Well, yeah. But you have to go with your best guess. What the hell else can you do?
Of course, what really matters is how fast, and precisely in what order, reopening happens. Throwing open the doors of every business is probably not the right approach.
In any respect is the irresponsible desire to reopen that we are currently seeing, a predictable response to the ill-advised and excessive closings? I’m thinking about the limited success of programs like DARE or “Just say no”, especially when kids realize that a hit on a joint DOESN’T kill them or make them crazy. Or ill-advised abstinence education, as opposed to teaching safe, responsible sex.
IMO, it is unfortunate that TPTB didn’t enact tailored restrictions from the get go, aimed at protecting the most vulnerable populations and eliminating the greatest potential risks.
So, you’re actually saying that taking steps to stop what is perhaps the most deadly virus on the planet is as “ill-advised and excessive” as telling kids that smoking a joint is dangerous? THAT is what you are basing your argument on? Seriously?
If it is that “ill-advised and excessive”, why is a Georgia church closing again after being reopened for only 2 weeks because “families” (notice the plural) in the congregation have contracted the disease?
You can argue that some of the closings at the statewide level were excessive, but that’s more of a retrospective judgment. State governors had absolutely no idea where the virus was 10-12 weeks ago when they began ordering the closures statewide. That was a rational decision.
That said, now that we have a better (though far from perfect) understanding of the virus’s scale, it’s not unreasonable to ask how we can start at least trying to resume life as normally as we can live it. That’s not unreasonable.
Now that the curve has gradually stabilized, we have a precious commodity right now: a little bit of time. We have time to ramp up testing, ramp up production of masks and PPE, and we can print money to help people and businesses avoid suffering the worst financial consequences of the shut-down. But if we don’t test and if we start acting in defiance of common sense, we’ll be back where we started, and it’ll be right in the middle of flu season.
The virus is not appearing to be among the most deadly on the planet, tho. Granted, data is not well-established yet, but at this point COVID-19 is about as contagious as the cold, and about as deadly as West Nile:
Infectious Diseases in Context
It’s worth noting that the media is focused almost solely on COVID-19 death counts, which distorts, IMHO, what is really happening. It makes it seem like this virus is the only thing killing people in the world right now, which it is not.
I’ve talked to restaurant owners who are thinking of moving to drive in service. It’s going to be at least a year before they are allowed to reopen at full capacity, and Covid-20 will be out by then anyway.
We should expect to start seeing dining rooms demolished to make way for larger car park areas. Every fast food restaurant is going to go to Sonic’s model.
The point of testing is that you know what the hospitalization rate will be in the next week or so. If you do not have adequate testing, and are just basing everything on the number of people going to the hospital, then it’s like trying to drive down the interstate while only using your rear view mirror.
The public will probably become complacent, but I do not think that scientific investigations will.
“Flatten the curve” was in response to an immediate and dire need – to prevent hospitals from becoming war zones. There was no expiration date on that, it was just hitting a giant red button to shut shit down because we completely failed to prevent the virus from entering the country and spreading nationally.
I’m not sure how things have been communicated in other states, but like others here have suggested, things here pretty quickly transitioned from “flatten the curve” to “prepare for an exit.” That meant producing or acquiring tests, putting an infrastructure in place to tamp down hot spots, stockpiling PPE, figuring out how to operate businesses safely, etc. Ohio is now opening back up, having done a decent job (if you trust our leadership) at building up a public health infrastructure and developing guidelines for businesses, but still short on PPE and woefully short on tests.
So what now? To me, saying we’ve flattened the curve so we can open back up is silly, because we’re actually in a worse position now than we were on March 9th in terms of viral spread. It seems very likely that things can get out of hand and overwhelm the hospitals again. The problem is that as a state, we’re out of money. Our unemployment system is strained, the federal response has been fucking awful, and so people just straight up need to go back to work. Even though we’re clearly not really ready for wave #2.
It sucks. There SHOULD have been a plan in place to pay people to stay home for multiple months, while states got their shit together in terms of PPE and testing. There SHOULD have been a nationalized effort to produce PPE and tests starting back in January. There’s no reason we should be in this awful situation, where we’ve got to send people back to work even though we know it’s going to lead to another spike. But it’s where we are.
I just took a look at that site and the data is HORRIBLY out of date. The COVID-19 data was updated on March 20 with stats of 130 000 cases per year and 4 700 deaths. Visualizations are great for understanding the data, but the data has to be valid.
Yeah I see that as well. They have another, more current, page with more visualizations here including the deadliness/contagiousness graph. The take-away is about the same, tho.
What does actually worry me more than being shut down again is if we should get shut down again, but aren’t.
