2020 has not been good for people who live in, work in, or visit cities. In March, we found out that cities are excellent breeding grounds for COVID-19. New York City led the country in this grisly statistic but a similar statement can be made that large cities dominate state COVID-19 infection rates. Ironically, public health officials have been particularly inept in their response to the COVID-19 pandemic in the cities they work in. As a general rule of thumb, if you want to avoid getting infected with COVID-19 you should avoid big cities and people from big cities.
The second problem we learned from the COVID-19 pandemic is the jobs and businesses that are especially vulnerable to COVID-19 distancing requirements are primarily located in cities. In contrast, most of the jobs in suburbia and rural areas are either essential or the distancing requirement is not a problem. It may be a long time until sports, entertainment, and convention industries return to normal. The businesses that depend on these industries such as, the restaurant, hospitality, and travel industries, are at risk, too. A real risk to business owners is their business will not be profitable in the foreseeable future. Some business owners cannot afford to wait for their business to recover fully.
The final problem is that the “crazy Karens” and the rioters are making cities unattractive to live in, work in, or to visit. It is as if the “crazy Karens” and the rioters are trying to get people to leave the cities. However good the intentions of a protest, it is foolish arrogance to not see that it is your people, your neighborhoods, and your police you are hurting when the protest becomes a riot. The folks in suburbia are more concerned with getting their hair cut then the trashing of your neighborhood. At some point, the media will get tired of the story, too. If you keep up this foolishness, you will get your wish. The people who can move will move and you will be poorer for it.
Since cod loins were on sale this week, I tried this America’s Test Kitchen recipe, Oven Steamed Fish With Scallions And Ginger. It is a nice change of pace meal that is easy to make. I cooked it a bit longer due to the thickness of the loins and spiced up the white rice with some cilantro.
When you look at this graph from the article, Coronavirus death toll is heavily concentrated in Democratic congressional districts, you can see that the trends in densely populated urban and suburban areas(Democratic districts) are vastly different trend than those in less densely populated districts(Republican districts). When I plotted the raw COVID-19 numbers from the Ohio COVID-19 site, it looks like a bunch of straight lines. So it is not a surprise that the best match for a trend line is a straight line. In the chart below the trend lines are such a good match you cannot tell the difference between raw data and the trend line for ICU, Hospitalizations, and Deaths.
I have been plotting this data for several weeks now. I was looking to see the downward trend in Ohio from the mitigation efforts. It looks like it will keep chugging along on this low rate. The good news is that that the ICU, hospitalization, and deaths for Ohio are low and manageable. I suspect that the current mitigation efforts work best in densely populated districts and long term care facilities with exponential increases. The rest of the country probably needs a plan that works for linear increases.
The genesis of this question comes from the report of healthcare professionals who despite wearing personal protective equipment have tested positive for COVID-19 and in some cases died. These are healthcare professionals trained in infection control and did not have underlying medical conditions. This is not one of the vulnerable groups so it is unnerving when they get sick. The simple scientific question is, does wearing a mask increase the viral load of asymptomatic patients? Does wearing a mask for long periods explain the severity of the COVID-19 symptoms in healthcare professionals? If I want to boil water faster, I put a lid on it. For an asymptomatic patient, is wearing a mask the equivalent of putting a lid on a pot of boiling water? If 66% of new cases of coronavirus hospitalizations were coming from their own homes, do we need to re-think our mitigation strategies based on the data we are seeing? Out of an abundance of caution, maybe we are making COVID-19 infections worse!
I am not against wearing a mask but it is at the bottom of my COVID-19 priority list. My first three priorities I think we can all agree are important. Wearing a mask is my fourth priority and it has problems. To prevent the spread of COVID-19 here is what I consider to be important.
My first priority is to keep a safe distance from other people. When I first heard about social distance, my first thought was that I have been doing that for years. Over the years most of my communications are brief and we are typically 6 to 10 feet apart. My interactions with people from the world’s infection hot spots are almost non-existent. An area I can improve upon is maintaining a good social distance while standing in grocery store lines. This is not hard and there are little crosses on the floor to remind you.
My second priority is to wash my hands more often and avoid touching my face. This is something I have improved upon.
My third priority is to give my immune system a fighting chance. This generally involves eating well, sleeping well, doing something outdoors, exercising daily, and minimizing stress. This disease is a great reason to start living a healthier lifestyle.
My fourth priority is to wear a mask and clean it daily. Although many people think this is a ‘slam dunk’ policy, I remain skeptical about wearing a mask. It sounds like a good idea but so did finding WMDs in Iraq. I hate to be picky but has anyone done a scientific study showing that wearing a mask will prevent the spread of COVID-19? Wasn’t it a month ago our experts were arguing against this policy? It does look like this policy is based on anecdotal information and not on scientific studies. Does a dirty mask make it more likely you will get sick? How do you clean a mask to prevent diseases? When it comes to wearing a mask, I am willing to let someone else be the guinea pig.
A few days ago I complained that a web page discussing COVID-19 cases at Long-Term Care Facilities had disappeared. I found it by going to the Ohio COVID-19 Dashboard. It has been several days and the page has not re-appeared. I can see where a Long-Term Care Facility would not want to talk with residents or family members about this subject at this time. When I viewed the page it had COVID-19 statistics for every Long-Term Care Facility that had a least one confirmed case. Courtesy of the Wayback Machine here is what the summary page said:
Long-Term Care Facilities
The case counts here reflect cases of COVID-19 among facility staff and residents during the calendar year 2020. This week’s numbers ?are cumulative and may include individuals who have been discharged from area hospitals and are in recovery, as well as past cases when an individual has fully recovered and returned to their prior place of residence. Moving forward, this number will be updated as they are reported to the Ohio Department of Health by local health departments weekly. Numbers will be updated at 2pm on Wednesday every week.
This information does not replace a thoughtful conversation with facility staff about their current infection control practices and mitigation strategies. Questions that families might ask a care facility include:
What are you doing currently to protect residents from COVID-19?
What precautions do you take when you do identify a person who is symptomatic of COVID-19?
How are families kept apprised of changes related to your infection control policies?
In addition, residents and family members should understand that the presence of COVID-19 at a facility is no way an indicator of a facility that isn’t following proper procedures. Families should always feel free to ask questions of the facility where their loved one resides, and if not satisfied, contact their local ombudsman.
On Thursday, April 17, I went to a page off of the Ohio COVID-19 Dashboard called Long Term Care. It listed confirmed cases at long term care facilities. Today I cannot find the page. From a purely scientific viewpoint, this is important information. On Thursday after visiting the page, I was quizzing my wife whether she remembered the long term care facility her grandmother was in. It was a few years ago and she did not remember the facility. One of the long term care facilities sounded vaguely familiar. Our situation has changed over the years. Her mom is now 84 years old. She is a pain in the butt but I think it is highly unlikely we will ever transfer her to a long term care facility. Like most people caring for the elderly, long term care is on our mind. So what is the plan with long term care facilities? Obscuring the obvious is not a winning plan. If we are planning to let the state get back to work, it is important that we have the most vulnerable portion of the population taken care of. So what is the plan?
I was curious whether population density mattered in the spread of COVID-19. To answer this question I calculated the population density for every Ohio county and did a scatter plot of the March 26th Confirmed Cases. The three points on the right side of the plot are Cuyahoga(Cleveland), Franklin(Columbus), and Hamilton(Cincinnati) Counties. The exponential trend line looks like a pretty good match to the data.
This graph is created using the numbers on the dashboard at the Corona Virus Case for Ohio page using R. This will be my last edition of this graph. The dashboard displays a similar graph and has more functionality to subset the data. Important things to notice:
So while the number of counties with at least one confirmed case of coronavirus increased to 60, the number of cases, hospitalizations, and deaths are dominated by the Cleveland-Akron, Columbus, and Cincinnati metropolitan areas. When these areas slow down, hospitalizations and potential deaths will have peaked for the state. The rest of the state’s counties continue to participate at a much slower rate.