The Walls Come Down: No Travel Betwen US and Europe for 30 Days

[madd0ct0r]

Ghetto edit.

So there's a barrel of assumptions in the best guess description of the strategy.
The big one is how long immunity lasts. The next is how the virus spreads.
The concept hinges on the 60% infected NOT being a cross section of the population. The ICU rate and 1% death rates so far are for the population segment with the infection - travelers, health staff, nursing homes...

I can't see how they direct the infection. I'm not in a vulnerable category, but I share a small house with two who are. Another friend is fighting fit, but his young daughter is severely asthmatic.

I can't see how these family and generational overlaps can be avoided.

[Nicholas]

One benefit of the US's heath care system. We have about three times the ICU beds per capita as Italy or Canada. Might well not stop COVID-19 from overwhelming the US health care system but will make it harder.

Nicholas

https://www.theglobeandmail.com/opinion ... of-a-lack/

Hospital bed shortages amid COVID-19 expose the deadly cost of a lack of vision
Doug Saunders
Doug Saunders
Berlin
Published 2 days ago
Updated 1 day ago
214 Comments
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A coronavirus patient is treated in an intensive care unit at the Cremona hospital in northern Italy, in this still image taken from video, on March 5, 2020.

LA7 PIAZZAPULITA/Reuters

To understand the heartbreaking consequences of governments stuck in short-term thinking, listen to Christian Salaroli, the 48-year-old anesthesiologist who serves as the medical director of a hospital in the alpine city of Bergamo in northern Italy, where the novel coronavirus pandemic is peaking.

“Some of us are crushed – the primary physicians, the newly arrived young people who find themselves in the early morning having to decide the fate of a human being,” he told the Italian newspaper Corriere della Sera. His job every morning is to go through the packed emergency ward and decide who, among the scores of new patients, will be admitted to the few intensive-care beds and hooked up to the hospital’s extremely limited supply of ventilators – and which ones will be left to their fate.

“It is a terrible thing to say, but unfortunately, it is true – we are not in a position to attempt so-called miracles.”

It is, he says, exactly the sort of triage that army hospitals are forced to conduct during terrible attacks.

If virus victims are very old, or if they have cardio-respiratory problems or coronary-artery problems, then they are essentially left on their own, likely to die. No point using a scarce ventilator to save someone’s life if they aren’t young and healthy enough to have a good chance of making it. And it’s not just virus patients: When people come in with heart attacks, they’re now forced to wait hours rather than minutes. People with chronic diseases are being kicked out of intensive-care rooms for younger virus patients.
Globe Background
30 SEC READ
What can I do to stay safe from COVID-19?

It turns out one of the key factors affecting the mortality rate of coronavirus disease, or COVID-19, appears to be the availability of intensive-care beds – and that means the availability of ventilators. Countries whose governments decided to invest in large numbers of ventilators appear to have half the mortality rate of countries that didn’t.

But it’s not just the COVID-19 death rate that rises when beds and ventilators are scarce. As Dr. Salaroli’s awful experience tells us, a bed shortage during a pandemic also dramatically increases the mortality rate of everything else.

In China, where the average hospitalized person required four weeks on a ventilator, hundreds of people in China died unnecessarily because of a lack of critical-care beds available there – just four for every 100,000 people. The Chinese government’s reported efforts to keep the virus outbreak under wraps for more than a month, while declining to rush crucial medical equipment to Wuhan, didn’t help. Some of the countries that have fared much better have done so partly because they invested in more intensive-care beds and ventilators years ago.

The world leaders in equipped-bed availability are the United States, with 35 beds with ventilators for every 100,000 people, and Germany and Taiwan, with 30 each. Italy has about a dozen. Canada, with 10 to 12 ICU beds for every 100,000 people (depending how they’re measured), does not fare very well – according to the Organization for Economic Co-operation and Development, Canada has about half as many intensive-care beds as the average developed country, despite spending 15 per cent more on health care.

But it’s often much worse than that. According to a 2015 study, the availability of intensive-care beds and ventilators varies widely by province and region. Newfoundland has an impressive 19 beds, with ventilators for every 100,000 people, whereas the governments of British Columbia and Alberta, at the bottom of the ranking, have a rate of seven and eight, respectively – not far from the rates of badly affected Iran and China.

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This is not a matter of haves and have-nots. An ICU ventilator unit generally costs less than $10,000; the cost of supplying and equipping a room will be more, but this is not an eyebrow-raising budgetary decision. For poor countries, ICU beds are difficult expenses; for Canada or Italy, they’re negligible.

This comes down to the way governments think of future needs. Funding of hospitals by Canadian provinces tends to be calculated in order to meet current needs – and then sometimes only barely. The most populous provinces have severe problems with emergency-ward overcrowding even during quiet, non-pandemic periods. Canada’s shortage of critical-care beds and ventilators, and its lack of capacity to handle a pandemic, has been a known problem for years. But too often, provincial health departments instead worry about having too many unused ICU beds during normal times.

But we don’t live in a steady-state world. This century’s big lesson for governments should be that they should be planning and spending not for a gentle expansion of current trends, but for black swans and worst-case events. To survive moments such as this one, we need to invest in overcapacity.

We have a pandemic. And we have some catching up to do – not just in this crucial area, but in our whole approach to planning for an unstable future.​

Doug Saunders, The Globe and Mail’s international affairs columnist, is currently a Richard von Weizsaecker Fellow of the Robert Bosch Academy in Berlin.

[MKSheppard]

RNC chair Ronna McDaniel, who's being tested for coronavirus, attended a Senate GOP lunch Tuesday with "the President, members of his administration & most Senate Republicans"

https://t.co/YpQXTzOWkh
Steve Lookner (@lookner) March 14, 2020

RNC Chairwoman Ronna McDaniel WAS at Senate GOP lunch where Trump presented a variety of ideas to counter the coronavirus’ impact on the economy, an RNC official tells @cmsub

Event not only featured the President, but members of his administration & most Senate Republicans

— Christal Hayes (@Journo_Christal) March 14, 2020

Ronna McDaniel also flew on Air Force One on Monday
(She's currently being tested for coronavirus)
https://t.co/n0SAIHBUGf
Steve Lookner (@lookner) March 14, 2020

[MKSheppard]

France in shutdown. restaurants, bars, clubs, theaters

everything closes at midnight until further notice.

only food supermarkets, gas stations and banks remain open

[MKSheppard]

Regarding the UK Strategy, that same numbered list was posted at another board.

