How long should the lock down last?

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GeneralVeers said:
People like Siggy keep praying to the alter of the high and mighty "science".

Science in the case of COVID is a set of data based on observations, testing, and statistical analysis. "Science" does not tell us whether to open or close the economy, as science doesn't care one way or the other.

The decision to open or close the economy is a political, not a scientific one. The decision is based on data (science), culture, and the political climate, hopefully balanced against job loss, deaths from despair, and degradation to the healthcare system.

The "Science" has led politicians to generally favor shut downs without balancing the other end of the equation.

I wholeheartedly disagree with Siggy, who likely has a secure job with at least some income that putting 30-40 million people out of work, and destroying livelihoods was worth the balance of theoretical saved lives. We still haven't calculated the loss of life, mental health, livelihoods from the shutdowns, but it will almost certainly eclipse 200,000, mostly elderly people at the end of their lives who will be claimed.

The arrogance of all these politicians and scientists who have secure jobs who advocate for the destruction of other poeple's lives is astonishing. I think their opinion would change if they were forced to go without salary, and had to quit their jobs through the extent of the lockdowns.\\\

For many people lockdown = death.
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Strange... because the case study in "if we ignore the COVID it'll go away" (Sweden) is, as mentioned, also having issues with their economy and severe unemployment, but they're 7th in deaths per million population in the world.

Looks like they're getting the worse of both worlds.

Of course this ignores other places that didn't shut down or ignore COVID... but we're not supposed to talk about South Korea because it doesn't fit the narrative that the "open everything up" crowd wants to push.
 
Birdstrike said:
They don’t care about “science.” They were the ones that called me an ignorant “science denier” early in this thread, then after I shared more CDC data and scientific articles than anyone else on this thread, without reading any of it, they overruled all of the “science” with a 2 cups of anecdote and a 3 pounds of hysteria all rolled up into a burrito bomb of emotion.

This virus is here to stay, life will go on, and some are coming to grips with that better than others.
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Please cite the post where I did that?

I remember posting articles on this forum when people were still freaking out about using bipap or HFNC in SARS-CoV-2 patients.
 
MLNS said:
I’ve been intrigued about this last article for quite some time now. I’ve seen it before, from a family member freaking out. But, dude the n is literally 5... freakin’ FIVE...

Saying they were grasping for straws with this article is an understatement, wouldn’t you agree?
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Rekt said:
Clearly strokes in young people didn't happen before Covid.

I understand that Covid is prothrombotic, but five patients is kind of silly to make an argument that it's a presenting and/or common feature.
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I don't think that the article or @AMEHigh were claiming that large vessel strokes in young patients is a common presentation for COVID. But I also don't think case reports are equivalent to "grasping at straws" when we're discussing an emerging disease that is not fully understood. Of course large RCTs are a better source of data than case reports, but I'd also hope that we can all agree large vessel strokes in young patients should be taken seriously and warrant further investigation to elucidate their etiology.
 
MLNS said:
I’ve been intrigued about this last article for quite some time now. I’ve seen it before, from a family member freaking out. But, dude the n is literally 5... freakin’ FIVE...

Saying they were grasping for straws with this article is an understatement, wouldn’t you agree?
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Yes I understand it’s a low sample size.
I included it in along with several other articles in regards to morbidity and Covid.

I didn’t include that article alone to say omg we all need to stay locked up forever.

My original post was responding to someone who only talked about mortality. I think it’s important to bring up morbidity, especially among those under 65. Someone asked for non-anecdotes so I include an article that wasn’t just me telling a story about the patients under 65 that have had strokes and PEs as a consequence of Covid.

I hope that clears things up in the overall picture of Covid causing morbidity and complications that to my knowledge we haven’t seen with other respiratory viruses in this country in such large numbers. I was asked to provide information that wasn’t anecdotal so that’s what I did.
 
