California sets Covid-19 daily record, Bay Area cumulative total passes 20k

https://www.eastbaytimes.com/2020/06/23/coronavirus-california-sets-another-daily-record-as-bay-area-surges-past-20000-cases/

by MilnerRoute • 6 years ago

158 391 6 years ago

eastbaytimes.com

blakesterz• 6 years ago

"The number of deaths per day and hospitalized patients, however, has remained flat for weeks, down from their peaks in mid-April. That is beginning to change, as hospitalization levels creep back up. Gov. Gavin Newsom said on Monday that hospitalizations had increased 16% in the past two weeks."

I always thought, based on what I've read/heard, that one of the big reasons, maybe the biggest reason we're doing all this is to flatten the curb so hospitals don't get overwhelmed. For some reason headlines always seem to be number of cases or positive test results, and maybe then the number in the hospital is mentioned. The article does say "hospitalization and deaths are also believed to be a lagging indicator." so maybe that's why, but I don't get why (from what I've seen) hospitalizations don't seem to be all that important when reporting on COVID numbers in general. Could it be the people getting the virus now are less likely to end up in the hospital so that number won't keep going up to the point of causing trouble? Another headline on the site says "17+ students test positive for COVID-19 after beach trip".

danhak• 6 years ago

Of course cases will go up as testing becomes more widespread. As you point out, headlines mention case numbers as those are the high, eye-catching numbers. The more important numbers to watch are positivity and hospitalization, which are starting to tick up after several flat weeks.

taborj2• 6 years ago

This article goes so far as to flirt with the testing numbers without actually siting them. I really don't see what's so hard for news outlets to throw the total number of tests alongside the total number of positive results.

kop3163• 6 years ago

I always thought, based on what I've read/heard, that one of the big reasons, maybe the biggest reason we're doing all this is to flatten the curb so hospitals don't get overwhelmed.

This was my understanding as well, and it is what is shown in Wikipedia:

https://en.wikipedia.org/wiki/Flatten_the_curve

The bigger thing that I have chatted about with several other is that the area under the curve is the same, i.e. the same amount of inidividuals will still get sick.

snug• 6 years ago

Exactly this, in fact we did such a good job, that people who were sick for other reasons didn't seek medical help and health care professionals have been laid off

https://calmatters.org/health/coronavirus/2020/05/health-car...

zzleeper• 6 years ago

afaik not true; google for "epidemic overshoot"

marvin• 6 years ago

If everyone gets vaccinated a year from now, the total area under the curve will be lower if it's spread out over a long time than if everyone got sick before the vaccine became available.

bluGill3• 6 years ago

The area under the curve need not be the same though. There are many things that can change the area under the curve. A vaccine is an obvious one, once one hits the area doesn't change, so the less there is the better. (ecconmics can debate how much we should have reopened after that) the virus could also mutate and affect everyone again thus increasing the area.

I have never been able flattening the curve. If people would just stay home for a month and take precautions this would be over as it wouldn't spread and those who have it get over it. The details of living like that are tricky but too many people didn't try.

tunesmith11• 6 years ago

I am amazed at how many people repeat the point about the area under the curve being the same. It's just completely irrelevant unless we believe that we will make no medical advancements.

You flatten the curve to buy time for medical advancements, which will reduce the total area under the curve. It can be any or all of:

1) flattening the curve enough to make contact tracing viable, which can eradicate breakouts before they take hold

2) finding a decent anti-viral treatment so that number of deaths or "permanent damage" cases decrease, even if # of cases does not

3) developing a vaccine

This thing about "area under the curve remaining the same" is only true for calculus, it has no bearing on real life because we are making medical advances.

Leherenn• 6 years ago

I don't know, look at Europe, quite a few places have managed to do quite a bit more than flattening the curve. At the current rate, reaching even 50% of the population would take decades, hopefully there will be a vaccine well before them.

djohnston• 6 years ago

Gotta get those clicks

mikeyouse2• 6 years ago

I love how reporting on the increasing number of cases in a pandemic that has caused over 120,000 American deaths can somehow be "for the clicks".

devalgo4• 6 years ago

Flatten the curve was meant to spread the infections across time to decrease stress on the healthcare system. Our lockdown was ineffectual because of lax enforcement and the public's apathy. So it achieved none of its goals. Places like Italy, Spain, New Zealand have "won" against the virus using lockdowns and are now on track to be back to normal. In NZs case they are already back to normal. Without another lockdown it's almost assured at this point that we will reach the breaking point of our healthcare system. It's inevitable unless a miracle vaccine arrives very soon.

rlt2• 6 years ago

But... we did flatten the curve enough to avoid overwhelming the healthcare system. To suggest it wasn't enough now is moving the goalposts.

nepthar• 6 years ago

Without another lockdown it's almost assured at this point that we will reach the breaking point of our healthcare system. It's inevitable unless a miracle vaccine arrives very soon.

What sources of information lead you to this conclusion?

DiogenesKynikos2• 6 years ago

we're doing all this is to flatten the curb

Different people have different goals.

One goal would be to reduce the rate of new infections to a level that hospitals can handle.

A different strategy is to reduce the rate of new infections to a much lower level, so that contact tracing and containment is possible, and then open things back up.

If a vaccine is available at some point in the next year, the latter strategy saves many lives. It requires a sharp, relatively short (4-6 weeks) shutdown. Afterwards, it requires a high level of testing, quarantine for infected people, widespread use of fever checks in public places, a ban on large events, and extensive contact tracing. Many countries have now successfully deployed this strategy.

The US is stuck in limbo. Some states locked down hard, others didn't lock down enough. Things opened up too quickly, without the systems in place to contain the epidemic, and people are largely acting as if SARS-CoV-2 didn't exist any more. The consequence is that new infections never went down to a level where contact tracing is possible, and the rate of new infections is on the rise again.

SpicyLemonZest4• 6 years ago

Different people have different goals, but it's pointless to measure California's status against goals it's not trying to meet.

parliament322• 6 years ago

widespread use of fever checks

I've never understood this fascination with fever checks. I've never had a fever where I couldn't tell I had a fever -- everyone with a fever perfectly well knows they have a fever. The problem is people trying to hide it, I guess? And if they suppress it with medication, your forehead scanner will be useless anyway.

The solution for that is to make quarantine less painful. Here's a list of grocery delivery services, here's a guarantee your employer can't punish you for taking time off work, here's a nursing service that'll call you to check in daily, etc. Enjoy your vacation.

dehrmann3• 6 years ago

The US is stuck in limbo. Some states locked down hard, others didn't lock down enough.

Umm, I think you mean the world. the nordics can't decide what do do with Sweden. New Zealand will be perpetually close to zero cases, but be sealed off from the world. Obviously US/Brazil tourism is good to go.

Some states locked down hard, others didn't lock down enough.

On the world scale, India locked down hard, but failed because arguably, the hard lockdown created more problems. I think Sweden had fewer cases per capita at the peak than the UK, despite avoiding a formal lockdown, but Norway had even fewer. A lot of factors you'd think would be meaningful haven't been, and the ones we're left with is developed East-Asian countries did OK, isolated developed countries did OK, countries lead by populists haven't done so well, and North Korea still claims to have zero cases.

pbreit4• 6 years ago

The obsession with total cases is maddening. First, they are driven significantly by amount of testing. Secondly, whether they lead to complications is significantly impacted by age and health. The recent article routinely fail to acknowledge that age of infection has fallen drastically (from 65 to 35 in Florida, for example). The people getting infected now, the out-and-abouters, are much, much lower risk of complications. Which is why death rates continue down (lowest in US since March).

buhhh3• 6 years ago

The obsession with total cases is maddening. First, they are driven significantly by amount of testing.

I think more significantly they're driven by total cases. Are you suggesting we test less?

Also you seem to have a very black and white view of outcomes. It's not clear cut between alive or dead. There's many things that we still don't know about this virus and the harm it causes. https://www.bbc.com/future/article/20200622-the-long-term-ef...

sandworm101• 6 years ago

> First, they are driven significantly by amount of testing.

