Coronavirus pandemic

[LM117]

NC Gov. Roy Cooper has asked Trump for a major disaster declaration for the state.

https://governor.nc.gov/news/governor-cooper-requests-major-disaster-declaration-covid-19

Trump approved it.

https://www.fema.gov/news-release/2020/03/25/president-donald-j-trump-approves-major-disaster-declaration-north-carolina

[GenExpwy]

Got an email yesterday that Spectrum cable is letting everyone watch the Showtime and Epix bundles of movie channels, because so many people are stuck at home.

I mention this because one of the Showtime movies last night happened to be 12 Monkeys.

[Brandon]

Would that actually even stop you from doing that?

No. I went to Cincinnati today, and I noticed nobody cares that Ohio is under martial law.

Their funerals

It's hardly the Black Death (CFR of about 30% in 1348).  The CFR of this thing has been calculated to be anywhere from 0.05% to 1%.  The CDC is using a CFR of 0.8%; higher than the seasonal flu, but lower than the 1918 flu (CFR of 1% to 2.5%).
https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-as-the-coronavirus-pandemic-takes-hold-we-are-making-decisions-without-reliable-data/

Of course, if the FDA would get out of the way, we might actually get enough people tested to make a real difference (and it may lower the CFR even further).  The FDA's testing timeline is one of the reasons we haven't been able to move as fast as say, South Korea.  And that testing timeline goes back decades, through many administrations, both Republican and Democratic.
https://www.health.com/condition/infectious-diseases/coronavirus/at-home-covid-19-test

The CDC and NIOSH also need to streamline their approvals for new N95 masks to make this work right.  Again, these are rules that go back decades.
Look at how complex the application itself is: https://www.cdc.gov/niosh/npptl/resources/certpgmspt/pdfs/APR-FFR-03122018-508.pdf
And this is if you want to make them, even off a tried and true design that's already been approved by NIOSH.  Approval can take up to 90 days.  At least Congress and the White House managed to make it easier and got the FDA out of the way of the sales channels: https://www.washingtonpost.com/business/2020/03/19/change-us-law-will-make-millions-more-masks-available-doctors-nurses-white-house-says/

The only way to really be sure how to respond is to follow the South Korean model and test as many as we can (they tested 1 in 160).
https://www.wsj.com/articles/how-long-will-the-coronavirus-lockdowns-go-on-11584899513
https://www.washingtonpost.com/opinions/2020/03/23/mass-testing-is-only-sustainable-solution/

[kalvado]

Would that actually even stop you from doing that?

No. I went to Cincinnati today, and I noticed nobody cares that Ohio is under martial law.

Their funerals

It's hardly the Black Death (CFR of about 30% in 1348).  The CFR of this thing has been calculated to be anywhere from 0.05% to 1%.  The CDC is using a CFR of 0.8%; higher than the seasonal flu, but lower than the 1918 flu (CFR of 1% to 2.5%).
https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-as-the-coronavirus-pandemic-takes-hold-we-are-making-decisions-without-reliable-data/

Of course, if the FDA would get out of the way, we might actually get enough people tested to make a real difference (and it may lower the CFR even further).  The FDA's testing timeline is one of the reasons we haven't been able to move as fast as say, South Korea.  And that testing timeline goes back decades, through many administrations, both Republican and Democratic.
https://www.health.com/condition/infectious-diseases/coronavirus/at-home-covid-19-test

The CDC and NIOSH also need to streamline their approvals for new N95 masks to make this work right.  Again, these are rules that go back decades.
Look at how complex the application itself is: https://www.cdc.gov/niosh/npptl/resources/certpgmspt/pdfs/APR-FFR-03122018-508.pdf
And this is if you want to make them, even off a tried and true design that's already been approved by NIOSH.  Approval can take up to 90 days.  At least Congress and the White House managed to make it easier and got the FDA out of the way of the sales channels: https://www.washingtonpost.com/business/2020/03/19/change-us-law-will-make-millions-more-masks-available-doctors-nurses-white-house-says/

The only way to really be sure how to respond is to follow the South Korean model and test as many as we can (they tested 1 in 160).
https://www.wsj.com/articles/how-long-will-the-coronavirus-lockdowns-go-on-11584899513
https://www.washingtonpost.com/opinions/2020/03/23/mass-testing-is-only-sustainable-solution/

Two recent papers calculate fatality rate being 1.4 and 1.6%.
1% seems optimistic.
And there are long term effects, potentially serious disability.

[hotdogPi]

Somehow, Northwest Arkansas has only about 10 cases despite being a medium-sized metro area.

