Japan's tripling of coronavirus tests unlikely to improve fight, experts say

What is the government thinking about. WHAT are we tax payers paying taxes for???.

The problem behind that discussion are the specifity and sensitivity parameters of all that test methods, wether you buy a cheap testing kit yourself or have yourself checked by expensive PCR procedures. that very much differ in their theoretical values and real clinical environment. You will get enormous numbers of people who are infected while the test says not infected and you get also an enormous number of people who are not infected while the test says that they are. To find the balance to minimize those errors is. rather difficult. As a consequence you should test the whole population or strictly only those few people with known COVID-19 symptoms. Anything between doesn’t make so much sense at those error rates.

Because it's still 100 times less than most developed nations, and they still won't let you get it here unless you've been in direct contact with a proven case (and even then have to jump through hoops in most cases or pay a fortune).

Ironic.

The country that relies on tests for EVERY little THING (even when unnecessary), refuse to test for this?

I don't get it.

They do not put forward alternative suggestions, they express the standard, expected way of using the testing

My impression is they are expressing their opinions in light of the current testing and approval process

but want other countries to have tests available where they do not.

They do have tests available.

Isnt it a requirement upon arrival?

Yes he is saying just increasing tests will be of limited benefits, as are the other experts quoted in the article.

Quoting the article "Satoru Hashimoto... said there's no proof that increasing testing will prevent deaths."

Epidemiological data is perfectly clear, a correctly directed exhaustive testing, searching for asymptomatic patients (by definition people without symptoms) is an integral part of the strategy that better control the pandemic. The only way this phrase would be correct is by assuming the testing is indiscriminate, which would be a terribly bad assumption. Is like saying that there is no proof that washing hands helps stop transmission (true, as long as you assume the washing is only done improperly, or without soap).

The rest of the experts do not say that the increasing the test would not give benefits, they simply explain that the benefits come from a correct distribution of those increased tests, something that for every professional dealing with infectious diseases is perfectly clear. They do not put forward alternative suggestions, they express the standard, expected way of using the testing.

Nothing in the original declaration would lead anybody to assume the increase of tests have to be a disorganized mess, in the same way that it is also unjustified to think the increase would have to be with less sensitive tests.

Great info and insights.

Much appreciated @virusrex.

Weighed against the resources needed for it, do you think it would be practical?

According to the international experts of epidemiology and infectious diseases? yes, completely.

Again, indiscriminate random testing of people without any kind of medical reason definitely is not really beneficial, the problem is immediately assuming this is the only way of doing increased testing. I have mentioned strategies that are being recommended for the control of the epidemic, even as the most cost effective way to deal with it, because once the spreading is controlled by exhaustive tracing the number of testing that is required to keep that control drops very importantly. Not to forget also that every vulnerable patient that does not get infected means not having to treat someone for weeks in the hospital.

PCR testing is not exactly a resource heavy procedure where specialist are needed at every step. Once the system is in place a trained technician takes the sample (where it stops being infectious), RNA extracted by routine use of a ready to use kit, then PCR or real-time PCR on batches of close to 100 samples on a single machine.

Not counting the salary of the technicians you can run a test for $5 to $10 depending on the scale. It is so cost effective that some hospitals and universities are running their own in-house testing of all personnel without problems, in their own labs, running on top of the usual workload. For a city/country that can use dedicated labs or distribute loads into many different laboratories or hospitals it requires even less resources.

If he had done that he would not have talked about "testing everyone regardless of symptoms", that is the part where is is mistaken.

Yes he is saying just increasing tests will be of limited benefits, as are the other experts quoted in the article.

The others also put forward alternative or complementry suggestions.

What they are saying are not in contradiction with what you are saying is the correct way to implement (increased) testing

Tripling the amount of tests could (should) also result in tripling the amount of positive cases. Having a low resting rate is a good way to keep the amount of positive results to a minimum.

Lets get clear. That Doctor is not an "expert" as the article implies.

That Kyoto Hospital's doctor has no more authority than you and me to talk about epidemic spreading.

A doctor has no more authority than you and me about a medical subject? I sincerely doubt that.

Anyways, he is an expert on treating serious life threatening cases, and his professional opinion is there's no evidence more tests will lead to less deaths.

Not saying it's true or not just commenting on his expertise

Yep that's one of the odd things for me, just because epidemiology or virology is not his especially doesn't mean he doesn't know about it or understand it. Even the non doctors here understand it right? So he must have taken that into consideration.

