Corona Virus: It's a Marathon, Not a Sprint

[LordMortis]

designing new furniture

That's something new to me.

[hitbyambulance]

I feel very tired but I continue living without mass events, travelling abroad, concerts, shows and cafes. Maybe I'm overreacting but... I prefer safety against entertainment. I entertain myself by gaming, reading books, designing new furniture I'm going to order, doing sports, walking alone or in small company in natural areas. But, ofc, I'm tired, very-very tired of this.

i've given up going to a number of concerts due to the risk factor. it sucks.

[Max Peck]

Even Fauci is officially done with the pandemic.

The US is out of the Covid-19 pandemic phase, Fauci says

The United States is out of the Covid-19 pandemic phase, said Dr. Anthony Fauci, President Joe Biden's chief medical adviser and the director of the National Institute of Allergy and Infectious Diseases.

"We are certainly, right now, in this country, out of the pandemic phase," Fauci said on PBS NewsHour Tuesday.

"Namely, we don't have 900,000 new infections a day and tens and tens and tens of thousands of hospitalizations and thousands of deaths. We are at a low level right now. So, if you're saying are we out of the pandemic phase in this country? We are," he said.

Covid-19 cases in the US have tumbled dramatically over the past couple of months as the Omicron wave receded.

But daily cases are still two times higher than they were for most of last summer.

New cases are ticking back up in most states, and hospitalizations have started to rise over the past week too.

Fewer people are dying of Covid-19 now than during most of the pandemic, but with more than 400 deaths a day, the past two months of Covid-19 have been more deadly than most recent flu seasons.

Fauci said that while coronavirus won't be eradicated, the level of virus in society could be kept very low if people are intermittently vaccinated, possibly every year.

Currently, local health officials on the ground across the US are still working to get more people fully vaccinated and boosted against Covid-19.
The Covid-19 situation in the United States also doesn't necessarily reflect what's happening in the rest of the world, Fauci noted.

"Pandemic means a widespread, throughout the world infection that spreads rapidly among people," Fauci said. "So, if you look at the global situation, there is no doubt this pandemic is still ongoing."

[Smoove_B]

I don't even know how to respond to that. We are averaging 50,000 new cases a day but because hospitals aren't being over run we're out of the pandemic phase? We're in a different spot, but to just arbitrarily decide that death is the only measure of the pandemic is...not what I expected from Dr. Fauci.

[malchior]

It's a little surprising but honestly it's politics all the way down. The administration wants to push a message that everything is moving to normal because everything is not. Even during Trump he went along to keep along more than he didn't. This is him accepting the trade off here that risk levels aren't what they used to be (even if we still don't understand the real risk) as a good soldier.

Edit: Where I take a dim view is that he individually dropped out of the WH Correspondent's Dinner over COVID concerns. So the message is there is a pandemic, we're not in a pandemic here, but he is personally going to avoid an event because of the individual risk of the non-pandemic. This is pretty much an expression of the constant CDC/public health problem where the message is muddled beyond belief.

[Smoove_B]

I think you're right. My new take is that at some point there was a real discussion about the two (broad stroke) paths we could take on this. The first maintained masks, encouraged remote work, encouraged remote school - pushed for flexibility in response as the virus continues to move through populations. The second path is the one we're on now. The reason all comes back to the economy. Could we have pursued the first option? Sure. But it really feels like people ran the numbers and said it wasn't worth the short and/or long term hit to the economy overall. I mean - think of how all the businesses that would be impacted if masks were required. Plus, it's just too complicated to try and explain why you don't need to wear a mask in church or a restaurant but you do need to wear one on a plane. Sure, people are going to die on our current path and untold millions are going to get sick, but the economy will continue chugging along - and that is what is most important. Simplistic and yes, cynical, but I can't see it any other way given how things are going. We're ignoring kids under 5. We're ignoring chronically ill people. We're ignoring Long COVID. This is the antithesis of public health. Why would that be communicated through the people and institutions that should be promoting public health? I keep saying it, but I cannot comprehend what's happening.

