How long should the lock down last?

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Tomorrow I'm going to the local gun store to sign the recall petition for our governor. We need 234k signatures.

If neighboring Utah, and CO (hardly a Republican stronghold) can both start relaxing lockdown measures this week, there's no reason we can't as well.
 
DoctwoB said:
Of course, and everyone will have set their specific threshold for risk. As you said, the goal is to limit risk rather then eliminate it. For your above example, id see my family but do an outdoor event where distancing is easy. I will see friends in small gatherings but masking while indoors. I’ll bring my kids to the park. I’ll send them to daycare. I probably won’t eat much at restaurants beyond a rare night out. I definitely will limit travel. That’s also why “opening the economy” isn’t a magic bullet. Consumption/spending and thus GDP and jobs will still be way down as people modify their behavior.
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I agree generally, and I’m not optimistic that people will be able to return to even a modicum of normalcy. I just don’t see how we get from here to there. From seeing other people (even family) as death bringers to saying “let’s hang out”. Our leaders and media got the ball rolling but the people took it and ran, which is how social distancing morphed into wearing masks while walking alone down the street and scrubbing groceries in the garage. If flattening the curve to avoid overwhelming the hospitals was the goal, then there’s no reason my 14-year-old can’t play with her 2-year-old cousin. The only way that prohibition makes sense is if the goal is: nobody can get infected or sick, ever. Now that we’ve set this precedent it seems impossible to back off.
 
MHYDE said:
There’s a psychological hurdle that we will need to get over too. I have lots of extended family in town. We haven’t seen any of them in person for over a month, and won’t for a while. It’s “too dangerous”. When society gradually reopens, can we have my siblings and in-laws over for dinner? If it’s safe in a month, why isn’t it safe now? Conversely, if it’s dangerous now, why won’t it be dangerous in a month, or a year? I think the answer is that there’s no such thing as “safe”, only varying degrees of risk we learn to live with as social animals. We’ve been conditioned now to reject all risk. We’re going to have to have a family BBQ knowing one of us could be infected and could share it with all, and we’re going to have to just be ok with that. After the last 2 months of being told we must stay home and stay safe, that will be a high hurdle for many. And let’s not kid ourselves that more testing will change that, given that so many infected people can be asymptomatic or presymptomatic.
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If you and everybody else at that barbecue have been socially distancing for 2 weeks and are asymptomatic, I would think the risk is low.
 
KGflyboy said:
His point stands. The 2.2 million estimate was not accurate. In the paper being referenced, they estimated deaths could be reduced by 50% if strict measures were taken. Our deaths are nowhere near 1.1 million, so either social distancing is way more effective than the authors thought it would be, or they grossly overestimated the number of deaths.

You may believe the discrepancy is attributed to social distancing having an unexpectedly profound positive impact, but I think the far more likely explanation for the discrepancy in the predicted deaths is that the initial number was an overestimate.
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The paper defined their version of strict measures, which were not all that strict. If I recall, they were isolating all old people.
 
nimbus said:
If you and everybody else at that barbecue have been socially distancing for 2 weeks and are asymptomatic, I would think the risk is low.
Click to expand...

I’m a doctor, my sister works at an urgent care. I guess I’ll never see her again. My point isn’t that the risk of infection is low, it’s that the risk of infection will never go away so what’s the point, really?
 
GeneralVeers said:
No end in sight in my state, despite being middle of the pack in terms of deaths/capita.
www.reviewjournal.com

VICTOR JOECKS: Sisolak hints coronavirus lockdown could last through June

Gov. Steve Sisolak doesn’t have a plan to open Nevada. But he’s rhetorically committed to extending the lockdown through June — and potentially much longer.
www.reviewjournal.com www.reviewjournal.com

We've achieved the primary goal. Our hospitals are all empty. We need to re-open.
Click to expand...

Maybe he means Las Vegas? Perhaps they can transform all of those lights in Vegas into UV lights and kill it. They we can go back to our old ways of debauchery.
 
