More interesting data regarding Covid

[Guest]

... The charts strongly suggest that the lock downs have worked...

 

Lockdowns definitely had the intended effect in many countries around the world...

Thank you for putting up those charts. It certainly puts things into perspective. I certainly don't get the message from the charts that lockdowns have anything to do with Covid-19 rates. I certainly think that the lockdowns needed to be done when they were, and that they were the right decision at the time. However, with the new information we now have, it doesn't seem that we need to continue the lockdowns in order to prevent overwhelming the healthcare system. On what basis do you say the lockdowns "definitely" had the intended effect? What makes you so sure? At this point, we really don't know why things went the way they did. To say that one knows, let alone "definitely" knows, seems rather presumptuous. Has the virus mutated? Does the warmer weather have something to do with it? Something else that we don't know? What would have been the result of not doing into lockdown? We really don't know the answer to these questions. However, we do have the data from dozens of states, and the one thing we do know is that, at this time, opening things up will not cause our healthcare system to be overwhelmed--or even cause a spike in cases.

The damage done by a prolonged lockdown is enormous, however. Massive unemployment, bankruptcies, poverty, and long lines at food banks are all testimonies of this. Do we make decisions based on looking at the evidence in front of us, or on the basis of fear and supposition?

Edited May 24, 2020 by Unicorn

[+ bigjoey]

Thank you for putting up those charts. It certainly puts things into perspective. I certainly don't get the message from the charts that lockdowns have anything to do with Covid-19 rates. I certainly think that the lockdowns needed to be done when they were, and that they were the right decision at the time. However, with the new information we now have, it doesn't seem that we need to continue the lockdowns in order to prevent overwhelming the healthcare system. On what basis do you say the lockdowns "definitely" had the intended effect? What makes you so sure? At this point, we really don't know why things went the way they did. To say that one knows, let alone "definitely" knows, seems rather presumptuous. Has the virus mutated? Does the warmer weather have something to do with it? Something else that we don't know? What would have been the result of not doing into lockdown? We really don't know the answer to these questions. However, we do have the data from dozens of states, and the one thing we do know is that, at this time. opening things up will not cause our healthcare system to be overwhelmed--or even cause a spike in cases.

The damage done by a prolonged lockdown is enormous, however. Massive unemployment, bankruptcies, poverty, and long lines at food banks are all testimonies of this. Do we make decisions based on looking at the evidence in front of us, or on the basis of fear and supposition?

The problem with trying to identify if lockdowns are good or bad is that they cover different populations and were executed differently. For example, NYC’s population is dense and depends highly on public transportation while Kansas City’s population is spread out and there is less reliance on public transport. NY badly executed protections for nursing home residents by mandating they accept Covid19 residents while Florida kept Covid19 residents away and the death rate difference tells the tale.

 

The purpose of lockdowns were to control the flow of patients into the healthcare system by “flattening the curve.” Now that healthcare systems have expanded capacity and are better stocked with PPE, the initial urgency is less. As Dr Fauci has said, at some point, keeping the lockdowns cause “irreparable” harm.

 

There needs to be a balance between keeping the heath care system intake within the system capacity and the emotional, personal health and economic issues that Dr Fauci says will suffer “irreparable” harm.

 

 

Now just because the lockdowns end, that does not mean that test, trace and isolate does not happen and that precautions are not needed. For example, Falwell’s Liberty University defied the media predictions of infection and death by keeping students on campus; the result was no on campus infections of either students or staff; best practices can be done.

[Guest]

The problem with trying to identify if lockdowns are good or bad is that they cover different populations and were executed differently...

I totally agree, BJ. In Brazil, tens of millions live in slums with overcrowded conditions and poor sanitation. The result was a disaster there. And, as I've said multiple times in multiple strings, we need to concentrate on protecting the vulnerable population, namely the elderly for the most part. No one should be allowed to work in nursing facilities, assisted living facilites, or other locations that care for the elderly unless they either (1) have antibodies to Covid-19, or (2) have negative daily tests for the virus.

[+ bigjoey]

Politcal issues are part of every day Life. If you believe the political forum is a cellpool, try to make it better rather than just frequently complain in this forum. Jeez

 

Sorry, somethings can be beyond redemption. The problem lies not with me but other posters as you well know. As you well know, other posters have left not only the Political Forum but this site due to the stench in the Political Forum.

 

The Political Forum is not an place to honestly exchange ideas and learn from each other. It has become a place to insult, bully, etc. Sorry, but I have a life outside our virtual one and just do not have the time to waste rolling around in the mud.

[+ WilliamM]

Sorry, somethings can be beyond redemption. The problem lies not with me but other posters as you well know. As you well know, other posters have left not only the Political Forum but this site due to the stench in the Political Forum.

 

The Political Forum is not an place to honestly exchange ideas and learn from each other. It has become a place to insult, bully, etc. Sorry, but I have a life outside our virtual one and just do not have the time to waste rolling around in the mud.

You continue to claim without any proof that members are leaving that forum and even this site. And please stop writing "as you well know." I have never considered leaving the political forum.

Edited May 24, 2020 by WilliamM

[+ bigjoey]

You continue to claim without any proof that members are leaving that forum and even this site. And please stop writing "as you well know." I have never considered leaving the political forum.

 

I have never said YOU were going to leave the Political Forum. As you well know because we discussed it privately, I was going to leave the Political Forum last October and you talked me into staying until the end of the year. When December 31st came and things had not changed, I departed. That is not a breach of confidentiality because it concerns me directly and your personal accusations against me; I only reveal this as my defense against your personal attacks.

 

As you well know you discussed privately other people who have left and why. I am not disclosing any personal information from those PM’s. Just saying that you discussed the matter is not a breach of confidentiality but just shows “as you well know” was not a fantasy of mine. This is just a defense against your personal attacks.

 

It does not take rocket science to figure out who has left the Political Forum and why.