[Max Peck]

Locally, it appears that the wastewater viral signal has probably plateaued for now, although there appears to be a lot of noise in the data recently. I continue to suspect that is due to spring runoffs, but the researchers have yet to flag any data as omitted when calculating the moving average.



Even so, the level is still far higher than in any prior phase of the pandemic.



Given the progression from Delta to Omicron OG to Omicron BA.2, I wonder what the graph will look like when/if a variant comes along to supplant BA.2.

[malchior]

Why would that be communicated through the people and institutions that should be promoting public health? I keep saying it, but I cannot comprehend what's happening.

It seems like you are comprehending what is happening. What I think you are struggling with is that we're as amoral as we are. We could do a lot more with little effort. Instead I argue we have essentially proved what some of our fiercest critics have said about America forever. We only care about money.

[Zaxxon]

Why would that be communicated through the people and institutions that should be promoting public health? I keep saying it, but I cannot comprehend what's happening.

It seems like you are comprehending what is happening. What I think you are struggling with is that we're as amoral as we are. We could do a lot more with little effort. Instead I argue we have essentially proved what some of our fiercest critics have said about America forever. We only care about money.

That's it on some level, but it's deeper than that. The random Joe Blows of the nation didn't cease masking en masse because it cost them money. They did it for freedom and stuff.

[malchior]

Why would that be communicated through the people and institutions that should be promoting public health? I keep saying it, but I cannot comprehend what's happening.

It seems like you are comprehending what is happening. What I think you are struggling with is that we're as amoral as we are. We could do a lot more with little effort. Instead I argue we have essentially proved what some of our fiercest critics have said about America forever. We only care about money.

That's it on some level, but it's deeper than that. The random Joe Blows of the nation didn't cease masking en masse because it cost them money. They did it for freedom and stuff.

I'd argue that was the effect. Lots of pols and business people pushed anti-masking. Trump specifically made behind the scenes statements that he thought shutting down the economy would cost him the election. He set the tone for anti-masking based on this stance IMO. Also people reacted very negatively to lockdowns and masking (or any control) was associated with economic effects. It isn't just top down I think economics is at the heart of it for a lot of folks.

[gbasden]

Instead I argue we have essentially proved what some of our fiercest critics have said about America forever. We only care about money.

I'd argue it's just another sign of our essential disfunction. Since half of the country decided that COVID was a liberal hoax, anything to fight it was an infringement on their liberty. Sure, the politicians and media personalities and the wealthy that fund them pushed this narrative because of money, but at the little person level it's just more tribal warfare.

[Zarathud]

How do you play football when more than half of your players are going to spike or fumble the ball for Team Virus anyway? They’ve made COVID-19 widespread and stabilized the infected numbers. I’m pretty sure pandemic requires a disease that is spreading but not widespread. We have to fight battles we can either win, or make progress.

[Smoove_B]

So Dr. Fauci is officially skipping the WHCA dinner (he should) and President Biden will attend but not be eating (because that would require taking off a mask - also smart).

This is apparently "terrific" and what the average American should be doing now? Attend indoor events mask free and just keep getting COVID-19 -or- wear a mask around your friends, family, peers, etc... and exclude yourselves from the high risk activities everyone else is engaging in?

They really expect people to do this for the next 2+ years???

Also, this:

https://twitter.com/medriva/status/1519787852606976004

New York state reports 9,342 new coronavirus cases, the biggest one-day increase since January

And again, we're going out of our way to suppress testing. I can only imagine what the actual numbers are.

[Zaxxon]

Nothing to see in Denmark. Just the end of their COVID vaccination program for the season.

[Smoove_B]

It's funny to me how this is isn't even news any more - as additional (potentially problematic) variants have been identified:

https://twitter.com/Tuliodna/status/1520123573192568832

Summary of what we know about Omicron BA.4 & BA.5:
- Suggesting a discrete reservoir, such as chronic human infections and/or animal reservoirs
- BA.4 and BA.5 have a growth advantage over BA.2
- Escape BA.1 infection & potential new wave

There's detailed information in that thread but of note:

Today, new results from our friend @sigallab show that previous infections with Omicron BA.1 will not be sufficient to prevent a second infection with BA.4 and BA.5. This confirm our epi and Evo results suggesting that South Africa may start a new wave of infections with BA.4 & 5

It's almost like...actively ignoring spread is causing more problems? Yeah, what do I know? I'm just some random dude.

In summary: Pain.

[Kraken]

I thought I was the only grocery shopper wearing a mask today, but I eventually did see two others.

[Unagi]

What does this mean:

- Suggesting a discrete reservoir, such as chronic human infections and/or animal reservoirs

[Smoove_B]

What does this mean:

- Suggesting a discrete reservoir, such as chronic human infections and/or animal reservoirs

I'm glad you asked!

In communicable disease parlance, reservoirs are the natural places where disease agents live, grow and/or multiply. So if we picked something like E. Coli bacteria, generally we'd say the reservoirs are the intestines of animals. For something like malaria, the reservoir is humans. For SARS-CoV-2...we don't know, but it truly might be humans at this point.

However, when they look at the genetic lineage of BA.3 and BA.4, they're apparently seeing "clues" that suggest where the virus might have come from - genetic fingerprints that point to a likely source of origin.

One of the working theories for some of these variants is that there are people spawning them. Namely, people that aren't able to "clear" (i.e. destroy) the virus and instead are shedding it. Think of it like a castle defense game where the virus mounts an attack, the body fights it off and kills 90% of the virus, but that 10% then reformulates and tries again. And then 90% of that wave (inside a single person) is destroyed but another 10% survives and repeats the process again. The person might be experiencing low level symptoms. Or they might be completely asymptomatic and not realize they're releasing variants back into the wild.

This scenario feels likely as we're still allowing uncontrolled spread. So the more people that get it, the more likely it is that eventually there will be a host (not the same as a reservoir) the virus gets into where it can then engage in this type of relationship. Some scientists have suggested the spectrum of vaccinations (1 shot, 2 shots, 3, shots, etc...) might also encourage this type of development.

The animal reservoirs are the same idea. We now know that the virus can be found in numerous animal species. The one that made big news was finding it in deer. If the virus has the ability to get into other animals and live, grow and multiply there's a chance then that the virus could work its way back into humans. We know this because it's already happening with other viruses - influenza is the perfect example.

This scenario also feels likely and what makes this more problematic is that when it jumps into an animal, it's likely picking up new potential genetic code that can change how the virus presents itself to the next host it tries to invade. Maybe the code is useless. Maybe the code is harmful to the virus. Or maybe the new code makes it more problematic for humans.

The reason they are mentioning this is to try and figure out then how we're going to try and address it (short and long term). Now that we know the virus can spread to other animal species, eradication seems unlikely. If we're finding that the variants are being driven by animal "spill back", that has different implications than if the problematic variants are coming from people that are chronically infected.

Either way, we really (and I mean really) need to stop uncontrolled spread - where we've been since March of 2020. The idea that we're actively encouraging it now is something I will never understand.

[Unagi]

I’m glad I asked too.

Thank you. You have been an incredible source of information the last couple years. I try and pass on what I’ve learned.

[Zaxxon]

Yes, but we're not gonna. So we should really stop falling back to saying we need to do that. Which sucks. But nonetheless it's true.

[Max Peck]

Yes, but we're not gonna. So we should really stop falling back to saying we need to do that. Which sucks. But nonetheless it's true.

If it's true, why shouldn't we say it?

[Zaxxon]

Yes, but we're not gonna. So we should really stop falling back to saying we need to do that. Which sucks. But nonetheless it's true.

If it's true, why shouldn't we say it?

Saying it is fine, but saying it as though it's the way forward is less fine. In the same way that I could say that all my users should follow proper data/password/cybersecurity hygiene and our org would then be at much lower risk. That's clearly the ideal way forward. It's also absolutely not something that I can professionally suggest as our plan. Here in the real world, I need to manage our network knowing that our staff are the weak link in the chain.

