[Health] The Infectious Diseases Thread

[pr0ner]

WA state still holding on at #18, but NC has zipped on past TN and is coming up fast - they'll surpass us in a few days

Gov. Cooper is giving an address at 5pm. It was expected to be an announcement of Phase II re-opening, but considering we had our highest daily increase it will be interesting to see what they decide. I do know they've been making much ado about testing increases being the reason for the higher case count, but I'm still skeptical.

The DC area news radio station, WTOP, attributed a spike in Maryland's positive test numbers yesterday to increased testing. There are several places in the DC area where you can now, or soon, go to drive up and get tested, particularly if you're asymptomatic.

[YellowKing]

Ok just did some looking and we're still trending downward in number of positive tests as a percentage of total tests. Which is good. We're down 2% from last week. Testing is currently at ~10,000/day.

[Daehawk]

Maybe they're just testing the same 10,000 people each day. That way they're not totally lying

[hitbyambulance]

aaand that was fast:

[YellowKing]

Just watched the governor's briefing. Due to the rising number of cases, but due to looking good in the other 3 reopening factors, NC is moving into a modified Phase II. That means we're going into Phase II in terms of opening more businesses, etc. but they are stressing extra caution in terms of strongly recommending face masks, requiring social distancing, etc. It's essentially just regular Phase II but with your mama shaking her finger at you saying you better listen. They're also expanding Phase II over a longer period before allowing a move to Phase III.

So we'll just have to wait and see what happens. It's really going to come down to how well NCers behave themselves. It could go really well if most people take this seriously, or more likely it can go south real fast as people just do whatever they want to do.

The biggest positive is that the state is doing a decent job getting test counts up and contact tracing up, even if it's not where it needs to be yet.

[dbt1949]

I don't see opening slow or fast making much difference. Sooner or later everybody gets exposed to it.
Except for stay at home forever me.

[Jeff V]

I don't see opening slow or fast making much difference. Sooner or later everybody gets exposed to it.
Except for stay at home forever me.

Well, it's inevitable if everyone tries to go back business as usual before the pandemic. I for one have no intention mingling with the masses until there's a vaccine. It might help cheat death another day.

[LordMortis]

I don't see opening slow or fast making much difference. Sooner or later everybody gets exposed to it.
Except for stay at home forever me.

Well, it's inevitable if everyone tries to go back business as usual before the pandemic. I for one have no intention mingling with the masses until there's a vaccine. It might help cheat death another day.

I plan to exercise *extreme*caution until there is vaccine. I plan to exercise extreme caution until it seems the vaccination process and the mutation process make if feel like I can get lazy as I am wont to do. My plans may not jive with reality. They often don't. As it goes, 8 weeks and work agrees with *extreme* caution so life is good. We'll see what happens as the belt tightens or the governor's orders are eased.

[Kraken]

I don't see opening slow or fast making much difference. Sooner or later everybody gets exposed to it.
Except for stay at home forever me.

Well, it's inevitable if everyone tries to go back business as usual before the pandemic. I for one have no intention mingling with the masses until there's a vaccine. It might help cheat death another day.

A vaccine, or an effective treatment, which is likely to be found sooner.

[Unagi]

WA state still holding on at #18, but NC has zipped on past TN and is coming up fast - they'll surpass us in a few days

Gov. Cooper is giving an address at 5pm. It was expected to be an announcement of Phase II re-opening, but considering we had our highest daily increase it will be interesting to see what they decide. I do know they've been making much ado about testing increases being the reason for the higher case count, but I'm still skeptical.

That's the funny.

The idea that we should not be scared off, just because we are seeing it for real.

I totally get your position here.

[Unagi]

I don't see opening slow or fast making much difference. Sooner or later everybody gets exposed to it.
Except for stay at home forever me.

Well, it's inevitable if everyone tries to go back business as usual before the pandemic. I for one have no intention mingling with the masses until there's a vaccine. It might help cheat death another day.

lol, what?

You've been forced to be tested for it. Something tells me that you are not someone that can, with confidence, declare: " I for one have no intention mingling with the masses until there's a vaccine."
Clearly, you are a unintentional or unavoidable mingle-er.... are you not?

