[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.

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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.