Coronavirus Numbers

[+ purplekow]

The one nonagenarian with Covid for whom I am caring had seen only two people for two weeks. So it is clear she got the virus from one of those two people. Both were her caretakers. One of them came to work and had a cough, the other was perfectly healthy. Now both of them are perfectly healthy and their charge is in the hospital and will likely die. The easy choice is to say that the woman with the cough transmitted it to her charge but when tested, it was the healthy woman who tested positive while the other was negative. There are no easy answers except total isolation.

[+ stevenkesslar]

Louisiana (Mardi Gras??) is right up there, as is California (biggest population), and Washington (first hit). There have been extensive discussions here about why this might be for New York and New Jersey, and the others are not difficult to figure out. But Michigan is consistently right in that mix too. Michigan?

 

Does anyone have a clue why Michigan and not, say, Ohio, Illinois or Texas? Was there some early exposure? Michigan really has only one large city, Detroit, and it has been emptying out for years.

 

We're not flying completely blind on this.

 

 

That's from a study of the impact of interventions in the 1918 pandemic. I'm not 100 % sure how good the data actually is. Part of the horror of this is that there are stories about people dying at home, bodies left in alleys, mass graves. So nobody may know for sure.

 

That said, that line above sums up the consensus: The 1918 flu pandemic depressed the economy. Public health interventions did not. The cities that were best prepared had the fewest deaths, and are generally believed to have bounced back the quickest. If those numbers are right, that was true by a factor of as much as 2 to 1. In Pittsburgh and Philadelphia, about 1,000 in every 100,000 died. In other cities, it was under 500 per 100,000.

 

The story in every documentary about 1918 is that Philadelphia went ahead with a huge World War I parade, despite public health warnings. The business boosters insisted that we needed to conduct business as usual. As a result, they ended up with what historians describe as a ghost town. People didn't want to come outside. Children starved in homes because their parents died and nobody wanted to come near them. So the modern day equivalent to that is probably New Orleans and Mardi Gras.

 

Other histories suggest that in some communities people banded more closely together, and helped each other out. I think one of the lessons is that if people are given false messages or false hope, trust just collapses. I keep posting those Bill Gates videos because I view them as the antidote to panic. By being sober and realistic, they are somehow comforting.

 

Coronavirus (COVID-19) U.S. Deaths

 

I think that's the best chart to assess the impact of different states' policies. And since this is in The Lounge, I'm going to avoid using the names of Governors and keep this apolitical. Other than to say that the biggest part of preparedness is community preparedness. If you are one of those people who have to go to work everyday, even in a pandemic, it makes a huge difference whether there are 100 other people sick in your city, or 100,000 people sick. Obviously the reason workers feel the subway in Seoul or Tokyo is safe enough is they don't have 100,000 sick people.

 

If you click on "deaths per million" on that chart above, it will rank all 50 states from highest death rate to lowest. I think that's probably the most accurate measure of how deep the virus has penetrated. Probably ZERO states have an accurate picture of testing. And they won't, until we have widespread random testing. But the death rates don't lie. If Dr. Fauci is right, you can take the number dead and multiply it by 100 (based on a 1 % death rate). And that will tell you how many infected people there were maybe two or three weeks ago. As Fauci keeps saying, "death lags".

 

So in California there are 285 deaths. That would suggest maybe 28,500 cases. Only about 12,500 people are diagnosed. So that would suggest at least half the positive people in California are not diagnosed, for whatever reason. But the ones who get severely ill or die will be in hospitals, and they will be counted.

 

To me, California and Ohio are two standouts. They have death rates of 7 to 8 people per million. And they both were ahead of the curve in taking measures to slow the spread of the virus. I don't know much about Ohio, other than they cancelled a primary, which in retrospect was a very, very wise move. In California, 962 of the cases are in LA County. So a county that is about one quarter of the state population has about 42 % of all cases. Within the state, LA was relatively more behind the curve on shutdown - literally by a matter of days. But what we have learned is that a few days or a week of inaction can make a massive difference in how many people get sick and die. When you adjust for population, I think California and Ohio are examples to look at for what is being done that works. Adjusting for population, they have 95 % fewer deaths than New York and 90 % fewer deaths than Louisiana.

 

Washington did a good job of getting ahead of the curve, I think. The first cases of COVID-19, back in January, suggest that this could have played out as having a West Coast epicenter. My guess, which may be wrong, is that the CDC was relatively effective in testing and tracing and suppressing the spread - up to a point. Where they failed is in testing people who had not been in China. And the asymptomatics probabaly sealed the deal on community spread. Dr. Fauci himself clearly did not see that coming in January. To his credit, he admits when he got it wrong, despite his vast knowledge. So at one point, Washington was the hot spot. Now they have a death rate of 38 per million. That's less than half of what it is in Louisiana. So I think Washington had the misfortune of being our Wuhan, where the virus first hit. But they were one of the first states to take extreme lock down measures once they got a clear picture of how this was spreading. Certainly, Seattle is not having the hospital crisis that New York City is. I think that speaks to the wisdom and effectiveness of aggressive intervention.

 

Texas is the interesting one. Of any big state, they have by far the lowest death rate - 3.6 residents out over 1 million. Some of that could be geography, since they may have less travel from "hot spots" than New York City did. But there's obviously a lot of travel through Texas. My best guess is that in cities like Houston and Dallas, the local governments did follow the more aggressive lock down strategies relatively quickly. At least at the front end, urban centers are the first ones hit. That may not be true two months from now. Less dense states will be hit just as hard, in relative terms, I think. If they don't prepare. But right now Dallas and Houston have about 2200 cases, which is about one third of the statewide total. Those two counties house about 1 in 4 Texas citizens. So they are a little over-represented in the state count, which you'd expect for two large urban centers. That said, I think the actions of their local governments helped control the spread - certainly compared to Louisiana, where there are 6000 cases in two counties around New Orleans alone. Houston is worried that travel between New Orleans and Houston will help spread the virus to Houston.