[Combustible Lemur]

I don't see opening slow or fast making much difference. Sooner or later everybody gets exposed to it.
Except for stay at home forever me.

Tell that to the families of people who ended up dying in a hallway because there weren't enough ventilators.
10,000 gallons in a couple hours is a trickle
10,000 gallons in a couple seconds is deadly.

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[gameoverman]

I don't see opening slow or fast making much difference. Sooner or later everybody gets exposed to it.
Except for stay at home forever me.

Tell that to the families of people who ended up dying in a hallway because there weren't enough ventilators.
10,000 gallons in a couple hours is a trickle
10,000 gallons in a couple seconds is deadly.

Sent from my SM-N975U using Tapatalk

I didn't think he was trivializing it. It's a reality, if we reopen things then it's going to spread faster. Slowing the spread was the reason we shut everything down. Once you have people gathering at a park or beach or bar or hair salon, what difference does a fast or slow reopening make? All it takes is for one person there to be infected and now it's spreading to a bunch of people. Those of us still willing to abide by the rules are undercut by everyone else. What's the point of locking down one state if next state over is partially reopened and the one next to that is mostly reopened? I see a grass roots movement to reopen forming and I don't think there's anything anyone can do to stop it. At best, governors are going to present 'new' rules for reopening to hide the fact that things will be reopened like it or not. My hope is that the summer heat really does suppress the spread to some degree, thus limiting the damage.

[dbt1949]

The only thing I trivialized was the last sentence about myself. During this whole mess I'm doing what I do all the time anyways. Combination of being agoraphobic and naturally anti social.

[Sudy]

What I find frustrating is the apparent lack of consistency and decisiveness between federal, provincial, and municipal levels of government. (And by many accounts I know it's far worse in many U.S. states.) We're slowly re-opening stuff. OK, fine. Is that because the infection rate is at a stable level that the health system can support? Or are we just hoping for the best? I'm sure a lot of this is said and discussed; there are multiple press conferences and releases each day. But so much of it is journalistic supposition and regurgitation. The big stuff should be clear enough to rise above the noise.

Just yesterday, all levels of government finally officially recommended non-medical mask use in situations where physical distancing may not be possible. (Shopping, public transit, etc.) But the directions are all so vague and formless. Would I be happier if mask-use was mandated? Well yeah, kinda, if quality masks were easy to acquire. (Though we don't need to be writing the homeless tickets over this stuff, etc.) Etsy is swamped with them and I'm waiting for my order to arrive. But my dad has struggled to locate any, despite looking in stores. I figure it's similarly challenging for those who aren't as internet-savvy. There's been stuff on Amazon all along, but you hear people have been waiting two-plus months for their orders to arrive. Could we have learned to sew in this amount of time? Sure. But have we? Lol... no.

[gameoverman]

I don't know about other areas but here in California there isn't consistency for reasons like the less populated, rural areas don't think they face the same problems as the high population density cities. So right away you have mayors, city councils, and law enforcement who all want to do their own thing.

The best way to deal with that is if the person at the top, the President, had a plan and had the leadership ability to command enough respect to get everyone on the same page. Haha. Other than Nixon during the Watergate scandal, our current President is the least likely one to pull that off of all the Presidents I've seen in my lifetime. It might not be so bad if this crisis didn't involve a contagious virus. Since this thing does spread, not being on the same page is bad for everyone.

[noxiousdog]

I don't know about other areas but here in California there isn't consistency for reasons like the less populated, rural areas don't think they face the same problems as the high population density cities. So right away you have mayors, city councils, and law enforcement who all want to do their own thing.

The best way to deal with that is if the person at the top, the President, had a plan and had the leadership ability to command enough respect to get everyone on the same page. Haha. Other than Nixon during the Watergate scandal, our current President is the least likely one to pull that off of all the Presidents I've seen in my lifetime. It might not be so bad if this crisis didn't involve a contagious virus. Since this thing does spread, not being on the same page is bad for everyone.

They clearly don't face the same problems.

There are 86 Texas counties that have 10 or less cases. Not 10 deaths, but total cases. It's easy to look at the John's Hopkins map and see it's dramatically different based on population density.

[Blackhawk]

I don't know about other areas but here in California there isn't consistency for reasons like the less populated, rural areas don't think they face the same problems as the high population density cities.

We don't. We'd have to plan in advance and put ads in the paper to gather the kind of dense crowd you'd see in a normal day in a city, and it still only be a fraction of the size. In the average day of everybody going about their non-lockdown business, you'll rarely find yourself within 6' of another person unless you're in a checkout line (and there is rarely more than one person in line.)

The answer, though, is a Federal and/or state mandatory baseline with local areas having the freedom to build off of that for their own needs.

[Blackhawk]

There's been stuff on Amazon all along, but you hear people have been waiting two-plus months for their orders to arrive. Could we have learned to sew in this amount of time? Sure. But have we? Lol... no.

I ordered mine off of Amazon. It took six weeks. Two weeks in I discovered Etsy and got a much better mask that was in my hands in four days. By the time my Amazon masks got here I'd already received a refund (and those Amazon masks were straight up terrible anyway.)

[Combustible Lemur]

The only thing I trivialized was the last sentence about myself. During this whole mess I'm doing what I do all the time anyways. Combination of being agoraphobic and naturally anti social.

Fair enough, but the fuckit mentality is really dangerous in this situation. Every individual who helps slow this thing does make a difference. Its easy to feel like this is "The happening". It's not, there are real transmission scenarios. The deaths are what they are despite the worst efforts of the government, not regardless of. People followed the lock downs. Even if in percentages, it made a difference. I just read an article that even just one week of delay cost 36k lives. If we each say fuckit, thats a lot of dead parents.

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[Blackhawk]

On the bright side, all this active disease prevention means that I haven't had a cold in forever!

[Zaxxon]

On the bright side, all this active disease prevention means that I haven't had a cold in forever!

[RunningMn9]

They clearly don't face the same problems.

There are 86 Texas counties that have 10 or less cases. Not 10 deaths, but total cases. It's easy to look at the John's Hopkins map and see it's dramatically different based on population density.

This is obviously true, but the problem is that they don’t face disconnected problems. What one county does can impact a neighboring county - because they aren’t in isolation. What happens in a city can impact its suburbs and vice versa.

The problem that I see is that I’m living through the experiment where you waited far too long to lockdown. And when we did lock down, the problem in NJ was isolated to just the NE corner of the state. So people around me (out among the hill people) didn’t take it seriously. And now NE Jersey problems are Hill People NJ problems and we’ve got people getting sick and dying.

But the point is that NY and NJ waited too long. Most other states didn’t. They locked down before this shit sandwich became a certainty for them.

Which of course makes it look like it wasn’t necessary. There’s only X cases. I’m sure there are areas in rural TX and places like Montana that probably never needed to be locked down.

But some of those places are going to find out that they were wrong, especially when their rural health infrastructure is instantly overwhelmed with a much lower patient load.

[LordMortis]

But some of those places are going to find out that they were wrong, especially when their rural health infrastructure is instantly overwhelmed with a much lower patient load.

This. We have two counties that still have 0 cases and a dozen or more that have had 2 or less. But all it takes is one person to visit the next town over and then to sit in church or go to the mill or to pass it to their child who then sits in a classroom, and you're going to from 0 to 60 in no time flat.

At the same time, it's hard to tell those places unaffected to date 300 miles away they have to lock down because people in my neighborhood are dying every day. It may be a bad decision for them but it's still hard to tell them they're wrong.

[Smoove_B]

But the point is that NY and NJ waited too long. Most other states didn’t. They locked down before this shit sandwich became a certainty for them.

Which of course makes it look like it wasn’t necessary. There’s only X cases. I’m sure there are areas in rural TX and places like Montana that probably never needed to be locked down.

Exhibit A:

The U.S. could have prevented roughly 36,000 deaths from COVID-19 if broad social distancing measures had been put in place just one week earlier, according to an analysis from Columbia University.

Underlining the importance of aggressively responding to the coronavirus, the study found the U.S. could have avoided at least 700,000 fewer infections if it had taken the same actions on March 8 that it started taking on March 15.

[dbt1949]

But would all of those people got it anyways eventually?

[wonderpug]

But would all of those people got it anyways eventually?

Not if they were exposed in the future after receiving a vaccine, and even without a vaccine more people would survive because there are more hospital beds, more ventilators, and more effective treatments. Or maybe their fate is unchanged but a nurse no longer has to die from treating them without proper protective equipment.

[LawBeefaroni]

But the point is that NY and NJ waited too long. Most other states didn’t. They locked down before this shit sandwich became a certainty for them.

Which of course makes it look like it wasn’t necessary. There’s only X cases. I’m sure there are areas in rural TX and places like Montana that probably never needed to be locked down.

Exhibit A:

The U.S. could have prevented roughly 36,000 deaths from COVID-19 if broad social distancing measures had been put in place just one week earlier, according to an analysis from Columbia University.

Underlining the importance of aggressively responding to the coronavirus, the study found the U.S. could have avoided at least 700,000 fewer infections if it had taken the same actions on March 8 that it started taking on March 15.

Even NPR was dropping a heaping of caveats on that analysis. We undoubtedly could have saved some deaths but the exact number is a WAG at best.

[Smoove_B]

Yup. I have no doubts there are going to be lots of studies and this one is rather raw in execution. I don't think it's debatable that lives would have been saved; it's always going to come back to how many and whether or not it was "worth" the cost of shutting down.

[Skinypupy]

In my 1-on-1 meeting this morning, the boss just asked if I thought I "still needed an office at HQ". Apparently the powers-that-be are thinking about making work from home permanent for our team.

I'm torn. While I love the lack of commute and working in my sweatpants is nice, I find that I'm far more productive at the office. There's just SO many distractions here, and it's only going to get significantly worse once the kids are done with school next week.

It's great to have the option of teleworking when I need to, but making that a permanent thing will be...interesting. It's been far tougher than I expected.

[Jeff V]

You've been forced to be tested for it. Something tells me that you are not someone that can, with confidence, declare: " I for one have no intention mingling with the masses until there's a vaccine."
Clearly, you are a unintentional or unavoidable mingle-er.... are you not?

I was forced to get tested because my wife got sick. She does not represent "the masses".

We will not be going to restaurants.
We will not be going to playgrounds.
We will not be going to beaches.
We will not be going to water parks (and I already spent $600 on season passes)
We will not be going to crowded parks such as Millennium Park
We will not be going to concerts or festivals.
We will not be going to movie theaters.
We will not be going to amusement parks.

It is so far unknown whether we will even host or attend small social gatherings with close friends.

[RunningMn9]

Yup. I have no doubts there are going to be lots of studies and this one is rather raw in execution. I don't think it's debatable that lives would have been saved; it's always going to come back to how many and whether or not it was "worth" the cost of shutting down.

What made it infuriating is that they weren’t deciding between shutting down and not shutting down. They shut down. They waited until the numbers said “holy shit you should have already shut down!!” rather than “holy shit you should shut down!!”.

Delay, delay, THEN shut down. What was the sense in that? Political calculation vs public health calculation.

[Smoove_B]

Which is also why the next shut down is going to be painful. Everyone is focused on the deaths right now - which is understandable. They're horrific and we'll never know exactly how many were likely preventable. There's a story behind every life that was lost and in a perfect world, we'd hear the stories of the people that lost their lives over this (as crazy as that sounds). But focusing on the numbers of dead right now is missing the bigger picture.

Instead, the number to watch over the next ~2 weeks (as states are opening up and loosening restrictions) will be the magnitude new cases. Of course that's already being (intentionally in some cases) obfuscated in some states. I predict the quote of mid to late June will be "How did we not see this coming?"

[malchior]

Yup. I have no doubts there are going to be lots of studies and this one is rather raw in execution. I don't think it's debatable that lives would have been saved; it's always going to come back to how many and whether or not it was "worth" the cost of shutting down.

It's also much easier to point backward and point out the optimal time. Especially considering these guys were flying blind. That piece's argument we should have been shutting down on March 8th? That only happens in an alternate universe where someone traveled back from the future with the missing evidence.

Yup. I have no doubts there are going to be lots of studies and this one is rather raw in execution. I don't think it's debatable that lives would have been saved; it's always going to come back to how many and whether or not it was "worth" the cost of shutting down.

