Rationing testing

[herecomesthsun]

www.thetimes.co.uk/article/health-chiefs-admit-rationing-of-coronavirus-tests-80gtl7hwg?fbclid=IwAR12a4CeiUwc3eGQoY_8miqhzrJZ_O97cYPruRPuAJ6ttsqSjaI9_A_uods

Apparently, they want to
a) discourage schools from testing pupils. (As someone ECV whose kids warily went to school today, this is terrible news)
b) they want to focus testing on hot spots. Great to have testing in hot spots, but without good testing elsewhere, we won't know where new hot spots are developing.

@ChanceChanceChance well, I can't really say how, but I do know. Whether it will succeed, or even be needed at that level, that I don't know.

THe school maybe taking the harder line and isolating for sore throat because of the feckless who would dose up their child with calpol to get the through the door.

I'm not suggesting this is what that poster is doing. But many do this, one of the mp's made a comment about parents having to think twice about doing this (would have helped if he had said, don't do it)

Corona or not a sore throat on it's own is fine. With a temp not so much, with a cold not so much

www.nhs.uk/common-health-questions/infections/how-long-is-someone-infectious-after-a-viral-infection/

Even ignoring money, needless tests take time, so instead of you finding out that X is positive on Friday, you find out on Saturday, that means the people track and trace find connected to X have been out and about unknowing for an extra day.

The cost is not just the money.

I'm amazed that anyone would inflict the test on their kids for a daft reason like a snotty nose - the test is quite painful and very unpleasant. I'd rather keep DS home for 14 days than have a stingy cotton bud rammed to the back of his sinuses and twisted (I've had it done twice, it was awful!).

@HavelockVetinari

I'm amazed that anyone would inflict the test on their kids for a daft reason like a snotty nose - the test is quite painful and very unpleasant. I'd rather keep DS home for 14 days than have a stingy cotton bud rammed to the back of his sinuses and twisted (I've had it done twice, it was awful!).

Easier said than done though as the parents also have to quarantine for 14 days. Employers are unlikely to be sympathetic for every cold the children get.

Rationing testing makes little sense. Maybe make a concerted effort to remind people of the criteria so they don't test unnecessarily.

What happened in Scotland at school start is that lots of kids got sick, had coughs and temperature so had to be tested. What were parents supposed to do? Divine from a crystal ball whether the temp was Covid or not? It's far more responsible to test than to ignore it and spread it.

[quote TheLastStarfighter]**@ChanceChanceChance* well, I can't really say how, but I do know*. Whether it will succeed, or even be needed at that level, that I don't know.[/quote]
I think given every testing aspiration has failed, and we are not even consistently at the much touted 200k, I will remain until more evidence or info then.

Will be super happy to be wrong but as every other promise has been bullshit...

If we are to function as a society and contain the spread of the virus then the testing system needs to be quick and efficient and available to anyone who needs it.

Not having an efficient system means

• less compliance
• more school missed than necessary
• decrease in working efficiency and loss of wages etc
• more people relying on state benefits
• decrease in public health, both physical and mental, because of people being stuck in doors isolating

You should be able to get a test the same day of symptoms - close to home, or delivered straightaway, with a fast 24hr turnaround for results.

The issue should not be demand, the system needs to scaled up logistically and deal with demand. They have had 6 months to sort this. The fact it is an omnishambles is pretty awful really.

[quote StatisticalSense]@Bwlch
There's plenty of capacity for 100,000 tests a day, as proven by the fact we are currently processing 170,000-190,000 tests per day on the average day. There is not capacity for the literally millions of tests per day that some would like to see and short of literally building new laboratories from the ground up and training thousands of people in processing the tests it won't be possible.[/quote]
We wouldn’t necessarily need millions of new labs. Plenty of universities have lab space and offered their PCR lasting kits to the government. they were turned down.
And without separating the pillar 1 & 2 capacities you can’t see where the issue is. It’s entirely possible that the commercial labs might be running over capacity while the NHS/PHE labs have spare capacity at the moment.

What’s mind boggling is that even having limited the testing criteria the system still can’t cope. It’s basically managing to fail on two different levels.

I did not know in the UK you could just request a test!
In Spain the test has to be "prescribed" by a HCP, or, in some cases, like known contagions in a certain place (generally pub/restaurant) they appeal for people who have visited the establishment between such and such date to apply for an appointment.
I guess you can lie and say you were at that restaurant, but other than that you have to go private (super expensive) and even then they are supposed to base it on clinical suspicion (which they don't necessarily do).

@GalOopNorth

Our school won’t accept children with any of the symptoms (sore throat OR cough, OR temp) without a negative test or 14 day isolation.

That’s why so many kids are needing tests.

I have DS home with a sore throat (no temp, no cough) when normally I would 100% send him in but school won’t allow it.

Totally agree with you!

Good. I've had school tell me to take both kids out of school and get them tested because one of them coughed when they got up, and I stupidly asked the school what they wanted me to do. No temperature, perfectly happy kids. I've had to take a half day off work to drive them on a 60 mile round trip to the only test centres with slots. And now they're sitting around at home for up to five days until the no doubt negative results come back. All for following rules, even if I don't like them, but this is a joke.

@RafaIsTheKingOfClay They haven't limited the criteria if the school receptionist can force me to have tests done for basically no reason.

My dd is off today as had a snotty nose and a slight temp. She’s now 38.5 and so I have to try and get her rested - no testing available either drive-in or home tests - and we are in a local lockdown area....

