Most states have already outlined their plans. Typically they involve a period of approximately 60 days of stay at home until the entrance criteria for Stage 1 of re-opening can be met. The entry criteria include: A trend in cases and hospitalization that is going down indicating clearly the peak is in the past. Availability of necessary COVID-19 test kits. Establishment of proper Contact Tracing. There are three stages of re-opening that gradually reduce restrictions (each with exit/entry criteria) - allowing restaurants, salons, large events, etc. to eventually re-open progressively. If a flare-up occurs than the next stage will be held off or further restrictions put back in place. At this point, most states, including North Carolina have published detailed plans. I will note - as Germany and South Korea have demonstrated - if you do proper Contact Tracing then you do not need to test large portions of your population. Only those who had contact with infected individuals.
Okay, but there will certainly be flare ups. What constitutes a problem which would then require another shutdown? Not trying to be a hard head, but we simply cannot have a fly by the seat of our pants approach, not this late in the game, and I fear it's later than we think, economically speaking
It is. In the US, each day now takes down many, many businesses that will never re-open. I see it already bigtime in my area. The "Closed for Covid" signs in the windows are more and more converting to "For Rent" and the spaces have been vacated.
so if Germany's leading expert says that testing everyone has not been done and it might not be needed... would GWB stop making shit up about testing and tracing? Q: Should all countries be testing everybody? A: I’m not sure. Even in Germany, with our huge testing capacity, and most of it directed to people reporting symptoms, we have not had a positivity rate above 8%. So I think targeted testing might be best, for people who are really vulnerable – staff in hospitals and care homes, for example. This is not fully in place even in Germany, though we’re moving towards it. The other target should be patients in the first week of symptoms, especially elderly patients who tend to come to hospital too late at the moment – when their lips are already blue and they need intubation. And we need some kind of sentinel surveillance system, to sample the population regularly and follow the development of the reproduction number. here is some more... https://www.theguardian.com/world/2...-drosten-germany-coronavirus-expert-interview Christian Drosten, who directs the Institute of Virology at the Charité Hospital in Berlin, was one of those who identified the Sars virus in 2003. As the head of the German public health institute’s reference lab on coronaviruses, he has become the government’s go-to expert on the related virus causing the current pandemic. In an exclusive interview, Drosten admits he fears a second deadly wave of the virus. He explains why Angela Merkel has an advantage over other world leaders – and why the “prevention paradox” keeps him awake at night. Q: Germany will start to lift its lockdown gradually from Monday. What happens next? A: At the moment, we are seeing half-empty ICUs in Germany. This is because we started diagnostics early and on a broad scale, and we stopped the epidemic – that is, we brought the reproduction number [a key measure of the spread of the virus] below 1. Now, what I call the “prevention paradox” has set in. People are claiming we over-reacted, there is political and economic pressure to return to normal. The federal plan is to lift lockdown slightly, but because the German states, or Länder, set their own rules, I fear we’re going to see a lot of creativity in the interpretation of that plan. I worry that the reproduction number will start to climb again, and we will have a second wave. (jem providing context.... San Diego ICUs been empty since day 1 We have had 111 deaths... and very little testing and tracing. So we know damn well we over reacted... ) Q: If the lockdown were kept in place longer, could the disease be eradicated? A: There is a group of modellers in Germany who suggest that by prolonging lockdown here for another few weeks, we could really suppress virus circulation to a considerable degree – bringing the reproduction number below 0.2. I tend to support them but I haven’t completely made up my mind. The reproduction number is just an average, an indication. It doesn’t tell you about pockets of high prevalence such as senior citizens’ homes, where it will take longer to eradicate the disease, and from where we could see a rapid resurgence even if lockdown were extended. jem comment - So if he had science and data supporting the lockdown we would be getting it... there is none so he tells he likes the models but he is not following them. Q: If there were such a resurgence, could it be contained? A: Yes, but it can’t happen based on human contact-tracing alone. We now have evidence that almost half of infection events happen before the person passing on the infection develops symptoms – and people are infectious starting two days prior to that. That means that human contact-tracers working with patients to identify those they’ve been exposed to are in a race against time. They need help to catch all those potentially exposed as quickly as possible – and that will require electronic contact-tracing. jem comment... So we know human contract tracing does shit... but maybe a phone app would work. Q: How close we are to achieving herd immunity? A: To achieve herd immunity we need 60-70% of the population to carry antibodies to the virus. The results of antibody tests suggest that in Europe and the US, in general, we are in the low single digits, but the tests are not reliable – all of them have problems with false positives – and herd immunity is also not the whole story. It assumes complete mixing of the population, but there are reasons – in part to do with the social networks people form – why the whole population may not be available for infection at any given time. Networks shift, and new people are exposed to the virus. Such effects can drive waves of infection. Another factor that could impact herd immunity is whether other coronaviruses – those that cause the common cold, for example – offer protection to this one. We don’t know, but it’s possible.
Seeing the same thing here in small restaurant and mom and pop type retail, all done. I do some part time project management type work for a small contractor, far south suburbs of Chicago. No work coming in for 3 weeks now, nothing. We typically quote 40 plus jobs per month, mostly for steel mills and other heavy industries. All of them downsizing, shuttering equipment or complete shutdowns. Emergency work only for them. We have a week, maybe two of work left in the shop. Have already let go 4 people out of a 28 man shop. They'll all be out by mid May. Multiple small vendors and shops we sub work out to closed or skeleton crews. Thousands upon thousands of blue collar type jobs gone, many for good. King Pritzker says shutdown goes through May for Illinois. They don't at least open up some manufacturing it's fucking over. I've been in this business since the early 70s, all the slow times, the early eighties wipe out of big steel, 2008 and all the shit that came with that for a couple of years. None of that even comes close to the total destruction I'm seeing now, not even close.
As I clearly stated many times Germany and South Korea did not need to test large portions of their population because they had effective and complete Contract Tracing in place. They only needed to test the contact paths. Of course, if there is a large scale resurgence then contact tracing will not be able to keep up with the pace so other measures will need to be taken (e.g. stay at home applied). However in both Germany and South Korea they had quickly jumped on the first cases with contact tracing which put them in a position to start opening up shortly. in most U.S. states we don’t have enough COVID-19 test kits to even test all individuals in a contact path - which is the entry criteria for Conact Tracing which of course is the entry criteria for Stage 1 of re-opening in most states.
Before Texas can safely re-open its economy, health experts say these four things must happen Pressure to return to normalcy is building, but health experts say even gradual steps will increase the number of COVID-19 cases. First, they say Texas needs more testing and contact tracing. https://www.texastribune.org/2020/0...lth-experts-say-more-resources-needed-reopen/ A call center run by the University of Texas at Austin Dell Medical School gets a notification every time its nurse triage team calls a patient with the bad news that they’ve tested positive for COVID-19, the disease caused by the new coronavirus. That’s the signal for a separate team of a few dozen medical students, graduate students and volunteers to make a second call to the patient, beginning an arduous process that experts say will be crucial for monitoring the spread of COVID-19 as society inches toward reopening: contact tracing. The caller’s goal: to quickly obtain a list of people and places where the patient might have spread the virus. Then they must track down everyone on that list to encourage them to self-quarantine and get tested for the virus before they potentially infect a whole new group of people. First, “we develop a bit of a rapport with the [patient],” said Darlene Bhavani, an infectious disease epidemiologist who oversees the center’s operations. How are they feeling? What resources do they need? Do they have a thermometer, and can they isolate themselves from other people in the home? The phone call might last hours and cover weeks of the patient’s movements. Bhavani had 67 contact tracers working in partnership with Austin’s public health department as of mid-April. That may be enough for now, but she said she needs more volunteers “to prepare for an eventual increase in cases that may or may not happen as Austin opens up and people start moving around more.” With Gov. Greg Abbott poised this weekto announce a plan for easingrestrictions on Texas businesses, experts are raising questions about whether the Texas public health surveillance system can ramp up its testing and contact tracing operations enough to safely inch back toward normal life. Health experts say that even gradual steps to reopen businesses will increase the number of people who become sick from the virus. To better understand where the virus is lingering, they say the state must rapidly increase testing. To track where it is spreading, they’ve urged the government to hire more workers to track down the contacts of those who become infected. “An exit strategy, as we call this, is sort of difficult to suppose right now,” said Rebecca Fischer, infectious disease epidemiologist at Texas A&M University School of Public Health. “The risk being that as soon as we lift restrictions, whatever that strategy is, if it’s gradual or tiered or certain sectors of the economy or population are released first, we can certainly expect to see a spike in cases.” “What we want to make sure is that we’re far enough into the tail end of the epidemic that that bump will be minor and it won’t wind up shutting down the economy again,” Fischer said. Interviews with 10 infectious disease experts show a growing consensus among health experts that four steps are necessary to measure how successfully Texas is containing the virus — and guide politicians seeking to reopen businesses. Texas needs to test a larger percentage of the state’s population, isolate those who test positive, track down their contacts and order those people to quarantine themselves for two weeks. Doing so, the experts said, will require personnel and lab capacity for testing and contact tracing that is perhaps an order of magnitude greater than what is currently available. And they say it will be expensive. (More at above url)
New Zealand has been able to eliminate community spread and is taking steps to eliminate the lockdown. Achieving no community spread is a huge milestone - but is probably more viable when you are a remote island nation. Coronavirus: New Zealand claims no community cases as lockdown eases BBC - https://tinyurl.com/y764lrp3 New Zealand says it has stopped community transmission of Covid-19, effectively eliminating the virus. With new cases in single figures for several days - one on Sunday - Prime Minister Jacinda Ardern said the virus was "currently" eliminated. But officials have warned against complacency, saying it does not mean a total end to new coronavirus cases. The news comes hours before New Zealand is set to move out of its toughest level of social restrictions. From Tuesday, some non-essential business, healthcare and education activity will be able to resume. Most people will still be required to remain at home at all times and avoid all social interactions. "We are opening up the economy, but we're not opening up people's social lives," Ms Ardern said at the daily government briefing. New Zealand has reported fewer than 1,500 confirmed or probable cases of coronavirus and 19 deaths. New Zealand's Director-General of Health Ashley Bloomfield said the low number of new cases in recent days "does give us confidence that we have achieved our goal of elimination". He warned that "elimination" did not mean there would be no new cases, "but it does mean we know where our cases are coming from". Ms Ardern said there was "no widespread undetected community transmission in New Zealand", adding: "We have won that battle." But she said the country "must remain vigilant if we are to keep it that way". How did New Zealand respond to the virus? The country brought in some of the toughest restrictions in the world on travel and activity early on in the pandemic, when it only had a few dozen cases. It closed its borders, started enforcing quarantine of all arrivals in the country, brought in a stringent lockdown and mounted an extensive testing and contact tracing operation. Beaches, waterfronts and playgrounds were shut on 26 March, as were offices and schools. Bars and restaurants were also closed, including for takeaway and delivery. Ms Ardern said modelling indicated New Zealand could have had more than 1,000 cases a day if it had not brought in the lockdown so early. She said the country could never know how bad it would have been, but that "through our cumulative actions we have avoided the worst". New Zealand's remote location and easily sealable borders played in its favour when the virus broke out, experts say. But the government has also been praised for the clarity of its messaging throughout the crisis. (More at above url)
The path to re-opening New York. This article defines a few terms regarding effective reproduction rate should be highlighted. Keep in mind that Rnaught is the raw reproduction number with no mitigation. Germany has driven their R (effective reproduction number) down to 0.7 by using testing and contact tracing. New York's low coronavirus transmission rate suggests the state's outbreak is contained for now https://www.businessinsider.com/new-york-contained-coronavirus-outbreak-reopening-plan-2020-4 A key measure of New York's coronavirus outbreak suggests the virus' spread is contained. Each person with the coronavirus in New York is infecting fewer than one other person on average right now, but cases could spike again if social distancing measures are lifted too soon. For the state to reopen, the hospitalization rate must be in decline for 14 days, Gov. Cuomo said on Sunday. New York has a way to tell when its coronavirus outbreak has run its course. When a population has immunity or social distancing measures are in place, epidemiologists look to a figure called the "effective reproduction number" (R), which represents the average number of people whom a single coronavirus patient is expected to infect. The effective reproduction at a specific point in time, called the R(t), shows how fast the virus is currently spreading within a population. It offers a real-time guide for states looking to ease social distancing or stay-at-home restrictions. New York's R(t) is now 0.8, Gov. Andrew Cuomo said at a press briefing on Sunday. That means, right now, every person is infecting fewer than one other person on average. Taken on its own, this figure suggests that New York's outbreak is temporarily contained. But the rate could easily rise if social distancing measures are relaxed. "Short term, the numbers are on the decline. Everything we have done is working," Cuomo said. But he cautioned against "getting too far ahead of ourselves." If the rate of transmission rose above 1.2, he said, cases could spike again dramatically. "If we just said, 'OK, guys, we're all tired of staying home — we're going to open the schools and everybody can go and hang out in the cafés,' I would expect we'd have another big rebound and it would not be pretty," Dr. Elizabeth Halloran, a biostatistician at Fred Hutchinson Cancer Research Center and the University of Washington, previously told Business Insider. New York's stay-at-home restrictions are scheduled to last until May 15. On Sunday, Cuomo outlined a plan for reopening the state: Phase 1: Resume construction and manufacturing. Wait two weeks to see if cases spike. Phase 2: Reopen low-risk businesses that have a plan to keep transmission low. Schools could reopen as well. Prohibit attractions that would draw large crowds from outside the local area. Cuomo said upstate regions are more likely to reopen sooner than downstate areas like New York City. The decision to reopen, he added, ultimately hinges on whether hospitalizations decline for two weeks. "The federal guidance from the CDC is that before you start reopening, the state and regional hospitalization rate must be in decline for 14 days," Cuomo said. "In this case, I think the CDC guidance is right." (More at above url)
finally the truth about the effective R0 is coming out. This was obvious to anyone with a brain looking at the stats rather than the headlines. Lockdown should have been customized for each area and low risk vs high risk groups should have been considered. .