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*** OFFICIAL *** COVID-19 CoronaVirus Thread. Fresh epidemic fears as child pneumonia cases surge in Europe after China outbreak. NOW in USA (13 Viewers)

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This is wonderful, if true.  Putting on my epidemiologist hat, which I've kept in the closet for just this occasion - we only get through this three ways: herd immunity, vaccine, or a ridiculously good therapeutic.  The above would indicate that herd immunity may be where we end up, just by nature, well before a vaccine can be developed.  It also means we're much further through this crisis than we thought we were.

Putting aside the thought of a vaccine, which may simply be too late to be a true end to this, herd immunity plus a big time therapeutic (remdesivir, leronlimab, etc.)  may well be the path out of this world wide travesty.

 
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This is wonderful, if true.  Putting on my epidemiologist hat, which I've kept in the closet for just this occasion - we only get through this three ways: herd immunity, vaccine, or a ridiculously good therapeutic.  The above would indicate that herd immunity may be where we end up, just by nature, well before a vaccine can be developed.  It also means we're much further through this crisis than we thought we were.

Putting aside the thought of a vaccine, which may simply be too late to be a true end to this, herd immunity plus a big time therapeutic (remdesivir, leronlimab, etc.)  may well be the path out of this world wide travesty.
Im subscribing to the theory.  When its all said and done I think the mortality rate would be between .1 and .5.  This is because a tremendous amount of people already had the virus and didnt know it.

 
I probably average a tuna fish sandwich at minimum once a week for probably 20 years. HOW HAS THIS NEVER OCCURRED TO ME

gamechanging.
Seems like it would still be too dry.  I could see using both but not just hummus.  I should point out I like a creamy tuna and chicken salad - YMMV.

 
This is why it is an abomination that some think we can now just rush into public life again. Great if there are more asymptomatic than suspected. But what if some of the infected are still incubating and will develop systems later, and are not recovered? 

It is not a time to relax.
Please explain how meeting the requirements to enter phase 1 and the restrictions that have to be met by businesses to be open in phase one is "rushing into public life" or "relaxing"?

 
JAA said:
Doesn’t apply to this board.  I asked about examples of posters her advocating for “aggressively” your words opening things back up.  That really hasn’t been the case here.  Anyways I’m done with this no need to argue about semantics.

 
The Commish said:
Has anyone heard on the testing requirements that make a state qualify for the "adequate testing" threshold?  I haven't seen a single detail on this.  I am also wondering which part of CARES is going to be paying for this testing or is the expectation that each state will have to figure out funding on their own too? 
I'm trying to find info on this still.  It SEEMS like whatever testing they are doing now, future testing has to stay at that level or increase (if I am reading correctly).  I still haven't found where the funding is going to come from for this or what happens when they can't get their hands on tests.  I also haven't seen a goal as to the % tested that needs to be seen per capita of the state.  It seems a bit odd to me that "current level or better" is the litmus test here given how far behind we continue to be.  Am I reading that correctly?  I know of just a handful of states that are getting close to the SK per capita levels.  That's where we need to be to get an idea of where we're at.  Current testing levels shouldn't be the bar set.  We need more than that.

 
Not what I’m referencing. I’d say the protestors on the streets in Minnesota and Michigan are rushing into public life. We’re seeing calls by prominent voices to deny stay at home orders or guidelines. 
All I can add to that is that I hope they're all wearing masks and keeping their distance from one another. Unfortunately they're probably not. Hopefully the great outdoors is helping mitigate some of the risk.

 
TheWinz said:
Of course I was exaggerating to make a point, but it's a valid point.  I present you with the following scenario...

You are around 50, and live with your wife, 20 yr old son, and your parents (in their late 70's).  You live in a house with unlimited supplies and everyone is COVID free.  Your bored son wants to attend a "COVID party" with 100 other youngsters who are going stir crazy at home.  You live in an area that has a big outbreak at the moment.  He asks your permission and you tell him to stay home.  He says, "I am an adult, I can do what I want", and attends the party.  Do you let him back in the house after the party?
Depends on how I'm feeling that day. Two weeks ago I would have changed the locks as soon as he left. Now I'm feeling less stressed and might let the SoB marinate in the garage for a couple of weeks.

