
California’s Roadmap to Modify the Stay-at-Home Order [pdf] - infodocket
https://www.gov.ca.gov/wp-content/uploads/2020/04/California-Roadmap-to-Modify-the-Stay-at-Home-Order.pdf
======
mikekij
This entire plan is based on models that do not align with what we are seeing.
The graph on slide two[1] of the official CA govt plan shows hospitalizations
With Intervention rising exponentially, exceeding our hospital capacity in
early June. The actual new infection data shows that the rate of new
infections has been decreasing since at least 4/4 [2], meaning that the graph
of active hospitalizations should be a bell curve with a maximum value of
~10,000 on ~4/20.

The mismatch between their models and the observed data does not engender
confidence.

[1] [https://www.gov.ca.gov/wp-
content/uploads/2020/04/California...](https://www.gov.ca.gov/wp-
content/uploads/2020/04/California-Roadmap-to-Modify-the-Stay-at-Home-
Order.pdf)

[2] [https://covid-19.direct/state/CA](https://covid-19.direct/state/CA)

~~~
Ninjak8051
Additionally, notice that the orange data points (actual hospitalizations) are
significantly under the "With Intervention" plot. So why even include the
slide? Clearly the assumptions behind the "With Intervention" plot do not
match reality TODAY, let alone in a few weeks.

Not a good sign if people are making actual decisions based on this.

~~~
xienze
> Clearly the assumptions behind the "With Intervention" plot do not match
> reality TODAY, let alone in a few weeks.

I feel like I’m taking crazy pills with the way people are talking about this
whole thing still being out of control, when data shows the situation is even
better than the most optimistic models were predicting. And by that I mean,
pretend I was on HN 3 weeks ago predicting 25K deaths in the USA by today. I’d
have been downvoted into oblivion and told I was delusional. But here we are.

Clearly NYC was hit far harder than the rest of the country, but it seems like
every state and municipality is simply basing their models on NYC case numbers
scaled by population. I don’t get it.

~~~
dehrmann
> I feel like I’m taking crazy pills with the way people are talking about
> this whole thing still being out of control

A week ago, I remember reading how the Bay Area was bracing for a bracing for
a surge and it was the calm before the storm. The Santa Clara county covid-19
dashboard told a different story: day-over-day, new cases were roughly the
same for the past two weeks. 2+ weeks into the lockdown, there was obviously
no surge coming.

[https://i.imgur.com/LrFZj3S.png](https://i.imgur.com/LrFZj3S.png)

Looking at that chart on the April 7th, nothing pointed to a surge.

~~~
TeMPOraL
Isn't this just California being in the "3.6 roentgen, not great, not
terrible" phase? I.e. number of new cases reported is limited by the number of
tests that are able to be made?

~~~
SpicyLemonZest
Every region (and almost every country) is generally believed to be severely
undercounting cases because of limited testing. There's not much reason to
believe the problem is worse in California than elsewhere, and a severe surge
would be evident in hospitalization and death rates no matter how bad testing
is.

------
mchusma
A real plan would look like this
[https://imgur.com/spemOeG](https://imgur.com/spemOeG) specifying the levels
of restrictions and the metrics we will use to track the metrics. This allows
people to understand what to expect the best possible. We already have huge
uncertainty, we don't need to add uncertainty of government response on top of
uncertainty of the virus. I think there is huge room to debate the numbers and
what goes in what level, but this is what a real roadmap looks like.

This "roadmap" is quite scary as this is not a plan that would pass muster in
in YC Boardroom. (1) The one chart with data is horribly innacurate: (a) It
shows interventions causing worse than no interventions in the short term? (b)
Shows hospitalizations increasing despite the fact that they have not for some
time. (c) Shows "Surge Capacity" as a static value, which you would hope they
are increasing if they really think this is the issue.

(2) It does not specify in any fashion what the different levels of coming
back are. When can medical procedures resume? When can non-essential work
where social distancing is easy resume (e.g. Los Angeles apparently has banned
gardeners, who don't need to get near a soul)?

(3) If he believes masks work (as I do and as indicated in this presentation),
why are masks not required and businesses shut down? Shouldn't we do the less
painful and restrictive measure first before we shut down businesses?

(4) Most importantly there is not an actual goal clearly articulated here. Is
he going for suppression? Is he going for mitigation?

I like many others are deeply upset by leadership from both parties, at all
levels of government.

~~~
charlesju
The reason why your solution is not good is because it pigeon holes the
government into expectations. The government doesn't have a crystal ball as to
how this all plays out, they need to have the flexibility to change how they
want to respond to each situation without having to defend an ultimatum.

