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My take on the mass testing is to segregate the sick from the healthy. I am less interested in how many people have it. Right now we are only testing the sick. That is fine—-but it won’t be enough to get live sports back. That’s what I am concerned about. I want football to happen!
 
While you want to test as much as you can I don't think the total number of tests is as meaningful as the percentage of positive results from those tests. It's that percentage that determines what we do.

Nebraska has always tested higher risk people. People that traveled, people exposed to positive people. It appears as long as the percentage of positive results stay in the teens, the hospitals can handle things. I saw a chart last week that showed most tests in Nebraska was in the teens, except Crete where they are having a packing plant outbreak and it was 30% there.

But to me the big deal was the new testnebraska results. Here the tests are by appointment but are more random then the other tests we've done. They started testing in Omaha and Grand Island, two places that have seen a jump in cases. But Rickets said the other day out of the first 900 results they got back there were only 30 positive results, that's just 3%.

From day one it's always been about not overrunning the hospitals, that hasn't changed. You keep the test results of positive cases under 20% there will be sports, maybe very restricted, but there's no reason not to have sports if the hospitals are not overrun.

There's no vaccine coming, so it's up to herd immunity. The key is how fast can you get up to 70% of the population getting the virus while still not overloading the hospital. If you're an old fart like me, you back off, stay safe, and let it all play out.

Honestly I don't think the percentage of positive tests is a driver either.

Say we're able to test a million a day and get 25% positive results. I assume you're only testing people going to the doc or a hospital who're symptomatic. To me the number that should be concerning is the hospitalization percentage and positives that result in death.
 
While you want to test as much as you can I don't think the total number of tests is as meaningful as the percentage of positive results from those tests. It's that percentage that determines what we do.

Nebraska has always tested higher risk people. People that traveled, people exposed to positive people. It appears as long as the percentage of positive results stay in the teens, the hospitals can handle things. I saw a chart last week that showed most tests in Nebraska was in the teens, except Crete where they are having a packing plant outbreak and it was 30% there.

But to me the big deal was the new testnebraska results. Here the tests are by appointment but are more random then the other tests we've done. They started testing in Omaha and Grand Island, two places that have seen a jump in cases. But Rickets said the other day out of the first 900 results they got back there were only 30 positive results, that's just 3%.

From day one it's always been about not overrunning the hospitals, that hasn't changed. You keep the test results of positive cases under 20% there will be sports, maybe very restricted, but there's no reason not to have sports if the hospitals are not overrun.

There's no vaccine coming, so it's up to herd immunity. The key is how fast can you get up to 70% of the population getting the virus while still not overloading the hospital. If you're an old fart like me, you back off, stay safe, and let it all play out.

Pretty much agree with everything you're saying:

There are studies coming out now that suggest that herd immunity comes into play at a number a lot lower than 70% (and the transmission tracing for this suggest that to be true), so getting to 70% probably isn't the threshold.

Most states are still testing symptomatic only. Some have opened up drive in testing, but not many people want to just head out to get tested (A rational decision IMO, if you don't have symptoms, what does it matter that you got tested? you could be positive an hour later, so the test itself is pretty useless in that context). I'm interested in antibody testing, but have no wish to test while asymptomatic.

I agree that the number of cases needs to be set up in the context of the testing positive rate (although a few states are screwing that up by double counting the same person in multiple tests now). But at least it gives us a context (cases along tells us virtually nothing).

Nebraska doesn't yet look to be at it's peak, but it's probably pretty close. Either way, it's getting clear that in most states the percentage positive is dropping and the hospitals are pretty much empty everywhere. So long as the hospitals aren't getting inundated states need to start opening up
 
Honestly I don't think the percentage of positive tests is a driver either.

Say we're able to test a million a day and get 25% positive results. I assume you're only testing people going to the doc or a hospital who're symptomatic. To me the number that should be concerning is the hospitalization percentage and positives that result in death.

According to Rickets in one of his news conferences last week, the percentage is a key factor they are looking at.
 



Honestly I don't think the percentage of positive tests is a driver either.

Say we're able to test a million a day and get 25% positive results. I assume you're only testing people going to the doc or a hospital who're symptomatic. To me the number that should be concerning is the hospitalization percentage and positives that result in death.

I think it's useful, but not the ultimate data point. As we test more people, we're testing and finding positives in people with lighter symptoms (if any symptoms). Part of the jump is things like testing packing plants where very few people are symptomatic but where there are likely a high percentage of positives.

I believe they think that cases can be extrapolated to hospitalizations, but as they find people who are positive, but with lighter symptoms that ratio will change (unfortunately, the data there seems lousy).

One of the big pushes is going to come from Medical systems who are bleeding cash at an atrocious level now across the country.
 
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Pretty much agree with everything you're saying:

There are studies coming out now that suggest that herd immunity comes into play at a number a lot lower than 70% (and the transmission tracing for this suggest that to be true), so getting to 70% probably isn't the threshold.

Most states are still testing symptomatic only. Some have opened up drive in testing, but not many people want to just head out to get tested (A rational decision IMO, if you don't have symptoms, what does it matter that you got tested? you could be positive an hour later, so the test itself is pretty useless in that context). I'm interested in antibody testing, but have no wish to test while asymptomatic.

I agree that the number of cases needs to be set up in the context of the testing positive rate (although a few states are screwing that up by double counting the same person in multiple tests now). But at least it gives us a context (cases along tells us virtually nothing).

