“If you have a social bubble, it’s popped.”

“If you have a social bubble, it’s popped.” - Printable Version

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RE: lex24 - M T - 12-09-2020

(12-09-2020, 01:52 PM)lex24 Wrote: Point 2 - when the Gov comes out with regional guidelines on day one and then on day two a few county health officials (unelected of course) essentially say “we know better we’re gonna push it forward” -I find that to be an overreach.

When the Pres comes out with no guidelines and "We've got it under control" and a few Governors (medically uneducated of course) essentially say "we know better we're gonna push it forward" - Do you find that to be an overreach?

P.S. It isn't an order from an elected official. It is Dr. Pan's order. Newsom just puts his face out there.

RE: “If you have a social bubble, it’s popped.” - OutsiderFan - 12-09-2020

(12-09-2020, 05:03 PM)Genuine Realist Wrote:
(12-09-2020, 03:59 PM)OutsiderFan Wrote: OK, let's get into this further...

I read the Morrow post and really appreciated his perspective. Honestly, there is not a lot to disagree with him about. That said, if you strip away everything he said, you are left with one overarching conclusion: He agrees everyone should avoid travel, gathering, keep distance, and mask up if outside their residence.

He effectively says the only reason he isn't issuing the same orders as the other Bay Area counties is because he doesn't know how effective telling people what to do is, and absent enforcement, what is the point of orders? He even makes my point, which is why in the hell are we allowing sports to be played if it is essentially important for everyone to avoid travel, gathering, and distance from others?

But the fact is at this point - as he points out - the stay at home orders are not as strict as they were in March. It seems everyone at all levels realizes you can't completely shut down all businesses any longer. Regulating capacity is a much more balanced and pragmatic approach. He says he's not sure how 20% capacity in grocery stores will impact them. I don't either, but given the amount of people using shopping services, and the fact Whole Foods isn't counting their paid shoppers against the 20% capacity AFAIK, I don't think it will be hurting them much.

As far as the "only those accountable to voters should make decisions" concept, this would be a terrible practice. There is a reason Federal judges are appointed to lifetime positions. It's the same reason public health officials should never be subject to voting. Can you even imagine the disaster it would be if a pro-business, anti-science lobby paid for a massive campaign to put a corporate shill in Dr. Cody's position? How'd you like Dr. Scott Atlas in charge in Santa Clara County? We as people are so vulnerable to greedy corporate interests as it is. Now you want us to put our public health for sale in our corrupt AF political systems? How much more do you think a pro-business, anti-science lobby could raise for its preferred candidate, versus a science-driven public health officer? Might it be 5x or maybe 10x? I can't believe anyone would think subjecting public health officers to elections is in any way a good idea. I can see the ads now "A public health officer who will balance business interest with our health." Think that message might win an election, versus "I will be guided by the science, data, and the best epidemiology."

But even f you say the public health officer shouldn't be subject to elections, but should give recommendations for elected officials to make their own calls, you're in effectively the same position, with public health officials neutered to protect public health. I again go back to the Korea example with the KBO and the Korean CDC. KBO only was able to play games in accordance with its CDC guidelines. This is how it should be, because this allows the health experts to make the calls, not business interests who really don't care about or have any responsibility for pubic health.

I get it, people are frustrated by the situation, but tearing down the systems we have in place to protect us because you don't like how we are being protected, is a recipe for future disaster. Rather than complaining about being told what to do, spend your time encouraging everyone you know to practice the behavior Dr. Morrow advocates, orders or not. We aren't near the end of this pandemic. So the best course of action is to stop it, because the more we don't do all we can to do so - which is what are public health leaders are trying to do - the longer it will be damaging us.
This might surprise you, but I am not at all on lex's page about non-elected officials. As a matter of practicality, I believe every county and municipality runs on a managerial system, whereby a county or city manager is appointed by a board of supervisors or city council. Health officers, police chiefs, and the like may not be elected, but they are definitely accountable. (You may not know this, but police chief in a small town is one of the hottest seats there is. They get fired all the time.) Goose is definitely correct that these regulations are strongly debated between executives and the Board. Cody is not a free agent, and - candidly - she will probably be fired after all this improves. She's a bit too rigid for my taste, and I bet for a lot of the supes.

