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Covid Pandemic Plan 2.0, What's next

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As complicated as things have been they're only going to get more complicated as we try to figure out to move out of hiding and somehow live with Covid-19.  So what's next?  Do we keep our current plan until it goes away?  That could be years and potentially longer depending how long an infection imparts immunity for.  

Obviously an effective vaccine would negate the need for any plan, although at the earliest that would be about a year away, and while there are claims of potential vaccines, it should be noted that despite trying for decades we have never successfully created a vaccine for any coronavirus strain, although there is certainly more incentive now than in the past.  

At this point there are certainly parts of the US where they can't cope with a rate of infection higher than what they already have, but much if not most of the US is ready for more cases than they are seeing.  Particularly since I think we've been over-hospitalizing these patients, early on we didn't know what patients would and wouldn't benefit from acute care in a hospital, now we have a better idea of who can benefit and it's a much smaller group than we were initially hospitalizing.  Most patients that will survive Covid will do so without any medical help, and most who die will die with or without aggressive treatment, it's that relatively small group in the middle that will take up hospital beds.

So I would argue we go ahead and get life going again, this will result in more infections, and more deaths, but I think it's unlikely these folks won't get it or wont' die from it eventually even if we stay on our current track.  

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I agree that we need to get things going again, but using a slow rollout, with more testing and contact investigation, and the ability to slow things down so that ICUs aren't overwhelmed. I think that PPE will still most likely be needed in the workplace with social distancing. And I think that a lot of work can continue to be done remotely. 

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I've been training my whole life to avoid crowds, so I'm fine with keeping social distancing something that's encouraged rather than being viewed as a personality flaw.

I'm an ICU nurse who's been caring for COVID-19 patients since February, and one thing we've found is that most of these patients don't benefit from ICU care.  We got slammed at first, mainly with 80+ year olds with multiple comorbidities, which we've learned don't belong in the ICU, they are more appropriately treated in a palliative care setting.  So I don't think that with what we know now that we need to be as concerned with overwhelming ICUs.  

PPE and testing are still certainly issues that need to be resolved no matter how we move forward.  No plans works well without both of those resources.

I'm not real keen on contact tracing for Covid-19, that sort of things works great for Ebola and even the 2009 SARS, but based on it's transmission characteristics I don't think it serves much purpose for Covid.  Probably the best case study on the usefulness of contact tracing came out of the first Seattle area case for which there was fairly extensive genetic analysis done, maybe the most interesting thing was that in the time the patient likely spread the virus prior to becoming symptomatic was that there was little rhyme or reason to who contracted it from him (more likely through multiple intermediary vectors).  And even if we know who was in a grocery store at the same time as someone who turned out to be positive, it wouldn't make sense to apply a different set of rules than what we're already moving to for exposed healthcare workers which is to continue to work but to monitor for symptoms.  So basically, we can skip the contact tracing and just tell everyone to monitor for symptoms all the time.  

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I agree with everything that has been said so far.  I think mass crowds are out for awhile until their is an effective vaccine and or treatment.  Big concerts and sporting events I think are out for the summer for sure.

I'd love to see wide scale antibody testing.  Maybe wishful thinking, but I'm hoping we are better off then what we think.

I often wonder how much mitigation could have been effective with people being mindful of simple measures like masks, hand washing, staying home when sick, etc vs what has happened.

At the same time, I realize it probably took drastic measures to get so many people to comply with the simple measures.  Hopefully, as we reopen things people will be mindful of and continue those simple things to mitigate this viral disease.

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I like the approach that when an area is shown to be on the downswing to continue social distancing in places where large gatherings occur such as concerts, churches, etc.  But allow smaller businesses and restaurants open and coffee shops, some small manufacturing businesses.

People have gotten their stimulus checks and I hear places like Walmart and Sam's are having long lines to get in.  This is good but doesn't help the little guy.

We can't wait until it's zero.  I'm one of the rare liberals I know that want sooner rather than later.

