what does flatten the curve but open up really look like/mean?

[ktgrok]

As in, a lot are saying that the goal is not to prevent people from catching it, but just to prevent hospital overwhelm. That opening up is part of that. ok...but what does that look like?

I mean, in New York City, they were overwhelmed. So we don't want that. How to do we open, but not get that again? How do places that have low levels, keep low levels? 

People are saying that we flattened the curve, now we need to learn to live with this virus, for the long term. What does that mean? What do people saying that mean? If we had more deaths in a few months than from the entire vietnam war, and part of that time was with things shut down, how do we "live with it" without overwhelming things?

[vonfirmath]

8 minutes ago, Ktgrok said:

As in, a lot are saying that the goal is not to prevent people from catching it, but just to prevent hospital overwhelm. That opening up is part of that. ok...but what does that look like?

I mean, in New York City, they were overwhelmed. So we don't want that. How to do we open, but not get that again? How do places that have low levels, keep low levels? 

People are saying that we flattened the curve, now we need to learn to live with this virus, for the long term. What does that mean? What do people saying that mean? If we had more deaths in a few months than from the entire vietnam war, and part of that time was with things shut down, how do we "live with it" without overwhelming things?

Here in Texas it means they are keeping an eye on the rolling 7 day numbers and encouraging people to be personally responsible.

 

I do think we'll have a problem if we get to the point of needing to lockdown harder again.

OTOH, maintaining the lockdown was also becoming a problem. people were just flagrantly disobeying the lockdown because they looked around them and felt the problem did not justify the "cure"

 

[J-rap]

From what I understand, it means slowly opening things up, while still mostly social distancing and wearing masks, and see how it goes.  If statistics start picking up again, then be ready to dial back again.  

[JustEm]

1 minute ago, J-rap said:

From what I understand, it means slowly opening things up, while still mostly social distancing and wearing masks, and see how it goes.  If statistics start picking up again, then be ready to dial back again.  

 

I don't think most people will tolerate the dialing back of it again. 

[J-rap]

2 minutes ago, hjffkj said:

 

I don't think most people will tolerate the dialing back of it again. 

Yeah, that part would be tricky, but perhaps an increase in numbers will help people realize that it's necessary?  I don't know.

[Pawz4me]

19 minutes ago, Ktgrok said:

I mean, in New York City, they were overwhelmed. So we don't want that. How to do we open, but not get that again? How do places that have low levels, keep low levels? 

People are saying that we flattened the curve, now we need to learn to live with this virus, for the long term. What does that mean? What do people saying that mean? If we had more deaths in a few months than from the entire vietnam war, and part of that time was with things shut down, how do we "live with it" without overwhelming things?

I guess this is kind of obvious, but I'll throw it out -- I think it means requiring that everyone who can must wear a mask as much as possible while around other people. It's very odd to me that the people who are pushing the hardest for re-opening also seem to be the ones who are the most adamantly against mask wearing. I think it's the one easiest things we can do to get back to something that resembles normal w/o overwhelming hospitals.

Edited May 15, 2020 by Pawz4me

[J-rap]

Our state follows numbers very closely (well --  I'm sure all states are doing that!), and these are things it will be watching for as it moves forward:

(copied from our local newspaper this morning)

 

“The whole purpose of this was just to push this thing out, flatten it and slow down. You’re not going to prevent it...  I think it’s hard for people to wrap their head around [that] folks are still going to get this. The fear was, you saw this in other places, they weren’t ready and it overwhelmed the system.”  (quote by the governor)

State health officials on Thursday identified new metrics they will be closely watching for signs that the pandemic is taking a turn for the worse. One bad sign would be if diagnostic testing finds positive COVID-19 cases 14% of the time, or if the rate of positive tests increases by 5 percentage points over 14 days. The current seven-day average is a positive rate of around 12%

Another threshold would be a doubling of COVID-19 cases every five days or less. The current rate is 9.5 days.

[JustEm]

1 minute ago, J-rap said:

Yeah, that part would be tricky, but perhaps an increase in numbers will help people realize that it's necessary?  I don't know.

 

Here's hoping.  My guess is the numbers would have to get really bad before the majority were scared enough to accept lock down again.  If not numbers than the percentage of younger people/kids being horribly affected increasing.  Right now the main thing I'm hearing from people of my demographic, mid thirties with kids, is that they just want to get it and be done with it since they are likely not to have it too badly. This is from people who took it seriously at first and were 100% compliant.  Now they're just burnt out and ready to get back to normal. 

[J-rap]

2 minutes ago, Pawz4me said:

I guess this is kind of obvious, but I'll throw it out -- I think it means requiring that everyone who can wear a mask whenever they can while around other people. It's very odd to me that the people who are pushing hard for re-opening also seem to be the ones who are the most adamantly against mask wearing. I think it's the one easiest thing we can do to get back to something that resembles normal w/o overwhelming hospitals.

I agree.  I really wish it would be required in more places...  For example, on public transportation.  As people are going back to work, busses are starting to get crowded again.

10 minutes ago, hjffkj said:

 

I don't think most people will tolerate the dialing back of it again. 

