Coronavirus

[DuckIII]

So what is your alternative suggestion? This is a temporary measure so we can slow the spread while we increase testing and accumulate data on which to make subsequent decisions. I see a lot of complaining for complaint’s sake with absolutely no logically suggested alternative other than “do something less and hope for the best!”

The alternative is to let the virus go and deal with the consequences as best you can, which might be extremely poorly and result in 2 million people dying.

If we don't learn something that puts us fundamentally in a better position to treat this without social distancing in the next two months then the social distancing decision will have been an unmitigated disaster and probably the worst thing we could do.

Because then, you will be faced with two choices:
1: Continue social distancing. By 6 months of social distancing, you will probably in a national state of emergency with military control all over the nation to attempt to stop riots. You will probably end up with unemployment levels higher than the great depression and cause the complete economic collapse of the country.

2: Stop social distancing. Now instead of causing complete economic collapse, you've just caused a great recession, but you are also now going to see the virus do the exact same thing it would have done had you not social distanced at all, because you won't have flattened the curve, you will have just pushed the peak of the curve out by 2 months.

We have chosen a tactic that is only going to work if we're willing to go all in at it for a year or if we are able to learn something over the time we're doing it that puts us in a fundamentally better place. To take that gamble on new information coming, we've likely caused a global recession already. To take the gamble on going all in to really flatten the curve, we will probably cause the meltdown of the entire global economy and widespread loss of standard of living.

It's a difficult situation, and I am not pretending it's not. There are hard choices to make here.

"Some may look at [safety measures] and say they're going to be really inconvenient for people. Some will look and say, well, maybe we've gone a little bit too far? They were well thought out," he said. “I'll say it over and over again -- when you're dealing with an emerging infectious diseases outbreak, you are always behind where you think you are."

For someone whom thinks that we're understating the impact of the virus, he sure understates the impact of social distancing on society. "Inconvenient" is not a word I'd use to describe creating the worst economic conditions in the country since the great depression with upside to be the worst in the history of our nation. We're not there yet, but it sure looks likely that we're headed there.

Many people are very convinced about the damage the virus will do, but seem blissfully unaware of the damage social distancing will do if we have to remain on this path for any length of time.

Just so I understand, your proposed alternative is to do nothing and just hope for the best until we develop a vaccine. I’m not going to bother arguing that and I’m shocked that you consider it a legitimate option. I mean the notion that social distancing measures can only work if we commit to doing it for a year is pretty ridiculous considering that the primary reason for doing it is to permit the accumulation of data on which to base future decisions. It’s temporary because we know we are flying blind and need to try to get above the clouds to get a better view.

Also, I think you misunderstand the strategy behind flattening the curve. It’s in large part to help the healthcare community not be overburdened all at once. Spreading it out now does not mean it will immediately bulge once lifted. More importantly, in the meantime we can better equip hospitals to deal with an influx of cases. Trump, for example, is faced with using war powers to require manufacturers to produce healthcare equipment hospitals currently lack. If we buy time to prepare and equip, I.e., flatten the curve, the less likely we become tragically overburdened like the healthcare community in Italy.

The part of the Fauci quote that matters is the part about being behind where you think you are. The “inconvenient” part is outdated because he said it before the waive of shelter in place orders. He was referring to far milder measures. I should have cut that part out of the quote or noted that.

[whonka]

I still see a huge number of unknowns:
- Is the quarantining and social distancing working? Logic says that it has to be but Italy has been doing it for weeks and their situation seems to continue to deteriorate.
- Once we get past the initial surge, then what? Are we just going to keep the country locked down for 6 months? Will this die out? Is there some type of treatment or vaccine around the corner that can radically mitigate this?
- We still really don't know how rapidly the virus spreads and how severe it is. IMO, the data is still bad. You outright can't trust the Chinese and most of the rest of the world is rationing tests.

The economic situation is rapidly deteriorating. A $2T stimulus isn't doing bunk in the face of this. This is really uncharted territory from an economic standpoint. We are sitting on a mountain of debt in the private sector and most people stopped doing anything of value or spending discretionary income. I wouldn't be surprised if our day to day GDP wasn't down 35%. No one is buying anything of value, going out to restaurants or taking trips. The energy sector got nuked. Its basically just food and other consumer goods, defense spending, other government spending and medical.

This touches with my main problem about the social distancing plan. What is the end game here?

A vaccine is likely a year away for safety reasons, and if you try to flatten the curve, you will have to stay in this social distancing mode for that long unless you can completely wipe it out. Society will absolutely break down if you try to keep this up for that long.

