Forums >Health and Nutrition>The COVID-19 Wild West Thread
Ah, UK journalist and presenter Mr Piers Morgan has a book coming out next month about the “outraged woke brigade”....and if you like an English accent then you can get it on audio book and read by the great man himself! Pre-order your copy now!
"Journalist"
I remember when Piers Morgan first came to US TV years ago, with great fanfare, being promoted as a highly respected and influential figure in the UK. Then it turned out he was an enormous douchebag. And later when I talked to people from the UK, they had been laughing their asses off at what a big deal the US had made of him, because he has always been considered an enormous douchebag over there. Feel free to confirm.
Dave
not bad for mile 25
I understand the testing is important for developing a vaccine. I don't understand how a test that can't tell me everything Trent outlined is valuable. am I a carrier? don't know. test doesn't tell me. do I have the virus? Can't say for certian since the teset can't tell me I DON'T have the virus. Might as well assume I have it since I fail to say I DON'T have it. am I spreading it? Don't know since the test doesn't say that. You're only spreading it if we link a positive test to you. You might not be if you're following all of the requirements for social distancing and quarantine and masking. might I get it in a few days? Don't know since the test can't tell us until you're actually feeling sick and showing signs of a positive test result. THEN we can tell you you're positive and you have to quarantine. Probably because you weren't wearing a mask and support Donald Trump. Go home and quarantine for the next 14 days. When you've recovered go back to wearing a mask and socially distancing. Unless you die in which case we'll help you quarantine indefinitely. Testing only works if people get tested, and of the number of tests given locally there is only a 10% positive test rate. I don't know how many of those are a false positive BUT if 90% of the people aren't testing positive, and the test sounds like it only works when you're showing enough signs to test positive, why even do the test or put emphasis on it? Just develop the vaccine and quit reporting the number of positive tests since it has no weight towards removing any layer of swiss cheese put in place. Remember a vaccine doesn't provide long term immunity so how are we going to bring those layers off? People don't vaccinate their kids for whooping cough, or stay up to date on their Tdap shots in some spots of the world. Where was the requirement for those individuals to protect others by wearing masks and staying home? Do people envision a society where wearing masks continues on indefinately? No possibility to conduct any kind of race due to social distance requirements. COVID 19 has now destroyed any possibility of a marathon happening or even my local turkey trot because too many people travel which keeps the spread of COVID 19 from stopping. Rolling starts can work, until I'm next to that heavy breather in my next marathon for 40 minutes on a cloudy winter day. Somehow I don't believe I'm magically safe from COVID 19 when I'm exercising outside regardless of what Gavin Newsom says I can do without spreading COVID 19.
I understand the testing is important for developing a vaccine. I don't understand how a test that can't tell me everything Trent outlined is valuable.
am I a carrier? don't know. test doesn't tell me.
do I have the virus? Can't say for certian since the teset can't tell me I DON'T have the virus. Might as well assume I have it since I fail to say I DON'T have it.
am I spreading it? Don't know since the test doesn't say that. You're only spreading it if we link a positive test to you. You might not be if you're following all of the requirements for social distancing and quarantine and masking.
might I get it in a few days? Don't know since the test can't tell us until you're actually feeling sick and showing signs of a positive test result. THEN we can tell you you're positive and you have to quarantine. Probably because you weren't wearing a mask and support Donald Trump. Go home and quarantine for the next 14 days. When you've recovered go back to wearing a mask and socially distancing. Unless you die in which case we'll help you quarantine indefinitely.
Testing only works if people get tested, and of the number of tests given locally there is only a 10% positive test rate. I don't know how many of those are a false positive BUT if 90% of the people aren't testing positive, and the test sounds like it only works when you're showing enough signs to test positive, why even do the test or put emphasis on it? Just develop the vaccine and quit reporting the number of positive tests since it has no weight towards removing any layer of swiss cheese put in place. Remember a vaccine doesn't provide long term immunity so how are we going to bring those layers off? People don't vaccinate their kids for whooping cough, or stay up to date on their Tdap shots in some spots of the world. Where was the requirement for those individuals to protect others by wearing masks and staying home?
Do people envision a society where wearing masks continues on indefinately? No possibility to conduct any kind of race due to social distance requirements. COVID 19 has now destroyed any possibility of a marathon happening or even my local turkey trot because too many people travel which keeps the spread of COVID 19 from stopping. Rolling starts can work, until I'm next to that heavy breather in my next marathon for 40 minutes on a cloudy winter day. Somehow I don't believe I'm magically safe from COVID 19 when I'm exercising outside regardless of what Gavin Newsom says I can do without spreading COVID 19.
