Hapless Bills Fan Posted July 11, 2020 Posted July 11, 2020 6 minutes ago, HappyDays said: Unfortunately a few states may have ruined it for the rest of us. If we had spent three weeks in a national lockdown early on the pandemic would be all but done by now. Our next chance was to have a national mask policy. Now that ship has sailed too. Several states are now getting close to ICU capacity and the death rate in those states has started going up again. A couple months ago I was optimistic that an NFL season would somehow happen. I underestimated how little this country trusts scientists. At this point I don't see how a season can happen until there is a vaccine. If they can somehow work a mask into the helmet that's the only way. That’s probably too simple. One problem is that in March, a lot of places that are spiking now didn’t have much of an outbreak. People who weren’t hearing sirens all day long and seeing trucks full of bodies were susceptible to a message “fake virus” “fear mongering” etc. Then as lockdowns ended, a lot of those places and people got the message “it’s done, it’s over, we’re open” or something like that. They didn’t get the message that the virus is still circulating in the community, caution and precautions are still necessary. Not being an epidemiologist, take this with a grain of salt but my guess is that maybe 6 or 7 steps could dial things back: 1) masks. Make them easy, make them common, make them something everyone does 2) no dense public gatherings indoors - bars, church revivals, rallies etc 3) ask people to limit the size of private Indoor social events to 6-10 (Probably 3-4 more) A lot of the outbreaks in this state are being fueled around churches, church revivals, a group of 25 friends going from activity to activity together, weddings etc. Cut those, and you cut the transmission chain. But we’re really dealing with a misinformation epidemic as well as a disease pandemic. The CDC put out guidance for reopening churches. The White House told them it wasn’t approved and made them take it down and edit it according to what was politically acceptable. You can’t fight a disease with political expediency, it simply doesn’t oblige. 1
Hapless Bills Fan Posted July 11, 2020 Posted July 11, 2020 5 hours ago, Mr. WEO said: You're being very disingenuous by insinuating that there is some genuine distrust of testing results because the sensitivity is what you claim. I’m not insinuating anything, nor am I making any personal claim. I thought that was fairly widely known in the medical community, but apparently not (for just one example - others in the COVID-19 threads). You stated that they were “proven negative”. One simply can not prove that someone does not have a contagious disease with a negative clinical test. I’m not speaking about “genuine distrust of testing results” whatever that means, but of Clinical Diagnostics 101. 5 hours ago, Mr. WEO said: But you do understand that a sensitivity of 80% is infinitely greater than zero, which is the sensitivity of no testing. There is no testing of supermarket workers or their patrons prior to them entering the store. There is no testing of HCW's before they got to work (or at all, if asymptomatic), nor their patients (or visitors, etc) unless symptomatic of for elective surgery. So these players will have far more protection by the limitations of who they come in contact with (at work) and those persons current (as possible) testing status. If you have gone to the grocery store at all you will see no social distancing. Depending where you live, possibly no masking either (by shoppers). There is no real protection for these workers. And you certainly know that any amount of PPE has not prevented HCWs from the disease. Having 100 guys in a facility who test negative every day or two plus screening, plus limiting access to outsiders (no matter what degree of contact they have once they get in the door) results in a FAR safer environment than the other workers I have mentioned exist in. Suggesting otherwise is not persuasive, to say the least. As for this, it’s pretty clear now that you’re unwilling or unable to acknowledge the differences between the intensity and duration of contact involved in playing a football game And visiting a grocery store, so further reiteration of a point you’re unwilling to acknowledge is not worth my time. 1
Hapless Bills Fan Posted July 11, 2020 Posted July 11, 2020 5 hours ago, SirAndrew said: I truly respect your opinions, and you come across as being very educated and informed. I apologize if I came across as thinking I know anything about this. I’m not a scientist, educator, or epidemiologist. I’m simply sharing personal anecdotes of what I’m seeing in the communities I work. I don’t have an appropriate link to the data I want, because it’s not out there on the web. Sure, I can find the numbers of positives for each county, but nothing shows when they occurred The NY Forward site has extensive bar graphs showing testing results for each region and even each county day by day, along with the number of tests done each day and the % positives. So go for it: https://forward.ny.gov/percentage-positive-results-county-dashboard Which counties are seeing more positives in the last month than they saw in the first three months of the pandemics? Would really like to know. I do know what you mean about people, even in NYS, not following the rules. We drove through the Southern Tier at the end of May to help my kid move to Buffalo. At rest stops and fuel stops, a lot of unmasked people, maybe one in three or four masked. Same thing as the spiking states would be my guess - it stayed pretty distant from them and they don’t see the need. But the stores did have workers protected with barriers and masks.
