The all-new "US Politics and coronavirus" thread

[Mader Levap]

P.S. Since the US has experienced 70,000 deaths, can it now be officially declared that COVID-19 is worse than the flu?

I am sure usual suspects will find new excuse why it is no worse than flu (and therefore screwups of their favourite politicians aren't big deal).

 

[newyorkguy]

Here in the U.S. we're not doing too good and I'm not sure why. I only know what's going on in downstate New York where this is being taken very seriously. In New York new cases spiked on April 25th at about 10,300 but since then has been in decline. Yesterday there were 2,300 new cases reported. The other states in the region -- Connecticut, New Jersey, Pennsylvania -- are not doing so well.

What I worry about is the criteria of fourteen days with downward trending before states reopen. If states have trouble getting to that number I'm afraid demands to get business restarted will create irresistible political pressure. Obviously, trump did not believe we'd have 1.2 million cases and 72,000 deaths by early May but I'm sure behind-the-scenes he's under intense pressure from big business to relax the restrictions. Pressure being applied by business people who are a lot smarter and a lot tougher than donald trump is.

The USA chart below shows, with spikes and dips, we have basically plateaued since early April. I fear the Republican political establishment deciding, forget the fourteen day stuff, plateauing is going to have to be good enough.


The US is on the left, Italy on the right. Click to enlarge.

 

[TragicMonkey]

Sigh. My state "reopened" Monday, with the cities on a separate timeline which will apparently be May 18. And we've also had more new cases daily, every day for the last five days.

I work for one of the local behemoth healthcare providers. We get daily internal updates on all things pandemic. Notably missing as yet has been a single word about "reopening" and returning to normal operations. On the contrary, we're taking steps to hunker down for a prolonged situation. The healthcare providers are preparing for a long siege while the citizens are rushing out unarmed to sunbathe on the battlefield.

This is going to get worse before it gets better.

 

[The Don]

Sigh. My state "reopened" Monday, with the cities on a separate timeline which will apparently be May 18. And we've also had more new cases daily, every day for the last five days.

I work for one of the local behemoth healthcare providers. We get daily internal updates on all things pandemic. Notably missing as yet has been a single word about "reopening" and returning to normal operations. On the contrary, we're taking steps to hunker down for a prolonged situation. The healthcare providers are preparing for a long siege while the citizens are rushing out unarmed to sunbathe on the battlefield.

This is going to get worse before it gets better.

That's what FEMA has said but President Trump has dismissed that warning because he thinks it's a do nothing, worst case.

 

[Giordano]

I have. A team of two egineers and a technician handling one machine should be able to get 500 tests done in one day. Add two administratos to each team for paperwork and a team of two epidemiologists and four asssistants to trace contacts and handle quaranene measures with police and other such forces.

To get to 55 million/day you therefore need about 110,000 such teams, each composed of 11 people, at least four of whom must have tertiary education in an appropriate field. Each team needs about $1 million worth of hardware and burns through ~$50k consumables each day, plus other expenses. This is if they all work for about 12 hours a day, 7 days a week, so you probably need about 150,000 teams in case of breakdowns, mechanical or mental. To provide sufficient consumables you'll need to upscale the production as well, so take those costs and double them.

This works about $1.5 trillion in immediate investments and a daily expense of about $15 billion plus wages, space and logistics and you have those 320 million tests a week. If you can get enough machines produced in time, which is a problem all by itself.

Or to put it in simpler terms, take the combined efforts of the Manhattan and Apollo projects at the same time and double the number of highly skilled people you need and you have a solid estimate as to what is needed to have any chance of reaching that milestone.

McHrozni

I wonder where you obtained these numbers? I do rtPCR all the time, I’ve looked up the specific procedures being used for covid-19 screening, and based on my experience one person can easily perform approx 300 to 400 tests a day using one of the very common 96 well PCR machines. I’ve trained undergraduates in one day to do exactly this kind of work. Engineers? Why? Even a widely trained technician is not required.