To be fair we went into lockdown so the healthcare system will not be overwhelmed. Now the healthcare system is not overwhelmed sure some ICU docs are boarding but some of these patients can be transferred to other ICUs.

Also mass testing for the virusis pointless because without a vaccine multiple people will have it and for most people the cases are mild. Do you want an antibody test.

People say flu will be bad this fall but actually will be less because we are social distancing and wearing masks also with the flu vaccine flu will probably be way less severe.
 
Brigade4Radiant said:
To be fair we went into lockdown so the healthcare system will not be overwhelmed. Now the healthcare system is not overwhelmed sure some ICU docs are boarding but some of these patients can be transferred to other ICUs.

Also mass testing for the virusis pointless because without a vaccine multiple people will have it and for most people the cases are mild. Do you want an antibody test.

People say flu will be bad this fall but actually will be less because we are social distancing and wearing masks also with the flu vaccine flu will probably be way less severe.
Click to expand...

Also "mass testing" is essentially worthless without contact tracing and isolation. Americans aren't compliant enough to let authorities track them and forcibly keep the infected and their close contacts in their homes for 2 weeks at a time.
 
GeneralVeers said:
Also "mass testing" is essentially worthless without contact tracing and isolation. Americans aren't compliant enough to let authorities track them and forcibly keep the infected and their close contacts in their homes for 2 weeks at a time.
Click to expand...
I think enough people would do it on their own to make a decent difference
 
GeneralVeers said:
Also "mass testing" is essentially worthless without contact tracing and isolation. Americans aren't compliant enough to let authorities track them and forcibly keep the infected and their close contacts in their homes for 2 weeks at a time.
Click to expand...

We actually had a circulating nurse test positive. The ortho implant rep in the OR with her heard it through the grapevine. He was never notified by the hospital and was livid.
 
Mr. Hat said:
The more time goes on, the more I find the two camps look something like this (at least in my circle):

1) The “Keeping things shut down is worth it even if it saves just one life, and if you think otherwise you’re selfish” Camp. Composed primarily of people who are still getting paychecks and can pay their bills. And who get very angry if you so much as suggest it might also be selfish to ask other people to have their lives totally destroyed so that you can avoid a small chance of dying, which can be even further mitigated by voluntarily choosing to self quarantine.
Click to expand...

I’m PP FFS anesthesia. 100% productivity based. All elective surgery is cancelled. We are only doing traumas/fractures/appys/cancer/etc. My volume and income are down 80%. I think if we restart too soon we will face more pain down the road. If someone can’t handle a few months of reduced income on a physicians income, they’re an idiot.
 
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nimbus said:
I’m PP FFS anesthesia. 100% productivity based. All elective surgery is cancelled. We are only doing traumas/fractures/appys/cancer/etc. My volume and income are down 80%. I think if we restart too soon we will face more pain down the road. If someone can’t handle a few months of reduced income on a physicians income, they’re an idiot.
Click to expand...

I'm not worried about the short term loss of income. Long term this is going to hit physicians to a degree. I can't speculate on how much that is going to be. I also have a lot of friends out of work who are suffering because of callous government officials.
 
I want to reopen as much as the next guy but it makes no sense to reopen now that things are much worse than they were when we shut down a month ago. The behavior of the virus should tell us when we reopen, not people losing patience. How long did people think this would last?

How to reopen playbook...

 
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GeneralVeers said:
I'm not worried about the short term loss of income. Long term this is going to hit physicians to a degree. I can't speculate on how much that is going to be. I also have a lot of friends out of work who are suffering because of callous government officials.
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As someone at the start of his career I'm curious as to why you think this will hit physicians long-term. Reduced volumes? Shift to single-payer? It would seem that this time is also a good opportunity to establish the relative value of emergency physicians and the work that they do. I don't think the profession will ever have a better leverage for lobbying for provider-friendly balance-billing legislation, lobbying for increased CMS reimbursement, etc.
 
