[Goose]

I mean there isn't really any need to point out the number of infections that exist have no relationship to those identified by testing, especially given how horrible our testing is, right?

NO relationship? Really? OF, IMHO that is just silly. Even if the number of tests is restricted, one can pretty well be assured that the % positive is proportional to the prevalence of the disease. Given what the restrictions are, it could be argued % positive should increase. What one can't do is compare raw number of positive tests from before the restrictions to after the restrictions. It is perfectly reasonable to be alarmed by these changes in testing priorities, but IMHO it is important to not make the problem bigger than it is. The problem is big enough to not require that.

Not only are we not doing enough testing to catch as many infections as there are, we're not letting people know if they are positive fast enough to make sure the infected people isolate and can be contact traced, which furthers spread.

I basically agree with this statement. However, I think it covers three separate problems. The problems are 1)Finding all the infections, 2) Getting the results fast enough to be effective, and 3) Making sure the infected people isolate.

The "propagation delay" (#2) problem is one reason the change in testing priority was made. It should speed up getting results to the people that are "most likely" to be positive. However, at this point in the epidemic it is difficult to understand why SCC is in this bind. At one point Stanford was doing all the testing for SCC. Is this still true, or have they developed their own capability? Are they relying on commercial labs and the commercial labs are overloaded? Did SCC decide that we had "won" and done nothing to ensure they were ready for a second (or third, or Nth wave). It wouldn't be a tragedy if the bought a "extra" 96 well PCR machine that they turned out not to need. It would be a tragedy if they need it and don't have it. Why don't we know, and why isn't the Press asking pointed questions?

The problem of locating everybody with this disease (#1) is turning out to be a disaster. As Fauci said, this virus is a bitch. Testing capacity is an issue, but it may not be the main issue. Initially, the assumption was people get the virus, become ill, get tested, test positive, isolate and all is well. If those people can't get tested, it is a problem. In SCC I think they can. However, we now know that there are lots of people who get the virus and do not become ill. Can those people pass on the disease? For sure, at least some of them can. How many is "lots"? 2X? 10X? We don't know. We also know that people who do become ill can transmit the disease for some period of time (several days) before they become ill. So testing sick people isn't going to do the job. OK, test everybody. Logistically impossible. Even tiny Iceland couldn't do that. Test a sample? Fine, but it has to be a large enough sample (which runs into limited testing speed) to detect the virus, and what do you do with the result? So some neighborhoods seem to have lots of cases. What do you do? What they do in Italy is lock it down, nobody goes in or out. They could (have the legal authority) do that in SCC, but they won't. And by the way, the non-hot neighborhoods aren't "clean". It is just below your test sensitivity.

Contact tracing and isolation could help find many asymptomatic spreaders. However, nobody in the Bay Area, and probably nobody in any USA urban area has a contact tracing and tracking capability that is "working". San Mateo County at least is (was) telling the truth. On July 19th, they reached 34% of the cases who tested positive. On July 19th, 18% of those cases were able to isolate. On July 19th they reached 41% of the contacts. However, since they only reached 34% of the "index" cases, the number of contacts was undoubtedly "small" relative to the number of "actual" contacts, even if 100% of the cases reached cooperated (unlikely). How small the number of contacts was I don't know, because that is not a number they provide. I am working on that. I strongly suspect SCC is worse.



So we don't lack for problems. Testing is one, but maybe not the main one. Places like Taiwan have really scrambled (using quarantine, testing, contact tracking etc.) to ensure there weren't many cases of "community spread". The USA never really did that. We never drove the number of detected cases low enough to ensure  we could contain them. We sat on our hands while we needed to be developing our contact tracking. SCC made all kinds of statements about how may people they would have on the job by July 15th. Unfortunately, that would have been too late, as we were already opening up. Did they reach that level of staffing? I don't know. Anybody have a link?

[Goose]

I mean there isn't really any need to point out the number of infections that exist have no relationship to those identified by testing, especially given how horrible our testing is, right?

NO relationship? Really? OF, IMHO that is just silly. Even if the number of tests is restricted, one can pretty well be assured that the % positive is proportional to the prevalence of the disease. Given what the restrictions are, it could be argued % positive should increase. What one can't do is compare raw number of positive tests from before the restrictions to after the restrictions. It is perfectly reasonable to be alarmed by these changes in testing priorities, but IMHO it is important to not make the problem bigger than it is. The problem is big enough to not require that.

Not only are we not doing enough testing to catch as many infections as there are, we're not letting people know if they are positive fast enough to make sure the infected people isolate and can be contact traced, which furthers spread.

I basically agree with this statement. However, I think it covers three separate problems. The problems are 1)Finding all the infections, 2) Getting the results fast enough to be effective, and 3) Making sure the infected people isolate.

The "propagation delay" (#2) problem is one reason the change in testing priority was made. It should speed up getting results to the people that are "most likely" to be positive. However, at this point in the epidemic it is difficult to understand why SCC is in this bind. At one point Stanford was doing all the testing for SCC. Is this still true, or have they developed their own capability? Are they relying on commercial labs and the commercial labs are overloaded? Did SCC decide that we had "won" and done nothing to ensure they were ready for a second (or third, or Nth wave). It wouldn't be a tragedy if the bought a "extra" 96 well PCR machine that they turned out not to need. It would be a tragedy if they need it and don't have it. Why don't we know, and why isn't the Press asking pointed questions?

The problem of locating everybody with this disease (#1) is turning out to be a disaster. As Fauci said, this virus is a bitch. Testing capacity is an issue, but it may not be the main issue. Initially, the assumption was people get the virus, become ill, get tested, test positive, isolate and all is well. If those people can't get tested, it is a problem. In SCC I think they can. However, we now know that there are lots of people who get the virus and do not become ill. Can those people pass on the disease? For sure, at least some of them can. How many is "lots"? 2X? 10X? We don't know. We also know that people who do become ill can transmit the disease for some period of time (several days) before they become ill. So testing sick people isn't going to do the job. OK, test everybody. Logistically impossible. Even tiny Iceland couldn't do that. Test a sample? Fine, but it has to be a large enough sample (which runs into limited testing speed) to detect the virus, and what do you do with the result? So some neighborhoods seem to have lots of cases. What do you do? What they do in Italy is lock it down, nobody goes in or out. They could (have the legal authority) do that in SCC, but they won't. And by the way, the non-hot neighborhoods aren't "clean". It is just below your test sensitivity.

Contact tracing and isolation could help find many asymptomatic spreaders. However, nobody in the Bay Area, and probably nobody in any USA urban area has a contact tracing and tracking capability that is "working". San Mateo County at least is (was) telling the truth. On July 19th, they reached 34% of the cases who tested positive. On July 19th, 18% of those cases were able to isolate. On July 19th they reached 41% of the contacts. However, since they only reached 34% of the "index" cases, the number of contacts was undoubtedly "small" relative to the number of "actual" contacts, even if 100% of the cases reached cooperated (unlikely). How small the number of contacts was I don't know, because that is not a number they provide. I am working on that. I strongly suspect SCC is worse.



So we don't lack for problems. Testing is one, but maybe not the main one. Places like Taiwan have really scrambled (using quarantine, testing, contact tracking etc.) to ensure there weren't many cases of "community spread". The USA never really did that. We never drove the number of detected cases low enough to ensure  we could contain them. We sat on our hands while we needed to be developing our contact tracking. SCC made all kinds of statements about how may people they would have on the job by July 15th. Unfortunately, that would have been too late, as we were already opening up. Did they reach that level of staffing? I don't know. Anybody have a link?