So I had a sister that got sick, she took a test, not COVID. She was still sick a little while later, another test another negative. She finally took a third one and that returned a COVID positive test.
In the meantime my children have been sick for a little while, and we got one of them tested and it was negative; however right before they got sick we had interaction with someone who had a positive COVID test shortly thereafter.
I am starting to wonder at the efficacy of the tests and is it that they just can't catch Omnicron as well? Are my kids really just sick with some other random thing despite dozens of people in our social circle getting COVID?
I'm just wondering at this point if there is a reason for the mass testing, because it doesn't really let you know anything except whether or not you have COVID and you'll get better or get worse. I can understand in hospitals or something like that, but in the general population I am failing to understand as it seems Omicron is incredibly virulent, and you can spread before you have symptoms, so what is the end game with the mass testing?
If you look at the actual testing data for antigen tests [0], the LoD for them is very high compared with PCR. This means a person needs a high viral load for tests to be effective. For example, the BinaxNOW kits require 140.6 TCID50/mL [1] vs 0.012 TCID50/mL for a PCR test (I picked a random one here) [2]. The FlowFlex tests are even worse, requiring 2500 TCID50/mL [3]. I personally purchased a few of the Lucira tests (not affiliated I promise) because they're more similar to an at-home PCR (they use LAMP) and so the LoD is lower (0.9 TCID50/mL) [4].
Wow those package leaflets are impressive. We (in Germany) get those Chinese test on an emergency admission and all they have is a single table with specifity and sensitivity (no info on viral load at all). They are however cheap and they still work . The responsible agency is actually testing them recently and at least publish the results: https://www.eurosurveillance.org/content/10.2807/1560-7917.E... . Still they allow companies to sell obviously nonworking tests with nonreproducible test results.
I am admittedly not a virology expert but my understanding is TCID50 signifies the concentration at which 50% of the cells are infected when the sample is inoculated with a diluted solution of viral fluid.
Health officials in other countries have found it is much easier to detect omicron in the throat, and not the nose, with these antigen tests. This started with a big wave of people who were PCR positive but nose antigen negative. When swabbing the antigen in the throat, the false negative percentage dropped
Swab throat too during rapid COVID test, Israel's Health Ministry says
The UK-issue lateral flow tests have always said to swab the throat (specifically the tonsils) and then both nostrils at about 2.5cm depth.
Every time you sniff, you get nose mucous in your throat (what with them being connected and all), and when you sneeze quite a bit of throat mucous will is drawn up along with air. And now remember that your intestines are physically connected to your mouth by only a foot or two of squishy pipe and you'll be wishing for a nice clean robot body.
Follow the directions on the box. If it doesn’t say to swab your throat, maybe wait on that. Free styling on medical tests doesn’t always lead to repeatable results.
U.S. diplomats in China were subjected to anal swab tests for Covid-19, a Department of State spokesperson confirmed Thursday, adding that a protest had been lodged with the Chinese Ministry of Foreign Affairs.
I would expect the FDA to push back against individuals doing throat swabs with an at-home test kit -- the organization approved these tests based on a specific testing protocol (nasal swab). The FDA won't offer alternative protocols until they've looked at test/trial data.
Antigen nose swabs are extremely unreliable, unfortunately. Barring public knowledge about this, the campaign could be ineffective at best or actively harm infection rate at worst.
Anecdotal: I was in my 3rd of 4th day of symptoms before I finally came up positive on antigen (at home and at testing sites; the test appeared to be the exact same). PCR showed it from day 0 but the results lag quite a bit especially right now in the US (it took 7-10 days for me to get the PCR back in early Jan).
They're not so much unreliable as ... really not very sensitive, as I understand it. Viral load in covid sufferers follows a curve with a rapid ramp up and a slower ramp down, both PCR and lateral-flow devices require a certain minimum level in order to read positive. PCR is much more sensitive (because it's an amplification technology, so can "see" a lower level of viral load) than lateral-flow devices - which means you can be "safe" on an LFD and "unsafe" on a PCR for a small amount of time on the ramp up and a fairly large amount of time on the ramp down. The level at which you're at risk of passing it to other humans is I _believe_ somewhere between the two tests, so it sounds like you maybe got unlucky with an LFD or two, but the results you report are about what I'd expect :(
LFDs are decent for telling you if you're infectious _right now_ - they're much worse than PCRs for telling you if you have covid at all.
Disclaimer: I'm a software engineer, do not take medical advice from me. My partner is a biochemist and I regularly chat with a couple of council covid-response officers, and the above is the explanation I've had from them when I've asked.
Best I’ve heard it described is that Antigen tests are best for detecting high virulence on days 3-5 (e.g., when the spread is happening from tons of viral production, including in the nasal passages). They are more for public health usage to prevent spread rather than diagnostic like PCR.
That aligns with my experience, that if you test positive on antigen you are definitely contagious but if you test negative you may still have the virus present in your system. PCR amplifies it so it can detect even small viral load.
If only we had some guidance and solid communication from public health experts that you could conceivably trust..
> They are more for public health usage to prevent spread rather than diagnostic like PCR.
Like the grandparent, I know several people that have all of the covid symptoms, but tested negative early on. These people just go about their day because they think they have some other cold, then stop testing until their symptoms go away. I would probably do the same.
My thoughts exactly. I believe the widespread misunderstanding of how to use the different tests and interpret the results will end up hurting infection rates overall. For exactly the reason you mention - it lulls people into a false sense of security. I disagree with this person's take 100% especially since PCR testing has been all but abandoned in the face of the magnitude the omicron wave.
Until a PCR can be done within 15 min instead of 2-3 day turnaround, there will always be a gap in using PCR for public health purposes. That time may come in the future for faster PCR, but it is simply not the reality yet today and we have to rely on antigen tests to at the very least rely on detecting the most virulent days to prevent super spreader events.
In Wake County, NC, rapid high-sensitivity PCR tests are available at about a half-dozen sites with results in 12 hours. Appts are have been available within 24-48 hours depending on demand.
You drive into a parking lot, they hand you a test, you self-swab and give it back to them.
