What's the end game here? - Printable Version
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RE: A roadmap to reopening - teejers1 - 04-07-2020
(04-07-2020, 10:23 AM)burger Wrote: I'd want to see at least a month or two of sustained declines in cases before we even start to open things up. This article: https://fivethirtyeight.com/features/coronavirus-case-counts-are-meaningless/ makes a good case that the peak in the number of positive tests is a poor indicator of the timing of the peak of infections. So, to be safe, lets wait a few extra weeks or even an extra month before opening things up again. A few extra weeks of lockdown will be less costly, financially and socially, than having to shut everything again.
You've already noted a lack of taxpayer $$ to fund anything. The longer the lock-down the greater the depletion.
It's a balancing, for sure, but the governor also needs to think about having something to save at the end of the day.
I guess the other way to look at it is if there is nothing to safe when you begin lifting restrictions on Day X; what incremental harm is there in waiting Day X +30?
RE: What's the end game here? - chrisk - 04-07-2020
Massachusetts has hired 1000 people to contact trace every case.
RE: What's the end game here? - oldalum - 04-07-2020
When restrictions are being lifted, one helpful factor is that many people (like me) will continue to be very careful not to contract the infection, and will continue doing many things to limit that risk. For example, I will go to the extent possible only to businesses that take steps to limit the risk of infection while customers are on premise, and if many others do the same, businesses will have an incentive to provide that environment until a protective vaccine is disseminated. And more to the point of this board, I'm not going to crowded public sporting events (at least I'll be able to sit in my upper level men's basketball season seats without fear!).
RE: What's the end game here? - Snorlax94 - 04-07-2020
Yay for Mass.
What is CA (whether at the county or state level) waiting for?
RE: What's the end game here? - burger - 04-07-2020
(04-07-2020, 01:03 PM)Snorlax94 Wrote: Yay for Mass.
What is CA (whether at the county or state level) waiting for?
I just did a quick search and couldn't find any mention of contact tracing by California officials. But there are loads of news articles where experts are mentioning this, so I'm sure that officials are aware of the need for this. There just isn't time right now to be thinking ahead more than a few days or weeks, and dealing with hospital beds, ppe, etc. is the priority.
I said elsewhere I think states will start being more future-oriented in the next couple of weeks as the numbers of cases drop below crisis levels and resources can be focused on next steps.
RE: What's the end game here? - OutsiderFan - 04-07-2020
If CA can use its sheer size and economic power to secure PPE, I’m going to bet it will be in position to do the same with testing capacity.
I’m going to surmise CA is going to get to contact tracing, along with massive testing capacity. But I’m more inclined to believe CA will do thr tracing with a mobile app like South Korea. The federal government would never be trusted to implement a tracking app, but the states can contract with software companies to do this.
I want nothing more than an app that attaches Covid-19 test results to mobile phone numbers. If tests are positive, they show up on GPS map. Could be the antibody or virus test, maybe green dots for has antibody and red dots for confirmed Covid-19 cases. There are a few web apps showing cases by county, but we need cases by neighborhood to do it right.
RE: What's the end game here? - M T - 04-08-2020
(04-07-2020, 07:47 PM)OutsiderFan Wrote: I want nothing more than an app that attaches Covid-19 test results to mobile phone numbers. If tests are positive, they show up on GPS map. Could be the antibody or virus test, maybe green dots for has antibody and red dots for confirmed Covid-19 cases. There are a few web apps showing cases by county, but we need cases by neighborhood to do it right.
While that might be useful, I'd say that is short sighted.
When life gets back to normal:
Do you share vehicles (bus, train, plane, cab) with others? How does where they live matter?
Do you work with other people? Someone I work with has a 100 mile commute.
Do you attend meetings (church, local government, ...)?
Do you attend sporting events?
Do you shop in stores? I wouldn't begin to guess where the sales clerk at Best Buy lives, or the guy I passed stocking coffee at the grocery store.
I surely don't know the mobile phone numbers of even 0.1% of the people I walked or sat by at Stanford WWB games.
If I look back to say a year ago, I doubt there are but 3 neighbors within 2 blocks that I was within 6' of.
RE: What's the end game here? - Snorlax94 - 04-08-2020
Re: Hiring for Contact Tracing
I accidentally clicked on the "Jobs" page for the SCC Health Dept (actually, I thought the phrase "work with us" meant something else), and I saw **one** opening for an epidemiologist. That's more than zero. And it's still unfilled. It's 999 short of the 1,000 contact tracers MA announced (I know an epidemiologist might supervise contract tracers, but still.).
https://www.governmentjobs.com/careers/santaclara?department%5b0%5d=Public%20Health&sort=PositionTitle%7CAscending
Re: Software for after the Shelter-In-Place
I agree we should use software. I proposed an approach last week here on the Cardboard, it was shot down, which hasn't discouraged me -- I'm still trying to circulate it. My thoughts started during a conversation with a friend of mine who is a privacy compliance attorney who is as we speak reviewing proposals like the one OutsiderFan proposed.
