03-22-2020, 08:54 PM
The next logical question is Do we have what is required to do the "dance" part of the equation? I don't have any idea, but I do hope that the powers that be are scrambling like mad to ensure we do in the interval where we are waiting for the curve to flatten.
I do not believe that even if we had no testing issues that we could have reacted with an epidemiological response. Certainly Spain, Italy, and France, who did not have the testing issues the USA did, were unable to do so. These nations also allow enforcement of quarantine without as much legal actibity as would be required in the USA. It is perfectly possible to defeat a disease via epidemiological methods in the absence of a good test for the disease. It has been done many times in the past. However, if the disease has reached the "community spread" point such that the resources of the authorities are overwhelmed, the actions taken by Italy, Spain et al are the only practical response.
China found that their test had a problem with "false negatives". This is somewhat of a misnomer, because in many cases the patient had not yet developed full scale disease and therefore tested negative even in the presence of the disease. The Chinese added a CT scan/chest X-ray as an additional method of diagnosing the disease. China also realized that if you have a symptomatic person who tests negative, you can't release him into the general population. You have to quarantine them anyway, because if you don't they can develop and spread the disease. It is worthy of note that the USA uses different tests than China did. Korea also uses a different test. The sensitivities may be different, we do not yet know.
Korea was fortunate that they had a residual epidemiological capability left over from the SARS outbreak that could be directed towards the problem. They also have a population that can generally be relied upon to do what they are requested to do (although the woman who tested positive and left the hospital to attend multiple religious events almost blew up the Korean response).
I just hope that if we "flatten the curve" we can respond adequately with contact tracing, testing, and quarantine. Many people aren't going to like the fact they in effect need to be locked up, as the people at Travis were. If we are lucky, that is coming. I hope we are ready.
I do not believe that even if we had no testing issues that we could have reacted with an epidemiological response. Certainly Spain, Italy, and France, who did not have the testing issues the USA did, were unable to do so. These nations also allow enforcement of quarantine without as much legal actibity as would be required in the USA. It is perfectly possible to defeat a disease via epidemiological methods in the absence of a good test for the disease. It has been done many times in the past. However, if the disease has reached the "community spread" point such that the resources of the authorities are overwhelmed, the actions taken by Italy, Spain et al are the only practical response.
China found that their test had a problem with "false negatives". This is somewhat of a misnomer, because in many cases the patient had not yet developed full scale disease and therefore tested negative even in the presence of the disease. The Chinese added a CT scan/chest X-ray as an additional method of diagnosing the disease. China also realized that if you have a symptomatic person who tests negative, you can't release him into the general population. You have to quarantine them anyway, because if you don't they can develop and spread the disease. It is worthy of note that the USA uses different tests than China did. Korea also uses a different test. The sensitivities may be different, we do not yet know.
Korea was fortunate that they had a residual epidemiological capability left over from the SARS outbreak that could be directed towards the problem. They also have a population that can generally be relied upon to do what they are requested to do (although the woman who tested positive and left the hospital to attend multiple religious events almost blew up the Korean response).
I just hope that if we "flatten the curve" we can respond adequately with contact tracing, testing, and quarantine. Many people aren't going to like the fact they in effect need to be locked up, as the people at Travis were. If we are lucky, that is coming. I hope we are ready.