WilcoWorld said:
I don't think that the article or @AMEHigh were claiming that large vessel strokes in young patients is a common presentation for COVID. But I also don't think case reports are equivalent to "grasping at straws" when we're discussing an emerging disease that is not fully understood. Of course large RCTs are a better source of data than case reports, but I'd also hope that we can all agree large vessel strokes in young patients should be taken seriously and warrant further investigation to elucidate their etiology.
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Yes thank you.
We’re asked to provide data beyond anecdotes and then when we do it’s criticized as well. This is a brand new virus, we’re all learning as we go. Maybe in 6 months we won’t need to put Covid patients on anti-coagulants, but for now the evidence seems pretty good that we should be doing that. We don’t do that with other respiratory viruses to my knowledge.

Everyone here understands the consequences of a forever lock down and no one is advocating for that. Just that we look at the available data, wear masks when you’re around people and continue to be vigilant because this is an infectious disease that can cause morbidity in most of us. It is not some "personal agenda" or conspiracy.
 
Rekt said:
Clearly strokes in young people didn't happen before Covid.

I understand that Covid is prothrombotic, but five patients is kind of silly to make an argument that it's a presenting and/or common feature.
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Did you read the rest of the articles I posted?
One of them talked about complications from Covid. Thrombotic events are Definitely a likelihood from what we know now. Covid patients in the hospital are put on anti-coagulation.
I was asked to provide evidence outside of anecdotes. That was just 1 article I posted of several in regards to morbidity associated with Covid.

That’s also why I asked the original person that I quoted if they’re seeing something else in their Covid patients. I’m truly open to hearing anecdotal experiences from other physicians and their patients. I would truly love if Covid is no big deal and has no longer term morbidity.

I never said that strokes don’t happen with young people before Covid. I’m sorry I didn’t have time to search every single literature piece but I’m sure if you’re interested you could find more information in regards to clotting and Covid. Again, my point was to discuss morbidity associated with Covid (especially in those younger than 65 since they are more likely to be contributing to the economy hence why I think it’s important we should all try to avoid getting Covid) thus I provided a brief overview. However, as a new virus there’s clearly more to learn and clearly I didn’t take hours to find every single article out there.
 
Siggy said:
US. 7,100 cases per million
South Korea 242 cases per million

Apparently someone has figured it out.
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I mean, if you want to call that all contact tracing, and not a myriad of other reasons, then be my guest. So I'll modify posting to say that only 1 place has maybe figured it out, and all the other ones trying seem to be not doing well.

You say you don't want to coddle people, but you aren't willing to call out magical thinking.
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Yeah, because calling it out has been shown not to work.
By the way, the President just said that we should slow testing and then said, "I was just joking." I remember when I was 5 and used the "I was just joking" excuse... it didn't work.
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I'm not sure why you think I'm a fan of his. But realize that me saying you being holier than thou to everyone, especially a group of your peers, makes 4 more years of Trump more likely. There are ways to enact change, and you're doing a terrible job of it.
 
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Siggy said:
You're trying to say that the side that believes in Trump, less testing, just open everything up is the same as the side that wants to actually use science. If you're endorsing Trump's approach of "open all the things," then you're endorsing the rest of his statements, like, " "Suppose that we hit the body with a tremendous, whether it's ultraviolet or just very powerful light," Trump said at the White House coronavirus press briefing, adding: "Supposing you brought the light inside the body, which you can do either through the skin or in some other way.""

No one is arguing that we should have 100% testing every two weeks... however one side is saying that if we stop testing we'd have very few cases. That side is opposed to the basic tenets of science, medicine, and logical thought.

-https://www.businessinsider.com/trump-wants-bring-light-inside-the-body-to-kill-coronavirus-2020-4
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Have you just been waiting to quote the article and the Trump bleach claim? I voted for Hillary and was a Sanders supporter before all this Biden crap. I don't know why you keep directing all this pro Trump rhetoric towards me. Are you trying to win some contest by most Trump bloopers on a forum or something? Your responses don't answer anything. Your comparisons are the equivalent of what I would hear post 9/11; either you're for the war or you're with the terrorists. We don't work in absolutes around here. Maybe you're a Sith and you work in absolutes.