GroveDiesel said:
I am not a medical professional, but my bet is that the homeless population is one of the most at risk and likely to be infected for a lot of reasons. Lack of access to PPE, inability to maintain good hygiene, lack of social distancing ability in shelters, and I’ve seen quite a few in Philly who are still panhandling at people’s car windows, etc. 
The homeless shelter here kicks everyone out on the street during the day and passes out food at the loading dock instead of the chow hall. I'm not sure if there has been a modification to huge dorm room that is filled with beds almost touching. I'm guessing the shelter has cut night time capacity because there is a few new places being used as campsites.

 
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I think you can make an argument that it is contained in the vast majority of MN. Anoka county has 350k people and zero deaths. 
Just read that the Gov. Walz opened up restrictions on recreational activities and that the stay at home order was through May 4th, a whole 17 days from now. So yeah, let's go out and not social distance while protesting in front of his house. That's responsible. 

 
The Commish said:
Has anyone heard on the testing requirements that make a state qualify for the "adequate testing" threshold?  I haven't seen a single detail on this.  I am also wondering which part of CARES is going to be paying for this testing or is the expectation that each state will have to figure out funding on their own too? 
I'm trying to find info on this still.  It SEEMS like whatever testing they are doing now, future testing has to stay at that level or increase (if I am reading correctly).  I still haven't found where the funding is going to come from for this or what happens when they can't get their hands on tests.  I also haven't seen a goal as to the % tested that needs to be seen per capita of the state.  It seems a bit odd to me that "current level or better" is the litmus test here given how far behind we continue to be.  Am I reading that correctly?  I know of just a handful of states that are getting close to the SK per capita levels.  That's where we need to be to get an idea of where we're at.  Current testing levels shouldn't be the bar set.  We need more than that.
Texas is looking to start opening up May 1 according to Governor Abbott's press conference today. Texas has currently tested one half of one percent of the population.

 
The Commish said:
Has anyone heard on the testing requirements that make a state qualify for the "adequate testing" threshold?  I haven't seen a single detail on this.  I am also wondering which part of CARES is going to be paying for this testing or is the expectation that each state will have to figure out funding on their own too? 
I'm trying to find info on this still.  It SEEMS like whatever testing they are doing now, future testing has to stay at that level or increase (if I am reading correctly).  I still haven't found where the funding is going to come from for this or what happens when they can't get their hands on tests.  I also haven't seen a goal as to the % tested that needs to be seen per capita of the state.  It seems a bit odd to me that "current level or better" is the litmus test here given how far behind we continue to be.  Am I reading that correctly?  I know of just a handful of states that are getting close to the SK per capita levels.  That's where we need to be to get an idea of where we're at.  Current testing levels shouldn't be the bar set.  We need more than that.
Texas is looking to start opening up May 1 according to Governor Abbott's press conference today. Texas has currently tested one half of one percent of the population.
Pretty much my point.  I live in Florida and they have been focused on getting testing kits from the beginning and have even said their goal is to be at the per capita testing levels of SK.  We aren't close and we can't get close without more testing resources.  My wife's results took almost TWO WEEKS to come back.  I am hopeful that these 10-15 minute tests become the gamechanger we need.  However, my overall point here is there is a substantial amount of lacking in these "phases" when it comes to testing.  I get why this has all been pushed back on the states, but if things aren't defined nationally where all states need to meet the same level we are going to be starting, stopping, starting, stopping has hotspots continue to pop up all the time.  If there's one thing that our federal government can do here it's set a single goal on testing that all states have to meet.

 
https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v1

Using the above I tried to fit the doubling time for both scenarios, sheltering in place and prior to sheltering in place.

I used a doubling time of 3 days prior to the shutdown and a doubling time of 5 days post shutdown, with a R0 of 3.5 and 2.5 for both scenarios respectfully.  I tried to backtrack the data to arrive at a reasonable date for patient 0.