Objections raised were:

Problems with that strategy:

1) as mentioned, the balancing act to not overwhelm the healthcare system

2) we still don't know enough about this novel virus. Does recovery provide immunity? For how long? What about the sporadic reports of reinfection? (Not just testing positive again after testing negative previously, but the woman in Japan who supposedly recovered, tested negative, was released, fell ill again and tested positive again).

3) we also don't know about long term/permanent damage with this novel virus. What are the percentages of people surviving, but with permanent damage to the lungs, liver, testes etc.?

And this link was posted:

Coronavirus: some recovered patients may have reduced lung function and are left gasping for air while walking briskly, Hong Kong doctors find

Some patients who recovered from Covid-19 have suffered reduced lung function and now experience problems such as gasping for air when walking quickly, Hong Kong’s Hospital Authority has revealed.

The authority released its findings on Thursday after observing the first group of discharged coronavirus patients.

The city has so far recorded 131 confirmed cases of Covid-19, including three fatalities. Of them, 74 patients have been discharged while one probable coronavirus case has also recovered.

Dr Owen Tsang Tak-yin, medical director of the authority’s Infectious Disease Centre at Princess Margaret Hospital in Kwai Chung, said doctors had already seen around a dozen discharged patients in follow-up appointments. Two to three were unable to do things as they had in the past.

“They gasp if they walk a bit more quickly,” Tsang told a media briefing on Thursday.

“Some patients might have around a drop of 20 to 30 per cent in lung function [after recovery].”

Tsang, who also heads an authority task force on the clinical management of infection, said these patients would undergo tests to determine how much lung function they still had.

A review of lung scans of nine infected patients at Princess Margaret found patterns similar to frosted glass in all of them, suggesting there was organ damage.

But Tsang said the long-term effect on recovered patients, such as whether they would develop pulmonary fibrosis, a condition where lung tissue hardened and the organ could not function properly, had yet to be ascertained.

He said discharged patients could do cardiovascular exercise such as swimming to help the lungs recover gradually.

The city’s public hospitals are about to conduct clinical trials on remdesivir, a drug originally developed to treat Ebola, to see how effective it is on Covid-19.

Tsang said the drug had already been delivered to hospitals. Doctors would begin identifying suitable patients to join the trials, which were expected to begin in the middle of this month.

He stressed that the drug could lead to some complications, such as affecting liver function and leading to inflammation of the blood vessels.

Covid-19 patients are being treated with Kaletra, a drug originally for HIV/Aids; Ribavirin, which was also used for hepatitis C; and interferon.

[MKSheppard]

As of this a.m. New York-Presbyterian is postponing all elective surgeries at it's 13 hospitals to preserve beds/equipment/supplies for what's about to hit.

I sincerely hope *every* hospital in NYC is doing the same.
Mark D. Levine (@MarkLevineNYC) March 14, 2020

This is kind of big, as elective surgeries are $$$ money makers for American Hospitals.

[ray245]

An interesting and nuanced breakdown of the UK strategy

Professor Ian Donald
@iandonald_psych
Profile picture
a day ago, 15 tweets, 3 min read

1. The govt strategy on #Coronavirus is more refined than those used in other countries and potentially very effective. But it is also riskier and based on a number of assumptions. They need to be correct, and the measures they introduce need to work when they are supposed to.
2. This all assumes I'm correct in what I think the govt are doing and why. I could be wrong - and wouldn't be surprised. But it looks to me like. . .
3. A UK starting assumption is that a high number of the population will inevitably get infected whatever is done – up to 80%. As you can’t stop it, so it is best to manage it.

There are limited health resources so the aim is to manage the flow of the seriously ill to these.
4. The Italian model the aims to stop infection. The UKs wants infection BUT of particular categories of people. The aim of the UK is to have as many lower risk people infected as possible. Immune people cannot infect others; the more there are the lower the risk of infection
5. That's herd immunity.
Based on this idea, at the moment the govt wants people to get infected, up until hospitals begin to reach capacity. At that they want to reduce, but not stop infection rate. Ideally they balance it so the numbers entering hospital = the number leaving.
6. That balance is the big risk.

All the time people are being treated, other mildly ill people are recovering and the population grows a higher percent of immune people who can’t infect. They can also return to work and keep things going normally - and go to the pubs.
7.The risk is being able to accurately manage infection flow relative to health case resources. Data on infection rates needs to be accurate, the measures they introduce need to work and at the time they want them to and to the degree they want, or the system is overwhelmed.
8. Schools: Kids generally won’t get very ill, so the govt can use them as a tool to infect others when you want to increase infection. When you need to slow infection, that tap can be turned off – at that point they close the schools. Politically risky for them to say this.
9. The same for large scale events - stop them when you want to slow infection rates; turn another tap off. This means schools etc are closed for a shorter period and disruption generally is therefore for a shorter period, AND with a growing immune population. This is sustainable
10. After a while most of the population is immune, the seriously ill have all received treatment and the country is resistant. The more vulnerable are then less at risk. This is the end state the govt is aiming for and could achieve.
11. BUT a key issue during this process is protection of those for whom the virus is fatal. It's not clear the full measures there are to protect those people. It assumes they can measure infection, that their behavioural expectations are met - people do what they think they will
12. The Italian (and others) strategy is to stop as much infection as possible - or all infection. This is appealing, but then what? The restrictions are not sustainable for months. So the will need to be relaxed. But that will lead to reemergence of infections.
13. Then rates will then start to climb again. So they will have to reintroduce the restrictions each time infection rates rise. That is not a sustainable model and takes much longer to achieve the goal of a largely immune population with low risk of infection of the vulnerable
14. As the government tries to achieve equilibrium between hospitalisations and infections, more interventions will appear. It's perhaps why there are at the moment few public information films on staying at home. They are treading a tight path, but possibly a sensible one.
15. This is probably the best strategy, but they should explain it more clearly. It relies on a lot of assumptions, so it would be good to know what they are - especially behavioural. Most encouraging, it's way too clever for #BorisJohnson to have had any role in developing.[\quote]

Or they could tighten restrictions early on, then gradually ease control in the summer months when the NHS is less stressed. The notion that the virus cannot be controlled seems to be going against WHO's advice.

