For the first time in weeks, I didn’t work over the weekend. I need the morning to catch up and deal with the most pressing issues, so just some links now. I’ll be back with a longer blog post in the afternoon.
How the pandemic will change retail stores.
How the pandemic will change higher education.
Homeschooling or Virtual Education or School Shutdown or whatever you want to call it is working for some kids and families, but not for others.
When will you feel comfortable going back to the theater?
In praise of pessimism.
Are some states opening up too soon?
Apt. 11d 
What college kids were learning.
https://mobile.twitter.com/ChuckeEChaves/status/1254562951522136067?s=19
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Question for BJ. The info I have seen says that people who survived don’t necessarily have immunity. 1) do they mean to the unmutated virus? 2) are there other viruses where having had the disease does not confer any immunity? Is that what happens with chicken pox and shingles?
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Let’s note that I am not a microbiologist, immunologist, or epidemiologist.
Here’s my thought, based on an article in the NY Times: https://www.nytimes.com/2020/04/13/opinion/coronavirus-immunity.html
Active yellow fever infections apparently conferred lifetime immunity. The same is true for measles. The data about the novel coronavirus is yet unknown. Does it confer immunity? and for how long? In an example of the “biology is very messy and brings every scientist to their knees”, some viruses provoke “enhanced” (where enhanced is bad) immune responses where a vaccine might cause a reaction to be worse (Dengue fever is an example). As a class, according to the article, when coronaviruses (colds) have been studied, some immunity, lasting a year or two seems to be conferred, even to the same virus.
Why so much variety? I think the answer is unknown, but has something to do with the propensity for the virus to mutate in ways that change the target of the immune response (viruses are always mutating, but if the target of the immune response is required for the virus to replicate). That is, can the virus mutate in ways that change the piece of the virus your immune response is trained to attack, and still be an effective virus in infecting the host.
Shingles seems to be the result of the chicken pox virus hiding in your nerves and then reactivating. I think AIDS can do something like that, too (it puts the DNA in your cell, but doesn’t start replicating virus right away).
(And, biology is messy, messy, messy, so this is incomplete, and also not in my area of expertise).
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If you have Netflix and the interest and can tolerate anime, “Cells at Work!”, https://www.netflix.com/watch/8102883 is actually a pretty awesome immunology introduction (though it might work better if you know something already).
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“When will you feel comfortable going back to the theater?”
3-6 months after the last new COVID-19 case in my state? Maybe 2 months of no new TX cases for dine-in?
Flying is a tough one. We mostly travel to visit family, and our trips aren’t long enough to allow for quarantining there before visiting older relatives. I’d ideally want no new US cases before flying. But on the other hand, my grandma is 95 and I have one close relative with advanced cancer, so we’re not working with unlimited time here. There are people that I may never see again in person in this life and (depending on timing), I may not even be able to attend the funerals.
I think I feel a lot more comfortable with outdoor versus indoor venues. And with regard to indoors, I suspect that in-and-out is a lot better than hours spent close to other people.
“Are some states opening up too soon?”
I think people overestimate the speed and scope of reopening:
https://www.fox7austin.com/news/retail-to-go-begins-as-first-phase-of-texas-businesses-reopening
For example, we just got curbside non-essential retail authorized in TX this past week.
“Customers are not allowed inside stores but can purchase items from a retail location for pickup, delivery by mail, or home delivery.”
“Employees must be screened for any coronavirus symptoms before coming to work and must wash or sanitize hands when arriving and dealing with each customer. Workers must wear face coverings and maintain at least six feet separation form one another.”
“As for payments, officials recommend they be done over the phone or online if possible.”
“Purchased items are expected to be delivered by store employees to the backseat or trunk of the customer’s vehicle when possible to also minimize physical contact.”
Of course, a lot depends on execution…
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I agree with you here — Georgia seems extreme, but “curbside pickup for retail” doesn’t seem like a big deal to me. It does cause questions about the workers, but, if there’s just one person in the store? and they bring bags and put them in your trunk? That’s pretty distanced.
People are reading “[state] is opening up” and assuming the extremes (which some states *are* doing). My worry is if there is no data being collected. We need to be able to roll back if things go wrong, and I am not seeing good evidence that’s being done in other states. WA announced plans to let some construction projects go ahead with plans for guidance developed by a construction round table + monitoring. This seems reasonable to me. And, no one is saying “WA is opening up” (like they do about Texas).
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bj said, ” It does cause questions about the workers, but, if there’s just one person in the store? and they bring bags and put them in your trunk? That’s pretty distanced.”
