stevenkesslar

This notion that lock downs were not effective should be banished. Sorry, but its just sounds ridiculous. Before lock down, the number of new cases in New York grew from 100 to 10,000 in a matter of weeks. We now know that this process of uncontrolled exponential viral growth killed over 20,000 New York City residents. Had there been no lock downs, do we think the virus would have stopped? Or might 20,000 and then 30,000 New York City residents a day have become infected before long as the exponential growth continued? I posted a recent story that estimated 60 million infections in the US were prevented. Those are of course the kinds of studies that invite ridicule. But the idea that no lock down would have meant less death in New York, or anywhere, is just not rational. I'll keep pointing to South Dakota and North Dakota. They had multiple communities that went from "that's a New York problem" to "this is a big fucking problem here" in a matter of weeks. Talk to the meat packing companies in those states about how well it worked not to be prepared, and how their penalty was having to shut down for a while. I think there were two big victories from the lock downs. The intended purpose was to crush the exponential and out of control growth of the virus. We did that. I think the other victory is that the lock downs were a sort of viral "time out". We behaved badly, so we had to go into a corner and learn our lesson. I think "time out" is actually a good way to think about it. I don't mean we are children, or stupid. I mean that we behaved in a way that did not include awareness of the virus. Now we have gone through a massive behavioral and societal change. Nobody wants to go back into time out. So I think "time out" served its purpose of changing behaviors that were, in this case, harmful to human life. Just ask the 20,000 dead in New York City how harmful being ignorant of the virus was, rest their souls. I'm going to post two clusters of states and their viral infection rates. It's a mystery to me. California Oregon Montana Those three states have solid plans for testing and contact tracing. As an aspiration, at least, contact tracing should be able to virtually eliminate the virus. Something like that has happened in Iceland and New Zealand. While "real" countries, like Germany or South Korea or France, have not done that, they appear to be well on the way. California is smaller than Germany, and Montana is smaller than New Zealand. So the specific thing that is puzzling to me is why none of these states can get the infection rate to stay below 1. The good news is they are keeping it under control. The bad news is they are only keeping it under control. Now let me add some caveats. In Montana the number of cases jumped in the last two weeks, from 0 to 4. In Oregon it also jumped, from 34 to 93. So those are small numbers of cases. The numbers could have jumped precisely because contact tracers are finding infected people through testing and isolating them. I've looked for articles on testing and tracing in both states, without success. This is the kind of boring stuff the media just doesn't cover very well. That number on contact tracing in California went from 10 % of all cases just a few weeks ago to 35 % now. I think the state is getting up to speed, but not there yet - as that 35 % clearly says. Part of the goal of lock downs, at least in California, was to get this testing and tracing infrastructure in place. My guess, which is based on total ignorance, is that state leaders hoped we would be further along by now. The fact that we didn't have the same level of national unity as many other countries may have had something to do with it. Regardless, we are where we are. California has had 4,772 COVID-19 deaths compared to an annual average of 4,701 flu deaths. By comparison, New Jersey has 944 flu deaths in an average year. They had 12,369 COVID-19 deaths in the last three months. So while California's data are "among the worst" in terms of growth, as you say, back in March there was talk about over half the state being infected, And hundreds of thousands dying. That didn't happen. So I agree with your assessment. Things could go either way in California. But from the perspective of the worst case scenario, or of what actually happened in New Jersey, California dodged the bullet. Again, I would argue its ludicrous to say the lock downs didn't work. California could have been just as bad as New Jersey. A similar death rate -12 times our annual flu deaths like what happened in New Jersey, would have meant 50,000 dead in California. Had New Jersey not locked down when it did, there could have easily been 50,000 dead there, too. To that point: New York New Jersey Massachusetts Those are the three hardest hit states. They account for almost half the national death toll. In all three states, the infection rate is well under 1. In all three states, caseloads are down in the ballpark of 90 % from their peak. They are very similar to Germany and Italy and France in terms of the trend. The virus has not been eliminated. But it has seemingly been crushed for now. All three states have contact tracing rates of like 30 % or so tops. In New York it's 11 %. I look at this site more than any other one. In New York the contact tracing was close to 0 % a few weeks ago. So they are also in early days and getting up to speed on tracing. I'm not sure any valid conclusions can be reached from this. It certainly seems like the lock downs drove the infection rates down in all six states. The hardest hit states in New England drove the infection rates down the most - like 0.77 in both New York and New Jersey. In California in particular, as you stated, the overall trend line has been a gradual increase. This is partly why I think the "time out for bad behavior" concept is not a bad theory. To put it in even harsher terms, being in the middle of a morgue where 20,000 people were in the process of getting sick, being hospitalized, being on vents, and dying must have scared the living shit out of almost everyone. The people I know from New York confirm this. @purplekow's posts are moving, and also like from a horror movie. They are painful to read. I'm very glad he is posting them, because they expose us to the reality of what it is actually like to be kind of living a horror movie. That reality may have driven compliance and behavioral changes in a way that just didn't happen in Florida or Texas or California. Even though my sense is that people - especially seniors - in those states made rapid behavior changes as well. We actually know that for a fact from GPS/cell phone data in places like Florida. And looking backward, contact tracing had little to do with any of this, since that is still getting up to speed. If I had to write an essay to get into college and try to make a rational argument based on this data, I think the argument I'd make is the single most important factor was changes in human behavior because people got the living shit scared out of them. And in the places where bodies were piling up in temporary morgues, people were even more scared and compliant. That's what the data says to me. Again, I think the elephant in the room is that we are going to be in recession and be fucked as long as this situation continues. It is good news that when stores reopened people were needed to work in them. I'm personally happy several million people are back to work. That was inevitable when businesses started to open again. But it's way too early to say that we are now well on our way to a V-shaped recovery. The news from the "front line" countries like Germany is mixed. Demand is not just springing right back to normal. Although I am quite sure the goals of those governments with testing and contact tracing and public education is to create an environment that leads consumers to think it is safe to come out and consume again, in stages. In California, we could have 50 % fewer cases by September as these other tools like more testing and contact tracing and aggressive efforts by corporations to create safe work spaces kick in incrementally. Or we could have 100 % or - worst case - 1000 % more cases. If anything like the latter happens, forget your V-shaped recovery. The best news, to me, is that the trend is so clear now all over the world that a certain set of behavior changes and containment steps work, wherever they are tried, that we seem to be on a global road to success. Maybe this virus has some surprise new feature to spring on us this Fall. But everybody is baking that possibility into the cake with testing and surveillance. So we ought to be able to incrementally reduce the number of cases before Fall even hits. If schools are open in California in the Fall and kids can go to Disneyland, albeit cautiously, those will be very good measures of success for me.

https://www.covidexitstrategy.org/ https://covidactnow.org/ I've posted those two websites a lot. I don't think there's anything wrong with CNN or the Times. But those two do the best job of giving a snapshot of all the variables you mention. The bad news is that there's not a lot of states that we can say are anywhere near licking this thing. At best you can say we're keeping it under control - sort of, maybe. What's sad to me is that pretty much every country in the continent of Europe except Sweden would probably meet the CDC's standards for reopening. The most important being a consistent 14 day downward trajectory. Even the UK, which has been the recent laggard - if they are even still "Europe" - is now on a clear downward trajectory. The US has been plateaued at 20,000 cases a day for like a month. So it could go either way. And if you leave the states that were hit hardest out, the number of cases is mostly trending up. That's mostly because in the most populous states outside New England - California, Texas, Florida - the trend is up. We are were we are. We are reopen, whether we should be or not. And we have a massive lock down on consumer demand that is driving a recession, and will keep us in recession, whether anyone wants to recognize that or not. Whether the goal is to stop the virus from killing people or to stop the virus from killing businesses and the US economy (I would argue there is almost no difference between the goals as long as the US is a consumer-driven capitalist economy), the goal should be killing the virus. I think that boils down to three words: test, trace, treat. And I think there's two main institutional forces to do it: Governors, and businesses. Probably large corporations are more important, at least in terms of setting the tone and showing what works. But what seems clear now, precisely because we are NOT seeing massive uncontrollable spikes - at least yet - is that the public education part of this has worked well. In February and early March, the virus had free reign over an ignorant public. And we know that took the death toll in New York City from 0 to 20,000 in no time. That is not happening now. So I think the main explanatory factor has to be an informed public. For the same reason, I would not discount the collective efforts of small businesses. They may be lacking in resources, but they have an even better reason to read the memo and comply with it - survival. I'm going to keep arguing that the downside of an informed public, if you happen to believe that the only thing that matters in an economy is buy, buy, buy and shop, shop, shop, is that an informed public simply won't do that until the virus goes away or is virtually eliminated, like in Europe or South Korea or Australia. Certainly the majority of consumers won't consume like they did in 2019. That is, no doubt, one of the reasons the virus is not spiking out of control. We Need to Reopen Schools—but How? While more than 20 European countries have reopened schools, America seems unable even to approach the problem rationally. That articles reinforces what I said about Denmark, and expands on it. I strongly agree with the author that being able to reopen schools this Fall would be a huge victory. If we can't figure it out, shame on us. And while there may be elements of this debate that are political, the core of it is what Fauci and others talk about: data. And the biggest data is what revolves around test, trace, treat. As the article states, all of these seeming successes are happening in the context of countries that are committed to tracking down the virus and killing it through testing and contact tracing. Recall that Merkel, who is one of the global stars (at least to me), opened discussion in her country by stating 70 % of Germans may get this. We now know better than we did then what a disaster that would have been - for the German people, and for the German economy. I think the news is mostly better than expected. Merkel is as straight a shooter as there is in politics. She thinks and talks like a scientist, at least on this issue. I doubt she thought three months ago that Germany, and Europe, could be talking about effectively eliminating the virus, without a vaccine, by this point. The other thing about children and schools is it is logical to think that they are going to be disproportionately asymptomatic rather than symptomatic, if infected. That's good news/bad news. It's good news for the kids, and the parents worried about them. It's bad news for somebody who could die if kids brought it home. There is no medical evidence I've read that children can not spread the disease. As that article states, there is plenty of evidence that they have viral loads comparable to adults. I'm not a scientist. But I would have to guess that in a completely uncontrolled environment, lots of infected children would be disease spreaders. My point is that all roads lead to Rome. We have to get a handle on asymptomatic spread. And the best way to do that is effective contact tracing. I suspect one reason why the US is doing a particularly poor job of getting the number of cases down is that we don't have a handle on asymptomatic spread. Even the math makes sense. If 1 in 3 infected people are asymptomatic, and they each infect 2 other people, that's a recipe for maintaining a steady level of new cases. In reality some asymptomatics are likely being caught through testing before they infect others. And some people with symptoms are infecting others. But almost every story I read about every nation that has virtually crushed COVID-19 talks about testing and contact tracing and tracking the virus down and killing it. That is a completely apolitical concept. I like the Texas word for it: "viral SWAT teams". It makes it sound like a macho guy action movie, where we are the good guys and we are going to beat this little fucker. That should be an idea everybody can get behind.

Coronavirus shutdowns prevented 60 million infections in the USA, study says A pretty amazing number. If you buy even a fraction of that number, the US and the world did a pretty amazing job of dodging a bullet. Or more like dodging a whole bunch of nuclear bombs. At least so far. As a reminder, the number of known cases in New York went from only about 100 on March 14th by 11,500 on April 4th. That's in the ballpark of a 25 % increase a day. If New York had done everything the same, but waited one week longer, that suggests that 11,500 cases would have continued to grow exponentially to about 40,000 new cases a day just 7 days later. Is that possible? Sure. In a state with close to 20 million people, I'd bet COVID-19 could have found 40,000 people to infect in one day in New York at the exponential rate it was spreading. And letting it go unchecked one more week, and quadrupling the number of infected, could have resulted in 80,000 deaths in New York alone by now. California's planning was based on the idea that over 20 million citizens could be infected in a matter of months, if we simply allowed the virus to grow completely unchecked at the exponential rate it was growing. Several weeks ago there was a bunch of utterly ridiculous articles arguing that the lock downs had failed. It was based on the idea that the rate of growth of the virus was lower after some states reopened than it was when they were in lock down. Hopefully just reading what I just wrote you've already detected the huge mathematical and logical fallacy in an argument like that. We had a virus growing at an exponential rate of maybe 25 % a day. So the lock down quickly slowed that down. And if you average out the rate of growth during the lock down, it's hopefully going to go from growing more quickly, to growing less quickly. Hopefully, by the time the lock down ends, you have dramatically lowered the rate of growth of the virus. In other words, if the rate of growth is lower after the lock down ends than in the middle of the lock down, you actually accomplished your goal. That was actually the point of the lockdown New York That chart shows a best guess of how the infection rate has actually been working out in New York. It quickly ran up to 3 - meaning each person infected 3 others - and gradually got down to 1 in the first week of April. Especially in the hardest hit states like New York and New Jersey, it worked pretty much like it was supposed to. The exponential growth was stopped, and then gradually shifted into a decline in new daily cases. If the end of lock downs was going to cause a huge spike in cases, or an immediate return to exponential growth like what we had in March and early April, I think we'd know that by now. So I think the other very good news in this is that humans were able to collectively alter their behavior to prevent a far more horrific outcome. And so far, we seem to have managed to keep those behavior changes in place. That said, I think one of the biggest problems in the US right now is we're not fully using the testing and tracing tools that have been in the toolbox of most other large industrialized nations. I think that's hindering us from achieving the kinds of reductions in new cases most other countries have. I think that also may be a good way of thinking about how the consumer-driven lock down is still hindering the US economy, and will continue to do so. There's the theory that at any given moment in time, the stock market is always right. Because you have all these individual buy and sell decisions based on massive amounts of information by millions of market participants priced into the system. When I see that number 60 million, it makes me think a similar thought. If it's true that 60 million Americans were at risk of getting infected, and avoided doing so, that may be priced into our economy right now as well. It is a fact that a massive consumer lockdown started in late March, and rolled quickly through places where the virus was close by - like Seattle, then New York and San Francisco. Dinner reservations were cancelled, plane tickets were refunded. Many people in Florida were staying within a mile of their home by late March, cell phone GPS data shows. Something similar is happening right now, I think. You can say people are just being irrational or overly fearful. But most people actually don't feel that way. And 60 million potential infections suggests all these fears may in fact have been well-placed. So if we want to dig ourselves out of the economic hole that survival required us to jump into, we might need to be clearer about whether or not this is going to continue to be a huge drag on the economy and employment. My read of even the "good news" jobs report is that we restored some percentage of jobs temporarily lost when everything was closed for business. But I think the "V-shaped recovery" crowd is delusional if they think it's now just smooth sailing from here, without really altering the perceptions of the tens of millions of Americans who still see the virus as as big a threat as it was two months ago.

https://www.worldometers.info/coronavirus/country/sweden/ Since I was on Denmark, I decided to take a look at Sweden for the first time in weeks. The case for herd immunity is looking worse and worse. Denmark has created the conditions where it appears to be safe for kids to go back to school, COVID-19-free. Sweden has passed their old threshold of new daily infections. They used to have at most about 750 new cases a day. In the last week on a number of days they've had 1000 new cases a day. The number of deaths in Sweden, relative to population, is 4.5 times higher than Denmark. Denmark has had 102 deaths for every 1 million residents. Sweden has had 465 deaths for every 1 million residents. Given that the virus has been beaten back by about 95 % in Denmark, and it has just grown by about one-third in Sweden, the death numbers in Sweden will look much worse a month from now. And a month ago Anders was saying they would perhaps attain herd immunity in a matter of weeks. I guess not yet.

