Reflection on Social Distancing

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Cwalker935

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Hank has good discussion going and I do not want to distract from that. I am at the office day and have had time to reflect on social distancing since my current job is pretty much dealing with employees and their issues. The majority of my reports do a lot of their work in the field and almost everyone has the ability to telecommute. As such, I have one entire side of our office to my self. I have four people in on the other side but my interaction with them has been limited. As a result, I am having a lot of social distancing. So much so that I took a long walk at lunch time and the streets were sparsely populated.
I am one of two baby boomers in the Division and I send the other guy home due to underlying health issues that place him in the high risk category. I’ve gotten several lectures from millennials in my office. Despite being a healthy 63 year old, they apparently think that I on the verge of death.
The empty streets and office prompted to reflect on social distancing. As I understand it, the concept is to reduce the rate of infection so that we do not overwhelm our hospitals, to develop more testing capability and to be better prepared. In other words, flatten out and extend the curve. Given the relative isolation I am experiencing, the thought occurred to me that if we are too successful in slowing down the rate of infection could we simply be shifting the infection peak to another time since we cannot practically continue wide spread social distancing on a sustained basis. I do think that we are acting prudently but cannot help having some contrary thoughts given the hardships that many people are experiencing.
 
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monophoto

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Cody

Many years ago, we had a secretary in our office who had four sons. She and her husband decided to set up a single bedroom for all four boys - two bunk beds - knowing that if one happened to get whatever disease was going around their school, all four would quickly get it. To some degree that made sense - the diseases weren't all that bad, and as kids they didn't have underlying conditions that complicated the outcome. Getting those childhood diseases is almost inevitable, so why not just encourage the process and get it over more quickly.

I think the concern today is that the while the virus can spread rapidly, and will eventually 'burn out' through a process called 'herd immunity' (when a significant fraction of the population has had the illness and recovered, and through that process, is resistant to reinfection). And eventually, there could be a preventive vaccine, or a specific medical treatment. But the problem is that for some fraction of the population, infection has very serious consequences, up to and including death, and our health-care/hospital system can't cope with the potential number of patients that would present if the rate of infection is too rapid. So instead, the objective is to slow down the rate of infection to a level that the system can realistically care for, while acknowledging that also means delaying the point where 'herd immunity' causes the disease to go away. The unknown is how can we balance the need for social distancing long enough to avoid an unmanageable peak in serious cases versus accepting the very serious impact that social distancing has on society and economics. I'm not sure anyone really knows where that balance point is, and I don't envy the folks who have to make the tough decisions right now.

The one thing that is obvious to me is that there was no plan to deal with this possibility, and as a result, our leaders appear to be fumbling.
 

Dehn0045

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Critical care rates for COVID-19 are estimated at about 5%. If it becomes endemic then there will be on the order of 100 million total infections in the US. Doing the math, we are talking 5 million cases requiring critical care. We only have 65,000 critical care beds in the US, many of which are occupied with cases unrelated to COVID-19. If cases that require critical care don't receive that care then they die. Our best bet is to prevent high-risk individuals from ever getting it hopefully reducing the demand for critical care beds, increase critical care capacity to the extent possible, improve specific treatments, and buy enough time to find an effective vaccine. Yesterday POTUS said this would go on through July/Aug, lots of people were very surprised, I am thinking more like July/Aug of 2021. If we can't find a vaccine, then "flattening the curve" means that we need to spread the infections over 10 years to not exceed existing healthcare capacity, now that seems pretty unlikely. I've been practicing social distancing for my entire life, so I might be uniquely prepared for this. It is a little hard for me to appreciate a lot of the downsides to this approach, but I think that it is our best or maybe even only shot at minimizing the loss of life.
 

FGarbrecht

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Your thinking is mostly correct; the virus appears to be easily transmitted and it is estimated that the majority of the population will become infected over time. If current public health recommendations are widely implemented, the incidence of infection and clinical disease will probably continue in smaller waves with a varying baseline that will not overwhelm the hospital systems / ICUs. The goal of course is to prevent overwhelming hospital capacity which will lead to excessive deaths and rationing of resources as is happening in northern Italy now. We are already so far into it at this point that the probability of just deferring an overwhelming peak of infection to a later date seems unlikely to me; hopefully systems will not be inadequate to treat the currently infected patients in the coming weeks and we have bought enough time to ramp up testing and treatment facilities to diagnose and treat going forward. I'm working near the front lines of this but am not in public health, so take this as just my informed opinion.

As far as age goes, the data I have seen suggests that there is a fairly steep increase in severity and probability of need for hospitalization and ICU care as age goes up. Children have low probability of needing hospitalization fortunately but when you get to our age (over 60), we are seeing up to 20% of hospitalized patients needing ICU care. Bottom line is be very careful, continue social distancing, minimum potential contact as much as possible.
 

Dehn0045

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so why not just encourage the process and get it over more quickly.

UK was going to take this approach. Then realized that it would lead to many more deaths than any leader was willing to stomach. They quickly changed course

The one thing that is obvious to me is that there was no plan to deal with this possibility, and as a result, our leaders appear to be fumbling.

There should have been a plan. It seems that almost any book written on epidemiology references concerns about a flu-like virus coming out of China. Pandemics are essentially a guarantee, its not if they are going to happen, its when. Hopefully this provides the necessary wake-up call.
 

PenPal

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I was made redundant at age 55 in this country it was very difficult to find work at that (young to me)age then while working as a sparky I suffered a severe head injury climbing into a roof space where an unauthorised huge steel cross beam was placed directly above the manhole.Light duties followed but until then I was expected to carry heavier and more than others ,they introduced mobile phones physically the size of a brick to carry at all times.Following the injury I was made redundant with 4 hrs notice and after that I received a copy of the accident report from the overall Supervisor that stated a normal active man would have been back at work in half an hour.

Acting on this I went to the Commonwealth Director of Medcine and he prescribed a disability pension and a carers pension for my wife that gave us the equivalent of a pension I would have had to work in that university for 20 yrs to qualify. Age not only is misunderstood but not tolerated. Now our Govt in its wisdom has raised the working age to 70 yrs before qualifying for a retirement. What a conundrum,I for one know of very few real active sparkies at that age.Incidentally at the tender age of 86 in July this year I appreciate the oportunity to spend such quality time with my wife 65 yrs married .

Peter.
 

MRDucks2

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I have wondered the same thing, about simply shifting the peak 4-6 weeks out.

I also find it interesting when we discuss “there should have been a plan”. What type of “plan” would be most effective in the USA short of complete government takeover?

Anything that anyone will toss out as something that should have been done will still be short sighted and full of holes. Our combination of freedom, values and government structure is far to complex for a canned plan in case an unknown happens, isn’t it?
 

FGarbrecht

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I have wondered the same thing, about simply shifting the peak 4-6 weeks out.

I also find it interesting when we discuss “there should have been a plan”. What type of “plan” would be most effective in the USA short of complete government takeover?

Anything that anyone will toss out as something that should have been done will still be short sighted and full of holes. Our combination of freedom, values and government structure is far to complex for a canned plan in case an unknown happens, isn’t it?
If you can build another couple million ICU beds in 4-6 weeks then shifting the peak would result in fewer deaths. Our combination of freedom, values, government structure AND market driven and profit motivated private healthcare system has led to a fatally flawed healthcare system with absolutely no surge capacity. As you are probably aware, we used to have a federal pandemic response structure that was dismantled two years ago. People are dying for lack of planning (which could have been done) and for lack of any coherent federal disaster response. I'm sorry to be emotional about this, but people are dying right now. I work in healthcare, I go to the hospital every day and am exposed in real time to this, and I'm afraid for myself and my family and my neighbors, and I am angry as hell that our response is so extraordinarily pathetic. I can't even get COVID testing for my patients. You may be hearing that testing is available, but on the ground here in New York, I can't get it. And I'm really afraid that we are rapidly approaching a time where I may have to tell you or someone like you that I don't have a ventilator for you to save your life.
 

leehljp

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We had a deacon's meeting tonight called by the pastor to discuss this subject. The nearest contagion is about 50 miles away and we are a small rural town of less than 2000. We will continue to have worship service but will space ourselves out. Our sanctuary will hold 150 max but we usually have about 75. We have video streaming and have encouraged those who are 65+, those who are at risk and those with children to watch from home, with about 30 expected to attend and spread out.

Once we have one positive case in our county, then we will close until it is over.

One item that I disagree with that seems to be accepted is the position on masks and gloves. Masks and gloves only protect the one wearing them. Well yes! IF I touch my face with my gloves and touch something else, then someone can get it from me. OF course! That same thing will happen if I DON'T have gloves on. Gloves and masks can do a lot in preventative care. I am hearing these discussions on the point of not wearing gloves or masks. Doesn't make sense to me.

I spent 26 years in Japan where they wear white masks at the drop of a hat, and it is not uncommon to wear white gloves in certain situations. (And they bow instead of touching.) It IS prevention if you prevent yourself from getting infected, which might prevent someone else from getting it from you, and all others do the same. I am aware that Americans are not used to wearing masks. LOML and I order a box or two of masks every year and use them in different situations regularly - such as in allergy seasons, cutting the yards, cleaning and dusting etc. I was the only one in a group of 10 tonight wearing a mask.

I went to my gastroenterologist yesterday in Memphis; wore my white mask, no one complained. Went to Sams club, CVS for meds, Lowes and Walmart after going to the doctor and no one complained. I don't think I would like to go into a bank with a mask on though. 😵
 

1080Wayne

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In my view , any pandemic response plan is doomed to fail if it requires people to pay a substantial amount for a test . If it is not free or nearly free under your basic health care regime , it needs to be made so ASAP when a pandemic threatens . In this case , that should have been a day after China quarantined 50 million people .

I may be misinterpreting your mask comment Hank , but probably its most important function is to protect other people from an infected wearer , by reducing the virus laden droplet count in the air .
 

Dehn0045

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The nearest contagion is about 50 miles away and we are a small rural town of less than 2000.

A word of caution, the lack of testing has created a false sense of security. As of yesterday morning the state of Mississippi had only tested 389 people. In my opinion the time to act is now. Taking precautions in gathered groups is good, but for older people and immune compromised their best bet is going to be extreme social distancing. I do think that smaller rural areas will probably get hit last, but I don't think any location will be spared. One concern is that by the time rural areas get hit the healthcare system may already be overwhelmed.

I do agree with your approach with respect to masks -- given that it is pretty clear that asymptomatic people can spread the virus (either prior to symptoms or never getting symptoms) the prior guideline telling people to only wear masks if you are "sick". Well, how do you know you are "sick"?
 

leehljp

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. . . .
I may be misinterpreting your mask comment Hank , but probably its most important function is to protect other people from an infected wearer , by reducing the virus laden droplet count in the air .

Agree - IF an infected person would wear a mask, but most don't know they have it, and then there are those like the one in Boston where the lady with the virus gave a bogus phone number and address. It is long past that stage, only it has not sunk in completely.

As much as a mask keeps an infected wearer from spreading it, a mask on an healthy person will keep him/her from contracting it for a similar percentage. When a contagion is out in the general public, and it is now, it is no longer viable for the sick person only being responsible for preventing the spread.

Hazmat suits are to protect those who are healthy; masks are not hazmat suits, but will bring the percentage of protection UP considerably from nothing at all. It is obvious that we were not ready for this from the mask availability alone. LOML and I buy a box or two of masks each year for allergy prevention. But, alas, they are no longer available.
 