Read a funny meme the other day that went something along the lines of... “you have to disclose wether or not you are still getting a paycheck, and then you can let people know of your thought that people should still be mandated to stay home or return back to work”.

Aka all you govt workers and to everyone else that’s getting their paychecks as they work from online and carry on with business as usual. It’s pretty high almighty for them to make those that are suffering financially to do their bidding. Just a thought lol!
 
KGflyboy said:
As of the time of my response, there are 16,599 deaths in New York State attributed to Covid. The state population is 19.5 million.

That's 0.085%.

I think your point still stands. The number will likely surpass .1% very soon.

But if you are going to call somebody out for incorrect math, you should not rebut them with incorrect math of your own. We need accurate information posted here.
Click to expand...

Can you imagine if we used this logic on 9/11/01?

Oh, 0.015% state wide mortality rate? Meh, carry on as usual.

Idiot tries a few years later to blow his shoes up and fails. Zero mortality and yet we're all still taking off our shoes and limiting the amount of soap we can carry on a plane. No one bats an eye at it and if you question the heroes at the TSA, you're un-American and want the terrorists to win!
 
nimbus said:
I want to reopen as much as the next guy but it makes no sense to reopen now that things are much worse than they were when we shut down a month ago. The behavior of the virus should tell us when we reopen, not people losing patience. How long did people think this would last?

How to reopen playbook...

Click to expand...


Huh? How are things worse? Am I missing some data?
 
turkeyjerky said:
Sorry, but I'm just so sick of this "2.2 million people didn't die, so it was all a hoax. Drink your bleach and keep on carrying on" schtick he has.
Click to expand...

Remember when it was "ThE fLu KiLlEd MoRe PeOpLe! We didn't shut down for the flu." It seems like last week and we've almost surpassed the upper estimate of last year's flu season.

It's like if it didn't happen immediately (Despite the criminal lack of tests that were promised. We're no where near the most tests per capita), then it's all a liberal lie.
 
Siggy said:
Remember when it was "ThE fLu KiLlEd MoRe PeOpLe! We didn't shut down for the flu." It seems like last week and we've almost surpassed the upper estimate of last year's flu season.

It's like if it didn't happen immediately (Despite the criminal lack of tests that were promised. We're no where near the most tests per capita), then it's all a liberal lie.
Click to expand...

It's actually really care to compare because deaths due to Corona is being tallied differently than the flu. We have never retroactively labeled deaths as "caused by flu" in the past, or "presumptive flu deaths" like we are doing with this disease. The reasons why they are doing this is multifactorial. I'd like to see numbers on flu-proven deaths and compare with Corona-proven deaths as I think it would be a better comparison.
 
Want the real test for when it's time to reopen? Let us know when the executive mansions are back to being open for tours. Too unsafe to tour the White House? Probably too unsafe to open the economy.
 
Siggy said:
Want the real test for when it's time to reopen? Let us know when the executive mansions are back to being open for tours. Too unsafe to tour the White House? Probably too unsafe to open the economy.
Click to expand...

No, when hospitals aren't overwhelmed and can handle more cases......as was the originally stated intent.
 
GeneralVeers said:
That's better than 1-2 weeks ago. Deaths, ICU beds occupied, and admissions are all declining.

Also daily new cases is not a useful metric. Testing is increasing everywhere, so of course cases will go up.
Click to expand...

Today was the 1st day we had a substantial drop. No actual trend yet. We shut down mid March when we had 30-70 deaths/day. Now we are consistently around 2000.

9FD29917-BEDF-4A42-A745-627EBD7513F7.jpeg
 
GeneralVeers said:
It's actually really care to compare because deaths due to Corona is being tallied differently than the flu. We have never retroactively labeled deaths as "caused by flu" in the past, or "presumptive flu deaths" like we are doing with this disease. The reasons why they are doing this is multifactorial. I'd like to see numbers on flu-proven deaths and compare with Corona-proven deaths as I think it would be a better comparison.
Click to expand...