That depends which numbers you follow. "Cases" is different than "clinical cases". A clinical case will show some sort of symptom. While asymptomatic spread is almost certainly a thing, symptomatic patients spread much more readily than asymptomatic. So rather than look only a total cases, look for data on clinical cases because those are the ones that are most likely to spread to others. That will normally be patients under treatment rather than the larger number of people who have tested positive, show no real symptoms, and are sitting at home waiting for another test.

HarryHirsch3• 6 years ago

On the contrary, one should absolutely be concerned about the number of total cases. In ~ 15 % of cases the convalescence period is greater than a month, and there is reason to be concerned about CFS in recovered patients. With SARS, the incidence of CFS was 40 %!.

If you aren't sufficiently worried, John Campbell has a video about the clinical presentation: https://www.youtube.com/watch?v=U7BbXEOB1gk

ashtonkem3• 6 years ago

When the total number of positive tests and the percentage of tests that are positive both rise, that implies that the issue is not driven by the amount of testing, and in fact you’re seeing community spread.

godshatter• 6 years ago

I've been watching the number of deaths (although it's a morbid way of looking at it), too. If the number of cases goes up but after a suitable lag time and the number of deaths doesn't, then we are likely just uncovering more people who had it through more thorough testing. If the number of deaths rises, then it's not just that we're testing more - it's spreading more.

The logic behind this is that people are going to the hospital whether or not they have been tested, they are not going to stay away because they haven't been. I don't have easy access to numbers of hospitalized patients, so I watch the number of deaths. Right now they have been flattening out or decreasing, as you pointed out. When that changes I'll get worried more. In either case, I am playing it safe by social distancing and wearing my mask and reducing the amount of time I'm in the office.

enraged_camel• 6 years ago

Hospitalizations have also been rapidly increasing. Houston hospitals expect 100% ICU usage in less than two weeks.

kgwgk5• 6 years ago

First, they are driven significantly by amount of testing.

But that's not the only driver. And when you increase testing and the percentage of positives you find goes up from 5% to 20% (as it's happening in some states) instead of going down you really have a problem.

The people getting infected now, the out-and-abouters, are much, much lower risk of complications.

But the people that will now be infected by them (relatives, coworkers, customers) will be closer to the general population and have higher risk.

codyswann• 6 years ago

That's weird. To me, it makes perfect sense to horse-race total case percentage increase.

Young people are generally on the front lines now. Both voluntarily through outings, bars, etc, and front-line jobs, so they are a leading indicator that "things are getting worse."

And while that doesn't guarantee that most "at risk" people will get sick and require hospitalization, it's a safe assumption that the probability of that occurring is increasing.

It's the same reason you get a mole checked out. Might be nothing now, but it could be something much worse in the near future.

kaitai6• 6 years ago

The number of cases has nothing to do with the amount of testing!

The number of reported or confirmed cases is correlated with testing.

That's a significantly different statement, and also tautological and essentially vacuous.

Average time to death after confirmation of disease is around 13 days, so the death rate today has essentially nothing to do with the number of cases confirmed today. The death rate today has a lot to do with the number of cases confirmed a few weeks ago.

One of the reasons the US is doing so incredibly poorly is the incredible sloppiness of the analyses in so much of the media. I don't know if it's willful -- an attempt to pretend that nature will bend to political delusion -- or if it's simple innumeracy.

Izkata• 6 years ago

First, they are driven significantly by amount of testing.

Daily case numbers in Illinois, at least, have no correlation with the increase in testing. I'm certain all we've found with the extra tests is people who never had it.

chiefalchemist• 6 years ago

Yes, flatten the curve is to prevent chaos. In that context, total cases is close to meaningless. Active case would be a far better metric. Cases that have "completed the process" have no value - other than fear-mongering.

Then you break active cases down by area (read: hospital) and carrier profile (e.g., age, pre-existing conditions, etc.). The point is, not everyone who tests positive is high risk. Not everyone who shows symptons will end up at hospital. Not everyone who ends up at hospital will need a ventilator. And so on.

As it is, this whole event has been a text book case of how not to use data and statistics properly.

sesuximo• 6 years ago

Will be interesting to see what happens in the next two weeks. Certainly most places have handled the bumps well so far, but some have not e.g. Texas hospitalizations are up

tunesmith11• 6 years ago

They say a 28-day lag between infection and death. So I'm curious about the last two weeks of July, if we'll have more deaths in that period than we've had over the last two weeks. I currently suspect we will, but I've been wrong about the south before.

rsynnott2• 6 years ago

but I don't get why (from what I've seen) hospitalizations don't seem to be all that important when reporting on COVID numbers in general.

To an extent, by the time the hospital numbers are going up sharply, it's too late, and the hospitals will inevitably be overwhelmed, so it's not a good guide of policy. New case count is the only vaguely timely indicator we have.

catawbasam3• 6 years ago

"inevitably be overwhelmed" now looks less likely than it did in March. There is less use of ventilators and ICU usage has been less than initially anticipated.

ccktlmazeltov6• 6 years ago

Exactly, if we want to achieve herd immunity then increasing the number of infected is a goal we want to achieve, keeping hospitalization levels steady is needed to not increase the amount of death (covid related or not).

SomeoneFromCA7• 6 years ago

Never understood the point of herd immunity through deliberate infection with a potentially deadly disorder. I mean what the point of getting sick now, instead of later. I can kinda get a point that second could be potentially deadlier, but what if it never happens? SARS-CoV from 2003 never gave a second wave.

jogjayr• 6 years ago

Even though I'm young and relatively healthy, I'm not interested in acquiring the virus in the service of "herd immunity". Especially after hearing reports of it causing lung and organ damage even in asymptomatic patients. Please count me out.

adamjcook• 6 years ago

maybe the biggest reason we're doing all this is to flatten the curb so hospitals don't get overwhelmed.

I think the other, possibly just as important, reason to lower the infection count is that medical professionals are yet unsure of the long-term, chronic health impacts of this disease and that there appear to be some preliminary signs of significant respiratory and pulmonary issues that can effect many age groups - perhaps even in those not necessarily requiring hospitalization.

It would appear that medical science has a few additional treatments in their toolbox now (as compared to, say, March or April) that lower the severity of the disease and helps prevent death in some populations, but still, many concerning unknowns remain.

At least that is what I have seen here and there from several medical professionals that I have seen on Twitter over the past few weeks...

erik_seaberg• 6 years ago

They say any vaccine would take at least a year, and I don't think we have the fear and determination to protect the majority from this for so long.

vmception• 6 years ago

COVID Articles start with a random selection of cases, tests or deaths over a random selection of time frames and areas.

Then halfway through the article it randomly changes to a different combination of cases, tests or deaths or a different time frame and different larger or smaller area.

And then finally it switches again, but about a totally different country or worldwide statistics.

Now you can procedurally generate multiple articles all day!

"Wow engagement is so high", said the Product Manager. "Our KPIs are through the roof, keep doing more of that our customers must love us."

logicNSci• 6 years ago

There was an NYT article saying ventilators only give a 12% additional survival rate. This is the service hospitals provide.

Sure oxygen can be given at a hospital, but if we are overwhelmed, you can easily do oxygen at home.

Anyone have a different understanding?

pas• 6 years ago

My understanding is that just the most severe cases are put on ventilation, and understandably alas a lot of those people die. But the overall effectiveness of intensive care and general hospitalization is likely much higher, but I haven't seen a chart about this.

jhayward• 6 years ago

There are many more therapies than just oxygen that hospitalized patients receive. Lots of monitoring of e.g., blood values that indicate stress on one organ or another, or danger of crisis due to many different processes. Drug therapy and supportive treatments are varied in response to those.

It's not as simple as "welcome to Wendy's, would you like the oxygen today, or can we supersize you to a ventilator?"

jschwartzi• 6 years ago

I'm not sure what you're arguing for here.

