerns, so this part wouldn't be required in the 1.0

I don't know about the legal aspects and maybe it wouldn't be legal under current laws, but the technological aspects are very feasible, though admittedly there would be some complexities to minimize cheating. It wouldn't be foolproof, and it'd be important to make GPS-spoofing the app a crime.

RE: Presymptomatic transmission - Goose - 04-03-2020

(04-03-2020, 05:56 PM)Snorlax94 Wrote: I don't know about the legal aspects and maybe it wouldn't be legal under current laws, but the technological aspects are very feasible, though admittedly there would be some complexities to minimize cheating. It wouldn't be foolproof, and it'd be important to make GPS-spoofing the app a crime.

I am pretty sure it is legal under current laws. One state can exclude travel from another state if the is a "legitimate public health reason". I don't agree that it is very feasible however. Not everybody has a cell phone. The technology is only a small part of the problem. The enforcement logistics would be a nightmare. There are just too many ways into California. Remember the old Produce Inspection Stops? Even they do not exist any more. We would need a "reverse TSA" at every airport, including general aviation ones. That would all be real hard.

Despite the fact we don't seem to be doing it, generating a large, effective case tracing and surveillance capability would be no more difficult. It would also give us the capability to contain any other outbreaks that were "home grown". More bang for the buck.

RE: Presymptomatic transmission - Snorlax94 - 04-03-2020

(04-03-2020, 06:30 PM)Goose Wrote:
(04-03-2020, 05:56 PM)Snorlax94 Wrote: I don't know about the legal aspects and maybe it wouldn't be legal under current laws, but the technological aspects are very feasible, though admittedly there would be some complexities to minimize cheating. It wouldn't be foolproof, and it'd be important to make GPS-spoofing the app a crime.
I am pretty sure it is legal under current laws. One state can exclude travel from another state if the is a "legitimate public health reason". I don't agree that it is very feasible however. Not everybody has a cell phone. The technology is only a small part of the problem. The enforcement logistics would be a nightmare. There are just too many ways into California. Remember the old Produce Inspection Stops? Even they do not exist any more. We would need a "reverse TSA" at every airport, including general aviation ones. That would all be real hard.

Despite the fact we don't seem to be doing it, generating a large, effective case tracing and surveillance capability would be no more difficult. It would also give us the capability to contain any other outbreaks that were "home grown". More bang for the buck.

To clarify: the enforcement wouldn’t have to be done at the borders. It would be done at shop entrances, which is what I’ve heard they do in some Asian countries.

You can drive in from NV or OR, but you won’t be able to eat in any restaurant, enter any state park, enter any non-essential shop, or enter any kind of attraction. Parks already have parking attendants, many stores already have greeters, restaurants have hosts — they could all check quarantine status of patrons.

It would require the locations to all have people and eventually an app monitoring anyone who wants to go in, and there would have to be some trust for shops to comply. But they could lose more business if they weren’t checking every patron.

And by the way I don’t disagree with you at all. Absolutely I wish the state and country could do contact tracing, adequate testing, etc. The thing about this approach is that it would require very little by government except adopting it. Sure, contact tracing can be plan A, I’m all for it. But I’d love there to be a Plan B being driven by Apple, Google, Amazon, etc.

Yes, it would require everyone to have a smartphone to access non-essential services, but I think virtually everyone has a smartphone. A high percentage of children at my kids’ school qualify for subsidized and free lunches, but every parent has a smartphone. people need cell phones to work anywhere.

RE: Presymptomatic transmission - needle - 04-03-2020

I actually know something about this topic (or, at least what the CDC has been saying).

March 28 (via Wayback Machine):

Quote:Can someone spread the virus without being sick?
People are thought to be most contagious when they are most symptomatic (the sickest).

Some spread might be possible before people show symptoms; there have been reports of this occurring with this new coronavirus, but this is not thought to be the main way the virus spreads.

https://web.archive.org/web/20200328191833/https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html

April 2 (via Wayback Machine):

Quote:"There are reports of asymptomatic infections (detection of virus with no development of symptoms) and pre-symptomatic infections (detection of virus prior to development of symptoms) with SARS-CoV-2, but their role in transmission is not yet known."

Link to archived page: https://web.archive.org/web/20200402025439/https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html#transmission

April 3:

Quote:"Some recent studies have suggested that COVID-19 may be spread by people who are not showing symptoms."

Link: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html

How would you grade the CDC's communication on this issue? I'm very interested in the responses here, if you have an opinion.

RE: Presymptomatic transmission - dabigv13 - 04-03-2020

When you have IgG's in your blood, you get a wristband. Getting some central entity to organize it will be tough. States prob have to lead.

RE: Presymptomatic transmission - cardcrimson - 04-03-2020

This thread is hysterical. California closing it's borders or it's shops, parks, and restaurants to individuals that can't prove they're Covid-19 free with a smartphone app? I thought it was a sanctuary state and anyone was welcome here. The hypocrisy astounds. . . .

RE: Presymptomatic transmission - magnus - 04-03-2020

(04-03-2020, 07:05 PM)needle Wrote: How would you grade the CDC's communication on this issue? I'm very interested in the responses here, if you have an opinion.