Let me ask you directly.

1) How would you do contact tracing in the US where people love their freedom and don't want to share information freely. Waterboard them to give up their information?

2) We aren't an island nation so how would you isolate us from imported cases of Covid?

3) How would you further prevent the spread in the US? Mandate masks even when eating?

4) How would you achieve all this without destroying the economy?

5) What are the basic tenets of science, medicine, and logical thought? I just love how this is thrown around to sound intelligent but lack much meaning behind it.

Please can you drop the Trump references in every answer.
 
4) -> failing to create an environment in which the virus is controlled/folks feel safe patronizing the retail/restaurant economy is going to have a greater negative effect on the economy than commonsense restrictions and leadership encouraging good hygiene/masks/distancing etc. These Florida/Texas/Arizona upticks in cases are not great examples of sustainable engines of economic recovery.

A repeat "lockdown" is not necessary – and increasingly draconian restrictions should be tailored to local communities, not an entire state – but the toxic discussion conflating greater societal benefit with stripping of civil liberties is literally costing people lives.
 
xaelia said:
4) -> failing to create an environment in which the virus is controlled/folks feel safe patronizing the retail/restaurant economy is going to have a greater negative effect on the economy than commonsense restrictions and leadership encouraging good hygiene/masks/distancing etc. These Florida/Texas/Arizona upticks in cases are not great examples of sustainable engines of economic recovery.

A repeat "lockdown" is not necessary – and increasingly draconian restrictions should be tailored to local communities, not an entire state – but the toxic discussion conflating greater societal benefit with stripping of civil liberties is literally costing people lives.
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We are adults. We have been told to wash our hands, wear masks, and social distance multiple times. People are actively not choosing to do it. What do we do with those people? Have the police enforce this? The terminator has told people to wear masks and they aren't listening. What do you recommend we do?

Your argument about civil liberties really lacks meaning for me. This is costing people their lives because we aren't more stern with adults about how they should wear their masks and wash their hands. Cool. What do you suggest we do with these people? Force it on them like a Hannibal mask? After this is over can we then take it a step further and make the anti-vax movement go away? Lets force them to get vaccinated because their civil liberties cost others their lives. Lets keep taking it a step further and make sure a car will not drive unless the seat belt is on and will always drive the speed limit. This will also save lives. Lets keep going and make sure that the flu shot is a national mandate with no exceptions. This way none of the people who die from that die needlessly. I can cite how many lives will be saved by all of this but I think you're smart enough to figure out where I am going with this.

What is your understanding of Arizona, Texas, Florida other than the cases have ticked up and the median age is dropping rapidly (popular headlines). Younger people are now going out and patronizing the retail and restaurant economy hence more spread of the virus. What else are you gathering from this? Why is it that in Indiana, Ohio, Michigan we are doing extremely well? Indiana and Ohio have been open for a month now.

Getting everyone to comply with these mandates is next to impossible without martial law.
 
As lock-downs end and the country reopens, USA had it's lowest daily death total (267) since March 23, in the infancy of the pandemic. The steady decline in deaths continues.

1592836736178.png
 
Still no commensurate rise in deaths to match cases, in the states that reopened first and have increased cases. Daily deaths remain flat, or down, in these states.

ARIZONA

az1.GIF


az2.GIF
 
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These states have been reopened for weeks, months in some cases. The increase in cases started many weeks ago, back in late May. A delayed but commensurate rise in deaths has been predicted by many, and they just keep saying, "But wait...just wait..." That was a very reasonable prediction that I hoped wouldn't come, but I've been watching for daily with great interest, since my state has a massive spike in cases.