 

Totally agree.  I think that one reason states are cautious to re-open is they realize there's no way they can close up again.

[J-rap]

3 minutes ago, hjffkj said:

 

Here's hoping.  My guess is the numbers would have to get really bad before the majority were scared enough to accept lock down again.  If not numbers than the percentage of younger people/kids being horribly affected increasing.  Right now the main thing I'm hearing from people of my demographic, mid thirties with kids, is that they just want to get it and be done with it since they are likely not to have it too badly. This is from people who took it seriously at first and were 100% compliant.  Now they're just burnt out and ready to get back to normal. 

I'm seeing this too.

[sassenach]

13 minutes ago, hjffkj said:

 

I don't think most people will tolerate the dialing back of it again. 

You’re right. Unfortunately, I think a lot of people feel hoodwinked from this round and won’t be as cooperative in the future.

[J-rap]

12 minutes ago, happysmileylady said:

To me, learning to live with it means figuring out what level of risk is acceptable.  We accept a particular level of risk every single day.  

For example, the risks of driving.  There are millions and millions of car accidents in the US every year.  Any anywhere from 35k to 50k people die due to those accidents, and hundreds of thousands of people are injured, many with life long disabilities.  We, as individuals and as a society in general, accept that level of risk.  We accept it every single time we get into our cars and drive somewhere, because driving is, for most of the nation, a necessity to access all our other necessities like groceries and work places.  

Like cars, we are stuck with this thing.  It's not going to go away.  We are working on treatments and vaccines but as we all know, those may or may not work.  So since we can't cure it, what is the level of risk we find acceptable in order to be able to carry on as a society.  

I think part of it though is that it's not even as much about risk as it is overwhelming our health system, and of course completely wiping out the very elderly and most vulnerable.  

ETA:  In the end, I don't know if we'll be able to protect our very elderly in the longterm (without a vaccine), especially those in care centers.  Even centers taking every precaution could easily have one staff member who comes in without symptoms.  

But the health care system will need to be able to keep up without the absolute chaos we've seen in some parts of the world.  That's probably what it really boils down to.  

Edited May 15, 2020 by J-rap

[sassenach]

Our first wave of transmission was based on zero behavior modification. As we go back, we’re already adjusted to huge modifications. That in itself will lead to less transmission. If we add readily available testing on top of that, I’m very hopeful that we can keep things at a slow burn. 
 

I live in CA so there’s no fear of too few restrictions here but a lot of angst over how we’re already seeing the economy crumble. We’ve lost SO MANY businesses already. Not just small. We’ve had several big ones close their SF offices. Our food bank demand has doubled. I’m incredibly concerned. 

[JustEm]

6 minutes ago, sassenach said:

You’re right. Unfortunately, I think a lot of people feel hoodwinked from this round and won’t be as cooperative in the future.

 

It would have to get really bad before we get the level  of cooperation that we got at the beginning of this.  And at the really bad level people would start complying at, I think it would already be way too late to matter much.

Mind you I'm considering the hot spots throughout the country and I don't think most people would consider even those levels to be enough to get them to start fully complying like they did before.

[JustEm]

1 minute ago, sassenach said:

Our first wave of transmission was based on zero behavior modification. As we go back, we’re already adjusted to huge modifications. That in itself will lead to less transmission. If we add readily available testing on top of that, I’m very hopeful that we can keep things at a slow burn. 
 

I live in CA so there’s no fear of too few restrictions here but a lot of angst over how we’re already seeing the economy crumble. We’ve lost SO MANY businesses already. Not just small. We’ve had several big ones close their SF offices. Our food bank demand has doubled. I’m incredibly concerned. 

 

I am so incredibly scared of the economic crisis looming. 

[sassenach]

1 minute ago, hjffkj said:

 

It would have to get really bad before we get the level  of cooperation that we got at the beginning of this.  And at the really bad level people would start complying at, I think it would already be way too late to matter much.

Mind you I'm considering the hot spots throughout the country and I don't think most people would consider even those levels to be enough to get them to start fully complying like they did before.

It’s really too bad. There was so much good will at the start. I think when they shifted from “let us prepare” to “we will save you all” they lost that. 

[sassenach]

Just now, hjffkj said:

 

I am so incredibly scared of the economic crisis looming. 

I still feel like we can crawl out but they have to start making changes now (much like flattening the curve). I keep hearing about how we need scientists at the helm and I disagree. We need scientists AND economists because we have TWO crises not one and they both need experts at the helm. 

[ktgrok]

36 minutes ago, hjffkj said:

 

Here's hoping.  My guess is the numbers would have to get really bad before the majority were scared enough to accept lock down again.  If not numbers than the percentage of younger people/kids being horribly affected increasing.  Right now the main thing I'm hearing from people of my demographic, mid thirties with kids, is that they just want to get it and be done with it since they are likely not to have it too badly. This is from people who took it seriously at first and were 100% compliant.  Now they're just burnt out and ready to get back to normal. 