I feel like if those messages were each a month earlier, they'd still be behind the news. As they're supposed to be the best in the world, those messages should have each been at least 2 months earlier

RE: Presymptomatic transmission - cardcrimson - 04-03-2020

(04-03-2020, 07:40 PM)cardcrimson Wrote: This thread is hysterical. California closing it's borders or it's shops, parks, and restaurants to individuals that can't prove they're Covid-19 free with a smartphone app? I thought it was a sanctuary state and anyone was welcome here. The hypocrisy astounds. . . .

Thanks for the down arrow Pete! That's what twelve in a week or so? Amazingly, you've not made a single reply to any of my posts. . . .

RE: Presymptomatic transmission - stupac2 - 04-03-2020

(04-03-2020, 08:24 PM)cardcrimson Wrote:
(04-03-2020, 07:40 PM)cardcrimson Wrote: This thread is hysterical. California closing it's borders or it's shops, parks, and restaurants to individuals that can't prove they're Covid-19 free with a smartphone app? I thought it was a sanctuary state and anyone was welcome here. The hypocrisy astounds. . . .

Thanks for the down arrow Pete! That's what twelve in a week or so? Amazingly, you've not made a single reply to any of my posts. . . .

For the most part they don't merit reply. (Do you honestly think that one dude's opinion of a way to open life back up during a global pandemic is representative of the attitudes of a whole state during normal times? Sheesh).

And who on earth watches their points, let alone who's doling them out?

RE: Presymptomatic transmission - pefloresjr - 04-03-2020

(04-03-2020, 08:24 PM)cardcrimson Wrote:
(04-03-2020, 07:40 PM)cardcrimson Wrote: This thread is hysterical. California closing it's borders or it's shops, parks, and restaurants to individuals that can't prove they're Covid-19 free with a smartphone app? I thought it was a sanctuary state and anyone was welcome here. The hypocrisy astounds. . . .

Thanks for the down arrow Pete! That's what twelve in a week or so? Amazingly, you've not made a single reply to any of my posts. . . .

If you were interested, you would notice that I don't down vote all of your posts, only the ones that are overtly political, critiques that are too personal, or posts that are clearly just meant to provoke. I like your post about cats and the few in COVID19 that were looking to actually help to solve the crisis. I've down voted other posters in this forum who have gotten too political as well. Some political posts are unavoidable in this type of discussion but, in my opinion, far too many of yours have been avoidably political. I like most of your sports related posts on the main forum so it's not personal. I have no interest in a flame war and am simply registering my disagreement with your general approach and in a few I noted that I thought you were being too political. I hope you continue in a constructive way.

Cheers,
Pete F.

PS: Feel free to down vote me if you want, I won't lose any sleep over it.

RE: Presymptomatic transmission - cardcrimson - 04-03-2020

(04-03-2020, 09:11 PM)stupac2 Wrote:
(04-03-2020, 08:24 PM)cardcrimson Wrote:
(04-03-2020, 07:40 PM)cardcrimson Wrote: This thread is hysterical. California closing it's borders or it's shops, parks, and restaurants to individuals that can't prove they're Covid-19 free with a smartphone app? I thought it was a sanctuary state and anyone was welcome here. The hypocrisy astounds. . . .

Thanks for the down arrow Pete! That's what twelve in a week or so? Amazingly, you've not made a single reply to any of my posts. . . .
And who on earth watches their points, let alone who's doling them out?

Then why are they there, if not for people to notice? Get rid of them then.

(04-03-2020, 09:47 PM)pefloresjr Wrote:
(04-03-2020, 08:24 PM)cardcrimson Wrote:
(04-03-2020, 07:40 PM)cardcrimson Wrote: This thread is hysterical. California closing it's borders or it's shops, parks, and restaurants to individuals that can't prove they're Covid-19 free with a smartphone app? I thought it was a sanctuary state and anyone was welcome here. The hypocrisy astounds. . . .

Thanks for the down arrow Pete! That's what twelve in a week or so? Amazingly, you've not made a single reply to any of my posts. . . .

If you were interested, you would notice that I don't down vote all of your posts, only the ones that are overtly political, critiques that are too personal, or posts that are clearly just meant to provoke. I like your post about cats and the few in COVID19 that were looking to actually help to solve the crisis. I've down voted other posters in this forum who have gotten too political as well. Some political posts are unavoidable in this type of discussion but, in my opinion, far too many of yours have been avoidably political. I like most of your sports related posts on the main forum so it's not personal. I have no interest in a flame war and am simply registering my disagreement with your general approach and in a few I noted that I thought you were being too political. I hope you continue in a constructive way.

Cheers,
Pete F.

PS: Feel free to down vote me if you want, I won't lose any sleep over it.

Please. Have you read most of the posts on the Covid board of late? 95% of them are extremely political and all slanted one direction. And silence on your part.

And FWIW, calling out hypocrisy is constructive. Don't you find it ironic that your compadres are calling for the closing of the borders of CA now? Just two months ago, Trump was a xenophobe for stopping flights from China into the US.