[dabigv13]

LA county is also (I think) much worse than other counties. So maybe the other counties would do the same thing if they were dealing with LA's outbreak. Outdoor dining is low risk. But there are only so many levers that can be pulled.

If the current trajectory holds, within a week the SoCal region will hit a new peak of covid ICU occupancy. Our hospitalization rate has just about equalled the summer peak now, and is well above the spring peak. No signs of slowing down.

As I mentioned earlier, we should be at SIP stage.

[dabigv13]

LA county is also (I think) much worse than other counties. So maybe the other counties would do the same thing if they were dealing with LA's outbreak. Outdoor dining is low risk. But there are only so many levers that can be pulled.

If the current trajectory holds, within a week the SoCal region will hit a new peak of covid ICU occupancy. Our hospitalization rate has just about equalled the summer peak now, and is well above the spring peak. No signs of slowing down.

As I mentioned earlier, we should be at SIP stage.

[lex24]

[tweet]https://twitter.com/Elex_Michaelson/status/1331652384695623680?s=20[/tweet]

Is shutting down outdoor dining overkill?  I think opponents of the lockdowns are right to be frustrated given the lack of transparency into the decision-making.  Note I am not reflexively anti-restrictions.  If there is a good rationale for limiting certain activities based on data, we should definitely limit them.  And if the LA County health commissioner showed that limiting outdoor dining (or for Lex, limiting alcohol sales) is necessary because of spread through this mechanism, then by all means limit them.

BC

But the LA County Health Director made no such showing.  Indeed, it was admitted that they did not have scientific backing.  As for banning post  5PM sales of alcohol (not just in restaurants,but in liquor stores- please.  That is an absurdity.

The problem, BC,  is the more that these restrictions appear arbitrary the less people will abide by them. 

 Look at the numbers in LA County by demographics and it’s pretty clear the spread is not emanating from outdoor restaurants. 

  Frankly it’s not that I care that much about shutting the restaurants down ( except for the substantial harm it does to the people who work there). It’s that it appears arbitrary. If you have the data to support the move -  then show it. If you do not have such data – then why are you making the move. 

 The county approach also has been somewhat “interesting“. The difference between Santa Clara county and San Mateo County has been quite telling. As I indicated a while ago - until very recently there was a period where I could drive about a mile to cross the county line and eat indoors in Menlo Park. Couldn’t do that in Palo Alto you could only eat outdoors. Please tell me how that makes any sense.

[lex24]

[tweet]https://twitter.com/Elex_Michaelson/status/1331652384695623680?s=20[/tweet]

Is shutting down outdoor dining overkill?  I think opponents of the lockdowns are right to be frustrated given the lack of transparency into the decision-making.  Note I am not reflexively anti-restrictions.  If there is a good rationale for limiting certain activities based on data, we should definitely limit them.  And if the LA County health commissioner showed that limiting outdoor dining (or for Lex, limiting alcohol sales) is necessary because of spread through this mechanism, then by all means limit them.

BC

But the LA County Health Director made no such showing.  Indeed, it was admitted that they did not have scientific backing.  As for banning post  5PM sales of alcohol (not just in restaurants,but in liquor stores- please.  That is an absurdity.

The problem, BC,  is the more that these restrictions appear arbitrary the less people will abide by them. 

 Look at the numbers in LA County by demographics and it’s pretty clear the spread is not emanating from outdoor restaurants. 

  Frankly it’s not that I care that much about shutting the restaurants down ( except for the substantial harm it does to the people who work there). It’s that it appears arbitrary. If you have the data to support the move -  then show it. If you do not have such data – then why are you making the move. 

 The county approach also has been somewhat “interesting“. The difference between Santa Clara county and San Mateo County has been quite telling. As I indicated a while ago - until very recently there was a period where I could drive about a mile to cross the county line and eat indoors in Menlo Park. Couldn’t do that in Palo Alto you could only eat outdoors. Please tell me how that makes any sense.

[teejers1]

LA county is also (I think) much worse than other counties. So maybe the other counties would do the same thing if they were dealing with LA's outbreak. Outdoor dining is low risk. But there are only so many levers that can be pulled.

If the current trajectory holds, within a week the SoCal region will hit a new peak of covid ICU occupancy. Our hospitalization rate has just about equalled the summer peak now, and is well above the spring peak. No signs of slowing down.

