COVID mass testing
In my opinion, the biggest failure of Canadian and other western governments when it comes to COVID has been the failure to mass produce enough testing kits to be able to test the entire population, identify all cases of COVID, and quarantine all infected indiviuals to stamp out the virus.
It's my contention that such an approach would have ended Canada's pandemic months ago.
I agree.
Me too.
A combination of testing and response are certainly the key to covid suppression prior to a vaccine, but it is not a simple combination decision for Western regimes.
Canada seems to be near average in tests for countries that are sizable and advanced. Looking at the Worldometer and selecting the menu order by "tests per million population", the correlation between testing vs "cases per million population" is far from definitive. https://www.worldometers.info/coronavirus/#countries
Testing is essential and more testing is definitely better, but I doubt increased testing would drastically change Covid rates in Canada. More tests don't profoundly affect human behaviour and social interactions--the only cause of infection.
It does allow faster, more targeted, suppression in response to outbreaks--should restrictive measures be mandated by the state.
Authoritarian states (eg China) can be much more effective where the concept of personal freedom of association and movement are neither ingrained in the populace nor presumed to have presidence over state interests.
In the West, loud protests against even wearing masks are commonplace and silent ignoring of recommendations and restrictions are rife. In liberal democracies it would be (so far) political suicide to try to enact the the kind of enforced lockdowns openly displayed mass surveillance that has made China's response largely a success.
By comparison, tracing in much of Europe remains a shambles, and the ability to conduct mass testing is lacking in many countries. Where testing is conducted, the utility of the results is often squandered because the infrastructure for tracing and quarantining regional clusters is still lacking.
Similarly, European borders have remained largely open -- despite the bloc having the right to close its usually open boundaries in the name of public health -- with summer travelers blamed for several recent outbreaks.
The World Health Organization (WHO) noted as far back as February that "much of the global community is not yet ready, in mindset and materially, to implement the measures that have been employed to contain Covid-19 in China.""Fundamental to these measures is extremely proactive surveillance to immediately detect cases, very rapid diagnosis and immediate case isolation, rigorous tracking and quarantine of close contacts, and an exceptionally high degree of population understanding and acceptance of these measures," the report said.
Unfortunately, in the intervening months, even as China's response has been shown to be effective -- and similar models have shown success in South Korea, Japan, Hong Kong and other parts of Asia long exposed to the virus -- Europe continues to lag behind.
https://www.cnn.com/2020/10/20/asia/china-europe-coronavirus-intl-hnk/in...
A combination of testing and response are certainly the key to covid suppression prior to a vaccine, but it is not a simple combination decision for Western regimes.
Canada seems to be near average in tests for countries that are sizable and advanced. Looking at the Worldometer and selecting the menu order by "tests per million population", the correlation between testing vs "cases per million population" is far from definitive. https://www.worldometers.info/coronavirus/#countries
Testing is essential and more testing is definitely better, but I doubt increased testing would drastically change Covid rates in Canada. More tests don't profoundly affect human behaviour and social interactions--the only cause of infection.
It does allow faster, more targeted, suppression in response to outbreaks--should restrictive measures be mandated by the state.
South Korea was able to deal effectively with COVID through mass testing, identifying all the positive COVID cases, and then quarantining those individuals for 14 days.
In the West, loud protests against even wearing masks are commonplace and silent ignoring of recommendations and restrictions are rife. In liberal democracies it would be (so far) political suicide to try to enact the the kind of enforced lockdowns openly displayed mass surveillance that has made China's response largely a success.
This strategy doesn't work through a lockdown. It works through testing everyone and then having government mandated quarantine for all who test positive, with strict penalties to ensure that people comply.
"Lockdowns don't work" is a strawman argument in relation to what I'm actually advocating in this thread.
Testing isn't a cure all but it does allow for a reduction if not absolute stop on "lockdowns". We haven't had any real lockdowns in Canada. Many businesses have never closed. Public transit has never been shutdown. What we have is rolling semi-lockdowns to control the rate at which it spreads, not to stop it from spreading.
Mass testing would be a huge help.
Left Turn, if you are advocating government mandated quarantines for people who test positive, with strict penalties, and you want to test everyone, well... from a civil liberties perspective, that's actually worse than a lockdown. People in Ontario are already freaking out about secret internment camps that don't exist, good luck pulling this off.
A combination of testing and response are certainly the key to covid suppression prior to a vaccine, but it is not a simple combination decision for Western regimes.
