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Chickenboy -> RE: OT: Corona virus (3/4/2020 3:11:42 PM)
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quote:
ORIGINAL: PaxMondo
When a virus is in the general population, testing is kinda moot except for people are really ill to determine what (which virus/secondary infection) they have.
Exactly right.
From an interventional / treatment perspective, diagnostic tests are a tool that will help dictate the next course of action. Too many people think that testing for testing sake is worthwhile. Usually it's not. Unless one is trying to determine the next course of action for a choice of available treatments or gain in-depth understanding of disease incidence/prevalance, the information gathered by diagnostic testing is often overrated.
In the case of COVID-19, I have scientific curiosity about how many Americans have been exposed to the virus. But we wouldn't know that unless we had a broad profile of the population tested. So, how many of the 330 million Americans do we need to test for that? Is that the right thing to do now-test millions of people across the board-to assess the trajectory of this virus in the population? Can our laboratories handle that throughput and provide meaningful real-time information based on that study design. I think the answer is no.
We have to assume that the genie is out of the bottle on this thing. Assume that most everyone could have contact with someone that may have been shedding virus at some point or another. Eventually, I'd like to see a big study looking at seroconversion in the population, but that may take months or years to see how many people (or a representative sample) have been exposed. Assume 'lots' and go with that for the time being.
Diagnostics in the face of an outbreak-what we have here-are better suited for interventional strategies. Think flow chart or decision tree. If someone tests positive for X, we assign treatment/prevention Y. What happens if there IS NO treatment/prevention Y? The value of the test and the rationale for the test diminishes.
So with COVID-19, what would we do *differently* with the patient if they test positive with RT-PCR? Perhaps one could argue that there is greater scrutiny about self-quarantine or imposed quarantine procedures. Several health departments have been remitting positive cases or positive contact cases to self-quarantine. I guess I'm OK with that rationale. But would our instructions to 'wash hands, stay home, drink plenty of fluids, avoid social gatherings, etc.' be any different for someone with a high fever and respiratory disease (ala influenza) be so radically different between someone that tested positive versus someone that tested negative on that given diagnostic test? Probably not.
We've got this virus running around. Take heed. Take precautions to limit its spread. Prepare yourselves accordingly. In the absence of a specific treatment or preventive measure (e.g., vaccine), the panacea of widespread testing won't do much to inflect the epidemic curve.
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