I'm thinking of drinking more heavily.

As a sanitizer?

No change here, but we don't travel at the holidays. I'd be a little concerned if we were: unvaxxed dad & sis, new baby due any day now. As it is, we'll have some friends over and spend a lot of time in the snow. (15" of fresh powder means I am not grading this morning.)

The lunatics in my family and the family members I no longer communicate with are identical sets. My immediate nuclear family will be entirely vaxed and boosted when we visit my sane siblings and their families in January. I'm not too worried about it. The vaccines still appear to provide significant protection, and the early returns seem to suggest that omicron illness is somewhat less severe.

The first known omicron death was recently reported. Obviously there have been more deaths, but if omicron were notably deadly, I think we would have seen more confirmed deaths by now.

Pfizer booster shows 75% protection against infection with omicron -- a considerable deterioration from prior variants, but still pretty darn good by my reckoning.

Omicron does appear to be a lot more transmissible, though. I'll be watching the calendar to schedule my next booster in late April. (And of course, things will no doubt change by then in unpredictable ways.)

ugh this whole thing.

I got my booster last Thursday. Friday I was so tired I was at a party at a friend's new villa and had to lie down on the couch for an hour or two. Next day was much the same. Then the cough came (not helped by the fact that I'd started smoking in bars again, and I go to the bar a lot). Went to the doctor yesterday and I have bronchitis. Then earlier today I got an email from work saying I'm a potential secondary exposure. All this would be fine more or less but I have a ticket to fly back to NY this Friday morning. I need a PCR test on Thursday so I guess I'll find out tomorrow. Fortunately I insured the flight so I should be able to get my money back, if I can figure it out. I was supposed to pack today (work was closed because of the Arab Cup being played nearby) but I just slept the entire day away. We'll see what tomorrow brings.

2: Anti-anxiety.

5: I'm not a doctor, but I think smoking may be bad for you.

I know, I'm a big dummy

unvaxxed dad & sis, new baby due any day now.

just to be clear, I didn't miss an announcement, did I?

It's hard for me to disentangle caution from my general dislike of flying to see family for the holidays, but we're going to fly.

I'm starting to feel bad for my kids, because covid has gone from something that I hoped would be a blip in their childhood, to how they'll remember a lot of it.

Boosted yesterday, in a primary care clinic sharing a building with a cannabis retailer! Felt crummy overnight and woke up with a headache, but it's responded to acetominophen.

I just scheduled an 8-day trip to NYC at the end of January. Plenty of time to see if omicron gets bad, but I'm hoping the boosters keep it in check in aggregate in blue states.

The only reason I'm going back is the new job assumes I'm coming from the US so they'll fly me back business class free with about 200 lbs of my stuff (and I've been storing stuff in my folks' basement that my old man has been at me to deal with). I have 6 months of my start to avail myself of this and only needed to buy my ticket back home.

We're driving to see my parents. We'll all do home tests, and we're all vaccinated now at least.

Oh, and my brother had minor symptoms and tested positive, which was scary (first in immediate family), but he's tested negative twice since then (awaiting PCR), so probably either it was a false positive or the tail end of a very weak case.

The final link in 4 is interesting for it's glass-half-empty approach. Topol recognizes that the virus has innovated in a way that will help it prosper, but we've become so conditioned to stupidity that it's hard to think about how much the situation has improved. The vaccines worked, and they still work!

Yes, it's very bad that people aren't getting vaccinated, and the danger is still awful for people who aren't able to benefit fully from the vaccine. And the burden on hospitals is grim. I'm old, so it's not a good idea for me to be exposed. But the threat from the libertarians has been greatly diminished. Mostly, they'll just be killing and crippling other libertarians, and it is only with some effort that I can manage to feel bad about that.

9: not clear from that sentence who is having the baby.

We were going to a friend's who usually hosts a big party, but not a lot of people here are boosted, so I'm nervous about that. I got mine on the 3rd. I had scheduled based on illness, but a lot of people waited for the official recommendation.

I've read some stuff that omicron and delta might wind up co-existing.

Does anybody know anything about at home rapid flu tests? Flu A is back, and if I got it, I'd really prefer to find out at home and get a script for tamiflu without having to go to my pcp/urgent care.

The final link in 4 is interesting for it's glass-half-empty approach.

I think Topol is generally a good source, and he has been very cautious about endorsing good news about Omicron. I think he's wary because some people are leaning so hard on, "it's only mild cases" that he doesn't want to be part of that group.

I think there are some reasons for optimism, but Omicron could also be really scary, and watching closely to see what we learn in next few weeks.

I don't have holiday plans any more, because my daughter's situation made it important that the wife spent the month with her (and granddaughter -- to the very real benefit of all 3) so all I'm supposed to be doing is nothing stupid. Ski hill opens Friday, and the first days usually there's a lot of wood showing, so maybe waiting a week (going XCing instead?) is the better play.

I'm going skiing in Austria and Switzerland for two weeks, beginning in the latter half of January. We're a group of 61 this time, for the Austria part, including my little brother. All vaxxed, and tested according to the then-existing rules. I'm not sure my niece is going to let me into proximity to her 5 year old twins at the end of that -- obviously completely her call.

16: There was a study which showed that only 4000 white college educated folks between 25 and 64. If the same rates applied to people of color nearly 90% fewer would have died. Not everybody unvaccinated and dying is a libertarian.

The health system overload is a big deal. Even here in vaccinated MA our health systems are stressed. The percentage of those hospitalized for Covid who are unvaccinated her is as high as 75% in some places but as low as 60% in others,

19: I don't think I have 60 people to go skiing with. What a group!

The lunatics in my family and the family members I no longer communicate with are identical sets.

Same here. The single Trump-voting relative I still speak with, a younger cousin, very much regretted his 2016 vote and voted D in 2020.

As far as I can tell, from reading reports in the press, there's a big omicron wave coming in the UK. Anecdotal, but a colleague of a friend has omicron, and they are 1. triple vaccinated, 2. had COVID in August, 3. young.

I don't think I'll change many of my local plans. I'm meeting friends on Friday and going to the pub, and we have various Christmas related things the week after. But we were thinking of visiting my Mum between Christmas and New Year, and we might skip that, in the interests of not bringing London-level exposure to rural Scotland.

