Practical Covid Guidlines

[thompnickson2]

I wonder what The Congregation, including the Diaspora, thought about this. Nothing very dramatic, here, but that’s just the point.  Nothing on travel. 

 

From Dr. James Stein, Professor of Cardiovascular Research at the University of Wisconsin School of Medicine and Public Health…

 COVID-19 update as we start to leave our cocoons. The purpose of this post is to provide a perspective on the intense but expected anxiety so many people are experiencing as they prepare to leave the shelter of their homes. My opinions are not those of my employers and are not meant to invalidate anyone else’s – they simply are my perspective on managing risk.

 In March, we did not know much about COVID-19 other than the incredibly scary news reports from overrun hospitals in China, Italy, and other parts of Europe. The media was filled with scary pictures of chest CT scans, personal stories of people who decompensated quickly with shortness of breath, overwhelmed health care systems, and deaths. We heard confusing and widely varying estimates for risk of getting infected and of dying – some estimates were quite high.  

Key point #1: The COVID-19 we are facing now is the same disease it was 2 months ago. The “shelter at home” orders were the right step from a public health standpoint to make sure we flattened the curve and didn’t overrun the health care system which would have led to excess preventable deaths. It also bought us time to learn about the disease’s dynamics, preventive measures, and best treatment strategies – and we did. For hospitalized patients, we have learned to avoid early intubation, to use prone ventilation, and that remdesivir probably reduces time to recovery. We have learned how to best use and preserve PPE. We also know that several therapies suggested early on probably don’t do much and may even cause harm (ie, azithromycin, chloroquine, hydroxychloroquine, lopinavir/ritonavir). But all of our social distancing did not change the disease. Take home: We flattened the curve and with it our economy and psyches, but the disease itself is still here. 

Key point #2: COVID-19 is more deadly than seasonal influenza (about 5-10x so), but not nearly as deadly as Ebola, Rabies, or Marburg Hemorrhagic Fever where 25-90% of people who get infected die. COVID-19’s case fatality rate is about 0.8-1.5% overall, but much higher if you are 60-69 years old (3-4%), 70-79 years old (7-9%), and especially so if you are over 80 years old (CFR 13-17%). It is much lower if you are under 50 years old (<0.6%). The infection fatality rate is about half of these numbers. Take home: COVID-19 is dangerous, but the vast majority of people who get it, survive it. About 15% of people get very ill and could stay ill for a long time. We are going to be dealing with it for a long time.

 Key point #3: SARS-CoV-2 is very contagious, but not as contagious as Measles, Mumps, or even certain strains of pandemic Influenza. It is spread by respiratory droplets and aerosols, not food and incidental contact. Take home: social distancing, not touching our faces, and good hand hygiene are the key weapons to stop the spread. Masks could make a difference, too, especially in public places where people congregate. Incidental contact is not really an issue, nor is food.

 What does this all mean as we return to work and public life? COVID-19 is not going away anytime soon. It may not go away for a year or two and may not be eradicated for many years, so we have to learn to live with it and do what we can to mitigate (reduce) risk. That means being willing to accept *some* level of risk to live our lives as we desire. I can’t decide that level of risk for you – only you can make that decision. There are few certainties in pandemic risk management other than that fact that some people will die, some people in low risk groups will die, and some people in high risk groups will survive. It’s about probability.

 Here is some guidance – my point of view, not judging yours:

1. People over 60 years old are at higher risk of severe disease – people over 70 years old, even more so. They should be willing to tolerate less risk than people under 50 years old and should be extra careful. Some chronic diseases like heart disease and COPD increase risk, but it is not clear if other diseases like obesity, asthma, immune disorders, etc. increase risk appreciably. It looks like asthma and inflammatory bowel disease might not be as high risk as we thought, but we are not sure - their risks might be too small to pick up, or they might be associated with things that put them at higher risk.

People over 60-70 years old probably should continue to be very vigilant about limiting exposures if they can. However, not seeing family – especially children and grandchildren – can take a serious emotional toll, so I encourage people to be creative and flexible. For example, in-person visits are not crazy – consider one, especially if you have been isolated and have no symptoms. They are especially safe in the early days after restrictions are lifted in places like Madison or parts of major cities where there is very little community transmission. Families can decide how much mingling they are comfortable with - if they want to hug and eat together, distance together with masks, or just stay apart and continue using video-conferencing and the telephone to stay in contact. If you choose to intermingle, remember to practice good hand hygiene, don’t share plates/forks/spoons/cups, don’t share towels, and don’t sleep together.

 2. Social distancing, not touching your face, and washing/sanitizing your hands are the key prevention interventions. They are vastly more important than anything else you do. Wearing a fabric mask is a good idea in crowded public place like a grocery store or public transportation, but you absolutely must distance, practice good hand hygiene, and don’t touch your face. Wearing gloves is not helpful (the virus does not get in through the skin) and may increase your risk because you likely won’t washing or sanitize your hands when they are on, you will drop things, and touch your face.

 3. Be a good citizen. If you think you might be sick, stay home. If you are going to cough or sneeze, turn away from people, block it, and sanitize your hands immediately after.

 4. Use common sense. Dial down the anxiety. If you are out taking a walk and someone walks past you, that brief (near) contact is so low risk that it doesn’t make sense to get scared. Smile at them as they approach, turn your head away as they pass, move on. The smile will be more therapeutic than the passing is dangerous. Similarly, if someone bumps into you at the grocery store or reaches past you for a loaf of bread, don’t stress - it is a very low risk encounter, also - as long as they didn’t cough or sneeze in your face (one reason we wear cloth masks in public!). 

5. Use common sense, part II. Dial down the obsessiveness. There really is no reason to go crazy sanitizing items that come into your house from outside, like groceries and packages. For it to be a risk, the delivery person would need to be infectious, cough or sneeze some droplets on your package, you touch the droplet, then touch your face, and then it invades your respiratory epithelium. There would need to be enough viral load and the virions would need to survive long enough for you to get infected. It could happen, but it’s pretty unlikely. If you want to have a staging station for 1-2 days before you put things away, sure, no problem. You also can simply wipe things off before they come in to your house - that is fine is fine too. For an isolated family, it makes no sense to obsessively wipe down every surface every day (or several times a day). Door knobs, toilet handles, commonly trafficked light switches could get a wipe off each day, but it takes a lot of time and emotional energy to do all those things and they have marginal benefits. We don’t need to create a sterile operating room-like living space. Compared to keeping your hands out of your mouth, good hand hygiene, and cleaning food before serving it, these behaviors might be more maladaptive than protective. 

6. There are few absolutes, so please get comfortable accepting some calculated risks, otherwise you might be isolating yourself for a really, really long time. Figure out how you can be in public and interact with people without fear.

 

    

Steven W. Tabak, M.D., F.A.C.C.   |   Medical Director, Quality and Physician Outreach

____________________________________________________________________________________________________________________________________________________________________________

 

 

Nicholas Thompson

Emeritus Professor of Ethology and Psychology

Clark University

[hidden email]

https://wordpress.clarku.edu/nthompson/

 

 

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[Jochen Fromm-5]

FRIAM Diaspora in Europe here, makes sense to me. Here in Europe each week the restrictions are lifted a bit further, since the number of new cases is low enough. We still have to wear masks if we go shopping or use the public transport, which makes sense because the virus spreads through the respiratory system, and we have no vaccine yet. 

Our cleaning lady here in Berlin is from Chile where the situation looks really bad. She said her whole family in Chile has the virus, and her grandfather has died from it. If the situation on the southern hemisphere escalates it could swap back to the northern hemisphere again. There might be a second major wave if we are not careful. 

-J.

-------- Original message --------

From: [hidden email]

Date: 6/11/20 19:36 (GMT+01:00)

To: 'The Friday Morning Applied Complexity Coffee Group' <[hidden email]>

Subject: [FRIAM] Practical Covid Guidlines

I wonder what The Congregation, including the Diaspora, thought about this. Nothing very dramatic, here, but that’s just the point.  Nothing on travel. 

From Dr. James Stein, Professor of Cardiovascular Research at the University of Wisconsin School of Medicine and Public Health…

 COVID-19 update as we start to leave our cocoons. The purpose of this post is to provide a perspective on the intense but expected anxiety so many people are experiencing as they prepare to leave the shelter of their homes. My opinions are not those of my employers and are not meant to invalidate anyone else’s – they simply are my perspective on managing risk.

 In March, we did not know much about COVID-19 other than the incredibly scary news reports from overrun hospitals in China, Italy, and other parts of Europe. The media was filled with scary pictures of chest CT scans, personal stories of people who decompensated quickly with shortness of breath, overwhelmed health care systems, and deaths. We heard confusing and widely varying estimates for risk of getting infected and of dying – some estimates were quite high.  

Key point #1: The COVID-19 we are facing now is the same disease it was 2 months ago. The “shelter at home” orders were the right step from a public health standpoint to make sure we flattened the curve and didn’t overrun the health care system which would have led to excess preventable deaths. It also bought us time to learn about the disease’s dynamics, preventive measures, and best treatment strategies – and we did. For hospitalized patients, we have learned to avoid early intubation, to use prone ventilation, and that remdesivir probably reduces time to recovery. We have learned how to best use and preserve PPE. We also know that several therapies suggested early on probably don’t do much and may even cause harm (ie, azithromycin, chloroquine, hydroxychloroquine, lopinavir/ritonavir). But all of our social distancing did not change the disease. Take home: We flattened the curve and with it our economy and psyches, but the disease itself is still here. 

Key point #2: COVID-19 is more deadly than seasonal influenza (about 5-10x so), but not nearly as deadly as Ebola, Rabies, or Marburg Hemorrhagic Fever where 25-90% of people who get infected die. COVID-19’s case fatality rate is about 0.8-1.5% overall, but much higher if you are 60-69 years old (3-4%), 70-79 years old (7-9%), and especially so if you are over 80 years old (CFR 13-17%). It is much lower if you are under 50 years old (<0.6%). The infection fatality rate is about half of these numbers. Take home: COVID-19 is dangerous, but the vast majority of people who get it, survive it. About 15% of people get very ill and could stay ill for a long time. We are going to be dealing with it for a long time.

