Why are we testing non sick people

3,739 Views | 41 Replies | Last: 3 yr ago by Infection_Ag11
dermdoc
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And reporting them as "cases" for a virus with an IFR of about 0.3%?

To my knowledge we have never done this with any other respiratory spread infections including those with a higher IFR.

And I am not trying to be inflammatory, it just seems totally illogical and unprecedented.
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dermdoc
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Would not it make sense to test symptomatic people like we do with all other respiratory spread infections so we can make a diagnosis and let that guide our treatment?
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nortex97
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dermdoc said:

Would not it make sense to test symptom a tic people like we do with all other respiratory spread infections so we can make a diagnosis and let that guide our treatment?
Correct. The testing now should only be done as per ILI/flu patients presenting with symptoms, unless the patient is in an at-risk category and based on contact tracing has met another metric justifying the test, or if the patient is paying out of pocket to get themselves tested (though this presents a false positive possibility individual liberty should allow it).

Random testing as happens at universities today is harmful, and expensive/wastes resources, period.
zachsccr
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By testing so many people at random, doesn't this help drive the IFR lower still? At some point money will finally talk loud enough and people will realize it's sucking funds that are needed else where for something that's not helping. I imagine the universities will have to stop it soon since their athletic departments are hemorrhaging money and tuition and secondary incomes are also lower.
eric76
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dermdoc said:

Would not it make sense to test symptomatic people like we do with all other respiratory spread infections so we can make a diagnosis and let that guide our treatment?
Would it not make sense to test people who have been exposed so that they might know if they have it now and should avoid interacting with others, especially the elderly?

Also, it's pretty easy for people to rationalize that they can't possibly have it.
bigtruckguy3500
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Several reasons that I can think of

1) Americans are obssessed with testing, even when it won't change management (or they're unwilling to do what they're supposed to - getting tested, but not isolating after)
2) Asymptomatic people can still spread it to others can cause death
3) While they likelihood of it is constantly diminishing, the ability for a large scale outbreak to increase hospitalization rates faster than capacity can surge is very real
4) Certain non-vulnerable populations (think a large military base) are unlikely to be affected with a high infection rate, but they have the potential to rapidly spread it among themselves, and then inoculate a large chunk of the local population when they go out on Friday/Saturday night.
5) Likewise, the Marines likely sparked an outbreak in Okinawa several months ago that lead to the deaths of several dozen locals. No way to prove it, but there hadn't been a case on the island in months until a new set of Marines showed up and there were nearly a hundred cases among them, and many had gone into town to eat and shop, driven in cabs, etc.
6) Unlike the flu, there's no vaccine, regardless of vaccine efficacy

But I do agree that we are overtesting. Most people don't need to be tested, even if they have a little bit of the sniffles, just stay home for a couple days.
AgE Doc
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dermdoc said:

And reporting them as "cases" for a virus with an IFR of about 0.3%?

To my knowledge we have never done this with any other respiratory spread infections including those with a higher IFR.

And I am not trying to be inflammatory, it just seems totally illogical and unprecedented.
Depending on local COVID prevalence I know nursing home workers regulations require testing once or twice a week. Our rural county has about 6 nursing homes with about 60 employees each. They have been having to test twice weekly because our percent positivity rate has been over 10%.

That is over 700 tests per week for our rural county on non-sick people. That has helped to drive down our percent positivity rate and we are now down to a 5% positivity rate and can have those employees do screening test once a week. We've had several test positive and then come down with symptoms a day or two after the swabbing was done. It has really saved us from having big nursing home outbreaks to try and identify those people early.
ramblin_ag02
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Most of our testing of non-sick people has been for employees of the nursing home, the public schools, the daycare, and the jail. They are testing to prevent an outbreak among a group of people that's pretty much stuck together.
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dermdoc
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And I do not have a problem with that. But there is a lot of random testing going on of young adults which makes no sense to me.
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Keegan99
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dermdoc said:

And I do not have a problem with that. But there is a lot of random testing going on of young adults which makes no sense to me.