For example, even in your own example here are several situations you didn't
account:

\-- The availability of tests for the public at large

\-- Whether we're doing temperature checks everywhere

\-- Whether we're requiring people to download a contact tracing app

\-- How much capacity we have in the hospital system even though cases are
going down

\-- If we can find a drug that helps shorten the time people spend in a
hospital

\-- If we find new information like masks don't help or they greatly help

\-- We run out of swabs but cases are low

There are a lot of factors that has to go into how the government changes the
rules and while it might make it easier for the public to be at ease when the
rules are hard, it also makes it a lot harder to adjust the rules.

I think being upset at the government is your right, but I also think you
should channel your energy into something more productive and thank that at
least in California we acted a lot faster than other areas of the country.

I think Governor Cuomo said something very interesting the other day, to
paraphrase, when he was asked whether he should've started stay at home
earlier and if that would've saved lives. Of course it would have, but the
interviewer is not taking into account compliance and public sentiment.
Likewise, for you, I think you're viewing this problem from a very
individualistic point of view to get strict rules on what happens when, but
you're not accounting for the edge cases where the government needs a backdoor
to change the rules with new information and to play it close to public
sentiment.

~~~
wahern
> I think Governor Cuomo said something very interesting the other day, to
> paraphrase, when he was asked whether he should've started stay at home
> earlier and if that would've saved lives. Of course it would have, but the
> interviewer is not taking into account compliance and public sentiment.

I'm living on the West Coast, but the way _I_ remember the news from NY was
that De Blasio wouldn't shutdown the city because he said he lacked the
authority; he passed the buck to Cuomo to issue shutdown orders. Cuomo said
that it was the Federal governments responsibility to organize and order
shutdowns, passing the buck to Trump while implicitly admitting it was
something that needed to be done. Trump in turn said that it was the states'
responsibility. _Importantly_ , De Blasio and Cuomo knew the stance of the
person they were passing the buck, which means they knew nothing would be
done. Equally as importantly, they both ended up later ordering measures they
previously refused, and otherwise contradicting their earlier selves.

Meanwhile, over here on the West Coast, we saw real leadership--making hard
decisions in a moment of public paralysis.[1] Cuomo and De Blasio seem to be
smart administrators, at least smart enough to recognize and follow expert,
consensus opinion smacking them in the face. But they clearly suck as leaders.

I'm still astonished how quick we all are to retcon recent history. (And I
don't mean to imply that _you_ are doing that, though I am responding to a
sentiment that seems to defend Cuomo.) Similar revisionism happened after 9/11
and the Great Recession, where people ended up judging people and events
according to narratives and sentiment that arose weeks and even days
subsequent, despite obvious contradictions with then recently reported facts.

[1] Not just politicians. Noteworthy (and apropos HN) is how Seattle Flu Study
researchers stuck their necks out and bent the law rather than twiddle their
thumbs while the CDC fumbled.

~~~
stDerfel
I recommend you read this which details how Breed's actions seem somewhat
politically motivated to steal show. Chiefly, there was an agreement that all
counties would let their health director's announce the lock down order and
Breed jumped ahead to announce it herself.

[https://missionlocal.org/2020/04/covid-atlantic-london-
breed...](https://missionlocal.org/2020/04/covid-atlantic-london-breed/)

~~~
wahern
The story leaked that morning. The SF Chronicle reported on it at ~11:30AM,
explaining "County authorities were expected to announce the move at 1 p.m.
and gave a draft of the order to media outlets to prepare. The Chronicle is
reporting the story after a television station published the news early."
[https://twitter.com/sfchronicle/status/1239620219376504832](https://twitter.com/sfchronicle/status/1239620219376504832)

I knew Breed jumped the gun and thought it a little showy, but I _assumed_ she
did it partly to get ahead of the rumor mill. Maybe her office coaxed the TV
station (KTVU?) to leak it early?

Anyhow, this is all largely irrelevant. I purposefully didn't single out Breed
in my previous comment. What's relevant is that these counties had clearly
been working on this order long before the announcement, which means that for
her part Breed would have known about it and approved of it days prior. Which
is in stark contrast to mayors like De Blasio and most other politicians
outside the West Coast and especially outside the Bay Area--Newsom was almost
too late in ordering a state-wide shutdown, judging by how bad Los Angeles
got. They were consistently days late, during a time when days and even hours
mattered.

I'm not very concerned by Breed trying to capitalize on her decisions. What
matters is that she has made decisions that could have easily resulted in
intense blowback (and still might) while others sat around on their thumbs too
afraid of the political costs. There's plenty to still criticize Breed for,
but _relatively_ speaking she deserves some praise. And that's basically how
the Mission Local article lands, too.

EDIT: See also Breed's first tweet at 11:57AM, which I _think_ comes before
her press conference, though Youtube isn't showing the time of the video, just
the date.
[https://twitter.com/LondonBreed/status/1239626809865416704](https://twitter.com/LondonBreed/status/1239626809865416704)
Speaking of which, it's highly annoying how the SF Chronicle and the Mercury
News update their articles in ways that obscure the timeline of what was said
and when.

------
mdorazio
Am I missing something? I don't see any kind of roadmap in here - it's just 6
generic talking points without any actual plan or timeline.

