Pandemic preparation? ?

[+ Charlie]

I stopped at a local Von's supermarket this morning to buy fresh produce--you can't stockpile lettuce, tomatoes, mushrooms or bananas--and it was the most crowded I have ever seen it on a Sunday morning, my normal time there. The checker told me that when she arrived for work at 5:30am, there was a line of people waiting to get in. They got a fresh stock of tp overnight, and it was all sold out by 7am. It is strange to walk down an aisle and see the shelves normally stocked, then turn a corner into another aisle and see them stripped bare.

[+ Charlie]

If restaurants are closed, how are people who don't have kitchens or pantries supposed to feed themselves? What about workers who can't bring food to work?

[handiacefailure]

For my small business sake....I hope carry out (drive thrus) and delivery still allowed, I’m ok closing dining rooms

 

I'm ok with closing dining rooms. Just hoping restaurants stay open and don't decide to close since they aren't making enough off carry out. I'd be fine with everything closed if people weren't hording all the groceries. Places will have to stay open for take out though. THere's a lot of people in hotel rooms without kitchens that need to eat and people on long drives will needs to eat something.

[+ WilliamM]

If restaurants are closed, how are people who don't have kitchens or pantries supposed to feed themselves? What about workers who can't bring food to work?

 

Single room occupants find ways to survive without kitchens or pantries. They often don't have enough money to frequently visit restaurants. Based on my experience with the Redevelopment Authority in Philadelphia and single room occupants, including a few students.

[handiacefailure]

If restaurants are closed, how are people who don't have kitchens or pantries supposed to feed themselves? What about workers who can't bring food to work?

 

They'll almost have to allow carry out to continue. There's also people who are driving long distances that will have to eat that will have no way to prepare food.

 

As much as I despise our governor this is a smart move on his part. One of his aids that spoke encouraged people to patronize takeout and delivery to help keep people employed and to help cut down on the congestion at grocery stores. Sucks for the places that were depending on St Pat sales but the state is allowing bars and restaurants to return unopened excess liquor and kegs purchased for st pats day for a full refund and is also waiving the one week waiting period for unemployment for food service and bar workers unemployed due to this.

 

My chase saphire credit card includes a $60 door dash credit and also waives the delivery fee on orders over $15 so I may be putting that benefit to use.

 

Figures I just received an email for a free birthday burger from Red Robin and it's for dine in only LOL. Maybe I'll go there tonight for my "final meal"

[+ Pensant]

Our governor in Ohio just ordered all restaurants closed at 9 p.m. tonight. At least carryout and delivery is still allowed and opening a lot of restaurants stay open since the grocery stores are so low on food. At least I'm only a few minutes from the Michigan border as long as they don't close their restaurants.

Gov Wolf has ordered the same for metro Philadelphia, according to relatives who live in Montgomery County

[+ stevenkesslar]

That leaves 01% (2.6 million) who will exhibit sever symptoms which is some cases will lead to death. This group consists of three subgroups 1.) people under the age of 20 with severe preexisting health problems mostly of the pulmonary variety (cystic fibrosis for example), 2.) people between the ages of 20 and 60 with severe preexisting health issues and those with severely compromised immune systems, 3.) people over 60. This is the group most at risk because of multiple preexisting health issues and weak immune systems.

 

In a word, Italy.

 

This is consistent with the CDC worst case scenario projections: 217 million Americans infected, 1.7 million Americans dead - IF NO ACTION IS TAKEN. The CDC projected that 2.4 million to 21 million people in the US could end up in the hospital, overwhelming emergency wards and ICUs. So if everyone is internalizing that number as a worst case scenario, that is a good thing.

 

Italy is already running out of capacity. I don't quite get it. They have 20,000 cases in a country with 60 million people. It's not clear why they are already at the breaking point. I have to assume this is a localized issue. There are likely large clusters of outbreaks in certain regions or towns that don't have enough hospital beds.

 

One way or the other, it gives us a picture of what a disaster it would be to allow 200+ million people to get infected. No government leader is going to sit back and let that happen. It is not happening in China, or South Korea, or Spain.

 

The bottom line math is horrific. 1 % turns out to be a big number. In Italy, which skews older, about 10 % of cases are requiring hospitalization. So if you project out 200 million cases, you have maybe 2 to 20 million hospitalizations? Nobody really knows. The horror in that math is the US has fewer than 1 million hospital beds.

 

This is easy math everyone can understand. Swine flu in the US resulted in 60 million infected, 275,000 or so hospitalized, 12,000 or so dead. The death rate was 0.02 %. With COVID-19, the best guess is a 1.0 % death rate. To be clear, COVID-19 seems to kill 50 times more infected people than the swine flu did. To even achieve that death rate, we have to be really smart about this. So that means we have to urgently lower the number and characteristics of the people infected. That is clearly what nations are urgently trying to do.

 

Every Governor in America is probably worrying about ventilators right now, as well as getting the trained medical professionals who know how to use them. The other massive problem is that if all of that happens, the 99 % who still get in car accidents, have heart attacks, or want a knee replacement are pretty much shit out of luck. It is a nightmare scenario. The death rate in Italy is more like 10 % (one report I read said 14 %). Part of that is likely because they were completely unprepared and lack the resources.

 

Government is reactive it is not proactive. This applies to totalitarian dictatorships like China as well as Western democracies such as the United States or Europe.

 

Anyone expecting that “government“ will save them from disaster is going to be a casualty.

 

As an objective fact, that's just not true.

 

China would likely be in the millions of cases right now, had they not been pro-active. That 200+ million number in the US is consistent with the idea that, absent containment, the majority of Americans could get infected. So China was on its way to lots of cases. 500 million? 750 million?

 

You can agree or disagree with what they did. But you can't argue it was not "pro-active". The word being used a lot is "draconian".

 

A WHO study of some 50,000 cases in China showed that the death rate of those infected in the first week (in January) was something like 17 %. The death rate in those infected in the last week (in February) was something like 0.7 %. On the front end "government" was sweeping it under the rug and suppressing information. By the last week they were on top of it. I read that one hospital in Wuhan - I believe one of the makeshift ones - put up a notice that from the beginning of February there had been 1700 patients treated, none of whom died.

 

So China dramatically flattened the curve, and sorted out all the capacity issues - staffing, beds, ventilators, etc. That is, in fact, what "government" does. It actually did prevent lots of people from being a "casualty". That is simply an objective fact.

 

There is overwhelming evidence that some governments were more pro-active, figured out containment strategies and capacity issues, and have dramatically reduced the spread of the virus. Others, like Spain and Italy, are taking desperate measures to flatten the curve - like fining you if you leave your home. Right now I would bet they are planning measures like what China and South Korea have proven to be effective.

 

South Korea is probably most relevant to Western democracies. They are mostly using voluntary compliance and smart coordination, as opposed to top-down and coercive mandates.

 

South Korea designates regions hit hardest by coronavirus as disaster zones

 

South Korea on Sunday reported 76 new coronavirus cases and three deaths, marking the first time in over three weeks that new cases have dropped to double-digits, as President Moon Jae-in declared the hardest hit provinces “special disaster zones”. South Korea has been experiencing a downward trend in new cases and the latest numbers are significantly lower than the peak of 909 cases reported on Feb. 29 and down from the 107 recorded on Saturday.

 

South Korea has been able to dramatically flatten the curve. That is the urgent priority in the US if we don't want a lot of seniors to die completely unnecessarily. The differences with Italy, a nation about the same size, are stark. Italy has 21,000 cases and 1441 deaths so far. South Korea has about 8100 cases and 75 deaths. If you got sick, would you rather be in Italy or South Korea?

 

Part of the reason South Korea is doing this better is they've been through these things before. So they were just much better prepared. They have more hospital beds than almost any other nation in the world. And by being aggressive about free testing and free treatment, they were able to both flatten the curve on infection rate, and provide better life-saving treatment to those who did get sick.