Nebraska doesn't yet look to be at it's peak, but it's probably pretty close. Either way, it's getting clear that in most states the percentage positive is dropping and the hospitals are pretty much empty everywhere. So long as the hospitals aren't getting inundated states need to start opening up

When people question opening, one of their points is the delay between cases numbers, hospitalizations, and need for a ventilator. I think that's what looking at the percentage of positive cases is all about. Say you test and have a 10% positive rate, but the next week it's 15%, and then 20%. This should tell you to expect an increase of hospitalizations before the need actually arises which gives you time to prepare yourself. Move patients to other hospitals so you don't get overrun. Again that's what it's all about, don't overrun the hospital.
 
When people question opening, one of their points is the delay between cases numbers, hospitalizations, and need for a ventilator. I think that's what looking at the percentage of positive cases is all about. Say you test and have a 10% positive rate, but the next week it's 15%, and then 20%. This should tell you to expect an increase of hospitalizations before the need actually arises which gives you time to prepare yourself. Move patients to other hospitals so you don't get overrun. Again that's what it's all about, don't overrun the hospital.

Agree, that's why they are doing it. Problem they have is that just percentages don't really work. To use the packing plant example from above. They might test 30% positive in a plant, but that has almost no impact on hospitalizations.

From the beginning, it's been obvious that we should be doing risk stratification in regards to response to this virus. Instead most regions are pretending that the overall risk is homogeneous with our response. That's why we've ended up spending resources on things that don't matter while not protecting nursing homes, or worrying about outbreaks at packing plants where the people are at as much risk as if they'd caught the flu.
 
Agree, that's why they are doing it. Problem they have is that just percentages don't really work. To use the packing plant example from above. They might test 30% positive in a plant, but that has almost no impact on hospitalizations.

From the beginning, it's been obvious that we should be doing risk stratification in regards to response to this virus. Instead most regions are pretending that the overall risk is homogeneous with our response. That's why we've ended up spending resources on things that don't matter while not protecting nursing homes, or worrying about outbreaks at packing plants where the people are at as much risk as if they'd caught the flu.


I guess I was thinking the way it worked was, you test and you have X number of positive people, of that, X number need hospitalization, and of that, X number will need a ventilator. The percentage that needs hospitalization is a constant, so when testing if the percentage of positive tests increases, in time the percentage of hospitalizations should increase.

I may be way off, but that's the way I thought it was working.
 



I guess I was thinking the way it worked was, you test and you have X number of positive people, of that, X number need hospitalization, and of that, X number will need a ventilator. The percentage that needs hospitalization is a constant, so when testing if the percentage of positive tests increases, in time the percentage of hospitalizations should increase.

I may be way off, but that's the way I thought it was working.

This is from a while back, but it gives you the rough idea:



I think those numbers are a bit skewed also. as they were from 1 1/2 months ago before we knew how prevalent asymptomatic cases are. As we've seen from the mass testing of prisons, meat packing plants, and the boston homeless shelter, there are a lot more asymptomatic cases than anyone thought, so if an 85 year old is 9x more likely to go to the hospital when both presented as symptomatic), the real number is likely much, much higher (say the number of asymptomatics are twice as high as thought in younger age bands, then you're up to 20x more likely to go to the hospital and I wouldn't be surprised if it was a lot higher than that even)

And that isn't even adjusting for co-morbidity/underlying conditions.
 
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here's a great source of lots of contact tracing information from a doctor at the Univ. of St. Andrews:



"High infection rates seen in household, friend & family gatherings, transport suggest that closed contacts in congregation is likely the key driver of productive transmission. Casual, short interactions are not the main driver of the epidemic though keep social distancing! "

Thanks for this.
Deductive reasoning, reading scenario after scenario, certain commonalities kept cropping up in what I'd read.
Virus loading is key.
Outdoors seems as safe as anyone could be with others around, dispersal,temps and uv tremendous helpers.
Loading outdoors almost impossible.

Wonder how safe it would be in stands ;)
 
While you want to test as much as you can I don't think the total number of tests is as meaningful as the percentage of positive results from those tests. It's that percentage that determines what we do.

Nebraska has always tested higher risk people. People that traveled, people exposed to positive people. It appears as long as the percentage of positive results stay in the teens, the hospitals can handle things. I saw a chart last week that showed most tests in Nebraska was in the teens, except Crete where they are having a packing plant outbreak and it was 30% there.

But to me the big deal was the new testnebraska results. Here the tests are by appointment but are more random then the other tests we've done. They started testing in Omaha and Grand Island, two places that have seen a jump in cases. But Rickets said the other day out of the first 900 results they got back there were only 30 positive results, that's just 3%.

From day one it's always been about not overrunning the hospitals, that hasn't changed. You keep the test results of positive cases under 20% there will be sports, maybe very restricted, but there's no reason not to have sports if the hospitals are not overrun.

There's no vaccine coming, so it's up to herd immunity. The key is how fast can you get up to 70% of the population getting the virus while still not overloading the hospital. If you're an old fart like me, you back off, stay safe, and let it all play out.
3% is on par, and likely the number they're looking for, as most countries started opening up at that level.
Counting everyone we know that's infected,add in the antibody tests showing large numbers of asymptomatic people, it wouldn't surprise me if over 5 million have had the virus in the US.
Likely,2% or higher nation wide.
 




Thanks for this.
Deductive reasoning, reading scenario after scenario, certain commonalities kept cropping up in what I'd read.
Virus loading is key.
Outdoors seems as safe as anyone could be with others around, dispersal,temps and uv tremendous helpers.
Loading outdoors almost impossible.

Wonder how safe it would be in stands ;)
A lot of early transmission was at outdoor functions. Viral dilution is a very good thing, but I still do not get too close to people outside unless I can't avoid it, especially those refusing to wear a mask. One poorly timed sneeze or cough......and I am in the apparently disposable age group (60+) ;)
 

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