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

[ktgrok]

And...my state COVID 19 dashboard has us back up to over 1K new cases yesterday. Now, yesterday's numbers were lower than they had been, so maybe this was a weird fluke and they had a backlog of tests that got done on a Saturday??. We are right at two weeks after the first soft reopening of restaurants and retail (25% capacity, plus outdoor seating) and less than a week after salons could open. 

Oh, and with over 1K cases yesterday,  we are opening up gyms tomorrow, and going to 50% capacity for restaurants and stores. Gyms can open to 50% capacity as well, only requirement is to offer disinfectant for people to wipe down machines between uses. 

Actually...now that I think about it...the suspicious part of me wonders if that abnormally low number of new cases on Friday was so that the Governor could say that cases were down when he made the announcement on Friday? 

Who knows. Going to hope the spike is the fluke, not the dip. 

Edited May 17, 2020 by Ktgrok

[KungFuPanda]

1 hour ago, Ktgrok said:

And...my state COVID 19 dashboard has us back up to over 1K new cases yesterday. Now, yesterday's numbers were lower than they had been, so maybe this was a weird fluke and they had a backlog of tests that got done on a Saturday??. We are right at two weeks after the first soft reopening of restaurants and retail (25% capacity, plus outdoor seating) and less than a week after salons could open. 

Oh, and with over 1K cases yesterday,  we are opening up gyms tomorrow, and going to 50% capacity for restaurants and stores. Gyms can open to 50% capacity as well, only requirement is to offer disinfectant for people to wipe down machines between uses. 

Actually...now that I think about it...the suspicious part of me wonders if that abnormally low number of new cases on Friday was so that the Governor could say that cases were down when he made the announcement on Friday? 

Who knows. Going to hope the spike is the fluke, not the dip. 

Dh has been watching numbers from different states and has noticed that most have an anomaly day where the numbers don't follow the pattern.  He doesn't know why yet.  It could be different reasons in different locations . . . different reporting cycles the numbers guy gets that day off, or whatever.  For whatever reason one day a week is just off.  We might be better off backing up and thinking of weeks as a unit and not zoning in too much on particular days.  I think we can all expect to see a big spike two weeks after things open up again.

[Ottakee]

5 minutes ago, KungFuPanda said:

Dh has been watching numbers from different states and has noticed that most have an anomaly day where the numbers don't follow the pattern.  He doesn't know why yet.  It could be different reasons in different locations . . . different reporting cycles the numbers guy gets that day off, or whatever.  For whatever reason one day a week is just off.  We might be better off backing up and thinking of weeks as a unit and not zoning in too much on particular days.  I think we can all expect to see a big spike two weeks after things open up again.

I have seen people doing a moving 7 day average....to help address those random spikes.

It will be interesting to see if there are big spikes.   Michigan was predicted to have a big spike after the Operation Gridlock protest....that didn't happen even though people gathered from all over the state.    No big spike after a second protest.   We will have to watch and see.

We're there huge spikes in Florida after the crowded beach days?   Or in those from other states that were there?   Not trying to play one side or the other, but wondering if the big spikes that were predicted came to be or not.

[ktgrok]

34 minutes ago, Ottakee said:

I have seen people doing a moving 7 day average....to help address those random spikes.

It will be interesting to see if there are big spikes.   Michigan was predicted to have a big spike after the Operation Gridlock protest....that didn't happen even though people gathered from all over the state.    No big spike after a second protest.   We will have to watch and see.

We're there huge spikes in Florida after the crowded beach days?   Or in those from other states that were there?   Not trying to play one side or the other, but wondering if the big spikes that were predicted came to be or not.

Yeah, I'm not seeing that with our numbers, as far as a certain day of the week or anything. I am not sure how our spikes correlate to the beach days, that was a while ago other than just in an area of Jacksonville. Beaches have been closed for a while, and my dashboard I'm looking at doesn't go back that far. 

[TracyP]

2 hours ago, Ktgrok said:

And...my state COVID 19 dashboard has us back up to over 1K new cases yesterday. Now, yesterday's numbers were lower than they had been, so maybe this was a weird fluke and they had a backlog of tests that got done on a Saturday??. We are right at two weeks after the first soft reopening of restaurants and retail (25% capacity, plus outdoor seating) and less than a week after salons could open. 

Oh, and with over 1K cases yesterday,  we are opening up gyms tomorrow, and going to 50% capacity for restaurants and stores. Gyms can open to 50% capacity as well, only requirement is to offer disinfectant for people to wipe down machines between uses. 

Actually...now that I think about it...the suspicious part of me wonders if that abnormally low number of new cases on Friday was so that the Governor could say that cases were down when he made the announcement on Friday? 

Who knows. Going to hope the spike is the fluke, not the dip. 

Ok, I think maybe I'm understanding your question better. Or maybe not, lol. Let me see...

There is a contradiction, right? We are going to "flatten the curve" is the message we keep hearing. Yet with reopening is there actually any chance that case numbers don't rise? I mean, how can they not - more people mingling = more opportunity for transmission. Nobody wants to own it but it seems we are all following Sweden's playbook at the end of the day.

Is that kind of where you are going with your question? How can people say we are going to flatten the curve or even see a drop in cases? It seems illogical. 

If that's at the root of your question, I think you are right on. I don't know that a lot of people have come to terms with what we are doing. (And I'll note that much of Europe is doing the same. This isn't just the U.S. I'll also say that I don't think we have a choice between lack of compliance and the fear of longterm economic consequences.) A lot of people are walking around saying " yay, we flattened the curve so we can open up now." Except they don't seem to understand that opening up will mean more cases, more hospitalizations, and more deaths. 