Chandler#81 Posted July 11, 2020 Posted July 11, 2020 10 hours ago, HappyDays said: Unfortunately a few states may have ruined it for the rest of us. If we had spent three weeks in a national lockdown early on the pandemic would be all but done by now. Our next chance was to have a national mask policy. Now that ship has sailed too. Several states are now getting close to ICU capacity and the death rate in those states has started going up again. A couple months ago I was optimistic that an NFL season would somehow happen. I underestimated how little this country trusts scientists. At this point I don't see how a season can happen until there is a vaccine. If they can somehow work a mask into the helmet that's the only way. Jesus Christ ?♂️! No, Einstein, it wouldn’t. And it WON’T be until a viable vaccine is found and globally distributed. Forget about 2020 and hope for ‘21. Masks/washing/distancing will only aide you from getting it or spreading it. Everything else is bunk. 1
Ralonzo Posted July 11, 2020 Posted July 11, 2020 On 7/7/2020 at 10:15 PM, EasternOHBillsFan said: playing Russian roulette with others lives. I also want a gun that holds somewhere from 400 to 2000 rounds, or maybe way more, we don't quite have enough data to know yet how many we need.
Mr. WEO Posted July 11, 2020 Posted July 11, 2020 10 hours ago, Hapless Bills Fan said: I’m not insinuating anything, nor am I making any personal claim. I thought that was fairly widely known in the medical community, but apparently not (for just one example - others in the COVID-19 threads). You stated that they were “proven negative”. One simply can not prove that someone does not have a contagious disease with a negative clinical test. I’m not speaking about “genuine distrust of testing results” whatever that means, but of Clinical Diagnostics 101. As for this, it’s pretty clear now that you’re unwilling or unable to acknowledge the differences between the intensity and duration of contact involved in playing a football game And visiting a grocery store, so further reiteration of a point you’re unwilling to acknowledge is not worth my time. We are talking about working in the store. Anyway, as someone who is actually part of "the medical community" and regularly exposed to COVID in a meaningful way, I can tell you that when a patient is tested negative prior to surgery, we absolutely consider them "proven negative" for purposes of risk reduction to them and to us. Every testing entity, including the NFL, rightly assumes this, your "not every test is 100%/sensitive/specific/accurate so tests really can't prove anything" position not withstanding. It should go without mentioning (but clearly I must) that repeatedly testing the same individuals in short time intervals will increase the confidence in a negative test. It would also follow that such individuals would pose the lowest risk to each other---no matter how intimate the contact. Two NFL players who serially test negative will have an extremely small theoretical risk to infect each other no matter how long they grapple, drool sweat, spit on each other. It would be orders of magnitude lower than a supermarket patron pulling their mask off (if they even have one) and sneezing on or near a worker, who will touch his or her face at some point after contacting those surfaces coated in the patron's sneeze effluent. This will happen countless times per day. Also, it should go without saying (but clearly I must) that if NFL players were at all concerned about small but real risks to their short and long term health, they would never play the game. 3
HappyDays Posted July 11, 2020 Posted July 11, 2020 5 hours ago, Chandler#81 said: Masks/washing/distancing will only aide you from getting it or spreading it. So if those things stop the virus from spreading, what else is there? You just described what ending the pandemic looks like. We would not have fully eradicated it, but even once a vaccine comes out that won't happen. The point is to control it as well as possible. Banning long distance travel, mandating masks, and contact tracing would have gotten it under control if we had had national policies. Other countries have gotten back to some level of normal life. Meanwhile we're breaking new case records and the death rate has started increasing again. 4
FireChans Posted July 11, 2020 Posted July 11, 2020 4 hours ago, Mr. WEO said: We are talking about working in the store. Anyway, as someone who is actually part of "the medical community" and regularly exposed to COVID in a meaningful way, I can tell you that when a patient is tested negative prior to surgery, we absolutely consider them "proven negative" for purposes of risk reduction to them and to us. Every testing entity, including the NFL, rightly assumes this, your "not every test is 100%/sensitive/specific/accurate so tests really can't prove anything" position not withstanding. It should go without mentioning (but clearly I must) that repeatedly testing the same individuals in short time intervals will increase the confidence in a negative test. It would also follow that such individuals would pose the lowest risk to each other---no matter how intimate the contact. Two NFL players who serially test negative will have an extremely small theoretical risk to infect each other no matter how long they grapple, drool sweat, spit on each other. It would be orders of magnitude lower than a supermarket patron pulling their mask off (if they even have one) and sneezing on or near a worker, who will touch his or her face at some point after contacting those surfaces coated in the patron's sneeze effluent. This will happen countless times per day. Also, it should go without saying (but clearly I must) that if NFL players were at all concerned about small but real risks to their short and long term health, they would never play the game. There are virtually zero tests with 100% sensitivity or specificity. And yet everyday, real health care providers make real health care decisions using those tests. A patient comes in with vague RLQ pain and the CT is negative. A CT’s sensitivity is 91% for acute appendicitis. Then they go home. If you got a SECOND CT that was negative, the odds of that person having a missed appendicitis would be virtually 0. 2
