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Experts consider how long the coronavirus crisis will last — and how we'll get out of it

County, state health officials say COVID-19 cases could peak by early May

We're in for a grim April and a harsh May before we approach some new kind of normalcy.

That's the message that has been imbedded in statistical models, white papers and pronouncements made by governors, mayors and White House advisers over the eerily quiet and brutally long two weeks that stretched from March 16, when Santa Clara County and five other Bay Area counties first ordered residents to stay at home due to the coronavirus outbreak, to this past Tuesday, when the counties extended the order to May 3.

But while the initial Bay Area shutdown seemed jarring, the March 31 extension felt almost inevitable. Between the two orders, the number of confirmed cases in the county jumped from 138 to 890 and the number of deaths from COVID-19 went from three to 30. Bay Area schools officially shuttered for the rest of the academic year; and U.S. President Donald Trump abruptly pivoted from a bullish plan to reopen the country by Easter to declaring on Tuesday, "This is going to be three weeks like we've never seen before."

While health experts are reluctant to answer the elusive question "How long will the outbreak last?" with any degree of certainty or specificity, most measures indicate that Santa Clara County, like the state and the nation, will see a sharp increase in cases in April and early May before things begin to level off.

Health officials have been reluctant to predict the duration of the outbreak, partly because the lack of widespread testing makes it difficult to know how many people in the county are infected. County Executive Jeffrey Smith said on March 24 that he believes that based on modeling done thus far, the number of infected persons is probably at least 5,000. (The county's confirmed number of cases on April 2 was only 1,019, however.)

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Testing remains far from widespread, despite efforts to boost supplies of tests by academic institutions like Stanford University and University of California, San Francisco and commercial firms such as Abbott, Roche and Quest Diagnostics.

Some experts estimate the peak in cases could happen earlier or later — in part varying by location. Santa Clara County health leaders say a local surge will start by mid-April, but Dr. Mark Ghaly, the state's secretary of health and human services, projected a peak in the state as a whole in mid-May. Both state and county leaders have refused to publicly release details regarding their modeling, saying they prefer to reserve those models for internal decision making.

The Institute for Health Metrics and Evaluation, which is part of University of Washington, created a model for every state in the nation. On April 3, it predicted that in California, the COVID-19 curve showing numbers of cases will peak on April 26, when the state would see 119 deaths that day related to the virus. Under this model, the number of daily deaths would then gradually go down to 16 on June 1 and then dip to single digits by mid-June.

At best, experts can only take an educated guess based on "assumptions" and prepare for the worst, they said.

"Nobody knows," Dr. Yvonne Maldonado, medical director of infection control at Lucile Packard Children's Hospital and Stanford professor of pediatric infectious diseases and health research and policy, said this week when asked about the projected peak and when the crisis might end.

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"Two weeks ago, experts said we would be like Italy. Two weeks have passed and we are not like Italy. On the other hand, we could be like New York or New Jersey," she said.

The virus might be distributed differently across the Bay Area, making predictions difficult, Maldonado said. Some communities may have a higher infection rate, others a lower one. Demographics, levels of health within communities and populations, access to medical care, the movement of people and daily behaviors can all affect how the virus spreads.

There are some officials who are willing to openly predict numbers. The city of San Jose's manager's office reported grim estimates for Santa Clara County at the March 24 City Council meeting, estimating 2,000 to 16,000 deaths and 9,000 to 19,000 people who could be ill in the next 12 weeks out of a population of 1.94 million. County public health leaders, however, distanced themselves in a single-paragraph statement the next day, saying they hadn't vetted the information and were studying it.

On April 1, San Jose Mayor Sam Liccardo voiced support for the data, noting the city manager's office had presented it to Smith prior to releasing it. Emails show the county did not dispute the data so long as it was clear the numbers were based on assumptions. And those estimates and assumptions were fundamentally correct, Liccardo said, even as City Manager David Sykes conceded the county and the city were not completely "in sync."

Despite those worrisome projections, county health leaders say they are starting to see signs of hope. Local hospitals are not yet nearing their capacity and are not seeing the types of shortages of personal protective equipment needed by health care workers as in New York and Michigan.

Dr. Dean Winslow, professor of medicine in the division of hospital medicine, division of infectious diseases and geographic medicine at Stanford University School of Medicine, said Tuesday that about 33 patients at Stanford had been admitted for suspected COVID-19 infections. About half are confirmed cases; a smaller number tested negative. The rest of the results are still pending.

And among the county's 11 hospitals, which have 1,475 beds, there were 152 confirmed COVID-19 patients and another 90 who were suspected of having COVID-19 on March 30, according to Smith.

On March 31, even as county Health Officer Sara Cody announced the extension of the stay-at-home order and added new restrictions — including a clamp down on nonessential construction activities and new requirements for businesses to post plans for keeping their facilities safe — she said there are signs that the order is working and that the spread of the virus is slowing.

"We have some signs, some very soft signs, but I think the train is beginning to slow down a little bit," Cody said.

"What we need to see is that our demand curve — which is how many people are ill, requiring hospitalization and ICU care — comes to a place where it's comfortably nestled under our supply curve," Cody said, referring to the supply of beds, staff and medical equipment that is needed to properly take care of the patients.

"It's a complex balance. I want to say that bringing in the data to understand all the needs in our health care system — be they supplies of beds, or staff or personal protective equipment — is fairly complex, as is understanding the trajectory of the epidemic in our county."

Looking at the coming months

Any estimate of when the pandemic will end is inherently fuzzy, given that the determination depends on myriad variables, including availability of testing for COVID-19, hospital capacity, and effectiveness of social-distancing measures.

Andy Slavitt, who served as acting administrator for Centers of Medicare and Medicaid Services during the Obama administration and who now heads the organization United States of Care, suggested in a March 28 post on Medium that social-distancing measures would probably need to remain in place through May or even into June to slow the spread of the virus.

"If we buckle down (6 to 10 weeks?) with social isolation, the curve flattens and, in a really strong effort, can decline. If we let up, we are in for a very rocky and lethal extended period of time," Slavitt wrote.