 Key point #3: SARS-CoV-2 is very contagious, but not as contagious as Measles, Mumps, or even certain strains of pandemic Influenza. It is spread by respiratory droplets and aerosols, not food and incidental contact. Take home: social distancing, not touching our faces, and good hand hygiene are the key weapons to stop the spread. Masks could make a difference, too, especially in public places where people congregate. Incidental contact is not really an issue, nor is food.

 What does this all mean as we return to work and public life? COVID-19 is not going away anytime soon. It may not go away for a year or two and may not be eradicated for many years, so we have to learn to live with it and do what we can to mitigate (reduce) risk. That means being willing to accept *some* level of risk to live our lives as we desire. I can’t decide that level of risk for you – only you can make that decision. There are few certainties in pandemic risk management other than that fact that some people will die, some people in low risk groups will die, and some people in high risk groups will survive. It’s about probability.

 Here is some guidance – my point of view, not judging yours:

1. People over 60 years old are at higher risk of severe disease – people over 70 years old, even more so. They should be willing to tolerate less risk than people under 50 years old and should be extra careful. Some chronic diseases like heart disease and COPD increase risk, but it is not clear if other diseases like obesity, asthma, immune disorders, etc. increase risk appreciably. It looks like asthma and inflammatory bowel disease might not be as high risk as we thought, but we are not sure - their risks might be too small to pick up, or they might be associated with things that put them at higher risk.

People over 60-70 years old probably should continue to be very vigilant about limiting exposures if they can. However, not seeing family – especially children and grandchildren – can take a serious emotional toll, so I encourage people to be creative and flexible. For example, in-person visits are not crazy – consider one, especially if you have been isolated and have no symptoms. They are especially safe in the early days after restrictions are lifted in places like Madison or parts of major cities where there is very little community transmission. Families can decide how much mingling they are comfortable with - if they want to hug and eat together, distance together with masks, or just stay apart and continue using video-conferencing and the telephone to stay in contact. If you choose to intermingle, remember to practice good hand hygiene, don’t share plates/forks/spoons/cups, don’t share towels, and don’t sleep together.

 2. Social distancing, not touching your face, and washing/sanitizing your hands are the key prevention interventions. They are vastly more important than anything else you do. Wearing a fabric mask is a good idea in crowded public place like a grocery store or public transportation, but you absolutely must distance, practice good hand hygiene, and don’t touch your face. Wearing gloves is not helpful (the virus does not get in through the skin) and may increase your risk because you likely won’t washing or sanitize your hands when they are on, you will drop things, and touch your face.

 3. Be a good citizen. If you think you might be sick, stay home. If you are going to cough or sneeze, turn away from people, block it, and sanitize your hands immediately after.

 4. Use common sense. Dial down the anxiety. If you are out taking a walk and someone walks past you, that brief (near) contact is so low risk that it doesn’t make sense to get scared. Smile at them as they approach, turn your head away as they pass, move on. The smile will be more therapeutic than the passing is dangerous. Similarly, if someone bumps into you at the grocery store or reaches past you for a loaf of bread, don’t stress - it is a very low risk encounter, also - as long as they didn’t cough or sneeze in your face (one reason we wear cloth masks in public!). 

5. Use common sense, part II. Dial down the obsessiveness. There really is no reason to go crazy sanitizing items that come into your house from outside, like groceries and packages. For it to be a risk, the delivery person would need to be infectious, cough or sneeze some droplets on your package, you touch the droplet, then touch your face, and then it invades your respiratory epithelium. There would need to be enough viral load and the virions would need to survive long enough for you to get infected. It could happen, but it’s pretty unlikely. If you want to have a staging station for 1-2 days before you put things away, sure, no problem. You also can simply wipe things off before they come in to your house - that is fine is fine too. For an isolated family, it makes no sense to obsessively wipe down every surface every day (or several times a day). Door knobs, toilet handles, commonly trafficked light switches could get a wipe off each day, but it takes a lot of time and emotional energy to do all those things and they have marginal benefits. We don’t need to create a sterile operating room-like living space. Compared to keeping your hands out of your mouth, good hand hygiene, and cleaning food before serving it, these behaviors might be more maladaptive than protective. 

6. There are few absolutes, so please get comfortable accepting some calculated risks, otherwise you might be isolating yourself for a really, really long time. Figure out how you can be in public and interact with people without fear.

 

     <img width="192" height="32" style="width:2.0in;height:.3333in" id="m_-5089887865504843604m_-1055917697182651435Picture_x0020_1" src="content://com.samsung.android.email.attachmentprovider/1/8361/RAW" onmouseover="imageMousePointerUpdate(true)" onmouseout="imageMousePointerUpdate(false)" name="com_samsung_android_email_attachmentprovider_1_8361_RAW_1591900344239">

Steven W. Tabak, M.D., F.A.C.C.   |   Medical Director, Quality and Physician Outreach

____________________________________________________________________________________________________________________________________________________________________________

 

 

Nicholas Thompson

Emeritus Professor of Ethology and Psychology

Clark University

[hidden email]

https://wordpress.clarku.edu/nthompson/

 

 

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[Prof David West]

I was going to make a separate post this morning claiming that my June 15th prediction had been realized. The 'straw' was 19 Governor's of states with rising rates, stated that restrictions would continue to be lifted on schedule and the rise in rates could be handled. All said there would be no return to lock down.Utah is the only state that delayed, by two weeks and for the Salt Lake City area, complete lifting of restrictions. The word "spike" is seldom seen in headlines — replaced with "rise."

Poker rooms are opening, even in CA, with 5-6 person tables instead of 9-10

Travel is not mentioned in the missive Nick included because people are simply traveling. The highways in southern Utah and the parks is typical summer volume already. RV parks are full. Campgrounds are full. Greyhound and FlixBus are reopening.

Carnival operators in Holland blocked a major highway today demanding, and evidently getting, permission to open for the summer traveling season. (talk about a vector!)

davew

On Thu, Jun 11, 2020, at 11:35 AM, [hidden email] wrote:

I wonder what The Congregation, including the Diaspora, thought about this. Nothing very dramatic, here, but that’s just the point.  Nothing on travel. 

 

From Dr. James Stein, Professor of Cardiovascular Research at the University of Wisconsin School of Medicine and Public Health…

 COVID-19 update as we start to leave our cocoons. The purpose of this post is to provide a perspective on the intense but expected anxiety so many people are experiencing as they prepare to leave the shelter of their homes. My opinions are not those of my employers and are not meant to invalidate anyone else’s – they simply are my perspective on managing risk.

 In March, we did not know much about COVID-19 other than the incredibly scary news reports from overrun hospitals in China, Italy, and other parts of Europe. The media was filled with scary pictures of chest CT scans, personal stories of people who decompensated quickly with shortness of breath, overwhelmed health care systems, and deaths. We heard confusing and widely varying estimates for risk of getting infected and of dying – some estimates were quite high.  

Key point #1: The COVID-19 we are facing now is the same disease it was 2 months ago. The “shelter at home” orders were the right step from a public health standpoint to make sure we flattened the curve and didn’t overrun the health care system which would have led to excess preventable deaths. It also bought us time to learn about the disease’s dynamics, preventive measures, and best treatment strategies – and we did. For hospitalized patients, we have learned to avoid early intubation, to use prone ventilation, and that remdesivir probably reduces time to recovery. We have learned how to best use and preserve PPE. We also know that several therapies suggested early on probably don’t do much and may even cause harm (ie, azithromycin, chloroquine, hydroxychloroquine, lopinavir/ritonavir). But all of our social distancing did not change the disease. Take home: We flattened the curve and with it our economy and psyches, but the disease itself is still here. 

Key point #2: COVID-19 is more deadly than seasonal influenza (about 5-10x so), but not nearly as deadly as Ebola, Rabies, or Marburg Hemorrhagic Fever where 25-90% of people who get infected die. COVID-19’s case fatality rate is about 0.8-1.5% overall, but much higher if you are 60-69 years old (3-4%), 70-79 years old (7-9%), and especially so if you are over 80 years old (CFR 13-17%). It is much lower if you are under 50 years old (<0.6%). The infection fatality rate is about half of these numbers. Take home: COVID-19 is dangerous, but the vast majority of people who get it, survive it. About 15% of people get very ill and could stay ill for a long time. We are going to be dealing with it for a long time.

 Key point #3: SARS-CoV-2 is very contagious, but not as contagious as Measles, Mumps, or even certain strains of pandemic Influenza. It is spread by respiratory droplets and aerosols, not food and incidental contact. Take home: social distancing, not touching our faces, and good hand hygiene are the key weapons to stop the spread. Masks could make a difference, too, especially in public places where people congregate. Incidental contact is not really an issue, nor is food.

 What does this all mean as we return to work and public life? COVID-19 is not going away anytime soon. It may not go away for a year or two and may not be eradicated for many years, so we have to learn to live with it and do what we can to mitigate (reduce) risk. That means being willing to accept *some* level of risk to live our lives as we desire. I can’t decide that level of risk for you – only you can make that decision. There are few certainties in pandemic risk management other than that fact that some people will die, some people in low risk groups will die, and some people in high risk groups will survive. It’s about probability.

 Here is some guidance – my point of view, not judging yours:

1. People over 60 years old are at higher risk of severe disease – people over 70 years old, even more so. They should be willing to tolerate less risk than people under 50 years old and should be extra careful. Some chronic diseases like heart disease and COPD increase risk, but it is not clear if other diseases like obesity, asthma, immune disorders, etc. increase risk appreciably. It looks like asthma and inflammatory bowel disease might not be as high risk as we thought, but we are not sure - their risks might be too small to pick up, or they might be associated with things that put them at higher risk.

