next November
This Trumpian time dilation is really a bitch.
I don't think you actually need a revolutionary president. I think you need a someone to rerig the system against Republicans. Like a Lincoln Republican. Or paleo-progressive. Or meso-liberal. Or something. Is Biden that guy? Presumably not.
Not a someone---we need 51 such someones in the Senate who will vote to take the Senate norms and shove them up the Republicans' asses. We're not going to get that, but that's not really Joe Biden's fault.
3 is correct. And I am not sanguine that this will "bring down" Trump. Complicated reasons for my thinking (and it really is me attempting pessimisticly prophylactic reasoning* but basically it is that a shitstorm fucks up everything but shit.
*If I can think it will not happen. (kind of reverse Lathe of Heaven.)
I'm not confident that this will bring down Trump, either, to be honest. But it's really hard for me not to spin out good scenarios instinctively where this wrecks him.
Cool things I learned from twitter and a businessy healthcare blog I follow.
1. In 2010 a bunch of MIT folks put together for $100 a device that could do a lot of the things that a $30,000 ventilator does. We should find a way to scss as we those ASAP.
2. A company called Everlywell issued a $1million dollar challenge to promote improved testing. Their goal is to develop a test that you can swab at home so that you stay out of your doctor's office and avoid transmission.
i'm just wondering how we are going to get our laundry done. no washing machine in the flat, laundromats not included in "essential businesses," i'm genuinely flummoxed. what good does all this handwashing do once we run out of clean towels??? bedding??? knickers and bras can be handwashed, but what about the rest of our clothes?
any ideas super welcome!
also - how many days before the field hospital goes into construction on the usf football field? perfect location - the hospital is a block away. so at least that will be conveniently located.
I believe laundromats are included, no? They are allowed to remain open in Contra Costa County, anyway, per the email I received yesterday -- or perhaps a county closer to you?
8: there isn't a shared one in the building?
In a world with no toilet paper, the laundromat is an essential business.
You should be good with the laundromats (page 6)
12: oh thank you! calm reading ftw! :)
10: no, we are in an edwardian three-plex, each flat quite small, none with laundry and the basement isn't finished out/has no sprinklers so we don't have access to it for storage, parking bikes, installing a washing machine - it is quite irritating. my bike lives in our looooong hallway, thank god the guys understand how much i love my bike.
11 It's probably to late to install a shattafa but maybe you can order one on Amazon and do it yourself. Hose your butt down. It's cleaner actually. And you also have a shower (no don't poop in it and mash it down with your feet as in legendary Unfogged posts of the Long Before Time, poop in your crapper and wash your butt in the shower.).
Every sink is a bidet if you're agile enough.
||
Tech Bleg. I'm finding myself doing Zoom Conferences. My part of this large organization uses Cisco WebEx, so now I am working with some people who seem to be on Office 365 and some of us are not yet on Windows 10 etc.
I downloaded an extension for google chrome and a desktop app and maybe an Outlook extension. Should I give up on the desktop app and just use the browser?
|>
Listening to Pence with his incessant fawning is almost worse than listening to Trump himself.
Just kidding; I can't listen to either.
16: I use the desktop app on a Mac and it's perfectly fine.
An app ain't gonna wash yo ass, Moby.
I've been procrastinating by watching financial markets, and it's fascinating how the usual relationships have completely broken down. The S&P, gold, and bitcoin are all moving in absolute unison. Dead cat bounce today, presumably the rout will return tomorrow or the day after.
Dr. Deborah Birx does not seem super trustworthy. Saying "game changer" in this climate does not seem entirely appropriate.
The environment turns everyone into a fawning moron. Even if they are "knowingly" doing it to remain in a position to do something about it, or get him to listen to you.
"It's A Good Life" remains the essential must watch of our times.
2:
you need a someone to rerig the system against Republicans
You're 100% right but I don't think Bernie is that guy either. The man wants to keep the filibuster.
Stupid question: if I live alone, mostly stay in or go on hikes alone, and scrupulously wash my hands before going out, is there a real reason to stop touching my face while indoors?
I guess I've answered myself in framing the question: to build up the habit for when I am out and about.
I'm still working on not picking my nose when alone. I have no idea how to stop touching my face.
Just thought of a "glad Ko/be didn't live to see this" tweet in response to the NBA season canceled that probably would have gotten me canceled.
Our generally terrible Republican governor, who is facing a recall election that he very well may lose, has actually been doing a remarkably good job responding to the crisis, listening to experts and shutting down a bunch of stuff well in advance of a significant number of positive tests. (My theory is that he's terrified of the recall and trying to take this as seriously as possible to stave it off.) Our local authorities in Anchorage are also doing a very good job, but that's less surprising. Today they announced that they're starting drive-through testing. Statewide we're up to three confirmed cases, all linked to out-of-state travel.
The Iditarod is still going on, but Nome cancelled all the public events at the finish and is discouraging people from coming. Several of the villages along the route are also shifting checkpoint locations or keeping the public away from them.
Everyone points to that Johns Hopkins tracker as authoritative, which I believe, but it only ever shows the day's data, and what I always want is the curve over time specific to the US or my state. What's a good source for that?
Daft question, but what kind of symptoms are sufficient to trigger more drastic isolation?*
Mild sniffle/chest cold for a couple of days, but no fever?
* my wife and I are debating whether we should be keeping our son home from school for 2 weeks. He has no symptoms, we both had mild cold-like symptoms a week ago, but no fever, no persistent long running cough.