If you thought social distancing until say April 15th would solve this problem, then sure, I'm all in, but there's really absolutely no reason to think that will do anything except slow it for a bit and the moment you stop, you're right back where you started a month later.

If you are trying to prevent the most economic impact while not causing lack of life then the ideal would be to flatten the curve enough that hospitals are always operating at maximum capacity, so that you don't make the duration too long.

You’re assuming social distancing in a vacuum. Social distancing is always to buy time, to let both medical capacity and knowledge catch up. Although a vaccine is a ways away, what we know now in terms of potential treatment options is already leaps and bounds ahead of where we were a month ago.

What needs to happen right now - enforced lockdown, government production of medical PPE and ventilators under that defense act, and hope that in 2-3 months our medical knowledge and capacity has caught up where we can at least have the tools to effectively combat this. Maybe then you release some restrictions.


To give you an idea of how bad it is right now, the CDC published new guidelines for PPE for medical providers along the lines of “if PPE is not available, consider using homemade equipment like bandannas and scarves as last resort”, when we have data out there saying bandannas and scarves are actually worse than no protection at all. Like what the **** is that? That is like being sent to a war zone to fight a gun fight with an home made cloth bullet proof vest”

We need to buy time. There is no alternative.

[coldfish]

https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-as-the-coronavirus-pandemic-takes-hold-we-are-making-decisions-without-reliable-data/

Sums up my feelings.

Weird article. What he says all the way to the end makes sense - we don’t have adequate testing or data to really know what is going on or what is the best course of action. Anyone who has been following the virus knows and accepts this reality.

Where he gets completely off the rails is at the end when he starts suggesting lockdowns and hard line social distancing is akin to jumping off a cliff without adequate decision making data. That is utter nonsense and is actually backwards.

The lockdowns and social distancing mandates are temporary caution induced measures to hopefully buy us more time to accumulate this much needed data so that we can make better informed long term decisions. It is the opposite of jumping off a cliff. Once you jump off a cliff you just fall. You cannot reverse course, and instead just pick up speed until you terminate. Here, we can reverse course and undo lockdown and social distancing guidelines if the increasingly accumulated data suggests we should.

Ironically, it’s the contrary approach that is akin to jumping off a cliff. If you do not take steps to slow the spread while data is accumulated, you cannot undo the spread that occurs during that time. You just pick up speed. The toothpaste does not go back in the tube.

I realize the data can be attributed to numerous things, but look at the respective data between Kentucky and Tennessee. Border states which took completely opposite approaches (KY cautiously preemptive minded and TN business as usual minded), seeing the reported cases spread in very different ways.

One can only hope that, much like in 1918, life will continue. Conversely, with lockdowns of months, if not years, life largely stops, short-term and long-term consequences are entirely unknown, and billions, not just millions, of lives may be eventually at stake.

If we decide to jump off the cliff, we need some data to inform us about the rationale of such an action and the chances of landing somewhere safe.

I took the article as "I have no idea what we should do and neither does anyone else because the data is crap." The "jumping off the cliff" seems to be referring to lockdowns of months if not years. I didn't take it the way you did and I agree with him that locking the entire economy for months is akin to jumping off a cliff.

[whonka]

I'm thinking if the government should pay volunteers in their 20s, 30s to get exposed and get immune. After 3 weeks, these people can start working in all kinds of services and slowly restarting the economy. That way you keep buying more time for a cure or a vaccine.

Great. And think about the backlash when a small percentage of those 20s, 30s die or get intubated.

This will get past absolutely no IRB.

[TallDude]

USA 14 000 positive test today. Numbers will be skyrocketing soon. Sadly only small amount of people get tested. Hopefully people avoid crowds. Here in Finland i`m just waiting when numbers rise fast. All the idiots are now at bars etc. Tomorrow they might close hole Helsinki city area. Around 1,3million people. And soon goverment must make more radical moves for hole country.

[DuckIII]

https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-as-the-coronavirus-pandemic-takes-hold-we-are-making-decisions-without-reliable-data/

Sums up my feelings.

Weird article. What he says all the way to the end makes sense - we don’t have adequate testing or data to really know what is going on or what is the best course of action. Anyone who has been following the virus knows and accepts this reality.

Where he gets completely off the rails is at the end when he starts suggesting lockdowns and hard line social distancing is akin to jumping off a cliff without adequate decision making data. That is utter nonsense and is actually backwards.