Gugny Posted July 11, 2020 Posted July 11, 2020 1 hour ago, HappyDays said: So if those things stop the virus from spreading, what else is there? You just described what ending the pandemic looks like. We would not have fully eradicated it, but even once a vaccine comes out that won't happen. The point is to control it as well as possible. Banning long distance travel, mandating masks, and contact tracing would have gotten it under control if we had had national policies. Other countries have gotten back to some level of normal life. Meanwhile we're breaking new case records and the death rate has started increasing again. What you're describing would have required leadership and intelligence. We don't have that at a national level, clearly. And unfortunately, some states have those two necessary things, but most do not, as we're seeing now. 1
Hapless Bills Fan Posted July 11, 2020 Posted July 11, 2020 19 hours ago, Hapless Bills Fan said: That’s probably too simple. One problem is that in March, a lot of places that are spiking now didn’t have much of an outbreak. People who weren’t hearing sirens all day long and seeing trucks full of bodies were susceptible to a message “fake virus” “fear mongering” etc. Then as lockdowns ended, a lot of those places and people got the message “it’s done, it’s over, we’re open” or something like that. They didn’t get the message that the virus is still circulating in the community, caution and precautions are still necessary. Not being an epidemiologist, take this with a grain of salt but my guess is that maybe 6 or 7 steps could dial things back: 1) masks. Make them easy, make them common, make them something everyone does 2) no dense public gatherings indoors - bars, church revivals, rallies etc 3) ask people to limit the size of private Indoor social events to 6-10 (Probably 3-4 more) A lot of the outbreaks in this state are being fueled around churches, church revivals, a group of 25 friends going from activity to activity together, weddings etc. Cut those, and you cut the transmission chain. But we’re really dealing with a misinformation epidemic as well as a disease pandemic. The CDC put out guidance for reopening churches. The White House told them it wasn’t approved and made them take it down and edit it according to what was politically acceptable. You can’t fight a disease with political expediency, it simply doesn’t oblige. I just want to link in here to an interview with an eminent epidemiologist about how he feels we can still rein covid-19 in. What I think on the matter doesn't have the weight of actual epidemiologist training (just exposure ? and science) but it's notable to me that this guy does not have "shut everything down again" on his "epidemic to do list"
Hapless Bills Fan Posted July 12, 2020 Posted July 12, 2020 On 7/11/2020 at 8:25 AM, Mr. WEO said: Anyway, as someone who is actually part of "the medical community" and regularly exposed to COVID in a meaningful way, I can tell you that when a patient is tested negative prior to surgery, we absolutely consider them "proven negative" for purposes of risk reduction to them and to us. Strange. Now I don’t work in the medical profession any more, but I was an EMT at the dawn of Universal Precautions in response to Hepatitis B/HIV. And it was explained to us in our training that you must assume, and take precautions, as though everyone is infected, even if they show you a test result they received that day saying they’re negative, because no test is 100% sensitive and even if it’s correct, it’s just a snapshot in time - the person could have been incubating disease that was too low to detect when the test was taken and is now developed and infectious. My neighbor’s boyfriend was just hospitalized with complicated diverticulitis. They tested him for Covid-19 and he was negative on admittance. They tested him again before emergency surgery and he was negative. And he still had to wear a procedure mask 100% of the freakin’ time , all day and all night because “no test is 100% sensitive and you could have been exposed before admission and be incubating the disease”. He would have loved to be treated as “proven negative” and relieved of that damned mask. But your hospital/clinic infection control staff frames it as “consider a patient that is tested negative to be proven negative”? What does that mean, practically speaking? Does the patient not have to wear a mask in their room or the hallway enroute to the OR? Does it mean the anesthesiologist intubates them in scrubs and with a surgical mask, not an N95 and a face shield and impermiable gown or suit? (horrid, if so!). I would have thought it’s a risk-reduction strategy to protect you and your staff by eliminating known positive patients from high-contact, but that all staff would still treat the patient as “potentially infectious” because no test is 100%. Well, learn something every day. Quote Every testing entity, including the NFL, rightly assumes this I don’t believe this is factually correct