COVID-19 Shutdown Exit Strategy?

[donheff]

I just watched a New York Academy of Sciences webinar that was a bit disconcerting, if not surprising. The impression I got was that we will end up seeing some version of the original scenario Fauci pointed toward. Shutdown briefly to allow us to tamp down the virus to a degree and ramp up our resources for the long haul as it continues to burn through the population. Whether that burn through is slow and controlled or full of raging fires is a bit of a crap shoot. Regardless, we can't just stay shut down.

The head of The Center for Infectious Disease Research and Policy at the University of Minnesota had some interesting thoughts on testing. He thinks we can probably mount a rational approach to standard RNA tests to find infected individuals who show symptoms or are in high risk groups. From there we should be able to do followup tracing and testing. We have reliable tests for that. He thinks the 90 or so antibody tests in the wild that people are proposing we roll out to millions are a mess, He said that they are all over the place in quality with the best having about 95% specificity. He posted the chart below to show how bad that is. If the background infection rate is 5% (which he thinks is high) half the positive results of such antibody tests would be false.

 

[statsman]

The March 16 Imperial College of London study forecast 2.2M U.S. deaths without protective measures, 1.2-1.4M with strict social distancing (actually suppression is the term they use - it did not model economic shutdown/collapse). I think it was the first major study that suggested massive overwhelming of ICUs even with social distancing, which of course didn't happen. It was also the study that seemed to be the tipping point on shutdowns.

Ah, thank you. I reversed the numbers. 1.2-1.4 million is still a lot.

 

[copyright1997reloaded]

The "one per million" risk is an "acceptable" risk taught by my Environmental Risk Assessment class that I attended at UC Berkeley. The risk of being killed by lighting is about one per 800,000 so the one per 1,000,000 is generally acceptable by the public.

Curious. This site: https://injuryfacts.nsc.org/motor-vehicle/historical-fatality-trends/deaths-and-rates/
shows that in 2018 we had 39,404 vehicle deaths with 12 per 100K population. So that is 120 per million. EACH AND EVERY YEAR.

I haven't seen anyone suggest that we should no longer travel in automobiles, i.e. that the risk was too high.

Between 2005-2014, the United States averaged 3,536 drowning (non boating related) per year. Using 330 Million people, that's 10.7 per million. I bet that some people reading this post STILL have and STILL use their pool.

 

[Independent]

Here is a link below on what a computer model developed by Epidemiologists at the IHME based their projected “threshold” dates for loosening restrictions. The dates are when the model suggests the rate of new daily infections will fall below 1 per million residents in a given state.

The "one per million" risk is an "acceptable" risk taught by my Environmental Risk Assessment class that I attended at UC Berkeley. The risk of being killed by lighting is about one per 800,000 so the one per 1,000,000 is generally acceptable by the public. Please note that the computer model results may change based on more recent data.

https://news.yahoo.com/coronavirus-computer-modelers-revise-dates-021424815.html

You can review the projected date when the one per million will be achieved for your state. Minnesota, Michigan and Virginia are also of interest based on a recent and well known tweet.

Like I stated previously, I am a positive person by nature and this recent model suggest a positive outcome for the State of California where I live. The link also discusses the negative side of the model for the negative people to make comments.

Are you sure of the bold?

The documentation that I found says "below the 1 prevalent infection per million threshold"

and then I found this "Prevalence: The proportion of individuals in a population having a disease or characteristic. Prevalence is a statistical concept referring to the number of cases of a disease that are present in a particular population at a given time, whereas incidence refers to the number of new cases that develop in a given period of time."

One active case per million population seems like such a low number that I have trouble imagining any populated area getting there.

http://www.healthdata.org/sites/default/files/files/Projects/COVID/Estimation_update_041720.pdf
https://www.medicinenet.com/script/main/art.asp?articlekey=11697

 

[Leo1277]

Didn't the Administration state that the projected 2.2m deaths was WITHOUT strict social distancing and if nothing was done with any preventive measures?

That's right; it simply correspond to 220M infected, about 2/3 of the population, at an assumed actual death rate of 1% once undiagnosed cases are filtered in. After you reach around 2/3, you have herd immunity and the virus dies out on its own.

 

[Leo1277]

One important thing that is often missing from the discourse is how China achieved their control (with the caveat that their numbers may be fudged around the edges). They had such extreme distancing that their cases dropped to ZERO. And they started opening up only after they stayed at zero for more than 14 days. The idea is that after this, the virus has essentially died out naturally. Then you can start from a clean slate, being very careful about quickly stomping out new cases.

The US and Europe are obviously far from this, but to minimize casualties, this is what needs to happen. Otherwise in the long run, you will still have 1-2% of the population die until 2/3 have had it. The only difference is whether you control the speed of the virus so that hospitals can keep up, or you let it rip freely. The difference may amount to a factor of 2 in total death rate, and in the controlled mode, the story will take much longer, but in both cases the numbers are high.

 

[Leo1277]

...

One active case per million population seems like such a low number that I have trouble imagining any populated area getting there.

http://www.healthdata.org/sites/default/files/files/Projects/COVID/Estimation_update_041720.pdf
https://www.medicinenet.com/script/main/art.asp?articlekey=11697

That's actually what China did, such kinds of low numbers are what you need to "stomp out" the virus.

 

[copyright1997reloaded]

China achieved their control (with the caveat that their numbers may be fudged around the edges)

Love it ... "fudged around the edges"

WUHAN COVID-19 DEATH TOLL MAY BE IN TENS OF THOUSANDS, DATA ON CREMATIONS AND SHIPMENTS OF URNS SUGGEST

https://www.newsweek.com/wuhan-covid-19-death-toll-may-tens-thousands-data-cremations-shipments-urns-suggest-1494914

China Pushes for Quiet Burials as Coronavirus Death Toll Is Questioned
Officials are ​trying to curb expressions of grief and control the narrative​ amid doubts about the official number of deaths in China.

https://www.nytimes.com/2020/04/03/world/asia/coronavirus-china-grief-deaths.html

One study by six researchers from the University of Hong Kong found that 232,000 people in China may have been infected by Feb. 20, compared to the approximately 75,000 cases the country had officially reported on that date.

https://time.com/5813628/china-coronavirus-statistics-wuhan/

 

[MissMolly]

Curious. This site: https://injuryfacts.nsc.org/motor-vehicle/historical-fatality-trends/deaths-and-rates/
shows that in 2018 we had 39,404 vehicle deaths with 12 per 100K population. So that is 120 per million. EACH AND EVERY YEAR.

I haven't seen anyone suggest that we should no longer travel in automobiles, i.e. that the risk was too high.

Between 2005-2014, the United States averaged 3,536 drowning (non boating related) per year. Using 330 Million people, that's 10.7 per million. I bet that some people reading this post STILL have and STILL use their pool.

How can you compare deaths due to drowning that take place over an entire year to the lives we have already lost due to COVID-19 in only 2 short months? We have already lost over 47,000 lives in 2 short months. Even compared to car accidents, the lives lost to COVID-19 in 2 short months surpasses the lives lost to car accidents in an entire year. How can you possibly compare these numbers? It is plainly obvious that we will suffer far, far greater numbers of deaths due to COVID-19 than drownings or car accidents or any other number of causes.

 

[copyright1997reloaded]

How can you compare deaths due to drowning that take place over an entire year to the lives we have already lost due to COVID-19 in only 2 short months? We have already lost over 47,000 lives in 2 short months. Even compared to car accidents, the lives lost to COVID-19 in 2 short months surpasses the lives lost to car accidents in an entire year. How can you possibly compare these numbers? It is plainly obvious that we will suffer far, far greater numbers of deaths due to COVID-19 than drownings or car accidents or any other number of causes.

I'm not.

Vchan's post was talking about acceptable risk - expressed as deaths per million, and espoused as needing to be under 1 per million.

I was simply stating that there are many things in life whose risk factors are higher than that (1 death per million population) and that we accept. So I am NOT questioning the large numbers of COVID19 deaths - but that wasn't being debated, rather the 1 death per million threshold to declare "all clear".

We also need to count the uncounted deaths - those that will happen because people aren't getting medical care for other conditions. Elective surgeries that really aren't. Doctors appointments that aren't happening that would catch a condition that is worsening by the day. Lives lost because of increased drinking because of social isolation. Increased suicide rates due to depression. Increased rates of domestic violence. Shorter lives due to impacted economic conditions. And so on.

You see, these are harder to see, but they exist. And every day they are becoming more problematic. My brother (diabetic who has recently had open heart surgery) has had TWO doctors appointments cancelled involving an infection in one of his feet.

 

[Leo1277]

Love it ... "fudged around the edges"

https://www.newsweek.com/wuhan-covi...ata-cremations-shipments-urns-suggest-1494914

https://www.nytimes.com/2020/04/03/world/asia/coronavirus-china-grief-deaths.html

https://time.com/5813628/china-coronavirus-statistics-wuhan/

Yes, I read about these too, and when all is said and done, it will likely turn out to be clear that there are more cases than reported. A similar thing is emerging in early general mortality studies in the US, yet perhaps not quite as extreme as the Wuhan urn sales seem to suggest. But then again, even the study from Hong Kong stating that there is three times more cases than reported makes China look quite good. Even in that estimate it's 1/3 of the current US situation, with 4 times the US population

But it is important to point out that what I meant with the "fudge" is whether or not the cases are actually zero or very nearly so as they claim, as this is the basis of their strategy of (near) total containment.