... and that's why the flu deaths are presented as a range with a 95% confidence interval.
...and no... you do not need a positive influenza test to code for the flu, just like I don't need a PFT to diagnose a COPD exacerbation in a patient with no prior history of COPD, but has wheezing, a smoking history, and a CXR consistent with COPD. The patient can go have his PFT as an outpatient since it's needed to formally diagnosis COPD.


"If the provider records “suspected” or “possible” or “probable” avian influenza, or novel influenza, or other identified influenza, then the appropriate influenza code code from Category J11, influenza due to unidentified influenza virus, should be assigned. A code from category J09, influenza due to certain identified influenza viruses, should not be assigned nor should a code from category J10, influenza due to other identified influenza virus."

krhio.org

Looking Into The Basics of Coding Influenza - Kentucky RHIO

Now that fall is here, winter and the holidays are quickly approaching – and that means that flu season is upon us. Before it really begins, it’s a good idea to go over the basic guidelines for coding influenza. While it is not possible to predict what this flu season will be like, we can be...
krhio.org krhio.org
 
GeneralVeers said:
No, when hospitals aren't overwhelmed and can handle more cases......as was the originally stated intent.
Click to expand...
So when can I go tour the White House? If it's safe to open because the hosptials aren't overwhelmed, then it's safe for a tour, right?
 
nimbus said:
www.whitehouse.gov

Combating COVID-19 | The White House

The Biden-Harris plan to beat COVID-19
www.whitehouse.gov www.whitehouse.gov

We have a written plan.
Click to expand...

Yeah the plan sucks. The plan should have been developed before we went on lockdown with specific criteria. Not after the fact to give panicky governors broad cover under which to hide and avoid blame. I do blame Trump for this.
 
GeneralVeers said:
No, when hospitals aren't overwhelmed and can handle more cases......as was the originally stated intent.
Click to expand...
Yeah that's what keeps getting me. The whole point of the shutdown was to prevent an Italy style situation from developing. Flattening the curve doesn't decrease total cases (or if so not by a huge amount), it lowers the total daily cases from overwhelming the hospitals.

Much of the country has plenty of hospital capacity. Here in SC we're running right at 50% capacity. We're heading into summer, the time when hospitals are at their lowest capacity anyway. Now is the time to try a slow, phased reopening and see how it goes. If we wait until the fall, the hospital will be full with flu patients and we'll have less capacity should this go poorly.
 
thegenius said:
The paper defined their version of strict measures, which were not all that strict. If I recall, they were isolating all old people.
Click to expand...
They were more strict than isolating the elderly.

"Two of the interventions (case isolation and voluntary home quarantine) are triggered by the onset of symptoms and are implemented the next day. The other four NPIs (social distancing of those over 70 years, social distancing of the entire population, stopping mass gatherings and closure of schools and universities) are decisions made at the government level."

They assumed the interventions would all be implemented at different times when specific epidemiologic criteria were met, but they certainly included universal social distancing in their model.

I'm not sure what they meant by social distancing though. Did they mean businesses could remain open while we all shopped with masks on standing 6 feet apart, or did they mean we would need mandatory stay at home orders and mass business closures? I couldn't tell by reading the paper.
 
VA Hopeful Dr said:
Yeah that's what keeps getting me. The whole point of the shutdown was to prevent an Italy style situation from developing. Flattening the curve doesn't decrease total cases (or if so not by a huge amount), it lowers the total daily cases from overwhelming the hospitals.
Click to expand...

Correct, that was my interpretation as well, which was reasonable on the face of it. Now we are worried about "another spike", but that could happen if you open now, or in 6 months.

There seems to be two primary motivations now for the most timid governors:

1. Unwillingness to risk getting blame for a spike in infections
2. Sabotage the economy to influence the election.

It's not even a party line problem now. Democratic governors, like in CO are opening things up, whereas Republican governors in AZ are keeping things locked down.

