Coronavirus

[SageBrush]

The Florida Covid dance:
Even before taking the lag into account, Florida is staring at hospital collapse by Independence day

 

[cwerdna]

Hope this isn't a repost as it isn't new:
Texas bar owner prohibits customers from wearing masks

Liberty Tree Tavern co-owner Kevin Smith posted a note outside the bar that reads, "Due to our concern for our customers, if they FEEL (not think) that they need to wear a mask, they should stay at home until they FEEL that it's safe to be in public without one. Sorry, no mask allowed," according local station KXAN.

"It is more of a pushback — the snitches, and the contact tracers out there," said Smith. "This is still a rural county."

Smith told The Washington Post that "being scared all the time isn't good for your health. It suppresses your immune system."

 

[N5329K]

Dexamathasone study deep dive:

Robin

 

[madodel]

Hope this isn't a repost as it isn't new:
Texas bar owner prohibits customers from wearing masks

This is why US citizens are going to be banned from visiting the EU. Terminally stupid people proud to be stupid.

 

[AlanSubie4Life]

Situation Summary: We had a chance to get a handle on this nationwide in early May with a massive testing (etc.) push prior to and concurrent with reopening, but we did not. Instead, we went for the "thread the needle" approach (barely enough testing), but looks like we came down on the wrong side of that knife edge. Definitely going to cost us trillions of dollars now; that's baked in. Definitely would have made sense to spend a few hundred billion on testing (etc.). Of course, it is not like this is a surprise to anyone - I guess it was by design? Beginning to understand how Trump bankrupts everything he touches.

State Summary:

Blowing up (raging sh**shows with rapid hospitalization increases): AZ, FL, TX, SC

Taking off (rapidly increasing positivity, nothing apparently being done): GA, ID, NV, OK, UT

Barely hanging on (substantially increasing cases & testing, sometimes with substantial hospitalization increases): AR, AL, CA, LA, MO, MS, NC, TN

Wrong direction (hints of bad positivity trends; mitigation measures can still work): KS, MN, MT, OH, WA

It's interesting how varied the results are. Speaks to the local nature of outbreaks, and the significance of local actions (mask ordinances, testing & public health robustness, citizen compliance/trust).

While I certainly hope that none of this turns out to be "another NYC," based on the lack of action over the course of 5 weeks as these trends developed, and continued lack of action (with some late actions recently), I do think that in aggregate this has the possibility of easily exceeding the true size of the prior NYC outbreak (~2 million infections). Obviously the case counts are going to far exceed it, but the testing visibility is a considerably better now than then (probably catching 2-3x as many infections as in April - ratio of infections to true cases might be as low as 3-5x these days, depending on location).

I think it's fairly likely at this point that the infection density is high enough that breakouts into the senior population are likely. I'd watch trends of infection proportion carefully (in AZ about ~55% of the infections recently have been in people below 45, but there have still been 2300 infections of people over age 65 in the last 10 days (historically, 1000 people out of the prior 5400 infections in that age bracket died)).

I don't see how economic activity nationwide will be able to be sustained over the coming weeks. The longer the massive growth goes on for, the more "baked-in" things become. In terms of looking for positive signs, I would look to see a positivity drop in the raging firestorm states - that would be the first hint of progress. If that doesn't start to show, things look grim and we should expect continued growth.

 

[SageBrush]

Hope this isn't a repost as it isn't new:
Texas bar owner prohibits customers from wearing masks

I call this 'barn door' reasoning:

Mask wearers would very likely stay away anyway, so no lost business there. Might as well pander to the fools who show up, and if it helps to delay public action to close his bar again, all the better (for him.)

--
I'm much more impressed by the pathetic politicos who say they do not mandate mask wear 'because it is un-enforceable.' Does anybody buy that pathetic excuse for non-action ?

 

[jerry33]

I'm much more impressed by the pathetic politicos who say they do not mandate mask wear 'because it is un-enforceable.' Does anybody buy that pathetic excuse for non-action ?

Other politicians.

 

[Dr. J]

Hope this isn't a repost as it isn't new:
Texas bar owner prohibits customers from wearing masks

He may get cited for public nudity, though:

"Sorry for the inconveniences please bare with us thru the ridiculous fearful times," his note reads.

 

[SageBrush]

Tangential trivia: 'Proning' is also a time honored position for people on vents. It is mostly used in sedated patients, in part due to patient discomfort. The general idea is to put the least involved lung tissue on the top so it is not under the the weight of the soggy, involved tissue.

Carrying on about this for a moment ...
It should be clear that 'proning' only has virtue if the posterior parts of the lungs are relatively uninvolved, although the more general approach should be to put the best lung tissue on top. The actual decision how to place a patient is actually fairly complicated though because lung involvement is complicated in both 3D space and severity; and positions vary in their influence on blood flow and thorax dynamics, AKA work of breathing, sighing and coughing.

The media reports of 'one small trick' to keep patients off ventilators is non trivial, and blind use of 'proning' will lead to worsening of the patient condition in some cases.

 

[AlanSubie4Life]

Regardless, we've been less than 10% daily growth for new cases for eight days now. Seems we have reached a peak.

Guess it turned out to be a temporary lull. Oh well. Depending on whose numbers you use, it's about 39k cases today. (Of course, this is only detected cases - undoubtedly the number of actual infections was highest in early April. We'll see whether we reach that peak, soon - probably within 2-3 weeks if we're going to.)

But at least deaths aren't up much, yet. There are the starts of some troubling trends there, too, in AZ and FL. Should know more in the next few days about how that's going to go, and how much improved care has been helping.

We'll probably relearn in the next few days that deaths mostly lag cases by a couple weeks. The lag is likely longer than it used to be, due to faster testing & reporting (earlier case identification). The earlier identification of cases likely helps somewhat with outcomes, as well. Earlier treatment is apparently helpful. (Other reasons: younger people infected, better treatments, more testing - so lower CFR, etc. )

However, as an example, you can see extremely clearly in the AZ plot that we're going to have an increase in deaths there; it's inevitable. The last two weeks of this graph typically drop off. I'm attaching one from 5 days ago too for comparison so you can see the backfill. (Also shows 18 people between 20 and 54 have been recorded as dying in the past 5 days.)

The COVID Tracking Project pointed out that there are a huge number of people in the areas which are now hot (more than twice as many as in the Northeast). So this sucker could really build up some momentum! We're really going to need that best testing apparatus in the world that Donald Trump has personally built, in the next couple weeks.

 

[SMAlset]

Well Santa Clara County had 122 new cases yesterday and it was starting to alarm Cody. She said mainly construction workers. Just checked today’s numbers and 125. Not good but hopefully these are mostly asymptomatic who won’t need hospitalization and got caught early in testing.

 

[SageBrush]

Well Santa Clara County had 122 new cases yesterday and it was starting to alarm Cody. She said mainly construction workers. Just checked today’s numbers and 125. Not good but hopefully these are mostly asymptomatic who won’t need hospitalization and got caught early in testing.

That is interesting. I suspect that the workers that work inside buildings without ventilation are the problem, and the solution is to mandate ventilation along with social distancing and mask use. "Asymptomatic" or not is a red herring.

 

[AZRI11]

I find it interesting that the local newspapers of the collapsing states (AZ, FL, TX) report the increasingly dire hospital situation reasonably well but not a one mentions the past few weeks that each of those states had increasing case loads but did not take action because their politicos bought into the 'it is from more tests' BS

Now they are kinda sorta, maybe taking action but it is too late. The simple lesson of epidemics is that either you act early and aggressively, or you are too late. It is an exponential thang with lag built in. Way too complicated for trumpers.

In my state (RI) restaurants opened to 50% capacity and will now open to 75% beaches are packed, stores are packed, and everyone is out enjoying the summer. Cases continue to collapse because people are wearing masks and in general respect everyone's space. This is not a hard thing to do. We're not that smart here, the rest of the country can't be that dumb

 

[SageBrush]

This is not a hard thing to do

Exactly

 

[doc333]

Ready for the slings and arrows (be sure and tell me where I'm wrong).
1. Masks do not provide provide total protection.... the virus can enter you through the mucus membrane in your eyes and UNLESS your mask is absolutely airtight, it can enter from the bottom, top and sides.
2. All you mask adjusters keep touching your face and mask and .... oh, never mind.
3. Keep re-breathing that hot, steamy, fetid air... you might just luck out and get fungal pneumonia..... the spores LOVE that environment.
4. Solution: wear a wet suit, scuba gear and goggles. Just don't eat or drink since that pesky virus will get you when you do (unless you can do it while in your scuba gear).
5. If you are afraid...STAY HOME! If you are sick... STAY HOME. To everyone else....LIVE LIFE!

 

[TEG]

Well Santa Clara County had 122 new cases yesterday and it was starting to alarm Cody. She said mainly construction workers.

Lots of yelling... Sharing tools... Sharing "port-a-potties", ...

 

[SageBrush]

Ready for the slings and arrows (

Please, please, please tell me you are not a physician. I have met my share of not-smart physicians but none I would call morons.

be sure and tell me where I'm wrong.

I'm tired of spoon feeding. Read the thread where mask use is discussed. Even though few posts are from physicians or epidemiologists, almost all have understood the basics. I take that back. Of those I have not placed on ignore ...

 

[doc333]

I'll answer your question when you prove you can follow simple instructions and "tell me where I'm wrong"

 

[jerry33]

In my state (RI) restaurants opened to 50% capacity and will now open to 75% beaches are packed, stores are packed, and everyone is out enjoying the summer. Cases continue to collapse because people are wearing masks and in general respect everyone's space. This is not a hard thing to do. We're not that smart here, the rest of the country can't be that dumb

Unfortunately, they are.

 

[Daniel in SD]

Ready for the slings and arrows (be sure and tell me where I'm wrong).
1. Masks do not provide provide total protection.... the virus can enter you through the mucus membrane in your eyes and UNLESS your mask is absolutely airtight, it can enter from the bottom, top and sides.
2. All you mask adjusters keep touching your face and mask and .... oh, never mind.
3. Keep re-breathing that hot, steamy, fetid air... you might just luck out and get fungal pneumonia..... the spores LOVE that environment.
4. Solution: wear a wet suit, scuba gear and goggles. Just don't eat or drink since that pesky virus will get you when you do (unless you can do it while in your scuba gear).
5. If you are afraid...STAY HOME! If you are sick... STAY HOME. To everyone else....LIVE LIFE!

I am curious how people like this explain what's happening in other countries?
Seat belts don't provide total protection either...