I’ll tell you right now, Ohio cannot afford a 2nd shutdown. When the next wave hits, and it will hit, we’re just going to have to plow through it.
That fact has really got me not knowing what to do. Do we start seeing friends again? Letting the kids have playdates? It feels like we shouldn’t be socializing yet, since the virus is still out there, and worse than before the shutdown, but at the same time, the damage is done. We lost. Is there any point in continuing to quarantine?
Broomstick, thanks for your long posted reply. I did notice, however, that many of the quotes you attributed to me (the OP) were not mine. Not that I really disagreed with them.
I think that’s an example of the over-politicization of ‘more testing’ as the answer. It’s entirely impractical to fine tune the policy response every week based on what ‘testing’ (supposedly) could tell you about next week’s hospital admissions. At some point you have to make a decision to change restrictions with the knowledge you can’t micro adjust that on anything like a weekly basis.
Anyway it’s beside the point I was making, which is that what you care about in the end with a ‘flatten the curve’ goal is hospitalizations. You don’t directly care whether X hospitalizations is from 1% of the population being ‘confirmed cases’ or 5% actually having been exposed in the same time frame. The difference in confirmed and actual exposures only really matters when the higher number gets toward some kind of ‘herd immunity’ level which is much higher.
In this part of NJ at least anybody can get a test any time, walk in, free. I walked in for an antibody test a couple of weeks ago (positive). This is good, but hasn’t actually fundamentally changed the situation here, in the highest per capita COVID death rate state. The numbers are going down now, but that’s because aspect(s) of the stay home, social distancing mask etc. must be working (though important to keep in mind nobody knows which specific measures in which situations account for how much of the improvement, some, ‘we highly recommend you wear a mask outdoors’ are quite likely nearly useless ‘feel goods’). It’s not because of ‘testing’, which would only make a big difference if the disease were contained, to keep it contained. That’s water under the bridge here.
Again I think the politics blame game tends to result in routine overstatement of what testing can really do for you, though it is important.
No, that would be an example of science and evidence based decisions.
What you are describing is politicization of the crisis. That it is inconvenient to respond to the data, and so you won’t.
I didn’t say anything about fine tuning. Do we “fine tune” our houses when the smoke detector goes off? No, we realize that there is an emergency and take care of it.
At the very least, even if you refuse to make any changes to policy or public announcements, it gives the hospitals a heads up about what they should be expecting over the next week or so.
Right, and if you are not testing, then you have no idea what number to expect in hospitalizations. Exponential growth’s not something to mess with.
You don’t want to have any policy changes, but you want to “fine tune” your number of hospitalizations, without even testing to know what they will be ahead of time.
Testing is not a cure, and no one has said it was. Testing is a tool. It has two important aspects. The first is individual, that a person knows whether or not they are infected, which I would argue is a good thing, YMMV. The second is that it gives public health officials a tool to monitor the progress of the disease, because as has been repeated, it takes a week for it to go from infection to sending someone to the hospital (if they get it that badly), so without testing, your data is a week out of date. When you are talking about something that can easily double every 3 days, that’s not soon enough.
I think that politics is undermining the need for testing, because as you said, responding to the information that testing gives you may be politically inconvenient. We’d have to have a hell of a spike here in Ohio for DeWine to shut us down again. It may be in the best interests of public health to do so, but it would not be in his interests politically, so it is easier to pretend that testing doesn’t matter than to use it as a tool to protect public health.
Not sure the arguments for or against testing are necessarily political. (Even if some decide their beliefs based on partisan signaling.) Both do though require accepting or not accepting certain assumptions as being more likely valid.
To me, as much as I believe a strong surveillance system is a key part of needed data inputs, it seems that there is little evidence to support a belief that results of more global testing have very strong predictive value for the hospitalization rate next week, at least in a context in which the disease is already moderately widespread. There’s just too much noise from many sources in who gets tested and why. It is a very very very poor measure of the true rate of infection and an even poorer measure of how much risk those who are infected are at of being hospitalized or ending up in the ICU. Using it as a primary indicator risks lots of chasing your tail, and impacting the behaviors of the vast majority of the population would be poorly accomplished with frequent adjustments up and down even on the basis of data that had good short term predictive value. Really any adjustments on restrictions back up at all will be hard to accomplish, and likely will need to be done at some point. Considering compliance of the public in response to “orders” may be “political” in that it is “the art of the possible”, but ignoring it, thinking that all will just comply, would be dangerously naive.