Cases    Date
1    8-Feb
2    11-Feb
4    14-Feb
8    17-Feb
16    20-Feb
32    23-Feb
64    26-Feb
128    29-Feb
256    3-Mar
512    6-Mar
1024    9-Mar
2048    12-Mar
4096    15-Mar -- shelter in place started and doubling time changed
8192    20-Mar
16384    25-Mar
32768    30-Mar
65536    4-Apr

The average time on a respirator is 10 days according to a university of washington study, according to CDC the average time from onset of symptoms to needing a respirator is 8-12 days, and the average asymptomatic time is 5 days. For a total time of case resolving of ~25 days.

Currently there have been 69 deaths in santa clara county  and I calculated somewhere around 12,000 cases 25 days ago.

This means that I would estimate the mortality rate at 0.5% with a very large factor of error since I do not know the R0 value before or after the shutdown, I do not know when patient 0 arrived in Santa Clara county and perhaps most importantly I do not model diseases for a living, so I do not know which direction my assumptions are wrong. Besides that i feel pretty confident with my estimate.

 
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I think you can make an argument that it is contained in the vast majority of MN. Anoka county has 350k people and zero deaths. 
I hope that doesn't change.
I'm encouraged by how well MN appears to be doing so far, but I'm slightly concerned that MN is still very much in the initial stages of this. The number of new daily cases is still growing (159 new cases 4/17, 94 new cases on 4/10, although I readily admit we've had some recent days with much lower counts and some with higher counts). 

 
JAA said:
Sand said:
JAA said:
This is wonderful, if true.  Putting on my epidemiologist hat, which I've kept in the closet for just this occasion - we only get through this three ways: herd immunity, vaccine, or a ridiculously good therapeutic.  The above would indicate that herd immunity may be where we end up, just by nature, well before a vaccine can be developed.  It also means we're much further through this crisis than we thought we were.

Putting aside the thought of a vaccine, which may simply be too late to be a true end to this, herd immunity plus a big time therapeutic (remdesivir, leronlimab, etc.)  may well be the path out of this world wide travesty.
Im subscribing to the theory.  When its all said and done I think the mortality rate would be between .1 and .5.  This is because a tremendous amount of people already had the virus and didnt know it.
I didn't see in the article what percentage of the people tested had symptoms previously. The way the test was conducted, it could have attracted people who had symptoms but couldn't get a COVID-19 test, which skews the data. Still somewhat promising.

 
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GroveDiesel said:
I am not a medical professional, but my bet is that the homeless population is one of the most at risk and likely to be infected for a lot of reasons. Lack of access to PPE, inability to maintain good hygiene, lack of social distancing ability in shelters, and I’ve seen quite a few in Philly who are still panhandling at people’s car windows, etc. 
I would take it as a good sign since they are a high risk group. If 50% are positive but most are asymptotic, that’s a good sign for the general public. There’s more chance for it to continue spreading but likely less people are at high risk. Though obesity is one trait common in CV high risk patients that’s not common in the homeless population.

 
Mr Anonymous said:
Please explain how meeting the requirements to enter phase 1 and the restrictions that have to be met by businesses to be open in phase one is "rushing into public life" or "relaxing"?
MR A- I know you asked this of Ham, but let me take a shot at responding (not on his behalf, but just generally).

I understand your frustration and sympathize with your POV that some may not be fully appreciating the economic suffering of others who cannot easily work from home.  I also think you have raised very good points about needing different solutions...at different times...for different states/counties.  I also have read the federal guidelines for re-opening and my general conclusion is that they are pretty good: clear, gradual, focused and most importantly they IMPLY that this will take some time.  But here's where I disagree with you...and I think it will require me to state some assumptions that you may not agree with, not sure so let's check.  The purpose of the extensive stay-at-home orders was to:

  • ensure that our healthcare system was not over run in the near term
  • assess where we were impacted because lack of testing made us blind
  • buy us time time to: increase healthcare capacity (beds, PPE, vents, etc.), tamp down hot spots, and develop re-opening plans
I think you and I are in agreement on the above, but where we differ is:

