There are two general ways to reduce the transmission of the virus. One is “engineering”, changing the physical environment, the other is “social”, changing behavior to keep people distant from each other. Under engineering, we can include not only physical partitions, UV lighting and ventilation, but also mask-wearing and other PPE. I know, there is a very large behavioral component to masking, but I want to focus on the distancing aspect, so let’s put everything else in the engineering box.
Now for distancing. Suppose we know instantaneously and with certainty everyone who is infected. In that case, we can selectively quarantine them, and this will cut off transmission. That is possible only in rare circumstances, such as a country that has fully eradicated the virus but has occasional external visitors. If you have a reliable test you can identify anyone arriving with the disease and isolate them. The rest of the population, known to be uninfected and unexposed, can move freely and congregate as they want.
A more realistic case is that you know with near certainty everyone who is infected, but only with a delay. Then those who came into contact with them during their potential spreading period are also suspect and need to be isolated. This is the idea behind contact tracing, which imposes distancing on a small subset of the population who may not be infected but leaves everyone else free to go on with their life.
July 16, 2020
G20, heal thyself
By Jeffrey D. Sachs
The G20 ministers of finance meet this week under the auspices of Saudi Arabia, which holds the group’s presidency this year. But it is hard to imagine the G20 countries leading the world, as they like to pretend that they do. Most of them can’t effectively lead themselves through the current COVID-19 crisis
As the world’s largest economies, the G20’s members have one overriding responsibility at the upcoming meeting: to agree on actions to suppress the pandemic. A few G20 countries are doing well; the laggard countries need to take urgent measures to stop the spread of the virus. All G20 countries need to cooperate on global-scale policies to overcome the health crisis.
An overview of the G20 countries is sobering. Many are so poorly governed that they have been utterly ineffective in containing the pandemic. Judging by data from the past two weeks, the biggest G20 failure, at 176 new cases per day per million population, is Brazil, led by the reckless populist Jair Bolsonaro, who has himself now contracted the virus. The second-biggest failure is the United States, led by the Bolsonaro of the north, Donald Trump, with 137 new cases per day per million population. The two other G20 countries with more than 100 new cases per day per million population are South Africa (129) and Saudi Arabia (112).
The next tier of countries, reporting 10-100 new cases per day per million population, includes Russia (47), Mexico (43), Turkey (16), India (15), and the United Kingdom (11). These countries are all at risk of a significant rise in transmission, with Mexico and India appearing to be at the greatest risk.
Six of the G20 countries currently report 1-10 new cases per day per million population – reasonably low rates that make possible decisive suppression of the virus in the near future: Canada (8), France (8), Germany (5), Indonesia (5), Italy (4), and Australia (3).
Only three of the G20 countries report under one new case per day per million population: South Korea (0.96), Japan (0.9), and China (0.01). These three northeast Asian countries have displayed the necessary combination of political leadership, public-health professionalism, and responsible behavior (wearing face masks, maintaining physical distancing, and enhancing personal hygiene).
An epidemic is a social phenomenon and needs a social response. As South Korea, Japan, and China have shown, the virus can be suppressed – that is, new cases can be brought to near zero – if a basic logic is followed. Those who are infected with the virus need to protect those who are not infected. They can do this in four ways during the two weeks while infectious: keep their physical distance; wear face masks; stay at home and away from others; and remain in a public quarantine if the home is not safe.
This protection does not have to be perfect; indeed, it won’t be. It has to be good enough, however, to ensure that on average an infected individual infects less than one other. All people must be cautious until the pandemic is suppressed. That means wearing face masks in public places, keeping a prudent distance from others, and monitoring ourselves and our close contacts for symptoms. Officials must make available testing sites and support services for the isolation of infected individuals, whether at home or in public facilities. Managers of workplaces must take precautionary measures, including remote work or safe physical distancing on site.
The egregious G20 failures have in most cases started at the top. The likes of Bolsonaro and Trump are braggarts, bullies, dividers, and sociopaths. Their countries’ massive death tolls have moved them neither to expressions of sympathy nor to effective public-health policies. One sees similar perverse behavior among other G20 strongmen. Whereas women leaders (in New Zealand, Finland, Denmark, and elsewhere) have a superior track record on the pandemic, the G20, alas, has no woman leader.
