In roughly Feb/Mar/Apr of 2020 I had an unexamined belief that the cause of the failure of the US medical system and government to protect the health of the citizens was that “no one knew that it was feasible to do mass public testing for relatively little money” and so I poured brain power into designing a mass testing framework to test >1 time per week “roughly everyone who wanted to be tested”.
The process that seemed likely to work best didn’t use swabs. I was worried about this, because it seemed necessary to have a thing simple enough for almost anyone to do right… but then research came out that suggested that saliva and gargling based sampling methods actually beat “nurses sticking swabs up your nose with skill”. So that was nice for a while. (I haven’t gone back to double check this, it might be wrong at this point? Maybe?)
The idea was just to do saliva-and-gargling, and you got a cup in the mail, and swished, and let the pickup person take it away for pooled analysis.
I think I could get the price down to roughly “cost of the moving the cups to the home then to a lab + chemistry cost of approximately LOG(cups) test reactions”. So like… $0.50 per cup? So like $150 million per week to test 98% of anyone in the U.S. who wants a test, every week?
This seems like part of how one would eradicate covid. After you eradicate you still have to keep the green zone (that is: the whole country) green before you can dial back the testing? Success: technically possible!
Only about five or six regulations had to be ignored to make it work (like OSHA and HIPAA stuff and so on), so it seemed promising.
Surely a technical solution could be found to the social problem of dumb regulations and a big fat cone of sound absorbing mud in the place where “people working to solve coordination problems” should be?
In the happy model: covid could maybe even be a retrospective blessing for helping to demonstrate that problem solving is possible! Fixing not just covid, but also cleaning up some of the mud!
But I could never communicate the relevant vision to the relevant people (do “the relevant people” even exist in America anymore?) and then I ran out of steam. Convincing medical workers to break laws doesn’t work. Convincing mayors runs into state/federal prosecution. Governors are hard to talk to, and harder to convince to give blanket pardons for violation of OSHA/HIPAA/FDA rules. Each agency would have to change their rules in a coordinated way to allow cheap mass testing to work… The higher you go the less they understand and the more they want certainty that they won’t be yelled at by dumb voters. The lower you go the more you find scared little rabbits in tiny little cages. The rabbits can’t promise the wimpy governors that “the thing will work...or if it doesn’t work we won’t blame you” because they’re just rabbits :-(
In concurrent computing, a deadlock is a state in which each member of a group waits for another member, including itself, to take action...
That’s us! That’s America!
So for a while I switched AWAY FROM the unexamined belief that “no one knew that it was feasible to do mass public testing for relatively little money” TO an unexamined belief that America was semi-intentionally self-destructively stupid, and so covid and covid’s tragedies were our just and balanced nemesis, acting upon our collective wrongness, in a tragically balanced way.
This oscillated between “collective (because officially democracy)” and “just the elites deserve the suffering (because de facto oligarchy)”. Now I just feel sad. Even suicidally stupid people don’t deserve to die :-(
But… ignoring the big picture insanities of my unexamined past beliefs… I DO think that saliva tests are probably Correct (and pooled testing could be very efficient (even though it is still basically illegal)).
That’s a really interesting point. I wish we had a conventional way of suspending certain regulations in certain circumstances, rather than having to wait decades for an entirely overhauled piece of legislation on the whole macrotopic. Are there things like, I don’t know, executive non-enforcement orders that ever get used similarly?
Do you know of any non-pooled tests that are cheap and fast, that perhaps a group of individuals could order loads of? I’ve heard people talk about LAMP and such for a while but without any persuasive end-to-end evidence.
A complexity here is that “the macrotopic to reform” is “the entire system… like practically all of it”.
You can’t just delete the FDA because while the FDA is the current lynchpin (and “FDA delenda est”), to have a good system, that was not broken (in the way or other ways), you also need tort reform, and insurance reform, and on and on and on...
As near as I have been able to tell, the reason Pooled Testing is illegal, is because there are OSHA laws protecting chemists, basically, so if a chemist in a lab is running test reactions all day every day, and they accidentally put a “cut finger” into a jar of slime… OSHA requires that the jar of slime be traceable all the way back to someone who can be tricked or compelled or begged into somehow taking an HIV test. If the jar “from the patient to the chemist” lacks a chain of custody, then the chemist’s employer is not allowed to have the chemist to do that job.
If you have a cup, and can check the box “[X] let me know by text message” and write your phone # on the cup, and your cup goes into a jar with 2000 other people, and the whole 2000-cup batch gets a negative, then 1 test reaction generates 2000 “negative results”… great… except OSHA will shit a brick. That’s not allowed.
OSHA things the poor chemist can’t just refuse? Isn’t grownup enough to decide for themselves what risks they’ll take for what amount of pay?
The macrotopic for which we need to “suspend certain regulations”, as near as I can tell is simply: “using paternalistic reasoning to forbid people from owning risk to themselves after looking at local factors and deciding for themselves”.
Delete all ALL the laws whose only flimsy excuse is paternalism, and then I think any small city mayor could save their small city from covid using stuff you can buy at the grocery store (or maybe a lab supply company) based on ideas and tutorials you can look up online… Then they hire some (potentially inadequate) people to take some risks and learn on the job, and it “solves for covid”? I think?
(Though maybe a non-assertive half-competent chemist or two gets HIV. In my mind: worth it!)
Do you know of any non-pooled tests that are cheap and fast, that perhaps a group of individuals could order loads of? I’ve heard people talk about LAMP and such for a while but without any persuasive end-to-end evidence.
Antigen tests. They take 15min to give results, and are 0.8€(retail) here.
