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

[$iljanus]

I think it's going to take some time and a few thousand more deaths before we can start to reverse the damage that the Republican death cult has done.

I guess with a strong showing of reasonable people at the polls in Nov along with every maskless rally being held we get a little closer to that goal.

[Lagom Lite]

Your outlook is so refreshing. You're embarrassed and concerned about truth and credibility. Hey America, remember when we felt that?

Frankly, many Americans seem quite embarrassed these days.

[Smoove_B]

For the folks into math stuff (thread)

https://twitter.com/nataliexdean/status ... 0385915904

THINK LIKE AN EPIDEMIOLOGIST: There are more new confirmed cases each day in the US than at any time during the earlier April peak. But is it really meaningful to compare those numbers? How do epidemiologists decide when to sound the alarm? A thread. 1/11

[malchior]

Good thread - I thought she had a plot hole glazing over the testing criteria in NYC early on but she is discounting that implicitly in the graph by just abstracting it as 'less testing'. I thought that was a smart way to simplify this model. It's sad that following the local trend is the only thing that is meaningful since lack of national standards skews everything and makes comparisons between states tricky. Thanks again Trump.

https://twitter.com/nataliexdean/status ... 9672084480

[Smoove_B]

I don't think this has been shared yet from The Atlantic -- The Week America Lost Control:

For months this spring, Americans clawed back ground from the coronavirus. Many of us stayed home, canceled vacations, and avoided friends and family. It was awful, but it worked: The U.S., by one estimate, avoided more than 4 million infections. We are now losing that work, watching weeks of pandemic suppression vanish in days. It took the country acting in concert to subdue the virus in the spring. We may need to do the same, again, to avoid the worst now.

[Default]

Nothing like getting mocked by white men for wearing a mask on the job.

Waiting for the shitstorm that will be this fall.

[Holman]

https://twitter.com/CNNPolitics/status/ ... 49376?s=20

I know this isn't the first time, but it's always terrifying to see health officials refusing to provide accurate health data for fear of contradicting Dear Leader.

[Smoove_B]

Excellent video for sharing on social media.

[Grifman]

Woman turns into zombie for some reason:

https://twitter.com/whosalex/status/127 ... 61313?s=20

I'm guessing she has a different form of the virus than most people get.

[LawBeefaroni]

Woman turns into zombie for some reason:

https://twitter.com/whosalex/status/127 ... 61313?s=20

I'm guessing she has a different form of the virus than most people get.

She was drunk as F and got kicked out of the bar. If it was the virus though, everyone in there has it now.

[LawBeefaroni]

Down the street from me.


https://twitter.com/timobrien/status/12 ... 8180384769

[Unagi]

I was just looking at some data.

Miami-Dade county has nearly* as many active cases as the entire state of Illinois and the entire state of South Carolina, combined.

About 42k. vs. 27k+27k

(well, it’s only like 75% their combined numbers, but still)

[malchior]

I was just looking at some data.

Miami-Dade county has nearly* as many active cases as the entire state of Illinois and the entire state of South Carolina, combined.

About 42k. vs. 27k+27k

(well, it’s only like 75% their combined numbers, but still)

To adjust for population

Code: Select all

               |  IL 12.7M | SC 5.1M | Miami-Dade 2.7M
Cases per 100k |     213   |   529   |     1556 (really!?!)

I feel like it is off because that'd be like 1.5% of the population *actively confirmed* in Miami-Dade which sounds insanely high to me. However, looking at Florida overall they've reported nearly 1% of population confirmed infected (over all time). Even worse. Florida went from 50K to 100K between May 23rd and June 22nd. From June 22nd to yesterday they doubled again. And they've basically done little via policy to stem the tide. Could we see another 200K over the next couple of weeks. Feels plausible.

[YellowKing]

Just anecdotally I feel like the mandatory mask thing combined with general peer pressure has started to put some real stress on the anti-maskers. When I was out and about this weekend, there were very few people without masks, and the handful I did see all looked embarrassed and paranoid.

[Smoove_B]

Georgia Tech won't require masks for students:

Over 750 faculty at Georgia Tech signed a letter to the University System of Georgia's Board of Regents saying that the school's plan to reopen campus without face mask requirements is dangerous and not based on science.

