Yes, it needs to get worse. We have already demonstrated that we can handle the current rates. We need to see a sustained and rising death count of 25,000 per week for at least 4 consecutive weeks. At that point I fully support a complete lockdown in the cities that are the hotspots and initially those cities only. Should the spread continue to outlying areas then the lockdown becomes more broad as needed. No knee jerk decisions. For the record IMO, a total lockdown would include all bars and restaurants closed, including fast food. All non essential businesses closed. This includes Home Depot and the like. All schools closed. All events canceled, every single one, including and especially "protests". We have seen that a half measured lockdown doesn't accomplish much, so what's the point. I can support a real lockdown but only under extreme circumstances. We're not there yet
Wasn't North Dakota like that before ? Now they are leading the pack. Pretty much everyone there is getting Covid it seems, despite a low density. Deaths per million in North Dakota are over 900 and they weren't even on the map earlier this year. In Canada, the worst recent outbreak is in Winnipeg, and now parts of Alberta. Ontario's recent numbers look bad, but on a per capita basis they are amongst the lowest in Canada. That being said, we may move up that ladder in December ( or not, guess we'll see ).
Two aspects on this. One, results are always on up to a 4-5 week lag on your actions. Two, it's already out of control in some areas of the US and Canada. Yes, bars/indoor dining are one of the mistakes many areas have made.
A possible explanation of that is Covid had not really spread into those areas until recently. The most vulnerable of their populations had not yet been exposed, now they are. Consequently they need to start taking precautions more seriously like mask wearing and distancing. Some large crowd restrictions also prudent. Wait and see before a next move. Panic driven decisions are not needed
Yes, the numbers lag and we can do some anticipating. My 25K dead per week is not a line in the sand. I'm just saying that while the numbers are rising we're not ready for a complete lockdown, in most places. The particular hotspots can begin to implement shutdown. I do not support a broad based plan. Isolate and keep an eye out for other areas is the best approach. We must remain flexible.
Ontario has had this approach since the first lockdown ended. There have been posters on here saying Canada was "closed" most of the year and this just hasn't been the case. For those who believe in a compromise between Asian full lockdowns ( which may not even be possible in NA ) and free-for-all Florida, we are a decent case study. Given the nature of the virus, this does not guarantee we won't get huge new Covid infection records in December, but we may weather the entire cycle better then most. We opened our schools and let a lot of indoor dining open up, and there are calculated risks to both decisions.
The Dakotas are 'as bad as it gets anywhere in the world' for COVID-19 https://www.usatoday.com/story/news...th-south-dakota-masks-kristi-noem/6237635002/ South Dakota welcomed hundreds of thousands of visitors to a massive motorcycle rally this summer, declined to cancel the state fair and still doesn't require masks. Now its hospitals are filling up and the state's current COVID-19 death rate is among the worst in the world. The situation is similarly dire in North Dakota, with the state's governor recently moving to allow health care workers who have tested positive for COVID-19 to continue working if they don't show symptoms. It's a controversial policy recommended by the U.S. Centers for Disease Control and Prevention in a crisis situation where hospitals are short-staffed. And now — after months of resisting a statewide mask mandate — North Dakota Gov. Doug Burgum changed course late Friday, ordering masks to be worn statewide and imposing several business restrictions. “Our situation has changed, and we must change with it,” Burgum said in a video message posted at 10 p.m. Friday. Doctors and nurses “need our help, and they need it now,” he said. Both North and South Dakota now face a predictably tragic reality that health experts tell USA TODAY could have been largely prevented with earlier public health actions. Pandemics require people to give up some of their freedoms for the greater good, University of British Columbia psychiatry professor Steven Taylor told USA TODAY. In conservative regions like the Dakotas and elsewhere in the world, it's common to see push back like an “allergic reaction to being told what to do,” said Taylor, author of "The Psychology of Pandemics". But months of lax regulations have contributed to a growing public health crisis in the Dakotas. How widespread is COVID-19 across North and South Dakota? The current rates of infection and deaths per capita in South Dakota and previously restriction-free North Dakota are what Dr. Ali Mokdad would expect to see in a war-torn nation — not here. “How could we allow this in the United States to happen?" asked Mokdad, a professor at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle. “This is unacceptable by any standards.” North Dakota's COVID-19 death rates per capita in the past week are similar to the hardest hit countries in the world right now — Belgium, Czech Republic and Slovenia — according to Saturday New York Times data. That data also places South Dakota's recent per capita deaths among the world's highest rates. And there's currently nowhere in the U.S. where COVID-19 deaths are more common than in the Dakotas, according to data published by The COVID Tracking Project. It's a situation “as bad as it gets anywhere in the world," Dr. William Haseltine told USA TODAY. How did it get so bad? Mokdad pointed to a number of factors that have made both North and South Dakota vulnerable to the virus' spread. He cited higher rates of preexisting conditions and economic inequality in the region, in addition to health care that lags behind the U.S. standard. But the lack of regulation from the states' leaders is an ongoing and fixable problem, Mokdad said. Haseltine, president of ACCESS Health International and author of My Lifelong Fight Against Disease, blamed politicians — especially South Dakota Republican Gov. Kristi Noem — for ignoring public health measures that have been successfully used to curb the spread of the virus elsewhere in the world. Noem has cast doubt on whether wearing masks in public is effective, saying that she’ll leave it up to the people to decide. She has said the virus can’t be stopped. Burgum, also a Republican, had pleaded with people to wear masks and praised local towns and cities that have mandated masks. He had avoided requiring masks and refused to enforce limits on social gatherings and business occupancies until late Friday. The new mandate requires residents to wear face coverings in indoor businesses and indoor public settings, as well as outdoor public settings where physical distancing isn’t possible. The directive goes into effect Saturday and will last until Dec. 13. Burgum also directed all bars and restaurants to limit capacity to 50%, and closed all in-person service between 10 p.m. and 4 a.m. Large-scale venues also are limited to 25% capacity. Noem and Burgum have touted ideals of limited government, with Noem continuing to express concern about how decisive state action could be an example of a government overreach. But Haseltine framed public health actions another way: Not enacting them is like standing in the way of an ambulance — the ambulance being proven health measures like mask mandates and social gathering restrictions. Even worse, encouraging large scale events in a pandemic as South Dakota has done is equivalent to manslaughter, Haseltine said. North Dakota now requires masks. Why not South Dakota? On Friday, Noem's office responded to President-elect Joe Biden's proposed nationwide lockdown and mask mandate by saying she has no intention of using state resources to enforce any federal COVID-19 orders. "It's a good day for freedom. Joe Biden realizes that the president doesn't have the authority to institute a mask mandate," said Ian Fury, communications specialist for Noem. "For that matter, neither does Gov. Noem, which is why she has provided her citizens with the full scope of the science and trusted them to make the best decisions for themselves and their loved-ones." Fury said in an emailed statement that a third of the state's hospital beds are open and 20% are used by COVID-19 patients. "We have availability in all regions of our state," the statement reads. In response to critics, including Andrew Cuomo — New York's Democratic governor whose handling of the pandemic has been mostly praised by many public health experts — Noem remained defiant. "I appreciated that President (Donald) Trump gave us the flexibility to do the right thing in our state, and we'll continue to do that. He let me do my job," Noem told ABC's George Stephanopoulos on Sunday. Noem also criticized New York's total death rate during the pandemic, which is higher than South Dakota's. Fury said the South Dakota's death rate is below the national average. Mokdad said such comparisons are misleading, given how early and hard New York City was hit this spring. “You in the Dakotas … you knew it was coming,” Mokdad said. “You denied it ... even today you are denying it.” What's next for the Dakotas? The Institute for Health Metrics and Evaluation's influential model predicts daily deaths in North and South Dakota will peak, then decrease in coming weeks, but total deaths will more than double by March 1. In two states with less than 2 million people between them, more than 3,000 are expected to die of COVID-19 by then. Mokdad and Haseltine said that number is not fixed. Widespread mask adoption and a serious commitment to physical distancing in the Dakotas can still save lives. If Burgum's mandate works and the entire state begins wearing masks, about 250 peoples lives will be saved, the IHME model estimates. Masks can still save a similar number in South Dakota, according to the model. Without statewide enforcement in South Dakota, some local leaders have sought to enact local rules — particularly mask mandates. "I'll tell you what, I'm scared," said Sioux Falls City Councilor Curt Soehl as he fought a failed battle for a mask mandate in South Dakota's largest city. "I'm ... scared. Two daughters that are nurses. Two son-in-laws that work in health care. I have eight grandchildren. And I'm scared for them. And I'm scared that when I go to bed tonight — if I do tonight — when I go, that I haven't done enough."
It’s Time to Hunker Down A devastating surge is here. Unless Americans act aggressively, it will get much larger, very quickly. https://www.theatlantic.com/health/archive/2020/11/lock-yourself-down-now/617106/ The end may be near for the pestilence that has haunted the world this year. Good news is arriving on almost every front: treatments, vaccines, and our understanding of this coronavirus. Pfizer and BioNTech have announced a stunning success rate in their early Phase 3 vaccine trials—if it holds up, it will be a game changer. Treatments have gotten better too. A monoclonal antibody drug—similar to what President Donald Trump and the former Governor Chris Christie received—just earned emergency-use authorization from the FDA. Dexamethasone—a cheap, generic corticosteroid—cut the death rate by a third for severe COVID-19 cases in a clinical trial. Doctors and nurses have much more expertise in managing cases even in using nonmedical interventions like proning, which can improve patients’ breathing capacity simply by positioning them facedown. Health-care workers are also practicing fortified infection-control protocols, including universal masking in medical settings Our testing capacity has greatly expanded, and people are getting their results much more quickly. We may soon get cheaper, saliva-based rapid tests that people can administer on their own, itself a potential game changer. The Centers for Disease Control and Prevention has finally acknowledged that aerosol transmission happens and that ventilation is important. The initial bungled messaging and science around masks was unfortunate, but things have turned around; the CDC has even publicized how masks can help protect the wearer from infection, as well as lower the chances of onward transmission. The importance of clusters and super-spreading is more widely appreciated, maybe partly because of the highly publicized White House cluster, which is still simmering. We have reasons to celebrate, but—and you knew there was a but—a devastating surge is now under way. And worse, we are entering this dreadful period without the kind of leadership or preparation we need, and with baseline numbers that will make it difficult to avoid a dramatic rise in hospitalizations, deaths, and potential long-term effects on survivors. Almost every day, America is breaking new records in confirmed cases: They are up 40 percent from just one week ago. These cases are not confined to a region or a state; the whole nation is in the midst of a terrible surge. So too is much of Europe, where country after country is experiencing record numbers of cases. This is not a “casedemic”—the false notion that we just have better testing and detection, without any real change in the underlying risk for illness and death. It’s true that we missed a lot of cases in the spring because we didn’t have enough tests, and that we are catching more of them now. But it’s not just confirmed cases that are on the rise. The United States is also experiencing a steep increase in hospitalizations, as well as about 1,500 reported deaths a day; those are the highest numbers since mid-May, and they are still rising sharply. Trevor Bedford, a scientist at the Fred Hutchinson Cancer Research Center, in Seattle, calculates that more than 2,000 deaths a day may already be baked in for early December, meaning that even if we stopped every new infection from now on, we’d still see that many people die per day in just a few weeks among those already infected. The Pfizer-BioNTech vaccine—or Moderna’s vaccine—may be available in the United States to health-care workers and other high-priority people as early as the end of this year. But it won’t be distributed widely until well into 2021, even in the best-case scenario—and the Pfizer vaccine needs two doses, about 21 days apart. Those promising monoclonal antibodies, too, are in very short supply. The president was one of fewer than 10 people to receive the treatment outside of a clinical trial. Even if the drug works as well as we hope, the 300,000 doses that Eli Lilly has agreed to deliver will not be enough when they finally arrive, probably toward the end of this year, when we have 150,000 positive cases a day, and still rising. Dexamethasone availability is excellent, but deaths are climbing despite its widespread use, because it helps address only one of this disease’s complications. We have little reason to count on the authorities for leadership that has the precision and scale we need. The outgoing president has refused to concede the election and has launched a flurry of frivolous lawsuits to muddy the transition, thereby making the odds of an effective federal response over the next few months less likely. All of this means we desperately need to flatten the curve again before hospitals nationwide are overrun. Utah, Illinois, Minnesota, Colorado, and other states are already reporting that hospitals and intensive-care units are at or near capacity. The bottleneck for medical care isn’t just lack of space, or even equipment, which we may be able to increase, but staff—trained nurses and doctors who can attend to patients, and who cannot be manufactured out of thin air. During the spring crisis in the New York tristate area, health-care workers from around the country rushed to the region, buttressing the exhausted medical workforce. With a nationwide surge, doctors and nurses are needed in their hometown hospitals. If fewer people can be admitted to hospitals because of lack of space, patients won’t benefit from our improved clinical management of COVID-19. We may give back some of our gains in the mortality rate. We may also see deaths rise from other causes: Fewer nonurgent but important surgeries, more overworked medical staff, and overburdened emergency rooms could all contribute to worsening health outcomes for many other viruses that peak in winter months, like influenza, as well other ordinary medical conditions. This seasonality is not a huge surprise, which makes our lack of preparation even more tragic. The 1918 flu pandemic saw an earlier, milder wave in the spring; a lull in the summer; and a deadlier surge starting in the fall. Other coronaviruses endemic to us are also sharply seasonal, tending to peak in winter. This may be because the humidity and temperature conditions of fall and winter favor the virus more. It may also be because we spend more time indoors during the winter. Most likely, it’s a combination, along with other factors (Less vitamin D? Less light?). Whatever the causes, public-health experts knew a fall and winter wave was a high likelihood, and urged us to get ready. But we did not. The best way to prepare would have been to enter this phase with as few cases as possible. In exponential processes like epidemics, the baseline matters a great deal. Once the numbers are this large, it’s very easy for them to get much larger, very quickly—and they will. When we start with half a million confirmed cases a week, as we had in mid-October, it’s like a runaway train. Only a few weeks later, we are already at about 1 million cases a week, with no sign of slowing down. Americans are reporting higher numbers of contacts compared with the spring, probably because of quarantine fatigue and confusing guidance. It’s hard to keep up a restricted life. But what we’re facing now isn’t forever. It’s time to buckle up and lock ourselves down again, and to do so with fresh vigilance. Remember: We are barely nine or 10 months into this pandemic, and we have not experienced a full-blown fall or winter season. Everything that we may have done somewhat cautiously—and gotten away with—in summer may carry a higher risk now, because the conditions are different and the case baseline is much higher. When community transmission is this high, every kind of exposure is more dangerous. A gym class is more likely to have someone who is infectious. Workplaces will have more cases, meaning more employees will unknowingly bring the virus home. More people at the grocery store will be positive. A casual gathering of friends may be harder to hold outdoors. Even transmission from surfaces may pose a higher risk now, because lower humidity levels may improve the survivability of the virus. Plus, the holidays are upon us, which means a spike in gatherings of people who do not otherwise see one another. Such get-togethers, especially if they are multigenerational, can spark more outbreaks. I take no joy in saying this, but all of this means that any gathering outside one’s existing quarantine pod should be avoided for now—especially if it is indoors. Think of it as a postponement and plan to hold it later. Better a late Christmas than an early medical catastrophe. Pods should not expand unless absolutely necessary. Order takeout instead of dining indoors. Make game night virtual. Shop in bulk, so you can do fewer trips to the store. It’s not the right time for wedding receptions or birthday parties. Young people present one of the biggest challenges. Many colleges are ending school and sending students home, for what could be a country-wide super-spreader event. That age group—young adults—is especially dangerous; although they can get infected, they are less likely to get very sick, so they don’t stay put the way sick people would. That means they pose a great risk to their more vulnerable parents and other older relatives as they go about their lives. Ideally, colleges should offer the students already on campus the option to stay in the dorms over winter break, and those who live in off-campus housing should consider staying put. If they do go home, the students should quarantine for the recommended two weeks to the greatest degree possible. It might also be time for ordinary people to consider using higher-quality masks (N95s and KN95s)—something that public-health experts have long recommended. This is especially true for low-wage workers, a disproportionate number of whom are people of color and have to work indoors; older people, and anyone who works with them; and people with preexisting conditions that put them at higher risk. Ideally, we’d have a significant aid package, allowing businesses to remain closed and workers to stay home as much as possible, while also increasing workplace standards through better ventilation and masks. Tragically, that doesn’t seem to be in the cards. On the plus side, though, it’s now possible for ordinary people to purchase higher-quality masks, which suggests that the dire shortage of the spring is over. It’s still wise to avoid hoarding; most people don’t need that many, and this surge will put a fresh strain on the supplies. As long as they are put on and taken off carefully (use hand sanitizer before and after), such masks are reusable after being left in a paper bag or breathable container for at least five days, which means as few as five are enough to rotate through a typical work week for people who work with others—especially indoors. All of this is unpleasant, but the alternative is much worse. There is a Turkish saying for times like these, when we can see a light at the end of the tunnel: “Time passes quickly if we can count the days until the end.” We are no longer in the open-ended, dreadful period of spring 2020, when we did not know if we’d even have a vaccine, whether any therapeutics would work, and whether we’d ever emerge from the shadow of this pandemic. We can see the cavalry coming, but until it’s here, we need to lock ourselves down once again. Zeynep Tufekci is a contributing writer at The Atlantic and an associate professor at the University of North Carolina. She studies the interaction between digital technology, artificial intelligence, and society.
You do what some of us have been saying since the second or third week of the spring. Tell the high risk group to cease trusting masks... and isolate themselves. Let the low risk group live their lives. Its a virus.. that hurts some groups much more than others. Mask give the high risk group a false sense of security.