Canada seems to be near average in tests for countries that are sizable and advanced. Looking at the Worldometer and selecting the menu order by "tests per million population", the correlation between testing vs "cases per million population" is far from definitive. https://www.worldometers.info/coronavirus/#countries
Testing is essential and more testing is definitely better, but I doubt increased testing would drastically change Covid rates in Canada. More tests don't profoundly affect human behaviour and social interactions--the only cause of infection.
It does allow faster, more targeted, suppression in response to outbreaks--should restrictive measures be mandated by the state.South Korea was able to deal effectively with COVID through mass testing, identifying all the positive COVID cases, and then quarantining those individuals for 14 days.
In the West, loud protests against even wearing masks are commonplace and silent ignoring of recommendations and restrictions are rife. In liberal democracies it would be (so far) political suicide to try to enact the the kind of enforced lockdowns openly displayed mass surveillance that has made China's response largely a success.This strategy doesn't work through a lockdown. It works through testing everyone and then having government mandated quarantine for all who test positive, with strict penalties to ensure that people comply.
"Lockdowns don't work" is a strawman argument in relation to what I'm actually advocating in this thread.
Of course I never said that "lockdowns don't work" quite the opposite, I only said that more restrictive measures are potentially political poison for the narrowly embraced libertarian mindset of westernized populations.
Calling "lockdowns a red herring" is meaningless unless you are using some unusually specific definition of that general use term for different restriction:
COVID-19 pandemic lockdowns
There are curfews, quarantines, and similar restrictions (variously described as stay-at-home orders, shelter-in-place orders, shutdowns or lockdowns) in place in many countries and territories around the world, related to the COVID-19 pandemic and established to prevent the further spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19.[1] By April 2020, about half of the world's population was under lockdown, with more than 3.9 billion people in more than 90 countries or territories having been asked or ordered to stay at home by their governments....
https://en.wikipedia.org/wiki/COVID-19_pandemic_lockdowns
South Korea you specifically mention is no exception to restrictive measures.
As for the Mass Testing component of that two-fold panacea, S. Korea testing rate is MUCH lower than Canada's 274,717 tests per million pop versus S.Korea's 54,903 tests per million.
Even so, the lower rate Korean rate of symptomatic cases would indicate something is different for Korea than merely insufficent testing.
A possible reason for the limited number of cases, which may not have been discussed on this site, is mass adult vaccinations with MMR which a number of studies studies suggest provides significant protection against covid:
MMR Vaccine Appears to Confer Strong Protection from COVID-19: Few Deaths from SARS-CoV-2 in Highly Vaccinated Population
....
South Korea had a huge outbreak of measles in 2000 - 2001 (55,707 reported cases) resulting in the government going back and vaccinating its entire population at well above the typical child-only MRCV protocols in most other
countries. In addition to childhood immunizations, the South Korean military requires all new recruits to get two MMR vaccinations. Since every male in the country is required to join the military between age 18 to 28, many men
received the MMR vaccine as many as three or four times, conferring maximum immunity. During measles outbreaks, there have even been MMR vaccine shortages in South Korea as many in the adult population sought to get
immunized. South Korea is showing an unusually low incidence of death from COVID-19 as compared to other countries with a similar timeline of initial infection....
https://www.researchgate.net/publication/341354165_MMR_Vaccine_Appears_t...
See also:
MMR Vaccination: A Potential Strategy to Reduce Severity and Mortality of COVID-19 Illness
https://www.amjmed.com/article/S0002-9343(20)30902-5/fulltext
Global trial to test whether MMR vaccine protects front-line health-care workers against COVID-19
Vaccine may strengthen immune response to viral infections; trial to enroll up to 30,000 health-care workers
Jim Dryden•September 3, 2020
https://medicine.wustl.edu/news/global-trial-to-test-whether-mmr-vaccine...
Let's say 1% of a population is estimated to carry the coronavirus. It makes much more sense to find and treat that 1% than it does to hammer the other 99%. But for that you need to effectively utilize the proven successful tools of an efficient test, track, trace and quarantine program. This has not been done here. As a result we have spiking community spread. We have lost control of the virus and can't eliminate it because we don't know where it is.
Hence the contemplated use again of the lockdown 'hammer' instead of the superior, proven interventionary techniques employed in such places as South Korea, Thailand, China, New Zealand, Melbourne and elsewhere, which allow a society and economy to function in a more or less normal fashion. In Ontario it can still take a week to get the results of a covid test back. All the while the politicians make speeches, the situation grows worse and once again, having wasted the last one, we are 'looking down the barrel' of another major lockdown. Too bad.