My wife has been really sick all this week, with classic Covid symptoms, but her PCR test and LFTs have all come back negative. So, maybe it's the flu.

21 This will be my 6th trip with the group. The size varies: we had 16 people for Verbier 2011, and 72 for Zermatt 2018. Val Gardena 2016 was pretty good at 36. But on a daily basis you go out with 6-8 people, usually the same, and group rules are that you have to have dinner with different people every night, so there's plenty of mixing too. Other main rule is no whining or complaining about anything. And the one out-and-proud looking-to-be-offended Trumper isn't coming this year.

Omicron is really depressing, and suggests we'll all be getting covid a lot more often than I'd thought (probably once or even twice a year, rather than every 2-5 years like I'd assumed a year ago). It feels like we've gotten really unlucky to have a disease that changes this much this quickly and is this contagious.

We generally just travelled to a relative's house in Ohio. But they are in Florida so driving down (and stopping to see new grandkid on way down and back up). Not wild about the timing, but ...

Two kids and another sister flying in; one driving back up with us. Have stocked up on home test kits.

There's never a good time to go to Ohio.

Anyway, our plans are just the three of us and two grandparents. Should be safe and we'll test before seeing the olds.

It feels like we've gotten really unlucky to have a disease that changes this much this quickly and is this contagious.

Not only that, Trevor Bedford points out that people are assuming that Omicron will replace Delta in the same way that Delta quashed all other variants but, not only is Delta still here at the moment, it's entirely possible that Omicron and Delta will both continue to circulate in parallel.

If the next twelve months are like the past twelve months, I feel like we'll be talking about reviving the draft, but for nursing.

Anything to keep the government from making me wash my hands after I poop.

I'm worrying, A substantial part of the Conservative party here has been bitten by a libertarian dog and are voting against even the most minimal measures. This is going to bring compliance still further down. I am myself at some risk -- age, heart, even though triple jabbed. Much worse, I have an immunocompromised sister whom I see almost every day at the moment.

The hospital system is on the verge of breakdown. We have just recorded 78,000 cases in a day, the highest figure for the whole pandemic. Even if the overwhelming majority are mild, as I expect, the severe minority will probably be large enough in absolute terms to choke the hospitals entirely.

So it's all a mess. And I am going to stay out of London.

33 reminds me that my main reaction to covid lately has been to watch my blood pressure more closely.

With a dependent family member recently diagnosed with an autoimmune disorder and local hospitals nearly at capacity, we are back to remaining at home in perpetuity.

My holiday plan is to go to Vermont to see my parents and sister. Vermont's numbers throughout the pandemic have been great (concerning in the past couple months, maybe because so many people got vaccinated so early that effectiveness waned before boosters became available?) but still far better than most of the country. I'm more worried about bringing covid up there with me than getting it there, and I'm not all that worried about that.

36: Vermont *was* great. It's actually gone up quite a bit, but if you're not going to the moral rural places, e.g. the Northeast Kingdom, you'll probably be fine.

If the next twelve months are like the past twelve months, I feel like we'll be talking about reviving the draft, but for nursing.

I'm trying to imagine if one could create a bootcamp that successfully trained soldiers to be able to handle basic hospital tasks in a way that actually was helpful.

I'm thinking it would come down entirely to weather there was buy-in or not.

Also I'm starting to think that buy-in is the fabric of society.

Or just not deliberately attempting to destroy civil society out of a sense of butthurt and to avoid capital gains taxes.

Buy-in to be less shitty.

Yes. We don't have it though.

Plus all this covid.

We weren't planning to go anywhere for the holidays anyway, so Omicron doesn't really change anything for us. I have been thinking that Omicron might be the point where COVID starts to shift from epidemic to endemic, at least in terms of how societies conceptualize and address the challenge. I guess we'll see.

43: Endemic just kind of means it happens without massive exponential growth - not necessarily that you need to drop controls, tracking or fighting it. Tuberculosis is endemic in a lot of places. So is flu, but we monitor it. Small pox was once endemic, but that was not really a tolerable state of affairs. Endemic with high disease burden is not really an acceptable outcome.

I kinda think Omicron is where the wheels start to fall off of the wagons of our hospital systems. Delta already featured a handful of publicized cases of deaths due to urgent medical care not being available. If Omicron is as transmissible as it appears, and our reactions are as unserious as seems likely, I am legitimately worried about being able to get a hospital bed for my dependent should they require one urgently.

"I think Topol is generally a good source, and he has been very cautious about endorsing good news"

I am unable to read this and not think you are talking about Dr Zarkov.

"I'm trying to imagine if one could create a bootcamp that successfully trained soldiers to be able to handle basic hospital tasks in a way that actually was helpful"

Literally what we have been doing for the last 18 months. They have been terribly helpful but there just aren't enough of them. The army is ludicrously tiny compared to the NHS. It's about the same size as the NHS for the Thames Valley. People who say "oh send in the army" simply do not understand this because they aren't interested in defence.

"The hospital system is on the verge of breakdown".

No, it isn't. In January it was on the verge of breakdown because we had over 4000 COVID patients on ventilators. Now we have 896. It is stressed, heavily, but it is not on the verge of breakdown.

Honestly, you're better known for the Navy anyway.

47: Ours locally is having capacity disaster issues - not necessarily from COVID, likely due to deferred care.

48: embarrassingly, the Navy is probably not much better off. It has very few actual warships and most of them, except the carriers, are getting a bit elderly.

We're looking at a quiet Christmas at home, but then traveling to Vegas to join my MIL and her husband for the week leading up to new year's. We're scheduled to clear out of Vegas on the 30th, so hopefully we'll miss the biggest party nights.

I'm a bit grumbly because this is the second big chunk of vacation that MIL is taking up this year, and visiting her is an obligation for my wife but not a joy. Since MIL was recently diagnosed with a relatively benign brain tumor, stepping up our support feels mandatory. Hopefully we'll endure it fine; it just sucks to waste vacation on something that we hope (but are not confident) will be more enjoyable than stressful or anxiety inducing.