My own shtick is a little different. I'm strongly hostile to the idea that 'rigorous' equates to 'scientific', and 'flexible' means the opposite. The science of this thing does not get down to that filigree detail, and the personal values of Cody and Morrow come into play after the science runs out. Personality types, too - if you're cautious, you can't get burned, and yet there is such a thing as over-caution. You can do real harm to non-quantifiable social values that are quite real and valid even if they can't be calculated.

Finally, you're on my turf with one opinion. if the Founding Fathers had envisioned the extent to which federal courts have become involved in the making of social policy, there's no way judges would have life tenure. You should never have contested elections, but my own thought is that the CAlifornia system, in which you have an extended term for justices, followed by a yes/no plebiscite, is close to ideal. No institution should have unchecked power. I knew Rose Bird and in fact succeeded her as the motions and appeals deputy in the Santa Clara Public Defender's Office when she left to join Jerry Brown's campaign. She was a decent person, but an appalling judge, absolutely rigid inside her own value system. When she looked at the California Constitution, she saw her own reflection, and unfortunately not one with much balance. It is almost impossible to describe the carnage she and her cohorts had inflicted on California tort and criminal law by 1986 (when the voters quite wisely threw them out). You do need that sort of check. Lex disagrees with this, I think, because he clerked for one of the justices who was a good guy. But he'd joined the wrong faction.

Cody is accountable, though unelected, in the same way Rose Bird was. So I think Lex's complaints on that basis are misplaced. But she has shown a school marm's strictness at times when the wisdom was debatable, and which did real harm. (Right now, drastic measures are appropriate.) I don't think she is going to be with us this time next year.

Very well said, GR. FWIW, I don't agree with lifetime appointments, was just making the broader point about shielding people from consequences for making decisions others have to accept that might not be popular. We have to have a final decider and the checks and balances system ensures that we can make changes over time. But it can't be knee-jerk and reactionary not accepting of the results the system gives us. These unhinged lawsuits challenging election results after votes are counted and certified, demonstrate why.

lex24 - lex24 - 12-09-2020

(12-09-2020, 05:03 PM)Genuine Realist Wrote:
(12-09-2020, 03:59 PM)OutsiderFan Wrote: OK, let's get into this further...

I read the Morrow post and really appreciated his perspective. Honestly, there is not a lot to disagree with him about. That said, if you strip away everything he said, you are left with one overarching conclusion: He agrees everyone should avoid travel, gathering, keep distance, and mask up if outside their residence.

He effectively says the only reason he isn't issuing the same orders as the other Bay Area counties is because he doesn't know how effective telling people what to do is, and absent enforcement, what is the point of orders? He even makes my point, which is why in the hell are we allowing sports to be played if it is essentially important for everyone to avoid travel, gathering, and distance from others?

But the fact is at this point - as he points out - the stay at home orders are not as strict as they were in March. It seems everyone at all levels realizes you can't completely shut down all businesses any longer. Regulating capacity is a much more balanced and pragmatic approach. He says he's not sure how 20% capacity in grocery stores will impact them. I don't either, but given the amount of people using shopping services, and the fact Whole Foods isn't counting their paid shoppers against the 20% capacity AFAIK, I don't think it will be hurting them much.

As far as the "only those accountable to voters should make decisions" concept, this would be a terrible practice. There is a reason Federal judges are appointed to lifetime positions. It's the same reason public health officials should never be subject to voting. Can you even imagine the disaster it would be if a pro-business, anti-science lobby paid for a massive campaign to put a corporate shill in Dr. Cody's position? How'd you like Dr. Scott Atlas in charge in Santa Clara County? We as people are so vulnerable to greedy corporate interests as it is. Now you want us to put our public health for sale in our corrupt AF political systems? How much more do you think a pro-business, anti-science lobby could raise for its preferred candidate, versus a science-driven public health officer? Might it be 5x or maybe 10x? I can't believe anyone would think subjecting public health officers to elections is in any way a good idea. I can see the ads now "A public health officer who will balance business interest with our health." Think that message might win an election, versus "I will be guided by the science, data, and the best epidemiology."

