[Mick]

https://www.thehour.com/news/article/CDC...304621.php

First CDC briefing of reporters in 90 days.

[Mick]

https://www.thehour.com/news/article/CDC...304621.php

First CDC briefing of reporters in 90 days.

[oldalum]

"We were never really blind when it came to surveillance" for covid-19, the disease caused by the virus, CDC chief Robert Redfield said. Even if widespread diagnostic testing had been in place, it would have been like "looking for a needle in a haystack," he said.

This statement seems totally bogus to me. How can you detect community transmission if you only allow testing of people with known exposure? Case in point: the Feb. 6 death in SCC that was recently discovered to be due to Covid-19 and is now thought to be the earliest known example of community transmission within SCC. The County coroner who performed the autopsy on Feb. 7 suspected Covid-19 but was unable to test her for it because she didn't meet testing criteria. 

[oldalum]

"We were never really blind when it came to surveillance" for covid-19, the disease caused by the virus, CDC chief Robert Redfield said. Even if widespread diagnostic testing had been in place, it would have been like "looking for a needle in a haystack," he said.

This statement seems totally bogus to me. How can you detect community transmission if you only allow testing of people with known exposure? Case in point: the Feb. 6 death in SCC that was recently discovered to be due to Covid-19 and is now thought to be the earliest known example of community transmission within SCC. The County coroner who performed the autopsy on Feb. 7 suspected Covid-19 but was unable to test her for it because she didn't meet testing criteria. 

[akiddoc]

"We were never really blind when it came to surveillance" for covid-19, the disease caused by the virus, CDC chief Robert Redfield said. Even if widespread diagnostic testing had been in place, it would have been like "looking for a needle in a haystack," he said.

This statement seems totally bogus to me. How can you detect community transmission if you only allow testing of people with known exposure? Case in point: the Feb. 6 death in SCC that was recently discovered to be due to Covid-19 and is now thought to be the earliest known example of community transmission within SCC. The County coroner who performed the autopsy on Feb. 7 suspected Covid-19 but was unable to test her for it because she didn't meet testing criteria. 

If widespread testing was in place every urgent care center and ER on the west coast would have been testing every patient with a cough back in February.

[akiddoc]

"We were never really blind when it came to surveillance" for covid-19, the disease caused by the virus, CDC chief Robert Redfield said. Even if widespread diagnostic testing had been in place, it would have been like "looking for a needle in a haystack," he said.

This statement seems totally bogus to me. How can you detect community transmission if you only allow testing of people with known exposure? Case in point: the Feb. 6 death in SCC that was recently discovered to be due to Covid-19 and is now thought to be the earliest known example of community transmission within SCC. The County coroner who performed the autopsy on Feb. 7 suspected Covid-19 but was unable to test her for it because she didn't meet testing criteria. 

If widespread testing was in place every urgent care center and ER on the west coast would have been testing every patient with a cough back in February.

[Goose]

"We were never really blind when it came to surveillance" for covid-19, the disease caused by the virus, CDC chief Robert Redfield said. Even if widespread diagnostic testing had been in place, it would have been like "looking for a needle in a haystack," he said.

This statement seems totally bogus to me. How can you detect community transmission if you only allow testing of people with known exposure? Case in point: the Feb. 6 death in SCC that was recently discovered to be due to Covid-19 and is now thought to be the earliest known example of community transmission within SCC. The County coroner who performed the autopsy on Feb. 7 suspected Covid-19 but was unable to test her for it because she didn't meet testing criteria. 

If widespread testing was in place every urgent care center and ER on the west coast would have been testing every patient with a cough back in February.

Unfortunately, even if the CDC didn't have problems with their manufacturing process, there was never a plan to distribute the tests to every urgent care center or ER on the west coast or anywhere else. The CDC was going to (and did) distribute the tests to every state lab. After that, they would validate at least 5 tests from each state and then declare victory. That was the plan. One might conjecture at this point that plan was flawed.

We can't know what would have happened if the level of testing had be much higher than it was. It would be speculative. That said, what do people thing would have changed? Honest question, I have no opinion (yet) and would like to hear the ideas about this. I do think random testing wouldn't have helped much, as the number of positives would have been so small it would haver been meaningless. Targeted testing of people showing symptoms would be another matter.

[Goose]

"We were never really blind when it came to surveillance" for covid-19, the disease caused by the virus, CDC chief Robert Redfield said. Even if widespread diagnostic testing had been in place, it would have been like "looking for a needle in a haystack," he said.

This statement seems totally bogus to me. How can you detect community transmission if you only allow testing of people with known exposure? Case in point: the Feb. 6 death in SCC that was recently discovered to be due to Covid-19 and is now thought to be the earliest known example of community transmission within SCC. The County coroner who performed the autopsy on Feb. 7 suspected Covid-19 but was unable to test her for it because she didn't meet testing criteria. 

If widespread testing was in place every urgent care center and ER on the west coast would have been testing every patient with a cough back in February.

Unfortunately, even if the CDC didn't have problems with their manufacturing process, there was never a plan to distribute the tests to every urgent care center or ER on the west coast or anywhere else. The CDC was going to (and did) distribute the tests to every state lab. After that, they would validate at least 5 tests from each state and then declare victory. That was the plan. One might conjecture at this point that plan was flawed.

We can't know what would have happened if the level of testing had be much higher than it was. It would be speculative. That said, what do people thing would have changed? Honest question, I have no opinion (yet) and would like to hear the ideas about this. I do think random testing wouldn't have helped much, as the number of positives would have been so small it would haver been meaningless. Targeted testing of people showing symptoms would be another matter.

