20200415

Wed Apr 15 06:00:01 EDT 2020 ======================================== Slept from eleven to seven. Woke briefly around four. Slight chance of snow showers early in the morning, then slight chance of light freezing rain in the morning. Snow showers until early evening. Accumulations up to half an inch. Highs in the upper 30s. West winds 5 to 10 mph. Chance of precipitation near 100 percent. Work ---------------------------------------- - Patch Tuesday Done. - 1 PM Entrata call (Remember to lunch at noon!) Call postponed. - Schedule call with Sarah for thin client setup No. - More Entrata PO approval routing Done. Snow. It's seriously snowing on April 15. Didn't feel up to braving the snow, so I paced around the apartment like a caged animal for fifteen minutes. Wow, the snow's actually accumulating in a thin layer on roofs and branches. It snowed for hours today. Home ---------------------------------------- Vacuumed. https://www.theatlantic.com/health/archive/2020/04/pandemic-summer-coronavirus-reopening-back-normal/609940/ > When restrictions relax, as they are set to do on April 30, the coronavirus will likely surge back, as it is now doing in Singapore, China, Hong Kong, Taiwan, and other Asian states that had briefly restrained it. > … one group of health experts, led by Ezekiel Emanuel, an oncologist and former adviser to the Obama administration, argues that stay-at-home orders must continue until at least May 20. Another team, led by Scott Gottlieb, a former FDA commissioner, suggests that states should relax their restrictions only after new case counts have fallen for 14 consecutive days. Currently, the U.S. is still averaging about 30,000 new confirmed cases every day. > … before relaxing the guidelines on social distancing the U.S. urgently needs to expand its ability to test for the virus, and to shore up hospitals with sufficient supplies. > But as testing capacity has grown, so has the pandemic. As my colleagues Robinson Meyer and Alexis Madrigal have reported, private labs have taken on more orders than they can fulfill, and are experiencing huge backlogs. > Compounding these issues, testing companies all rely on the same chemical ingredients, which were already running low and are becoming even scarcer as the pandemic spreads. > For the summer, the U.S. might have to abandon the dream that “everyone who gets sick is going to get a test and we’ll be able to count every case with a lab diagnosis,” > Crucial medical drugs are also running out. According to a University of Minnesota analysis, about 40 percent of the 156 drugs that are essential parts of critical care are becoming limited. Many of these depend on supply chains that involve China (where the pandemic began), Italy (the hardest-hit region in Europe), or India (which halted several exports). These chains have been discharging their contents like a sputtering garden hose that has now begun to run dry. “The medium term is going to be particularly perilous,” said Nada Sanders, a professor of supply-chain management at Northeastern University. “Global demand is so high, and supply is so far behind, that it’s very hard to envision enough of a ramp-up.” > There aren’t enough masks and gowns to adequately protect staff, ventilators to deliver oxygen to patients who can’t breathe, or respiratory technicians and nurses to operate those ventilators. Overwhelmed and underprotected, doctors and nurses are falling sick. > The most crucial piece of missing information, and the one that most dramatically shapes the nation’s options, is what proportion of people have actually been infected. So far, the U.S. has more than 576,000 confirmed cases. But between the lack of testing and the unknown proportion of people who experience mild or nonexistent symptoms, the true number of cases is anyone’s guess. > Tracking such a pathogen requires a lot of people, but due to chronic underfunding, local U.S. health departments lost more than 55,000 workers from 2008 to 2017. In their absence, a corps of volunteers could be quickly trained in the basics of contact tracing, as Massachusetts Governor Charlie Baker is planning to do. > If there aren’t enough tests, as seems likely in the near term, health officials could focus their attention on looking for spikes in flu-like symptoms, or for less orthodox indicators such as crowded hospital parking lots and restaurant cancellations. > Now that the U.S. is slowing the pandemic, gently easing back on social distancing would be safer, Morris argues, than snapping back to business as usual when small missteps could be catastrophic. “If we’re judicious about how we lift restrictions, we might never have to go back into lockdown,” he said. > Stay-at-home orders might lift first, allowing friends and family to reunite. Small businesses could reopen with limitations: Offices might run on shifts and still rely heavily on teleworking, while restaurants and bars could create more space between tables. Schools could restart once researchers determine if children actually spread the virus. > This process might take several weeks to unfold, and even at the end of it, none of the experts I spoke with was comfortable with the return of crowded public spaces. Gottlieb’s road map, for example, recommends that until a vaccine or an effective treatment is produced, social gatherings should be limited to 50 people or fewer. That will be especially challenging in large cities: An average Manhattan street or subway car is the equivalent of a mass gathering. > First, antibodies aren’t always effective at neutralizing viruses. If you picture the coronavirus as a car, an antibody might slash its tires, or just gum up its wipers—and simple serology tests can’t tell which. Second, even if the antibodies are the right kind, no one knows what concentration you’d need to confer immunity. “Even for diseases we’ve been studying for over 100 years, like whooping cough, we still don’t know what level of antibody would indicate that you’d be protected if you got reexposed,” said Sam Scarpino of Northeastern University, who studies infectious-disease dynamics. The only way to find out is through long studies. > Third, serological tests for the new coronavirus could be deeply misleading for individuals. Consider the test produced by Cellex—the only one thus far with emergency use authorization from the FDA. The test has a 93.8 percent chance of correctly identifying people with antibodies against the new coronavirus, and a 95.6 percent chance of correctly identifying people who lack those antibodies. Those numbers sound great, but if only a minority of Americans have been infected, the test would return far more false positives than true ones. Put it this way: If you have a positive result, the odds that you actually have any relevant antibodies are roughly one in two if 5 percent of the U.S. has been infected, and just one in six if only 1 percent has been infected. Scientists can correct for these errors if they use serological tests to assess immunity in a population, but it’s much harder on a person-by-person basis. > These problems might be surmountable. The U.S. is still a scientific and biomedical powerhouse. To marshal that power, it needs a massive, coordinated, government-led initiative to find the cleverest ways of controlling COVID-19—a modern-day Apollo program. No such program is afoot. Former Trump- and Obama-era officials have published detailed plans. Elizabeth Warren is on her third iteration. But the White House either has no strategy or has chosen not to disclose it. > That responsibility would typically fall to the Centers for Disease Control and Prevention, but it has been strangely silent. For almost a month, the CDC’s leaders have been absent from press briefings, and its supporters fear that its reputation has been tarnished. Local leaders are making hundreds of public-health decisions—should we close this park, or open that beach?—without consulting the nation’s top public-health agency. Jha said he regularly fields calls from mayors and governors who would normally ring the CDC. “People don’t know where to turn to for expertise,” he said. > In 2018, when writing about whether the U.S. was ready for the next pandemic, I noted that the country was trapped in a cycle of panic and neglect. It rises to meet each new disease, but then settles into complacency once the threat is over. With COVID-19, I fear that the U.S. might enter the neglect phase before the panic part is even finished. If the current shutdown succeeds in flattening the curve, sparing the health-care system and minimizing deaths, it will feel like an overreaction. Contrarians will use the diminished body count to argue that the panic was needless and that the public was misled. Some are already saying that. > Over the coming months, we need “to normalize COVID in the public psyche, and reinforce that this will be a part of our day-to-day lives,” said Kissler, the Harvard disease modeler. “Many people I've spoken with are aghast at the thought. We thirst for a swift and decisive 'victory.' But I'm reminded of images from World War II as people in London walked to work, briefcases in hand, against a backdrop of bombed-out buildings. I think we are in store for a similar period in history, as we learn to make greater peace with the world's chaos and our own mortality.” The Atlantic has been killing it with their coronavirus coverage. Maybe I should subscribe. The thing about the low accuracy of antibody tests matches an NPR piece I heard this morning. Current antibody tests are diagnostic at a population level but not for individuals. https://twitter.com/dylanhmorris/status/1249443687484010498 > The virus decays exponentially: every hour makes you safer, but the biggest changes happen in the first few hours. Nine days might be right for plastics, but there are a lot of variables and some unknowns. https://plato.stanford.edu/entries/happiness/ > There are roughly two philosophical literatures on “happiness,” each corresponding to a different sense of the term. One uses ‘happiness’ as a value term, roughly synonymous with well-being or flourishing. The other body of work uses the word as a purely descriptive psychological term, akin to ‘depression’ or ‘tranquility’ What does happiness mean to me? First, in the moment, having a mostly positive experience such that I'm not preoccupied by wishing the current circumstances were different. Second, having produced something with some value, a thing I can point to at the end of a day to prove I didn't fritter away my hours entirely emptily. But that's just a first stab. Jake called. We chatted for a half hour. He and his family are well. Slightly better numbers than yesterday, but when are we going to see a real leveling-off or decline?? Michigan COVID-19 cases: 1058 new; 28059 total Deaths: 153 new; 1921 total Total MI tests: ??? Michigan's rate of increase: 115% → 118% → 112% → 110% → 110% → 110% → 107% → 106% → 106% → 105% → 103% → 104% → 105% → %104 (today) MI recovered (4/10/2020): 433 Oakland country: 5576 cases; 392 deaths Oakland country ranked #22 (#21 yesterday) globally. Oakland county new cases: 214 → 281 → 276 → 191 → 345 → 356 → 271 → 240 → 264 → 291 → 113 → 158 → 291 → 212 (today) U.S. new tests: 146,614 Servings: grains 5/6, fruit 1/4, vegetables 3/4, dairy 1/2, meat 3/3, nuts 0/0.5 Brunch: egg and cheese wrap, cucumber, orange, coffee Lunch: ramen with diced tomato and onion Afternoon snack: Dinner: chicken and rice, popcorn -30 118/70

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