If he had done that he would not have talked about "testing everyone regardless of symptoms", that is the part where is is mistaken. Directed testing towards contacts of asymptomatic patients, or as a regular procedure to corroborate the people in close contact with vulnerable people are not shedding viruses is a well known way to prevent uncontrolled spreading and involvement of patients that complicate easily, that is a very evident and important benefit.

What I mean is not that his declarations are unclear so he must have made a mistake somewhere, his declarations are clear and his mistake (assuming increasing testing can only mean indiscriminate, random testing of anybody that wants it) is also written here.

More simply, his lack of expertise is not just an excuse to disqualify his conclusions thinking he may have made a mistake. He is expressing a mistaken assumption, the lack of expertise is just one way of explaining why he did not immediately understood a strategy that is obvious to an expert in infectious diseases.

In addition to bureaucratic obstacles, Japan has no longer the medical human resources to mass test. That is probably another reason...

Politics have been involved in the medical choices from the start, it was so obvious from figures even so more pre 2020 olympics path.

A shame of course.

Did anyone see the report on NHK News last night about this? Hospitals and clinics don’t want to be testing, it takes up time and resources that can be spent on more lucrative patients. One doctor says performing the test makes patients cough and sneeze so passes on the virus to staff. He obviously doesn’t want to shell out for PPE for his staff.

The most galling part about this is that Japan expects foreign residents wishing to return to not only have had a negative PCR test before getting on a plane, but want other countries to have tests available where they do not.

I 100% support “test, test, test”. Even though the results depending on which kind of test and testing efficiency should be taken into account. Tests must be regular for “at risk groups”. Must be free as the cost of treatment is far more expensive.

..he is arguing that testing people regardless of symptoms would bring no benefits,

Actually he said limited benefits, and he weighed that with the "huge amounts of resources" it entails.

There is no doubt that what you are saying is correct in general.

But his opinion is for the situation of Japan.

Of course it also applies to Japan buti giventhe numbers here how many more lives do you think will tripling number of tests will save?

Weighed against the resources needed for it, do you think it would be practical?

I myself don't have answers for those questions.

The doctor may well be wrong but it's not productive to just dismiss the opinion as uninformed to say the least

@i@n

 just because epidemiology or virology is not his especially doesn't mean he doesn't know about it or understand it.

Lets get clear. That Doctor is not an "expert" as the article implies.

That Kyoto Hospital's doctor has no more authority than you and me to talk about epidemic spreading.

Thank you Reuters. Finally the truth is, inadvertently, published.

Health ministry authorities must then approve the test and have in some cases refused to authorize them.

The truth that this government are controlling the test numbers even by refusing a case that clearly has been passed by a Doctor (fever, symptoms, consultation, approval for testing).

How on earth can a health ministry overrule a local Doctors approval for testing?

Nobody is an expert in everything, it should not be odd that expertise in one field or subfield does not automatically confers expertise in others. He assumed a lack of purpose or strategy most likely because his formation does not make this purpose obvious. An epidemiologist or virologist can immediately recognize how increased testing can have a role in stopping a contagious disease that can be importantly spread by people without symptoms.

Yep that's one of the odd things for me, just because epidemiology or virology is not his especially doesn't mean he doesn't know about it or understand it. Even the non doctors here understand it right? So he must have taken that into consideration.

Prime Minister Shinzo Abe, who announced his resignation on Friday due to health reasons, said on the same day the government would increase testing capacity to 200,000 a day.

how interesting that he announced testing on the same day as he resigns. Maybe he doesn't want to be blamed when the increased testing leads to a huge revelation that Japan isn't doing so well in combatting this virus?

The testing regime is ridiculous. One of the parents at the school my son goes to tested positive a couple months ago. The guy's family, including my son's schoolmate, was NOT approved for tests because they were asymptomatic despite living in the same tiny house!

Why aren’t we testing random people for HIV, Typhoid, Beri Beri, Nile fever, whooping cough and any number of other infectious diseases? The answer of course is because it is pointless unless the person has good reason to be tested. Just like covid-19! No symptoms? No known contact? Then no need to test.

These are different beasts.

For 3~4 weeks COVID-19 carriers are asymptomatic.

Every carrier infects an average of 5 people if you can't detect it early and stop it from spreading.

Why is it so difficult to get a test in Japan?

Hawaii has free test for anyone no appointment drive or walking in.

Freeway will close for mass testing.

https://www.kitv.com/story/42562973/where-to-get-a-free-covid19-test-this-weekend

The claims about how hard it is to get tested do not square with my experience. Last month, my teenage son had mild off and on symptoms suggestive of COVID-19. A generic neighborhood doctor asked for a test. My son got it the next day. The (negative) results came two days later.

Odd comment for me, implies many things that I think aren't realistic.

Anyway I think we should weigh his (professional) opinion based on precisely his field.

Nobody is an expert in everything, it should not be odd that expertise in one field or subfield does not automatically confers expertise in others. He assumed a lack of purpose or strategy most likely because his formation does not make this purpose obvious. An epidemiologist or virologist can immediately recognize how increased testing can have a role in stopping a contagious disease that can be importantly spread by people without symptoms.

His job is keeping patients in serious condition alive and if he is confident that he and the rest of the healthcare system can keep them alive in the present situation then his opinion may well be valid.

I mention specifically what is his misunderstanding, or to be more clear what is the part where he assumed something (indiscriminate, random testing of people) that is not being the purpose of the increased testing.

He is not arguing that the health system is strong enough to save everybody irrespective of the speed of the spread or the involvement of vulnerable population, he is arguing that testing people regardless of symptoms would bring no benefits, which would be true only by random unorganized testing without a clear purpose.

Increasing testing is being meant to be part of a strategy of quick identification of asymptomatic/presymptomatic carriers so their close contacts can be also isolated opportunely before clusters appear, and for periodic testing of people in close contact of with vulnerable population, so they can be identified before they spread the contagion to patients in high risk. That would very clearly have an effect on the spreading of the infection, and the load that the health services would have to deal with, it would not be logical to say that this is not a benefit.

 The reason is that testing is not permitted unless you have special permission from the prefectural office.

Just to sum up:

we got lots of spare resources to test but we don't do it just because... Why?!

my partner is a doctor. When the first 2 staff (reception) were infected, the hospital closed for 2 weeks. Only a couple of very close staff were told to self isolate. The hospital was still running for inpatients, but not outpatients. All staff continued working but outside doctors/specialists didn’t come.

then last week a nurse got infected. She was sent home for isolation. She works on the second floor. Again, only a couple of close colleagues were told to self isolate with no testing. No patients, mostly elderly, were never tested.

i asked my partner why all staff are not tested? The reason is that testing is not permitted unless you have special permission from the prefectural office.

My partner is very worried because although they wear two masks, they can’t wear a face shield in their field.

i can’t believe these 100000 test can suddenly appear out of nowhere and Abe has only had 6 months to prepare. Idiot.

also, didn’t I hear about only 5000 test are done in japan daily?

To be fair his expertise is apparently much different from epidemiology or virology. Which explains why he can misunderstand the situation.

Odd comment for me, implies many things that I think aren't realistic.

Anyway I think we should weigh his (professional) opinion based on precisely his field.

His job is keeping patients in serious condition alive and if he is confident that he and the rest of the healthcare system can keep them alive in the present situation then his opinion may well be valid.

As others have rightfully pointed out, the negative test is valid for that moment in time.

Did you read virusrex's last comment?

Quite amusing to see the experts here summarily dismiss the doctor's opinion =)

Regular testing in elderly care homes and hospitals would be beneficial.

Seeing as 99% of serious cases are old or sick.

Why aren’t we testing random people for HIV, Typhoid, Beri Beri, Nile fever, whooping cough and any number of other infectious diseases? The answer of course is because it is pointless unless the person has good reason to be tested. Just like covid-19! No symptoms? No known contact? Then no need to test. As others have rightfully pointed out, the negative test is valid for that moment in time. The very next day you could be infected. So daily tests for everyone?

People always forget that a test result is just for the moment.

The negative result is just for the moment!

At once after the test, or also during the test you can get infected.

That has no importance, nobody is tested to know about the future but to evaluate the current situation. This is just a misunderstanding of what is being looked at with the testing.

Everywhere at once after or even during the test, you can get infected.

So what? the results of the test are still quite useful, for example to decide if the recent contacts of the person being tested should be isolated or not. That applies for example if the people conducting the test are also tested periodically, that would help by letting the people that were exposed to them know they are at risk of contagion.

In my opinion it makes no sense to test other people than the ones who show symptoms and the ones who got in contact with an infected person.

And how will you know when someone got in contact with an asymptomatic infected person?

...

with testing, which is exactly what will let you know what other people need to be tested since lack of symptoms does not means lack of transmission.

If you have spare tests to use you can preemptively test people that come in contact with a lot of other persons, or with vulnerable population. Then you would be able to identify and isolate them before they inevitably transmit the disease to an important number of people (or those at higher risk).

People always forget that a test result is just for the moment.

The negative result is just for the moment!

At once after the test, or also during the test you can get infected.

You can get infected from the nurse or the doctor at the hospital during the test, you can get infected when you leave the hospital in the elevator, on the stairs if you meet someone, in the trains, buses on your way home.

Everywhere at once after or even during the test, you can get infected.

So the test you just took 5 minutes ago, makes already no sense, because 5 minutes later, you can not be sure that you are still negative.

In my opinion it makes no sense to test other people than the ones who show symptoms and the ones who got in contact with an infected person.

Because these people are at a "real" high risk, that they caught the virus.

It doesn't help when journalists or politicians ask the wrong people for advice.

But Satoru Hashimoto, who directs the intensive care division at Kyoto Prefectural University of Medicine, said there's no proof that increasing testing will prevent deaths.

He may be a doctor but he is not an epidemiologist, nor an infectious disease expert. It is not his job and he doesn't have the knowledge or experience to make that decision. On top of that he is definitely lying: countries that have tested more and traced better have been able to control the epidemic and limit the number of fatalities.

The whole process of judgment and testing should have been left to the general practitioners, leaving out any centralization in the making.

Sure, let's leave it to the quacks that give you antibiotics no matter what your symptoms are. I'm sure they'll make the right decisions. Their tiny waiting rooms filled with old people are great for preventing the spread of the virus to high-risk people as well.

This is the "expert" …?!

I can give you lots more "experts" saying just the opposite all around the globe.

To be fair his expertise is apparently much different from epidemiology or virology. Which explains why he can misunderstand the situation.

Yes, randomly testing people without any reason may not help much (unless you are lucky and catch an asymptomatic cluster that has not been identified yet) so he would be right in his declaration. The thing is that this is not how testing has been recommended, the increase in testing can specifically directed to people that are at increased risk of infection (for example because they come in contact with lots of other people during the day) and specially those people that could transmit the disease to vulnerable population, obviously also anybody that could be suspected of being in contact with someone carrying the infection.

The point is that nobody is talking about just testing for the sake of testing, but with a clear objective of quickly identifying carriers.

Satoru Hashimoto, who directs the intensive care division at Kyoto Prefectural University of Medicine, 

This is the "expert" …?!

I can give you lots more "experts" saying just the opposite all around the globe.

But Satoru Hashimoto, who directs the intensive care division at Kyoto Prefectural University of Medicine, said there's no proof that increasing testing will prevent deaths.

Testing everyone regardless of symptoms "takes a huge amount of resources and brings very limited benefit", he said.

How did this guy become a doctor, has he never heard of the asymptomatic. I won't want to be attended to by this guy.

Eh, Very little benefit...yeah, Abenomask was more beneficial or allowing asymptomatic cases unknowingly running around infecting others and eventually the elderly and those with underlying diseases.

Health ministry authorities must then approve the test and have in some cases refused to authorize them.

I know this from first hand experience, and until the recent explosion in cases here, it was possible to get tested at private hospital, but those stopped as well.

A friend of mine caught pneumonia at the end of April, and had serious (obviously) concerns (worried sick) about having corona, he (long story short) NEVER got tested, as the health center didnt deem his symptoms serious enough.

Thee virus ain't going nowhere, so let's just keep a cool head and do thi gs in a calm way, no need to get hysterical

Hey Randy, go and ask Gov. Cuomo of New York about more testing and how it can help stop the spread. New York is up to 100 000 tests a day, and the numbers are not increasing, and they are getting things back to normal! That is how you do things, without scaring people.

Wait, it's the methodology used in testing, not testing, that is unlikely to improve the fight.

Terrible headline.

Testing everyone regardless of symptoms "takes a huge amount of resources and brings very limited benefit", he said.

No it does not. The only people who say this, are those who cannot acknowledge that handling the crisis through public health centers are idiotic, and during the time of a global pandemic is borderline criminal.

The whole process of judgment and testing should have been left to the general practitioners, leaving out any centralization in the making.

You cannot make a circular reasoning that testing is difficult because public health centers are over-stretched, and then public health-centers are over-stretched because of the number of testing, because it's just dumb and it's a logical fallacy.