COVID Transmissions for 11-12-2020
Good morning! It has been 361 days since the first documented human case of COVID-19.
Today’s a headlines one, and I also have some comments to discuss, at least briefly. Sorry about the headlines, it’s kind of bleak today. Stay safe.
I want to take a minute out to thank everyone who has commented or has sent me emails; there are a lot of great questions that have been posed to me over the last few days, both vaccine-related and not. That’s a lot of material that I need to cover, and I’m glad to have it to cover. It’s not easy to write a daily newsletter that people want to read and open; by engaging with it and telling me what you want to read, we help each other and we make this a better project together. So really, I appreciate it.
As usual, bolded terms are linked to the running newsletter glossary.
Keep the newsletter growing by sharing it! I love talking about science and explaining important concepts in human health, but I rely on all of you to grow the audience for this:
Now, let’s talk COVID.
Uncontrolled spread in most of the US
This is today’s map from covidexitstrategy.org:
Covid Exit Strategy uses a combination of factors to make their assessments, but nobody serious seems to be arguing with them when it comes to their scores right now. This is a bad situation. Right now we are seeing a huge spike in global COVID-19 deaths, driven mostly by Europe and the US. Please don’t become one of them. Don’t take risks. Keep yourself safe. Wear a mask if you have to go out.
New York imposes new restrictions
Effective Friday night at 10 PM, Governor Andrew Cuomo of New York has imposed some new restrictions. This is because spread of COVID-19 cases in New York is happening uncontrolled right now. Here’s what he has put in place:
Private gatherings of 10 or more people are now banned
Bars, restaurants, and gyms must close at 10 PM
A question I’ve gotten a lot about this is, “what’s the point of closing things early? How does that affect the spread?”
There are a couple of reasons this is effective. Firstly, risk is a function of exposure over time. Bars, restaurants, and gyms in New York already have strict capacity limits. That lowers the “exposure” part of reducing the number of potential infected people causing them.
To further lower risk, then, time is the other lever that can be pulled. So with this restriction, we are now seeing a reduction in both exposure opportunities as well as the time in which they can occur; together these lower risk.
Another reason for this, at least when it comes to bars and restaurants, is that as nights get later, people tend to behave in a less restrained fashion. There is contact tracing evidence supporting this concept, as I understand. Late night at bars, people act a little freer. This isn’t good when discipline is needed.
When it comes to gyms, I’m not sure what the rationale is exactly, since I don’t think a lot of NY gyms were open past 10 PM anyway. I think the government may be overly worried about gyms. As I’ve covered before, gyms can actually be quite safe provided certain protocols are followed.
Returning to bars and restaurants, I think that the Governor may be moving too slowly here. I’ve said before that we need to assume that a trend we see today always reflects events that occurred 1 to 2 weeks ago; when we have a certain amount of community spread of disease measured, and we know the trend is upward, we should assume that the spread events happening right when we get that number have already expanded exponentially. In other words, when it’s going up, it’s going to keep going up at a rate that will accelerate faster tomorrow than it did today. That’s bad.
To me, once there is a clear upward trend, it’s important to jump right on it and control it. This has the advantage of allowing less severe measures to be used, if you act early enough and strongly enough.
I don’t want to see restaurants, hair salons, nail salons, retail stores, churches, synagogues, and other types of businesses close again. I really don’t. But I think given the current situation, we need to walk back certain indoor activities. The only unmasked indoor activities currently allowed in New York State are eating in restaurants and drinking at bars. I think these activities need to be shut down totally, and again restricted to being outdoors only. I hate to say it, but I think that’s a way that we get this thing back under control.
I expect the restrictions to escalate to this point eventually; I just hope that that time comes when it will still be enough to get ahead of the spike we’re experiencing.
The outbreak on the USS Theodore Roosevelt aircraft carrier
You may recall the USS Theodore Roosevelt for making headlines when its commanding officer was fired for begging for help with an outbreak of COVID-19 aboard the ship. I’m not going to wade back into that, but I did want to share that an analysis of the outbreak on the ship is now available from The New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMoa2019375
Outbreaks on ships, as relatively closed systems, can be interesting. Skimming this paper, I am particularly interested in how a large proportion of cases never showed any symptoms at all. This underscores further that in areas of active spread, you should assume that you are a risk to others, even if you feel fine. Keep others safe by wearing a mask and maintaining distance.
What am I doing to cope with the pandemic? This:
Listening in on a Torah seminar (“shiur”)
For months, my wife has been working on setting up a series of seminars (in our community, called “shiurs”), taught by a very interesting person in our community. This person, Rabbi Ysoscher (yih-sos-ħar) Katz, was born and studied in an ultra-Orthodox community of great prominence, to wildly oversimplify things. He has gravitated towards a more modernist strain of Orthodoxy during his life, and is currently the chair of the department of Talmud at a notable institution of Jewish learning known for its progressive Orthodox attitudes.
I have watched as my wife has worked to make this series possible, with great excitement, because it is touching on amazing subject matter. For example, the nature of inclusion of disabled and LGBT people within Orthodox communities.
Tonight, the first shiur in the series was held, and I had the chance to listen in. Some interesting discussion centered on the role of sociology in decisions of Jewish law, as well as reframing our conceptualization of various Jewish communities, particularly with regard to how open they might be to change.
It’s interesting that this was discussed, because when I was growing up I never would have imagined a serious discussion in religious law in Orthodox Judaism that would tackle these key issues of humanity and inclusion, and tonight it happened. We live in incredible times, aside from the ongoing pandemic.
Yesterday’s newsletter sparked a very long comment from reader Ferret:
I have lots of vaccine questions. No idea if you'll be able to answer them. My main questions on the Pfizer vaccine and any other vaccine is what the process may look like to sign up to get it. Who will be in charge of distribution? Is it going to be completely private sector, whatever hospital or pharmacy or logistics company happens to get their hands on some doses will make a signup form and there'll be a mob rush to sign up, and when they have a dose available and decide you're eligible they call you up? Will the government be involved in choosing and/or distributing who gets a dose when? What metrics will be used to decide? Is there an argument between, say, blanketing Wisconsin or some other state that's doing particularly badly first and getting everyone in the state vaccinated and then moving to other states, vs. a more distributed approach where every state will get some vaccine doses initially but not enough to cover their whole population?
And are the different vaccines different enough in how they might potentially be distributed that these questions must wait until a particular vaccine receives approval before deciding who gets doses when, or could this all be decided and transparently explained ahead of time to the broader public in detail this winter even if mass distribution won't happen until next year? Why isn't there a way for me to sign up now and get an assignment like "Based on your geographical location, health condition, and randomization, you have been placed in vaccine distribution subdivision D4, which will receive vaccination approximately when doses # 80 million to 100 million have been produced and distributed. You will be contacted to schedule vaccination appointments when this happens and we will keep you up to date as the timeline becomes clear." ?
Also, what are social interaction protocols going to look like once part of the population has received the vaccine? Will you be able to open up restaurants for indoor dining but only for vaccinated people, and if so, how do you identify vaccinated people? Or is it wiser practice to wait until some large percentage of the population has been vaccinated, or until the disease rate is under some target, even if theoretically it would be reasonably safe for vaccinated people to go out?
I just want to say: Wow! These are great questions. Some of them I am not the right person to answer. Some of them, no one can answer right now. Some of them I can definitely discuss.
I think these questions deserve treatment in full, however, beyond a comment reply. I would like to rely upon the patience of this newsletter’s readership while I work to address these in a series of in-depth pieces to come in this newsletter over the coming weeks. I have some work cut out for me!
I also have some work cut out for me from a reader named Jonathan who has sent me some things to read through and cover in coming issues—I’ve got them in the queue, Jonathan, and I’ll definitely be addressing them.
As I mentioned at the top, I’m really grateful for all this interest and these suggestions. I want to take the time to give them all the treatment they deserve, but please—keep them coming.
Join the conversation, and what you say will impact what I talk about in the next issue.
Also, let me know any other thoughts you might have about the newsletter. I’d like to make sure you’re getting what you want out of this.
This newsletter will contain mistakes. When you find them, tell me about them so that I can fix them. I would rather this newsletter be correct than protect my ego.
Though I can’t correct the emailed version after it has been sent, I do update the online post of the newsletter every time a mistake is brought to my attention.
No corrections since last issue.
Thanks for reading, everyone!
See you all next time.
Always,
JS
Couple of questions for you -
What is a good test/population rate to be able to "trust" the positivity rate?
Meaning, when NYC was only testing people with symptoms the rate was through the roof, so we sort of know not to use it as a basis for anything.
My zip code is currently 5.2% positivity in the last 2 weeks (https://www.phila.gov/programs/coronavirus-disease-2019-covid-19/testing-and-data/#/ - I am 19147). There have been 582 tests / 10,000 people, or 5% of people have had a test. Is that enough tests to consider that number really high? Or, is it inflated because of a lack of tests?
10025 is testing 700/100,000 per day based on the NYC dashboard. Over 2 weeks that would be 980/10,000, so nearly 10% of residents are getting tested in a 2 week period - and the positivity rate is much lower (even if you halved my zipcode, the UWS is still better, but its not as stark a difference).
So, should I be totally freaked out by a 5.2% positive rate? Or is that inflated because of not enough testing? (And yes, I know we should be freaked out because relative numbers are skyrocketing.)
Also, not sure if you noticed, but NYT now has # hospitalized nationally as one of their metrics. Given the lag with deaths, and the fluctuation of #s based on testing, I know Cuomo liked to talk about hospitalizations during his briefings. I assume this is NYT finally getting national numbers to start to use this as a metric to counter the "it's because we are testing more" rhetoric, which I think its great.
Thanks!
-david