[chrisk]

Newsom is using $2.5 billion of funding to encourage/enforce accountability among the counties.

We’ll see how the carrot and stick approach works.

He is expecting that compliance with the mask rule is essential.

---

No, it isn't even that hard. It is much more like garbage collection. It is well understood, totally necessary, and requires a significant but not gigantic staff to do the work.

Well, it is not helping that public health workers are being threatened.



https://www.washingtonpost.com/health/am...story.html



We are our own worst enemy.



BC

Amen! This is an area where the county supervisors/commissioners/whatever have to stand up and give the public the "bad" news. The county health department has lots of legal power, and the county will back them up. You will be arrested and charged if you don't cooperate. Unfortunately (IMHO) the political operators in most counties are keeping the mouths tightly shut on the subject. Worse still, many county health offices have elected not to actually enforce their quarantine requests. "Don't ask, don't tell" of another sort is in full flower. I don't know to what extent compliance is a problem, but I do know that if nobody checks, it is unlikely compliance will be very good, especially for contacts that are feeling fine and see no reason not to live normally. Maybe that is why track and trace is approached without much urgency. If we aren't going to actually use the results, why bother?

I don't think the rights and wrongs here are quite that certain. In a nation of this size and complex pluralism,  a regime as authoritarian as that imposed with SIP was bound to meet resistance. This is NOT a compliant culture, which in most political situations is a Good Thing. We also have far more social energy than any other country, probably more than in Europe and China combined. There was always going to be pushback against these measures.

Also, in retrospect, although it's only been three months, the lockdown was imposed with incredible insensitivity. If there was any concern for the hundreds of thousands of hospitality workers, food servers, barbers and personal attendants suddenly without any means of making a living, I never heard it from any health officials. The official attitude often came down to a single word  . . .  tough. In retrospect again, maybe the better strategy would have been to limit the lockdown period drastically to a fortnight or soand create task forces to draft with some urgency the rules and regulations by which the sensitive industries and professions could begin to do business again. 

Finally, was the notion of 'flattening the curve' chimerical from the start? A goal that is not possible to achieve as a practical matter, because of the number of essential businesses and the quantum of non-compliance? If so, wouldn't it be better to accept the society as it is and work towards practicable goals of realistic containment than insist on the imposition of draconian controls with no set time limit?

The bottom line is that health officials are not infallible and the ultimate story may be that the policies adopted with some haste were massive overkill, and also somewhat arrogantly enacted. This hasn't been helped by the indifference to social distancing demonstrated in the recent protests by various officials (Gretchen Whitmer comes to mind). Debate and pushback were only to be expected against a regimen imposed as drastically and quickly as this one was.

Sometimes you have to lean on and bend the culture. In WWII, there was rationing, travel restrictions, price controls, and conscription. If our society could make sacrifices to defeat the enemy then, we should be able to do it now. Otherwise, our culture has deteriorated rather than strengthened.

[chrisk]

Newsom is using $2.5 billion of funding to encourage/enforce accountability among the counties.

We’ll see how the carrot and stick approach works.

He is expecting that compliance with the mask rule is essential.

---

No, it isn't even that hard. It is much more like garbage collection. It is well understood, totally necessary, and requires a significant but not gigantic staff to do the work.

Well, it is not helping that public health workers are being threatened.



https://www.washingtonpost.com/health/am...story.html



We are our own worst enemy.



BC

Amen! This is an area where the county supervisors/commissioners/whatever have to stand up and give the public the "bad" news. The county health department has lots of legal power, and the county will back them up. You will be arrested and charged if you don't cooperate. Unfortunately (IMHO) the political operators in most counties are keeping the mouths tightly shut on the subject. Worse still, many county health offices have elected not to actually enforce their quarantine requests. "Don't ask, don't tell" of another sort is in full flower. I don't know to what extent compliance is a problem, but I do know that if nobody checks, it is unlikely compliance will be very good, especially for contacts that are feeling fine and see no reason not to live normally. Maybe that is why track and trace is approached without much urgency. If we aren't going to actually use the results, why bother?

I don't think the rights and wrongs here are quite that certain. In a nation of this size and complex pluralism,  a regime as authoritarian as that imposed with SIP was bound to meet resistance. This is NOT a compliant culture, which in most political situations is a Good Thing. We also have far more social energy than any other country, probably more than in Europe and China combined. There was always going to be pushback against these measures.