Is the info about this maybe causing fertility issues on anyone's minds, I wonder, when they say get it and get it over with? If not for them, than for their kids? I mean, maybe it is, and they are willing to accept that (still unknown) risk? Just wondering. That's one of my concerns with young people, personally, but I don't know enough yet to know HOW concerned to be. 

34 minutes ago, happysmileylady said:

To me, learning to live with it means figuring out what level of risk is acceptable.  We accept a particular level of risk every single day.  

For example, the risks of driving.  There are millions and millions of car accidents in the US every year.  Any anywhere from 35k to 50k people die due to those accidents, and hundreds of thousands of people are injured, many with life long disabilities.  We, as individuals and as a society in general, accept that level of risk.  We accept it every single time we get into our cars and drive somewhere, because driving is, for most of the nation, a necessity to access all our other necessities like groceries and work places.  

Like cars, we are stuck with this thing.  It's not going to go away.  We are working on treatments and vaccines but as we all know, those may or may not work.  So since we can't cure it, what is the level of risk we find acceptable in order to be able to carry on as a society.  

Right, but this killed more people in a few months than driving does in a year. And we came up with safeguards to get those driving deaths down to that level, so I'm wondering what safegaurds people are thinking in order to keep/get Covid deaths down? Or do they think we can or should get them down? Like, are we just going to plan on the deaths staying at the rate they are, accepting them going up to a certain level, or not basing decisions on that at all? Truly curious. 

If we had 86,000 deaths in about 3 months, are we saying we anticipate about 30K deaths a month from now on? More? Less? 

Edited May 15, 2020 by Ktgrok

[Laura Corin]

Here it means keeping R below 1, closing back down if necessary.  It's unclear (so far) what it means for people who have been shielding (having no contact at all due to severe underlying conditions).

[sassenach]

1 minute ago, Ktgrok said:

Is the info about this maybe causing fertility issues on anyone's minds, I wonder, when they say get it and get it over with? If not for them, than for their kids? I mean, maybe it is, and they are willing to accept that (still unknown) risk? Just wondering. That's one of my concerns with young people, personally, but I don't know enough yet to know HOW concerned to be. 

Right, but this killed more people in a few months than driving does in a year. And we came up with safeguards to get those driving deaths down to that level, so I'm wondering what safegaurds people are thinking in order to keep/get Covid deaths down? Or do they think we can or should get them down? Like, are we just going to plan on the deaths staying at the rate they are, accepting them going up to a certain level, or not basing decisions on that at all? Truly curious. 

 

I want the only deciding factor to be hospital preparedness and capacity. I want every person who needs it to have a bed and every health care provider to have full PPE. As soon as you start basing it solely on death rates, you have to ask what is an acceptable amount of death and the truth is that we ALL want no deaths. But that is not possible and the idea that we can control people to the point of containing this virus is far in the rear view. Like the generations that have come before us, we’re going to have to come to grips with viruses and death. As a people we have been sooooo blessed to mostly escape this experience but we are not unique in it. Maybe uniquely mentally and emotionally unprepared...

[ktgrok]

Just now, sassenach said:

I want the only deciding factor to be hospital preparedness and capacity. I want every person who needs it to have a bed and every health care provider to have full PPE. As soon as you start basing it solely on death rates, you have to ask what is an acceptable amount of death and the truth is that we ALL want no deaths. But that is not possible and the idea that we can control people to the point of containing this virus is far in the rear view. Like the generations that have come before us, we’re going to have to come to grips with viruses and death. As a people we have been sooooo blessed to mostly escape this experience but we are not unique in it. Maybe uniquely mentally and emotionally unprepared...

Ok, so as many people in ICU as we can hold? So as long as we can keep ramping up bed/PPE/ventilators/etc, that's the goal? Does this include temporary type hospitals, etc? (assuming same with morgues/etc as well?)

[ktgrok]

Also, does flattening the curve mean just spreading things out, or does it still include trying to limit exposure to those "most vulnerable"? Or does "learning to live with the virus" mean letting go of that goal, for the most part? Or is that idea just not even possible?

[sassenach]

11 minutes ago, Ktgrok said:

Ok, so as many people in ICU as we can hold? So as long as we can keep ramping up bed/PPE/ventilators/etc, that's the goal? Does this include temporary type hospitals, etc? (assuming same with morgues/etc as well?)

I don’t know what to tell you on that. Our hospitals are on hiring freezes, have stopped scheduling all of their per diems and are WAY under capacity right now. Do I want them overflowing? No. Do I believe that there is a death toll connected with poverty? Yes. Do I think the needle can be moved away from protecting hospital capacity and toward people not losing work (at this moment)? Yes. 

 

Edited May 15, 2020 by sassenach

[ktgrok]

1 minute ago, sassenach said:

I don’t know what to tell you on that. Our hospitals are on hiring freezes, have at opped scheduling all of their per diems and are WAY under capacity right now. Do I want them overflowing? No. Do I believe that there is a death toll connected with poverty? Yes. Do I think the needle can be moved away from protecting hospital capacity and toward people not losing work (at this moment)? Yes. 

 

Oh, I agree. I'm just trying to figure out where that line is, so we know it when we hit it, lol. 