Yet, still we see no increase in deaths. Remember back in April, this thing was killing many people in just a few days after diagnosis and we were told, "If you get this you'll crash, young and healthy, then you'll be dead in 2 days. Run! Hide!" Why now all of a sudden has it changed to, "It'll kill you....but you wait....It might take a long, l o n g time to kill anyone, weeks isn't enough time. The delay is months even for 70 and 80 year olds."?
 
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Asking epidemiology questions of Emergency Physicians who cannot answer doesn't mean there isn't an answer.

Why are only certain states caseload hotspots? What's different between GA/OH/IN etc. and the other places in the news? I don't know ... some combination of culture, behavior, low baseline rate, and luck keeping R values down? I really don't know – but that doesn't mean there isn't a good reason.

Where are the deaths? Cases -> hospitalizations -> deaths. FL/NC/TX/AZ are the places moving from more cases to more hospitalizations. There will ultimately be excess deaths. The reasonable debate has been and remains the balance between downstream economic deaths and deaths from COVID19. Unfortunately, you can't just re-open by decree – the millions of Americans who are older and have health conditions simply aren't going to return to previous levels of economic activity unless local viral activity is below whatever threshold meets their risk tolerance.
 
xaelia said:
There will ultimately be excess deaths.
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It's had a month to do that and hasn't. How long is it going to take, a year?

The virus killed people in two days in April like a horror movie, but now it takes multiple months?
 
Nationally, daily deaths are down 70% from their peak. In the few states showing many weeks of increased cases, deaths are not increasing at all, despite having many weeks to do so. That's immensely positive news. If some people want to continue to see panic in positive news, so be it.
 
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xaelia said:
... do you think hospitalizations are people doing clinically well?
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Answer: Hospitalizations are better than deaths, but worse than being asymptomatic. Now that I answered your question, will you answer mine, which I asked first (restated below)?

After not showing any increase in deaths a month after cases increased (AZ, TX, FL, SC), how many months will it take?

Why was the virus progressing from diagnosis to death in a matter of days in April, but now it's taking at least a month, or possibly longer?
 
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Birdstrike said:
I'll answer this after you answer my questions.
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My apologies, I didn't know these were serious questions. I usually assume folks debating the natural course of SARS CoV-2 infection are as familiar with it as myself and others treating it in our EDs and ICUs on a daily basis.

The natural course of moderate or severe COVID is usually several weeks duration. There have been quite a few articles detailing the clinical course of COVID early in the year. Patients who worsen typically develop moderate or severe symptoms somewhere between 5 and 15 days after onset of symptoms, which is a pretty wide range since we rely upon patients to self-report. After that, ~70% remain hospitalized a week later. At two weeks, about 30% remain hospitalized (60% have recovered, 10% have died) – and these are contemporary data from remdesivir trials. This remaining 30% who *still* haven't recovered at two weeks are about half ICU (high-flow, ventilation, ECMO). So, about half the deaths might be about 2-3 weeks after the onset of symptoms, and the other half are later.

I think the main reason were aren't seeing as you say, cases where someone is dead in two days, is probably related to the availability of testing. Early in the pandemic, there were few tests available and a high bar for testing – folks didn't present for their initial positive diagnosis until typically late in their disease course (we weren't even allowed to test folks if they weren't being admitted to the hospital). Some patients do have a rapid clinical course, but I suspect some of these anecdotal reports are related to patients who had been mildly ill for some time before finally presenting with pneumonia and hypoxia and an apparent rapid clinical course.

I don't think it's appropriate to trivialize rapid increases in cases with corresponding rapid increases in hospitalizations. I agree there are many areas where testing is simply picking up the mild cases that were already circulating, hence no true increase in community prevalence despite increased numbers of cases. I don't live in FL, TX, OH, IN, etc. and I don't know what is different between those locations as far as individual behavior patterns, use of public transit, different industries and workplace activities, etc. I think someone should figure out why it's working in those areas and help the rest of the U.S. similarly adapt!
 
A question of clarification: Is a "hospitalization" someone actually admitted to the hospital, or does that include someone seen int he ED and released?
 