31: https://www.worldometers.info/coronavirus/country/us/
https://www.worldometers.info/coronavirus/usa-coronavirus/
31 - You could probably do your own state-by-state graph from the data here:
https://docs.google.com/spreadsheets/u/2/d/e/2PACX-1vRwAqp96T9sYYq2-i7Tj0pvTf6XVHjDSMIKBdZHXiCGGdNC0ypEU9NbngS8mxea55JuCFuua1MUeOj5/pubhtml#
From the Covid Tracking project: https://covidtracking.com/
(specifically the states daily 4PM ET tab)
34: I've been wondering about that. I'm the sort of person who is slightly sniffly more than half the time -- I don't think of sneezing occasionally as cold symptoms, it's just baseline. But I do sneeze occasionally, and now I'm looking at myself suspiciously whenever I do.
38: I am now riding my bike back and forth to work, and yesterday evening after I came home, my throat felt sore; it seems to just have been from breathing in lots of cold air as I rode home.
re: 38
Exactly. I haven't had a fever, neither has my wife, and neither of us has had a continuous cough. So, according to the government guidelines, we are fine.
But, we both did have some mild cold-like symptoms -- nothing even close to anything like as bad as ordinary seasonal flu -- and a bit of a tight chest. But, that's not that unusual for me. I smoke, so if I get a cold, I sometimes get chest symptoms, also, sometimes caused by stress. And I stopped smoking last week, which tends to aggravate things in the short term.
Congratulations. Hope you can keep it going.
30: They should use the Iditarod to bring desperately needed diagnosis kits and medical supplies to Nome and the villages along the way. Next year, the vaccine.
By August it feels like the dilemma is: Join the failure side of collective action, or be a minority that self-isolates for five more months until 2021.
Or get a mild case, get immunity, then go about your daily life, neither in danger nor a danger to others.
This requires testing we don't have, but it is the way out of the bind.
I keep saying. If you aren't in a high risk group, getting it early and serving your quarantine is the right path.
(I know all you freakouts are going to be all, but what if it isn't mild?!?!?!? and re-infects, only the second time, you grow antenna, like a wasp!!!!!!!! Sure, what if.)
You can use paper strip tests and a drop of blood to detect antibodies. Much easier to roll out than the viral RNA tests.
Isn't a sniffle not a sign of COVID-19? It's supposed to be a dry cough. If you have the sniffles, then you mostly likely have a cold.
I truly think that when this is stabilized, it would be worthwhile to (somehow) schedule blocks of the safest people to be deliberately exposed then supported in quarantine.
Maybe slightly positive news, an antiviral (favipiravir) that is relatively easy to mass produce showed some effect at improving lung symptoms. When you're talking about such huge numbers, even something that moves 30% of patients off of intense support saves thousands of lives.
Also someone reported that with appropriate filters, t-valves, and tubing you can make one ventilator support 8 people which the kind of multiple-fold increase needed to deal with the expected capacity overload.
This requires testing we don't have, but it is the way out of the bind.
The existence of an antibody test would definitely allay some of my fears.
If it turns out you do get immunity, I bet the length and scope of social distancing will lead to the immune adopting some kind of visual signifier, like an armband.
(Although who knows how many previous-but-no-longer-asymptomatic-carriers will know they once had it. Will there be a test like with TB?)
Possibly deserving of its own thread: Propublica has released a region-specific tool modeling just how much area hospitals will be overloaded in different scenarios - 20%, 40%, or 60% of the population infected; and each of those over 6, 12, or 18 months. (All the scenarios assume 20% of infections will require hospitalization.)
In Alameda County, CA, the "best" of these cases has hospitals reaching about 120% capacity. The worst, almost 500%.
Turns out my rowing club is letting us "sign out" ergs (indoor rowers) during the hiatus, so I pick that up tomorrow. Good for getting workouts, but it will be there spreading guilt rays 24x7 especially since there were not enough to go around for everyone.
54- that appears to be the wrong link, but at least you didn't pull a JMM.
Selah had to be seen for her asthma and bronchitis today, but her regular doctor's office has been shut down and one office will serve the whole region. There were three nurses and two tables full of various supplies right inside the door making sure no one without an appointment entered. She was extremely cute in her mask but the whole thing was unnerving while also I suppose reassuring.
I am assuming Ace's adenoid/tonsillectomy/turbinate reduction will not go on as scheduled.
53 et al: That's why "wait, no, give them to ME!" was my immediate reaction to that email. (Again, this is more flippancy/weird knee-jerk emotional response than an actual policy position of mine.)
56: Ha, thanks for noting. Corrected hospital scenarios link.
58: Our office is scheduling non-sick visits for five weeks out at the earliest.
Also, my wife is definitely angling for a nice stay-at-home vacation with lots of cuddle time with the kid. Torturous logic to find ways to justify it, but in denial. She has the kind of job where if she is at home, she literally has nothing she has to do. Maybe an email, or a 10 minute call every day or two.
Me, if I am at home, I'm working full time, and every period I spend not working, I have to catch up later. So, for me, having everyone else at home is just storing up huge amounts of work, stress and pain for me. So, I want to not have to do that until we are actually fucking sick, or they actually shut the fucking schools/workplaces.
Sister-in-law is a teacher and reckons they'll shut the schools by next week. So many teachers are self-isolating they're finding it increasingly hard to keep going.
58: I have a follow up to my septoplasty turbinate reduction and I half expect that the ENT will be working in the ICU.
I keep coughing, but I often cough when I'm anxious. I sneezed some, possibly from allergies.
I am truly worried about domestic violence overwhelming support systems. Upsetting anecdotes just came in secondhand from a CPS worker who said her caseload is blowing up, drug use has increased and she expects more overdoses (good luck finding an ICU to help you there), etc. I'm going to discount that as "anecdata" to the greatest extent possible so I don't lose my shit, but I have no real reason to disbelieve it. Americans are on the whole, and I feel comfortable generalizing about this one thing, terrible at dealing with stress.
|| So, HG, shouldn't Sen Sanders be winning Alachua County, Florida? |>
He got 40%, at least! He overperformed!