Good news, and probably not so good news. Reopening schools in Denmark did not worsen outbreak, data shows Denmark reopened schools and day cares starting April 15th for younger children. It would make a tremendous difference if we could get US schools back up and running by Fall. I read somewhere that several hundred thousand of the "new" jobs created in the last jobs report were day care workers that were able to go back to work. Obviously, having day cares and schools open would make life much easier for working parents. Not to mention that it would be much better for the kids to be in school. https://www.worldometers.info/coronavirus/country/us/ At its peak, Denmark had 400 cases a day. If you do a crude adjustment for population, that would be equivalent to about 20,000 cases a day - about what we have in the US right now. By the time Denmark sent kids back to school, they were down to 200 cases a day, or what would be the equivalent of 10,000 new cases a day in the US. Probably even more important, Denmark rolled out a universal testing and tracing program that they describe as an effort to find the virus and crush it in any places it is hiding. Here's a good story and a short CNN video about that: Denmark increases testing, contact tracing to prevent second coronavirus wave And the video This country is rolling out universal Covid-19 testing In the last week, Denmark has had anywhere from 25 to 65 new cases a day. So they haven't crushed it completely. But they have demonstrated, so far, that they can keep it contained. Their rhetoric suggests that both Denmark and Germany now think they practically eliminate the spread of the virus in their populations. I haven't seen anything about Denmark, or any other country, that suggests children can't spread the virus. The CDC website says that children "can still pass this virus onto others who may be at higher risk, including older adults and people who have serious underlying medical conditions". So the most logical reason to believe children in Denmark did not get COVID-19 or pass it along by going to school is that the pandemic was already being curbed. And universal testing and tracing in Denmark was keeping it from spreading. And therein lies the potentially not so good news for the US. Just 6 states meet these basic criteria to reopen and stay safe That article was originally published April 24th, although it says it was updated a few days ago. I post it because it shows why we could have problems. Two weeks have passed, and it's not clear we are in any better shape then we were two weeks earlier. We still have about 20,000 new cases a day. One of the states named as making "strong progress", Kentucky, actually had a 79 percent increases in new cases - from 126 to 226 - in the last two weeks since that article was written. If, by the Fall, we have fewer then 10,000 cases a day, and we have rolled out universal testing and contact tracing in every state, we would be in the same position Denmark was on April 15th. If Denmark could get to that position in one month, we should be able to do it in two or three. There's every reason to think that with those tools in place, and a public that continues to abide by the rules we learned over the last few months, that we should have the same positive outcome as Denmark. If, on the other hand, we've gradually ramped back up to 30,000 or more cases a day, and testing and tracing is spotty at best, sending kids back to school would seem to be like throwing millions of pieces of kindling on a barely contained wildfire. In the middle of the lockdowns, many people made excellent points about how in the long run it was harmful to keep kids out of schools. True. In the short term, of course, it harmful for children to lose their parents. A few children whose parents were NYC police officers did lose their parents. There's no rational argument that starts with the idea that we'd somehow been better off if we had done nothing and let every city and town in America become like the morgue New York City did. Versions of that did happen in states like North Dakota and South Dakota. It could have and likely would have happened everywhere. So I hope everybody who wants to see kids back in school this Fall is unified around the idea that we have to have testing and tracing ramped up to a high standard in every state by this Fall. That is what Denmark is doing. And North Dakota. And South Dakota. And the same things that keep kids from bringing COVID-19 home from school are the things that prevent meat packers from spreading it at work, and ending up in a hospital, or Granny getting it in a nursing home, and ending up dead. I think people who still see this as a "health versus wealth" debate are ignoring pretty much every basic principle of consumer-based capitalism. We live, and thrive, in a market economy. That market economy started to shut down long before any government ordered it to. And it is still substantially shut down now. And for the foreseeable future. The language being used in Denmark suggests the strategy has almost as much to do with public confidence as it does with childrens' educations. The language is that they want to track the virus down and kill it in any small cluster where it is hiding. I think that is a very good idea. Apart from the value of kids being able to go to school, and parents being able to go to work, I think people seeing kids go to school in the Fall without it ending up in another horrific outbreak would be a big step toward restoring consumer confidence. But if we do that without being prepared in the way that countries like Denmark or Germany were, we are asking for lots of trouble.

States Nearly Doubled Plans For Contact Tracers Since NPR Surveyed Them 10 Days Ago May 7, 2020 That article is a month old. But it gives one of the best overviews I've read of what is happening in the US with contact tracing. As the headline suggests, the idea is becoming more popular. It's too early to get a clear read on whether it is working. I think the best evidence so far is anecdotal. I was surprised and delighted when I learned that North and South Dakota have the most contact tracers of any state relative to population. Those people are pragmatists. As I said in the post above, tracers went into areas where hundreds of workers were sick, and meat packing plants had to be shut down. We now know for a fact they were able to trace the spread of the infection and contain it. The closed factories have reopened. To the degree that employers and workers see this as something that actually makes it possible to safely go to work, that's a good thing. Those two states probably have relatively high numbers of contact tracers because they see it that way. And if they see it that way, that is consistent with what contact tracing has done for decades with other infectious diseases, from SARS to all sorts of STDs. Before I say more about what states are doing on contract tracing, there's two other strong impressions I have that put contact tracing in context. The first is that the single biggest driver of change has been a massive change in human behavior all over the planet. That started before any government lock down. But I think it's clear the lock downs reinforced the change in two ways. First, they interrupted the exponential growth of the virus. Instead of doubling every 3 or 4 or 7 days, the virus went to a plateau. And in the worst hit places, from Italy to Spain to New York, the caseloads went into steep decline. All the places I just named have 90 %+ fewer new daily cases now. Second, as the lockdowns end, individual behavior is not going back to normal. Nobody wants to get or spread this virus. So I think the lockdowns were also a massive global medical "time out". The evidence suggests most of us learned our lesson. We are not going to behave in a way that makes it easy for the virus to infect us, or those we love or work or play with. Unfortunately, for anyone who owns a shopping mall, a restaurant, a cinema, or a sports arena, it also means consumers are going to avoid you for now. So people may live. But your business may be dead in three months. My second strong impression is that the countries that made testing and contact tracing a priority from the start have outperformed other countries. South Korea, Australia, Germany, and Iceland are four examples of countries that hammered "test, trace, treat" hard, and effectively. Relative to population, Germany had about the same caseload as the US at their peak. They've reduced their caseload by about 95 %. The US has reduced ours by one third. Better use of testing and contact tracing probably has something to do with it. The first and the second points are related. Dr. Fauci has said from the start that contact tracing works best when it is focused on a limited numbers of people. The CDC definitely screwed up in January and February. Forgivably, no one knew that the virus was spreading through asymptomatic people. Less forgivably, the CDC totally botched test kits. The CDC now says the sheer volume of cases overwhelmed the CDC's infrastructure to do tracing, which worked far better on diseases like SARS. So when Germany crushed the virus through lockdowns, and brought daily caseloads from 7000 to 500 a day, it made the job of contact tracers much easier. The US still has 20,000 new cases a day. Whether that absolute number can be significantly reduced by contact tracing remains to be seen. What U.S. States Are Ready To Test & Trace Today? How We Reopen Safely Tracking states as they make progress towards a new normal Those are two websites I've been looking at for a month or so. The first is mostly about infrastructure: what is each state currently doing to test and trace new cases. It tells you the number of contact tracers in each state, both in absolute terms and relative to population. The second website puts contact tracing in a broader set of variables. It's one tool in a tool box. The second website is particularly useful because it shows you the short term trends in the last few weeks. Right out of the box, this is NOT great news if you are an American that owns a business, or has a job you want to keep. COVID-19 cases are increasing in more states than they are decreasing. So when the former FDA says that COVID-19 is still on a slow boil all over America, and it wouldn't take a whole lot for it to start to boil over again, he is probably right. If the biggest problem for US business is that about half of US consumers prefer survival to things like shopping or traveling or eating out, that problem is NOT being solved right now. In states like California and Texas and Florida, the problem is slowly but surely getting worse. Is this the frog in the water that is slowly starting to boil? We don't know. Having looked at this about once a week for the last month, my impression is that the states with more contact traces tend to be the ones that have stable or decreasing caseload. A lot of states are still getting the infrastructure in place. California is partway on a goal to 100,000 trained contact tracers. So I think the best conclusion right now is that in other countries this has definitely worked well, and in the US there are some promising signs. Two weeks ago I counted 13 states that had had 25 % or higher increases in new cases in the last 14 days. Meanwhile, there were 14 states that had 25 % or more reductions in caseloads. Of the 13 states with substantially increasing news cases, only one had 10 or more contract tracers for every 100,000 residents. That state was California, with exactly 10 tracers per 100,000 residents. Of the 14 states with substantial decreases, 8 of the 14 had at least 10 contact tracers per 100,000 residents. The state with the most tracers two weeks ago was North Dakota, which had 46 tracers per 100,000 residents and had experienced a 25 % reduction in cases in the last two weeks. I just did the same exercise again. This list is very fluid. So there are now 11 states with new cases that increased over 25 % in the last 14 days. Of those eleven, three have 10 or more contact tracers per 100,000 residents. California is again one of them. It now has 11 tracers per 100,000 residents, and a 34 % increase in cases in the last 14 days. There are now 12 states with new cases that decreased 25 % or more in the last four days. Of those 12 states, 6 have at least 10 contact tracers per 100,000 people. North Dakota is one of them, again. It still had 46 contact tracers per 100,000 residents. It's new caseload went down 60 % in the last two weeks. On the face of it, the states with the highest numbers of increasing cases tend to be those with fewer or minimal contact tracing. The states with the highest number of decreasing cases tend to be those with the most contact tracers. I don't know that it's clear there's a causal relationship there. Anecdotally, it seems that way. Texas brags about how it sends in viral "SWAT teams" to find the virus, trace it, and kill it in factories. They may have a point. There's a few important caveats. The states with massively decreasingly caseloads are largely the ones that became morgues in April: New York, New Jersey, New England. Again, I think the single most important thing that has worked in the US, and globally, is massive changes in individual behavior. Government lockdowns may have reinforced those behavior changes. But they did not cause them. The consumer lock downs started weeks before the government lock downs. And now that the government lock downs are over, or ending, the evidence suggests that the consumer lock downs remain in place. If you are a small business, there is a good chance you will die soon. The virus will kill you. It will kill you by killing your customers, or more likely scaring the shit out of them so that they stop being your customers until you are driven out of business. So the real survival problem for businesses is to figure out how to get consumers who are scared shitless about a virus to consume. Where these contact tracers are demonstrating they can come into towns in North Dakota or South Dakota and find the virus and kill it, people and businesses tend to like that. Is anyone surprised? Whether that works across America, or whether it helps gradually reduce the consumer lockdowns completely remains to be seen. I left off several states in those tallies above: Alaska, Vermont, and Montana. In percentage terms, all three states just had massive percentage increases in new cases. Alaska's caseload wet up 450 %. But, in reality, Alaska went from 2 cases to 13, Montana went from 2 to 8, and Vermont went from 3 to 7. That is in the entire state. All three states rely heavily on contact tracing. So while the percentages sound scary, the numbers sound good. It could mean that in Alaska the known cases went from 2 to 13 because tracers found a small cluster and contained it before it caused an outbreak. I don't know. But if those three states have a total of 28 cases, that is probably an argument for contact tracing - not against it.

COVID-19 Pandemic Planning Scenarios That's the May CDC guidance, which is hyperlinked in the USA Today article. As USA Today notes, some of the data deniers are taking what they see as a victory lap. They are saying this wasn't such a big deal after all. I guess some people forgot that 110,000 people have died, which caused the extraordinary step of lockdowns to stop the exponential growth of the virus. And that 1,000+ people a day are still dying. And that while it may get better, it may also get worse. Part of the good news to me right now is that the grown ups now get to deal with the data more wisely. Which is to say corporate America. As well as small business across America. They all have two survival issues to worry about: physical survival, as in not dying of COVID-19; and economic survival, as in not dying from the ongoing market lock down in consumer demand. So they have every reason to get this right, and to make the numbers go down. Because if the numbers stay where they are, or go up, many of these businesses will be dead by the end of the year. At the high end of the CDC range, 1 %, that would be 3.3 million dead Americans, potentially. (The New York antibody study, one of the largest in the world, suggests a death rate of close to 1 % in New York City.) Even if you take 0.26 %, we're still in the ballpark of 750,000 potential US deaths. Whatever the number of actual dead, the bigger horror for most businesses is probably their own survival. I posted on another thread one recent survey about the broad lock down in consumer demand. In many of these categories, like going to a movie or an amusement park, a majority say they'd be "very uncomfortable" doing that now. Even on one of the core activities people felt more comfortable with - eating out - 40 % say they'd feel "very uncomfortable" doing that now, as opposed to only 12 % that say they feel "very comfortable". Other surveys I've seen ask people when they might feel comfortable - one month? six months? a year? The best answer seems to be months from now. What we're experiencing now is not unlike March, when people started to first figure out what was going on. They just stopped buying, traveling, shopping, and eating out. It's a broad consumer lock down. So it is an existential threat to businesses across America. Even the good news reinforces this deep lack of interest in consuming on the part of consumers, which will continue to cripple and destroy many businesses. Maybe an unemployment rate of "only" 13 % is a victory. But here's a telling figure from one news report: Do the math. That's five steps backward, one step forward. If the underlying health problem were solved, at least we would know that consumers will be back, sooner rather than later. But the virus problem is not solved. Those 7.5 million jobs won't be back when demand is down 25 % or 50 %, which most of these surveys suggest it is for many core consumer-driven activities. It's too soon to know whether Germany or South Korea or Australia can lure consumers back to consuming. The initial trends suggest that the countries I just named figured out that stopping the virus from killing people and stopping the virus from killing businesses is basically the same thing. This Bloomberg article spells out how in sector after sector - hotels, airlines, restaurants - an "ugly Summer" is looming. Some part of the picture is that some of these "new" jobs were furloughed workers for businesses that got PPP loans. Many PPP loans subsidize paying employees, whether there is organic demand for them or not. I think the original idea was to build a bridge to the other side. Even in countries like Germany and Italy and Spain where cases are down 95 % or so, demand is not simply roaring back. In the US, we still have a much bigger challenge. Those PPP loans don't last forever. So if we don't get the virus under control, we'll likely have a massive and ongoing demand problem. I think the verdict is in globally that the single most important factor, and the single biggest success, is countless individuals who changed their behavior to beat the virus. But that behavior change includes a broad and deep lockdown on most consumer demand. (Amazon is doing well, of course.) So I'm counting on businesses to collectively try to figure out how to avoid their own demise. I'm going to do a separate post on testing and contact tracing. But here's a question with an answer that surprised me: Name the two US states with the highest number of government contact tracers per 100,000 state residents. North Dakota has the most, with 46 paid contact tracers per 100,000 residents. South Dakota is second, with 40 paid contact tracers per 100,000 state residents. California, by comparison, has 11 tracers per 100,000 residents. There are two distinct COVID-19 problems: 1) it's a senior citizen death machine, and 2) it's a massive workforce challenge for employers. In North and South Dakota, it's a workforce issue in places like meat packing factories. When you have to shut down your business because hundreds of workers are becoming sick, or even dying, I suspect that makes corporations like contact tracers real quick. Maybe businesses could solve the problem by testing all their workers regularly. In the US, we don't have the test kits. And even if we did, that doesn't stop a factory worker from showing up at work not knowing she has the virus, because her husband picked it up at church. Data deniers like to argue that COVID-19 is not that big a deal, since maybe 1 in 3 infected people don't even have symptoms. I think that is what makes it hell for meat packing plants and offices across America. How do you even know who is getting people sick? I have to imagine companies across North and South Dakota are hoping that these contract tracers are skilled and quick enough to keep the virus out of their workplace. North Dakota had one of the largest reductions in cases of any state in the last two weeks: a 60 % decrease. South Dakota's trend was flat in the last two weeks. But that follows a huge reduction in new cases after a bunch of outbreaks at factories in the Spring. In the US, I think it's too early to tell whether contact tracing is working. It's likely helping, based on initial data I'll put in a different post. The key point is that this is a primary tool that seems to help employers to catch infections early. Ideally before it gets on the factory floor and makes hundreds of employees sick. Which leads to one final set of data, if we are doing a CDC to CDC comparison to talk about how businesses are still fucked: Estimated Influenza Illnesses, Medical visits, Hospitalizations, and Deaths in the United States — 2017–2018 influenza season Those are comparable rates of illness, hospitalization and death for the 2017-2018 flu season. You can look at any year for the last decade on that link. But I picked that year because about 60,000 people died, making it the worst flu season in the last decade. The numbers are not even in the same ballpark, if you look at this through the eyes of any corporation with lots of middle-aged employees. The hospitalization rate for the flu in the worst year for people aged 50 to 65 was just about 1 % of everybody ill. With COVID-19, the estimated hospitalization rate is 4.5 %. So instead of 140,000 actual hospitalized people aged 50 to 65 with the flu in 2017-2018, we might have 750,000 with COVID-19. And since there is no vaccine or immunity from past infections, like with the flu, we're not talking about 13 % of the population getting infected, like in 2017-2018. With COVID-19, the sky's the limit. In the factories where this actually happened in North and South Dakota, it spread quickly and broadly and silently. So if this were allowed to spread, I think it's safe to say we could have at least ten times as many hospitalizations of middle-aged workers as we did in the worst flu year of the last decade. This is not good news for any employer in America. Of course, the more stories people hear about this happening in factories or offices or schools near them, the more it reinforces the broad and deep consumer lock down that is going to kill many businesses across America. So it is a perfect storm. And despite what fortunately turned out to be better than expected jobs numbers this month, we are nowhere near the end of this problem. We don't even really know if we are still at the beginning. So whatever the data deniers say moving forward, I'm more optimistic that corporations and all businesses will take the numbers as an existential threat. They will have to figure out quickly how to contain the virus in order to prosper. Or even to just survive.