[+ WilliamM]

 

 

It does not take rocket science to figure out who has left the Political Forum and why.

@bigjoey, I don't keep track of the people who post in a specific forum here.

[+ stevenkesslar]

Opinion: We are infectious disease experts. It's time to lift the COVID-19 lockdowns

Canada needs a hospital capacity-based approach to guide local lifting and reintroduction of restrictive measures as necessary

 

I think you will like this article, @bigjoey. It's sort of an argument for herd immunity, Canada-style. It's primarily based on the assumption that the goal is "flattening the curve". Which presumably means avoiding hospitals being crushed while the virus continues to spread.

 

You can't have concurrent strategies to both eradicate the virus, on the one hand, and encourage and manage its further community spread, on the other. That said, some of the methods that work for one approach also work for the other.

 

I think a national debate about herd immunity would be helpful. If you advocate herd immunity, for example, it really is important to come up with a clear plan to "bubble wrap" seniors for a year. Or for however long you think natural herd immunity will take. It's now known that COVID-19 is a senior death machine. So having a debate about how to give "special protections" to seniors is a good thing, anyway.

 

I think the article is helpful. That said, I'm going to cut and paste sections of it that raise more questions than they answer. Being Mr. Wall Of Text, I get that the authors have word limits to deal with. But the devil is in the details. If we don't want 100,000 more dead seniors, some leaders are going to have to go beyond just throwing around words like "harmonious balance".

We need a tailored regional approach if the local hospital system gets strained. Germany, for example, chose a local threshold of 50 new cases per 100,000 population per week for when reinstitution of lockdown measures must be considered based on local capacity. The Ontario equivalent using the same threshold would be 7,300 new cases per week, or 1,043 per day.

 

That's the closest I've seen to an answer to the question: how many people have to die? I could take those numbers and estimate how many people would die in the service of herd immunity, based on actual rates of hospitalization and death in Germany. I'm not going to bother. My point is that it doesn't surprise me that Germany, which has been ahead of the curve, is thinking this way. As Anders Tegnall has said, this is an advantage of a national health care system. Both Sweden and Germany can think about how a nationalized medical system can best serve national objectives in a crisis. The US can't do that.

 

If I am reading it right, Germany is saying they think their hospitals can handle 500 new cases per week for every million citizens. There are 83 million people. So while their concern is local hospital capacity, on a national level that's 41,500 new cases per week.

 

The actual number of new cases in Germany in the last week is 3,742 cases. That compares to a peak of just under 7,000 new cases in one day. They had 273 new cases yesterday. That's a 93 % reduction from the peak. If Germany is trying to eradicate the virus, like many other countries, they are well on its way. Or is Germany trying to manage herd immunity? If so, it needs to pick up the pace.

 

My guess is that most Germans are hoping to contain or eradicate the virus. That said, if Plan B is controlling a long and ugly slog to natural herd immunity, they have that worked out, too. The methods toward Plan A and B are somewhat similar.

 

COVID-19 is like a wildfire. It certainly was in New York City. It was also a wildfire in Sioux Falls, and everywhere else in the US - like Ohio prisons or Navy ships - where it popped up. The only positive thing about Sweden, to me, is they have proved that you can at least manage community spread among working age adults. How far along the path to herd immunity they are is completely unclear. Anders keeps saying "soon". And yet by his own projections, most people in Sweden have not been infected, and don't have antibodies.

 

Given the novelty of the virus we do not have long-term data, but we know from 2003 SARS that immunity may last up to 13 years. Once a vaccine is available that would be the preferred option. However, there is no guarantee of whether and when a vaccine will be available, or how effective it will be, to say nothing of how broad the uptake of it will be in the population.

 

This is also one of the few articles on herd immunity I've read that articulates what "herd immunity" might mean. If it is proven that infection from COVID-19 does confer immunity for 13 years, that would be a significant fact. As the authors say, we don't know when to expect a vaccine, or what it might do. If it turned out three months from now that a vaccine was going to be much harder to develop than we thought, but people who were infected and recovered from COVID-19 seem to have lifelong immunity, that would be a game changer. For now, we have absolutely no clue.

 

Did the lockdown achieve the desired goals? Yes and no. Success in “flattening” the outbreak curve permitted the health-care system to handle the surge in cases safely and to avoid unnecessary deaths. But, we were not successful in protecting the elderly and frail population in nursing homes, where roughly 80 per cent of Canada’s deaths occurred. It is important to point out that more than 95 per cent of COVID-19 deaths occurred in those over 60, compared with none under age 20. Protection of the former group deserves the most attention; this will be easier if limited resources are diverted from other, low-risk groups.

 

That statement is very Friedmanesque. They introduce an idea, check the box, and move on. In this case, the idea is that COVID-19 is a senior death machine. At least they don't use the words "harmonious balance". But having said COVID-19 is really good at killing seniors, and we should think about special protections, they just move on. Again, I realize that you can't just tweet a plan to save millions of seniors from dying.

 

My emotional reaction to reading this is that it's just not very responsible. It's like saying that it's perfectly okay to have sex without rubbers. Actually, it's not. I use this example because the best way to prevent transmission and death with AIDS is to bubble wrap a penis. So until Friedman or these doctors can tell us how to bubble wrap seniors in a way that actually works, I don't buy it.

 

What seems inevitable, IN EVERY COUNTRY, is that herd immunity leads to mass senior citizen death. Because there are simply not practical ways to stop a virus spreading like wildfire from getting to seniors. Not in Canada. Not in Sweden. Not in Italy. Not in Spain. Not in the US. Not anywhere.

 

That's said, I'll hyperlink to this article that talks about nursing homes and seniors in Florida. I agree with the author that Florida is more good news than bad. But I would not hold them up as a poster child.

