COVID-19 Shutdown Exit Strategy?

[donheff]

I live in Iowa. We are well behind NY or WA. Some factoids

Population ................3,156,000
Hospital beds ................. 6,300
Confirmed Cases ............... 179
Negative Tests ................ 2,975
New cases today ................. 34
Number in hospitals today .... 31
Number discharged ............. 16
Number of deaths ................. 1

Governor recommended that all schools close as of March 16 (many were already on spring break).
Governor ordered no groups of more than 10, also closed restaurants, bars, gyms, theaters, casinos, senior centers as of March 17 (I was at the gym and they kicked us out at noon).

The actions above occurred when we had 27 confirmed cases. We are now 9 and 10 days into the closed period.

I'm interested in how this plays out. New York closed restaurants one day sooner than Iowa. I think it had 700 cases at the time, and now has 37,000.
Iowa's case load is growing much more slowly. I wonder if we actually got out ahead of it, or just had better luck.

The issue is what happens if cases continue to grow very slowly in Iowa?

We won't know for sure until the dust settles but some early data are eye opening. In the chart below Kentucky (pop 4.5M) and Tennessee (pop 6.7M) started out about the same but KY took faster action than TN. The growth charts speak volumes. As of yesterday KY had 198 positives and TN had 784. So TN may slowing the growth rate down a bit or may just be falling behind in testing.

 

[Clone]

Confirmed Cases ............... 179
Negative Tests ................ 2,975
New cases today ................. 34
Number in hospitals today .... 31
Number discharged ............. 16
Number of deaths ................. 1

So, 6% of the tests showed positive. I assume (perhaps a bad assumption) that the folks being tested had some reason. If there had been more tests, what would we have done different? If there were only 2% positive, would more people have poo-pooed the severity?

I think a lot of folks are hung up on the lack of testing, but would it make any difference? To me, the idea of shutting things down despite the lack of overwhelming numbers holds the results from becoming overwhelming.

I don't know how you exit this situation. If somebody develops an effective and readily available cure or vaccine, then release the isolation. Otherwise, we are probably going to see these second and third waves of cases as folks relax from isolation.
If a large number of testing materials becomes available, what would we do different with better numbers?

 

[anethum]

So, 6% of the tests showed positive. I assume (perhaps a bad assumption) that the folks being tested had some reason. If there had been more tests, what would we have done different? If there were only 2% positive, would more people have poo-pooed the severity?

I think a lot of folks are hung up on the lack of testing, but would it make any difference? To me, the idea of shutting things down despite the lack of overwhelming numbers holds the results from becoming overwhelming.

I don't know how you exit this situation. If somebody develops an effective and readily available cure or vaccine, then release the isolation. Otherwise, we are probably going to see these second and third waves of cases as folks relax from isolation.
If a large number of testing materials becomes available, what would we do different with better numbers?

If we had had sufficient numbers of fast & reliable tests at the beginning (as some countries had), we could have tested anyone who presented with symptoms, and positive test results should have resulted in contact tracing. Those who had been in contact with the infected person should have been put under mandatory quarantine orders. THAT is what sufficient fast & reliable testing could have done in the USA, and was successfully done in a few countries.

Because the numbers of infected persons is out of control in the USA, and test availability is still woefully inadequate, we can neither test everyone, nor do contact tracing even if we had sufficient testing. Testing & contact tracing might still be possible in some parts of the USA where the number of infected is still low. And I would hope that it would be implemented if the numbers drop over the summer, but infections ramp up in a second wave in the fall/winter.

 

[Sunset]

Related, Neil Ferguson of the Imperial College of London COVID-19 response team (and source of 2.2 million Americans are going to die if we do nothing with 1.1 if we shut everything down), just testified in Parliament that their model of 250,000 dead in UK with shutdown has been revised and is now less than 20,000. That's a big revision.

https://www.newscientist.com/articl...e-care-units-for-coronavirus-expert-predicts/
.....
See my sig.

That will be terrific, but I notice the article hedges that statement quite a bit.
Personally I peg the UK deaths at 31,652 by April 16, which is 21 days from now.. but I'm not an expert.

 

[PatrickA5]

If we had had sufficient numbers of fast & reliable tests at the beginning (as some countries had), we could have tested anyone who presented with symptoms, and positive test results should have resulted in contact tracing. Those who had been in contact with the infected person should have been put under mandatory quarantine orders. THAT is what sufficient fast & reliable testing could have done in the USA, and was successfully done in a few countries.

Because the numbers of infected persons is out of control in the USA, and test availability is still woefully inadequate, we can neither test everyone, nor do contact tracing even if we had sufficient testing. Testing & contact tracing might still be possible in some parts of the USA where the number of infected is still low. And I would hope that it would be implemented if the numbers drop over the summer, but infections ramp up in a second wave in the fall/winter.

I agree. We should be in a much better position to take on the Fall/Winter wave. Hopefully. If I recall correctly, more people died in the 2nd wave of the 1918 flu pandemic. Do we avoid shutting everything down again by doing massive testing?