Ditto. And don't forget Mitch Gaylord. I have to wonder whether young Gay men today are even aware of having missed the opportunity to secretly lust after men like these, and wonder why they feel this way. Of course, lots of teens are still closeted, or unsure. But these days, if it's a 17 year old, they're more likely to be out, and have a boyfriend. My how times change. Speaking of which, I liked this picture, and this story, and this quote. It's from January 2020. So it's not in reference to his death. ISU to honor Thomas, '77 gymnastics team He was having the time of his life. And if you read the whole story, it sounds like a life well lived.

I guess you need to define "well". Does "well" mean being the global leader in allowing COVID-19 to be a death machine for seniors? To infect 20,000 or so Americans a day, of which at least 1000 or so - mostly seniors - will die on daily base? China, which is now #18 on the list of countries with the most cumulative cases, reports 3 new cases and no new deaths yesterday. Is Florida, or the US, doing "well" compared to them? Germany, # 9 on the list with 90 % fewer cumulative cases, reported 491 new cases and 27 deaths yesterday. They are about one quarter the size of the US. Is Florida, which had over double the number of new cases and deaths as Germany yesterday, doing "well" compared to that? Perhaps, as you said, some part of this has to do with "the American personality". But if it does, I imagine the American personality has got to be wondering how she managed to fuck this up so badly. There were five states with over 1000 new COVID-19 cases yesterday. In order: 1) California: 2331, 2) North Carolina: 1423, 3) Florida: 1270, 4) Texas 1137, 5) Arizona: 1119. That's a good reflection of where COVID-19 is lurking the most right now. Not the most New England states that had a wall of infection and death this Spring. Will COVID-19 make a comeback? I hope not. But if it does, the states I just named will be where it already has a really good foothold to build on. And perhaps a slightly more complacent public, who didn't directly experience what people in New York or New Jersey did. What part of this suggests Florida is doing "well"? Or California? or Texas? This matters in terms of nursing home deaths. Because at this point some capable quant person could come up with a formula for how many dead seniors we'll have a month from now. Just tell me how many new cases - like 20,000 a day - and COVID-19 will do the rest. 1000 or so of those people will be dead relatively soon. Mostly, they'll be seniors. The states that do the best job keeping the virus out will actually have the most seniors deaths, as a percentage of all deaths in the state. Because what COVID-19 is very good at, even when it is being actively suppressed, is finding Granny in a nursing home, infecting her, and killing her. You can talk all you want about "best practices". But it has little or no impact on the math and science. Tell me there's 20,000 new cases, and I can assure you we will have lots of dead Grannies. Figure out how to gradually double that to 40,000 cases, and we'll have twice as many dead Grannies, lung for lung. This is not good news for Florida, or nursing homes. This is not going well. There is now a chorus of people with one dimensional views that suggest that 1000 or so dead Grannies is not that bad for the economy. Or at least a less bad alternative. So whenever I mention dead Grannies I will also remind people of this. COVID-19 kills the economy by killing people. Those two things - the virus and the economy - can't be separated. If we want to stop the virus from killing the economy, we have to stop the virus from killing Granny. It's not two separate and conflicting goals. It is the same, unified goal. Now that the government lock downs are ending, we're getting a clearer picture of how the market lock downs are continuing. Ask almost any question about any vital economic activity, and the vast majority of Americans are uncomfortable doing it: Go out to eat at a restaurant? 64 percent feel uncomfortable. Go to a shopping mall? 68 percent feel uncomfotable. Go to an amusement park? 74 percent feel uncomfortable. That last number might not be all bad news. Germany has banned these types of mass events through the end of Summer. Mass gatherings are potentially good virus peti dishes. And we know for a fact they will lead in a chain of infection and death back to nursing homes. That said, if anybody is going to get this right and set a good set of standards, it's places like Disney World. The overall picture, though, is devastating. It is devastating for Granny, and devastating for the economy. In the real, multi-dimensional world human beings actually live in, killing Granny and killing the economy are kind of the same thing. Whether 2 in 3 Americans are worried about Granny or themselves or their kids or all of the above is impossible to say. But this kind of fear of a virus is fatal to a consumer economy. And the virus itself is fatal to Granny. To deal with the fear, you have to stop the virus from killing Granny. It's too early to tell whether Germany's far more effective approach will mean less national economic damage. There are far fewer dead German Grannies. And it sounds like their economy is relatively more open, with far fewer infections. If the US was at the same place as Germany, relative to population, we'd have 2000 new cases a day. Not 20,000. My guess is the difference has an economic impact. As well as being good news for the virus, whose job is to infect and kill Granny. All of this assumes that we'll actually be able to keep the virus at 20,000 new cases a day. I quoted that piece @bigjoey posted on offices because I think the most significant thing keeping the spread of the virus in control is simple: human behavior, and compliance to a new set of rules we all just learned the hard way. And corporations like Apple have no interest in killing their employees. Or killing Granny, for that matter. So they will do their best. But if the casesload nudges back up to 30,000 and 40,000, and the deaths go from 1000 a day back to 2000 a day, I don't see how that helps either Granny or the US economy. The good news is that it means 13 % unemployment rather than 20 % unemployment. But how exactly is 13 % unemployment and consumers that are afraid to shop or eat out good news? I would not say Florida, or the US, are doing well. I would say we are sitting on a powder keg. And we should be aware that it is ripe to explode again. That's very bad news for Granny.

If you're talking about the Rachel Maddow interview, I thought he nailed it. This is catnip for me. On the one hand he's gorgeous. On the other hand he's this focused voice of compassion and clarity about the underlying injustices. I posted the Maddow interview in the politics forum, since it's so obviously political. He's a stud. I had no clue who the guy was until yesterday. Before I even absorbed the headline about police something or other I had to Google his name and find out who he is. Only after that did I begin to read about what was actually going on. And, yes, I am very predictable. Also, before I started learning about the cop part I had to know whether he way Gay. [MEDIA=twitter]711174194378227712[/MEDIA] Despite his apparent heterosexuality, there is also this from Wikipedia: He was grew up went to college in Virginia, it turns out. So I don't know that Minnesota gets to take credit for the essential beauty of the man.

A second video on Shanghai Disney, more of a behind the scenes look at what they are doing https://www.youtube.com/watch?v=UtGcdQIvD88 We're going to have to change the Urban Dictionary definition of "Mickey Mouse" to mean the exact opposite: mickey mouse Substandard, poorly executed or organized. Amateurish. "Who's in charge of this mickey mouse operation, anyway?" And in the spirit of Disney, this kind of fits in, too. https://www.youtube.com/watch?v=te7jRqVBLpE I found it to be a beautiful statement about how we're one world, all in this together. That was February, right when COVID-19 was silently infecting people all over the world. The song is not entirely off topic. Something titled "Into The Unknown" that communicates hope and optimism in a universal language is perhaps exactly the point. By the way, Aurora, the siren, is from Norway. It's not personal, Anders. But I'm going with Norway rather than Sweden on this one.

More ranting on "flattening the curve". This post is about contact tracing. I think the biggest driver of a first crushing wave of virus suppression was consumer fear. If you run an airline, a store, a hotel, or a restaurant, the consumer message was swift and stark: FUCK YOU! Right now you are bad for my health. That wave has passed. In many countries and states I'm guessing contact tracing will now play an increasing role in killing the virus. https://www.worldometers.info/coronavirus/usa/new-york/ https://www.worldometers.info/coronavirus/usa/california/ Compare New York and California. New York has had about 10 times their normal annual deaths from flu. California was spared about 90 % of the deaths. But both state's economies are badly crippled. New York has not only flattened the curve. They have crushed it. (See the Daily New Cases graph.) New infections are down about 90 % from the peak. That "crushing the virus" curve looks like any country in continental Europe (here's Italy and Spain) that was hit hardest, with the exception of Sweden. Other states like New Jersey, Louisiana, and Massachusetts have similar declines. New daily cases dropped 75 to 90 % from the peak. There's obviously many factors involved. That "early warning" website offers indirect data on the impact of consumer fear. The infection reproduction rate in New York is 0.80 right now. It was as low as 0.65 a few weeks ago. That's very similar to behavior in Sioux Falls, which is almost the opposite in terms of density or government philosophy. Their infection rate is 0.76. I think the common denominator for similar behavior is consumer fear. Mass infection drove behavior that quickly slowed the spread of the virus. California looks more like Sweden. It's a "flattening the curve" plateau. That said, the "flattening the curve" idea, back in March, was that 60 % of Californians might inevitably get sick. The initial goal was to manage an ongoing hospital crisis. Thankfully, that never happened. At the current rate of 2000 - 3000 news cases a day in California, we might have 10 % herd immunity by the end of the year. California has 0.2 % of all citizens confirmed positive. Based on antibody studies, multiplying by 10 is a good guess for real infections. So California could have about 2 % herd immunity. Add seven months of the same and we'd be at 10 % herd immunity by year end. That still leaves 90 % of California at risk. I've figured the driver of the plateau in California is people who feel it is their right to disobey any rule - including simple social courtesy. Like the stories about grocery stores. Customers in each other's faces. Grocery store workers who say customers who don't observe social distancing guidelines put their health at risk. The "consumer fear" idea seems to describe New York, Sioux Falls, Spain, Wuhan. People see death and disease everywhere. So that drives behavior that kills the virus, but also the economy. Factories shut down. People avoid interaction. This is all consistent with what happened in 1918. A variation is happening in Peru now. Since many people don't have refrigerators, they stand in lines to get food every day. Having to chose between starvation and possible infection drives a situation that is only getting worse. None of what I just described is happening in California. It's closer to the opposite. Some California county that has zero known infections (there are a few) feels they are being punished for some shit happening in New York City. Even in LA, people just want to get back to work, or the beach. I'm wondering whether a big part of the problem in California is asymptomatic spreaders who go undetected, and keep seeding another cycle of infected people. In terms of behavior, we're not New York, where people went quickly from having no idea the virus was spreading like crazy, to then feeling they were living in a death camp. Both New York and California had infection reproduction rates that were out of control a few months ago. New York for weeks has an infection spread rate of 0.65 to 0.80 That has driven reduction. California's reproduction is stuck at 1.00, which means a plateau. As the crisis in New York passes and people feel a bit safer, their virus reproduction rate is nudging back up. That's not good news. In terms of the math, asymptomatic spread is a possible explanation for California being stuck. The CDC's guidelines suggest that maybe 1 in 3 people remain asymptomatic. Absent testing, they usually infect two new people. That's a recipe for plateau. Some people who get sick will infect others, as well. But there may still be a lot of people who don't feel sick who are infecting others, which creates a similar sized next cycle of infection. It amazes me that people who make the big bucks at JP Morgan can't connect this back to nursing homes deaths. The virus is not the tooth fairy. It does not appear by magic. It is brought in to homes by the millions of people who are employed caring for seniors. If we have symptomatic people who have no clue they have the capacity to kill Granny, what do we think is going to happen? This is why it has proven to be impossible to keep death out of even well run nursing homes. This may help explain Canada's high rate of nursing home deaths in some provinces: https://www.worldometers.info/coronavirus/country/canada/ Canada's curve looks a lot like California. The good news is there is less death. The bad news is that the number of new cases seems stickier. It's going down, but not as quickly as in many countries. Here's what one newspaper said: Look at this map of where Canada's COVID-19 infections are concentrated. Almost all the community infections are in two provinces, where most nursing home deaths are. I get why a genius "quant" from JP Morgan thinks that if 81 % of the deaths are concentrated in 1 % of the economy - nursing homes - you just wall off nursing homes. I'd guess that "quant" does not have a Mom in a nursing home. Let an asymptomatic college student hand out plates at dinner and she can efficiently kill 50 seniors. She has no temperature. She won't test positive until it's too late. Gloves will prevent this, in theory. In practice, this magic wall always fails. Everywhere. Until we track down asymptomatics who are seeding new cycles of infections, the death machine in nursing homes will continue. Canada is one more example of how community spread in each province determines the eventual number of nursing home deaths. There's a direct relationship between younger people who get infected and older people who die. The best indicator that contact tracing will play a big role in detecting and ending infections are the countries that have done it best. 5 % of Iceland's population (maybe 20,000 people) spent weeks in voluntary isolation. That's better than two months or a year out of work. The smart countries realized early that to beat back the virus, they head to break the silent but deadly chains of transmission. You can dismiss Iceland. It's harder to dismiss Germany or China. Germany dropped from 7000 to 500 cases a day. They focused on testing and contact tracing to find asymptomatic carriers from the beginning of March. It worked. There are fewer deaths, fewer deaths in nursing homes, and probably less fear. My guess is we'll learn Germany suffered less economic damage and permanent job loss than the US did. You just can't separate the virus - as in deaths and hospitalizations - from the complex interactions it has with an economy driven by consumer confidence and fear. I think that is becoming increasingly obvious based on the successes and failures of different countries, states and provinces. Fear of COVID-19 won't go away until the virus does. But the best case of "flattening the curve" now seems like a worst case scenario. It keeps the medical system under constant stress. That drives other bad outcomes - kids missing vaccinations, or cancers going undetected. It also drives the fear and market lockdowns that are crippling the economy. Countries like Germany and China will be in the forefront or showing how much consumer fear can be reduced while COVID-19 is lurking in the background.

