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Interesting editorial article from the New England Journal of Medicine: Asymptomatic Transmission, the Achilles' Heel of Current Strategies to Control Covid-19

The below quote is from the end of the article. Please click the link and read the whole article for context and more detail, and please note that they are primarily talking about testing in congregate living situations (care homes, prisons, etc), which (IMHO) shows the eventual wisdom of more complete testing in the wider community.

Quote

Asymptomatic transmission of SARS-CoV-2 is the Achilles’ heel of Covid-19 pandemic control through the public health strategies we have currently deployed. Symptom-based screening has utility, but epidemiologic evaluations of Covid-19 outbreaks within skilled nursing facilities such as the one described by Arons et al. strongly demonstrate that our current approaches are inadequate. This recommendation for SARS-CoV-2 testing of asymptomatic persons in skilled nursing facilities should most likely be expanded to other congregate living situations, such as prisons and jails (where outbreaks in the United States, whose incarceration rate is much higher than rates in other countries, are increasing), enclosed mental health facilities, and homeless shelters, and to hospitalized inpatients. Current U.S. testing capability must increase immediately for this strategy to be implemented.

Ultimately, the rapid spread of Covid-19 across the United States and the globe, the clear evidence of SARS-CoV-2 transmission from asymptomatic persons,5 and the eventual need to relax current social distancing practices argue for broadened SARS-CoV-2 testing to include asymptomatic persons in prioritized settings. These factors also support the case for the general public to use face masks10 when in crowded outdoor or indoor spaces. This unprecedented pandemic calls for unprecedented measures to achieve its ultimate defeat.

Disclosure forms provided by the authors are available with the full text of this editorial at NEJM.org.

This editorial was published on April 24, 2020, at NEJM.org.

 

 

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Press Release from the Rob Vine Fund   Following the cessation of Motor Sport on the Isle of Man in the midst of the Covid-19 pandemic the Directors of the Rob Vine Fund, Registered Charity No.954

@Lost Login - (and anyone else who thinks this doesn't apply to them particularly) I seem to recall you're an accountant so you can do this. Set up your own model of exponential growth in numbers

There's a lot of difficult concepts and difficult decisions being made here.  I'll have a go at a further explanation.  Possible long post ahead. First the difference between 'public health' and

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2 hours ago, Kopek said:

Not any easier than in their own empty home and there isn't any reason to believe they would more likely to breach the rules than the rest of us?

Less cost to the Govt.

Anyone know if those at Comis were all tested? Either on arrival or before leaving?

I have been in touch with a “guest” and they were not tested or seen by any health worker or otherwise throughout their stay.

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46 minutes ago, NoTail said:

It's very disappointing to have 4 more cases today. I realise it could be just an aberration. 

Question for Wrighty,  are we really doing tracing properly?  If the public were involved I think it must help. For instance Manx Radio could put out a message along the lines of

"A Ramsey man has been tested positive,  could everyone who went to the post office between 10am and 11am last Wednesday please make themselves known by ringing  x number"

Such messages would surely make tracing much more accurate. 

According to a post made by @wrighty last Friday:

On 4/24/2020 at 9:09 PM, wrighty said:

Tracing is in a forward direction. If someone tests positive they’re asked to identify who they might have had significant (<2m for >15min) contact with during their infective period. Those people are contacted and either tested, or asked to isolate - not aware of the exact mechanics of it. They’re not told who they got it from, but the process may identify it, and it’s possibly on the database. 
 

The point is to shut down onward spread, not to identify blame. 

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45 minutes ago, NoTail said:

It's very disappointing to have 4 more cases today. I realise it could be just an aberration. 

Question for Wrighty,  are we really doing tracing properly?  If the public were involved I think it must help. For instance Manx Radio could put out a message along the lines of

"A Ramsey man has been tested positive,  could everyone who went to the post office between 10am and 11am last Wednesday please make themselves known by ringing  x number"

Such messages would surely make tracing much more accurate. 

