Weekly coronavirus-related chat, questions, and minor updates - week of December 7

Usual personal update:

Remember, back at the beginning of the pandemic, when anxiety and uncertainty had pushed the world to what felt like the very edge of a precipice? Where the immediate future looked dark, menacing, and unrecognizable? Where every individual day was so fraught it felt, emotionally and temporally, like its own complete week?

I'm back to that place.

Thanksgiving cases have started to hit. Our numbers were already high last week; we continued getting notifications over the weekend; even more today. These are only going to escalate over the coming days.

Some parents are now voluntarily pulling their kids from school as a precaution. I fully support them.

Ex-government employee who helped develop Florida's COVID tracking was raided yesterday by police at gun point presumably because she launched her own COVID tracking website which told a slightly different story. Here's her tweet about it.

San Mateo Health Officer Statement on Bay Area Stay-At-Home Orders

2. I’m not sure we know what we’re doing. (Please don’t misinterpret this sentence. The science and public health principles around disease transmission interruption – no gathering, mask wearing, social distancing, etc. – are clear. I’m referring to how to get you, the community, to change your behavior). I look at surrounding counties who have been much more restrictive than I have been, and wonder what it’s bought them. Now, some of them, are in a worse spot than we are. Does an unbalanced approach on restrictions make things worse? Maybe, maybe not. But I think there is a more likely explanation. When I look at the trend data, the Bay Area seems to mostly move as a region, and it seems to me to be pretty independent of individual Health Officers’ actions.

3. Surely a hard, enforced, SAH order will certainly drive down transmission rates. But what we have before us is a symbolic gesture, it appears to be style over substance, without any hint of enforcement, and I simply don’t believe it will do much good. I think people should stay at home, avoid all non-essential activities, wear masks, and not gather with anyone outside their households. I’ve been saying this for about 10 months now. If you didn’t listen to my (and many others) entreaties before, I don’t think you’ll likely change your behavior based on a new order. I appreciate that some of you think I (or the government) have magical abilities to change everyone’s behavior, but I assure you, I (we) do not.

• Dec 1st, First coronavirus vaccine flights pass through Brussels Airport
  
• Yesterday, Margaret Keenan receiving the first post-trial vaccine (via /r/nextfuckinglevel)

Both of these are hitting me pretty hard. The beginning of the end. I almost cried at that second picture.

Request for information: what solid info/recommendations/best practices are out there about air ventilation and filtration in cold temperatures?

We were discussing this as a staff today now that it's regularly cold and quite chilly in our classrooms. We're seeing info about how the virus is more transmissible and lingers longer in the air in the cold. Up until now we've kept our windows open and the air flowing to prevent aerosol accumulation, but with the waning temperatures outside making their way into our classrooms, are we potentially creating a better environment for the virus by making our rooms colder?

I'd do my own digging on this, but I'm very strapped for time (with so many teachers out every day I'm doing six different jobs it feels like), so if anyone can point me in the right direction on this, it'll undoubtedly help me, my coworkers, and our students.

Vaccine Nationalism Is Doomed to Fail: Countries seeking to inoculate their citizens at the expense of everyone else are chasing a false promise

To better understand the extent to which richer countries have dominated the prospective-vaccine supply, it helps to look at the numbers. According to the Duke Global Health Innovation Center, which is tracking vaccine procurement worldwide, high- and upper-middle-income countries have collectively reserved nearly 5 billion vaccine doses. These doses are largely the product of bilateral deals between governments and vaccine makers, known as “advance market commitments,” in which governments commit to purchasing doses up front in exchange for priority access once the vaccine is approved. The U.S., for example, has entered into at least six of these bilateral deals, totaling more than 1 billion doses—more than enough to inoculate the entire American population. The European Union, Britain, and Canada have each entered into seven bilateral deals, with the potential of securing enough doses to cover their populations two, four, and six times over, respectively, the Duke numbers show.