There is other testing available - this is just the county-provided testing. It’s well run.
>I am starting to wonder at the efficacy of the tests and is it that they just can't catch Omnicron as well? Are my kids really just sick with some other random thing despite dozens of people in our social circle getting COVID?
Ever since the vaccines came out and were implemented in full force, I am wondering what the purpose of testing even is. At least in the US, even the most restrictive locales have no intention of shutting down commerce to limit transmission. I do not know anyone who is not treating this coronavirus like any other, or the flu, or a rhino, or whatever other sicknesses normally go around.
My kids' daycare (or local government, not sure which is responsible) has a crazy policy of shutting down a class for 2 weeks if a covid case is detected. But not if any of the kids are sick with RSV/flu/rhino/noro/rota, etc. The daycare has not had any reports of covid for months. I am pretty sure all the parents are simply choosing to not get their kids tested because who can afford to drop their obligations for 2 weeks and also force all the other parents in class to do the same. Every single kid walking through those doors has a snotty nose, and surely at least 1 has had covid 19 over the past few months.
What if you don't have symptoms, but know you were exposed to Covid? What if your symptoms are mild and you aren't even sure are caused by a communicable disease?
If I isolated every time I got the sniffles or was more tired than usual I'd be home a lot..
Exactly, why is covid 19 still getting put on a pedestal? RSV is worse for kids than covid 19, yet daycare does not shutdown for 2 weeks because of RSV.
I also want to do my best not to infect others, but I do not see people risking their economic livelihood to do that outside of those with the luxury of working from home.
I guess what I am getting at is the dichotomy of leaders officially acting if people should test and quarantine and all that jazz, while obviously knowing that those who need to go out and work to put food on the table and funds in the retirement account will continue to do so.
Based on the stats, I would bet all I have on one of those snot nosed kids at my kids' daycare having covid right now. But I am sure many or most of the parents need to work for the cash to meet the mortgage payments or whatever their expected quality of life is.
Even if somebody does have to go to work while sick with covid for whatever reason, they can avoid other nonessential contact with people based on their test result.
I do agree there's a lot of hypocrisy and ass-covering going on. Even earlier in the pandemic healthcare workers were discouraged from getting tested so they wouldn't need to stay home from work. I think making tests available prevents at least some unnecessary transmission which is good enough for me.
From that link, like 1 in 10 people dying are vaccinated. And even ignoring that, I will still personally choose to stay home when infected with covid even if it only helps the unvaccinated.
The daycare age population are not the ones dying. Point being that yes, COVID 19 is resulting in more deaths than RSV nationwide, but as a vaccinated individual, I am more concerned about RSV (one of my kids has already got it), than I am from COVID 19.
Right, same as all the other viruses floating around, that we also had before SARS-CoV-2 or covid-19 or whatever.
I get the initial lockdowns and period of time to figure out this new thing, but at this point in time, I do not see how people's risk profile is any different than what it was before Dec 2019.
>I do not see how people's risk profile is any different than what it was before Dec 2019.
There are virtually zero deaths attributable directly to flu by hospitals. The vast majority are imputed by estimated excess deaths.
So even by completely different and unfair metrics, covid is vastly more dangerous. If you went by that standard covid likely has claimed over a million US deaths already, compared to a few tens of thousand for flu.
On top of that, covid has a significantly higher R0 value, which means you’re much, much more likely to come into contact with it.
That’s how you change your risk calculation: it’s the cost of getting it (probability of death or maiming) times the probability of getting it (community spread level and nasal viral shedding rate). There is no mitigating factor here wrt covid vs flu risk.
That does seem to be changing now that we've all been vaccinated, though. It seems that training your immune system to recognize the virus leads to symptoms developing earlier in the course of disease, below the ~10^6 copies/mL threshold a rapid test can detect. I don't know if everybody who is vaccinated is getting early symptoms but anecdotally it seems to be pretty common.
1. Things such as influenza mostly spread when the person is symptomatic.
2. Something along the lines of 50% of covid infections are from pre-symptomatic and asymptomatic people. Self isolating when you have symptoms is certainly good, but it is by no means the entire picture.
if there is a reason for the mass testing, because it doesn't really let you know anything except whether or not you have COVID
If you test positive, you're supposed to stay home and isolate so you don't spread COVID.
Tests aren't perfect, since as you said, there seems to be a significant false-negative rate with Omicron, and you can be contagious before you show symptoms, but the tests help prevent people from spreading confirmed cases, and can be helpful to pre-test before you spend time with someone who is at high risk for COVID.
> Tests aren't perfect, since as you said, there seems to be a significant false-negative rate with Omicron
Its not even Omicron. Rapid tests always had something like a 40% false-negative rate or something stupidly high.
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That's why you're supposed to take two tests if you're asymptomatic, to reduce the chances of a false-negative.
Fortunately, the false-positive rate is less than 5% IIRC, and fairly reliable.
EDIT: Sensitivity and Selectivity isn't really false-negatives or false-positives. But for the purposes of this discussion, its probably good enough. Besides, I'm just an ignorant programmer who doesn't know the difference between them.
“RADx recently performed preliminary studies evaluating the performance of some antigen tests using patient samples containing live virus, which represents the best way to evaluate true test performance in the short-term. Early data suggests that antigen tests do detect the omicron variant but may have reduced sensitivity,” according to the FDA.
I'm sure. But the sensitivity of rapid tests were always much much worse than the sensitivity of PCR tests. The original sensitivity of rapid tests were like 60%.
Frankly, going from 60% to 40% doesn't change my viewpoint on rapid tests. Its all "unreliable false negative" to me (I don't know what it is for Omicron, I'm just pulling 40% out of nowhere). But whatever it was, the sensitivty was always so low that you never could rely upon a negative-reading, due to the high chance of false-negatives.
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Rapid tests remain useful, but you _MUST_ always be mindful of their high false negative rate. The fact that their "unreliable stat got even more unreliable" isn't really news, because you shouldn't have been relying upon it anyway.