 

Every time Dr. Birx opens her mouth I am more impressed with her. She has already said she is going to prioritize rural areas for these quick test kits. I hope they make Texas a big priority. If you go to the John Hopkins map, there are counties all across Texas with one or two or a handful of cases. So those are all ideal candidates where we could figure out how we get two weeks ahead of the virus, rather than two weeks behind. That is essentially what all those East Asian countries have done. Texas would be an ideal lab for that, I think. It embodies all the crosswinds in American culture. There are no doubt people in rural areas who think this all may be an overreaction. But they don't want to die, or end up in a hospital that is 100 miles away.

 

Birx's language is almost flawless. When she speaks, she does so in a way that anticipates all the objections. But then she points out, soberly and factually, that 5 goes to 50 goes to 500 in no time. That is math everybody gets. Dr. Birx will go down is history as an American hero and life saver.

Edited April 4, 2020 by stevenkesslar

[+ stevenkesslar]

The one nonagenarian with Covid for whom I am caring had seen only two people for two weeks. So it is clear she got the virus from one of those two people. Both were her caretakers. One of them came to work and had a cough, the other was perfectly healthy. Now both of them are perfectly healthy and their charge is in the hospital and will likely die. The easy choice is to say that the woman with the cough transmitted it to her charge but when tested, it was the healthy woman who tested positive while the other was negative. There are no easy answers except total isolation.

 

There is some cruelty to fate at work here. What that could mean is that next Fall, the care giver who unwittingly led to a death will actually be safe to put to work around older people. She presumably would pass an antibody test. The other caregiver probably should not be allowed around caregivers, because she won't have antibodies. Whether that form of testing is even legal or not is a good question. But it is practical, if the goal is to save lives of people in nursing homes. Obviously, these people also go to the front of the line when a vaccine is developed.

 

That story you told above also goes to the many "soft" reasons why letting a pandemic run wild makes no sense. Critics keep saying, correctly, that this lock down could lead to more domestic abuse, or alcoholism, or depression. That is all correct. The main rebuttal is that our medical system and our society is simply not set up to deal with this amount of death, period. People just don't go to movies during pandemics. They don't even want to go to work. But when going to work, even when you are young, means you may kill somebody, that's a very heavy emotional burden to bear. Who would want to be that caregiver, who tested positive? By virtue of the fact that she was asymptomatic and was tested, I assume she may have figured out why she was tested.

 

That would not be a truth I would want to bear for the rest of my life. As an escort, I felt bad having to tell certain clients that I may have given them an STD that could be cured with a shot in the butt and a week or so of abstinence.

[+ stevenkesslar]

Daily New Cases in South Korea

 

Daily New Cases in Italy

 

Since this is turning into a thread about understanding the numbers, those are the sets of numbers I find most sobering, and most hopeful. What I am talking about in particular are the charts on new caseloads every day. It shows how "flattening the curve" is actually going in two very different countries.

 

I think the essential fact about South Korea boils down to one word: compliance. There is a culture of compliance at work in those numbers. Everyone wears a mask. Everyone seems to more or less accepts that in this environment there is no clear line between personal safety and public safety. The actions of everyone else determine whether YOU get sick taking a subway to work. That's true with the flu in any year. But the rules clearly change when there is a pandemic. I think we can now conclude that this is just an unwritten rule of human nature. Pandemics change the rules.

 

That has not always been true in South Korea. All the East Asian nations keep saying that they were better prepared to move rapidly this time precisely because they got caught flat-footed and unprepared the last time, with SARS.

 

What's interesting and unique about South Korea (as opposed to Taiwan, Singapore, China, Japan) is they had one group that said "Fuck the rules." That's not quite fair. The religious sect that broke the rules probably had no clue what they were doing. But of about 10,000 sect members tested, about 4,000 tested positive. About half of the cases in South Korea stem from one group of bad actors.

 

So you had this one huge break in a society that was otherwise compliant. And it caused this big spike, like a tenfold increase in new cases. But it all happened within a few weeks. And now it is back under control. So far, South Korea is proving that they can keep this to less than 100 new cases a day. Relative to the US population, that would mean that maybe, if we have fewer than 1000 new cases a day, we can start to get life back to a modified version of normal, like South Korea is doing. But the lesson seems to be that this all depends on a compliant group of citizens who are committed to avoiding sickness and death.

 

The curve is not flattening out quite as easily in Italy. They have cut the numbers of new cases by roughly one-third, to somewhere in the ballpark of 4000 to 4500. The curve at least appears to be on a gradual decline. Before March 21, when the number of new daily cases peaked at 6,557, the number of cases was doubling every four to five days. Had there been no intervention, that would mean today there would be about 45,000 new cases in Italy per day, as opposed to 4500. At some point, the spread would slow down because there were just be fewer new bodies to infect. But I think we now know enough to understand that really would be an apocalyptic scenario.

 

I have no idea what "compliance" means in a place like Italy. There are stories about how they are very proud of the work they are doing to contact trace and test people. But I think the bottom line, according to all the experts, is that contract tracing is just impossible when you have thousands of new cases a day. Italy is about the same size as South Korea. So we probably won't even begin to understand how well contact tracing works in a country like Italy until they get the number of new cases down to about 100 a day. That's going to take a while.

 

I suppose you can make an argument that the cure is worse than the disease. And that the economy of Italy would be better off if they had 40,000 new cases today, rather than 4,000. How you get to such an argument just makes no sense to me, though.

