Month: March 2020

• Virginia ends their school year.
• New York is requesting the Army Corps of Engineers begin immediate construction on 4 temporary hospitals.
• New York orders hospitals to figure out how to increase their capacity by a minimum of 50% as soon as possible.
• New Zealand and the United Kingdom enact nation-wide isolation measures.
• More states are issuing shelter-at-home or only-essential-business orders. They vary in strictness and enforcement so it's hard to track what each state is doing, but new restrictions were announced by Delaware, Indiana, Louisiana, Maryland, Massachusetts, Michigan, Ohio, and Virginia.
• The Federal Reserve announced they will undertake an unlimited quantitative easing program to try to stabilize the financial markets.
• The Fed also announced plans to extend credit directly to businesses and cities; something way beyond their scope historically.
• DJIA closed down another 3.0% (18,592, down 11,000 points since January).
• Congress failed to move forward the third stimulus/relief bill. The goal was to pass it today, which isn't likely to happen.
• 2020 Summer Olympics have been postponed, likely to 2021.
• Alameda County cases: 112.

Last night Trump tweeted out that we need to loosen restrictions and get people back to work to improve the economy. This morning the Surgeon General gave a press conference emphasizing that the situation throughout the country is only going to get worse this week. So messaging is mixed-at-best coming from the Federal Government.

The Lab has officially transitioned to "Minimum Safe Operations" as of today in response to Alameda County's shelter-at-home directive that went into effect last week. Only those necessary for the safety and security of the facility are allowed on site without approval. I am now starting my third week working from home.

Restaurants, closed to dining-in, have been providing delivery or take-out orders of prepared food and many have started providing retail access to their supplies. It's interesting, the restaurant space represents an entirely separate supply chain from the retail grocery space. With the strict restrictions on restaurants their supply chains are presumably glutted with excess product. Meanwhile, retail grocery supplies are being stripped bare.

It seems likely there are people trying to work out the fastest way to divert restaurant supplies to store shelves, but that's going to take time. UPCs need to be entered into computer systems, contracts need to be written up and signed, trucks and warehouses need to be retasked. Though, if retail supply chains have plenty of product and it's just a matter of delivering it, then it may not make sense to bring in another logistical system. Meanwhile, I can go to the quickly-thrown-together online-ordering website for a restaurant in town and order butter, strawberries, chicken nuggets, ground beef, flour, oats, hamburger buns, potatoes, pasta, bread, etc. and pick it up the next day.

I baked some bread yesterday and for dinner we had fresh bread, apples, and Vermont cheddar cheese. Heather declared it one of the best meals she's ever had. Heather and I had more of the same for lunch today.

From today's walk, another fairy house:

• New Jersey issues a shelter-at-home order. ~25% of U.S. population now under varying degrees of shelter-at-home orders.
• 3 Congress members have now tested positive.
• Alameda County reporting 100 confirmed cases.

The weekend is fairly calm so far (Sunday morning).

I reached 14-days of extra-familial isolation on Friday. Then I went to the grocery store last night to refresh our supply of perishables.

Safeway wasn't as bad as I feared, but it was still like nothing I've ever seen or ever expect to see again once this has passed. Plenty of fresh produce, milk, cereal, chips, snacks, & desserts. No eggs, pasta, rice, beans, flour, yeast, sugar. Limited quantities of yogurt, cheese, butter, and frozen goods.

Bread, milk, and eggs were all on limit-2 per household restrictions.

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The store wasn't crowded, but of the people there many had either face-masks or gloves on. I wore nitrile gloves. I keep a box in the garage for working on the car or doing other tasks that get messy but still require digital dexterity. I did not buy them in response to this event--I've had them for months. So I'll use what I've got to try and slow the spread.

Safeway is usually open 24/7; under the isolation measures it now closes at 10 for restocking and cleaning. I left as they were announcing that they were preparing to close and everyone needed to begin checking out. They've installed clear plastic barriers between the cashiers and the customers to avoid as much respiratory interaction as they reasonably can.

