We are all escorts now

[+ stevenkesslar]

So here's a piece of good news to savor while you are sheltering at home.

 

We are all escorts now. Every one of you gets to think just like the best escorts in the United States do. Congratulations!

 

I'm posting this partly in response to two things: the thread on whether escorts websites should voluntarily shut down, and the announcement of the cancellation of the Palm Springs pool party.

 

I don't want to weigh in directly on whether escort websites should voluntarily shut down. Other than to say that the question pretty much answers itself. I think we all know what the word voluntary means. It's a decision to be made by the people who run those websites.

 

The analogy of the restaurant on that thread was a good one. There are two decisions being made: one by the restaurant owner, and one by the customer. If customers don't come, restaurants won't stay open. That is what is happening to restaurants, cinemas, and escorts right now.

 

The AIDS analogy was a good one, too. @Benjamin_Nicholas didn't say it quite this way. But we didn't decide to permanently ban sex. In fact, even the hint of a suggestion that the problem was Gay sex caused a huge and very understandable negative reaction. It's very understandable that there would be a similar reaction when we're being told that going to a bar or going to a beach somehow causes a problem.

 

What we did do to contain AIDS is temporarily close bath houses, which later were safely reopened. We did massive public education about the need to change individual behavior until treatments or cures were found. That alone was arguably the single most important and effective thing to do. It probably saved millions of lives globally.

 

The key messages on AIDS are ones we all know. Use a rubber. Don't share needles. The fact that we all know these messages, and most of us practice them, is why they have been so successful. And why you are reading this, rather than in a grave. We can thank the scientists who figured it all out for that.

 

Having a sort of vaccine for AIDS also has changed the game. But that took a long time to develop. Hopefully it will take much less time to develop a vaccine for this virus. Until then, a lot of this comes down to individual responsibility. It's important to understand what keeps us safe, and observe those rules.

 

For that reason, we are all escorts now. For 18 years or so I lived with the knowledge that the next client I met could infect me with something nasty I didn't want to have, or share with others. Having sex with the wrong person in the wrong way could have killed me. COVID-19 means we are all escorts now. Thinking smart about this and acting responsibly as individuals is what is going to keep us alive. Any escort worth his reputation can tell you that.

 

Morals and money aligned perfectly. Even if I had no scruples about being sick and getting people sick, it was just not a very good business plan. The same applies to restaurants. Before this crisis, restaurants that had outbreaks of salmonella paid for their mistakes dearly, both in their reputation and their bottom line.

 

We're all now in the same situation. Forget about a kiss. The best knowledge on this virus is all it takes to infect someone you care about is to have dinner together.

 

There's another part of the escort ethic that applies. It basically just sucks. But it is particularly important right now, since we are not up to speed on testing and tracing yet. I hated having to call clients to say I had gonorrhea or scabies, and I might have infected them. But I did. And I also got a few calls from public health departments telling me that somebody unnamed had had sex with me and I should come get a test. That will be part of our future, if we want to beat this thing. Until the tracing protocols are set up, I know my plan. I plan to stay negative to COVID-19. And if I do turn positive, I'll tell anyone I think I likely exposed.

 

To be honest, I had a morally relative view of that. There were people I definitely called, because I'd had sex with them very recently. I knew that as much as it's a shitty call to get, they would hopefully end up appreciating the warning. The client that I met only once, and a week before I knew I had the clap, didn't get a call. I figured it was very unlikely I infected him. Maybe I rationalized, but I figured the cost of having him worry and have to get a shot he probably didn't need wasn't worth it. Once tracing protocols are set up, there will be clear recommended guidelines for this with COVID-19. Health professionals will follow them. For the time being, anyone unfortunate enough to be infected can choose whether to follow them voluntarily and inform the people you were close to.

 

So all the lessons we learned from AIDS, and all the best practices of the best escorts, apply to this situation. Getting out of this situation as quickly as possible, and as healthy as possible, depends on one thing more than any other: individuals making responsible decisions based on really good information. That's one very good reason why a website like this one is particularly important right now, actually. The bureaucratic jargon is "harm prevention". Escorts know a lot about living - and living well - in a "harm prevention" community.

 

That said, I think we now all realize that we need massive and pro-active government leadership. Back in the scariest days of AIDS it was government organizations like the CDC, or local health departments, that were hammering the public about the need to use rubbers, and not share needles. Right now we are being instructed by the same organizations, and in some cases the same leaders. We are being told to shelter at home, or not have gatherings of 10 or more, depending on where we live.

 

Dr. Fauci, who is my personal AIDS hero, has been very clear pretty much since this started that we all need to hunker down. The sooner we do that, the sooner we can unhunker, and focus on humping again.

 

These are the same people who told us to use rubbers and not share needles. They kept me alive as an escort. I'm counting on them to do it again.

 

Not to sound scary, but reports coming in from Italy suggest that a lot of people in their 30's are ending up in ICU units. Worse, they are getting the respirators that 70 year olds need as a matter of life and death. This virus could come in waves and mutate, just like the Spanish flu did. So it's not 100 % clear that the virus in Italy is exactly the same as the one that has been contained in China. Or that this is mostly a serious personal health risk for 70 year olds, but not 30 year olds.

 

For that reason, I applaud @Oliver's decision. I was observing the discussion happening there without commenting, since I didn't feel like it was any of my business. It is actually probably a good model for decision making. This is a once in a century crisis, hopefully. And it changes by the day. In the midst of that, informed and responsible people can mostly be counted on to make informed and responsible decisions, I think.

 

And speaking of Italy. They are proving that they are all escorts now, too. Buona salute, amico mio!

 

Edited March 18, 2020 by stevenkesslar

[+ stevenkesslar]

Who knew? Hugh Hewitt is an escort now, too!

 

I read this interview shortly after I wrote that post above. I offer it in a nonpartisan, apolitical spirit. Dr. Fauci was a hero to the Gay community on AIDS. He is being a hero to America and the world, again. God bless him. I think the spirit of this is right on target.

 

HH is Hugh Hewitt and AF is Dr. Anthony Fauci.

 

Dr. Anthony Fauci ... on Coronavirus and Day Two of the Great American Shutdown

 

 

HH: Now I want to drill down on seniors. My target audience, we’ve got 6 million people who listen to this show. The vast majority of them are between 45 and 64, but we’ve got a lot of older people as well. A lot of grandparents, including me, all of my grandkids are under 9. This weekend, I was going to go drive and see them, because my daughter’s alone. My son-in-law is deployed. And they’re three kids under 9, and she said to me yesterday, don’t come. Is she right?

 

AF: You know, she is. Right now, what we’re trying to do, and you know, yesterday at the White House Taskforce press conference, we made an announcement to really ratchet up some of the guidelines for what we call physical and social distancing. And one of them if you have someone who is elderly and particularly an elderly person with an underlying condition such as heart disease and lung disease or diabetes that puts them at an increased risk of getting the complications of Coronavirus, if in fact they get infected, you really want to protect those vulnerable people. So the guideline, as stringent as it sounds, I think it’s, it’s not I think, I know is appropriate because it has worked in other settings, is to essentially have these individuals, the elderly, self-isolate in the home for at least the next 15 days to see what the direction of this outbreak is. And that means physical separation. Now you don’t want to make someone so socially lonely that their life is miserable, but you want to physically separate yourself from them, because a young person might go out into the community, get infected, and we know how from good experience with China, with South Korea, and now most recently with Italy and France, that younger individuals who get infected tend to do very well. Some of them have minimal symptoms as opposed to the chance of getting into trouble. So a young person may go out, get infected, and inadvertently come back and by physical interaction with the elderly or those with compromised immune systems, might actually infect them. And then the consequences are much more severe than a younger person getting infected.

 

HH: So Dr. Fauci, I’m going to use myself as an example, and we’ll expand from there. I’m 64. I’m in terrific shape. Just had my physical. Ran seven miles on Kauai a week ago, in fact, the Spouting Horn. I know you run every day 3 ½ miles. I’ve got runner’s back and a tear in a rotator cuff, but I’m in great shape. My grandkids are healthy. You would still tell me don’t go visit them?

 

AF: No, you know, I would tell you the following: that as a general guideline rule, you should not. But you know, when you talk about the elderly, particularly if as you say you are otherwise really quite healthy, you know, there’s a numerical age, and there’s a physiologic age. And some people who are 55, 60, are really kind of, you know, compromised because they don’t age well, where some people 75 and even 80 who are vigorous, athletic, and they do well. So when you get a guideline, you have a cut-off, and you say well, if you’re 70 years of age or older, there really needs to be some flexibility in interpreting that. I mean, if you want to be totally safe, then you overshoot and say okay, I’m 60 years old, I’m 65, but I’m very, very healthy, but I’m still going to self-isolate, because even though I’m very healthy and I have no issues or problems, I’m not going to take a chance. You can do that. You can do that.