Is anyone promoting flattening the curve is the goal anymore? I think the flattening the curve people were the ones that saw this huge tidal wave coming that nobody was prepared for. Reality did confirm their fears. Wuhan, Italy, Spain, France, London and NYC were not prepared. The impact was crushing - as predicted. We've had ten 9/11's - 30,000 dead Americans - in New York alone. There's a myth that this is just NYC or some old dead woman in a NJ nursing home. So I'll keep bringing it back to South Dakota. Minnehaha County, South Dakota That's Sioux Falls, where they put the fire that started in a huge pork processing plant out. They now have a virus reproduction rate of 0.76. COVID-19 is being caged and killed. The state reports contact tracing 46 % of all positive cases. That's how they actually got a handle on it in Sioux Falls, so they could reopen the plant. They tested and traced thousands of people to find the ones infected, and isolate or treat them. It worked. The local hospital capacity was strained. I read that some ICU's in Sioux Falls were filled to capacity. That graph shows it got as high as 57 % of capacity in the entire county. It is now back down to 32 %. My point is that this is not just about New York City. No one knew where it was going to strike next. To that point: Beadle County, South Dakota Huron went a month without a COVID-19 case. Now there are more than 100. Now the fire is raging in Beadle County. Guess what? It didn't start in a nursing home. It started in a turkey processing plant and a beef jerky factory. Out of 190 cases, 9 people have been hospitalized and 2 are dead so far. Death lags. So both those numbers are likely to go up. Alpena jerky plant to expand; 75 new jobs possible Alpena jerky plant to expand; 75 new deaths possible That first headline is real, from 2012. I think it explains itself. The second headline is one I made up. It think it explains itself, too. Granted, 75 people won't die, or even get sick. Many will. I think that is why we are fucked. People want to work, of course. But they don't want to get sick, or be hospitalized, or die. I have 12 tenants, and most are out of work in some form. All of them want to work. None of them want to die. So as much as I want them to pay the rent, them being in a hospital or dying doesn't help me, or them. That's why market lockdowns are happening everywhere. Ford plants and meat packers mostly shut down as soon as the virus pops up. They don't want to wait and see how badly illness fucks up the production line. Or how many end up in a hospital or die. The more this happens, the more I think it focuses businesses and workers on one goal: crush the virus. Kill it. Blow it back to hell. That is, in fact, what the plan now is in many large capitalist nations. Germany, Austria, and Australia have pro-business governments. Should I connect the dots? This is a nightmare for corporations and businesses. Outside China, no nation has crushed it completely. But they have caged it. They want people to be able to feel safe to work, or eat out, or shop in stores. No one ever settled whether that red area and blue area are the same size. It's all models, anyway. I think initially, before the tidal wave hit, the model was that we have to assume we can't stop the tidal wave. We just have to try to spread it out. As the model says, the model focused on one goal: avoid crushing our health care system's capacity. That was what California set out to do a few months ago. The assumption was that 56 % of Californians would get sick. Like it or not, we had to create capacity for that. You can say that was alarmism. But that is how public health works. The goal is to inform people of the worst outcome, in order to avoid it. That helps explain why we have just under 30,000 dead in New York and just over 4,000 dead in California. New York and New Jersey now have about 10 times more dead in a few months than their entire annual flu season - AFTER extraordinary market lockdowns. California deaths from COVID-19 are about 85 % of annual flu deaths. Which is not to say anyone in New York or New Jersey was stupid. They were caught off guard. Again, the people who cancelled a reservation may have kept themselves from getting sick, or ill, or dying. Nick Cordero, 41, and his wife had just bought a new house in LA. She thinks it was the flights between NYC and LA where he got infected. You can say Cordero, down a leg and with lungs that are permanently damaged, is an exception. Nobody cares. Except it works out that lots of 41 year olds and even 21 year olds are saying, "I think I'd rather wait a while to fly. If I do fly, I don't want to catch COVID-19 on a plane." That's why United and beef jerky plants in South Dakota are interested in how they can organize the illness or hospitalization or death of their workers and customers most efficiently. I think they just want to make work and the economy safe. I think they now want to crush the virus. America’s COVID warning system If we're talking about flattening the curve, I think that website is where many of the "flattening the curve" crowd are at now. So Tomas Pueyo did write on March 10th that if we didn't lock down immediately, millions would die. Everything he predicted turned out to be right. No one in New York had died of COVID-19 on March 10th. No one would have believed that 30,000 New Yorkers would be dead by Memorial Day. As much as I respect the "quants" from JP Morgan and read their data to see how badly this has killed the US economy, the idea that the lock downs killed more people than they saved is absurd, and offensive. These are people who claim to understand consumer-driven economies? Come on! So you can look at any state on the warning system above and get an updated model that has nothing to do with "flattening the curve". The message in the US is muddled, and we have no clear national plan. So it's hard to create models, I think. At least for now what they are doing is saying here's what we think happens if we stay the course, and here's what happens if we go back to "normal". Reality will obviously be neither. California is interesting. They're right on the line of an infection rate of just about 1.00. So the state has been stuck on this plateau. Meanwhile, Sioux Falls has an infection rate of 0.76. That's good news for that pork processing plant and the people who work in it. The virus is quickly being contained. Beadle County, SD has an infection rate close to 2.00. That's very bad news for anyone who owns a beef jerky plant, or works there, or knows anyone who does. The good news in Beadle is there are only so many people that can be hospitalized or die, anyway. Although if you actually work in a beef jerky plant, one more dead person matters if the dead person is you. California is a better macro example. This model projects that if we stay on a course of gradual decline, we go from about 4400 hospitalizations now to about 3300 by August. We'll have about 15,000 dead by the end of August. That's almost 4 times higher than the death count today. If we liberate the virus and go back to "normal", like January 2020, they think 215,000 Californians will die. Cue up the chorus that says these are models, and this is stupid. But given the outcome when the virus ran rampant in New England, I don't think most people doubt this is a realistic worse cases scenario. Even if they are right about 15,000 deaths in California, I would not call that flattening the curve. It's closer to crushing the virus. California would still have very little herd immunity. And this does not factor in the full deployment of 10,000 contact tracers. In states like Oregon and Montana that have done contact tracing early and often, infection rates below 1.00 that are stable or declining. As successes emerge, it's a given that consumers who are afraid to eat out or fly will gravitate toward, "Can't we just kill this virus?" Too bad Arnie is a senior now. In his prime, there was a movie to be made out of this. Surprisingly, it would not be The Terminator. It would be Kingergarten Cop, where Arnie needs to explain things calmly. And figure out ways to get the whole class to go along.

Got it. If the number is 100,000, you don't care. Here's a reality check. It's not 100,000. It's 100,000,000 Americans at least. They're not all dead. They're just all fucked. You run a restaurant? Sorry. You're fucked. You're an escort? Sorry. You're fucked. You run a meat packing plant? Sorry. You're fucked. You get the point. You're just fucked. It has nothing to do with government. You want me to eat in your restaurant? Fuck you. You want me to fly on your airplane? Fuck you. You think I'm gonna hire an escort? Fuck you. Not everyone feels that way. But these were market lockdowns. In every sector where we have objective measures, maybe 2 in 3 restaurant or hotel or plane reservations were cancelled, anyway. And maybe 2 in 3 people say they won't stay at a hotel or go to a movie or fly. Not now. Maybe in a few months. But not now. So the message of consumers to businesses is clear: Fuck you. So you can try to convince the consumer that 100,000 don't mean shit. Or some dead senior don't mean shit. But the consumer has spoken. The market has spoken. People are just fucked. They are deeply fucked. I see no distinction between whether the virus kills 100,000 people, or the virus kills the economy for 100,000,000 people. It's the virus doing the killing, either way. And as long as the virus is killing, lots of people are gonna die. And that means the economy is fucked. And if you don't like it, you need to take that up with the American consumer. Maybe you can take 60 year olds and force them at gunpoint to fly on a plane. Or go have fun watching a play at gunpoint. But that is what you'd have to do, pretty much. And that moves us from capitalism and a market economy to socialism, or maybe even terrorism. Short of that, what happened in early March, and what the polls say people feel now, and what is happening in Germany and Georgia where the economy is open and crippled, say one incredibly clear thing. As long as the death continues, the economy is fucked. Maybe people are wimps or stupid. But you have to concede they have a point. At 100,000 dead, that's 9/11 every day for one month. Think about the impact one 9/11 had on America. Now we've had 30. I'm an optimist at heart. So I meant that stuff about Mickey and Minnie. It works out well that corporations like Disney have no interest in their employees having to get sick or be hospitalized in droves. Let alone being Death Number 100,001 or 200,002. And they sure don't want that happening to their consumers. It's the Magic Kingdom, not the Viral Kingdom. If they understand the market economy and consumers - which Disney and Apple and Google do - they can figure out some really cool shit. Masks and social distancing is pretty basic. Testing and contact tracing is a bit more complicated. But they'll help drive a consensus on that. Just like they did in Germany and Austria and South Korea and Australia and all these other places that are reopening. Having workers in hospitals or dead is just not good for corporations. Or for consumer demand for the products they sell. That's true whether it's 10 or 100 or 100,000. To continue the airplane analogy, part of the reason we were fucked by 9/11 is it caught us off guard. Which was of course the plan. That was COVID-19's plan, too. And it worked pretty well. It sure had us fooled. So far it got thirty 9/11's out of us. I had a friendly little heart to heart with COVID-19 recently. Just between you and me, it told me it was just getting started. So I'm hoping Mickey and Minnie and the people who figured out how to make an iPhone will be able to help figure these things out. (Former Disney CEO Bob Eisner actually is on the kitchen cabinet California put together to figure out how to reopen the economy while killing the virus.) If we are really lucky, to use the 9/11 example, they'll figure out something like this: More likely, it's the same shit corporations like Disney and Apple and GM do everyday. Grind, and discipline, and incremental progress. Even in the last week, two Ford plants that just reopened had to close down again. A few people got sick. Ford didn't want to wait until 20 employees were in hospitals, and maybe one or two died. So corporations will quickly get the protocols down. They'll figure out it is in their interest to make sure that these tracers are good enough to track the virus down and kill it, through isolation of sick people. Before it finds its way to the Ford auto plant floor. Let alone the nursing home down the street. That just fucks up your consumer economy. And Ford and Apple don't want the consumer economy to be fucked. I like that Open Table data. Because it shows that consumer demand pretty much tanked the entire US restaurant industry. Government had nothing to do with it. ' Since I'm focusing on planes, I can't find airline data on consumer-driven flight cancellations. But people cancelled flights like crazy. Here's what I found that indirectly measures the impact of consumer fear of flying: [MEDIA=twitter]1241366059590049792[/MEDIA] No government told those people they couldn't fly. They just wouldn't fly. So what Disney and Apple and GM and Ford and Amazon and meat packing plants and even every small restaurant owner are going to do is try very hard to make things as safe as they can. So that people will work, and shop, and eat, and buy things. It works out that's a much better way to get people to work, eat out, fly, and buy than getting them sick, or putting them in hospitals. If we all do what we are supposed to do, we know how the movie ends. A plane landing in the Hudson is a once in a lifetime thing. That's why I like this plane story as an analogy. My guess is I'll only live through one pandemic capable of killing at least 2 million Americans in my lifetime. So normal is not an option. Yeah, the plane was supposed to go to Mexico. But we're fucked. We don't want to end up in the World Trade Center. So the goal now is to avoid crashing. And figure out what we all have to do to get out of this alive. So we can get back to normal eventually. It actually did not matter, in the real world, what people thought about what they were doing on that plane. Or whether they agreed. All that mattered is that they did what they were supposed to do to make a very abnormal situation end in the least worst outcome. In this case, maybe you give a shit about not having 100,000 more dead people. Or maybe you don't. Maybe you give a shit about how the virus is killing the economy for 100,000,000 Americans. All that really matters is what you do. Mickey and Minnie will help make that clear, I think. It doesn't matter whether you get the memo from Mickie or Minnie, or Fauci or Birx. What matters is what you do. That said, for me, Mickey is the one that for some reason always gets me hard. Speaking of which, me being an ignorant whore, there are certain things I never figured out. I never figured out how to give a socially distant blow job. I never figured out how to get my cock inside a socially distant ass. So if you want a poster child for people who are fucked by the virus, until the virus is dead or caged, people like you and me are it. Again, not everyone feels this way. But most people do. Eastwood is one of my favorite directors because he tells stories about how abnormal events turn average people into everyday heroes. And he rarely makes it up. They are real people that did real things, a soldier or a pilot or whatever. Although he may add drama to make it sell popcorn. So in this case there is a good argument that the hero is Sully. Not to take anything away from the really Sully, but Tom Hanks did Sully best. He refused to accept the idea that he was the "x" that got everybody through this thing. He said it was everybody. The crew. The passengers. The people who showed up in the boats. Everybody had to do their thing. That was the "x". So "x" can be 100,000 or 100,000,000. It doesn't matter. What matters is we have to do our thing. That's the lesson, I think. And in this case, it fits like a glove. It's the doctors like @purplekow , the nurses, the grocery stores workers. And now, believe it or not, Mickey and Minnie, handing out masks and not shaking your hand. All this stuff I'm saying is based on facts, and real life events. But I'll make up a few hypotheticals, just to underscore the point. In the real plane, you could have had someone who refused to wear his seat belt and was running around saying, "Liberate the plane! Put it back up in the sky!" It might have added drama in the movie. Most likely, everybody around him would have said, "Buddy, please sit down and shut up. Stop being such an asshole, okay?" So the analogy works for me. We are all on the plane. We are all fucked. That's not even a choice. The choice at this point is just about the least worst outcome. And how many people make it out alive. To that end, whether "x" is 100,000 or 100,000,000 is irrelevant. The "x" that matters is what we do. Here's to a safe 4th of July!

