It's bad out there - Printable Version
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RE: It's bad out there - Leftcoast - 12-16-2020
My hope (backed up by the regional dashboards) is that death rate will fall by 30%-40% once we have vaccines available for LTCF elders and LTCF staff.
RE: It's bad out there - Goose - 12-16-2020
The State imposed SAH order for Southern California has now been in place for 10 days. Probably not quite long enough yet to really evaluate the effects, but if we really believe that 7 days is mostly long enough to see symptoms, it would be reasonable to expect cases to have leveled off or even started to decline. That hasn't happened, at least not yet. This certainly isn't a good sign. Granted, the cases from the 6th to the 13th were already in the pipeline and the SAH wouldn't matter. However, by now, the effects of the SAH should have started to appear.
RE: It's bad out there - dabigv13 - 12-16-2020
No sign of slowing yet. We're in deep shit if this SAH doesn't start yielding some results soon. Unfortunately this SAH happened with more community prevalence, and seems to be less stringently followed. Back in the spring the highways were empty on my way to work. Now it seems barely below normal traffic, if that.
RE: It's bad out there - OutsiderFan - 12-17-2020
Anyone else hear the clip of Dr. Cody literally crying about how awful the situation is in Santa Clara County? Anyone want to claim she's just acting?
It has to be really bad, and much worse than the public writ-large seems to be grasping, for someone who has been as professional and composed as she has been, to emotionally break like she did while being interviewed.
It seems there is clearly a segment of the population that is not taking the precautions necessary to stop spread. Asa a slice of the roughly 2 million Santa Clara County residents, what is that percentage? Do we know if it is 5%, 10%, 20%? And do we know the profile of those who are getting sick? Age? Ethnic background? Location in county? Or is it a wide cross-section? Then, can we identify any behavior those who are sick have engaged in that can be identified as a common denominator?
After seeing the study on NPI efficacy, it is clear full shutdowns are not necessary to stop spread. But this does not mean spread can stop without full shutdowns and Shelter in Place orders. What I mean is if a large enough percentage of the population continues to engage in risky behavior, the spread is not going to stop even with stay at home orders that keep businesses open, because that segment of the population is where all the spread is happening. If you have 80% following safety protocols, there is still 20% of the population not being safe. That's still 200,000 people engaging in risky behavior who are going to be infected. So no matter if the 80% is safe, you are still overwhelming the hospitals with the 20% not following guidelines. It's almost akin to AIDS when some people refused to wear protection during sex.
To me, it all adds up to this. As usual, a few ruin it for the many, so we will have no choice but to do a mandatory SIP and sanction people for violating the order. There were 110 new hospitalizations yesterday. It's been over 80 for several days in a row, which is unsustainable. We are still seeing 1,000 cases per day even two weeks after stay at home order. You can see why Dr. Cody was crying. She has done everything she can and it still isn't stopping the spread enough to keep the system afloat. If we don't see a real drop in new cases by Friday, the only way to get it under control is going to be a mandatory SIP. It sucks, but that is just what the reality indicates.
RE: It's bad out there - Goose - 12-17-2020
(12-17-2020, 08:33 AM)OutsiderFan Wrote: It seems there is clearly a segment of the population that is not taking the precautions necessary to stop spread.Kind of true by definition, but it assumes that we know what those precautions are and that they exist. It may be true that only physical separation or hazmat suits are adequate. Masks may help but not enough if people are too close for too long. We just don't know. The only places that have actually contained this epidemic have done so at a very low level of disease. We never got there, and Europe got there but couldn't maintain it.
Quote:Asa a slice of the roughly 2 million Santa Clara County residents, what is that percentage? Do we know if it is 5%, 10%, 20%? And do we know the profile of those who are getting sick? Age? Ethnic background? Location in county? Or is it a wide cross-section? Then, can we identify any behavior those who are sick have engaged in that can be identified as a common denominator?As of now, we don't really know what is driving the spread. I am virtually certain that if Dr. Cody knew what people were doing to spread the disease, she would have identified it and taken steps to combat it. Is non-compliance the issue, or is this virus just a real bitch? Probably both, but exactly how and in what ratio I don't think we know.
Quote:After seeing the study on NPI efficacy, it is clear full shutdowns are not necessary to stop spread.Or that the NPI study is missing some factor that invalidates it's analysis.
