COVID-19 Shutdown Exit Strategy?

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Based on what I’ve read, though we’re ramping up testing quantity, it’s nowhere near the quality or utility (results take too long) needed to really manage our way out of this efficiently (prioritizing tests and contact tracing). And people and businesses lose patience every day, and most are low risk if infected. The chances of being legitimately prepared (like many Asian countries) before a critical mass of citizens just won’t wait to reopen is almost nil. So we’re going to reopen, some states/cities will get through it OK if citizens use PPE/distancing and some states/cities are going to have new, higher peaks.

We’re still behind the curve on PPE as far as I can tell also. I’ve yet to see N95 masks for sale since mid-March.

Between the lack of proactive federal coordination and Americans demand for freedom/independence (too many people steadfastly refuse to comply with even simple guidance), we’re going to fare far worse than several advanced Asian countries, Germany and a few others. We could’ve done much better, but there’s no going back now...

You keep saying things like this, but the USA has pretty much caught up in terms of tests/million. As of now, USA is at 19,385 per million, Hong Kong 20,674, Singapore 24,600. The UK is only at 13,286 and even the vaunted did every correct South Korea is ONLY at 12,153. https://www.worldometers.info/coronavirus/#countries

Nor does the United States have the same population density issues as many countries. If you look at cases/deaths, one could almost call this the "New York Subway" virus in terms of deaths and case hot spots. As of the 63,972 deaths, almost half have been in NY + NJ, and looking at those states most are in the NY metro region. For example, of 18,321 NY state deaths, 17,384 (94.5%) are from the NYC, Nassau, Suffolk, Rockland, Orange NYC commuter area. Similarly, in New Jersey, of 7228 deaths, 4381 (60.6%) are in the Bergen, Hudson, Essex, Union, Middlesex counties. These 11 counties make up over 34% of the ENTIRE USA death count. Throw in a couple other high vector for death (e.g. nursing homes) areas, and we see where the action is.

The United States is not homogeneous, and in general has a lower population density. Thus, the solution required for Singapore just might not apply to the vast majority of this country.

Sigh. I'm not saying throw the doors wide open. What I am saying is that I am getting tired of folks saying it is the fault of "Americans demand for freedom/independence (too many people steadfastly refuse to comply with even simple guidance)". Some of the "guidance" is just plain stupid.
 
What can we learn from how other countries handled coronavirus?
Singapore was initially praised for its clampdown on the virus. Even people who had no symptoms but tested positive had to be hospitalized until they tested negative.

But Singapore was also relaxed, allowing businesses, churches, restaurants and schools to stay open during its first wave of the virus. And some communities were overlooked by government testing.

The number of cases in Singapore shot up, and the country suffered a strong second wave of coronavirus.

By contrast, Germany, South Korea, Iceland and Taiwan have been able to suppress the virus. They also have among the lowest death rates from Covid-19 in the world.

Taiwan was proactive, launching its Central Epidemic Command Center before the island even confirmed its first infection.

Iceland required all its citizens returning to the country to undergo 14 days of quarantine – regardless of which country they traveled from.

Germany and South Korea quickly launched widespread testing and have some of the highest per-capita testing rates in the world. Their ability to identify and isolate those infected has helped prevent deadlier outcomes.
 
I saw a phrase on another website that struck home, they said the nation is "committing suicide by fear of death".
Well that’s just seems silly. Suicide? Really? It’s not as if many states aren’t opening up again and trying to find a middle ground now that most hospitals weren’t overwhelmed, plus many doctors and scientists are hard at work figuring out how to treat people more successfully and make this less deadly.

I know there are folks who feels it’s better to get this over with as quickly as possible and preserve the economy never mind if lot more people die including medical staff and first responders. But that ignores that the economy would be damaged either way.
 
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You keep saying things like this, but the USA has pretty much caught up in terms of tests/million. As of now, USA is at 19,385 per million, Hong Kong 20,674, Singapore 24,600. The UK is only at 13,286 and even the vaunted did every correct South Korea is ONLY at 12,153. https://www.worldometers.info/coronavirus/#countries

Nor does the United States have the same population density issues as many countries. If you look at cases/deaths, one could almost call this the "New York Subway" virus in terms of deaths and case hot spots. As of the 63,972 deaths, almost half have been in NY + NJ, and looking at those states most are in the NY metro region. For example, of 18,321 NY state deaths, 17,384 (94.5%) are from the NYC, Nassau, Suffolk, Rockland, Orange NYC commuter area. Similarly, in New Jersey, of 7228 deaths, 4381 (60.6%) are in the Bergen, Hudson, Essex, Union, Middlesex counties. These 11 counties make up over 34% of the ENTIRE USA death count. Throw in a couple other high vector for death (e.g. nursing homes) areas, and we see where the action is.

