I'm losing track - what are we trying to accomplish again?

[dreamshark]

This is about the pandemic again. Move on now if you're sick of the topic.

Yes, I agree that there is no national strategy as directed by the White House (except "do everything possible to get the president reelected" of course, but let's just ignore that for the time being). There are still people in the public health sector, including the beleaguered CDC, trying very hard to formulate a national policy of some sort. But most of the public policy is actually being made at the state and city level, with some input from whichever part of the national approach is agreeable to the local point of view. And ultimately, every individual has to make their own decisions about their own actions. I've been paying very close attention to all of this, trying to sort through masses of vague platitudes and deliberate misinformation to find (1) actual data on the behavior of the virus and (2) some kind of  public health policy to support. I'm forming clearer and clearer theories about #1, but getting increasingly confused about #2. 

I know what my personal goal is. To avoid being infected long enough for a reasonably effective vaccine to become available, get myself and my family vaccinated, and then take my chances on it working. So for the time being, government guidelines and/or mandates have little effect on the decisions I make. New information on the behavior of the virus has and will. Currently, my family's approach is to do essential shopping only (in person, not by delivery app), avoid all indoor contact with people outside the household, but do a little bit of cautious socializing outdoors. We wear masks when we shop but not every time we step outside. I bike or walk during the day, always taking a mask along but only wearing it if I'm around other people for longer than fleetingly passing them on the street. Richard walks at night. I don't think he even bothers taking a mask, since there's not really anyone else on the street. Thorin seems to be following similar guidelines. None of this has changed as Minnesota has moved into different "phases" and I have largely lost track of what's open, closed, or restricted in various ways.

But I feel like I should at least follow what is happening at the city, state, and national level and formulate some kind of opinion on what policies are on the right track in terms of public health. I am increasingly confused on how to make any kind of judgments. What exactly are we (for any value of collective "we") trying to accomplish at this point?

• KEEP THE VIRUS FROM OUR SHORES. It is far too late for the quarantine/trace/isolate strategy that was followed by New Zealand, China, and South Korea. So what is all this chatter about "contact tracing?" Contact tracing only works for stamping out small outbreaks in a population that is largely uninfected. It might POSSIBLY be of some help in New York City, where the main outbreak seems to have blown over and they are trying to open things up very very gradually. But when you're at the point where there is so much community spread that few people know where they were infected, what's the point? And when every attempt at contact tracing ends with something like, "And then I went to Mardi Gras" there is really nothing to be gained. 
• FLATTEN THE CURVE: That's an achievable goal - accept the fact that most of the susceptible population is going to be infected eventually but keep the infection rate to the point where hospitals can handle it. I think that's what we were trying to do in Minnesota, and it has been successful. We do not have the lowest rate of overall infection, but we never reached the point where bodies were being stacked in the streets and people were being sent home to die. Our flattened curve is gradually rising now as younger people come out of hiding and start trading germs again, but it's showing no sign of spiking out of control. If that's the goal, we've met it. So I'm not sure why all the scowling and finger pointing at the young people infecting each other in the bars. It's going to happen eventually, and maybe now is the best time. 
• OPEN THE SCHOOLS IN THE FALL: Politics aside, that is a worthy goal. Rather than turning the issue into the usual political football, maybe it's time for everybody to start concentrating on exactly what is the safest way to do that. It's about time that we accept the obvious evidence that the virus spreads like wildfire in enclosed, stale air and figure out how to ameliorate that. Instead of spending billions on useless plexiglass partitions, invest in equipment that increases the number of air exchanges in indoor spaces. Maybe spend some more and install UV and HEPA filtering. At the very least, OPEN THE FUCKING WINDOWS. European countries have had health standards for years requiring every public building to have windows that open. It's not an impossible feat, technologically or financially. Maybe states like California, Oregon and Washington that have mild climates year round could move some of their classes into outdoor tents. 
• FIGURE OUT EXACTLY HOW THE VIRUS SPREADS and concentrate on risk reduction.  Pay no attention to the fucking WHO, which has its head up its collective ass. We've known for months that the virus is airborne and that indoor air is the main problem, not sneezes or surfaces or even crowded beaches. Instead of pretending that the virus can somehow be eliminated by sufficient amounts of hand washing, we need to figure out where people are actually getting sick and tell people what they actually need to know to decrease their  risk. This is the one clear benefit that I can see to contact tracing at this point, but we have to trace backwards as well as forwards. I really want to know if anybody has EVER been infected while grocery shopping. Or by touching a contaminated surface, for that matter. Why is that so hard to determine? 

Have I missed anything? What do you think the public health goals / priorities should be? 

Comments

[quadong]

"OPEN THE FUCKING WINDOWS"

OMG, yes. And as you've said, let's rapidly go back to buildings with functional windows so that's possible. My office at the U has unopenable windows, and I *hate* it. It's stuffy and always too hot. I've complained a number of times, and they claim to fix things with the ventilation and it remains stuffy and hot, which could be fixed by opening the window, if that were possible. I have wondered just how hard I'd have to throw a chair at the window to get air in the case of a chemical leak or whatnot, especially because we've been *evacuated* for a chemical leak once. I am sure my whole building is a terrible place to be with the virus.

[spiderplanet]

I could write for an hour about your employer's bad habits regarding HVAC maintenance and implementation.

Here is an opinion. It is not mine. Operable windows are regarded as a bad idea because controlling the indoor climate via an expensive electrical system is better. If it's too hot or cold, then something should be fixed.

Back to my own views - We do have a problem in a building with operable windows where some departments have empty offices, or infrequent occupants, and if the last person left the window open, it will be open forever. I feel like that's a solvable problem. I can LOOK at the building and see which windows were left open in March, but whatevs.

[redbird]

Finding any sort of meaningful treatment is, and should be, a goal: it doesn't have to be a cure, something that reduces the death rate and/or how severity of illness would be valuable. There are risks I'll take if the expected bad outcome is a week of with what feels like a bad cold, that I won't right now.

(It doesn't help that there have been claims that, for example, chloroquine is a ocmplete cure, along with claims that it reduces the severity or mortality rate. Both seem now to be untrue, but having those floating around together makes it harder to think about how useful a drug that ameliorates symptoms would be.)

[dreamshark]

Yes, definitely. Possibly that goes without saying, but maybe not; when you're deciding how to allocate research money, for instance, you could decide to allocate more or less of it to finding interim treatments as opposed to directing every possible dollar towards developing a vaccine.

A fair amount of time and money HAS flowed in that direction, of course, and a lot of progress has been made even if no magic bullet has been found.

[spiderplanet]

On the issue of touch - I don't remember where I read it, but I have read that touching a contaminated surface, and then touching your eyes is a good virus path. I've it in multiple places, and heard of multiple accounts where eye touching was considered the infection path. C-19 is probably not contracted by touching your cheek, but keep your fingers out of your eyes unless they are freshly washed.

I wear safety glasses when I leave the house. I wear safety glasses to Cub, I shit you not. When I first started doing so, it was alarming to me how much I love touching my eyes - ALL THE FUCKING TIME. Now my fingers bump into the sides of the safety glasses and I am reminded that if my eyes are itchy, I need to find a place to wash my hands.

[dreamshark]

Eyes make more sense to me as an infection path than touching any other part of your face. And even if you don't touch your eyes at all, any virus that comes through the air into your nose could just as easily land in your eyes, right? And your eyes are just sticking out there above your face mask, unprotected. So safety glasses don't seem like a crazy precaution, especially since you don't wear regular glasses any more. When I get home from shopping I wash not only my hands but my face and my glasses. Seems like it couldn't hurt.

The virus CAN infect the eyes directly, causing pinkeye. But that is only a symptom in 1-2% of COVID cases. So even if every case of COVID conjunctivitis arose from the eye being an infection path (and it can certainly move from the nose to the eyes rather than the other way round) it doesn't seem to be a very common infection mechanism.

[maruad]

10 days in a row without a new case in Manitoba, thank ghu. Newfoundland just had their first case in 43 days (person was newly arrived from the USA).

We have been doing the isolation/social distancing thing while awaiting the vacinne(s). Our sons have had their university courses interrupted though one of my son's girlfriend is still doing her architecture course. Apparently there is plenty of room for social distancing in that department (not so much for kinesthesiology or philosophy).

There have been some positive rumours floating around, credited to someone in the International Centre for Infectious Disease that is located here (sorta of the Canadian version of the CDC). The rumours are saying at least one, if not two, viable vaccine is expected by the new year but ramping up production is going to be an issue. So it is a matter of hanging tight for a while longer.

[dreamshark]

Sounds like some kind of success story, but which one? Did Manitoba manage to keep the disease from ever taking hold, or is this the downside of a spike and recovery? (I'm guessing the former). Did Manitoba do stay at home orders, contact tracing, and business restrictions or were they just lucky?

[maruad]

think it is a combination of things. Quebec got hit hardest and fastest because their spring break was two weeks ahead of the rest of the nation (iirc). This sent warning bells everywhere and most people were very good about social distancing and wearing masks (this is dropping rapidly as complacency is rearing it's ugly head). The province was fumbling the ball for the first week or so but I suspect having the national experts located here meant there was no hiding from the reality (and I think someone got the ear of the premier and made him listen to reason).

Another factor is that no one from out of province really seems to want to visit Winnipeg in the late winter/early spring. Not much of an international hub or tourist destination (go figure).

There was a flurry of early cases but people hunkered down for the most part.

[maruad]

So basically most of our cases were truckers involved in moving essential goods to and from the USA and some folks who brought it in from out of province (mostly out of country).

[minnehaha]

Dave told me that all the roads north were closed too, to keep the infected and the virus out of the northern reserves. I guess the roads north have opened now? Since they're in Flin Flon?

K.

[maruad]

I think that is the case for Manitobans but it may be only for people who have cottages/residences there. I am not certain if the province is open to all the rest of the country yet or not. IIRC the borders are open with Saskatchewan but I don't know about the rest.

We are seeing US plates but apparently a large percentage of those are returning snowbirds or NATO personnel based at 17 Wing. There have been idiots abusing the Alaska loophole but those folks are more likely to go to Banff than anywhere in Manitoba.

[minnehaha]

When I visited classrooms at a university in China in January, all the windows were open because the students were accustomed to and liked all that fresh cold air. The teacher from Canada went around and shut the windows before starting class.

K.

[minnehaha]

Is there any value in identifying pockets of the unaffected and working to keep them safe and spreading the "clear" zone? I don't think there's a single case of the virus yet in Lake of the Woods County.

K.

[dreamshark]

I don't know. That's the situation where aggressive testing and contact tracing actually has a chance of accomplishing something, but is it worthwhile to create isolated populations of virus virgins just waiting for somebody to toss a match into their population and set it ablaze?

If they can maintain that state of innocence until a reliable vaccine is in play, I guess so. If we never get that reliable vaccine, they are just setting themselves up for eventual disaster.

Oddly enough, I never mentioned the most obvious public health goal, and nobody else has brought it up. That would be to reduce the total number of deaths (or infections) over the long haul. I have no idea how you do that, particularly if we never do get a fully effective vaccine. It might still turn out that letting the virus burn through and create herd immunity leads to fewer total deaths in return for short-term horror.

[minnehaha]

Is there anything useful in the serum idea?

K.

[dreamshark]

You mean treating COVID patients with the blood of the healed? God, I hope so. I love the idea that people who have suffered through a bout of the plague can rescue their neighbors by donating their blood.

Or did you mean something else?