There's a very short period of time between when a patient starts drowning in their own fluids and when they die. So you need to be oxygenating in a clinical setting because you need people immediately available to intubate in case your oxygenated patient starts drowning in their own fluids, which they do often. That's why it confers a 12% survival rate. If you've progressed to the point where supplemental oxygen doesn't work then you're pretty close to dying. I'll take 12% over 0% any day of the week.

As always you should look past the statistics to what actually needs to happen in those situations. Statistics provide very little assistance in determining whether an individual patient needs to be hospitalized or not. You can't look at someone and go "oh this guy is one of the X% that will eventually need a ventilator." You have to assume that any one patient that needs supplemental oxygen may be one of that X%.

So sending people home with supplemental oxygen should be a last-ditch effort if the hospitals become completely overwhelmed, not a routine activity. And to facilitate that, we should absolutely be trying to keep people from getting sick so our hospitals remain open for the unavoidable cases.

glofish15• 6 years ago

the stat that I read was that 86% of people put on ventilators die

as for those that survive - most have serious breathing problems for the rest of their lives -

https://www.webmd.com/lung/news/20200415/ventilators-helping...

dillondoyle3• 6 years ago

Lots of strokes and other complications that can only be treated in a hospital. I haven't seen data on successful intervention there though (or maybe that it overlaps largely with the already low survivability).

kaitai6• 6 years ago

Cardiac arrest is a significant "side effect" of COVID-19, leading to death. Hospitals are better equipped for that.

Kidney problems are popping up in some folks post-infection; that's also better dealt with in a hospital.

baxtr2• 6 years ago

Great observation. I see the same pattern in other countries, too. One reason for this I believe is the lack of “goal clarity”. What’s the goal we’re aiming for? I see several options:

1) we want to eradicate the virus from our population => total cases matter and should be 0 sometime soon, I think that was and is China’s goal

2) we don’t try to eradicate the virus, but we want to keep the stress on the health system manageable => total cases don’t matter that much, bed capacity is the relevant indicator. This seems to be the goal of the “flatten the curve” thinking

3) we don’t care that much, let the virus spread like wildfire so we will have herd immunity asap => I am not sure, but from outside it seems like Brazil is trying to do this

I think the reason you and I are confused is because it’s seems to be unclear if we are trying to achieve 1) or 2). It’s not communicated. Maybe it’s unclear to policy makers, too.

kelnos• 6 years ago

I think the goal a couple/few months ago was #2, but in the meantime we've learned that there might be some bad long-term consequences to contracting the disease that weren't previously known, like possible permanent respiratory damage.

Without that, then we shouldn't be too worried about getting the disease as long as we keep transmission rates low enough so hospitals don't get overwhelmed. But if some people end up with long-term respiratory issues after contracting the disease, now there's a reason to keep people from getting it, period, regardless of hospital capacity.

But it would be nice to hear these goals actually articulated by public health officials. I'm not sure if my above paragraph is actually what any public health officials are thinking or are worried about (I'm just guessing), but it would be nice to know, because I agree with you that there seems to be a lack of "goal clarity" at this point.

ganafagol• 6 years ago

I think it's a mix between 1 and 2. Eradication is unrealistic. But the optimum is _not_ the point where every last hospital bed is used. It's where the balance between lockdown and infections is the most societally acceptable.

That is, we want to minimize infections, just not at all costs (to society/economy/...). And similarly, we want to minimize impact on society/economy/..., just not at all cost (to health).

Keep in mind that every infection bears a risk for long time health impact or short term (death), no matter if a hospital bed is available or not.

Finding this compromise is a matter of opinion and therefore a political question. It's not as easy and black-and-white to formulate as it would be to say whether we do 1 or 2.

dvirsky2• 6 years ago

It looks like policy makers are sort of starting to work under the assumption that a vaccine is around the corner (the plan AFAIK is if all goes well to start around October in the US). Assuming that's correct, I guess the goal is/should be somewhere between 1 and 2. Keep as few people as possible from getting it for a few more months, while not collapsing society/economy completely.

throwawaygh5• 6 years ago

I think a lot of countries do have clarity.

The USA definitely does not. I'm starting to wonder if "not knowing what we want" will be the root cause for the end of American hegemony.

We entered 2 wars without clarity on what it would mean to win. This was the #1 post-mortem on Iraq and Afghanistan from basically every general involved over 15 years: they never had mission clarity.

On the back of that tough lesson, we immediately entered a trade war with zero clarity on what it would mean to win.

And before we could learn the lesson a third time we're now up against a pandemic and apparently can't decide what it means for us to win.

I'm starting to wonder if "not knowing what you want" is even worse than wanting something dumb.

Tempest1981• 6 years ago

I feel bad that we're putting a continuous load + risk on US healthcare workers, 3+ months and counting.

They probably expected to see light at the end of the tunnel last month, like other countries. Now, maybe next year?

somerandomness• 6 years ago

It’s definitely 2 for most western countries

siruncledrew• 6 years ago

When I think about the vaccine side, I still wonder how long that will take. I don’t know how it works, will there just be almost immediate economies of scale to vaccinate people?

If vaccines will also be available in ‘waves’ as they are produced, then that must mean testing is some kind of a prerequisite to know who to give the vaccine to that needs it most - and who also may already be immune from exposure?

It seems like the total cases —> 0 option is virtually unattainable in the near term (probably into 2021). Maybe with more cases being reported, we are aiming for 2) but actually going through 3).

dehrmann3• 6 years ago

I think that was and is China’s goal

I agree, and with the recent outbreak, I don't think it's possible, at least not for China. New Zealand has a shot at it.

lucideer• 6 years ago

Maybe it’s unclear to policy makers, too.

I think rather than it being "unclear" to policy makers, it's rather that there's a short-term economic imperative to go for 3), or if not, then 2), while 1) upfronts economic cost. This means that while the general desire might be to go for 1) from an ethical/expert/academic-advice perspective, policy makers are doing their best to hedge (while not wanting to appear as if they are).

Farox• 6 years ago

In Germany its 50 cases per 100'000 in a borough. After that lock downs are supposed to happen again. (with discretion, if, for example, cases can be isolated)

What other country do you think of that doesn't have clarity?

reaperducer2• 6 years ago

For some reason headlines always seem to be number of cases or positive test results, and maybe then the number in the hospital is mentioned

The problem is that in a lot of places, the information about hospital use isn't available, isn't timely, or isn't reliable.

Hospital owners and their lobbying groups have blocked some states and county health departments from reporting such information, claiming it's "proprietary information."

One of the Las Vegas newspapers had a series of articles about it. The hospital lobbying group actually somehow "prohibited" the state from releasing the information, as if hospitals have some kind of authority over the government.

_7fvc• 6 years ago

Hospitalized Increase is being tracked. The good news is it hasn't increased with positive cases. That is likely because the younger infected cases.

https://vida.io/dashboards/ckbk04mht00000ul63lr6m53w

kaitai6• 6 years ago

I think it's purely a media thing. When the public health folks I know have been modeling, they've been modeling with a primary eye toward number of ICU beds needed and number of ventilators needed. For instance if you look at https://mn.gov/covid19/data/modeling/index.jsp which has a pretty decent model (on Github at https://github.com/MN-COVID19-Model) you can see all their pdf slides predict peak infection, number of ICUs/vents needed, and then mortality. But that's not what gets headlines, as you observe.

It is certainly true that survival rates have improved as treatments have changed based on experience. I think folks know better how to manage things at home, to some extent. Earlier testing also allows earlier intervention, which allows treatment that may avoid ventilator usage. Vent usage corresponds with pretty poor outcomes, although that too is improving.

newacct583• 6 years ago

Could it be the people getting the virus now are less likely to end up in the hospital so that number won't keep going up to the point of causing trouble?

It could. Or it could be simply getting out of control (though specifically California is in much less trouble than Texas, Florida or especially Arizona at the moment). The point is that (1) it's fundamentally impossible to tell the difference until the bodies are counted and (2) the boundary between "well under capacity, we're fine" and "well over capacity, tens of thousands needlessly dead" represents just a week or two of growth.