The lockdowns and social distancing mandates are temporary caution induced measures to hopefully buy us more time to accumulate this much needed data so that we can make better informed long term decisions. It is the opposite of jumping off a cliff. Once you jump off a cliff you just fall. You cannot reverse course, and instead just pick up speed until you terminate. Here, we can reverse course and undo lockdown and social distancing guidelines if the increasingly accumulated data suggests we should.

Ironically, it’s the contrary approach that is akin to jumping off a cliff. If you do not take steps to slow the spread while data is accumulated, you cannot undo the spread that occurs during that time. You just pick up speed. The toothpaste does not go back in the tube.

I realize the data can be attributed to numerous things, but look at the respective data between Kentucky and Tennessee. Border states which took completely opposite approaches (KY cautiously preemptive minded and TN business as usual minded), seeing the reported cases spread in very different ways.

One can only hope that, much like in 1918, life will continue. Conversely, with lockdowns of months, if not years, life largely stops, short-term and long-term consequences are entirely unknown, and billions, not just millions, of lives may be eventually at stake.

If we decide to jump off the cliff, we need some data to inform us about the rationale of such an action and the chances of landing somewhere safe.

I took the article as "I have no idea what we should do and neither does anyone else because the data is crap." The "jumping off the cliff" seems to be referring to lockdowns of months if not years. I didn't take it the way you did and I agree with him that locking the entire economy for months is akin to jumping off a cliff.

That’s how I took up until the end. You don’t get to months of lockdowns without first having days and weeks of it. It had to start.

If he means “these shelter in place and social distancing orders are excellent ideas until we get sufficient data to consider other options” he could have said that. But his article sets a very, very different tone and sends the opposite message.

He’s got it backwards. The article strongly implies we don’t have the data to justify these steps, when the whole point of taking the steps is that we know we need to get caught up on the data. The article is factual in content and counterintuitive in message.

[DuckIII]

I still see a huge number of unknowns:
- Is the quarantining and social distancing working? Logic says that it has to be but Italy has been doing it for weeks and their situation seems to continue to deteriorate.
- Once we get past the initial surge, then what? Are we just going to keep the country locked down for 6 months? Will this die out? Is there some type of treatment or vaccine around the corner that can radically mitigate this?
- We still really don't know how rapidly the virus spreads and how severe it is. IMO, the data is still bad. You outright can't trust the Chinese and most of the rest of the world is rationing tests.

The economic situation is rapidly deteriorating. A $2T stimulus isn't doing bunk in the face of this. This is really uncharted territory from an economic standpoint. We are sitting on a mountain of debt in the private sector and most people stopped doing anything of value or spending discretionary income. I wouldn't be surprised if our day to day GDP wasn't down 35%. No one is buying anything of value, going out to restaurants or taking trips. The energy sector got nuked. Its basically just food and other consumer goods, defense spending, other government spending and medical.

This touches with my main problem about the social distancing plan. What is the end game here?

A vaccine is likely a year away for safety reasons, and if you try to flatten the curve, you will have to stay in this social distancing mode for that long unless you can completely wipe it out. Society will absolutely break down if you try to keep this up for that long.

If you thought social distancing until say April 15th would solve this problem, then sure, I'm all in, but there's really absolutely no reason to think that will do anything except slow it for a bit and the moment you stop, you're right back where you started a month later.

If you are trying to prevent the most economic impact while not causing lack of life then the ideal would be to flatten the curve enough that hospitals are always operating at maximum capacity, so that you don't make the duration too long.

You’re assuming social distancing in a vacuum. Social distancing is always to buy time, to let both medical capacity and knowledge catch up. Although a vaccine is a ways away, what we know now in terms of potential treatment options is already leaps and bounds ahead of where we were a month ago.

What needs to happen right now - enforced lockdown, government production of medical PPE and ventilators under that defense act, and hope that in 2-3 months our medical knowledge and capacity has caught up where we can at least have the tools to effectively combat this. Maybe then you release some restrictions.


To give you an idea of how bad it is right now, the CDC published new guidelines for PPE for medical providers along the lines of “if PPE is not available, consider using homemade equipment like bandannas and scarves as last resort”, when we have data out there saying bandannas and scarves are actually worse than no protection at all. Like what the **** is that? That is like being sent to a war zone to fight a gun fight with an home made cloth bullet proof vest”

We need to buy time. There is no alternative.

I’m really grateful to have someone in the field injecting sane, real world content into this thread. Thank you.

[chitowndish]

Not sure if this has been posted already but a friend sent this along and I think she does an amazing job summing things up.

https://www.nbcchicago.com/news/local/chicago-doctors-blunt-speech-about-covid-19-hit-home-across-the-country-read-her-full-speech/2241815/

[dougthonus]

Just I understand, your proposed alternative is to do nothing and just hope for the best until we develop a vaccine. I’m not going to bother arguing that and I’m shocked that you consider it a legitimate option.