Like, just because they are under capacity now doesn't mean they will be in a month. New York City was under capacity and then it wasn't. How do we go from where your area is now, to wherever we think is okay, without hitting the point that NYC hit? 

[sassenach]

6 minutes ago, Danae said:

The death rate (and case rate) isn't only about how many deaths we're willing to "come to grips" with. It's also an indicator of how fast the virus is spreading, which is goes to hospital preparedness and capacity.  Once a hospital is close to capacity it's only going to stay under if the new case number stays flat.  If it's increasing, the hospital will be overwhelmed.

The only way we have a chance at a bed for everyone who needs it is to keep the reproduction rate at or below 1. Or continually increase hospital capacity.

And that’s the tricky part that I don’t feel equipped to sort out. 

[ktgrok]

Just now, happysmileylady said:

Well, I think in some ways....limiting exposure to the most vulnerable is really one of the better ways to look at flattening the curve.  When 50% of the cases that end up in the hospital are among 15% of the population, working to limit the exposure of that 15% is going to go a long way toward keeping the healthcare system from being overwhelmed.  

But, I think that the ways we "limit exposure to the most vulnerable" could be debatable.  

Well that's kind of what I'm asking, lol. What are the possible ways to do that, if that is the goal? Are they feasible. what are people's various thoughts?

I mean, I want to know what people are thinking, expecting, hoping, planning, etc. If I don't know that I don't know what I can expect, you know? 

I see some saying "protect the vulnerable" and ohters saying we just need to accept they will die, and then some saying both at different times, or showing up at nursing homes without masks (not to mention a politician's name..sigh) with a person who turned out to test positive the next day. So it's confusing, lol. 

[TracyP]

1 minute ago, Ktgrok said:

Also, does flattening the curve mean just spreading things out, or does it still include trying to limit exposure to those "most vulnerable"? Or does "learning to live with the virus" mean letting go of that goal, for the most part? Or is that idea just not even possible?

In my state.... the goal is to spread it out so hospitals are not overwhelmed. So some level of social distancing will be in place for the long term - masking, no huge gatherings, stay home when sick. At the same time the most vulnerable (people over 65 with underlying health conditions) are encouraged to shelter in place for the long term. This will also help with hospital capacity since this is the group of people most likely to be hospitalized.

Concurrently, testing should be at a level that outbreaks can be caught before they get out of hand.

I think to judge capacity you need to watch the doubling rate. If you get to the place where you will reach max capacity in 6 weeks, it may be time to scale back. That's just my thought though - maybe 4 weeks out is enough time to be safe, maybe it should be even more than 6.

Nursing homes... we have to get a rapid testing program in place for them. There is no other option I can see. Until then, the nursing home situation will continue to be a huge problem and lockdowns have not seemed to be at all helpful in protecting that population.

[Ottakee]

I think the flatten the curve was to protect the hospitals from overflow and let them get policies and procedures in place.  We are not going to eliminate all COVID or COVID deaths, likely for years, if ever.   We might get a shot for it like influenza which helps greatly but doesn't eliminate it.

I think people overall will be more cautious about hand washing, being very close to people outside of their families, and hopefully staying home when sick.   I really hope this bring about a change in the work place that will allow workers, esp. those who are new hires and/or in lower wage jobs an opportunity for sick leave/pay.  I know that many factories in our area (that pay $11-14/hour) have a ZERO tolerance policy for sick days for the first 3-6 month.  Basically, if you don't show up, don't bother coming back tomorrow as you won't have a job.  That needs to change so that those that ARE sick and safely stay home.

 

[ktgrok]

2 minutes ago, Danae said:

I think part of the problem is that our national leaders haven't articulated what the goal is. Or even decided on one. I still think reducing cases to the point where we can trace them and treat this like TB -- which is also highly contagious and mostly not vaccinated for in the US --- is possible. Other people think the only realistic perspective is that everyone gets it eventually and trying to stop that is just dragging things out.  If we don't have a national decision, or maybe a state-by-state decision as to which option we're pursuing it's no wonder that the messaging around how to get there (where?) is incoherent.

Yes! I can't being to understand how to get there until I know where there is, lol!

And those who say "get it over with", I want to understand what that means. Like, ok, lets have NYC level stuff, and get it done? Or less than that? Like, what does that mean? If NYC had 10 percent of the population infected over 3 months or so, so 3-4% of people infected a month lets say, and had the hospitals overwhelmed, that to me means we need to be slower than that. But does less than 3-4% of the population getting  it a month equal "getting it over with" to those advocating that approach, or do they mean faster than that? 

[Ottakee]

3 minutes ago, happysmileylady said:

Well, one thing I think that was handled horribly was the nursing home situation.  Improvements in nursing home/elderly/assisted living situations really need to happen.  More staff that stays in the same place.  More strict controls regarding safety and sanitation standards in such place, better oversight in general.  

Perhaps making more masks available, more comfortable, more affordable, of the sort that protect the wearer....so that those who are most vulnerable are better protected themselves.  

Partly though, I think some of the answer has to come from the most vulnerable themselves. 

