Corona Part 3
Lars Poulsen - 2020-05-19
Corona 3 - When Can We Reopen?
Lars Poulsen - 2020-05-19
Flattening the curve - Revisited
Back in early April,
The "social distancing" protocols that have now been pretty uniformly adopted,
aim to slow down the infection rate, so that it takes three or four days
for the number of cases to double. That means that it takes a month
to get from 1000 cases to a million cases, and by then, many of the early
cases have healed, their hospital beds are freeing up, and an increasing
percentage of the people they come in contact with have already healed
and have immunity.
Under these circumstances, it may take 3 to 6 months for the infection to pass
through the population, but there may be ICU beds and ventilators for most
of the severely ill patients, at least in the wealthier countries,
so the death toll will be much lower. Just how much lower depends on many
factors that we do not yet know, but for the USA, it is projected to be
between 100,000 and 250,000 - compared to 3 to 6 million without these
I also wrote:
If we had plentiful and reliable tests before the first infections, we
could have done what South Korea and Iceland did:
and release them only ofter the two-week incubation period expired,
further directing everyone with symptoms to isolation hospitals.
- Screen everyone coming into the country from areas with the disease.
- Divert everyone with the infection to a quarantine area,
If followed diligenty, these measures might maintain a situation where the
virus is not circulating in the community.
All of that still makes sense. The prediction that by "social distancing"
we might reduce fatalities by a factor of 20 has played out.
While New York City (and its surrounding metro area including parts of
Connecticut and New Jersey) was totally overwhelmed by the outbreak, they did
eventually slow it down to where they had no more severe cases than their
hospitals could manage, and nowhere else reached that level of
near-collapse. Indeed, in most of the country, we have stayed at very
low levels of infections (2-5%) except for a limited number of hot
The Hot Spots
The hot spots are very well defined. Outbreaks grow rapidly ...
The meat business has seen incredible consolidation. Most meat is
supermarkets in the USA is processed by 4 companies: Cargill, Smithfield,
Tyson, and JBS. One of the affected meat plants in Iowa is reported to
produce 5% of all meat sold is US supermarkets. This creates high
pressure to keep the plants open even when the workers are getting sick.
Some of the plants have resisted testing of their workers, but when
testing has happened, up to 80% of the workers were infected.
- In prisons - where it is not possible to maintain proper distancing.
Indeed, these facilities are overcrowded in "normal" times, often
holding twice the population they were built for.
- In retirement homes and extended care nursing homes. Again, many people
living together, so if one gets it, many will be infected.
Made worse by the fact that the residents are old people in poor
health; that is why they are there to begin with.
- In slaughterhouses and meat packing plants.
People working shoulder to shoulder in confined spaces with
blood spattering everywhere. Because the working conditions are
poor, and the pay is very low, they are mostly staffed by
immigrants (many of them undocumented) who live in poor quality
housing, often packed two or three families in one apartment.
And because these low-paying jobs do not offer health insurance
to the employees, they come to work even when they are sick.
The Upside of Low Infection Rates
The upside of the low infection rates in many places is that these areas
might be able to do what South Korea, Taiwan and Iceland were able to do
from the outset (as described in the second quote at the top):
- Test everyone with symptoms and isolate them.
- Test everyone they have been in close contact with and isolate THEM
- Eventually test EVERYONE
The problem is that in order to maintain a "clean" region, you have to
have a fairly hard border and screen everyone coming in or passing
through. This means roadblocks on the interstate highways, where we
take everyone's temperature before they can continue, and everyone who
"fails" the screening test is refused entry and/or sent to 2 weeks of
quarantine. This is very hard to do in the USA.
The Downside of Low Infection Rates
The downside of the low infection rates is that the disease continues
for a long time. I had predicted that with social distancing, it might
take 3-6 months for the disease to work its way through the population.
But here in Santa Barbara, we have suppressed infeactions to the point
that it may take YEARS for that to happen. The assumption behind that
prediction was that we could suppress the infecton rate just enough that
we did not overwhelm the hospitals - and no more.
NY Times' science and health report Donald McNeil says that managing
this pandemic requires tht we go back and forth between "the hammer"
(slowing down infection rates to protect the hospitals) and "the dance"
of opening enough to maintain a working economy. I find that we are not
"dancing" enough in my area.
At the present time, I would say that Southern Santa Barbara County
where I live is clean enough that we could open most activities if
they are compatible with keeping distance.
- Very few new cases
- Plenty of hospital beds and ICU beds
- People are fairly compliant to distancing protocols
- Testing is becoming available
I do fear that if we open up, and word gets out in Los Angeles that
Santa Barbara is open for business, our hotels will rapidly fill up with
people from Los Angeles who might be less well behaved. I just do not see
us getting away with putting a border checkpoint up
on the 101 freeway at Rincon Beach.
The North half of our county has more cases than we here on the South
Not only the Lompoc
prisons, but also the city of Santa Maria. I suspect half of the Santa
Maria cases are related to prison staff; the rest may reflect more
low-income neighborhoods with more people per dwelling.
My Own Urges at This Time
I am ready to take more steps toward reopening than our local
All of this to be rolled back swiftly if we start to see hospitalization
rates go up too much.
- Relaxed distancing: 1 meter (3.5 feet) with masks.
- All shops open - subject to occupancy limits and distancing.
That probably means we should not open bars too much.
Drunk people like to crowd in close and touch.
But sidewalk cafe's should be fine, and sit-down
restaurants with 6 feet between groups.
- I want to see my dentist open. Massage therapists.
- Open preschools and elementary schools. Although, California has
already declared that public schools will not reopen this school
year, so only preschools and boys/girls clubs.
- Open gyms and health clubs. I miss the "TechnoGym" weight room at the YMCA.
- Let's visit with family members so long as they follow similar house rules
as we do.
I think the requirements for "dancing out" are
Any time these are not met, we "bring down the hammer" again: Tighten
restrictions again until we meet the qualifications.
- Less than 2 deaths per 100,000 population over the last 7 days
- less than 20 hospitalized COVID patients per 100,000 population
on any given day
- less than 50 % occupancy in ICU/CCU
- ready access to virus tests and antibody tests with less than
2 hour response time.
Some things that we are not ready for yet:
- public gatherings of more than 20 people.
- church services - see above.
- movie theaters - more than 20 people in a theater.
Update Friday 2020-04-22
Today, the county tells us:
What businesses can reopen?
The types of businesses now allowed to reopen in the latter phase of Stage 2 include dine-in restaurants (with modifications), schools and child care, retail stores, shopping malls, some offices, campgrounds, and RV parks.
Higher risk businesses, such as hair and nail salons, gyms, churches, and hotels for non-essential stays, are not allowed to open until the Governor declares that eligible counties can move into Stage 3.
So no dentist, no haircuts.
Big 4 Meatpackers - Article from 2011; since then a Chinese company bought
 Smithfield Foods:
 JBS S.A.:
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