Causing economic conditions on par with the great depression doesn't sound like a reasonable plan either does it?

I mean the notion that social distancing measures can only work if we commit to doing it for a year is pretty ridiculous considering that the primary reason for doing it is to permit the accumulation of data on which to base future decisions. It’s temporary because we know we are flying blind and need to try to get above the clouds to get a better view.

I didn't say it was the only outcome.

There are many possible outcomes:
1: We find much better treatment in two months, and now we go back to work and don't worry about it because we can stop it from becoming so bad and overwhelming hospitals (best outcome) - makes social distancing a good decision

2: We do not find any real better treatment (or can't ramp up production of it meaningfully fast), and now need to continue social distancing for a longer period of time - medically this works out ok, but puts us close to great depression like conditions and may be worse than doing nothing depending on your view

3: Same as 2, except we say "screw it, we need to get back to work because the economic cost was to great" - makes social distancing decision terrible because we did nothing to improve the situation and still face the economic consequences

4: We find the virus really isn't that bad and would have been fine to just let go - makes social distancing a horrible decision

There might be other viable scenarios here, and I'm not saying each of these scenarios are equally likely either. I don't know what the weight of them is, but I do know that you can model the economic impact of this as well as the medical impact and that you could then make a decision based on numbers we've used in the past about how much money we spend to prevent loss of life to guide our decisions, but we're not doing that, at least no one I've seen is.

Also, the part of the Fauci quote that matters is the part about being behind where you think you are. The “inconvenient” part is outdated because he said it before the waive of shelter in place orders. He was referring to far milder measures. I should have cut that part out of the quote or noted that.

I have no problem with milder measures, obviously we should be taking milder measures. I mean at a minimum, everyone in this country whom can work at home should work at home. Some industries were probably going to break no matter what too because many people were going to self select out of things regardless of whether we were sheltering in place.

[P.C.]

I posted it in here because this is just the absolute scariest time for this to be happening. She’s now severely at risk and no one knows yet what affect covid-19 could have on a new born.

My wife is eight weeks pregnant. It is scary how little is known about the effects on the pregnant mother or the fetus. Just thinking about going to our first Dr visit on Thursday is un-nerving.

That said, CONGRATULATIONS!! Stay safe, stay sane and you will come out of this with the greatest gift you could ever imagine.

There is a lot of contradictory information out there. But hopefully this article is right. Says pregnant women do not pass it to the baby and are not considered more at risk.
https://www.healthline.com/health-news/coronavirus-may-less-harmful-for-children-pregnant-women

Last week, a newborn in the UK was either born with coronavirus or caught it in its first week. So people are questioning the pregnant women not passing it to babies bit.

https://www.livescience.com/newborn-has-coronavirus-london.html

[whonka]

Edit.

[Friend_Of_Haley]

There’s 6 reported deaths so far in Illinois.

To shut down the entire state seems pretty insane considering that a lot more than 6 people get shot in Chicago every month. Yet there’s no executive action/response to that problem.

At what point do we need to seriously think about what we’re doing? People losing their jobs and businesses seems much more damaging to me.

We've seen plenty of instances of how much this can spread. Italy has gone from its first deaths to now 750+ per day in under a month. So the first 6 deaths are just the tip of the tip of the iceberg. And even if mitigation is successful we could still see days ahead where deaths reach the hundreds in a day, the hope is it doesn't continue exponentially past there.

Interesting to the topic though, I read an interesting article several years ago about treating violence like an infectious disease, and how violent areas have actually successfully curbed violence with that strategy.
https://mosaicscience.com/story/violence-crime-knife-chicago-glasgow-gang-epidemic-gun-health-prevention/

Cole works as a “violence interrupter”, employed by Cure Violence to intervene in the aftermath of a shooting to prevent retaliations, and to calm people down before a dispute escalates to violence.

“My job is to interrupt transmissions,” Cole tells me. “We try to come up with different kinds of ways to deter these kids from the ways they’re used to thinking, and give them a different outlook.”

Almost sounds like social distancing. Now coronavirus is a multitude times more infections than violence. If shooting outbreaks have the potential to spark a dozen shootings from one in a short time, the coronavirus has the potential to spark thousands of infections and hundreds of deaths within a very short time.