[Genuine Realist]

"We were never really blind when it came to surveillance" for covid-19, the disease caused by the virus, CDC chief Robert Redfield said. Even if widespread diagnostic testing had been in place, it would have been like "looking for a needle in a haystack," he said.

This statement seems totally bogus to me. How can you detect community transmission if you only allow testing of people with known exposure? Case in point: the Feb. 6 death in SCC that was recently discovered to be due to Covid-19 and is now thought to be the earliest known example of community transmission within SCC. The County coroner who performed the autopsy on Feb. 7 suspected Covid-19 but was unable to test her for it because she didn't meet testing criteria. 

If widespread testing was in place every urgent care center and ER on the west coast would have been testing every patient with a cough back in February.

Unfortunately, even if the CDC didn't have problems with their manufacturing process, there was never a plan to distribute the tests to every urgent care center or ER on the west coast or anywhere else. The CDC was going to (and did) distribute the tests to every state lab. After that, they would validate at least 5 tests from each state and then declare victory. That was the plan. One might conjecture at this point that plan was flawed.

We can't know what would have happened if the level of testing had be much higher than it was. It would be speculative. That said, what do people thing would have changed? Honest question, I have no opinion (yet) and would like to hear the ideas about this. I do think random testing wouldn't have helped much, as the number of positives would have been so small it would haver been meaningless. Targeted testing of people showing symptoms would be another matter.

This is the kind of article I like in terms of tone, rather plain spoken article, with a minimum of moralizing.

[Genuine Realist]

"We were never really blind when it came to surveillance" for covid-19, the disease caused by the virus, CDC chief Robert Redfield said. Even if widespread diagnostic testing had been in place, it would have been like "looking for a needle in a haystack," he said.

This statement seems totally bogus to me. How can you detect community transmission if you only allow testing of people with known exposure? Case in point: the Feb. 6 death in SCC that was recently discovered to be due to Covid-19 and is now thought to be the earliest known example of community transmission within SCC. The County coroner who performed the autopsy on Feb. 7 suspected Covid-19 but was unable to test her for it because she didn't meet testing criteria. 

If widespread testing was in place every urgent care center and ER on the west coast would have been testing every patient with a cough back in February.

Unfortunately, even if the CDC didn't have problems with their manufacturing process, there was never a plan to distribute the tests to every urgent care center or ER on the west coast or anywhere else. The CDC was going to (and did) distribute the tests to every state lab. After that, they would validate at least 5 tests from each state and then declare victory. That was the plan. One might conjecture at this point that plan was flawed.

We can't know what would have happened if the level of testing had be much higher than it was. It would be speculative. That said, what do people thing would have changed? Honest question, I have no opinion (yet) and would like to hear the ideas about this. I do think random testing wouldn't have helped much, as the number of positives would have been so small it would haver been meaningless. Targeted testing of people showing symptoms would be another matter.

This is the kind of article I like in terms of tone, rather plain spoken article, with a minimum of moralizing.

[BostonCard]

I do think random testing wouldn't have helped much, as the number of positives would have been so small it would haver been meaningless. Targeted testing of people showing symptoms would be another matter.

Agree that random testing of asymptomatic individuals would have been very low yield.  I think at that point in the pandemic, the goal would have been to test people showing symptoms consistent with COVID-19. We know from the case in Vallejo that testing at the time was limited to individuals with symptoms and a travel history to Hubei province; because of that limitation, by definition, we were never going to find cases of community spread.  So, yeah, it would have been nice to be able to test patients with a severe viral pneumonia, regardless of travel history, followed by patients with symptoms of COVID-19 (whether hospitalized or not).  Most tests would have been negative, but even a couple positives would have alerted the authorities that community spread was already ongoing.  If you have enough tests, then you try to track contacts and test them, but given what I've seen to date, I don't have much confidence that it would have been able to be carried out effectively.

BC

[BostonCard]

I do think random testing wouldn't have helped much, as the number of positives would have been so small it would haver been meaningless. Targeted testing of people showing symptoms would be another matter.

Agree that random testing of asymptomatic individuals would have been very low yield.  I think at that point in the pandemic, the goal would have been to test people showing symptoms consistent with COVID-19. We know from the case in Vallejo that testing at the time was limited to individuals with symptoms and a travel history to Hubei province; because of that limitation, by definition, we were never going to find cases of community spread.  So, yeah, it would have been nice to be able to test patients with a severe viral pneumonia, regardless of travel history, followed by patients with symptoms of COVID-19 (whether hospitalized or not).  Most tests would have been negative, but even a couple positives would have alerted the authorities that community spread was already ongoing.  If you have enough tests, then you try to track contacts and test them, but given what I've seen to date, I don't have much confidence that it would have been able to be carried out effectively.

BC

[OutsiderFan]

It’s awesome to see the CDC taking responsibility for not doing better. Arguments can be made about if more could have been done or not, and to what degree, but saying it’s foolish to say there were no mistakes gives the agency some much needed credibility.

The thing that perplexed me is why regular flu testing wasn’t used as a stop-gap to help isolate potential Covid infections much more aggressively. Of course, the 2-3 week incubation periods and inconsistent test results for Covid even when tests are available, is a big problem too. This is where Redfield has a point.

Most of the Asian countries implemented immediate mask wearing, mass testing and Sophisticated, if not privacy-invading contact tracing and never went into shutdowns. The U.S. could have done something similar, but had no leadership (and still doesn’t) and too many people who want everything for free. As I always say, everything has a cost. Want to have freedom to not wear a mask or prevent prevent government from tracking you with your phone? Then STFU about lockdowns. Don’t want to pay any price for prevention? Enjoy your society being wrecked.