The most recent guidance says isolate for 5 days, then go back to work if you want to, or optionally take another rapid test and if it's still positive, isolate for another 5 days. The CDC also acknowledges that the virus is transmissible for 10 days after symptom onset. These "shoulds" and "supposed tos" are being thrown out the window. Health care workers in CA can go back to work immediately following a positive test if their symptoms aren't severe and in many cases they're being asked to.
Rapid tests give you a result within 15 minutes. PCR tests you gotta ship to a lab, and wait maybe 2 or 3 days before they report back to you.
I think PCR tests (which nominally take 15 minutes) are the best. But we clearly don't have the infrastructure to support it. Every lab doing PCR tests is going at full throttle and yet we still have this 2 or 3 day delay everywhere.
Meanwhile, at-home rapid tests work immediately. They're way less accurate, but its better to have some degree of testing rather than nothing at all.
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Lets say you have a workforce consisting of 10 people who are sick with COVID19 right now. PCR tests might catch 9/10 of those people. Rapid tests might only catch 6/10.
But removing those 6-people with Rapid tests in your workforce will slow down the spread. 4-people spreading COVID19 in your workplace is better than 10-people spreading COVID19.
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EDIT: More importantly, Rapid tests will catch those 6 people _TODAY_. PCR tests will take ~3 days before they report back, meaning if you're on PCR-tests only, your COVID19 positive people will be around the workforce for 3 days.
If you use both Rapid Tests + PCR tests, you remove those 6 people _TODAY_ from the workforce (meaning 4 people will be spreading COVID19 in your workforce). 3 days later, those 3 other people are removed which is "too late". The Rapid test was in fact more useful.
PCR tests are better for contact tracing, due to their higher reliability. If someone tests positive with PCR tests, you trace their contacts and tell _THOSE_ people to get PCR tests and/or rapid tests, in an attempt to "get ahead" of the disease. (IE: those 3 people who weren't caught by rapid tests were in contact with 15 people total. You now tell those 15 people to rapid test + PCR test).
I'm going to "vouch" your post, because its a fine point even if I disagree with it.
Rapid tests _always_ had bad sensitivity. Its gotten worse for Omicron, but going from "bad" to "worse" isn't really a big deal, because you never should have been relying upon negative test results anyway.
That's my point. The "use" of rapid tests was their "rapid" nature, coming back with a result in 15 minutes is way better than waiting for 3 days. The PCR is needed if you want to truly rely upon the result (well, kinda sorta. PCR got better sensitivity / specificity but its still not perfect).
My symptomatic, boosted SO received 4 negative nasal-swab PCR tests (1 day apart each), given by a nurse, before finally testing positive on the 5th test. Seems totally unreliable
In our area, when kids test positive, they don't have to be tested for many weeks after. I know several that tested positive a few weeks before Omicron hit, then were refused when they eventually had Omicron symptoms.
There are a few news stories out there indicating that because Omicron grows better in the throat that also swabbing the throat helps reduce false negatives. Though the official word would be to not do this since the tests were officially only developed tested with nasal swabbing.
It's worth noting that rapid test results roughly align with contagiousness, which makes them an excellent tool to fight the spread of this thing. [1] (See the 2nd image on this page).
PCR tests will report COVID infections that are way below the threshold of transmissibility, and they'll keep reporting positive results long after the infected person is no longer contagious.
"Am I contagious?" is arguably a more useful question to answer than, "Do I have any detectable amount of COVID in my body, at all, using the best laboratory testing processes available?"
I my country they did a (pre-omicron) comparitive study, testing people with PCR and giving them an antigen test to use at home [1]. There they found a false-negative rate of 16% (sensitivity 84%) for symptomatic people with high viral load, which is a proxy for contagiousness. For people without symptoms false-negative rate was 77% (sensitivity 23%). Not that great.
The answer is probably something along the lines that it's not a magic bullet but 1.) There's a lot of political pressure to do "something" and tests are one of those things and 2.) Whether useful or not testing is required either literally or people want it for the peace of mind (illusory or not) so lack of tests is a headache.
Covid is much more dangerous for the elderly than the young, even vaccinated. The young are so safe that there have been ~250 total covid deaths in the US age 0-4.
Also, there is growing evidence that the lateral flow tests correlate well with being infectious.
Testing reasons:
For lots of staff (medical, school, factories), to avoid unnecessary prophylactic isolations, particularly for people whose work cannot be done remotely. And for the same group of people, testing daily (were we in a competent country with the test manufacturing to support) could significantly reduce community spread. Daily tests are infeasible to do with pcr if for no other reason than the reporting lag.
For visiting high risk people: reasonably reliable, fast indicator of whether you have covid in order to make near realtime decisions about activities to engage in. Like masks, this will reduce community spread.
From what my pharmacist told me a fair bit of the kits can't detect omnicron reliably. The ones that do seem to have about a 7-10% failure rate. He suggested doing two or even 3 kits at once or space them out over a couple of hours to decrease the chance of a false negative.
Tests aren't statistically independent events. Taking multiple rapid antigen swabs doesn't improve their accuracy. Multiple tests spaced out over a few days does.
> I am starting to wonder at the efficacy of the tests and is it that they just can't catch Omnicron as well? Are my kids really just sick with some other random thing despite dozens of people in our social circle getting COVID?
My understanding is:
1) Existing rapid tests are not as sensitive to Omicron as previous variants.
2) Negative results on rapid tests are unreliable, especially single negatives. They're more reliable when taken in series, and the instructions for the ones tell you to take two tests, 3 days apart. However, their positive results are very reliable, so if only 75% of the positive people who take one actually test positive, you've still successfully detected 75% of those infections.
PCR tests are far better at detecting infections early.
With this variant, the tests seem mainly about "how much longer should I quarantine?" It's test two or that finally shows positive, after you're pretty sure it's COVID.
I'm full on board the "let'r rip" train, but don't knowingly expose people to sicknesses. Even if they'll get it eventually, it's better if everyone doesn't get it all at once.
I am really surprised I haven’t heard anyone talk about false positive rates, false negative rates, or bayes’ theorem since covid tests first became available. I mentioned it to family when the stories of conflicting tests showed up on the news and they balked at the idea of using math…we are very different people, my family and I lol
I took a self test after having symptoms and it was positive so I just isolated myself instead. I skipped doing an official test because just as you said it does not provide any relevant information to me other than what I already know.