GeneralVeers said:
A question of clarification: Is a "hospitalization" someone actually admitted to the hospital, or does that include someone seen int he ED and released?
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Good question. I don't know the answer. Also, how many of the "hospitalizations" are definitively COVID positive?

The reason I ask, is I know for a fact my state health department is including "admitted persons under investigation (PIUs)" as part of their COVID-positive hospitalization numbers. Considering 85% of COVID tests are still coming back negative in my state, that could give a very misleading, and likely highly inaccurate, number for "COVID hospitalizations." Of course media picks up on the numbers and reports it as "COVID HOSPITALIZATIONS UP!" and makes no mention of the fact that a very large number of the admitted PIUs will ultimately turn out not even to be COVID patients after they test negative.
 
We are also having a lot of people who are COVID + from tests done in the community who show up in the ED with mild symptoms and are discharged. We simply didn't have these back in April/May as almost all the tests were done in hospital at the time. If they are counted as hospitalizations, it could inaccurately portray a picture of increased hospitalizations.
 
I can't guarantee you equal reporting across all settings, but when I look at:

North Carolina Respiratory Virus Summary Dashboard | NC COVID-19

covid19.ncdhhs.gov covid19.ncdhhs.gov
www.tmc.edu

TMC Covid-19 Total Bed Occupancy Trend - Texas Medical Center

Located in the heart of Houston, Texas Medical Center campus is home to leaders in research, medicine, and innovation in healthcare.
www.tmc.edu www.tmc.edu

Page or Document Not Found

www.azdhs.gov www.azdhs.gov

I think these are all inpatient beds, not ED beds/visits.

We used to admit PUIs to a PUI ward as probables, but now we have rapid tests – and hold specifically in the ED until testing is complete to make sure they don't have to go to the COVID ward. It doesn't seem likely the numbers are PUIs rather than confirmed cases.

I think cases are actually going up, and the number of patients sick with COIVD are going up. Again, I'm not advocating for lockdowns – just for folks who don't take this very seriously to maybe kick it up a notch to help reduce transmission, rather than the other way around. And, primarily in areas where it is likely a true increase in prevalence is occurring.
 
xaelia said:
I don't live in FL, TX, OH, IN, etc. and I don't know what is different between those locations as far as individual behavior patterns, use of public transit, different industries and workplace activities, etc. I think someone should figure out why it's working in those areas and help the rest of the U.S. similarly adapt!
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If the deaths ultimately do follow the rapid rise in these states, then obviously we won't be able to say what they're doing is working. But let's assume for a minute, for the sake of argument, that it never does. If that ends up being the case, maybe what they're doing that's working in these states is not a result of any policy.

Could if be from the young and most susceptible returning to normal life, getting the virus, spreading it and for the most part, building immunity while not dying from COVID in great numbers? At the same time, are the most susceptible, ill and elderly continuing to self isolate (I've seen this in my area, and been told this by countless elderly patients) and due to that, not dying from COVID in great numbers as they wait for a vaccine?

If so, is that the needle we need to thread, moving forward?

I don't know. Maybe

On the other hand, if my state and county, which have show a 400% increase in cases in the past month, end up with a 400% increase in deaths in the coming weeks, I'll certainly change my tune. But so far that hasn't happened.
 
I mean, my parents aren't going out to a restaurant anytime soon – open or not.

They aren't going retail shopping anytime soon - open or not.

Whenever they drive around, they see people just circulating miscellaneously without masks. Background COVID is low in OR, but gradually increasing, but it's enough they don't feel safe.
 
Birdstrike said:
If the deaths ultimately do follow the rapid rise in these states ...
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Ah, you misinterpreted my unclear statement.

