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You are here: Home / Healthcare / COVID-19 / More (Slightly Longer) Pandemic Stories

More (Slightly Longer) Pandemic Stories

by | 45 Comments

This post is in: 

Courtesy of commentor Redshift:


Read the whole thing — seriously:

… Even if the stages of vaccine development could be compressed and supplies could be rapidly manufactured and deployed, it could take many more months or longer before most Americans would be able to roll up their sleeves. And in many countries around the world, the wait could be far longer still — perpetuating the worldwide risk the new coronavirus poses for several years to come.

That reality is being obscured by reports that some of the earliest vaccine candidates — including one from the biotechnology company Moderna and another from University of Oxford — may within months have enough evidence behind them to be administered on an emergency use basis.

Michael Osterholm, director of the University of Minnesota’s Center for Infectious Diseases Research and Policy, is worried people aren’t preparing for the possibility of a fall wave of infections — which some experts fear will be bigger than what we’ve seen so far — because they expect a vaccine will be at hand.

“I’ve actually heard higher education experts say, ‘Well, you know, we’re kind of counting on the vaccine maybe by September because we keep hearing about that.’ And of course, in their mind, they’re equating [that to mean] colleges and universities will have the vaccine,” he told STAT…

Assuming a vaccine can be developed quickly, the issue of manufacturing is not a small one. Production of some vaccine candidates could be more easily ramped up than others, noted Emilio Emini, who is leading work at the Bill and Melinda Gates Foundation on the issue.

Should some of the more “scalable” vaccines prove to be protective, it’s conceivable that they could be made at existing plants, rather than require the construction of whole new facilities. Production of this type of candidate could reach hundreds of millions of doses within about a year, Emini said. But any vaccines that would require bricks-and-mortar construction is obviously going to take longer to reach those output levels…

Health care workers would likely followed by people at the highest risk — those 65 and older and people with chronic health conditions, like diabetes, that have been seen to increase the risk of dying from Covid-19, Robinson said.

“I don’t think that the general population will have vaccine probably until the second half of 2021. And that’s if everything works OK,” he said.


One of my go-to twitter reads — “Tara C. Smith, Professor of Epidemiology at Kent State University in Ohio. Her research focuses on disease transmission in rural populations”:

… The pandemic in rural America will not be the same as the one that has overwhelmed cities across the nation. Less dense and less interconnected (without the sprawling public transit systems and international airports that serve cities), many of these regions are likely to experience outbreaks that are less dramatic than those in urban centers. But rural areas are woefully unprepared for even a slower-moving epidemic. Just as they have suffered factory closures and job losses over the last decade, these regions have been devastated by the loss of hospitals and medical personnel. One hundred and twenty-eight rural hospitals have closed since 2010, scattered across the country but concentrated in the South and Midwest. An additional 430 rural hospitals were described by one consulting firm in 2019—prior to the pandemic—as “near collapse.” And the loss of hospitals often means the loss of the medical providers these institutions employed, leaving fewer health professionals to treat rural residents, who tend to be in worse health overall than their urban counterparts.

Rural Americans are more likely to be obese, to smoke, and to have high blood pressure than Americans who live in cities. They have higher poverty rates, have lower rates of health insurance coverage, and are generally less physically active. All of these factors make them more likely to suffer serious complications if they are infected with the coronavirus.

In many ways, Ohio’s experience with the novel coronavirus has been representative of the nation’s at large. Governor Mike DeWine ordered schools to close in March, when there were scarcely more than a dozen confirmed cases in the entire state. He closed down businesses shortly thereafter. Although the state still lacks critical testing capacity, the numbers of confirmed cases and deaths have risen relatively slowly compared with the numbers in neighboring states of similar size that implemented shutdowns later, such as Michigan and Pennsylvania.