As I mentioned earlier, we should be at SIP stage.

Meanwhile, in Santa Clara County . . . 

The hospitalization numbers of Covid patients has essentially doubled from about 100 to about 200 in 2.5 weeks.  Not good.

Available bed capacity has dropped from 37% to 29% in that period, which is decent (but assumes the capacity numbers are "real" and not theoretical - i.e., not sure what practical, real-world capacity numbers are).  Also, it should be noted that there has been an increase in non-Covid hospital bed patients from those 37% (1481 other patients) to 29% (1622 other patients) capacity signposts.

Lastly, since mid October, there has been some notable increases in LTCF numbers.  In the 2H of October, there were 120 Covid cases reported in such facilities; in November to date, about 70 new cases.  It's unclear to me how much of the recent doubling of new hospitalizations are attributable to LTCF occupants/workers (other than it cannot account for all of it - but maybe a majority of it?).  And I'm also not sure why that information isn't readily available.  Is it because hospitals don't know if an admitted patient resides at a LTCF?  I really don't know.

UPDATE on SCC hospitalization numbers:

Bed capacity has dropped to 27%.
Covid cases in hospital up to 235 (213 confirmed; 22 suspected);
Non-Covid patients up to 1838 in county (a high for November - as far back as chart goes).
That's a bad combo for capacity - wonder if they will discourage admission of new, non-Covid cases in near-term.

132 LTCF cases reported since November 1st.  Big number; can't tell what % of current hospitalizations LTCFers account for.

[teejers1]

LA county is also (I think) much worse than other counties. So maybe the other counties would do the same thing if they were dealing with LA's outbreak. Outdoor dining is low risk. But there are only so many levers that can be pulled.

If the current trajectory holds, within a week the SoCal region will hit a new peak of covid ICU occupancy. Our hospitalization rate has just about equalled the summer peak now, and is well above the spring peak. No signs of slowing down.

As I mentioned earlier, we should be at SIP stage.

Meanwhile, in Santa Clara County . . . 

The hospitalization numbers of Covid patients has essentially doubled from about 100 to about 200 in 2.5 weeks.  Not good.

Available bed capacity has dropped from 37% to 29% in that period, which is decent (but assumes the capacity numbers are "real" and not theoretical - i.e., not sure what practical, real-world capacity numbers are).  Also, it should be noted that there has been an increase in non-Covid hospital bed patients from those 37% (1481 other patients) to 29% (1622 other patients) capacity signposts.

Lastly, since mid October, there has been some notable increases in LTCF numbers.  In the 2H of October, there were 120 Covid cases reported in such facilities; in November to date, about 70 new cases.  It's unclear to me how much of the recent doubling of new hospitalizations are attributable to LTCF occupants/workers (other than it cannot account for all of it - but maybe a majority of it?).  And I'm also not sure why that information isn't readily available.  Is it because hospitals don't know if an admitted patient resides at a LTCF?  I really don't know.

UPDATE on SCC hospitalization numbers:

Bed capacity has dropped to 27%.
Covid cases in hospital up to 235 (213 confirmed; 22 suspected);
Non-Covid patients up to 1838 in county (a high for November - as far back as chart goes).
That's a bad combo for capacity - wonder if they will discourage admission of new, non-Covid cases in near-term.

132 LTCF cases reported since November 1st.  Big number; can't tell what % of current hospitalizations LTCFers account for.

[BostonCard]

There are two numbers that go into capacity calculations: the number of physical beds, and the staffing to support those patients.  In the short term, staffing can be surged to meet demand, but over the long term, nurses, respiratory techs, doctors, etc. will burn out.  It's easier to count beds than staff to support the patients, but in practice, it is often the staffing that is the limiting factor.

BC

[BostonCard]

There are two numbers that go into capacity calculations: the number of physical beds, and the staffing to support those patients.  In the short term, staffing can be surged to meet demand, but over the long term, nurses, respiratory techs, doctors, etc. will burn out.  It's easier to count beds than staff to support the patients, but in practice, it is often the staffing that is the limiting factor.

BC

[dabigv13]

Right. When we run out of ICU beds, we can convert OR rooms and vents to a quasi ICU. But when we run out of intensivists, then you get ENT docs and general surgeons running your vents and floor nurses acting as ICU nurses. Not good for mortality rates.

[dabigv13]

Right. When we run out of ICU beds, we can convert OR rooms and vents to a quasi ICU. But when we run out of intensivists, then you get ENT docs and general surgeons running your vents and floor nurses acting as ICU nurses. Not good for mortality rates.

[chrisk]

Now that Sweden’s case rate has gone to 10x that of Finland and 4x of Norway, they have now shifted from voluntary to legal restrictions. No gatherings of more than 8 and no alcohol sales after 10.

If voluntary doesn’t work in Sweden, what are the chances of it working in the US?

[chrisk]

Now that Sweden’s case rate has gone to 10x that of Finland and 4x of Norway, they have now shifted from voluntary to legal restrictions. No gatherings of more than 8 and no alcohol sales after 10.

If voluntary doesn’t work in Sweden, what are the chances of it working in the US?

[Goose]

Right.  When people say "follow the science", that means that if the data doesn't support your hypothesis that small gatherings are a nexus of spread of the virus, then stop telling people that their small gatherings are spreading the virus.  I'm as guilty as anyone in following the conventional wisdom that small gatherings were bad, but if the data is not there to support it, then the assumption needs to be reassessed.

I am at least as guilty as you are in this regard. Often we see a possible mechanism for spread and assume that mechanism actually functions in "real life" as we hypothesize. Sometimes, we are right, but many times we are not. It may happen not at all, less than we thought, or more than we thought.

I really do wish we would have much better data available in near real time to guide us.
<snip>
Our limited infrastructure was challenged before the fall surge; now it is completely overwhelmed.  But at the least we (our public health and government officials) should be focused on the low-hanging fruit.  Find the activities that are clearly leading to the most infections and restrict or risk-reduce those.  Then repeat the process.



BC

Totally agree with these ideas. As has been commented before, the studies we would hope to see from the State health authorities regarding spread in their jurisdictions just aren't there. The lack of available data naturally creates questions about the degree of transparency in their decision making process. For instance, is buying pinot a problem but syrah not <bad joke>? To what degree do they know what they are doing and to what degree are they guessing and hoping for the best?

I was really struck by how Tony Fauci answered a question about the Danish study on masks. He basically stated we have many studies showing masks are effective and did not address the Danish study at all. That really bothers me, because the "many studies that show..." are not in evidence AFAIK, and not talking about the Danish study seems evasive. The Danish study doesn't say masking is useless, it just didn't prove that it reduced spread by 50%. People need to understand that, and not dealing with this fact isn't a good look.

[Goose]

Right.  When people say "follow the science", that means that if the data doesn't support your hypothesis that small gatherings are a nexus of spread of the virus, then stop telling people that their small gatherings are spreading the virus.  I'm as guilty as anyone in following the conventional wisdom that small gatherings were bad, but if the data is not there to support it, then the assumption needs to be reassessed.

I am at least as guilty as you are in this regard. Often we see a possible mechanism for spread and assume that mechanism actually functions in "real life" as we hypothesize. Sometimes, we are right, but many times we are not. It may happen not at all, less than we thought, or more than we thought.

I really do wish we would have much better data available in near real time to guide us.
<snip>
Our limited infrastructure was challenged before the fall surge; now it is completely overwhelmed.  But at the least we (our public health and government officials) should be focused on the low-hanging fruit.  Find the activities that are clearly leading to the most infections and restrict or risk-reduce those.  Then repeat the process.



BC

Totally agree with these ideas. As has been commented before, the studies we would hope to see from the State health authorities regarding spread in their jurisdictions just aren't there. The lack of available data naturally creates questions about the degree of transparency in their decision making process. For instance, is buying pinot a problem but syrah not <bad joke>? To what degree do they know what they are doing and to what degree are they guessing and hoping for the best?

I was really struck by how Tony Fauci answered a question about the Danish study on masks. He basically stated we have many studies showing masks are effective and did not address the Danish study at all. That really bothers me, because the "many studies that show..." are not in evidence AFAIK, and not talking about the Danish study seems evasive. The Danish study doesn't say masking is useless, it just didn't prove that it reduced spread by 50%. People need to understand that, and not dealing with this fact isn't a good look.

