Why social distancing matters now more than ever
There is a lot of debate in this country about when the proper time to relax social distancing and work to re-open. Everyone agrees we have to re-open at some point but the discussions around when and how are filled with misinformation. An epidemiologist I know who has obviously been getting a lot of questions pulled this together to help simplify what the models are showing (he's a maryland fan, hence the turgeon reference). The tl;dr version is that social distancing is working but we need it for another few weeks to get to the optimal outcome from both a public health and economic perspective. I hope people find this informative as they think through the issue.
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Friends, we are beating COVID-19. We have the lead. We have the momentum. We can't let up. We're not a Turge team in the B1G Tournament. We can finish out this game.
Aggressive social distancing is just as important now as it has ever been. It is in our public health AND economic interest to do so. I have attached the following scientific figures* to show where we are, and where we might be headed.
*MS Paint drawings, inspired by real-life epidemiological models.
Figure 1 shows where we are. This is the "flattening the curve" graph we all became familiar with in mid-March. We have just started the downslope. Congrats y'all, the curve is flattened. The red line is dead.
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Figure 2 shows our immediate options, projecting out until roughly early fall.
1. We can fully re-open (gold line). This would kill just as many people as if we had never done anything at all, only a little faster this time around.
2. We can partially re-open (blue line). We can go to the barber and have restaurants and churches that are 25% full, and we can keep the number of cases just below national capacity as long as we can.
3. We can keep doing what we're doing now (green line), with aggressive distancing.
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Note that that the difference between #2 and #3 is tens of thousands of American lives. And a lot of those restaurants that barely turned a profit before went out of business when they had to go to 25% capacity.
Figure 3 shows the potential second wave in the fall and winter. Sorry, a vaccine probably won't swoop in and save us in time for college football season. Let's check in on our 3 options.
1. In the second half of 2020, we've killed people at roughly the same rate as the extermination phase of the Holocaust. Your barber was open up until the day before he died. (gold line)
2. Everyone's out of business because they couldn't operate at full capacity, AND several hundred thousand people are dead. (blue line)
3. We won the race. We implemented containment before the second wave hit. There are still some restrictions on large gatherings, but by and large, the economy is open, and we had a total of 100k-125k deaths in 2020. Prevalence has fallen to a level where we can do testing and tracing, and we contain local pockets of infection. (green line)
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The choice is pretty obvious to me. The option that is best for public health is also the one that is best for the economy. We have to bite the bullet for the next little while. We have to continue to socially distance as aggressively as ever, y'all.
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We can beat this thing. If you'd like to get deep in the weeds of some pretty advanced epidemiology, Figure 4 shows how aggressive social distancing at this stage can manipulate the coronavirus' transmission dynamics in such a way that we save both a whole bunch of lives and a whole bunch of jobs.
Fear is the best way to control people.
Social distancing leads to weak immune systems and more sickness. People need to interact with each other's bacteria and viruses to have a strong immune system. Social distancing and masks lead to weak immune systems and a second wave. Watch what happens.
Nonsense in regards to Covid-19. Please list your credentials or link to scientific studies suggesting this will cause a 2nd wave.
I don't think anyone is suggesting social distancing for the rest of our lives. There's plenty of time to give our immune systems some exercise when we don't have a novel virus running around. There's a pandemic right now. That's a temporary thing.
Nope, just "until there's a vaccine," which apparently can be conjured out of thin air as long as there's a project plan with a Gantt chart handy.
Hell, we don't even need to wait for a vaccine. A bunch of countries have pummeled this thing into submission with lockdowns and distancing and they're starting to open up with responsible measures (masks, distancing, etc). Our cases are rising if you exclude NYC.
Well, many other countries ::cough::SouthKorea::cough:: are back to mostly normal, and they never shut down like we have.
What we are doing is a necessary response to a failed initial response.