[The Romulan Republic]

RNC chair Ronna McDaniel, who's being tested for coronavirus, attended a Senate GOP lunch Tuesday with "the President, members of his administration & most Senate Republicans"

https://t.co/YpQXTzOWkh
Steve Lookner (@lookner) March 14, 2020

RNC Chairwoman Ronna McDaniel WAS at Senate GOP lunch where Trump presented a variety of ideas to counter the coronavirus’ impact on the economy, an RNC official tells @cmsub

Event not only featured the President, but members of his administration & most Senate Republicans

— Christal Hayes (@Journo_Christal) March 14, 2020

Ronna McDaniel also flew on Air Force One on Monday
(She's currently being tested for coronavirus)
https://t.co/n0SAIHBUGf
Steve Lookner (@lookner) March 14, 2020

Jesus. The GOP is just one step away from literally drinking the Kool Aid.

Dear Leader said coronavirus isn't a threat. And we must support the Dear Leader.

Well, worst comes to worst, it'll be natural selection in action. Couldn't have happened to nicer people.

[The Romulan Republic]

Norway:

Prime Minister Solberg just announced that Norway is closing its borders from Monday morning 0800 until after Easter. Goods will be allowed to pass, and citizens are allowed to return home.

All foreigners will be turned around and deported back to their country of origin.

With so many countries closing their borders... why do I have the terrible feeling that some of these "temporary" closures will never be lifted? All foreigners turned back at the borders is a state of affairs too many people have been wanting for a very long time.

[ray245]

With so many countries closing their borders... why do I have the terrible feeling that some of these "temporary" closures will never be lifted? All foreigners turned back at the borders is a state of affairs too many people have been wanting for a very long time.

International travel is a huge component of modern life. There's too much financial rewards for keeping borders open, so most countries will want to open the borders again as soon as possible.

[MKSheppard]

https://news.yahoo.com/unprecedented-mo ... 33592.html

The federal administration that oversees regulations for America's six million professional drivers has temporarily suspended a trucking safety law that's been in place since 1938.

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In an unprecedented move, the Trump administration suspended an 82-year-old road safety law for some truck drivers, showing how much coronavirus is pressuring retailers and hospitals to maintain cleaning and medical supplies
rpremack@businessinsider.com (Rachel Premack)
Business InsiderMarch 14, 2020, 4:07 PM EDT
David McNew/Getty Images

The hours-of-service laws, which mandate how many hours a truck driver may work and have been in place for truck drivers since 1938, are suspended at a federal level for the first time in history.

As of Friday evening, truck drivers who are moving medical supplies and consumer goods like masks and hand sanitizer do not have to follow HOS.

It's common on a local or state level to lift these safety regulations amid natural disasters, like floods or hurricanes, that require stores and hospitals to stay stocked with necessary goods.

Truck drivers move 70% of the nation's goods by weight. They're responsible for replenishing stores and hospitals with necessary items.

Visit Business Insider's homepage for more stories.

The federal administration that oversees regulations for America's six million professional drivers has temporarily suspended a trucking safety law that's been in place since 1938.

The Federal Motor Carrier Safety Administration said Friday evening that truck drivers who are moving goods "in support of emergency relief efforts related to the COVID-19 outbreaks" will temporarily not have to follow the hours-of-service laws, which mandate how many hours a truck driver may work.

This is the first time since 1938, when the rule was developed, that it's been suspended on a national level. It's common for states and local governments to lift the rule amid natural disasters, when consumers "panic buy" household goods and hospitals need medical supplies.

"Waivers of this type are a common response by FMCSA to natural disasters and crises because trucks delivering food, fuel and medicine are a critical part of the response," America Trucking Associations spokesperson Sean McNally said in a statement to Business Insider. "This waiver will help keep loads of medicine, supplies and food moving as the country manages this current pandemic."

Read more: Grocery stores would run out of food in just 3 days if long-haul truckers stopped working

Around 70% of the nation's goods by weight is moved by a truck — so ensuring that they can get to your local grocery store or hospital ramps up in times of crisis. "Everything from the fuel you put in your vehicle to consumables in your home all get put in play because of a truck driver," Tampa-based truck driver Dennis Felix-Shannon told Business Insider.

In its current edition, HOS requires truck drivers to drive only 11 hours within a 14-hour work period. They must then log 10 hours of "off-duty" time. The safety law, which is aimed at eliminating exhausted truck drivers from the nation's highways so they do not endanger others, is disliked by many drivers. Some say the strict regulations actually disrupts their sleep schedule and makes them more likely to drive tired.

According to the FMCSA's Friday evening emergency declaration, here are the types of loads that are exempt from HOS laws:

Medical supplies and equipment related to the testing, diagnosis, and treatment of COVID-19

Supplies and equipment necessary for community safety, sanitation, and prevention of community transmission of COVID-19 such as masks, gloves, hand sanitizer, soap, and disinfectants

Food for emergency restocking of stores

Equipment, supplies, and persons necessary to establish and manage temporary housing, quarantine, and isolation facilities related to COVID-19

Persons designated by Federal, State or local authorities for medical, isolation, or quarantine purposes

Persons necessary to provide other medical or emergency services, the supply of which may be affected by the COVID-19 response

[The Romulan Republic]

Interesting comparison of different countries' "curve" in terms of number of cases/deaths:

https://theglobeandmail.com/canada/arti ... ho-isnt-a/

MURAT YÜKSELIR AND JOHN SOPINSKI/THE GLOBE AND MAIL, SOURCE: FONDAZIONE GIMBE (VIA M.W. FONG ET AL, CDC, EMERGING INFECTIOUS DISEASES)
For anyone who has ever wondered why math is such a big deal, the coming weeks are about to offer a memorable lesson.