I also favor letting younger healthier people out first and ask those at higher risk for death to stay in.  99% of the cases in Italy have a co-morbity.  It's something like 94% here but the 30 year old that's an outlier that dies will make headline news and the 19,990 others don't because their older or have other things wrong with them.

I'm also for testing and testing for aytibiodies as well.  Knowledge is power.  Here the rate of infection vs. testing is in the area of 10 to 11%.  Sadly 900 to 1000 new cases a day....but still that's flat.  We're looking at the curve wrong.  The curve looks awful because they keep adding the new cases every day and it goes up.  If you look at it side by side daily it's flat and not rising.   Still, I know that Florida is not near ending it's lockdown and we shouldn't under these circumstances.  It also seems our gazillion nursing homes are starting to feel it.

I also think it might should be regional.  Some areas here in Florida aren't hard hit and others are.  Washington is ahead of the curve since they were hit earlier than say Texas.  Some areas should open soon in a week or two, others should wait longer.

Sadly, people will still get it and some will still die, same as every year with the flu, but mercifully over all the death rate is still relatively small.  My county has a million people, 500 cases, and 15 deaths.  To me that's better than flu deaths and cardiac arrests.  

It's all really a guessing game at this point.  Sadly we'll make some mistakes and opening up somewhere will cause an upswing and liberals will say "see I told you so".  

Surely though we should listen to scientists, doctors and the medical community and not necessarily politicians whom have big business whispering in their ear to open up.

 

Edited by Tweety

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10 hours ago, MunoRN said:

I've been training my whole life to avoid crowds, so I'm fine with keeping social distancing something that's encouraged rather than being viewed as a personality flaw.

I'm an ICU nurse who's been caring for COVID-19 patients since February, and one thing we've found is that most of these patients don't benefit from ICU care.  We got slammed at first, mainly with 80+ year olds with multiple comorbidities, which we've learned don't belong in the ICU, they are more appropriately treated in a palliative care setting.  So I don't think that with what we know now that we need to be as concerned with overwhelming ICUs.  

PPE and testing are still certainly issues that need to be resolved no matter how we move forward.  No plans works well without both of those resources.

I'm not real keen on contact tracing for Covid-19, that sort of things works great for Ebola and even the 2009 SARS, but based on it's transmission characteristics I don't think it serves much purpose for Covid.  Probably the best case study on the usefulness of contact tracing came out of the first Seattle area case for which there was fairly extensive genetic analysis done, maybe the most interesting thing was that in the time the patient likely spread the virus prior to becoming symptomatic was that there was little rhyme or reason to who contracted it from him (more likely through multiple intermediary vectors).  And even if we know who was in a grocery store at the same time as someone who turned out to be positive, it wouldn't make sense to apply a different set of rules than what we're already moving to for exposed healthcare workers which is to continue to work but to monitor for symptoms.  So basically, we can skip the contact tracing and just tell everyone to monitor for symptoms all the time.  

You appear to be discounting all the contact tracing that China did.e

It seems to have worked well there.

Your argument against it, appears to be weak in my opinion.

I happen to think it is a necessary and useful tool, against a virus that we don't have the tools to fight.

Coronavirus is more virulent that Ebola.

I listened to The Daily, last night, on NPR. It is produced by the NY Times, and an investigative reporter from the the Times, Sherry Fink, was embedded in a Brooklyn hospital.

Fink wrote a book: Five Days At Memorial, about the Katrina healthcare debacle in New Orleans, to give context to who she is.

It was a depressing report.

They rounded on ICU patients.

The doctor was explaining that 40 and 50 year-olds were hooked up to ventilators. Some had comorbidites.

A 54-year-old mother of one of the attending physician's medical students was on a vent, and subsequently died.

As the piece was ending, the attending was telling staff to get ready for another patient in the ICU, a 40-year resident from the hospital, who was likely infected on the job.

The ICUs in NYC still seem overwhelmed.

