Do you, though? Right now in my state the hospitalization rate is 10%. It makes me wonder if I’m doing myself a disservice by continuing to stay home (other than bringing my garbage to the dump once, which is a contactless activity, I have been home since March 22) given I’m mildly asthmatic because aren’t my chances better if I get it soon and get it over with while hospitals are in decent shape rather than during the almost inevitable second wave this fall/winter?
I always welcome your posts.
Just one small point - how do you feel about the term “essential” as it is being used WRT jobs/businesses/etc. I know it is the commonly used term, but I find it quite problematic.
A number of nations in Europe and Southeast Asia are currently engaged in the ticklish and tricky business of reopening and returnig to normal, while watching that R number like hawks. What they have in common is that the did not just “flatten” the curve, but rode that slope down all the way on the other side.
This is an article from almost a month ago on nations reopening. To the best of my knowledge none of them are finished and they are all still doing baby steps.
Yep. That’s happening here in NYC, which has not started to reopen yet. But people are sick of it all and are (irresponsibly) not wearing masks, not distancing, and bars and restaurants that cater to younger groups are re-opening (semi-clandestinely, but they’re open, no doubt about it).
I’d be surprised if we don’t see an uptick in rates of infection (and death) soon.
That’s the thing, tho. Any relaxing of restrictions is likely to result in an increase in infection and possibly deaths. I think we need to accept a certain amount of risk here, with the capacity at hospitals being the primary constraint, and higher-risk individuals continuing precautions. Otherwise, we are going to have to stay locked in our homes until a vaccine appears.
The term is certainly being thrown about with little regard for the literal meaning; golf courses, bars, hair and nail salons are not “essential” by any definition. On the other hand, I am sympathetic to the fact that many of these are small businesses that cannot modify their practices to align with “social distancing” measures in any conceivable way to be able to operate and make any kind of revenue. Nor, frankly, can sit down restaurants, fitness studios, coffeeshops, et cetera, and we are collectively doing little figure out ways of assuring that these businesses do not fail hard even though they cannot possibly pay expenses like rent or payroll much less participate in the economic infrastructure of purchasing supplies.
I’m particularly concerned about restaurants because many of the people who work in restaurants and hospitality do not have college degrees or experience that could be applied to other industries, many are part time or gig workers who already lacked any job stability or significant savings, and the industry as a whole simply cannot survive with any kind of “social distancing” measures as most restaurants are marginally profitable even when they are doing strong business (and without alcohol sales many upscale restaurants would be totally underwater). These businesses are the end point of many other industries supplying meat, fresh produce, baked goods, dishware, linens, equipment, advertising, et cetera so what is already a significant industry upon itself is just the tip of the iceberg from an economic standpoint which is already rippling through the meat, cheese, and beer/wine/liquor suppliers and will affect others in turn. I would like to find a way for these businesses to reopen in a sustainable fashion but am at a loss for how to do so in the foreseeable future.
So, I think some plan for staged reopening has to be considered and implemented both for the economic reality and so we can have a managed approach to getting enough immunity that the contagion doesn’t spread like wildfire. And businesses that are actually essential to the economy, and businesses that are essential for health and welfare, including non-contagion-related medical practices, dentists, physical and occupational therapists, et cetera, also need some plan to return to service, as do less-than-essential-but-still-necessary services like barbers and hair salons, clothing stores, et cetera. But just opening everything up for business, giving the notion that physical distancing and mask wearing are optional, and hoping for the best is not a plan.
And without a plan, that “flattened curve” (which, in the United States even few states have actually achieved) is rapidly going to return to aggressively positive, and the longer that goes on the harder it will be to drive it flat again until maximal exposure levels are achieved. Which, if you are okay with writing off a few million people, is a plan of sorts. It just isn’t the kind of plan I think any rational person who actually understands anything about epidemiology or has concerns for other people should advocate.
Stranger
We have covered this ground enough by now that I am sure my broad agreement with your take in that post is no surprise, so I’ve only included a portion that includes something deserves special emphasis and something that I think is not as clearcut as you state it.
