Come for the politics, stay for the snark.

Let’s delete this post and never speak of this again.

Verified, but limited!

The house always wins.

I’m going back to the respite thread.

Saul Alinsky is my co-pilot.

Where tasty lettuce and good mustard aren’t elitist.

The math demands it!

Balloon Juice has never been a refuge for the linguistically delicate.

I swear, each month of 2020 will have its own history degree.

Consistently wrong since 2002

A snarling mass of vitriolic jackals

Make the republican party small enough to drown in a bathtub.

The revolution will be supervised.

Deploy the moving finger of emphasisity!

Wetsuit optional.

… riddled with inexplicable and elementary errors of law and fact

Come for the politics, stay for the snark.

Our job is not to persuade republicans but to defeat them.

This blog is Obama’s Katrina.

Good luck with your asparagus.

Shelter in place is one thing. Shelter in pants is quite another.

It’s the corruption, stupid.

It’s always darkest before the other shoe drops.

What fresh hell is this?

You are here: Home / Healthcare / COVID-19 Coronavirus / COVID-19 Coronavirus Update – Saturday/Sunday, March 21/22

COVID-19 Coronavirus Update – Saturday/Sunday, March 21/22

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  1. 1.

    La Nonna

    This morning’s call and text around for our circle of 30 or so living nearby, 2 people sick with dry cough, intermittent fever, body aches and pains.  The calls are in to their family doctor, we’ll see what happens later today.  One a heavy lifelong smoker, the other in the high risk age group.  Conte announced an even more thorough lockdown for Italy, details to come out today.  We are now prepared for this to last til Autumn, at least.  The house, garden, and pets have never been so well groomed as now!  Common courtesy now in Puglia seems to be wear the mask even if you are asymptomatic, lots of local seamstresses making their own, as we did.  Police are doing random checks near the roundabouts at the entrances for the main rojtes into the small villages and cities here, I think now we will be limited to only 1 person per auto, and that self-certification updated for every trip.

  2. 2.

    opiejeanne

    This was in my mailbox today, from the Seattle Times. This is the hell that Italy has been living for several weeks, and it may become ours shortly:

    State preparing to make life-or-death decisions if coronavirus overwhelms health care system
    Washington state and hospital officials have been meeting to consider what once was almost unthinkable — how to decide who lives and dies if, as feared, the coronavirus pandemic overwhelms the state’s health care system. The triage plan would assess factors such as age, health and likelihood of survival in determining who will get access to full care and who will merely be provided comfort care, with the expectation that they will die.

  3. 3.

    La Nonna

    @opiejeanne: Indeed, we are resigned and aware that should we need aggressive treatment, we will be triaged out to palliative care due to age, and in Il Nonno’s case, many underlying comorbidities.  We have had 10 years of beautiful retirement in one of Italy’s garden spots, unspoiled by mass tourism, with the bonuses of great universal healthcare, low cost of living, warm and open society, la dolce vita indeed.  Mille grazie ad Italia, no matter what happens.  The hardest part has been to explain this to our grown children in the US, it will be a quick cremation, no funeral, no travel doe any of this.

  4. 4.

    R-Jud

    @La Nonna: I hope the end of this year sees you both enjoying Italy again. Stay safe.

  5. 5.

    Geminid

    I hit Kroger’s for more groceries yesterday. The shelf stockers were still going hard, and brown rice was still absent. Most shoppers were briskly going about their business, but I noticed one woman I guess in her fifties who was just trudging along, with a five year old child sprawled in the cart with the groceries. He looked tired, but the woman I assume was his grandmother looked exhausted. I thought later that if I were king of the world my economic stimulus plan would start with giving grandmothers raising children $1000 a week. Trickle up economics.

  6. 6.

    gene108

    Couldn’t sleep well. Felt flushed, when I went to bed. Woke up at 3:30 after very intense dreams. Can’t fall back asleep.

    Checked temperature at 5 am and it was 102. Checked 20 minutes ago, it was 99.1. Didn’t take any medication

    Just very strange. No body ache, fatigue, etc.

    Contacted doctor’s office. See what they recommend

  7. 7.

    satby

    @La Nonna: I echo R-Jud’s hope that you and Il-Nonno come through this epidemic and get to enjoy not just your life in Italy, but a reunion with your family in the future.