 

HH: Well, let’s expand it out, Dr. We’ve got seniors who live for golf and who live for tennis. And they’ve got regular golfing partners, and they’ve got regular tennis partners. And they want to go to their club, and they say oh, it’s all very clean, and I’m only going to see the caddy, and I’m only going to see the bag boy, and I’m going to play 18 with my friend who’s also very healthy. Do you want them to stay home?

 

AF: Well, in general, yes.

 

HH: Perfect.

 

AF: But again, with exceptions. For example, you don’t want people to have crowds that are 10 or more. You don’t want to say after you’ve been one on one with someone you then go to the bar and have a few drinks with 50 people in the bar.

 

HH: Yeah.

 

AF: Those are the kind of things you don’t want to do. But if you want to bend on the side of caution, I would say even though it’s relatively low risk to go out and mingle with a few people, for now, for the 15 day trial period, I think it’s the better part of valor if you are an elderly person to just hunker down for a couple of weeks, see what the trend of the outbreak is.

[+ stevenkesslar]

Who knew? Even handsome young college students are all escorts now, too.

 

 

Sathvik Namburar achieved several feats during 2014 while passing out of High School - He had a perfect score in ACT, was a valedictorian, won US Presidential Award.

 

Medical students like me can fight on the front lines against coronavirus

We might not be able to treat patients on our own. But as hospitals and centers become overwhelmed during this crisis, we can help lighten the load.

 

Everyone must do what they can

 

Before I saw any patients that day, my supervising physician counseled me on the importance of asking for the travel history of anyone with coronavirus symptoms. Throughout the afternoon, I overheard clinicians speaking in hushed, anxious tones about how people would be tested for coronavirus and where to send patients who could possibly have it.

 

Left unsaid in all of these conversations was the risk that the clinic’s providers were taking every time they entered the room of a patient who had a fever, cough and/or shortness of breath. My supervising physician told me to be extra careful to wash my hands before and after seeing every patient, but we did not discuss any other protective measures throughout the day.

 

As I prepared to leave, my supervising physician offered a warning: “The virus is in our community now,” she told me, “and ready or not, it is my job as a doctor to be on the front lines combating it. In this line of work, we take an oath to take care of our patients, and we are needed more than ever now.”

 

Students have fought pandemics before

 

It is not unprecedented for medical students to join the front lines in combating a pandemic. In 1918, a severe doctor shortage meant that third- and fourth-year medical students were enlisted to treat waves of Spanish influenza patients, sometimes with little training or preparation. We medical students should begin training now in case the new coronavirus pandemic becomes worse and our contributions are more urgently needed.

 

 

Because most medical students are generally young and healthy, we are not among the high-risk populations for serious illness from the coronavirus, unlike some of the older physicians who are treating patients. And we can easily be taught to use the proper protective equipment to reduce the chances of spreading the virus.

 

When we put on our white coats for the first time, we willingly accepted that one day we would be responsible for treating patients, no matter their affliction, to the best of our abilities. Now, we may be needed sooner than we once expected. We are ready to help.

 

Sathvik Namburar is a second-year student at the Geisel School of Medicine at Dartmouth College.

 

 

 

There's been a lot of discussion in the last week about ideas like this. Gov DeWine is guessing there could be as many as 100,000 people infected with COVID-19 in Ohio alone right now. I hope he's wrong. No one knows the hospitalization rates for sure. And everybody is working 24/7 to figure out how to keep people who do not absolutely require hospitalization out of hospitals. For example, in New York they are working on a protocol to give people oxygen saturation meters that can be monitored remotely by nurses.

 

 

If I understand the idea correctly, which I may not, normally a patient who even needed oxygen level monitoring would be in a regular hospital bed. Because she said if you fall off the cliff, you go into shock. A lot of the patients in China then went into sepsis. And then you are moving very much into "this could go either way" territory.

 

As the author said, under normal circumstances, Coronavirus treatment is not something any college medical student would be involved in. If the numbers DeWine is throwing around are right, having college medical students doing low-level tasks could free up others to do the life saving stuff.

 

There's been a lot of talk about how young Millennials are going to get the Coronavirus in bars, and be just fine. Then they'll go visit Grandpa and pass it on. And Grandpa won't be fine.

 

There's also may be a lot of young Millennials like this guy, who rise to the occasion to keep us well.

[wbtravis]

So here's a piece of good news to savor while you are sheltering at home.

 

We are all escorts now. Every one of you gets to think just like the best escorts in the United States do. Congratulations!

 

I'm posting this partly in response to two things: the thread on whether escorts websites should voluntarily shut down, and the announcement of the cancellation of the Palm Springs pool party.

 

I don't want to weigh in directly on whether escort websites should voluntarily shut down. Other than to say that the question pretty much answers itself. I think we all know what the word voluntary means. It's a decision to be made by the people who run those websites.

 

The analogy of the restaurant on that thread was a good one. There are two decisions being made: one by the restaurant owner, and one by the customer. If customers don't come, restaurants won't stay open. That is what is happening to restaurants, cinemas, and escorts right now.

 

The AIDS analogy was a good one, too. @Benjamin_Nicholas didn't say it quite this way. But we didn't decide to permanently ban sex. In fact, even the hint of a suggestion that the problem was Gay sex caused a huge and very understandable negative reaction. It's very understandable that there would be a similar reaction when we're being told that going to a bar or going to a beach somehow causes a problem.

 

What we did do to contain AIDS is temporarily close bath houses, which later were safely reopened. We did massive public education about the need to change individual behavior until treatments or cures were found. That alone was arguably the single most important and effective thing to do. It probably saved millions of lives globally.

 

The key messages on AIDS are ones we all know. Use a rubber. Don't share needles. The fact that we all know these messages, and most of us practice them, is why they have been so successful. And why you are reading this, rather than in a grave. We can thank the scientists who figured it all out for that.

 

Having a sort of vaccine for AIDS also has changed the game. But that took a long time to develop. Hopefully it will take much less time to develop a vaccine for this virus. Until then, a lot of this comes down to individual responsibility. It's important to understand what keeps us safe, and observe those rules.

 

For that reason, we are all escorts now. For 18 years or so I lived with the knowledge that the next client I met could infect me with something nasty I didn't want to have, or share with others. Having sex with the wrong person in the wrong way could have killed me. COVID-19 means we are all escorts now. Thinking smart about this and acting responsibly as individuals is what is going to keep us alive. Any escort worth his reputation can tell you that.

 

Morals and money aligned perfectly. Even if I had no scruples about being sick and getting people sick, it was just not a very good business plan. The same applies to restaurants. Before this crisis, restaurants that had outbreaks of salmonella paid for their mistakes dearly, both in their reputation and their bottom line.

 

We're all now in the same situation. Forget about a kiss. The best knowledge on this virus is all it takes to infect someone you care about is to have dinner together.

 

There's another part of the escort ethic that applies. It basically just sucks. But it is particularly important right now, since we are not up to speed on testing and tracing yet. I hated having to call clients to say I had gonorrhea or scabies, and I might have infected them. But I did. And I also got a few calls from public health departments telling me that somebody unnamed had had sex with me and I should come get a test. That will be part of our future, if we want to beat this thing. Until the tracing protocols are set up, I know my plan. I plan to stay negative to COVID-19. And if I do turn positive, I'll tell anyone I think I likely exposed.

 

To be honest, I had a morally relative view of that. There were people I definitely called, because I'd had sex with them very recently. I knew that as much as it's a shitty call to get, they would hopefully end up appreciating the warning. The client that I met only once, and a week before I knew I had the clap, didn't get a call. I figured it was very unlikely I infected him. Maybe I rationalized, but I figured the cost of having him worry and have to get a shot he probably didn't need wasn't worth it. Once tracing protocols are set up, there will be clear recommended guidelines for this with COVID-19. Health professionals will follow them. For the time being, anyone unfortunate enough to be infected can choose whether to follow them voluntarily and inform the people you were close to.

 

So all the lessons we learned from AIDS, and all the best practices of the best escorts, apply to this situation. Getting out of this situation as quickly as possible, and as healthy as possible, depends on one thing more than any other: individuals making responsible decisions based on really good information. That's one very good reason why a website like this one is particularly important right now, actually. The bureaucratic jargon is "harm prevention". Escorts know a lot about living - and living well - in a "harm prevention" community.

 

That said, I think we now all realize that we need massive and pro-active government leadership. Back in the scariest days of AIDS it was government organizations like the CDC, or local health departments, that were hammering the public about the need to use rubbers, and not share needles. Right now we are being instructed by the same organizations, and in some cases the same leaders. We are being told to shelter at home, or not have gatherings of 10 or more, depending on where we live.

 

Dr. Fauci, who is my personal AIDS hero, has been very clear pretty much since this started that we all need to hunker down. The sooner we do that, the sooner we can unhunker, and focus on humping again.

 

These are the same people who told us to use rubbers and not share needles. They kept me alive as an escort. I'm counting on them to do it again.

 

Not to sound scary, but reports coming in from Italy suggest that a lot of people in their 30's are ending up in ICU units. Worse, they are getting the respirators that 70 year olds need as a matter of life and death. This virus could come in waves and mutate, just like the Spanish flu did. So it's not 100 % clear that the virus in Italy is exactly the same as the one that has been contained in China. Or that this is mostly a serious personal health risk for 70 year olds, but not 30 year olds.