Correct. Young people should be encouraged to live normally, stay away from the vulnerable, and, if actually ill, stay home until they are well.
Not a Bot
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The data shows the virus has a long latent phase, much longer than the flu. There have also been some papers written on evidence of pre-symptomatic spread. So if I'm not mistaken someone who has been inoculated but not yet symptomatic is a possible spreader of the virus.

GAC06
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AgE Doc said:

dermdoc said:

And reporting them as "cases" for a virus with an IFR of about 0.3%?

To my knowledge we have never done this with any other respiratory spread infections including those with a higher IFR.

And I am not trying to be inflammatory, it just seems totally illogical and unprecedented.
Depending on local COVID prevalence I know nursing home workers regulations require testing once or twice a week. Our rural county has about 6 nursing homes with about 60 employees each. They have been having to test twice weekly because our percent positivity rate has been over 10%.

That is over 700 tests per week for our rural county on non-sick people. That has helped to drive down our percent positivity rate and we are now down to a 5% positivity rate and can have those employees do screening test once a week. We've had several test positive and then come down with symptoms a day or two after the swabbing was done. It has really saved us from having big nursing home outbreaks to try and identify those people early.


Testing the same people twice a week every week to "drive down" the positivity rate to justify testing those same people once a week? Perhaps positivity rate isn't terribly useful in that instance.
Carnwellag2
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Moxley said:

The data shows the virus has a long latent phase, much longer than the flu. There have also been some papers written on evidence of pre-symptomatic spread. So if I'm not mistaken someone who has been inoculated but not yet symptomatic is a possible spreader of the virus.


the data shows that younger people (k-12) don't show symptoms and aren't spreaders
iisanaggie
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I don't know how many fit this scenario but I have known of a few asymptomatic young people who have been tested so that they can return to school after an exposure. Some school districts are allowing exposed students (school exposure who were sent home to quarantine) to present a negative test (performed 5-7 days after exposure) to return to school. This would be the only reason that I would allow my kids to get tested if they weren't showing any symptoms.
eric76
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GAC06 said:

AgE Doc said:

dermdoc said:

And reporting them as "cases" for a virus with an IFR of about 0.3%?

To my knowledge we have never done this with any other respiratory spread infections including those with a higher IFR.

And I am not trying to be inflammatory, it just seems totally illogical and unprecedented.
Depending on local COVID prevalence I know nursing home workers regulations require testing once or twice a week. Our rural county has about 6 nursing homes with about 60 employees each. They have been having to test twice weekly because our percent positivity rate has been over 10%.

That is over 700 tests per week for our rural county on non-sick people. That has helped to drive down our percent positivity rate and we are now down to a 5% positivity rate and can have those employees do screening test once a week. We've had several test positive and then come down with symptoms a day or two after the swabbing was done. It has really saved us from having big nursing home outbreaks to try and identify those people early.


Testing the same people twice a week every week to "drive down" the positivity rate to justify testing those same people once a week? Perhaps positivity rate isn't terribly useful in that instance.
Wouldn't it be more likely that a higher positivity rate would be far more likely to justify testing people again? It seems to me that the lower the positivity rate, the less need there is for routine testing.

Or do I misunderstand what a "positivity rate" means?
dermdoc
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eric76 said:

GAC06 said:

AgE Doc said:

dermdoc said:

And reporting them as "cases" for a virus with an IFR of about 0.3%?

To my knowledge we have never done this with any other respiratory spread infections including those with a higher IFR.

And I am not trying to be inflammatory, it just seems totally illogical and unprecedented.
Depending on local COVID prevalence I know nursing home workers regulations require testing once or twice a week. Our rural county has about 6 nursing homes with about 60 employees each. They have been having to test twice weekly because our percent positivity rate has been over 10%.

