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<div dir="auto">FRIAM Diaspora in Europe here, makes sense to me.
Here in Europe each week the restrictions are lifted a bit
further, since the number of new cases is low enough. We still
have to wear masks if we go shopping or use the public
transport, which makes sense because the virus spreads through
the respiratory system, and we have no vaccine yet. </div>
<div dir="auto"><br>
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<div dir="auto">Our cleaning lady here in Berlin is from Chile
where the situation looks really bad. She said her whole family
in Chile has the virus, and her grandfather has died from it. If
the situation on the southern hemisphere escalates it could swap
back to the northern hemisphere again. There might be a second
major wave if we are not careful. </div>
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<div dir="auto">-J.</div>
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<p>It is not June 15 yet, but we've been assured that "the Pandemic
will be over by mid June". I *do* believe that the "Panic" over
the Pandemic is lessening up, *but* overcaution was warranted
based on the stakes and the knowledge of risk and in the spirit of
the "The Hammer and the Dance" it is time to dance. <br>
</p>
<p>According to live.rt, in the US state-by-state: we've edged back
up from 9 of 50 states with an estimated R0 *over* 1.0 to 15 of
50, trending up. If we are conservative and look only at the
estimates with >50% confidence, we might be closer to 25++ of
the states with R0>1.0, which implies it is still
growing/spreading there. <br>
</p>
<p><img src="cid:part1.5C4CA776.22755CBD@swcp.com" alt=""
width="589" height="259"></p>
<p><img src="cid:part2.70D453C2.4C9B0710@swcp.com" alt=""
width="582" height="252"></p>
<p>I'm pretty sure we can't call it OVER until after-the fact, in
hindsight whenever that may be (June 15 but which year?). If
somehow Dave's prognostication *were* to be true by some objective
measure, I think we'd need to see R0 trending *down* not *up* and
*continue to*. NZ *can* say "the pandemic is over" or more aptly
"the pandemic is currently excluded from NZ and more dependent on
our immigration, testing, and quarantine procedures than on the
state of the Pandemic in the rest of the world". <br>
</p>
<p>I *do* think we are finding a balance with care in everyday life
(outside of "Liberate XYZ" and BLM Street Protests) that doesn't
require full-lockdown to "manage R0". In wildland fire, what used
to be "prescribed burns" have become "managed burns" which means
keeping the spread rate high enough to clear fuels but low enough
to not become uncontained. I don't see us deliberately infecting
people to build "herd immunity" but adjusting our behaviour to
"tune" the infection rate to be manageable *and* selectively to
exclude vulnerable populations from our ongoing "experiment".<br>
</p>
<p>Mary and I have been *deliberately* eating at restaurants which
have opened (50% seating, various rules) and been very pleased
with the experience. Of course, we *missed* the experience of
eating out but also wanted to also participate in helping these
places work through their re-opening procedures and give ourselves
the opportunity to tip heavily to those who have been out of work
for >2 months. <br>
</p>
<p>We also returned to lap-swimming (Los Alamos Aquatic Center)
where they are very controlled... no locker/shower room usage....
enter one door masked opposite masked/gloved employees, swim (in
the center of your lane!) for 45 mins, exit another door (no
shower). About 10 laps into our swim I realized that each time I
crossed opposite the next lane, that the other swimmer not only
splashed water on me each time but exhaled sharply like a whale
through a blowhole. I wasn't personally worried, but mused at
how some might be very worried/offended. I am no where near as
*aggressive* of a swimmer and had no problem adjusting my
breathing cadence to inhale facing the other side and "out of
phase" with his. I suspect there are *0* infected people
*living* in Los Alamos (and likely to swim there in the middle of
the day) and few if any cases commuting in on any given day. But
I'm happy to participate in good habits while we "dance" our way
back to something less extreme.<br>
</p>
<p>It was good to get back in the water, but we may shift to
swimming in Abiqui Lake, even though it is still mostly
snow-melt... <br>
</p>
- Steve<br>
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<div>-------- Original message --------</div>
<div>From: <a class="moz-txt-link-abbreviated" href="mailto:thompnickson2@gmail.com">thompnickson2@gmail.com</a> </div>
<div>Date: 6/11/20 19:36 (GMT+01:00) </div>
<div>To: 'The Friday Morning Applied Complexity Coffee Group'
<a class="moz-txt-link-rfc2396E" href="mailto:friam@redfish.com"><friam@redfish.com></a> </div>
<div>Subject: [FRIAM] Practical Covid Guidlines </div>
<div><br>
</div>
</div>
<div class="WordSection1" dir="auto">
<p class="MsoNormal">I wonder what The Congregation, including
the Diaspora, thought about this. Nothing very dramatic, here,
but that’s just the point. Nothing on travel. </p>
<p class="quotation">From Dr. James Stein, Professor of
Cardiovascular Research at the University of Wisconsin School
of Medicine and Public Health…<o:p></o:p></p>
<p class="quotation"> COVID-19 update as we start to leave our
cocoons. The purpose of this post is to provide a perspective
on the intense but expected anxiety so many people are
experiencing as they prepare to leave the shelter of their
homes. My opinions are not those of my employers and are not
meant to invalidate anyone else’s – they simply are my
perspective on managing risk.<o:p></o:p></p>
<p class="quotation"> In March, we did not know much about
COVID-19 other than the incredibly scary news reports from
overrun hospitals in China, Italy, and other parts of Europe.