Overtaxed Idaho health facilities on brink of rationing care

Soldiers triaging patients in parking lots in a capital city is normally the stuff of science fiction.

Yet that’s the reality in Boise, where troops direct people outside an urgent-care clinic revamped into a facility for coronavirus patients as infections and deaths surge in Idaho and nationwide.

About 20% of his staffers are out because they’re isolating or have tested positive for the virus. Judy said he’s trying to fill 50 openings after workers couldn’t take the stress anymore and quit. He’s increased front office pay by $2.50, to $14 an hour.

Tens of millions of doses of the Covid-19 vaccine manufactured in Belgium will be flown to Britain by military aircraft to avoid delays at ports caused by Brexit, under contingency plans being developed by the government.

For those unaware, you can donate blood with the Red Cross and find out if you have COVID antibodies.

I donated blood for the first time in 10 years on Friday and had the results of my test by Monday afternoon. My test came back negative so it seems like I haven't been asymptomatic, which is a relief as I was horrified at the thought of having spread it.

Covid-19 vaccine: First person receives Pfizer jab in UK

A UK grandmother has become the first person in the world to be given the Pfizer Covid-19 jab as part of a mass vaccination programme.

Margaret Keenan, who turns 91 next week, said it was the "best early birthday present".

She was given the injection at 06:31 GMT - the first of 800,000 doses of the Pfizer/BioNTech vaccine that will be dispensed in the coming weeks.

The second person vaccinated in Coventry was William Shakespeare, 81, from Warwickshire, who said he was "pleased" to be given the jab and hospital staff had been "wonderful".

Heavy new restrictions in Alberta (where I live) now, since it's been going very poorly recently: Alberta imposes tough new restrictions in bid to curb soaring COVID-19 infection rates - Government imposes province-wide mandatory mask mandate, closes casinos, restaurants, pubs

Need a COVID-19 Nurse? That’ll Be $8,000 a Week

Hospitals have long relied on traveling nurses to fill gaps in staffing without committing to long-term hiring. Early in the pandemic, doctors and nurses traveled from unaffected areas to hot spots like California, Washington state and New York to help with regional surges. But now, with virtually every part of the country experiencing a surge — infecting medical professionals in the process — the competition for the finite number of available nurses is becoming more intense.

(From two weeks ago. I wonder how bad it is now?)

When can children get the COVID-19 vaccine? 5 questions parents are asking

When can my child be vaccinated?

Right now, it appears unlikely that a vaccine will be ready for children before the start of the next school year in August.

Will children need more shots than adults?

It does not appear that the schedule of COVID-19 vaccine doses will be different for children, but that could change as testing goes on.

Are the vaccines safe for kids?

So far, no serious safety concerns have been identified with either the Pfizer or Moderna vaccines, but the trials are still in the early stages for children. Several other vaccines are also under development around the world, and a few drugmakers have started trials with younger children in other countries.

Is vaccinating adults enough?

Just vaccinating adults would not be enough to end the pandemic. Children can still become infected, transmit the virus and develop complications. If a vaccine is not available, children will likely serve as a reservoir of the virus, making it harder to end the pandemic.

Do we have to keep wearing masks and social distancing?

In the meantime, it will be important to continue standard preventive measures, including social distancing, wearing face masks, washing hands and following other guidance from the Centers for Disease Control and Prevention.

No more ICU beds at 3 Bay Area hospitals

According to health officials, the following hospitals have reached capacity as of Wednesday, Dec. 9:

• Regional Medical Center (San Jose)
• O’Connor Hospital (San Jose)
• St Louise Hospital (Gilroy)

403 people in Santa Clara County are hospitalized with the virus, including 10 kids.

Additionally, 31 ICU beds are available in the entire county.

Why shielding businesses from coronavirus liability is a bad idea

My research on the role of civil lawsuits in reducing foodborne illness outbreaks suggests that fears of excessive litigation are unwarranted. What’s more, the modest liability exposure that does exist is important to ensuring businesses take reasonable coronavirus precautions as they resume normal operations.

Newly elected N.H. Speaker of the House dies unexpectedly

Hinch, a real estate agent who was elected to his seventh term as a state representative from Merrimack last month, had a longtime goal of becoming speaker. He had previously served as the House Republican Leader and the House Majority Leader.

Republicans picked up control of both the state House and the Senate last month, and Hinch and Morse were sworn in on Dec. 2.

New Hampshire’s GOP governor blasts anti-maskers after House speaker dies of covid-19

In the weeks leading up to his death, Hinch was at the center of a tense controversy between Republican and Democratic state legislators about a lack of adherence to public health guidelines by the GOP members.

On Nov. 9, Hinch and about 50 New Hampshire GOP representatives were photographed at an indoor gathering to celebrate the election results, in which they gained the majority in the state House. None of them were wearing masks, according to the Concord Monitor.

The Republican lawmakers gathered again Nov. 20 for an indoor caucus meeting at McIntyre Ski Area. That same day, the governor passed an executive order mandating masks. The New Hampshire Department of Health and Human Services later determined that at least four state lawmakers contracted the virus at the event.

Monterey County's ICU beds are near full capacity due to Covid-19.

"Unfortunately that's a very complicated and nuanced number," he said. All four of Monterey County's hospitals had increased their ICU capacity with "surge" beds. "The reality is we can turn any bed into an ICU bed if we have a ventilator," he added.

But it also depends on nursing staff availability, Radner said: "Depending on which number you look at, we are anywhere between 40- to 100-percent filled in our ICUs."

Radner said all of Monterey County's licensed ICU beds are full, and the surge ICU beds aren't quite full, but are populated by people who in normal times would be in a licensed ICU bed because they require close monitoring.

[...]

[Community Hospital of Monterey Peninsula] is canceling surgeries because there is no bed space for recovering patients. Some patients who came into the emergency department yesterday are still waiting for beds in the hospital, Blum reported.

https://www.npr.org/2020/12/08/944322462/week-after-giuliani-hearing-michigan-house-is-accused-of-covid-19-violations

Chatfield took Giuliani's word that "he was COVID-negative while in Michigan and no one in Michigan is being considered for contact tracing, per CDC guidelines" despite advice from the state's chief medical executive and Vail, who said it's likely Giuliani was contagious during his testimony.

Repeat after me: This. Is. Not. About. Trust. Wear the fucking mask you god-damned self righteous asaholes, you're supposed to be setting an example.

FYI, Michigan is still under an MDHHS order to wear masks.

Pennsylvania governor tests positive for Covid

It’s not just COVID-19 that’s closing schools — it’s a lack of substitute teachers. The shortage has reached crisis levels in some districts.

Many aren't buying public officials' 'stay-at-home' message. Experts say there's a better way

Health officials are up against a fatigued public, as well as a number of people who don't believe in the danger of the virus, Gandhi said. But she is also part of a growing number of experts who think there's a better way to engage those who do want to take the pandemic seriously — by taking a lesson from the public health strategy known as harm reduction.

Typically used to describe sex-education programs and needle exchanges for drug users, harm reduction aims to mitigate the risks of dangerous behaviors instead of trying to get people to cease altogether.

When it comes to the COVID-19 pandemic, a harm-reduction approach would encourage masking and social distancing instead of demanding that people have no contact at all with friends or family they don't live with. In other words, even during a pandemic, abstinence-only isn't effective.

L.A., however, has adopted more of a "just say no" attitude. Last week the county became one of the only places in the nation to halt all outdoor gatherings among people who aren’t in the same household, prohibiting two friends from meeting up in a park or going on a hike with masks on. Gov. Gavin Newsom followed suit and included the ban in his regional stay-at-home order.

[...]

The concept of harm reduction originally came into use in the 1980s when doctors and activists struggled to reduce HIV transmission among people injecting drugs. Instead of stopping them from using drugs altogether, they opted to provide clean needles that would at least make the behavior safer.

The philosophy now applies to any public health issue for which mitigating risk has been found to be more effective than an all-or-nothing approach, including providing condoms to teenagers to promote safer sex or slowly weaning patients off junk food to improve their diet, said Dr. Eric Kutscher, an internal medicine physician at New York University.

Kutscher, who recently wrote about harm reduction and COVID-19, said it acknowledges an uncomfortable truth: that people are going to socialize whether they are allowed to or not.

Health officials concerned about Fresno County's shrinking number of ICU beds

The San Joaquin Valley's regional ICU capacity was at about 5% on Tuesday, but in Fresno County, that number is even lower with just nine ICU beds available.

"All the things you are hearing about how impacted our hospitals are about how dire the situation with our ICU's is, is absolutely true," said Dr. Rais Vohra, interim health officer for the Fresno County Department of Public Health.

The county is quickly approaching having zero ICU beds available, as the need only grows.

Some facilities have been left with no choice but to treat patients in other wards.

"Our ICUs are full, and in fact, most hospitals are holding ICU patients in their emergency departments," said Dan Lynch, director of Emergency Medical Services.

[...]

At this point, the alternate care site at the Fresno Convention Center has not been activated because of staffing shortages.

A disproportionate amount of Black Americans, women and Republicans aren’t sure about taking a COVID-19 vaccine

68 percent of those who are over age 65 said they would take the vaccine, compared to 54 percent ages 18-34.

68 percent of people with a college degree said they would take a vaccine, compared to 61 percent without a degree.

67 percent of men but just 54 percent of women said they would take the vaccine, per Pew. There is not an obvious explanation for this finding, which showed up not only in all four of these polls but surveys done recently of people in Colorado, North Carolina and even Ireland. In fact, this finding contradicts the general trend in American health — women generally take more preventative measures than men.

Black Americans are very Democratic leaning but also less likely than Asian or white Americans to have college degrees. So those two factors may not be good explanations for the wariness of Black Americans in particular about the vaccine. Instead, experts say there is long-standing mistreatment of Black Americans in U.S. health care research and lingering suspicion from that mistreatment about how the American health care system treats them. The most prominent example of this mistreatment is the Tuskegee study, in which a group of Black men, many of whom had syphilis, were denied treatment that would have lessened the effects of the disease because researchers at Tuskegee wanted to secretly study how the men dealt with the illness.

Sweden’s Covid Workers Are Quitting in Dangerous Numbers

Even before the first wave of the pandemic back in March, there was “a shortage of specialist nurses, including at ICUs,” she said in a phone interview.

The development shows that even countries with universal health-care systems are struggling to keep up with the Covid crisis. This week, Stockholm’s intensive care capacity hit 99%, sending the city into a panic and prompting calls for outside help.

[...]

Part of the problem is that nurses in particular are increasingly unwilling to subject themselves to the hours and conditions facing them during the Covid crisis, given the average pay level. Sara Nordin, once an assistant nurse at an intensive care unit, told Bloomberg in October that she quit because she couldn’t make ends meet on the $33,600 basic pay she got a year.

Surge Continues as Northeast and West Coast Cases Spike: This Week in Long-Term Care COVID-19 Data, Dec 9

The COVID Tracking Project hasn’t been able to obtain current data about the number of people living in Pennsylvania’s long-term-care facilities. But if numbers have remained relatively constant over the past five years, we can estimate, based on a 2015 figure of residents in LTC facilities, that nearly 30 percent of people living in these environments have gotten COVID-19. Pennsylvania combines staff and residents in their long-term-care facility death counts, but based on an analysis of our dataset, we know that 99 percent of all COVID-19 deaths from LTC facilities are among residents. We estimate that nearly one in five Pennsylvania long-term-care residents who contracted COVID-19 has died.