Put aside the microbiology, the biochemistry and the genetics. At a practical level, how the coronavirus pandemic is being experienced by different countries and how it’s likely to unfold in Canada comes down to the slope of a curve.

As events this week made clear, the feasibility of containing the outbreak within China and a few regional hot spots is over. While officials at the World Health Organization stress that containment measures – such as contact tracing and isolation of infected individuals – remain critically important, the question now for places where the virus is still ramping up is how to blunt the impact of the approaching wave.

It’s called “flattening the curve,” a term popularized this week by Anthony Fauci, head of the U.S. National Institute of Allergies and Infectious Disease. Instead of exclusively focusing on preventing infections, like plugging holes in a dike, authorities are shifting to a strategy of delay. Their objective is to keep the rate of new cases – especially serious ones – from rising too steeply, so that the epidemic doesn’t completely overwhelm finite resources and force hard choices about who should be prioritized for care.

“Our message to countries continues to be: you must take a comprehensive approach,“ said World Health Organization director-general Tedros Adhanom Ghebreyesus on Friday. “Even if you cannot stop transmission, you can slow it down and save lives.”

Already, the story of COVID-19 offers some striking contrasts. They are emerging in places where the outbreak has begun to level off and where it’s just peaking now. If there’s one key takeaway, it’s that the same pathogen with the same basic characteristics can lead to very different outcomes.

Some of that is almost certainly about demographics. For example, Italy, with its aging population, has suffered a fatality rate of around 6 per cent – far higher than most other countries. But another big factor is whether governments are getting ahead of the pandemic. The difference between what happened in Wuhan province, where local officials initially refused to acknowledge the threat, and the rest of China, where there was time to react, is a case in point. As the virus goes global, the trajectory of the pandemic will also depend on the degree to which communities and individuals will get on board with health measures that most of us have never seen at a population-wide scale.

Here, the math is unforgiving. Because this coronavirus is a newcomer to our species, virtually no one has immunity, though many will experience it as a relatively mild illness.

Studies based on the initial outbreak and isolated pockets, such as the Diamond Princess cruise ship, show that each case of COVID-19 can spawn, on average, an additional two to 2.5 cases. But that’s a statistical measure influenced by a host of variables. Epidemiology suggests that many who are infected won’t pass the virus on to anyone, while a few will spread it widely based on physiology and social context. In practice, this is why the fraction of people who will ultimately be infected is so hard to predict.

But whether that fraction ultimately turns out to be one-third or two-thirds or something else is not the most important number right now. What matters now is how fast the cases occur and what countries are doing to stretch out the pandemic’s rise so that it becomes an extended but manageable incline, and not a looming spire of disease.

Where ‘the curve’ is around the world
The charts below show the number of confirmed and recovered cases by country, as measured by national health authorities and compiled by the Center for Systems Science at Johns Hopkins University. If a country’s first case is within the time period shown, it is marked with a dotted line and the date. Pay close attention to the vertical axis on each chart: the number of cases varies dramatically from country to country, so not all charts are on the same scale.

Confirmed cases Recovered cases
AS OF MARCH 13
CHINA
China, specifically the city of Wuhan, is where COVID-19 originated last December. Local authorities in Hubei province at first played down reports of the virus, but by late January, as more cases were reported in China and overseas, authorities put Wuhan and other nearby cities under travel lockdowns and delayed the Lunar New Year holiday to slow down travel nationwide. Work-from-home policies and an aggressive public-health response brought China’s curve to the flat plateau shown below: still a higher number of infections than anywhere else, but fewer new ones as time goes on.

0
50,000
100,000
Feb 02
Feb 16
March
Cases 80,932 | Recovered 62,901 | Deaths 3,172
SOUTH KOREA
Until COVID-19 reached Europe (more on that later), South Korea was one of the largest centres of reported infections outside China. One possible reason for this is that it tested for the virus earlier, and more widely, than almost any other country. By mid-March, South Korea had conducted more than 230,000 tests, free of charge, including at drive-through facilities.

0
5,000
10,000
Feb 02
Feb 16
March
Cases 7,869 | Recovered 333 | Deaths 66
SINGAPORE
Anxious to avoid a repeat of the 2003 SARS epidemic, jurisdictions that could easily sever travel links to the Chinese mainland – such as Singapore, Hong Kong and Taiwan – acted fast to restrict travel by the beginning of February. Singaporean health authorities were also vigilant in testing lots of people with coronavirus- or influenza-like symptoms, even mild ones. As in South Korea, testing was free.

0
100
200
Feb 02
Feb 16
March
Cases 178 | Recovered 96 | Deaths 0
ITALY
Italy’s prevention measures got off to a late start in February, when health workers in Lombardy failed to catch a super-carrier, dubbed Patient No. 1, who visited a hospital several times before being tested and isolated. The disease spread fast through northern Italy before the national government started incrementally tougher lockdowns on travel and public assembly, first in the north, then nationwide. Each step came after alarming rises in infections over the preceding 24 hours, hence the steeply rising curve. Other European countries that traced their infections back to Italy show similar curves, but lower numbers, and only a handful of deaths compared with more than 800 in Italy.

0
5,000
10,000
Feb 02
Feb 16
March
Jan 31
Cases 12,462 | Recovered 1,045 | Deaths 827
IRAN
Iran’s curve is likely much different from the official numbers show, because Iranian officials are suspected of lowballing the infection toll in February to hide the scale of the country’s epidemic. Canadian health officials began to deduce that when they saw more cases linked to Iranian travel than the official numbers would support.

0
5,000
10,000
Feb 02
Feb 16
March
Feb 19
Cases 10,075 | Recovered 2,959 | Deaths 429
UNITED STATES
Though the U.S. numbers are still lower than Italy’s, its curve is essentially similar. U.S. authorities have come under criticism for performing far fewer tests per capita than other developed countries and for President Donald Trump’s repeated suggestions that the risk is greater abroad than at home. His focus has been on travel restrictions on affected regions (first China, then 26 European countries, excluding Britain).