"We are alarmed to see the Board of Regents and the University System of Georgia mandating procedures that do not follow science-based evidence, increase the health risks to faculty, students, and staff, and interfere with nimble decision-making necessary to prepare and respond to Covid-19 infection risk," the letter from faculty says.

The faculty letter comes after Georgia Tech issued its "Tech Moving Forward" plans for reopening campus with in-class instruction in the fall. According to the plan, Georgia Tech students are "strongly encouraged" to wear a cloth face covering on campus but are not required to do so.

That's....surprising.

[Holman]

Just anecdotally I feel like the mandatory mask thing combined with general peer pressure has started to put some real stress on the anti-maskers. When I was out and about this weekend, there were very few people without masks, and the handful I did see all looked embarrassed and paranoid.

Folks are generally masking up again in my neighborhood after some relaxation last month.

I see three kinds of unmasked folks around here:

1) High-school/college kids who presumably think they're immortal,
2) Adult dudes presumably afraid of looking weak, often accompanied by masked wives or girlfriends,
3) A certain kind of middle-aged citizen who really has an aura of following no news sources whatsoever, and to whom the virus is perhaps just a distant tale.

[malchior]

Georgia Tech won't require masks for students:

Over 750 faculty at Georgia Tech signed a letter to the University System of Georgia's Board of Regents saying that the school's plan to reopen campus without face mask requirements is dangerous and not based on science.

"We are alarmed to see the Board of Regents and the University System of Georgia mandating procedures that do not follow science-based evidence, increase the health risks to faculty, students, and staff, and interfere with nimble decision-making necessary to prepare and respond to Covid-19 infection risk," the letter from faculty says.

The faculty letter comes after Georgia Tech issued its "Tech Moving Forward" plans for reopening campus with in-class instruction in the fall. According to the plan, Georgia Tech students are "strongly encouraged" to wear a cloth face covering on campus but are not required to do so.

That's....surprising.

It is a long-game. They need to move some of these old codgers out to free up some tenure lines.

[El Guapo]

It is a long-game. They need to move some of these old codgers out to free up some tenure lines replace them with cheaper adjunct professors.

[$iljanus]

Georgia Tech won't require masks for students:

According to the plan, Georgia Tech students are "strongly encouraged" to wear a cloth face covering on campus but are not required to do so.

That's....surprising.

Unless they come up with a mask with a valve for drinking beer, good luck with that...

[Smoove_B]

Conversely, my (maybe?) employer has announced this morning that they are going to a mainly remote-instruction for the Fall 2020. I've been assuming this was the case since May, but I guess they needed to run down all the options and see how things were evolving. How they're going to justify full tuition i have no idea, but I think it's a huge mistake. Then again, hands might be tied over capital improvement and student amenities they needed to have in order to attract business. This only reaffirms my belief that the higher education bubble is about to pop.

[malchior]

Conversely, my (maybe?) employer has announced this morning that they are going to a mainly remote-instruction for the Fall 2020. I've been assuming this was the case since May, but I guess they needed to run down all the options and see how things were evolving. How they're going to justify full tuition i have no idea, but I think it's a huge mistake. Then again, hands might be tied over capital improvement and student amenities they needed to have in order to attract business. This only reaffirms my belief that the higher education bubble is about to pop.

Yup. I don't know what the situation overall for higher ed in NJ is going to look like but all signs point to trouble. I thought the crippling state aid cuts 15 years ago were bad. Though I'm retrospectively glad because they forced me into a much more lucrative now. Now the state likely has to cut even more...and many schools built out facilities significantly back then and are 10-20 years into long-term bond repayments. Those debt payments aren't going anywhere.

[Jaymon]

I have been thinking about the elementary schools.

If students don't wear masks, then if one of them has a case, , within a month the whole school will be infected, even if they are all young and healthy. Most will probably have a mild case, and maybe not even know they are sick. But they will infect all the adults, regardless of mask status of adults. And the kids will also go home and infect their entire households.


But even if they do try to have masks for kids, If you even met a school age child, you know it will be useless. There is no way for 6-12 year olds to maintain mask integrety for 6-8 hours a day, including snacks and lunches. Shit is bad out there now, but wait until September. Currently the country is on fire and spiriling, September is when we colide with the ground and explode.

[Smoove_B]

September is when we colide with the ground and explode.