People over 60-70 years old probably should continue to be very vigilant about limiting exposures if they can. However, not seeing family – especially children and grandchildren – can take a serious emotional toll, so I encourage people to be creative and flexible. For example, in-person visits are not crazy – consider one, especially if you have been isolated and have no symptoms. They are especially safe in the early days after restrictions are lifted in places like Madison or parts of major cities where there is very little community transmission. Families can decide how much mingling they are comfortable with - if they want to hug and eat together, distance together with masks, or just stay apart and continue using video-conferencing and the telephone to stay in contact. If you choose to intermingle, remember to practice good hand hygiene, don’t share plates/forks/spoons/cups, don’t share towels, and don’t sleep together.

 2. Social distancing, not touching your face, and washing/sanitizing your hands are the key prevention interventions. They are vastly more important than anything else you do. Wearing a fabric mask is a good idea in crowded public place like a grocery store or public transportation, but you absolutely must distance, practice good hand hygiene, and don’t touch your face. Wearing gloves is not helpful (the virus does not get in through the skin) and may increase your risk because you likely won’t washing or sanitize your hands when they are on, you will drop things, and touch your face.

 3. Be a good citizen. If you think you might be sick, stay home. If you are going to cough or sneeze, turn away from people, block it, and sanitize your hands immediately after.

 4. Use common sense. Dial down the anxiety. If you are out taking a walk and someone walks past you, that brief (near) contact is so low risk that it doesn’t make sense to get scared. Smile at them as they approach, turn your head away as they pass, move on. The smile will be more therapeutic than the passing is dangerous. Similarly, if someone bumps into you at the grocery store or reaches past you for a loaf of bread, don’t stress - it is a very low risk encounter, also - as long as they didn’t cough or sneeze in your face (one reason we wear cloth masks in public!). 

5. Use common sense, part II. Dial down the obsessiveness. There really is no reason to go crazy sanitizing items that come into your house from outside, like groceries and packages. For it to be a risk, the delivery person would need to be infectious, cough or sneeze some droplets on your package, you touch the droplet, then touch your face, and then it invades your respiratory epithelium. There would need to be enough viral load and the virions would need to survive long enough for you to get infected. It could happen, but it’s pretty unlikely. If you want to have a staging station for 1-2 days before you put things away, sure, no problem. You also can simply wipe things off before they come in to your house - that is fine is fine too. For an isolated family, it makes no sense to obsessively wipe down every surface every day (or several times a day). Door knobs, toilet handles, commonly trafficked light switches could get a wipe off each day, but it takes a lot of time and emotional energy to do all those things and they have marginal benefits. We don’t need to create a sterile operating room-like living space. Compared to keeping your hands out of your mouth, good hand hygiene, and cleaning food before serving it, these behaviors might be more maladaptive than protective. 

6. There are few absolutes, so please get comfortable accepting some calculated risks, otherwise you might be isolating yourself for a really, really long time. Figure out how you can be in public and interact with people without fear.

 

    

Steven W. Tabak, M.D., F.A.C.C.   |   Medical Director, Quality and Physician Outreach

____________________________________________________________________________________________________________________________________________________________________________

 

 

Nicholas Thompson

Emeritus Professor of Ethology and Psychology

Clark University

[hidden email]

https://wordpress.clarku.edu/nthompson/

 

 

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[Frank Wimberly-2]

Arizona and Texas are "spiking" as of today.  We're surrounded.

On Thu, Jun 11, 2020, 1:45 PM Prof David West <[hidden email]> wrote:

I was going to make a separate post this morning claiming that my June 15th prediction had been realized. The 'straw' was 19 Governor's of states with rising rates, stated that restrictions would continue to be lifted on schedule and the rise in rates could be handled. All said there would be no return to lock down.Utah is the only state that delayed, by two weeks and for the Salt Lake City area, complete lifting of restrictions. The word "spike" is seldom seen in headlines — replaced with "rise."

Poker rooms are opening, even in CA, with 5-6 person tables instead of 9-10

Travel is not mentioned in the missive Nick included because people are simply traveling. The highways in southern Utah and the parks is typical summer volume already. RV parks are full. Campgrounds are full. Greyhound and FlixBus are reopening.

Carnival operators in Holland blocked a major highway today demanding, and evidently getting, permission to open for the summer traveling season. (talk about a vector!)

davew

On Thu, Jun 11, 2020, at 11:35 AM, [hidden email] wrote:

I wonder what The Congregation, including the Diaspora, thought about this. Nothing very dramatic, here, but that’s just the point.  Nothing on travel. 

 

From Dr. James Stein, Professor of Cardiovascular Research at the University of Wisconsin School of Medicine and Public Health…

 COVID-19 update as we start to leave our cocoons. The purpose of this post is to provide a perspective on the intense but expected anxiety so many people are experiencing as they prepare to leave the shelter of their homes. My opinions are not those of my employers and are not meant to invalidate anyone else’s – they simply are my perspective on managing risk.

 In March, we did not know much about COVID-19 other than the incredibly scary news reports from overrun hospitals in China, Italy, and other parts of Europe. The media was filled with scary pictures of chest CT scans, personal stories of people who decompensated quickly with shortness of breath, overwhelmed health care systems, and deaths. We heard confusing and widely varying estimates for risk of getting infected and of dying – some estimates were quite high.  

Key point #1: The COVID-19 we are facing now is the same disease it was 2 months ago. The “shelter at home” orders were the right step from a public health standpoint to make sure we flattened the curve and didn’t overrun the health care system which would have led to excess preventable deaths. It also bought us time to learn about the disease’s dynamics, preventive measures, and best treatment strategies – and we did. For hospitalized patients, we have learned to avoid early intubation, to use prone ventilation, and that remdesivir probably reduces time to recovery. We have learned how to best use and preserve PPE. We also know that several therapies suggested early on probably don’t do much and may even cause harm (ie, azithromycin, chloroquine, hydroxychloroquine, lopinavir/ritonavir). But all of our social distancing did not change the disease. Take home: We flattened the curve and with it our economy and psyches, but the disease itself is still here. 

Key point #2: COVID-19 is more deadly than seasonal influenza (about 5-10x so), but not nearly as deadly as Ebola, Rabies, or Marburg Hemorrhagic Fever where 25-90% of people who get infected die. COVID-19’s case fatality rate is about 0.8-1.5% overall, but much higher if you are 60-69 years old (3-4%), 70-79 years old (7-9%), and especially so if you are over 80 years old (CFR 13-17%). It is much lower if you are under 50 years old (<0.6%). The infection fatality rate is about half of these numbers. Take home: COVID-19 is dangerous, but the vast majority of people who get it, survive it. About 15% of people get very ill and could stay ill for a long time. We are going to be dealing with it for a long time.

 Key point #3: SARS-CoV-2 is very contagious, but not as contagious as Measles, Mumps, or even certain strains of pandemic Influenza. It is spread by respiratory droplets and aerosols, not food and incidental contact. Take home: social distancing, not touching our faces, and good hand hygiene are the key weapons to stop the spread. Masks could make a difference, too, especially in public places where people congregate. Incidental contact is not really an issue, nor is food.

 What does this all mean as we return to work and public life? COVID-19 is not going away anytime soon. It may not go away for a year or two and may not be eradicated for many years, so we have to learn to live with it and do what we can to mitigate (reduce) risk. That means being willing to accept *some* level of risk to live our lives as we desire. I can’t decide that level of risk for you – only you can make that decision. There are few certainties in pandemic risk management other than that fact that some people will die, some people in low risk groups will die, and some people in high risk groups will survive. It’s about probability.

 Here is some guidance – my point of view, not judging yours:

1. People over 60 years old are at higher risk of severe disease – people over 70 years old, even more so. They should be willing to tolerate less risk than people under 50 years old and should be extra careful. Some chronic diseases like heart disease and COPD increase risk, but it is not clear if other diseases like obesity, asthma, immune disorders, etc. increase risk appreciably. It looks like asthma and inflammatory bowel disease might not be as high risk as we thought, but we are not sure - their risks might be too small to pick up, or they might be associated with things that put them at higher risk.

People over 60-70 years old probably should continue to be very vigilant about limiting exposures if they can. However, not seeing family – especially children and grandchildren – can take a serious emotional toll, so I encourage people to be creative and flexible. For example, in-person visits are not crazy – consider one, especially if you have been isolated and have no symptoms. They are especially safe in the early days after restrictions are lifted in places like Madison or parts of major cities where there is very little community transmission. Families can decide how much mingling they are comfortable with - if they want to hug and eat together, distance together with masks, or just stay apart and continue using video-conferencing and the telephone to stay in contact. If you choose to intermingle, remember to practice good hand hygiene, don’t share plates/forks/spoons/cups, don’t share towels, and don’t sleep together.

 2. Social distancing, not touching your face, and washing/sanitizing your hands are the key prevention interventions. They are vastly more important than anything else you do. Wearing a fabric mask is a good idea in crowded public place like a grocery store or public transportation, but you absolutely must distance, practice good hand hygiene, and don’t touch your face. Wearing gloves is not helpful (the virus does not get in through the skin) and may increase your risk because you likely won’t washing or sanitize your hands when they are on, you will drop things, and touch your face.

 3. Be a good citizen. If you think you might be sick, stay home. If you are going to cough or sneeze, turn away from people, block it, and sanitize your hands immediately after.

 4. Use common sense. Dial down the anxiety. If you are out taking a walk and someone walks past you, that brief (near) contact is so low risk that it doesn’t make sense to get scared. Smile at them as they approach, turn your head away as they pass, move on. The smile will be more therapeutic than the passing is dangerous. Similarly, if someone bumps into you at the grocery store or reaches past you for a loaf of bread, don’t stress - it is a very low risk encounter, also - as long as they didn’t cough or sneeze in your face (one reason we wear cloth masks in public!). 

5. Use common sense, part II. Dial down the obsessiveness. There really is no reason to go crazy sanitizing items that come into your house from outside, like groceries and packages. For it to be a risk, the delivery person would need to be infectious, cough or sneeze some droplets on your package, you touch the droplet, then touch your face, and then it invades your respiratory epithelium. There would need to be enough viral load and the virions would need to survive long enough for you to get infected. It could happen, but it’s pretty unlikely. If you want to have a staging station for 1-2 days before you put things away, sure, no problem. You also can simply wipe things off before they come in to your house - that is fine is fine too. For an isolated family, it makes no sense to obsessively wipe down every surface every day (or several times a day). Door knobs, toilet handles, commonly trafficked light switches could get a wipe off each day, but it takes a lot of time and emotional energy to do all those things and they have marginal benefits. We don’t need to create a sterile operating room-like living space. Compared to keeping your hands out of your mouth, good hand hygiene, and cleaning food before serving it, these behaviors might be more maladaptive than protective. 

6. There are few absolutes, so please get comfortable accepting some calculated risks, otherwise you might be isolating yourself for a really, really long time. Figure out how you can be in public and interact with people without fear.

 

    

Steven W. Tabak, M.D., F.A.C.C.   |   Medical Director, Quality and Physician Outreach

____________________________________________________________________________________________________________________________________________________________________________

 

 

Nicholas Thompson

Emeritus Professor of Ethology and Psychology

Clark University

[hidden email]

https://wordpress.clarku.edu/nthompson/

 

 

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[Marcus G. Daniels]

Find something really heavy, and try to pick it up.  ☺ ☺  There’s still time for a clean exit. 

 

From: Friam <[hidden email]> on behalf of Frank Wimberly <[hidden email]>
Reply-To: The Friday Morning Applied Complexity Coffee Group <[hidden email]>
Date: Thursday, June 11, 2020 at 12:57 PM
To: The Friday Morning Applied Complexity Coffee Group <[hidden email]>
Subject: Re: [FRIAM] Practical Covid Guidlines

 

Arizona and Texas are "spiking" as of today.  We're surrounded.

---
Frank C. Wimberly
140 Calle Ojo Feliz,
Santa Fe, NM 87505

505 670-9918
Santa Fe, NM

 

On Thu, Jun 11, 2020, 1:45 PM Prof David West <[hidden email]> wrote:

I was going to make a separate post this morning claiming that my June 15th prediction had been realized. The 'straw' was 19 Governor's of states with rising rates, stated that restrictions would continue to be lifted on schedule and the rise in rates could be handled. All said there would be no return to lock down.Utah is the only state that delayed, by two weeks and for the Salt Lake City area, complete lifting of restrictions. The word "spike" is seldom seen in headlines — replaced with "rise."

 

Poker rooms are opening, even in CA, with 5-6 person tables instead of 9-10

 

Travel is not mentioned in the missive Nick included because people are simply traveling. The highways in southern Utah and the parks is typical summer volume already. RV parks are full. Campgrounds are full. Greyhound and FlixBus are reopening.

 

Carnival operators in Holland blocked a major highway today demanding, and evidently getting, permission to open for the summer traveling season. (talk about a vector!)

 

davew

 

 

On Thu, Jun 11, 2020, at 11:35 AM, [hidden email] wrote:

I wonder what The Congregation, including the Diaspora, thought about this. Nothing very dramatic, here, but that’s just the point.  Nothing on travel. 

 

From Dr. James Stein, Professor of Cardiovascular Research at the University of Wisconsin School of Medicine and Public Health…

 COVID-19 update as we start to leave our cocoons. The purpose of this post is to provide a perspective on the intense but expected anxiety so many people are experiencing as they prepare to leave the shelter of their homes. My opinions are not those of my employers and are not meant to invalidate anyone else’s – they simply are my perspective on managing risk.

 In March, we did not know much about COVID-19 other than the incredibly scary news reports from overrun hospitals in China, Italy, and other parts of Europe. The media was filled with scary pictures of chest CT scans, personal stories of people who decompensated quickly with shortness of breath, overwhelmed health care systems, and deaths. We heard confusing and widely varying estimates for risk of getting infected and of dying – some estimates were quite high.  

Key point #1: The COVID-19 we are facing now is the same disease it was 2 months ago. The “shelter at home” orders were the right step from a public health standpoint to make sure we flattened the curve and didn’t overrun the health care system which would have led to excess preventable deaths. It also bought us time to learn about the disease’s dynamics, preventive measures, and best treatment strategies – and we did. For hospitalized patients, we have learned to avoid early intubation, to use prone ventilation, and that remdesivir probably reduces time to recovery. We have learned how to best use and preserve PPE. We also know that several therapies suggested early on probably don’t do much and may even cause harm (ie, azithromycin, chloroquine, hydroxychloroquine, lopinavir/ritonavir). But all of our social distancing did not change the disease. Take home: We flattened the curve and with it our economy and psyches, but the disease itself is still here. 

Key point #2: COVID-19 is more deadly than seasonal influenza (about 5-10x so), but not nearly as deadly as Ebola, Rabies, or Marburg Hemorrhagic Fever where 25-90% of people who get infected die. COVID-19’s case fatality rate is about 0.8-1.5% overall, but much higher if you are 60-69 years old (3-4%), 70-79 years old (7-9%), and especially so if you are over 80 years old (CFR 13-17%). It is much lower if you are under 50 years old (<0.6%). The infection fatality rate is about half of these numbers. Take home: COVID-19 is dangerous, but the vast majority of people who get it, survive it. About 15% of people get very ill and could stay ill for a long time. We are going to be dealing with it for a long time.

 Key point #3: SARS-CoV-2 is very contagious, but not as contagious as Measles, Mumps, or even certain strains of pandemic Influenza. It is spread by respiratory droplets and aerosols, not food and incidental contact. Take home: social distancing, not touching our faces, and good hand hygiene are the key weapons to stop the spread. Masks could make a difference, too, especially in public places where people congregate. Incidental contact is not really an issue, nor is food.

 What does this all mean as we return to work and public life? COVID-19 is not going away anytime soon. It may not go away for a year or two and may not be eradicated for many years, so we have to learn to live with it and do what we can to mitigate (reduce) risk. That means being willing to accept *some* level of risk to live our lives as we desire. I can’t decide that level of risk for you – only you can make that decision. There are few certainties in pandemic risk management other than that fact that some people will die, some people in low risk groups will die, and some people in high risk groups will survive. It’s about probability.

 Here is some guidance – my point of view, not judging yours:

1. People over 60 years old are at higher risk of severe disease – people over 70 years old, even more so. They should be willing to tolerate less risk than people under 50 years old and should be extra careful. Some chronic diseases like heart disease and COPD increase risk, but it is not clear if other diseases like obesity, asthma, immune disorders, etc. increase risk appreciably. It looks like asthma and inflammatory bowel disease might not be as high risk as we thought, but we are not sure - their risks might be too small to pick up, or they might be associated with things that put them at higher risk.

People over 60-70 years old probably should continue to be very vigilant about limiting exposures if they can. However, not seeing family – especially children and grandchildren – can take a serious emotional toll, so I encourage people to be creative and flexible. For example, in-person visits are not crazy – consider one, especially if you have been isolated and have no symptoms. They are especially safe in the early days after restrictions are lifted in places like Madison or parts of major cities where there is very little community transmission. Families can decide how much mingling they are comfortable with - if they want to hug and eat together, distance together with masks, or just stay apart and continue using video-conferencing and the telephone to stay in contact. If you choose to intermingle, remember to practice good hand hygiene, don’t share plates/forks/spoons/cups, don’t share towels, and don’t sleep together.

 2. Social distancing, not touching your face, and washing/sanitizing your hands are the key prevention interventions. They are vastly more important than anything else you do. Wearing a fabric mask is a good idea in crowded public place like a grocery store or public transportation, but you absolutely must distance, practice good hand hygiene, and don’t touch your face. Wearing gloves is not helpful (the virus does not get in through the skin) and may increase your risk because you likely won’t washing or sanitize your hands when they are on, you will drop things, and touch your face.

 3. Be a good citizen. If you think you might be sick, stay home. If you are going to cough or sneeze, turn away from people, block it, and sanitize your hands immediately after.

 4. Use common sense. Dial down the anxiety. If you are out taking a walk and someone walks past you, that brief (near) contact is so low risk that it doesn’t make sense to get scared. Smile at them as they approach, turn your head away as they pass, move on. The smile will be more therapeutic than the passing is dangerous. Similarly, if someone bumps into you at the grocery store or reaches past you for a loaf of bread, don’t stress - it is a very low risk encounter, also - as long as they didn’t cough or sneeze in your face (one reason we wear cloth masks in public!). 

5. Use common sense, part II. Dial down the obsessiveness. There really is no reason to go crazy sanitizing items that come into your house from outside, like groceries and packages. For it to be a risk, the delivery person would need to be infectious, cough or sneeze some droplets on your package, you touch the droplet, then touch your face, and then it invades your respiratory epithelium. There would need to be enough viral load and the virions would need to survive long enough for you to get infected. It could happen, but it’s pretty unlikely. If you want to have a staging station for 1-2 days before you put things away, sure, no problem. You also can simply wipe things off before they come in to your house - that is fine is fine too. For an isolated family, it makes no sense to obsessively wipe down every surface every day (or several times a day). Door knobs, toilet handles, commonly trafficked light switches could get a wipe off each day, but it takes a lot of time and emotional energy to do all those things and they have marginal benefits. We don’t need to create a sterile operating room-like living space. Compared to keeping your hands out of your mouth, good hand hygiene, and cleaning food before serving it, these behaviors might be more maladaptive than protective. 

6. There are few absolutes, so please get comfortable accepting some calculated risks, otherwise you might be isolating yourself for a really, really long time. Figure out how you can be in public and interact with people without fear.

 

    

Steven W. Tabak, M.D., F.A.C.C.   |   Medical Director, Quality and Physician Outreach

____________________________________________________________________________________________________________________________________________________________________________

 

 

Nicholas Thompson

Emeritus Professor of Ethology and Psychology

Clark University

[hidden email]

https://wordpress.clarku.edu/nthompson/

 

 

 

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[gepr]

To be clear, below is Dave's predictions: http://friam.471366.n2.nabble.com/the-end-of-the-pandemic-td7595888.html#a7595894

I don't see how your claim that they've come to pass are anything but confirmation bias. Every one of the predictions seems to have failed. The pandemic hasn't ended. There's no *radical* shift in perception. Everyone I know (including the morons at the pub without masks, with ~6 trips since our county went to phase 2) admits it's worse than the flu. "Science" is only just now working out demographics and treatments. All the signs point to *huge* changes in the way most of us behave.