A recent analysis by National Geographic of how different cities handled the 1918 influenza pandemic shows the devastating impacts of halting social-distancing measures too soon. San Francisco did so immediately after its count of daily casualties dropped, only to see a second wave about a month later. It ended up with 673 deaths per 100,000 residents, according to the analysis. New York City, which kept its measures in place for longer, had 452 deaths per 100,000 over the same period.

"A delay or letting up a little early on social distancing means lives lost," Slavitt wrote, pointing to the data.

Stanford health experts echo that sentiment.

"We really need to be very careful not to relax measures too early," Winslow said.

Testing has lagged throughout the state, and that's a major concern, he said. Asymptomatic people who are still carriers are being neither tested nor tracked. There's also no significant understanding of who is potentially already immune — two pieces of critical missing data to understanding the outbreak, he said.

Winslow and Maldonado said predictive models to determine if there could be a resurgence of the disease also aren't reliable at this point, and they urged caution.

Some analysts see a way we can ease out of the current economic and social crisis while also keeping an eye on public health.

A new white paper from the American Enterprise Institute, a conservative-leaning think tank, proposes a phased "roadmap" for getting out of the pandemic. In the first stage, governments impose social distancing measures such as bans on public gatherings, stay-at-home advisories and isolation of COVID-19 cases either at home or at hospitals, allowing communities to flatten the curve. During this time, the health care system ramps up its capacity and obtains life-saving ventilators, personal protective equipment and other critical medical tools.

The paper's authors, a list that includes three former FDA officials as well as Johns Hopkins Center for Health Security epidemiologist Caitlin Rivers and Johns Hopkins health security expert Crystal Watson, propose remaining in this stage until there's a decrease in cases for 14 consecutive days; hospitals are safely able to treat all patients that require hospitalization; and each state has enough tests for people with COVID-19 symptoms. The paper estimates that the country would need to produce about 750,000 tests per week — a number based on the testing ratio in South Korea, a nation lauded for its quick and effective response to the pandemic.

Once these goals are met, the nation can move to the next stage, in which schools can reopen and most people can start going back to work. Physical-distancing restrictions would be gradually lifted, though not eliminated, until the third stage, when a vaccine is developed.

(At a Wednesday news briefing, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease and top White House adviser on the pandemic, called the development of a vaccine "the ultimate solution" to keeping the coronavirus from coming back.)

The American Enterprise Institute paper argues for a slow and gradual progression between phases, done on a state-by-state basis. Furthermore, a state that reopens should revert to the first phase "if a substantial number of cases cannot be traced back to known cases, if there is a sustained rise in new cases for five days, or if hospitals in the state are no longer able to safely treat all patients requiring hospitalization."

In other words, states may need to go through another cycle of social-distancing measures if the nation has not yet developed and scaled up production of a COVID-19 vaccine.

Getting to the end point

Stanford University biologist Erin Mordecai and her team have likewise been modeling scenarios for the critical period between June, when the surge is expected to abate, and July 2021, when a vaccine would presumably be in place.

But like the American Enterprise Institute, Mordecai's team sought to identify ways to get society back to its normal rhythms before the vaccine is created.

"The idea of a shelter-in-place for a year or more doesn't seem feasible," Mordecai said. "We were interested in a possible alternative to just having everyone stay home for a very long time."

Their modeling suggests that the most effective approach may require repeated social-distancing interventions, with strategies quickly adapting to the situation on the ground.

The models also indicate that launching social-distancing interventions early in the epidemic cycle is more critical than the severity of the social measures imposed.

Hence she and her team created the "lightswitch" approach. Under this concept, social-distancing measures are gradually added or removed over the course of the year, based on the fluctuations in numbers of COVID-19 cases. On one end of the scale are strict interventions like quarantines and fines for people who flout stay-at-home orders. On the other, public life starts to open up while restrictions remain in place for vulnerable populations and people with COVID-19.

"You can turn on and off social-distancing interventions over time," Mordecai said.

Such an approach, she said, would require "very careful surveillance," enabling authorities to quickly intervene if the number of hospitalized COVID-19 patients creeps up.

"We can use that as a benchmark. Do you exceed hospital capacity? Then we may need a shelter-in-place. Will hospitalizations go down? Then we can resume normal activities."

(The team's interactive website, covid-measures.github.io, allows users to test out intervention strategies by plotting two — one after the outbreak and another one later in the year — and seeing the impacts of these strategies on hospitalizations, infections, recoveries and deaths.)

While much is being discussed about effective strategies for handling the outbreak and the best ways to get us at an endpoint, health experts can only speculate about whether the new coronavirus will mutate and continue to plague our lives.

Maldonado noted that COVID-19 is related to six other coronaviruses, including the common cold. Some of those mutate over time and come back; others don't.

The 2003 Severe Acute Respiratory Syndrome (SARS) coronavirus, which sickened 8,000 people and killed nearly 800, never came back after 16 years, although some thought it would. The 2012 Middle East respiratory syndrome-related coronavirus (MERS) did reappear, although not at a high level because it was transmitted only through contact with camels.

COVID-19 is highly contagious, which gives Maldonado pause.

"It's highly possible we'll see it again," she said. "That's why we need to develop antivirals and a vaccine."

Find comprehensive coverage on the Midpeninsula's response to the new coronavirus by Palo Alto Online, the Mountain View Voice and the Almanac here.

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Experts consider how long the coronavirus crisis will last — and how we'll get out of it

County, state health officials say COVID-19 cases could peak by early May

by / Palo Alto Weekly

Uploaded: Mon, Apr 6, 2020, 5:41 pm

We're in for a grim April and a harsh May before we approach some new kind of normalcy.

That's the message that has been imbedded in statistical models, white papers and pronouncements made by governors, mayors and White House advisers over the eerily quiet and brutally long two weeks that stretched from March 16, when Santa Clara County and five other Bay Area counties first ordered residents to stay at home due to the coronavirus outbreak, to this past Tuesday, when the counties extended the order to May 3.