0
1,000
2,000
Feb 02
Feb 16
March
Cases 1,663 | Recovered 12 | Deaths 40
CANADA
Canada’s numbers were fairly stable through February, when the disease was more limited to Asia, but it has reached more provinces and cities since the beginning of March. Some provincial governments responded by banning indoor public gatherings of more than 250 people and by urging Canadians not to travel abroad.

0
50
100
Feb 02
Feb 16
March
Jan 26
Cases 117 | Recovered 8 | Deaths 1
With reports from The Associated Press and Reuters

Graphics by Jeremy Agius

Bravo South Korea (relatively low death rate, number of cases is no longer sharply increasing) and Singapore (178 cases, 0 deaths!).

This bit is bad news, though:

Though the U.S. numbers are still lower than Italy’s, its curve is essentially similar.

[madd0ct0r]

One benefit of the US's heath care system. We have about three times the ICU beds per capita as Italy or Canada. Might well not stop COVID-19 from overwhelming the US health care system but will make it harder.

Nicholas

https://www.theglobeandmail.com/opinion ... of-a-lack/

Snip

This is not a matter of haves and have-nots. An ICU ventilator unit generally costs less than $10,000; the cost of supplying and equipping a room will be more, but this is not an eyebrow-raising budgetary decision. For poor countries, ICU beds are difficult expenses; for Canada or Italy, they’re negligible.

This comes down to the way governments think of future needs. Funding of hospitals by Canadian provinces tends to be calculated in order to meet current needs – and then sometimes only barely. The most populous provinces have severe problems with emergency-ward overcrowding even during quiet, non-pandemic periods. Canada’s shortage of critical-care beds and ventilators, and its lack of capacity to handle a pandemic, has been a known problem for years. But too often, provincial health departments instead worry about having too many unused ICU beds during normal times.

But we don’t live in a steady-state world. This century’s big lesson for governments should be that they should be planning and spending not for a gentle expansion of current trends, but for black swans and worst-case events. To survive moments such as this one, we need to invest in overcapacity..

I'm not disputing your figures, but there seems a strange disconnect between hospital beds per capita a d ICU beds per capita. Us has a high rate of ICU but a low rate of beds overall.

https://data.oecd.org/healtheqt/hospital-beds.htm

[The Romulan Republic]

Georgia suspends its presidential primary:

https://thehill.com/homenews/campaign/4 ... us-concern

Georgia election officials postponed the state's presidential primary election scheduled for March 24 due to concerns of over the coronavirus, the Georgia Secretary of State first announced Saturday.

Election officials are moving the primary to May 19, and early voting for the primary will resume again shortly before the new voting date.

“Events are moving rapidly and my highest priority is protecting the health of our poll workers, their families, and the community at large,” Georgia Secretary of State Brad Raffensperger said in a statement to The Hill.

The move comes as Louisiana on Friday became the first state to postpone their primary due to concerns over the virus, pushing their contest from April 4 to June 20.

Georgia currently has 66 confirmed cases of the virus and one death, according to Johns Hopkins’ Center for Systems Science and Engineering. However, according to health officials, cases will continue to pop up before they decrease.

Election officials fear that the outbreak could put voters at risk and potentially lessen turnout as Americans are urged by government officials to practice “social isolation.”

“Given these circumstances, I believe it is necessary and prudent to suspend in-person voting in the Presidential Preference Primary, and the local elections associated with them, and resume in-person voting for those elections as part of the already scheduled May 19 General Primary,” Raffensperger said.

It’s unclear how many more states will follow in the coming days or weeks.

On Tuesday, four states host their primaries: Arizona, Florida, Ohio and Illinois. And three other states — Alaska, Hawaii and Wyoming — are set to hold their votes in early April.

New York and Maryland — both states whose governors have issued states of emergency due to the outbreak — are also among the states scheduled to host primaries in April.

The move means candidates have nearly a month longer to win over Georgia's 105 delegates.

In previous polls, former Vice President Joe Biden has garnered nearly double the support of Sen. Bernie Sanders (I-Vt.) in the Peach State.

Thus far, they're just pushing it back to the same time as the state's general primary in May. Of course, that might change depending on how long the epidemic lasts.

This all raises a rather interesting question: What if we get to the end of the primary season, and so many primaries have been postponed that no candidate has been able to achieve a majority of delegates? Do we pick a nominee based on the states that have already voted, and tell the others they just won't be represented in picking the nominee? I doubt that'll go over well. Do we just have the Superdelegates pick the nominee at the convention? In that case nothing materially changes (Biden wins), but it'll be divisive.

I'm just curious as to what the procedure is going to be if we get to a point where half the states never got to hold their primary, and as a consequence no candidate has achieved a majority of delegates.

[Zaune]

The hours-of-service laws, which mandate how many hours a truck driver may work and have been in place for truck drivers since 1938, are suspended at a federal level for the first time in history.

As of Friday evening, truck drivers who are moving medical supplies and consumer goods like masks and hand sanitizer do not have to follow HOS.

An administration run by sensible people would mandate that haulage firms moving medical supplies etc double-crew their trucks instead, so they can keep going almost round the clock without running the risk of drivers falling asleep at the wheel and causing a wreck.

[mr friendly guy]

German company claims they have a vaccine for testing soon. Trump tries to buy them out.

https://www.dw.com/en/germany-and-us-wr ... a-52777990

Germany and US wrestle over coronavirus vaccine: report
US President Donald Trump is attempting to entice a German lab to develop a vaccine exclusively for the US, a German newspaper reported. Berlin health authorities are in intensive talks with the company.

The governments of Germany and the United States are wrestling over the German-based company CureVac which is working on a vaccine for the novel coronavirus, reported German newspaper Welt am Sonntag.

The prominent German media outlet reported, citing unnamed sources, that US President Donald Trump was offering large sums of money to German scientists working on a vaccine. He wanted to secure exclusive rights to their work, the newspaper reported.

Trump was doing everything he could to secure a vaccine for the United States, "but only for the US," the newspaper quoted an anonymous German government source as saying.

The newspaper reported that the German government has tried to offer the company financial incentives to remain in Germany.

A German health ministry spokesman told Die Welt that the government was in "intensive" dialogue with CureVac.

