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1. Here is the homepage of the website of the Gainesville Times, the largest newspaper in Hall County, Georgia, in the northeastern part of the state.
It would seem from this coverage that all is quiet on the coronavirus front in the Greater Gainesville Metroplex. It would seem that, like many rural areas in America, Gainesville has been spared the kind of death, public health, and medical infrastructure crises that New York City and other far-away places have confronted.
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2. It might seem that way from the Gainesville paper, but 55 miles to the southwest, the Atlanta Journal-Constitution tells a different tale:
A new coronavirus hot spot has emerged in northeast Georgia, stirring fears the region could see the devastating human toll already experienced in the state’s opposite corner.
The number of new cases in the Gainesville area increased exponentially each week during April, according to state data. By Tuesday, nearly four dozen patients had died in the area’s dominant hospital system….
“They’re being strained pretty hard up there at the moment,” Gov. Brian Kemp said Tuesday. He spoke in Albany, the center of what has been Georgia’s most concentrated outbreak of COVID-19, the disease caused by the new coronavirus, and said he hopes lessons from that region will help avert catastrophe across the state.
The Gainesville outbreak, which has spread into neighboring Habersham County, is another indicator that the coronavirus is far from contained in Georgia. A report to the White House by the federal Centers for Disease Control and Prevention showed that in much of Georgia, including its northeast corner, confirmed cases of the virus continue to increase or, at best, have leveled off on a high plateau….
Georgia’s death toll from the virus stood at 1,294 on Tuesday evening, up by 51 from 24 hours earlier. During each of the past seven days, the total number of deaths climbed by an average of 43, according to state data….
Hall County, which includes Gainesville, has seen a dramatic increase in confirmed cases in the past five weeks. During the week of March 29, the county recorded 86 new cases, or 12 a day. The daily average increased to 22 the following week, then 47 and then 61. Last week, Hall confirmed 662 new cases, or 95 a day — more than a seven-fold increase in five weeks….
In Hall County, the virus has disproportionately affected Latinos, who account for about half the positive cases but less than one-third of the population. Couch said the hospital system’s analysis shows that economic status also affects whether individuals contract the virus. However, he said there is no evidence that an unusual number of cases are tied to the area’s poultry processing plants, where a significant part of the workforce is Latino.
Might this story be under covered locally because of who is being most directly impacted by the pandemic?
Let’s defer that question for the moment.
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3. Once upon a time, when the virus first hit hard on both coasts, America decided that the only way to respond quickly enough was to order an unprecedented shutdown of nearly every institution in the country (business, civic, religious), except for essential services.
There was broad consensus on this emergency strategy – from Donald Trump to Gavin Newsom, from the AFL-CIO to the Chamber of Commerce, from Nancy Pelosi to Mitch McConnell, from mom-and-pop diners to Starbucks. If there was real-time disagreement, it wasn’t part of the dialogue.
Everyone appeared to concur: in order to keep hospitals in New York City and around the country from being overwhelmed and the number of deaths from rising dramatically, a shutdown was required to slow the spread.
There were no protests, no objections from the Wall Street Journal editorial page, no second-guessing by academics. Not every governor went along with the strategy, but the vast majority of Americans lived in states where citizens accepted they needed to shelter in place, and businesses and workers accepted that life was going to be strange and hard for a while.
This was Phase 1.
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4. Then Phase 2 began.
Even as New York set a terrifying example of the nightmarish circumstances that were widely expected to sweep across the country, increasingly loud voices, including the president’s, suggested that maybe Gotham City was different (international travel hub, densely packed population, vulnerable citizenry), that the cure was worse than the disease outside of extreme hotspots.
The shutdown continued during Phase 2; in fact, it expanded in some places. Stay-at-home orders and school closings were extended. Officials warned that there would be no return to business-as-sort-of-usual for quite some time.
Phase 2 was sustained, at least in part, by the continuing lack of understanding of the properties of the virus, how it was spread, how it affected the human body in vastly different ways in different individuals and groups.
The experts warned that without an exponential increase in testing, tracking, and tracing the country would be beyond foolish to consider reopening; much more visibility into the nature of the invisible enemy was needed.
All that medical mystery put the fear of death in government officials and citizens across America, who saw the chaos and carnage of the New York City area and said, in effect, better safe at home than infected with a stealthy and murderous virus.