Quote:But this does not mean spread can stop without full shutdowns and Shelter in Place orders. What I mean is if a large enough percentage of the population continues to engage in risky behavior, the spread is not going to stop even with stay at home orders that keep businesses open, because that segment of the population is where all the spread is happening. If you have 80% following safety protocols, there is still 20% of the population not being safe. That's still 200,000 people engaging in risky behavior who are going to be infected. So no matter if the 80% is safe, you are still overwhelming the hospitals with the 20% not following guidelines. It's almost akin to AIDS when some people refused to wear protection during sex.As you may know, I have been saying full SIP probably would be required for about three weeks. I am not as sure as you are that people not being "safe" is the problem. It may be that our definition of "safe" isn't. Obviously, it isn't absolute even best case. As the prevalence of disease goes up, it becomes more likely you will get sick even if you take precautions. This effect may also be non-linear, which doesn't help.
For sure, there are some people who don't attempt to be safe. How many, I have no idea, and I am not sure anybody else really knows either. If such a group exists, we haven't identified it yet. I strongly suspect, but can't prove, that many positive cases are not isolating, and that messes up attempts to be "safe". I do know that 50% of the cases don't reveal any contacts, and that is a problem too. The contacts start spreading disease without knowing it until they actually have symptoms. Both these things drive Reff up. It is also "probable" IMHO that people are being safe a large percentage of the time but not all the time, often inadvertently doing something they shouldn't. With this virus, that level of compliance may not be enough.
RE: It's bad out there - M T - 12-17-2020
As I've said, I have a relative that felt poorly on a Monday, had more symptoms (no fever) on the next day & got a test.
She indicates NOTHING at where she took the test (not in SCC) that said QUARANTINE!!! She didn't.
Three days later she got a positive result back.
I believe that is a failing that should be corrected. Everyone that gets a test should be getting a notification about quarantining until the result comes back. One physical handout at the time of the test, and a notification later that day however they are going to get their results.
RE: It's bad out there - Goose - 12-17-2020
(12-17-2020, 11:12 AM)M T Wrote: As I've said, I have a relative that felt poorly on a Monday, had more symptoms (no fever) on the next day & got a test.Yes, it is a failing. Quarantining while waiting for test results is useful. Isolating is "better", because if you just quarantine you may still infect your family (if you haven't already). If you are symptomatic, you probably are infectious if it turns out to be COVID-19.
She indicates NOTHING at where she took the test (not in SCC) that said QUARANTINE!!! She didn't.
Three days later she got a positive result back.
I believe that is a failing that should be corrected. Everyone that gets a test should be getting a notification about quarantining until the result comes back. One physical handout at the time of the test, and a notification later that day however they are going to get their results.
In Korea if you test positive they send a cop to your home to ensure you are there and isolating. If you aren't there, APB for you. That works. Advice, particularly in the USA, probably will not, at least to the extent necessary, be adequate. I unfortunately realize that our county public health officers will not ask our Sheriffs to do that, and that it is only possible to do that if you have a "small" number of cases. However, consider why a country where the citizens are normally quite compliant (Korea) chose to verify positive cases are isolating. They do it because they know from experience it is necessary.
RE: It's bad out there - Farm93 - 12-17-2020
We saw a US Senator and a medical doctor by training take a test in March, then do all kinds of things in public before the test result came back positive. So as a country we had a great example in March, but let this type of failing continue.
However, I would note the USA has a different issue in the mix. You generally only have a pre-existing condition if you KNOW you have a pre-existing condition. For a lot of workers they can work if they are sick and fear they have COVID, but they would not be allowed to work if they KNOW they have COVID. In the USA there are incentives to avoid testing. I am not sure forcing those that take a test to then quarantine/isolate until the results come back is better as some would likely just opt to avoid testing even when they suspect they have COVID. It would be great to get the results back in hours, but that's not how we do it.
FWIW - My elderly mother-in-law had a friend in another part of CA that suspected she might have COVID in July. That person, also elderly, felt awful and was rightfully very worried given her age. So she went to a health center and got a test. They told her she should assume she is positive and avoid contact until the results came back.
Now in some places in the world she would get a ride from the facility back to her home from medical officials, police, or other government types. Not in the USA. So amazingly, she took Uber/Lyft home presumably putting that person at risk. Ultimately she was negative, but illustrates that the USA has a lot of failings when it comes to the incentives, penalties and logistics of testing.
Those countries with the lowest rates definitely do things differently.
A great country would look at best practices around the world and be prepared to implement those things them next time.