 

As it relates to seniors in Florida, the single best point I've read repeatedly is that they are well educated and got the memo early. This article talks about how they started to stay at home, based on mobile phone data, long before the government told them to. It is relevant that seniors don't seem to be advocating herd immunity. They seem to understand that community spread of COVID-19 does not work out in their favor.

 

As far as nursing homes go, the story describes a sound basic nursing home protocol: constant temperature checks, constant testing for infection or antibodies, constant social distancing (try that if you are dressing Granny, or changing her adult diapers). What struck me the most, again, is early and often public education. In Florida many nursing homes got the memo early and took preventative measures where they could. As one person said, the state testing effort was "great but way too late".

 

I still stand by my point. These are all good barriers. But to think that you can have broad community spread of COVID-19 without it getting into nursing homes is naive to the point of delusional. The best way to stop it from spreading to seniors is to stop it from spreading, period. That is what I think the polls say most seniors, and most people, agree on.

 

One final note on that point. The protocols that work in nursing homes - constant temperature checks, ubiquitous testing, masks, social distancing, targeted lock downs (like not letting outsiders in) - are the same tool kit China or South Korea or Germany are using. But they are using it to "test, trace, treat" the virus into eradication, or at least containment. So in China there are temperature checks at airports, train stations, office buildings. In South Korea you get your temperature checked to enter a restaurant. I think that is what California will soon require. If you test positive, in China you went to a "fever clinic" where you were tested and, if needed, isolated until you were well. Which is exactly how they eradicated almost all the community spread.

 

Again, the goals may not be the same, but many of the methods are. Why would we would want to keep playing constant "whack a mole", if just getting rid of the moles or putting them in a cage is an option? I get the fact that getting rid of the mole, or putting it in a cage, is not easy. It may be impossible. But it sure seems like a lot of countries and trying it, with pretty remarkable results.

[+ bigjoey]

An update on Covid19 and nursing home deaths in Johnson County, Kansas. To refresh memories, there are over 600,000 people in Johnson Country with 150 senior long term care facilities. Those facilities house about 20,000 seniors.

 

The newest dashboard:

https://public.tableau.com/profile/mapper.of.the.day.mod.#!/vizhome/shared/558GFDZKM

 

The one poorly managed nursing home now has had 17 dead but the rest of the nursing homes in the county have had no additional deaths and their total remains at 14 deaths. Bottom line, 143 of 150 nursing homes figured out best practices to where there were no deaths. One poorly managed nursing home is now responsible from more than half the deaths. The first lawsuit has already been filed! Poor management will shortly put Brighton Gardens out of business as the lawyers descend. Personally, this virus hot spot is eight blocks from my home; a little frightening.

 

Best practices have kept deaths away from our seniors. In a few days, the nursing homes will be opening up; I do not know the protocols they will be using but my guess they will be strict. However, while this has been hard and difficult work, it can be done.

 

The same goes with keeping down infections everyday which kill about 380,000 seniors each year in nursing homes. The better run nursing homes have figured out this difficult task while poorly managed places have everyday infections killing seniors. Same principle: good protocols and good management save lives. We just go not throw up our hands and say the task is too hard.

 

Yes, it would be an easier job to protect seniors if there was no Covid19 virus in the general community. In the same vein, my father use to say: “I would rather be young, rich and healthy than old, poor and sick.” By all means, eradicating the virus in the community should be our goal BUT that does not mean we can not protect seniors in nursing homes as the facts presented in the dashboard show. Both goals can be done at the same time.

 

I posted earlier about Falwell’s Liberty University bringing back students to campus. The media hysteria was that students would die BUT just like the Johnson Country nursing homes, best practices executed with good management can produce good results. Liberty had no on-campus infections of students or faculty. Yet, other university campuses are undecided on what to do. Apparently, what Liberty University did last Spring, other universities feel is too difficult for their management to execute this Fall. Yes, it was hard work but Liberty showed it could be done.

 

Be it a senior campus or university campus, people know what proper protocols need to be done. In both cases, the hard work would be a lot easier if the virus was crushed and not in the community. We should be able to multi-task and do both goals.

[+ stevenkesslar]

In Canada, the individual rate of death from COVID-19 for people under 65 years of age is six per million people, or 0.0006 per cent. This is roughly equivalent to the risk of dying from a motor vehicle accident during the same time period. In other countries where data are available, 0.6-2.6 per cent of deaths in people below age 65 have occurred in people without known underlying health conditions. Although the risk of death is small in this group, ongoing research to discover the critical risk factors for death from COVID-19 in younger age groups must remain a top priority. This will permit us to better protect those at risk, while loosening restrictions for the majority.

 

This is also from that Canadian article above. I have to give Canadians credit. Even when they are making arguments I don't agree with, they are always very logical about it.

 

Everywhere in the world, COVID-19 is first and foremost a brutally efficient senior citizen killing machine. So as the authors say, that should be Priority Number One. The experience in Canada seems to be more lopsided than in most places. They say 95 % of the cases in Canada are people 60 or older. In California 80 % of the deaths are 65 or older.

 

I will keep bringing up South Dakota in part because the state's data is clearer and more detailed than most. So while it is only one snapshot, it is a very clear snapshot. And in South Dakota I think COVID-19 can be thought of as a "workforce disease". It started in a meat packing plant and moved out from there. 85 % of the cases are workforce age, meaning under 60. But what's interesting about South Dakota is that even though they have a disease that primarily impacted the work force, it primarily killed seniors. 10 of the 50 deaths were people under 60. So 80 % of the deaths were over 60, even though 85 % of the cases were under 60.

 

My point is that I think you have to think of COVID-19 both ways. It is a senior citizen death machine. But it is also a workforce disease. I think herd immunity advocates tend to dismiss the workforce part. That quote above captures what I am now used to reading. Maybe we need to tinker a little bit with the idea that some young Black women have diabetes, or some young White guy is obese. But mostly, if you are under 60, it's either the sniffles or nothing it all. That's an exeggeration, of course. But in the real world, workers everywhere are freaking out. More important, in the real world, meat packing plants and car factories are being shut down as soon as someone tests positive. This is happening all over the US.

 

So for anyone who wants to avoid lockdowns, the workforce part of this is critical. It's not just an incidental problem where some rare younger Gay nurse bodybuilder loses 50 pounds after a few weeks on a vent. It's not just an exception to the rule. It's a massive problem. I think it is actually the weakest part of the herd immunity argument.

COVID-19 Pandemic Planning Scenarios

 

That's the new CDC guidelines that state a "best estimate" fatality rate of 0.4 %, alongside scenarios that range from 0.2 % to 1 % fatality. I think it bears noting that the two biggest antibody studies that covered the most testing of the largest populations - Spain and New York - both suggest the actual fatality rate is about 1 %.

 

For purposes of this post, I'm going to simply dismiss the idea that anyone under 50 could die. In South Dakota, two of 50 deaths were people under 50. As the Canadian authors argue, you can say that's like your chances of dying in a car, or whatever. So I'm just going to pretend like it doesn't matter to workers, even though of course it does.

 

So here's the herd immunity workforce problem I want a solution to. There are 55 million Americans aged 50 to 65. I'm going to assume all of them work. In South Dakota, to use that example, a fair number of deaths start to show up after age 50. So 3 of the 50 people that died were under 50. 7 were in their 50's, 7 were in their 60's. 33 were 70 are older. Of the actual people who worked at Smithfield who died, based on what I read, they were all over 50.

 

In a typical flu year, like 2016-2017, 38 million people get the flu. I used that year because 38 million is the average of all of the last ten years. So it is a very typical year. In that year, 7.5 million of the people who got sick were aged 50-65. Of those 7.5 million people, 78,986 required hospitalization. That's a hospitalization rate of about 1.1 %. And to sound like a herd immunity advocate, the typical technique is to argue something like this: Well, we never hear of such a thing any other time. So why all of a sudden is it such a problem?

 

Here's the problem. On the face of it, the CDC is now saying the hospitalization rate for COVID-19 for people aged 50 to 65 is 4.5 %. It may be 3.6 %, or it may be 5.7 %. But I'll go with the "best estimate", which is 4.5 %. So now, instead of 78,986 people requiring hospitalization for the flu, you have 335,000 (out of 7.5 million) requiring hospitalization for COVID-19. And these are not 335,000 older people, who are heading into their senior citizen death machine lottery. These are "younger" workers, aged 50 to 65.

 

But wait. It's much worse. Part of the problem is that the hospitalization rate for COVID-19 is about four times higher than a typical flu season: 4.5 % rather than 1.1 %. (In the real world, in South Dakota, the actual hospitalization rate was 8 %. Even though most cases were people under 60, it's quite likely that half those hospitalized were over 60. So something like 4.5 % for people aged 50 to 65 probably accurately describes reality in South Dakota.) The even bigger problem is that the infection rate is far higher. So in 2016-2017, we actually had 7.5 million people out of a total of 55 million people aged 50 to 65 that came down with the flu. That's about 14 %. With herd immunity, by design, it has to be much higher. 50 %? 70 %? 100 %?

 

This is where it gets really complicated. And why I keep wondering, "Okay. So what is the plan?" Friedman's "harmonious balance" theory is essentially that the young part of the herd happily goes to work and gets the sniffles so that old part of the herd is spared death. Sounds harmonious to me. (Check with that black 40 year old grocery clerk with diabetes, though. She may not agree.) What I wonder is where all these 50 to 65 year olds fit in. I'm no math genius. But, in theory, for all seniors to be spared from the death machine infection lottery, it would probably mean that most 50 to 65 year olds have to play the lottery.

 

I'm just going to arbitrarily say that under herd immunity, whether by design or because of ugly inevitability, 50 % of those aged 50 to 65 are going to get infected. So instead of 7.5 million people with the flu, we have 27.5 million aged 50 to 65 with COVID-19. Instead of 78,986 of those 7.5 million people who actually needed hospitalization in 2016, at a rate of 1.1 %, we'd have 1,237,000 of 27.5 million middle-aged workers needing hospitalization, at a rate of 4.5 %. The "good news", based on the new CDC estimates, is that "only" 55,000 of those workers will die, at a rate of 0.2 %. But that still leaves you with over 1 million workers who need hospital beds. How does this work into the herd immunity plan?

 

You like to keep pointing out that lockdown is not good for people's mental health, @bigjoey. You are right. Then again, death isn't good for people's mental health, either.

 

So if you wanted to come up with a plan to destroy the mental health of every CEO, every human resources director, and every small business owner in America, this would be it. The list of practical problems is enormous. How do you cycle through 1 million middle-aged workers being hospitalized? How do you keep factories open when every week some new worker just got sick? And how do you deal with age discrimination? Because my guess is employers would do the math and find a reason to hire a 22 year old and not hire a 52 year old.

 

To me, the "workforce problem" is an even bigger reason than the "senior citizen death machine" to do "test, trace, treat" with the goal of containing COVID-19. My guess is the goal of corporations is keeping this out of workplaces completely. At least right now, the standard for Smithfield or Ford is to shut down when workers get sick. The more workers get sick in factories, the more pressure to soften that standard will grow. Which will just make it easier for the virus to spread. That is an organic race to the bottom in the making.

 

I can't imagine that anybody in corporate America would be behind a plan like this. It creates huge uncertainty, huge stop/start, huge costs, huge problems. I'm actually counting on big corporations from Apple to Ford to Amazon to be smart enough to demand a really aggressive "test, trace, treat" protocol in every state. That seems like a much better plan to keep factories open. And to allows workers to work safely.

 

You just can't do that with herd immunity. Again, if i am missing it, please spell it out.

[+ stevenkesslar]

Bottom line, 143 of 150 nursing homes figured out best practices to where there were no deaths. One poorly managed nursing home is now responsible from more than half the deaths. The first lawsuit has already been filed!

 

Best practices have kept deaths away from our seniors.

Florida reports 650 coronavirus deaths at nursing homes

May 9, 2020

 

Florida Department of Health figures released late Friday night show that 656 patients, eight employees and one person of unknown status have died at the state's nursing homes and assisted living facilities with 14 reporting at least 10 deaths and 183 reporting at least one. That means nursing homes and ALFs account for almost 40% of the state's 1,715 confirmed deaths from COVID-19.

 

According to the Florida Health Care Association, a trade group, there are 700 nursing homes and 3,100 ALFs in the state caring for 155,000 people. The facilities employ 200,000 people.

 

So what's your take on this?

 

At least 5 % of the state's facilities - 197 out of 3800 - failed to "figure out best practices to where there were no deaths." They failed, right? Should they be sued? Or closed?

 

And if several hundred institutions in Florida screwed up on best practices and seniors died of COVID-19 (that's more than the total number of institutions in Johnson County) does that mean the policy failed? Florida prioritized keeping seniors in nursing homes safe. And yet by the standard you are saying - "to where there were no deaths" - hundreds of these places failed!

 

Bottom line: how could hundreds of these nursing homes in Florida be letting seniors die of COVID-19? Hundreds! There's something very wrong here.

 

So I'll give you some of my personal takes. My Mom and Dad collectively spent years in nursing homes, and died in them. My Dad died of pneumonia two years ago, aged 96. My Mom died of dementia, also aged 96, last year. Mom was nonverbal and almost vegetative by the end. So I get the idea that we don't want to stop the entire US economy just to protect really old people who lived long, happy lives. Mom and Dad both fall in that category.

 

My Dad actually was in the rehab center/nursing home three times: twice for a month each for rehab on a knee and hip after falls at home, which happened like 5 years before his final time, after another almost fatal fall at home. During the two rehab stints he was an A+ student whose focus was to do his job with rehab and get home to his wife ASAP. Then, after my Mom had a stroke and was admitted, he drove to visit my Mom there every day for years. He was adamant about living independently. He kept referring to the nursing home as a place "people go to wait to die".

 

I intervened with staff on issues with my Mom or Dad a number of times. Whether it was my Mom's involvement in activities, my Dad's rehab, Medicare reimbursements, or whatever, the staff kind of blew my mind with their professionalism. As well as their understanding of my Mom and Dad's specific needs. And even how they interacted with each other. There was one exception, a social worker who my sister and I tagged as "The Airhead". One time he came up to me in a hallway to start telling me something about my Mom. It took me a few minutes to realize he was telling me about a woman who was not my Mom. So he was sort of the exception to the rule. In general, the more time I spent in that home the deeper I respected the professionals, mostly women, who worked there.

 

My sister, who happened to also be a county employee and was friends with several of the women who worked there, was far harsher about the home than I was. My own take was when Mom needed lots of attention to keep her diapered and fed and dressed, I wasn't as concerned about whether her hair was combed, or how she was often alone in her room. My point is that within my own family, the expectations around "best practices" varied widely.

 

I have a really hard time with your definition of "best practices". I guess it would be easy for someone to say that if someone dies of COVID-19 in a nursing home, then that home can't be following best practices. Whereas if people don't die of COVID-19, well that home is following best practices.

 

What does "best practices" mean to you? What practices have you observed that you think reflect quality care? What things did these inferior places do that allowed residents to die of COVID-19? By your standard, hundreds of these institutions in Florida have failed, and perhaps need to be closed. And the state as a whole has failed miserably.

 

I hyperlinked a Slate article on Florida and nursing homes in a prior post. Two of the more obvious "best practices" are daily temperature checks, and mass testing of employees. That's why I asked. What are the specific things these Kansas homes did or did not do that you think are "best practices"?

 

The problem in Florida, as that article said, was testing was "great but way too late", according to one nursing home administrator. Some of these homes put "protective measures" in place a month before the state got around to it. So that would be a good "best practices" standard: having a written pro-active plan that is communicated to all staff. But if you don't have testing, you are still flying blind. Even with temperature checks, you'll miss people who are contagious but asymptomatic. The best home with the best practices could, in theory, kill dozens of seniors because of one asymptomatic employee. Do you agree?

 

Do you agree with Merkel's idea about "immunity passports"? Florida has 200,000 people who work in these senior facilities. And every one of them is capable of bringing COVID-19 to work with them every day. It's a massive problem.

 

If there is anyplace where "immunity passports" make sense to me, it's nursing homes. Testing is the next best thing. But you'd have to test every employee almost every day, or at least once or twice a week, to keep COVID-19 out.

 

You said "you do not know the protocols they will be using". So what you are basically saying is this. If a nursing home in Kansas let people die of COVID-19, they are not following best practices. But if nobody died of COVID-19, they are following best practices. That seems very facile.

 

In Florida, I would not jump to the conclusion that over 200 nursing homes are inferior, or are following bad practices. Even though residents in all of them died of COVID-19. That article above was in early May. I'm quite sure that weeks later in Florida it is far more than 200 facilities, and more than 5 % of all the facilities that have had COVID-19 deaths.

 

The reality that you really won't accept is that having 50 % or 60 % or 70 % of the population infected with COVID-19 means mass illness and mass death. And that is inevitably going to filter into about 100 % of nursing homes. If you have 200,000 employees, in a state like Florida, and most get infected, it is going to be very hard to avoid.

 

Right now, Florida has more seniors who died in nursing homes than Johnson County, Kansas has total COVID-19 infections (711 cases). Senior nursing home deaths in Florida (1,024) increased 24 % in the last week alone.

