BIRTH OF A VIRUS … – Regie's Blog
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The FDA, NIH and CDC have a combined budget of ~$50 billion annually.
It has taken them 3 months to develop and begin distributing a Covid-19 test. (A simple qPCR test that should cost less than 50 cents per kit to produce.)
Would anyone in their right mind ever consider giving more money to a private company that produced results so poor?
3 months IS quick as far as this thing getting across the world like it has. It's sneaky, and only China has had the most long term contact with it. But we can't trust their findings on anything worth a damn, since it's not out of the realm of possibility that they made it to begin with and it got loose due to their legendary diligence. For making and distributing a test? I don't know about that. I'm not an epidemiologist, or any sort of medical professional. But a test seems to have existed for some time, and it seems like major population areas should absolutely have gotten some. Instead, here in New York, JUST NOW are they finally able to test and turning up positives. That's insane, considering this bug has potentially been here for 2-3 months. Doesn't surprise me to see federal agencies overfunded for the work they do though. Whenever the federal government funds anything it ends up paying way too much for what we actually get from it. It just ends up being too big and with too many cracks the money leaks into.
Capitalism, full fat, real laissez faire capitalism is the way forward. Absolutely right. However, not just because it incidentally produces better outcomes, but because it is the only moral political system in which it is practical for rational beings to live.
Well, the second test kit may cost 50 cents, but the first one costs quite a bit more to design and test. How sensitive and specific should it be? How many similar coronaviruses should it identify as COVID-19 for the purposes of a “positive” test? They have to get this right, because unlike in China, our government agencies, as unwieldy and inefficient as they are, are still tenuously accountable to us. This is a major reason why the response to and the impact of this virus will be different here.
Plus add in the fact that after three months the test don't work correctly.
Coronavirus: US CDC finds some test kits sent to states are faulty
Why did the CDC develop their own test that tends to fail when WHO already had a working test? This doesn't create confidence in the CDC.
that is a theatrical cost to have the test kits madeQuote:
And more importantly, where are you getting the 50 cents number?
in China
This is not new or slow technology.
There are thousands of Ph.D students who could figure out how to do it effectively in about a week.
A little thought experiment.
In a properly capitalist environment hit by a suspected epidemic, the price of a Testing kit should increase substantially; after all, the whole population should be tested, and the production capacity of the testing kits, not to mention the ability to process them is limited.
It might be that at some point, the price goes up so much that a lot of people will be unwilling topay the price of testing themselves, which will only increase the spread of the contagion (The Governor of the State of New York has recently mandated for NY insurers to waive testing costs, so this might not be that imaginary an issue. source: https://twitter.com/NYGovCuomo/statu...34259912155137).
In such an environment, it might also be quite likely that sick days are paid only up to a limit, or maybe not at all; thus, employees might consider not worth their while to call in sick if they suspect they have been infected, another factor that could spread the contagion even further (In a recent editorial, the NYT has called for paid sick leave to be provede, which makes me think it might not be widespread. Source: https://twitter.com/nytopinion/statu...65636873166849).
In other words, in a perfectly capitalist environment there might factors that might facilitate the spread of the contagion, more than in other social set-ups.
IPB
The production capacity of EVERYTHING is limited. Supply, demand, and the signals that can only be sent by market prices account for how we allocate our inherently limited resources to produce things. So basically, your assertion is completely wrong. You've asserted the price will go up and left it there.
Here's a much more likely, logical scenario in a true market economy: The price would indeed go up, at first, as demand spikes. This causes more entrants into the market of production - instead of making the same amount of pencils and plastic knives and band-aids and shampoo and washclothes and T-shirts and ice cream cones and radios and coffee makers etc...that are made during normal times, producers allocate their resources to get in on the booming testing kit business, driving the price back down very quickly. Likely driving it down below what it was in the first place. After all, aren't our socialist friends constantly railing against how greeeeeeeeedy the evil capitalists are? Would they not want to get their greedy, grubby hands on this big money that the testing kit business is now offering?