On May 11, 2020; 7:42am, Prof David West wrote:

> The COVID-19 pandemic will end, at least in the US, by mid-June, 2020.
>
> This assertion is premised on making a distinction between the biological and the perceptual.
>
> The virus is not going away, a vaccine may or may not be found and made widely available, and treatments that reduce severity and death rate may or may not be soon at hand. Hot spots will continue to flare. Model-based prognostications will be confirmed.  And none of this will matter.
>
> A radical shift in perception from "we're all going to die" to "I have next to zero chance of severe illness or death" is reaching a tipping point and a catastrophic (mathematical sense of the word) change from one to the other is imminent.
>
> "Science" will quickly confirm (justify / rationalize) this shift  — after all, my individual risk is 150,000 / 300,000,000 or "pretty damned small."
>
> Politicians will quickly cave to this new perceptual reality and socio-economic restrictions will collapse.
>
> The percentage of the population that wear masks (just one example of a behavioral phenomenon) will roughly equal the number that fastidiously fasten their seat belts; but this and similar behaviors will mitigate the the infection/death rate.
>
> Covid will be PERCEIVED to be no worse than the flu, the death rate will become "acceptable," and the current media "hysteria" will fade away.
>
> There will be a segment of the populace — mostly the affluent elderly and individuals who have acquired money/influence/notoriety the past few months — who will argue against these changes but their objections will be quickly countered with, "why should I suffer all kinds of consequences — ones you do not share — to cater to your fears or your ego?"
>
> None of the above should be interpreted as anything except a simple observation / prediction.
>
> davew

On 6/11/20 12:56 PM, Frank Wimberly wrote:
> Arizona and Texas are "spiking" as of today.  We're surrounded.

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[Prof David West]

"spiking" according to ... ? Governor? Health department? Official or semi-official (or media) analyst? And how isolated is the spike?

davew

On Thu, Jun 11, 2020, at 1:56 PM, Frank Wimberly wrote:

Arizona and Texas are "spiking" as of today.  We're surrounded.

---

Frank C. Wimberly

140 Calle Ojo Feliz,

Santa Fe, NM 87505

505 670-9918

Santa Fe, NM

On Thu, Jun 11, 2020, 1:45 PM Prof David West <[hidden email]> wrote:

I was going to make a separate post this morning claiming that my June 15th prediction had been realized. The 'straw' was 19 Governor's of states with rising rates, stated that restrictions would continue to be lifted on schedule and the rise in rates could be handled. All said there would be no return to lock down.Utah is the only state that delayed, by two weeks and for the Salt Lake City area, complete lifting of restrictions. The word "spike" is seldom seen in headlines — replaced with "rise."

Poker rooms are opening, even in CA, with 5-6 person tables instead of 9-10

Travel is not mentioned in the missive Nick included because people are simply traveling. The highways in southern Utah and the parks is typical summer volume already. RV parks are full. Campgrounds are full. Greyhound and FlixBus are reopening.

Carnival operators in Holland blocked a major highway today demanding, and evidently getting, permission to open for the summer traveling season. (talk about a vector!)

davew

On Thu, Jun 11, 2020, at 11:35 AM, [hidden email] wrote:

I wonder what The Congregation, including the Diaspora, thought about this. Nothing very dramatic, here, but that’s just the point.  Nothing on travel. 

 

From Dr. James Stein, Professor of Cardiovascular Research at the University of Wisconsin School of Medicine and Public Health…

 COVID-19 update as we start to leave our cocoons. The purpose of this post is to provide a perspective on the intense but expected anxiety so many people are experiencing as they prepare to leave the shelter of their homes. My opinions are not those of my employers and are not meant to invalidate anyone else’s – they simply are my perspective on managing risk.

 In March, we did not know much about COVID-19 other than the incredibly scary news reports from overrun hospitals in China, Italy, and other parts of Europe. The media was filled with scary pictures of chest CT scans, personal stories of people who decompensated quickly with shortness of breath, overwhelmed health care systems, and deaths. We heard confusing and widely varying estimates for risk of getting infected and of dying – some estimates were quite high.  

Key point #1: The COVID-19 we are facing now is the same disease it was 2 months ago. The “shelter at home” orders were the right step from a public health standpoint to make sure we flattened the curve and didn’t overrun the health care system which would have led to excess preventable deaths. It also bought us time to learn about the disease’s dynamics, preventive measures, and best treatment strategies – and we did. For hospitalized patients, we have learned to avoid early intubation, to use prone ventilation, and that remdesivir probably reduces time to recovery. We have learned how to best use and preserve PPE. We also know that several therapies suggested early on probably don’t do much and may even cause harm (ie, azithromycin, chloroquine, hydroxychloroquine, lopinavir/ritonavir). But all of our social distancing did not change the disease. Take home: We flattened the curve and with it our economy and psyches, but the disease itself is still here. 

Key point #2: COVID-19 is more deadly than seasonal influenza (about 5-10x so), but not nearly as deadly as Ebola, Rabies, or Marburg Hemorrhagic Fever where 25-90% of people who get infected die. COVID-19’s case fatality rate is about 0.8-1.5% overall, but much higher if you are 60-69 years old (3-4%), 70-79 years old (7-9%), and especially so if you are over 80 years old (CFR 13-17%). It is much lower if you are under 50 years old (<0.6%). The infection fatality rate is about half of these numbers. Take home: COVID-19 is dangerous, but the vast majority of people who get it, survive it. About 15% of people get very ill and could stay ill for a long time. We are going to be dealing with it for a long time.

 Key point #3: SARS-CoV-2 is very contagious, but not as contagious as Measles, Mumps, or even certain strains of pandemic Influenza. It is spread by respiratory droplets and aerosols, not food and incidental contact. Take home: social distancing, not touching our faces, and good hand hygiene are the key weapons to stop the spread. Masks could make a difference, too, especially in public places where people congregate. Incidental contact is not really an issue, nor is food.

 What does this all mean as we return to work and public life? COVID-19 is not going away anytime soon. It may not go away for a year or two and may not be eradicated for many years, so we have to learn to live with it and do what we can to mitigate (reduce) risk. That means being willing to accept *some* level of risk to live our lives as we desire. I can’t decide that level of risk for you – only you can make that decision. There are few certainties in pandemic risk management other than that fact that some people will die, some people in low risk groups will die, and some people in high risk groups will survive. It’s about probability.

 Here is some guidance – my point of view, not judging yours:

1. People over 60 years old are at higher risk of severe disease – people over 70 years old, even more so. They should be willing to tolerate less risk than people under 50 years old and should be extra careful. Some chronic diseases like heart disease and COPD increase risk, but it is not clear if other diseases like obesity, asthma, immune disorders, etc. increase risk appreciably. It looks like asthma and inflammatory bowel disease might not be as high risk as we thought, but we are not sure - their risks might be too small to pick up, or they might be associated with things that put them at higher risk.

People over 60-70 years old probably should continue to be very vigilant about limiting exposures if they can. However, not seeing family – especially children and grandchildren – can take a serious emotional toll, so I encourage people to be creative and flexible. For example, in-person visits are not crazy – consider one, especially if you have been isolated and have no symptoms. They are especially safe in the early days after restrictions are lifted in places like Madison or parts of major cities where there is very little community transmission. Families can decide how much mingling they are comfortable with - if they want to hug and eat together, distance together with masks, or just stay apart and continue using video-conferencing and the telephone to stay in contact. If you choose to intermingle, remember to practice good hand hygiene, don’t share plates/forks/spoons/cups, don’t share towels, and don’t sleep together.

 2. Social distancing, not touching your face, and washing/sanitizing your hands are the key prevention interventions. They are vastly more important than anything else you do. Wearing a fabric mask is a good idea in crowded public place like a grocery store or public transportation, but you absolutely must distance, practice good hand hygiene, and don’t touch your face. Wearing gloves is not helpful (the virus does not get in through the skin) and may increase your risk because you likely won’t washing or sanitize your hands when they are on, you will drop things, and touch your face.

 3. Be a good citizen. If you think you might be sick, stay home. If you are going to cough or sneeze, turn away from people, block it, and sanitize your hands immediately after.

 4. Use common sense. Dial down the anxiety. If you are out taking a walk and someone walks past you, that brief (near) contact is so low risk that it doesn’t make sense to get scared. Smile at them as they approach, turn your head away as they pass, move on. The smile will be more therapeutic than the passing is dangerous. Similarly, if someone bumps into you at the grocery store or reaches past you for a loaf of bread, don’t stress - it is a very low risk encounter, also - as long as they didn’t cough or sneeze in your face (one reason we wear cloth masks in public!). 

5. Use common sense, part II. Dial down the obsessiveness. There really is no reason to go crazy sanitizing items that come into your house from outside, like groceries and packages. For it to be a risk, the delivery person would need to be infectious, cough or sneeze some droplets on your package, you touch the droplet, then touch your face, and then it invades your respiratory epithelium. There would need to be enough viral load and the virions would need to survive long enough for you to get infected. It could happen, but it’s pretty unlikely. If you want to have a staging station for 1-2 days before you put things away, sure, no problem. You also can simply wipe things off before they come in to your house - that is fine is fine too. For an isolated family, it makes no sense to obsessively wipe down every surface every day (or several times a day). Door knobs, toilet handles, commonly trafficked light switches could get a wipe off each day, but it takes a lot of time and emotional energy to do all those things and they have marginal benefits. We don’t need to create a sterile operating room-like living space. Compared to keeping your hands out of your mouth, good hand hygiene, and cleaning food before serving it, these behaviors might be more maladaptive than protective. 

