Here is an article from Scientific American last week that provides a good explanation of potential immunity or lack-of-immunity from antibodies
https://www.scientificamerican.com/article/what-immunity-to-covid-19-really-means/
COVID-19 Pandemic: Transmissions, Deaths, Treatments, Vaccines, Interventions and More...
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Here is an article from Scientific American last week that provides a good explanation of potential immunity or lack-of-immunity from antibodies
https://www.scientificamerican.com/article/what-immunity-to-covid-19-really-means/
yep, posted that one - what I'm dying to see are the data, especially from the convalescent plasma therapy, which has the potential to be a gamechanger for the seriously ill, if the early studies of "curing" some folks on ventilators (very unusual) are corroborated in the larger ongoing trials. My fear is the data might be equivocal, since we haven't heard anything definitive yet (although we're really not supposed to until they're done).
More on NY's outbreak and subways and testing
NY's outbreak was out of control already before they had enough testing to figure that out, as testing was almost non-existent until about 3/7 (when less than a few hundred tests had been run - NY testing wasn't even approved by the CDC until 3/2), well after the outbreak truly started; see the graphic below for the very few positives before about 3/10 really (when NY hit 100 new cases in a day), when testing really got going.
So, even though NY has now done more tests per capita than any country, massive testing was started too late to stop the exponential spread, especially since social distancing wasn't strongly in place before about mid-March, when it all started (NY gatherings were limited on 3/12 and schools were closed on 3/16, but the full stay at home order wasn't until 3/22) - especially on the very crowded subways and trains. Other states had later outbreaks than NY and had enough testing to keep better on top of that (like CA).
Speaking of NY, a cool paper from MIT (thanks @Knight Shift) just came out analyzing the NY outbreak data and the likely correlation to subway ridership and transmissions. Population density and the subways/buses have been discussed a lot in this thread, so was wondering when we'd see a paper like this. No doubt that the subways were the biggest transmission vector imaginable and should have been shut down first, before the schools or anything else, but that would have been a very hard sell before there were deaths. Nowhere else in the US has the population density or the commuter density that NYC does (and that also seeded the major outbreaks in NE NJ and SW CT).
And the first NY death wasn't until 3/14, so closing subways and the city before then would've been a hard sell, but it would've been the thing to do, in hindsight. There were 60 a week later and nearly 1000 by 3/28, which is not surprising since deaths lag infections by 2-4 weeks, which is why NY really needed to be shut down in early March. And as an aside, disinfecting the subways is like rearranging the deck chairs on the Titanic - almost useless compared to keeping people from being on top of each other in the subways (and buses/trains, too), where the vast majority of infections occurs.
http://web.mit.edu/jeffrey/harris/HarrisJE_WP2_COVID19_NYC_13-Apr-2020.pdf
NY's outbreak was out of control already before they had enough testing to figure that out, as testing was almost non-existent until about 3/7 (when less than a few hundred tests had been run - NY testing wasn't even approved by the CDC until 3/2), well after the outbreak truly started; see the graphic below for the very few positives before about 3/10 really (when NY hit 100 new cases in a day), when testing really got going.
So, even though NY has now done more tests per capita than any country, massive testing was started too late to stop the exponential spread, especially since social distancing wasn't strongly in place before about mid-March, when it all started (NY gatherings were limited on 3/12 and schools were closed on 3/16, but the full stay at home order wasn't until 3/22) - especially on the very crowded subways and trains. Other states had later outbreaks than NY and had enough testing to keep better on top of that (like CA).
Speaking of NY, a cool paper from MIT (thanks @Knight Shift) just came out analyzing the NY outbreak data and the likely correlation to subway ridership and transmissions. Population density and the subways/buses have been discussed a lot in this thread, so was wondering when we'd see a paper like this. No doubt that the subways were the biggest transmission vector imaginable and should have been shut down first, before the schools or anything else, but that would have been a very hard sell before there were deaths. Nowhere else in the US has the population density or the commuter density that NYC does (and that also seeded the major outbreaks in NE NJ and SW CT).