The media was filled with scary pictures of chest CT scans,
personal stories of people who decompensated quickly with
shortness of breath, overwhelmed health care systems, and
deaths. We heard confusing and widely varying estimates for
risk of getting infected and of dying – some estimates were
quite high. <o:p></o:p></p>
<p class="quotation">Key point #1: The COVID-19 we are facing
now is the same disease it was 2 months ago. The “shelter at
home” orders were the right step from a public health
standpoint to make sure we flattened the curve and didn’t
overrun the health care system which would have led to excess
preventable deaths. It also bought us time to learn about the
disease’s dynamics, preventive measures, and best treatment
strategies – and we did. For hospitalized patients, we have
learned to avoid early intubation, to use prone ventilation,
and that remdesivir probably reduces time to recovery. We have
learned how to best use and preserve PPE. We also know that
several therapies suggested early on probably don’t do much
and may even cause harm (ie, azithromycin, chloroquine,
hydroxychloroquine, lopinavir/ritonavir). But all of our
social distancing did not change the disease. Take home: We
flattened the curve and with it our economy and psyches, but
the disease itself is still here. <o:p></o:p></p>
<p class="quotation">Key point #2: COVID-19 is more deadly than
seasonal influenza (about 5-10x so), but not nearly as deadly
as Ebola, Rabies, or Marburg Hemorrhagic Fever where 25-90% of
people who get infected die. COVID-19’s case fatality rate is
about 0.8-1.5% overall, but much higher if you are 60-69 years
old (3-4%), 70-79 years old (7-9%), and especially so if you
are over 80 years old (CFR 13-17%). It is much lower if you
are under 50 years old (<0.6%). The infection fatality rate
is about half of these numbers. Take home: COVID-19 is
dangerous, but the vast majority of people who get it, survive
it. About 15% of people get very ill and could stay ill for a
long time. We are going to be dealing with it for a long time.<o:p></o:p></p>
<p class="quotation"> Key point #3: SARS-CoV-2 is very
contagious, but not as contagious as Measles, Mumps, or even
certain strains of pandemic Influenza. It is spread by
respiratory droplets and aerosols, not food and incidental
contact. Take home: social distancing, not touching our faces,
and good hand hygiene are the key weapons to stop the spread.
Masks could make a difference, too, especially in public
places where people congregate. Incidental contact is not
really an issue, nor is food.<o:p></o:p></p>
<p class="quotation"> What does this all mean as we return to
work and public life? COVID-19 is not going away anytime soon.
It may not go away for a year or two and may not be eradicated
for many years, so we have to learn to live with it and do
what we can to mitigate (reduce) risk. That means being
willing to accept *some* level of risk to live our lives as we
desire. I can’t decide that level of risk for you – only you
can make that decision. There are few certainties in pandemic
risk management other than that fact that some people will
die, some people in low risk groups will die, and some people
in high risk groups will survive. It’s about probability. <o:p></o:p></p>
<p class="quotation"> Here is some guidance – my point of view,
not judging yours:<o:p></o:p></p>
<p class="quotation">1. People over 60 years old are at higher
risk of severe disease – people over 70 years old, even more
so. They should be willing to tolerate less risk than people
under 50 years old and should be extra careful. Some chronic
diseases like heart disease and COPD increase risk, but it is
not clear if other diseases like obesity, asthma, immune
disorders, etc. increase risk appreciably. It looks like
asthma and inflammatory bowel disease might not be as high
risk as we thought, but we are not sure - their risks might be
too small to pick up, or they might be associated with things
that put them at higher risk. <o:p></o:p></p>
<p class="quotation">People over 60-70 years old probably should
continue to be very vigilant about limiting exposures if they
can. However, not seeing family – especially children and
grandchildren – can take a serious emotional toll, so I
encourage people to be creative and flexible. For example,
in-person visits are not crazy – consider one, especially if
you have been isolated and have no symptoms. They are
especially safe in the early days after restrictions are
lifted in places like Madison or parts of major cities where
there is very little community transmission. Families can
decide how much mingling they are comfortable with - if they
want to hug and eat together, distance together with masks, or
just stay apart and continue using video-conferencing and the
telephone to stay in contact. If you choose to intermingle,
remember to practice good hand hygiene, don’t share
plates/forks/spoons/cups, don’t share towels, and don’t sleep
together.<o:p></o:p></p>
<p class="quotation"> 2. Social distancing, not touching your
face, and washing/sanitizing your hands are the key prevention
interventions. They are vastly more important than anything
else you do. Wearing a fabric mask is a good idea in crowded
public place like a grocery store or public transportation,
but you absolutely must distance, practice good hand hygiene,
and don’t touch your face. Wearing gloves is not helpful (the
virus does not get in through the skin) and may increase your
risk because you likely won’t washing or sanitize your hands
when they are on, you will drop things, and touch your face.<o:p></o:p></p>
<p class="quotation"> 3. Be a good citizen. If you think you
might be sick, stay home. If you are going to cough or sneeze,
turn away from people, block it, and sanitize your hands
immediately after.<o:p></o:p></p>
<p class="quotation"> 4. Use common sense. Dial down the
anxiety. If you are out taking a walk and someone walks past
you, that brief (near) contact is so low risk that it doesn’t
make sense to get scared. Smile at them as they approach, turn
your head away as they pass, move on. The smile will be more
therapeutic than the passing is dangerous. Similarly, if
someone bumps into you at the grocery store or reaches past
you for a loaf of bread, don’t stress - it is a very low risk
encounter, also - as long as they didn’t cough or sneeze in
your face (one reason we wear cloth masks in public!). <o:p></o:p></p>
<p class="quotation">5. Use common sense, part II. Dial down the
obsessiveness. There really is no reason to go crazy
sanitizing items that come into your house from outside, like
groceries and packages. For it to be a risk, the delivery
person would need to be infectious, cough or sneeze some
droplets on your package, you touch the droplet, then touch
your face, and then it invades your respiratory epithelium.
There would need to be enough viral load and the virions would
need to survive long enough for you to get infected. It could
happen, but it’s pretty unlikely. If you want to have a
staging station for 1-2 days before you put things away, sure,
no problem. You also can simply wipe things off before they
come in to your house - that is fine is fine too. For an
isolated family, it makes no sense to obsessively wipe down
every surface every day (or several times a day). Door knobs,
toilet handles, commonly trafficked light switches could get a
wipe off each day, but it takes a lot of time and emotional
energy to do all those things and they have marginal benefits.
We don’t need to create a sterile operating room-like living
space. Compared to keeping your hands out of your mouth, good
hand hygiene, and cleaning food before serving it, these
behaviors might be more maladaptive than protective. <o:p></o:p></p>
<p class="quotation">6. There are few absolutes, so please get
comfortable accepting some calculated risks, otherwise you
might be isolating yourself for a really, really long time.
Figure out how you can be in public and interact with people
without fear. <o:p></o:p></p>
<p class="quotation"> <o:p></o:p></p>
<p class="quotation"> <img
style="width:2.0in;height:.3333in"
id="m_-5089887865504843604m_-1055917697182651435Picture_x0020_1"
src="content://com.samsung.android.email.attachmentprovider/1/8361/RAW"
onmouseover="imageMousePointerUpdate(true)"
onmouseout="imageMousePointerUpdate(false)"
name="com_samsung_android_email_attachmentprovider_1_8361_RAW_1591900344239"
moz-do-not-send="true" width="192" height="32"><o:p></o:p></p>
<table class="MsoNormalTable"
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<p class="quotation">Steven W. Tabak, M.D., F.A.C.C.
| Medical Director, Quality and Physician Outreach <o:p></o:p></p>
</td>
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<tr style="height:4.0pt">
<td style="width:440.8pt;padding:0in 5.4pt 0in
5.4pt;height:4.0pt" width="588">
<p class="quotation"><span
style="font-size:5.0pt;color:#A50021">____________________________________________________________________________________________________________________________________________________________________________</span><o:p></o:p></p>
<p class="quotation"><span
style="font-size:3.0pt;color:#A50021"> </span><o:p></o:p></p>
</td>
</tr>
</tbody>
</table>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Nicholas Thompson<o:p></o:p></p>
<p class="MsoNormal">Emeritus Professor of Ethology and
Psychology<o:p></o:p></p>
<p class="MsoNormal">Clark University<o:p></o:p></p>
<p class="MsoNormal"><a href="mailto:ThompNickSon2@gmail.com"
moz-do-not-send="true">ThompNickSon2@gmail.com</a><o:p></o:p></p>
<p class="MsoNormal"><a
href="https://wordpress.clarku.edu/nthompson/"
moz-do-not-send="true">https://wordpress.clarku.edu/nthompson/</a><o:p></o:p></p>
<p class="MsoNormal"> <o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
</div>
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