 

For that reason, I applaud @Oliver's decision. I was observing the discussion happening there without commenting, since I didn't feel like it was any of my business. It is actually probably a good model for decision making. This is a once in a century crisis, hopefully. And it changes by the day. In the midst of that, informed and responsible people can mostly be counted on to make informed and responsible decisions, I think.

 

And speaking of Italy. They are proving that they are all escorts now, too. Buona salute, amico mio!

 

Such a cool, articulate perspective. I really appreciate you sharing it.

[+ stevenkesslar]

I'm posting this mainly because of the last paragraph.

 

Italy’s death toll soars to 3,405, surpassing China’s.

 

Italy, which has been one of the hardest-hit countries in the world since the coronavirus first began to spread, passed a grim milestone on Thursday: it announced that deaths from the virus had soared to 3,405, outstripping the toll in China, where the virus first hit.

 

With the crisis mounting, Italy is increasingly turning to its military for help.

 

Cemeteries in the northern city of Bergamo are so overwhelmed that the army was called in to transport bodies elsewhere to be cremated, and the army sent 120 doctors and health professionals to help in Bergamo and nearby Lodi, two cities in the Lombardy region, while field hospitals and emergency respiratory units are being set up elsewhere in the north.

 

The spread of the virus in Italy has been swift, and terrifying, even after the country became the first in Europe to impose strict limits on people’s movements to try to curb the outbreak. As the death toll grew, traditional funeral services were outlawed as part of the national restrictions against gatherings.

 

The country tallied 902 deaths in the last two days alone: 475 Wednesday and 427 on Thursday. Most of those who died had serious pre-existing conditions, officials said. Italy now has 41,035 cases.

 

The Italian Prime Minister, Giuseppe Conte, said in an interview in Corriere della Sera Thursday that he expected the government’s restrictive measures to limit movement would be extended past the current April 3 deadline.

 

“The restrictive measures are working, and it’s obvious that when we reach a peak and the contagion begins to descend, at least in percentages, hopefully in a few days, we won’t immediately be able to return to our regular lives,” he said.

 

In the face of relentlessly bad news, Italians have risen to meet the crisis — the worst the country has faced since World War II — with fortitude, and creative attempts to keep their spirits up. Some housebound Italians, trying to follow social distancing rules in a famously social country, began serenading one another from their balconies in the evenings. And many began taking to their balconies to applaud the doctors and medical workers risking their own lives on the front lines, a show of communal gratitude later emulated by Spain and other countries.

 

 

 

 

It's a good time to be scared, but it's also a good time to be grateful. Mostly, it's a good time to be prepared.

 

Another way to think about this is we are soldiers now.

 

There is a group of Americans for whom these kinds of restrictions on liberty are typical: the military. And we are at war. Military medical ships have been dispatched to New York and California. As that article says, there is every reason to think that military-style field hospitals may need to be set up in hot spots.

 

It's now incredibly clear that the ethic that is the best for a situation like this is the ethic of the military: "one for all and all for one".

 

Some version of that was true all over China. In Wuhan, the medical system was completely overwhelmed. They had to bring in thousands of doctors and nurses from other parts of the country and building emergency hospitals overnight.

 

In the rest of China, very few people died. There are provinces in China that are larger than any state in the United States where the death rate was literally zero. They had maybe 500 to 1000 cases. But because the hospitals were not completely overwhelmed, like they are in Italy right now, everybody who did need life saving hospital care was able to get it. To the point that you could argue, "Why the overreaction? Why the fuss?"

 

What's clear is that the reason so few people died and they can now start getting back to normal is that there was a sort of enforced, but temporary, military discipline. Probably more important is that there was a deep cultural belief that we are all in this together. "One for all and all for one." Had they not done that, it's also clear that every province in China would have been as bad as Wuhan, or worse.

 

What the Italian Prime Minister said is now sinking in everywhere, I'd guess. We won't be able to immediately get back to our regular lives. The fact that we can look forward to doing that gradually is something to be grateful for.

Edited March 19, 2020 by stevenkesslar

[+ stevenkesslar]

What I want you to know about coronavirus, from a Seattle woman who recovered from COVID-19

 

 

Here’s what I want people to know:

 

You will most likely be fine if you get this. We’re all hearing a lot about what it’s like to have the worst version of COVID-19, which is one reason I want folks to know what it was like for me. My friends and I are recovered, or almost there. None of us had to be hospitalized. The kids I know who’ve been exposed have emerged without a scratch; that jibes with findings from around the world.

 

We all need to look out for those who will not be fine. Testing personnel and materials are scarce, and resources are rightfully going to help those who most need them. Which means that yes, untested, untreated people are walking around with this virus. One of them gave it to someone I know, who gave it to me. But rather than looking around at your fellow humans and wondering if they’re going to give you coronavirus, think about whether you might be the one giving it to them. Try not to be that person. If you’re sick, stay home. If you’re not sick, know that you might still transmit it, so wash those hands, wipe those surfaces and stay out of spitting distance of other people!

 

The feds aren’t going to save us. With federal agencies decimated and disorganized, we’ve learned, sadly, that we can’t wait for someone at the top to tell us what to do. I’m glad the Seattle Flu Study folks didn’t wait. The lack of national coordination is reason for deep disappointment, but it’s not a reason for despair. Instead, I hope this realization strengthens our resolve to do what we have to do.

 

We are going to save each other. Did you ever wonder how you would have acted if you had been caught up in one of those difficult times in history — the American Revolution, the flu of 1918? Do you hope you would have been one of the brave, helpful ones? Here’s your chance.

 

I love that folks are starting to think about how they can assist vulnerable people of all kinds, whether that be an elderly neighbor or a struggling small business. I’ve been buying gift certificates to use after this is all over and donating to help artists. We all need to pressure elected officials, right now, to implement policies that will help those most affected. We all need to help health care workers do their jobs by doing ours — and right now, our job is to keep each other healthy.

 

As for me, I’m wondering what I should do next (once I’m out of quarantine, that is). I’m hoping to hear good news from research into whether having had the virus gives us immunity going forward. If it does give me immunity, I hope to use that superpower for good.

 

This is our once-in-a-lifetime challenge. Let’s rise to it.

 

 

What can I say? Some of us like to bang pots. Some us like to write.

[+ easygoingpal]

Breaking News (just now) on CNN: California governor orders all 40 million residents to stay at home to prevent spread of coronavirus.

[+ Charlie]

Breaking News (just now) on CNN: California governor orders all 40 million residents to stay at home to prevent spread of coronavirus.

That was a sensational headline, not an accurate summary of the actual order.

[+ WilliamM]

That was a sensational headline, not an accurate summary of the actual order.

 

And we are not all escorts now.

[+ easygoingpal]

That was a sensational headline, not an accurate summary of the actual order.

Straight from CNN... I agree with you - Details and less sensational headlines started to be reported after that initial piece of news.

[+ stevenkesslar]

So here are three very comprehensive sources of data. If you don't like charts and graphs, definitely give this post a pass.

 

What seems obvious already is that the spirit of "all for one and one for all", with extra big helpings of human kindness, is kicking in.

 

AIDS - or any STD - is a helpful analogy for thinking about this to me. It is real. It is scary. And staying healthy means staying informed and being smart, and working through this together.

 

I had a line I always used when new clients asked me about STDs. I always advised them that while AIDS is a killer, the things they really needed to worry about are things like gonorrhea. AIDS is pretty hard to get, as long as you do easy things to prevent it. The clap is very easy to pass along before you even know you have it. This is somewhere between the two. Much more like gonorrhea than AIDS. The difference is the risk group is the entire human population. And basic human behavior is now risky.

 

Live tracker: How many coronavirus cases have been reported in each U.S. state?

 

That shows testing rates and numbers of positive results by state. I think Politico updates it daily.

 

The hopeful lesson from provinces in China is that by acting quickly, and aggressively testing and tracing, they minimized the spread of the virus in almost every province. Very few people outside Hubei Province died. Like 0 to 10 people died in provinces bigger than California. I suspect that, absent a tidal wave of thousands getting this all at once, the risk groups that did get very ill in the other provinces all got the life saving medical care they needed. They avoided the "hospital-demic" that befell Wuhan.

 

We've missed the ball in some states, starting with New York. But I'm hoping people in North Dakota, where they have 15 positives out of some 500 tests, are watching TV and hearing about that family of 8 in New Jersey that was half wiped out just because they celebrated together a few weekends ago. Nobody will want this movie playing in their dining room, or their local hospital ER rooms, if they can avoid it. And I'm sure this is now priority # 1 for every Governor in America. It will take a while to get the tests outs. But my guess is within a few months tops there will be a tidal wave of testing, including hopefully "do it at home" tests.

 

I for one think it would be smart if we did impose more restrictive quarantines in certain hot spots, like China did. People agreed with it once they understood the basic idea was to keep them alive and well. But this is America, where individualism rules. To go back to AIDS, it is the equivalent of saying we will close the bath houses, so that when we reopen them we are all safe.