Might want to look at Singapore, great initial response, but then not so much. South Korea did not respond well to SARS and learned not what to do
Singapore is still doing fine. It exploded within the migrant worker dormitories because they sleep like 15-20 to a room and get treated like shit but Singapore's testing is also catching a lot of the cases that are slipping through the cracks in other places. That is why looking at total positives isn't super helpful. If you look at mortality rate per capita and hospitilization rate Singapore is still handling it well
But if we are looking at hospitalization rate, the US is actually doing just fine as well. I think that's the point many are making: We were told that if we did not lock down to a certain degree (honestly, much more strict than just about anywhere actually did), our hospitals would be overrun.
The models had dates where each state would peak, almost every prediction far above their capacity (your scary steep mountain). I guess it got to close happening in SE Detroit, NYC and maybe a hospital in New Jersey? But that was before we had a good idea of what we were dealing with.
Meanwhile states that never locked down or locked down late aren't in the dire straits they were predicted to be in. Florida was supposed to be the next hot spot. South Dakota's governor was criticized by New York writers who gleefully wrote about their outbreak in a meatpacking facility (curiously, not much was said about New York's subway system running unclean for the last few months), but they've already flattened that outbreak.
I would argue our death rate stems from our widespread response instead of a surgical response. We failed to protect the elderly and that is where people are dying: In their apartments because they live with their kids who are locked in with them at home and infected them, in nursing homes, etc.
If you take out places like San Marino and focus on just larger more developed nations the US has the 10th worst per capita death rate in the world, we are pretty far from doing fine in that regards. The US is at 226 deaths per 1 million, Singapore is at 3 despite almost the entire country being as dense as the New York metropolitan area. Its not really comparable levels of success.
I am looking at it from the perspective of failed opportunities to hit this the right way, earlier.
All this discussion about all this is infuriating—if this was handled the right way from the beginning, we would not be here, debating effectiveness of lockdowns and hospitalization rates being “just fine”.
Cluster. Fark.
And, your comment about NY writers being ‘gleeful’ is BS. Nobody is gleeful about any human suffering.
That's all hindsight and we have no idea how much of that is luck.
It will never be admitted, but on this board, in the media and on social media, there has definitely been a certain...eagerness...to declare a "red" area the next hot spot.
I've seen it in regard to Liberty University, Florida, the Villages, South Dakota, "rural" areas.
There is a reason there is so much negative focus on Georgia opening up and not Colorado.
Decided to look into this for Maryland. Based on deaths per million, MD is at 250 which is 9th in country (10th if you count DC). It is above the national average of 230
MD currently has 1311 ICU beds
https://www.arcgis.com/apps/opsdashboard/index.html#/8c4dcccd9e3845eb89f6401f919007f2
This appears to be a slight increase to address Potential Covid demand. As this article suggests a historic number of 1200
Current ICU beds for Covid patients is 584. That looks pretty good, but presumably some ICU beds are being used for other purposes.
https://coronavirus.maryland.gov/
Estimate of ICU beds for other purposes. From the linked, average US ICU capacity is about 63% and could be halved (presumably by postponing “elective surgeries”?).
Assuming 31.5% capacity for non-covid (using the non-expanded capacity of 1200), that is another 378 ICU beds for a total of 962 beds or 73.4% capacity. A few things of note:
1. If the estimate for non-covid beds is right, MD would be overcapacity if not for whatever measures were required to reduce typical ICU capacity even with the expanded capacity.
2. ICU covid use peaked on 4/30 at 590 beds. It has largely leveled off, but we are not seeing a big drop.
3. ICU for covid use rose most dramatically from 3/26 (40 beds) to 4/14 (448 beds) presumably before stay at home orders had an impact and growth slowed, then plateaued.
This makes it fairly apparent why MD would be cautious about opening. A growth like the one seen between 3/26 and 4/14 would mean ICU beds close to or at capacity. Maryland has allowed resumption of elective surgeries, which seems consistent with a prioritized/staged opening and an indication that ICU bed need for Covid-19 has plateaued at below full capacity.
Obviously there are a few key assumptions in my back of the envelope analysis that could be wrong and this only applies to Maryland, a fairly hard hit state.
I would argue that what we are doing is NOT a necessary response.
If vaccines are the answer, how come every year I get a flu shot, and still get the flu?
This is a joke, right?