We don't have time to wait and see, we need an answer now. And we can't get it until the demographics is done postmortem. So what is supposed to happen is that we all behave conservatively until the outbreak shrinks to the point where it can be contained via contact tracing.

And... that almost worked. It worked in Asia and Europe, It almost worked here, at least in the hardest hit areas with the early outbreaks. But... it didn't take. Half the population decided they didn't need to bother with this stuff (largely because of reasoning like yours) and walked back into enclosed indoor spaces.

And now we're right back where we were in March. Effectively no progress. While the rest of the industrialized world is finishing this off and coming back to life, we're having to talk about new lockdowns. It's so deeply frustrating.

SpicyLemonZest4• 6 years ago

You have a mistaken perception of what the rest of the industrialized world is doing. South Korea is talking about new lockdowns, China has imposed them, and much of Europe still hasn't really opened up. Only a very few countries believe they're "finishing this off".

gonehome• 6 years ago

I live in Palo Alto - last weekend I cycled past some sort of art festival in downtown Los Altos.

There were hundreds of people packed together looking at and touching art.

There was a big sign that 'we'd get through this together'.

They're also opening up farmers markets.

I think we're going to see the number of cases rise again.

jeffbee2• 6 years ago

Farmers' markets never closed here in Alameda County which is a lot more densely populated than Los Altos. I think the risk of transmitting respiratory diseases in the outdoors is wildly overstated. Also, people gotta eat.

SomeoneFromCA7• 6 years ago

Nah, it is not overstated. Last time I checked, Wuhan marke was outdoors.

tingletech• 6 years ago

Farmer's markets have been open the whole time in Alameda county.

tylersmith• 6 years ago

When people move from more isolation toward more interaction cases of all communicable diseases should rise so I think that's a safe assumption.

spike021• 6 years ago

They're also opening up farmers markets.

The one near me in downtown San Jose just re-opened a couple of weeks ago. I walked through to see what it was like. Not too bad, they require masks for patrons and also the people working the vendor stalls. Also, customers aren't allowed to touch produce at all and contactless payment is preferred.

So all of that looked relatively decent. My issue was I would see patrons walking around or about to pay and they'd be lowering their mask to talk, not covering their nose with the mask, wearing their mask on their neck, etc.

I'm not sure how to correct issues like that.

chillacy• 6 years ago

Supposedly if it's outside it's not as bad: https://www.youtube.com/watch?v=n6QwnzbRUyA

kpennell4• 6 years ago

Given that there hasn't been a bump from the protests, it seems like outdoor spread is not super common.

ping_pong• 6 years ago

Incorrect, the bump we are seeing now looks like it perfectly correlates to the protest. The initial spread you would see in the beginning few weeks wouldn't be noticeable, but it's laying the seeds. It's about 4-6 weeks after we see the effects of those early sees from exponential growth.

anonymousiam• 6 years ago

How many are symptomatic?

buhhh3• 6 years ago

asymptomatic =/= free of harm caused by the virus

matz14• 6 years ago

ok then how many are positive but free or minimal of harm caused by the virus ?

jiveturkey2• 6 years ago

The question was 'symptomatic'.

Lest you think it's a typo, the number of symptomatic tests is a critical number to know.

It's not about whether the individuals beings tested have been harmed, it's about whether testing shows us the infection rate in the population or not. If 100% of tests were of symptomatic patients, the numbers tell us almost nothing.

kpennell4• 6 years ago

In some Italian villages that tested extensively, they found 50-70% asymptomatic

https://www.cebm.net/covid-19/covid-19-what-proportion-are-a...

babesh• 6 years ago

It is spreading fast amongst the Latino population and more slowly amongst other populations. In SF, Latinos are over 50% of the cases now. In San Mateo, it is closing in on 50% of the cases as well.

A couple of weeks ago, the number of Latino cases in San Mateo was about the same as the Asian and white groups. It is now over triple.

https://data.sfgov.org/stories/s/fjki-2fab

https://www.smchealth.org/san-mateo-county-covid-19-and-othe...

sandeeps_• 6 years ago

why is the latino population seeing large number of cases?

rabidrat• 6 years ago

I would venture, insular communities and bad luck. Maybe also something to do with cultural mores around visiting family when sick, or insufficient "how to mask/distance/etc" materials in Spanish.

I think it's like Gay-Related Immune Deficiency (GRID, before it was AIDS). There's no inherent reason that it showed up predominantly in the gay male population, except a) the first superspreader was a gay airline steward (so he had lots of contacts with the gay community all over the country), and b) gay men were enjoying the fruits of their sexual revolution.

If you think about it, monogamy is basically an extreme form of "sexual distancing", and so a non-monogamous community is much more likely to have an outbreak of an STD. Other non-monogamous communities heavily promote wearing masks (condoms), but as this had been viewed primarily as a way to prevent pregnancy, the gay community did not think it was necessary.

kpennell4• 6 years ago

In SF, I've heard that a good percentage of the latin population will share rent-controlled places 12 to a room. I think it's more common they are living in tight quarters.

asdff• 6 years ago

Overcrowding. Multiple families sharing apartments is typical of low income areas in CA.

wrycoder4• 6 years ago

It's almost like it's spilling over from Mexico into Texas, New Mexico, Arizona, and S California, and moving north from LA.

Many outlying areas of Mexico appear to be out of control. Chihuahua, for example, has a 21% fatality rate.

wrycoder4• 6 years ago

“Part of what’s driving the soaring case loads in Imperial County is the influx of positive patients from Mexico. State officials say they’re primarily US citizens, hundreds of thousands of whom live in neighboring Baja, crossing back in search of superior health care.

The county has by far the state’s highest case numbers on a per capita basis, 3,414 per 100,000, as well as a positivity rate for tests that’s more than four times the state average.“

https://www.technologyreview.com/2020/06/30/1004696/theres-n...

lxe• 6 years ago

I'm wondering if this can be attributed to large gatherings associated with protests and demonstrations as well as the "reopening" that's currently on-going?

ruddct• 6 years ago

Re: protests, NYC has had large, extremely dense protests for weeks now. Mask compliance is near 100% at them, and testing is easy, ubiquitous and free. We have not seen a spike in cases.

SomeoneFromCA7• 6 years ago

Masks are only partially efficient. There is actually a spike all over US. The issue of protests is political, and no one wants to kick the wasps nest, because Republicans want unsafe Trump rallies to keep going.

pmoriarty• 6 years ago

Don't count your chickens before they hatch.

It can take weeks after infection to start showing symptoms, weeks more to be sick enough to need hospitalization, weeks after that to die.

These days, many people won't even go to hospitals, even when they're dying, and when they die at home they may never be tested for the virus at all, so won't necessarily be counted as having died from COVID-19.

The direct repercussions of the highly irresponsible mass gatherings that have been taking place over the last few weeks may not be evident for some time.

All this doesn't even take in to account all the people who did not attend any gathering but got infected by someone who did, and yet further infections from the first-order indirect infections, and so on.

Those later, indirect cases (which will still be the result of infections spread during these gatherings) will take even longer to be noticed.

jrnichols• 6 years ago

mysteriously, the protests seem to be completely absent in the reporting. (yes, I'm aware of mask usage) it's blamed on Memorial Day gatherings, graduation parties, etc. or primary voting in Wisconsin.. which did not lead to a spike, and did not lead to a bunch of deaths.

The numbers are crazy in some areas, not in others. Texas has 254 counties, and probably 200 of those counties have had less than 75 cases each. many of them have reported 0 cases, and 0 covid-19 related deaths. Even some of the counties around Dallas are doing just fine.

This whole thing is bizarre.

If masks work this well and protesters aren't spiking, I'm not really seeing a good case for allowing more fans at outdoor sporting events.

ls612• 6 years ago

In Minneapolis cases and hospitalizations have been trending down(!) ever since Memorial Day when this all started. To the point that hospitalizations are about half of what they were then. So it can’t just be the protests.

ccktlmazeltov6• 6 years ago

I just want to point out that the government has not clearly outlined its strategy, and the reason is that the end-goal is to reach herd immunity in 12-18 month. Infections are OK, what's not OK is too-high rates of hospitalization which leads to death that can be prevented.

gregwebs2• 6 years ago

A lot of commenters here are stating that this is because of increased testing. Which is true compared to April. But I want to point out that at least in southern Callifornia the positive test percentage is actually going up now. https://www.sfchronicle.com/bayarea/article/6-000-plus-Calif...

gregwebs2• 6 years ago

There are a lot of comments here essentially saying this is not a problem an we are properly reaching herd immunity.

I am wondering if these commenters are discounting the possibility of a vaccine? There is a strong possibility that we will have a vaccine before we can safely reach herd immunity.

matz14• 6 years ago

Not a problem in the sense that, tested positive doesn't mean you are sick, tested positive doesn't mean you are having severe symptom.

nradov3• 6 years ago

The timing and effectiveness of a potential vaccine are still unknown. Hopefully some of the vaccines being tested now will work, but it's quite possible that all will prove to be ineffective or unsafe. So from a public policy standpoint we have to proceed on the assumption that a vaccine isn't going to save us.

tunesmith11• 6 years ago

Natural herd immunity is a non-starter anyway. If we reach herd immunity before a vaccine arrives, the economic damage would be far worse than any shutdown. If the R0 is 5.7, you need 82.5% (4.7/5.7) of the population either immune or quarantined/locked-down. If everyone stops the lockdown, that means 82.5% of the population infected. No matter how much we want to argue down the IFR, that's catastrophic.

Semi-related note, I think we haven't properly socialized the basic numbers behind the disease. I hear that Covid-19 is more contagious than first thought, with a "natural" R0 of 5.7. I also hear that it has a doubling time of around three days, originally thought to be more like 5-6. I also hear that the contagion period is 8-10 days. These three numbers do not make sense together. The R0 number needs to be reached during the contagion period. The average contagion period is likely far longer, or, it's way more contagious than 5.7 (which would mean the herd immunity threshold goes higher).

Also, if the illness is more contagious than we first thought, it means that the lockdown was even more effective than we first thought.

Here's a fun mental exercise for whoever's reading this. Say that you have a bubble of 100 people, and released a disease that infected 50 people and killed all of them; 100% fatality. Then say you discovered that it actually infected all 100 people, but only 50% of them died. Is the disease less dangerous than you first thought?

wrycoder4• 6 years ago

The US is at 121K deaths atm. I made an estimate a while back assuming 60% of the population becomes infected and came up with 350K deaths. Bad, but not catastrophic. And I don't think we will get that high.

logicchains• 6 years ago

the economic damage would be far worse than any shutdown.

Any evidence for this? Singapore has 35k recovered and just 26 deaths, because the vast majority of infections are working-age migrants. A disease that kills less than 1/1000 working age people is not going to have a big effect on the economy.

mrfusion2• 6 years ago

In other news .. https://outkick.com/media-ignores-90-coronavirus-death-colla...

user_501238902• 6 years ago

Coronavirus deaths lag new cases by about 3 weeks

jeffdavis4• 6 years ago

But it seems like a decline in deaths marks the end of a "wave", which is a good thing.

We could face another wave, which of course would be bad. Lockdown fatigue and protests could easily bring it back. But if we've brought one wave under control, at least we know what it takes to do it and we can try to react a little faster for the next one.

subsubzero3• 6 years ago

Good article, reading the news the past few months makes it seem like the apocalypse had landed in the US and we are faring worse off than any other nation on the planet wrt covid-19. The reality is quite different, this article from the economist states such[1]*stats taken from May 27th:

"But seven EU countries (including Belgium, France, Italy, the Netherlands and Spain) currently rank above America in their mortality rate. So does Britain, where the official rate is a shocking 559 per million"

[1] https://beta.trimread.com/articles/22723.

elsonrodriguez2• 6 years ago

In other news social distancing caused a dip in deaths, so we should all go mingle again so we can cause a rise in deaths?

This article is ridiculous, the author is simply upset that many sports are closed for a season, and is looking for any justification to reopen. Yes the media blows things out of proportion, but the author even has a graph in the article that shows covid19 kills old people more effectively than flu and pneumonia!

The last few days have seen global upticks in infections, maybe they'll get their chance to write another article about the media being fearmongers once a few hundred thousand more people die and the death curve hits another flat spot.

Absolutely absurd.

mrfusion2• 6 years ago

How do you know what caused the dip?

Are you sure it’s not any of these:

1. The most likely to die have already died

2. The virus has mutated to be less lethal

3. We are learning how to treat it better

4. Higher vitamin d levels in the summer

5. A younger population is now getting it

6. Some level of herd immunity especially in Europe and NY.

(Im probably missing some)

usaar3333• 6 years ago

That somewhat exaggerates things. There are fewer "deaths" over the weekend due to reporting delays. It's still 500+.

subsubzero3• 6 years ago

Paywall free article: https://beta.trimread.com/articles/22708.

Somewhat related to the OP's post, what really drives me crazy is focusing on cases since beginning of time. California has 174k cases in this case. What really should be looked at is week over week increases and number of new cases, and only of active cases, old cases shouldn't really be included but newspapers love sensationalism. In addition states are combining antibody test positives(person had covid, recovered) with active positive tests(nose swabs, person is infected with covid) [1]. Basically testing and presenting digestible results have been a disaster. In addition finding decent dashboards for this info is surprisingly hard. Local ones like santa clara counties one are good [2], but step up the state and national level and its hit or miss.

[1] https://www.beckershospitalreview.com/public-health/this-is-...

[2] https://www.sccgov.org/sites/covid19/Pages/dashboard.aspx

alwaysdoit• 6 years ago

Agreed. The news functions like a monitoring system with an extremely bad alert configuration.

blackrock• 6 years ago

People are getting quarantine fatigue.

I think at some point soon, people are just going to give up.

We could’ve bit the bullet, and did a hard lock down for 4 weeks. This would’ve killed the virus in its tracks. But instead, we didn’t take the hard actions. And now, this virus is going to take its toll.

But, no worries. The stock market is doing all time highs.

rsweeney21• 6 years ago

Yep. At first it was SHOCKING to see the new cases rise. Then the death tally started rising fast. Then the videos from Italian and US hospitals.

But like most things, once you are accustomed to it, the amount of fear people feel declines. As fear declines, apathy increases.

It's like gang violence, child trafficking, or casualties of war. At first it is shocking, but then people get used to it and go on with their lives.

jeffdavis4• 6 years ago

Is there any evidence that the virus is evolving to change its deadliness?

jeffdavis4• 6 years ago

From a pandemic standpoint, it seems confusing to group together all of California. The article seems to be saying most of the outbreak is in LA and Riverside counties.

dragonwriter5• 6 years ago

The article seems to be saying most of the outbreak is in LA and Riverside counties.

LA and Riverside Counties are about 1/3 of California by population, so while it is somewhat disproportional for most of (whatever) to be there, it's not anywhere close to what it might seem when you name 2 out of 58 counties.

jeffdavis4• 6 years ago

Is there any sign that summer in the northern hemisphere will help us out? UV, heat, outdoors, or other factors?

kpennell4• 6 years ago

Major spread is happening in Florida, Arizona, and Texas.

reaperducer2• 6 years ago

Places where people concentrate inside during the summer.

The virus doesn't hang around outside at the open bus stop. It goes with the people.

glofish15• 6 years ago

yeah but in those states it is way too hot to be outside thus people spend even far more time inside than during the winter.

then Americans like their rooms numbingly cold so the AC goes full blast

so there, it actually makes perfect sense

these states got few cases in the winter because the weather was warm and sunny and they spent more time outside, now they are inside all the time in the cold, you get more cases

reissbaker2• 6 years ago

The Johns Hopkins database implies that California's overall positivity rate (i.e. the percent of COVID-19 tests of Californians that are positive) remains roughly flat at just under 5%. [1] While that's still a concerning number (and it seems like LA in particular is not doing as well as the rest of CA), California overall is doing reasonably well, as it has been throughout the outbreak, despite our dense cities and massive population. More tests mean more positive results, but doesn't necessarily indicate worsening conditions. Cumulative totals are especially meaningless; of course an area with a large population (e.g. the Bay Area) will have large cumulative totals.

