Everyone knows that we're facing a real crisis from the coronavirus. But do you know how we got here and what we need to do next? Ron Klain, former White House Ebola Response Coordinator, breaks it down for us: pic.twitter.com/XRkIw2EzM4
— Joe Biden (Text Join to 30330) (@JoeBiden) March 21, 2020
Gideon Lichfield, at the MIT Technology Review, “We’re not going back to normal” includes a good explanation of the infamous Imperial College ‘Eighteen Months’ prediction:
… It’s now widely agreed (even by Britain, finally) that every country needs to “flatten the curve”: impose social distancing to slow the spread of the virus so that the number of people sick at once doesn’t cause the health-care system to collapse, as it is threatening to do in Italy right now. That means the pandemic needs to last, at a low level, until either enough people have had Covid-19 to leave most immune (assuming immunity lasts for years, which we don’t know) or there’s a vaccine.
How long would that take, and how draconian do social restrictions need to be? Yesterday President Donald Trump, announcing new guidelines such as a 10-person limit on gatherings, said that “with several weeks of focused action, we can turn the corner and turn it quickly.” In China, six weeks of lockdown are beginning to ease now that new cases have fallen to a trickle.
But it won’t end there. As long as someone in the world has the virus, breakouts can and will keep recurring without stringent controls to contain them. In a report yesterday (pdf), researchers at Imperial College London proposed a way of doing this: impose more extreme social distancing measures every time admissions to intensive care units (ICUs) start to spike, and relax them each time admissions fall…
What counts as “social distancing”? The researchers define it as “All households reduce contact outside household, school or workplace by 75%.” That doesn’t mean you get to go out with your friends once a week instead of four times. It means everyone does everything they can to minimize social contact, and overall, the number of contacts falls by 75%.
Under this model, the researchers conclude, social distancing and school closures would need to be in force some two-thirds of the time—roughly two months on and one month off—until a vaccine is available, which will take at least 18 months (if it works at all). They note that the results are “qualitatively similar for the US.”
Eighteen months!? Surely there must be other solutions. Why not just build more ICUs and treat more people at once, for example?
Well, in the researchers’ model, that didn’t solve the problem. Without social distancing of the whole population, they found, even the best mitigation strategy—which means isolation or quarantine of the sick, the old, and those who have been exposed, plus school closures—would still lead to a surge of critically ill people eight times bigger than the US or UK system can cope with… Even if you set factories to churn out beds and ventilators and all the other facilities and supplies, you’d still need far more nurses and doctors to take care of everyone…
And what if we decided to be brutal: set the threshold number of ICU admissions for triggering social distancing much higher, accepting that many more patients would die? Turns out it makes little difference. Even in the least restrictive of the Imperial College scenarios, we’re shut in more than half the time…
(Excellent graphs & full explanations at the link.)
For sewist volunteers: From the SmartAir Filters website, an in-depth dissection of “What Are The Best Materials for Making DIY Masks?”
(Short answer: Vacuum cleaner bags!)
From the Brisbane Times, “‘It’s a powder keg’: South-east Asian countries grapple with virus”:
South-east Asia’s response to the coronavirus had varied wildly, from world’s best practice in Singapore to possible disaster in Indonesia.
As of Thursday night, Indonesia (309 infections), Malaysia (900 infections) and Thailand (272 infections) had all recorded their largest single-day rises in case numbers. Vietnam (76 infections), Cambodia (37 infections) and the Philippines (217 infections) were recording steady daily rises in infections, while Laos and Myanmar still claimed to have zero cases…
The lessons for other countries to learn from Singapore, Hong Kong, Taiwan and South Korea are that “testing early and extensively, and effective isolation, contact tracing and quarantining has been key to bringing epidemics under control”.
“Any country that hasn’t been able to implement these measures quickly, for whatever reason, is at high risk of uncontrolled community transmission, as we’re seeing now in a number of European countries and the US,” Tam says.
On the face of it, the recent cases in Malaysia are a particular concern – it has recorded rises of more than 100 cases per day for five days in a row, and more than two-thirds of the cases were linked to a three-day mass prayer gathering of about 16,000 people at the Sri Petaling mosque complex in late February.
But Malaysia’s health system is relatively advanced, its doctors and professors well trained and competent. It is better equipped than many nations in the region to handle the outbreak, and the closing of its borders to foreigners – while perhaps belated – will stop more cases being imported…
It’s Indonesia, which has more than 50 times the population of Singapore and which has already reported 25 deaths – despite only confirming its first infection on March 2 – that is causing the greatest concern.