One could multiply that throughput at least 4 fold using multiple PCR machines in parallel (especially the newer 394 well PCR machines; fairly common at most universities and biotech companies). The bottleneck however is in the initial sample preparation. Once the PCR machine is started it just runs on its own and the output is dumped to a computer. No administrators. To move to thousand sample preps per day per person is risking exhaustion. One solution is “robotic” sample preparation (also already available at most universities and biotech companies). There are scores of these devices (essentially just computerized sample trays and pipetters) even where I work.

This doesn’t take into account obtaining the swabs, of course.

I also don’t get the size of team of epidemiologists and case tracers you suggest per 500 tests. Depends on the numbers of positives but wouldn’t one epidemiologist, or even trained case worker, be able to supervise many more than 500 tests? The basic ideas are well known.

 

[Skeptic Ginger]

Trump is shutting down the coronavirus taskforce

Now that public disapproval caused him to take it back, my prediction: this is as much about ending Fauci and Birx from being in press conferences reminding the public Trump's version of reality is a fantasy.

 

[Horatius]

Here in the U.S. we're not doing too good and I'm not sure why. I only know what's going on in downstate New York where this is being taken very seriously. In New York new cases spiked on April 25th at about 10,300 but since then has been in decline. Yesterday there were 2,300 new cases reported. The other states in the region -- Connecticut, New Jersey, Pennsylvania -- are not doing so well.

...

The USA chart below shows, with spikes and dips, we have basically plateaued since early April. I fear the Republican political establishment deciding, forget the fourteen day stuff, plateauing is going to have to be good enough.

You're not wrong to wonder about this. I was thinking about this myself the other day, and then yesterday saw a plot that confirmed my thinking:

The only reason the US as a whole has plateaued is because New York and New Jersey are declining. The efforts you see locally are working, but they are only local. All of the improvement you see has been wiped out on a national level by increases elsewhere.

The plot I saw yesterday basically treated "NY" and "US minus NY" as two separate jurisdictions, and compared the number of new cases per day. NY has clearly peaked, and the number of new cases per day is less than half what it was at the peak. The rest of the US is clearly trending upwards.

And that's just "minus NY". NJ is also declining, so a "US-NY-NJ" chart would look even worse.

And the states that are increasing the most seem to be those pushing hardest to re-open.

This is going to get worse. There's no way it can't, if these trends continue.

 

[The Don]

And that's just "minus NY". NJ is also declining, so a "US-NY-NJ" chart would look even worse.

And the states that are increasing the most seem to be those pushing hardest to re-open.

This is going to get worse. There's no way it can't, if these trends continue.

Sure, but Coronavirus isn't going to affect those red states so much because of *reasons* so even if they have a lot of infections their lower population density will mean that Coronavirus won't spread as widely - or something

 

[Skeptic Ginger]

Regarding travel restrictions, if they are done too late, when the spreading has already started and the cat is already out of the bag, then as shown they are not effective, and slow the spread at most. That link to the model posted previously assumed, rightly, that there were already seed clusters of infections before the travel bans take place; at that point its simply too late for there to be any big effect.

However, if done later when the outbreaks are coming under control or when there are little or no clusters, they definitely can be effective, as they stop any new seed clusters starting.
Hong Kong has (fingers crossed) managed to wipe out new local infections. We haven't had any for 17 days.

This is largely because the vast majority of travel to Hong Kong has been stopped, apart from HK residents returning. All tourism, business travel etc is forbidden. We had to ban all non-resident travel simply because there would not be enough capacity for the testing/quarantine measures described below.

All returnees are tested at the airport, and may only leave if the result is negative. If positive, straight into government quarantine or hospital, depending on symptoms.

If airport test is negative, and if they are able to quarantine at home they are tagged with wristband and must provide random location updates via an app to ensure they stay at home. After several cases of rule breakers being arrested and charged, this flouting has stopped, and people have been observing the home quarantine strictly.