Fun facts: 99.999 % of people who died in the US in 2019 were alive 10 minutes before they died. The 0.001 % is a rounding error. Meanwhile, 99.74 % of the global population in the 1940's was not annihilated in The Holocaust. Other than showing we like intellectual masturbation, which I obviously love, I'm not sure what the point is. The Most Important COVID-19 Statistic: 43% Of U.S. Deaths Are From 0.6% Of The Population This is out of Forbes. The first chart shows the percentage of all COVID-19 deaths in each state that were nursing home deaths. New York is actually one of the lowest in the country. By this standard - percentage of deaths in nursing homes - New York did a particularly good job. When you look at the actual number of deaths it gives you an entirely different picture. So in New York, a small percentage of all COVID-19 deaths still works out to be a lot of people. New York is in the ballpark of 5000 dead seniors in nursing homes. In Oregon, 60 % of all dead works out to be about 100 actual dead seniors in nursing homes. Almost 1 in 10 residents of long-term care facilities in New Jersey died of COVID-19. That's four times higher than New York state as a whole. This could be where @purplekow adds that New Jersey is the densest state in the US. I think density matters in the sense that if you have a dense place, and if it spreads everywhere, you have now turned every nursing home in a dense state into a death camp. But BOTH conditions have to be present. You can't just have density. You have to have mass spread - either unintentionally, through the silent seeding of a pandemic; or willfully, through planned herd immunity. The five states with the lowest infection rates are Montana, Alaska, Hawaii, Oregon, and West Virginia. They have 500 to 1000 diagnosed COVID-19 cases per million. The five states with the highest infection rates are New York, New Jersey, Massachusetts, Rhode Island, and DC. Does anyone see a pattern between higher state infection rates and how nursing homes tend to turn into death camps? Two of the densest cities, Hong Kong and Taipei, are actually two of the safest places on the planet right now. A story in the Times about how California's economy is fucked reported this: I think that makes an important point. The government lock down was a government ratification of a market lockdown. And the market lockdown continues. So it doesn't matter whether U of C is open. Adrian ain't gonna play. You can take your fancy schools and your fancy economy and shove it up your ass. Adrian is probably not 85 and co-morbid. He's probably young and healthy. He's the kind of guy who is supposed to kickbox this wimpy ass COVID-19 piece of shit right into a corner. Yet for some strange reason, Adrian is staying put in Hong Kong it appears. Can somebody please tell me where Bruce Lee is when we need him? This is true all across the US economy, as that Times article talks about. California makes a fortune on tourism. As awesome a guy as he is, I'm guessing @mike carey isn't in a rush to share the California COVID experience. Bringing tourism back to life in California means killing COVID, not seniors. Whether governments ratify market lockdowns or not has little to do with the market lockdown itself. So when Open Table tells us that by March 13th about half the restaurant industry in Seattle was crushed in a computer click by consumers, there's a problem. Of course, what did we expect from a place like Seattle? They breed these nerdy science geeks like Bill Gates. Gates is a case of your cure being worse than the disease. So now we see the consequences of this stupidity exercised by these science dipshits. There's one dead senior in a nursing home in Washington for every 40 dead seniors in nursing homes in New Jersey. What the fuck were people in Washington thinking? What the fuck was Bill Gates thinking? Can I please just have Bruce Lee, so we can all go kick some viral ass? A smart publication like Forbes should get that large economies are dynamic and fluid. And yet, they say this: Again, Forbes is supposed to understand market economies. Somebody might want to send them the memo about how 2 in 3 consumers said "Hasta la vista, baby" to dining out and shopping before any government said anything. And polls show that American consumers are pretty much saying the same thing about their intentions today. That reflects what's happening - or not happening - in economies that have reopened, from Germany to Georgia. Who'd a thunk? We dodged the Bernie socialism bullet. And now capitalism is doing us in! There is good news. While we all wait for Super Fauci to fly in with the vaccine, at least we have Mickey and Minnie Disney World plans to reopen in July This is actually good news. I'm serious. Corporations have been the missing player. Obviously because they had to shut down. (Remember now. Consumers did it. Not the government.) Beyond that, Disney has no interest in rebranding their amusement parks as death camps. And they have way more resources than nursing homes. Finally, they understand the difference between a government regulation, and a market economy. Disney can not afford having consumers who view them like rats spreading a virus. Which is where Mickey and Minnie come in. And remember now. They're mice. Not rats. I like Dr. Fauci and Dr. Birx a lot. But let's face it. Mickie and Minnie have a certain charm Tony and Deborah don't. Who better to rebrand the rules of hugging, kissing, and social distancing? The polls suggest to me probably 9 in 10 Americans have gotten the memo. But it can't hurt to have Mickey and Minnie reinforcing it daily. As far as the Liberate The Virus crowd goes, maybe we could pay Disney to be creative. How about we open up Virus World, and let the no-mask crowd enter for free? We just have to make sure they build two new hospitals for every hotel. It'll be good for the economy, right? Disney aside, every meat packing plant, call center, and car making factory in America now has the same problem. That will settle the herd immunity question quick. Every CEO in America is wondering how to test, trace, and treat COVID-19 out of existence. At least among their workforce. Which brings us full circle to why Forbes is wrong. You can't just build an economic wall around nursing homes. Seniors in homes don't go to Disney World. But the young Moms who care for them do. If they catch COVID-19 at Disney World and bring it to work, your nice little economic wall just crumbled. The lockdowns were designed to stop community spread. States like New Jersey with the most community spread ended up with the most dead seniors. Germany banned large gatherings, and amusement parks, through Summer at least. Their priority is factories, small businesses, shops, making it safe for people to shop and eat out. That makes sense to me. If a worker or consumer gets sick with the virus, you can contact trace COVID-19 back to factories and stores. But if a nursing home aide from New Jersey gets COVID-19 at Disney World, forget contact tracing. So reopening Disney World could be a problem for nursing homes - even in New Jersey. Mostly I think corporate America will help get this right. But this is an example where not having a clear plan and message like Germany could undermine the broader economy.

I think the best formula for killing seniors - and I mean big killing, like concentration camp levels - is to fail to admit that COVID-19 turns nursing homes into concentration camps. I'll repeat what I said. You tell me the number of people that died of COVID-19 in any country or any US state. And I'll tell you how many seniors died in nursing homes. It's going to be about 50 %. So if you want more senior citizen death, the very best plan is herd immunity. You definitely will have more cases, which leads to more death, which leads to more dead seniors. It's as simple as 2 + 2 = 4. One-Third of All U.S. Coronavirus Deaths Are Nursing Home Residents or Workers Now, granted, New York fucked up. They did not get their full share of senior citizen death. So really, they should have had thousands of more dead seniors in nursing homes. Many New York cops and young adults died instead. So that is a big policy glitch. If we'd just let the nursing homes function properly as quasi-concentration camps, we would have had a much more efficient and targeted slaughter in New york focused largely on senior citizens. Now, sorry to keep infecting wonderful theory with troubling practice and actual facts, but you guys know me. Only 20 % of New York's deaths were seniors in long-term care facilities. By comparison, since @bigjoey mentioned Florida, 42 % of all Florida deaths were in long-term care facilities. So that is a big failing on New York's part. They really fucked up the part about having a lot of dead seniors in nursing homes. If they had done as well as Florida, they could have had 5,903 more dead seniors in nursing homes. (Meaning if 42 %, not 20 %, of the 27,015 dead in New York at that point were seniors in long-term care facilities.) Others states were much better than Florida in focusing death on seniors with nursing homes with Nazi-like efficiency and precision. As I said in another post, Oregon and Washington have both had about 60 % of their deaths in nursing homes. Canada has been particularly efficient. 80 % of their COVID-19 deaths have been in nursing homes. There is a data note that needs to be made. That New York Times chart is incomplete, as it states. I posted it mainly to show that New York has one of the lowest percentages of deaths in long-term care facilities. The number dead there, 5,403, does not completely match up with the state's own reported number as of today, which is actually about 3000 confirmed COVID-19 nursing home deaths. The Times may be including presumed deaths, and non-nursing home long-term care facilities. And I'm not 100 % sure the Florida number is right, either. Florida nursing home deaths from COVID-19 spike dramatically: up to 22 at a single home That articles says that 60 % of all COVID-19 deaths in Florida in one week were in nursing homes, which represented a huge spike. So if we are talking about how policies were used to doom seniors in nursing homes to death, we have to admit that New York is just a slacker. These place like Canada and Oregon and Washington are the models for how to have nursing homes playing the roles Auschwitz or Dachau did in the Third Reich. These are the places were death is concentrated, and executed very efficiently. Cops? They'll be fine. Workers? They'll pretty much be okay. It's the seniors in nursing homes that get slaughtered. New York fucked that up completely. They had lots of dead cops, and workers. I think everybody has drawn the proper conclusion from my sarcasm. Which is that New York is what Plan Herd Immunity gets you. @sniper has made this point repeatedly, and he's right. Pretty much every nursing home in New Jersey had cases, because when it is everywhere it is simply hard to keep out of nursing homes. They are the sitting ducks. I posted that New York list because you can go county by county and see that most counties have senior deaths in nursing homes. And, no surprise, the counties with the most deaths in nursing homes are the counties where the most community infections occurred. Starting with any county in or around the metro area. So you have to get to "M" - Montgomery County - before you have a county in New York with zero nursing home deaths. That county has 50,000 residents, and is in between Albany and Syracuse. All those counties where the virus was spreading like crazy in February and March ended up with hundreds of nursing home deaths. 2 + 2 = 4. The pattern and math is incredibly clear. The flip side is that Canada and Oregon and Washington had a lot less death, period. Testing and contact tracing fits in here, too. All three places, like Germany and Iceland, have been leaders on contact tracing. So my guess is that tracing did what it was supposed to do: stopped or at least slowed broad spread of the virus in the general community. That said, all it takes is one asymptomatic nursing home worker and you can have a nursing home wave of death before you know it. By the time the first senior is sick, lots of them are infected. And all of them are at high risk of death. I'm not sure contact tracing has much value in nursing homes. What does have value is ubiquitous testing and temperature checks to keep the virus out. But, again, the more potential for any one of those workers to get infected at church or home or the grocery store or wherever, the harder it is to keep them from bringing the virus to work. I am NOT arguing that there are not bad apples. There are. But to blame this on most nursing homes is counterproductive. Partly because the people who work in those homes are good, dedicated people who don't want to get sick and maybe be hospitalized and maybe die either. So if we keep the virus out, it is a win/win for the residents and for the dedicated employees who care for them. Not to mention the volunteers like @bigjoey , of course. And the loving family like me and my siblings who want to go hang out and play cribbage or cards with Mom and Dad. In my romp through stories on Germany yesterday one of the endless list of creative things I read they did is built (or redesigned, I'm not sure) a nursing home specifically for COVID-19-infected nursing home residents. There's some scale and expense issues there, which probably only a government could do. Many nursing homes are corporate. But I'm not sure in the US you could easily move an infected senior from Kansas to California. I'm trying to steer clear of any remotely political or partisan comment in The Lounge. But in that category, I think it paid off big for Germany that Merkel herself seemed to act like the chemist and research scientist she is, not a partisan politician. That right there was one of the things that worked out very well for Germany. She viewed this as a science problem to be solved, much like Dr. Fauci or Dr. Birx. At one point I had a roommate from hell with a pit bull in a home in Sacramento. I was living in SF at the time and whoring and flipping homes. So I would show up one or two days a week. Other than that the house was his. So after he moved in the first week I showed up the back slider was open - in the middle of the Summer with the AC on. There were probably hundreds of dead flies in the house, and dozens of pieces of dog shit in the fenced back yard. So I told him he had to keep the door closed other than to let the pit bull out. And he had to clean up his dog's shit. The next time I came there were no dead flies in the house, and no dog shit in the back yard. Maybe I am oversimplifying things. It would be more complicated and maybe interesting to figure out how to have an open door, and still have no dead flies in the house and no dog shit in the back yard. But I think everyone gets my point. It is way easier to just close the fucking door. It is helpful that Germany and Iceland and South Korea and China and Australia have given us examples of how to do it. It seems to work in places like Washiongton and Oregon. New York has "only" 20 % senior citizen nursing home deaths, whereas Oregon and Washington have 60 % senior citizen nursing home deaths. But in New York that means thousands of dead seniors. Versus hundreds of dead seniors in Washington, and dozens in Oregon. Meanwhile, dozens of New York cops died, at least one of whom has a young widow in her 30's with young kids and now maybe no health insurance to pay for their vaccinations. To my knowledge, Washington and Oregon have zero dead cops. The numbers and facts speak for themselves.

Germany extends social distancing rules until June 29 Regions can allow up to 10 people, or members of two households, to meet in public. Germany has substantially reopened, with many shops, factories, and at least some schools back. They're now recognized as one the global leaders on "best practices". It seems like one of many things they got right is to limit any kind of large gatherings while they also attempt to get most functions of the economy up and running. Large sports events and festivals are banned through at least the end of August. Here's an interesting and encouraging trip down memory lane: Coronavirus: Up to 70% of Germany could become infected - Merkel March 11, 2020 It's not clear whether the tone of that message was meant to indicate inevitability, a desired outcome - or, more likely, a worst case scenario. But nothing like that has come to pass. On it's worst day, March 27, Germany peaked at just under 7000 cases a day. In the last week they've had between 273 and 692 cases a day. The Bundestag just passed a new law that envisions ramping up mass testing further and hopefully "wiping out the virus for good". That sounds ambitious, maybe impossible. But it's a long way away from the inevitability of herd immunity. Germany's peak caseload is actually comparable to the US, since their population is about one-fourth the sizes of ours. So with that adjustment, their peak of 7000 cases is in the ballpark of our peak days, which were in the ballpark of 30,000 per day. Here's a good summary of why Germany has done a good job reducing infections: Germany is reopening with one of the lowest death rates in the world. Here's how it barely missed a trick as it fought the coronavirus. In addition to focusing on testing from the start of the outbreak, Germany also got contact tracers up and running very quickly. Here's a detailed article on that effort, that mostly compares Germany's successes to the UK's failures. Germany Has Shared The Details Of Its Coronavirus Contact Tracing Operation. The UK Won’t. This line from the article struck me, simply in terms of the scope and the speed of the effort: March 1 is basically a few days after the first German death from COVID-19. I wonder whether the states already has teams of contact tracers in place for other infectious diseases that they were able to build on. Either way, they were able to ramp tracing up very quickly. Here's one other paragraph about contact tracing that really struck me. While the article is about Germany, it mentions other countries, like Iceland, that have done a particularly good job: It struck me that if over half of Iceland's infected citizens are already isolated by the time they test positive, because they were contact traced and isolated and tested, that would explain why countries like Germany and Iceland have been able to slow the spread of infection rapidly and decisively. The US or UK are unable to do the same, probably in part because there is less testing, and a lot less contact tracing and isolation. These numbers suggest that there could still be armies of people in the US who are asymptomatic and spreading the virus. This also made me think that Germany's peak of 7500 cases may not be in the ballpark of the US's 30,000 cases, after all. Even though our population is about four times larger. In the US, given the lack of testing and tracing, it's a certainty that those diagnosed cases are a small fraction of the actual infections. The places that have done antibody tests, like New York, confirmed that there might be 10 or more infections for every diagnosed case. In Germany, it's quite possible that their 7500 cases represented a much higher percentage of the true cases out there. They made an aggressive effort to find infected people, test them, and isolate them. We mostly haven't done that yet. Another thing that became clear to me reading this is that the lack of large gatherings in Germany helps them with their contact tracing. If there's lots of crowds, it's obviously impossible to know some or even most people you were in contact with. If gatherings are limited to a few people, if you do get infected it makes it much easier to identify who you might have infected. And to get to them quickly before they infect others. Unrelated to Germany but related to contact tracing, Santa Clara County's Chief Health Officer Sara Cody had this to say today about Gov. Newsom's announcement that religious gathering and other large gatherings of up to 100 people can occur: That concern makes sense. Most of the large European countries - Italy, France, Spain, Germany - have all reduced their new infections by 80 or 90 %. Australia, South Korea, and Japan are all examples of medium-sized countries that have few daily infections. But many US states, including California, seem stuck at a plateau that won't go down. In California we've been at a plateau of about 2000 new cases a day for about a month. I've assumed it was because there's a small minority of people who just won't abide by masks or social distancing, and end up getting infected. But when I read Cody's statement it made me realize that we could also be stuck at a plateau because there's a subset of asymptomatic spreaders that just keep infecting more people, Some of whom then become the next cycle of asymptomatic spreaders. If that's true, we're going to remain stuck until we get both testing and contact tracing going to find and isolate those infected people. It seems like that is what Germany and many other countries have gotten to be very good at. And that is in part why their number of new cases is down 95 % or so from the peak. One final short video that is worth watching: Sentiment downbeat as German stores reopen I've posted this Open Table reservation data from late February and early March several times. I think what it indicates is that long before any government lockdown, there was a sharp market lockdown that was driven by consumer fear. Germany is now experiencing the flip side of that. It also appears to be happening in the US in states like Georgia and Texas. Businesses may be open. But that doesn't mean people will come. In Germany it's not clear how much of this is the economic pain of the pandemic, meaning people have less money, and how much of it is fear of going shopping or eating out. Those two things obviously reinforce each other. The more fear there is and the longer it lasts, the more the economy will be stuck. That is probably why the Bundestag is talking about trying to get rid of the outbreak for good. So that consumer confidence can actually start to get back to normal. Mostly this is good news. Germany has come a long way from March 11th, when they were talking about 70 % of Germans being infected.