The national government has been in denial about the problem for weeks, with the country having tested about 1500 out of 270 million people, compared to more than 80,000 people tested in Australia and 250,000 in South Korea. Health Minister Terawan Agus Putranto claimed prayer had kept the country virus-free and a tourism campaign has been launched on social media to capitalise on the virus’ alleged non-spread to the nation…
Tam, the epidemiologist, says Malaysia, Indonesia and the Philippines face very specific challenges “because of their large and widely-dispersed populations and the fact that they have very sizeable migrant working populations”.
And while some countries do have the capacity to mount an effective response, “we can’t rely solely on our individual national capacities, because epidemics in other countries pose a continuing risk of re-importation and local transmission. This means that in order to have an effective, coordinated response, we need far greater investment in strengthening health systems region-wide.”
San Francisco has the best, most comprehensible “Stay home except for essential needs” notice I’ve seen so far:
What to do
The City issued a Public Health Order requiring people to stay home except for essential needs.
Vulnerable populations must stay home. People who are over 60 or have a chronic health condition are the most vulnerable to this virus.
Everyone else is required to stay home except to get food, care for a relative or friend, get necessary health care, or go to an essential job.
It is OK to go outside for walks or bike rides if you are not in a group.
Stay at least 6 feet apart when leaving your home for essential activities.
This order is in effect until April 7.
It may be extended depending on recommendations from public health officials…What can’t I do?
You cannot engage in group activities in person with others.
You cannot have dinner parties. You cannot invite friends over to your home to hang out.
You cannot go to bars or nightclubs.
You cannot go to a nail salon or get your hair cut by a stylist or barber.
You cannot go shopping for non-essential goods.
You cannot take unnecessary trips on public transport or in your car or motorbike…
Something actually encouraging — from Bloomberg News, “The Virus Hunter Showing the World How to Fight an Epidemic”:
As South Korea’s coronavirus outbreak risked veering out of control, with infections rising thirty-fold in just ten days last month, the country’s health authorities got an unexpected break. The secretive religious sect whose meetings were early vectors for spreading the virus had agreed to disclose the names of all 212,000 members — critical information for figuring out where it would appear next.
The deal was brokered, in part, by Jung Eun-kyeong, the head of Korea’s Centers for Disease Control and Prevention, whose management of the response has made her something of a national hero, and a potential role model for virus-fighters elsewhere. Since the agreement with the Shincheonji Church of Jesus on Feb. 25, South Korea has tested more than 320,000 people, a diagnostic blitzkrieg that’s brought the daily tally of new infections to less than 100, compared with more than 900 two weeks ago.
A former small-town doctor who was deeply involved with the response to a 2015 epidemic of Middle East Respiratory Syndrome that killed 38 in Korea, Jung’s daily briefings have become must-see TV for many citizens. Social media buzzes with praise for her straightforward approach to pandemic communications: tell the public exactly what’s going on, but without over-promising about what’s possible…
Although it was one of the first countries outside of China to experience a large-scale epidemic, Korea’s response has been measured compared with the U.S. and Europe. Cities aren’t locked down, many workplaces remain open, and school is likely to resume in early April. The CDC’s aggressive early actions, centered on an enormous but focused testing operation that’s moved far faster than efforts in the U.S. and U.K., were a big part of why it was able to avoid more drastic measures…
[I]t’s the approach to testing that’s given Korea its edge. The country approved its first coronavirus test on Feb. 4, just 16 days after the initial domestic case was confirmed. By Feb. 27, four different companies were manufacturing test kits, allowing the authorities to process as many as 20,000 people a day. Jung’s teams, meanwhile, worked on novel methods of administering the tests, from drive-through centers to compact stations that look like phone booths…
Please amplify this important request. https://t.co/dHuOIW4duw is providing critical help to the dedicated frontline healthcare workers who need protection so that they can care for their patients. https://t.co/APeITOaqZ0
— Dr. Angela Rasmussen (@angie_rasmussen) March 22, 2020
Zzyzx
I have two mental goal dates in my own world: April 15 and May 1.
4/15 will be a chance to see if China is having a relapse or not and to see if the deaths in Italy are finally going back down.
5/1 will be when we can see if the restrictions we’ve been doing in the US are starting to work or not.
