[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