24 ms·

California’s Roadmap to Modify the Stay-at-Home Order [pdf]

252 points by infodocket 7y ago

bpodgursky 7y ago
This has far less content and fewer concrete action items than the lowest-tier Mckinsey or Accenture report. And that is setting a very low bar. The roadmap appears to be "we have no idea, so we'll set un-measurable goals and pretend we've hit them, once the collateral damage of economic collapse is unbearably large"
- ajross 7y ago
  I think that's largely true, because no one has good answers here. All reasonable plans cannot be feasibly financed at the state level in the USA. Still, it seems like a properly framed argument like yours would need to start with "They have no plan" and then move on to... a plan. There are no good plans. At the end of the day we stay home, wait for infection rates to go down, and then spend a ton of money on testing and tracing. The other alternatives are to re-spawn the outbreak or to wait for a vaccine, both of which are even more expensive. But that plan needs to happen at the federal level, California doesn't have the money.
mdorazio 7y ago
Am I missing something? I don't see any kind of roadmap in here - it's just 6 generic talking points without any actual plan or timeline.
- ABeeSea 7y ago
  He said during the press conference that exact dates might be available in two-four weeks. He wants to see a further reduction in hospitalizations, an increase in testing, and a supply chain for PPE before committing to reopening dates.
  - mdorazio 7y ago
    Ok, thanks for the additional context. Was there any mention of actual targets for these things? Ex. "I'd like to see a 10% reduction of hospitalizations and at least 1M tests."
    - wbl 7y ago
      Why would there be? If something goes really wrong in one of those pushing it off a goal is going to be a problem.
      - mdorazio 7y ago
        Because without those things it's not a real plan. Anyone can say "we'll change policies when things get better". Defining what "better" means is the actual challenge and exactly what people as a whole are looking for.
        icelancer 7y ago
        They'd have to take responsibility for real metrics and a way to measure their performance. That's not going to happen at the government level.
        clsec 7y ago
        Newsom said he was giving this information to the public in the interest of disclosure. He wants the public to know what they're doing behind the scenes. He said it was just what they've been talking about, not a plan. He stated that any of this could change at a moments notice and to keep on doing what CA residents are doing because we do seem to be plateauing a bit.
  - ravenstine 7y ago
    > He said during the press conference that exact dates might be available in two-four weeks. That's incredibly vague. Almost worthless, given that they already extended the order by another month at the last minute.
  - 7y ago
- HarryHirsch 7y ago
  Can't have antibody testing to determine who is immune and can get back to work, can't have antigen testing to know who needs to quarantine, can't have government support for those who are off work because of quarantine, can't have support for undocumented workers who make up a good proportion of the workforce in some industries. Not going to work.
- mturmon 7y ago
  I think part of the point is that the clock does not determine when we can start to relax quarantine, it's our readiness/ability to detect and tamp down breakouts.
- icelancer 7y ago
  It notably does not present any sort of figures, expectations, statistics, or mathematics. No one wants to take responsibility. They'd rather have nebulous goalposts they can shift whenever they like. Hell, it's worked so far in convincing people mathematical models don't need to be accurate anymore - you have people in the streets defending embarrassingly poor epidemiological models.
  - anewhope 7y ago
    I’m not into politics but as a person this is not good leadership. These people are not sharing in the sacrifices they demand. Ante up if you’re going to play with people’s lives and livelihoods to this extent.
kurthr 7y ago
I’d like to see something that’s clear and doesn’t risk so much on rapid accurate testing and tracking of... everyone with significant delayed feedback. Something that could be done in rural areas or even developing countries. A reliable next step in the Hammer and the Dance. I found this: http://pandemicbreak.org/ http://pandemicbreak.org/
- eunoia 7y ago
  Anecdote: My wife and I were tested at Stanford today. There was no line, the process took 5-10 minutes and we never left the car. We were told to expect results in 24 hours. Widespread testing might not be that far off and feedback might not be that delayed. Edit: Since HN won't let me comment fast enough I figured I'd share the information here. We were referred to Stanford by our PCP yesterday. We were not members of Stanford Health prior. The process looked like this: - Video chatted with our PCP yesterday evening, who referred us to Stanford Health. - Video chatted a few hours later with a physician from Stanford Health who approved the test. - Scheduled the test for noon the next day We are not overtly symptomatic for most of the symptoms (at the moment, it has been worse) and have not travelled abroad in a relevant timespan.
  - raywu 7y ago
    Are you part of Stanford Health Care or is the test site open to public?
    - papeda 7y ago
      Similar but more general question: is testing available to everyone, e.g. random asymptomatic passersby?
      - raywu 7y ago
        I found a source[0]. Stanford was testing a larger population to get an estimate of the spread. [0] https://www.stanforddaily.com/2020/04/04/stanford-researchers-test-3200-people-for-covid-19-antibodies/ https://www.stanforddaily.com/2020/04/04/stanford-researcher...
fasteddie31003 7y ago
I personally think we need a county-by-county approach. There is a high variation of the infection at local levels. All the news is currently about how bad New York is and it's true but we're not all New York. http://www.countycovid19.com/ http://www.countycovid19.com/
- ajross 7y ago
  It's true that regions are different, but I don't see how that translates. Can you be specific? How would a plan for Queens County, NY differ from one for Waukesha WI, except in trivial stuff like dates? Some outbreaks are smaller, but you'll note that they all leveled off at roughly the same time and on the same schedule. That's because we locked down on "New York's schedule"[1]. If we didn't, these places which seem to have "handled" the outbreak would look like New York. The plans should absolutely be regional in that the lockdown rules should be based on infection rate thresholds, etc... But to do that they all need exactly the same per-capita testing resources. It's the same plan. [1] Really that's not true. We locked down on Seattle's schedule, because they moved first on most things. Seattle had by far the biggest early outbreak, but peaked earlier, peaked lower, and is now one of the better managed areas in the country. Cuomo gets all the attention but it's really Jay Inslee who saved us all.
  - bcrosby95 7y ago
    Jay Inslee and the Seattle Flu Study. Without the flu study going against medical guidelines (along with the guidance of the CDC to adhere to those guidelines) and testing some of their samples for COVID-19 (which isn't what they were collected for), Washington's timeline would have been pushed much further back.
  - 333c 7y ago
    Don't forget Newsom, who issued the first state-wide shelter in place order. That has been invaluable in keeping California safe(r).
  - timr 7y ago
    Different regions have dramatically different population densities, and don't necessarily need shelter-in-place rules. In NYC, shelter-in-place is probably the only feasible way to reduce social interactions when case-count is exploding, but in Boise, where people mostly live in detached housing and drive cars and cases are measured in the hundreds, it might be sufficient to eliminate large gatherings and shut down restaurants. It's not just a matter of thresholds. For all the various politicians are talking about "following the science", there's very little actual science backing up these measures. We're pretty much making it up as we go, and you would be hard-pressed to find "scientific" justifications for most of what we're currently doing.
mshroyer 7y ago
Why is the April section of the "removal of intervention" curve below the "with intervention" curve? Particularly since there are actual "hospitalizations" data points plotted along the former?
- momokoko 7y ago
  Because the graph was probably made in Powerpoint or Illustrator.
dsalzman 7y ago
My favorite line so far. Opening up areas of the country in an uncoordinated fashion is like having a peeing section in a pool...
- bsder 7y ago