Any person not entering ICU is a huge saving.

So... 1.5k positives/day have been found recently (moving average). Out of 100,000 tests (I think). Suppose that one person is stopped from getting infected for every two positive cases found (because everyone should isolate when symptomatic anyway). And that 10% of infected persons get a hospital stay, and 50% of those who went to hospital went to ICU. And the average stay in ICU is... 8 days, plus 2 days before & 2 days after in hospital not ICU beds.

And a day in hospital not in ICU is half cost of an ICU bed day.

So 100k tests = £1 million spent (maybe)
1500 confirmed positives -> 750 saved new positives.
10% of 750 = 75
38 saved from going to ICU.

£1 million /38 = £26,315.
Does a day in ICU cost >= £2631.5?
I'm finding 2010 values of like £1400 for a critical care bed, so £2000 for 2020 bed days in critical care might be about right, not sure.

I'm ignoring the 38 cases who only went to hospital but not to ICU, of course.
Are real health economists working out actual savings with better numbers?

Seems like the tests need to cost < £10 each to make testing as control strategy cost-effective.

@lljkk

Any person not entering ICU is a huge saving.

So... 1.5k positives/day have been found recently (moving average). Out of 100,000 tests (I think). Suppose that one person is stopped from getting infected for every two positive cases found (because everyone should isolate when symptomatic anyway). And that 10% of infected persons get a hospital stay, and 50% of those who went to hospital went to ICU. And the average stay in ICU is... 8 days, plus 2 days before & 2 days after in hospital not ICU beds.

And a day in hospital not in ICU is half cost of an ICU bed day.

So 100k tests = £1 million spent (maybe)
1500 confirmed positives -> 750 saved new positives.
10% of 750 = 75
38 saved from going to ICU.

£1 million /38 = £26,315.
Does a day in ICU cost >= £2631.5?
I'm finding 2010 values of like £1400 for a critical care bed, so £2000 for 2020 bed days in critical care might be about right, not sure.

I'm ignoring the 38 cases who only went to hospital but not to ICU, of course.
Are real health economists working out actual savings with better numbers?

Seems like the tests need to cost < £10 each to make testing as control strategy cost-effective.

Oh just let them all catch it then

I think you're massively undercosting your ICU patients there. Some have many months physio plus no work etc once they get out.

It's not just the cost of ICU though. It's also the economic cost of fear of getting ill once the virus is out of control. How many people would be happy going about town if they were in a know hotspot. All the empty cafes and shops due to fear have a huge economic impact.

Suppose that one person is stopped from getting infected for every two positive cases found

This would be R = 0.5. The R number is still hovering around 1 where it's been since they started easing restrictions.

because everyone should isolate when symptomatic anyway

No employer is going to allow someone with mild symptoms to take 10 days off work without getting a test. Also none of their contacts will be traced and even if you phone those you know about yourself, none of them will be able to take 2 weeks off work to quarantine without verification by test and trace.

Before you know it, we're back to widespread community transmission and exponential growth. We've seen how that goes and we really can't afford to go through it again.

yeah that's why economists need to work out the lot.

I don't know anybody who has had a test "for fun".

Most of us who have had kids tested have felt obliged to drag the kids to a centre, wrestle them down and swab them because nursery, school or childminder says they will not have them with a cough (and "continuous" coughing is vague... so is three episodes a day just three separate coughs? Three lots of two coughs? Three lots of three coughs? Do you count coughing at night when their nose drips down the back of their throat? when do you count the next episode? Next hour? Or is it same episode if same evening? all very vague in the context of young children and you know they just have a cold but are just trying to do the right thing and follow the jolly rules!

I don't think there's much of a problem with people getting a test if they have some symptoms that don't quite fit. We know for a fact that people can be infected and contageous without having a new, continuous cough, a high temperature, or a loss of taste or smell. We also know this virus can cause all sorts of other symptoms. Probably a fair few cases are picked up from testing people whose symptoms don't quite fit.

There seems to be a problem with asymptomatic contacts and this idea that you can shorten quarantine by getting a negative test.

I think employers are partly to blame, I've heard a few accounts of people who've been told to stay at home for 14 days by test and trace, who are then told by their employer to just get a test and come back to work if it's negative.

But also there are people who've been called by their friend or relative who has tested positive (or who has symptoms but can't access a test), and they're told they're a contact, way before contact tracing gets its arse in gear. So they don't get the proper advice and they book a test asap because they're worried.

These situations are doubly harmful - not only does it waste a test but it gives people a false sense of security that they do not have the virus.

this idea that you can shorten quarantine by getting a negative test.

And popping my tinfoil hat on for a moment, I wonder if this sudden shortage of testing capacity has anything to do with the aviation industry's recent calls for airport testing?

In Scotland testing centres were overrun about 10 days after schools went back. There was so much cold going round after months at home. And a lot of children will get a fever or coughs with a cold. Throw in some ambiguous messages from school and parental panic into the mix and everywhere ran out of tests.

I wonder why the UK government didn't learn from Scotland's experience and anticipate the increased demand for tests?

Any person not entering ICU is a huge saving

Way more than that. It is also about lost productivity of previously healthy people of workIng age. I think it is clear that the knock-on long term effects of Covid are going to shorten lives, and cause disabilities and who knows what else. Young people and children who lose parents early are also impacted - mental health, more likely to live in poverty etc