 

I hope part of hunkering down is we're all going to be training ourselves to think not only about six feet around us. I hope we all start drawing circles out from that: is my community safe? is my city safe? is my state safe? Living in a state like California that is going to have a huge wave of cases for a while, it would give me a reason to feel good and hope that this is something people in North Dakota don't have to worry about, at least. Hopefully, they have all the tests and ICU beds they need. People in North Dakota will of course be hoping California gets it contained soon, so they can come bike through the Presidio and hang out at Fisherman's Wharf again.

 

How Much Worse the

Coronavirus Could Get, in Charts

 

That is a cooler version of the "flatten the curve" graphic we have all seen by now. It was helpful for me to think about this. (The New York Times now offers all COVID-19 news, like the article above, free to non-subscribers we sign in on Facebook or Google.)

 

Here's the things that were helpful for me to think about.

 

1. It will get a lot worse before it gets better. The better job we all do of taking care of ourselves and those we care about the less horrible this will be. But it will be horrible. I think this is one where it's just hard to overreact - which is what Dr. Fauci has been saying consistently.

 

2. Look at those timelines. Gov. Newsom said in California we're in "shelter at home" mode for a few months, which I think is correct. He's also said it could go on for longer. My view of this is that China was able to eradicate community spread of the virus in a few months - FOR NOW - by using a heavy hand. South Korea has been able to largely contain community spread in about a month while using a softer hand. Remember the magic words: test, trace, treat. For those of us who like whoring, we're just doing a reverse Halloween. First we treat, then we can trick again.

 

After looking at that chart, I changed my "emergency" timeline from three months to one year. Which is to say, we are all living on the timeline of the virus now. Sort of like we live on the timeline cancer gives us, if we get it. This is actually a much better prognosis than almost any form of cancer. Because even if it can't be treated with a vaccine, this form of cancer is 99 % survivable, if we catch it. And the virus will likely go away in a year or so. But if you look at those infection curves, this is going to be around for much longer than a few months - no matter what we do.

 

I'm trying to get a handle on how my tenants pay rent for the next year, how much I can cut the rent to help them while still being able to pay mortgages and utility bills, etc. There are at least some industries that are likely to take quite a while to get back to normal, no matter how big a bailout they get. Schumer said something that struck me as wise: this is worse than 9/11 or the predatory lending crisis. Because we're just all going to have to learn to live with a lot of uncertainty for a while. The 1918 pandemic is probably the best analogy. At some point this shall pass. But it may take a year. And we don't get to decide whether, like in 1918, the virus backs off in the Summer and then comes back even worse in the Fall. But even in the worst case, at least we now know we have six months to prepare for that possibility.

 

As the politicians and scientists and doctors think this through, it seems inevitable that we're going to have to think of living with this like we think about living with AIDS, or some forms of cancer. Meaning the majority of people in low risks groups can act one way. But the minority in high risk groups have to be way more careful.

 

The young and healthy won't want to stay home for a year. So we'll have to find a way they can go back to 90 % normal work and play. As of what we know now, they'll face less risk of dying from COVID-19 than they do from a car crash or drug overdose. So by next Spring, hopefully they'll be tons of them partying on the beach in Florida or Mexico so that airlines and hotels have revenue again.

 

That said, the significant minority of people that are older or sicker are going to have to live by different rules. Maybe for like a year. It's not clear how a 70 year old with diabetes and a heart condition goes to Starbucks and gets served by a college student who may have an undiagnosed infection. Unless they know there are zero cases of COVID-19 in their state. We'll all probably have to recalibrate what acceptable risks mean. Unless this magically disappears, or we expedite an effective vaccine.

 

I assume the people who make the big bucks are all trying to figure out how you have an economy that can get back to "mostly normal", while we all have the threat of this virus hanging over us for a year, or maybe for longer. At a minimum, I think we're going to have to deal with the "hospital-demic" issue before people who are at higher risk of ending up in a hospital are going to feel safe at Olive Garden, or in a casino.

 

Being a senior, or younger and sick, is going to be like the new "Gay" for a while. Just like AIDS, this will require a different set of needs, treatments, and precautions. Unlike Gays and AIDS in the 80's, it will be impossible for the rest of society to sweep this under the rug.

 

Which Country Has Flattened

the Curve for the Coronavirus?

 

Those charts from China and South Korea are the things that give me the most hope. And those charts from almost every country really bring home that we are in the early stages of a huge global mess. The idea that we'll be able to just hop on a plane and go to Mexico or Brazil or Thailand this Fall doesn't sound very likely. And when we are able to do it, it's going to be different.

 

I'm glad every country is shutting down their borders. We should have done that earlier, in my mind. But once the borders are open again this is going to require a greater degree of global cooperation than before. We now know, from experience, that this could start anywhere in the world and be everywhere in a few months. We're going to pay a huge price for letting this happen, and we only want to pay that price once. No country that beat this back is going to want business travelers and tourists coming in and kicking off a second wave of infections.

 

The other "good news", if you can call it that, is that this is a form of democracy at work. Some nations will handle this better than others. We'll all learn from them. Scientists all over the globe are working together to understand the virus and find treatments and vaccines. So we'll gradually get a better handle on how we get this under control, and keep it under control.

Edited March 21, 2020 by stevenkesslar

[+ FreshFluff]

NYC has some tips on safe sex during the pandemic. Remember: Your safest sex partner is you.

 

https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-sex-guidance.pdf

[+ stevenkesslar]

NYC has some tips on safe sex during the pandemic. Remember: Your safest sex partner is you.

 

https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-sex-guidance.pdf

 

 

At a minimum, I think we're going to have to deal with the "hospital-demic" issue before people who are at higher risk of ending up in a hospital are going to feel safe at Olive Garden, or in a casino.

 

And here is an early and tragic example that I think underlines this point.

 

COVID-19: NYC should brace for impact and shut down now.

 

 

Those charts, which I'll grow through, explain why we will all have to view this partly as a "hospital-demic". And any hope of getting back to anything near normal is fucked until we lower the number of infections and hospitalizations by getting this virus under control.

 

Michael Donnelly is a professional data scientist at Facebook. But the charts above are his own projections he is putting out there to create public awareness. It is getting picked up in news pieces by credible outlets of journalism like Politico. And whether the guy is 100 % right or 70 % right, what he is doing is brilliant. It could save a hell of a lot of lives.

 

It would be a very good thing if the Governors Association (or The White House) adopted some standard like this ASAP, so that people in every state could know what their risk looked like. If you assume that we will get this in control in most parts of the US in a few months, daily updates like this also really help the public and restore confidence. Like we would know WHEN and WHERE it is save to go back outside. And WHEN and WHERE they have to be extremely careful. Every large city in the US could be doing this, too.

 

We know enough about how this played out in China and is playing out in Italy to make some educated guesses. So the math is simple and sound, even though it is based on assumptions. And you could do math like this for any state or any city in the US.

 

There are 777 COVID-19 hospitalizations in NYC as of yesterday. The assumption this guy makes is that 10 % of cases require hospitalization. (I've read reports on cases in China that suggest that it could be as high as 20 %. That said, probably 10 % of all cases are serious, but not so severe that sending you home because the hospital does not have any more beds is not an automatic death sentence.)

 

So he backs up and says that 777 cases means that's from a population of 7770 infected people, 10 % of whom now need to be in a hospital. And he backs that 7770 infections up a week, because the 777 people in the hospital today got infected a week ago. (I've read things that suggest it could be up to two weeks from infection to hospitalization. So if anything this may underestimate the actual number of infections.)

 

Finally he takes the actual number of diagnosed infections a week ago (220) and divides that by his estimate of how many infections he thinks there really were (7770). He concludes that only about 3 % of infected people last week were diagnosed. He estimates that now that we are finally ramping up testing, maybe 5 % of cases are being diagnosed today. Based on that, he estimated that there are now about 70,000 infected people in NYC. In a week, there will be about 400,000 people.

 

He's calling for a complete shutdown of NYC, like we have in California, other than essential services. Gov. Cuomo, after resisting the idea for days, has now issued similar state at home orders statewide. I assume this is why.

 

The obvious flaw in the logic here is that the rate of infection may have declined. The scientists seem to agree that every infected person infects two more people, often or maybe usually without even knowing they are sick. Which is why we have to stop letting this grow exponentially before we have a NYC-style like crisis in all 50 US states.

 

Donnelly is estimating that by next week all 3000 beds that NYC has available for COVID-19 patients will be full by next week. He is also saying that all 3000 people who will need those beds are already infected. We will know in a week if his estimates were right.

 

Safety net hospitals a 'disaster' as coronavirus patients begin to flood in

 

“It’s a disaster,” said Dr. Conrad Fischer, residency program director in internal medicine at Brookdale University Medical Center. “We just had a half dozen staff just test positive. We have 17 ventilators left in the institution. Some staff can't come because they’re getting wiped out.”

 

Gov. Andrew Cuomo expects the surge of Covid-19 patients to come within the next 43 days, though Michael Donnelly, a data scientist at Facebook, believes New York City hospitals will reach capacity of 3,000 cases by Tuesday. Based on his modeling, hospitals could see 100 new patients an hour by March 28. Greater New York Hospital Association, which represents many private hospitals in the city, did not return a request for comment on the analysis.

 

The increase in caseload could not only overwhelm the bed capacity but also sicken front-line health care workers who have limited protective gear. Under mandates that all health care workers report for duty, even if those staffers were furloughed, units could fall sick to the virus should someone test positive, but show no symptoms.

 

That article from Politico is how I got to Donnelly. This is going to be a disaster. It is already a disaster in the "safety net" hospitals. But soon it will be a disaster for hospitals the serve the relatively affluent, just like it is in Italy.

 

This will definitely help get the message through that if you are well you need to stay home. If you even possibly could be infected, you need to stay away from other people. The experience of China and South Korea is that as bad as it is going to get, if we do that we can get it under control in a month in many places, and a few months in the hot spots.

Edited March 21, 2020 by stevenkesslar

[+ stevenkesslar]

This is worth reading or scanning. It is written by Michael Donnelly. Same data scientist as in the prior post.

 

COVID-19: No Good Options

An epidemiological, economic, and policy analysis of the novel coronavirus epidemic

Michael Donnelly — March 11, 2020

 

• Reported cases of COVID-19 in the US dramatically understate the current number of infected Americans.
  
• The current US mortality rate is likely much lower than reported (~0.4%).
  
• Asymptomatic and mild cases are hard to detect and make this disease incredibly difficult to contain.
  
• Without strong government intervention to slow the spread, the disease could spread to millions of Americans in very little time. This would overwhelm hospitals and increase the mortality rate of the disease.
  
• Federal, state, and local governments will be forced to take unprecedented steps to slow the spread of the virus, including quarantines, school and business closures, and domestic travel restrictions. While there will be significant economic fallout from these measures, the damage to the country and economy would be worse without them.
  
• Most of the economic costs of the government response will fall to lower and middle income wage workers. Policies, such as enhanced unemployment insurance, should be adopted quickly to compensate these workers for the sacrifices made in the best interest of the country.
  
• Policymakers should also implement smart economic policies that will slow the spread of the virus in order to protect the public. Requiring paid sick leave and guaranteed healthcare will slow the spread and economic consequences of COVID-19.
  

Quick note from the author

 

Disclaimer. I am writing this on my own behalf to try to increase transparency and information about the seriousness of the situation we’re facing. The views and work contained in this note are purely my own and represent no one else and no organization or company.

 

(He works for Facebook.)

 

Note what Donnelly wrote in that report just 9 days ago:

 

As of writing this, the world has over 100,000 confirmed cases of the novel coronavirus disease, COVID-19. Most of the cases are still in China, but that picture is changing rapidly. As recently as two weeks ago (Feb 23), China’s cases represented >97% of global cases. As of March 10, that number has dropped to 68%. It is becoming clear that the rest of the world will soon surpass China’s infection count.

 

In fact, we're now at 275,000 cases globally. About 30 % of them were in China, which has eradicated community spread for now.

 

And in a week plus change, many of the unprecedented government actions he predicted would be needed have actually happened.

 

Donnelly thinks the actual death rate may be as low as 0.4 %. Dr. Fauci thinks it is probably 1 %. If 200 million Americans get infected that means 1 million to 2 million deaths. And it actually probably means much more. Because the hospitals beds, doctors, nurses, and respirators that could have kept many alive will not be available.

 

Italy has overtaken China as the country with the most cases, over 4000. Italy has just under 50,000 cases. They have consistently been averaging a death rate of slightly less than 10 % as the number of cases and deaths has grown.

 

I think Italy illustrates that we have to think of this as both a pandemic and a "hospital-demic". The reason the death rate is so much higher in Italy is that partly the patients or older. Almost all of them had at least one underlying condition, like a heart or lung condition. But in addition they have run out of hospital beds and life saving equipment in the hardest hit areas. In a new study of 2003 Italian patients in this study who died, 1425 of them were in Lombardy (71 %) and 346 of them (17 %) were in Emilia-Romagna. So you had older people in their 60's, 70's, and 80's with serious pre-existing conditions crammed into hospitals without the capacity to save all of them. That's a "hospital-demic".

 

We also now have a report that documents the huge difference between having a "hospital-demic" and catching this earlier through test, trace, and treat. This is a study of 1099 COVID-19 patients in China:

 

Clinical Characteristics of Coronavirus Disease 2019 in China

 

What's particularly interesting about this report is that it is almost the exact opposite of what happened in Italy. In Italy, the death rate is close to 10 %. In this study in China, it was 1.4 %. The average age of those who died in Italy is about 80. Only 15 of the Chinese patients in this study died, and it does not give their age. But the average age of all 1099 patients was only 47.

 

This is a breakdown of those patients. I'm posting it because I think you could look at this as representative of "America's workforce". The huge problem every nation in the world has now is how can people go to work when just doing their day to day routine may kill them? Whether that is true or not is irrelevant. The panic is growing, and as the deaths mount it will only get worse. So right now having clear information and hope based on real numbers, not bullshit, is critical.

 

 

Half of the patients are people who lived in Wuhan. Almost everyone else had either recently visited Wuhan, or had direct contact with Wuhan residents. The million dollar question for the rest of the world right now is: how did you find these infected people? I assume some of them got sick and came forward. But I also assume most of them were found quickly through a very aggressive tracing program, before they could spread the disease.

 

It looks like all the people in this study were hospitalized. It's not clear to me whether the Chinese put everybody that had COVID-19 in hospitals, or whether this represents some portion of all the people infected who were judged to need hospital care. My guess from the numbers, and from China's aggressive policy, was that EVERYBODY who was found to be infected was hospitalized and isolated.

 

From that point on, the news is actually pretty good. Of these 1099 patients, 926 (or 84 %) had "nonsevere" cases. That is consistent with everything we've heard so far. If you read the whole report, there are several other tables on what interventions were required, and how 14 people died - mostly acute respiratory distress syndrome and septic shock as organs shut down. The scary part to me is that 5 % of patients needed to be admitted to the ICU. 2.3 % underwent invasive mechanical ventilation.

 

As I said above, 1.4 % died. The report does not list the age or pre-existing conditions of the 14 who died. But as you can see above almost one quarter of the 1099 patients had pre-existing conditions, including things like cancer, hepatitis B, and diabetes. Almost all of them lived.

 

The reason I think this matters is that with every day it is more apparent that we are going to have to live with this virus and contain it, much like we do AIDS. We'll also need extremely aggressive testing and tracing protocols. If we had been told two months ago we needed to stop this virus immediately, because otherwise it will shut America and the world down, we probably would have almost all agreed to do whatever it takes.

 

So I think once we get this under control we're going to have to live in a nation for a while where there is every reason to think this is under control. But also where we recognize there is going to be some risk of a new outbreak somewhere. At a minimum, I think we could mostly all go back to work at such a point if we knew that there were policies everywhere to nip this in the bud wherever it breaks out. As a matter of national policy, I think anyone who gets COVID-19 should get 100 % free medical care. If we really get it under control, I think anyone who gets COVID-19 should be sent immediately to a hospital, where they are isolated and treated until they are well. That's better than having thousands of infected people walking around infecting other people, because they don't have the money to be treated and they only have a mild illness themselves.

 

The good news from the data from China above is that if you are a middle-aged employee and you get sick, despite that fact that everyone in the nation is now focused on wiping this virus out, you have an 85 % chance of this being like a bad case of the flu. Ideally, in my mind, people would think of it as a two week paid vacation, albeit spent in a hospital bed, so all the rest of us can work safely while you get well. The bad news is that 1 out of every 100 people or so will die. But the data suggest that those are most likely to be people who had serious health issues already.

 

I can't see Americans tolerating a situation where this virus is allowed to run rampant, and we have hundreds of thousands of people dying in hospitals and makeshift hospitals all at once, until several million of us are dead. I can see America living with the consequences of where China and South Korea are right now. Until there is a vaccine or this virus goes away, it's a given that there will be outbreaks somewhere. But if we do some version of what China and South Korea did, we could realistically mostly contain the virus and prevent community spread. Perhaps we can limit the numbers of deaths that occur to what happens in a particularly bad flu season.

 

We'll know much better soon, because the tidal wave is starting to hit.

Edited March 21, 2020 by stevenkesslar

[+ stevenkesslar]

So I think the picture is already emerging of how we are going to be living and protecting ourselves for the next year, or however long it takes to eradicate or contain this virus. If that is what we actually try to do, as opposed to just letting it run its course through the population.

 

This is the COVID-19 state by state tracker that Politico used to do that state-by-state graphic I posted above.

 

The COVID Tracking Project

 

It lists current diagnosed cases per state, deaths, and other data. It also has a list to each state's own website dealing with COVID-19. Of the half dozen or so I looked at, they are all run by the state's Department Of Public Health.