that “every testing entity” assumes this, or that they’re right if they do. One of my early gigs was doing academic research for a guy who happened to be Director of Clinical Labs at a major hospital here and that’s not what he explained when we were discussing interpretation of test results (his academic research, the work I did, involved working with massive chunks of bloody tissue from patients who had tested negative for HIV and Hep B, but we still had infection control procedures and treated the tissue as potentially infectious material). Maybe I should go re-listen to Weird Al (“Everything You Know Is Wrong”) to understand modern hospital infection control philosophy and practice, where negative tests mean the sample is “proven negative” and the people doing my former job today could doff some of that that uncomfortable protective gear and go back to slicing up human tissue wearing a cotton lab coat, safety glasses, and a single layer of thin nitrile gloves Quote your "not every test is 100%/sensitive/specific/accurate so tests really can't prove anything" position Misrepresentation/distortion of my “position”. I said specifically you can not prove someone is negative on the basis of a clinical test with mediocre sensitivity. That’s different than saying “tests can’t prove anything”. One has to understand the test and its limitations. The selectivity is excellent - a positive test means the patient has the infection. Quote not withstanding. It should go without mentioning (but clearly I must) that repeatedly testing the same individuals in short time intervals will increase the confidence in a negative test. Come on, WEO, you know better than this, or you should. I don’t know orthopedics, but I know a damned lot about testing. If a negative test is caused by a fault with the actual test itself, sure, repeat testing will improve sensitivity. But Covid test faults are not believed to be all of the problem or even the main problem with false negatives in COVID-19 RT PCR tests, assuming a good validated test is used. What a negative RT-PCR Covid-19 test shows is that the patient did not have a threshold level of virus in their nasopharyngeal swab sample (or saliva sample, or whatever is being tested) at the time of the test. If they are being swabbed and the same person is taking swabs with poor technique, repeat negative results can occur because of the same sample collection technique. If the person has a developing infection that will cross the LOD threshold on Day 5, testing them on day 1, 2, 3, and 4 will not pick it up. It may give confidence if they’re playing the game on Day 5, but it may be false confidence. We just don’t know enough yet about the point (and viral titer) at which someone becomes infectious and it undoubtedly varies with the proximity, intensity, and duration of contact. We also tend to just test nasopharyngeal samples in this country. If you have the virus but it’s hanging out somewhere else like lower respiratory or GI tract, an UR test won’t pick it up. Quote It would also follow that such individuals would pose the lowest risk to each other---no matter how intimate the contact. Two NFL players who serially test negative will have an extremely small theoretical risk to infect each other no matter how long they grapple, drool sweat, spit on each other. It would be orders of magnitude lower than a supermarket patron pulling their mask off (if they even have one) and sneezing on or near a worker, who will touch his or her face at some point after contacting those surfaces coated in the patron's sneeze effluent. This will happen countless times per day. As far as I can tell, the only data we really have about infection risk is that most infections that have been traced arise from prolonged close contact. And there are few things that involve closer contact than being on the football field for an hour-plus game. I would welcome data showing that masked or barrier protected grocery workers are being infected by unmasked shoppers sneezing on them or by fomite transmission from sneezed-on surfaces. The latest guidance from the CDC claims that fomite transmission (touching contaminated surfaces) does not appear to be a major route of disease transmission, FWIW. The grocery worker can minimize their risk by washing or sanitizing hands thoroughly between touching any surfaces and touching their face. And of course, the contacts aren’t “countless” - each store well knows how many shoppers they have, what the peak times of day are, etc. If they are not adopting “best practices” such as limiting # of patrons, blocking off aisles that are being restocked, putting up barriers between checkers and customers, etc. Shame on Them!!!!! But I don’t understand the argument that poor infection control on the part of a store that fails to mitigate risk to their workers (again, Shame on Them!) somehow reduces the risk of playing a close contact peak-exertionAl physical game for an hour. Quote Also, it should go without saying (but clearly I must) that if NFL players were at all concerned about small but real risks to their short and long term health, they would never play the game. WEO, we all get to pick our risks. I don’t understand the specifics of football injury guarantees or disability insurance - do you? But clearly, if a player contracts COVID-19, it might be hard to prove it was contracted during the performance of football duties, so it could be considered a “NFI” in which case the player doesn’t get paid and any disabilities might not be covered by the league. Teams have tried to make this argument about players who contracted MRSA within the team facility.
