How the CDC’s restrictive testing guidelines hid the coronavirus epidemic

&gt; As the coronavirus epidemic spread around the globe, the Centers for Disease Control and Prevention provided restrictive guidance on who should be tested, archived pages on its website show. While agencies in other countries were advising and conducting widespread testing, the CDC, charged with setting the U.S. standard for who should be tested for the virus, kept its criteria limited<p>Well, &quot;other countries&quot; also did the same. Spain, for example, seems to be the 3rd country with most infected and I got pneumonia about 2 weeks ago. Called the agencies here but they still didn&#x27;t want to test me, even with pneumonia! Still got a cough since then and they still won&#x27;t test me.<p>So, the US is not alone. And it does make a bit sense, I didn&#x27;t require hospitalization, so makes sense they want to save the resources. But I feel like the article author could have done some better research.

We have 330 million people in US.<p>China has ramped their mask production to 200 million masks a day.<p>Had US government had the foresight and common sense to contract mask manufacturers to even produce half of what China is producing - let’s say 100 million masks, we could have had enough for everyone to have a mask in 3-4 days.<p>Universal masks for everyone (not only health care workers) together with hygiene protocol should be the way to “flatten the curve”. This would at the very least inhibit spread by those who have coronavirus but don’t know it yet (asymptomatic).<p>But instead, we’re having these mass shelter in place orders that are destroying our economy, killing businesses and destroying people’s livelihoods.<p>And I still haven’t heard of massive government contracts to mask manufacturers at the scale needed to provide masks for everyone.

I hope one thing that comes of this outbreak is that all nations develop the processes and capabilities to quickly stop the spread of outbreaks in general.<p>COVID19 is worse than flu, but not as bad as it could have been. We could get hit with something worse in the future. Imagine a strain of Ebola that gestates asymptomatically longer, or another coronavirus with higher mortality rate. This outbreak is good preparation for that one.<p>Anytime you’re dealing with a harmful exponential growth process like an outbreak, the best way to handle it is to overreact early, quickly and briefly. Kill it hard while it’s still small and easy to kill, or it will get out of control fast.<p>Put everything on lockdown&#x2F;shelter-in-place for a few weeks - [max(gestation period|time to develop and deploy test kits) + safety factor] - test extensively, isolate and treat the infected, stop the outbreak, and then return to normal. Outbreak stopped dead in its tracks, economic damage is minimized and mostly short-term.<p>This is basically what South Korea did and they got their first COVID19 diagnosis the same day as the US:<p><a href="https:&#x2F;&#x2F;www.reuters.com&#x2F;article&#x2F;us-health-coronavirus-testing-specialrep&#x2F;special-report-how-korea-trounced-u-s-in-race-to-test-people-for-coronavirus-idUSKBN2153BW" rel="nofollow">https:&#x2F;&#x2F;www.reuters.com&#x2F;article&#x2F;us-health-coronavirus-testin...</a><p>That needs to be become a social and political norm everywhere, not just the Asian countries that have faced a widespread outbreak before.

I think a lot of people in medicine, science, economics, policy and the media think what&#x27;s happening right now is their shining moment, but if you talk to people on the ground -- this is a catastrophe and no one has any clue what&#x27;s happening and people see that and they are internalizing it.<p>The experts are f* this up and it is going to have long term implications for already eroded public trust in institutions.

Rather than just blaming the CDC, I think the real problem here has been the lack of coordination between the CDC and FDA?<p>CDC: Our test is going to be so much better than the WHO&#x27;s, we&#x27;ll test for SARS-CoV-2 in two samples and also test for other simultaneous infections in this third part!<p>FDA: Approved<p>Hospitals: Hey, we can&#x27;t get that third part to work!<p>CDC: That&#x27;s ok, just use the first two parts, that&#x27;s all you really need to diagnose COVID-19. Though I&#x27;m sad I won&#x27;t get any data on simultaneous infections, apparently that was a problem in Northeast China and we want to figure that out for our guidelines.<p>FDA: Only running the first two tests is not what we approved! Verboten!<p><i></i>*<p>Laboratory: Let&#x27;s develop our own SARS-CoV-2 test!<p>FDA: Sure, just make sure to fill out these forms, be sure to send them to us by mail rather than email, and oh, make sure to test against the original SARS to make sure your test doesn&#x27;t give a false SARS-CoV-2 reading if they patient just has that.<p>Laboratory: Uh, sure. Hey, CDC, can I have a sample of SARS to test against?<p>CDC: NO WHAT ARE YOU CRAZY I&#x27;M NOT GIVING YOU THAT! THAT&#x27;S SUPER DEADLY!