6. There are few absolutes, so please get comfortable accepting some calculated risks, otherwise you might be isolating yourself for a really, really long time. Figure out how you can be in public and interact with people without fear.

 

    

Steven W. Tabak, M.D., F.A.C.C.   |   Medical Director, Quality and Physician Outreach

____________________________________________________________________________________________________________________________________________________________________________

 

 

Nicholas Thompson

Emeritus Professor of Ethology and Psychology

Clark University

[hidden email]

https://wordpress.clarku.edu/nthompson/

 

 

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[Marcus G. Daniels]

https://github.com/nytimes/covid-19-data

https://www.nytimes.com/interactive/2020/us/arizona-coronavirus-cases.html

https://www.nytimes.com/interactive/2020/us/arizona-coronavirus-cases.html

 

 

From: Friam <[hidden email]> on behalf of Prof David West <[hidden email]>
Reply-To: The Friday Morning Applied Complexity Coffee Group <[hidden email]>
Date: Thursday, June 11, 2020 at 1:53 PM
To: "[hidden email]" <[hidden email]>
Subject: Re: [FRIAM] Practical Covid Guidlines

 

"spiking" according to ... ? Governor? Health department? Official or semi-official (or media) analyst? And how isolated is the spike?

 

davew

 

 

On Thu, Jun 11, 2020, at 1:56 PM, Frank Wimberly wrote:

Arizona and Texas are "spiking" as of today.  We're surrounded.

 

---

Frank C. Wimberly

140 Calle Ojo Feliz,

Santa Fe, NM 87505

 

505 670-9918

Santa Fe, NM

 

On Thu, Jun 11, 2020, 1:45 PM Prof David West <[hidden email]> wrote:

 

I was going to make a separate post this morning claiming that my June 15th prediction had been realized. The 'straw' was 19 Governor's of states with rising rates, stated that restrictions would continue to be lifted on schedule and the rise in rates could be handled. All said there would be no return to lock down.Utah is the only state that delayed, by two weeks and for the Salt Lake City area, complete lifting of restrictions. The word "spike" is seldom seen in headlines — replaced with "rise."

 

Poker rooms are opening, even in CA, with 5-6 person tables instead of 9-10

 

Travel is not mentioned in the missive Nick included because people are simply traveling. The highways in southern Utah and the parks is typical summer volume already. RV parks are full. Campgrounds are full. Greyhound and FlixBus are reopening.

 

Carnival operators in Holland blocked a major highway today demanding, and evidently getting, permission to open for the summer traveling season. (talk about a vector!)

 

davew

 

 

On Thu, Jun 11, 2020, at 11:35 AM, [hidden email] wrote:

I wonder what The Congregation, including the Diaspora, thought about this. Nothing very dramatic, here, but that’s just the point.  Nothing on travel. 

 

From Dr. James Stein, Professor of Cardiovascular Research at the University of Wisconsin School of Medicine and Public Health…

 COVID-19 update as we start to leave our cocoons. The purpose of this post is to provide a perspective on the intense but expected anxiety so many people are experiencing as they prepare to leave the shelter of their homes. My opinions are not those of my employers and are not meant to invalidate anyone else’s – they simply are my perspective on managing risk.

 In March, we did not know much about COVID-19 other than the incredibly scary news reports from overrun hospitals in China, Italy, and other parts of Europe. The media was filled with scary pictures of chest CT scans, personal stories of people who decompensated quickly with shortness of breath, overwhelmed health care systems, and deaths. We heard confusing and widely varying estimates for risk of getting infected and of dying – some estimates were quite high.  

Key point #1: The COVID-19 we are facing now is the same disease it was 2 months ago. The “shelter at home” orders were the right step from a public health standpoint to make sure we flattened the curve and didn’t overrun the health care system which would have led to excess preventable deaths. It also bought us time to learn about the disease’s dynamics, preventive measures, and best treatment strategies – and we did. For hospitalized patients, we have learned to avoid early intubation, to use prone ventilation, and that remdesivir probably reduces time to recovery. We have learned how to best use and preserve PPE. We also know that several therapies suggested early on probably don’t do much and may even cause harm (ie, azithromycin, chloroquine, hydroxychloroquine, lopinavir/ritonavir). But all of our social distancing did not change the disease. Take home: We flattened the curve and with it our economy and psyches, but the disease itself is still here. 

Key point #2: COVID-19 is more deadly than seasonal influenza (about 5-10x so), but not nearly as deadly as Ebola, Rabies, or Marburg Hemorrhagic Fever where 25-90% of people who get infected die. COVID-19’s case fatality rate is about 0.8-1.5% overall, but much higher if you are 60-69 years old (3-4%), 70-79 years old (7-9%), and especially so if you are over 80 years old (CFR 13-17%). It is much lower if you are under 50 years old (<0.6%). The infection fatality rate is about half of these numbers. Take home: COVID-19 is dangerous, but the vast majority of people who get it, survive it. About 15% of people get very ill and could stay ill for a long time. We are going to be dealing with it for a long time.

 Key point #3: SARS-CoV-2 is very contagious, but not as contagious as Measles, Mumps, or even certain strains of pandemic Influenza. It is spread by respiratory droplets and aerosols, not food and incidental contact. Take home: social distancing, not touching our faces, and good hand hygiene are the key weapons to stop the spread. Masks could make a difference, too, especially in public places where people congregate. Incidental contact is not really an issue, nor is food.

 What does this all mean as we return to work and public life? COVID-19 is not going away anytime soon. It may not go away for a year or two and may not be eradicated for many years, so we have to learn to live with it and do what we can to mitigate (reduce) risk. That means being willing to accept *some* level of risk to live our lives as we desire. I can’t decide that level of risk for you – only you can make that decision. There are few certainties in pandemic risk management other than that fact that some people will die, some people in low risk groups will die, and some people in high risk groups will survive. It’s about probability.

 Here is some guidance – my point of view, not judging yours:

1. People over 60 years old are at higher risk of severe disease – people over 70 years old, even more so. They should be willing to tolerate less risk than people under 50 years old and should be extra careful. Some chronic diseases like heart disease and COPD increase risk, but it is not clear if other diseases like obesity, asthma, immune disorders, etc. increase risk appreciably. It looks like asthma and inflammatory bowel disease might not be as high risk as we thought, but we are not sure - their risks might be too small to pick up, or they might be associated with things that put them at higher risk.

People over 60-70 years old probably should continue to be very vigilant about limiting exposures if they can. However, not seeing family – especially children and grandchildren – can take a serious emotional toll, so I encourage people to be creative and flexible. For example, in-person visits are not crazy – consider one, especially if you have been isolated and have no symptoms. They are especially safe in the early days after restrictions are lifted in places like Madison or parts of major cities where there is very little community transmission. Families can decide how much mingling they are comfortable with - if they want to hug and eat together, distance together with masks, or just stay apart and continue using video-conferencing and the telephone to stay in contact. If you choose to intermingle, remember to practice good hand hygiene, don’t share plates/forks/spoons/cups, don’t share towels, and don’t sleep together.

 2. Social distancing, not touching your face, and washing/sanitizing your hands are the key prevention interventions. They are vastly more important than anything else you do. Wearing a fabric mask is a good idea in crowded public place like a grocery store or public transportation, but you absolutely must distance, practice good hand hygiene, and don’t touch your face. Wearing gloves is not helpful (the virus does not get in through the skin) and may increase your risk because you likely won’t washing or sanitize your hands when they are on, you will drop things, and touch your face.

 3. Be a good citizen. If you think you might be sick, stay home. If you are going to cough or sneeze, turn away from people, block it, and sanitize your hands immediately after.

 4. Use common sense. Dial down the anxiety. If you are out taking a walk and someone walks past you, that brief (near) contact is so low risk that it doesn’t make sense to get scared. Smile at them as they approach, turn your head away as they pass, move on. The smile will be more therapeutic than the passing is dangerous. Similarly, if someone bumps into you at the grocery store or reaches past you for a loaf of bread, don’t stress - it is a very low risk encounter, also - as long as they didn’t cough or sneeze in your face (one reason we wear cloth masks in public!). 

5. Use common sense, part II. Dial down the obsessiveness. There really is no reason to go crazy sanitizing items that come into your house from outside, like groceries and packages. For it to be a risk, the delivery person would need to be infectious, cough or sneeze some droplets on your package, you touch the droplet, then touch your face, and then it invades your respiratory epithelium. There would need to be enough viral load and the virions would need to survive long enough for you to get infected. It could happen, but it’s pretty unlikely. If you want to have a staging station for 1-2 days before you put things away, sure, no problem. You also can simply wipe things off before they come in to your house - that is fine is fine too. For an isolated family, it makes no sense to obsessively wipe down every surface every day (or several times a day). Door knobs, toilet handles, commonly trafficked light switches could get a wipe off each day, but it takes a lot of time and emotional energy to do all those things and they have marginal benefits. We don’t need to create a sterile operating room-like living space. Compared to keeping your hands out of your mouth, good hand hygiene, and cleaning food before serving it, these behaviors might be more maladaptive than protective. 

6. There are few absolutes, so please get comfortable accepting some calculated risks, otherwise you might be isolating yourself for a really, really long time. Figure out how you can be in public and interact with people without fear.

 

     Error! Filename not specified.

Steven W. Tabak, M.D., F.A.C.C.   |   Medical Director, Quality and Physician Outreach

____________________________________________________________________________________________________________________________________________________________________________

 

 

Nicholas Thompson

Emeritus Professor of Ethology and Psychology

Clark University

[hidden email]

https://wordpress.clarku.edu/nthompson/

 

 

 

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[Frank Wimberly-2]

Arizona and Texas increase in Covid-19 cases called spikes:

https://www.vox.com/2020/6/11/21286431/coronavirus-arizona-covid-19-cases-deaths-navajo-nation 

https://www.kvue.com/article/news/health/coronavirus/austin-coronavirus-updates-cases-spike/269-5e7306b0-244e-481c-bf40-1f20e798bbed  

 

On Thu, Jun 11, 2020 at 2:59 PM Marcus Daniels <[hidden email]> wrote:

https://github.com/nytimes/covid-19-data

https://www.nytimes.com/interactive/2020/us/arizona-coronavirus-cases.html

https://www.nytimes.com/interactive/2020/us/arizona-coronavirus-cases.html

 

 

From: Friam <[hidden email]> on behalf of Prof David West <[hidden email]>
Reply-To: The Friday Morning Applied Complexity Coffee Group <[hidden email]>
Date: Thursday, June 11, 2020 at 1:53 PM
To: "[hidden email]" <[hidden email]>
Subject: Re: [FRIAM] Practical Covid Guidlines

 

"spiking" according to ... ? Governor? Health department? Official or semi-official (or media) analyst? And how isolated is the spike?