And the first NY death wasn't until 3/14, so closing subways and the city before then would've been a hard sell, but it would've been the thing to do, in hindsight. There were 60 a week later and nearly 1000 by 3/28, which is not surprising since deaths lag infections by 2-4 weeks, which is why NY really needed to be shut down in early March. And as an aside, disinfecting the subways is like rearranging the deck chairs on the Titanic - almost useless compared to keeping people from being on top of each other in the subways (and buses/trains, too), where the vast majority of infections occurs.
http://web.mit.edu/jeffrey/harris/HarrisJE_WP2_COVID19_NYC_13-Apr-2020.pdf
Actually @becktheory found that paper first.More on NY's outbreak and subways and testing
NY's outbreak was out of control already before they had enough testing to figure that out, as testing was almost non-existent until about 3/7 (when less than a few hundred tests had been run - NY testing wasn't even approved by the CDC until 3/2), well after the outbreak truly started; see the graphic below for the very few positives before about 3/10 really (when NY hit 100 new cases in a day), when testing really got going.
So, even though NY has now done more tests per capita than any country, massive testing was started too late to stop the exponential spread, especially since social distancing wasn't strongly in place before about mid-March, when it all started (NY gatherings were limited on 3/12 and schools were closed on 3/16, but the full stay at home order wasn't until 3/22) - especially on the very crowded subways and trains. Other states had later outbreaks than NY and had enough testing to keep better on top of that (like CA).
Speaking of NY, a cool paper from MIT (thanks @Knight Shift) just came out analyzing the NY outbreak data and the likely correlation to subway ridership and transmissions. Population density and the subways/buses have been discussed a lot in this thread, so was wondering when we'd see a paper like this. No doubt that the subways were the biggest transmission vector imaginable and should have been shut down first, before the schools or anything else, but that would have been a very hard sell before there were deaths. Nowhere else in the US has the population density or the commuter density that NYC does (and that also seeded the major outbreaks in NE NJ and SW CT).
And the first NY death wasn't until 3/14, so closing subways and the city before then would've been a hard sell, but it would've been the thing to do, in hindsight. There were 60 a week later and nearly 1000 by 3/28, which is not surprising since deaths lag infections by 2-4 weeks, which is why NY really needed to be shut down in early March. And as an aside, disinfecting the subways is like rearranging the deck chairs on the Titanic - almost useless compared to keeping people from being on top of each other in the subways (and buses/trains, too), where the vast majority of infections occurs.
http://web.mit.edu/jeffrey/harris/HarrisJE_WP2_COVID19_NYC_13-Apr-2020.pdf
I don’t follow anyone’s lead... I listened to the presser and heard the question and Fauci’s reply... it was obvious he was not giving a complete answer ... yes the virus could return and a B1G yes that there is much more to decipher from China’s attempt to wreck havoc whether by accident or worse on purpose... The truth shall set China free.
The reported number of cases is vastly underestimated.
My Son in Brooklyn and my sister in Connecticut now have COVID-19 .
We need to expand testing. Stay safe.
FWIW - spoke with my daughter last night, a nurse at a NY hospital I would prefer not to name. She said some of her worst COVID patients seem to be responding remarkably well to this plasma therapy.
Also, fwiw, she said the thing about COVID-19 that is scaring senior doctors and medical professionals is how patients can enter the ER and in an hour some are dead and others with the same symptoms recover and can be released and it does not appear to be age related. Some of those deaths were otherwise healthy and fit young men. There is so much unknown.
Thanks for the intel - great to hear and not surprised, as it should simply work - how well and under what conditions, for how long, etc., etc. are the details the trials should mostly answer, but it's proven technology with viruses and should simply work. Which is why it's been the only treatment that has had me excited since I first saw people discussing it seriously in early March (and obviously medical experts were talking about this on day one).
Thank your daughter for us for her great service. It must be incredibly hard to have so many patients die and feel somewhat powerless to save them and to simply just not know what works vs. doesn't
Lesions on the feet are another possible symptom of COVID-19....specifically in children and adolescents and also some adults.
https://www.foxnews.com/science/researchers-discover-new-coronavirus-symptoms-feet-lesions
https://www.today.com/today/amp/tdna178991
https://www.foxnews.com/science/researchers-discover-new-coronavirus-symptoms-feet-lesions
https://www.today.com/today/amp/tdna178991
Update on N95 respirator use/decon. just posted on another thread, but thought the folks who come here for useful info, might find this, well, useful. First off, if I had a public-facing job, I'd do whatever I could to find and wear an N95 respirator, which actually filters out most virus droplets/particles, as opposed to surgical masks which do little of that (they'll protect against larger droplets only). I still think all employees that are exposed to the public should have N95 respirators (we're using them for high contact essential jobs where I work).
