Did you catch it ?

Okay by me, so do I.
I think we've derailed this COVID thread enough even by PoA standards. If you'd like to continue further on the virtues of proper debate and discourse create a new thread in Hangar Talk or shoot me a PM. Til then...
 
And here's an aspect of Vermont's response to the pandemic that makes no sense to me: The Green Mountain Club has closed all of the trails that they maintain "until further notice". It's not an edict from the governor, they just won't be doing any trail maintenance and want everyone to stay off the trails to avoid spreading the virus. I can see not wanting to work on the outhouses and not staffing shelters - and it would probably be stupid to overnight in a crowded shelter anyway - but they are very unlikely to spread the virus by working, with reasonable protection, to maintain trails, reroute eroded stretches, repair puncheon on stream crossings, etc. And hikers, at least day hikers, are VERY unlikely to spread the virus in the outdoors anyway - it is normally quite windy on most stretches of the Long Trail and other ridgeline trails and you are extremely unlikely to breathe in coughed or sneezed droplets or ingest any significant viral load from a passing hiker's breath.

It makes perfect sense to close the trails during Mud Season - they do that every year - but this policy sounds a little like being so afraid of the virus that you stop living. And to me that is going too far.
Isn't the Green Mountain Club a volunteer organization not affiliated with the state? Seems like they would make their own decisions within the framework of Vermont's or the local area policies. If the trails run through state parks or national forest land, that may also have a bearing. Around here (San Francisco Bay Area) different localities have varying policies with regard to open space. For example, beaches and parks in the city and county of SF have been open the entire time. Not so in some of the surrounding counties, although I think most have reopened by now, with some restrictions. I am a volunteer gardener on Alcatraz. That was shut down by the Conservancy before any government orders went into effect.

Thinking back now, Covid-19 fear was affecting the area before any shutdowns. All the big tech companies were telling their workers to work from home. I take the bus through Chinatown, and remember thinking how nice it was that the busses were less crowded. People were being encouraged to support the merchants because tourists and others were afraid to be there. I went to the Chinese New Years Parade in late January because I figured this would be a great opportunity without having to face as many crowds. Ironically, I looked at a map of the zip codes that showed the cases in different areas of the city, and Chinatown has not been badly affected. Actually no place is as bad as they thought it would be. The more affected places are where you would expect; the Tenderloin, south of Market, and the lower income areas.
 
Isn't the Green Mountain Club a volunteer organization not affiliated with the state? Seems like they would make their own decisions within the framework of Vermont's or the local area policies. If the trails run through state parks or national forest land, that may also have a bearing. Around here (San Francisco Bay Area) different localities have varying policies with regard to open space. For example, beaches and parks in the city and county of SF have been open the entire time. Not so in some of the surrounding counties, although I think most have reopened by now, with some restrictions. I am a volunteer gardener on Alcatraz. That was shut down by the Conservancy before any government orders went into effect.

They are a volunteer organization, yes. I think I said that this was their decision, not due to state policy - though they do cite the Governor's "stay at home order" as one reason they are not working. Well, the Governor is now allowing on-site construction work involving small (I think < 5) numbers of workers at a site, with protection. Seems to me trail construction/maintenance should fall under that umbrella. It is very much virus fear driving all of this, not so much realistic public health concerns. They also cite the possibility of picking up the virus from picnic tables and other exposed surfaces. Sure, use common sense. Carry soap or hand sanitizer (if you have any) and take precautions. I still think the risk is small in open areas exposed to direct sunlight. You have to ingest a lot of virus to fall ill.

They explain their decisions here. Some of it makes sense IMO, I agree that thru-hiking the Long Trail is probably unwise unless you carry your own tent and bedding (I did that when I was younger). Pee and poop in the woods, not in the privies. But I think the rest of it is overreaction. Personally I'll be cautiously taking to the (mostly non-GMC) trails after Memorial Day, but I'll be on the lookout for problems and won't be surprised to find erosion and impassable blowdown in places. I still have to inquire about the state parks, as some of the areas I normally hike in are on state land.

I just noticed that this thread is in the Medical Matters section... I've been clicking on the Alerts button and didn't notice what section it was in until now. Oops. Apologies, I'll stop derailing the thread at this point.
 