Also let me remind everyone (and myself) that the Imperial College model is just one model. We need to not dismiss it, but we also need to not make it out to be 100% true. It’s setting an upper bound for how things can go wrong based on one set of assumptions but others have been better.
MomSense
In local COVID news, the unions at Bath Iron Works have been pushing for a work stoppage for weeks. Of course National Semi-conductor has said no, citing the DOD decision that building destroyers is essential. Well, now at least one worker has tested positive. They often work in tight quarters and in large shifts. This could get ugly fast.
CCL
Better short term answer – 100% cotton (two layers) t-shirt or woven (such as pillow cases). I made three Olsen masks (with a pocket for a HEPA filter – taken from the last HEPA vaccuum cleaner bag we have on hand) yesterday. Will be making simple surgical masks for family today.
Baud
My many years of psychological distancing have prepared me for long term social distancing.
L85NJGT
China is getting travelers bringing it back in, and all it takes is one to slide by screening.
The 1918 H1N1 succeeded by leveraging the large troop concentrations and movements of WWI. This pathogen is succeeding by leveraging the ubiquity of global travel, and the standardization of best practices for health care facilities globally.
CaseyL
@CCL: The community DIY response reminds me of civilians doing the same during WWII. There was a LOT of civilian-organized materiel manufacture then – and I think gasmasks were among the items people made for Our Boys Over There.
germy
https://sciencebasedmedicine.org/are-hydroxychloroquine-and-azithromycin-an-effective-treatment-for-covid-19/
Michael L. Barnett@ml_barnett
There are reports in Boston that pharmacies are seeing a spike of hydroxychloroquine prescriptions by physicians for themselves or their families
Just a reminder that this is not only deeply unethical and but also quite harmful if it doesn’t work
Katherine Rowland@DRxKatherine
Well it finally happened to me.
A dentist just tried to call in scripts for hydroxychloroquine + azithromycin for himself, his wife, & another couple (friends).
NOPE.
I have patients with lupus that have been on HCQ for YEARS and now can’t get it because it’s on backorder.
Mandalay
While there’s praise floating around for state and local politicians “taking charge”, there are some glaring examples of them showing mind boggling stupidity in the past couple of weeks.
California:
Oklahoma:
Florida:
New York:
I realize they are all working under intense pressure, but they have also been fully informed about the importance of social distancing. It’s not like they were unaware of the risks when they made these dumb decisions.
Le Comte de Monte Cristo, fka Edmund Dantes
@Baud:
I’ve laughingly called this “The Psychotic Revenge of the Introverts” for being dragged to parties and events and forced to talk to other people by their extroverted families and friends.
I’m an extrovert – this has been actually difficult. I got screamed at yesterday for talking to an older neighbor (who’d been a music teacher for all of our kids) in the street. He’s an extrovert, too, and was escaping the house he shares with his wife, his alcoholic son, his alcoholic son’s ex-wife and their three kids. Even though we kept a respectable 6-8 feet distant, I got yelled at and forced to shower when I came back in.
Dorothy A. Winsor
@CCL:
Once again, it’s those who work with fibers who will come through, the way they did with the kitty cat hats.
Shalimar
OT: Task Force press briefing today is at 5:30pm. They’re not going to risk letting Trump speak until after markets close.
CindyH
Anyone watching McConnell on CNN? He is shredding Democrats – I’m sure it’s a total mischaracterization to outright lies, but it looks bad.
Baud
@Dorothy A. Winsor:
From pussy hats to pussy masks. The Trump era comes full circle.
opiejeanne
@Mandalay: I don’t know about the other attractions but Disneyland has been shut down for at least a week now.
raven
So are people taking a shower after they go out? I had to take Lil Bit to her eye vet. They came out and got her and brought her back. Since I was out I made a click-it order at Lowes and picked up 15 bales of pine straw for the boss lady.
Baud
@CindyH:
Not watching, but that’s what he always does.
raven
@CindyH: It really does. Fucking solar power????
Baud
@raven:
No, I just wash my hands and clean my phone thoroughly.
Gin & Tonic
@raven: I wash my hands and face, but do not take a shower or throw my clothes in the wash. Living on the edge, I know.
PenAndKey
@CindyH: He’s lashing out because the Democrats didn’t play along with his “loot the treasury and pretend it’s emergency relief” power grab. Of course it’s lies and anger. That feigned outrage is part and parcel for his “do it my way or else” negotiation tactic he’s always employed.