With regard to decon/reuse, if one had 3 or 4, they could be rotated each day, such that every time one is used it would have sat for >72 hours (beyond which virus viability has not been seen to date), which should be safe. Alternatively, heating in an oven at 140F (70C) for 30 minutes will destroy any viruses, with what appears to be minimal impact to the filtration capability, although that hasn't been evaluated beyond a few cycles. Vapor phase H2O2 (hydrogen peroxide) works best, but not many people have that at home, lol. And UV can work, but it's very technique dependent, as every surface needs to be irradiated for it to work. Don't use ethanol though.
https://www.sages.org/n-95-re-use-instructions/
https://www.medrxiv.org/content/10.1101/2020.04.11.20062018v1.full.pdf
With regard to decon/reuse, if one had 3 or 4, they could be rotated each day, such that every time one is used it would have sat for >72 hours (beyond which virus viability has not been seen to date), which should be safe. Alternatively, heating in an oven at 140F (70C) for 30 minutes will destroy any viruses, with what appears to be minimal impact to the filtration capability, although that hasn't been evaluated beyond a few cycles. Vapor phase H2O2 (hydrogen peroxide) works best, but not many people have that at home, lol. And UV can work, but it's very technique dependent, as every surface needs to be irradiated for it to work. Don't use ethanol though.
https://www.sages.org/n-95-re-use-instructions/
https://www.medrxiv.org/content/10.1101/2020.04.11.20062018v1.full.pdf
Given that this thing seems to travel almost predominantly via asymptomatic hosts is it really the testing that is keeping this thing in check in SK? They don't really test a lot of people comparatively.It's worth revisiting South Korea now that they've relaxed social distancing even further. They should be the model for the world, as they did it right during the first wave with implementing very aggressive and early testing (the early part is very, very important, before it gets out of hand like it did in much of Europe and much of the US, especially NY/MJ) and aggressive contact tracing/quarantining, as well as effective social distancing. This is what the US and Europe could have done, but didn't. And remember, at one time, they had the biggest outbreak outside of China, by far, and they're not a tiny country with 52MM in population (similar to Italy, Spain, etc and more than NY/NJ combined - 29MM)
Also, by establishing the infrastructure and procedures during the first wave, they've been able to stamp out any flare-ups without hard core social distancing. In fact, over the past few days they've loosened SD rules even further, opening up cafes and many businesses that had been shut down and they just held a nationwide election, where the incumbent won by a landslide (duh), given how well their government led their country during the pandemic. So far no major spikes, but I'm sure we'll see some and I'm guessing their infrastructure will be able to deal with it. It should be noted that everyone is still wearing masks outdoors and at work.
https://www.bloomberg.com/news/arti...s-apple-store-lines-show-mass-testing-success
Are they more of a mask wearing country then others? Were they quicker to go full mask then the other Asian countries? Certainly there are/were moreso then Europe or the US.
IMO, you need the testing (and fever checks and such to catch the worst offenders in public), tracing, quarantining (in facilities, not at homes!) and masks, all working together, if you want to relax social distancing. And since they had a big scare with SARS and MERS, they were already a mask-wearing culture to some extent.
Add this to the list of questionable data.
According to Worldometer:
Russia has conducted the 2nd most tests in the world behind only the US. They have conducted more tests per population then the US, but worldwide they have the 11th most cases in the world,
According to Worldometer:
Russia has conducted the 2nd most tests in the world behind only the US. They have conducted more tests per population then the US, but worldwide they have the 11th most cases in the world,
But do they always wear masks, or were they just quick to done them once the news of this thing got out? I also wonder if they were a little more aware of the situation(ie not duped by false reports) given their proximity.
But I'm big on the masks as a key to opening things back up, even moreso then then testing, and while most people around me are wearing masks, I'm not really hearing it as part of the messaging. I hear testing, testing, testing, but imo it's about the masks.
Also, are the worst offenders, more prone to spreading the virus? If so do we know to what extent vs a non symptomatic carrier?
Edit: But without question SK is the model we should be following, probably another part of the messaging that I would like to hear.
Some great news for the Ridgewood kid Jack Allard
https://www.pressherald.com/2020/04...ed-from-hospital-after-battling-coronavirus/#
https://www.pressherald.com/2020/04...ed-from-hospital-after-battling-coronavirus/#
Masks are a key part but no one has answered my question regarding them. If they open restaurants and we all wear masks, how do we eat and drink?
Another mask-related data point. Czechia has over 10 million people and they have less total cases then we have reported in the last two days. They wear masks by law during this pandemic.
What does SK do? Or Czechia?
My thought on restaurants is anyone working on the floor wears masks, tables kept at a distance, and full fledged sanitizing between customers at a table.