The government goal has been to allow covid-19 to spread keeping the numbers just below what would overwhelm the health care system. Messaging has been manipulative, long on rules and short on explanations.
Mass testing gives the public the information we need to judge the situation rather than blindly following whatever politicians are telling us to do.
Testing without contact tracing and isolation will not succeed as many people will still be spreading the disease. Mass testing is already a sign that a government has failed to minimize infections because it did not prepare in advance for a pandemic and/or did not take action fast enough. At some point, mass testing, while useful in identifying an individual with the disease, fails because there are so many already infected that contact tracing every possible carrier becomes impossible. Taiwan's response was highly effective because it was already very well prepared to deal with a pandemic. By contrast New Zealand, although doing much better than Canada, was not well prepared to deal with the problem initially but later did respond fairly effectively.
In other words, Canada needs to create a much stronger effective pandemic control system for future pandemics, because with human invasion of wildlife areas around the globe and air travel, more pandemics are coming and in a much shorter period than the century between the 1918 and current major pandemics. The following article from Lancet, one of the world's leading medical journals, looks at why Taiwan was so successful.
We examined the approach up to August 2020 taken by two jurisdictions which had successfully eliminated COVID-19 by this time: Taiwan and New Zealand. Taiwan reported a lower COVID-19 incidence rate (20.7 cases per million) compared with NZ (278.0 per million). Extensive public health infrastructure established in Taiwan pre-COVID-19 enabled a fast coordinated response, particularly in the domains of early screening, effective methods for isolation/quarantine, digital technologies for identifying potential cases and mass mask use. ...
The responses of Taiwan and New Zealand to the COVID-19 pandemic varied as a result of pre-COVID infrastructure and planning, and may also have been influenced by the different timing of first confirmed cases in the respective jurisdictions (as shown in Appendix 1). These circumstances resulted in differential timing of the mandated use of case-based (eg, contact tracing and quarantine) and population-based (eg, face mask use and physical distancing) interventions. A recent modelling analysis using the detailed empirical case data in Taiwan concluded that population-based interventions likely played a major role in Taiwan's initial elimination efforts, and case-based interventions alone were not sufficient to control the epidemic [
Major features of the differing COVID-19 responses consist of the following:
Probably the most fundamental difference between the situation of Taiwan and New Zealand was that in Taiwan responsiveness to pandemic diseases and similar threats is embedded in its national institutions. Taiwan established a dedicated CDC in 1990 to combat the threat of communicable diseases. By contrast, the equivalent organisation in New Zealand (the NZ Communicable Disease Centre, a business unit within the Department of Health) was closed in 1992 with its functions transferred to a newly formed Crown Research Institute (ESR) and then contracted back to what became the Ministry of Health. In addition, Taiwan established a National Health Command centre (NHCC) in 2004 following the SARS epidemic. This agency, working in association with the CDC, was dedicated to responding to emerging threats, such as pandemics, and given the power to coordinate work across government departments and draw on additional personnel in an emergency.
Taiwan's pandemic response was largely mapped out through extensive planning as a result of the SARS pandemic in 2003, and was developed in such a way that it could be adapted to new pathogens. By contrast, New Zealand was reliant on its existing Influenza Pandemic Plan as a framework for responding to COVID-19, which has rather different disease characteristics. ...
As in many Asian countries that had experience with SARS, Taiwan had an established culture of face mask use by the public. It also has a very proactive policy of supporting production and distribution of masks to all residents, securing the supply, and providing universal access to surgical masks during the COVID-19 pandemic from February 2020 onwards. ...
Taiwan's well-developed pandemic approach, with extensive contact tracing through both manual and digital approaches, and access to travel histories, meant that potential cases could be identified and isolated relatively quickly. This ability to track individuals or identify high-risk contacts resulted in fewer locally acquired cases. In contrast, New Zealand's contact tracing methods varied by local authority level and until May 2020 did not involve a centralised digital approach. ...
Taiwanese officials began border management measures (initially health screening air passengers) the day the World Health Organization was informed of the outbreak in Wuhan (31 December 2019) and more extensive border screening of all arrivals occurred in late January, which coincided with the first case in Taiwan. New Zealand's first case occurred in late February 2020, and initially coincided with the first restrictions on foreign nationals from China. Both jurisdictions imposed wider entry restrictions to non-citizens in March 2020. The earlier introduction of entry restrictions and health screening in Taiwan is likely to have influenced the relatively lower case numbers in Taiwan. ...
