in Covid-19 , 3720 references
This virus is not being spread the way we're told.
Social distancing is close to worthless.
NY's data makes this quite clear. So does Florida's.
Both slammed the door; SE Florida and NYC.
The bend should be evident in one viral generation time. The new case rate should collapse in two viral generation times. If Community Transmission via bars, restaurants and "social interaction" was more than 2/3rds of the total the effective R0 would go under 1.0 and community transmission would collapse. If it was half then R0 would be 1.5 and we'd have transmission approximately equal to a bad seasonal flu.
IF you actually bent the curve.
These measures did not bend it to any material degree. Enough time has passed to know this is true; at most they have lengthened a "turn time" by one day (in other words, R3.0 to R2.5.) That's effectively nothing!
It's being spread in the medical environment -- specifically, in the hospitals -- not, in the main, on the beach or in the bar.
When Singapore and South Korea figured out that if as a medical provider you wash your damn hands before and after, without exception, every potential contact with an infected person or surface even if you didn't have a mask on for 30 minutes during casual conversations with others (e.g. neither of you is hacking) transmission to and between their medical providers stopped.
Note -- even if you didn't have a mask on and were not social distancing in the work environment, which of course is impossible if you're working with others in a hospital, you didn't get infected.
And guess what immediately happened after that? Their national case rate stabilized and fell.
The hypothesis that fits the facts is that a material part of transmission is actually happening in the hospital with the medical providers spreading it through the community both directly and indirectly.
Remember that all disease R0 is a composite of all the elements of transmission. If any material part of transmission is happening in hospitals and other medical settings stopping that will stop or greatly attenuate community transmission. Every medical provider goes home and interacts with the public.
Then the hospital fills up and guess what -- they call in more doctors, nurses, orderlies and other people. In fact they've done exactly that; in hard-hit places they're getting volunteers. Excellent, they need the workers, except every one of those new workers in the place is also a brand new vector to the rest of the community too unless they wash their damn hands before and after every contact with any item or person as well.
What's worse is that the data is that if you wind up on a vent you die nearly all the time. They had a doc on Tucker Carlson last night confirming that we are not doing materially better than Wuhan in this regard.
We're wrong about how this thing is spreading and we're wrong about the silent attack rate. The step functions in the data here in the United States cannot be explained by ordinary community transmission but they are completely explained if the transmission is happening not among ordinary casual contact -- that is, not "social distancing", but rather through the medical system itself. That explains the step functions that are seen in places like Florida since it takes several days before you seek medical attention after infection and it also explains why NY, despite locking down the city and more than one viral generation time passing -- in fact two -- has seen no material decrease at all in their transmission rate.
In addition it further is supported by the fact that what we've seen here, in Italy, in Wuhan -- indeed everywhere is not an exponential curve. It's a step-function flat acceleration graph. Broad community transmission doesn't happen this way (you instead get a straight and continual exponential expansion until you start to obtain suppression via herd immunity) but if the spread happens as each "generation" gets driven to hospitals for testing and medical attention and the spread is largely happening there what we see here and in other nations in the case rate data is exactly the function you produce in terms of exposure rates.
In other words there should be no straight-line sections in the case rate graphs -- but there are.
Fix the protocols in the hospitals right damn now. PPE is not the answer if your hands, gloved or not, become contaminated and not immediately washed off. Hand-washing at an obsessive level -- before and after each patient interaction and before and after each contact with a piece of equipment that might be contaminated is. In other words the monster vector (remember, R0 is a composite, not a single number) which I've hypothesized since this started is not oral droplets -- it's fecal.
This also correlates exactly with the explosive spread in nursing homes where many residents are incontinent.
Folks, by definition medical facilities concentrate sick people into small spaces. If what's wrong with them is not infectious this doesn't matter. But if it is you had better not transmit anything between them or between you and them or you instantly become one of the, if not the only vector that matters.
Then as the place fills up you have more people working and thus more vectors into the rest of the community. Even if you have gotten the virus as a nurse or doctor and recovered and thus are immune if you have it on your hands and go down the escalator to the subway you can still contaminate the railing and the grab-rail in the car unless you wash your damn hands before and after any contact with any thing or person!
The presence of step functions and apparent linear-fit line segments in what should be a clean parabolic curve says this is exactly what has happened.
That in turn explains why the lockdowns are not doing a damn thing -- except destroying the economy, that we must do everything in our power to keep people out of the hospital in the first place and that, in turn, means using even potentially-valid prophylaxis and promising (but not yet proved) treatments early in the course of the disease so as to keep people out of the damned hospital in the first place while fixing the protocols in the hospitals so they stop transmitting the bug.
Don't tell me about all the doctors and nurses doing this already. That's a lie. I've been in plenty of hospitals (and worse, in nursing homes) in my years and in exactly zero instances have I seen any evidence that before and after each contact, with zero exceptions, those hands go under a stream of water with soap.
And reopen the damned economy.