As anticipated, cases were initially concentrated in urban areas such as Cleveland and Columbus. But that changed on April 20, when test results from the Marion Correctional Institute were released. With almost 2,100 cases among inmates and 300 among staff, rural Marion County, population 66,000, suddenly became Ohio’s coronavirus capital, eclipsing even Cleveland’s Cuyahoga County with a population 18 times greater. Rural Pickaway County, with a population of 55,000, is not far behind with 1,825 cases to date that stem from the county’s two state prisons. Per capita, infection rates in Marion (3,600 per 100,000 people) and Pickaway (3,300 per 100,000) Counties are higher than those in New York City (2,107 per 100,000)…

While rural communities are weeks or even months behind their urban counterparts on the pandemic curve, they may be about to see a sudden increase in COVID-19 cases and deaths. The outbreaks currently underway in high-risk facilities will inevitably spread outward, following workers, patients, and inmates to their homes and neighborhoods. Poorer health among rural Americans in general means there will likely be a higher percentage of serious cases in these regions. Lack of health insurance will mean that more people wait until the infection is potentially life-threatening before they report to an emergency room—if one is even accessible. And inability to test to identify early mild cases means that these communities won’t even know that the outbreak is increasing until hospitals start to be overwhelmed.

Rural outbreaks will be slower, steadier, and likely to continue for a longer period of time than those in urban areas. In some ways this may be advantageous—because there are fewer medical facilities, the curve in rural areas needs to be much flatter than in cities to avoid overwhelming local hospitals. But a flatter curve means a longer epidemic—potentially months of watching the infection spread slowly among friends and loved ones. This will be particularly crushing to first responders and other medical professionals. In small communities, doctors usually know friends or relatives of their patients—if not the patients themselves. Now, doctors will have to watch many of these people suffer or die from the illness. And with 60 percent of rural Americans living in areas with a shortage of mental health professionals, survivors may be left traumatized and without help to process their experiences…

And if areas are reopened before testing capacity increases, which is all but certain, these outbreaks may go undetected until they are too large to contain, necessitating another round of lockdowns. Ironically, in rural areas, where some social distancing occurs naturally, lockdowns may not even be the most efficient way to slow the spread of the disease. Face coverings may be a better option, but there has been some resistance to making them mandatory…


Before any of this began, I used to wonder about the ‘historical amnesia’ of Americans who lived through the Spanish Flu. Despite the impact it must have had, it just didn’t seem to exist in books or movies written by the survivors. Now I suspect at least some of it was a form of deliberate avoidance — a sort of societal PTSD.

Pretty sure I posted the video tweet when it first appeared, but it’s worth parsing:


The responses from other medical professionals to Dr. Karan’s thread are worth reading, too!

Doug Saunders, The Globe and Mail’s international affairs columnist, on the difference between this and ‘historic’ pandemics:

… When a pandemic comes, cities scare the hell out of people. The crush and bustle of the sidewalks and subways feels like a big petri dish. One instinct is to run. The literature of viral apocalypse, including recent masterpieces such as Robert Harris’s The Second Sleep and Emily St. John Mandel’s Station Eleven, starts with masses fleeing to the countryside. This choice rarely turns out well.

That’s the paradox of the megalopolis. Its population density means it’s the place where viruses often begin and that epidemics, if undetected, can explode fast there. New York is about to become a major focal point of infection and mortality, and London is not looking too good, either, because they didn’t close their crowded drinking places earlier.

But the biggest cities are also the safest places in the world.

Only they have the infrastructure, staff and organization to really quash an outbreak – Taipei and Tokyo, both more dense than New York, were able to flatten their virus-spread curves almost instantly using the unavoidable communications, visible deterrence and bureaucracies that only a tight-packed urban centre can muster. If you’ve spent any time in a small town, you’ll know how hard it is to keep people inside or away from each other.

And only huge cities have the resources and the reserve armies of medical talent to tool their health-care systems up to pandemic-level capacity in time to save lives. New York, because it’s able to build and staff huge convention-centre hospitals in short order, will have a lower mortality rate than the smaller, more elderly towns and cities that will be hit next…

Cities were, until the 19th century, “population sumps,” in the words of the late Canadian historian William H. McNeill, that attracted thousands of immigrants every year and promptly killed them with epidemic diseases. London required 6,000 immigrants a year in the 1700s just to maintain its population of 650,000 because disease deaths greatly outnumbered births.

Then two things happened. First, the tight-knit populations of cities, and their connections to other cities, meant that the urban world became a homogenous human pool of immunity. The practice of inoculation saw its first widespread Western practice in the English countryside at the end of the 18th century to fight smallpox – by that point, Londoners didn’t need it because their immunity had transformed it into a fairly harmless childhood disease. In 1790, London baptisms outnumbered deaths for the first time and, from then on, cities became safer than towns…

Reader Interactions

45Comments

  1. 1.

