Coronavirus

[Dr. J]

But the authorities may not enforce the requirement ?

I believe the authorities can enforce it on stores (fine them) but not on customers.

 

[AlanSubie4Life]

Thank you for proving my point, beyond a reasonable doubt, that this thread has gone completely off the rails.

I half expect to see more explicit "Critical Theory" or Postmodernism explanations of pandemics next. Where's the popcorn...?

Since your original “off the rails” complaint (and @SVMike ‘s ) was perhaps directed at my post about superspreading at the White House, let me explain my frustration:

I am in San Diego. We have a relatively low disease burden fortunately.

I cannot go back to my office and work (where I can work more efficiently), because it is not safe. My manager says that no one will be forced back to work because it is not safe, and likely if people do want to go back for their own reasons, they’ll have to sign a waiver. We can’t get N95 masks and other PPE. The automated temperature checking and mask checking that will be installed will not be sufficient to ensure that people do not enter the office in a diseased state.

While we have a mask order in San Diego County, when I went back to office to briefly pick something up in the lobby, I had to wait outside 10 minutes because the cleaning staff were milling around inside without masks (probably because they are not provided appropriate quality PPE for free, and possibly because the appropriate behaviors are not being modeled by the President).

One option to reduce risk is to just take a PCR test every time before entering the office. But then the ridiculous question comes up: “how much does a test cost?” Why is this even a question? Why is anyone paying for a test?

There has been no effort to mount a coordinated response to eliminate the virus nationwide, and we’ve been at this for 3.5 months. And still no N95s for all. Dentists are getting them from their friends and reusing them. And I still hear people asking “how much do tests cost?”

I can’t rock climb at the gym, because it is not safe. I can’t eat bean and cheese burritos at my favorite Mexican restaurant because it is also not safe. All I can do is mountain bike (fortunately quite safe).

To visit my parents in Oregon without potentially killing them, I have to find a way to get there without visiting any bathrooms or restaurants or hotels. While possible, my wife is not the biggest fan.

The federal government is there to defend us from all enemies, including viral ones! Where are they? They appear to have largely given up. In fact, they have declared it is time to celebrate!!! Are they gaslighting me?

In the next couple weeks we’re going to rehash the lessons from March - you can’t stop an outbreak quickly that started three weeks ago, and deaths and even hospitalizations lag infections. I hope it is all over in a few weeks and states (since there is no federal government) respond NOW (meaning last week when it was obviously really not good). That way it can be over in a few weeks. It’s not going to be another NYC, but that is a low bar.

But after this blip are we going to finally learn our lesson and eliminate the virus? Or are the feds and everyone else going to keep acting like deranged fools?

Yeah, I’m frustrated. I want something to generate an actual response out of leadership. If that takes a COVID infection, so be it. This is not that f’ing hard. We’re the greatest country in the world - what is wrong with us?

I suppose the next thing will be a great national 4th of July celebration where everyone gathers together to cheer our great victory?

 

[dfwatt]

SNG-001 any good?
Potentially Life-Saving COVID-19 Inhaler Using Synairgen Drug to Carry Out Nationwide Trials in the UK

Might be useful. Interferons help the body shut down cells that have been co-opted and turned into viral factories, and IFN 1b has a complex transcriptional profile with interestingly enough some anti-inflammatory properties. But once again it's untested. And interferons have legendary negative effects, particularly on CNS function.

Oh, so its now OK to say I regret to inform you that I wish you were dead?
Sorry, there should be no excuse for anyone saying things like this.
Everyone should strive for a high level of decorum or this thread and all of social media just spirals to the least common denominator.

The other incongruity about which you seem unconcerned is that the person most severely lacking decorum in the National conversation, the president of United States, is somebody you appear to be defending, and you have posted several 'disagrees' in relationship to a number of negative posts about President Trump's behavior and personality.

 

[Dr. J]

even with the politics, except for the recent sugar arguments.

I keep getting confused about this, thinking how TMC makes "sugar" a replacement for sh1t. But then I remember there was an extended debate about the forms of sucrose. Everyone disagreeing with me has sugar arguments!

 

[Singuy]

We have 19+ Covid pts in our hospital in Central FL. Everyone of them is on remdesivir which is pretty available right now. Our cases are increasing but out ventilator usage is not. Looking at our 7 day moving average on deaths overall in the US, it is decreasing. It's not conclusive or anything but just letting you guys know the drug is being used and available for every Covid + pt we have.

 

[Dr. J]

Since your original “off the rails” complaint (and @SVMike ‘s ) was perhaps directed at my post about superspreading at the White House, let me explain my frustration:

I am in San Diego. We have a relatively low disease burden fortunately.

I cannot go back to my office and work (where I can work more efficiently), because it is not safe. My manager says that no one will be forced back to work because it is not safe, and likely if people do want to go back for their own reasons, they’ll have to sign a waiver. We can’t get N95 masks and other PPE. The automated temperature checking and mask checking that will be installed will not be sufficient to ensure that people do not enter the office in a diseased state.

While we have a mask order in San Diego County, when I went back to office to briefly pick something up in the lobby, I had to wait outside 10 minutes because the cleaning staff were milling around inside without masks (probably because they are not provided appropriate quality PPE for free, and possibly because the appropriate behaviors are not being modeled by the President).

One option to reduce risk is to just take a PCR test every time before entering the office. But then the ridiculous question comes up: “how much does a test cost?” Why is this even a question? Why is anyone paying for a test?

There has been no effort to mount a coordinated response to eliminate the virus nationwide, and we’ve been at this for 3.5 months. And still no N95s for all. Dentists are getting them from their friends and reusing them. And I still hear people asking “how much do tests cost?”

I can’t rock climb at the gym, because it is not safe. I can’t eat bean and cheese burritos at my favorite Mexican restaurant because it is also not safe. All I can do is mountain bike (fortunately quite safe).

To visit my parents in Oregon without potentially killing them, I have to find a way to get there without visiting any bathrooms or restaurants or hotels. While possible, my wife is not the biggest fan.

The federal government is there to defend us from all enemies, including viral ones! Where are they? They appear to have largely given up. In fact, they have declared it is time to celebrate!!! Are they gaslighting me?

In the next couple weeks we’re going to rehash the lessons from March - you can’t stop an outbreak quickly that started three weeks ago, and deaths and even hospitalizations lag infections. I hope it is all over in a few weeks and states (since there is no federal government) respond NOW (meaning last week when it was obviously really not good). That way it can be over in a few weeks. It’s not going to be another NYC, but that is a low bar.

But after this blip are we going to finally learn our lesson and eliminate the virus? Or are the feds and everyone else going to keep acting like deranged fools?

Yeah, I’m frustrated. I want something to generate an actual response out of leadership. If that takes a COVID infection, so be it. This is not that f’ing hard. We’re the greatest country in the world - what is wrong with us?

I suppose the next thing will be a great national 4th of July celebration where everyone gathers together to cheer our great victory?

I think the Nation (sic) has given up on leadership and is awaiting a vaccine: the deus ex machina of plagues.

 

[SageBrush]

Probably, but this is: Counties can require stores to require masks of customers and employees. One is a right, the other is an obligation.

NERD ALERT

Obligations and Rights are the Yin and Yang of law. Neither exists in isolation. One party's right is another party's obligation.

In your example the stores had a choice about enforcing mask wear; now they do not if the County puts out an order. Or to use the above right/obligation framework, the County was obliged to respect the store owner choice, but that may be rescinded.

 

[dfwatt]

NERD ALERT

Obligations and Rights are the Yin and Yang of law. Neither exists in isolation. One party's right is another party's obligation.

In your example the stores had a choice about enforcing mask wear; now they do not if the County puts out an order. Or to use the above right/obligation framework, the County was obliged to respect the store owner choice, but that has been rescinded.

Exactly. It's amazing how few people appreciate that rights and obligations or responsibilities are mirror images in social / political space and you cannot have one without the other (especially those who loudly trumpet their rights while trampling on other people's because they cannot see the complementary obligation.) And without both of them you can't have a society. Otherwise it's just a free-for-all where might makes right and the most dominant sociopath wins. And the United States looks like it's really close to embracing might-makes-right notions, if we are to take the comments of the Chief Consiglieri William Barr seriously (where he talks about "history is only made by the winners"). We've never had a more bold-faced sociopath who is not really hiding his sociopathy much anymore as chief executive. We had better wake up and wake up fast!

 

[SageBrush]

I believe the authorities can enforce it on stores (fine them) but not on customers.

Yet the stores have no law enforcement arm.
Is your governor asking stores to take on the role of the police ?

 

[SageBrush]

Exactly. It's amazing how few people appreciate that rights and obligations or responsibilities are mirror images in social / political space and you cannot have one without the other. And without both of them you can't have a society. Otherwise it's just a free-for-all where might makes right and the most dominant sociopath wins.

It is the problem of trumperism in a nutshell. They want e.g. 'freedom' to be idiots but refuse to understand (or simply do not care) that they are forcing others to accept the obligatory risk of getting infected by them and to pay the economic consequences when they get sick.

 

[AlanSubie4Life]

Also, @FoverM, you may want to encourage your local authorities to get on the ball in Gwinnett County. Just up the street from the CDC!

Probably a lot of infections making their way down from South Carolina and North Carolina on I-85.

You've got the CDC there, so probably a lot of competent public health experts in the vicinity, which gives one hope. Maybe they'll get on it before it's too late. Right now the scale is small enough that it should be manageable with testing (which fortunately Georgia has been pretty good about so far - but they have unfortunately not continued to scale it up and take advantage of their early success). Anyway, the outbreak is still on the scale of what Georgia has dealt with previously...

Don't want it to get out of hand though. Hospitalizations are just starting to tick up, which is not a good sign.

Nice visualization of the states here I saw today...does not take into account test volume though (which is critical to understand the approximate size of the underlying outbreak).

 

[AlanSubie4Life]

COVID-19 Projections have tightened their confidence intervals considerably and lowered their projected number of deaths (due to reducing IFR from various causes).

I tend to think this could still be slightly optimistic, given the current behavior in the "hot" states, but very hard to predict, as it depends on people's behavior at this point. Overall these current outbreaks ARE relatively small compared to the big outbreaks we've seen so far. But we'll see whether they remain that way - I tend to think they have more momentum than this projection gives them credit for (I think it's based on deaths, so it will tend to lag, and I'm not sure how they deal with that). I think there's a real chance that people losing patience with physical distancing and falling for anti-mask nonsense is going to lead to less impact from those measures than expected, and there are now a lot of vectors wandering around, so it should propagate quickly if the transmissibility is high enough to sustain transmission in summer (which it appears to be).

Projecting 184k deaths by October 1st. [155k, 220k]

COVID-19 Projections Using Machine Learning

 

[TespaceX]

COVID-19 Projections have tightened their confidence intervals considerably and lowered their projected number of deaths (due to reducing IFR from various causes).

I tend to think this could still be slightly optimistic, given the current behavior in the "hot" states, but very hard to predict, as it depends on people's behavior at this point. Overall these current outbreaks ARE relatively small compared to the big outbreaks we've seen so far. But we'll see whether they remain that way - I tend to think they have more momentum than this projection gives them credit for (I think it's based on deaths, so it will tend to lag, and I'm not sure how they deal with that). I think there's a real chance that people losing patience with physical distancing and falling for anti-mask nonsense is going to lead to less impact from those measures than expected, and there are now a lot of vectors wandering around, so it should propagate quickly if the transmissibility is high enough to sustain transmission in summer (which it appears to be).

Projecting 184k deaths by October 1st. [155k, 220k]

COVID-19 Projections Using Machine Learning

I doubt that model factors in back to school season, which will likely mean back to work for many folks as well. As I’m trying to stay as up to date as possible on my kids school plans, I’ve followed what’s being planned in other areas and states as well. Many places seem to be attempting to do full-time in-person as usual, especially in districts and counties where parents are needing or wanting to go back into the office.
That model is too optimistic IMO.

Not the best comparison example of what schools could be like in the Fall, but a foster center in FL was in the news today because they had 11 children out of 47 test positive, along with 7 staff members.

 

[AlanSubie4Life]

Many places seem to be attempting to do full-time in-person as usual, especially in districts and counties where parents are needing or wanting to go back into the office.
That model is too optimistic IMO.

Yeah. I agree. Not going to work unless we get rid of the virus or develop a miraculous new preventative/protective treatment that can be administered outside a hospital. It's total lunacy. I know a number of teachers, and none of them have any interest in going back to work to risk a ~0.1% chance of death, and probably closer to 1% chance of hospitalization.

Not the best comparison example of what schools could be like in the Fall, but a foster center in FL was in the news today because they had 11 children out of 47 test positive, along with 7 staff members.

Yeah, the only thing we'll have by fall is a better idea of how much children can transmit the virus. The answer is probably going to be less than most, especially for children who are not teenagers, but enough to be a problem.

I hope I'm wrong, but I think it's just insane to open schools with a virus that is so dangerous to teachers (and parents and grandparents!) floating around.

Seems like we should just get rid of the virus. Testing is still increasing. Maybe it will happen by fall.


I lol'ed when I saw Oklahoma Governor Stitt's clip this morning.

"Do we really think that in July or August or November, coronavirus is not going to be here?"