Your questions here are very much focused on one individual, that is, yourself. Understandable. But in order to get the pandemic (or other societal issues) under control, we need to focus on the community. If you are not tested, you have a lot of uncertainty about the disease, If you are tested, you have less uncertainty, but there is still some. But with a well run, large scale testing program, there can be remarkable certainty about how the disease is affecting the community at large, thanks to epidemiology, statistics, scientific method, etc etc. That is the kind of certainty we need to get this under control. As members of the community, we have our societal obligations to do our part.
Problem Child
"Testing only works if people get tested, and of the number of tests given locally there is only a 10% positive test rate." Only?!? Gulp. I am very glad I'm in Maine.
"Testing only works if people get tested, and of the number of tests given locally there is only a 10% positive test rate."
Only?!? Gulp. I am very glad I'm in Maine.
how is a test going to work if no one gets tested? I guess things work different up in Maine. Where I'm at a test I don't take doesn't do me any good to tell me if I'm positive for COVID 19.
What a silly screed. You know full well that what Trent was noting was that NO test is 100% accurate. If it works in some fairly high percentage of cases, then it helps those infected stop themselves from spreading it. Some will be missed, and some will be false positives. That's reality. I do. For specific situations where a mask makes an effective contribution to risk reduction. We will join those other areas of the world where mask wearing has been a norm long before COVID. You seem very focused and reactionary to who delivers the information, rather than the information. Trust science. Respect Nature. Respect others.
What a silly screed. You know full well that what Trent was noting was that NO test is 100% accurate. If it works in some fairly high percentage of cases, then it helps those infected stop themselves from spreading it. Some will be missed, and some will be false positives. That's reality.
I do. For specific situations where a mask makes an effective contribution to risk reduction. We will join those other areas of the world where mask wearing has been a norm long before COVID.
You seem very focused and reactionary to who delivers the information, rather than the information. Trust science. Respect Nature. Respect others.
So the testing is for those who spread it. I thought we gathered everyone can spread it since it can't be determined if you don't have it. This is why I'm having a problem understanding the importance of testing, or pretty much any focus on anyone who doesn't have the virus.
So we're just going to keep wearing masks when COVID stops being in the news because there is no way to prevent spreading it even with the vaccine.
I don't care who gives me the information. Since Trent seems to be busy at the moment, and you replied, I'd appreciate you delivering me some answers. I trust the science that says a recovered person has recovered and cannot spread the virus. I trust the science that says you can't have a vaccine for a virus since it's DNA and you can only have a vaccine for proteins encoded by DNA.
reactionary...interesting choice of word. https://en.wikipedia.org/wiki/Reactionary Apparently that's like a code word for right wing. Wouldn't opposition to political change just mean supporting the way things are being done? 8 years ago reactionary could mean I'm supporting keeping things the way they are since I oppose change. Why use the word "reactionary" to mean an opposition to change when it's actually "I want things my way and not the other way"? Why not say "facist" or "Marxist" or even "white nationalist" to convey a seemingly popular opinion of me in this thread? Maybe I'm like those German soldiers who didn't consider themselves reactionary in the 1930-50s.
respect others...funny in the same thread where Trump supporters don't deserve respect because they hurt others. It's almost as if the rules of one group of people don't apply to the other group of people. I've never labeled anyone here yet it's free range on labeling me.
Many of us aren't sure what the hell point you are trying to make and no matter how we guess, it always seems to be something else. Which usually means a person is doing it on purpose.
VDOT 53.37
5k18:xx | Marathon 2:55:22
reactionary...interesting choice of word. https://en.wikipedia.org/wiki/Reactionary
Interesting article, thanks for the link. I'd say there's a lot more there than "code word for right-wing".
If I'm tested I have MORE uncertainty since I can't be certain if I have it or carry it after being tested. All the test tells me is if I have it and my understanding from reading is I'll pretty much know if I have it. I'm not focused on the ME in this point. I'm focused on society. I already said that people wouldn't be happy if Trump took control and closed all the borders. Can you honestly tell me you'd support President Trump closing down every border in the county, including cities, just so we could stop the spread of COVID 19? This would protect everyone better than masks because communities would be isolated to stop the spread. As a country we need to work together to get through this together so we can protect each other. I'm sure this will be seen as apolitical. As Samuel L. Jackson said...stay the fuck home. I'm trying to think of a future where 70% of the population hasn't been vaccinated and we justify removing all the layers of swiss cheese built up to protect us. Just take them all down because a vaccine has been developed so it's now safe to walk around without everyone protecting me from COVID 19.
