COVID-19 Shutdown Exit Strategy?

[Midpack]

This could get interesting.

NC started phase 1 reopening May 8, with the phase 2 stage tentatively planned for May 22. Hospitalizations, by far the most indicative metric the state is tracking IMO, were trending down ever so slightly (a good sign), but there was a slight tick up yesterday and the worst day so far today. Not surprising as it reportedly takes 2-14 days to see new infections so it was going to take up to 2 weeks to see the influence of phase 1 changes.

They'll probably wait with fingers crossed and see what tomorrow brings regarding phase 2, but it could get interesting for our Governor who (like all of them) says they will follow the data. I sure hope we don't go all the way back to full lockdown - and I don't believe any Governor would now. All the states are between a rock and a hard place - coronavirus cases versus blown up state budgets and business & individuals stressed more every day.

 

[Leo1277]

This could get interesting.

NC started phase 1 reopening May 8, with the phase 2 stage tentatively planned for May 22. Hospitalizations, by far the most indicative metric the state is tracking IMO, were trending down ever so slightly (a good sign), but there was a slight tick up yesterday and the worst day so far today. Not surprising as it reportedly takes 2-14 days to see new infections so it was going to take up to 2 weeks to see the influence of phase 1 changes.

Yes it will be interesting to watch, we can add it to the list of canaries. I haven't followed NC specifically, but I believe the federal guidelines ask that for the first phase of reopening, there should be a sustained (14 day?) downward trend discernible. But the curve you show seems to have an upward trend in the days leading up to May 8? Or was the wished for downward trend in the number of new cases? In that case, would you have that curve too (although I agree, the new hospitalization count is probably the most meaningful of all markers, the test results are too skewed by whom and how many you test).

 

[Midpack]

Yes it will be interesting to watch, we can add it to the list of canaries. I haven't followed NC specifically, but I believe the federal guidelines ask that for the first phase of reopening, there should be a sustained (14 day?) downward trend discernible. But the curve you show seems to have an upward trend in the days leading up to May 8? Or was the wished for downward trend in the number of new cases? In that case, would you have that curve too (although I agree, the new hospitalization count is probably the most meaningful of all markers, the test results are too skewed by whom and how many you test).

On second thought, I don’t think the NC metrics or the sustained 14 day downward trend are primary. The overriding goal should be ensuring we don’t overwhelm health care resources, same as “flattening the curve.” We should reopen as quickly as we can while meeting the overriding goal, not seek to minimize hospitalizations. YMMV

 

[harllee]

This could get interesting.

NC started phase 1 reopening May 8, with the phase 2 stage tentatively planned for May 22. Hospitalizations, by far the most indicative metric the state is tracking IMO, were trending down ever so slightly (a good sign), but there was a slight tick up yesterday and the worst day so far today. Not surprising as it reportedly takes 2-14 days to see new infections so it was going to take up to 2 weeks to see the influence of phase 1 changes.

They'll probably wait with fingers crossed and see what tomorrow brings regarding phase 2, but it could get interesting for our Governor who (like all of them) says they will follow the data. I sure hope we don't go all the way back to full lockdown - and I don't believe any Governor would now. All the states are between a rock and a hard place - coronavirus cases versus blown up state budgets and business & individuals stressed more every day.

I know the NC Governor personally (he is a really smart guy and is really trying to do the right thing all around). I am sure he is very torn about what to do. Knowing him I bet he thinks the right thing to do in the long run is to postpone Phase 2. But he has been getting a lot of political grief about taking things slow. Then there is the issue of the armed protestors who have been showing up every week outside of his house--one week they broke down the gate. I do not envy the hard decisions these Governors are having to make. I just pray they make the right decision.

 

[Leo1277]

... The overriding goal should be ensuring we don’t overwhelm health care resources, same as “flattening the curve.” We should reopen as quickly as we can while meeting the overriding goal, not seek to minimize hospitalizations. YMMV

Yup, but once you have sustained growth in the number of cases, you are in "exponential" mode again and have an R0 > 1. And if the distancing stays unchanged, you eventually will overwhelm the system. And even in this "slow burn" situation with R0 < 1 but near 1, things will only stop once you have a vaccine, or herd immunity, which may require 10 to 30 times more total cases and deaths than we have right now. Tough choices...

