We, as a society had made a collective decision or indecision to resume economic and social activity even before the anti-racism and anti-police brutality focusing event of Mr. Floyd’s murder by cops took place.
I am working with the COVIDExitStrategy.org to track states progress on meeting the White House gating criteria for re-opening. There are three main areas with six criteria:
- Downward trajectory of Influenza Like Illness within past 14 days
- Downward trajectory of Covid Like Syndromic cases reported within past 14 days
- Downward trajectory of documented COVID Cases within past 14 days
- OR
- In context of constant or increasing testing, downward positivity rate of tests
- Hospitals have sufficienct non-crisis/non-surge capacity available to treat current patients
- Healthcare workers are well protected.
As of this morning, NO STATE has met all of these criteria. A few states are close. Yet all states have gone to at least a Phase 1 re-opening even as testing is still insufficienct to meet White House goals much less independent analysts’ predicates for safe re-opening. Testing and tracing is not widely deployed.
This is the case today. It was the case yesterday. It was the case on May 15th.
Yet we have made the societal wide decision that stay at home is over.
Breaking News: Casinos are filled with people choosing not to wear masks, and who generally poorly understand risk https://t.co/fj3DJTCUoB
— Kevin Collins (@kwcollins) June 7, 2020
So what should be communicated for public health in the context of a societal wide decision that first best advice will be blithely ignored?
I think the second best advice is to adopt harm reduction communication. That means acknowledging that people are going to be protesting and out and about and then offering strategies to minimize the very real risk of COVID spread. It won’t be perfect, but it will be much better. It is the same logic of safe injection sites for individuals addicted to injectable opioids and condom distribution to sex workers.
So what is the advice.
- If you feel like you have symptoms or know you have likely been exposed to someone who is infectious, go get tested and STAY HOME
- If you have significant risk factors, be aware of them and acknowledge your risk in your decision making.
- Stay outside
- Keep moving
- Keep a mask on and wear it correctly (over the mouth AND nose)
- Hand hygiene
- Keep physical distance as much as possible
Almost all of the protests are outside. Many but not all have significant movement through marches/walks. The Durham protest I was at on Thursday and the Chapel Hill march that my wife and daughter attended on Saturday were 97% or more masked. Looking at pictures from other protests, masks are fairly common to very common.
We as a society have made a collective decision to re-engage in economic and social activity despite still having insufficient testing, low contact tracing capacity and a fairly high baseline level of background infections. The collective socio-political decision is to engage in harm reduction while accepting significant risk of increased deaths from COVID. Protesting is part of that decision.
Enhanced Voting Techniques
No, the racists assholes forced this on us because they decided only poor and minorities were dying. That’s part of the BLM protests.
mvr
Yeah, I appreciate the overall point of the post but didn’t like the “we as a society framing” either. Aside from the fact that for some groups people were required to work whether or not they were at risk, that requirement is spreading as the governments (Federal and State) have normalized and even promoted pressure to return to work. Also doesn’t help that Republicans are blocking further assistance for those who cannot safely work. If your work says you’ve got to go back to keep your job, what are you going to do? This isn’t society as a whole making a decision.
@Enhanced Voting Techniques:
WereBear
@mvr: All true. So guess what? Assholes demanded we open up, and this is part of it.
Matt McIrvin
There’s a LOT of geographic variation in how seriously people are taking this. You can see that in the state-by-state case numbers. Massachusetts and New York are still mostly taking it seriously, or were until the George Floyd protests got big (it’s been long enough that we should start to see effects of that very soon if they exist). They’re completely laughing it off in Arizona and will probably do so until the numbers get as bad as they got in the Northeast.
There was a lot of worry early on that cloth masks would give people a false sense of security, but until recently, the people most likely to ignore other recommendations weren’t masking up either. I’m wondering if the protests might be our actual first example of the “false sense of security” effect since most people actually are wearing them there, but they’re gathering in crowds. For many, perhaps most, it’s a conscious decision to take a calculated risk on moral grounds, but there also could be some people figuring that if they wear their mask they’re OK.
Bob Hertz
Most of the Western states had very few COVID cases. Of course this is due to low testing capacity, but there were few hospitalizations as well.
A resident of South Dakota who did not work in meat packing would know of no one who had a serious COVID case. Even the deaths that did occur in these states were often tied to nursing homes.
A lockdown made no sense to these folks.
Enhanced Voting Techniques
@Bob Hertz: I though South Dakota never had any lock down and the state fought it in the cities that tried it after the meat packing plant out breaks.
But it’s just more “It’s only poors and browns dying, so who cares?”
Matt McIrvin
@Bob Hertz: Yeah, and in some of those states (the Southwest particularly), that’s gonna change really soon. Looking at the AZ numbers is like watching a car speeding toward a brick wall.
David Anderson
@Enhanced Voting Techniques: The assholes get a vote and they get listened to more than the non-assholes under the current government
WereBear
I never saw the sense in that. I now regard all the FUD about masking as both Asian prejudice and their attempt to cover up their lack of preparation, like all the missing PPE which would have saved more medical professionals.
Armadillo
Hi David, thank you for this and all your analysis. Can I ask how recovery from COVID-19 or positive antibody tests factor into the risk analysis? If the answer is “you should learn to Google” that’s fair. But thought I would ask. The situation I am thinking about:
My brother-in-law has recovered from COVID (although he still can’t taste everything). His wife, my sister-in-law, has tested positive for antibodies to COVID but isn’t aware of ever having the disease. They have two children (6-9 y.o.) who mysteriously have negative antibody tests.
Are they safe to go out in public (on the theory they are immune) and then interact with my elderly in-laws? Are their children potential vectors for disease?
Mel
Agreed. It is NOT “we, as a society” who decided to open things up.
It was purely a political decision, and it is being imposed at great risk upon not just the MAGA nuts who crowed and screeched against lock downs, but also on the majority of citizens who understand and stated in polls that it is too damn soon to open things up.
I’ve already lost two people to complications from COVID-19. Both were taking all possible precautions (mask, 6 foot distancing, gloves, proper hand washing, etc.) but became ill anyway. We are sure that one person got exposed at work (nursing), but the only way the other person could have been exposed was through a non-visibly symptomatic carrier at her local grocery, farm market, or pharmacy, since those were her only two trips out in the two weeks preceding her illness. She only ventured out after stay at home orders were lifted. She reported that after her trips out, she was worried, b/c people were not taking precautions as seriously BECAUSE the lifting of the stay at home order made them feel safe to behave as they would have before the pandemic. She was in her 70s, and died a terrible death, first choking on her own body fluids, and then meeting her final end through a Covid-19 induced clotting cascade and a massive stroke.
Harm reduction is like depending upon the rhythm method of contraception – it’s not “if” it’s going to fail; it’s “when” it’s going to fail, because fail it will.
The protests are necessary. They are essential to rooting out evil. They must happen.
But let’s not conflate or confuse a politically motivated, anti-science, long-term “re-opening the economy” without testing, without adequate PPE, and without reliable vaccines or treatments, with the protests. They are not the same thing.
Matt McIrvin
@WereBear: In the early articles disparaging cloth masks there is a certain undercurrent of “East Asians do that for inscrutable cultural reasons, not because it actually does any good”. Just saw that again in an anti-masking article from back in April when dinosaurs roamed the earth.
The early discussion in the West now seems hopelessly confused by people mixing up the question of whether cloth masks are adequate personal protective equipment (which was a relevant question in itself because hospitals were so short on PPE that nurses were resorting to homemade cloth masks) with whether they have a collective society-wide benefit.
Mel
To clarify: the protests have to happen. The “re-opening” did not. There were methods to stabilize income, methods to test and track cases, bridge methods to fund small businesses and keep them afloat during a shutdown. Those methods weren’t implemented b/c Repubs didn’t allow them to be implemented, because, as others have stated, they don’t want poor people, working class people, black people, brown people, single parents, sick people, disabled people, or any other non-wealthy and/or or non-white people to be safe and secure.
Why were bowling alleys, barber shops, tanning beds, nail salons, etc. the first places instructed to re-open? Take a look at the wages paid to employees who work there, and who will be forced to have high risk exposures every day.
Take a look at Ohio, for example, where employers were instructed to report any employee who was afraid to come back to work because of exposure risks, in order that the state could then cut off that employee’s unemployment. Think about the smash and grab that corporations did with the funds intended for small business survival loans.
The re-opening is all about the corporate bottom line and the right-wing agenda, and nothing about “the will of the people.”
David Anderson
@Armadillo: the big question is how confident are we that any individual actually had COVID and recovered from it. Given that your BIL had obvious symptoms, confidence is high for him and reasonably high for your SIL.
We think that recovery from COVID offers at least an intermediate term immunity shield. Reinfections have not been noted beyond what we would expect from false positives from tests.
Once recovery has happened, they should be safe to go out, but check with their docs first.
WereBear
@Mel: I’m so sorry for your losses. The encouraged irresponsibility infuriates me.
Mr WereBear’s doctor heartily approved of my Lock Him in a Vault plan, and I’ve got risk factors myself; even aside from our age.
I only go out at lengthy intervals, observing all precautions, then take a shower and use an airlock approach with fresh clothes. If anything can be left in the vehicle to age for 24 hours, it is. Refrigerator stuff either quarantined in a separate fridge or wiped down.
sdhays
The family and I were in Arlington, VA on Saturday, and what we saw was absolutely shocking. Clarendon was buzzing. People were standing in line – no social distancing – to get a table for brunch. Tiny outside tables were packed with people. It was no different from what you’d have seen last year at this time. And all this while the numbers just across the river in Maryland and DC are still quite concerning.
I think the root of the problem is the utter failure at the top. The things that needed to be done weren’t done, and there hasn’t been a competent, sustained effort to correct that nationally, and there never will be. So there’s a tacit acknowledgement that waiting to hit those guidelines is like waiting for Godot – they’ll never arrive. And I think we’re definitely still suffering from the CDC’s decision to lie about masks early on in a stupid effort to prevent hoarding.
Ohio Mom
Armadillo: I had three doctors appointments recently, with specialists for checkups. I had a list of questions about COVID that I thought showed I had some understanding of the basics.
The answers I got all boiled down to, No one can know about any particular individual’s chances.
Which is pretty much true for any condition. Doctors can say, this medication or procedure is successful in 98% of cases, or the prognosis for your condition is 98% whatever, but they can’t ever say in advance if you will be in the 98% group or the 2% group.
One of my doctors shrugged and said, The virus will just burn through until there is herd immunity; another, ever chipper, declared there will be a vaccine in a year or two (I think these two predictions could coexist).
The third (the smartest of the bunch) said it depends on the individual’s immune response. She added that she decided she is just going to do what she is going to do (almost a koan).
One more appointment to go, this one with the internist next week. I’ll be asking her too.
Armadillo
@David Anderson: Thanks very much. I guess I should add that my BIL tested positive for COVID as well.
@Ohio Mom: Thank you for the detailed response. Good luck with the remaining appointments.
Ohio Mom
Mel: My condolences.
It’s infuriating when there are so many “If only”s: if only your friend the nurse had had better protections at her job, if only your 70 year old friend’s fellow-shopper had stayed home, or worn a mask, or otherwise done the right thing.
It’s like all of us are conducting our lives behind enemy lines.
The Moar You Know
Well, I’ll be the outlier on this thread.
We sure did. Given the compliance with sanity I’d seen here in my SoCal beach town, I would have disagreed and said “oh yeah, most people are OK with lockdown”. Until June 1, when the state “reopened”.
It took one day. Forget masks, except inside grocery stores and Costco where they enforce it, those are gone. Forget any of the state limits on restaurant occupancy or distancing or anything else, that went right out the fuckin’ window. Took a drive through downtown on 101 on the 3rd, every restaurant at fire department capacity or more (butts to nuts as a military friend of mine says) no masks, people waiting outside in clumped crowds, no distancing. There were well north of 3000 people out there. On a Wednesday at 5pm. And it’s been like that every day since. I think bars reopen this week. That’ll help things in the wrong direction.
At any rate, I got a completely wrong impression. I thought most of my fellow residents were down with not spreading the plague, but they’re tired of sitting in front of their computers at home, they are REALLY tired of having their kids at home, and simply don’t give a shit anymore (and don’t believe that this is as bad as it is, in part, I suspect, because we just didn’t get that many cases here. Maybe we did too good of a job at the beginning). There’s five million people in San Diego County and as of today, only 312 COVID deaths. The hospitals have been fine. Few people know anyone who has had it. So at least in my southwestern corner of the planet, Mr. Anderson got it right – the people decided, and they’ve decided that we all get to take our chances whether we want to or not.
I do not, but that decision got made for me last week, when my employer put me in charge of reopening the office. So I’ve been going through both the CAL/OSHA and Fed OSHA guidance on COVID workplace safety, and I’m going to fight a full reopen all the way (I’ve already managed to sell the idea that nobody is going to be in the office more than two days a week, and I’m fighting for more of that, but will lose.) It helps that owners are square in the kill zone (65+, cardiac and autoimmune issues) so they are on board with most precautions: we will be masked, we have separate offices, I’m trying to figure out how to handle the few shared items (scanner and copier) and trying to figure out who gets to be the cleaning bitch for things like all the common door handles and the handrails on the staircase.
I resent this. I really do. I’ve got a good friend who worked bioterrorism for Interpol and Sandia for a couple of decades, and as he’s fond of saying, “this isn’t even the end of the beginning, much less the end of COVID”. We’ll get that second wave, we’ll get the full hospitals and we will get a shitload of dead people. And it was totally avoidable.
But we gotta give the people what they want. And they most definitely want this.
Ohio Mom
Armadillo: I just saw this and thought of you. It’s from today’s NYT: https://www.nytimes.com/interactive/2020/06/08/upshot/when-epidemiologists-will-do-everyday-things-coronavirus.html
TL/dr is, there is no consensus among the experts, mostly because virus protection efforts clash with other highly valued goals. For example, young epidemiologists who want to date in hopes of finding a life partner.
I’d say I hope this helps but I know it won’t.
jl
Thanks for important and informative post. I’ll check out the site. I like that, from David’s description, does not overly rely on confirmed cases, since the significance of that is difficult to evaluate given the differences between states and over time in testing strategy and volume. And some states are playing games with that measure.
I think two measures are key, very low current prevalence of the disease, and ‘Testing and tracing’ is very widely deployed. Here is SF Bay area, most counties are moving at a glacial pace in getting that capacity up to speed, despite all their promises.
Some counties seem to have fallen in love with permanent social distancing policies, that are getting increasingly desperate, over elaborate and unworkable. And they got some pushback from governments to make more progress on their promises. But, like everything else for us ‘lesser people’ no money for it. And all the while, more and more countries, big and small, rich and poor, are outpacing this huge failed state by miles on progress on returning to something normal. Not the sad excuse of ‘new normal’ we in the US babble about and cannot even manage to do that, but something resembling an reasonable approximation to a real normal. Like, schools opening without any sign of a big second wave.
The US continues to deliver a performance that would embarrass a self-respecting failed state with a competent strongman. Sadly.
jl
@The Moar You Know: Sad that so many people in the US are too childish to take even the easiest measures, like wearing masks, that would allow them to go about their business and get back to sustainable economy and society that they claim they want, like wearing a damn mask. Then they whine and cry and complain, while they plunge ahead on a self-defeating course of action.
frosty
The site you linked ( COVIDExitStrategy.org ) is really good. I’ve been looking for this info and wondering if my PA and MD were being smart about reopening. Conclusion: PA almost, basically not enough testing; MD no. Lots of indicators pointing the wrong way.
The Moar You Know
@jl: Agreed. Soapbox time:
We’ve done a great job as a society of educating people that they have rights.
We have utterly failed in three important, vital, related areas;
WaterGirl
@frosty: I fixed your link for you.
I also like this site from ProPublica: States are Reopening
Matt McIrvin
@Ohio Mom: Every so often, Erik Loomis (who of course is not any kind of doctor or public-health expert) posts on this at LGM and he seems to have this sort of doom-ist defeatist attitude: you’re going to get COVID, I’m going to get COVID, we’re all going to get COVID, all the old people are gonna die, there’s nothing we can do about it so we might as well take the punch with just enough mitigation in place to keep the hospitals from being swamped.
It kind of irritates me. I tend to be far more optimistic about science/tech than Loomis is. But my impression is that there’s actually a pretty good chance of either some kind of vaccine or prophylaxis or a better treatment regime (or some combination of these things) emerging in the next couple of years. If that’s true, then any degree of slowing-down we can manage saves a lot of lives, even if it’s the kind of half-assed stuff we’ve been doing. He seems to just be assuming automatically that there will be nothing.
Bill Arnold
@Matt McIrvin:
Perhaps a few, but most protesters are figuring that if everyone is masked/has a face covering on, then the probability of transmission will be reduced substantially, during protests outside where the transmission rate is already very low.
In New York, nearly all protesters were masked. (Police, not. Arrested protesters were treated with reckless disregard for their health.)
Since you’re focused on New York, please look at the new case bar charts at NYSDOH COVID-19 Tracker., Look at all the history, and note when the Cuomo’s masks-indoors-in-public-places order was issued (Apr 17, 2020)), +5-10 days. Also look at the other states with similar orders. (Not yet counting Virginia which had an order May 29.)
Bill Arnold
Re-linking this since it’s to the point:
Perspective: Reducing transmission of SARS-CoV-2 (Kimberly A. Prather, Chia C. Wang, Robert T. Schooley, Science 27 May 2020)
Here’s a summary:
Nice short abstract:
TL;DR – this image: https://science.sciencemag.org/content/sci/early/2020/05/27/science.abc6197/F1.large.jpg
Only want to read a few sentences:
Dr. Omed
In re Las Vegas: Where’s Trashcan Man when you really need him?
JaneE
My county met the criteria to go to the next phase of re-opening. No new cases in probably 3 weeks. And in the last week we have 3 new cases. I won’t see the new numbers covering the weekend till late this afternoon, or tomorrow in the local news. Not an auspicious beginning, I would say.
Major Major Major Major
Thanks David, this is a good write-up. I wish people understood harm reduction better. If only we had some sort of centralized public health authority that could handle communication about the tradeoffs around reopenings, as well as how to wear masks and how they work. (I suspect conservatives would be more amenable to it if we finally allowed ourselves to point out that they help protect the wearer.)
I have to agree with David’s framing about “we as a society”, though. State officials pursuing reopening are, for the most part, following the wishes of the majority of their constituents. And the people who oppose reopening are now out protesting, which is probably worse than a day at the beach. Social distancing is over; we have collectively decided this.
ETA: Gotta agree with @The Moar You Know too. The good liberals in the places I’ve been lately (Midtown East, East Village, Williamsburg/Greenpoint) are crowding parks, sidewalk bars, restaurants, with zero regard for distancing, though many are masked when they aren’t putting things in their mouths.
Brachiator
Coming late to the thread. Just wanted to note that there is a lot of good stuff here.
@Matt McIrvin:
Because we have learned a little bit more about science and nature, some of us seem to have gone from “It’s in God’s hands” to “Life is tough” in deciding that older and vulnerable people are basically on their own.
In the UK the advice for those who might be most at risk to becoming ill is “just stay home.” Nothing is being done to try to accommodate these people, or to change much in the world so that they might be better able to also continue their daily lives.
Bob Hertz
@sdhays:
Thanks for your observations. The crowd at the restaurant meant that servers and cooks now had a job, and maybe the restaurant owner will not need to declare bankruptcy.
This is one reason why the restaurant patrons might be feeling OK (for now)
As a side comment, I have never understood why anyone would stand in line waiting for a table. This is uncomfortable for me, (I have sore hips), plus it guarantees that the meal itself will be rushed.
Bob Hertz
@Mel:
Thanks for your posting. I read your account of the death of the 70 year old woman, and I was saddened. I do a ton of reading on the virus, and I have kind of sllid into the opinion that the only casualties were persons in nursing homes or those exposed to super-spreaders. Yet there are the cases like the one you described, which sounds like they can happen even with some social distancing going on.