San Mateo County Health Officer Statement on Bay Area Stay-at-Home Orders
smchealth.org
smchealth.org
While I detect a hint of futility in this statement, I am nonetheless deeply heartened to know some public health officials are themselves questioning some of the simplistic premises that have been driving policy to this point at all levels of government. Really there at least three attributes that I see in this statement that I don't typically see in utterings of our bureaucrats:
1) I actually get the sense of outright honesty from this statement. Not some overly messsaged, PR driven/reviewed statement by some spokes-hole. I actually think this statement is really what this guy believes... a public statement that even expresses some vulnerability. Despite the subject, very refreshing and I'd be more likely to listen seriously to what he has to say in future.
2) Struggling with right and good uses of power and seeing not using one's power as itself a public good. Good heavens... this guy should run for President! I expect I'd disagree with much of his politics, but I'd vote for him just for having such thoughts and expect the nation would be better off no matter his other leanings.
3) Questioning the mandates, their effectiveness, and whether they might be causing more harm than good. And not doing so from some artificial posturing to show "the right politics", but honest, genuine questioning.
Whether you agree or not... I wish more of our public officials were this thoughtful on critical issues such as face us in this pandemic.
And especially in the context about the use of power, the acknowledgement that imposing a lockdown doesn't actually necessarily change people's behavior all that much is a really good point. We've definitely seen that there are some that will intentionally do the opposite if they feel their freedoms are being impinged upon, so if it's not going to actually make an improvement, the gesture could be a huge mistake.
Within a week, positive tests started declining significantly. The lockdown ended on the 2nd of December.
Within a week, positive tests started going up again.
https://www.theguardian.com/world/2020/dec/08/covid-cases-an...
There is plenty of evidence that lockdowns do work. Whether they make sense from an economic or overall quality of life perspective is a separate issue. But they work.
...because there is no data.
Outcomes are also not binary (life or death). There is also the possibility of a gamut of lifelong health problems from, e.g. scarred lungs, for both kids and parents.
[1] 12.7% deaths and 29.1% cases https://www.sccgov.org/sites/covid19/Pages/dashboard-demogra...
First, I think that you are implicitly assuming that there are an equal number of people in each age category. In addition to the percentages you quote, you also need to know the percentage of the population per age range. Second, the "case" rate is the not the same as the "infection" rate, as it only includes confirmed cases. It's usually assumed that for each confirmed case, there is some unknown multiple of this number of infected individuals.
Eyeballing the chart here (and realizing that Santa Clara might not match these numbers, and guessing equal number in the relevant 5 year age ranges) a better estimate of the death rate for the 40-60 year old group is probably something around .15%: https://www.acsh.org/news/2020/11/18/covid-infection-fatalit...
Arguably this reduced the pain, while also reducing the effectiveness of the lockdown measures. It's a fine balancing act. It's hard to compute precisely, we're not yet good at it as a society. That said, expecting people to work while having children at home and at the same expecting grandparents to stay isolated, puts people on a very tough spot. How do people cope with that in places that kindergartens are still closed?
There is a major complaint here against the lockdowns. They have positive and negative outcomes and there is very little evidence that the two sides have been weighed against each other. The scale of the damage done by our response is too great to accept best effort attempts to control the disease. The standard of the response needs to be excellence, not competence.
We also can't discount the possibility that there were easier, less invasive measures than lockdowns that captured a lot of the benefit without the costs. It has been a chaotic year but there is no natural law that says every time there is a pandemic the only option is to scuttle the economic ship.
The UK's number of COVID-19 patients in hospital peaked at 19,500 in mid-April and fell to 800 by the start of September.
That's despite things like the 'eat out to help out' scheme that ran until the end of August.
Schools and colleges re-opened in September [1] and the government started "encouraging" workers back to offices [2] - and admittedly, by the end of September patients in hospital had only risen to 2,400.
But by mid-November we see the second wave peaking at 16,500 hospitalised. Today, as we come out of the second lockdown, there are still 15,000 patients in hospital.
The UK has not demonstrated that schools can safely be kept open.
Unfortunately, as the geniuses in government decided to reopen schools and universities and offices all at the same time, it's difficult to directly attribute the second wave to any single policy decision.
[1] https://www.gov.uk/government/news/schools-and-colleges-to-r... [2] https://www.bbc.co.uk/news/uk-53942542
From our data, it doesn't appear that schools were a massive driver of transmission.
We know that kids don't spread it as much as they do the flu, so on balance, keeping schools open seems like the better course of action as long as it's not a major driver of infection rates.
https://www.theguardian.com/world/2020/dec/08/covid-cases-an...
We shouldn't expect hospitalised cases to fall immediately - although they have been falling for the past week or so. Lockdowns - even excluding schools - clearly are effective at reducing transmission rates below 1. Unfortunately the lesser measures we're currently under don't seem to be - as cases have plateaued and are starting to rise again.
For a good reason.
By almost all the statistics, the second wave hasn't been as bad as the first. Comparing peaks, measures like "Deaths within 28 days of positive test" (942 vs 486) and "Weekly deaths with COVID-19 on the death certificate" (9,495 vs 3,371) and "Patients in hospital" (19,518 vs 16,421) and "Patients in mechanical ventilation beds" (3,252 vs 1,461) say the second peak was about half the height of the first one.
On the other hand, "Cases by date reported" peaked at 5,113 in the first lockdown and 25,329 in the second lockdown - making the second wave 5x higher than the first. Presumably due to a lack of test capacity.
If I'd chosen the one metric which makes the second wave look 5x the first instead of 0.5x, that'd be a pretty deceptive way of describing the results of government policy (although technically accurate).
During our second lockdown the increase in cases did slow down a bit, but only a bit. One could argue, that the soft lockdown didn't really work that well, as it didn't turn the ship around.
The interesting part of the statistics was, that the age bracket of 20 - 35 was the only one with reduced infection numbers during the 2nd (soft) lockdown. So all positive effects from this age group were totally negated by every other age bracket - be it school children (massively increased numbers due to open schools), of kinder garden kids (same with open). Or also older people seemingly (no idea of the reasons) contracting Sars-CoV-2 at an increased rate during the soft lockdown.
I have no idea for why these other age brackets have increased numbers. Could be that these are also the age brackets were you find the most critics, but that is just a totally unproven hypothesis of mine.
Could be that behavior changed in regards to the first lockdown and people do not keep their social distancing as much as they did (that is just anecdotal evidence from encountering people not keeping their distance while grocery shopping).
You can see this very well in the heatmap of cases by age group here: https://www.berlin.de/corona/lagebericht/desktop/corona.html...
It worked particularly well in Victoria, where a second lockdown turned a ~700 case per day nightmare into 38 straight days of no deaths or locally acquired cases.
New Zealand also used a lockdown strategy. stats: https://www.health.govt.nz/our-work/diseases-and-conditions/...
Suicide rates in the most affected Australian states were surprising: https://www.theguardian.com/australia-news/2020/nov/09/suici...
The lockdowns were terrible for many people - for all the reasons you can imagine. On the other hand, I doubt anyone here would now argue that those crazy times were a mistake.
From March
"The Silicon Valley Doctor Who Doesn’t Mince Words on Coronavirus Threat"
Not only mandates are completely ineffective (compared to the other much better alternatives) some of the folks like me feel compelled to call BS on many of the "dictats" and make it an ideological issue. At that stage, states credibility reduces even further.
And, to be clear, what makes you say they are ineffective? Because literally everything I’ve seen everywhere says that those three things are basically the only things that have been effective.
Education, facts, and increasing public consciousness seem like they’d be more effective than mandates for private gatherings. People who would follow the mandate in private would likely also follow educational campaigns. Voluntary compliance based on understanding works everywhere. Mandates only work where you can be seen.
they are using the pandemic as convenience to an extent. they don't have a holistic solution and they don't know what they are doing.
yes, it does keep case numbers lower and lagging.
the health official here is right though.
> I think people should stay at home, avoid all non-essential activities, wear masks, and not gather with anyone outside their households. I’ve been saying this for about 10 months now. If you didn’t listen to my (and many others) entreaties before, I don’t think you’ll likely change your behavior based on a new order.
I disagree with this wholeheartedly.
People are getting a LOT of pressure to see family right now. Strong messages from people in authority absolutely will cause some people to think more about this. It also gives them an external authority to appeal to when resisting peer pressure.
Yes, you're not going to get the dipshits.
However, being able to tell family, that you maybe didn't even want to see all that much anyway (a lot of people only do the extended family thing out of obligation at the holidays), that there is an "Official Order(tm)" to "Don't gather" helps.
This is similar to official "mask mandates". This helps because a store can now say "Sir, the city/county/state has issued official orders to wear masks and we will have to ask you to leave if you don't wear it." An official mandate gives the store political cover. It also gives the average citizen the ability to ask the store to kick someone out who is non-compliant.
The "Bully Pulpit" is a real thing.
My kid's scout troop is still meeting, kinda sorta complying with the letter of the order. I have advocated multiple times with the leadership to stop the meetings or at a minimum restrict them to small, stable groups, but I am the only one who feels that way. Perhaps a more severe shutdown would persuade them, but perhaps not. I wonder if just a few token enforcement actions, such as pulling people over and asking if they are complying, or modest fines for the local megachurch with 95 cars in the parking lot on Sundays, would go a long way toward making people think twice. There's a common feeling that if something is legal, it's OK, and I find that's rarely true. It's legal to fart in an elevator, but that doesn't make it right.
BTW, the "bully pulpit" specifically
It takes a lot of guts to just look objectively at the data and do what you think is right, regardless of what pressure you’re getting from the media, the state, the governor, your peers in other counties, etc. Not to mention, publicly call out the defects and contradictions in the state level orders. Much respect for this man.
> “But what we have before us is a symbolic gesture, it appears to be style over substance, without any hint of enforcement, and I simply don’t believe it will do much good. I think people should stay at home, avoid all non-essential activities, wear masks, and not gather with anyone outside their households. I’ve been saying this for about 10 months now. If you didn’t listen to my (and many others) entreaties before, I don’t think you’ll likely change your behavior based on a new order.”
> “Being in the purple tier, the State has already put significant restrictions on businesses and the public space in San Mateo County. I am aware of no data that some of the business activities on which even greater restrictions are being put into place with this new order are the major drivers of transmission. In fact, I think these greater restrictions are likely to drive more activity indoors, a much riskier endeavor. While I don’t have scientific evidence to support this, I also believe these greater restrictions will result in more job loss, more hunger, more despair and desperation (...) and more death from causes other than COVID. And I wonder, are these premature deaths any less worrisome than COVID deaths?”
The reason for the lock down is to prevent numbers from skyrocketing - the anemic response from the US ensures long term economic damage due to failure to control the outbreak - the question becomes one of what the numbers in Sean Mateo will do over the next few weeks compared to the surrounding cities. Ignoring of course infections spread to the surrounding areas by San Mateo remaining open.
This suggests he is aware of data indicating that some of the business activities being restricted drive transmission, just not all of them. (I'm guessing maybe, say, indoor dining?) So should those known to do this be restricted or not? Did restricting them previously help or not? Should we ignore them?
So, I'd say Dr. Morrow is aware that some of the restricted business activities drive transmission and he's supporting those restrictions. There are other activities -- like outdoor dining, as long as you're not putting diners in circulation-restricting tents -- that seem to be lower risk, and could probably further mitigate risks by having limitations on group size, dining time, etc., rather than just a point-blank ban. And there are some other restrictions which just seem more like theatre, such as curfews. Do we think coronavirus is nocturnal?
> Should we ignore them, then?
I'm not sure how useful that question is for folks who don't run businesses facing that decision. If I was a restaurant operator, I wouldn't flagrantly flout the local regulations even if I disagreed with them. I'm not, though, and the restrictions that more directly apply to me as a citizen -- e.g., try to stay at home during this surge, don't gather in groups even with folks in your "quarantine bubble" -- don't seem that wildly unreasonable.
The way I've heard some people explain it is that human behavior changes nocturnaly. After 10pm what are most people doing out? Nightlife and drinking overlap pretty heavily, social drinking and social distancing are kindof contradictory, and alcohol isn't known for increasing people's capacity for conscientious observance of safety practices.
The problem is that this is EXACTLY what they are doing.
One mexican restaurant near me has a nice parking lot that they converted to outdoor dining. Yes!
And then put a tent up with heaters under it because it got "cold". ARRRRGH!!!!!!