The schools portion I, as a pediatrician, completely concur on. Keeping schools closed is imposing a huge cost on children and their futures while the risks to them from this disease are a small fraction of the risk they must deal with every influenza season. This from a letter in JAMA Pediatrics
The degree to which spread is slowed to others by school closures is unknown but by the evidence to date remains is fractional compared to influenza as well.
Bars? Concerts? No question. Tightly packed enclosed space, yelling and singing even, big risk. Benefits to quality of life and the economy non-zero but not as vital. I can imagine socially spaced concerts but hard to imagine them being worthwhile financially … or very fun.
Beaches? Now we get into some question. Open air is much less risk than enclosed spaces and while some are beaches are very crowded they are not in general tightly packed spaces. Even fairly busy beaches usually have families setting up their umbrellas and chairs at least six feet away from each other. Stating that as a more clear guideline seems to be not so difficult and the violations that will occur of a low risk sort.
Houses of worship, such as churches. I am not so religiously observant myself but the importance of in person services is huge to many. The quality of life reduction by none for this group is massive. Are there ways to allow services in ways that minimize the risks? And yes there are. Reduced capacity services with every other row seating spaced six feet apart, possibly with several services in shifts, and more attending on line, or perhaps alternating cohorts that attend in person on different weeks. Crowded services with lots of singing though? No. Late stage only.
These are though the sorts of disagreements and discussions to have, over what is actually the most benefit change for the least risk to make, and how to decide how to stage. Yes some will be by the natural experiments going on as different places relax in different ways. The results will need to be interpreted with caution: The U.S. is not Sweden and Texas is not Michigan. They are not controlled studies methodically designed. Still we will learn what we can by watching other nations and individual state results from their approaches. The lack of strong and effective national level leadership (I hope that does not cross the political line) has left us with this patchwork of experiments (I don’t presume the results of any of them), and some will very likely have flares that minimally test the limits of their systems as they make it up on the fly. Yes it does seem like some are rushing in where angels fear to tread. But spinning this the best way possible - summer is the time to learn these lessons, when capacity is not already strained with influenza, and the lessons learned may help prevent worse problems in the Fall.
I could have written this. Some of us continue to self-isolate for our own benefit, not for any “community” benefit. And the economy is other people’s concern, not mine. My only concern is my life and that of my husband. I already see some people without masks, and I stay as far away from them as possible. This will continue until there is a vaccine.
Sounds like Mr VOW and me. He’s 70, recent heart attack. I’m 67, Type 2 Diabetes, high blood pressure, etc etc. Neither one of us is ready to die. Hell, these are our Golden Years!
~VOW
Your arguments on both points are valid, although I would note that getting actual compliance from the general public on following guidance is a different issue. But that gets to another salient issue, which is that if you don’t open up at least some venues for public interaction people are eventually going to start violating the prohibitions en masse anyway, which will also further erode any confidence or respect people have for government. So while I would argue that beaches are not essential (I’ll grant the benefits of houses of worship for those who are pious though I doubt many are going to follow strict guidelines) but that when you get to the point that people are going to go to them regardless, you may as well at least give some allowance and try strongly recommended guidance because the other alternative is mass disobedience. And frankly, a resultant wave of infections that could be traced back to people on beaches ignoring distancing measures may serve to reinforce the need for such measures pour encourager les autres, as awful as that sounds.
I’m not unsympathetic to the need for people to be able to get out and do things to relieve the pressure of being stuck at home; I’ve been personally frustrated by the inability to go out camping or hiking (even though the trails are generally pretty sparse, the potential for infection in open air is much lower, and the ability to maintain distance is pretty easy) and when the local wilderness trail opened up last week, their strictures were so ridiculous and in some ways counterproductive (everybody has to be counted and go through a gate, which led to people just bunching up) that I gave up on it. But I also see a thundering herd of people walking around and interacting in apparently complete ignorance of distancing guidelines, and even the occasional expression of contempt for maintaining distance or wearing a face mask, which means even the marginal effectiveness of basic distancing measures is probably overstated. And this is in a state where the government has actually taken the threat of widespread epidemic seriously.
