I've seen the "gift shop" thing reported by various sources today, but haven't found the origin of it. Doesn't pass the smell test to me. The logistics of gutting a gift shop and converting it to a treatment area seem non-trivial. Maybe it's just being used as a triage waiting room? Does anyone have any details on this?
>The CEO of the Martin Luther King, Jr. Community Hospital in Los Angeles, Dr. Elaine Batchlor, separately said patients there have spilled over into the gift shop and five tents outside the emergency department.
Yea, there are lots of aspects to this article that have the same feel of the article that made it to the top of HN news a few weeks back about a nurse who claimed her patients denied COIVD was real as they were dying. The Wired article that dug deeper into that story, showing the glaring holes in it, didn't get as much attention:
There are no indications in this story where the capacity is coming from. What percentage of people are in the ICU for other conditions (heart attacks, car crashes, delaying treatment for conditions they needed surgery for months ago) vs infections? What are the percentage for flu, strep and other serious infections vs COVID? There's a lot missing in this article.
> placing patients in conference rooms and gift shops
If there's any truth to it, I can imagine the hospital's snack/convenience shop is being used. So it's not a neighborhood gift shop but some room in the hospital that sells a branded keychain. Definitely a click-baity title though.
Why did they not extend capacity with field hospitals weeks ago? They’ve been telling us it was going to get bad, then it did and they’re not prepared for it? What is going on here?
From what I understand, space isn't the only limiting issue. You might find more space with some difficulty but you cannot suddenly produce more nurses and doctors, many of whom are overwhelmed or themselves ill and out of commission.
Yeah space really isn't the problem at all. It is nurses and doctors and oxygen. They have nurses - who are supposed to treat 2, maybe 3 at a time - treating 30 people at a time.
That makes sense, but then I think about the military. Don’t they have a massive medical force? They are not _all_ doctors and nurses (although many are) but all are highly trained and could serve here. Why not deploy them to the current battlefield?
> Why did they not extend capacity with field hospitals weeks ago?
They...did. There is a limit to the ability to magic up staffed medical facilities on short notice ex nihilo, however.
> They’ve been telling us it was going to get bad, then it did and they’re not prepared for it?
Had it not been predicted that it would exceed the potential to boost capacity, they would not have implemented the capacity-cobtingent statewide stay at home order (which is undermined by county sheriffs widespread and public non-enforcement stance.)
ICU patients require a significant amount of highly-trained personnel 24/7. You quickly burn through those people.
And, since the Federal government never stepped up to fund anything, no one is going to bother training personnel that they'll just get rid of in 12 months.
> And, since the Federal government never stepped up to fund anything
I'm not sure where this idea came from, but I really wish people would start arguing about what Congress actually did rather than making it up, because Congress did step up to fund medical care. The CARES act appropriated $130B for health care providers, including hospitals. The followup appropriations bill allocates $69B for vaccines, testing, health care providers, and mental health.
One might argue that that's not enough money, but at least make the argument that they should have spent more rather than falsely claiming they spent nothing. Congress' direct payments to the healthcare providers in these two bills totaled $199B. Broken down by department, only two agencies are allocated more than $199B next year, the DOD ($695B) and the VA ($243B). And that's just looking at direct payments to medical providers, I didn't even mention the remaining $2.1T from the CARES act.
So far it's a two time payment, plus however you consider the forgivable loans. Most commenters on the issue expect that there'll need to be more bills next year.
There is a lot to blame the federal government for in this pandemic, but the lack of nurses just isn't one. The federal government has very little leverage to increase the supply available, since the vast majority of nurses are employed by the private sector or state systems. Congress could provide more money to underwrite training and nurse salaries, but they'd just be setting up for mass layoffs once the demand for that form of labor returns to historical norms. And there is very little chance that these new nurses would be trained in time to make a difference.
Maybe the federal government could undo the residency program that constrains the supply of doctors, but at best they could flush out all the doctors waiting for residency to complete right now. That would provide a small boost, but at most they could add 3 extra years worth of new doctors at once. Nothing the federal government could do would drastically increase the supply of doctors other than relaxing immigration requirements for foreign trained doctors, but that still takes time and is uncertain.
If there's any aspect of this pandemic that I'd lay right at the feet of the federal government, it would be the lack of PPE. Both Congress and the executive branch have all of the tools at hand to goose the production of PPE domestically should they have decided to do so, and yet our medical personnel continue to reuse N95 masks nine months into this pandemic. An extra supply of N95 masks would have also reduced the attrition of medical personnel, as actual sickness and perceived risk has been a big drag on the supply of properly trained personnel to fight this pandemic.
They weren't ultimately needed then and you couldn't staff them now that the pandemic is countrywide rather than restricted to NYC. The real limiting factor here is availability of trained medical personnel and there is no surplus of them anywhere.
> earlier this year we had setup unused overflow facilities and those were taken down.
No, they mostly weren't.
> Why were they dismantled?
They have largely been activated, including ones which while prepared stood empty in the initial, far lower, peak, and many additional ones were set up for this surge.
China has a localized crisis and could move surplus doctors and nurses from other places (they also have a system of government that lets them do that without political and partisan friction, which is bad for lots of reasons but useful for this specific situation.)
While California is worse off, the US has a national problem and no region to ship surplus from, even leaving aside the political problems which would add friction if the capacity existed.
China was able to get a clamp down by becoming more authoritarian and literally wielding doors shut of people suspected of COVID19.
The hospital growth thing is a red herring. Gaining +2000 hospital beds (or 20% growth for a lot of areas) means jack diddly squat against a Virus that replicates into the millions.
Its far easier to stay home for Thanksgiving and cut down on the spread, rather than grow hospitals. But of course, we're growing hospitals where we can (moving Navy Hospital Ships, hiring student nurses before they graduate, etc. etc.) But the USA already had a nurse shortage BEFORE COVID19 came around.
There comes a point where there's no point building Hospital beds: we simply don't have enough nurses / doctors in this country to staff them. Even if we include student nurses / doctors.
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In either case: China has the right idea. You stop the spread before it becomes a million cases. You can't just magically grow hospitals and create expert nurses out of thin air.
Free Liberal countries like New Zealand got to stop the exponential growth because their society was more unified and rational about things. Authoritarian wasn't necessary, but its clearly a good cudgel to use in this situation.
Anecdotally, I noticed that private indoor parties started back up in ~August back when I lived in Santa Monica, and that mask compliance was pretty poor in the touristy areas. This was preventable, but I’m far from surprised sadly.
Maybe I've been out of the US too long (spent my first 32 years in the Midwest / East Coast, out here in Hong Kong for 9 years now), but I don't understand why the public service announcements aren't just promoting it as incredibly rude beyond the pale to not take basic precautions.
I can understand why some people's first reaction is to dig in their heels when they're confronted with the state's power of coercion. But, here in Hong Kong, not covering your nose and mouth is seen as spit-on-a-baby-rude. Yea, we have a mask ordinance and I'm sure there's a law against spitting on babies, but 98% of people were wearing masks before the ordinances were passed. Part of it is fear and self preservation, remembering SARS from 2004, but a lot of it is basic manners. If you see someone spit on a baby, your first reaction isn't "hey, the state will punish you for that".
Hong Kong is one of the most densely populated places on the planet, and we've had SARS-CoV2 here since January 2020, but the population of 7.5 million has fewer than 9,000 confirmed cases. It helps that at tropical temperatures, the virus survives only a few hours on stainless steel or non-porous plastic, but basic precautions, testing, and contact tracing really work.
Peer pressure really only works if it crosses a critical mass. Maybe early on in the pandemic government leaders could have pulled off the messaging that you recommend, but they waffled on the initial messaging. The result is that we're now polarized into separate camps, and everyone is capable of retreating into their own side to seek affirmation if the other side expresses disapproval.
Not to sound grim, but I now wonder if it would have been best to let things be. Of course inform the public, but enforce no action. Would/could it have led to a huge overwhelming initial spike that has died down months ago? It feels now that we've been in various states of lock down for a year and reached the same result, unfortunately.
Wait you're wondering if not taking any action would have had the same result? Or masks on but no social distance? Or both social distance and masks on? Because social distance will preclude many activities.
But in any case, in my opinion more should have been done, not less. Specifically, cut people a check so that they can afford to stay safely inside.
I mean, the govt can make recommendations and let people decide what to do. I'm -not- an antimasker...and haven't left the house much since March. But it feels like our people will inevitably decide it's boring and give up, as I've seen not only in news but in my friend group. So it feels like we just delayed mass infection rather than preventing it.
The.. whole point was delaying it by “flattening the curve”. We were not remotely prepared at all and knew nothing about the virus. Mass infection now is incredibly more safe because we know how to treat it, and most cities have extra buildings retrofitted as hospitals.
Infection is more safe. Mass infection is not. I was recently hospitalized with covid and got the experimental cocktail (remdesivir, convalescent plasma, dexamethasone, azithromycin, anti-clotting drugs, zinc, D, C, probiotics) that only became available a few months ago. It cost over $62000. How many people can afford that? And it requires hospital beds because it is strictly inpatient treatment. It's not without its risks either. It's really only viable if 1) the patient has insurance and money and 2) the hospitals can avoid being overrun.
Regeneron could change things. That's an outpatient treatment that could be administered at clinics to patients who have tested positive. The problem is it's simply not available and it's still expensive.
If you catch covid, have good healthcare and can be admitted to a hospital then your prognosis is very good. What we can't do is treat large numbers of people simultaneously. Mass infection is a disaster.
But we have the vaccine rolling out now. So mass infection is not inevitable. If there was some leadership on the top and a working political system, we could’ve done a lot better
They do not want to stay inside, and that is the problem. In the small town I live now not far from LA, most restaurants are closed for indoor, as well as outdoor dining, but several places just refuse to obey this order . What do you think is happening ? They are packed to the brim, with lines waiting to get in and have their beer and fried wings their usual way. No need to say local community is split between outraged "conscious" citizens demanding managers' heads on a plate, and "freedom lovers" demanding first group mind their own business and stay the fsck out of others' way to have their regular fun.
I'm watching this hitshow with both amusement and fright .
I don't get how these restaurants can get away with this. It's not like the police suddenly can't enforce the rules anymore. If I refused to obey the speed limit or refused to pay my CA income taxes, they'd come down on me like a ton of bricks, but for some reason, when a restaurant refuses to obey the closures loudly, visibly, in full view of the public, where are the police? Suddenly it's "oh, we just can't seem to enforce things, golly what do we do?!"
There's your answer. The unwritten rule is everyone in California drives 10 mph over the speed limit and no one gets a ticket. More than 15 over and you're pushing your luck.
I think they were doing a thought experiment where you'd let it run wild in the beginning, and let people see the horrors of that, and let that fear be the motivating factor. Arguably fewer deaths could have come out of that strategy, because the anti-maskers and political covid minimizer have successfully spread the misinformation of "it's just a flu, very few deaths" etc. discounting the fact that the fewer deaths were happening coz of masks and lockdowns.
Half of what we're seeing right now is lockdown fatigue and a lot more people making the decision that the risk is worth it. It's not because they haven't seen how bad it could be, it's because they're numb to what they've seen, and 9 months is a long time.
I observe the COVID-19 narrative is probably false, starting with the timeline for the initial spread of SARS-CoV-2 across the globe in November/December 2019. Like the good doctor said, "#containment was never possible" [0].
Many people, including myself, probably had COVID-19 before tests were available. I think people did much better surviving the dreaded virus before the medicalists were treating COVID-19 as a diagnosis.
People still are spreading, and believing, disinformation. Even here, when the numbers came out of the 400k extra deaths this year in the U.S., 300k from COVID, no shortage of commenters were disputing the numbers and the causes.
One political party has worked so hard over the last generation to convince people that science and experts are the enemy, and now we're paying the price.
I think he is suggesting there would be a strong information campaign about masks, social distancing, hand washing etc then leave people be while moving on with the vaccines and so forth.
On the other hand, if all the people would followed the restrictions to the letter it would been under control many times over, as demonstrated by NZ, TW, AU, CN.
This -> if all the people would followed the restrictions to the letter it would been under control many times over, as demonstrated by NZ, TW, AU, CN.
Yeah this is what I thought the US would do, as its a country where individual decision making feels like its prided above all else. I was absolutely surprised about this joke-authoritarian style regulations that CA and the counties tried to push over and over. Absolutely absurd.
When hospitals hit capacity, the death rate dramatically spikes. Take a look at early NYC data to see how hospital overload affects this. Letting things be would have been true disaster.
Because we took steps, this is not going to reach anywhere close to the same result in terms of deaths, even if it comes to equal cases. The solution to the time problem was more strict action earlier, ironically for most on the "economy" side of pandemic action. Give people a big stimulus, stop all jobs beyond food and true essentials, and enforce strict contract tracing. We might have been out of this in two months if we did that.
The early NYC numbers came from a variety of situations:
1) Gov Cuomo sending elderly to nursing homes and packing them in for treatment. This killed thousands (same with Gov Whitmer in Michigan) and yet Cuomo wrote a fucking book about how great he is instead of facing any consequences.
2) Overuse of ventilators. People were putting vents right as they came in, mostly based off bad advice from doctors in Europe. Turned out this was a death sentence. Most of the young people who died, most likely died from high pressure ventilators over anything else.
3) Overflow hospitals in NYC were entirely empty because they were intended for non-covid patients and were incredibly difficult to get into. Many people who didn't have COVID, who were kept for monitoring, were kept on COVID floors of regular hospitals and got COVID.
Not this again. Where do you put elderly folks who are recovering but not sick enough to keep in the hospitals which need to freed up for more seriously sick people?
They live in the nursing home FFS, that is their home.
They could have been put in the massive empty emergency facilities they put up but never used.
They were cramming sick elderly people into nursing homes with perfectly healthy people; nursing homes without individual rooms! They were packing sick people next to unsick people. It literally killed thousands.
Janice Dean covers all the details very well in her podcast with Megyn Kelly, including reasonable countermeasures they could have taken instead of cramming sick elderly people together:
Why do you not consider this as valid? Nursing homes were the primary spread for COVID cases back in March/April and there is more than enough damning evidence against both Como and Whitmer.
You can simply compare them to Denmark, Norway and Finland on infection rates, death toll and economic impact. If those countries manage to immunise their populations quickly then Sweden's approach was a huge failure in comparison.
But more to the point Sweden has now started trying to mandate restrictions and lockdowns as their health system is struggling and relying on public goodwill to do the right thing just isn't enough.
Brutal that this idea keeps surfacing on Hacker News contrary to the advice of almost all epidemiologists out there. It seems like utter hubris to assume you know something they don't.
There's also been hubris from epidemiologists because they're not politicians, economists, or experts in human behavior, and this very much isn't just a problem of a virus spreading.
Nothing new here. Hacker News (and more generally a lot of people in tech) are pretty sure they have the solution to: debt, famine, equality, global warming, etc.
Sure, maybe, and we could spin out dozens of scenarios and approaches that could have been better or worse.
I think one phrase from your comment highlights the entire problem though: “enforce no action.”
You can’t enforce a society wide shutdown. You can only get that from citizens who voluntarily participate in a social order that they trust. We (Americans) are faced with enormous problems as a society as a result of our inability to trust one another.
We may be able to engineer a zero trust replacement for our monetary system. We seem to desire the same thing for our society. Everyone demands infinite verification of everything. Fact check the fact checkers and audit the auditors that audit the election results! At some point though, it’s turtles all the way down. Political debate is starting to sound like epistemology.
It appears that societies that have greater levels of trust are faring better in this pandemic. That cannot become an excuse for our failure. It should instruct us on how to proceed.
EDIT: re-reading this I realize I’m singling out “society wide shutdown” as the sort of imagined best response, maybe it is, but what I was really thinking of was “highly coordinated society wide response where everyone does what they are supposed to based on their role.”
Already people are dying of non-COVID disease due to lack of capacity. Is that a fair trade off? We can directly connect the dots from "I wanna do what I want!" who then get sick or make other people sick who then end up at a hospital who take up a bed and someone else who isn't sick but has a plumonary or cardiac episode dies.
If we had perfect information, we could trace the liability back to people's behavior and fine them properly for non-compliance. But that would run up against privacy concerns wouldn't it?
What about a general strike by health care workers and grocery stockers and food delivery service workers? Right now. In the middle of a pandemic. Can you imagine the outrage? And why would people be outraged? Because they think these workers are slaves. They shouldn't have a choice. It's everyone who isn't on the front line who should get to choose whether to comply with public health orders.
It is certainly more civilized for health care workers to just quit en masse right now, than to propose people should just get to flaunt public health orders without any kind of penalty. But I'm getting the strong indication this is not a civil society.
It's debatable whether we'd be dealing with multiple significantly more transmissible strains of the virus if we hadn't amplified the evolutionary pressures (and time scales) necessary for it to happen.
We've only eradicated smallpox and rinderpest, so we have almost no experience doing something like this. It was also crazy to think that short-term containment measures (masks and social distancing) wouldn't start selecting strains that are more virulent.
The good news is that vaccine distribution is moving very quickly--hopefully faster than the virus can mutate. The bad news is only developed countries, India, and China will likely vaccinate that quickly.
> It was also crazy to think that short-term containment measures (masks and social distancing) wouldn't start selecting strains that are more virulent.
Why? It can't evolve against "no way to reach the human" like it could chemical/biological countermeasures.
But there's not "no way" when people work essential jobs, leave their homes for groceries, touch packages getting delivered, live with other people, etc.
I'm not sure what you're trying to argue for here, but if we had allowed a huge initial spike, many hundreds of thousands would have died needlessly. We are still doing much better than that.
This is an incorrect take, and deeply frustrating that it is so pervasive, given that there is literal evidence of it being wrong. China, especially Wuhan, was the center of the virus outbreak early in 2020. China successfully locked down and stopped the spread of the virus. Today, Wuhan and China in general has no community spread of Covid. So there is clearly a solution, even with out a vaccine.
Our political leadership was too weak to make the decisions necessary to implement these solutions. Some readers may retort that lockdowns are a violation of democratic or constitutional freedoms, but there have been times in the past when these rights were suspended. During the civil war, Lincoln suspended habeas corpus and jailed people without a trial. In extreme situations, extreme actions may be warranted. (The US will soon have more Covid deaths than US soldiers died in all of WW2, if you think my war comparison is unfair). China took extreme actions to enforce lockdowns and successfully ended the spread of Covid. America's leadership decided that peoples lives did not matter, and did not.
Ultimately, I will be significantly more suspicious of any western politician who demands we go to war to protect lives, or give up liberties for personal safety. 2020 has shown that politicians would not take even the weakest measures to protect personal safety (e.g mask mandates) - exposing their lies in other domains as well. The war on terror was fiction. The war on drugs is a jobs program. And a 9/11 amount of deaths can happen every day and politicians will literally do nothing and people will demand nothing. I am deeply pessimistic about our future.
The "stay at home orders" in the USA were so unenforced, they were jokes. Politicians wanted to seem like they were doing something so they rolled their eyes and enacted these half-assed "orders", making sure to forget to have the police enforce them. In CA, our brilliant governor told everyone to wear masks and avoid restaurants, then went out and had a fun maskless restaurant outing himself.
Most people I know took stay-at-home seriously, but enough people didn't that it was totally ineffectual.
It’s not just that the political leadership was lacking; our media and the people of the US also collaborated in this failure. There is no sense of community or duty amongst our people, only selfishness.
I mentioned in another thread [1] that COVID-19 was a gigantic game of Prisoner's Dilemma, where cooperation meant staying at home and wearing a mask when you go out, and where defection meant going out and horsing around, and we utterly failed the game.
Since, I don't know... WW2, we seem to no longer have the ability as a country to act in coordinated cooperation for some greater good. It's all individualism, now. It's all about me, me, me! My rights! My need to go shopping! My desire to eat at Olive Garden! Other people are dying? Fuck em... I'm going to enjoy my life and not let "the man" tell me what to do! Wait, I got the disease?? Well, crap! Who could have predicted it? God certainly works in mysterious ways.
2020 has pretty much robbed me of what empathy I had left. It's insane how selfish we have become.
> 2020 has pretty much robbed me of what empathy I had left. It's insane how selfish we have become.
When I start thinking along these lines, I consider the doctors and nurses, firefighters/EMS, vaccine researchers, food bank volunteers, grocery store workers, open-source data volunteers, ... “Look for the helpers,” as Mr. Rogers said.
I think that many people have been conscientious during the pandemic. They aren’t visible - they only show up in year-over-year measures of reduced traffic, etc.
None of this obviates my frustration at the political and cultural response to the pandemic. Covidiots and maskholes still piss me off, but I don’t think they’re the whole story.
You forgot the part where the selfish and decadent, upon becoming sick, demand not only the right to health care services, but the right to cutting in front of the line merely because they paid extra for the VIP health care plan.
This is not a civil society. It is a caste system.
The problem is in the US hospitals get overloaded quite easily. Our healthcare is not as robust as Sweden's, so that option hasn't been able to be on the table.
Keep in mind the surge we are seeing right now is from Thanksgiving. It is most likely going to get worse.
I wonder how much was done to increase surge ER capacity between May and November. The was obviously a possibility, there were a lot of warnings about holiday gatherings.
Hopefully hospitals are preparing for the surge in a few weeks, but I have a feeling they're too busy with the current surge.
You can't just give nurses more patients indefinitely though. That reduces the quality of care and leads to more deaths. An intubated patient is literally only being kept alive by machinery 24/7 and needs a high level of nursing care, a level that you don't remotely get if every single nurse is responsible for more than a couple patients. We simply don't have enough medical staff.
CA has had stricter lockdowns than most other states since the very beginning. Now our per capita rate is worse than Florida.
I think CA has many counterproductive restrictions. For example, outdoor dining should’ve been open which could, in theory, prevent people from gathering inside.
The San Mateo County Health Officer recently published a statement that rhetorically asked this and other similar questions about CA, and I suppose human behavior and response to various types of SAH orders and the like. It was a very well-written piece and was featured here on HN 3 weeks ago[0]. Here’s a direct link[1]. I highly recommend reading to get an honest perspective from someone who has to make these kinds of decisions at the county level.
I'll pick on the curfew for outdoor dining. It was a restriction that was added in November. It did nothing, and could have made things worse by having people gathered in a shorter time window. I'm not sure if that's the case, but there wasn't any evidence suggesting it would help, either.
what is crystal clear about this virus now is that gathering with others inside is very bad.
Outdoor dining is not ideal, but could have prevented many indoor gatherings. Remember how CA was closing the beaches in the spring despite that clearly being stupid?
Some guesswork here, but looking at the percentages in SoCal the hispanic percentage of COVID cases is much higher[0] and perhaps a driver for the bigger numbers (whatever the root cause).
too many stupid restrictions just made people fed up and ignore most if not all of them.
Anecdotal evidence, of course, but I was shocked to learn that many of my friends had inside guests for holidays. This is instead of going camping by themselves (banned) or going skiing by themselves (banned too). Even outdoor dining is banned - all you can do is gather inside now.
Many people see stuff like the curfew and know that there is absolutely no science behind such a restriction. If there are restrictions put on people for no good reason people will rebel against data based restrictions as well.
Total deaths per capita still suggests that Florida has more numbnuts than California.
The reporting is also partially where stuff is active right now. El Paso was sending people in ambulances 600 miles to Austin because they were out of room.
"LA Runs Out of Hospital Rooms" is more of a headline than "El Paso Still Out of Hospital Rooms".
I agree. There have been many doctors across the US who have been using ivermectin or inhaled steroids with incredible success rates. Meanwhile controlled trails for using it have slowed to a halt (we've been waiting since August) while The Gavi Alliance and gates are promoting an mRNA vaccine of a type that has never been approved or deployed before.
It's a clear money grab too. They want this vaccine out because it opens the door to a ton of other mRNA treatments they haven't been able to get approved.
Super tragic for sure. Seems like something was screwed up because the goal was to flatten the curve below hospital capacity, not merely delay the spike until later. At this point it seems like LA will probably be another Italy or NYC.
An extra 10+ months to gain experience and increase capacity made a huge difference in the 3rd spike. If this had happened 8 months ago things would have been vastly worse nationally.
Further, this is very much a flattened curve. We could have easily seen 2 or more times the current rates of infection back then.
> Seems like something was screwed up because the goal was to flatten the curve below hospital capacity, not merely delay the spike until later.
Yes, people are screwed up.
You have antimask morons protesting grocery stores. [1]
The goal of flattening the curve was to flatten the curve...we never really did that. We gave it a shot until everyone got bored or were deemed essential or had a pre-existing condition of being poor.
How much has anti-mask protesters contributed to the surge? They got a lot of coverage in [social] media, but what's the marginal impact they have, given their frequency?
It's important to establish the actual significant causes of issues, so we now how to improve in future. Actions of those on opposing political sides would be a convenient and perhaps comforting significant cause, so we should be careful in prematurely concluding that.
Anti-maskers made masks political. Even people who aren't anti-mask themselves can be surrounded by a political atmosphere where wearing a mask can be construed as a political message.
Also, people can get demoralized in their personal efforts when they see mask wearing as a "divisive" thing that is a matter of opinion, and when they see other people, especially public leaders not wearing masks themselves.
This may be true, but if you want to blame LA’s situation on anti-maskers you also need to answer the question of why LA wasn’t so bad in April or November when much of the rest of the country was spiking. And on the flip side, why is LA so much worse than ‘red states’ today?
I think a more likely explanation is that the lockdown worked up through the holidays, and then people went overboard the other way. If you lived in Texas or North Carolina, you may have seen your friends and family throughout the year. So it’s easier to keep Thanksgiving small, because the public messaging has been, ‘now it’s serious’.
If you live in California, you’ve been told since March that basically any activity puts you at risk of the virus. Depending on your county, this year you’ve been told to wear a mask when you’re within 30 feet of someone outdoors; that playgrounds and parks must be closed while bars can stay open; that indoor dining is banned unless you’re the governor; that there’s a 10pm curfew despite no evidence that such a curfew will slow the spread. At some point people get COVID fatigue and start to tune the messaging out. And I’m betting that point is around the holidays for many, many people.
The problem with the holiday theory is that the spike started being detected around Nov 1, not thanksgiving. Cases nearly doubled in the first week of the month - and tests are always a lagging indicator.
I really have no idea of the specifics between different states and timing in the USA. I live in Finland, so here's what US looks like from here since February:
- leaders downplaying the virus
- no top-down leadership in tackling the virus
- masks made political
- hundreds of thousands of people dead
- media focused on wedge issues and Trumps fantastical statements while people are dying
I do not live in the US and I don't for a second believe that everyone is anti-mask there, but judging from the outside looking at your numbers and media coverage, your whole attitude towards this deadly disease seems f'd up. I don't mean to direct this as an insult to the American people, more as a criticism towards the cultural and political attitudes surrounding this crisis. Anti-maskers of course are not solely to blame - nobody is - but they certainly seem to play a huge role culturally when compared to other countries.
My suspicion is that these events directly contributed very little overall. However, they normalized non-compliance and increased the number of people who don't wear masks as a point of resistance.
Their anti-reality stance should not be tolerated. In a time of crisis we are divided over a piece of cloth. They are a net negative in our efforts to contain a highly contagious virus. There's nothing redeemable about them.
You’re implying that the impact only matters if it is direct.
‘Actual cause’ implies a singular input and output relationship which is both rarely accurate and the type of logic that enables things like anti mask lunacy, and vaccines, and other conspiracy theories.
Overall I don’t see the problem as anti mask protests...I see anti mask protests as a symptom of the selfish stupidity that seems to impede progress.
In the convenience store or at the pump? If it's just at the pump, a lot of stations let you pay by card at the pump, it's outdoors, it's pretty easy to stay six feet from someone, and you're there less than 15 minutes.
and instead decided on this? I do appreciate this over whatever comment you decided not to make, but still.
I would gladly pay up to $1 (or 100 upvotes) for every comment I make here if only to prevent the steady decline into Reddit-style self-indulgent noise.
Has anyone considered that people periodically pointing out places where HN is being Reddit-like is part of what contributes to keeping this perception an illusion?
Unclear. We’re not sure how dangerous the new strain that popped up in London is. Often viruses tend to get less lethal as they get more infectious, like the common cold. Certainly I’d still advise caution, but London might not be in terrible shape yet.
The best evidence right now suggests that B.1.1.7 is significantly more trasmissible, but doesn't produce less (or more!) serious cases. (See the cohort matching study in this week's PHE report on the variant[0]). Maybe a statistically significant difference will emerge once we have more data, but at least for now it's better to not assume that.
But let's say for argument's sake that the new variant is indeed half as serious, while being 70% more transmissive. That gives you one single multiplicative change in hospital utilization, but a permanent change to the exponent of the epidemic growth curve. The multiplicative benefit will basically get nullified by the increased growth in a week or two, and after that it is all downside.
Isn't that because it's easier to transmit when the host doesn't die. Like a survival of the fittest thing. Covid isn't deadly enough to stop transmissions
Generally speaking it’s better for the virus to not kill the host, yes. Covid isn’t lethal enough to burn itself out rapidly, but one can imagine that the R0 would be a smidge higher if it was less lethal, since all those dead people could’ve spread it just a bit more if they’d lived.
But it doesn’t appear like Covid is the absolute Max lethality possible for a pandemic; the 1918 flu pandemic seems to indicate that a virus can have a higher CFR and not burn out. So it could certainly get worse, but in general the trend is towards being less lethal making viruses more fit.
All early of course. But it doesn’t appear the new variant is more deadly, but also its not clear its less deadly yet either. Assuming it’s about the same severity as the current variant then that spells bad news. This thread here does a decent job explaining that https://twitter.com/AdamJKucharski/status/134356742510788198...
Actually we’re pretty sure now. They did studies of the new strain based on contact tracing and it was found to have a 50 % greater chance of infecting contacts. It’s also in the US now.
With mass testing, public awareness, social distancing, etc., I'm not sure if the virus getting less lethal will hold. We're certainly selecting for more virulent strains, though.
I live near a hospital. At least they’ve stopped running the sirens all the time; there’s no point in rushing to the hospital when the ambulance will have to wait for hours anyway. It was getting pretty annoying on Christmas Day, no traffic noise save for the parade of ambulances.
It’s sad that so many people are dying, but that’s the price of not living in an authoritarian mask state where humans care about each other’s survival.
We make people cover up their butt holes to go into the grocery store. I don't see why some people get all neurologically bent out of shape over covering up their pie holes.
Depressingly avoidable, but too many people are too self interested to do what they should have been doing ten months ago.
Now we’ve got to where actual epidemiologists were warning: the overflow of COVID patients will start killing non-COVID patients through lack of care and ED resources.
I was dealing with a severe chronic issue at start of covid. Lost access to all my doctors. Avoided going to ER. Ended up having a small stroke. So yea. Lots of people suffering from general lack of care.
i live in canada, but this matches my experience in normal times... my brother had a bike accident and cracked his head off a car and we walked into a nearby hospital with blood running down his face, he was concussed such that he kept asking me where he parked.. and the triage nurse said, "just go home, unless you want to spend 3-4 hours waiting to see someone". we left. so the issue of hospital capacity seems to go way beyond covid, imo
I’m inclined to not believe your story, sorry, hospitals generally have a policy of someone bleeding from the head, or extensively, or serious injury, are bumped to the front of the queue over someone who is queuing for a sore stomach or checkup etc. So while you might have to wait, it shouldn’t be 3-4 hours, unless something like massive pile up happened and 25 people were rushed in, in critical condition.
It doesn't matter how acute your condition is if all the beds in the ER, hospital and/or ICU are full with COVID patients - there is simply nowhere to put you. Getting emergency treatment on a gurney in a hallway by hospital staff that is stretched thin and exhausted due to overwork isn't as good or effective as getting proper care.
Additionally, there are all sorts of treatments for chronic conditions, cancers and other maladies that take place in the hospital that are being delayed and/or cancelled due to lack of capacity.
Canadian here. No, people have stories that their uncle tells them happened to them or their friends, but actually the uncle just read about it online. And then you repeat it as though it happened to you personally. The healthcare system works well. I've been to the hospital for a concussion and was seen quite quickly.
You should qualify which numbers you're describing.
I see an average wait time (to get an initial assessment from a doctor) of 1.2 hours. There are lots of averages, though, depending on which stage and which path people take.
thats left as an exercise for the reader -- im no expert in the hospital system my point is simply that after i shared my experience of what happened one particular night when i needed to go to the hospital, im getting flagged for it and downvoted like its a lie and i have some other agenda and that's frankly absurd. it happened. ive never gotten that reaction on hn before and im not sure what it means. i posted some links so those readers can expand their knowledge. i digress.
I understand being upset at the reaction, but if you're going to make the argument with numbers, you're not going to have much success by pointing to a website and telling everyone to educate themselves.
Regardless, I am indeed sorry to hear that happened to your brother. Waiting in a hospital in an emergency is one of the worst experiences in many people's lives.
All those measures that CA took that were lauded - they don't seem to be working as expected. The per capita rate in all other states is better, with only TN and AZ approaching CAs levels.
The problem is, every few weeks there's a new "well, if you ignore this state, the US is doing really well" story.
CA is still only 34th/50 per capita in infections and 40th/50 per capita in deaths.
We can't exclude outliers and expect to get a useful dataset. Especially when those outliers change all the time, and exhibit the same patterns as each other.
That's in the last 7 days only. Is that what you mean by "at this time"? California is doing better than most US states in the longer term, and even the "best" state long term, Vermont, seems to be worse off than most countries.
CA recently is in a wave; the color from the linked page is about the new cases / capita in the last 7 days. Overall CA is doing better than the median state.
I see many other comments in this thread saying that this was preventable, how so ?
Looks like California tried a lot of things (stay at own orders, business closures etc) and they are not in a better shape than more "relaxed" states.
A real national commitment to testing and contact tracing early on. A full lockdown which probably needed to be done at a national level since states can't restrict travel. Pay everyone to stay home.
I simply don't get the "we couldn't have done anything" mindset when we see countries like South Korea, Japan, Australia, and New Zealand with deaths per capita as little as 1%-3% of what it is here.
The Federal government has severely circumscribed authority to restrict travel, as the Supreme Court has repeatedly determined it to be a fundamental Constitutional right on the same level as freedom of speech. You can’t suspend that right without narrowly tailored due process for each of 330 million Americans. (This cuts both ways — there are several things that are effectively impossible because “due process” doesn’t scale regardless of the purpose.) This is the reason no State implemented real “lockdowns”, the Supreme Court has overturned such attempts many times historically, it is settled law at this point. States actually have fewer restrictions than the Federal government in this regard.
Similarly, effective contact tracing by the government is illegal in the US, ignoring that the disease was endemic before anyone even noticed. It isn’t just illegal, the US infrastructure is intentionally designed to make it extremely difficult to do at a technical implementation level, with the idea that it would hinder potential abuses. You could modify the systems to make contact tracing work, ignoring legality, but it would require at least a year of lead time to do the technical implementation. Many senior people in US government did ask about this early in the year and were repeatedly told that implementation would require a very long time both legally and technically. So they dropped the idea.
No amount of “real national commitment” will address these issues, and denying that these limitations exist isn’t the basis for a constructive policy.
You are speaking as if you have indisputable facts on your side which doesn't appear to be the case. The Federal government has broad power to respond to communicable diseases and the full extent of those powers can only really be known as new court cases are decided.
There are also steps between what we did and the type of martial law style lockdowns and quarantining done in places like China. You don't need 100% participation in lockdowns or coverage for contact tracing to get the R0 below 1 which will lead to dropping case numbers.
These are indisputable facts, there is a lot of case law on the limits of travel restrictions in many contexts. They can’t even use regulatory powers to implement de facto restrictions on travel by common conveyance (e.g. closing all the roads or prohibiting the sale of gasoline) — that has already been decided broadly by the Supreme Court in multiple cases.
Restrictions on freedom of travel, as laid down by the Supreme Court, are similar as for freedom of speech: the state must have a reasonable belief and compelling interest that a specific individual is an imminent threat to other people. You can’t quarantine a broad class of people over wide geographies on vague grounds, it requires clearing evidentiary hurdles that a narrowly targeted group of people harbors the disease. As a concrete example, this is the legal basis for how people remove their names from the No Fly List; having terrorist sympathies does not make one an imminent threat, and so the right to travel by common conveyance is upheld. (Unfortunately, the government has been successful at removing standing from everyone that challenges the Constitutionality of the No Fly List, but USSC justices have already made public statements that they take a very dim view of the legality of the practice.)
And this is why there were no real lockdowns. The AG in every State is well-aware that broad prohibitions on travel aren’t Constitutional and would lead to an instant court injunction. It has been tried in the past on many occasions. The most they can do is strongly disincentivize travel using their regulatory power over public establishments i.e. give people no reason to leave their house.
> t isn’t just illegal, the US infrastructure is intentionally designed to make it extremely difficult to do at a technical implementation level, with the idea that it would hinder potential abuses
You think that the country which went from never leaving the earth to landing on the moon in 8 years, from 0 to hundreds of planes and dozens of ships per month in a few short months (WW2) couldn’t stand up a national infrastructure for contact tracing? Don’t confuse lack of will with lack of capability.
This challenge isn’t just legal and operational, the required computer science and data infrastructure software literally doesn’t exist. I am a subject matter expert on this and was consulted by a few national governments to see if it was feasible. Large-scale technical experiments were run in the US several years ago.
If you use off-the-shelf computer science, you have an O(n^2) problem on a data model that is growing by several petabytes per day. Existing systems can’t even ingest data at that rate in a useful way, never mind analyze it. Much more scalable algorithms exist; this was literally the topic of my supercomputing research back in the day. If you can severely constrain the data model in certain ways that are not possible in many countries, or you have a small enough population, you can kinda sorta brute force it. In practice no one is AFAIK, because off-the-shelf software simply isn’t designed for it, even at small scales. The US has an unconstrained data model combined with extremely high scale and topological complexity. You can’t magick state-of-the-art exotic data infrastructure into existence.
I did “what would it take” studies earlier this year for a couple governments. We are talking about 100k lines of advanced C++ for a system design that has never been built before, only theorized. It isn’t something you do over the weekend. Even in the most optimistic scenario, building the software would take at least 18 months. For COVID, there is no point (but they are still interested for the next pandemic).
We know from prior experiments that if a disease is endemic in a population and extremely draconian lockdown measures are not realistically possible — both true in the US and some parts of Europe — then contact tracing is basically an exercise in futility unless you have some exceptionally advanced data infrastructure (we don’t) and the legal authority to use it (the US doesn’t nor many countries in Europe).
Don’t confuse the lack of capability with a lack of will. The fact is that I was approached by multiple national governments on this subject very early on because they know I design this type of data infrastructure.
Not who you are responding to, but really interesting comment, thanks!
I am not too knowledgeable on the topic, may I ask you what sort of confidence is required for a well working contact tracing application? A naiv those-who-live-together is so utterly useless that it was rejected?
And do I get it right, you meant to real-time track everyone and if someone turns out to be infected, everyone gets quarantined who they met in the preceding days? What percentage of contacts can “slip through” so that it is still effective? Isn’t there a working trade-off like counting people who work together and family or is it still subject to unimplementable exponential explosion?
Or am I asking the wrong questions as these are epidemiologic ones rather than technical? If so, excuse my lack of knowledge on the topic.
I’m not sure what you’re talking about. China did this in a few weeks. I’m not even talking about automated tracing of cell phone signals - just databases and people making phone calls.
> All those measures that CA took that were lauded - they don't seem to be working as expected
Yes, they did.
And then the subsequent widespread public rebellion by county sheriffs, who lean very strongly to the political right and to whom state law invests exclusive and largely discretionary authority for enforcement of public health orders, that they simply would not enforce any of the orders also worked exactly as expected.
National media has tended to cover the state and regional public health orders, but not so much the very public announcements of non-enforcement by sheriffs. But they are extremely well distributed by local traditional and social media, and effect behavior.
> Do you have a relevant study backing this assertion ?
The assertion is that the outcome sought by the intervention was (from context, in the short-term, before the other events mentioned in the comment) achieved; the curve was flattened in the early wave. That was the relevant expectation, and it occurred.
This is statistics at its worst. How can you conclude from just the last seven days that "those measures that CA took... don't seem to be working as expected"?
You did a good job including the fact that some of the states that are slighty better per capita are also states that just so happen to have officials raiding the homes of people trying to ensure accurate data is transparently posted.
Also the fact that some of said states are near entirely run by people who have claimed that the virus did not exist from the start. I wonder how that may affect the transparency of data we get to see...