But while the initial Bay Area shutdown seemed jarring, the March 31 extension felt almost inevitable. Between the two orders, the number of confirmed cases in the county jumped from 138 to 890 and the number of deaths from COVID-19 went from three to 30. Bay Area schools officially shuttered for the rest of the academic year; and U.S. President Donald Trump abruptly pivoted from a bullish plan to reopen the country by Easter to declaring on Tuesday, "This is going to be three weeks like we've never seen before."

While health experts are reluctant to answer the elusive question "How long will the outbreak last?" with any degree of certainty or specificity, most measures indicate that Santa Clara County, like the state and the nation, will see a sharp increase in cases in April and early May before things begin to level off.

Health officials have been reluctant to predict the duration of the outbreak, partly because the lack of widespread testing makes it difficult to know how many people in the county are infected. County Executive Jeffrey Smith said on March 24 that he believes that based on modeling done thus far, the number of infected persons is probably at least 5,000. (The county's confirmed number of cases on April 2 was only 1,019, however.)

Testing remains far from widespread, despite efforts to boost supplies of tests by academic institutions like Stanford University and University of California, San Francisco and commercial firms such as Abbott, Roche and Quest Diagnostics.

Some experts estimate the peak in cases could happen earlier or later — in part varying by location. Santa Clara County health leaders say a local surge will start by mid-April, but Dr. Mark Ghaly, the state's secretary of health and human services, projected a peak in the state as a whole in mid-May. Both state and county leaders have refused to publicly release details regarding their modeling, saying they prefer to reserve those models for internal decision making.

The Institute for Health Metrics and Evaluation, which is part of University of Washington, created a model for every state in the nation. On April 3, it predicted that in California, the COVID-19 curve showing numbers of cases will peak on April 26, when the state would see 119 deaths that day related to the virus. Under this model, the number of daily deaths would then gradually go down to 16 on June 1 and then dip to single digits by mid-June.

At best, experts can only take an educated guess based on "assumptions" and prepare for the worst, they said.

"Nobody knows," Dr. Yvonne Maldonado, medical director of infection control at Lucile Packard Children's Hospital and Stanford professor of pediatric infectious diseases and health research and policy, said this week when asked about the projected peak and when the crisis might end.

"Two weeks ago, experts said we would be like Italy. Two weeks have passed and we are not like Italy. On the other hand, we could be like New York or New Jersey," she said.

The virus might be distributed differently across the Bay Area, making predictions difficult, Maldonado said. Some communities may have a higher infection rate, others a lower one. Demographics, levels of health within communities and populations, access to medical care, the movement of people and daily behaviors can all affect how the virus spreads.

There are some officials who are willing to openly predict numbers. The city of San Jose's manager's office reported grim estimates for Santa Clara County at the March 24 City Council meeting, estimating 2,000 to 16,000 deaths and 9,000 to 19,000 people who could be ill in the next 12 weeks out of a population of 1.94 million. County public health leaders, however, distanced themselves in a single-paragraph statement the next day, saying they hadn't vetted the information and were studying it.

On April 1, San Jose Mayor Sam Liccardo voiced support for the data, noting the city manager's office had presented it to Smith prior to releasing it. Emails show the county did not dispute the data so long as it was clear the numbers were based on assumptions. And those estimates and assumptions were fundamentally correct, Liccardo said, even as City Manager David Sykes conceded the county and the city were not completely "in sync."

Despite those worrisome projections, county health leaders say they are starting to see signs of hope. Local hospitals are not yet nearing their capacity and are not seeing the types of shortages of personal protective equipment needed by health care workers as in New York and Michigan.

Dr. Dean Winslow, professor of medicine in the division of hospital medicine, division of infectious diseases and geographic medicine at Stanford University School of Medicine, said Tuesday that about 33 patients at Stanford had been admitted for suspected COVID-19 infections. About half are confirmed cases; a smaller number tested negative. The rest of the results are still pending.

And among the county's 11 hospitals, which have 1,475 beds, there were 152 confirmed COVID-19 patients and another 90 who were suspected of having COVID-19 on March 30, according to Smith.

On March 31, even as county Health Officer Sara Cody announced the extension of the stay-at-home order and added new restrictions — including a clamp down on nonessential construction activities and new requirements for businesses to post plans for keeping their facilities safe — she said there are signs that the order is working and that the spread of the virus is slowing.

"We have some signs, some very soft signs, but I think the train is beginning to slow down a little bit," Cody said.

"What we need to see is that our demand curve — which is how many people are ill, requiring hospitalization and ICU care — comes to a place where it's comfortably nestled under our supply curve," Cody said, referring to the supply of beds, staff and medical equipment that is needed to properly take care of the patients.

"It's a complex balance. I want to say that bringing in the data to understand all the needs in our health care system — be they supplies of beds, or staff or personal protective equipment — is fairly complex, as is understanding the trajectory of the epidemic in our county."

Looking at the coming months

Any estimate of when the pandemic will end is inherently fuzzy, given that the determination depends on myriad variables, including availability of testing for COVID-19, hospital capacity, and effectiveness of social-distancing measures.

Andy Slavitt, who served as acting administrator for Centers of Medicare and Medicaid Services during the Obama administration and who now heads the organization United States of Care, suggested in a March 28 post on Medium that social-distancing measures would probably need to remain in place through May or even into June to slow the spread of the virus.

"If we buckle down (6 to 10 weeks?) with social isolation, the curve flattens and, in a really strong effort, can decline. If we let up, we are in for a very rocky and lethal extended period of time," Slavitt wrote.

A recent analysis by National Geographic of how different cities handled the 1918 influenza pandemic shows the devastating impacts of halting social-distancing measures too soon. San Francisco did so immediately after its count of daily casualties dropped, only to see a second wave about a month later. It ended up with 673 deaths per 100,000 residents, according to the analysis. New York City, which kept its measures in place for longer, had 452 deaths per 100,000 over the same period.

"A delay or letting up a little early on social distancing means lives lost," Slavitt wrote, pointing to the data.

Stanford health experts echo that sentiment.

"We really need to be very careful not to relax measures too early," Winslow said.

Testing has lagged throughout the state, and that's a major concern, he said. Asymptomatic people who are still carriers are being neither tested nor tracked. There's also no significant understanding of who is potentially already immune — two pieces of critical missing data to understanding the outbreak, he said.

Winslow and Maldonado said predictive models to determine if there could be a resurgence of the disease also aren't reliable at this point, and they urged caution.

Some analysts see a way we can ease out of the current economic and social crisis while also keeping an eye on public health.

A new white paper from the American Enterprise Institute, a conservative-leaning think tank, proposes a phased "roadmap" for getting out of the pandemic. In the first stage, governments impose social distancing measures such as bans on public gatherings, stay-at-home advisories and isolation of COVID-19 cases either at home or at hospitals, allowing communities to flatten the curve. During this time, the health care system ramps up its capacity and obtains life-saving ventilators, personal protective equipment and other critical medical tools.

The paper's authors, a list that includes three former FDA officials as well as Johns Hopkins Center for Health Security epidemiologist Caitlin Rivers and Johns Hopkins health security expert Crystal Watson, propose remaining in this stage until there's a decrease in cases for 14 consecutive days; hospitals are safely able to treat all patients that require hospitalization; and each state has enough tests for people with COVID-19 symptoms. The paper estimates that the country would need to produce about 750,000 tests per week — a number based on the testing ratio in South Korea, a nation lauded for its quick and effective response to the pandemic.

Once these goals are met, the nation can move to the next stage, in which schools can reopen and most people can start going back to work. Physical-distancing restrictions would be gradually lifted, though not eliminated, until the third stage, when a vaccine is developed.

(At a Wednesday news briefing, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease and top White House adviser on the pandemic, called the development of a vaccine "the ultimate solution" to keeping the coronavirus from coming back.)

The American Enterprise Institute paper argues for a slow and gradual progression between phases, done on a state-by-state basis. Furthermore, a state that reopens should revert to the first phase "if a substantial number of cases cannot be traced back to known cases, if there is a sustained rise in new cases for five days, or if hospitals in the state are no longer able to safely treat all patients requiring hospitalization."

In other words, states may need to go through another cycle of social-distancing measures if the nation has not yet developed and scaled up production of a COVID-19 vaccine.

Getting to the end point

Stanford University biologist Erin Mordecai and her team have likewise been modeling scenarios for the critical period between June, when the surge is expected to abate, and July 2021, when a vaccine would presumably be in place.

But like the American Enterprise Institute, Mordecai's team sought to identify ways to get society back to its normal rhythms before the vaccine is created.

"The idea of a shelter-in-place for a year or more doesn't seem feasible," Mordecai said. "We were interested in a possible alternative to just having everyone stay home for a very long time."

Their modeling suggests that the most effective approach may require repeated social-distancing interventions, with strategies quickly adapting to the situation on the ground.

The models also indicate that launching social-distancing interventions early in the epidemic cycle is more critical than the severity of the social measures imposed.

Hence she and her team created the "lightswitch" approach. Under this concept, social-distancing measures are gradually added or removed over the course of the year, based on the fluctuations in numbers of COVID-19 cases. On one end of the scale are strict interventions like quarantines and fines for people who flout stay-at-home orders. On the other, public life starts to open up while restrictions remain in place for vulnerable populations and people with COVID-19.

"You can turn on and off social-distancing interventions over time," Mordecai said.

Such an approach, she said, would require "very careful surveillance," enabling authorities to quickly intervene if the number of hospitalized COVID-19 patients creeps up.

"We can use that as a benchmark. Do you exceed hospital capacity? Then we may need a shelter-in-place. Will hospitalizations go down? Then we can resume normal activities."

(The team's interactive website, covid-measures.github.io, allows users to test out intervention strategies by plotting two — one after the outbreak and another one later in the year — and seeing the impacts of these strategies on hospitalizations, infections, recoveries and deaths.)

While much is being discussed about effective strategies for handling the outbreak and the best ways to get us at an endpoint, health experts can only speculate about whether the new coronavirus will mutate and continue to plague our lives.

Maldonado noted that COVID-19 is related to six other coronaviruses, including the common cold. Some of those mutate over time and come back; others don't.

The 2003 Severe Acute Respiratory Syndrome (SARS) coronavirus, which sickened 8,000 people and killed nearly 800, never came back after 16 years, although some thought it would. The 2012 Middle East respiratory syndrome-related coronavirus (MERS) did reappear, although not at a high level because it was transmitted only through contact with camels.

COVID-19 is highly contagious, which gives Maldonado pause.

"It's highly possible we'll see it again," she said. "That's why we need to develop antivirals and a vaccine."

Find comprehensive coverage on the Midpeninsula's response to the new coronavirus by Palo Alto Online, the Mountain View Voice and the Almanac here.

Comments

Common sense
Cuesta Park
on Apr 7, 2020 at 10:28 am
Common sense, Cuesta Park
on Apr 7, 2020 at 10:28 am

Local leaders' lack of transparency around their modeling suggests that they are trying to hide the ball and keep the general population held at their whim. By all accounts, the local situation is rapidly improving and either has peaked or will peak within just a few days. The bay area and CA's approaches have been successful and local leaders get credit for that. The medical system should continue focusing on helping those who are sick, and the politicians should now turn to the much more difficult task of helping guide a slow return to normal (and be transparent in doing so). Of course there is concern about return to normal too quickly, but no reason to not be transparent about those risks and what the model says about doing so.

BTW, what is the status of Gov Newsom's "rapid test" that was going to be approved "within hours" as of Saturday???