Stranger
I don’t know if it’s any different than it’s been for the past couple of months; with the exception of going to grocery curbside pickup, and to get my younger son stitches in his chin (tree climbing accident), I haven’t gone anywhere.
But the thing was, this wasn’t sloppy, this was just like it would have been this time last year, except that maybe 5% of people were wearing masks.
Had one person actually been contagious, there could have been a huge number of people who ended up infected.
Yes, we’ve flattened the curve to some degree, but we’ve done that not by producing tests or by tracing, tracing, and quarantining people. We’ve largely achieved flattening the curve by shutting everything down for 6-10 weeks. Even weeks and weeks after the lock-downs began, we had 2000 deaths per day until fairly recently.
We’re right to be concerned about the economy. People don’t want to accept that millions of lost jobs is inevitable, but at the same time, people don’t want to just accept that their lives are inevitably going to end 10-20 years early. People don’t want to accept that they have to end up in the ICU for 3 weeks and bankrupt after they leave the hospital (speaking of economics).
Right now probably no more than 5% of the country’s population’s been exposed to the virus. What happens when start letting our guard down and workers start dropping like flies? Look at what’s happening at meat packing and industrial facilities.
I agree with this and I think we are all getting a lesson in human psychology. We are higher level beings, but at the core we are animals. I think it is unrealistic to tell people for more than the two months we have been doing this that they cannot interact with others, that they can keep in touch online, and not hug, slap each other on the back, shake hands, congregate in bars and churches (some people do both) etc. People start getting a little squirrely and will rationalize why they can go back to that. It is the vast minority of people who are okay with being socially distant for extended periods of time.
Any plan must take that into account and it seems that at least publicly, none of the plans have admitted this very basic fact. People did what was asked for two months, but preach all you like, they will not do it for six to eighteen months.
Further, I am not in the restaurant business, but I know people who are, and you simply cannot, in that business or any, operate at 25 or 50 percent capacity. Your rent or mortgage is not at 25 or 50 percent. The electric bill is not at 25 or 50 percent. Although you can lay off some staff, it is nowhere near linear. If you had 10 people at full capacity, you cannot have 5 or 2.5 at reduced capacity, more like 8. Your personal expenses are not at 25 or 50 percent.
So you either continue the slow slide into bankruptcy or close now and take a financial hit that is merely terrible instead of catastrophic.
Right. I think it is terribly irresponsible for some in the media to be reporting as if TX is failing here. It was always about flattening the curve, then relaxing restrictions, and once they were relaxed, of course we would see an increase in cases. That doesn’t mean it failed or it was too early, it was exactly as predicted.
It is bait and switch to say that restrictions cannot be relaxed until we are sure that there will not be an increase in new cases. That will never happen without a cure or a vaccine and nobody (at least when this started) said that we were locking down that long.
I find it interesting that drive in theaters, before most were closed or going down, are now having record business. The ones open here in Kansas City are showing old movies but to sell out crowds. Musicians are starting to dodrive in concerts. A high school is holding their graduation at one.
One local drive in has gotten record bookings.
So the new normal may be the re-opening of the drive in.
Yes, that is correct.
Yes, oddly enough most people have some smarts and self-interest. Also, while in isolation some things - such as the 6 foot distance and wearing a cloth mask - might not be super-effective in combination there’s an additive effect that has helped.
You have asked the million dollar question here.
The goal going forward is to balance between keeping the medical system functional while opening as much of the economy as possible while still keeping infection rates manageable. As others have noted, a certain number of people can’t distinguish between “easing some restrictions” and “anything goes”.
Going forward we WILL need to continue distancing, mask wearing, hand washing, and so forth. That is absolutely vital. We will NOT be going back to life-as-normal last year.
That’s why we clerks and cashiers don’t do that at my store - we call a manager or store director to do it for us.