 

'The kinds of systems for public awareness and testing and tracing are being built state by state as we speak. No surprise, some states do better than others. Here are two state information systems that seem better than average to me.

 

Colorado Case Summary

 

Florida's COVID-19 Data and Surveillance Dashboard

Florida Department of Health, Division of Disease Control and Health Protection

 

As of right now, Colorado has 363 cases, 44 hospitalizations, and 4 deaths

 

Florida has 563 cases, an unknown number of hospitalizations, and 10 deaths. The Florida website is the most user friendly and full of data of any of the ones I looked at. For each county they list the numbers of people tested, confirmed positive cases, people under investigation, people hospitalized.

 

Every county in Florida lists "people under investigation". I assume that refers to the beginnings of an infrastructure to try to trace who else people with diagnosed infections may have infected. The current scientific best guess is that everyone infected goes on to infect 2.3 other people.

 

Miami has it's work cut out for it. If you click on Dade County on the Florida website above, you will see there are 125 people currently hospitalized for COVID-19. That would mean that roughly 1250 people were infected in Dade County a week ago, and now 10 % of them need hospitalization. During the last week, it would also mean everybody with the virus infected 2.3 more people. That means there are possibly 4000 infections in Dade County now.

 

The Dade County data says that only about 1000 people have been tested, of which 123 are positive. That means that maybe only about 3 % of the people with COVID-19 know they have it. My guess is those are people who ended up in hospitals, anyway, and were tested. Meanwhile, that leaves close to 4000 other people spreading the virus right now around Miami, unless they are isolating themselves.

[+ stevenkesslar]

Breaking News (just now) on CNN: California governor orders all 40 million residents to stay at home to prevent spread of coronavirus.

 

That was a sensational headline, not an accurate summary of the actual order.

 

I finally got the brilliant idea of watching Gov. Newsom's press conference today. It could not possibly be more sensational. Not in the sense that it is wrong. I mean in the sense that if it is right, we are going to go through a once in a lifetime roller coaster ride together.

 

Gavin Newsom: 56% of California projected to be infected with coronavirus in 8-week period

 

California Gov. Gavin Newsom requested a hospital ship from the federal government Thursday afternoon, citing a shocking projection from state officials.

 

Newsom expects 56 percent of California’s population, a whopping 25.5 million people, will be infected over an eight-week period this spring. He did not say whether the projection covered the next eight weeks, a period that has already begun or a future period.

 

Newsom’s huge projection of spread may seem outlandish.

 

“Is it plausible? Is it possible? Yes. Should we be planning for the worst while hoping for the best? I think that’s what the governor is trying to do,” said Arthur Reingold, division head of epidemiology and biostatistics at UC Berkeley.

 

“We need to plan for something as dire as that in terms of hospital beds, testing, ventilator, to try and convince people that this is a serious problem.”

 

Reingold pointed out that that figure represents the number of people infected, not the number who may show symptoms or require a hospital visit.

 

“If we’re talking about the population that will get infected, some proportion of that will not get sick and a lot of those who do get sick will be with a mild, self-limited illness,” he said.

 

 

Newsom's tone was hopeful, and his language was cautious. He talked about "outcomes" rather than "death". He went through it very matter of factly and said California and Californians will rise to the occasion. But what is clear is the the state is preparing for the absolute worst while it tells Californians to be take this very seriously but also hope for the best.

 

Here's his 45 minute press conference if anyone wants to watch it.

 

Major Announcement on CA's Response to COVID-19

 

California is planning on the idea that they need to have "hospital" beds ready for 20 % of those roughly 25 million Californians. They are buying up hotels and redeploying construction workers to retrofit structures as emergency hospital or care centers.

 

California construction workers prepare to mobilize for coronavirus surge response

 

OAKLAND — The head of California’s powerful building and construction trades union says plans are in the works to deploy tens of thousands of construction workers to retool and refit hospitals, hotels and buildings the state needs as a surge response to the coronavirus pandemic.

 

“We’re being mobilized — more than we’re being told to step back,’’ said Robbie Hunter, president of the California Building and Construction Trades Council, which represents 460,000 workers and 63,000 apprentices.

 

They also are organizing recently retired medical professionals to come back to work to get us through this. Elon Musk, or some other "well known" entrepreneur, is working with the state on the emergency production of respirators.

 

If I did the math right, Newsom walked through that the state has something in the ballpark of of 10,000 respirators. Using that study of 1000 sick patients in China I posted earlier in this thread, in that "normal" population with a median age of 47 something like 2 % of people needed them. So if 25 million Californians get sick, 20 % of them require hospital care, and 2 % of them may require respirators, that's about 100,000 repsirators needed. That's assuming that this all hits in one massive wave over eight weeks.

 

Newsom kept using the number 19,543 as a primary cause of concern. He mentioned it several times, and it wasn't clear to me what he was talking about. So I Googled it. He was referring to 19,543 hospital beds that they are short, based on these projections. It was a smart approach, I thought. Whether anyone thinks it is hysterical or not, the feeling it creates it that there is a plan for the worst case scenario. And he is trying to make sure there are beds and care for all the people who need it. If something like that is happening at the federal level, I'm not hearing it.

 

This surprised me. The average age of Californians is only 36. That's a few years younger than the average American. That should help in terms of capacity, because most young people who are infected don't get really sick, or even symptomatic in any way. So that 20 % hospitalization rate errs on the high side, which Newsom basically said. No one knows why certain patients in their 20's get hit harder than others. One theory is that young adults and teens who smoke or vape are more are risk, because it harms their lungs. Some of the young adults in ICUs are known to have been vapers.

 

Mostly, the verdict appears to be coming in that a lot of young people - teens and in their 20's - are infected with the disease but not symptomatic. That is why this thing is spreading so quickly. They are highly contagious before they get sick with something that seems like the flu. And many of them never get sick. But they are unknowingly spreading a virus that is potentially life threatening to those who are older and/or sicker.

Edited March 21, 2020 by stevenkesslar

[+ easygoingpal]

I finally got the brilliant idea of watching Gov. Newsom's press conference today. It could not possibly be more sensational. Not in the sense that it is wrong. I mean in the sense that if it is right, we are going to go through a once in a lifetime roller coaster ride together.

 

Gavin Newsom: 56% of California projected to be infected with coronavirus in 8-week period

 

California Gov. Gavin Newsom requested a hospital ship from the federal government Thursday afternoon, citing a shocking projection from state officials.

 

Newsom expects 56 percent of California’s population, a whopping 25.5 million people, will be infected over an eight-week period this spring. He did not say whether the projection covered the next eight weeks, a period that has already begun or a future period.

 

Newsom’s huge projection of spread may seem outlandish.

 

“Is it plausible? Is it possible? Yes. Should we be planning for the worst while hoping for the best? I think that’s what the governor is trying to do,” said Arthur Reingold, division head of epidemiology and biostatistics at UC Berkeley.

 

“We need to plan for something as dire as that in terms of hospital beds, testing, ventilator, to try and convince people that this is a serious problem.”

 

Reingold pointed out that that figure represents the number of people infected, not the number who may show symptoms or require a hospital visit.

 

“If we’re talking about the population that will get infected, some proportion of that will not get sick and a lot of those who do get sick will be with a mild, self-limited illness,” he said.

 

 

Newsom's tone was hopeful, and his language was cautious. He talked about "outcomes" rather than "death". He went through it very matter of factly and said California and Californians will rise to the occasion. But what is clear is the the state is preparing for the absolute worst while it tells Californians to be take this very seriously but also hope for the best.

 

Here's his 45 minute press conference if anyone wants to watch it.

 

Major Announcement on CA's Response to COVID-19

 

California is planning on the idea that they need to have "hospital" beds ready for 20 % of those roughly 25 million Californians. They are buying up hotels and redeploying construction workers to retrofit structures as emergency hospital or care centers.

 

California construction workers prepare to mobilize for coronavirus surge response

 

OAKLAND — The head of California’s powerful building and construction trades union says plans are in the works to deploy tens of thousands of construction workers to retool and refit hospitals, hotels and buildings the state needs as a surge response to the coronavirus pandemic.

 

“We’re being mobilized — more than we’re being told to step back,’’ said Robbie Hunter, president of the California Building and Construction Trades Council, which represents 460,000 workers and 63,000 apprentices.

 

They also are organizing recently retired medical professionals to come back to work to get us through this. Elon Musk, or some other "well known" entrepreneur, is working with the state on the emergency production of respirators.

 

If I did the math right, Newsom walked through that the state has something in the ballpark of of 10,000 respirators. Using that study of 1000 sick patients in China I posted earlier in this thread, in that "normal" population with a median age of 47 something like 2 % of people needed them. So if 25 million Californians get sick, 20 % of them require hospital care, and 2 % of them may require respirators, that's about 100,000 repsirators needed. That's assuming that this all hits in one massive wave over eight weeks.

