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

[Isgrimnur]

It's like someone opened Pandora's Box.

[Smoove_B]

Goes to show, no matter how much you know, there's always more to learn. This is the literal first time I'm hearing about this after 20+ years in public health:

The quartering of sick troops forced civilians to come into intimate contact with disease. Soldiers sometimes paid to stay in private homes instead of hospitals, but they weren’t always welcome. One man complained that soldiers had whipped his children, killed his animals, and deprived “his wife of her Bed by plasing in one of their party whome they said was sick.”

...

Madison soon proposed a Bill of Rights that included a provision against quartering, and Congress approved a version that became the Third Amendment.

The final text does not mention disease, but the text of the amendment has not been an impediment to expansive (albeit controversial) interpretations in other regards. In 1965, the Court, in Griswold v. Connecticut, cited the amendment to find an implied constitutional right to privacy, and similar reasoning could be used again. Yet if the Third Amendment may have something to do with a right to be free from infection, what exactly is that right?

[Daehawk]

plasing?

[Alefroth]

Hey Europe, hows it going?

https://twitter.com/EricTopol/status/13 ... 97/photo/1

Nearly vertical you say? I mean, really.

Is that us soon? Are we doing anything better than Europe?

[Little Raven]

Is that us soon? Are we doing anything better than Europe?

Impossible to say. We've done a lot of stuff differently than Europe...just look at the shape of the curves up until now.

[El Guapo]

FWIW my kids' school (K-8) has been doing in-person instruction (with remote learning options) for close to two months now. About a month ago one parent tested positive, followed by their kid (which led to that kid's learning "pod" going mandatory remote for a few weeks), although there were no further cases, which makes me think that the parent got it outside of school and transmitted it to their kid.

Knock on wood, that's it so far and it's been working well. One thing is that the school has a lot of options that other schools don't - a fairly big building relative to attendance, lots of outdoor space (which they're using as much as possible), comparatively low community infection rates, a new ventilation system, enough staff to implement smaller learning "pods", and a mask-friendly community (I've been to a few outdoor school events, and I have yet to see a parent even have to remind their kid to keep their mask on, which even in relatively sane Massachusetts has been a pleasant surprise to me).

We'll see how it shakes out going forward.

[Isgrimnur]

plasing?

*placing

[Smoove_B]

Is that us soon? Are we doing anything better than Europe?

We're in trouble - broadly. I don't know if the rate is going to spike to a straight line like it apparently is in the EU, but our third bump is going to be much, much higher. I mentioned it before, but we're seemingly creating what's known as a propagated curve. In short, each subsequent peak is higher than the last. This is why over the last ~5 days numerous public health people have been in the media saying we're in the "next wave". If you look at that graph and the first two "peaks" (~40 days; 140 days) that's why there's a guess we're going to peak again in another 4-6 weeks. At what level? I guess we'll see.

[Daehawk]

plasing?

*placing

Oh. Its a strange word to use there yet its right in front of me.

Also Trump says if we didn't test so much there'd be less sick people. Too much testing going on. Stop it and we are amazing here. Just fine.

[Kraken]

there's a guess we're going to peak again in another 4-6 weeks. At what level? I guess we'll see.

Thanksgiving and Xmas are going to bring millions of not-super spreader events, because too many Americans will party like it's 1999. The peak will come some weeks after xmas.

[Daehawk]

Dont forget Black Friday.

[Smoove_B]

Thanksgiving and Xmas are going to bring millions of not-super spreader events, because too many Americans will party like it's 1999. The peak will come some weeks after xmas.

Thanksgiving in Xmas might be the *next* peak, in early 2021. However, if things are really bad right before Thanksgiving, maybe that will change people's plans the increases will stop.

(pauses for laughter)

So yeah, more pain.

EDIT: And you don't need to take my word for it. Just listen to Steak-umm:

https://twitter.com/steak_umm/status/13 ... 8729296896

[YellowKing]

Just when I think things can't get any worse, Steak-Umms is giving better medical advice than our government.

[$iljanus]

Thanksgiving and Xmas are going to bring millions of not-super spreader events, because too many Americans will party like it's 1999. The peak will come some weeks after xmas.

