I am going on my eighth week of “sheltering in place”; the state has officially had a “stay at home” directive in place since March 22; on Friday a facemask directive was added to that. Based on the statistics provided by the Illinois Department of Health, there are no actual signs of the number of new cases diagnosed daily peaking. The number of new cases diagnosed yesterday was greater than a week before which was greater than the week before that which was greater than the week before that. The number of cases or new cases is not doubling every six days but they weren’t doubling every six days a month ago, either.
Some of that stands to reason. The number of cases diagnosed is positively correlated with the number of tests conducted. More tests—more cases. I see no signs that the number of ICU beds or ventilators in use are being stressed. In Chicago the increases in the use of both are due to more use for non-COVID-19 cases, at least some of which I attribute to the shooting spree going on in a few South Side neighborhoods.
Politically, it’s easier for the governor to double down on his present policy that it would be to acknowledge defeat. Keep the state shut down long enough and there will surely be some improvement. Any improvement, whether produced by the measures in place or not, will allow the governor to declare victory. Or else the state will run out of money.
CA has had it’s shelter in place mandate in place since March 19, adding wearing a mask to that edict later, just like Illinois. N CA has had remarkably low numbers of CV cases and deaths, with many counties barely effected. Los Angeles, OTOH, has had the lion’s share of problems. But, considering the county’s diversity and density, infections and deaths have been relatively “light†as well.
Nonetheless, Gov. Newsom, is holding firm on tightly locking everything down, as the state falls into deeper fiscal holes, businesses are struggling to survive, while Newson’s approval rating rises 40 points from his pre-pandemic numbers. There are rumors floating around that he might be up for consideration for the dem nominee spot should Biden be pulled. And, I really think this gives Newsom an incentive to keep CA on itâ€s lockdown status…unless the anti-lockdown rebellion here grows and gets out of hand.
I’m sure you are aware of the various comparisons floating around: heavy lockdown vs light lockdown – and their result on corona deaths. Its obviously not exact science, but no matter the venue: US vs foreign, state vs state, county vs county, the result is the same – lockdown procedure is almost uncorrelated to result.
This should not be surprising, age, general health and so on appear to be much better indicators. In fact, I quoted a stat last week that perhaps 25-30% of all deaths were in nursing home venues. Now I’m seeing citations its more like 40-45%. I sure wish someone had pointed out that a focused strategy on the vulnerable would have been much more effective. Oh, that’s right, I did. As have many others. But not Fauci. Of course, he’s an “expert.” So. And as a side note – he’s disingenuous when he goes off wringing his hands on a second or third wave. Second or third spikes in flu are typical. But why be honest with the people when you have a bureaucratic agenda.
If hard quarantine is effective, its only at the lightest touches. A third order effect. And only in very limited venues. I wouldn’t want to be the guy arguing cost benefit.
I see Mish succumbed to the limited sampling error of Sweden vs Denmark etc. He failed miserably in citing as many hard vs soft quarantine examples as available. Sounds like a man with a horse he wants to beat.
This whole thing is a travesty.
At this point latitude seems to be a risk factor. There are predictive indicators and non-predictive indicators. To my eye lockdown does not appear to be a predictive indicator. If it were, wouldn’t you expect the date of onset to change the number of cases?
I see the mask requirement, coupled with softening of restrictions (opening select businesses like golf courses, florists, nurseries, state parks) as essentially converting the state to a social-distancing policy. Our Democratic mayor wrote the Governor a few days ago requesting that all of the remaining non-essential businesses be allowed to open if they can abide by the social distancing requirements for essential businesses.
The legislature needs to be called back to do its job. Whatever one thinks about the 30-day expiration of the emergency order, it will expire some day and any orders that are intended to transition from a state of emergency to a state of law disappear. If there are longer term precautions necessary, laws need to be passed.
That’s my position in a nutshell.
The first thing on the legislature’s agenda should be allowing them to do business remotely. That this was not done after 9/11 at the federal level was an outrage and one I commented on at the time.
“There are predictive indicators and non-predictive indicators. To my eye lockdown does not appear to be a predictive indicator. If it were, wouldn’t you expect the date of onset to change the number of cases?â€
Exactly my point. I haven’t seen any decisive latitude studies, but if you have I believe you. But we, and this crazed bureaucrat Fauci, seem to have basically only one tool: harsh lockdown. Insanity.