 

Florida long-term-care facilities’ resident deaths from coronavirus jump by 199 (23.9%) in past week

MAY 23, 2020

 

So it's very easy to pick a US county where there is low community spread of COVID-19, and say most nursing homes have kept it out. That's because very few people in the community have COVID-19. When more people in the community get COVID-19, it inevitably spreads into more nursing homes.

 

You want to play Anders Tegnall and pretend it won't happen. Even though it does - everywhere, every time. Then when it happens, you want to blame it on them. People died of COVID-19, so obviously that is not "best practices".

 

I do not know the protocols they will be using but my guess they will be strict. However, while this has been hard and difficult work, it can be done.

 

Woo hoo! You get the Tom Friedman award of the week. "I have no idea what the work is. But it is hard and difficult work. And it can be done." :oops:

 

Come on! Give me a fucking break.

 

So here is a very good Florida articulation of protocols. You might want to learn a little bit about what you are preaching about.

 

Nursing Homes

Safe. Smart. Step-by-Step.

 

That is a really good list, as far as it goes. That said, if I were running a nursing home, I would agree with the administrator quoted. Gloves and gowns and sanitizer are great. But without testing, I'm being asked to fly blind. Even with testing, if I have hundreds of employees, there is every reason to fear that one of my rehab therapists or aides is going to walk through the door one day with an asymptomatic COVID-19 infection. And they have to touch people to dress them or feed them.

 

So how do I stop her from infecting people?

 

I think the only good answer to that question is to keep her from being infected in the first place. By the way, the nurse or aide or rehab therapist doesn't want to be infected, anyway.

Edited May 25, 2020 by stevenkesslar

[+ bigjoey]

Florida reports 650 coronavirus deaths at nursing homes

May 9, 2020

 

 

 

So what's your take on this?

 

At least 5 % of the state's facilities - 197 out of 3800 - failed to "figure out best practices to where there were no deaths." They failed, right? Should they be sued? Or closed?

 

And if several hundred institutions in Florida screwed up on best practices and seniors died of COVID-19 (that's more than the total number of institutions in Johnson County) does that mean the policy failed? Florida prioritized keeping seniors in nursing homes safe. And yet by the standard you are saying - "to where there were no deaths" - hundreds of these places failed!

 

Bottom line: how could hundreds of these nursing homes in Florida be letting seniors die of COVID-19? Hundreds! There's something very wrong here.

 

I have a really hard time with your definition of "best practices". I guess it would be easy for someone to say that if someone dies of COVID-19 in a nursing home, then that home can't be following best practices. Whereas if people don't die of COVID-19, well that home is following best practices.

 

What does "best practices" mean to you? What practices have you observed that you think reflect quality care? What things did these inferior places do that allowed residents to die of COVID-19? By your standard, hundreds of these institutions in Florida have failed, and perhaps need to be closed. And the state as a whole has failed miserably.

 

I hyperlinked a Slate article on Florida and nursing homes in a prior post. Two of the more obvious "best practices" are daily temperature checks, and mass testing of employees. That's why I asked. What are the specific things these Kansas homes did or did not do that you think are "best practices"?

 

The problem in Florida, as that article said, was testing was "great but way too late", according to one nursing home administrator. Some of these homes put "protective measures" in place a month before the state got around to it. So that would be a good "best practices" standard: having a written pro-active plan that is communicated to all staff. But if you don't have testing, you are still flying blind. Even with temperature checks, you'll miss people who are contagious but asymptomatic. The best home with the best practices could, in theory, kill dozens of seniors because of one asymptomatic employee. Do you agree?

 

Do you agree with Merkel's idea about "immunity passports"? Florida has 200,000 people who work in these senior facilities. And every one of them is capable of bringing COVID-19 to work with them every day. It's a massive problem.

 

If there is anyplace where "immunity passports" make sense to me, it's nursing homes. Testing is the next best thing. But you'd have to test every employee almost every day, or at least once or twice a week, to So it's very easy to pick a US county where there is low community spread of COVID-19, and say most nursing homes have kept it out. That's because very few people in the community have COVID-19. When more people in the community get COVID-19, it inevitably spreads into more nursing homes.

 

You want to play Anders Tegnall and pretend it won't happen. Even though it does - everywhere, every time. Then when it happens, you want to blame it on them. People died of COVID-19, so obviously that is not "best practices".

 

 

 

Woo hoo! You get the Tom Friedman award of the week. "I have no idea what the work is. But it is hard and difficult work. And it can be done." :oops:

 

Come on! Give me a fucking break.

 

So here is a very good Florida articulation of protocols. You might want to learn a little bit about what you are preaching about.

 

Nursing Homes

Safe. Smart. Step-by-Step.

 

That is a really good list, as far as it goes. That said, if I were running a nursing home, I would agree with the administrator quoted. Gloves and gowns and sanitizer are great. But without testing, I'm being asked to fly blind. Even with testing, if I have hundreds of employees, there is every reason to fear that one of my rehab therapists or aides is going to walk through the door one day with an asymptomatic COVID-19 infection. And they have to touch people to dress them or feed them.

 

So how do I stop her from infecting people?

 

I think the only good answer to that question is to keep her from being infected in the first place. By the way, the nurse or aide or rehab therapist doesn't want to be infected, anyway.

 

Typical Steven post which twists and distorts what I have said to produce a misleading post.?

 

When I said I did not know the protocols, that was clearly referring to what they were going to be using in the future when they opened up. I do not know that the protocols have even been finalized. I do know they will be hard work going forward just as the ones that have been in place during the lockdown have been hard work. You have specifically taken something out-of-context and twisted it to then hold it up to ridicule, a Steven argument trick. Nice.?

