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ER doctor: Stop indoor dining now, before we have to shut even more things down again

Dr. Jeremy Faust, an ER doctor at Brigham and Women's, takes a look at recent Covid-19 data in Massachusetts and is not liking what he's seeing. Really not liking it:

We need to ban indoor dining immediately.

We need some other restrictions as well for a few weeks.

If we don’t, our R could skyrocket and a full shutdown may become necessary.

R is a value for the typical number of people somebody with Covid-19 infects. If it's below 1, that's good, means that the typical Covid-19 patient is likely in quarantine and not spreading the disease to others. Massachusetts's rate is now 1.20.

In a series of tweets yesterday, Faust explains. He starts by saying he's going to re-start publishing Massachusetts "excess mortality" data - numbers that show the number of total deaths per week now compared to data from the same period in past years:

I‘ve been monitoring this all summer but stopped publishing when we had many weeks without excess deaths.

Today, I see signs that our streak ended.

In addition, I should add that I believe our relatively long shelter in place and phased re-opening meant that we could see this coming.

Cases were <200 per day for a while.

Now we see that doubled.

The point of reopening when cases are low is to be willing to make behavioral modifications (partial shutdown/restrictions) in MOMENTS LIKE THIS.

H/t Adam Castiglioni.

Earlier:
State makes it official: Boston has a high rate of coronavirus.

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Comments

Too bad the wealthy ER doctor has no say in the economy getting shut down or staying open. I know no one else cares about others loosing jobs over a shutdown and it must be awesome making his salary and having job security. Thanks for your general opinion Dr.

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Doctors aren't supposed to care about saving lives, right?

Doctors should work for free, after all. His credentials, experience and salary should bar him from providing science-based advice about preventing death. That's why we have you.

Why don't you move to Florida?

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So his option is the same as all doctors across the world? And his Twitter political stance represents all doctors? Hopefully you were able to fully survive the economic impact of Covid. Or maybe you are independently wealthy I don’t know. How long should we stay shut down? Are you just waiting for the nod from Biden? Nice bigot attitude about Floridians.

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obviously directly tied to your partisan viewpoint. Science doesn't have a political agenda, outside of folks like the Tobacco Institute and extraction-industry-funded 1% of scientists who still deny climate change.

As for Floridians, I lived in Florida for a few years, still have many friends there, but looking at the state as full of a special kind of stupidity isn't bigotry; you just have to read the news.

There's a reason fark.com has a dedicated tag for stories about Florida, unlike the other 49 states. It's a magnet for Darwin-Award-level idiocy.

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I lost my job due to covid and I also think "reopening the economy" right now is a fucking stupid and deadly idea.

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Sucks about your job I yell you. You won’t catch me at a bar right now but Dr. Political needs to stay off social media.

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Fuck off and die.

Science became political when anti-science whackjobs like you and your idiot "friends" started spewing attacks on rational thought and objective investigation.

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Adam, how do you allow a person to post this? Twice! Literally telling someone to die. I mean disagree all you want, but telling a person to die over a comment section post is absolutely insane.

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the bar to "Go shit in [his] fucking hat" for still arguing that the Sox would have been better off signing A-Rod instead of Manny, without wanting him to literally do that. I once told my sister, whom I love more than I love a great banh mi (and I love even a middling banh mi) that she needed to "Die in a fire" for suggesting that Todd Rundgren is a greater artist than David Bowie. I promise you, I don't want her to die in a fire, but I was pretty heated up in that moment.

I try to reserve such figures of speech for people I know, because they know I don't really wish death on anyone for their opinions. I prefer simpler takedowns for strangers, like "Fuck off, you black hole of dumbassery, before more light gets sucked into your vortex", or "Fie on your church and grammar school for not amending your ignorance of science / civics / human empathy", or "I'm arguing with a troll who lives in a Brutalist suburban-Moscow project and earns six bucks per thousand shit-posts: sorry, dude!"

"Die" is not the most decorous way to tell someone, "I think you are supremely full of shit" in a public forum. I avoid it, myself. But you might want to focus on the awfulness of the idea being expressed, as opposed to the way other people object to it. Both are protected under our system: which do you truly find offensive? If someone politely advocates broiling babies for lunch, and I rudely wish a horrible fate on them to object, which really bothers you?

That's extreme, of course, but what if someone advances junk science that could lead to millions of people dying, or getting sick with grave lifelong consequences? Would that make you mad enough to curse their hides with the kind of ills their ignorance might foist on innocents? In that case, I'd say, "Cruel metaphor, but fair."

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You won’t catch me at a bar right now but

"Sure, I don't think it's safe to go out to these places right now, but that's no reason why other people who don't have any choice but to work there shouldn't have to do it."

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he has the courage to say something controversial and sign his name to it, something you clearly lack. All one can derive from your “name” is that you align yourself with a political party which refuses to condemn racism, among other things.

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He's earning that good paycheck because he chose that career, paid for med school, studied incredibly hard, and is taking on the incredible stress of saving people's lives! And I thank him for it! Wear a mask!!! Is that too much to ask of you!??

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Were you always this moronically asinine or was that most recent head injury the final blow to your humanity? This guy may be wealthy, but he is also going to be one of the first ones to suffer extreme exposure and work 18 hour shifts if things go sour again.

And he knows this because he's already been through that hell.

In fact, he may be the one person who saves your sorry ass when your callous stupidity lands you in deep trouble.

Unless of course you can just promise to stay home and die because its all a hoax anyway. Yeah - please don't expose yourself to that evil science and just stay home.

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You're making the argument that the impact of closing down indoor dining is worse than the impact of keeping indoor dining open.

That's not, on the face, a crazy argument at all.

But it's a quantitative argument, so you need to do what every math and science teacher says to do: show your work. Put a price on a COVID-19 fatality and on a nonfatal COVID-19 case. Model the number of cases with and without indoor restaurant dining. Estimate the economic damage from closing indoor restaurant dining. Compare.

As AI pioneer John McCarthy famously said, "He who refuses to do arithmetic is doomed to talk nonsense."

If you don't want to use actual numbers, all you're doing is shouting.

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Far more jobs will be saved if we shut down again before things are out of control.

Not to mention lives.

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but this guy is my favorite of all the parody accounts.

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Hey, I hope this message finds you well. I am someone who works in community health as a social worker, and all through CoVID I have been having to support people who have been impacted by the social distancing measures, the loss of jobs, the bulwark of unemployment that became so bad that folks weren't hearing back for 3 months about their claims, with no one to answer their calls. My job has, quite literally, been to support the inordinate amount of stress that everyone has been under, primarily because of these measures.

That said, if it comes back and we return to where we were in March/April/May, it's going to be much much longer that shutdowns will have to occur.

Think on it: We are currently experiencing about 300-500 cases per day. Our overall case prevalence (active cases) is at 5700, which is about 2.5-3x higher than it was in July at it's lowest amount. Each person who is sick is a vector for transmission, which means that when the overall numbers are low, the number of possible people to transmit virus is minimal. As the number increases, that creates an exponential growth in transmissions.

Now - looking at places where people will transmit - the likelihood that one person amongst those going to eat is sick, is much higher now than it was in July, AND, a restaurant is more likely to have people without masks on because they are eating. These are all factors which we know will increase possible infection. If you go to the North End right now, and look at the restaurants that are running - they are getting as much business as they can before they have to close for the season in December, and realistically, it's going to be much earlier as people won't be going out to eat when it's 35 degrees nearly as much as when it's 75 degrees. There's a perverse incentive for restaurant owners to say "fuck it" and get the money while they can.

On the flip side, jobs and quality of life are impacted by shutdowns. If we get to a place where we have 10-20,000 active infections, it will take SUBSTANTIALLY longer for us to get it under control via a subsequent lockdown. If we lockdown now, reduce transmission while it's still at 5-6,000 cases, we are much more likely to be able to contain it within a couple of weeks, versus a couple of months.

Do we sacrifice a bit of time in the present to prevent an unknown but very likely risk in the future, or do we say fuck it, have fun now, and then deal with a lockdown for several months through the winter, likely losing more lives, causing more trauma, further overwhelming our already overwhelmed medical providers.

It's better for our economy to pre-empt things now before it's too late. The only reason we're at the low rate that we are is because we locked down effectively at the outset. Mind you, this is a mutating virus which is adapting to certain ways in which we try to prevent it. A major outbreak may not be able to be as well contained as it was in March/April. With all of the politics involved (which you are seeming to be manipulated by), people are thinking less rationally and more emotionally about something that gives zero fucks about what political party you belong to.

My $.02 - take what you will, call me a libtard, I could give a shit, I have bigger problems to deal with in supporting my patients who have it far worse than most of us.

In other news, it's a great day outside, take advantage of the weather before it's too late.

<3

-dh

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There’s a good chance this ER doctor gets paid less than many Boston cops. And he’s probably still in debt for his education.

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Yeah, the ER doctor probably works the same, or longer hours, without getting paid overtime for details.

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One month from now we will be wishing we listened so that schools, etc could stay open. Heaven forbid people got...TAKEOUT, or...GASP...COOK THEIR OWN FOOD.

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Also, by the looks of his Twitter page he’s a pretty political guy. No surprise he wants another shut down. Even Biden winning will not result in a shutdown. Sorry!

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Prohibiting indoor dining isn't a shutdown.

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If you work in the industry, i would imagine you'd view this as a shut-down. We're heading in to the colder months and not all establishment have outdoor dinning.

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Person chooses "Republican" as username, tells others to stop being so political.

Get bent.

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So funny.

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Your account.

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...that red hat is on way too tight.

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And your user name is "Republican".

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We are now testing more than before, with students back in college, people back at work, and people seeking out tests more. Of course rates were going to go up, since so many people have few or no symptoms.

There have been several outbreaks in nursing homes recently, the exact place that should be most protected by now. What are we doing to support the homes? Are we giving high risk people in the state the support they need?

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We are now testing more than before, with students back in college, people back at work, and people seeking out tests more. Of course rates were going to go up, since so many people have few or no symptoms.

Let's say for the sake of argument that the actual rate of infected people among the population is 1%. That means, everything else being equal, if you test 100 people you're likely to find 0, 1, or 2 positives. If you test 1000 people you'll get around 10 positives. If you test 1,000,000 people you'll get around 10,000 positives. The positivity rate is going to be right around 1% no matter how many people you test -- testing more people doesn't drive up the positivity rate.

Testing more does, of course, drive up the absolute number of reported cases, but that isn't a number that's generally used to make policy decisions without some level of adjustment to reflect the degree of testing.

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A compromise would be banning indoor dining for anyone over the age of 40 or 50. Card people at the door, and turn away people who are too old.

(and yes, I know and everyone knows that there is plenty of anecdoctal evidence about young people having a bad time with COVID, but the statistics relating mortality vs. age are rock solid and have barely budged since March. The average age of covid fatalities is still 82 years old.)

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This completely misses the point that the people who die of COVID spread via people going to bars and restaurants aren't necessarily the people who went to the bars and restaurants -- it'll be the others that they secondarily infect.

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it'll be the others that they secondarily infect

You just yada-yada'd over the most important part; how does that secondary infection of high-risk people happen, when the high-risk population themselves are prudently socially distancin from the low-risk population?

Everything about the impact of the virus screams 'age group' as the #1 dependent variable. The lockdown policy ought to do that as well. Instead, we're being handed a one-size-fits-all policy.

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You just yada-yada'd over the most important part; how does that secondary infection of high-risk people happen, when the high-risk population themselves are prudently socially distancin from the low-risk population?

healthy 29 year old Tom goes to the bar, becomes infected, and becomes contagious. Tom rides the bus and infects Suzie on the bus. Suzie has to ride the bus, even though she lives with her vulnerable 75 year old grandfather, because that's her only way to get to work and she's sole breadwinner for her family. While contagious but before she has symptoms, Suzie goes to the grocery store and infects Maria the cashier, who has a weak immune system but can't afford to forego the income and health insurance that the cashier job represents. Suzie goes home and infects her grandfather, who, after a brief unpleasant illness, goes to the hospital and dies. Maria infects 4 customers before realizing that she is sick. Maria survives, but she's out of work for 3 months and her lungs are permanently weakened. Suzie survives but loses her job. Tom has a mild flu-like case and is fine in 3 weeks.

Do you really think there's any practical way to isolate the higher risk from the lower risk population? People live together in family groups. They work. They take public transport. They shop in grocery stores.

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A compromise would be banning indoor dining for anyone over the age of 40 or 50. Card people at the door, and turn away people who are too old.

Oh, come off of it! Really, Refugee--how stupid can one get? Ban indoor dining for people over the age of 40 or 50, and you may as well ban indoor dining for everybody, regardless of age.

Indoor dining should be banned while the Covid-19 pandemic is still out of control, for everybody, regardless of age.

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...or do you just think everyone else is?

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Who are you talking to, lbb?

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The fake Fugee, of course.

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Do you also advocate firing all the workers at these places who are over 40? From your response I am assuming you are under 40. Before you know it, you won't be.

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There's a perfect example in Maine. A number of people who did not go to the wedding died after being exposed by guests.
https://boston.cbslocal.com/2020/09/20/big-moose-inn-maine-coronavirus-w...

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It would totally be a fair compromise if everyone under 40 is banned from going to the grocery store and other essential business or living with or visiting anyone over 40.

Having people at higher risk avoid non-essential places like restaurants only impacts one part of the problem. The higher the numbers get among younger people, the higher the likelihood they pass it to older people in other settings.

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They tried that in Sweden. Didn't go as they expected.

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Being in an indoor space with an infected person will expose you to the virus, even further than 6 feet away due the the circulation of the air system (again, my career for the last 30 years so I kinda know what I'm talking about). You can add all the filters you want back at the fans but you will be exposed before the infected air ever gets back to the fans. This is safer at retail and other indoor locations due to people wearing masks (including in offices regardless of office policy - wear masks indoors) but in a restaurant, you have to take off the mask to eat. Outdoors, the virus will disperse with the air currents so it's safer (although some of those outdoor seating areas are less than 6 feet apart when occupied). This is a model of the spread from someone sneezing 3 times in 10 minutes in an open office plan (similar to a restaurant with covid distancing). Then there's the statistics of infected rates increasing with the opening of indoor eating and the infected twice as likely to have eaten indoors - deny all you want but its related. We're heading for another shutdown so selfish people can have nachos fresh instead of delivered.

https://www.holt.com/covid-19-simulation-indoors/

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Remember when they tried having smoking and non smoking sections in restaurants? None of the hvac adaptations made a difference with tobacco smoke either.

Living off tips from the unmasked must be as humiliating and risky now as it was back when waitstaff had to put up with smokers. If not more.

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On the Commonwealth's Coronavirus Dashboard, the fact that we have contact tracing capabilities has been highlighted for a while now. This means that in theory, we know how people get infected. How many cases have come from indoor dining at restaurants? This cannot be hard to track down. In other states, with worse numbers than Massachusetts, they have been producing data like this. Why isn't Massachusetts tracking, or informing the public if they are in fact tracking things like this, how Covid has been spreading?

I'm not saying what the guy has to say has no merit, but where is the data for restaurants? In Ireland, they have been showing examples of how socializing is helping the spread, but they lay it on people, not establishments. In any event, they have been able to show how the spread happened, not just theorizing about what may be driving the uptick.

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How many tens of thousands of contact tracing calls have been made, in Mass. alone? We should have more data on what (if any) differences exist between people who do and don't get the virus.

Privacy rules and non-compliance/lying because people don't wish to admit to doing the wrong thing add problems, but it's shocking to me that six months into this we are still talking in terms of vague generalities.

I'm aware of one recent study that stated that people who went to restaurants had double the risk of getting Covid vs. those who didn't, but it was based on a whopping N=250 people. That's almost criminally underpowered when we have millions of infected.

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'm aware of one recent study that stated that people who went to restaurants had double the risk of getting Covid vs. those who didn't, but it was based on a whopping N=250 people. That's almost criminally underpowered when we have millions of infected.

I read that study. The authors acknowledge that there's no way from the data they have, that you can determine whether going to restaurants had any causal link to COVID infection rates, or whether going to restaurants was simply a marker for broadly taking more risks across the board.

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