Gary
Sylvan Park
on Apr 7, 2020 at 11:20 am
Gary, Sylvan Park
on Apr 7, 2020 at 11:20 am

There appears to be grave uncertainty about who and what can carry and transmit this virus. It is highly contagious, pummels many recipients and kills others. And the animal kingdom alone has an estimated 600,000 different viruses - many of which could "jump" to humans. Socially, the world and nation must reconsider the wisdom of gathering by the hundreds or thousands at school or at work. That means we need learning and working remotely as a model - or at least an option. Sporting events and Happy New Years in Times Square can be scheduled but cancelled in response to threats - if organizers see them coming. But there surely are even more contagious and deadly viruses no one will see coming and they could spread from, for example, the Olympics to the whole world in short order. So, another lesson here is that risky practices around the world place the whole world at risk. Whether it's buying live animals to eat in mainland China or allowing North Korea to expand its nuclear arsenal and develop inter-continental delivery systems or ignoring the causes of climate change, what happens elsewhere threatens the lives of Americans and the continued existence of this political and economic house-of- cards. Certainly, for one thing, we should get and support candidates for important political offices - starting with President and Vice-President - who will give high priority to heading off and preparing for global threats to lives, the country and the human race.


Common sense, or just literacy?
Blossom Valley
on Apr 7, 2020 at 11:29 am
Common sense, or just literacy?, Blossom Valley
on Apr 7, 2020 at 11:29 am

> By all accounts, the local situation is rapidly improving and either has peaked or will peak within just a few days.

Peaked? Please supply all the "accounts" who think we've peaked or will peak in a few days. Maybe the top three who claimed we've "peaked"? I must have missed them.

.....

> what is the status of Gov Newsom's "rapid test" that was going to be approved "within hours"

"But I want to caution people," California Gov. Gavin Newsom said (Saturday) of what he said were the small number of Abbott tests his state had received. "It's an insignificant total amount of tests that we can produce in five to 15 minutes in California."

Do you have a link to your claim? Perhaps you misread the reports.


The Business Man
Castro City
on Apr 7, 2020 at 11:29 am
The Business Man, Castro City
on Apr 7, 2020 at 11:29 am

In response to Common sense you said:

“Local leaders' lack of transparency around their modeling suggests that they are trying to hide the ball and keep the general population held at their whim.”

Actually their transparency is very good, because NO ONE knows how long this will have to last given that there is NO TREATMENT or VACCINE for the COVID 19 Virus. You said:

“By all accounts, the local situation is rapidly improving and either has peaked or will peak within just a few days.”

What evidence do you have to prove this? This is like Donald Trump saying that they have medicines to treat this virus when in fact they don’t. What medical degree do you have and what experiments do you have to prove this? You said:

“The bay area and CA's approaches have been successful and local leaders get credit for that. The medical system should continue focusing on helping those who are sick, and the politicians should now turn to the much more difficult task of helping guide a slow return to normal (and be transparent in doing so).”

We cannot do that until there is a TREATMENT or VACCINE. Otherwise you just want to get people to work and GAMBLE that their health will be at RISK. SORRY, even though so many groups want to stop this order because it is damaging the economy, PUBLIC HEALTH comes FIRST. The report still indicates that we are at least a year away from a vaccine.
Of course there is concern about return to normal too quickly, but no reason to not be transparent about those risks and what the model says about doing so.

Again let’s say that 1.9 Million people are tested and as of now 380,000 people are positive and we have an under counted deaths of 11,850. This means that 20% of people are testing positive and .6% are dying.

This means that out of 330 Million Americans, 66 Million people are likely infected as of now and that 1,980,000 people at this time can die. And if we stop the social distancing we will just reactivate the lack of control over infection.

WHY ARE WE LISTENING TO THE ECONOMIC THINK TANK REGARDING PUBLIC HEALTH? Again PUBLIC HEALTH “TRUMPS” ECONOMICS EVERY DAY AND TWICE ON SUNDAY.


Billy Bob
Bailey Park
on Apr 7, 2020 at 1:29 pm
Billy Bob, Bailey Park
on Apr 7, 2020 at 1:29 pm

[Post removed due to disrespectful comment or offensive language]


The Business Man
Castro City
on Apr 7, 2020 at 3:31 pm
The Business Man, Castro City
on Apr 7, 2020 at 3:31 pm

In response to Billy Bob

I had a life before the virus hit.

I had a job I was going to have to move to take, but the VIRUS prevented me from getting it.

I had a life because I had friends and social groups I was able to participate it. The VIRUS killed that.

But now, I am stuck at home. The VIRUS did this to me. So I am doing what I can to be constructive and discuss the topic based on reasonable statistics. Please do the same for us?


Common sense
Cuesta Park
on Apr 7, 2020 at 4:54 pm
Common sense, Cuesta Park
on Apr 7, 2020 at 4:54 pm

@Common sense, or just literacy?

Re the # of cases, and in particular severe cases, being at or near the peak see any of the publicly available local data (including the Santa Clara County dashboard) or follow the insights of Dr. Bob Wachter @ USCF. On the west coast, the data is unambiguous that we should all be cautiously optimistic. If politicians have data to the contrary, they should be transparent about it.

Re Gov. Newsom's statements over the weekend about tests being approved within hours, see among others: Web Link "The Stanford serology test is expected to be rolled out next week and will help the state with increased testing capabilities, said Dean of the state’s public health department. However, the test was still awaiting federal approval as of Saturday. Newsom said he expects the test to be approved “within hours.”


Common sense, or just literacy?
Blossom Valley
on Apr 7, 2020 at 6:02 pm
Common sense, or just literacy?, Blossom Valley
on Apr 7, 2020 at 6:02 pm

> However, the test was still awaiting *** FEDERAL *** approval as of Saturday. Newsom said he expects the test to be approved “within hours.”

is a lot different than the way you framed it:

"BTW, what is the status of Gov Newsom's "rapid test" that was going to be approved "within hours" as of Saturday???"

He's waiting on the Feds, fercrissakes. Is this your first rodeo?

...

Still waiting for your accounts who you claimed they said we've peaked.

