PlagueWatch 2020-23 - Coronavirus

[OldPhiKap]

So, at what point do you have to start closing other stuff because the hospitals are overflowing?

Webster Groves (MO) School District, ludicrously, is reopening for face-to-face grades 3-5 tomorrow (my kid) and grades 6-8 (my wife) on Veterans' Day. This contradicts everything they previously said about the relationship of reopening to COVID numbers in the region, which are exploding.

Can you open something as large as a middle school with 1200 kids, 50 teachers, and I'm not sure how many support staff, when emergency medical care basically becomes unavailable? Since the administration aren't willing to be adults here, my remaining hope lies with that bastard god, Liability.

You married someone in the 6th-8th grade?

(Sorry, someone was gonna say it).

I have not dealt with anything as difficult as sending my son back to school this year (11th grade) and my daughter to college in a pandemic. Best of luck, it sucks.

[wilson]

This is my second week of in-person hybrid instruction (up to 50% capacity in the building, alternating full virtual weeks, everyone with the option to remain full virtual).
I expect this to last another 3-4 weeks before we go back to full virtual sometime just before or after Thanksgiving.

[Bluedog]

Utah hospitals are so overloaded they are preparing to ration care: https://www.sltrib.com/news/2020/10/...zS5zYc-pKR49VY

It seems like hospitals/ICU beds are going to possibly be a limited factor in many locations. Correct me if I'm wrong, but it seems like ventilator availability is not as limiting anymore as the standard of care has shifted since the spring and hospitals by and large try to avoid using ventilators for COVID patients if at all possible. I remember in the spring governors were clamoring for more ventilators, but seems like that supply/demand issue is no longer in play because of the changed philosophy of using it in only very specific circumstances? I have heard figures that 60% of people that go on a ventilator with COVID, end up dying.

My school district is scheduled to re-open for only for some low income/ESL/learning disabled students in mid-November, but I imagine that will be pushed out/canceled and everybody will remain 100% remote. The high school has already said 2021 for any in person learning at the earliest. Our positivity rate has gone from about 1.5% to 2.0% in recent days while our broader region is near 6%. Interestingly, the school district to the north of me looks for sub-8% rates to have some in person whereas my district is looking for consistent sub 3% (and not just in our city, the region). Very different approaches 10 minutes apart.

[Neals384]

It seems like hospitals/ICU beds are going to possibly be a limited factor in many locations. Correct me if I'm wrong, but it seems like ventilator availability is not as limiting anymore as the standard of care has shifted since the spring and hospitals by and large try to avoid using ventilators for COVID patients if at all possible. I remember in the spring governors were clamoring for more ventilators, but seems like that supply/demand issue is no longer in play because of the changed philosophy of using it in only very specific circumstances? I have heard figures that 60% of people that go on a ventilator with COVID, end up dying.

My school district is scheduled to re-open for only for some low income/ESL/learning disabled students in mid-November, but I imagine that will be pushed out/canceled and everybody will remain 100% remote. The high school has already said 2021 for any in person learning at the earliest. Our positivity rate has gone from about 1.5% to 2.0% in recent days while our broader region is near 6%. Interestingly, the school district to the north of me looks for sub-8% rates to have some in person whereas my district is looking for consistent sub 3% (and not just in our city, the region). Very different approaches 10 minutes apart.

I still haven't heard whether hospitals, when they use ventilators, are using revised ventilator settings. In the meantime, Mrs. Neals has an addendum to my health care PoA, stating simply, "do not ventilate."

[MChambers]

It seems like hospitals/ICU beds are going to possibly be a limited factor in many locations. Correct me if I'm wrong, but it seems like ventilator availability is not as limiting anymore as the standard of care has shifted since the spring and hospitals by and large try to avoid using ventilators for COVID patients if at all possible. I remember in the spring governors were clamoring for more ventilators, but seems like that supply/demand issue is no longer in play because of the changed philosophy of using it in only very specific circumstances? I have heard figures that 60% of people that go on a ventilator with COVID, end up dying.

My school district is scheduled to re-open for only for some low income/ESL/learning disabled students in mid-November, but I imagine that will be pushed out/canceled and everybody will remain 100% remote. The high school has already said 2021 for any in person learning at the earliest. Our positivity rate has gone from about 1.5% to 2.0% in recent days while our broader region is near 6%. Interestingly, the school district to the north of me looks for sub-8% rates to have some in person whereas my district is looking for consistent sub 3% (and not just in our city, the region). Very different approaches 10 minutes apart.

I agree. I also think staffing is a limiting factor, with the outbreak being so widespread. Also, health care providers have been hit really hard by this pandemic, both in terms of catching Covid-19 and in terms of mental fatigue.

[mph]

Thanks, mph and many others who expressed concern about my mother. I'm beyond thrilled and thankful that even as of today, 5 days later, she remains symptom free. I continue to pray for her, and the heroes taking care of her. Realizing how very fortunate I am to have had a mom who has lived thru 41% of our country's history. As I believe Sage wisely said, I am truly blessed.

Great News, GWD! Keep us updated.

[sagegrouse]

Above, I summarized the soaring number of new cases of COVID-19 in France, Spain and Italy compared with March (1.8 to 3.5 times) and similar data for the U.S. Given that cases are surging in Europe and the US, there may be a lag in new deaths resulting.

New deaths, seven-day average:

USA: 825 now, 2,208 peak in April

France: 199 now, 972 in the spring

Spain: 148 now, 866 earlier

Italy: 123 now, 809 earlier

Trends worth watching, I believe. Clearly, many cases in the spring were unidentified. I also believe that treatment is better, especially now compared with a time when facilities were overwhelmed and residences for senior unprotected.

[Bluedog]

Above, I summarized the soaring number of new cases of COVID-19 in France, Spain and Italy compared with March (1.8 to 3.5 times) and similar data for the U.S. Given that cases are surging in Europe and the US, there may be a lag in new deaths resulting.

New deaths, seven-day average:

USA: 825 now, 2,208 peak in April

France: 199 now, 972 in the spring

Spain: 148 now, 866 earlier

Italy: 123 now, 809 earlier

Trends worth watching, I believe. Clearly, many cases in the spring were unidentified. I also believe that treatment is better, especially now compared with a time when facilities were overwhelmed and residences for senior unprotected.

Any additional push to test/release the polyclonal antibody cocktail treatment that Trump got to the masses? I assume so, but probably slow going...I can't find anything about it since then.

[rsvman]

Any additional push to test/release the polyclonal antibody cocktail treatment that Trump got to the masses? I assume so, but probably slow going...I can't find anything about it since then.

I haven't seen a lot of push on this front. I saw recently a study that suggested that convalescent plasma might not have worked as well as expected, but the study wasn't very rigorous.

[wavedukefan70s]

This is my second week of in-person hybrid instruction (up to 50% capacity in the building, alternating full virtual weeks, everyone with the option to remain full virtual).
I expect this to last another 3-4 weeks before we go back to full virtual sometime just before or after Thanksgiving.

I expect that about mid December in my area.i don't think a full lockdown is the answer .but i believe people have become lackadaisical on social distancing handwashing ect.
This aint the time to let up.

[DukieInKansas]

Thanks, mph and many others who expressed concern about my mother. I'm beyond thrilled and thankful that even as of today, 5 days later, she remains symptom free. I continue to pray for her, and the heroes taking care of her. Realizing how very fortunate I am to have had a mom who has lived thru 41% of our country's history. As I believe Sage wisely said, I am truly blessed.

This is great news. I will continue to pray for her and her caregivers and all her family. Enjoy every moment you have with her.

[Dr. Rosenrosen]

Did anyone else hear that the pandemic is over??? White House Science Policy Office published a press release today noting the ending of the COVID-19 pandemic as one of the top accomplishments of Trump’s first term. What amazing news for our country!

https://thehill.com/policy/healthcar...mic-as-us-hits

[YmoBeThere]

Up 19% in case counts compared to last Tuesday. We are rounding the turn and heading for home it appears.

[kexman]

So, at what point do you have to start closing other stuff because the hospitals are overflowing?

Webster Groves (MO) School District, ludicrously, is reopening for face-to-face grades 3-5 tomorrow (my kid) and grades 6-8 (my wife) on Veterans' Day. This contradicts everything they previously said about the relationship of reopening to COVID numbers in the region, which are exploding.

Can you open something as large as a middle school with 1200 kids, 50 teachers, and I'm not sure how many support staff, when emergency medical care basically becomes unavailable? Since the administration aren't willing to be adults here, my remaining hope lies with that bastard god, Liability.

This same school district put out a video from a Wash U. infectious disease doctor basically saying that schools are completely safe as long as they take mitigation strategies like wearing masks. He basically said that community case numbers do not matter since mitigation strategies work so well. Any thoughts by our infectious disease experts. I will say schools do not seem to be the disaster I expected them to be, but he seemed very confident in the safety of our schools. If there was such overwhelming evidence for the safety of our schools (lack of transmission in school) I would think that more schools would be returning around the country. Thoughts from our experts.

[mpj96]

If there was such overwhelming evidence for the safety of our schools (lack of transmission in school) I would think that more schools would be returning around the country. Thoughts from our experts.

Not an expert. Just another parent so take the below for whatever it is worth.

Schools have a strong proclivity to shut down to avoid risk, however slight. Where I live we have had many a "snow day" without precipitation of any kind. Famously adopted by doctors, the culture of public education in many cases can well be described as "first do no harm". It makes sense. Both are fiduciary cultures.


Add that cultural proclivity to the fact that there could not possibly be overwhelming evidence as to safety of in person schooling so early in the game. Inevitably many schools will choose to remain virtual whether or not harm is likely to occur. The weight of potential harm balanced against a host of unknown virus variables militates strongly for a virtual approach.

All that said, it seems so far that the great preponderance of schools (not colleges) have been ok. From what I have read, heard & observed the kids attending school are doing better in school and much happier about life in general. There are real harms that result from a lack of in person schooling. As more and more people experience virtual schooling those harms become easier to recognize.

For parents with the option to return their kids to school this "which does least harm" choice is difficult because there is real risk of harm no matter which decision you make. No great choices. Do you choose the one with the best possible upside (return to school) or the one with the least bad potential downside (stay home).

We chose to let our daughter return to school in early October after keeping her out for the months prior. Our son doesn't have that option as his school is 100% virtual until at least next semester.

In the meantime we monitor the situation and have told our daughter that we could have to pull her back if the situation changes for the worse. The numbers are ticking up so gather your rosebuds while ye may.

[MChambers]

This same school district put out a video from a Wash U. infectious disease doctor basically saying that schools are completely safe as long as they take mitigation strategies like wearing masks. He basically said that community case numbers do not matter since mitigation strategies work so well. Any thoughts by our infectious disease experts. I will say schools do not seem to be the disaster I expected them to be, but he seemed very confident in the safety of our schools. If there was such overwhelming evidence for the safety of our schools (lack of transmission in school) I would think that more schools would be returning around the country. Thoughts from our experts.

This study, published in the Lancet, found a 24% increase in R 28 days after reopening schools. https://www.thelancet.com/journals/l...785-4/fulltext

"An increasing trend over time in the R ratio was found following the relaxation of school closure, bans on public events, bans on public gatherings of more than ten people, requirements to stay at home, and internal movement limits; the increase in R ranged from 11% to 25% on day 28 following the relaxation compared with the last day before relaxation, although the increase was significant only for school reopening (R ratio 1·24, 95% CI 1·00–1·52) and lifting bans on public gatherings of more than ten people (1·25, 1·03–1·51); for all other NPIs, the lower bound of the 95% CI was below 1."

I think that reopening schools is a tough question. I see both sides of the debate. (I don't have any school age kids, so haven't followed the issue as closely as some of you.)
It would be an easier question if we closed bars and restaurants and required universal mask wearing.

[budwom]

Saw several articles noting that despite The Covid running rampant in Europe, deaths are not rising as quickly because older people have the sense to stay home, the infected at generally much younger and healthier (for now, anyway).

[dukebluesincebirth]

Not an expert. Just another parent so take the below for whatever it is worth.

Schools have a strong proclivity to shut down to avoid risk, however slight. Where I live we have had many a "snow day" without precipitation of any kind. Famously adopted by doctors, the culture of public education in many cases can well be described as "first do no harm". It makes sense. Both are fiduciary cultures.


Add that cultural proclivity to the fact that there could not possibly be overwhelming evidence as to safety of in person schooling so early in the game. Inevitably many schools will choose to remain virtual whether or not harm is likely to occur. The weight of potential harm balanced against a host of unknown virus variables militates strongly for a virtual approach.

All that said, it seems so far that the great preponderance of schools (not colleges) have been ok. From what I have read, heard & observed the kids attending school are doing better in school and much happier about life in general. There are real harms that result from a lack of in person schooling. As more and more people experience virtual schooling those harms become easier to recognize.

For parents with the option to return their kids to school this "which does least harm" choice is difficult because there is real risk of harm no matter which decision you make. No great choices. Do you choose the one with the best possible upside (return to school) or the one with the least bad potential downside (stay home).

We chose to let our daughter return to school in early October after keeping her out for the months prior. Our son doesn't have that option as his school is 100% virtual until at least next semester.

In the meantime we monitor the situation and have told our daughter that we could have to pull her back if the situation changes for the worse. The numbers are ticking up so gather your rosebuds while ye may.

Well said. Not an expert either, but I work in elementary and middle schools (very small populations). Our county has been fairly aggressive in reopening (a conservative county politically), and most teachers and administrators were skeptical. We all said "once this county reports 1 positive case, they'll shut the whole thing down again!" Well, there have been at least a few cases in almost every school in our district (teachers and students), and we continue to go on. The problem for us has not been huge outbreaks/clusters, it's been the logistics of keeping the ship sailing when numerous staff/students are out due to quarantine from exposures. Substitutes are hard to find, and anyone who's been to public school knows having a sub teacher is WAY different than the regular teacher being in class. The hybrid schedule has also been a nightmare for teachers, trying to juggle too many moving parts to stay sane. The other important part to note about school reopenings is the difference in ages of students at the schools. I was very nervous at first, but after the Yale study came out and after a few months of opening, I do think the transmission is less at the elementary school age level. In the larger schools/cities, I think the main risk in elementary schools is adult to adult transmission, particularly if adults don't follow precautions consistently. As far as middle/high schools, I still fear student transmission is a real risk. This is where we are now, but as mpj96 said, cases are spiking and this may or may not last. Best of luck to everyone with kids, as this is a challenging new course to navigate.

[MChambers]

“North Dakota has the highest covid death rate per capita in the world right now,” said Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington, referring to deaths in the past week. At the same time, he said, data compiled from Facebook indicates that the state has the lowest mask-wearing rate in the United States, between 45 and 49 percent.

https://www.washingtonpost.com/healt...105_story.html

So discouraging.

[CDu]

Saw several articles noting that despite The Covid running rampant in Europe, deaths are not rising as quickly because older people have the sense to stay home, the infected at generally much younger and healthier (for now, anyway).

Eh, I think the most likely reason that deaths haven't spiked as high as in March/April is a combination of things:

1. We vastly underestimated the number of cases back in February/March/April. Most believe we were probably underestimating infections by a factor of 5 to 10 back when testing was not as prevalent.
2. Deaths are a lagging indicator by a few weeks, and the re-emergence of cases in Europe started about 3 weeks ago (i.e., we are still a week or two away from seeing the real spike in deaths).

So I think the story is about to start looking less rosy. It will still look better than things did in March/April, by virtue of much more extensive testing now than we had back then.

I do suspect that we're doing a better job of taking care of the elderly and other high-risk people (mainly the elderly and high-risk folks are taking more precautions). But I don't think that is the major driver for the divergence in deaths to cases we've seen so far in October in Europe.