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Is the goal FLATTEN THE CURVE or ELIMINATE COVID?


Ottakee
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19 minutes ago, StellaM said:

 

Elimination, and then very strict border controls until a safe, effective mass vaccination program exists, along with co-operation with other 'virus extinguished' nations, is a possibility in some countries, like NZ. 

It's a possibility in AU also, but the poltical will isn't behind it as a strategy, even though we're almost there.

 

Island countries have a definite advantage if elimination is a goal!

The smaller the country the more manageable.

NZ is doing great, I do think it would be possible in Australia. Don't think it is a viable option here.

Maybe not even desirable as it can contribute to fear of and antagonism towards people perceived to be foreigners; that's become a major issue in China as the government narrative there is that the virus was eliminated domestically and any new cases must trace back to re-importation by people coming from outside the country. People who are not ethnic Chinese are being targeted and harassed. We've already got more than enough distrust of foreigners issues in this country.

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2 hours ago, happysmileylady said:

Just because X article or Y media blurb doesn't specifically say X or Y, that doesn't meant they and/or their headlines don't confuse people.  THAT is specifically my point.  It's not willful ignorance, its confusion.  

 

The truth is there is SO MUCH media coming at all of us, and really, once you actually read most of it, so much if it is really just a giant nothingburger.  It's all so full of mights and coulds and maybes and such.  And much of it is deliberately worded and crafted to scare the hell out of people.  Bill Maher used the phrase "panic porn."  Yeah, I think much of the media is engaging in panic porn.  

It shouldn't be a shock that all of it is really confusing to a lot of people.  

You make it sound as though people have no control over their media consumption and are simply helpless in the face of a media onslaught. I don’t think that is true. Sure, there’s lots of clickbait crap out there. But there is always the option to ignore it and choose one or two trusted sources for your news. It continues because people support it and it was no different before the pandemic.

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1 hour ago, Meriwether said:

The goalposts have absolutely been moved. I think the powers that be knew they wouldn't get buy in if they had said months at the beginning, especially if they had said many months. If you wanted to, you could go back and see the change of language on this board. And, no, I am not going to look for links.

My area is just beginning to have an increase in cases. I think we will be hit hard in the next couple of weeks. Hopefully not too hard, but we won't know until we weather it. After the worst has past here locally, we (my family) will evaluate how to proceed. We will continue to be careful, but I doubt we will be as limited as we are now.

I think because it is an ever evolving situation with lots of moving parts, no one could actually predict at the very beginning how long things would go on like they are now. it is a novel virus after all and the US was woefully unprepared.

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1 hour ago, bolt. said:

Interesting.  I think the different geographic locations are a serious factor, but, for us, when they closed the schools (effectively the beginning of our various restrictions) the narrative was clearly months.

On fact, the thinking at one point was that they didn't know if they should close schools *because* if it was bad enough to close them, it was pretty clear that it was going to be for the entire school year. (So, initially, they thought they might hold off.) This was mid-march, and even though our numbers were low, we had the advantage of seeing the progress in other parts of the world and our country, which helped us see that a few weeks wasn't really what we were looking at. They did close them after a weekend of dithering, and called parents in for student belongings, and shut them down with the expectation of months. Other restrictions followed shortly.

I wonder if our original understanding of 'unknown duration but probably quite a while' helped us cope without the sense of bait-and-switch.

This is how it was in my state as well. While the schools gave a tentative initial date for reassessing, it was completely obvious they would be closed for the remainder of the year. With everything that was known and happening by mid March, I can’t imagine how anyone could have thought otherwise.

I haven’t seen any evidence anywhere of a bait and switch or moving the goalposts.

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39 minutes ago, happysmileylady said:

Sure, lots of folks make stuff up.  And sure, lots of news organizations are not reputable.

So, can you blame people when they struggle, between cooking at home, trying to work at home, trying to help their kids learn at home, that end up getting all confused about what's real and what isn't, what's reputable and what isn't, and which headlines full of craziness are worth clicking on and which aren't?  

 

Didn’t they ever think about reputable news sources before the pandemic?

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1 minute ago, square_25 said:

This was just an opinion poll about what people are worried about. How is it panic-inducing?

I'll explain the stats in a little bit. The only problem is randomizing, but you don't really need to worry about representing each state, per se. 

Panic inducement is maybe not the right term, but the best substitute I could come up with for the other term being used in this thread. Whatever you call it, I'm addressing the headline that says "As some areas of the U. S. begin relaxing social distancing restrictions, a new poll showed a majority of Americans fear easing those guidelines could result in more deaths." But no such poll is linked or explained. I think it might be the poll that I referenced in my earlier post but really can't tell. If it is indeed that poll, then is it really representative of the majority of Americans? If it is the majority of Americans, then why are so few people I'm in IRL contact with expressing that fear? 

Why not couple the first part of that headline about states lifting restrictions with something that will assist people in understanding that this is a part of the Hammer and Dance that has been referenced in this thread? Why couple it with a mention of fear and then not even explain anywhere in the article what this fear is about, how to address it, what states are doing to mitigate those things that lead to fear, etc. Why address fear and not work to alleviate it if possible through thorough reporting? Highlighting people's fears in such a manner, especially if it is so widespread, seems to only work to stir up even more fears. If nothing else, it leads to confusion.

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49 minutes ago, meena said:

Regarding willful ignorance vs. confusion: 

I don't normally use Yahoo for anything, news-related or other, but since it was mentioned here I decided to go down the rabbit hole. There's a banner at the top of the page in orange/red that says, "U.S. death toll surpasses 45K; CDC director issues warning about second wave". Yes, that is just factual data. It's important so it doesn't seem too overly dramatic to have it take top spot and in a red banner. It's a clickable link, so I went to that page.

I scroll down the page to look at the current update bullet list. This bullet catches my interest: "As some areas of the U.S. begin relaxing social distancing restrictions, a new poll showed a majority of Americans fear easing those guidelines could result in more deaths." I'm interested in this because many people I know IRL have expressed interest in opening things back up, cautiously of course. I haven't really heard of fear regarding an incremental approach, so I'm curious about this poll saying it's the majority of Americans. Clicking on the link just takes me to an article about what plans various states are putting in place, but there's no mention of the poll or fear referenced in the teaser text.

I go back to the corona update page and scroll down quite a bit. There's a headline about a poll but no indication that it's the poll mentioned above: "New poll: States earn more praise for outbreak response". No mention of fear in the headline or short description, but I click on it since it does address state response. I click to see the article about this poll. The article features a large graph image at the top. Only if you scroll to the third graph do you see statistics about "widespread worry". This doesn't address fear, so maybe it's a different poll. It's hard to tell. The poll surveyed 1057 people in all 50 states + DC. That's roughly 20 people per state/district, although I realize it could have been done relative to state population since it's supposed to be a representative sample. That seems like a low number surveyed to make the conclusions of "All Americans" think x, y, or z. I know statistical samples can use small numbers if they are an accurate cross-section, but after going to the source of the poll (AP-NORC) and reading their methodology, it doesn't seem great. But then again, I took statistics many years ago, so what do I know. I'm confused as to whether this is the poll that was used to write that "a majority of Americans fear easing the guidelines". 

All of this to say, the news can be very confusing. In just this one instance, a news source says in a prominent place that most people fear easing guidelines. But it doesn't follow through in explaining that assertion so I don't know where it's coming from, if it's valid, whether to take it with a grain of salt given what I'm hearing IRL, and so on. I have a degree in English and have work experience in research and analysis/synthesis of various text sources, yet found it hard to analyze just this one news thread. I think about relatives who would just look at the headline, be like, "Ok, sure" and not even bother to see if there's any credence to what is being posited. That may be willful ignorance, but if the information is that difficult to get down to brass tacks I think the responsibility is on the shoulders of the journalist and media outlet rather than the average educated reader.

When I clicked on yahoo news a little while ago, this article was one of the first articles I noticed and clicked on, and it still shows up on the first page when I look at the website. It reports information from two different polls:

"Just 14 percent of Americans believe the country "should stop social distancing to stimulate the economy even if it means increasing the spread of coronavirus," a Morning Consult/Politico poll released Wednesday found. A massive 76 percent meanwhile say social distancing should continue "even if it means continued damage to the economy," the poll taken just days ago found.  .... The Morning Consult poll mirrors a recent survey from Pew Research, which found 66 percent of Americans were more concerned that social distancing guidelines would be lifted too soon than last too long.  Morning Consult/Politico surveyed 1991 registered voters online from April 18-19, and the poll had a two percent margin of error."

The article even includes a direct link to the Morning Consult poll data (the specific question quoted in the article is towards the bottom of page 4 of the poll data), and to a CNN article that includes a link to the Pew survey  as well as multiple other polls that show similar results, including a Quinnipiac poll that shows 81% favor continued SAH order, an ABC poll, an NBC/WSJ poll, a Gallup poll, and a Fox News poll. Those links go directly to the poll reports.

All that information took me about 2 minutes to find.

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1 hour ago, Meriwether said:

The goalposts have absolutely been moved. I think the powers that be knew they wouldn't get buy in if they had said months at the beginning, especially if they had said many months. If you wanted to, you could go back and see the change of language on this board. And, no, I am not going to look for links.

My area is just beginning to have an increase in cases. I think we will be hit hard in the next couple of weeks. Hopefully not too hard, but we won't know until we weather it. After the worst has past here locally, we (my family) will evaluate how to proceed. We will continue to be careful, but I doubt we will be as limited as we are now.

I 100% agree that they couldn’t mention the timeline without a bigger/earlier revolt.

I do think a lot of people consider stay at home/shelter in place to be the same as social distancing, and that’s a big part of the disconnect. They’re two mostly different things. The official guidelines call for “opening up” while continuing social distancing. On top of that, a federal official contradicts the official guidelines pretty much every day since they were released, so the confusion is understandable.

FWIW, I severely restrict my news consumption in favor of putting my time into multiple live briefings.Some of them are no less confusing than the spinned news.

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13 minutes ago, StellaM said:

 

Well, we had an outbreak that infected my friend's sons (one son worked in the area, infected his sibling before he knew he was ill) due to people gathering for fun times on Bondi beach, so my personal trust in people applying social distancing measures on the beach is pretty much nil, but YMMV.

I'm hoping that because of such cases, people will take these measures more seriously than they might have a month ago. Of course, unfortunately, some people won't follow rules or sense, so I'm hoping that enforcement will be thorough. Our county sheriff seems very cautious and sounds like he will take enforcement seriously once the beaches are open. Parks have done well with patrolling and enforcement so I think that there is a chance beaches could be the same.

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3 hours ago, happysmileylady said:

If you pull up the first page of yahoo, it's like full of it.  While the media you choose to consume online might not be like that, obviously MANY other people people do use media like that.  I am not talking right wing fox news or whatever, I am talking about large numbers of people, who are confused, who don't know what to read or how to read it, or what to believe or which news sources are good enough, etc etc etc.  And when you couple that with the fact that a lot of people have had their entire worlds thrown way out of whack and are spending lots of time just figuring out how to work their new schedules, how to get their kid properly logged into their video class, how to deal with everyone in their house needing to be online all at the same time etc etc, and there are many people that simply don't have time to try to carefully pick out and discern and vet every single news article and headline and source they happen across.  

 

Here's what yahoo is showing right now, I don't see anything super panicky. 

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4 hours ago, Corraleno said:

When I clicked on yahoo news a little while ago, this article was one of the first articles I noticed and clicked on, and it still shows up on the first page when I look at the website. It reports information from two different polls:

"Just 14 percent of Americans believe the country "should stop social distancing to stimulate the economy even if it means increasing the spread of coronavirus," a Morning Consult/Politico poll released Wednesday found. A massive 76 percent meanwhile say social distancing should continue "even if it means continued damage to the economy," the poll taken just days ago found.  .... The Morning Consult poll mirrors a recent survey from Pew Research, which found 66 percent of Americans were more concerned that social distancing guidelines would be lifted too soon than last too long.  Morning Consult/Politico surveyed 1991 registered voters online from April 18-19, and the poll had a two percent margin of error."

The article even includes a direct link to the Morning Consult poll data (the specific question quoted in the article is towards the bottom of page 4 of the poll data), and to a CNN article that includes a link to the Pew survey  as well as multiple other polls that show similar results, including a Quinnipiac poll that shows 81% favor continued SAH order, an ABC poll, an NBC/WSJ poll, a Gallup poll, and a Fox News poll. Those links go directly to the poll reports.

All that information took me about 2 minutes to find.

Interesting, that article doesn't show up on the first page of Yahoo or Yahoo News for me. I did see that poll data linked from another news site. But it doesn't show up on Yahoo/Yahoo News. Maybe if I clicked around more. That's part of the confusion of online news. What you see as top billing may not even show up for me until several clicks deep due to target-based placement.

Editing to add: I was checking my local news before I went to bed and realized that the Quinnipiac poll for my state was the link that I had seen earlier. As some soothing before bed reading, I went to the Quinnipiac poll site and read the poll methodology which also included all of the exact questions the surveyors asked respondents. It was really interesting seeing both questions and responses, and then seeing the responses also broken down by various categories (demographic, party affiliation, and others). The question regarding continuing the stay at home order is asked as such: "Do you think [state's name] should loosen social distancing by the end of April, or don't you think so?" Total result: Yes/should loosen, 22%; No, 72%. There are questions on the Q-poll regarding being concerned that someone you know/yourself will be infected and regarding being concerned if someone you know/yourself will need to be hospitalized, choices being Very, Somewhat, Not So, Not. 

I also read the NBC/WSJ poll. There is a question about worries but it as posed as a choice question (do you choose this or that): "Which worries you more about responding to the coronavirus and restrictions that require most Americans to shelter in place and only leave their homes for essential needs: That the US will move too quickly in loosening restrictions and the virus will continue to spread with more lives being lost OR That the US will take too long in loosening restrictions and the economic impact will be even worse with more jobs being lost" Total result: Choice 1, 58%; Choice 2, 32%.

The Quinnipiac poll did not mention fear or worry at all. The NBC/WSJ asked about fear but only posed as a which do you fear more question. If asked that question I would choose the first option (regarding lost lives), as I do think there's more harm today in loosening too quickly and slim chance right now that we are going too slowly. But if you asked me differently my answer would come across much differently. For example, if asked if I felt my state or the local group of cooperating states was moving too quickly in loosening guidelines I would say No. I feel like they are taking a measured approach at this point and moving at an appropriate pace. Those are two similar questions asked two different ways with very different potential answers. I feel like the way this NBC/WSJ question was asked leads to a false dichotomy that assumes worry one way or another.

So having read the specifics of three different polls, I think the Yahoo headline ("As some areas of the U.S. begin relaxing social distancing restrictions, a new poll showed a majority of Americans fear easing those guidelines could result in more deaths.") must have been referring to the NBC/WSJ poll. If you read how the question was asked in the poll, though, it wasn't saying people feared easing the guidelines but rather that given a choice between worrying about preceding too quickly + lives lost or worrying about moving too slowly + jobs lost, they worried more about the former than the latter. Ah, semantics.

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I think my teenagers using my computer must be skewing the results I get. My first page of Yahoo results was mostly about Celeb news, which I don't follow or read about. I normally just read my local newspaper online and supplement with some of the larger national news outlets here and there. Now I think I need to check my history to see what they've been reading that Yahoo thinks that I've been reading 😂

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3 hours ago, happysmileylady said:

I will say, that it can certainly feel like "moving the goalposts" when a SAH order is extended.  Yes, waiting for the curve to flatten etc etc etc.  But it can still certainly feel that way.  (and no, I am not saying that's what I am thinking.)

As a new teacher I was taught, all new teachers were taught, that it's easier to start out with strict classroom policies and loosen them up later. If you don't have a good handle on the behavior of your students from the start it will be hard to ever get it. I hate to say it but many governors acted like new teachers who didn't heed that lesson and many people are acting like their students, i.e. children.

Some states and local areas started out with loose restrictions, realized they weren't strong enough, and then had to deal with people complaining when stronger measures were in fact needed.

3 hours ago, KeriJ said:

But as was mentioned in the post I quoted above, the general public doesn't seem to be getting it.  If you are on social media at all, the minute there is a headline about lifting any restrictions, 532 people comment that "we're going to kill everyone if we don't stay home for months longer!!!"  

But that doesn't mean the goal posts were moved. It just means people don't bother to read. 

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5 hours 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 they  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. 

My husband cracked a tooth last week.  When I called the dentist they told me they were only open for emergencies and that a cracked tooth was not allowed to be fixed until the Michigan governor lifts the stay at home order.  If it gets infected and starts to hurt then the order would allow him to have some pain medication.  She said they have patients waiting for a month with cracked teeth.

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4 minutes ago, Mom2mthj said:

My husband cracked a tooth last week.  When I called the dentist they told me they were only open for emergencies and that a cracked tooth was not allowed to be fixed until the Michigan governor lifts the stay at home order.  If it gets infected and starts to hurt then the order would allow him to have some pain medication.  She said they have patients waiting for a month with cracked teeth.

This is Michigan.

People above were saying telemed is available.  Some yes, but not all.  My DD had a medical issue that needed attention.  I called the specialist that treats these things and even though she was an established patient and actually had an appointment on the books for this week I was told no appointment, no telemed...but they could schedule her.for the end of June.

I called our primary and asked if they could look at the issue.  They could and she got an appointment within an hour and got the proper medical care.  Had it been something a bit more serious or if the procedure the doctor did didn't work we would be in the wait til the end of June category.

Another Michigan one....friend of a friend has an aneurysm....quite severe and if it ruptures almost certain death.  Yet, she can't get an appointment for surgery to repair it as it isn't life threatening TODAY.  Any other time she would have had surgery within a day or 2.

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2 hours ago, SKL said:

You cite the order that extends to May 1.  The medical offices shut (except for emergencies) based on an earlier order.  The governor has made a long series of orders gradually picking off one thing after another.  None of them is opening back up based on the order you cited.

Telemedicine won't help with our dental issues, nor the mammogram I need to schedule, nor a lot of other things.  We are using it for psych appointments and while it costs the same as an in-person visit, the experience is not comparable.

So you are saying that the most recent order, that specifically says health care is essential and the order is not to impact matters of health and safety, doesn't actually mean that because of an earlier order?

2 hours ago, happysmileylady said:

I was simply counteracting the statement “telemedicine is everywhere”

its not

 

regardless of whether that’s legally required or not....it’s not everywhere 

Teledoc and Doc on Demand are nationwide services. They may not be affordable for everyone, (don't get me started on health care costs) but they are available everywhere in this country I think. 

32 minutes ago, Ottakee said:

This is Michigan.

People above were saying telemed is available.  Some yes, but not all.  My DD had a medical issue that needed attention.  I called the specialist that treats these things and even though she was an established patient and actually had an appointment on the books for this week I was told no appointment, no telemed...but they could schedule her.for the end of June.

I called our primary and asked if they could look at the issue.  They could and she got an appointment within an hour and got the proper medical care.  Had it been something a bit more serious or if the procedure the doctor did didn't work we would be in the wait til the end of June category.

Another Michigan one....friend of a friend has an aneurysm....quite severe and if it ruptures almost certain death.  Yet, she can't get an appointment for surgery to repair it as it isn't life threatening TODAY.  Any other time she would have had surgery within a day or 2.

But the fact that one doctor was closed and wouldn't see her, and another was open and would see her, just shows that the closing isn't part of a legal order to shut down. It is that individual offices are making that decision, likely based on availability of PPE, staff, cleaning concerns, etc. If it was a statewide order that all medical offices be closed, they both would be. In fact, Michigan's order cleary exempts health care/medical workers as exempt, and allows going out to medial appointments. 

Regarding dental, this is the info on what is and isn't essential/urgent. It does say that a cracked tooth with no pain would be put on hold, if there is infection or pain than treatment with antibiotics and pain meds would be the preferred option, if possible. https://www.michigandental.org/Portals/pro/ProDocuments/Membership/Coronavirus/Essential vs Non-essential Dental Treatment.pdf

Which makes sense - dental procedures are high risk - patient obviously can't be masked, and there is saliva flying around only inches from the face of the dentist. It may be one of the higher risk things there is right now. 

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3 hours ago, Dreamergal said:

What about general check up ? I have a family history of diabetes, hypertension which is kept at bay by basically exercising. Now, pretty much everyone has slowed down exercising. These family walks are not cutting it, apps are not the same. So are we supposed to buy a BP monitor and a sugar testing kit like we have oximeters at home now ? How is one supposed to maintain their general health ? How are we supposed to maintain our children's health without actually seeing a doctor ? 

Sure, if it will help monitor your health and stay motivated to exercise. BP monitors and sugar testing kits are quite inexpensive, I'd want them for sure if I had a family history, even when not sheltering in place. We actually own both of them just as a monitoring type thing,  but not an oximeter. 

The kids I know don't go to the doctor unless they're sick. Even the annual well visit tapers off quite a bit once they start school - I don't know what regulations might be in place now, but when my kids were little we had zero wellness coverage. ERs are still open for emergencies. For more routine illnesses that might still require a doctor, a video visit would be my first choice. 

Anyone who doesn't know what they would do in case of illness or emergency right now should pause and figure it out. Which ERs have remote check in, so you're not sitting in a waiting room? Does your current doctor offer video visits? If not, check with your insurance plan to see who does. National services like Teladoc will also check to see who takes your insurance. 

I also find it much harder to work out 'hard' at home versus my club, but nobody can solve that problem but me. The idea of saving that monthly fee has a lot of appeal, so I'm trying to make that my motivation. I ordered a couple of things to add to what we have at home: an agility ladder (aka bunny hop ladder), another jump rope, walking poles. Many of the machines at my club track distance, time, calories, etc, so I'm going to try tracking at home in a more casual way. Alexa talks me through my stretching every day, and there are tons of free and paid apps and videos. I just need to get on it. Somebody motivate me! 

2 hours ago, Dreamergal said:

 

So how do you when to go for labs ? Just call your doctor and they will decide if the appointment is telemedicine or in person ? 

Yes, talk to your doctor. My dh recently had scheduled bloodwork and a visit, at different times. They did the bloodwork in person (obviously, lol) with the follow-up visit on video. 

1 hour ago, happysmileylady said:

I was simply counteracting the statement “telemedicine is everywhere”

its not

 

regardless of whether that’s legally required or not....it’s not everywhere 

It's everywhere because it is offered everywhere in the country, and has been since long before this mess. Your dh may not have been able to see his doctor via telemedicine, but he definitely could have seen a different doctor (which is what he did anyway). You mentioned this was in the "first couple of weeks" so I'm guessing his doctor was just slammed with calls and fell far behind. A call to the insurance company may have helped - not that they weren't slammed also, but most of them seemed to get a handle on things fairly fast, probably because they are national and the waves of phone calls were coming from different areas at different times. 

A lot of people weren't/aren't aware that telemedicine has been a thing for so long, but it really has been everywhere for quite some time. I think your dh just had unfortunate timing with needing a scrip filled right in those first couple of weeks, but even then it worked out. It's great for people who lack insurance, bc visits tend to be quite a bit less. 

1 hour ago, happysmileylady said:

  And I think it's cute that people keep using the word "newspapers."  As if most people in todays world get their info from "newspapers" and not online.  

The New York Times, The Washington Post, and The Guardian take exception to being called "cute" 😋

We don't have a catchy word to replace "newspapers" yet; it may live on even when none are on paper. 

47 minutes ago, Seasider too said:

There is no Easy Button for this. 

So much this. 

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2 hours ago, happysmileylady said:

 

And I think it's cute that people keep using the word "newspapers."  As if most people in todays world get their info from "newspapers" and not online.  

 

 

21 minutes ago, katilac said:

 

 

The New York Times, The Washington Post, and The Guardian take exception to being called "cute" 😋

We don't have a catchy word to replace "newspapers" yet; it may live on even when none are on paper. 

 

There are a lot of words we still use that don't mean what they once did. People put cc in an email when cc means carbon copy. We're all aware that there isn't a carbon copy going to someone just as we're aware that the word newspapers probably means online.

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My take on the shutdown was to provide some time for the hospitals and governments etc to procure items they needed, make sure they weren’t overloaded like Wuhan, Italy and NY were, give some time to figure out what treatments worked, figure out policies, and so forth.  It was NOT to eliminate it.  People will still get covid, but now hospitals should be able to handle it better, and everyone else know how to better protect themselves. 

Of course I don’t want to get it, but I also know this shutdown needs to end.  Most of the country has flattened the curve and is in a better position to now handle people getting sick.  If it gets bad again, certain areas can make temporary restrictions to make sure it stays at a level they can handle.  But people will still get sick. 

Also, I think some lawmakers are using this as an opportunity to make Americans subservient and reliant on government to do anything.  They’re holding Americans hostage to get their policies passed.  That is not the American way.  They are also holding up bills that could help Americans, to expand government and our debt.  And some would rather pay Americans to not work 😡. Not a fan.

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All dentists are taking emergency patients a day or 2 a week in my area. A cracked tooth would be an emergency.

Our state is allowing routine dental appointments starting next week.  The dentist I work for said we do not have enough PPE for more than a week and masks are still on back order.  So we can not reopen until we have a decent amount of PPE.  Who knows when that will be?  In December, masks started to be showing up on backorder, so we were ordering what we could.  Thought that was pretty weird-before CV19 was known.  Then in February/March, we were having to order weekly because we were only allowed so many for an order.  So, the PPE we have now the Dr, assistants, and front desk(never had our office people using PPE before) are using what we have.

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4 minutes ago, matrips said:

My take on the shutdown was to provide some time for the hospitals and governments etc to procure items they needed, make sure they weren’t overloaded like Wuhan, Italy and NY were, give some time to figure out what treatments worked, figure out policies, and so forth.  It was NOT to eliminate it.  People will still get covid, but now hospitals should be able to handle it better, and everyone else know how to better protect themselves. 

 

Can hospitals handle it? I'm not hearing that they all have a bunch of PPE now, compared to before. In fact my friend who works in a hospital has asked me to make her a mask, as she got ONE to use. Period. She doesn't have direct patient contact with COVID patients, but hello - she is in the hospital interacting with people. (she's a social worker). 

Others are reporting the same thing, around the country. Hopefully in the next week or so that will start to change? If not, we can't increase their burden. Without PPE they can't safely treat people. They will get sick, and then who will treat people?

As to others knowing how to protect themselves...maybe. We STILL dont' really know how this is being transmitted. We have guesses. First it was only important to wash your hands. Then stay 6 ft away. Then wear a mask. We just don't know yet. 

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re Is the goal "flatten the curve" or "eliminate COVID" ?

We don't have a tool to eliminate COVID.  We don't even know yet if immunity holds (which is what the hopes of EITHER a vaccine OR cut-loose-and-let-it-run-its-course until we have "herd immunity" is premised on). So obviously "eliminate COVID" isn't the goal.

 

6 hours ago, Farrar said:

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.

 

 

Steps 2 and 3 have also been described as The Dance.  Open in some places, in phases, with sufficient testing and contact tracing to know if we need to retreat again, with the political will and the plans to re-impose restrictions if/where new infections start to increase steeply again.

6 hours ago, Acadie said:

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. ....

Local conditions include not just the number of infections, but also the availability of PPE within the wider (non-COVID-facing) medical/ dental / other service provider community, and above all the availability of TESTS.  Two months into this, just under 4.5M tests have been throughout the country.  That is less than 1.5% of the US population.  

Not only do we not know where the next Smithfield is, we do not have the capacity to know. Nor do we have the capacity for, nor have we worked through the privacy tradeoffs associated with, contact tracing.  Unless we get there, every meatpacking cluster => Walmart transmission => church gathering => sharp increase in cases. That's not panic porn, its just how the virus *has transmitted* and *will transmit* until we get start dancing with widespread, repeated, testing coupled with privacy-bashing contact tracing coupled with isolation of the positive.  None of which we're any more ready for, as a society, than we are for continued SIP measures.

 

Distinction between "sufficient ventilators that Grandma isn't triaged to death" vs "ready for Normal"

4 hours ago, Corraleno said:

Who exactly is the "they" that keep "moving the goalposts"? I realize this is a major talking point in certain media outlets, but IMO it's a straw man being pushed for political purposes. I have not seen or read anything from any governor, epidemiologist, public health expert, scientist, etc., suggesting that the economy needs to remain shut down until there is a vaccine. I've heard a few people say that they personally plan to SIP as much as possible until there is a vaccine, but I have never heard anyone say they think the entire country should, or even can, remain shut down that long.

The shut down is supposed to flatten the curve until (1) hospitals can handle the level of CV19 patients they are getting AND (2) we have enough PPE and testing/tracing capacity to keep it that way. Maybe some people are just assuming that if their local hospital has plenty of capacity, then their county is ready for business as usual, even if the hospital still doesnt have enough PPE for more patients and there is no ability to test/trace to reduce continuing outbreaks? If that's the case then the problem isn't that the goal posts were moved, it's that people didn't understand where they were to begin with.

Right.

There is no Back to Normal! switch. 

In less than two months, with SIP in place, there have been 47,676 confirmed COVID deaths. As we begin to re-open, even in phases, even with social distancing, even with masks, the rate of illness and death will increase. That's not panic porn, and we can hope for the better-case rather than the direst-case end of the modeling ranges, but that rate -- 25K/month -- will be HIGHER.  

Supply chain interruptions like Smithfield and Tyson will continue to happen, rapid transmission through religious gatherings like in New Rochelle will continue to happen.  Doctors and dentists in low population density areas who struggled to make a living before COVID may opt now to pick up and move, or enter another business, rather than risk the lives of their own/their staff's lives if there isn't sufficient testing & verifiable differentiation of who's exposed.

3 hours ago, Ordinary Shoes said:

...I think many think there are only two options: shelter in place or everything back to normal. When we say that things can't go back to normal yet, then we hear that the goalposts have been moved. But that's not the case. Did anyone who advocated for the shutdowns claim that it would eliminate COVID? 

I think many people are threatened by the idea of a world with continued social distancing. But there is no way around that because enough people will continue social distancing to affect attendance at public events. 

 

Right. If people don't see and trust and believe in the Dance -- including assurance that if cases spike in a particular locality that locality will re-tighten measures to slow down the spread --a great many people will scale a great number of non-essential activities back. Out to medical appointments again, yes with precautions and masks; but to movie theaters?  Concerts? Rallies?  Not this family.  Summer camps will ponder liability, and many will decide not to open even if they're "allowed" to. Many people who can avoid flying will avoid flying.  Only Darwin Award wannabes will sign up for cruises, however deeply discounted. 

No government - federal or state or local - can MAKE people go to restaurants or sports events or Disney World if they don't want to expose themselves or a more fragile family member or medical personnel. That's another facet of personal liberty.

"Back to Normal!" isn't on the table. 

 

 

3 hours ago, Farrar said:

I hate all the false choices that the "we must open soon!" camp keeps offering. If we end up on a roller coaster curve, it will not help the economy. And then all those problems you're worried about will still exist. Some will even be worse.

We can go back outside in a staged way over time. But people need a plan. Harvard's Roadmap to Pandemic Resilience was just released and this is what we need to do. Many of the coalitions of states are already trying to implement these sorts of steps. 

https://ethics.harvard.edu/covid-roadmap?fbclid=IwAR26VTvTmt7pbTrZFRkJiXie3lpvalEm6ieUmzN0zqhU0PVIMgdsNThsx04

This is an extremely good article, thank you.

The whole thing is worth reading, but the summary outlines the essential way stations of the roadmap (as we've already discussed in this thread: massively stepped up testing -- more per day than we've done thus far in 2 months -- coupled with privacy-corrosive contact tracing coupled with mandatory isolation of the positives.)

Quote

COVID-19 IS A PROFOUND THREAT TO OUR DEMOCRACY, COMPARABLE TO THE GREAT DEPRESSION AND WORLD WAR II.

As ever, the greatest bulwark of democracy is us. What we do together—for one another and, even more, with one another—to fight this terrible disease, protect human life, secure our institutions, and prevent the destruction of our economy will determine whether free societies will prove resilient in the face of existential emergency.

What we need to do is much bigger than most people realize. We need to massively scale-up testing, contact tracing, isolation, and quarantine—together with providing the resources to make these possible for all individuals.

Broad and rapid access to testing is vital for disease monitoring, rapid public health response, and disease control.

We need to deliver 5 million tests per day by early June to deliver a safe social reopening. This number will need to increase over time (ideally by late July) to 20 million a day to fully remobilize the economy. We acknowledge that even this number may not be high enough to protect public health. In that considerably less likely eventuality, we will need to scale-up testing much further. By the time we know if we need to do that, we should be in a better position to know how to do it. In any situation, achieving these numbers depends on testing innovation.

The great value of this approach is that it will prevent cycles of opening up and shutting down. It allows us to steadily reopen the parts of the economy that
have been shut down, protect our frontline workers, and contain the virus to levels where it can be effectively managed and treated until we can find a
vaccine.