That is over 700 tests per week for our rural county on non-sick people. That has helped to drive down our percent positivity rate and we are now down to a 5% positivity rate and can have those employees do screening test once a week. We've had several test positive and then come down with symptoms a day or two after the swabbing was done. It has really saved us from having big nursing home outbreaks to try and identify those people early.


Testing the same people twice a week every week to "drive down" the positivity rate to justify testing those same people once a week? Perhaps positivity rate isn't terribly useful in that instance.
Wouldn't it be more likely that a higher positivity rate would be far more likely to justify testing people again? It seems to me that the lower the positivity rate, the less need there is for routine testing.

Or do I misunderstand what a "positivity rate" means?


The problem with a "positivity rate" is that it can change in a day. Imho, the only people who need to get tested are symptomatic people to help with treatment or people who work at NH, etc.
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eric76
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dermdoc said:

eric76 said:

GAC06 said:

AgE Doc said:

dermdoc said:

And reporting them as "cases" for a virus with an IFR of about 0.3%?

To my knowledge we have never done this with any other respiratory spread infections including those with a higher IFR.

And I am not trying to be inflammatory, it just seems totally illogical and unprecedented.
Depending on local COVID prevalence I know nursing home workers regulations require testing once or twice a week. Our rural county has about 6 nursing homes with about 60 employees each. They have been having to test twice weekly because our percent positivity rate has been over 10%.

That is over 700 tests per week for our rural county on non-sick people. That has helped to drive down our percent positivity rate and we are now down to a 5% positivity rate and can have those employees do screening test once a week. We've had several test positive and then come down with symptoms a day or two after the swabbing was done. It has really saved us from having big nursing home outbreaks to try and identify those people early.


Testing the same people twice a week every week to "drive down" the positivity rate to justify testing those same people once a week? Perhaps positivity rate isn't terribly useful in that instance.
Wouldn't it be more likely that a higher positivity rate would be far more likely to justify testing people again? It seems to me that the lower the positivity rate, the less need there is for routine testing.

Or do I misunderstand what a "positivity rate" means?


The problem with a "positivity rate" is that it can change in a day. Imho, the only people who need to get tested are symptomatic people to help with treatment or people who work at NH, etc.
It took me a bit to figure out that NH=Nursing Home.

How about those of us who are often in close contact with the elderly or with others who are at greater risk?
dermdoc
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eric76 said:

dermdoc said:

eric76 said:

GAC06 said:

AgE Doc said:

dermdoc said:

And reporting them as "cases" for a virus with an IFR of about 0.3%?

To my knowledge we have never done this with any other respiratory spread infections including those with a higher IFR.

And I am not trying to be inflammatory, it just seems totally illogical and unprecedented.
Depending on local COVID prevalence I know nursing home workers regulations require testing once or twice a week. Our rural county has about 6 nursing homes with about 60 employees each. They have been having to test twice weekly because our percent positivity rate has been over 10%.

That is over 700 tests per week for our rural county on non-sick people. That has helped to drive down our percent positivity rate and we are now down to a 5% positivity rate and can have those employees do screening test once a week. We've had several test positive and then come down with symptoms a day or two after the swabbing was done. It has really saved us from having big nursing home outbreaks to try and identify those people early.


Testing the same people twice a week every week to "drive down" the positivity rate to justify testing those same people once a week? Perhaps positivity rate isn't terribly useful in that instance.
Wouldn't it be more likely that a higher positivity rate would be far more likely to justify testing people again? It seems to me that the lower the positivity rate, the less need there is for routine testing.

Or do I misunderstand what a "positivity rate" means?


The problem with a "positivity rate" is that it can change in a day. Imho, the only people who need to get tested are symptomatic people to help with treatment or people who work at NH, etc.
It took me a bit to figure out that NH=Nursing Home.

How about those of us who are often in close contact with the elderly or with others who are at greater risk?


If over fifteen minutes of close contact yes get tested. But understand that the only accurate test is a PCR test which takes a couple of days to get the results of. The quick test is 50/50. And even the PCR is a snapshot in time. A negative test could be a positive test half a day later.