BTW – I may have the virus as we speak. Fever and associated symptoms, lethargy, cough, some mild GI distress. Some very light, probably not psychosomatic, breathing restriction. Cold? Regular flu?? Simple allergies? Won’t know until ultimately tested. The prescription ? Watch, wait and see. Beware of an adverse change.
Of course.
“Now I’m seeing citations its more like 40-45%. I sure wish someone had pointed out that a focused strategy on the vulnerable would have been much more effective.”
And I keep pointing out that we dont know how to do that. Many places tried and failed. You cant live in fantasy land. You can fund some experiments to see if you can find something that works, but as of right now we dont know how to do it.
“Politically, it’s easier for the governor to double down on his present policy that it would be to acknowledge defeat.”
Politicians usually do what keeps them in office. When the polls favor going back to work I expect that is what will happen. In the states that are mostly open majority opinion (among those who vote for the states’s governor) seemed to favor re-opening.
Steve
Darn, forgot. Hope you do well Drew. If you dont have a pulse oximeter try to get one. Hopefully you test negative but if you are positive do your best to self isolate. Hard to do.
Steve
“Many places tried and failed”?
What is the definition of trying?
Ontario, Canada imposed a rule that employees cannot work at multiple care facilities — AFAIK, that has not been done anywhere in the US.
Has anyone tried a rule that positive cases must be taken out of a care facility and taken to a hospital (which have the space)?
This doctor tried and he was told his time was better spent discussing DNRs.
https://thehealthcareblog.com/blog/2020/05/02/covid-19-physicians-in-shackles/
Trying and failing is understandable — but lets not mince words; what is occurring is not trying.
You can’t be serious, steve. The first thing you do is not have the governors of NY and NJ dictate to nursing homes to retake in patients from hospitals. It’s a start. It would have moved the needle on deaths.
The second thing you do is violate their civil liberties, just like the civil liberties of the nation are being violated. For a pittance you could quarantine them, bring in Morton’s steak every night, and provide they or their families a $50k bonus.
As I pointed out early on, once the government is in the business of violating civil liberties at least do something effective, and relatively cheap.
For the younger people:
Big difference between skilled nursing home and assisted living. Nursing home residents are not just older, they’re ill.
Strokes emphysema, heart failure, Alzheimer’s, on and on. The death rate will be higher no matter what you do. We all still want to do better, and should. But we remain mortal, each and every generation, so don’t flatter yourself you’ll never end up like that.
Drew, hope you’re having those symptoms because of allergies, and nothing more. In the meantime take care of yourself
“The first thing you do is not have the governors of NY and NJ dictate to nursing homes to retake in patients from hospitals. It’s a start. It would have moved the needle on deaths.”
Thats good. Have you been keeping up with the literature? How long do people stay infectious? We, and everyone else know send pts back to their nursing homes while still needing oxygen. We get 2 negative tests and/or wait until they are no longer considered infectious. I dont really know when the NYC pts went back to their nursing homes and neither do you. That may have affected things, or maybe not. We had lots of nursing home problems outside of NYC too.
“The second thing you do is violate their civil liberties, just like the civil liberties of the nation are being violated. For a pittance you could quarantine them, bring in Morton’s steak every night, and provide they or their families a $50k bonus.”
How do you know the people taking care of them are not infected? How often are you going to test? Once a day? Twice? We think we know that people are most infectious right befog they have symptoms, so we cant use symptoms as a guide. So the guy who tested negative in the morning becomes infectious later in the day. He helps bathe 5 pts. He needs help to fo that so the person helping is a contact. That person takes care of other pts.
CO- Yes, I haver had discussions with Dr Koka. He very much has a POV and is willing to stretch the truth to make some point. Idont really have the interest or energy to go through everything he claims, but first he is a cardiologist. If he works in a hospital of any size he doesnt do Icu care. So, he doesnt know how we actually manage pts on a vent in the ICU. Yes, we usually start out with a protocol. But believe it or not people monitor pts and adjust that protocol if needed. We learned early on that most Covid pts dont act like ARDS pts, thought their Chest X ray looks like it. So we start off with a protocol designed for most Covid pts, but guess what? Some Covid pts do act like they have ARDS. So we adjust. So I am not inclined to take this guy at his word. He doesn’t tknwo what he is talking about when it comes to ICU care.