    @gene108: and here’s hoping your temp is a false alarm!

  8. 8.

    WereBear

    @La Nonna: I will be wearing a mask here in NY. The governor’s speech said “if near vulnerable persons” and since I don’t know, masks will reassure others.

    I hope you can weather this and be part of Italy’s recovery.

  9. 9.

    WereBear

    So the idiot in chief is going to sell this bio-weapon conspiracy theory to his minions? Even though it is completely made up by his giant ego?

    Cutting off his media access, at least by “reputable” sources, seems even more prudent now.

  10. 10.

    OzarkHillbilly

    Somebody directed me to this site: The COVID Tracking Project

    The COVID Tracking Project collects information from 50 US states, the District of Columbia, and 5 other US territories to provide the most comprehensive testing data we can collect for the novel coronavirus, SARS-CoV-2. We attempt to include positive and negative results, pending tests, and total people tested for each state or district currently reporting that data.

    What and Why

    Testing is a crucial part of any public health response, and sharing test data is essential to understanding this outbreak. The CDC is currently not publishing complete testing data, so we’re doing our best to collect it from each state and provide it to the public. The information is patchy and inconsistent, so we’re being transparent about what we find and how we handle it—the spreadsheet includes our live comments about changing data and how we’re working with incomplete information.

    From here, you can also learn about our methodology, see who makes this, and find out what information states provide and how we handle it.
    Best Practices for Data Release

    Pretty basic data, but reliable in that they grade the reliability of the data. For instance, the Michigan data gets a D, Minnesota’s an A, Mississippi’s a B, and Misery’s a C.

    Their system for grading:

    How trustworthy are your numbers?

    We get the bulk of our data directly from state public health authorities, so we’re as reliable as they are, though we don’t have a live feed, so our numbers can be a few hours behind. States, however, report their numbers in inconsistent ways, which makes working with this dataset a bit complicated. Some states, like Oregon, provide the full set of numbers we track: the total number of tests conducted, breaking out positive, negative, and pending tests. For these states, we can provide data stretching through time, so they are maximally useful.

    Other states provide some or none of these numbers on an ongoing basis. Some crucial states in this outbreak, notably California, Washington, and New York, have not been regularly reporting their total number of people tested. For these, we have to use other reporting tools: directly asking state officials, watching news conferences, gleaning information from trusted news sources, and whatever else it takes to present reliable numbers. Our hope is that all the states will begin providing comprehensive statistics, including negatives and totals from commercial and university labs.

    Each state has a data quality grade associated with it based on the reliability of their reporting. This grading system is described below.
    State data quality grades

    A number score is tallied based on 4 simple components:

    +1 for reporting positives reliably (only NV fails)
    +1 for reporting negatives sometimes
    +1 for reporting negatives reliably
    +1 for reporting all commercial tests

    The total score for each state corresponds to a letter grade:
    A = 4
    B = 3
    C = 2
    D = 1

     Anyway, looks good to me.

  11. 11.

    New Deal democrat

    If the diagnoses grow in the next 10 days at the same rate as they have in the past 10 days, 10 days from now the US will have over 500,000 *diagnosed* cases.

    Since voluntary “social distancing” started in earnest about 10 days ago, we should have a good handle on whether it is significantly effective or not. I predict it will fail, and there will be absolutely enormous pressure for more States to order total lockdowns.

  13. 13.

    YY_Sima Qian

    I just returned from hospital stay at Wuhan, after going to the ER for internal stomach bleeding a couple of weeks ago. I am now resting and recuperating, in self-quarantine at another place of ours for a week, before heading home. It was an interesting experience at the designated non-COVID hospital (one of the top ones in the city):