@50 assuming we can work out most long term effects in that time.
I'm worried about women and children in domestic-violence situations; and also about isolated seniors who don't belong to a good, 'friends-and-family' network of support.
Continuing this, a cow-orker and good friend just told me she went to 3 different primary care centers to get her card and was refused at every place. They told her emergencies only. Thank god I was born and raised a NY-er so I can be pushy af when I have to be.
It had better turn out that I'm helping my parents rather than putting them more at risk by staying with them. Tomorrow I take my dad in for a routine and necessary doctor's appointment that previously my parents would both go to. Then later I'll do some grocery shopping they would do. I don't go out beyond situations they would have to take care of themselves if I weren't here. We'll be relying more heavily on delivery over time.
I've been with them over a week and we aren't all seriously ill so my worry I could have brought it with me is decreasing. Or we're very lucky with mild cases so far.
Two thoughts this morning:
1) careful reading of the Imperial College study shows that it will be impossible to contain deaths and keep schools/universities open until a vaccine appears. That is "12 to 18 months" away but no one actually knows. If you look at the sawtooth suppression model that cheered ajay, they have to close the schools again every time the figure of new cases jumps above a certain threshold, which it will.
I don't think schools can be closed for all that time, but the present model of terms and holidays is going to be completely smashed.
2) How long with dentists be open? I had a crown come off last night, and it would be really nice to get that fixed before the boom comes down completely.
I was idly browsing some California newspapers for flu news from 1918-1921 and it seems like periodic quarantines were a thing for a few years.
75: my dentist sent out an e-mail saying that she is closing until the 6th for all non emergency care. This is the recommendation of the State Dental board.
Apparently they are also recommending it as away to preserve the supply of personal protective equipment. I don't understand why we don't have enough of this stuff. I'm supposed to go on the 8th, but I doubt that I will be.
My contact in Prague informs me that the Czech government is now issuing instructions on how to sew your own mask... all shops are closed except grocers', pharmacies, and fabric shops!
They'll be fine as long as they keep their windows open.
Why the hell isn't the US Army Corps of Engineers not been given orders to set up field hospitals in WA, NY, CA, and other states now?
Although the sawtooth graph does answer Heebies question in the OP: My true fear is this: Most of America bails by, say, June. Over the summer, we get increasingly panicked requests to stay home from the responsible news sources. By August it feels like the dilemma is: Join the failure side of collective action, or be a minority that self-isolates for five more months until 2021.
As soon as some critical minority breaks quarantine the cases spike up and scare everyone back home. Only detailed testing and tracing can break that pattern. And that will require not just equipment but a state capacity which is just not present in the contemporary UK.
As an example of the hapless state of the British state, here is an extract from the BBC reconstruction of the Manchester suicide bombing that killed 22 people at an Ariana Grande concert a couple of years ago:
The first chemical purchase of all, by a cousin who later gave evidence at trial, took place on the same day in January 2017 that Salman and two associates visited Abdalraouf Abdallah, a convicted terrorist then serving time at Altcourse prison on Merseyside.
Abdallah, seen as an influence on Salman, is confined to a wheelchair due to injuries he received fighting in Libya.
A dangerous radicaliser jailed for IS organising largely via a phone, Abdallah nevertheless had an illegal mobile in prison that he used to call Salman.
Neither the Ministry of Justice nor G4S, the private firm that runs the prison, provided a statement when the BBC asked how it was possible for a serving terrorist prisoner to obtain a phone.
...
Neither brother had a driving licence, yet they bought and drove three cars in the relevant period, using them to travel between the different addresses, transporting their purchases.
And this in a country which has been devoting considerable resources to counter terrorism for decades now, and whose security services fought the IRA to a draw in the Eighties and early Nineties.
Worth a read (source: a professor of medicine and epidemiology at Stanford). The most interesting bit for me: the Diamond Princess is the only time that an entire population has been tested. 700 people tested positive. Seven died. That is a 1% case fatality rate in a population that was way more elderly than the population at large (although richer and maybe also with fewer comorbidities because really sick old people don't go on cruises).
84 And yet Italy has an almost 10% mortality rate. Such wide variation everywhere.
All the passengers who got sick on the Diamond Princess were being treated by a Japanese health service (possibly the best in the world, especially at treating elderly patients) under no pressure. In Italy they're having leave older patients with comorbidities to die because there aren't enough staff or equipment to treat everyone.
Italy has a "10% of people who have tested positive, having been prioritised for testing because they were regarded as at risk or had visible definite symptoms" mortality rate. That is not the same thing as "10% of people who catch coronavirus die from it". He also makes the point that because someone a) dies and b) tests positive, it doesn't mean that they died of the virus.
And he makes the comparison with flu: "In the U.S., for example, so far this season 1,073,976 specimens have been tested and 222,552 (20.7%) have tested positive for influenza. In the same period, the estimated number of influenza-like illnesses is between 36,000,000 and 51,000,000, with an estimated 22,000 to 55,000 flu deaths." On that argument, flu has a 10% to 25% mortality rate!
I think the point is we don't know the denominator in Italy because not everyone has been tested like on the ship.
I see only a few ways out of this given how we fucked up the infection testing option:
- Rapid repurposing of existing drugs. Too late for vaccine or new drugs. I've seen positive reports on three now- resdemivir, chloroquine, and favipiravir. None is spectacular but I hope someone is testing them in combination.
- The actual infection rate and asymptomatic carrier rates are orders of magnitude higher than we think. Antibody test is needed to determine this. Highly unlikely but if way more people have gotten it than we think the growth curve will slow even with half assed containment.
- Technological innovation like the multiple use ventilator above. But that requires simultaneous surge in nontechnological resources like health workers and beds and hospitals. Don't see it happening.
This thread: https://twitter.com/chadloder/status/1239800805575671810
"Most patients who need intubation don't get it. It's just: morphine, transport to iso ward to die."
86: also, importantly, most of the people who tested positive on the Diamond Princess weren't really treated at all because they didn't get seriously sick. Yes, I'm sure the Japanese health service did well in reducing the fatality rate among severe or critical patients, but most of the 700 never got near that stage.
BTW if the 8 person ventilator with lots of hoses becomes widespread they're obviously going to call it the octopus.
It depends what you mean by "seriously sick." I can't find the stats immediately, but a lot of those classed as "mild" actually had pneumonia, just not severely enough to require intensive treatment.
89: We are trying to do as much healthcare virtually as possible to slow transmission.
Home testing for actively Ill patients as well as antibody testing would be good.
It seems like if 2500 people have died of a virus and/or the related impacts of a virus in Italy alone, then some temporary precautions against getting it aren't an overreaction, even though that one time only 7 people on one cruise ship died of the same thing. The article in 84 is suggesting only 10,000 people in the US will die from it, which would be fantastic, and also hard to square with non-cruise ship data. Certainly a cruise ship is a closed environment, but they took the kind of "draconian" measures the article suggests may be unnecessary and excessive once the epidemic was undeniable. Maybe it was too late for the isolation, quarentine, sanitizing, monitoring, and treatment to do any good and the passengers would have had the same outcomes had they just said, "colds can be bad too, what can you do?"; this seems unlikely.
I think the Ioannides article isn't arguing against the temporary precautions that we are doing, it's arguing against the predictive models that are saying "these precautions have to be maintained for 18 months and the hospitals are still going to be overloaded by 200% instead of 1200% anyway" and sending people into a spiral of despair.
Morally, the argument is at one level a simple trolley problem. if we don't lock down now, very large numbers of people will definitely die in the next couple of months. The more severely we lock down now, the fewer people will die, but the greater will be the medium-term economic and social damage.
We just don't have enough information to know what will happen in the long term, as the models depend on assumptions that may be inaccurate by orders of magnitude.
So the choices are the certainty of massive death now with the possibility (not certainty) of herd immunity, or the certainty of fewer deaths now with time bought for vaccine development and other solutions at the cost of a massive, long-drawn-out economic hit.
I believe that's why the UK government changed tack when they were forced to show their modeling; the idea that the Imperial model is based on "new scientific information" is an out-and-out lie, as pointed out by the editor of the Lancet and others who were modeling those numbers weeks ago. Johnson and Cummings might have thought it worth letting a quarter of a million people die to get the country up and running again in six months rather than 18, but they would never have been able to persuade the voters of that.
I agree with that argument but I don't think he's making it that specific. He's not wrong that the data we have isn't reliable, but he certainly seems to be suggesting it's so unreliable we shouldn't make any major decisions until some future state where the data is better. Maybe we shouldn't flatten the curve, as the kids are calling it these days. Maybe don't close the schools. He might be right about bith of those things, but it's not the case that he isn't saying them.
Morally, the argument is at one level a simple trolley problem.
Ume is dead to me now.
She doesn't have to be! You can still pull the lever!
The Ioannides piece highlights a key issue: The lack of available data and the difficulty extrapolating from the data we have. But then Ioannides asserts an upward limit on the fatality rate of 0.625%. Ioannides makes a good case, but it will be interesting to see how it all shakes out. Certainly selection bias has always been a huge, obvious problem with current estimates of the fatality rate.
Here's a paper that puts the death rate at 1.4% with four important qualifiers:
-It's based on data from Wuhan
-It's talking about people 15 or older
-It's seeking to measure the death rate of symptomatic people.
-The 1.4% figure is the middle of a range of possibilities from 0.8% to 2%.
So altogether, a fairly optimistic take, and one that is not really inconsistent with the Ioannides estimate.
Here is the Stat piece discussing the study. (Apologies if all of this has been linked here before.)
Qualifier 3 is the important one there. The FT reports on the small town of Vo', in Italy, where they tested all 3300 people, repeatedly, and beat the disease very fast - they also found that half the people carrying the disease had no symptoms at all. So if you think that 1.4% sounds good from that paper - and why not - then it looks like the actual death rate of people with the disease is more like 0.7%.
Of course, you can't generalise the Vo' strategy to a country of 60 (or 300) million people - there aren't enough tests yet. But once you've beaten the disease down with suppression, you can go Vo' on the remaining cases and their contacts, and on every new case that pops up.
https://www.ft.com/content/0dba7ea8-6713-11ea-800d-da70cff6e4d3
go Vo'
I feel a Latinate grammar joke should be possible here.
That's terrific, but they 'beat the disease' as long as no one enters town without a test/quarantine. That seems very difficult to sustain with normal commerce, right?
they also found that half the people carrying the disease had no symptoms at all.
So if you don't test and trace aggressively, and don't lock down, we're looking at catastrophic levels of mortality. No?
The 1968 Hong Kong influenza pandemic had a case fatality rate estimated at 0.5%, and killed a million people worldwide, including 100,000 in the US. https://en.wikipedia.org/wiki/1968_flu_pandemic
It didn't really lead to enduring changes in society, witness the fact that most of us hadn't even heard of it.
So if you don't test and trace aggressively, and don't lock down, we're looking at catastrophic levels of mortality. No?