But even f you say the public health officer shouldn't be subject to elections, but should give recommendations for elected officials to make their own calls, you're in effectively the same position, with public health officials neutered to protect public health. I again go back to the Korea example with the KBO and the Korean CDC. KBO only was able to play games in accordance with its CDC guidelines. This is how it should be, because this allows the health experts to make the calls, not business interests who really don't care about or have any responsibility for pubic health.

I get it, people are frustrated by the situation, but tearing down the systems we have in place to protect us because you don't like how we are being protected, is a recipe for future disaster. Rather than complaining about being told what to do, spend your time encouraging everyone you know to practice the behavior Dr. Morrow advocates, orders or not. We aren't near the end of this pandemic. So the best course of action is to stop it, because the more we don't do all we can to do so - which is what are public health leaders are trying to do - the longer it will be damaging us.
This might surprise you, but I am not at all on lex's page about non-elected officials. As a matter of practicality, I believe every county and municipality runs on a managerial system, whereby a county or city manager is appointed by a board of supervisors or city council. Health officers, police chiefs, and the like may not be elected, but they are definitely accountable. (You may not know this, but police chief in a small town is one of the hottest seats there is. They get fired all the time.) Goose is definitely correct that these regulations are strongly debated between executives and the Board. Cody is not a free agent, and - candidly - she will probably be fired after all this improves. She's a bit too rigid for my taste, and I bet for a lot of the supes.

My own shtick is a little different. I'm strongly hostile to the idea that 'rigorous' equates to 'scientific', and 'flexible' means the opposite. The science of this thing does not get down to that filigree detail, and the personal values of Cody and Morrow come into play after the science runs out. Personality types, too - if you're cautious, you can't get burned, and yet there is such a thing as over-caution. You can do real harm to non-quantifiable social values that are quite real and valid even if they can't be calculated.

Finally, you're on my turf with one opinion. if the Founding Fathers had envisioned the extent to which federal courts have become involved in the making of social policy, there's no way judges would have life tenure. You should never have contested elections, but my own thought is that the CAlifornia system, in which you have an extended term for justices, followed by a yes/no plebiscite, is close to ideal. No institution should have unchecked power. I knew Rose Bird and in fact succeeded her as the motions and appeals deputy in the Santa Clara Public Defender's Office when she left to join Jerry Brown's campaign. She was a decent person, but an appalling judge, absolutely rigid inside her own value system. When she looked at the California Constitution, she saw her own reflection, and unfortunately not one with much balance. It is almost impossible to describe the carnage she and her cohorts had inflicted on California tort and criminal law by 1986 (when the voters quite wisely threw them out). You do need that sort of check. Lex disagrees with this, I think, because he clerked for one of the justices who was a good guy. But he'd joined the wrong faction.

Cody is accountable, though unelected, in the same way Rose Bird was. So I think Lex's complaints on that basis are misplaced. But she has shown a school marm's strictness at times when the wisdom was debatable, and which did real harm. (Right now, drastic measures are appropriate.) I don't think she is going to be with us this time next year.

Nice exchange, OF and GR. And you are correct, OF, Morrow’s disagreement is primarily with the use of the power.

I realize most disagree with my position vis-à-vis the county health officials. And that’s fine. What I don’t understand is the vitriolic responses that I get from some by even making the suggestion. I’ve never once said I’m not gonna follow the orders; I’ve never once said that this isn’t serious etc. I just dare to question. Which I will continue to do.

RE: “If you have a social bubble, it’s popped.” - M T - 12-09-2020

Teejers, you can also see the state's LTCF data: cases overall, cases per facility, indoor visitation, etc
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/SNFsCOVID_19.aspx

I have a relative that has been in the hospital and is choosing to go to a SNF rather than home. I was able to check for the number of infected patients and staff currently (0 & 0) and historically at that facility.

Judging from the graph, I believe the infection rate at the SNFs seems to have tracked the cases in the general population, perhaps a little delayed. Currently the daily new cases across the state at SNF is 400 (7 day moving average) and climbing.

The SCC LTCF data page indicates it is updated every Wednesday. Indeed, it has been updated today.

RE: “If you have a social bubble, it’s popped.” - Farm93 - 12-09-2020

(12-09-2020, 05:03 PM)Genuine Realist Wrote: Cody is accountable, though unelected, in the same way Rose Bird was. So I think Lex's complaints on that basis are misplaced. But she has shown a school marm's strictness at times when the wisdom was debatable, and which did real harm. (Right now, drastic measures are appropriate.) I don't think she is going to be with us this time next year.

