This problem is addressed by some of the most famous sayings of military science: "No plan survives first contact with the enemy" and "Plans are useless. Planning is essential."(foot#1)(foot#2)
A ^comment on my previous blog^ ("Resident" at 2020-04-20 4:35 pm) reminded us that Shelter-in-Place (SIP) is not a goal, but a method to achieve "flattening the curve", that is, slowing the spread of the disease to avoid hospitals becoming so overloaded that people unnecessarily die from lack of treatment. "Flattening the curve" works by a combination of reducing demand at a given time and by giving the medical system time to expand its capabilities.
When the original SIP was issued, there was limited knowledge about COVID-19, and much of it was wrong. For example, statistics from China were not credible, but were better than nothing. And the lack of US data resulting from unforgivable errors by the CDC.(foot#3)
With current knowledge/beliefs about the disease indicating that it is much less dangerous, I would have expected the SIP Order to have been adjusted to take this into account, for example, loosening up restrictions where reasonable. But as discussed in ^my previous blog^, restrictions were made stricter in case where I thought they could be loosened.
----Optional: Details on how the situation has changed----
With hospital capacity as the major justification for the SIP Order, let's look at stats from the ^Santa Clara County's (SCC) Public Health Dashboard for hospital utilization^ as of 2020-04-21.
There are currently 175 hospitalized COVID-19 patients.
• Acute Hospital Beds: total of 771 in use. Available beds (665) is 7.73 times the current usage by COVID-19 patients (86).
• ICU Beds: 134 in use. Available (105) is 1.46 times current COVID-19 usage (72).
• Surge Capacity of 1617 is only 1% used (17).
• While 28% of ventilators (186 of 671) are currently in use, recognize that there is now a well-established practice of excess ventilators from other areas to where there are shortages, as well as releasing them from storage. Recognize also that intubation ventilators are being used on a smaller percentage of severe cases because they have significant risk of serious harm, even death, and there are more effective replacements.(foot#4) SCC has a cumulative total of 1949 confirmed COVID-19 cases, with 88 deaths for a fatality rate of 4.5%.(foot#5) This death rate is now widely accepted to be invalid because of the massive undercounting of COVID-19 cases (limited testing). A study in Iceland randomly tested almost 10% of its population and found an infection rate of 0.3-0.8% in that snapshot, with roughly half of those who tested positive being asymptomatic. This was without a national shutdown. Studies elsewhere have reported an asymptomatic rate of 25-50%.
Similarly, at the time of the original SIP Order, the public statements from the medical community seemed to have a consensus that 20% of COVID-19 cases were "severe". However, my reading of the fuzzy definition of "severe case" included cases where the person had a virtually incapacitation fever extending over multiple days but did not require hospitalization, or possibly not even a telephone consultation with a doctor. With limited testing available at that time, the number of non-severe cases would have been substantially under-counted, and the count of "severe" cases would have overstated the need for hospital facilities. Consequently, I would not give any credibility to this (old) ratio.
Stanford sampled SCC residents for antibodies that would indicate that the person had had COVID-19. The study found a raw rate of 1.5%, which became 2.5% to 4.2% after various statistical adjustments.(foot#6) This study has been criticized for whether the adjustments in the statistical analysis were adequate and sophisticated enough, and whether the false positives that the test was known to produce were adequately compensated for. However, my assessment of the critiques is that they involve potential small adjustments in the results. A similar study in the Los Angeles area by the University of Southern California (USC) produced similar results.
Notice that: Although the knowledge of COVID-19 has greatly increased and its severity is assessed to be far less than earlier thought, the SIP restrictions have gone in the opposite direction without any explanation of why.
Note: Although many current assessments place the fatality rate of COVID-19 to be near that of the flu, that does not mean that it can be treated as similar to the flu. Recognize that because of vaccines, accumulated personal immunity, and herd immunity and thus is limited in the number of people it infects. In contrast, COVID-19 has the apparent potential to infect large numbers at the same time, and a small percentage of that large number could be a large enough number to overload medical facilities.
----You must obey orders!!! The authorities know more than the public and we must trust that they have made good decisions (even if they say 2+3 equals 8) ----
"Governments are instituted among Men, deriving their just Powers from the Consent of the Governed" - US Declaration of Independence.
I am disheartened by the number of comments on my previous COVID-19 blogs and other blogs that advocate for what is essentially blind obedience of orders. They reject attempts to question if rules make sense or if they are effective (^Raised in a comment on another blog^).
Point out errors and bad decisions is criticized distracting, or even undermining, the authorities. Similarly for trying to point out that the situation has changed enough that what had been a good policy no longer is.
It is discouraging the number of petty-tyrant officials that appear in online videos: front line police officers, their supervisors, local officials, governors. It is disturbing to see the number of officials who see their role as getting people to obey orders, the literal rules, rather than the intent of those rules. Does being in an apartment in a large multi-story apartment complex with interior hallways somehow block the transmission of the virus whereas being in an open field on a windy, sunny day with the nearest person 100-yards away create a serious threat requiring police enforcement and a fine. There are some (how many?) jurisdictions that act in this manner.
----Attitude toward small businesses: Carelessness, Cluelessness or Unconcerned??----
I submitted my comments to our ^County Supervisor Joe Simitian^ and receive a stock reply that was largely text from a Public Health Department FAQ that is now a dead link. While it is encouraging that there were enough emails on this issue to warrant creating a stock message, it is disconcerting that we Palo Altans also got a Cupertino-specific paragraph.
Stock message received 2020-04-21, the web link is dead as of this writing:
Thank you for your input on plant nurseries being categorized as non-essential under the most recent Public Health Order. We have heard from many members of the public on this topic so we reached out to the County Executive's office for more information. Here is what they had to say:
¶
"The goal of the shelter-in-place Order is to maximize the number of people who are staying home and limit activity as much as possible to reduce the spread of COVID-19. The Order's exemptions for allowable activities are intended to be narrow. If in doubt, the Order asks us to err on the side of avoiding activity and staying home. It is with this principle in mind that plant nurseries have been deemed non-essential businesses. Larger stores (such as Home Depot and Lowes) are allowed to stay open because they provide essential materials that help maintain the habitability of one's home (such as home plumbing emergencies). However, in our FAQ ^https://www.sccgov.org/sites/phd/DiseaseInformation/novel-coronavirus/Pages/public-health-orders.aspx#businesses^ 's, we state that plant nurseries can operate to provide for the delivery of existing inventory to residences or businesses. The decision whether or not to not operate in this capacity is up to the individual plant nursery's owner."
¶
Additionally, our office has been alerted to the closure of Yamagami's Nursery in Cupertino. We have reached out to both County Counsel and the District Attorney in regards to this closure, so please know it is being taken seriously. If you would like further information about Yamagami's, I suggest you reach out to the DA's office at pubhealthreferral@dao.sccgov.org
¶
In closing please know that as conditions change, it's likely the directions provided in the shelter-in-place order will change as well. For that reason, it's great that you got in touch with our office and we were able to forward your concerns on to the Emergency Operations Center team. They will benefit from being informed by your concerns going forward.
¶
Most importantly, I hope you are safe and well during this unprecedented time.
Another recipient of the stock message was upset enough about this response to post it as a ^comment on my previous blog^.
Of course I was troubled by the FAQ's first sentence -- that is the theme of this blog. But it was the last sentence that hit me hard, one that seemed to tell the owners they had their choice of poisons. The danger of having narrow specialists make decisions on "broad picture" issues is that they often don't realize how much damage they are doing outside their scope. Does anyone know of a good quote for this situation in the sense of The Great Gatsby's "They were careless people, Tom and Daisy -- they smashed up things and creatures ..." (chapter 9, pg 170)??
----Requests to commenters----
Many discussions on this topic have quickly become cluttered by commenters who are there to state a position, not to add to the discussion.
If you don't try to understand other perspectives, I may well interpret your comment as misrepresenting others, and potentially delete it as a violation of the guidelines.
Similarly for comments that I interpret what is being said as "There is only one correct position: Mine!".
Statements that reduce down to "The authorities must be trusted and obeyed" add nothing to the discussion (except clutter).
Aside: To begin to understand my skepticism of government, be aware that I came of age during the Vietnam War. By the mid-1960s the US leadership was aware that the war was unwinnable militarily, but built up troop levels to over 500,000, resulting in 58,000 US dead and over 300,000 wounded. Then in the Iraq invasion, the Bush Administration "allowed" themselves to be deceived by discredited intelligence in order to do what they already planned to do. They sent under-equipped National Guard units into the war -- families and towns were buying equipment such as body armor for their soldiers. Once in Iraq, the troops had to use scrap steel to provide their vehicles with non-trivial armor against IEDs (bombs). Well into the war, Secretary of Defense Rumsfeld was asked about these persistent failures and replied "You go to war with the army you have, not the army you want". Many of these failures resulted from him rejecting the issuing of additional contracts for equipment that the existing contractor couldn't deliver in sufficient volume. Better the troops suffer and die from shortages than the DoD fund a competitor to the incumbent contractor.
----My other blogs on coronavirus (COVID-19)----
"Is Palo Alto prepared for a Coronavirus outbreak?", 2020-01-30.
"Coronavirus (COVID-19): Underappreciated Unknowns & inexplicable failures", 2020-02-28.
"Preparing for COVID-19: An epidemic is not a hurricane. Panic buying harmful", 2020-03-03.
"COVID-19: Critiquing News Releases: What's missing + teachable opportunities", 2020-03-19.
"Remember the failures for when it's time for fixes: COVID-19", 2020-03-27.
"Profiteering off medical equipment and its export unimpeded", 2020-04-03.
"America held hostage ... by Congressional Democrats (COVID-19)", 2020-04-09.
"Open Letter to SCC Public Health on excessive restrictions, esp Nurseries", 2020-04-18.
----Footnotes----
1. Quote attributions:
• "No plan survives first contact with the enemy." - ^Helmuth von Moltke the Elder^, Prussian Field Marshall, reformer (revolutionary?) in the management of armies in the field, especially organization and tactics.
• "Plans are useless. Planning is essential." - US General Dwight D. Eisenhower on D-day (WW2 landing in France).
Many other variants, including "Rely on planning, but never trust plans"and "The plans are nothing, but the planning is everything".
2. Famous example of failure resulting from treating method as the goal:
The German invasion of France in 1940 was as much a French self-defeat as a German victory.The French Maginot Line work well and as intended.The French discovered the Germans moving through the Ardennes in time to respond.The French statistically had the superior army, including more tanks and better tanks.Negating all this was a communications doctrine that prioritize security of communications over speed.My favorite example is off a major French unit receiving orders over the telephonebut needing to wait for a hardcopy before they could execute on the order -- that hardcopy arrived the next day via motorcycle,long after it became irrelevant.The French were routinely unable to respond to German movements in a timely manner.Similarly for local French victories, which were routinely followed by the need to retreat.Even after the severity of the communications problem became obvious, the French army failed to respond.
3. Unforgivable errors by the CDC:
• "^The Infuriating Story of How the Government Stalled Coronavirus Testing^" by Julia Ioffe in GQ.
• "^CDC's failed coronavirus tests were tainted with coronavirus, feds confirm^" - Ars Technica, 2020-04.
• "^How testing failures allowed coronavirus to sweep the U.S.^" - Politico, 2020-03-06.
4. Harm from intubation ventilators (tube inserted down your wind pipe):
"^Ventilators are overused for Covid-19 patients, doctors say^" - STAT.
5. Santa Clara County cumulative COVID-19 case count and deaths:
April 21 update of ^Palo Alto Online's cumulative update article^.
6. Stanford antibody study:
"^Way more people may have gotten coronavirus than we thought, small antibody study suggests: Between 50 and 85 times as many people in Santa Clara County have coronavirus antibodies as have tested positive for the virus^" - Live Science, 2020-04-19.
----
An ^abbreviated index by topic and chronologically^ is available.
----Boilerplate on Commenting----
The ^Guidelines^ for comments on this blog are different from those on Town Square Forums. I am attempting to foster more civility and substantive comments by deleting violations of the guidelines.
I am particularly strict about misrepresenting what others have said (me or other commenters). If I judge your comment as likely to provoke a response of "That is not what was said", do not be surprised to have it deleted. My primary goal is to avoid unnecessary and undesirable back-and-forth, but such misrepresentations also indicate that the author is unwilling/unable to participate in a meaningful, respectful conversation on the topic.
A slur is not an argument. Neither are other forms of vilification of other participants.
If you behave like a ^Troll^, do not waste your time protesting when you get treated like one.