 

davew

 

 

On Thu, Jun 11, 2020, at 1:56 PM, Frank Wimberly wrote:

Arizona and Texas are "spiking" as of today.  We're surrounded.

 

---

Frank C. Wimberly

140 Calle Ojo Feliz,

Santa Fe, NM 87505

 

505 670-9918

Santa Fe, NM

 

On Thu, Jun 11, 2020, 1:45 PM Prof David West <[hidden email]> wrote:

 

I was going to make a separate post this morning claiming that my June 15th prediction had been realized. The 'straw' was 19 Governor's of states with rising rates, stated that restrictions would continue to be lifted on schedule and the rise in rates could be handled. All said there would be no return to lock down.Utah is the only state that delayed, by two weeks and for the Salt Lake City area, complete lifting of restrictions. The word "spike" is seldom seen in headlines — replaced with "rise."

 

Poker rooms are opening, even in CA, with 5-6 person tables instead of 9-10

 

Travel is not mentioned in the missive Nick included because people are simply traveling. The highways in southern Utah and the parks is typical summer volume already. RV parks are full. Campgrounds are full. Greyhound and FlixBus are reopening.

 

Carnival operators in Holland blocked a major highway today demanding, and evidently getting, permission to open for the summer traveling season. (talk about a vector!)

 

davew

 

 

On Thu, Jun 11, 2020, at 11:35 AM, [hidden email] wrote:

I wonder what The Congregation, including the Diaspora, thought about this. Nothing very dramatic, here, but that’s just the point.  Nothing on travel. 

 

From Dr. James Stein, Professor of Cardiovascular Research at the University of Wisconsin School of Medicine and Public Health…

 COVID-19 update as we start to leave our cocoons. The purpose of this post is to provide a perspective on the intense but expected anxiety so many people are experiencing as they prepare to leave the shelter of their homes. My opinions are not those of my employers and are not meant to invalidate anyone else’s – they simply are my perspective on managing risk.

 In March, we did not know much about COVID-19 other than the incredibly scary news reports from overrun hospitals in China, Italy, and other parts of Europe. The media was filled with scary pictures of chest CT scans, personal stories of people who decompensated quickly with shortness of breath, overwhelmed health care systems, and deaths. We heard confusing and widely varying estimates for risk of getting infected and of dying – some estimates were quite high.  

Key point #1: The COVID-19 we are facing now is the same disease it was 2 months ago. The “shelter at home” orders were the right step from a public health standpoint to make sure we flattened the curve and didn’t overrun the health care system which would have led to excess preventable deaths. It also bought us time to learn about the disease’s dynamics, preventive measures, and best treatment strategies – and we did. For hospitalized patients, we have learned to avoid early intubation, to use prone ventilation, and that remdesivir probably reduces time to recovery. We have learned how to best use and preserve PPE. We also know that several therapies suggested early on probably don’t do much and may even cause harm (ie, azithromycin, chloroquine, hydroxychloroquine, lopinavir/ritonavir). But all of our social distancing did not change the disease. Take home: We flattened the curve and with it our economy and psyches, but the disease itself is still here. 

Key point #2: COVID-19 is more deadly than seasonal influenza (about 5-10x so), but not nearly as deadly as Ebola, Rabies, or Marburg Hemorrhagic Fever where 25-90% of people who get infected die. COVID-19’s case fatality rate is about 0.8-1.5% overall, but much higher if you are 60-69 years old (3-4%), 70-79 years old (7-9%), and especially so if you are over 80 years old (CFR 13-17%). It is much lower if you are under 50 years old (<0.6%). The infection fatality rate is about half of these numbers. Take home: COVID-19 is dangerous, but the vast majority of people who get it, survive it. About 15% of people get very ill and could stay ill for a long time. We are going to be dealing with it for a long time.

 Key point #3: SARS-CoV-2 is very contagious, but not as contagious as Measles, Mumps, or even certain strains of pandemic Influenza. It is spread by respiratory droplets and aerosols, not food and incidental contact. Take home: social distancing, not touching our faces, and good hand hygiene are the key weapons to stop the spread. Masks could make a difference, too, especially in public places where people congregate. Incidental contact is not really an issue, nor is food.

 What does this all mean as we return to work and public life? COVID-19 is not going away anytime soon. It may not go away for a year or two and may not be eradicated for many years, so we have to learn to live with it and do what we can to mitigate (reduce) risk. That means being willing to accept *some* level of risk to live our lives as we desire. I can’t decide that level of risk for you – only you can make that decision. There are few certainties in pandemic risk management other than that fact that some people will die, some people in low risk groups will die, and some people in high risk groups will survive. It’s about probability.

 Here is some guidance – my point of view, not judging yours:

1. People over 60 years old are at higher risk of severe disease – people over 70 years old, even more so. They should be willing to tolerate less risk than people under 50 years old and should be extra careful. Some chronic diseases like heart disease and COPD increase risk, but it is not clear if other diseases like obesity, asthma, immune disorders, etc. increase risk appreciably. It looks like asthma and inflammatory bowel disease might not be as high risk as we thought, but we are not sure - their risks might be too small to pick up, or they might be associated with things that put them at higher risk.

People over 60-70 years old probably should continue to be very vigilant about limiting exposures if they can. However, not seeing family – especially children and grandchildren – can take a serious emotional toll, so I encourage people to be creative and flexible. For example, in-person visits are not crazy – consider one, especially if you have been isolated and have no symptoms. They are especially safe in the early days after restrictions are lifted in places like Madison or parts of major cities where there is very little community transmission. Families can decide how much mingling they are comfortable with - if they want to hug and eat together, distance together with masks, or just stay apart and continue using video-conferencing and the telephone to stay in contact. If you choose to intermingle, remember to practice good hand hygiene, don’t share plates/forks/spoons/cups, don’t share towels, and don’t sleep together.

 2. Social distancing, not touching your face, and washing/sanitizing your hands are the key prevention interventions. They are vastly more important than anything else you do. Wearing a fabric mask is a good idea in crowded public place like a grocery store or public transportation, but you absolutely must distance, practice good hand hygiene, and don’t touch your face. Wearing gloves is not helpful (the virus does not get in through the skin) and may increase your risk because you likely won’t washing or sanitize your hands when they are on, you will drop things, and touch your face.

 3. Be a good citizen. If you think you might be sick, stay home. If you are going to cough or sneeze, turn away from people, block it, and sanitize your hands immediately after.

 4. Use common sense. Dial down the anxiety. If you are out taking a walk and someone walks past you, that brief (near) contact is so low risk that it doesn’t make sense to get scared. Smile at them as they approach, turn your head away as they pass, move on. The smile will be more therapeutic than the passing is dangerous. Similarly, if someone bumps into you at the grocery store or reaches past you for a loaf of bread, don’t stress - it is a very low risk encounter, also - as long as they didn’t cough or sneeze in your face (one reason we wear cloth masks in public!). 

5. Use common sense, part II. Dial down the obsessiveness. There really is no reason to go crazy sanitizing items that come into your house from outside, like groceries and packages. For it to be a risk, the delivery person would need to be infectious, cough or sneeze some droplets on your package, you touch the droplet, then touch your face, and then it invades your respiratory epithelium. There would need to be enough viral load and the virions would need to survive long enough for you to get infected. It could happen, but it’s pretty unlikely. If you want to have a staging station for 1-2 days before you put things away, sure, no problem. You also can simply wipe things off before they come in to your house - that is fine is fine too. For an isolated family, it makes no sense to obsessively wipe down every surface every day (or several times a day). Door knobs, toilet handles, commonly trafficked light switches could get a wipe off each day, but it takes a lot of time and emotional energy to do all those things and they have marginal benefits. We don’t need to create a sterile operating room-like living space. Compared to keeping your hands out of your mouth, good hand hygiene, and cleaning food before serving it, these behaviors might be more maladaptive than protective. 

6. There are few absolutes, so please get comfortable accepting some calculated risks, otherwise you might be isolating yourself for a really, really long time. Figure out how you can be in public and interact with people without fear.

 

     Error! Filename not specified.

Steven W. Tabak, M.D., F.A.C.C.   |   Medical Director, Quality and Physician Outreach

____________________________________________________________________________________________________________________________________________________________________________

 

 

Nicholas Thompson

Emeritus Professor of Ethology and Psychology

Clark University

[hidden email]

https://wordpress.clarku.edu/nthompson/

 

 

 

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[Steve Smith]

FRIAM Diaspora in Europe here, makes sense to me. Here in Europe each week the restrictions are lifted a bit further, since the number of new cases is low enough. We still have to wear masks if we go shopping or use the public transport, which makes sense because the virus spreads through the respiratory system, and we have no vaccine yet. 

Our cleaning lady here in Berlin is from Chile where the situation looks really bad. She said her whole family in Chile has the virus, and her grandfather has died from it. If the situation on the southern hemisphere escalates it could swap back to the northern hemisphere again. There might be a second major wave if we are not careful. 

-J.

It is not June 15 yet, but we've been assured that "the Pandemic will be over by mid June".    I *do* believe that the "Panic" over the Pandemic is lessening up, *but* overcaution was warranted based on the stakes and the knowledge of risk and in the spirit of the "The Hammer and the Dance" it is time to dance. 

According to live.rt, in the US state-by-state: we've edged back up from 9 of 50 states with an estimated R0 *over* 1.0 to 15 of 50, trending up.   If we are conservative and look only at the estimates with >50% confidence, we might be closer to 25++ of the states with R0>1.0, which implies it is still growing/spreading there.

I'm pretty sure we can't call it OVER until after-the fact, in hindsight whenever that may be (June 15 but which year?).  If somehow Dave's prognostication *were* to be true by some objective measure, I think we'd need to see R0 trending *down* not *up* and *continue to*.   NZ *can* say "the pandemic is over" or more aptly "the pandemic is currently excluded from NZ and more dependent on our immigration, testing, and quarantine procedures than on the state of the Pandemic in the rest of the world".   

I *do* think we are finding a balance with care in everyday life (outside of "Liberate XYZ" and BLM Street Protests) that doesn't require full-lockdown to "manage R0".  In wildland fire, what used to be "prescribed burns" have become "managed burns" which means keeping the spread rate high enough to clear fuels but low enough to not become uncontained.   I don't see us deliberately infecting people to build "herd immunity" but adjusting our behaviour to "tune" the infection rate to be manageable *and* selectively to exclude vulnerable populations from our ongoing "experiment".

Mary and I have been *deliberately* eating at restaurants which have opened (50% seating, various rules) and been very pleased with the experience.   Of course, we *missed* the experience of eating out but also wanted to also participate in helping these places work through their re-opening procedures and give ourselves the opportunity to tip heavily to those who have been out of work for >2 months.    

We also returned to lap-swimming (Los Alamos Aquatic Center) where they are very controlled... no locker/shower room usage....  enter one door masked opposite masked/gloved employees, swim (in the center of your lane!) for 45 mins, exit another door (no shower).   About 10 laps into our swim I realized that each time I crossed opposite the next lane, that the other swimmer not only splashed water on me each time but exhaled sharply like a whale through a blowhole.   I wasn't personally worried, but mused at how some might be very worried/offended.   I am no where near as *aggressive* of a swimmer and had no problem adjusting my breathing cadence to inhale facing the other side and "out of phase" with his.   I suspect there are *0* infected people *living* in Los Alamos (and likely to swim there in the middle of the day) and few if any cases commuting in on any given day.   But I'm happy to participate in good habits while we "dance" our way back to something less extreme.

It was good to get back in the water, but we may shift to swimming in Abiqui Lake, even though it is still mostly snow-melt...  

- Steve

-------- Original message --------

From: [hidden email]

Date: 6/11/20 19:36 (GMT+01:00)

To: 'The Friday Morning Applied Complexity Coffee Group' [hidden email]

Subject: [FRIAM] Practical Covid Guidlines

I wonder what The Congregation, including the Diaspora, thought about this. Nothing very dramatic, here, but that’s just the point.  Nothing on travel. 

From Dr. James Stein, Professor of Cardiovascular Research at the University of Wisconsin School of Medicine and Public Health…

 COVID-19 update as we start to leave our cocoons. The purpose of this post is to provide a perspective on the intense but expected anxiety so many people are experiencing as they prepare to leave the shelter of their homes. My opinions are not those of my employers and are not meant to invalidate anyone else’s – they simply are my perspective on managing risk.

 In March, we did not know much about COVID-19 other than the incredibly scary news reports from overrun hospitals in China, Italy, and other parts of Europe. The media was filled with scary pictures of chest CT scans, personal stories of people who decompensated quickly with shortness of breath, overwhelmed health care systems, and deaths. We heard confusing and widely varying estimates for risk of getting infected and of dying – some estimates were quite high.  

Key point #1: The COVID-19 we are facing now is the same disease it was 2 months ago. The “shelter at home” orders were the right step from a public health standpoint to make sure we flattened the curve and didn’t overrun the health care system which would have led to excess preventable deaths. It also bought us time to learn about the disease’s dynamics, preventive measures, and best treatment strategies – and we did. For hospitalized patients, we have learned to avoid early intubation, to use prone ventilation, and that remdesivir probably reduces time to recovery. We have learned how to best use and preserve PPE. We also know that several therapies suggested early on probably don’t do much and may even cause harm (ie, azithromycin, chloroquine, hydroxychloroquine, lopinavir/ritonavir). But all of our social distancing did not change the disease. Take home: We flattened the curve and with it our economy and psyches, but the disease itself is still here. 

Key point #2: COVID-19 is more deadly than seasonal influenza (about 5-10x so), but not nearly as deadly as Ebola, Rabies, or Marburg Hemorrhagic Fever where 25-90% of people who get infected die. COVID-19’s case fatality rate is about 0.8-1.5% overall, but much higher if you are 60-69 years old (3-4%), 70-79 years old (7-9%), and especially so if you are over 80 years old (CFR 13-17%). It is much lower if you are under 50 years old (<0.6%). The infection fatality rate is about half of these numbers. Take home: COVID-19 is dangerous, but the vast majority of people who get it, survive it. About 15% of people get very ill and could stay ill for a long time. We are going to be dealing with it for a long time.

 Key point #3: SARS-CoV-2 is very contagious, but not as contagious as Measles, Mumps, or even certain strains of pandemic Influenza. It is spread by respiratory droplets and aerosols, not food and incidental contact. Take home: social distancing, not touching our faces, and good hand hygiene are the key weapons to stop the spread. Masks could make a difference, too, especially in public places where people congregate. Incidental contact is not really an issue, nor is food.

 What does this all mean as we return to work and public life? COVID-19 is not going away anytime soon. It may not go away for a year or two and may not be eradicated for many years, so we have to learn to live with it and do what we can to mitigate (reduce) risk. That means being willing to accept *some* level of risk to live our lives as we desire. I can’t decide that level of risk for you – only you can make that decision. There are few certainties in pandemic risk management other than that fact that some people will die, some people in low risk groups will die, and some people in high risk groups will survive. It’s about probability.

 Here is some guidance – my point of view, not judging yours:

1. People over 60 years old are at higher risk of severe disease – people over 70 years old, even more so. They should be willing to tolerate less risk than people under 50 years old and should be extra careful. Some chronic diseases like heart disease and COPD increase risk, but it is not clear if other diseases like obesity, asthma, immune disorders, etc. increase risk appreciably. It looks like asthma and inflammatory bowel disease might not be as high risk as we thought, but we are not sure - their risks might be too small to pick up, or they might be associated with things that put them at higher risk.

People over 60-70 years old probably should continue to be very vigilant about limiting exposures if they can. However, not seeing family – especially children and grandchildren – can take a serious emotional toll, so I encourage people to be creative and flexible. For example, in-person visits are not crazy – consider one, especially if you have been isolated and have no symptoms. They are especially safe in the early days after restrictions are lifted in places like Madison or parts of major cities where there is very little community transmission. Families can decide how much mingling they are comfortable with - if they want to hug and eat together, distance together with masks, or just stay apart and continue using video-conferencing and the telephone to stay in contact. If you choose to intermingle, remember to practice good hand hygiene, don’t share plates/forks/spoons/cups, don’t share towels, and don’t sleep together.

 2. Social distancing, not touching your face, and washing/sanitizing your hands are the key prevention interventions. They are vastly more important than anything else you do. Wearing a fabric mask is a good idea in crowded public place like a grocery store or public transportation, but you absolutely must distance, practice good hand hygiene, and don’t touch your face. Wearing gloves is not helpful (the virus does not get in through the skin) and may increase your risk because you likely won’t washing or sanitize your hands when they are on, you will drop things, and touch your face.

 3. Be a good citizen. If you think you might be sick, stay home. If you are going to cough or sneeze, turn away from people, block it, and sanitize your hands immediately after.

 4. Use common sense. Dial down the anxiety. If you are out taking a walk and someone walks past you, that brief (near) contact is so low risk that it doesn’t make sense to get scared. Smile at them as they approach, turn your head away as they pass, move on. The smile will be more therapeutic than the passing is dangerous. Similarly, if someone bumps into you at the grocery store or reaches past you for a loaf of bread, don’t stress - it is a very low risk encounter, also - as long as they didn’t cough or sneeze in your face (one reason we wear cloth masks in public!). 

5. Use common sense, part II. Dial down the obsessiveness. There really is no reason to go crazy sanitizing items that come into your house from outside, like groceries and packages. For it to be a risk, the delivery person would need to be infectious, cough or sneeze some droplets on your package, you touch the droplet, then touch your face, and then it invades your respiratory epithelium. There would need to be enough viral load and the virions would need to survive long enough for you to get infected. It could happen, but it’s pretty unlikely. If you want to have a staging station for 1-2 days before you put things away, sure, no problem. You also can simply wipe things off before they come in to your house - that is fine is fine too. For an isolated family, it makes no sense to obsessively wipe down every surface every day (or several times a day). Door knobs, toilet handles, commonly trafficked light switches could get a wipe off each day, but it takes a lot of time and emotional energy to do all those things and they have marginal benefits. We don’t need to create a sterile operating room-like living space. Compared to keeping your hands out of your mouth, good hand hygiene, and cleaning food before serving it, these behaviors might be more maladaptive than protective. 

6. There are few absolutes, so please get comfortable accepting some calculated risks, otherwise you might be isolating yourself for a really, really long time. Figure out how you can be in public and interact with people without fear.

 

     <img style="width:2.0in;height:.3333in" id="m_-5089887865504843604m_-1055917697182651435Picture_x0020_1" src="content://com.samsung.android.email.attachmentprovider/1/8361/RAW" onmouseover="imageMousePointerUpdate(true)" onmouseout="imageMousePointerUpdate(false)" name="com_samsung_android_email_attachmentprovider_1_8361_RAW_1591900344239" moz-do-not-send="true" width="192" height="32">

Steven W. Tabak, M.D., F.A.C.C.   |   Medical Director, Quality and Physician Outreach

____________________________________________________________________________________________________________________________________________________________________________

 

 

Nicholas Thompson

Emeritus Professor of Ethology and Psychology

Clark University

[hidden email]

https://wordpress.clarku.edu/nthompson/

 

 

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