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The Billy Plan (Le Plan Billy) - Part 5 of the Plan - TESTING

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A great deal can be written about Testing individuals for the SARS-CoV-2 virus.

A great deal has already been written.

 

Here we will try to write as little as possible.

 

The emphasis here must be on efficiently explaining how Part 5 of the Plan is structured.

 

The goal of testing is to find those who are infected with the virus.

Some who are infected may have few or no symptoms. That is a doube edged sword.

Some will become moderately ill. A few will become more severely ill or for lonegr than anticipated.

We have learned those outcomes. They are all real and possible.

 

But of course testing is just one part of assuring the health of the inhabitants. Testing for illness has always been just one of many tools in Medicine. But we should place testing in the light of a goal.

 

This can be expressed specifically as follows:

 

GOAL : to have more people who have Recovered from COVID-19, than the number who are still sick. We call the latter the Actively iLL. So if we are being successful, the number Recovered divided by the number of those Actively iLL will always be greater than one. In fact, it should be much greater than one.

 

R : A > 1

 

Here is an example in Belgium today, October 29, 2020.

 

(data from Johns Hopkins CSSE)

 

JH CSSE for Belgium - 29 October

 

23 969 divided by 333 198 = 0,071.  The R:A ratio = 0.071 : 1

This means that for each person still sick with COVID-19 on this day, not even 1 person has recovered.

0.071 have recovered for each actively ill patent. 

 

How does that compare with other countries ? 

 

And most importantly, how does that relate to testing ?

 

Here are the R:A ratios for 25 countries we have been following since the end of February.

R to A ratio for these 25 countries - 25 October

Some are low (which is bad), some are high (good) and some are intermediate.

 

Lets jump direcly to those with a low (bad) R:A ratio, below 1. - more sick than recovered COVID-19 patients. 

 

These are the countries having great difficulty with this illness at this time. Many have had difficulty all along during this pandemic.

 

R to A ratio in lowest countries - 25 Oct

 

 

Below, some countries that are doing well. Some, like Germany are currently seeing more cases. But these are countries known for having gained control over this viral epidemic. At least during the majority of the time since the virus arrived in their country.

 

R to A ratio in top countries - 25 Oct

How did they do it?

 

Did they do more tests?  Here are the tests per million inhabitants for the same 25 countries:

 

Tests per million inhabitants - 25 countries - 25 October

 

But the real secret, the thing that correlated best with the R:A ratio and the most people recovered, is not just the number of tests. 

 

To avoid further delay, I'll tell you: it's the test positivity rate. It must be low.

 

Here are the countries that are doing poorly ...

 

R to A ratioless than 1

R:A ratio : 0.27 : 1 on average. (few patients healed)

Average Test Postitivity rate : 10.9% of all tests done for SARS-CoV-2 are positive.

That 11% may not seem high but it is.

 

 

 

How about those who do a bit better? Notice the names of the countries.

 

R to A ratio between 1 and 6 (Average, 10 countries) - 25 October

 

On average 3.2 patients (and up to 18.4!) have recovered for each patient still actively ill.

So that is laudable.

And this was matched with a Test Positivity Rate of 5.9%.

 

 

Is it possible to do still better?

 

R to A ratio greater than 6 (Excellent, 6 countries) - 25 October

Here are the real champions ! Notice the names of the countries. We should be learning from them.

 

17 patients recovered (on average, and up to 26!) for each person still sick.

1.13% Test Positivity Rate.

 

What was that value in Belgium today?

 

While Public Health announced today a value of 23.6% for test positivity, their graph suggests over 30 !

Taux de positivité - 29 oct

Why?

 

Because they have harvested what was sown.

A system that has continuously been behind in testing.

An absolutely naive belief and hope that the virus would never do exactly what it is now doing.

 

Not having enough reagents, they said. Not enough testing swabs they said. Can you imagine ?

 

A clear maldistribution of testing centers and laboratories in Flanders, Brussels, and Wallonia right from the start, and many months that passed before even addressing that problem.

 

At first, only testing those hospitalized or working in hospitals.

Then adding Nursing Home residents.

 

Now, only those who have certain symptoms that a General Practitioner will decide over the phone, merits a test. A "recognized expert" in Belgium actually said in a video I saw 2 days ago, that one should wait until one has a fever of 38.5°C or greater before calling a doctor's office to obtain a test! 

