[FRIAM] Practical Covid Guidlines

Thu Jun 11 20:35:31 EDT 2020

> 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. 
>
> 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. 
>
> -J.

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. 

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.

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".   

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".

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.    

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.

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...  

- Steve
>
> -------- Original message --------
> From: thompnickson2 at gmail.com
> Date: 6/11/20 19:36 (GMT+01:00)
> To: 'The Friday Morning Applied Complexity Coffee Group'
> <friam at redfish.com>
> Subject: [FRIAM] Practical Covid Guidlines
>
> I wonder what The Congregation, including the Diaspora, thought about
> this. Nothing very dramatic, here, but that’s just the point.  Nothing
> on travel. 
>
> From Dr. James Stein, Professor of Cardiovascular Research at the
> University of Wisconsin School of Medicine and Public Health…
>
>  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.
>
>  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.  
>
> 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. 
>
> 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.
>
>  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.
>
>  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.
>
>  Here is some guidance – my point of view, not judging yours:
>
> 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.
>
> 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.
>
>  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.
>
>  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.
>
>  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!). 
>
> 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. 
>
> 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.
>
>  
>
>     
>
> Steven W. Tabak, M.D., F.A.C.C.   |   Medical Director, Quality and
> Physician Outreach
>
> ____________________________________________________________________________________________________________________________________________________________________________
>
>  
>
>  
>
> Nicholas Thompson
>
> Emeritus Professor of Ethology and Psychology
>
> Clark University
>
> ThompNickSon2 at gmail.com <mailto:ThompNickSon2 at gmail.com>
>
> https://wordpress.clarku.edu/nthompson/
>
>  
>
>  
>
>
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