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5. So onto Phase 3.
The impact of the economic devastation came into much sharper focus. The realization that people were dying from heart attacks and strokes without proper medical care. The stir-craziness of the American people. The increasingly vocalized sense that life, liberty, and the pursuit of happiness were being unacceptably abridged. The growing belief that New York was, in fact, an aberration. And the apparent inability of the trillions of dollars in spending and stimulus from Washington to halt the fallout for families and businesses.
A loud minority of business owners and citizens started agitating for an end to the shutdown. Public health officials went from being lukewarm about masks to saying that they could in fact mitigate a lot of community spread. The president gave states the license to start to reopen.
The debate was fractious and uneven, as Red State governors pushed towards imminent reopenings, and Blue State governors pushed back
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6. We are now in Phase 4, exemplified by President Trump’s words in Arizona on Tuesday:
“Our country is now in the next stage of the battle” against the virus and “now we are reopening our country.”
In Phase 4, Blue State governors are touting reopening alongside their Red brothers and sisters.
In Phase 4, lots of government officials and private citizens don’t wear masks in public.
In Phase 4, New York’s presidential primary is back on.
In Phase 4, news organizations besides the Gainesville Times are covering a lot of stories unrelated to the virus.
In Phase 4, the White House has begun to wind down the formal work and existence of the Pence-led task force.
In Phase 4, there is an unspoken agreement among many that the deaths of the elderly, the vulnerable, and the populations of nursing homes and meat packing facilities are the price the country will have to pay for paychecks, NFL football, and getting the kids back to school in the fall.
And in Phase 4, the argument that successful reopening is contingent on building up adequate testing, tracking, and tracing to avoid risking the creation of mini-New Yorks all over the nation is confined to the news and op-ed pages of fancy newspapers and academic journals.
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7. The full-blown advent of Phase 4 seems both inevitable and somewhat insane.
Nothing we have learned about the virus or from public health examples around the world would seem to have lessened the argument for the imperative to test, track, and trace, including finding ways to humanely isolate those who are infected from the rest of the population.
The Feds and the states give lip service to the necessity of being on guard for localized outbreaks and reacting accordingly, even, theoretically in some cases by going back to lockdowns.
But that does not seem in the cards, even (more seeming insanity) as public opinion polls continue to reflect a widespread consensus that the policies of Phase 1 are much better than the policies of Phase 4.
Look at what is happening right now, today, in – and in reaction to -- Gainesville, Georgia.
So today let’s turn most of Wide World of News over to a few voices that are relics of the long-ago Phase 1 period.
The first two voices make the case that things are not only going to get worse, but that they are worse already. See, for example, Gainesville, Georgia.
And three of those voices make the case that testing, tracking, and tracing remain the key to mitigating the damage until there is a vaccine – and that the amount of money it would take to Manhattan Project those efforts is a bargain.
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8. The New York Times with an essential read on the mirage of progress:
Across America…signs of progress obscure a darker reality.
The country is still in the firm grip of a pandemic with little hope of release. For every indication of improvement in controlling the virus, new outbreaks have emerged elsewhere, leaving the nation stuck in a steady, unrelenting march of deaths and infections.
As states continue to lift restrictions meant to stop the virus, impatient Americans are freely returning to shopping, lingering in restaurants and gathering in parks. Regular new flare-ups and super-spreader events are expected to be close behind.
Any notion that the coronavirus threat is fading away appears to be magical thinking, at odds with what the latest numbers show.
Coronavirus in America now looks like this: More than a month has passed since there was a day with fewer than 1,000 deaths from the virus….
Rural towns that one month ago were unscathed are suddenly hot spots for the virus. It is rampaging through nursing homes, meatpacking plants and prisons, killing the medically vulnerable and the poor, and new outbreaks keep emerging in grocery stores, Walmarts or factories, an ominous harbinger of what a full reopening of the economy will bring.
Ironically, the New York case was misleading when the city had a massive breakout, and is misleading again for the opposite reason, as it gets community spread under control:
“If you include New York, it looks like a plateau moving down,” said Andrew Noymer, an associate professor of public health at the University of California, Irvine. “If you exclude New York, it’s a plateau slowly moving up.”
In early April, more than 5,000 new cases were regularly being added in New York City on a daily basis. Those numbers have dropped significantly over the past few weeks, but that progress has been largely offset by increases in other major cities.
Consider Chicago and Los Angeles, which have flattened their curves and avoided the explosive growth of New York City. Even so, coronavirus cases in their counties have more than doubled since April 18. Cook County, home to Chicago, is now sometimes adding more than 2,000 new cases in a day, and Los Angeles County has often been adding at least 1,000.
Dallas County in Texas has been adding about 100 more cases a day than it was a month ago, and the counties that include Boston and Indianapolis have also reported higher numbers.
It is not just the major cities. Smaller towns and rural counties in the Midwest and South have suddenly been hit hard, underscoring the capriciousness of the pandemic.
Dakota County, Neb., which has the third-most cases per capita in the country, had no known cases as recently as April 11. Now the county is a hot zone for the virus.
And there are more Gainevilles out there, not getting much attention in the media or the national debate:
Trousdale County, Tenn., another rural area, suddenly finds itself with the nation’s highest per capita infection rate by far. A prison appears responsible for a huge spike in cases; in 10 days, this county of about 11,000 residents saw its known cases skyrocket to 1,344 from 27.
As of last week, more than half of the inmates and staff members tested at Trousdale Turner Correctional Center in Hartsville, Tenn., were positive for the virus, officials said.
“It’s been my worst nightmare since the beginning of this that this would happen,” said Dwight Jewell, chairman of the Trousdale County Commission. “I’ve been expecting this. You put that many people in a contained environment and all it takes is one.”
Everyone in town knows about the outbreak. But they are defiant: Businesses in the county are reopening this week. On Monday evening, county commissioners held an in-person meeting, with chairs spaced six feet apart. They have a budget to pass and other issues facing the county, Mr. Jewell said.
Most ominously, perhaps, many of the citizens of this nation are now like the proverbial frog, slowly and obliviously boiling to death in a pot of water that is heating up imperceptibly but inexorably:
[E]pidemiologists say the nation will not see fewer than 5,000 coronavirus-related deaths a week until after June 20, according to a survey conducted by researchers at the University of Massachusetts at Amherst.
Across the country, scientists tried to project the virus’s future course, and the results have been a range of shifting models. An aggregate of several models assembled by Nicholas Reich, a biostatistician at the University of Massachusetts, predicts there will be an average of 10,000 deaths per week for the next few weeks. That is fewer than in previous weeks, but it does not mean a peak has been passed, Dr. Reich said. In the seven-day period that ended on Sunday, about 12,700 deaths tied to the virus occurred across the country.
“There’s this idea that it’s going to go up and it’s going to come down in a symmetric curve,” Dr. Reich said. “It doesn’t have to do that. It could go up and we could have several thousand deaths per week for many weeks.”
Because of the time it will take for infections to spread, incubate and cause people to die, the effects of reopening states may not be known until at least six weeks after the fact. One model used by the Centers for Disease Control and Prevention includes an assumption that the infection rate will increase up to 20 percent in states that reopen.
Under that model, by early August, the most likely outcome is 3,000 more deaths in Georgia than the state has right now, 10,000 more each in New York and New Jersey, and around 7,000 more each in Pennsylvania, Illinois and Massachusetts. Under the model’s most likely forecast, the nation will see about 100,000 additional deaths by Aug. 4.
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9. Here is another version of the same case, from Dr. Leana Wen, an emergency physician and George Washington University Milken Institute School of Public Health professor:
I am deeply worried that the next phase of the coronavirus pandemic will bring much more suffering and many more preventable deaths…
Once social distancing is relaxed, covid-19 will again spread with explosive speed….
But, of course, that might not be apparent for weeks or even months. That’s because of the lag between new exposures to the virus and the subsequent increase in infections, hospitalizations and deaths. As everyone knows by now, the incubation period — the time between exposure and symptoms — is up to 14 days. It could take another week or two before people become ill enough to seek medical care, and another week or more for those who are severely ill to succumb to the virus. (Washington Post)
Dr. Wen projects into the future without doubt:
The danger here is that policymakers and the public will jump to the wrong conclusions if they don’t immediately see the numbers increasing. Instead of breathing a sigh of relief, they should prepare for the surge that will inevitably arrive a month or so from now: What New York went through at its peak will happen in communities across the country. Hospitals will become overwhelmed with ill patients. Staff will be forced to ration personal protective equipment. There will be shortages of intensive care unit beds and ventilators.
The difference is that this time there will likely be numerous outbreaks at once. That will strain the nation’s capacity to respond. Also worrisome is that many of these outbreaks will occur in rural communities that already struggle with lack of hospitals and health-care workers....
It will be tempting to see reopening as a return to our way of life before the coronavirus, but it will be anything but. As a society, we have made the decision to reopen before the science says we are ready. We are knowingly going back to where we were in mid-March, before the first exponential surge in infections and deaths. That surge will come again, but this time no one can say they didn’t see it coming….
What New York went through at its peak will happen in communities across the country.
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10. If one believes that these dire forecasts are accurate, what is the answer?
Back to, yes, a push for testing, tracking, and tracing.
Here is Larry Summers in a Washington Post op-ed piece, arguing that reopening without spending (relatively) small sums on the basics that most public health experts support is a mistake:
[T]his economic slowdown is a price we do not have to pay. We could substantially reduce transmission, save lives and permit the safe acceleration of reopening — if we are willing to commit the necessary resources. These would be small compared to the economic damage the virus is wreaking and the amounts we are paying to try to compensate for the losses.
The most promising strategy is establishing a system of pervasive targeted testing. If we were able to identify individuals who have potentially been infected, then quarantine those who test positive, we could substantially reduce the transmission rate. Suppose this required testing every American every week and that each test cost $20. (Both are pessimistic assumptions.) The $6.6 billion price tag would be less than one-tenth of the weekly cost of the Cares Act.
Similarly, investments in contact tracers for those who identified with covid-19 would have an extraordinarily high return. Suppose the total cost of a contact tracer is $400 daily, and that 300,000 tracers are needed to follow up on all newly discovered positive cases. The cost would only be $600 million a week, less than 1 percent of the cost of the Cares Act.
The same kinds of calculations make the case for much more spending on masks, on potential therapies and on pursuing production of plausible but still unproven vaccine candidates.
Amounts of money that are small compared to the economic losses we are suffering are immense relative to battling the virus. They should be the first priority going forward.
Dr. Tom Frieden, the former director of the CDC, and Dr. Kelly Henning, the director of public health at Bloomberg Philanthropies, make a very similar argument to Summers here.
I am for reopening safely, in a way that uses our resources and brainpower to simultaneously reduce the human carnage of both the shutdown and the virus.
How about we figure out how to make that Phase 5?
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11. Some notable Texas conflicts in America in the Age of the Virus:
* A Dallas salon owner will spend a week in jail after she was found in contempt of court Tuesday for violating an order to close her salon during the coronavirus pandemic….
“Feeding my kids is not selfish,” she told Moyé. “If you think the law is more important than kids getting fed, then please go ahead with your decision, but I am not going to shut the salon.” (Dallas Morning News)
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* “On Tuesday, state Reps. Steve Toth and Briscoe Cain sat wearing barbers’ gowns in a Houston-area salon, ready for their haircuts. Both Republicans were breaking state law by doing so, but to them, it mattered no less — one was there to send a message to Gov. Greg Abbott, and the other was there as an act of civil disobedience.
“‘A little less on the sides,’ Toth, from The Woodlands, told the hairstylist while on the phone with a Texas Tribune reporter, noting that ‘there's absolutely no reason’ why such businesses couldn't reopen their doors under proper health guidelines during the coronavirus pandemic. ‘I think these businesses need to be open,’ Cain, from Deer Park, told Fox 26 while getting his haircut.
“Hours later, their wish was granted: Abbott announced that hair salons and barber shops were among the businesses that could begin to reopen Friday — several days earlier than he had previously signaled.” (Texas Tribune)
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12. Pause for change of tone.
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13. Pause for change of tone.
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14. I cannot fully explain why Maria DeCotis lip syncing Andrew Cuomo makes me laugh out loud every time I watch it.
I just know that it does.
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CORRECTION: The wise people of Chelm only debated whether to replace one sign on the road leading to town – not several signs, as I reported on Tuesday. I regret the error, in part because the joke is funnier with just one sign.
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Please stay in touch and stay well.
Mark