We can have bottom-up innovation and participation and top-down direction and protection at the same time; that is what our federal
system is designed for.

This policy roadmap lays out how massive testing plus contact tracing plus social isolation with strong social supports,
or TTSI, can rebuild trust in our personal safety and the safety of those we love. This will in turn support a renewal of mobility and mobilization of the economy...

 

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2 hours ago, Ktgrok said:

So you are saying that the most recent order, that specifically says health care is essential and the order is not to impact matters of health and safety, doesn't actually mean that because of an earlier order?

Teledoc and Doc on Demand are nationwide services. They may not be affordable for everyone, (don't get me started on health care costs) but they are available everywhere in this country I think. 

But the fact that one doctor was closed and wouldn't see her, and another was open and would see her, just shows that the closing isn't part of a legal order to shut down. It is that individual offices are making that decision, likely based on availability of PPE, staff, cleaning concerns, etc. If it was a statewide order that all medical offices be closed, they both would be. In fact, Michigan's order cleary exempts health care/medical workers as exempt, and allows going out to medial appointments. 

Regarding dental, this is the info on what is and isn't essential/urgent. It does say that a cracked tooth with no pain would be put on hold, if there is infection or pain than treatment with antibiotics and pain meds would be the preferred option, if possible. https://www.michigandental.org/Portals/pro/ProDocuments/Membership/Coronavirus/Essential vs Non-essential Dental Treatment.pdf

Which makes sense - dental procedures are high risk - patient obviously can't be masked, and there is saliva flying around only inches from the face of the dentist. It may be one of the higher risk things there is right now. 

Plus putting a suction hose right into your mouth and the water squirters

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7 minutes ago, Pam in CT said:

This is an extremely good article, thank you.

The whole thing is worth reading, but the summary outlines the essential way stations of the roadmap (as we've already discussed in this thread: massively stepped up testing -- more per day than we've done thus far in 2 months -- coupled with privacy-corrosive contact tracing coupled with mandatory isolation of the positives.)

 

Is this amount of testing by the dates they propose plausible? I know there is a lot of research and development being done regarding testing, but I haven't read much about what is currently being made and ultimately will be put to available use in the near future. I'm not saying this information doesn't exist, just that I am personally unaware and would love to know more.

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4 hours ago, Pen said:

Depends on location.

NZ can achieve eradication as an island country probably.

Many other places the goal is flatten curve, and then keep it at a fairly flat ripple as there is easing up (and tightening down if necessary) so that medical system can handle it. 

Some places in world are probably not going to bother to try to do either, for example, Malawi is apparently going to just let it run its course since there is not much of a medical system in first place.  UK seemed to be going to try that direction but I think as system started go into overwhelm changed mind.  I suppose also that having some prominent people get it made a difference—it wasn’t just old people in nursing homes. 

 

https://mobile.abc.net.au/news/2020-04-22/coronavirus-eradication-suppression-new-zealand-australia/12172100
 

this is an article on Australia’s approach.  I think there’s actually some concern that we may eliminate completely and we don’t want that because it means indefinite border closures.  I mean I personally still want that but I realise I don’t have the bigger picture of what that means.  It also depends if there’s an end in sight like a vaccine or mutation toward a gentler form of the virus or the virus is going to disappear worldwide it could be worth shutting down for a while.  But closing borders forever won’t work.

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2 hours ago, rjand6more said:

All dentists are taking emergency patients a day or 2 a week in my area. A cracked tooth would be an emergency.

Our state is allowing routine dental appointments starting next week.  The dentist I work for said we do not have enough PPE for more than a week and masks are still on back order.  So we can not reopen until we have a decent amount of PPE.  Who knows when that will be?  In December, masks started to be showing up on backorder, so we were ordering what we could.  Thought that was pretty weird-before CV19 was known.  Then in February/March, we were having to order weekly because we were only allowed so many for an order.  So, the PPE we have now the Dr, assistants, and front desk(never had our office people using PPE before) are using what we have.

 

 

Well, December was when it was really taking off in Wuhan and the public in China were all wearing masks too. Combine that with how much ppe comes from China and the pieces fit together.

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2 hours ago, Lady Florida. said:

 

There are a lot of words we still use that don't mean what they once did. People put cc in an email when cc means carbon copy. We're all aware that there isn't a carbon copy going to someone just as we're aware that the word newspapers probably means online.

Right. And when someone shares an article from the New York Times or the Washington Post on Facebook, now people are 'getting their news from social media'. So that phrase when used as a slight could probably be retired.

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35 minutes ago, KathyBC said:

Right. And when someone shares an article from the New York Times or the Washington Post on Facebook, now people are 'getting their news from social media'. So that phrase when used as a slight could probably be retired.

 

The problem with getting your news from Facebook rather going to the newspaper is that many people have created there own little echo chambers so the things posted are only what you want to hear.

 

Not all people create echo chambers and it isn't bad to check something out that someone posted but many of my family post those random anonymous posts like the one about how Bill Gates actually sponsored  the project to create covid and garbage like that. I sadly have unfollowed many of my own family because I couldn't deal with it. 

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1 hour ago, Ausmumof3 said:

https://mobile.abc.net.au/news/2020-04-22/coronavirus-eradication-suppression-new-zealand-australia/12172100
 

this is an article on Australia’s approach.  I think there’s actually some concern that we may eliminate completely and we don’t want that because it means indefinite border closures.  I mean I personally still want that but I realise I don’t have the bigger picture of what that means.  It also depends if there’s an end in sight like a vaccine or mutation toward a gentler form of the virus or the virus is going to disappear worldwide it could be worth shutting down for a while.  But closing borders forever won’t work.

 

Not necessarily indefinite border closures.  

Quarantines for new arrivals.

Or test results showing antibodies and non current infection ...

or some use of PPE

...

 

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21 minutes ago, Pen said:

 

Not necessarily indefinite border closures.  

Quarantines for new arrivals.

Or test results showing antibodies and non current infection ...

or some use of PPE

...

 

Yes for sure they are all options.  That’s what the rationale behind it it.  I don’t necessarily agree with it.  

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1 hour ago, frogger said:

 

The problem with getting your news from Facebook rather going to the newspaper is that many people have created there own little echo chambers so the things posted are only what you want to hear.

Facebook filters as well. Even if I follow the newspapers e.g BBC on Facebook, I might get to see a BBC article a few days after it was posted on BBC’s Facebook page while I get another BBC article a few minutes after. Same Facebook account but what appears on my newsfeed on my iPhone is different from on my iPads. My iPads don’t even show the same Facebook content under my account. 

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I honestly have no idea how we get back to "normal life". Maybe we have to redefine "normal" for awhile. 

I have to admit that until this thread, I hadn't thought about what I was hoping for re: flatten or eliminate. I realized that I've really been operating with the hope that we can eliminate COVID-19 or make it so very rare that we can all return to something close to normal by fall. But that isn't likely to happen, I think. 

I've read reports from various experts saying that social distancing will may need to be in place for a couple of years, barring some miracle vaccine that hits the market quickly.  At first I thought "Sure, sure, I can wear a mask at the store, use lots of hand sanitizer, and we'll keep a low profile for awhile, no problem". Then it hit me that it also meant "If travel loosens up, you could see your family, but you can't hug them. They may not want to see you, though.  You might be too big of a risk for them.  And a socially distanced birthday party for your nearly-12 year old sounds quite terrible, actually. How do you 'socially distance' at the children's museum? Everything there is meant to be touched.  Will we ever be able to go again, while he still loves going?! How do you trick-or-treat with social distancing? Pictures with Santa? He still cares about those things.  We're talking about moving away from here, but how do you make friends in a new place with social distancing? How does a kid do that?" 

A whole new wave of grief just washed over me. 😞 

Edited by MissLemon
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Since apparently eradicating, does anyone know what Greenland has done with regard to border closures or quarantines or ________?

 

Iceland has had major decline in daily cases and looks like it may be headed toward another Island country eradication. 

 

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14 hours ago, Pen said:

Depends on location.

Some places in world are probably not going to bother to try to do either, for example, Malawi is apparently going to just let it run its course since there is not much of a medical system in first place.  UK seemed to be going to try that direction but I think as system started go into overwhelm changed mind.  I suppose also that having some prominent people get it made a difference—it wasn’t just old people in nursing homes. 

 

As far as I remember, the change in tack came as a result of different scientific advisors being brought in. Prince Charles (the first 'prominent person' that I recall) tested positive on 26 March; lockdown occurred in 23 March.