" Please supply all the "accounts" who think we've peaked or will peak in a few days. Maybe the top three who claimed we've "peaked"? "

Wachter ain't it.

"There was “reasonably good evidence of some flattening of the curve,” Dr. Bob Wachter, ... told the New York Times last week.

Still, as of the end of last week, Bay Area counties had topped 3,000 cases, and mounting."

Your backpedaling at least gets you a lot of good exercise!




Common sense
Cuesta Park
on Apr 8, 2020 at 8:55 am
Common sense, Cuesta Park
on Apr 8, 2020 at 8:55 am

@Common sense, or just literacy?

"Re: > However, the test was still awaiting *** FEDERAL *** approval as of Saturday. Newsom said he expects the test to be approved “within hours.”

is a lot different than the way you framed it:

"BTW, what is the status of Gov Newsom's "rapid test" that was going to be approved "within hours" as of Saturday???"

He's waiting on the Feds, fercrissakes. Is this your first rodeo?"

Not sure what wasn't clear to you about the original point - obviously Newsom was talking about the Feds but it doesn't change the fact that there hasn't been an update at least as of last night. I never said this was within Newsom's control.


Re "Still waiting for your accounts who you claimed they said we've peaked.

" Please supply all the "accounts" who think we've peaked or will peak in a few days. Maybe the top three who claimed we've "peaked"? "

Wachter ain't it.

"There was “reasonably good evidence of some flattening of the curve,” Dr. Bob Wachter, ... told the New York Times last week.

Still, as of the end of last week, Bay Area counties had topped 3,000 cases, and mounting."

Your backpedaling at least gets you a lot of good exercise!"

You should follow Wachter and other data sources more closely. Yesterday Wachter emphasized in multiple venues that CA has flattened the curve. Or, if you don't believe him, you can look at covid19.healthdata.org, which predicts 5 days until peak resource use - resource use lags at least critical cases. Or, if you still don't believe that data you can see the 91-divoc.com visualizations, which show a dramatic leveling off of cases in California, much like Washington.

For one who accuses others of lacking literacy, you miss key point: the medical professionals now have the current health emergency under control on the west coast and while we still need to be very cautious, local political leaders need to start thinking through phase two: how we are going to ease back into something resembling normal. Our mutual friend Dr. Wachter was making the same point yesterday.


Common sense, or just literacy?
Blossom Valley
on Apr 8, 2020 at 9:14 am
Common sense, or just literacy?, Blossom Valley
on Apr 8, 2020 at 9:14 am

> By all accounts, the local situation is rapidly improving and either has peaked or will peak within just a few days

Even Wachter isn't calling it the peak. And you said "all accounts". Changing the frame to "well, it's flattening" isn't the same as "all accounts ... has peaked or will peak within just a few days"

Keep backpedaling.

At a safe distance, of course.

;-)


It will be prolonged here
Another Mountain View Neighborhood
on Apr 8, 2020 at 9:58 am
It will be prolonged here, Another Mountain View Neighborhood
on Apr 8, 2020 at 9:58 am

The cross community contamination going on via Rancho San Antonio's open parking lots will ensure we have a tougherfight against the spread.
People come in, hike, then go get some groceries and maybe some gas before heading back to locations far and wide.

Textbook behavior if you want to spread a virus.
Thank you MidPen for your concern. Thank you for knowing how the virus is spread and for ignoring that so some people won't have to walk in another area for a few weeks.


My 2 cents
another community
on Apr 8, 2020 at 10:46 pm
My 2 cents, another community
on Apr 8, 2020 at 10:46 pm

The Business Man states “ We cannot do that until there is a TREATMENT or VACCINE.“

I believe the first step is actually going to be extensive antibody testing. Those who’ve been exposed and developed immunity should be green lit to go back to work and go about their normal lives.


The Business Man
Castro City
on Apr 9, 2020 at 1:39 am
The Business Man, Castro City
on Apr 9, 2020 at 1:39 am

In response to My 2 cents you said:

“I believe the first step is actually going to be extensive antibody testing. Those who’ve been exposed and developed immunity should be green lit to go back to work and go about their normal lives.”

I totally agree with you but there are some complications.

It appears that nationwide we can only get as much as 150,000 tests done a day, and lets just be very generous and make it that 75,000 of them are in California.

There are logistics involved here:

First, what order of people are going to be tested? Probably based on lottery of birth date. That means that there will be at least 365/6 days of testing.

Second, when are people determined as non-infectious? Do we have that established yet?

Third, when can those infected work around those not infected? When is it safe?

Finally, even if we just did 75,000 tests a day, the state of California has approximately 40,000,000 people thus it will take 534 days to test all Californians. To say achieve this in say 90 days we will need to perform 444,444 tests a day. And the tests would have to be flawless, NO false negatives can be TOLERATED.

And realize that the public safety cannot be gambled with. In order to have sufficient community immunity you have to establish that at least 95% of the people are recorded as to either be clean, or are infected.

Now there is another approach, find those with the antibodies and use their plasma to inoculate those that are sick, or not yet infected. But that will take time to produce and administer as well.

We cannot seem to accelerate this process in any significant way.


The Medical Man
Another Mountain View Neighborhood
on Apr 9, 2020 at 4:43 am
The Medical Man, Another Mountain View Neighborhood
on Apr 9, 2020 at 4:43 am

Reads like a perfect reason why we shouldn't go to a carpenter for plumbing advice.


The Business Man
Castro City
on Apr 9, 2020 at 9:38 am
The Business Man, Castro City
on Apr 9, 2020 at 9:38 am

In response to The Medical Man you said:

“Reads like a perfect reason why we shouldn't go to a carpenter for plumbing advice.”

And yet Donald Trump and many others are making the same claims? Like prescribing drugs for a disease that hasn’t been proven to work at all?

Lets go a little deeper, say we do try to do 444,444 tests a day, and let’s say it takes as short as 5 minutes to run a test.

That means it will take 2,222,222 minutes or 37,037 hours to perform.

And let’s say that a lab worker is constrained to at most 8 hours of work per 24 hours, it will take 18,518 lab workers to do the job every day.

Let’s say these lab workers get paid market rate of $26 an hour, that means the cost per day to get this work done is $481,468 a day.

That means in the lab test labor alone it will cost $43,332,120 to achieve testing in 90 days.

Oh wait, we don’t have enough lab equipment or facilities yet, that could cost a lot more to build or use emanate domain to take over other labs.

Oh wait, what about the testing equipment? Or the testing agents? We ASSUMED that this was in good or infinite supply.

Now I may not be a doctor, but my number crunching here is not unreasonable. WHEN will we mobilize the medical ARMY to COMBAT the COVID 19?


The Business Man
Castro City
on Apr 9, 2020 at 9:47 am
The Business Man, Castro City
on Apr 9, 2020 at 9:47 am

REVISION FOR MATHMATIAL ERROR

In response to The Medical Man you said:

“Reads like a perfect reason why we shouldn't go to a carpenter for plumbing advice.”

And yet Donald Trump and many others are making the same claims? Like prescribing drugs for a disease that hasn’t been proven to work at all?

Lets go a little deeper, say we do try to do 444,444 tests a day, and let’s say it takes as short as 5 minutes to run a test.

That means it will take 2,222,222 minutes or 37,037 hours to perform.

CORRECTION: And let’s say that a lab worker is constrained to at most 8 hours of work per 24 hours, it will take 4,630 lab workers to do the job every day.

CORRECTION: Let’s say these lab workers get paid market rate of $26 an hour, that means the cost per day to get this work done is $120,371 a day.

CORRECTION: That means in the lab test labor alone it will cost $10,833,323 to achieve testing in 90 days.

Oh wait, we don’t have enough lab equipment or facilities yet, that could cost a lot more to build or use emanate domain to take over other labs.

Oh wait, what about the testing equipment? Or the testing agents? We ASSUMED that this was in good or infinite supply.

Now I may not be a doctor, but my number crunching here is not unreasonable. WHEN will we mobilize the medical ARMY to COMBAT the COVID 19?


The Medical Man
Another Mountain View Neighborhood
on Apr 9, 2020 at 10:00 am
The Medical Man, Another Mountain View Neighborhood
on Apr 9, 2020 at 10:00 am

On topics of medical information, take the advice of medical professionals when they offer it. Ignore the verbose posts of off topic-ers and CAP lockers.


The Business Man
Castro City
on Apr 9, 2020 at 1:49 pm
The Business Man, Castro City
on Apr 9, 2020 at 1:49 pm

In response to The Medical Man you said:

“On topics of medical information, take the advice of medical professionals when they offer it.”

No argument there, but they are not talking about logistics at this time.

In fact President Trump is starting to prevent the Medical Professionals from answering straight forward questions. He did so on live broadcast during a “press-conference”

I have been waiting for someone to address this issue scientifically.

The facts are no one is even tracking the number of tests being performed at this time, nor demonstrating if the tests are not allowing false negatives to cause potential problems.

As the famous scene in Caddyshack went, “Well, we’re waiting?” You said:

“Ignore the verbose posts of off topic-ers and CAP lockers.”

I am actually on topic, because the topic title is “Experts consider how long the coronavirus crisis will last — and how we'll get out of it”

Isn’t that what I am discussing? The LOGISITICS of actually getting us out of this mess? However, you appear to be not providing any medical expertise. Please provide us with some medical information regarding the method of getting us out of the COVID 19 crisis?

Again, “Well, we’re waiting”?


Common sense
Cuesta Park
on Apr 9, 2020 at 2:24 pm
Common sense, Cuesta Park
on Apr 9, 2020 at 2:24 pm

Re: > By all accounts, the local situation is rapidly improving and either has peaked or will peak within just a few days

Even Wachter isn't calling it the peak. And you said "all accounts". Changing the frame to "well, it's flattening" isn't the same as "all accounts ... has peaked or will peak within just a few days"

Keep backpedaling.

At a safe distance, of course.

;-)"

Per Wachter on Twitter yesterday: "Many questions re [Newsom's] statements that CA peak will be in May. That's not what I'm hearing. [University of Washington model] predicts peak next week, with very few cases by May). Maybe CA is using different model? Or maybe Gov. N just wants folks to stay vigilant?"

This confirms my point and raises one of the same questions. Why are we hearing different things from politicians than what the data indicates? If politicians believe differently, they need to be transparent about why (and have data to back it up).

Now you can quibble with my "all accounts" language but I'm not seeing any accounts (e.g., data & commentary re data) that indicate to the contrary. Speculation is something very different.

Cheers! Back to yet another walk around the neighborhood.


Common sense, or just literacy?
Blossom Valley
on Apr 9, 2020 at 3:11 pm
Common sense, or just literacy?, Blossom Valley
on Apr 9, 2020 at 3:11 pm

> By all accounts, the local situation is rapidly improving and either has peaked or will peak within just a few days

And your ultimate response (after referring to a doc who doesn't support your position) is...

> Now you can quibble with my "all accounts" language but I'm not seeing any accounts (e.g., data & commentary re data) that indicate to the contrary.

Now you're just throwing up an obtuse word salad. There are no 'all accounts' that think we've peaked, as you claimed.

Stop with the Trump/Fox "we can go back outside in a big bang" talking points.

See ya on da' block.


Common sense
Cuesta Park
on Apr 10, 2020 at 9:50 am
Common sense, Cuesta Park
on Apr 10, 2020 at 9:50 am

@Common sense, or just literacy?

Re "Stop with the Trump/Fox "we can go back outside in a big bang" talking points."

You're completely misunderstanding or misstating my point, and I couldn't disagree more with Trump/Fox talking points. To be clear, at no point did I ever suggest that we can return to normal in a *big bang*. To the contrary, I said that local leaders should start focusing on how to guide "a slow return to normal" and emphasized reasonable concern about returning to normal too soon.

If you feel better about staying inside and hunkered down for an indefinite time, and you have time time and money to do so, more power to you. Many of us are also concerned about the impact that all of this is having on the broader economic situation, our and our children's mental health, and our own ability to feed our families each week. So it is important that our leadership (local, state, federal) work to strike a reasonable balance of all these factors, and this balance should be informed by data. So far our local and state folks have done a good job, as the current numbers indicate. But the next phase/task (a slow reopening) may prove much more challenging.


The Business Man
Castro City
on Apr 10, 2020 at 11:01 am
The Business Man, Castro City
on Apr 10, 2020 at 11:01 am

In response to Common sense you said:

“If you feel better about staying inside and hunkered down for an indefinite time, and you have time time and money to do so, more power to you.”

We don’t feel better at all, but it is the only tool we have at this time. We need to be able to establish that to a 95% certainty that all Californians are free or have overcome the virus and are not infective and that less than 5% of the tested can be a false negative results. That is real science, you said:

“Many of us are also concerned about the impact that all of this is having on the broader economic situation, our and our children's mental health, and our own ability to feed our families each week.”

THAT is the purpose of the legislation being passed by the U.S. and State, to provide the means to ride out the VIRUS while using the shutdown and the social distancing. Since they are the only tool we have to prevent a widespread outbreak. With regards to the “broader economic situation” public health TRUMPS business every day and twice on Sunday. You said:

“So it is important that our leadership (local, state, federal) work to strike a reasonable balance of all these factors, and this balance should be informed by data.”

What a second, you want the government to in effect take risks on the public health and safety when it doesn’t even know what it is dealing with? The testing isn’t even close to enough to establish who is infected and who is not. That was a ridiculous idea. Again, the public health and safety is always going to TRUMP the economics. Where do you have the information or data that would be valid to determine that it is currently safe to reduce the only tool we have to control COVID 19? You said:

“So far our local and state folks have done a good job, as the current numbers indicate. But the next phase/task (a slow reopening) may prove much more challenging.”

Boy you just ain’t whistling dixie there. The reality is that there is no additional risks that should be encouraged until this virus is in CONTROL.

Isn’t this “common sense” enough?


Common sense, or just literacy?
Blossom Valley
on Apr 10, 2020 at 11:16 am
Common sense, or just literacy?, Blossom Valley
on Apr 10, 2020 at 11:16 am

> Isn’t this “common sense” enough?

But didn't you read his first post? He said: By all accounts, the local situation ... has peaked (he added 'or in a couple days', which has since passed.)

Gosh. Let's go, everybody!

Snark aside, Trump's blocking of massive testing (to 'keep' numbers low for his ego AND his feeble reelection prospects) is what will hold us back from any serious analysis about moving forward. Until we have tests in the tens of millions, safety trumps trump's desire to stroke his ego.

Donny, boo-boo, just quit speaking/lying to the public every day and go visit your family. Let the professionals run this (Fauci, not Pence.)


Common sense
Cuesta Park
on Apr 10, 2020 at 11:32 am
Common sense, Cuesta Park
on Apr 10, 2020 at 11:32 am

> Isn’t this “common sense” enough?"

But didn't you read his first post? He said: By all accounts, the local situation ... has peaked (he added 'or in a couple days', which has since passed.)"

Actually I said "few" (not couple) days, which is consistent with what the UW and other models/publicly-available data are showing.

While I generally avoid responding to BUSINESS MAN's nonsensical rants, it is worth emphasizing that the state and Federal legislation is severely insufficient to help many of us in the bay area who are suffering severe losses due to the pandemic -- especially small businesses.


The Business Man
Castro City
on Apr 10, 2020 at 12:39 pm
The Business Man, Castro City
on Apr 10, 2020 at 12:39 pm

In response to Common sense you said:

“While I generally avoid responding to BUSINESS MAN's nonsensical rants, it is worth emphasizing that the state and Federal legislation is severely insufficient to help many of us in the bay area who are suffering severe losses due to the pandemic -- especially small businesses.”

I cannot argue against your observation. The unfortunate reality is that you are going to have to use your “Chambers of Commerce” lobbyists to get more protection for those businesses.

You cannot expect that the governments are going to open up business during this ongoing crisis simply to prevent small business from closing.

Those you describe are “Zombie” businesses, they are leveraged too much and do not have the market futures that would result in eventually paying off their debt. This has been used as a tax reduction technique for more than 30 years. By offsetting profits with debt, the incomes of these businesses are negated so they don’t pay as much or any taxes at all.

The risk has always been when there is an EVENTUAL situation where the markets would be impacted by an event like this.

EVENTUAL meaning that this has occurred in the past with diseases like Spanish Flu or Polio.

But these companies do not manage themselves with the cost remediation of these events in place.

Simply put, those who own these companies made very big gambles or assumptions that they would not be in this situation. It was always a danger, it was just when would it happen? It did NOW.

This is where “moral hazard” from Alan Greenspan comes into place, these owners never had any plans to deal with this situation. Any person going to any business school would have been educated about this, or worse, plenty of business information regarding this can be found “on-line” in the internet, so there is really no excuse.

Now if you’re expecting that the government protect all businesses by bailing them out with grants, that is NOT a CAPITALIST economy but a SOCIALIST economy. Are you declaring that our CAPITALISM has reached its operational dead end?

Sorry, but the REALITY is that in this case, MANY businesses are going to die.

WHERE there is a direct link to a shutdown and a business failing, I see no reason for the governments to NOT in fact BAIL out these kinds of businesses. BUT, it will likely cost as much as $15 Trillion to ensure all of them are provided assistance. WHERE is this money going to come from?

You still haven’t addressed the fact that this problem is not going away until a treatment and vaccine are discovered and used.


Rich
Blossom Valley
on Apr 10, 2020 at 3:11 pm
Rich, Blossom Valley
on Apr 10, 2020 at 3:11 pm

It says so much to see how much trouble people go to to use this forum to argue. This is why America is so messed up now. None of us are the “other”. We are all invested in our community. So we’re on the same team.


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