[chrisk]

[tweet]https://twitter.com/Elex_Michaelson/status/1331652384695623680?s=20[/tweet]

Is shutting down outdoor dining overkill?  I think opponents of the lockdowns are right to be frustrated given the lack of transparency into the decision-making.  Note I am not reflexively anti-restrictions.  If there is a good rationale for limiting certain activities based on data, we should definitely limit them.  And if the LA County health commissioner showed that limiting outdoor dining (or for Lex, limiting alcohol sales) is necessary because of spread through this mechanism, then by all means limit them.

BC

But the LA County Health Director made no such showing.  Indeed, it was admitted that they did not have scientific backing.  As for banning post  5PM sales of alcohol (not just in restaurants,but in liquor stores- please.  That is an absurdity.

The problem, BC,  is the more that these restrictions appear arbitrary the less people will abide by them. 

 Look at the numbers in LA County by demographics and it’s pretty clear the spread is not emanating from outdoor restaurants. 

  Frankly it’s not that I care that much about shutting the restaurants down ( except for the substantial harm it does to the people who work there). It’s that it appears arbitrary. If you have the data to support the move -  then show it. If you do not have such data – then why are you making the move. 

 The county approach also has been somewhat “interesting“. The difference between Santa Clara county and San Mateo County has been quite telling. As I indicated a while ago - until very recently there was a period where I could drive about a mile to cross the county line and eat indoors in Menlo Park. Couldn’t do that in Palo Alto you could only eat outdoors. Please tell me how that makes any sense.

Wouldn't you say that LA is implementing actions they can enforce? What other enforceable actions do they have in their toolkit? They might be able to do more with masks and social distancing but there is not much low hanging fruit there. The most effective would be quarantining people in their homes and hotels, but they haven't really shown the capacity or will to do that.

[chrisk]

[tweet]https://twitter.com/Elex_Michaelson/status/1331652384695623680?s=20[/tweet]

Is shutting down outdoor dining overkill?  I think opponents of the lockdowns are right to be frustrated given the lack of transparency into the decision-making.  Note I am not reflexively anti-restrictions.  If there is a good rationale for limiting certain activities based on data, we should definitely limit them.  And if the LA County health commissioner showed that limiting outdoor dining (or for Lex, limiting alcohol sales) is necessary because of spread through this mechanism, then by all means limit them.

BC

But the LA County Health Director made no such showing.  Indeed, it was admitted that they did not have scientific backing.  As for banning post  5PM sales of alcohol (not just in restaurants,but in liquor stores- please.  That is an absurdity.

The problem, BC,  is the more that these restrictions appear arbitrary the less people will abide by them. 

 Look at the numbers in LA County by demographics and it’s pretty clear the spread is not emanating from outdoor restaurants. 

  Frankly it’s not that I care that much about shutting the restaurants down ( except for the substantial harm it does to the people who work there). It’s that it appears arbitrary. If you have the data to support the move -  then show it. If you do not have such data – then why are you making the move. 

 The county approach also has been somewhat “interesting“. The difference between Santa Clara county and San Mateo County has been quite telling. As I indicated a while ago - until very recently there was a period where I could drive about a mile to cross the county line and eat indoors in Menlo Park. Couldn’t do that in Palo Alto you could only eat outdoors. Please tell me how that makes any sense.

Wouldn't you say that LA is implementing actions they can enforce? What other enforceable actions do they have in their toolkit? They might be able to do more with masks and social distancing but there is not much low hanging fruit there. The most effective would be quarantining people in their homes and hotels, but they haven't really shown the capacity or will to do that.

[Goose]

Wouldn't you say that LA is implementing actions they can enforce?  What other enforceable actions do they have in their toolkit?  They might be able to do more with masks and social distancing but there is not much low hanging fruit there.  The most effective would be quarantining people in their homes and hotels, but they haven't really shown the capacity or will to do that.

I would agree they are grasping at straws (what they can enforce) but I would also say that is a bad idea if it isn't going to help much. It demonstrates to the public that the County Health Officer will ask them to do "stupid" things, and that is a very bad message. You need to trust those people, and things like this destroy trust.

You are certainly correct that they are unwilling to quarantine/isolate people. The sad thing is that they don't need to quarantine/isolate everybody. If they would just do that with the people who test positive or are exposed that would help a lot.

