COVID-19 Shutdown Exit Strategy?

[Dtail]

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Originally Posted by statsman As should be the case. There are far too many situations in the country to be managed by a single entity. What the White House can and has done is suspend foreign travel. What is unclear is if any of those travel suspensions can be lifted to a city still in lockdown mode that has an international airport.

So for example, if NY stays closed and PA opens up totally, can the folks from PA travel to NY?

[USGrant1962]

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Originally Posted by Dtail So for example, if NY stays closed and PA opens up totally, can the folks from PA travel to NY?

The Federal Government certainly has authority over foreign travel. But freedom of movement between states is a Constitutional right. Within states, the state has more authority. I'm not saying travel into a hot zone is a good idea, but short of totalitarianism or martial law I don't see how it is prohibited.

From Wikipedia:

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The U.S. Supreme Court also dealt with the right to travel in the case of Saenz v. Roe, 526 U.S. 489 (1999). In that case, Justice John Paul Stevens, writing for the majority, held that the United States Constitution protected three separate aspects of the right to travel among the states: (1) the right to enter one state and leave another (an inherent right with historical support from the Articles of Confederation), (2) the right to be treated as a welcome visitor rather than a hostile stranger (protected by the "Privileges and Immunities" clause in Article IV, § 2), and (3) (for those who become permanent residents of a state) the right to be treated equally to native-born citizens (this is protected by the 14th Amendment's Privileges or Immunities Clause; citing the majority opinion in the Slaughter-House Cases, Justice Stevens said, "the Privileges or Immunities Clause of the Fourteenth Amendment . . . has always been common ground that this Clause protects the third component of the right to travel.").

[statsman]

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Originally Posted by statsman There appears to a good number of people not willing to go along for the common good. Stories about teenagers sneezing on store produce. People sneezing and spitting on others and stating they have COVID-19. Seems we already have individuals being charged with a crime related to these types of actions. Think about everyday life. Think about places that have a buffet or a salad bar where people walk up and handle the prepared food themselves. If I'm Whole Foods, do I put out the salad bars again knowing just one person acting like an idiot (or terrorist, take your pick) claims to have infected the entire salad bar?

And so it continues. If you think we have food shortages now, and businesses are on the edge of bankruptcy, watch what happens if the following becomes more commonplace going forward:

Grocery store loses over $35K after woman intentionally coughs on food in Pennsylvania

https://wset.com/news/coronavirus/gr...n-pennsylvania

[Dtail]

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Originally Posted by USGrant1962 The Federal Government certainly has authority over foreign travel. But freedom of movement between states is a Constitutional right. Within states, the state has more authority. I'm not saying travel into a hot zone is a good idea, but short of totalitarianism or martial law I don't see how it is prohibited. From Wikipedia:

Okay, though I do wonder from the opposite perspective too in how would PA feel about NY travelers?

[BeachOrCity]

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Originally Posted by Gearhead Jim There has been much talk about the shutdowns Flattening the Curve to prevent overwhelming hospitals, but I haven't seen any statistics about how effective hospitalization actually is for C-19 patients. Surely, more people would die without hospitalization. But many die even with hospitalization, and many more get better with little or no treatment. Precise predictions are impossible, but does anyone have an idea of how many lives we expect to save with the shutdowns?

Actually it is the ventilators that save your life (if you get so bad you need one). Someone who declined to go to a hospital if that hospital has an available ventilator and they need mechanical assistance to breath.... well hospitalization would have saved their life.

[Fermion]

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Originally Posted by statsman And so it continues. If you think we have food shortages now, and businesses are on the edge of bankruptcy, watch what happens if the following becomes more commonplace going forward: Grocery store loses over $35K after woman intentionally coughs on food in Pennsylvania https://wset.com/news/coronavirus/gr...n-pennsylvania

If we get to food shortages and someone does that, I predict bad things will happen to that person right in the store or outside.

[PatrickA5]

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Originally Posted by BeachOrCity Actually it is the ventilators that save your life (if you get so bad you need one). Someone who declined to go to a hospital if that hospital has an available ventilator and they need mechanical assistance to breath.... well hospitalization would have saved their life.

My question is how many of the people that go on ventilators actually get off of them and recover?

I read somewhere that a small hospital in Italy hasn't had anybody other than dead people come off the ventilators (around 30 deaths at that point). Maybe it's too early to tell? I wonder what the survival rate stats are normally (non-covid19) for someone on a ventilator for a couple of weeks?

[Fermion]

I read about a person who had recovered after being on a ventilator for a week or two.

[Aerides]

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Originally Posted by PatrickA5 My question is how many of the people that go on ventilators actually get off of them and recover? I read somewhere that a small hospital in Italy hasn't had anybody other than dead people come off the ventilators (around 30 deaths at that point). Maybe it's too early to tell? I wonder what the survival rate stats are normally (non-covid19) for someone on a ventilator for a couple of weeks?

I think it's too early to tell, but I agree it's not looking great. Of course, many patients are hospitalized for care that precedes the need for a vent, oxygen and fever management, etc.

[gerntz]

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Originally Posted by Dtail So for example, if NY stays closed and PA opens up totally, can the folks from PA travel to NY?

Seems NY would be saying no.