Trump is a special case, because he governs the world’s greatest military power. The sociopathy of a U.S. president is a worldwide tragedy, unlike that of a Brazilian president (though Bolsonaro’s sociopathy affects the world through an anti-environmental agenda that fuels the wanton and deliberate destruction of the Amazon). Trump’s decision to withdraw the U.S. from the World Health Organization in the midst of the pandemic battle has immediate global repercussions. The same is true of his efforts to launch a new cold war with China, instead of saving his own country and cooperating with China to help the rest of the world fight the pandemic.
In this, China obviously has much to offer. It has used the world’s most decisive measures to suppress a fulminant pandemic (after the first outbreak in Wuhan) and may well be on the way to producing the first useful vaccine.
Yet, societal outcomes are not just the result of political leadership. They also depend on culture and social responsibility. The Confucian culture of northeast Asia emphasizes social cooperation and pro-social personal behavior such as wearing face masks. American hotheads, stoked by Trump, loudly proclaim the freedom to reject face masks – that is, the freedom to infect other Americans. One would rarely hear such a claim in northeast Asia.
What is also notable is the failure of U.S. business leaders to take measures to contain the epidemic. One of America’s leading entrepreneurs, Elon Musk, demanded the reopening of the economy (and his business), rather than using his engineering genius to help contain the virus. Other top business leaders, too, have contributed little or nothing to suppressing the epidemic. This, too, is part of American culture: money over lives, personal wealth over the social good.
The G20 finance ministers will no doubt talk of money – budgets, stimulus, monetary policy – and so they should, but only after they have spoken about stopping the virus itself. There is no way to save the economy without stopping the pandemic. Ensuring effective public-health measures is today’s essential economic policy.
Jeffrey D. Sachs is a Professor of Sustainable Development and Professor of Health Policy and Management at Columbia University.
There were 71,670 new confirmed coronavirus cases in the United States on July 15. Evidently, federal government policy on the epidemic on July 16 has turned to the hiding of the data.
Cases ( 3,545,077)
Deaths ( 139,143)
Cases ( 3,616,747)
Deaths ( 140,140)
Paul Krugman @paulkrugman
The Trump administration is trying to “solve” the pandemic by suppressing information. It’s both unbelievable and totally predictable.
Building consensus requires addressing social and financial problems of people much more aggressively. Distancing obliterated my career in civil aviation and is doing the same for tens of thousands and hospitality and other sectors are devastated, too. Distancing and the fundamental service of these sectors are incompatible mostly, and I get that. But if “distancing” is more valuable to society than what I was doing up to a few months ago, then where is my compensation, including health care for my wife and 4 kid?. Where are the yard signs for the heroic unemployed? I recognize that distancing in fact is a lot less valuable to Americans than what I used to do….I see that every week. I wear a mask because I wish to. I do not go to bars because I never went to them. But if other folks do not want to wear a mask and others want to go to bars, well many are hearing the same message I hear about the value of distancing. Even those who kept their jobs can see that distancing is not valued. Something a lot more definitive and a lot easier to understand is needed to help build consensus sufficient to really get buy-in.
In Michigan the numbers of those dying went from ~one in 10 who contracted Covid to ~one in 12. An improvement due to wearing mask a mask, social distancing, and shutting down businesses. The numbers of those contracting Covid in Michigan are increasing again which means the death rate will increase also. If you care to risk your life by not doing such easy measures, do not risk my life while do it as it takes away from my right to a safe environment. You are as free to do what you wish as long as your actions cause no harm to someone else.
I have not touched upon what if we did not shut down and the numbers who will suffer physical health damage from Covid.
Building consensus requires addressing social and financial problems of people much more aggressively….
[ Absolutely so. This is what has been the intent and has been done in Germany, Japan, Korea, New Zealand and China… ]
Building consensus requires addressing social and financial problems of people much more aggressively. Distancing obliterated my career in… But if “distancing” is more valuable to society than what I was doing up to a few months ago, then where is my compensation, including health care for my wife and 4 kids?
[ I am saddened, but the question is profoundly important. ]
How to fix the raging Covid-19 dumpster fire in the US
via @statnews – July 14
There’s no point in sugar-coating this. The U.S. response to the Covid-19 pandemic is a raging dumpster fire.