 

All of this paints a very clear picture of what the new normal in the US or UK or Canada or the European continent will look like in a few month's time. Let alone the countries that have way fewer resources to fight a virus like this. It will definitely not be like the old normal until we have a vaccine.

[BgMstr4u]

We're not flying completely blind on this.

 

 

That's from a study of the impact of interventions in the 1918 pandemic. I'm not 100 % sure how good the data actually is. Part of the horror of this is that there are stories about people dying at home, bodies left in alleys, mass graves. So nobody may know for sure.

 

That said, that line above sums up the consensus: The 1918 flu pandemic depressed the economy. Public health interventions did not. The cities that were best prepared had the fewest deaths, and are generally believed to have bounced back the quickest. If those numbers are right, that was true by a factor of as much as 2 to 1. In Pittsburgh and Philadelphia, about 1,000 in every 100,000 died. In other cities, it was under 500 per 100,000.

 

The story in every documentary about 1918 is that Philadelphia went ahead with a huge World War I parade, despite public health warnings. The business boosters insisted that we needed to conduct business as usual. As a result, they ended up with what historians describe as a ghost town. People didn't want to come outside. Children starved in homes because their parents died and nobody wanted to come near them. So the modern day equivalent to that is probably New Orleans and Mardi Gras.

 

Other histories suggest that in some communities people banded more closely together, and helped each other out. I think one of the lessons is that if people are given false messages or false hope, trust just collapses. I keep posting those Bill Gates videos because I view them as the antidote to panic. By being sober and realistic, they are somehow comforting.

 

Coronavirus (COVID-19) U.S. Deaths

 

I think that's the best chart to assess the impact of different states' policies. And since this is in The Lounge, I'm going to avoid using the names of Governors and keep this apolitical. Other than to say that the biggest part of preparedness is community preparedness. If you are one of those people who have to go to work everyday, even in a pandemic, it makes a huge difference whether there are 100 other people sick in your city, or 100,000 people sick. Obviously the reason workers feel the subway in Seoul or Tokyo is safe enough is they don't have 100,000 sick people.

 

If you click on "deaths per million" on that chart above, it will rank all 50 states from highest death rate to lowest. I think that's probably the most accurate measure of how deep the virus has penetrated. Probably ZERO states have an accurate picture of testing. And they won't, until we have widespread random testing. But the death rates don't lie. If Dr. Fauci is right, you can take the number dead and multiply it by 100 (based on a 1 % death rate). And that will tell you how many infected people there were maybe two or three weeks ago. As Fauci keeps saying, "death lags".

 

So in California there are 285 deaths. That would suggest maybe 28,500 cases. Only about 12,500 people are diagnosed. So that would suggest at least half the positive people in California are not diagnosed, for whatever reason. But the ones who get severely ill or die will be in hospitals, and they will be counted.

 

To me, California and Ohio are two standouts. They have death rates of 7 to 8 people per million. And they both were ahead of the curve in taking measures to slow the spread of the virus. I don't know much about Ohio, other than they cancelled a primary, which in retrospect was a very, very wise move. In California, 962 of the cases are in LA County. So a county that is about one quarter of the state population has about 42 % of all cases. Within the state, LA was relatively more behind the curve on shutdown - literally by a matter of days. But what we have learned is that a few days or a week of inaction can make a massive difference in how many people get sick and die. When you adjust for population, I think California and Ohio are examples to look at for what is being done that works. Adjusting for population, they have 95 % fewer deaths than New York and 90 % fewer deaths than Louisiana.

 

Washington did a good job of getting ahead of the curve, I think. The first cases of COVID-19, back in January, suggest that this could have played out as having a West Coast epicenter. My guess, which may be wrong, is that the CDC was relatively effective in testing and tracing and suppressing the spread - up to a point. Where they failed is in testing people who had not been in China. And the asymptomatics probabaly sealed the deal on community spread. Dr. Fauci himself clearly did not see that coming in January. To his credit, he admits when he got it wrong, despite his vast knowledge. So at one point, Washington was the hot spot. Now they have a death rate of 38 per million. That's less than half of what it is in Louisiana. So I think Washington had the misfortune of being our Wuhan, where the virus first hit. But they were one of the first states to take extreme lock down measures once they got a clear picture of how this was spreading. Certainly, Seattle is not having the hospital crisis that New York City is. I think that speaks to the wisdom and effectiveness of aggressive intervention.

 

Texas is the interesting one. Of any big state, they have by far the lowest death rate - 3.6 residents out over 1 million. Some of that could be geography, since they may have less travel from "hot spots" than New York City did. But there's obviously a lot of travel through Texas. My best guess is that in cities like Houston and Dallas, the local governments did follow the more aggressive lock down strategies relatively quickly. At least at the front end, urban centers are the first ones hit. That may not be true two months from now. Less dense states will be hit just as hard, in relative terms, I think. If they don't prepare. But right now Dallas and Houston have about 2200 cases, which is about one third of the statewide total. Those two counties house about 1 in 4 Texas citizens. So they are a little over-represented in the state count, which you'd expect for two large urban centers. That said, I think the actions of their local governments helped control the spread - certainly compared to Louisiana, where there are 6000 cases in two counties around New Orleans alone. Houston is worried that travel between New Orleans and Houston will help spread the virus to Houston.

 

Every time Dr. Birx opens her mouth I am more impressed with her. She has already said she is going to prioritize rural areas for these quick test kits. I hope they make Texas a big priority. If you go to the John Hopkins map, there are counties all across Texas with one or two or a handful of cases. So those are all ideal candidates where we could figure out how we get two weeks ahead of the virus, rather than two weeks behind. That is essentially what all those East Asian countries have done. Texas would be an ideal lab for that, I think. It embodies all the crosswinds in American culture. There are no doubt people in rural areas who think this all may be an overreaction. But they don't want to die, or end up in a hospital that is 100 miles away.