The United States is not homogeneous, and in general has a lower population density. Thus, the solution required for Singapore just might not apply to the vast majority of this country.

Sigh. I'm not saying throw the doors wide open. What I am saying is that I am getting tired of folks saying it is the fault of "Americans demand for freedom/independence (too many people steadfastly refuse to comply with even simple guidance)". Some of the "guidance" is just plain stupid.
Don’t take my word for it, how many tests doesn’t matter if the results take too long, too many false readings, who’s tested isn’t coordinated, and there’s no contact tracing. Other countries have done this sooner and better. Watch these two videos and comment https://www.early-retirement.org/forums/f55/bill-gates-on-covid-19-a-103623.html

The WH direction is so broad brush I’m not sure what states can do with it. They mention testing but they’ve been behind the curve the whole way - leaving 50 states and governors to figure it out is idiotic.

If you don’t like Singapore, look at Germany. I’ve mentioned a half dozen examples of other countries (again just above), not just Singapore. Maybe let’s learn what we can from them instead of just leaving it at ‘but we’re different.’

And the Americans demand for freedom evidence? I see some people without masks not observing distancing every time I’m out. Some people here have repeatedly voiced very strong objections to lockdowns, closures and even basic precautions. Protestors all across the nation demanding reopening and not taking recommended precautions. They may all be minorities now, but they’re growing and that will continue until we're much further down the road.

Add more and more people and businesses under increasing financial stress with uncoordinated testing and the outlook isn't great. Hopefully we get lucky with therapies like remdesivir or another, lots of research underway, fingers crossed.

BTW, you tell me where I’m wrong, honest that’s great. I’m learning as I go like most, and I’ve been wrong in hindsight quite a few times. What do you recommend?

EDIT: And I’m not trying to provoke anyone. I’m trying to learn, I’ve made mistakes in hindsight and I’ve been reminded of aspects I hadn’t thought of. Take my thoughts with a grain of salt...
 
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Why can our country not do sufficient testing and tracing? Surely it is not that complicated --other countries have done a much better job. Where is the weak link in the chain on testing and tracing? History will look back on this time and say that our government/medical establishments failed our citizens on this.

I believe, and I hope, that USA has the power and resources to do testing and tracing. Both NY and CA governors announced recruiting tens of thousands of tracers to do that job.

Moving the big country is like moving an oil tanker, while other smaller countries are driving a speed boat. While we wait, tens of thousands American will continue to die. I just need to make sure I won't be one of the unlucky ones.
 
Man, I don't know how you all can talk about every facet of this day after day. I pop in to see if I can glean any relevant info in the morning but all I can see are armchair quarterbacks.

My hope is all of you remain well during this. When it opens up I hope we still have some sort of economy. In addition I hope everyone finds a hobby or something else to spend their energies on other than talking about this.
 
I saw a phrase on another website that struck home, they said the nation is "committing suicide by fear of death".


Since I am a retired Environmental engineer, I like to play with numbers so I can do a proper risk assessment: I live in a county in California with a population of 1,144,863. In my county, the current number of confirmed COVID19 inflections are 907. The current number of people in the hospital is 24 and the current number of deaths is 28.

907 infections out of 1,114,863 = 81 inflections out of 100,000 people
24 in the hospital out of 1,114,863 = 2 hospitalized out of 100,000 people
28 deaths out of 1,114,863 = 2 deaths out of 100,000 people

To put this in prospective:

Number of fatal car accidents = 11.59 out of 100,000 people.
Number of fatal heart attacks = 258 out of 100,000 people.
Number of fatal cancer deaths = 163 put of 100,000 people.

Your county may have different numbers than my county so you should do the math yourself.

In my case, I have a greater probability of dying from a fatal car accident, a fatal heart attack, a fatal cancer condition than dying from CoVid19 in my county.