Thanksgiving in Xmas might be the *next* peak, in early 2021. However, if things are really bad right before Thanksgiving, maybe that will change people's plans the increases will stop.

(pauses for laughter)

So yeah, more pain.

EDIT: And you don't need to take my word for it. Just listen to Steak-umm:

https://twitter.com/steak_umm/status/13 ... 8729296896

When the public health officials, doctors and scientists are ridiculed, ignored or silenced and officials at all levels of government fail in their duty to educate and safeguard the public, all that's left to teach people about the consequences of this disease is pain and death where the innocent and guilty suffer together.

The data is fucking out there but if you're not listening what the hell is really left?

[Smoove_B]

Just when I think things can't get any worse, Steak-Umms is giving better medical advice than our government.

If you read through the replies, they even speak to creating emotionally intelligent messaging. It's surreal (but correct).

[El Guapo]

Would it be possible for Biden to appoint Steak-Umms as the next Director of Health and Human Services?

Or maybe just to the coronavirus task force. I'm assuming that there's too much of a conflict between Steak-Umms products and HHS's missions more generally.

[Kurth]

Just when I think things can't get any worse, Steak-Umms is giving better medical advice than our government.

Love that Steak-umm account, but I think it’s a little cursory to just say, “follow public health guidelines.” One of the fundamental problems in our response has been confusion about what those guidelines are and where to find them. Not sure we can do much about the fact that government can’t get its shit together to issue one set of consistent guidelines - or several tailored sets based on circumstances in a given location - but would it be that hard to make it impossible to miss whatever guidelines apply in a given place? Shouldn’t they be on billboards and reprinted every single day on the front page of the paper and reposted daily on the top 100 internet sites? I just feel like we could do more to push those guidelines front and center.

[Grifman]

Just when I think things can't get any worse, Steak-Umms is giving better medical advice than our government.

Love that Steak-umm account, but I think it’s a little cursory to just say, “follow public health guidelines.” One of the fundamental problems in our response has been confusion about what those guidelines are and where to find them. Not sure we can do much about the fact that government can’t get its shit together to issue one set of consistent guidelines - or several tailored sets based on circumstances in a given location - but would it be that hard to make it impossible to miss whatever guidelines apply in a given place? Shouldn’t they be on billboards and reprinted every single day on the front page of the paper and reposted daily on the top 100 internet sites? I just feel like we could do more to push those guidelines front and center.

Seriously, you don't know public health guidelines there are for this? Wear masks, maintain social distancing, and wash your hands. If we were to do this, infections and deaths could be dramatically reduced. It's really not all that hard.

[NickAragua]

I guess it's hard for some people to give up their nightly routine of going out to crowded strip clubs, snorting coke off "shared surfaces" then licking every doorknob in sight. I mean, I don't expect everyone to be able to peer review published papers in scientific journals, but is it really that hard to just put on a goddamn mask when you go into a space with other people?

Rhetorical question, unfortunately, I already know the answer.

[El Guapo]

To be fair, snorting cocaine off of strippers in night clubs is a lot of fun.

[stessier]

To be fair, snorting cocaine off of strippers in night clubs is a lot of fun.

Lawyers have all the fun.

[Jaymann]

To be fair, snorting cocaine off of strippers in night clubs is a lot of fun.

As long as you have a six foot straw.

[Blackhawk]

Just when I think things can't get any worse, Steak-Umms is giving better medical advice than our government.

Love that Steak-umm account, but I think it’s a little cursory to just say, “follow public health guidelines.” One of the fundamental problems in our response has been confusion about what those guidelines are and where to find them. Not sure we can do much about the fact that government can’t get its shit together to issue one set of consistent guidelines - or several tailored sets based on circumstances in a given location - but would it be that hard to make it impossible to miss whatever guidelines apply in a given place? Shouldn’t they be on billboards and reprinted every single day on the front page of the paper and reposted daily on the top 100 internet sites? I just feel like we could do more to push those guidelines front and center.

Seriously, you don't know public health guidelines there are for this? Wear masks, maintain social distancing, and wash your hands. If we were to do this, infections and deaths could be dramatically reduced. It's really not all that hard.

Yes, but at the same time the public is given contradictory information, different guidelines every time they cross county lines, and have the people who should be setting the guidelines telling them not to follow them.