If airport test is negative but they are unable to quarantine at home, straight into government quarantine.

After 14 days, they are tested again and must be negative before leaving quarantine.

So we have effectively stopped all imported causes entering the community, and local transmission has died down to nothing. Currently 135 active cases, 4 deaths overall.

Note these measures were taken in response to a local outbreak that was traced to ongoing imported cases from UK and USA, and as we were learning more how prevalent asymptomatic cases were.

But is shows that travel restrictions can and do have an effect, if used at the right time, and as part of a suite of supporting measures. Yes, they have an economic impact, but as part of the "hammer", all measures have an economic impact.

That can only be done in small well defined areas like Hong Kong or Taiwan. It cannot be done in any larger countries or areas, it's impractical.

 

[Giordano]

I have. A team of two egineers and a technician handling one machine should be able to get 500 tests done in one day. Add two administratos to each team for paperwork and a team of two epidemiologists and four asssistants to trace contacts and handle quaranene measures with police and other such forces.

To get to 55 million/day you therefore need about 110,000 such teams, each composed of 11 people, at least four of whom must have tertiary education in an appropriate field. Each team needs about $1 million worth of hardware and burns through ~$50k consumables each day, plus other expenses. This is if they all work for about 12 hours a day, 7 days a week, so you probably need about 150,000 teams in case of breakdowns, mechanical or mental. To provide sufficient consumables you'll need to upscale the production as well, so take those costs and double them.

This works about $1.5 trillion in immediate investments and a daily expense of about $15 billion plus wages, space and logistics and you have those 320 million tests a week. If you can get enough machines produced in time, which is a problem all by itself.

Or to put it in simpler terms, take the combined efforts of the Manhattan and Apollo projects at the same time and double the number of highly skilled people you need and you have a solid estimate as to what is needed to have any chance of reaching that milestone.

McHrozni

More questions about sources of your numbers:
A million dollars in hardware? One real time PCR machine, enough to for 300 to 400 samples a day, costs about $50,000 to 70,000 dollars. The commercial supplies range a lot in cost depending on manufacturer but a lot is pure price gouging. I could assemble my own reagents with all the controls and verification for maybe $4 or at most $8 a test.

 

[Meadmaker]

More questions about sources of your numbers:
A million dollars in hardware? One real time PCR machine, enough to for 300 to 400 samples a day, costs about $50,000 to 70,000 dollars. The commercial supplies range a lot in cost depending on manufacturer but a lot is pure price gouging. I could assemble my own reagents with all the controls and verification for maybe $4 or at most $8 a test.

And I assume that's based on current pricing.

Surely it could come down with volume.

Why would we not do an Apollo level program on this? I just don't understand how that isn't happening.

We would even get the same degree of spinoff technology improvements we got from Apollo. All the things we learn in trying to figure out how to do hundreds of millions of tests would have other applications. How can we throw two trillion dollars of borrowed money into the wind and hope for the best, but we can't take a million of the newly unemployed and give them jobs running fancy machines which, from the user's perspective, are just consoles where you have to punch buttons and wait until the light turns green.

The only thing I don't know is if there is some sort of raw material in the test process that simply can't be ramped up in production.

 

[Squeegee Beckenheim]

Now that public disapproval caused him to take it back, my prediction: this is as much about ending Fauci and Birx from being in press conferences reminding the public Trump's version of reality is a fantasy.

Do you have a citation for that?

 

[Andy_Ross]

Do you have a citation for that?

He tweeted that the Task Force will continue on indefinitely with its focus on opening up the country.

 

[Resume]

He tweeted that the Task Force will continue on indefinitely with its focus on opening up the country.

That's called an economic task force dumb ass. Coronavirus task force should focus on --just off the top of my head-- the coronavirus, and all the related health and safety issues.