People like myself would act very differently to a cold than COVID. It changes also needs to isolate/quarantine, and helps us get a handle on asymptomatic cases who otherwise would go around continuing to infect others.
This won't help us get a handle on asymptomatic cases - to do that, we'd have to be able to test everyone on a frequent and consistent basis.
This program doesn't even cover one test for everyone in my house, let alone weekly or more frequent testing. And aside from this, I have to spend hours looking for any available rapid tests to buy around here, and if/when I have some, I can't afford to use them on randomized or even weekly testing.
The rapid tests have a very high false negative rate regardless of variant, but a very low false positive rate. They should not be trusted as proof that you do not have COVID, only as proof that you do have it.
I think you can generally reasonably be sure that you dont have it if you test negative on a rapid test, especially if you take multiple. The accuracy of the better ones (which is what we're getting in the US) looks to be about 80% for people who do have the virus. To me, you can trust that to say you dont have covid, especially if youre vaccinated.
Does every submission related to covid have to be an opening for a HNer to recount a personal anecdote about how a thing being done to try and reduce covid spread is questionable?
My post was put in earnest because I am really trying to understand, I live in an area that is pretty much of one mind and believe that the best way to try and work through some of the division we are facing in this country is to understand and listen to the perspective of others. Even if I don't agree, trying to hear the other side may make me aware of considerations and factors I was unaware of before.
Ordering is super easy. I'm glad they're using USPS's existing infrastructure so we don't get a healthcare.gov 2.0. We'll see how actual shipping goes.
Wow… I run uBlock Origin, Privacy Badger, Firefox Tracking Prevention, Little Snitch, and a pi-hole, and I only had to allow one domain on LS for this to work. That's a better experience than like 99% of the internet for me most of the time.
Man, I was so bummed I didn't have to make an account and everything /s
I mean, for what it's worth, this gets high marks from me for ease of use and seems to be consistent with just about every advice you see surface here about getting your users through an ordering funnel. Of course the fact that the cost is 0 here makes it a simpler problem for them, but given that it is a gov't project I could have envisioned a lot, lot worse.
The US post office gets a lot of crap thrown at it when in reality it is quite well run. They're totally bootstrapped (stamp sales pay for everything) and take no money from taxes. They service every household in the country, rain or shine. They've scaled from nothing to hundreds of millions of customers and survived hundreds of years. They move millions and millions of physical goods across the entire country in days. If this were a startup or private company we would be in awe of their track record.
This isn't quite true; the USPS was formed in 1971, out of the United States Post Office Department.[1] It didn't '[scale] from nothing'.
The USPS also enjoys a monopoly on mailbox deliveries, as well as price protections, in the form of a floor imposed on potential competitors. This doesn't seem particularly admirable.
However, on the flip side, they are not really allowed to shut down unprofitable service areas in the middle of nowhere and are required to pre-fund retiree benefits to a greater extent than other organizations.
> ALL companies are required to fund any pension promises they make to their employees. (...) NONE of them are permitted to take a “pay as you go” approach but must contribute to a pension fund an amount equivalent to what a worker has accrued that year in benefit promises, regardless of how far into the future that worker will be retiring, and must make up for any shortfalls due to asset losses or other reasons. The USPS and private sector companies use the same general actuarial principles to do so, though there are differences in assumptions, particulars of the calculations, etc.
> What is distinctive about the USPS is that, a a result of the 2006 Postal Accountability and Enhancement Act (PAEA), they are also required to pre-fund their retiree medical promises. However, what is also distinctive is that any private-sector company may simply cancel its retiree medical benefits at any time; the funding requirement for the USPS exists because only an act of Congress would enable them to cut these benefits.
> However, even here, again, all companies which promise retiree medical benefits must account for them in their financial reporting even if they don’t prefund.
As well as this line when discussing the USPS Fairness Act, which would eliminate the pre-funding requirement.
They also have a number of competitive disadvantages, they have to pre-fund their pension plans, as well as the fact that they are required to service remote addresses that private companies don't, since they aren't profitable.
And that's not even touching on the point that looking at the postal service as a private business is completely asinine. No one looks at the military or schools as a private business that needs to make a profit.
In exchange for that monopoly they have a universal delivery mandate. Amazon pays them $3 to essentially tape a $10 bill to parcels and deliver them to rural communities.
The USPS probably would not survive in its current form in a free marketplace, where competitors could obtain equal access to mailbox deliveries. If they did survive, the service would become a pale imitation of its current offerings, because there would be an exodus of customers eager to try a viable alternative.
Anecdotally, I would be among the first in line to dump them, just as I would choose to dump every government monopoly if I had such a choice (e.g. fire, police, etc.). You know, the way things were back when citizens had a modicum of actual freedom, rather than the constant gaslighting that attempts to redefine our modern cultural slavery as "freedom".
Everything the government touches turns to the worst possible kind of shit.
"They have scaled from nothing to hundreds of millions of customers and survived hundreds of years."
Okay, this is not particularly novel, and the implied comparison to scaling digital services is flawed.
"If this were a startup or private company we would be in awe of their track record."
Again, if a startup operated like USPS they would fold real quick. The USPS has continuously received public money to remain in operation. They are not innovative. The only area where they are expanding is in parcel delivery, and they often turn it over to other partners to do the last-mile pickup and delivery.
However, startups can aspire to the ubiquity of USPS. In many towns, the Post Office is the only happening place and fosters community, and occupies an important place in the hearts of people who rely on it in a big way. Many private logistics providers such as UPS and FedEx do not serve these areas because it's uneconomical for them, and the Post Office is the only logistics provider. For this reason, the USPS deserves taxpayer support.
I really, really don't want to see the post office innovate on the timescales of startups. IMO "more reliable" > "more features" for this kind of work. I don't want someone thinking of how to put (more) ads on my mail, I just want my mail.
I also think they are important for national security. If you ever needed to roll out a vaccine quickly - the USPS would be the first bit of infrastructure you would leverage.
