I think it’s really helpful to know where the increase is coming from. In MA according to our DPH, 4736 our of our total 7538 deaths have occurred in long term care facilities. That is horrifying. Our small town had been holding steady at about 100 cases since the onset but last week the number increased by 37 and people were alarmed. How could we have had such a huge jump? People here are wearing masks and we are slowly opening non-essential businesses. Well it was an outbreak in a nursing home that accounted for 35 of the new cases. So for reasonable people, it reinforces that masks, social distancing and good hygeine will work. We need to protect our most vulnerable but that has been a mess from the start.
For a lot of states, we can learn whether that is true, because the information is published.
Sometimes you have to do a little bit of math. But looking at Arizona’s dashboard, we can see that there were 45 outbreaks in congregate care three weeks ago, 42 outbreaks two weeks ago, and 28 outbreaks this week. The number of outbreaks per week in congregate care hasn’t been going up in Arizona, so that doesn’t look like the source of the surge of cases this week.
Moreover, 45% of cases are in people 18-44. Only 15% are in people aged 65 or older. Again, that doesn’t look like nursing home cases are driving the surge.
Doesnt every state by now know the vulnerability in long term care facilities/assisted living facilities? Why haven’t they taken the necessary precautions to prevent the spread in these facilities?
People who work in these facilities live in communities, as do their families and friends. They aren’t isolated from them. If it’s getting into the nursing facilities it is coming in from the staff, or in states that have opened up these facilities to visitors, also.
We know it’s coming in from the community, because the patients aren’t out in the community at all.
Thank you for asking.
I do believe that the SAH orders helped to “flatten the curve”. I do have mixed emotions about a lot of the state’s handling of the situation though. At first I thought we may have reacted a little early but in hindsight that was probably appropriate.
I’m very upset that my state didn’t do much more to protect those in nursing homes. Over half of our deaths are from nursing homes and I think the fact that stricter protective measures were not put in place is criminal.
Just like one size doesn’t fit all on a national level, I also believe that is the case in Maryland with our counties. Maryland is a small state but we vary greatly from our urban to rural areas. I think earlier in this lockdown we could have had a more localized approach. There was never any real reason to shut down our most rural county that still only has 10 cases that were well over a month ago (7 from a nursing home) and zero deaths.
Thankfully our governor has decided to open up more quickly now. He has given counties the ability to open more slowly. Several of our hardest hit areas are taking him up on not easing restrictions as quickly. You can’t please everyone though because now the county executives in those areas are taking heat because they are allowed to make local decisions and keep more restrictions in place. They say the whole state should go together and is not ready. I personally don’t agree, areas should be able to tailor more to their specific conditions.
My county is rural and is able to open up as much as we are allowed. All in all I feel the whole state has “flattened the curve” and we are now able to take advantage of that. I think we’ll see a blip in cases. I’m not really worried that we’ll overwhelm things though. I think we have a much better understanding and handle on things.
Thanks again for asking. These are just my personal houghts.
Absolutely these cases are being brought in by workers at the facilities or those that travel between facilities, drawing blood, working multiple jobs, etc. Perhaps even he national guard, who in Maryland are helping in these facilities, are helping to spread the virus. I personally know of one local home that won’t let anyone in that doesn’t work there, are limiting staff to only working there and are taking other extreme measures to keep their patients safe. So far it has worked.
Yes, by now we really should have a better handle on this. It’s maddening that we aren’t doing better as of now. What are people thinking??
They’re not thinking. And they lack the will or the discipline to listen to the guidelines of those who are. And we’re getting, at best, conflicting leadership and definitely conflicting messaging from state and federal authorities. These are among the reasons why we’re so behind the rest of the developed world in getting a “handle on this.”
But wasn’t Memorial Day was ~20 days ago, and given that the vast majority of infections turn symptomatic in 14 days…is it a matter of slow test results coming back?
Not sure R naught has anything to do with speed or rate over time (“quickly”). It just means cases are increasing.
Our state has decided that we will focus on teaching the 4 core subjects next year–math, English Language Arts, Science, and Social Studies. Everyone who teaches other things (PE, Music, Art, etc) will instead help teach the above 4 things so that we can have smaller class sizes. The teachers who teach other things are quite upset with this. There is great concern about students who have not made progress this spring and a focus to ensure they make enough gains this coming year to make up for that in English and math especially.
Our school district is prioritizing Special Education students and others with greater need as well as younger students in terms of having school in person. We are looking at all sorts of creative ways to ensure those students have as much in person school as possible. All of us agreed with the goal of them to be with teachers daily.
As a staff we are all in agreement that these students must have either daily in person class (a priority) or if that isn’t possible, daily video lessons. And also, we decided all students must have daily video lessons on a bell-like schedule if we do distance learning.
I also think students need some type of social time and social events scheduled online with peers. There were so limited opportunities for them to just be with friends and socialize (except those who do that already, but that type of video game playing or watching Tik Tok videos etc isn’t the same type of in person quality interaction that happens between students at school.)
During distance learning I had to push to get daily online classes with my low readers. I only had one of the group before that who was consistently watching my instructional videos and doing the work. Once I got them all online with me at the same time things went well and we made progress forward in the curriculum for all students. I had a phone list and routinely called all parents at the start of class if their students didn’t show up (and I made calls almost every day because some were almost always forgetting to come to class). I had one student who missed quite a lot of classes and I had her stay after class one-on-one with me whenever she did show up to have her do the work she missed and for me, sometimes keeping her an extra hour or more. I just insisted they come to class and was fortunate that for the most part their families were supportive of that.
I also had students in other classes where I was not able to have regular video classes (I found not being able to have them very frustrating) who fell apart. They had been OK or good or even great students in person but online they were doing little to no work. I would call and message them until I got times to work with them via video and that helped a lot. I got all my students but one to pass doing this, but the last day I spent over 3 hours working with stragglers to help them get enough work done to be in the B ranged up from flunking. It was so much extra work to track down students.
I have heard from multiple friends who have children who are strong, smart students who fell apart in distance learning. It made them feel like terrible parents. I want to hear from more parents about their experiences and what teachers like me can do to help make things more effective if we have distance learning again. It makes me feel terrible to know that we could have done things better and made things harder on families in some ways. But overall, I think our district is among the ones that was more effective at distance learning and had a lot go well.
I usually am so happy during summer and go out and swim outside as much as I can and other fun things. This summer I hope I can have some fun but I’m avoiding public places and people. And I feel I have this great chance to make thoughtful lesson plans that I hope will be effective and more students forward in ability effectively. I want to make things that could work whether we are working together in person or at home. I have a lot of thinking and work to do.
It’s not about what they’re thinking. It’s about the money.
Nursing homes don’t have enough money. They can’t afford to have enough staff, and because the staff are underpaid they often have to work at more than one facility, thus bringing germs from one facility to another. They don’t have enough money to buy PPE for workers, or to train workers in infection control.
We can talk all we want about stopping outbreaks in nursing homes, but if we don’t provide the money, it’s not going to happen.
Just to be clear, my comment was towards the nursing home issues not the virus reaction in general.
Our nursing homes, our most vulnerable, should have the best practices and procedures.
We shouldn’t have to shut down the greater society to protect these nursing homes. We should be able to treat them with greater care than we are.
States should have put guidance in place for best practices and individual homes could have went above and beyond that. Each county here has a health department that could certainly be of use in directing these things.
Reading your post CF, it made me realize that my mind appears to be focused on #deaths and not #cases. So, perhaps when I was reading “surge”, my mind was equating it to hospitalizations & deaths.
When I look at the #cases in Illinois, it’s ages 20-59 leading the way. Deaths are skewed heavily at over 80. So startling to see it in bar graph form!
Someone, was it Amesh Adalja???, was estimating the hospitalization rate at 5%.
No time to look it up! Gotta go lift weights.
Thank you for the discussion, all.
R has everything to do with speed of spread. It’s the average number of people an infected person infects. The bigger the R, the faster the spread, exponentially.
In this model (which is simplified, but works with big numbers of cases), the number of total cases at time t is proportional to R^t.
Local observation today…
I went to two crafts stores today (heaven!), bought almost everything I’ve wished I had in my stash over the past three months. All this stuff had either been sold out online, would have been sketchy to ship (bottle of glazing medium, paint) or had to be picked out personally to make sure they were the correct color, in decent condition, or whatnot. I exchanged pleasantries with the sales girl, and she made a comment that the customers have been “so much nicer now that they are able to get out”.
Wished I had asked her to explain more. Been thinking of that ever since she said it. Were folks really taking out their own anxieties on a hapless salespeople whose primary contact with customers for the past several months was to drop something in their trunk?
“Daily video lessons on a bell-like schedule” with school sponsored social zoomcalls sounds horrific to me. And to most kids, I bet.
@CountingDown My condolences.
I like the sound of this. I wonder where the funding will come from because I doubt it’s adequate now. And given the attitude “they will die anyway” that’s cropping up in regards to Covid restrictions, I doubt communities will vote to tax themselves to ensure/enforce the practices and procedures you espouse. But… maybe. I’d love to see this health crisis bring about social changes we clearly need. On this, and other fronts.
Luckily, total population density isn’t the main issue (which is good because there’s not much you can do about that). The data shows that population density isn’t the biggest factor in spread, it’s multigenerational families and density of individual households.
https://www.wsj.com/articles/covid-19-households-spread-coronavirus-families-navajo-california-second-wave-11591553896?mod=searchresults&page=1&pos=1
Covid-19 Stalks Large Families in Rural America
A Wall Street Journal analysis found that, across the country, the virus has spread more widely in places with the most crowded households, not necessarily places with the largest or densest populations. Remote, rural hamlets where extended families live under the same roof have turned deadlier than some of the densest blocks of Manhattan or Chicago, the analysis found. In both contexts, the virus has zeroed in on crowded homes, sometimes wiping out generations in a matter of days.
The Journal analyzed all 1,487 U.S. counties with at least 50 Covid-19 cases, as of June 7. The 10% with the highest rates of crowding accounted for 28% of the coronavirus cases among those 1,487 counties, according to census and Johns Hopkins University data.
The Journal also found that in selected areas—including Cook County, Ill., New York City and Wayne County, Mich.—ZIP Codes with the largest share of households of at least five people have disproportionate shares of their counties’ Covid-19 infections. The problem is particularly acute in poorer and minority communities, according to data from some cities, where extended families often live together and lack space and resources to isolate anyone who falls ill.
Families that live on Indian reservations often live in crowded homes, which the census defines as more than one occupant per room. These areas have also seen some of the highest infection rates in the nation.
……
As states reopen, stopping transmission of the virus within households will be key to preventing a second wave of infections, said Dr. Ashish Jha, a health-policy professor at the Harvard T.H. Chan School of Public Health.
….
A study from New York University’s Furman Center found that in New York City, the areas hit hardest by the disease weren’t those with the densest population; they were the ones with the greatest household crowding among renters.
….
In California, the three counties with the highest coronavirus rates—Kings County, Imperial County and Los Angeles County—are majority Latino and Black and have among the highest rates of household crowding in the country.
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In Italy, where multigenerational households are common and most people with Covid-19 remain at home, the country’s National Health Institute found that one in five people who have tested positive in April and early May were likely infected by family members, the second-highest source of infection after nursing homes.
A study from the London School of Hygiene & Tropical Medicine found that in a city of four million people, home-based isolation would result in a 20% reduction in coronavirus cases, while isolation in quarantine centers would cut cases by 59%.
In the U.S., quarantine centers have been used sparingly. Because testing hasn’t been as widespread as in some other countries, many people have passed the virus to loved ones before even realizing they are sick.
Kansas officials have set up quarantine centers in six counties across the state, including Ford County, where outbreaks at two meatpacking plants have sickened workers and their family members. The county of 33,600 people has more than 1,800 confirmed cases, the highest total in the state. According to census data, 18% of households in Ford County have five or more people and 7.1% are crowded, both well above the national average
[SO… MORE TESTING AND RAPID TESTING PLUS SETTING UP ISOLATION HOUSING FOR INFECTED PEOPLE SO THEY DON’T SPREAD TO OTHERS IN THEIR HOUSEHOLD WOULD MAKE A BIG DIFFERENCE. THESE ARE THINGS EVERY STATE CAN DO.]
I guess we have different sources of scientific data:
It’s not a measure of the rapidity of a pathogen’s spread through the population because the R or R0 number itself doesn’t include how fast a person infects someone else. However, in the case of covid, we know how fast a person infects someone else. And therefore, we can use R to estimate the rapidity of spread.
Note that when I wrote the equation for the number of cases at time t, R^t, I didn’t tell you how t was measured. It’s measured in infection cycles, which for covid is something like four days or five days. People are calculated what R has been in various areas in the last week, or month, or whatever, and they do that by figuring out which R makes R^t fit the data.