Canadian military details horrific conditions in nursing homes battling Covid-19 "The reports they provided us were heartbreaking. They were horrific." I swear to God I want to post something about Germany, which I will. But I'm like a kid in a candy store. I keep seeing other new stories that are relevant. My strong reaction to the article above is this. COVID-19 is going to make everything in nursing homes much worse. Period. These places always have challenges, as the report outlines. Most of what is described in that article are long-term issues. But whatever they are, COVID-19 will multiply and deepen them. The "best practices" places will have more problems and challenges. At the worst places it will invite absolute disaster. To say the same thing with a different emphasis, the only reason to unleash COVID-19 on to a community is to make all the people who work and live in nursing homes in that community miserable. Maybe they are miserable already. But COVID-19 will create more misery. Maybe things are going pretty well. COVID-19 will ensure things go at least somewhat worse. The proof of the pudding is that the report even exists. I am quite sure that in Canada nursing homes are regulated. So I was wondering why the military would issue a report. They were sent in because of staff shortages, which makes sense. And I assume they were shocked, and decided to write a report about it. The fact that any of this happened reinforces my point: COVID-19 is a nightmare for nursing homes. Period. On his thread about the front line @purplekow told a story that is relevant here about staffing. Correct me if I get the details wrong, PK. A senior was admitted with COVID-19. I believe she ended up dying. There were only two people that could have infected her, both of whom were in-home care providers. One had flu-like symptoms, the other didn't. The one who tested positive was the asymptomatic one. As much as I feel sorry that Granny died, I also felt bad for the in-home care provider. I keep thinking of Dr. Birx's grandmother, regretting her whole life that she brought the Spanish flu home from school and it killed her Mom. Some young woman will now know for the rest of her life that she killed someone's Granny, even though she was just trying to take care of her. I would not wish a medical and emotional hell like COVID-19 on my worst enemy. Even if we have ubiquitous and rapid testing, which we don't, figuring out a way to ensure that none of the staff are infected has to be a challenge. I can also see why a lot of low-paid staff wouldn't want to work in these circumstances. It's a bit like being a doctor or a nurse. If COVID-19 gets in, it would quickly expose all the staff to infection, too. My experience is these are mostly very dedicated people. But it's easy to understand why there would be staffing shortages with COVID-19 that would require sending the military in. All of this leads to one inexorable conclusion: keep COVID-19 out. It's that simple. Do whatever it takes to keep it out - if you can. Which means you have to keep it out of the community and state the nursing home is in. I think I can tell you the number of COVID-19 deaths in nursing homes in any state or nation in the world. You tell me how many COVID-19 deaths, and I'll tell you how many were in nursing homes. I'm just going to guess 50 % of the total. And most of the time I'll be in the ballpark. So if you want less deaths in nursing homes, the key variable is this: reduce infection and death in the community around it. Nursing homes linked to up to half of coronavirus deaths in Europe, WHO says A different report with a similar tone and conclusion says its varies from 42 % in Belgium to 57 % in Spain. But no one kept COVID-19 out of nursing homes, or even close. What determines the number of COVID-19 deaths is simply how deep the virus penetrates into the community around it. I'm going to transfer a few points @sniper made on a different thread that nailed it. I hope that's okay sniper. The first statement is just a fact. The second is more debatable, which is what I did on another thread. But I mostly agree. In Washington and Oregon, two of the states that have done a better than average job, I think, of reducing and minimizing community spread, 60 % of the deaths are in nursing homes. The Washington numbers are interesting, expressed as percentages by age: 64 % of the cases are worker age (20-59) and 30 % are senior age (60 +) 36 % of the hospitalizations are worker age (20-59) and 63 % are senior age (60+). 26 % of all hospitalizations are patients 40-59. That's significant. 10 % of deaths are worker age (20-59) and 90 % of senior age (60+). Again 9 % of deaths are patients aged 40-59. That's not a minor risk. I think Anders just has this part completely ass backwards. The concept is we'll let the people who can afford to get sick catch COVID-19. It's not worse than the flu, and in Sweden the care is high quality and free. And we'll make sure seniors don't get exposed. That's the idea. Here's the reality. First, for people aged 40-59, it's hardly a picnic. I have to think this is a picture of hell, and unwanted expense, for corporations with middle-aged workers who will spend lots of time in hospital beds - if this hits their factories of offices. But where Anders is just wrong is that somehow this can be kept out of nursing homes. @sniper is right that the seniors in these homes are most likely to get it. They are the sitting ducks. And they will have the worst consequences. @sniper pointed out in his response to my post that in Canada 80 % of all deaths are linked to nursing homes, which is also what the report above says. So if you assume that Canada, like Oregon and Washington, have done a better than average job of reducing community spread, it follows that they'll have a particularly high percentage of nursing home deaths. Seniors are the sitting ducks. Thankfully, percentages are percentages. So in real numbers Washington has 1093 deaths and Oregon has 148 deaths. You can figure out what 60 percent of those numbers are. That number is far lower than the 5000 or so deaths in nursing homes in New York City alone. All roads lead AWAY from nursing homes. If you don't want COVID-19 in nursing homes, you don't want this in the surrounding community. It is easy to blame this on nursing homes that are death traps. And it is fair. One function of even the best homes is to be a deathtrap, where very old and very sick people go to die. That is basically what happened to my Mom and Dad, who I loved deeply and miss a lot. That said, some of these places just suck. They deserve to be attacked, like this report does. But to repeat the crux of a different rant, I wrote a report like the one above - albeit on adult foster homes in Oregon, not nursing homes in Canada. I worked closely with the woman who ran the agency that regulated those homes. I got my view from her: the vast majority of these homes are staffed by dedicated people who do a good job. There were reports for every inspection of every home. Every violation of standards and resulting penalty was cited. So I could tell state legislators that the adult son of this owner raped patients, and that Romanian family slaughtered pigs in the back yard. It was all written up in reports by inspectors that also did a good job, I think. Rape and slaughtering pigs and insect infestations are definitely the details that got me the momentum I wanted, both with media and legislators. I went after a "Dirty Dozen" out of maybe 1000 adult foster homes at the time. But I could not have named a "Horrible One Hundred". There were just not that many that were that bad. The goal was to make it easier to eliminate a small number of bad apples. So I fully agree with you @bigjoey that there are bad apples. And I commend you for your great volunteer work. But with COVID-19 this is not primarily about seniors dying because of a few bad homes. Even though there are definitely a few bad homes. This about seniors dying because of a virus that is a perfect senior citizen killing machine. COVID-19 is going to make staffing and running homes more difficult for even the best homes with the best practices. And the deeper it gets into any community, the more likely it will eventually find a way to get over the wall into a nursing home. The easiest way is probably by going through an asymptomatic staff person.

I agree, but I'd go way further than you. I know you are mainly talking about nursing homes. I completely agree with your point. As you know, infection control was a big nursing home issue before COVID-19. COVID-19 will make it more of an issue for a long time. Even after the crisis is over. So part of the impact of this is it created a huge amount of public awareness and education about infection control. But I think the same thing applies to everyone. Society as a whole. This is NOT the kind of awareness and public education anyone would wish on anyone. That said, it is for sure necessary. And it has already made a huge difference in terms of preventing mass illness and death. I think the leading reason there is a lot less death in any Asian country is simply because there was much deeper public awareness of how bad things could get. Quickly. And what actions were effective to stop an infectious disease. In a sense, South Korea and Taiwan and others were lucky to have to deal with SARS and similar bugs in a way we didn't. Because when something much bigger and more lethal came along, they were prepared for immediate action. Some of those stories I already posted about scientists and modelers talked about discussions they had in March with leaders who said, basically, "You can't shut things down based on a model." They were right. People would have gone nuts. Unless, of course, people knew exactly how bad things could get because the ICUs in New York and Sioux Falls are filled and there's 30,000 dead New Yorkers. I agree with every point made about how kids can't go to school, cancer victims can't get treatment, vaccinations are being missed, etc. But that's all a reason to crush the virus. Having more virus, more hospitalizations, and especially more fear, will not make any of those problems easier. They will make them worse. Scott Atlas just put out another one of his screeds. He uses the word "fear" a lot, which is appropriate. Like people are missing cancer treatments because they are afraid. But it does matter that that what people fear is the VIRUS. So Atlas mostly likes to slam the idea of lock downs. But what he misses is that this is a market lock down. People are avoiding things out of fear. And to some degree ignorance. So public lock downs are basically public ratifications of a market lock down. I think we should be clear that fear and ignorance are the real drivers. I think the chart in this article helps explain why New York has almost 30,000 dead, Massachusetts has about 7500 dead, and Washington has "only" about 1100 dead. The fundamental drivers are fear, ignorance, and public awareness. For most or all of the period from Feb. 20 to March 14th, Massachusetts and New York had ZERO COVID-19 deaths. Washington had their first death in late February, which started a cascade of nursing home deaths there. New York's first death was March 14th. Massachusetts was March 20th. I think that explains what you see in those charts. It was a market lockdown, based on fear, and to some degree ignorance. In late February, when we now know the virus was spreading like crazy, restaurant reservations in Massachusetts were going up. By March 7th, Seattle was already going into a massive market lockdown. New York was starting, but to a much smaller degree. By the following weekend, the entire country was in market lockdown. This was all public fear, and ignorance. Was the fear misplaced? Was the ignorance wrong? Not really, in my view. I think all those restaurant cancellations, which are simply one measure of a much broader market lockdown, are a big part of the reason why a lot fewer people in Washington died. This is completely relevant to what's going on in Georgia and Texas today. To some degree the ranting about government this or that misses the point. The real point is market lockdown. That's what that JP Morgan data I posted is so good with. For the most part, people still won't get on planes and go to restaurants. Because they are afraid. And they are not stupid. They have good reasons to be afraid. This is mostly good news. America in May 2020 is not the same as America in February 2020. Nor is the world the same. It certainly does not mean we beat the virus. But it at least means we are much better prepared. And we won't go down without fighting. Texas is doing a somewhat better job than California. That's a bit embarrassing to me, as a Californian, actually. I mean, yeah, I know they have their viral SWAT teams. But shit! We've got Arnie. Isn't that supposed to be better? The thing that makes me sad is that a lot of good people probably think that masks and social distancing are enough. It's a big improvement from late February. Which probably means what happened in late February and early March is not happening now, and won't happen again. Thank God. But my main point is that, as you know from nursing homes, this is complicated. It's a whole bunch of layered steps, that collectively make a huge difference. So more public awareness and more public education is a very good thing. This is why Dr. Fauci and Dr. Birx are national heroes. While we will pay a price on lost cancer treatments and diagnoses and many other things - which is all a good reason to control the virus as soon as we can - there will also be residual benefits for a long time from all this increased public awareness about infection control. Here's one example: COVID-19 Social Distancing Has Mitigated 2020 Flu Season As that chart shows, COVID-19 was late to the flu party this season. But public awareness and the fear-based lockdowns clearly reduced the spread of the flu, too. As bad as 100,000 deaths are, it would have been far worse but for a fearful public that was smart enough to know they were ignorant. So we all went up a steep learning curve as quickly as we could. That is going to make all the difference moving forward. The fear-based market lockdowns were the driver. And they still are. The quicker we build awareness of how to beat this thing, and prove that it actually works, the less fear and market lockdown we'll have. Again, I agree with you. But I think you are underselling public awareness as one of the victories we have already won. We should be very proud of that. To be really optimistic, one of the other things we might learn from this is basic science about infections that might help keep seniors in nursing homes alive. As the risk of being crude, to some degree nursing homes are senior citizen death machines. My Dad said for years about the nursing home his wife was in that this was a place "people go to wait to die". So in many cases COVID-19 simply speeds up the process. My Dad died at the age of 96 of pneumonia, less than a year after he moved into the same nursing home. Had that not happened, he could have easily died there of COVID-19 at 98. I would never argue that is a reason to stop the global economy. What I also never argued is that somehow this was the nursing home's fault. I know you are not saying it is. But I have a deep emotional history with this. There's a wonderful woman named Linda, same name as my sister, who runs the social service dept. in that nursing home. She would tell me she saw my Dad trudging in through the snow every day in the Winter to visit his wife, where he'd drive to from his home a few miles away. She told me she worried about him being alone at home. I did my best to convince him to move into the assisted living facility across the street, where he could have kept his car and had his own room. He just wouldn't. He wanted to live independently as long as he could. On the subject of fear, I can't say he was wrong to fear having to live in a nursing home. Within a year he was dead of pneumonia. But he had congestive heart failure, anyway. Was this in any way the nursing home's fault? That is somewhere I wasn't going to go. Nor did my siblings go there. But every winter there were always lots of deaths from the flu and pneumonia. So some part of that, like you said, is regulation and inspection. That is ongoing anyway, like I ranted about several posts ago with adult foster homes. But there is also a piece that is just about science, and medicine. We are throwing tons of money into research on infectious disease. This is exactly what Bill Gates was begging for. So I'm hoping there will be lots of residual benefits. Helping fight infectious disease in nursing homes could be one of those benefits. At least we can hope.