GR - Great post. Really enjoyed your outline of your position on different aspects.

One thing I did see that I certainly agree with, "I don't think she is going to be with us this time next year."

That's likely correct. My assumption is that the USA government and companies will complete retrospective looks into things that went right and wrong with this pandemic. Some decisions were made too late, or by the wrong levels of government. Some officials took decisive action when others did almost nothing until November. As she was a player in a number of those first mover actions she could parlay this into different opportunities, be encouraged to find something different, or just grow tired of the lose-lose choices with epic consequences associated with the role.

However I should note

I can only imagine that she has been receiving death threats from all types of people, as other health officials have been getting around the USA. So I do hope she is going to be with us (literally) this time next year. I have no doubt you did not mean it that way, but a lot of USA health officials have a lot of security right now because some out there are literally saying these officials should not be with us any longer.

RE: “If you have a social bubble, it’s popped.” - BostonCard - 12-09-2020

Quote:Looking back a few months, Santa Clara County and San Mateo were in roughly similar positions. San Mateo permitted the movie theaters to re-open, subject to some restrictions on attendance, masking, etc. Santa Clara County also permitted reopening, but forbade food and beverage sales, which effectively meant no reopening.

Because it is a short drive from Santa Clara to San Mateo, I would say the restriction had a minimal impact. If you were a Santa Clara resident and wanted to watch a movie, you could just go to a movie theater in Redwood City. Thus, the effect of closing movie theaters in Santa Clara county is mostly symbolic.

That being said, the cumulative state and local restrictions on movie theaters had a very large effect nationally, because they made it so that it was not worth releasing big blockbuster tentpole movies. And because the selection of movies was limited, even in places where theaters were open, my guess is few people watched.

For those two reasons, I would expect that the difference in restrictions had a small or non-existent effect on the proportion of residents who went to the movies between the two counties, which is what actually affects transmission.

By the way, that is the one place where I disagree with Marrow (who I agree, wrote a very well-reasoned and strong justification for his decision). Because the Bay Area counties are so tightly knit together and it is so easy to go between one and another, to some extent San Mateo runs the risk of being the "weak link" in the region. It does no good fro Santa Clara and San Francisco to put in stay at home orders, when it just means their residents drive up (or down) 101 and go to San Mateo. Agree or disagree, it would have been more effective for all the county health commissioners to agree to be on the same page.

BC

lex24 - lex24 - 12-09-2020

(12-09-2020, 06:50 PM)BostonCard Wrote:
Quote:Looking back a few months, Santa Clara County and San Mateo were in roughly similar positions. San Mateo permitted the movie theaters to re-open, subject to some restrictions on attendance, masking, etc. Santa Clara County also permitted reopening, but forbade food and beverage sales, which effectively meant no reopening.

Because it is a short drive from Santa Clara to San Mateo, I would say the restriction had a minimal impact. If you were a Santa Clara resident and wanted to watch a movie, you could just go to a movie theater in Redwood City. Thus, the effect of closing movie theaters in Santa Clara county is mostly symbolic.

That being said, the cumulative state and local restrictions on movie theaters had a very large effect nationally, because they made it so that it was not worth releasing big blockbuster tentpole movies. And because the selection of movies was limited, even in places where theaters were open, my guess is few people watched.

For those two reasons, I would expect that the difference in restrictions had a small or non-existent effect on the proportion of residents who went to the movies between the two counties, which is what actually affects transmission.

By the way, that is the one place where I disagree with Marrow (who I agree, wrote a very well-reasoned and strong justification for his decision). Because the Bay Area counties are so tightly knit together and it is so easy to go between one and another, to some extent San Mateo runs the risk of being the "weak link" in the region. It does no good fro Santa Clara and San Francisco to put in stay at home orders, when it just means their residents drive up (or down) 101 and go to San Mateo. Agree or disagree, it would have been more effective for all the county health commissioners to agree to be on the same page.

BC

“Agree or disagree, it would have been more effective for all the county health commissioners to agree to be on the same page.”