Round where I am, the hospital has lost 150 beds for covid-related reasons; at least one patient has died in an ambulance parked outside A&E because there was no available place to treat them; about 10% of the workforce was off sick last month before the omicron surge got under way. I think this is the verge of collapse. The difference between this and the previous peak is that in the previous peaks no one was going to hospital unless they felt they really had no choice. And the health workers were a year less exhausted. This could well be a really horrible winter.

On the plus side, they probably weren't bankrupted by the ambulance fee before they died.

I've been interested to see, per the NYT map, everything go to hell in the US, case-wise, above the Mason-Dixon line. Weather seasonality, I'm guessing.

9: ha! no. sister's baby, not mine -- so we won't be traveling to bring good tiding and omicron to the baby.

One unusually unlucky or badly run hospital isn't the same as the entire hospital system being on the verge of collapse, though. (And if that's Addenbrookes, the patient death was almost two months ago, so it isn't entirely ok not to mention thay and make it sound as though it just happened.)

I have decided to believe that omicron will in fact eliminate all other variants, that everyone in the entire world will get it, and that will be the end for coronavirus.

The relevant metric for hospital availability isn't number of patients on ventilators, rather it the is number of beds available.

If we made a draft for nurses (and medical aides, etc.) it probably wouldn't start out with men aged 18-25.

"The relevant metric for hospital availability isn't number of patients on ventilators, rather it the is number of beds available."

An excellent mansplanation. Thank you!

"If we made a draft for nurses (and medical aides, etc.) it probably wouldn't start out with men aged 18-25"

Trying hard not to read this as "nursing, like child care and laundry, is women's work" but it is really difficult.

Also, while I'm sure the British Army is disproportionately make, surely there are some women there? It's not purely soldiers=boys, nurses=girls, right?

It's the U.S. already using soldiers or similar to fill medical roles in a few states?

It's s/b isn't.

63: they sent a temporary strike team to help a small hospital in NH that was overwhelmed.

In MA, we're also using the National Guard, because we have a school-bus driver shortage.

62: it isn't, and it's not even infantry=boys any more.

My colleague lives in a pretty rural, conservative area. Their kid is in kindergarten. For dress up days this week, today was Reindeer or Camo. Isn't that adorable? it's like some of your students are trying to kill others of your students.

Same school district had grandparents lunch at peak Delta. No masks in sight.

67: in my mind, these people all feel fully vindicated and, in many cases, have been permanently changed by their years-long experience of indifference to public health. Life is back to normal for them, or was never really all that abnormal for them, and it is completely worth it. I don't know whether the number of people who actually feel this way is 0 or 100 million, unfortunately.

Megan was the one saying that all the GOP voters dying of covid would make some difference at the polls, right? There can't possibly be a chance that that's true unless some particular area has lost 15% of its population, right? It sounded unlikely (sorry Megan).

They want death. We want Pepsi-Cola.

Someone made the point last time that it only has to be a differential mortality in razor thin districts to make an electoral difference. It doesn't have to be a sizable difference across the board.

60: I'm sure you had a good reason to post that metric then but it eludes me.

Minivet linked to a fairly convincing argument that it wouldn't matter, but I want to prompt them like a kid on a long drive. Even with this much mortality? How about now?

72: If you thought this was your last chance not to have to undergo apotheosis into an avenging storm goddess of death... I'm sorry, but there's no covid ex machina, you just gotta do it.

Sorry. I'm extremely loopy. I am leaning toward the doomier scenarios for omicron, fwiw; seriously hope I'm mistaken.

72 is an interesting question - on the one hand, COVID kills the elderly and uneducsted, who tend to be right wing, but on the other hand it kills the poor, urban and nonwhite, who tend to be leftwing, and I'm not sure which effect will dominate.

71: number of available beds is a bad metric because hospitals can vary their elective activity to use available capacity.

68.q: I suspect the same is true of a lot of ore Conservative voters, who have been trained to view politics as entertainment by twenty years of massive news stories that have had zero effect on them personally. They didn't get touched by the Iraq War, their pensions survived the 2008 recession untouched, they don't see any real downside to Brexit - it's all just on the TV for them.

76: elective here sometimes includes surgery fir cancer which isn't a pn imminent danger, but if you delay it too long, it becomes les elective.

75 in general is what I've read, with the caveat that I do not think there has been an urban/rural bias over the long run. Admittedly there are a lot of confounding factors such as vax/non-vax and various demographics (including age)in those populations

Removing a vestigial tail is elective surgery unless the tail is prehensile.

Maybe because then it's not really vestigial?

arguably even an artificial human tail is prehensile to some extent. weird research here: https://vr.cs.ucl.ac.uk/portfolio-item/human-tails/

Let's not argue for contention's sake. There's a serious debate about what is medically necessary.

79: thr US may be different (as you say, confounding factors like general rural weirdness) but the coronavirus.data.gov.uk site allows you to rank local authorities by death rate and the lowest are all places like Shetland and Moray and Cornwall, while the highest are urban areas like Barnsley and Havering and Rochdale (also of course poor and high minority).

In rural America, even in the really white parts everyone thinks of when they picture rural America, there are non-white people and generally they are (were?) suffering more covid deaths than the local oafs eating the horse paste. It turns out that packing plants have bad ventilation.

February is pretty obviously going to be horrible. Everyone is coming home from college and traveling to see family as a more spreadable variant emerges into a population with less protection because of overdue boosters and the unvaccinated and, locally, recently repealed mask/isolate rules.

February is supposed to be horrible anyway, I guess.

My birthday is in February.

I'm asking for a prehensile tail.

Just the rest of the month is what I meant.

How is twerking possible without a vestigial prehensile tail?

I think you know what it would take to offset the rest of the days.

91 is me

https://m.youtube.com/watch?v=WJBrAIVrK-4

Nobody is merry on the fifth of February...

Well, sure, not if I don't get my tail.

If you're a Highlander-style immortal, you should probably isolate, wait for others of your kind to get sick, and then cut off their heads when they can't breathe well.

85: Yup. Even the reddest of the red states have blue pockets, and those blue pockets tend to have jobs & family situations (multigenerational households) that make them disproportionately more vulnerable. Early in the pandemic the county north of us had an outbreak, and one of the leaders was insisting it didn't really count, because it was at a meatpacking plant, which was mostly immigrants/Hispanic workers, not the real common-clay-of-the-West rural real Americans.