COVID-19 pandemic on naval ships I also revisited something else from a month ago that was a natural experiment: what happened on those Navy ships that had mass outbreaks? I think the conclusion we can reach from the charts on the Wikipedia page are pretty much the same as with the Ohio prisons. If the goal is "test, trace, treat", it appears to have worked. The problem to be solved was the same as in the Ohio prisons: a mass outbreak silently crept in. By the time they figured it out, hundreds were infected. Ultimately, over 1000 were infected on one US ship, and also one French ship. As I said above, this mirrors the real problem in New York and New Jersey in February and March. It could be a real problem anywhere in the US in June or July - absent masks, social distancing, and "test, trace, treat". And as with the Ohio prisons, "test, trace, treat" seems to have worked as a solution, at least so far. Where it was out of control, on the Roosevelt, the problem was eradicated through testing, tracing, and treating. It has not gotten similarly out of control on any other ship - at least so far. There's one huge difference with the Ohio prisons. Since the inmates were more representative of a typically aged US workforce, the death rate of inmates was 1.46 %. While we don't know it, I'm guessing based on that the hospitalization rate was at least 5 %. (Again, the CDC now says 4.5 % is the standard rate for hospitalization of 50 to 65 year olds.) In this case, we don't know the age of the sailors. I'm guessing it was much younger. On both ships with mass outbreaks of over 1000, only one sailor (aged 41) died. From media reports, I think maybe 5 US sailors were hospitalized total. So the hospitalization rate was maybe 0.5 % to 1 %. My point in bringing this up is that if there is an argument to be made for intentional herd immunity, this is the part of the workforce that might actually be interested. We know that the death rate was pretty close to zero. Hospitalization was close to zero, and in this case free. If we really wanted to play out an unrealistic by not insane scenario, this could actually be something the military would do to prepare soldiers and sailors for biological warfare. Unlike in 1918, it didn't kill sailors. It actually gave them herd immunity. If we were really to seriously consider this, there's a few important details that Tom Freidman always leaves out, that I'd focus on. First, we might want to ask what the odds are that anybody actually has herd immunity. I already posted it in another thread, but I'll at least mention that one new study suggests some of these sailors (13 out of over 1000) may have already been re-infected. Most likely, this is just a technical testing glitch with false positives. But we have no idea what herd immunity means, and how long it lasts with COVID-19. That's not a minor issue with Plan Herd Immunity. The other issue with Plan Herd Immunity is that some people actually do die. (Not, of course, that anyone cares, if we're going by the herd immunity myth. Young people are immortal. And even if they're not, they don't care.) If we are basing all this on reality, not theory, I think it is worth mentioning that the 41 year old sailor who died probably did not have to die. This is utter speculation on my part. He was left in isolation, and found non-responsive when someone checked in on him once every 12 hours. Only then did he end up in an ICU. I think that was a learning curve problem. After that, the Navy instituted regular observation, at least through "buddy checks". My point is that if we really wanted to do herd immunity, I'd want to at least do what China did: you get isolation for free, and medical care for free. And the care is actually pretty good. The difference is that if you are Boris Johnson, you get 24/7 care. And that could be the difference between life and death. Those are Boris's words, not mine. If you are Boris Bumblefuck, the standard isn't quite the same. In the real world, of course, not everyone gets treated like a Prime Minister. But to me this is one of the massive conceptual problems with herd immunity, even for the young and healthy. China's goal was to eradicate the virus, not control its spread. In the service of that, everyone did get free care. For some that meant isolation, to observe whether they got sick. For others, that meant an ICU. No one paid for any of it. And by the last month or so, when China had gone up a steep learning curve, the reported death rate was very low. As soon as you move from eradicating the virus among the few to controlling the spread of the virus among the many, giving people free isolation and free care gets a lot more expensive. More important, it gets exponentially more difficult to work out the medical resources needed. If we are talking 20 and 30 and 40 year olds, there is probably room for error. But if the idea was really to get the young part of the herd through this physically, mentally, and financially intact, no one has begun to think through how you do that. Other than by the kind of disaster planning that occurred in March. No one knew for sure then that lockdowns would prevent every community from being just like New York City. Which is the biggest reason that herd immunity is extremely unlikely to ever be seen as a goal, as opposed to a miserable outcome to be avoided if at all possible. I haven't seen any poll anywhere that shows anything other than overwhelming support for lock downs - in the past, present, or future. Right now, about 2 in 3 Americans say that if the virus gets out of control again, they want a return to shelter in place. What's been a little bit of a surprise to me is that many of these polls disaggregate by age. And there is little variation of support for lock downs by age. There might be a few points more opposition to lock downs among the young. But an overwhelming majority of every age group supports it. I know people who are able to work at home that are sick of it, and would like to return to their office. But I don't know anyone who wants to do that so they can catch COVID-19, and get herd immunity. They miss the socialization, and just want things to be the way they used to be. There's no evidence I can see that people who actually are the most exposed to infection - people in "essential" jobs - have any interest in herd immunity. I haven't seen polls or data that really paints a clear picture of which parts of the herd are most exposed to the virus every day. Nor have I seen polls about how they feel. But from I read and see anecdotally, it seems like these workers tends to be younger, browner, and lower income. They work in the grocery stores and meat packing plants, for example. These are the workers who are most subject to what I'd call workforce misery. While there are no polls that prove this, my guess is they are most concerned about stable work at decent pay. That said, there's also lots of evidence that they are worried about their health, and the health of their families and friends. If they are looking for herd immunity as a way of having some kind of work advantage, I don't hear it or see it. My own impression about what is really creating workforce misery for younger workers is the fear and uncertainty that is creating a market lockdown, even as the government lockdowns gradually lift. Most other countries are using "test, trace, treat" to create as safe a work environment as they can - both for the workers, and for the people who use those services. For example, that's how countries like South Korea were able to avoid closing restaurants, period. The idea is that you can safely go out to eat, not to catch COVID-19. Makes sense, right? The biggest problem I see, short of course of a full blown return of exponential growth of the virus, is this stop/start/stop/start work pattern when individual workers test positive. It's happening in auto manufacturing and meat packing and other factories right now. When more offices reopen, like that South Korea call center, it will no doubt happen there. Unless things change dramatically in countries all over the world, I think what is happening in Europe and Asia and Australia is the handwriting on the wall for the US. Corporations in the US will see that it is cheaper and healthier to contain the virus than to figure out how to deal with mass illness, mass hospitalization, and a lot of death among their workers. The pressure from employers to get our shit together on "test,trace, treat" will grow. And workers of all age groups will like that. If they are 55 and have asthma, they don't want to end up in a hospital. If they are 25 and healthy, they won't like the stop/start/stop/start of having to shut down and lose work every time somebody else gets infected.

This discussion about COVID-19 penetrating nursing homes, and whether you can keep it out, led me to go back and look again at two things that have been discussed here before: the Ohio prison outbreaks, and the Navy ship out breaks. They both provide unique pictures of real fatality rates, since they involve contained environments. We more or less know that all the positive cases actually are all the infected people, not just some of them. What I'm interested in is what conclusions you can reach, if any, about two different approaches: "test, trace, treat", or letting herd immunity take it's course. I have two big issues with herd immunity that are the filters I translate this through. One is the senior death machine. The other is the huge workforce problem. And the workforce problem can be split into two issues: workforce hospitalization, and workforce misery. I also think each of these three problems comes with an objective standard for measurement, and an age group to look at. The senior death machine is people aged 65 and over, obviously. And the standard to look at is also obvious: what's the fatality rate? The workforce hospitalization problem is one I think we know little about right now. But the new CDC data suggests that 4.5 % of people aged 50-65 will require hospitalization to recover. That's a big number, if we're talking about all US workers aged 50 to 65. So the question is: how many Americans will need to be hospitalized to get well? The workforce misery problem is for people aged 18 to 50. I'm just going to assume that nobody really gives a shit if these people get sick or die - including them. That's obviously a false assumption. But it plays to the idea that lock downs are evil, and do horrible things to all these younger workers who just want to work, God damn it! It also plays to the (not really true) idea that COVID-19 is mostly a few sniffles and coughs for them. So the measure for this group, which is the hardest to measure, is how much economic pain is being caused to them? And how? Obviously death and hospitalization and economic pain matter to all three groups. But I think it's realistic that seniors are marginally more worried about death, and Millennials are marginally more worried about the economic impact of the pandemic. Ohio COVID-19 Inmate Testing It looks like the first (and hopefully) only wave of COVID-19 infection to go through Ohio prison's system is now pretty much done. So one lesson to be learned is this erroneous headline from April 23: "Despite Massive Outbreak, Just 0.3 Percent of Ohio Inmates with COVID-19 Have Died". The lesson from that headline is whatever we think we know might be wrong, and will be different a month from now. The headline was closer to correct on prison staff death - as of today it is 0.62 %, or 4 out of 627. I have no idea what staff testing criteria were. I'm assuming the goal was to test any staff that could potentially have the disease. The inmate death rate was 1.48 %, or 68 out of 4606 positive cases. I'm going to assume that accurately reflects all inmates infected, not just some. As the report shows, 8940 inmates out of at total of 35,517 were tested. So my assumption could be wrong. But the very fact that this testing was done so systematically puts Ohio in the "best practices" category. So I'm also going to assume they know what they are doing. Further evidence of that is that the problem to be solved was this mass silent infection in a few prisons. Now that time has passed, I think we can say they accomplished their goal. They blocked the virus from doing the same thing in other prisons. I think this gives us a preview of the massive workforce problems the path of herd immunity would create. And the huge advantage to businesses of just being able to contain the God damn virus. The average age of Ohio prisoners is 38. This article, if you are curious, tells you about the ten oldest, aged 88 to 94. The average age of a US citizen is 38. The average age of a US worker is 42. So my assumption is that this gives us a picture of what could happen in any US work environment where lots of people gather. And it is not a good picture. Maybe the 1.48 % fatality rate is higher because of the ages in these specific prisons, or the inclusion of some older prisoners, or the fact that prisoners just have poorer health. But if you translated this outcome to any office or factory with hundreds or thousands of workers, it would be a disaster. You could use this to argue for or against herd immunity. Meaning let the virus roll, but keep it out of certain walled structures - like a prison, or a nursing home. You could argue that by using "best practices" Ohio kept the virus from causing new outbreaks in more prisons. That is true. So we can keep it out of nursing homes, right? Maybe. But there are these three things: 1) to do this, they had to test and trace the fuck out of the inmates; 2) they also had to test the fuck out of the staff; and 3) the broad goal was to reduce, not control, the overall transmission of the virus in the surrounding community and state. I'd go with the opposite argument. This is a good example of how, and why, "test, trace, treat" is effective. The broad goal was to stop the virus, not control its spread. In a few prisons, hundreds had silently gotten infected before hospital beds started to fill up. This is exactly what was happening in the US in February and March. It could happen again in June or July, absent steps to prevent community spread. If there is anyplace where one COULD make an argument for herd immunity experiments, prisons are it. Why not? These are criminals. They'd make perfect guinea pigs. My point is that even with prisoners, that concept would raise holy hell. The goal here was obviously the complete opposite. Anyone who thinks we might try this in a call center, an Amazon distribution center, or a meat packing plant is kidding themselves. No corporation or workforce wants this. My takeaway is that Ohio intervened to stop the unintentional and unwelcome progress of natural herd immunity. They used a rigorous protocol of "test, trace, treat" to: 1) stop and treat infections where they are out of control, and 2) prevent the virus from getting out of control everywhere else. A month plus later, it appears to have worked. If this were any workforce, the 1.48 % fatality rate would be very bad news. I'm going to guess the hospitalization rate was at least 5 %. So if this were any office in America, the combination of worker illness, hospitalization, and death would be a disaster. My guess is this is exactly why as recently as today any car manufacturer or pasta-making factory or meatpacking plant that starts to have an infection problem just shuts down. It is extremely disruptive to the workforce. But no corporation wants this set of problems. Which is why I have to imagine the idea of gradual infection and herd immunity would be anathema to them. They probably want this virus to just go away - whatever it takes. You could argue that Ohio prisons are bad examples of what happens in real workforces. But then you have to explain this: That's a diagram of a call center in South Korea. It was the second worst mass outbreak they had. In this case, 94 out of 216 call center workers (the red ones) on one floor became infected. This could be a call center, a prison cafeteria, or a meat packing plant. The outcome here was the same as in the Ohio prisons. South Korea went in and tested and traced the virus into oblivion. Texas has gotten the memo. They actually have the lowest infection rate for any state their size: 1,955 infections per million, compared to 2,451 per million in California. Both states have maybe 2 to 3 % natural herd immunity. (Assuming ten actual infections for every diagnosed one.) Neither state has any interest in herd immunity. Texas has viral "SWAT teams" designed to go into these places and blow the virus back to the hell it came from. That actually sounds better in Texas than jargon like "test, trace, treat." That South Korea diagram comes from a good National Geographic article that speculates about how corporations will trash open office spaces because of COVID-19. Call me a skeptic. Every corporation in the US has a big red bottom line after just a few months of this shit. Now you tell me I need to redo my air system, and my office architecture? You'll meet Ayla, a Texas insurance broker with asthma. We don't know her age. But she's worried that she'll be one of the 4.5 % of middle-aged workers who may need to be hospitalized. She's requested an extension to work remotely. This is of course what human resources departments are for. But no corporation or business in America would welcome this mess and expense. Not if testing, tracing, treating, and ultimately vaccinating the virus out of the workforce proved to be a feasible alternative.