Also, joy of joys, Wisconsin is joining the shelter-in-place crowd and my wife is likely back out of a job after being told by her boss she was going to be working from home just yesterday. I know it’s a minor thing compared to actually getting sick, but the constant headache of this all is tiring and we’re barely into it. This timeline sucks.
MomSense
@germy:
I’m doing my part by drinking tonic water with quinine. I’m adding “medicinal” substances and a bit of lime.
bbleh
So Korea mobilizes to test hundreds of thousands of people and manages to get control of the curve without a prolonged and extensive shutdown. Meanwhile, the US can’t even get masks to healthcare workers, our (Republican-led) government doesn’t know how many even they’ve sent, and the (Republican) president is dragging his feet on using (not even abusing!) existing emergency authority to produce more because he thinks it might upset the corporate class.
Unbelievable. Thanks again, Republicans!
opiejeanne
@raven: I did last week, because Home Depot made me come into the store to verify my identity, after I’d been to Costco pharmacy a little earlier, and then I went to Urgent Care, and dealt with another pharmacy.
Too many people were too close to me that day and I came home and showered after I got the prescription at the last place. It was like when you’ve been in room full of smokers, and you don’t smoke, and you can smell it on you and in your hair when you leave. I could smell something on me and in my hair and I was really stressed by it, so I took a shower and washed my hair.
Around the neighborhood we can pretty much control how close anyone comes, so I don’t have that reaction.
NotMax
Repeating.
Relevant to these times, TCM is showing Enemy of the People, an adaptation of Ibsen’s play about political, business and public relations efforts to distort or otherwise misdeal with a public medical crisis, Tuesday at 6 p.m. Eastern time.
hedgehog the occasional commenter
@raven: No, just make sure I wash my hands before and after I go out,
joel hanes
@raven:
So are people taking a shower after they go out?
Absolutely. And then washing every doorknob touched on the way into the house, and the light switches, and the places on the walls and woodwork where people put their hands, and the handles of the kitchen appliances. And then washing clothes.
And eventually, it probably won’t be enough. By May we’ll have to assume that half the people out and about are carrying the virus.
L85NJGT
Most of the deaths in Spain are at long term care facilities for the elderly. Inadvertently concentrating vulnerable health populations for an opportunistic virus.
Healthcare is 11% of our workforce. They are concentrated in large buildings\campuses filled with those who already health compromised. I’m not saying this is wrong in terms of normal costs or patient outcomes, but it’s definitely a significant factor for patients, workers and communities in this pandemic.
Gin & Tonic
@MomSense: Very logical.
West of the Rockies
No theme parks, sporting events, casinos are open in California, nor will be in the foreseeable future.
JoyceH
I have to break my shelter in place bubble today to go to the post office and I’m pretty angry about it. I’ve got to go to pick up a certified letter – when I went to down the driveway and got my mail on Friday there was one of those attempted delivery slips. Well, I was home all day and I know darn well nobody came to the door. Pretty sure the mail carrier just filled out the slip and claimed to have tried to deliver because they didn’t want to fool with coming up the driveway and getting out of the car.
raven
@opiejeanne: Having to go in to Lowes did not make me happy since I’d already paid. I had on plastic gloves when I singed the stupid document and put leather over them while I loaded the pine straw. I kept my interval at all times. We also are having new HVAC installed in our rental and the guy are in and out under the house.
The Moar You Know
@CindyH: Don’t underestimate this sack of crap. This was planned for a week. And it will work; the Dems damn well shouldn’t sign it, but not signing it is going to really hurt us.
Elizabelle
@Baud:
That could be a tagline.
NotMax
@raven
Renters still there or have moved on?
Amir Khalid
The latest numbers for Malaysia as of today are 1,518 cases, of which 159 people have recovered and 14 have died. 57 are listed as serious or critical and the remaining 1,345 are listed as having a mild case of the disease.
Me, I’m fine. I’m told there are now soldiers in camo fatigues and filter masks at army roadblocks in addition to the police roadblocks. I hope I’ll still be able to get to my medical appointments on Wednesday and Thursday. Bianca has something like two months food reserve or so, although most of it is Whiskas from the supermarket rather than specialty senior cat food. Fortunately, she’s not a picky eater.
Sure Lurkalot
@CCL: I made two double layer masks out of sheets. I think the material is 50/50 poly cotton.
