The curve is flattened enough

The “flatten the curve” idea became well-known a couple of months ago, and we in the US have responded better than I could have imagined.

The whole point of that was not to reduce the number of people who eventually get infected, but to keep them from being infected all at the same time, to keep the hospitals from being overwhelmed. Because when enough of the population is infected that it overwhelms the hospitals, that’s when people die in excess of the mortality rate you’d see if the hospitals can adequately treat those who are hard-hit.

Isn’t that right?

I expected the rates to keep increasing along an exponential curve longer that they did, which means that we’ve done a better job at quarantining than I would have thought.

But it seems that hospitals in most of the country are far from being overwhelmed. Where do we go from here? A vaccine is a long way off - too far away to sustain the quarantine while waiting. Herd immunity is way way way off: something like 0.5% of the US has been infected, and at 30,000 new cases a day, it will take a decade or more to achieve herd immunity.

Should we just accept that most people are going to get it, that a percentage of those will die, and dial back the quarantine just enough to keep the health care system from hitting its capacity? People have to work to feed their families, and if most people are going to get it anyway, should we just move along as much as we can, short of hitting infection rates that cause a higher percentage to die?

Or is there some other goal? Are we hoping that testing and contact tracing will help us isolate the pockets of infection to stamp it out that way? We just need to wait for more and better tests?

I’m asking a lot of questions, sincerely not knowing the best answer, but it seems at this point that we just need to relax the quarantine and let the infection spread more. I realize that a lot of people will die (millions in the US alone), but if they’re going to get killed by it anyway, is it doing us any good to delay the inevitable and cause more suffering due to unemployment and economic damage?

I am not an expert or anything, but if the goal is to “stamp out” the virus I think that is an unrealistic goal, and I agree waiting it out until a vaccine emerges is also unrealistic. That does not mean we should just let it fly, of course, but if the infection rate is such that hospitals are able to keep up while also delivering on other non-COVID community needs, then perhaps relaxing some of the restrictions should be considered while maintaining caution and vigilance (social distancing, masks, workplace measures to limit spread, hand washing, etc.).

The complimentary goals should be both slowing the spread while allowing gradual re-opening of our economy and reducing the unemployment rate. If there is a setback in a specific area (measured by hospital capacity issues) then restrictions are restored for a while. I think it is unrealistic to have a goal of “preventing” spread, illness, hospitalizations, and death from the virus - but we should implement measures to slow it down, as we have done.

For myself, I’ve been working with the assumption that as some point I will get COVID-19, but I’m doing what I can to delay that as long as possible.
Delay to give scientists a better chance to collect data and to learn (can we get reinfected for example), time for manufacturing to turn around and make what we are short on (masks and other PPE, ventilators), time for treatments to be devised and tested.
And time for the overworked and stressed health care workers to rest and recover.
The longer I personally can delay getting COVID, the better I feel my chances of recovering are.

So I won’t be dining in any time soon, or going to bars, or attending large gatherings. These are luxuries, not necessities. I’d rather revamp the economy than sacrifice peoples’ lives to “save the economy”.

The issue seems to be that a significant minority of the U.S. population isn’t interested in “dialing it back just a bit” – as states have been opening things back up, some people are acting like everything can and should be back to normal now. They refuse to wear masks, they’re crowding into bars and restaurants, etc.

If, as a result of that sort of behavior, we don’t see the curve head back upwards in those areas in the next few weeks, I’ll be stunned. And, if/when that happens, I fear that we can expect to see angry protests if those areas attempt to reinstate shelter-in-place orders.

This is the only really weak part of your post. God only knows what the real numbers are because for the most part Americans can only get tested if their physician/ER feels they have it. That demands symptoms strong enough to send someone to the doc or ER. So mild cases, and family members of confirmed cases may have it, get over it, and stay off the statistic charts (my situation). On top of that, Doc/ER may not test you anyway because 1) It’s clear you’ve got it, or 2) they don’t have the means to do the testing anyway. And on top of THAT, the COVID tests are wildly inaccurate, yielding false negatives even fairly early on in the affliction.

Otherwise, I’d be inclined to agree that as long as the local hospitals have the capacity then it’s appropriate to take measures that will increase the number of cases they see–with an aim of meeting but not beating their capacity. Because we’re not going to get rid of this thing any time soon.