"The German government is very interested in having the development of vaccines and treatments against the novel coronavirus undertaken in Germany and Europe," the spokesman said.

CureVac declined to comment to Die Welt. The company is based in the southwestern German city of Tübingen and works with the Paul Ehrlich Institute, linked with the German health ministry. It also has sites in Frankfurt and the US city of Boston.

On Friday, CureVac co-founder and chief production officer Florian von der Mülbe told Reuters that research into several possible vaccines had begun and the two most promising would be chosen for clinical tests. The company hoped to have an experimental vaccine developed by June or July, and then to get approval for testing on people.

Meeting with Trump

Trump on Saturdaytested negative for the coronavirus after potentially being exposed to several cases.

The COVID-19 outbreak, which started in China, has spread across the globe with more than 156,000 confirmed cases and 5,800 deaths. More than 70,000 people have recovered from the virus, which presents for most people as a mild to moderate illness, but can become a serious condition in others.

On March 2, CureVac's then-CEO Daniel Menichella attended a meeting at the White House to discuss coronavirus vaccine development with Trump and members of his coronavirus taskforce.

On March 11, the company announced Menichella would be replaced by company founder Ingmar Hoerr, without giving a reason why.

If the Germans can't even protect what is clearly of national interest, then they suck.

[Ziggy Stardust]

The COVID-19 predictions you make here strike me as both incredibly pessimistic and incredibly optimistic.

Incredibly pessimistic because you assume that, in the United States, COVID-19 is going to behave like an uncontrolled epidemics, which tend to infect most everyone who is susceptible in a fairly short period of time and then die down as herd immunity develops.

Incredibly optimistic in that you think there will be widespread immunity and the resulting ability to treat COVID-19 as an insignificant concern by November.

Nicholas

I never said nor implied that covid-19 is going to behave like "an uncontrolled epidemics", nor made any comment about widespread immunity. My post is informed by the statistical projections made by the CDC, WHO, John Hopkins Bloomberg School of Public Health, the Chinese CDCP, and a variety of other academic sources. These projections are in turn informed by: 1) what is known about the biology and epidemiology of beta-coronaviruses in general and SARS-CoV-2 in particular; 2) the observed trends in infection and mortality during the pandemic thus far, particularly in China and Italy; and 3) the estimated range of the reproduction value, which allows us to model the probable trajectory of the pandemic based on well-established epidemiological theories developed studying any of a large number of infectious diseases in both animals and humans (in fact, the people who know the most about beta-coronaviruses are veterinary epidemiologists, since these viruses have been known in livestock for decades).

Does that mean that these projections are necessarily correct? No, of course not. There are wide confidence intervals on everything, due to the difficulty of getting reliable data quickly enough for it to be validated and analyzed. While the virus is fairly well understood, there are still a lot of question marks about the precise mechanisms of the disease and why there is so much variability between the course of the pandemic between different locations and over time. But this IS the scientific consensus (and yes, I would know, since the study of global health and infectious diseases are literally my profession). And what we have observed so far in China and Italy has presented no evidence that this consensus is based on faulty assumptions.

Now, to be more specific with some of your claims, herd immunity is largely irrelevant to what I am talking about. Herd immunity is not even something that can be biologically developed mid-pandemic, that's not really how immunity works. Immunity only develops over years of exposure; it's much more a tool for resisting future outbreaks than it is about slowing the spread of the novel one. The reason flu is seasonal, for example, has nothing to do with immunity (all immunity really regulates is how severe the seasonal flu outbreak is). The seasonality is caused by a complex combination of factors, including the fact that cool temperatures and low humidity both dries out our mucous membranes (which are our first-line defense against respiratory infections) and helps respiratory droplets containing virus particles remain stable and airborne for longer. Note that these are more or less independent of the virus itself and any properties that it has, which is why you can reasonably expect these properties to apply to SARS-CoV-2, since we know they apply to other, genetically similar viruses. The only genetic factors on the viruses end that can really disrupt this seasonality to any significant degree are ones that allow the viruses to survive for longer on surfaces (so they don't need to remain airborne), for example a mutation that makes it more resistant to ultraviolet radiation. However, the fact is that transmission via contact with infected mucous on surfaces is far less efficient than via respiratory droplets, so even assuming coronaviruses has such mutations you would still expect seasonal decline in transmission.

So, for covid-19 to continue as a pandemic through the summer and all the way to November is incredibly unlikely, unless it is VERY different from every respiratory infection we have ever seen, even ones that are genetically highly related. Of course this is possible, and that represents a very bad scenario for the world, but it is also highly unlikely. So far there has been no evidence that substantially raises the probability of this outcome.

I think it far more likely that COVID-19 will be mostly controlled by the current move to social isolation. What this will mean is that it will die down but the bulk of the population will not be immune which means there will need to be a constant and aggressive monitoring program in place to prevent and contain outbreaks.

Yes, which is precisely in line with what I said in my post. SARS-CoV-2 will almost certainly become endemic, and there will be outbreaks of it on a seasonal basis in parallel with the existing seasonal flu outbreaks. Over time, the development of vaccines and immunity are likely to modulate the severity of these outbreaks, and this will likely result in an increase in funding for existing monitoring programs aimed at such seasonal viral diseases.

The tests and laws needed for that (given US culture I expect the US will need mandatory quarantines at government facilities with jail sentences for breaking quarantine) cannot come soon enough because I doubt it will be more then a few weeks before people start deciding in large numbers that the risks of COVID-19 are worth it to be with people. Depending on the structure of these laws I would not be willing to say that it will be impossible for corrupt and amoral people (on either side) to use them to manipulate turnout in November.