[Dresden]

From what I understand, the shelter in place orders are put in place to slow down the spread, and to give us time to prepare, as people have been saying. After 3 weeks or so of that, the spread will hopefully have been slowed enough that we don't get overwhelmed. I am assuming that here in San Francisco, when the SIP order expires on April 7th, we'll all go back to work, but with new practices put in place to slow the spread. I know many people in my industry (construction) are coming up with a set of guidelines for our workers to follow such as mandatory hand washing, limiting the number of people on a particular job site, limiting the sharing of tools and the interaction of different crews, frequent sanitizing of things like doorknobs and locks and other surfaces, avoiding leaving the job site for food and coffee as much as possible, etc,.

And that will be the new normal until we get a vaccine or the outbreak burns itself out. We can't stay on lockdown forever- the economic consequences soon outweigh the benefits. But if we can just blunt the full force of the first wave of infections, we'll have bought some very valuable time.

[DuckIII]

Rand Paul has it.

[DuckIII]

From what I understand, the shelter in place orders are put in place to slow down the spread, and to give us time to prepare, as people have been saying. After 3 weeks or so of that, the spread will hopefully have been slowed enough that we don't get overwhelmed. I am assuming that here in San Francisco, when the SIP order expires on April 7th, we'll all go back to work, but with new practices put in place to slow the spread. I know many people in my industry (construction) are coming up with a set of guidelines for our workers to follow such as mandatory hand washing, limiting the number of people on a particular job site, limiting the sharing of tools and the interaction of different crews, frequent sanitizing of things like doorknobs and locks and other surfaces, avoiding leaving the job site for food and coffee as much as possible, etc,.

And that will be the new normal until we get a vaccine or the outbreak burns itself out. We can't stay on lockdown forever- the economic consequences soon outweigh the benefits. But if we can just blunt the full force of the first wave of infections, we'll have bought some very valuable time.

Exactly. And if you don’t buy that time now, you cannot do it later. It has to be early to have any positive effect. That’s just a scientific fact based on how diseases spread, not an opinion. Indeed, the likely scenario is that we already started much later than we should have.

[GetBuLLish]

All I can say as a front line medical worker seeing the deluge, your tune will likely change once you or someone you know is struggling to breath with no ICU beds available. How about arguing economic impact at that time?

This post exactly why people in the medical field should be part of the policy discussion but not determining policy.

You only see what's in front of you, which are the patients suffering from the virus. But you have no awareness of the social and economic impact of whatever policy you are advocating. You don't even consider those things.

So let me ask you, what is the effect of millions of people losing their jobs in the next two months? What strains does that cause on society? How many people die as a result? What happens to rate of violent crime?

At what point do the negative consequences of nationwide shutdowns outweigh the benefits of flattening the curve?

Or let me put it like you did: will your tune change if a family member is murdered as a result of mass rioting? Or if a family member commits suicide because he lost his job and can't care for his family?

[GetBuLLish]

Many people are very convinced about the damage the virus will do, but seem blissfully unaware of the damage social distancing will do if we have to remain on this path for any length of time.

Exactly.

[dougthonus]

Exactly. And if you don’t buy that time now, you cannot do it later. It has to be early to have any positive effect. That’s just a scientific fact based on how diseases spread, not an opinion. Indeed, the likely scenario is that we already started much later than we should have.

So far all explanation for social distancing I read about is flattening the curve. To flatten the curve you need to do it for a super long time and the economic impact to flatten the curve is catastrophic.

I do think there is value in getting more information, or mass producing ventilators, or making tons of make shift hospital beds, or figuring out ways to ramp up the number of sick we can care for at once. If you find a good treatment method and mass produce that as well then that also has tons of value.

I'm not against social distancing per se, I just don't think you can do it for an extended period of time. I think anything more than 2 months will be catastrophic and even 2 months might be catastrophic. You have to gain something in those 2 months that is meaningful, because you won't flatten the curve in that time.

[Dresden]

One positive impact of the shelter in place order- air pollution in San Francisco is down 38% from what it was....

[Dresden]

Exactly. And if you don’t buy that time now, you cannot do it later. It has to be early to have any positive effect. That’s just a scientific fact based on how diseases spread, not an opinion. Indeed, the likely scenario is that we already started much later than we should have.

So far all explanation for social distancing I read about is flattening the curve. To flatten the curve you need to do it for a super long time.

I do think there is value in getting more information, or mass producing ventilators, or making tons of make shift hospital beds, or figuring out ways to ramp up the number of sick we can care for at once.

It worked in China after about 6-8 weeks of very tight restrictions. Same in South Korea, along with aggressive testing and aggressive tracking down who infected people came in contact with.