Now those in the kitchen wearking masks makes sense too, but I wonder about how much of a hindrance that is.
No, but usually when a paper like that is linked that has to be downloaded and read is that nobody digs into the content. That is an excellent read and highly recommend people read it and understand why NYC is in such bad shape right now. A lot of bad local decisions in NYC.
Yes, some bad/late decisions in NYC, as I posted on over a week ago here, but those pale in comparison to the impact of not having testing available in late Feb/early March and that's on the Feds, 100%, as I just detailed in that other thread. Flying blind into a pandemic is very, very bad. I'll get yelled at if I post the whole thing here, lol.
It’s the same as people saying we should have shut the borders to travel before there were even a few deaths let’s be real if Trump tried to do that there would have been such an outcry as the same as people resistance to social distancing and all the other rules in effect which I still see people breaking dailyMore on NY's outbreak and subways and testing
NY's outbreak was out of control already before they had enough testing to figure that out, as testing was almost non-existent until about 3/7 (when less than a few hundred tests had been run - NY testing wasn't even approved by the CDC until 3/2), well after the outbreak truly started; see the graphic below for the very few positives before about 3/10 really (when NY hit 100 new cases in a day), when testing really got going.
So, even though NY has now done more tests per capita than any country, massive testing was started too late to stop the exponential spread, especially since social distancing wasn't strongly in place before about mid-March, when it all started (NY gatherings were limited on 3/12 and schools were closed on 3/16, but the full stay at home order wasn't until 3/22) - especially on the very crowded subways and trains. Other states had later outbreaks than NY and had enough testing to keep better on top of that (like CA).
Speaking of NY, a cool paper from MIT (thanks @Knight Shift) just came out analyzing the NY outbreak data and the likely correlation to subway ridership and transmissions. Population density and the subways/buses have been discussed a lot in this thread, so was wondering when we'd see a paper like this. No doubt that the subways were the biggest transmission vector imaginable and should have been shut down first, before the schools or anything else, but that would have been a very hard sell before there were deaths. Nowhere else in the US has the population density or the commuter density that NYC does (and that also seeded the major outbreaks in NE NJ and SW CT).
And the first NY death wasn't until 3/14, so closing subways and the city before then would've been a hard sell, but it would've been the thing to do, in hindsight. There were 60 a week later and nearly 1000 by 3/28, which is not surprising since deaths lag infections by 2-4 weeks, which is why NY really needed to be shut down in early March. And as an aside, disinfecting the subways is like rearranging the deck chairs on the Titanic - almost useless compared to keeping people from being on top of each other in the subways (and buses/trains, too), where the vast majority of infections occurs.
http://web.mit.edu/jeffrey/harris/HarrisJE_WP2_COVID19_NYC_13-Apr-2020.pdf
Sorry, not the same at all. Closing borders only delayed the epidemic a bit (which I supported as it certainly gave us more time, but then we wasted that time) and never could have stopped it since hundreds of thousands of Chinese were traveling abroad and to the US in Dec/Jan, before most knew what was going on.
Having early aggressive testing, tracing, quarantining and social distancing (with masks) in place when this hit was eminently doable and should have been done, but it wasn't done or it was done too late. It wasn't done in most of Europe either, but it was doable, with the appropriate planning and leadership. A bunch of other countries did it successfully.
We're already at essentially 40k and averaging close to 2k deaths per day. If that keeps up for another 1-2 weeks we'll pass 60k easily within a month. The death rate in NYC should start going down soon but other areas are on the way up so those will offset the improvements in NYC. Long term, who knows. Will NYC be able to maintain control once people start crowding into Subways again? Will we ever manage to get to the testing/tracing capacity that we need? Will any of the therapeutics prove to be really effective and if so, will we be able to make enough to treat large numbers of people? What happens next fall/winter when flu season arrives. Lots of ways this could go,
When all is said and done a couple of years from now (assuming people develop immunity either through exposure or vaccine), I'm sure total US deaths will be over 100k.
Since South Korea had a huge scare from MERS in 2015, which had a fatality rate of over 30%, but fortunately ended up being far less transmissible than COVID, they learned the value of early testing, tracing and quarantining and many adopted wearing masks. This made doing those this time around a bit easier for them and yes, everyone in SK started wearing masks as soon as this hit, pretty much.
https://www.marketwatch.com/story/w...-in-addition-to-wearing-face-masks-2020-03-31
However, widespread mask usage can only explain so much. South Korea, Hong Kong and Singapore have all experienced bad coronavirus outbreaks in the past, and they learned lessons that the U.S. and other countries appear to have missed: the value of early testing...