I'm hearing a lot from some public health pros that sounds the same as what I heard in mid-2020. Yet the field of play has changed, and it's not changing back. Here in 2022 if I managed my org's network the same way we did in 1999, I'd be fired.

Again, that reality sucks, but it is the reality.

[Blackhawk]

If there is no way to make it happen, then constantly restating that it's the solution, while true, stops people from looking for other solutions that we might actually manage to make happen.

"Congress really should fix the voting process prior to the midterms."
"People really should stop driving while texting."
"People really should exercise more and eat less junk."

We don't live in a perfect world, and once it is clear that the perfect solution won't happen, it makes more sense to focus our energies on lesser solutions that will at least help.

[Smoove_B]

I just can't process that.

If you've identified that users are your highest risk and you then say to management that you need to acquire [software solution] along with [employee training] to reduce risk that seems smart. Following those items, if you do all that and employees still engage in [behavior], management will 100% fire them.

Here, public health has identified a spectrum of responses to our employer (i.e. the American people, elected officials, school officials) to address the pandemic. Clearly and repeatedly the employer has said, "Nah, we don't want to do any of that".

Would you be able to secure and support IT infrastructure if your employer didn't back whatever plan you created? Any plan you created? We have a set of tools - tools that have worked for (checks calendar) 150+ years. The times have changed, but the tools for infection control are still rather similar - which is likely why you're hearing the same things that you were back in mid 2020. Its because we know what works - if we actually did it.

Instead our employer has decided it's not worth it. That doesn't mean we shouldn't still be saying what works.

I can't really come up with an clean analogy here. What would your job be like if suddenly no one cared about InfoSec or digital backups? Just arbitrarily decided it didn't matter any more and whatever cost you were paying as an organization wasn't worth all the extra "stuff" you're doing to prevent possible future outcomes that could negatively impact your business operation? I'd like to believe IT professionals would be out of the got-damn minds at the insanity associated with disregarding what has come to be a common and generally accepted practice for business. But it is still a sloppy analogy because it doesn't involve "freedom" and "personal responsibility", so I'm not really sure how to thread that in.

What's happened is that 150+ years of public health practice has come to a crossroads with American culture (yes, I'm ignoring global events right now for this discussion). It's been made pretty clear that politicians, elected officials, and large swaths of the American public weren't ambivalent to public health for the last 150 years, but perhaps they were also actively against it - and we just didn't know it because we hadn't been tested in this way and at this scale since 1918.

[Zaxxon]

I think you're under the mistaken assumption that your infosec what-ifs aren't already the reality. The point I'm trying to make is that the things that would work best (eg, secure your servers by airgapping them all and then turning them off, or perhaps removing email from all employees since it's well-established that people are phalling for phishing at nearly actually-can't-believe-it levels) aren't realistic.

What we know works best isn't workable. Even though it may have been the practice in the past. So we still put our employees through training, but our primary lines of defense are endpoint security, web filtering and DLP everywhere, managed XDR products, etc. Some employers will fire some particularly egregious folks for bad cybersec behavior, but by and large orgs expect a certain level of internal threats. They don't stick to what worked in the past as though we don't now live in a world with ubiquitous connectivity and access and a computing populace that just can't be bothered to give two shits about security.

To bring it back to infection prevention, masking and social distancing combined with targeted lockdowns work well to slow spread. As you said, that's proven over centuries of experience. But they've now been shown to be the air-gapped servers or Blackberries of 2022. Those are no longer options for much of the world. Your employer decided that we're not buying that product. Your job is now to make the largest impact you can to improve the situation while doing so using approaches that are workable in today's world.

Stop recommending Blackberry Enterprise Server. It works against your goals because for a large portion of the population, it now actively makes them tune you out.

Again, I don't like this at all. But it is what it is (and it definitely is ).

[Blackhawk]

I just can't process that.

I get that. Health professionals, from my own limited experience, are dedicated to bringing about the best possible solution with the best possible outcome.

But when that solution becomes impossible, what do you do? Change your goals to "do the greatest good with available options", or keep pushing the thing that won't work, bringing about a much more limited benefit?

And for analogies, I have to think that teachers would understand this better than anyone. They know what needs to be done to achieve the best results, and they're constantly prevented from doing it by politicians and bureaucrats who don't understand or prioritize education, and by communities pushing absurd social limitations. And so they're having to do the best they can to achieve the best results within the limitations placed on them by society. The alternative would be to let a generation of children get through with no education at all. That doesn't mean that they're not screaming and shouting for those groups to do better.

[Blackhawk]

Another partial analogy might be 'battlefield triage.' This isn't Scrubs, this is MASH.

[Smoove_B]

Perhaps its because of the temporal element here? There are things that work right now that we should be doing (but aren't). Bigger picture - long term - there are other things we now know we need to be doing. Improving ventilation technology. Improving therapeutics. Developing more robust vaccinations that could potentially help to address spread. None of those are going to address what's happening right now though - the spread that's still occurring. We know how to deal with that.

I don't know of any other immediate strategies that work. It's...disease transmission. 100 years ago we would have first clubbed people that didn't comply and then eventually locked them up until they complied. We have moved on from that, though maybe that was a mistake?

Infectious disease control and ventilation professionals are the rock-stars now - pushing for change in how we build structures. How we make spaces safer in homes, workplaces and schools. Well, they're trying. But people are saying protections aren't necessary:

Behind the scenes, one prominent coronavirus expert is scrapping with party organizers hesitant to install devices that disinfect the air using ultraviolet light because of concerns the devices might interfere with the program.

[Zaxxon]

There are things that work right now that we should be doing (but aren't).

You're doing it again.

[Smoove_B]

I can't help it. If someone is squirting blood from a cut on their neck, I'm not going to say that we should really explore alternative options here and just forget what we know conventionally works.

What we're saying is that we know what's right but should just accept it's not feasible, so good luck to you all as we effectively do nothing, arguably encouraging the arterial neck spray to get worse?

I can't. I can't do it.

[Zaxxon]

What we're saying is that we know what's right but should just accept it's not feasible, so good luck to you all as we effectively do nothing, arguably encouraging the arterial neck spray to get worse?

No. We're saying it's not feasible, so change the approach to maximize positive impact.

Our societal neck isn't bleeding; we have a bunch of open sores. It feels like we're on the ground bleeding out, I'm sure, and it's a tragedy that we've decided that we're now ok having constant sores when in the past it was largely frowned upon. But the game is that society has made this decision. Acting as though it hasn't reduces the possible impact you can have.

I've come around to see why the CDC made the 'community levels' changes it did. I'm sure the org as a whole wouldn't have preferred it that way. But they read the room and made a call to advise people in a way they might actually follow. They're working to have a widespread impact meeting people where they are.

It's absurd that this is reality, just as it's absurd that Trump was the Republican nominee in 2016. Reality's been absurd for awhile, and it's impacting your career field as it's impacting everywhere else.

[Blackhawk]

I can't help it. If someone is squirting blood from a cut on their neck, I'm not going to say that we should really explore alternative options here and just forget what we know conventionally works.

What we're saying is that we know what's right but should just accept it's not feasible, so good luck to you all as we effectively do nothing, arguably encouraging the arterial neck spray to get worse?

I can't. I can't do it.

I'll come back to my MASH analogy. A doctor knows the best way to save an injured person. But when there's no operating room, you use a tent. And when that tent's being shelled and dust is falling on your patient, you cover him up and keep going when it stops. And when there isn't adequate lighting, you have Radar hold a flashlight, or you open the wall and pull a jeep up for the headlights.

What you don't do is get stuck on the idea that you need a proper OR with proper sanitation and lighting while the patient is bleeding.