The focus on absolute numbers of positive cases (without normalizing by testing rate or population) pretty dramatically distorts the national discourse on COVID-19. California has been slow to reopen — although it is reopening — and has been criticized by the right as experiencing surging cases regardless. But that's largely inaccurate: CA is just much, much larger than any other state, and it's been reliably ramping up testing. As counterexamples, Florida and Arizona are places where the surge in cases is actually reflective of significantly worsening community spread: Arizona's positivity rate has tripled from a low of 6.5% in May to nearly 20% today [2], and Florida's positivity rate has grown 5x from a low of 2.3% in May to over 12% today [3]. Texas, another state that reopened quickly, had its positivity rate double from a low of 4.7% — approximately similar to the rate CA has managed to keep itself at — to 11% today. [4]

1: https://coronavirus.jhu.edu/testing/individual-states/califo... 2: https://coronavirus.jhu.edu/testing/individual-states/arizon... 3: https://coronavirus.jhu.edu/testing/individual-states/florid... 4: https://coronavirus.jhu.edu/testing/individual-states/texas

Barrin92• 6 years ago

despite our dense cities

Californian cities are actually not dense at all, which may explain why it isn't even worse. LA at 7.5k /mi2, San Diego 4.4k/mi2 etc.. compare that to New York at 27k/mi2, or even Paris 54k/mi2, Barcelona 41k/mi2

reissbaker2• 6 years ago

San Francisco is the fourth-most dense city in America (among cities with >75,000 residents). If you only count cities with >200,000 residents, it's the second-most dense city in America, behind NYC. Its overall density is 17k/mi2.

https://en.wikipedia.org/wiki/List_of_United_States_cities_b...

And if you look at entire metropolitan areas, rather than just cities, LA is actually the second-most dense metropolitan area in the country.

Meanwhile, Phoenix, Arizona has a population density of 2k/mi2, and is having a massive outbreak.

Public policy appears to be the determining factor in flattening the curve of COVID outbreaks, not density.

christkv• 6 years ago

Does anyone know how many health care personnel in percentage of f.ex nyc hospitals that have had the illness. I’ve been wondering if institutional immunity in centers of spread would slow down resurgence as hospitals and health care centers get more immune workers.

m4rtink7• 6 years ago

From what I've read, it is still far from certain infection gives a usable immunity. So rather than that, it might as well kill off medical personal due to repeated exposure in huge amounts.

GhostVII• 6 years ago

Could this be due to an increase in testing or better testing strategy rather than an increase in cases? Daily COVID cases have been rising significantly over the last couple months in California, while deaths have been flat or slightly declining. Deaths are probably a more accurate indicator than positive tests, so it seems like positive test results do not match the actual case count very well.

usaar3333• 6 years ago

It's both. Hospitalization is up, so it's really unlikely infections aren't also up.

Animats• 6 years ago

Only the US and Brazil, and some of the small Gulf states, seem totally unable to get their coronavirus epidemics under control.[1] Remember when Italy had a huge problem? That's over. China? Over.

[1] https://ig.ft.com/coronavirus-chart/?areas=usa&areas=chn&are...

meddlepal• 6 years ago

When mainstream and social media turned the public health crisis into a political issue it ruined any chance of ending well. Politics destroys everything it touches in this country.

Or put more simply: We would be a lot better off if everyone would just shut the fuck up for 10 minutes.

untog• 6 years ago

So the current administration botches the response to a pandemic but the media is blame because they politicized it?

Healthcare is a political issue. Pretty much everything is a political issue. To pretend otherwise is to bury your head in the sand.

archagon• 6 years ago

Sure, let's just take politics out of things that affect people.

K0SM0S• 6 years ago

There is a popular expression in French that explicits a worthy distinction: “Politique politicienne”.

It literally means politician politics, or politicians' politics (a politician is a political figure, like an elected official), and it very derogatorily qualifies all the noise, the blablabla, the unimportant chatter in politics — Wherein politics speaks of egos, not ideas; the part that seldom leads to actual or worthwhile "policy".

When a leader is said to be making “de la politique politicienne”, it basically means that's degree zero of intelligent discourse, and solely aimed at tackling political opponents. Cue false claims, supporting opinions you provably don't believe yourself (but party line prevails), etc.

It's an old expression, before my time (1980s). It's fallen out of flavor. Probably because 99% of politics has now become de la politique politicienne...

salmon30salmon19• 6 years ago

See the reply I just posted. You are comparing a Italy to a massive nation. We only had uncontrolled community spread in a few areas in the Mid-Atlantic and New England, MI and LA. Other than that, we had very few cases and locked down burning through all potential goodwill while there was nothing to lock down over.

Compare the states of New York and New Jersey to the country of Italy. That is a more fair comparison. Not USA -> Italy.

One more thing. Italy didn't beat it. As soon as free movement is restored to the EU, it will spread again. The only thing that would prevent that is the ballyhooed theory that there is latent immunity in 40-60% of the population. If that is the case, than yes Lombardy is in the clear.

But if that is the case, then we also ruined the economy over a disease that was only going to infect a quarter of the people feared, and kill even less. Changes the math, doesn't it?

Edit: Fixed my stupidity about regions of my own country.

glofish15• 6 years ago

Yes, exactly plotting Lombardy and New York show very similar trends.

To be fair, in my opinion neither region "defeated" the virus - they just ran out of people that could be easily infected.

The seropositivity in NYC is probably pushing 30-40 percent now.

kgwgk5• 6 years ago

We only had uncontrolled community spread in a few areas in New England, MI and LA.

NY/NJ are not part of New England. And what's your definition of "uncontrolled community spread"? [Other places like Louisiana surely qualified. Edit: never mind, I didn't parse LA as Louisiana.] Would you say it's now "uncontrolled" in say Arizona or South Carolina?

greedo12• 6 years ago

123K and counting.

glofish15• 6 years ago

Would you like to live like the Chinese? No.

Would you like to have the same death rates as Italy (much higher than US)? No.

Is the disease eradicated in either country? No.

The story of who did better remains to be written.

If anything California shut down way too soon. That's the problem that no one seems to talk about.

Judgmentality• 6 years ago

If anything California shut down way too soon. That's the problem that no one seems to talk about.

What?

cvlasdkv• 6 years ago

What is the death rate of Italy given demographics? Is it still "much higher than [the] US"?

MarkMarine• 6 years ago

Countless lives were saved by California shutting down, that’s WHY the death rate isn’t like Italy.

addicted3• 6 years ago

Italy was the first western country to be hit with COVID.

Italy is also not the richest country with the highest per capita ICU bed availability with a ridiculously expensive healthcare system which while terrible for general welfare was excellently places for an emergency like the pandemic.

And if California shut down too early, it was still not a bad decision because you did not know what a good decision was at the time.

The fundamental problem in the US has not been shutdowns. It’s been shutdowns which have involved absolutely no planning for the reopenings.

That’s the fundamental disaster in the US handling of the situation. The northeast could maybe be forgiven for not doing planning for reopening because they were actually dealing with a crisis during the shutdown. But the rest of the country had no excuse. And unlike the northeast they weren’t the first to be hit, so they had time to see and prepare.

Instead, they declared it a Northeast problem as if the virus could tell Jersey Shore residents from South beach residents, and decided to go on with their lives without any planning or preparation anyways.

physicles• 6 years ago

Would you like to live like the Chinese? No.

Don’t know what you guys are seeing on the media but I’ve been in China since February and the response has been pretty reasonable and very effective, at least from where I’m sitting. Before I came back in early Feb I thought about fleeing to the US, but haven’t entertained the idea since.

SllX• 6 years ago

Most Bay Area counties still aren’t reporting recoveries distorting the Active Case number, unless you believe 0 people who have had COVID-19 in San Francisco have recovered since the SFDPH started tracking cases.

EDIT: Additional context: https://www.worldometers.info/coronavirus/usa/california/

If a county’s active case number equals Total Cases Minus Deaths, then they’re not reporting recoveries. Los Angeles is the largest county not reporting recoveries. In just the Bay Area, Alameda, Santa Clara, San Francisco, San Mateo are the 4 of the 5 largest counties in the Bay Area by population and are not tracking recoveries. Contra Costa and all the North Bay counties appear to be tracking recoveries.

salmon30salmon19• 6 years ago

We locked down _too soon_ in many places. Hear me out.

In my state, Oregon, we locked down when there were only a handful of cases, and not much community spread. Most spread was either in long-term care or familial. But we locked down _hard_ and had pretty good compliance. I am talking, standing in the middle of I-5 at noon compliance. Sure you'd have to keep an eye out for trucks from time to time. But still.

We set up surge capacity. Hospitals in Portland set up triage tents and cleared out other beds for a surge...... that never came. A few weeks in, the tents were taken down, the staff was laid off. We sat in our cocoon waiting for something, not sure what. Eventually the pain of being closed started to tick away, and we started reopening...

But nothing materially _changed_ between then and now. We just stopped community spread of an infection nobody really had. We've had less than 6k infections in Oregon. Now we are opening up and guess what? Cases are increasing! We didn't flatten the curve we crushed the curve. So there was no controlled spread, it was just us all feeling proud of ourselves for three months while the poor suffered.

The sneaky lie was that, in a country as big as the US, a flatten the curve strategy was never going to work at a national level. We need community level response.

We locked down Oregon over what was happening in NYC. That is akin to Northern Ireland locking down because of Moscow. That isn't an exaggeration. If anything, it is an understatement.

All of the European countries that we are saying "why can't we be more like them?" all had orders of magnitude more cases than Oregon. So if Oregon quadruples in cases over the next month we are still better off than a lot of nations.

To flatten the curve, there needs to be a damn curve to flatten. Had we waited until there was known, uncontrolled community spread and _then_ shut down, we would have a lot more political will. Now if it gets to that point after three months of being shut down, I doubt anyone will give a shit what the Governor says. Goodwill has been burned through and then some.

somewhereoutth• 6 years ago

You make a good point. See Croatia for a similar example in the EU. However we have the advantage of final control over our borders (sovereignty is pooled upwards, not flowed downwards here) - so we are better able to tailor our response and deal with problem areas (Sweden, greater Lisbon).

salmon30salmon19• 6 years ago

Yes. Right now, there is large spread in a community in eastern Oregon around a church. Lets do phase 0 lockdown in that community. Let the rest of Oregon be in a different phase. If it breaks out in Portland, Portland restricts for a while etc. Not just "I am scared lets just close everything".

It was never going to work and people were screaming that at the top of their lungs in March. We were called ghouls or accused of supporting genocide. I am not kidding.

triceratops5• 6 years ago

We locked down _too soon_ in many places

Or maybe the real answer was a coordinated national response.

Why wasn't the NYC cluster confined to NYC or NY state? If the initial lockdown succeeded in killing community transmission in Oregon, how did it start growing again? Most likely from external sources.

Only a national strategy could have made these individual state-level lockdowns worthwhile. Since we didn't have that, the states implemented a haphazard, patchwork of lockdowns that weren't coordinated.

I doubt anyone will give a shit what the Governor says. Goodwill has been burned through and then some.

Unfortunately you're right about that.

salmon30salmon19• 6 years ago

State border closures are unconstitutional in the United States, we could never have a national lockdown. The interstate commerce clause prevents it. Among other laws I am sure.

glofish15• 6 years ago

you cannot eradicate this disease unless you turn the nation into China.

The viable model is the Swedish model, schools are open, restaurants are open, nobody wears a mask. What they do is voluntarily keep more distance between people. That's it. that will do it.

The sky has not fallen, they are exactly on the same track as the US.

glofish15• 6 years ago

This is a really good point, and it all goes back to treating US or even a state as a European nation.

The US is not like that at all.

What is appalling that the CDC seemed to be completely clueless to these basic observations, as if it weren't their job to make sane recommendations beyond the "everyone everywhere immediately shut yourself indoors for a few months" (a recommendation imported from China FWIW)

khazhoux2• 6 years ago

"We never got wet... these umbrellas were useless!" :-)

I tend to agree with your point, though. Many many areas could likely have been just fine by only restricting large gatherings (concerts, etc), requiring masks, strongly encouraging WFH, and so on. But keep open hair salons, local shops, restaurants (with precautions), etc.

Even in the Bay Area, I can't help but think we shut too much down.

salmon30salmon19• 6 years ago

Go stand with an umbrella in the Atacama. We literally had no "rain" here when we locked down. That is my point.

Now that it is raining in the Atacama, we have no political will to do anything.

Edit: I was sassy before I saw your edit :D. High-five on agreeing in principle!

MengerSponge3• 6 years ago

Oregon locked down over what was happening in Seattle. Seattle didn't become NYC because their pols listened to their public health experts.

Since we "crushed the curve" we've learned what masks are good for, and how they should be used. We've developed a lifesaving protocol for the most sick patients. We've gotten into the summer which plays somewhat in our favor.

In fact, it looks like universal masking and a bit of care is sufficient to get R0<1. Problem solved, eventually. Unfortunately... leadership matters.

salmon30salmon19• 6 years ago

Seattle locked down over what was happening in Italy. Seattle never had uncontrolled spread that risked its healthcare.

How many people died from other, preventable things, while we learned that masks work? Something we knew then, by the way. Just ask any country that dealt with SARS Ver. 1.0

addicted3• 6 years ago

This is dumb. NYC became NYC because it didn’t lock down when SF or Seattle did.

If it had, it would have had about half the deaths it eventually did.

salmon30salmon19• 6 years ago

That simply is not true. Not by a long shot. NY became NY because they responded poorly, infected nursing homes by housing non-critical patients there and intubated patients that didn't need it through "caution" or some excuse.

Also, NY is about as dense as the US gets, and has way more shared, multi-generational housing than the rest of the US. Also NYC has way more transit usage than any other area in the USA, which was one important vector.

Everyone keeps pretending like the lockdown is the only variable. It isn't!

m4rtink7• 6 years ago

The Czech Republic, here smack in the middle of Europe did something similar - pretty strict lockdown, hospitals cleared of non essential procedures to keep capacity, most shops closed & mandatory masks everywhere.

Seems to have worked fine, as the average number of cases has been around 50 daily for a couple of weeks, all that while most of the restrictions have been lifted.

So where is the difference ? I think in two aspects: - all the neighboring countries did similar strict lockdown and achieved similar levels of success - we closed our borders to everyone, including preventing residents from going out - the Prague international airport was deserted for month and a half, all international bus and train connections have been shut down & border crossing were guarded by police with army helping out, letting only trucks through

I think this really helped as each country could apply their lockdown separately for a limited period, without worrying about international travel bringing it right back in.

While from what I've read and even been told by people in the US - even is a single US state did a very strict lockdown with potentially huge economical cost - the neighboring state (or in some cases even the next city!) will do hardly anything at all. Combined with no state border lockdown, the strict state will get infections back in from the less responsible areas.

The Czech Republic border is no longer closed, buses and trains go over the borders again & local flights have been reestablished. Still, a version of the border lockdown is still going on, with the Czech Ministry of health maintaining a list of "red" countries, such as for example Sweden or Portugal, that you should not visit but if you do you should go to quarantine and get tested.

salmon30salmon19• 6 years ago

Most of Oregon's neighbors had strict lockdowns. Idaho being the exception. Except I still went to Washington several times, because interstate travel was never restricted. It is a matter of debate (as someone mentioned in a different reply) if that would be legal in the USA.

greedo12• 6 years ago

I call this the pool theory (hat tip to Merlin Mann). The problem as you said is that each state followed its own lockdown policy, yet travel between states is unregulated. It's as if we had a giant pool, and said, "you can pee in this area, but only this area." Not realizing how after a certain amount of time, all the water was tainted with urine.

refurb3• 6 years ago

This is a good point.

Looking back, it would have made more sense to do the lockdown in phases. Ask every company who can have their employees work from to do so. Track the numbers!

Ok, is it still spreading quickly? Well identify the next round of business that should shutter.

We basically did it all at once and like Oregon, CA was pretty adherent, but I just went for a walk this afternoon and it looks no different than per-Covid.

We basically went from on, to off, to on again.

salmon30salmon19• 6 years ago

We stuck a knife in an electrical outlet and got shocked. We turned the power off and back on again and then expected it not to shock us the second time.

Thorentis• 6 years ago

We locked down Oregon over what was happening in NYC. That is akin to Northern Ireland locking down because of Moscow. That isn't an exaggeration. If anything, it is an understatement.

Yep, this right here is the problem. Unfortunately, social media and the 24/7 news cycle (that magnified 100x by social media) has meant that people react strongly to events that have no effect on them, and then go and do things which have no effect on the underlying cause, just because they saw people doing is thousands of miles away.

This is what happened with the COVID lock downs. People panicked when they saw NYC, but there was no reason for most place to lock down (when they did). Far better to wait for a more effective time. But no, you had people slamming governors for doing nothing in states that had very few cases.

This extends to a ton of other causes and problems. See the BLM movement. You have people protesting in countries that have nothing to do with George Floyd and a very different police force, risking their lives and others by spreading covid, because they saw people on the news in another country protesting. Utterly absurd.

dillondoyle3• 6 years ago

But ideally wouldn't we have wanted to crush it hard - get prepared with testing, isolation ability, contact tracing so that when we lift and cases rise we can smother them before they get too large?

It seems fairly successful so far in China/Korea/Australia etc. Maybe it was never possible with a fractured America filled with selfish idiots. I've completely lost hope in my country for the first time in my life I don't have confidence we can our system can fix itself

muzika• 6 years ago

As an Oregon resident, I confirm that this is spot on. We handled the lock down very badly, to a point where I had to convince some of my friends that COVID-19 actually exists.

m463• 6 years ago

The problem is that a properly executed disaster response will be drama free.

How many people had covid, self quarantined, and never spread it ... unbeknownst to anyone?

The way exponentials work maybe nobody was saved, or maybe a whole nursing home or a city of old people.

I recall the y2k problem and the hysteria. In the end, nothing happened. But... was it an overreaction, or was it an appropriate reaction seeing that all these companies didn't meltdown financially?

cbayram• 6 years ago

Hindsight bias.

wiseleo• 6 years ago

California is still not doing enough. The original criteria for phase II were not met and yet the state decided to reopen anyway. Bay Area is thankfully staying stricter.

I was at a sit-down restaurant packed at capacity with live music a week ago about 100 miles from Bay Area. That should not be possible.

Close the state border to all interstate traffic. Test truck drivers at weigh stations near the state border. There should be sufficient capacity of the 5-minute Abbott test for this. Test other interstate travelers at mandatory checkpoints with a test that shows results no later than 60 minutes.

Close county borders. Mandatory testing at each county border. Issue a photo + ID card to each person tested. Mandatory verification of negative result before public transit boarding. Mandatory door to door testing in resisting areas. Deny all walk-in service to anyone not able to verify current test results with at-door scanner. Assume they are infected and serve them curbside. Have them scanned by a mobile dispatched unit at their if unable to travel to a testing location.

Annoying? That's what "essential" activity means. We are not making it inconvenient enough to not do non-essential activities.

Sounds extreme? That's what EU did to contain Italy and Spain. They closed internal borders and localized efforts.

Sounds expensive? Abbott will make a lot of money. Lives will be saved. The entire state could reopen and resume operations once strict testing protocols are in place and the curve is properly slammed.

We do not have an effective CDC to set national policy. Compare the real guidelines [1] leaked to press to the softened guidelines[2]. There is a reason why schools are rejecting[3] the official guidelines.

Finally. Want to host a church gathering? Your entire congregation is welcome to stay quarantined for 14 days on your premises.

P.S. The current CDC document has been updated. It was far less prescriptive earlier. Some sense prevailed. The entire section related to churches has been deleted.

Counties with zero infections should be allowed to open, but border protocols must be enforced. [1]https://www.documentcloud.org/documents/6889330-Guidance-for... [2]https://www.cdc.gov/coronavirus/2019-ncov/downloads/php/CDC-... [3]https://www.usnews.com/news/education-news/articles/2020-05-...

m4rtink7• 6 years ago

This is pretty much what was done here in Europe - country borders closed for everything except freight and on top of that towns and villages with exceptionally high infection rate were closed off and put under even stricter quarantine rules.

Even now with most of the wide area lockdown lifted, there are local clusters being isolated by locking down towns or whole regions, as at the moment with the German slaughter house cluster and the Czech and Polish coal mine clusters.

wonderwonder5• 6 years ago

The absolute fascinating thing about this is that for much of the country, they just got bored of Corona virus. Federal leadership is fading away to almost nothing, with getting the economy rolling prior to the election being the main focus. Then on top of that we have people who for whatever reason just want to go back to normal, thinking that its no big deal. There are many more who agree that the sickness is a big deal but it really only kills the elderly or weak and that's not a big deal, the sacrifice is worth it.

We decided that staying home and socially isolating was just to hard. The rest of the world must be looking at us in horror.

dillondoyle3• 6 years ago

I think a lot of us inside our country are looking on in horror too. I for sure am - and terrified. I have lost all confidence and don't know if we can 'right the ship' (beyond just Covid I'm talking about basically everything all of our values)

wonderwonder5• 6 years ago

Honestly have never seen anything like it. I am in shock that so many people are applauding whats going on here. If it happens again, I am not sure what to think.

zaroth3• 6 years ago

We know now — definitively — those populations who are at risk from COVID, and those populations which are not.

In general the world is too connected, and populations too mobile, for a virus like SARS-CoV-2 to be contained, save for special case island nations that are willing to keep borders closed or visitors quarantined and ensure compliance until a vaccine becomes available.

For the rest of the world, what is abundantly clear in countries that are willing and able to perform the requisite testing, is that this is a virus that spreads easily and rapidly but thankfully in those under 50 is vanishingly unlikely to kill if it is symptomatic at all.

With over 10 million confirmed cases worldwide, likely in excess of 100 million actual infections, COVID could burn out in it’s own before widespread vaccination is available. Not due to containment measures, but due to enough people gaining immunity.

In my non-expert estimation, the public health response to COVID will ultimately result in about an order of magnitude more deaths, or roughly an order of magnitude more years of life lost, than due to COVID itself. The longer we continue lockdown-type policies, the greater the damage done.

COVID spread anyway, COVID continues to spread, although now it seems to be mostly in less risky populations as case counts surge and hospitalization and death rates remain constant. Some of this is of course simply sampling bias now that testing is more available for lower risk populations. We also see people who know they aren’t at any real risk willing to be exposed in order to live their lives. Most inexcusably is that the most vulnerable populations (e.g. in nursing homes) were not adequately protected and even directly harmed by policies while the general masses bore the economic and social brunt of the involuntary enforcement measures.

In general every person who gets COVID and is asymptomatic or minimally symptomatic is basically someone getting an early access vaccine, and this can only be regarded as a positive in exerting a downward effect on R.

I think that speculating about long term effects in largely asymptomatic populations is an academic exercise which misses the forest for the trees. We need to reopen emergency rooms for the cardiac patients, reopen oncology departments for the chemo patients, reopen primary care clinics for health screenings, and reopen gyms, all to reduce/prevent well known and proven morbidities that cost millions of lives a year, not just continue to incur increase death in our most prevalent causes of death out of fear or politics.

pvaldes• 6 years ago

It seems that nobody dare to say this, so I will do, because I'm an idiot.

This is the expected outcome by the recent "black lives matter" events. Right actions but really bad time choice.

I wonder why people expected other results.

California sets Covid-19 daily record, Bay Area cumulative total passes 20k

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