 

There is no question that what governments around the world are doing has resulted in highly variable outcomes. So the CDC can say that 200+ million Americans could become infected. That's like saying 200 million people could get in car accidents, if we have no speed limits or stop lights and encourage everyone to only drive drunk. China and South Korea have both proven, in very different ways, that it doesn't have to play out that way. I don't want to trash Italy. But they are a poster child for what happens when you don't get on top of it quickly, and just keep reacting as each new disaster unfolds.

 

The real question is this: can governments eradicate this virus? If not, how is it contained? When and how do we get back to normal again? South Korea is nowhere near full containment. They still have closed schools and offices, and have banned large public events. And we don't know what will happen when China gradually opens back up again. It will certainly not go right back to normal.

 

The encouraging thing to me is that China, which has cases all over the country, has not had mass outbreaks like what happened in Wuhan all over the country. Bottom line, that means that life is not normal, but it is probably more normal than what is happening in the US right now. They are figuring out ways to test, trace, isolate, and treat any new outbreak.

 

In the US, I think the good news now is that we are past debating whether this is a big fucking deal, and whether the government needs to do anything about it. Now we are into debating the details of what government can and should do. The quicker we get that sorted out, the sooner we can get a handle on this and start gradually getting back to normal. That's the clear lesson from the countries that have been hit hardest and are responding to this the smartest.

 

This LA Times article is a good overview of how free testing, which is about to roll out in the US, could save lots of lives:

 

South Korea’s rapid coronavirus testing, far ahead of the U.S., could be saving lives

Edited March 15, 2020 by stevenkesslar

[+ tassojunior]

Most bars in DC were packed full last night with long lines to get in. The restaurants were also packed. And CBP held thousands in the immigration hall at Dulles for 6 hours, mostly Americans rushing back in.

 

Ridiculous.

[MikeBiDude]

Most bars in DC were packed full last night with long lines to get in. The restaurants were also packed. And CBP held thousands in the immigration hall at Dulles for 6 hours, mostly Americans rushing back in.

 

Ridiculous.

I spoke with a regular seeking.com companion this morning, a USC student who went home to Florida. He said the bars are packed and he said “ no one knows what to do so they’re out drinking which only spreads it more” my smart boy is staying home with his family, not going out

[+ bashful]

If restaurants are closed, how are people who don't have kitchens or pantries supposed to feed themselves? What about workers who can't bring food to work?

 

Good point about workers who can‘t bring food to work. In the 80’s I worked in a couple of hotels that prohibited employees from bringing any food into the hotel. However, all employees were provided free meals prepared by the hotel. I ate better than I did at home. How they accommodated specific dietary needs, I don’t know as I didn’t work in Food and Beverage.

Edited March 15, 2020 by bashful

[+ stevenkesslar]

A great article on what is working in South Korea. This is probably a preview of what the "Western democacy model" of COVID-19 containment will look like in the US and many other countries.

 

Coronavirus in South Korea: How 'trace, test and treat' may be saving lives

 

"I think that early patient detection with accurate tests followed by isolation can lower the mortality rate and prevent the virus from spreading," said Prof Kwon. "To learn from the past and prepare systems in advance… that might be the true power to overcome this new kind of disaster."

 

There is no shortage of testing kits in South Korea. Four companies have been given approval to make them. It means the country has the capacity to test 140,000 samples a week.

 

Prof Kwon believes the accuracy of South Korea's Covid-19 test is around 98%. The ability to test so many people has made the country a role model as others look to battle their own coronavirus outbreaks.

 

But there have been missteps too.

 

At least two patients died waiting for a hospital bed in Daegu, the worst affected city. The initial reaction was to quarantine everyone infected with the virus in a hospital bed, but now the doctors have learned to treat those with mild symptoms in residential centres and leave the clinical beds for those needing critical care.

 

"We can't quarantine and treat all patients. Those who have mild symptoms should stay home and get treated," Dr Kim Yeon-Jae, an infectious disease specialist from the Korea National Medical Centre told me.

 

"We should change our end goal strategy to lower death rates. So other countries like Italy, that see huge numbers in patients, should also change their strategies as well."