In reality, what we are doing is opening slowly to see how far we can push the envelope. I think most places expect a rise in cases, but they hope that by monitoring it closely they can find a sweet spot where we learn to live with this virus. This comes at a price though. This price is going to likely be higher in more densely populated areas, but none of us are completely insulated from it. I don't know that the average person is understanding that, so that is the disconnect you are seeing.  

Ack, I could say a lot more but I'm not even positive I'm addressing your question. I may just be going off on my own tangent.... 🙂

[ktgrok]

20 minutes ago, TracyP said:

Ok, I think maybe I'm understanding your question better. Or maybe not, lol. Let me see...

There is a contradiction, right? We are going to "flatten the curve" is the message we keep hearing. Yet with reopening is there actually any chance that case numbers don't rise? I mean, how can they not - more people mingling = more opportunity for transmission. Nobody wants to own it but it seems we are all following Sweden's playbook at the end of the day.

Is that kind of where you are going with your question? How can people say we are going to flatten the curve or even see a drop in cases? It seems illogical. 

If that's at the root of your question, I think you are right on. I don't know that a lot of people have come to terms with what we are doing. (And I'll note that much of Europe is doing the same. This isn't just the U.S. I'll also say that I don't think we have a choice between lack of compliance and the fear of longterm economic consequences.) A lot of people are walking around saying " yay, we flattened the curve so we can open up now." Except they don't seem to understand that opening up will mean more cases, more hospitalizations, and more deaths. 

In reality, what we are doing is opening slowly to see how far we can push the envelope. I think most places expect a rise in cases, but they hope that by monitoring it closely they can find a sweet spot where we learn to live with this virus. This comes at a price though. This price is going to likely be higher in more densely populated areas, but none of us are completely insulated from it. I don't know that the average person is understanding that, so that is the disconnect you are seeing.  

Ack, I could say a lot more but I'm not even positive I'm addressing your question. I may just be going off on my own tangent.... 🙂

I think maybe I'm wondering how flat is flat, for those who advocate flattenning the curve? And am learning for some it means keeping cases about the same as now, or lower, for others it means up to whatever current ICU capacity it. so some mean flat like stay where we are, others mean flatten as in lower than worst case, not same as now. I think those two different understandings were causing me confusion. 

Edited May 18, 2020 by Ktgrok

[Frances]

3 hours ago, Ottakee said:

I have seen people doing a moving 7 day average....to help address those random spikes.

It will be interesting to see if there are big spikes.   Michigan was predicted to have a big spike after the Operation Gridlock protest....that didn't happen even though people gathered from all over the state.    No big spike after a second protest.   We will have to watch and see.

We're there huge spikes in Florida after the crowded beach days?   Or in those from other states that were there?   Not trying to play one side or the other, but wondering if the big spikes that were predicted came to be or not.

I think we are understanding more and more that being outside is significantly less risky than inside when it comes to transmission, all else being equal. So I’m not sure outdoor protests or full beaches tell us much about opening up restaurants, gyms, etc.

Edited May 18, 2020 by Frances

[Pen]

41 minutes ago, Frances said:

3 hours ago, Ottakee said:

I have seen people doing a moving 7 day average....to help address those random spikes.

It will be interesting to see if there are big spikes.   Michigan was predicted to have a big spike after the Operation Gridlock protest....that didn't happen even though people gathered from all over the state.    No big spike after a second protest.   We will have to watch and see.

We're there huge spikes in Florida after the crowded beach days?   Or in those from other states that were there?   Not trying to play one side or the other, but wondering if the big spikes that were predicted came to be or not.

I think we are understanding more and more that being outside is significantly less risky than inside when it comes to transmission, all else being equal. So I’m not sure outdoor protests or full beaches tell us much about opening up restaurants, gyms, etc.

 

https://www.nytimes.com/2020/04/11/us/florida-spring-break-coronavirus.html

[Pen]

3 hours ago, Ottakee said:

I have seen people doing a moving 7 day average....to help address those random spikes.

It will be interesting to see if there are big spikes.   Michigan was predicted to have a big spike after the Operation Gridlock protest....that didn't happen even though people gathered from all over the state.    No big spike after a second protest.   We will have to watch and see.

We're there huge spikes in Florida after the crowded beach days?   Or in those from other states that were there?   Not trying to play one side or the other, but wondering if the big spikes that were predicted came to be or not.

 

Yes. It appears so, even given out of doors and young people. 

There were very few cases in Florida at spring break time.  The graph then takes a sharp upward direction.  

[Pen]

https://www.nbcnews.com/news/us-news/florida-coronavirus-cases-surge-spring-breakers-express-regret-n1168686

The clip went viral. "If I get corona, I get corona. At the end of the day, I'm not gonna let it stop me from partying," Brady Sluder, a spring breaker in Miami, said last week.

Now, as the United States is at about 55,000 cases of the coronavirus, including more than 780 deaths, and is on track to become the new center of the pandemic, he has revised his message: "Don't be arrogant and think you're invincible like myself."

...

[Frances]

34 minutes ago, Pen said:

 

Yes. It appears so, even given out of doors and young people. 

There were very few cases in Florida at spring break time.  The graph then takes a sharp upward direction.  

But spring breakers don’t just hang out at the beach. They pack into bars and nightclubs at night and restaurants all day.

[Pen]

1 minute ago, Frances said:

But spring breakers don’t just hang out at the beach. They pack into bars and nightclubs at night and restaurants all day.

 

That’s true.  

[TracyP]

5 hours ago, kand said:

My understanding has been that the original plan laid out was that we would open with testing and contact tracing ramped up to the degree that we could catch and contain new outbreaks so that we never had cases start increasing out of control like we did in the first wave. Initially the thought was that it may at times require some smaller, rolling closures in areas to keep it contained. This approach has been successful so far in a number of other countries.

In my state this is definitely still the plan. And I think it is a good plan, but whether or not it has been successful elsewhere depends how you define success. South Korea is shutting back down after being open for like 2 weeks, I think. I don't think "open up" and "flatten the curve" can ever go hand in hand. You can open up and hopefully with contact tracing you can keep things under control, as in not overwhelm the system. (This seems to be the current plan as far as I can tell.) But if your goal is truly a drop in cases or a literal flattening of cases, then I don't think you can open up. I do think some people think that there will be a downward trend even with the country opening up, and I hope they're right! But while I think testing is crucial to spotting outbreaks, I don't think it is enough to literally flatten the curve. South Korea is facing this now.

[Ausmumof3]

12 minutes ago, TracyP said:

In my state this is definitely still the plan. And I think it is a good plan, but whether or not it has been successful elsewhere depends how you define success. South Korea is shutting back down after being open for like 2 weeks, I think. I don't think "open up" and "flatten the curve" can ever go hand in hand. You can open up and hopefully with contact tracing you can keep things under control, as in not overwhelm the system. (This seems to be the current plan as far as I can tell.) But if your goal is truly a drop in cases or a literal flattening of cases, then I don't think you can open up. I do think some people think that there will be a downward trend even with the country opening up, and I hope they're right! But while I think testing is crucial to spotting outbreaks, I don't think it is enough to literally flatten the curve. South Korea is facing this now.

I’m hopeful that we can learn a bit from their experience about what was safe and what wasn’t.  For example apparently a high intensity indoor gym class resulted in spread but Pilates and yoga didn’t.  And the last outbreak was linked to a guy that went to multiple nightclub venues.  I’m not sure how that can be avoided but maybe a one venue only clubbing experience.  I know clubs here are saying it may not be financially viable to open with social distancing Requirements though.

https://wwwnc.cdc.gov/eid/article/26/8/20-0633_article

[ktgrok]

1 hour ago, Ausmumof3 said:

I’m hopeful that we can learn a bit from their experience about what was safe and what wasn’t.  For example apparently a high intensity indoor gym class resulted in spread but Pilates and yoga didn’t.  And the last outbreak was linked to a guy that went to multiple nightclub venues.  I’m not sure how that can be avoided but maybe a one venue only clubbing experience.  I know clubs here are saying it may not be financially viable to open with social distancing Requirements though.

https://wwwnc.cdc.gov/eid/article/26/8/20-0633_article

I'd imagine the club thing is both the number of people, but also that you usually have to shout into someone's face in order to be heard. So..yeah....spewing infection right into someone's face isn't going to be safe...and you can't social distance and hear someone speak unless they turn down the music. And a club where you stand 6 feet apart and listen to music quietly..is not a club, lol. 

[Pam in CT]

re spring breakers gotta spring break

9 hours ago, Pen said:

https://www.nbcnews.com/news/us-news/florida-coronavirus-cases-surge-spring-breakers-express-regret-n1168686

The clip went viral. "If I get corona, I get corona. At the end of the day, I'm not gonna let it stop me from partying," Brady Sluder, a spring breaker in Miami, said last week.

Now, as the United States is at about 55,000 cases of the coronavirus, including more than 780 deaths, and is on track to become the new center of the pandemic, he has revised his message: "Don't be arrogant and think you're invincible like myself."...

 

And that article is dated March 25. As of today, the US is at just shy of 1.5 million cases, including just shy of 90,000 deaths.  Less than months from that article's publication, with SIP measures in place.  This isn't just a nasty flu.

[Pen]

9 minutes ago, Pam in CT said:

re spring breakers gotta spring break

 

And that article is dated March 25. As of today, the US is at just shy of 1.5 million cases, including just shy of 90,000 deaths.  Less than months from that article's publication, with SIP measures in place.  This isn't just a nasty flu.

 

And there were some other places that showed how the Florida spring break partying seeded CV19 to various parts of USA and even Canada. It was really a tragedy IMO that that was allowed to happen.  Though if it had not, even more people would be deniers and saying “see, it wasn’t a big deal, we could have partied.” 

[Pen]

2 hours ago, Ktgrok said:

I'd imagine the club thing is both the number of people, but also that you usually have to shout into someone's face in order to be heard. So..yeah....spewing infection right into someone's face isn't going to be safe...and you can't social distance and hear someone speak unless they turn down the music. And a club where you stand 6 feet apart and listen to music quietly..is not a club, lol. 

 

? ?? 

Snazzy designer masks and face shields and ear buds with mikes to talk to each other without spewing into each other’s faces?

 

I expect the Club scene people have “disposable” money for such things.  

[EmseB]

20 minutes ago, Pen said:

 

And there were some other places that showed how the Florida spring break partying seeded CV19 to various parts of USA and even Canada. It was really a tragedy IMO that that was allowed to happen.  Though if it had not, even more people would be deniers and saying “see, it wasn’t a big deal, we could have partied.” 

But also, those were crowded parties with people crammed up next to each other on purpose and people jammed into hotels and sharing goodness onow what. I don't know if that's really comparable to people laying out on the beach in small family groups or walking or swimming or surfing.

I saw some pics of VA Beach oceanfront from last weekend. I used to live there and the photos were clearly, clearly taken with a long lens to make it look like people were on top of each other. I don’t think it's a good idea to overstate the risk and close off outdoor spaces because of spring break parties from 2 months ago where a bunch of people were deliberately all up on each other shouting and swapping sweat in a tent with a dj. Even if beaches are open, no one is scheduling big parties in small spaces.

[J-rap]

4 hours ago, TracyP said:

In my state this is definitely still the plan. And I think it is a good plan, but whether or not it has been successful elsewhere depends how you define success. South Korea is shutting back down after being open for like 2 weeks, I think. I don't think "open up" and "flatten the curve" can ever go hand in hand. You can open up and hopefully with contact tracing you can keep things under control, as in not overwhelm the system. (This seems to be the current plan as far as I can tell.) But if your goal is truly a drop in cases or a literal flattening of cases, then I don't think you can open up. I do think some people think that there will be a downward trend even with the country opening up, and I hope they're right! But while I think testing is crucial to spotting outbreaks, I don't think it is enough to literally flatten the curve. South Korea is facing this now.

I think you're right...  And I think the curve most places are looking for is "semi" flat, and not spiraling completely out of control toward a sharp peak.

[TracyP]

13 minutes ago, kand said:

I hope South Korea continues to be successful. This article from today indicates they believe they have the outbreak under control and the testing and tracing is working and they’re not closing back down: https://www.upi.com/Top_News/World-News/2020/05/18/COVID-19-nightclub-outbreak-under-control-in-South-Korea-with-testing-tracing/8741589787871/

First two paragraphs:

”A COVID-19outbreak that began in crowded Seoul nightclubs and bars appears to be coming under control, health authorities said Monday, as newly confirmed cases fell to single digits after a vigorous cycle of testing and tracing of those who may have been exposed.

The Korea Centers for Disease Control and Prevention announced 15 new COVID-19 patients Monday morning, with just two of the cases connected to the nightclub outbreak. Ten were imported from overseas arrivals.”

Then there are other countries such as Hong Kong, Japan, Taiwan that have had good success with test and trace as well. 
 

It’s doable, and while not foolproof, it’s the best thing we have right now to be able to manage this while also opening the economy back up. Which makes it all the more frustrating there are people adamant that they will not participate. We can’t have it both ways. It almost seems like some people are hell bent on everyone getting the disease and aren’t interested in drastically reducing deaths 🤷‍♀️ . 

Thanks for the info on South Korea. That is great to hear! Interesting that they tested anonymously because people there were not wanting to participate. (Worry inside the LGBTQ community in this case.) Maybe that is something that would get more people on board here?

I don't think those other countries have opened yet, have they? 

I am 100% behind the test and trace plan. I'm just not convinced it is enough to keep the cases on a downward trend. I would love to be wrong, though! 

[Pen]

 

12 minutes ago, TracyP said:

I am 100% behind the test and trace plan. I'm just not convinced it is enough to keep the cases on a downward trend. I would love to be wrong, though! 

 

I don’t think for most places it would keep cases on downward trend. 

But especially in summer without flu cases, it might be able to keep cases low enough not to overwhelm medical systems. Especially if emergency facilities that were put up, like Javitz center are left in place. 

 

[Pen]

44 minutes ago, EmseB said:

But also, those were crowded parties with people crammed up next to each other on purpose and people jammed into hotels and sharing goodness onow what. I don't know if that's really comparable to people laying out on the beach in small family groups or walking or swimming or surfing.

I saw some pics of VA Beach oceanfront from last weekend. I used to live there and the photos were clearly, clearly taken with a long lens to make it look like people were on top of each other. I don’t think it's a good idea to overstate the risk and close off outdoor spaces because of spring break parties from 2 months ago where a bunch of people were deliberately all up on each other shouting and swapping sweat in a tent with a dj. Even if beaches are open, no one is scheduling big parties in small spaces.

 

I think outdoor spaces should be open.  

But I think in many places some systems for not having crowds are needed. 

Possibly something that would give people different days of week to go.  Don’t know how that could be done.  

But some of the places where outdoors is most needed, like NYC, also have dense populations that tend to make for very crowded beaches.

Even the Los Angeles area with less dense packed population and often much broader / deeper expanses of sandy beaches, it gets very crowded on beaches even in regular years.

Where I am, a lake public swim area tends to get very crowded, but I think that could be largely controlled by limiting parking, since the number of people who could walk or bike to it would be limited and there isn’t good public transportation there.   A problem could be that if people drive from city to it thinking to get a day pass, and then can’t park they would probably be upset, or start parking along roads which would be a hazard.   However, seasonal parking passes are sold and if they were issued by day of week limits, instead of open for anytime, that could help. 

 

Edited May 18, 2020 by Pen

[Joker]

The vibe I’m getting from my state is that it really isn’t so much about number of cases but rather use of hospitals.
 

We’re just now finally testing more so our numbers are definitely going to keep rising but those getting tested now aren’t all super ill. We started opening back up before we had wide spread testing.  We’re having around 400-600 new cases daily right now and 20-50 deaths reported daily. The dates for those numbers seem to be fluctuating quite a bit though. Our hospitals have about 40% of ICU beds available and 80% of our ventilators are available. It actually shows the majority of our ICU beds are occupied with non Covid cases at the moment. So, they don’t seem as concerned about the positive case numbers but seem to be looking more at what’s happening at hospitals. I could be completely wrong though.

[KungFuPanda]

2 hours ago, Pen said:

 

? ?? 

Snazzy designer masks and face shields and ear buds with mikes to talk to each other without spewing into each other’s faces?

 

I expect the Club scene people have “disposable” money for such things.  

 

[ktgrok]

2 hours ago, Pen said:

 

? ?? 

Snazzy designer masks and face shields and ear buds with mikes to talk to each other without spewing into each other’s faces?

 

I expect the Club scene people have “disposable” money for such things.  

Maybe just text each other?