[OutsiderFan]

It’s awesome to see the CDC taking responsibility for not doing better. Arguments can be made about if more could have been done or not, and to what degree, but saying it’s foolish to say there were no mistakes gives the agency some much needed credibility.

The thing that perplexed me is why regular flu testing wasn’t used as a stop-gap to help isolate potential Covid infections much more aggressively. Of course, the 2-3 week incubation periods and inconsistent test results for Covid even when tests are available, is a big problem too. This is where Redfield has a point.

Most of the Asian countries implemented immediate mask wearing, mass testing and Sophisticated, if not privacy-invading contact tracing and never went into shutdowns. The U.S. could have done something similar, but had no leadership (and still doesn’t) and too many people who want everything for free. As I always say, everything has a cost. Want to have freedom to not wear a mask or prevent prevent government from tracking you with your phone? Then STFU about lockdowns. Don’t want to pay any price for prevention? Enjoy your society being wrecked.

[oldalum]

It’s awesome to see the CDC taking responsibility for not doing better. Arguments can be made about if more could have been done or not, and to what degree, but saying it’s foolish to say there were no mistakes gives the agency some much needed credibility.

I didn't get that assumption of responsibility from that interview. He just said the CDC's failure with the test kits didn't affect anything.

[oldalum]

It’s awesome to see the CDC taking responsibility for not doing better. Arguments can be made about if more could have been done or not, and to what degree, but saying it’s foolish to say there were no mistakes gives the agency some much needed credibility.

I didn't get that assumption of responsibility from that interview. He just said the CDC's failure with the test kits didn't affect anything.

[Goose]

I do think random testing wouldn't have helped much, as the number of positives would have been so small it would haver been meaningless. Targeted testing of people showing symptoms would be another matter.

Agree that random testing of asymptomatic individuals would have been very low yield.  I think at that point in the pandemic, the goal would have been to test people showing symptoms consistent with COVID-19. We know from the case in Vallejo that testing at the time was limited to individuals with symptoms and a travel history to Hubei province; because of that limitation, by definition, we were never going to find cases of community spread.  So, yeah, it would have been nice to be able to test patients with a severe viral pneumonia, regardless of travel history, followed by patients with symptoms of COVID-19 (whether hospitalized or not).  Most tests would have been negative, but even a couple positives would have alerted the authorities that community spread was already ongoing.  If you have enough tests, then you try to track contacts and test them, but given what I've seen to date, I don't have much confidence that it would have been able to be carried out effectively. 

BC

That matches my thinking. I additionally think that it would have had very minimal effect on decision making at the national level, because the total number of cases detected from community spread would not, of themselves, been of such a large number that a national reaction could be politically justified. I agree that based on what we see even at this late date contact tracing and other mitigation activities would not have been carried out effectively, and even if they had been, there would have been way too many asymptomatic cases already brewing in the community to allow full containment. This property of the virus was not understood at the time and even now makes it difficult to estimate how many people really are/have been infected with COVID-19.

What I would have desired (hoped?) to happen if these additional tests detected community spread would have been that everyone involved in the Public Health system at all levels would have made sure that they were ready as possible for the worst in case it happened. For instance, the people that managed the strategic reserve of equipment at the federal level should have, on their own initiative, ensured that all the ventilators were working. It was their job to ensure that anyway, but a "warning order" of imminent requirements might have spurred them along. That isn't the kind of thing that is going to happen from the top down quickly enough to matter in the one to three weeks more testing might have bought us unless the worker bees at all levels step up and do it on their own. Getting every stakeholder thinking about "what if" actively and urgently would have helped. How much, I don't know. It appears that the PPE problem was not really anticipated by anyone, even though in hindsight it is obvious that consumption would skyrocket in an epidemic.

---

Most of the Asian countries implemented immediate mask wearing, mass testing and Sophisticated, if not privacy-invading contact tracing and never went into shutdowns.

I think this statement misses several important points. First of all, these countries (Taiwan, HK, Korea) closed their borders immediately and initiated mandatory quarantines on any arrivals that were still allowed (mostly returning citizens), and they did this very early on. They knew from passed experience that injection of cases from abroad was a big driver in community spread. These countries have basically one major airport and few international ports, so controlling entry is possible. Second, they did shut down large meetings, nightclubs, etc. Schools were closed in some places. They did not continue business as usual, but did not go to a full SIP as the US did. Third, while they did plenty of testing it was not done as a "mass testing program" where essentially everyone got tested or there was lots of random testing. It was and is targeted testing.

[Goose]

I do think random testing wouldn't have helped much, as the number of positives would have been so small it would haver been meaningless. Targeted testing of people showing symptoms would be another matter.

Agree that random testing of asymptomatic individuals would have been very low yield.  I think at that point in the pandemic, the goal would have been to test people showing symptoms consistent with COVID-19. We know from the case in Vallejo that testing at the time was limited to individuals with symptoms and a travel history to Hubei province; because of that limitation, by definition, we were never going to find cases of community spread.  So, yeah, it would have been nice to be able to test patients with a severe viral pneumonia, regardless of travel history, followed by patients with symptoms of COVID-19 (whether hospitalized or not).  Most tests would have been negative, but even a couple positives would have alerted the authorities that community spread was already ongoing.  If you have enough tests, then you try to track contacts and test them, but given what I've seen to date, I don't have much confidence that it would have been able to be carried out effectively. 

BC

That matches my thinking. I additionally think that it would have had very minimal effect on decision making at the national level, because the total number of cases detected from community spread would not, of themselves, been of such a large number that a national reaction could be politically justified. I agree that based on what we see even at this late date contact tracing and other mitigation activities would not have been carried out effectively, and even if they had been, there would have been way too many asymptomatic cases already brewing in the community to allow full containment. This property of the virus was not understood at the time and even now makes it difficult to estimate how many people really are/have been infected with COVID-19.

What I would have desired (hoped?) to happen if these additional tests detected community spread would have been that everyone involved in the Public Health system at all levels would have made sure that they were ready as possible for the worst in case it happened. For instance, the people that managed the strategic reserve of equipment at the federal level should have, on their own initiative, ensured that all the ventilators were working. It was their job to ensure that anyway, but a "warning order" of imminent requirements might have spurred them along. That isn't the kind of thing that is going to happen from the top down quickly enough to matter in the one to three weeks more testing might have bought us unless the worker bees at all levels step up and do it on their own. Getting every stakeholder thinking about "what if" actively and urgently would have helped. How much, I don't know. It appears that the PPE problem was not really anticipated by anyone, even though in hindsight it is obvious that consumption would skyrocket in an epidemic.

---

Most of the Asian countries implemented immediate mask wearing, mass testing and Sophisticated, if not privacy-invading contact tracing and never went into shutdowns.

I think this statement misses several important points. First of all, these countries (Taiwan, HK, Korea) closed their borders immediately and initiated mandatory quarantines on any arrivals that were still allowed (mostly returning citizens), and they did this very early on. They knew from passed experience that injection of cases from abroad was a big driver in community spread. These countries have basically one major airport and few international ports, so controlling entry is possible. Second, they did shut down large meetings, nightclubs, etc. Schools were closed in some places. They did not continue business as usual, but did not go to a full SIP as the US did. Third, while they did plenty of testing it was not done as a "mass testing program" where essentially everyone got tested or there was lots of random testing. It was and is targeted testing.

[BostonCard]

That matches my thinking. I additionally think that it would have had very minimal effect on decision making at the national level, because the total number of cases detected from community spread would not, of themselves, been of such a large number that a national reaction could be politically justified.

I pulled the data from the Oxford Stringency Index comparing the US (teal) versus the German (red) response:



You can see that until mid-March, Germany was ahead of the US in terms of response (the stringency index was higher in Germany than the US until March 15).  But you can also see that during this time, we are talking about sub-lockdown levels of stringency (the index is under 30% for both countries) and that is what seems to have made a difference.  The numbers represent the number of cases and number of deaths on each day that the stringency index was increased.  Two things are pretty clear from the data: 1) Germany responded earlier and at an earlier stage in the pandemic than the United States and two, because of widespread testing, Germany saw its cases earlier (before deaths) in the course of the pandemic than the United States (they had identified 900+ cases before the first death), while at a similar number of cases, the United States had already recorded 28 deaths.

With testing as widespread as Germany had, we probably would have seen 5000 known cases by the middle of the first week in March, and I do think that our response might have been more vigorous.  Obviously, it is easy to look at this in retrospect, and it is possible that the German experience would not have translated to the US.  However, my view at this data (and also comparing New York and California, and even the Bay Area to Los Angeles), makes me think the key was not necessarily getting the shelter-in-place order in, but instituting lower intensity restrictions like limiting large gatherings (that prevent super-spreader events) from happening.  And I think that seeing hundreds, if not thousands of cases in that critical first week in March might have been enough to prompt Cuomo and De Blasio to be more aggressive in New York (a little prompting from Trump and [especially] Faucci might have nudged them as well).  Remember, on March 3 there were still only 2 diagnosed cases and no deaths in New York, even though there were almost certainly hundreds of cases walking around.

BC

[BostonCard]

That matches my thinking. I additionally think that it would have had very minimal effect on decision making at the national level, because the total number of cases detected from community spread would not, of themselves, been of such a large number that a national reaction could be politically justified.

I pulled the data from the Oxford Stringency Index comparing the US (teal) versus the German (red) response:



You can see that until mid-March, Germany was ahead of the US in terms of response (the stringency index was higher in Germany than the US until March 15).  But you can also see that during this time, we are talking about sub-lockdown levels of stringency (the index is under 30% for both countries) and that is what seems to have made a difference.  The numbers represent the number of cases and number of deaths on each day that the stringency index was increased.  Two things are pretty clear from the data: 1) Germany responded earlier and at an earlier stage in the pandemic than the United States and two, because of widespread testing, Germany saw its cases earlier (before deaths) in the course of the pandemic than the United States (they had identified 900+ cases before the first death), while at a similar number of cases, the United States had already recorded 28 deaths.

With testing as widespread as Germany had, we probably would have seen 5000 known cases by the middle of the first week in March, and I do think that our response might have been more vigorous.  Obviously, it is easy to look at this in retrospect, and it is possible that the German experience would not have translated to the US.  However, my view at this data (and also comparing New York and California, and even the Bay Area to Los Angeles), makes me think the key was not necessarily getting the shelter-in-place order in, but instituting lower intensity restrictions like limiting large gatherings (that prevent super-spreader events) from happening.  And I think that seeing hundreds, if not thousands of cases in that critical first week in March might have been enough to prompt Cuomo and De Blasio to be more aggressive in New York (a little prompting from Trump and [especially] Faucci might have nudged them as well).  Remember, on March 3 there were still only 2 diagnosed cases and no deaths in New York, even though there were almost certainly hundreds of cases walking around.