What made it infuriating is that they weren’t deciding between shutting down and not shutting down. They shut down. They waited until the numbers said “holy shit you should have already shut down!!” rather than “holy shit you should shut down!!”.

Delay, delay, THEN shut down. What was the sense in that? Political calculation vs public health calculation.

You have to consider that the playbook they were expecting to run got thrown in the garbage can. They had no visibility. They had no national guidance as expected. They were trying to figure out authority to act in that vacuum. Also, I don't think they waited until the fire was burning their feet. More like they were smelling smoke and CA, NY, and NJ did it within days of each other. Many of the other states got away with a week or two of delay on top beyond that. They don't look bad because they mostly got lucky.

[LordMortis]

Instead, the number to watch over the next ~2 weeks (as states are opening up and loosening restrictions) will be the magnitude new cases. Of course that's already being (intentionally in some cases) obfuscated in some states.

This

I predict the quote of mid to late June will be "How did we not see this coming?"

I'm hoping you are wrong. I'm hoping the opening is measured and monitored. That in spite of opening before mass testing on a daily basis is available, that we've know enough to keep close tabs and keep the numbers at bay... The flattening of the curve we were after. (and the warming season to boot) I dunno how much faith I have but I do have hope. I also hope that encouraging numbers over the next two week don't encourage us to get stupid.

[malchior]

Instead, the number to watch over the next ~2 weeks (as states are opening up and loosening restrictions) will be the magnitude new cases. Of course that's already being (intentionally in some cases) obfuscated in some states.

This

I predict the quote of mid to late June will be "How did we not see this coming?"

I'm hoping you are wrong. I'm hoping the opening is measured and monitored. That in spite of opening before mass testing on a daily basis is available, that we've know enough to keep close tabs and keep the numbers at bay... The flattening of the curve we were after. (and the warming season to boot) I dunno how much faith I have but I do have hope. I also hope that encouraging numbers over the next two week don't encourage us to get stupid.

I expect it to be a rough summer. Texas is already looking rough and antibody studies coming out of Europe aren't good. We don't know why but even Sweden which is less restrained achieved something like 7-10% showing positive for antibodies by April end. If the tests were accurate...which is far from certain. Sweden's chief epidemiologist was touting mid-20% numbers mid-April. It seems like everyone is hoping for tons of asymptomatic cases and more and more evidence is showing that it isn't likely. I hope it isn't so bad but the evidence is not trending in a good direction.

[Blackhawk]

I had an appointment with my oncologist today, followed by some blood work. The oncologist's office was extremely cautious, as is to be expected from a doctor where many of the patients are having their immune systems compromised.

The blood work was at my own local hospital, a very small community hospital that is currently dealing with dozens of cases of COVID-19. I was checked by an employee with her mask under her nose, and masks were optional for visitors. In a hospital. With active cases.

Then, when I got home I had to take my elderly, diabetic mother-in-law to a hair appointment in a local barbershop the size of a large shed with multiple customers where nobody wore masks. I waited in the car.

This is the part where I add commentary to my experiences, but there just aren't any words left.

[Daehawk]

Was good knowing you. God speed BH.

That does all sound messed up though.

[Smoove_B]

Then, when I got home I had to take my elderly, diabetic mother-in-law to a hair appointment in a local barbershop the size of a large shed with multiple customers where nobody wore masks. I waited in the car.

My 76 year old aunt revealed to me that there's a whole underground network of women cutting hair in Northwest NJ - women that are retired former stylists. The don't fear losing their licenses so they're allowing women (and maybe men) to come into their homes and cutting their hair for cash. My aunt has friends that have been telling her about it and offering to give her the contact information. Retirees are risking their health to get a trim. You cannot make this stuff up.

[RunningMn9]

They (NY and NJ) were being told weeks earlier by experts that the only way was a near total lockdown. I know this because Smoove was telling me all of this while I laughed and said it couldn’t happen, you can’t just shut things down.

They waited until it was bad enough that it was politically tolerable. I get why. But it cost a lot of people their lives.

Other states followed suit and locked down before there were widespread outbreaks like we had here. Much smarter, but they will be tricked into thinking it wasn’t necessary.