People are ALREADY deciding in large numbers that the risks of covid-19 are worth it to be with people. It's a gigantic public health challenge to get people to self-quarantine, and our government's inability to communicate clear guidelines to the public represents a massive institutional failure. That's one of the reasons we can reasonably expect this pandemic to get MUCH worse in the next couple of weeks, unless social distancing measures being enacted end up being sufficient to curtail the worst of the pandemic (and the potential for more data coming in from China and Italy telling us that some of our early projections and assumptions were overly pessimistic). And, in fact, the US already has an existing legal framework for large-scale isolation and quarantine, though it hasn't been used since 1919. It is very probable that Trump et al are willing and able to exploit these laws in some fashion, which I acknowledge in my previous post (which I'm not entirely sure you even read in its entirety, given the tenor of some of your statements here). But, as I said very clearly in my last post, if these laws (or any additional legislation) are going to be used they are going to be used in the next month or two, and the pandemic will lose steam sometime soon thereafter (likely by June). That would mean extending the state of emergency justifying these laws for MONTHS past when the pandemic is already over. That is also a possibility (I would put nothing past Trump at this point), but I'm sure you can recognize how much more difficult of a proposition that is then the scenario where the pandemic is literally concurrent with the general election.

[MKSheppard]

An administration run by sensible people would mandate that haulage firms moving medical supplies etc double-crew their trucks instead, so they can keep going almost round the clock without running the risk of drivers falling asleep at the wheel and causing a wreck.

Doesn't work that way. If you double team people; you just end up with sleepy driver B replacing Sleepy driver A, since Driver B was in the seat next to the driver.

Same issue the railroads face with their locomotive crews.

Better way would be to establish shift changes at set mileposts.

[MKSheppard]

NYC Comptroller calling for Big Apple Shutdown:

The way to get out of crisis is to act logically and strategically.

Logic says we need universal testing but that’s sadly not happening. Strategy says we need more aggressive social distancing.

That is why today, out of an abundance of caution, I am calling for a city shutdown.

Only essential services should remain open. No bars, restaurants, or movie theaters.

And I am again calling for NYC schools to be shut down.

We cannot go on with business as usual.

Scott M. Stringer (@NYCComptroller)
March 15, 2020

And summary of Cuomo Presser by another forum:

Gov. Cuomo giving live presser. Tone a bit more somber than his usual self.

Requesting military assistance from POTUS to build out additional temporary ICU capacity (“MASH” units). Also requesting all NY residents to voluntarily stay home, close businesses, limit all public interaction, practice extreme social distancing, etc. Mandatory steps under consideration. Getting emotional about a federal protocol being in effect rather than a state by state protocol.

Almost 800 diagnosed COVID-19 cases. 19% of these cases required hospitalization. ICU capacity at 80%.

Also, NYC shutdown now being called for by City Comptroller.

Cuomo actually thanked POTUS and VP for their efforts to date.

Closed with don’t let fear override logic.

Summary via twitter:

NY Gov. Cuomo calls for the federal government to order the Army Corps. of Engineers to begin finding buildings and constructing facilities NOW to deal with the coming increase in coronavirus cases that could overwhelm the current medical infrastructure.

Cuomo is speaking in blunt terms that most of the public is not used to hearing.

He's speaking in terms that the country has used before, but not perhaps since WWII.

He's basically saying you better start doing these things, or you're going to wish you did very soon.

Micah Grimes (@MicahGrimes) March 15, 2020

NEW: NY Gov. Andrew Cuomo announces 69 new cases in New York State and over 400 tests taken since last night, an improvement he says from several days ago when only 200 tests a day were administered.

19% of the 729 total cases have led to hospitalizations.

65 patients in ICUs

— Tom Winter (@Tom_Winter) March 15, 2020

CUOMO SAYS GOING OVER THE STATE’S ICU BED CAPACITY, WHICH IS ONLY ABOUT 3,100. AND 80% OF THEM ARE ALREADY FILLED.

First Squawk First Squawk (@FirstSquawk) March 15, 2020

[MKSheppard]

https://governor.maryland.gov/2020/03/1 ... -covid-19/

In light of the serious public health emergency created by the COVID-19 pandemic, I have issued an emergency order to close all Maryland casinos, racetracks, and simulcast betting facilities to the general public indefinitely.

It is critical to public health and safety that bars, restaurants, and other non-essential businesses across the state comply with the executive order prohibiting mass gatherings. Failure to follow this order is a crime, and will be enforced if businesses fail to comply.

Anyone who hosts or is part of the crowds in bars this weekend is jeopardizing the health of others and must avoid any contact with family members or friends over the age of 60 or those with underlying health conditions.

[MKSheppard]

How to make sanitizer, the WHO approved way:

https://www.who.int/gpsc/5may/Guide_to_ ... uction.pdf

Elsewhere....

The Math for Concentrations:

When mixing concentrations, multiply the percentage in decimal form (so 95% = 0.95) of the target ingredient by the number of parts added, add the results, and then divide that resultant number by the total quantity of parts.

Example:

3 parts 95% ethanol = 3x0.95 = 2.85
1 part Aloe = 1x0.00 (it has no ethanol) = 0
----------------------------------------------------------------------
TOTAL= 2.85 / 4 = 0.7125 = 71.25% ethanol in solution with aloe.

[MKSheppard]

https://medium.com/@donnellymjd/covid-1 ... a5c8137d42

Tl;dr:

Analysis strongly suggests that the NYC metro area has 5–10 days to quarantine the city or face dramatically overwhelmed hospitals, extremely high death rates, and a ruined economy.

The outlook for NYC and COVID-19 is bleak. The policy response is far too slow and too weak to meet the needs of the moment.

This note started as a twitter post on Wednesday March 11.

I’ve attached updated charts with two additional days of data to this note.

It's long but the summary is:

The NYC region has between 1,200 and 3,000 open hospital beds. This analysis suggests that enough people will become infected by March 23 and March 25 that NYC’s hospitals will be fully at capacity approximately 7 days later. (Infected people who will become severely ill do not immediately need medical care upon being infected. There is approximately a 5–7 day incubation period. After which, most severe cases present to the hospital within 2–3 days.)

...

The Obvious Choice

NYC must implement more severe social distancing measures and potentially fully shut down no later than a week from now in order to avoid overwhelming its hospital system.

Think about the choices here:

The Status Quo: The governor and the mayor continue to allow the virus to spread at schools, subways, restaurants, cafes, and workplaces. This is the exact same approach Italy took at the beginning of its outbreak. Seriously take a look at this article from two and a half weeks ago when Italy only had 160 cases (vs NYC’s 500+).