And that all comes down to money again.  Our most vulnerable in society (the elderly, poor, those with special needs or mental illness) are the ones that suffer the most but most of the time have the least amount of financial resources.

Nursing home workers in our are are paid just barely above minimum wage, most less than Walmart is paying.  That is not right but that is all medicaid/medicare funding will allow.

[Ottakee]

1 minute ago, Arctic Mama said:

 

It’s going fine here after many areas are reopening. Steady cases but not massive growth, except in the areas where testing has increased and that has caused a reporting spike.  This is what living with the virus looks like in a population like this. I’m pretty pleased with the data from the last week or two.

 

I would love to see some good, hard numbers on spikes here in Michigan.  It was predicted that there would be huge spikes after the Operation Gridlock protest in Lansing and then again after the protest a week or 2 ago.  I can't seem to find anything on spikes.....or no spikes.

I am hoping that Michigan will slowly begin to open up again....using reasonable caution.....but also being aware that we are living with a virus and there will be risks no matter what you do.

[Joker]

I honestly don’t know. 

In my state those over 60 only make up 30% of positive cases but they are 90% of our deaths. Nursing homes appear to be about 40% so the majority of those deaths aren’t happening in those facilities. I don’t know how we protect them without hiding them away.

My mom is 70 but she still wants to see us often. So far we’ve been sitting a good distance away and visiting outside. When the weather changes this fall I’m not going to ignore her and make her constantly be alone if that’s not what she wants. She also still works (in a hospital) and loves her job. She has no desire to hide away.

[Pen]

6 minutes ago, Arctic Mama said:

And there really is no good way to tell if it worked and suppressed numbers or was an overreaction and the numbers would have never peaked to NY levels in most of the country - it would look the same from the outside. Anyone who says they have certainty on that fact in either direction is a fool.
 

The curve was the needs surpassing treatment options, avoiding the catastrophes of Spain and Italy.  Social distancing, isolation of sick patients and their families, and cleanliness practices to keep the spread mostly contained to family units and not unchecked through the population.  We can manage that, and many states are doing well with people living life with their level of care and awareness of the illness informing their daily practices. 
 

It’s going fine here after many areas are reopening. Steady cases but not massive growth, except in the areas where testing has increased and that has caused a reporting spike.  This is what living with the virus looks like in a population like this. I’m pretty pleased with the data from the last week or two.

 

 

Had people kept on traveling, socializing etc., what do you think would have stopped exponential growth? 

[JustEm]

39 minutes ago, Ktgrok said:

Also, does flattening the curve mean just spreading things out, or does it still include trying to limit exposure to those "most vulnerable"? Or does "learning to live with the virus" mean letting go of that goal, for the most part? Or is that idea just not even possible?

 

I think limiting exposure to the most vulnerable is still important but it needs to be handled in a different way.  Those most vulnerable and their families need to come up with a plan that keeps them safest, companies need to find a way to allow the most vulnerable to continue working from home or some sort of support for those too at risk to work needs to be implemented. But if the vulnerable want to live their lives like everyone else we need to be ok with that also.

[Pen]

1 minute ago, Arctic Mama said:

I already told you I don’t know and neither do you.  We aren’t seeing these things spike right now in the places opening back up, and arguably they may never have.  But we will never know, because there is no way to run two parallel realities and see which had the proper assessment.  It doesn’t really matter, though, does it?  Because as things are opening the rates in most areas are steady or dropping a bit, which is  what we want.

 

Right. We don’t know for sure.

 

I hope we are not seeing what will be for some areas a new start onto an exponential graph shape that is now the blade part of hockey stick before it starts back onto the shaft part.

 

I think slow opening with safety protocols in place would tend to help prevent that, but in some places that isn’t happening. 

 

[ktgrok]

41 minutes ago, happysmileylady said:

Well, one thing I think that was handled horribly was the nursing home situation.  Improvements in nursing home/elderly/assisted living situations really need to happen.  More staff that stays in the same place.  More strict controls regarding safety and sanitation standards in such place, better oversight in general.  

Perhaps making more masks available, more comfortable, more affordable, of the sort that protect the wearer....so that those who are most vulnerable are better protected themselves.  

Partly though, I think some of the answer has to come from the most vulnerable themselves. 

Regarding masks to protect themselves, would you say we should hold off on opening things up more until they do have access to those? Like, is the idea of them having PPE to protect themselves a nice idea, or something that should be a benchmark, in your mind? And would that replace others using masks, be in addition, or?

AS for coming up with other answers, and them coming up with them themselves, what if the vulnerable's answer is something the rest of the population has to cooperate with to make work? Like, do you mean they come up with ideas, and everyone implements them, or they figure out how to protect themselves without the aid of others, or? And if they are the ones least likely to come up with solutions, due to age, infirmity, poverty, etc? I mean, it sounds good, but what does that look like, what does it mean? 

21 minutes ago, Arctic Mama said:

Most areas will not and have not seen NYC numbers, because of the lack of shared transit and high density housing.

