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Three Things: Bracing for Omicron’s Overrun

[NB: check the byline, thanks. /~Rayne]

Not going to lie or mince words: the White House fucked up its response to Omicron. They let businesses, pressure from the GOP’s COVIDiots, and public polling tell them what to do instead of gaming out an effective response. They focused on the economy and then-irrational fear of inflation instead of COVID, only to create the problem they wanted to address.

While the impending COVID explosion would likely have happened anyhow, the curve could have been flattened and the blow to health care systems softened had the White House not only emphasized getting testing out to the public but getting better quality masks to the people while asking any and all public facilities conducting business indoors to ensure better air quality immediately.

You know, advocate the things which have been proven to work in other countries like Japan — a densely-populated country with a population more than a third of the U.S.’s but less than 19,000 COVID deaths to date.

But more on that in a moment.

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I’ve been furious since a friend told me last week they were blindsided by someone in their social circle who has fallen prey to disinfo about COVID.

In a nutshell, their acquaintance is:

1 – Peeved about the unvaccinated being blamed for the spread of COVID;

2 – Doesn’t think the lack of vaccinations in a sizable percentage of the population caused a new variant;

3 – Feels the virus will mutate and spread whether people are vaccinated or unvaccinated;

4 – Believes vaccines will reduce severity of cases and keep hospitalizations down, but the mutations and contagion will happen anyhow.

Jesus Christ, where to even start except tell them to quit Facebook. These half-truths about COVID are truly problematic with an American public weak on science education – well, weak education as a whole, when it comes to critical thinking.

Mr. Blindsider needs to understand:

1 – The ongoing threat is the willfully unvaccinated, not those who can’t be vaccinated because of legitimate health problems or those whose circumstances have prevented them from being vaccinated. Anyone willfully choosing not to be vaccinated isn’t merely putting themselves at risk but others like children for whom we do not yet have vaccinations, and those who want but can’t get vaccinated. Fuck the willfully selfish gits and piss on your peevedness.

2 – Yes, the lack of vaccinations DID cause a variant to rise. Unvaccinated humans are pools for new variant development. More unvaccinated people means a bigger resevoir in which new variants can develop.

3 – Take a fucking look around: do you see any new variants of polio (caused by poliovirus)? Measles (measles morbillivirus)? Chicken pox (varicella-zoster virus)? All of these are infectious diseases caused by viruses for which children have been routinely vaccinated as children over decades. Because vaccination rates are above 85% of all US children, the pool of unvaccinated is too small for the viruses to develop variants. This is what needs to happen with COVID.

4– As long as the pool of willfully unvaccinated remains as large as it is, SARS-CoV-2 will have adequate opportunity to mutate and new variants will emerge. The answer is two-fold: (1) everyone must be vaccinated who can safely tolerate a tested vaccine, and (2) a better vaccine is needed, one designed to protect against all coronaviruses.

But the answer is really four-fold:

– The U.S. public school system needs to do more and better biological science education because too many adults are quite stupid when it comes to basics like infection control let alone microbiology. That education should also include new content on airborne spread of disease like measles and COVID, the latter by aerosolized particles.

– The White House needs to fix CDC and FDA communications problems, because they’re frankly doing an abysmal job this deep into a pandemic. We should not still be arguing with our neighbors 23 months into this about simple infection control and its affects on individuals and society.

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Mr. Peeved Blindsider will be part of the reason Omicron explodes; they’re incapable of systems thinking necessary to enact effective mitigation, too busy folding like a broken lawn chair under disinformation and minor frustrations all of us have had to deal with.

Too busy throwing a pity party for the poor maligned willfully unvaccinated to think about what is about to erupt across the country.

Read this Twitter thread:

There were school systems across the country which didn’t have enough bus drivers under the Beta and Delta waves. This is about to happen again even though more people are vaccinated and Omicron is not as severe as Delta, because Omicron still sickens people and still forces people into quarantine and isolation.

If all schools don’t close this week, children are going to bring Omicron into classrooms, spread it to each other because they got it over the holidays, because they weren’t given N95 masks, and their schools’ HVAC systems haven’t been upgraded to improve air quality and reduce exposure time to aerosolized virus.

They will infect school teachers and staff and bus drivers, who will infect their families.

Schools will be forced to go to remote learning again for the lack of teachers and bus drivers.

Students’ and teachers’ family members will take it to work, including places like grocery stores and fast food chains and manufacturing facilities and shipping companies.