The disease is ruining families, killing the economy, causing divorces, keeping kids from socializing and going to parks (locally they're still closed) and testing hasn't changed any of it. States are in need of bailouts because of COVID 19. I don't need to see more test results to see what COVID 19 has done to society.
an amazing likeness
reactionary...interesting choice of word. https://en.wikipedia.org/wiki/Reactionary Apparently that's like a code word for right wing.
I was not aware of that specific interpretation of the word; I was not using it in that context. My usage was intended to note you are (seemingly, from what you write) one who reacts. (or recoils, or assigns negative intent...to use other phraseology)
Acceptable at a dance, invaluable in a shipwreck.
This is a really exhausting thread, but, as a family doc, it reflects the conversations I have with patients and acquaintances, so I guess at least there’s that.
All tests have something called sensitivity (which is, if I have the disease, how likely is the test to accurately find it?) and specificity (which is when I have a positive test, how likely is it that I actually do have the disease?)
Then, on top of that you have characteristics of the disease itself which influence what it is that you can do with a test result. So, for example, when we are screening for a condition, a screening test is most useful if the condition has a pre-symptomatic phase or a recognized pre-disease state which means if we find the condition early, there is something we can do to prevent it or treat it before it causes a bigger problem. (Think of Pap smear screening for cervical cancer - we can catch pre-cancerous issues and treat them before cancer occurs. On the flip side, ovarian cancer can’t really be picked up reliable until it’s advanced enough to already cause a big issue, so there is no reliable screening test)
Coronavirus testing is fairly specific in that the person testing positive is shedding the virus. It’s less sensitive - you could be shedding the virus and still test negative. (We will set aside for the moment that folks seem to be able to continue to test positive after they are no longer able to transmit the disease for some period of time)
if someone tests positive, we are reasonably assured they are shedding virus and can recommend isolation to avoid spreading to more people. if someone texts negative, we are only moderately sure they aren’t shedding virus. Add in the disease characteristic that people my never develop symptoms but still shed the virus, and that they may be able to shed virus for several days before they develop symptoms, and testing is useful from a public health point of view so that you can best recommend isolation. it’s also useful from a public health point of view, because knowing the prevalence in the population helps you know about risk in public situations. When the positivity rate is 1%, your risk in a group is lower than when the positivity rate is 10%.
what would be perfect is if everyone who had COVID turned purple when they became infectious, then bright green when they had recovered and stayed bright green while they had antibodies. Then at a glance we could see who has the disease and who has already recovered and is still unable to be infected. Sadly, we don’t have that, so we have to make due with the tools we do have.
Good Bad & The Monkey
This is the answer I would have written.
And yea, been a busy week and day. And this morning I have a bit of brain fog from after my second dose of the Moderna COVID vaccine I received yesterday and the goodly fever I had last night, oof.
RP, the tests are not useless. But they are not perfect either. A positive test is particularly helpful, while a negative test cannot rule out the disease (just as a negative strep test does not necessarily mean you don't have strep).
In the hypothetical case that the test has 80% sensitivity and you screen 10 asymptomatic people who are COVID+, you will find it 8 times. If you do this in a community with 10% prevalence (using your number from above), out of 100 tested individuals, you will get 8 positives and 92 negatives. Of those, 2 are falsely negative. This still gives you a reasonable estimate of disease prevalence in the community.
At the more individual level, based on identifying 8 asymptomatic cases, you can isolate those cases and reduce the number of people they contact and potentially infect. For the 2 you missed, well, they could potentially be out infecting people. Which is why we would ALSO want folks wearing masks, keeping distant, staying at home, etc. If those 2 people with false negative tests were to keep these other measures in place, they too may not infect anybody. However, since we don't know who the 2 out of the 92 are, we do better if everybody wears masks, and keeps distance, etc.
Yes, when we have a vaccine and better therapies, we can relax some of the other slices of cheese, if you will. But we don't have those now and won't anytime in the immediate future.
I'm running somewhere tomorrow. It's going to be beautiful. I can't wait.
Poor baby
Interval Junkie --Nobby
what would be perfect is if everyone who had COVID turned purple when they became infectious,. . .
2021 Goals: 50mpw 'cause there's nothing else to do
MoBramExam
As a practicing physician, do you find the publishing front and center of daily test / case numbers by every county and state useful to the general public, or do you find it mostly serves as more fodder for contention than public health awareness? In other words, does the public's perception of the data make your job easier or more difficult on a day-to-day, patient-to-patient basis?
Welcome to my life. Somehow words, and symbols, I've used unaware of what everyone else's knowledge or interpretation of them doesn't negate me from being associated with that group of people. Try posting up a photo of the emoji that shows up as an autocorrect suggestion in an iPhone for the word "okay" where three fingers are raised and two make a circle. Apparently it's a white supremacist thing that came from somewhere else on the internet and I'm to know this.
doctorjen how are you going to recommend isolation based on a test where you can't trust the negative results? "sorry individual who identifies as female. You must quarantine for the next 14 days. While your test shows you're negative we can't trust the test to tell us you're not going to spread the virus."