Many parts of the US, including SD, didn’t see anywhere near that transmission even with things more opened up the entire time.  And if you’re looking in various places around the world there seems to be some risk factors that are conglomerates in cities but not countryside, and that does make a difference when you consider that the vast majority of households in this country are in suburbs or rural.  NYC and nursing facilities are more and more looking like special cases rather than the rule to judge the rest of the varied and enormous US by.

Ok, see, thank you, that's some actual detail! So you are thinking/hoping that the high rate of spread is going to be limited to places with a lot of density and public transport, so those places may need different precautions than less dense areas, and less dense areas may not need any precautions, or minimal, because there is just less ways for it to really spread? 

I don't know if I agree or not yet (will take more info) but at least that is a very concrete answer that I can understand, so thank you! That does explain a lot more of what people are hoping for. 

13 minutes ago, hjffkj said:

 

I think limiting exposure to the most vulnerable is still important but it needs to be handled in a different way.  Those most vulnerable and their families need to come up with a plan that keeps them safest, companies need to find a way to allow the most vulnerable to continue working from home or some sort of support for those too at risk to work needs to be implemented. But if the vulnerable want to live their lives like everyone else we need to be ok with that also.

The problem is, how DO we come up with a way to keep them safe, if we at the same time are trying NOT to prevent the general spread? What does that mean/look like?

[sassenach]

Armchair Expert had Dr. Rajiv J. Shah, the president of the Rockefeller Foundation, on yesterday. They have a brilliant plan to roll out high scale testing. It’s basically my dream- enough tests for daily tests. It makes me very hopeful. 

[EmseB]

I think people on all sides of the argument need to accept there are no good answers or perfect ones. There are a million variables and facets to reopening that are going to be tried to various degrees of success by various different metrics. There is no one "what it would look like".

Every life is precious and death is horrible. No one here, and no society (or very few), operates on doing whatever it takes to ensure no one dies. On the flip side, no one (or very few) lives as if they don't care how many people die, either. Everyone finds a balance they can live with (that is the larger point about cars, not that car accidents are comparable to covid). 

The news is going to highlight the idiots and outliers. I think most of us are doing the best we can to be good neighbors to everyone...grandma, small business owners, essential workers, etc.

But we could all just argue about who wants to kill grandma more. 😉

Edited May 15, 2020 by EmseB

[Clemsondana]

8 minutes ago, Plum said:

I'm recalling a model or study that said 80% will eventually get it. Of course more people have it than the case numbers show; there's a lot of asymptomatic people walking around. I picture that population unknowingly spreading it through normal every day things. 

I agree one grocery store trip doesn't wipe out the elderly pop. But along the way I'm spreading it to people who may care for the more vulnerable or may be high risk themselves. 

I think this is such a localized thing.  Currently our positive test rate is less than 1%, and we're doing 2000+ tests/week.  We've had 2 people hospitalized recently, but both have been discharged.  We have 4 hospitals in town but one hospital set up a covid ward - I don't think we ever had more than 5 patients, unless we had some from other counties, and currently we have no covid patients.  We have around half a million people in our region and have had 5 deaths and around 300 positive cases, although I'm sure there were some early ones that were missed before testing became widespread.  The models actually predict that we're catching almost all of our cases, although obviously there could be a time of asymptomatic spread before they are caught.  Our Phase 1 openings started over 2 weeks ago but the number of positive cases per day hasn't really changed, and ranges between 0 and 12 on any given day.  In our state, the governor has a general plan that is similar to others, but for the 4 city/county regions with their own health departments, they can come up with their own plan.  Our area is opening more quickly than the other 3 areas, which have had more cases.  They seem to be doing some contact tracing - testing all coworkers of somebody who has tested positive - but I don't think they're going back and testing everybody that they might have encountered at the grocery store a week ago.  If they had done something with a known risk - a masked exercise class or a haircut - I'd imagine they'd test those involved.  

It's an odd thing, though - knowing that there are some asymptomatic carriers, and yet, with testing widely available and yet mostly being done for people who think they might have reason to test (either feeling bad or known exposure) and still only having a 1% positive rate, the likelihood that you'd actually encounter one of the asymptomatic carriers is very small.  

[hopeallgoeswell]

2 hours ago, Pawz4me said:

I guess this is kind of obvious, but I'll throw it out -- I think it means requiring that everyone who can must wear a mask as much as possible while around other people. It's very odd to me that the people who are pushing the hardest for re-opening also seem to be the ones who are the most adamantly against mask wearing. I think it's the one easiest things we can do to get back to something that resembles normal w/o overwhelming hospitals.

Is there anything out there yet that looks at mortality rates from places where masks are mandatory v. not mandatory? 

"Sweden’s Public Health Agency, however, says that while masks are worn by healthcare staff in close contact with patients, they are 'not needed in the community.'"  https://www.rt.com/news/488567-sweden-pm-face-masks-coronavirus/

[ktgrok]

35 minutes ago, EmseB said:

I think people on all sides of the argument need to accept there are no good answers or perfect ones. There are a million variables and facets to reopening that are going to be tried to various degrees of success by various different metrics. There is no one "what it would look like".