If the item of concern is hospitalization rates (both as its own primary concern and as a proxy of next week’s ICU rates and the following week’s death rates) then look at it directly rather than at a proxy of dubious and at best limited predictive value. I am not married to any specific parameter but it seems to me that continued rolling average drop for three weeks after entering a stage, or staying below a much lower certain level and within a very limited rate of rise, would be reasonable to require before progression into a next stage. And alternatively some specific rate of rise or crossing of some absolute threshold reason to pull back a level. (Along with other criteria like having enough capacity available otherwise, no huge outlier increase in surveillance testing results, so on …)
Now from the POV of politicians’ self-interests … they should be aware that the biggest harm would not come from opening up a bit slower than was possible, but from either having to reimpose restrictions once removed, or having a flare that overwhelms systems. Their informed self-interests should be conscious that sometimes shortcuts take much longer and want to err to the slower side in order to avoid risk of either of those politically most devastating outcomes.
I actually think there is a very strong argument that aiming for herd immunity is the best strategy in this situation. We know that we can risk stratify coronavirus deaths by age, and that those under 45 have a much lower risk of death than older people (COVID-19 Provisional Counts - Weekly Updates by Select Demographic and Geographic Characteristics), and that the risk of death increases exponentially with age. I’m not sure where the 74-89% of population immunity required for the herd immunity benefit comes from–mostly I hear somewhere around 70%. COVID-19 and the long road to herd immunity | Hub. I think that the suggestion that the lower-risk population start entering society again is well worth considering
I think the major benefit of opening slowly is simply to continue to not overwhelm the healthcare system, and to protect the most vulnerable from actually getting ill (now does the population of “most vulnerable” count as <30% of the population? That’s a complicated question which requires further, more nuanced risk stratification). A vaccine could be years off, and we cannot keep suppressing the economy for that long. I think the question of the capacity of the health care system and how to know when to “clamp down” again is tricky–if we open up restaurants, and see a small surge, do we close them again? When do we then reopen? And what if we see another small surge after re-reopening?
I agree that testing is useful for larger-scale epidemiological purposes (like anticipating an outbreak and preparing appropriately), but I question the ability of our public health infrastructure to contact major contacts of a known case to recommend testing and disease suppression in that way. My understanding is that our testing capacity now exceeds our testing demand: https://www.washingtonpost.com/health/as-coronavirus-testing-expands-a-new-problem-arises-not-enough-people-to-test/2020/05/17/3f3297de-8bcd-11ea-8ac1-bfb250876b7a_story.html
IOW, I think the benefits of opening slowly and aggressive testing are to avoid overwhelming the healthcare system, and possibly waiting for other treatment options. I don’t think continuous restrictions are necessary or optimal while waiting for a vaccine. I don’t think I need to elaborate on the economic toll this has on the American population; suffice it to say it is substantial.
How is this supposed to work, though? For example, we hear that kids are very very low risk, so sending them back to school would be one place to start. However, schools aren’t operated by the kids, and a fair chunk of teachers (and janitors and bus drivers and lunch ladies and so forth) are older or have health conditions that put them in the “not lower-risk” category. The last statistics I’ve seen (admittedly from 2011-2011) are that 30%+ of US teachers are over 50. If they stay home, how do the schools operate? or do we make them come to work anyway?
How do you make it possible financially for workers over the age of 45 (or 55, or whatever your cut-off is) to stay home to minimize their risk, while still encouraging people who are presumed to be lower-risk to go back to work? How do you do this WITHOUT breeding resentment and age discrimination and ageist feuding?
Again, herd immunity is not a strategy; it is an end result of whatever strategy (or lack thereof) that is applied to deal with contagion. And while it is true that “ those under 45 have a much lower risk of death than older people”, the deaths that occur are horrific, as are the long term consequences for many that contract a severe case of COVID-19. Writing the susceptible cohort of the population (who we still cannot reliably identify) off in service of some hypothetical return-to-normality is not a good strategy.
The estimate of 74% to 89% threshold for herd immunity comes from the simple calculation for that threshold (T[SUB]H[/SUB]=1-1/R[SUB]0[/SUB]), which assumes that exposure results in long-lasting (many years) long resistance based on the most current estimates of R[SUB]0[/SUB] of 3.8 to 8.9 (which are much higher than the original estimates provided by the WHO but are actually remarkably consistent with early tracking models of the rate of contagion). If it turns out that immunity is not long-lived or the SARS-CoV-2 virus mutates sufficiently in its antigen properties that it can reinfect previously exposed people, there may not be any effective herd immunity without a periodic vaccine, which itself is years in the offing. Thus, we need to start thinking beyond the simplistic solutions like “expose everyone now to achieve herd immunity” or “a vaccine will be here by January”, neither of which are realistic strategies that both minimize mortality and morbidity nor return us to a stable economic environment.
Stranger
If we cannot develop immunity to SARS-CoV-2, we’re fucked. There’s really no strategy except to prepare more hospital bed space and start training nurses.
Did you miss the “without a vaccine” part?