Case in point: In 2015, South Korea battled an outbreak of Middle East respiratory syndrome that infected 186 people and killed 38 people. The first MERS case during that outbreak was traced to a 76-year-old businessman who returned from a trip to the Middle East. Because he was not diagnosed for several days, more people came into contact with him.
That ultimately ignited a chain reaction which eventually placed 17,000 people in quarantine. Before he was diagnosed with the virus, he visited four different hospitals in South Korea, according to a 2018 study on South Korea’s response to the outbreak published in Asia Pacific Journal of Public Health. The country learned the importance of early testing.
South Korea currently has the capacity to manufacture 100,000 test kits a day, and they can indicate whether a person has coronavirus within hours.
At that time, South Korea quickly got to work on developing tests. “In mid-January, our health authorities quickly conferred with the research institutions here,” South Korea’s foreign minister, Kang Kyung-wha, told the BBC, “and then they shared that result with the pharmaceutical companies, who then produced the reagent [chemical] and the equipment needed for the testing.”
Currently, the country manufactures 100,000 test kits a day that can indicate whether a person has coronavirus within hours, the New York Times reported. “Testing is central because that leads to early detection. It minimizes further spread,” Kang said, and it allows health authorities to quickly treat those who have the virus. “That’s the key behind our very low fatality rate,” she added.
In the U.S., two months after the disease was detected, many people still couldn’t get tested, the Associated Press reported. That’s partly because there was a limited supply of tests that were reserved only for people who had traveled to China and other parts of the world that reported high rates of infection. In February, as the coronavirus was tightening its grip on major U.S. cities like New York and Seattle and the virus was spreading in the community, U.S. laboratories processed only 352 COVID-19 tests, the CDC said.
I have to say, I was in Vegas until March 13 for the PAC 12 hoops tourney and also general carnage. When they banged the Jazz game on the 11th I got freaked a bit. Not bad but like well we can’t bet on this anymore. Bummer. Never expected the next month. I lost an old friend out there since then. Last 2 days out there were bizarre and I knew I was coming back to a NJ shit storm. What were our political leaders doing? I was in Vegas and knew stuff was gonna hit the fan man. I shoulda found some peyote and went into the desert in retrospect.
EDIT — probably wrong thread but thank you for reading anyhow
EDIT — probably wrong thread but thank you for reading anyhow
Well it is Saturday night and I don't think you can go wrong on peyote in the desert...
Some geeky sciency goodness in this NIH report on designing antibodies that might attach to a vulnerable portion of the coronavirus and how that will likely inform designing vaccines to elicit such antibodies in humans.
https://directorsblog.nih.gov/2020/04/14/antibody-points-to-possible-weak-spot-on-novel-coronavirus/
https://directorsblog.nih.gov/2020/04/14/antibody-points-to-possible-weak-spot-on-novel-coronavirus/
Ok, @LETSGORU91 and @RUfubar and this preprint is for you. Not sure if this qualifies as groundbreaking or just intriguing (since I'm not an MD/clinician), but if verified, it's one of the first papers I've seen that seems to have found some markers (IgG response time and NLR - neutrophil to lymphocyte ratio) that correlate reasonably well with COVID-19 severity and outcomes. The obvious next step might be to tailor treatments relative to these markers, where the markers might suggest certain types of treatment.
Findings A total of 222 patients were included in this study. IgG was first detected on day 4 of illness, and its peak levels occurred in the fourth week. Severe cases were more frequently found in patients with high IgG levels, compared to those who with low IgG levels (51.8% versus 32.3%; p=0.008). Severity rates for patients with NLRhiIgGhi, NLRhiIgGlo, NLRloIgGhi, and NLRloIgGlo phenotype was 72.3%, 48.5%, 33.3%, and 15.6%, respectively (p<0.0001). Furthermore, severe patients with NLRhiIgGhi, NLRhiIgGlo had higher proinflammatory cytokines levels including IL-2, IL-6 and IL-10, and decreased CD4+ T cell count compared to those with NLRloIgGlo phenotype (p<0.05). Recovery rate for severe patients with NLRhiIgGhi, NLRhiIgGlo, NLRloIgGhi, and NLRloIgGlo phenotype was 58.8% (20/34), 68.8% (11/16), 80.0% (4/5), and 100% (12/12), respectively (p=0.0592). Dead cases only occurred in NLRhiIgGhi and NLRhiIgGlo phenotypes.