I&#x27;m still trying to understand why Japan&#x27;s numbers are so low. You can argue they aren&#x27;t testing but if the infection rate is similar then the death rate should be similar was well regardless of testing or not.<p>They aren&#x27;t staying home. Restaurants, bars, and events are still open. Trains are still packed at rush hour. Festivals are still happening. They&#x27;re planning on starting school in April.<p>I can only see a few possibilities<p>(1) the numbers are false and Japan&#x27;s death rate is going to accelerate<p>(2) the numbers are true but it&#x27;s still coming<p>(3) Something about Japanese culture already limits the spread.<p>I don&#x27;t believe this one. Japanese might wear masks but not all of them wear masks and they are not N95 masks. Japanese are also known to go to work sick, go to cafes sick, visit friends and family sick. Places are crowded. Open and over crowded offices everywhere.<p>(4) Something about Japanese genetics makes them less likely to have a strong reaction<p>I have no idea how to tell which of those it is except to see where they are in a few weeks. If the death rate rises it was (1) or (2). If not then it must be (3) or (4)?<p>Here&#x27;s their latest graph. The 2 shallow lines at the bottom are Singapore (bottom) and Japan (2nd from bottom). The rest are Italy, Spain, Germany, France going left to right at the top.<p><a href="https:&#x2F;&#x2F;rpr.c.yimg.jp&#x2F;im_sigg.R1UwQuI2tgBhV1fzJ5o7A---x799-n1&#x2F;amd&#x2F;20200322-00169120-roupeiro-001-27-view.jpg" rel="nofollow">https:&#x2F;&#x2F;rpr.c.yimg.jp&#x2F;im_sigg.R1UwQuI2tgBhV1fzJ5o7A---x799-n...</a>

I have a box of n95 masks I bought a few years back while living in Singapore (there is an annual smoke “haze” there from neighboring countries burning forest to clear land for palm oil production). I tried to give them to a nurse to distribute to other medical staff, but they couldn’t use them because they are a year or so beyond the expiration. News to me that masks even have an expiration date.

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The mask guidance is confusing as well. I get they are trying to preserve masks for medical staff. But, they also say it&#x27;s mainly spread by coughing, sneezing, and resulting spray of bodily fluids. Surely even a scarf around your face would have some benefit? Yes, I get that the virus is small enough to pass through, but some deflection is better than none.

Metagenomics would solve these issues. Of course we have these problems when a new disease comes along if we have to invent new diagnostics for it. Metagenomics isn’t new, you just sequence the everything and look to see what DNA&#x2F;RNA is in the environment. That’s orders of magnitude more data because it doesn’t require labels, you don’t need to know in advance what you’re looking for...<p>The devices to do this are getting cheaper faster than Moore’s law. Just takes the will to set up the programs

My concern here is that bad decisions were made early on in the US, and there will be no accountability.<p>What do mechanisms for accountability here look like? Will they be used?<p>Edit: And more importantly how will we prevent theses same mistakes from happening again?

In late January my wife and daughter visited Disneyland, and there were a handful of COVID-19 cases reported in SoCal around the same time. On the Sunday they were due to fly back, my daughter came down with a very strong cough (she said it was even &quot;hurting her throat&quot;) and a high fever of around 102F. We had been following the outbreak in China and my wife called the CDC to inquire about getting her tested for COVID-19.<p>They said they had no ability to get her tested, that we should not be concerned at all that it might actually be COVID-19, and she should visit a clinic. The clinic said it was probably just the flu, and told her to go ahead and fly back but to wear a mask.<p>This was absolutely criminal incompetence on the CDC&#x27;s part.

