On Reopening ..

.. Let’s just not reopen, let’s move ahead:

  • We have learned much about Telecommuting, Remote Education and Telemedicine .. let’s learn more. I’m sure there are a few symposiums in the future for these groups.
  • We’ve also learned about traffic patterns .. do all these streets need to be reopened? Especially those around parks? Let’s have a look.
  • Our digital infrastructure performed well enough for my company’s ~2,200 global staff .. but did it for everyone else? Where does this need to be upgraded? The responsibility for this will likely fall into the hands of forward-thinking corporate sponsors.

Right now, let’s learn from this. We must “Apply the Lessons of History” and make the new present the roadmap to move forward.

What’s possible? Well, if we think through it:

  • Companies can spend less on office space.
  • Workers will spend less on gas.
  • Everyone gets their commute time back.

Sounds good .. But:

  • Offices can re-think workspaces, manage meeting rooms and traffic patterns. Might be easier if part of their workforce remains in WFH mode.
  • Commercial buildings must consider public spaces, elevators, traffic patterns from the car park to the buildings. Easy to put tape on the floor, but how to ensure compliance?
  • Restaurants need to manage profitability at 25-50% of capacity .. easier with outdoor seating, but what changes can they consider for inside? More open-air? Better ventilation / filtration?
  • Schools can separate desks and manage traffic patterns, but reducing schools to 40-50% of capacity potentially means split shifts, more teachers, automated curriculum, a combination of in-person and remote education, and many more considerations.

Just some thoughts, fueled by the push to re-open, regardless of the risks that still exist in some areas.

Again, the variable in the equation is us. I call this out in “Follow the Data .. Not the Date ..“. If we find ourselves returning to these shared spaces we must ensure we take all the precautions available to us and modify our behavior accordingly .. not only to protect us, but to protect everyone else.

Respect the Mask .. it’s important.

Be smart. Stay connected. Stay safe. Stay home when you can. Be careful when you’re not.

We Need to Learn to Live With It ..

.. not pretend it will go away .. it’s still here.

.. not believe it has gone away .. it’s still here.

.. avoid discounting it .. it’s’ still here.

.. respond, rather than react .. it’s still here.

.. to behave. Forget Herd Immunity for now .. think Herd Protection:

  • My actions protect you and those whom I love.
  • Your actions protect me and those whom you love .. and by proxy, those whom I love.
  • Our actions protect us all.

Herd Immunity occurs roughly with ~60-70% of the population being infected. Given the transmission and the mortality rate of this virus, we would see an even more-horrifying human toll if we just let ‘nature take its course’.

Let’s not.

We must adapt, to recognize:

  • Susceptible  / at-risk populations must be protected.
  • There is no shame in wearing a mask.
  • There are some trips we don’t need to take right now.
  • Cooking at home is fun and saves money.
  • Trusting in each other will get us through this.

We must also recognize that the results of any changes we make today will not show up for 10-14 days after we make them.

I posted “Georgia on my Mind” on April 21st, three days before Governor Kemp reopened certain businesses that included Tattoo and massage parlors, salons and barbers, and bowling alleys. These are not exactly businesses where social distancing could be followed (or enforced).

In two weeks, 10,024 new cases and 500 deaths (5% of new cases). Rough math (please check me and advise) suggests a 69% increase in cases and a 64% increase in deaths. In two weeks.

Today is May 13th. COVID-19 cases in Georgia stand at 35,427 with 1,517 deaths in the state.

All figures from 11Alive WXIA, our local all-news channel (from the About page on their site).

This does not appear to be moving in the proper direction .. so, why these businesses? Why this time frame?

Back to basics. “Follow the Data .. Not the Date“. “Behave Like you have it ..” and “Let’s Not Undo ..“.

By now, you know the drill.

Be smart. Stay connected. Stay safe. Stay home when you can. Be careful when you’re not.

Testing .. Tracing .. Isolating

That’s the kit. “If the White House Isn’t COVID-Free ..” we simply cannot expect that any place else will be.

We have to “Follow the Data .. Not the Date“, where I state: “COVID-19 is the only constant in the equation” and send you off to “The Virus is Unpredictable ..” (with which I disagree .. It’s quite predictable, especially when compared to other, more human factors).

Okay. Now you’re caught up .. or I am. I can never tell these daze.

Testing, tracing and isolating (those who test positive, rather than the entire population) are three components necessary to stop the spread and move toward normality. Period. End of statement. Full stop:

  • We need to know who has it.
  • We need to know with whom they’ve interacted.
  • We need to isolate those who test positive so they can recover without infecting others.

Until we have the infrastructure to test, trace and isolate in place, we must all “Behave Like You Have It ..“.

Apologies. NOW we’re all caught up.

So, without testing, tracing and isolating, we are, by default, depending on the painful and dangerous method of Herd Immunity. Herd Immunity is an indirect method of protection, dependent on reaching a stage in an infection where the majority of the population is immune so the virus cannot find a place to take hold. If it cannot take hold, it stops spreading.

Painful, because a lot of people will get sick. Dangerous, because a lot of the susceptible will die. I don’t want to dive back into the lore of “The Resolved” (written quite a while back), as many people who have resolved have developed other, fatal symptoms .. the most recent group being US Children Severely Sickened by Coronavirus. An earlier group from South Korea: “South Korea reports recovered coronavirus patients testing positive again“.

To this, we’re not sure if the Resolved are permanently (or even temporarily) immune to 1) contracting the virus again, or 2) being able to spread it, even though they’d resolved.

So, Herd Immunity is out .. or so you would think. Note that some 47 states are “Betting on the Come ..” in that they’re betting that something will get better. Lower numbers, a therapeutic or that a vaccine will suddenly materialize and save us all (‘Abracadabra’ instead of ‘Avada Kedavra’). While the Governors have some good re-opening plans, I have concerns they cannot depend on the vagaries of human behavior and the need for us all to behave.

Okay. Closing this one down. Testing .. tracing .. isolating are the three components necessary to stop the spread and move toward normality. Let’s get there.

Be smart. Stay connected. Stay safe. Stay home when you can. Be careful when you’re not.

If the White House Isn’t COVID-Free ..

.. how can the Governors, Mayors and Business Owners reliably assure us that it’s safe to go out?

Please don’t misinterpret my statements:

  • I’m all for getting out .. safely.
  • I’m all for the impacted workers to get back to their workplaces and their lives.
  • I’m all for keeping family members safe should we go out and be exposed before it’s safe to do so.

If the White House cannot do it, how do we ensure that the spaces we occupy are also COVID-Free?

Taking lessons from major operational changes we’ve enacted for keeping essential workers safe goes a long way. Think about your last trip to the grocery:

  • All workers wear masks and gloves.
  • Workers are disinfecting the carts and regulating customer density in the store.
  • Carts help to manage the distance between customers.
  • Marks on the floor guide you where to stand when queuing to pay.
  • Cashiers are safely behind plexiglass.
  • When you leave, someone else is allowed in.
  • Shorter hours and nightly disinfection operations.

Consider some options for Restaurants and Retail:

  • 25% of capacity.
  • Mandatory reservations and appointments for dining and shopping.
  • Ordering in advance. Online menus make this easy for restaurants, retailers might have to be creative.
  • “Camping” (restaurant) and “Browsing” (retail) are discouraged .. perhaps even extending to mandated departure times.
  • Everyone wears masks and gloves .. workers and customers.
  • Shorter hours and nightly disinfection operations.

Now, grocery stores are essential businesses and can likely offset the additional labor costs for customer management and cleaning operations through shortened hours and mostly-guaranteed traffic. Restaurants aren’t so lucky, and may be challenged to make a profit with only 25% of capacity. Those with an outside seating option may fare better as we’re into Spring and Summer.

But, what of retailers? Curbside pick-up? Adapt the online ordering model and set up shopping ‘zones’ where selected items could be relocated for a shopper? Mandatory purchase of a gift certificate to be spent this visit or the next?

Economists will do studies on this transition for years .. aided by lots of BI, I’m sure.

Now, as to the offices. How can we trust the person in the next chair? In the next cubicle? On the bus? In the Uber?

We cannot. Americans want to be protected when they get back to work. Assuming we make it into the office (transit aside), our employers must consider:

  • Temperature screening.
  • Testing protocols.
  • A multitude of CDC-defined best practices.
  • New cleaning protocols.
  • Liability insurance.

These challenges are of no fault of our employers .. but as with grocers, restaurants and retailers, there are significant challenges to ensure the workplace is safe. Recall that in “Updated Symptoms for COVID-19” I reference an outbreak that took place in January in a Chicago Contact Center (thanks to the New York Times for this article).

The White House is now testing and contact tracing on a daily basis, so they should be safe (ish). However, on a nationwide level, we are not seeing the same kind of testing and contact tracing.

Note to self: write an article that covers the LOE of contact tracing. The short bit:

  • You test positive.
  • A Contact Tracer (a person) sits down with you, likely referring to your mobile device to see where you’ve been over the past; days that represent your acquisition and incubation period.
  • This person grills you for all the folks with whom you interacted and makes a list.
  • Other Contract Tracers start dialing these people to ascertain their status .. and with whom they interacted.
  • If positive, lather, rinse, repeat. If negative, caution to stay safe and “Behave Like You Have It ..” until they know.

.. it goes on and on. It will take an Army, however, given the current employment environment, we do have folks we could hire and train to do this work.

The States say they’re ‘going slow’ .. but have they acquired the tests and the means to process them? Have they recruited the army of contact tracers? I guess it depends on the state.

Enough on this one .. too many circular references that all end in one conclusion: we don’t have the tests we need. I posted “Testing, Testing, Testing” two months ago, asking exactly the same question.

For now, Follow the Data .. Not the Date.

Stay connected. Stay safe. Stay home when you can.

Follow the Data .. Not the Date

Or the title could read: “Follow the Data .. Not the Desire ..”  .. Or, “.. not the Demand ..“, as it seems today.

Speaking of dates .. it’s been six daze since my last post. Six busy daze. Apologies.

Back to it. I got to thinking .. there are so many folks who ask:

  • “When can we .. “
  • “When will we be able to .. “
  • “How will we know when .. “

.. you get the drift.

To be clear .. we don’t set the timetable. COVID-19 sets the timetable. COVID-19 is the only constant in the equation. I discuss this in an earlier post: “The Virus is Unpredictable ..“.

It’s not. We must:

  • Follow the data which gives us the facts.
  • Follow the science, old (how viruses behave) and new, in the form of the developments that guide us.
  • Follow the recent history. This has demonstrated how changing our behavior (behavior is inherently a variable in any equation that involves humans) has changed the course of the spread of the virus.

Forty-seven states are in various stages of re-opening at this time (link to a Friday recap, but the situation is changing by the moment). As of this writing:

  • None of the states have met the Guidelines for Opening Up America Again, as set by the White House. None.
  • The White House has rejected the CDC plan to provide guidance to states, so we’ll see fifty different plans .. but granted, there are fifty different states each with their own demographics, geography, assets and data.
  • The State Governors are leveraging their best resources to provide the most practical (and safe) directives to their populace .. I don’t agree with some of the policies I’ve heard, but I’m not an elected official, and “I’m Not a Doctor ..“. I hope that good judgment is applied by the Governors and their people to avoid a second wave of the virus.

As to the people: we need to behave. We need to follow the guidelines, even so far as to “Behave Like You Have It ..” to protect others:

  • If you need to go to work, go to work, but safely.
  • If you need to go out, go out, but safely.
  • Follow the rules. Avoid large gatherings. Wear a mask.

The pressure to re-open is more for economic and political reasons, and not based on the science. However, as situations differ across states, cities and within companies, we can apply the science to act safely and reduce risk. This is up to the people, as the government is giving us the latitude to make these decisions ourselves.

We have the option to choose to behave safely, or not. It is up to us. “Let’s Not Undo ..” the good work we’ve done.

Stay connected. Stay safe. Stay home when you can.

Wear / Where’s Your Mask?

Wear your mask / where’s your mask?

I posted “Respect the Mask” one month ago, today. My primary concern was for those of us (non-essential workers) who have to venture out to protect those who have to venture out. In it, I said:

Any mask (even a scarf) will give you some protection from some spray droplets from others (and others from yours, should you sneeze), but not 100%, and not from aerosolized droplets.

So, I’ve said that my mask / scarf protects you from me, your wearing a mask / scarf protects me from you. It goes further. Our masks protect those who are not with us at the moment we encounter each other. They are our family members, our co-workers, the essential workers we might encounter .. the list goes on.

Each potential contact is a potential infection .. If not for us, for someone else:

  • The ambulance or hospital worker who has to admit either of us to the hospital.
  • Consumption of the PPE for workers attending to us.
  • A hospital bed.
  • A ventilator.
  • Consumption of any drugs administered to us.
  • Last, any of those with whom we came into contact ..

.. just because one of us chose to avoid the mask.

The masks aren’t perfect. Only the N95, and only when properly used is near 100% effective.

Masks are not a challenge to your personal or political right or your party, nor are they a challenge to your Constitutional Freedoms.

Let’s make this simple: given that the virus hasn’t changed and is every bit as contagious as it was back in February / March, we need to “Behave Like (We) Have It ..“. In short: If you don’t have to be about in public right now, please don’t. The virus has not changed .. “Let’s Not Undo ..” the good work we’ve done.

If nothing else, think of wearing a mask it as a courtesy .. think of it as you won’t have to shave for a while longer .. get a decorative one and make it a fashion statement.

Please, just wear it when in public. Protect yourself and others.

Stay connected. Stay safe. Stay home.

Betting on the Come ..

Betting on the Come” is a gambling term. In cards, it’s when a player doesn’t quite have the hand s/he needs, but will place or increase their bet in the hopes they’ll get the card they need to win.

For me, it’s a Craps term. I play Craps .. well, when I can get to Las Vegas (and I’m hoping to in the coming year .. has been too long). ‘Betting on the Come’ in Craps means the dice select the number on which your bet will be placed, and when this number is thrown again (before a 7), the player wins. I know .. it sounds a bit circular. Think of it as a Quick Pick in Lotto.

I am not a Doctor ..“, but I feel like the states that are opening in defiance of the “Support for States, Tribes, Localities and Territories” guidance published by the CDC are ‘Betting on the Come’. Now, in cards or in craps, it means money is on the table and a bet can be lost.

With COVID-19, it can mean:

  • At the least, longer in Shelter in Place for many (or all).
  • The risk of a second wave.
  • At the worst: an increase in the numbers of cases and deaths.

.. or any / all of the above.

The states are betting on things like:

  • People will “Behave Like They Have It ..“, practicing social distancing, wearing masks, avoiding large groups, and so many other activities that protect all of us.
  • People, Cities and States will protect the most vulnerable from those who behave (or don’t).
  • Hospital resources can handle any additional capacity from those who behave (or don’t).
  • States and Communities will roll out “Testing, Testing, Testing” and “Contact Tracing“.
  • Remdesivir will give critical patients an extra edge to survive .. but note this is only after they’re hospitalized.
  • Herd Immunity will start to grow, protecting the bulk of the population (not necessarily the most vulnerable).
  • A vaccine will appear .. the earliest, and only for emergency use, is projected to January 2021.

We’re a big, diverse country. The states

In short (too late!) “Let’s Not Undo ..” all that we’ve gone through up to this point. Let’s not roll back the clock and the wave of infection growth to two weeks past (the incubation period) pre-shelter levels. For context:

  • Shelter in Place appeared mid- to end-of-March (I’ve been SIP since March 13th and Georgia Ordered and Commanded it on April 1st.).
  • On April 1st, the US death toll was ~4,300.
  • The present US death toll (noon on May 1, 2020) is 63,127.

30 days. 59,123 lives lost. This is with Shelter in Place, Social Distancing and all the rest.

It’s not just me: “As states ease coronavirus restrictions, some are taking a ‘significant risk,’ Fauci says“. He also “.. warns states against ‘leapfrogging’ guidelines on reopening“.

They (the States) are .. leapfrogging, that is.

Stay connected. Stay safe. Stay home.

Remdesivir

Remdesivir (I had to add it to spell check). From the maker of the product:

Remdesivir is an investigational nucleotide analog with broad-spectrum antiviral activity – it is not approved anywhere globally for any use.

I had to look some other bits up too:

  • A Nucleotide is a compound consisting of a nucleoside linked to a phosphate group. Nucleotides form the basic structural unit of nucleic acids such as DNA.
  • A phosphate group is made when a phosphorus atom is surrounded by four oxygen atoms and then attached to (one of many) carbon-containing molecules in our bodies.
  • A phosphate group can activate proteins, referred to as phosphorylated. When phosphorylated, a protein is activated and can do a different job, such as carrying a message to another protein in the cell, or even phosphorylating another protein.

:: whew ::

That’s as far as I got down the rabbit hole before I remembered the words of Dr. Fauci:

“The data shows that Remdesivir has a clear-cut, significant, positive effect in diminishing the time to recovery ..”

and

“What it has proven is that a drug can block this virus.”

It does so by blocking an enzyme that the virus uses, slowing the growth / spread within a patient.

You’ve read the results by now: in a small (but significant) test, people who were administered the drug (intravenously) recovered three days sooner (11-14 days) than those in the placebo group. This is significant because:

  • Getting well is always better .. although this cohort would have likely gotten well on their own.
  • Shorter duration is always better .. less time for the virus to do damage to your lungs or other organs.
  • It gives us all some hope .. and helps revise targets for the researchers.

It is not a cure .. you have to have the virus for it to be effective. It slows the growth of the virus so your body can build the antibodies to kill it.

It is good news. Please don’t read my notes above in any way that says otherwise. It doesn’t get us out of the woods .. We still have to avoid undoing all the good we’ve done, and testing is still a critical factor in getting to a ‘newer normal’.

Stay connected. Stay safe. Stay home.

Let’s Not Undo ..

.. all the good effort .. let’s not re-do all the pain.

Let’s not waste what we’ve gained in the form of:

  • Lower case count ..
  • Lower hospitalization count ..
  • Lower death count ..

.. because we’re impatient, have cabin fever or don’t believe .. or don’t behave.

Some states (including the one in which I live) are opening prematurely and potentially carelessly.

Prematurely in that:

Georgia might meet the criteria for hospital beds and ICUs (I couldn’t find these numbers). It also sounds like PPE is finally flowing and medical staff is less strained. But even with impressive medical capacities, we are flying blind.

Carelessly in that the types of businesses the Georgia Governor has chosen to open (see “Georgia on my Mind ..“). The short version:

  • It’s physically impossible to get a hair cut or style from six feet away.
  • Or getting a tattoo .. or a massage.
  • On Monday, restaurants and movie theatres were allowed to open (guidelines therein). Note that even at reduced capacity (seats in a theatre, tables in a restaurant) patrons who enter will touch the same door handles, interact with the same people for a duration, breathe the same air, use the same restrooms, etc.

It is incumbent on the individual businesses to:

  • Protect their employees.
  • Protect their customers.
  • Protect against contributing to additional spread.
  • .. and more. Many business have heard the call to open and what some businesses have said back.

Our discipline has flattened the curve and slowed the spread. The effort has been no less than tremendous. The numbers are lower than originally cited because of this. While this has proven to be an unbelievable challenge for many families, businesses and to our economy, it was the only tool in our kit to combat the virus at scale. We do not want to undo these efforts and prolong the pain.

The “Numbers are Good ..” because of our vigilance. Our vigilance ensures the Healthcare Heroes are not overwhelmed.

Be smart. If you go out, avoid close contact, large groups, and “Behave Like You Have It ..“. Assume others are similar risks to you as you are to them.

Stay connected. Stay safe. Stay home.

Maybe I’m Coming Late To This Party ..

.. wouldn’t be the first time.

After posting “Updated Symptoms for COVID-19“, I went through my emails in January as I recalled that I felt poorly in January. I had attributed it to my office as the primary AC return vents are therein, and the temperature varies widely. My case was mild .. light fever, chills, foggy head and general aches / pains that went on for about five days. My solution was to WFH where I felt better.

So .. two bits out of this:

  • Did I have it? Not sure .. It was odd, and I’m rarely sick.
  • How would I get an antibody test?

No clue as to either. I’ve written my PCP and Atlanta Blood Services (I donate platelets regularly) to see if I could be tested the next time I donate .. but other than these two avenues, I have no idea how to get a test.

Now, I wrote at length about “The Resolved” .. those who have had the virus where I suggested that antibody testing is critical, and we don’t know (yet) if all detected antibodies are viable against COVID-19, or if they are persistent for all time. Please recall that we receive various ‘boosters’ from time to time to ensure initial inoculations remain viable.

So .. step by step, learning every day, we sort the issues this Novel Coronavirus creates for us .. and we conquer them. Right now the most important and powerful weapon in our arsenal is the ability to avoid transferring the virus amongst ourselves, which replenishes and extends the reservoir that will come back to haunt us.

Stay connected. Stay safe. Stay home.

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