[MikieTimT]

Somehow, Northwest Arkansas has only about 10 cases despite being a medium-sized metro area.

I would chock it up more to a lack of testing than anything.  Although the schools in Arkansas shut down for AMI learning a week ago Monday, which undoubtedly helped, and lots of folks that I work with are working from home now as thankfully we have relatively large areas of fantastic fiber Internet here unless you're in the boonies of Benton County.

[kalvado]

Somehow, Northwest Arkansas has only about 10 cases despite being a medium-sized metro area.

I would chock it up more to a lack of testing than anything.  Although the schools in Arkansas shut down for AMI learning a week ago Monday, which undoubtedly helped, and lots of folks that I work with are working from home now as thankfully we have relatively large areas of fantastic fiber Internet here unless you're in the boonies of Benton County.

Not sure if that is the only thing. a sure sign of NYC being a hot spot is morgues running out of capacity. I don't think there are similar issues elsewhere in US.

[ftballfan]

Somehow, Northwest Arkansas has only about 10 cases despite being a medium-sized metro area.

I would chock it up more to a lack of testing than anything.  Although the schools in Arkansas shut down for AMI learning a week ago Monday, which undoubtedly helped, and lots of folks that I work with are working from home now as thankfully we have relatively large areas of fantastic fiber Internet here unless you're in the boonies of Benton County.

Not sure if that is the only thing. a sure sign of NYC being a hot spot is morgues running out of capacity. I don't think there are similar issues elsewhere in US.

New York City is a hot spot for these reasons (and likely others):
1. Very high population density (over 8 million residents (plus the office workers that live outside the city and commute in for work) in an area smaller than Benzie County, MI (the smallest by area county in Michigan))
2. Lots of international travel (recent immigrants going back and visiting their home country; there were direct flights from JFK Airport to Wuhan, China)
3. Large low-income population (I saw an article somewhere that one of the hardest-hit hospitals normally takes care of a lot of people that don't have primary doctors)

[J N Winkler]

Case fatality ratio is defined as number of deaths divided by number of cases and, as such, is regarded as a situationally specific measure that is dependent on the availability of treatment resource, demographics of the infected population, etc.  I distrust estimates of CFR for COVID-19 that put it as low as 1% because inevitably they rely on educated guesses as to how much current testing oversamples serious cases.

The leading candidate for disease agent causing the Black Death is bubonic plague, which (if caught early) is actually more straightforward to treat with modern antibiotics than COVID-19 is with therapies predicated on respiratory support.  The other plague I've seen cited as politically destabilizing is the one that hit Athens in 430 BC during the Peloponnesian War (killing something like 30% of the population), and the leading candidates for it are typhus and typhoid--both eminently treatable today.

The gold standard is the percentage of confirmed cases that end up in ICUs, as this gets past sampling bias in testing at a given point in time, though not large-scale expansion or contraction of testing through time.  If, for example, we find about 14% of those tested need ICU treatment and the ICUs are running at more than 100% load, then the death rate we end up with is going to be closer to 14%.

And Kalvado's point about nasty sequelae for survivors is well taken.  It's much too early to know this for COVID-19, but enough time has passed since SARS in 2003 that it has become evident it is correlated with very high rates of bone tissue necrosis in survivors.

[Rothman]

Case fatality ratio is defined as number of deaths divided by number of cases and, as such, is regarded as a situationally specific measure that is dependent on the availability of treatment resource, demographics of the infected population, etc.  I distrust estimates of CFR for COVID-19 that put it as low as 1% because inevitably they rely on educated guesses as to how much current testing oversamples serious cases.

The leading candidate for disease agent causing the Black Death is bubonic plague, which (if caught early) is actually more straightforward to treat with modern antibiotics than COVID-19 is with therapies predicated on respiratory support.  The other plague I've seen cited as politically destabilizing is the one that hit Athens in 430 BC during the Peloponnesian War (killing something like 30% of the population), and the leading candidates for it are typhus and typhoid--both eminently treatable today.

The gold standard is the percentage of confirmed cases that end up in ICUs, as this gets past sampling bias in testing at a given point in time, though not large-scale expansion or contraction of testing through time.  If, for example, we find about 14% of those tested need ICU treatment and the ICUs are running at more than 100% load, then the death rate we end up with is going to be closer to 14%.

And Kalvado's point about nasty sequelae for survivors is well taken.  It's much too early to know this for COVID-19, but enough time has passed since SARS in 2003 that it has become evident it is correlated with very high rates of bone tissue necrosis in survivors.

Are you in the medical field?