  • you believe that "developing re-opening plans" means simply writing up guidelines like the federal ones released yesterday whereas
  • I (and I suspect many others) believe that wide-scale testing and contact tracing are key components of a re-opening plane EVEN for the least impacted and least densely populated parts of the country
So, is that the disagreement?  Is it that you believe that testing and tracing are NOT necessary in these (presumedly) lightly impacted areas?  Because I (and I suspect others) fear that without this tool that there is a decent chance (25%?) that the results 60 days from now will be FAR worse.  Alternatively, perhaps you believe that the 25% chance is greatly over-stated...or that the ability to "shut down any resurgence," regardless of the probability, is much higher than I believe.  That is, with the lack of testing, lack of seriousness I think some are taking, lack of realistic expectation-setting from these state and federal politicians for what re-opening means, and lon incubation period I have serious concerns that this is a steam train we won't see coming until it is on top of us.  That's why I am concerned about re-opening discussions with wide-scale testing and contact tracing.

Now, one thing that could get me to join your side is IF I was told that wide-sale testing (i.e. 1M+ tests per day, results within 24 hours) just isn't possible within the next 30 days.  If THAT is true then I'd probably agree that we need to go to war with the army we've got...and in this case that army doesn't include wide-scale testing.  Ok, I've rambled on but that's my POV and I think there is alot of agreement between us...I just wanted to probe for the specific points of disagreement as I don't think that has been very clearly expressed.  

Does that help?

 
Pretty much my point.  I live in Florida and they have been focused on getting testing kits from the beginning and have even said their goal is to be at the per capita testing levels of SK.  We aren't close and we can't get close without more testing resources.  My wife's results took almost TWO WEEKS to come back.  I am hopeful that these 10-15 minute tests become the gamechanger we need.  However, my overall point here is there is a substantial amount of lacking in these "phases" when it comes to testing.  I get why this has all been pushed back on the states, but if things aren't defined nationally where all states need to meet the same level we are going to be starting, stopping, starting, stopping has hotspots continue to pop up all the time.  If there's one thing that our federal government can do here it's set a single goal on testing that all states have to meet.
Why has it been?

 
I'm sure it has been discussed already, so for that I apologize, but what are the consequences for employees of organizations large than 500+ that don't qualify under Families First Coronavirus Response Act?

Mrs. SLB is being told she needs to go in to work or else she's fired and will be denied unemployment benefits.    Neat company.
Two additional items:

1. Mrs. SLB had much needed back surgery last year.  Literally put it off for over a decade.  She used to gobble pain pills but dope fiends took that option away from her.  I think she had 6 slipped discs as well as stenosis.  I bring this up because she can't file  FMLA because she used all of her time 49 weeks ago.

2. We have been the primary caregivers for my parents.  Mom was diagnosed with lung cancer in the first week of March.  Half of her lung was removed last week.  She's on the mend but contracting COVID-19 would kill her within a day.  FWIW, neither of my parents are smokers.

3.  School is canceled for the year and we have kids in middle and HS.

My best guess is that these (I won't get banned, I won't get banned) "people" are using this as leverage to screw over employees.  Also, FWIW, she's a RN at an outpatient surgery facility.  All non-life threatening procedures but there would be doctors performing these operations that are also in area hospitals, there.   Hell, there would only be a couple of hours of work A WEEK. 

TIA

If anyone wants to do some bare knuckle boxing, I'm totally up for it. ;)

 
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MR A- I know you asked this of Ham, but let me take a shot at responding (not on his behalf, but just generally).

I understand your frustration and sympathize with your POV that some may not be fully appreciating the economic suffering of others who cannot easily work from home.  I also think you have raised very good points about needing different solutions...at different times...for different states/counties.  I also have read the federal guidelines for re-opening and my general conclusion is that they are pretty good: clear, gradual, focused and most importantly they IMPLY that this will take some time.  But here's where I disagree with you...and I think it will require me to state some assumptions that you may not agree with, not sure so let's check.  The purpose of the extensive stay-at-home orders was to:

  • ensure that our healthcare system was not over run in the near term
  • assess where we were impacted because lack of testing made us blind
  • buy us time time to: increase healthcare capacity (beds, PPE, vents, etc.), tamp down hot spots, and develop re-opening plans
I think you and I are in agreement on the above, but where we differ is:

  • you believe that "developing re-opening plans" means simply writing up guidelines like the federal ones released yesterday whereas
  • I (and I suspect many others) believe that wide-scale testing and contact tracing are key components of a re-opening plane EVEN for the least impacted and least densely populated parts of the country
So, is that the disagreement?  Is it that you believe that testing and tracing are NOT necessary in these (presumedly) lightly impacted areas?  Because I (and I suspect others) fear that without this tool that there is a decent chance (25%?) that the results 60 days from now will be FAR worse.  Alternatively, perhaps you believe that the 25% chance is greatly over-stated...or that the ability to "shut down any resurgence," regardless of the probability, is much higher than I believe.  That is, with the lack of testing, lack of seriousness I think some are taking, lack of realistic expectation-setting from these state and federal politicians for what re-opening means, and lon incubation period I have serious concerns that this is a steam train we won't see coming until it is on top of us.  That's why I am concerned about re-opening discussions with wide-scale testing and contact tracing.

Now, one thing that could get me to join your side is IF I was told that wide-sale testing (i.e. 1M+ tests per day, results within 24 hours) just isn't possible within the next 30 days.  If THAT is true then I'd probably agree that we need to go to war with the army we've got...and in this case that army doesn't include wide-scale testing.  Ok, I've rambled on but that's my POV and I think there is alot of agreement between us...I just wanted to probe for the specific points of disagreement as I don't think that has been very clearly expressed.  

Does that help?
The guidelines actually call for contact testing and robust general testing, but it lacks specifics. I imagine that's where governors will be left to fill in the blanks. It would be an easy way to justify opening early or later than appropriate. It's the biggest weakness of the guidelines.

I'll get more into testing when I have more time but all I'll say for now is that they don't have a very good track record. Too many false results to sit on our hands and do nothing. So while an ideal world we'd have mass testing ready to go, we simply cannot continue to sit at home. The numbers are manageable in many places based on hospitalizations, ICU capacity, etc. So while we continue to develop better tests, we take baby steps forward with strict regulations on the businesses allowed to reopen.

 
Dr Tennent asked a colleague to pass wind directly into two Petri dishes from a distance of five centimeters - first while wearing pants, and then without.
So much wrong with this...

- For those who don't know the metric system, 5 cm is roughly 2 inches.  If your nose and mouth are within 2 inches of someone's ###, you better be having sex.
- Why test without pants?  Do we have an outbreak of streakers I haven't heard about?
- The doctors colleague can fart on demand?  And how did the doctor measure the amount of each of the 2 farts?

 
The guidelines actually call for contact testing and robust general testing, but it lacks specifics. I imagine that's where governors will be left to fill in the blanks. It would be an easy way to justify opening early or later than appropriate. It's the biggest weakness of the guidelines.

I'll get more into testing when I have more time but all I'll say for now is that they don't have a very good track record. Too many false results to sit on our hands and do nothing. So while an ideal world we'd have mass testing ready to go, we simply cannot continue to sit at home. The numbers are manageable in many places based on hospitalizations, ICU capacity, etc. So while we continue to develop better tests, we take baby steps forward with strict regulations on the businesses allowed to reopen.
Not really - It says to open up phase one with enough testing for health care workers.  My biggest issue with the entire guidelines is that while it discusses testing and tracing, widespread testing and tracing aren't one of the metrics for opening stuff up.  

 
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I wonder how this will be handled city vs. state. NYC is currently trending much better than the overall statewide cases. There will be a lot more pressure to open up the city if the numbers warrant it.

 
Dr Tennent asked a colleague to pass wind directly into two Petri dishes from a distance of five centimeters - first while wearing pants, and then without.
So much wrong with this...

- For those who don't know the metric system, 5 cm is roughly 2 inches.  If your nose and mouth are within 2 inches of someone's ###, you better be having sex.
- Why test without pants?  Do we have an outbreak of streakers I haven't heard about?
- The doctors colleague can fart on demand?  And how did the doctor measure the amount of each of the 2 farts?
Dude... it's the Sun.