I was trying to say: I don't know what's different between OH and IN versus FL and AZ where hospitalizations don't seem to be increasing. I'd like to know what they're doing right about daily life in OH and IN, such that more places can stay OH and IN rather than become FL and AZ.
 
xaelia said:
I think cases are actually going up, and the number of patients sick with COIVD are going up. Again, I'm not advocating for lockdowns – just for folks who don't take this very seriously to maybe kick it up a notch to help reduce transmission, rather than the other way around. And, primarily in areas where it is likely a true increase in prevalence is occurring.
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I also think cases are actually going up, where they are reporting them up and that it's not only due to increased testing. I agree it's likely the number of hospitalizations due to COVID are likely up some, where cases are going up. However, 'm still trying to find out why hospitalizations in my state are only up 50%, when cases are up 400%. I strongly suspect its not all be due to delays in people progressing from diagnosis, to inpatient, to death. The gap in the numbers is just too big and my state has been open far too long, with the case increase present far too long, to be explained by only a time delay.

I suspect it's got to be either due to the known shift to younger patients, a milder viral strain, some herd immunity starting to form, or a combination. There's just absolutely no sign whatsoever of total US covid-deaths going up, despite the fact that many states have been open for a long time now, including some states large enough to influence national numbers (Texas and most of the South).

Time will tell.
 
The Shape of the graph seems to be the same in countries that have big outbreaks. I suspect nothing we do at this point will significantly alter the graph one way or the other.
 

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Birdstrike said:
However, 'm still trying to find out why hospitalizations in my state are only up 50%, when cases are up 400%. I strongly suspect its not all be due to delays in people progressing from diagnosis, to inpatient, to death.
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Oh, I get your point. I mean, all those kids in the pool at the Ozarks made national news – and now it's four weeks later and we aren't seeing articles with headlines like "Ozarks Pool Party Now a COVID-19 Death Party." There's a lot of mild disease associated with COVID. I mean, the official CFR in the U.S. is still >5% based on actual positives. The real IFR is probably a tenth that. If there were some practicable way, for real, to get all the kids and under-30 people infected while the older folks were safely locked away, almost everyone would recover and then R values would drop precipitously and we'd be pretty much through this by fall with probably a net of lives saved (assuming a lot we don't know about recovery and immunity).
 
xaelia said:
Oh, I get your point. I mean, all those kids in the pool at the Ozarks made national news – and now it's four weeks later and we aren't seeing articles with headlines like "Ozarks Pool Party Now a COVID-19 Death Party." There's a lot of mild disease associated with COVID. I mean, the official CFR in the U.S. is still >5% based on actual positives. The real IFR is probably a tenth that. If there were some practicable way, for real, to get all the kids and under-30 people infected while the older folks were safely locked away, almost everyone would recover and then R values would drop precipitously and we'd be pretty much through this by fall with probably a net of lives saved (assuming a lot we don't know about recovery and immunity).
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You've actually just stated what we should be realistically doing this Summer. This is the low season for hospitalizations, meaning we have the most hospital capacity and ability to deal with an outbreak. We should be letting young people go to Summer camp, pool parties, and get exposed to this, while protecting the elderly at risk people. Hopefully by the time flu season rolls around, we will have 25% or greater immunity which should lessen the risk of a second wave. It's complete nonsense when people suggest we plan our strategy around a vaccine that might never come, or might only be partially effective.
 
GeneralVeers said:
You've actually just stated what we should be realistically doing this Summer. This is the low season for hospitalizations, meaning we have the most hospital capacity and ability to deal with an outbreak. We should be letting young people go to Summer camp, pool parties, and get exposed to this, while protecting the elderly at risk people. Hopefully by the time flu season rolls around, we will have 25% or greater immunity which should lessen the risk of a second wave. It's complete nonsense when people suggest we plan our strategy around a vaccine that might never come, or might only be partially effective.
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I'm not opposed, and those are reasonable justifications. However, there *are* young people who do get very ill from COVID. A lack of effective treatments makes it challenging to ask young parents and kids to take even such a small risk. This is an instance where it can't be a haphazard ad hoc thing, but a national strategy with almost like a Federal fund to pay COVID life insurance or hospitalizations as a backstop for encouraging these risks.

