Maybe Destin is what she calls her living room? ¯\_(ツ)_/¯

SI

And yet, other countries have managed to greatly reduce the number of new cases, while we are on the rise. We don't want to admit it, but we failed at containing the virus and now the plan is to look away while tens of thousands die.

I spoke with my brother in law yesterday. He is from S. Africa and now lives in London. Minimal ties or allegiance to the US other than his wife.

He was saying we are in such a terrible spot globally and that we are the only country in the world politically divided by this. He stressed just how fucked we are with regards to the handling of this.

I highly doubt that.

Yeah they are just not making the news as much, but Trump wannabees like Brazil's leader vs mayors stay at home orders is certainly political

Yeah when Boris Johnson was hospitalized the twitter feed "debate" of British users was a dead on replication of America's with Trump.

The global impression of the United States goes no farther than the political affiliation of our president. No doubt Trump is an outlier that deserves no support but just comparing Obama and Bush Jr. we went from most hated evil empire in the world to greatest place in the world with strikingly similar foreign policies. Again Trump needs no defense and is doing horribly but I fail to see what Spain, Italy, England, Sweden... are doing that is really getting any better results. In fact one could say if New York/New Jersey were their own country the United States of the other 48 would be outshining most of the countries of the world. (Again though it shouldn't have to be said in spite of Trump)

He actually addressed that. Said that while there is division there both party leaders are at least focused on the victims, fixing the problem, etc...

I suppose the gist was similarly developed.

Look t the number of new cases reported. Italy and Spain are both seeing dramatic downturns while the US, outside of NYC, is seeing a steady increase. Our isolation failed and now we've largely stopped trying.

Not to going to argue since he clearly lives there it would be like me saying I know New Jersey for than you. I just remember when he was hospitalized the tweets were "I hope you die you fat fuck. The blood of thousands is on your hands" Sounded like America to me.

The goal was never going to be completely stop the advance of the virus. It was only ever going to be, stop the advance long enough for the medical community to both handle the first wave, and develop and understand the best ways to manage care going forward. As awful as this whole mess is, as long as there's an amount of sick that are able to be treated without completely overwhelming the system, the rest of the country will accept that and move on.

It's the same that I said earlier. It's both a testament to the resilience of the human psyche and somewhat unnerving that we can become desensitized enough to what's actually going on to accept it and continue to move forward.

Does that make all the people who will end up dying from this forgotten? Hardly, but the reaction and subsequent pro activity to manage the continued outbreak are more important in the grand scheme. Does that mean that we stop trying to keep people from getting it? No at all, but we do presume that it means that more will get it and more will continue to die from it. That doesn't mean that every single person living who tries their best to go about their daily routine is an awful person who wants everyone dead either. This is a threat. So far, it's been managed piss poor at the national level, and barely successful at the state and local level, but that is the new reality that we are facing, and we can't backtrack and fix what's already been done. We can only manage what we have. Threats are going to cause chaos. At this point, we can't eliminate it, and we're well on the way to saying "That's life", and that may or may not acceptable from everyone's point of view and that's ok too. But it's still the reality of the situation.

Ya, I've lost track of what the end game is again. If we hold the assumptions that antibodies provide some defense for some period of time, and that there is some seasonal aspect to this and that there will be a significant second wave in the fall - doesn't the severity of the second wave depend entirely on how restrictive we are now? In that the more restrictive we are, the more severe the second wave will be?

I thought the goal was to ensure that the hospitals were not overwhelmed and then drag this out until we have a vaccine or some from of gradually increasing herd immunity. I feel like we're drifting back to this idea that if we just all stay inside and watch Netflix this will go away on its own faster somehow.

Which makes me frustrated sometimes by the voices (much louder on my facebook wall than all of yours, I think, where I have no conspiracy theories or Trump supporters present), that we must stay fully locked down indefinitely with no end in sight and otherwise you're with Trump. What is the goal? Open up in the fall when we're most vulnerable? Or literally just wait for a vaccine with may never come?