[webny99]

Somehow, Northwest Arkansas has only about 10 cases despite being a medium-sized metro area.

I would chock it up more to a lack of testing than anything.

Definitely that, and probably the fact that there's multiple cities instead of a single larger one, no major international airport, and so on.
Not exactly a major travel/tourism hot spot.

In other news, West Virginia reports 51 cases, surpassing Wyoming at 49, ND at 45 and SD at 41, thus ending its long reign as the state with the fewest cases.

[hbelkins]

Even those states that have issued shelter-in-place orders are, to the best of my knowledge, letting people whose businesses or offices aren't closed still go to work, still allowing them to shop at businesses that are still open, and are encouraging outdoor recreation. I've seen those "bear hunts" I mentioned yesterday being promoted in communities in several states.

On a totally unrelated note, what are those who are getting their stimulus checks planning to do with them? Any road-related thoughts? I may rent a car and go county-collecting or route-clinching.

The closest states to me that would be easiest to complete in terms of clinching counties are Missouri and Arkansas. Of course, I still lack Suffolk and Nassau in New York, and the island counties of Massachusetts, but I may forego those for awhile.

My best route-clinching options are I-65 and US 31, an easy down-and-back from Nashville. I have everything north of Birmingham for I-65, and everything north of Nashville for US 31. Two routes I'd really like to clinch, US 23 and US 52, are problematic because I have the middles of both routes pretty well done, but need portions on either end.

[Max Rockatansky]

Regarding road related use of the stimulus check upcoming I've been more or less buying up signs with a budget of 1/3rd of the money in mind.  I'll get out to Northern California sooner or later if not Idaho which I'll probably lump some of that money onto.  More than likely the rest will he spent on a October road trip I had planned to Arizona anyways. 

To that end if things start to cool off and work isn't so jumpy with phone calls I'll probably go for some route clinching around Los Angeles before the smoke totally clears.  I kind of want to go that way anyways to see if it's possible to finish the Old Ridge Route...because it was last year when I decided to hike much of it when it was supposedly closed. 

[kalvado]

Case fatality ratio is defined as number of deaths divided by number of cases and, as such, is regarded as a situationally specific measure that is dependent on the availability of treatment resource, demographics of the infected population, etc.  I distrust estimates of CFR for COVID-19 that put it as low as 1% because inevitably they rely on educated guesses as to how much current testing oversamples serious cases.

The leading candidate for disease agent causing the Black Death is bubonic plague, which (if caught early) is actually more straightforward to treat with modern antibiotics than COVID-19 is with therapies predicated on respiratory support.  The other plague I've seen cited as politically destabilizing is the one that hit Athens in 430 BC during the Peloponnesian War (killing something like 30% of the population), and the leading candidates for it are typhus and typhoid--both eminently treatable today.

The gold standard is the percentage of confirmed cases that end up in ICUs, as this gets past sampling bias in testing at a given point in time, though not large-scale expansion or contraction of testing through time.  If, for example, we find about 14% of those tested need ICU treatment and the ICUs are running at more than 100% load, then the death rate we end up with is going to be closer to 14%.

And Kalvado's point about nasty sequelae for survivors is well taken.  It's much too early to know this for COVID-19, but enough time has passed since SARS in 2003 that it has become evident it is correlated with very high rates of bone tissue necrosis in survivors.

Would you take my statement about 1.4 and 1.6% fatality rate as well?
This is latest published data, and it actually rings well with a few other numbers I see. Much lower for <30, suchs to be in 60+ cohort though, moreso 70+.

[1995hoo]

Even those states that have issued shelter-in-place orders are, to the best of my knowledge, letting people whose businesses or offices aren't closed still go to work, still allowing them to shop at businesses that are still open, and are encouraging outdoor recreation. I've seen those "bear hunts" I mentioned yesterday being promoted in communities in several states.

On a totally unrelated note, what are those who are getting their stimulus checks planning to do with them? Any road-related thoughts? I may rent a car and go county-collecting or route-clinching.

....

Regarding the stimulus check, we need to have the outside of our house painted and some rotted wood repaired, so we plan to put the stimulus check towards that, along with the tax refunds we already received.

Regarding staying at home, I'm unaware of any state that says you can't go out at all. Most states encourage people to get outside for exercise (maintaining appropriate distance from anyone other than family members), and certainly there is no reason why you couldn't take your car out for a drive. I drove two of ours on a short loop this past weekend, maybe 15 minutes each, just to run them and to keep the tires from flat-spotting. Surely I could have gone further had I wanted to do so, but there was nowhere I really wanted to go.