This is why there's been a call over the last few weeks (I posted it up thread) suggesting we need to collectively decide what's more important? Indoor dining, large gatherings and bar visits now or K-12 schools having classroom time in the Fall? It feels like we already decided, but there might be a sliver of time left if we act now.

Really, the goal would be to do what we've done in NJ and NY - get the circulating virus levels down low enough to minimize risk and keep crowds from gathering to minimize risk of spread. But if we spend the next 8 weeks as a nation pretending the virus went away or that our individual choices aren't going to impact how this all unfolds, we're deluding ourselves.

[malchior]

I agree and it is why our failure to control this has been another level of national disgrace. It ultimately is yet another in a long line of failures to protect children and their future. In many other industrialized countries they have a fighting chance to have a reasonable return to school (or continue their existing school schedules in the case of some). Here we might not normalize for years because people want to go to the bar? We're finding out how low a bar we will collectively set for a garbage culture. This will have generational impacts that we can't even fathom yet.

[El Guapo]

The suggestion I read on Twitter the other day is to say that any state that can get its positive test rate below X% (1%? 3%?) for a week will get free Taco Bell for everyone in the state.

I kind of feel like this would work really well.

[LordMortis]

I have been thinking about the elementary schools.

If students don't wear masks, then if one of them has a case, , within a month the whole school will be infected, even if they are all young and healthy. Most will probably have a mild case, and maybe not even know they are sick. But they will infect all the adults, regardless of mask status of adults. And the kids will also go home and infect their entire households.


But even if they do try to have masks for kids, If you even met a school age child, you know it will be useless. There is no way for 6-12 year olds to maintain mask integrety for 6-8 hours a day, including snacks and lunches. Shit is bad out there now, but wait until September. Currently the country is on fire and spiriling, September is when we colide with the ground and explode.

All of this all of the time. Leaving aside the workers (which you shouldn't), now I have to work with all of the people sending their kids back to school. Everyone is itching to get back in the office (I am on an as needed basis and I was not itching) and we have far too many coworkers with young children for me to feel good about the extent of mask wearing and safe distancing. I think the HVAC discussion put the fear of Smoove in to me. (Also the young children's parents vector has long since been the way to get an entire office sick, in general, and it doubled down when we moved to an open office format... where my biggest fear was... disease spread...)

[El Guapo]

I have been thinking about the elementary schools.

If students don't wear masks, then if one of them has a case, , within a month the whole school will be infected, even if they are all young and healthy. Most will probably have a mild case, and maybe not even know they are sick. But they will infect all the adults, regardless of mask status of adults. And the kids will also go home and infect their entire households.


But even if they do try to have masks for kids, If you even met a school age child, you know it will be useless. There is no way for 6-12 year olds to maintain mask integrety for 6-8 hours a day, including snacks and lunches. Shit is bad out there now, but wait until September. Currently the country is on fire and spiriling, September is when we colide with the ground and explode.

All of this all of the time. Leaving aside the workers (which you shouldn't), now I have to work with all of the people sending their kids back to school. Everyone is itching to get back in the office (I am on an as needed basis and I was not itching) and we have far too many coworkers with young children for me to feel good about the extent of mask wearing and safe distancing. I think the HVAC discussion put the fear of Smoove in to me. (Also the young children's parents vector has long since been the way to get an entire office sick, in general, and it doubled down when we moved to an open office format... where my biggest fear was... disease spread...)

My office doesn't seem like it's going to open anytime soon (not before Labor Day). But now I feel like I'll need to ask questions about the HVAC / air circulation systems in the office before I make any decisions about going back when it happens, and I'm not 100% sure that I know the questions that need to be asked.

[malchior]

The air circulation thing is worrying to me as well - though I'm unlikely to face it this year. Especially since over the weekend we heard more noise that WHO has a large group of experts (200+) trying to push the 'elders' at WHO to call the virus airborne or an aeresol or whatever the terminology is. We know so little and people really can't make reasoned decisions about this yet we're going to throw tens/hundreds/thousands of children and adults back into buildings? Let's get this under control and then the perhaps the risk will be manageable. Otherwise, this feels like a big live experiment.

[stessier]

My office was making plans to bring everyone back in and today announced that those plans are on hold for the foreseeable future. We're also told that face coverings may be mandated soon.

[Smoove_B]

The air circulation thing is worrying to me as well - though I'm unlikely to face it this year.WHO has a large group of experts (200+) trying to push the 'elders' at WHO to call the virus airborne or an aeresol or whatever the terminology is.

I was amazed at how much chatter there was about this over the weekend in the circles I travel in. If you want to read more in a casual tone, this is good:

As we’ve outlined here and here, a major problem plaguing this discussion is the false dichotomy between “droplet” and “airborne” transmission that we use in healthcare settings (for simplicity of messaging, and because it has served us well for several decades—for reasons I’ll get back to later). This dichotomy divides application of transmission-based precautions between those pathogens spread via respiratory droplets, all of which must absolutely fall to the ground within 6 feet of the source, and those pathogens which become airborne, meaning they travel long distances on air currents, remain in the air for very long periods of time, and most importantly, can cause infection after their airborne sojourns if they find the right mucosal surface.

And the core issue:

It’s important to distinguish SPAT from “classic airborne transmission” (let’s call it CAT). The CAT pathogens (TB, measles, VZV) have very different transmission dynamics than SPAT pathogens, as I outlined here (R0s of >10, household transmission rates of 50-90%). The distinction is important because for most healthcare epidemiologists, using the term “airborne” implies a common set of “one-size fits all” interventions to prevent transmission, interventions that require resource-intensive engineering controls and PPE requirements. It is not at all clear that such interventions are required to prevent transmission of SPAT pathogens. In fact, most evidence (and real world experience) suggests that they are not. This is why the droplet-airborne dichotomy has served us fairly well over the years—either because droplet precautions appear to be pretty effective at preventing SPAT, or because SPAT is rare even among those viruses capable of it.

Not surprisingly, once again so much of this comes down to a "war" between private and public health practitioners, academics, researchers and practitioners. For reference was taught (and still use) droplet vs airborne spread when thinking about and describing risk for various disease agents.

[stessier]

those pathogens spread via respiratory droplets, all of which must absolutely fall to the ground within 6 feet of the source,

I've been curious - is that just the definition of "respiratory droplets", or do we somehow know that these droplets hit the ground within 6'?

[El Guapo]

The air circulation thing is worrying to me as well - though I'm unlikely to face it this year.WHO has a large group of experts (200+) trying to push the 'elders' at WHO to call the virus airborne or an aeresol or whatever the terminology is.

I was amazed at how much chatter there was about this over the weekend in the circles I travel in. If you want to read more in a casual tone, this is good:

As we’ve outlined here and here, a major problem plaguing this discussion is the false dichotomy between “droplet” and “airborne” transmission that we use in healthcare settings (for simplicity of messaging, and because it has served us well for several decades—for reasons I’ll get back to later). This dichotomy divides application of transmission-based precautions between those pathogens spread via respiratory droplets, all of which must absolutely fall to the ground within 6 feet of the source, and those pathogens which become airborne, meaning they travel long distances on air currents, remain in the air for very long periods of time, and most importantly, can cause infection after their airborne sojourns if they find the right mucosal surface.

And the core issue:

It’s important to distinguish SPAT from “classic airborne transmission” (let’s call it CAT). The CAT pathogens (TB, measles, VZV) have very different transmission dynamics than SPAT pathogens, as I outlined here (R0s of >10, household transmission rates of 50-90%). The distinction is important because for most healthcare epidemiologists, using the term “airborne” implies a common set of “one-size fits all” interventions to prevent transmission, interventions that require resource-intensive engineering controls and PPE requirements. It is not at all clear that such interventions are required to prevent transmission of SPAT pathogens. In fact, most evidence (and real world experience) suggests that they are not. This is why the droplet-airborne dichotomy has served us fairly well over the years—either because droplet precautions appear to be pretty effective at preventing SPAT, or because SPAT is rare even among those viruses capable of it.

Not surprisingly, once again so much of this comes down to a "war" between private and public health practitioners, academics, researchers and practitioners. For reference was taught (and still use) droplet vs airborne spread when thinking about and describing risk for various disease agents.

So this is a terminology dispute, right? It's not like these insurgent experts are arguing that the coronavirus's method of transmission is any different than how we have previously understood it, but rather they are arguing that the known method of transmission should be classified differently, correct?