We (collectively) as a society aren't going to do the Ideal Thing here. It isn't going to happen, and pushing the idea of that Ideal Thing isn't going to convince anyone. In fact (and this goes back to the CDC's changes), it may even be detrimental, as people have learned to actively rebel against the concept of the Ideal Thing. That's the reality. So, if we can't do the Ideal Thing, what's the thing that we do instead?

What do you do? Do you lose the patient for lack of an OR, or do you send Radar for a flashlight?

[Smoove_B]

That's the reality. So, if we can't do the Ideal Thing, what's the thing that we do instead?

What we're doing now - it's called eugenics.

We have apparently collectively decided there are groups of people that are less than and we're no longer interested in how this is impacting them.

That's why I continue to struggle with this.

Changing the message or "going to the people" isn't an option because apparently we're comfortable with this as a nation. I've been saying it for 2+ years now - I don't know how we recover from this. Our societal bar has somehow been lowered ever more than it was when we elected Trump.

[Zaxxon]

That's the reality. So, if we can't do the Ideal Thing, what's the thing that we do instead?

What we're doing now - it's called eugenics.

We have apparently collectively decided there are groups of people that are less than and we're no longer interested in how this is impacting them.

That's why I continue to struggle with this.

You described America since before it was founded.

Changing the message or "going to the people" isn't an option because apparently we're comfortable with this as a nation. I've been saying it for 2+ years now - I don't know how we recover from this. Our societal bar has somehow been lowered ever more than it was when we elected Trump.

It's an option because it's the only option.

I've been saying the rest for 5+ years now--we're fucked. This is but the latest chapter of that book.

[Smoove_B]

I've been saying the rest for 5+ years now--we're fucked. This is but the latest chapter of that book.

I guess the good news is that it might not be global climate change that gets is directly. It could be global climate change that spawns more pandemics. The jury is out on whether or not we can deal with climate change. But I'm crystal clear we can't handle pandemics, so hooray?

[Zaxxon]

I saw the term 'pandemicine' this week--the notion that our failure to address climate change in time has now created an environment that encourages pandemics due to species being forced closer together.

So that's just fantastic.

[Smoove_B]

No just pandemics but dramatically expands the range and seasons of insect-borne illnesses. Something like Dengue fever (for example) is currently present in Florida (again) having been previously eliminated like 75+ years ago. It's been spreading in FL for a decade now and all signs point to it potentially creeping north as things get warmer. To date there hasn't been locally acquired Dengue in Georgia, but it won't surprise me to see it reported before 2030.

And wait until the "natural immunity" folks start scrapping with Dengue. First infection, not great. Second infection? Not at all fun like second breakfast.

[malchior]

I'm pretty sure our future of regional rolling power outages and grid instability isn't going to be good for pandemic relief either.

[Max Peck]

Covid deaths no longer overwhelmingly among the unvaccinated as toll on elderly grows

Unvaccinated people accounted for the overwhelming majority of deaths in the United States throughout much of the coronavirus pandemic. But that has changed in recent months, according to a Washington Post analysis of state and federal data.

The pandemic’s toll is no longer falling almost exclusively on those who chose not to or could not get shots, with vaccine protection waning over time and the elderly and immunocompromised — who are at greatest risk of succumbing to covid-19, even if vaccinated — having a harder time dodging increasingly contagious strains.

The vaccinated made up 42 percent of fatalities in January and February during the highly contagious omicron variant’s surge, compared with 23 percent of the dead in September, the peak of the delta wave, according to nationwide data from the Centers for Disease Control and Prevention analyzed by The Post. The data is based on the date of infection and limited to a sampling of cases in which vaccination status was known.

[RunningMn9]

What happens when there aren’t “other” options? The “ideal” option here isn’t a pristine medical facility with a clean OR (to borrow the MASH analogy).

The guys in the tent are being asked to where gloves and a mask, and their response is “fuck you, we can’t do that.”

You’re asking Smoove for other options on how to manage a pandemic. There aren’t any. We won’t do *any* of them, because we decided that there isn’t a pandemic.

Which may be what it is. Accept that our response now isn’t to do some other, less optimal solution. It’s to do nothing.