    David ? ☘The Establishment☘? Koch

    COVID-19 infections and deaths may soon pick up in rural areas, where it may be even more difficult to combat

    I’m sure Patriotic Farmers won’t mind sacrificing their families for Dump’s portfolio.

  2. 2.

    khead

    Rural Americans are more likely to be obese, to smoke, and to have high blood pressure than Americans who live in cities. They have higher poverty rates, have lower rates of health insurance coverage, and are generally less physically active. All of these factors make them more likely to suffer serious complications if they are infected with the coronavirus.

    And a lot of them are pretty ticked off that they haven’t been able to go to the bar on Saturday and then church on Sunday.

  3. 3.

    Goku (aka Amerikan Baka)

    That first tweet isn’t correct wrt effectiveness at filtering small particles. They can prevent you from getting sick.

  5. 5.

    Mike in NC

    We went to the supermarket today. Have been wearing masks for at least a week. I had to remove mine as I needed to sneeze several times. Felt stuffy by the time we got home. Soon took a sinus tablet and cleared right up.

    Close call!

  8. 8.

    counterfactual

    My county in Ohio has had 40 cases according to The NY Times count, but that assumes that none of the 3 or 4 correctional facilities in the county have had outbreaks yet.

  9. 9.

    Brachiator

    Rural Americans are more likely to be obese, to smoke, and to have high blood pressure than Americans who live in cities. They have higher poverty rates, have lower rates of health insurance coverage, and are generally less physically active. All of these factors make them more likely to suffer serious complications if they are infected with the coronavirus.

    This will be an interesting and useful experiment. Many conservatives are convinced that they are healthier and are protected by better values than the non-white people cut down by the disease. I even read a comment at the UK Daily Mail where an American claimed that black people were dying because they deliberately ignored the rules that might keep them safe, while applauding while Americans who were ignoring the rules that might keep them safe.

    I expect the Trump administration to continue to downplay the value of testing and even to interfere in data collection as the pandemic whips through rural areas. But we will still be able to get an idea of the number of people willing to die for Trump. We may even need a new category, total unnecessary deaths, to go along with the others.

  10. 10.

    Redshift

    @Goku (aka Amerikan Baka): Hopefully that’s true, but

    The research has not yet been peer-reviewed

    Medical reporting in normal times has a bias toward the sensational, and it’s gotten worse with subjects related to covid-19. It sounds plausible, but something shouldn’t be described as true based on unpublished research.

  11. 11.

    BBA

    AIUI, the reason why the 1918 flu doesn’t loom as large on our collective memory as its death toll would suggest is that pandemics and disease were just part of life back then. Antibiotics were still years away, after all. A particularly bad flu season just wasn’t anything special.

    With modern medicine, we’ve forgotten what that was like.

  13. 13.

    West of the Rockies

    Okay, I will confess that my sarcastic first reaction (red state Trumplings will suffer) is, “That’s a bummer, man!”

    But going high (when “they” go low) and better angels tell me not to linger on that response.

    I hope they do alright.  More so, I hope they learn humility, compassion, and some fucking gratitude.

  14. 14.

    Goku (aka Amerikan Baka)

    @Redshift:
    That’s true, but I have seen other studies that prove that surgical (or otherwise) masks are better than nothing and do provide some protection. Also, while not peer-reviewed, NPR did ask some experts for comment and they did see the study as interesting/sound. I guess we’ll have to see. When I return to work next month, I’m going to use that nylon overlayer along with my molded surgical masks. Hopefully, that will create a better seal

    I expect the Trump administration to continue to downplay the value of testing and even to interfere in data collection as the pandemic whips through rural areas.

    So do I. Arizona has already done this. The state department of health has instructed local state universities to stop modeling and have cut off the date needed for modeling as well

  15. 15.

    HumboldtBlue

    As well as California has done in addressing the emergency, the Lost Coast is prime for some wingnut fuckwittery. We have two (well, one-and-a-half now that layoffs have hit Mad River and the one is a fucking Catholic hospital) hospitals and the region has always struggled to attract and more importantly retain medical professionals.

    We’re not as bad off as others but just like with an earthquake, sometimes that first jiggle is just the harbinger of a rumbler.

  16. 16.