Unfortunately, sewing was a skill not present in my upbringing. I bought a sewing machine decades ago…for repairs and shams. So, I’m not going into production but some protection for family if someone gets sick.
MomSense
@Gin & Tonic:
I had a feeling you would approve.
rk
Our hospital is asking for volunteers who can sew and have a sewing machine and are available 24/7 to help make masks. It made me sick to even read the mail. We’re recycling stuff which would have earlier been thrown away.
Wapiti
Two days ago my local Safeway grocery store had placed yellow taped lines on the floor, 6 feet apart, leading up to the checkstands, to keep the customers from crowding each other. Yesterday they had installed plexiglass panels between the checkers and the customers – a sneezeguard of sorts – because 6 foot distancing wasn’t quite possible. People are thinking about how to work through this.
Fair Economist
@Zzyzx: I’m not sure the Imperial College report gives an upper bound. By that model Italy should have peaked but it hasn’t yet, or *maybe* just did at an unexpectedly high level. Italian results have shaken my confidence in my own recommendations, which were largely based on Imperial College.
When I first saw the worst-case projections from Imperial College, my reaction was “well, that’s not as bad as I thought it would be” even though they were still very, very bad.
Fair Economist
@Le Comte de Monte Cristo, fka Edmund Dantes: I think people are being a little too paranoid about casual street interactions. If nobody is coughing or sneezing and there’s no shared surface contact the transmission risks should be quite low.
Sure Lurkalot
@joel hanes: I’m getting to this level myself but I know it’s not sustainable and probably not good for one’s mental health. Every trip out and in is fraught with danger…what did I touch? What might be contaminated? Oh no, I touched this after that! Deliveries…box not safe! Contents packed by sick peeps!
Today’s old person’s shopping hour was scarier then regular hours except for a bit more stock. Rushed through so fast…panic like, who knows what we’ll be eating this week!
Zzyzx
@Fair Economist: I’m really hoping that Italy is peaking right about now. Deaths are a lagging indicator and they really waited way too long.
What’s giving me hope is that Seattle was 10 days behind Italy. Now it feels closer to 2-3 weeks behind where they are. We’ve definitely slowed the curve; it’s just a question as to if it was enough.
NotMax
@Sure Lurkalot
Rushin’ roulette.
“Hmm. Canned green beans, apricot jam, sardines and cornmeal. Must be something I can whip up….”
:)
JoyceH
@JoyceH: responding to my own post- I called the post office and they said they had new district regulations that they are not allowed to pull into driveways that they have to back out off. But I can sign the back and put it in the mailbox with the flag up and they’ll bring it the next day. So yay, my bubble is intact.
JoyceH
Awww! And my neighbor just left two big rolls of TP on my porch!
Ken
@NotMax: We are all Chopped! contestants now.
JaySinWA
@CCL: From the article referenced, breathability argues against vacuum bags and double layers.
Duane
@Ken: There’s an Instant Pot recipe for that.
trollhattan
Looking at the trajectory of US total cases, is there any scenario under which we don’t pass Italy in a couple of days and China by next week?
WereBear
I time my trips so I take my shower when I get back. Keep coat and gloves for these trips in the airlock. I haven’t reached the point where I wipe down all the groceries before I put them away, but I heard of at least one epidemiologist who does…
Just One More Canuck
@Mandalay: All of these stories are from at least a week ago – the Disneyland story was from March 12. What’s the relevance to now?
CCL
@JaySinWA: Yup – against vaccuum cleaner bags – but cotton double layer ain’t bad -as long as one is talking tee-shirt fabric or cotton shirting, muslin, pillow case fabric essentially. Plus can build a pocket for a HEPA filter if you have one (the Olsen version).
Probably too much info for here – but it helps if one does grain on one layer and cross grain on the other if using a woven — have my boring details killed the thread yet?
MCA1
@MomSense: Are you the one who’s bought up every last bottle of diet tonic water within a 5-mile radius of me? I’ve been to four places looking and can’t find a drop of it. Always assumed I was the only one who drank it.
patrick II
Question: I don’t have much money, but the money I contribute to politicians is either local or Act Blue. So, now I am wondering, are there some blues with a touch of purple potential Senators or Congressman running in a red state who might, given the current political environment, have a shot this year?
Who might they be, and is there an act Blue with a touch of purple place to contribute?