I don't think the ICUs in my area are overwhelmed, as KY has managed to keep infection rates steady, through strict social distancing guidelines.

In this case, I agree strongly with the sentiments expressed by nursej.

Much work can be done remotely.

And as she stated, there needs to be more testing.

Allowing for relaxation of social distancing, without the proper availability of testing, is foolhardy.

 

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3 hours ago, Tweety said:

I like the approach that when an area is shown to be on the downswing to continue social distancing in places where large gatherings occur such as concerts, churches, etc.  But allow smaller businesses and restaurants open and coffee shops, some small manufacturing businesses.

People have gotten their stimulus checks and I hear places like Walmart and Sam's are having long lines to get in.  This is good but doesn't help the little guy.

We can't wait until it's zero.  I'm one of the rare liberals I know that want sooner rather than later.

I also favor letting younger healthier people out first and ask those at higher risk for death to stay in.  99% of the cases in Italy have a co-morbity.  It's something like 94% here but the 30 year old that's an outlier that dies will make headline news and the 19,990 others don't because their older or have other things wrong with them.

I'm also for testing and testing for aytibiodies as well.  Knowledge is power.  Here the rate of infection vs. testing is in the area of 10 to 11%.  Sadly 900 to 1000 new cases a day....but still that's flat.  We're looking at the curve wrong.  The curve looks awful because they keep adding the new cases every day and it goes up.  If you look at it side by side daily it's flat and not rising.   Still, I know that Florida is not near ending it's lockdown and we shouldn't under these circumstances.  It also seems our gazillion nursing homes are starting to feel it.

I also think it might should be regional.  Some areas here in Florida aren't hard hit and others are.  Washington is ahead of the curve since they were hit earlier than say Texas.  Some areas should open soon in a week or two, others should wait longer.

Sadly, people will still get it and some will still die, same as every year with the flu, but mercifully over all the death rate is still relatively small.  My county has a million people, 500 cases, and 15 deaths.  To me that's better than flu deaths and cardiac arrests.  

It's all really a guessing game at this point.  Sadly we'll make some mistakes and opening up somewhere will cause an upswing and liberals will say "see I told you so".  

Surely though we should listen to scientists, doctors and the medical community and not necessarily politicians whom have big business whispering in their ear to open up.

 

You are not the rare Liberal who wants things to open up, Tweety!!!!!

I want things to open up.

My hair needs to be cut. The pixie is overgrown.

I need Botox, next month, and just before all elective procedures were shut down, I had an appointment for facial filler.

I cancelled the appointment because the APRN who does all my facial work, has a medical condition that affects her kidneys and heart.

Realizing I was a risk to HER, for a vanity procedure, I cancelled my appointment.

She thanked me for doing so.

I LOVE this APRN. She is fantastic at her job. I am worried about her.

I want this to be over!! I need my quality time with Leslie. The most amazing Plastics APRN, ever.

But, safety and preserving lives comes before my wants and wishes.

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11 hours ago, MunoRN said:

I've been training my whole life to avoid crowds, so I'm fine with keeping social distancing something that's encouraged rather than being viewed as a personality flaw.

I'm an ICU nurse who's been caring for COVID-19 patients since February, and one thing we've found is that most of these patients don't benefit from ICU care.  We got slammed at first, mainly with 80+ year olds with multiple comorbidities, which we've learned don't belong in the ICU, they are more appropriately treated in a palliative care setting.  So I don't think that with what we know now that we need to be as concerned with overwhelming ICUs.  

PPE and testing are still certainly issues that need to be resolved no matter how we move forward.  No plans works well without both of those resources.

I'm not real keen on contact tracing for Covid-19, that sort of things works great for Ebola and even the 2009 SARS, but based on it's transmission characteristics I don't think it serves much purpose for Covid.  Probably the best case study on the usefulness of contact tracing came out of the first Seattle area case for which there was fairly extensive genetic analysis done, maybe the most interesting thing was that in the time the patient likely spread the virus prior to becoming symptomatic was that there was little rhyme or reason to who contracted it from him (more likely through multiple intermediary vectors).  And even if we know who was in a grocery store at the same time as someone who turned out to be positive, it wouldn't make sense to apply a different set of rules than what we're already moving to for exposed healthcare workers which is to continue to work but to monitor for symptoms.  So basically, we can skip the contact tracing and just tell everyone to monitor for symptoms all the time.  

I am curious about your first sentence.

How have you been training your whole life to avoid crowds?

If it is too personal a question to answer, that is fine. Again, your first sentence piqued my curiosity.

But like you, I tend to avoid crowds. Especially after 9/11.

Social distancing really isn't difficult for me, either.

In fact, it relieved me from having to decline unwanted Easter invitations this year.

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11 hours ago, MunoRN said:

 

I'm not real keen on contact tracing for Covid-19, that sort of things works great for Ebola and even the 2009 SARS, but based on it's transmission characteristics I don't think it serves much purpose for Covid.  Probably the best case study on the usefulness of contact tracing came out of the first Seattle area case for which there was fairly extensive genetic analysis done, maybe the most interesting thing was that in the time the patient likely spread the virus prior to becoming symptomatic was that there was little rhyme or reason to who contracted it from him (more likely through multiple intermediary vectors).  And even if we know who was in a grocery store at the same time as someone who turned out to be positive, it wouldn't make sense to apply a different set of rules than what we're already moving to for exposed healthcare workers which is to continue to work but to monitor for symptoms.  So basically, we can skip the contact tracing and just tell everyone to monitor for symptoms all the time.  

I suppose it depends on what you consider a contact. I work in TB and we use the model of first investigating household contacts, and then those with specified time of proximity. In the the case of COVID-19, a close contact has been within 6 feet for 10 minutes. So if wide-spread testing occurs, contact tracing would help to notify those at highest risk of the need to isolate, but not necessarily everyone who might possibly become infected. This would also be useful data for epidemiologists. 

Antibody testing is interesting, but if the duration of immunity is not yet known, I think it has limited usefulness. 

A big question I have is, who is going to pay for all of this? 

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2 hours ago, Lil Nel said:

I am curious about your first sentence.

How have you been training your whole life to avoid crowds?

If it is too personal a question to answer, that is fine. Again, your first sentence piqued my curiosity.

But like you, I tend to avoid crowds. Especially after 9/11.

Social distancing really isn't difficult for me, either.

In fact, it relieved me from having to decline unwanted Easter invitations this year.

Do you wanna talk preference for social distancing with the retiree in rural alaska?

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57 minutes ago, toomuchbaloney said:

Do you wanna talk preference for social distancing with the retiree in rural alaska?

Sure, baloney.

One of the equine vets I use, travelled to Alaska twice, in the past eight months to work.

I think it had something to do with a woman.

😊

The first time he came back, he said: "The hiking in Alaska is really walking in wilderness."

And he seemed unprepared for it.

I said: "Have you never read Into The Wild?" Of course it is wilderness."

But he went back up to Alaska, and returned to KY just before all the social distancing guidelines went into place.

My sister lived up there for a time.

As did a friend from J-school.

But I don't think I could manage it, baloney.

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Just like in the lower 48, our trailheads are on the road system, so the trails can get congested with hikers. A couple years ago I hiked up to a place called Angel Rocks where you get a vantage point overlooking a river valley in the White Mountains, just northeast of Fairbanks about 55 miles.  My son and I encountered at least a dozen other hikers on the trail, including a young mother with 3 kids ranging from probably kindergarten to age ten! It was a blustery April day with Temps in the 40s. 

The trail groups and clubs up here are really really encouraging people to hike only with household contacts and to take masks with you for encounters on the trails.  They are recommending loop rather than destination hiking.  For instance, the trail I mentioned can either be a 4-5 hour moderate loop or an 8-10 hour hike to a hot springs.

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