ETA: it was input from Imperial College London (University) - article dated 21 March: https://www.nationalgeographic.co.uk/science-and-technology/2020/03/uk-backed-herd-immunity-beat-covid-19-well-ultimately-need-it

' After new simulations of the outbreak from Imperial College London showed how badly hospitals would be overwhelmed, the U.K. suddenly reversed course on Monday and introduced new social distancing measures. By Friday, the Prime Minister had ordered all pubs, restaurants, gyms, and cinemas to close.'

Edited by Laura Corin
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9 hours ago, StellaM said:

 

Elimination, and then very strict border controls until a safe, effective mass vaccination program exists, along with co-operation with other 'virus extinguished' nations, is a possibility in some countries, like NZ. 

It's a possibility in AU also, but the poltical will isn't behind it as a strategy, even though we're almost there.

 

yes I read 2 news articles just yesterday saying that AUS may get elimination by fluke  because it wasn't the intention of the government . 😀

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There is also frustration because the restrictions got more strict even as the disease predictions got much less scary.  So initially they were saying that even if we all hid in our bunkers for x weeks, the hospitals would still be overwhelmed and they were scouting hotels, dorms, etc. for extra space for when that happened.  Now, as we all know, the actual hospitalizations in most places are so low that hospitals are actually underutilized.  Yay!  So the government response is to take more things away for longer.  How do you expect people to react to that?

I'm not talking about going to the beach.  People still aren't allowed to have funerals for the deceased.  People aren't able to get preventative health services.  And on and on.  This is what we get for obeying the orders and flattening the curve.

The fact that nobody knows what to believe and nobody can make plans - with or without a current income/bank balance - is incredibly stressful for many people.

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I'm not sure I agree that the disease predictions got less scary. When this started, people were concerned about having enough ventilators which would lead to deaths. There were those scary stories from Italy about care being rationed based on age. We've since learned that COVID19 is actually worse because there is more to fear than just death. We are beginning to see evidence of serious long term complications from this. 

Nobody knows who to believe? I have a pretty good idea of who to believe. The credible medical experts have been pretty consistent. 

And there is always uncertainty in how a disease will progress and affect different people. 

IDK it seems strange, when you look at human history, for people to complain about not being able to make plans. It has only been in the last century that people have been able to make plans about their future with a reasonable certainty that a health concern would not interfere. The developments that made that possible were vaccines and antibiotics. Since we're all generations removed from people dying from a cut or the measles, we've forgotten how vulnerable the human body is. 

 

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40 minutes ago, Ordinary Shoes said:

I'm not sure I agree that the disease predictions got less scary. When this started, people were concerned about having enough ventilators which would lead to deaths. There were those scary stories from Italy about care being rationed based on age. We've since learned that COVID19 is actually worse because there is more to fear than just death. We are beginning to see evidence of serious long term complications from this. 

I agree.  Personally, I am a lot more worried about COVID now than I was before. 

Six weeks ago when we went into lockdown, I was doing it for my parents, the elderly, and all the vulnerable members of our community.  I did not see COVID as a significant threat to my immediate family.  My goal was to delay getting sick, which I viewed as inevitable and mostly an inconvenience, to help flatten the curve for others who would not weather the illness as easily.

My views have changed.  I no longer think of COVID as only impacting the old and the already sick.  This is a disease that could make me or my husband (39 and 49 years old) very, very sick...perhaps leaving both of us unable to care for our children for weeks...perhaps requiring hospitalization, a ventilator, an induced coma...perhaps causing long-term damage to vital body systems.  It is still statistically unlikely that we would die from COVID, but the more I learn, the more my aim is to avoid getting sick rather than just delay it.

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There still isn't enough PPE.  Not only for current use but for stepped up use for when other healthcare opens up.  There still isn't enough testing so that you are catching even asymptomatic carriers of the illness.  There are still debates on the reliability of antibody tests and there isn't enough testing going on to clear people for work (assuming that this virus even allows for much immunity).  Those are the things that are keeping things from opening up.  Not fear or moving goal posts. Healthcare esp. would open up if there was enough equipment and if healthcare workers had some way of knowing if they were introducing COVID 19 into their non-COVID practices.   I know that the normal channels for getting PPE, tests, chemical reagents etc. have been strained by the global nature of this virus.  And governments don't pivot very quickly.  Factories and labs don't either (though some labs have been trying). 

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re is it feasible to get to 5 million daily tests (to start phased reopening by early June) to 20 million daily tests (to fully re-mobilize the economy, ideally by end-July) as per the Harvard Roadmap

12 hours ago, meena said:

Is this amount of testing by the dates they propose plausible? I know there is a lot of research and development being done regarding testing, but I haven't read much about what is currently being made and ultimately will be put to available use in the near future. I'm not saying this information doesn't exist, just that I am personally unaware and would love to know more.

I don't know.  It will entail a massive mobilization as well as associated massive cost.  

(We have not yet touched at all on this thread, or much on other threads I've loosely followed, on the COST side of either what "orderly  management of the Dance" or the ad hoc distribution of medical expenses of let-er-rip-Open-Everything-Up.  Even mild cases entailing days rather than weeks of ICU rather than ventilators, will take a whole lot of even-insured households past their financial capacity. We have not discussed personal bankruptcy due to medical costs, hospital bankruptcy due to unpaid bills, the second stage of triage for the "routine mild cases" based on who's insured how.  There are no good options, looking at this issue from a cost vantage point. But that is another thread.)

Oxford is doing a very good data roundup and visualization comparing different nations' testing, positive cases, and fatality numbers (though there are, inevitably, data issues as different nations' CDC equivalents track different metrics).  One of their indicators is a rolling 3-day average of "tests per 1,000 people" (which is, I think, the best way to render apples(ish) to apples(ish) to correct for the relative size of economies, medical/research sectors, and manufacturing capacity; and population -- both the capacity to produce tests and the need to deploy them).

The Harvard Roadmap's 5M to 20M daily tests in the US would amount to about 1.3 tests per thousand (to begin phased commencement of The Dance) to 5.3 (fully re-mobilize the economy based on widespread public trust that The Dance is working).  Right now, two months in, Italy and Estonia are approaching the bottom end of that range -- suggesting that yes, at least this level is within the range of plausibility.  The US is still testing well less than 1/2 person per thousand per day.

But it will COST. To the extent that test deployment is fully dependent upon for-profit market actors to develop/manufacture/deploy tests based on their independent profitability calculations, it will cost considerably MORE.  And I don't know if the will is there.

We want to re-open, but we also want to do so on the cheap.  Those two (legitimate, understandable) desires are in tension with one another.

 

re COVID's looking more, or less, alarming now than it did back in February:

43 minutes ago, wendyroo said:

I agree.  Personally, I am a lot more worried about COVID now than I was before. 

Six weeks ago when we went into lockdown, I was doing it for my parents, the elderly, and all the vulnerable members of our community.  I did not see COVID as a significant threat to my immediate family.  My goal was to delay getting sick, which I viewed as inevitable and mostly an inconvenience, to help flatten the curve for others who would not weather the illness as easily.

My views have changed.  I no longer think of COVID as only impacting the old and the already sick.  This is a disease that could make me or my husband (39 and 49 years old) very, very sick...perhaps leaving both of us unable to care for our children for weeks...perhaps requiring hospitalization, a ventilator, an induced coma...perhaps causing long-term damage to vital body systems.  It is still statistically unlikely that we would die from COVID, but the more I learn, the more my aim is to avoid getting sick rather than just delay it.

I'm also far more acutely aware now, than then, about the invisibility of transmission -- that folks who have it, transmit before they have any symptoms; and even more that folks who never have symptoms, transmit it unwittingly. Back then (when we were *panicked* about transmission to my FIL, who was in a rehab center in NYC for wholly unrelated issues), I was paranoid about anyone with a hint of a cough; I now appreciate that literally anyone who walked into his room could have been shedding it.

I also assumed, then, that it was only a matter of time before a vaccine was developed (a lengthy time, to be sure) and that in the interim folks who'd had it, would be protected and could resume normal activities.  My husband and I presumed, eventually, that this would be us.  I assumed that immunity would hold, and that ultimately control of it, via either vaccine and/or prevalence was possible. I am seriously concerned by the indications of relapse among patients who've had it, recovered, and then fallen ill again.

 

 

More than anything else, though, I'm alarmed that we seem unable, as a society, to perceive this virus on its own terms. 