[Goose]

Wouldn't you say that LA is implementing actions they can enforce?  What other enforceable actions do they have in their toolkit?  They might be able to do more with masks and social distancing but there is not much low hanging fruit there.  The most effective would be quarantining people in their homes and hotels, but they haven't really shown the capacity or will to do that.

I would agree they are grasping at straws (what they can enforce) but I would also say that is a bad idea if it isn't going to help much. It demonstrates to the public that the County Health Officer will ask them to do "stupid" things, and that is a very bad message. You need to trust those people, and things like this destroy trust.

You are certainly correct that they are unwilling to quarantine/isolate people. The sad thing is that they don't need to quarantine/isolate everybody. If they would just do that with the people who test positive or are exposed that would help a lot.

[M T]

Do we have evidence that excludes outdoor restaurants from being a contributor to spread?

The evidence quoted in
   https://www.cdc.gov/mmwr/volumes/69/wr/m...mm6936a5_w
(brought to our attention by BC)
resulted in the conclusion "Adults with positive SARS-CoV-2 test results were approximately twice as likely to have reported dining at a restaurant than were those with negative SARS-CoV-2 test results."
applied to indoor, patio, and outdoor seating at restaurants.  I know we BELIEVE that this must be from the indoor seating and not the outdoor seating, but has that been tested?  

As measured in that study, the study supports closing all restaurants (indoor & outdoor).   Otherwise, one could argue something like "Well, it hasn't been measured but I believe the effect only applies if you aren't eating spicy foods. So don't close spicy food restaurants."

I feel that if we added up all the statements "It hasn't been shown that ...[athletics, food, school, ...] contributes much to COVID spread", we would no longer have an epidemic.

[M T]

Do we have evidence that excludes outdoor restaurants from being a contributor to spread?

The evidence quoted in
   https://www.cdc.gov/mmwr/volumes/69/wr/m...mm6936a5_w
(brought to our attention by BC)
resulted in the conclusion "Adults with positive SARS-CoV-2 test results were approximately twice as likely to have reported dining at a restaurant than were those with negative SARS-CoV-2 test results."
applied to indoor, patio, and outdoor seating at restaurants.  I know we BELIEVE that this must be from the indoor seating and not the outdoor seating, but has that been tested?  

As measured in that study, the study supports closing all restaurants (indoor & outdoor).   Otherwise, one could argue something like "Well, it hasn't been measured but I believe the effect only applies if you aren't eating spicy foods. So don't close spicy food restaurants."

I feel that if we added up all the statements "It hasn't been shown that ...[athletics, food, school, ...] contributes much to COVID spread", we would no longer have an epidemic.

[fullmetal]

I'm sure any individual's risk of contracting covid in an outdoor dining setting would generally be low, but LA county is...special.  Special to the tune of more than 10.4 million people, and what works for individuals doesn't scale to 10.4 million people when it comes to public health.  

Outdoor dining isn't just people sitting at tables, distanced.  It's also the cooks in the back of house, working in close, unventilated quarters.  It's the waitstaff spending time indoors near each other between tables.  It's the cleaning staff rushing to get everything cleaned and potentially cutting corners as they go from job to job.  Your essential economy workers have a much higher risk of contracting covid and spreading it to those around them (not only do they work closely with others, but they may have multiple people in their household who are working too -- because service industry jobs don't always pay enough to allow for a single-person residence).

If we are not the praying type, I think it still might be worth a thought to providence, hoping that this Thanksgiving won't be as bad as the airline flight number hint.  Your healthcare workers would appreciate it.

[fullmetal]

I'm sure any individual's risk of contracting covid in an outdoor dining setting would generally be low, but LA county is...special.  Special to the tune of more than 10.4 million people, and what works for individuals doesn't scale to 10.4 million people when it comes to public health.  

Outdoor dining isn't just people sitting at tables, distanced.  It's also the cooks in the back of house, working in close, unventilated quarters.  It's the waitstaff spending time indoors near each other between tables.  It's the cleaning staff rushing to get everything cleaned and potentially cutting corners as they go from job to job.  Your essential economy workers have a much higher risk of contracting covid and spreading it to those around them (not only do they work closely with others, but they may have multiple people in their household who are working too -- because service industry jobs don't always pay enough to allow for a single-person residence).

If we are not the praying type, I think it still might be worth a thought to providence, hoping that this Thanksgiving won't be as bad as the airline flight number hint.  Your healthcare workers would appreciate it.