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Is the goal FLATTEN THE CURVE or ELIMINATE COVID?


Ottakee
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When this all started, the shelter at home measures were all put in place to flatten the curve.....making it so that hospitals and medical centers could prepare and not have a huge spike in needs all at once.   Now I seem to see a shift more towards continuing a lot of measures to eliminate COVID or make it very rare.

Those are 2 very different ways of thinking.

Do you think that we have done enough to flatten the curve (at least in most areas) so that we can go back to slowly returning things to a new normal or do you think we need to continue much more restrictive measures in order to greatly reduce/eliminate COVID?

I am supportive of our flatten the curve measures.  I think our new normal might need to look quite different for the next few weeks/months or more.  That said, I don't see remaining under restrictive rules long term as a viable option.

I do NOT want to see people die.  I don't want to put people at needless risk.  That said, there are also risks to not starting to loosen the restrictions (and I am not saying go back to a huge parade and beach bashes next week).  People are having medical treatment for cancer and other life threatening (but not today emergency) situations delayed and that may cause more deaths in the future.  Doctors and nurses and health care professionals in more rural areas are being laid off because they have no patients.  Some clinics might not survive and be there to serve the rural population if this continues for a long time.

Some children and vulnerable adults are at higher risk of abuse/neglect and other tragedies because they have no outlets, no one watching out for them, etc.  Individuals with mental health concerns are suffering from lack of care.  Suicides and domestic violence calls are up.

Children with special needs aren't getting needed services.  Here is an article about a young girl I have personally worked with.  She is not able to get her wheelchair adjusted for her after surgery so she has no mobility.  That in and of itself, could lead to severe health complications for her if she can't be more upright safely.  Remote learning in no way replaces OT, PT, Speech, and hands on teachers that children with special needs require.

Then you add in the financial costs to businesses, farmers, and even our government with the shutdown.  Many small businesses might not survive.  This isn't just about the money, but having a healthy economy and thriving small businesses helps out the health of a community as well.  People that are working, in general, have better health, better access to medical care, better mental health, etc. than they do if they are unemployed (not talking disabled that can not work here).

OK, that was my soap box.  Again, I am NOT saying lets go out to big community parties, parades, and large group settings right away.  BUT......is there a way to work towards more normal life in the next few months?

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I think we’ll be in the flatten the curve stage until they have some trials finished. It seems unrealistic at this point to think we could eliminate covid. It’s not burning itself out and we’re not sure about immunity and vaccines are a long way off. So mitigation and monitoring are all we have. People will have to get used to wearing masks. They will have to still keep a distance. Businesses will have to do things differently. 

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I think it started as flatten the curve and has morphed into eliminate covid for a lot of people.

Which doesn't make sense to me. I mourn the death of every soul because every single person on this earth is valuable. Period. But every day we do all kinds of things whose death/risk rate is not 0% and I don't understand why covid should be any different.

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Where I live, we’ve flattened the curve to the point that the largest hospital system has cut hours or furloughed over 2,000 employees.  That was over a week ago.  To me, that’s the point where things should have started reopening.  There’s no reason to continue with stay at home orders.  I don’t mean we should start having large gatherings, but let’s start working towards normal.

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I think that the first, most emergency/urgent goal was flatten the curve, to avoid overwhelming hospitals.  But the codicil in my mind was always 'until we can get a better handle on this thing', because you can't keep the curve flat enough and still relax the restrictions unless you can be fairly certain of successful prevention or treatment protocols or at least enough capacity and supplies to let the curve go less flat.  Plus the illness is horrendous for many and really you want to avoid it.

Regarding what to do right now, I'm not sure.  I think that one thing that has been largely not acted on is the need to enable people to do things from home that they can't easily do now.  For instance, rural internet is abysmal to nonavailable.  And any high speed internet at all is unaffordable for many.  For worthy enabling of educational, telemedicine, and WFH goals, this needs to be addressed as a public health/public utility issue, quickly.  

Abuse is a huge concern of mine, largely because in my rural outpost I get a report from the county sheriff's office daily of reported crimes, and they used to mostly be thefts, and now they are mostly domestic violence.  The change was immediate and very abrupt.  It's a mess.  Also, I know perfectly well that in any 'helpless care' place such as rehab or nursing homes, patient care is directly effected by quantity of visits from outside, and now that that is effectively 'none allowed', AND Covid is spreading like crazy in those places, this is a dangerous situation for the elderly and frail.  There are specific exceptions to the SIP rules here for abuse situations, but they are not easy to act on.

 

 

Edited by Carol in Cal.
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I'm not sure I've heard "eliminate" as a possibility at all.  I'm in a hard hit county in a state that closed quickly and we haven't peaked yet.  We are still flattening the curve.

The wheelchair story is upsetting.  Certainly that could be done with safety protocols in place?  It sounds essential for many reasons.  

I hope this time creates more clarity of how to respond in an emergency as a nation, as states.  How much better this could have gone if the US had any preparation and protocols in place.  Fire safety protocols we all take for granted grew out of tragedies.  I hope this experience teaches us something.

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6 minutes ago, Pawz4me said:

I haven't heard or read anything other than flattening the curve. How would any reasonably intelligent person think we could eliminate it unless/until we have an effective vaccine?

I have heard many people say things along the lines of "if it will even save one life then it's worth it to ____" which in my mind is equivalent to eliminating it. Perhaps I'm wrong about that, but that's what it means to me.

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2 minutes ago, happi duck said:

I'm not sure I've heard "eliminate" as a possibility at all.  I'm in a hard hit county in a state that closed quickly and we haven't peaked yet.  We are still flattening the curve.

The wheelchair story is upsetting.  Certainly that could be done with safety protocols in place?  It sounds essential for many reasons.  

 

It certainly could be done with safety protocols in place.  Child might not be able to wear a mask but could likely wear a face shield.  Parents and the people working on the chair (usually 1-2) could wear masks and gloves, etc.  

What makes me mad about all of this is that lottery tickets can be sold, liquor stores are still open (even though you can buy alcohol at the grocery store in our state), I can get McDonalds, but a medically fragile child can not get a wheelchair adjusted to fit her new needs after surgery.  This isn't even the regular wheelchair adjustments that these students get 2-4 times a year, but a major change.

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My understanding was always that flattening the curve was step one, not a final goal.

Here's my understanding.

Step 1. Flatten the curve by staying inside as much as possible.
Step 2. Implement measures such as widespread testing and contact tracing as well as Covid patient isolation so that we can gradually re-open more and more businesses.
Step 3. Re-open but continue with some distancing measures and continue with testing, etc. The new world would be a little different. Fewer mass gatherings. More masks. More testing.
Step 4. Vaccine. As the vaccine is distributed, resumption of normal life, though hopefully with new pandemic response infrastructure.

Currently we're still in step 1, but we're pretty much there. Which means step 2 could begin in many areas. But many places haven't gotten enough tests or implemented infrastructure to support it. So... that's a problem. Because we want to get to step 3 as soon as possible and the longer step 2 takes, the worse it is.

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I think this is why alot of people are frustrated.  We were told that we needed to stay at home (shelter in place) so we can flatten the curve, which in most places is happening.  It's like they changed the goal post.  Now you hear we might need to stay at home for anywhere for 1-2 years until there is a vaccine.  I agree we can not go back to large crowds and have to ease into some kind of normalcy and it will be a new normal.

I have a 1 year old grandson who was born with Arthrogryposis.  In mid January he went to Shriner's Hospital in Philadelphia for a elbow release surgery on his right elbow in hope that he could have any chance of being able to bend his elbow and have any use of his arm.  It was vital that he have therapy so they can stretch his muscles so they would not lock back in place.  This takes 3-6 months.  He was having therapy 3 times a week and making excellent progress.  All therapy was cancelled, for how long no one knows.  It is not a surgery that can be repeated.  While my dd is very diligent to continue stretches on her own, it is not the same thing.  He also had surgery on his achilles tendons to on both feet to give him any chance of walking.  His therapy sessions included stretches on his feet also.  So this is not something that will affect him the next year or two, this is his whole life we are talking about.  So when I read on this board that if you protest or if you are not willing to give up a year or two of your life you will have blood on your hands, it makes me angry.  But I guess my grandson is just considered collateral damage and we should just suck it up.

I have 3 sons and a SIL that works in grocery stores.  Two are managers and the youngest two stock shelves.  They have worked so many extra hours to make sure items are available for everyone to be able to survive.  I have a son that works in hospitals, on the COVID 19 floors, making sure the air pressure to the isolation and ICU rooms are correct.  They take pride in the fact that they are contributing to this crisis.  They are exposed and since two live at home, means the rest of us that live here are exposed.  They do not have the luxury of working at home and waiting this out.  And it is a luxury.

Just needed to get this off my chest.

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It's flatten the curve until hospitals can handle it - not just in terms of how many beds they have or ventilators or ICU units or how much PPE there is available.  It's also while they figure out appropriate treatments for a novel disease.  A vaccine would be great but I would settle for treatments that are not last minute treatments that are just trying desperately to keep people alive.  We are getting there on treatments but we aren't there yet.  Right now treatments are still in the area of "promising experiments". 

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6 minutes ago, Teresa in MO said:

I think this is why alot of people are frustrated.  We were told that we needed to stay at home (shelter in place) so we can flatten the curve, which in most places is happening.  It's like they changed the goal post.  Now you hear we might need to stay at home for anywhere for 1-2 years until there is a vaccine.  I agree we can not go back to large crowds and have to ease into some kind of normalcy and it will be a new normal.

I have a 1 year old grandson who was born with Arthrogryposis.  In mid January he went to Shriner's Hospital in Philadelphia for a elbow release surgery on his right elbow in hope that he could have any chance of being able to bend his elbow and have any use of his arm.  It was vital that he have therapy so they can stretch his muscles so they would not lock back in place.  This takes 3-6 months.  He was having therapy 3 times a week and making excellent progress.  All therapy was cancelled, for how long no one knows.  It is not a surgery that can be repeated.  While my dd is very diligent to continue stretches on her own, it is not the same thing.  He also had surgery on his achilles tendons to on both feet to give him any chance of walking.  His therapy sessions included stretches on his feet also.  So this is not something that will affect him the next year or two, this is his whole life we are talking about.  So when I read on this board that if you protest or if you are not willing to give up a year or two of your life you will have blood on your hands, it makes me angry.  But I guess my grandson is just considered collateral damage and we should just suck it up.