I haven't been notified about any of the details of any of the lockdowns. In the Spring, I encountered a group of people who had just been released from jail during one of my monthly shopping trips. Despite having just been in government custody, they didn't even know the basics about things like social distancing, much less any more specific restrictions.
How are these things supposed to be effective when it's so hard to learn about them?
Even with the link you sent me, that site gives no indication that it's a way to get updates on pandemic-related news and restrictions. It seems to just be an emergency subscription. What other messages does it send that aren't described in the FAQs?
1: https://www.nytimes.com/2020/03/12/us/coronavirus-san-mateo-...
This is directly from the horse’s mouth. This is San Mateo County’s health website.
Also Nextdoor.
Also if you subscribe to emails from your city.
Also the local news.
There's been a total of 164 registered COVID-19 related deaths in San Francisco county, the vast majority of which had other comorbidities, assuming trend[1]. On the other hand, there has been nearly three times (~460) as many deaths in San Francisco related to overdoses between January and August alone[2].
It's hard to disagree with his sentiment.
[1]: https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm#Co...
[2]: https://www.sfchronicle.com/projects/2020/sf-overdoses-inter...
I really hope SF can keep it that way. The recent trend is pretty scary, but if we all hunker down for the next month or two, we can still turn it around.
The USA overall has had about 86 confirmed Covid deaths / 100k.
And the USA total is likely a more significant underestimate than the SF total, as there are many places where there has been an abnormal spike of “pneumonia”, “stroke”, etc. deaths never attributed to Covid.
Even ignoring financial considerations, expecting people to have no in-person contact with anyone outside their homes for 9+ months is utterly unrealistic.
He has been a straight shooter from the get go, including a while back when he said the State's orders didn't make sense because they were all or nothing for opening up and he felt that many indoor spaces were not safe to reopen.
Unfortunately, it seems much of his frustration stems from the fact that humans suck at nuance with things like this but are absolutely amazing at rationalizing anything.
I wish I knew who he was referring to specifically when he says things like:
"I may have a different view of the power and authority I have, as a function of my position, than some of my colleagues."
If they are elected, I want them out.
Ultimately, it is disheartening that the people who need to hear his message the most will not read his post.
Maybe some of his colleagues believe that sheriffs report through the Attorney General, as per the California constitution.
If they are elected, I want them out.
Gasp!
One thing I've noticed is that the cases are not evenly distributed.
California has 600/1M new cases, vs 1000/M in South Dakota.
LA county has 740/1M. San Mateo County has 313/1M.
Within San Mateo County, San Carlos is 119/1M, and East Palo Alto is 675/1M.
Links:
https://covidtracking.com/data/state/south-dakota
https://public.tableau.com/views/COVID-19CasesDashboard_1593...
San Carlos is white, rich, and old. East Palo Alto it not.
Has anyone in San Mateo caught covid eating at a restaurant? How many?
Has anyone in San Mateo caught covid grocery shopping? How Many?
Has anyone in San Mateo Caught covid exercising outside? How many?
Has anyone in San Mateo Caught covid at school? How many?
Look I got covid while wearing a mask. Infection was either at a grocery store. Or while walking at a park. Or while at a dog park. Or who knows.
How do you log that in your stats?
If you get a positive test, contact tracers may ask you where you went and who you interacted with. They then call those people and ask them to get a covid test. IF the contact tests positive, then rinse and repeat. [3]
If I live alone and only leave my house to grocery shop, it is pretty clear where I got covid. Similarly, if Bob had covid, I had dinner with Bob, and now I have covid, it is pretty safe to assume I got at dinner.
Anecdotally, I had a friend who tested positive and the contact tracer told them that they had likely contracted while it shopping at a big 5 several days earlier.
https://coronavirus.jhu.edu/contact-tracing/state-survey-res...
Full disclosure: I've had covid.
We assume we were exposed at the clinic, where our kid needed emergency medical treatment. But if so, only one of us was with the child indoors -- in a cleaned room with a doctor in full PPE and us in masks -- and treatment lasted less than 5 minutes.
But by the time we experienced onset of symptoms, days later, we had been in close proximity with my in-laws (they need care and were part of our bubble) for over 24 hours. Luckily, they developed no symptoms and tested negative.
So 5 minutes of exposure to an asymptomatic carrier at the clinic likely transmitted the virus to us, but 24 hours in close contact failed to transmit the virus to my in-laws.
The delay of onset and inconsistent transmission patterns make this virus exceedingly difficult and expensive to track. Your questions are unanswerable.
As I responded to the sibling comment, I don't think that is accurate. Of course many, if not most cases can not be traced, many certainly can be. Some people know exactly where they got covid, and who they exposed, and where.
The US has 50,000 full time contact tracers working to collect this information. Surely there is some data by now?
>Your questions are unanswerable.
IF the question is categorically unanswerable (which I don't believe), contact tracing programs should be disbanded.
Instead, please think of it as "one of the most powerful, non-medicinal, mechanisms for interrupting disease transmission."
It accomplishes this through its overt actions: attempting to alter the behavior of potential and exposed contacts by encouraging quarantining for an appropriate length of time and to get tested if symptoms develop.
I disagree. Understanding how and where COVID spreads has been an essential part of contract tracing in all of the countries that have successfully implemented it. This data is absolutely collected by tracers.
http://publichealth.lacounty.gov/media/coronavirus/data/cont...
http://publichealth.lacounty.gov/media/coronavirus/locations...
Everyone living in a multi-generational household with e.g. grocery store clerks is at significantly higher risk than a couple of childless yuppies working from home.
https://www.gov.ca.gov/2020/12/03/california-health-official...
In SF case counts have been doubling about every 2 weeks; we started from a low baseline (relative to most of the rest of the USA) but another few doublings and we’ll be in huge trouble.
The state-level mandates are timed to be reactive instead of proactive; if we assume the restrictions are successful at curbing spread, we should enact them ASAP, before our hospitals are on track to be completely overwhelmed. (For that matter we should have taken strong steps before Thanksgiving weekend.)
It is extremely unfortunate that this is hammering small businesses; if the US had responsible federal leadership (if the Senate & White House hadn’t just sat on their hands for 7 months) we could do something about this (fingers crossed for January), but counties and even states have limited ability to provide large-scale relief of the type required.
But waiting to impose the same restrictions until the state mandates kick in, if inaction results in cases continuing to rise along their current trajectory, will lead to even larger economic devastation than decisive action a few weeks sooner.
What are you thinking of? Personally I think we could do much better at hiring contact tracers, getting test sites into vulnerable neighborhoods, doing general community outreach, making sure public-facing workers have sufficient PPE, figuring out how to get infected people places to isolate away from their households, protecting incarcerated people, etc.
But historically the USA has been heavily reliant on the CDC and the federal government more generally to muster resources and coordinate responses. When leadership is entirely absent (and indeed, federal officials are out lying about the pandemic every day), states have a tough time picking up the slack.
> look at people’s personal behaviors. I saw more and more people walking around without masks recently
From what I understand, a major goal of shelter-in-place orders is to convince individual people to act more carefully.
Even if things are OK in San Mateo, they don't have to deal with the cases of people who go there because there are less restrictions. That is the whole point of counties working together.
California’s page about this is an easy read: https://covid19.ca.gov/stay-home-except-for-essential-needs/
Which is why I highlighted the situation was quite bad in my county, yet the bay area as a whole hasn't triggered the state mandates. It should be both county and region based.
Even aside from his particular recommendations, I can't remember the last time I heard a government official talk like an actual human being in this manner. A breath of fresh air.
A mix of Mayor Garcetti’s (the city of LA) messaging mixed with the state and county orders, alongside two conflicting health department orders (Pasadena + LA County) have made navigating guidance totally confusing. There’s even infighting within the LA County Board of Supervisors, and talk of some cities to create their own health departments.
>14. The new State framework is rife with inexplicable inconsistencies of logic.
Not just that, you should read Garcetti’s stay at home orders last week, ordering people to stay home with 12 pages of exceptions.
>15. Beyond the basic human needs for air, water, food, shelter, and safety, it has, to date, been impossible for me to define what is “essential” to the 800,000 people who live here.
At this point, it seems like it’s up to the business owner to decide if they’re essential. Anecdotally I’ve heard of every small business owner here in LA call themselves essential simply because they “support essential infrastructure”.
This half-assed "wear a mask and social distance if you want" stance just made the economy sputter for a whole a year. I've seen this in France twice, where they've oscillated between doing nothing and doing a lot, a couple brief lockdowns can reverse things quickly even after things have gotten worse than they ever gotten in the USA. In Asia they managed to control the whole thing by trying to squelch it.
Just to be clear - it was near perfect and not 100%
How did a virus cause businesses to close permanently? This doesn't happen during flu season or even with the h1n1 pandemic.
not in Bay Area. These new nice outdoor areas with heaters etc. have been packed all these months.
> This aversion has little or nothing to do with government directives.
the businesses closure is direct result of the government orders. It is evidenced by how people flocked back to businesses when they [partially] opened. A well beyond middle age neighbor drove to San Mateo county for a gym and only 1 hour long line prevented her from going there more.
In Russia they came up with a new word - Coronoia, ie. "Corona + Paranoia", and your post is typical Coronoia style in that it ignores the straight reality and facts which are staring right into the face.
> virtually never take group outcomes into consideration when making choices unless forced to under the threat of violence.
Group outcomes are effectively a moot point. That presumes that the group, as a whole, has an agreed upon preferential outcome, and an agreed upon means of getting there. We do not (and basically never do, when it comes to the group). Some people want more stringent lockdowns, some people just want the lockdowns to be lifted. People who want more stringent lockdowns are averse to the risk of COVID, and are willing to sacrifice some of the joy of life to avoid it. People who want to lift the lockdowns are unperturbed by the risk, or are okay with allowing people to assume that risk to be able to go on with their lives. I don't see a clear winner from a utilitarian perspective; either really bad things happen to a small ratio of people, or mildly bad things happen to everyone. I certainly don't think the gap in net happiness is wide enough to warrant condescension about people ignoring group outcomes.
Melbourne AU — which is comparable to many European and American cities — eradicated Covid after 4 months of hard lockdown [1] combined with federal financial support.
Covid is the "endemic malaria problem" of 2020: just like malaria can be eradicated through water management, Covid can be eradicated through Australian-style government intervention. Today, both diseases are problems with clear and proven solutions.
Yes, undoubtedly government lockdowns cause some additional compliance from businesses and customers, but from what I saw in SF during the early days of the virus, a huge portion of the economical damage to local businesses was done due to the actions of individuals and businesses before the government even got involved with lockdowns.
The lockdown is not necessary in the first place.
In most places, hospital are not overloaded. Even in the event of overload, the correct measure should be to increase capacity, do not admit people with mild symptoms, etc.
Case number are misleading, vast majority of the case are not actually sick or only have mild symptoms.
Better test needed to be identify people who actually sick and need intervention.
If anything the lockdown could cause hospital overloaded due to delayed treatment and nurses being furloughed.
If you speak to any doctor or nurse they will disagree with you. While we might not be at a breaking point for number of beds, the staff that have to put themselves in harms way do have the option to just quit. When that starts happening in mass we are all screwed.
To say that lock down was needless because the worst case scenario isn’t proof the lock down wasn’t needed. It is evidence (not proof mind) that the lockdowns worked.
It’s like saying you didn’t need to save money because you never ran out of money so you didn’t need the savings in the first place
Its not like there is not enough healthcare worker looking for employment all over the country.
The lockdown was needless because it is worse than the risk if covid.
My experience of talking to medical professionals is that they consider a number like 50% reduction in infections "very little protection", because they (correctly) would use a mask providing 99% protection or whatever in any situation where real protection was needed. But outside of a hospital setting, epidemiologically, a 50% or even 20% reduction in reproduction number makes a big difference to the overall dynamics of an outbreak.
Meanwhile, here is a pretty good article about how healthcare workers are handling the pandemic: https://www.theatlantic.com/health/archive/2020/11/third-sur...
As additional anecdata, the sentiments expressed in the article are in line with what I have been hearing from healthcare professionals in my circle of friends.
Anyway, the government bureaucrats are naturally go for simple short-term game like lockdowns without doing any complex long-term thinking (which for example would be the things like efficient preparation for the second wave and achieving herd immunity with minimal losses and minimizing the total losses).
Covid itself is a result of such accelerated selection performed in that Wuhan lab - what is called "gain of function" experiments.
A natural example of a global virus evolution phenomenon was observed in the 2nd wave of Spanish flu - that strain was mostly killing by causing hyper-reaction of immune system and especially in the healthy 20-50 years old individuals, as the strains normally killable by immune system were cleaned in the first wave.
While all that is obvious, if you need a reference to authority there is a virus evolution discussion by a Harward guy:
https://myvoice.opindia.com/2020/04/evolution-of-virulence-a...
"Let’s assume that every propagule generated from the quarantined individuals has a very small chance of escaping isolation and infecting someone. Just because the virulent ones can make more propagules, they have a higher chance of surviving than the milder varieties. This means we are giving a selective advantage to the more virulent ones over the milder ones and as a result virus will evolve for increased virulence."
Are you saying this form of the virus was created in a Wuhan lab? As far as I know, that's 100% dead red conspiracy theory, but I'm open to learn more from reputable sources.
When I asked you for evidence, you try to reverse the burden of proof. No, you made the claim, you're the one who's supposed to prove something.
You mentioned Asia. I saw this headline today:
"South Korea's Health Minister Describes Seoul As A 'COVID-19 War Zone'"
By US standards, their case count is still incredibly low. The point is they haven't actually been able to contain it, either; they're just acting sooner and more aggressively for the second wave. Apparently New Zealand still has single digit cases most days.
If "half-assed 'wear a mask and social distance if you want'" kept the r0 below 1, lockdown or not, new cases would drop.
What's scarier is that the Bay Area, with ubiquitous masks, good-ish weather, partial closures, and lower population wasn't even able to keep new cases down.
Well yeah, after the first wave people threw all caution to the wind and decided to go back to their old habits. So of course cases are surging again.
This isn’t rocket science. Not sure why everyone is pretending there’s some sort of huge mystery. We know how the virus spreads.
They went into EXTREMELY hard lockdown for 6-8 weeks, and now they haven't had a single case in four weeks.
https://www.vox.com/2020/12/4/22151242/melbourne-victoria-au...
- Australia had had an unusually bad fire season and an associated scandal about the government response: our PM was on holiday in Hawaii while an unprecedented area of land was burning. The framework for state/federal cooperation on disaster management was being revised right as 2020 started, and there was political will for strong measures, such as ignoring WHO recommendations to let international borders stay open.
- Victoria had strong state of emergency/disaster powers, including the right to impose movement restrictions, and clear conditions and precedent for imposing them.
- The states had the power to close their borders, and did so, isolating the second wave to one state. Victoria was the odd one out - the other states set the bar at near-total suppression.
- The lockdown really, really sucked. The Victorian state government relied heavily on the support of the federal government, support from the general populace, and federal spending on income supplements. They still came under enormous pressure to end the lockdown early, even with more federal and individual support than states in the US would have gotten.
I’d contest that characterization of the Bay Area - even in Santa Clara County where I live, I’ve not seen ubiquitous mask wearing.
It’s not within the regions power to shut down the state and interstate highways.
Spread was going to come from the rest of the country no matter what they did.
NZ hasn't had any new cases in the general population for quite some time. The cases that NZ has been reporting are all recent arrivals undergoing the mandatory 14-day quarantine in an isolation facility.
Both Australia and New Zealand have shown (multiple times) that it is entirely possible to completely eradicate this virus using nothing more sophisticated than masks, social distancing, testing, and (targeted) strict lockdowns.
I wonder about this. I'd expect freight truck traffic in China to play at least as big of a role in distribution there that it does in Europe. China is a giant connected piece of land, and if their numbers are to be believed even in the slightest, it's clear China was able to keep Covid under control to a much greater extent than the western world.
Australia never fully halted interstate freight truck traffic, as it was deemed essential. I've heard Covid tests were given to truckies at state borders, but that seems possible for US states or European countries to do, even with limited resources. Is freight truck traffic really to blame for Covid spread, then?
And although Australia largely shut itself off from foreign crop labor, and is struggling to harvest crops given this, there's not all that much appreciable damage that I can see. Perhaps this was really a good season to err on the side of going short handed. Prices will go up, but the juice is worth the squeeze, it seems.
Also, Hawaii is an island, as is the UK. Alaska would seem to have similar advantages to an island state. Yet these islands are doing very much more poorly compared to Australia and New Zealand.
China's lockdown involved e.g. welding the doors of apartment blocks shut and forcing the populace to install a spyware app on their phones. Claiming that a Western country "could have just done like China" is basically saying that that Western country could have just junked all its civil liberties.
> And although Australia largely shut itself off from foreign crop labor, and is struggling to harvest crops given this, there's not all that much appreciable damage that I can see.
Things are different in the EU. After decades of the single market, keeping people fed absolutely relies on getting those harvests done with imported labour.
> I've heard Covid tests were given to truckies at state borders, but that seems possible for US states or European countries to do, even with limited resources.
Tests were in short supply for a long time. By the time they were available, it was too late to lock down as effectively as Oz or NZ. Again, you underestimate just how special those two countries are among Western nations.
Plus, you've got to remember that disease outbreaks grows exponentially, and exponential growth always has low numbers at the start until it doesn't.
In Australia, hard lockdown looks like the following:
1. International borders closed to all non-citizens, permanent residents or essential travelers
2. State borders closed per 1
3. City "borders" closed per 1 — happened in Melbourne
4. You can't leave your home for any reason not deemed essential
5. If you do leave your home for an essential reason, you must stay within 5km of your home, or have a job/emergency/essential imperative to travel further away
All of the above is enforced by police officers.
In Melbourne, they even closed off a high-risk, high density building for a while, just because the health authorities deemed it a risk.
Could you expand more on what these European "hard lockdowns" mean? Because at no point during this pandemic has any of the above happened in any American state or city, at least not to my knowledge.
The Australian federal government also enacted Job Keeper to suspend work hours yet keep working people employed, and took additional steps to ensure as many people as possible could remain on lockdown without a source of income. This was as important as — if not more important than — the hard lockdown enforcement measures themselves.
If the consensus of the region is net wrong, then we are irrationally sacrificing our regional economic health, and we are certainly also trading lives in the other direction as well. All policy choices from here have the price of blood.
I don't accept the position that a policy without robust enforcement is a non-policy, as I think government largely works by a compliant population that trusts their leadership; however, as it becomes increasingly apparent that some wins are purchased by the losses of others, the disparity will brew acute resentment.
I like that this is raised explicitly. There's lots of space for "lockdown with proper support" that the US is extremely unlikely to execute. But I don't think it's mentioned often enough that that's a possible direction.
I feel like those type of good value decisions are hampered by the lack of federal response. A cohesive "wear your mask", massive PPE manufacturing mobilization, and benefits would have really driven home the seriousness of the situation and provided people the tools to weather the storm. Bars are open because owners don't have many other options to support themselves. If the government provided support, that would surely reduce the overall amount of places where masks and social distancing aren't enforced, which in turn would allow for better enforcement of existing policies. All this results in a negative feedback cycle where the reduced cases improve contact tracing, reduce waits for tests, etc.
> what we have before us is a symbolic gesture, it appears to be style over substance
I think the problem with being idealistic is people will see this leader,(especially in liberal mecca that is the sf bay area or how ever those people talk now) will latch on to this as a reason to do keep acting irresponsibly and justify their behavior.
> Less overall mobility, means less spread. The take home message here is: STOP MOVING!
This is why all the counties should act together, otherwise people just go to the open place to do what they want. The adults act like children and need to be treated that way.
> I continue to strongly believe our schools need to be open. The adverse effects for some of our kids will likely last for generations.
This comes off as dramatic. Like is missing a year of 4th grade going to be a problem for anyone? I barely remember school up until 11th grade at this point. Generations? Why is he saying that?
I agree with this though
> That the State considers pro sports a critical infrastructure (essential) activity undermines this whole rubric in my mind.
Yes definitely. I've been tutoring students in 5-7th grade for about two years, most of them benefit from tutoring because they have knowledge gaps missing from previous school years (for whatever reason). Before March this year, all the tutoring was in-person and it was relatively easy to keep them engaged and they made good progress. Now that I'm doing this over video calls, their attention wanders much more easily. Motivating them to do work is very challenging nowadays.
Many won’t. There’s a lot of data about how students fall behind in a compounding way: they start to feel dumb compared to their peers; start to think school isn’t for them, or that they just aren’t smart enough to ‘get math’ — fast forward a few years and they’ve dropped out completely.
Allow me a counter example: My significant other was a war refugee and had severely disrupted schooling from the age of seven to about nine years of age.
Yet her generation had higher graduation and matriculation rates than their parents. Indeed, their achievement rates were in line with other countries in the region that didn't experience war.
I'll readily concede that, for children in an abusive home, less time at school is dangerous to their wellbeing. But the hand wringing about long term learning damage to all kids seems overwrought and unsupported by any evidence I've seen.
But I'm more interested in being informed than winning arguments on the internet, so if you can point me in the direction of studies, I'd much appreciate it.
School sucks fir the vast majority of kids. It’s a warehousing system so parents can both work.
If you miss learning addition well, subtraction and multiplication is going to be hard. If you can't subtract and multiply, then learning division is going to be hard. If you can't multiply and divide, algebra will be impossible, but many life tasks will also be more difficult.
My point is not that this is the right interpretation, it's just that I don't think it's settled about how much it will impact students, and which groups will be impacted disproportionately. Points about nutrition, getting out of abusive homes, etc., are all interesting and relevant and outside the scope of what I mean, which is purely focused on education outcomes.
To use your model, what you say is possible, but I think it's equally possible that the delta is additive rather than multiplicative. A 20% student and a 100% student might both lose 10% or 20% to [10%, 90%] or [0%, 80%] without intervention by involved parents.
My kids (grade 4 and 6) are getting a ton of dedicated 1:1 time including more coding time, paid math programs they enjoy playing, white-boarding problems with us, watching Nova/Nasa/other science content with us, and a lot more reading than if they were chained to a desk learning 2 hours of material in 6.5 hours. They might do better in this half school, half home school situation.
Yah. There's a whole big subset of the population that barely manages to stick with school at baseline. Educational interruption in other circumstances has been shown to have bad outcomes. We're trying to do better this time, but the school system as a whole is overtaxed.
I'm a middle school teacher. Even with best practices for remote education, I've seen all kinds of negative impacts. It's going to take a whole lot of support to get these kids to anywhere near a normal curriculum.
I’ve only looked at the data for literacy and its impacts on life outcomes. (I do charity in that space.) Something like being 6 months behind in third grade can materially predict high school graduation rates, SAT scores and incomes. Even if one controls for gender, race and income.
Even the 12 year olds I work with who had many years of schooling have had to readapt to meet (greatly relaxed) expectations for in person instruction with several missed months. A whole bunch of 2nd graders with a wasted end of Kinder and 1st grade year is going to be chaotic.
Depression is on a big swing upwards. And there's kids in difficult situations who are not receiving help from caring teachers and social workers. There is going to be impact that lasts for a long, long time.
I came to comment the same thing about this quote. I don't understand how he comes to this conclusion either. Anyone know?
A year off probably won't have much impact on children with families with the capability to care for and educate them at home. This is not the case for all demographics. For some students, a year off school literally means nutritional insecurity during a time when brains are developing and the only stable environment they have is gone.
My friend is a first grade teacher and has about 5 students who are homeless. It shouldn't be a shock that they are not attending class via zoom.
My interpretation of the statement is that compounding interest applies to education as much as it does to bank accounts. Missing 5k in contributions to retirement accounts at 25 and then making up for it with extra at 26 is very different than making up with an extra contribution at 46. Same applies to education, and if you're trying to make up missed "contributions" in 6/7th grade, you're already the educational equivalent of a 46 year old.
At risk of stretching a thin metaphor even further, this is to say nothing of Social Security (long-term structural impact of system-wide attempts to catch up half a generation of students on 12+ months of education).
edit: formatting/proofreading
> That the State considers pro sports a critical infrastructure (essential) activity undermines this whole rubric in my mind. Pro sports is very nice to have and is probably a pleasant distraction. It is not essential. ...
This is bad for several reasons:
- sporting events involve close contact between participants
- sporting events draw crowds
- sporting events require infrastructure to service them (restrooms, food, parking, etc)
- the blatant contradiction encourages those who have been told to shut down to disobey the order
- sporting events draw crowds
- sporting events require infrastructure to service them (restrooms, food, parking, etc)
- the blatant contradiction encourages those who have been told to shut down to disobey the order
I think there’s a lot of misinformation and disinformation out there, which is the leading cause of people disobeying the order(s).
I personally think the whole country should focus more on the greater good for everyone by culling the virus instead of doing this open-nd-close back and forth juggling, as to optimize for the best outcome available (similar to New Zealand). But then again I am not well versed on the Nash equilibrium when it comes to highly infectious diseases.
* Hone Heke, kept cutting down a flagpole to mess with the British
* The Southern Man popularised by a beer company, who prefers the company of his horse.
* The Good Keen Man popularised by Barry Crump, who prefers the company of the hills and his rifle.
* James MacKenzie, a sheep rustler who ended up with a sizable part of the South Island named after him (the MacKenzie Country)
* Edmund Hillary travelling to the South Pole by tractor "accidentally on purpose" when he was supposed to be laying out supplies for a British Lord's expedition.
However, what we have in our culture that the US seems to lack (from my _very_ distant POV) is a slight tendency towards collectivism over individualism.
Maybe it's from our long gone years as a "cradle to the grave" social democracy, maybe it's from the emphasis on mateship.
Maybe it's because we don't really like interpersonal conflict. (How do you know a Kiwi didn't like their meal in your restaurant? We haven't figured that out yet).
From experience, the difference is entirely in the way our societies are setup, and therefore how we treat each other.
In NZ/Oz/Canada, we have healthcare for all, affordable tertiary education, and we all pay higher taxes to help strangers. Looking out for each other is built into the makeup of our countries, systems and society.
In the US, it is literally "Me vs. You", "Everyman for himself", "Pay your own way", etc. It is simply not in the makeup of their society to help others. While of course there are extremely kind and generous people who do, it's not the way the systems are setup, so it's not the default way people think about things.
Also because tens of millions of people are within a millimetre of bankruptcy/starvation/living on the street, they literally have no head space or ability to do anything other than meet their own basic needs.
Here in Canada tens of millions of people have been getting $2k every month since March. Same in Australia.
In the US they got $1,200. ONCE. That changes a lot.
Issue is we live in times of asymmetrical informational warfare.
So we can't just provide strong data and recommendations while limiting intervention relative to respecting freedom.
Consider how we decreased cigarette smoking via reasonable science driven laws around indoor rules that impact health of others ... and yes graphic commercials of the health consequence which can only be described as full scale information warfare.
Would need an accelerated program along these lines to regularly show people suffering in this health crisis to help drive / scare people into doing the right thing.
- https://docs.google.com/document/d/1fB5pysccOHvxphpTmCG_TGdy...
You will not find much if any based on contact tracing data. Typical participation in CT isn’t remotely close to “I ate at x restaurant on y day”, and the entities tasked with CT are often inadequately equipped to handle the volumes/technical capacity of such a task.
There is, however, a wealth of literature using cell phone mobility, such as shown above.
I know I'm being the "[citation needed]" guy again, but the COVID-19 case numbers in the United States just don't seem like they support this optimistic take. If it were true, we should be closer to the median -- if not below it -- then we are.
I'm not honestly sure where you're going with the Prohibition comparison; your anecdotal examples seem to be "they're telling you to follow these restrictions but they're not following them themselves," which, okay, I guess, but they're still just anecdotes. Is this "they TOLD us not to have liquor during Prohibition, but there were county commissioners who were SNEAKING INTO SPEAKEASIES!"? I mean, sure, probably, but the comparison kind of breaks down at that point. Prohibition was based on a puritanical moral panic; our current pandemic-era lockdowns are based on a very real, highly contagious lethal disease.
This certainly does not happen for patrons at miscellaneous restaurants.
> most people are responsible enough to take the recommended precautions
Empirically this is not a sound belief, if by “most people” you mean a large enough majority to stop the epidemic from growing exponentially.
Even for the many, many months in many, many parts of the country where case growth was stable and eminently manageable? Wouldn't we want to avoid the hardship caused by extreme restrictions when possible? The better approach is to match the level of restrictions with the circumstances within the region, and adjust as needed. Just because most states/localities have failed to adjust aggressively enough (or have abdicated responsibility altogether) does not mean they should have simply set a dumb and blind policy of maximum restrictiveness and then sat on their hands, assuming no better way was possible.
So it’s our fault? Some countries succeeded in crushing this virus because of efficient testing and contact tracing, incisive lock downs, and other measures which are put in place by public authority or institutions.
What a poor way to deflect blame for the incredibly poor job our government and institutions have done to protect us.
Sure, a lot of started from the top down, states need federal funding, and so on and so forth. But to basically tell people they are on their own, is so bad. This is a public health crisis, what authority and power do I honestly have?
It’s incredible that our public officials continue to deflect blame to try to distract from how embarrassingly bad our infrastructure was and still is for handling a crisis like this.
I’m not sure how to solve that problem, and agree it is a difficult one. However, I don’t think that justifies public officials shifting the blame.
It's just disappointing that, if true, the opposite doesn't work. If only this happened: the gov says "We choose to do no lockdowns, and just have a list of suggestions. No need to follow them. Do your normal activities" and the response: "You can't tell me what to do! Screw you! I'm going to wear masks AND distance, esp among vulnerable populations! Do my normal activities my foot! So there, suck it!".
Reverse psychology always seems to work better in marketing, and low budget movies and sitcoms.
And then somehow everything got wrong during summer. Ironically, because almost no one got sick during the first wave, it became popular to believe that the entire pandemic is just made up by evil Western media. People took vacations all across the world, and in September shared the viruses at schools, which were no longer closed because "education is important".
In the beginning of September, the situation was worse than ever during the first wave, and the government did nothing. In October it was 20 times higher, and in the beginning of Novermber the goverment finally woke up and imposed some half-assed measures, which at least keep the infection rate constant (i.e. still 20 times higher than during the first wave).
Not sure what is the lesson here. Perhaps that reverse psychology can work for a while... and then it may revert again. Because if it is cool to be a contrarian and oppose the government, soon this opposition becomes the new normal, and then it becomes cool to oppose what was done yesterday. And also that the better you protect yourself against a disease, the more people will believe the disease was not real.
But analysis will be complicated by the porous border. There will presumably be even more people coming into SMC from SCC to patronize businesses that are more open than those in SCC.
Not really. Santa Clara county has San Jose, a city of 1M. San Mateo's largest city is Daly City (100k). San Mateo county also has a more rural and isolated coast. San Mateo county is also a lot whiter.
this is all we can expect of our health officers. look at the data and make the best decision possible.
if the data changes i hope he will also quickly change his mind
I appreciate the statement, and it's nice to see the reasoning of a health official laid bare. That said, it seems to be an inconsistent message and not something I think a health official should be putting out in the midst of a politicized pandemic rife with misinformation.
I really wish we had a functioning central government to help coordinate local responses, assist with data collection and monitoring, disseminate clear information, etc, etc.
Absolutely not. The federal government has no authority to force states to close and this is a good thing.
I'm based in Australia, Victoria (population of 6m+, exceeding the 800k mentioned in the Bay Area [EDIT: San Mateo county]) and we have now had over 30 days of zero cases of coronavirus, after having a peak of 680+ per day [1].
We went into a tough lockdown, stamped out the virus, and are slowly easing restrictions. We are working towards a "COVID normal" holiday season.
We had stay at home orders, restricted access to shops (supermarkets remained open but most closed, with one trip per day per household), social distancing orders, and months of wearing masks, and 10-20,000 COVID tests performed per day (again, free).
Our Premier Daniel Andrews faced a lot of criticism for pushing this hard, and it was a lot of pressure on small businesses and the mental health of citizens, but ultimately it was the right decision -- the alternative was untenable, let it become out of control and watch our (universal, free) health care become overwhelmed, and no one would even be able to do anything -- an acceptance of the virus flourishing was not acceptable.
If you don't have a leader capable of fighting this virus, get rid of them. It's frustrating and sad watching from afar this virus run amuck in the United States (and the health care system failing you - I'd _never_ want your insurance system anywhere near me - but that's another battle).
I hope and wish for the health of everyone affected by this pandemic.
[1] https://www.dhhs.vic.gov.au/victorian-coronavirus-covid-19-d...
The whole Bay Area has a population of closer to 8M.
Unfortunately no one here in the USA in a position of power recognizes that this should be the goal. Instead the lockdowns last only long enough for the ICU capacity to free up, then reopening the economy becomes the major goal.
We need to stamp this virus out entirely, like you and your neighbors in NZ and TW have done.
As you mention NZ did a great job (and the PM even offered to consult to other health officials [1] in how they carried out the lockdown), such leadership should be commended and people resisting should get out of the way to let leaders lead.
[1] https://www.reuters.com/article/us-health-coronavirus-newzea...
Also, pretending that there are no costs associated with strict lockdowns is terribly flawed.
Yes, South Korea and Australia span the gamut. So do Taiwan and New Zealand. The USA is somewhere in-between.
> Also, pretending that there are no costs associated with strict lockdowns is terribly flawed.
Those costs are largely suffered by this lockdown-reopen-lockdown cycle, without the benefit of getting rid of the disease. Indeed our trajectory is worse economically, because there's no light at the end of the tunnel.
Life in Taiwan and New Zealand goes on pretty much uninterrupted right now. We could have had that. We still could, if severe actions were taken.
Edit: Also, one of the main reasons vaccines were able to get through trials so quickly is precisely because countries like the United States, Brazil, the UK, etc did so poorly handling the pandemic. Doing phase 3 drug trials in a country that successfully dealt with SARS-COV-2 such as Australia would take significantly longer.
Hesitant to respond because I think your fishing for a certain response with that line, but the state has guidelines for each stage of lock down we're in.
All this long screed does is mess with people's heads and cause more problems than it solves. The virus doesn't care where the county line is. If everywhere else in the Bay Area is locked down, San Mateo should as well.
San Mateo county isn’t an average joe middle America bumble-nowhere county. It’s populace is highly educated with the nuance something all can comprehend.
That’s several times higher than how many positive test results have been logged in the past 14 days.
https://thecovidcomplex.com/state/california/san-mateo/summa...
Disclosure: this is my website based on data from the New York Times.
Testing is prone to variance due to behavior, test availability, development of symptoms, contact tracing effectiveness, etc... I suspect their modeling efforts use a more principled measure than positive tests.
Without even seeing the data I would infer among all tests a high positivity rate (certainly double digit).
Testing volumes are low, meaning we fail to capture a sizeable chunk of cases.
The testing strategy is bad. We’re testing people that are less likely to be positive.
And possibly, the model is just wrong.
How can Colorado estimate at roughly 2.5x and San Mateo county is 4-7x? I’m shocked that the variance can be so great between counties.
Instead we get BS numbers that make it seem like every person that is contagious is still running around.
1) Stay away from other people 2) Wear a mask if forced to go out 3) Go back home as soon as possible
This 15-point stream of words will only serve to confuse. The reason our kids are suffering from this year-long school outage is because our leadership is so confused. With unified, clear leadership we would have beat this thing in 6 weeks, tops. It is exactly this framing as a difficult moral wrestling match faced independently by millions of equals that has brought America to this depth of failure.
I think this could be cut down to a few salient points:
(1) Social distancing, mask wearing, and staying at home are the best ways to keep you and others safe.
(2) Based on the best available information about hospital capacity, San Mateo is not issuing a Stay at Home order at this time. This means outdoor dining, take out, full capacity grocery remain open at the retailer’s discretion. San Mateo will comply with a Governor’s order if and when that order is issued.
(3) Schools will remain open in San Mateo with appropriate sanitation and distancing measures as appropriate.
The other 11 points are not needed and should be eliminated. There is also a significant amount of hedging that is not appropriate for a public official / medical professional. He’s a leader and an expert, he should state his opinion as one.
it actually immensely increases my trust in him to understand the thought process behind his decision vs “let me lead and sound authoritative. trust me i know best”
in fact i’ve just about had enough of that style of leadership from politicians
This is generally a good rule to follow because we want to maximize compliance, and being anything but succinct defeats that goal.
However, this case is an exception to the rule because there's no action that requires compliance. The official is, in fact, asking for no compliance. Therefore, there's no need to be succinct. In fact, it's a great opportunity to build trust with the general public so that when compliance is required, you are able to achieve it.