 

I have never said a single death or even a few means that best practices are not followed. Nothing is 100% certain. In referring to the statistics in Johnson County, Kansas, 7 out of about 150 facilities had one or a few Covid19 deaths but one facility had 17 that is more that all the others combined! That single nursing home is the one I referred to has having poor management that lead to the deaths; I never referred to the other LTCF as being poorly run or not following best practices. You distort what I said to claim that I would condemn the 183 Florida LTCF that had at least one death. I would certainly question the management and if they followed best practices at the 14 LTCF that had 10 or more deaths. Those 14 facilities are .0036% of the 3,800 total Florida facilities.

 

Distortions and making false claims are Steven hallmarks. No where do I say a single death means best practices were not followed but yet you claim that is what I believe. More typical Steven distortion and lies.

 

I have clearly said that I am in favor of testing, tracing and isolation and that can be done while LTCF continue their own work. A community with no Covid19 makes that work easier; I agree. But until that happens, the hard work goes on. Just as the facts of what is being done in Johnson County, Kansas (or Liberty University did last semester with a university) shows there can be success in fighting the virus until it is conquered. Somehow, thousands of Florida LTCF have been successful, too. Maybe those thousands of Florida facilities were just lucky or maybe they had good management and followed best practices?

 

As for the places that you continually hold up as success stories, China, South Korea and Singapore have all had virus flare ups. This shows that until there is artificial or natural herd immunity, the virus will be a continued threat. NOTE: that is not “promoting” herd immunity but just recognizing reality.

 

I note you have failed to comment on the 380,000 seniors who die each year from infections in LTCF. Ever since I became involved as a volunteer in a nursing home over 50 years ago, infections have been an issue. The protocols that have been developed over the years are the basis for the current Covid19 protocols which are more extensive. Do you not consider that 380,000 deaths per year of seniors in LTCF is an important issue? I consider that a major issue. I was involved over 20 years ago in the design of the current LTCF building that had features in the building design to fight infections. (That 20 year old building is currently under renovation to incorporate the newest ideas in excellence of care). The facilities with better management and practices did not just happen with the appearance of Covid19. That helps explain the success in Johnson County and why thousands of Florida facilities have been successful

 

Please stop misrepresenting what I have posted, distorting my views and posting outright lies. To quote you: “Give me a fucking break.”

[+ bigjoey]

To be clear: the good LTCF did not just start fighting Covid19. The facilities with good management and practices have been on the battlefront of fighting infections for decades. The Covid19 fight is just the newest one in this long fight; a very contagious infection and a very deadly one but fighting infections is not new.

 

As I posted, two decades ago we considered fighting infections in the design of the building. However, our main weapon against infections has always been staff. Where I volunteer always put priority on hiring good people, training them and treating them well (which includes pay). When I became involved fifty years ago, the emphasis was on having good, caring staff and that has been the hallmark of the institution. That is why we are so far successful in fighting Covid19.

 

Years of fighting infections and the annual flu have prepared the better facilities for this moment. The Talmud has a very famous quote about starting something you know you will not finish. Even the knowledge that you will not be successful is not an excuse not to begin. Even if the task of not fighting Covid19 will not be a winning one, no reason we should not try. The better LTCF are at least engaged in the fight. The nay sayers just may be wrong as they were when Falwell opened Liberty University; in that case they attacked Falwell in that his actions will cause people to die. Falwell may not believe in evolution but not one student or staff that was on campus got infected.

 

From the Talmud:

https://www.voices-visions.org/content/poster/collection-poster-rabbi-tarfon-pirke-avot-221-bob-gill

 

A defeatist attitude runs against the positive Jewish attitude expressed in an old Jewish story:

A rabbi was widely believed to have wondrous powers to do miracles and cure the sick. His reputation reached the Czar who summoned the rabbi to appear. The Czar thought he would have fun and he would expose this “miracle” making rabbi as a fraud. The Czar demanded the rabbi teach his dog to talk or the rabbi would be put to death.

 

The rabbi thought about his bad choices and said that if given three years, he would teach the dog to talk. On leaving with the dog in tow, the rabbi’s companion looked at him and said: “Are you crazy? Youcan not teach that dog to talk.”

 

The rabbi responded: “In three years, I could be dead. In three years, the dog could be dead. Who knows, in three years, the dog could talk.”

 

I prefer to have a positive outlook and concentrate on fighting the virus to prevent seniors from dying. So far, thousands of facilities in Florida are successful. So far, almost all facilities in Johnson County are successful. This can all be happening while modified lockdowns are happening and test, trace and isolate is implemented. These things are not mutually exclusive. Besides, when all this is over, “the dog could talk.”

[+ WilliamM]

To be clear: the good LTCF did not just start fighting Covid19. The facilities with good management and practices have been on the battlefront of fighting infections for decades. The Covid19 fight is just the newest one in this long fight; a very contagious infection and a very deadly one but fighting infections is not new.

 

As I posted, two decades ago we considered fighting infections in the design of the building. However, our main weapon against infections has always been staff. Where I volunteer always put priority on hiring good people, training them and treating them well (which includes pay). When I became involved fifty years ago, the emphasis was on having good, caring staff and that has been the hallmark of the institution. That is why we are so far successful in fighting Covid19.

 

Years of fighting infections and the annual flu have prepared the better facilities for this moment. The Talmud has a very famous quote about starting something you know you will not finish. Even the knowledge that you will not be successful is not an excuse not to begin. Even if the task of not fighting Covid19 will not be a winning one, no reason we should not try. The better LTCF are at least engaged in the fight. The nay sayers just may be wrong as they were when Falwell opened Liberty University; in that case they attacked Falwell in that his actions will cause people to die. Falwell may not believe in evolution but not one student or staff that was on campus got infected.

According to an interview with Rev. Falwell on CNN after Spring break, all classes during the pandemic are on line. To the extent the University is open, some foreign students are still on campus, with appropriate social distance. To be fair, there may be other Liberty students on campus as well. Professors interact with students during face time.

 

The Universities of Virginia and North Carolina (Chapel Hill) are closed, of course.