    West of the Rockies

    I’m in a purple university town in a red county in super blue California.  I see a plurality of masks in stores and damn few in the park.  The deadly cocktail of ignorance and arrogance–shaken, not stirred–is on display more than I’d like.  Rural folks do not like to be told how to protect their dumb asses.

  18. 18.

    Amir Khalid

    This news, an Associated Press story via The Guardian’s liveblog, wants highlighting.

    A report by the US Centers for Disease Control and Prevention (CDC) was shelved by the White House, according to AP News.

    The document includes step-by-step guidance on how and when local authorities should allow businesses to reopen and life to resume as normal.

    The 17-page report was scheduled to be published on Friday but now the guidance “will never see the light of day”, a CDC official told AP.

    It urges businesses to slowly reopen while continuing to observe social distancing. Trump has pushed for a rapid reopening despite fears of a surge in coronavirus cases.

  19. 19.

    Goku (aka Amerikan Baka)

    @West of the Rockies:

    I’m in a purple university town in a red county in super blue California.  I see a plurality of masks in stores and damn few in the park.

    This is only going to get worse as the weather warms up. Masks can apparently get pretty uncomfortable in hot and humid conditions. I can kinda see why in parks, because it’s the open air with ideally lots of room to social distance, but as crowded as parks (and beaches) have been recently, it’s not going to work. I do wonder how much is it ignorance/conscious defiance at this point or just an inability to get face masks.

    My father recently bought some cotton face masks from some outfit but they were fairly expensive. I was lucky that I was able to get a hold of 30 molded surgical/dust masks from the store I work at in early March. I feel they probably offer better protection than the fabric ear loop masks both because of the non-woven plastic material they are made from as well as tighter seal to the face due to being “cup”-shaped

  20. 20.

    West of the Rockies

    @Amir Khalid:

    Truly, Trump and his cronies should be pilloried, tarred and feathered, and then hung.  History books will not be kind to them.

  21. 21.

    Goku (aka Amerikan Baka)

    @Amir Khalid:

    I saw that earlier! After the Flynn bullshit, I feel even more infuriated. I feel like so many US states are reopening too early without the right resources in place to quash outbreaks, even as cases are still rising. If you ever ask the Trump sycophants about why other countries have been able to control their outbreaks, you get, “well, we have a big population!”.

    And then they complain about how the media supposedly didn’t care about all of the H1N1 deaths. 12,500 over the course of a year vs 75,000 in 3-4 months isn’t anywhere close

  22. 22.

    HumboldtBlue

    @West of the Rockies:

    We do, but that’s more prevalent up north in Del Norte county.

    That doesn’t mean Jethro, Dougie and Booner aren’t ready to take up the flag for the sort of Sheriff who claims he is the lone Constitutional authority in the county.

    There’s a whiff of Oathkeepers up here and part of that is because we are saturated with law enforcement. We have local, county, state and feds due to the Supermax in Crescent City and all of the state and federal land, as well as a large and very active Coast Guard station.

    Combine that with a cannabis black market and the efforts to battle that from a government standpoint and we have a lot of sworn officers for a region that has a population of under 500K.

    A lot.

  23. 23.

    West of the Rockies

    @Goku (aka Amerikan Baka):

    If you are walking briskly or trail running, a mask is miserable.  I keep mine with me, and if I can keep 6+ feet distance from other people, I don’t put it on.  If it looks iffy, I don it immediately until the exposure possibility has passed.

    We’ve had 18 cases in this county.  16 have recovered.  No deaths.  Some people are too lax as a result.

  24. 24.

    West of the Rockies

    @HumboldtBlue:

    I was a civilian in law enforcement from ’89-02 (evidence tech and CSI).  Somewhere in the mid 90’s there was a noticeable militarization (in terms of attitude and shaved heads) that took over.  I think that was to our national detriment.  I escaped to go teach college English, and haven’t missed it at all.

    Of course, now that I quit teaching in ’16, I miss that also not one bit.

  25. 25.

    Goku (aka Amerikan Baka)

    @West of the Rockies:

    If you are walking briskly or trail running, a mask is miserable.  I keep mine with me, and if I can keep 6+ feet distance from other people, I don’t put it on.  If it looks iffy, I don it immediately until the exposure possibility has passed.