Another interesting canary is Brazil, which is almost there catching up with the US in daily new cases and daily deaths; if they are even doing the counting right, which many doubt.

 

[Gearhead Jim]

On second thought, I don’t think the NC metrics or the sustained 14 day downward trend are primary. The overriding goal should be ensuring we don’t overwhelm health care resources, same as “flattening the curve.” We should reopen as quickly as we can while meeting the overriding goal, not seek to minimize hospitalizations. YMMV

When the gov of Illinois (Pritzker) instituted the stay at home order, it was all about "flattening the curve" to avoid overwhelming the health care system. Now that the curve has been flattened here and temporary hospitals are being disassembled, Pritzker has been correctly criticized for moving the goalposts- the goal is now to "keep everyone safe". The former governor (Rauner) says that we can't "keep everyone safe" without having an indefinite shutdown that eventually turns us all into starving peasants. He thinks we need to restart the economy at a measured pace and accept that we can't save everyone. Each of us gets to decide what activities we will or won't engage in as things open up.

Me, I'll keep my head down for a while. A 30 year old with a job might decide differently.

 

[audreyh1]

I just hope temporary hospitals can be quickly erected again.

 

[USGrant1962]

I just hope temporary hospitals can be quickly erected again.

Where? Pray tell.

 

[Gearhead Jim]

The main temporary hospital in Chicago was the McCormick Place convention center, turned into a temporary field hospital. There was also another hospital that had recently closed and was being prepared to open for Covid overflow.
I can't verify but believe both are now being dismantled/mothballed, but likely have the potential to be quickly reactivated.

 

[Leo1277]

CDC Re-Opening Criteria Phases 1-3

The CDC this evening released a detailed document about re-opening criteria, as well as the following summary page. I suppose that according to this, NC should not have had the phase 1 re-opening some two weeks ago (see items 1 and 2). Also, I personally think there are several limitations of this:

1) There should not only be a "downward trend", but the amount should be quantified - say 10% over a two week period? Without this, the current death numbers may continue until herd immunity (unless we get a vaccine), which means say 1% to 3% (death rate of COVID-19) of 60% (herd immunity) of the US population - which is roughly 2 to 5 million people.

2) The document does not contain any triggers for going back to a lower level, or maximum level of shutdown, should the case numbers rise again. But this is necessary to avoid further exponential growth. This is perhaps the most essential issue, since as written, it allows for exponential growth to resume at any of the three levels without explicit remediation.

 

[audreyh1]

Where? Pray tell.

Where needed.

 

[Leo1277]

The CDC this evening released a detailed document about re-opening criteria, as well as the following summary page...

Another significant shortcoming in my opinion:

3) There is no provision for contact tracing. Instead it asks for a "robust testing program" which just requires that no more than 20% of tests (for going to phase 1) or 10% of tests (for going to phase 3) come back positive. If you do random testing, that means that at any time, 10% of the population can be actively infected! If the average COVID-19 infection takes say four weeks, you'll get to herd immunity in half a year, (but incur millions of deaths along the way), this is how lax this requirement is.

So comparing these criteria to the best practices that would be taught in Epidemiology 101, these rules fall woefully short. Makes me wonder why we have an extensive government structure if an attentive freshman epidemiology student could do better.

 

[Dtail]

The CDC this evening released a detailed document about re-opening criteria, as well as the following summary page. I suppose that according to this, NC should not have had the phase 1 re-opening some two weeks ago (see items 1 and 2). Also, I personally think there are several limitations of this:

1) There should not only be a "downward trend", but the amount should be quantified - say 10% over a two week period? Without this, the current death numbers may continue until herd immunity (unless we get a vaccine), which means say 1% to 3% (death rate of COVID-19) of 60% (herd immunity) of the US population - which is roughly 2 to 5 million people.

2) The document does not contain any triggers for going back to a lower level, or maximum level of shutdown, should the case numbers rise again. But this is necessary to avoid further exponential growth. This is perhaps the most essential issue, since as written, it allows for exponential growth to resume at any of the three levels without explicit remediation.