    ER: I got to the ER after mid-night, and it was quite crowded. Patients overflowed into the corridors and reception area. The first thing nurses did was to check temperature. Anyone higher than 37.3 C had to go to the fever clinic, instead. Then a quick consult with the ER doctor, who prescribed a full blood panel and upper abdominal CT scan, and I had to wait at the ER for a bed to become available in the hospital ward. A full COVID-19 screening was required for before any in-patient stay: nasal PCR swab + blood test for SAR-CoV-2 antibodies + chest CT scan for early signs of pneumonia, all came back negative for me. All tests results were available within one and half hours. I was placed in a wheel chair for five hours, while on IV (including a blood coagulant shot to stop the bleeding), before an wheeled gurney became available for me to lie down on. It was another five hours before I was told I could transfer to a buffer ward. Two weeks ago Wuhan was still adding over 100 confirmed cases a day, so I was hyper alert at the ER. Fortunately, I did not hear anyone with dry coughs, and no one seemed to have shown positive on COVID-19 screening (I think there would have been arguments between the families of patients and the medical staff if that happened). All patients and family members wore masks. None of the patients at the ER were in good shape. Many people in this city had been putting off visiting hospitals during the epidemic, allowing moderate illness to progress to severe. Some have been waiting at the ER for days, or going from hospital to hospital, waiting for a bed to open up. The ER felt understaffed, as many from the hospital are still stationed at the designated COVID-19 hospitals, or are under 14 day quarantine after a COVID-19 hospital is closed after the discharge/transfer of the last patient. All ER medical staff wore full protective gear, as if they were working in a COVID-19 ward: surgical mask over N95 mask, eye goggle, face shield. full body protective suit, double gloves, double shoe covers.

    Buffer ward: Standard protocol is only non-COVID patients need to stay in a buffer ward for three days, for observation whether he/she develops COVID-19 symptoms, before transfer to standard ward. Only those that pass the COVID-19 screening at the ER can even get into the buffer ward. On the second day, another nasal PCR swab and blood test for antibodies are taken. Any caretaker for the patient has to go through the same screening process. If the caretake had to leave for whatever reason, he/she had to go through the same screening process again before re-entering. Imagine my nerves when I learned that the wife of may roommate at the buffer ward had a weak positive result on the nasal swab! She tested negative for the antibodies and chest CT. Analyzing the situation with him, and consulting my wife’s relatives working in Wuhan’s hospitals and the municipal CDC, I advised him to ask his wife to test again the next day. Thankfully, the next round screening came back negative. It was probably a false positive the first time, due to a bad lab assay. We were kept in a large room that normally hold six patients, but now only two (at the opposite ends of the room to maximize distancing). The buffer wards were divided into the same departments as standard wards (digestive tract illness in my case), and staffed with the relevant doctors and nurses from the respective departments. The idea is to get started with treatment during the observation period. All medical staff wore the same full protective gear as those at the ER. All patients and caretakers wore masks at all times, we wore masks to sleep.

    Standard ward: With the second round of COVID-19 screening coming back negative again for me, I was moved to the standard ward when bed opened up. It was actually more crowded at the standard ward than the buffer ward. The four person room I was staying was fully occupied, with three patients and a caretaker for one of the other patients. Everyone still hd to wear masks, even while sleeping. Nurses still wore full protective gear. Doctors were somewhat less rigorous (some did not bother with goggles and/or face shield), perhaps because they interacted less with patients. While there were beds in the hallways, the hospital did not accept patients to be placed there, perhaps due to understaffing.

    Treatment: Due to fear of COVID-19 infection, Wuhan’s hospitals have placed on hold all invasive procedures, except in life threatening circumstances. Therefore, the doctors treating me could not order a gastroscopy exam to assess the bleeding wound. Therefore, the doctors could only assess me via my vital signs, external symptoms, and test results from blood/stool samples. They ordered a blood transfusion, since my hemoglobin count was low, and I was looking quite pale. I was on IVs for a full week, before liquid food for another week. 8 – 10 bags of IV per day, from antibiotics, to medicine to rebuild and protect the stomach lining, to vitamins/electrolytes/nutrients. I also got upper and lower abdominal CT scans to confirm there is no tumors. In normal times, when the doctors could assess the bleeding would with gastroscopy and order blood transfusion early, I probably would have been discharged in a little over a week. My company also has an international emergency medical assistance service on retainer for its expats, and I had doctors from Beijing and Shanghai calling me every couple of days to check on my status and review the course of treatments. They concurred with treatment plan that the doctors at the hospital developed. After the lock down ends in Wuhan, I will have to come back for gastroscope to assess the nature and the status of the wound in the stomach.