[Max Rockatansky]

Something else I need road related is new tires in about 10,000 miles.  I've been looking at a scrap compressor and mounting machine too, it would probably be good investment given how cheap they are. 

[vdeane]

Given NY's catastrophic budget shortfall (we already had a sizeable deficit to try to close, which the economic fallout from the virus more than doubled at the same time Congress moved to block the strategy were were going to use to deal with the original deficit), I think I'm going to wait to see how state employees are affected by this before doing anything with the money.

[LM117]

On a totally unrelated note, what are those who are getting their stimulus checks planning to do with them? Any road-related thoughts? I may rent a car and go county-collecting or route-clinching.

First thing I'm doing is packing up my crap and moving back to NC once the pandemic levels off, and if I have enough pennies left after the initial move, I'll probably go for a little joy ride. Haven't decided where yet, though.

[webny99]

Even those states that have issued shelter-in-place orders are, to the best of my knowledge, letting people whose businesses or offices aren't closed still go to work, still allowing them to shop at businesses that are still open, and are encouraging outdoor recreation.

Speaking for upstate New York (obviously a completely different world than the NYC area, but part of a shelter-in-place state nonetheless) I would say this is an accurate reflection of the situation here.

Traffic is light, but there's still movement of people, goods and services. It's just different. More economic activity is happening from home. Parks are busy, especially those with good walking trails. Restaurants have taken a bit hit but most are still operating in limited capacity. Most grocery stores are back to (somewhat) normal. If this is the new normal for a few months, I think I can handle it. Not exactly living the dream, but not horror movie type stuff, either.

[US71]

On a totally unrelated note, what are those who are getting their stimulus checks planning to do with them? Any road-related thoughts? I may rent a car and go county-collecting or route-clinching.

First thing I'm doing is packing up my crap and moving back to NC once the pandemic levels off, and if I have enough pennies left after the initial move, I'll probably go for a little joy ride. Haven't decided where yet, though.

I'm likely staying out, but a roadtrip is in order. I may take a couple extra days in June if the Jefferson Highway Conference is still on and try to follow it north.

[kalvado]

will we surpass China when it comes to confirmed cases soaring dangerously?

Didn't take too long. US is officially #1 on the list as of right now.
ANd probably that is not only the number of tested, but close match in the number of actual infected as death count is on the same page, and US number will keep increasing even if infection suddenly stops.  I still believe Italy is up there with much lower testing rate, though.

[jeffandnicole]

Given NY's catastrophic budget shortfall (we already had a sizeable deficit to try to close, which the economic fallout from the virus more than doubled at the same time Congress moved to block the strategy were were going to use to deal with the original deficit), I think I'm going to wait to see how state employees are affected by this before doing anything with the money.

CNBC had some really sobering numbers referencing that.  Ouch.

We know NJ will have a shortfall as well...I don't think I've seen any estimates yet though.

[kphoger]

Popping onto the forum for a minute after a bit of a break...  I've had a lot on my mind lately.

So, I was in Mexico last week, and travel was rather more stressful than usual.  This was a church mission trip, our family plus two other gentlemen.  It was originally planned for October but got postponed to Spring Break.

For starters, literally two days before we left home (Thursday 3/12), we started hearing rumors that Mexico was closing the border due to the Coronavirus.  For a day or so, I couldn't find any news articles to either confirm or deny the rumors.  Then, the day before we left (Friday 3/13), I saw that the Sub-secretary of Health in Mexico had stated publicly:  "If technically necessary, we would consider mechanisms to restrict or intensify surveillance (at the border)..."  So, basically, the news took a political "maybe" statement and ran with it.  Still, though, you never know.

When we arrived in Del Rio (TX) on Saturday evening (3/14), I asked the Motel 6 clerk about the border closing.  She responded with something like "yeah, that's what we've been hearing, and we're just going day by day here".  The next morning (Saturday 3/15), we crossed the border without issue–no search, no stop, no nothing–and drove the 1.5 hours to the customs building in Allende (Coah).  I asked the immigration agent there what he had heard about the border closing.  His reply (in Spanish):  "They haven't said anything;  there are only two cases in the whole state of Coahuila;  they haven't said anything."  Cool.  And so, we went on our merry way south to Parras de la Fuente.

On Wednesday (3/18), it was announced in Parras that they were shutting down the biggest tourist spots, including the big swimming tank.  We had all forgotten or decided not to pack swimming suits anyway, so we went with the children from the home down the street to the local swimming hole instead and just swam in our clothes.  Less sanitary (ironically), but more fun because all the kids were with us.