Not really. Vaccines were deployed via centralized health centers.
> pressing private companies into service
I am talking about a distribution network. Lets go back to that time in March 2020 when the US started realizing COVID was a real thing and everyone went into lockdown. Imagine the next time, where we are able to mass manufacture a vaccine pill within the matter 1-2 weeks. Having the USPS distribution system could be invaluable here. We certainly wouldn't be in our third year of COVID-related disruptions as we are now.
And it's really nice that they're actually using the physical address for this instead of the given email address. Especially since some imbecile put my email address in when ordering her tests. I was concerned that I would not be able to order my own since my email was already used. But no, I was able to.
USPS gets points for practicality and execution, but is yet another service that performs zero email address verification and ends up with idiots that don't know their own email sending me their info.
Would it matter? The address has to be valid and once input it is the unique key. I didn't see any address validation on my end (which is also an option for other forms).
The worst case is you input someone else's address (whether by mistake or on purpose) and...they end up getting free COVID tests. Not really something worth validating.
USPS does have ways to validate your address, for example when you set up mail forwarding or the daily digest thing.
Literally my only complaint is that they ask for first/last name rather than full name. But I wonder if that’s some kind of legal/regulatory requirement in this case.
According to the real time analytics [0], as of 1PM (central time), there are more visitors to COVIDtests.gov (754,000) than to all other federal government websites combined (1.33 million)
In spite of appearances, I'm not sure if they went with existing USPS web resources, at least on the frontend. Looks like custom build using a very typical modern managed AWS services stack. In any case, interesting new state of the art for government, compared, let's say, to the HealthCare.gov launch.
At first I thought it would just be a new SKU in the USPS.com website. But it looks like they rolled something custom, using CloudFront, S3, Route53 (two new domain names, special.usps.com and special-api.usps.com for POSTing the order form JSON to), API Gateway (and probably Lambda and DynamoDB):
Not sure if USDS (U.S. Digital Services) team worked specifically on the covidtests.gov rollout, but USDS was largely borne out of the dev effort that rescued Healthcare.gov:
> The spectacular failure of Healthcare.gov at launch led to the creation of what came to be known as the Tech Surge, a group of Silicon Valley developers who rescued the website from disorganized contractors and bureaucratic mismanagement. That group gave rise to the U.S. Digital Service and, to a lesser extent, 18F, two government agencies now working to improve the state of federal technology
> Not sure if USDS (U.S. Digital Services) team worked specifically on the covidtests.gov rollout
They did[1]:
> The United States Digital Service, which grew out of the effort to rescue healthcare.gov, is also assisting with the launch. "We have the best tech teams across our administration working hard to make this a success, and we think we're well positioned to do that,"
The US Digital Services was formed to prevent exactly that. The main lesson learned was "follow industry best practices instead of just paying a contractor who sounds like they could do it."
Strange thing is this was supposed to go live tomorrow (19th). Though maybe they were going by Guam where it is already 1/19.
Just speculating, because it's using a suite of AWS managed services throughout (CloudFront, S3, Route53, API Gateway) and it's a common design to use Lambda functions with API Gateway. Knowing that this is a very high profile, high traffic site launch, and knowing something of the attitudes of the USDS team, they are likely to want to minimize the number of moving parts and services they have to manage themselves. Also, observing the interaction of the site, which all boils down to a simple HTTP POST of a small JSON blob to the API Gateway endpoint, I am (again just speculating) assuming they are wanting to do minimal processing and just stuff the JSON into a database as quickly as possible. It could be an RDS database, but that still seems like too much administration, and especially since DynamoDB can do highly scalable writes, it just seems like the least surprising choice. I could be wrong, and it would be great to hear the team share on record what's actually under the hood, but given what we can confirm externally by observation plus what we know about the mission and the team, I feel reasonably confident it is all managed services, at least on the frontend component we can interact with.
It appears that omicron almost always returns false negatives with the rapid antigen tests for mild cases.
Since omicron is the vast majority of cases in the wild, and nearly all cases are mild (and the ones that aren't are probably going to get a PCR test anyway), rapid tests are practically next to useless now.
So in that first 380 million, 1 out of 3 is already good for omicron. Hopefully as they work toward more contracts for the remainder of the 1 billion tests, the government will try to take omicron into account.
I just want to point out this is a false assumption.
> So in that first 380 million, 1 out of 3 is already good for omicron.
The text says those 3 companies have been contracted for a combined 380 million tests. It doesn't say equally, or list a number for them. You could have a worst case scenario (I'm being overly dramatic here) of 1 test from Roche, and 379,999,999 combined tests from Abbott and iHealth.
A comment above says that omicron is hard for rapid tests to detect from nasal fluids and that swabbing one's throat leads to much more reliable tests.
Is it? If there's a significant false negative rate, that will mislead people who may otherwise isolate/quarantine based on symptoms. If I feel kinda sick but test negative and need milk, I'm probably going to the store. Same with taking flight that I can't afford to reschedule, or a Dr. office visit, etc etc.
I got a cuehealth [1] molecular test kit from my employer. I've been using it for family and friends we interact with and has detected 1 positive so far, confirmed by PCR.
I'm told they are equivalent to PCR but I'm not sure if that holds true. It has been a relief being able to test myself and family anytime from home. But I doubt I'd pay for it if it wasn't employer sponsored. It's pretty pricy. But I can see this as something you can share with a small community.
There's also detect [2] that is much more reasonably priced, but seems to be sold out since I heard about them.
If you have a fever and are coughing and sneezing - stay home!
If your fever is high or you are having trouble breathing - see a doctor.
If someone you spend a lot of time around is sick, wear a good mask and avoid people as much as possible for a few days to make sure you don't have it too.
Or, are we supposed to be testing asymptomatic people? If so, then we're going to need a lot more than four.
It is still legitimately useful. Positive test means you can get sick leave at a lot of places, even if you dont have any sick time left. This is a tiny amount of money and for a generally good thing.
UPS is effectively acting like a CDN here. Stocking up on COVID tests right at the edge (your local USPS distribution store) and shipping it off immediately when ordered. Hmmm interesting...