Interpretation COVID-19 severity is associated with increased IgG response, and an immune response phenotyping based on late IgG response and NLR could act as a simple complementary tool to discriminate between severe and nonsevere COVID-19 patients, and further predict their clinical outcome.
https://www.medrxiv.org/content/10.1101/2020.03.12.20035048v1.full.pdf
Findings A total of 222 patients were included in this study. IgG was first detected on day 4 of illness, and its peak levels occurred in the fourth week. Severe cases were more frequently found in patients with high IgG levels, compared to those who with low IgG levels (51.8% versus 32.3%; p=0.008). Severity rates for patients with NLRhiIgGhi, NLRhiIgGlo, NLRloIgGhi, and NLRloIgGlo phenotype was 72.3%, 48.5%, 33.3%, and 15.6%, respectively (p<0.0001). Furthermore, severe patients with NLRhiIgGhi, NLRhiIgGlo had higher proinflammatory cytokines levels including IL-2, IL-6 and IL-10, and decreased CD4+ T cell count compared to those with NLRloIgGlo phenotype (p<0.05). Recovery rate for severe patients with NLRhiIgGhi, NLRhiIgGlo, NLRloIgGhi, and NLRloIgGlo phenotype was 58.8% (20/34), 68.8% (11/16), 80.0% (4/5), and 100% (12/12), respectively (p=0.0592). Dead cases only occurred in NLRhiIgGhi and NLRhiIgGlo phenotypes.
Interpretation COVID-19 severity is associated with increased IgG response, and an immune response phenotyping based on late IgG response and NLR could act as a simple complementary tool to discriminate between severe and nonsevere COVID-19 patients, and further predict their clinical outcome.
https://www.medrxiv.org/content/10.1101/2020.03.12.20035048v1.full.pdf
For the sickest of the sick (those entering the cytokine release syndrome (CRS) stage and progressing to cytokine storm (CS)), identifying the markers you mentioned and adjusting treatment based on the trajectory of those numbers seems like an optimal plan. The treatments being used today have been based on past practices of similar viruses or in a reactionary manner and many don't seem to be working well in patients with CS. Either the treatment is ineffective or the window of opportunity has expired. Hopefully more data backs the findings of the article you cited. I feel a forward type, proactive treatment plan is the key to to identify and treat CRS before it progresses to CS. Here is an interesting article detailing many of my points.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102614/
"a timely anti-inflammation treatment initiated at the right window time is of pivotal importance and should be tailored in individual patient to achieve the most favorable effects."
RU numbers what if the issue with the saliva test that RU' developed as it wa reported that it had the capacity to test up to 50,000 a day? Why is that test not being rolled out in more places and why isn't it being used up to the supposed capacity they said it had as an article I nnj.com this morning still said NJ is woefully short on testing and another thing which is in the article said they are only reporting positives so how are the numbers they are reporting even close to accurate?
China probably failed..they are just lying about their failure.
I responded to the limitations of testing on another thread.
Basically hourly/daily testing numbers are limited to the weakest link in the chain. Prescriptions need to be procured, people need to be registered and entered into a database, testing kits need to be available, space in the testing machines needs to be allocated, good staffing to handle high volumes (administration/registration, swabbers, supervisors). Any one or more of these gets restricted and you can't maximize the ability of the others.
Exactly. And just to illustrate, if there is just one "assembly line" of workers doing all the sequential steps from checking the prescription, to registering the person in some database, to collecting the saliva, to prepping the sample in the lab, to putting that sample into the testing machine's sequence with the correct information, to the machine running the automated test and populating a result, then whatever step takes the longest is the rate-limiting step, i.e., if the longest step takes 2 minutes, then in a 10-hour workday (600 minutes), 300 samples can be taken and analyzed.
You'd then need 166 parallel assembly lines to be able to handle 50,000 samples per 10-hour day and I'm guessing we don't have more than a few. Or if the longest step is 2 minutes and every other step is 1 minute, you can double throughput by just splitting the 2 minute job over 2 people, which then gets you 600 samples per day, so you'd "only" need 83 parallel assembly lines to get to 50,000 samples in 10 hours.
The machine likely runs 24/7 and presumably takes 1.7 seconds to analyze the sample (86,400 seconds in a day/50,000 sample capacity per day), so I'm certain the machine time isn't the issue.
https://www.mudamasters.com/en/lean...nsformations/takt-cycle-process-and-lead-time
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