Also, in retrospect, although it's only been three months, the lockdown was imposed with incredible insensitivity. If there was any concern for the hundreds of thousands of hospitality workers, food servers, barbers and personal attendants suddenly without any means of making a living, I never heard it from any health officials. The official attitude often came down to a single word  . . .  tough. In retrospect again, maybe the better strategy would have been to limit the lockdown period drastically to a fortnight or soand create task forces to draft with some urgency the rules and regulations by which the sensitive industries and professions could begin to do business again. 

Finally, was the notion of 'flattening the curve' chimerical from the start? A goal that is not possible to achieve as a practical matter, because of the number of essential businesses and the quantum of non-compliance? If so, wouldn't it be better to accept the society as it is and work towards practicable goals of realistic containment than insist on the imposition of draconian controls with no set time limit?

The bottom line is that health officials are not infallible and the ultimate story may be that the policies adopted with some haste were massive overkill, and also somewhat arrogantly enacted. This hasn't been helped by the indifference to social distancing demonstrated in the recent protests by various officials (Gretchen Whitmer comes to mind). Debate and pushback were only to be expected against a regimen imposed as drastically and quickly as this one was.

Sometimes you have to lean on and bend the culture. In WWII, there was rationing, travel restrictions, price controls, and conscription. If our society could make sacrifices to defeat the enemy then, we should be able to do it now. Otherwise, our culture has deteriorated rather than strengthened.

[oregontim]

Of course we can do way better. We all agree there's a lot more of this to come, so I hope those in charge will take the miserable results in the US so far as inspiration for doing better from now on. If others can do better, then so can we, if we have national resolve. Let's put USA in context.



The data in the first image here comes from a statnews article OldAlum posted two days ago (https://www.statnews.com/2020/06/19/fast...19-deaths/). Notice the "stringency index" and how our low number on that score correlates with a high number of deaths.







And the second image here comes from Johns Hopkins data and was posted by @ValaAfshar on Twitter:

[oregontim]

Of course we can do way better. We all agree there's a lot more of this to come, so I hope those in charge will take the miserable results in the US so far as inspiration for doing better from now on. If others can do better, then so can we, if we have national resolve. Let's put USA in context.



The data in the first image here comes from a statnews article OldAlum posted two days ago (https://www.statnews.com/2020/06/19/fast...19-deaths/). Notice the "stringency index" and how our low number on that score correlates with a high number of deaths.







And the second image here comes from Johns Hopkins data and was posted by @ValaAfshar on Twitter:

[akiddoc]

While things aren't looking great in Florida, Texas, Arizona, California and a few other places, we still aren't talking about things spiraling out of control.

BC

California probably isn't fully out of control.  And I guess you could make an argument that Florida and Texas aren't truly awful (I would disagree, but the numbers aren't completely insane yet).  But I don't see how anyone can say Arizona isn't out of control.


Of course, if these trends continue at the current rates for a few more weeks, then all of these states are in big, big trouble.

Edit: I added NY for perspective.

Texas is about as awful as it can get right now. ICU's at 98% capacity. 

[akiddoc]

While things aren't looking great in Florida, Texas, Arizona, California and a few other places, we still aren't talking about things spiraling out of control.

BC

California probably isn't fully out of control.  And I guess you could make an argument that Florida and Texas aren't truly awful (I would disagree, but the numbers aren't completely insane yet).  But I don't see how anyone can say Arizona isn't out of control.


Of course, if these trends continue at the current rates for a few more weeks, then all of these states are in big, big trouble.

Edit: I added NY for perspective.

Texas is about as awful as it can get right now. ICU's at 98% capacity. 

[BostonCard]

Texas is about as awful as it can get right now. ICU's at 98% capacity. 

Where are you seeing that?  I see Texas with 2,260 ICU beds available and 408 beds currently needed:

https://covid19.healthdata.org/united-st...rica/texas

https://covidactnow.org/us/tx?s=56070

ICU headroom used is at 34%.

BC

[BostonCard]

Texas is about as awful as it can get right now. ICU's at 98% capacity. 

Where are you seeing that?  I see Texas with 2,260 ICU beds available and 408 beds currently needed:

https://covid19.healthdata.org/united-st...rica/texas

https://covidactnow.org/us/tx?s=56070

ICU headroom used is at 34%.

BC

[fullmetal]

Confirmed, Texas ICUs in all major cities are in very, very bad shape.  Don't look at the aggregate state numbers, otherwise you'll get all the empty hospitals in Tyler, Lufkin, Longview, etc.  Just look at the major cities.

Source: family.

[fullmetal]

Confirmed, Texas ICUs in all major cities are in very, very bad shape.  Don't look at the aggregate state numbers, otherwise you'll get all the empty hospitals in Tyler, Lufkin, Longview, etc.  Just look at the major cities.

Source: family.