Literally even if the entire world was tested we'd still not be able to test the negative results so you can't actually say who is spreading it and who isn't. You'd only know who actually has it. So we need a global lockdown in order to stop the spread because once the virus has gone through all it's hosts it can't survive, right? Everyone who has it either dies or kills it off, right? That's how a virus works isn't it? kill or be killed kind of thing?
EDIT:
https://public.tableau.com/views/COVID-19CasesDashboard_15931020425010/Cases?:embed=y&:showVizHome=no
California has tested about 1/3 of the population.
5.8% have tested positive.
This means 94.6% of the people who tested negative are probably spreading it.
how can anyone find it acceptable to have anything open in California with this much spread going on? 94% of the population tested might actually be wrong about the test results. What kind of error rate is acceptable for this testing to be valid? I just don't get why I'd need to get tested if I'm in the 94% of negative people in California, but I'm actually spreading it. Just stop the testing and keep with the closed businesses and mask requirements and distance learning.
interestingly 30% of the deaths are white people and 49% are Latin(x).
EDIT 2:
Wait a second.....18-49 year olds are 60% of the positive test rates (seems like a large age group) and only 7% of the deaths. So this really isn't as dangerous as I thought it was 5 months ago. 93% chance of living through this if someone else gives it to me because they're not protecting me with their mask but I'm wearing mine.
This is 180 degrees reversed from how medical testing actually works.
If you test negative, no one is going to tell you to isolate. We know that some % of the negatives are not actually negative. These false negatives are a small percentage of all tests. Ideally, infinitesimally small.
Again, testing reduces the overall risk by allowing isolation of those who test positive.
At the expense of some false positives isolating unnecessarily, and some false negatives not isolating and possibly infecting others.
At this point, if you're not able to accept this, or make the effort to develop an understanding of these basic tenets, your seeming confusion is understandable and lamentable. If you're simply sport trolling and enjoying the dust-up, well played.
Semiotics are really interesting. This is a seminal work -
https://www.communicationtheory.org/the-meaning-of-meaning-model/
Welcome to my life. Somehow words, and symbols, I've used unaware of what everyone else's knowledge or interpretation of them doesn't negate me from being associated with that group of people.
It’s really a mixed bag. Living somewhere where the positivity rate and number of cases is still high, sharing that information with patients often helps to reinforce the recommendations for mask wearing, physical distancing (I don’t prefer the term “social” distancing) and avoiding congregating in groups. On the other hand, I hear a lot of pushback too - well, I don’t know anyone who’s sick, and my friend so-and-so had covid and didn’t even cough and the government just wants to force us all to do what it says and next they’ll say we aren’t allowed to breathe!
RP - the recommendation is that all people utilize several measures to reduce spread (wear a mask to stop droplet spread, stay 6 feet away from people, avoid close contact with larger numbers of people. In addition, if you are currently testing positive, stay as isolated as possible for 14 days until you are past the window of actively spreading the virus. Those are public health measures, not measures that necessarily make sense for each particular individual. If you test the whole world, and isolate the positives, you’d miss some cases, but do it again next week, and the week after, and you’d have greatly reduced the circulating virus and the risk of contracting. Same with getting an effective vaccine - now the virus comes knocking at your door, but it can’t get in. Hopefully we can reduce the numbers down to the level where it’s no longer a public health emergency. For context, I live in a medium sized midwestern city. My hospital has been holding steady at around 59 patients on any one day admitted with COVID, usually about 15% of those in ICU. We’ve discharged over 600 patients alive after COVID - but many with continuing issues. We’ve had about 14% of the hospitalized patients die (that’s not total patients, just the hospitalized ones) One of my nurses lost her mom, a friend lost her physician husband, we’ve had 3 office staff and 3 resident physicians infected, all recovered, although a young health resident had to miss a month of work due to being too sick to work. We are still in need of public health measures to reduce the burden on the general population - and, particularly on those most vulnerable (especially my mostly African American patient population with several comordities). If we had a test that did a better job of predicting public health impact, we’d sure like to us it. Turning colors would be even better (love Bert and Ernie!).
Trent - sounds like maybe you got the real vaccine! One of my residents participated and didn’t notice anything with the shot. We are guessing she’s placebo.
Dang, I type fast but I cannot keep up. Headed back to calling some patients with their (also imperfect) blood test results (unrelated to COVID because unfortunately people are still having diabetes and high cholesterol and stuff as well)