    Cost: All COVID-19 related screenings (two nasal PCR swabs, two blood antibody tests, one chest CT scan) were free. For the two weeks of in-patient stay, two CT scans, a blood transfusion, 10+ blood tests, stool sample test, 8 – 10 bags of IV per day, total cost was under 20K yuans, or less than 3K USD, without medical insurance. My international insurance will probably cover 85% of that.

    All in all, not a bad experience. The medical treatment was professional, though bedside manners a bit uneven (most medical staff were fairly friendly). The hospital has all the modern equipment one would expect at such an institution. The facility was aged, and the furnishing mediocre to begin with and not that well maintained (discoloring no the walls and ceiling at some places). The odd cockroach crawling out of the sewer was not pleasant. The hospital’s newer campuses in other parts of the city are much more modern, and much better furnished.

    As I was discharged, Wuhan had zero new confirmed cases for two consecutive days (four days now). There is rumbling that the lock down measures will start to be eased from early Apr., if there is fourteen consecutive days of no new confirmed cases. Companies deemed important to national and international supply chains are busy applying for permits to reopen in the next week. Some key enterprises actually resumed work from Feb. 10 (Huawei’s R&D center, Lenovo’s plant, large LCD plants, semiconductor fabs, optical fiber plants, plants making lasers, companies making medical supplies and equipment and medicines). I was very lucky not to have developed internally bleeding earlier. There were no designated non-COVID hospitals in late Jan. to early Feb., only segregated ERs and wards, but the risk of nosocomial infection there would still have been very high, assuming a bed was available. Even after designated non-COVID hospitals opened in early to mid-Feb., some of their ERs were seeing 30 – 40% of their patient also infected with COVID-19. Too many non-COVID patient (and their family members) had been desperately going hospital to hospital for days in search of available beds, and had unknowingly infected. Hence, the protocol I described above.

    The above protocols also explains why China is claiming greatly reduced nosocomial transmission since early Feb., and that none of the 42K medical personnel sent from rest of China to reinforce Wuhan have been infected. With the rapid fall in active cases in Wuhan, those doctors and nurses from the rest of the country are not returning home, to heroes’ send offs and welcomes.

  16. 16.

    NotMax

    Android phone? Be alert about malware that’s been showing up.

    Cybercriminals have been busy lately trying to exploit the coronavirus for their own malicious purposes. As such, the spread of COVID-19 has led to an increase in phishing emails and other malware designed to entrap people looking for information about the virus. A new type of ransomware known as CovidLock encrypts key data on an Android device and denies access to the victims unless they pay up, according to the threat intelligence firm DomainTools. Source

  18. 18.

    Steeplejack (phone)

    Sam Wang suggests tracking deaths is more useful than tracking “cases.”

    Once again: DO NOT TRACK THE NUMBER OF CASES. THIS IS SUPPOSED TO INCREASE AS TESTING COMES ONLINE.

    Instead, track the number of deaths per day. If the "doubling time" of these slows to more than 3 days, we're starting to bend the curve.

    Thread: https://t.co/T0MvzCxtPQ

    — Sam Wang (@SamWangPhD) March 21, 2020

  20. 20.

    YY_Sima Qian

    @Steeplejack (phone): Deaths can lag infection by 3 – 5 weeks (10 weeks in outlier cases), depending on the quality and availability of care. The feedback loop is far too long to be of utility for public health policymaking. For academic study, perhaps.

  21. 21.

    debbie

    @gene108:

    It’s not unusual to have a higher temperature when you first wake up, especially if you sleep under covers. More so if it’s a down quilt.

  22. 22.

    New Deal democrat

    @Steeplejack (phone):

    I read that.

    Here’s the problem: how do we know that the people died *as a result of the coronavirus*? Most likely, *because they were tested*!

    So I don’t think Wang’s reasoning quite holds up. Also, diagnoses tell us that the disease has infected *at least as many people* who test positive. So it is useful that way.

    I think the best measure is the ratio of tests to diagnoses. South Korea’s pandemic peaked when that ratio rose to 15:1 for five days. I think yesterday the US ratio was about 8:1. Not good.

  24. 24.

