Local Covid-19 Report and Infection Modeling

Even though Lambert and I are not keen about videos as a method of getting information (transcripts are faster!), we thought we’d pass along a reader’s video account as a way of eliciting more reports on what is happening on the ground, particularly near hot spots.

From Kurt:

As a recent (2 years) reader I much enjoy hearing everyone’s perspective, especially localized views like the readers in the UK, so I thought they might like to see how an average American town is handling things. Obviously, we’re worried here in the shadow of NYC, but in some ways, it’s not stopping things? Which is a bit odd. What I found most interesting was how many families I saw out and about (within reason, people did try and stick to some distancing, but it was hard at intersections or when the sidewalks got narrow).

Consider the popularity of the center of town (and in particular the grocery store) in light of this very informative toy modeling exercise (hat tip Monty). This is a terrific demonstration of how various interventions, and cheating around those interventions, affects disease propagation. Per Kurt’s concerns about people still going to his main street and grocery store, at around 16:56, the modeling exercise below shows how having people go to a central location, like a grocery story, significantly undercuts the benefit of social distancing.

Note that early on, the video also demonstrates that quarantining, as in sending the infected to a separate location, is very effective in tamping down the spread of infection. However, Bloomberg reports today that what most of the world is doing, quarantining at home, is another kettle of fish:

Italy needs to shift to mass quarantining of coronavirus patients with mild symptoms instead of letting them isolate at home, according to a group of Chinese experts who traveled to the European nation to advise officials there.

Doctors in Wuhan made the same error early on in the outbreak, said Liang Zong’An, head of the respiratory department at the West China Hospital at Sichuan University. While seriously ill patients were admitted to hospitals, doctors at the time recommended that those with mild symptoms isolate themselves at home, in part to reduce the strain on Wuhan’s overburdened health care system.

Back then, it was not well understood how infectious the virus can be even in those who don’t seem very sick. But researchers now know that those with mild symptoms who are told to stay at home usually risked passing the virus to family members, as well as to others outside their homes as some still moved around freely….

Liang said his team advised Italy to follow China’s lead to forcibly isolate patients with mild symptoms from their families. In China, a study of one province showed that 80% of cluster infections originated from people told to rest at home, according to Xiao Ning, a researcher from the Chinese Center for Disease Control and Prevention who was part of the team.

Finally, to round out this odd assortment of efforts to understand how behaviors affects disease spread, readers (and Lambert and yours truly) have been consistently lamenting that the data on the disease is terrible due to limited testing and inconsistencies in classification, most notably China not counting positive test results as confirmed cases unless the patient also presented symptoms. Even South Korea, widely viewed as having engaged in extensive testing, as of about a week ago had administered 338,000 tests in a country with a population of over 50 million, meaning fewer than 1% were tested. So in the absence of more random testing of the population, we are really flying blind.

Readers suggested working back from deaths. The wee problem is that even thought that data is probably less bad than the confirmed cases tally, that does not mean it is all that good. For instance, readers have said one reason the Covid-19 death rate in Germany is low is in part because if there is a co-morbidity, like COPD, hospitals are classifying that as the cause of death and not the virus.

Similarly, in the UK, deaths understated because people who died at home are not counted even though some almost certainly died of Covid-19:

At least 40 more people have died from coronavirus in the UK – as hidden deaths at home were today revealed for the first time.

New figures reveal 210 people died in England and Wales from the killer bug up to March 20 – 23 per cent more than official NHS numbers have shown.

Yesterday the Department of Health reported 1,408 deaths in the UK but these numbers only include those who have died in NHS hospitals.

If the 23 per cent increase was applied to yesterday’s hospital-only total of 1,408, it would result in a total of 1,732 deaths.

The new ONS figures which include non-hospital deaths only go up to March 20 – three days before strict lockdown measures were imposed by Boris Johnson to curb the spread of the disease.

Unlike the NHS figures, which are limited to those who died in hospital after testing positive for the disease, these wrap in deaths where Covid-19 is mentioned as a suspected cause of death where someone has not necessarily tested positive for the disease.

https://www.thesun.co.uk/news/11291979/uk-coronavirus-deaths-home-deaths/

In New York City, about 1 million people are over 65, and roughly 1/3 of them live alone. Particularly with the hospitals so overwhelmed, any who died at home would not have an autopsy done to determine if Covid-19 were the cause. Readers can pipe up, but it would seem unlike that any investigation would be made of seniors who had died outside a hospital. Unless they had tested positive for Covid-19, their deaths would be unlikely to be attributed to it even if that were a reasonable surmise.