 

Health officials believe this approach may be saving lives. The fatality rate for coronavirus in South Korea is 0.7%. Globally the World Health Organization has reported 3.4% - but scientists estimate that the death rate is lower because not all cases are reported.

 

The preventative measures being taken in South Korea have so far involved no lockdowns, no roadblocks and no restriction on movement.

 

Trace, test and treat is the mantra. So far this country of over 50 million people have been doing their bit to help. Schools remain closed, offices are encouraging people to work from home, large gatherings have stopped.

 

However, slowly, day by day, more people are creeping back onto the streets of the capital city, Seoul. Restaurants, buses and subways are beginning to get busy again.

 

Dealing with the threat of coronavirus is the new normal. Most people wear masks (if they can get hold of one). There are thermal imaging cameras in the entrances to major buildings.

 

Bottles of hand sanitisers have been placed in lifts. There are even people dressed in costumes at subway entrances reminding you to wash your hands.

 

This may be the new normal for South Korea and elsewhere. But health officials are still on edge and warning there is no room for complacency. One large outbreak at a church, office, exercise class or apartment block can change everything.

 

And as for Rachel Kim, she got a text the day after her test. She doesn't have coronavirus. But she's glad she got tested.

 

"Better to know", she said, "and that way I am not a danger to others."

 

 

There is mostly good news, but one piece of bad news in this, in my eyes.

 

The really good news is that in any Western country, good preparation brings rewards. We don't necessarily need a complete, martial law type lockdown, like China did. And like Spain and Italy seem to have elements of. Schools close, Disney closes, concerts are cancelled. But you can get food at a grocery store, and do the basic things you need to do.

 

On a family level, China and South Korea made opposite choices, which reflect perhaps both family systems and how government works. In China, they took sick Moms who did not need hospitals to quarantine centers to get well. You did not have a choice. It was a logical approach. They found that the main way people got infected was through other family members. And in Wuhan, they had to build makeshift hospitals, anyway. So they took extreme measure to try to stop every individual infection.

 

In South Korea, they told sick Moms that did not need hospitals to go home. It almost certainly caused more infections. If there were kids in the home, it was no big deal. If Grandpa lived with the family, that probably had to be addressed. But it left decisions like that up to individuals and families, which is obviously what would work better in the culture of the US, where many people doubt that the government can actually protect public health.

 

The death rate of 0.7 % cited above is roughly the same death rate as the last wave of patients treated in Wuhan. (As opposed to something like 17 % with the first wave in Wuhan, when they had no idea what this virus was, or how to deal with it.) So all roads lead to Rome. There is plenty of information on how good protocols can save lots of lives in very different government systems.

 

The bad news is what that article says: South Korea is hardly back to normal. At some point, we all want to go back to offices, schools, shopping malls, movie theaters.

 

If there is an advantage to what China did, it is that maybe - huge maybe - taking extreme steps can mostly eradicate the virus, and people can mostly go back to normal without having to worry about getting infected or passing along an infection they don't know they have.

 

Either way, both China and South Korea will clearly be in a mode where they immediately jump on even the smallest outbreak and "trace, test, and treat."

Edited March 16, 2020 by stevenkesslar

[handiacefailure]

I spoke with a regular seeking.com companion this morning, a USC student who went home to Florida. He said the bars are packed and he said “ no one knows what to do so they’re out drinking which only spreads it more” my smart boy is staying home with his family, not going out

 

That's what I find so funny about U of M cancelling classes the rest of the semester. A lot of the students are staying in ann arbor and don't have to go to class because of a fear of spreading it but have no issues going to a crowded bar which will spread it a lot faster.

 

I decided to go to Red Robin tonight to use my free birthday burger coupon before they had to close at 9 and sat at the bar. My bartender told me her brother is a musician who gives lessons and supplments his income by being in a local band and driving for uber. Outside of doing Uber (and she said with the bars closed he'll have practically no rides) he is going to be without income for a while since his band plays at bars and none of his positions offer unemployment insurance:(

[Toddbb]

Bathhouses need to close or at the very least not admit anyone over 60 (hold off on the jokes). It's just too dangerous for older people.

[rvwnsd]

I have been to 4 different grocery store chains over the last few days. Not to stockpile anything but to get stuff to cook for dinner.

 

The things vanishing off the shelves (in no particular order)... lunch meat, certain fresh vegetables (why the hell people are buying up all the onions is anyone's guess lol!), certain cleaning products, fresh meat & seafood, water, bread, certain bagged snacks (i.e. potato chips) and of course tp.

 

It's like walking into a Communist grocery store as depicted in an 80s movie.

 

I don't mean to make light of the overall situation, but the panic buying is ridiculous.

In Central Phoenix, Safeway and AJs had no broccoli, onions, or bananas. Why people are stocking up on bananas, which go bad quickly, is beyond me.

 

On the other hand, if you like zucchini, broccolini, green beans, cabbage, kale, or sprouts you are in luck - plenty to go around. Likewise apples, raspberries, citrus, and potatoes. Apples last a long time, so not sure why folks aren't stocking up on THAT.

 

AJ's has very good sushi and it is usually sold out by 4:00 on Sunday. Not today! Plenty of sushi. They are having their semi-annual (maybe quarterly) 50% off prime steaks sale. All were gone. Butcher said that's typical of a sale, so apparently no one is hoarding $10/pound steaks.

 

People have lost their damned minds. Not their minds, but their damned minds.

[handiacefailure]

I was able to find bananas this afternoon at a gas station of all places. I went into the Circle K by my condo this afternoon to grab a soda and they some fresh fruit and had bananas three for $1. I bought three since I'm a diabetic and like to eat one before exercising so my blood sugar doesn't plummet (hopefully my gym will stay open). Not sure why people are hording those since you are lucky to get a weeks shelf life from them,

[rvwnsd]

I was able to find bananas this afternoon ...Not sure why people are hording those since you are lucky to get a weeks shelf life from them,

Because they have lost their damned minds!

[thickornotatall]

We live near one of the largest Publix Markets....Fully stocked except for toilet and paper towels. I don't get what sort of shitstorm is coming.

Anyway the store was packed..no such thing as staying 6 feet apart. I didn't go In to shop. I texted our list to Shipt and they delivered our order. We will stay close to home...not mix in crowds...no movies/restraurants or bars. . We want to cooperate and get this over.

BIG PROBLEM...Our lack of a clear message from the Feds have made a bad situation worse. We are afraid that the panic will keep the virus live for an extended period of time.

An opportunity to head this off was squandered by an incompetent POTUS....He needs to resign ASAP!

[mike carey]

[MEDIA=twitter]1239383989074317312[/MEDIA]

[+ FreshFluff]

Glad I was not trying to get some rest in that neighborhood

 

It didn’t work so well in Germany.

[MEDIA=twitter]1238934746043990016[/MEDIA]

[mike carey]

Interesting panel discussion about the pandemic and what to do, all the usual issues of which medical advice to take, move quickly or be slower and more methodical. One panelist, a medical professor, although not an infectious disease specialist, made an interesting point on social distancing. He said that those that can isolate themselves to some extent, be that because they have the resources to do so, or their job can be done at home should do so, not for their personal health but because reducing the number of people out in the community makes it more unlikely that those who have to be there will contract the virus. I think he makes a good point. He was practising what he was preaching, he had returned from the US last week, before the cutoff for mandatory isolation, but had nevertheless isolated himself and was appearing on the program by Skype.

 

While I'm here, today's Coronacast https://www.abc.net.au/radio/programs/coronacast/think-coronavirus-only-kills-the-old-think-again/12058160

 

And, edited to add the short info video from the ABC's 7.30 program.

[MEDIA=twitter]1239487451166461952[/MEDIA]

Edited March 16, 2020 by mike carey

[+ stevenkesslar]

He said that those that can isolate themselves to some extent ... should do so, not for their personal health but because reducing the number of people out in the community makes it more unlikely that those who have to be there will contract the virus.

