20200629

Mon Jun 29 06:00:01 EDT 2020 ======================================== Slept poorly from midnight to seven. Sunny. Highs in the mid 80s. Northeast winds up to 5 mph. Work ---------------------------------------- - Test lockbox Done. - Give Jamie and Julie access to Gary's mail Done. - Order two printers to KW Done. - Update Entrata ticket with new schedule Done. - 2 PM weekly Fifth Third call Done. - Create phase 3 users in Entrata production and test Done. - Start configuring field laptops No. Fifteen-minute walk at lunch. Warm and sunny. Home ---------------------------------------- - Go to bed not late https://www.newyorker.com/news/q-and-a/what-activities-are-safe-as-the-coronavirus-continues-to-spread > What we don’t know yet is which parts of that we can relax while still maintaining transmission at an acceptable level. Probably that’s because different people have different ideas about what’s acceptable, and partly that’s because we haven’t done the relaxation in places that really had it under control—and we especially haven’t done that in the winter. > I think the question is, How much can we restore society to a minimal level of functioning while still controlling the virus? Is there an overlap between acceptable viral control and acceptable social functioning? I think that depends a lot on the location, because both concepts of acceptability are social constructs, but I think it’s going to be particularly challenging in a place like the U.S., which seems to have some of the least tolerance of any place in the world for the pain brought by the lockdowns. > I think we’re missing a second opportunity. In those places where it’s not a crisis right now, which is most of the United States, we should be, again, using the time to actively prepare for the eventuality of having our health-care system overwhelmed and also trying to prevent it. Even this morning, there was news from Florida that the governor is trying to change the reporting of intensive-care beds, and that in a state that’s been one of the worst states for reporting clearly what the data show throughout the epidemic. You know, this is a crisis where good data is essential, and playing around with the way that you report data to try to make things look better is exactly the opposite of what we need. I think that, at some state levels, there are a lot of missed opportunities to be gearing up rather than gearing down. We’re missing the second opportunity. It’s not just the history. > In New York City, for example, they’ve been the first that I’m aware of to publish their data on contact tracing, and they got panned in the press for doing it, but they responded to that by publishing more and trying to get more people to look at the data. My understanding is that there’s a clear awareness within state governments like Massachusetts and New York that things could get really bad again, and that plans are being made for how to deal with that and try to avoid some of the difficulties from the first round. It’s treating this as an ongoing threat where, like with insurance, you hope you don’t use it, but you put some money and some time into it because you want to be in a better position should things get bad. Also, the reopening is being targeted to specific metrics of improvements in the COVID-19 burden, and is being done fairly gradually. That’s really different from a lot of other states. > It feels from what I read about Texas that the same thing is happening, that this is a New York problem and a Louisiana problem, not something that’s going to hit us. The problem with that type of thinking—apart from being relatively unimaginative—is that our control levers have delayed impact. In our analysis of the Wuhan data, the peak demand for intensive care was reached a month after the lockdown. I’m not sure I could explain the full month, but perhaps one part of a week was explained by the fact that people kept getting infected for a little while after the lockdown. Another probably two weeks could be explained by the fact that most people don’t get sick quickly after infection, but take a long time to need intensive care, maybe a week and a half or two weeks. Then how long you stay in intensive care also contributes, because the burden on the intensive-care unit is the number of people coming in per day times the amount of time they stay there. It took a whole month before the number of beds being occupied in intensive care came down after the lockdown. > I think the initial success in Singapore and some other parts of East Asia were a little bit of a surprise. Given what we know about this virus’s natural history, I’m surprised that the sort of case-based interventions of testing and tracing without lockdown or significant containment activity worked for as long as it did. I think I would have said that it would fall apart sooner than it did. It did fall apart eventually. But it didn’t fail until quite a while later, and it failed not in general but because there was a particular subpopulation that was being ignored, essentially, and left in very high transmission conditions: the migrant workers. > We are interacting with people outdoors at distance without masks as a family. We’re trying not to have any contact with strangers that’s up close and unmasked. I think that zero risk does not exist. Going to the grocery store with a mask is a necessity, or a near-necessity, and that has some risks; and being outside means you could catch a wayward virus from someone on an air current. That’s certainly not zero risk. But I think the data on large outbreaks suggests that the risk is considerably higher inside. We’re trying to balance having a little bit of social contact with trying to keep our risk as low as possible. > I find it really hard to give an answer, because everything is risky and we don’t know exactly how risky each thing is. To my way of thinking, there are certain things we should expect every well intentioned person to do, which are to be masked when they’re in public indoors and likely to encounter other humans, to avoid close contact with people, when possible, and at the same time, to attend to the necessities of their life. > I think that what we’ve learned by understanding some of these super-spreading events, but also by carefully monitoring what’s happened to our health-care-worker population, is that by far the riskier interactions happen in densely packed indoor spaces, where there’s poor air circulation and where there are more surfaces that are coming in contact with multiple people. > We’ve learned more about surfaces, and the fact that this can stay around on metal or plastic for three days. And so it still probably makes sense to not climb all over the same playground structures, though that’s not where the majority of transmission has happened. The majority of transmission is happening in indoor, poorly ventilated environments commonly used by multiple people who are coming in and out. > I think bathrooms are a bit of a conundrum, especially around this wave of businesses reopening. But, also, I think one of the thorny challenges is schools reopening. Listen, it’s pretty clear that you can shed the coronavirus in stool and probably urine. And, in fact, there’s some community-monitoring epidemiological surveys that are monitoring the spread of the coronavirus in communities by testing sewer water. So we know that there’s theoretical transmission there. Plus it’s just that sort of enclosed space. > I’ll add two more things. In male bathrooms, there’s urinal proximity, which is incredibly close, and there’s sink proximity in all bathrooms. So that’s one issue. The second issue is the hand dryers. They totally circulate air particles in an enclosed space at high speeds, and that’s concerning as well. US tests / positive results (higher is better, ideally dozens): 24 20 20 17 18 18 19 17 16 13 15 14 14 14 15 (today) 3-day avg: 21 18 17 14 14 US new deaths: 375 → 713 → 782 → 695 → 650 → 630 → 297 → 285 → 775 → 722 → 2500 → 619 → 506 → 273 → 332 (today) 3-day avg: 623 658 452 1280 370 MI tests / positive results (higher is better, ideally dozens): 64 340 62 63 1 99 33 77 43 44 45 42 55 55 59 46 (today) 3-day avg: 155 54 51 44 56 46 MI new deaths: 1 → 17 → 2 → 25 → 6 → 20 → 3 → 7 → 12 → 5 → 19 → 1 → 19 → 5 → 3 (today) 3-day avg: 7 17 7 8 9 Oakland county new deaths: 2 → 1 → 1 → 3 → 3 → 1 → 1 → 1 → 1 → 1 → 1 → 1 → 1 → 1 → 1 (today) 3-day avg: 1 2 1 1 1 Beaumont 5/28: COVID-19 patients: 227; COVID-19 ICU patients: 70; all patients bed occupancy: 68% Beaumont 6/01: COVID-19 patients: 178; COVID-19 ICU patients: 70; all patients bed occupancy: 61% Beaumont 6/04: COVID-19 patients: 163; COVID-19 ICU patients: 67; all patients bed occupancy: 65% Beaumont 6/08: COVID-19 patients: 130; COVID-19 ICU patients: 54; all patients bed occupancy: 55% Beaumont 6/11: COVID-19 patients: 132; COVID-19 ICU patients: 64; all patients bed occupancy: 70% Beaumont 6/15: COVID-19 patients: 114; COVID-19 ICU patients: 59; all patients bed occupancy: 63% Beaumont 6/18: COVID-19 patients: 117; COVID-19 ICU patients: 57; all patients bed occupancy: 72% Beaumont 6/22: COVID-19 patients: 122; COVID-19 ICU patients: 56; all patients bed occupancy: 64% Beaumont 6/25: COVID-19 patients: 123; COVID-19 ICU patients: 51; all patients bed occupancy: 71% Beaumont 6/29: COVID-19 patients: 121; COVID-19 ICU patients: 49; all patients bed occupancy: 66% HCC Region 2 North 6/17: in critical 55, on ventilators 30, inpatients 91 HCC Region 2 North 6/18: in critical 44, on ventilators 23, inpatients 89 HCC Region 2 North 6/19: in critical 34, on ventilators 25, inpatients 89 HCC Region 2 North 6/22: in critical 41, on ventilators 37, inpatients 84 HCC Region 2 North 6/23: in critical 46, on ventilators 40, inpatients 95 HCC Region 2 North 6/24: in critical 52, on ventilators 38, inpatients 92 HCC Region 2 North 6/26: in critical 55, on ventilators 39, inpatients 84 HCC Region 2 North 6/29: in critical 44, on ventilators 32, inpatients 78 Servings: grains 1/6, fruit 1/4, vegetables 2/4, dairy 2/2, meat 2/3, nuts 0/0.5 Brunch: coffee Lunch: banana, egg and avocado wrap Dinner: egg with avocado and peppers -30

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