 

Birx's language is almost flawless. When she speaks, she does so in a way that anticipates all the objections. But then she points out, soberly and factually, that 5 goes to 50 goes to 500 in no time. That is math everybody gets. Dr. Birx will go down is history as an American hero and life saver.

 

That’s all very interesting, @stevenkesslar . But still no word about Michigan. Any thoughts, anyone? From a sometimes loyal Spartan, who still knows the not-very racy alternative words to the MSU fight song.

[+ stevenkesslar]

That’s all very interesting, @stevenkesslar . But still no word about Michigan. Any thoughts, anyone? From a sometimes loyal Spartan, who still knows the not-very racy alternative words to the MSU fight song.

 

I don't know. And I am trying to respect @Guy Fawkes and other posters and keep this apolitical. So hopefully this is apolitical:

 

Police: Don’t expect us to enforce Michigan’s confusing coronavirus lockdown

March 24, 2020

Jerome Kirby did as he was told and showed up for work at his job at a small manufacturing firm in Westland on Tuesday, the first day of Michigan Gov. Gretchen Whitmer’s stay-at-home order.

 

“We’re at work, but I don’t think we’re supposed to be here,” Kirby said.

 

“I don’t want to get sick, and we could,” he said. “I just don’t think [my bosses] care.”

 

 

My guess is that, at some level, Kirby speaks for every worker in America. Certainly for all the medical professionals like @purplekow who are putting their lives on the line to keep us alive, fed, entertained, and healthy - even if entertainment these days means being a couch potato with a disinfected remote control.

 

If I had to guess, the most telling thing about that article isn't the part about confusion (what "essential" means is somewhat confusing in every state). It's the date the stay home order was put in place in Michigan: March 23rd. That's a week after San Francisco.

 

So, no surprise, Wayne County (Detroit) has more infections than Texas - 6,762 in Wayne County versus 6,359 in all of Texas. But because we get an "F -" for testing, I'm not sure how valid a measure diagnosed cases is.

 

Macomb County has 1,838 cases. San Francisco, which has about a 10 % larger population than Macomb County, now has about 525 cases. Since the number of cases doubles maybe every four to five days absent public intervention, a one week delay in a lock down would be a good theory to explain where most of the difference in number of cases comes from.

 

All the experts on this keep saying the same thing: speed trumps everything else. The CDC let the perfect be the enemy of the good in January by wanting to have a better and more comprehensive test. I don't know what role Dr. Fauci plays with actual production of the test kits in the CDC. But he has already publicly admitted this was a "failing". In fairness, I think even he had no clue how quickly this could spread through asymptomatic people. My guess is the CDC did help slow the spread of the virus for maybe a month or so, through contact tracing. That's when everybody should have been being warned and getting ready.

 

In Houston, bars and restaurants were forced to close on March 16th. Again, with COVID-19 one week of inaction can mean the number of infections more than doubles. So that is probably the most logical explanation for the difference between Califorrnia or Texas, on the one hand, and Michigan and Louisiana on the other.

Edited April 4, 2020 by stevenkesslar

[LivingnLA]

That’s all very interesting, @stevenkesslar . But still no word about Michigan. Any thoughts, anyone? From a sometimes loyal Spartan, who still knows the not-very racy alternative words to the MSU fight song.

 

There are multiple factors in Michigan. Age isn't the only demographic factor determining mortality, socioeconomics are substantially influential. Many early cases in any given area were frequently wealthy people who had good nutrition, which improves immune response, and access to good healthcare. Detroit is a major airport where it's a given many asymptomatic or mildly ill travelers passed through and shed virus along the way. Some early research shows clusters in vacation spots, like ski resorts, even back in January and February. Also consider the spring breakers who partied hard, caught the virus, and flew home to shed it. Once it got into the community, it spread and Detroit is a poor city full of poor people with poor health. Here's an article discussing these and other factors. Michigan is going to lose many people over the coming months and so will Louisiana, Florida, and other states that weren't taking it seriously back in March when the data and math were irrefutable. Exponential math is unforgiving even though it looks harmless in early days. We are headed toward hundreds of thousands of dead. I hope enough Americans take it seriously to keep the body count as low as possible.

Edited April 5, 2020 by LivingnLA

[BgMstr4u]

Thank for both of these responses, @stevenkesslar and @LivingnLA . Both helpful.

[Guest]

The one nonagenarian with Covid for whom I am caring had seen only two people for two weeks. So it is clear she got the virus from one of those two people. Both were her caretakers. One of them came to work and had a cough, the other was perfectly healthy. Now both of them are perfectly healthy and their charge is in the hospital and will likely die. The easy choice is to say that the woman with the cough transmitted it to her charge but when tested, it was the healthy woman who tested positive while the other was negative. There are no easy answers except total isolation.

Or it could be that the one who came in coughing, but is now "perfectly healthy" overcame her infection and is now Covid-19 free. However, she gave it to the nonagenarian who then gave it to the non-coughing caregiver, who's now an asymptomatic carrier. It will be interesting to get results of the antibody tests when they'll be available, which should be soon.

[+ stevenkesslar]

That’s all very interesting, @stevenkesslar . But still no word about Michigan. Any thoughts, anyone? From a sometimes loyal Spartan, who still knows the not-very racy alternative words to the MSU fight song.

 

Let me answer the question another way, which follows on the things I said above.

 

I think the single best thing we could all agree on right now is martial law. And I see that as a statement that is 0 % political, and 100 % patriotic. The way I would phrase it in patriotic terms is simple: there is nothing more patriotic than wanting to save the lives of every other living American.

