Purgatory: Coronavirus

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  • It’s not terrible as a strategy, human behaviour is integral to how spread happens.

    I think some modesty about out ability to predict human behavior in the face of a once in a lifetime event may be in order (leaving aside that behavioral science is one of those fields hit heavily by p-hacking and large parts of it are probably misleading at best).

    They are working on probability of outcomes

    Yeah, but they don't have multiple data points to work with - there are simulated scenarios but they would tend to support more lockdown and less nudge.
  • EutychusEutychus Shipmate
    Eutychus wrote: »
    She was also feeling unwell, and still attended a function at No 10.

    But this is a real dilemma for people in public-facing leadership positions. Do you keep on in your work and lead by example, or disappear from view to protect your office?
    The phrase "lead by example" comes to mind. We're all being told to prepare to work from home if needed (when my computer at work was replaced my working files were moved from the hard drive of my old computer to OneDrive ... but we're now being told to copy any files we may need from local computers to the cloud so that if we have to work at home we can access them). Public-facing leaders will be able to do a lot from home with modern IT - a lot already do TV interviews without going into the same studio as the presenter; email, phone, Skype (or similar) to keep in contact with staff. If the Pope can lead mass through a TV screen/computer monitor then a government minister can stay home for a few days until the test results come through (and, longer if those results are positive).

    "Lead by example" was perhaps not the best choice of words. Part of leadership is traditionally being "out on the ground" and leaders get strong criticism when they fail to be seen to be doing this. And traditionally, crises call for strong leadership figures, not somebody in a bunker somewhere.

    I keep wondering about this for my role as a prison chaplain. The presence of people from the outside is an important social factor in prison life. Remove that, and riots happen sooner rather than later - as has already been the case in Italy. Leave it, and you introduce an obvious contamination vector into the incubation equivalent of a cruise liner. Plus the danger of becoming a vector the other way after being in contact with people for whom personal hygiene, or an understanding of contamination risks, is not high on the list. Somewhere, somehow, a tradeoff between theoretical best public health strategies and the social implications has to be found.
  • Golden KeyGolden Key Shipmate, Glory
    Mario Cuomo, governor of New York (US) has come up with an interesting approach to the unavailability of hand sanitizer: New York will put out its own brand, manufactured by prison inmates.

    Stephen Colbert showed a clip of Gov. Cuomo's press conference on "The Late Show" Tues. night. It was unintentionally funny.

    I'm not sure what the price of the hand sanitizer will be.
  • orfeoorfeo Suspended
    So, there was a football match in Valencia, Spain last night (using local time) in the Champions League, with an empty stadium. Normally there's be 50,000 for a match like that.

    It turns out that thousands of fans were hanging around outside the stadium cheering and banging drums and so forth. Seriously, what's the point of the closure then?
  • Robertus L wrote: »

    If it's British, shouldn't that be a nudge nudge unit?

    :smiley: Oooh, Matron...
  • Re-iterating on my point above -- which probably indicates my current level of irritation, we know what the WHO advise.

    The UK has taken a different path to other countries which presumably also have epidemiologists - so the difference is one of setting priorities and listening to .. a behavioural science unit - and there are numerous things in that article that one can take issue with (there are no citations for a number of the things that Halpern claims as fact).
  • The UK has taken a different path to other countries which presumably also have epidemiologists - so the difference is one of setting priorities and listening to .. a behavioural science unit - and there are numerous things in that article that one can take issue with (there are no citations for a number of the things that Halpern claims as fact).

    Furthermore, look at other parts of their 'strategy'.

    What's interesting about this approach is that they seem to be assuming they have time to do this and that telling people to wash their hands will put off the impact till the summer -- after all if you are initiating this conversation at this point and looking for outside expertise on analytics and modelling then the chances are you are unware of the capabilities you already have.
  • orfeo wrote: »
    My local Co-Op corner shop was out of anti-bacterial handwash this morning, but everything else seemed present and correct. This probably means that peeps are taking sensible precautions.

    Antibacterial handwash is not a sensible precaution, because we're not dealing with a bacterium.

    Plain old soap will do at least as good a job if not better.

    Yes, I stand corrected. Thank you.

    I should perhaps have just said 'handwash', and ordinary soap was not to be seen, either, when I went in earlier today.

    Mind you, they don't stock enormous amounts of anything - soap is more readily available at the Pharmacy just up the street. Maybe I'll pop in there tomorrow to see how they're doing!