Mr. WEO Posted July 12, 2020 Posted July 12, 2020 2 hours ago, Hapless Bills Fan said: Strange. Now I don’t work in the medical profession any more, but I was an EMT at the dawn of Universal Precautions in response to Hepatitis B/HIV. And it was explained to us in our training that you must assume, and take precautions, as though everyone is infected, even if they show you a test result they received that day saying they’re negative, because no test is 100% sensitive and even if it’s correct, it’s just a snapshot in time - the person could have been incubating disease that was too low to detect when the test was taken and is now developed and infectious. My neighbor’s boyfriend was just hospitalized with complicated diverticulitis. They tested him for Covid-19 and he was negative on admittance. They tested him again before emergency surgery and he was negative. And he still had to wear a procedure mask 100% of the freakin’ time , all day and all night because “no test is 100% sensitive and you could have been exposed before admission and be incubating the disease”. He would have loved to be treated as “proven negative” and relieved of that damned mask. But your hospital/clinic infection control staff frames it as “consider a patient that is tested negative to be proven negative”? What does that mean, practically speaking? Does the patient not have to wear a mask in their room or the hallway enroute to the OR? Does it mean the anesthesiologist intubates them in scrubs and with a surgical mask, not an N95 and a face shield and impermiable gown or suit? (horrid, if so!). I would have thought it’s a risk-reduction strategy to protect you and your staff by eliminating known positive patients from high-contact, but that all staff would still treat the patient as “potentially infectious” because no test is 100%. Well, learn something every day. I don’t believe this is factually correct that “every testing entity” assumes this, or that they’re right if they do. One of my early gigs was doing academic research for a guy who happened to be Director of Clinical Labs at a major hospital here and that’s not what he explained when we were discussing interpretation of test results (his academic research, the work I did, involved working with massive chunks of bloody tissue from patients who had tested negative for HIV and Hep B, but we still had infection control procedures and treated the tissue as potentially infectious material). Maybe I should go re-listen to Weird Al (“Everything You Know Is Wrong”) to understand modern hospital infection control philosophy and practice, where negative tests mean the sample is “proven negative” and the people doing my former job today could doff some of that that uncomfortable protective gear and go back to slicing up human tissue wearing a cotton lab coat, safety glasses, and a single layer of thin nitrile gloves Misrepresentation/distortion of my “position”. I said specifically you can not prove someone is negative on the basis of a clinical test with mediocre sensitivity. That’s different than saying “tests can’t prove anything”. One has to understand the test and its limitations. The selectivity is excellent - a positive test means the patient has the infection. Come on, WEO, you know better than this, or you should. I don’t know orthopedics, but I know a damned lot about testing. If a negative test is caused by a fault with the actual test itself, sure, repeat testing will improve sensitivity. But Covid test faults are not believed to be all of the problem or even the main problem with false negatives in COVID-19 RT PCR tests, assuming a good validated test is used. What a negative RT-PCR Covid-19 test shows is that the patient did not have a threshold level of virus in their nasopharyngeal swab sample (or saliva sample, or whatever is being tested) at the time of the test. If they are being swabbed and the same person is taking swabs with poor technique, repeat negative results can occur because of the same sample collection technique. If the person has a developing infection that will cross the LOD threshold on Day 5, testing them on day 1, 2, 3, and 4 will not pick it up. It may give confidence if they’re playing the game on Day 5, but it may be false confidence. We just don’t know enough yet about the point (and viral titer) at which someone becomes infectious and it undoubtedly varies with the proximity, intensity, and duration of contact. We also tend to just test nasopharyngeal samples in this country. If you have the virus but it’s hanging out somewhere else like lower respiratory or GI tract, an UR test won’t pick it up. As far as I can tell, the only data we really have about infection risk is that most infections that have been traced arise from prolonged close contact. And there are few things that involve closer contact than being on the football field for an hour-plus game. I would welcome data showing that masked or barrier protected grocery workers are being infected by unmasked shoppers sneezing on them or by fomite transmission from sneezed-on surfaces. The latest guidance from the CDC claims that fomite transmission (touching contaminated surfaces) does not appear to be a major route of disease transmission, FWIW. The grocery worker can minimize their risk by washing or sanitizing hands thoroughly between touching any surfaces and touching their face. And of course, the