The gradual and targeted re-openings and emphasis on minimizing, not eliminating, risk, seem to be to be a fair way to bring things back and let people act in accordance, to some degree, with their own personal risk tolerance and need to leave the house. I like how my state is doing it. Our Republican governor is pissing off the far right with restrictions, and also pissing off the harder-core stay-at-home contingent. Which seems like a good sign. Though, our rate of cases (and results of first round of antibody testing) is so low that I also worry about being vulnerable later if we restrict too much now. Most people are taking precautions, there are no large gatherings, there are much fewer small informal gatherings than there'd normally be this time of year, there is much less pedestrian and vehicle traffic. I think that's what we can reasonably expect. The fact that not everybody is all-in on all-aspects of the most severe lockdown requirements doesn't bring us back to square one, the way we were all living in early March. If we did nothing but ban large gatherings, and actually enforce that, the virus would not spread as quickly as it would otherwise. Every other restriction slows the infections as well. Those gains aren't wiped out if say, retail stores open with recommended restrictions that at least some people will follow. But doing that may save some jobs, and feed some people, and provide some tax revenue, and give people the option to balance risk against the desire to have a life.

I am against Trump, but I do think somewhere along the line the message became perverted from "flatten the curve" to "prevent all deaths". That is simply not possible.

HOWEVER, some states didn't really have a curve to begin with, and they are going to make things pretty bad for themselves with some of the policies being enacted.

South Korea would be the country I would look at as doing a tremendous job. A very dense country population wise that had its first recorded case the same day as us and barely has a handful of new cases now. Their experience with MERS set them up for success and I could only hope we will apply lessons learned this time for next time. But I won’t get my hopes up as SK used some big brotherly methods to contain this and we know what would happen here if we instituted the same methods..... people with AR-15’s and Confederate flags will ascend on our state houses screaming “Muh rights!”

It's also clear that the increase in cases (which is a completely unreliable and bullshit thing to measure with any significance) is tied to the country wide increase in testing, which is still a good thing. The real telling number is deaths and that is holding very steady. I think when this is all said and done, and they've analyzed the date two years from now, we're going to have a marked increase in deaths attributed to Covid-19, because we didn't have the testing resources in large enough quantities, and we didn't have enough diagnosable data and evidence when we were in the middle of it to know any better. Both of those things fall on the national leadership.

It would be nice if this administration and their followers were at least of the mind of "prevent as many deaths as possible". Since the feds have been actively involved in taking valuable resources away from states either directly taking them or else out bidding them or redirecting things they already shipped and pid for...yeah. This is the problem.

And instead of let's all figure out a sane way to live, it's OPEN EVERYTHING AND NOW! USE YOUR GUNS TO FORCE STATES TO OPEN! SUE EVERYONE IN OUR WAY!

Seoul is one of the most video-surveilled cities on the planet. You can find plenty of pre-pandemic articles criticizing their intrusions on citizen privacy from left-leaning sources. And I don't think it's only the far right that would have had a problem with the Trump administration tracking everyone by video, credit card transactions, cell phone data, etc, back in February and early March when those kinds of tactics would have been effective. Maybe there will be a tolerance of that kind of thing going forward.

Again, if you take NYC out, the number of cases daily is on the increase. The curve isn't flattening, it's rising. That's why I say the isolation was a failure, not because the disease is still active.

Look at Spain and Italy, and you see very clear indications of a prolonged decrease in new cases per day that is now leading to a gradual reopening. Here, we've decided it's too hard to flatten the curve and largely given up.

Seems dramatic. Is there anywhere in the U.S. back to 0% restrictions and pre-pandemic social activity yet? Any large gatherings?

I'll join in on this "shifting goals" from flattening the curve to keeping everyone at home until cases no longer increase. That just isn't feasible. As we start testing more, we are going to find more cases - that doesn't mean we are in worse shape. I think there's a movement for people to say how terrible the USA is at this (primarily because of the president). If you look at the tracked numbers (which I am not a fan of, but they are all we have), the US is better than Canada and every major European country except Germany with a death rate of 0.06 (deaths per case).

I get that people are aggravated that some areas are opening back up, but the hospital impact is pretty low in many states. Arizona is reopening Friday and Monday (in a limited capacity) because the covid cases need around 7% of total beds and ICU beds are at about 15-20% of capacity. We have been there consistently for 3-4 weeks. If that's not good enough, what number is? Remember, the goal of the shelter in place was to limit the impact on hospitals and health providers - not to completely eradicate the virus before slowly re-opening businesses.

Finally, South Korea is just not an apples to apples comparison to Europe, Canada and the US. They have been wearing masks for years, they are OK with apps that track if they have the virus and have a culture that has been battling viruses for a long time (and are OK giving up many liberties to do that). 75% of the things that South Korea is doing wouldn't fly here if we had a combination of Bernie Sanders, Obama and Bill Clinton running the US.

I don't think things have been open long enough, for there to be a measurable rise in cases at this point. You're seeing a rise as testing is more widespread. Any measurables from openings won't really show for another 2-3 weeks.

What I'm perceiving now is that the goal is that we can't open anything until there will be no increase in cases as the result of that opening. I don't know if that will ever be possible. So to me that's the equivalent of saying we have to wait for a vaccine to be fully deployed to lift any restriction.

If reopening is based on dates rather than healthcare metrics, the whole isolation period was a waste. I've mentioned him several times previously, but Dr. Gottlieb's plan is really good. It isn't based on no virus. It lays out clearly defined metrics that lead to clearly defined reopenings. Most of what's happening now is being based on feelings or dates, and that is the absolute wrong way to do things.

Right. In Georgia, the Governor basically decided to open up because he felt it was long enough. Even though cases have been rising. Even though places like Athens and Atlanta are at very high levels (and I hear Gainesville is another big center - due to chicken processing plants). No use of healthcare metrics at all. He could have even said the plan is to open the rural counties that don't have many cases and work our way to the big outbreak areas, that would a decent enough thought out idea.

Interestingly enough, the Georgia Governor's Mansion is still closed to visitors (and aren't pleased when you ask why) and the state tax office has just extended the deadline to when you need to get your vehicle registration done (which includes an emission test) until June 15. Which is a whole host of mixed messages.

Yeah outside of the major urban areas it seems like it was never a good idea to completely shutdown. Of course this is hindsight and I dont blame anyone for making those decisions because nobody really knew then how bad this was going to get but flattening the curve via complete shutdown was never necessary in these smaller areas. It really should be clearer that this is not a one size fits all problem in this country. Again my usual disclaimer in spite of Donald Trumps horrible leadership it's not like he was some genius that knew this.

Do you not agree that Sullivan, MO is going to have different factors at play than NYC?

Unless I missed something, Dr. Gottlieb's report says states can go to Phase II "when they are able to safely diagnose, treat, and isolate COVID-19 cases and their contacts." Isn't that just based on a feeling or a judgment call?
Our state has dates for various re-entry points, but those stages don't start unless observable metrics are met. We don't get to move to the next stage unless 5 observable metrics are met relating to downward trends in known cases, hospital admissions, available hospital supplies, etc. The local newspaper is tracking the progress in these metrics. Some think the government are Nazis to have any restrictions, and many others think we shouldn't be moving forward at all until "it's safe".

Edit: I dug into the Gottlieb eport more and I do see some of the "thresholds for action" with observable metrics. So basically my state is following this, but with extra thresholds. So I'd say we haven't "given up" - even though my own facebook wall thinks we're all going to die because their neighbors had people over last night. I'd probably have a different perspective if I was surrounded by Trump supporters and conspiracy theorists like so many of you seem to be.

Where is the leadership in Atlanta? Here in Missouri most of the state reopened but Kansas City, St Louis, and St Louis County have not yet. Was this not possible in Georgia? Seems like a failure of local leadership as well unless I am misunderstanding something.

"A sustained reduction in cases for at least 14 days" in part of his transition to Phase 2. Unfortunately, the testing hasn't been at a level where we can ever expect to get to that point. Testing is actually starting to ramp up pretty heavily so, unless we want to wait until the fall/winter (which would be a disaster given the cold/climate for a virus) - we just can't follow that one. Still, his other three conditions are pretty close to attainable now in most states:
1. Hospitals in the state are safely able to treat all patients requiring hospitalization without resorting to crisis standards of care.
2. The state is able to test all people with COVID-19symptoms.
3. The state is able to conduct active monitoring of confirmed cases and their contacts.

Again, the point of shelter in place was to flatten the curve and reduce the impact on hospitals. We've done that in most places. Plus, slowly reopening doesn't mean having 30,000 people at a baseball game or a rock concert - or even having 300 at a bar. It means allowing restaurants to have a certain number of sit in customers spaced properly (based on a % of capacity) and processes for the staff to minimize contact. It means allowing people to go to a hair salon that already spaces most people 6-feet apart by their design. At some point, we have to start doing this and waiting until the Fall when it gets cold would be a disaster.

The Governor's order overruled all local rules and orders. Atlanta literally cannot put more stringent requirements.

Wonder what differs in state law? Does Atlanta have local control of their police and city government?

https://www.nytimes.com/interactive/...-criteria.html

Most of these 30 states haven't met the Trump administration's national guidelines for reopening, according to a Thursday report in The New York Times.

These guidelines include that states should see a "downward trajectory" in cases for two weeks before they begin reopening. Eighteen of the 30 states don't meet that threshold.

If a state doesn't see a general decline in new infections, it could begin reopening if its proportion of positive tests is lower than it was two weeks prior. Nine of the 30 states have seen an increase in their share of positive tests.

Twenty-eight of the 30 states haven't met federally recommended 152 daily tests per 100,000. And total testing in two states that are looking to reopen — South Dakota and Utah — is actually declining.

Not necessarily. The biggest outbreak in the state of Georgia happened in the SW of the state, focused on the town of Albany, GA - population 77,000. It doesn't have to be major urban areas that have the biggest issues here. That outbreak in Albany GA made it extremely unpredictable which areas would get hit hard.

Yep. But states have wide latitude to overrule cities. This was one of the biggest issues with North Carolina's HB2 law a few years back - which mandated people use the bathroom of their birth - it included a provision that overruled city ordinances and was seen as a way for the state to roll back Charlotte's laws in favor of trans individuals.

Flattening the curve was not just about hospital capacity. Everything I read mentioned getting the R0 to 1 or lower so that we weren't just delaying overwhelming the hospitals. If one person is infecting more than one other person, eventually cases explode.

I remember a great video with Angela Merkel explaining the difference between slight changes in transmission over R1.

I think Trump's plan is stupid. We have never tested enough to meet that. Both Trump's above plan and the Gottlieb one essentially punish states for testing more. I don't think that is the right path. We need to start testing more but we can't have that be a reason to stop the progress on a careful reopening. Again, hospital rates and impact on our health providers should be the major factor. Once that gets to a safe, consistent number, we have effectively flattened the curve.

But we don't test enough to know that. So, is everyone supposed to shelter in place until we get testing to the point where we can actually do that? If so, the only real answer is to open in 2021. Good luck with that stance. I'll use Arizona because I have been following it the closest. We have 7.3 million people - 450 have died from the virus over a 2+ month span. Now, let's even double that to 900. We have tested 111,000 people and 9,945 have had it. And that's not random population - that's over 100,000 people with symptoms or a reason to think they had it. Our hospitals are at less than 10% capacity and some are in the red because they bought so many ventilators, masks and other PPE during the initial pandemic that they didn't need. There are stories about some hospitals beginning to cancel shifts for nurses because of their financial issues (purchased too much equipment combined with no elective surgeries). I think it is a fair move by the governor to start re-opening things next week.

Not at all. That's what the 14 decline is about. If that happens, there's a good chance that transmission is 1 or lower. The 14 day decline is taking into account that there's not enough testing to be definitive.

Right. The decline of 14 days shows that the curve has been flattened. Otherwise, without proper testing, states could be on the upswing and haven't flattened anything at all.

I'm not sure anybody here really disagrees on this that much. It's just hard to tell. But I think we're all well within the extreme viewpoints here.

The lack of testing is all a part of the con.

I'll agree that nearly all levels of government have done a poor job of communicating the metrics and goals for re-opening. I think we'd be in a better position f everyone understood what the goals were.

it appears there are two main options:

1. We don't reopen until testing shows a decline over 14 days. Given the level of testing done to this point (less than 2% of total population in most states), this won't be achievable until the fall at the earliest. It just isn't physically possible to ramp up testing to that level to get there when 98% haven't been tested. At this point, you would probably be reopening in the worst possible moment for virus propagation (fall/winter) or wait until 2021.

2. Look at the other factors and make a calculated decisions. Look at the overall death rate, hospital capacity for beds/ventilators over a 2-3 week period and make a decision when all those numbers are low enough to where if you had a second wave - you could handle it. There is risk, so you have to still try to social distance when possible.

If there's another option, I'd be open to it - it just doesn't seem like there is one. Our lack of testing has really hurt our ability to "know" the status of each state. So either we stay paralyzed until the fall or try some baby steps when the hospitals are well out of the danger zone.

Talking to my conservative parents (who live in Michigan) they generally agree. There's a lot of information and misinformation floating around out there and a whole bunch of projections from Universities and governments that don't agree. Given that I think they're taking any recommendations from the government with a grain of salt although they'll still follow any laws.

This hits at the core of the current issues, I think. We don't really know where we stand, and getting there would take too long to keep an already-impatient populace willing to comply. At this point, the best approach seems to be: "hope a state of similar size, demographics, and weather opens before yours does, and see what happens there." (So, NC, let's see what happens in GA, ok?) And if no such state exists? Yeah, it's really just based on what seems to be most politically expedient for that governor.

The Oregon re-open plan was just announced and our governor has impressively managed to pass the buck even further, saying that particular counties can re-open starting May 15th...if they submit a plan & get approved by the governor's office.

On the one hand, doing things county by county seems pretty close to common sense and allows for differing approaches for rural and urban areas, but on the other hand we have reached the point where I am going to have to rely on whatever plan my county commissioner can toss together on a week's notice?

Oregon is such a weird one. May as well be 2 different states.

None of the recommendations indicates that the decline over 14 days requires an X amount of population be tested. And indeed the guidelines even speak to a 14 day decline "of positive tests as a percent of total tests within a 14-day period":

https://www.whitehouse.gov/wp-conten...rica-Again.pdf

However, the vast majority of states that are loosening restrictions haven't come close to declining over 14 days, either in total or percentage of tests.

But...am I missing something, or how could they even know? Most (all?) are increasing their testing capacity still, and it doesn't appear that said capacity is going to stabilize any time soon, thus making it impossible to know if we are dealing with an increase in cases, or just an increase in testing.

In short, unless I'm missing something, we royally screwed the pooch by not ramping up testing fast enough--even during the lockdowns--and now it's just a total SNAFU.

You are correct. We have messed up by not testing quick enough. But a state just itching to reopen would definitely know the percentage of tests that are positive compared to the days or weeks before. And in fact, by dramatically ratcheting up testing and providing it to people who have no symptoms, they could make sure that the % of tests that are positive would decline, even if the raw numbers went up.

But they aren't even doing that.