[ktgrok]

59 minutes ago, Joker said:

The vibe I’m getting from my state is that it really isn’t so much about number of cases but rather use of hospitals.
 

We’re just now finally testing more so our numbers are definitely going to keep rising but those getting tested now aren’t all super ill. We started opening back up before we had wide spread testing.  We’re having around 400-600 new cases daily right now and 20-50 deaths reported daily. The dates for those numbers seem to be fluctuating quite a bit though. Our hospitals have about 40% of ICU beds available and 80% of our ventilators are available. It actually shows the majority of our ICU beds are occupied with non Covid cases at the moment. So, they don’t seem as concerned about the positive case numbers but seem to be looking more at what’s happening at hospitals. I could be completely wrong though.

That makes sense. I mean, it's not my personal metric of how things should go...as personally I don't want myself or my family or friends to NEED a ventilator....so for my own metric the goal is as few people needing them as possible, not just having enough to go around, but I can see how others would use this metric. 

[TCB]

On 5/15/2020 at 10:53 AM, 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.

 

It just seems like too soon to tell though to me. Our state opened on May 4th, and our area seems like it is business as usual, as pre-covid. I think we need at least a few more weeks before we'll really know how it's going to be. We did not have a lot of spread before things closed down, so I think we can't even assess what the consequences of our behavior locally will be until enough time has passed for the virus to have the opportunity to even get to our area again. If we could put up a force field around our area lol, and be careful, we could definitely eradicate it here, but of course there is no way to make that happen. Also, even with the controlled, limited spread here, our ICU was fairly busy for a while, and that was with virtually no normal patients in it.

[TracyP]

1 hour ago, kand said:

Anonymous testing here might help, though I don’t understand how anonymous tracing can be a thing. Even with policies in place that would require tracing records to be destroyed by businesses after three weeks, people were still ready to riot. I wish there was a way to do it wouldn’t cause people to worry about what was happening with their information (and I’m one of those with all kinds of tracking blockers and privacy software on my devices). The trade off for not sharing it in this case is likely to end up high.

I just saw this opinion piece about why track and trace is unlikely to work here, and it’s right in line with this discussion. it’s sad, because it’s not unlikely to work because it couldn’t work, but because there’s just not going to be the cooperation required for it to do so: We won’t end COVID-19 with test and trace

And another from last week: Widespread testing might not work in America. We love our ‘freedom’ too much.

So, I think it really could work. Unfortunately, I think it won’t because many people won’t cooperate. Maybe we can hope enough cooperate enough to at least keep the numbers down— I think polls indicate the vast majority of Americans would do so, but I expect those unwilling to participate are likely to also be those more likely to be engaging in risky behaviors that are more likely to spread it. It sure would be nice to become one of those countries where people can venture out with a little more confidence, because they know outbreaks are being actively searched for and contained when they are found.

And I think that is the goal - don't let hospitals get overrun. Test/trace will hopefully be enough to stop any huge outbreaks. Even without complete compliance, if a county/city is seeing a sharp rise in cases behavior will change. Decent testing and even half assed contact tracing should be enough to identify these areas before they get out of hand. 

But I think the article you linked is a perfect example of the confusion out there. The headline says that we won't end Covid with test/trace. Right. Not here. Not in South Korea. I have never thought the goal of test/trace was to end covid, but I think a segment of the population has gotten that idea. 

[Bootsie]

22 minutes ago, Ktgrok said:

That makes sense. I mean, it's not my personal metric of how things should go...as personally I don't want myself or my family or friends to NEED a ventilator....so for my own metric the goal is as few people needing them as possible, not just having enough to go around, but I can see how others would use this metric. 

I think there is a difference in describing what is a reasonable goal for public health and what someone wants or wishes to see happen.  I don't think anyone wants to see people get COVID-19.  When people say that the goal is to flatten the curve to prevent hospitals from being overwhelmed--it isn't that they wouldn't prefer that no one gets COVID-19, it is just that given the situation, flattening the curve is preferred to not flattening the curve.  

From the beginning, I think there has been a lack of policy regarding how things are opened up, and what that means.  I think that is what some of the resistance to "shelter-in-place" orders has been.  It is not like the virus is a hurricane that we shelter-in-place until its peaked and then its over.  The virus is still there and just as contagious and deadly as it was before the shelter-in-place.  The whole idea about flattening the curve was to slow down how quickly it spread through the population--so that only some of us needed medical care at any particular point in time.  The only lives it was intended to save was those that could have been saved by medical treatment, but were not because hospital facilities and staff were not available.  

One of the reasons for rapid spread was that people can become infected and spread the virus before they become ill themselves.  If I infect one person a day between the time that I was infected and the time that I become ill and know to isolate myself and it takes five days before I become ill after being infectious, I have infected five people.  We don't know how long someone can possibly be contagious without realizing they are infected, but most studies I have seen point to an average of about five days, up to 14 days, with some rare cases of up to one month.  If that is true, most of the benefit from a lockdown seems like it would come from the first 5-14 days of the lockdown.  During that time period, people who are infected have time to realize that they are ill and then isolate themselves and take additional precautions.  Many of the chains of infection should have been broken by that point.  I wonder if extreme, but short, lockdowns--no restaurant delivery, no curbside pickup, no going to multiple grocery stores and big box retailers--would be more effective, even if they had to be repeated, than prolonged closures with many loopholes.  

 

[EmseB]

21 minutes ago, Bootsie said:

I think there is a difference in describing what is a reasonable goal for public health and what someone wants or wishes to see happen.  I don't think anyone wants to see people get COVID-19.  When people say that the goal is to flatten the curve to prevent hospitals from being overwhelmed--it isn't that they wouldn't prefer that no one gets COVID-19, it is just that given the situation, flattening the curve is preferred to not flattening the curve.  