~~~
ABeeSea
He said during the press conference that exact dates might be available in
two-four weeks. He wants to see a further reduction in hospitalizations, an
increase in testing, and a supply chain for PPE before committing to reopening
dates.

~~~
mdorazio
Ok, thanks for the additional context. Was there any mention of actual targets
for these things? Ex. "I'd like to see a 10% reduction of hospitalizations and
at least 1M tests."

~~~
wbl
Why would there be? If something goes really wrong in one of those pushing it
off a goal is going to be a problem.

~~~
mdorazio
Because without those things it's not a real plan. Anyone can say "we'll
change policies when things get better". Defining what "better" means is the
actual challenge and exactly what people as a whole are looking for.

~~~
clsec
Newsom said he was giving this information to the public in the interest of
disclosure. He wants the public to know what they're doing behind the scenes.
He said it was just what they've been talking about, not a plan. He stated
that any of this could change at a moments notice and to keep on doing what CA
residents are doing because we do seem to be plateauing a bit.

------
yodsanklai
I would cynically summarize this as: lockdown is economically unsustainable.
We need to go back to work. Let's hope we can control the epidemics this time
better than before the lockdown. We _may_ have new tools this time (contact
tracing, masks, test). But we're not really sure they'll work.

It's the exact same situation in France where we're planning to go out of
lockdown in 4 weeks. It seems unclear that we'll have the needed tools by
then. It's not even clear that they'll work but there are no other options.

At least the California roadmap isn't pretending they have the answers to the
question they raised...

~~~
throwaway237683
Isn't it amazing that an absolutely massive privacy invasion that is called
contact tracing is already accepted as _inevitable_ if we are ever to be
allowed to step out of our homes?

Talk about cynicism.

~~~
yodsanklai
> if we are ever to be allowed to step out of our homes?

In France, we need to fill a form every time we want to leave our homes. Any
non-work related trip should be limited to one hour and 1km, at most once a
day.

This was decided with no vote or concertation within a couple of days. It also
applies to people who live in rural area. They even fly drones in the
mountains in order to catch lonely hikers breaking the rules. It's crazy.

Worth than that, part of the population is getting obsessed about rule-
breakers, as if lone cyclists suddenly became a danger for the nation. The
police is flooded with calls of people denouncing cyclists, hikers, or
joggers...

Funny thing, our president said in his speech that this pandemics shall not
restrict our freedom.

~~~
tachyonbeam
> Worth than that, part of the population is getting obsessed about rule-
> breakers, as if lone cyclists suddenly became a danger for the nation. The
> police is flooded with calls of people denouncing cyclists, hikers, or
> joggers...

I've definitely noticed on Facebook, since the beginning of this, there's a
lot of shaming of people doing X, virtue signalling, I'm doing this right, how
about you? etc. There's a huge political correctness and peer pressure angle
to the social distancing policies.

Most people seem onboard with this so far, but I think at some point, the tide
will shift. There will be growing social unrest. We're a social species, we're
not meant to live in isolation indefinitely.

------
fasteddie31003
I personally think we need a county-by-county approach. There is a high
variation of the infection at local levels. All the news is currently about
how bad New York is and it's true but we're not all New York.
[http://www.countycovid19.com/](http://www.countycovid19.com/)

~~~
ajross
It's true that regions are different, but I don't see how that translates. Can
you be specific? How would a plan for Queens County, NY differ from one for
Waukesha WI, except in trivial stuff like dates?

Some outbreaks are smaller, but you'll note that they all leveled off at
roughly the same time and on the same schedule. That's because we locked down
on "New York's schedule"[1]. If we didn't, these places which seem to have
"handled" the outbreak would look like New York.

The plans should absolutely be regional in that the lockdown rules should be
based on infection rate thresholds, etc... But to do that they all need
exactly the same per-capita testing resources. It's the same plan.