However, given the chaos surrounding this administration’s handling of the outbreak, it’s suppression of CDC studies, and any number of corporations claiming to have the necessary snake oil to beat it…who will be the first to try any proposed vaccine or medicine? Not me or mine, seems wiser to let someone else take that chance.

Personally I think America will handle it the same way as it has handled any frontier: lots of trial and error, astounding ingenuity, and copious rolls of the dice. We will go back to a slightly modified ‘normal’ way too soon, we will lose way more people than we would have had we behaved like better-favored countries, and we will emerge with the strongest economy in the world for our ‘sacrifices’. And although this is not the moral path, it is the only path that will land us the respect of whomever is left and the power to maintain control of our national destiny; because at the end of all things, he who has the gold will still be making the rules.

I find this characterization a little problematic.

IMO, the restrictions imposed were not tailored to address the greatest risks. Nor is it clear to me that the loosening of those restrictions is entirely sensible. The terminology used (essential) is problematic in itself.

One local example involved churches (something I have ZERO use or sympathy for.) In CHicago, a number of churches wanted to hold services. They were denied, despite what impressed me as detailed plans including social distancing/masks, disinfectant/door openers/etc. I could not understand why the city wanted to deny responsible behavior - in effect, lumping well-intentioned behavior in with the irresponsible.

Given the irrational aspects of the regs and reopening plans, it does not strike me as unreasonable that some people rebel.

I certainly agree with you that folk who say, “Open everything up immediately” are off base - and dangerous.

I hope I don’t contract COVID-19 because I have several serious risk factors, and I’m not ready to die yet. Therefore, my personal behavior is for my benefit not the economy’s. I will continue to self-isolate until at least there is a proven vaccine. When the majority of people in my area stop wearing masks, I will switch to a mask that protects me instead of one that protects other people, and i will wear it everywhere outside of home. I will urge my husband to do the same, but if he does he will be doing it for me more than for himself, because he doesn’t have most of the risk factors I have.

So go ahead, open all the movie theaters and restaurants and bars you want, I won’t be going to them for a while.

Yep.

My family and I went to a strawberry picking farm this morning- it’s about 50 miles north of Dallas, and there were about 200-250 people there, in a small field, and about 1 in 20 were wearing masks, and virtually none of them were actually paying attention to social distancing.

It was like their lizard brains interpreted “limited lifting of restrictions” to mean “back to normal”. We were pretty astounded, annoyed and not a little bit frightened.
The hope was that after we’ve flattened the curve and kept the spread from becoming exponential, that we’d follow that up with really vigorous testing and contact tracing combined with social distancing, mask-wearing and other precautionary measures to keep the virus cases at a relatively low, manageable level until a vaccine is found.

But with these imbeciles doing what they were doing at the strawberry farm, and what I’m sure they’re doing in hundreds of other places, we just delayed the exponential outbreak and probably guaranteed ourselves another round of total lockdown later in the summer.

So, we definitely cannot eradicate the SARS-CoV-2 virus in the population without a vaccine (and an aggressive global vaccination campaign) because even if we could eliminated it in the human population of industrial nations it will likely become endemic in both developing nations and in other mammals in which it has been shown to infect. (How much of an actual reservoir and how much spillback can occur is uncertain but given the infectiousness of the virus any propensity for spillback will ensure persistence of the contagion.)

So, we need to have a plan for dealing with the spread of the virus and resulting COVID-19 outbreaks that allows it to advance through the population at a controlled non-epidemic rate while identifying the particular conditions or factors that make certain people (not all of them older or having evident co-morbidities; the serious and critical presentations of COVID-19 are now known to affect some proportion of young and health individuals including a small minority of children) while developing therapeutic treatments and working on vaccine development and trials. If we could identify the people who are not prone to severe reactions we could actually expose them to the virus in a controlled fashion (variolation) thus driving toward a herd immunity threshold.

However, this doesn’t just mean that “the curve has flattened enough” and we should just open everything up and let the contagion takes its natural course. Doing so would simply result in a delayed epidemic that would look like what Iran or Russia is experiencing now. Instead, what is needed is a controlled loosening of isolation guidelines that allows for essential services to be expanded combined with tracking and trending the spread of contagion to prevent it from getting out of control and overwhelming health services. This does mean faster and more accurate testing (both antigen and antibody) so that these trends can be monitored and models can be corrected with reliable data.