BC

[Genuine Realist]

That matches my thinking. I additionally think that it would have had very minimal effect on decision making at the national level, because the total number of cases detected from community spread would not, of themselves, been of such a large number that a national reaction could be politically justified.

I pulled the data from the Oxford Stringency Index comparing the US (teal) versus the German (red) response:



You can see that until mid-March, Germany was ahead of the US in terms of response (the stringency index was higher in Germany than the US until March 15).  But you can also see that during this time, we are talking about sub-lockdown levels of stringency (the index is under 30% for both countries) and that is what seems to have made a difference.  The numbers represent the number of cases and number of deaths on each day that the stringency index was increased.  Two things are pretty clear from the data: 1) Germany responded earlier and at an earlier stage in the pandemic than the United States and two, because of widespread testing, Germany saw its cases earlier (before deaths) in the course of the pandemic than the United States (they had identified 900+ cases before the first death), while at a similar number of cases, the United States had already recorded 28 deaths.

With testing as widespread as Germany had, we probably would have seen 5000 known cases by the middle of the first week in March, and I do think that our response might have been more vigorous.  Obviously, it is easy to look at this in retrospect, and it is possible that the German experience would not have translated to the US.  However, my view at this data (and also comparing New York and California, and even the Bay Area to Los Angeles), makes me think the key was not necessarily getting the shelter-in-place order in, but instituting lower intensity restrictions like limiting large gatherings (that prevent super-spreader events) from happening.  And I think that seeing hundreds, if not thousands of cases in that critical first week in March might have been enough to prompt Cuomo and De Blasio to be more aggressive in New York (a little prompting from Trump and [especially] Faucci might have nudged them as well).  Remember, on March 3 there were still only 2 diagnosed cases and no deaths in New York, even though there were almost certainly hundreds of cases walking around.

BC

What is puzzling to me in this discussion of January/February testing is asymptomatic cases. The existence of these is the basic reason for the shutdown and the pronounced social distancing required. But how do you test for these types on any large scale? As I read the article, there were some 800 exposed persons from Wuhan and later Europe, circulating in metropolitan areas and elsewhere. Within a few days - or hours - testing their contacts on a universal basis becomes impossible. Many who do have the virus are asymptomatic, compounding the problem. So what do we do here?

These aren't rhetorical questions, but general inquiries.

Also, my understanding is that Germany was able to identify a single source Patient Zero who was symptomatic. This greatly simplified the test-and-trace procedure. This was never possible in the US. The horses had left the barn long before the extent of the contagion was known.

[Genuine Realist]

That matches my thinking. I additionally think that it would have had very minimal effect on decision making at the national level, because the total number of cases detected from community spread would not, of themselves, been of such a large number that a national reaction could be politically justified.

I pulled the data from the Oxford Stringency Index comparing the US (teal) versus the German (red) response:



You can see that until mid-March, Germany was ahead of the US in terms of response (the stringency index was higher in Germany than the US until March 15).  But you can also see that during this time, we are talking about sub-lockdown levels of stringency (the index is under 30% for both countries) and that is what seems to have made a difference.  The numbers represent the number of cases and number of deaths on each day that the stringency index was increased.  Two things are pretty clear from the data: 1) Germany responded earlier and at an earlier stage in the pandemic than the United States and two, because of widespread testing, Germany saw its cases earlier (before deaths) in the course of the pandemic than the United States (they had identified 900+ cases before the first death), while at a similar number of cases, the United States had already recorded 28 deaths.

With testing as widespread as Germany had, we probably would have seen 5000 known cases by the middle of the first week in March, and I do think that our response might have been more vigorous.  Obviously, it is easy to look at this in retrospect, and it is possible that the German experience would not have translated to the US.  However, my view at this data (and also comparing New York and California, and even the Bay Area to Los Angeles), makes me think the key was not necessarily getting the shelter-in-place order in, but instituting lower intensity restrictions like limiting large gatherings (that prevent super-spreader events) from happening.  And I think that seeing hundreds, if not thousands of cases in that critical first week in March might have been enough to prompt Cuomo and De Blasio to be more aggressive in New York (a little prompting from Trump and [especially] Faucci might have nudged them as well).  Remember, on March 3 there were still only 2 diagnosed cases and no deaths in New York, even though there were almost certainly hundreds of cases walking around.

BC

What is puzzling to me in this discussion of January/February testing is asymptomatic cases. The existence of these is the basic reason for the shutdown and the pronounced social distancing required. But how do you test for these types on any large scale? As I read the article, there were some 800 exposed persons from Wuhan and later Europe, circulating in metropolitan areas and elsewhere. Within a few days - or hours - testing their contacts on a universal basis becomes impossible. Many who do have the virus are asymptomatic, compounding the problem. So what do we do here?

These aren't rhetorical questions, but general inquiries.

Also, my understanding is that Germany was able to identify a single source Patient Zero who was symptomatic. This greatly simplified the test-and-trace procedure. This was never possible in the US. The horses had left the barn long before the extent of the contagion was known.

[BostonCard]

What is puzzling to me in this discussion of January/February testing is asymptomatic cases. The existence of these is the basic reason for the shutdown and the pronounced social distancing required. But how do you test for these types on any large scale? As I read the article, there were some 800 exposed persons from Wuhan and later Europe, circulating in metropolitan areas and elsewhere. Within a few days - or hours - testing their contacts on a universal basis becomes impossible. Many who do have the virus are asymptomatic, compounding the problem. So what do we do here?



