PlagueWatch 2020-23 - Coronavirus

[Bluedog]

As you may have heard, Sweden is proceeding without major shut-downs and shelter-in-place rules, unlike most other countries, including the other Nordic countries.

Sweden is paying a price. Here are the stats for the four neighboring Nordic countries

Sweden (pop. 10.1 M)
Cases per M: 1,463
Deaths per M: 156

Denmark (pop. 5.8 M)
Cases per M: 1,297
Deaths per M: 63

Norway (Pop. 5.4 M)
Cases per M: 1,314
Deaths per M: 32

Finland (Pop. 5.5 M)
Cases per M: 698
Deaths per M: 18

Sweden is experiencing about 100 more deaths per million than its neighboring countries, who have imposed restrictions on travel and business. That's about 1,000 more deaths, given its population of 10.1 million.

Yes, I find this interesting, particulary because I have a vacation planned in late August visiting family in Denmark and then proceeding onto Sweden. We'll see...

Having said all that, the Sweden numbers of death per M aren't all that different than the USA, where the majority of the country has locked down (currently at 125 but certain to go up). I read that the vast majority of the cases in Sweden are in the dense urban centers (i.e. Stockholm basicallly) and that the government has essentially said they trust people to take their own precautions. I will say that in general Scandanavia is much more of a "rule following" bunch than the US, but certainly if restaurants, cafes and the like are still open, there is more opportunity for spread. Will be interesting to continue to monitor the differences.

Denmark and a lot of Scandanvia is getting ready to open though, earlier than the rest of Europe. Denmark has announced all schools with children up to age 11 are re-opened, including daycare centers whereas a large number of the US school system has been shut down through the remainder of the academic year.

[PackMan97]

Singapore says "not so fast"

https://www.nytimes.com/2020/04/20/w...singapore.html

Thanks for the link. I hadn't bothered to check world events as much as I normally do once this thing go local. It's important to learn from other countries.

[budwom]

Thanks for the link. I hadn't bothered to check world events as much as I normally do once this thing go local. It's important to learn from other countries.

and bye bye warm weather theory as well...

[BD80]

We've basically had 40,000 deaths in a little more than a month, and that's with extreme societal measures. I guarantee you if that happened with autos, there would be some changes.

The auto analogy isn't perfect but it is apt. There is no perfect analogy.

Automobile restrictions are sparingly and precisely imposed, promulgated by agencies after substantial review of mounds of data (antiquated term) and subject to review and approval of THREE branches of government. Generally, driving is a risk we take to go about the lives we consider normal. People WILL die everyday in traffic accidents. More will die this year in traffic accidents than because of Covid (even with traffic deaths plummeting over the last month).

In framing these "emergency" restrictions, and striking a proper balance, where do the governors draw their data and assumptions in imposing executive orders? Since there is no legislative or judicial review, they should cite the bases for their actions. This pertains to the federal recommendations as well. I am not optimistic. This lack of transparency and forthcomingness breeds suspicion. Even the highly educated and thoroughly experienced members of this forum can't answer basic questions about morbidity, fatalities, or infectiousness based upon available data.

[PackMan97]

The auto analogy isn't perfect but it is apt. There is no perfect analogy.

Automobile restrictions are sparingly and precisely imposed, promulgated by agencies after substantial review of mounds of data (antiquated term) and subject to review and approval of THREE branches of government. Generally, driving is a risk we take to go about the lives we consider normal. People WILL die everyday in traffic accidents. More will die this year in traffic accidents than because of Covid (even with traffic deaths plummeting over the last month).

That's a No.

2019 Auto deaths: 38,800
US Covid-19 deaths: 41,356

It's worth noting that regulations regarding automobiles have had over a century to develop and get put in place. We've basically had two months to sort out this pandemic response.

[JasonEvans]

We've all heard about these large, national chains being first in line to get what were supposed to be small business loans (often by using creative bookkeeping to make themselves look smaller than they are) while the actual small, community businesses have been left with nothing, right? I mean, Ruth Chris even found a way around the $10 mil per business limit by applying as two separate entities so it could get what amounts to a $20 mil gift from the government.

Well, today the CEO of Shake Shack gave back the $10 mil SBA loan given to his company. This man is a real hero!

Shake Shack CEO Randy Garutti and chairman Danny Meyer revealed their decision to give back the funding in an open letter Monday, saying that the NYSE-listed company no longer needs the money because they are "fortunate to now have access to capital that others do not." The company said in a filing Friday that it expects to be able to raise up to $75 million from investors by selling shares.

Garutti further explained to CNN's Poppy Harlow that the program was a "great opportunity" for restaurants to receive funding, but the company changed its mind and returned the loan after hearing small business owners' stories about not getting access to it.

"That doesn't seem right to us," he said on CNN Newsroom. "As we watched this opportunity play out over the weeks, it was very clear that the program was underfunded and wasn't set up for everyone to win."

I don't know about the rest of you, but I plan to become a very frequent Shake Shack diner as soon as I am let out of the damn house, that's for sure!

[JasonEvans]

Would you, in this environment of COVID-19 at it's peak:
1) Go to a gym?
2) Go out to eat?
3) Go see a movie?
4) Go to a department store and try on some clothes?
5) Go to a furniture store and test set in a few dozen couches?
6) Send your kids to school?
7) Go on a cruise?
8) Invite your in-laws to town to stay at a hotel (ok, maybe some of you world)?
9) Go to the hospital or medical provider for an elective procedure?

The answer to all of this is NO, you wouldn't not. The end result is pretty much the same with or without a stay-at-home order. The only difference is whether we end up with a manageable case load or we end up with a completely overwhelmed medical system.

Well, some people might not think the disease was all that bad and go out anyway. I mean, just because science says it is real, doesn't mean it actually is real.

Open my neighborhood bar! Don't tread on me! My constitutional right to get a beer is essential!

(((**image that made this seem sorta funny removed because it could be seen as political, sorry**)))

[CDu]

Even the highly educated and thoroughly experienced members of this forum can't answer basic questions about morbidity, fatalities, or infectiousness based upon available data.

Sure we can. We can't give you EXACT numbers. But we can give you relative numbers. And we can use the evidence that does exist - that this thing overwhelms the healthcare system if unchecked in ways that other respiratory viruses have no done in at least a half-century. Whether this thing has a fatality rate of 0.3% or 3% matters not as much as the fact that the disease spreads fast, we have no natural immunity it, and it kills people much more than the flu. We have seen 40,000+ US deaths in less than 1 month, and that's WITH extreme restrictions for over 3 weeks. The average death toll of an entire 6-month flu season in the US is around 35,000 deaths. So whether it is due to the infectiousness or the severity or both, it's something that needs to be handled differently than prior viruses of memory.

I get that it's hard to trust government decisions on faith in these decisions. Which is especially problematic with viral epidemics, because the decisions have to be made before things get bad in order for them to work. But they aren't acting without data. As mentioned above, we have the disaster in Italy, from Washington, and from the Diamond Princess cruise ship to work from. And now, we have New York/New Jersey, who are unfortunately suffering the consequences for which the rest of the country is benefiting in terms of information. Again, we don't know yet exactly what the case fatality rate is nor the infection rate, but (a) we have a fairly decent idea of it and (b) we know that the combination of the two is a big deal.

[BD80]

I wouldn't defend "lock her up," but I hear from my brother in Michigan that the protests are partly fueled by feelings that the restrictions are too tight and defy common sense. As an example, landscapers are not allowed to work as they are considered non-essential. My brother has three elderly neighbors who now have no landscape service and don't even own lawn mowers. Brother has been doing some extra mowing. Landscapers are the epitome of a social distancing business - they do not interact with the homeowner except by phone. A common sense approach would be to allow services like landscapers (and pool service, etc.) to continue if they can do so with safe social distancing.

Another example is vegetable gardening. Stores can sell groceries, but if they have a nursery section is must be roped off - no sales. I can hardly think of a better stay-at-home family activity than buying some seeds or starts and working together in the back yard vegetable garden. Selling vegetable seeds would help social distancing while giving families a way to save a little more cash and spend less time in the grocery store later this summer.

The other main reason for the Michigan protests is suspicion that the Governor isn't motivated only by what's best for the people of her state. I'd detail but that's probably 'nuf said.

Whitmer's explanation is that the landscapers would have to buy gas, which would increase the potential for the virus to spread.

Seriously. That was her nearly verbatim response to that direct question in the press conference.

Singapore says "not so fast"

https://www.nytimes.com/2020/04/20/w...singapore.html

Reading the article gives more perspective:

the contagion was spreading in government-built dormitories crowded with 200,000 foreign laborers, mostly from South Asia and China.
The first low-wage foreign workers tested positive for the coronavirus in February, and their close contacts were quarantined and tested, according to the Singaporean authorities.
Now, dozens of dormitories and lodges are suffering from outbreaks. Clusters of infections have also popped up at construction sites and an industrial park. On Monday, Singapore recorded 1,426 new cases mostly tied to the testing of migrants, a record jump in a country that a month ago had about 300 total cases.
The Singaporean authorities, it seems, failed to fully appreciate the infectiousness of the virus. Most of the cases are mild or asymptomatic and none so far have required critical care, according to the government, perhaps explaining why the spread among the foreign-worker population was not caught earlier.
Packed with up to 20 laborers in a single stifling room, these foreign-worker dormitories have been the sites of previous outbreaks of disease, like tuberculosis. ...

How would/did confining these workers to stay at home have helped? The additional testing and positive results seem to confirm that the virus is not as deadly as feared.

[cato]

Well, some people might not think the disease was all that bad and go out anyway. I mean, just because science says it is real, doesn't mean it actually is real.

Open my neighborhood bar! Don't tread on me! My constitutional right to get a beer is essential!

Thankfully for our local breweries, including a friend and client who owns one a few miles from my house, beer *is* an essential good here in SD. Delivery and pick up only, which is not nearly the same as packing people into tasting rooms, but it is enough to keep the lights on and the employees employed so far!

[BD80]

That's a No.

2019 Auto deaths: 38,800
US Covid-19 deaths: 41,356

It's worth noting that regulations regarding automobiles have had over a century to develop and get put in place. We've basically had two months to sort out this pandemic response.

My bad. Relying on memory instead of checking easily verifiable facts. I remember things from 20 years ago far better than those from 20 minutes ago.

Fascinating to see how the automobile fatality rate has declined over the years from a peak of over 50,000. Active and passive collision awareness/prevention systems should improve that number even more.

[TampaDuke]

Right! The industries and businesses hardest hit are the ones that would be hardest hit in an unchecked pandemic.

Let's put ourselves into the height of epidemic in NYC, in Italy, in France, in anywhere in the globe where the healthcare system has been overwhelmed. Ambulance sirens begin to blend into the background noise. Most everyone knows someone who is on a ventilator or dead. Even the healthcare workers, cops, EMTs are being hospitalized and dying.

Would you, in this environment of COVID-19 at it's peak:
1) Go to a gym?
2) Go out to eat?
3) Go see a movie?
4) Go to a department store and try on some clothes?
5) Go to a furniture store and test set in a few dozen couches?
6) Send your kids to school?
7) Go on a cruise?
8) Invite your in-laws to town to stay at a hotel (ok, maybe some of you world)?
9) Go to the hospital or medical provider for an elective procedure?

The answer to all of this is NO, you wouldn't not. The end result is pretty much the same with or without a stay-at-home order. The only difference is whether we end up with a manageable case load or we end up with a completely overwhelmed medical system.

That's certainly the case in NYC, but would it apply to rural Montana?

[CDu]

That's certainly the case in NYC, but would it apply to rural Montana?

I think the point being that once the pandemic reaches wherever you are, you'll stay inside.

Rural Montana might not apply, if their contact rates are low enough (full disclosure: I know very little about rural Montana). But rural Montana also probably doesn't have THAT much business at risk as is, at least not the part of Montana that is rural enough where folks wouldn't notice the impact of a COVID outbreak.

[AustinDevil]

We've all heard about these large, national chains being first in line to get what were supposed to be small business loans (often by using creative bookkeeping to make themselves look smaller than they are) while the actual small, community businesses have been left with nothing, right? I mean, Ruth Chris even found a way around the $10 mil per business limit by applying as two separate entities so it could get what amounts to a $20 mil gift from the government.

Well, today the CEO of Shake Shack gave back the $10 mil SBA loan given to his company. This man is a real hero!



I don't know about the rest of you, but I plan to become a very frequent Shake Shack diner as soon as I am let out of the damn house, that's for sure!

I mean, they had to choose to apply in the first place, so not sure how admirable they are. (Certainly more so than Ruth's Chris! And others who took and so far are keeping the money, like Fogo de Chao.)

[Bostondevil]

That's certainly the case in NYC, but would it apply to rural Montana?

Yes. I looked at a map of movie theaters in Montana and compared it to the locations of the most confirmed cases in Montana (New York Times map). Locations of movie theaters and higher numbers of infections are correlated. Like I said upthread, when you live in a small town, it only takes one death for you to know someone who has died.

[AustinDevil]

In framing these "emergency" restrictions, and striking a proper balance, where do the governors draw their data and assumptions in imposing executive orders? Since there is no legislative or judicial review, they should cite the bases for their actions. This pertains to the federal recommendations as well. I am not optimistic. This lack of transparency and forthcomingness breeds suspicion.

What in the world are you talking about? Of course these actions are subject to judicial review, which is why a Trump-appointed judge was just able to stay the Kansas governor's order restricting religious gatherings, and why the Texas ban on abortions has now been to the Fifth Circuit twice.

I'm not going to try to go executive-by-executive to refute your assertion that those in charge are not citing the bases for their actions, but overall they are entirely clear and relate to WHO and CDC guidance. The suspicion was a preexisting condition, if not for you, then certainly for many.

[TampaDuke]

I think the point being that once the pandemic reaches wherever you are, you'll stay inside.

Rural Montana might not apply, if their contact rates are low enough (full disclosure: I know very little about rural Montana). But rural Montana also probably doesn't have THAT much business at risk as is, at least not the part of Montana that is rural enough where folks wouldn't notice the impact of a COVID outbreak.

No doubt. I don't disagree. But should Montana have issued a lockdown? I don't know. My only point being that it's not as simple or obvious that every state should immediately take the NYC approach (where it is certainly appropriate) and that such an approach will have far-reaching impacts, even on the population's non-COVID health.

Personally, I'm hoping that we can get testing ramped up sooner than later to allow us to begin relaxing restrictions where appropriate, but I'm concerned that a number of leaders and talking heads are already calling for restrictions to remain in place until late in the year, next year, or even until a vaccine can be had. If that were to happen, many vital businesses would fail and I have to think there is a real possibility that the damage from that exceeds what COVID would do.

[MChambers]

It's entirely possible. But if we're at the point of having huge global pandemics more frequently than every ~50 years, then we will have even MORE need for a pandemic disaster preparedness strategy much better than the (absence of) one we had this time around.

That being said, if we are going to be having pandemics more frequently, that will likely require lifestyle and economic changes regardless of how we handle the responses to the pandemics.

Yes, that's my point.

[TampaDuke]

Yes. I looked at a map of movie theaters in Montana and compared it to the locations of the most confirmed cases in Montana (New York Times map). Locations of movie theaters and higher numbers of infections are correlated. Like I said upthread, when you live in a small town, it only takes one death for you to know someone who has died.

I don't disagree, BD. My point is that, by locking down, we are quite possibly making a health-related tradeoff whether we realize it or not. It's not as simple as saying that, since Montana has 433 cases and 10 deaths, that the whole state should lock down. There are numerous reports that many hospitals and health clinics will go out of business if the lockdowns linger too long.

[BD80]

Sure we can. We can't give you EXACT numbers. But we can give you relative numbers. And we can use the evidence that does exist - that this thing overwhelms the healthcare system if unchecked in ways that other respiratory viruses have no done in at least a half-century. Whether this thing has a fatality rate of 0.3% or 3% matters not as much as the fact that the disease spreads fast, we have no natural immunity it, and it kills people much more than the flu. We have seen 40,000+ US deaths in less than 1 month, and that's WITH extreme restrictions for over 3 weeks. The average death toll of an entire 6-month flu season in the US is around 35,000 deaths. So whether it is due to the infectiousness or the severity or both, it's something that needs to be handled differently than prior viruses of memory.

I get that it's hard to trust government decisions on faith in these decisions. Which is especially problematic with viral epidemics, because the decisions have to be made before things get bad in order for them to work. But they aren't acting without data. As mentioned above, we have the disaster in Italy, from Washington, and from the Diamond Princess cruise ship to work from. And now, we have New York/New Jersey, who are unfortunately suffering the consequences for which the rest of the country is benefiting in terms of information. Again, we don't know yet exactly what the case fatality rate is nor the infection rate, but (a) we have a fairly decent idea of it and (b) we know that the combination of the two is a big deal.

Please understand that I am not criticizing the initial imposition of emergency orders. Given the information, it was prudent, and in retrospect it appears to have saved many lives.

But now, SIX weeks later, what decisions are to be made. We know which segments of the population are most at risk, and can greatly reduce the fatality rate and the burden on the healthcare system by placing restrictions to protect those segments. Our treatment protocols are improving and thus our success in treating infections. Supplies are supposedly on the way to support our front line responders. We understand congregations of people were likely the greatest source of the spread of the virus. Let's use this knowledge in crafting future orders and work back toward normalcy. I'm not saying we lift restrictions in areas that haven't sufficiently flattened, but have a plan in place and anticipate that the curve will flatten.

I have a daughter who is a nurse on the front lines in Detroit (neurosurgery ward) and many close acquaintances who were thrown into action in Detroit's northern suburbs. A huge issue now is the effect the restrictions have had on the hospitals, that are now closing entire floors and laying off employees due to lost revenue. My daughter no longer has a resident to report to with respect to patient inquiries, she must directly report to the attending, who is usually the chief of neurosurgery on her shift. The residents were let go due to cost constraints.

As Covid patients are released, the hospitals will be more and more empty.