Working From Home - Impacts of Coronavirus

[nctnico]

IMHO if the US managed to suppress Covid-19 like many of the other western and rich Asian countries did they would also have bought time to get people vaccinated. My gut feeling is that 50% to 75% of the fatalities that have occured and the many more that are likely to follow in the next months could have been avoided. Hindsight will tell but it is so sad to whitness.

[rstofer]

Only in the US would I be required to wear a mask to the grocery store but not to a protest or political rally.  It truly is insane!

Back to the topic:  My wife has been working from home for the last couple of months.  The company is trying to get their people back in the office and, right out of the gate, somebody tested positive.  It has yet to be determined how many others were affected and 'contact tracing' is a joke because the American With Disabilities Act prevents disclosing WHO is infected so you can't really report whether you interacted with them of not!!  There has been some resistance to coming back to the office (incubator).

If a positive case is identified in the workplace, the employer is encouraged to investigate the exposure of others in the workplace without disclosing the name of the individual or any personally identifiable information about the person.

So, when you ask employees about their contacts, you are relying on their memory of an unremarkable encounter.  If you could ask "Were you in contact with Joe?" it might pull up an entirely different memory of contacts.  But that question can't be asked.

See 3rd bullet under Confidentiality under the ADA

https://www.natlawreview.com/article/covid-19-what-employers-need-to-know-about-hipaa

Yup!  We're insane!

[Zero999]

IMHO if the US managed to suppress Covid-19 like many of the other western and rich Asian countries did they would also have bought time to get people vaccinated. My gut feeling is that 50% to 75% of the fatalities that have occured and the many more that are likely to follow in the next months could have been avoided. Hindsight will tell but it is so sad to whitness.

Sorry, that's overly optimistic. Antibody tests show the percentage of the population infected in areas with relatively high levels of infection, such as the UK, is under 10%. The UK's Office for National Statics study estimates just under 6.8% of the population had been exposed to COVID-19 at the end of May. It'll be a little higher now, but not much, due to social distancing, so let's say 7%. This means we're only at 10% of the 70% required for herd immunity, so we can expect a huge increase in deaths, before we get a vaccine or a decent therapeutic. Hopefully dexamethasone will mean ten times the current number of deaths won't happen, even if we don't get a vaccine or any new therapeutics.

As of 24 May 2020, 6.78% (95% confidence interval: 5.21% to 8.64%) of individuals from whom blood samples were taken tested positive for antibodies to the coronavirus (COVID-19). This is based on blood test results from 885 individuals since the start of the study on 26 April 2020.

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/coronaviruscovid19infectionsurveypilot/12june2020

EDIT: Just reread your post and if our governments handle this properly, then I suspect your gut feeling is right: we're at around 50% to 75% of the total fatality rate for COVID-19. This might be true in Europe and perhaps the richer Asian countries, but I doubt it's the case worldwide, as most countries are much poorer. Hopefully the US government will sort it out soon.

[DrG]

... I suspect by the time it has torn through the country it will be easily 500k deaths, ...

I don't think so. Obviously, we both hope that you are wrong, but I think that the calculated case fatality rate (that is, number of fatalities as a proportion of confirmed cases) has been steadily declining and will continue to do so. I have thought about it a lot and I think that there are three main reasons for that drop...

First is that we have a much better grip on how to lock down nursing homes/LTC facilities. Around the time that the US hit 100K a study showed that 40K deaths were associated with those facilities - an incredibly sobering statistic. There are plenty of vulnerable elderly who are not in those kinds of facilities but it is clear to me that those very vulnerable folks (and some workers) were just incredibly hard hit.

Second is an improvement in the SOP practiced by medical personnel.  This has been aided by a couple of drugs with at least some efficacy - we are learning to treat cases a bit better.

Third is that I think we are seeing a change in the distribution of documented cases toward the lower end of the age groups and they are less vulnerable. Of course, as we all know, they can and do infect others.

[DrG]

....
At this point my view is that we failed, the war is lost. All there is to do now is look out for ourselves as best we can and watch the body count climb....

I try to remain optimistic and, like many folks, I have my good days and bad days with that. I am optimistic because of some solid successes in the some areas of the US and because I believe that we will have some good treatments coming and vaccines following shortly thereafter. This, despite some of the spectacular failures we are seeing.

