[DocSavage]

Since you are being snarky:

Are you aware that the sensitivity quoted was mostly in symptomatic and hospitalized patients and not those in the very earliest stages who could also be shedding less virus?

Are you aware that each false negative can infect N others, some of whom might have also been previously tested, and also be greenlit to deal with high-risk populations like nursing homes?

Are you aware that your 4^x vs 1^x comparison assumes that in that chain everyone is tested, which is not even close to the case now.

[gitgudnubs]

My favorite game.

Are you aware that the test can be improved by training medical personnel on sampling technique?

Are you aware that tests will, as a general rule, improve?

Are you aware that the majority of people understand the difference between 70% and 100% accurate?

Are you aware that public policy was affected by poor data on the spread?

Are you aware that it's far easier to successfully test [nearly] everyone in the chain when the number of cases is small, like it would have been when this test was initially available?

The _only_ way this can be contained is through massive lockdowns. If tests were performed _as soon as possible_, then there's a good chance we could have done a good job containing it through contact tracing. Even if that weren't the case, it would have given our medical system several extra weeks to prepare for the case load. It would have given our politicians better data to enact policies.

[DocSavage]

So after you try to belittle me about not understanding 4^x vs 1^x, you are now talking about future efforts, hopes how an entire medical community can be retrained, etc. Let's stay focused on the real world and not some hypothetical past where we were like South Korea. None of your comments apply to a 1^x spread in the current system since we aren't testing many people, and in hot spots, we aren't testing hardly anyone outside those in hospitals.

Here's where we agree. We agree that the only way this can be contained is massive lockdowns, and I believe this particularly true in the face of unreliable and unavailable testing. I also think it has to be coordinated across the country to prevent constant reseeding. We agree that testing everyone would've been good, particularly in the containment phase, but that ship has sailed.

My original point is that under the current system where we are occasionally testing the public at large, and also using swab RT-PCR just after suspected infected contact (way before symptoms like Pence, etc), the variable sensitivity is troubling.

[gitgudnubs]

It's like talking to a brick wall. Medical technology is approximately monotonically increasing, so it's absurd to think the test we cobble together in the first month won't be improved upon. The CDC FUCKED UP. I expect careers to be finished. I want a criminal investigation, just in case of corruption, and I hope some people lose their license.

But even in the current environment, testing is important. It guides public policy, and it helps doctors triage patients in serious condition. It still helps to limit the spread, and will do so even more when testing overtakes the infection rate (aided by lockdowns). If testing improves, then it could cut weeks off a global lockdown, because the long tail will die that much faster.

Not everyone is a neckbeard with a programming job who can live in a basement for two weeks without a single human contact, so anything that helps extinguish this disease helps. Now if you'll excuse me, I should go shave.

[DocSavage]

> It's like talking to a brick wall.

Yes, it certainly is. Did I ever say we shouldn't test? Did I ever argue testing couldn't be improved? Suggest you argue points that were actually put forth instead of using straw men arguments. Re-read the last line of my original post. I'm all in favor of trying to find positive cases.

[gitgudnubs]

Brick. Wall.

>Re-read the last line of my original post.

Still wrong. Reread the second to last line of your original post.

>There's a reason why screening tests need to be highly accurate.

They don't. That's the point. It doesn't need to be 99.9% accurate unless the disease is so aggressive that you're all dead anyway.

There's the contention. The goal is exponential decay, and the only scalable method is to reduce the reproduction rate. Even if you don't drop below 1, a smaller exponential still grows exponentially slower.

[DocSavage]

Screening tests need to be highly accurate OR you need to be fully aware and manage the fallout from false negatives, which is the point I'm making. First, screening tests have costs, that's why many diseases don't have screening tests. It's what's drummed into us in medical school. Sometimes the medical community backs away from a screening test like has been done in many areas with prostate exams. The cost/benefit isn't worth it. One cost in the COVID case is use of PPE, health care worker time, and test availability hence why CA is backing away from broad testing to triage tests to in-hospital use. Another cost is the possible grouping of symptomatic patients together as they wait for tests. Sure, if rollout can be perfect this isn't a problem, but medicine is about what happens in the real world where delivery is not perfect. By the way, NYC and CA medical community is saying the cost/benefit isn't good enough for broad COVID screening at this time. I'm sure you know better because you know the math of disease spread and are completely unable to grok other reasons why'd they do that.

Second and less talked about, there are consequences of a false negative population which is NOT handled appropriately -- like not letting people know if they test negative they STILL should stay away from high-risk population or take precautions like you still could be infected. That directive has been circulated a little but most people I've seen don't know that. The news reporters don't ask Pence about serial tests. They seem satisfied he had one negative test.

Once again, and I don't know how many times I have to say this, I'm not against widespread testing of the current RT-PCR swab, particularly if we had lots of tests, didn't have PPE shortages in the area, and guidance was given to all those receiving results. Your contention that accuracy doesn't matter is incorrect. It matters because false negatives matter and it's great to do testing to decrease the spread, which is pretty obvious, but you absolutely need additional management depending on accuracy. Like not setting the standard of working with high-risk patients as a single negative test. They need to be tested serially and hopefully get a more accurate test for nursing home workers in future. Like not assuming Pence isn't spreading disease because of a single negative test. He could be one of the many asymptomatic infected. This has been my point for this entire thread. I'll leave you to argue something different.