The reddest of the red counties might disproportionately kill off more Republican voters, but they don't have all that much population. It's easy to have a high per capita rate when there are 20,000 people in the county, but per capita don't vote.

AND... look, hoping it would kill off political dissendents was TFG's rationale for downplaying the pandemic. People I don't take my ethical cues from for $5000, Alex...

Trying hard not to read this as "nursing, like child care and laundry, is women's work" but it is really difficult.

Wouldn't start out with just that group, I should have said. Better pickings if you start with, say, everyone from ages 20-40 and then whittle down, as opposed to the army looking for young men primarily.

Getting boosted on Tuesday, still vaguely planning to go see a jxmas movie in the theater and eat Chinese actually AT the restaurant, both subject to adjustment for nervousness. Could end up being takeout and Brief Encounter on my phone, sort of in for a penny/in for a pound pathos-wise.

You guys get really good prices in Chinese food.

76: To a point, but elective to a hospital mostly just means "scheduled", it says little of importance or even urgency.

To me, personally, it could mean the difference between my dependent having a bed should they experience a crisis vs. being advised to monitor and manage at home as best we can.

I admit I am not having the best of times recently, and tends towards cynicism and acerbity in general, but I'm legit rankled by your dismissiveness. I know I'm taking this personally, but my family has had two medical crises in as many years in which death was a likely outcome had emergency care not been promptly available. It's hard not to take folk downplaying the impact of the pandemic on hospital capacity impersonally.

AND... look, hoping it would kill off political dissendents was TFG's rationale for downplaying the pandemic. People I don't take my ethical cues from for $5000, Alex...

Eh. I have no influence on nor any duty of care to Republican anti-vaxxers. I was not elected to represent them, for example. If they asked me what to do, I'd tell them to go get the shots. But they won't. I'll hold myself to mildly pro-social behavior, but I'm not going to police my hopes or motivations around this. I am also not going to be sorry if a side effect of their shitty decisions turns out well for my preferred outcomes.

If you got a booster you're not being dismissive. You've done by far the most important thing you can do and everything else is just a rounding error on that. The people being dismissive are the unvaccinated, save your rankle for them.

Sorry that was me.

Like there's not going to be a big difference in terms of what care your family members can get based on whether the omicron spike overwhelms hospitals by 50% or by 40%. They're getting overwhelmed either way.

We're flying to CO to see my in-laws over Christmas. Everyone is boosted, and I don't have to teach in January, so while I'm nervous I'm just going with it. I was the killjoy who canceled Christmas last year, and I can't do it again (especially since we visited my family in FL over Thanksgiving, though that was pre-omicron). For the moment, I've resolved not to object to seeing people unmasked in private, as my in-laws and Mr. Robot will be doing so any way, and if they get sick then I probably can't avoid exposure. (My oncologist says I'm no longer immunocompromised, and shouldn't be at any greater risk than average, in case anyone is wondering.)

I really hate all of this. Among my friends and cow-orkers, we default to respecting the wishes of the most cautious person present re: masking, indoors vs outdoors, and other Covid precautions. It feels so much more fraught with family, even though they've all been diligent about getting vaccinated and wearing masks where legally required. It's hard to tell if I'm being unreasonably sensitive.

101: I am not being dismissive, but for pretty much every day of my life for the last year my actual job has been to answer the question "how likely is the hospital system to collapse today, this week, this month, due to pressure from COVID". So if I am downplaying the current crisis, i am not doing so from a position of complete ignorance and blind optimism. I do actually know what elective care is, for example.

I really don't want to know that number locally. There's not much I can do to improve things and I need to manage my own anxiety.

Nurses from Altoona are in Pittsburgh protesting the covid-created backlog created at their hospital and calling for more staff. Fortunately, I'm completely capable of being emotionally removed from something as far away as Altoona.

The real Altoona was the shits we didn't give along the way.

85, 97. Here's an assessment, counties binned by the way they voted. Not corrected for age (ie, no way to know whether rural counties being on average older is a sufficient explanation)
https://twitter.com/Noahpinion/status/1471288548984692737/photo/1

Now I just need an overlay with margins in the last election...

It looks like the new Pfizer drug will work fine but some of the monoclonals probably won't. There was a long-term prophylaxis treatment which looked good for immunosuppressive folks. Hopefully, that will stand up.

106: Yes. Travel during this thing has highlighted how small differences in people's views of risk and health etc. are hugely magnified. Per the other thread, our travel is somewhat "complex" with various family members taking slightly different views of what is prudent and it is all quite volatile. No anti-vaxxers among immediate family* but I can see already that pre-existing strong views** on holiday travels and families etc. are putting everyone on edge. My wife and I for instance! When do we test? Do we continue with our booked short tour of Savannah on the way down? Do we stay with son/DIL/grandchild on the way back up after being with a number of people just coming of off air travel? or just meet outside for a hike or something? Arguing about it ahead of time is half the fun!

*My antivaxxer DIL's mother and boyfriend, but who ultimately did get vaxxed (and Covid just as they got vaxxed) have moved back into the house from the unheated yurt, and my Son/DIL/grandkid have fled across the mountains to live near other relatives of hers.

**Those are the real underlying issues and conflict-averse JP caved to those pressures to agree to go the fracking Villages*** in the first place which did not really sit well with my Jewish "It's your fucking holiday" wife.

***Maybe we can commit some voter fraud or get an STD.

Did I mention that I hate freaking Christmas.

Also my country. my generation, and my peeps in general.

Best wishes on the season.

111, 112: But what I want to know is those purple bars at 5th and 6th percentile, with the rates of 47 and 57 fatalities per 10K: are those counties with a blue layer and a red layer that are largely unmixing, ie the blue layer has a fatality rate of 30/10K, and the red layer is 70/10K, and it averages out? Or do are the two political halves so blended and intermixed between work and families and schools that there's plenty of intermingling of who gets vaxxed and who doesn't, and the average of any subsample would be in the ~50/100K range?

Heebieville is definitely in one of those bars, and my perception is that it's fairly unmixing, although not entirely.

117. I'd be interested in either seeing separate age aggregation within bins or at least an estimate of how much is explained by age variation. I suspect that age + (distance to hospital) as the main explainers. Most vaxxed: least vaxxed by state doesn't have much range, https://www.mayoclinic.org/coronavirus-covid-19/vaccine-tracker. Here's countywise for TX: https://data.rgj.com/covid-19-vaccine-tracker/texas/48/ . People cross county lines pretty often, no idea how that affects reporting, and obvs empty counties will have relatively huge variance, both for vax fraction and for death rates.

I often describe this region as highly balkanized, although maybe that's true of the whole country. We've had some significant hate crimes recently, and I attribute it to the proximity and chafing at the boundary of political territories.

107: I appreciate the work you are doing and it is helpful to hear an insider's perspective that things aren't maybe as bad as I fear, though it's also hard to reconcile with e.g. Ed Yong's recent grim reporting.

I'm starting to feel bad for my kids, because covid has gone from something that I hoped would be a blip in their childhood, to how they'll remember a lot of it.

I hear this. This pandemic has been really tough on children, adolescents, and young adults, in ways that are probably not being tracked and measured, because the negative effects are too broad and amorphous to be easily identified, defined, and measured.

I'll hold myself to mildly pro-social behavior, but I'm not going to police my hopes or motivations around this.

This suggests a test for good Christians. (I mean the good turn-the-other-cheek Christians, not the bad hellfire-and-brimstone ones.) The test: Are you glad that Donald Trump didn't die of Covid?

I would make a bad good Christian.

I'm fine with him dying of Covid.

122/123 The best answer I've seen to that question was from a commenter on Scalzi's blog who replied with the following:

From Danish poet Piet Hein? (He calls his poems Grooks, which is largely irrelevant except to explain the title:)

AN ETHICAL GROOK
I see
and I hear
and I speak no evil;
I carry
no malice
within my breast;
yet quite
without
wishing
a man to the Devil
one may be
permitted
to hope for the best.

When to test ? As close to the meeting/event as possible, it would seem:

A demo of how fast you can turn positive:

Yesterday morning, yesterday lunchtime, yesterday evening, this morning.

Do LFTs *just* before meeting up. pic.twitter.com/3zM2rDkoa7

— Billy Quilty (@BQuilty) December 16, 2021

It would have been such a delightful spectacle in so many ways. Instead I'm just left with my despairing feeling that old evil people never fucking die.

Instead I'm just left with my despairing feeling that old evil people never fucking die.

Wishing death upon the oldsters just sort of makes me feel queasy and uncomfortable, and in very real danger of lapsing from my lapsed Catholic status!...

old evil people never fucking die

Sadly, when your systems are broken, often the replacements are even worse. Ah, for the relative restraint and probity of Eric Cantor! What did we get when Scalia died?

That said, Trump dying would 100% be a good thing, and I hope it happens soon.

So: I have strep. (Last time I had this the amoxicillin came in the little pink bottle but as an adult one gets pills ). Pebbles learned I was sick and her immediate questions were: is it the coronavirus? Are you going to be okay? We have downplayed the risks of the pandemic as much as possible for a 5yo who has to wear a mask everywhere but she was clearly worried. It's hard to contextualize illness for her.

The assistant kindergarten teacher is out with Covid. Contracted it over Thanksgiving and currently getting the antibody treatment. There are a lot of worried kindergartners.

Of the panoply of viruses you can choose from these days, you pick strep?

She can play any role.

Anyway, we have amoxicillin in the house too, but I'm not the infected.

More detail:
https://icemsg.wordpress.com/politics/the-republican-democrat-covid-divide/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8242603/
still no assessment of age difference.

Strep is bacterial, not viral. If only ogged lived with a doctor; then he wouldn't make this kind of mistake.

One thing that might help to anchor these discussions: what is the measure of a health service that has actually collapsed? When we're on the verge of collapse (or not, as ajay says) then there are two things to ask:
1) how close is the collapse?
2) How would we know when we had it?
Doctors abandoning their patients in terror? (one case I know of, when the first wave hit, of a Dr in Addenbrookes refusing to go onto the covid wards. But one case is not a general collapse)
People dying in corridors?
People dying in ambulances?
10s of thousands of people stuck in hospital beds because there is no place for them to go? (tick)
Terminal cancer patients with sepsis waiting two hours in A&E because no beds? (Ume's dad, eight years ago)
There is a great deal of frog boiling going on. There are also unspeakable numbers involved -- no one is going to talk publicly about an acceptable level of degradation, but clearly some such number must exist and shape policy.

One measure of collapse would be the number of CC units declaring CRITCON 4 and having it approved by DHSC. At present it is zero as it has been throughout the pandemic.

None of the other indicators you mention are good definitions of collapse or of impending collapse, either locally or nationally. Collapse means, if anything, sustained and widespread inability to provide essential services (hence my use of CRITCON). MFFD numbers are high all the time. People die in ambulances all the time. Patients are treated in corridors all the time. That's bad and a sign that improvement is needed but it isn't a sign of impending collapse.

Think about it in terms of other public services - like electricity or the road network. What does "the road network has collapsed" mean? Not just "there is a fallen tree stopping me getting to work", surely.

This is interesting. What exactly would lead to a declaration of CRITCON 4?

I'm not sure that electricity is a very good thing-that-is-banned for the health service, because in the industrialised world it is either on or off and what's happening to the NHS is more like a succession of brownouts.

It's almost certainly true that people die in ambulances all the time -- but I think it's novel that they should do so while the ambulance is parked for hours outside the A&E (ER) department. And "Patients treated in corridors" was a news story within living memory.

I think my definition of absolute collapse comes from Moscow in the early Nineties, when one of the local staff for the Independent had to go into hospital for some reason and they offered her an ice pack in place of anaesthetic. I agree we're a long way off that, but I think that most people would place the point of collapse rather nearer to our situation.

And, yes, of course my view is coloured by the fact that I still haven't heard back from the cardiology department even to get an appointment to tell me to wait some more in the fortnight since my angiogram.

What exactly would lead to a declaration of CRITCON 4?

Two days of CRITCON 3 and an anti-vax Christmas party.

"I'm not sure that electricity is a very good thing-that-is-banned for the health service, because in the industrialised world it is either on or off"

I picked that one deliberately, because it isn't on or off for everyone at once. After the storm a few weeks ago thousands of people lost power - some for weeks. But I wouldn't say the storm made the system collapse, even though, for a few people, it felt like it.