You can't make this stuff up. Running up the white flag. Such loser talk. Totally un-American.

https://twitter.com/atrupar/status/1273998988669321220?s=20

 

[kbM3]

Surprised this isn’t talked about more:

https://www.newsweek.com/multiple-florida-hospitals-run-out-icu-beds-coronavirus-cases-spike-1511934

Asi understand it even if FL reshutdown today, hospitalizations would still increase for the next 10 days.

 

[dfwatt]

Surprised this isn’t talked about more:

https://www.newsweek.com/multiple-florida-hospitals-run-out-icu-beds-coronavirus-cases-spike-1511934

Asi understand it even if FL reshutdown today, hospitalizations would still increase for the next 10 days.

You do not need to look any further than Ron DeSantis who is one of the most loyal Trumpers among the state Governors to understand why this is the case. I identified myself as someone in healthcare and wrote his administration a long letter 3 months ago suggesting ways in which they could use the time that they had to better prepare. I never heard back, but I wasn't surprised on the other hand that they didn't bother to respond, and I'm not surprised by the way they played this. He is of course taking the Mike Pence / Donald Trump dismissive approach that the increased cases are just due to increased testing. He's also stated recently that any increased cases are due to immigrants. It's really sadly predictable but it's also pathetic and disgusting. Florida is poised to become a major hotspot and has a boatload of vulnerable elderly citizens.

 

[Daniel in SD]

Surprised this isn’t talked about more:

https://www.newsweek.com/multiple-florida-hospitals-run-out-icu-beds-coronavirus-cases-spike-1511934

Asi understand it even if FL reshutdown today, hospitalizations would still increase for the next 10 days.

In New York hospitalizations peaked on April 12th. The stay at home order was announced on March 20th and started March 22nd (though behavioral changes occurred before that). Looks like ~2600 hospitalizations on March 22nd ~19k at the peak. There were probably also a lot of people who should have been hospitalized but decided to ride it out at home. There were only 100 deaths in New York cumulatively (!) from COVID-19 on March 20th. I doubt it will spread as quickly in AZ, FL, and TX as this, but yeah, it could be bad.

 

[kbM3]

You do not need to look any further than Ron DeSantis who is one of the most loyal Trumpers among the state Governors to understand why this is the case. I identified myself as someone in healthcare and wrote his administration a long letter 3 months ago suggesting ways in which they could use the time that they had to better prepare. I never heard back, but I wasn't surprised on the other hand that they didn't bother to respond, and I'm not surprised by the way they played this. He is of course taking the Mike Pence / Donald Trump dismissive approach that the increased cases are just due to increased testing. He's also stated recently that any increased cases are due to immigrants. It's really sadly predictable but it's also pathetic and disgusting. Florida is poised to become a major hotspot and has a boatload of vulnerable elderly citizens.

Agree, but this has major implications. If FL reaches the same state as Italy earlier, where some patients are denied ICU beds, the state will at least partially shutdown again, and this has national consequences as other states will undoubtedly follow, since they’re relaxing social distancing as well. FL just looks to be the early canary in the coal mine.

I know it’s been stated before the country will not shutdown again, but I believe patients being triaged away from ICU beds would force the issue.

 

[AlanSubie4Life]

Surprised this isn’t talked about more:

https://www.newsweek.com/multiple-florida-hospitals-run-out-icu-beds-coronavirus-cases-spike-1511934

Asi understand it even if FL reshutdown today, hospitalizations would still increase for the next 10 days.

I captured a screen shot a few days ago so I could keep track of how things change (rates vs. levels!), with the topline numbers. But I did it at the county level (might be a bit more fair since presumably you can go to a hospital in your own county). And also some counties don't have any ICU space, period, at any time. There's only one county that has no capacity left (but they only had 8 beds to start with), out of the counties that have ICU beds. Not minimizing the issue though - definitely not trending the right direction.

Looks like from June 15th to now (4 days) Adult ICU census has increased by 401 (4768-4367)

Pediatric ICU census has increased to 408 from 361, an increase of 47.

Looks like they have increased Adult ICU capacity by 156 beds in that time, too. And Pediatric ICU.

They have 1379 Adult ICU beds remaining, so at that net usage rate of 245 beds per 4 days, that would be 22.5 days. But I doubt the increase in utilization will be linear (and I'm assuming linear increase in ICU capacity).

Stay safe out there, all you Florida folks. Sounds like you may not be able to count on an ICU bed. Don't get sick!

 

[kbM3]

In addition, this has national implications. If some states have very active outbreaks and others don’t (very likely).

New York considers quarantine for Florida travelers, Gov. Andrew Cuomo says