Most new NY coronavirus hospitalizations are from people who stayed home
cnbc.com
cnbc.com
The relevant metric is how many fewer people have caught it due to the lockdown, and assuming the numbers are accurate, it's pretty clear that the lockdown has substantially reduced the infection rate.
It also could be those easy targets get infected first, then people indoor. Either way, the metric seems to be not very helpful and extremely misguiding.
66% of the people in the hospital are people who normally live at home. What percent of the normal population lives at home - 90%?
NYC has been on lockdown for weeks. A very large percentage of the city is staying home. Some completely isolated, but most are not completely isolated.
People have periodic contact with family, friends, neighbors, pharmacies, grocery stores, and/or delivery people. People who live in buildings with shared common areas (doors, entryways, elevators, mail rooms, laundry rooms, ventilation systems, etc.) cannot help but risk some exposure. Masks and social distancing are not 100% effective.
It's actually been since March 22nd so well into its second month now. When the order is lifted on the 15th it will be a week shy of two months. On it's face anyway the news definitely isn't encouraging.
"He said the information shows that those who are hospitalized are predominantly from the downstate area in or around New York City, are not working or traveling and are not essential employees. He also said a majority of the cases in New York City are minorities, with nearly half being African American or Hispanic."
"Cuomo said nearly 84% of the hospitalized cases were people who were not commuting to work through car services, personal cars, public transit or walking. He said a majority of those people were either retired or unemployed. Overall, some 73% of the admissions were people over age 51."
It doesn't surprise me that the rate of infection by those staying home, that are in poor neighborhoods and minorities, is high. How many of those households have an essential worker in their family? How many of them might be living in large multi-generational families where one or more are instacart shoppers, Uber/Lyft drivers, etc?
We need more data before we can really determine if this is surprising or not.
I'll tell you what I thought immediately after seeing those photos: - First reaction: OMG, those people are not social distancing and are putting everyone at risk. - Second reaction: If those essential workers can't deliver food to all the people trapped in their apartments, society would collapse very quickly.
I personally find this alarming that there is still widespread community spread. In my more rural state I think there is community spread, but nursing homes and long term care facilities are still dominating hospitalizations and deaths.
In the countries that were effective at stopping the spread, they quarantined sick people outside of their house. Since transmission is so effective its almost a guarantee that the rest of your household will catch it if you stay home, either by touching a shared doorknob, then touching their face, or by droplets landing on surfaces, or any number of other mechanisms.
We should seriously consider paying for hotel rooms for people that test positive. The total cost would likely be far lower than letting them infect the rest of their family.
You should probably expect it - you only end community spread in short order with R=0. With, say R=0.5, you get something like a ten day half-life for number cases. Furthermore, tests tend to have ramped up after social restrictions, so number of new cases isn't a useful figure outside of the context of % of positive tests, and deaths are a lagging indicator.
In both France and Italy seven weeks of hard lockdown have only reduced deaths to about a quarter in that time-frame.
What are those hints exactly? Cell phone tower data, metro card swipes, bandwidth usage? I'm guessing it's not yet warm enough for power consumption(ACs usage) to be an indicator.
[Edit] It was a mix / not sure -https://www.washingtonpost.com/archive/politics/2003/04/18/i...
Faecal oral transmission is an active research topic, but it does not appear to be a major infection vector. There is no evidence to date that this has occurred.
https://www.who.int/news-room/commentaries/detail/modes-of-t...
https://www.cdc.gov/coronavirus/2019-ncov/php/water.html
https://theconversation.com/we-dont-know-for-sure-if-coronav...
Living in Brooklyn in a predominantly hispanic neighborhood (relevant only because the article mentions it hitting black and hispanic communities hardest), had to venture out this weekend for the first time in weeks to facilitate moving apartments.
Observations:
1. An incredibly high amount of people are out and about, even people who seem to just be socializing, standing around / hangout out on their stoop, talking to friends or neighbors, having small 5-15 person gatherings or cookouts (on their stoop), or going for walks (without pets). There is a big culture among natives of socializing outside in front of your building, gathering to share in smoking, eating, listening to music, and chatting, which is honestly a beautiful thing about New York when it isn't a pandemic. But these gatherings seemingly haven't decreased, at least not to the degree one might expect.
2. An incredible amount of people have access to surgical masks. This was news to me as I figured stocks were still depleted, but it turns out that they are to be found in a variety of pharmacies, groceries, hardware stores, bodegas etc. just at inflated prices and in small batches. I purchased a replacement pack of 6 surgical masks at my grocery store checkout counter for about a dollar each. I would estimate 80-90% of people in public here are wearing a mask, mostly surgical, a minority KN95 (also was available at the grocery I was at in individual units at a fairly high price) or bandana/improvised masks.
3. A huge percentage (maybe 30-45%)? of people that I see wearing masks seem to be putting them around their chins or wearing them over their mouth but with nostrils exposed or hanging around their neck. Or I see people pulling them down and only pulling them back up when they walk by someone or go into a store (most stores have signs on the entrance requiring masks but state that improvised is OK).
It's incredibly frustrating seeing people wearing PPE incorrectly and/or treating it as optional outside of stores.
4. The young transplant/white/yuppie minority population in the area seems to be either wearing masks correctly, clutching their grocery basket tightly with a stern look on their face or alternatively treating the whole thing like a joke and walking their dogs outside shining new development luxury buildings with a look of glee and wearing no masks at all. For the most part they are not to be seen at all except for seemingly in a grocery store or walking back from one, or walking a pet. Where I would normally see dozens of young, predominantly white hipsters in bars or at restaurants, coming and going to the subway, or just walking, now I see 10-20% of usual traffic of them.
5. Older people seem to be more likely than younger people to be wearing no mask, to be wearing a mask incorrectly, or to be just standing around on their front porch/stoop aimlessly.
Anyway, these are not meant to be construed as directly relevant as evidence for a cause for the present infection demographics as we don't have a complete picture of initial infections, of percentages of population that can work from home vs works outside as essential workers, etc.
But certainly if you asked me about what my hypothesis might be about the causes of minority populations in NYC having bad outbreaks, I would say we can't ignore self inflicted wounds due to bad education or cultural disregard / machismo around rules and authority, skepticism towards government or science, etc. No idea what the solution would be besides reducing inequality and lifting people out of poverty, improving their education, or role models within the communities stepping up and speaking out to those who flaunt social distancing.
Lastly, I don't think these communities are alone in not abiding by quarantine as much as they can, I think most of the United States is being as lackadaisical, but the initial seeded infection just had much more time to develop here unchecked so we're seeing those much worse outcomes despite most of the country also breaking social distancing rules in a multitude of ways.
Where a surgical mask is 95% effective at preventing transmission; This is reasonable use.
*If only pulled up before interaction and taken off only after interaction, and treating hands that touched the mask as contaminated after taking it off, you maintain the 30% reduction in contracting the virus.
> or to be just standing around on their front porch/stoop aimlessly
If they're not within 6' of another person; there is nothing inherently bad about being outside.
I think we're still waiting on data on how much virus gets in the air from normal breathing, but it seems plausible that it's not insignificant and may be reduced drastically by you wearing a mask. If you're leaving a cloud of virus in your path, putting on a mask for only the few seconds you're passing someone isn't going to do anything about the cloud of virus you could possibly be leaving in your wake.
> If they're not within 6' of another person; there is nothing inherently bad about being outside.
6ft is a bit of an arbitrary number that's easy to remember, but people are treating it like it's some magic shield. Time spent in proximity presumably plays a factor as well. Walking quickly past someone at 3ft away is probably a lot safer than standing 10ft away from someone and talking for ten minutes. Being outside certainly should help, but in a place with a high concentration of people with the virus I would not consider it a safe activity.
You don't leave a "virus cloud path" behind you. It just follows the wind in random directions and quickly disperses within a few feet to concentrations that are safe (studies have shown that viral load of initial exposure is a significant factor in disease severity). Below a certain concentration, your immune system will just handle the few viral cells which landed on you.
I would challenge the 3ft vs 10ft thing as actually being a big stretch. I think further research is needed to say anything about that for sure, but keep in mind that beyond some certain distance, probably around 10 feet, distance stops mattering. In some sense, 100 ft is the same as 1000 ft. I would guess the threshold where distance stops mattering is somewhere between 6ft and 10ft, and realistically 10ft should be safe.
We don't know what a "low viral load" means for infectiousness.
Yes, maybe you fight off the virus successfully after being exposed to a low amount of virus. But perhaps you are infectious for 2 days and infect 2 people.
Who each infect 2 people.
Who each infect 2 people.
Who each infect 2 people.
I shouldn't have to explain this here...
2 4 8 16 32 64 128 256 512 1024 2048 4096 8192 16,384 32,768 65,536 131,072 262,144 524,288 1,048,576
One way the phrase is used refers to severity being dependent on initial viral load. That's what I think you're talking about. Someone can have a mild infection or asymptomatic but still be contagious.
What jsharf is referring to is that below the infectious dose, exposure to the virus doesn't necessarily develop into an infection. This idea is explored here: https://erinbromage.wixsite.com/covid19/post/the-risks-know-...
It's palpable the difference in behavior across demographics. I can even experience ramped up activity just going through the freeway through certain cities, some are dead, others are pretty active. Would be a great lil documentary with a dash cam sampling different neighborhoods. Population density is a function of the differences as well I'd imagine.
In Palo Alto, I see some people out and about but almost everyone is wearing a mask, sticking with family groups, and mindful of keeping a distance from other groups of people. The only exception is parks, which I avoid like the plague.
This fixation on masks is puzzling to me. The evidence for their effectiveness is weak (particularly for non-medical masks) at best, and people have turned "social distancing plus masks" into "masks plus social distancing", which is exactly what public health experts were trying to avoid.
As you've noticed, a huge percentage of people don't know how to wear masks or don't care to know. Even if they do know and care, it's incredibly inconvenient and difficult to wear a mask properly, so people generally don't. Moreover, as you've also noted, people are consuming medical equipment that really should be reserved for professionals. It's exactly what researchers said would happen when the mandatory mask idea was floated, and it's why the CDC didn't recommend masks in the first place (and why the WHO still doesn't).
More and more research is calling out mask laws as a questionable idea:
https://www.cebm.net/covid-19/covid-19-masks-on-or-off/
https://www.dora.dmu.ac.uk/bitstream/handle/2086/19526/Face%...
https://bmjopen.bmj.com/content/5/4/e006577?ijkey=24b32ab627...
https://www.medrxiv.org/content/10.1101/2020.04.01.20049528v...
https://www.cidrap.umn.edu/news-perspective/2020/04/data-do-...
https://www.bmj.com/content/369/bmj.m1422
And yet, every day, I see comments judging people for not wearing them, not wearing them properly, etc. Again, there's little evidence for doing it, they're misused/misworn in practice, and they seem to lead to a false sense of security. Why are we doing this, again?
(I think wearing masks makes sense as long as there's a chance they'll help—but I don't think there's evidence that they necessarily do help either.)
Ok, say most people fail to use masks to protect themselves (they take masks under their skin for example) but how does it affect protecting other people? Considering that many cases are first asymptomatic then wearing masks may considerably limit the spread.
This is not complicated.
Every Single Avoided Infection Reduces The Pandemic.
Whataboutism is irrelevant.
The virus simply does not care about logic.
It only cares about math.
If I'm infectious and wear a mask and avoid infecting you, then you and everyone you would have infected do not get the disease (from me).
If I'm part of 5% of people who are actively trying to avoid spreading the infection, then it probably does not matter much and the virus spreads and spreads and spreads.
If I'm part of 90% of people who are actively trying to avoid spreading the infection, then it matters a great deal and the virus vanishes.
That is why we are doing this.
It is dangerous to equate "acts as I do about X" with "cares about X".
No, you're trying to apply logic with incorrect data.
Corona is so contagious that nothing short of a Level 4 biohazard facility can stop it, if that.
> That is why we are doing this.
No, it's just feel-good corona theater. We need herd immunity sooner than later. Let's get to 80% ASAP!
We do not have to avoid 100% new infections. Just enough that R0 goes below 1.
How long do you think herd immunity will last because its up for debate. What should we tell the families of the 0.08 - 0.8% of the world population who died when it turns out to not be long? Even if herd immunity lasts forever, if we get a vaccine months later many died for no reason.
It’s to protect other people from you.
The problem is that in order to be effective, everyone must be wearing a mask, and wearing it properly at all times.
This includes when they are talking on their cell phones. You’ve seen people pull their mask down, while talking on their phones. Well, these people may be spreading the virus around when they do that.
The problem is that masks are not effective, and the sources I cited demonstrate this.
The Chinese were able to halt the spread of the virus through combinations of social distancing, physical isolation, lockdowns, and wearing masks in public, whether N95 or KN95.
Gloves also help limit the spread, but you have to be aware of not cross-contaminating everything. As well as hand sanitizers.
Obviously, wearing the masks alone will not do the job. You need a full spectrum of behavioral changes, in order to halt the spread of the virus. Especially the combination of social distancing, plus masks. And everyone must get educated about it. No excuses!
But at this point, you have to question if all this is worth it, as states are opening up prematurely because people want to go to the beaches.
Hell, I want to go to the beach too! But the virus containment fight is not over.
The 2nd wave is coming, and it’s going to be bad!
Besides, it is not important to protect everyone. It is just enough to reduce R0 below 1.
1) They're trained in correct PPE use
2) They wear a full set of PPE
3) They're supervised when putting it on and taking it off to avoid contaminating themselves
4) They have dedicated areas to don and doff PPE.
5) They use huge amounts of PPE. (A team will use about 30 sets of PPE per ICU patient per day.)
6) They have access to alcohol hand gel (often carrying it on them)
7) They have plentiful and easy access to handwashing facilities - elbow operated faucets, soap, running water.
8) They've been trained in handwashing, and they are regularly audited in handwashing.
If a person only puts a mask on while being inside and otherwise wears it under the chin then well, bud luck, not much change to avoid infection but when infected, this person will spread it less likely to somebody else who is handling the mask properly.
Btw. did you realize that the second link you provide supports the opposite conclusion?
"On this occasion, we believe public-facing communications regarding the scientific view on the balance of risks and benefits of widespread uptake of face masks have exceeded the scientific evidence base. Efforts to communicate a position so strongly in favour of widespread use of masks in the community, against current WHO advice and in the face of persistent evidence gaps and debates, risk promoting policy that is based more on eminence—the track record, credentials and status of the authors—than on evidence."
I am not claiming that masks are the only solution. Quite to opposite. The solution is a combination of multiple measures.
The most effective has been early social distancing so far.
Yet also:
"Most new Covid-19 hospitalizations in New York state are from people who were staying home and not venturing much outside, a “shocking” finding, Gov. Andrew Cuomo said Wednesday."
Seem contradictory, no?
From the data it’s not clear that shelter in place orders have had anything other than a marginal effect.
I do some contracting work for a British company, and had some extremely unrealistic deadlines looming in late February.
For this reason, I was keenly watching their government's announcements at the time and was amazed as weeks went by and my country's restrictions got tighter and tighter while the UK didn't budge.
Now, in May, it's not exactly apples to apples but they're now the hardest hit (deaths-wise) in Europe, and my country has dropped down below 1000 active cases (and decreasing some 50/day).
You could probably substitute my country for almost any other early mover and the UK for almost any other late mover and arrive at the same result. Even across different pandemics.
"Moving", here, means locking down.
Given that, my personal biases lead me to think that lockdowns probably work. I have to acknowledge that there's a moderately high bar set for data which disproves this thesis, because it's just so damned intuitive.
This doesn't meet that bar.
In reality though, I feel like in comparatively sparsely populated places like Sweden, New Zealand, etc. there's not a lot of difference at this point between a supermarket with significant social distancing imposed and a cafe with significant social distancing restrictions imposed.
It's once you get to the densities of London, NY, Madrid, Rio and Paris that the difference starts to become important.
From the perspective of reducing the spread, this should mean that many of the US states should have been able to emulate Sweden's approach (inform citizens and trust them to cooperate - up to the reader to decide if this translates between Scandinavia and the US), and many are trying to. I guess we'll see, but I think it's pretty clear that if you're New York you don't have that option on the table.
But it's also about the relative danger. Hospitality staff in South Australia right now, were that state to return to "business as usual", probably aren't being asked to risk their lives. That is and has been a different story in different states and cities around the world.
It was fairly evident that every country will end up in a lockdown except that the countries where it was applied early did not encounter huge loss of life.
What data are you referring to that suggest shelter in place orders could be having only a marginal effect?
We're living in a hyper-partizan country right now and everything published about this virus is going to be taken by both parties as a way to support their case and attack the other. Until there's another civil war or the country decides to break into smaller nations this is only going to get worse.