Every life is precious and death is horrible. No one here, and no society (or very few), operates on doing whatever it takes to ensure no one dies. On the flip side, no one (or very few) lives as if they don't care how many people die, either. Everyone finds a balance they can live with (that is the larger point about cars, not that car accidents are comparable to covid). 

The news is going to highlight the idiots and outliers. I think most of us are doing the best we can to be good neighbors to everyone...grandma, small business owners, essential workers, etc.

But we could all just argue about who wants to kill grandma more. 😉

I'm seriously not arguing that anyone wants to kill grandma, I'm just trying to figure out what all people are saying/advocating/exptecting. Like, I can't even begin to accuse you of trying to kill grandma if I don't even know what you want/expect, lol. (you general, not you specific). 

I can't have an opinion on other people's plans, goals, or desires if I don't understand what those plans/desires/goals ARE. Just like "flatten the curve" was rightly criticized as too vague, I'm finding "open up" and "get it over with" and "learn to live with it" to be too vague. 

(Now, I will say that when public officials go to a nursing home without a mask, THATS a bit too cavalier with grandma's health...but even then I don't think they WANT to kill grandma. )

 

[JustEm]

1 hour ago, Ktgrok said:

 

The problem is, how DO we come up with a way to keep them safe, if we at the same time are trying NOT to prevent the general spread? What does that mean/look like?

 

It means the families with at risk members continue to stay home if they are concerned about reducing their families risk. They continue to limit exposure by doing curbside pick up and grocery delivery.  The community helps them by offering help to them if they need something but don't want to leave their house. It means nursing homes continue to not allow visitors and keep implementing better cleaning standards.  It means no visitors in hospitals needs to continue.  It means a bunch of other stuff.

Life can go on while the people most at risk stay safe at home. For the majority of at risk people our society is set up nicely to figure it out.  However, of course there are people still at risk that it will be harder for such as the homeless, people who don't have close community ties or family to help, and people who financially need to work but can't do so from home.  

[ktgrok]

1 minute ago, hjffkj said:

 

It means the families with at risk members continue to stay home if they are concerned about reducing their families risk. They continue to limit exposure by doing curbside pick up and grocery delivery.  The community helps them by offering help to them if they need something but don't want to leave their house. It means nursing homes continue to not allow visitors and keep implementing better cleaning standards.  It means no visitors in hospitals needs to continue.  It means a bunch of other stuff.

Life can go on while the people most at risk stay safe at home. For the majority of at risk people our society is set up nicely to figure it out.  However, of course there are people still at risk that it will be harder for such as the homeless, people who don't have close community ties or family to help, and people who financially need to work but can't do so from home.  

Gotcha...

So on a societal level that means figuring out how to make sure they can work, or support them if they can't, making sure they have curbside or delivery services available...also need to figure out things like medical appointments, etc....my mom is high risk, and doing grocery shopping via delivery, but she still has medical appointments that can't be stopped, still will need to use public restrooms while at such places (her cancer specialist is a long drive), etc. My dad also had an ER visit last month, for a kidney stone, that couldn't be helped, etc. 

And not having visitors in nursing homes, okay, but what about the workers? If we raise the incidence in the general population, including those workers, how do we best protect the residents at the nursing home? Not saying it can't be done, but how? Was it even visitors that spread it in the known cases, or workers, or?

[Bootsie]

2 hours ago, kand said:

I don’t see a way that we can ensure hospital capacity for everyone while allowing rates to increase. If the R0 is above 1, it’s going to keep spreading exponentially, which means hospitals WILL be overwhelmed. I can’t numerically see a way around that. Am I missing something?

I also don’t agree the problem is people being too emotionally weak to let the deaths increase. I don’t think it’s a moral failing to find life precious and worth saving. I’m wondering why it’s seen by some as more acceptable to be scared too death about the economy, but not about losing hundreds of thousands of people who otherwise would have lived. The seroprevalence studies that have come out in the last couple days have all come with the conclusion that far too few have been infected for herd immunity without a vaccine to be a viable strategy. Even Spain has only 5% of their population infected so far. 

The R0 cannot remain above 1 indefinitely if any resistance is associated with having had COVID-19--unless we have a huge birth rate.  The rate cannot continue to increase exponentially because there is a limited population size.  Different demographics have different incidence of being hospitalized.  So, it depends not only on the number of cases, but who in the population is infected, how impacted the hospitals are.  If you have a town with one hospital and COVID infects a large portion of the local nursing home, the hospital will be overwhelmed.  In a town where a large portion of a younger demographic is infected, there will be a less overwhelmed hospital.  

There are things associated with the economy that help keep us from losing hundreds of thousands of people who would have otherwise died.  The farmer growing vegetables is part of the economy.  The trucker transporting the crop is part of the economy.  So is the grocery stocker.  So is the lab tech who is helping to diagnose cancer.  Or, the worker for a pharmaceutical company who is working on a treatment for diabetes.  Or, the engineering student who is studying ways to design automobiles so that they are safer.  And the company that produces the reflectors that are used on highways to help reduce accidents.  And the airline that delivers life saving medical equipment.  

 

 

[JustEm]

1 minute ago, Ktgrok said:

Gotcha...

