DawgTalkers.net Forums DawgTalk Everything Else... 28 Days Later: COVID-19

Let the kids and those at lower risk start building "herd immunity". Do our best protect the vulnerable and let those less susceptible start the process of defeating this. You can flatten the curve to nothing but every disease doc I've heard so far in the hospital says you'll be at that point eventually anyway. We cant escape loss...

Exactly.

At first, I thought they were fools, but more and more I am a supporter of Sweden's approach to this.

They are the ONLY country in Europe that didn't lock down. They enacted social distancing and have everyone wearing masks and stuff, but they did not shut down their economy.

Yes, their deaths are higher relative to their number of cases, and I don't have any data to support "why", but I suspect that due to their approach, they are simply moving through the curve faster, so therefore they are hitting their death totals quicker.

We're still going to hit those totals, it's just going to be more drawn out and looking at daily totals won't be as staggering. But, in the next two to four weeks, they will have reached herd immunity in Stockholm and the largest part of their population will no longer be capable of significant spread.


FWIW: The population of Sweden compares well with that of Ohio. Stockholm compares well to Columbus.

I'm now interested to see if I can find any articles where they perhaps regret their course. I'm betting that they're pragmatically grateful for it as their nightmare is just about over with.

link

So, it appears that most Swedes approve of their approach, and where they actually went wrong and caused the higher deaths was in not being more protective of their elderly in nursing homes. That appears to be the cause of most of their deaths.

Their system was never overwhelmed. They never ran out of PPE.
I think the difference is that, like South Korea, they acted early before it got a foothold in an area. We did in Ohio as well (though, again, I was convinced at the time it was too late). NYC and other areas weren't as fortunate, BUT now that we are putting those runaway areas to rest, it is conceivable to adopt their approach.

Although, areas of extremely high population density may want to continue with stricter controls as the same rate of spread there as another area will absolutely destroy hospital capacity where it might be just a blip in another area.

I know nothing about this site orbis writer but found this kinda interesting and it does mention Sweden.

Sorry, this didn't show the graphs. Probably delete it and I can try later..


https://medium.com/@yinonweiss/coronavirus-shutdown-effectiveness-visualized-part-2-1a6e7b97649d
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Coronavirus Shutdown Effectiveness — Visualized (Part 2)
Comparing 50 US States, Spain, Italy, France, UK and Sweden
Yinon Weiss
Yinon Weiss
Apr 19 · 8 min read


Times Square stands mostly empty as much of the city is void of cars and pedestrians. Getty Images.
This is a follow up to my April 12th Let’s Visualize State-By-State Shutdown Effectiveness article. Although it’s only been a week since that post, a lot has changed and we have a lot more data.
The main element I am analyzing here is the effectiveness, or at least the correlation, between how quickly a State ordered Stay-At-Home and the COVID-19 deaths it accumulated in the 3 weeks after presence of coronavirus. This is important because it can help inform how quickly we lift lock downs now as well as how quickly we should consider enacting them in the future.
Intuition may tell you that the faster a State orders a shut down, the fewer deaths it would see, but that is surprisingly not reflected in the correlation analysis.
A lack of correlation between speed to shutdown and deaths implies we may have overestimated the need to shut down and underestimated other social distancing measures.
The updates to the analysis are:
Now using reported deaths instead of IHME death projections.
Added other western countries for comparison; Italy, Spain, France, United Kingdom, and Sweden, in addition to the 50 US States.
Time is normalized from when 1 death per million residents is reached
You can jump down to the results if you like, but first I’ll explain the methodology.
Normalizing to population is important to get an honest picture
There has been some poor analysis out there failing to normalize basic data such as population size. Below is a chart from one of the world’s most elite consulting firms in a report meant for industry leaders. In the chart they claim that national trajectories “diverge based on demographics and measures taken” and then you see the United States running wildly at a higher rate than all the other countries. Seems bad for the US, right?
But this is nearly worthless because it doesn’t normalize to population size. Since the US has 5.5x more people than Italy, then of course you would expect it to have more cases. Everything has to be normalized to population size to make sense.

The slide above claims the United States had “the steepest rate of growth” but that’s primarily because it has the largest population of all the countries listed.
When normalized for population, the United States is much more similar to other western nations. Below are the same countries normalized to population size, which gives a completely different picture.

I also added Sweden in there because Sweden has not shut down and the world is watching to see how that strategy will play out. It’s therefore important to include Sweden as a reference point to maintain intellectual honesty in all such comparisons.
The problem with the above graph however is that each country started picking up cases at slightly different times. So while the steepness of the curves can be compared for rates, the final outcomes cannot. For that you also have to normalize time not based on a calendar date but based on a milestone in cases or deaths.
Normalizing to a starting milestone — 1 Death per Million
To get all the data on the same timeframe, I’ve normalized the starting milestone to be when a State reached 1 death per million residents.
This is intended to mark a moment in time in which we can say with a high degree of confidence that the virus was definitively present throughout a State.
One death today means that at least 100 people had it ~16 days prior, which means that as it grows exponentially during those 16 days, there would be many hundreds if not thousands of infected at the milestone date, per million.
Furthermore, I am tracking 21 days of mortality data because that would capture at least some meaningful effects of a shutdown in the mortality cycle. This data did not exist a week ago and each week that goes by we can get a better and better understanding with more data.
Now let’s look at the results
There’s a lot going on in one graph, so let’s first walk through it
First, here is a general illustration of the chart you’re about to see…

The vertical Y-axis represents the State’s total accumulated Covid deaths 21 days since the start milestone; that’s the 1 death per million start of the clock.
The horizontal X-axis reflects the number of days a State took to shut down relative to the same milestone of 1 death per million. Speedy States are to the far left, slow States are to the far right. So for example, NY passed 1 death per million on March 20th but didn’t shut down until March 22nd, so it goes on the “2 days” column on the X-axis for speed to shutdown because it shut down 2 days after the mortality milestone.
On the other hand, Delaware reached 1 death per million on March 26th, but it shut down on March 24th, so it gets a “-2 days” on the x-axis for shutting down two days before reaching the mortality milestone.
NY therefore ordered its shut down 4 calendar days before Delaware, but since we are normalizing the shutdown to a mortality presence mark, we can see that Delaware actually shut down 4 days before NY relative to the mortality milestone of 1 death per million. While this is a bit complicated, it’s key to getting to the heart of the true correlation.
I hope that makes sense. Ok, let’s keep going. Here are the results:

So what do we see?
There is very little correlation between speed of shutdown and total death after 21 days. In fact, there is a slight negative correlation of -0.05 R², but that is basically an insignificant correlation.
You have some States that shut down well after others States (relative to reaching the 1 death per million mark), but they are all over the map on outcomes. This is another way of saying there is little correlation.
Spain, Italy, UK, and France are in a similar category to some of the harder hit US States but not nearly as bad as NY. Sweden had fewer deaths in the first 21 days compared to the UK, Italy, and Spain, even though it has kept its schools, malls, and bars open. More on this later.
Some of the smaller States get a little murky, for example Oklahoma closed down non-essential businesses on April 1st but hasn’t actually issued a Stay-at-Home order according to covid19.healthdata.org. So here is the same graph but without the smaller US states which remained open. The results are similar, and in fact the correlation becomes even weaker with an R² of 1%.

We need to be careful not to infer causality, but what can we conclude?
There is no general correlation between how fast a State shut down and how many people died in the first 3 weeks following an early mortality milestone.
So what factors may explain the different outcomes?
If speed to shutdown doesn’t cause such a large difference in outcomes, what is it?
Social distancing does work, but we need to get smarter on exactly which social distancing actually contributes the most benefit.
I would next want to look at and control for the following 8 variables:
Population density
Extent of public transportation use
High transmission events such as conferences and sporting events
Amount of travel from to/from coronavirus hot spots
Level of voluntary social distancing behavior
Hygiene practices such as washing hands, cleaning, masks, etc.
Health and age demographics
Standards used to classify COVID vs. non-COVID deaths
The above variables, and others, are critical for us to better assess risk factors for a pandemic as well as taking measured steps for its mitigation.
Coronavirus transmits through close contact. Nobody should be doubting whether social distancing works as a general concept. Given the extraordinary economic and mental damage that shut downs cause, we ought to more carefully consider whether shutdowns are effective compared to all the other measures we can take.
Bonus: Population density seemed the most interesting so I ran some numbers on that…

X and Y axis on a logarithmic scale. Source: covidtracking.com
The correlation R² here is 0.36, which is more meaningful than random but not extremely strong. A better chart for population density would probably be to compare metro areas rather than States. Nonetheless, we do see that population density is a correlating factor to increased deaths, but that should not be surprising for a virus that is transmitted person to person and benefits from close contact.
The above is on a logarithmic scale otherwise most states get bunched up in the corner, but it’s still interesting to look at it on a linear scale:

Source: covidtracking.com
There seems to be two patterns that emerge. There’s the France, Italy, UK, CT/MA/NJ story, and then there’s the Sweden, LA/MI, Spain, and NY story.
Although it’s not fair to group them all in the same category because Sweden and France are at 77 and 69 deaths per million after 3 weeks, while NJ and NY are 2–5 times higher.
It’s also important to consider that Sweden never shut down while all the other places I just listed did, which again reinforces that legal shut downs may only play a small role in the slowing down of the spread when compared to other factors such limiting travel to/from hot spots, degree of public transportation use, washing hands, cancelling high transmission events such as conferences, and whether people are staying home when sick or exposed.
So while speed to shut down does not show meaningful correlation, population density has some correlation and we should study variables 1 through 8 listed above to see which ones have the biggest impact.
Conclusion: We need to better understand the cost/benefit of different kinds of social distancing
This is important as our nation begins a marathon of mitigation against coronavirus, and in this struggle we need to better understand the benefits and the trade offs of all the measures we can take. Allowing the purchase of jewelry and lottery tickets but not gardening supplies is an example of how misguided some of our government decisions have been.
Next time somebody seems to panic and wants a shut down, we should remember that there is likely a long list of less costly measures that may be even more effective before we jump to the most drastic extreme.
Coronavirus
Covid-19
Shutdown
Socialdistancing
Effectiveness
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Yinon Weiss
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Yinon Weiss
I write about leadership, business, and human performance.
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That was a really interesting read, and I *really* appreciate that it was absolutely agnostic in its approach. It didn't care what the result was, only the approach to the result... which is what we need.

The conclusion was entirely unexpected.... shutdown date has no effect/correlation? While I've been telling people lately that opening won't change the number of deaths, just the timeline, I would not have expected those number to reflect that shutting down had no effect on deaths.

Before I took that too far, I would want to carry that out another several weeks.

Since this disease has built-in lag times of a few weeks to begin with (~2 weeks to symptoms, ~1 week after that for hospital, ~1 week after hospital to death), I would think/expect that the longer into a shutdown you go the greater the divergence, BUT I would also want to see the data after a much longer time (which, obviously, we have to wait for) as a place like Sweden and even NYC are likely to plateau and then drop precipitously, evening things out over time. I'd still contend that a death will be a death and all that changes is the When.

p.s. definitely click through and look at the graphs. The data written in the article basically covers everything, but the graphing helps illustrate nicely

How many more cases/deaths would we have had if we hadn't shut things down and had shelter in place orders? That's the one question no one can really answer.

Also, how do those countries count COVID-19 deaths? In Ohio, if someone had a heart attack, (for example) but also had the virus, and dies, it is counted as a death by the virus.

Further, I have read news clips of people being reinfected. It's a small % in S. Korea, (IIRC) but it is still happening. Also, who knows how many others are reinfected and just try to push through it because they assume they are immune?

I think that there are still lots of moving pieces to this thing.

I'll take those in order, lol:

Part of what that last article is showing out is that the number of deaths may be completely unaffected by shutting down. At least, there appears to be no correlation between deaths per capita and when an area did shut down.
As always, the purpose of the shutdowns was to prevent overload of the hospitals, not "prevent deaths" except as a secondary effect. Quite literally, if this didn't have the capacity to overload hospitals, we would absolutely NOT be shut down. Guaranteed.

Counting: I don't know. But, we aren't even apple-to-apples here in the US, either.

Reinfection: there is a good deal of concern there, and there are basically three possible answers, but nobody knows which is correct, yet: 1.) false negatives to clear a patient. An entire bad batch of tests could give a large group of false negatives 2.) the virus 'reactivates' in some people 3.) immunity doesn't last long, or at all, and you can get reinfected
In short: nobody knows, yet

Progressive is 20% for the next two months.

I called nationwide and put my son's car "in storage" status for now. Made him an occasional driver... saving him/us 50 bucks a month.

well, that bites... I'm paid up for the half, lol

j/c...

Okay, this is something I would like to see those here who work in the medical field answer for me. Because I keep seeing the claims they are telling the public about wearing masks and none of it is making sense to me.

What they are telling us........

Wearing a mask will not protect you from getting the virus. What it does is protect you from spreading the virus if you have it. Many people who contract the virus are asymptomatic and do not know they have the virus. so just act like you have the virus and wear a mask to protect the people around you.

What I'm seeing and why the above makes no sense to me..........

We see all hospital workers around the nation wearing masks anywhere that they are around any coronavirus patients. Their patients are already infected with the virus. These masks are considered part of their PPE. (personal protection equipment) They talk about how critical their PPE and masks are in preventing them from contracting the virus and taking it home to their families.

How can these two opposing things we see and are told make any sense?

When working in direct contact with Covid-19 patients, healthcare workers are not only wearing masks, but face shields/eye protection.

You aren't going to directly treat or intubate an infected patient with just a mask on.

Different masks Pit. There are procedure masks and isolation masks which you are seeing most folks wearing. Not doing much at all. If both parties are wearing them it offers better than nothing protection but I wouldnt
go into a known carriers room with one on.
We are in these in my hospital currently.
I personally think they're not the best bet for this virus.

You get into to your N95s which must be fitted properly. No facial hair or makeup allowed. They'll keep out contamination and spray from a cough or sneeze. These are in short supply currently. At least good ones. There are some real crappy Chinese junk being shipped over right now.
(Dont they need them?!) I don't think I'd trust those much but still could be better than the previous. These are the masks that can be cleaned 3 times before being tossed.

Most first line docs and nurses will have respirators and face shields on though. I see respirators in the shots from NY. Obviously, these have changeable filters for different scenarios.

There are others all rated for different levels of protection but these are the three we've laid in as hefty of a supply as possible.

Probably doesn't really hurt to wear the procedure masks and I might if I was a diabetic or doing chemo and couldn't get
my hands on an N95 but it probably is more a feel better thing than real solid protection. That's just my opinion though. I'm a supply guy and not a physician!

j/c:

All I know is that my wife's last patient of the day had the Coronovirus. We took all possible precautions when she arrived home, but this stuff is scary.

I mean no offense, but it's a bit annoying to see all the post about opening things back up when you have a loved one facing this pandemic on the front line.

My best to You and Yours, Vers.
Frontline professionals are Our Heroes.

That’s one area that most people dont think about: the nurses/doctors/staff who have to go home after caring for a patient. Hope for continued health to you guys

I'm a bit leary myself. Since this thing hit us......when my wife(RN) comes home, I/we seem to keep our distance. She in the living room and I in the great room.

Our daughter(RN) and grandkids generally spend Fri nights at our house. Nada the last 3-4 weeks. Nada tonight.

I miss "THE NOISE"!!!

Yes, a lot of people are at risk. We have many board members who either work in--or have relatives who work in--health care, grocery stores, etc.

Think of Portland. Both him and his wife are nurses. That's gotta be a lot to do deal w/mentally and emotionally.

My opinion is that all folks should do their best to not endanger others. Sacrificing isn't a bad thing.

Wishing you and your wife all the best Vers.

This

I just got home from my morning patient visits. Thankfully no known COVID in the nursing facility I visited. I managed to get stripped down in the garage and through the shower when my girlfriend, also a community nurse, pulled into the driveway. She was in a known COVID facility, seeing a suspected COVID patient. She was still dressed in head to toe gear. Like out of the movie contagion. (There’s no place for her to safely strip and decontaminate at these facilities.) I let her through the back gate and into the shed out back. There I helped her strip down and safely store her contaminated gear. It’s a procedure with many steps. She’s just now out of the shower.
There’s a good chance both of us will have to go out again today. It’ll be the same procedure when we arrive home. It’s tedious. It’s exhausting mentally and emotionally to know that this is our new norm.

I can't imagine the mental toll this has to take on both of you on a daily basis. God bless both of you.

Thankfully, at baseline, we’re both very laid back ‘roll with the punches’ types of people. Our default setting is ‘happy’. So while it sucks, we try not to let it wear on us. You can choose happiness and gratitude for what we do have. And we do.
This doesn’t mean there’s not an underlying stress to it all. Because there certainly is.

Now I have to chart for a couple of hours... that makes me more depressed than the other stuff. Lol

My sis in-law loves charting soo much, too!

Thanks for the work you do. Stay safe.

Think of yourselves as cops or soldiers strapping on your body armor, or a firefighter suiting up to go into really hot spaces.

Stay safe; learn to love your protective gear.

I don't want to "Like" your post because the news is horrific, but I think your story needs to be recognized.

Sorry that I said "wife" instead of "girlfriend," but it has to be so taxing for both of you to go through this. My wife strips down in the garage, too. She leaves a change of clothes out there.

I understand why you say it is tedious. I also get how it is exhausting both mentally and emotionally. What makes it even worse is that both of you are being exposed. I hate saying that because I don't want to be a downer, but I think other folks need to see it. It's important!

I hope that people who are upset about not getting out and missing on doing things like shopping, dining out, going to the beach, concerts, etc will read stories like yours and then possess enough discipline and selflessness to do all they can to make folks like you and your girlfriend safer.

Hang in there, bro. I want you to know that while some might seem selfish, there are a lot of us who value and respect what you guys are doing for your community.

Agreed.

Aside from my wife and daughter being RN's......short story.....

After 46 years, retired from the grocery business a year ago this May 17th. Still talk to/ communicate with alotta them. One works at, I believe, the first supermarket in NEO-ville to have an employee that had it. Young female cashier.

At the time.....perhaps, give or take, 5-6 weeks ago.....talked to a good friend of mine who works at the same store as above.

Me: Are you guys wearing a masks?
He: No. I guess I prob should.
Me:

Keep in mind.....they wear masks all the time......Meat cutters, deli, bakery, produce, kitchen, etc. Anywhere food prep is goin on.

Not the Covid masks at the time but masks none-the-less.

And yes, I scolded him.

And still.....no grandkids tonight.

An amendment to the above: The people on the salesfloor weren't wearing them. The people prepping were.

j/c...

From "THE FRONT LINES".....

Cleveland Clinic doctor returns from front lines in NY: ‘Incredible’ how COVID-19 patients present in ‘all kinds of ways’
Darcie Loreno

CLEVELAND, Ohio (WJW) — Cleveland Clinic Dr. Judy Welsh has spent a lot of time in New York, living, training, visiting friends and working in the medical field.

Last week, she made a trip there that she’ll never forget: she volunteered her time to work with patients affected by the coronavirus epidemic in one of the biggest hotspots in the country.

“The whole week was a little sad, and a little inspiring,” said Welsh.

Welsh was one of 25 Cleveland Clinic caregivers who left for New York on April 17 to help with the COVID-19 pandemic. She was assigned to Brooklyn Methodist Hospital, which is part of New York-Presbyterian. She returned Thursday night.

Welsh is an emergency physician who works in the emergency department of the Cleveland Clinic’s Avon Hospital. She’s also associate chief experience officer in the office of patient experience and is a medical director for community paramedicine.

Welsh was actually living in New York during working in an EMS rotation during 9/11, but she didn’t have the opportunity to help out with recovery efforts at that time.

“So this was kind of a second chance for me to help out in New York City,” she said. “When the call went out from the Cleveland Clinc, I offered my time and talents.”

When she and the other Cleveland Clinic caregivers arrived in New York, they got off the plane, got settled in their hotels and went straight to the hospital to start orientation and take a tour.

“The next morning, we hit the ground running and started seeing patients,” she said.

She said she couldn’t even begin to count the number of patients she saw there, and the majority had coronavirus infections.

She said one thing that struck her was that the COVID-19 patients presented symptoms in “all kinds of ways.”

“Some had new-onset heart arrhythmia, new-onset diabetes, severe low blood sugar, kidney failure of all kinds, dehydration, mental status changes,” she said. “All of it was coronavirus, It was incredible how different each of these patients presented. There was no one standard way these folks showed up in the emergency department.”

Another large group of patients were those who had put off their emergencies since the outbreak started. They were “different types of victims of coronavirus,” she said.

“Every single patient I saw seemed to be critically ill in their own way,” she said. “Many required oxygen and multiple drips.”

One woman who stood out to her was a cancer survivor. The woman began to have weakness in her right side and eventually couldn’t walk anymore. That was the trigger for her to seek treatment.

“She had the diagnosis of a brain tumor that I had to give her wearing a mask,” said Welsh, with tears in her eyes. “And it was hard. It was hard for me. It had to be hard for her.”

She said one of the worst parts for the patients is that they couldn’t have visitors, so it was very hard to advocate for themselves. Welsh spent a lot of time talking with family members and learning medical histories to get patients the care they needed.

A lot of her time was also spent comforting patients. She credits the Cleveland Clinic for providing the training and education she needed to do that.

She said the hospital staff was very grateful for their help. Four of their physicians were out with their own infections, and the team was very tired from working overtime.

She said she felt very comfortable at the hospital.

“We had ample protective equipment, every resource imaginiable,” she said. “I was very comfortable and felt very safe while I was there.”

The city was also very supportive of its medical teams. Every night at 7 p.m., fire trucks would line the streets around the hospital and applaud for all the caregivers at shift change.

“It was absolutely magical and incredible,” she said. “I’ve never seen anythig like it. People were hanging out their windows, banging drums. People were on the streets applauding.”

She said the week in New York was like a “whole new residency” and she’s brought back a wealth of experience and knowledge to help deal with the crisis in Cleveland.

“I think number one, just understanding coronavirus and the multiple presentations, the different ways it shows up in people and the best ways to treat them,” she said.

She was also impressed with the hospital’s telemedicine program and the ability to manage patients with infections from their homes.

Moving forward, Welsh said she is trying to get cleared to return to work as soon as she can.

“This morning I went for a run with my dog, took a look outside, breathed in the fresh air,” she said. “It’s ice to be in a quiet place where there’s not a lot of noise. Spend some time with my husband. I came home and had a cocktail hour last night to catch up.”

More importantly she’s excited to share the knowledge she learned in New Yrok with those her ein Cleveland.

“I really took a lot away and hopefully will be able to come and share some of that information with my colleagues,” she said.

https://www.newsbreakapp.com/n/0OrGw4XV?s=a99&pd=02pCc6CA

Was that second bump [of new cases] driven by the recent prison cases we were hearing about?

j/c

The ex co worker (who lives in Arizona now), but her daughter, and grand daughter were doctored, here in Ohio, by a doctor that had covid, was intubated, seemed to get better....got worse. Back in the hospital.


My wife found out Wed. that a co worker of hers that had been feeling 'not right' has been at home W,T, F. with a fever. No testing was done on him at this point.

Son is in the same situation as all/most nurses, doctors, etc. Stay safe everyone.

Wow! There is a true hero!