 

I realize there are lots of good reasons NOT to have martial law. First on the list would be that it could be a logistical nightmare. It could be more trouble than it is worth. All that is above my pay grade, and I'll leave it to the generals. On an operational level, the most important work to be done is the stuff with medical ships and emergency hospitals and ventilators that the military is deploying. They probably could also do a lot of good in the short term with testing - if the number of test kits needed were available.

 

One of the main reasons to be against martial law, in theory, is that it somehow abridges individual liberty. And that goes to the heart of the matter, for me. Are we all in this together, or not?

 

In the military, there is no question about the answer. You are all in it together. That actually IS the ethic of the military. And it works.

 

 

This should be something that is apolitical to all Americans. Presumably, we all respect that symbol above. And there is no distinction made about whether "E Pluribus Unum" applies to either of the two symbols in that image. In fact, it applies to both. The symbolism is completely relevant to the unfortunate and unprecedented situation we find ourselves in right now: the olive branches and spears symbolize that the United States has "a strong desire for peace, but will always be ready for war."

 

Well, you can think of this one of two ways. You can believe we are at war with an invisible enemy. Or you can believe that for the next year or two, peace is war and war is peace. The phrase that sums in all up nicely for me is this: we are all in this together. Period.

 

Whether we actually have martial law or not, I think we all have to start thinking of this as if we have martial law.

 

I think most people get that. Because it is now basically a matter of survival.

 

In a March 11 Yahoo poll, 35 % of Americans favored a lock down, 43 % opposed it, and 22 % were unsure. There's no such thing as "majority rules" on that one. There was no majority. The first cities to lock down were the Bay Area ones, I believe, on March 16th.

 

In a March 26th Yahoo poll, the exact same question yielded a startlingly different response. 67 % favored a lock down, 17 % opposed it, and 16 % were not sure. That's obviously an overwhelmingly majority.

 

The thing that I think is confusing about this is that in the military, the minority does not get to do it their way. It's a matter of life and death that everybody acts as a team. That applies in this situation. If Spring Breakers go get infected in Miami and fly back to Iowa, or if Mardi Gras partyers bring back a virus to a city on lock down like Houston, it simply defeats the entire point of the lock down.

 

It's really easy for me to get my mind around this. I think we are all living a bin Laden moment. Or, better stated, a bin Laden year.

 

I've posted this super long essay about "The Shooter" before. He is one of the SEALS who took out bin Laden. No one knows for sure who took the kill shot. Which is partly the point. It was a team effort. But this is one of the guys who fired one of the bullets. And I think two different parts of his story apply directly to this moment.

 

The Man Who Killed Osama bin Laden... Is Screwed

For the first time, the Navy SEAL who killed Osama bin Laden tells his story — speaking not just about the raid and the three shots that changed history, but about the personal aftermath for himself and his family.

 

First, there's this:

 

The Shooter is sitting next to me at a local movie theater in January, watching Zero Dark Thirty for the first time. He laughs at the beginning of the film about the bin Laden hunt when the screen reads, "Based on firsthand accounts of actual events."

 

His uncle, who is also with us, along with the mentor and the Shooter's wife, had asked him earlier whether he'd seen the film already.

 

"I saw the original," the Shooter said. As the action moves toward the mission itself, I ask the Shooter whether his heart is beating faster. "No," he says matter-of-factly. But when a SEAL Team 6 movie character yells, "Breacher!" for someone to blow one of the doors of the Abbottabad compound, the Shooter says loudly, "Are you fucking kidding me? Shut up!"

 

He explains afterward that no one would ever yell, "Breacher!" during an assault. Deadly silence is standard practice, a fist to the helmet sufficient signal for a SEAL with explosive packets to go to work.

 

And also, there's this:

 

The Shooter's friend is also looking for a viable exit from the Navy. As he prepared to deploy again, he agreed to talk with me on the condition that I not identify him.

 

"My wife doesn't want me to stay in one more minute than I have to," he says. But he's several years away from official retirement. "I agree that civilian life is scary. And I've got a family to take care of. Most of us have nothing to offer the public. We can track down and kill the enemy really well, but that's it.

 

To me, both of those pieces speak to what is unique about the moment we are in, and will be in for probably a year or two.

 

First, this moment really does call for the type of military discipline described in that story. Saying "Breacher" may not get your Grandma killed. But touching the wrong door handle, or giving her a hug, could. That's not the way Americans are used to thinking. Reality has changed, basically pretty much overnight. So, like it are not, we are all kind of like Navy SEALS now. And COVID-19 is like bin Laden on steroids.

 

Second, it really always has been a national disgrace how we treated the 9/11 first responders, and how we treated the people that went and took out bin Laden. So that second quote speaks to the Grand Canyon between US civil society, and the military culture and discipline we all depend on to keep us safe.

 

I actually think that one of the silver linings in this cloud is that it blows that line to shit, certainly more than 9/11 and bin Laden did. This isn't about something going on in caves in Afghanistan. This is about something going on in kitchens and nursing homes and playgrounds all over America. The virus could be anywhere.

 

Again, I wrote this so that it is hopefully viewed as 0 % political, and 100 % patriotic. In a democracy, there is always room for partisan disagreement. But I think the best way to get through this is to agree that there is also a level of this that relates to some very basic things: survival, and patriotism, and a willingness to put a type of military ethic ("E Pluribus Unum") much more to the forefront than it usually is.

 

For that matter, you could also call it a "hospital" ethic. Part of what I'm grateful about relating to @purplekow's posts is not only the sacrifices people like him are making, but also the sense of detail about how disciplined an operation this requires. Every detail about the mask you wear, or the way you clean up after work, could be a matter of life and death - to you, and to those you most love. We're not used to that.

 

Maybe every detail about what I said is not quite correct. But I think the essence of what I said is correct. We've all been drafted into a war with a virus, whether we like it or not. The sooner we get our mind around that and act as a team, the sooner we'll start to win the war.

