outbreak! (ebola, sars, coronavirus, etc)

Oh I'm sure he'll be able to gather a little fan club handwringing over nasty intolerant ILXors the way esby has.

Lol @ burrito. I hadn't seen Mordy's post, so thanks for that.

btw, burrito irl looks and acts like William Atherton's characters from Die Hard/Ghostbusters.

The Arizona Daily Star reports:

Mexican authorities are closing the U.S-Sonora border to nonessential travel this holiday weekend, when Arizonans would normally flock to Mexican beach towns like Rocky Point and San Carlos for the Fourth of July.

Starting Saturday, July 4, southbound travelers without essential business in Sonora will be turned away at border checkpoints in Nogales, Agua Prieta, Sonoyta and San Luis Rio Colorado, said Sonora Gov. Claudia Pavlovich’s office. The governor did not specify an end-date for the border closure.

Huh, Mexico is paying for a wall after all.

it's definitely possible to get sick on airplanes, they still theorize you're at risk if the people in immediate rows near you, masked or not, have COVID and if they're coughing like fiends, but the HEPA filter does help for those you're further away from. HEPA filtering isn't instant so nasty droplets can squeak through if someone is hacking up a lung the row over.

but yeah, it's still definitely safer than indoor bars without question.

"Anybody need any Ventilators???"

https://www.nytimes.com/2020/07/04/health/239-experts-with-1-big-claim-the-coronavirus-is-airborne.html

This kind of shit doesn't make the WHO look very good and raises some serious questions about what the role of such an organisation should be in the middle of a dangerous pandemic. They seem unable or unwilling to change course and give direction regarding how to best stop the spread of COVID despite mounting evidence that they haven't gotten it right so far.

The WHO has been inconsistent and incoherent, but afaict there is literally no real information in that article, let alone "growing evidence on airborne transmission of the coronavirus." Barely any attributed names, definitely little in the way of numbers, not even a link to the "open letter" these anonymous scientists have apparently written to WHO (which is reportedly being published next week). Theories may very well come to be proven true, but I'm pretty sick of articles that prematurely introduce alarming claims (ibuprofen makes Covid worse! people can be reinfected! you can get it from flushing toilets and people passing you on bicycles!) with nothing concrete to back up the claims. Perhaps that's why the article spends more than half its word count criticizing WHO, which is the real story but which is imo separate from the specific headline charge. Doctors and scientists are fallible and often driven by ego, and do make mistakes in judgement and communication, but the same thing goes for journalists reporting on scientists.

For weeks, information has been trending more and more towards airborne transmission and problems with enclosed spaces, but yes, looking forward to this question being settled definitively once we are all dead. Meanwhile, it's totally cool to send kids back to school in a little over a month while we stand back and watch case counts spiral out of control in states that have reopened too quickly. But definitely, let's not be concerned about sticking more people in enclosed spaces. We don't know for sure how dangerous it is, so let's assume the best and see what happens.

Just checked the WHO website, and comprehensive mask wearing is still not recommended, but hand washing is the #1 item they recommend for everyone. I'm sorry, but this seems hopelessly behind the curve and indefensible. How much evidence is needed before you are willing to say, everyone wear masks, crack open windows, make sure you have some strategically placed fans and high quality air filters in place?

I think the WHO is an inexplicable mess, and I have no idea how or if places are going to handle school. Prolonged time in enclosed spaces has always seemed to be the problem, afaict, but I always thought that's because the particulates shot out by coughing and sneezing and whatnot were more likely to reach your face when you're stuck in the same space with someone. There's a difference between that and significant viral loads hanging and lingering in the air and infecting people that way, which is what I thought they meant by "airborne transmission." If there is proof or evidence of that they should, well, air it.

Speaking of airborne transmission, if they ever come up with a vaccine they should just pack it into fireworks and everyone around here would be inoculated overnight.

There's been (by my recall) around a dozen articles on virus being detectable (sometimes at high titers) much further than 2 m from an infected patient. Mostly researchers taking air samples and swabbing surfaces/vents in hospital rooms. But by March we also had documented transmission > 2 m outside of health care settings, like the Skagit Co. choir practice and the Chinese restaurant contact tracing study where diners were exposed via airflow from the index case, to the end of the room, then back through the HVAC system to the other side of the room. Remarkably, there's no established threshold in droplet size between those that will drop by gravity within 2 m, and those small enough to be lofted about until they evaporate. And it looks like SARS-CoV-2 remains viable in the "residue" left after most of a droplet evaporates, at least on some surfaces.

