Refleks

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Yes Well... yes. In the end, that accomplishes the same task. If you're sick and don't know it, it mitigates the chances that you will spread it to others. If you're not sick but everyone else is wearing source control, it reduces the chances that you will become infected. Tackling this problem from both ends. The approaches aren't mutually exclusive and work best together. That's why health care providers wear N95 / Eye Pro / Gowns / Gloves / Practice hand hygiene / Minimize contact time / Practice social distancing..... AND put a mask on the patient. Source control only works if sources practice it, and what a lot of us have been trying to drive home here is that everyone is a potential source, even if you don't feel sick, since you can spread this well before you feel sick yourself, to a more significant degree than other things we're familiar with like Flu. And breathing, even. All of this was well known since early March. The information was not appropriately disseminated by officials.

If a silver lining can be found in all of this, it is that perhaps those who have adapted to become utterly dependent on the state for their well-being now has a healthy skepticism about their competence and a more realistic assessment of their limitations, and take it upon themselves to share at least some responsibility for their own well-being going forward, at least to give the Government time to gear up their response and shake the rust off. This would result in a healthy mix of responsibility and a far more resilient populace with a robust ability to absorb hardship whether it be through natural disaster, terrorism, scarcity, or otherwise. Unfortunately, I suspect many will go out of their way to miss the lesson and instead say the shortcomings were a flaw in this particular administration rather than an inherent limitation of the nature of the state, and these lessons will be forgotten in a generation.

Indeed. This is a summary of some of my earlier comments but bears mentioning IMO They knew, it was a deliberate decision to try and reduce panic buying (which happened anyway) as Fauci implicitly admitted in an article shortly before the announcement. I understand the need to try and avoid panic, but there are two things wrong with that. Firstly, there should never be a reason that we lack mission critical items (especially PPE, given the universal nature of its importance) necessary to do the job, and that represents a failure of leadership full stop. Our stockpile consisted of somewhere around 112 million N95 masks, reduced after the H1N1 epidemic in 2009-2010 to just 12 million and never replenished. It should have been on the order of 3.5 billion according to one testimony by a SME, which at $2.50 / kg represents less than $200 million in material costs. That's stupid cheap, in the grand scheme of things, even accounting for having to replace them due to expiration dates. Sometimes distribution can understandably be a problem (such as immediately following a natural disaster) but supply should not be -- panic buying is a known variable that can be accounted for in emergency management planning, and whether or not the public panic buys should therefore be irrelevant to mission readiness on the healthcare end if things are running as they should. Unfortunately, we are where we are, you fight with the army you have, and that will hopefully be addressed in the after action report (along with several ranking members hopefully having to update their resume) Secondly, it's disingenuous to deliberately mislead people about the efficacy of an intervention at mitigating potential risk in order to manipulate their actions (in other words, saying "masks do not help the general public" driven not by actual evidence, but because we're short and want to avoid panic buying) and is extraordinarily unethical and would likely be career ending if anyone else was caught doing it. The layperson may not be subject matter experts but they know when something doesn't add up, and it understandably sounded suspect when officials implied that coughing into your arm helps, as do masks for medical professionals, but not for anyone else. People aren't stupid, and they really don't like being misled. Public threads on social media indicated that a non trivial number of people immediately referenced the Surgeon General and parroted the claims that masks don't help. Their contention was likely that if you're practicing social distancing like you should be doing, the general public doesn't need masks, and combined with the severe shortage of PPE they were hoping it would trick the populace into not panic buying. Not only did it not prevent panic buying, but downplaying the seriousness and significant potential for pre-symptomatic transmission (relative to things like Flu) which were known caused everyone down the line to drag their feet in their response, and it illustrated a fundamental disconnect between ostensible guidelines and the realities on the ground, as evidenced by the pictures in mid-March of standing room only crowds at the airport and essential businesses being slow to implement social distancing measures. Those people really thought masks didn't help. So I get their contention, and do not care. This isn't China or HBO's Chernobyl, this is the United States and It's unethical to not be fully truthful to the public for fear of them not being responsible enough to do what is necessary. We can't make informed decisions when authoritative sources deliberately and selectively manipulate information. These actions were deliberate and hurt the public trust, potentially irrevocably, and in the press conference they tried to play this information off as if they didn't have it the whole time and were keeping us up to date with the latest developments. Their approach was conduct unbecoming and this should not be forgotten in the wake of this, because without a doubt their actions cost lives that didn't have to be lost.

February

https://twitter.com/...197218941468673 Now recommends people wear masks, turns out this stuff can be spread pre-symptomatically. Gee.

I have to admit, this one kinda chaps my ass. https://www.politico.com/news/2020/03/31/fauci-mask-recommendation-coronavirus-157476 Dr Fauci admits that the reluctance to recommend masks for all was driven by an effort to prevent panic buying rather than them actually not being potentially helpful. If there wasn't a shortage, hypothetically, if we were just swimming in PPE, would officials recommend masks for those who do go out (in addition to social distancing and proper hand hygiene), out of an abundance of caution? If yes, then it was disingenuous for them to say masks don't help as a technique to reduce panic buying. The panic buying occurred anyway. Lying to the populace in an effort to manipulate their actions through game theory is something an authoritarian country would do, that's conduct unbecoming in the west at least ostensibly. Again, masks aren't a panacea, there are some caveats but as part of a comprehensive strategy to mitigate risks they have their place. The point is, you don't lie about the potential efficacy of an intervention that could mitigate risks for unrelated reasons, like the fear that we aren't responsible enough to handle the truth: that we shouldn't get them, not because they don't help, but because healthcare workers need them more. That destroys the public trust. People may not be doctors but they're not stupid, they know when something doesn't add up. Like when public officials say "coughing into your arm helps, and a masks for those with a medical license helps" but implying nothing in between is effective.

Comfort is in New York now. Great sight, but those things are aching for replacement... maybe in the wake of this a clean sheet hospital ship will get funded and produced in useful numbers

Indeed. And 112 million masks wouldn't have lasted long either, on the order of a week or so with best practices that preclude reuse. That's it -- that's all we had for contingencies. Had this been a significantly worse pandemic, the tolls would be staggering. Speaking of expiration dates, our stockpile of pharmaceuticals and domestic capacity to produce them would probably be another surprise to most. Even with the DOD SLEP testing and evaluating their efficacy after expiration dates, a lot of people aren't going to be getting their medicine in very short order. Even covering 10% of the population over existing capability seems well out of reach -- that would be on the order of 30 million patients once ICUs are full. Well outside the bounds of what we could expect to achieve without giving it armed services like budgets (which I'm not opposed to). We are, in the end, consumers, living figuratively paycheck to paycheck.

"US never spent enough on emergency stockpile, former managers say" https://www.registerguard.com/zz/news/20200327/us-never-spent-enough-on-emergency-stockpile-former-managers-say Meanwhile... https://www.space.com/space-force-2021-budget-request.html Considering this has done more damage to the US (and global) economy than ISIS, North Korea, Iran, or literally anyone else could have ever dreamed of accomplishing through conventional means, you'd think it would warrant the same attention as a branch of the armed forces, from the national security perspective.

One of my biggest questions as a first responder was how were we so ill equipped to respond on the PPE and basic necessities front? I had assumed all this was well sorted... but In the IAFC brief they were tapping into the strategic national stockpile and still predicting severe shortages in short order. Why? We're mere weeks into this thing. What would have happened if a far more serious outbreak occurred, a real world CBRN event or even natural disaster? Why does it take a pandemic to illuminate the issues? I did finally find an article at least referencing it (refreshing considering it should have _literally_ been the next question after "healthcare workers are running out of PPE"). According to this article 100 million masks were used under Obama for the H1N1 event, leaving around 12 million in the stockpile and the stockpile was never replenished. But even if it had been replenished, it's well short of the 3.5 billion mask recommendation. https://www.studentnewsdaily.com/daily-news-article/la-times-and-bloomberg-news-federal-stockpile-of-n95-masks-was-depleted-under-obama/ We can argue whether heads should roll or not, but the way forward is clear -- un-f*&# it and never let it happen again. Too many people ostensibly responsible for emergency management planning and preparation on the federal level are getting paid fat salaries for this to be a thing. We all know the Federal Govt can screw up a wet dream, but a lot of people are utterly dependent on the state and their faith is still inexplicably unshaken.

Just remember, when the first case arrives it's been there, spreading, potentially a week or more (4.5 days serial interval, up to 14 days incubation period). Turns out if you cough loud enough you don't have to wait in line at the grocery store though

IAFC briefing

Speaking of bad advice... Any time a public figure says "if you are feeling healthy..."

By far the most significant change public officials can make is to tell everyone to they should consider themselves a potential source of infection even if they don't feel sick and even if they're in a low-risk age bracket, and rescind this nonsense that masks don't do you any good. We don't need to cause panic, but we do need to improve source control (that includes potential source control), and that includes pre-hospital healthcare providers treating every patient as potentially infected even if they called 911 for unrelated reasons (the regular calls don't stop just because there's a pandemic) not just when they have flu-like symptoms. Masks aren't a pancea by any means as we've discussed earlier, but if everyone was on the same page regarding best practices it likely wouldn't have even gotten to the point of community spread as long as aggressive and decisive action was taken early, especially considering the lead up and warning we enjoyed this time around. People balk at the idea of shutting down flights, schools, and large gatherings early (after all, that's tens of billions to the taxpayer and weeks of lost revenue).... right up until the alternative is trillions and months.

While it's accurate that the flu kills more every year and the media doesn't give it attention (it's just accepted as a given, like drunk driving deaths), so in broad scope I get what your saying, but there are some key differences as it relates to people on an individual level. There is a flu immunization available, so Grandma might be able to avoid it (or at least benefit from herd protection) without having to pay extra special attention to social distancing precautions, the flu has a significantly lower mortality rate and ICU resources are generally available when there isn't a pandemic going on at the same time, so even if Grandma gets it she is generally less likely to die, and the flu has significantly less pre-symptomatic transmission risks. So it's not an apples to apples comparison as it relates to people on an individual level.

Using flu-like symptoms and screening questions is fine, but is insufficient on it's own given what we know about pre-symptomatic transmission. The only thing that would have helped would be a populace properly educated by public officials early on, especially regarding treating themselves as a potential source even if they don't feel sick. Calling for calm is appropriate, but not at the expense of providing critical information, thinking that they can't handle it.

Our own website mentioned the number of tests are only in the hundreds. That means there is very little correlation between confirmed and actual cases, the number of infected are likely orders of magnitude higher. Given what we know about the potential for pre-symptomatic transmission along with how little the media or official announcements are emphasizing that potential risk, we are about to see a significant rise in cases that didn’t have to happen.

As far as I know, no. When a relative of mine selected a course, it was from a list of private vendors which varied in price but none were free that I saw. Some of the slides said "Department of Tennessee Safety & Homeland Security" in the corner, so my guess is that the state left it up to private companies to deliver state mandated minimum content which they presumably provided, while still leaving some flexibility for the companies to add their own two cents with regards to additional content on top of that, but having only seen the content of one of the courses that's just as guess. I don't know why they didn't just make the information available and accessible publicly for self study then offer a test like they do with the Boater Safety Course, but perhaps it was a way to appease the companies given the loss of business they may have experienced in the wake of this.

Double tap

The tragic irony (and paradox) of countering pandemics is if you are appropriately aggressive early enough and successfully isolate and contain an outbreak, the population will think you overreacted because it wasnt worse. But it wasnt worse because of how you reacted. They will associate it with not being as bad as the govt thought. That means spending tens of billions (which seems reasonable now compared to the economic impact) will be so relatively extreme early on that people will balk at the idea. This is one of the things where proportional response is not what you want. Experience overseas has shown the median serial interval for coronavirus is shorter than the median incubation period so an infected person can spread the virus potentially for days prior to feeling ill, showing signs and symptoms or even knowing they are infected. I am concerned with this one, but its because I live in proximity to a 65 yo and 70 yo who are important to me, and who have a lot of comorbid risk factors. So I will take the funny looks going to the store wearing a mask while people buying all the toilet paper get a nod.

Yes it’s true that eyes are a vector for infection, but it’s irresponsible to tell people that if you don’t have a full face respirator you may as well not even bother. When it comes to mitigation measures across populations we do not take an all or nothing approach . Respiratory protection is not a panacea, but as one part of a comprehensive strategy they can and do help, and in more ways than most people might think. Though you can still rub your eyes if only wearing half face protection, it’s a lot more difficult to inadvertently touch your nose or mouth. Even surgical masks, which provide negligible protection for those who aren’t sick, perform this function, and if you ARE sick and don’t know it, it’s a silly simple way to insure you’re covering your mouth when you cough and sneeze and reduce the distance at which aerosolized droplets will travel. Finally, it’s fairly trivial to complement a half face mask respirator / disposable mask with eye protection. The most important thing is education and ensuring the average baseline literacy on the subject is increased across the population, but organizations endeavor to keep things simple and that sometimes leads to misunderstandings and people drawing their own conclusions to the detriment of the objectives. These little measures do add up, and are most effective it implemented early, but significantly less so if people wait until it’s in their local community where self quarantine starts to become crucial

One point of frustration for me is the attitude I'm seeing locally that "keep calm and wash your hands" equates to "we can stop this by washing our hands". In other words, people are thinking that as long as susan over in so-and-so county doesn't screw this up, it won't even reach my hometown and will peter out. That's not how this works. Once it spreads beyond a certain point, the best case scenario isn't "it likely won't even reach me", it's instead "this is going to get significantly worse before it gets better, and the majority of the population is likely to be exposed at some point or another, and the knob we can control is getting the fatalities down near the bottom of the estimated rates if we all do our part" which is a very different takeaway when they say keep calm and wash your hands. The cavalier attitude and bemused mood on social media is a bit disconcerting, considering an authoritarian regime with little to no individual rights to worry about was unable to prevent the pandemic despite clamping down relatively decisively (after the usual denial stage) with near draconian measures. Maybe they should have just washed their hands? Pay close attention to what's happening in Italy. New York is going to be a canary, and will set the pace for what's to come. Now of course we know that in almost every age bracket (except apparently the very young) there is a small percentage that someone will be killed by this, as with most viruses (including the Flu, to a lesser degree of lethality), particularly if they have comorbid conditions or other risk factors like high blood pressure, heart disease, obesity, diabetes and so on. The problem is exacerbated, however, when the healthcare infrastructure is inundated with many new cases simultaneously, along with the staff becoming diminished as they get sick as well -- the end result being a certain percentage of people who ordinarily have no business dying from this under ordinary circumstances where they would receive more focused care may end up succumbing because we simply don't have the resources to help them all. That's partially in our control (through the aforementioned best practices) but realistically there's only so much we can do to ameliorate this and stem the tide of new patients when combined with lack of testing resources and the apparent ability for this virus to spread prior to showing signs and symptoms. The point being, by the time one case is actually detected in the AO (assuming we're not talking about a controlled point of entry), there are almost certainly orders of magnitude more who have been exposed over the past several days. You're late to the party if you wait till then to start wearing your respiratory protection, practice self quarantine and run to the store for last minute supplies. People certainly shouldn't panic, but it's almost always a better approach to take it seriously and err towards the side of it being a little bit worse than the Government would have you believe.