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.

There is no treatment for this though. It's not like say, some cancers, where early diagnosis and therefore early treatment leads to being cured.

There is only supportive care. Which if you are symptomless you don't need anyway.

I’m not talking about asymptomatic cases, though. Rather mild/moderate cases that left to their own devices can turn rapidly severe.

Under isolation and supervision those cases have been administered HIV drugs and other supportive therapies which the Chinese and Koreans claim prevented some cases from progressing to severe ARDS type situations.

To add — whilst there is no cure, there is a growing list of suggestive therapies (the above mentioned HIV drugs, remisdivir, and an anti-malarial called chloroquine).

The earlier a case is diagnosed, the earlier this therapy may be commenced.

Exactly OP. Not to mention, even "supportive care" may be of some benefit, as it looks like there is permanent lung damage amongst those who survive severe illness - if there's a possibility of averting severe illness by early intervention, why not do so? It's not just a case of "well, if you're NOT DEAD therefore you're fiiiiiiiiine."

I remember our testing capacity have gone up to 10,000 per day in the news maybe last week, I remember I read that news from BBC and was glad. And we are not using this , why? Why we don't do anything like social distance? And we don't do mass testing like Korea and Singapore? So we don't do any of this, we just follow our unique herd immunity way. Hope we are lucky.

Regarding the early intervention, it is true that China has used lots of different treatment for the earlier stage, everything is in experiment though. Like the HIV drug, antivirus drugs, later on, they have also developed Herb medicine, which was quite effective for early stage, can reduce the rate of mild case turn into serve case.

I clearly remember the first case in America, he turned sever in around 9 days, then took one antivirus drug and get better. So the clinical trial of that drug has started in China afterwards.

I do hope WHO have collected all the information and knowledge from every country and made sure every country can access it.

Yes they expanded capacity to 10,000 then ditched it before it even kicked in!

I just keep thinking about the American situation — where they are launching free drive-through testing in Walmart and Target carparks. Suspected cases will know early on what they have, and will be more vigilant about disease progression. And when they get to hospital, should they deteriorate, the medical staff won’t have to waste time establishing whether they have Covid-19 or not, they can immediately commence treatment with the right supportive therapy.

If they don't test how do we know immunity will work? If someone has it mildly, then gets it again next autumn it would suggest low/ no immunity, but if they are not tested if symptoms are mild then how do we know?

We need to test so it can be tracked, mapped and understood.

Re. not having the capacity to test all possible cases - could they not test a sample of the population and extrapolate? Wouldn't be perfect, but would tell us something.

"well, if you're NOT DEAD therefore you're fiiiiiiiiine." This is the general attitude to sickness in this country at the best of times and it seems to be the flag we're flying now.

I didn't get it all properly but a doctor on the Today programme said we need to test for antibodies which will test for immunity, which is not the test we use right now?

Surely we need that kind of testing, then if you're immune you can go into the outside world and the food retail, pharmacies and medical employees could at least go to work knowing they are neither going to catch it or spread it on. (That is, if you are not a transmitter of CV once you've had it?)

That’s what Scotland is doing @MooseIsLooseInTheHoose.

Like you say, it’s better than nothing.

I think the advice is very unclear and difficult to follow. I have heard so many different interpretations!
Agree that we should be extensively testing.

Actually no, after 7 days you are no longer infectious. Also you’ll either be better and fine to go back to work, or worse and seeking medical treatment.

They haven't got the resources to test widely, that is why it is being restricted. Likewise, the NHS has been run down over the last 35 years or so to the point where it cannot serve even routine, average needs, let alone an emergency like this. We have fewer beds per 1000 population than anywhere in Europe (including Italy, and far fewer than China) and have decades of under investment and internal wastage in the NHS. It is well known and spoken of in Europe that our health care system is terrible.

IMO this is the reason behind the current strategy - no other is in fact possible.

Not testing has to be the most dangerous part of the govrrnments strategy by far. People will tecieve treatment too late and need more agressive treatment as a result.

I understand both sides. It would be very difficult to test everyone - people would have to go out and expose themselves with symptoms if they had to travel to the hospital drive thru's and would take up a lot of nhs staff to do home tests when the number is in the thousands. It would be handy if they could develop some kind of home swab kit that was posted out and a phone number for results to be texted in. In any case I think the numbers need to be recorded. I'm currently isolating as I'm symptomatic but my symptoms aren't that different from my average bad cold, so I'll probably never know.

I am confused as to why we aren't testing as much as we can (obviously we should prioritize serious cases and NHS staff).

But if we're supposed to have herd immunity or whatever, how is anyone going to know what portion of the population has had it if we dont test?

I think they’re going to try and extrapolate from deaths @IStressheadI which is grim and likely to be inaccurate.

Inaccurate because their maths already appears to based on dodgy stats. I read their current models and planning here were based on a hospitalisation rate of 5% of symptomatic cases. In China, though, this number was more like 20%. Italy looks like it might be even worse from their stats.

What’s that data science saying — “garbage in, garbage out”.

Well, the WHO have once again made their position very clear.

Test, test, test!

I really don’t think you are not infectious after seven days !

WHO have stated today that you can still be infectious for TWO WEEKS POST RECOVERY . So seven days after starting symptoms is not true. It could be a month or longer .

Whilst I would always urge people to take newspaper articles with a pinch of salt, here's another example of a potential COVID treatment that can help if the infection is caught early enough. Which requires us to test, test, test!

www.theguardian.com/world/2020/mar/18/japanese-flu-drug-clearly-effective-in-treating-coronavirus-says-china

Doctors in Japan are using the same drug in clinical studies on coronavirus patients with mild to moderate symptoms, hoping it will prevent the virus from multiplying in patients.

But a Japanese health ministry source suggested the drug was not as effective in people with more severe symptoms. “We’ve given Avigan to 70 to 80 people, but it doesn’t seem to work that well when the virus has already multiplied,” the source told the Mainichi Shimbun.

That is interesting and hopeful . I had read that early treatment helps milder cases not to progress, but nothing clear enough on what that treatment may be. If milder cases could be treated, then it might be possible to stop some people from needing intensive care ? Also could free people from Hospital earlier ?

If milder cases could be treated, then it might be possible to stop some people from needing intensive care ? Also could free people from Hospital earlier ?

Exactly! Reduces pressure on the health service.