MAGNT - "Make America Great Next Time"
RE: It's bad out there - Goose - 12-17-2020
(12-17-2020, 12:11 PM)Farm93 Wrote: We saw a US Senator and a medical doctor by training take a test in March, then do all kinds of things in public before the test result came back positive. So as a country we had a great example in March, but let this type of failing continue.The quarantine/isolate waiting for the results is an issue, but the isolate if it comes back positive is much more of an issue. Part of it is the economic incentive to not lose a week plus pay because you isolated. That can be mitigated by providing state sick leave or mandated sick leave under these conditions. A worse problem is that your household needs to quarantine as contacts. That is more people who probably don't feel sick (yet). These people may need to go to work. Can we pay those people too? Will we? FWIW I posted almost exactly these words in the spring. No resolution in sight. Without solving this problem and at the same time convincing the public of their social obligation, tracking and tracing will never work. Enforcement is possible only if the public basically supports the idea people should comply. That won't happen if many people can't afford to comply.
However, I would note the USA has a different issue in the mix. You generally only have a pre-existing condition if you KNOW you have a pre-existing condition. For a lot of workers they can work if they are sick and fear they have COVID, but they would not be allowed to work if they KNOW they have COVID. In the USA there are incentives to avoid testing. I am not sure forcing those that take a test to then quarantine/isolate until the results come back is better as some would likely just opt to avoid testing even when they suspect they have COVID.
RE: It's bad out there - chrisk - 12-17-2020
The number of COVID deaths in the US yesterday exceeded the average daily deaths from cardiovascular and cancer combined, normally the top 2 causes of death.
RE: It's bad out there - Farm93 - 12-17-2020
(12-17-2020, 12:27 PM)Goose Wrote:The USA is far enough away from doing this right that it is not hard to understand why some just say...."Fxxk it. I need to keep my housing, pay my bills, etc. If I die then that's god's will (or whatever), but I don't trust the system/government/health officials enough to listen to them. Those promises for money or relief take forever, and when they happen after 8 months of negotiations I only get $600!?"(12-17-2020, 12:11 PM)Farm93 Wrote: We saw a US Senator and a medical doctor by training take a test in March, then do all kinds of things in public before the test result came back positive. So as a country we had a great example in March, but let this type of failing continue.The quarantine/isolate waiting for the results is an issue, but the isolate if it comes back positive is much more of an issue. Part of it is the economic incentive to not lose a week plus pay because you isolated. That can be mitigated by providing state sick leave or mandated sick leave under these conditions. A worse problem is that your household needs to quarantine as contacts. That is more people who probably don't feel sick (yet). These people may need to go to work. Can we pay those people too? Will we? FWIW I posted almost exactly these words in the spring. No resolution in sight. Without solving this problem and at the same time convincing the public of their social obligation, tracking and tracing will never work. Enforcement is possible only if the public basically supports the idea people should comply. That won't happen if many people can't afford to comply.
However, I would note the USA has a different issue in the mix. You generally only have a pre-existing condition if you KNOW you have a pre-existing condition. For a lot of workers they can work if they are sick and fear they have COVID, but they would not be allowed to work if they KNOW they have COVID. In the USA there are incentives to avoid testing. I am not sure forcing those that take a test to then quarantine/isolate until the results come back is better as some would likely just opt to avoid testing even when they suspect they have COVID.
The mindsight has a lot of me, myself and I and not much of the we & us, but I understand how some just give up living in our culture. It is only made worse when leaders that know better support that logic rather than take sensible preventative steps.
COVID-19 must adore spreading across the USA and apparently it loves LA.
LA county had more cases yesterday than most nations in the world.
RE: It's bad out there - BostonCard - 12-17-2020
Southern California is out of ICU beds.
https://www.latimes.com/california/story/2020-12-17/southern-california-out-of-icu-beds-amid-covid-19-surge
Quote:California is now opening temporary field hospitals to help with overflow patients. The field hospitals will care for non-ICU patients in places such as Costa Mesa, Porterville, Sacramento, Imperial and Orange County; other facilities are on standby status in Riverside, Richmond, Fresno, San Diego and San Francisco.
BC
RE: It's bad out there - Goose - 12-17-2020
(12-17-2020, 02:40 PM)Farm93 Wrote: The USA is far enough away from doing this right that it is not hard to understand why some just say...."Fxxk it. I need to keep my housing, pay my bills, etc. If I die then that's god's will (or whatever), but I don't trust the system/government/health officials enough to listen to them.Totally true. That is why I believe that the decision to pay people to isolate has to come from the county. The State and Federal levels just take too long and diddle around too much. Maybe if we had a defined policy on this beforehand that wouldn't be the case. If we are paying say 2000 people (200 cases a day for 10 days) to isolate in San Mateo County, that is possible. Paying their contacts to quarantine could be more difficult because there could be lots of contacts, but at the current contact tracing frequency we could do it.