Conclusions
Taiwan's successful response to COVID-19 up to August 2020 has resulted in relatively low cases and mortality. This positive outcome reflected pre-COVID-19 preparation for disease outbreaks with a dedicated national public health agency and infrastructure including integrated manual and digital solutions to support the coordination of key functions. This pro-active response to COVID-19 in Taiwan is in contrast to the more reactive pandemic response in New Zealand. While some aspects of the Taiwan approach might not be acceptable in other jurisdictions, the potential social and economic benefits of avoiding a lockdown might alleviate some objections. Therefore, the Taiwanese model warrants further examination for transferable elements that could improve current responses to COVID-19, and prepare health systems and populations for a timely and effective global response to the inevitable next pandemic.
https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(20)30044-4/fulltext
I'm here to pour cold water on the idea that we can test our way out of this pandemic. The problem with covid is that it spreads very easily, may mutate, and also jumps back and forth between human and animal hosts. Is there any practical way to tame a virus that spreads that easily? You can blame the Canadian government for this, but the fact that there are only a few countries that appeared to have succeeded tells me more about how difficult this thing is to control rather than any failure of government. One idea that we have to put on the table is the possibility that this is beyond human control, which is not easy for our culture considering that we are used to being in control of our envrionment. Furthermore, consider what a "case" is. It could be someone who tested positive but otherwise had no symptoms and would have had no reason to suspect anything was wrong otherwise. Maybe the reason testing is such a mess is because public health is trying to chase down everyone with a sore throat and their contacts. Perhaps testing would be more successful if it was applied in certain areas where covid exposure is detrimental, for example care homes, jails, and meat packing plants. The disease can spread easily in those particular settings, so there you would want to identify it quickly to reduce the spread. In the general public, maybe not so much.
Jay Bhattacharya gives more information about the limits of test and trace
I'm here to pour cold water on the idea that we can test our way out of this pandemic. The problem with covid is that it spreads very easily, may mutate, and also jumps back and forth between human and animal hosts. Is there any practical way to tame a virus that spreads that easily? You can blame the Canadian government for this, but the fact that there are only a few countries that appeared to have succeeded tells me more about how difficult this thing is to control rather than any failure of government. One idea that we have to put on the table is the possibility that this is beyond human control, which is not easy for our culture considering that we are used to being in control of our envrionment. Furthermore, consider what a "case" is. It could be someone who tested positive but otherwise had no symptoms and would have had no reason to suspect anything was wrong otherwise. Maybe the reason testing is such a mess is because public health is trying to chase down everyone with a sore throat and their contacts. Perhaps testing would be more successful if it was applied in certain areas where covid exposure is detrimental, for example care homes, jails, and meat packing plants. The disease can spread easily in those particular settings, so there you would want to identify it quickly to reduce the spread. In the general public, maybe not so much.
Jay Bhattacharya gives more information about the limits of test and trace
Jay Bhattacharya is not talking about what I'm talking about, which is testing the entire population, in which case contact tracing would not be required because all or almost all the COVID cases would have been identified from the testing.
Obviously, Canada doesn't have the test swab production capacity that would be required to test the entire population. I believe that amounts to a massive public health failure.
I'm here to pour cold water on the idea that we can test our way out of this pandemic. The problem with covid is that it spreads very easily, may mutate, and also jumps back and forth between human and animal hosts. Is there any practical way to tame a virus that spreads that easily? You can blame the Canadian government for this, but the fact that there are only a few countries that appeared to have succeeded tells me more about how difficult this thing is to control rather than any failure of government. One idea that we have to put on the table is the possibility that this is beyond human control, which is not easy for our culture considering that we are used to being in control of our envrionment. Furthermore, consider what a "case" is. It could be someone who tested positive but otherwise had no symptoms and would have had no reason to suspect anything was wrong otherwise. Maybe the reason testing is such a mess is because public health is trying to chase down everyone with a sore throat and their contacts. Perhaps testing would be more successful if it was applied in certain areas where covid exposure is detrimental, for example care homes, jails, and meat packing plants. The disease can spread easily in those particular settings, so there you would want to identify it quickly to reduce the spread. In the general public, maybe not so much.