These aren't rhetorical questions, but general inquiries.



Also, my understanding is that Germany was able to identify a single source Patient Zero who was symptomatic. This greatly simplified the test-and-trace procedure. This was never possible in the US. The horses had left the barn long before the extent of the contagion was known.

Not sure that Germany was able to identify the true "patient zero"; rather they identified a patient zero.  There were probably multiple introductions, at least one, documented from China in late January (https://www.thelocal.de/20200205/coronav...rus-spread), and then several brought in from Italy.  Yes, Germany was in some ways lucky that an early case was symptomatic and sought treatment, but they were also able to pivot rapidly to reasonably widespread testing. They had more cases than they could track and trace early, but because of early widespread testing they had a much better understanding of where and how COVID-19 was spreading and were able to respond more quickly.

The US was hampered.  First of all, we didn't even have a test until February 5, so we wouldn't have even been able to test at all at the time the German's identified "patient zero".  Secondly, until late February, all tests had to be shipped to the CDC in Atlanta to be tested (though in the latter half of February some local health labs were doing their own tests and issuing a provisional result until they could be re-tested at the CDC).  So, there was a several day delay between when a sample was drawn and when it was resulted.  Third, of course, the test kits were flawed.  Finally, until the end of February, testing availability was so limited that only patients who had traveled to Hubei province or been in direct contact with those who had could be tested.  It is telling that local officials in both Seattle and the Bay Area were prevented from testing patients because they could not get the tests approved because of the lack of link to Hubei.

https://www.npr.org/sections/health-shot...d-for-days

Same story at the nursing home in Washington, where local officials flagged an outbreak of a respiratory illness, but couldn't test for COVID-19 until Feb 29, 10 days after the first patient was taken to the hospital.

The knowledge that there was undetected community transmission should have been a game-changer.  But we were delayed in finding that out, and we were very delayed in responding to it.

BC

[BostonCard]

What is puzzling to me in this discussion of January/February testing is asymptomatic cases. The existence of these is the basic reason for the shutdown and the pronounced social distancing required. But how do you test for these types on any large scale? As I read the article, there were some 800 exposed persons from Wuhan and later Europe, circulating in metropolitan areas and elsewhere. Within a few days - or hours - testing their contacts on a universal basis becomes impossible. Many who do have the virus are asymptomatic, compounding the problem. So what do we do here?



These aren't rhetorical questions, but general inquiries.



Also, my understanding is that Germany was able to identify a single source Patient Zero who was symptomatic. This greatly simplified the test-and-trace procedure. This was never possible in the US. The horses had left the barn long before the extent of the contagion was known.

Not sure that Germany was able to identify the true "patient zero"; rather they identified a patient zero.  There were probably multiple introductions, at least one, documented from China in late January (https://www.thelocal.de/20200205/coronav...rus-spread), and then several brought in from Italy.  Yes, Germany was in some ways lucky that an early case was symptomatic and sought treatment, but they were also able to pivot rapidly to reasonably widespread testing. They had more cases than they could track and trace early, but because of early widespread testing they had a much better understanding of where and how COVID-19 was spreading and were able to respond more quickly.

The US was hampered.  First of all, we didn't even have a test until February 5, so we wouldn't have even been able to test at all at the time the German's identified "patient zero".  Secondly, until late February, all tests had to be shipped to the CDC in Atlanta to be tested (though in the latter half of February some local health labs were doing their own tests and issuing a provisional result until they could be re-tested at the CDC).  So, there was a several day delay between when a sample was drawn and when it was resulted.  Third, of course, the test kits were flawed.  Finally, until the end of February, testing availability was so limited that only patients who had traveled to Hubei province or been in direct contact with those who had could be tested.  It is telling that local officials in both Seattle and the Bay Area were prevented from testing patients because they could not get the tests approved because of the lack of link to Hubei.

https://www.npr.org/sections/health-shot...d-for-days

Same story at the nursing home in Washington, where local officials flagged an outbreak of a respiratory illness, but couldn't test for COVID-19 until Feb 29, 10 days after the first patient was taken to the hospital.

The knowledge that there was undetected community transmission should have been a game-changer.  But we were delayed in finding that out, and we were very delayed in responding to it.

BC

[Goose]

I pulled the data from the Oxford Stringency Index comparing the US (teal) versus the German (red) response:





You can see that until mid-March, Germany was ahead of the US in terms of response (the stringency index was higher in Germany than the US until March 15).  But you can also see that during this time, we are talking about sub-lockdown levels of stringency (the index is under 30% for both countries) and that is what seems to have made a difference.

It is certainly plausible that the German banning of large gatherings etc. made a big difference. Obviously no way to know, but it certainly couldn't have hurt.

  The numbers represent the number of cases and number of deaths on each day that the stringency index was increased.  Two things are pretty clear from the data: 1) Germany responded earlier and at an earlier stage in the pandemic than the United States and two, because of widespread testing, Germany saw its cases earlier (before deaths) in the course of the pandemic than the United States (they had identified 900+ cases before the first death), while at a similar number of cases, the United States had already recorded 28 deaths.


With testing as widespread as Germany had, we probably would have seen 5000 known cases by the middle of the first week in March, and I do think that our response might have been more vigorous.