The supply chain will be throttled down again and we’ll hear yet another round of bullshit about inflationary pressures about which the right-wing and neoliberals will lie and claim the GOP can fix in spite of its ongoing anti-vaccination campaign.

Omicron may burn itself out inside 3-4 weeks, but the effects will be much longer. We still do not have data about the long-term effects of Omicron on those infected; the data will be complicated by the spectrum of unvaccinated/unvaccinated-but-previously-infected/vaccinated-only/vaccinated-and-boosted.

We can plan ahead, though, for a worst case in which those infected with Omicron have some degree of neurological sequelae and increased fatigue along with increased risk of death because we’ve seen this with previous variants. Expect more people acting irrationally or sluggishly because of COVID brain fog.

Social distancing throughout the rest of the winter may be our best approach.

Gods help us all if we need health care services for anything urgent apart from COVID.

~ 1 ~

As I wrote when I started this post, the White House fucked up the response to this variant. The Omicron scenario was always a possibility and a plan for it should have been on the books, ready for roll out. (Has no one in Centers for Disease Control and Food and Drug Administration as well as the White House done any simulations and scenario planning at all for this pandemic??)

A shorter isolation period due to Omicron’s allegedly milder symptoms combined with more rapid testing isn’t a rational response without better mitigation to flatten the curve, not to mention the assumptions made about illness severity relying on early data which could have been flawed in analysis.

Though a key component of the White House’s answer to Omicron, rapid tests simply haven’t been available at the scale of numbers and breadth of distribution this country needed. We’ve seen far too many examples of people waiting in lines for hours to get tested throughout the holiday season.

Propublica’s reporting on the clown car that is America’s COVID rapid test approval process explains much of the problem, but this should have be addressed as an emergency skunkworks in November, with the White House fully engaged with the FDA as soon as Omicron was announced.

There have also been people claiming huge quantities of rapid tests could be available inside weeks. Read that Propublica report, and then think like a manufacturer for a moment – one which has had problems with obtaining raw materials, difficulty with reliable shipments (hello, fire Louis DeJoy), and labor shortages due to illness and insufficient child/eldercare for workers.

I know people being courted for jobs in testing production; the industry literally doesn’t have enough current employees to step up production for delivery inside weeks let alone days.

Given all the barriers to adequate numbers of reliable rapid tests, heightened infection control measures are an absolute necessity.

And yet the response to Omicron has been sadly lacking emphasis on infection control – even after the absurd theater of an airline CEO sickening with COVID testifying before the Senate that masks don’t do much.

Every single American should have been mailed (7) N95 masks – one per day to use on rotation through this Omicron surge. They’re cheap, easy to ship by mail (hello, fire Louis DeJoy), don’t need special testing and approval; we have multiple manufacturers in the U.S. ready to step up production.

Every single health care worker should have received at least twice that number already. Health care facilities should be able to hand them out to patients and their families.

Every single public facility should have been ordered to improve air quality with improved ventilation; CO2 tests should have been distributed to every school for every classroom as a measure of air quality and a proxy for risk of aerosolized virus exposure. Higher CO2 levels – roughly equating to increased aerosolized particles from occupants and low air flow – should result in windows and doors being opened, addition of Corsi-Rosenthal Cube filter systems, or dismissal of classes until CO2 levels fall to acceptable levels.

Longer term, legislation providing funding for improving air quality in all public facilities should be on Congress’s agenda, because this isn’t the last variant we’ll see before this pandemic is over. There will be other reasons for improving indoor air quality – increasing numbers of wildfires and dust storms as the climate emergency deepens will be adequate justification to continue HVAC improvements.

And as I already said, something needs to be done pronto about the communications out of CDC and FDA about COVID, including infection control measures.

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All that said, double down on measures to protect yourself, friends, and loved ones through this Omicron wave. Use the measures Japan’s health ministry has advocated and apparently work when used widely.

Avoid the Three Cs:
— Closed spaces with poor ventilation or unmonitored air quality
— Crowded spaces occupied by many people
— Close-contact settings which don’t allow adequate social distance

Do the Three Ws:
— Wear a better mask (N95 preferred)
— Watch your social distance to reduce exposure to aerosols
— Wash your hands to prevent spread of any infectious agents

And if you haven’t yet gotten your booster, do whatever you can to get that on board.

Three Things: More Family Fun with COVID-19

[NB: Check the byline, thanks! / ~Rayne]

My second kid, who attends a Big 10 university, is sick. They’re running a temp, have a headache and sore throat. Fortunately they have no other symptoms like a dry cough and chest congestion. They wouldn’t meet the criteria for COVID-19 testing even if they develop a dry cough common to 68% of those infected with the virus

We had the awkward conversation about avoiding coming home for at least two weeks — even if the school shuts down, which it now has. This scenario is increasingly likely for all other Michigan and Midwestern colleges/universities. With the damage to my lungs from an autoimmune disorder we can’t take the chance my kid has something besides a common cold. I never expected to have to tell one of my kids not to come home.

~ 3 ~

By now you’ve probably heard about the initial quarantine of Lombardy region of Italy, and then the subsequent quarantine of the entire country. It’s bad. Italy is about two weeks ahead of Washington state in the virus’s spread.

Twitter thread by a UK anesthesia and intensive care registrar passes on a report from a friend in A&E (ER department) in northern Italy (includes Lombardy).

Tweets by an academic in Austria (next to Italy):

The “codice nero” or “black code” to which she refers is a label applied to patients who are DOA or for whom death is imminent. During triage they are apparently applying this to patients over 60-65 years old who arrive in respiratory distress because they have no equipment for them. Other accounts from Italy mirror both the news reports about hospital conditions.

A news report from France covering Italy’s crisis (open in Chrome and translate) notes concerns about COVID-19’s possible impact on southern Italy because it has even fewer resources. Hence the failed quarantine in the north.

In this news report from Brescia which is in northern Italy (open in Chrome and translate) you’ll note they are out of beds and are putting patients on cots, evident in the photo at the top  of the page.

Some better news: China agreed to supply Italy with 1,000 ventilators and 2 million masks. Additionally, they are donating 100K respirators, 20K protective suits, and 50K test kits as part of an aid package. Must have leftover supplies now that China is closing down their rapidly-built emergency COVID-19 dedicated hospital. See story (open in Chrome and translate).

These purchases and aid will not be enough fast enough, though. The Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care has now published a guidance document today which appears to codify triage under current conditions. It’s grim.

Tom Bossert, Trump’s first Homeland Security Advisor, wrote an op-ed for the Washington Post published yesterday. He told Ken Dilanian/NBC, “We are 10 days from the hospitals getting creamed.”

ER doctor Rob Davidson from Ottawa County in West Michigan spelled out the anticipated challenge at video in this link:

Up to this video, Michigan had been lucky, having 39 negative tests out of the 375 tests it was allotted by CDC. Last night the state announced there had been two positive cases; Gov. Gretchen Whitmer then declared a state of emergency. In an email today, Michigan State University indicated a third likely case was associated with its campus — hence an announcement moving coursework offline as of noon today. MSU is one of four Michigan schools to make such a move.

We need to see more moves like this to increase social distance if we are going to “flatten the curve” of demand for medical services. It will not be just COVID-19 cases affected by the additional demand on the system, but all other health care needs including emergencies. If we don’t slow down the spread of the virus, ALL mortality may increase in addition to COVID-19 cases.

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Particularly aggravating as the U.S. tries to wrap its head around this growing crisis is the active, malign action of the White House.

A House Oversight and Reform Committee (HORC) hearing today focused on U.S. coronavirus response; the White House interfered with its continuation by calling an emergency meeting requiring the attendance of the hearing’s witnesses, including CDC Director Robert Redfield, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and Terry Rauch, director of the defense medical research and development program for the National Institute of Health.

The HORC meeting was cut short without having answered all questions the committee had, although not before Dr. Fauci was able to provide a reality check to the committee.

“Is the worst yet to come, Dr. Fauci?” Rep. Carolyn Maloney, chairwoman of the House Committee on Oversight and Reform, asked Fauci on Wednesday.

“Yes, it is,” Fauci replied.

While this coronavirus is being contained in some respects, he testified, the U.S. is seeing more cases emerge through community spread as well as international travel.

“I can say we will see more cases, and things will get worse than they are right now,” Fauci said. “How much worse we’ll get will depend on our ability to do two things: to contain the influx of people who are infected coming from the outside, and the ability to contain and mitigate within our own country.”

He added: “Bottom line, it’s going to get worse.”

A report published at 12:29 p.m. after the meeting was suspended revealed the Trump White House ordered public health officials to treat certain meetings on COVID-19 as classified.

The sources said the National Security Council (NSC), which advises the president on security issues, ordered the classification.”This came directly from the White House,” one official said.

This is absolutely unacceptable. The public has both a right and need to know about the course of the virus’s spread and its government’s response. There is no constructive, positive reason for secrecy apart from hiding corrupt or incompetent decisions, which in this case could result in Americans’ deaths.

In fact, this arbitrary secrecy may already have resulted in Americans’ deaths if state and local public health authorities could not make informed decisions because necessary information was denied them.

U.S. Vice-President Mike Pence, the administration’s point person on coronavirus, vowed on March 3 to offer “real-time information in a steady pace and be fully transparent.” The vice president, appointed by President Donald Trump in late February, is holding regular news briefings and also has pledged to rely on expert guidance.

The classification order also makes Pence’s vow look like a lie to the public if on March 3 Pence knew there was information about the government’s response withheld by classification.

Constituents should demand their representatives and senators address this both by holding more investigative hearings into this unwarranted secrecy, and by disclosing whatever information they can obtain about COVID-19 and executive branch response so that the public and their health care system can act appropriately. Further, they need to provide support in a way that states can use without interference by the White House.

Congressional switchboard: (202) 224-3121

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This weekend’s real live drama revolving around cruise ship Grand Princess’s docking at the port of Oakland hints at a solution to the bullshit obstruction and abuse of power surrounding the federal government’s COVID-19 response.

Note in the video that California’s Gov. Gavin Newsom takes center stage, leads and directs the release of information.

And yet the docking and debarking and transportation to quarantine facilities required considerable effort on the part of federal officials. Newsom thanked Pence, saying “His team is truly exceptional.”

Gilding the lily a bit, because the real work was done much farther below Pence’s office.

What was particularly interesting was the lack of response from Trump. We could have expected him to badmouth Newsom the way he badmouthed Inslee, but he didn’t. Perhaps Trump was too busy playing golf.

Or perhaps he didn’t want to draw attention to Newsom.

The docking happened, people were moved, and it happened without a lot of hullabaloo.

That’s exactly what we want — effective, speedy resolution meeting the problem head on.

This same model could work across the entire country if governors work cooperatively and collaboratively to share information and best practices, and are willing to be the point person out in front. The National Governors Association could provide the bipartisan vehicle for networking; it’s outside the purview of the White House, can’t be forced to operate under federal classification.

Granted, taking this approach means governors run the risk of mean tweets from Trump. Screw him and his germy iPhone. Residents in every state want calm and effective leadership they can trust and see in the days ahead. Governors should provide it — particularly since governors are a lot closer to their constituents than Trump is.

Every state should already have in place a process by which their residents can decide what action to take if they believe that they or their family members are infected with COVID-19. There have been far too many reports of individuals making calls to 911 and asking for ambulance rides to the hospital for testing. Such unnecessary use of resources, from calls to 911 operators to ambulance response to demands on hospital personnel represent heightening the curve, not flattening it.

States’ departments of health should have a published decision tree online for residents to use to decide their next course of action. It’s clearly not enough to tell the public “What to do if you’re sick” if they are calling 911 for non-emergency situations.

Website design has also been poor, forcing people who may already be panicky for lack of information to wade through a website to get what they need to make a health care decision, and in some cases design ignores that many residents rely on mobile devices.

Nor has the information process made it all the way down to county and city level.

More effective outreach across broadcast and social media is also needed to manage expectations in the days and weeks ahead.

A collaborative effort by governors could reduce costs to create a comprehensive communication plan across each state and across the U.S. — all while avoiding the obstructive influence of the White House.

Until governors catch on, though, each of us will have to push our state and local health departments to do better BEFORE the coming crisis. There is no extra time, there is no room for failure. Check to see how your state and local health departments are working right now.

And in saying this I’ll tell you my own county is screwed up. The web page with FAQ about COVID-19 doesn’t render on mobile devices. It doesn’t tell residents what to do if they have symptoms matching COVID-19. I really need to call and have a little constructive chat with them because the county hospital is less than a mile from my house. I don’t want problems I can anticipate on my back porch.

A pretty good example of how a county health department’s COVID-19 website should look is Santa Clara County, CA. See SCCPHD — the only nit I have with the site is that it needs a decision tree, something a little less fuzzy to help residents who are either panicky or not well educated.

Santa Clara County has also published a nice handout on social distancing. Really worth copying by other state and local health departments.

Wish I could give you a link to the websites and phone numbers you’ll need to address this personal assignment but I can’t. Do share in comments what you’ve learned in your search.

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One more thing for the physicians among us who might be willing to translate this into layperson’s English:

Threadroll link here.

This is an open thread.