[malchior]

@Smoove_B - that blog post you posted reinforces my concern. Maybe it is a terminology dispute but as the end notes what we need are concrete recommendations. That is the part that bothers me. Our policy response is so bad that I think that any uncertainty is the easy off-ramp that everyone takes to avoid tough decisions. Not that I think Trump will suddenly care if WHO recommends avoiding putting hundreds of children in the same school without masks. But more backing could be helpful to someone who is in a weaker position but needs something to point at.

As a totally random example, let's say a particular NJ Governor is bogged down in home rule issues and politically weak in part of the state. They might need firmer guidance to stand their ground and it might be more than welcome support if the science was more conclusive. The same goes for businesses. Perhaps the recommendation is that they should be remote unless absolutely unworkable. Maybe that'll overcome the somewhat pervasive 1970s management philosophy that I have to see them to manage them.

[El Guapo]

Yeah, and actually any advice from Smoove on how risky the following situations would be:

(1) me sitting in a closed office (e.g., with my door closed) for 8 hours with no mask on;
(2) me sitting in a closed office for 8 hours with a mask on;
(3) me sitting in a conference room for 8 hours with something like 3 - 5 people where everyone has masks on. This is significant because that would allow for in-person depositions if reasonably safe (even if the court reporter would no doubt love trying to hear everyone talking with masks on).

Again, I don't know the exact HVAC situation, but the place is air conditioned, so there must be some air circulation throughout the building as a result.

[Smoove_B]

I've been curious - is that just the definition of "respiratory droplets", or do we somehow know that these droplets hit the ground within 6'?

Yes. The "classic" definitions/usage I was taught is really couched in how long it will persist in the environment. True "airborne" means it's circulating in air currents and can be infectious hours after someone puts them out into the environment. Airborne agents can also potentially be spread through HVAC systems.

"Respirator droplets" are larger and don't float around. Depending on how they're ejected (talking, singing, coughing, sneezing) they're going to "arc" through the air and stick to whatever they touch. Someone's eyes. The a desk. A doorknob. The ladle at a buffet salad bar. The ground.

Our public health controls are broadly focused into these two scenarios. Infectious control doctors (rightly so) have more nuance and take a different approach and so they have this author has a "SPAT" model that suggests there's likely transmission in the space in between the two that's a mix of both. If you look at the video I linked yesterday, you can get a sense of that as you look at the air currents being generated around someone's nose and mouth as they simply exhale. There's a "micro environment" that's created around a person (like PigPen, I guess) and when you crowd people indoors without a mask it's possible that the virus can spread easier because of it. It's not really airborne or droplet spread - maybe it's in between.

[Smoove_B]

@Smoove_B - that blog post you posted reinforces my concern. Maybe it is a terminology dispute but as the end notes what we need are concrete recommendations. That is the part that bothers me. Our policy response is so bad that I think that any uncertainty is the easy off-ramp that everyone takes to avoid tough decisions. Not that I think Trump will suddenly care if WHO recommends avoiding putting hundreds of children in the same school without masks. But more backing could be helpful to someone who is in a weaker position but needs something to point at.

I'm of the mind that Americans need to be wearing masks at all times when outdoors when social distancing and/or crowd density increases to some magical level. I'm also of the mind that masks should be on for indoor activities and the amount of time spent indoors with others (not in your household) should be minimal even when wearing a mask.

Part of this relates to messaging. Expecting people to run calculations every time there's a situation unfolding is too much. Make it simple - always wear a mask unless you're at home and with people you've been social distancing with. Always. I don't think we should be doing indoor dining. I don't think bars should be open indoor or outside. Outdoor dining is technically low risk but I think it's inviting trouble (as outdoor drinking has done).

As a totally random example, let's say a particular NJ Governor is bogged down in home rule issues and politically weak in part of the state. They might need firmer guidance to stand their ground and it might be more than welcome support if the science was more conclusive. The same goes for businesses. Perhaps the recommendation is that they should be remote unless absolutely unworkable. Maybe that'll overcome the somewhat pervasive 1970s management philosophy that I have to see them to manage them.

I'm astounded that any business (white collar) with the ability to work remote is in any way encouraging office time if there are other workable options. As I said when this all started, we're still learning. Evidence (based on NJ and NY) suggests wearing masks and keeping social contact to a minimum (what we did during our lock down) reduced spread. Conventional wisdom then suggests going back to what we were doing before increases risk. By how much, we have no idea because the experiment is still ongoing.

