Collection of articles to guide the reopening strategy. Provides context for what we have learned and what we still don't know about the coronavirus, what the trajectory of the pandemic might be over the next year, and how we should build up our public health capacity.
Examples of reopening indicators used by NY and Chicago are included for LA to benchmark its own progress. References for CA and LA's own reopening indicators are also included.
- Context
- Dangers of Reopening Too Early
- Are We Past the Peak?
- Building Public Health Capacity
- Antibodies and Immunity Research
- Its Effect on Subgroups
- Its Effect in the Air
- Known Unknowns
- The Path Toward Reopening
- How the virus spread out of China, within the US, and the unique failure to control the virus in the US .
- New York Times interactive analysis of global and US cases, how the US compares against other hotspots and the periods of US peaks.
- Track each US state's: initial reopening and now pauses in reopening. Track the White House coronavirus task force's report on each state.
- Timeline of administrative failures.
- Timeline of various gatherings that resulted in outbreaks in the US and Europe.
- Track outbreaks on college campuses, trends among children, and whether K12 schools are publishing counts.
- Illustration of exposure, incubation, and spread
- Build your own NYT dashboard to track cases
- Track ICU capacity by county and by hospital facility
- Track your county's risk level
- Track your state's vaccination efforts
- Scenarios for reaching herd immunity with vaccine rollout, with global data showing vaccines being extremely effective
- Track your state's 2021 reopening plans
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As of early May: Rushed reopenings are a global trial-and-error experiment.
- Most US states reopening fail to meet the WH guidelines.
- Virus spread speeds up in Georgia, Texas, and on average, everywhere outside NYC; in Japan, South Korea, Singapore, France, Lebanon and Iran.
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As of late May, 24 US states have uncontrolled virus spread
- By late July, CA is estimated to have 1,000 deaths per day without further mitigation
- The R0, or reproduction number, which shows how fast the virus is spreading, is still above 1 in these 24 states.
- In CA, seeing a plateau of cases, but not decreases, suggests that R0 is hovering close to 1, where virus spread is sustained, and each infected person infects 1 person, on average.
- Leading CA health official warns that CA is making modifications toward reopening too quickly
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As of early June, the world rushes to reopen even as caseloads are rising, including 21 US states, and we can't wish the virus away by reopening. Surge in cases explained.
- How coronavirus compares to 100 years of deadly events
- 8 states that are the next hotspots, and TX, FL, CA are the states that saw the largest increases in cases in the past week. As of mid-June, Florida is predicted to be next US epicenter by mid-July.
- Rising caseloads are predictable and avoidable.
- Preventing superspreader events will be key.
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As of early July, states that reopened early are driving the US surge in cases, with death toll expected to rise soon
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As of mid July, CDC estimates that deaths vastly undercounted and cases are 2-13x higher than confirmed cases.
- Hospitalizations nationwide now match the April's peak hospitalizations.
- By early September, experts are estimating how many deaths could have been averted.
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As of Sept, CDC estimates that about 10% of Americans have antibodies, leaving 90% vulnerable, and herd immunity very far off.
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As of late Oct, researchers found that death toll in the US amounted around 2.5 million person-years, had those who died lived to their expected life expectancy.
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CDC finds indoor and outdoor dining linked to more transmission and cases
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Contrary to popular belief, a survey of expert economists shows support for a large contraction of economic activity until the spread of infections has dropped significantly.
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Polls show that whites are increasingly ready to reopen, but Blacks are not.
- Survey also finds that Black and Latino families are extremely vulnerable, especially financially
- Lockdowns 1 week earlier would have prevented 36,000 deaths in the US).
- Deaths in LA County by May 3 estimated to be 451 instead of 1,223 if we stayed at home 1 week earlier.
- University of Minnesota and Harvard studies on possible trajectories of the pandemic into late 2020 and 2021 shows that a one-time social distancing effort is not sufficient to control this in the long term. Experts recommend turning social distancing on and off depending on case levels.
- Germany says regions must reinstate restrictions if cases pass a certain threshold.
- Are any countries close to herd immunity? Not even close.
- Our understanding of asymptomatic transmission has evolved to a significant fraction of cases are due such spread
- A study from China, Hong Kong, and Singapore: 30-60% of spread from asymptomatic transmission
- Hong Kong study: estimated 44% transmission occurred prior to symptoms, infectious around 2 days prior to onset of symptoms
- UK study: estimated 50% of spread attributed to asymptomatic transmission
- Study about spread on the Diamond Princess: estimated 18% of spread on-board from asymptomatic transmission that occurred before the quarantine start
- Study by US CDC: 25% of patients might have no symptoms
- Germany's Robert Koch Institute study: infectiousness before or on day of symptom onset was substantial, which is when transmission was likely.
- South Korean study found that asymptomatic people carried similar viral loads in their nose, throat, and lungs, and for just as long as those who develop symptoms
- There are way more cases beyond simply more testing.
- Mask mandates work, based on Vanderbilt University's research, as hospitalizations spike when a smaller share of patients come from counties with a mask mandate. Report here.
- In areas hard-hit, doubling-up on masks can help slow the transmission, medical journal article here.
- With the new UK variant, which is estimated to be 50% more transmissible, US COVID cases may spike in coming weeks, and may be dominant strain by Mar 2021.
- We aren't testing enough nor have enough contact tracers to manage the current caseloads.
- What experts say is necessary for a national testing strategy:
- 10% positive share for mitigation
- 4% positive share to halt virus spread
- JHU state-by-state analysis of who meets WHO recommended guidelines for testing and positive rate, where states should see less than 5% positive for 14 days prior to reopening.
- Open, transparent, and public data is crucial for agencies and researchers to simultaneously learn about the virus and tackle the outbreaks from multiple fronts.
- Reporting all-cause mortality and testing the high risk are ways to move forward, since deaths are likely undercounted.
- Summary of what we've learned: always wear masks, we can't depend on herd immunity, and we can't count on warmer weather alone.
- Philisophical differences between state-led strategy vs federal strategy
- Behavioral science has insights for how to encourage and reinforce good public health behaviors
- CDC will soon label masks with their effectiveness
- Restrictions must be paired with vaccinations to save the most lives
- If restrictions are strengthened until mid-July, there would be 19 million fewer infections in the US
- If current restrictions were lifted in February, there would be 29 million more infections in the US
- Germany's research on who has antibodies, how long antibodies last after infection, and what levels of antibodies are needed to prevent re-infection
- How long do antibodies last? Remains to be seen.
- Spain, with one of the worst outbreaks in Europe, only sees about 5% of its population with immunity and in NYC, with the worst US outbreak, about 20% of its population.
- Antibodies don't last longer than a couple months, with the CDC later confirming that antibodies may last 3 months. Its role in preventing re-infection is not yet clear. But, studies show that asymptomatic people are shedding the virus for potentially longer periods of time than symptomatic people.
- 1st documented re-infection in Hong Kong and in the US.
- Do virus mutations matter? There's evidence at a biomolecular level, but unsure if this makes the mutation more infectious.
- Nov 2020: more evidence emerges that a particular mutation can be more contagious, though not causing more severe symptoms
- Can you get COVID-19 twice? Emerging evidence suggests maybe but unlikely
- Initial study shows immunity may last longer than a couple of months
- Using game theory to model best approach for vaccination plan
- Why it is more dangerous for older adults
- Young people may have seeded infections in older people in the US from May-Aug 2020 according to the CDC's report
- Long-term effects: some have shown symptoms persist in the long-term
- Impact on children: children carry similar viral loads or more but appear to be less impacted, making them vectors of transmission.
- Even small gatherings may play a role in the spread
- US CDC finds children under 10 are half as likely to get infected, but children 14 yrs and older are just as likely as adults to get infected.
- Study in India on 85k children finds that children of all ages can infect and spread
- Impact on pregnant women: fetal infection is possible. More evidence emerging.
- How to safely reopen schools: nearly 40% of school staff are vulnerable
- How indoor ventilation affects the path of virus infection, possibly spreading through ducts.
- How long does virus linger through air?
- How long does virus remain on surfaces?
- Airborne transmission vs respiratory droplets, with increasing evidence showing the role of airborne transmission, with the WHO finally acknowledging airborne transmission. The research understanding is still evolving, with airborne spread playing an increasing role in the virus's spread.
- Implications are that indoor spaces need to be reconfigured with higher air filtration, more cleaning high touch surfaces, and UV light to kill germs.
- A Diamond Princess study found that the virus spread through airborne transmission. Over 60% of infections were spread through the smaller droplets, with implications that good ventilation is not enough, but masks would still be necessary.
- Airborne floating virus can infect others at distances greater than 6 ft.
- [China's bus study](https://www.nytimes.com/2020/09/01/health/coronavirus-bus-china.html
- What we still don't know (NY Times, Vox: from number of cases, impact on children, the types of social distancing that can work as we reopen, and role of immunity.
- Legionnaires' a potential health threat for dormant office buildings.
- 1 in 5 at risk for severe COVID-19 globally, with additional UK research on 17M reinforcing this.
- White House: Opening Up America Again gating criteria
- NY State's and Chicago's reopening indicators, and a comparison spreadsheet.
- Arguably, LA is more similar to NYC and Chicago than other regions due to persistent caseloads that are flattening, but not dropping. As Chicago's benchmarks are tougher than the rest of IL, and it should be so for LA than the rest of CA.
- LA, DC, and Chicago remain hotspots in the US
- CA and LA County recovery metrics
- Brookings Institution: Reopening America Guide
- Urban Institute: Where Low Income Jobs Are Being Lost to COVID-19
- Urban Institute: COVID-19 Resource Tracker for State and Local Responses