When I got home I stocked the new goods in the garage to quarantine them for several days. Perishables got wiped down with at least some kind of sanitizing solution before being put in the fridge. It may not be effective on coronavirus, but I figure it's better than nothing.

Should be able to avoid leaving the house again for another 1.5-2 weeks. I only expect the medical conditions to get worse in that time frame. No idea what to expect for the food availability. Will people just keep hoarding as it comes in or will they eventually decide they don't actually need any more and shelves will refill?

This morning I walked down to the local Mexican Market to see if I could find some eggs. They did have eggs and a few other things I couldn't find at Safeway.

I will not be surprised to see states starting to do border closures at this point. If the federal government doesn't start actually doing something to enact isolation measures nationwide it's going to start looking like every-state-for-itself. California started earliest, so that's encouraging. It's still not going to be good, but better than it would have been. I'm shocked that Washington State still doesn't have shelter-at-home orders in place since it is one of the worst-hit places already.

We're going to get the girls outside to ride their bikes today before more rain moves in.

A picture from yesterday's walk:

• U.S./Mexico border closed.
• Illinois puts in place a shelter-at-home directive.
• New York puts in place a not-quite shelter-at-home directive. If it expands to a shelter-at-home directive (which it likely will) it, with Illinois and California, would put ~22% of the U.S. population under shelter-at-home directives.
• The State Department shuts down visa services and advises U.S. residents to not leave the country and if abroad to return home immediately or prepare to stay where they are indefinitely.
• As additional economic-bailout-measures are debated, states are enacting moratoriums on evictions; moratoriums on utility disconnects have already be enacted in many places.
• Between loss of demand and increased production by Russia and Saudi Arabia oil prices have collapsed. WTI is trading at ~$20/barrel, down from ~$60 in January.
• Financial firms are forecasting GDP drops of 10-24% per quarter.
• DJIA down another 4.5% today.
• Alameda County is reporting 45 cases as of today.

It appears that much of the rapid implementation of strong isolation requirements is due to the release of this report dated March 16 from the WHO Collaborating Centre for Infectious Disease Modelling, MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London. This is apparently a very well respected epidemiology group.

The report is...I'll say "sobering" rather than "terrifying" (oh, too late). It describes three broad scenarios of response: do nothing special, "mitigation", and "suppression" (further broken down into particular measures). Using the best available information and filling in the gaps with their own expert-based opinions the team performed computer modeling of how the disease would affect the U.K. and the U.S.

The "do nothing special" category suggests 2.2 million U.S. deaths; peaking in late June and ICUs already being overwhelmed by mid April.

Applying "mitigation" measures over a three-month period suggests that number could be reduced to 1.1 million U.S. deaths.

We therefore conclude that epidemic suppression is the only viable strategy at the current time. The social and economic effects of the measures which are needed to achieve this policy goal will be profound.

From the summary:

We show that in the UK and US context, suppression will minimally require a combination of social distancing of the entire population, home isolation of cases and household quarantine of their family members. This may need to be supplemented by school and university closures, though it should be recognised that such closures may have negative impacts on health systems due to increased absenteeism. The major challenge of suppression is that this type of intensive intervention package – or something equivalently effective at reducing transmission – will need to be maintained until a vaccine becomes available (potentially 18 months or more) – given that we predict that transmission will quickly rebound if interventions are relaxed. We show that intermittent social distancing – triggered by trends in disease surveillance – may allow interventions to be relaxed temporarily in relative short time windows, but measures will need to be reintroduced if or when case numbers rebound. Last, while experience in China and now South Korea show that suppression is possible in the short term, it remains to be seen whether it is possible long-term, and whether the social and economic costs of the interventions adopted thus far can be reduced.

And this is what has the world freaking out. Governments were reading this report on Monday (and presumably inside groups were being briefed on the findings before the report was completed).

Note: I can't find an explicit statement in the report of the modeled death count when applying "suppression" measures. They have a complicated chart with technical language I'm not versed in and am not sure how to read.

With "suppression" measures in place, the modeling suggests U.S. ICUs being overwhelmed in early August, but only by 40% rather than the 1500% in the "do nothing" approach. This assumes the full suppression measures are in force by early April.

With that modeling, under a best-case scenario the worst of it is still weeks away and when the suppression measures are lifted we'll still get clobbered about 6 weeks later, requiring waves of suppression.

However, we emphasise that [it] is not at all certain that suppression will succeed long term; no public health intervention with such disruptive effects on society has been previously attempted for such a long duration of time. How populations and societies will respond remains unclear.

So, yah. That's not comforting. Of course, it's possible that this analysis is fundamentally flawed. As more data (especially testing) becomes available these models will be updated and re-run. Until then, this seems to be the best information available. And when the best information available says that even with mitigation measures a million people are going to die then people start freaking out.

Here's a picture of some flowers I saw on my walk today. Deep breath.

I spent my work day implementing tests for code that will populate names for active users and clean up duplicate accounts. Feels super relevant.

To protect public health, I as State Public Health Officer and Director of the California Department of Public Health order all individuals living in the State of California to stay home or at their place of residence except as needed to maintain continuity of operations of the federal critical infrastructure sectors [...]

[...] this order is to go into effect immediately and shall stay in effect until further notice.

ORDER OF THE STATE PUBLIC HEALTH OFFICER - March 19, 2020

Soooooo.... not stabilizing from sweeping changes yet.

Changes from the last day or so:

• Australia and New Zealand have closed their borders
• China reports no new domestic cases
• Italy's fatality count surpasses China's
• For the first day in quite some time (at least it feels that way) the stock market stayed relatively stable throughout the day. The DJIA closed up 0.95% rather than the 5+% swings we've been seeing.

Overall today has been a calmer day. Fewer dramatic events in the news. Hopefully the situation essentially stabilizes (at least in terms of sweeping changes, the case count is going to keep climbing quite rapidly as testing rolls out).

The daughter of some of our friends is symptomatic, but won't receive a COVID-19 test because there aren't enough tests so she doesn't meet the strict testing criteria (known contact with a positively-tested patient, dangerously symptomatic with no other known cause, or symptomatic and in high-risk group). It may just be a cold or the flu, or a million other things, but without testing one doesn't know--which is stressful to their family. Jess, Heather, and Corinne interacted with them at the library last Thursday, so it's also a tiny bit stressful for us.

I'm trying to keep a consistent routine to provide some structure to my own days. My alarm still goes off at 7. I get up and eat breakfast then take a shower and get dressed. I check in on work and take care of anything that my team is waiting on from me to keep them moving. Then I take a walk.

Since I'm not driving in to work I don't have commute time to keep up with the two daily podcasts I listen to. So a walk gives me a chance to stretch my legs, get out of the house, and catch up on podcasts. Then it's back to work until lunch. After lunch is more work until the end of the day.

Once I'm "home" it's time to try to help entertain Heather and Corinne and figure out dinner. Dinner and bedtime for the girls. Then a couple of hours of reading, TV, or games mixed with some time on the stationary bike or some sit-ups/pushups/other exercise.

I ran across this meme yesterday which describes my life well:

Aside from working from my closet and going for a walk my daily routine is pretty much the same.

Yesterday's post covered "flattening the curve." The action to reach this goal is "social distancing." Minimize physical interactions as much as possible. If you can't avoid people, keep a 6-foot minimum distance. In practice this means when I go out for a walk and meet someone coming the opposite direction on the sidewalk one of us steps out into the street so we can pass by each other without getting too close. It's....odd.

Back on March 3 (2 days before the Lab announcement about a presumed case on site) we had my friend Thomas over for an evening. We played the board game Pandemic. We lost. Badly. I'm not taking that as a sign on how things are going in reality.

And what's a pandemic without a little stress eating. We have cake from Corinne's birthday, of course. Last week I made brownies. For Pi Day I made a cream-cheese pie, and last night I made brownie pudding.

And now for something less exhausting. I decided I'll try to take one picture during each of my daily walks that brings some calm. Today's entry is this fairy house on our neighbor's tree: