How long should the lock down last?

[ShockIndex]

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Or the will do it isn't there. Here lies an opportunity to fix a food shortage problem without relying on the taxpayer's dime...

It will get fixed, but it won’t be instantaneous. Market pressures will act, and in a few days food will get to the consumer. Capitalism is wonderful.

Contrast this with what happened in the USSR where food rotted on trucks and trains for years because the government’s central planning “better angles” couldn’t centrally plan fast enough...

 

[ShockIndex]

Not that many...
LA just saw a huge spike in new cases over the past two reporting days.
I did read that some of those came from a backlog of tests that finally resulted.
We were seeing daily new cases in CA go slightly on the decline for the past week (indicating SIP orders working), but now these last two days makes me wonder. Hopefully it's a blip and not a trend.

I watched the EMRAP live update last night. They discussed the antibody testing and 2 papers out of CA that looked at who might be immune.

The gist is that there are multiple antibody tests coming on line and all have different sensitivities. The ones used in the 2 studies are probably pretty good with specificities ~ 99% and PPV of 97%. The newly released home ab kits are essentially worthless.

Interestingly the 2 papers that used antibody testing found that our current PCR testing practice is underestimating the incidence and prevalence on the order of 40-50X. That means that the mortality is likely much much lower than 1-5%.

Now for the bad news and this is really bad - only 2-3 % of the population had antibodies. That means that we are nowhere near herd immunity (assuming that antibodies offer protection for more than a year or 2). It also means that any relaxation in social distancing will cause spikes. How big and fast those spikes develop depends on the prevalence of COVID when social distancing is relaxed and the degree of social mixing that occurs. Places like NY, LA, Chicago will likely blossom quickly with new spikes.

So, what does everyone think will happen to our healthcare systems and our economy as a whole if we are constantly pumping the breaks to keep our hospitals from being overrun? People need to pray that antibodies confer lifelong immunity or we develop an amazingly effective vaccine. Otherwise, a lack of toilet paper is going to be the least of our worries for the next several years..

 

[GeneralVeers]

I watched the EMRAP live update last night. They discussed the antibody testing and 2 papers out of CA that looked at who might be immune.

The gist is that there are multiple antibody tests coming on line and all have different sensitivities. The ones used in the 2 studies are probably pretty good with specificities ~ 99% and PPV of 97%. The newly released home ab kits are essentially worthless.

Interestingly the 2 papers that used antibody testing found that our current PCR testing practice is underestimating the incidence and prevalence on the order of 40-50X. That means that the mortality is likely much much lower than 1-5%.

Now for the bad news and this is really bad - only 2-3 % of the population had antibodies. That means that we are nowhere near herd immunity (assuming that antibodies offer protection for more than a year or 2). It also means that any relaxation in social distancing will cause spikes. How big and fast those spikes develop depends on the prevalence of COVID when social distancing is relaxed and the degree of social mixing that occurs. Places like NY, LA, Chicago will likely blossom quickly with new spikes.

So, what does everyone think will happen to our healthcare systems and our economy as a whole if we are constantly pumping the breaks to keep our hospitals from being overrun? People need to pray that antibodies confer lifelong immunity or we develop an amazingly effective vaccine. Otherwise, a lack of toilet paper is going to be the least of our worries for the next several years..

Isn't this all irrelevant if the mortality rate is 0.1 to 0.5% as we are now seeing? One of the reasons we shut down was crazy, inflated mortalities based on incomplete/garbage data that said the mortality was 1-3%.

If it's proven a mortality of 0.5% or less, then we shut down society for nothing.

 

[ShockIndex]

Isn't this all irrelevant if the mortality rate is 0.1 to 0.5% as we are now seeing? One of the reasons we shut down was crazy, inflated mortalities based on incomplete/garbage data that said the mortality was 1-3%.

If it's proven a mortality of 0.5% or less, then we shut down society for nothing.

Not exactly. The mortality may be lower but the R0 is higher previously thought, at least in dense population centers. Their point on EMRAP was that we need to get to 80+% of the population to get sick for herd immunity to work. A 0.5% mortality illness is more than enough to collapse the healthcare centers of major metro areas if a majority of the population is going to get sick in a short period of time. This is why NYC got nailed.

 

[bravotwozero]

Not exactly. The mortality may be lower but the R0 is higher previously thought, at least in dense population centers. Their point on EMRAP was that we need to get to 80+% of the population to get sick for herd immunity to work. A 0.5% mortality illness is more than enough to collapse the healthcare centers of major metro areas if a majority of the population is going to get sick in a short period of time. This is why NYC got nailed.

So, our only options are 1) End the lockdown, reach herd immunity, with disastrous consequences like overwhelming the hospitals and potentially millions dead, or 2) Stay in perpetual lockdown until a vaccine is developed, since we can never otherwise reach herd immunity without running into the problems in option 1?

 

[ace_inhibitor111]

So, our only options are 1) End the lockdown, reach herd immunity, with disastrous consequences like overwhelming the hospitals and potentially millions dead, or 2) Stay in perpetual lockdown until a vaccine is developed, since we can never otherwise reach herd immunity without running into the problems in option 1?

Stop all immigration into the country and then intense lockdown for 14 days. After the virus is cleared by those who have it, I don’t see why it should resurface into the population unless carried in from an outside source. That’s what (I believe) was done in South Korea.

 

[ShockIndex]

So, our only options are 1) End the lockdown, reach herd immunity, with disastrous consequences like overwhelming the hospitals and potentially millions dead, or 2) Stay in perpetual lockdown until a vaccine is developed, since we can never otherwise reach herd immunity without running into the problems in option 1?

I’d propose a 3rd option. Gradually come off lockdown in a couple of few weeks starting with less populated regions while still restricting mass gatherings like football games, concerts, and movies theaters. See how it goes while being prepared to make some hard choices if things take a turn for the worse. By hard choices I mean a refocusing of our healthcare dollars on those most likely to survive and contribute to society instead of pissing away our resources away on those already near the end of their lives or living outside of our society. In a worst case scenario, this may mean a top to bottom restructuring of our priorities where football coaches are no longer the highest payed college employees and 80-year olds can’t expect government funded CABGs on demand. Then again, we may get lucky and be able to go back to the old days of offering hip replacements to 90-year olds on the government dime until the next financial crisis hits in a decade or so.

 

[Birdstrike]

I agree that the whole country likely doesn't need to be under total lockdown; my point was that it's not as minor a problem as you imply by using the whole population as the denominator. I think the far more frustrating aspect of this situation is that, in the weeks since this whole crisis started, there's hardly been any talk as to how we are going to move beyond lockdown/shelter-in-place, as if talking about such things will jinx the whole operation. As if the government thinks the general population will flock right back to doing things as if this had never happened without threat of legal action.

Problem is, how many people does it take to not care about social distancing to undo what we've already done to this point? Have the past few weeks been one giant example of sunken-cost fallacy?

So, our only options are 1) End the lockdown, reach herd immunity, with disastrous consequences like overwhelming the hospitals and potentially millions dead, or 2) Stay in perpetual lockdown until a vaccine is developed, since we can never otherwise reach herd immunity without running into the problems in option 1?

There is a middle ground between those two.

 

[Mushdoc]

Realistically the US can't do an intense of enough shut down to have everyone burn through the disease in 14 days. Realistically the US can't even stop travel (immigration and non-immigration, imports/exports etc) 100% for 14 days. Even if we could, afterwards realistically the US cannot keep in and out travel (regardless of immigration) limited enough to keep if from getting out of control again in the US. Its here to stay. The questions is how slow or fast and what level are we comfortable with, in what parts of the country, and with what level of economic repercussions.

Stop all immigration into the country and then intense lockdown for 14 days. After the virus is cleared by those who have it, I don’t see why it should resurface into the population unless carried in from an outside source. That’s what (I believe) was done in South Korea.

 

[greatnt249]

There is a middle ground between those two.

I'm aware that there should be a middle ground between the two; what concerns me is how to go about doing so without rendering what we've already done a giant wasted effort. And as far as I can see, no one that's in a position to do anything has any actual plan beyond continuing to "wait and see."

 

[turkeyjerky]

Realistically the US can't do an intense of enough shut down to have everyone burn through the disease in 14 days. Realistically the US can't even stop travel (immigration and non-immigration, imports/exports etc) 100% for 14 days. Even if we could, afterwards realistically the US cannot keep in and out travel (regardless of immigration) limited enough to keep if from getting out of control again in the US. Its here to stay. The questions is how slow or fast and what level are we comfortable with, in what parts of the country, and with what level of economic repercussions.

Exactly. We are simply not equipped to do a wuhan-style lockdown, which is what would be required to actually suppress the outbreak. Hell, we'll not equipped to lockdown a single city. It would be unthinkable to lockdown the entire country.

I'm aware that there should be a middle ground between the two; what concerns me is how to go about doing so without rendering what we've already done a giant wasted effort. And as far as I can see, no one that's in a position to do anything has any actual plan beyond continuing to "wait and see."

Ideally, we would have spent the past several weeks increasing surge capacity, while also building up containment capabilities (eg testing, tracing, quarantining, etc), in anticipation of a mitigation based strategy (eg more limited social distancing, isolation of vulnerable populations). Unfortunately, these efforts have been half-assed at best.

 

[Mushdoc]

Even if you re-open everything now, people will only go back hesitantly, both due to fears of covid, and fears about the economy (not wanting to spend when they need to save.) The idea of an immediate V shaped economy recovery is likely gone.

German shoppers not rushing back as stores reopen

HEALTH-CORONAVIRUS/GERMANY-SHOPS:German shoppers not rushing back as stores reopen

news.trust.org

(And yes, yes, Germans are notorious savers but I think this is what we will see too)

 

[deleted941485]

Even if you re-open everything now, people will only go back hesitantly, both due to fears of covid, and fears about the economy (not wanting to spend when they need to save.) The idea of an immediate V shaped economy recovery is likely gone.

German shoppers not rushing back as stores reopen

HEALTH-CORONAVIRUS/GERMANY-SHOPS:German shoppers not rushing back as stores reopen

news.trust.org

(And yes, yes, Germans are notorious savers but I think this is what we will see too)

The longer it goes on the more people will have issues return to business as usual. a V shaped recovery is fantasy thinking at this point.

 

[Birdstrike]

Even if you re-open everything now, people will only go back hesitantly,

That's fine. Slow but steady is what we want. That gives us time to watch the virus and allows adjustments if needed. Georgia is our guinea pig right now. If their cases spike in the next two weeks, we know we need to roll out our reopening slower. If their cases don't change or they drop as they reopen, the we can follow suit. Georgia is going to give us valuable information, as will the cautious reopenings in other states.

But if you're New York, New Jersey, >60 years old, or an essential worker, stay the ---- home.

 

[Birdstrike]

10% US Population Already Infected With COVID-19 (as of 4/17-4/19)

Case Fatality Rate 0.14% (45,000 / 33,000,000)

Analysis of CDC Non-Flu Influenza-Like Illness by Justin Silverman MD/PhD, of Penn State University: Technical Analysis (pdf). Video explanation by Dr Silverman.

 

[RoyBasch]

It seems a lot of people on this website are fairly anti-lockdown. I agree it cannot go on forever, and it realistically cannot go on long enough until a vaccine is available. That being said, the current lockdown has bought valuable time. Although the "miracle" cures are still in the pipe, the lockdown has bought enough time for healthcare systems to learn how to optimally manage the disease with existing techniques, namely optimizing the approach of old fashioned critical care/supportive measures.

If you look at the data coming out of New Orleans, they are extubating ~60% of their patients and averaging 3 ventilator days. When you compare this to the early reports in Italy, it seemed fewer than 20% were getting extubated (80% something percent mortality for intubated patients) and those patients were on the vent for an average of 2 weeks.

This is saving lives, and improving efficiency of resource utilization allowing for more sustainable care, which will be a key component of success in the months ahead.

Furthermore, speaking from my own experience, in the last 6 weeks, my own hospital system has used this time to scale up testing and protection. In the early weeks of the pandemic in my area, their were serious concerns about PPE supply. We now have enough, and have improved our re-sterilization/sustainability to have enough PPE going forward for some time. Furthermore over the period of several weeks/months our sourcing/supplying is going up (companies like 3M scaling up production).

Early in the pandemic we could only test some of the inpatients (only ICU) and the test took nearly a week to result. Now we have testing that can turn around in the ER and be utilized on any symptomatic patient.

I believe as testing scales up we can more efficiently move from mitigation back to containment with use of aggressive testing and contact tracing. I think of the 20 M people out of work, some of these should be put to work by contact tracing/epidemiology units.

Antibody testing should be coming to my region en masse in the next few weeks to, and it may have an important role in tracking spread, safety, and facilitating safe gradual reopening.

The most immediate game changer of course could be discovery that an existing pharmaceutical can drastically alter the course of disease. Obviously a totally novel drug will take months/years to come to market, and we may have herd immunity by then.

It is difficult to study a disease and make progress on treatment when the system is completely overwhelmed/collapsing. The lockdown and curve flattening has allowed clinicians to study the disease and optimize care using existing techniques not just provide as much disaster triage/clinical care as possible. It is much better to get severe COVID 19 right now than it was 3 months ago, and your survival chance is much higher.

 

[thegenius]

10% US Population Already Infected With COVID-19 (as of 4/17-4/19)

Case Fatality Rate 0.14% (45,000 / 33,000,000)

Analysis of CDC Non-Flu Influenza-Like Illness by Justin Silverman MD/PhD, of Penn State University: Technical Analysis (pdf). Video explanation by Dr Silverman.

that's probably believable. However I imagine there are fairly wide CI with both those numbers, and the 10% is not evenly spread out among the population. It's probably higher in denser areas like major cities.

All these numbers
- PCR testing is not that reliable
- 45,000 deaths (which is easier to count but still subject to guessing)
- 33,000,000 estimated cases based on modeling.

Models can be so inaccurate. There was an NYT article yesterday about some statisticians from UMass looking at 5 different common models for spread of virus and death estimates and they are all over the map.

It's like pooling heterogeneous studies in a meta-analysis on the efficacy of a drug yields no useful information, because the studies are heterogenous.

 

[turkeyjerky]

10% US Population Already Infected With COVID-19 (as of 4/17-4/19)

Case Fatality Rate 0.14% (45,000 / 33,000,000)

Analysis of CDC Non-Flu Influenza-Like Illness by Justin Silverman MD/PhD, of Penn State University: Technical Analysis (pdf). Video explanation by Dr Silverman.

That smells high to me. If you believe the recent serology, LA county, which is probably higher than most areas in flyover country, is only at 4-5%. NYC, which is likely far above average, is at 21%.

Those numbers actually track quite well to my quick and dirty method of adjusting the mortality rate to 0.3-0.5% and then extrapolating the total # of cases. That would put us at 8.7M cases country wide.

It seems a lot of people on this website are fairly anti-lockdown. I agree it cannot go on forever, and it realistically cannot go on long enough until a vaccine is available. That being said, the current lockdown has bought valuable time. Although the "miracle" cures are still in the pipe, the lockdown has bought enough time for healthcare systems to learn how to optimally manage the disease with existing techniques, namely optimizing the approach of old fashioned critical care/supportive measures.

If you look at the data coming out of New Orleans, they are extubating ~60% of their patients and averaging 3 ventilator days. When you compare this to the early reports in Italy, it seemed fewer than 20% were getting extubated (80% something percent mortality for intubated patients) and those patients were on the vent for an average of 2 weeks.

This is saving lives, and improving efficiency of resource utilization allowing for more sustainable care, which will be a key component of success in the months ahead.

Furthermore, speaking from my own experience, in the last 6 weeks, my own hospital system has used this time to scale up testing and protection. In the early weeks of the pandemic in my area, their were serious concerns about PPE supply. We now have enough, and have improved our re-sterilization/sustainability to have enough PPE going forward for some time. Furthermore over the period of several weeks/months our sourcing/supplying is going up (companies like 3M scaling up production).

Early in the pandemic we could only test some of the inpatients (only ICU) and the test took nearly a week to result. Now we have testing that can turn around in the ER and be utilized on any symptomatic patient.

I believe as testing scales up we can more efficiently move from mitigation back to containment with use of aggressive testing and contact tracing. I think of the 20 M people out of work, some of these should be put to work by contact tracing/epidemiology units.

Antibody testing should be coming to my region en masse in the next few weeks to, and it may have an important role in tracking spread, safety, and facilitating safe gradual reopening.

The most immediate game changer of course could be discovery that an existing pharmaceutical can drastically alter the course of disease. Obviously a totally novel drug will take months/years to come to market, and we may have herd immunity by then.

It is difficult to study a disease and make progress on treatment when the system is completely overwhelmed/collapsing. The lockdown and curve flattening has allowed clinicians to study the disease and optimize care using existing techniques not just provide as much disaster triage/clinical care as possible. It is much better to get severe COVID 19 right now than it was 3 months ago, and your survival chance is much higher.

Perhaps the high extubation rates are related to the widespread practice of intubating people who were failing NC? I think they were widely using HFNC and NIV in italy and china, but early on we weren't due to concerns over spreading viral particles.

I do agree with you that the current lockdown has allowed us to avoid catastrophe and buy time. However, I'm not sure we've really put the time to use as well as you seem to believe:
--testing is really a public health measure. It doesn't affect clinical care. And the number of false results is very troubling.
--what pharma game-changing candidates are left--Ivermectin? Hcq seems dead in the water and the recent word on remdesivir is not promising. tocilizumab might be the answer for some critically ill patients, but it's not going to broadly applicable.
--as a country, we should have the capability to institute a test/trace containment regimen, but I don't see much progress on it. We need broadly accessible non-hospital based testing, combined w/ random screening and widespread serology.
--It was reassuring to see how much surge capacity we were able to produce by stopping elective procedures and dissuading people from coming in for BS, but hospitals are preparing to deescalate and return to the business of medicine. The question, how rapidly will they be able to pivot back if needed? There will be reticence to do so because of the success of the recent lockdown measures.

Rather, I see an attempt for a relative return to normalcy starting in May, followed by a slowly building 2nd wave much larger than the current one. A virus w/ a mortality rate of 0.5% doesn't sound too bad, but it's more than enough to overwhelm the healthcare system w/o effective mitigation.

So I mean, I don't think dead bodies are going to be stacking up in the streets, but I don't think we're out of the woods yet.

 

[RoyBasch]

That smells high to me. If you believe the recent serology, LA county, which is probably higher than most areas in flyover country, is only at 4-5%. NYC, which is likely far above average, is at 21%.

Those numbers actually track quite well to my quick and dirty method of adjusting the mortality rate to 0.3-0.5% and then extrapolating the total # of cases. That would put us at 8.7M cases country wide.

I agree the actual prevalence is about 10x what is reported, so 850,000 confirmed positive means 8.5million cases in all of the USA. That being said, the distribution is very uneven (much higher rates in NYC/NJ, but close to zero in other areas).

I agree with your estimate of the true CFR and caveats about distribution.

Perhaps the high extubation rates are related to the widespread practice of intubating people who were failing NC? I think they were widely using HFNC and NIV in italy and china, but early on we weren't due to concerns over spreading viral particles.

I don't have the actual numbers, but they reported more extensive use of HFNC and NIV compared to earlier in the pandemic and the patients they intubated by their report were floridly altered or failing more conservative measures.

I know we are intubating fewer people in the ER at my hospital than we were several weeks ago, and this has a significant implication for decreased resource utilization and sustainability of our response going forward. This is in line with developing guidelines favoring more conservative measures and less early intubation.

I do agree with you that the current lockdown has allowed us to avoid catastrophe and buy time. However, I'm not sure we've really put the time to use as well as you seem to believe:
--testing is really a public health measure. It doesn't affect clinical care. And the number of false results is very troubling.

--as a country, we should have the capability to institute a test/trace containment regimen, but I don't see much progress on it. We need broadly accessible non-hospital based testing, combined w/ random screening and widespread serology.

These two statements are relatively contradictory, you say ramping up testing doesn't make a difference, but then you say it's important. When you look at countries that have had a better response than others (Taiwan, South Korea, etc.) one common variable is extensive testing. We have more testing now than we did 6 weeks ago.

Also I can tell you it does have immediate clinical implications. For example, all suspected cases that needed CTs would require terminal clean of the scanner taking it off line for a protracted period of time. Now patient can be tested and resulted quickly. If negative, no more need for terminal cleans. This applies to patient rooms as well. Also cohorting inpatients. This has had significant effect on clinical flow and throughput.

I agree with you we are not building the apparatus to take advantage of this increased testing, but I am optimistic that we can/will. I am disappointed there isn't much federal will to do this, but I think individual states, municipalities, and large healthcare systems may make extensive use in the near future.

--what pharma game-changing candidates are left--Ivermectin? Hcq seems dead in the water and the recent word on remdesivir is not promising. tocilizumab might be the answer for some critically ill patients, but it's not going to broadly applicable.

HCQ is toast, I agree. Convalescent plasma is showing some promise, I am still awaiting results of the Chicago trial on remdesivir, and there is another experimental PO antiviral EIDD-2801 trial being conducted at Emory in Atlanta. There are other projects underway whose details are unknown to me but may work.

 

[turkeyjerky]

These two statements are relatively contradictory, you say ramping up testing doesn't make a difference, but then you say it's important. When you look at countries that have had a better response than others (Taiwan, South Korea, etc.) one common variable is extensive testing. We have more testing now than we did 6 weeks ago.

I guess I differentiate between bedside clinical care and public health measures. To me, in the care I would provide to a patient, it makes little difference whether or not a covid test is positve. You are right about the logistical concerns though. (But these do lead to some problematic decisions, esp since a PCR test is not a rule out test--with a sensitivity of 70% and a spec of 95% and a pre-test prob of 20% (low in certain circumsances) a negative test would still leave a 7% post-test probability.)

However, testing is an integral part of a strong public health containment policy. Right now, we are well past containment nationwide. I don't think testing does much at all for us right now, during a mitigation or suppression period, other than helping us gauge where we're at in the outbreak. Ideally, we'd be able to suppress the current wave, institute containment and ride it out until we have a vaccine. I just don't see that happening.

Good point about convalescent plasma. I hadn't heard of EIDD-2801 before, hopefully it pans out. I'm not bullish on remdesivir

 

[GeneralVeers]

However, testing is an integral part of a strong public health containment policy. Right now, we are well past containment nationwide. I don't think testing does much at all for us right now, during a mitigation or suppression period, other than helping us gauge where we're at in the outbreak. Ideally, we'd be able to suppress the current wave, institute containment and ride it out until we have a vaccine. I just don't see that happening.

Good point about convalescent plasma. I hadn't heard of EIDD-2801 before, hopefully it pans out. I'm not bullish on remdesivir

Agree completely. There has never been a containment strategy, or any scenario where "shelter in place" would eliminate the virus. Very few areas of the country have even approached saturation point with cases. For the vast majority of the country the lockdowns have had no benefit, and have served to prolong the virus, perhaps into the Flu season. We've probably done way more harm than good from multiple standpoints.

Many governors took rash, drastic action based on completely garbage data (2.2 miillion dead!) and now have no way of easily reversing course without public criticism. They are concerned that they will be blamed for any spike in infections. The problem is that regardless of when we come off of lockdowns, we will have a spike. I'd rather we do it now, than in in late Summer/Fall in time to get a double whammy from a flu season.

 

[Maybedoc1]

Could this be the game changing treatment we've been waiting for??

Coronavirus: Outcry after Trump suggests injecting disinfectant as treatment

Doctors call the president's latest remarks about coronavirus treatment "dangerous" and "ridiculous".

www.bbc.com

"So, supposing we hit the body with a tremendous - whether it's ultraviolet or just very powerful light," the president said, turning to Dr Deborah Birx, the White House coronavirus response co-ordinator, "and I think you said that hasn't been checked but you're going to test it.

"And then I said, supposing you brought the light inside of the body, which you can do either through the skin or in some other way. And I think you said you're going to test that too. Sounds interesting," the president continued.

"And then I see the disinfectant where it knocks it out in a minute. One minute. And is there a way we can do something like that, by injection inside or almost a cleaning?

"So it'd be interesting to check that."

Pointing to his head, Mr Trump went on: "I'm not a doctor. But I'm, like, a person that has a good you-know-what."

 

[thegenius]

Could this be the game changing treatment we've been waiting for??

Coronavirus: Outcry after Trump suggests injecting disinfectant as treatment

Doctors call the president's latest remarks about coronavirus treatment "dangerous" and "ridiculous".

www.bbc.com

"So, supposing we hit the body with a tremendous - whether it's ultraviolet or just very powerful light," the president said, turning to Dr Deborah Birx, the White House coronavirus response co-ordinator, "and I think you said that hasn't been checked but you're going to test it.

"And then I said, supposing you brought the light inside of the body, which you can do either through the skin or in some other way. And I think you said you're going to test that too. Sounds interesting," the president continued.

"And then I see the disinfectant where it knocks it out in a minute. One minute. And is there a way we can do something like that, by injection inside or almost a cleaning?

"So it'd be interesting to check that."

Pointing to his head, Mr Trump went on: "I'm not a doctor. But I'm, like, a person that has a good you-know-what."

I couldn't believe it, then I watched the video.

I just can't believe someone didn't stop him. He sounded like a baffoon.

People are seriously going to inject or inhale bleach based solely on his recommendation!

 

[thegenius]

Re: all this chatter about a second wave of COVID-19, here are my unsolicited thoughts.

In the US, it will not happen. I think there is almost a zero chance that we will get another "surge" of COVID-19 anywhere. We might get trickles or a steady stream here and there, but we will not get repeats of NYC, Detroit, Atlanta, New Orleans, Connecticut, or New Jersey. That is my definition of surge, where we have several hundreds to thousands of deaths in a single locale over a brief period of time.

I think simply wearing masks in public is enough to keep this virus from doing anything but smolder. We won't get rid of it, but it's not going to peak again.

We might hear about nursing homes here and there where "15 of 45 nursing home residents die of COVID-19" over the next year. But no huge repeat outbreaks.

 

[Lawpy]

I'm still hoping for a randomized controlled trial that has some promising results. Or at least more well designed studies. I'm seeing way too many garbage covid studies that Trump's remarks look strangely reasonable in comparison.

 

[GeneralVeers]

It's too bad governors worried about re-election (or Trump's) are keeping the majority of the country locked down, and worsening the economic pain while destroying millions of lives.

 

[d2305]

The people will only put up with government overreach for a limited time. That time has expired.

 

[Birdstrike]

Georgia is in 16th place and is at 86 deaths per million residents compared to the US average of 152. As the state most aggressively ending their lockdown, it will be important to watch what their ranking does relative to average, and whether it goes up, down or stays the same. If it goes down, stays the same or even goes up slightly but stays below average, I think you’re going to see many states ease restrictions. Keep your eye on SC & TX as well, as they ease restrictions.

Note that there are some states where the COVID-19 problem (Deaths/Milllion) is 100 times worse than some others. Making the states at the bottom of this chart follow restrictions necessary for those at the top is as calamitously stupid and destructive as it is unnecessary.

United States COVID - Coronavirus Statistics - Worldometer

United States Coronavirus update with statistics and graphs: total and new cases, deaths per day, mortality and recovery rates, current active cases, recoveries, trends and timeline.

www.worldometers.info

 

[Spikebd]

The people will only put up with government overreach for a limited time. That time has expired.

Yep. I started out in full support of the lockdown until we could gather more information. The longer this has gone on, the more convinced I am that the powers that be are loving how quickly they realized they could stir the populace into a worried frenzy. They’re Having too much fun sending out washed up celebs lecture us in “Quarantine special” brought to you by Taylor Swift, Colbert, and Jimmy Fallon. The same corporatist shills any person with a few random firing synapses have learned to ignore.

Unless you are extremely obese or have other risk factors this just isn’t a disease that has thus far proven itself to be worth the lockdown. I advocate for a slow return to normalcy, with continued careful monitoring of the situation. If I’m wrong and cases continue, then we can reverse course and try to backtrack. Thankfully some people have the courage to start a trial of re-opening, even in the face of corporatist opposition.

 

[RoyBasch]

Yep. I started out in full support of the lockdown until we could gather more information. The longer this has gone on, the more convinced I am that the powers that be are loving how quickly they realized they could stir the populace into a worried frenzy. They’re Having too much fun sending out washed up celebs lecture us in “Quarantine special” brought to you by Taylor Swift, Colbert, and Jimmy Fallon. The same corporatist shills any person with a few random firing synapses have learned to ignore.

Unless you are extremely obese or have other risk factors this just isn’t a disease that has thus far proven itself to be worth the lockdown. I advocate for a slow return to normalcy, with continued careful monitoring of the situation. If I’m wrong and cases continue, then we can reverse course and try to backtrack. Thankfully some people have the courage to start a trial of re-opening, even in the face of corporatist opposition.

I'm not sure who exactly you are referring to by "corporatists" but if you are referring to large business interests, (with the exception of some tech companies like Amazon) they have some of the most to lose with the lockdown. A lot of corporate interests are heavily in favor of the lockdown ending as soon ass possible. It's hard to get by as an airline when people aren't flying, or as a goods manufacturer when people aren't buying products, etc. etc.

 

[GeneralVeers]

I wish there was legal liability for the Imperial Colllege epidemiologists who got this so spectacularly wrong. When you are off by a factor of at least 20 on your estimates, it's not "science". Anyone could have achieved similar comically bad estimates with a dart board.

Part of being an epidemiologist is know when the data is bad (China) or incomplete (Italy) and not trying to make a broad projection based upon that data. That inaccurate model panicked politicians and the media into making hasty, disastrous decisions.

 

[ShockIndex]

We already have pretty good data on what happens when you half-ass the social distancing or take your foot off the pedal too soon.

Sweden tried half-assing it. They enacted loose social distancing recommendations (crowds limited to 50 people, schools and restaurants open) about a month ago. That have roughly 2.5X the population-adjusted deaths as their neighbors Denmark and Norway.

Singapore, that supposed model of socialized medicine and the value of rigorous testing, is now swimming in COVID with about 1000 cases per day. That is 2X the population-adjusted incidence of the US.

My point is that we can debate if our social distancing measures are worth the economic damage. That is a legit point of contention. However, claiming that social distancing has no effect, or this bug won’t re-emerge if we relax too early is not grounded in experience.

 

[thegenius]

I wish there was legal liability for the Imperial Colllege epidemiologists who got this so spectacularly wrong. When you are off by a factor of at least 20 on your estimates, it's not "science". Anyone could have achieved similar comically bad estimates with a dart board.

Part of being an epidemiologist is know when the data is bad (China) or incomplete (Italy) and not trying to make a broad projection based upon that data. That inaccurate model panicked politicians and the media into making hasty, disastrous decisions.

I assure you that recent decisions (after March 1st, let's say) were not based on this data. There were lots of competing models.

It's not like decisions this week, and last week, and the week before, and the month before, were based on initial data of "doing nothing" and having max 2.2 million deaths.

It's just silly to continue to keep on harping on this one incomplete model that came out 2 months ago as an explanation for every bad, single thing that has happened since.

Even if the government said nothing, people would do some social distancing themselves. Word would get out. People would react to news that "wow people are dying in NJ and NYC at much higher numbers than normal."

The health and economic damage is done and it was basically unavoidable. There is no scenario where we just don masks, wash our hands, and everybody flies all around and goes to concerts and bars and restaurants and weddings and continues mass gatherings. Why you keep on harping and lamenting this fact is surprising.

It's not the fault of the Imperial College epidemiologists, that's for sure.

 

[thegenius]

Yep. I started out in full support of the lockdown until we could gather more information. The longer this has gone on, the more convinced I am that the powers that be are loving how quickly they realized they could stir the populace into a worried frenzy. They’re Having too much fun sending out washed up celebs lecture us in “Quarantine special” brought to you by Taylor Swift, Colbert, and Jimmy Fallon. The same corporatist shills any person with a few random firing synapses have learned to ignore.

Unless you are extremely obese or have other risk factors this just isn’t a disease that has thus far proven itself to be worth the lockdown. I advocate for a slow return to normalcy, with continued careful monitoring of the situation. If I’m wrong and cases continue, then we can reverse course and try to backtrack. Thankfully some people have the courage to start a trial of re-opening, even in the face of corporatist opposition.

You think this is fun for people? You think they are sitting around in their large houses smiling and drinking and happy their portfolios are down 20% and they get to lay off millions of people? And then they get phone calls that their best friend died at age 42 from COVID-19?

 

[GeneralVeers]

Point taken. I guess we shouldn't reconsider drastic policies when new evidence comes to light....

 

[Birdstrike]

Point taken. I guess we shouldn't reconsider drastic policies when new evidence comes to light....

🙂

 

[Spikebd]

You think this is fun for people?

Yes.

 

[Birdstrike]

Looks like Michigan's "Reopen Michigan" protests were effective. Michigan's Governor has revised her stay at home order and has relaxed it significantly despite having the sixth highest COVID-19 deaths per capita in the nation.

 

[thegenius]

I certainly think some restrictions can be lifted, like here in Northern California we can’t even go hiking.

Although I’ve noticed a steady increase in cars in the road, although I still think we are 60-70% normal. That is one thing I will not miss, clogged roads and highways.

I was in Safeway today, wearing a mask buying some produce. I walked up next to an older man, and when I got about 2 ft from him he took a step back. I said “oh your good, your fine.” He replied “it’s not me, it’s you. Your too close to me.”

I backed off and never made eye contact with him again.

Jeez

 

[Birdstrike]

I certainly think some restrictions can be lifted, like here in Northern California we can’t even go hiking.

Although I’ve noticed a steady increase in cars in the road, although I still think we are 60-70% normal. That is one thing I will not miss, clogged roads and highways.

I was in Safeway today, wearing a mask buying some produce. I walked up next to an older man, and when I got about 2 ft from him he took a step back. I said “oh your good, your fine.” He replied “it’s not me, it’s you. Your too close to me.”

I backed off and never made eye contact with him again.

Jeez

Attempted murder? Lol

 

[GeneralVeers]

I certainly think some restrictions can be lifted, like here in Northern California we can’t even go hiking.

Although I’ve noticed a steady increase in cars in the road, although I still think we are 60-70% normal. That is one thing I will not miss, clogged roads and highways.

I was in Safeway today, wearing a mask buying some produce. I walked up next to an older man, and when I got about 2 ft from him he took a step back. I said “oh your good, your fine.” He replied “it’s not me, it’s you. Your too close to me.”

I backed off and never made eye contact with him again.

Jeez

The supermarkets now remind of Handmaid's Tale: "They have oranges today, praise be! Under his eye!"

 

[turkeyjerky]

I certainly think some restrictions can be lifted, like here in Northern California we can’t even go hiking.

Although I’ve noticed a steady increase in cars in the road, although I still think we are 60-70% normal. That is one thing I will not miss, clogged roads and highways.

I was in Safeway today, wearing a mask buying some produce. I walked up next to an older man, and when I got about 2 ft from him he took a step back. I said “oh your good, your fine.” He replied “it’s not me, it’s you. Your too close to me.”

I backed off and never made eye contact with him again.

Jeez

Yeah, no hiking is nuts.

I'm really getting sick of people crossing the street when they're still a block away from me (when I'm out running). The other day a lady with a stroller and two young children got off the sidewalk and moved into the middle of the road (where the speed limit is 40 mph and there's poor visual lines) I'll move off the sidewalk into the shoulder for people, but I'm not gonna do it when I'm 500 feet away...

 

[RustedFox]

Yeah, no hiking is nuts.

I'm really getting sick of people crossing the street when they're still a block away from me (when I'm out running). The other day a lady with a stroller and two young children got off the sidewalk and moved into the middle of the road (where the speed limit is 40 mph and there's poor visual lines) I'll move off the sidewalk into the shoulder for people, but I'm not gonna do it when I'm 500 feet away...

Saw a guy in full bunny-suit and canister, military-issue gas mask at the grocery store the other day.
He backed away from me, as well. I couldn't hide my scoff.
It's a COVID world, and we're just livin' in it.

 

[GeneralVeers]

I can't wait until they mandate us to wear masks at all time in public. Going to be an opportunity to wear some great neoprene numbers.....

 

[ShockIndex]

I can't wait until they mandate us to wear masks at all time in public. Going to be an opportunity to wear some great neoprene numbers.....

I was just in Victoria’s Secret yesterday trying on some makeshift masks...

 

[Apollyon]

I can't wait until they mandate us to wear masks at all time in public. Going to be an opportunity to wear some great neoprene numbers.....

That's in effect here in NYS. Czar Andy Cuomo made it an executive order. Everyone looks like an outlaw or bandito. I'm surprised that robberies have not risen.

 

[GeneralVeers]

I have one of these (don't ask). It would be great for mandatory mask laws at the supermarket.

 

[bravotwozero]

That's in effect here in NYS. Czar Andy Cuomo made it an executive order. Everyone looks like an outlaw or bandito. I'm surprised that robberies have not risen.

Not statewide, but my county has definitely enacted mandatory masking.

 

[Apollyon]

Not statewide, but my county has definitely enacted mandatory masking.

No, the Gov made it a statewide executive order. If your Co Executive is taking credit for it, they're wrong.

I'm in Erie County, and our Co Executive certainly didn't mandate it. And, the governor has been interrupting TPIR, the news, and Jeopardy! quite enough.

 

[ShockIndex]

I’m alternating odd and even days with:

and this: