Category Archives: Re-opening

NYTimes: Lockdown Delays Cost at Least 36,000 Lives

Even small differences in timing would have prevented the worst exponential growth

New York Times, by James Glanz & Campbell Robertson, May 20, 2020
CLICK TO ENLARGE – By Lazaro Gamio | Source: “Differential Effects of Intervention Timing on COVID-19 Spread in the United States,” by Sen Pei, Sasikiran Kandula and Jeffrey Shaman, Columbia University

If the United States had begun imposing social distancing measures one week earlier than it did in March, about 36,000 fewer people would have died in the coronavirus outbreak, according to new estimates from Columbia University disease modelers.

And if the country had begun locking down cities and limiting social contact on March 1, two weeks earlier than most people started staying home, the vast majority of the nation’s deaths — about 83 percent — would have been avoided, the researchers estimated.

Under that scenario, about 54,000 fewer people would have died by early May.

The enormous cost of waiting to take action reflects the unforgiving dynamics of the outbreak that swept through American cities in early March. Even small differences in timing would have prevented the worst exponential growth, which by April had subsumed New York City, New Orleans and other major cities, the researchers found.

“It’s a big, big difference. That small moment in time, catching it in that growth phase, is incredibly critical in reducing the number of deaths,” said Jeffrey Shaman, an epidemiologist at Columbia and the leader of the research team.

How Earlier Control Measures Could Have Saved Lives

 

By Weiyi Cai·Source: “Differential Effects of Intervention Timing on COVID-19 Spread in the United States,” by Sen Pei, Sasikiran Kandula and Jeffrey Shaman, Columbia University

The findings are based on infectious disease modeling that gauges how reduced contact between people starting in mid-March slowed transmission of the virus. Dr. Shaman’s team modeled what would have happened if those same changes had taken place one or two weeks earlier and estimated the spread of infections and deaths until May 3.

The results show that as states reopen, outbreaks can easily get out of control unless officials closely monitor infections and immediately clamp down on new flare-ups. And they show that each day that officials waited to impose restrictions in early March came at a great cost.

After Italy and South Korea had started aggressively responding to the virus, President Trump resisted canceling campaign rallies or telling people to stay home or avoid crowds. The risk of the virus to most Americans was very low, he said.

“Nothing is shut down, life & the economy go on,” Mr. Trump tweeted on March 9, suggesting that the flu was worse than the coronavirus. “At this moment there are 546 confirmed cases of CoronaVirus, with 22 deaths. Think about that!”

In fact, tens of thousands of people had already been infected by that point, researchers later estimated. But a lack of widespread testing allowed those infections to go undetected, hiding the urgency of an outbreak that most Americans still identified as a foreign threat.

In a statement released late Wednesday night in response to the new estimates, the White House reiterated Mr. Trump’s assertion that restrictions on travel from China in January and Europe in mid-March slowed the spread of the virus.

On March 16, Mr. Trump urged Americans to limit travel, avoid groups and stay home from school. Bill de Blasio, mayor of New York City, closed the city’s schools on March 15, and Gov. Andrew M. Cuomo issued a stay-at-home order that took effect on March 22. Changes to personal behavior across the country in mid-March slowed the epidemic, a number of disease researchers have found.

But in cities where the virus arrived early and spread quickly, those actions were too late to avoid a calamity.

In the New York metro area alone, 21,800 people had died by May 3. Fewer than 4,300 would have died by then if control measures had been put in place and adopted nationwide just a week earlier, on March 8, the researchers estimated.

All models are only estimates, and it is impossible to know for certain the exact number of people who would have died. But Lauren Ancel Meyers, a University of Texas at Austin epidemiologist who was not involved in the research, said that it “makes a compelling case that even slightly earlier action in New York could have been game changing.”

“This implies that if interventions had occurred two weeks earlier, many Covid-19 deaths and cases would have been prevented by early May, not just in New York City but throughout the U.S.,” Dr. Meyers said.

The fates of specific people cannot be captured by a computer model. But there is a name, a story and a town for every person who was infected and later showed symptoms and died in March and early April. Around the country, people separate from this study have wondered what might have been.

Rushia Stephens, a music teacher who had become a county court records technician in an Atlanta suburb, collapsed on her bedroom floor, unable to breathe, and died on March 19. Adolph Mendez, a businessman in New Braunfels, Texas, was confined to his own bedroom as his terrified family tended to him until he died on March 26. Richard Walts, a retired firefighter in Oklahoma, was ferried to a hospital in an ambulance and died two weeks later, on April 3.

Mr. Mendez’s widow, Angela Mendez, said she still couldn’t say for sure whether action should have been taken earlier. It didn’t matter now anyway, not for her husband.

“They probably could have had earlier a better way to not let this pandemic go that far,” she said. “But they didn’t.”

Official social distancing measures don’t work unless people follow them. While the measures have enjoyed generally widespread support among Americans, the findings rely on the assumption that millions of people would have been willing to change their behavior sooner.

People are apt to take restrictions much more seriously when the devastation of a disease is visible, said Natalie Dean, an assistant professor of biostatistics at the University of Florida who specializes in emerging infectious diseases. But in early March, there had been few deaths, and infections were still spreading silently through the population.

“If things are really taking off, people are likely to clamp down more,” Dr. Dean said. “Do people need to hear the sirens for them to stay home?”

Dr. Shaman’s team estimated the effect of relaxing all control measures across the country. The model finds that because of the lag between the time infections occur and symptoms begin emerging, without extensive testing and rapid action, many more infections will occur, leading to more deaths — as many as tens of thousands across the country.

The timing and circumstances of those who were infected in March raise haunting questions.

It was a Friday night in mid-March when Devin Taquino began feeling sick. Neither he nor his wife was thinking at all about the coronavirus. There were already more than 200 cases in the state by that time, but most of those cases were in the eastern part of the state, not in the small city of Donora, south of Pittsburgh.

Plus, Mr. Taquino did not fit the profile: he was only 47 years old with no underlying conditions and his main symptom — diarrhea — was not something broadly associated with the disease. He was planning to work a Saturday morning overtime shift at a call center half an hour away, but he called in sick. Offices all over the area were asking people not to come in, but Mr. Taquino’s had not taken that step.

He worked on Monday, but on Tuesday he returned home sick from work, passed out in bed and didn’t wake up for 16 hours. The next morning, his wife, Rebecca Taquino, 42, woke him up and told him they needed to get tested. She didn’t think he had the virus, but she thought it was the smart thing to do.

Without primary care doctors, they went to a nearby urgent care clinic, where they learned that his blood oxygen level was very low. The people at the clinic offered to call an ambulance, but fearing the cost, and still skeptical that this was that serious, the Taquinos chose to drive to an emergency room.

At the hospital, he was given an X-ray and diagnosed with pneumonia. He stayed, kept in an isolation unit just in case, and she returned home. The next evening, March 26, he called her with two developments. One: his work had emailed with the news that someone at the call center, where the work stations sat about a foot apart, had tested positive for the virus. The other bit of news was that he had tested positive.

There has been a lot for Ms. Taquino to think about in the weeks since that phone call, including the long days during which she never left the house and her husband’s situation got more horrifyingly worse.

Should the call center have sent the employees home earlier? When she called the center on Friday to report his condition, it was already empty: the workers had been sent home. Did they act too late?

“I kind of tossed that one back and forth myself,” she said. “I really want to blame it on them, I really do.”

Could she know definitively where he got it? It was hard to say for sure. Still, given that email the day of his diagnosis, it seemed by far the most likely possibility that he got it at work.

After three weeks of agony, Mr. Taquino died on April 10. Whether he was one of the thousands of people who might be alive if social distancing measures had been put in place a week earlier can never be known.

Ms. Taquino said officials should have known.

“If it’s spreading that fast you have to know it would have come here,” Ms. Taquino said. “They should have been implementing programs. I think it was a giant lapse in our country. There was no way to think that we were going to be spared from this.”

Solano County’s Reopening Approval Comes With Some Confusion

Unlike Napa, it appears almost none of the business owners had any idea exactly when they could start reopening their dining rooms.

NBC Bay Area News, By Jackie Ward, May 21, 2020
Interior of Kinsmoke barbecue restaurant in the Sonoma County wine country, Healdsburg, California, August 24, 2018. (Photo by Smith Collection/Gado/Getty Images)

Just one day after Napa County got the green light for dine-in restaurants to reopen, Solano County got approval to do the same.

The state told the county late last night that it had met the criteria to expand further into Phase 2 of reopening. But unlike Napa, it appears almost none of the business owners had any idea exactly when they could start reopening their dining rooms.

Restaurants in Solano County will finally be able to let people eat inside and outside of their establishments starting Friday at 6 a.m. Getting that sorted out was confusing though, since the state gave approval Wednesday.

“I don’t know anything about it. No emails, no nothing, nobody said anything,” said Piero Tropeano, the owner of Evelyn’s Big Italian Pizzeria.

Tropeano has owned his restaurant for 11 years and says his takeout-only business has been manageable, but keeping up with the forever-changing rules has not been.

“They tell you, they send you email, no salt and pepper shakers, you gotta have plastic, you gotta do this, you gotta do that,” he said.

Late Wednesday night, Solano County was approved by the State Health Department to allow its restaurants to enter into the next part of Phase 2. Resham Sangh, the manager at Saffon says, he has one problem. “It’s not really safe for me and my colleagues. And it’s also not safe for the people who come over here.”

Solano County explained the reason for the confusion in a statement, writing in part:

“Since we just received the green light from CDPH on the “at a station” request late last night, we are working quickly to amend the order and inform our business community of the reopening process.”

Tiffany Hachett of Fairfield says getting to do this again is, “Heaven. I always do it anyway.”

Even when restaurant owners get the official word from the county, Piero says it will take him up to three days to comply with the new regulations. He wonders if it’s even financially worth it. He said his takeout business without additional rules is, “a lot easier with no aggravation.”

Solano County officials said they planned to start extensively reaching out to businesses today in order to get everyone on the same page.

Solano County approved for immediate opening of retail stores, shopping malls, swap meets, and restaurants

Solano County expands reopening: dine-in restaurants, shopping malls OK’d by state

San Francisco Chronicle, Matt Kawahara May 20, 2020
Dr. Bela Matyas, Publie Health Officer for Solano County Health and Social Services, answers a question during a press conference in Fairfield, Calif., on Thursday, February 27, 2020.
Dr. Bela Matyas, Publie Health Officer for Solano County Health and Social Services, answers a question during a press conference in Fairfield, Calif., on Thursday, February 27, 2020. Photo: Carlos Avila Gonzalez / The Chronicle

Solano County has received state approval to move ahead with reopening, allowing dine-in restaurants, schools and other businesses to resume operations.

The California Department of Public Health endorsed Solano County’s variance report on Wednesday night, county officials said, making it the second Bay Area county allowed to advance further into stage two of the state’s plan to reopen from coronavirus restrictions. Napa County is the only other Bay Area county to also have this approval.

Retail stores, including shopping malls and swap meets, and restaurants will be able to open immediately with appropriate health guidelines in place, per the county’s attestation report. Schools “will open later in summer or fall once guidance is developed,” the report states.

Businesses such as salons, gyms, fitness studios and clubs remain prohibited in stage two of California’s plan.

Businesses that reopen must follow social distancing requirements in the county and state’s health orders and comply with sector-specific guidance, Solano County officials said.

Solano County submitted a revised report to the public health department on Wednesday outlining its readiness under state criteria for expanded reopening.

The county’s COVID-19 hospitalization rate, positive case rate, testing and hospital capacities meet state requirements, health officer Bela T. Matyas wrote in the report. The county will continue tracking epidemiological data and could retighten restrictions if its case rate increases sharply or infections in health care workers rise for an extended period, the report states.

“As we move to advance more quickly through Stage 2, we will continue to monitor the situation, and our top priority will always remain the health and safety of Solano County residents,” Matyas said in a statement earlier Wednesday after the report was submitted.

County officials said they still encourage residents to maintain distance of six feet from other people in public, wear a cloth face mask outside the home when unable to maintain distance and stay home if feeling unwell.

As of Wednesday, Solano County had confirmed 435 total cases of the coronavirus, including 43 active cases, and 18 deaths. Of the deaths, the county had reported 11 in the last 10 days.

State health officials have now received paperwork from 39 of 58 counties seeking approval to advance more quickly with reopening, according to the public health department website.

Solano County asks for quicker reopening of stores, shopping malls, swapmeets, dine-in restaurants and schools

By Roger Straw, May 21, 2020
Potential future COVID-19 deaths if social distancing is relaxed too early [Michigan Medicine]
Solano County resubmitted it’s “Variance Attestation” yesterday, May 20, and State officials approved it on the same day.  Talk about quick!  Seems our County and State officials aren’t too worried about the inevitable new illnesses and deaths on the back half of our downward curve.

The variance attestation itself seems not to be available on the County’s website.  I will post it here if/when I can get it.

Below is the County’s press statement, released before the approval was granted.  For news on the State’s approval, see Solano County approved for immediate opening of retail stores, shopping malls, swap meets, and restaurants.


FOR IMMEDIATE RELEASE
May 20, 2020
News Contact: Matthew Davis, Senior Management Analyst and Public Communications Officer (707) 784-6111 MADavis@SolanoCounty.com

County resubmits COVID-19 attestation documentation to the State, looks to advance more quickly through Stage 2

SOLANO COUNTY – County officials are pleased to announce they have resubmitted COVID-19 County Variance Attestation paperwork to the California Department of Public Health, and are confident the County meets the criteria necessary for advancing more quickly through Stage 2 of the Governor’s order.

Counties with California Department of Public Health (CDPH) approved variance attestation plans for modification are permitted move more quickly through Stage 2 of the Governor’s Stay-at-Home public health order, including the safe reopening of destination retail stores like shopping malls and swap-meets, dine-in restaurants and schools – all with social distancing modifications.

“We believe that we are ready for this next step in the recovery process and look forward to expanding opportunities for our public and business communities,” says Erin Hannigan, District 1 Supervisor and Chairwoman of the Solano County Board of Supervisors. “Thank you to all of the County staff who worked on the attestation variance application process and for helping keep our community safe.”

To be approved to advance through Stage 2, either more quickly or in a different order, a county must attest they are ready to meet specific criteria, including stability of the disease rate in the community, protection of Stage 1 essential workers and vulnerable populations, have adequate testing, containment and hospital capacity and a COVID-19 containment plan.

“The state’s revised application for variance attestation was lengthy, and, based on their new criteria, we are confident we will be given CDPH approval,” says Bela T. Matyas, M.D., M.P.H, Solano County Public Health Officer. “As we move to advance more quickly through Stage 2 we will continue to monitor the situation, and our top priority will always remain the health and safety of Solano County residents.”

As Solano County moves to relax its Stay-at-Home health order, we encourage all residents to continue to follow the Centers for Disease Control and Prevention, California Department of Public Health and Solano County Public Health social distancing best practices, including wearing a cloth face mask outside your home whenever physical distancing cannot be maintained, maintaining a physical distance of six-feet from others, practicing coughing and sneezing etiquette, using a hand sanitizer or washing your hands for at least 20-seconds and to stay at home if you’re not feeling well. Businesses that are permitted to reopen must abide by the social distancing requirements in the County’s and State’s Orders.

For more information about Solano County’s Roadmap to Recovery, social distancing protocol and frequently asked questions about the phased reopening, visit the Solano County website at www.SolanoCounty.com/COVID19 and on Facebook at www.Facebook.com/SolanoCountyPH.