  • It's becoming clear what the uk "government" is up to. Knowing that the NHS will not be able to treat anything like the predicted number of critically ill patients, they've decided to just hope that the epidemic goes away all by itself. And if it doesn't, and you die or your granny dies, it's your fault for not washing your hands enough. Nothing to do with the government. Hand washing is an entirely appropriate metaphor.
  • Well, yes - maybe 'they' (Boris & Company) think that the virus will see off all the elderly, the poor, the mentally unstable, the generally unwell, the Horrid Foreign People, etc. etc., and so make The English Empire a much better place in which to enjoy their £££.

    They forget that there are no pockets in a shroud.
  • Rocinante wrote: »
    It's becoming clear what the uk "government" is up to. Knowing that the NHS will not be able to treat anything like the predicted number of critically ill patients, they've decided to just hope that the epidemic goes away all by itself.

    That is my feeling too - though I don't think it's all that conscious, the UK is led by someone who has spent their life running away from hard decisions and his team is there to protect him from having to make any of them.
  • I guess the words 'is led by', when used of Boris Johnson, actually form a kind of oxymoron.

    Sorry - wrong thread...
  • Rocinante wrote: »
    It's becoming clear what the uk "government" is up to. Knowing that the NHS will not be able to treat anything like the predicted number of critically ill patients, they've decided to just hope that the epidemic goes away all by itself. And if it doesn't, and you die or your granny dies, it's your fault for not washing your hands enough. Nothing to do with the government. Hand washing is an entirely appropriate metaphor.

    He did talk about taking it on the chin, i.e., let a ton of people die. I don't what the scientists would say.
  • NicoleMRNicoleMR Shipmate
    Mario Cuomo, governor of New York (US)

    Mario Cuomo was governor a long time ago and is now dead. Our governor now is Andrew Cuomo, his son.
  • I think this really is one situation where we shouldn't necessarily listen entirely to the experts. Intensive care doctors will throw up their hands and say "we don't have the capacity". No, we won't be able to give the full modern ICU experience to everyone who needs it. But if we commandeered buildings suitable for use as isolation hospitals, and staffed them with people who have some knowledge of medical procedures, working under the supervision of ICU doctors and nurses, we'd save more of the critically ill than if we do nothing. Plus they'll be kept away from vulnerable patients in the general hospital ICUs.

    (Prepared to be shot down by those with more expertise.)
  • No, no - that sounds like Common Sense.

    A commodity, like Soap, in short supply in some countries.
  • Rocinante wrote: »
    I think this really is one situation where we shouldn't necessarily listen entirely to the experts. Intensive care doctors will throw up their hands and say "we don't have the capacity". No, we won't be able to give the full modern ICU experience to everyone who needs it. But if we commandeered buildings suitable for use as isolation hospitals, and staffed them with people who have some knowledge of medical procedures, working under the supervision of ICU doctors and nurses, we'd save more of the critically ill than if we do nothing. Plus they'll be kept away from vulnerable patients in the general hospital ICUs.

    (Prepared to be shot down by those with more expertise.)

    Yes, I was reading Richard North's blog, and he described something like that, using the equivalent of combat medics.
  • CrœsosCrœsos Shipmate
    edited March 2020
    Rocinante wrote: »
    I think this really is one situation where we shouldn't necessarily listen entirely to the experts. Intensive care doctors will throw up their hands and say "we don't have the capacity". No, we won't be able to give the full modern ICU experience to everyone who needs it. But if we commandeered buildings suitable for use as isolation hospitals, and staffed them with people who have some knowledge of medical procedures, working under the supervision of ICU doctors and nurses, we'd save more of the critically ill than if we do nothing. Plus they'll be kept away from vulnerable patients in the general hospital ICUs.

    (Prepared to be shot down by those with more expertise.)

    For someone saying we shouldn't (necessarily) listen to the experts your suggestion relies on a lot of expertise: people with "some knowledge of medical procedures", "ICU doctors and nurses", the kind of experts that can say which buildings are "suitable for use as isolation hospitals", etc.
  • Merkel opining that 70% of Germans could catch the virus. I was waiting for a dramatic sequel, but something about slowing it down. How?
  • EutychusEutychus Shipmate
    Slowing it down involves using the barrier techniques already recommended.
  • So not a la Italian?
  • BoogieBoogie Heaven Host
    I’m in the minibus taxi - just me and the driver. Frankfurt airport is a ghost town. Just me at passport control!

    Surreal

    😷
  • BoogieBoogie Heaven Host
    The taxi driver and I elbow bumped as a greeting.

    It didn’t feel too odd, not really.
  • EutychusEutychus Shipmate
    So not a la Italian?
    There is no doubt that cultural practices will have an impact. Hand-shaking and kissing on the cheeks disappeared in open society here about ten days ago. My wife is wondering about the correlation between plosives in any given language and rates of contamination, too.

  • EutychusEutychus Shipmate
    edited March 2020
    Meanwhile the usual con artists are out in force: Jim Bakker is being sued for marketing a fake cure.
  • CrœsosCrœsos Shipmate
    BTW, one of the barriers to commandeering existing buildings as isolation hospitals are the HVAC standards required of medical buildings. I'm not certain about the standards elsewhere, but in the U.S. hospitals, doctors offices, etc. all have to have 100% outside air HVAC systems. The reasons for not recirculating return air in a medical setting should be obvious, and are doubly applicable for any building serving as a COVID-19 isolation hospital. Ducting an existing HVAC system to an outside air source instead of a return plenum is fairly easy (depending on building configuration, of course). The main problem is that once this conversion is made the existing chiller and heating plant will likely be undersized. It takes a lot more energy to heat/cool outside air to room temperature than it does to heat/cool a mix of return air and outside air.

    That's just one of the issues that might not be considered if you don't listen to expertise. It's nothing insurmountable, but you need experts to let you know there's going to be X problem and that to correct it you'll need to do Y and Z.
  • Bishops FingerBishops Finger Shipmate
    edited March 2020
    Of course, Jim Bakker is so Holy™ that he won't catch the virus - if he did, it would be proof that God does not exist, and that would never do...
    :rage:

    Transpondines, where do you find these fruitloops?
  • Eutychus wrote: »
    So not a la Italian?
    There is no doubt that cultural practices will have an impact. Hand-shaking and kissing on the cheeks disappeared in open society here about ten days ago. My wife is wondering about the correlation between plosives in any given language and rates of contamination, too.

    No, I meant not imposing a lock-down, as Italy has. I think there is a row going on in Germany about what to do next.
  • Eutychus wrote: »
    Meanwhile the usual con artists are out in force: Jim Bakker is being sued for marketing a fake cure.

    Without clicking I guessed it would be his Silver Solution - and sure enough it was.
  • GalilitGalilit Shipmate
    A friend who works in a tourist-oriented diamond centre said half the staff were just laid off (from tomorrow till October at least). The other half will tidy up and close down next week then they're off home too. His wife (a hotel chef) will probably get her marching orders next week.
    Our kibbutz's baptismal site and shops on the River Jordan are closing on Sunday
    Bethlehem is a ghost town and lots of local people are sick there

    The Baby Jesus will be thrilled at the reduced commercialisation of His Life and Works!


  • Further to the Merkel story, a German virologist, Alexander Kekule stated that a max of 40 000 would get it, and Merkel is wrong.
  • RocinanteRocinante Shipmate
    edited March 2020
    Crœsos wrote: »
    Rocinante wrote: »
    I think this really is one situation where we shouldn't necessarily listen entirely to the experts. Intensive care doctors will throw up their hands and say "we don't have the capacity". No, we won't be able to give the full modern ICU experience to everyone who needs it. But if we commandeered buildings suitable for use as isolation hospitals, and staffed them with people who have some knowledge of medical procedures, working under the supervision of ICU doctors and nurses, we'd save more of the critically ill than if we do nothing. Plus they'll be kept away from vulnerable patients in the general hospital ICUs.

    (Prepared to be shot down by those with more expertise.)

    For someone saying we shouldn't (necessarily) listen to the experts your suggestion relies on a lot of expertise: people with "some knowledge of medical procedures", "ICU doctors and nurses", the kind of experts that can say which buildings are "suitable for use as isolation hospitals", etc.

    I'm not saying "don't listen to experts", I'm not Michael Gove ffs. What I AM saying is that when experts in Intensive Care are telling us they're isn't anything like enough ICU capacity (which there isn't), we need to get creative. "People with some knowledge of medical procedures" could be extended to "any normally intelligent person who's done a first aid course". In a setting where there are hundreds of people who all have essentially the same condition, treatment could be broken down into smaller tasks which people could be trained to repeat as required. Enormous economies of scale could be achieved. Procedures would need to be clearly written down by the experts in charge. This is how, IME, people with only GCSE's are trained to manufacture microprocessors. Yes, the death rate would be (a lot) higher than in a proper ICU. But it would be lower than the gutter.

    On the subject of buildings, I know of a couple of manufacturing facilities with large clean rooms (i.e. with very hi-spec air-handling plants) that are currently standing empty.
  • Bishops FingerBishops Finger Shipmate
    edited March 2020
    This is England, so let a Committee be formed immediately, to investigate, and implement, what @Rocinante says.

    I suggest that the Navy, Army, and Air Force be called upon to lead. They are, after all, the Best in the World™, and very good at dealing sensibly with extreme situations.

    Seriously. FFS, don't leave it to the Cabal of Headless Chickens which currently pretends to be our 'government'.
  • BTW, I've seen online (can't remember where) that in some place, somewhere, gatherings of over 100 people are being banned pro tem.

    I wryly observe that this would not affect most C of E congregations in England, where the average Sunday turn-out is reckoned to be about 30!

    (Of course, there are numerous 100+ churches, but also many with attendances in single figures, so YSWIM).
  • It is a worry that Boris is twiddling his thumbs, nervous of doing anything. Will it be too little too late?
  • EutychusEutychus Shipmate
    Further to the Merkel story, a German virologist, Alexander Kekule stated that a max of 40 000 would get it, and Merkel is wrong.

    The reality is that nobody knows, and empirical assessments of what "get it" means vary wildly depending on what one is counting. Worse is the media picking up on Merkel's 70% figure in such a way as to convey visions of 70% of the German population requiring ICU treatment or respirators, possibly all at once. In the same way that the BBC is reporting "troops being sent in" in Rochelle NY when what the troops are doing is carting food supplies and stuff around.

    Indiscriminately following media reports on this is a sure way to fuel one's anxieties.
  • CrœsosCrœsos Shipmate
    edited March 2020
    Eutychus wrote: »
    Further to the Merkel story, a German virologist, Alexander Kekule stated that a max of 40 000 would get it, and Merkel is wrong.
    The reality is that nobody knows, and empirical assessments of what "get it" means vary wildly depending on what one is counting.

    I'm hoping we don't end up answering that question with a large n sample.
  • EutychusEutychus Shipmate
    Amen.
  • Eutychus wrote: »
    Further to the Merkel story, a German virologist, Alexander Kekule stated that a max of 40 000 would get it, and Merkel is wrong.



    Indiscriminately following media reports on this is a sure way to fuel one's anxieties.

    This.

  • CrœsosCrœsos Shipmate
    edited March 2020
    The World Health Organization has made it official, declaring COVID-19 a global pandemic.

    Don't click that link if you're avoiding media accounts of COVID-19.

    Here's the official WHO transcript, but that also uses a medium (the internet) to communicate.
  • It is a worry that Boris is twiddling his thumbs, nervous of doing anything. Will it be too little too late?

    Yes. Boris is a fluffy-minded chancer who just wants to dish out good times and bonhomie to his chums. That and get laid. Where's the fun in managing a pandemic? He's surrounded himself with "advisors" who are are good at weaponising lies into insurgent political campaigns and nothing else.

    We are screwed.
  • EutychusEutychus Shipmate
    Crœsos wrote: »
    Don't click that link if you're avoiding media accounts of COVID-19.
    I did say indiscriminately... although (having hung around the outermost fringes of the UN a bit) I think one needs to factor in that even WHO declarations, while undoubtedly the best we have in terms of global public health declarations, inevitably (and perhaps necessarily) have a political component too. They're not pure science.
  • Alan Cresswell Alan Cresswell Admin, 8th Day Host
    Rocinante wrote: »
    Crœsos wrote: »
    Rocinante wrote: »
    I think this really is one situation where we shouldn't necessarily listen entirely to the experts. Intensive care doctors will throw up their hands and say "we don't have the capacity". No, we won't be able to give the full modern ICU experience to everyone who needs it. But if we commandeered buildings suitable for use as isolation hospitals, and staffed them with people who have some knowledge of medical procedures, working under the supervision of ICU doctors and nurses, we'd save more of the critically ill than if we do nothing. Plus they'll be kept away from vulnerable patients in the general hospital ICUs.

    (Prepared to be shot down by those with more expertise.)

    For someone saying we shouldn't (necessarily) listen to the experts your suggestion relies on a lot of expertise: people with "some knowledge of medical procedures", "ICU doctors and nurses", the kind of experts that can say which buildings are "suitable for use as isolation hospitals", etc.

    I'm not saying "don't listen to experts", I'm not Michael Gove ffs. What I AM saying is that when experts in Intensive Care are telling us they're isn't anything like enough ICU capacity (which there isn't), we need to get creative. "People with some knowledge of medical procedures" could be extended to "any normally intelligent person who's done a first aid course". In a setting where there are hundreds of people who all have essentially the same condition, treatment could be broken down into smaller tasks which people could be trained to repeat as required. Enormous economies of scale could be achieved. Procedures would need to be clearly written down by the experts in charge. This is how, IME, people with only GCSE's are trained to manufacture microprocessors. Yes, the death rate would be (a lot) higher than in a proper ICU. But it would be lower than the gutter.

    On the subject of buildings, I know of a couple of manufacturing facilities with large clean rooms (i.e. with very hi-spec air-handling plants) that are currently standing empty.
    I think written procedures that someone with a GCSE could follow may be a bit of a stretch.

    As a gross generalisation there will be three categories of people infected:
    1. Mild symptoms, similar to a cold, which can be treated by simply self-isolating at home until the symptoms clear. May need testing to confirm a) the symptoms were Covid-19 rather than a cold (or other 'flu) and b) then to confirm end of symptoms means that isolation is no longer needed.
    2. More severe symptoms that warrant closer observation, and/or other medical complications that Covid-19 may worsen. Needing an isolation ward (because of being contagious) but no facilities significantly different from a normal hospital ward.
    3. Severe symptoms and/or other severe medical conditions that require ICU.

    In terms of current capacity within the NHS (or, any other health care system elsewhere):
    1. There aren't enough people to collect and process tests for the first group, but this could probably be scaled up relatively quickly - the level of medical training needed to hand over a mouth swab and then collect it back to send for testing is minimal.
    2. There aren't enough beds in our existing hospital wards for seasonal 'flu and almost anything else, even without Covid-19. Nor, enough nurses and other medical staff to look after patients even if there were the beds. And, very few of those hospital beds are sufficiently isolated to prevent spread to other patients. This needs rapid construction of additional hospital wards, isolated from existing hospital facilities - as the Chinese did with their "pre-fab" hospitals that went up very quickly. Conversion of other existing buildings has a lot of potential problems. Additional staff could probably be recruited with minimal health care training - I've seen suggestions of student nurses being given temporary licenses, maybe some St John's volunteers would have sufficient training; I know in the swine 'flu a decade ago lots of clinically trained NHS staff in admin roles were drafted back onto the wards with non-clinical staff then drafted in to cover the admin. But, these patients are in hospital in case there's a more severe issue and the staff need to be able to deal with that (which includes a range of underlying medical conditions, so a "Covid-19 tick sheet" won't suffice).
    3. It will take a significant period of time to increase the number of ICU beds, a handful may be made available but these need specialist equipment and highly trained staff, neither of which are readily available even if space to put these beds could be found.
  • Alan Cresswell Alan Cresswell Admin, 8th Day Host
    The short version of the above, if we want to be ready for Covid-19 we need to go back 10 years and maintain NHS and related services. Undoing a decade of draconian "austerity" isn't going to happen overnight, or in three months.
  • Apparently the American leader of the virus defence force or virus denial force or whatever, a guy named Mike Pence who is also trump's vice president has continued to shake hands. Which is a great example to set. There was comment about whether he's qualified to lead a tour of a creationism theme park or not. Apparently obliquely referring to his lack of knowledge and and formal education, or at least education that took in his brain as may exist.
  • EutychusEutychus Shipmate
    Apparently the American leader of the virus defence force or virus denial force or whatever

    Ahem. You mean "the leader of America's virus defence force"... etc.

    Just sayin'.
  • Gramps49Gramps49 Shipmate
    Just got a notice my campus will test online classes on Monday and Tuesday after Spring Break, which will be next week. There is no change in work schedules for staff at this time, though.
  • DoublethinkDoublethink Admin, 8th Day Host
    edited March 2020
    Inside Health on radio 4 today, had a walkthrough report on hospital prep.

    I didn’t catch all of it, it’ll be on bbc sounds, but I noted they thought they’d expand icu by stopping elective surgeries and using the theatres and recovery suites. (They said that you couldn’t do icu in corridors, as Italy is reported to be doing, because our hospital corridors do not have plug holes - which you would need for ventilators etc.)

    They also said the theatre ventilators (in that specific hospital) were more customisable than the icu ones, so they’d probably put covid patients on the icu ventilators and people with less compromised respiration on the theatres ventilators.

    I note the Chinese have now offered to send the Italians 1000 ventilators, tens of thousands of masks and other supplies. Which is both very generous and an indication they think they have their domestic situation under control.
  • Yes, I had also heard of the plans to use theatres as ICU, very sensible as they have the equipment and trained staff. I suspect the armed forces will also be drafted in for health care, including setting up of field hospitals if necessary.
    The sending of equipment from China is a positive move.
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