Targeted lockdowns are the new way to control the coronavirus

https://www.axios.com/targeted-coronavirus-lockdowns-new-york-city-88c0a1a0-5e00-4694-8027-3289d3f11539.html

As a new wave of coronavirus cases hits the U.S. and Europe, governments are shifting away from total shutdowns toward more geographically targeted lockdowns to stifle the virus’ spread.

Why it matters: Precision shutdowns can slow emerging outbreaks while lessening the overall economic impact of the response. But they risk a backlash from those who are targeted, and may not be strong enough to keep a highly contagious virus under control.

Driving the news: New York City tried to control a flare-up of new coronavirus cases this month by instituting partial shutdowns on a neighborhood-by-neighborhood basis, curtailing economic and social activity in areas harder hit by the virus while continuing reopening elsewhere.

  • British Prime Minister Boris Johnson on Monday instituted a similar response for the U.K., putting in place a three-tier escalating system of lockdowns on a city or regional basis.
  • “We don’t want to go back to another national lockdown,” Johnson told the British Parliament. But “we can’t let the virus rip.”

What’s new: Some early research indicates more-targeted lockdowns can effectively smother outbreaks while leaving broader city and regional economies mostly intact.

  • paper published by a team of economists in July found a more precise shutdown focused on places where viral spread was most common could have reduced economic losses in New York by as much as 50% compared to a uniform lockdown.
  • As long as new outbreaks are still in the relatively low flare-up stage, targeted lockdowns can efficiently cut off the oxygen to new spread. That seems to be the case in New York, where data released on Thursday indicates transmission has slowed in six of the ZIP codes that had been the focus of targeted lockdowns.

Yes, but: Individuals move around a city, and some epidemiologists worry that over time cases will break out of targeted lockdown areas and spark a wider outbreak.

  • preprint paper published in August found people were willing to travel outside of lockdown areas to get services they needed, potentially spreading the virus along the way.
  • That was especially true for religious services. The paper found that during March, even as the total number of visits to churches declined, between 10% and 30% of churches nationwide saw increases in attendance. Those who were motivated to go simply went to churches outside of restricted areas.
  • The small, seemingly geographically isolated outbreaks officials are focusing on may actually be the first signs that a city or region’s control measures simply aren’t working. As a result, “targeted measures can end up chasing the outbreak wider and wider, to the point where restrictions are equivalent to a broader blanket policy,” epidemiologist Adam Kucharski told Wired.

What to watch: A targeted lockdown is inevitably going to appear to single out specific groups of people, which risks creating a backlash that can undermine public support for long-term control measures.

  • That’s already been the case in New York, where Orthodox Jewish communities have taken to the street to protest targeted lockdowns in their neighborhoods.
  • In New York’s Queens borough, stores and restaurants in one mall have been ordered closed, while those in an adjacent mall are still open, simply because of which side of the line they fall on.
  • The experience of COVID-19 has already been a deeply unfair one, with both the direct health effects and indirect economic costs falling on those who can least afford it, and focused lockdowns will exacerbate that unfairness.

The bottom line: Targeted lockdowns can throttle the virus while minimizing economic damage, at least in the short term. But one thing we’ve learned is that if COVID-19 gets out of control in one place, it may be only a matter of time before it ends up everywhere else.

U.S. Covid Hospitalizations Reach 7-Week High As Cases Surge In Midwest

TOPLINE

More Americans are now in the hospital with Covid-19 than at any other point since late August, causing some states to nearly run out of hospital beds, as coronavirus infections continue to increase nationwide ahead of a potential end-of-year surge.

KEY FACTS

Some 37,048 coronavirus patients were hospitalized as of Wednesday, the highest level in almost two months according to new data from the COVID Tracking Project, though total hospitalizations are still below their mid-April peak of almost 60,000.

Among hospitalized patients, 7,156 were in ICUs and 1,776 are currently on ventilators — both of those numbers have increased slightly in recent weeks.

Texas leads the nation with more than 4,000 patients in hospitals, followed by California and Florida, though all three states’ hospital counts declined since the summer.

Hospitalizations and new cases soared in Wisconsin over the last month, and officials opened an emergency field hospital near Milwaukee this week as medical centers across the state fear they will run out of space.

Hospital numbers are also on the rise across other parts of the Midwest and South: Missouri reported a new record this week, and levels in Kentucky and Ohio are both within striking distance of their summertime peaks.

BIG NUMBER

217,933. That’s the total number of Americans who have died from Covid-19, according to figures from Johns Hopkins University. Daily fatalities are still below their peak in April, but they remain steady at more than 700 per day.

KEY BACKGROUND

When the coronavirus first surged in the New York City area, some hospitals nearly buckled under the pressure, contending with thousands of sick patients and inadequate protective equipment. Covid-19 cases gradually decreased nationwide but never fully subsided. The West Coast and Deep South dealt with cascading upticks after states loosened coronavirus restrictions during the summer, and the Midwest and small states like South Dakota are now struggling to open up more hospital capacity as new infections surge. Some experts warn cases could spike yet again over the fall and winter, straining the nation’s medical system and making it tough to get sick patients the medical attention they need.

CRUCIAL QUOTE

“When we see an overwhelming number of patients get infected, a lot of them are going to need hospitalization and support,” Dara Kass, a New York-based emergency room physician, told CBS News on Thursday. “We’re seeing hospitals in Wisconsin be overwhelmed with no ICU beds … This is a big concern of those of us who are looking to prevent as many deaths as possible.”

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Dr. Fauci on COVID surge

Dr. Anthony Fauci, the nation’s top infectious disease expert, tells CBS Evening News anchor and managing editor Norah O’Donnell that Americans need to “double down” on mask-wearing and social distancing to help control a surge in new coronavirus cases.

He also spoke about President Trump’s recovery from COVID-19, progress towards a vaccine, and how the pandemic will affect this year’s holiday gatherings. Watch the full interview.

Fauci on coronavirus herd immunity: ‘That is nonsense and very dangerous’

https://www.yahoo.com/news/fauci-on-coronavirus-herd-immunity-132851933.html

Dr. Anthony Fauci on Thursday denounced the concept of herd immunity — the notion that if a large enough group of people contract an infection, it will ultimately stop the disease from spreading — calling it “nonsense” during an interview with Yahoo News.

“Anybody who knows anything about epidemiology will tell you that is nonsense and very dangerous,” Fauci said, “because what will happen is that if you do that, by the time you get to herd immunity, you will have killed a lot of people that would have been avoidable.”

Fauci, the director of the National Institute of Allergy and Infectious Diseases and member of the White House coronavirus task force, discussed the coronavirus pandemic and the country’s response to it during a live interview Thursday morning with Yahoo News Editor in Chief Daniel Klaidman and Chief Investigative Correspondent Michael Isikoff.

The coronavirus has killed more than 216,000 people in the U.S. and infected almost 8 million, according to data from Johns Hopkins University.

Now, more than seven months after the coronavirus was declared a pandemic, Fauci said Thursday that the U.S. is not in a good place.

“We talk about a second wave,” he said. “We’ve never really gotten out of the first wave. If you look at the baseline number of daily infections that we have had over the last several weeks, [it’s] been around 40,000 per day. It’s now gone up to about 50,000 per day. So right away, we have a very unfortunate baseline from which we need to deal.”

President Trump and his administration have been pushing the herd immunity approach as a possible solution to ending the pandemic, the New York Times reported Wednesday. During a call with reporters, two officials who requested anonymity cited a petition called the Great Barrington Declaration, which calls for states to lift coronavirus restrictions for the bulk of American citizens, the Times reported.

When asked about the herd immunity approach, Fauci said that while he agrees with what the declaration says about protecting the vulnerable and not closing down the country, virtually anyone with a solid understanding of epidemiology would disagree with the idea of letting everyone get infected.

“My position is known. Dr. Deborah Birx’s position is known, and Dr. [Robert] Redfield,” he said. “So you have me as the director of the National Institute of Allergy and Infectious Diseases, Debbie Birx, as the coordinator and a very experienced infectious disease person, the coordinator of the task force — and you have Bob Redfield, who’s the director of the [Centers for Disease Control and Prevention]. All three of us very clearly are against that.”

Experts Slam The White House’s ‘Herd Immunity’ Plan

Experts warn Trump's misinformation about coronavirus is dangerous

The White House is reportedly embracing a herd-immunity approach focused on “protecting the elderly and the vulnerable” but experts are calling the plan dangerous, “unethical”, and equivalent to “mass murder”.

The news comes following a petition titled The Great Barrington Declaration, which argued against lockdowns and school and business closures and got almost 500,000 signatures – although some of them were fake.

“Current lockdown policies are producing devastating effects on short and long-term public health,” the declaration states, adding, “The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection.”

Essentially, herd immunity is when enough people are immune to a disease, like Covid-19, that the disease can’t be transmitted as easily and thus provides indirect protection.

It’s been rumoured that the government has been leaning towards this plan of action for some time now, although this is the first real admission.

In response to today’s news, experts around the world have been voicing their concerns.

And this isn’t the first time we’ve heard experts say herd immunity is not a good idea.

For example, the head of the World Health Organization said Monday that allowing the novel coronavirus to spread in an attempt to reach herd immunity was “simply unethical.”

Similarly, the National Institutes of Health (NIH) director Francis Collins also denounced herd immunity as a viable plan.

“What I worry about with this is it’s being presented as if it’s a major alternative view that’s held by large numbers of experts in the scientific community. That is not true. This is a fringe component of epidemiology. This is not mainstream science. It fits into the political views of certain parts of our confused political establishment,” he said in an interview.

Not to mention studies continue to show that Sweden’s attempts at herd immunity have failed and have resulted in a higher Covid-19 death toll than expected.

As more research comes out, scientists are starting to learn that Covid-19 immunity, even in those who were severely infected, can fade after a few weeks.

This is why we’ve seen cases of reinfection and why many experts are advising against a herd immunity plan.  

Currently less than 10% of the population in the U.S. are immune to Covid-19 but for herd immunity to be achieved most experts estimate between 40% to 80% of the population would need to be infected.

To put that into context, that means around 197 million people would need to be infected in America. And assuming that the Covid-19 fatality rate is somewhere between 0.5% and 1%, based on numbers from the World Health Organization (WHO), more than 1 million people would die – at minimum.

William Haseltine, Chair and President of ACCESS Health International, told CNN “herd immunity is another word for mass murder. We are looking at two to six million Americans dead – not just this year but every year.”  

This is an unmitigated disaster for our country – to have people at the highest levels of our government countermanding our best public health officials. We know this epidemic can be put under control. Other countries have done it. We are doing the opposite.”

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America’s newest wave of Covid-19 cases, explained

https://www.vox.com/coronavirus-covid19/2020/10/11/21511641/covid-19-us-cases-update-testing-deaths-hospitalizations

A new wave of Covid-19 cases is building across the United States, a harbinger of difficult winter months ahead.

America is now averaging nearly 48,000 new confirmed cases every day, the highest numbers since mid-August, according to the Covid Tracking Project. More than 34,500 Americans are currently hospitalized with Covid-19 in the US, up from less than 30,000 a week ago. Nearly 700 new deaths are being reported on average every day, too — and while that is down from August, when there were often more than 1,000 deaths a day, deaths are going to eventually start increasing if cases and hospitalizations continue to rise. It’s a pattern we have seen before.

Public health experts have been warning for months that fall and winter could lead to a spike in Covid-19 cases. Why? Because the best way to slow down the coronavirus’s spread is to keep your distance from other people and, if you are going to be around others, to be outside as much as possible — and both become harder when the weather gets cold.

We may now be seeing those predictions start to come true. The US already has more than 7.7 million confirmed cases and 214,000 deaths. Both numbers will continue to climb.

Eight months into the pandemic, America’s failures to contain Covid-19, and states’ eagerness to reopen even if they haven’t gotten their outbreaks under control, is once again leading to a surge in cases and hospitalizations.

Covid-19 cases are rising everywhere across the country

Earlier in the year, there was limited value to discussing “waves” because some states would have a decline in cases while other states were experiencing surges. What distinguishes this autumn wave is that it seems to be happening everywhere.

Case numbers are up in the Northeast, the Midwest, and the West. The South appears to be, at best, plateauing at a level even higher than that which the Northeast endured during the worst of New York’s outbreak.

What’s so worrisome is that no one state or region can be blamed for this new wave. Just 13 states have seen their number of new Covid-19 cases drop over the last two weeks, according to Covid Exit Strategy. Cases are up in all the others.

Raw case numbers can, of course, obscure important differences in population; 100 new cases means something different for California than it does for Wyoming. Experts will use another metric — new cases per million people — to gauge how saturated a given state is with Covid-19.

The goal would be to have fewer than 40 new cases per million people. But just three states — Maine, Vermont, and New Hampshire — meet that threshold. Meanwhile, North Dakota (627 cases per million), South Dakota (596), Montana (474), and Wisconsin (434) are some of the states seeing very high levels of new infections.

As Vox’s German Lopez reported this week, just one state — Maine — meets all of the benchmarks established by experts for a state to consider its Covid-19 outbreak contained. And yet, most states have reopened many of the businesses that were closed in the spring: 40 or so states have reopened restaurants, bars, gyms, movie theaters, and nonessential retail.

“Part of the problem is America never really suppressed its Covid-19 cases to begin with,” Lopez wrote, explaining why experts were anticipating a new surge in cases. “Think of a disease epidemic like a forest fire: It’s going to be really difficult to contain the virus when there are still flames raging in parts of the forest and small embers practically everywhere. The country always risks a full blaze with each step toward reopening and with each failure to take precautions seriously.”

Too many Covid-19 tests are coming back positive right now

Another closely watched indicator for renewed Covid-19 spread is the percentage of coronavirus tests that come back positive. The number of tests being conducted doesn’t actually tell you all that much; if a high percentage of them are positive, that suggests that many others aren’t being caught at all and the virus could continue to spread unchecked.

So while the US is now averaging nearly 1 million tests every day, that is not quite the triumph it might sound like (or President Donald Trump would like to believe it is). The country’s positive test rate is 5 percent, right at the threshold experts say would reflect adequate testing. Ideally, it would be even lower, 2 percent or less.

But even with that passable national positivity rate, most states are still not conducting nearly enough testing. Here are the 10 states with the highest positive test rates, according to Covid Exit Strategy:

  1. Idaho (25 percent)
  2. South Dakota (20.6 percent)
  3. Wisconsin (19.5 percent)
  4. Iowa (17.1 percent)
  5. Kansas (16.1 percent)
  6. Wyoming (15.5 percent)
  7. Utah (14.7 percent)
  8. Nevada (14.4 percent)
  9. Indiana (13.6 percent)
  10. Alabama (13.3 percent)

It’s really only a handful of better-performing states — namely, New York, with more than 115,000 tests conducted per day and a 1.2 percent positivity rate — that’s keeping the US’s overall positive test rate from looking a lot worse.

America has never had a cohesive Covid-19 testing strategy. Since February, there have been regular supply shortages delaying test results. States have been fighting each other for precious testing resources. Contact tracing has not been a priority for the federal government, and most states have still not hired nearly enough people to perform that work.

Wealthy countries like Germany and South Korea have used effective test-trace-isolate programs to keep their Covid-19 outbreaks in check. The US, meanwhile, is still struggling to perform enough tests or scale up its contact tracing capabilities. Just 11 states, plus the District of Columbia, could realistically expect to perform adequate contact tracing, according to Covid Exit Strategy, considering their positivity rate.

Without improvement in both of those areas, it will continue to be difficult for the US to contain the coronavirus before a vaccine becomes available.

More Americans are being hospitalized with Covid-19 too

Both case numbers and the positive test rate can be a little deceptive, depending on how many tests are being performed. They suggest what’s happening on the ground — in this case, Covid-19 is spreading — but they do have their limitations. There is some truth to the president’s claim that more tests will mean more cases, though that is not a reason to stop testing.

Hospitalizations, on the other hand, are more concrete. If more people are developing symptoms severe enough to warrant being hospitalized, that is a strong indicator that the real number of people being infected with Covid-19 is growing, regardless of whether they are getting tested.

And after a dip in September, the number of Americans currently in the hospital with Covid-19 is higher than it’s been in a month. That trend has been seen across the country.

The worry becomes that if hospitals take in too many patients, they’ll have to turn other people away, or that overwhelmed staff and facilities could lead to some patients receiving substandard care. According to Covid Exit Strategy, 20 states currently have reduced ICU capacity that puts them in a danger zone; 21 states have an elevated occupancy rate in their regular hospital beds.

Wisconsin, where the number of hospitalized Covid-19 patients has risen over the last month from about 300 to 876 today, recently established a new field hospital on its state park fairgrounds over fears that the state’s hospitals wouldn’t have enough beds given the recent surge in cases.

Fortunately, hospitals have gotten much better at treating Covid-19. They have proven treatments, like remdesivir and dexamethasone, that reduce the length of hospital stays and reduce mortality in patients with severe symptoms. They have learned techniques like putting patients on their stomach to improve breathing. Hospitals that have endured multiple spikes of Covid-19 cases report patients in the later waves are spending less time in the hospital and dying less frequently.

Nevertheless, more people developing severe symptoms, as we are starting to see, will inevitably lead to more deaths. Over the summer, people wondered why deaths were falling while cases and hospitalizations rose — until deaths did start to increase. There is a long lag between cases rising and deaths rising, because it can take a month or more between when a person first contracts Covid-19 and, if they die, when their death is reported.

That’s why these new Covid-19 trends in the US are so worrisome. Cases are rising, as are hospitalizations. It could be only a matter of time before deaths start to spike as well.