Also, just to make it very clear that while what I wrote in the last few posts may sound somewhat "China friendly", I am surely not a troll, Chinese or otherwise. And I'd be the first to point out the severe problems in their near totalitarian society, both from having traveled there several times and having many close w*rk colleagues and friends from mainland China / HK / Taiwan. Crazily enough, this totalitarianism is what may turn out to be the best weapon against the dreaded virus...

 

[PatrickA5]

Well the Administration just disagreed with the choices of types of businesses opening in Georgia, but will not prevent it, so the choices in Oklahoma de facto would have the same disagreement.

The Oklahoma governor mentioned several times how the state is meeting the administrations guidelines. I don't buy it, but who knows. The mayors of the major cities shut things down much sooner than the governor did, so we'll see if they adhere to the governors reopening.

 

[MissMolly]

I'm not.

Vchan's post was talking about acceptable risk - expressed as deaths per million, and espoused as needing to be under 1 per million.

I was simply stating that there are many things in life whose risk factors are higher than that (1 death per million population) and that we accept. So I am NOT questioning the large numbers of COVID19 deaths - but that wasn't being debated, rather the 1 death per million threshold to declare "all clear".

We also need to count the uncounted deaths - those that will happen because people aren't getting medical care for other conditions. Elective surgeries that really aren't. Doctors appointments that aren't happening that would catch a condition that is worsening by the day. Lives lost because of increased drinking because of social isolation. Increased suicide rates due to depression. Increased rates of domestic violence. Shorter lives due to impacted economic conditions. And so on.

You see, these are harder to see, but they exist. And every day they are becoming more problematic. My brother (diabetic who has recently had open heart surgery) has had TWO doctors appointments cancelled involving an infection in one of his feet.

Then I apologize for misunderstanding.

 

[audreyh1]

The Oklahoma governor mentioned several times how the state is meeting the administrations guidelines. I don't buy it, but who knows. The mayors of the major cities shut things down much sooner than the governor did, so we'll see if they adhere to the governors reopening.

In GA the governor has said he is overriding local rules about which small businesses can open.

Shelter in place is still in effect through April 30th, and for those most at risk until May 13th which is when the emergency order runs out.

Social distancing, wearing masks and gloves “as possible/as appropriate” are still in effect.

Here is the full press release if anyone wants to read it. https://gov.georgia.gov/press-releases/2020-04-20/gov-kemp-updates-georgians-covid-19

The next point is an important one. The entities that I am reopening are not reopening for 'business as usual.' Each of these entities will be subject to specific restrictions, including adherence to Minimum Basic Operations, social distancing, and regular sanitation. Minimum Basic Operations includes, but is not limited to, screening workers for fever and respiratory illness, enhancing workplace sanitation, wearing masks and gloves if appropriate, separating workspaces by at least six feet, teleworking where at all possible, and implementing staggered shifts.

 

[copyright1997reloaded]

Then I apologize for misunderstanding.

MissMolly, no problem. I am finding myself a little quick on the judgement scale, and probably should have just left VChan’s post as is without replying.

 

[blueskyk]

I’m comfortable with how things are proceeding here. You can download an app (voluntary/opt in) that will help with contact tracing and let you know if you’ve been near an “infection event”. I’m assuming they will also use the info to monitor how mobile everyone is getting and offer guidance accordingly on a local scale. To give a sense of proportion, our expected max death rate per day is 5 people.

Officially, delayed surgeries and medical procedures may now proceed as PPE levels are deemed adequate.

I’m noticing sort of a quiet, cautious, under the radar sort of reopening of a variety of things (UT is one of the states that issued a directive, but no formal stay at home order) that adhere to social distancing, masks, etc. because the business generally serves people one at a time anyway (doctors offices, lawyers, accountants, etc.) or is an outside activity where there is naturally distance between people (construction, yard care, dog grooming, etc.) People seem to be taking the balance of social responsibility and economic considerations to heart and helping each other navigate (IMO). Everyone I know monitors the daily state briefings and website to follow what is happening locally. It has a sustainable, flexible feel that could adjust as circumstances require without requiring detailed, possibly over-specific edicts. It’s as if we are feeling our way forward in in the dark of the situation we have and not waiting for the situation we wish we had (where all is known and clear).

No restaurants (except for takeout) or gyms or anything where larger groups gather indoors reopening yet and that seems wise (again, IMO).

Actually, I’m finding myself very comfortable with local leadership (governor, mayors, state epidemiologists and public health offices) and, in general, responsible citizenry.

We’ll see how it goes.