****  

One of the reasons for rapid spread was that people can become infected and spread the virus before they become ill themselves.  If I infect one person a day between the time that I was infected and the time that I become ill and know to isolate myself and it takes five days before I become ill after being infectious, I have infected five people.  We don't know how long someone can possibly be contagious without realizing they are infected, but most studies I have seen point to an average of about five days, up to 14 days, with some rare cases of up to one month.  If that is true, most of the benefit from a lockdown seems like it would come from the first 5-14 days of the lockdown.  During that time period, people who are infected have time to realize that they are ill and then isolate themselves and take additional precautions.  Many of the chains of infection should have been broken by that point.  I wonder if extreme, but short, lockdowns--no restaurant delivery, no curbside pickup, no going to multiple grocery stores and big box retailers--would be more effective, even if they had to be repeated, than prolonged closures with many loopholes.  

 

For the first paragraph I feel like this is what I have been trying to say in a lot of my posts. Individual goals and choices are not ever going to be able to be the same as public health goals and mandates, but individual goals and choices will somewhat align with perceived risk a lot of the time.

 

To the second part I quoted, if you read the news articles about what the US Navy did to get everyone on the Nimitz healthy, this was pretty much it. Even then, with asymptomatic cases and simple human mistakes it was EXTREMELY difficult to do and the jury is still out on whether or not it was accomplished. For an entire US city or region? I don't think it's doable. I mean the military was able to take some drastic measures because they can force people into isolation because people in the military don't have the same rights as you and I.

[Pen]

https://medicalxpress.com/news/2020-05-covid-staggering-death-infected-symptoms.html

 

The national rate of death among people infected with the novel coronavirus—SARS-CoV-2—that causes COVID-19 and who show symptoms is 1.3%, the study found. The comparable rate of death for the seasonal flu is 0.1%.

"COVID-19 infection is deadlier than flu—we can put that debate to rest," said study author Anirban Basu, professor of health economics and Stergachis Family Endowed Director o

[ktgrok]

43 minutes ago, Bootsie said:

The whole idea about flattening the curve was to slow down how quickly it spread through the population--so that only some of us needed medical care at any particular point in time.  The only lives it was intended to save was those that could have been saved by medical treatment, but were not because hospital facilities and staff were not available.  

 

 

So that would mean that the goal is not/was not to save those who are vulnerable and will die even with medical care. 

[Wheres Toto]

New Jersey is doing a slow, gradual opening.  It seems like one thing at a time.  Opened state and county parks, wait to see how that goes.   Open non essential businesses for curbside, wait and see how that goes.  Open the beaches, wait and see how that goes (although I think the beaches are going to be rough with people from out of state coming).   I think they are doing a pretty good job of trying to control things as we open. 

I was in a grocery store for the first time since mid-March today.    It was the closest grocery store to me that wasn't a gourmet store (we have a Kings closer, this was an Acme).   Every single person in the store was wearing a mask.  Every one of them.    They had the aisles marked for one way access and asked people to stay "2 cart lengths apart", which wasn't always happening.  There were few enough people in the store that I was occasionally the only person in an aisle and often one of only two people. (probably about 30-40 people total in the store).    I honestly didn't even notice the one way thing until I was about 1/3 of the way through the store.   After I noticed it, I did try to follow it but then noticed that a lot of people weren't.    Cashiers had a plexiglas shield, they had clingwrap over the card reader which they seemed to be changing frequently, they wouldn't use reusable bags so I bagged myself since I had washable bags, they had marks on the floor for standing apart.  

So, lots of steps taken and people primarily being careful.  I think that's how we open and keep things under control.

[ktgrok]

12 minutes ago, Where's Toto? said:

New Jersey is doing a slow, gradual opening.  It seems like one thing at a time.  Opened state and county parks, wait to see how that goes.   Open non essential businesses for curbside, wait and see how that goes.  Open the beaches, wait and see how that goes (although I think the beaches are going to be rough with people from out of state coming).   I think they are doing a pretty good job of trying to control things as we open. 

I was in a grocery store for the first time since mid-March today.    It was the closest grocery store to me that wasn't a gourmet store (we have a Kings closer, this was an Acme).   Every single person in the store was wearing a mask.  Every one of them.    They had the aisles marked for one way access and asked people to stay "2 cart lengths apart", which wasn't always happening.  There were few enough people in the store that I was occasionally the only person in an aisle and often one of only two people. (probably about 30-40 people total in the store).    I honestly didn't even notice the one way thing until I was about 1/3 of the way through the store.   After I noticed it, I did try to follow it but then noticed that a lot of people weren't.    Cashiers had a plexiglas shield, they had clingwrap over the card reader which they seemed to be changing frequently, they wouldn't use reusable bags so I bagged myself since I had washable bags, they had marks on the floor for standing apart.  

So, lots of steps taken and people primarily being careful.  I think that's how we open and keep things under control.

That does seem good!

[Pen]

4 minutes ago, Ktgrok said:

So that would mean that the goal is not/was not to save those who are vulnerable and will die even with medical care. 

 

I think that is also a goal.

And I think retirement and nursing homes are better prepared now than they were in March.  So, potentially, fewer of the most vulnerable will die.  But I also think we have seen that short of a NZ bubble system or a Singapore police state like system, it is really hard to keep CV19 out of places like that and keep it from spreading. 

There has also been time now for people to get their vitamin D, zinc, magnesium, etc levels up in many cases—which may perhaps help.   I hope. 