USPS* is acting like a retailer and following patterns of distribution and logistics that have been in place for centuries. Not everything is about software..
If someone is more familiar with a CDN that the traditional retail logistics and distributions infrastructure, then it would probably be more helpful of them to think of the situation using that analogy.
USPS is acting both like a retailer, and as a sort of an analogue to a CDN. Both can be helpful models in understanding how this works.
I know it sounds dumb but I have always been super interested in Supply Chain and logistics networks and digital networks because of the fascinating graphs they produce and how complex and fascinating they are. I think your analogy is apt.
In the UK (which has lower per capita healthcare spending than the US), you can pick up 7 or 14 tests from your local library or local pharmacy, without any appointment, pre-booking or ID.
I live in Edinburgh and there was a _really_ small window (between christmas and new year) where they were hard to get, I had to visit 3 pharmacies. Other than that they've been available every time me or anyone I know has wanted one.
AFAIK there was a week around Christmas when the whole country was low on stock, but the situation improved rapidly after that. What's the situation now?
In the US you also get 8 tests per person per month covered by insurance. It's not ideal, since you have to buy them and fill out a reimbursement form, but it's not like this is the only way we can get tests.
This was mandated by the federal government less than a week ago. My health insurer sent me an email:
"Following guidance from the Biden administration, Kaiser Permanente will now reimburse members for FDA-approved rapid antigen home tests. Submit a reimbursement claim here for tests purchased on or after January 15, 2022"
Yes, there are other ways to get tests. But, lately, booking a drive-through or walk-up test (via Kaiser or one of the 'community sites') is more challenging now than it was in December. You may have to book more than 3 days in advance.
They were around christmas as there was a sudden surge in demand. I believe that they're back to normal now. You can also get them posted, usually arriving next day, for free, which is what I do
I will probably make use of this, even if I do have a stockpile of tests. Why a stockpile?
My mother, whom I take care of and live with, has COPD. Despite being vaxxed and boosted, I worry about her contracting it. It would be incredibly easy for me to pass Omicron to her even if I was avoiding being in the same room with her, so I have developed a plan.
Essentially, I have a "bug out bag" in a storage unit, along with entertainment and other ways to keep me occupied. Should I come down with COVID, I am going to go to a motel (not a hotel, a motel, which circulates the air to the outside) and simply hide there, not letting the maids change anything, until the fever breaks. Five days after the fever is gone, I start using tests until I am "clear" on several consecutive tests (swabbed throat and nose). I found a grocery store which delivers food to be left outside of the door, I plan on asking them about motel deliveries (unusual I know).
At checkout time, I hose everything down with Lysol and pay for an extra day in the room, tell them not to let the maids in.
Anyway, I figure this prevents me from exposing people. I cannot figure out anything better that isn't "living in the National parks, catching rabbits and shivering in the cold" hermitage. Anyway, this is going to take a stack of tests to go through. I don't feel great about it, like I am hoarding, but I don't know what else can be done.
I will likely be symptomatic. I tend to have a really overblown immune response to vaccines, infections, and so on. I will get a 104F fever for a simple cold and typically go from "hrm, my throat is a little scratchy" to "cook an egg on my forehead" in the space of three hours.
I will then blow through three or four tests. The bigger hoard is for coming out of COVID.
At this point I don't even see the reason to test for most (exceptions apply). My kid got a very low grade fever and we kept him home and got him a covid test. He tested negative but of course we kept him home due to the fever. Next day his school called and said he has to isolate because a kid at his table tested positive. He had to isolate for 5 days or until he got a negative test. We already had a negative test so technically we could send him back to school. Obviously we didn't because he likely had covid even though he tested neg.
(no other real symptoms except the fever). We waited for the fever to go away and sent him back on day 5. No one else in the family got any symptoms so none of us tested. At this point it just seems to make sense that if you have symptoms to do the right thing and stay home from work or school until the symptoms pass, the test really has no bearing since they are so unreliable. Just treat it like the flu, if you have flu like symptoms you should stay home.
If this thing spreads as effectively as its portrayed then we will all likely get it or have had it and not realized. I have been in large crowds several times unmasked now and not gotten any symptoms. Optimally I already had it and just never noticed which is pretty much the perfect scenario. I am vaxxed but my kids are not, still debating getting them vaccinated at this point.
Apparently my address is marked as a business, despite specifying an apartment number like "Apt. 2". So I can't order the tests. Considering how many people are likely to have problems, I'm skeptical I'll ever receive these, but I put in a support request anyway.
I'm curious if this will be a problem with everyone that has an apartment? Or anyone who's residential address is shared with a business? If so, a lot of people won't be able to receive these tests.
I entered just my apartment number in that field no "apt", etc. Worked fine. You can always go the insurance route and get 8 tests/months. Best of luck!
It's a reimbursement system, and obviously only applies to people with insurance; so it has its downsides. I filed a claim and it was easier than expected.
This fairly large caveat is worth noting:
> To be eligible for reimbursement, the following must apply...The tests are being used when a person has COVID symptoms or has had direct exposure, and not for school, work, travel, or attending events
This went into effect on January 15, so only applies to tests purchased then or later.
Ah well if it's reimbursement that depends on being able to find them in stock somewhere. FWIW, I found this info on my insurer Cigna's site hidden behind a descriptive "Important Information for Customers" banner, and only accepts the reimbursement form via printed mail despite using online forms for every other reimbursement.
Strange. I filled out all my info but says tests for my address have already been ordered. Only other person that lives with me is my wife and she didn’t even know this existed.
In the UK Whilst ordered through the gov.uk site, which is super easy and clear (thanks to government digital services https://www.gov.uk/government/organisations/government-digit...) the distribution of lateral flow is via Royal Mail and the PCR tests is or was mid 2020 delivered by Amazon
When I was visiting in December for a month I literally said ‘wow’ when a pack of 7 dropped through my letterbox less than a day after ordering.
I have to admit that I do think they’re on the right track with this - it’s certainly better than some other European countries that were initially getting a lot of praise at the start of the pandemic.