"Catastrophic" is a big word. Every death is catastrophic to the person who dies, and to their friends and family. But a lot of people need to die before something is catatstrophic for a society. In 1968 the US lost 100,000 people to a pandemic and barely even broke stride.
They had a pretty busy schedule that year.
108: yes, completely agree. I was pointing at the asymptomatic rate they found as the interesting bit.
Though "no one enters without a test" isn't impossible if some clever science type comes up with one that only takes, say, quarter of an hour to yield a result.
But that requires simultaneous surge in nontechnological resources like health workers and beds and hospitals. Don't see it happening.
Jumping on this belatedly (from SP at 89 above) because a lot of people here have been saying similar things and I find it very difficult to understand. Really? No improvement at all in recruiting? No temporary wards set up anywhere? No beds? They're all just going to sit back and do nothing?
Look at this, for example: https://www.theguardian.com/business/2020/mar/17/uk-manufacturers-regear-factories-build-ventilators-nhs
If you spend all your time focussing on the, frankly, largely irrelevant political shouty bits at the top - ooh! Trump has said a naughty thing! ooh! Boris is being offensive! ooh! Elizabeth Warren is much better than Bernie NO SHE ISNT YES SHE IS - you run a real risk of forgetting the key fact here which is the truly extraordinary and on occasion terrifying power of a modern state, especially when things like Emergency Powers Acts come into force. The political shouties at the top don't have a lot of input and in fact get in the way when they can, but the state itself can do some quite exceptional things when you let it. Maybe I am coming at this from a different angle because I have been much more closely involved recently with the state in full-on Doing Stuff mode. The reason that the state does not do more of this stuff on an everyday basis is because you (collectively) do not want it to and convey that sentiment to the shouties.
114 The problem is that almost none of that is being done in the US at the present moment. Trump said the other day the states will have to fend for themselves in obtaining ventilators. FFS.
I mean, would you like the state to stop (comment 83) Manchester bombers more? Sure! But you need to have a lot more undercover police officers. You'll need to be happy with some pretty heavy-handed policing of everyone who's had contact with an imprisoned IS terrorist, and all the family members of each of those contacts - especially the young men - and we'll need around 20 officers per suspect to put a box around them, effectively forever or at least until they age out of the auto-exploding demographic. The state can definitely do all of that. The state could intern them, for that matter - just as it did in 1939. That it does not do so is not necessarily a sign of the state's lack of ability to act, it's a reflection of the fact that you, collectively, don't want a state that does that.
111 I'd regard high six figures and to low 7 figures mortality catastrophic. But this is semantics.
I, for one, look forward to the impact of the people whose job is making "THIS IS NOT A BILL" papers being thrust into the front lines against COVID.
I don't have a sense of how bad things are in the UK, government-functioning-wise, but Trump has been actively breaking the capacity of the federal government to do things for three years now. We are not going to respond to this with the normal capacity of a modern state to Do Stuff. We might get back there in a couple of months, maybe? But we're not functioning normally at all now.
the state itself can do some quite exceptional things when you let it
I do get that completely. A friend is a public health official, and she's frantically busy organizing, among other things, extra morgue capacity. There's a hell of a lot of preparations going on behind the scenes. But there just isn't *time* to train hundreds more doctors and nurses and technicians in ICU techniques and source the ventilators (they're complicated things, with lots of sensors as well as the physical parts; it's really unlikely a car manufacturer will be able to manufacture ones that are immediately usable from scratch) and other equipment needed. Given two or three months, possibly, I don't know. But we've got two or three weeks.
And couple that with stories (truth of which I'm not certain) that there is 3-4 month ramp-up capacity in the system and team dumbass hasn't event bothered to look into it, and increased healthcare capacity is not happening.
https://www.google.com/amp/s/www.forbes.com/sites/baldwin/2020/03/14/ventilator-maker-we-can-ramp-up-production-five-fold/amp/
(they're complicated things, with lots of sensors as well as the physical parts; it's really unlikely a car manufacturer will be able to manufacture ones that are immediately usable from scratch)
I've seen reports that they're looking at resurrecting older designs - not as user friendly or flexible as a modern ventilator but a lot easier to produce for a non-specialist manufacturer.
The first modern ventilators were cobbled together in the 1950s out of, among other things, Sturmey-Archer bicycle gears and old windscreen wiper motors. You can't tell me that JLR or Honda couldn't knock a few of those together in a hurry.
Meanwhile in the Czech Republic: https://news.yahoo.com/stitch-time-czechs-sew-combat-virus-mask-shortage-205213804.html
Personally I think this is genius because it will keep all those extremely vulnerable but annoyingly active grannies indoors rather than insisting on going OUT and being HELPFUL. "NO, mum! You can't go and help out at the playgroup/old people's home/whatever! You need to stay at home and work on more masks!"
I can't find the piece now - it came up on my Twitter account a few days ago - but I'm basing that assumption on a despairing article by an anesthetist about how complex present-day ventilators are, and how difficult he believed it would be to produce something reliable in that short time that would be clinically useful in today's hospitals. Current ventilators automatically adjust pressure in response to sensors, and ICU protocols depend on that - there isn't time for staff to make the measurements required and constantly adjust them manually, particularly staff who are overwhelmed and exhausted. Though of course in this sort of emergency anything's worth trying, and will hopefully save some lives at least.
I have some experience in medical device development, these production lines don't run anywhere near full capacity in most cases. Given available labor (easyish) and supply chain (ummmm) I bet most shops could go 3x-5x production without major infrastructure changes, almost over night. I suspect it supply chain limited though.
It's certainly true that death from disease was more common in the past, and cultural norms practices were more adjusted to that reality than, say 50 years later. We can return to that, after we get used to more routine death. We may have to. We're trying not to choose to do so.
125: They gave your old office to a dentist. That's probably a metaphor.
I was figuring the first Covid-19 transmission at a religious institution in Pittsburgh would be either Catholic or Jewish, but the Presbyterians beat us. Shout out to old, old Pittsburgh.
Further to @120 if it is true that healthcare workers are not being tested at the moment, we are about to see a drop the capacity of the health service anyway.
Mr. Rogers said, "Look for the helpers." He's a great tactician.
119: but Trump has been actively breaking the capacity of the federal government to do things for three years now.
Some tidbits from various sources:
The agency has been key in providing guidance to federal workers and agencies in regards to dealing with working through the coronavirus.
Another source familiar with the Office of Personnel Management said it was friction between OPM and the White House that led to Cabaniss' "abrupt" resignation as director of OPM,
The source specifically cited Johnny McEntee, the new 29-year-old director of the Presidential Personnel Office, and Paul Dans, who was recently assigned to be the OPM's White House liaison, as being "part" of the tension.
Complicating the resignation, most members of the OPM staff are working from home due to Covid-19.
Adding to the tension: The White House has hired a third college senior to be an administration official in a sensitive post
Half the point of the administration is to say "Fuck you" to people who know how to do stuff and there's only so many jobs you can give to Jared.
I am breaking quarantine to get an eye exam. I went from about 1988 until this year without breaking my glasses. I've broken two this year.
Technically, the guy driving the car that hit me broke one and my son broke the other, but still.
"I did have to go to one place today. The General O'Neill gravesite where the #Hibernians of Omaha celebrate a man responsible for bringing many Irish to Omaha.
Here's my dad sing the Irish National anthem in Gaelic"
Thanks. I've never actually been to that grave.
I went out to pick up a few groceries on Monday, and the shelves were looking bare. I went out again today, for 20 minutes, and i) the streets of the London suburb where I live were surprisingly busy, ii) no dried food, no tins, no frozen goods, no medicines, no toilet paper, no tissues, in the main shop(s), and the pharmacy were handing out partially opened blister packs of paracetamol. Any prolonged lock down is going to get really shitty, really fast.
132: If there were any silver lining from this, it would be for those people to question the disparagement of expertise. Not that I have any hope of that.
134: I'm glad you're not seeing this as an-eyeglasses-for-an-eyeglasses sort of problem. But I guess you aren't seeing much of anything.
137: We're in inner North London. I had to go to the vet twice today, to drop my cat off and pick her up (seriously, our cat's a lemon). Wasn't too bad going there, but on the way back I ran into the getting-out-of-school crowd. Parents just dithering around on the too thin sidewalk, chatting with each other and blocking traffic. Christ. At least that'll only be a problem for two more days. I last got groceries over the weekend; it was a mess at the supermarket but the mildly more expensive chain corner store was well stocked. We're trying to switch over to grocery deliveries as much as possible, but there were hardly any slots.
Yeah supermarkets are looking pretty bare these days. I am hoping that people will calm down once they have built up what they think is a good stockpile and go back to steady state buying...
At present full of people buying bottled water (...why?)
Gswift was wondering about that. I think the answer is, "For the earthquake."
I refer the gentlemen to the thread title.
@140 the other possibility is that as the illness hits the workforce of logistics and food service companies there is also a lower level of supply.
One thing that's become very visible in the last few weeks: The Great Firewall cuts off the rest of the world from Chinese stories. If the Western internet had been flooded with firsthand accounts of the suffering in Wuhan and the struggles of living under quarantine, maybe the problem would have been taken a little more seriously. Front-line health care workers' experiences also barely seem to have filtered through to their counterparts in the West, potentially costing lives. And censorship is only tightening. (I had a great piece on this lined up from a Chinese writer until they became too scared of retaliation to publish it.)
Some dipsomaniac has been wandering around the block shouting "TRICIA!" at the top of his lungs for half the afternoon. Knew I should have bought a shotgun as soon as things started getting serious. Dammit.
Don't do it, Nat. Suicide is a sin.
I wouldn't really shoot an annoying drunk. Being stuck at home is all the more irritating when you can't climb stairs due to a broken ankle. And I don't even drink anymore. I don't have a clue what we are going to do about my sister, she's been doing better, but obviously most transplant timelines would be less than the projected length of this emergency. Well, honestly, I have always been pretty sure something like this would happen if I lived long enough. It was stupid not to prepare better.
I've been trying to get the city's public playgrounds closed. I feel like the villain in a movie about a rag-tag group of plucky neighborhood kids.
149: Sorry to hear about the ankle and how Covid is affecting your sister. It is hard to tolerate drunks if you haven't drank in a while.
I feel a little bit bad about going to the eye doctor tomorrow (and I'll call off if I or anybody in the house wakes up with symptoms), but I think having no recent, unbroken pair of glasses counts as urgent.
I've joined the list of the exposed. Turns out that both of the leaders and one member of my therapy group have tested positive since I saw them last week. (We've now switched to meeting on Zoom.) I have no symptoms but am going to try to get tested anyway because Kraabniece #1 has elevated risk and is staying with us.
I'm sorry to hear it, Sir K. Fingers crossed for you (and your niece).
"Americans can do anything for a week or two, but 60 days is a lifetime. Businesses will go under, and kids will go on unsanctioned play dates. And let's not even talk about teens and young adults who are supposed to forgo social life and dating for that long."
USA! USA! USA! The nation that can do anything for a week or two (from the Washington Post)
if sixty days is a lifetime, one generation is twenty days. Mr President, there will soon be three generations of Americans who have never known sex. Three generations of feral children raised with the experience of unsanctioned play dates.