There has been a lot of discussion about tracking and tracing of individual exposures and outbreaks but after looking at a lot of the most recent data I’m dubious that at the current low level of exposure (estimated somewhere between 5% and 10% in North America but heavily weighted toward urban populations) and the latency period of the infection that track & trace of individual contacts even via automated smartphone tracking is really going to provide useful information that will let health authorities isolation outbreaks. The smarter thing to do is to look at predictive models (with the knowledge that they are going to provide a very broad range of different values) and select isolation measures to be relaxed based upon infecting specific groups both with an eye to controlled infection limiting contact to known severely affected cohorts AND to what are the most essential services for society as a whole. To that end, reopening primary and secondary schools to all children who don’t have any underlying conditions and whose parents are willing probably makes sense both from a practical point of view of controlled infection while also ensuring that children are getting both the education and social interaction that they need for development.

Reopening bars, beaches, churches, and concert venues however, is just asking for mass outbreak, and particularly among people who are more likely to have severe consequences. What is really needed is both a public education campaign combined with modeling from political leaders on appropriate levels of interaction, and in that we have seen numerous failures with potentially catastrophic consequences in terms of both overwhelming health systems and political stability.

BTW, there has been a lot of discussion here and elsewhere about the need to achieve “herd immunity” as fast as possible so we can “reopen the economy”. First of all, it should be understood that herd immunity is not, in and of itself, a strategy; it is an exposure threshold above which the contagion drops below epidemic proportions, i.e. the virus can not longer infect enough people to grow at geometric rates. Provided that the immunity conveyed by exposure lasts for a significant duration (years, hopefully decades) we will achieve that herd immunity threshold one way or another, but rushing toward it just ensures maximum mortality. The other consideration is that due to the infectiousness of the virus (with an estimated R[SUB]0[/SUB] of now between 3.8 and 8.9) the herd immunity threshold falls between 74% and 89% of the population being exposed and developing and effective immune response. That is very high, and if the effective immune response only lasts for a few months or the spike protein mutates between variants such that the immune response does not cover all circulating virus, there may be no herd immunity. We never achieved herd immunity with varicella zoster despite the fact that nearly every person on the planet was infected as a child and attained effective lifelong immunity, and so it is possible we may have to live with regular (if less severe) outbreaks of SARS-CoV-2 indefinitely until an effective virus is developed, and even that may require periodic inoculation similar to influenza although the mutation rate of this virus appears to be about a quarter compared to the influenza viruses, so you might need an inoculation only once every few years.

The result is that we probably need to consider some long term modifications to both our socioeconomic institutions as well as more vigorous surveillance for infectious pathogens rather than to just assume that we can achieve some herd immunity threshold and everything goes back to normal. We need that, anyway, because this is neither the last nor most virulent infectious pathogen we are going to have to deal with as a civilization, and the next one that comes along might have a mortality that is an order of magnitude greater than this or worse.

Stranger

I think one issue is that the promises/plans to preserve social distancing are either intentionally disingenuous or pipe dreams. Businesses can’t enforce social distancing rules on their customers–they just can’t. The whole “customer is always right” culture makes it impossible for a clerk or a cashier to tell someone or a group to leave a store, or even remind them forcefully to observe the rules. And in many cases, businesses just can’t follow the rules if they want to stay in business. You can’t afford to run a restaurant if you never go about 25% capacity, and probably not if you never go above 50%. And everyone knows this. So gradual reopening is, at least here in TX, pretty openly being practiced with a wink and a nod, a common understanding that businesses will do the "best they can’.

What we need, desperately, is some actual science about how this shit spreads and what is actually effective to stop it. There doesn’t seem to be any consensus. I am happy to believe that it’s half security theater, but I don’t know WHICH half. I don’t know if it’s surfaces or enclosed spaces or hugs or what that does the damage.

We are about to have a huge set of “socially distant” but in-person graduation ceremonies around here. I truly don’t know if 1) the precautions as written are reasonable and prudent and 2) if it’s actually logistically possible to follow those precautions. And I don’t think anyone else knows, either.

One question I haven’t seen answered is just how much can hospiutals effectively do to treat Covid-19?

I know that a lot of people who get infected never need hospitalization. And I know that a substantial number of people who do get hospitalized or put on ventilators end up dying anyway. What I wonder about is how many people survive because they got hospital treatment who would have died if they hadn’t—how much does medical treatment improve a person’s chance of survival?

Right, although my impression is that we are making some progress and we do know more than we did a month or two ago.