As you probably know, there were and are significant issues with the German reports of COVID-19 deaths. Their methods are different than the ones used in the US and tend to understate those who died of COVID-19. The cause would be pneumonia even though that pneumonia was COVID-19 related. This makes the data harder to interpret. However, even allowing for that, I think the German response was more aggressive than ours because the German States were actually trying to contain the disease. There testing levels were higher because of contact tracing. Some of that was done in Washington State and I guess in retrospect turned out better than initially thought. Unfortunately, that wasn't enough. To find those 5000 cases in the US, we would have needed the same aggressive contact tracing that occurred in Germany. We didn't have the ability to do that, not necessarily because of the lack of the ability to test (although that may have become an issue) but rather because we lacked the ability/will to do the necessary tracing.

Obviously, it is easy to look at this in retrospect, and it is possible that the German experience would not have translated to the US.  However, my view at this data (and also comparing New York and California, and even the Bay Area to Los Angeles), makes me think the key was not necessarily getting the shelter-in-place order in, but instituting lower intensity restrictions like limiting large gatherings (that prevent super-spreader events) from happening.  And I think that seeing hundreds, if not thousands of cases in that critical first week in March might have been enough to prompt Cuomo and De Blasio to be more aggressive in New York (a little prompting from Trump and [especially] Faucci might have nudged them as well).  Remember, on March 3 there were still only 2 diagnosed cases and no deaths in New York, even though there were almost certainly hundreds of cases walking around.



BC

I certainly agree that instituting the lower intensity restrictions would have been a good idea. However, I think that actually finding the 5K cases nationwide would have been difficult. Even with hundreds of cases wandering around New York, we wouldn't even find those without contact tracing to one of the two known cases. A couple of weeks later, when they became sick, we would, but that is basically what actually happened. Germany is smaller than California in land area and has twice the population of California. That makes any given number of cases there much more important than in the much larger US. They were also trying to contain the outbreak, which requires earlier action. We never really had that option.

[Goose]

I pulled the data from the Oxford Stringency Index comparing the US (teal) versus the German (red) response:





You can see that until mid-March, Germany was ahead of the US in terms of response (the stringency index was higher in Germany than the US until March 15).  But you can also see that during this time, we are talking about sub-lockdown levels of stringency (the index is under 30% for both countries) and that is what seems to have made a difference.

It is certainly plausible that the German banning of large gatherings etc. made a big difference. Obviously no way to know, but it certainly couldn't have hurt.

  The numbers represent the number of cases and number of deaths on each day that the stringency index was increased.  Two things are pretty clear from the data: 1) Germany responded earlier and at an earlier stage in the pandemic than the United States and two, because of widespread testing, Germany saw its cases earlier (before deaths) in the course of the pandemic than the United States (they had identified 900+ cases before the first death), while at a similar number of cases, the United States had already recorded 28 deaths.


With testing as widespread as Germany had, we probably would have seen 5000 known cases by the middle of the first week in March, and I do think that our response might have been more vigorous.

As you probably know, there were and are significant issues with the German reports of COVID-19 deaths. Their methods are different than the ones used in the US and tend to understate those who died of COVID-19. The cause would be pneumonia even though that pneumonia was COVID-19 related. This makes the data harder to interpret. However, even allowing for that, I think the German response was more aggressive than ours because the German States were actually trying to contain the disease. There testing levels were higher because of contact tracing. Some of that was done in Washington State and I guess in retrospect turned out better than initially thought. Unfortunately, that wasn't enough. To find those 5000 cases in the US, we would have needed the same aggressive contact tracing that occurred in Germany. We didn't have the ability to do that, not necessarily because of the lack of the ability to test (although that may have become an issue) but rather because we lacked the ability/will to do the necessary tracing.

Obviously, it is easy to look at this in retrospect, and it is possible that the German experience would not have translated to the US.  However, my view at this data (and also comparing New York and California, and even the Bay Area to Los Angeles), makes me think the key was not necessarily getting the shelter-in-place order in, but instituting lower intensity restrictions like limiting large gatherings (that prevent super-spreader events) from happening.  And I think that seeing hundreds, if not thousands of cases in that critical first week in March might have been enough to prompt Cuomo and De Blasio to be more aggressive in New York (a little prompting from Trump and [especially] Faucci might have nudged them as well).  Remember, on March 3 there were still only 2 diagnosed cases and no deaths in New York, even though there were almost certainly hundreds of cases walking around.



BC

I certainly agree that instituting the lower intensity restrictions would have been a good idea. However, I think that actually finding the 5K cases nationwide would have been difficult. Even with hundreds of cases wandering around New York, we wouldn't even find those without contact tracing to one of the two known cases. A couple of weeks later, when they became sick, we would, but that is basically what actually happened. Germany is smaller than California in land area and has twice the population of California. That makes any given number of cases there much more important than in the much larger US. They were also trying to contain the outbreak, which requires earlier action. We never really had that option.

[BostonCard]

As you probably know, there were and are significant issues with the German reports of COVID-19 deaths.

The German data on excess deaths (at least through April 26) did not show a large number of excess deaths that were not attributed to COVID-19.

https://www.nytimes.com/interactive/2020...eaths.html

In fact, Germany reported more deaths due to COVID-19 (5737) than the number of excess deaths (3000), though because the baseline is noisy, calculating how many deaths were "excess" is not an exact science.  In fact, the excess mortality was pretty low (only 3% above the expected baseline). Nonetheless, the data doesn't show a large mortality increase in March and April that was probably due to COVID-19 but was attributed to other causes.

I don't think this explanation accounts for Germany's low mortality.

BC

[BostonCard]

As you probably know, there were and are significant issues with the German reports of COVID-19 deaths.