 

Newsom kept using the number 19,543 as a primary cause of concern. He mentioned it several times, and it wasn't clear to me what he was talking about. So I Googled it. He was referring to 19,543 hospital beds that they are short, based on these projections. It was a smart approach, I thought. Whether anyone thinks it is hysterical or not, the feeling it creates it that there is a plan for the worst case scenario. And he is trying to make sure there are beds and care for all the people who need it. If something like that is happening at the federal level, I'm not hearing it.

 

This surprised me. The average age of Californians is only 36. That's a few years younger than the average American. That should help in terms of capacity, because most young people who are infected don't get really sick, or even symptomatic in any way. So that 20 % hospitalization rate errs on the high side, which Newsom basically said. No one knows why certain patients in their 20's get hit harder than others. One theory is that young adults and teens who smoke or vape are more are risk, because it harms their lungs. Some of the young adults in ICUs are known to have been vapers.

 

Mostly, the verdict appears to be coming in that a lot of young people - teens and in their 20's - are infected with the disease but not symptomatic. That is why this thing is spreading so quickly. They are highly contagious before they get sick with something that seems like the flu. And many of them never get sick. But they are unknowingly spreading a virus that is potentially life threatening to those who are older and/or sicker.

So far, the best advice that I've heard on the news is to act and think as if you are infected and that you don't wish to infect anyone else special your family and loved ones... So, be well and stay healthy...!

[+ stevenkesslar]

Study shows how easily coronavirus can potentially spread

 

According to a virologic study by researchers in Germany, COVID-19 can be spread before it causes symptoms and for as many as 12 days after recovery. The study of nine infected patients at a Munich hospital that was published Monday has not yet been peer-reviewed.

 

In comparison to findings from the 2003 outbreak of SARS, the novel coronavirus began producing high viral loads — a term used to describe the quantity of virus in a given volume — more quickly.

 

How does the new coronavirus compare with the flu?

 

Virus transmission

 

The measure scientists use to determine how easily a virus spreads is known as the "basic reproduction number," or R0 (pronounced R-nought). This is an estimate of the average number of people who catch the virus from a single infected person, Live science previously reported. The flu has an R0 value of about 1.3, according to The New York Times.

 

Researchers are still working to determine the R0 for COVID-19. Preliminary studies have estimated an R0 value for the new coronavirus to be between 2 and 3, according to the JAMA review study published Feb. 28. This means each infected person has spread the virus to an average of 2 to 3 people.

 

Coronavirus: New graph shows people in their 20s are more asymptomatic and not being tested for COVID-19

 

 

These three articles explain what this virus is spreading like crazy, and will now likely be impossible to eradicate. After missing the signals and covering it up for maybe a month, China reversed course and was extremely pro-active (or draconian) in testing, tracing, and treating. South Korea has basically done a different version of the same thing, with a softer touch.

 

While the red bars in that graph are not "scientific", they probably represent a better picture of how COVID-19 is ditributed through the population. More than a third of the infected in South Korea were under 30 years old. The only reason we know they were infected is the voluntary mass testing effort. No one knows, but looking at that chart there's probably a good chance that a lot of children are probably infected, but they don't get sick and nobody knows it because there is not mass testing.

 

https://www.statista.com/statistics/1102777/south-korea-covid-19-daily-new-cases/

 

South Korea has been able to keep it contained, so far. Just in the last week, as the graph in that link shows, there was a bump up in new cases again. But my guess is they traced contacts and tested those people, so the new of new cases a day is back down into the high double digits. Meanwhile, partly because of the fact that we are now finally testing, we have about 5000 new cases a day. And those are people who were probably tested because they are sypmtomatic. So probably very few of the people who are infected but not sick are being tested in the US right now.

 

Add all this together and the plans I described in the prior post by Gov. Newsom sound very rational. We don't have adequate tests to do mass testing, since we weren't warned or prepared. Now it may be too late. So what he seems to be doing is trying to reduce and spread out the size of the first tidal wave, so that the state's health system is better able to handle it. And he's telling older and sicker people to stay home.

 

Some of the articles I've been reading are saying this is going to be like a roller coaster. There will be waves of outbreaks, which will gradually grow smaller as more people get sick, recover, and get immunity - assuming that once you get sick and recover you are immune from this, and it doesn't mutate into something else.

 

Herd immunity

 

There's an interesting chart toward the bottom of that article that I can't cut and paste. It provides a broad range - about 30 % to 75 % - of Americans that would need to be infected and recovered so that the transmission of COVID-19 can be significantly slowed, or prevented.

 

If Newsom is right, California will spend Spring 2020 going through a wave of mass infection. If that happens, my guess is we'll then move on to a period of mass testing to identify people who did not get sick but may be carrying the virus.

 

Earlier in this thread I described an Italian village that reduces new infections to zero. They tested everybody, and 3 % of the population was positive but asymptomatic. They self-isolated those people and those they'd been close to, and a few weeks later tested again. At that point, 0.3 % of the population tested positive. After those people were isolated, they wiped it out.

 

That may work in a village that is self-quarantining. But it obviously can't work in a globally connected economy like California's. What I've been wondering is how do you deal with the facts that seniors who could get seriously ill from this are being served coffee or dinner from 20 year olds who are asymptomatic but may be shedding the virus like crazy?

 

If millions of young Californians get infected with COVID-19 this Spring and recover without even knowing they were sick, and then have immunity, that problem party solves itself. It will be a once in a lifetime form of Spring break, hopefully. As long as the state can provide the care for the small percentage of young people that experience this as something more than the flu. Even after that happens, which is where the state seems to think this is headed, we're still going to have an aggressive program to deal with the 40 %+ of the population that can create new outbreaks until we have a vaccine.

[+ stevenkesslar]

So far, the best advice that I've heard on the news is to act and think as if you are infected and that you don't wish to infect anyone else special your family and loved ones... So, be well and stay healthy...!

 

You mean stay well, healthy, and fed! My favorite grocery store is a few blocks away and is still fairly well stocked. I think all the stores here have a few hours set aside for only seniors to shop in the morning so they can minimize their risk of exposure. I'm glad the state is figuring this out for older and more vulnerable seniors who don't feel safe going to the grocery store.

 

Gavin Newsom deploys national guard to help distribute food

 

March 20, 8:20 p.m. California Governor Gavin Newsom announced Friday night that California National Guard members will be deployed to help with distribution at food banks.

 

“It’s in these times of crisis that Californians are at their best, coming to the aid of those in their community who are most in need," Newsom said in a statement. "Food banks provide a critical lifeline for families, and are needed now more than ever. Families across our state are suddenly losing work, and millions of Californians most vulnerable to COVID-19 are staying home to protect their health and the health of others."

 

The California Guard will first deploy personnel and logistical equipment to a food bank distribution warehouse in Sacramento County, and will then "conduct immediate site assessments statewide for those counties that have requested short-term support and stabilization."

 

Newsom also formally launched the Neighbor-to-Neighbor campaign, a government partnership with Nextdoor.com and California Volunteers intended to help deliver food to individuals facing an elevated risk of complications due to the coronavirus.

 

"The collaboration will allow the state to reach more than 22,000 neighborhoods using the platform," the release reads. "Neighbors use Nextdoor to exchange helpful information and California Volunteers will use this site to share ways residents can safely check on each other during the COVID-19 outbreak. The platform will also be used to share ways to safely ensure community members have the basic necessities they may need during periods of home isolation."

[+ WilliamM]

Better more comprehensive information for the East Coast is available every day in New York Governor Cuomo's press conferences.

 

Cuomo is a real hero and is mostly very well informed. Unlike President Trump.

 

But Doctor Fauci is the very best.

[+ easygoingpal]

@stevenkesslar Thanks for summarizing a lot of this data that is coming from different sources and for the links you provide. Much grateful...!

[Guest]

Doctors are now saying that the Spring Breakers in South Florida are now possibly super spreaders of Covid-19.

 

TALLAHASSEE, Fla. — As Florida officials move to expel the hundreds of thousands of spring breakers who ignored calls for social distancing, public-health specialists are nervously wondering what will happen once the party’s over.

 

For much of this week, revelers continued to cram four and five to a hotel room, swarm beaches over hundreds of miles of coastline, and then gather shoulder-to-shoulder in bars and clubs – almost a model process for spreading contagious diseases.

 

Edited March 22, 2020 by Oaktown

[+ WilliamM]

Rand Paul has tested positive from the virus. He is a United States Senator, not an escort.

[+ stevenkesslar]

'It’s pretty bad': Diaz-Balart, McAdams detail their struggles with COVID-19

 

 

Rep. Mario Diaz-Balart spoke out Saturday about his battle with COVID-19 after testing positive for the coronavirus, saying he believes the “worst part" has passed.

 

“It’s a tricky bug because just when I thought I was over it or I was pretty close to getting over it, the fever will come back,” the Florida Republican said during his first on-camera interview on NBC's "Nightly News."

 

Diaz-Belart, 58, recalled the symptoms he said “hit him like a ton of bricks” last Saturday after he voted on a coronavirus response bill on the House floor, describing a headache that quickly developed into a fever and cough.