NT_2112

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My preferred social distancing tool. :)

Screen Shot 2020-03-15 at 7.38.58 PM.png
 

sbwertz

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Phoenix, AZ
Cody

Many years ago, we had a secretary in our office who had four sons. She and her husband decided to set up a single bedroom for all four boys - two bunk beds - knowing that if one happened to get whatever disease was going around their school, all four would quickly get it. To some degree that made sense - the diseases weren't all that bad, and as kids they didn't have underlying conditions that complicated the outcome. Getting those childhood diseases is almost inevitable, so why not just encourage the process and get it over more quickly.

I think the concern today is that the while the virus can spread rapidly, and will eventually 'burn out' through a process called 'herd immunity' (when a significant fraction of the population has had the illness and recovered, and through that process, is resistant to reinfection). And eventually, there could be a preventive vaccine, or a specific medical treatment. But the problem is that for some fraction of the population, infection has very serious consequences, up to and including death, and our health-care/hospital system can't cope with the potential number of patients that would present if the rate of infection is too rapid. So instead, the objective is to slow down the rate of infection to a level that the system can realistically care for, while acknowledging that also means delaying the point where 'herd immunity' causes the disease to go away. The unknown is how can we balance the need for social distancing long enough to avoid an unmanageable peak in serious cases versus accepting the very serious impact that social distancing has on society and economics. I'm not sure anyone really knows where that balance point is, and I don't envy the folks who have to make the tough decisions right now.

The one thing that is obvious to me is that there was no plan to deal with this possibility, and as a result, our leaders appear to be fumbling.
My husband is one of the high risk ones...40 percent chance of death the Dr says. 81 years old, insulin dependent diabetic, heart disease, psoriatic arthritis, etc. As a result I am being VERY careful when I have to go out. Today I had to go pick up one of his prescriptions. I wore long sleeves, long pants, latex gloves, and took disinfecting wipes to wipe down the cart. When I got home, showered and washed my hair, and bagged up my clothes. I'm 77 and take immunosupressants, but even with the immunosuppresants, my immune system knocks down a virus pretty fast....has all my life. (Bacterial infections are a totally different story, though...strep will hitchhike a mile to bite me.) So I'm not really worried about me getting it, except for the danger of infecting him.
 

howsitwork

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Like Frederick I’m frontline to some extent , pharmacist out in community.

Here in UK we are using social distancing to reduce the RATE of infection and prevent the hospital capacity of intensive care being overwhelmed. Testing remains a problem and they are now trying a city by city approach to see what the incidence of ACTUAL infected individuals is . By that I mean the number with or without symptoms themselves who actually have the active virus and can spread it. Testing capacity is increasing but there is still much work to do here too despite our politicians promising it’s all wonderful, the reality on the ground daily does not, as yet reflect this.

They have built and equipped new hospital over the uk and given them units with ventilators but there are not the doctor’s, nurses, pharmacists, receptionists, cleaners etc to crew them and you cant just train these up in a few months .

Masks are being promoted to try to limit onward transmission ie you cough it goes into the mask ,not the air to spread to others. The masks offer little protection to you once moist it seems, but they stop you spreading it to others.

If you can stay socially distant PLEASE for your own and everyone else’s safety do so. Waiting until it hits your town, neighbourhood, street etc is too damn late.
BUT also PLEASE do keep in touch with your friends, ring those you haven’t seen for a while, email them, wave through the window at them, gesture ( politely ) from the car. We are seeing an awful lot of mental health issues arising from fear, isolation and loneliness over here. Try to make life more bearable for everyone if you can.

Currently I’m enjoying a weeks holiday break from the total madness and remaking contact with those I can. I find it lifts me as much as it lifts them.

Hope things start to improve over there soon, hang in there Frederick and everyone else.

Keep on turning and posting !
 
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