 

My average temperature throughout the day is 36.7°C. When I have a temperature of 37.6°C, I have a fever!

 

Testing only symptomatics when those with no symptoms, or no symptoms yet, are the apparently well who transmit this illness to a significant number of their contacts.

 

If we had the time, I would show you the results from tiny Andorra in Spain. More importantly, the details of what they did. They took to the streets and with huge amounts of volunteer help from the populace, everyone was tested. Did it make a difference?

 

Here are recent results for those still actively ill in Andorra and the rest of Spain.

 

Actively iLL in Spain\\\'s regions - arrow on Andorra - 19 Oct

 

For Andorra, no interpretation is necessary. Belgium now has an incidence of illness far above that of Spain. And the high hospitalization rates, the increase in deaths, are all events that while deplorable and frightening, are the only possible results in the setting of inadequate testing. And that is what is to be deplored.

 

Back to Belgum and its testing weaknesses

 

There is worse. It's not just medical. 

 

The problem, the hold-up is legal, political, and who is surprised?

 

Courts decided in favor of a company that has dragged its feet on testing in a non-competition legal action brough to the tribunal.

It had its contract with the government. Why should any other company have a contract for testing in this time of obvious national emergency? The court could not find a reason.

 

Other companies with scientifically viable tests to offer, were not allowed to sell them or even put them into use!

 

So now we lower the drawbridge on all of that, and sit quietly in Stavelot, deciding what to do to regain effectiveness of testing, and return the strongest tool to break the current obvious chain of transmission of the virus in our city.

 

The slings and arrows of an outrageous virus aimed at each of us. We lower the drawbridge.

 

RECOMMENDATIONS :

Stavelot 2 days ago had a population of 7205.

 

  1. The first target is to test all of these inhabitants.
  2. The second target is to repeat this same generalized testing 2 and 3 weeks later.
  3. The third target is to make this mass testing possible, available, and uncomplicated :
        1. tests will be done using a saliva method in use until recently in Liège at the university where it was developed. It has now moved towards use in Nursing Homes. This company and its network of labs, can now deliver 8000 tests per day. That should be enough to make a start in Stavelot.
        2. Some are concerned about the sensitivity and specificity of this test. All positive tests will be followed with the golden standard qPCR tests.
        3. No long lines nor PPE equipment for a required testing staff. Instead, each person does the test himself or herself. Some will need a little help. Self-screening in Belgium for illnesses such as colon cancer have been in place for years.
        4. Any other reliable tests that are available will be sought, obtained and utilized.
  4. The fourth target is to keep careful records locally, and of course share all results with Public Health.
  5. The fifth target, (actually the 1st!) is to confirm that the number of tests adequate to this task have been obtained. Stavelot should accept no excuses. If the tests can not be had, and had quickly in Belgium, then tests available from other countries must be obtained. All entities in the European Union who can facilitate this objective should be communicated with as soon as possble. Their headquarters is located in Brussels in case you didn't know.

 

And what is to be done for those citizens who are informed that they have a positive test?

 

Because it is Step 4 of the Billy Plan - The Colony - an answer to that question will be provided in another article, and quite soon.

 

Increasing testing in Stavelot to a point where the positivity rate falls below 2%, will assure the highest R:A ratio. 2% of 7205 inhabitants is 144 positive tests. But clearly, the number of infected in Stavelot is proabably 10 times that figure. Adequate testing will assure that the goal of breaking the chain of transmission of the virus is obtained and maintained.

 

It will save lives.

 

So now Stavelot is where it hoped it would never be. It's time to move, and move as a team.

All hesitancy based in a fear of being wrong about a decision taken, must now be put aside.

Speed is of the essence.

 

As you read this, think of your abilities and strong points. Think of how you will bring them to bear on the solution for Stavelot. Everyone has a role to play.

 

Related :

 

<<<< Current testing policy, procedure & criteria in Belgium

 

<<<< Map of Where tests are done in Belgium 

 

 

 

 

26 October : Know when to go fast >>>>>>>>>>

 

29 October : From Ideas to ACTIONS >>>>>>>>>

 

 

 

<<<<<<< The Billy Plan - Index to related articles

 

 

 

<<<<<< Home

 

 

 



29/10/2020
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