I have 3 sons and a SIL that works in grocery stores.  Two are managers and the youngest two stock shelves.  They have worked so many extra hours to make sure items are available for everyone to be able to survive.  I have a son that works in hospitals, on the COVID 19 floors, making sure the air pressure to the isolation and ICU rooms are correct.  They take pride in the fact that they are contributing to this crisis.  They are exposed and since two live at home, means the rest of us that live here are exposed.  They do not have the luxury of working at home and waiting this out.  And it is a luxury.

Just needed to get this off my chest.

Wow, I've not heard anything about shelter in place being 1-2 years!

I'm so surprised your grandson's therapy is not consider emergency or essential.  For example, I can't have my dental cleaning right now but I could go in for an emergency.  I would think them similar even though one is ongoing therapy.

This is exactly the kind of stuff that is vital to have straightened out.  Sort of how we have fire drills so in the rare instance there's a fire we know what to do.

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We locked down so early in our area that the curve never even developed. There is certainly a large contingent that seem to be under the impression that that was the goal, and that "testing" is key to safety. It's not just rural areas where medical personnel are being furloughed.

We are about to open up the economy to a greater extent here. There will likely be more infections. It's frightening, but inevitable, and probably positive in the big picture.

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Sigh. They did not move the goalposts. They had a simple message for a fast looming emergency so that people could understand a complex issue and enough political will could be established to avert a more serious disaster. In many places, it worked, which is great. But every country that has successfully controlled this has implemented testing and contact tracing and isolation. All the experts understood that would have to be the next step. And people were discussing it a month or more ago when we first started to get lockdown orders.

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9 minutes ago, GoodGrief1 said:

We locked down so early in our area that the curve never even developed. There is certainly a large contingent that seem to be under the impression that that was the goal, and that "testing" is key to safety. It's not just rural areas where medical personnel are being furloughed.

We are about to open up the economy to a greater extent here. There will likely be more infections. It's frightening, but inevitable, and probably positive in the big picture.

Testing + contact tracing and isolation IS a key to making us safer. You say it like that's not true. It is.

When we say mass testing, what we mean is that if you're in a vulnerable position, such as a healthcare working with repeated exposures, you might get tested every few days. Students in dorms might test every week. Any time there was any reason to think you might have been exposed, you'd be tested. And then you'd be isolated so you didn't go home to infect your family, much less other people.

We're nearly at the point where some places can enter that phase where we can begin to reopen if we can just get the testing, tracing, and isolation in place. If we open up and the curve goes way back up, that's not good for the economy either, so this is a false choice you're presenting. People will suffer more that way, not less.

Edited by Farrar
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The goal I am hearing in my state is flatten the curve--a truly flat curve meaning that on average every person infected with covid-19 transmits it to only one other person (there's some epidemiological way to express this rate of transmission but I don't remember it). I'm in a more rural state without super high infection levels, our hospitals are not overwhelmed. I would imagine a place like New York City would need to see actual falling rates of infection for a sustained period before even a steady rate of infection is sustainable.

In practice, I think we need to see falling rates of infection even here before we can loosen up restrictions, because if fairly tight restrictions can't bring us below a one-to-one transmission rate looser restrictions will definitely push us above that. Any time the rate of transmission is higher than 1 we fall back into exponential spread.

Edited by Bronze
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8 minutes ago, happi duck said:

 

I'm so surprised your grandson's therapy is not consider emergency or essential.  For example, I can't have my dental cleaning right now but I could go in for an emergency.  I would think them similar even though one is ongoing therapy.

My dentist is closed. Luckily my molar chipped last year and not now. I won’t know where to go for emergency dental. 

I managed to get my echocardiogram done because insurance only approved the procedure for a certain time period and obviously the clinic wants that money for a 15mins procedure since their staff is idling (not the staff fault). 

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4 minutes ago, happysmileylady said:

Oh, there's never been anything official.  There's been a few scare mongering media stories about how we can't lift lockdown until we have a vaccine which is 12 to 18 months, or it's just all going to spike again.  And that's what I mean by the fear oozing out of the screens and confusing people.

Thanks!  I'm sticking to a couple trusted sources so that explains why I hadn't heard that.

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3 minutes ago, Arcadia said:

My dentist is closed. Luckily my molar chipped last year and not now. I won’t know where to go for emergency dental. 

I managed to get my echocardiogram done because insurance only approved the procedure for a certain time period and obviously the clinic wants that money for a 15mins procedure since their staff is idling (not the staff fault). 

This is the stuff I hope gets straightened out for the future.  Why has one state closed dentists completely and one says emergencies only?  This could have been thought through before things were an emergency.

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33 minutes ago, Teresa in MO said:

I think this is why alot of people are frustrated.  We were told that we needed to stay at home (shelter in place) so we can flatten the curve, which in most places is happening.  It's like they changed the goal post.  Now you hear we might need to stay at home for anywhere for 1-2 years until there is a vaccine.  I agree we can not go back to large crowds and have to ease into some kind of normalcy and it will be a new normal.