That's because Bill Gates changes the code every year silly.
Considering they are already starting testing on 3-4 different vaccines, I guess they don't need to be " conjured out of thin air".
Do you realize what percentage of drug trials fail?
I'm hopeful that there will be a vaccine, but it's ridiculous to expect that there will be one, or to put forth a timeline as though research follows a calendar. (And the timeline that I'm hearing -- 12-18 months away -- would be the fastest vaccine ever developed).
Vaccines are significantly different than most therapeutic drugs.
The most dangerous vaccine we've ever used widely (smallpox) had about the same fatality rate as Tylenol.
Good to see that Dwight Schrute is posting again
Did you honestly read the Dr's full presentation, including following each colored line in the slides?
If so Dr. Western, which medical specialty is your degree in, to instantly refute everything an epidemiologist had just presented?
Fair question
I down voted your post but didn't feel as though that was enough.
1. Everything in your post is incorrect.
2. Specifically, if there is a second wave (as anticipated) it will most certainly NOT be because masks and social distancing has caused everyone's immune systems to wither.
Please, please consider what sort of information you spread about this. There are reasonable, science based discussions to be had about the current situation. Your rando hypothesis based on how you feel detracts from helpful discourse. Sorry this sounds like it's coming from a soapbox, but facts matter and your opinions are not the same as facts.
Cheers,
BS Microbiology, MPH Hospital and Molecular Epidemiology, MD
Fruits and goats are now testing positive for cerveza. Tests are a joke.
You're either an epic troll (in which case, excellent work) or a QAnon moron. Not sure .....
1) No tests are perfect - they ALL exhibit type I and type II errors.
2) Specificity vs. Sensitivity is often a trade off
3) Contaminated samples are a thing.
Heck - mammograms have about a 20% false positive rate in young women...
Congrats on being a moron. Listening to Laura Ingraham for your medical info will do that.
Social distancing doesn't keep you from going out and crawling in the dirt and sucking up immunity
Fantastic write up. I am #NotDyingForWallStreet. Stay home!
Oh, good God.
Do you think the 33 million people who have filed for unemployment are all investment bankers?
You can get a job again in the future when you get laid off. Dying is sort of a permanent outcome. There exist economic models for when the economic costs of the shutdown outweigh the benefits of lives saved. No economists are arguing to open up because we haven't hit that point yet.
Hey AK -
Thanks for all of the info. What are your feelings about daycare? Should I be taking my kids to daycare or try to somehow continue to work and take care of them at home?
@Ak47 - the editorial board at the WSJ suggests otherwise.
https://www.wsj.com/articles/rethinking-the-coronavirus-shutdown-11584659154
How about you crawl under your bed where it is safe and let the rest of the world get back to it?
Your desire for physical safety is then not at all impacted by the economic choices others want to exercise.
If you're younger than 60, you're not dying no matter what we do. But you will never be able to retire if we continue to lockdown for the rest of the year.
Expect an additional 14,000 suicides in the U.S. during recessions compared to economic expansions. That is just suicides and does not include lack of healthcare due to closed clinics, hospitals, or other things that diminish for lack of funds.
Anybody can put together a graph, with no axes, in MSPaint. Color me unimpressed.
I have seen no evidence that we are anywhere near healthcare capacity except in limited pockets of the country. Your graph looks very different if "fully reopen" stays below the capacity line.
We didn't go over healthcare capacity because of social distancing. We completely shut down the country and 74,000 people have died in 8 weeks but sure if we had done absolutely nothing I'm sure that would have had no impact, makes sense.
My role at work provides an inside look at the realities of the Gov’t situation, the healthcare industry, and many other market sectors. With 100% confidence I can tell you the healthcare system involved with caring for pandemic and flu like illness is still stretched pretty thin.
Just because people have heard about some doctors and nurses involved in primarily elective fields being laid off, does not mean the healthcare system is not stretched thin addressing pandemic and flu like illnesses. It would be like saying a football team has great depth at QB because after the starter and back up there are still 83 other guys who could play QB on the team.