    YY_Sima Qian

    @satby: Thanks for the concern! Digestive tract illness are often associated with stress, so I have been taking it easy. Ironically, in the month and half of lock down my diet has been by far the healthiest in a long long time (little alcohol, no carbonated drinks, no cold drinks, no greasy and salty take outs, much more vegetables). I did not feel any stress from work or personal life. Perhaps the daily onslaught of COVID-19 news, and the strict lock down, had been placing subconscious pressure. Or my digestive system could not adjust to the sudden change of diet…

  26. 26.

    WereBear

    @YY_Sima Qian: I discovered I was “sensitive” to both fiber and gluten when I dropped them as part of an elimination diet.

    People still unaware that this is a real thing can be surprised how their body reacts when they eat like everyone else. That turns out to be a luxury my body can’t deal with.

    Just in case it helps :)

  27. 27.

    prostratedragon

    @YY_Sima Qian:
    Thanks for the sobering report, and glad you’re out and feeling better.

    In normal times, when the doctors could assess the bleeding would with gastroscopy and order blood transfusion early, I probably would have been discharged in a little over a week.

    For comparison, I had the same problem during Christmas (when else, I ask you), with the complication of being on warfarin, which made it a bit dramatic for a day or so. I got a standard bed within a few hours, with several transfusions and some iv fluids that started in the er and continued for a couple of days, after which I was stable enough for endoscopic diagnosis and repair. Between this, and not having to wait out a monitoring phase in the beginning, I was able to get out in about 1 week, though recovery at home continued for several more weeks.

    So one can see the strain on hospital systems from having to take many more precautions even with non-COVID19 cases, in addition to the number of serious or critical cases we might have. By the way, even in the golden days of December 2019 I was considered only borderline for an icu bed with a hemoglobin level below 6 and my normal continuous need for O2.

  31. 31.

    PsiFighter37

    @La Nonna: Yikes. I had booked a trip to South Tyrol (the Dolomites) in early August…in your opinion, you think that is likely to not happen at this rate?

  33. 33.

    Xenos

    Isolation does seem to be effective where used consistently.

    Here in our neighborhood in the EU we were sent home from most workplaces about 10 days ago, and the daily rate of increased infections just today dropped from 50% to 20%.  If we can keep this rate under 20%, or even reduce it further for a few days we may turn a corner on this by the time another month passes.

  35. 35.

    YY_Sima Qian

    @New Deal democrat: COVID-19 death counts were underestimated at Wuhan and Hubei until mid-Feb., due to lack of testing kits and lab capacity (same thing happening in norther Italy right now). That finally changed with the shift in criteria for confirmation, to including clinical diagnosis. Definition changed back a week later, as test kit availability and lab capacity were no longer bottlenecks. Every place constrained by testing should implement confirmation by clinical diagnosis. There will be higher false positives and false negatives with clinical diagnosis, but it is much better than waiting for PCR test capacity.

    Every place should learn how China is managing 200 CT scans per machine per day at the peak of the epidemic. It only takes a couple slices of the lung to make a clinical diagnosis, no need for full scans. Purchase portable CT scanners from China ASAP, instead of relying on the big hulking machines for this purpose.

    Lastly, what really pushed actual transmission rate (Rt) down in Wuhan was centralized quarantine of mild cases/suspect cases/closed contacts. There is a Harvard study that estimated Rt in Wuhan during the first three weeks of Jan., without NPI measures, to be 3.8(!!!). The lock down and social distancing measures (closing all non-essential business and manufacturing operations, stopping public transport/taxi/ride sharing/private vehicles, etc.) from Jan. 23 knocked Rt down to 1.2 – 1.3. Better, but that just means a somewhat more slowly but still exponentially growing epidemic. From early to mid Feb., with centralized quarantine of mild cases in makeshift medical facilities, suspect cases and close contacts in hotels and university dormitories, and other further distancing measures (lock downs the community level, with food deliveries arranged, no more grocery shopping trips), Rt was knocked all the way down to 0.3! One does not need to take all of these measures (community level lock down and de facto house arrest might be hard to stomach in the West), but reducing Rt to 0.5 – 0.7 will allow the epidemic to burn out and provide relief to the medical system.