Yes and great, I agree, the UK press have reported shortages of lateral flow tests recently but only this week I had exactly the same experience as you.
This is on top of the 8 Home Rapid Antigen Tests per person per month that private insurance plans are now required to cover. (Check with your insurance provider for details as the roll out has been a bit chaotic) (Also not going into the issues of obtainability, fairness of paying out of pocket and waiting for reimbursement, Medicare and Medicaid not being included, etc.)
Anyone know if there's an easy way to get PCR tests in the US? I've got the at-home antigen kit, but if I actually think I have COVID, I want it registered somehow so the state counts me in their test numbers. And I want to actually know if I've had it and not get a false negative.
My current employer actually mobilizes phlebotomists to come to your home/office for what you need (like Uber for diagnostic testing...including covid tests)...of course for zip codes that are currently covered: https://covidtesting.scarlethealth.com/scarlet/ccrz__CCPage?...
To clarify, it is not my intent to advertise for my current day-job/employer...but they do actually provide what OP asked for. Good luck!
EDIT: @0xbadcafebee Sorry, I should have also added that the Scarlet service and associated tests are (likely) *NOT* free...so either you would have to pay out of pocket, or have health care (hope) to cover cost.
Last week my pharmacy became inaccessible b/c they offered free covid testing. Lines were out the door! Luckily four days later the pharmacy ran out of tests, normal capitalism was restored and I could pick up my prescription.
I see no utility in arbitrary testing. It burdens urgent care clinics and pharmacies; normal business ceases completely until the testing stops.
If you're ill, stay home and/or call a doctor. If you're desperately ill, call 911 or go to a hospital. If you're OK then stay away from crowds, including covid testing sites.
Asking USPS to distribute/collect covid tests will slow USPS delivery further. The USPS had recently announced a slowdown in delivery anyway. This looks like a politician's way to damage the USPS or its reputation.
somewhat related but for those outside the US, the governments candor with the postal service is nothing short of schizophrenia.
for the past 40 some years theyve worked to basically bankrupt the entire service under some misplaced neoliberal economic imperative that somehow private industry will delight in delivering an ikea catalogue to the furthest foetid reaches of alaskan frozen tundra, and that somehow the postal service as it exists currently is wrong and bad for not turning a 15% profit year over year, every year, until the end of years.
the last US president famously worked to remove and destroy postal sorting machines and even outright blocked funding entirely for the organization which singlehandedly created a crisis that still endures in 2022.
now somehow the governments forgotten its holy crusade against grandmas crypto puzzles and uncle ed's mail order cigars and decided screw it, they provide not only the worst service in the history of government services but surprise, now they provide a critical lynchpin of healthcare designed to detect and identify a global pandemic thats killed millions.
the irony is that somehow im sure a bureaucrat will champion this as an innovation, when for the past forever most americans have ordered cheap prescription drugs through the post from Canada and Mexico to treat a cornucopia of other diseases their healthcare system cant seem to without bankrupting them.
The people who are trying to destroy the post office are not the same people using it to deliver tests. Those folks are not in favor of using it to deliver tests. Hope this helps
Are those tests hard to come by in the US? They sell those tests everywhere here where I am in Scandinavia in supermarkets and on gas stations. They are something like $5.
For most of the pandemic in the US it's been about that easy, but right now specifically it's very challenging to get tests because of the Omicron surge
Very easy to get until recently. However, much of the public communication about testing focused on PCR test centers. It seems like demand for home antigen was driven by a combination of omicron and public awareness of these tests.
From my anecdotal experience these tests are no better than guessing. Plenty of people around me got sick and thought they have cold. Testing every day always negative. One person got considerably worse and had to go to hospital, rapid test still negative at hospital. The PCR however came positive. Now, because the hospital gets paid extra for treatment of Covid patients, we still don't know if that person really had Covid and hospital just faked the result to collect money. Apart from that one person, everyone got better after a couple of days. The unlucky person needed few more days but is fine as well now.
Hospital discharged him and said to come back if he gets considerably worse and was told to take acetaminophen.
Total joke.
a friend who lives in Seattle visited over the holidays and then spent Christmas with his family in Minneapolis. everyone in the family tested every single day and suddenly almost everyone went from negative to positive... but only a couple had the mildest symptoms possible, the rest were entirely without symptoms. nobody got even as sick as I did the last time I caught a cold a few months ago! nevertheless my friend said they "all got covid," which is hard to square with seeing my multiple-comorbidities-having mother be the sickest she's been in the thirty years I've been alive, from having covid for ten miserable days straight back in 2020. obviously this is going to be an unpopular opinion but the cynic in me can't help but think that controlling the supply chain of tests (going from them being available everywhere to suddenly in-demand and available nowhere to now suddenly easy to obtain again) is being used as a means of controlling the current number of "cases" reported, making the pandemic seem like it's still ongoing and deadly and terrible when it's kind of pretty much over in reality, and has been for awhile now, at least out here (maybe major population centers are different, I have no idea).
I tested positive over the Christmas break via PCR with basically zero noticeable symptoms (I had a headache and a runny nose for half a day.) I only got tested out of a sense of due diligence for upcoming family visits.
I suspect that numbers in this wave are being VASTLY underreported not through any malfeasance, but by the fact that omicron has already run through a huge swath of the population more or less asymptomatically.
what's the point of reporting asymptomatic cases, especially when there doesn't seem to be any distinction between symptomatic and asymptomatic cases, just a total "cases" count? what are we missing out on by not knowing that thousands or millions of people would test positive, while not exhibiting any symptoms?
> the cynic in me can't help but think [...] the supply chain of tests [...] is being used as a means of controlling the current number of "cases" reported.
Check the dashboard for your county to see if the PERCENT of tests coming back positive has increased. Where I live the % positive rate spiked to 20%, twice has high as the last surge.
i have to agree, testing is pointless. When the omicron wave washes out of the hospitals and the available bed count goes back up then the pandemic is over.
True is irrelevant. Common sense requires some level of acting ‘as if’. Act as if you have a cold. I don’t go around sneezing on people with a cold. I don’t waltz into the office and touch everything with a cold. I rest, eat some soup. Act as if.