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GAC06
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AG
Repeatedly testing people who work in nursing homes makes sense to me. Repeatedly testing the same people to "drive down" the positivity rate makes that rate a pointless number.
eric76
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GAC06 said:

Repeatedly testing people who work in nursing homes makes sense to me. Repeatedly testing the same people to "drive down" the positivity rate makes that rate a pointless number.
Who does repeated testing for the purpose of driving down positivity?
GAC06
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It's what AgE Doc said they're doing in his rural community
eric76
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GAC06 said:

It's what AgE Doc said they're doing in his rural community
Ahhh. I missed that.

Thanks.

Or did I miss it?

Is this the post: https://texags.com/forums/84/topics/3147367/replies/57653862

If it is, his words were:
Quote:

Our rural county has about 6 nursing homes with about 60 employees each. They have been having to test twice weekly because our percent positivity rate has been over 10%.

That is over 700 tests per week for our rural county on non-sick people. That has helped to drive down our percent positivity rate and we are now down to a 5% positivity rate and can have those employees do screening test once a week.

I don't interpret this to mean that they were doing extra testing for the purpose of driving down positivity rates. Test more so we don't have to test more?

Rather, it seems to say that because of the required testing, positivity rates have fallen.
GAC06
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Chicken or the egg
docb
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A whole lot of this doesn't make any sense at all. If this pandemic is worldwide then how in the world are countries like India and Bangladesh not having overwhelming mortality? These people live in extreme density and poor sanitary conditions.
Keegan99
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Much stronger immune systems with strong T cell responses coupled with much younger population. If you don't have a lot of people over age 60, this isn't much of a pandemic.
Agsrback12
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We would see all kinds of records broken and hysteria if we did this during flu season. There are COVIDs carriers like there are flu carriers.

KlinkerAg11
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I think I know your answer but I'll ask anyways.

From a public policy perspective, once America vaccinates it's old immune compromised population do you think America should open as normal?

I would assume the Covid deaths and hospitalized would go down once this occurs.
dermdoc
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docb said:

A whole lot of this doesn't make any sense at all. If this pandemic is worldwide then how in the world are countries like India and Bangladesh having overwhelming mortality? These people live in extreme density and poor sanitary conditions.
Honestly? Because they do not have 24/7 media who have put politics into medicine and scared the crap out of people.

And what Keegan said. Exposing healthy, younger people to a novel virus is how you beat it.

Does anyone think India and Bangladesh shut down their schools or places of worship? Or markets? Or whatever?
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docb
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I honestly already knew the answer to this.

[We don't want the political comments on this forum. See WatchOle's thread stickied above. - Staff]
gomerschlep
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dermdoc said:

And I do not have a problem with that. But there is a lot of random testing going on of young adults which makes no sense to me.
I'm 36 and have no health issues. I have been tested multiple times. All negative.

I'm a Flight Paramedic and my only child is immunocompromised. He has to be quarantined away from me every time I get a COVID+ patient. PPE and infection control is damned near impossible in a rotor-wing flight environment. N95 masks do not fit properly under our helmets and we are all crammed in a tin can like sardines for up to an hour at the time.

I wait about 10 days after the patient contact and then go get tested. It's negative, kiddo gets to come home.
dermdoc
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gomerschlep said:

dermdoc said:

And I do not have a problem with that. But there is a lot of random testing going on of young adults which makes no sense to me.
I'm 36 and have no health issues. I have been tested multiple times. All negative.

I'm a Flight Paramedic and my only child is immunocompromised. He has to be quarantined away from me every time I get a COVID+ patient. PPE and infection control is damned near impossible in a rotor-wing flight environment. N95 masks do not fit properly under our helmets and we are all crammed in a tin can like sardines for up to an hour at the time.

I wait about 10 days after the patient contact and then go get tested. It's negative, kiddo gets to come home.
May I ask how your child is immune compromised? I have an immune compromised daughter and have not restricted her from anything.