I have a 1 year old grandson who was born with Arthrogryposis.  In mid January he went to Shriner's Hospital in Philadelphia for a elbow release surgery on his right elbow in hope that he could have any chance of being able to bend his elbow and have any use of his arm.  It was vital that he have therapy so they can stretch his muscles so they would not lock back in place.  This takes 3-6 months.  He was having therapy 3 times a week and making excellent progress.  All therapy was cancelled, for how long no one knows.  It is not a surgery that can be repeated.  While my dd is very diligent to continue stretches on her own, it is not the same thing.  He also had surgery on his achilles tendons to on both feet to give him any chance of walking.  His therapy sessions included stretches on his feet also.  So this is not something that will affect him the next year or two, this is his whole life we are talking about.  So when I read on this board that if you protest or if you are not willing to give up a year or two of your life you will have blood on your hands, it makes me angry.  But I guess my grandson is just considered collateral damage and we should just suck it up.

I have 3 sons and a SIL that works in grocery stores.  Two are managers and the youngest two stock shelves.  They have worked so many extra hours to make sure items are available for everyone to be able to survive.  I have a son that works in hospitals, on the COVID 19 floors, making sure the air pressure to the isolation and ICU rooms are correct.  They take pride in the fact that they are contributing to this crisis.  They are exposed and since two live at home, means the rest of us that live here are exposed.  They do not have the luxury of working at home and waiting this out.  And it is a luxury.

Just needed to get this off my chest.

I havent' seen any states where the stay at home order applied to medical services. I just looked up Ohio, as a random one and it specifically says you can still leave home for anything related to health and safety. And that rehabilitation services are considered essential. I think a lot of what people are seeing is not that the government is prohibiting these things, but that the rehab companies/hospitals/etc have made that determination, for the safety of their workers. Or maybe liability. 

But lifting the stay at home orders won't fix that, because those orders were not what shut them down. 

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Just now, happi duck said:

This is the stuff I hope gets straightened out for the future.  Why has one state closed dentists completely and one says emergencies only?  This could have been thought through before things were an emergency.

California did not close dentists officially but dentists opt to close. It’s harder to be compliant then to stay closed. 

“ Therefore, we recommend that dental health care personnel: 
  • Postpone routine procedures, surgeries, and non-urgent dental visits and direct patients to call the office for guidance if they feel they have a dental emergency.  All dentists should be available for emergencies of their patients of record or have arranged coverage with another provider.  Guidance from the ADA can be found on the ADA website (PDF).
  • Perform only those procedures that are needed to treat dental emergencies (e.g., uncontrolled bleeding, severe pain, trauma, cellulitis). The urgency of a procedure is a decision based on clinical judgement and should be made on a case-by-case basis. Guidance from the ADA can be found on the ADA website (PDF).
  • Screen all patients before they enter the dental office for COVID-19 risk, including fever, respiratory symptoms or potential exposure and triage appropriately. Patients with fever, respiratory symptoms or potential COVID-19 exposure who need to enter the dental office for urgent consultation should be provided a surgical mask and isolated from others.”
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4 minutes ago, happi duck said:

This is the stuff I hope gets straightened out for the future.  Why has one state closed dentists completely and one says emergencies only?  This could have been thought through before things were an emergency.

It may be that a city or county put in a more stringent requirement, due to being a hot spot, or it could be that they are not required to be closed, but the business itself decided to be, due to safety, or liability, or inability to pay employees while not having many clients. 

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The concept of The Hammer and The Dance helps here. Stay-at-home orders are the Hammer, which flattens the curve so that hospitals (mostly) aren't overwhelmed and buys us time to increase production of PPE and get testing, treatment supplies & equipment, and knowledge of the disease up to speed. 

The Dance is the gradual loosening of restrictions, when we have enough testing capability, so that outbreaks can be caught early enough to avoid overwhelming health care facilities while also allowing more economic activity, elective health care, etc. The Dance will involve some smaller spikes in cases, which can be snuffed out with adequate testing, contact tracing and quarantining affected individuals. Restrictions need to be loosened incrementally, with a gap of 2-3 weeks between different measures, and combined with extensive testing to gauge the impact of each intervention and catch new outbreaks before they get overwhelming. It may be a process of two steps forward and one step back at times, in certain areas.

This article is a little dated and way too long, but it's well worth just scrolling down to Chart 13 where you can see a graph of what the curve might look like in both The Hammer and The Dance phases, and what the primary public health interventions will be in each phase.

https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56

It's not a moving goalpost. The message to flatten the curve was to mobilize The Hammer, and now The Dance begins in many areas, depending on local conditions. Huge challenge for public health officials to communicate the subtlety of this and how needs will change in different areas over time, depending on cases. 

It would be a terrible mistake to trash all the gains we've made in the Hammer phase by opening everything up at once. Unfortunately there are states that are trying that experiment now. In the end I think it will look like the race between The Tortoise and The Hare. States that open up slow and steady, relying on testing to identify and address outbreaks and assess the safety of loosening various restrictions, will come out ahead both economically and in terms of having fewer cases.

Edited by Acadie
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Sorry I can't quote everyone as I am on my phone now.

