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COVID-19/Coronavirus thread

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1 hour ago, almagest said:

Yup. That was me. There is some concern about how accurate antibody tests are (pointed out by @Balta1701), so I'd take all these results with a grain of salt, but we do seem to be converging on a large disparity between known infections and actual infections. Hopefully that holds because it means this is A) less deadly than we thought and B) we may be closer to herd immunity than we realize.

Its okay - Everyone ignores when I hit on the 10-50 times greater and impacts it has (or rip me for those views - even though they are as substantiated as all the other stuff posted).  None of these new facts downplay the importance of what we are doing (in terms of social distancing / slowing the curve). It just points out that the higher end of the models was likely VERY VERY wrong.  The facts also remain that mortality rates in high risk and elderly is VERY VERY high.  In those non high risk demographics, it very well might be more closely aligned to the flu (the problem is...no one has enough data to know for sure and there seem to be some extreme outliers where very healthy individuals get hit and harder than anyone would ever suspect).  The big difference is we do have treatments for the flu & vaccines (albeit not always effective).  

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1 hour ago, almagest said:

Yup. That was me. There is some concern about how accurate antibody tests are (pointed out by @Balta1701), so I'd take all these results with a grain of salt, but we do seem to be converging on a large disparity between known infections and actual infections. Hopefully that holds because it means this is A) less deadly than we thought and B) we may be closer to herd immunity than we realize.

I’d say we are consistently seeing that there is a very small portion of the population who actually has been exposed and in almost all cases almost every positive antibody test is a false positive. Such that removing restrictions will produce huge spikes in cases, exactly as seen in Japan and Singapore.

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13 minutes ago, Chisoxfn said:

Its okay - Everyone ignores when I hit on the 10-50 times greater and impacts it has (or rip me for those views - even though they are as substantiated as all the other stuff posted).  None of these new facts downplay the importance of what we are doing (in terms of social distancing / slowing the curve). It just points out that the higher end of the models was likely VERY VERY wrong.  The facts also remain that mortality rates in high risk and elderly is VERY VERY high.  In those non high risk demographics, it very well might be more closely aligned to the flu (the problem is...no one has enough data to know for sure and there seem to be some extreme outliers where very healthy individuals get hit and harder than anyone would ever suspect).  The big difference is we do have treatments for the flu & vaccines (albeit not always effective).  

Florida is reopening their beaches tonight. Why I am commenting on that in a post where you said something about an extreme mortality rate amongst the elderly is totally a mystery as no one thinks of retirees and Florida.

(my 90 year old grandmother who usually winters in Florida headed back to Indiana in late February after someone in that trailer park tested positive).

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43 minutes ago, Balta1701 said:

Florida is reopening their beaches tonight. Why I am commenting on that in a post where you said something about an extreme mortality rate amongst the elderly is totally a mystery as no one thinks of retirees and Florida.

(my 90 year old grandmother who usually winters in Florida headed back to Indiana in late February after someone in that trailer park tested positive).

What some of these states are doing is just absurd. I get it if people want to go on walks and enjoy some fresh air but you can’t have people partying on beaches etc. Vitamin D is a good thing and might actually help people bounce back from this thing but any benefit of Vitamin D is offset by higher infection rates if the beaches looks like they did a couple weeks back. 

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3 minutes ago, Chisoxfn said:

What some of these states are doing is just absurd. I get it if people want to go on walks and enjoy some fresh air but you can’t have people partying on beaches etc. Vitamin D is a good thing and might actually help people bounce back from this thing but any benefit of Vitamin D is offset by higher infection rates if the beaches looks like they did a couple weeks back. 

The peak in deaths, per our current data, comes 18-21 days after the peak in infections. So, we will see the results of opening these beaches and Texas state parks and all the other things sometime around May 15. We will see the results of keeping them open during the subsequent days. This is the absolute worst state to play this game, but my state is going to create the same disaster.

This is a worthy thread for anyone.

 

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1 hour ago, Balta1701 said:

I’d say we are consistently seeing that there is a very small portion of the population who actually has been exposed and in almost all cases almost every positive antibody test is a false positive. Such that removing restrictions will produce huge spikes in cases, exactly as seen in Japan and Singapore.