My concerns about privacy are similar to what has been mentioned:
1) After the shelter-in-place, we need to make sure we can turn it off and delete all the data
2) We need to make sure data is anonymized and privacy is protected
3) We shouldn't trust anyone with people's private data, especially not the federal government or private companies that can make a profit by being a broker of data.
4) We shouldn't open "back doors" into privacy that can be abused later. For example, if we let companies and government start tracking people's locations with help from carriers like Verizon without users' knowledge or consent, there's no turning it off. Considering the standing warrant for the arrest of Snowden and the firing of anyone related to whistleblowing or oversight in the Trump administration, good luck on any whistleblower reporting any abuses.
RE: What's the end game here? - Goose - 04-08-2020
(04-07-2020, 01:53 PM)burger Wrote: There just isn't time right now to be thinking ahead more than a few days or weeks, and dealing with hospital beds, ppe, etc. is the priority.I fear that approach will get us in another bind. Understand when you are up to your ass in alligators... , but planning ahead is critical here. We know we don't have the trained people. Training people takes time. Starting when things have calmed down may be too late to provide the service just when we need it.
I said elsewhere I think states will start being more future-oriented in the next couple of weeks as the numbers of cases drop below crisis levels and resources can be focused on next steps.
RE: What's the end game here? - JustAnotherFan - 04-08-2020
(04-08-2020, 05:02 PM)Snorlax94 Wrote: Re: Hiring for Contact Tracing
I accidentally clicked on the "Jobs" page for the SCC Health Dept (actually, I thought the phrase "work with us" meant something else), and I saw **one** opening for an epidemiologist. That's more than zero. And it's still unfilled. It's 999 short of the 1,000 contact tracers MA announced (I know an epidemiologist might supervise contract tracers, but still.).
https://www.governmentjobs.com/careers/santaclara?department%5b0%5d=Public%20Health&sort=PositionTitle%7CAscending
Re: Software for after the Shelter-In-Place
I agree we should use software. I proposed an approach last week here on the Cardboard, it was shot down, which hasn't discouraged me -- I'm still trying to circulate it. My thoughts started during a conversation with a friend of mine who is a privacy compliance attorney who is as we speak reviewing proposals like the one OutsiderFan proposed.
My concerns about privacy are similar to what has been mentioned:
1) After the shelter-in-place, we need to make sure we can turn it off and delete all the data
2) We need to make sure data is anonymized and privacy is protected
3) We shouldn't trust anyone with people's private data, especially not the federal government or private companies that can make a profit by being a broker of data.
4) We shouldn't open "back doors" into privacy that can be abused later. For example, if we let companies and government start tracking people's locations with help from carriers like Verizon without users' knowledge or consent, there's no turning it off. Considering the standing warrant for the arrest of Snowden and the firing of anyone related to whistleblowing or oversight in the Trump administration, good luck on any whistleblower reporting any abuses.
Here's a great book that highlights how 3 and 4 have already been lost: https://www.publicaffairsbooks.com/titles/shoshana-zuboff/the-age-of-surveillance-capitalism/9781610395694/.
RE: What's the end game here? - Goose - 04-09-2020
As many of you are aware, I have been expressing concern about how ready the local area is to execute "the dance". Having not seen any signs of great hiring efforts etc. I decided to do something radical. I decided to ask. I sent a message to Scott Morrow, who is head of the San Mateo County Health Department. I really didn't expect an answer, but I figured it was worth a try. He didn't reply directly, but forwarded my message to Ms.Siraj Srinivasan, who is the deputy chief of San Mateo County Health. She replied to me at 2112, so she is putting in some long days. I was frankly surprised to get an answer. I sent her an email asking if I could share her answer with others, and she replied I could, but if it involves media, they should contact the San Mateo Health Department directly. So, any media folks on this board reading this, you are NOT free to quote it, go to the source. That said, here is her reply.
"Thank you for your interest in SM County Health’s actions to investigate contacts as part of our public health protection responsibilities that we are engaged in with the challenge of COVID-19.
We are continuing to perform contact investigations for all residents who have tested positive for COVID-19 as well as follow-up on identified exposures in San Mateo County, including ill individuals visiting the area. As the availability of testing increases, we expect to see the number of cases continue to rise. Contact investigation and follow-up is resource-intensive. We are continuing to increase staffing capacity, redirecting Health staff from other areas of responsibility that have been curtailed as we prioritize our essential functions and/or for which demand has lessened, so that new positive results can be investigated quickly even as the number of reports rise.
Regards,
srija
Srija Srinivasan
Deputy Chief
San Mateo County Health
(650) 573-2095 T"
So, as I read it, they are saying they will be ready. Hope they are right, but since this group has a good reputation, there is reason to expect they are not underestimating the challenge. She responded at 0515, so the days are even longer.
RE: What's the end game here? - BostonCard - 04-09-2020
Thanks for contacting the SMCHD and for sharing with us.
The devil will be in the execution, but at least they are trying.
BC
RE: What's the end game here? - DenverCard - 04-21-2020
A transcript of an interview with Michael Osterholm, infectious disease specialist at Minnesota, reminded my of this recent dormant thread.
Whereas there have been recent studies that suggest the IFR may be in the 0.2% range, those studies have questionable methodology. Today the NIH put forth treatment guidelines that, at least as of now, do not recommend any medications for the Covid infection.
https://www.cnn.com/2020/04/21/health/nih-covid-19-treatment-guidelines/index.html
It is probable that a vaccine is 12-18 months away at best.
Set against recent discussions here in which there are predictions that the total number of U.S. fatalities from the virus will be below 100,000, Dr. Olsterholm stated the following:
"There are 320 million people in the United States. If half of them get infected in the next 6 to 18 months, that's 160 million people. The 50% rate of infection over the course of the pandemic is at the low end of my colleagues' consensus on what we can expect to see given the infectiousness of this virus. Based on what we know from Asia, from the European Union and from the United States, about 80% of these cases will have asymptomatic, mild or moderate illness but won't need professional medical care. About 20% of infected people will seek medical care. That's 32 million people. Of those, about half will be hospitalized. That's 16 million people. Of those who are hospitalized, about half will actually require some form of critical care. That's 8 million people. About 0.5 to 1% of the total number of 160 million infected people will die. So you have the possibility of at least 800,000 deaths in the US over the next 18 months. This is the number of deaths I'm expecting."
Why is he wrong?
The entire interview is here:
https://www.cnn.com/2020/04/21/opinions/bergen-osterholm-interview-two-opinion/index.html
RE: What's the end game here? - magnus - 04-21-2020
(04-21-2020, 09:53 PM)DenverCard Wrote: "There are 320 million people in the United States. If half of them get infected in the next 6 to 18 months, that's 160 million people. The 50% rate of infection over the course of the pandemic is at the low end of my colleagues' consensus on what we can expect to see given the infectiousness of this virus. Based on what we know from Asia, from the European Union and from the United States, about 80% of these cases will have asymptomatic, mild or moderate illness but won't need professional medical care. About 20% of infected people will seek medical care. That's 32 million people. Of those, about half will be hospitalized. That's 16 million people. Of those who are hospitalized, about half will actually require some form of critical care. That's 8 million people. About 0.5 to 1% of the total number of 160 million infected people will die. So you have the possibility of at least 800,000 deaths in the US over the next 18 months. This is the number of deaths I'm expecting."
Why is he wrong?
Why did he ramble on about how many people would end up in the ICU...and then use none of those numbers except what he originally started with to calculate 800K deaths? Or is he trying to point out two facts. ICU _and_ deaths? OK, that would make more sense.
Still, the reason he's wrong...the 80% number doesn't include (in the denominator) all the asymptomatic cases that are popping up in these more extensive testing environments. The 80% is based on the tested confirmed cases. But in most places, the tested confirmed cases is no where near a proper sample of the population. Many experts believe the actual number of cases is 10x-20x more.
If that's true, then you have 10x more cases, which reduces your medical help cases from 20% to 2%. And if only 1/4 of your medical help cases go into the ICU, then that 2% reduces to 0.5%. And if you started with 160M, you're now at 800K who will need critical care.
As for deaths...sure, 800k-1.6M is the projected outcome...if _no_ intervention. No social distancing, no group avoidance, no shelter at home. With all that changed social behavior, that 800K-1.6M drops. How much it drops? Who knows for sure, but it does appear that it will reduce by at least 10x.
RE: What's the end game here? - Snorlax94 - 04-21-2020
(04-21-2020, 10:35 PM)magnus Wrote:The multiplier — 10x maybe even 50x — may hold for younger people, driving down hospitalizations and casualties to very, very low levels, but I fear, based on what we’ve seen on cruise ships, senior centers, and in the age-based cfrs from korea, that the multiplier will not hold for the elderly, and we will see an ifr of 5-10%+ with medical care, and even higher rates if things collapse.(04-21-2020, 09:53 PM)DenverCard Wrote: "There are 320 million people in the United States. If half of them get infected in the next 6 to 18 months, that's 160 million people. The 50% rate of infection over the course of the pandemic is at the low end of my colleagues' consensus on what we can expect to see given the infectiousness of this virus. Based on what we know from Asia, from the European Union and from the United States, about 80% of these cases will have asymptomatic, mild or moderate illness but won't need professional medical care. About 20% of infected people will seek medical care. That's 32 million people. Of those, about half will be hospitalized. That's 16 million people. Of those who are hospitalized, about half will actually require some form of critical care. That's 8 million people. About 0.5 to 1% of the total number of 160 million infected people will die. So you have the possibility of at least 800,000 deaths in the US over the next 18 months. This is the number of deaths I'm expecting."
Why is he wrong?
Why did he ramble on about how many people would end up in the ICU...and then use none of those numbers except what he originally started with to calculate 800K deaths? Or is he trying to point out two facts. ICU _and_ deaths? OK, that would make more sense.
Still, the reason he's wrong...the 80% number doesn't include (in the denominator) all the asymptomatic cases that are popping up in these more extensive testing environments. The 80% is based on the tested confirmed cases. But in most places, the tested confirmed cases is no where near a proper sample of the population. Many experts believe the actual number of cases is 10x-20x more.
If that's true, then you have 10x more cases, which reduces your medical help cases from 20% to 2%. And if only 1/4 of your medical help cases go into the ICU, then that 2% reduces to 0.5%. And if you started with 160M, you're now at 800K who will need critical care.
As for deaths...sure, 800k-1.6M is the projected outcome...if _no_ intervention. No social distancing, no group avoidance, no shelter at home. With all that changed social behavior, that 800K-1.6M drops. How much it drops? Who knows for sure, but it does appear that it will reduce by at least 10x.
RE: What's the end game here? - Leftcoast - 04-21-2020
I'll confidently take the under on that.
I don't see how you get to 800K based upon what we've seen so far. Specifically there is no adjustment for societal changes (Social distancing, masks, other behavior changes), medical treatment improvements (over time treatments will emerge), improved government policy (including test/contact trace, etc) or improvement in infection R or IFR statistics (I'm still hoping for a seasonal slowdown). There's no reason to believe we must follow the 1918 patterns.
Often it seems establishment spokesmen are overly inclined to take the most pessimistic outlook to guide public behavior. Perhaps they fear giving the public a brighter forward picture will reduce our fervor for the shutdowns which would be short-sighted. The reality is that for whatever reason both new cases and deaths are leveling off in both the US and Worldwide. I want to see greater testing capability and our death rate in California significantly falling before Phase 1 but see no reason in denying the improvements that are obvious.
Finally, I know this could change and infection trends could pick up again but .... 800K? I'd like to hear the argument for how we get there from here (44K and death rate dropping).
RE: What's the end game here? - BostonCard - 04-22-2020
(04-21-2020, 11:01 PM)Leftcoast Wrote: Finally, I know this could change and infection trends could pick up again but .... 800K? I'd like to hear the argument for how we get there from here (44K and death rate dropping).
I don't see any evidence that the daily date of death has started to come down. There were 2800 deaths yesterday, which is the most deaths in a single day in the US. There does seem to be some stabilization in terms of the number of deaths per day in April, with numbers ranging from 1500 to 2800 the entire month, with a lot of noise. At the very least you can say it is no longer increasing exponentially.
I agree that 800k looks unlikely, but you could see a situation where we we stabilize the death rate but can't bring it down and continue seeing about 2000 deaths a day for the next year. My admittedly wishful thinking is that having stabilized the death rate will slowly come down over the next two months down into the hundreds. That gets you to 100,000 cases in the acute phase, and maybe another 50 to 100K over the next year.
BC
RE: What's the end game here? - magnus - 04-22-2020
(04-21-2020, 11:01 PM)Leftcoast Wrote: Finally, I know this could change and infection trends could pick up again but .... 800K? I'd like to hear the argument for how we get there from here (44K and death rate dropping).
The quote by DenverCard leaves out a little context. Michael Osterholm was answering the question:
Quote:if I were at the local café, how could I explain what's going on to a group of people sitting at that table? I'd say to them, let's just take the following simple numbers.
So I took the answer to address...if at the beginning of this outbreak, how would you get people to understand what's going on, what would you tell them. In that light, there's no need to mention social distancing or any other mitigating factors as you want them to understand the probably worst case scenario.