... Then the political rallies are equally stupid and arguably far less necessary. I don't really understand the point of those at all...

Hopefully, it is the farewell tour. [sorry, I just couldn't resist]

[Zero999]

... I suspect by the time it has torn through the country it will be easily 500k deaths, ...

I don't think so. Obviously, we both hope that you are wrong, but I think that the calculated case fatality rate (that is, number of fatalities as a proportion of confirmed cases) has been steadily declining and will continue to do so. I have thought about it a lot and I think that there are three main reasons for that drop...

First is that we have a much better grip on how to lock down nursing homes/LTC facilities. Around the time that the US hit 100K a study showed that 40K deaths were associated with those facilities - an incredibly sobering statistic. There are plenty of vulnerable elderly who are not in those kinds of facilities but it is clear to me that those very vulnerable folks (and some workers) were just incredibly hard hit.

Second is an improvement in the SOP practiced by medical personnel.  This has been aided by a couple of drugs with at least some efficacy - we are learning to treat cases a bit better.

Third is that I think we are seeing a change in the distribution of documented cases toward the lower end of the age groups and they are less vulnerable. Of course, as we all know, they can and do infect others.

I hope you're right, but I think 500k deaths is a reasonable estimate. The R is above one in many areas, so it's growing exponentially again. People seem to be complying less with the social distancing. As someone who has never stepped foot in the country, I'm only going by news coverages, so I could be wrong and hope I am. I'm also worried that hospitals will become overwhelmed and have heard that's already the case in some areas. Without treatment, the IFR will be several times higher than it is.

Hopefully the authorities will get a handle on enforcing social distancing and contact tracing, until a vaccine or better therapeutic comes along. If this never happens, then 500k deaths is on the optimistic end of the spectrum.

[SilverSolder]

... I suspect by the time it has torn through the country it will be easily 500k deaths, ...

I don't think so. Obviously, we both hope that you are wrong, but I think that the calculated case fatality rate (that is, number of fatalities as a proportion of confirmed cases) has been steadily declining and will continue to do so. I have thought about it a lot and I think that there are three main reasons for that drop...

First is that we have a much better grip on how to lock down nursing homes/LTC facilities. Around the time that the US hit 100K a study showed that 40K deaths were associated with those facilities - an incredibly sobering statistic. There are plenty of vulnerable elderly who are not in those kinds of facilities but it is clear to me that those very vulnerable folks (and some workers) were just incredibly hard hit.

Second is an improvement in the SOP practiced by medical personnel.  This has been aided by a couple of drugs with at least some efficacy - we are learning to treat cases a bit better.

Third is that I think we are seeing a change in the distribution of documented cases toward the lower end of the age groups and they are less vulnerable. Of course, as we all know, they can and do infect others.

I hope you're right, but I think 500k deaths is a reasonable estimate. The R is above one in many areas, so it's growing exponentially again. People seem to be complying less with the social distancing. As someone who has never stepped foot in the country, I'm only going by news coverages, so I could be wrong and hope I am. I'm also worried that hospitals will become overwhelmed and have heard that's already the case in some areas. Without treatment, the IFR will be several times higher than it is.

Hopefully the authorities will get a handle on enforcing social distancing and contact tracing, until a vaccine or better therapeutic comes along. If this never happens, then 500k deaths is on the optimistic end of the spectrum.

Even the dumbest, thickest people will "get the message" once family members start to die off -  It was easy enough to be brave and "free" while the disease hadn't reached their neck of the woods yet.

[james_s]

Only in the US would I be required to wear a mask to the grocery store but not to a protest or political rally.  It truly is insane!

Honestly I think it's just being pragmatic. I mean if you've got a massive lawless angry mob that is behaving entirely emotionally, torching buildings and police cars and physically assaulting cops are you going to try to demand they wear masks? Likewise the political rallies, if the president is refusing to wear a mask and not requiring attendees to wear them who is going to make that requirement? It's pretty clear to me that control of the situation was entirely lost and the powers that be simply gave up. Like everything else, masks became political with the decision to wear or not wear one becoming another form of virtue signalling. Ordinary law abiding people going to the grocery store are a lot more likely to behave rationally and comply with mask requirements than angry mobs that are already out of control.

[james_s]

Even the dumbest, thickest people will "get the message" once family members start to die off -  It was easy enough to be brave and "free" while the disease hadn't reached their neck of the woods yet.

If you look at it mathematically I don't think there are going to be enough of them for everyone to get the message. Looking at just the USA, we have 330 million people. If the death count hits 500k, that's 1 out of every 660 people in the country dying. Even that big number of deaths is small enough that a majority of us will probably not have someone we personally know well die from it. 500k is a lot of people, but we'd probably need 10 times that many dead before the effects are immediately visible to the majority of the population.

[EEVblog]

First is that we have a much better grip on how to lock down nursing homes/LTC facilities. Around the time that the US hit 100K a study showed that 40K deaths were associated with those facilities

As sad as that is, if you are talking correct numbers then you should probably subtract the numbers of elderly that would have died from flu like viruses annually anyway. In effect just lumping covid in as another one of the infectious respiratory illnesses which is what it technically is. In my mum's small retirement village alone there are half a dozen deaths a year due to the flu, they "drop like flies every flu season" to use my mum's words.
Yes, I've been saying from the start that this whole thing is arse-backwards in terms of who's being protected. There should be police and a testing station and a system in place at the entry to every retirement village.

[maginnovision]

Wait we SHOULDN'T put covid patients into retirement facilities? Geez... We did mess this up.

[floobydust]

It's the staff that quickly spread it around- they work shifts at multiple care facilities.

[nctnico]

First is that we have a much better grip on how to lock down nursing homes/LTC facilities. Around the time that the US hit 100K a study showed that 40K deaths were associated with those facilities

As sad as that is, if you are talking correct numbers then you should probably subtract the numbers of elderly that would have died from flu like viruses annually anyway.

And add the numbers they left out (if any). People doing those studies aren't stupid. World wide you can see spikes in death rates which are far higher compared to the regular death rates.
For example; this is the graph with death rates in the NL from the Dutch government statistics bureau:


For clarity they plotted the expected death rate in their as well. And if you add the excess deaths up then you'll see that you reach a much higher number than the official number of Covid-19 deaths!

[coppice]

First is that we have a much better grip on how to lock down nursing homes/LTC facilities. Around the time that the US hit 100K a study showed that 40K deaths were associated with those facilities

As sad as that is, if you are talking correct numbers then you should probably subtract the numbers of elderly that would have died from flu like viruses annually anyway. In effect just lumping covid in as another one of the infectious respiratory illnesses which is what it technically is. In my mum's small retirement village alone there are half a dozen deaths a year due to the flu, they "drop like flies every flu season" to use my mum's words.
Yes, I've been saying from the start that this whole thing is arse-backwards in terms of who's being protected. There should be police and a testing station and a system in place at the entry to every retirement village.

The way the information has been presented is somewhat unclear, but what I have seen suggests UK nursing home death rates this spring have been about 1/3 higher than last year, which was considered a fairly typical year. People look at the high death rate attributed to COVID-19 and think its awful. They miss just how many people are elderly and in care homes in western countries. There is a strong continuous flow of people coming into those homes, when its finally clear they can no longer cope on their own, and heading out to the mortuary.

[EEVblog]

It's the staff that quickly spread it around- they work shifts at multiple care facilities.

That's why I said they should have put effort into putting protection systems in place for the vulnerable. Just in Australia this thing was costing us around $4BN a week, that buys you a lot of protection measures.
At the very least I would have liked to have seen a cop stationed at the entry to every retirement village restricting access, but it never happened, at least not here.
One plus side of all of this is that people are more vigilant now, so that should help reduce spread of covid and all the other viruses. I would expect a reduction of flu related deaths this season because of this (we are in flu season here now).

[DrG]

First is that we have a much better grip on how to lock down nursing homes/LTC facilities. Around the time that the US hit 100K a study showed that 40K deaths were associated with those facilities

As sad as that is, if you are talking correct numbers then you should probably subtract the numbers of elderly that would have died from flu like viruses annually anyway. In effect just lumping covid in as another one of the infectious respiratory illnesses which is what it technically is. In my mum's small retirement village alone there are half a dozen deaths a year due to the flu, they "drop like flies every flu season" to use my mum's words.
Yes, I've been saying from the start that this whole thing is arse-backwards in terms of who's being protected. There should be police and a testing station and a system in place at the entry to every retirement village.

You will get no argument from me on how backwards this has been. The worst of what happened I think was at the medicaid-type facilities. Folks who have no money left for much of anything. That might also mean the most lower-skilled labor and the less sufficient amount of labor. Maybe I am being to pessimistic, but I think that they had only later Government involvement and the numbers were already staggering.

In one state, the Governor went out and bought 500K testing kits from, and get this, South Korea. After a while people wanted to know where all the deployment was and he told them - to cover the State's nursing homes.

As just a technical matter, they track documented corona deaths. There has been a lot of discussion about that and we (in the US) started added 'probable' deaths, but they make up a much smaller percentage. So, yeah, many of these folks were very vulnerable to a lot of things like all of the usual flu strains, but this is what was documented for that bin.

Nobody with much SME thinks that those documented case numbers are inflated - that is, most everyone thinks it is a low estimate.

But they got a handle on it eventually. People are basically not allowed to visit and some cases where the family looks through the window and with a phone is how they are spending their last days and it is heart wrenching.

Here is today's graph of corona deaths in the US showing what I was saying before regarding the decrease.

[PlainName]

This means we're only at 10% of the 70% required for herd immunity, so we can expect a huge increase in deaths, before we get a vaccine or a decent therapeutic.

Whilst we'll get a large number, the rate will tail off as the herd becomes immune, won't it? So overall the number would be large but it would be spread out, and be a decreasing rate.

[james_s]

Whilst we'll get a large number, the rate will tail off as the herd becomes immune, won't it? So overall the number would be large but it would be spread out, and be a decreasing rate.

I hope so, but I don't think anybody really knows for sure yet.

In hindsight the lockdown was probably futile as we didn't do it in a coordinated and complete enough fashion to really help in the long run. The constitution makes it virtually impossible to ban all travel between states, counties or other arbitrary boundaries and the leadership at the top was clearly not interested in orchestrating anything. A less drastic lockdown combined with much more aggressive measures such as masks, sanitation, distancing where possible and other changes likely could have provided similar benefits without quite as drastic of an economic impact and perhaps more importantly the mental health impact. I strongly suspect that the combination of general anger/frustration/stress, uncertainty and large scale unemployment is a very significant contributor to the riots and unrest. People who are employed and busy don't have time to camp downtown for weeks at a time and are much less inclined to burn down the businesses that employ them.

[Nusa]

This means we're only at 10% of the 70% required for herd immunity, so we can expect a huge increase in deaths, before we get a vaccine or a decent therapeutic.

Whilst we'll get a large number, the rate will tail off as the herd becomes immune, won't it? So overall the number would be large but it would be spread out, and be a decreasing rate.

The death rate will be dramatic once the health system becomes overwhelmed and doesn't have the capacity to save many of those that could have been saved. Which will happen long before we get to 70% in many places if things aren't slowed down. Never mind the fact that many of those coming out of hospital alive will have permanent organ damage from either the disease or the treatment. The desirable route to herd immunity remains vaccination, when one is developed that works. But otherwise you're right...the death rate will decrease when the most vulnerable people are dead.

https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/herd-immunity-and-coronavirus/art-20486808

[SilverSolder]

Whilst we'll get a large number, the rate will tail off as the herd becomes immune, won't it? So overall the number would be large but it would be spread out, and be a decreasing rate.

I hope so, but I don't think anybody really knows for sure yet.

In hindsight the lockdown was probably futile as we didn't do it in a coordinated and complete enough fashion to really help in the long run. The constitution makes it virtually impossible to ban all travel between states, counties or other arbitrary boundaries and the leadership at the top was clearly not interested in orchestrating anything. A less drastic lockdown combined with much more aggressive measures such as masks, sanitation, distancing where possible and other changes likely could have provided similar benefits without quite as drastic of an economic impact and perhaps more importantly the mental health impact. I strongly suspect that the combination of general anger/frustration/stress, uncertainty and large scale unemployment is a very significant contributor to the riots and unrest. People who are employed and busy don't have time to camp downtown for weeks at a time and are much less inclined to burn down the businesses that employ them.

The lockdown has worked well in some states - e.g. CT has gone from one of the worst, to one of the best.

[PlainName]

First is that we have a much better grip on how to lock down nursing homes/LTC facilities. Around the time that the US hit 100K a study showed that 40K deaths were associated with those facilities

As sad as that is, if you are talking correct numbers then you should probably subtract the numbers of elderly that would have died from flu like viruses annually anyway.

And add the numbers they left out (if any). People doing those studies aren't stupid. World wide you can see spikes in death rates which are far higher compared to the regular death rates.

The excess deaths figure may be rather more subtle than first appears. Sure, the numbers directly attributable to covid19 (that is, those who died because they caught it) bump the graph up, but there could be significant numbers indirectly attributable. Dave points out those that would have died anyway, but not mentioned much are those that essentially died through being scared of covid19.

One factor in health services not being overwhelmed as they were predicted to be may have been that people were just unwilling to risk going to hospital. There was a significant dip in A&E attendance figures, and it's known that some people delayed seeking treatment until their issue was much further along that would otherwise have been the case. Had there not been a pandemic scare, many would have survived simply because they sought treatment sooner.

Additionallly, there was a big fuss about cancer patients not receiving their normal treatment. That wouldn't've done their prospects much good at all, and probably some of them are yet to die early because of covid19 albeit not because they caught it.

[james_s]

The lockdown has worked well in some states - e.g. CT has gone from one of the worst, to one of the best.

As it has also here in Washington. Unfortunately it only takes one person from some more infected area to set off another outbreak here and put us right back where we started. The lockdown indeed worked but with it not being coordinated between states and with nothing to prevent people from freely moving across state lines it's a bit like trying to keep all the pee in one part of the swimming pool.

[paulca]

One really interesting thing is that the WHO are supposedly now saying that transmission via surfaces is uncommon, as is transmission from asymptomatic people.

This was a bit of a f*** up on many counts.

The first report I seen from WHO said, "Less likely than previously thought", but this got reworded by every news agency and quickly became "very unlikely" a significantly different quantifier.

When pressed WHO admitted they had no data on asymptomatic transmission.

https://www.statnews.com/2020/06/09/who-comments-asymptomatic-spread-covid-19/

Currently their website says:

Can COVID-19 be caught from a person who has no symptoms?
COVID-19 is mainly spread through respiratory droplets expelled by someone who is coughing or has other symptoms such as fever or tiredness. Many people with COVID-19 experience only mild symptoms. This is particularly true in the early stages of the disease. It is possible to catch COVID-19 from someone who has just a mild cough and does not feel ill.

Some reports have indicated that people with no symptoms can transmit the virus. It is not yet known how often it happens. WHO is assessing ongoing research on the topic and will continue to share updated findings.

Source: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-coronaviruses 29/06/2020

I think we are seeing a wide spread of cases and death rates across different locations.  My own local has currently emptied ICU wards of CovId patients and had several days with no new cases.  However, the airports are open and England is seeing spots of increase again in some places and yet flights operate back and forward for business travellers every day.

My point is... if your county/locale has only a handful of cases, coming in contact with these is rare, so spread is very slow.  However it may not take long for that to change.  This is not over by far.  It would be a shame to ruin it all and see cases rising rapidly in places that have beaten them down so well.

[Zero999]

Even the dumbest, thickest people will "get the message" once family members start to die off -  It was easy enough to be brave and "free" while the disease hadn't reached their neck of the woods yet.

If you look at it mathematically I don't think there are going to be enough of them for everyone to get the message. Looking at just the USA, we have 330 million people. If the death count hits 500k, that's 1 out of every 660 people in the country dying. Even that big number of deaths is small enough that a majority of us will probably not have someone we personally know well die from it. 500k is a lot of people, but we'd probably need 10 times that many dead before the effects are immediately visible to the majority of the population.

Fortuntely people don't have to die for others to get the message, just very ill will do. In the UK, 43k have died from COVID-19, which is a tiny fraction of the 68 million population. The official number of cases is 311k, which again is still small, compared to the population, but this is due to lack of testing during the peak, so the actual number will be around ten times that or I hope so, because the case fatality rate would be very high. This mean most people know of at least one person who's had it, with a good number of them being sick enough to worry. Unfortunately, once the number of infections reaches this level, getting them down to managable levels requires taking drastic measures.

[tom66]

The lockdown will be still successful even if inter-state travel is allowed, because people working from home and avoiding contact will reduce the spread.  What you can't do is go back to normal until there's a vaccination or antiviral available.