An interesting companion piece that I take as optimistic, despite a somewhat ambiguous headline: The world needs Covid-19 vaccines. It may also be overestimating their power I think one of the pieces of very good news about this already is that Bill Gates got his wish. Five years ago, he was begging the world to prepare for this. He's got too much humility and tact to say, "Penny wise, pound foolish." That said, had we listened and years ago invested hundreds of billions, or maybe less, we could have saved trillions of dollars, many jobs, and many lives already. The good news is that COVID-19 will not be the last infectious disease, or even Coronavirus, we deal with. So I think we'll learn lots of good technical things, which most of us (at least me) won't fully understand. The part we all will understand is the public health mentality that all the Asian countries got right. They fell in line quickly around an effective strategy. And that was all about an ingrained public health awareness based on SARS and other recent bouts with pandemics. As a public, they knew much better what to do, and they just did it. We will have a much shorter learning curve in the future thanks to this. In fact, we already do. America today is not the America of February 2020. Which is partly why I doubt we could have the kind of undetected exponential viral growth we had in February and March. So we're all learning more than we every thought we would about disease and vaccines and infection control. The key thing I learned from that article is that the hunt for the vaccine may occur in stages. The phrase I had never heard before is "sterilizing immunity", as in: So it could be that an initial vaccine does not block infection or transmission all that well, but does make this a less nasty disease for those who get it. Like by preventing Covid-induced pneumonia. While it's not said quite this clearly, my takeaway from the article was "something's better than nothing". Right now it's all just speculation anyway. I went back and looked at the Navy ship infections for another post about keeping COVID-19 out of these places like nursing homes, and prisons, and ships. But there is one piece about the mass outbreak on the Roosevelt that fits right into this discussion about immunity. 13 USS Roosevelt Sailors Test Positive For COVID-19, Again May 16, 2020 Hopefully the positive test results are more about testing error than about bad news regarding immunity. There's about 1,000 sailors involved. The article isn't completely clear about who got retested when. But one explanation could be that about 1 % of the tests are simply false positives. That NPR articles mentions and hyperlinks to a similar story about South Korea. That article is from April 17, and it talks about how 163 patients out of 7,829 infected - about two percent - tested negative and then tested positive again. That would have been about a month after their one big wave of new infections from that church sect that caused about 5000 infections. So it would make sense in terms of timing that as they were clearing that large group for full recovery with a test and retest that a small percentage simply yielded false positives. I checked to see if there was anything since then from South Korea, and I came up with this from three days ago, which is obviously good news: South Korean Study Shows No Evidence Recovered COVID-19 Patients Can Infect Others May 22, 2020 South Korea is one of the gifts that keeps giving in terms of global understanding of this virus, and how to contain it. If people were getting re-infected quickly, they'd be one of the first countries to figure it out. So I think there's good reason to hope that these are just testing glitches to be expected. I included that quote from Perlman anyway because it could turn out that immunity is partial for some people - whether it is gained through infection and recovery, or through a vaccine. One more on my long list of reasons to think that the best way to deal with a COVID-19 infection is to just contain and crush the little bastard so that very few people get infected in the first place.

Healthcare Provider Resources & Recommendations I'm posting that as an addendum to my rants above about nursing homes. It is from the Washington state website, offering guidance to various kinds of providers. It sort of amazes me. It may or may not have to do with why the state keeps sliding down the list of infections and deaths, relative to other states. It is extremely thorough and thoughtful. 'So it covers PPE, and infection control. But if you are a massage therapist, here's guidelines. Are you an acupuncturist? (One of my sisters-in-law is). Here's guidlines for that. Need a waiting room sign in Chinese? Here ya go. And lest we forget anything, Washington also wants to make sure we understand that proper testing involves not one, not two, not three, but four good rotations in your nose. You could argue this is nanny state, or it goes too far. I think it sets a tone that this is important, and it saves lives. I think I know a lot about anal sex, and sex toys. But if I ever decide I need a master class on the proper use of dildos, I now know I need to contact Jay Inslee.

Long-term care facilities represent over 60 percent of Washington's COVID-19 deaths So, thanks, @bigjoey. I'd been meaning to do some homework about Washington state, for two reasons I'll tell you in a moment. But you gave me a third - which is nursing homes. This discussion of nursing homes made me think about Washington state. Because when this first popped up in the US, it was news about some nursing home around Seattle where lots of seniors are dying. There's also a two minute news video from KOMO, the local news outlet, embedded in that video. It gives a good overview. I think Washington state has done one of the best jobs of any state in what I'll call preventing herd immunity. Here's one metric of that. On March 16, the day the first US city (San Francisco) shut down, there were 48 dead in Washington and 18 dead in New York. Today there are 29,231 dead in New York and 1,086 dead in Washington. Something changed the trajectory. Even factoring in population, there are 10 deaths in New York for every death in Washington. I'll get to why I think that may be in a minute. In terms of senior care facilities, COVID-19 has penetrated Washington deeply. Hundreds of institutions have been impacted. In that KOMO piece, a reporter states that 1 in every 3 nursing homes have had at least one case of COVID-19. 1 in 3. So either there are a lot of shitty nursing homes in Washington that are failing to protect seniors. Or, in a pandemic, broad community spread of a virus makes it almost impossible to keep out of nursing homes. My view is the latter. I brought up my adult care home experience in Oregon because at first these numbers made no sense. When that article above was written a few weeks ago, it was a few hundred facilities in a state with 4000 facilities. That's not 1 in 3. But I think the difference is the same as Oregon, which I knew a lot about at one time. Many of those facilities are probably small residential ones in Eastern Washington, which has not been impacted as much - yet. If we let the virus spread, we now know from Sioux Falls and Iowa and other places that it will spread anywhere we let it. I didn't check, but I think it's a good guess that the large nursing homes are mostly based in the larger Washington population centers, where most of the virus is. So it makes sense to me that in the large nursing homes in population centers, at least 1 in 3 have been unable to stop the virus. And this is in a state where there has been no antibody studies, but where - if there were - my guess is at best 2 or 3 or 4 % of the entire population was infected - if that. So my point is that, even in a state that has I think been way ahead of the curve, a little bit of herd immunity necessarily involves a lot of dead seniors. The good news is that Washington has had way less death, period. The bad news is that 60 % of that death was seniors in nursing homes. That is not primarily about the failure of the state, or nursing homes. I think it is primarily about the plan built into the RNA of COVID-19. It is what the virus is. It is what the virus does. Everywhere. Every time. Let it loose, and it is going to find seniors and kill them, indiscriminately. That is happening in every state in the US, and every nation in the world. If there is even one exception, please name it. I said that there were two reasons I was interested in Washington. Contact tracing is one on of them. This website, Covidactnow.org, is the one I trust the most. These are the experts who were pushing for lock downs to save tens of thousands of lives. They are now in agreement with most of the rest of the world that "test, trace, treat" is actually working - at least so far. They have modeled out what the "death machine" will look like in each state - IF we went back to doing absolutely nothing to prevent the spread of the virus. So I know right now it's fun to scapegoat "unelected scientists" who are dedicated to saving the lives of countless seniors. But I personally think these people are national heroes who are serving their country very well. The part that matters related to this post is this website is starting to track contact tracing by state. Washington and Montana both have 100 % contact tracing. Oregon has 70 % contact tracing. I have not checked every state. But those three stand out. Georgia, for example, has 4 % contact tracing. Iowa has 1 % contact tracing. Does this make any difference? I think it's too early to tell. I've been looking for stories about how this actually works. Or whether it works. You can find lots of stories about the successes in South Korea or Iceland, where it's been happening for months under a global microscope. In these US states, it is brand new, I think. That said, every day I look at the RCP list of US infections by state. Right now Montana is #50 out of 50 states. Oregon is #47 out of 50. You can say that's about density. But Nebraska is # 11, Iowa is # 13, and South Dakota is # 15. Nebraska has 14 times more COVID-19 infection per million citizens than Montana. So, right or wrong, I think the approach is Montana and Oregon has been very aggressive. First, we are going to be pro-active in trying to keep the virus out. Second, wherever it pops up we will find it and kill it. As opposed to letting it kill seniors. It's working. Montana has 15 deaths per million. Oregon has 35 deaths per million. Iowa has 145 deaths per million. New York has 1,506 deaths per million, which is 100 times the rate in Montana. But guess what? Where are the 160 deaths in Oregon and Montana concentrated? Correct! Nursing homes. That is the plan. At least according to the RNA of COVID-19. Even in the states that do the best jobs of keeping COVID-19 out, it is just very good at finding seniors, and killing them. State closes Portland nursing home after 28 COVID-19 deaths I don't disagree that there may be poorly run nursing homes out there. Based on my past experiences, my strong hunch is that there are. And they may be places where COVID-19 gets a head start. But the reason that 5000 seniors died in nursing homes in New York and only 148 people died in Oregon, period, has absolutely nothing to do with nursing homes. Or the corporations that mostly run them. It has to do with whether or not we let the virus spread broadly. The more broadly it spreads, the more likely it will find its way into every nursing home in every state. This article gives a snapshot of the statewide picture in Oregon. Same pattern as every state. 60 % of the 148 COVID-19 deaths are seniors in nursing homes. From the map, where ever in the state there are infected population centers, there are infected nursing homes. It is as predictable and precise as 2 + 2 = 4. It is what the RNA of COVID-19 tells it to do. If we don't like that plan, we have to beat COVID-19 back. That's what Washington did. As those numbers above show, a few months ago Washington was the COVID-19 death capital of America. I've watched it gradually slide down that list of all 50 states. Not that long ago, it was in the Top 10. Now it is #29 on infections per million and # 22 on deaths per million. Whatever they are doing is working, relative to other states. If the goal is to keep infection and death out - out of the state, and out of nursing homes in the state. I won't repeat my over the top rant about COVID-19 snacking on lungs in that post about the Gay nurse. But I'll hyperlink this story from Seattle dated March 13, 2020. It made me realize something about how deeply most people fear herd immunity. The polls are very clear. The lock downs have broad support. People put their health first. They are worried about reopening in a way that invites the virus to surge exponentially again. So the lockdowns matter. But what that story made clear is the real driver is apolitical, and market-based. Back on March 13, before any lock down, the economy of Seattle had already collapsed. Catering was dead. Restaurants were dead. That article focused on dining. But I'm sure it impacted travel and shopping as well. It was a rapid, deep, and stunning public reaction - driven by a few dozen deaths, mostly in one nursing home around Seattle. I'd describe it as a mass market vote against herd immunity. Maybe people mostly cared about seniors in one nursing home. But I doubt it. I suspect people were afraid of a killer virus. And they did not welcome the idea that they were the part of the herd that would get it.

Excellent. So do I. As I said above, based on my personal experience as the child of two aging parents, the nursing home my parents both spent years in was full of caring and professional people. I came to deeply respect them. So everything you're saying about quality of care makes sense. And from my experience, I agree with your overall long-term take on senior care facilities. When I was the Organizing Director of a statewide action group in Oregon, I spent a year working with Oregon Legal Aid to get a statewide reform bill passed on adult foster care homes. They were and I think still are the predominant form of senior citizen care in the state, in terms of number of institutions. They are usually single-family homes. They are regulated and allowed to have only five residents. They are extremely popular, because families of the elderly view them as an effective residential alternative to large institutional nursing homes. A lawyer named Penny at Legal Aid was the brains behind the legislation, since she was an expert on elder care law. But my organization was the brawn and PR machine, since we could impact the Legislative members all over the state. So as a sort of publicity gimmick, I researched and released a report on the Dirty Dozen adult foster home providers. If you want to talk about either "best practices" or "worst practices", I can tell you about that. I personally spent weeks researching inspection reports and citations for violations. In one home, the adult son of a care home owner had raped residents. That would probably count as "worst practices". My goal was to generate lots of publicity to get the reform bill passed, which in part made it easier to close homes like that. I succeeded in making sure this was all over the news. Some jerk who said he owned one of these homes was calling me at work and making personal death threats to me. That's sort of seared in my memory as "worst practices", too. Another woman I leaned on heavily was named Jean, who ran the agency who regulated these homes. She happened to be a well known liberal and lesbian activist, so we got along great. Her perspective was that almost all these facilities were average to exceptional. Many of the people who ran them, typically women, viewed it as a calling. They were very people-oriented, caring people. I got to know some of them because our strategy was to have some of the best care providers, which Jean identified, testify in front of committee to make the point that we weren't trying to attack the whole industry, or create useless regulations. We were trying to weed out a few bad apples. Which we did. So I don't disagree with your point that particular care homes may be doing a poor job. And those homes should be called out, or sued. I have personally been there and done that, and received death threats for doing so. But I don't agree with you that you can just use one metric - whether residents get or die from COVID-19, to make such a determination. Especially in the middle of a raging pandemic. A lot of nursing homes in America are corporate. Like that nursing home in Washington, Life Care Centers Of America, where about 50 residents died that was Ground Zero. They have facilities in 28 states. That is neither a compliment, nor a criticism. But I think in a lot of these states, including Washington and Oregon and Florida, a lot of these care facilities are small "Mom and Pop" type places. They are very well run by very dedicated people, at least based on my experience when I was getting a statewide reform bill passed. The Crisis at My Husband’s Nursing Home The loss of 98 lives there is nothing short of a tragedy. That article popped up on RCP today. It's agonizing to read. The author says she feels "betrayed". She names New York leaders that she blames. From the perspective of an individual with a loved one, this make perfect sense to me. As a son who had parents in nursing homes, I can easily empathize. That said, I think it also makes my point. There is a simple mathematical relationship between community spread and deaths in nursing homes. I think the reason 5,000 residents died in nursing homes in New York is simple: the pandemic hit New York hardest. In Washington state, 5000 people have not died in nursing homes, because only about 1000 people in the state died, period. I'll be posting a few articles on Washington nursing homes in a separate post. If the pandemic had hit Kansas hardest, it would have killed more people in nursing homes in Johnson County. When it hit Sioux Falls, South Dakota, it infected thousands quickly and killed lots of seniors very efficiently. This is the nature of pandemics. They indiscriminately kill the most vulnerable people. Wherever the virus is, that is precisely what it will do. Everywhere. Every time. I thought the author's language was touching, and precise. Her husband was thrown into a war on the vulnerable without a chance. And she is also right that the main relevant fact is that this is a lethal virus, with no vaccine. She notes in this in the story: That sounds honest and sincere, based on my experience both as a son with parents in a home, and my legislative experience getting a senior care facility reform bill passed. The enemy is generally not the people who run, or work in, these homes. The enemy is the virus. We certainly don't want more people getting this virus. Not the people who work in these facilities. And not the seniors who live in them. The author also lists what I would view as some "best practices" that make sense: I don't think anyone can read that paragraph and not agree that herd immunity, as a plan, is an almost Nazi-like idea to effectively terminate as many seniors as possible. Because even when this pandemic meant 100 dead people in the US, which were concentrated in one nursing home in Washington, these were the real world problems: Where are the tests? Where are the plans? Where is the PPE? Why are people working in two homes and cross-infecting? Why are workers getting sick and dying? Why doesn't this end? Again, that is what actually happened in the real world, in Washington, in late February and early March. So I think the logic of herd immunity goes like this: "Let's have a lot more of that. Instead of thousands silently being infected, let's have millions getting silently infected. Most will be fine." Anders, like you, will temper this and acknowledge that maybe somebody in South Korea or Germany or some stupid little island somewhere is going off about testing and contact tracing. Blah blah blah. Blah blah blah. Blah blah blah. We all know that doesn't work, right? (Actually, it does work, Anders. Your plan is the one that failed.) So Anders often speaks from a tone of inevitability. It's not so much that I want people to get sick, and have lots of dead seniors. It is just sort of inevitable. It can't be helped. When asked about herd immunity, he uses language that sounds like what is happening is less a desired plan and more an inevitable outcome. I completely agree with you about having a positive outlook. I think we should be fighting for the life of every one of these seniors at risk. That is the perspective of the loving wife who wrote that agonizing op/ed. I think the main fact that is working against her is that maybe 20 percent of New York City residents got infected. If 60 percent get infected, there will be three times more dead seniors. It will create more huge problems with testing, planning, PPE, staffing shortages because you have lots of sick staff. But that is not inevitable, in my mind. Herd immunity, either as a desirable goal or as an inevitable outcome, is a process for a virus finding and killing tens of thousands of real senior citizens who lived and recently died in the US. That's what just happened. That is an undeniable fact. If we have more herd immunity, by will or by default, we will have hundreds of thousands more dead seniors.