In roughly Feb/Mar/Apr of 2020 I had an unexamined belief that the cause of the failure of the US medical system and government to protect the health of the citizens was that “no one knew that it was feasible to do mass public testing for relatively little money” and so I poured brain power into designing a mass testing framework to test >1 time per week “roughly everyone who wanted to be tested”.
The process that seemed likely to work best didn’t use swabs. I was worried about this, because it seemed necessary to have a thing simple enough for almost anyone to do right… but then research came out that suggested that saliva and gargling based sampling methods actually beat “nurses sticking swabs up your nose with skill”. So that was nice for a while. (I haven’t gone back to double check this, it might be wrong at this point? Maybe?)
The idea was just to do saliva-and-gargling, and you got a cup in the mail, and swished, and let the pickup person take it away for pooled analysis.
I think I could get the price down to roughly “cost of the moving the cups to the home then to a lab + chemistry cost of approximately LOG(cups) test reactions”. So like… $0.50 per cup? So like $150 million per week to test 98% of anyone in the U.S. who wants a test, every week?
This seems like part of how one would eradicate covid. After you eradicate you still have to keep the green zone (that is: the whole country) green before you can dial back the testing? Success: technically possible!
Only about five or six regulations had to be ignored to make it work (like OSHA and HIPAA stuff and so on), so it seemed promising.
Surely a technical solution could be found to the social problem of dumb regulations and a big fat cone of sound absorbing mud in the place where “people working to solve coordination problems” should be?
In the happy model: covid could maybe even be a retrospective blessing for helping to demonstrate that problem solving is possible! Fixing not just covid, but also cleaning up some of the mud!
But I could never communicate the relevant vision to the relevant people (do “the relevant people” even exist in America anymore?) and then I ran out of steam. Convincing medical workers to break laws doesn’t work. Convincing mayors runs into state/federal prosecution. Governors are hard to talk to, and harder to convince to give blanket pardons for violation of OSHA/HIPAA/FDA rules. Each agency would have to change their rules in a coordinated way to allow cheap mass testing to work… The higher you go the less they understand and the more they want certainty that they won’t be yelled at by dumb voters. The lower you go the more you find scared little rabbits in tiny little cages. The rabbits can’t promise the wimpy governors that “the thing will work...or if it doesn’t work we won’t blame you” because they’re just rabbits :-(
That’s us! That’s America!
So for a while I switched AWAY FROM the unexamined belief that “no one knew that it was feasible to do mass public testing for relatively little money” TO an unexamined belief that America was semi-intentionally self-destructively stupid, and so covid and covid’s tragedies were our just and balanced nemesis, acting upon our collective wrongness, in a tragically balanced way.
This oscillated between “collective (because officially democracy)” and “just the elites deserve the suffering (because de facto oligarchy)”. Now I just feel sad. Even suicidally stupid people don’t deserve to die :-(
But… ignoring the big picture insanities of my unexamined past beliefs… I DO think that saliva tests are probably Correct (and pooled testing could be very efficient (even though it is still basically illegal)).
That’s a really interesting point. I wish we had a conventional way of suspending certain regulations in certain circumstances, rather than having to wait decades for an entirely overhauled piece of legislation on the whole macrotopic. Are there things like, I don’t know, executive non-enforcement orders that ever get used similarly?
Do you know of any non-pooled tests that are cheap and fast, that perhaps a group of individuals could order loads of? I’ve heard people talk about LAMP and such for a while but without any persuasive end-to-end evidence.
A complexity here is that “the macrotopic to reform” is “the entire system… like practically all of it”.
You can’t just delete the FDA because while the FDA is the current lynchpin (and “FDA delenda est”), to have a good system, that was not broken (in the way or other ways), you also need tort reform, and insurance reform, and on and on and on...
As near as I have been able to tell, the reason Pooled Testing is illegal, is because there are OSHA laws protecting chemists, basically, so if a chemist in a lab is running test reactions all day every day, and they accidentally put a “cut finger” into a jar of slime… OSHA requires that the jar of slime be traceable all the way back to someone who can be tricked or compelled or begged into somehow taking an HIV test. If the jar “from the patient to the chemist” lacks a chain of custody, then the chemist’s employer is not allowed to have the chemist to do that job.
If you have a cup, and can check the box “[X] let me know by text message” and write your phone # on the cup, and your cup goes into a jar with 2000 other people, and the whole 2000-cup batch gets a negative, then 1 test reaction generates 2000 “negative results”… great… except OSHA will shit a brick. That’s not allowed.
OSHA things the poor chemist can’t just refuse? Isn’t grownup enough to decide for themselves what risks they’ll take for what amount of pay?
The macrotopic for which we need to “suspend certain regulations”, as near as I can tell is simply: “using paternalistic reasoning to forbid people from owning risk to themselves after looking at local factors and deciding for themselves”.
Delete all ALL the laws whose only flimsy excuse is paternalism, and then I think any small city mayor could save their small city from covid using stuff you can buy at the grocery store (or maybe a lab supply company) based on ideas and tutorials you can look up online… Then they hire some (potentially inadequate) people to take some risks and learn on the job, and it “solves for covid”? I think?
(Though maybe a non-assertive half-competent chemist or two gets HIV. In my mind: worth it!)
Antigen tests. They take 15min to give results, and are 0.8€(retail) here.
Hm, I meant to exclude those because of their abysmal sensitivities, but I suppose I should revisit them now in case they’ve gotten better.
They are not that bad.
sensitivity (Ct ≤33): 97,1% (132/136), (95% CI: 92,7%～98,9%)
sensitivity (Ct ≤37): 91,4% (139/152), (95% CI: 85,9%～94,9%)
Considering the price and simplicity they are often worthwhile.