Sir K. Tough situation! Sympathy and fingers crossed.
Does anyone have a link to guide for how to keep grocery and other retail store employees safe? I want something I can distribute to managers of local stores that tells workers not to wear gloves, how often to wash/sanitize their hands, how often to wipe down touch screens, etc. Maybe workers should be encouraged to wear some sort of face covering (even a bandana) to encourage them not to touch their faces?
If you don't have a link, can a science- or medicine-minded person here write up a few quick principles? I'm seeing some practices locally that look unsafe, and I'm assuming managers don't have better ideas about what to tell workers.
Bare shelves tonight! I think that makes all of us.
Why not wear gloves? (On the principle they make you less likely to touch your face.)
I'm guessing managers are under a fair bit of stress and not very open to posters from strangers.
You go to war with the produce department you have.
Anyway, last time in the store, they were all wearing gloves. The gloves were almost certainly the filthiest things in the store.
I'd need a cone of shame to stop touching my face.
Thanks, everyone. My doc's office says I can't get a test without symptoms, my niece's health notwithstanding. (There are only 23 confirmed cases in the city and I was in a room with 3 of them and can't get tested. We are all so fucked.) ydnew, if you're around, any advice whether I should push harder to get tested? From a public health standpoint, of course I should be tested, but from a personal standpont, I'm not sure it matters because even if I (or even my niece) tested positive, all they'd tell us to do is keep self-quarantining and watch for symptoms.
Good detail on Japan (but still concluding "basically, nobody knows"): https://safecast.org/2020/03/covid-19-testing-in-japan-the-situation-and-ramifications/
Good luck, Sir Kraab and family.
Trapnel, any news on your tests? Megan, how are you doing?
I'm symptom-free 11 days since exposure, so hopeful.
My theory on gloves is that they keep people from sanitizing or washing their hands as often as they should, contribute to spreading the disease to others, and don't necessarily discourage people from touching their faces.
Moby, you might be right about 166, but my theory is that many stressed out managers want to protect their employees and know they don't have reliable info about how to do it.
Fair. They should do like the bakers and dust their hands, but with hypochlorite.
That's funny that you ask, Ume. I kept telling people, dude, we have it! Look, low fever, dry coughs. Totally mild. Soon we'll be free! This is great. And people were all, lady, you have a daycare cold, get over yourself. What are the odds you really have it?
But late last night, on our Day 7, my partner started coughing and saying that his lungs and heart hurt. Then we fell asleep and he was breathing much better in his sleep. Today I'm trying to figure out what hospital could test him, since he's now got the scary symptoms. I 'm not hugely scared, since I think there's still bedspace here. Also, getting tested and confirmed to have had it is the key to returning to life after, so I really want that. I was resigning myself to waiting until serology tests become widely available.
178: Good luck, Megan! Good luck, SK! Good luck, Ume!
Stay safe, all!
Megan, keep us posted. I hope it passes soon.
Jammies ran a light fever (99) yesterday and felt fatigued, but is back to normal today.
Also, getting tested and confirmed to have had it is the key to returning to life after, so I really want that.
This.
Megan, good luck with getting tested.
Here it's impossible, full stop, unless you already have pneumonia or can afford a private test. And that's really fucking up hospital staffing, apparently. I messaged an old friend today who's an emergency nurse practitioner, just to wish her good luck really, and she said they're already short-staffed because lots of people are self-isolating who probably don't need to be, e.g. because their child has a cold. Testing could resolve that, but healthcare staff aren't being prioritized.
I messaged an old friend today who's an emergency nurse practitioner, just to wish her good luck really, and she said they're already short-staffed because lots of people are self-isolating who probably don't need to be, e.g. because their child has a cold.
Or because their child's school is closed.
Schools are still open through today (though yes, some have closed because of staff shortages), and they will still be open for NHS staff and other key workers' children next week.
One guy I work with isn't at work today because his wife (a nurse) hurt her ankle rushing around because so many other nurses aren't at work and he has to take her for scanning and pick up her car. Just a snowball effect.
I'm regretting not sticking with my original plan for a career as an NBA star.
178: At least your metro's academic medical center is supposed to be conducting its own tests on-site, adding to capacity. I'm sure they're rationing just as much as anyone, though.
182: at present we seem to be running at about 3,000 tests per day (30,000 conducted since March 9) - not nearly enough.
But it's a tricky question - should you be prioritising testing healthcare workers, even if they don't have severe symptoms, or should you be prioritising testing people who _do_ have severe symptoms so you know whether or not they need to be in one of your few isolation beds?
If you test a self-isolating nurse and clear them, you get two weeks of a nurse who would otherwise be at home unnecessarily for those two weeks. But if you test a pneumoniac and clear them, you get two weeks of an isolation bed which would otherwise be filled with a patient who didn't really need it.
Which is worth more?
Take care to all the sick people and families.
I think ICUs are the only hospital areas that have a 1:1 nurse:patient ratio. High-dependency units are 1:2, normal wards anything up to 1:8 or so. So I guess clearing nurses gives you a bigger advantage?
Do they need to be Scientologists?
I'm really not big at shaming people for not following public health guidelines, but I almost yelled at the guy spitting on the sidewalk.
The panic buying here is getting ridiculous. I walked out to get milk, kefir, yeast and fresh fruit/vegetables. The little Polish shop where I buy kefir seems absolutely normal. I've been going there two or three times a week for four years now and the staff still practice social distancing with me, so that's all right.
But the supermarket -- It was like Kiev in 1988. Ok, not quite like Kiev in 1988, where I saw a queue maybe ten metres long to buy radishes; but the produce section had been stripped bare of everything but onions. Fruit was more or less OK. No pasta or tinned stuff, obviously. No flour of any sort whatsoever. No yeast. Only the largest containers of blue milk. Meat shelves half empty. I didn't check out the freezer chests.