 

The workers deserve mention, too. It is just reality that the clerk at the grocery store, the woman at the pharmacy, the guy who delivers the food, the government employee who takes the subway to work because she has to so somebody can get a Social Security payment, are all going to feel much safer in a nation where there are 100 new infections a day, rather than 10,000 or 100,000. (We're now at 33,000 in the US in just one day!)

 

So apart from the question of how much death we can handle, we just owe it to the people we want to supply our food and our medications and our electricity and our internet to get in line, and follow a very tough set of rules.

Edited April 5, 2020 by stevenkesslar

[BgMstr4u]

For that matter, you could also call it a "hospital" ethic. Part of what I'm grateful about relating to @purplekow's posts is not only the sacrifices people like him are making, but also the sense of detail about how disciplined an operation this requires. Every detail about the mask you wear, or the way you clean up after work, could be a matter of life and death - to you, and to those you most love. We're not used to that.

 

I think this really gets to the heart of the matter. I'm not sure whether martial law is the answer. But somehow the message has to get out. I have friends in upstate New York who are still welcoming employees and friends, though on a somewhat reduced level. They think the guidelines there are strong suggestions, and they think they are taking enough precaustions, and that anyway human empathy and so forth are as important as separation. I don't know whether the guidelines in California are more dire and clear and direct, but I worry for them and others like them. I am praying not to hear in a week or two or three that some one or several of them has contracted the virus. Certainly here in California people are getting pretty disciplined about the details.

 

As someone once said, Details make the difference. Or perhaps more aptly, The devil is in the details.

[+ stevenkesslar]

Michigan is going to lose many people over the coming months and so will Louisiana, Florida, and other states that weren't taking it seriously back in March when the data and math were irrefutable.

 

Sadly, what you are saying already is starting to play out in Florida. Right now, it's subtle. I hope I'm wrong, but the trend right now is likely to be just the tip of the iceberg.

 

Coronavirus (COVID-19) U.S. Deaths

 

I intentionally excluded Florida in my comments above. So now that you cited them, I will lay down a marker, hoping I am wrong. I think the death rate there is going to explode. And before long they will be in the top 5 states with the highest death rates. More important than ranking, the point to me is that some large number of the deaths that are going to occur were completely avoidable.

 

Until just a few days ago, Florida actually was doing better than California, both on cases per million and deaths per million. My bias in looking at these numbers is basically what I've already been ranting about. Bill Gates is on the side of the angels on this one. Everything he is saying makes sense - both in theory, and in practice. So the sooner we lock down and take the tough medicine, the sooner we'll be able to safely reopen.

 

Florida actually had been an outlier. I made some comment a few weeks ago that may have been naive. I said that it made sense to me that Florida was not scolding teenage kids for wanting to go hang out on the beach with a few of their friends. And I still stand by that, kind of. If going to the beach with two friends and having your towels 6 feet apart keeps you sane, that's not exactly a stupid thing to do.

 

When I wrote that, I wasn't watching the tv screens about the kids packed like sardines on the beach, or in bars. That's of course a very different thing.

 

Florida is now # 21 in the nation in terms of deaths per million, and # 19 in terms of cases per million. So California and Ohio have 345 cases and 319 cases per million, respectively. Florida now has 537 cases per million. So they have jumped ahead of California, just like Michigan and Louisiana did (in cases per million) maybe a week ago. The rate at which they are flying up the charts is what is most troubling. Much more so than in Ohio or California, the increases in infections seems to be exponential. Now that they are under belated lock down, hopefully that will start to change.

 

The reality is that this contagion is not in control IN ANY STATE. The states that are doing best are simply those that are limiting the growth of the virus - or, if you prefer, the amount of damage it is doing.

 

Again, I think Gates is on the side of the angels, and of logic. He keeps saying that - IF WE DO THIS RIGHT - the growth of cases should plateau in April. And we should see a decline in new cases in May. Hopefully, at that point, to a place where testing and contact tracing is a viable strategy in the places we start to reopen.

 

Again, we are not flying completely blind. I don't fully trust whatever records were kept in 1918, relating both to the death toll and the impact on local economies. But the received wisdom is that the cities that took the strongest interventions the earliest were the ones that got back to normal the quickest. I think it is reasonable to think some version of that will likely play out in 2020 - hopefully with far fewer deaths and less fundamental economic damage than in 1918.

Edited April 5, 2020 by stevenkesslar

[+ Pensant]

CNN: Coronavirus can spread from talking or even just breathing.

And by the way, we also have receptors in the membranes of our eyes, so go buy your protective eyeglasses as well.

I wear sunglasses all the time!

[+ stevenkesslar]

Exponential math is unforgiving even though it looks harmless in early days.

 

Life actually really does suck, doesn't it?

 

The whole thing about this that seems incredibly unfair is that I could never figure out how to get that exponential growth thing to work with my penis.

 

Then again, like I said, I always sucked at math, anyway.

 

 

Fortunately, I was pretty fucking good at identifying offsetting skills, where just plain sucking turned out to be asset.

 

At least, like Donald above, we all have certain things to keep us occupied.

[BgMstr4u]

Florida is now # 21 in the nation in terms of deaths per million, and # 19 in terms of cases per million.

 

At this point (6:15 pm, 4/4/2020), according to RCP's chart of state statistics, Florida is now 10th in terms of total deaths, 9th (up from 19th) in terms of deaths per million. That's how quickly this is changing.

[+ stevenkesslar]

At this point (6:15 pm, 4/4/2020), according to RCP's chart of state statistics, Florida is now 10th in terms of total deaths, 9th (up from 19th) in terms of deaths per million. That's how quickly this is changing.