What we struggle with, at least at my store, is enforcing item limits. You know, telling people that no, you can’t roll out of here with a cart full of meat, you get only two pork, two beef, two chicken. (Yes, there are some people with large families - they can get two “family packs” which are 7-10 pounds of meat each, available in all of the above categories. That’s 15-20 pounds each of chicken, beef, and pork or 45-60 pounds of meat. In addition to sausage, turkey, lamb, etc.)
But even there, we can call in a manager or director. And those folks can call the police (and have in a few instances). Sure, some people threaten to never come back (which, to be honest, won’t break our hearts) but we really are an essential service. We are where the food is.
It’s more problematic for other businesses.
You are correct on this.
The problem here is that this is a new disease. There hasn’t been enough time to really learn the things you mention, and that the research is having to be done while also dealing with the ill doesn’t help.
Well, we do know that the curve has flattened. So we’re doing something right.
The precautions suggested by various organizations like the CDC and WHO were not pulled out of someone’s nether regions, it’s based on how a lot of diseases spread.
The good news:
As someone with mild, intermittent asthma I had a lot of concerns about increased risk myself but it seems that asthma, particularly the mild sort, is NOT a risk factor in severe reactions. link, link, link. You can, of course, still have a bad reaction as seen in people with no known additional risky conditions, but apparently being slightly asthmatic is not a huge red flag.
At this time (subject to change with more information) based on what I’ve been able to find on line the “viral load” has an effect on how severe subsequent illness might become. Which means if you get sick after picking up only a few viral particles you’ll likely have mild illness, but if you pick up a LOT of viral particles all at once you are more likely to have severe illness. So washing hands, wearing a mask, keeping your distance from others not only mean you’re less likely to catch covid at any one time, but if you do, you might have a more mild case of it. So even if we decide folks might as well catch it and get it over with there is STILL a benefit to keeping up with all that other, bothersome stuff because it makes it more likely those people will have a mild as opposed to a severe illness.
All of our chances will be best if we keep cases within levels that our health systems can manage. The trickly part is finding out the least restrictive way to do that.
The weakness in quoting known infection rate isn’t that the real infection rate is higher, as everyone realizes it is (I tested positive for antibodies on a test claiming 100% specificity, I was never tested for active infection), it’s that it isn’t the relevant number to overwhelming the health care system. That would be hospitalization rate, which as long as hospitals aren’t near capacity (and lots of people who should get hospital care are turned away) is a pretty accurate stat. And in more parts of the US now hospitals are in more immediate danger of layoffs or even shut downs because other care has been reduced by ‘lock downs’, than they are of being overwhelmed by COVID cases.
Not everywhere though, and hospitalization rate could rise a lot in various places depending the effect of ‘reopening’ measures.
In short, OP’s suggestion is being carried out now in many places, to a degree possibly enough to overwhelm hospitals in those areas. We don’t know. Certain statements about this tend to be from politicized people IME.
But OP’s basic logic is correct. If you can’t sustain a ‘lock down’ till there’s a vaccine/highly effective treatment (non starter as actual plan, see below) and you can’t ‘stamp it out’ first then ‘reopen’ (doesn’t seem possible in the US at this point), then you have to find the combination of economic restriction and load on the healthcare system which is sustainable. Like a lot of other COVID questions though that’s a lot more complicated than the politicized binary which it tends toward.
There are myriad economic activities and differing risk levels inherent to them, not just ‘on/off’. There’s wide variability in compliance with precautions…but if people won’t stick to somewhat relaxed measures what makes anyone think the same people would stick to them if they weren’t relaxed? OTOH the medical system is learning how to treat people better without any single headline grabbing breakthrough. A vulnerable person might have a significantly better chance of avoiding death or extreme suffering if they get it 3 or 6 months later just because hospitals are better at it. Nor is vaccine or highly effective treatment certain to be anywhere near the standard ‘18 months from whenever we’re speaking’. There still might never be either, or there could be one or both in quantity before the end of 2020.
I don’t see any way to find an answer to this without some degree of trial and error in various places, which is what is happening.
I would agree with much of what you said, Corry El, and I agree here that there will be some degree of trial and error.
But it seems that we in the US are applying a trial and error approach while being willfully ignorant of what has worked in other countries, and even when we acknowledge that other countries have been more successful, we shrug and say that “that won’t work here.”
Why did it take so long for us to accept that masks were a thing? It’s common damn sense, really.
Why has it taken so long for us to accept that we were woefully under-prepared in terms of testing?
When will it dawn on us that our system of employer-sponsored healthcare is very likely playing a HUGE role in why people are getting subpar care or waiting until it’s too late. I say likely because I can’t prove it without an actual study, but based on what I’ve read, other countries like Germany and Korea have done well not only at tracing but also separating and treating those who have become infected. We have not.
I think the problem I have with reopening America isn’t so much that I disagree that we need to reopen - we absolutely need to get our economy going again. Rather, my problem is that we’re just accepting the outcome that we’re seeing now (and will likely see again in the fall) as inevitable - like we just have to accept the death and the medical bankruptcies. That’s what irked me a little about the OP.
I absolutely disagree that we have to accept this outcome. This was not inevitable. This is a result of a society that doesn’t want to learn from science, doesn’t want to learn from others, and has a hard time accepting the idea that sometimes scientific reality confounds individual liberty. This “Let’s reopen now” is, I think, a deliberate attempt to get people conditioned to accept death and financial ruin.
It’s completely unfair to wage earners or even middle class salary earners - not to mention their families - to force them to come to work just because we don’t want to change how we live and work. It’s grossly unjust - and on some level, dishonest - to claim that we’ve done all we can and we’re just gonna have to live with this. It’s not right that we have to use our working class as pawns in a chess game against a virus and its economic collateral damage. I don’t accept this, and I think if we reading this accept it, we’re participating in our own decline as a society. We should demand better than this.
I’m sorry, I’m trying not to make this a political rant, but the question of reopening now is a policy debate. It’s inevitably political. I know this is not supposed to be political, and I’m trying to avoid singling out parties or individuals. FWIW, it’s a societal problem as much as a political one, IMO.
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If COVID-19 could talk, it might very well say, “I’ll be the judge of that.”
My dad, who could talk, used to say, “We shall see what we shall see.”
What I fear is that the number and severity of infections will go down over the summer (as other corona-virus infections do naturally), and because of that the urgency goes down, scientific investigations go down, and people stop doing the necessary precautions like social distancing and face masks. Hell, it bugs me that people already won’t do those simple and (quite frankly) minimally intrusive things. Come fall, more inside things, and the second wave will be worse than expected.
As I’ve been typing this, an even worse thought. RIGHT NOW, we’re talking about IF schools open in the fall with in-person attendance that masks would be required, and that maybe pre-school, kindergarten, and first grade would not attend because it would be impossible to get them to stay distant. As the summer comes and cases decline, will these measures be left behind and schools open up fully with disastrous results?
Oh, and in regards to
The treatment of COVID19 in the US is a symptom of this; it’s a much bigger problem, and aint’ gonna be fixed any time soon. COVID19 won’t jar people into an epiphany.
I think some businesses can enforce social distancing. It’s just not profitable for many of them like bars and restaurants that typically run on a slim margin.
There is a VERY small ‘grocery’ store about 4 miles from me. So small that they now only let one person in the store at a time. You tell them what you want, and they shop for you. I think they probably need two employees in the store at a time now, but they are enforcing social distancing very strictly (you can stand in the entrance to the store). I think they will be fine, it was rare that more that one customer at a time was in there anyway, but last time I went, I had to wait a few minutes before being allowed in.
What might actually help some of this is the people working from home now. I’m one of them. I can shop pretty much whenever I want. Don’t have to shop in the evening, or wait until the weekend. That may spread out the crowds a little bit. I’m really not an optimistic person, but that may help a tiny bit.