Where a number of countries in Asia and Europe have managed to dampen spread of the SARS-CoV-2 virus to the point where they can consider returning to a semblance of normalcy — friends from Paris just emailed me pictures from their Sicilian vacation — many international borders remain closed to Americans.
On Sunday, Florida reported more than 15,000 cases — in a single day. South Korea hasn’t registered 15,000 cases in the entire pandemic to date. One day last week the U.S. recorded more than 68,000 cases.
The website Covidexitstrategy.org has updated its previously tri-colored U.S. map, which showed states as either green, signifying they are trending better; yellow, making progress; or red, trending poorly. A fourth designation, called “bruised red,” signals states with uncontrolled spread; criteria for this category includes hospitals nearing capacity both in terms of overall beds and ICU space. Already 17 states are wearing bruised red.
The virus suppression gains earned through the painful societal shutdowns of March, April, and May — the flattened epidemiological curves — have been squandered in many parts of the country, dejected public health experts agree. A vaccine for the masses is still months away. What can be done?
One thing is clear, according to public health experts: Widespread returns to lockdown must be a last resort — and may not be doable.
“It would be really a morale breaker,” Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, told STAT. “The stress and strain that people were under during prolonged lockdown is the genesis of why, when they were given the opportunity to try and open up, they rebounded so abruptly. Because what I think happened is, they overshot.”
But this is not a binary choice between societal lockdowns and the “party like it’s 2019” approach that put the country in the bind it’s in now. With that in mind, STAT asked a number of public health experts for a single suggestion of how we get ourselves out of this mess. We got lots.
None is a magic bullet. This is going to be a painful and slow process. But there are things individuals, public health departments, state and local governments, and the Trump administration can do.
The fire brigade needs us all.
Turn the clock back
Pent-up people embraced newfound freedoms over-exuberantly, Fauci said. He suggests going back to Phase 1 of the reopening process and then working forward with more caution. “Do it the way they should have done it in the beginning,” he said.
“If we do that, particularly closing the bars, avoiding anything that has a congregation of a large number of people, wearing masks outside essentially all the time, keep distancing … I would almost guarantee that we would see a turnaround of the resurgence that we’re seeing now.”
Embrace al fresco living …
Ashish Jha, director of Harvard’s Global Health Institute, favors banning all indoor public activities that bring together groups of people, for now — including church services.
“My best read of the data is that a large chunk of the transmission is happening when people gather indoors. So, cut out the indoors. No restaurants, no bars, no nightclubs, obviously no schools right now,” Jha said.
He’d close stores, except pharmacies and grocery stores, and require those to limit the number of people they admit at any one time. Staff and customers would have to wear face coverings.
… but tailor tools to local settings
Saskia Popescu, an infection prevention epidemiologist at the University of Arizona, thinks advice like this needs to be pragmatic and take into account that conditions vary across the country. Like where she lives, in sweltering Phoenix.
“Everyone likes to say ‘eat outside!’ she notes. “You can’t do that in 115 F heat, so let’s give people the tools to apply infection prevention strategies for these environments.”
“Social responsibility is huge, but if we don’t do effective risk communication and education, you’re failing people,” Popescu said.
Get creative with risk communications
Marm Kilpatrick listens to a lot of NPR. On NPR, he hears a lot of public service announcements from the Centers for Disease Control and Prevention urging people to cover their coughs, wash their hands, practice social distancing. Kilpatrick, an infectious diseases dynamics researcher at the University of California, Santa Cruz, thinks most of that advice is, by now, not useful.
People should be wearing masks, so by definition coughs are covered. (Plus, people who are coughing should be staying home.) Fomites — viruses coughed onto surfaces — are no longer thought to be a major mode of transmission. And people don’t really get how to social distance except “avoid strangers,” he said.
They need better, more useful messages telling them how to do the things they want to do, but safely. Kilpatrick gives it a go: “Wear a mask. Meet outside. Give space.”
Teach people to think in terms of harm reduction
“One thing I notice is that when people ask me a question, they say ‘yet.’ ‘Can I do this yet?’’’ said Amesh Adalja, an expert on emerging infectious disease and pandemic preparedness at Johns Hopkins. “And I say, ‘There is no ‘yet.’”
He suggests borrowing a page from the harm reduction work that has been done to address sexually transmitted diseases and the opioid epidemic — helping people figure out the risks they face and how to navigate them.