This administration is pitiful, inept and hopelessly corrupt.

 

[Trebuchet]

Scientists at the University of Arizona are devloping a Covid-19 model for the state. The state government is trying to shut it down in case it tells them things they don't want to hear. The Republican war on science continues.

 

[slyjoe]

And I assume that's based on current pricing.

Surely it could come down with volume.

Why would we not do an Apollo level program on this? I just don't understand how that isn't happening.

We would even get the same degree of spinoff technology improvements we got from Apollo. All the things we learn in trying to figure out how to do hundreds of millions of tests would have other applications. How can we throw two trillion dollars of borrowed money into the wind and hope for the best, but we can't take a million of the newly unemployed and give them jobs running fancy machines which, from the user's perspective, are just consoles where you have to punch buttons and wait until the light turns green.

The only thing I don't know is if there is some sort of raw material in the test process that simply can't be ramped up in production.

How long did Apollo take?

 

[Giordano]

How long did Apollo take?

Unlike Apollo all the technology for Covid-19 screening by PCR is already in place and is already being performed at multiple locations using widely available methodologies. All that is required is to ramp up the throughput, with approaches to doing that also already understood.

I suspect use of simple robotic sample handling (widely in use already) plus rededication of PCR machines already “out there” could significantly increase the availability of testing within a few weeks. Commitment to assemble new, high throughput real time PCR machines and creation of dedicated centers for testing, a “Mercury” space program level of cost at most, would further increase throughput many, many fold in a month or two.

 

[Giordano]

A point about antibody testing: determining the correct antigens to use in the kits (low false positives, low false negatives, strong real positives) is the tricky part. But the physical test kits should be easy to manufacture IMHO. Pregnancy kits for example are actually the same concept, although the are designed to use the reverse process of screening for an antigen in urine using a defined antibody. The development of a plastic stick with a plus/minus result (using blood not urine) as a first level test seems to me to be quite possible. But I may be missing something here. Anyone?

 

[Meadmaker]

How long did Apollo take?

Unlike Apollo all the technology for Covid-19 screening by PCR is already in place and is already being performed at multiple locations using widely available methodologies. All that is required is to ramp up the throughput, with approaches to doing that also already understood.

I suspect use of simple robotic sample handling (widely in use already) plus rededication of PCR machines already “out there” could significantly increase the availability of testing within a few weeks. Commitment to assemble new, high throughput real time PCR machines and creation of dedicated centers for testing, a “Mercury” space program level of cost at most, would further increase throughput many, many fold in a month or two.

Exactly. This isn't even rocket science.

It would require a major infusion of cash, but that doesn't seem to be a problem these days. Nothing about this is difficult unless there is some chemical that is part of the testing that just cannot be produced for hundreds of millions of doses.

And hundreds of millions of swabs, assuming there is no better way to gather the samples.

Those are huge numbers. Hundreds of millions of anything is pretty hard to ramp up, but for Pete's sake we can make hundreds of millions potato chips. If we had a trillion dollars to do it, and 30 million people with nothing better to do right now, I'll bet someone could find a swab-making machine, make a few more copies of it, put them in a building with some box packing machines, and we'd be on our way.


And I'm not saying that really is the best thing to do. Maybe it isn't, although it sure seems to me like it's the best idea I've heard. The real point is that people sitting at desks and preparing reports for the coronavirus task force ought to be sitting down and figuring out what it would take, and they ought to be thinking on that scale. This is a really big deal, right? Pretty much the biggest deal of my lifetime if I've got this figured out correctly. Certainly nothing else that has ever happened in my lifetime has left me locked in my basement for weeks wondering whether there will be any toilet paper, but afraid to go get some because there is a measureable chance I might die trying.

And yet the only truly massive effort our government has undertaken in response has been the one to kickstart the stock market.

 

[The Great Zaganza]

Even if the "Virus came from the Lab" theory is correct, at this point it is still a distraction, and will remain so.