How long should the lock down last?

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@WilcoWorld, I presented this data from the CDC (below). I encourage you to go to the source link and read the data straight from the source without the filter of my summary. I'm curious as to your reaction.

I am eager to start taking my kids to the pool, the movies and the library. We're going camping later this week, because my state just reopened its campgrounds. I fully support the use of well-designed mathematical models to guide our plans, followed by updating those plans and those models in response to new data. That appears to be the approach that the CDC is proposing.

Y'all lost me at "but.... ACEP".

Please do not mistake my above post for an endorsement of ACEP. I withdrew my membership years ago. Is anyone in this thread supporting ACEP?

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I suspect many of you think I'm a bleeding heart liberal. Yet I support reopening businesses in areas with a sustained decline in new cases. These reopenings should be paired with robust monitoring - an acceleration in new cases would indicate we've jumped the gun but if our monitoring shows us that these moves are followed by a continued decline in cases, it would indicate that we can accelerate reopening. Most of the "liberals" I talk to feel similarly. What the "liberals" I talk to disagree with is a one size fits all approach to repoening that lacks a plan for monitoring and responsiveness.

Sure, you can find crazies out there making ridiculous assertions, but these crazies exist on both "sides" of this issue (an issue that really shouldn't have sides, IMO). Arguing against the extreme of a position, when that is not actually what your opponent is arguing for, is straw-manning and can make for appealing rhetoric but doesn't actually advance the conversation.

Complete nonsense. This is not why we are locked down. You have bought into the group-think about "second spikes" which has resulted in the shifting goal past. The goal of the original lockdown was to prevent hospitals from being overwhelmed. Check. We did that. We were successful. We are are as ready as we will ever be. Let's open everything up and get back to work. We can handle a "second spike" if it should come. We are now doing more damage and harm to people with every day we stay closed than the virus ever did.

I hope in the future people realize how their lives, businesses, relationships, and children were all destroyed or damaged by these feckless, cowardly politicians. I suspect they won't because the complicit media will bury any stories which reveal the truth.
 
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Complete nonsense. This is not why we are locked down. You have bought into the group-think about "second spikes" which has resulted in the shifting goal past. The goal of the original lockdown was to prevent hospitals from being overwhelmed. Check. We did that. We were successful. We are are as ready as we will ever be. Let's open everything up and get back to work. We can handle a "second spike" if it should come. We are now doing more damage and harm to people with every day we stay closed than the virus ever did.

I hope in the future people realize how their lives, businesses, relationships, and children were all destroyed or damaged by these feckless, cowardly politicians. I suspect they won't because the complicit media will bury any stories which reveal the truth.

I have had the same position from the beginning. I am not moving any goal posts. We should continue to monitor to ensure that we won't overwhelm our health system, not to ensure that zero people die from COVID. I think the fact that you called my post "complete nonsense" indicates that I should go back to not contributing to this thread.
 
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I have had the same position from the beginning. I am not moving any goal posts. We should continue to monitor to ensure that we won't overwhelm our health system, not to ensure that zero people die from COVID. I think the fact that you called my post "complete nonsense" indicates that I should go back to not contributing to this thread.

This is what I don't get: Our hospitals are empty. We don't need any more monitoring to tell us that we will be fine. Sure it would be great to spend weeks and weeks "collecting data" and "watching the trends", however there is inherent harm to waiting. We are at the point where the number of businesses that will go bankrupt is going to accelerate "exponentially" to borrow the favorite pandemic buzzword. Spending weeks and weeks going through these phased openings, will just ensure that the economic damage is catastrophically worse. The states that are completely re-open have not been overwhelmed. Knowing this, why can't we just open everything?
 
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I have had the same position from the beginning. I am not moving any goal posts. We should continue to monitor to ensure that we won't overwhelm our health system, not to ensure that zero people die from COVID. I think the fact that you called my post "complete nonsense" indicates that I should go back to not contributing to this thread.

You must not be married.
 
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We can open everything. And hopefully you live in a state with a rational Governor, who's proceeding to do exactly that.

Unfortunately my Governor is a *****. Everything can open completely in Utah and Arizona but its just not safe for some reason to open Nevada. They even opened casinos in AZ. So stupid.
 
This is what I don't get: Our hospitals are empty. We don't need any more monitoring to tell us that we will be fine. Sure it would be great to spend weeks and weeks "collecting data" and "watching the trends", however there is inherent harm to waiting. We are at the point where the number of businesses that will go bankrupt is going to accelerate "exponentially" to borrow the favorite pandemic buzzword. Spending weeks and weeks going through these phased openings, will just ensure that the economic damage is catastrophically worse. The states that are completely re-open have not been overwhelmed. Knowing this, why can't we just open everything?

While I agree we can open up faster and should expect (and accept) a spike in cases... there should be some level of caution.

1. No crowded mass events (ie packed concerts and sporting events or night clubs).

2. We can largely wear masks- even if the evidence is not solid that they help- the jury is still out.

I say this because the economic risk of these two measures is very small. And the upside is large. Wearing masks is a minor inconvenience and isn’t hurting anyone.

Taking a small continued self-inflicted economic hit is prudent— given we know this thing does have the potential to overwhelm health systems. Destroying the economy totally is not
 
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I just got done listening to the EMRAP segment from last week where Mel et al interviewed 3 EPs from Sweden. It was interesting to say the least. Before hitting the key points, keep in mind Sweden has a government funded, universal healthcare system.

1) Despite having a universal healthcare system, the Swedish hospitals faced similar challenges as our own headed into the pandemic such as boarding, in-patient bed closures, nursing shortages, etc.

2) Sweden is the population of NYC (10 million) in an area the size of CA.

3) Impoverished areas and nursing homes were hit the hardest.

4) Things got tight in the populated areas around Stockholm (and still are) but no patients have died due to lack of vents.

5) The general feeling from these 3 docs is that Sweden adopted the right approach but could have done a better job with nursing homes.
 
While I agree we can open up faster and should expect (and accept) a spike in cases... there should be some level of caution.

1. No crowded mass events (ie packed concerts and sporting events or night clubs).

I agree to an extent on this....the problem become at what point do we go back to having sporting events, night clubs, and shows? In Vegas for example shows cannot operate on 25% or 50% capacity. This virus will be around for the forseeable future, so I'd like to see some criteria for which point we can resume our entertainment.

2. We can largely wear masks- even if the evidence is not solid that they help- the jury is still out.

Sure if people want to and they think it protects them go ahead. I'm not going to, and I think any laws forcing this on people will just lead to civil disobedience and inappropriate use of law enforcement.


Taking a small continued self-inflicted economic hit is prudent— given we know this thing does have the potential to overwhelm health systems. Destroying the economy totally is not

Agreed, but the *****s in charge, including Trump decided to unleash the economic neutron bomb, rather than use simple, prudent steps.
 
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Sure if people want to and they think it protects them go ahead. I'm not going to, and I think any laws forcing this on people will just lead to civil disobedience and inappropriate use of law enforcement.

So much this.
One of the radio shows that I listen to recently did a bit entitled: "How to burn a COVID heretic" regarding how the mass *****s are making pariahs out of anyone who can think for themselves.
 
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I agree to an extent on this....the problem become at what point do we go back to having sporting events, night clubs, and shows? In Vegas for example shows cannot operate on 25% or 50% capacity. This virus will be around for the forseeable future, so I'd like to see some criteria for which point we can resume our entertainment.

Sure if people want to and they think it protects them go ahead. I'm not going to, and I think any laws forcing this on people will just lead to civil disobedience and inappropriate use of law enforcement.

I’d be fine if a governor made some criteria like hospitalizations/deaths from covid19 have to be stable or down for 2 months after their initial “reopening” — then we open the concerts, mass events etc. Criteria are fine.

In regards to the masks I agree law enforcement should stay away from this. At the same time, I think businesses have the right to politely refuse to serve you if you decide not to wear a mask. It’s not like the masks are hurting anyone — so given their effectiveness is up in the air— I see the people walking around the grocery store without one as basically saying “F-you everyone!! I’ll do exactly as I please because I’m an American and don’t care what anyone else thinks!”
 