[M T]

Texas Medical Center has one of the best set of graphs that I've seen at
   https://www.tmc.edu/coronavirus-updates/...ston-area/
Here is Texas Medical Center's web page on ICU beds:
  https://www.tmc.edu/coronavirus-updates/...occupancy/
showing the total ICU bed occupancy & availability.

They show "no concern" up to a bit more than 1050 ICU beds in use.  Moderate Concern goes to about 1475 or so,  while maximum surge capacity is 2207 beds.   (SCC has about 500 ICU beds total).

Normal ICU capacity: 1330 beds
Sustainable surge capacity: additional 373 beds (total 1703)
Unsustainable surge capacity: additional 504 beds (total 2207)


Today's ICU bed level is at 1298 of which about 900 (70%) are non-COVID.   Still a lot of headroom, but a disease that grows exponentially can overwhelm that.
(Note: I do not know if the ICU beds listed include NICU beds or not.)

I didn't find it at the site, but if ~900 ICU beds are non-COVID, I suspect they are continuing to do quite a few procedures ("an operation begins every 3 minutes").  If that is the situation, I would guess there are a number of ICU beds that can be freed up.

If ICU needs continue to rise as they have, they start using the surge beds on Friday, and the sustainable surge beds would be full in 12 days (July 6).  It appears that he unsustainable surge beds may give them another few days (week?) beyond that.
This seriously concerns me because those people needing ICU beds beginning July 6 are being exposed now.  A quick shutdown might stop the ICU from overflowing.

Texas Medical Center is the "largest medical city" in the world, with more than 106,000 employees.

By the way, their % positive test rate was 3.6% June 1-7;  7.6% the next week; 10.3% last week.
PPE is in good supply.

[M T]

Texas Medical Center has one of the best set of graphs that I've seen at
   https://www.tmc.edu/coronavirus-updates/...ston-area/
Here is Texas Medical Center's web page on ICU beds:
  https://www.tmc.edu/coronavirus-updates/...occupancy/
showing the total ICU bed occupancy & availability.

They show "no concern" up to a bit more than 1050 ICU beds in use.  Moderate Concern goes to about 1475 or so,  while maximum surge capacity is 2207 beds.   (SCC has about 500 ICU beds total).

Normal ICU capacity: 1330 beds
Sustainable surge capacity: additional 373 beds (total 1703)
Unsustainable surge capacity: additional 504 beds (total 2207)


Today's ICU bed level is at 1298 of which about 900 (70%) are non-COVID.   Still a lot of headroom, but a disease that grows exponentially can overwhelm that.
(Note: I do not know if the ICU beds listed include NICU beds or not.)

I didn't find it at the site, but if ~900 ICU beds are non-COVID, I suspect they are continuing to do quite a few procedures ("an operation begins every 3 minutes").  If that is the situation, I would guess there are a number of ICU beds that can be freed up.

If ICU needs continue to rise as they have, they start using the surge beds on Friday, and the sustainable surge beds would be full in 12 days (July 6).  It appears that he unsustainable surge beds may give them another few days (week?) beyond that.
This seriously concerns me because those people needing ICU beds beginning July 6 are being exposed now.  A quick shutdown might stop the ICU from overflowing.

Texas Medical Center is the "largest medical city" in the world, with more than 106,000 employees.

By the way, their % positive test rate was 3.6% June 1-7;  7.6% the next week; 10.3% last week.
PPE is in good supply.

[fullmetal]

I believe those numbers include PICU beds at least.  Texas Children's Hospital began opening its doors to adult patients to aid in capacity 1-2 days ago.  TMC numbers do not break down by individual institutions.

"Today, 97% of TMC ICU beds are occupied.  70% are non-COVID-19 patients.  27% are COVID-19 patients."
https://www.tmc.edu/coronavirus-updates/...-modeling/

That's the key message that needs to go out.

What's not being mentioned here is that the supply of ICU-capable nurses and staff is quite limited, and all the beds in the world won't make up for a staff stretched thin trying to keep several patients from coding all at once over the course of one shift.

[fullmetal]

I believe those numbers include PICU beds at least.  Texas Children's Hospital began opening its doors to adult patients to aid in capacity 1-2 days ago.  TMC numbers do not break down by individual institutions.

"Today, 97% of TMC ICU beds are occupied.  70% are non-COVID-19 patients.  27% are COVID-19 patients."
https://www.tmc.edu/coronavirus-updates/...-modeling/

That's the key message that needs to go out.

What's not being mentioned here is that the supply of ICU-capable nurses and staff is quite limited, and all the beds in the world won't make up for a staff stretched thin trying to keep several patients from coding all at once over the course of one shift.