Now, if I had the cold and it felt like no other cold I ever had, then I may go to the doctor (before I consider the hospital).
Things I won’t do if I suspect if I have the cold:
1. Order an online test to see if I have the cold.
In the past 2 months, at least 3 non-covid illnesses have torn through my family (flu and cold, all verified as non-COVID with multiple tests, both antigen and PCR).
If we start treating every case of the sniffles like COVID, we're going to be in perpetual shutdowns...
The opposite. We have a lot of information that says Covid is flu-like for most of us. If you just assume it’s covid, and do what we all do with the flu (take sick days, eat soup, rest, try to stay away from people), that would be the common sense thing to do.
A month ago you could pick up as many as you wanted at almost any drug store, but now they're sold out everywhere, and disappear off the shelves as fast as they appear. It's the new toilet paper...
limit 4 per address. I wonder if you put different unit numbers on the addresses (like 'apartment a" 'apartment b') it would let you order more. I'm not saying anyone should try that, but I'm curious if that would work.
I was definitely worried for the US Digital Services team when I heard President Biden promise a website that would within a few weeks handle test orders for millions of households. But using USPS infrastructure was definitely the obvious and right solution, considering how many critical and secure online services USPS.com already handles, like change of address and informed delivery (i.e. scans of physical mail emailed to you daily)
Informed delivery is just them leveraging the scanning and storing of the front and back of every piece of mail shipped in the US which they've been doing for over a decade and totally isn't creepy as hell...but yes. Singing up for this was amazingly easy. I think it took me under a minute to fill in and submit.
Instant page load and form submission processing.
No captcha checks.
No weird javascript address validators (half of them think my address is malformed).
No needlessly "cute" page design/graphics.
No problems with any of the slew of privacy and ad-blocking tools I have installed.
Filled in my address and email, clicked submit, done. Seconds later, I had an email from them confirming it.
This is proof that government can work just fine. Guarantee that if this had been a private contracted thing we would have ended up with some monstrosity of browser-choking javascript, needlessly cutesy page design, etc.
Can we please bring this sort of simplicity and efficiency to paying income tax / calculating withholdings and W4s? Or, FFS, everything the IRS does?
And how about a national ID system, please? We already have nearly 1% of the US population in such a system: the DoD's Common Access Card. Lessons learned from that could easily be applied to a national digital/physical ID card. The crap I (and especially my parents) had to go through to prove to my DMV that we were honest-to-god citizen and could have a RealID drivers license...which isn't actually useful for anything except getting on a plane or into a federal building...was insane. And embarrassing, for a "first world" nation in this day and age.
When you're literally the final word on what is, and is not, a deliverable address, you don't need a regex. You can just do a database lookup. Presumably they're also leveraging the same address matching technology they use with real mail in that API as well.
A lot of people love to dogpile on the USPS, but they're AWESOME and I'd happily give them a bigger slice of the funding pie to continue to improve.
I occasionally schedule package pickups for the next business day via the USPS website. No issues - package gets picked up by my mail carrier every single time. I occasionally go on vacation and pause my mail. No problem - all done online and delivered together when I get home. I've changed my address three times in the last decade - all done online and executed flawlessly. My day's mail gets scanned and sent to me digitally so I can decide if I need to go to the mailbox that day. It all just works pretty darn well.
It's cheap. And to get a test or four into the hands of (almost) anyone who wants one without red tape seems like a pretty good strategy at the moment even if it's probably not as useful as some people think.
Cant have them sent to college addresses, which really sucks. College students are probably some of the ones that should have it most, especially since testing at a lot of campuses is incredibly lackluster. Really hope they can whitelist university owned addresses
Universities are kind of weird in the way USPS treats them. They won't sort the mail to dormitories by address like they would for an apartment building; instead they make the university do it. So part of the issue may be that the system is not coded to track each dorm room as an individual delivery point so they can't give each person an individual order limit even if they marked the addresses as residential.
Yea all of our apartments/graduate complexes are listed under custom street addresses. USPS does deliver to individual buildings here, but only to the front desk.
The error code on the site says its listed as a business address. Pretty unfortunate
Lists it as a business address. I currently live in an apartment complex that is owned by the University, but is pretty separate from campus and everything.
-- deleted -- wrote without sufficiently thinking. Something is certainly better than nothing, though I think this will come up short for a lot of families since it's limited to one residential address.
A one time grant of 4 tests for a family of 5 is better than a kick in the shins, but it's not really going to make much of a dent in the frequency that my family can test.
Also there was a lot of talk about getting these out for lower income families - guess what, they're more likely to have multiple generations living under one roof, so limiting this to 4 per house is even worse for them.
why do people need to test all the time these days? what's the point? I understand having a couple tests on hand, maybe even one or two for every person in the household, if you're really paranoid and you want to see if the symptoms someone has started having might be related to covid instead of just being a cold or whatever, and you want to do it at home instead of rushing to urgent care to check. but what's gained from testing with "frequency"—especially now that it sure seems like the bulk of the deadliness of the pandemic is pretty much done with at this point?
> why do people need to test all the time these days?
We don't! I've had to use a bunch of these lately, as you are supposed to test twice if you have symptoms and test negative the first time (yeah - read the instructions!), and it's cold&flu season.
My entire family has had cold and flu symptoms multiple times in the past 2 months - that's 10 tests each time if we're following protocol.
In the meantime my children have been sick for a little while, and we got one of them tested and it was negative; however right before they got sick we had interaction with someone who had a positive COVID test shortly thereafter.
I am starting to wonder at the efficacy of the tests and is it that they just can't catch Omnicron as well? Are my kids really just sick with some other random thing despite dozens of people in our social circle getting COVID?
I'm just wondering at this point if there is a reason for the mass testing, because it doesn't really let you know anything except whether or not you have COVID and you'll get better or get worse. I can understand in hospitals or something like that, but in the general population I am failing to understand as it seems Omicron is incredibly virulent, and you can spread before you have symptoms, so what is the end game with the mass testing?