And a modeling study predicting there will be an excess of 33,890 deaths due to cancer in the US in the next year because of the responses to Covid-19. "the model estimated 6,270 excess deaths at 1 year in England and 33,890 excess deaths in the US." This is for cancer only. In preprint form at this time.

https://www.researchgate.net/public..._and_multimorbidity_in_the_COVID-19_emergency
Yes, not surprising. Screening procedures are on hold, as are elective procedures such as biopsies. Many primary care clinics have closed or drastically cut back their services. I am several months overdue for my annual mammogram and it is not going to be scheduled anytime soon.

What are the reasons for continuing these cutbacks, especially in areas that have not been hard hit? Is it mainly to minimize exposure to patients? Or is it more to conserve scarce resources such as PPE, or to divert health care people to harder hit areas? Most explanations I've seen are very vague - all I've seen is boilerplate "as part of our response to the COVID-19 pandemic" with little more detail. They made sense at first when there was a chance that the health care system everywhere would be quickly overwhelmed. But unless there is considerable diversion going on, it does seem now like an overreaction to continue this in counties where the total number of cases since the start of the pandemic can be counted on one hand.
 
But unless there is considerable diversion going on, it does seem now like an overreaction to continue this in counties where the total number of cases since the start of the pandemic can be counted on one hand.
Total number of cases that we know about.... We can only report cases that are known. If we don't test, we don't know. There are still lots of places where testing is reserved for only those who are very sick.

And that would be my guess as to why elective non critical procedures are not being done. We don't have the capacity to treat each of those patients as though they're infected (positive pressure rooms, full PPE, etc) and we don't have the capacity to test them to verify they're negative before entering the facility.
 
Total number of cases that we know about.... We can only report cases that are known. If we don't test, we don't know. There are still lots of places where testing is reserved for only those who are very sick.

And that would be my guess as to why elective non critical procedures are not being done. We don't have the capacity to treat each of those patients as though they're infected (positive pressure rooms, full PPE, etc) and we don't have the capacity to test them to verify they're negative before entering the facility.
Granted, we only know about the cases that have tested positive. But those are the ones that overwhelm the health system. The people with mild infections who recover at home are not going to be an issue regardless. Even if they come in and are diagnosed, they are sent home to self-quarantine unless they get worse, and I have to think most of the serious cases are ultimately caught and diagnosed. (Yes, there will always be people who die at home without ever seeing a doctor and are never diagnosed, but I strongly suspect those are rare exceptions.)

And I'm not sure it's necessary to TEST everyone who comes in for an elective procedure, much less treat them as though they're infected. I was allowed a visit a couple of weeks ago at my primary care clinic for a steroid injection for a painful rotator cuff tear. I was certainly screened, had my temperature taken and asked a bunch of questions, but not tested. They're simply cutting services way back, as if the resources need to be conserved for other uses. I can't believe I would have been allowed in for a shot for pain if there was a significant chance that I would be exposed there - or that I would expose them if I was infected but asymptomatic. I did wear a mask, but they told me it was optional as long as I wasn't sick.
 
Total number of cases that we know about.... We can only report cases that are known. If we don't test, we don't know. There are still lots of places where testing is reserved for only those who are very sick.

And that would be my guess as to why elective non critical procedures are not being done. We don't have the capacity to treat each of those patients as though they're infected (positive pressure rooms, full PPE, etc) and we don't have the capacity to test them to verify they're negative before entering the facility.
So what.
 

The "so what" is that public health officials are trying to thread the needle between a complete lockdown and free-for-all viral spread by gradually opening up economic activity while monitoring and attempting to control local outbreaks. To do that successfully, you must be doing enough testing to catch local outbreaks before they run away, and you have to reserve enough hospital capacity to isolate and treat the patients from local outbreaks. If you don't test, you don't know what is out there. It's not going to be easy to get it right...the path forward is going to be iterative, with testing, hospital admissions, and mortality statistics guiding policy. The measures will lag inputs by 7-21 days depending on which measure you consider.
 
Total number of cases that we know about.... We can only report cases that are known. If we don't test, we don't know. There are still lots of places where testing is reserved for only those who are very sick.