The actual title is: How the CDC’s Restrictive Testing Guidelines Hid the Coronavirus Epidemic<p>This is very different from guidelines in general. Encouraging people to avoid large crowds, wash their hands and wipe surfaces, and possibly self-quarantine could have made a huge impact earlier on.<p>Instead, people kept going to bars, concerts, and traveling. A lot could have been done, and testing is only part of the story.

Related article: <a href="https:&#x2F;&#x2F;thedispatch.com&#x2F;p&#x2F;timeline-the-regulationsand-regulatorsthat" rel="nofollow">https:&#x2F;&#x2F;thedispatch.com&#x2F;p&#x2F;timeline-the-regulationsand-regula...</a><p>(via <a href="https:&#x2F;&#x2F;news.ycombinator.com&#x2F;item?id=22656060" rel="nofollow">https:&#x2F;&#x2F;news.ycombinator.com&#x2F;item?id=22656060</a> but no comments there)

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My colleagues are out of PPE and now using scarves because we are so under supplied. CDC guidelines were just changed to allow staff to be exposed to COVID patients without properly protecting themselves.<p>I was talking with some physicians and providers when I said that I think this will be the Chernobyl like moment of our era: where the truth is hidden from people to prevent a panic paradoxically exacerbating the current crisis. Shockingly, almost all agreed with me.

This whole corona virus episode has definitely shown one thing. US, under the current govt can’t execute. Despite claims Like “world best”, “most powerful in the world” and whatever else our leaders proclaim it’s all baseless “marketing”. as they say past performance is not a indicator of future performance in the same way we did quite well from 40s&#x2F;50s onwards for a certain time and build an image based on substance what we had at the time but is now just gone. It’s all a house of cards run on decrepit systems.

CDC has there shortcomings, no doubt but let’s not forget who’s truly to blame for the mess we’re in now. The trump administration’s disbandment of federal institutions created to combat this and the ongoing denial of a serious problem have led to a collapsing economy and isolation of millions. Good article here for sure but let’s not pass the blame to the CDC. We know who to blame...

Is anyone else bothered by how many of these articles are behind paywalls?

From what I gather, the CDC is also largely sweeping the Hepatitis issue under the rug (which is something of a quiet epidemic, but certainly nothing on the scale of covid19).<p>It disproportionately impacts the homeless. The problem appears to have started in San Diego and spread outward from there.<p>I&#x27;m aware of the issue because a reporter from San Diego contacted me and interviewed me via email in September 2017 because I run the San Diego Homeless Survival Guide.* Another reporter contacted me when it reached Los Angeles.<p>I received an email last September from something I&#x27;m subscribed to indicating it had reached Washington state, though my county was not listed.<p>On a per capita basis, the small town I live in has a worse homeless problem than the big cities that routinely make the news for it. If I had any real power, I would be trying to come up with the means to do a free hygiene event for the homeless and give away hand sanitizer and free haircuts and Hepatitis vaccines, something I had on my mind before covid19 became a thing.<p>I&#x27;ve seen relatively little in the press about it. I have seen at least one article about the resurgence of &quot;Medieval diseases.&quot;<p>To my mind, our homeless policies are actively creating a health hazard for the entire nation. CDC policy looks to me like part of the problem. They seem to be sitting on the data about the spread of hepatitis and intentionally not making an effort to publicize it.<p>I imagine it will get swept under the rug entirely in the face of covid19. This seems to me like a good means to compound our problems.<p>I have no idea what do about it.<p>* <a href="https:&#x2F;&#x2F;sandiegohomelesssurvivalguide.blogspot.com&#x2F;2017&#x2F;09&#x2F;for-record.html" rel="nofollow">https:&#x2F;&#x2F;sandiegohomelesssurvivalguide.blogspot.com&#x2F;2017&#x2F;09&#x2F;f...</a>

Oh, data, that pesky thing. I go here, and observe rate of change (log) graphs. I ignore linear body counts, which all the headlines scream: <a href="https:&#x2F;&#x2F;www.worldometers.info&#x2F;coronavirus&#x2F;" rel="nofollow">https:&#x2F;&#x2F;www.worldometers.info&#x2F;coronavirus&#x2F;</a><p>Italy is flattening and exponential growth becomes exponential decay.