As this persists (for years?), there'll be a boom in retrofitting HVAC systems with HEPA filters and UV-C lamps..

"Easy" measures, like cloth/surgical masks and physical distancing (2 m) are enough to reduce most transmission outside of health care settings. But this aerosol stuff is why I schedule my bi weekly grocery trip just after "senior hour" in the early morning.

The author of the NYC piece:

Together, they paint a picture of the @WHO as an org with an overly medicalized idea of scientific evidence, too risk-averse to move quickly during a pandemic, and dominated by a few conservative proponents of hand-washing 5/x

— Apoorva Mandavilli (@apoorva_nyc) July 5, 2020

xxp

This is the problem though, it is very difficult to prove conclusively, but public health measures have largely been based on the more optimistic scenarios (also not proven), and seem to be breaking down. Areas that have based mitigation plans off the more pessimistic scenarios have fared better. I think it is completely unacceptable at this point not to mandate mask wearing, at the barest minimum.

Oh, I totally agree! That's not what that article was about, though. (Speaking of health care settings, my ER doc neighbor told me the covid virus is small enough to slip through a N95 mask, so even those things are not as good as people think they are, alas.)

xpost There's detectable (like RNA remnants) and there's transmissible, and those things keep getting conflated, especially in simulation studies.

Has there been any indication of people catching it in grocery stores, one of the few enclosed space destinations that have remained relatively active throughout this entire pandemic? I thought not (miraculously), and if not it would be good to learn why not. As for the choir practice and that infamous Chinese restaurant, I thought (incorrectly?) that was still largely due to people spending prolonged periods of time in very close proximity to one another. When I think of airborne transmission, my go-to standard remains something like measles, where it can hang in the air and infect people for hours after the infectious people have left. Obviously spittle and the like is going through the air, too, and that's how people are often getting it, but I guess I never thought of that as airborne transmission the same way measles can be transmitted. Anyway, in the end this kind of hair-splitting, per that great Times article on the communication failures in the early days of the pandemic, is appropriately indicative of how discourse can get bogged down in the details.

Yeah 'airborne transmission' doesn't mean that there's just a cloud of virus blowing around outside but I think most people have come round to the idea that spending prolonged periods of time indoors with someone is a risk, even if you're washing hands regularly.

IDK though, my wife was working opposite someone in the office who came down with covid a couple of days after the office closed - and was complaining about a sore throat even in the office - and she didn't get ill. So she was either asymptomatic or the virus just didn't reach her in that time.

It is truly amazing how you are drawing the exact opposite of the correct conclusion from any of this stuff. No shit that people are bogged down in the details, THAT is the point of the article, and you are example #1 with your endless ruminations about what exactly might airborne transmission mean. This hesitancy and deliberation and total unwillingness to take decisive action and make clear guidance because something cannot be proven to 100% certainty is getting people killed. When major public health orgs are unable to update their guidance for months, there's a downstream effect on public policy that just assumes the best and throws people out there without the precautions that are truly needed to stop this.

xp

Relax.

I didn't think there was anything remotely new or controversial about the idea that spending prolonged periods of time indoors with someone is a risk. That's why we avoid crowds and, well, spending prolonged periods of time indoors with someone. And we've been told that for months. The conclusion relayed by the Times article?

If airborne transmission is a significant factor in the pandemic, especially in crowded spaces with poor ventilation, the consequences for containment will be significant. Masks may be needed indoors, even in socially-distant settings. Health care workers may need N95 masks that filter out even the smallest respiratory droplets as they care for coronavirus patients.

Like, what's new or controversial about that? In my experience those are the guidelines I see being followed everywhere, at least by people taking this even remotely seriously, and it's not because it is or is not coming from the WHO.

"at least by people taking this even remotely seriously" doing a lot of work there. There is nothing new or controversial about it, but major health orgs, the federal government, and lots of state governments are unable to accept this and communicate it clearly and firmly. Trying to manage a public health crisis through the whims of personal responsibility doesn't work. The absence of a clear top down policy only leads to confusion and inconsistency, and the failure of public health orgs to come to grips with this has seriously exacerbated the problem.

You will get absolutely no argument with me about that. Maybe my misreading of the article was that the gist was not "here is some new and controversial thing, why doesn't the WHO get with it," but "here is a thing that everybody has thought for months that the WHO has yet to adopt." To which I say, well, yeah. But, for example, as far as I can tell my state is following those guidelines. You can't go inside anywhere without a mask, and I assume healthcare workers are using serious PPE. So they clearly managed to figure something out without the WHO. I mean, this whole scenario has highlighted failures of communication across the board, from the top down, which is not reassuring. But seeing so many come to the correct conclusion regardless has been slightly more reassuring.

I should also say that I suspect anyone not following those guidelines by now, or that are doing so in a half-assed way, are not citing the WHO as the basis of their decision, they just don't give a shit about public safety, their own or anyone else's.

I'm glad they managed to get it right where you live. Where I live, hospitals are at capacity.

I don't know if anyone knows exactly what is right, honestly. It's always what seems to be right right now, but who knows how things will look in 6 months. Where are you at?

josh in chicago may be an example of someone gaslighting themselves.

I think mask wearing might be right. Would it be so bad for public health orgs and governments to say if your infection rate is over X you must wear a mask? Or fo we need to study it further before taking that step?

I live in Austin, Texas, home of the highest positivity rate in the country.

xpost lol

I'm suggesting that at this point anyone claiming you don't need to wear a mask won't be convinced by the world health organization, or anyone else for that matter.

Like, this discussion, argument, debate, me gaslighting myself, I get serious déjà vu, because I thought everybody, myself included in some cases, moved beyond this "masks? y/n?" a couple of months ago.

Illinois seems to be one of the few states doing OK, which I've seen attributed to the state having a good public health leader in Dr. Ngozi Ezike, and the governor at the least following that guidance.

So instead of top-down guidance from the CDC or WHO, it's probably more about having a state government that's funded enough to hire and maintain actual expertise in-house, and then to have someone semi-competent in charge that actually listens to them.

So it's kind of down to Illinois having Chicago, which has both the population density and need for those services because the other 90% of the state is pretty sparse.

So, I understand why Josh, being a resident of the city of Chicago, would gloat over our covid-infected mortuaries

Yes, everyone did, except the major public health orgs, the federal government, lots of state and local governments, and a massive portion of the population.

xp

is this the new The Coup album

the rest of us out here are trying to keep an eye on the useful information because there's no top-down guidance and we're trying to keep our optimistic relatives who think the state or federal government will provide them with useful information either at home or at the least masked up

I read just about all sources now, and where the emerging consensuses are. the WHO does seem a bit reactionary and the hand-washing thing does seem like a relic from the time it was believed to be mostly spread through fomites. and yet I still do the hand-washing thing.

though it does seem that the claims by the one Italian epidemiologist claiming the virus was "weakening" seems to have little to no support outside of his circle, with the current consensus being it's mutated to become more infectious, but not more dangerous in terms of the severity of the infection.

xxxpost Come on, I'm not gloating, that's really not fair.

Anyway, this all stems from my original misreading of that times article, which I thought suggested we were not doing enough because the transmissible virus could live a long time in the air, a la measles, not just that the WHO was not officially supporting many practices I though were already common knowledge, common sense and/or common practice.

The bigger question is even if the major public health orgs, the federal government, lots of state and local governments were all in agreement and clear about the best way to protect people, how do you then enforce those rules across a massive portion of the population? Let alone in a country where people literally take up arms to protect their right not to wear a mask?I don't know. Abbott in Texas seems to have gotten a little more serious about it there in recent weeks, how are Texans reacting to his softening positions?

moodles has the right idea. when the evidence is not clear public health messaging should follow the precautionary principle

josh, the virus does live in the air. whether it has been demonstrated to do so above a certain arbitrary experimentally defined threshold are the sort of details that can be worked out later. even if the risk is small wearing a mask is benign and reduces that risk, and public health guidance should reflect that

the WHO not reflecting guidance to wear a mask is also used as fodder by the anti-mask contingent - "SEE??!! they can't even agree internally whether we should wear one or not!!"

Josh, despite whatever your intentions are, I think your posts generally come off as gloating or have this kind of forced-naivety in tone that, while optimistic in saying "things seem to be working well here" ignores the fact that no one else posting right now shares this experience. I mean, "guy just giving the lay of the land" is useful when describing a local phenomena or using your local as a representative sample but that's not what's going on.

The bigger question is even if the major public health orgs, the federal government, lots of state and local governments were all in agreement and clear about the best way to protect people, how do you then enforce those rules across a massive portion of the population?

Here in Miami-Dade County, where we've been under a mask ordinance since late March, quite easily. Many of these seniors will wear HAZMAT suits to Publix and vote for Trump in November.

mask wearing, despite not being enforced here, has improved a lot in Orange County. there are still definitely places I don't see them, but last time I went to Publix, I found just one guy not wearing them, and honestly if I'd have seen the guy's pic before I entered the store, could have guessed he'd be the one not wearing it.

i suspect the people who are still going to restaurants are probably less likely to give a shit. though some restaurants have sign on their doors now saying you must wear a mask to be let in.

It's hard to tell how effective it is in Texas since it has only been a few days since Abbott put a mask rule in place, after weeks of keeping city leaders' hands tied. It feels like too little too late, but I guess we'll see. Meanwhile, kids are supposed to be returning to school on Aug 18, which is coming up real fast.

The WHO changing its messaging will not fix things on its own, but getting to clear consensus messaging will have positive effects. Beyond that, it's not down to just messaging, but actual enforcement. If people can't take responsibility on their own, they may need legal encouragement as well.

of course the enforcement part is a challenge because we've already seen in cities that do have some sort of enforcement on the books, it's been enforced disproportionately against the Black community.

IMO $250 fine is sufficient, that's enough to give the less wealthy pause, and maybe make the fine on a sliding scale for people who make more than $75,000

there was enough anger about the fact a grocery store here had an outbreak among employees, refused to tell the other employees at the store about it let alone the public, and had such bad policies in general that a local BLM group set up a rally/protest at their parking lot for worker solidarity

otm about unequal enforcement being a huge issue, Neanderthal

some anecdotal evidence from a pretty cool guy who I used to work for several lifetimes ago in Indiana:

Our hundreds of staff have surely encountered 10’s of thousands of people during these last months, and to our knowledge we’ve had one staff member fall sick to the virus— A cook in our kitchen at Hive, a busy kitchen where he worked full-time in close quarters with other staff. The day he was diagnosed in late March, we immediately closed, and have only re-opened two weeks ago.

Here’s the thing, that staff member was masked up, as were our other staff, and as far as we know, no other staff contracted virus. Apparently three of his family members all contracted the virus at a family event. One of them didn’t make it. Our staff member nearly died after being in a coma for almost 3 weeks, and he is a young man.

I know we’ve done the right thing in requiring masks. It’s a thing that we can do to help protect each other. I’d urge our governments to mandate them in confined spaces and wherever possible in order to slow transmission. I realize it’s impossible to enforce, but does such a mandate even need an enforcement mechanism? I’m not sure it does. Let’s try a little bit harder.

anecdotes-as-evidence are a slippery slope (hello brain worms, etc.) but I think when they're in service of something that's a relatively easy, low-effort thing like encouraging masks I'm all for them

places with more masks seem to have a lower rate of infection, wear the damn mask for your family and your community. if you want to protect yourself, even better

Try a little bit harder is a great starting point. The idea that nothing can be improved by making small but necessary changes is really holding us back right now.

it's the same logic used for the anti-gun control faction.

I am required to teach that cheesy "starfish" story in my training classes, where the kids are throwing beached starfish back in the ocean , and some old stodgy man tells them it's pointless, because they can't save them all.

in the 2020 version of that story, the kid says "you're right grandpa, let's go trigger some libs" and hops on the back of his Harley.

Aside: for others like myself thinking of more vulnerable family members, the EVMS MATH+ protocol and its first 25 references has some ideas for lower-cost and potentially helpful prophylaxis. Eastern Virginia Medical School seems to have decent results with their inpatient protocols (3.5% hospitalization mortality, vs around 20% in NYC and for NHS).