    The “lock downs” in Europe and NY and CA likely will not flatten the curve enough to avoid overwhelming the medical systems. These “lock downs” are not as strict as those implemented in Wuhan in late Jan./early Feb., and not paired with massive testing and contact tracing. In fact, they have given up on contact tracing and testing of mild cases. I do not believe these measures will suppress Rt to close to 1, let alone below 1.

    I really don’t why the US and Europe are not building makeshift medical facilities at a massive scale to house the clinically diagnosed mild cases. These cases only need a bed, no ventilators, no ICUs, no ECMOs. There are plenty of idle convention centers, indoor stadiums, gyms and mothballed hospitals available. The draw back of self-quarantine at home is continued transmission in the household (75 – 80% of transmission in Wuhan after the lock down). Self-quarantine without medical supervision also increases risk of mild symptoms developing into severe or critical before medical intervention (and this is not limited to the elderly cohort). Centralized quarantine and medical care avoid all of that…

  37. 37.

    Mousebumples

    @rikyrah:  Talked with my sister (MD in a large city, by Wisconsin standards) yesterday, and she shared that her city’s university lab is able to treat ~1000/day. About 4 hours per test, but the backlog of pending tests means its currently about a week to get results. There’s also a shortage of the reagents needed to do the test. That helped to fill in something that wasn’t making sense to me about why some tests were taking longer than others to get results. Hopefully more medical center labs will step up testing capabilities – and innovate better ways to test. (eg is a pregnancy test style at home test feasible? Maybe with spit versus the pee stick style?)

  38. 38.

    YY_Sima Qian

    @prostratedragon: And this is Wuhan well on the down slope of the epidemic, and the medical system here had largely recovered, after massive reinforcement from across the country. Imagine what it would have been like in late Jan., on the steep up slope, before most of the reinforcements have arrived…

  39. 39.

    YY_Sima Qian

    @prostratedragon: Do you mind sharing what was the cost before medical insurance (order of magnitude) for your stay? I have never had to go to the hospital while in the US, so I have no frame of reference. My dad suffered a bleeding ulcer twenty years ago. He had to go to the ER, stayed in the hospital for nearly a week, and was out a few thousand dollars even with medical insurance.

    It seems Chinese medical care (aside from surgeries) really is pretty cheap.

  40. 40.

    Marigold

    @debbie: Ohio gets a D because they are only reporting the positive cases, but not how many tests they’ve done in all.  5 positive tests is okay, but there’s a big difference between 5 positive out of 10 vs 5/100 or 5/1000.  DeWine has been proactive enough on this that I don’t think they’re trying to hide information, so maybe it’s a problem communicating with the private labs.

  41. 41.

    New Deal democrat

    @YY_Sima Qian: I absolutely agree that most US States are only engaged in half-measures. I agree that we need a Wuhan-style lockdown for at least 2 weeks to get back out in front of the pandemic.

    As the cases continue to increase, probably still exponentially, the pressure for such a lockdown is going to become immense. Businesspeople are going to realize that a complete closure for a few weeks is better than an ongoing huge drop-off in business for months.

  43. 43.

    Fair Economist

    @La Nonna: One of my personal concerns is that if my mother (80’s and severe COPD) catches this it won’t be safe for me to travel to see her when she is ill or to attend the funeral. She is aware of the risks and taking such steps as she can but when you have to have a continual stream of caretakers there is only so much you can do.

  44. 44.

    Fair Economist

    @WereBear: I got a sports mask (reusable) back when this first got reported. It’s supposed to be N99 but the mask’s scheme, which is to use a neoprene covering to hold a filter against your face, allows leaks. Still, it’s a lot better than nothing.

  45. 45.

    joel hanes

    For every confirmed case of coronavirus, another 5 to 10 are out there undetected

    This is much, much better than I expected.

    In fact, I don’t believe it.
    Based on long experience with the statistics of sampling and selection (I once did quality testing for semiconductors that went into enormous mainframe computers) I’d have been willing to bet that the actual number is somewhere between a hundred and a thousand.

  48. 48.