Several of you brought up some concerns that I have too.   

What are the long term effects of no in person therapy for the grandson with surgery, Benny, etc.?  Depending on how long this goes it could affect them for the rest of their lives.

The heart tests.....will people die because they could not get their routine cardiology checkups and tests that might have caught problems before they became too severe?

What about the domestic violence effects....physical and emotional?  The elderly with no one to mentally stimulate them or watch over their care?

I don't think this has to be an either/or situation.  I see too many people on the polar ends saying stay shut down or the covid deaths are on your head and those on the other end wanting everything open now.

Can we value ALL lives....those at risk for COVID complications but also those at higher risk of other deaths/complications of not having things open?

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37 minutes ago, GoodGrief1 said:

We locked down so early in our area that the curve never even developed. There is certainly a large contingent that seem to be under the impression that that was the goal, and that "testing" is key to safety. It's not just rural areas where medical personnel are being furloughed.

We are about to open up the economy to a greater extent here. There will likely be more infections. It's frightening, but inevitable, and probably positive in the big picture.

 

Agreed. I'm in Travis County and while we have cases, its nowhere near enough to overwhelm hospitals so they have furloughed some here too.

 

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14 minutes ago, Ottakee said:

Sorry I can't quote everyone as I am on my phone now.

Several of you brought up some concerns that I have too.   

What are the long term effects of no in person therapy for the grandson with surgery, Benny, etc.?  Depending on how long this goes it could affect them for the rest of their lives.

The heart tests.....will people die because they could not get their routine cardiology checkups and tests that might have caught problems before they became too severe?

What about the domestic violence effects....physical and emotional?  The elderly with no one to mentally stimulate them or watch over their care?

I don't think this has to be an either/or situation.  I see too many people on the polar ends saying stay shut down or the covid deaths are on your head and those on the other end wanting everything open now.

Can we value ALL lives....those at risk for COVID complications but also those at higher risk of other deaths/complications of not having things open?

Does your state not have a plan yet? Many states do. But to really implement good plans, adequate testing, contact tracing, isolation, and PPE need to be in place. We’ve been behind on all of those things since the beginning, so we are still playing catch up. I know that here more other medical stuff is now being handled that was previously put off, but I think hospitals and health systems here are all making different calls depending on their unique situation. 

Edited by Frances
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11 minutes ago, Ottakee said:

Sorry I can't quote everyone as I am on my phone now.

Several of you brought up some concerns that I have too.   

What are the long term effects of no in person therapy for the grandson with surgery, Benny, etc.?  Depending on how long this goes it could affect them for the rest of their lives.

The heart tests.....will people die because they could not get their routine cardiology checkups and tests that might have caught problems before they became too severe?

What about the domestic violence effects....physical and emotional?  The elderly with no one to mentally stimulate them or watch over their care?

I don't think this has to be an either/or situation.  I see too many people on the polar ends saying stay shut down or the covid deaths are on your head and those on the other end wanting everything open now.

Can we value ALL lives....those at risk for COVID complications but also those at higher risk of other deaths/complications of not having things open?

I think we definitely should have medical be the first to open up. But, as I pointed out earlier, a lot of the medical that is closed is not actually legally required to be closed. So not sure how to fix that part? Or if it is county restrictions or city versus state? My county had stricter measures in place well before my state did, so maybe that is the issue? 

But yes, medical should be absolutely first. 

I'm VERY big on stay at home if you can, but would say that medical should be open for needed things, not just emergency things. And that the best way to make medical appointments safer for patients and staff is to keep in place other measures to limit the spread via the population. I'll stay home from stores/restaurants so that Benny can get his therapy!

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I live in a state that seemed to lock down early, but I still know people who are keeping their physical therapy appointments.  I think individual offices have some say in whether or not they remain open.  If everyone who wanted to open the floodgates got their way, where would we be?  People would not stay home without the government making it hard not to, but they will still go to the emergency room if their life is threatened.  Of course they should, but we need to space it out a bit.  Healthcare workers will get sick and be off work for weeks on end or even die.  That's fewer people to care for the sick. 

I have a disabled child.  His appointments are very important, but nobody wins if Covid kills him, or his neurologist or cardiologist or physical therapist or pharmacist.  It's not just grandma in her rocking chair who is at risk.  None of those neurologists at Johns Hopkins are spring chickens.  If we don't protect them they won't be around to help us.  

I KNOW we have to come out gradually before the coast is clear, but there are people screaming to end quarantine when they numbers in their area are just beginning to shoot up.  That's not the time to escalate the situation.  It's a big country.  Resuming a normal pace of life is going to happen at different times.  I haven't heard ANYWHERE but in the OPs first paragraph that anyone thinks we're going to be locked in our homes for two years until a vaccine is manufactured.  My guess is that people are confusing the "it could take at least 18 months to develop a vaccine" reports with how long quarantine is likely to last in their area?  

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Just now, Ktgrok said:

I think we definitely should have medical be the first to open up. But, as I pointed out earlier, a lot of the medical that is closed is not actually legally required to be closed. So not sure how to fix that part? Or if it is county restrictions or city versus state? My county had stricter measures in place well before my state did, so maybe that is the issue? 