    That’s pretty reasonable.

    We’ve had 18 cases in this county.  16 have recovered.  No deaths.  Some people are too lax as a result.

    That’s what will get rural areas eventually. My county, while not particularly rural (pop. roughly 229,000), has had 1044 confirmed cases, 115 deaths, and 254 hospitalizations. Most of the cases have been in people 60+ and the majority of the deaths have been residents of long-term care facilities according to the ODH. No idea on the number of the recoveries as the ODH doesn’t list that information, but it’s reasonable to assume some have by now

  27. 27.

    West of the Rockies

    @Goku (aka Amerikan Baka):

    You have NO idea.  I had colleagues, tenured professors, who quit because they just could no longer take the essays.  To read and meaningfully comment on a 3-5 page essay and note a half dozen (or 3 dozen!) mistakes takes easily 15 minutes.  Multiply that by 20-25 students.  Multiply that times four classes.  First draft, revision/final draft, a 10-page term paper at the end of the semester…

    It’s brutal.

  28. 28.

    West of the Rockies

    @Goku (aka Amerikan Baka):

    I’m in Butte County, California.  We had the Paradise fire in November 2018 (my home town though I moved away on ’95).  Now the Coronavirus… The “were tough, we can take it” attitude is being tested, and unfortunately, a lot of people here are under-informed or combative about being told to protect themselves and each other.  It’s a weird mix of beleaguered but militant.

  31. 31.

    rikyrah

    Biden's current national polling edge isn't just about a swing among seniors but a swing among 45-64 year olds. Here's last week's Nationscape survey vs. the 2016 exits.18-29: Biden +19 (Clinton +18)30-44: Biden+8 (Clinton +8)45-64: Biden +6 (Trump +9)65+: Biden +6 (Trump+8)— John Sides (@johnmsides) May 7, 2020

  32. 32.

    sanjeevs

    @rikyrah: In the Monmouth poll Trump’s overall favourable figures haven’t moved much (low 40s to around 40) but his strong favourable figures have gone from 35 ish to 24.

  34. 34.

    rikyrah

    Maddow did a segment on Nebraska.

    Multiple meat packing plant breakouts

    Refuses to release the numbers for nursing homes

    Has not tested one prisoner.

     

    Trying to hide all the test results.??

  36. 36.

    Amir Khalid

    @rikyrah:

    I keep hearing from American jackals how coronavirus testing is rationed over there, in a way that simply isn’t done where I am. About the lack of contact tracing, which is a vital part of the Malaysian (among other countries) strategy against Covid-19. About the lack of informed, coherent federal leadership. It makes me fear for America.

  39. 39.

    opiejeanne

    @Amir Khalid: Those things worry me too. I feel like I’m not going to be comfortable leaving this property for the rest of my life, especially if it takes 4 years before we can be vaccinated, if ever.

    The fastest creation of a vaccine took 4 years. Mumps.  1963 – 67, but it was never available to me from 1967 until about 10 years ago. The chickenpox vaccine existed but wasn’t available to my kids when they were growing up in the 70s-90s, so all three had chickenpox in the 1980s.

  42. 42.

    Sebastian

    @opiejeanne: 

    But that was almost 60 years ago and technology is way more advanced. There is an unreal amount of genetic folding computing happening right now to help fighting COVID-19. Sheer compute power that was unthinkable just a few years back, much less 60.

    And on top of that, a lot of work has been done for SARS and this is being used so scientists are not starting from zero.

    Hang in there.

  43. 43.

    Gvg

    @opiejeanne: why wasn’t the mumps vaccine available to you? I was required to have it to go to school. I had the chicken pox late 60’s before kindergarten but I thought the vaccine was soon after.

  44. 44.

    opiejeanne

    @Gvg: Because I was 17 by the time it was available, and with limited quantities available, they gave the vaccine to younger children first. My kids had the MMR to enter school.

    I’m not sure but maybe it was thought that most kids had already had the mumps by the time they were my age, and younger kids are “disease vectors”. My best friend had it when we were 5. She lived two doors down and we played together all of the time, so it’s a wonder that I never caught it.

  45. 45.

    I'll be Frank

    Slow in the rural? My in-laws live in a rural county with no hospital, a Federal prison and only one grocery store. They have gone from zero to 33 in a week. It won’t be slow.

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