 

[Sunset]

In the NY press conference today, the Governor said they had a significant number of people that have been on ventilators for 20-30 days. He went on to state that the prognosis for someone on a ventilator for that time period is poor. I imagine families are having to make tough choices.

Wow... that is a long time a ventilator is used by 1 patient, by the time that person is done with the ventilator, there could be 1,000 extra patients in ICU...
No wonder Italy is swamped.

 

[PatrickA5]

Wow... that is a long time a ventilator is used by 1 patient, by the time that person is done with the ventilator, there could be 1,000 extra patients in ICU...
No wonder Italy is swamped.

If it gets bad enough, do doctors take people off after a certain number of days in order to give someone else a chance? That's what we're trying to avoid and hopefully will.

 

[Amethyst]

I don't see how it could be avoided. It will have to be like transplant protocol. Which patient is more likely to survive?

If it gets bad enough, do doctors take people off after a certain number of days in order to give someone else a chance? .

 

[Midpack]

If it gets bad enough, do doctors take people off after a certain number of days in order to give someone else a chance? That's what we're trying to avoid and hopefully will.

They’re already doing that in Italy, when you run out of ventilators there’s no choice, same as wartime MASH triage. I don’t think it’s days, it’s who’s more likely to survive and who’s unlikely to survive that drives the decision. Shortages of PPE, doctors, nurses and other could also force some highly undesirable decisions. No way around it. I don’t get the impression it’s come to that in the US or even NYC yet, but it could - that’s the whole reason for “flatten the curve.” No one knows how bad it will get versus our healthcare resource capacity and they can’t ramp up unlimited.

 

[Popeye]

Speaking as someone who lives in NY we don't want people visiting from PA even at the best of times

And vice versa!

 

[Corporateburnout]

Testing & contact tracing might still be possible in some parts of the USA where the number of infected is still low. And I would hope that it would be implemented if the numbers drop over the summer, but infections ramp up in a second wave in the fall/winter.

+1.

Massachusetts has ramped up testing, contact tracing, quarantine and monitoring according to their COVID 19 website.

The website provides a comprehensive data on number of individuals tested and a breakdown of positives by age group

https://www.mass.gov/info-details/covid-19-cases-quarantine-and-monitoring

 

[Independent]

We won't know for sure until the dust settles but some early data are eye opening. In the chart below Kentucky (pop 4.5M) and Tennessee (pop 6.7M) started out about the same but KY took faster action than TN. The growth charts speak volumes. As of yesterday KY had 198 positives and TN had 784. So TN may slowing the growth rate down a bit or may just be falling behind in testing.

Interesting.

 

[Independent]

So, 6% of the tests showed positive. I assume (perhaps a bad assumption) that the folks being tested had some reason. If there had been more tests, what would we have done different? If there were only 2% positive, would more people have poo-pooed the severity?

I think a lot of folks are hung up on the lack of testing, but would it make any difference? To me, the idea of shutting things down despite the lack of overwhelming numbers holds the results from becoming overwhelming.

I don't know how you exit this situation. If somebody develops an effective and readily available cure or vaccine, then release the isolation. Otherwise, we are probably going to see these second and third waves of cases as folks relax from isolation.
If a large number of testing materials becomes available, what would we do different with better numbers?

I included the tests here as a quality check on the "cases" number. In other states, case counts were understated because testing was limited. So in NY we got a sudden increase in confirmed cases when there testing accelerated.

I'm thinking Iowa is doing enough tests that they are probably getting most of the cases with symptoms. So their case count is decent.

You're talking about the benefits of testing. I've probably heard the same ideas as you:

• Peace of mind - "Good news, it's not the coronavirus. Probably just a cold."
• Behavior - People who get a positive test are likely to be more careful about self quarantines just because they know they really have the virus.
• Contact Tracing - If we find all the active cases, we can warn their contacts. And, if enough tests are available, we can actually test the contacts. Hopefully, this allows the contacts to make good decisions.

Unfortunately, I think the exit is herd immunity. I'm hoping there are a lot of asymptomatic infections. If we develop high volume antibody testing, we can let people go back to their lives.

 

[USGrant1962]

The President extended the CDC coronavirus guidelines through April 30. Nothing is reopening before then IMO.

 

[donheff]

The President extended the CDC coronavirus guidelines through April 30. Nothing is reopening before then IMO.

And targeted June 1st to begin getting back to business which he described as an aspirational target that he hopes we can beat.

 

[2177V]

Data on New COVID19 positive cases in a Northern California county near San Francisco where I live with a population of 1.1M...

March 16: Sheltered in place Order by the county health official.

March 22: 10 new cases
March 23: 10 new cases
March 24: 15 new cases
March 25: 22 new cases
March 26: 23 new cases
March 27: 17 new cases
March 28: 20 new cases
March 29: 7 new cases (Total cases are 175)

The recent March 29 data point is very encouraging. However, this is only one data point. IMO the county health official made the right call to "shelter-in-place" EARLY rather than later.