 

“Now luckily, I have not had an issue breathing so I’ve never had a scary moment but obviously very, very unpleasant with headaches, with coughing, and with a pretty intense fever — all coming at the same time it seems,” he recounted.

 

Rep. Ben McAdams, 45, the second congressman who has tested positive for the coronavirus, detailed a similar experience.

 

“I’m feeling about as sick as I’ve been,” the Utah Democrat said during a CNN interview on Friday. “I got really labored breathing. I feel like I have a belt around my chest, really tight. When I cough, my muscles are so sore so I just feel pain every time I cough, which is frequently. I feel short of breath, and I have a fever of about 102. So, it’s pretty bad.”

 

 

 

 

 

Kudos to Rep. Diaz-Balart and Rep. McAdams for sharing their stories.

 

I think it helps that, randomly, nature picked a 45 and 58 year old Congressperson as a poster child. McAdams is a good example of someone "youngish" and fit who should come out of this just fine. Diaz-Balart is right at the edge of where the death rate starts to go over 1 %, and the chance of a hospital stay significantly increases. It also helps that one is a moderate Republican, and one a moderate Democrat. This is a nonpartisan virus, and it could happen to anyone.

 

The messages it sends to me are: 1) Calm down. You are not going to die. 2) This is serious. Don't take it lightly.

 

We've yet to resolve as a nation or a globe whether the strategy is to suppress this virus until we have a vaccine or it goes away. And if we do resolve to do whatever it takes to suppress it, it's not clear that we can actually do that.

 

I think this will tilt the scale, particularly for the small group of individuals that are members of Congress. The average age of US Reps is 58, so Diaz-Balart is right there. The average age of Senators is 61. They have every reason to not want to experience this. And their colleagues' experiences will likely drive that preference home.

[+ stevenkesslar]

5 lessons on social distancing from the 1918 Spanish flu pandemic

 

An interesting article about how the world has been here and done this before. Including social distancing.

 

Some of my takeaways:

 

This article claims that cities that were well prepared and implemented mitigation strategies - school closures, a ban on mass gatherings, social distancing - were able to reduce the rate of deaths by about half. When these measures were relaxed prematurely, infection rates - and deaths - spiked again. Same pressures between health, work, and play we are experiencing right now. The lesson from history is that the best way to save lives is to not let off until the storm really passes. In our case, that would presumably be when we have a vaccine, which was not available in 1918.

 

The overall US infection rate is estimated in Wikipedia to be 28 % of a population of 105 million in 1918. So that would be about 30 million Americans who got sick. Of those, an estimated 500,000 to 675,000 died, or between 1.7 % and 2.2 % of all people infected. None of these numbers seem very well documented. There's nothing even remotely comparable to the online data about COVID-19 in every country on the planet.

 

One of the most interesting things about the article is the comparison between Philadelpia and St. Louis. There is very specific documentation of weekly death rates there. Based on the charts in the article, it looks like about 1 % of the total population died in Philadelphia. In St. Louis, it looks more like 0.5 % of the total population. So I'll go with Wikipedia's estimate and assume about one in three people was infected. That would triple the death rate to 3 % of everyone infected in Philadelphia, and 1.5 % of everyone infected in St. Louis.

 

I say that because these death rates don't sound so different than what's happening with COVID-19. Even in South Korea, the death rate is well over 1 % of infected people who die. And their testing does include a lot of younger adults who only get mildly ill. In countries like France and Spain and Iran, the death rate is more like 3 - 5 %, probably reflecting the fact that younger people who don't get as sick aren't counted in the total. COVID-19 is also like the Spanish flu in that the primary cause of death is that people succumb to bacterial pneumonia. The main difference is that for some reason the Spanish flu was particularly deadly to young adults aged about 20-40. COVID-19 isn't.

 

Another interesting point the article makes is that back in 1918 epidemics and quarantines were much more common. Some of them involved diseases that we don't even think about today, like polio and smallpox. So the article suggests people might have been more compliant to the "social distancing" measures of that era because they knew the drill. They had lived through the consequences of epidemics before.

 

A related point is that once the outbreak started, people wanted social distancing, because they were afraid of getting sick and dying. In that sense, people in 2020 are just like people in 1918. I find it interesting that some politicians and talking heads have either subtly or bluntly pitched the idea of "herd immunity" as kind of inevitable. Their argument is that a large percentage of the population is simply going to get this virus, anyway. A few will die, but most will be fine. So let's just get on with it, shall we? Boris Johnson initially earned the nickname "The Grim Reaper". Now he has clearly backed off. He now seems to be acting on the idea that people would prefer to embrace a likely recession than embrace a huge wave of illness, and hospitals that are death mills.

 

What hadn't occurred to me until I read this article is that part of the reason people may view this as an exaggerated crisis is that they can't understand what they haven't experienced. None of us personally had friends or relatives who died of polio or smallpox epidemics. Our concerns are cancer, heart disease, diabetes, HIV. And with the young it's doubly true. They feel invulnerable. And they understand Spring break much better than they understand pandemic.

 

I wonder if that explains why the world seems to be choosing the path of certain recession over the path of possible death. We are just like people were in 1918. Once death actually appears at our door, people get scared. If it's true that in 1918 people were more likely to simply accept epidemics as a part of life, that actually could mean we are more terrified than a century ago. At least once the reality of what an epidemic is hits. We all of course know death is coming eventually. But we have no experience whatsoever with it coming this way. That may explain what seems to me like a pretty strong reaction against these ideas of "herd immunity", except perhaps among elites.

 

1918 may also give us a clue about whether we are headed into a recession, or a depression. The more I read about the Spanish flu, the more it sounds like it was in the ballpark of COVID-19: in terms of death rates, mitigation strategies like school closures and restrictions on gatherings, and people just being afraid. I haven't read anything about factories shutting down, and stores closing. So one big difference is that the economy probably just kept going back then. But if 675,000 people died (the equivalent of over 2 million today) and lots more got sick, and people were afraid to be out in public, that had to have an impact on the economy, as well.

 

In at least two ways, there were a few things in 1918 that might have made the situation worse. A lot of 20 to 40 years olds were sick or dying from Spanish flu. I suspect some of the descriptions I read of that time - like how young men woke up fine and dropped dead on the way to work - may be urban legends that simply speak to the fear people had. Whether it was death, illness, or simply fear of it, having that going on in a big chunk of the young adult workforce had to be a drag on the economy.

 

Also, WW1 had ended. So unemployment spiked when lots of soldiers came home. And wartime production dropped. In fact, the 1918 recession is usually described as the "Post-World War I Recession". The Spanish flu isn't even mentioned in several summaries of it I've read.

 

So the good news, if 1918 is used as a model, is that the recession in 1918 was "a brief but very sharp recession" according to Wikipedia. It lasted only seven months, from July 1918 to March 1919. That made it the shortest recession between The Civil War and The Great Depression.

 

They didn't record unemployment rates and GDP data back then. But the measures that were used for recessions, which you can scan on that Wikipedia link, suggest that the 1918 recession was moderate. There was a 25 % reduction in business activity. That looked like about average for recessions during that period. The 1920-21 Depression saw a 38 % drop in business activity, by comparison.

 

The one thing that is completely absent from that article about social and political responses to the 1918 virus is the idea of "test, trace, treat". They didn't even know in 1918 that what was causing the disease was a virus. So there was no vaccine, and no test for it - or for antibodies for people recovered from it. There may have been health departments. But I haven't read anything that suggests that there were people trying to trace the contacts of people who had the virus. There certainly were not cell phones or GPS systems you could use to track where people had been.

 

The best news to me in a bleak picture is that "test, trace, treat" has mostly worked in many Asian countries. It's contained the virus and allowed people to get on with work, school, and at least some percentage of normal social life - like eating in a restaurant, or shopping. While aspects of it may fit somewhat better with their culture, it was not "normal" for them, either. That chose to embrace it after they got hit by past epidemics like SARS. So there's no particulars reason to thin Europeans or Canadians or Americans can't embrace it, too.

 

If that is true, that would be the most significant innovation compared to 1918. Going back to the estimated infection rate then, 28 %, that close to 100 million Americans getting sick, and 1 million or more dying. No matter how well we spread that out, it is just going to be ugly.

 

South Korea, with 60 million citizens, has had the most cases of any Asian country outside China to have a well organized "test, trace, treat" mitigation strategy. Two months into an epidemic, 8000 people - which is 0.01 % of their population, has been infected.

 

There's a massive difference between 0.01 % and 28 % of a population. If we can bend the curve and swiftly implement these mitigation strategies as soon as we end the lock down, there's at least reason to hope that we can shoot for 0.01 %. That would probably also involve a year without mass gatherings, including ones like The Olympics and sports and political rallies. Whether that is possible to agree to as a society is a very good question. But it actually looks like an improvement when the baseline is now a lock down without end in sight.

 

Speaking for myself, that sounds better than three months or so of a death game in which we are the contestants. We can call it "Survival Of The Fittest: Pandemic Edition."

 

Some experts thought it

Edited March 26, 2020 by stevenkesslar