The other issue is I sit in my nice house with my wife and two kids happily insulated from anyone over 50. The strategy as above will harm the elderly population of those in lower socioeconomic status, blended families, and high-density multi-family. The number of bad ways out of this mess seem to outnumber the good, unfortunately.
 
xaelia said:
However, there *are* young people who do get very ill from COVID. A lack of effective treatments makes it challenging to ask young parents and kids to take even such a small risk.
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Yes, some people think a near zero percent "risk" of their kid dying from COVID is too great. Those same people will happily make their kids travel in cars, let them swim in water, or make them live with medicines in the home, because those activities which are the actual leading causes of death in children, are "safe."
 
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Birdstrike said:
Yes, some people think a near zero percent "risk" of their kid dying from COVID is too great. Those same people will happily make their kids travel in cars, let them swim in water, or make them live with medicines in the home, because those activities which are the actual leading causes of death in children, are "safe."
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Perceived control over outcomes. Pretty basic cognitive dissonance.
 
In the houston metro area, inpatient and icu hospitalization rates have gone up significantly. If this keeps up, I do think hospitals will get overwhelmed, and we may need to lock down again.
 
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bravotwozero said:
In the houston metro area, inpatient and hospitalization rates have gone up significantly. If this keeps up, I do think hospitals will get overwhelmed, and we may need to lock down again.
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I don't think it's possible to lock down again. Businesses spent a lot of money adapting to the new rules, and re-hiring employees. Many will not be able to survive another indefinite lock down.

The problem is that this virus is here to stay. Assuming there's a spike in death at re-opening, it's going to happen regardless of when we re-open. Locking down for another 3 months just pushes the pain into the future.
 
bravotwozero said:
In the houston metro area, inpatient and hospitalization rates have gone up significantly. If this keeps up, I do think hospitals will get overwhelmed, and we may need to lock down again.
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Ultimately, Texas can do what Texas feels is right for Texas. But could there be other alternatives to "locking down" entire cities and states everytime a few hospitals get overwhelmed, like transferring patients to hospitals in the state that aren't overwhelmed?

According to Texas DSHS, the state has >14,000 empty hospital beds, almost 6,000 ventilators sitting unused, and 1,500 ICU beds sitting empty.

When did drastic shutdowns of all businesses, schools, activities and social events, become the first line response, when other far quicker, less obtrusive and less costly solutions are available?

Screen Shot 2020-06-22 at 7.34.21 PM.png
 
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Birdstrike said:
SOUTH CAROLINA

No rise in deaths in daily deaths to match the rise in cases
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Florida new cases vs new death with moving 7 day average. Looks like there's a 1.5 to 2 week lag between cases and deaths, which mirrors my expereince in the ICU where the people who die end up sitcking around for 1-2 weeks before SARS-CoV-2 destroys there lungs to the point where they can't ventilate or oxygenate regardless of what you do with PEEP or minute ventilation.

So... yea... this is the same thing that's been going on since the start of this where the "we should ignore it and it'll go away" crowd wonders why there's a delay between new cases and new deaths, and tries to pretend that this is all a hoax so that Gates can microchip the population.
 

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SeekerOfTheTree said:
Have you just been waiting to quote the article and the Trump bleach claim? I voted for Hillary and was a Sanders supporter before all this Biden crap. I don't know why you keep directing all this pro Trump rhetoric towards me. Are you trying to win some contest by most Trump bloopers on a forum or something? Your responses don't answer anything. Your comparisons are the equivalent of what I would hear post 9/11; either you're for the war or you're with the terrorists. We don't work in absolutes around here. Maybe you're a Sith and you work in absolutes.

Let me ask you directly.

1) How would you do contact tracing in the US where people love their freedom and don't want to share information freely. Waterboard them to give up their information?

2) We aren't an island nation so how would you isolate us from imported cases of Covid?

3) How would you further prevent the spread in the US? Mandate masks even when eating?