But yes, medical should be absolutely first. 

I'm VERY big on stay at home if you can, but would say that medical should be open for needed things, not just emergency things. And that the best way to make medical appointments safer for patients and staff is to keep in place other measures to limit the spread via the population. I'll stay home from stores/restaurants so that Benny can get his therapy!

I think it also depends on different healthcare providers. I know here that some systems had stricter criteria for testing than the state criteria, which were already pretty strict, due to shortages of supplies. So I would imagine that even within the same city, not all healthcare settings would be ready at the same time to open up. Some will have access to more testing and PPE than others. Some can more easily adopt safe protocols than others.

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I'm in WA I know people are wondering why we aren't re-opening since our curve looks so much better now (except my area). The problem is we have very little testing etc.  Only very sick people here are getting tested here.  If we open now we will be right back to exponential growth.   

We have been very careful but somehow my DH and ODD likely caught it.  They had symptoms starting Easter Sunday I had gone shopping Friday, dropped things off at my parents and a friends house.  I wore a mask and did my best to be careful but  there is a good chance I was carrying at that point with no idea. 

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6 minutes ago, Frances said:

Does your state not have a plan yet? Many states do. But to really implement good plans, adequate testing, contact tracing, isolation, and PPE need to be in place. We’ve been behind on all of those things since the beginning, so we are still playing catch up. I know that here more other medical stuff is now being handled that was previously put off, but I think hospitals and health systems here are all making different calls depending on their unique situation. 

I am in Michigan.  I don't think there is a clue as to what will happen and when.  It is a big red vs blue mess here with lots of restrictions that don't make much sense but then other things open that likely shouldn't be. 

I do agree we need more testing (quick ones) and PPE, etc.  

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24 minutes ago, Arcadia said:

I won’t know where to go for emergency dental. 

Anyone who needs dental care when their dentist is closed should call their local emergency department. There is a very good chance they'll have connections with local dentists for referrals. 

12 minutes ago, Ktgrok said:

I havent' seen any states where the stay at home order applied to medical services. I just looked up Ohio, as a random one and it specifically says you can still leave home for anything related to health and safety. And that rehabilitation services are considered essential. I think a lot of what people are seeing is not that the government is prohibiting these things, but that the rehab companies/hospitals/etc have made that determination, for the safety of their workers. Or maybe liability. 

But lifting the stay at home orders won't fix that, because those orders were not what shut them down. 

Ohio has bent over backwards to try to continue accommodating people who need services that aren't inherently risky or where the risk can be balanced (and there isn't a lot of PPE required). I saw a FB post where a mom expressed concern about a club foot surgery for her son, and the governor called her personally to address this (she was reporting this in the post, not sure how she was able to ask him--maybe e-mail). Dr. Acton from the state health department has urged patients and doctors to work through the restrictions on a case by case basis.

There are some areas that were asked to go to emergencies only, like dentists and optometrists. Around here, nearly all are offering what services they can (ordering contact refills, etc.). My son will be able to order glasses if necessary--he's outgrowing his frames. He has a sensitive Rx, and we're crossing our fingers that won't need to be adjusted because he has developmental vision problems that could worsen. 

My son has to see an ophthalmologist periodically, and when his appointment was cancelled, we were told that appointments were being prioritized, and my son's case was not urgent enough (which I agree with--if they hadn't cancelled it, I would've postponed it), but some kids with the same diagnosis are likely still being monitored. 

From the frustrations I hear from people in other states, I am guessing that Ohio is either communicating better, or they have worked to smooth out the bumps of policy decisions, but I don't know for sure. Even in Ohio, they are really repeating themselves in press conferences--I think people aren't always able to watch every day, or they don't want to, or they are just to stressed to hear it (we all know this happens with learning!). 

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I don't get the moving goalposts as much from public officials as from the general public. Where I Iive we have flattened the curve. Hospitals have capacity and equipment. We have testing and contract tracing set up (supposedly? I guess people are rightfully skeptical of government) and we are beginning to reopen. However, my FB feed and the comments I notice on any news article on FB  seem to overwhelmingly suggest that people are expecting we should stay shut down until there are no more positives. I think our area meets the guidelines laid out for opening but I get that people are nervous. I'm nervous too. However, the general sentiment I am getting is that we should shut down until no one is at risk at all. I'm not one to get into arguments or wade into controversy on social media but i am curious as to what the end game is for these folks. It seems they just want everything shut down until it is gone.

I think things will gradually reopen, there will be more cases but the hospital system can handle, and when it ticks up too much we'll pull back. That's the dance, right? However, the general public seems to think we should either stay shut down until the disease is gone, or we should open wide and not have any problems. I think people are going to go nuts when we open some things and there still are cases. I really need to get off social media. If someone expresses that they wish their kid could have speech therapy people respond with things like "you think people should DIE just so your kid has perfect speech!"  and "blood on your hands!" Ugh. 

We aren't going to get to zero cases. 

Now everyone is warning about the second wave in the fall and that we need to stay shut down until that passes. I haven't heard that from public officials, yet (except for things like large events) but it seems to be what the public is clamoring for. Maybe it is just the vocal minority.