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Masks are this generation’s “Support Our Troops” bumper sticker. They are a means to show solidarity.
 
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I’d be fine if a governor made some criteria like hospitalizations/deaths from covid19 have to be stable or down for 2 months after their initial “reopening” — then we open the concerts, mass events etc. Criteria are fine.

In regards to the masks I agree law enforcement should stay away from this. At the same time, I think businesses have the right to politely refuse to serve you if you decide not to wear a mask. It’s not like the masks are hurting anyone — so given their effectiveness is up in the air— I see the people walking around the grocery store without one as basically saying “F-you everyone!! I’ll do exactly as I please because I’m an American and don’t care what anyone else thinks!”

I'm one of those grocery store people. Mainly because I find them uncomfortable, and gross to wear after a while. I'm not going to suffer an ineffective discomfort just to show solidarity with others. I do agree that private business has every right to make their own policy on this and refuse service to those who won't comply.
 
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Unfortunately my Governor is a *****. Everything can open completely in Utah and Arizona but its just not safe for some reason to open Nevada. They even opened casinos in AZ. So stupid.
That's either stupidity or sabotage. You should see my town. It's teaming with people packed shoulder to shoulder on the beaches, streets and in stores, dripping of sweat with no masks or social distancing for weeks. Cases & deaths are decreasing.
 
Masks are this generation’s “Support Our Troops” bumper sticker. They are a means to show solidarity.
It's vIrtue signaling. Even if your mask-selfie shows you with a crocheted mask with holes the width of a billion virions, you've successfully sent the signal to your Karens on Team Fear.

What a time to be alive.
 
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Interesting how Karens are being invoked on both sides of the mask issue.

I think the continued decrease in case counts, despite the reopenings, suggests seasonality. Which is also likely why Sweden's outbreak wasn't as bad as predicted and why Croatia has no new cases.

So the question is, will we get numbers down low and beef up public health enough to allow for contact tracings and containment, or are we facing another lockdown in the fall?
 
Interesting how Karens are being invoked on both sides of the mask issue.

I think the continued decrease in case counts, despite the reopenings, suggests seasonality. Which is also likely why Sweden's outbreak wasn't as bad as predicted and why Croatia has no new cases.

So the question is, will we get numbers down low and beef up public health enough to allow for contact tracings and containment, or are we facing another lockdown in the fall?
I know 2 weeks ago my state hired 1400 contact tracers (normal number here is 20)...
 
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HALF POPULATION MAY HAVE SOME PRE-EXISTING IMMUNITY TO COVID-19

A study accepted for publication in Cell, finds "CD4+ T cell responses were detected in 40-60% of unexposed individuals. This may be reflective of some degree of cross-reactive, preexisting immunity to SARSCoV-2..." The study was done by researchers from UCSD, UNC, Mt. Sinai and La Jolla Institute of Immunology.
 
I have had the same position from the beginning. I am not moving any goal posts. We should continue to monitor to ensure that we won't overwhelm our health system, not to ensure that zero people die from COVID. I think the fact that you called my post "complete nonsense" indicates that I should go back to not contributing to this thread.
This is what I don't get: Our hospitals are empty. We don't need any more monitoring to tell us that we will be fine. Sure it would be great to spend weeks and weeks "collecting data" and "watching the trends", however there is inherent harm to waiting. We are at the point where the number of businesses that will go bankrupt is going to accelerate "exponentially" to borrow the favorite pandemic buzzword. Spending weeks and weeks going through these phased openings, will just ensure that the economic damage is catastrophically worse. The states that are completely re-open have not been overwhelmed. Knowing this, why can't we just open everything?


Trump’s White House published its own guide to reopening which is in line with WilcoWorld’s posts. Then Trump ignores his own guidelines.

 
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Since mid-March we’ve been testing every single patient presenting for surgery in our hospital and freestanding surgery center in a large West Coast city. We’ve done over 2000 tests and have had 5-6 test COVID+ on RT-PCR. Even accounting for false negatives, the prevalence is extremely low. It’s unlikely there is widespread immunity in my community.
 
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I suggest not to fight data with your own feelings, leanings and biases...data is data.

CDC most recent estimates revise the case fatality ratio down to 0.40%. This matches the high end of Ionnadis’ publication estimates. Which makes the infection fatality ratio likely 0.1% or lower (similar to flu).

We can logically expect the CDC estimate of CFR and thus IFR to continue to trend down as testing becomes more widespread (CDC are also assuming 35% asymptomatic, likely a low assumption).


>0.1% of all New York State residents died of COVID in the past 2 months so it’s unlikely the IFR is 0.1%. Assuming 10% seroprevalence in NY state, the IFR is closer to 1%.
 
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Trump’s White House published its own guide to reopening which is in line with WilcoWorld’s posts. Then Trump ignores his own guidelines.

It's all moot at this point. People have decided to go on with their lives, regardless. The lockdowns are over, whether they're "over" or not.
 
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Since mid-March we’ve been testing every single patient presenting for surgery in our hospital and freestanding surgery center in a large West Coast city. We’ve done over 2000 tests and have had 5-6 test COVID+ on RT-PCR. Even accounting for false negatives, the prevalence is extremely low. It’s unlikely there is widespread immunity in my community.
If your community had a large percentage with some pre-existing immunity, this is exactly what you'd see. Those people would not test positive for COVID-19. Only those with current infection would. The pre-existing immunity as described in the above study I posted, was not from active or previous COVID-19 infection, it was from T cells from previous non-COVID-19 coronavirus infections, that cross-reacted to COVID-19 when exposed in the lab.

In other words, if a large percentage of people in your community had been exposed to other (similar, but non-COVID-19) coronaviruses in the past, they may have developed some immunity to COVID-19, and therefore would be less likely to ever get symptomatic COVID-19 and therefore would be less likely to test positive for active COVID-19 when you screened them. The only way you would pick this up on your routine hospital screening would be if you were specifically also testing those patients for CD4+ T cell response to COVID-19, which there woudl be no reason to ever do as a "screening" test.

Consider reading the paper: https://www.cell.com/action/showPdf?pii=S0092-8674(20)30610-3
 
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>0.1% of all New York State residents died of COVID in the past 2 months so it’s unlikely the IFR is 0.1%. Assuming 10% seroprevalence in NY state, the IFR is closer to 1%.
NY State is not the only place in the world with COVID-19. What happened in NY, including the fatality rate, does not extrapolate to everywhere else. If you actually read the study I posted on this 1-2 days ago, he explains how IFRs vary based on location and local factors, some being higher (NY) others being much lower, which gives you an average that's somewhere in the middle. The locations and local data are listed.

NY state has a deaths per capita (1,503/1M) over 5x greater than the national average (300/1M) and over 100x greater than several US states (Montana, 15; Alaska, 14; Hawaii, 12).

What's right for New York, isn't necessarily what's right for everyone else.
 
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My kid's are 4, so of it's not in person it's not worth doing
I pay for private school, I have a 4 year old as well. Let's be serious most of his preK is childcare. His online assignments were pictures to color that we needed to print out and for him to send in via an app. So there was that.
 
If your community had a large percentage with some pre-existing immunity, this is exactly what you'd see. Those people would not test positive for COVID-19. Only those with current infection would. The pre-existing immunity as described in the above study I posted, was not from active or previous COVID-19 infection, it was from T cells from previous non-COVID-19 coronavirus infections, that cross-reacted to COVID-19 when exposed in the lab.

In other words, if a large percentage of people in your community had been exposed to other (similar, but non-COVID-19) coronaviruses in the past, they may have developed some immunity to COVID-19, and therefore would be less likely to ever get symptomatic COVID-19 and therefore would be less likely to test positive for active COVID-19 when you screened them. The only way you would pick this up on your routine hospital screening would be if you were specifically also testing those patients for CD4+ T cell response to COVID-19, which there woudl be no reason to ever do as a "screening" test.