[+ stevenkesslar]

I prefer to have a positive outlook and concentrate on fighting the virus to prevent seniors from dying.

 

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.

 

My husband was thrown into a war on the vulnerable without a chance — he cannot care for himself or protect himself from a virus that doesn’t have a vaccine. The fact that he is still alive is a miracle. As of May 10, it was likely that over 5,000 residents in nursing homes statewide had perished. They matter.

 

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:

 

One of our night aides has worked at Isabella for over 25 years. One night I asked him, “Do you love what you do?” and he responded, “This is what we are supposed to do on this earth: serve the sick.”

 

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:

 

To be given a chance to live is a human right, and the business of care that impedes this right in any way needs a major reckoning. Not testing health care workers and residents, not addressing staffing shortages, not updating families on loved ones’ conditions and not producing effective plans for managing infections within nursing homes is unacceptable.

 

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.

Edited May 25, 2020 by stevenkesslar

[+ stevenkesslar]

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.

According to DSHS, which regulates the state’s long-term care facilities, at least one or more cases of COVID-19 in residents or staff have been reported in 94 assisted living facilities, 76 nursing homes, 51 adult family homes and 30 supported living providers as of May 5th.

 

Wright tells KOMO News that of the state’s more than 4,000 long-term care facilities, teams have inspected at least half of them. DSHS has worked alongside federal partners to make sure they’re following proper infection control.

 

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.

Edited May 25, 2020 by stevenkesslar

[+ stevenkesslar]

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.

[+ bigjoey]

According to an interview with Rev. Falwell on CNN after Spring break, all classes during the pandemic are on line. To the extent the University is open, some foreign students are still on campus, with appropriate social distance. To be fair, there may be other Liberty students on campus as well. Professors interact with students during face time.

 

The Universities of Virginia and North Carolina (Chapel Hill) are closed, of course.

According to the story in the Wall Street Journal, at Spring break students were given the choice to finish online or return to campus. 1,200 students chose to return to campus. In addition to the 1,200 students attending live classes, there were the staff which included professors, food service, etc.

[Beancounter]

I think we should have a treasure hunt here in the Forum and I’ll provide a prize to the winner. The Forum member who can locate the shortest posting by Steven Kessler will receive a gourmet dinner herein Dallas. Transportation not included.

[+ WilliamM]

[

According to the story in the Wall Street Journal, at Spring break students were given the choice to finish online or return to campus. 1,200 students chose to return to campus. In addition to the 1,200 students attending live classes, there were the staff which included professors, food service, etc.

Perhaps more students decided to shelter on line in their dorm rooms than Rev. Falwell anticipated. The classes were definitely not live because Mr. Falwell was concerned about teachers interacting with students in person. He was progressive in his thinking, to a degree. Perhaps students and parents reached an acceptable compromise on their own.

[+ keroscenefire]

A new study done in California suggests those who recover from COVID have a strong immune response. The doctors behind the study say the T-cells produced after the infection are strong, robust and protective of reinfection. They don't know for sure how long this immunity might last, but are hopeful for a "long-lasting impression," based on the quality and number of memory T-cell produced by the recovered patients they studied (possibly around the same 2-3 year period of SARS and MERS immunity). These same studies have also looked at the data from the Moderna vaccine and the immune response it produced compared favorably to that of these recovered patients.

 

So good news I'd say on the vaccine and immunity front, though this was a relatively small study (only 20 patients), but still good news overall.

[+ stevenkesslar]

A new study done in California suggests those who recover from COVID have a strong immune response. The doctors behind the study say the T-cells produced after the infection are strong, robust and protective of reinfection. They don't know for sure how long this immunity might last, but are hopeful for a "long-lasting impression," based on the quality and number of memory T-cell produced by the recovered patients they studied (possibly around the same 2-3 year period of SARS and MERS immunity). These same studies have also looked at the data from the Moderna vaccine and the immune response it produced compared favorably to that of these recovered patients.

 

So good news I'd say on the vaccine and immunity front, though this was a relatively small study (only 20 patients), but still good news overall.

 

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:

 

Ideally, vaccines would prevent infection entirely, inducing what’s known as “sterilizing immunity.” But early work on some of the vaccine candidates suggests they may not stop infection in the upper respiratory tract — and they may not stop an infected person from spreading virus by coughing or speaking.

 

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

 

The U.S. Navy says 13 sailors from the USS Theodore Roosevelt who had apparently recovered from the coronavirus and had received negative test results have now tested positive for a second time.

Stanley Perlman, a professor of microbiology and immunology at the University of Iowa, recently told NPR's Nell Greenfieldboyce that patients who recover from the virus may have at least some level of protection from it in the future, but much remains unknown.

 

"Based on other infections where you get a deep lung infection, you are usually protected against the second infection. If you just have a mild COVID-19 infection that involves your upper airway, maybe it will behave like a common cold coronavirus and maybe you can be reinfected again," Perlman said. "We just really don't know. It's even hard to speculate."

 

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

 

Health officials there studied 285 patients who tested negative for the virus after recovering, but weeks later tested positive again. The question — in this and similar situations — is whether a positive test in this circumstance means that these people can still spread the virus.

 

To find out, the scientists followed up with nearly 800 of those people's personal contacts, such as family members. They found no evidence that they had contracted the virus from the people who had a fresh positive result. The scientists also tried to grow the virus in secretions from these patients. They could not.

As a result of these findings, published online Tuesday, the South Korean CDC no longer recommends that people in this situation be isolated. Their contacts do not need to be quarantined, though health officials do plan to continue investigating cases of people who have tested positive again after having had a negative test.

 

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.

[+ stevenkesslar]

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.

Edited May 26, 2020 by stevenkesslar

[+ stevenkesslar]

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.

Edited May 26, 2020 by stevenkesslar

[Guest]

Here's a graph I received from the New York Times. Not nice, of course, but it puts things into perspective: