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Boston a week or two away from New York City coronavirus levels, Mass. General doctor predicts

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That would be ugly.

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Fortunately, they were wrong when they said Massachusetts was "2 weeks behind Italy." Italy at that time had over 12,000 cases and over 800 deaths. As of today, 17 days later, Mass has around 4,000 cases (granted, a vast undercount) and 44 deaths. We don't even have 800 hospitalizations. So perhaps we can beat these predictions.

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Italy has over 60 million people. Massachusetts just under 7 million. We're at about 700 confirmed cases per million. Italy was at that point ten or eleven days ago. (And now 1600/million.)

Or, if we look at March 12 and go forward: Italy was at about 200 per million. Two weeks later on the 26th, Massachusetts was over that at 350 per million. So I guess I wouldn't rest easy just yet.

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How much worse things would be if people hadn't been reasonably good about social distancing for the past ~2 weeks.

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Unquestionably it will get worse. Don't know if we'll match scale of NY - hoping not.

I think social distancing here accomplished some good. The week of March 15-21 MA was generally ahead of NY on the events/actions/reactions/precautions curve.

NY passed in MA in actions last weekend, though it was a bit bizarre. Declaring the Friday afternoon that - yes, dire emergency; no, moderate measures not enough; declaring mandatory measures to go into effect...Sunday night???!!! I understand giving a time cushion crucial or you'd see all sorts of panic buying and hoarding a level or two worse than what we have seen - but I wonder if ~52+ hours of "as you were" was counterproductive.

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Stop fear mongering and stay positive. If social distancing only results in it getting worse, there isn’t much else that can be done. Until that happens let’s hope everyone works out for the best... No reason to get folks wound up. Just stay home and try to get your mind off of this madness.

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The good news is we have slowed the pace. If we keep focused we can slow the spread enough to allow the infected people optimal care and treatment.

What I am really hoping for is the post test for antibodies. The more data we can get the better.

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I don't get.

We've been doing quite a lot of social distancing. All concerts, sporting events, bars/restaurants, schools, universities, almost every workplace cancelled for about 10-14 days now.

Shouldn't we be seeing a peak in the next week at worst case? Sure, people still go out to the store, go for walks, etc. But every gym is closed. Every museum and library. How on earth can it keep getting worse for months?

The only explanation that makes any sense is that COVID-19 is so wildly infectious that we all already have it and are giving it to our quarantined family/roommates, and that we'll hit herd immunity in some extremely fast interval.

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So it's going to spread no matter what, just, hopefully, more slowly. What social distancing and staying at home buys us is time - so that not everybody gets sick at once and our healthcare system collapses.

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and 10-14 days is not enough time to see a difference. personally, articles like this worry me because I wonder if it will result in some people giving up and deciding to just resume their normal lives.

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Yes, many have been distancing but a fair number have not (who can but are choosing not to) or are not able to because of their work. Every time one of us goes to a store we are breaking the distance, so to speak, and our "day count" starts all over again. You are correct - it is wildly contagious and among us there are many many more who have it than we, or they, know. So the person who is infected and doesn't know it goes to the store, rides the T, arranges play dates for their kids...whatever... they are unknowingly spreading it around. It won't keep getting worse forever. There will be a peak..that's the part we all are trying to ease, the whole flatten the curve thing. Make it so our systems can handle it.
As for herd immunity, for a virus this contagious it might need an immunity rate in the 90s to be effective. Either way it is too soon to know much amount immunities. I read today that some people in Wuhan who had it, recovered and tested negative are now testing positive again. Lots still to learn.

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We've been doing quite a lot of social distancing. All concerts, sporting events, bars/restaurants, schools, universities, almost every workplace cancelled for about 10-14 days now.

But sadly, not everyone is distancing. People's "bubbles" are not all closed. I've heard of several people whose rationale for who they can "safely" interact with seems based on emotional or familial closeness rather than rationality. And we see evidence of other people rationalizing not maintaining a safe distance when they're outdoors.

Shouldn't we be seeing a peak in the next week at worst case? Sure, people still go out to the store, go for walks, etc. But every gym is closed. Every museum and library. How on earth can it keep getting worse for months?

It can get worse because closing museums, libraries, gyms and workplaces for a couple of weeks does not make anyone immune.

The only explanation that makes any sense is that COVID-19 is so wildly infectious that we all already have it and are giving it to our quarantined family/roommates, and that we'll hit herd immunity in some extremely fast interval.

I have no idea how you come to that conclusion. It IS very contagious AND very infectious (not the same thing), but no, we don't all already have it. And if we're all exposed, you will get a great many dead people, and you will quite possibly be one of them -- you, or those you love the most.

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I think it's excellent that the media is interviewing health care workers at the hospitals, because it gives us a glimpse into the front lines which the rest of us are not seeing first hand.

However, I question whether publishing the opinion of a neurosurgery resident on the timing/spread of this infection is responsible. I'm not necessarily disagreeing with his opinion - I have no idea - which is why I look to the epidemiologists and virologists for that information.

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This could be accurate but we should be careful about listening to a single neurosurgery resident's sweeping prediction. Let's make sure we have good sources. Sounds like the resident was just caught for a statement on his way into or our of work.

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was thinking the conventions was the worst of it; but, it seems things are now trending upwards again ?

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... from the last days before everything closed down, when there were mobs in the box stores and every barstool and restaurant seat was filled.

All the people who picked up the virus two weekends ago are going symptomatic now. Everyone they stayed at home with has been exposed. But because of stay-at-home, we've stopped the cycle upwards from there. So peak in 2 weeks from Monday, combined with testing and quarantining remaining cases and their contacts, means that opening things up in May or June is actually feasible.

New York? Maybe July.

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We will not see the case numbers that NYC has. That's because we have less than 10% of the population of NYC.

But we may see the rates: incidence (number of new infections per capita) and prevalence (number of infected people).

On the other hand, MA has actually done a fairly good job of social distancing and we had a bit of a head start on NYC when it comes to flattening the curve. Let's hope it is working. https://www.unacast.com/covid19/social-distancing-scoreboard

I'm also wondering why they are talking to a surgeon in residency and not an infectious disease specialist with an RN/MPH or MD/MPH. He really isn't offering any insight into the population dynamics, only current hospitalization numbers which include transfers from multiple states.

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I can check the out-of-state counties where my relatives live and argue with more resources.

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Doesn't exist in a vacuum. The area inside I-95 , the inner ring, has millions. The whole metro area has anywhere from 5-6 million depending how it's calculated. Boston CSA is 8.3 million. Boston has the 3rd largest population density of any big city in the US, after NYC and SF (very close to SF). MA is the 3rd most densely populated state (after NJ and RI).

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I'm also wondering why they are talking to a surgeon in residency and not an infectious disease specialist with an RN/MPH or MD/MPH.

Because the purpose of articles is not first and foremost to inform, but rather to generate page clicks for advertising revenue. You need a guy in a white coat with a medical background; any doc will do.

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and I saw a story about him early yesterday on ESPN online. Guess he’s doing some PR for MGH. Interesting story. Thank you, Dr. Rolle, for your work!

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Probably because the infectious disease specialists are either busy taking care of patients, or getting a few hours of much-needed sleep. A neurosurgeon in residence is someone with a medical degree plus some amount of the training that goes after that. And they're not doing non-emergency surgery right now.

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But clinical training isn't the same as public health training, and it shows in his vague comments. Medical schools offer at best a couple of weeks or a single course in epidemiology and biostatistics unless somebody pursues the MD/MPH route - this is a serious issue that the public health has been trying to work on for years.

I'm sure that he is a top notch neurosurgeon if he is at MGH, and he's clearly trained in media relations, but the lack of population level context here is not contributing to understanding of the situation.

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Let's all thank Trump for turning Logan airport (and JFK and O'hare) into Covid incubators by spurring the panic return of so many Americans to the US from Europe and doing nothing to get them received home safely.

And yes, this is pointing fingers and casting blame. If 45 is still going to try to rile up racism against innocent Asians, then we NEED to point fingers and get the blame back where it belongs.

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There are a lot of venues where social distancing still doesn’t happen. Parties and takeout lines, yes, but also homeless shelters, state hospitals... factories, fire stations, hospitals, hospitals, hospitals... I don’t think we have flattened the curve as much as we hope

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It seems like the state's closure of all but "essential" businesses has not resulted in all that many closures. Any business can apply and plead their case, and from what I've heard anecdotally, the majority seem to have their request approved.

My work is still open, though they're being very proactive with precautionary measures (which they first implemented in Asia and revised/expanded from there). Anyone who can WFH is doing so, and the rest of us are screened at the door every day. Screenings include questions (about travel, contact with confirmed or suspected cases, any symptoms, etc.) and a non-contact temperature check with a relatively low threshold for being turned away (anything over 99.3 degrees). Anyone who is turned away or stays home due to symptoms (like I did with a runny nose today) still gets paid. They also temporarily closed two local sites recently for deep cleaning after employees reported close contact with confirmed cases. I'm proud of the way they're handling things.

Then there are places like UPS. Their services are obviously essential, but they're doing next to nothing to protect their workers, despite what they tell the public. I see a strike looming in the near future if they don't change their tune and start taking some serious steps to mitigate the spread within their facilities. (Source - an employee at a distribution center in Massachusetts)

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In other parts of the world, I see teams of people in hazmat suits disinfecting public areas at night. Is this a waste of time or should it be considered in some of the newest hotspots like Boston?

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Yet.. that ice cream truck circled my neighborhood again last night. If there was a way for me to have a small cow come out of my body last night... it did.

Yet arm chair doctors on facebook are still trying to tell me its "no big deal" and "just like the flu" and "shame on Cuomo for not allowing Hydroxychloroquine to help NYC"

(Yeah that one got blocked quick)

Yet yesterday people on here are complaining about people being in parks and playing basketball.

Sure we probably won't have the same *numbers* but ratios, yes.

But sure arm chair Facebook doctor on my hometown's Facebook in rural New Hampshire keep tell me all the doctors and scientists are wrong and I'm a sheep for staying in and that "its no big deal".

I mean whatever.. Just wait for it to hit up there, locally community hospital has 4 ICU beds and no vents. The larger hospital 45 mins away will be at capacity within a week due to it being the North Country's regional medical center (DHMC in Hanover).

It will.. and it will hit slower and harder because people didn't think "it would come there" (I had someone say that to me also "but you live in the city"). Sorry folks, your idiot republican governor waited too long, the New Yorkers and Spring Breakers who have summer homes on the lakes have already brought it with them.

but whatever. arm chair doctor knows better cuz ya know

"All hail Trump. Thank God for President Trump right? Thank god we don't have a woman or a black man for president. Who cares if NYC has people dying from this every 6 mins or they have tractor trailers backing up to hospitals for bodies. Eh who cares, its some liberal city. Her emails were important. MAGA! MAGA! MAGA!"

(above is paraphrased from most trump supporters i've seen in the past week)

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"From what we're hearing, it's probably going to maybe reach NY"
-- Dr. Myron Rolle, MGH

Huh? From what we're hearing? Probably going to? Maybe? That doesn't sound very confident or scientific. Meanwhile, it was nice to see Tom Hanks back behind the wheel of his Range Rover in what People magazine described as a "joyful return" to Los Angeles after he and wife Rita Wilson endured a mild case of the virus in Australia. Oddly, their brief quarrantine seemed to get much more coverage than their speedy recovery. As WHO Director General Dr. Tedros Adhanom has said, “Most people will have mild disease and get better without needing any special care.”

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Many people experience this as a mild disease. True.
Many others experience it as one of the worst and most prolonged flus they've ever had, but don't require medical intervention. True.
Enough other people require hospitalization and ventilators that hospitals are running short on equipment, beds, and protective gear for medical professionals. Hospital workers are beyond maxed out. Hospitals are so overwhelmed that responses to non-covid emergencies such as heart attacks and strokes, not to mention services such as cancer treatments, are severely impacted. Our loved ones are dying alone. Indisputably true and happening now.

The first two don't negate the need to do everything we can to alleviate the third as much as humanly possible. How is that so hard to understand?

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US population is about 330 million.
If half get it 165 million
If it's really bad for 10% that's 16.5 million people who need medical care/hospitalization.
If 2% of those die that's 330,000 people dead. And that's only counting those that die from the virus. There will be others who die from other causes that lacked treatment due to lack of beds and other resources.

The fact that for most of us it will be mild, doesn't matter in the end other than we should thank our lucky stars if that's our lot.

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So in that case, it's going to be much higher than 2%.

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Today's new case count is smaller than yesterday's, and so is the day's death toll.

Worth posting.

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The experts were saying Boston would be "just like Italy in eight days". Thankfully that timeline has passed.

I take what the "experts" say with a grain of salt. This hasn't happened before. This isn't 1918, and it's not SARS or H1N1.

Everything is different.

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We are still in the ramp-up phase. The hospital ICUs are filling with a lot of covid patients, ask your friends who actually work in a hospital. Be glad it didn't only take 8 days because we want it to take longer. The longer it takes for people to come in the greater the chance there will be enough ICU beds and ventilators for everyone.

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I am neither an epidemiologist nor a statistician, but I know a bit about numbers and patterns. MA's median daily multiplier for positive cases has been 1.28, that means a rough prediction of tomorrow's count can be calculated by multiplying today's by that value. To surpass NY at over 60K cases, it would take 45 days, and if we take March 2nd (with 2 cases) as the starting point, that brings us to April 16th.
With the measures we have in place, we COULD see the curve start to flatten out at the end of next week. Then we'll know for sure if we'll hit NY numbers that soon.
This is all back of the napkin calculation, so take with a grain of salt.

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