It's like we're so primed to receive anything BAD in terms of our usual blame categories that we are literally unable to see it clearly. This is a disease, is of a scale and transmission ease and -- thus, in combination -- lethality that literally no one alive has seen. It has already crossed all national and state borders. We do not understand very much about it. It has already incurred tremendous cost in lives, health, money and disruption. We have not begun to contain it and we don't have the information we need to be able to contain it.

It is a VIRUS. It is not an ideology.

I feel like we're so used to blaming the Other Party that we can't adjust to the REALITY that we are facing down an amorphous enemy that truly DOES NOT CARE about our partisanship problems or other societal fractures. Sure, I think this Administration made errors early on.  Sure, the Chinese government did as well.  OK.

But King Solomon himself would not have been able to see the outlines of this beast.  Such a beast has never before prowled this earth.

Whether we like it or not -- absolutely no one likes it -- we are facing a war.  Like all wars, it came on so abruptly that the mind has trouble adjusting. Like all wars, there is tremendous uncertainty on how it will unfold going forward. Like all wars, no government can promise when it will be over or on what terms. Like all wars, there will shortages, hardships, long periods of boredom punctuated by moments of heart-dropping panic. Like all wars, it will bring out the best and worst in us as individuals and as a society.

We haven't endured a war that imposed real hardship across all segments of society since people my mother's age were children.  Even then the war was Over There, not here.

And unlike other wars, this enemy is invisible, moving within us, here.  That is a very different front line.  Its ultimate defeat, if we manage to defeat it, will be a matter of science and collective action; and many of us distrust one or both of those.  And -- like all wars -- developing and deploying the tools to defeat it will be immensely costly.

But it is what it is.  It's a VIRUS, not an ideology.  We really seem to be struggling with that reality.

Remember who the real enemy is.

 

 

 

 

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49 minutes ago, Pam in CT said:

More than anything else, though, I'm alarmed that we seem unable, as a society, to perceive this virus on its own terms. 

It's like we're so primed to receive anything BAD in terms of our usual blame categories that we are literally unable to see it clearly. This is a disease, is of a scale and transmission ease and -- thus, in combination -- lethality that literally no one alive has seen. It has already crossed all national and state borders. We do not understand very much about it. It has already incurred tremendous cost in lives, health, money and disruption. We have not begun to contain it and we don't have the information we need to be able to contain it.

It is a VIRUS. It is not an ideology.

I feel like we're so used to blaming the Other Party that we can't adjust to the REALITY that we are facing down an amorphous enemy that truly DOES NOT CARE about our partisanship problems or other societal fractures. Sure, I think this Administration made errors early on.  Sure, the Chinese government did as well.  OK.

But King Solomon himself would not have been able to see the outlines of this beast.  Such a beast has never before prowled this earth.

Whether we like it or not -- absolutely no one likes it -- we are facing a war.  Like all wars, it came on so abruptly that the mind has trouble adjusting. Like all wars, there is tremendous uncertainty on how it will unfold going forward. Like all wars, no government can promise when it will be over or on what terms. Like all wars, there will shortages, hardships, long periods of boredom punctuated by moments of heart-dropping panic. Like all wars, it will bring out the best and worst in us as individuals and as a society.

We haven't endured a war that imposed real hardship across all segments of society since people my mother's age were children.  Even then the war was Over There, not here.

And unlike other wars, this enemy is invisible, moving within us, here.  That is a very different front line.  Its ultimate defeat, if we manage to defeat it, will be a matter of science and collective action; and many of us distrust one or both of those.  And -- like all wars -- developing and deploying the tools to defeat it will be immensely costly.

But it is what it is.  It's a VIRUS, not an ideology.  We really seem to be struggling with that reality.

Remember who the real enemy is.

This x1000

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3 hours ago, SKL said:

 

I'm not talking about going to the beach.  People still aren't allowed to have funerals for the deceased.  People aren't able to get preventative health services.  And on and on.  This is what we get for obeying the orders and flattening the curve.

The fact that nobody knows what to believe and nobody can make plans - with or without a current income/bank balance - is incredibly stressful for many people.

Yes, in most places people CAN have small funeral services, just immediate family. Larger memorials will have to wait, which is sad, but not a true argument for causing MORE funerals. As for preventative health services, do you mean just regular yearly check ups? Is it really so critical that people get their checkup at month 12 and not month 15? That seems rather arbitrary, and again, many doctors ARE still doing visits both in person and via telemedicine. People cited Michigan and Ohio, and both of those places the orders specifically do NOT include medical care although some guidelines are given as far as minimizing exposure, putting off things that are not time sensitive, etc. The reason many offices are not open is not government orders, it is lack of ability to practice safely. My friend owns an eye care center and they may be opening up next week but can't find bulk quantities of disinfecting materials for cleaning, PPE, etc. Until they can, they can't open up. 

52 minutes ago, Jean in Newcastle said:

There still isn't enough PPE.  Not only for current use but for stepped up use for when other healthcare opens up.  There still isn't enough testing so that you are catching even asymptomatic carriers of the illness.  There are still debates on the reliability of antibody tests and there isn't enough testing going on to clear people for work (assuming that this virus even allows for much immunity).  Those are the things that are keeping things from opening up.  Not fear or moving goal posts. Healthcare esp. would open up if there was enough equipment and if healthcare workers had some way of knowing if they were introducing COVID 19 into their non-COVID practices.   I know that the normal channels for getting PPE, tests, chemical reagents etc. have been strained by the global nature of this virus.  And governments don't pivot very quickly.  Factories and labs don't either (though some labs have been trying). 

Yup. Many of the things people are complaining about are not effected by the stay in place orders, but by the lack of PPE. That's a market problem, not a policy problem. 

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I keep forgetting which of these threads I'm on but we are going to have an answer to some of the questions really soon because some states are opening up. Georgia is really going for it. I know parts of Georgia have been hit really hard, so not sure how that is going to go. My 55 year old school friend who got Covid is near Atlanta where he has been on a vent for over 3 weeks and is now heading to rehab. My state seems to be making plans to open up. Restaurants around here are planning to open May 4th. Somehow the opening up in stages message has not gotten through. I keep reading the recommended criteria and laughing nervously because not being followed!

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17 hours ago, Ottakee said:

Another Michigan one....friend of a friend has an aneurysm....quite severe and if it ruptures almost certain death.  Yet, she can't get an appointment for surgery to repair it as it isn't life threatening TODAY.  Any other time she would have had surgery within a day or 2.

I typed all this out, and then realized you could be talking about a brain aneurysm, not aortic. So, some of this might not apply, but some will. I'll leave it in case it applies to someone else. 

This is terrifying--aneurysms are all over my family (my son has Marfan Syndrome, and the rest of the family just has them, cause unknown), and they don't all live near tertiary centers, so emergency means helicopter to a facility that is 3 hours away by car. So, don't take this as minimizing. I am listing some of this in case she is able to ask more questions or explore other options. 

First, could she be referred to a tertiary center in another state that is doing these electively? If not, then I would guess this is a big decision based on PPE and other factors, such as availability of ICU space, anesthesiology, heart-lung bypass equipment, and specialized nursing. There are some excellent surgeons in MI who deal with this all the time, so I am guessing they aren't making this decision lightly.

It's been a while since I've sat in on a presentation on this, but surgery risk is assessed by the risk of waiting vs. the risk of rupture. Surgery happens when that risk is about equal. The fact that surgeons can intervene at all before a rupture is a luxury of fairly recent progress. There are a couple of advantages to electively having surgery--ruptures make things an emergency, so you might have fewer options and you must act faster; potentially "neater" surgery where the repair materials are more easily matched up to the areas being replaced, etc. 

Risk also depends on type of dissection--there are two types, and she might be at risk for the lesser type (which is sometimes not fixed as odd as that sounds). 

If she's really at the "could drop dead at any moment stage," is there a way for her to maybe relocate and live with a family temporarily who lives near the facility that would do the repair emergently so that she can get the team that knows her case and has prepared for this moment? Has her care team given her a specific game plan for an emergency situation? This could involve documentation with local EMS so they know that she might need a helicopter flight, etc. It could mean that she has to go to a lesser preferred hospital for rupture repair vs. elective--does she have a clear line of communication that can be handed to trauma people in her local area so they can immediately access her cardiac surgeons? They plan these elective surgeries based on careful measurements and selection of materials, and that information would be useful to the second choice team. For instance, if her aneurysm is asymmetrical, it might look different when you get inside than the second team would expect, but the primary surgeon might have already prepared for that and be expecting that.