 

Having lived in both NJ and NYC in small non air conditioned apartments, I don’t think an ongoing sip through a hot muggy summer would necessarily work.  I think there might end up being heat stroke in place of CV19. 

[TracyP]

37 minutes ago, kand said:

I can’t tell if we’re saying the same thing, or not. I think the goal of test/trace is that ideally outbreaks will be very small and it will keep case numbers low until we have vaccine and/or treatment. I sense that some people think keeping things at current levels would be a good outcome, but I disagree with that. In my opinion, the goal should be much lower, and I believe most epidemiologists putting plans forth are aiming for much lower case numbers as well. 

Haha, I'm not sure either. 🙂 I think maybe that is because you are saying what *you* think would be a good outcome. I am saying what I think is happening. Most of what I have been saying leaves my opinion out of it. I do not think government leaders are aiming for much lower cases. Some are being blunt about this, some are beating around the bush. If actions speak louder than words, I would say that the government has decided that reopening is worth the cost. I'm not addressing whether or not I agree, but only pointing out what I see. I think maybe we agree overall but are looking at it through different lenses.

[Bootsie]

31 minutes ago, Ktgrok said:

So that would mean that the goal is not/was not to save those who are vulnerable and will die even with medical care. 

As I have understood flattening the curve, is really about spreading those who are going to get sick out over a longer period of time.  Measures, such as extra precautions taken in nursing homes are intended to help protect the vulnerable; but that is really different than flattening the curve.  Flattening the curve means not as large of spike, but a much wider curve, so instead of having 10,000 cases in a month,, spread those cases out so that there are 1,000 over ten months.  Then, the medical community can better take care of 1000 people at a time than 10,000 people at once.  

The rate of spread really depends upon how long someone who is infected is contagious, how many people the person comes into contact with, and how likely it is that those people get the disease.  Some measures such as masking, distancing, hand washing may impact the third component, and if people build immunity and are unlikely to get re-infected, the it impacts the third component.   We can't do much to address the first component (rapid and often testing might help).  Lockdowns help with the second component, but only during the periods of the lockdown; it doesn't permanently change the disease. 

[Momto6inIN]

3 hours ago, Joker said:

The vibe I’m getting from my state is that it really isn’t so much about number of cases but rather use of hospitals.
 

We’re just now finally testing more so our numbers are definitely going to keep rising but those getting tested now aren’t all super ill. We started opening back up before we had wide spread testing.  We’re having around 400-600 new cases daily right now and 20-50 deaths reported daily. The dates for those numbers seem to be fluctuating quite a bit though. Our hospitals have about 40% of ICU beds available and 80% of our ventilators are available. It actually shows the majority of our ICU beds are occupied with non Covid cases at the moment. So, they don’t seem as concerned about the positive case numbers but seem to be looking more at what’s happening at hospitals. I could be completely wrong though.

I think you're in the same state as me, if I remember correctly, and yes, this is my take on it as well.

[Bootsie]

1 hour ago, EmseB said:

To the second part I quoted, if you read the news articles about what the US Navy did to get everyone on the Nimitz healthy, this was pretty much it. Even then, with asymptomatic cases and simple human mistakes it was EXTREMELY difficult to do and the jury is still out on whether or not it was accomplished. For an entire US city or region? I don't think it's doable. I mean the military was able to take some drastic measures because they can force people into isolation because people in the military don't have the same rights as you and I.

I haven't seen too many details about the Nimitz.  Do you know if they tested at the beginning and if there were any cases that developed during the quarantine period?

 

[EmseB]

27 minutes ago, Bootsie said:

I haven't seen too many details about the Nimitz.  Do you know if they tested at the beginning and if there were any cases that developed during the quarantine period?

 

They did not test at the beginning. This article outlines some of what they did. It doesnt really answer the second part of your question though.

[Bootsie]

From mid-March:

In flattening the curve, the goal is not so much to reduce the total number of people getting sick but to slow the rate at which they do.

The ability for the health care system to care for patients "is much better if they come in small doses," said Gurley, an expert in infectious diseases.

“Our best guess is that most people are going to get this virus at some point. There’s not much we can do about that without effective vaccines," Gurley said. "But our ability to appropriately treat patients and for society to accommodate and care for these patients and cope is much better if infections don’t occur all at the same time.

"The public health goal is to keep the number of new cases happening at any given time as low as possible, as long as possible,” she said.  https://eu.usatoday.com/story/news/health/2020/03/11/coronavirus-flattening-curve-quarantine-stop-spread/5021564002/

If you go back to articles in mid-March that were promoting the concept of flattening-the-curve, many specifically mentioned that it was not a way of reducing total number of infections, but of simply spreading them out for better health care response for those inevitably infected.  It is much more of a public health approach and of the risk of COVID-19 overwhelming our medical infrastructure; it is not really about the risk of any particular individual being infected

[ktgrok]

26 minutes ago, Bootsie said:

From mid-March:

In flattening the curve, the goal is not so much to reduce the total number of people getting sick but to slow the rate at which they do.

The ability for the health care system to care for patients "is much better if they come in small doses," said Gurley, an expert in infectious diseases.

“Our best guess is that most people are going to get this virus at some point. There’s not much we can do about that without effective vaccines," Gurley said. "But our ability to appropriately treat patients and for society to accommodate and care for these patients and cope is much better if infections don’t occur all at the same time.

