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Everything posted by cangelmd

  1. It’s very tough right now. Increased production of tests will take time and frankly, the market has to be there. The Recent Biden speech confuses matters considerably, - what he proposed regarding testing is a great idea that has been preached since the beginning of the pandemic, but the devil is in the details of launching the testing program. A lot of test kits have expired unused and the manufacturers will want some guarantees before ramping up production. Another problem is manufacturing capacity - will we start to run low on testing for other illnesses, we’ve already seen some of that. Im going to sound nagging now, but the best insurance is to isolate yourself, including masking when no one else is (I swear that’s the hardest!) for a couple of weeks before the trip. Get a PCR 1 week out and have a backup plan. If you have to fly cross country or transatlantic, maybe this isn’t the time to go, sad to say.
  2. Agree, it is pure luck that rapid Ag tests are going to catch any cases in asymptomatic people. I think there might be 2 things going on - one is to discourage people with mild symptoms from ignoring them and sailing anyway and second , maybe CDC wanted testing at the pier and Celebrity demonstrated why that was a bad idea in a spectacular fashion. ( although they might be able to make it work given more than 2 days to prepare ). Posters here have talked about why don’t the cruiselines get together and jointly offer testing at the pier - I don’t think the finances of that work out, plus you can see from these threads and your experience Rick, that flying into the port is a big issue - you want to know if you are going to be denied boarding before you leave home. We are in the uncomfortable transition period. Eventually, I think CDC will allow the ships to treat Covid more like Noro - isolate, contact trace, manage symptoms, don’t kick people off unless that person is truly ill. But there will be a number interim changing requirements before then. Two advances in the pipeline that will help cruising are the nasal vaccine and the universal Covid vaccine - one because it should reduce transmission by vaccinated people and the other because it will generally decrease the danger of respiratory viruses.
  3. That link might rate its own thread. I recognize some of those as insurance companies, but have not read about many of them as travel insurance sources here on CC.
  4. We saw Reflection in Aug when we were leaving FLL, don’t think she has sailed across Atlantic since?
  5. All I can think Rick, is that since they are using Ag tests, and delta has a compressed incubation as compared to alpha, that they would catch a few more people by going to 2 days. The Ag tests are still poor at identifying asymptomatic infections, so I don’t get how they help, other than persons who “just have the sniffles” being caught as Covid positive- and there’s no way to know how many of those there are. The part where I think CDC is being unscientific about this is in not factoring in the data and experience of cruising over the past few months when decisions were made. I guess they have to treat cruiselines as a monolith, where the experience and the financial imperatives of say Carnival and Celebrity are very different.
  6. On our August cruise, the elevators were rarely crowded, but after the first couple of days I started masking when I got on an elevator with someone else, I just felt more comfortable. Honestly though, given the short period of time you are on an elevator, I’m not sure what the risk is, and may not matter if the other people are actually on with you, vs just got off the elevator.
  7. We’ve done Chefs Table twice on Celeb, once on Princess. One Celeb was just a few weeks ago, one of the first post-Covid. Honestly, on Celebrity, I would wait until we are well through Covid. The galley tour, especially on S class is a real highlight and it is not being done right now. The food and wine is a cut above Luminae and Murano, but you have to pay for the pairings, so it is a pricy evening. Huge amount of food to eat. It is a small group of people dining in the Murano wine room, so tight quarters if you are concerned about infection. The other issue at all Cefs Tables is that there is often one person or one couple that imbibes a bit too much or is just annoying, that can ruin the dinner for everyone else. Or you can get lucky and have a convivial group - I’ve had both scenarios. can be a good way to burn onboard credit with some wonderful wines not usually available by the glass
  8. Since everyone has been so helpful: Ian Rankin - Edinburgh series, gritty, atmospheric, relative short reads, excellent!
  9. Have enjoyed at least one from all those authors except Krueger and Jonasson, will have to put them on my list. Not a fan of MC Beaton or of her books under her other name, just couldn’t like them. the author of the Mississippi books is Iles, no “s” - don’t mean to be snarky, just didn’t want someone to get frustrated searching for it.
  10. Notice in Jim’s picture that the cards are basically identical.
  11. Glad I went to Venice and stayed in Venice, years ago, almost 20. Ev en back then it was a whole different place when evening came and the day trippers cleared out, can only imagine what it was like the last several years. I do feel for people who have to rework plans.
  12. You are getting there! To be complete, and someone will correct me if I’m wrong, #s 2 and 3 are actually the same test, it’s just that one comes with the telehealth observation of collection and running the test and the other you do the test, but have no proof of identity or result.