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56 comments

  1. vlade

    I believe one of the reasons why ITaly has so many deaths is it tests deaths that are not caused by accidents etc. for CV-19. I do not believe China did that for example, and a you can see, the UK doesn’t either.

    That’s TBH why comparing the deaths is quite a bit misleading.

    In Italy, I believe most seniors don’t live alone, so only few would be unnoticed.

    Reply
    1. Ignacio

      A problem, big problem, in Italy and Spain has been the penetration of clusters in nursing homes where mortality is high. Strictly isolating these should have been priority number 2 after protecting health care professionals. This was realised a bit too late to prevent thousands of deaths. The personnel working in these places should have been extensively tested as well as their surrounding circles. This has been the biggest failure so far. Also people who live with elder relatives should have taken all precautions.

      Reply
      1. vlade

        Nursing homes are a problem across the board, unfortunately. It seems that a lot of them (even those not run for profit) were quite lax.

        Reply
      2. Diego M

        The only way to prevent that would have been to give personnel the option to live inside the nursing home and not letting strictly anybody into the nursing home. I know a successful nursing home that did just that. Personnel were devout Catholics, so it was easier than in the usual work arrangement.

        Reply
        1. vlade

          That is (living inside the nursing home) the current CZ govt recommendation where possible. Plus setting aside (again, where possible) 10% of capacity as an isolation ward.

          Reply
      3. JTMcPhee

        My wife worked as a CNA and then as a nurse at several nursing homes here in FL. I did part of my clinical training in a couple also. These warehousing operations-for-profit are a shame even before CV. My wife was let go from one place for sending a patient out to hospital because a cast on a broken limb was choking off blood flow to the limb beyond the cast and the doctor who put it on got annoyed. I know nurses, my wife included, who would come home in tears because of the overwork and the pains caused to patients by the abusive operation of their employers.

        Understaffing/overwork, physical abuse, poor quality of staff, overmedication, ignoring patient distress, the looting that goes on just to get into and maintain a person in these facilities, doctors pretending to “care” for hundreds of patients doing fly-by assessments from the nurses’ station and charting falsely and committing polypharmacy, it’s for many, maybe most, a hell of a way to die slowly and in a kind of horrific dream. There are good places, I did some training time at one of the better ones around here, but even there, patients would fall and sicken due to inadequate staffing/overworked staff. So many residents were just sitting, being propped up enough medically to keep them breathing, but it’s just what we do with old folks these days. The ice floe treatment could in some ways be kinder.

        Here’s some advice for the PMC on what to look for in finding a place to stash your dementia-suffering oldster: https://money.usnews.com/money/personal-finance/articles/2014/05/07/5-traits-of-the-worst-nursing-homes Outlines some of the telltale signs. One mentioned toward the end is “How does the place smell?” Is there a whiff of urine and sweat? And look at the upper floors and the farthest wings from the nurses’ station, where the unwanted and problematical inmates get stored.

        These places are such a wonderful metaphor for what’s wrong with our culture and how difficult it is going to be to mitigate and ameliorate this virus. Short of just letting the susceptible and vulnerable die. Or in many instances, carrying forward behaviors and policies that ensure spread of the disease and “excess deaths.”

        Reply
    2. Carolinian

      I saw an interesting article that suggested one reason for the heavy death toll in Italy is that they had a mild flu season this winter and therefore more potential victims to this new disease. And in this morning’s Links there’s an article talking about the population age in various parts of the US and it says NYC has, by far, the largest percentage of over 65 year olds of any major city and the same figure for Los Angeles (and so far death toll for LA) is much smaller.

      I do think the news coverage may not be giving enough emphasis to the fact that this is overwhelmingly a disease of the old and sick when it comes to mortality. And there have been suggestions that a primary diff from regular flu is the symptomless spread by the healthy and young. IMO mass testing and virus hotels are not going to work here but the currently percolating suggestion of making everyone wear simple masks could be. Let’s get some fashion designers to work and top runway models on TV showing off their designs. It could become a thing.