 

Just to clarify, all the stuff I said above was based on the second column - deaths per million. Not the absolute number of deaths in each state. It makes sense that a state with 40 million people like California will have more absolute deaths - from anything, including drunk driving or suicide - than a state like Wyoming with about half a million people. And, no surprise, Wyoming is now the last US state with zero COVID-19 deaths.

 

(To make sure it's clear, the list is ordered numerically by absolute number of deaths, which is the first column. You have to go to the header of the second column, "deaths/1m pop" and click on it. That will reorder the entire list based on that measure. When you do that, Florida is still #21 as of 4/4/2020 based on that measure. You can do the same thing with "confirmed cases/1m pop" and Florida is # 19.)

 

I'm hoping it doesn't take Wyoming turning into a rural version of New York to get everybody on board. Stated in positive terms, I would love it if Dr. Birx sent in the army and they could figure out how to make Wyoming the first COVID-19 free state in the country. It begs the question of how you keep the virus out. But the first step is to stop it from growing.

 

We agree that martial law raises any number of problems. That said, I doubt Wyoming is known for its public health infrastructure. I think one place the military could really help right now is going into states like Wyoming and just doing shit loads of testing. Not surprisingly, I think China relied heavily on their military to execute their lock down strategy. We simply would not do it in the draconian way they did. But, ultimately, people reportedly did not object to the idea that temporary and tough measures were being taken to save lots of lives.

 

Again, that is all premised on the notion that we actually have the testing capacity, which we don't.

Edited April 5, 2020 by stevenkesslar

[LivingnLA]

Sadly, what you are saying already is starting to play out in Florida. Right now, it's subtle. I hope I'm wrong, but the trend right now is likely to be just the tip of the iceberg.

 

Coronavirus (COVID-19) U.S. Deaths

 

I intentionally excluded Florida in my comments above. So now that you cited them, I will lay down a marker, hoping I am wrong. I think the death rate there is going to explode. And before long they will be in the top 5 states with the highest death rates. More important than ranking, the point to me is that some large number of the deaths that are going to occur were completely avoidable.

 

Until just a few days ago, Florida actually was doing better than California, both on cases per million and deaths per million. My bias in looking at these numbers is basically what I've already been ranting about. Bill Gates is on the side of the angels on this one. Everything he is saying makes sense - both in theory, and in practice. So the sooner we lock down and take the tough medicine, the sooner we'll be able to safely reopen.

 

Florida actually had been an outlier. I made some comment a few weeks ago that may have been naive. I said that it made sense to me that Florida was not scolding teenage kids for wanting to go hang out on the beach with a few of their friends. And I still stand by that, kind of. If going to the beach with two friends and having your towels 6 feet apart keeps you sane, that's not exactly a stupid thing to do.

 

When I wrote that, I wasn't watching the tv screens about the kids packed like sardines on the beach, or in bars. That's of course a very different thing.

 

Florida is now # 21 in the nation in terms of deaths per million, and # 19 in terms of cases per million. So California and Ohio have 345 cases and 319 cases per million, respectively. Florida now has 537 cases per million. So they have jumped ahead of California, just like Michigan and Louisiana did (in cases per million) maybe a week ago. The rate at which they are flying up the charts is what is most troubling. Much more so than in Ohio or California, the increases in infections seems to be exponential. Now that they are under belated lock down, hopefully that will start to change.

 

The reality is that this contagion is not in control IN ANY STATE. The states that are doing best are simply those that are limiting the growth of the virus - or, if you prefer, the amount of damage it is doing.

 

Again, I think Gates is on the side of the angels, and of logic. He keeps saying that - IF WE DO THIS RIGHT - the growth of cases should plateau in April. And we should see a decline in new cases in May. Hopefully, at that point, to a place where testing and contact tracing is a viable strategy in the places we start to reopen.

 

Again, we are not flying completely blind. I don't fully trust whatever records were kept in 1918, relating both to the death toll and the impact on local economies. But the received wisdom is that the cities that took the strongest interventions the earliest were the ones that got back to normal the quickest. I think it is reasonable to think some version of that will likely play out in 2020 - hopefully with far fewer deaths and less fundamental economic damage than in 1918.

 

Michigan has already passed California in confirmed cases. Louisiana should tomorrow or the day after. Massachusetts and Florida should as well, but they'll be a few days. Georgia and Texas may get scary. Their testing remains limited which is probably why their counts look so low, but their hospitals seem to be reporting more activity than they should be based on the official case counts. They likely have many more cases than their offical numbers suggest.

 

California continues to be an example of how early and aggressive actions seem to work. They also appear to be ramping testing capacity. If the rapid serology is approved soon, Californians that can prove they have antibodies should allow for even greater economic activity. It will also reveal where the virus has already been, which will help us learn a great deal.

Edited April 5, 2020 by LivingnLA

[+ stevenkesslar]

Georgia and Texas may get scary.

 

I'm going to cut and paste something from another post in the politics forum. The video I posted includes a warning that this could spread like wildfire through rural America. The guy in the video mentions Mississippi, his home state, in particular. So I checked, and the two places that jump out in the Deep South are these:

 

Dougherty County, Georgia has 685 COVID-19 cases now. With about 90,000 residents, the county is about one-tenth the size of San Francisco, but has about 30 % more cases than San Francisco. It is about 67 % Black and 30 % White.

 

Caddo Parish, Louisiana has about one quarter million residents, with the main city being Shreveport. They have 598 cases. So about one-quarter the population of San Francisco, and about 20 % more cases. It is 50 % White, 40 % Black. That may be an offshoot of people who went down to Mardi Gras, got sick, and came home.

 

So that's two examples where COVID-19 seems to be taking off in predominantly rural areas. If it can happen there, it can happen anywhere in Mississippi. It would be a catastrophe on the scale of New York City.