I especially appreciate the stores that have the same person shop and deliver.
“WA announced plans to let some construction projects go ahead with plans for guidance developed by a construction round table + monitoring.”
Israel is using this as an infrastructure construction opportunity.
https://www.reuters.com/article/uk-health-coronavirus-israel-transportat/risking-contagion-israel-upgrades-empty-roads-and-rails-idUSKCN2252E4
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It sounds stupid, but I think haircuts and other personal maintenance services pose unique challenges.
The guys can just buzz it off, but as time goes by, it’s harder and harder for the ladies to look presentable. Furthermore, there seems to be an active black market in haircuts and other personal maintenance services:
https://www.today.com/style/undercover-officers-arrest-2-women-running-home-salons-during-quarantine-t179372
I don’t love the idea, but there is a harm reduction argument for opening that stuff up with safety restrictions (masks, as much distancing as possible, remote payment) so that any services that take place are as safe as possible. Oh, yeah–and so that taxes will be paid.
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I think the personal services are really tough. I am not looking for any, but I don’t think masks are enough. The NY Times picture on the front cover talking about Georgia/Florida had a picture of a barber wearing his on his chin cutting someone’s hair. But, I am not opposed to people trying, as long as they stop if cases are coming up. Are they doing that? I worry that they aren’t..
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bj said, “But, I am not opposed to people trying, as long as they stop if cases are coming up. Are they doing that? I worry that they aren’t..”
There’s been SO much emphasis in the media (and I’m afraid from people like Georgia’s governor) on “opening up” and so little on the precautions. I hope that the precautions are getting through to the business people, but I can see how they might not get through. Being a business with good safety precautions is excellent marketing, though!
I don’t love the snitch lines in general, but given the number of businesses opening up, it probably is a good idea to have a centralized local public health number for major safety violations.
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And the personal care I am wondering about is providing services for special needs and children. When will have daycare again?
And, more personally, when will I feel comfortable having my house cleaned again?
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bj said, “And the personal care I am wondering about is providing services for special needs and children. When will have daycare again?”
Maybe open up on-on-one therapy before group stuff?
I’ve wondered about masking for therapy (because the kids need to see the therapist’s face and expression and vice versa), but I’ve seen some clear face shields that might be good for this setting.
“And, more personally, when will I feel comfortable having my house cleaned again?”
Oh, yeah. My big kids have gotten pretty good at it (and the Roomba helps a lot), but I’d like to hand off the heavy work to the professionals.
(We have a bit of a labor situation at home. I pay the kids $5 for a full bathroom, $10 for vacuuming carpet on the stairs and the bedroom corners that the Roomba can’t hit, $15 for cleaning the rest of the floors including wet mopping the kitchen–but the problem is that they are making so much money that they’re not interested in doing much more than what they are required to do.)
Individual private cleaners are probably safer. Maybe a price bump for first cleaning of the day? And fresh mask and gloves?
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Okay, don’t hate me, because I have easy straight hair that is still almost all brown (Good hair genes.) I also live in a small town where the good hairdresser charges $20 for a regular cut. But is it really so impossible for most women to get to “presentable”? Can we ratchet down our expectations of what’s presentable?
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af184793 said,
“But is it really so impossible for most women to get to “presentable”? Can we ratchet down our expectations of what’s presentable?”
I have bangs, so the clock is ticking. “Sheep dog” or “headband that makes my forehead look weird” is about two weeks from now.
I haven’t had this much hair in at least 20 years.
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If you dye your hair pink, no one will pay much attention to the split ends. That’s my next step.
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I still have this at home: https://overtone.co/ (but, sadly, only the chocolate brown, which I used once). All the interesting colors work better on light colored hair.
Grab the pink while you can! the colors are going out of stock.
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When will you feel comfortable is I think an impossible question. It will really depend on how much I want to do the thing. And not on whether it is “essential”. We have been ordering deliveries, ordering food, picking up prepared food, and buying flowers.
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I’ve been following a lot of good people on twitter, but I’d like to especially recommend Lyman Stone, an American living in Hong Kong.
https://mobile.twitter.com/lymanstoneky
As he points out, test and track is deficient if you don’t have anything to do with people once you get a positive. He is a big fan of the Asian/Israeli practice of central quarantine of positives, as opposed to the US/European practice of stay-at-home-and-get-your-entire-household-sick.
(There is a historical precedent for this in the US, by the way. In the good old days, if you got TB, you went into a TB sanatorium and got to leave once you were either cured or dead. Betty MacDonald spent 9 months in a TB sanatorium in the late 1930s.)
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They were talking about this on NPR this morning, suggesting that we have unfilled hotels that could be used for self quarantine. Brown U’s president suggested that as a solution for test/trace/isolate on college campuses as well.
That form of isolation won’t work for people who need more direct care (at different levels). In WA a friend tried to see if there was any placement for a nursing home patient she was caring for (as a physician) and was told that there wasn’t because what facilities they had (mostly for people who don’t have homes) only worked for people who can take care of themselves. Megan McCardle presumably faces a similar issue with her father (could he be isolated at a hotel? or does he require more care?).
But, it could work for adults who are not in nursing homes/group homes, . . . .
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My friend’s cousin wrote this up about Mary Mallon, aka Typhoid Mary, if anyone is interested in deeply researched blog posts about communicable diseases and quarantines. https://seccorecit.blogspot.com/2020/04/the-many-mary-mallons.html
This post also reminded me that my great-grandmother’s brother died at age 38 of typhoid pneumonia in Brooklyn in 1910, so I’m looking for a possible connection using the same sources I use for genealogy. In 1910, Typhoid Mary had been released from quarantine on the promise that she no longer would be a cook, but she apparently did not keep that promise and fell off the map for a few years.
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bj said, “That form of isolation won’t work for people who need more direct care (at different levels).”
I read today that New York State was forcing nursing homes to accept COVID positive new patients.
https://www.nbcnews.com/news/us-news/coronavirus-spreads-new-york-nursing-home-forced-take-recovering-patients-n1191811
“The coronavirus patients began arriving the last week of March, transferred to the Gurwin Jewish Nursing and Rehabilitation Center under a New York state mandate requiring nursing homes to accept those recovering from COVID-19, even if they still might be contagious.”
They had one COVID positive resident before the transfers.
“A month later, Gurwin is battling an outbreak that’s killed 24 residents — only three of whom were hospital transfers — and one staff member, who worked in housekeeping, Almer said. And the nursing home is still mandated to take in recovering hospital patients known to have the virus, potentially increasing its spread in the facility.
“Three states hit hard by the pandemic — New York, New Jersey and California — have ordered nursing homes and other long-term care facilities to accept coronavirus patients discharged from hospitals.”
I believe about half of European deaths have been of nursing home residents, so this was a really terrible choice.
https://www.businessinsider.com/half-europes-covid-19-deaths-in-long-term-care-facilities-2020-4
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No good solutions to the group home issue. My doctor friend said group homes were told to treat the group like a family unit. I heard someone suggest having COVID Positve nursing homes, but patients are difficult to move and there aren’t any new nursing homes being set up, probably. They are underfunded and poorly regulated, even, apparently, in Sweden.
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Our state has been setting up COVID positive nursing homes for patients. It’s a step down from hospitalization. Most likely, they set it up to free up hospital beds. This is a news article about one of the facilities cooperating with the state, but there are more: https://www.mcknights.com/news/massachusetts-nursing-home-blazes-trail-by-emptying-out-to-become-covid-19-specific-facility/
From news articles, it seems patients are (and can be) moved to other homes to free up space for rehabilitation homes dedicated to COVID-19 patients.
A positive COVID patient should never be knowingly brought into a nursing home. That is lunacy, to bring an infectious person into a building housing the oldest and most frail people. It’s like bringing a torch to a pile of kindling.
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I wonder how that is working, a month later? I couldn’t find anything searching quickly, but, have other facilities started the isolation of COVID patients? Are there fewer nursing homes deaths and positive cases in MA?
I’ve been following Megan McArdle’s description of her father’s discharge it doesn’t seem like the isolating nursing home patients with COVID+ has happened on any scale.
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I think only historians will be able to sort out whether the use of such facilities decreased the number of nursing home deaths, because it’s not being universally adopted. There have been some terrible outcomes in specific nursing homes in Massachusetts already. But it falls under the authority of the towns or cities, as well as the state, I gather, so it’s very patchwork.
The state updates statistics each afternoon. If you scroll to the end of the document, you’ll find current test results for nursing homes and assisted living facilities with 2+ positive results: https://www.mass.gov/info-details/covid-19-response-reporting
There are so many, many run by different outfits, of different sizes, that it’s hard to draw conclusions. That the state reports in categories of 30 positive, confirmed, cases doesn’t help at all to judge as a non-expert whether there’s a pattern. For me, the only conclusion seems to be that you don’t really want to end up in a nursing home, if you can avoid it.
Searching online, I find that the state is trying to improve care for nursing home residents: https://www.wbur.org/commonhealth/2020/04/15/nursing-homes-assisted-living-baker-state-plans-efforts
Baker also told reporters Wednesday that there are plans to convert long-term care facilities into “dedicated” COVID-19 recovery centers in Brewster, Falmouth, New Bedford, East Longmeadow and Great Barrington. He expects all five to be operational within the next 10 days, and said plans to create more dedicated recovery center across the state are in the works.
Attempts to create such centers were stalled, when inhabitants due to be moved tested positive, but asymptomatic: This follows news that a plan to move healthy residents at the Beaumont Center in Worcester to another skilled nursing facility in Northbridge was temporarily put on pause after residents began testing positive for COVID-19. Another skilled nursing facility in Wilmington temporarily halted its plans to transform into a COVID-19 recovery building after testing of residents set to be transferred revealed more than half of them were positive for the coronavirus. All tested positive while asymptomatic, according to the health care owner.
I suppose it’s good news that half were asymptomatic, rather than at death’s door?
In other good news, Fall River and New Bedford have been able to set up dedicated facilities: https://www.heraldnews.com/news/20200409/new-bedford-establishes-coronavirus-recovery-centers-in-former-nursing-homes
“As the storm gathered … and as we started to learn more and more in January and certainly February about COVID-19 and the way that the disease was playing out in China as well as in Europe, we started thinking ahead and thinking, ‘What if here? What do we need to anticipate?’” Mitchell said.
If all goes as planned the facilities will open the week of April 13, but before they can open they require the state’s authorization to exempt these types of facilities and those who work in them from civil liability for COVID-19-related care, according to a press release from the city.
New Bedford entered into leases for the designated facilities at 1123 Rockdale Ave. and 4586 Acushnet Ave. this week, which have 107 beds and 123 beds, respectively.
“This is a great site,” Coogan said during a press conference at one of the locations Thursday morning. “It’s what we needed. We were looking in Fall River for one and thank God New Bedford stepped up and got one for us. It’s very important. The people on the front lines are going to be the ones that win this battle and my hat goes off to them.”
New Bedford had been working for weeks to “increase capacity of the region’s health care system to manage a surge of COVID-19 patients,” according to to a news elease, and in conjunction with that began to explore sites.
Once the facilities were identified, the New Bedford Department of Facilities and Fleet Management worked to clean and repair the buildings.
Southcoast physicians, nurse practitioners, RNs, and CNAs will staff the centers, which will serve patients from throughout Southeastern Massachusetts, according to Keith Hovan, the group’s president and CEO. Hawthorn Medical Associates will help staff the facilities and Greater New Bedford Community Health Center will provide resources and support, according to the news release.
New Bedford and Fall River aren’t thought of being more foresighted than New York, but in this case, it seems they were.
The facilities have opened. Note the importance of the state agreeing to exempt the staff and management from civil liability. I think that will be essential for most, if not all, businesses going forward.
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Argh, it seems the symbols for less than and more than disappear. Ok, it should read, the state reports only three categories for the homes, fewer than 10 cases tested positive, between 10 and 30, and more than 30. The last category is most exciting, but there are no details. Are we talking about 31? 91? Who knows. So far, 1,982 deaths have been reported in care facilities.
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Here’s the world’s worst gif:
https://mobile.twitter.com/dansinker/status/1255220187948814343
It’s an animated gif of droplet spread on a plane–basically dozens of passengers are in range.
On the other hand, I can’t recall hearing of any major airplane transmission cases.
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https://www.bloomberg.com/news/articles/2020-04-28/trump-says-he-s-issuing-order-for-tyson-s-unique-liability?
“Using the Defense Production Act, Trump is ordering plants to stay open as part of the critical infrastructure needed to keep people fed amid growing supply disruptions from the coronavirus outbreak. The government will provide additional protective gear for employees as well as guidance.”
I think people (especially Trump) have been treating the DPA as a sort of button that makes all kinds of things magically happen–but it’s not.
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The WSJ indicates that the primary purpose of Trump’s action will be to override any state or local orders requiring meat packing plants to close. It will very likely achieve that, without any particular magic being required. Also, there may be a concomitant federal effort to protect meat packing plant owners from any resulting liability.
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I am becoming seriously worried about systems that require some people to work to serve the others. It is dangerous territory.
NPR did a report this morning on the “CivMars”, civilians who provide services on navy ships, including provisions. They’ve been locked down on their ships since March 21 (while Navy contracters and Navy personnel are still allowed to go to dock). The news report wasn’t clear, but I think, because the Navy doesn’t want (or can’t) provide them with protective gear.
https://www.npr.org/2020/04/30/847878423/civilian-mariners-say-strict-navy-coronavirus-restrictions-are-unfair
The work orders for nursing home personnel and at the meat packing plants are similar, too.
And, all of these workplaces are not reflective, demographically, of the population at large (or the population they are serving).
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Now that the paper goods and cleaning supplies are more or less doing OK, I guess it’s time to start rolling shortages of protein.
Based on how it went last time, I’m expecting that we start with meat shortages and then we move on to shortages of things with meat in them and shortages of everything that can plausibly be substituted for meat. On the bright side, there is a greater variety of food products than paper goods and cleaning supplies. And presumably people are as stocked up as finances allow right right now.
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I cannot find tofu right now (or rather, my husband can’t; I don’t leave the house except to walk). A friend told me about a secret stockpile in a local store we don’t usually go to, so I am pressuring my husband to go there.
Personally, I’d be happy to go back to being a vegetarian, but the men in my house seem to prefer meat. 😛
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I wonder if this is fair:
https://slate.com/news-and-politics/2020/04/sweden-coronavirus-response-death-social-distancing.html
“There are a number of explanations for Sweden’s unique approach, but they revolve—I think—around a culture of conformity and the self-image of exceptionalism. Prior to my return, the phrase “We’re only following recommendations” had been regurgitated to me for two months by Swedish friends. Susan Sontag once described the Swedish capacity for conformity: “Whenever possible, situations and words are taken at face value.” Often, this has meant listening to experts offering advice for the greater public good. But what happens when the experts are telling people things that could make them sick? Wouldn’t many of the citizens of a nation with such a high education rate revolt over such an outlier response from their government, now proven to result in mass death? The answer to that is no.”
Some of the things the author is worried about (like outdoor dining or picnics) are probably pretty harmless. But at the same time, a lot of the stuff he mentions (ignoring asymptomatic transmission and not promoting masking) does sound really bad.
““I think to great parts we have been able to achieve what we set out to achieve,” Tegnell recently told the BBC. “What has not worked out very well is our death toll, and that’s very much—I mean, it’s partly due to the strategy, but not really very much. It’s mainly due to that our homes for elderly have not been able to keep the disease out.””
I don’t know how the Swedes react to that, but here in the US, we wouldn’t buy this. “The operation was successful but the patient died,” is a joke.
It’s an interesting paradox that high social trust and compliance themselves can be dangerous when the policies being promoted from the top are inadequate.
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I think attributing differences to culture is generally sloppy. Cultures develop in the context of communities, resources, politics, personalities, leaders, . . . . There might be minor differences but structural differences (for example, the competent leaders we appear to have in Seattle) play a significant role.
You are citing the dangers of conformity to culture, but I don’t know that “Americans wouldn’t buy this” — Texas lieutenant governor, Dan Patrick, suggested that very thing, to let the old people die, or at least take the risk of dying in order to mitigate the economic effects. (the first link on a google search on my computer was a Borowitz Report article).
I don’t think we will know the results of the Sweden or the Korea or Washington or the Texas or the Georgia or the South Dakota experiments for a while and that no one should be thinking they’ve found *the* solution.
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bj said,
“I don’t think we will know the results of the Sweden or the Korea or Washington or the Texas or the Georgia or the South Dakota experiments for a while and that no one should be thinking they’ve found *the* solution.”
That’s true.
“You are citing the dangers of conformity to culture, but I don’t know that “Americans wouldn’t buy this” — Texas lieutenant governor, Dan Patrick, suggested that very thing, to let the old people die, or at least take the risk of dying in order to mitigate the economic effects. (the first link on a google search on my computer was a Borowitz Report article).”
I think saying, something like “our life-saving plan worked except for the deaths” is different from saying “our economy-saving plan is going to cost lives.” It’s not an attractive argument phrased like that, but it doesn’t violate logic in the same way as the first formulation.
And yeah, I think culture is going to be important. Some cultures are more rule-abiding, so if you make a rule, you don’t need to build as much tolerance in for rule-breakers. For example, if you know that groups of 10 are pretty safe and also that people are going to obey rules en masse, you don’t have to forbid all gatherings, because you can just allow groups of 10 and under. (This is a hypothetical–I don’t know if groups of 10 are safe right now.) Ditto beach and parks. If people are actually obeying distancing, you can allow them to enjoy beaches and parks. So, on reflection, the Swedes weren’t nuts to believe that they could be a bit laxer and achieve better results than other countries with stricter rules.
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