      Reply
      1. periol

        I saw that article, and the data presented did not provide a very solid foundation for the claim that the Italian deaths are “late flu” missed deaths from the end of 2019. It *might* explain a few deaths, at best

        I would call the “mild flu” reason for Italy’s issues with coronavirus to be a huge stretch, at best.

        If anything, I despise this explanation. It is basically saying that a good chunk of the people who died from coronavirus *should* have died from the flu, and just missed their visit from death by a few months. That is not a human approach to sickness, care, and helping to keep folks alive, no matter their age.

        Reply
        1. Carolinian

          I don’t think the article was suggesting that was the only reason but rather a contributing factor (and therefore interesting).

          And it certainly wasn’t about whether we should keep old people alive or not. However if you think medicine doesn’t constantly make calculations about probable survival, quality of life etc then you don’t have much experience of elder care (and I do).

          Reply
          1. periol

            However if you think medicine doesn’t constantly make calculations about probable survival, quality of life etc then you don’t have much experience of elder care (and I do).

            That’s fine. I do have experience with elder care, and I despise the mentality behind it.

            And I do think you are wrong, the article did not even have enough (really, any) supporting evidence to say that the “mild flu” season is even a contributing factor to the Italian Covid-19 death rate. It was all conjecture. I’m not throwing the idea away, but as long as there isn’t any real data behind the idea, it is only conjecture, and probably not the most plausible explanation anyways.

            The disease spread too far and too fast in the elderly community, nursing homes, etc. That is why the death rate is so high. They didn’t lock things down before it had taken root among the most vulnerable Italians. Flu season had, if anything, very little to do with it. Government inaction and a general sense of invulnerability before the virus took hold – those are your causes for elevated death levels.

            Reply
      2. Bsoder

        “I do think the news coverage may not be giving enough emphasis to the fact that this is overwhelmingly a disease of the old and sick when it comes to mortality.” If I may, you’re talking about only one aspect of the CV-19 getting sick and then perhaps dying. But, 20-55 year olds that are the main carriers of the disease and asymptotic ones at that. This is both a medical and public health problem. As this is @NC yes financial too.

        Reply
        1. rtah100

          The UK statistical report on C-19 ICU patients is very interesting. It presents the data on 775 C-19 patients this year compared to several thousand ICU patients with flu in previous 3 years. Key differences are:
          – activities of daily living. 25% of flu patients need help with some ADLs. Only 10% of C-19
          – comorbidities, 30% of flu patients have comorbiditues, only 10% of C-19
          – ages were similar
          – sex was not! 70% C-19,are male, cf c. 50% flu.

          In summary, ICU C-19 patients are NOT frail elderly, they are healthy elderly. ICU C-19 deaths are (only early deaths so far) more frail, more like the flu cohort. But from the data, we cannot tell if unresolved cases will have declining death rate because healthier subjects survive better or same death rate because healthier patients merely take longer to die. :-(

          In any event, ICU survivors may be significantly disabled (lung fibrosis, cardiomyopathy, sequelae of ventilation, musculoskeletal wasting from being bedridden, bed sores / hospital acquired infections etc.) so even if a healthier elderly on entry, not on discharge. :-(

          Perhaps the only argument governments understand is money – it is not a cheap win to wipe out the frail elderly if you also enfeeble the strong! Who will provide the free childcare for carbon-based work units now?

          Reply
          1. Carolinian

            I read another article that said the current setup may actually be more dangerous for the elderly because they are the babysitters for all those kids who are out of school and kids are virus carriers.even if they don’t get sick. In fact the Chinese decided that the family quarantine situation that they tried was making more people sick because a number one way of getting the disease was from a family member.

            Meanwhile the young have that childcare problem if they still have jobs at all. All of which is to say that to ignore the plight of the young can be as callous as ignoring the plight of the old and here’s suggesting most of those old put greater priority on the well being of their children and grandchildren then they do their own. The government is making choices for people rather than let them make their own. That’s appropriate for now because this emergency has to be understood. But any attempt to impose a quarantine for more than a few weeks is likely to result in public rebellion IMO. Trump of course is willing to go with any policy that will get him reelected. It’s a bit flip to suggest that everything that is going on is about ideology.

            Reply
  2. VietnamVet

    What is disturbing is that sheltering in place in the coronavirus pandemic is not as effective as old fashion public health contact tracing and quarantine of the infected that worked in Asia. A family or housemates cannot avoid infecting each other if one becomes infected and infects everyone else before the illness sets in. The homeless have no shelter.

    I doubt it was a conscious decision to be incompetent but is part and parcel of profit taking and the arrogance of the Elite. It has yet to sink in that temperature testing is worthless when 40% of the coronavirus infected are shedding virus with no symptoms. The federal government failed to order a top priority crash program to develop a quick valid lab test to identify if a person is infected with the virus or not. There are no safe quarantine facilities to house the infected away from the uninfected. Public health decisions are made by 50 different state governments.

    Universal testing, contact tracing, monitoring, quarantine of the infected, and allowing the tested healthy virus free to resume work are the only way to overcome this in the short term and control future waves of the virus plus getting the economy back on its feet. Everything is being done on the cheap except for aid for the wealthy. Because of this, a moving evolving pandemic will continue to collapse healthcare systems and the economic depression could last until a vaccine or a treatment is developed.

    The US military is on the brink of fighting battle with an invisible enemy and to maintain readiness to fight a war with Iraqi Shiite militia, Iran, or Russia will suffer a 20% causality rate.

    Reply
    1. Biologist

      In several European countries, including UK and Netherlands, they gave up contact tracing and testing, I believe already more than a week ago, because it was ‘unfeasible’. In Netherlands, only now the politicians are promising to ramp up testing. Go figure how long that will take.

      Reply
        1. Biologist

          Thanks, that’s interesting. One thing that struck me was the following:
          >Instead of testing, the UK government decided to prioritise intensive care unit and ventilator capacity at hospitals, believing that this was the best way to save the lives of those worst affected by the disease, rather than widespread tests, two sources told BuzzFeed News.
          >Prioritising ICU capacity and ventilator procurement over testing was the right strategy, the second source argued, because while data on overall cases may be useful overall, it is a secondary concern compared to ensuring the elderly and vulnerable can receive treatment.

          Why does investing in ICU capacity and ventilators preclude ramping up testing?
          [something about walking and chewing gum at the same time]

          Reply
          1. vlade

            Because if you’re aiming for herd immunity, testing is wasted money.

            Testing is important only if you want to separate the population somehow. Testing now-infected makes sense only if you want to separate now-infected from not-infected.

            Testing had-infection (antibodies), which the UK seems to want more than the now-infected, is usefull only if you want to say “had infected can lead normal life”, or monitor the “herd immunity”, i.e. the number of “had it” is beyond cut-off and you can return to normal.

            Reply
      1. PlutoniuKun

        I think we’ll only know when all the dust has settled as to why nobody outside SK, Taiwan and Singapore really attempted aggressive contact tracing and testing – I suspect that the justification is that this virus is simply too contagious to make it viable unless you’ve a very strong pre-existing infrastructure in place to carry it out (as South Korea and Singapore have. But I also wouldn’t rule out simple incompetence, exacerbated by a failure by WHO to advocate stronger messages. Back in February I was reading a lot of ‘we can’t do this, WHO says its not necessary’ type commentary from official sources – they were a handy fall back for bureaucratic inertia.

        During SARS1 I remember a major street kerfuffle close to my office. An Asian woman had been accidentally discharged from hospital despite having symptoms. The hospital panicked, called the police, and they ended up cruising the streets with nurses and social workers trying to find her. They spotted her on the street, but the unfortunate woman, who couldn’t speak much English, panicked in turn when the police and nurses shouted at her, and they ended up having to drag this screaming woman into the car, which of course caused chaos on the street as people thought she was being attacked. An overreaction perhaps, but I can’t help contrasting that reaction to the shrugged shoulders when it was suggested here that at the very least, people should be checked at airports coming in.

        Reply
        1. vlade

          CZ is planning for this, their problem is how to trace well w/o relying on people, so are now looking into card transactions + phone, so they are now running a pilot, and hope to roll out in a week or so.

          CZ also mandated masks – not for personal protection,but, as the slogan goes “my mask protects you, your mask protects me” – i.e. to reduce the potential spread by asymptomatic.

          Reply
          1. Oregoncharles

            Czech Republic – had to look it up. Should have known.

            I just found a small box of dust masks I didn’t know we had; that and nitrile gloves out in the shop, so I guess we’re ready.

            Reply
        2. The Rev Kev

          Why the difference? Remember by the way when it was theorized that this virus really only targeted Asian men? I am sure that this was only a month or so ago. I’m thinking that countries like South Korea, Taiwan, Hong Kong and Singapore were hit hard by SARS & other viruses and so did a hard lessons-learned – and it has paid off in spades. Meanwhile we in the west just went with neoliberal arrogance on the part of our leaders and tried to solve this pandemic using the invisible hand of the market. If the news got bad, we either went with censorship or with spin. Not working out so well that.

          Reply
          1. PlutoniumKun

            I think George Monbiot has it right – it smacks very much of the run up to WWI. A lazy complacent establishment had simply forgotten the lessons of past wars and assumed their own superior judgement.

            I think a key factor was the battle hardness – the countries which seem to have done the right thing were at the front line in SARS1, MERS and bird flu – SK, Singapore, Taiwan and Vietnam (although Vietnam seems to be fighting a losing battle now to stop a secondary surge). This gave them a key few weeks start in preparedness over other countries, which either lacked the institutional strength (Thailand, Indonesia, etc), arrogant (Japan) or just disorganised, arrogant and unprepared (nearly everyone else). It also helps that at core these are highly authoritarian States (including SK) who regularly intrude in personal lives in a manner which would probably not be acceptable elsewhere.

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        3. Maurice

          I think you overlook something very important, population buy-in and false symptoms.

          I know from the Netherlands that they haven’t the test capacity to test everybody. It is easy to blame them for this, and the test capacity should probably have been higher, but as a country it is not big enough to have all industries in house, so you always have external dependencies.

          But testing is only going to work if people step forward to be tested, which will only happen once they take the virus serious, which basically only happens when it is already too late.
          The other problem is that there are simple too many people with corona like symptoms which don’t have it. Everyone with a cold or the flu should basically be tested and given the season that is probably more than 25% of the whole population. Even South Korea did not match such a coverage.

          Given these two problems, I don’t blame the government for basically given up on containment but concentrating on the healthcare capacity instead, which seems to be successful (although barely) so far.

          Reply
          1. vlade

            I don’t buy this, as the governments had at least a month to prepare.

            I was concerned enoug that I rebooked my early Feb London visit from a hotel to a self-catering apartment (mainly so I could avoid public transport).

            The governments should have started planning then, even if silently (I do buy that a lot of people at that time would have told them not to waste money).

            That would have been both on planning, healtcare capacity and testing. No-one seemed to have done that.

            Reply
    2. ObjectiveFunction

      You’d remember more than I about this, VV (/quiet bow), but all this obsessive tracking of caseloads and deaths seems a lot like the body counts: everyone knew it was a terrible metric, and that it drove even worse behavior, but the media especially would far sooner track and prognosticate using a bad metric than none at all. Otherwise, it’s Morely Safer saying the same thing night after night after night. Much the same thing in Iraq, except it was our bodies not theirs that was the focus.

      Reply
    3. John Wright

      “Army asks industry to develop handheld or smartphone test system to screen patients for the coronavirus”

      https://www.militaryaerospace.com/sensors/article/14172933/smartphone-test-coronavirus

      Note, this is NOT for Covid-19, it is for Sars-Cov-2, but the article does have:

      “Army researchers want LFIs for SARS-CoV-2. Also of interest is handheld screening capability for Coronavirus Disease (COVID-19), which has caused a global pandemic. The Army Contracting Command issued this announcement on behalf of the U.S. Defense Biological Product Assurance Office (DBPAO) at Fort Detrick, Md.”

      It appears the military views SARS-CoV-2 as the primary concern while COVID-19 is relegated to “also of interest”.

      Reply
        1. John Wright

          Thanks, I was confused by the use of both terms in the text.

          This makes more sense, otherwise this is a case of fighting the last war.

          Reply
  3. Ignacio

    I very much dislike the idea of mass quarantine sites. I know of several cases of self isolated Covid-19 positive cases at their home who did not pass the disease to their relatives. This requires strict behaviour and care but it is not that difficult except in houses that are somehow overcrowded and you cannot designate a room for the diseased. In those cases the quarantine sites make sense.

    Reply
    1. The Rev Kev

      I don’t think the problem would lay so much in designating a room as an isolation room but in trying to make toilet arrangements. Sure you can do bed-baths for a sick person if you have the right gear and can feed and take care of them but if there is only one toilet in the house, what do you do then? That would make a great vector for spreading this virus to others in the household. Still trying to nut out a solution to this problem with my own household in case one of us falls sick to this virus and there are no easy solutions.

      Reply
      1. Ignacio

        In that case first is to avoid air droplets and air contamination. If you don’t have masks it is easy to arrange a home made mask with cotton napkins or some other similar solution. Second is touching things. The person infected should wash hands immediately when entering and take with her/him all towels or other personal items used to her/his room. It is not that difficult. This bug spreads easily but you can prevent a lot of contagions with caution. Bathrooms are “wet” rooms, not the best for virus survival.

        Reply
        1. Amfortas the hippie

          but also keep in mind that a flush toilet routinely aerosolises what’s in it…that’s why you don’t keep your toothbrush where the toilet is(ugh).
          and why one always closes the lid before flushing.

          Reply
    2. vlade

      There was an article on BBG yesterday with Chinese doctors saying that first they did the self-isolation, but it didn’t work, so you have to isolate in the mass-quarantine sites.

      As you say, I believe it depends, and then it very much depends on the discipline in the household. I suspect Chinese might have taken the view that the discipline is likely to be lacking, hence forcible ensuring it.

      Say we’re lucky, if we had to, we could make a room + a bathroom available for a self-quarantine. But my brother lives in a relatively small apartment with his three kids, no chance they could self-isolate.

      Reply
      1. Ignacio

        When I analysed Hubei epidemics, the duration of the logistic curve from the quarantine start to the declining phase was about 6 days longer (31 days) than expected given the contagion-to-death median time (about 25 days). My guess was that this occurred because, as the Chinese say, there were many home contagions in the first days of quarantine plus some initial chaos. I believe that in the case of Italy or Spain, knowing previous experience, this was not so chaotic and I expect the decline phase to arrive earlier compared to Hubei. Somewhere about 27 days or so after quarantines, if we see a significant decay in casualties, this would mean it worked better. We will know soon as Italy is today in 23th day after quarantine so I expect the number of casualties to drop sharply by the 4th-5th of April. If the Chinese are right then we should wait to see that drop to about 7th-8th April. By the way, now it would be too late to go for those mass quarantine sites, it should have been done the very first day of quarantine so Chinese counselling arrives a bit too late for that. Doing this now, or one week after the start of quarantine, would only worsen the situation.

        Reply
        1. rtah100

          My colleague with the doctor spouse in Bergamo tells ne:
          – exponential growth has broken. – ER at hospital has been almost empty (by recent standards) for several nights
          – ICU now emptying out, spare beds
          – hospital expecting second wave of cases from other parts of Italy

          Also, therapy has changed:
          – antivirals abandoned
          – using massive doses of CQ and azithromycin, trying to suppress immune reaction that is killing lungs, other organs
          – autopsy on all ICU deaths, to confirm new treatment hypothesis

          On quarantine, I think you are right Ignacio. The first two serial intervals after lockdown will accelerate the growth by forming household clusters and then it wil peter out. We should have filled the empty hotels with mild cases and symptomless prolonged contact patients….

          Reply
    3. Diego M

      Ignacio, for how long would you recommend self-isolation and separate bathrooms once the patient stops having symptoms?

      Reply
      1. Ignacio

        You can follow CDC rules for HC personnel returning to work when the disease has not been tested:

        2. Non-test-based strategy. Exclude from work until
        o At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,
        o At least 7 days have passed since symptoms first appeared

        https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/hcp-return-work.html

        Reply
    4. Biologist

      I’m actually in that situation: me, my partner and a flatmate in the same house, with the flatmate infected. So far he’s been OK–some chest pain, shortness of breath, headaches, shivering, and of course coughing. He’s a doctor.

      The house is large enough, so we try to manage by being careful and rational, but it’s giving quite some stress, and it’s annoying to confine someone to quarters and keep telling him how to behave.

      Flatmate mostly sticks to his (large) bedroom, where we bring him food (or delivery). There are two toilets, luckily, but only one bathroom / shower room. He also insists on coming down to the kitchen, at the end of the day after we’ve used it, and eat / cook there.

      We use hydrogen peroxide (H2O2) diluted to 0.5%, and spray it on contact points in the bathroom before we use it. We also spray it basically everywhere in the kitchen in the morning.

      We try to not go out for shopping but we’ve had to go once a week since online grocery slots are impossible. We wash our groceries with hot water and soap, and in some cases (e.g. paper / carton packaging) leave them for 1 or 2 days in a separate area without using. Same with post / packages.

      We’ve now found simple surgical masks in a corner shop, which we’ll use next time we have to go out, and we’ll give one to the flatmate for when he comes out of his room.

      So far (knock on wood) my partner and I have not developed symptoms–it’s 9 days after the flatmate developed them. This is London by the way.

      Reply
      1. Ignacio

        Allow him to the kitchen but with a mask and not for a long time. Even a home made mask and wash hands in the kitchen before touching anything.

        Masks are very much recommended for infected people to protect their home mates.

        Reply
        1. rtah100

          Buy a humidifier and put Lugol’s solution (iodine plus potassium iodide) in the water tank and mist the apartment with iodine. Iodine was used at low concentration for disinfecting public places in previous influenza epidemics. It is an excellent viricide and much better safety profile than bleach etc.

          There is a paper on this (iodine, the forgotten weapon against influenza, by Derry).

          Reply
  4. Mell Pell

    AEP has a nice article up about the virus. He references this study:
    https://www.corriere.it/politica/20_marzo_26/the-real-death-toll-for-covid-19-is-at-least-4-times-the-official-numbers-b5af0edc-6eeb-11ea-925b-a0c3cdbe1130.shtml
    The real death toll for Covid-19 is at least 4 times the official numbers

    They took a town with 11000 people and found the deaths in excess of the average over the previous four years. They attributed the excess deaths to the virus. Assuming that the entire population of the town had been infected they propose a 1% Case Fatality Rate.
    [QUOTE]Nembro, one of the municipalities most affected by Covid-19, should have had – under normal conditions – about 35 deaths. 158 people were registered dead this year by the municipal offices. But the number of deaths officially attributed to Covid-19 is 31

    In the hypothesis – not at all remote – that all citizens of Nembro have caught the virus (with many asymptomatic, therefore), 158 deaths would equate to a lethality rate of 1%. That is precisely the expected and measured lethality rate on the Diamond Princess cruise ship and – made proportionally by demographic structure – in South Korea. We have made exactly the same calculation for the municipalities of Cernusco sul Naviglio (Mi) and Pesaro using exactly the same methodology. In Cernusco the number of anomalous deaths is equal to 6.1 times those officially attributed to Covid-19, also in Pesaro 6.1 times. But even more staggering are the Bergamo figures, where the ratio reaches 10.4.
    It is extremely reasonable to think that these excess deaths are largely elderly or frail people who died at home or in residential facilities, without being hospitalized and without being swabbed to verify that they have actually become infected with Covid-19. Given the decline seen in the last few days after the peak, flock immunity has likely been attained in Nembro. To a certain degree, Nembro represents what would happen in Italy if everyone were infected by CoronaVirus, Covid-19: 600,000 people would die. The numbers of Nembro also suggest that we must take those official deaths and multiply them by at least 4 to have the real impact of Covid-19 in Italy, at this moment.
    [/QUOTE]

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  5. Tom Stone

    Here in Sonoma County testing is almost non existent, Law enforcement gets it, nurses do not.
    There is insufficient or no PPE available for nurses according to both two Nurses I have spoken to and a Doctor who does rounds at St Joseph’s.
    Nurses who wear masks not provided by the Hospital are fired immediately.
    Our Population is roughly 500K, there are 1,000 Hospital beds and fewer than 200 ICU beds.
    We also have a high percentage of elderly because young people can’t afford to live here, there are also a LOT of “Recovery” homes and SLE’s, Sonoma County has been a “Dry out” center for well to do San Franciscans since the 19th century.
    They have dorm living for the most part.
    I expect the surge to hit here starting in 2-3 weeks based on the little information available and the eventual mortality to exceed 10% due to the lack of medical facilities and the age of the population.

    Reply
    1. PhillyPhilly

      Nurses who wear masks not provided by the Hospital are fired immediately.

      I’ve seen several instances of hospital administrators firing medical personnel who share information via social media. It’s hard to imagine the mindset that allows you to fire medical personnel during a pandemic. What an evil health system we have in the US.

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    2. John Wright

      Currently there have been two deaths in Sonoma County.

      As I mentioned yesterday, eight members of the Santa Rosa Police Department (in Sonoma County) were positive for Covid-19.

      Now a relatively young 43 year old detective has died.

      https://www.pressdemocrat.com/news/10863702-181/santa-rosa-police-officer-dies

      One can wonder if the authorities will ever shut down the ongoing “critical” construction activity building homes and apartments that cannot be occupied for months.

      Reply
  6. Kevin C. Smith

    Maybe one could approximate the covid toll by comparing last-year’s all-cause mortality [or a subset of causes] with this year’s similar statistics for a given time period. Some subsets of that data could be even more likely to reveal useful info.

    Working from that approximation of covid deaths, you might then estimate total number of infections.

    I expect that some epidemiologist has already done this … or has a good reason for not bothering with this approach.

    Reply
    1. Oregoncharles

      “Mell Pell’s” post just above does exactly that, finds at least 4 times as many deaths as officially reported.

      Reply
  7. Noone from Nowheresville

    Youtube video transcripts: click the 3 dots to the right of Save in the title bar box, open transcript. The auto-generated transcript pops up in the panel to the right of the video.

    ETA: What I will say about watching videos is that words themselves don’t always convey nuance. When I read, unless I know the person personally or their positions, my default is my own voice inside myself. Or in the case of what’s been reported in the Assange trial, words from the transcript didn’t really convey what was happening in the court room.

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  8. LAS

    One thing for sure … by emphasizing the role of individual behavior the responsibility of government policy (or lack thereof) and systemic weaknesses/corruption are likely to squeek by unexamined. Once more it’s all our own fault what happens to us, as if institutional social forces had nothing to do with it.

    Long before covid-19 appeared, governments had already disinvested in social welfare, leaving it to those in the mostly privatized medical system to remark upon and solve for the social determinants of health. It is odd that for years we’ve overlooked the raw fact that expensively trained clinical staff should not be used to solve for social determinants of health. Governments should be the accountable entity for overall population health.

    BTW, epidemiologists purposely call them “cases” b/c they know they have not got a representative population sample. They are totally conscious of the fact it is only cases.

    Reply
  9. Oregoncharles

    Since Yves was interested in local: calm before the storm here. So far there are only about 6 confirmed cases in a university town of 60,000, and one death, a woman who was over 80 and had a pre-existing condition. Several of the cases are health care workers. We’re lucky; the smallish county to the east has about 80 cases and several deaths, because it started in a nursing home.

    The governor has announced a stay-at-home policy, and the streets are emptier than I’ve ever seen them. I had to go out today to drop off my tax info at the preparer’s; she was ready, with a form to sign outside the door and a mail slot in the door. So I signed and dropped my packet through, then sprayed my hands with alcohol. Similarly, the food Co-op is doing a good job of coping; the staff are getting hazard pay and some other considerations, and they’re providing pickup service where they do the shopping, box it, and hand it over outside (I used a card – and we had someone pick it up for us); they’ll also deliver. A few glitches, which they handled well – to be expected with a completely new program.

    Wife and I are over 70 and don’t need to go out much, so we’re mostly staying home. I’ve actually been working some, since I work alone and the season won’t wait. Was just planting spinach and peas; our drought has broken and we’re getting rain, so the clay soil has reverted to glue. Should grow, anyway.

    A lesson: the weather was beautiful the other day, so we thought we’d go for a hike nearby. Trouble was, the trail was full of people, and there isn’t room to pass others at an adequate distance. We turned back, went home. Will try another place that’s less popular and has more room.

    I assume it will hit full force at some point, just hope to stay out of its way.

    Reply

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