“Strict emergency measures were put in place over the weekend, including a ban on public events in at least 10 municipalities, after a spike in confirmed cases in the northern regions of Lombardy and Veneto.

Italy’s Health Minister Roberto Speranza announced severe restrictions in the affected regions, which included the closure of public buildings, limited transport, and the surveillance and quarantine of individuals who may have been exposed to the virus.

“We are asking basically that everyone who has come from areas stricken by the epidemic to remain under a mandatory house stay,” Speranza said at a Saturday press conference.” — CNN, Feb 24 2020

Sound familiar? It’s the exact same thing New York is trying now. It won’t work here either.

After that fails here too, we will wind up with the Italian situation. Overflowing hospitals. Demand at two, three, five times the capacity of the hospitals’ ability to deliver care. What’s worse is that their capacity will decline as cases overflow. Their doctors and nurses will be exposed and have to be quarantined, reducing an already strained workforce. Soon after, chaos in the hospitals will lead to fear in the whole city. You will see reports of people dying in their apartments because there isn’t capacity for them in hospitals. This fear alone will shut down the city. The economy will be ruined and tens, if not hundreds, of thousands of New Yorkers will die this year. This could all start at the beginning of April, if we don’t act within the next 5–10 days.

The Better Alternative: Shut down the city this week. Close everything but grocery stores, banks, and pharmacies. Convert schools into food distribution centers. Bring in the National Guard to provide essential services like food and augment police and emergency services. Issue checks to all New Yorkers for the length of the quarantine for at least $500 per person per month. Limit travel outside of the region. Slow the growth of the virus to a crawl immediately.

We know quarantines work. It did in Italy and Wuhan. It looks like France and Spain are convinced it will work too. The economy will be wrecked, but depending on when you do it, you might keep deaths in NYC under 5,000. Many times fewer deaths than the status quo approach. And, it will cost less. The economy will rebound more quickly and trust will be maintained in the ability of the government to protect the public.

This is an easy decision. We need Gov. Andrew Cuomo to take action now.

[MKSheppard]

Trump speaks at 5PM Eastern DT.

BREAKING: Puerto Rico declares daily curfew from 9 p.m. to 5 a.m. due to coronavirus; non-essential stores, cinemas, and gyms close at 6 p.m.
BNO Newsroom (@BNODesk) March 15, 2020

BREAKING: Italy reports 3,590 new cases and 368 new deaths, raising total to 24,747 cases and 1,809 dead

BNO Newsroom (@BNODesk) March 15, 2020

Italy's population is about 60m, vs 325m for USA. This in USA terms would be: 9,700~ dead.

[MKSheppard]

https://www.theguardian.com/world/2020/ ... s-teachers

A growing revolt by teachers raised the prospect of a mass "sickout" in New York City classrooms on Monday, even as Mayor Bill de Blasio continued to defend his controversial decision to keep schools open.

Entire school districts in more than a dozen states have shut down operations for more than 15 million students until the coronavirus crisis has passed. Just over the Hudson river from New York the city of Hoboken, in New Jersey, has gone so far as to enforce an overnight curfew.

But New York remains an anomaly, prompting a backlash from teachers unions who have attacked the decision as "irresponsible".

De Blasio, however, remains determined to keep classes in session for the school district's million students.

"My blunt fear is if the schools shut down they will be done for the year, done for the school year, maybe even for the calendar year," he said on CNN's State of the Union.

"So I'm very reticent to shut down schools for a variety of reasons, not just that it's where a lot of kids get their only good meals, but they get adult supervision, especially teenagers who otherwise would be out on the streets. There's health and safety ramifications to that.

"Those first responders, those healthcare workers who depend on the schools, they can get to work and we need those workers desperately."

De Blasio said he believed the crisis could last at least six months, and the situation was escalating daily.

"Because of community spread [coronavirus] is clearly widespread already in New York City and will continue to grow," he said.

"We had 25 confirmed cases on Monday, we have 269 this morning and that'll grow today, we'll clearly have a thousand cases probably not too far into next week. That doesn't mean people should be overwhelmed. It means people have to be smart about listening to guidance from healthcare professionals."

The mayor did concede, however, that schools could close quickly if he felt the situation warranted it.

"It is literally a day-to-day reality. If we can keep our schools open we will, if at any point we feel it doesn't make sense we will make a move," he said, adding that preparations were in hand to care for the children of essential workers.

"A variety of contingencies are being set up. They are far from perfect, let's be clear, the distance and difference between a functioning school system program for a million kids versus creating alternative centers feeding kids of healthcare workers, that kind of thing."

De Blasio's stance has angered teachers in the nation's largest school district, who have watched a steady stream of classroom closures in other sizeable districts, including Los Angeles, Boston and entire states including Florida.

Michael Mulgrew, president of the United Federation of Teachers, which represents about 150,000 educators in New York city schools, said De Blasio's failure to fall in line risked students' health.

"Because of his irresponsible decision to keep the public schools open, Mayor Bill de Blasio can no longer assure the health and safety of our students and school communities," Mulgrew said in an email to parents.

"We have a small window of time to contain the coronavirus before it penetrates into our communities and overwhelms our healthcare system's capacity to safely care for all the New Yorkers who may become gravely ill."

The Movement of Rank and File Educators, a faction of the UFT, has urged its members to call in sick on Monday as a protest.

"Transmission is clearly already happening in the schools and the sooner it stops the fewer people will die," the group said in a statement.

The faction has sent out several tweets with the hashtag "sickout", one stating that: "If de Blasio won't #closenycpublicschools to protect students and their families, teachers will."

Some parents have taken the decision to keep their children home.

"It would be a hardship if they closed the schools, but I think it's a necessary one we need to take in the space of this emergency," said Anna Gold, who pulled her third-grader and kindergartner out of public schools in Brooklyn.

In contrast to New York's relative freedoms, meanwhile, neighboring Hoboken has imposed a 10pm to 5am curfew on residents to try to keep coronavirus at bay.

Mayor Ravi S Bhalla announced on Saturday night that exceptions would be made for emergencies and people required to work, adding that restaurants can only offer takeout and delivery services.

[MKSheppard]

Ohio indefinitely closes restaurants and bars at 9pm tonight.