 
Not really - It says to open up phase one with enough testing for health care workers.  My biggest issue with the entire guidelines is that while it discusses testing and tracing, widespread testing and tracing aren't one of the metrics for opening stuff up.  
From the guidelines...

Robust testing program in place for at-risk healthcare workers, including emerging antibody testing

Ability to quickly set up safe and efficient screening and testing sites for symptomatic individuals and trace contacts of COVID+ results

Ability to test Syndromic/ILI-indicated persons for COVID and trace contacts of COVID+ results

Ensure sentinel surveillance sites are screening for asymptomatic cases and contacts for COVID+ results are traced (sites operate at locations that serve older individuals, lower-income Americans, racial minorities, and Native Americans)

Develop and implement policies and procedures for workforce contact tracing following employee COVID+ test.


All suggested before state's proceed to phase one, but as I said, lacking specifics.

 
FYI - 10 states have bottle/can deposits (CA, CT, HI, IA, ME, MA, MI, NY, OR, VT).  I just watched my (CT) Governor daily brief, and he was asked why we are still paying a deposit, because no stores are allowing you to redeem.  He smiled, then passed the question down to one of his lackey's.  The lackey said that stores can still allow you to redeem, and since it is optional, the deposit remains.  What a crock!  Stores hate redeeming, and now they don't have to.

 
From the guidelines...

All suggested before state's proceed to phase one, but as I said, lacking specifics.
See the 2nd slide in link - Gating items don't cover testing for anyone other than healthcare workers.  So you can move to open up without testing and tracing.  I don't really want to get to in depth on on the good and bad of this plan here as feel like it is more PSF stuff but just to be clear the plan as presented is not widespread testing and tracing before opening up.  Hope that isn't too political as I am just conveying what plan says.  

https://context-cdn.washingtonpost.com/notes/prod/default/documents/f70115f7-a330-49d8-b0a9-ff6b3ce56ae1/note/8cb9b5df-b98d-4382-a7e8-9ca2fa6c9038.#page=1

 
FYI - 10 states have bottle/can deposits (CA, CT, HI, IA, ME, MA, MI, NY, OR, VT).  I just watched my (CT) Governor daily brief, and he was asked why we are still paying a deposit, because no stores are allowing you to redeem.  He smiled, then passed the question down to one of his lackey's.  The lackey said that stores can still allow you to redeem, and since it is optional, the deposit remains.  What a crock!  Stores hate redeeming, and now they don't have to.
My local beer distributor (NYC) only allowed returns for people who purchased at first but has now opened back up to all, including those that roam the street picking up empties. They have a huge deposit operation there.

 
Am pretty sure that my neighbor across the street has the virus. Around noon today, an emergency vehicle pulled up, the EMT's went to the front door. It was opened by the husband in a white, head to toe outfit and what appeared to be a full fledged gas mask. He brought out his wife who was leaning on him pretty heavily and was wearing the the same white outfit and a regular cloth face mask. She was lead into the vehicle on a stretcher and they pulled away all within 10 minutes or so. It was painful to see the husband wave through the vehicle window as it left. He turned around and went back into the house because he is not able to accompany her to the hospital.

Man, that would suck. Hadn't really thought about that aspect of it until I saw it in real life. To be in that position, not knowing if you are ever going to see your loved one again. You would feel so helpless. Damn....

 
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Was pretty sure that my neighbor across the street has the virus. Around noon today, an emergency vehicle pulled up, the EMT's went to the front door. It was opened by the husband in a white, head to toe outfit and what appeared to be a full fledged gas mask. He brought out his wife who was leaning on him pretty heavily who was wearing the the same white outfit and a regular cloth face mask. She was lead into the vehicle on a stretcher and they pulled away all within 10 minutes or so. It was painful to see the husband wave through the vehicle window as it left. He turned around and went back into the house because he is not able to accompany her to the hospital.

Man, that would suck. Hadn't really thought about that aspect of it until I saw it in real life. To be in that position, not knowing if you are ever going to see your loved one again. You would feel so helpless. Damn....
one of the saddest things about this is people being hospitalized alone.

 
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