    PsiFighter37

    @Fair Economist: I think it is inevitable that sad situations like this will happen. I missed catching my flight out to CA to see my grandmother, because someone at my work got the virus and I didn’t want to chance it. My mom, who is effectively stuck out there, can only go and see her because she feeds her lunch and dinner – otherwise cannot go and see her. She is in far worse shape than she was just 3 months ago…very groggy and barely awake, dementia much worse (IMO – barely cognizant of surroundings), and she just got diagnosed for hospice care. If, as it seems inevitable, that the nursing care facility has to completely lock out everyone else, then it’s possible the my grandmother will pass with no immediate family present. That would suck – but I think it is inevitable.

  50. 50.

    Fair Economist

    @YY_Sima Qian:

    I really don’t why the US and Europe are not building makeshift medical facilities at a massive scale to house the clinically diagnosed mild cases. These cases only need a bed, no ventilators, no ICUs, no ECMOs.

    We are not yet at the point that anybody with a fever can be presumed to have COVID, so people would not be willing to go to such facilities. We would need to be able to test everybody symptomatic, and we are far from that.

  52. 52.

    debbie

    This’ll kill Trump. What are the odds he’ll say he never wanted to kill Obamacare?

    The Trump administration is considering opening up a special enrollment period for the Affordable Care Act to help uninsured Americans during the coronavirus crisis, Politico and The Wall Street Journal reported Saturday.

    At least nine states that run their own health insurance exchanges have already reopened Obamacare enrollment to uninsured residents so they can obtain coverage now, according to the Journal.

    But most states depend on the insurance marketplace run by the federal government. Open enrollment for states that use the federal exchange ended on Dec. 15. But a spokeswoman for the Centers for Medicare and Medicaid Services (CMS), which runs the Trump administration insurance marketplace, HealthCare.gov, said officials are now considering a new enrollment period.

  53. 53.

    YY_Sima Qian

    @Fair Economist: That is why I am saying clinical diagnosis. At least in Wuhan, clinical diagnosis means a combination of fever, dry cough, and early signs of ground glass pattern in the lungs from chest CTs. If you tell people that they are developing pneumonia with high likely hood being caused by SARS-CoV-2, they might be willing to get away from their families and get to a place where they can receive some medical care, and can arrange ambulances to go to the hospital if their situation deteriorate.

    South Korea did much more than massive testing and contact tracing, that is just information gathering. The actual response is case isolation. Every confirmed case is sent to hospital or medical quarantine. None of this self-quarantine of self-diagnosed mild cases at home, and poorly enforced at that.

  54. 54.

    L85NJGT

    Heroic medicine is largely a fiction of entertainment. A hospital has a hard capacity determined by staffing and facilities. Once that has been reached, jamming patients into converted ORs isn’t medicine, it is just really shitty hospice care, with the added benefit of staff and outpatients becoming infected and sharing to the broader community.

    The salient point from YY_Sima Qian is what to do with those diagnosed with moderate symptoms. House calls\home monitoring?  Dedicated temporary facilities? Something else?

  55. 55.

    Lyrebird

    @joel hanes:

    …I don’t believe it.

    Yeah I looked, thanks to NYT making COVID 19 articles free, and this is the rest:

    according to the report, which was based on data from China.

    So the proportion is likely to be different in NYS or in NV or in Florida, and in all cases worse.

     

    I am one of the newly online instructors for a college that sent its students home.  No testing on the students first.  We do not know if we just protected our students or if we just put their home communities at greater risk.

     

    aaaaaaaaaaaaaaah…

  56. 56.

    MazeDancer

    The New England Journal of Medicine has issued the definitive word on how long COVID-19 infectious parts can live and infect people on various surfaces:

    Plastic: 72 hours
    Stainless Steel: 48 hours
    Cardboard: 48 hours
    Copper: 8 hours

    Let those deliveries sit outside.

  59. 59.

    kindness

    It would be proper karma for China to start blaming the United States for importing the virus to them.  Trump would blow a fuse.  Twofer.

  60. 60.

    different-church-lady

    Not sure we’ve communicated well enough that social distancing interventions will pay dividends in 1-3 weeks.

    No, you haven’t. All anyone has been communicating is SEAL YOUR MOUTH WITH DUCT TAPE AND WAX AND DON’T LEAVE THE HOUSE FOR 18 MONTHS!!1!