Quote:Those promises for money or relief take forever, and when they happen after 8 months of negotiations I only get $600!?"True but different issue. Those are economic stimulus that go to everybody. No way the county could do that. Just don't have the money.
RE: It's bad out there - OutsiderFan - 12-17-2020
Damn...
Dec. 17 in SCC: +1,200 new cases and +99 hospitalizations
The restrictions are not materially stopping spread in Santa Clara County.
RE: It's bad out there - dabigv13 - 12-17-2020
Things are at a breaking point. Many doctors, nurses, and staff doing work outside of their usual scope of practice to take care of this overwhelming volume of patients. I think there is a very admirable sense of duty amongst most HCWs, but it is obvious that our normal high quality care will be compromised if this keeps up.
There will be a lot of healthcare workers with PTSD after this is done as well. I suspect a lot of intensivists will look to do something else after the pandemic. Being in the ICU is a brief interlude from my usual duties, but seeing this shit every day for so long.....I would definitely be looking for a change once the pandemic is over.
RE: It's bad out there - M T - 12-17-2020
In Sierra foothills, a for-profiit agency that runs a skilled nursing facility (at which my relative is currently) has brought in a number of staff from Wisconsin. I expect this was to allow (some of) their regular staff to work at the community hospital to help out there.
RE: It's bad out there - Farm93 - 12-17-2020
(12-17-2020, 05:48 PM)dabigv13 Wrote: Things are at a breaking point. Many doctors, nurses, and staff doing work outside of their usual scope of practice to take care of this overwhelming volume of patients. I think there is a very admirable sense of duty amongst most HCWs, but it is obvious that our normal high quality care will be compromised if this keeps up.All of this feels true. The SoCal system is bursting at the seams right now. The weather is decent in SoCal so field hospitals can create more viable beds, but that doesn't help the system get more staff. In most of the world the fatality rate moves up when the staff resources are stretched, so the recent move up has been a troubling trend. This is all something those often hated county health officials cried about pre-Thanksgiving, but a lot of people apparently had to eat turkey with relatives. :(
There will be a lot of healthcare workers with PTSD after this is done as well. I suspect a lot of intensivists will look to do something else after the pandemic. Being in the ICU is a brief interlude from my usual duties, but seeing this shit every day for so long.....I would definitely be looking for a change once the pandemic is over.
Feels like the fatality rate could start climbing in the USA over the next 2-3 weeks as in some places in the USA they are making very tough calls already. Hopefully as we get to late January the death rates will fall thanks to SiP efforts in at least a few states now, and vaccine efforts for LTCF next week. Those two will be key as without those efforts Christmas could accelerate the already troubling case growth rates.
RE: It's bad out there - dabigv13 - 12-17-2020
LTCF patients may be 40% of the fatalities, but they are a much smaller portion of the ICU cases. Getting them vaccinated will be helpful but we'd still be stretched even if they all already had their shots.
RE: It's bad out there - dabigv13 - 12-18-2020
Larger ICU rooms now have two patients in them, separated by sheets hung over string. Non-covid ICU patients are in large halls separated by curtains. Just wild stuff in an American hospital in the 21st century. And the scary thing is how much worse it's going to get. Most covid patients in the ICU stay there for a while, before they die or get better. Not gonna be room for all the new people being hospitalized who will eventually need intensive care. The next month is going to be so dark.
RE: It's bad out there - teejers1 - 12-18-2020
(12-17-2020, 08:45 PM)dabigv13 Wrote: LTCF patients may be 40% of the fatalities, but they are a much smaller portion of the ICU cases. Getting them vaccinated will be helpful but we'd still be stretched even if they all already had their shots.
That seems counterintuitive to me - is it because LTCF patients just go from regular hospital bed to the morgue (and skip ICUs altogether)? Or that they never make it to ICUs in the first place and perish at home?
BTW, front page story in Merc today about ridiculous spike in LTCF cases across the state, and identifying some pretty head-shaking numbers at some SCC facilities. It's like for 7 months (after some early gaffes revealed the extreme vulnerability of senior folks) the state (and SCC in particular) did pretty well in containing LTCF cases . . . and then the dam broke. Strange.