 

I can not understand why the military is not being sent into rural areas all across America, other than the lack of testing supplies. I would not even try to count nationally, but there are like 1000+ tiny red points of death all over that John Hopkins map. I did count Wyoming, and I think there are 17 little red points of death, each representing a county. In about two thirds of them, the number of diagnosed cases is in a single digit. The county with the most cases, Cheyenne, has 42.

 

If they wait a month, there is every reason to think Cheyenne could have 200, or 500 cases. The longer they wait, the less effective contact tracing will be. Wyoming right now is an ideal place to go in and see if they can trace the virus into a corner. But it won't stay this way for long. And my assumption is that bringing in the military would add resources the state or county simply do not have ready to deploy in the numbers needed. That would not require martial law.

[cany10011]

Not sure if this is the best place to put this, but does anyone have any additional insights as to when the quarantine will be over esp in NYC. The apex is expected this week (April 6th) in terms of deaths. NJ is also coming up too. So it's quite dire. A few days ago, Cuomo said the apex was supposed to be end of April... how did it move up so quickly? Or, is this upcoming week a prelude to the additional tolls ahead???

[LivingnLA]

Not sure if this is the best place to put this, but does anyone have any additional insights as to when the quarantine will be over esp in NYC. The apex is expected this week (April 6th) in terms of deaths. NJ is also coming up too. So it's quite dire. A few days ago, Cuomo said the apex was supposed to be end of April... how did it move up so quickly? Or, is this upcoming week a prelude to the additional tolls ahead???

 

Life is going to be different for a long time. The goal is herd immunity. A widely deployed vaccine is over a year away so the only way to get herd immunity right now is naturally and the only way to do that and not have millions of deaths, is slowly over time so the healthcare system isn't overwhelmed. Here's a public site with a decent model for NY because NY's public data is pretty good.

 

It's important to understand that these models are fluid because human behavior plays a very large role in the outcomes. The range for NY's apex is anywhere from 3-30 days from now. That range is so wide because of the diversity of choices people are making right now. I hope the apex is in the next week because that will mean deaths due solely to lack of hospital capacity will be maybe 10k. Assuming that we see this, then the next step depends on how long it takes to free up hospital capacity. There must be open capacity if the public health orders are to be relaxed at all. Think of it like a dance: relaxing the rules enough to get the economy more active but only enough so that hospitals are not overwhelmed by new cases. This is a controlled exposure exercise to build natural immunity and minimize deaths. That sort of scenario will run maybe 18 months. The same author wrote an in-depth follow-up piece that I recommend.

[+ honcho]

There must be open capacity if the public health orders are to be relaxed at all. Think of it like a dance: relaxing the rules enough to get the economy more active but only enough so that hospitals are not overwhelmed by new cases. This is a controlled exposure exercise to build natural immunity and minimize deaths.

 

 

I wish there was an emoticon that says "I agree with the truth of what you wrote, and I don't the fact of it at all". Maybe some kind of sour face?

[LivingnLA]

I wish there was an emoticon that says "I agree with the truth of what you wrote, and I don't the fact of it at all". Maybe some kind of sour face?

 

Agreed. We waited too long. If we'd acted decisively in January or perhaps early February, it could've been kept to low thousands. Reality now is to do our best to keep it near 100,000 deaths.

[+ Charlie]

The first cases were in China. The first cases on the west coast were connected to people who had been in Wuhan. I think most Americans do think spatially, and the east coast is still a long way from the west coast, so folks in New York and DC thought about the flow of disease as a trans-Pacific problem. The first tests of the strains of the virus now seem to show that the initial infections in New York/New Jersey were brought across the Atlantic from Europe, not directly from China. The first US bans were on flights from China (most of which land in cities like Los Angeles, San Francisco and Seattle). It took a lot longer for the US to start banning flights from Europe, even though the disease was already established there. That probably explains part of the reason why New York, rather than Los Angeles as people might have expected, exploded into the major hotspot in the US.

 

The reason why there are so many cases in group housing for the elderly, like nursing homes and assisted living, is that most of the staff in such facilities are very poorly paid; they come to work when they are sick because they don't get paid sick leave, and they often work extra shifts in more than one facility, because it is the only way they can make ends meet. The same is true for in-home caregivers, who are frequently untrained and don't have the same kind of supervision as someone in a managed care facility. My house cleaner, who is self-employed, has also done gigs as an in-home care-giver for sick and elderly people, even though she has no training for it, and will probably do so again now that she is losing many of her house-cleaning jobs. I have given her a paid holiday for the duration, because I know she needs the income, but I don't want her possibly bringing the virus into my home.

Edited April 5, 2020 by Charlie

[lonely_john]

Until US enforces national shutdown, nothing will be accomplished

 

[Guest]

Not sure if this is the best place to put this, but does anyone have any additional insights as to when the quarantine will be over esp in NYC. The apex is expected this week (April 6th) in terms of deaths. NJ is also coming up too. So it's quite dire. A few days ago, Cuomo said the apex was supposed to be end of April... how did it move up so quickly? Or, is this upcoming week a prelude to the additional tolls ahead???

Nothing quite like this has ever happened before (some similarities to Spanish flu, but that was a different time and different virus), so it would be very difficult to predict. That being said, if this virus behaves like other coronaviruses, one would expect infections and severity of infections to decrease substantially when the weather heats up (in the northern hemisphere), so perhaps things will be able to be relaxed as we lose the danger of the healthcare system being overwhelmed. Also, if they find a treatment that is effective enough so as to make hospitalization and/or mechanical ventilation very unlikely, and the treatment can be made readily available, that could also be a game changer. Too many unknowns to be able to make good predictions. But I have a sense that things may be able to be relaxed somewhat at least in June.