The Walls Come Down: No Travel Betwen US and Europe for 30 Days

[mr friendly guy]

Or You lock down the country for a few weeks until you develop the testing capacity to trace any new clusters while you bring back aspects of your workforce. Lockdowns isn't meant to bring a complete end to the virus. It's to bring the number of new cases down to an extend that it is manageable and you can once again contain clusters and isolate the cases.

That ship sailed over a month ago. We are not Singapore, Taiwan, or even South Korea. The testing capacity does not and will not exist in that time frame, nor do we have the surveillance ability to backtrack positive cases and test & quarantine all their contacts.

You could start by buying the kits from countries that runs tens of thousands of tests each day. South Korea, China etc. I mean Canada only has what, 30 million people.

[loomer]

Economic devastation is inevitable one way or another at this stage, whether you go full lockdown or not. Months of supply chain disruptions, complete transformations in commodities and resource markets, and the illness and death of workers are all pointing that way. The only question now is, Recession or Depression?

[The Romulan Republic]

I mean, is it going to fuck the economy or the health care system any less if we open everything up, and then tens of millions of people get it all at once? Seems to me we have a choice between months of lockdowns and a recession/depression, or no lockdowns and a recession/depression plus hundreds of thousands or millions dead.

[J]

You could start by buying the kits from countries that runs tens of thousands of tests each day. South Korea, China etc. I mean Canada only has what, 30 million people.

We could, we should, and it will help.

The US on the other hand crossed the bridge from TARFU to FUBAR a while ago...

The only question now is, Recession or Depression?

Actually, the question is Depression or Revolution.

I mean, is it going to fuck the economy or the health care system any less if we open everything up, and then tens of millions of people get it all at once? Seems to me we have a choice between months of lockdowns and a recession/depression, or no lockdowns and a recession/depression plus hundreds of thousands or millions dead.

You forget the 2nd order effects of an extended lockdown. It will break the supply chains and cripple hospitals and other critical infrastructure systems. You'll likely end up with a similar number of deaths.

[loomer]

The supply chains that are already broken, and the critical infrastructure that's already feeling the pinch?

[loomer]

My state is releasing some prisoners due to the outbreak.

[loomer]

It's funny New York came up earlier in the spat about resource allocation, because apparently the current guidelines on ventilator distribution in a crisis permit the seizure of ventilators from the chronically ill and disabled who present at an acute care facility with their own ventilator in order to hand it to someone else under the principle of distributive justice. This is not, to say the least, actually distributive justice except in its crudest form of absolute equality rather than equity, and crosses the threshold from a decision of where to allocate available resources into actively seizing already allocated, sometimes privately owned, resources and quite literally condemning disabled people who would otherwise live without this intervention to die for the sake of the able-bodied.

This is the core distinction between what is proposed in terms of sending additional resources to vulnerable communities and this approach. This approach in fact strips resources from vulnerable people to hand them directly to other communities rather than allocating a larger share of what resources are currently unallocated to vulnerable people.

EDIT:
This, of course, means that any chronically ill or disabled person reliant on a ventilator who discovers they are ill and is aware of these guidelines is going to have a very good reason to avoid the hospital. Many of those people are in group homes, aged care facilities, or are reliant on staff - all of whom, if the person has contracted SARS-CoV-2, are now unwittingly exposed. This policy reinforces the odds of particularly vulnerable communities becoming disease hotspots.

[madd0ct0r]

That's a 272 page pdf. Could we get a page number?

[loomer]

Pages 40-42.

"After additional consideration and review of public comments, the Task Force agreed with the 2006 Adult Clinical Workgroup’s recommendation that distinctions should be maintained between acute and chronic care facilities once the Guidelines are implemented, permitting chronic care facilities to maintain their specific mission. Patients using ventilators in chronic care facilities are not subject to the clinical protocol. If such patients require transfer to an acute care facility, then they are assessed by the same criteria as all other patients, and the possibility exists that these patients may fail to meet criteria for continued ventilator use. ...

Applying the clinical ventilator allocation protocols to chronic care facilities fail to adhere to the duty to care –the ethical principle of providing care for each patient, including the most vulnerable. The second principle of using resources wisely must also be considered. Ventilators in chronic care settings may not be usable even if they were to be reallocated to the general resource pool, so they may offer little additional benefit.75Furthermore, if chronic care patients become so ill that they must be transferred to an acute facility, they may not be eligible for ventilator therapy and lose access to the ventilator at that point. The ventilator may eventually enter the wider pool without prospectively triaging these patients at chronic care facilities. Therefore, the ventilators in chronic care facilities should remain there for the chronically ill, who are likely to have severely limited access to ventilators in acute care facilities, which offers an appropriate balance between the duties to care and to steward resources wisely.

The Task Force reaffirmed that chronic care patients are only subject to the Guidelines when they arrive at an acute care facility. With their arrival at the hospital, they are treated like any other patient who requires a ventilator and need to meet certain criteria to be eligible for ventilator therapy.76While a policy to triage upon arrival may deter chronic care patients from going to an acute care facility for fear of losing access to their ventilator, it is unfair and in violation of the principles upon which this allocation scheme is based to allow them to remain on a ventilator without assessing their eligibility. Distributive justice requires that all patients in need of a certain resource be treated equally; if chronic care patients were permitted to keep their ventilators rather than be triaged, the policy could be viewed as favoring this group over the general public. Allowing sick patients to remain in long-term care facilities as an alternative to transfer may increase the burden on these facilities. However, it is appropriate for the health care providers at these facilities to balance the burdens of treating an acute condition against the risk of a patient losing access to the ventilator upon transfer, and act accordingly.

Finally, there are a small but increasing number of ventilator-dependent individuals who reside in the community, rather than in institutions. The Task Force concurred that community-dwelling persons should not be denied access to their ventilators and the Guidelines are only applied to these patients upon their arrival at an acute care facility."

Basically, the guidelines seem to be:
1. Existing ventilation supports for disabled or chronically ill people should be continued unless and until they become sick;
2. When they become sick and require transfer to acute care facilities, they should be subjected to the same standards of triage;
3. If they meet the criteria for withholding ventilation, their ventilation support should be withdrawn and that ventilator distributed to other patients.

The basic problem is they came in with that support - it isn't taking resources from others to continue it because those resources were not available prior to the admission of the chronically ill person, and the decision to discontinue existing ventilation support from the chronically ill on the basis that they have a reduced likelihood of survival effectively jumps that reduced likelihood to zero. Let's say you come down with the Vid while on ventilator supports and they estimate you're at a 15% chance if ventilation support is continued. Well, we might justify not giving you a ventilator if there aren't enough to go around and there are patients with a much higher chance, right? That's a basic principle of crisis management, that we put maximum effort into saving those where that effort has the highest investment:outcome ratio. It can be ethically troubling and a hard choice to make, but a justifiable one. But the difference is, you already had that ventilator. You had a 15% chance. They remove that support because it's only 15%, and it drops to 0%. They didn't give you that support in the first place - maybe you even privately own it. It wasn't part of the pool free for allocation - but the moment you enter a hospital these guidelines permit them to consider it as part of that pool.

[madd0ct0r]

Well that is unambiguous. I know my sister the vet has been called up as a skilled nurse and the vet clinic handed over all their equipment that might (not will, just might) be of use.

We're building field hospitals in requisitioned conference centers and hotels now.

I just find it hard to believe there are enough breathing aids in the community that someone bothered to add that rule. It's literally the second part of the trolley problem where you have to stop the trolley by pushing someone in front of it to save three.

British medical journal on triage: https://blogs.bmj.com/bmj/2020/03/09/co ... ght-think/

They aren't convinced it will have a measurable impact and might cause a lot more harm.

[Broomstick]

Well, what's the maximum penalty under US law for committing terrorism with a bio-weapon?

Death.

Of course, you have to get them convicted first.

[Broomstick]

You know, I'm just going to laugh at the fact that the Democrats are now two quarantined Republicans away from a temporary Senate majority, because Republicans were so negligent of safety in the early days that a disproportionate number of them ended up exposed/sick.

Well, that's what happens when you dismiss public health warnings as a "democrat hoax" and believe your own bullshit.

[Broomstick]

You know, I'm just going to laugh at the fact that the Democrats are now two quarantined Republicans away from a temporary Senate majority, because Republicans were so negligent of safety in the early days that a disproportionate number of them ended up exposed/sick.

Why do you assume the Democrat senators were taking more precautions and it's not just luck?

Because after Rand Paul got tested he gallivanted around in public in groups for an additional 6 days because he didn't believe he could actually be infected, that he was somehow special and immune by dint of, oh, I don't know, being rich and powerful or Republican or something. If there was sufficient concern of exposure that he was tested he should have self-isolated until he got the results just like anyone else should do.

[Broomstick]

Well, Dickless just said, in answer to a reporter's question, that they would "open up" America soon, and that it would not be months. Keep in mind that experts expect this to last until Summer at the soonest.

Yeah, America's going to make Italy look like a regular old flu season, at this rate. It makes you wonder if he's deliberately trying to make it bad enough to justify a declaration of martial law and sweeping "emergency powers". Or if he's just doing what Wall Street told him.

You're being far too generous.

Trump is upset because the stock market in going down like water over Niagara Falls and thinks that if he lifts restrictions and orders the serfs Americans back to work the economy will pick up again and he'll get re-elected. He can't comprehend that this is not something he can threaten, bully, or ignore.

I hope the governors tell him to go fuck himself with a cactus if he tries to end the control measures.

Anyone else notice that Dr. Fauci is no longer in the daily White House press conference? Too much fact, not enough fawning.

[Broomstick]

The problem is we in North America waited too long. There are now 2 choices 1) open up the country and let the cat out of the bag, however many people die, die. 2) Lock down everything until the virus burns out or runs its course which is projected to take somewhere between 6-18 months. The latter results in a complete destruction of the economy, complete failure of all healthcare & other vital systems as all the previously unknown key nodes in the system are shut down or bankrupted and various critical supplies are exhausted. The death toll from that will likely be worse than letting the virus run its course.

Really?

You think that letting the virus "run its course" won't slam the healthcare systems even worse? Have you seen the images of patients lying on the floors of hospitals in Spain along with the images from Italy? That's WITH stay-at-home and lockdowns.

How effective do you think the economy will be if a large percentage of the population in any given area are lining in bed with high fevers, coughing, aching, and exhausted?

There are no good solutions here. It WILL get very, very, very ugly over the next few weeks. A lot of people are going to die. No matter what we do BOTH the hospitals and the economy are going to crash.

We should stack the body bags on the front porch of the politicians who dragged their feet.

[loomer]

The situation in Spain continues to worsen. They're turning one of the ice rinks in Madrid into a temporary morgue, and the army is finding abandoned nursing homes filled with the patients, both living and dead.

[Broomstick]

Economic devastation is inevitable one way or another at this stage, whether you go full lockdown or not. Months of supply chain disruptions, complete transformations in commodities and resource markets, and the illness and death of workers are all pointing that way. The only question now is, Recession or Depression?

For once I agree with this person.

And it's going to be Depression. A big one. At least as big as the one after the 1929 stock market crash. At least that big.

[ray245]

That ship sailed over a month ago. We are not Singapore, Taiwan, or even South Korea. The testing capacity does not and will not exist in that time frame, nor do we have the surveillance ability to backtrack positive cases and test & quarantine all their contacts.

No it has not. A lockdown will drastically reduce the number of new cases to a more manageable level even in a matter of a few weeks, or months at most. You can reduce the number of cases to double-digits, then you can start contact-tracing once again. Lockdown is not the magical solution. Lockdown is meant to impose some level of control over the spread of the virus.

[mr friendly guy]

Man dies after ingesting chloroquine, after Trump touts it as a treatment for covid 19
Not, I repeat, not the Onion

Arizona man dies after taking chloroquine for coronavirus
Reuters
By Deena Beasley
,Reuters•March 24, 2020

By Deena Beasley

(Reuters) - An Arizona man has died and his wife is in critical condition after they ingested chloroquine phosphate - an aquarium cleaning product similar to drugs that have been named by President Trump as potential treatments for coronavirus infection.

The couple, in their 60s, experienced immediate distress after swallowing the drug, an additive used at aquariums to clean fish tanks, according to Banner Health Hospital in Phoenix.

Chloroquine phosphate shares the same active ingredient as malaria drugs that President Trump has touted as possibly effective against COVID-19, the potentially life-threatening disease caused by the coronavirus.

On Saturday, Trump tweeted about the combination of hydroxychloroquine and azithromycin, saying it had “a real chance to be one of the biggest game changers in the history of medicine.”

The nation’s top infectious disease expert, Anthony Fauci, played down that claim, saying the therapy must be tested to assure its safety and efficacy.

"Chloroquine, a malaria medication, should not be ingested to treat or prevent this virus," Banner Health said in a statement on Monday.

The new coronavirus, which causes the highly contagious COVID-19 respiratory illness, emerged in December in Wuhan, China and has spread throughout the world.

There are currently no vaccines or treatments approved for the disease, but researchers are studying existing treatments and working on experimental ones. At the moment, most patients can only receive supportive care.

“Given the uncertainty around COVID-19, we understand that people are trying to find new ways to prevent or treat this virus, but self-medicating is not the way to do so,” said Dr. Daniel Brooks, Banner Poison and Drug Information Center medical director.

Brooks urged the medical community to not prescribe chloroquine medication to any non-hospitalized patients.

“The last thing that we want right now is to inundate our emergency departments with patients who believe they found a vague and risky solution that could potentially jeopardize their health.”

I propose we now call all overdoses with chloroquine the proper medical terminology, Trump disease.

[MKSheppard]

Florida tells NY to go away.

Gov. Ron DeSantis issued an executive order Monday for travelers flying in from New York and New Jersey to stop the spread of the virus from one of the nation’s coronavirus hotspots.

Anyone traveling from the two states will have to do a mandatory self-isolation, the Governor said in a televised press conference. Violating the order would constitute a criminal offense.

“That’s the only way we can be sure that that virus is not going to be reintroduced in the state of Florida and then spread,” DeSantis said."

https://floridapolitics.com/archives/32 ... new-jersey

[mr friendly guy]

Just to make one even more depressed. A website which runs predictions on number of cases in the next ten days by country, developed by Associate Professor Ben Phillips of the University of Melbourne.

https://benflips.shinyapps.io/nCovForecast/

I am not sure if its updated, because its using figures dated march 22, but I will check tomorrow. The numbers are depressing.

[Ralin]

Isn't it illegal for one state to restrict interstate travel?

[loomer]

That depends. Is there precedent establishing that the right to freedom of movement is exempt from public safety requirements, or guaranteeing the right to travel into a state specifically by plane, which is all that appears to be subject to quarantine provisions? Are quarantine provisions themselves unconstitutional?

[Elheru Aran]

That depends. Is there precedent establishing that the right to freedom of movement is exempt from public safety requirements, or guaranteeing the right to travel into a state specifically by plane, which is all that appears to be subject to quarantine provisions? Are quarantine provisions themselves unconstitutional?

It's certainly going to invoke a bunch of rather interesting court cases down the road if people aren't distracted enough by the current situation to bring it up...

For example, say someone from NY hears that their parent in FL is ailing and decides to fly down to be with them. They are therefore forced to self quarantine for a couple weeks. In that time, their parent dies. They then sue the state of Florida for, I dunno, grief and distress or whatever.

[loomer]

That depends. Is there precedent establishing that the right to freedom of movement is exempt from public safety requirements, or guaranteeing the right to travel into a state specifically by plane, which is all that appears to be subject to quarantine provisions? Are quarantine provisions themselves unconstitutional?

It's certainly going to invoke a bunch of rather interesting court cases down the road if people aren't distracted enough by the current situation to bring it up...

For example, say someone from NY hears that their parent in FL is ailing and decides to fly down to be with them. They are therefore forced to self quarantine for a couple weeks. In that time, their parent dies. They then sue the state of Florida for, I dunno, grief and distress or whatever.

I'd imagine there's precedent on similar circumstances already from the Spanish Flu epidemic. Quarantines aren't particularly new, but we'll see.