“We have to get better at individual risk calculus,” Adalja said. “It’s not something that people are very good at. And I think that’s why when bars opened in certain places it was like the whole town turned 21.”
Accept that for now the virus has the upper hand
We need to learn to live with SARS-CoV-2, said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Diseases Research and Policy.
Pretending the virus is not a threat or trying to will it away is a recipe for disaster. “You have less chance of winning a policy debate against this virus than you do of … winning a debate against 2,000 angry 2-year-olds,” Osterholm said.
“People have to understand that. It’s like trying to defy gravity. Just because you want to doesn’t mean you can.”
Mine the data more efficiently
Public health is amassing lots of information about who is getting sick and where they’re getting infected. That data should be put to better use, said Caitlin Rivers, an assistant professor of epidemiology at the Johns Hopkins Center for Health Security.
“We can use that information to better direct resources and interventions, for example by closing high-risk activities rather than broad shutdowns,” Rivers said. These kinds of analyses will need to be ongoing, because conditions will change, and should be made public to help people assess their personal risks and guide their decision-making.
Cloudy with a chance of Covid
Data mining could be used to develop local forecasting services, said William Hanage, an epidemiologist at Harvard’s T.H. Chan School of Public Health.
He envisages something like: “Covid activity in your area is currently low. While the risk is not zero, all you need to do is wear a mask while indoors in a public space,” or “Covid activity is expected to be very high and you are advised to shelter in place. Please avoid contact with at-risk persons.”
Enough with the “but the flu” and “it’s getting better” and “it’s going to go away on its own” talk. There needs to be consistent communications from all levels of government about the risk the virus poses, said Alessandro Vespignani, director of the Network Science Institute at Northeastern University.
“I know it sounds trivial,” Vespignani said, “but I have the feeling that is impossible to win the fight if a large fraction of the population is not believing there is something to fight.”
Cut out the politics
With more than six months’ worth of experience with Covid-19, the world has good evidence about what works to suppress spread of the virus. All levels of government should be urging people to take those steps, said Tom Inglesby, director of the Center for Health Security at Johns Hopkins.
“If leaders from this point forward spoke with the same messages, consistently, clearly, without division, they likely have the power to change the views of many who have been less convinced of the right things to do because of conflicting, confusing messages they have been hearing,” he said.
Leaders should also practice what they preach — masks in public, avoiding large gatherings — and be guided by science, Inglesby said.
Provide more help for the hardest hit
Black, Latinx, and Native American communities have been disproportionately hard hit by this pandemic, said Richard Besser, president and CEO of the Robert Wood Johnson Foundation. And too little has been done to ensure that essential workers, many in low-paying jobs, have the tools to protect their health and the health of their families and communities.
Fixing this means providing income support so people who are sick or exposed can stay home, and ensuring they have sick leave and family medical leave. It also means funding unemployment insurance for the millions of people who have lost their jobs in the pandemic, and extending rent forgiveness and moratoriums on evictions and foreclosures, Besser said, as well as providing safe places for people who need to isolate or quarantine but don’t have the space to do it at home.
Pop-up testing sites
Natalie Dean said more geographically focused testing would turn up cases that are being missed. And bringing the tests to where the people are would result in a lot more people being tested. Dean, an assistant professor of biostatistics at the University of Florida, said more mobile testing vans could help identify where transmission is happening. That’s a different approach than the efforts to find and quarantine people who have been contacts of confirmed cases.
“So, it is less about using tracing to reconstruct a chain, and more about identifying a hot spot and trying to flood the area with tests,” she said.
Daily home testing, on Uncle Sam
Low-cost — $1 a day or less — home testing for Covid-19 is doable, said Michael Mina, a Harvard epidemiologist and associate medical director of clinical microbiology at Boston’s Brigham and Women’s Hospital.
“The tests exist. The technology exists. They could be manufactured tomorrow and they would detect people on the days that they are most likely to be transmitting,” Mina said.
These tests aren’t as sensitive as laboratory tests — they miss some cases — but they have the advantage of giving an instant answer. The turnaround for lab testing can be a week. If everyone in a high transmission zone could test themselves daily and stay home while they test positive, it would dramatically lower transmission, he said, arguing the government should pay for these tests.
Contact tracing, with national support
Too few states have the capacity to do effective contact tracing, says Crystal Watson, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health.
“We need this capacity now and we will need it in the fall,” said Watson, alluding to the fact that Covid-19 and influenza will be co-circulating as we get into the autumn and winter. “The White House should embrace a national initiative for contact tracing, and Congress should provide additional funding for state and local public health authorities to expand contact tracing capacity.”
The US is the accidental Sweden
which could make the fall ‘catastrophic’ for Covid-19
via @statnews – July 15
With the Covid-19 pandemic rampaging across the U.S. in April and 20 million people filing for unemployment in that month alone, libertarians thought there was a better way. The Heritage Foundation praised Sweden for “preserving economic freedom.” The Cato Institute said Sweden’s response to Covid-19 “may prove to be superior from a public health perspective.” In early May, Sen. Rand Paul (R-Ky.) said at a committee hearing that the U.S. “ought to look at the Swedish approach.”
The Swedish approach was to largely allow businesses to remain open. And at first, it seemed to work, with a death count nowhere near what it was in countries such as Italy, Spain, and the U.K. But even as Sweden was being hailed as a model, its cases were steadily rising, and its death rate now exceeds that of the U.S. Sweden also did not seem to stave off the economic damage it was aiming to avoid.
Sweden’s Covid-19 strategy, adopted in March, emerged from the country’s top epidemiologist and other leaders’ evaluation of what little science about transmission there was at the time, factoring in economic considerations, and making a considered — albeit controversial — decision to stop well short of the full shutdown that other countries in western Europe (and many U.S. states) adopted.
In early summer, parts of the U.S. began following a very similar path — but one it has stumbled onto, not chosen based on science. Now, the next few weeks will show the consequences of being the accidental Sweden.
“In some ways you could say we’re doing Sweden, but unintentionally” and, crucially, without the guardrails that kept that country’s case count from exploding, said physician David Rubin, director of PolicyLab at Children’s Hospital of Philadelphia (CHOP), whose Covid-19 model shows the epidemic resurging through early August almost everywhere in the U.S. but New England.
In addition to places like Arizona, Texas, and Florida that have been hammered since June, the latest run of the CHOP model identifies Las Vegas, Los Angeles, northern California, Kansas City, Mo., Tulsa, Okla., Greenville, S.C., and Atlanta as poised for widespread transmission. And there are early signs that the virus is moving up busy travel routes, spreading north to Baltimore, Philadelphia, and all of Ohio’s major cities.
By “doing Sweden,” Rubin and other experts mean Americans’ pullback from social distancing that dates from May, when states began lifting stay-at-home orders and other policies aimed at reducing viral transmission. The effect has had many of the failed aspects of Sweden’s approach, but with none of the steps that kept that country from being a total disaster.
Sweden never imposed a total shutdown of nonessential businesses. It closed universities and banned gatherings of more than 50 people, including sports events, and discouraged domestic travel. But most bars, restaurants, schools, salons, and stores were allowed to remain open, with largely voluntary social distancing. “If Spain and Italy got hit by an early Covid-19 tsunami,” said Peter Kasson of the University of Virginia School of Medicine and Sweden’s Uppsala University, “Sweden said, ‘let’s go swimming.’”
Many of its citizens, however, didn’t jump into the deep end. For one thing, “a lot of Swedes went well beyond the official recommendations for social distancing, individually taking the kinds of actions that in other countries were mandated,” said Kasson, co-author of a recent study of Sweden’s strategy. “A lot of people self-isolated at home, and companies promoted working from home even though it wasn’t mandated. That shows that individual decisions that reduce [viral transmission] can have a substantial effect on national outcomes.”
Among those individual decisions: 58% of Swedes didn’t meet friends, and 74% stayed home during their spare time, researchers reported in May.
Sweden also issued its distancing recommendations early. Imposing less restrictive policies right away can be more effective at slowing transmission and preventing cases than stricter measures later in an outbreak.
In contrast, if Swedes had done everything they were allowed to do (especially since face coverings were never required nationally), such as shop and socialize at the same levels they had pre-pandemic, “it would likely have led to runaway infection,” Kasson said. But “Sweden is a place with a very strong embrace of government authority.” When that authority said keep gatherings small, Swedes “took individual actions that went beyond the mandated measures,” he said.
Sweden is 18th in the world in Covid-19 cases per million people, with 7,524 as of Tuesday. That’s better than the U.S. (10,626), but much worse than European countries that imposed shutdowns. Sweden is seventh in deaths per million people (with 549; the U.S. is ninth, with 419), though the U.K., Spain, and Italy are worse, possibly because of older populations, denser cities, and more imported cases early on. But a death rate nearly 12 times Norway’s is hardly reason for celebration. (In fairness, however, there is evidence that one reason for Sweden’s high death toll is that when elderly people contracted Covid-19, they did not receive aggressive treatment, Kasson found; if they had, about one-third might have survived.)
Because factors that kept Sweden’s numbers from being even more dire are largely absent in much of the U.S., there is growing concern that this country will blow past Sweden’s death rate and exceed its case rate even further.
Some states, especially in the South, began easing restrictions in late April. But many people seemed to take “bars and restaurants can reopen with capacity limits” as “back to normal!” An entrenched culture of “don’t tell me what to do” just about ensured the opposite of Swedes’ placing greater restrictions on themselves than the government did. And that’s what happened.
In early-reopening Tennessee, 20- and 30-somethings packed Nashville clubs, skin-to-skin with scores of strangers (and few face coverings). That pattern repeated from pool parties at Lake of the Ozarks to bar openings, such as one in Michigan blamed for more than 100 cases.
Call it “individualism, cultural libertarianism, atomism, selfishness, lack of social trust, suspicion of authority,” The Week columnist Damon Linker wrote, “it amounts to a refusal on the part of lots of Americans to think in terms of … what’s best for the community, of the common or public good. Each of us thinks we know what’s best for ourselves. We resent being told what to do.”
The White House’s coronavirus task force, led by Vice President Mike Pence, is now stressing that individual decisions to distance, wear masks, and practice good hygiene can reduce transmission, even as the Trump administration has not rolled out new strategies to address the skyrocketing case numbers in parts of the country. …
July 15, 2020
Cases ( 76,492)
Deaths ( 5,572)
Deaths per million ( 549)
Cases ( 3,616,747)
Deaths ( 140,140)
Deaths per million ( 423)
Cases ( 83,611)
Deaths ( 4,634)
Deaths per million ( 3)
July 16, 2020
Cases ( 3,657,022)
Deaths ( 140,610)
Paul Krugman @paulkrugman
FL, with 21 million people, now consistently having more deaths than the European Union, with 420 million.
Ronald Brownstein @RonBrownstein
Florida sees another coronavirus fatality record of 156 as nearly 14,000 new cases added, second most ever in one day.
2:43 PM · Jul 16, 2020
Looking to public healthcare systems, compare the workings of the Dominican Republic and Cuban systems, while considering that since 1970 per capita GDP growth in the Dominican Republic has been faster than any country in the Western Hemisphere, let alone not being constrained by continual sanctions as has the Cuban system.
July 16, 2020
Cases ( 48,743)
Deaths ( 941)
Deaths per million ( 87)
Cases ( 2,440)
Deaths ( 87)
Deaths per million ( 8)
July 16, 2020
Cases ( 292,552)
Deaths ( 45,119)
The ratio of deaths to coronavirus cases in the United Kingdom is 15.4%. There is a need to expressly and publicly ask why.
July 16, 2020
Cases ( 3,667,145)
Deaths ( 140,760)
July 16, 2020
Cases ( 3,677,395)
Deaths ( 140,921)
The fierce spread of the coronavirus through the southern hemisphere, where it is winter suggests a continuing in the north as the season changes, with the complication of flu season coming north.
CGTN America @cgtnamerica
#Coronavirus data has been removed from the U.S. CDC website after the Trump administration’s order to re-route hospital data directly to the administration. Missing are current inpatient and intensive care bed occupancy, health worker staffing, and PPE supply status.
Anne 5:19 PM · Jul 16, 2020
Lol, being told what to do……Your Freedoms are inventions of the state. Decadent behavior is globalism. Individuality is tribal.
There were 71,670 new confirmed coronavirus cases in the United States on July 15. Then, there were 78,278 new confirmed coronavirus cases on July 16.
These are largely community cases and they are widespread, so dealing with the national infection apart from shutdowns strikes me as especially problematic, however there will be no widespread shutdowns. Masks remain the viable option, but mask wearing needs to be everywhere.