She should NOT be taken to the ED without a well-informed support person as well as documentation. She could probably get a doctor's order for that and file documentation with local EMS to avoid an argument. Backpack Health offers the full version of their app for FREE if you have a qualifying condition (aortic aneurysm is one), and can put a lot of really detailed information on it, including scans and such. You can make ALL of that information available with a single, private URL. 

So, she might have some options.

I am so sorry to hear this. Truly. It's tragic.

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5 hours ago, Ordinary Shoes said:

I'm not sure I agree that the disease predictions got less scary. When this started, people were concerned about having enough ventilators which would lead to deaths. There were those scary stories from Italy about care being rationed based on age. We've since learned that COVID19 is actually worse because there is more to fear than just death. We are beginning to see evidence of serious long term complications from this. 

Nobody knows who to believe? I have a pretty good idea of who to believe. The credible medical experts have been pretty consistent. 
 

And there is always uncertainty in how a disease will progress and affect different people. 

IDK it seems strange, when you look at human history, for people to complain about not being able to make plans. It has only been in the last century that people have been able to make plans about their future with a reasonable certainty that a health concern would not interfere. The developments that made that possible were vaccines and antibiotics. Since we're all generations removed from people dying from a cut or the measles, we've forgotten how vulnerable the human body is. 

 

The “credible medical experts” were scaring us with predictions of 2.2 million deaths to get us to comply with stay at home orders until oops, sorry our model was wrong.

i agree that antibiotics have helped, but while a vaccine slowed measles spread, mortality from measles was declining before a vaccine.

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2 hours ago, Pam in CT said:

re is it feasible to get to 5 million daily tests (to start phased reopening by early June) to 20 million daily tests (to fully re-mobilize the economy, ideally by end-July) as per the Harvard Roadmap

I don't know.  It will entail a massive mobilization as well as associated massive cost.  

(We have not yet touched at all on this thread, or much on other threads I've loosely followed, on the COST side of either what "orderly  management of the Dance" or the ad hoc distribution of medical expenses of let-er-rip-Open-Everything-Up.  Even mild cases entailing days rather than weeks of ICU rather than ventilators, will take a whole lot of even-insured households past their financial capacity. We have not discussed personal bankruptcy due to medical costs, hospital bankruptcy due to unpaid bills, the second stage of triage for the "routine mild cases" based on who's insured how.  There are no good options, looking at this issue from a cost vantage point. But that is another thread.)

Oxford is doing a very good data roundup and visualization comparing different nations' testing, positive cases, and fatality numbers (though there are, inevitably, data issues as different nations' CDC equivalents track different metrics).  One of their indicators is a rolling 3-day average of "tests per 1,000 people" (which is, I think, the best way to render apples(ish) to apples(ish) to correct for the relative size of economies, medical/research sectors, and manufacturing capacity; and population -- both the capacity to produce tests and the need to deploy them).

The Harvard Roadmap's 5M to 20M daily tests in the US would amount to about 1.3 tests per thousand (to begin phased commencement of The Dance) to 5.3 (fully re-mobilize the economy based on widespread public trust that The Dance is working).  Right now, two months in, Italy and Estonia are approaching the bottom end of that range -- suggesting that yes, at least this level is within the range of plausibility.  The US is still testing well less than 1/2 person per thousand per day.

But it will COST. To the extent that test deployment is fully dependent upon for-profit market actors to develop/manufacture/deploy tests based on their independent profitability calculations, it will cost considerably MORE.  And I don't know if the will is there.

We want to re-open, but we also want to do so on the cheap.  Those two (legitimate, understandable) desires are in tension with one another.

 

re COVID's looking more, or less, alarming now than it did back in February:

I'm also far more acutely aware now, than then, about the invisibility of transmission -- that folks who have it, transmit before they have any symptoms; and even more that folks who never have symptoms, transmit it unwittingly. Back then (when we were *panicked* about transmission to my FIL, who was in a rehab center in NYC for wholly unrelated issues), I was paranoid about anyone with a hint of a cough; I now appreciate that literally anyone who walked into his room could have been shedding it.

I also assumed, then, that it was only a matter of time before a vaccine was developed (a lengthy time, to be sure) and that in the interim folks who'd had it, would be protected and could resume normal activities.  My husband and I presumed, eventually, that this would be us.  I assumed that immunity would hold, and that ultimately control of it, via either vaccine and/or prevalence was possible. I am seriously concerned by the indications of relapse among patients who've had it, recovered, and then fallen ill again.

 

 

More than anything else, though, I'm alarmed that we seem unable, as a society, to perceive this virus on its own terms. 

It's like we're so primed to receive anything BAD in terms of our usual blame categories that we are literally unable to see it clearly. This is a disease, is of a scale and transmission ease and -- thus, in combination -- lethality that literally no one alive has seen. It has already crossed all national and state borders. We do not understand very much about it. It has already incurred tremendous cost in lives, health, money and disruption. We have not begun to contain it and we don't have the information we need to be able to contain it.

It is a VIRUS. It is not an ideology.

I feel like we're so used to blaming the Other Party that we can't adjust to the REALITY that we are facing down an amorphous enemy that truly DOES NOT CARE about our partisanship problems or other societal fractures. Sure, I think this Administration made errors early on.  Sure, the Chinese government did as well.  OK.

But King Solomon himself would not have been able to see the outlines of this beast.  Such a beast has never before prowled this earth.

Whether we like it or not -- absolutely no one likes it -- we are facing a war.  Like all wars, it came on so abruptly that the mind has trouble adjusting. Like all wars, there is tremendous uncertainty on how it will unfold going forward. Like all wars, no government can promise when it will be over or on what terms. Like all wars, there will shortages, hardships, long periods of boredom punctuated by moments of heart-dropping panic. Like all wars, it will bring out the best and worst in us as individuals and as a society.

We haven't endured a war that imposed real hardship across all segments of society since people my mother's age were children.  Even then the war was Over There, not here.

And unlike other wars, this enemy is invisible, moving within us, here.  That is a very different front line.  Its ultimate defeat, if we manage to defeat it, will be a matter of science and collective action; and many of us distrust one or both of those.  And -- like all wars -- developing and deploying the tools to defeat it will be immensely costly.

But it is what it is.  It's a VIRUS, not an ideology.  We really seem to be struggling with that reality.

Remember who the real enemy is.

 

 

 

 

This scares the hell out of me. I think I've been naively counting on a vaccine. 

Those things you say we need to do - we aren't going to do them. I hate to be pessimistic but that kind of effort requires something that we don't have in the US today. 

Definitely agree that people don't see the real threat. I've been so disappointed by the responses of some people but it has become obvious that they see it through a filter. The "other side" believes X about this virus so Y must be correct. 

We live in a society of tremendous inequality which leads to resentment of the other. Many are conditioned to doubt "mainstream" science and medicine. I'm know people who believe this is all a hoax and that the vaccine is a plot by Bill Gates to take over the world. They will never change their minds because they have so much invested in being 'contrary' to the mainstream. We've been trained over the last 50 or so years to doubt the capability of government to help. You hear people say all of the time that the government can't do anything right. Most Americans have no idea how much they personally benefit, on a daily basis, from actions of "the government." 

I'm very pessimistic about this and think that we will be on on our own feeding into the anti-communitarian world-view which makes this harder. Some states and local governments are more functional and might be able to do some good. 

I read something that stuck with me. I can't remember where I read it so don't have the cite. It contrasted two kinds of people; those who insist that nothing changes because they don't want things to change and people who can conceptualize significant changes. (I'm not wording this well.) Basically, the first group is usually right because things rarely change all of that much but are catastrophically wrong when things do change. The second group is wrong most of the time but right when those once in a lifetime changes occur. 

I don't think that we will do the right things. There will be coverups of the deaths and the long term complications. This will be easier because the effects of COVID seem to fall more on the people we hardly notice anyway. I think the next step will be a denial of the difference of the 'current' to the 'before,' i.e. "this is the way it's always been." Tinfoil hat time but I sometimes tell my daughter to remember things if people ever try to tell her otherwise in the future. For example, I've told her to remember that the fires we see every fall are worse than they've ever been before. This isn't normal. This isn't how it always was. I think I'll need to have a similar discussion with her about this subject. 

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