I'm hearing that 'several' people were infected following a party. Supposedly quite 'responsible' adults too I'm led to believe. If these infections are a result of this party, I'd be willing to volunteer to shoot them. There are some absolute idiots about, they don't deserve to be at liberty.

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5 minutes ago, Zarley said:

According to a post made by @wrighty last Friday:

I was thinking forward.  If our Ramsey man is tested positive on Friday then you want to trace those he has been in contact with over the previous couple of days. They could be monitored and maybe put in isolation.  I am not interested in how he got it or who he got it from.

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1 minute ago, NoTail said:

I was thinking forward.  If our Ramsey man is tested positive on Friday then you want to trace those he has been in contact with over the previous couple of days. They could be monitored and maybe put in isolation.  I am not interested in how he got it or who he got it from.

Thanks for the clarification. :thumbsup:

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1 hour ago, NoTail said:

It's very disappointing to have 4 more cases today. I realise it could be just an aberration. 

Question for Wrighty,  are we really doing tracing properly?  If the public were involved I think it must help. For instance Manx Radio could put out a message along the lines of

I don’t think a radio announcement would help. A contact is within 2m for 15 minutes. Popping to the post office doesn’t count, particularly since one assumes they have a queuing system in place which avoids being a contact. 
 

A positive case gets interviewed to find out who they’ve been in contact with, those contacts get traced and told to isolate or get tested as appropriate. If your man in the post office said he was at the counter for ages arguing over a tax disc or whatever then the postie may count as a contact and be traced. You don’t need Manx Radio. 
 

The 4 cases today have all been looked into appropriately. 

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We were incredibly lucky that Chris Helm was just kicking around some old lab equipment when low and behold under a dust sheet there was a real time PCR testing machine. Apart from being incredibly lucky it raised a few questions with me

1) I take it you can not toddle into the local currys and get one of the shelf

2) How much do these thing cost (39.990

3) What was it purchased for in the first place and why was it not used (causing embarrassment to the government with the environment results/incinerator/vehicle testing resulting in loss of income)

As people are fond of saying discuss

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regarding the testing of asymptomatic persons mentioned in zarleys quote above,  if they are showing no symptoms why would you even think to test them in the first place?  you'd assume they didn't have it.   does it mean that EVERYONE should be tested 

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53 minutes ago, wrighty said:

I don’t think a radio announcement would help. A contact is within 2m for 15 minutes. Popping to the post office doesn’t count, particularly since one assumes they have a queuing system in place which avoids being a contact. 
 

A positive case gets interviewed to find out who they’ve been in contact with, those contacts get traced and told to isolate or get tested as appropriate. If your man in the post office said he was at the counter for ages arguing over a tax disc or whatever then the postie may count as a contact and be traced. You don’t need Manx Radio. 
 

The 4 cases today have all been looked into appropriately. 

Thanks for the explanation.  It seems that the virus isn't very infectious after all if you need to be close to someone for 15 minutes. All the sanitizing of shopping trolley handles etc is presumably more of a psychological idea.

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1 hour ago, Max Power said:

I'm hearing that 'several' people were infected following a party. Supposedly quite 'responsible' adults too I'm led to believe. If these infections are a result of this party, I'd be willing to volunteer to shoot them. There are some absolute idiots about, they don't deserve to be at liberty.

If so...they should be isolating at Her Majesty's pleasure.

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6 minutes ago, Albert Tatlock said:

If so...they should be isolating at Her Majesty's pleasure.

Depends who you are of course....

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Just now, Non-Believer said:

Depends who you are of course....

You have to make examples of such people. They are destroying livlihoods. If we get rid of this virus, keep the borders shut, we can get back to some normalcy in a couple of months.

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1 minute ago, Albert Tatlock said:

You have to make examples of such people.

We undoubtedly will as long as they're not wealthy or influential :lol:

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