I am hoping March 25 to March 28 will be the peak acceleration of the curve and there will be a trend of less and less new cases in the future.

My wife has a business which is generating ZERO revenues so I am monitoring the new cases in our county like a hawk.

As far as the exit strategy: IMO....The number of new cases will drive the decision to exit the shutdown. I am more concerned about the trauma the virus is causing to the public willingness to spend money after all of the layoffs of their friends and neighbors.


We will get through this. We always have.

 

[audreyh1]

Having the antibody test widely available will really help individuals get back to work. If not their old job, something else useful.

DH and I have been expecting around 6 weeks of stay-at-home/social distancing, so around 1 week down and 5 to go*. And then we’ll see where we are.

*thats pretty close to the April 30 date.

 

[Gearhead Jim]

Data on New COVID19 positive cases in a Northern California county near San Francisco where I live with a population of 1.1M...

March 16: Sheltered in place Order by the county health official.

March 22: 10 new cases
March 23: 10 new cases
March 24: 15 new cases
March 25: 22 new cases
March 26: 23 new cases
March 27: 17 new cases
March 28: 20 new cases
March 29: 7 new cases (Total cases are 175)

The recent March 29 data point is very encouraging. However, this is only one data point. IMO the county health official made the right call to "shelter-in-place" EARLY rather than later.

I am hoping March 25 to March 28 will be the peak acceleration of the curve and there will be a trend of less and less new cases in the future.

My wife has a business which is generating ZERO revenues so I am monitoring the new cases in our county like a hawk.

As far as the exit strategy: IMO....The number of new cases will drive the decision to exit the shutdown. I am more concerned about the trauma the virus is causing to the public willingness to spend money after all of the layoffs of their friends and neighbors.


We will get through this. We always have.

The problem with counting new cases is that so little testing has been done that additional testing will definitely show lots more "new" cases which might actually be rather old.

Unfortunately, the only reliable statistic now is new deaths. When new deaths start to decline on a day-to-day basis, that will mean the area has indeed passed its infection peak about 2-4 weeks ago. That seems to be happening in Italy now, let's hope it continues.

 

[tmm99]

Having the antibody test widely available will really help individuals get back to work. If not their old job, something else useful.

Does anybody know how the antibody test works with two different strains of the coronavirus that are supposedly circulating around (now some are saying there are 8 strains...)?

 

[dixonge]

Related, Neil Ferguson of the Imperial College of London COVID-19 response team (and source of 2.2 million Americans are going to die if we do nothing with 1.1 if we shut everything down), just testified in Parliament that their model of 250,000 dead in UK with shutdown has been revised and is now less than 20,000. That's a big revision.

https://www.newscientist.com/articl...e-care-units-for-coronavirus-expert-predicts/

See my sig.

"Meanwhile a paper by separate colleagues at Imperial predicted just 5,700 deaths if the lockdown continues."

That's one helluva margin of error!

https://www.dailymail.co.uk/news/article-8164121/Professor-predicted-500-000-Britons-die-coronavirus-accused-having-patchy-record.html

 

[Toocold]

This is a very good sign. They started treatment earlier this week and the FDA is allowing hydroxychloroquine to be used as a treatment for COVID-19. That likely means they are seeing favorable early results. We won't definitive know until the clinical trial reports out, but (to be hopeful) this could part of the exit strategy. Let's cross our fingers.

https://www.hhs.gov/about/news/2020...ossible-treatments-for-covid-19-patients.html

 

[Alan]

"Meanwhile a paper by separate colleagues at Imperial predicted just 5,700 deaths if the lockdown continues."

That's one helluva margin of error!

https://www.dailymail.co.uk/news/article-8164121/Professor-predicted-500-000-Britons-die-coronavirus-accused-having-patchy-record.html

Deaths are already at 1,228 so I don't think there is any way they will make that prediction of 5,700 as no evidence yet of deaths declining by day although the hospital admission rate has stopped increasing I believe.

 

[donheff]

The conservative AEI is out with a comprehensive recovery strategy. It implies a lot of Government involvement and, interestingly, calls for us all to start wearing masks.

 

[2177V]

The problem with counting new cases is that so little testing has been done that additional testing will definitely show lots more "new" cases which might actually be rather old.

Unfortunately, the only reliable statistic now is new deaths. When new deaths start to decline on a day-to-day basis, that will mean the area has indeed passed its infection peak about 2-4 weeks ago. That seems to be happening in Italy now, let's hope it continues.

The use of "counting new cases" in my comment #266 came from Dr Fauci in minute 1 of the following video:

Do you mind citing a reference or video from a reputable source of using the "number of deaths" as better data to use?

 

[MichaelB]

The conservative AEI is out with a comprehensive recovery strategy. It implies a lot of Government involvement and, interestingly, calls for us all to start wearing masks.

Scott Gottlieb is a smart guy and this roadmap / set of recommendations make a lot of sense.