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Medicine Science

Social Distancing Is Not Enough (theatlantic.com) 270

We will need a comprehensive strategy to reduce the sort of interactions that can lead to more infections. The Atlantic: COVID-19 has mounted a sustained attack on public life, especially indoor life. Many of the largest super-spreader events took place inside -- at a church in South Korea, an auditorium in France, a conference in Massachusetts. The danger of the indoors is more than anecdotal. A Hong Kong paper awaiting peer review [PDF] found that of 7,324 documented cases in China, only one outbreak occurred outside -- during a conversation among several men in a small village. The risk of infection indoors is almost 19 times higher than in open-air environments, according to another study [PDF] from researchers in Japan. Appropriately, just about every public indoor space in America has been shut down or, in the case of essential businesses such as grocers, adapted for social-distancing restrictions. These closures have been economically ruinous, transforming large swaths of urban and suburban life into a morbid line of darkened windows.

Today, states are emerging from the lockdown phase of the crisis and entering a queasy period of reopening. But offices, schools, stores, theaters, restaurants, bars, gyms, fitness centers, and museums will have no semblance of normalcy until we learn how to be safe -- and feel safe -- inside. To open these spaces, we must be guided by science and expertise. Fortunately for us, researchers are discovering the secrets of how COVID-19 spreads with a combination of clever modeling and detective work. Before we review the relevant studies and draw out lessons for the future of the great indoors, a brief word of humility. Our understanding of this disease is dynamic. Today's conventional wisdom could be tomorrow's busted myth. Think of these studies not as gospels, but as clues in a gradually unraveling mystery.

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Social Distancing Is Not Enough

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  • by JoshuaZ ( 1134087 ) on Friday May 22, 2020 @11:10AM (#60091048) Homepage
    We know what works from places like South Korea and Taiwan. Social distancing is important, along with masks and test and trace. The entire point of doing a lockdown is to get other measures, especially test and trace, up and running. South Korea didn't need to go through a full lockdown because they had such a system already in place (in part due to prior experience with SARS and in part due to worry about biological warfare from North Korea). Unfortunately, due to a lack of serious federal coordination, the US hasn't really set up nearly enough ready for the tracing end of test-and-trace. Only six US states are about ready for systematic test and trace https://testandtrace.com/state-data/ [testandtrace.com] .
    • by AmiMoJo ( 196126 ) on Friday May 22, 2020 @12:01PM (#60091314) Homepage Journal

      Japan has been asking people to keep indoor spaces well ventilated, the theory being that it prevents micro droplets hanging around in the air for so long, similar to outdoors. I'd love to know how effective that is but I couldn't immediately see an studies looking at it.

      • Studies like that take a long time.

        We have to go by other illnesses.

        I'm not going to hunt out the studies, but one of the Oregon doctors running our response was saying that ventilation makes a big difference in illnesses that spread in a similar way, like the flu.

        But you don't actually need medical studies, you just need engineering data on air flow and turnover in an enclosed space, and you can find out that in large supermarkets, box stores, nicer offices, etc., you have increased air turnover and the ai

      • the theory being that it prevents micro droplets hanging around in the air for so long, similar to outdoors

        Outside there is wind that can spread the droplets further meaning that you may not have an easily identifiable event that researchers can pinpoint as the source of your infection. They may not hang around in the air next to the source but they will remain in the air. Generally, indoor events inside are better documented: you know who attended them and when they happened. You do not know all the people you happened to walk by on a street nor is it easy to trace them.

        This can result in selection bias. Fo

    • by hey! ( 33014 )

      I'm not sure you can look at a place that has done X successfully and declare that "X works". There has been significant differences in success in the US between states that have implemented similar isolation measures around the same time.

      The following states have seen clear and sustained reductions in new cases over the past 4 weeks (fastest to slowest): New York,New Jersey,Massachusetts,Pennsylvania,Michigan,Connecticut,,Colorado,Rhode Island.

      The following states have shown clear and sustained increases i

      • This is disingenuous. I live in Texas; our "lockdown" was never anything like New Jersey, (where the rest of my family lives.)

        We don't have mandated masks in stores, they do. Our lockdown was really soft compared to them. We let the lady who opened her salon early in Dallas slide, New Jersey fined not just the owner of a gym that opened early, but the customers who refused to disburse as well. And most importantly, we started opening things back up three weeks ago now, and most everyone went back to acting like normal as soon as that happened. NJ is just now starting to ease up a bit.

        You're comparing apples to oranges, so you can't draw the kinds of conclusions you're try to.

        • customers who refused to disburse

          I'm pretty sure they call a customer who doesn't disburse a "thief" in Texas. I don't believe they simply fine them.

        • by hey! ( 33014 )

          The conclusion I'm drawing is that we all may say we're doing "X", but in fact we're doing different things.

          The common thread among the high reduction states is that they were hit hard early. I live in one of those states, and voluntary compliance with restrictions is extremely high. I run into people in the middle of the woods and nearly all of them are wearing masks, even though it's not even mandated for outdoors.

  • Air cleaning (Score:4, Interesting)

    by drinkypoo ( 153816 ) <drink@hyperlogos.org> on Friday May 22, 2020 @11:12AM (#60091054) Homepage Journal

    Hospitals, dentist's offices, etc. have UV air sanitizers. Would piping air to the roof to be run through clear (polycarbonate?) ducting be effective at sanitizing the air? Obviously there are a lot of other considerations like whether the air goes past other patrons' faces before it gets to the vent, I only want to know whether the air could theoretically be cleaned in this fashion.

    Nobody wants to eat in a paint booth, probably, but a downdraft air system would ostensibly do the trick of not spreading germs from one person to the next. Perhaps such systems could be installed in future waiting rooms and lobbies.

    • Don't see why it couldn't, in theory only. But buildings are deliberately not air-tight. They need to breathe, or you get mold in your walls. There's soffit vents all over usually.

    • Would piping air to the roof to be run through clear (polycarbonate?) ducting be effective at sanitizing the air?

      If the air is moving quickly then it is probably not exposed long enough to UV. It would hurt your HVAC efficiency pumping that air up into a greenhouse-like duct then back down.

      Those old goofy ionizers that leave huge dusty footprints around them are probably effective. Less particles in the air mean less places for a virus to stand. People quit using those ionizers not because they are ineffective, but because they kind of make a mess and get pretty gross looking.

      Nobody wants to eat in a paint booth, probably, but a downdraft air system would ostensibly do the trick of not spreading germs from one person to the next. Perhaps such systems could be installed in future waiting rooms and lobbies.

      Newer hospitals are designed around mainta

    • by skids ( 119237 )

      Combined with a spray guard, air handling probably could cut rates of transmission significantly. It wouldn't be perfect because you can't fully control air's chaotic motion, but it is worth looking into.

      We do a piss poor job on proper indoor air handling in general. I don't think there will be many places that can spin up something in time for this pandemic, but it is something we should be paying much better attention to in general. Our indoor environments are full of all sorts of nasty stuff coming of

      • It's not the indoor air handling is done piss-poor: It's done to the extent needed to ensure comfort. Anything above that would just be seen as a waste of money. Air handling has never been seen as part of infection control before, outside of hospitals. Perhaps that will change in future, but it's not something you can easily retrofit to existing buildings.

      • Most indoor air handling probably targets cost and energy efficiency, not air quality. Move the least amount of air possible at the lowest energy cost possible while trying to meet minimal temperature comfort thresholds.

        And nobody cares about a 1001 Office Karens with space heaters, since that power consumption isn't baked into the building's "energy efficiency" rating.

    • Re:Air cleaning (Score:5, Interesting)

      by LostMyAccount ( 5587552 ) on Friday May 22, 2020 @11:37AM (#60091178)

      Modify HVAC for maximum updraft so that air had little chance of migrating horizontally across a room or stagnating. It's probably easier to add more air return capacity in ceilings. This would probably also mean fresh air supplies would need to be dropped down in columns from the ceiling to close to the floor.

      Some kind of UV filtration stage in the HVAC system makes sense, I don't see why this couldn't be retrofitted into any HVAC system inline with the return and/or supplies regardless of other modifications.

    • If the outside temperature is within tolerable range, there's an even easier way: Just suck all the air out and blow it out the roof, drawing fresh air in. Just forced ventilation, turned up far higher than needed for comfort alone.

      If you wanted to do that with a heated or cooled building, you'd need a giant heat counterflow heat exchanger on the roof too, which makes it prohibatively expensive.

      • If the outside temperature is within tolerable range, there's an even easier way: Just suck all the air out and blow it out the roof, drawing fresh air in.

        For much of the world, that period of time of nice weather is preciously SMALL.

        For example, I live in New Orleans....and well, we are past the mark of comfortable outdoor air.....even today, high in the 90F's...and I think humidity may be in the 85% range.

        And this will get worse and worse, peaking in late August/Sept time frame.

        We actually had a dece

    • by Rhipf ( 525263 )

      The UV light used in UV sanitizers is a lot more powerful than the natural UV of sunlight. I'm not sure if your ducting scheme would be effective.

    • I've been wondering whether a simple UV HV electric fly zapper will also help clean the air of micro-organisms.
  • Indoors is where people mostly touch things more intimately, there's more more concentration of people per touchable and less things such as UV that would be harsh on the virus. Air flow isn't great either.
  • Maybe outdoor markets and cafes are the way to go, at least during fair weather.

    • Re:Outdoor commerce (Score:4, Interesting)

      by satanicat ( 239025 ) on Friday May 22, 2020 @11:23AM (#60091118)

      Frankly I'd welcome that. I far prefer sitting out on a deck at a restaurant or cafe if available. Unfortunately you don't see them all over the place because they often cover sidewalks etc.

      For obvious reasons we've been seeing a lot less traffic (cars) lately. I know some trends are likely to remain or remain on some level after this, and the reduction in cars is not likely; but it would be a nice side effect of being able to re-purpose some of the sidewalk and road real estate for something like this.

    • by Waffle Iron ( 339739 ) on Friday May 22, 2020 @11:27AM (#60091138)

      Maybe outdoor markets and cafes are the way to go

      I've got an idea: With the current shortage of processed meat, maybe we could stock the outdoor markets with live captured wild animals.

    • Alas, I live in a place where 30C and 80% humidity is a mild day. Most of the time, it's hotter and more humid.

      In other words, your proposed solution might work where you live, not so much elsewhere....

  • I've seen reports that airflow can increase the spread of the virus, can it be used to diminish the spread of the virus. eg, if there were a pressure gradient forcing air from ceiling to floor and through filters before recycling might that reduce the radius of transmission significantly ?

    Also I'm surprised we're not seeing more protective headgear, eg. a ball cap with a visor and air filtration, a small fan in the peak would seem to be enough to keep the face bathed in filtered air

  • We had diseases like this before. We will have them again.

    The key thing that changed this time, is that the anxiety epidemic crossed a treshold, from letting tenthousands of people die because that's just the normal thing with such diseases, to the extreme opposite, where we want *complete* control and *zero* infections or it's not good enough, as *nobody* must die!

    As somebody who formerly had a crippling hygiene/cleaning obsessive-compulsive disorder, let me tell ya: That will never happen!
    Society is just

    • by AmiMoJo ( 196126 )

      Excess deaths in the UK are somewhere around 65k. We don't know how high it would have been had we not gone into lockdown.

      Problem for any government is that they can't say to people that 100k deaths or 500k deaths or 1 million deaths is acceptable. Estimates were around 1 to 1.5 million dead if we did nothing, so around 2% of the population, maybe a little more. We would have had to dig many mass graves and the economic shock would probably have been as bad or worse anyway. People wouldn't just carry on, th

      • Estimates were around 1 to 1.5 million dead if we did nothing

        You mean those estimates that have been continually downgraded? More than anything, this has been an exercise in panic inducement.

        • by AmiMoJo ( 196126 )

          Even if they were wrong (no saying they are) that was the information available at the time. Ignoring it would have been gambling at best, probably criminally negligent under UK law.

    • The key thing that changed this time, is that the anxiety epidemic crossed a treshold, from letting tenthousands of people die because that's just the normal thing with such diseases,

      A lot more than "tens of thousands" of people have already died. Get your numbers straight.

      I know it is expecting a bit much, but can we think sanely for once, please?

      Get your numbers right or the world will seem insane, but it will be you that is insane.

    • I totally agree that many have misunderstood the measures and are going far beyond reason into anxiety mode.

      But I think it's a small fraction of the population. For the majority, the goal is only to make the contamination factor go below 1 so that time makes this disease disappear (or at least under control until we have a vaccine or a way to quickly reduce the death rate). So we should not "accept" deaths nor ruin our lives to avoid any death. We should design and follow good practice to ensure the factor

    • The death toll in the US is not "tenthousands". It's a hundred thousand already, with just about 5% of the population infected (assuming that the number of undetected cases is ten times higher than the official count), and with (mostly) adequate treatment. The death toll of letting this virus run its course unimpeded would certainly reach a million in the US and likely exceed that number by far. And there is still a risk that this will happen, thanks to "rational" idiots like you.
    • I mean, we could let a bunch of people die... or people could be forced to wear masks (which isn't a big issue), and we can test people extensively. With a few 2-3 week lockdowns spread throughout.

      It's not "YOLO" vs. "do nothing for a year". It's building a reasonable middle ground. Like punishing people who throw/threw coronaparties and don't use a mask. And contact tracing. And frequent testing.

      Also, I'll not that Ebola, AIDS and Sarin all have much lower R0 values than Coronavirus.

    • by jschultz410 ( 583092 ) on Friday May 22, 2020 @12:43PM (#60091576)

      Most of what you wrote there is specious.

      In the USA, we've already lost ~100k people even though a very small percentage of the population has been infected so far. Even if you estimate 4 - 5% of the population has already been infected, if Covid-19 is allowed to run rampant then it could easily get to 50% and you can similarly scale up the death toll by at least a factor of ten.

      1M needless deaths in the USA is something that we should be willing to go to great lengths to try to prevent!

      Meanwhile, other countries have shown that complete containment and minimization of infection is a much better path than simply allowing it to roll over you in an uncontrolled manner. S. Korea, Australia, New Zealand, and Taiwan have all shown that if you tightly control your borders, aggressively test, back trace, and quarantine within your population, then you can have *VASTLY* lower infection rates and resulting deaths than in countries (like the USA) where it is allowed to get out of control.

      As a bonus, you don't need to shut down broad sections of your economy either to try to mitigate mass spread!

      You present an extremely deadly false choice when there is an obviously better way to proceed that is being empirically proven in other countries right now.

    • We don't even have to do anything that's costly to the economy, but until we actually get those things implemented, everything needs to stay shut down, because people dying or getting sick and spreading it around is ALSO costly to the economy.

      It isn't 'health or economy' it's 'sick and dead people aren't very economically productive either'.

      1. Wear a mask
      2. Move all businesses that serve the public outside as much as they can be.
      3. Centralized quarantine where the government pays for you to be isolated away

  • More options... (Score:5, Insightful)

    by Dan East ( 318230 ) on Friday May 22, 2020 @11:26AM (#60091134) Journal

    will have no semblance of normalcy until we learn how to be safe

    ...or until we have a vaccine. ...or until we have a highly successful method of treating infected patients. ...or until we determine why the vast majority of those infected either have no symptoms or mild symptoms while others die from it, so that those most susceptible can take additional precautions.

    researchers are discovering the secrets of how COVID-19 spreads

    The CDC just updated guidelines a couple days ago indicating that the risk of surface-based spread is very low. The vast majority of infections are NOT coming from an infected person touching a doorknob, and then someone else touches that doorknob and is also infected. We also know that this isn't being spread so profusely because people kiss, or have sex, or through blood transfusions, etc. It's a respiratory disease, being spread by typical respiratory methods (anything that can expel virus particles into the air - coughing, sneezing, talking, singing and probably even just breathing), just like the flu or common cold. The main difference is that we have an (at least marginally effective) flu vaccine, plus natural immunity from exposure to it over generations, so the flu and cold don't just randomly kill people that seem to be otherwise healthy.

    Short of total isolation, the wearing of masks is probably the greatest single thing that can be done to reduce the transmission between people. One thing that would help is the manufacture of masks with close to N95 quality filtering, but in a more fashionable and comfortable form factor. It is utterly impossible for the general public to obtain any masks actually rated to handle virus sized particles at this time. That is a major part of the problem.

    • by g01d4 ( 888748 )

      masks actually rated to handle virus sized particles at this time

      Is that really necessary? My understanding is that the virus is primarily transmitted within liquid droplets which ideally would be captured on the inside of the mask of the person exhaling them. If the liquid evaporates (and recall the inside of a mask should be humid) and viruses become free to pass through the mask then the slightest of air currents should rapidly disperse them.

    • until we determine why the vast majority of those infected either have no symptoms or mild symptoms while others die from it, so that those most susceptible can take additional precautions.

      It's not obvious that that would work. If everybody tries to reduce the spread and only 0.1% of the population is asymptomatically spreading, modest isolation measures are enough to protect the vulnerable.

      If the diseases rages through the less susceptible 80% of the population and 3% of the people are asymptomatic carriers, then the requirements on the degree of isolation of the other 20% become 30x more strict. That's the difference between wearing a surgical mask and entering rooms through airlocks while

    • One thing that would help is the manufacture of masks with close to N95 quality filtering, but in a more fashionable and comfortable form factor.

      It's hard because N95 masks have to be tight to be effective, otherwise diffuse particles can get around the edges of the mask. Fortunately normal masks can make a huge difference [youtube.com], since coronavirus is not normally diffuse in the air.

    • Re:More options... (Score:4, Interesting)

      by Dixie_Flatline ( 5077 ) <vincent.jan.goh@NoSPam.gmail.com> on Friday May 22, 2020 @12:54PM (#60091656) Homepage

      Wearing masks and doing things outside. We should really take advantage of the fact that it's spring/summer in the northern hemisphere and move everything we can outside. Outside supermarkets, outside cafes and restaurants. Reclaim some parking lot space and put as much stuff as we can out there. Don't even bother letting people inside to shop, do most shopping online and pick up outside. There's no reason to force people to work inside with other people right now.

      The worst places to be will be things like public transit, where you can't help but be inside something, but buses should have all their windows open to pass air through more quickly.

      As stupid as I thought it was to see all those people on the beach 2 months ago, in retrospect, if you're just out on the beach and not gathering in groups and being an asshole, that's *exactly* where we want everyone to be. The sun and huge volume of air dilutes and degrades the virus.

      The last thing is centralized quarantine. Something like 80% of spread happens inside families. If one person gets sick, for goodness sake, move them to a central quarantine that the government pays for. Pay a hotel for their rooms and fill it with people that aren't sick enough for the hospital, pay for their food and internet and porn, and have nurses come around every day to check on them.

      Honestly, the things we need to do are simple and effective, we just need to actually get on it.

  • by Strider- ( 39683 ) on Friday May 22, 2020 @11:37AM (#60091182)

    I don't know, the whole Social/Physical distancing thing has worked pretty well in British Columbia. Out of a population of just over 5 million, we've kept new serious cases (ie those that warrant testing) to about 10 to 20 for the last month. Hospitalizations are sitting at 43 and dropping, with only 9 in ICU. This without a full lockdown, just strong encouragement of social/physical distancing. A significant number of people are wearing masks, but it's not somethign that the government has ordered, nor have we had the whole shelter in place orders like the US. People have been encouraged to use parks, go out for walks, and just to ensure they maintain the distance.

    The key has been good, solid, public health information with a solid, science based leader. Our premier (kind of like a governor), has stayed out of the limelight, letting the actual experts run the show, and Dr. Bonnie Henry (Chief Medical Officer) has been an absolute godsend to this province.

    • by Kinthelt ( 96845 )

      Social distancing has worked even better in MB. We're down to 18 active cases, with only one person in the hospital (not ICU).

    • I think the reason why there are few Covid deaths in BC, is because of the large number of Chinese-Canadian citizens, who got a TB vaccine in China as a baby.
  • I've been socially distancing since 1982.

    In other words... welcome to my world.

  • I can't help but think that the lockdown and social distancing are having a strong negative effect on the lifestyles of people of "negotiable affection." I also expect one of the unforeseen consequences to be a drop in the birthrate, especially for single women.
  • by mveloso ( 325617 ) on Friday May 22, 2020 @12:39PM (#60091534)

    The latest preprint implies that coronavirus infections tend to occur when taking deep breaths: singing, yelling, etc. That jibes with the indoor contact/family member spread. Laughing, coughing, yelling will expel more virus from the lower part of the lungs, sending your neighbors a plume of droplets that gets into their eyes and lungs.

    If they're breathing deeply, like if they're singing, they'll suck the droplets into their lungs.

    Masks will help because it's hard to expel a plume of virus into the air if you have a mask on.

    Masks also help because it's hard to inhale deeply with a mask on.

    As for the eyes, well, wear glasses.

  • by t4eXanadu ( 143668 ) on Friday May 22, 2020 @12:54PM (#60091646)

    Fat chance of that in the U.S.. We are guided by intuition, mediocrity, and conspiracy theories. Looks like it's working pretty well for us, so far. /s

  • The layoffs run across all departments including events, sales and editorial. The editorial department had 22 layoffs, half due to the company closing its video department. Bradley also said executives would take pay cuts and there would be a general pay freeze for the remainder of the year.

    https://edition.cnn.com/2020/0... [cnn.com]

  • ...because Liberals seem to believe that the only way to cope with a tiny problem is to curl up under their beds and cry that there aren't enough guardrails on life.

    Certainly conservatives will suffer more deaths from their relatively cavalier attitude toward the virus, but at least they'll leave their house to actually vote.

    (Which explains why Democrats are working so hard to enable voting from home, preferably from the fetal position.)

"Everything should be made as simple as possible, but not simpler." -- Albert Einstein

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