Consider reading the paper: https://www.cell.com/action/showPdf?pii=S0092-8674(20)30610-3

It’s an interesting paper but why can’t we get to the studies that address whether these people with T-cell responses (or with antibodies) correlate with immunity (or mild disease)??? That will be the key.
 
I pay for private school, I have a 4 year old as well. Let's be serious most of his preK is childcare. His online assignments were pictures to color that we needed to print out and for him to send in via an app. So there was that.
We also pay for private school, and what you're saying is basically the point I was making.
 
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It’s an interesting paper but why can’t we get to the studies that address whether these people with T-cell responses (or with antibodies) correlate with immunity (or mild disease)??? That will be the key.
That takes time.
 
We also pay for private school, and what you're saying is basically the point I was making.
Agreed. For this year semester we would have continued to pay not just because we were obliged (year a time) but for teaching staff etc. The tough decision is to repay for another year if they are not open. What are your plans?
 
NY State is not the only place in the world with COVID-19. What happened in NY, including the fatality rate, does not extrapolate to everywhere else. If you actually read the study I posted on this 1-2 days ago, he explains how IFRs vary based on location and local factors, some being higher (NY) others being much lower, which gives you an average that's somewhere in the middle. The locations and local data are listed.

NY state has a deaths per capita (1,503/1M) over 5x greater than the national average (300/1M) and over 100x greater than several US states (Montana, 15; Alaska, 14; Hawaii, 12).

What's right for New York, isn't necessarily what's right for everyone else.

Ionnadis’ paper is more of an editorial than a study. Nobody knows the actual prevalence of SARS-COV2. Hawaii, Montana, and Alaska probably have exceedingly low prevalence. Their IFR may still be high. I agree IFR will vary depending on local conditions and patient factors.
 
Researchers in China tracked 455 people exposed to asymptomatic carrier of COVID-19. None of the 455 developed COVID-19.

Remind me again what purpose continued “lockdowns” of the well, serve?

 
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Researchers in China tracked 455 people exposed to asymptomatic carriers of COVID-19. None of the 455 developed COVID-19.

Remind me again what purpose continued “lockdowns” of the well, serve?


"Conclusion: In summary, all the 455 contacts were excluded from SARS-CoV-2 infection and we conclude that the infectivity of some asymptomatic SARS-CoV-2 carriers might be weak"

Dude, they tracked the contacts one asymptomatic carrier.
 
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"Conclusion: In summary, all the 455 contacts were excluded from SARS-CoV-2 infection and we conclude that the infectivity of some asymptomatic SARS-CoV-2 carriers might be weak"

Dude, they tracked the contacts one asymptomatic carrier.
Yes. And?
 
Yes. And?

All of the available evidence suggests that this is far less infectious than we thought.

- Unlikely to contract through contact with infected surfaces
- Spread through close family members and nosocomial exposure
- Community spread is in poorly ventilated areas to people in close proximity
- Killed rapidly on outdoor surfaces.
 
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We don’t really understand asymptomatic spread yet. My buddy has cancelled his July wedding.


My brother is supposed to get married end of June. Although I'm a dual citizen, I don't think cross border travel restrictions between the US and Canada are going to be lifted, so don't think I can make it. They're just going to have a very small ceremony with a few immediate family members...
 
Asymptomatic spread, or symptomatic spread?

“Symptomatic index patient”

My bad. Should have read more carefully. Index patient started feeling sick on March 7, attended choir practice on March 10 where up to 52/61 people got sick.
 
My brother is supposed to get married end of June. Although I'm a dual citizen, I don't think cross border travel restrictions between the US and Canada are going to be lifted, so don't think I can make it. They're just going to have a very small ceremony with a few immediate family members...

Sorry to hear that.
 
Remind me again what purpose continued “lockdowns” of the well, serve?
It gives everyone an idea as to what life would be like if the left enacted just half of the Green New Bull****.

My buddy has cancelled his July wedding.

Someday, he will thank COVID if he is smart.
 
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Yes. And?

It's an anecdote, not data.

All of the available evidence suggests that this is far less infectious than we thought.

- Unlikely to contract through contact with infected surfaces
- Spread through close family members and nosocomial exposure
- Community spread is in poorly ventilated areas to people in close proximity
- Killed rapidly on outdoor surfaces.