The main thing in a non-market economy that stops this is the gov't "saving us all" by placing a price ceiling on such an important good to avoid "price gouging," thus leaving little to no incentive for producers to ramp up production or new ones to enter the market. Thus limiting supply so lots of people remain untested.
What do you think is the hard and slow part about putting this test together?
I will answer this question myself, because I don't think it will be answered otherwise:
The knowledge, testing protocols, reagents and commercial equipment have been readily available (even to the public) for quite some time now. I would easily and cheaply be able to perform the test in my garage (or hospital or clinic or pathology laboratory), but I would not officially be able to call it a Covid-19 or tell patients the results or sell it to others. The hard and slow part is bureaucracy and regulation.
You answered your own question (with my answer) attempting to point out that my question was dumb. The quip about it not being answered was a nice touch too.
Now for grins, should “you* be able to offer the test out of your garage?
Bureaucracy is very often a clusterfuck. Regulation too, but not always.
Assembling a PCR test to spec from a kit is probably pretty straightforward these days. I believe you there. But how do you arrive at the specs? How sensitive and specific should the test be? How many coronaviruses similar to COVID-19 should be judged "positive"? How many false positives and negatives are acceptable? These are policy questions well beyond your average PhD student. How do you manufacture a test kit for mass distribution that performs under reliable circumstances? That is probably beyond the equipment available in your garage. Aside from the bureaucracy, which I agree is formidable, these are the difficult parts of this problem.
Having a look at the labeling and quality issues pervasive in the supplement industry should be sufficient to temper the rush to an unregulated "pure capitalist" approach to public health.
The hard and slow part is the vetting of the test, not the design of the test. Would you be able to say what the detection limit of your garage test is? What would you use as test material to determine the detecting limit? How about the specificity? How much variation in sequence would your garage test be able to tolerate? How much should it tolerate? What types of samples would your garage test work on? Could you say that it will work on samples that have been handled in a way that was not ideal? Could you say that it should work on the type of machine that I have in my garage or just the one that is in your garage? Figuring this stuff out is the hard and slow part, not the test design.
Why, it's almost as if this crazy wackadoodle theory is borne out empirically as well! The one thing I might need to revise about my comment above is that culture matters too - while 34 states have passed anti price gouging laws since 1995, there is also a cultural bias. I might argue that the laws contribute to this cultural bias and I suspect they do - but it's probably not solely due to the laws. So while gov't is the main impediment, a cultural bias against so-called "price gouging," due to lack of economic understanding of how beneficial that practice actually is, is also probably at work.
Anti-Gouging Laws Can Kill – AIERQuote:
I wish the Surgeon General had studied economics. The Law of Supply and Demand — the most fundamental principle of economics — tells us that shortages cannot exist when prices are allowed to adjust to changes in supply and demand. Or, to put it another way, shortages *only* arise when the price mechanism is impeded, whether by law or by custom.
In the United States, and around the world, both law and custom prevent market prices from adjusting when such adjustment is most urgently needed: when there is a supply disruption and/or a spike in demand for that product. That is happening right now, when it comes to “N95” masks, the type that filter out 95% of particles and are deemed most effective in preventing the spread of coronavirus.
I actually bought a box of 10 of these masks last year for a trip to Mumbai, India, where I used them — quite successfully — to protect me from the highly polluted air in that city. It cost about $15. Yet today at all of the drug and hardware stores around town that used to sell these masks, I see signs on their front doors that say, “No masks available.”
Demand has spiked for these masks. Whether this spike in demand is based on sound medical opinion or not, it is a fact. If prices were allowed to adjust, they would rise. This would have two effects. First, it would reduce the quantity purchased. Those who were not willing to pay the higher price for the masks would not get them, while those who urgently needed the masks — and could pay for them (think: hospitals!) — would find them readily available.
And, while we were arguing about whether the CDC was too slow to fix their test, FDA has addressed the situation:
Coronavirus (COVID-19) Update: FDA Issues New Policy to Help Expedite Availability of Diagnostics | FDA
I couldn’t find mention of all the entrepreneurs producing tests in their garages, but you might still want to get your test out there and compete on price! I’m sure there’s a market for home tests to be found on eBay!