And yet, I feel like I am under house arrest. Don't get me wrong. If I am ever released from house arrest, I will wear a mask, keep social distance, wash my hands, etc in order to keep the virus from spreading.

I was active duty Army and I was taught "Never make decisions based on fear". This is because bad things usually happen when you do. They are indeed making decisions based on fear.
 
907 infections out of 1,114,863 = 81 inflections out of 100,000 people
24 in the hospital out of 1,114,863 = 2 hospitalized out of 100,000 people
28 deaths out of 1,114,863 = 2 deaths out of 100,000 people

Those numbers are indeed low, and encouraging, and evidence that social distancing has indeed worked for now. If 900 people are infected despite CA being on stay-at-home orders longer than other states, my simple math skills tell me that number would probably have at least one extra digit on it if things had been "old normal" for weeks longer.

My county is a bit bigger than yours, about 1.5M residents. We went on stay-at-home by city and stuff but very hodge podge in march, state-wide only in April.

Our numbers:
2982 infections (3x yours)
439 hospitalized (18x yours)
191 deaths (~7x yours)

So, a fair bit worse for a similar population. And every county is different of course. But there's even huge variation in counties. My parent are in the same county as me, but their zip has triple the cases/population of my zip.

I guess we all just have to hope that new social habits, continued limits on big gathering events, and mask wearing will keep things in line with your county numbers, not mine.
 
Good analysis. Isn't it partially voided by your choice of comparisons? Your comparisons aren't communicable, and don't have a twelve day spread period. Don't they represent a different kind of risk then COVID?
 
Since I am a retired Environmental engineer, I like to play with numbers so I can do a proper risk assessment: I live in a county in California with a population of 1,144,863. In my county, the current number of confirmed COVID19 inflections are 907. The current number of people in the hospital is 24 and the current number of deaths is 28.

907 infections out of 1,114,863 = 81 inflections out of 100,000 people
24 in the hospital out of 1,114,863 = 2 hospitalized out of 100,000 people
28 deaths out of 1,114,863 = 2 deaths out of 100,000 people

To put this in prospective:

Number of fatal car accidents = 11.59 out of 100,000 people.
Number of fatal heart attacks = 258 out of 100,000 people.
Number of fatal cancer deaths = 163 put of 100,000 people.

Your county may have different numbers than my county so you should do the math yourself.

In my case, I have a greater probability of dying from a fatal car accident, a fatal heart attack, a fatal cancer condition than dying from CoVid19 in my county.

And yet, I feel like I am under house arrest. Don't get me wrong. If I am ever released from house arrest, I will wear a mask, keep social distance, wash my hands, etc in order to keep the virus from spreading.

I was active duty Army and I was taught "Never make decisions based on fear". This is because bad things usually happen when you do. They are indeed making decisions based on fear.

Accidents are not contagious. Heart attacks are not contagious. Cancer is not contagious. You cannot compare a highly contagious deadly virus with these other problems. That's like comparing an apple to a bicycle. Silly.
 
Good analysis. Isn't it partially voided by your choice of comparisons? Your comparisons aren't communicable, and don't have a twelve day spread period. Don't they represent a different kind of risk then COVID?

Yes. it is an apples and oranges comparison.
 
The continuing comparisons of COVID with other types of death, such as auto accidents or seasonal flu, are deeply misleading. Likewise the conclusion that the models were wrong because the mortality rate is below the original predictions. It’s an attempt to make a risk equivalence that is not real and should not exist.

From the medical expert community, the following seems to represent their views on this:

- If COVID were handled like the flu, or left unhandled at all, like auto deaths, the mortality count would reach millions.

- If season flu deaths were verified the same as COVID, flu mortality rate would be far lower and stable at those lower levels.

- If COVID like preventative measures were in place for driving or seasonal flu, those infection and mortality rates would be far lower.

- COVID attacks, infects and kills health care professionals while they treat patients.

COVID is far more dangerous because we haven’t figured out how to treat it, we don’t yet know if there is an “upper limit” on the infection or mortality rate, and it endangers health care workers. We are still too far on the left side of the COVID learning curve to be making those judgements, and minimizing risk can have dangerous outcomes. Risk is acceptable only when it can first be properly quantified.

That doesn’t mean we should continue with strict isolation measures. There is a clear and compelling need for people to work, goods and services to flow. What we should be looking for are smaller, more specific opportunities to open, as opposed to broad region or state wide. Likewise, measures we can take to enable or accelerate that, and a clear statement of how it will be tracked and measured. There are multiple roadmaps with recommendations and proposals that offer guidance.
 