I thought maybe I was in the wrong timeline and Corbyn had won the election after all.
[of course this is also what no deal Brexit would have been / might still be like, complete with the pound crashing downwards]
193: Went to the Sainsburys and it was crazy. Grabbed two of the last half dozen or so things of pasta. There was no pasta sauce. Produce was bare, paper products was bare. Alcohol was at maybe 20%.
Will swing by the Londis later to see if that's any better.
I think ICUs are the only hospital areas that have a 1:1 nurse:patient ratio.
In California the mandatory ratio, under a law hospitals endlessly complain about, is 1:2 nurse:patient in ICU, 1:5 most everywhere else. (Most states don't have such laws; politically, they're considered union "wins".)
Either a lesser-known strength of the NHS, or maybe you just define ICU more narrowly.
Are folks actually doing regular disinfecting with alcohol or bleach? We haven't been, just lots of soap and water. I'm inclined to think there's no reason to start doing it until we end quarantine unless something new comes into the house.
My sister is dropping off a book I need for work, though I can wait a day or two to start using it, so I think I'll just leave it outside.
195: I don't know how intensive care is defined in California, but in the UK for Level 2 patients (high-dependency) the required ratio is 1:2, and for Level 3 patients (intensive care) it's 1:1, using the definitions below. "Advanced respiratory support" is mechanical ventilation.
02 Level 2 (PATIENTS requiring more detailed observation or intervention including support for a single failing organ system or post-operative care and those 'stepping down' from higher levels of care.)
03 Level 3 (PATIENTS requiring advanced respiratory support alone or monitoring and support for two or more organ systems. This level includes all complex PATIENTS requiring support for multi-organ failure.)
Serious family situation with this but I'm too distraught now and drunk now to go into into it.
In short, a family friend who was at that spring break is going to go to my brother's house where my parents are staying. I gave them my credit card details and told them to please put her up in a hotel at my expense. They're not going to do that I know. I'm about to block them all.
Told them that if they don't get her other accommodations then they should tell her next time, if my parents' survive, she'd better fear me. And her father too.
Sorry, Barry. You're a good son, but there's only so much you can do to get people to protect themselves.
You can't control your parents and that was a hard thing for me to deal with. Then, when I could control my parents, it was much worse.
198: what spring break? Someone known to be exposed?
Oh -- full fat milk, which has a blue cap here. Green milk is semi-skimmed -- half fat -- and red is skimmed entirely. Green is much the most popular.
seconding 201.last
170/196: Sorry, was at work. I'd say that even if you do your Karenest, you won't get a test. It's not worth the bad will between you and your doc, and you're right that there is no difference in what you'd be told to do. I think we're close to seeing tests being distributed normally, but I'm worried there's some remaining clusterfuckery, like withholding from blue areas or some other petty scheme.
We are disinfecting things at home. It might be a little crazy/overkill, but we figure it's not harmful. When we come home, we take off shoes and coats at the door and leave bags. We go in and wash hands, then pull out phones/keys/tablets and wipe them down with Chlorox wipes. We've been doing door handles and light switches indoors, and car doors/consoles/steering wheels with disinfectant (Microban) every 2-3 days. It legitimately probably won't keep either of us from getting it, but it might keep one of us from giving it to the other (which we rarely do anyway) and might keep us from spreading our germs elsewhere.
205: That's so funny. Blue milk to me is slang for skim, ie it looks a bit blue in color because of the lower fat content. Our milk is color coded that way, too. Skim is blue; whole milk is red.
206: You're thinking of green milk. Blue milk is what Luke drank growing up and in A New Hope.
Hey if you want to play the "so how fucked are we game" with an interactive simulator, here you go: https://neherlab.org/covid19/
(it's actually pretty well put together)
also skim milk is the devil, only slightly superior to powdered milk.
209: You're right. It's been a while.
We disinfected with bleach yesterday for the first time. Mostly door handles, light switches, and stuff in the kitchen that we use a lot. Amadea got a bunch of bleach and other cleaning supplies a few days ago, way more than we're likely to actually need but not at hoarding levels. Her initial idea was that we'd be doing this daily, but I think weekly is more likely. She's very freaked out about infecting her dad, who is relatively young but in generally poor health. I don't think it's likely, but it doesn't hurt to take precautions, especially since we're both still going in to work so far.
I have a lot of vinegar. I've been trying to buy hydrogen peroxide. Understand that if you alternate spray it's almost as effective as chlorine bleach.
Tim brought home some alcohol wipes for me. Trader joe's used to make an alcohol based cleaner that I was thinking of looking for.
What's the best disinfecting wipe to look for once they get back in stock?
I was wondering if I could mix oxyclean with water to wipe down surfaces.
We have apple cider vinegar, which makes salad dressing better.
216: Not recommended for cleaning, though.
@125 Well, they've just had someone from one of the UKs ventilators manufacturers on TV and he claimed that they had received no further orders from government -- you'd assume they'd tap up existing suppliers before getting car manufacturers to re-tool.
214: Disinfecting wipes are basically equally good, the difference is usually contact time, based on the thpe and concentration of active ingredient. No need to use vinegar with your hydrogen perioxide that I'm aware of, and yes, Oxyclean makes hydrogen peroxide.
Here's an EPA list of cleaners known to work on similar coronaviruses:
https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2
Update, the family friend only stayed two days and left. I think she was planning on staying longer but my outrage may have cut her stay short.
Especially since people are still probably licking each other goodbye.
222: That's just a Pittsburgh thing, Moby.