A better question is to ask how can a restaurant stay in business while being safe? Most places around here switched to being takeout or delivery only. I’ve read where some are reopening inside seating service but with HUGE restrictions.
So its not trying to keep them closed. Its finding ways they can reopen and stay in business.
I am reminded of Charles Guiteau’s argument “The doctors killed Garfield, I just shot him.”
Well I know the exact opposite is true. And I am not wrong. Where do you even GET this wrong “knowledge”??? I know it from primary sources and first principles. Where does the wrong knowledge come from?
I am not a Dr but I know enough from basic knowledge. Plus I think actual Dr.s have posted in other threads confirming this.
In my country at least, there are laws and regulations about determining cause of death. And these are followed strictly.
For every death, there must be a doctor who identifies the primary cause of death, and contributing causes. This is the doctor who treated the person while alive, or the resident doctor of the care home, etc. The primary cause of death is recorded on the official death certificate.
My country uses international WHO standards for classifying causes of death, currently ICD-10.
Inflenza deaths here are recorded as J09-J11, link here.
Influenza cannot be uniquely identified from symptoms. There are large ranges of causes that present with broadly similar symptoms.
Both J09 and J10 call for identifying an influenza virus. This is an expensive test and is rarely done for routine influenza symptoms.
J11 is an allowed cause when the virus is not identified. This is typically done when a person has influenza symptoms during an influenza outbreak and then dies. Because of this, we see a clear rise in influenza deaths during the usual recurring influenza epidemics. It is just an artefact of reporting conventions, not a reliable measurement of influenza as a cause of death.
Clearly, influenza is underreported as a cause of death.
And that’s just the normal, seasonal influenza.
Initially COVID-19 was also reported as a cause of death only after positive identification of the virus through PCR. This was (still is) a very expensive test with limited availability. It was certainly not performed on old people who had already died in a care home. Therefore, it is absolutely plain that it is underreported as a cause of death, just like normal influenza outside of an outbreak is.
Some countries have changed the criteria for reporting COVID-19 as a cause of death and you see this as large spikes in the stats. Again, these are artefacts of diagnosing and reporting.
A different subject is the EUROMOMO project that attempts to discern influenza deaths from overall excess death statistics. Such projects invariably show higher influenza deaths. “Official” influenza deaths are still reported by counting death certificates as I explained earlier.
Maybe an actual Dr can correct me if I’m wrong.
Just in case I wasn’t clear, they will be labeled as flu victims if they didn’t die of another identifiable cause and their doctor thinks they had the flu.
Most (old) people do die of another identifiable cause, which rapidly worsens due to the flu. In these cases the doctor records that other cause as the primary cause.
And the doctor can practically never know for certain if they had the flu.
I’m not a Republican and don’t know many, but I’m about ready to endorse opening up. Here’s why:
Allowing businesses to open doesn’t mean they have to. And it doesn’t mean people have to go to them. It’s not compulsory. Companies and employees can make the best decisions for themselves. If you want a haircut, you can choose to go get one at a salon or cut it at home. If you’re at-risk (at-promise?), I suggest you cut it yourself.
Perhaps more important than 1, opening up doesn’t mean the end of countermeasures. It doesn’t mean the end of mask wearing, hand washing, contactless delivery and payment, physical distancing, and the rest. Restaurants can move seats outdoors, close the bar area, mask up, limit contemporary diner numbers, and other things. We can still Lysol everything in sight.
We can open up but give people the option of still collecting unemployment if they choose not to work, even if their businesses have recalled them. So if the machine shop says come back to work, and the employee says no thanks I’m diabetic (or whatever), let them get their $900/week for a couple more months.
Our hospitals have the capacity (except where they don’t), the virus isn’t going to burn itself out. We need a certain number of people getting sick every week, so they can end up on the healthy side again when others are getting ill. We need a bottleneck to the viral spread, not a complete stop, or else it’ll just flare up in July or August and exceed our hospital capacity. The only way to avoid an eventual overwhelming is to get a certain transmission rate, because that means immunity later. We cannot flatten the curve too much now or it’ll be too high later. Hopefully that made sense.
A sizeable chunk of the population can keep on working from home for the summer. Their life is altered, but not disrupted. If we open up, we should ask that those businesses who CAN stay home TO keep staying home. That’s how we’ll keep the curve low and flat while at least some people are getting sick.
We don’t have to open up today. We can plan this for May 22 or something, depending on where you are and what your state’s statistics are like. 2 or 3 weeks is a long time for COVID. Things can change in that amount of time.
If we plan ahead, we can always shut down again for a week or two here and there. Just because it’s complicated and difficult doesn’t mean it’s a bad plan. Good strategies are often intricate and complicated. Bad ones are often blunt, unsophisticated, and non-specific.
So those are my reasons. We’re better prepared now, we’re over the hump, and we don’t have to go from 100 mph to 0, so to speak. We can ease off the gas a little bit, and if necessary, step on it again later.
How can we know if we’ve reached the hump, or over the hump, when our testing capacity is so small? We need to up our testing massively before we can open up even a little bit, at least so we’ll know quickly if something’s changed and we need to shut it down again.
There is a new Kremlin/GOP canard out there, that the covid deaths are inflated as people who die in a auto accident (for example) are classed as Covid deaths. This is being done to scare the populace and get them to vote trump out. :rolleyes::rolleyes:
Having worked for a year in the Coroners office (hence my nickname), altho cause of death wasnt my thing (elder fraud was), they are careful to actually determine it. It’s a big deal.
Since the rest of the usual causes of deaths roll on like normal* - it is not true that covid deaths are being deliberately inflated and misclassified.
Thanks…I always wondered. 
First of all, let me express my appreciation for your organized points, which allow for actual discussion/debate.
I agree with the broad outline of this, however, there is are consequences as to whether a business is closed to external reasons (hurricane, governor imposed shut-down, etc.) vs. internal decisions. This can range from insurance coverage (which typically pays out ONLY for external business stoppage) to whether or not aid of various sorts is available to businesses struggling with the economic side effects of the pandemic. Some business owners will favor a declared shut-down because it enables them to collect on insurance or aid that they otherwise would not have. Given how rationally and thoughtfully you laid out your post I’m sure you will be able to see the pragmatic roots of their viewpoint even if you disagree with it.
We can - but will we?
I fear that all too many people see “open up” as the cue to discard all those other measures and precautions. Fortunately, in at least my state (I have not exhaustively reviewed all the current permutations), what is meant by “open up”, or perhaps better put “loosening of restrictions”, is separated into phases with defined measures and recommendations.
A lot depends on being able to deliver a useful message to the masses.
We could - but will we?
I believe that in some cases the cry to “open up!” comes from people seeking to limit (if not entirely eliminate) social spending.
So… what are you doing to communicate this point to your representatives in government?
It does, but it is a difficult balancing act given that there are still so many unknowns and uncertainties about this disease.
I’d argue that’s not a bad thing to encourage even in normal times - there are benefits to encouraging people to work from home, from reduced wear and tear on roads, changes in energy consumption, and so forth. Of course, not every job can be done from home (that is the case with myself) but it’s a good option where feasible.
Again, a phased approach has merits. In my state all but three counties moved from one phase to a less restrictive one last Monday - the remaining three will do so next Monday. This decision was made mostly on the basis of where the virus is most present. As long as such a schedule is seen as a plan and not a mandate I think that can work.
One problem is that the Federal level seems to be seeking “blunt, unsophisticated, and non-specific”. Thank Og the governors (at least most of them) seem to be stepping up to the plate. My state is making decisions county-by-county. Illinois has divided the state into five different regions for planning/phasing purposes. Given the differences between dense urban and spare rural populations that sort of thing likely makes for a more nuanced approach.
I disagree with your assumption that we are, in fact “over the hump”. I say we don’t know whether or not most areas are “over the hump” or still driving up the initial slope or not.
Except that we’re emphatically NOT OVER THE HUMP. The country, taken as a whole, is pretty clearly only very slightly declining (although, as jshore points out, Rachel Maddow pointed out last night that, if you exclude New York City, the number of cases in the country is still rising). Compare us to countries like Spain and even COVID-ravaged Italy, and we’re clearly nowhere near ready to re-open:
Shows that trump is clueless and useless still as far as Covid goes.
Not that I believe that conspiracy theory but how many deaths came off the CDC board for Covid deaths? And why were they up there without knowledge that they were in fact Covid 19 deaths?
For the purposes of measuring the virus’s effects vs. our hospital capacity, we don’t need testing, we just need hospital utilization rates. We can just ask hospitals what their current rates are, then have a need for a buffer.
Consider that we don’t technically care if a patient is intubated because of COVID, or flu, or any other reason. A bed is a bed, a vent is a vent. Suppose a chemical plant exploded and 600 people had caustic burns to their lungs, and they were all sent to the ICU and intubated. We’d have to shut down again (in that area) because the hospital would be overwhelmed, and so COVID patients couldn’t be cared for.
So all we need to know is how much space we have in ICUs in each particular county. Open if we can, shut down if and when we need to, regardless of reason.
Now that’s not to say we don’t need testing; we do. We just don’t need it for reopening planning.