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Wow, my small county has much worse numbers than those cited above. My county only has 148,000 residents. In 2 months we have 217 diagnosed cases of Covid-19 and 15 deaths and the numbers are increasing rapidly. Of the 217 diagnosed cases 15 people have died--that is a death rate of about 7% which seems awful to me. Of course the infection number is probably much higher but people cannot get tested.
 
Wow, my small county has much worse numbers than those cited above. My county only has 148,000 residents. In 2 months we have 217 diagnosed cases of Covid-19 and 15 deaths and the numbers are increasing rapidly. Of the 217 diagnosed cases 15 people have died--that is a death rate of about 7% which seems awful to me. Of course the infection number is probably much higher but people cannot get tested.

We are about half that. However, we may be spread over a wider area.
 
My county of 862k people has 7900 identified COVID cases (916 per 100k) and 533 deaths (62 per 100k). The county that borders my town to the West has 943k people, with 11,612 cases (1231 per 100k) and 839 deaths (89 per 100k).
 

Thanks, I will watch these later tonight when I get a chance.

And the Americans demand for freedom evidence? I see some people without masks not observing distancing every time I’m out. Some people here have repeatedly voiced very strong objections to lockdowns, closures and even basic precautions. Protestors all across the nation demanding reopening and not taking recommended precautions. They may all be minorities now, but they’re growing and that will continue until we're much further down the road.

Add more and more people and businesses under increasing financial stress with uncoordinated testing and the outlook isn't great. Hopefully we get lucky with therapies like remdesivir or another, lots of research underway, fingers crossed.

BTW, you tell me where I’m wrong, honest that’s great. I’m learning as I go like most, and I’ve been wrong in hindsight quite a few times. What do you recommend?

EDIT: And I’m not trying to provoke anyone. I’m trying to learn, I’ve made mistakes in hindsight and I’ve been reminded of aspects I hadn’t thought of. Take my thoughts with a grain of salt...

Thank you, your statement makes me feel better at responding. So, here's my feelings and thoughts on the matter:
1. The American people were asked to "flatten the curve", that their help was required to have that happen so that our health care system wasn't overwhelmed.
2. The vast majority of them responded to that request. Sure, there were exceptions - like the kids that went on spring break because they had already paid for it. And perhaps negligent governments like NYC and NYS who refused to close the schools because they didn't know what to do with school lunch issues. (I mention this only because I was at the point of REFUSING to let my child go to school in early March). But for the most part, people went along as best they could during the lock down.
3. This willingness to cooperate is both time-bounded and sanity-check bounded. What I mean by sanity-check is once people start to see restrictions and loss of rights that make no sense (like citations given to a church service where all the participants are IN THEIR OWN VEHICLE with the windows up), like the old couple who were told they couldn't sit on the bench but sitting on the sand/grass was allowed, like Home Depot's in certain states having to have their seed section taped off, like... well after awhile, people start to see that and say F. that. The time-based aspect comes because unlike we "rich, retired" people, most people don't have the luxury to stay home forever. They are losing their businesses and wave after wave of newly unemployed.
4. There is a city-centric, coastal bias in news reporting and action plans associated with the virus. Look, I worked in NYC for ten years and rode the trains there, rode the subways - so I understand their importance. But the cases seen in NYC (likely from extensive use of mass transit by carriers) is NOT the norm. My county (upstate NY) has had so far 298 cases...and yes we have indoor plumbing here! :) Yes, there is a reason for me to wear a mask if I go into a store - but there is NO reason that I should be required to wear a mask while walking down a rural road by myself. Nor is there any reason why I shouldn't be able to use my class A RV - located less than 20 miles from my house - just because it is in a campground, and the private campground remains closed by state order. A REASONABLE approach would perhaps place limits on public facilities (e.g. rest room, pool), but what is the REALISTIC risk of me being in my RV, by myself, with my own bathroom?

What I am saying here is Americans buck when they see this. There are tons of rural counties with next to any case load, and the state governors need to recognize this and not treat them the same. For example, Winemaker just posted this: https://www.early-retirement.org/forums/f55/what-was-your-covid-news-for-the-day-102601-74.html#post2422428
Our county south of "The 'Burgh" has a population of 200,000. We have 115 cases, 2 deaths, total. My circle of friends, relatives, tenants, contractors, winery customers and Home Depot & grocery store cashiers knows of no positive tested persons.