[LawBeefaroni]

Just when I think things can't get any worse, Steak-Umms is giving better medical advice than our government.

Love that Steak-umm account, but I think it’s a little cursory to just say, “follow public health guidelines.” One of the fundamental problems in our response has been confusion about what those guidelines are and where to find them. Not sure we can do much about the fact that government can’t get its shit together to issue one set of consistent guidelines - or several tailored sets based on circumstances in a given location - but would it be that hard to make it impossible to miss whatever guidelines apply in a given place? Shouldn’t they be on billboards and reprinted every single day on the front page of the paper and reposted daily on the top 100 internet sites? I just feel like we could do more to push those guidelines front and center.

Seriously, you don't know public health guidelines there are for this? Wear masks, maintain social distancing, and wash your hands. If we were to do this, infections and deaths could be dramatically reduced. It's really not all that hard.

Yes, but at the same time the public is given contradictory information, different guidelines every time they cross county lines, and have the people who should be setting the guidelines telling them not to follow them.

Because the Federal government threw up its hands and let all the little fiefdoms figure out for themselves.

[LordMortis]

Because the Federal government threw up its hands and let all the little fiefdoms figure out for themselves.

They have been chastising the fiefdoms and fiefdom leadership that.... they didn't... like... and have encouraged armed civil disobedience against some fiefdoms figuring, so they were doing something.

[Kurth]

Just when I think things can't get any worse, Steak-Umms is giving better medical advice than our government.

Love that Steak-umm account, but I think it’s a little cursory to just say, “follow public health guidelines.” One of the fundamental problems in our response has been confusion about what those guidelines are and where to find them. Not sure we can do much about the fact that government can’t get its shit together to issue one set of consistent guidelines - or several tailored sets based on circumstances in a given location - but would it be that hard to make it impossible to miss whatever guidelines apply in a given place? Shouldn’t they be on billboards and reprinted every single day on the front page of the paper and reposted daily on the top 100 internet sites? I just feel like we could do more to push those guidelines front and center.

Seriously, you don't know public health guidelines there are for this? Wear masks, maintain social distancing, and wash your hands. If we were to do this, infections and deaths could be dramatically reduced. It's really not all that hard.

I was absolutely serious. What you are pointing to are the most basic of precautions and, while I think everyone knows or should know those by now, they address the tip of the iceberg as far as questions I have about how my family should be conducting daily life.

Should my kids be going to in-person school (they're not)? Should they be playing soccer (they are)? Last week, there were no soccer games permitted on town fields. This week, soccer games are permitted, but only if the kids wear masks. Should my son be playing in those games (he is)? Should we be eating out (we are)? Should we be limiting it to outdoor dining (we are not)? Halloween is coming up. Should the kids trick-or-treat (they're not)? Should we have candy and keep the lights on encouraging trick-or-treaters at our house (we are not)?

You can say, "Just follow the guidelines . . . It's really not all that hard." But I think that's complete bullshit. Every day, since this thing started, I've been trying to figure out what the right thing is to do in a million and one situations. I think it's not nearly as clear as you are making it out to be.

[Remus West]

Because the Federal government threw up its hands and let all the little fiefdoms figure out for themselves.

They have been chastising the fiefdoms and fiefdom leadership that.... they didn't... like... and have encouraged armed civil disobedience domestic terrorism against some fiefdoms figuring, so they were doing something.

ftfy

[stessier]

Just when I think things can't get any worse, Steak-Umms is giving better medical advice than our government.

Love that Steak-umm account, but I think it’s a little cursory to just say, “follow public health guidelines.” One of the fundamental problems in our response has been confusion about what those guidelines are and where to find them. Not sure we can do much about the fact that government can’t get its shit together to issue one set of consistent guidelines - or several tailored sets based on circumstances in a given location - but would it be that hard to make it impossible to miss whatever guidelines apply in a given place? Shouldn’t they be on billboards and reprinted every single day on the front page of the paper and reposted daily on the top 100 internet sites? I just feel like we could do more to push those guidelines front and center.

Seriously, you don't know public health guidelines there are for this? Wear masks, maintain social distancing, and wash your hands. If we were to do this, infections and deaths could be dramatically reduced. It's really not all that hard.