contacts aren’t “countless” - each store well knows how many shoppers they have, what the peak times of day are, etc. If they are not adopting “best practices” such as limiting # of patrons, blocking off aisles that are being restocked, putting up barriers between checkers and customers, etc. Shame on Them!!!!! But I don’t understand the argument that poor infection control on the part of a store that fails to mitigate risk to their workers (again, Shame on Them!) somehow reduces the risk of playing a close contact peak-exertionAl physical game for an hour. WEO, we all get to pick our risks. I don’t understand the specifics of football injury guarantees or disability insurance - do you? But clearly, if a player contracts COVID-19, it might be hard to prove it was contracted during the performance of football duties, so it could be considered a “NFI” in which case the player doesn’t get paid and any disabilities might not be covered by the league. Teams have tried to make this argument about players who contracted MRSA within the team facility. Name any health care entity that has simply stopped testing due to concerns over the validity of the tests. Serially testing the same cohort over and over will improve sensitivity. The "technique" is widely practiced and you would have to show me were a large testing entity has stopped or had to stop testing due to their "poor technique". Those would be extreme outliers. Current COVID negative patients are presumed negative--at every hospital everywhere. I and everyone I work with (and the health care field as a whole) comfortably assume this because no entity has determined that we should not. Individuals testing negative daily can be described as proven negative without a lot of mental heavy lifting. People have tested positive (in bunches) after simply attending house parties and the like. Intimate sweaty prolonged strenuous physical contact is clearly not required. Such contact between 2 individuals who serially and repeated test negative imparts, essentially, zero risk to them--your protestations not withstanding. Patients who are are COVID negative wear masks in the hospital for their OWN protection--especially now that visiting restrictions have eased. That's not just a policy at my hospitals. Most injured players get put on IR and get paid. Ones under contract who struggle to return often work out an injury settlement on the non-guaranteed portion of their contract. NFL players are free to "opt out" of this season without penalty of fines. This is easier than you are making it. Ask anyone in this country the following: "would you rather get paid millions of dollars to show up to your job (which is actually a game played by kids for free everywhere) while receiving precautionary and health surveillance measures that exist nowhere in this country outside of the White House....or would you like to strap on your same old mask and head to work for $7/hour in a place where the boss has put up some scraps of plexiglass to keep the minimize the final 3 minutes of worker/customer contact (for the cashiers only though) and take your chances that the great unwashed will keep their mask on and not cough or spit on the food you handle or sneeze on you?" No living human would choose that latter. Again, if players, like you, cannot be made to feel fully confident in the current testing infrastructure, they have the fairly unique luxury of sitting out the season at home with tons in the bank. They won't get paid this year, but they will still have jobs and they won't starve or lose their homes/cars/etc.
SirAndrew Posted July 12, 2020 Posted July 12, 2020 4 hours ago, Hapless Bills Fan said: Strange. Now I don’t work in the medical profession any more, but I was an EMT at the dawn of Universal Precautions in response to Hepatitis B/HIV. And it was explained to us in our training that you must assume, and take precautions, as though everyone is infected, even if they show you a test result they received that day saying they’re negative, because no test is 100% sensitive and even if it’s correct, it’s just a snapshot in time - the person could have been incubating disease that was too low to detect when the test was taken and is now developed and infectious. My neighbor’s boyfriend was just hospitalized with complicated diverticulitis. They tested him for Covid-19 and he was negative on admittance. They tested him again before emergency surgery and he was negative. And he still had to wear a procedure mask 100% of the freakin’ time , all day and all night because “no test is 100% sensitive and you could have been exposed before admission and be incubating the disease”. He would have loved to be treated as “proven negative” and relieved of that damned mask. But your hospital/clinic infection control staff frames it as “consider a patient that is tested negative to be proven negative”? What does that mean, practically speaking? Does the patient not have to wear a mask in their room or the hallway enroute to the OR? Does it mean the anesthesiologist intubates them in scrubs and with a surgical mask, not an N95 and a face shield and impermiable gown or suit? (horrid, if so!). I would have thought it’s a risk-reduction strategy to protect you and your staff by eliminating known positive patients from high-contact, but that all staff would still treat the patient as “potentially infectious” because