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Old 03-14-2020, 09:19 AM
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How do we tell if social distancing is working?


After we all spend the next two weeks at home with our stacks of toilet paper and cleaning supplies what are medical professionals are looking for to say we can all go out again?
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Old 03-14-2020, 09:47 AM
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The idea is, they won't say that we can all go out again. Coronavirus has a fairly long incubation time between when you catch it and when you start showing symptoms. If you have it, then by the time the two weeks are up, you'll have symptoms, and hopefully be tested to confirm, and continue to stay away from others, and get medical care if you need it. If, after two weeks, you're still not showing symptoms, then you can be confident that you're not infected, and you can go out and mingle again without worry about potentially infecting others.
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Old 03-14-2020, 10:18 AM
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The idea is, they won't say that we can all go out again.
That's why the advice we're getting here is to self-isolate if you have symptoms, and that most of those who do will clear it within 7-14 days. This could presumably continue to apply more or less indefinitely, or at least until numbers of new cases are so low that the response can shift back to test+trace contacts.

This is different from limiting mass gatherings: presumably those restrictions would be lifted when numbers of new cases drop to negligible levels (but what would constitute "negligible" is unpredictable, like so much else about what is, after all, a new virus - e.g., we don't know if it might come back in a mutated form, or just disappear).
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Old 03-14-2020, 11:49 AM
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In about a week or two there will be enough test kits to start screening people and then they can start to track the rate of new infections. Fellers law is that epidemics end as fast as they start so they will have a good idea of how long that will take.
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Old 03-15-2020, 09:34 AM
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Fellers law is that epidemics end as fast as they start so they will have a good idea of how long that will take.
Care to elaborate? I'm not familiar with this one.
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Old 03-15-2020, 11:03 AM
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One way the epidemiologists hope to to know they have been successful is when the public starts complaining that the precautions were a gross over-reaction. If that happens then the precautions worked and the spread was stopped. If everyone is saying wow, the docs were right this is serious-that is a failure.

It is a curious business to be in. As business where success is partly measured by the how much criticism are received.
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Old 03-15-2020, 12:48 PM
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But experts are now saying the virus can be asymptomatic in children and very mild in young adults, and these age groups are NOT staying home. I've been watching that here in my corner of western Washington, where there are fewer cases here than in King County: the restaurants and bars are packed at night, and the mall is still busy, mostly--from what I can tell--with 20-40-year-olds.

If young people are still infecting each other, how long would it take for the virus to have run through that population? Isn't that how long the rest of us will be socially isolating?
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Old 03-15-2020, 01:07 PM
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We might not, but the more we stay home, the better the chances.
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Old 03-15-2020, 04:03 PM
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We might not, but the more we stay home, the better the chances.
We old farts mostly stay home but some excursions are necessary or prudent. A weekly supply of fresh milk is necessary. Vehicle repair is prudent. I'm scheduled to venture out in two days for some necessary shopping (meds, mostly) and a prudent drive to the dealer to have faulty RV airbags replaced, which they should have done a year ago but they ran out. So, go out and maybe catch the COVID if I haven't already? Or stay home till we drive the RV, then get in a wreck and die? Hmmm...

Best I can do is practice 2-meter distancing. If I survive, it worked.
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Old 03-15-2020, 05:18 PM
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Social Distancing does not prevent people from getting the disease, but it slows the rate of infection so that health services can manage the cases.

It's called "Flattening the Curve"

If the infection rate is no longer an exponential increase, then social distancing is working.
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Old 03-15-2020, 05:28 PM
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In about a week or two there will be enough test kits to start screening people and then they can start to track the rate of new infections. Fellers law is that epidemics end as fast as they start so they will have a good idea of how long that will take.
And it should be noted that as soon as test kits are widely available, the numbers will appear to sky rocket, even if nothing changed.

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We old farts mostly stay home but some excursions are necessary or prudent. A weekly supply of fresh milk is necessary. Vehicle repair is prudent. I'm scheduled to venture out in two days for some necessary shopping (meds, mostly) and a prudent drive to the dealer to have faulty RV airbags replaced, which they should have done a year ago but they ran out. So, go out and maybe catch the COVID if I haven't already? Or stay home till we drive the RV, then get in a wreck and die? Hmmm...

Best I can do is practice 2-meter distancing. If I survive, it worked.
No one is saying you're not allowed to leave your house. They just don't want people to gather unnecessarily. Go get your air bags fixed, but skip the retirement party for your friend's mom.
Illinois just shut down all bars and restaurants, but stores are still open.
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Old 03-15-2020, 05:57 PM
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I looked up the working definition of Social Distancing and was mildly depressed to find that I've been doing it for a while now.
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Old 03-15-2020, 07:31 PM
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As one of my friends just posted on Facebook:

So I've been applying social distancing all this time? And here I thought I was just an anti-social recluse!
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Old 03-15-2020, 09:52 PM
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One way the epidemiologists hope to to know they have been successful is when the public starts complaining that the precautions were a gross over-reaction. If that happens then the precautions worked and the spread was stopped. If everyone is saying wow, the docs were right this is serious-that is a failure.

It is a curious business to be in. As business where success is partly measured by the how much criticism are received.
How do you distinguish an "over-reaction perception" being a success versus having applied the social distancing too early? If the latter people could resume normal life and then get hit. Also the USA is a big country. It seems the entire country is following the same start time. So maybe New Rochelle declares it was bad but not so bad, now things have died down maybe. But then some place that locked down with everyone else thinks they are done like New Rochelle, and so they resume normal activity and then might get hit later, as they are really entirely new to the virus. Is that a possibility?

Last edited by Jim Peebles; 03-15-2020 at 09:53 PM.
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Old 03-15-2020, 10:47 PM
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The paper linked to in this tweet alleges to show direct evidence of curve flattening by comparing two regions in Italy which implemented shutdowns at different times. As close to an A/B test as we're going to get.
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Old 03-15-2020, 11:15 PM
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Originally Posted by Jim Peebles View Post
How do you distinguish an "over-reaction perception" being a success versus having applied the social distancing too early? If the latter people could resume normal life and then get hit. Also the USA is a big country. It seems the entire country is following the same start time. So maybe New Rochelle declares it was bad but not so bad, now things have died down maybe. But then some place that locked down with everyone else thinks they are done like New Rochelle, and so they resume normal activity and then might get hit later, as they are really entirely new to the virus. Is that a possibility?
To a certain extent, what you described is the point of all this. In a perfect world this would be a stop gap. If we had a way to lock everyone up so they had no contact with anyone else for the amount of time it takes to go from the moment you catch it until you're no longer contagious anymore, this entire thing would be behind us in a matter of weeks.
But we can't do that, so we compromise. We ask everyone to limit their contact with others as much as possible. There's no martial law, no curfews, just avoid big gatherings for the next few weeks. It's not going to stop anything, and it's entirely possible the majority of people that would have gotten it will still get it anyway. However, what it does is slows it down. If I was going to get it tomorrow night at my brother's birthday party along with a dozen other people, maybe instead I'll catch it next week and the other dozen people will catch it over the next 3 weeks.
So, plenty of people still get it, but at a rate at which our medical professionals can handle. They'd rather have thousand people show up over the next month than a thousand people show up tomorrow.

TLDR: Flattening the curve.

ETA, I keep wondering about jails. It seems like that's going to be really problematic.

Last edited by Joey P; 03-15-2020 at 11:17 PM.
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Old 03-16-2020, 01:45 PM
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ETA, I keep wondering about jails. It seems like that's going to be really problematic.
Probably not. There is already much more social distancing between visitors & residents than in nursing homes, in some jails there is no social contact as there is a partition between the inmate & any visitors. Also, generally the population is younger & healthier than those of nursing homes so less co-morbid factors.
If the situation gets bad enough, they can enforce a lockdown; keeping inmates in their cells enforces social distancing much greater than can be done with the general public.
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Old 03-16-2020, 02:22 PM
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After we all spend the next two weeks at home with our stacks of toilet paper and cleaning supplies what are medical professionals are looking for to say we can all go out again?
We won't know for a while, but if it's starting to work, we'll see the number of cases/deaths drop below the current trend.

But: It's going to take longer than two weeks. The best estimate I read is that the peak of the epidemic in the US is expected to be in May. We're going to be staying as far away from people as we can for months. It's not going to be better in two weeks. It's going to be far worse. And two weeks after that, it'll be still worse. And two weeks after that, it'll be even worse. Brace yourself. Barring some dramatic and fairly unlikely change, we're not keeping to ourselves for a few weeks. We're probably drastically cutting down on social contact for the next year.

And as testing capability ramps up, we'll start to see known cases increase faster than the curve because there are a lot of latent cases out there that we just don't know about, so it's going to take a while for the data to become reliable.
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Old 03-16-2020, 03:45 PM
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Dr. Fauci made a good point at today's press conference (though he probably lost major points by not kissing butt and praising the fast reaction of the Administration throughout his portion of the event).

He said that the data we have available to determine the progression of the pandemic is behind the actual progression, so if the measures being put in place look like they are an over reaction, we're probably reacting about right for where the pandemic actually is. (my paraphrase)

When the dust settles, we'll know if what is being advised (and in some cases enforced) is too much or not enough, but I agree that if we are going to err, it is better to be a bit over reactive rather than under.
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Old 03-16-2020, 04:26 PM
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Yes, the data in that excellent Medium article that we've all seen claims that the time between implementing a restriction and it having an effect , is about ten days.

And if you think about it, it has to be at least five days, because that's the average incubation period. If we all start <some particular restriction> today, it won't stop the infections of all the people who got infected yesterday, who'll be showing up at doctors offices some time after the weekend.
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Old 03-16-2020, 04:34 PM
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Basically the idea is that when you implement a restriction, the effects ought to be seen somewhere after the incubation period, which according to the CDC right now, is 2-14 days, with an average of 11.5 days.

So the slope of the curve of identified new cases (i.e. the transmission rate) should flatten out after that period. In other words, people shouldn't be being infected at such a high rate, and that should be apparent after two weeks.
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Old 03-16-2020, 04:39 PM
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Basically the idea is that when you implement a restriction, the effects ought to be seen somewhere after the incubation period, which according to the CDC right now, is 2-14 days, with an average of 11.5 days.

So the slope of the curve of identified new cases (i.e. the transmission rate) should flatten out after that period. In other words, people shouldn't be being infected at such a high rate, and that should be apparent after two weeks.
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Old 03-16-2020, 11:31 PM
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Basically the idea is that when you implement a restriction, the effects ought to be seen somewhere after the incubation period, which according to the CDC right now, is 2-14 days, with an average of 11.5 days.
I believe the average is about 5 days, and 11.5 is 2 standard deviations (95%).
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Old 03-17-2020, 11:47 PM
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But experts are now saying the virus can be asymptomatic in children and very mild in young adults, and these age groups are NOT staying home. I've been watching that here in my corner of western Washington, where there are fewer cases here than in King County: the restaurants and bars are packed at night, and the mall is still busy, mostly--from what I can tell--with 20-40-year-olds.

If young people are still infecting each other, how long would it take for the virus to have run through that population? Isn't that how long the rest of us will be socially isolating?
What worries me is that we're going to have a potential explosion of cases in the next 7-14 days. At my university they told the college kids not to come back to campus next week after spring break, but at some schools similar announcements came while at many schools they were already on spring break. Had they all gone home right as spring break began maybe that'd of been okay, but lots and lots went on vacations last week and lots are on vacation this week. And now they're all headed home soon to share the virus with their parents and grandparents...
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Old 03-18-2020, 10:58 AM
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What worries me is that we're going to have a potential explosion of cases in the next 7-14 days. At my university they told the college kids not to come back to campus next week after spring break, but at some schools similar announcements came while at many schools they were already on spring break. Had they all gone home right as spring break began maybe that'd of been okay, but lots and lots went on vacations last week and lots are on vacation this week. And now they're all headed home soon to share the virus with their parents and grandparents...
Right- in terms of disease transmission, from what I've read, there is no such thing as "too early" for things like quarantine, social distancing, enhanced hand washing, etc... If anything, the earlier the better; I suspect had they implemented this (somehow), back before there were any positive cases in the US, it would have significantly slowed the transmission, as well as made contact tracking on any future positive cases a LOT easier.

But disease transmission is not the only consideration in play, so I'm not sure when the *best* time overall to implement this stuff would have been.
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Old 03-18-2020, 11:44 AM
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If the situation gets bad enough, they can enforce a lockdown;
They ended up doing the opposite. They released as many people as they possibly can. In some states they brought judges in over the weekend to plow through all the 'easy' cases. Basically all the cases where the person was going to plead guilty, the verdict had already been decided and the trial was just a technicality at that point. For example, all the people that had worked out deals to plead guilty and get house arrest...no point in having them sitting around the jail for another week if we can get them home today.
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Old 03-21-2020, 06:37 AM
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And it should be noted that as soon as test kits are widely available, the numbers will appear to sky rocket, even if nothing changed.


No one is saying you're not allowed to leave your house. They just don't want people to gather unnecessarily. Go get your air bags fixed, but skip the retirement party for your friend's mom.
Illinois just shut down all bars and restaurants, but stores are still open.
Bolding is mine. My coworker in northern Italy is not allowed to talk to his neighbor, unless by phone. Even here in Switzerland the message is to stay home, and if you are out and about, make sure the group is 5 or less. For now it seems that going out for a walk is still permitted and even encouraged. As long as it is a single person, or just the household, and there is no contact with others.
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Old 03-21-2020, 02:45 PM
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Probably not. There is already much more social distancing between visitors & residents than in nursing homes, in some jails there is no social contact as there is a partition between the inmate & any visitors. Also, generally the population is younger & healthier than those of nursing homes so less co-morbid factors.
If the situation gets bad enough, they can enforce a lockdown; keeping inmates in their cells enforces social distancing much greater than can be done with the general public.
While inmates are generally younger than those in nursing homes, they are more likely than the general population to have chronic conditions or infectious diseases.

Moreover, a lockdown does NOT enforce social distancing from other inmates or from the guards, social workers, medical personnel, contract workers, attorneys, etc., etc. etc., who are heading out into the wide world at the end of shift. The photo accompanying this article, for example, shows the open dorms that are quite common in American penal institutions; what do you think will happen to inmates locked down inside such a place if a respiratory infection starts spreading? Add in notoriously poor health care, lack of access to sanitary supplies, and the lack of maintenance and adequate ventilation common to many facilities, and it is a recipe for disaster.

Last edited by slash2k; 03-21-2020 at 02:46 PM. Reason: grammar
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Old 03-21-2020, 03:19 PM
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I've posted similar to this in another thread but it belongs here likely more. This is the best time course data we have. See figure one. Incubation period on average 5 to 6 days. "Confirmed infection rate" is a meaningless number to follow as it more reflects kit availability and testing guidelines than anything else. Death rate is a believable number, as would be confirmed cases in ICUs. Deaths most commonly occur at about 19 days into having symptoms according to that article. We have public access to the daily deaths number which is now doubling every 2 days.

A change in that daily deaths rate off of the same doubling rate next week reflects either natural topping off of the disease -very very unlikely - or - of public behavior changes two weeks ago (e.g. voluntary social distancing adopted most consistently by those at highest risk and hopefully better self quarantining if sick). A change in a bit over three weeks from now in that daily deaths rate reflects what we have done in the last couple of days. (5 days incubation plus 19 days until death, each on average, equals 24 days.)

If we can get the ICU numbers then that would be lagging a week less.

Rates of diagnosed infections will be useless.
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Old 03-21-2020, 03:40 PM
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But experts are now saying the virus can be asymptomatic in children and very mild in young adults, and these age groups are NOT staying home. I've been watching that here in my corner of western Washington, where there are fewer cases here than in King County: the restaurants and bars are packed at night, and the mall is still busy, mostly--from what I can tell--with 20-40-year-olds.

If young people are still infecting each other, how long would it take for the virus to have run through that population? Isn't that how long the rest of us will be socially isolating?
Children also apparently much less contagious, which if confirmed is a huge big deal.

A hypothetical in which the younger adults all did nothing would have it likely do the same peak timing that the experts say would be the case if all did nothing, taking about 3 months. Not all high risk people could be protected though, and a lower death rate in a larger group of people still adds up. To some degree that may be what we are seeing now - three weeks ago more higher risk people self-isolating, while younger people kept with business as usual - so now a relative shift to more younger people in the hospitals and ICUs. Herd immunity building but with risk of overwhelming healthcare system capacity before it peaks. If so the actual current numbers of infections out there is likely HUGE.
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Old 03-21-2020, 05:49 PM
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Illinois just shut down all bars and restaurants, but stores are still open.
Including liquor stores, which are apparently essential. I guess a lot of people need to swig a bottle of whiskey to maintain their sanity. I do anyway, so I happy liquor stores will remain open.

https://chicago.eater.com/2020/3/20/...ivery-covid-19

Last edited by Harrington; 03-21-2020 at 05:51 PM.
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Old 03-21-2020, 07:14 PM
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One place to look to see how effective a national quarantine might be is Italy. (Note it won't tell us how much more effective than other measures could have been, just if effective.) They went on lock down March 9, 12 days ago. If effective then new ICU admissions for COVID-19 should begin to persistently decline this next week, and daily death rates by another 10 days.
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Old 03-21-2020, 07:15 PM
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No one is saying you're not allowed to leave your house. They just don't want people to gather unnecessarily. Go get your air bags fixed, but skip the retirement party for your friend's mom.
As it happens, impassible heavy snow canceled our airbag-fix trip. I'll just have to drive safely so they're not needed. Any deer jumping in front of us will just have to die, sorry. And any parties are likely to be virtual. We may Skype with the family for Easter. Darn.

Quote:
Illinois just shut down all bars and restaurants, but stores are still open.
I finally broke through our mountain snow and drove down to the small county seat for a bit of shopping. Most eateries were open, all for takeout, and the taco trucks were busy. Taverns were shut and a local violator lost their liquor license and lease. Most essential stores were open and the trivial sort were closed; I picked the wrong day to accessorize the library. Our local gourmet ice cream parlor ("best in greater Sacramento!") is open. Their small outside tables are ten feet apart so social distancing is the rule there.
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Old 03-22-2020, 07:37 AM
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One place to look to see how effective a national quarantine might be is Italy. (Note it won't tell us how much more effective than other measures could have been, just if effective.) They went on lock down March 9, 12 days ago. If effective then new ICU admissions for COVID-19 should begin to persistently decline this next week, and daily death rates by another 10 days.
Some cities started earlier.
Quote:
Unlike other parts of northern Italy, Lodi implemented a strict lockdown early in the course of the outbreak. When compared with other cities, the effects of that early intervention are clear: cases did not increase as quickly as in other parts of the country.
There's a graphic about ¾ down the page of the article.

This article does mention
Quote:
Infections of the new virus have not stopped in Codogno, which still has registered the most of any of the 10 Lombardy towns in Italy’s original red zone, but they have slowed.
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Old 03-22-2020, 08:21 AM
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Our local gourmet ice cream parlor ("best in greater Sacramento!") is open. Their small outside tables are ten feet apart so social distancing is the rule there.
Perhaps local Sacramento-area ice cream shops feel they still have a few more years of good luck owed to them after this 1972 plane crash.
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