I was absolutely serious. What you are pointing to are the most basic of precautions and, while I think everyone knows or should know those by now, they address the tip of the iceberg as far as questions I have about how my family should be conducting daily life.

Should my kids be going to in-person school (they're not)? Should they be playing soccer (they are)? Last week, there were no soccer games permitted on town fields. This week, soccer games are permitted, but only if the kids wear masks. Should my son be playing in those games (he is)? Should we be eating out (we are)? Should we be limiting it to outdoor dining (we are not)? Halloween is coming up. Should the kids trick-or-treat (they're not)? Should we have candy and keep the lights on encouraging trick-or-treaters at our house (we are not)?

You can say, "Just follow the guidelines . . . It's really not all that hard." But I think that's complete bullshit. Every day, since this thing started, I've been trying to figure out what the right thing is to do in a million and one situations. I think it's not nearly as clear as you are making it out to be.

Your situations are interesting and I'm curious how you make the decisions. What are you guiding principles?

For me, it's avoid gatherings and indoor settings, maintain social distance, wear a mask, wash your hands. This seems like what is generally advised.

Using your situations - we aren't sending the kids to school. I wouldn't feel great about letting them play soccer, but could be talked into it. I won't eat out but could see others choosing to do so outdoors. I would never do it indoors. I would let them Trick-or-Treat if they did it alone and never got near a candy giver or another group. I wouldn't hand out candy.

[Ralph-Wiggum]

Trump just signed an executive order that seemingly gives him the power to fire civil servants that otherwise were protected. Presumably this is the first step in him firing Fauci?

[LordMortis]

Because the Federal government threw up its hands and let all the little fiefdoms figure out for themselves.

They have been chastising the fiefdoms and fiefdom leadership that.... they didn't... like... and have encouraged armed civil disobedience domestic terrorism against some fiefdoms figuring, so they were doing something.

ftfy

The thing is I wasn't being facetious or using hyperbole, even if I was sarcastic. I don't think federal government has overtly encouraged domestic terrorism (even if they are dog whistling so much the dogs are like "enough already!"). Federal government has gotten on TV and Twitter and literally attacked state and local health guidelines (without pointing to federal ones as the correct one) and has literally encouraged armed civil disobedience.

Hopefully, it will forever be historical record.

https://www.cnn.com/2020/05/01/politics ... index.html

Using your situations - we aren't sending the kids to school. I wouldn't feel great about letting them play soccer, but could be talked into it. I won't eat out but could see others choosing to do so outdoors. I would never do it indoors. I would let them Trick-or-Treat if they did it alone and never got near a candy giver or another group. I wouldn't hand out candy.

Mom just did trunk or treat... in Ann Arbor... I'm glad it was outdoors... But Ann Arbor...

https://www.clickondetroit.com/all-abou ... 19-spread/

[Smoove_B]

You can say, "Just follow the guidelines . . . It's really not all that hard." But I think that's complete bullshit. Every day, since this thing started, I've been trying to figure out what the right thing is to do in a million and one situations. I think it's not nearly as clear as you are making it out to be.

No, I think you have raised valid criticisms all around. There is absolutely mixed-messaging going on and I agree it's hard to know which voices to listen to - particularly when there's difference in what elected officials (mayors, county commissioners, governors) are saying/doing vs what state and local public health officials are saying/doing.

Truly the breakdown stems from the federal government and the CDC inability to take the lead on this. It's also become readily apparent that even when they tried, their messages were either deleted or edited at the whim of the White House - which is bonkers.

I'm jacked-in to the mothership (i.e. the public heath community) so my information is coming from trusted professionals. It's also largely congruent with what's happening in my own state so there isn't confusion.

I can't speak to what your state public health officials are saying, but I can understand how your locals are confusing the issue. I'm currently trying to advise a local Boy Scout council on how they should proceed with Fall/Winter camping as local and even state health officials can't seem to make official recommendations because there seems to be a disconnect with the idea that people (and groups) are camping or could be camping outside of a window of time they would normally consider.

Regardless, there's still so much guessing going on regarding schools, mass-transit, indoor dining and even outdoor events.