4) How would you achieve all this without destroying the economy?

5) What are the basic tenets of science, medicine, and logical thought? I just love how this is thrown around to sound intelligent but lack much meaning behind it.

Please can you drop the Trump references in every answer.
Click to expand...


Well, the group that thinks that we should open up so that they can get hair cuts, the group that thinks that this is a hoax so Gates can microchips the entire population, and the people who support the red hated leader who stated that this would all go away like a miracle and recently said that we should test less tend to be represented by three overlapping circles.


1. The government can deal with it the same way they deal with everyone who refuses quarantine. Or are you suggesting that the government lacks the ability to quarantine people?

2. Entry screening is still a thing. Limiting entry from hot spots is a thing. Quarantine on entry is a thing. It's almost like we are supposed to be able to control the people who come into this country.

3. Masks, test and trace. Targeted lock downs based on testing. Suggesting we not do anything and accept that our public health system is no better than Italy and Spain shouldn't be a thing.

4. This would actually help the economy. What do you think the economy is going to do if nothing is done and people stay home because infection rates are out of control and the hospitals become overwhelmed? Doing nothing will destroy the economy as well.

5. Things like test and trace aren't exactly new. The concept of PPE and limiting spread aren't novel. However the hair cut crowd acts like if we don't test and ignore the virus, it'll go away.
 
bravotwozero said:
In the houston metro area, inpatient and hospitalization rates have gone up significantly. If this keeps up, I do think hospitals will get overwhelmed, and we may need to lock down again.
Click to expand...

Why lock down? I mean... think of the damage that will do to the SP500 where deaths don't cause any issues to the economy. Besides, cases are up over the past week and the number of deaths didn't also increase immedately... therefore all is well and this is all a big liberal hoax! Don't even think about anything less, like masks, because of 'meh freedom!'

1592873891003.png
 
Hawaii has been doing pretty well. The lt governor is a practicing ER doctor.
They've used basic epidemiological work to keep things under control.

www.politico.com

How Hawaii Became a Rare Covid Success Story

The islands’ geography and small population helped. But so did two enterprising doctors who pushed for aggressive tracing and testing—and sometimes found themselves at odds.
www.politico.com www.politico.com
 
We've been off "lockdown" for almost 2 months.

ED back at 90% pre-pandemic daily volumes. 45k community shop.

COVID still isn't really a thing here. See a few scattered cases here and there but most go home and I personally saw the highest number of COVID + ARDS/MODS patients in mid-March.

I think our state/local government and hospital system did a great job planning for the unknown throughout the first months of the pandemic, mainly because this is a "novel" virus.

I would not support any further lock-down measures here. Sars-cov-2 or whatever is a stupid URI virus. It causes m&m in the elderly and people who are already unhealthy, like literally every other infectious disease. I was all ready to be dominating the ED with a laryngoscope for a few months with hallways full of vent patients and instead just sat around and basically had two months of vacation. I'm not complaining since it was an awesome time (we could still do outdoor activities and spring was beautiful here) but at some point it's like, come on man..

The other annoying thing is for a "novel" virus it doesn't really do anything medically interesting. It's just basic hypoxic resp failure/ards/mods only not nearly as severe has gram-neg sepsis. Give oxygen prn then check "yes or no" on the ETT box, dispo: home or COVID unit.

I will say though that going out is pretty awesome now. We've been out maybe 25 times since reopening and every table is like VIP now. We had drinks on a rooftop bar overlooking the city the other night and had 15 feet of a wrap around leather booth to ourselves.
 
This is a good straight forward article with visuals. Seems to show that distancing and masks, especially when indoors are very helpful. Simple measures to help keep people safe while keeping things open.

english.elpais.com

An analysis of three Covid-19 outbreaks: how they happened and how they can be avoided

An office, a restaurant and a bus were the settings for multiple infections that have been studied in detail by health authorities. Their conclusions offer valuable lessons for the deescalation process
english.elpais.com english.elpais.com
 
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