  13. Most IDNow NAAT tests that get results rapidly are collected and done onsite in an urgent care or a pharmacy. It is the collection that is supervised, so yes they count. You could theoretically do at home collection for an IDNow NAAT, and I’ve done it, but not for travel because the collection wouldn’t count
  14. I hope your late night rant was directed at the USAToday article and not at me, because i completely agree with your rant, i also deleted the positive predictive value, etc because I don't keep that knowledge right up front as you do, I have to look it up, and I was really tired. (Actually hoping you would chime in) I didn't check the date on the USAT article, but I suspect it was several months old and heavily edited. The experts I think were trying to be reassuring because honestly a lot of the earliest Ag and Ab tests were a joke - we validated/tried to validate several of them - and created the internet misinformation that the article is trying to refute. I know exactly what you are talking about population level vs machine level, learned that the hard way during the spring of 2020. When the end users of your data know exactly what those numbers mean (or mostly, LOL) and know how the numbers fit into the entire clinical picture of the patient, then I have the luxury of only worrying about the accuracy of the numbers that are turned out. We were figuring out context as we went along. The question of "do I need to make a second appt in case my test is falsely positive" is a still a good question with no absolute answer. Right now, I would say no, because if your test is positive it is likely true positive, even if you are vaccinated, but at some point that could change, ?when.
  15. The USAToday article is accurate, but it is primarily talking about Ab tests. Both Ag and Ab tests for coronavirus can potentially have some cross-reactivity with the other strains of coronavirus- they share some proteins and therefore some RNA sequences (Covid and it’s cousins are RNA viruses). The trick for developing any sort of lab test to detect viral antigens or your antibodies to the virus or even the presence of viral RNA (that’s a PCR test) has to be concerned about the test accidentally picking up the evidence of coronavirus “cousins”. Coronavirus are a cause of bad colds, about 30-40% of colds and we all have some antibodies to them, and have some immunity to them ( but obviously not enough). There will be more circulating cold viruses in the winter and over a population more people will have infections from these innocuous viruses. The articleis talking about “clinical” levels of accuracy in a sense. People on the internet were making blanket statements that the flu or a cold would make the tests inaccurate. Early on, some of the rapid tests, both antigen and antibody weren’t super good tests, and the lack of familiarity with Covid and the amount of circulating virus magnified these shortcomings and started these rumors. Now, though, with a lot of tinkering with the tests and more understanding of Covid, the tests are functionally much more useful and accurate. The problem is we aren’t talking about the utility of any of these tests for an urgent care doc trying to diagnose a person with cough, fever and stuffy head. We are talking about asymptomatic people trying to prove they are negative before going on vacation. The incidence of the disease (Covid) is much lower in this group of people, so the chance that any given positive test is a false positive becomes higher. Question is, is it high enough for you the potential traveler to change your plan for being tested? Most likely, not, these tests are still pretty darn accurate, and the false negatives are of more real importance (that’s part of why CDC went from 3 days pre-cruise to 2 days for testing, false negatives for Ag tests in asymptomatic people are high, 25% maybe). I would become a little more concerned about a false positive test when and where the incidence of Covid is low, maybe 3% or less positive tests and during the winter, again when more viruses are circulating and your chance of having another coronavirus goes up. We are talking about very rare events, but the n is 1 when it is your trip which is why you are concerned. Right now rather than fretting about the small chance of having a false positive test, I think it is more useful to do everything to prevent a true positive test. My hope is that by the time the prevalence of Covid in the US gets so low that chances of a false positive become a more realistic concern, we will have better ways of dealing with the risk both on the cruise ship and in our daily lives. Ways of dealing that are less about testing and more about proving vaccination status and having confidence that vaccination prevents severe disease even with Delta. Sorry for the long winded response, your questions are quite thoughtful and hard to answer without a lot of background!
  16. No, I wouldn’t chance it, that’s a traditional PCR. Abbott uses the term PCR because IDNow uses DNA probes, but the detection system in effect is different. When these names came into common use, no one dreamed that these semantic differences would matter to anyone except clinicians in sub specialities! Abbott likes to call attention to the fact that IDNOW is a molecular test, which is great marketing, but di oes muddy the water
  17. All through the pandemic we have as a society demanded that testing perform in a way that it is not able to perform. If a test has 1% false positives, that sounds great until you do the math and realize that 2000 passengers on a cruise ship means potentially 20 could have false positive tests. Medically, that’s an excellent test as long as the prevalence of disease is (very roughly) 5% or higher. In the case of Covid or flu during flu season, it’s great, because the disease prevalence might be 10-20%, so the chance that that positive test is falsely positive goes way down. But if you are one of those 20 people, your vacation is ruined. The test actually often perform much better than their published false positive rate, so please don’t panic, but as the amount of circulating disease goes down and more testing is done for things like travel, this will become a bigger problem.
  18. I’m far from an expert on this topic, but this is what I know. Short answer is with current prevalence of Covid, I would be ok with an antigen test and wouldn’t schedule a back-up, even though my first choice would be some sort of NAAT. False positives on the antigen test are primarily related to prevalence of the disease in the population and the actual specificity of the reagents in the test for the virus or bacteria you are looking for (if you happened to have a bad cold from another coronavirus when you got swabbed, would your Covid test be positive). Early on in the pandemic, when also sorts of manufacturers were adapting all kinds of rapid test platforms to make a buck off the panic and lack of understanding of the purchasers (like mayors and governors and CEOs), the reliability wasn’t all that great. Now a lot of that has shaken out of the market and most of the tests that CVS, etc are doing, come from experienced clinical lab companies the reliability is much better. Plus the prevalence of the disease is so high, although that doesn’t mean much when you are talking about ruining your vacation. What I would do (what I did before our cruise) is first and foremost, I would double down on masking and social distancing for 10-14 days prior to my cruise, best defense is don’t catch it. My first choice, as I have never had Covid would be a PCR, either traditional or IDNOW. If timing didn’t work out and I needed to do an antigen test, I wouldn’t be worried about false positives. As we get deeper into winter, that might change, the nature of the test is such that there is only so much that can be done to eliminate cross-reactivity, but 98% accuracy is pretty good, I would trust those odds. If a lot of cold viruses start circulating, that’s when I would begin to think about the strategy you talked about.
  19. Technically IDNow is an isothermal PCR, so it is a NAAT test, but not a traditional PCR. Practically, what this means is that IDNow is not as sensitive as a traditional PCR, but much faster. IDNow is more sensitive and more specific than an antigen test (but not necessarily more clinically useful). I know zilch about the UK requirements and I’m a little embarrassed to say I can’t quote the sensitivity and specificity of IDNow, but the numbers you posted sound like it would qualify. In the world of viral load testing for HIV and HCV, 100,000 copies is huge, but for Covid testing and other simple viral disease diagnosis uses of PCR, 100,000 copies is more typical.
  20. This may get taken down, but Biden is supposed to give a speech soon about incentives to help businesses, schools and other venues require and enforce vaccination and/or testing for entry. If we start doing any sort of organized, widespread testing in the US, it will throw a HUGE monkey wrench into the requirements for pre-cruise testing and cruises will be small potatoes. Covid has been a classic, business school boom and bust problem for the lab industry. There’s been a lot of talk about the expiration date of the BinaxNow, the reason why they have all those tests is that they are pretty useless in many settings like hospitals, and we aren’t doing a lot of serial testing and we are kinda selfish. We are just now coming around to the idea of I’m feeling a little bad, let me test and see if it’s Covid - early, mild symptoms is the Ag tests best use. The reagents and other supplies for the NAATs are, again, expensive and still not that many places make them. Normally the rapid NAATs are used for flu testing which is very seasonal, so they don’t even make the kits during part of the year, that time is used for maintenance in the factory - Covid played havoc with the formulation of the tests (do you make a single test for Covid or a panel for flu, RSV and Covid, or some other combo) and the timing. Then Covid numbers went down, hospitals stopped routinely testing all admissions and the bottom fell out of the market. I feel for people who want to travel and aren’t as savvy as the CC members over the next several weeks, particularly. I do hope though, that if we can get some actual guidance and requirements going forward, that the lab market can stabilize, and testing can be available for everyone when they need it, regardless of why it’s needed.
  21. The rapid result PCR is either the Abbott IDNow (most likely) or possibly a Cepheid or one of a few other instruments I’m less familiar with. While rapid from an in-house PCR perspective, the Cepheid takes an hour to hour and half, the IDNow gives a positive result in 15 minutes, takes about 20 altogether. The molecular lab test is likely sent to a central location and run on a high throughput instrument that can do 1000/s in a day - but each test individual test still takes an hour.
  22. 1) The reagents for these tests are very expensive, compared to other lab testing. I’m not saying $200 isn’t profiteering, but $99 for a NAAT with 2-3 hour TAT isn’t a huge profit. We’ve been doing courtesy travel testing for physicians and other staff and their families, and have been discussing a charge, a very similar discussion about insurance vs private charge, plus we have to worry about Stark. The figure I thought was reasonable was about $85, and that was break even, with same day or early next AM results - most results back in 2-3 hours, but for convenience, swabbing done at an outside location, s9 transport time and the sick patients come first. 2) Based on what I know about testing and reading the Celebrity guidance, both are acceptable if sampling is observed (which is implicit if you are going to Walgreens, urgent care, etc). They should tell you what the TAT should be - although life sometimes happens, and for the NAAT I would allow at least 4-5 hours JIC. Another thing to remember, especially about NAAT - short time is actually bad, it’s the positive results that come up fast, we don’t want that 😉
  23. That’s how we got our extra CC points, photos of sea passes from Zenith and Horizon, 1993 and 1995.
  24. Orlando was our butler, too, a few weeks ago, eager to help.
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