Jay Bhattacharya gives more information about the limits of test and trace
Jay Bhattacharya is not talking about what I'm talking about, which is testing the entire population, in which case contact tracing would not be required because all or almost all the COVID cases would have been identified from the testing.
Obviously, Canada doesn't have the test swab production capacity that would be required to test the entire population. I believe that amounts to a massive public health failure.
Can you imagine the logistical nightmare assocaited with that undertaking? How would you deal with people who refuse to co-operate with testing? Do you wait until you have the capacity to test everyone at the same time? Suppose you can only test a certain number of people. You test them, then isolate the positive cases, and then move on. But people who tested negative can still contract the virus later. Do these people need to be tested again a second time? Or suppose you test one group of people, move on, test a second group, and people from the first group who tested negative come down with covid. Given the massive resources that would take, wouldn't it be better to target those investments towards more pressing health concerns?
This could also create more problems than it solves. Suppose you have a small city where over half of the firefigthers test positive for covid, even though none of them show symptoms and otherwise feel fine. These people now all have to isolate for 14 days. How do you maintain adequate fire protection in this particular scenario? Firefighters already use PPE on the job for all kinds of hazards that come directly from it, so I would assume that providing them PPE that would actually prevent asymptomatic transmission would be relatively easy. I see firefighters and paramedics in Winnipeg rearing respirator equipment designed to do just that.
That doesn't even get into the problems with the test itself. You have PCR testing which is very sensitive to viral particles and quite likely to return a positive test in otherwise healthy individuals. You also have rapid tests which even though many of these results will show negative, fail to detect the presence of the virus in many cases and give people false security. By all means, test people who are sick or in other settings where spread is dangerous and poses a health risk, but I think the idea that we can test our way out of this pandemic is at this point wishful thinking.
Video from CBC News: The National about how Cornell University is using mass testing to keep COVID cases low. This works and should be massively scaled up by governments and other organizations.
A university has a much smaller population than a city or a country in most cases. Given that the vast majority of university students are at low risk for bad outcomes, I'm not sure if testing really serves a useful purpose there, especially if it results in closures over "cases" of people without symptoms. And even if it could be scaled up, how to you handle the problem of people who refuse to co-operate? I could easily see non-compliance with testing becoming an issue among certain segments of Winnipeg's population.
A university has a much smaller population than a city or a country in most cases. Given that the vast majority of university students are at low risk for bad outcomes, I'm not sure if testing really serves a useful purpose there, especially if it results in closures over "cases" of people without symptoms. And even if it could be scaled up, how to you handle the problem of people who refuse to co-operate? I could easily see non-compliance with testing becoming an issue among certain segments of Winnipeg's population.
You do realize that every person infected with COVID that we can identify and get to self-isolate for 14 days is 1 less person with COVID out there walking around with the potential to spread the virus, do you not?
I believe that as a society we have a moral obligation to find as many infected people as possible and get as many as possible to self-isolate and curb the spread of this deadly virus. I'm open to debate about what coercive measures to use or not use to get people to get tested and to self-isolate if they test positive. What I'm absolutely against is the idea that identifying the asymptomatic carriers of COVID is not desirable.
You do realize that every person infected with COVID that we can identify and get to self-isolate for 14 days is 1 less person with COVID out there walking around with the potential to spread the virus, do you not?
On paper, yes. But if this virus is as deadly as many people claim, why are so many people who test positive for the virus not experiencing any symptoms? Furthermore, the jury is out on just how dangerous asymptomatic spread is. Some evidence suggests it is. Some evidence suggests it is not. Some statements also distinguish between asymptomatic and presymptomatic people. In either case, why confine otherwise healthy people in isolation?
I believe that as a society we have a moral obligation to find as many infected people as possible and get as many as possible to self-isolate and curb the spread of this deadly virus. I'm open to debate about what coercive measures to use or not use to get people to get tested and to self-isolate if they test positive.A university has a much smaller population than a city or a country in most cases. Given that the vast majority of university students are at low risk for bad outcomes, I'm not sure if testing really serves a useful purpose there, especially if it results in closures over "cases" of people without symptoms. And even if it could be scaled up, how to you handle the problem of people who refuse to co-operate? I could easily see non-compliance with testing becoming an issue among certain segments of Winnipeg's population.
That's interesting because I would presume this community would have been absolutely against coercive measures used to deal with infectious diseases. HIV is far more dangerous than covid, and yet we speak out against coercive measures taken against people who are HIV positive. Why are coercive measures all of a sudden okay in dealing with people with covid?