What you say is also true. Goes back to what we are doing and staying diligent on it (for at least another month) is going to be key. Get this thing as beat as you can to the point where we can increase possibility of staying unlocked for the long haul (with just isolated closures until we get a cure/treatment).  Get the infastructure and everything ready so we can handle (and don't go too crazy too fast or potentially don't get crazy at all...some lessening of restrictions is better than nothing).

We need to be measured...if you can get back to 75% of normal and curb this thing with a high probability, it is better than going to 100% and having to shut back down and literally start from square one at zero (because we weren't ready).  

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11 minutes ago, Balta1701 said:

The peak in deaths, per our current data, comes 18-21 days after the peak in infections. So, we will see the results of opening these beaches and Texas state parks and all the other things sometime around May 15. We will see the results of keeping them open during the subsequent days. This is the absolute worst state to play this game, but my state is going to create the same disaster.

This is a worthy thread for anyone.

 

It is easy for me to make the statements I'm making. CA has just done a stellar job (for once).  State has its issues but I think they have been a great leader in how proactive and thoughtful they were in this process.  But it is also a massive state with a ton of urban areas so you get forced into that decision. I kind of get it for those states that don't have massive urban areas / centers which tend to be more rural.  If you had good testing a more targeted approach would be pretty efficient (to the point you might say the cost-benefit is okay).  But you just can't get people in massive areas (i.e., big church gatherings, big events, etc). Big urban area or small city, the risk of mass infection events is way too high with this thing (next thing you know a small town of 1000 people has 500 roaring cases and no possible way of treating its people).  

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6 minutes ago, Chisoxfn said:

What you say is also true. Goes back to what we are doing and staying diligent on it (for at least another month) is going to be key. Get this thing as beat as you can to the point where we can increase possibility of staying unlocked for the long haul (with just isolated closures until we get a cure/treatment).  Get the infastructure and everything ready so we can handle (and don't go too crazy too fast or potentially don't get crazy at all...some lessening of restrictions is better than nothing).

We need to be measured...if you can get back to 75% of normal and curb this thing with a high probability, it is better than going to 100% and having to shut back down and literally start from square one at zero (because we weren't ready).  

Based on what we are seeing internationally, specifically the surges in Singapore and Japan, I think the evidence is convincing that anything less than Italian level “we will arrest you if you are within 20 feet of another human” lockdown will eventually enable a massive surge in cases, within a few weeks. There are too many underserved populations packed into spaces that are too small, the time in between infections measurable data and Is too long, too many people defy these voluntary rules and one single infection can become a superspreader, and I’m No longer confident that testing and tracing can deal with this, especially not at the scale of the US.

so yeah, I think these guys are going to start reopening stuff and then we are going to see more spikes a few weeks later, including in urban areas in the south where they will be very lethal and hard to control.

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15 minutes ago, Chisoxfn said:

It is easy for me to make the statements I'm making. CA has just done a stellar job (for once).  State has its issues but I think they have been a great leader in how proactive and thoughtful they were in this process.  But it is also a massive state with a ton of urban areas so you get forced into that decision. I kind of get it for those states that don't have massive urban areas / centers which tend to be more rural.  If you had good testing a more targeted approach would be pretty efficient (to the point you might say the cost-benefit is okay).  But you just can't get people in massive areas (i.e., big church gatherings, big events, etc). Big urban area or small city, the risk of mass infection events is way too high with this thing (next thing you know a small town of 1000 people has 500 roaring cases and no possible way of treating its people).  

https://amp.cnn.com/cnn/2020/04/17/politics/republican-governors-stay-at-home-coronavirus/index.html?__twitter_impression=true

 

Quote

Just as cases are starting to plateau in some big cities and along the coasts, the coronavirus is catching fire in rural states across the American heartland, where there has been a small but significant spike this week in cases. Playing out amid these outbreaks is a clash between a frontier culture that values individual freedom and personal responsibility, and the onerous but necessary restrictions to contain a novel biological threat.

The bump in coronavirus cases is most pronounced in states without stay at home orders. Oklahoma saw a 53% increase in cases over the past week, according to data compiled by Johns Hopkins University. Over same time, cases jumped 60% in Arkansas, 74% in Nebraska, and 82% in Iowa. South Dakota saw a whopping 205% spike.

The remaining states, North Dakota, Utah and Wyoming each saw an increase in cases, but more in line with other places that have stay-at-home orders. And all of those numbers may very well undercount the total cases, given a persistent lack of testing across the US.

 

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Another obvious element to consider is the need to reopen schools in order to reopen the country...or day care centers, at the very least.

Trump seemed to project a belief that some states would be bringing students back in May, and that just doesn't make a lot of sense...when most districts would be theoretically closing in late May or early June.

Are they going to push all those kids into mandatory summer school to catch up?

It makes sense from a nutritional standpoint, perhaps, in poorer or rural districts.  

But who do you bring back first?  Middle schoolers?   High schoolers have the ability to stay at home (theoretically!), but sending KG and primary/elementary carries that risk because of the high level of transmission in that age group...passing it quickly to others and then families/relatives.

Some are considering staggered...where you have JR/SR and then FR/SO on alternate days.   What are the social distancing rules?  How easy to maintain six feet?  What about PE and recess?  Cafeteria?

 

There are so many considerations here...pushing kids back into school for just 2-3 weeks of “benefit” (their parents both being able to go back to work) doesn’t seem worthwhile.   Granted, a lot of white collar jobs are flexible and allow for the majority of workers to function reasonably well through teleconferencing and stay ay home or only the most essential workers (let’s say 30%) returning to work, and you can even stagger or rotate that until you’re relatively confident in the efficaciousness of such a strategy.

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6 minutes ago, Balta1701 said:

It is going to be interesting when states start shutting down their borders, etc.  If I'm next to one of those states and took a different, more aggressive approach and got things situated, I'm not about to get messed up by a fellow state. I'd help as much as I could resource wise, but I'm protecting my states population.  

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14 minutes ago, Balta1701 said:

South Dakota is mostly accounted for by that Smithfield plant...and related infections.

That said, each of one those governors being pointed out as now having “solved this thing” (like Asa Hutchinson in Arkansas), are going to end up killing increasing numbers of their state residents out of sheer stubbornness.

Maybe they believe their electoral prospects are so secure (or not in an election year), they can get away with almost anything, but that’s certainly not the case with Kim Reynolds in Iowa.     
 

Georgia, Texas and Florida will be three of the leading indicators, and, as noted, that won’t start to show up in the statistical noise until the second week of May in all likelihood.

Edited by caulfield12

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6 minutes ago, caulfield12 said:

Another obvious element to consider is the need to reopen schools in order to reopen the country...or day care centers, at the very least.

Trump seemed to project a belief that some states would be bringing students back in May, and that just doesn't make a lot of sense...when most districts would be theoretically closing in late May or early June.

Are they going to push all those kids into mandatory summer school to catch up?

It makes sense from a nutritional standpoint, perhaps, in poorer or rural districts.  

But who do you bring back first?  Middle schoolers?   High schoolers have the ability to stay at home (theoretically!), but sending KG and primary/elementary carries that risk because of the high level of transmission in that age group...passing it quickly to others and then families/relatives.

Some are considering staggered...where you have JR/SR and then FR/SO on alternate days.   What are the social distancing rules?  How easy to maintain six feet?  What about PE and recess?  Cafeteria?

 

There are so many considerations here...pushing kids back into school for just 2-3 weeks of “benefit” (their parents both being able to go back to work) doesn’t seem worthwhile.   Granted, a lot of white collar jobs are flexible and allow for the majority of workers to function reasonably well through teleconferencing and stay ay home or only the most essential workers (let’s say 30%) returning to work, and you can even stagger or rotate that until you’re relatively confident in the efficaciousness of such a strategy.

How many kids in lower income / high poverty areas are actually worse off (by not being in school). It is a delicate concept, but is school actually a safer place (with the risk of Coronavirus) vs. being at home. In many cases...the answer is probably no, but I bet you there are situations where the answer is a resounding yes.  

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4 minutes ago, caulfield12 said:

South Dakota is mostly accounted for by that Smithfield plant...and related infections.

That said, each of one those governors being pointed out as now having “solved this thing” (like Asa Hutchinson in Arkansas), are going to end up killing increasing numbers of their state residents out of sheer stubbornness.

Maybe they believe their electoral prospects are so secure (or not in an election year), they can get away with almost anything, but that’s certainly not the case with Kim Reynolds in Iowa.     
 

Georgia, Texas and Florida will be three of the leading indicators, and, as noted, that won’t start to show up in the statistical noise until the second week of May in all likelihood.

That’s precisely the problem of this. It spreads rapidly so if an area isn’t shut down, the cases that are isolated or tracked burn out, but it is still going to find its way into your untracked, dense populations of immigrants, nursing homes, whatever. In South Dakota it hit a meat packing plant where the rich owners didn’t care about distancing. The fact that it is concentrated is a natural result of how this spreads, not some anomaly.

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2 minutes ago, Chisoxfn said:

How many kids in lower income / high poverty areas are actually worse off (by not being in school). It is a delicate concept, but is school actually a safer place (with the risk of Coronavirus) vs. being at home. In many cases...the answer is probably no, but I bet you there are situations where the answer is a resounding yes.  

Right.  These are the kind of calculations the insurance industry typically makes.  If you’re a school administrator, it’s certainly much easier to take the conservative approach of keeping the school closed (of course, you have economic impacts in states like Iowa where education sector is the leading employer)...and then doing as much proactive outreach as possible with meal delivery services, food banks, churches, charity groups, etc.  

This in one huge area for a win-win...if you can contract with local restaurants to keep them with enough revenue opportunities to keep them open, while not paying prohibitively high prices that garner negative headlines.  There are also numbers of high quality food warehousers/distributors who no longer are able to sell to higher end restaurants, at least not at the previous rates.  Most of these are in urban areas, but it’s another area worth looking into if both sides are willing to compromise on pricing.

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7 minutes ago, Balta1701 said:

That’s precisely the problem of this. It spreads rapidly so if an area isn’t shut down, the cases that are isolated or tracked burn out, but it is still going to find its way into your untracked, dense populations of immigrants, nursing homes, whatever. In South Dakota it hit a meat packing plant where the rich owners didn’t care about distancing. The fact that it is concentrated is a natural result of how this spreads, not some anomaly.

This risk is particularly acute in places of detention, such as prisons, jails, and immigration detention centers, as well as residential institutions for people with disabilities and nursing facilities for older people, where the virus can spread rapidly, especially if access to health care is already poor. States have an obligation to ensure medical care for those in their custody at least equivalent to that available to the general population, and must not deny detainees, including asylum seekers or undocumented migrants, equal access to preventive, curative or palliative health care. Asylum seekers, refugees living in camps, and people experiencing homelessness may also be at increased risk because of their lack of access to adequate water and hygiene facilities.

https://www.hrw.org/news/2020/03/19/human-rights-dimensions-covid-19-response

 

So you have these rural issues...whereas SF, LA, Seattle...are worrisome for their own set of reasons, especially homeless populations.  Vietnam veterans.  Nursing homes are obvious.   Prisons in Illinois have already been discussed.    

Heck, just the 30+ million group of those without any health insurance or a preexisting relationship with a local physician.  Those without regular checking or savings accounts for direct deposit.

When this is all over, investigating statistics in Europe among refugee/displaced groups, human trafficking victims...it’s going to exhibit quite emphatically how particularly vulnerable these poor populations really are in a health crisis. And how dramatically those groups can impact entire communities.

But one can guarantee that’s the exact topic that will never be discussed or even raised in a coronavirus briefing

“We’ll have to get back to you.”

 

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10 hours ago, bmags said:

Mmm hmm because we are in a perpetual state of pandemic and all of our normal incentives apply. 

Let's say our wishes are granted and Remdesivir is actually an effective drug. It can be applied at regular doctors offices and keeps people from dying and lessens need to stay at hospitals.

Do you think Gilead is going to be able to say "wellp, we are the only providers, we get to charge whatever we want because we have a patent, and this is how things normally go"

Because I think it's pretty clear there will be enormous pressure by ...the entire world to provide this at as accessible a cost as possible. I don't know gilead's entire portfolio, but it is very likely to be in Gilead's best interest to do so.

1) As long as this pandemic is as is, elective surgeries and visits to doctors have decreased. With less visits, less opportunity for uncovering and prescribing a host of options.

2) As long as this pandemic is as is, insurance is going to have huge negative pressure with all of the additional ICU and hospital stays causing massive strain on their payouts. This will fall back on drug manufacturers on prices paid or larger copays charged and then...

3) As long as is this pandemic is as is, there will be huge economic fallout causing job loss, (in US) lack of insurance and a host of externalities that reduce purchasing power specifically to a gilead

And then on top of that, there will be a huge push for governments globally to get access to the drug. With economies shut down and people dying by the thousands, there will be huge pressure to gilead to provide the govt close to cost as any number of governments may decide not to respect IP law and take the risks  - because it's extraordinary circumstances right now. Kind of a once in a century pandemic type thing.

Or maybe they would decide to take a huge prize, play the hero, and then lobby the shit out of changing any laws that restrict them.

Or maybe they burn down a hospital! 

“At $50 a test it wasn’t enough to hire a tech to run the tests full time but at $100 a test it is”. 1:07 into today’s briefing under that post.

I hope you’re already asleep so you don’t hear that phrase in your sleep.

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The amazing thing is how just 4-6 weeks of Covid arriving late (r) totally changed this year’s election. 

Biden if the race was interrupted indefinitely after Nevada never gets his momentum going.

The entire race then hinges on health care and economic inequality (just imagining Sanders’ reaction to the aforementioned anecdote about private lab testing not being profitable enough.)

Now, the Biden/Trump race hinges on Democratic governors, Trump “mistakes,” a “return to decency/empathy” and restoring normalized diplomatic relations with the rest of the world.

Even the economic/unemployment numbers can be blamed on “coastal elites” shutting down the country and trying to take away our unique rights/freedoms, conspiring to prolong the shutdown in order to deny reelection.  Those Dem governors and Crazy Joe Biden simply don’t want America to succeed, they instead want to turn America into a socialist nanny state like the EU. 
 

The big question here (blaming governors or taking credit for only successes, like the stock market now “only” being down 18% instead of mid 30’s) is whether 30-40% of the country in the middle of the spectrum politically actually buy what is being sold.

Normally, it’s impossible during a presidential election year to narrow the blame to just governors or Congress when the economic success or (relative degrees of) failure begins and ends at the top of the ticket.

Edited by caulfield12

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Why are the Fox News personalities that drive Trumps decisions working from home if they feel everyone should be back at work? At least show by example. Fox News should go back to normal operations. I don’t think they would be violating any orders because they are considered the press, but if not,rules apparently don’t apply to presidential advisors as Ivanka and Jared were able to skate the shelter in place order and go to a Trump hotel in NJ.  Which probably put several Secret Service employees in harms way.

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The simple fact is that the country needs a coordinated and well-planned overall strategy to battle this thing. The other simple thing is we don't have one. And we are not going to have one.

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7 hours ago, Balta1701 said:

“At $50 a test it wasn’t enough to hire a tech to run the tests full time but at $100 a test it is”. 1:07 into today’s briefing under that post.

I hope you’re already asleep so you don’t hear that phrase in your sleep.

I’m not sure what you think is damning about this. I know your galaxy brain sees The word profit and thinks it’s a rich white man sitting on a bed of money, but the rest of these diagnostic companies are losing lots of money and they are furloughing those employees. 

So they need to hire up techs specifically for this testing but the current cost per test, and hiring costs money. They need to be trained and aren’t as productive as current staff.

They could get a loan to hire for something that isn’t profitable long term for them and lay off more staff from other parts of their business, or ... the government could increase the costs they pay for each test.
 

Or maybe the government should force them into bankruptcy after this is over along with the many hospitals losing money right now so that balta can sleep comfortably knowing the technicians that worked around the clock during this crisis got laid off immediately after.

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There’s another issue at play here.

I have a friend (chemistry teacher) who used to work at my school in China and now back in California waiting  to get his teaching credentials in order and for fall semester hiring to take place.

He works temporarily in a grocery store doing stocking/inventory for something like $15/hr.

Meanwhile, you have lots of people who are getting $832/week for unemployment, plus they’ll be getting an extra $600 per week on top of that.

That works out to something like $6000 per month, $24,000 for four months max....$36/hr or $72,000 for a full year.

How can we justify paying those actually at risk half or in many cases 1/3rd as much those essential workers (looking at you Wal Mart and Amazon)?

 

How can we give Ruth’s Chris steakhouses a $20 million small business loan when they are sitting on something like $60 million in reserves?   That’s really pushing it to define that as anything resembling a “small business.”  I think it’s 500 employees or less...?

Edited by caulfield12
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35 minutes ago, bmags said:

I’m not sure what you think is damning about this. I know your galaxy brain sees The word profit and thinks it’s a rich white man sitting on a bed of money, but the rest of these diagnostic companies are losing lots of money and they are furloughing those employees. 

So they need to hire up techs specifically for this testing but the current cost per test, and hiring costs money. They need to be trained and aren’t as productive as current staff.

They could get a loan to hire for something that isn’t profitable long term for them and lay off more staff from other parts of their business, or ... the government could increase the costs they pay for each test.
 

Or maybe the government should force them into bankruptcy after this is over along with the many hospitals losing money right now so that balta can sleep comfortably knowing the technicians that worked around the clock during this crisis got laid off immediately after.

How can South Korea and Germany manage the same feat for 1/10th the cost, or roughly $10 per test?

Very simple solution.  The Federal government (not states, since they can’t magically create money out of thin air like Treasury) subsidize the cost, or the US will suffer billions more in economic damages when no corporations can assume the liability risk of going back too early without adequate testing systems in place to protect the workers. 

 

For antibody tests, the cost is even cheaper.   The cost for a technician to (non)profitably analyze one test in 15 minutes would be roughly $160/hour or $40 for 15 minutes?    So they need to charge the equivalent of roughly $300-325 hour to break even?

Antibody blood tests have been used for about two decades in other disease-tracking initiatives, including for HIV in rural Africa, Ho said in a video call sponsored by the group Committee of 100. The kits cost $1 to $6 each, he added, depending on the volume purchased.
Some US companies are already selling antibody tests to other countries.   The California biotech company Biomerica sells COVID-19 antibody tests for less than $10 in Europe and the Middle East, according to Reuters. Chembio Diagnostics, a medical-device company based in New York, is sending its antibody tests to Brazil and plans to study them in the US, Reuters reported.

https://www.businessinsider.com/coronavirus-antibody-blood-test-covid-19-2020-3

Edited by caulfield12
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20 minutes ago, caulfield12 said:

How can South Korea and Germany manage the same feat for 1/10th the cost, or roughly $10 per test?

Very simple solution.  The Federal government (not states, since they can’t magically create money out of thin air like Treasury) subsidize the cost, or the US will suffer billions more in economic damages when no corporations can assume the liability risk of going back too early without adequate testing systems in place to protect the workers. 

 

For antibody tests, the cost is even cheaper.   The cost for a technician to (non)profitably analyze one test in 15 minutes would be roughly $160/hour or $40 for 15 minutes?    So they need to charge the equivalent of roughly $300-325 hour to break even?

Antibody blood tests have been used for about two decades in other disease-tracking initiatives, including for HIV in rural Africa, Ho said in a video call sponsored by the group Committee of 100. The kits cost $1 to $6 each, he added, depending on the volume purchased.
Some US companies are already selling antibody tests to other countries.   The California biotech company Biomerica sells COVID-19 antibody tests for less than $10 in Europe and the Middle East, according to Reuters. Chembio Diagnostics, a medical-device company based in New York, is sending its antibody tests to Brazil and plans to study them in the US, Reuters reported.

https://www.businessinsider.com/coronavirus-antibody-blood-test-covid-19-2020-3

Yes absolutely! Feds should subsidize the shit out of it! Massively build up our own testing capabilities so we don’t rely as much on quest! But while you need them...pay them what they need to scale for it.

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