Good thing this was released AFTER all the states have already reopened.

 

[Leo1277]

Good thing this was released AFTER all the states have already reopened.

Yeah, really - never let a regulation get in the way of "you gotta do what you gotta do". But now, if things go wrong, it's the states' faults for not following the rules.

 

[slingshot]

When the gov of Illinois (Pritzker) instituted the stay at home order, it was all about "flattening the curve" to avoid overwhelming the health care system. Now that the curve has been flattened here and temporary hospitals are being disassembled, Pritzker has been correctly criticized for moving the goalposts- the goal is now to "keep everyone safe". The former governor (Rauner) says that we can't "keep everyone safe" without having an indefinite shutdown that eventually turns us all into starving peasants. He thinks we need to restart the economy at a measured pace and accept that we can't save everyone. Each of us gets to decide what activities we will or won't engage in as things open up.

Me, I'll keep my head down for a while. A 30 year old with a job might decide differently.

THIS^

 

[gwraigty]

Here's a twist on an exit strategy, sue to reopen:

Court ruling: Gyms that reopen against Dr. Acton and Ohio’s coronavirus-related closures cannot be punished

A Lake County Court of Common Pleas judge ruled against Dr. Amy Acton and the Ohio Department of Health in a lawsuit filed by more than two dozen gyms that were ordered to close as part of the statewide stay-at-home directive.

Court records from May 20 show Judge Eugene Lucci granted a preliminary injunction blocking the state’s and county health officials from taking any action against fitness centers that violate the safety restrictions by reopening.

The ruling states that Dr. Acton, the Lake County General Health District, law enforcement officers, prosecutors, and the Ohio Attorney General are “enjoined," or prohibited from imposing any penalties for non-compliance of the Department of Health director’s order, given that they operate in compliance with safety regulations.

IIRC, at the time the lawsuit was filed, DeWine had given no guidance or timeline as to when these types of businesses would be allowed to reopen. Other types of businesses already had finalized guidelines and a timeline or they were nearly completed.

 

[eytonxav]

Given the strong opinions we express in the Covid sub-forum, maybe the CDC or WHO have some job openings

 

[gwraigty]

Here's another article about the lawsuit I mentioned a couple of posts back, but it focuses more on the questionable (?) legality of Ohio's shutdowns in general:

Ohio Judge Deems the State's COVID-19 Lockdown 'Arbitrary, Unreasonable, and Oppressive'

Ohio's COVID-19 lockdown is illegal, a state judge ruled today, because it exceeds the powers granted by the statute under which it was imposed.

In issuing her business closure and stay-at-home orders, Acton relied on a statute that gives her department "ultimate authority in matters of quarantine and isolation." Lucci concluded that Ohio's lockdown does not meet the legal requirements for "isolation," which is defined as "the separation of an infected individual from others during the period of disease communicability," or a "quarantine," which is defined as "the restriction of the movements or activities of a well individual or animal who has been exposed to a communicable disease during the period of communicability of that disease." A quarantine is supposed to last only as long as "the usual incubation period of the disease"—two to 14 days, in the case of COVID-19.

By contrast, Lucci writes, "The director has quarantined the entire people of the state of Ohio, for much more than 14 days. The director has no statutory authority to close all businesses, including the plaintiffs' gyms, which she deems non-essential for a period of two months. She has acted in an impermissibly arbitrary, unreasonable, and oppressive manner and without any procedural safeguards."

 

[USGrant1962]

Excellent analysis by the judge. Applies nationwide IMO.

 

[Chuckanut]

Our governor wants the death rate to be no more than 1 out of 100,000 before we go to the next phase. The highly populated counties are having a hard time meeting this requirement. One supervisor has pointed out that about 50% of the deaths occur in the county’s convalescence centers. We are much nearer the ratio without the center’s deaths.

So, we are keeping business closed causing loss of tax revenue while people in convalescence centers are not being adequately protected. Maybe, let’s open up business, and use some of the additional tax revenue to pay for better protection in the convalescence centers. It’s a thought.