The German data on excess deaths (at least through April 26) did not show a large number of excess deaths that were not attributed to COVID-19.

https://www.nytimes.com/interactive/2020...eaths.html

In fact, Germany reported more deaths due to COVID-19 (5737) than the number of excess deaths (3000), though because the baseline is noisy, calculating how many deaths were "excess" is not an exact science.  In fact, the excess mortality was pretty low (only 3% above the expected baseline). Nonetheless, the data doesn't show a large mortality increase in March and April that was probably due to COVID-19 but was attributed to other causes.

I don't think this explanation accounts for Germany's low mortality.

BC

[magnus]

What is puzzling to me in this discussion of January/February testing is asymptomatic cases. The existence of these is the basic reason for the shutdown and the pronounced social distancing required. 

I'm not so sure about the timeline of the above.  Correct me if i'm wrong, but while there was speculation and pockets of "proof" of asymptomatic cases in Jan/Feb, the WHO and the CDC and the MSM didn't really latch onto it til late March, early April.  I feel like the shutdown was a result of escalating numbers, comparisons to Italy/Spain, and for later states, NYC.

[magnus]

What is puzzling to me in this discussion of January/February testing is asymptomatic cases. The existence of these is the basic reason for the shutdown and the pronounced social distancing required. 

I'm not so sure about the timeline of the above.  Correct me if i'm wrong, but while there was speculation and pockets of "proof" of asymptomatic cases in Jan/Feb, the WHO and the CDC and the MSM didn't really latch onto it til late March, early April.  I feel like the shutdown was a result of escalating numbers, comparisons to Italy/Spain, and for later states, NYC.

[Goose]

As you probably know, there were and are significant issues with the German reports of COVID-19 deaths.

The German data on excess deaths (at least through April 26) did not show a large number of excess deaths that were not attributed to COVID-19.

https://www.nytimes.com/interactive/2020...eaths.html

In fact, Germany reported more deaths due to COVID-19 (5737) than the number of excess deaths (3000), though because the baseline is noisy, calculating how many deaths were "excess" is not an exact science.  In fact, the excess mortality was pretty low (only 3% above the expected baseline). Nonetheless, the data doesn't show a large mortality increase in March and April that was probably due to COVID-19 but was attributed to other causes.

I don't think this explanation accounts for Germany's low mortality.

BC

Looking at the excess deaths is a good way to find the "real" increase due to COVID-19, because it should cancel out any reporting bias (either way). I have read (as I am sure you have as well) articles discussing the apparent German low mortality. As you point out, excess mortality is a "noisy" metric, complicated by the fact that deaths due to other causes drops during SIP. However, during the time in question, SIP wasn't in place so that issue disappears.

The mortality rates of Germany and the USA are similar. However, the Germans have 32% as many cases per 10K population as does the US. That isn't just due to testing. If one only tests people who are already requesting medical care/think they are sick, you are measuring the problem but not affecting it. It is possible that Germans are just that much better at social distancing compared to citizens of the US. I do believe that is a factor. However, I believe the major factor in having fewer cases was the significant early on attempt at containment. While it was not entirely successful. it did reduce the penetration of the disease into the population. It got people who didn't know they were sick/not yet sick out of circulation. The initial higher testing rate in Germany was driven by that attempt.

In short, my "read" is that Germany made a much better attempt at containment that the US did, and that reduced the level of community spread both initially and going foreward. It also delivered more and better data to the national leaders, although initially things were pretty confused everywhere. The reduced number of cases per 10K people delivered a reduced number of deaths per 10K people. The larger number of tests in the early days was an expected side effect of aggressive tracing.

[Goose]

As you probably know, there were and are significant issues with the German reports of COVID-19 deaths.

The German data on excess deaths (at least through April 26) did not show a large number of excess deaths that were not attributed to COVID-19.

https://www.nytimes.com/interactive/2020...eaths.html

In fact, Germany reported more deaths due to COVID-19 (5737) than the number of excess deaths (3000), though because the baseline is noisy, calculating how many deaths were "excess" is not an exact science.  In fact, the excess mortality was pretty low (only 3% above the expected baseline). Nonetheless, the data doesn't show a large mortality increase in March and April that was probably due to COVID-19 but was attributed to other causes.

I don't think this explanation accounts for Germany's low mortality.

BC

Looking at the excess deaths is a good way to find the "real" increase due to COVID-19, because it should cancel out any reporting bias (either way). I have read (as I am sure you have as well) articles discussing the apparent German low mortality. As you point out, excess mortality is a "noisy" metric, complicated by the fact that deaths due to other causes drops during SIP. However, during the time in question, SIP wasn't in place so that issue disappears.

The mortality rates of Germany and the USA are similar. However, the Germans have 32% as many cases per 10K population as does the US. That isn't just due to testing. If one only tests people who are already requesting medical care/think they are sick, you are measuring the problem but not affecting it. It is possible that Germans are just that much better at social distancing compared to citizens of the US. I do believe that is a factor. However, I believe the major factor in having fewer cases was the significant early on attempt at containment. While it was not entirely successful. it did reduce the penetration of the disease into the population. It got people who didn't know they were sick/not yet sick out of circulation. The initial higher testing rate in Germany was driven by that attempt.

In short, my "read" is that Germany made a much better attempt at containment that the US did, and that reduced the level of community spread both initially and going foreward. It also delivered more and better data to the national leaders, although initially things were pretty confused everywhere. The reduced number of cases per 10K people delivered a reduced number of deaths per 10K people. The larger number of tests in the early days was an expected side effect of aggressive tracing.