As an aside, what happens to the 2-3% mortality rate when the whole population is tested? Math happens and the mortality rate drops below 1%...perhaps even .05%.
Am I wrong? Or are the experts (CDC / Who / MSM) pretending to fail when they push the 2-3% mortality rate? Could this possibly be political?
I think anybody who's following this seriously understands that the mortality rate, as it stands now, is based on very incomplete data, i.e. the most serious cases. That's pretty much par for the course for any emergent pathogen. As this plays out, the true R0 will likely be quite a bit higher than current estimates, and the true mortality rate will probably be quite a bit lower. Same thing happened with SARS. Not to mention that there's a really good chance that, given enough transmissions, the virus will mutate to be less deadly (although there's some evidence from Asia that this can also lead to reinfection with this particular bug).
Mild or asymptomatic cases are a known unknown here. You still calculate R0 and mortality based on known numbers, though.
The head of the CDC agrees with you.
COVID-19 Mortality Rate May Be 'Considerably Less Than 1%'
Did Trump Fire the US Pandemic Response Team?
Look, the current administration pushed out or at the very least allowed the pandemic team to quit did not replace them.
Trump even admitted it and said, it'd be easy to just "hire them back."
On one hand we're being told not to panic buy and hoard. And on the other hand here's what the New York Times just printed "Prepare your family, and communicate your plan about evacuations, resources and supplies. Experts suggest stocking at least a 30-day supply of any needed prescriptions. Consider doing the same for food staples, laundry detergent and diapers, if you have small children." If you haven't already planned for the inconveniences that can sometimes come, then the only way to quickly build a 30 day supply is to buy a lot all at once, which sounds a lot like panic buying. Of course, if you've used common sense, then you already have a well stocked pantry.
So, look, while a lot of the numbers are estimates, this may give you an idea of the serouslness of this pandemic:
The Spanish Flu of 1918 infected 1/3rd of the world's population with a mortality rate of 2-3% and it was estimated to have killed more than 25mm people. Today, the world's population is more than 4x that of 1918. So, if 1/3rd of teh world's population gets infected, then a .05% mortality rate is still pretty, pretty, pretty bad.
Why would we see comparable stories about TB given in this country we have almost zero risk from it? The cases and deaths are almost exclusively in the undeveloped world, and while I was vaccinated against it 30 years ago I don't think we even routinely vaccinate against it anymore in the US. Despite a lot of Indians dying from it, Americans and most of the western world are at very little risk from it.
The issue with this virus are not about what the statistics show today, but what they will look like in 6 months if this reaches the same sort of population exposure as established pathogens like flu. If this gets worse it is likely to do so exponentially.
Maybe this is why: "More than 95% of deaths occurred in developing countries, and more than 50% in India, China, Indonesia, Pakistan, and the Philippines." Tuberculosis - Wikipedia
Coronavirus seems to have quite a high death rate among people older than say 65, and people with underlying health conditions like diabetes. There are a LOT of people in those categories. I was at an event at my mom's church last weekend--mostly grey heads in the crowd--wondering of a lot of these folks were going to be dead in six months.
Also, something like 10% or more of coronavirus patients require intensive care--ventilators and so forth. And if they need it, they tend to need it for weeks. What happens when we run out of hospital beds? What happens when hospital staff are sick themselves? What happens to the death rate when people who need intensive care for coronavirus can't get it? What happens when people who need intensive care for other reasons can't get it because all the beds are full of coronoavirus patients?
The growth rate so far has been exponential. Panic isn't the answer, but there is reason for concern. It is encouraging that China seems to have slowed down the outbreak (if you trust their numbers), but they did so by drastically slowing their economy. Eventually people will have to go back to work.
I have seen claims that the modern history of epidemics is full of examples of the powers that be going out of their way to prevent panic--but few actual examples of harm due to panic, and many examples of harm due to failure to take aggressive preventative measures. For instance, in the 1918 flu outbreak some American cities continued to hold huge public events, and those cities had higher death rates. Panic isn't good but neither is complacency.
In my view, the downside to panic is the pressure put on healthcare resources by people who are simply worried and flood ERs, shortages of masks that healthcare workers need so they do not become vectors of disease but that do not help the public contain the spread. This is a problem for the reasons you mentioned.
There are alternatives to panic and complacency. One would be reasonable precaution: avoid unnecessary physical contact, wash your hands more often than you want to, stay home if you are sick or have sick contacts. If you or a family member are immunosuppressed or otherwise vulnerable, have a low threshold for medical evaluation. If not, leave your doctors office and local ED to the people who need it.
We’re all going to be exposed to this virus eventually, probably over a period of weeks to months if not sooner, unless you are a true hermit. Many people will get really sick, there will be deaths. My comparison with TB was not to minimize the impact of this thing, but to respond to the previous poster who felt that 0.05% fatality rate was “really really bad.” We don’t know what the true fatality rate will be worldwide or in the US yet, but 0.05% would be pretty darn good in the big picture.
We are all innately bad at judging relative risks, our brains are not wired to be purely reasonable about things like this. It is possible to overcome this tendency, however, and act rationally. I’m working at it, and am trying to encourage others who are doing the same. If you want to cope by panic or denial or in some other way, that’s cool. Different strokes, after all.
This detail has been overplayed by both the media and governments health officials. It wasn't until this Tuesday, that health workers were permitted to use the masks you commonly find at local stores. The N95 mask I use when steel grinding doesn't met the hygiene standards for health workers. Plus the supply chain is completely different.
As Elon Musk said: https://mobile.twitter.com/elonmusk/...29449042198528
I question if these reasonable precautions are effective or just make people feel like they are doing something proactive.
In 1918 there were many highly aggressive panic responses and isolation attempts. Did any of them work?
Health care workers are permitted to wear any plain paper mask at any time AFAIK, and many hospitals require employees who do not get flu vaccine to wear one at all times during flu season. The fancier masks that require fit testing are required when working with patients on certain types of infection precautions. I agree that hospital mask shortage has not become an issue yet to my knowledge, and may be media hype.
The people outside of health care who should wear paper masks are people with febrile respiratory illness who should kindly wear the masks to keep their germs to themselves outside of their homes. Anyone who doesn’t have a mask yet will have a hard time finding one.
The bigger issue with panic, for me, is the crowding of EDs with the worried well. Other shortages or economic impacts are likely, but will probably not be tragic.
Yes, in the Spanish Flu epidemic some towns took severe isolation precautions, which did at times work. Look up Gunnison, CO for an example of this. Does “panic” work? I would say that panic, by definition, is excessive, but I suppose it can get results.
The good outcome here would be for the virus to move through our population slowly enough that we can care for the afflicted and save as many lives as possible. I’m not an epidemiologist or ID specialist, but I have not heard anyone so qualified suggest that we will avoid near universal infection sooner or later.
Steve Sailer has been posting about research on this.
"San Francisco, St. Louis, Milwaukee, and Kansas City had the most effective interventions, reducing transmission rates by up to 30–50%.
Philadelphia had about twice the death rate of St. Louis. This is often blamed on a very popular war bond parade held in Philadelphia on September 28, 1918 for which 200,000 turned out. Within days, the hospitals were overflowing."
Severe social distancing cut 1918 death rate by 30%-50%, by Steve Sailer - The Unz Review
A lot of people are not going to like this, but I'm damned if I can argue with the man:
YouTube
Hmmm, Carlson sounds like he may be on to something. Let's look at US/PRC relations over the last few years.
* We enter into trade talks. Stalemates, tariffs, etc. ensue.
* Protests in Hong Kong against oppressive PRC rule break out. The US manages to achieve bipartisan consensus sending resolutions of support. Maybe some covert fomenting of it all.
* The PRC appears to fold on the trade agreement and all is resolved. At least so it seems.
* Shortly thereafter this virus breaks out,makes the news, and wreaks some volatility to US and worldwide financial markets setting loose the usual suspects to dog Trump. Again.
The PRC may be playing catch up with the US in general and Trump in particular.