Excellent analogy. I have used an example of a mall. Hospitals are like malls with a lot of different store providing different products: candle shops, shoe stores, electronics, big box stores. Right now, one store has really high demand and lines out the door but the other stores have very little demand and are boarding up. People are being laid off, the the mall is losing a lot of money but that one store is still being overrun and people are perilously close to not getting what they need in time from that store because of capacity issues for that one specific product/service.
J: I agree as usual. All of this is agenda driven. There are those who want to ruin the economy so as to gain power both national and locally then rebuild America in their view.
With 75,000 deaths in two months this is one terribly potent "agenda".
Among those are cancer patients dying under COVID. Some numbers DO LIE!
You are so, so ignorant it's just... I don't know. It's something.
We have a whole lot of excess deaths over and above the annual average the past several years, that are NOT attributed to Covid-19. What is your inane response to that?
As to your fuckwit comments about "this being agenda driven" to hurt Dear Leader... okay. Now what about the rest of the world? Are they sabotaging their own economies and killing thousands of their citizens to hurt your precious?
You are a painfully stupid person. I hope you don't have kids, but I'm sure that's too much to ask. Seriously. You are dumb. You have zero critical thinking. Fucking sheep. Baaaaaaaa. Muh rights. Baaaaaaa. But her emails. Baaaaaaa
This part isn't to you, runner, though it's definitely about you.
I sincerely can't believe how dumb the average person really is. Until recently, it wasn't readily apparent just how fucking stupid people were. Social media, and this current political clusterfuck we're going through have brought it into crystal focus.
Mrunner, this is the type of sad, sick, cynical view of dealing with a pandemic that was being lambasted in Brian's post yesterday. Politicizing the virus response (or accusing any approach that isn't directly from trump's mouth as politically motivated).
My response, then and now:
If the Obama administration was treating the response to this as cavalierly as this administration is (from "hoax" to "exaggerated" to "try some unproven drugs" to "maybe an injection of disinfectant?") the same armed ppl marching to protest social distancing & masks today would be marching to demand we implement them if Obama was president!
Your views of the seriousness of the virus, how best to prevent its spread, indeed if we should do anything at all, are COMPLETELY born of the political slant you brought with you to the pandemic!
So, accuse others of the same if you wish, but you ain't fooling anybody but yourself!
Yes, this is true; in your universe. Not mine. Know that our nation is very divided, almost 50/50. We should agree on that.
If I were Trump's #1 advisor, I would have told him to name Obama as the head of the task force. The media loves him and he can do no wrong-again in your universe.
I do take this virus seriously but a debate will rage on for years to come if we overreacted or not. Was the cure worse than the disease?
1. You say "true" but not in your universe. You weren't clear what specifically you meant, but true is true. You're talking spin.
2. Our nation is certainly divided, but not nearly 50/50. Thanks to a system put in place to assuage slave-owning states to sign onto the Constitution, a candidate who received 3mill fewer votes in aggregate won by securing 70K more votes, spread across just 3 states. That's the Constitution at work, but does not imply a 50/50 split in public opinion, not even close.
3. Trump would NEVER appoint anyone who took attention away from himself (his #1 advisor du jour knows this better than most), and even if he did he wouldn't listen to them anyway, which would only lionize Obama & lessen trump more.
4. You overestimate the attention span of this citizenry! Due to economic reasons, states - even liberal ones - are going to start returning to degrees of normalcy.
California re-opens retail tomorrow (albeit with masks & curbside delivery). It won't be much longer, unless that's a total disaster, until we are going about our business.
If the $EC opens its schools and plays football, as they're saying they will, would the B1G have the backbone not to? Doubt it
Have you seriously not seen anybody ardently support the lockdown and then in the next breath assert that the lockdown is proof we need UBI and socialist healthcare?
If not, they're around. Mad Hatter is one of them. These people are rooting for a longer lockdown because they're hoping it will necessitate an expansion of socialism. To them, the economic damage is not a problem of the lockdown, it's a feature.
What point would we actually be able to get to "test and trace"? 10,000 cases a day? 5,000? 2,000?
And if so, how long would that be with a current average of ~24500 over the last few days? A month? Two months?