"The public health goal is to keep the number of new cases happening at any given time as low as possible, as long as possible,” she said.  https://eu.usatoday.com/story/news/health/2020/03/11/coronavirus-flattening-curve-quarantine-stop-spread/5021564002/

If you go back to articles in mid-March that were promoting the concept of flattening-the-curve, many specifically mentioned that it was not a way of reducing total number of infections, but of simply spreading them out for better health care response for those inevitably infected.  It is much more of a public health approach and of the risk of COVID-19 overwhelming our medical infrastructure; it is not really about the risk of any particular individual being infected

The bolded is what I initially was thinking. But I don't hear that now. No one seems to be saying "as low as possible". Rather, "up to the point we get overwhelmed" which to me is not the same as "low as possible". Hence a lot of my confusion. 

[Bootsie]

3 minutes ago, Ktgrok said:

The bolded is what I initially was thinking. But I don't hear that now. No one seems to be saying "as low as possible". Rather, "up to the point we get overwhelmed" which to me is not the same as "low as possible". Hence a lot of my confusion. 

I think that the "at any given time as low as possible" is an important part of understanding the public health initiative, especially since it follows as statement about how most people are going to get the virus at some point.  

[ktgrok]

26 minutes ago, StellaM said:

Up to the point of overwhelm is a heck of a lot of people being hospitalized. 

I have to say, I don't understand the claim of confusion. It isn't difficult to understand that, given a novel virus, information will change, sometimes daily, and that you have to be flexible in your understanding as well.

I also don't understand the fretting about goals changing. I mean, initially, here, the goal was 'stop hospitals getting overwhelmed'. That's now changed to 'suppress the virus as much as possible', not 'let's use up all that lovely capacity for really sick people because we have it!', and I'm not sure why that should be a problem?

No, I'm saying that at the very same time, some mean keep it as low as possible, and some mean stop hospitals from being overwhelmed, but both call it flatten the curve. 

[Joker]

I will say I wish we had figured out a way to flatten the curve but still tackle important elective surgeries better. They completely stopped here until this month. My mom desperately needs surgery and is now in severe pain. At the beginning of this it was tolerable, but it’s awful now. And because of the complete halt there is a crazy backlog of people needing their surgeries so who knows how long it will take. They just keep upping the pain meds which is going to create a whole different problem for some people. I know we didn’t really have time to figure it all out but I do think some of those things are reasons for wanting to get things going again. It’s not just people wanting to eat out and get hair done.

[DoraBora]

3 hours ago, StellaM said:

Up to the point of overwhelm is a heck of a lot of people being hospitalized. 

I have to say, I don't understand the claim of confusion. It isn't difficult to understand that, given a novel virus, information will change, sometimes daily, and that you have to be flexible in your understanding as well.

I also don't understand the fretting about goals changing. I mean, initially, here, the goal was 'stop hospitals getting overwhelmed'. That's now changed to 'suppress the virus as much as possible', not 'let's use up all that lovely capacity for really sick people because we have it!', and I'm not sure why that should be a problem?

No one is advocating using up our hospital capacity.  Even people who rank money before lives wouldn't think that way because treating patients is expensive -- in the US, the federal government has promised to cover any Covid treatment costs not paid by insurance.  Most people have a least a modicum of compassion and don't really want anyone to be sick.  Most people hope the virus will go away.

But if it's here to stay, at least for a long while, some of us think we must adapt -- we must be flexible in our understanding -- and realize that if we wait until Covid-19 is no longer spreading to get back to work, our economy will never recover.  We've averted the crisis of overwhelming our hospitals and healthcare workers, and it's time to begin opening up.

Of course you understand what's behind the fretting.  It's simple.  People need to earn a living.  Governors and mayors ordering "non-essential" businesses "indefinitely" closed is fret-worthy imo.

[Bootsie]

The healthdata.org model was built to address hospital needs:

"We were initially asked by colleagues at the University of Washington School of Medicine to develop models to help in planning their response to COVID-19. As other hospital systems and governments around the world reached out for help in determining the impacts of COVID-19 on their health systems, we developed forecasts for all 50 US states, and are continuing to add other regions of the world facing similar questions about COVID-19. "

It was not a plan for minimizing number of people infected.  There are two important things to keep in mind: (1) there is a difference in minimizing number of people infected and minimizing number of deaths and (2) there is a difference in minimizing number of infection or deaths in a short period of time (this week or month) and minimizing that number over a longer period (say several years).  

 

[ktgrok]

Well, this doesn't help people have confidence in the decisions being made. https://www.usatoday.com/story/news/nation/2020/05/19/florida-covid-19-coronavirus-data-researcher-out-state-reopens/5218897002/

After USA TODAY Network first reported Jones' removal from her position in charge of the Florida COVID-19 Data and Surveillance Dashboard she created, she confirmed, as reported by CBS-12 in West Palm Beach that she was fired because she was ordered to censor some data, but refused to "manually change data to drum up support for the plan to reopen."

[hopeallgoeswell]

On 5/19/2020 at 10:54 AM, Ktgrok said:

Well, this doesn't help people have confidence in the decisions being made. https://www.usatoday.com/story/news/nation/2020/05/19/florida-covid-19-coronavirus-data-researcher-out-state-reopens/5218897002/

After USA TODAY Network first reported Jones' removal from her position in charge of the Florida COVID-19 Data and Surveillance Dashboard she created, she confirmed, as reported by CBS-12 in West Palm Beach that she was fired because she was ordered to censor some data, but refused to "manually change data to drum up support for the plan to reopen."

I know what the headline said, but in the article it doesn't say she has any concrete evidence that she was fired for refusing to "manually change data to drum up support for the plan to reopen."  It even says, "She provided no further details."  There have been other scientists and doctors who have been sidelined/disregarded/lost income during this whole thing because they produced data which didn't fall in line with the science and numbers being pushed out by mainstream media.  Science requires disagreements and free debate between peers.  When people are shut down because they have differing data and interpretations, no one wins.  When the media's output is, at best, bad journalism, no one wins.