[1] Really that's not true. We locked down on Seattle's schedule, because they
moved first on most things. Seattle had by far the biggest early outbreak, but
peaked earlier, peaked lower, and is now one of the better managed areas in
the country. Cuomo gets all the attention but it's really Jay Inslee who saved
us all.

~~~
timr
Different regions have dramatically different population densities, and don't
necessarily need shelter-in-place rules. In NYC, shelter-in-place is probably
the only feasible way to reduce social interactions when case-count is
exploding, but in Boise, where people mostly live in detached housing and
drive cars and cases are measured in the hundreds, it might be sufficient to
eliminate large gatherings and shut down restaurants. It's not just a matter
of thresholds.

For all the various politicians are talking about "following the science",
there's very little actual science backing up these measures. We're pretty
much making it up as we go, and you would be hard-pressed to find "scientific"
justifications for most of what we're currently doing.

~~~
ajross
> don't necessarily need shelter-in-place rules

Is there a cite for that? Because that's not the way the data looks.

Everywhere was growing with roughly the same exponent before lockdown. The
numbers were bigger in NY because it grew longer pre-detection, but there's no
reason to believe that everywhere else was any different. Really this
disease's growth constant looks shockingly consistent almost everywhere in the
world.

> It's unclear to me why we're making these policies at a federal level.

We... aren't. Literally every existing lockdown regime is being enforced at
the state level or lower. For the Boise example you mention, the relevant
regulation is a stay in place order from Gov. Little in late March.

Edit to show the point better: Go here (easily the best visualization site,
FWIW), scroll to the bottom where you can see a log chart of per-capita
infection rates normalized to a single "start time" metric, and compare the
Idaho chart with the New York one.

[https://91-divoc.com/pages/covid-
visualization/](https://91-divoc.com/pages/covid-visualization/)

They are almost _exactly_ the same chart, modulo a vertical offset and a kink
in NY data in the second week (which consensus says is the testing backlog
finally catching up).

If Idaho's detached housing and automobile dependence was reducing its rate of
infection spread, it should be visible in the slope of this line. And it
clearly isn't.

~~~
timr
_" Everywhere was growing with roughly the same exponent before lockdown."_

No, they weren't. You're just asserting that this is true. There's effectively
no way to know _what_ the doubling rate was in a place like Boise before the
national lockdown, because the numbers were in the low single digits:

[https://covid-19.direct/metro/Boise?tab=glance](https://covid-19.direct/metro/Boise?tab=glance)

But even ignoring that...the site you're linking to shows a wide range of
slopes on the per-state graph. You just _think_ they look the same, because
the log Y-axis compresses dramatic differences in scale, particularly near the
origin. New York, NJ, Michigan and Louisiana are well above the diagonal line,
while states like Wyoming, Montana, Vermont, Maine etc. are all well below it.

~~~
ajross
Idaho on 20 March was at 23 confirmed cases (above the "low single digits"
metric you picked, but you can pick other points too and get the same result).
On 31 March it hit 515.

That's a doubling period of less than three days. It was spreading every bit
as fast as New York was. It looks like exactly the same chart with a different
constant factor. Yet you insist that these identical results are somehow due
to different underlying behavior? Why? Where's the research showing that?

Because the pretty obvious hypothesis is that the disease was spreading the
same way because it's the same disease and doesn't care about whether you live
in Boise.

------
adrianmonk
From indicator #1:

> _How prepared is our state to test everyone who is symptomatic?_

Another view is that opening the economy should involve testing people who are
NOT symptomatic.

Quoting from an MIT Technology Review article
([https://www.technologyreview.com/2020/04/08/998785/stop-
covi...](https://www.technologyreview.com/2020/04/08/998785/stop-covid-or-
save-the-economy-we-can-do-both/)):

> _The key, says Romer, is repeatedly testing everyone without symptoms to
> identify who is infected. (People with symptoms should just be assumed to
> have covid-19 and treated accordingly.) All those who test positive should
> isolate themselves; those who test negative can return to work, traveling,
> and socializing, but they should be tested every two weeks or so._

...

> _He calls the $2 trillion legislation passed by Congress “palliative care”
> for the economy. If you took $100 billion and put it into testing, he says,
> we would “be far better off.”_

Obviously for medical intervention purposes, you need to sometimes test people
with symptoms. But for epidemiological and economic ones, it may be more
important to test those without. So maybe neither is wrong, just different
purposes.

Incidentally, the same article presents a reasonable argument that while
keeping the economy shut down causes damage, opening it too early might cause
more _long-term economic_ damage than it prevents in the short term. If so,
choosing between the economy and saving lives might be a false choice.

~~~
bhickey
> Another view is that opening the economy should involve testing people who
> are NOT symptomatic.

Testing people with symptoms is a waste of tests. When tests are in short
supply assume everyone with symptoms is positive, isolate them and test their
contacts who don't have symptoms. As of last week, Boston Medical Center had a
44% positive rate on the tests they were running on symptomatic people. They
could find more positive cases per test by testing people without symptoms.

[https://www.medrxiv.org/content/10.1101/2020.03.27.20043968v...](https://www.medrxiv.org/content/10.1101/2020.03.27.20043968v1)

~~~
Shank
> Testing people with symptoms is a waste of tests.

It's not, though. Someone suffering from severe symptoms that aren't COVID-19
may have other treatment options available, and may be placed in hospitals
with less strict isolation requirements. In a perfect world we would have
isolation beds and supplies for everybody, but that still doesn't get around
the fact that treatment for COVID-19 and bacterial pneumonia are two different
beasts, and both lead to similar end results.

~~~
bhickey
> Someone suffering from severe symptoms that aren't COVID-19 may have other
> treatment options available

And someone suffering from severe symptoms has other diagnostic options: a
chest X-ray or CT.

If your goal is to find people with coronavirus (and this should be your goal
if you want to slow its spread) you'll almost always find more of them by
testing people without symptoms.

------
maxlamb
Why is it that hospitalizations are expected to keep increasing indefinitely
even with the interventions in place? I assume the graph represents point-in-
time hospitalizations and not accumulated # of interventions? If so it would
be nice to see some of their assumptions, like average expected duration of
hospitalization. I just don't understand why hospitalizations keep going up in
this roadmap when every country that has put strict social distancing measures
in effect starts to see a leveling-off and decrease in hospitalization after
around the 3 week mark. In short, I wish they could put more details into what
goes into these projections, and explain why they expect to see
hospitalization number to keep going up even withs social distancing. Unless
someone messed up and put the graph of accumulated hospitalizations since
beginning of year instead of point-in-time # of hospitalizations.

~~~
maxsilver
> why hospitalizations keep going up in this roadmap when every country that
> has put strict social distancing measures in effect starts to see a
> leveling-off and decrease in hospitalization after around the 3 week mark

Because that's not a safe assumption. Hospitalizations are still going up in
areas across the US, even in areas of US that are now on week 4 or 5 of
lockdown.

Michigan, for example, is on week 4 and while the growth of the curve is
slowing, hospitalizations still continue to rise every single day -
[https://www.clickondetroit.com/news/michigan/2020/04/13/mich...](https://www.clickondetroit.com/news/michigan/2020/04/13/michigan-
gov-whitmer-coronavirus-curve-starting-to-flatten-in-parts-of-state/)

~~~
maxlamb
Michigan’s order started on March 23rd, so just 3 weeks and 1 day ago. I guess
next week we’ll have better data on the impact.

------
standardUser
It's worth looking at Denmark, Austria, Czechia and other European countries
that have already started loosening restrictions this week. Like California,
they locked down fast and flattened the curve. Now, Denmark is opening school
and all three (plus Germany and parts of Italy) are opening smaller non-
essential shops.

I haven't found great info on how well these countries have implemented
contact tracing, but they do have per capita testing rates much higher than
the US (and _vastly_ higher than California).

Here's an interesting article that describes some of the specific precautions
Denmark is taking as they open up some schools tomorrow:
[https://www.thelocal.dk/20200413/schools-and-day-care-
centre...](https://www.thelocal.dk/20200413/schools-and-day-care-centres-gear-
up-for-staggered-and-restricted-reopening)

~~~
yodsanklai
I don't think Europe is doing particularly well either. Well, at least France
where I live.

France is going to release lockdown in a month. My impression is that this is
mostly for economical reasons because it was unsustainable. I'm not confident
we'll deal with the epidemics much better this time. The gvt still hasn't
released their roadmap, but they hope to improve their testing capacity, the
availability of masks, and to enable contact tracing using some hypothetical
app. There's no silver bullet, but we just hope that it'll work, otherwise
we'll have to go into lockdown again (or not if it appears too costly). Our
gvt hasn't communicated clearly on the possible outcomes. The president speech
was mostly unsatisfying politician rhetoric, trying to avoid the fact that
they didn't anticipate the crisis, and that they had no satisfactory
solutions.

~~~
standardUser
"France is going to release lockdown in a month."

I highly doubt that will happen. The preferred approach seems to be
incremental opening to try and control the transmission rate. There might be
one or two very stupid leaders who want to open things up with a bang (cough
Trump cough), but the European nations currently easing restrictions seem to
being doing so very cautiously.

~~~
yodsanklai
You are correct. Most shops and schools are expected to re-open but things
won't be back to normal. Restaurants and cafe will remain closed, and people
at risk should remain home. They still need to figure out the details.

It seems that France is not much better prepared now that we were before the
lockdown (masks/tests/contract tracing apps are still nowhere to be seen at
that point).

As for our leaders, they distinguish themselves in their rhetorics and in some
symbolic measures, but I have the feeling everyone is following the same path.

Exceptions are some Asian countries who seem to have the epidemics under
control). They are the big winners...

------
ravenstine
It doesn't make any sense that we continue the lockdown in its current state.

Hospitals in California aren't overrun. We were insisted upon that the
"flattening the curve" was to prevent the medical system from being
overwhelmed. With what we've been able to do, we're not even close to having
overrun hospitals. By now, we should have ramped up the system to account for
greater numbers of severe cases.

Given that, we should quarantine the vulnerable population and allow the rest
of the population to get things back to normal. Otherwise, we'll come out of
this with no herd immunity, potentially making the last month a total loss,
and creating further loss in the near future.

~~~
0xy
Agreed, and it's worth noting that the death rate from economic damage could
be significantly higher than the death rate from coronavirus.

For each 1% increase in unemployment, several thousand people die.
Unemployment substantially increases the risk of mortality.

~~~
macintux
Let’s say the unemployment jumps to 30%, which is conceivable, but awful.

That would mean 200-300k people die from increased unemployment. Terrible.

The new virus’s worst case is more along the lines of 2-3 million, and at that
point we’re probably in health care meltdown which would make it much worse
than even those staggering numbers.

So yes, we don’t want to shut down the economy for 6 months, but it’s critical
that we don’t swerve too far out of control. We can pay people to stay alive.
We can’t wave a financial wand and solve the virus.

~~~
SpicyLemonZest
We can pay people to stay alive in the short term. In the long term, the
economy is what allows the average American to live better than the average
Ghanaian. 6 months of an essentials only economy - a subsistence economy, it's
typically called - would do incredible and irreparable damage.

------
balozi
This is a very strange Mckinsey-esque document. 1) Is this really a roadmap?
2) What does "Modify the Stay-at-Home Order" actually mean? 3) Is the state
staking CA's economy and wellbeing on its ability to accomplishing the
impossible?

------
mshroyer
Why is the April section of the "removal of intervention" curve below the
"with intervention" curve? Particularly since there are actual
"hospitalizations" data points plotted along the former?

~~~
momokoko
Because the graph was probably made in Powerpoint or Illustrator.

------
kurthr
I’d like to see something that’s clear and doesn’t risk so much on rapid
accurate testing and tracking of... everyone with significant delayed
feedback. Something that could be done in rural areas or even developing
countries. A reliable next step in the Hammer and the Dance.

I found this: [http://pandemicbreak.org/](http://pandemicbreak.org/)

~~~
eunoia
Anecdote: My wife and I were tested at Stanford today. There was no line, the
process took 5-10 minutes and we never left the car. We were told to expect
results in 24 hours.

Widespread testing might not be that far off and feedback might not be that
delayed.

Edit: Since HN won't let me comment fast enough I figured I'd share the
information here.

We were referred to Stanford by our PCP yesterday. We were not members of
Stanford Health prior. The process looked like this:

\- Video chatted with our PCP yesterday evening, who referred us to Stanford
Health.

\- Video chatted a few hours later with a physician from Stanford Health who
approved the test.

\- Scheduled the test for noon the next day

We are not overtly symptomatic for most of the symptoms (at the moment, it has
been worse) and have not travelled abroad in a relevant timespan.

~~~
raywu
Are you part of Stanford Health Care or is the test site open to public?

~~~
papeda
Similar but more general question: is testing available to everyone, e.g.
random asymptomatic passersby?

~~~
raywu
I found a source[0]. Stanford was testing a larger population to get an
estimate of the spread.

[0] [https://www.stanforddaily.com/2020/04/04/stanford-
researcher...](https://www.stanforddaily.com/2020/04/04/stanford-researchers-
test-3200-people-for-covid-19-antibodies/)

~~~
Ankaios
That reference describes a separate antibody survey that Stanford ran on April
3 and 4. It's unrelated to great-great grandparent's test today.

------
throwawaysea
There is data suggesting that the current number of recognized infections is
just 6% of the total infection count. This also means that case fatality rates
are vastly overstated, since the rate would drop if we had enough testing to
recognize the true total case count: [https://reason.com/2020/04/12/official-
covid-19-numbers-repr...](https://reason.com/2020/04/12/official-
covid-19-numbers-represent-just-6-of-total-infections-a-new-analysis-
suggests/)

A new antibody study in LA may give us better numbers:
[https://www.latimes.com/california/story/2020-04-10/coronavi...](https://www.latimes.com/california/story/2020-04-10/coronavirus-
antibodies-testing-los-angeles-county)

My one hope is that the leaders of these states (CA OR WA) do not follow the
“noble lie” strategy adopted by the WHO and others to manipulate the
population. Insofar as coercive orders are tolerated at all, they must be
accompanied by truthful metrics, believable goalposts, and a practical mindset
that doesn’t aim for perfect outcomes.

------
walterbell
_> Slide 1: How prepared is our state to test everyone who is symptomatic?_

Positive tests could trigger notifications based on data collected by
voluntary contact tracing apps. By only testing the symptomatic, mathematical
models will continue to lack data for the subset of population that is already
immune.

We also need to test asymptomatic cases that would benefit from therapeutics
which work best in early stages. We need to avoid cases reaching late-stage,
where e.g. > 80% of people on ventilators do not survive. The federal
government has allowed pharmacies to administer tests, once these become
available.

 _> Slide 5: Have we worked with businesses to support physical distancing
practices and introduced guidelines to provide health checks when employees or
the general public enter the premises?_

Is this alternate A/B work days for employees to reduce building occupancy by
50%? Do "health checks" mean forehead or long-distance thermal sensor
temperature measurements before employees (customers?) enter buildings?

 _> Slide 6: Do we have the ability to quickly communicate the need to
reinstate these measures?_

Existing SMS text messaging for government alerts. No need for
dedicated/mandatory apps.

~~~
dillonmckay
Yes, each county should have the ability to send sms messages countywide via
their emergency management body.

That already exists.

------
adelHBN
Thanks for sharing this. The first slide throws two pretty big hurdles to
reopening - testing and contact tracing. While Google and Amazon are working
on contact tracing, it's not clear when it'll be widely implemented or when
tests will become prevalent. If the stay-at-home order is conditioned on the
implementation of those two indicators, then we may be waiting for a while.

~~~
wbl
Contact tracing requires shoe leather not tech.

~~~
DennisP
Either works. South Korea applied tech pretty effectively.

~~~
raphlinus
They applied the combination of shoe leather and tech effectively. I think
tech on its own without a robust public health infrastructure would be pretty
ineffective, but the latter on its own could do well.

[https://khn.org/news/how-do-we-exit-the-shutdown-hire-an-
arm...](https://khn.org/news/how-do-we-exit-the-shutdown-hire-an-army-of-
public-health-workers/)

~~~
adelHBN
I totally agree that only the combo works. But my concern is that we don't
have the cohesive, political and business structure to pull off something like
that.

~~~
wbl
I hope you remember next November that competence matters.

------
bpodgursky
This has far less content and fewer concrete action items than the lowest-tier
Mckinsey or Accenture report. And that is setting a very low bar.

The roadmap appears to be "we have no idea, so we'll set un-measurable goals
and pretend we've hit them, once the collateral damage of economic collapse is
unbearably large"

~~~
ajross
I think that's largely true, because no one has good answers here. All
reasonable plans cannot be feasibly financed at the state level in the USA.

Still, it seems like a properly framed argument like yours would need to start
with "They have no plan" and then move on to... a plan.

There are no good plans. At the end of the day we stay home, wait for
infection rates to go down, and then spend a ton of money on testing and
tracing. The other alternatives are to re-spawn the outbreak or to wait for a
vaccine, both of which are even more expensive.

But that plan needs to happen at the federal level, California doesn't have
the money.

------
dsalzman
My favorite line so far. Opening up areas of the country in an uncoordinated
fashion is like having a peeing section in a pool...

~~~
bsder
It's not actually a very good analogy.

A peeing section in a pool simply diffuses and doesn't spontaneously generate
another high-density peeing section elsewhere in the pool.

We _wish_ Covid-19 would simply diffuse down with distance.

~~~
ravenstine
Did you ever swim in a pool and wonder why your eyes burned?

That's not the chlorine alone. The ammonia in the piss combines with the
chlorine to create chloramine, which causes the eye burning and respiratory
problems associated with pool water. It doesn't even take that much piss in
the first place, and once it diffuses in the water, it will affect the whole
pool.

I'd say it's an excellent analogy. Whether it's noticeable or not, if one
person pisses in the pool, everyone's swimming through their piss.

~~~
jdminhbg
That’s a bit of a myth. Sweat also reacts with chlorine to create chloramine,
so it doesn’t actually require any urine. Cf.
[https://www.premierhealth.com/your-health/articles/women-
wis...](https://www.premierhealth.com/your-health/articles/women-wisdom-
wellness-/pool-chlorine-can-t-live-without-how-to-live-with)

------
mrfusion
This doesn’t say anything about when I can see my family again.

~~~
pm_me_ur_fullz
You can come into the state and you can leave the state, what state-level
circumstance is preventing you?

I'm grasping at straws but maybe you are estranged and your family is on the
street but they won't let you into the hobo-hotel?

Every other circumstance I can think of is a Federal issue closing borders for
people that aren't Americans.

~~~
mrfusion
Isn’t CA under lockdown? Only supposed to leave your apartment for groceries
right?

~~~
viklove
They're not saying you can't return to your family, they're just saying not to
congregate in large numbers. I've moved back from my apartment (Chicago) to
the suburbs to stay with my parents until this lockdown ceases. Of course, we
both started isolating two weeks before I came home, and they picked me up so
I wouldn't have to take the train.

Just use your head, don't do things that will risk spreading the disease.
Taking public transit to/from your family a few times a week is very
dangerous. Going someplace and staying there is not.

------
anon543210
Maybe I'm the idiot but its pretty clear as to whats on the roadmap.

>defines a goal or desired outcome and includes the major steps or milestones
needed to reach it.

Yeah its missing some specifics but there are certainly goals stated before
the decision to relax the stay at home policy is reached.

------
sergiotapia
I don't understand why at risk people don't just stay at home. Why lock
everybody else up? Enough is enough, kids need to go back to school and people
need to go back to work.

This document seems hand-wavy and doesn't answer anything.

~~~
chillacy
One passibility is: if some people are going to work then everyone's going to
have to work, or else risk falling behind. It's the prisoner's dilemma,
someone who wants to stay home would end up having to go to work anyways. This
has already happened with the laughable amount of people considered
"essential" when the governor of NYC made it optional (investment bankers
taking the subway to go to work!)

Taken like that it becomes more like restrictions on pollution or laws against
corporate espionage in how the government shapes the economy already.

~~~
sergiotapia
>One passibility is: if some people are going to work then everyone's going to
have to work, or else risk falling behind.

Then that's the reality. Again, I don't believe we should be forced to be
locked down by the government, let alone some rinky dink local government
politician on a power trip. Leave it to the individual.

------
redis_mlc
I see a dozen questions with no answers.

Where is our leadership when we need it?

------
zaidf
For everyone who has tracked California’s response over the past month (the
good and the bad), the #1 problem is obvious:

a) California’s testing and reporting infrastructure is _absolutely_ abysmal,
arguably the worst in the country

b) there are very few signs that it will improve anytime soon

California leaders haven’t had to confront this publicly because much of the
last one month had been focused almost exclusively on reducing fatalities and
increasing hospital capacity. Testing matters but not _that_ much for the most
acute cases.

It matters a lot more in determining the the rate of incline/decline of new
infections, both numbers that will increasingly matter more as fatalities and
hospitalizations stabilize.

~~~
dnautics
I would argue that reducing the rate of deaths is the #1 problem, followed by
reducing the rate of infections, followed by being able to determine the rate
of infections.

So, unless you believe california results are 10x off, based on empirical
results and your assertion that the testing and reporting infrastructure is
"the worst", the state of california has at least done a fair job of managing
its effort in the face of a limited resource. Knowing in detail what's going
on is strictly secondary to reducing deaths.

~~~
zaidf
I believe California has done an amazing job so far on the whole; “fair” would
be a gross understatement. So I think we are in agreement there.

That said, I do think as new casualties and hospitalizations are on the
decline, test reporting and infrastructure matters disproportionately more for
the next phase (planning for gradual reopening) and phases after.

------
ninetyfurr
They should quit padding the numbers if they're so concerned about minimizing
fatalities.

A man gets hit by a bus and tests positive for Coronavirus, I don't care what
the science has to say about it, that is not a Coronavirus death and you can't
change my mind.

~~~
esoterica
Do you think it's likely that 26,000 people happened to get hit by a bus right
after getting diagnosed with the coronavirus?

4% of the patients diagnosed with coronavirus in the US have already died (and
many more of the currently diagnosed patients are still sick and have not yet
died but will in the future). It's wildly implausible that a meaningful
fraction of 4% of that sample could have coincidentally died within a few
weeks of getting diagnosed with the coronavirus, but for entirely unrelated
reasons. If 4% of the population were dying every few weeks, humanity would be
virtually extinct within a few years. Your "stat-padding" theory doesn't pass
a basic smell test.

You can construct far-fetched pathological scenarios for how 1 or 2 people
might be wrongly identified as coronavirus victims, but you can't explain away
26k deaths with baseless conspiracy theories.

~~~
s1artibartfast
2.8 million Americans die in a normal year, or about 7,500/day.

The risk factors for normal causes of death are basically identical to those
of covid-19 ( age, vascular disease, cancer, respiratory disease, ect). I
think it is reasonable to wonder how many of the people who died from covid-19
were already loosing a battle with pre-existing condition.

