Why not testing “mild” cases is a mistake

[defthand]

Because early intervention matters.

Covid-19 is not the flu, it is clinically unique. It is typically a very long illness (12-32 days) and symptoms — particularly in the early stages — can be intermittent. Mild cases can abruptly turn severe 7-10 days into the illness.

In Wuhan — where all mild confirmed cases were placed in “mobile temporary hospitals” and all suspected cases and contacts were quarantined in designated hotels — they found early diagnosis and treatment helped to prevent cases progressing to become serious. This is summarised at page 61 of this excellent Harvard study of 25,000 cases in Wuhan:

drive.google.com/file/d/14tGJF9tdv4osPhY1-fswLcSlWZJ9zx45/view

In addition, South Korea has 8162 cases but just a 0.7% case-fatality-rate, something they largely claim comes down to early detection and early clinical intervention:

“Testing is central because it leads to early detection. It minimises further spread and it quickly treats those with the virus and that’s the key behind our very low fatality rate”

• South Korean Foreign Minister,

twitter.com/oxforddiplomat/status/1239147373416394754?s=21 (This tweet was liked by the director-general of the WHO).

Right now in the U.K., by leaving people to isolate until their symptoms become severe, we are surely on track for a similar CFR to Italy.

It really concerns me that the illness can be so long yet we are only being told to self isolate for 7 days. This is a real worry. I work for the NHS..could theoretically go back to work in a week, yet still be contagious if I do have the virus. As it is I'll probably never know unless I get a lot worse and have a hospital admittance (hopefully not!) I realise we cant test everyone but some more community testing would at least give us a sense of where we are right now and pick up on any hotspots where more resources and possible lockdowns might be particularly helpful.

I agree re: 7 days. It’s too short. It’ll slow things down in terms of spread, but enough? The Wuhan paper linked above claims the Chinese only managed to get the virus reproduction number below 1 when they started rounding up all suspect cases and isolating them!

But on a treatment level I think the government is over-simplifying things. Many patients in China and South Korea benefited from antivirals (HIV drugs and remdesivir) during the more moderate phase.

Christ on a bike.

If this doesn't get raised in parliament and plastered all over the media I want to know why. And if our govt don't start a rigorous testing programme right now then I will be forced to believe something sinister is afoot. THIS is SCIENCE.

Yes agreed re: treatment too. Obviously not everyone needs treatment, most people will hopefully feel virally and then get better. But theres a big gap between that and feeling you are dying and needing emergency treatment. I've been ill for 10 days, I'm ok, but have pain in one side of my chest and wheezing ongoing and I have no idea if or when I should ever mention that to someone...I mean I could just have a chest infection. It's very confusing!

@tangledyarn

I’m so sorry you’re dealing with that. How exactly is one supposed to know when to pull the trigger and request additional assistance when the advice is vague? I fear a small percentage of tough types will leave it too late.

I hope you feel well soon.

Also, if mild cases are not treated. When this pandemic passes, how will they accurately trend it etc and establish exact transmission rates and outcomes .

Treated = tested

Good question. We will have very inaccurate data, based on extrapolations from deaths I suppose. Not ideal.

This is part of why Scotland announced they’d start community surveillance testing today.

I have been baning on about this on other threads today and coming up against the opinion that a fixation on numbers and testing is unhealthy, irrelevant and futile. Also that the public shouldn't be worrying about the subject but leave it to the experts who know better.

@OldQueen1969

You’re in good company, Professor Devi Sridhar agrees with you:

Why does testing matter?

1. People can alter behaviour based on whether they have COVID.
2. Break chains of transmission.
3. Local hospitals can plan for how many patients will need care.
4. To know where cases are emerging (hotspots).
5. How do we know how large problem is?

twitter.com/devisridhar/status/1238814256713392128?s=21

But knowing that early medical intervention can significantly alter the outcome of some cases is the big one for me.

Absolutely. I totally agree. Early detection is essential for determining the right treatment and will save lives and allow measures to be taken to slow transmission. It's a no-brainer.

@defthand thanks..I'll be fine, but I'm lucky! I feel confident in managing my own health conditions usually, I work in the nhs and I'm not elderly or vulnerable or on my own feeling frightened. I worry about those that are xx

I wonder if we're not following by China and S.k example because we haven't got the same level of infrastructure, services and finances of back up plan available like they have?
I'm guessing, it's just a possibility.
It does seem ludicrous too not learn from example.
Perhaps the UK's government theory is survival of the fittest?

It would be amazing to see the UK build a hospital as quickly as they did... I wonder if NHS staff would have to pay for parking there if they did?

Advice is to self isolate for at least 7 days. If on day 8 you still have symptoms then you need to seek medical advice by ringing 111 while still self isolating from the general public.

The U.K. can process approx 2000 corona virus tests a day. As the gov believes their are already 10,000 public cases and with and 1:2 transmission rate add in regular viruses causing temperature there is no way they can nor is it helpful to process that data. Also remember 20% of people will have no symptoms.

The government have already said they won’t build new hospitals, instead they will use private clinic and hotels if needed.

And if our govt don't start a rigorous testing programme right now then I will be forced to believe something sinister is afoot. THIS is SCIENCE.

In an ideal world yes, but this is a pandemic and with its sheer scale is impossible to test every case, or probably even a fraction of cases. What do we do while waiting around for the results, results that can take 5 days.

How do you propose we should test so many people

I would imagine that they know they can't give early treatment to everyone who tests positive. So if you don't test people you don't have to tell people who've tested positive that you're not going to do anything.

Out of interest, what early clinical intervention was happening in South Korea? Because I thought the only real treatment was to ease symptoms and assist with breathing if it got severe?

I think the idea is that if it was not Covid19 you would feel much better in 7 days whereas they have advised to call 111 if symptoms have not gone in 7 days!

Testing vast numbers of people would remove huge amounts of staff from areas where they would be better served looking after sick people. It would overwhelm laboratories testing relatively well people when they should be concentrating on testing unwell people in hospital. There is also the risk of false negatives early in the illness which could be falsely reassuring.

I think the idea is that if it was not Covid19 you would feel much better in 7 days

Is that right? I thought they'd said that for most people it would cause a mild illness for about 5 days? I mean, obviously that could have been them talking a load of bollocks.

Either way I think 7 days is a reasonable starting point for isolation, no point having people off for two weeks over a minor cold that lasts a couple of days, and if necessary the isolation can be extended if symptoms are still there.

I would imagine that they know they can't give early treatment to everyone who tests positive. So if you don't test people you don't have to tell people who've tested positive that you're not going to do anything.

Basically this. We know there's virtually no spare capacity in the health service and yet are determined to Get COVID Done in one bold buccaneering swoop, and so even if there was an early treatment that could ameliorate (not cure, obviously) the illness, if the system is flooded they're not going to be able to administer it to all. Better to keep people at home, getting sicker and sicker, missing the early window for intervention, then shrug sadly and say "oops, can't be helped just your bad luck you were one of the 0.6% (special British science modelled CFR), after all it is an untreatable disease." Saves a lot of money and effort that way.

Plus artificially keeping our numbers down so we look better.

We don’t have the capacity to test everyone with potential mild cases. And if we had the lab capacity, it would be a waste of limited staff resources taking the tests. Yes, ideally we would test everyone. We can’t.

We don't have the resources to test everyone, yet we're to calmly accept infection rates of over 60% within a period of possibly mere weeks because treating millions of infectious sick people and disposing of many thousands of bodies whilst overworked and underequipped staff who will themselves be getting infected, will totes be within our resources.

Yup.

Yup. Keep saying it on other threads. If you are facing something unknown and unpresidented then you need to have the most upto date and accurate information as possible. The people and computers who will be plotting the curve of this virus can only be as accurate as the information they are given. Also there is a real fear that people who have been saying oh it's just flue, there is only x amount of cases or it's not showing in my area will be less careful as they will see the drop off of positive cases as confirmation that it was all a big fuss over nothing

And yes I k ow we can't test everyone, but we should be testing front line NHS staff, people with contact to at risk groups such as care home workers and people who have been in contact with a confirmed case. Nearly every other country seems capable of doing this