What counts as trying? How much detail do you want? Ok, the local nursing homes banned all visitors, not just some. They installed extra hand cleaning stations. They had staff check their temps at night and checked temps themselves on arrival to work. They had supervisory staff actively mondoe staffing to make sure they complied with hand washing. They confined pts to their rooms as much as possible. Meals served in rooms. They drilled staff on what to do if they suspected a pt might be coming down with Covid symptoms. Any staff who felt sick were told to say home. Some places, the more affluent ones, gave them sick pay to stay home. Cleaning staff were instructed to emphasize cleaning stuff people actually touch, like doorknobs. There is more but hope you get the point.
“Canada imposed a rule that employees cannot work at multiple care facilities ”
How would we enforce that? In a nationalized system it would show up. I could go work someplace in New Jersey and unless someone recognized me no one would ever know.
“Has anyone tried a rule that positive cases must be taken out of a care facility and taken to a hospital (which have the space)?”
Dont know. Early on many of us didnt have space so moot. Could we try it now? Sure. Figure out how to pay for it and then monitor to see if it helps. Probably not very much. I am sure that Drew, man of science, has been following the literature, but as I noted, people are probably most infectious right before they become symptomatic. They probably become much less infectious a few days after being symptomatic. Up until recently it took 4-5 days to get a test back. Now that we can get them back in a day or two we could probably cut down on their infectious time a bit. (Actually, a nice study out of Taiwan that suggests people rarely transmit the disease after 5 days, though I read it at 2 in the morning so hope am remembering correctly. )
“but lets not mince words; what is occurring is not trying.”
Let’s not mince words. Some places have tried really, really hard. The way that Covid manifests and when it is infectious make it hard to control in a nursing home situation. So lets not mince words. For every problem there is a simple and easy solution, that is wrong and uninformed. But, prove me wrong. Tell me how we know people are infectious if they are most infectious right before they have symptoms. How often do we test? q24h? q12h? q6h? Until we get pop up buttons like a turkey that tells us when we are infectious I sure dont see a good answer.
Finally, to be very clear I can think of some ways to address at least some of these issues, but it will cost a ton of money. Maybe it is worth spending that ton of money because we might save more money in the long run spending it there than elsewhere. We are still left with the problem that we hadn’t figured this all out until recently.
Steve
So you don’t feel alone, I got sick 3 weeks ago yesterday, low grade fever and a cough, worst is weakness and what feels like arthritis. O2 was 91%.
So, Z pak, steroid taper, chest x-ray, (clear) cov-2 test, (negative). And a phone visit with a pulmonologist, I’m informed they presume me positive due to symptoms.
That really seems unlikely to me, given the number of cases in town (200), And the fact I don’t go anywhere .
Just info, I’m still breathing.
Steve; you are listing reasons why you think it is infeasible or will fail — but reminder; it has not been tried in this country.
FYI; nursing homes are not nationalized in Canada either; and yes imposing the rule is resource intensive; but Ontario is trying anyway.
You said you have some ideas too — everyone does. But we we haven’t moved much beyond banning visitors — that was 7 weeks ago.
CO- They went way beyond banning visitors. I listed a bunch of things they did. I notice you dont have any ideas to solve the testing of staff issue. No one else does either. So you could put staff into PPE/isolation gear as soon as they arrive to protect patients. But its hard to work in that stuff all day, so you need more staff. Most of the staff working in nursing homes are not high end staff. You need to seriously upgrade nursing home staffs if you want them to successfully negotiate PPE gear and give good patient care. Not sure where you intend to find those people without depriving hospitals of staff. Next, a good number of the patients are not cooperative. They can tear through PPE. They wont keep on masks.
If we spend lots of money and train a bunch of people these are surmountable, but not the kind of stuff you do overnight. Just convincing mayors to increase the funding to do all of this will take a long time I predict.
Steve
Steve; if you want an idea — pay caregivers to stay on-site for 2 weeks at a time 24/7. Like the workers at a PPE plant who stayed on-site for a month. Reduces the need for constant tests and scrupulous PPE.
How about you give an idea?
Thank you steve.
So after three days of 102 temp it broke last night. I haven’t had more than 100-101 in many years. 102 is abnormal. We’ve all been there. Sweat like a mother. Muscle aches and headache subside. Strength slowly recovering. Fever is an underappreciated bitch. I have never has a pulse oximeter reading less than 99. Maybe good lungs. Didn’t take one, though.
I clearly am not spiraling down. The hack cough is subsiding. No real breathing issues. In retrospect this was a 4 day event, pending any relapse. It seems it may take awhile to regain best stamina.
And if this is corona virus, it only confirms my skepticism. I know many have different experiences. But let’s keep perspective. If corona, this was a nothingburger for me, and probably most. If you are impaired, perhaps not.