[Smoove_B]

Yeah, and actually any advice from Smoove on how risky the following situations would be:

(1) me sitting in a closed office (e.g., with my door closed) for 8 hours with no mask on;
(2) me sitting in a closed office for 8 hours with a mask on;
(3) me sitting in a conference room for 8 hours with something like 3 - 5 people where everyone has masks on. This is significant because that would allow for in-person depositions if reasonably safe (even if the court reporter would no doubt love trying to hear everyone talking with masks on).

Again, I don't know the exact HVAC situation, but the place is air conditioned, so there must be some air circulation throughout the building as a result.

I haven't seen any changes or updates in recommendations, but ASHRAE's formal position seems to be unchanged since the Spring:

Transmission of SARS-CoV-2 through the air is sufficiently likely that airborne exposure to the virus should be controlled. Changes to building operations, including the operation of heating, ventilating, and air-conditioning systems, can reduce airborne exposures.Neither WHO nor CDC rule out the possibility of aerosol transmission under some circumstances and both recommend the use of engineering controls in some cases and cannot explain all incidents of community spread of COVID-19. ASHRAE’s position that engineering controls to reduce airborne concentrations of viral particles or droplets are warranted to mitigate this risk is not in conflict with WHO and CDC’s positions.

In short, I'd want to know what your building's maintenance / HVAC team is doing to work with the guidelines posted by ASHRAE. If your building maintenance people and HVAC staff have no idea who ASHRAE is, that's trouble. "Reduction of viral aerosols" for a building's HVAC system might involve special filtration ($$$$$) or more likely changing the mixture of makeup (outside) air (which is wear and tear on the system as you then need to cool and dehumidify gross outside summer air).

So all of your concerns are linked to that, without question, #1 and #2 specifically. #2 potentially puts your viral particles out into the air and increases likelihood of re-circulation. By how much? Is is a concern? No idea. Again - we're all in the experiment together.

#3 is an interesting one. I would think even with masks that's higher risk just based on contact time. The best observational data we have right now are those hairdressers that wore masks and worked 8 shifts over 9 days, wearing masks and being in close contact for ~30 minutes at a time. No one came down with COVID - which is amazing.

The difference here is that you are proposing 3-5 people all sitting in a room for 8+ hours. That's not exactly the same as having a stylist in a room for 8 hours with a rotating pool of clients every 30 minutes. But the fact that no disease spread could be traced to their exposure is certainly a good sign. I haven't seen an in depth report yet on exactly how the salon was setup (layout inside, air conditioner, fans, windows open, etc...) but broadly it seems encouraging.

I wish I could offer something specific but the science just isn't there yet. All we're doing (collectively) is quickly scrapping together observational studies based on outbreaks we know about - church choirs, college students in fraternity houses, college students hanging out at bars, birthday parties, etc... and trying to figure out exactly what they did that put them at risk. About the best we have is (1) close, indoor contact (2) long period of time (30+ minutes) and (3) no masks.

I can't recall actually seeing anything outbreak related to people being in close contact for a long period of time, indoors and wearing masks. The best comparison would be medical staff but I wouldn't want to extrapolate their exposure risk to a regular business environment.

[Smoove_B]

So this is a terminology dispute, right? It's not like these insurgent experts are arguing that the coronavirus's method of transmission is any different than how we have previously understood it, but rather they are arguing that the known method of transmission should be classified differently, correct?

Sort of. The terminology confusion is there. However, at some point over the weekend I saw suggestions that the government (federal) should be issuing N95 masks to every American and mandating use. If primary spread is via indirect aerosols that would make sense (maybe). If primary spread is through droplets and possibly close-quarters airborne (that SPAT model), the cloth face coverings are likely enough (and certainly better than nothing).

All this goes back to the various groups arguing over whether or not masks should be used at all (any type) and then arguing when you make people wear cloth masks that's not really helping (observational evidence suggests otherwise).

[malchior]

How do people like this live with themselves?

https://twitter.com/BrianKarem/status/1 ... 9925921794

[Smoove_B]

Well, we are apparently leading the fight in trying to maximize spread. So maybe *technically* she's correct?