[gerntz]

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Originally Posted by statsman And so it continues. If you think we have food shortages now,

Why would anyone think that?

[NameRedacted]

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Originally Posted by gerntz Why would anyone think that?

The stores in my area are routinely out of most meat, lots of canned goods, frozen foods and pasta.


It's not that we are short of food there is still plenty to eat - it's that there are sporadic shortages of certain foods.



On my last shopping trip I visited 5 stores to get everything that we needed/wanted.

[doneat54]

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Originally Posted by vchan2177 They should let small businesses open first. Small businesses are suffering the most and the workers are usually minimum wage employees with no sick leave and they are very disparate people. The higher paying jobs with sick leave benefits, work at home options, high salaries, etc can afford to wait.

That's a very good point. And to add, small businesses in general have smaller populations of people, so less person to person contact/proximity. And if they open first, they will get a preferential boost when they are not competing with the larger businesses.

[kyzymurgist]

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Originally Posted by RetireBy90 WSJ this morning has a couple opinion pieces that try to use others where there are numbers where an entire population has been tested and suggests that infection rates are a factor of 10 higher and mortality is likewise much lower. Just something to think about. There are other places that have tested populations and not just those with symptoms. Hrmm

The Diamond Princess was an epidemiologists dream. Nearly all passengers and crew tested and 712 positives.

So far 1.4% dead with another 2% still in critical condition. Very likely CFR will be well above 2% and the other critical survivors will have lasting debilitating lung damage.

Yes, the average age was higher than general population of most countries but the crew age offset some of the age effect.

And keep in mind that Diamond Princess CFR was not influenced by a saturated healthcare system.

I think when this is over and all the data is in, the untreated CFR will be close to the 1% estimated by Dr. Fauci.

However, the actual fatality rate could be shifted higher if we fail to lower R0 by social distancing orders and saturate hospitals. Or much lower if we quickly approve effective treatments or manage to keep R0 near 1 for long enough to develop a vaccine.

[Gearhead Jim]

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Originally Posted by BeachOrCity Actually it is the ventilators that save your life (if you get so bad you need one). Someone who declined to go to a hospital if that hospital has an available ventilator and they need mechanical assistance to breath.... well hospitalization would have saved their life.

Quote:

Originally Posted by PatrickA5 My question is how many of the people that go on ventilators actually get off of them and recover? I read somewhere that a small hospital in Italy hasn't had anybody other than dead people come off the ventilators (around 30 deaths at that point). Maybe it's too early to tell? I wonder what the survival rate stats are normally (non-covid19) for someone on a ventilator for a couple of weeks?

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Originally Posted by Fermion I read about a person who had recovered after being on a ventilator for a week or two.

My point was that the percentage of covid-19 people who get ventilated and go on to survive is unknown to us common folk.
I'm surprised that we're not hearing more from doctors on this subject.
I think that having lots of test kits early in the spread would have been better than having lots of ventilators now. Having both would be better, but that ship has sailed.

[USGrant1962]

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Originally Posted by RetireBy90 WSJ this morning has a couple opinion pieces that try to use others where there are numbers where an entire population has been tested and suggests that infection rates are a factor of 10 higher and mortality is likewise much lower. Just something to think about. There are other places that have tested populations and not just those with symptoms. Hrmm

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/article...pert-predicts/

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He said that expected increases in National Health Service capacity and ongoing restrictions to people’s movements make him “reasonably confident” the health service can cope when the predicted peak of the epidemic arrives in two or three weeks. UK deaths from the disease are now unlikely to exceed 20,000, he said, and could be much lower.

See my sig.

[NameRedacted]

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Originally Posted by Gearhead Jim My point was that the percentage of people who get ventilated and go on to survive is unknown to us common folk. I'm surprised that we're not hearing more from doctors on this subject. I think that having lots of test kits early in the spread would have been better than having lots of ventilators now. Having both would be better, but that ship has sailed.

I saw a study online earlier today:


https://www.ncbi.nlm.nih.gov/pubmed/8404197


Not sure of course if we'll see the same numbers for Covid-19 but here are the ones from the study - they make grim reading:


"We reviewed a 5-year experience with mechanical ventilation in 383 men with acute respiratory failure and studied the impact of patient age, cause of acute respiratory failure, and duration of mechanical ventilation on survival. Survival rates were 66.6 percent to weaning, 61.1 percent to ICU discharge, 49.6 percent to hospital discharge, and 30.1 percent to 1 year after hospital discharge. When our data were combined with 10 previously reported series, mean survival rates were calculated to be 62 percent to ventilator weaning, 46 percent to ICU discharge, 43 percent to hospital discharge, and 30 percent to 1 year after discharge. Of 255 patients weaned from mechanical ventilation, 44 (17.3 percent) required an additional period of mechanical ventilation during the same hospitalization."

[NameRedacted]

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Originally Posted by gerntz Seems NY would be saying no.

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

[Teacher Terry]

A Italian doctor said if you go on a ventilator at age 60+ you are just prolonging your death.

[Fermion]

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Originally Posted by Teacher Terry A Italian doctor said if you go on a ventilator at age 60+ you are just prolonging your death.

That is very arbitrary. So a 58 year old smoker who goes on a ventilator is fine but a 62 year old in great health shouldn't bother?