I feel any of those contingencies can be covered the same way we caused them in the first place - with appropriate legislation and executive orders. I’m no lawyer, but I’m confident there’s some way to allow restaurants to open while not violating their insurance policies if they need to be closed. Call it an automatic health inspection failure or something. I don’t know the specifics, but it’s a matter of law, not science, and legislatures are very good at that sort of thing.
When I go out, I see masks on most people. So somehow, people got the message that we needed masks, and from the stats I’ve seen around the world, I’m of the belief that masks are the #1 best way to stop this thing. I think that’s 80%-90% of a solution all by itself.
So if we got the message out the first time, I have faith we can get that message out again. And when I wear a mask, I visually encourage others to as well. “If we all do it, everyone else will too” - Yogi Berra, probably. :p.
I don’t feel responsible for other people’s motivations. I can’t speak to what they think.
Well, by we, I guess I mean my area. The east and west coasts are a little further ahead of the central time zone. We built up hospital capacity and turned a few outlying buildings into care facilities, so I think we’re ready to take on a few more sick people. Last I heard, the ERs and ICUs were no busier than usual. If that changes, my opinion changes.
IANA epidemiologist, but I don’t think it’s that simple. Hospitalization rates are an indicator of whether you made the right call a few weeks ago, and if the answer is “no”, well, you’re screwed.
And, because of the exponential nature of a spreading virus, I am skeptical that we could even make an inference like, say, “Since the hospitalization rate now is less than little-n, we can be confident that it won’t exceed big-N if we open up”. We don’t know that.
Let’s first see if the government can implement adequate testing, contact tracing and, heck, medical supplies. This is not an unreasonable dream, plenty of countries implemented all within weeks. Then we might have confidence the government will legislate and handle the reopening correctly.
Otherwise we’re just saying it’s all going to shit thanks to the trump admin, but let’s reopen anyway because maybe the trump admin might start doing the right things.
I am starting to think that most testing and contact tracing are complete wastes of time. The only useful test at this point is antibody testing to gauge how far along we are. Social distancing, and strictly guarding nursing homes from infection should slow down the hospitalizations enough to just let the virus run its course. The media as well as the health organizations are deliberately not giving the public enough information as to who exactly would be at high risk. Those individuals simply sheltering in place with a good support system would allow us to get through this quickly with no interruption to the economy.
This is false. No matter how many times you’re allowed to repeat this across different threads, it’s still false.
But I’m not advocating opening this very instant. I’m saying I think we’re ready for opening in about two weeks. From today’s numbers, it looks like two more weeks will be enough time. Happy to change that date as it draws closer if I’m wrong.
And as for excluding NYC…why? Do New Yorkers not count in this discussion? Does NYC not need to reopen? Do NYC hospitals not have PPE and equipment that can be sent elsewhere once their wave has passed?
I get that you’re trying to say the numbers are still rising elsewhere, but again…two weeks more.
I think we can, though. I think we know enough science and math to say “If we’re little-n today, then we’ll at most be big-N in two weeks, which is less than max-N by 10%, so we’re fine.” I’ve seen the studies and the charts. I’ve seen how experts in this field can say “We have X dead today, so there are Y infected in a Z-mile radius, so there’s something between A and B future infections starting right now.” I’m optimistic we have the brain power.
I never said the Federal government, though. I’m talking about the same people locking us down in the first place. And they seem to have a handle on it, acting where the Feds refused to do so. I’m not suggesting that we open all 50 states at once on the same day. That’s foolishness. Again, the hallmark of a bad plan is when it’s blunt, nonspecific, and simple. “Everyone open up on May 20th and go back to normal life” would be such a plan. But something like “Cook county apparel stores may open May 20th. Restaurants may open May 22nd with no more than 5 customers per room…” would be appropriate. Nuanced, specific, and fact-based. And that wouldn’t come from the Trump administration, but rather the government of Illinois and the Chicago city council.
That’s what I support.
No this is true! Using the term underlying conditions might cover 75% of those over 65 and maybe 25% of the general public. Not anywhere near that number of people is at high risk. They need to be much more specific to help alleviate anxiety and fear instead of stoking it.
You’re missing the point. Of course New Yorkers count. The point is that if you exclude New York City, then there’s no sign of the US having “made it over the hump”. The cases in the rest of the country are still rising. It’s not clear when the country as a whole will pass that hump, but nothing indicates that it’s going to be in another two weeks.
The point of excluding New York is that their examplary efforts at containing the spread of CoVID-19 (they are the epicenter of the disease in this country, after all) is distorting the trend of the disease in the rest of the country. Lump in New York City and its environs and it looks as if we’re just passing over that hump. Exclude it and you can see that the country as a whole is not.
Even if the above was true, it does not make the following true