"What exactly would lead to a declaration of CRITCON 4?"

If you Google "critcon 4" you'll get some detail on this. Basically it is the point at which you start triage and rejecting - or withdrawing care from - CC patients who have either the least need or the least chance of survival.

Presumably, what happens first here is they shout "free Ivermectin in the parking lot" to try to voluntarily reduce census.

I'm less worried about an orderly plan of triage (though obviously a ideal) and more worried that things get so hard on the nurses that they all leave in a particular ward or hospital and that things just fall apart.

+ not -a

Our local hospital has gone from over 100 beds of capacity to 60 beds, largely due to staff loss. That seems collapse-adjacent.

If only ogged lived with a doctor; then he wouldn't make this kind of mistake

Clearly I was asking why she would choose an unglamorous bacterium when so many au courant viruses were available.

142 is honestly not something that I have spent any time worrying about. Does that happen a lot in the US? Nurses just walk off the ward en masse and leave the patients to look after themselves?

It hasn't happened yet that I'm aware of, but in addition to everything else, significant violence is a real possibility.

146: IANAExpert and I don't know if Moby was thinking of a specific place/incident. It also would surprise me if it was a coordinated thing, because (a) US labor isn't very coordinated and (b) it would be ethically dubious. But if enough individuals choose to quit their jobs or burn out and take unplanned leave at the same time, the effect is similar, maybe worse.

People who believe covid is fake are losing family members to covid and they all have guns. It seems likely some medical worker is going to get shot by someone who thinks the hospital killed Uncle Cletus.

"It seems likely some medical worker is going to get shot by someone who thinks the hospital killed Uncle Cletus."

No doubt, but that isn't going to cause the system to collapse unless it happens a lot, and I doubt it's happened very much if at all so far and this has been going on for almost two years.

Staff burnout is definitely a worry but it won't cause the NHS to collapse next month.

Many rural areas have only one hospital.

But also very few people.

So, yes, if a thing that has never happened so far happened, it might close one small hospital which serves a fairly small number of people. (Other things thay could close a small rural hospital: budget cuts, MRSA, flood, fire, meteor impact.)

This is not the same as "the system is now on the verge of collapse".

My daughter got a breakthrough case of covid (in spite of both jabs of Moderna). Thankfully, it was pretty mild. Now she's looking for a booster next week and not having much luck. Speaking of which, has anyone ever used the CVS online jab-hunting site? It is undoubtedly the most time-consuming, badly-designed site I've ever encountered.

Budget cuts have closed many rural hospitals. There's not much slack in the system in good times.

153: Yeah, it was a pain trying to find something there. The "no appointments available" message seemed to come up if any store in a fairly wide location/date range I selected was unavailable, but when I tried specific stores or specific dates, I eventually found something.

149. It's an anecdote, and no weapon, but this is happening already: https://www.reddit.com/r/QAnonCasualties/comments/rakxun/my_career_of_treating_patients_has_ended/

There's always more violence over the holidays.

In the US, the potential collapse of the healthcare system is kind of like the potential senility of Donald Trump: A lot of folks wouldn't be able to tell the difference.

I guess I don't really care if my local hospital's inability to provide bed to my dependent in a potential crisis fits the technical definition of a collapse or it's merely reduced capacity or whathaveyou. At some point, focusing on the technical definitions serves simply to obscure or even diminish the reality.

The definition of CRITCON 4 on this powerpoint seems apt. "This must only be implemented on national directive from NHSE and in accordance with national guidance." Me, a naive outsider, armed with what I know about this British government, I assume the NHSE has a very strong incentive to not order such a directive. Similarly, the CDC and the WHO had strong predilections to not recognize COVID as a pandemic, or admit that it's airborne.

All this to say: I'm staying the fuck home. I have zero confidence in the American systems of public policy in the face of the evolving situation.

158 to 159.1.

Wasn't the policy of shipping out covid patients to care homes last May a very pure example of triage? They deliberately chucked out the "bedblockers", irrespective of infection status, to make room for other, iller people, and as a result thousands, or tens of thousands died. But they died off the books, in care homes. Somebody else's problem.

And something similar was certainly happening in Sweden at about that time -- I remember an interview on their radio.

On testing, I've heard one 24 hours before and then use the 2nd one in the box *right* before you go in. BUT don't do it outside if it's cold, because that can affect the reagents. In the car is fine.

I second 160.

159: airborne transmission is acknowledged by some docs but official infection control policy at hospitals here does not - even one of the hospitals that first introduced universal masking.

If a whole bunch of nurses on a unit get COVID at the same time and can't work for 10 days that's near collapse. Maybe they get it in the community and spread it in the break room and not from their patients. During our initial surge it was all hands on deck. Outpatient providers were repurposed. Now they are trying to do procedures (even if at ambulatory centers) to get around rules and everybody is more exhausted after 18 months of this

Plus, at least locally, they're hiring traveling nurses at a much higher wage than they are paying the permanent staff.

Anyway, this reminds me to go buy more home tests. Someone had a cold and we used many.

I have finally seen evidence of the long-predicted shortage of pharmacists. My local Walgreens pharmacy will now be closed on weekends, and the nearest 24-hours pharmacy now closes at midnight, due to a shortage of both pharmacists and techs. Already this fall my pharmacy was closed entirely for more than a week, once because Walgreens' computer system in Philly conked out (possibly due to flooding), and once because the power went out and a lot of medications went bad and had to be restocked. I'd go to mail order, but some of my meds are controlled, and I can also no longer trust the postal service to deliver them on time.

The other day when I was buying the Covid tests, the first pharmacy I went to was closed because they lacked staff.

"Wasn't the policy of shipping out covid patients to care homes last May a very pure example of triage?"

No, absolutely not, though it was a stupid idea. Triage is something rather different.

"If a whole bunch of nurses on a unit get COVID at the same time and can't work for 10 days that's near collapse. Maybe they get it in the community and spread it in the break room and not from their patients."

You are making up things to be terrified of.

It's not quite that severe yet here, but the local CVS did just send out an email that the pharmacy will be closed for 30 minutes for lunch every day due to lack of staffing.

It's better when they have capacity to give notice. The first I heard of our store being closed was a hand-written sign on the door.