Now that I have you reading along, I'm also going to tell you (OO) a secret. There are no plans and no way for any mass vaccinations to involve children. Why? Because they're not testing vaccines on children. So when the vaccines are eventually released not only are they going to be staged to the first-tier workers that have already been identified (i.e. not suburban parents), but they're absolutely not going to be offered to children. No one seems to be talking about this yet, but I suspect when they figure it out it'll be news. Why? Because it's an entire cohort (70+ million) that won't be vaccinated - which means that it's going to be even more important for as many people 18+ to receive the vaccination when it's available.

So yeah, it's still a mess. There isn't a single "best" answer for everyone either. You're comfortable eating indoors at a restaurant. I'm telling you I won't be doing it until 2022 at the earliest unless something changes. I've repeatedly been invited to informal indoor social gatherings since April and have declined every single time. Hell, a few months ago my MIL told me she was coming to visit us for Christmas (update: she's not). I still don't know anyone with COVID despite hearing about various vacations, gatherings and travel all summer long.

But to circle back, the general advice of (1) wearing a mask (2) maintaining distance and (3) remaining outdoors are all solid. Applying those to specific scenarios is the rub and where comfort and willingness to take risk enter the equation.

[ImLawBoy]

Any ideas around the time frames for vaccinating kids? Would they be willing to make exceptions for "high risk" kids, or does the lack of testing on kids shut that down completely?

[Smoove_B]

I'm not exactly sure. I'm sure there are mechanisms that will allow for exceptions that will somehow involve agreements between the doctors, parents and vaccine manufacturer, but I'm pretty confident it'll be on a case-by-case basis. I cannot imagine a scenario like an influenza clinic where anyone can just roll up and get a vaccination; it's going to be much more controlled and ordered.

But yes, the hesitancy comes from a complete lack of data. Maybe after the initial round of vaccinations are offered they'll consider testing in groups (16-18? 14-18?) to verify safety, but given how quickly the initial vaccine is allegedly coming out, we're really (still) in uncharted waters.

[coopasonic]

My main rule is don't go anywhere that isn't necessary. According to my wife, gatherings at her parent's house are, in fact, necessary. Her parents are in their late 70s and her step-dad is very much out and about. Oh and my wife works in a hospital dealing with COVID patients on a regular basis and my kids are going to in person school. I am not sure who poses the most risk to the health of my family, but it's much higher than I would like.

[LawBeefaroni]

The American Academy of Pediatrics wrote an open letter to the FDA last month about this. It is indeed a concern.

Any ideas around the time frames for vaccinating kids? Would they be willing to make exceptions for "high risk" kids, or does the lack of testing on kids shut that down completely?

You'd probably have to get into a clinical trial. No one is going to give an adult vaccine to kids against FDA recommendations.

[stessier]

FDA approves Gilead’s remdesivir as coronavirus treatment

Wasn't there just a European study that said it didn't help?

[malchior]

FDA approves Gilead’s remdesivir as coronavirus treatment

Wasn't there just a European study that said it didn't help?

IIRC it essentially was flat against the control for mortality. It may shorten the time in the hospital for non-fatal cases (something like 10-11 days versus 14 average). So there may be some benefit but this feels pretty politicized.

[wonderpug]

FDA approves Gilead’s remdesivir as coronavirus treatment

Wasn't there just a European study that said it didn't help?

IIRC it essentially was flat against the control for mortality. It may shorten the time in the hospital for non-fatal cases (something like 10-11 days versus 14 average). So there may be some benefit but this feels pretty politicized.

I'd be curious to see if the FDA approval signature was done in giant black sharpie.

[Smoove_B]

Snapshot USA:

The U.S. set a record Thursday as the number of new coronavirus cases rose to over 77,000, topping the previous record in July.

Nationwide, 77,640 new cases were reported for the day, up from the previous record of 75,723 on July 29, according to the latest tally compiled by NBC News.

The record-breaking daily tally comes as the total number of coronavirus cases in the country has reached nearly 8.5 million, with 224,280 deaths. There were 921 coronavirus-related deaths reported on Thursday.

[Paingod]

At what point can we stop calling it "record-breaking" like it's going into the Guiness Book? It's the escalating loss of human life. It's going to continue breaking records until we have a huge vaccination push.