The next morning (Thursday 3/19), we hiked up to Santo Madero because they hadn't closed that and it's one spot we simply can't ever miss because of the amazing views.  Later in the day, my boss called to let me know that, by order of the Kansas Department of Health and Environment, I would be required to self-quarantine for two weeks upon returning home:  anyone who had traveled internationally after 3/15 had to do so.  I would not be allowed to set foot in the office, and I was to text her a list of everything I needed (computer included) so someone could drop it off on our front porch.  This was frustrating, considering I was traveling in both (1) a country with fewer cases of COVID-19 than the USA and also (2) a state with fewer cases of COVID-19 than Kansas.  But whatever.  I texted her my list.  Later that evening, we took the children's home directors out for steaks, and it was weird to see all the staff wearing face masks and only one other family in the whole restaurant.

Friday morning (3/20), we left town and headed north again.  Our youngest son got carsick in the middle of nowhere with no shoulder to pull off on, so I simply parked in the middle of the road somewhere just south of Hipólito, rummaged for all the napkins we could find in the glove box, dug a change of clothes out of luggage in the rear hatch (thank goodness that suitcase wasn't in the cargo box ratchet-strapped to the roof), wiped him down, changed his clothes, washed the booster seat fabric with bottled water, stuffed the nasty clothes in a plastic grocery bag, and pushed on.  A couple of hours later, my wife got a text message from a friend saying Trump was closing the US border.  We didn't figure they'd keep us out of our own country even if so, but you never know.  After texting a few other people for more details, we learned that they were merely closing the border to people who didn't already have papers (foreigners with no visa).  But, still, as I keep saying:  you never know.  So we decided to get our lunch to go, just in case and to not waste any time making it to the border.  I had already been driving about 5 to 10 mph faster than usual because we would be losing an hour at the border (re-entering DST), and this was becoming an ever more prudent practice.  In fact, I didn't even give up the wheel to let my wife take a turn driving, because I knew she wouldn't drive as fast as I wanted.

Back in Del Rio again that evening, we found out that the governor of Texas had shut down all restaurant dine-in.  Ordering in the drive-through for seven people, then trying to divvy up the food, with hardly any room to maneuver because of all the luggage–a minor inconvenience, really.  Boy, though, Chick-fil-A was ROCKING the drive-through (even more than usual).  We stayed the night in Sonora (TX), and I gave a hairy eyeball to the car with California plates in the parking lot:  What are you doing out of the state? at my motel? 

The next morning (Saturday 3/21), we went to the lobby for breakfast.  I always choose this particular motel because, in addition to the typical continental-type breakfast food you find everywhere, they also have someone who will cook you eggs and omelets to order.  Nope, not today.  Not only was the dining area closed (by order of the governor), but they weren't taking orders either.  Instead, there were brown-bag breakfasts lined up on the counter for guests to "grab and go".  Pretty lame, but better than nothing.  At least the coffee pot and juice dispenser were still OK to use.

And now here I am, on my fourth day of working from home, with another 1.5 weeks of self-quarantine to go.  My wife had to close down her home daycare because of the self-quarantine order, too.  Not that we'd probably have kids to watch anyway:  one parent was furloughed or laid off (I can't remember which), and the other kids' parents are a teacher (school is out for the rest of the year, though transitioning to online classes) and an A/V tech for hotel conventions (which aren't happening anymore).

I had been planning to get some pictures for the 1-2-3 road sign game–I could have gotten 2333, 2335, 2365, and 2395–but my heart and mind simply weren't in a place for snapping road sign photos.


Edited to add:  Two days ago, our friends who live in Parras as missionaries texted us that they've closed the entrance to town.

[Max Rockatansky]

I was kind of wondering if you had popped down to Mexico.  Suffice to say your trip was way more eventful than mine was.  I flew back 2/25 and the only Virus talk I heard was at the airport when they asked I had been in China the previous 14 days prior.  We just had a similar restriction for border crossings requiring a 14 day quarantine at work that started last week.  Makes me glad in my case that I got to enjoy some quiet and not all that crazy crap. 

[jakeroot]

So, I was in Mexico last week, and travel was rather more stressful than usual.  This was a church mission trip, our family plus two other gentlemen.  It was originally planned for October but got postponed to Spring Break.

Although everything seems to have worked out fine, I'm surprised that you didn't postpone the trip again. Or just straight-up cancel it. Especially with how risky the border situation was.

I've been seeing people in my area canceling holidays/vacations right and left. To hear that you drove literally a thousand miles in each direction for a mission trip doesn't seem to have been advisable. But I'm also not religious, and don't necessarily understand the importance of missions.