And, depending on what the “actual science about how this shit spreads and what is actually effective to stop it” turns out to be, there might, or might not, be effective steps we as a society can take to stop the spread, even in the absence of a vaccine. If we had a good way to tell who’s infectious and who isn’t, and how to keep those who are infectious from infecting others, we’d be a long way toward having this thing licked.

I think we have a lot more data than we did, and a lot of studies, but I don’t know that any sort of consensus is emerging.

Very well put.

Said lizard brains say, "WooHOO, we flattened the curve, let’s party! They don’t want to understand that the best behavior to insure survival is to EXTEND that flattened curve.

It’s frightening.

The same people are saying that the only ones to die are the old ones with compromised health, and everyone would be better off if they were dead, anyhow. Since I fall in that miserable category, I’m not happy.

I have many rude comments on the whole mess.
~VOW

I’m from Dallas, but have been quarantining in east Texas, south of Tyler, since March 12.

What you saw with people being sloppy with masks and social distancing - is that different from what it’s been for the last two months? That’s what I’ve seen as a universal rule, but even with that sloppiness we’ve managed to flatten the curve to well below the level that it stresses hospitals. My family and I actually dined in at a restaurant in Tyler on Saturday.

I don’t want to get it - my wife and I are approaching 60, so it is concerning (we’re both healthy so the concern is not dire). But I can’t see society keep up the severe restrictions for even six more months, even sloppily following restrictions, so I’m wondering what is the best plan for the next three months to two years.

The survival rate on mechanical ventilation has gone up a bit but the statistics are still rather dire, and it is possible that in many cases ventilation my actually be exacerbating the coagulation problems. However, there have been a number of revelations on therapeutic treatments to prevent people from being put on mechanical ventilation that have made significant improvements. More early detection testing and an effective anti-viral treatment combined with prophylaxis (specific anti-viral immune system factors, inhibition peptides) may significantly reduce the potential for infection or progression of the COVID-19 disease.

Because this has now been determined to be more than a respiratory infection, and specifically the propensity to cause blood clotting, physicians know the signs and symptoms to look for and can apply treatments to reduce coagulation and prevent strokes due to blood clots. And of course supplemental oxygen is quite necessary for anyone suffering low oxygen perfusion, and hospitals and medical gas suppliers have limits to how much medical grade oxygen they can produce and store at a given time. Without that support, people will become hypoxic and suffer brain and nervous system damage, and eventually death.

So, there is a lot that general hospital and ICU support can do to help many patients provided these facilities are not overwhelmed. But if they are, we can’t just conjure up beds, anti-coagulant and steroidal treatments, or supplemental oxygen out of thin air, and people who need that support now will not receive it.

Stranger

I have diabetes and hypertension. So getting it would NOT be good. I’d likely need a hospital. So I’m waiting, hoping for medication that can help fight it off. I would think that finding medication will be easier than the vaccine, so maybe that Remedivir or whatever else can be discovered quickly/

Texas reports massive jump in COVID-19 cases in single day

A huge part of the reason that we cannot reopen things is becuase we do not have the testing in place necesary.

We cannot just base things on hospital emmisions, we have to know ahead of time what hospital emissions are going to be.

The fun thing about exponential growth is that it tends to go up faster than you’d expect.

Let say we start with 5 people a day are being admitted to a hospital that can handle 30 a day.

Now, with robust testing, we see a spike in infections. We know that the number of hospitalizations will be going up over the next week. So, a week from now, we will have 15. You prepare for the increase, and then the next week it starts going back down, as social distancing measures start to take effect.

Without robust testing, you have 5 people a day coming into the hospital. Next week, it’s 15 a day, and you are starting to get nervous, so you start pushing for social distancing and business shut downs. By the end of the next week, you have 45 a day coming in, and your hospital is overwhelmed, and you hope that you did enough that next week you are back down to 15 a day.

As I was talking to a client just today, “He asked, when will we get back to normal?” My reply, “When we accept this as the new normal.”

Maybe I played Trimps too much back in the day, but exponential growth seems to be pretty obvious to me, but for whatever reason, many don’t seem to see it that way. You really can’t “ride the line” of picking a hospital utilization threshold and trying to stay there. You really need to overdo things, because there really is not much wiggle room in there, not when you are dealing with exponents.

So Greg Abbott decided this would be a good time to announce additional easing of restrictions including allowing bars to open on Friday.