 

 

 

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5 minutes ago, KungFuPanda said:

None of those neurologists at Johns Hopkins are spring chickens.  If we don't protect them they won't be around to help us.  

That's a good point--an office with a lot of older practitioners vs. young ones might make very different decisions about opening. 

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6 minutes ago, Ottakee said:

I am in Michigan.  I don't think there is a clue as to what will happen and when.  It is a big red vs blue mess here with lots of restrictions that don't make much sense but then other things open that likely shouldn't be. 

I do agree we need more testing (quick ones) and PPE, etc.  

Michigan worries me. Communication seems to be nearly absent. 

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26 minutes ago, Arcadia said:

California did not close dentists officially but dentists opt to close. It’s harder to be compliant then to stay closed. 

“ Therefore, we recommend that dental health care personnel: 
  • Postpone routine procedures, surgeries, and non-urgent dental visits and direct patients to call the office for guidance if they feel they have a dental emergency.  All dentists should be available for emergencies of their patients of record or have arranged coverage with another provider.  Guidance from the ADA can be found on the ADA website (PDF).
  • Perform only those procedures that are needed to treat dental emergencies (e.g., uncontrolled bleeding, severe pain, trauma, cellulitis). The urgency of a procedure is a decision based on clinical judgement and should be made on a case-by-case basis. Guidance from the ADA can be found on the ADA website (PDF).
  • Screen all patients before they enter the dental office for COVID-19 risk, including fever, respiratory symptoms or potential exposure and triage appropriately. Patients with fever, respiratory symptoms or potential COVID-19 exposure who need to enter the dental office for urgent consultation should be provided a surgical mask and isolated from others.”

I am in California and had no trouble seeing multiple dentists when I had a dental emergency two weeks ago. The CDA advised them to close except for emergencies is what my dentist told me. I could have seen my dentist but my problem was beyond their scope of service. I saw both an endo and an oral surgeon in two different practices in two different cities. My regular dentist and the surgeon both called me back to make sure I didn't need to be seen for follow up care. All of them had plenty of patients and I was really freaked out about the waiting room situations.

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In my country (Canada) the goal is to flatten the curve -- and it's nice and flat with these measures. That was the point. The measure in place is producing the desired result.

However, from what I understand about outbreaks, if we reduce many restrictions at all, it's like we are restarting an exponential process. We're just starting it on the day of restriction reduction. We would have delayed the same peak, occurring later in time, not a successful ongoing flattened curve. A successful ongoing flattened curve is what we have now.

Now, maybe it's theoretically possible to do the kind of reduction-in-restrictions that allows for low-moderate spread. I can see that as a goal, but I can't see how to predict what actions would produce that exact target.

In fact, being right where I am geographically, I think that we are semi-unintentionally creeping up our amount of contact due to nice weather and being encouraged to engage in nice distant outdoor fitness activities near our homes. We were allowed that kind of outing the whole time, but few people do it on blustery cold days with snow and sleet. Now almost everybody is taking a lovely walk most days. Also gardening (and home/garden related shopping). So, that's a nice fractional increase in contact level: perfect for the idea of a very slight increase in transmission.

So the goal is to transmit slowly thorough the spring and summer, allowing the population to get it gradually, with every sufferer who needs care getting care. This would be at a rate that never goes beyond hospital capacity. (It won't change the deaths due to symptoms. Those will keep coming, but it will change deaths due to symptoms-plus-inadequate-care. That's the goal.) I imagine once outdoor socializing creates its bump, there will be some analysis of how to release restrictions or restart portions of economic activity one-by-one strategically and fractionally.

However, that does not mean life as normal in the summer, or the fall, or any time before a vaccine (if we get a vaccine) or effective treatment. It means a new normal that respects a rampant virus and the risks of a partially exposed population to outbreaks and clusters. I picture that as somewhere between a lock down and a full and free life, with plenty of testing, contact tracing, and more specific and targeted instances of mandatory isolation... specifics will vary.

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Another concern.....I just got notice that a day program for adults with developmental disabilities is closing permanently.  They couldn't survive the shut down.   Not only did their employees lose jobs but now we will have lots of special needs adults that will have no programming that they (and their caregivers) counted on.

Possibly some other group will try to fill this fap but honestly, disabled adults are low priority, CMH finding is dismal, and wages for their caregivers is low....not a lucrative business.

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12 minutes ago, EmseB said:

I am in California and had no trouble seeing multiple dentists when I had a dental emergency two weeks ago. 

I am in Santa Clara county and my family’s regular dentists have closed when shelter in place started on March 17th. Maybe they don’t have the protective gear required. I have my dentist’s personal email so I could still email her in an emergency.

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30 minutes ago, KungFuPanda said:

My guess is that people are confusing the "it could take at least 18 months to develop a vaccine" reports with how long quarantine is likely to last in their area?  

California’s stay at home order has an indefinite end date. That’s why people are starting to get frustrated since there is no end date to look forward to.