 

Sanjay Gupta said something on CNN tonight that sounds like it is in the same ballpark. He said that after we achieve a 1 % infection rate, the effectiveness of social distancing starts to break down. He didn't explain how we know that, or why it would break down after 1 %.

 

It does make sense to me for the same reason as the guy you quoted. Eventually, it seems like you would get to the point where there are just too many infected people to contain it. Particularly if we do it the way South Korea does: trace, test, treat. In US terms, not even a vast government bureaucracy would be able to trace all the daily contacts of 3 million infected Americans. If it does get to that point, probably the only options are everybody gets sick, or we go into the kind of extreme quarantine and isolation that was effective in Wuhan.

 

My growing impression is that our best hope is to lock down as much as we can now, test like crazy, flatten the curve, and then try to go after any infected cluster wherever it pops up. China, South Korea, and Singapore all seem to proving that some version of that can work.

 

If you want to read a really sobering horror story scenario, read these two articles:

 

Can herd immunity really protect us from coronavirus?

 

Can You Get Coronavirus Twice? How Long Are You Immune After COVID-19?

 

In that Coronacast you posted, there was a mention of the population gradually developing immunity to COVID-19, absent a vaccine. It's not the first time I've heard someone say that. The concept didn't make sense to me, until I read that first article. Now it makes sense to me. But as the article concludes, it only makes sense as a sort of nightmare scenario no sane nation would inflict on itself. Which is, I assume, why leaders all over the world who are smart are moving to lock down.

 

The herd immunity concept, illustrated in that article in a nice graphic, is that a minimum of 70 % of us have to become infected and recover for herd immunity math to kick in. I'm guessing this might explain what Merkel was talking about when she used similar numbers. Presumably, if the vast majority of the population can't be infected any longer, even those without immunity are safe because the virus can't get enough hosts.

 

The problem with this, as the article points out, is that for the virus to pass through the population so that 70 % recover it means 20 % or so have to get seriously sick. And 1 % or so have to die. The article gives numbers for the UK. So in US terms that's 60 million or so seriously sick people, and 3 million or so dead ones. In theory, that could "work" as long as you find a way to delay the spread so that you at least try to space out the hospital crisis.

 

There's also an idea that you could protect the most vulnerable somehow while all this is happening. Yeah, okay. How? You can't tell seniors to just stay in their homes for a year while everybody else gets sick and recovers.

 

Ultimately, the article concludes that what China did is a more humane approach, even if it sounds draconian.

 

The further complication is that no one knows for sure whether you can get re-infected after you get sick and recover.

 

And for those of you that want yet more masochism, here's an article in The Lancet that only focuses on a small group of in-patients that were seriously ill. Of that group of 181 patients, 53 ended up dying. Again, these were not all people infected. These were severely ill patients in two hospitals in Wuhan in the first month of the outbreak.

 

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

 

The good news is that even if you are one of the unfortunate ones to get severely ill, you still have pretty good odds of recovering. The bad news is that if you die, it ends up taking about three weeks from when you fall ill. And the cause ends up being sepsis, after your organs gradually shut down. If any of you ever knew the escort Bill, one of my best friends, I actually watched him die this way. It is not a pretty thing. I can only imagine what all these patients in Italy and the medical professionals serving them are going through.

[EZEtoGRU]

Bars and restaurants in Michigan ordered closed today starting at 3:00pm. Not yet clear if take-out and delivery will continue (I expect they will).

[+ bashful]

In Illinois, bars and dining rooms close at end of business today. Drive through, pickup, and delivery still available.

[MikeBiDude]

City of Los Angeles limiting food and beverage. For now take out, is still ok. Dining rooms closed. This is good for those I consult with...we hope CA governor goes with similar.

[+ Charlie]

Palm Springs City Manager has used emergency authority to close all bars. Restaurants can stay open, but seated patrons have to be distanced. Group gatherings of more than ten people are discouraged. Governor has asked all Californians over 65 to isolate themselves at home, except for necessary trips to grocery store, pharmacy, or medical appointments; sex with young men seriously frowned upon (OK, that's my interpretation).