And that would be my guess as to why elective non critical procedures are not being done. We don't have the capacity to treat each of those patients as though they're infected (positive pressure rooms, full PPE, etc) and we don't have the capacity to test them to verify they're negative before entering the facility.

There is no such thing as zero risk, and trying to create the impossible out of good intentions is catastrophic.

If you delay routine physicals, mammograms, colonoscopies, and so forth because some hypothetical person might have asymptomatic COVID-19, you're just shifting the risk to the very real people whose health unquestionably is being endangered by denial of medical services. To protect hypothetical people from a possible risk caused by a theoretical person who might be asymptomatically infected, you're causing actual harm to actual people. But they don't matter. They're expendable.

This sort of myopia is typical of this entire response. Nothing and no one matters except the virus. You've given the virus celebrity status, and no one else's pain, suffering, medical condition, jobs, businesses, nor even their lives, matter anymore.

Neither do the jobs of health care providers who are being laid off and furloughed because the restrictions leave their hospitals with no work for them to do, matter. If they're treating COVID cases, health care workers are heroes. Otherwise, they're expendable, along with their patients.

Rich
 
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The "so what" is that public health officials are trying to thread the needle between a complete lockdown and free-for-all viral spread by gradually opening up economic activity while monitoring and attempting to control local outbreaks. To do that successfully, you must be doing enough testing to catch local outbreaks before they run away, and you have to reserve enough hospital capacity to isolate and treat the patients from local outbreaks. If you don't test, you don't know what is out there. It's not going to be easy to get it right...the path forward is going to be iterative, with testing, hospital admissions, and mortality statistics guiding policy. The measures will lag inputs by 7-21 days depending on which measure you consider.

Judging by what I’m seeing certain ones doing they’re not threading needles at all. Just doing as they please. One supposedly even said so today in a press conference.

Mortality statistic isn’t the guide. Hospital overload is. Given the same level of care, the thing kills the same number of people, just at different times.

And as Rich pointed out, any politician keeping other medical services closed, is a murderer. Er know this because we have places, like right here, who stopped them only long enough for the medical experts to determine what they could handle and not. Not Mayor McCheese and his parade float degree. Three days. Completely separated wards and even buildings in larger campuses and they had everything running again.

Covid, sign says turn right. Non-Covid, turn left. Not freaking rocket science.

Seeing other places with their hospitals hobbled by politicians really cheeses me off, considering the medical facts that opened ours right back up. One of the only good things about going early.

Mayor McCheese and his sidekick The Hamburglar, his PR wonk, didn’t have “political guidance” from anybody. Had to actually leave hospitals to hospital professionals. Go figure.

Because you know. The last place you might find people who understand infectious diseases might be... at a hospital. LOL.
 
Neither the DoD or VA have antibody testing in my area, or anywhere that I know of.

I'm just going to continue to contend I had it in January/February and not worry about staying away from other humans.

Except stupid people and bad drivers... Ewww!
 
There is no such thing as zero risk, and trying to create the impossible out of good intentions is catastrophic.

If you delay routine physicals, mammograms, colonoscopies, and so forth because some hypothetical person might have asymptomatic COVID-19, you're just shifting the risk to the very real people whose health unquestionably is being endangered by denial of medical services. To protect hypothetical people from a possible risk caused by a theoretical person who might be asymptomatically infected, you're causing actual harm to actual people. But they don't matter. They're expendable.

This sort of myopia is typical of this entire response. Nothing and no one matters except the virus. You've given the virus celebrity status, and no one else's pain, suffering, medical condition, jobs, businesses, nor even their lives, matter anymore.

Neither do the jobs of health care providers who are being laid off and furloughed because the restrictions leave their hospitals with no work for them to do, matter. If they're treating COVID cases, health care workers are heroes. Otherwise, they're expendable, along with their patients.

Rich
I liked your post once, but I'd like to like it more than once.
 
The "so what" is that public health officials are trying to thread the needle between a complete lockdown and free-for-all viral spread by gradually opening up economic activity while monitoring and attempting to control local outbreaks. To do that successfully, you must be doing enough testing to catch local outbreaks before they run away, and you have to reserve enough hospital capacity to isolate and treat the patients from local outbreaks. If you don't test, you don't know what is out there. It's not going to be easy to get it right...the path forward is going to be iterative, with testing, hospital admissions, and mortality statistics guiding policy. The measures will lag inputs by 7-21 days depending on which measure you consider.
Umm ok. It’s time to let it ride. We can’t afford to continue on our current path. The money is gone.
 
I'm all for doing what Sweden did. So let's start with free healthcare and free education. Lets cut our rate of diabetes from 10.80% to 4.8%. Lets cut our rate of obesity from 36.2% to 20.6%. And then we too can not lock down and only experience a covid-19 death rate that is 72 people per 1M population higher than what we currently have. Sign me up.

Note that while Sweden has been doing pretty well compared to nations like Spain and Italy, when compared to its nordic neighbors (probably the most closest comparison possible in population density, access to healthcare, socioeconomic status etc) it is doing ~6x worse on a deaths per million population basis. As you note, Sweden is doing worse than us, by approximately 30% in deaths per million population.

https://www.businessinsider.com/pho...nearly-six-times-that-of-norway-and-finland-3
 
I'm all for doing what Sweden did. So let's start with free healthcare and free education. Lets cut our rate of diabetes from 10.80% to 4.8%. Lets cut our rate of obesity from 36.2% to 20.6%. And then we too can not lock down and only experience a covid-19 death rate that is 72 people per 1M population higher than what we currently have. Sign me up.

Again, you're ignoring the victims of the lockdown itself. Oh wait, I forgot: they don't advance a political agenda, so they don't matter.

Rich
 
Again, you're ignoring the victims of the lockdown itself. Oh wait, I forgot: they don't advance a political agenda, so they don't matter.
I don't have a political agenda. But I have also not seen data that definitively counts victims of the lockdown itself other than by pure speculation.
 
Again, you're ignoring the victims of the lockdown itself....
Economies eventually recover; dead people don't. Will more people will die with lockdowns than without them? I'm not sure we have enough data to answer that question.
 
I don't have a political agenda. But I have also not seen data that definitively counts victims of the lockdown itself other than by pure speculation.

Economies eventually recover; dead people don't. Will more people will die with lockdowns than without them? I'm not sure we have enough data to answer that question.

Again, no one is suggesting that people MUST go about living their lives. We are suggesting that they should be ALLOWED TO go about living their lives, if they want to.

If you're afraid and want to hide under your bed, by all means do so. Isolate yourself completely. Live in a bubble if you like. No one -- NO ONE -- is telling you not to. Seal yourself in a food saver bag if you like. Then you will be absolutely safe from both the virus and freezer burn.

Also for the umpteenth time, every argument against mandatory lockdowns begins with aggressively protecting the most vulnerable, which includes both isolation and all the services they need to endure it. They will not die if they are in isolation, and they are more likely to stay in isolation if we provide services to make it more bearable (unlike the current control-based approach, which provides literally nothing in the way of services).

Most people, if allowed to do so, will choose to go about their lives, but will take the simple precautions needed to protect themselves. If they abide by those precautions, they will not die.

So who will die? Those who are too stupid, arrogant, and reckless to take precautions. Let Darwin deal with them.

Rich
 
Most people, if allowed to do so, will choose to go about their lives, but will take the simple precautions needed to protect themselves.
If that were true, some of the lockdown orders that are currently in effect in my state would not exist.
 
free healthcare and free education

I don’t believe you understand the word free. None of that is free, it all gets paid for by the population. If we taxed at that rate, almost none of could afford to fly.

Sweden’s response is not based on having free services, it is based on a rational approach that does not prevent work, does not require quarantining healthy people for their own good and does not create resentment in the population. It is voluntary, with the ability to get stricter if necessary. the people decide their level of activity.

The objective is herd immunity, but to reach that you have let some people get infected. You cannot reach herd immunity without having some sick people. The voluntary nature means those who have the highest risk can isolate the most.

It should have been apparent weeks ago that we had gone too far because our hospitals have been under utilized. Emergency hospitals were set up and never used.
 
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It should have been apparent weeks ago that we had gone too far because our hospitals have been under utilized. Emergency hospitals were set up and never used.

It may well be true, but I don't think it is apparent at all. One can't assume that the projections of millions of cases and an overwhelmed health system were wrong, simply because it didn't happen after we took measures to prevent it. We've cut the R-number way down by the lockdown and physical distancing measures we've taken, and that has almost certainly done a great deal to mitigate the pandemic. I agree that it's time to start easing those measures - gradually and carefully if we can afford to do it that way. If we can't, if we are facing economic disaster and possible mass starvation if we don't open things up fully right away (I'm not saying that's the case, I'm just saying IF it is), then we HAVE to open things up fully ASAP. But if we do that, we are in uncharted territory and there is no guarantee that we won't be looking at the worst-case scenario that the lockdowns were supposed to prevent.
The objective is herd immunity, but to reach that you have 1) do widespread testing and 2) let some people get infected. You cannot reach herd immunity without having some sick people.

Ultimately, yes, the objective is herd immunity. The best way to achieve it is by vaccination en masse. But we can't do that yet. Whether we should try to do it the way Sweden has, let some people get sick, depends a lot on whether we can tolerate the outcome that they've experienced. Has Sweden achieved herd immunity? What fraction of the population needs to be immune for the still susceptible to be unlikely to be exposed (which is how herd immunity works)? I've heard numbers anywhere from 40% to 90%. If we don't know the answer, I'm not sure that's an experiment we should be conducting unless we have no choice.
 
<SNIP>

It should have been apparent weeks ago that we had gone too far because our hospitals have been under utilized. Emergency hospitals were set up and never used.
The emergency hospitals in Central Park and the Javits center, in NYC, were actually used.
 
How contact tracing can help the U.S. get control over coronavirus

https://www.pbs.org/newshour/health...can-help-the-u-s-get-control-over-coronavirus
Contract tracing may work in areas where people don't have much contact with strangers, but not so much in others. I went on a long walk yesterday (about 10 miles), then decided to take the bus home. That was interesting. No social distancing. Most seats were full except for the ones near sketchy people. Passengers are supposed to wear a mask, but that is impossible to enforce because they are also supposed to board through the rear doors unless they need the "kneeling bus" function. This is in order to protect the driver. Even in better days, the front door was mostly used for elderly, handicapped, and those who paid with cash. This was my first bus ride since lockdown (March 17). Not sure how contract tracing will work in these situations, and I was closer to these people than I have been to anyone else through the period.
 
I don’t believe you understand the word free. None of that is free, it all gets paid for by the population. If we taxed at that rate, almost none of could afford to fly.

Sweden’s response is not based on having free services, it is based on a rational approach that does not prevent work, does not require quarantining healthy people for their own good and does not create resentment in the population. It is voluntary, with the ability to get stricter if necessary. the people decide their level of activity.

The objective is herd immunity, but to reach that you have let some people get infected. You cannot reach herd immunity without having some sick people. The voluntary nature means those who have the highest risk can isolate the most.

It should have been apparent weeks ago that we had gone too far because our hospitals have been under utilized. Emergency hospitals were set up and never used.
And we will pay for the huge bailout with the dollars already in our pocket. Money dilution.
 
Economies eventually recover; dead people don't. Will more people will die with lockdowns than without them? I'm not sure we have enough data to answer that question.

You do actually. With the same hospital care available to all, nothing changes the death rate. Just the amount of time over which they occur.

Better treatments over time only appear to have a very tiny, if even statistically significant impact.

Full lockdowns slow the infection rate, but it’ll get around eventually. We’re seeing this in the food supply chain now and the even more locked down with heavy procedures nursing home death rate being, at least in my home state, roughly half of all deaths.

The macro numbers are more than clear right now. People are still stuck at the inaccurate motion pushed early on that this is a maximum two month event. The infection rate math here in my State, showed 1.75 years at full lockdown.

The other known is that testing 320 million people isn’t a two month event either. Various societal bigger problems crop up long before that process even can get into anything resembling full swing.

So from a systems triage standpoint, you’ve got plenty of data. Throttle hospitals below overload with opening up, and expect hot spots and closures and cleanings and reopenings for a year.

If we had a society that valued savings for a rainy day and wasn’t $12T in consumer debt, you’d have more options, but we already know theee households at significant risk of mortgage non-payment who won’t be able to recover from how far behind they would get in more than say maybe, three months? And they’re 1/3 of the way there.

They won’t be staying home by June. They also won’t be out licking their fingers and sticking them in grandpa’s eye either. LOL.

They’ll learn the same techniques my nurse wife has been using to not only be within six feet of, but touching, a hundred people a week, knowing it’s the best they can do... and they’ll let nature run its course. If they can stay home three days between outings without symptoms, they will, and they’ll know they’re not carrying anything to anybody. If grandpa lives at home, they’ve either already learned to change their clothes walking in at night, and keeping grandpa out of the clothes hamper, and washing up before the evening welcome home hug. After that, they can wipe down all the items that come in from outside and such, to whatever level of paranoia they feel is adequate.

Just like a house with a person prepping for transplant surgery on immune suppressants. All sorts of people know how and do this stuff every day.

Adaptation to environment is what humans do. Big fat brains and weak bodies and we are still here. Going to have to think harder.

We just aren’t used to the lion snagging the weak and old zebras from the edge of the herd quite as hard as nature feels like doing right now.

Which hand did you contaminate grabbing that door handle? Not too hard to start noticing. Wash it off before you pick your nose with it. :)

Any nurse can teach and tell ya where you need practice on your cross-contamination skillset to whatever level you like.

Having lived with one for a lifetime, get ready to enjoy the smell of bleach or seeing weird streaks from stronger chemical wipes on surfaces. :)

I knew not to dig around in her scrubs hamper decades ago though. Once you learn what a Code Brown is... LOL.

Plenty of data for triage for sure, though.

Certain incompatible businesses and events, but people can choose their own risk level. We let people ride motorcycles in rush hour traffic if they please, and fly those dangerous little airplanes with reasonable rules that pretend to keep them from crashing into the school bus full of kiddies and nuns.

Doesn’t take much to know you’re not killing anybody if you can do three days between outings. My “essential” cant and hasn’t changed her schedule in over 50 days while touching hundreds of people, so ask the medical cuties how they’re not killing anybody and get on with whatever you truly *need* to do.

It ain’t rocket science. Anybody who van pre-flight an airplane can learn this stuff. Anybody who screws it up is running some small risk of initial infection until they wash up properly, and a less than 1% chance of death after that.

Stop licking door handles, if that was ever your thing. But even then, might be nicer to be sick in summer months than fall or winter. Choose your own adventure on that one. :)

The critical mindset change needed is this isn’t a two week or even a two month event. Get prepped for the long game, and if something comes along to change it, so be it. If not, you’re adapted and unstuck from the inaccurate initial marketing of “flattening the curve”.

It’s flat. Now it’s linear. Well probably bumpy more than linear. Open, infection, maybe rate accelerating too fast, close, clean, repeat.

Fly the airplane. Current death rate is about 1M people dead when it’s over, which is better than expected already. 1% is 3.2M in the US.

Virus is taking whoever it wants to. We know a 97 year old who recovered and a healthy 21 year old who’s dead. Both followed all the rules.

Another look ahead. At some magic number tested and known infected — for fun let’s just say it’s 50%. Half the population stops worrying about it and decides if you haven’t tested positive, it’s not really their problem anymore.

Another one: Inaccurate tests. You can get one right now for $119 anywhere. Can you live with the margin of error?

Hate to say that but humans aren’t particularly nice about such things, in general. You’ll be lucky if you can keep half of them wearing masks. Especially if you get into fall and they have a nasty cold. Ain’t nobody filling their cloth mask that’s doing nothing for them, with snot for ya. LOL.

Think three moves ahead. Chess. The next checkpoint. Whatever you want to call it. The current status isn’t anywhere even close to the end game on this thing.

Vaccine? Maybe. Vaccine that only partially works? Very likely. Now what? Brain been there yet? Ten miles ahead of where this airplane is right now? :)

Better push it out there. Figure out what you van without a chart or flight plan, because you’re months away from one.

And lots of other humans will change behavior in a fairly predictable way before you get there. Especially if they need to eat. No reason to be surprised by it.

$1200 FreeBucks ain’t gonna cut it. We all knew that the day it was announced.

Welcome to nursing school! :) Today’s lesson. Don’t eat your cheeseburger in your car with your gloves still on, like the lady who’s photo is being circulated. You’re probably going to have a bad day. :)

Wifey loved that photo. I believe her reaction went something like, “WTF is she doing?!” :)
 
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