I personally think we need a county-by-county approach. There is a high variation of the infection at local levels. All the news is currently about how bad New York is and it's true but we're not all New York. http://www.countycovid19.com/
Some outbreaks are smaller, but you'll note that they all leveled off at roughly the same time and on the same schedule. That's because we locked down on "New York's schedule"[1]. If we didn't, these places which seem to have "handled" the outbreak would look like New York.
The plans should absolutely be regional in that the lockdown rules should be based on infection rate thresholds, etc... But to do that they all need exactly the same per-capita testing resources. It's the same plan.
[1] Really that's not true. We locked down on Seattle's schedule, because they moved first on most things. Seattle had by far the biggest early outbreak, but peaked earlier, peaked lower, and is now one of the better managed areas in the country. Cuomo gets all the attention but it's really Jay Inslee who saved us all.
For all the various politicians are talking about "following the science", there's very little actual science backing up these measures. We're pretty much making it up as we go, and you would be hard-pressed to find "scientific" justifications for most of what we're currently doing.
Is there a cite for that? Because that's not the way the data looks.
Everywhere was growing with roughly the same exponent before lockdown. The numbers were bigger in NY because it grew longer pre-detection, but there's no reason to believe that everywhere else was any different. Really this disease's growth constant looks shockingly consistent almost everywhere in the world.
> It's unclear to me why we're making these policies at a federal level.
We... aren't. Literally every existing lockdown regime is being enforced at the state level or lower. For the Boise example you mention, the relevant regulation is a stay in place order from Gov. Little in late March.
Edit to show the point better: Go here (easily the best visualization site, FWIW), scroll to the bottom where you can see a log chart of per-capita infection rates normalized to a single "start time" metric, and compare the Idaho chart with the New York one.
https://91-divoc.com/pages/covid-visualization/
They are almost exactly the same chart, modulo a vertical offset and a kink in NY data in the second week (which consensus says is the testing backlog finally catching up).
If Idaho's detached housing and automobile dependence was reducing its rate of infection spread, it should be visible in the slope of this line. And it clearly isn't.
No, they weren't. You're just asserting that this is true. There's effectively no way to know what the doubling rate was in a place like Boise before the national lockdown, because the numbers were in the low single digits:
https://covid-19.direct/metro/Boise?tab=glance
But even ignoring that...the site you're linking to shows a wide range of slopes on the per-state graph. You just think they look the same, because the log Y-axis compresses dramatic differences in scale, particularly near the origin. New York, NJ, Michigan and Louisiana are well above the diagonal line, while states like Wyoming, Montana, Vermont, Maine etc. are all well below it.
That's a doubling period of less than three days. It was spreading every bit as fast as New York was. It looks like exactly the same chart with a different constant factor. Yet you insist that these identical results are somehow due to different underlying behavior? Why? Where's the research showing that?
Because the pretty obvious hypothesis is that the disease was spreading the same way because it's the same disease and doesn't care about whether you live in Boise.
Number of cases is largely a proxy for how many tests are being done (https://fivethirtyeight.com/features/coronavirus-case-counts...). Looking at deaths is more accurate, and that shows Idaho (and all other states) well below New York.
Shelter-in-place is a good general rule - we can roll it back when we've got infrastructure to vaccinate people.
I'm not sure what you're referring to about vaccination. As California's roadmap lays out, we'll need to roll back shelter-in-place long before vaccines are available and find less costly ways to mitigate the virus.
Dates are not trivial when people's very livelihoods are at stake.
That makes me think its sterling example of why we need a county-by-county. Don't just base it on infection levels though, as you pointed out. Include hospital support, ppe levels, interconnectedness, etc.
I don't see why any "deemed safe" county wouldn't be overrun by visitors from unsafe counties, making the county unsafe again. Maybe you could find a county so remote it wouldn't matter but whether those extremely isolated places are opened up now or not probably doesn't matter either way. I doubt they're much effected by this situation regardless.
Are you thinking of the people who would be willing to drive far distances simply to, for example, go out to eat? I would assume that this analysis would be included. Close proximity to a large population that's on lockdown is, in my opinion, a reason to keep the lockdown in a county, even if that county doesn't yet have many cases. But the next county over might or might not open up. Sure, people near the border from the second county will just go into that third county, and that's fine - as long as there aren't too many people coming from the first county.
Politicians and pundits simplify and say stupid things, when taken literally, but when it really comes down to it no one is really suggesting that the state of affairs within a county be the sole determining factor for the degree and form of economic activity which will be permitted. We have to look at the larger region. But once we look at the larger region, it will probably make perfect sense to completely lift the shutdown in some counties (esp. in Alaska, Montana, Wyoming, etc) while keeping a strong shutdown in other places.
Edit: I assume that we will also be looking at individual industries independently. Can the companies in a certain industry in a certain region reliably commit to following strong anti-COVID practices? If so, we might let them open up, while other industries are not allowed to. We don't have the time to create certification bodies or licensing departments to handle these specifics, so politicians will just have to make the best decisions they can.
I don't imagine there will a increased multiplicity of confusing rulesets beyond what we have now, either. Many counties will simply adhere to some standard recommendation from their state, and the rest will copy one of a small number of recommended levels along a spectrum of openness.
but i routinely see people with masks and gloves on while walking outside. not shopping, or going to shop, just walking. it's so odd, and frankly, wasteful.
I think I disagree.
It seems that face masks are quite effective in reducing the spread of illness. For example, look at the numbers in South Korea, Japan, etc. (where mask-wearing is common) compared to ours. Masks don't need to do 100% of the job -- rather, we would hope that in combination with moderate social distancing, better hygiene, improved testing, etc. we could reduce the rate of transmission. If each infected person spreads the illness to an average of only 0.9 others, then it won't do much more damage.
Now, from an economic angle, the US government just passed a $2 trillion stimulus package, which works out to about $6,000 per American. There are calls to spend much more money. Suppose we spend 5% of this on face masks, so $300 per American.
Currently, face masks can be bought at $20 for a box of 50 on Amazon. That gets 750 face masks to every American, at a cost that is cheap relative to the other costs of Covid-19.
And this is ignoring economies of scale. If the government decided to distribute free face masks in every school, every restaurant, in every theater, etc., then it could produce them at much cheaper than 40 cents each.
All in all, it seems like a potentially good investment.
it's a virus that rides on tiny masses of water to hopefully jump into the nasopharyngeal cavity of the next host. if it doesn't make it to those warm and juicy brachiae, it exponentially decays to the elements in hours. relative to air, those virus-laden water masses are heavy. most fall at your feet. some fly a few feet. very few make it many feet.
then imagine your chances of making a full-court basket (94 feet, 9.4" diameter ball in 18" hoop) and then divide those odds by the several orders of magnitude smaller that viruses are relative to us.
wearing masks (or gloves) outside makes no sense. you might as well walk around with your own lightning rod too then.
emergency personnel, medical professionals, and essential business workers should wear masks because they are at elevated, face-to-face risk.
This is an extremely strong statement. Although it might be plausibly true, my impression is that the transmission of the disease isn't well enough understood to make such assertions with confidence.
Can you cite a reference for your claim?
I think it is agreed that physical distancing alone while inside of closed spaces with strangers is an extremely good idea. Wearing masks is, potentially, also an extremely good idea.
Shouldn't we adopt any and all measures that have the potential (not certainty; potential is enough) to substantially cut down on Covid-19 transmission, and whose economic and other costs are comparatively modest? Even if we later determine that only one of these measures was really necessary, I doubt that we'll regret our efforts.
There seems to be a huge difference in the trajectory of cases in Japan, vs South Korea, so I don't know what you think you're saying, if you group them together. In South Korea, cases went up and then apparently flattened out almost completely. In Japan, the graph I saw has been lower than in other places but is, almost uniquely, not flattening so far, even in the way that Italy or the US has.
So it makes no sense to me to combine them and say "look, that is the example". If one is the example, the other most likely isn't.
Putting on a mask takes a few seconds, so compared to all the suffering it might prevent, even at 0.01% probability, it's well worth it.
risks differ with context.
A plausible rule of thumb seems to be: if you could smell someone's cigarette smoke, you could inhale their viruses. I certainly smell smoke from smokers I pass on the street.
but here's some additional intuition:
1. it's true that virus particles are roughly the same size as smoke particles, but infected people exhale virus "pucks" that are agglomerations of multiple viruses and water, leading them to fall while smoke floats (giving us the 3-6 foot rule, per prior coronavirus studies).
2. a single virus particle in the air without water could float around but is overwhelmingly likely to fall apart quickly. the air doesn't provide the countervailing forces to keep it together, and the bombardment of energies from all around also pull it apart.
3. the fact that a homemade mask allows smoke right through but filters out some portion of the virus pucks (as per your prior link) is evidence in itself of the differential affinities of smoke and virus pucks.
but let's face it, most people wearing masks (outside) do it because they think it's protecting them from the filthy other people. however, if you're sick, all you're doing is concentrating the virus pucks in one place right in front of a face we'll each touch 30 times an hour. no lay person consistently observes the contamination rules that hospital personnel do, especially when infection rates are <0.1% and failure to do so has no obvious downsides. masks could in fact be more dangerous because of a false sense of security.
Basically, just like you don't want to overwhelm hospitals, you don't want to overwhelm your contact tracing infrastructure
And, honestly, the US numbers are highly inaccurate as well due to a simply lack of an ability to test (instead of a lack of will to publish the real numbers).
https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
https://www.cdc.gov/healthequity/lcod/
At least that is what I could find. I was curious to see if I could find some month to month chart on all deaths for March, February, and January. I could not find one.
@MarkLevineNYC BREAKING: NYC publishes, for first time, data on fatalities that includes "probable" cases (those without a confirmed test result).
It has pushed the death toll in NYC up by 57%.
Was 6,589 before this adjustment. Now stands at 10,367. This is a painful but necessary accounting.
Have you seen any of the photos of the packed subway trains, a week and a half into the lockdown? Seattle doesn't see that sort of thing even in rush hour.
Likewise, if you live in a highrise in New York, you're going to be taking the elevator to go get groceries. Usually with other people...
New York didn’t think they’d top Wuhan.