And yet, that county is considered "Red" under Gov Wolff (PA). https://datawrapper.dwcdn.net/dDRhS/1/. So that county is under a mandatory "Stay at Home" ORDER. That means if I lived in that county, I couldn't even legally take my son out to practice driving (permit) in my own vehicle even if we didn't stop to get out of the vehicle! How does this make sense?

When I used to work for a living, I was frequently involved with issues involving system scaling. Big projects, complex setups. When I was called in, it was because things weren't working properly. On software projects, there is a perception that if there are performance problems, either you need to just add hardware (sometimes this works, but not usually), or you needed to rewrite the code to make it more efficient. What people don't realize is that MOST of the code base doesn't need to change - AT ALL. It is a small portion of the code base in which the issue lies, and perhaps that might need to be rewritten or analyzed IN DEPTH to fix the issues.

So when we look at the country, and the danger associated with the virus - a systematic non-emotional approach would be one that doesn't treat all possible transmission vectors as equals, but concentrates on those that are the most problematic. So where are the cases coming from, and what are the transmission vectors based on actual experiences? Yes, someone has a chance of transmission while at a crowded beach, perhaps even after walking in sand that someone 60 minutes coughed on...but what is the probability of that event in comparison of where the vast majority of cases are coming from: crowded mass transit, close quarters requiring close touch w/health impaired (e.g. nursing home), and other similar possible vectors.
 
COVID-19 is currently the leading cause of death

The continuing comparisons of COVID with other types of death, such as auto accidents or seasonal flu, are deeply misleading.

That's very true. In fact, there are deep and fundamental flaws in many of the statements about COVID-19 death rate comparisons. To say it very succinctly: COVID-19 is currently the LEADING CAUSE OF DEATH in the US.

In fact, in the current situation, we have usually 2000+ deaths in the US per day, see https://www.worldometers.info/coronavirus/. Compared to others:

Current Daily Death Rates
COVID-19 - 2000+
Heart Disease - 1780
Cancer - 1640
Accidents - 470
COPD - 440
Stroke - 400
Alzheimer's - 330
Diabetes - 230
Influenza&Pneumonia - 150
Nephritis - 140
Suicide - 130

The other numbers are converted to daily rates based on CDC data at https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm which lists deaths per year, and are rounded to nearest 10. Some important points:

1) Again, these numbers are WITH the current restrictions in place; it is anyone's guess what they would be without them, but it is not hard to imagine that in such a case, COVID-19 deaths would exceed all the other ten listed above combined.

2) In hot spots (downtown NYC, elder care homes,... ) death rates per capita are a large multiple of the above, which is averaged over the entire US.

3) In the absence of a vaccine, at the current burn rate with the current restrictions, this misery will be with us for give or take 2 years until herd immunity is reached. If that will even work, as it assumes immunity is sustained long enough and carries across current and newly mutating virus strains.

4) As it has been properly pointed out, someone dying of a heart attack, cancer... will not infect family members, or the doctors that try to save him/her.
 
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We will soon see what unconstrained coronavirus from Wuhan looks like. Brazil is bad enough that all neighboring countries have closed their border with them. Russia looks like a mess. No doubt we will have some nice hotspots in the "hold my beer and watch this" reopening States and cities.
 
We will soon see what unconstrained coronavirus from Wuhan looks like. Brazil is bad enough that all neighboring countries have closed their border with them. Russia looks like a mess. No doubt we will have some nice hotspots in the "hold my beer and watch this" reopening States and cities.
I don’t doubt it. We’ll learn like it or not. In GA’s defense, someone had to be first...
 
My county, 760,000 population, 557 covid positive, 25 dead.

Lets party!
 
My county, 760,000 population, 557 covid positive, 25 dead.

Lets party!

Better than mine!
My Parish (=county) has a population of 436,000, with 6305 COVID positive and 368 dead.

That said, our stats are improving remarkably compared with a month ago. So, I'll party too, even though right now I am still staying at home alone or with Frank. :D :dance:
 
How did that go? Did they make any adjustments?
It was very enjoyable.
It was not very crowded, so distancing was no issue. Our servers had masks, but some servers and the bartender did not.
 
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