  It's not actually a very good analogy. A peeing section in a pool simply diffuses and doesn't spontaneously generate another high-density peeing section elsewhere in the pool. We wish Covid-19 would simply diffuse down with distance.
  - ravenstine 7y ago
    Did you ever swim in a pool and wonder why your eyes burned? That's not the chlorine alone. The ammonia in the piss combines with the chlorine to create chloramine, which causes the eye burning and respiratory problems associated with pool water. It doesn't even take that much piss in the first place, and once it diffuses in the water, it will affect the whole pool. I'd say it's an excellent analogy. Whether it's noticeable or not, if one person pisses in the pool, everyone's swimming through their piss.
    - jdminhbg 7y ago
      That’s a bit of a myth. Sweat also reacts with chlorine to create chloramine, so it doesn’t actually require any urine. Cf. https://www.premierhealth.com/your-health/articles/women-wisdom-wellness-/pool-chlorine-can-t-live-without-how-to-live-with https://www.premierhealth.com/your-health/articles/women-wis...
walterbell 7y ago
> Slide 1: How prepared is our state to test everyone who is symptomatic? Positive tests could trigger notifications based on data collected by voluntary contact tracing apps. By only testing the symptomatic, mathematical models will continue to lack data for the subset of population that is already immune. We also need to test asymptomatic cases that would benefit from therapeutics which work best in early stages. We need to avoid cases reaching late-stage, where e.g. > 80% of people on ventilators do not survive. The federal government has allowed pharmacies to administer tests, once these become available. > Slide 5: Have we worked with businesses to support physical distancing practices and introduced guidelines to provide health checks when employees or the general public enter the premises? Is this alternate A/B work days for employees to reduce building occupancy by 50%? Do "health checks" mean forehead or long-distance thermal sensor temperature measurements before employees (customers?) enter buildings? > Slide 6: Do we have the ability to quickly communicate the need to reinstate these measures? Existing SMS text messaging for government alerts. No need for dedicated/mandatory apps.
- dillonmckay 7y ago
  Yes, each county should have the ability to send sms messages countywide via their emergency management body. That already exists.
maxlamb 7y ago
Why is it that hospitalizations are expected to keep increasing indefinitely even with the interventions in place? I assume the graph represents point-in-time hospitalizations and not accumulated # of interventions? If so it would be nice to see some of their assumptions, like average expected duration of hospitalization. I just don't understand why hospitalizations keep going up in this roadmap when every country that has put strict social distancing measures in effect starts to see a leveling-off and decrease in hospitalization after around the 3 week mark. In short, I wish they could put more details into what goes into these projections, and explain why they expect to see hospitalization number to keep going up even withs social distancing. Unless someone messed up and put the graph of accumulated hospitalizations since beginning of year instead of point-in-time # of hospitalizations.
- mandelbrotwurst 7y ago
  Where does it say that? The chart only goes through May.
  - maxlamb 7y ago
    The graph keeps going up in an exponential curve, even the one with interventions, through the end of May. You can see even the rate increasing at the end of May, so that means acceleration of growth with no hint of a leveling off. If they see it leveling off at some point I don't understand why they don't then extend the date range so we can see that.
- maxsilver 7y ago
  > why hospitalizations keep going up in this roadmap when every country that has put strict social distancing measures in effect starts to see a leveling-off and decrease in hospitalization after around the 3 week mark Because that's not a safe assumption. Hospitalizations are still going up in areas across the US, even in areas of US that are now on week 4 or 5 of lockdown. Michigan, for example, is on week 4 and while the growth of the curve is slowing, hospitalizations still continue to rise every single day - https://www.clickondetroit.com/news/michigan/2020/04/13/michigan-gov-whitmer-coronavirus-curve-starting-to-flatten-in-parts-of-state/ https://www.clickondetroit.com/news/michigan/2020/04/13/mich...
mikekij 7y ago
This entire plan is based on models that do not align with what we are seeing. The graph on slide two[1] of the official CA govt plan shows hospitalizations With Intervention rising exponentially, exceeding our hospital capacity in early June. The actual new infection data shows that the rate of new infections has been decreasing since at least 4/4 [2], meaning that the graph of active hospitalizations should be a bell curve with a maximum value of ~10,000 on ~4/20. The mismatch between their models and the observed data does not engender confidence. [1] https://www.gov.ca.gov/wp-content/uploads/2020/04/California-Roadmap-to-Modify-the-Stay-at-Home-Order.pdf https://www.gov.ca.gov/wp-content/uploads/2020/04/California... [2] https://covid-19.direct/state/CA https://covid-19.direct/state/CA
- ta1234567890 7y ago
  > The graph on slide two[1] of the official CA govt plan shows hospitalizations With Intervention rising exponentially It does not. The exponential curve, per the graph legend, is what would be expected without intervention.
  - mikekij 7y ago
    The light blue curve, labeled "With Intervention", is an upward-facing concave curve. Even if it were linear, it does not align with the observed data referenced in the link labeled [2].
    - joe_the_user 7y ago
      OK, looking at the new cases curve on your covid-19.direct page. As presented, you can't really see what the green curve is doing. If you remove the black, total curve, the green new case curve is visible but it seems to be going up and down fairly inconclusively. Until 4/1, it looks like exponential growth. After that, it goes down and then up. Sure, the optimistic view is it's plateaued or going downward and I hope that's true but counting on just twelve days of data seems foolish.
      - 7y ago
adrianmonk 7y ago
From indicator #1: > How prepared is our state to test everyone who is symptomatic? Another view is that opening the economy should involve testing people who are NOT symptomatic. Quoting from an MIT Technology Review article (https://www.technologyreview.com/2020/04/08/998785/stop-covid-or-save-the-economy-we-can-do-both/ https://www.technologyreview.com/2020/04/08/998785/stop-covi...): > The key, says Romer, is repeatedly testing everyone without symptoms to identify who is infected. (People with symptoms should just be assumed to have covid-19 and treated accordingly.) All those who test positive should isolate themselves; those who test negative can return to work, traveling, and socializing, but they should be tested every two weeks or so. ... > He calls the $2 trillion legislation passed by Congress “palliative care” for the economy. If you took $100 billion and put it into testing, he says, we would “be far better off.” Obviously for medical intervention purposes, you need to sometimes test people with symptoms. But for epidemiological and economic ones, it may be more important to test those without. So maybe neither is wrong, just different purposes. Incidentally, the same article presents a reasonable argument that while keeping the economy shut down causes damage, opening it too early might cause more long-term economic damage than it prevents in the short term. If so, choosing between the economy and saving lives might be a false choice.
- bhickey 7y ago
  > Another view is that opening the economy should involve testing people who are NOT symptomatic. Testing people with symptoms is a waste of tests. When tests are in short supply assume everyone with symptoms is positive, isolate them and test their contacts who don't have symptoms. As of last week, Boston Medical Center had a 44% positive rate on the tests they were running on symptomatic people. They could find more positive cases per test by testing people without symptoms. https://www.medrxiv.org/content/10.1101/2020.03.27.20043968v1 https://www.medrxiv.org/content/10.1101/2020.03.27.20043968v...
  - Shank 7y ago
    > Testing people with symptoms is a waste of tests. It's not, though. Someone suffering from severe symptoms that aren't COVID-19 may have other treatment options available, and may be placed in hospitals with less strict isolation requirements. In a perfect world we would have isolation beds and supplies for everybody, but that still doesn't get around the fact that treatment for COVID-19 and bacterial pneumonia are two different beasts, and both lead to similar end results.
adelHBN 7y ago
Thanks for sharing this. The first slide throws two pretty big hurdles to reopening - testing and contact tracing. While Google and Amazon are working on contact tracing, it's not clear when it'll be widely implemented or when tests will become prevalent. If the stay-at-home order is conditioned on the implementation of those two indicators, then we may be waiting for a while.
- wbl 7y ago
  Contact tracing requires shoe leather not tech.
  - DennisP 7y ago
    Either works. South Korea applied tech pretty effectively.
    - bluedays 7y ago
      Neither works as well as bother together. There are lots of places I go without my phone. There are lots of places I wouldn't report going, but the phone data would say otherwise.
    - raphlinus 7y ago
      They applied the combination of shoe leather and tech effectively. I think tech on its own without a robust public health infrastructure would be pretty ineffective, but the latter on its own could do well. https://khn.org/news/how-do-we-exit-the-shutdown-hire-an-army-of-public-health-workers/ https://khn.org/news/how-do-we-exit-the-shutdown-hire-an-arm...
      - adelHBN 7y ago
        I totally agree that only the combo works. But my concern is that we don't have the cohesive, political and business structure to pull off something like that.
        7y ago
ninetyfurr 7y ago
They should quit padding the numbers if they're so concerned about minimizing fatalities. A man gets hit by a bus and tests positive for Coronavirus, I don't care what the science has to say about it, that is not a Coronavirus death and you can't change my mind.
- ska 7y ago
  Most places are if anything undercounting fatalities, not overcounting. Do you have any evidence California is different?
- kinkrtyavimoodh 7y ago
  One pathological example doesn't make a trend.
  - lsh123 7y ago
    Not really one example: N.Y.C. Death Toll Soars Past 10,000 in Revised Virus Count The city has added more than 3,700 additional people who were presumed to have died of the coronavirus but had never tested positive. https://www.nytimes.com/2020/04/14/nyregion/new-york-coronavirus-deaths.html https://www.nytimes.com/2020/04/14/nyregion/new-york-coronav...
- esoterica 7y ago
  Do you think it's likely that 26,000 people happened to get hit by a bus right after getting diagnosed with the coronavirus? 4% of the patients diagnosed with coronavirus in the US have already died (and many more of the currently diagnosed patients are still sick and have not yet died but will in the future). It's wildly implausible that a meaningful fraction of 4% of that sample could have coincidentally died within a few weeks of getting diagnosed with the coronavirus, but for entirely unrelated reasons. If 4% of the population were dying every few weeks, humanity would be virtually extinct within a few years. Your "stat-padding" theory doesn't pass a basic smell test. You can construct far-fetched pathological scenarios for how 1 or 2 people might be wrongly identified as coronavirus victims, but you can't explain away 26k deaths with baseless conspiracy theories.
standardUser 7y ago
It's worth looking at Denmark, Austria, Czechia and other European countries that have already started loosening restrictions this week. Like California, they locked down fast and flattened the curve. Now, Denmark is opening school and all three (plus Germany and parts of Italy) are opening smaller non-essential shops. I haven't found great info on how well these countries have implemented contact tracing, but they do have per capita testing rates much higher than the US (and vastly higher than California). Here's an interesting article that describes some of the specific precautions Denmark is taking as they open up some schools tomorrow: https://www.thelocal.dk/20200413/schools-and-day-care-centres-gear-up-for-staggered-and-restricted-reopening https://www.thelocal.dk/20200413/schools-and-day-care-centre...
- yodsanklai 7y ago
  I don't think Europe is doing particularly well either. Well, at least France where I live. France is going to release lockdown in a month. My impression is that this is mostly for economical reasons because it was unsustainable. I'm not confident we'll deal with the epidemics much better this time. The gvt still hasn't released their roadmap, but they hope to improve their testing capacity, the availability of masks, and to enable contact tracing using some hypothetical app. There's no silver bullet, but we just hope that it'll work, otherwise we'll have to go into lockdown again (or not if it appears too costly). Our gvt hasn't communicated clearly on the possible outcomes. The president speech was mostly unsatisfying politician rhetoric, trying to avoid the fact that they didn't anticipate the crisis, and that they had no satisfactory solutions.
  - lbeltrame 7y ago
    At least in a couple of months we'll know the result of trials for some repurposed drugs (there's quite a bunch slated to end in June). I don't expect miracles or super effectiveness, but some of these might be beneficial enough to take some load off the hospital system.
  - standardUser 7y ago
    "France is going to release lockdown in a month." I highly doubt that will happen. The preferred approach seems to be incremental opening to try and control the transmission rate. There might be one or two very stupid leaders who want to open things up with a bang (cough Trump cough), but the European nations currently easing restrictions seem to being doing so very cautiously.
balozi 7y ago
This is a very strange Mckinsey-esque document. 1) Is this really a roadmap? 2) What does "Modify the Stay-at-Home Order" actually mean? 3) Is the state staking CA's economy and wellbeing on its ability to accomplishing the impossible?
- deleted 7y ago
  [deleted]
mchusma 7y ago
A real plan would look like this https://imgur.com/spemOeG https://imgur.com/spemOeG specifying the levels of restrictions and the metrics we will use to track the metrics. This allows people to understand what to expect the best possible. We already have huge uncertainty, we don't need to add uncertainty of government response on top of uncertainty of the virus. I think there is huge room to debate the numbers and what goes in what level, but this is what a real roadmap looks like. This "roadmap" is quite scary as this is not a plan that would pass muster in in YC Boardroom. (1) The one chart with data is horribly innacurate: (a) It shows interventions causing worse than no interventions in the short term? (b) Shows hospitalizations increasing despite the fact that they have not for some time. (c) Shows "Surge Capacity" as a static value, which you would hope they are increasing if they really think this is the issue. (2) It does not specify in any fashion what the different levels of coming back are. When can medical procedures resume? When can non-essential work where social distancing is easy resume (e.g. Los Angeles apparently has banned gardeners, who don't need to get near a soul)? (3) If he believes masks work (as I do and as indicated in this presentation), why are masks not required and businesses shut down? Shouldn't we do the less painful and restrictive measure first before we shut down businesses? (4) Most importantly there is not an actual goal clearly articulated here. Is he going for suppression? Is he going for mitigation? I like many others are deeply upset by leadership from both parties, at all levels of government.
- hartator 7y ago
  > I like many others are deeply upset by leadership from both parties, at all levels of government. Yes, I agree. What’a really upsetting is they try to justify why less transparency is good thing. When they are using this only as way to impose their authority.
- phkahler 7y ago
  >> I like many others are deeply upset by leadership from both parties, at all levels of government. I'm sitting at home in Michigan where the governor has closed almost all businesses. Politicians bicker over weather governors or the president have the authority to reopen things. And yet there is no plan as far as I can see. No goals, no criteria to trigger next steps, nothing. Meanwhile the press just snipes at people.
mrfusion 7y ago
This doesn’t say anything about when I can see my family again.
- pm_me_ur_fullz 7y ago
  You can come into the state and you can leave the state, what state-level circumstance is preventing you? I'm grasping at straws but maybe you are estranged and your family is on the street but they won't let you into the hobo-hotel? Every other circumstance I can think of is a Federal issue closing borders for people that aren't Americans.
  - mrfusion 7y ago
    Isn’t CA under lockdown? Only supposed to leave your apartment for groceries right?
    - viklove 7y ago
      They're not saying you can't return to your family, they're just saying not to congregate in large numbers. I've moved back from my apartment (Chicago) to the suburbs to stay with my parents until this lockdown ceases. Of course, we both started isolating two weeks before I came home, and they picked me up so I wouldn't have to take the train. Just use your head, don't do things that will risk spreading the disease. Taking public transit to/from your family a few times a week is very dangerous. Going someplace and staying there is not.
      - deleted 7y ago
        [deleted]
    - randyrand 7y ago
      No, you can go outside for exercise, walks, errands. etc.
      - war1025 7y ago
sergiotapia 7y ago
I don't understand why at risk people don't just stay at home. Why lock everybody else up? Enough is enough, kids need to go back to school and people need to go back to work. This document seems hand-wavy and doesn't answer anything.
- gdulli 7y ago
  First, because they live with people who aren't at risk and if those people go about their lives it defeats the purpose. Second, if everyone not explicitly at high risk went about their normal business, some percentage of them would still need medical attention and the hospitals would run out of beds, leaving some to die.
  - sergiotapia 7y ago
    So, you live with people that are at risk, you can stay home too! Second: That's the nature of nature. If you want, you can protect yourself, stay home!
    - gdulli 7y ago
      And what happens when you, with your good judgement, decide to protect yourself and stay home, and then you have an unrelated treatable condition but die because no hospital could take you because they're all busy dealing with all the Coronavirus patients who were left to their good judgement and didn't stay home?
      - sergiotapia 7y ago
        1. Your hypothetical isn't a possibility. The numbers do not reflect that possibility, not even close. 2. Even if it were a possibility, it's that vs. shutting down peoples lives for a very long time. "Is your life worth my liberty?" - that's something we fundamentally disagree on.
        objectivetruth 7y ago
yodsanklai 7y ago
I would cynically summarize this as: lockdown is economically unsustainable. We need to go back to work. Let's hope we can control the epidemics this time better than before the lockdown. We may have new tools this time (contact tracing, masks, test). But we're not really sure they'll work. It's the exact same situation in France where we're planning to go out of lockdown in 4 weeks. It seems unclear that we'll have the needed tools by then. It's not even clear that they'll work but there are no other options. At least the California roadmap isn't pretending they have the answers to the question they raised...
- throwaway237683 7y ago
  Isn't it amazing that an absolutely massive privacy invasion that is called contact tracing is already accepted as _inevitable_ if we are ever to be allowed to step out of our homes? Talk about cynicism.
  - 0xy 7y ago
    Australia and Singapore's governments are rolling out an app that allows them to track every person you meet with for more than a short period of time. Why would anyone trust them to not abuse this data? If they wanted people to volunteer information, maybe they shouldn't have repeatedly abused trust.
    - anthony_doan 7y ago
      Singapore is often refer to as soft-authoritarian. It's like choosing N.Korea as an example and asking why you should trust them with your civil liberties. https://privacyinternational.org/sites/default/files/2017-12/Singapore_UPR_PI_submission_FINAL.pdf https://privacyinternational.org/sites/default/files/2017-12...
      - dehrmann 7y ago
        I'm honestly not sure what to make of the People's Action Party winning something like 80% of votes. That's a Putin level of popularity.
ravenstine 7y ago
It doesn't make any sense that we continue the lockdown in its current state. Hospitals in California aren't overrun. We were insisted upon that the "flattening the curve" was to prevent the medical system from being overwhelmed. With what we've been able to do, we're not even close to having overrun hospitals. By now, we should have ramped up the system to account for greater numbers of severe cases. Given that, we should quarantine the vulnerable population and allow the rest of the population to get things back to normal. Otherwise, we'll come out of this with no herd immunity, potentially making the last month a total loss, and creating further loss in the near future.
- gabaix 7y ago
  Hospitals around me are at half capacity. San Mateo is at 56% capacity in ICU beds.[1] Covid cases were doubling every 3 days (up to 5). Would it be correct to say that had we waited another week, hospitals would have been overrun? If that's the case then I understand why health authorities are cautious. [1] https://www.smchealth.org/post/san-mateo-county-covid-19-data-1 https://www.smchealth.org/post/san-mateo-county-covid-19-dat...
  - marcell 7y ago
    Typically a hospitals run at near full capacity, especially during flu season. I have a friend who works at the Kaiser in Oakland in ER, and she says it has been pretty empty right now, relative to a typical flu season. The data linked shows about half the beds are taken up by COVID-19 patients, and the other half are other cases. They claim to have 77 standard ICU beds, and 300 surge beds available. Of those, 34% of the standard and 94% of the surge beds are unused. So out of 377 total beds, 5% are taken up by COVID-19 patients. I think it's hard to estimate the doubling rate based on the numbers we have out there. Confirmed cases is a poor proxy for actual cases, since it depends a lot on testing rates, who gets tested, etc. A lot of new data is suggesting that coronavirus spread further we previously though, and that it started spreading in America sooner than we previously though. We don't know the true numbers because they didn't start testing for coronavirus in America until March, and even then it was at a very low rate.
- 7y ago
anon543210 7y ago
Maybe I'm the idiot but its pretty clear as to whats on the roadmap. >defines a goal or desired outcome and includes the major steps or milestones needed to reach it. Yeah its missing some specifics but there are certainly goals stated before the decision to relax the stay at home policy is reached.
zaidf 7y ago
For everyone who has tracked California’s response over the past month (the good and the bad), the #1 problem is obvious: a) California’s testing and reporting infrastructure is absolutely abysmal, arguably the worst in the country b) there are very few signs that it will improve anytime soon California leaders haven’t had to confront this publicly because much of the last one month had been focused almost exclusively on reducing fatalities and increasing hospital capacity. Testing matters but not that much for the most acute cases. It matters a lot more in determining the the rate of incline/decline of new infections, both numbers that will increasingly matter more as fatalities and hospitalizations stabilize.
- oh_come_on 7y ago
  There’s no way that California is less effective then red states like Texas
- dnautics 7y ago
  I would argue that reducing the rate of deaths is the #1 problem, followed by reducing the rate of infections, followed by being able to determine the rate of infections. So, unless you believe california results are 10x off, based on empirical results and your assertion that the testing and reporting infrastructure is "the worst", the state of california has at least done a fair job of managing its effort in the face of a limited resource. Knowing in detail what's going on is strictly secondary to reducing deaths.
  - zaidf 7y ago
    I believe California has done an amazing job so far on the whole; “fair” would be a gross understatement. So I think we are in agreement there. That said, I do think as new casualties and hospitalizations are on the decline, test reporting and infrastructure matters disproportionately more for the next phase (planning for gradual reopening) and phases after.
redis_mlc 7y ago
I see a dozen questions with no answers. Where is our leadership when we need it?
throwawaysea 7y ago
There is data suggesting that the current number of recognized infections is just 6% of the total infection count. This also means that case fatality rates are vastly overstated, since the rate would drop if we had enough testing to recognize the true total case count: https://reason.com/2020/04/12/official-covid-19-numbers-represent-just-6-of-total-infections-a-new-analysis-suggests/ https://reason.com/2020/04/12/official-covid-19-numbers-repr... A new antibody study in LA may give us better numbers: https://www.latimes.com/california/story/2020-04-10/coronavirus-antibodies-testing-los-angeles-county https://www.latimes.com/california/story/2020-04-10/coronavi... My one hope is that the leaders of these states (CA OR WA) do not follow the “noble lie” strategy adopted by the WHO and others to manipulate the population. Insofar as coercive orders are tolerated at all, they must be accompanied by truthful metrics, believable goalposts, and a practical mindset that doesn’t aim for perfect outcomes.

252 points by infodocket 7y ago

This has far less content and fewer concrete action items than the lowest-tier Mckinsey or Accenture report. And that is setting a very low bar. The roadmap appears to be "we have no idea, so we'll set un-measurable goals and pretend we've hit them, once the collateral damage of economic collapse is unbearably large"

ajross 7y ago
I think that's largely true, because no one has good answers here. All reasonable plans cannot be feasibly financed at the state level in the USA. Still, it seems like a properly framed argument like yours would need to start with "They have no plan" and then move on to... a plan. There are no good plans. At the end of the day we stay home, wait for infection rates to go down, and then spend a ton of money on testing and tracing. The other alternatives are to re-spawn the outbreak or to wait for a vaccine, both of which are even more expensive. But that plan needs to happen at the federal level, California doesn't have the money.

mdorazio 7y ago

Am I missing something? I don't see any kind of roadmap in here - it's just 6 generic talking points without any actual plan or timeline.

ABeeSea 7y ago
He said during the press conference that exact dates might be available in two-four weeks. He wants to see a further reduction in hospitalizations, an increase in testing, and a supply chain for PPE before committing to reopening dates.
- mdorazio 7y ago
  Ok, thanks for the additional context. Was there any mention of actual targets for these things? Ex. "I'd like to see a 10% reduction of hospitalizations and at least 1M tests."
  - wbl 7y ago
    Why would there be? If something goes really wrong in one of those pushing it off a goal is going to be a problem.
    - mdorazio 7y ago
      Because without those things it's not a real plan. Anyone can say "we'll change policies when things get better". Defining what "better" means is the actual challenge and exactly what people as a whole are looking for.
      - icelancer 7y ago
        They'd have to take responsibility for real metrics and a way to measure their performance. That's not going to happen at the government level.
      - clsec 7y ago
        Newsom said he was giving this information to the public in the interest of disclosure. He wants the public to know what they're doing behind the scenes. He said it was just what they've been talking about, not a plan. He stated that any of this could change at a moments notice and to keep on doing what CA residents are doing because we do seem to be plateauing a bit.
- ravenstine 7y ago
  > He said during the press conference that exact dates might be available in two-four weeks. That's incredibly vague. Almost worthless, given that they already extended the order by another month at the last minute.
- 7y ago
HarryHirsch 7y ago
Can't have antibody testing to determine who is immune and can get back to work, can't have antigen testing to know who needs to quarantine, can't have government support for those who are off work because of quarantine, can't have support for undocumented workers who make up a good proportion of the workforce in some industries. Not going to work.
mturmon 7y ago
I think part of the point is that the clock does not determine when we can start to relax quarantine, it's our readiness/ability to detect and tamp down breakouts.
icelancer 7y ago
It notably does not present any sort of figures, expectations, statistics, or mathematics. No one wants to take responsibility. They'd rather have nebulous goalposts they can shift whenever they like. Hell, it's worked so far in convincing people mathematical models don't need to be accurate anymore - you have people in the streets defending embarrassingly poor epidemiological models.
- anewhope 7y ago
  I’m not into politics but as a person this is not good leadership. These people are not sharing in the sacrifices they demand. Ante up if you’re going to play with people’s lives and livelihoods to this extent.

kurthr 7y ago

I’d like to see something that’s clear and doesn’t risk so much on rapid accurate testing and tracking of... everyone with significant delayed feedback. Something that could be done in rural areas or even developing countries. A reliable next step in the Hammer and the Dance. I found this: http://pandemicbreak.org/ http://pandemicbreak.org/

eunoia 7y ago
Anecdote: My wife and I were tested at Stanford today. There was no line, the process took 5-10 minutes and we never left the car. We were told to expect results in 24 hours. Widespread testing might not be that far off and feedback might not be that delayed. Edit: Since HN won't let me comment fast enough I figured I'd share the information here. We were referred to Stanford by our PCP yesterday. We were not members of Stanford Health prior. The process looked like this: - Video chatted with our PCP yesterday evening, who referred us to Stanford Health. - Video chatted a few hours later with a physician from Stanford Health who approved the test. - Scheduled the test for noon the next day We are not overtly symptomatic for most of the symptoms (at the moment, it has been worse) and have not travelled abroad in a relevant timespan.
- raywu 7y ago
  Are you part of Stanford Health Care or is the test site open to public?
  - papeda 7y ago
    Similar but more general question: is testing available to everyone, e.g. random asymptomatic passersby?
    - raywu 7y ago
      I found a source[0]. Stanford was testing a larger population to get an estimate of the spread. [0] https://www.stanforddaily.com/2020/04/04/stanford-researchers-test-3200-people-for-covid-19-antibodies/ https://www.stanforddaily.com/2020/04/04/stanford-researcher...

fasteddie31003 7y ago

I personally think we need a county-by-county approach. There is a high variation of the infection at local levels. All the news is currently about how bad New York is and it's true but we're not all New York. http://www.countycovid19.com/ http://www.countycovid19.com/

ajross 7y ago
It's true that regions are different, but I don't see how that translates. Can you be specific? How would a plan for Queens County, NY differ from one for Waukesha WI, except in trivial stuff like dates? Some outbreaks are smaller, but you'll note that they all leveled off at roughly the same time and on the same schedule. That's because we locked down on "New York's schedule"[1]. If we didn't, these places which seem to have "handled" the outbreak would look like New York. The plans should absolutely be regional in that the lockdown rules should be based on infection rate thresholds, etc... But to do that they all need exactly the same per-capita testing resources. It's the same plan. [1] Really that's not true. We locked down on Seattle's schedule, because they moved first on most things. Seattle had by far the biggest early outbreak, but peaked earlier, peaked lower, and is now one of the better managed areas in the country. Cuomo gets all the attention but it's really Jay Inslee who saved us all.
- bcrosby95 7y ago
  Jay Inslee and the Seattle Flu Study. Without the flu study going against medical guidelines (along with the guidance of the CDC to adhere to those guidelines) and testing some of their samples for COVID-19 (which isn't what they were collected for), Washington's timeline would have been pushed much further back.
- 333c 7y ago
  Don't forget Newsom, who issued the first state-wide shelter in place order. That has been invaluable in keeping California safe(r).
- timr 7y ago
  Different regions have dramatically different population densities, and don't necessarily need shelter-in-place rules. In NYC, shelter-in-place is probably the only feasible way to reduce social interactions when case-count is exploding, but in Boise, where people mostly live in detached housing and drive cars and cases are measured in the hundreds, it might be sufficient to eliminate large gatherings and shut down restaurants. It's not just a matter of thresholds. For all the various politicians are talking about "following the science", there's very little actual science backing up these measures. We're pretty much making it up as we go, and you would be hard-pressed to find "scientific" justifications for most of what we're currently doing.

mshroyer 7y ago

Why is the April section of the "removal of intervention" curve below the "with intervention" curve? Particularly since there are actual "hospitalizations" data points plotted along the former?

momokoko 7y ago
Because the graph was probably made in Powerpoint or Illustrator.

dsalzman 7y ago

My favorite line so far. Opening up areas of the country in an uncoordinated fashion is like having a peeing section in a pool...

bsder 7y ago
It's not actually a very good analogy. A peeing section in a pool simply diffuses and doesn't spontaneously generate another high-density peeing section elsewhere in the pool. We wish Covid-19 would simply diffuse down with distance.
- ravenstine 7y ago
  Did you ever swim in a pool and wonder why your eyes burned? That's not the chlorine alone. The ammonia in the piss combines with the chlorine to create chloramine, which causes the eye burning and respiratory problems associated with pool water. It doesn't even take that much piss in the first place, and once it diffuses in the water, it will affect the whole pool. I'd say it's an excellent analogy. Whether it's noticeable or not, if one person pisses in the pool, everyone's swimming through their piss.
  - jdminhbg 7y ago
    That’s a bit of a myth. Sweat also reacts with chlorine to create chloramine, so it doesn’t actually require any urine. Cf. https://www.premierhealth.com/your-health/articles/women-wisdom-wellness-/pool-chlorine-can-t-live-without-how-to-live-with https://www.premierhealth.com/your-health/articles/women-wis...

walterbell 7y ago

> Slide 1: How prepared is our state to test everyone who is symptomatic? Positive tests could trigger notifications based on data collected by voluntary contact tracing apps. By only testing the symptomatic, mathematical models will continue to lack data for the subset of population that is already immune. We also need to test asymptomatic cases that would benefit from therapeutics which work best in early stages. We need to avoid cases reaching late-stage, where e.g. > 80% of people on ventilators do not survive. The federal government has allowed pharmacies to administer tests, once these become available. > Slide 5: Have we worked with businesses to support physical distancing practices and introduced guidelines to provide health checks when employees or the general public enter the premises? Is this alternate A/B work days for employees to reduce building occupancy by 50%? Do "health checks" mean forehead or long-distance thermal sensor temperature measurements before employees (customers?) enter buildings? > Slide 6: Do we have the ability to quickly communicate the need to reinstate these measures? Existing SMS text messaging for government alerts. No need for dedicated/mandatory apps.

dillonmckay 7y ago
Yes, each county should have the ability to send sms messages countywide via their emergency management body. That already exists.

maxlamb 7y ago

Why is it that hospitalizations are expected to keep increasing indefinitely even with the interventions in place? I assume the graph represents point-in-time hospitalizations and not accumulated # of interventions? If so it would be nice to see some of their assumptions, like average expected duration of hospitalization. I just don't understand why hospitalizations keep going up in this roadmap when every country that has put strict social distancing measures in effect starts to see a leveling-off and decrease in hospitalization after around the 3 week mark. In short, I wish they could put more details into what goes into these projections, and explain why they expect to see hospitalization number to keep going up even withs social distancing. Unless someone messed up and put the graph of accumulated hospitalizations since beginning of year instead of point-in-time # of hospitalizations.

mandelbrotwurst 7y ago
Where does it say that? The chart only goes through May.
- maxlamb 7y ago
  The graph keeps going up in an exponential curve, even the one with interventions, through the end of May. You can see even the rate increasing at the end of May, so that means acceleration of growth with no hint of a leveling off. If they see it leveling off at some point I don't understand why they don't then extend the date range so we can see that.
maxsilver 7y ago
> why hospitalizations keep going up in this roadmap when every country that has put strict social distancing measures in effect starts to see a leveling-off and decrease in hospitalization after around the 3 week mark Because that's not a safe assumption. Hospitalizations are still going up in areas across the US, even in areas of US that are now on week 4 or 5 of lockdown. Michigan, for example, is on week 4 and while the growth of the curve is slowing, hospitalizations still continue to rise every single day - https://www.clickondetroit.com/news/michigan/2020/04/13/michigan-gov-whitmer-coronavirus-curve-starting-to-flatten-in-parts-of-state/ https://www.clickondetroit.com/news/michigan/2020/04/13/mich...

mikekij 7y ago

This entire plan is based on models that do not align with what we are seeing. The graph on slide two[1] of the official CA govt plan shows hospitalizations With Intervention rising exponentially, exceeding our hospital capacity in early June. The actual new infection data shows that the rate of new infections has been decreasing since at least 4/4 [2], meaning that the graph of active hospitalizations should be a bell curve with a maximum value of ~10,000 on ~4/20. The mismatch between their models and the observed data does not engender confidence. [1] https://www.gov.ca.gov/wp-content/uploads/2020/04/California-Roadmap-to-Modify-the-Stay-at-Home-Order.pdf https://www.gov.ca.gov/wp-content/uploads/2020/04/California... [2] https://covid-19.direct/state/CA https://covid-19.direct/state/CA

ta1234567890 7y ago
> The graph on slide two[1] of the official CA govt plan shows hospitalizations With Intervention rising exponentially It does not. The exponential curve, per the graph legend, is what would be expected without intervention.
- mikekij 7y ago
  The light blue curve, labeled "With Intervention", is an upward-facing concave curve. Even if it were linear, it does not align with the observed data referenced in the link labeled [2].
  - joe_the_user 7y ago
    OK, looking at the new cases curve on your covid-19.direct page. As presented, you can't really see what the green curve is doing. If you remove the black, total curve, the green new case curve is visible but it seems to be going up and down fairly inconclusively. Until 4/1, it looks like exponential growth. After that, it goes down and then up. Sure, the optimistic view is it's plateaued or going downward and I hope that's true but counting on just twelve days of data seems foolish.
    - 7y ago

adrianmonk 7y ago

From indicator #1: > How prepared is our state to test everyone who is symptomatic? Another view is that opening the economy should involve testing people who are NOT symptomatic. Quoting from an MIT Technology Review article (https://www.technologyreview.com/2020/04/08/998785/stop-covid-or-save-the-economy-we-can-do-both/ https://www.technologyreview.com/2020/04/08/998785/stop-covi...): > The key, says Romer, is repeatedly testing everyone without symptoms to identify who is infected. (People with symptoms should just be assumed to have covid-19 and treated accordingly.) All those who test positive should isolate themselves; those who test negative can return to work, traveling, and socializing, but they should be tested every two weeks or so. ... > He calls the $2 trillion legislation passed by Congress “palliative care” for the economy. If you took $100 billion and put it into testing, he says, we would “be far better off.” Obviously for medical intervention purposes, you need to sometimes test people with symptoms. But for epidemiological and economic ones, it may be more important to test those without. So maybe neither is wrong, just different purposes. Incidentally, the same article presents a reasonable argument that while keeping the economy shut down causes damage, opening it too early might cause more long-term economic damage than it prevents in the short term. If so, choosing between the economy and saving lives might be a false choice.

bhickey 7y ago
> Another view is that opening the economy should involve testing people who are NOT symptomatic. Testing people with symptoms is a waste of tests. When tests are in short supply assume everyone with symptoms is positive, isolate them and test their contacts who don't have symptoms. As of last week, Boston Medical Center had a 44% positive rate on the tests they were running on symptomatic people. They could find more positive cases per test by testing people without symptoms. https://www.medrxiv.org/content/10.1101/2020.03.27.20043968v1 https://www.medrxiv.org/content/10.1101/2020.03.27.20043968v...
- Shank 7y ago
  > Testing people with symptoms is a waste of tests. It's not, though. Someone suffering from severe symptoms that aren't COVID-19 may have other treatment options available, and may be placed in hospitals with less strict isolation requirements. In a perfect world we would have isolation beds and supplies for everybody, but that still doesn't get around the fact that treatment for COVID-19 and bacterial pneumonia are two different beasts, and both lead to similar end results.

adelHBN 7y ago

Thanks for sharing this. The first slide throws two pretty big hurdles to reopening - testing and contact tracing. While Google and Amazon are working on contact tracing, it's not clear when it'll be widely implemented or when tests will become prevalent. If the stay-at-home order is conditioned on the implementation of those two indicators, then we may be waiting for a while.

wbl 7y ago
Contact tracing requires shoe leather not tech.
- DennisP 7y ago
  Either works. South Korea applied tech pretty effectively.
  - bluedays 7y ago
    Neither works as well as bother together. There are lots of places I go without my phone. There are lots of places I wouldn't report going, but the phone data would say otherwise.
  - raphlinus 7y ago
    They applied the combination of shoe leather and tech effectively. I think tech on its own without a robust public health infrastructure would be pretty ineffective, but the latter on its own could do well. https://khn.org/news/how-do-we-exit-the-shutdown-hire-an-army-of-public-health-workers/ https://khn.org/news/how-do-we-exit-the-shutdown-hire-an-arm...
    - adelHBN 7y ago
      I totally agree that only the combo works. But my concern is that we don't have the cohesive, political and business structure to pull off something like that.
      - 7y ago

ninetyfurr 7y ago

They should quit padding the numbers if they're so concerned about minimizing fatalities. A man gets hit by a bus and tests positive for Coronavirus, I don't care what the science has to say about it, that is not a Coronavirus death and you can't change my mind.

ska 7y ago
Most places are if anything undercounting fatalities, not overcounting. Do you have any evidence California is different?
kinkrtyavimoodh 7y ago
One pathological example doesn't make a trend.
- lsh123 7y ago
  Not really one example: N.Y.C. Death Toll Soars Past 10,000 in Revised Virus Count The city has added more than 3,700 additional people who were presumed to have died of the coronavirus but had never tested positive. https://www.nytimes.com/2020/04/14/nyregion/new-york-coronavirus-deaths.html https://www.nytimes.com/2020/04/14/nyregion/new-york-coronav...
esoterica 7y ago
Do you think it's likely that 26,000 people happened to get hit by a bus right after getting diagnosed with the coronavirus? 4% of the patients diagnosed with coronavirus in the US have already died (and many more of the currently diagnosed patients are still sick and have not yet died but will in the future). It's wildly implausible that a meaningful fraction of 4% of that sample could have coincidentally died within a few weeks of getting diagnosed with the coronavirus, but for entirely unrelated reasons. If 4% of the population were dying every few weeks, humanity would be virtually extinct within a few years. Your "stat-padding" theory doesn't pass a basic smell test. You can construct far-fetched pathological scenarios for how 1 or 2 people might be wrongly identified as coronavirus victims, but you can't explain away 26k deaths with baseless conspiracy theories.

standardUser 7y ago

It's worth looking at Denmark, Austria, Czechia and other European countries that have already started loosening restrictions this week. Like California, they locked down fast and flattened the curve. Now, Denmark is opening school and all three (plus Germany and parts of Italy) are opening smaller non-essential shops. I haven't found great info on how well these countries have implemented contact tracing, but they do have per capita testing rates much higher than the US (and vastly higher than California). Here's an interesting article that describes some of the specific precautions Denmark is taking as they open up some schools tomorrow: https://www.thelocal.dk/20200413/schools-and-day-care-centres-gear-up-for-staggered-and-restricted-reopening https://www.thelocal.dk/20200413/schools-and-day-care-centre...

yodsanklai 7y ago
I don't think Europe is doing particularly well either. Well, at least France where I live. France is going to release lockdown in a month. My impression is that this is mostly for economical reasons because it was unsustainable. I'm not confident we'll deal with the epidemics much better this time. The gvt still hasn't released their roadmap, but they hope to improve their testing capacity, the availability of masks, and to enable contact tracing using some hypothetical app. There's no silver bullet, but we just hope that it'll work, otherwise we'll have to go into lockdown again (or not if it appears too costly). Our gvt hasn't communicated clearly on the possible outcomes. The president speech was mostly unsatisfying politician rhetoric, trying to avoid the fact that they didn't anticipate the crisis, and that they had no satisfactory solutions.
- lbeltrame 7y ago
  At least in a couple of months we'll know the result of trials for some repurposed drugs (there's quite a bunch slated to end in June). I don't expect miracles or super effectiveness, but some of these might be beneficial enough to take some load off the hospital system.
- standardUser 7y ago
  "France is going to release lockdown in a month." I highly doubt that will happen. The preferred approach seems to be incremental opening to try and control the transmission rate. There might be one or two very stupid leaders who want to open things up with a bang (cough Trump cough), but the European nations currently easing restrictions seem to being doing so very cautiously.

balozi 7y ago

This is a very strange Mckinsey-esque document. 1) Is this really a roadmap? 2) What does "Modify the Stay-at-Home Order" actually mean? 3) Is the state staking CA's economy and wellbeing on its ability to accomplishing the impossible?

deleted 7y ago
[deleted]

mchusma 7y ago

A real plan would look like this https://imgur.com/spemOeG https://imgur.com/spemOeG specifying the levels of restrictions and the metrics we will use to track the metrics. This allows people to understand what to expect the best possible. We already have huge uncertainty, we don't need to add uncertainty of government response on top of uncertainty of the virus. I think there is huge room to debate the numbers and what goes in what level, but this is what a real roadmap looks like. This "roadmap" is quite scary as this is not a plan that would pass muster in in YC Boardroom. (1) The one chart with data is horribly innacurate: (a) It shows interventions causing worse than no interventions in the short term? (b) Shows hospitalizations increasing despite the fact that they have not for some time. (c) Shows "Surge Capacity" as a static value, which you would hope they are increasing if they really think this is the issue. (2) It does not specify in any fashion what the different levels of coming back are. When can medical procedures resume? When can non-essential work where social distancing is easy resume (e.g. Los Angeles apparently has banned gardeners, who don't need to get near a soul)? (3) If he believes masks work (as I do and as indicated in this presentation), why are masks not required and businesses shut down? Shouldn't we do the less painful and restrictive measure first before we shut down businesses? (4) Most importantly there is not an actual goal clearly articulated here. Is he going for suppression? Is he going for mitigation? I like many others are deeply upset by leadership from both parties, at all levels of government.

hartator 7y ago
> I like many others are deeply upset by leadership from both parties, at all levels of government. Yes, I agree. What’a really upsetting is they try to justify why less transparency is good thing. When they are using this only as way to impose their authority.
phkahler 7y ago
>> I like many others are deeply upset by leadership from both parties, at all levels of government. I'm sitting at home in Michigan where the governor has closed almost all businesses. Politicians bicker over weather governors or the president have the authority to reopen things. And yet there is no plan as far as I can see. No goals, no criteria to trigger next steps, nothing. Meanwhile the press just snipes at people.

mrfusion 7y ago

This doesn’t say anything about when I can see my family again.

pm_me_ur_fullz 7y ago
You can come into the state and you can leave the state, what state-level circumstance is preventing you? I'm grasping at straws but maybe you are estranged and your family is on the street but they won't let you into the hobo-hotel? Every other circumstance I can think of is a Federal issue closing borders for people that aren't Americans.
- mrfusion 7y ago
  Isn’t CA under lockdown? Only supposed to leave your apartment for groceries right?
  - viklove 7y ago
    They're not saying you can't return to your family, they're just saying not to congregate in large numbers. I've moved back from my apartment (Chicago) to the suburbs to stay with my parents until this lockdown ceases. Of course, we both started isolating two weeks before I came home, and they picked me up so I wouldn't have to take the train. Just use your head, don't do things that will risk spreading the disease. Taking public transit to/from your family a few times a week is very dangerous. Going someplace and staying there is not.
    - deleted 7y ago
      [deleted]
  - randyrand 7y ago
    No, you can go outside for exercise, walks, errands. etc.
    - war1025 7y ago

sergiotapia 7y ago

I don't understand why at risk people don't just stay at home. Why lock everybody else up? Enough is enough, kids need to go back to school and people need to go back to work. This document seems hand-wavy and doesn't answer anything.

gdulli 7y ago
First, because they live with people who aren't at risk and if those people go about their lives it defeats the purpose. Second, if everyone not explicitly at high risk went about their normal business, some percentage of them would still need medical attention and the hospitals would run out of beds, leaving some to die.
- sergiotapia 7y ago
  So, you live with people that are at risk, you can stay home too! Second: That's the nature of nature. If you want, you can protect yourself, stay home!
  - gdulli 7y ago
    And what happens when you, with your good judgement, decide to protect yourself and stay home, and then you have an unrelated treatable condition but die because no hospital could take you because they're all busy dealing with all the Coronavirus patients who were left to their good judgement and didn't stay home?
    - sergiotapia 7y ago
      1. Your hypothetical isn't a possibility. The numbers do not reflect that possibility, not even close. 2. Even if it were a possibility, it's that vs. shutting down peoples lives for a very long time. "Is your life worth my liberty?" - that's something we fundamentally disagree on.
      - objectivetruth 7y ago

yodsanklai 7y ago

I would cynically summarize this as: lockdown is economically unsustainable. We need to go back to work. Let's hope we can control the epidemics this time better than before the lockdown. We may have new tools this time (contact tracing, masks, test). But we're not really sure they'll work. It's the exact same situation in France where we're planning to go out of lockdown in 4 weeks. It seems unclear that we'll have the needed tools by then. It's not even clear that they'll work but there are no other options. At least the California roadmap isn't pretending they have the answers to the question they raised...

throwaway237683 7y ago
Isn't it amazing that an absolutely massive privacy invasion that is called contact tracing is already accepted as _inevitable_ if we are ever to be allowed to step out of our homes? Talk about cynicism.
- 0xy 7y ago
  Australia and Singapore's governments are rolling out an app that allows them to track every person you meet with for more than a short period of time. Why would anyone trust them to not abuse this data? If they wanted people to volunteer information, maybe they shouldn't have repeatedly abused trust.
  - anthony_doan 7y ago
    Singapore is often refer to as soft-authoritarian. It's like choosing N.Korea as an example and asking why you should trust them with your civil liberties. https://privacyinternational.org/sites/default/files/2017-12/Singapore_UPR_PI_submission_FINAL.pdf https://privacyinternational.org/sites/default/files/2017-12...
    - dehrmann 7y ago
      I'm honestly not sure what to make of the People's Action Party winning something like 80% of votes. That's a Putin level of popularity.

ravenstine 7y ago

It doesn't make any sense that we continue the lockdown in its current state. Hospitals in California aren't overrun. We were insisted upon that the "flattening the curve" was to prevent the medical system from being overwhelmed. With what we've been able to do, we're not even close to having overrun hospitals. By now, we should have ramped up the system to account for greater numbers of severe cases. Given that, we should quarantine the vulnerable population and allow the rest of the population to get things back to normal. Otherwise, we'll come out of this with no herd immunity, potentially making the last month a total loss, and creating further loss in the near future.

gabaix 7y ago
Hospitals around me are at half capacity. San Mateo is at 56% capacity in ICU beds.[1] Covid cases were doubling every 3 days (up to 5). Would it be correct to say that had we waited another week, hospitals would have been overrun? If that's the case then I understand why health authorities are cautious. [1] https://www.smchealth.org/post/san-mateo-county-covid-19-data-1 https://www.smchealth.org/post/san-mateo-county-covid-19-dat...
- marcell 7y ago
  Typically a hospitals run at near full capacity, especially during flu season. I have a friend who works at the Kaiser in Oakland in ER, and she says it has been pretty empty right now, relative to a typical flu season. The data linked shows about half the beds are taken up by COVID-19 patients, and the other half are other cases. They claim to have 77 standard ICU beds, and 300 surge beds available. Of those, 34% of the standard and 94% of the surge beds are unused. So out of 377 total beds, 5% are taken up by COVID-19 patients. I think it's hard to estimate the doubling rate based on the numbers we have out there. Confirmed cases is a poor proxy for actual cases, since it depends a lot on testing rates, who gets tested, etc. A lot of new data is suggesting that coronavirus spread further we previously though, and that it started spreading in America sooner than we previously though. We don't know the true numbers because they didn't start testing for coronavirus in America until March, and even then it was at a very low rate.
7y ago

anon543210 7y ago

Maybe I'm the idiot but its pretty clear as to whats on the roadmap. >defines a goal or desired outcome and includes the major steps or milestones needed to reach it. Yeah its missing some specifics but there are certainly goals stated before the decision to relax the stay at home policy is reached.

zaidf 7y ago

For everyone who has tracked California’s response over the past month (the good and the bad), the #1 problem is obvious: a) California’s testing and reporting infrastructure is absolutely abysmal, arguably the worst in the country b) there are very few signs that it will improve anytime soon California leaders haven’t had to confront this publicly because much of the last one month had been focused almost exclusively on reducing fatalities and increasing hospital capacity. Testing matters but not that much for the most acute cases. It matters a lot more in determining the the rate of incline/decline of new infections, both numbers that will increasingly matter more as fatalities and hospitalizations stabilize.

oh_come_on 7y ago
There’s no way that California is less effective then red states like Texas
dnautics 7y ago
I would argue that reducing the rate of deaths is the #1 problem, followed by reducing the rate of infections, followed by being able to determine the rate of infections. So, unless you believe california results are 10x off, based on empirical results and your assertion that the testing and reporting infrastructure is "the worst", the state of california has at least done a fair job of managing its effort in the face of a limited resource. Knowing in detail what's going on is strictly secondary to reducing deaths.
- zaidf 7y ago
  I believe California has done an amazing job so far on the whole; “fair” would be a gross understatement. So I think we are in agreement there. That said, I do think as new casualties and hospitalizations are on the decline, test reporting and infrastructure matters disproportionately more for the next phase (planning for gradual reopening) and phases after.

redis_mlc 7y ago

I see a dozen questions with no answers. Where is our leadership when we need it?

throwawaysea 7y ago

There is data suggesting that the current number of recognized infections is just 6% of the total infection count. This also means that case fatality rates are vastly overstated, since the rate would drop if we had enough testing to recognize the true total case count: https://reason.com/2020/04/12/official-covid-19-numbers-represent-just-6-of-total-infections-a-new-analysis-suggests/ https://reason.com/2020/04/12/official-covid-19-numbers-repr... A new antibody study in LA may give us better numbers: https://www.latimes.com/california/story/2020-04-10/coronavirus-antibodies-testing-los-angeles-county https://www.latimes.com/california/story/2020-04-10/coronavi... My one hope is that the leaders of these states (CA OR WA) do not follow the “noble lie” strategy adopted by the WHO and others to manipulate the population. Insofar as coercive orders are tolerated at all, they must be accompanied by truthful metrics, believable goalposts, and a practical mindset that doesn’t aim for perfect outcomes.