Agree completely. I thought Newsom’s regional plan achieved that quite nicely.

RE: lex24 - Goose - 12-09-2020

(12-09-2020, 07:24 PM)lex24 Wrote: “Agree or disagree, it would have been more effective for all the county health commissioners to agree to be on the same page.”

Agree completely. I thought Newsom’s regional plan achieved that quite nicely.

Actually, what it did is make the county health commissioners opinion somewhat irrelevant, something Dr. Scott Morrow also wrote a (somewhat less IMHO) well reasoned statement bitterly opposing. He is no fan of Newsom taking away the decision making authority from local authority, FWIW.

RE: lex24 - Farm93 - 12-09-2020

(12-09-2020, 07:24 PM)lex24 Wrote: “Agree or disagree, it would have been more effective for all the county health commissioners to agree to be on the same page.”

Agree completely. I thought Newsom’s regional plan achieved that quite nicely.

Not quite though. In the Southern California Region every county is essentially caught up whatever is happening in LA county. A number of counties want to be in a different region or to be in a redefined region that conveniently has better numbers (excludes LA). And this was just rolled out.

The one that I chuckled over was Ventura county. It literally is next to LA county, but their leaders already requested to form a newly defined region with its two northern coastal neighbors. It is ridiculous to think the region concept will work if the leaders in a county like Ventura don't see how their citizens are in the orbit of LA county from a hospital ICU capacity perspective.

At every turn everyone wants NIMBY concepts to apply.
Shutdown stuff, but not my business/industry/county.
Don't give handouts, but my business/industry/family needs rent/mortgage/tax relief.

I am still in the same place. These officials are generally trying to navigate a very challenging novel virus, those that have genuinely tried to do the right things have strong approval ratings right now. They will continue to make mistakes. At this point late December will be awful, so everyone needs to just keep pushing for citizens to do more even if they are not super excited about getting told what to do.

RE: “If you have a social bubble, it’s popped.” - akiddoc - 12-09-2020

This idea that we have to wait for science to "prove" that certain behaviors cause the spread of Covid-19 specifically is not workable. Scientific proof is a slow and ponderous process. We just aren't going to have those scientific studies and papers for many months or years. What we need now is extrapolation from previous related science to handle the next 6-9 months of the spread of this virus. Contact tracing and its analysis can be helpful as well.

Alameda County is making a brobdingnagian effort at contact tracing. The most thorough work is being done in the County Clinic network where I work. With regard to patients, it starts with the physician's note, where we document reports from patients regarding known Covid contacts or lack thereof, daycare attendance, parent's work situations and visits to other's homes or visits to the family's home. It then goes to our public health tracers, who try to further delineate who the contacts were and what the social interactions were that likely caused the spread.

Every employee who gets sick has an exhaustive history done, especially because the county health system cannot afford to have it spreading through the employees and affecting the work force.

We had a report today that is not private or privileged. Some interesting points.

The most likely infectious event for all cases, whether patient or employee, was at home or in a restaurant and indoors. Not single caregiver in the outpatient clinics has been documented to have been infected by a patient. There are people who have infected co-workers in the lunchroom, verified by DNA analysis of the virus.

In the hospital system, there have been no infections of hospital personnel by a patient for almost 4 months. We are lucky in the Alameda County system to have an abundant supply of PPE, an early and aggressive training program for infection control, and a very motivated work force.

I have personally seen a number of Covid positive patients, and some of my colleagues have seen more than I have, but we have essentially 100% compliance with PPE protocols. All patient contact personnel must wear a mask, eye protection and gloves while in any patient room. For any suspected Covid case, fuller PPE is worn. We have protocols for minimizing our actual time in the exam rooms, a number of negative pressure rooms, high volume HEPA filtration, and policies that encourage patients to do phone visits if they are sick.

The total number of employees who have tested positive is 2%. There are about 6400 employees in our system. In the community we serve, the positive antibody rate for Covid was about 20% 3 months ago, plus or minus a couple of percentage points. Not sure what it is now.

(The current test positivity rate in Alameda County is only 3.6%, much better than California as a whole. I'm not sure why.)

My point is that these protocols are not based on new scientific literature specifically looking at Covid. That literature is sparse at best. We generally know how respiratory viruses are spread, so we use that information to prevent the spread of Covid in our institution.

As far as outdoor dining is concerned, the problem is that these restaurants are not providing it. They are enclosing their patrons in tents in the parking lot or on the side walk. Anything that lowers air circulation or crowds people together is no longer allowing natural outdoor air movement to cause rapid diluting of viral particles. And indoor dining is a catastrophe for the spread of this virus. This is backed up by epidemiological data.

When exposure is fleeting, infection is unlikely.
In a true outdoor environment, without crowding, infection is unlikely.
In a true bubble, infection is unlikely (but how many are truly doing that?)

By the way, I haven't seen a single case of influenza this season. That's never happened before up to Dec 9. I had 9 positives for Covid in the last three days. It shows how darn infectious this virus is versus influenza. A little social distancing really put a dent in flu cases. Covid continues to roar. I suspect our county positivity rate is about to grow.

RE: “If you have a social bubble, it’s popped.” - BostonCard - 12-10-2020

Here's the CDC's "flu view": https://www.cdc.gov/flu/weekly/index.htm

[Image: ILI48_small.gif]

It is indeed a very light flu year, with fewer cases year to date than the lightest flu year in recent memory (2015/16). It's still early (we are just around the time that influenza cases typically start accelerating (2009 being the exception), so let's have another look in another 3-4 weeks.

BC

RE: “If you have a social bubble, it’s popped.” - akiddoc - 12-10-2020

(12-10-2020, 12:15 AM)BostonCard Wrote: Here's the CDC's "flu view": https://www.cdc.gov/flu/weekly/index.htm

It is indeed a very light flu year, with fewer cases year to date than the lightest flu year in recent memory (2015/16). It's still early (we are just around the time that influenza cases typically start accelerating (2009 being the exception), so let's have another look in another 3-4 weeks.

BC

Of the current ILI's, I'll bet many are Covid infections with false negative tests.

RE: “If you have a social bubble, it’s popped.” - BostonCard - 12-10-2020

Good point. Out of 17,000 specimens tested last week in clinical labs for influenza, 17(!), 0.1% have come back positive. Another 5 (out of 10,000) have come back positive from public health labs.

BC

RE: “If you have a social bubble, it’s popped.” - Genuine Realist - 12-10-2020

(12-09-2020, 11:53 PM)akiddoc Wrote: This idea that we have to wait for science to "prove" that certain behaviors cause the spread of Covid-19 specifically is not workable. Scientific proof is a slow and ponderous process. We just aren't going to have those scientific studies and papers for many months or years. What we need now is extrapolation from previous related science to handle the next 6-9 months of the spread of this virus. Contact tracing and its analysis can be helpful as well.

Alameda County is making a of immense proportions effort at contact tracing. The most thorough work is being done in the County Clinic network where I work. With regard to patients, it starts with the physician's note, where we document reports from patients regarding known Covid contacts or lack thereof, daycare attendance, parent's work situations and visits to other's homes or visits to the family's home. It then goes to our public health tracers, who try to further delineate who the contacts were and what the social interactions were that likely caused the spread.

Every employee who gets sick has an exhaustive history done, especially because the county health system cannot afford to have it spreading through the employees and affecting the work force.

We had a report today that is not private or privileged. Some interesting points.

The most likely infectious event for all cases, whether patient or employee, was at home or in a restaurant and indoors. Not single caregiver in the outpatient clinics has been documented to have been infected by a patient. There are people who have infected co-workers in the lunchroom, verified by DNA analysis of the virus.

In the hospital system, there have been no infections of hospital personnel by a patient for almost 4 months. We are lucky in the Alameda County system to have an abundant supply of PPE, an early and aggressive training program for infection control, and a very motivated work force.

I have personally seen a number of Covid positive patients, and some of my colleagues have seen more than I have, but we have essentially 100% compliance with PPE protocols. All patient contact personnel must wear a mask, eye protection and gloves while in any patient room. For any suspected Covid case, fuller PPE is worn. We have protocols for minimizing our actual time in the exam rooms, a number of negative pressure rooms, high volume HEPA filtration, and policies that encourage patients to do phone visits if they are sick.

The total number of employees who have tested positive is 2%. There are about 6400 employees in our system. In the community we serve, the positive antibody rate for Covid was about 20% 3 months ago, plus or minus a couple of percentage points. Not sure what it is now.

(The current test positivity rate in Alameda County is only 3.6%, much better than California as a whole. I'm not sure why.)

My point is that these protocols are not based on new scientific literature specifically looking at Covid. That literature is sparse at best. We generally know how respiratory viruses are spread, so we use that information to prevent the spread of Covid in our institution.

As far as outdoor dining is concerned, the problem is that these restaurants are not providing it. They are enclosing their patrons in tents in the parking lot or on the side walk. Anything that lowers air circulation or crowds people together is no longer allowing natural outdoor air movement to cause rapid diluting of viral particles. And indoor dining is a catastrophe for the spread of this virus. This is backed up by epidemiological data.

When exposure is fleeting, infection is unlikely.
In a true outdoor environment, without crowding, infection is unlikely.
In a true bubble, infection is unlikely (but how many are truly doing that?)

By the way, I haven't seen a single case of influenza this season. That's never happened before up to Dec 9. I had 9 positives for Covid in the last three days. It shows how darn infectious this virus is versus influenza. A little social distancing really put a dent in flu cases. Covid continues to roar. I suspect our county positivity rate is about to grow.

Defining the behaviors you want to assess in this context is really hard. 'Bubble' behaviors, outdoor events, and so on, are highly idiosyncratic. Each encompasses a brobdingnagian quantum of mini behaviors that have to be identified and separately evaluated.

RE: “If you have a social bubble, it’s popped.” - teejers1 - 12-10-2020

(12-09-2020, 05:50 PM)M T Wrote: Teejers, you can also see the state's LTCF data: cases overall, cases per facility, indoor visitation, etc
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/SNFsCOVID_19.aspx

I have a relative that has been in the hospital and is choosing to go to a SNF rather than home. I was able to check for the number of infected patients and staff currently (0 & 0) and historically at that facility.

Judging from the graph, I believe the infection rate at the SNFs seems to have tracked the cases in the general population, perhaps a little delayed. Currently the daily new cases across the state at SNF is 400 (7 day moving average) and climbing.

The SCC LTCF data page indicates it is updated every Wednesday. Indeed, it has been updated today.

Holy crap! The revised number for November 27 jumped to 71. The next two days reported LTCF numbers of 21 and 72. That's a 3 day LTCF total of 164 (and that doesn't even count the December numbers) - WAY higher than my spit ball guessing based on previously reported numbers. It's fair to conclude a big chunk of hospitalization usage (now over 400, which is very bad) is from LTCF patients - the exact percentage remains elusive.

RE: “If you have a social bubble, it’s popped.” - Farm93 - 12-10-2020

(12-10-2020, 11:03 AM)teejers1 Wrote: Holy crap! The revised number for November 27 jumped to 71. The next two days reported LTCF numbers of 21 and 72. That's a 3 day LTCF total of 164 (and that doesn't even count the December numbers) - WAY higher than my spit ball guessing based on previously reported numbers. It's fair to conclude a big chunk of hospitalization usage (now over 400, which is very bad) is from LTCF patients - the exact percentage remains elusive.

That's why LTCF residents and staff are in the highest priority tiers for the vaccine.

When the LTCF community gets vaccinated the national fatality, ICU, and hospitalization rates for COVID should improve dramatically.

RE: “If you have a social bubble, it’s popped.” - magnus - 12-10-2020

(12-10-2020, 11:25 AM)Farm93 Wrote: When the LTCF community gets vaccinated the national fatality, ICU, and hospitalization rates for COVID should improve dramatically.

*fingers crossed* that the vaccine(s) apply smoothly for the LTCF residents.

RE: “If you have a social bubble, it’s popped.” - teejers1 - 12-10-2020

(12-10-2020, 11:55 AM)magnus Wrote:
(12-10-2020, 11:25 AM)Farm93 Wrote: When the LTCF community gets vaccinated the national fatality, ICU, and hospitalization rates for COVID should improve dramatically.

*fingers crossed* that the vaccine(s) apply smoothly for the LTCF residents.

Anecdotally, fwliw, we just received a notice from the facility where my mom lives asking for vaccination sign off. The notice says that they are hoping to have residents vaccinated in the next 2-3 weeks. Walgreens will be sending the team over to set up and administer the vaccines. That would be terrific, if true. But my jaded self will believe it when I see it.

In all events, I really agree with notion that LTCF rollout needs to be a priority (along with those HCWs on front line) to greatly lower death rate; and share the hope that the vaccines apply smoothly to these recipients. [A great New Year's present for a lot of families would be a family dinner that includes the folks in assisted living facilities].

RE: “If you have a social bubble, it’s popped.” - Farm93 - 12-10-2020

(12-10-2020, 01:35 PM)teejers1 Wrote:
(12-10-2020, 11:55 AM)magnus Wrote:
(12-10-2020, 11:25 AM)Farm93 Wrote: When the LTCF community gets vaccinated the national fatality, ICU, and hospitalization rates for COVID should improve dramatically.

*fingers crossed* that the vaccine(s) apply smoothly for the LTCF residents.

Anecdotally, fwliw, we just received a notice from the facility where my mom lives asking for vaccination sign off. The notice says that they are hoping to have residents vaccinated in the next 2-3 weeks. Walgreens will be sending the team over to set up and administer the vaccines. That would be terrific, if true. But my jaded self will believe it when I see it.

In all events, I really agree with notion that LTCF rollout needs to be a priority (along with those HCWs on front line) to greatly lower death rate; and share the hope that the vaccines apply smoothly to these recipients. [A great New Year's present for a lot of families would be a family dinner that includes the folks in assisted living facilities].

Teejers1, you mean the New Year 2021 to 2022 right?

Most, if not all, USA states will not be letting those recently vaccinated do anything at the end of the month like you describe here.

The vaccine is a two dose process that is either three or four weeks depending on the vaccine.
So even if someone got the first dose tomorrow they would not get the second dose until 2021.
There is also a period of time days/weeks required after the doses for the body to build its defenses.

Then it is not as if the other family members are all in the clear for COVID just because the eldest are vaccintated. A three generation dinner could have the LTCF resident protected by Valentine's day, but the rest of the family would still be able to spread it to relatives not in the same household.

A few other reasons in play too, but I would think the more realistic goal might be an Easter dinner or perhaps a Mother's day dinner for a multi-household family dinner. Even that might be a bit of a reach.

RE: “If you have a social bubble, it’s popped.” - teejers1 - 12-11-2020

(12-10-2020, 06:22 PM)Farm93 Wrote:
(12-10-2020, 01:35 PM)teejers1 Wrote:
(12-10-2020, 11:55 AM)magnus Wrote:
(12-10-2020, 11:25 AM)Farm93 Wrote: When the LTCF community gets vaccinated the national fatality, ICU, and hospitalization rates for COVID should improve dramatically.

*fingers crossed* that the vaccine(s) apply smoothly for the LTCF residents.

Anecdotally, fwliw, we just received a notice from the facility where my mom lives asking for vaccination sign off. The notice says that they are hoping to have residents vaccinated in the next 2-3 weeks. Walgreens will be sending the team over to set up and administer the vaccines. That would be terrific, if true. But my jaded self will believe it when I see it.

In all events, I really agree with notion that LTCF rollout needs to be a priority (along with those HCWs on front line) to greatly lower death rate; and share the hope that the vaccines apply smoothly to these recipients. [A great New Year's present for a lot of families would be a family dinner that includes the folks in assisted living facilities].
Teejers1, you mean the New Year 2021 to 2022 right?

Most, if not all, USA states will not be letting those recently vaccinated do anything at the end of the month like you describe here.

The vaccine is a two dose process that is either three or four weeks depending on the vaccine.
So even if someone got the first dose tomorrow they would not get the second dose until 2021.
There is also a period of time days/weeks required after the doses for the body to build its defenses.

Then it is not as if the other family members are all in the clear for COVID just because the eldest are vaccintated. A three generation dinner could have the LTCF resident protected by Valentine's day, but the rest of the family would still be able to spread it to relatives not in the same household.

A few other reasons in play too, but I would think the more realistic goal might be an Easter dinner or perhaps a Mother's day dinner for a multi-household family dinner. Even that might be a bit of a reach.

Good points.
Jaded expectations re-set.