Wednesday, April 29, 2020

Hmm

According to Scott Johnson at Power Line, all of Minnesota's coronavirus deaths in people under 70 so far were people who lived in long-term care or similar facilities.

The present shutdown order ends on Monday.

Tuesday, April 28, 2020

Hard times

I’ve been dipping into various parts of Studs Terkel’s Hard Times:  An Oral History of the Great Depression. It’s been several years since I read the whole thing.

It contains many short accounts from a wide variety of people...some of whom did all right and even lived comfortably during the Great Depression. Others barely scraped through.

I also went back to a local history book put together by my grandmother and some other people in the Seventies. One of her friends wrote up the Great Depression section, giving an account of moving to the country from the city. They sold their few appliances, as there was no electricity to run them with. Their water source was a spring. For a time, they didn’t have a car, only their two farm horses. There was a grocer who did a delivery route through the area. She said that they mended and patched and wore their clothes until they really were just “threads”.

My grandparents were set up a little better in household and farm. My grandma said once that they had everything that they needed, although the fabric for their underwear came from feed sacks or some such that were sent to them by a cousin.

Saturday, April 25, 2020

A couple of more posts from Healthy Skeptic, Kevin Roche, about how the epidemic in nursing homes and in the larger population are largely separate:  first one; second one.

Over the past two days, over 90% of the new deaths have been of long-term care residents. They are now about three-quarters of Minnesota's death toll, while from numbers in his second post, they are less than 2% of the state's population (about 80,000, out of 5.6 million people).

There are now about one hundred care facilities in the state with known positives.  The bad news is that that must be a small fraction of the total number of facilities, so there are tens of thousands of potential infections still to come, with many deaths.  The good news is that there is still time to put a more effective infection firewall around many of them.

Thursday, April 23, 2020

About testing

A good article here about uncertainties in coronavirus testing, including the antibody tests.

The trends in my state continue as before. The median age of deaths has come down by a few years to    83, which I interpret as including more of the younger nursing home residents, who perhaps take a bit longer to die than the very old do.  Enough deaths have occurred recently to actually bring down the ICU population a little.

I hear that over half a million people in the state are now unemployed; over 20% unemployment.

Improvements

The neighbors handed down their children's outgrown bikes to us. They have been enjoying them.

I made another fabric-covered box, for storing baby clothes. The box I used was a bit shallow, so I measured the depth of the box plus the width of one flap, divided it by two, and scored a line across the flap at that point. This enabled me to fold the each flap down into the box so that it just came down to the bottom, making the sides taller and stronger.

With the proliferation of both economic insecurity and cardboard boxes from deliveries, it reminded me of the Seventies books Nomadic Furniture and Nomadic Furniture 2, which included a lot of cardboard structures...all the way up to a cardboard car seat, which would not be at all legal today.

Another idea I had for the fabric-covered box was to use clothespins to help hold the fabric in place until I could sew it. They were helpful.

Since the toddler is learning to open doors, we needed to pull out one of the plastic childproofing doorknob covers that we have. The problem was that the stem of the doorknob was too big for it to close around. But I was able to trim the doorknob cover with a pocketknife to make the hole large enough to fit.

I also used a pocketknife to trim some sharp edges off the plastic lid of the dish soap bottle that my husband likes to refill and re-use.  One less tactile annoyance.

Sunday, April 19, 2020

On the upswing

Last week I had a bit more energy, and got a few things done.

One thing I had been wanting to do for months was to do another round of stripping the bath towels of all of the stuff that the washer leaves behind. My previous post on that is here; the results this time were about the same as before, with the soak water being “almost brown”.

When I was sicker, I looked up online how to clean out and adjust the slow-filling valve on one of our toilets. Slow as in it would wait for many minutes, before refilling the tank. With some fiddling, I was able to get that working much better.

I also made some more pot scrubbers, although with half-double crochet stitches instead of triple crochet, and I cut some more disposable kitchen wipes from a worn-out T-shirt.

It feels like spring cleaning time, and I was able to give a few limited areas a thorough scrubbing.

Saturday, April 18, 2020

The bar is too high

The governor has entered into a a compact with several other states, regarding how to move toward fewer economic and social restrictions. I have not seen many details yet, but to me, any strategy at this point that relies on widespread testing is one that is not going to be implemented anytime soon, for sheer lack of tests and test processing supplies. Controlling infection and hospitalization rates basically requires continuing the present shutdowns, which is even so only containing the spread to linear growth in Minnesota. Health care systems being prepared for a surge in cases after some restrictions are lifted can only happen if the restrictions are eased very gradually; there has been a lot of back and forth lately on how many people have actually already had the coronavirus, but in general it is clear that the pandemic will go back to spreading exponentially as soon as it is possible for it to do so.  Even with rates of severe illness that are much lower than initially thought, the potential for hospitals to be swamped is very real.

The federal government’s ’sOpening Up America Again plan also takes a slow approach. Before even entering Phase 1, the recommendation is for a declining number of cases, and for the ability to do lots of testing of health care workers. In Minnesota, the former is not going to happen anytime soon. The number of “congregate care settings” with known positives is up over eighty now; I would put that as something like “the brush pile has caught on fire, we have no water, and we’re just going to have to wait for it to burn itself out”. I think it will take at least a month for that to happen, and probably longer.

The next step is readiness for “test and trace”, for hospital capacity to respond—including adequate supplies of protective equipment, and for adequate protection for other workers, mass transit users, and the general public, along with infection monitoring programs. I expect supply issues to persist in these areas for weeks, at a minimum.

Phase 1 tells vulnerable individuals to continue to shelter in place, limits group gatherings to 10 or less, opens most businesses and entertainment venues with restrictions, and (finally) allows elective surgeries to resume. If there is too much of a rebound in cases, it is back to Phase 0.

To enter Phase 2 requires continuing declines in case numbers. Vulnerable people are still isolated. Group number increases to fifty; schools and youth activities and bars can reopen.

With further declines in cases, Phase 3 opens things up most of the way, but with continuing precautions recommended for vulnerable people.


Wednesday, April 15, 2020

Something here doesn’t add up

The models being used by Minnesota predict that about 4000 ICU beds would be needed at the peak of the pandemic.  The state can cobble together 2700 or so, at the moment.

The earlier version of the models used a number of 235 ICU beds, according to Kevin Roche of Healthy Skeptic, and in early March, when I first looked into Minnesota’s number of ICU beds, it was about 250...according to the internet. The governor in late March said there were 243 adult ICU beds.

The current number of coronavirus patients in the ICU is about 75.

But, a Star Tribune article on Monday said that there were nearly 850 ICU beds total in use at the end of last week, of which coronavirus cases were a small fraction.

So who are in the other 600 beds, that the state may or may not have had a few weeks ago???  Some number of these must be infants and other children; a quick search tells me that the state’s available NICU beds run into the hundreds. But still.

I said when I got sick a few weeks ago, that it was either with the coronavirus, or with something that was just like it, and equally nasty. It certainly could have put me into the hospital, if things had been a little different. Is this whatever-it-is filling up the ICUs now? And what is it, if it tests negative for coronavirus?

As an aside, either the bug that I got is a very lingering one, or I’ve been reinfected a time or two at home. How much being infected produces immunity is still an open question with the coronavirus; we may have to adapt to it becoming endemic on a global scale.

In related news, it has come out that two-thirds of coronavirus deaths in Minnesota were of people in “congregate care” settings, and also that 90% of deaths were in people age 70 or older.

Update:  The number of 243 adult ICU beds was apparently an increase already from an earlier number of 197. Like many states, Minnesota regulates the number of hospital beds; usually that is done through a “Certificate of Need” process, but Minnesota had basically frozen the number of hospital beds by law—even through population increases.

Monday, April 13, 2020

A fake bowl for the fake flowers

 I finished the coffee filter hydrangeas that I was making. Since I was using paper and paint instead of coffee filters and food coloring, I found that I had to paint each side of each cutout separately. And I air-dried them, instead of using an oven at low heat.

When I bundled them together, I just used a paper clip at the bottom of each bunch, and left the leaves loose. I have some spools of fine wire, but I didn’t need them.

With the flowers finished, I looked around the house for a good bowl to put them, but didn’t find anything suitable. So I ended up taking paperboard from a saltine box, and using strips from it to make a “bowl”.  The quotation marks are because it has no bottom, and is actually only a ring.

I made it by taking two long sides from the box, and making interlocking slots at each end. Putting them together made a shape that was more like an eye than a ring, so I did the same thing with the other two long sides of the box, and slipped the second eye inside the first, rotating it so that the whole thing was reasonably round.

I glued on some scrap paper to cover and hold down the protruding tabs, then I painted the outside with craft paint. The unprinted side of the paperboard soaked up most of the water in the paint, so I did the second coat right away, and from there went straight into applying white puff paint in a geometric design.

The puff paint dried with a shine, while the craft paint didn’t, and the shine contrasts with the non-shiny flowers, so I’m glad I used the puff paint, even though it did run downward a little on the vertical surface. Otherwise, I would have added a coat of something clear like Mod Podge for shine, since the bookshelf the bowl is going on has almost nothing shiny on it, and could use a little sparkle.

Saturday, April 11, 2020

More of the same

Another day, a little more data from the state. The list of larger group living facilities with confirmed cases is now well over fifty—at least one of them is an addiction treatment facility, not a nursing home. The median ages increased slightly again, and the percentage of cases living in single-family homes declined slightly. The overall trend remains more or less linear; it is frustrating to see these weeks of lockdown and relative idleness for so many being largely wasted, so far as building immunity in the less-vulnerable population goes. While at the same time the most vulnerable are starting to get mowed down by the virus.

The day’s tests came back 94% negative again. I’m starting to wonder if they’re testing the wrong people; some medical workers ought to be immune by now, for example. And it would be good to find out what the false negative rate is; I can’t believe that it is zero.  If it is very high, they could be missing as many cases in testing as they catch—keeping in mind that false positives are also possible, though I would guess that they are less likely than false negatives here.

A notable mini-trend emerging over the last few days is that daily deaths are up somewhat, which is keeping the ICU demand flat, even as new cases are coming in.

Friday, April 10, 2020

Dribbles of information

The governor extended the shelter-in-place order until May 4; it originally was to end today. I am working hard to be grateful that my family and I have everything that we need for now.

For the last two days of published numbers, coronavirus tests in Minnesota have been 94% negative; that’s not very useful without knowing the testing numbers and thresholds for the different groups involved. Nursing home cases continue to increase, as can be seen in the increase in median age, and in the breakdown by residence type.  It appears that there are increasing cases among health care workers.

Since we’ve already been shut down for two weeks, the continued spread is through “essential” activities.  Detected cases could be as little as 1% of actual cases.

The state has released a few slides giving some of the details of the scenarios being modeled. They are assuming that social distancing will do little to “flatten the curve”, and will at best delay the peak ICU demand by some weeks; possibly out into July, given the present shelter-in-place order.

Present ICU surge capacity is projected to be about 1000 beds short of what would be needed at the peak, based on the graph.

The scenarios include various degrees of social distancing through the summer, expressed as percentage reductions in contacts: 20% and 50%, compared to 80% for shelter-in-place. They claim to be modeling far enough out to see a second peak in later months, but no further information is given about them.

Digging further, they have put out some technical information on the model. For the most part, I have no technical quibbles with it; my computer modeling experience is in large atoms, which while being governed by extremely complex physics, will at least behave consistently within the given physics. Things like coronavirus spread and climate change involve entire systems changing over time, so the whole thing is a moving target (and is very, very likely to diverge from the model’s predictions).

That said, their range of estimates for R0 looks overly conservative to me. A single person could infect dozens of other people, even now. They are figuring R0 = 3.87, on average.

I’m doubtful now that there will be much of a lull in the summer; they certainly didn’t model one. In the Twin Cities, a lot of activities come to a halt in the summer, as people go off on summer vacations or up north to their cabins, but there is going to be less of that this summer.  So my guess is that the first big peak is going to include almost everyone; even efforts to isolate the nursing home residents are failing already.

The other thing I noticed is that their ICU survival rate seems extremely optimistic, with a mortality rate of only 0.111 per 10 person-days for octogenarians.  Or perhaps I’m misunderstanding that part; I would have guessed it was no better than a 50-50 chance of survival for that age and severity, and that  many of them would die in the early days of their ICU stay.

Projected deaths for the state are now 9,000 to 36,000.

Hopefully there is a corresponding model for the economic effects of shutting down. But I haven’t heard that there is.

Wednesday, April 8, 2020

More deliveries

Another week of having people grocery shop for us, because of Symptoms. Again they were more or less able to get everything on our list. People from church dropped off some additional things, which were welcome.

I have been learning how to make artificial flowers from coffee filters. Except that I don’t have coffee filters. What I do have is several boxes of unused letterhead paper, which is harder to cut, so I’ve been making one less fold than in the video. I also don’t have food coloring, only paints.

I’m also planning on covering another cardboard box with fabric, for prettier storage.

The trend of confirmed cases in my state remains more or less linear, with gradual increases in the numbers currently hospitalized and in the ICU. The state has a summary of available medical resources up now.

The state is also publishing a list of the larger senior living places that have confirmed cases, which is now over forty, and scattered over many counties. The median age of confirmed cases has increased slightly, as expected.

Monday, April 6, 2020

I made a mask, and some children made pinatas

I used the instructions from the link that I gave a few posts back for the mask.

More ideas for elastic substitutes:  T-shirt yarn—cut a strip about three-quarters of an inch wide, and pull it to make the edges curl in.  These have a nice amount of stretchiness for ties. Another idea I saw is to use elastic hair ties for ear loops. Those might require making the mask wider, since they are shorter than the listed elastic length. I used the T-shirt yarn this time.

Based on other designs I saw online, I decided to add a little channel at the top edge for wire from a small paper clip, to allow for a better fit around the nose. I used needlenose pliers to bend over the ends of the wire, to help keep them from poking through the fabric.

The mask turned out all right, but I find it a bit short, and will add half an inch or so if I make any more of them. It also makes my glasses fog up a bit, so I don’t see myself wearing it while driving.

I foresee a trend in a few years, of making quilts out of all these masks that are being sewn. The question is, how much wear the masks will have gotten before being recycled.

The children with birthdays coming up have planned ahead and made themselves papier-mâché  piñatas. The paste used is just water with some flour whisked in, so they were able to carry the whole thing out very nearly independently.

It was neat to see how the older ones have learned from watching me in the past, and how now the younger ones are learning from watching the older ones.

Saturday, April 4, 2020

A bad time to not be healthy

I've received second-hand information that parts of the local medical-industrial complex are in such bad shape financially that they are closing down entire clinics, "essential" or not. I'm not entirely sure, but I think it is likely that the underlying issues for that--some of which preceded the pandemic--are not unique to the Twin Cities.

Thursday, April 2, 2020

Slow recovery

My husband got one of those little inexpensive pulse oximeters a few weeks back. It has been handy for quantifying just how ill we are, and how close we are to needing to go to a hospital. I'm much better now than I was last week, but far from completely well.

Minnesota's new confirmed cases per day has remained flat, after almost a week of shelter-in-place, at about 60. So the total number of cases appears to be growing linearly, not exponentially, which is good, but it is still growing, and at a constant rate.

Given that rate, I figure that it will take about 220 years for Minnesota to achieve herd immunity.  Actually, it won't really be that long, because so many cases go untested, or get false negatives when tested. If I take the confirmed cases as the "tip of the iceberg", 10% of the actual cases, then it will only take 22 years.  Maybe a bit longer than that, as some of those who are immune will die of old age or other causes each year.

I've received some fourth-hand-at-best information, though, that a number of senior living complexes in the area have been reached by the virus. Linear models no longer apply in those situations, and I think there is probably going to be a spike in severe cases soon. Which will give the state government an excuse to keep the shelter-in-place restrictions in place for everyone.

The health department says that the median age for confirmed cases is 47, for hospitalized confirmed cases is 64, and for confirmed deaths is 84.

To me, the median age of 47 looks to be just about in the center of the population age distribution, allowing for very low detection rates among the young. There have been very few confirmed positives under age 20, less than 3% of the total.

A few days, it was said that one in five of the total confirmed cases was a health care worker. It was thought that many of these had caught it through "community spread"; remember that they have better access to testing than the general population does. The health department attributes 30% of total confirmed cases to community spread, although realistically that has to be a lower limit, considering they don't know about the cases that they don't know about, and also considering that some of the cases that they attribute to other causes could have been caused by community spread instead.

One thing I've noticed in the graphs that are being given, is that the age cohorts are often not equal either in years covered or in population. In Minnesota, they've been breaking it down as 0 to 5 years, 6 to 19 years, 20 to 44 years, 45 to 64 years, and 65 and over. It's not surprising that there are very few cases in the 0 to 5 years bracket, which covers 5 years, compared to the the 65-plus bracket, which includes a 104-year-old and therefore spans 39 years. I don't know those categories compare in size on the demographic pyramid, but I do probably know more retirees around here than I do small children.