Corona Part 4 - How About That Re-Opening

Lars Poulsen - 2020-06-10


What I Said a Few Days Ago

I have proposed several things. My basic notion is that our social distancing protocols were designed to implement a situation where the virus would gradually spread through the population, but at a level where our hospitals are not overwhelmed.

Given that we will not have a vaccine in scalable quantity for at least 9 more months, and there is no guarantee that a vaccine will ever work, we cannot keep everything closed until we can do mass vaccinations.

So we have to accept a certain level of sickness in the community for now. There is no totally safe way out of this situation, but we have to keep headroom in our hospitals - and we are for now.

I think we need to hold on to limitation of crowds for now. Special permits required for groups larger than 25-30 people. Encourage people to stay within their immediate family and house mate group (4-6 people in the bubble).

No cruise ships.

Hotels are open - I think they have actually been the whole time.

Encourage (require!) people to cover faces and keep distance in the public spaces: Buses, shops and workplaces.

And be prepared to tighten when we start seeing the headroom in the hospitals diminish.

This still makes sense, but the questions I hear now, seem to indicate we need to deal in more specifics.

What Are the Chances?

"Everyone has a nonzero chance of dying in 2020. . . If you are an average American living outside of New York City . . . Your chance of being an extra fatality [excess deaths above those in a typical year] was in the ballpark of 1 in 5,000, somewhat higher than your chance of dying in an auto accident in a year. And if you were under 50 with no serious health conditions, your risk was in the ballpark of 1 in 50,000 similar to your risk of dying in a fire."
[from an insurance executive: Robert Rosenkranz, "the Measure of New York's Covid Devastation", Wall Street Journal, page A19, Wednesday, June 3, 2020.
To me, that confirms that outside of hotspots, we have very little COVID disease at this point. We need to control the hot spots ("bring down the hammer" as needed, but we can open for more activity in many places.

Political Rallies

Just wondering.... How do you think the resent protest gatherings across the country is affecting the Covid limits? Not much social distancing and masks.
I have been surprised that the Black Lives rallies have not been followed by a big spike in new infections and hospitalizations in those cities where they were held. To me, that indicates that we can have a lot of social activity in outdoor spaces, if people wear face masks and exhibit common courtesy. Of course, these rallies were mostly attended by youger people, maybe predominantly students, and middle class.

Will these same factors protect attendees at Trump rallies? My guess is that Trump rallies differ in several ways:

So I think they will likely be much more infectious.

And frankly, if the Republican party really goes ahead with stuffing 20,000 people into a convention center for their nominating convention, I don't see how that will not be an epic superspreader event.

More Questions and Answers

Hotels and AirBNB

So question, Hotels are still closed?? What about people doing airbnb out of their homes as of a month ago with out of towner's and out of state visitors in our neighborhood? On a nighty visit!! -- from Nextdoor Neighborhood.
Here in Santa Barbara County, we have very little COVID activity. (See tables with numbers near the end to get this perspective.) Our local people are well-behaved to a fault; the only hot spot has been the federal prison complex in Lompoc, and even though they discovered a lot of infected people when they tested their inmates and staff, they have had very few deaths, so they did something right.

So the obvious conclusion is that if we have few infected people that can spread the disease, and people are not crowding, milling around and mixing it up, this it unlikely to quickly flare up if we ratchet down the restrictions ... except if large numbers of people come in from the outside when we relax the travel restrictions. Santa Barbara is a resort town; a large part of our economy consists of attracting outsiders to come in and spend money here.

We have curbed that by issuing a decree that "hotels can be open, but only essential workers can stay in them, - not tourists." The tourists got the message. Those from far away can't get here anyway, becase air travel is severely restricted, but it would be a nice day trip or week-end trip for people from Los Angeles, San Diego and the Bay Area, who cannot travel further away. And the pattern is that in the larger cities, there have been higher infection rates. So there is some danger there. The fuzzy restrictions on our hotels - you must say your travel is for essential purposes, but nobody actually enforces that - allow us to be a little elastic. We could tolerate a bit more activity and then tighten up again if we have problems.

What have we learned from Sweden?

Just like different US states have had different policies, so have different European countries. For a while, many of them had their borders almost entirely closed: Citizens could come in to their home country, but gould generally not go out to other countries. But the detailed rules varied. Denmark would allow citizens, but not their non-citizen spouses, fiancees and other family members. Sweden never actually closed their borders, but encouraged people coming in to self-quarantine for 2 weeks.

Once Italy had blown up before anyone knew what hit them, almost all of Europe severely limited travel. In Italy, you could not walk on the street without getting a police permit; all you had to do was get on the police website, identify yourself (name, address, ID number) and record why you were going out, where you where going and when you planned to be back. You needed to show this permit sheet to any policeman you met on the street. This was very useful for contact tracking. And you could not travel outside your own region (roughly corresponding for Americans to your own county and the adjeacent counties).

Most other countries simply said you could not go out, except for food shopping and for essential workers, to go to work. All very familiar to how we have lived through this.

The slogan was flatten the curve. What it meant, was that the goal was to slow the rate of infection, so that the hospitalization rate would plateau at a level below the capcity of the health system to treat the sick people.

Sweden did it a little differently. They did not issue a national order to close the schools. They encouraged people to keep distance, and explained why, and clearly, they were ready to clamp down hard, if things went out of control. But they did not blow up. They plateaued at a 90% hospital utilization rate, and they are now coming down from that, even as the other countries are opening up to where Sweden has been the whole time.

Most other countries have been so effective at curbing transmission, that very few people have been infected outside of hot spots, which in most countries include inner cities, and retirement homes. As a result, these countries have not built up a population of people that have been infected and have recovered. Which means that they are vulnerable to repeated waves, when they inevitably have to open up again. Sweden has had 4 times the number of COVID deaths as Denmark and Norway, but has not incurred nearly the economic damage that these other countries have.

Britain (UK, England, Scotland, Wales) tried to do the Sweden thing, but too sloppily; they had a severe health system overload before they took action and now they are coming down.

Some Numbers

I feel that the best measure of the severity is the recorded number of deaths to date, scaled to be the number per 100,000 population. Infections are not a reliable number if there is not widespread use of good tests. But the number of dead is much harder to fudge.

These numbers are picked from the large database at New York Times .

Some Countries

Note that at least the official confirmed death count in China is miniscule. Italy was hit very hard and early, but UK has surpassed it. And the overall US figure is quite nigh, even if it is very unevenly distributes as we shall see next.

Place in the USA

The hardest hit places in the USA are:
New York State156
New York City254
New Jersey139
Los Angeles Co27
Imperial Co22
Tulare Co21
Ventura Co4
Santa Barbara Co3
Tama Co, IA169
Polk Co, IA (Des Moines)32
Madison Co, IA13
Warren Co, IA2
Hendry Co, FL47
Miami-Dade Co, FL29
Munroe Co, FL (includes the keys)7
Monroe Co106
Geaugea Co (Chesterland)37
Cuyahoga Co (Cleveland)24
Greer Co, OK118
Crane Co, TX103
California and Florida have not had nearly the outbreaks that New york has seen, but where Los Angeles County has the highest death rate in the state, it is lower than many large cities elsewhere. And Santa Barbara and Ventura have been very safe indeed.

The rural midwest is a very mixed bag.

I have a special interest in Iowa, where the overall numbers are middle of the road. But the areas around the slaughterhouses area are in very bad shape - see Tama County, which has been really badly ravaged. My daughter lives in Indianola, in Warren County, which has done very well.

Trump rallies will start this month in Oklahoma, and I expect soon after that in Texas. Both states look good, so long as you don't look too closely. When you do, they look a lot more than Iowa.

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