I was reading over this thread again and noticed comment 47, which started the "collapse" debate: "In January [the hospital system in the UK] was on the verge of breakdown because we had over 4000 COVID patients on ventilators." Just for clarity, ajay, did you mean to walk that claim back at all when you put up the CRITCON 4 criteria in 136 ("at present it is zero as it has been throughout the pandemic")? I think I remember you saying at the time that the whole thing was just barely holding together, but was in fact holding together.

Just had a negative PCR test, 24-hour turnaround, lots of appointments for them still available here. That seems slightly reassuring. I still probably shouldn't have eaten indoors at the restaurant where they didn't check vax cards, but if any dish I've had this year was going to be worth Covid, it was that one. (We were right next to the open door, which meant that it was probably warmer outdoors under the heat lamps, but they had no seats.)

Why would you give seats to heat lamps?

174: Because they don't complain about the service.

173: I would define "breakdown" as widespread critcon 4. Had the trend of December continued throughout January we would, I think, have reached that point; therefore in mid January we were close to breakdown. In fact by then the trend had halted. We were close to breakdown but no longer getting closer. By late January the pressure was easing rapidly.

We had no critcon 4, it is true, but a very large number on critcon 3.

Hopefully it wasn't seasonal. I looked it up and the next late January is really soon.

when my better half was in the icu post heart attack he heard from all the staff - doctors, nurses, non med staff - that his timing was great bc a few months earlier in jan 2021 all they did was treat covid patients. (his timing was also great bc had heart attack when hooked up to ekg & surrounded by attentive specialist med staff with catheterization lab just down the corridor). even in sf, where we've managed to dodge the worst straight through thus far, the capacity to provide care was severely comstrsained for non covid patients over last winter.

also several of his nurses had gone roving bc pays better & were definitely happy to hang in sf where they could make good money, not have to deal with deranged vonpiracy addled patients, and not be overwhelmed caring for preventable direly ill people. would be unaurprised if other areas of the u.s. ate feeling the down side of that calculus.

178: we are indeed preparing for the next wave to peak in mid January 2022.

January 15 is the new January 25.

"deranged vonpiracy"

God damn you, I wrote that history of the American West! Give me back my intellectual property! he screams impotently as I flee, cackling, my illicit royalties clutched to my chest, knowing I can easily outdistance the poor limping dupe.

lol well my phone typing certainly hasn't improved!

170.2: I recognize that you have far more experience in this area than I do (except possibly as a patient), but I don't think 164.3 is "making up things to terrified of." In the US, nurse staffing levels were scarily low even before the pandemic (mainly because hospital administrators didn't want to pay for more nurses), and throughout the pandemic I believe that most of the lack of available "beds" in US hospitals and ICUs has been due to lack of medical staff rather than lack of literal beds. That's not the same thing as system-wide collapse, but here there is every reason to believe that a cluster of staff cases can and will push individual hospitals past the breaking point. I'm also fairly worried about overtired and burned out medical professionals making mistakes they wouldn't otherwise have made.

If a load of nurses got COVID simultaneously it would be a major problem for that hospital. This is true. But this has not in fact happened anywhere that I know of - certainly not to the point where the hospital had to close down, whuxh is what we are talking about here because this is s conversation about collapse, not about things fetting more difficult - and it isn't happening now. That is what I mean by "making things up".

" that most of the lack of available "beds" in US hospitals and ICUs has been due to lack of medical staff rather than lack of literal beds"

Also true in the UK. Staff shortages are the single biggest worry and have been throughout the panic.

If a load of nurses got COVID simultaneously it would be a major problem for that hospital. This is true. But this has not in fact happened anywhere that I know of - certainly not to the point where the hospital had to close down, whuxh is what we are talking about here because this is s conversation about collapse, not about things fetting more difficult - and it isn't happening now. That is what I mean by "making things up".

" that most of the lack of available "beds" in US hospitals and ICUs has been due to lack of medical staff rather than lack of literal beds"

Also true in the UK. Staff shortages are the single biggest worry and have been throughout the panic.

If a load of nurses got COVID simultaneously it would be a major problem for that hospital. This is true. But this has not in fact happened anywhere that I know of - certainly not to the point where the hospital had to close down, whuxh is what we are talking about here because this is s conversation about collapse, not about things fetting more difficult - and it isn't happening now. That is what I mean by "making things up".

" that most of the lack of available "beds" in US hospitals and ICUs has been due to lack of medical staff rather than lack of literal beds"

Also true in the UK. Staff shortages are the single biggest worry and have been throughout the panic.

One maniac with a shotgun could kill all of the on duty intensive care staff in any given hospital, and of that happened forty or fifty times the UK hospital system would collapse. Should we be worrying about this?

What, no automatic rifle?

I didn't think most people in this thread were, in fact, worrying about lots of hospitals actually shutting down entirely (beyond the ones that keep closing in rural and poorer areas here, driven in part by what Covid is doing to budgets). It seemed like most of us were worried about themselves or loved ones being able to get timely care in an emergency. I've read quite a number of news articles about that ability being significantly compromised due to Covid-related staffing shortages in the US, though it's possible that's more of a perception based on anecdotes than comparative data. Speaking for myself, it's hard not to imagine another wave of cases like the one that overtook NYC hospitals at the beginning.

Already shitty standards of care in a non-trivial fraction of nursing homes also effectively collapsed here during the pandemic, and while that's technically separate from hospitals, it contributes to my worry.

These are all issues that deeply concerned me prior to the pandemic, and I don't think it's unreasonable to worry that Covid will be a tipping point in many homes and hospitals, even if it's not likely to bring about systemic collapse.

"I didn't think most people in this thread were, in fact, worrying about lots of hospitals actually shutting down entirely"

Oh, OK then. Sorry, I thought people were arguing that the hospital system might be on the verge of collapse. I don't think it is.

I feel like "collapse" is a moving target. Hospitals in Idaho haven't collapsed; they just sent all their excess patients to Salt Lake City. Our local hospital hasn't collapsed, but their ICU is full and patients are being sent to Salt Lake City. The main hospitals in Salt Lake City haven't collapsed, but they've rescheduled elective surgeries, nurses are covering double the amount of patients, and they turned regular wings into COVID-focused wings. I don't know if that's collapse, because load-leveling is a thing, but it's a lot of 'don't expect to get treated for anything serious at the local hospital, and expect much longer wait times at ERs.'

145: I'm just retro that way. I'm going to make strep cool again. (Very, very mild case, fortunately. Mostly back to normal today after antibiotics.)

Home covid test was negative so hitting the road at dark-thirty tomorrow morning.

Weird argument about the exact definition of a collapse of hospitals/health care. Did India's health care system collapse? I'd say yes, during the wave where they ran out of oxygen and people were begging on social media to get their loved ones admitted to hospitals. I'm not sure how close we've been to that level of desperation (right now, there are no additional federal support teams that can be deployed, although we aren't reassembling field hospitals yet), but it's definitely closer than I'd like. Just having field hospitals seemed pretty dire. Local hospitals are OK, but ones nearby are not. NPR is announcing cancellation of elective procedures and numbers like "130% of capacity." I don't know how long health care providers can keep this up without permanent damage. At some point, you just CAN'T anymore, and I suspect those numbers of folks unable or unwilling to continue will exceed new grads entering the workforce. We know mortality from COVID increases significantly in an overtaxed system. That's not unique. I don't see relief on the horizon for the strain with nothing else changing.

195: But that guy in The DogAss* Atlantic assured me that in your area (I thnk he said he lived in "rural southwest Michigan") no oncres about covid.

*I sure wish Adam Serwer would write for some other place.

I think one conclusion of this wrangling is that "there is a lot of ruin in a health care system". See letters in today's Guardian and other coverage earlier in the week.

Saying that chucking the patients out of hospitals and into care homes was not triage is technically correct -- no one assessed their symptoms before they came into hospital and decided whether they were worth treating. But the decision that some large class of patients was not worth treating compared to some other class was made -- retroactively, and after the treatment had begun -- and this kind decision about who doesn't get care, made on grounds of limited resources, is what I was getting at.

Ajay is surely right about the measurements not showing a crisis, but this is in part because the crisis is being managed to those measurements -- another instance of Goodhart's Law.

I don't think the Swedish experience is one to follow, but one of the things that impressed me about that approach at the beginning was Tegnell talking about all the indirect costs of a pandemic, and the long term damage that couldn't be measured in terms of the immediate death rate. The conclusion I draw from that is that you need much better sick pay and much better support for the unemployed. But that's another story ...

"Saying that chucking the patients out of hospitals and into care homes was not triage is technically correct -- no one assessed their symptoms before they came into hospital and decided whether they were worth treating. But the decision that some large class of patients was not worth treating compared to some other class was made --"

This is not an accurate description of what happened. The people who were moved from hospital beds to care homes in spring 2020 were MEDICALLY FIT FOR DISCHARGE. That's why they were being cleared out to care homes- to free hospital beds for new acute patients.
The fatal error was not testing them before discharge - a lot of them were still COVID positive and went back to care homes and infected other residents, many of whom died unnecessarily.

But it is simply false to say that they were being denied treatment in hospitals which they needed. This has been widely reported for the last year, inuding in your own paper, and I cannot for the life of me work out why you're saying this stuff.

"the crisis is being managed to those measurements -- another instance of Goodhart's Law."

Neat. "I'm right and I will reject any evidence you show me to the contrary."

196: the Atlantic has so much garbage about Covid, but they also have Ed Yobg, who is fantastic, and Katherine Wu. I subscribed in the last year or two, but I'm really conflicted about whether I should keep my subscription because of the aforementioned crap.

They have also been front and center in the mostly-bogus "free speech" wars.

196: I didn't read it, but yeah. I'm grateful my work has a strict mask mandate and is complying fully with the federal contractor mandate. There are very few masks worn at the grocery store, and it's worse outside town. AJ's work is not implementing a vaccine mandate at all "while it's so up in the air" (him: where else in this rural area is going to pay $20/hr? No one's gonna quit over it). Christmas and New Year have snapped back to normal for everyone I know here. Folk who have unvaccinated family members have completely capitulated because they love and miss them. The governor is up for reelection and has decided that no further action is politically palatable (a cost for acting coupled with poor compliance means no upside), and I can't fault her logic at this point.

There's a doc who's been writing OpEd pieces in the NYT from the area as well, and they're telling the same story from very different perspectives. Our little household will almost certainly be fine come what may, but I literally heard someone say, "Yeah, I know people that have died, but whatcha gonna do? Can't keep people from living their lives" and the truth is that I don't see an end other than keeping my vaccinations up to date and continuing to run my own risk assessment for everywhere we go and everything we do.

ajay -- I don't reject any evidence you show me to the contrary. If the official measure is critcon4, then the hospital system is clearly not on the verge of collapse.
But I do feel there are aspects of the present crisis which really aren't caught by your critcon4 measure; just for an example, I learned today via someone who works there that of the 70 staff of the A&E department at the hospital in Ipswich, 26 are currently off work with covid. This was the result of the departmental Christmas party, which had been planned and booked in April, when it seemed things were going to be better now, and because people had paid something like £60 a head in advance to attend there was a certain reluctance to write off the investment. YOu can say it's only one hospital, and so analogous to the people in rural areas who lost their electricity. But it's unlikely to be the only place where A&E is under considerable strain.
Presumably the number of those infected will rise as the testing ripples outwards to the all the contacts of those already identified, even if they don't work in the hospital.
As for the decision to chuck out all the bedblockers without testing them -- sure they didn't need treatment at the time. But they weren't going to get it once they had gone back to their care homes, and it was entirely predictable that some would need it. Whoever made the decision not to test them was deliberately condemning some of them, and must have known it. I can't help suspecting that was done with an eye to how the statistics would look.

The care-home thing hit differently when covid first happened and I had a mom in a home and a friend who lost a father to covid in a care home (one with so much covid that it made the news nationally). I get that covid deaths in nursing homes wasn't a sign of collapse or triage, but it's sure not a sign of a working system.

I guess it would be worse. If I were married to Jennifer Garner, I'd still be drinking.

Truly a fate worse than death.

It's just good to have someone to blame finally.

Maybe it's time to rewatch S1-2 of Alias.

Have you finished yet?

I actually did watch most of the pilot, but then we switched to Little Women for Christmas.