Agreed, and hence the massive success of the shutdown (outside of the northeast, which was relatively late to do so). (Although the widely estimated R0 of 2.3 (in a naiive population not practicing social distancing) doesn't sound crazy high to me.) All the crazy stuff that being circulated in pre-publications back in March is not aging well.
 
It's all moot at this point. People have decided to go on with their lives, regardless. The lockdowns are over, whether they're "over" or not.
"Conclusion: In summary, all the 455 contacts were excluded from SARS-CoV-2 infection and we conclude that the infectivity of some asymptomatic SARS-CoV-2 carriers might be weak"

Dude, they tracked the contacts one asymptomatic carrier.
All of the available evidence suggests that this is far less infectious than we thought.

- Unlikely to contract through contact with infected surfaces
- Spread through close family members and nosocomial exposure
- Community spread is in poorly ventilated areas to people in close proximity
- Killed rapidly on outdoor surfaces.



So what are you guys doing personally?

My county has about 7000 cases and my hospital usually has 30-35 cases in-house with half in icu. Businesses around here won’t let you in without a mask including my hospital. I’m still wearing an n95 all day, every day at work but I don’t wear a mask outside when I’m running or walking my dog. I do wear a regular surgical mask whenever I enter a building or can’t distance myself. Many restaurants have tables set across their front door so you can’t go in at all but you can pick up your takeout food at the table. Socially I still limit myself to my immediate family, no visiting or going out with friends.

Are your gyms and theaters open? Schools? Are people dining out? And I totally understand some counties have few if any cases.
 
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I wear a surgical mask at work with every patient (it's usually around my neck when I'm at a computer), N95s when I'm tubing or coding a patient. This has pretty much been my practice since mid-Feb and I expect it to continue. (I'm in my mid thirties and fit though. If I were older or fatter, I'd wear an N95 all day)

My city began reopening two weeks ago (although we never shut down to nearly the extent of california). I got my haircut last week and went to the gym a few times, then went to a local brewpub saturday night for burgers and beers (it was pretty crowded). I try to war a mask when I'm going into a grocery store or something, but it's mostly virtue signaling. I like to cook and haven't gotten takeout since the lockdowns started (it's either been homemade or hospital food for me)
 
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So what are you guys doing personally?

My county has about 7000 cases and my hospital usually has 30-35 cases in-house with half in icu. Businesses around here won’t let you in without a mask including my hospital. I’m still wearing an n95 all day, every day at work but I don’t wear a mask outside when I’m running or walking my dog. I do wear a regular surgical mask whenever I enter a building or can’t distance myself. Many restaurants have tables set across their front door so you can’t go in at all but you can pick up your takeout food at the table. Socially I still limit myself to my immediate family, no visiting or going out with friends.

Are your gyms and theaters open? Schools? Are people dining out? And I totally understand some counties have few if any cases.

Living life. Going to the gym. Occasionally going to restaurants. Hikes. Big box and grocery stores. I don't wear a mask, but if they enacted a rule for us too I wouldn't cry about it. Surgical mask for all patients. N95 when I'm tubing, lining, or coding or with obvious suspected.

I'm not Northeast but we had a pretty significant amount of cases and I intubated plenty. Still occasionally are. Been open for awhile and our local numbers continue to decline significantly.
 
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So what are you guys doing personally?
I were a mask at work and any store that requires it. I wash my hands and use sanitizer a lot more than pre-COVID. Otherwise, life as usual.

Are your gyms and theaters open? Schools? Are people dining out? And I totally understand some counties have few if any cases.
I'm in the southeast. Our COVID cases and deaths significant but below the national average. Pretty much everything has reopened here. The only thing not yet open is stadiums/concerts. Schools finished the year online and are out for summer. Maybe 5% of people I see in public have a mask on. I'd say life is 95% back to normal here. Took kids out for ice cream this weekend.

People are over it here. Done. Ready to move on with life, COVID or not. Me, too.

I must admit, my first nice dinner out post lockdown, was glorious.
 
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