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The many, many news stories I read and listened to spoke of flattening the curve as a way to avoid having so many people hospitalized that doctors would have to choose who to treat while allowing other, weaker people die.  It was supposed to keep hospitals from becoming completely swamped.  Certainly there has always been a hope for therapeutics (which are being used experimentally) and a vaccine, but that was not the original story.

https://www.livescience.com/coronavirus-flatten-the-curve.html

Quote:  A flatter curve, on the other hand, assumes the same number of people ultimately get infected, but over a longer period of time. A slower infection rate means a less stressed health care system, fewer hospital visits on any given day and fewer sick people being turned away. 

https://www.nytimes.com/article/flatten-curve-coronavirus.html

Quote: Think of the health care system capacity as a subway car that can only hold so many people at once. During rush hour, that capacity is not enough to handle the demand, so people must wait on the platform for their turn to ride. Staggering work hours diminishes the rush hour and increases the likelihood that you will get on the train and maybe even get a seat. Avoiding a surge of coronavirus cases can ensure that anyone who needs care will find it at the hospital.

These two stories were published on March 16th and March 27th respectively.  Yeah, I think the goalposts are being moved.

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2 minutes ago, Arcadia said:

California’s stay at home order has an indefinite end date. That’s why people are starting to get frustrated since there is no end date to look forward to.

I thought most people had an indefinite end date because we were all watching the case numbers.  I thought most states were waiting for x number of days with a flattened curve or x number of days with a decline in cases.  That's a real number; it's just not a date on the calendar.

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10 minutes ago, Ottakee said:

Another concern.....I just got notice that a day program for adults with developmental disabilities is closing permanently.  They couldn't survive the shut down.   Not only did their employees lose jobs but now we will have lots of special needs adults that will have no programming that they (and their caregivers) counted on.

Possibly some other group will try to fill this fap but honestly, disabled adults are low priority, CMH finding is dismal, and wages for their caregivers is low....not a lucrative business.

Day programs for adults are specifically listed as essential in all the stay in place orders I've looked at (various states). But if they don't have the PPE to be open safely, the owners may have decided to close. 

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5 minutes ago, DoraBora said:

The many, many news stories I read and listened to spoke of flattening the curve as a way to avoid having so many people hospitalized that doctors would have to choose who to treat while allowing other, weaker people die.  It was supposed to keep hospitals from becoming completely swamped.  Certainly there has always been a hope for therapeutics (which are being used experimentally) and a vaccine, but that was not the original story.

https://www.livescience.com/coronavirus-flatten-the-curve.html

Quote:  A flatter curve, on the other hand, assumes the same number of people ultimately get infected, but over a longer period of time. A slower infection rate means a less stressed health care system, fewer hospital visits on any given day and fewer sick people being turned away. 

https://www.nytimes.com/article/flatten-curve-coronavirus.html

Quote: Think of the health care system capacity as a subway car that can only hold so many people at once. During rush hour, that capacity is not enough to handle the demand, so people must wait on the platform for their turn to ride. Staggering work hours diminishes the rush hour and increases the likelihood that you will get on the train and maybe even get a seat. Avoiding a surge of coronavirus cases can ensure that anyone who needs care will find it at the hospital.

These two stories were published on March 16th and March 27th respectively.  Yeah, I think the goalposts are being moved.

Personally, I think of it as a fire.  Eventually we'll have to go out there, but do you want to jump into an inferno when your odds of reaching the fire department are low, or would you rather wait and pick your way amoung a few scattered campfires when you can find help stomping them out.  

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3 minutes ago, KungFuPanda said:

 I thought most states were waiting for x number of days with a flattened curve or x number of days with a decline in cases.  That's a real number; it's just not a date on the calendar.

 

“California’s 6 indicators for modifying the Stay-at-Home Order
 
   1
The ability to monitor and protect our communities through testing, contact tracing, isolating, and supporting those who are positive or exposed
Key Questions
How prepared is our state to test everyone who is symptomatic?
Do we have the ability to identify contacts of those who are positive to reduce further transmission?

   2
The ability to prevent infection in people who are at risk for more severe COVID-19
Key Questions
 Are older Californians and the medically vulnerable living in their own homes supported so they can continue appropriate physical distancing?
 Have we developed a plan to quickly identify and contain outbreaks in facilities housing older Californians, those living with disabilities, those currently incarcerated, and those with co-morbidities?

   3
The ability of the hospital and health systems to handle surges
Key Questions:
 Do we have adequate bed capacity, staff and supplies such as ventilators and masks?
 Can our healthcare system adequately address COVID- 19 and other critical healthcare needs?

   4
The ability to develop therapeutics to meet the demand
Key Questions:
 Have we built a coalition of private, public, and academic partners to accelerate the development of therapeutics?
 Have we identified potential therapeutics that have shown promise?

   5
The ability for businesses, schools, and child care facilities to support physical distancing
Key Questions
 Have we worked with businesses to support physical distancing practices and introduced guidelines to provide health checks when employees or the general public enter the premises?
 Do we have supplies and equipment to keep the workforce and customers safe?

   6
The ability to determine when to reinstitute certain measures, such as the stay-at-home orders, if necessary
Key Questions
 Are we tracking the right data to provide us an early warning system?
 Do we have the ability to quickly communicate the need to reinstate these measures?”

https://www.gov.ca.gov/wp-content/uploads/2020/04/California-Roadmap-to-Modify-the-Stay-at-Home-Order.pdf

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