Testing people who already have it, or are likely to die from it, does not seem like an effective way of protecting vulnerable people from getting it. i.e. people in nursing homes are not the bombs, they’re the targets.
The strategy that I think was hoped for is that the lockdown would reduce the incidence of infection to isolated hotspots, and aggressive testing and tracing would allow control of hotspots before they spread. This of course requires that the level of infection be driven down to a manageable level before easing. In US it looks as if that has, for the most part, not been achieved. So in that respect a significant part of the value of lockdown will be wasted. Had it held for longer, communities may have reached the levels needed to make test and trace effective.
So, it is probably inevitable that the second wave will minimally be as bad as the first. However, given what is now almost certainly diffuse seeding of infection right through communities, it will probably grow fast for longer, and lead to worse second wave. Mitigating that may be a heightened awareness of the risks in most of the populace, and although the infection will spread, more people will continue to employ distancing and hygiene measaures, and that will result in a better R[sub]0[/sub]. The entire problem is terribly sensitive to this in a manner that makes prediction difficult at best.
they represent targets that are already set up for isolation. They are no longer part of the economy so massive unemployment doesn’t have the same affect on them. If anything they rely on a solid infrastructure to survive.
By the very nature of a new virus we have to create tests from scratch at the time the virus comes into existence. There’s no way of storing tests in advance because they can’t exist ahead of time. It’s an automatic kill switch to rapid deployment of a defense system.
By default, the only defense to an unknown virus is to isolate people. That comes at a cost and we can’t maintain that strategy indefinitely. That dictates what the objective is. And that objective was to maintain our medical infrastructure in the hopes of saving as many lives as possible.
But they’re not set up for isolation–that’s the point. Nursing home residents rely on a large number of nurses, med techs, patient care techs, therapists, cooks, cleaners, and so forth, all of whom live out in the community and are exposed to whatever pathogens are spreading in that community, pathogens they bring to work with them. Nursing homes can and have restricted visitors such as family members, but they can’t really restrict that “infrastructure” necessary for survival.
Covid-19 is fairly sneaky. It takes a couple months to grow large enough to incite panic even when everyone is living a 2019 lifestyle and, even accepting that some people and some locals will be idiots about all this, in general I think that everyone will be living a more isolated life this year, even if not full quarantine. That will probably be sufficient to keep Covid-19 from really coming in and blowing up like it was on the way to do before we shut everything off. (Imho, obviously)
I think what will happen is that we’ll have fewer city-level events but that what will happen is it will jump up and take out elderly care facilities one by one with gaps of days and weeks between instances all around the country. Everything will be fine and suddenly there will be a hundred deaths all in a couple days in one building.
That won’t give us giant numbers of deaths, from a national standpoint, but it will be like living in a horror film, not sure when Freddy is going to jump out and take a life.
Isolation is not the same as quarantine but they are away from the general populace and those around them can focus on health regimes designed to limit contamination. It’s not perfect but the alternative is a collapse of an economy. There is no free lunch in a pandemic.
Which is true, but has little to do with testing. At least not the residents. A positive test of a home resident basically tells you that you failed. It doesn’t help you succeed.
Aggressive continuous testing of workers in homes may help. That and mandating that they cannot work in more than one home. Protecting the residents means that the support network of workers need to be managed. Given nobody has succeeded in protecting residents anywhere so far, this isn’t a simple problem. It certainly isn’t just a matter of testing residents.
Pedantically, perhaps, quarantine is specific case isolation. Quarantine refers to isolation of those that are suspected of being infected. 40 days at anchor before you get to dock. At least those that have not died already get to dock.
Explain this. Are you saying every home has had at least one confirmed or suspected case of infection in either staff or residents? At my wife’s facility, the non-essential staff are not allowed (hairdresser, mani/pedicures, barber.) Facility maintenance is emergency admittance only. Two staff members are barflys and were “whose house we partying at” until the bars reopened and one is a bartender also. Still zero cases.
Yes and no. It focuses on both workers and residents. One of the key areas of success after getting the virus is early diagnostics and treatment.
it’s not true that nobody has successfully treated residents anywhere so far. It is true that a substantial number of homes have failed.
I’m not entirely sure what you’re suggesting at this point. We’ve got this down probably to flu level. We are going back to work in a controlled manner and focusing on the most likely to be harmed if they get the virus.
Keep in mind that, when all of these protocols were put in place back in March, the objective was never to STOP the disease. That just wasn’t possible. The objective was to reduce the infections and deaths as much as possible and to flatten the curve so that emergency services and hospitals could handle the workload. In that regard, in my opinion at least, they succeeded spectacularly. We even never really used McCormick Place.
Yes, I was concerned that we would overwhelm medical capacity, which not only sucks for people with a pandemic, but also for all the other people that usually would go tot the hospital for injury or illness.
I think that we are mostly opening based on population. Lower population areas get to open before higher. Here in Ohio, as I’m sure you know, we’ve been back to “almost” normal for a few weeks now for many of us.
In New York, they may need a few more weeks.
What’s left are things that really just cannot open. Not until we either have developed an immunity through exposure or vaccine, or until we’ve just given up.
I do think that just eliminating large gatherings, and getting people to be conscious as to their role in protecting others with social distancing, will keep the numbers manageable.
Restaurants… well, let’s just say that I always wanted to have my own restaurant, and that for the first time, I’m really glad that I didn’t go that direction. They just cannot come back. By the time we do have a vaccine or general immunity, no one will remember what a restaurant is anymore. “So, people go inside and eat at tables? Weird.” Plus side, this may end the whole wars about tipping.
But if we start having sportsgames and concerts and conventions again. If the late night TV hosts start having audiences again, then I think we will be in for a spike that will not be manageable.
It’s gonna be a while before everything gets back to normal. It will be much faster to simply accept this as the new normal.
I sometimes think that this was about the best pandemic we could hope for. It was just bad enough that we had to take it seriously, but not so bad that even a serious screw up meant a truly existential threat. Worst case scenario is “only” a few million dead.
Next pandemic may not be so forgiving, and screwing it up may mean tens of millions dead, and a complete collapse of our society.
Nature tossed us a softball this time, we should take what we can from it. Next time is gonna be a slider.
It’s not doom and gloom. I do think that we’ve lost this battle with this disease, and that there are going to be a lot of people dead because of that. However, as I said, it could be worse, this could be much more virulent or contagious. I’ve been tracking the numbers too, and they are down a bit overall, Ohio’s trend has only been very slightly downward since we got past the peak, but some areas are increasing. It doesn’t take much to have an outbreak.
The lockdowns also gave us more time to make sure that our medical facilities had the capacity and ability to treat victims of Covid, while still functioning as a medical center for all of our other medical woes.
I also think that testing is absolutely necessary in order to keep things maintainable. When you are dealing with exponential growth, it can get away from you pretty quickly. If your only metric is hospital admissions, then you are behind the curve. If hospital admissions start going up, they may start going up exponentially, and we cannot handle that. If we are testing, then we get a week’s lead time, to either increase social distancing measures to reduce the spread, or at least to give the hospitals time to prepare.
I agree, but testing needs to be convenient, free, and easy. The way it is now where there needs to be doctor’s approval, you have to have symptoms, and then take however long to go out and get tested is too expensive and inconvenient. The only people who will do that are people who have obvious symptoms, but by then it’s late in the process. If instead people could drop in to get tested for free at drugstores, then people could get tested very early and catch it before they infected anyone else.
Oh yeah. Definitely needs to be free and easy.
We barely do enough testing now to have a basic idea of how it is progressing, we certainly do not have enough to actually make policies about it, and absolutely not at the local scale.
Not just drug stores, but drive up testing centers, as well as testers that will come to you. I would feel better if they came out and tested everyone at my workplace.
No jurisdiction (state/nation) that had a substantial outbreak succeeded in keeping the disease out of their nursing homes. Whether any individual home saw an outbreak was largely a matter of chance, but the protocols you describe were widely adopted in US northeastern nursing homes, and many of them ended up with devastating outbreaks anyway, so these protocols by themselves are clearly insufficient to prevent infection if one of the essential staff turns out to be a spreader.
By “nobody” I meant nations/states. Everywhere has had horrendous outbreaks in at least one care home with many dead. Here in Australia, despite being one of the real success cases with the virus, we have had at least two hot spots of deaths in homes. Once it is in a home it is terribly hard to avoid a major tragedy. Whether a specific home is hit is luck. Everything is. All we can do is stack the odds.
The virus has not changed in character. There is nothing about how it operates that is any different to the beginning of the year. We do have better knowledge of it that can inform choices made. But if people regard it as “beaten” or now “no worse the the flu” they don’t get the nature of the problem.