She has a much bigger risk from a lot of other stuff than covid. Basically if you are not over 80, are not grossly obese and/or diabetic than it is kind of like the flu now. Not so much in March but now.

And with all due respect, your job's protocol is bs. I see over fifty people a day, am 65, and stay with my immune compromised daughter three nights a week. And she works at my office.
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docb
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Fair enough. I'll email my physician credentials to you.
Old RV Ag
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dermdoc said:

gomerschlep said:

dermdoc said:

And I do not have a problem with that. But there is a lot of random testing going on of young adults which makes no sense to me.
I'm 36 and have no health issues. I have been tested multiple times. All negative.

I'm a Flight Paramedic and my only child is immunocompromised. He has to be quarantined away from me every time I get a COVID+ patient. PPE and infection control is damned near impossible in a rotor-wing flight environment. N95 masks do not fit properly under our helmets and we are all crammed in a tin can like sardines for up to an hour at the time.

I wait about 10 days after the patient contact and then go get tested. It's negative, kiddo gets to come home.
May I ask how your child is immune compromised? I have an immune compromised daughter and have not restricted her from anything.

She has a much bigger risk from a lot of other stuff than covid. Basically if you are not over 80, are not grossly obese and/or diabetic than it is kind of like the flu now. Not so much in March but now.

And with all due respect, your protocol is bs. I see over fifty people a day, am 65, and stay with my immune compromised daughter three nights a week. And she works at my office.
Come on derm....
gomerschlep
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dermdoc said:

gomerschlep said:

dermdoc said:

And I do not have a problem with that. But there is a lot of random testing going on of young adults which makes no sense to me.
I'm 36 and have no health issues. I have been tested multiple times. All negative.

I'm a Flight Paramedic and my only child is immunocompromised. He has to be quarantined away from me every time I get a COVID+ patient. PPE and infection control is damned near impossible in a rotor-wing flight environment. N95 masks do not fit properly under our helmets and we are all crammed in a tin can like sardines for up to an hour at the time.

I wait about 10 days after the patient contact and then go get tested. It's negative, kiddo gets to come home.
May I ask how your child is immune compromised? I have an immune compromised daughter and have not restricted her from anything.

She has a much bigger risk from a lot of other stuff than covid. Basically if you are not over 80, are not grossly obese and/or diabetic than it is kind of like the flu now. Not so much in March but now.

And with all due respect, your protocol is bs. I see over fifty people a day, am 65, and stay with my immune compromised daughter three nights a week. And she works at my office.
Well the flu is usually a 2 week hospitalization for us. It happens about once a year.

So yeah we'd like to avoid that. And I'll stick to taking advice from our Pulmonologist.
dermdoc
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Old RV Ag said:

dermdoc said:

gomerschlep said:

dermdoc said:

And I do not have a problem with that. But there is a lot of random testing going on of young adults which makes no sense to me.
I'm 36 and have no health issues. I have been tested multiple times. All negative.

I'm a Flight Paramedic and my only child is immunocompromised. He has to be quarantined away from me every time I get a COVID+ patient. PPE and infection control is damned near impossible in a rotor-wing flight environment. N95 masks do not fit properly under our helmets and we are all crammed in a tin can like sardines for up to an hour at the time.

I wait about 10 days after the patient contact and then go get tested. It's negative, kiddo gets to come home.
May I ask how your child is immune compromised? I have an immune compromised daughter and have not restricted her from anything.

She has a much bigger risk from a lot of other stuff than covid. Basically if you are not over 80, are not grossly obese and/or diabetic than it is kind of like the flu now. Not so much in March but now.

And with all due respect, your protocol is bs. I see over fifty people a day, am 65, and stay with my immune compromised daughter three nights a week. And she works at my office.
Come on derm....


I was talking about how his job made him do stuff. Or not do stuff. I should have said the job's protocol. Sorry and I will change it.

Please accept my apologies and by all means listen to your real doc.

And as the father of a special needs daughter myself I would never question any parent's treatment stuff.

So so sorry.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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