  63. 63.

    germy

    For the average American the best way to tell if you have covid-19 is to cough in a rich person’s face and wait for their test results

    — Harry Moroz (@hrmoroz) March 20, 2020

  65. 65.

    Suzanne

    @different-church-lady: I think I agree with you here.

    In order to actually get Americans to do this, our leadership should be giving us clear guidance about what to expect, and it needs to be workable. The president is worthless. And we need to know how well this is working and by when.

  66. 66.

    germy

    I’m calling on the Federal Government to nationalize the medical supply chain.

    The Federal Government should immediately use the Defense Production Act to order companies to make gowns, masks and gloves.

    Currently, states are competing against other states for supplies.

    — Andrew Cuomo (@NYGovCuomo) March 22, 2020

  68. 68.

    germy

    Future Republican president vows revenge:

    Chinese Communist Party lies & corruption turned a local health problem into a global pandemic, devastating lives & dreams across our country. There will be a reckoning. https://t.co/CPlEohA5ez— Tom Cotton (@SenTomCotton) March 22, 2020

  70. 70.

    germy

    @MazeDancer:

    That information is from a letter published in the NEJM on March 17, 2020, and includes this disclaimer:

    The findings and conclusions in this letter are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).

  71. 71.

    trollhattan

    I wonder if Jacinda Ardern is reconsidering her career path? She’s had one rough ride as PM and somehow managed to give birth in the midst of it, further complicating things a bit.

  73. 73.

    Miss Bianca

    @Dorothy A. Winsor: btw, Station Eleven? Great book, but dear God, why did I think that *now* would be a good time to pick up a sci-fi dystopia about a plucky little traveling theater company wandering about Michigan, my old home state, after a plague wiping out 99% of humanity?

    It’s like getting field reports on what my life would be after the End of the World As We know It.

    That said, I will keep reading. : )

  74. 74.

    PenAndKey

    @germy: These fuckers are already planning their next war, and they’re too stupid to realize they’re threatening the one country on Earth that the US relies on so much that a trade embargo against us would cripple us.

    Yes, they really are that stupid. They tried the same saber rattling shit before 9/11 when the Hainan Island incident occurred.

  76. 76.

    Terry Chay

    @New Deal democrat: you act like failure is binary. It isn’t.

    You act like nobody will see any difference in real world results between where and when different areas implemented different measures. They will.

    Already the difference between Seattle and New Orleans stands in stark contrast to San Francisco and Santa Clara.

  77. 77.

    ziggy

    @YY_Sima Qian: So good to hear from you again! Very interesting to hear your take on the responses so far in the US. I’m going to have to chew on that dedicated hospital idea. I think if things continue to deteriorate, US citizens might actually cooperate. I’ve been surprised at how compliant (for the most part!) people have been, at least around here.

    Also VERY encouraging to hear how the situation in Wuhan is finally resolving. Hope life returns to a more normal state for all of you soon.

  78. 78.

    ziggy

    I think it would be very helpful if people started wearing masks in public. Obviously there isn’t enough manufactured ones at present, hopefully that situation can improve soon. But what about making your own at home? Or wearing a scarf wrapped around the lower face? Especially in situations such as grocery stores, it would help protect other people from asymptomatic virus carriers. Is anyone seeing that in the general public, other than asian stores?

  79. 79.

    Terry Chay

    @Steeplejack (phone): Sam is wrong.

    – Deaths lag by three weeks

    – Deaths early on are a tiny sample size, too small and too slow to mean anything.

    – Deaths are a big function of: patient age (Seattle), awareness of COVID-19 (Wuhan, Seattle, Northern Italy), and whether the medical system locally fails (Italy, Wuhan).

    This last one by itself gives a 5-10x difference in mortality rates.

    The reality is testing is the better indicator but be aware that it is affected by the number of people tested and the time it takes to get the results.

  80. 80.

    terry chay

    @PenAndKey: These people won’t be in office to rattle the sabres.

    I don’t think people really comprehend the political impact of this disease. I don’t think I can really comprehend it. All I can say with certainty is that the uncertainty is astronomical because the risk is not measurable.

    It is uncharted territory. But people such as Cotton are doomed.

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