no test is 100%. Well, learn something every day. I don’t believe this is factually correct that “every testing entity” assumes this, or that they’re right if they do. One of my early gigs was doing academic research for a guy who happened to be Director of Clinical Labs at a major hospital here and that’s not what he explained when we were discussing interpretation of test results (his academic research, the work I did, involved working with massive chunks of bloody tissue from patients who had tested negative for HIV and Hep B, but we still had infection control procedures and treated the tissue as potentially infectious material). Maybe I should go re-listen to Weird Al (“Everything You Know Is Wrong”) to understand modern hospital infection control philosophy and practice, where negative tests mean the sample is “proven negative” and the people doing my former job today could doff some of that that uncomfortable protective gear and go back to slicing up human tissue wearing a cotton lab coat, safety glasses, and a single layer of thin nitrile gloves Misrepresentation/distortion of my “position”. I said specifically you can not prove someone is negative on the basis of a clinical test with mediocre sensitivity. That’s different than saying “tests can’t prove anything”. One has to understand the test and its limitations. The selectivity is excellent - a positive test means the patient has the infection. Come on, WEO, you know better than this, or you should. I don’t know orthopedics, but I know a damned lot about testing. If a negative test is caused by a fault with the actual test itself, sure, repeat testing will improve sensitivity. But Covid test faults are not believed to be all of the problem or even the main problem with false negatives in COVID-19 RT PCR tests, assuming a good validated test is used. What a negative RT-PCR Covid-19 test shows is that the patient did not have a threshold level of virus in their nasopharyngeal swab sample (or saliva sample, or whatever is being tested) at the time of the test. If they are being swabbed and the same person is taking swabs with poor technique, repeat negative results can occur because of the same sample collection technique. If the person has a developing infection that will cross the LOD threshold on Day 5, testing them on day 1, 2, 3, and 4 will not pick it up. It may give confidence if they’re playing the game on Day 5, but it may be false confidence. We just don’t know enough yet about the point (and viral titer) at which someone becomes infectious and it undoubtedly varies with the proximity, intensity, and duration of contact. We also tend to just test nasopharyngeal samples in this country. If you have the virus but it’s hanging out somewhere else like lower respiratory or GI tract, an UR test won’t pick it up. As far as I can tell, the only data we really have about infection risk is that most infections that have been traced arise from prolonged close contact. And there are few things that involve closer contact than being on the football field for an hour-plus game. I would welcome data showing that masked or barrier protected grocery workers are being infected by unmasked shoppers sneezing on them or by fomite transmission from sneezed-on surfaces. The latest guidance from the CDC claims that fomite transmission (touching contaminated surfaces) does not appear to be a major route of disease transmission, FWIW. The grocery worker can minimize their risk by washing or sanitizing hands thoroughly between touching any surfaces and touching their face. And of course, the contacts aren’t “countless” - each store well knows how many shoppers they have, what the peak times of day are, etc. If they are not adopting “best practices” such as limiting # of patrons, blocking off aisles that are being restocked, putting up barriers between checkers and customers, etc. Shame on Them!!!!! But I don’t understand the argument that poor infection control on the part of a store that fails to mitigate risk to their workers (again, Shame on Them!) somehow reduces the risk of playing a close contact peak-exertionAl physical game for an hour. WEO, we all get to pick our risks. I don’t understand the specifics of football injury guarantees or disability insurance - do you? But clearly, if a player contracts COVID-19, it might be hard to prove it was contracted during the performance of football duties, so it could be considered a “NFI” in which case the player doesn’t get paid and any disabilities might not be covered by the league. Teams have tried to make this argument about players who contracted MRSA within the team facility. You seem very well informed on testing, so I thought you might be able to answer this. I’m curious as to why saliva testing hasn’t become more common ? I’ve witnessed poor technique, and lack of patient cooperation to be a HUGE problem with the nasopharyngeal sample. It confuses me as to why we aren’t trying harder to find something that’s a little more fool proof. I’ve seen countless people have tests that read negative, positive, negative, positive. They have told me the test was more uncomfortable when they got the positive result, and I’ve witnessed questionable swab technique many times. We have tons of medical personal who don’t usually do this kind of thing, attempting to swab people. It seems like another method might be more optimal.
NoSaint Posted July 12, 2020 Posted July 12, 2020 On 7/10/2020 at 9:18 PM, HappyDays said: Unfortunately a few states may have ruined it for the rest of us. If we had spent three weeks in a national lockdown early on the pandemic would be all but done by now. Our next chance was to have a national mask policy. Now that ship has sailed too. Several states are now getting close to ICU capacity and the death rate in those states has started going up again. A couple months ago I was optimistic that an NFL season would somehow happen. I underestimated how little this country trusts scientists. At this point I don't see how a season can happen until there is a vaccine. If they can somehow work a mask into the helmet that's the only way. kind of feeling the same way. The polar opposites of total disregard for science paired against an over the top fear has really done us no good. If we could’ve followed a measured and practical approach across party lines I think it could’ve been realistic to have sports and probably even an ok attendance level. Now I won’t be at all surprised by a full cancellation 1
Mr. WEO Posted July 12, 2020 Posted July 12, 2020 1 hour ago, SirAndrew said: You seem very well informed on testing, so I thought you might be able to answer this. I’m curious as to why saliva testing hasn’t become more common ? I’ve witnessed poor technique, and lack of patient cooperation to be a HUGE problem with the nasopharyngeal sample. It confuses me as to why we aren’t trying harder to find something that’s a little more fool proof. I’ve seen countless people have tests that read negative, positive, negative, positive. They have told me the test was more uncomfortable when they got the positive result, and I’ve witnessed questionable swab technique many times. We have tons of medical personal who don’t usually do this kind of thing, attempting to swab people. It seems like another method might be more optimal. RNA doesn’t survive well in salivary enzymes making PCR very difficult. There are concerns about its inferior sensitivity but it will probably be used in addition to, not instead of, nasal swabs as a way to get more people tested 1
Hapless Bills Fan Posted July 13, 2020 Posted July 13, 2020 2 hours ago, SirAndrew said: You seem very well informed on testing, so I thought you might be able to answer this. I’m curious as to why saliva testing hasn’t become more common ? I’ve witnessed poor technique, and lack of patient cooperation to be a HUGE problem with the nasopharyngeal sample. It confuses me as to why we aren’t trying harder to find something that’s a little more fool proof. I’ve seen countless people have tests that read negative, positive, negative, positive. They have told me the test was more uncomfortable when they got the positive result, and I’ve witnessed questionable swab technique many times. We have tons of medical personal who don’t usually do this kind of thing, attempting to swab people. It seems like another method might be more optimal. I got nothin’, @SirAndrew. Inertia, maybe? There was a study published from a group in Yale back in April that said saliva testing was certainly as good, and might be more accurate than nasopharyngeal swabs. It’s not a one-off, there was a small study in Japan that confirmed. There’s a Chinese study from early on, one of the first reports of high false negative rate from the RT-PCR testing, that found a saliva test a bit less sensitive than a nasopharyngeal swab but it was a few percent as I recall (can’t find the study quickly, will look later) It’s potentially a huge advantage for PPE since in terms of best practice, a HCW getting into a patient’s face to swab them should be wearing high quality PPE vs just handing the patient a collection device, and when we run low on specialized swabs, it could help. So I really don’t know what the barrier is. I agree with you completely that proper nasopharyngeal swab technique may be influencing false negatives.
Hapless Bills Fan Posted July 13, 2020 Posted July 13, 2020 2 hours ago, Mr. WEO said: RNA doesn’t survive well in salivary enzymes making PCR very difficult. There are concerns about its inferior sensitivity but it will probably be used in addition to, not instead of, nasal swabs as a way to get more people tested The first step in the standard RT-PCR test is RNA extraction from the intact virus particles. The RNA is not bopping around the saliva solution on its own; it’s wrapped up in a lipoprotein coat. So the salivary enzymes really should not be a factor. I believe there are also RNAses in the nasopharynx as well - there are RNAses pretty much everywhere else in mucus and in serum. I know for DNA sampling from saliva or cheek swabs, there’s usually a nuclease cocktail added to stabilize it. I also know RNA purification from saliva samples has been done successfully by a number of research groups (but again, we’re not going after salivary RNA here but RNA packed up in a virus) It’s appropriate to have concerns about lower sensitivity and sample degradation but if reputable groups have worked out the protocol and shown that it’s as sensitive (using their techniques) at some point one needs to adapt.
TtownBillsFan Posted July 13, 2020 Posted July 13, 2020 I haven't kept up with this topic, but if one of our players is concerned, so are most of us. But guess what, if employer calls up and says that you're on deck for working, be there, or be unemployed. It's the same for all of us; be careful, be safe, and be ready for use wherever you're being paid to be used.
Recommended Posts