This should come down to a hospital capacity issue now. If you have excess hospital capacity, then things need to be relaxed. If like NYC (not the rest of the state) you are still running near capacity then maybe continue things a little longer.
 
GeneralVeers said:
Correct, that was my interpretation as well, which was reasonable on the face of it. Now we are worried about "another spike", but that could happen if you open now, or in 6 months.

There seems to be two primary motivations now for the most timid governors:

1. Unwillingness to risk getting blame for a spike in infections
2. Sabotage the economy to influence the election.

It's not even a party line problem now. Democratic governors, like in CO are opening things up, whereas Republican governors in AZ are keeping things locked down.

This should come down to a hospital capacity issue now. If you have excess hospital capacity, then things need to be relaxed. If like NYC (not the rest of the state) you are still running near capacity then maybe continue things a little longer.
Click to expand...


It depends on what you mean by capacity. We are still reusing N95s and there is still a national shortage of propofol and fentanyl.
 
nimbus said:
It depends on what you mean by capacity. We are still reusing N95s and there is still a national shortage of propofol and fentanyl.
Click to expand...

The metrics were ICU beds and ventilators. Most of the country as adequate amounts of both. Again we can't keep changing the goalposts and the mission.
 
The spike will happen in the winter, when it always does. When people congregate inside, where they will catch it.
It doesn't live on surfaces outside for long times. It does live on surfaces inside for long times.
Colds are called colds for a reason. They're not called hots.
 
Dr.McNinja said:
The spike will happen in the winter, when it always does. When people congregate inside, where they will catch it.
It doesn't live on surfaces outside for long times. It does live on surfaces inside for long times.
Colds are called colds for a reason. They're not called hots.
Click to expand...

Which is an excellent reason for trying to establish herd immunity now to get the maximum number of people infected before Winter hits. Social distancing will merely make the Winter spike much worse, along with the flu. Then we really will be overwhelmed.
 
We have no idea how many people would be required to be infected/die for herd immunity to occur.
 
bravotwozero said:
We have no idea how many people would be required to be infected/die for herd immunity to occur.
Click to expand...
We also have no idea when there will be an effective vaccine, or if it will even occur.
Simply put, we cannot remain locked down indefinitely. We simply don't have the ability to test people, and furthermore, allowing only people who have tested positive and are asymptomatic won't work anyway. Do we just keep testing them until they go back negative and then allow them free reign?
There are no easy answers here for sure.
 
Here's an email I sent to my governor, state senator, state representative and the president. If you agree, and feel it's appropriate to your state and location, feel free to copy/paste and add your name, name of addressee, state, "US" or country as needed, or otherwise modify.

Governor contact: www.usa.gov/state-governor
State rep/senator contact: www.openstates.org/find_your_legislator/
White House: Contact the White House | The White House


"Dear ,

As a physician in ********** I urge you to reopen our ***** and our ****** economy. All the relevant models show our ***** past peak in COVID-19 cases and deaths. There’s no evidence locations that enacted lockdowns sooner have less cases or deaths. And there’s no evidence quarantines for those that are well, and at low risk, saves lives.

As our hospitals & hospital systems have clearly not become overwhelmed and we have “flattened the curve,” it’s now time to breathe life back into the *********** economy. You can reopen our ******* while still giving those greater than age 60 and otherwise at risk the option to self-isolate as long as they need to.

We can beat this virus while moving on with our lives. We must do so, otherwise untold and irreparable damage will be done to our ****** economy, businesses and citizens.

Please, reopen ********! Your constituents want and need you to!


Sincerely,

**********
**********
********** "
 
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GeneralVeers said:
Correct, that was my interpretation as well, which was reasonable on the face of it. Now we are worried about "another spike", but that could happen if you open now, or in 6 months.

There seems to be two primary motivations now for the most timid governors:

1. Unwillingness to risk getting blame for a spike in infections
2. Sabotage the economy to influence the election.

It's not even a party line problem now. Democratic governors, like in CO are opening things up, whereas Republican governors in AZ are keeping things locked down.

This should come down to a hospital capacity issue now. If you have excess hospital capacity, then things need to be relaxed. If like NYC (not the rest of the state) you are still running near capacity then maybe continue things a little longer.
Click to expand...

I think Governors don't know who to trust. Trump was saying its no big deal and clearly the Governors who shut things down early are glad they did. The CDC dropped the ball and the Governors are still not getting adequate help on PPE. Then you have Brian Kemp being told by Trump to re-open and then when he does, Trump reneges on him!

I think at this point they're all saying lets see what happens in the next few weeks and then decide.
 
When these lockdowns started, one of my concerns was that the virus would far outlive the length of any possible lockdowns. And that if we didn't have the ability to live with the virus then, we wouldn't be any more able to live with it when the lockdowns ended. When people clamored for these lockdowns with no end:

Did you think you'd see your pay cut 30% and the virus would stil be here at the end?

Your kids would get a terrible education, not be able play with other kids, do sports, have birthday parties, graduations or go to camp and the virus would still be here at the end?

Did you think you'd be forced to live as a recluse?

Did you foresee you're non-physician, non-essential worker friends losing their careers, life's work and small business and the virus would still be here at the end?

Did you think the lockdowns would generate an additional $2,000,000,000,000 (trillion) in tax bills for the US taxpayer and we'd STILL have the virus to deal with?

Did you consider that we'd still have to learn to live with the virus, which we could have done with no lovkdown

The virus was threat before we undertook any lockdowns and it's still a threat now as people realize the lockdowns can't go on forever. Nothing has changed accept we've put ourselves on the cusp of a possible economic Depression of our own choosing.

And the virus is still here, still around and has we have to learn to live with it, just as if we had never had a lockdown at all.
 
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Dr.McNinja said:
Then what was the point of your statement? When should we reopen?
Click to expand...

I was addressing this statement that by opening up everything now we will hit herd immunity by winter. We don't know that will happen. I favor a gradual opening soon, like a lot of other people have. Elective surgeries should 100% be restarted, those patients will be in a hospital where they can be tested and monitored. Beyond that, I don't know...
 
Dr.McNinja said:
. We simply don't have the ability to test people,
Click to expand...

But I've heard the Federal Government promise multiple times that we have the best testing program in the world and that anyone who wants a test can get a test. Was the government also being sarcastic about these statements?
 
Great news!

Texas is opening a lot of non-essential businesses this Friday including malls and restaurants. Bars and hair salons will be open by May 11.

Expect the news media to explode with stories about how the Texas governor is killing his citizens. Any spike in cases will be evidence that the rest of us should remain in lockdown indefinitely.
 
Birdstrike said:
When these lockdowns started, one of my concerns was that the virus would far outlive the length of any possible lockdowns. And that if we didn't have the ability to live with the virus then, we wouldn't be any more able to live with it when the lockdowns ended. When people clamored for these lockdowns with no end:

Did you think you'd see your pay cut 30% and the virus would stil be here at the end?

Your kids would get a terrible education, not be able play with other kids, do sports, have birthday parties, graduations or go to camp and the virus would still be here at the end?

Did you think you'd be forced to live as a recluse?

Did you foresee you're non-physician, non-essential worker friends losing their careers, life's work and small business and the virus would still be here at the end?

Did you think the lockdowns would generate an additional $2,000,000,000,000 (trillion) in tax bills for the US taxpayer and we'd STILL have the virus to deal with?

Did you consider that we'd still have to learn to live with the virus, which we could have done with no lovkdown

The virus was threat before we undertook any lockdowns and it's still a threat now as people realize the lockdowns can't go on forever. Nothing has changed accept we've put ourselves on the cusp of a possible economic Depression of our own choosing.

And the virus is still here, still around and has we have to learn to live with it, just as if we had never had a lockdown at all.
Click to expand...
Everyone says we were slow to react, but I feel like the lockdown was a knee-jerk reaction without a real plan or exit strategy.
 
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