 

[Chuckanut]

“"The general public would be harmed if an injunction was not granted," Lucci writes. "There would be a diminishment of public morale, and a feeling that one unelected individual could exercise such unfettered power to force everyone to obey impermissibly oppressive, vague, arbitrary, and unreasonable rules that the director devised and revised, and modified and reversed, whenever and as she pleases, without any legislative guidance. The public would be left with feelings that their government is not accountable to them."”

This sounds very much like the Wisconsin ruling regarding an unelected appointed official vastly over reaching her powers to the point of dictating behaviors, punishment, and enforcement. It seems it’s time for the governors and legislatures to do their jobs

 

[Bir48die]

As I see it there are two certain truths:

1) If states open up and there's success then ER will be talking about it.
2) If states open up and there become issues then ER will be talking about it.

I'll stay tuned.

That's all

 

[gwraigty]

Excellent analysis by the judge. Applies nationwide IMO.

Absolutely. In Ohio, Dr. Amy Acton has repeatedly said that we could all be carriers of this disease and not even know it, therefore we have to assume that everyone has it. If she had her way, everything would still be shut down with no proposed reopening in sight. I found a brief interview that DeWine gave yesterday. He was asked what he thought about the ruling allowing the plaintiff gyms to reopen against his order. He said that the judge thought gyms should reopen 6 days before he did, but he's not too concerned about that.

As pressure mounted to reopen the economy, DeWine repeatedly said that if customers don't feel safe, they won't come, and if employees don't feel safe, they won't want to work, with the strong implication that businesses might as well stay closed. Maybe he should have kept up with the economic recovery task force meetings as I have. He might have learned something. He's being proven wrong, with what has been allowed to reopen so far. Many customers are coming back. Many employees have returned to work. Not all, but enough to make it worthwhile. New employees are being hired to fill in the gaps. Gas stations don't look abandoned anymore. The streets are full of traffic of all sorts. Last night I got "stuck" behind a slow moving semi in a no passing zone and didn't even get irritated.

Today I clicked through a link in that article and found this one, also dated yesterday:

A Pandemic Does Not Suspend the Rule of Law

In response to the COVID-19 pandemic, state officials have imposed unprecedented restrictions on our liberties and livelihoods, acting on the assumption that they can do whatever they think is necessary to protect the public from a potentially deadly disease. The courts, which were initially reluctant to second-guess state responses to COVID-19, are beginning to recognize that public health powers, while broad, are not a blank check.

Whether or not you agree with these decisions or the policies they overrode, the principle at stake is vitally important. Even in an emergency—especially in an emergency—government officials are bound by the law.

If we tolerate unconstitutional government orders during an emergency, whether out of expediency or fear, we abandon the Constitution at the moment we need it most," Texas Supreme Court Justice James Blacklock observed earlier this month. "Any government that has made the grave decision to suspend the liberties of a free people during a health emergency should welcome the opportunity to demonstrate—both to its citizens and to the courts—that its chosen measures are absolutely necessary to combat a threat of overwhelming severity. The government should also be expected to demonstrate that less restrictive measures cannot adequately address the threat."

BTW, Ohio's new "order" was signed yesterday. It's only 3 pages. To sum up, the best practices put into place by the various business advisory committees are mandatory for businesses to follow. Everything else is up to the individuals. The section for elderly (defined as 65+) and other high risk people goes beyond what it said in previous orders to now urge them "to avoid public places where they are likely to be exposed to an increased number of people. When out in public, they should wear a mask unless not otherwise indicated. They should also practice good hand-washing hygiene." There's a new section for Other Ohioans that lacks detail and doesn't really say much.

https://coronavirus.ohio.gov/static/publicorders/Urgent-Health-Advisory.pdf

 

[audreyh1]

In Ohio, Dr. Amy Acton has repeatedly said that we could all be carriers of this disease and not even know it, therefore we have to assume that everyone has it.

Well that part is absolutely correct, it then boils down to what you do about it.

 

[gwraigty]

Well that part is absolutely correct, it then boils down to what you do about it.

True, but the same thing could be said of many common illnesses.