 

[gwraigty]

We also need to count the uncounted deaths - those that will happen because people aren't getting medical care for other conditions. Elective surgeries that really aren't. Doctors appointments that aren't happening that would catch a condition that is worsening by the day. Lives lost because of increased drinking because of social isolation. Increased suicide rates due to depression. Increased rates of domestic violence. Shorter lives due to impacted economic conditions. And so on.

You see, these are harder to see, but they exist. And every day they are becoming more problematic. My brother (diabetic who has recently had open heart surgery) has had TWO doctors appointments cancelled involving an infection in one of his feet.

I'm sorry to hear about your brother's issue. The above is why our governor has reversed course and is now allowing medical procedures that were cancelled to proceed. Has your brother contacted the governor's office and anyone else in authority who might possibly get results on this?

 

[Midpack]

That's actually what China did, such kinds of low numbers are what you need to "stomp out" the virus.

If you want other models to compare to, it seems more people trust the approaches and results taken by South Korea, Taiwan, Hong Kong, Singapore, Germany and maybe Iceland. China may have done well, but there are more controversial reports to potentially discredit their results (somewhat). All results need to be normalized for population versus comparing raw numbers. All are planning on second waves using testing and contact tracing to closely monitor to keep the second wave somewhat contained. And it seems most other countries can rely on (or enforce) a public that will conform to official guidance, but that doesn’t mean most Americans won’t conform (some always will).

 

[copyright1997reloaded]

I'm sorry to hear about your brother's issue. The above is why our governor has reversed course and is now allowing medical procedures that were cancelled to proceed. Has your brother contacted the governor's office and anyone else in authority who might possibly get results on this?

Thank you. I have talked to him, he lives in another state (PA). I will follow up with him today to see if he was able to be seen. (He does have a spouse and adult children, so I know others are there to help him if needed.)

 

[MichaelB]

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 is far more dangerous because we haven’t figured out how to treat it and we don’t yet know if there is an “upper limit” on the infection or mortality rate. 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.

One thing that would be very helpful is “employment guidance”. Our labor regulations don’t help either employers or workers here, and both need to find a way to get back together, and minimize and share risk together. Public policy desperately needs to move past “wear a mask and continue social distancing” as primary guidance.

 

[youbet]

The medical community is nearly unanimous in stating the need for rigorous testing and tracing at the national level, but political leadership does not appear interested in this. The reason for the lack of interest is truly baffling.

I don't know why you're baffled......

Our culture will not take well to rigorous contact tracing and the required consequences. The first few folks unwillingly separated from children, pulled out of their single proprietor businesses, forced to be quarantined in what they consider to be "icky" surroundings, etc., will be elevated to sainthood by the media. The politicians associated with the unwanted action will be demonized. It will be hard to win re-election after that.

 

[Chuckanut]

Over the last two days, I've listened to my governor talk about opening back up. He was very vague other than to say we currently don't meet the criteria to open up (two weeks of declining number of documented cases). He is right about that from what I can see. Other than that I get the impression he is waiting to see what happens in states like George, Texas, Oklahoma, etc. If the opening goes well in those states, he may announce openings. If the virus comes back with a vengeance, he will be a hero for not opening to early.

As far as things like testing are concerned, it is a confusing mess from my point of view. One day they claim a lab is opening up and can add 1000 tests a day to the total. A few days later, there aren't enough swabs and reagent so not much testing is being done. Then a new simple test is developed. A few days later, the initial manufacturing run shows defects. A different expert questions its reliability. We are going to have drive-thru test centers set up in shopping center parking lots. They never show up. We need more tests to diagnose who has the disease. No, we need more tests to show who has the anti-bodies. No, we need both. The reality is we don't have enough of either. So now we are told we need more Testing, Testing, Testing! by politicians. No details, just Testing, Testing Testing! They haven't a clue what they are talking about or a plan to make it happen, but it makes a good sound bite.

 

[Ready]

Interesting article on Georgia. A woman plans to open her hair salon on Friday and is already booked throughout the weekend with appointments. I think there are a lot of people who are ready to go back to their old routines without any significant concerns about getting the virus.

https://www.reuters.com/article/us-...-out-welcome-mat-others-fearful-idUSKCN2251HT

 

[youbet]

They haven't a clue what they are talking about or a plan to make it happen, but it makes a good sound bite.

Yep. Unless you define "finger pointing" as a plan.

 

[audreyh1]

Over the last two days, I've listened to my governor talk about opening back up. He was very vague other than to say we currently don't meet the criteria to open up (two weeks of declining number of documented cases). He is right about that from what I can see. Other than that I get the impression he is waiting to see what happens in states like George, Texas, Oklahoma, etc. If the opening goes well in those states, he may announce openings. If the virus comes back with a vengeance, he will be a hero for not opening to early.

I think since new outbreaks take a while, there will be an initial lull that looks like things are going OK, maybe long enough for more governors to move forward, then suddenly oops - not looking too good but too late.