So on a societal level that means figuring out how to make sure they can work, or support them if they can't, making sure they have curbside or delivery services available...also need to figure out things like medical appointments, etc....my mom is high risk, and doing grocery shopping via delivery, but she still has medical appointments that can't be stopped, still will need to use public restrooms while at such places (her cancer specialist is a long drive), etc. My dad also had an ER visit last month, for a kidney stone, that couldn't be helped, etc. 

And not having visitors in nursing homes, okay, but what about the workers? If we raise the incidence in the general population, including those workers, how do we best protect the residents at the nursing home? Not saying it can't be done, but how? Was it even visitors that spread it in the known cases, or workers, or?

 

Well of course there is going to be exposure, it is near impossible to avoid it.  But it just isn't realistic for the entire population to stay home for those most at risk. But with appointments and rest rooms protocols such as regularly cleaning, keeping patients in their cars until they can go right into the room, employees being tempt and accessed for illness daily.  These are the things we can do to decrease the risk to the best of our ability.  But there is no decreasing it entirely.

[Starr]

We've spent many years finding ways to include all people in our society. It's sad to now hear so many people say that those at risk can just be alone for a couple of years. And if they can't afford the costs of helpers then too bad, so sad.

[Pawz4me]

26 minutes ago, hopeallgoeswell said:

Is there anything out there yet that looks at mortality rates from places where masks are mandatory v. not mandatory? 

"Sweden’s Public Health Agency, however, says that while masks are worn by healthcare staff in close contact with patients, they are 'not needed in the community.'"https://www.rt.com/news/488567-sweden-pm-face-masks-coronavirus/

I don't think we should be using Sweden as a barometer for any sort of preventative measures, given that's (mostly) not the approach they've chosen to take. There are probably studies all over the place, but the majority of the ones I've read definitely seem to indicate that mask wearing by enough of the population can make a difference. We already know that the numbers from countries where mask wearing was already normalized (South Korea, Taiwan, Japan, Hong Kong among others) look a lot better than ours. But of course that could be due to a number of factors. This is one interesting study.

At the very least, given the lack of definitive evidence I think a logical approach is to weigh the risk/benefit. As long as I'm careful in using a mask (not touching my face taking it on/off), and as long as I don't see it as a license to let up on social distancing or hand washing or any other known precautions, then there is zero risk to me from wearing a mask. The benefit of enough of us wearing a mask could potentially be huge. Thus I see no logical reason that those of us who can shouldn't wear one.

[ktgrok]

16 minutes ago, kand said:

One thing I keep being struck by is that while there are a number of measures we could enact to make it safer to open more things up, frequently the same people who really think we should be opening up are also the ones who disagree with enacting those measures.

I think that though is where the differing goals comes into play. I think some are saying they don't want to limit spread particularly, or see no point, or don't think it is possible, so if their goal is to get it over with more quickly, it makes sense they don't want masks, etc. 

I think that is why it is important to understand people's goals, expectations, etc as it drives their behavior, and I want to understand those drivers. 

[EmseB]

40 minutes ago, kand said:

I agree there is no perfect answer. That’s what makes this so difficult. It also doesn’t mean all answers are equally good. With regard to the bolded,  I’m afraid that the balance that many people are deciding they can live with, is at the expense of “others“.  Seems like when people realized this wasn’t hitting their particular demographic that hard, it was no longer worth the trade off to protect those that it was hitting. I’m not just talking Grandma, either. What I’ve been seeing is that the people who are hit hardest by this are not the ones arguing for things to open up and go for herd immunity (and again, i’ve seen very, very few scientists in relevant fields agree that herdimmunity is a valid goal at this point—most are saying it is not).

It will be great to start seeing more data on mask regulations.  It doesn’t make sense to me for the default to be no masks until we have data that they are worth it. Considering agree to which they are hypothesized to reduce spread if everyone is wearing one, it only makes sense to start out with people wearing them and if it’s later found that it’s not helpful, it can be discontinued. On the one hand, you could have people who wore masks and didn’t need to, while on the other you could have an out of control surge of cases and deaths that didn’t need to happen.

The point is there is always an expense of "others", it's just not usually highlighted with one specific cause so starkly and most of us don't like to think about the choices we make as weighing someone else's life in the balance but that is always in play in some way or another. Right now, as someone with higher risks associated with covid, the only thing I can do to ensure my safety is to modify my own behavior. I cannot ask society to bend to my particular unique risk factors and someone who wants to, say, open their business with certain safety parameters in place in order to feed their family isn't more or less important than my need to stay in in order to protect myself and my family. They aren't marginalizing me by opening up and I am not marginalizing them by not going in their store. It's both of us acting in accordance with what we see as safe and necessary.

You're presenting some false dichotomies with underlying assumptions about things no one is certain about as if they are facts. There is very rarely a binary choice like wear masks or be overrun with cases. Those aren't the only two variables or options.

Also, humans have a tendency to adjust behavior based on risk, regardless of what authorities are telling them to do. They adapt and act according to perceived and actual risk to themselves and their families.

Edited May 15, 2020 by EmseB