Weekly COVID Update – Dec. 18, 2020

The Data

Ordinarily, I put commentary on my charts from covidactnow.org. It’s no longer necessary. Everything is going straight up. We are now reaping what we sowed for Thanksgiving. It takes about two weeks after a super-spreading event for cases and hospitalizations to grow, and that’s exactly where we’re at now.

When I first started doing this back in March, you could make distinctions among zip codes, cities, and counties. That’s no longer very relevant. Whether it’s LA, OC, or SD, the situation is pretty much the same: exponential growth in cases and hospitalizations, accompanied by precipitous increases in deaths. Around 5% of all the cases require hospitalizations, and slightly over 20% of hospitalizations end up in the ICU. Deaths per day in CA averaged 150 one week ago; today, they average over 200 a day – a 33% increase in 7 days.

Until recently, a lot of people in southern California didn’t know anyone directly who had suffered from COVID. That’s no longer the case. Most of us now have a family member who has contracted COVID, died from it, or who has had to quarantine. For a long time, this was disproportionately the experience of people of color.

A member of my extended family is a doctor on the front lines. He said that his hospital ran out of ventilators two days ago. A patient in their 40’s, with no underlying conditions, had to wait 45 minutes until they could find a free ventilator for her.

Here’s the deal. We are on our own. The president has checked out. The court in San Diego has decided that the state can’t shut down restaurants and strip clubs. Congress is wrangling over financial relief, but even if they pass a package, it won’t include aid to cash-strapped states, who have to fund public health departments.

Sometimes, pictures do the job much better than words.

Adverse Reactions

Anti-vaxxers are jumping on the two cases of an adverse reaction to the new COVID vaccine from Pfizer. This is nothing more than data cherry-picking. Over 20,000 people have been vaccinated, and two of them had an allergic reaction. This amounts to all of 0.01%.

Just about every drug will result in an adverse reaction for someone. I myself had a very serious experience with an antibiotic called Augmentin. My bilirubin, which should be at around 1.0, was close to 30 for 3 months, causing every inch of my body to itch uncontrollably. That doesn’t mean Augmentin is a bad drug. Tens of thousands of people take it with no reaction. I was the exception. That sucked for me, but it was hardly cause for me to go on some rant about how Augmentin was a dangerous drug.

That’s exactly what anti-vaxxers are doing. They’re using every anecdote, news item, and piece of gossip to spread fear. Don’t listen to them.

American Exceptionalism

American Exceptionalism is the idea that the United States of America is unique among the nations of the world in that it was founded on the principles of individual liberty, private property rights, and equal justice for all. Because it is unique, the United States has a special role in the world and in human history.

What is American Exceptionalism? – American Exceptionalism (american-exceptionalism.org)

This is American Exceptionalism. We weren’t the only country to experience a surge in the fall. But we are exceptional in our inability to contain the outbreak. Other countries took measures; we didn’t. Other countries financially helped their small businesses and people, so that they wouldn’t have to choose between economic and physical health. We, on the other hand, are blessed with a Senate, led by Mitch McConnell, that for months refused to even consider a second aid bill. Other countries have political leaders who recognize their legacy is bound up with their response to COVID. We have a president who ignored the first public vaccine shot while he spewed out infantile tweets about his overwhelming defeat at the polls.

People to stay away from for the next three months

Nose-exposers – those who think just their mouth needs covering. All it takes is one sneeze!

Testing, Testing, Testing 1.2.3.4

The other day, my wife asked me about the differences among all the COVID tests. I think I gave her a pretty poor answer, and I suspect a lot of people may be a bit fuzzy on this. So I did some research and put together the chart below.

I think it’s accurate, but please, if you see an error, let me know and I’ll correct it right away!

Interview with a COVID investigator

Recently, I had the opportunity to communicate with an investigator on the front lines — someone who looks into positive cases and gathers the information needed to follow up on others who may have contracted the disease. This is an essential piece of the puzzle in containing the virus.

This person wants to remain anonymous, so I can only say that they work somewhere in the Southern California region. I asked 10 questions, and got 10 answers, although some of them may not apply exactly to every county in California. But I thought this would be instructive in giving you an idea of the valuable work they are doing and the challenges they face.

1. How much training to you need to do your job?

There aren’t enough people to fill the need, so training is just enough to do the job. I had 3 days of instruction – just enough for you to work a few cases and have your supervisor look over what you did. It’s definitely a “learn-on-the-job” position but they do try to to teach you as much as they can in the time allotted. If we weren’t so swamped, I would say more training would be helpful, especially in conducting a live 30-40 minute interview with someone you’ve never met.

There are two types of jobs where I work. Case investigators speak to cases who are positive to determine contacts and exposure and where they were when contagious; contact tracers call contacts collected from investigators and collect info from them and alert them to exposure, and ask to quarantine.

2. What percentage of people willingly answer your questions?

I would say that those that do answer our calls, around 90% answer them. This is just my personal observation, of course. Additionally, I can’t tell how true anything they tell me is. Everything they tell a case investigator is confidential, though. Those that don’t answer are generally the ones we struggle with getting answers out of anyway or don’t want to speak to us.

3. How “deep” do you go when looking at someone’s network?

We simply ask who they were around when they were contagious. We use the CDC criteria for what is a close contact. Contagious period is 48 hours before symptoms till the end of isolation. Isolation is 10 days from the start of symptoms. No one else really matters and we don’t want more info that we don’t need. We’re already swamped. Plus all contact info is HIPAA protected and we do not say who exposed you.

4. From your experience, what are the main sources of community outbreaks?

Personally, I see a lot of nursing homes, churches, and childcare facilities/schools. Restaurant/Bar combos next. A ton of outbreaks have been in the past few weeks. For each one that’s reported it has to meet certain criteria to be deemed an “outbreak”, but there are multiple potential outbreaks or shared exposure points found each day, which are investigated before an outbreak is reported and logged. [Note: the state of California has published criteria for defining an outbreak.]

5. What percentage of cases are analyzed?

Every completed test that is logged in the system, and we with every positive test, we try to call at least three times if not more (depending on the county or if it is a contact tracer vs investigator). The problem is that there are so many cases there’s a backlog, and they can’t train people fast enough to keep up. So the only solution is to ask already burnt out people to do more overtime until new people are hired. It devolves from there as you could assume. They are working on hiring and training more people though.

The metric at least most counties care about is to initiate contact within 24 hours of being assigned a case or the case being entered into the system. Before the most recent surge, some counties had a 95% or better contact rate within one day. That’s probably no longer the case — just too many cases. Additionally they are changing guidelines now to be more time efficient, for example reducing number of calls, prioritizing which cases to call first. The CDC recently released guidelines on what to prioritize and the counties follow their guidance biblically.

6. How long does it take to trace an average case?

If a person answers the initial call, we can create investigations for contacts, notifications, and referrals all within two hours. Otherwise it takes much longer. Each interview is between 20 to 50 minutes. Investigators also use translation services some of the time and it can take even longer. Many cases don’t answer initially and then the work is spread across however many days it takes that specific case to call us back. Each case gets 3 calls. After that we send a letter to the physical address asking them to call us. The paperwork alone for creating contact investigations for contact tracers, referrals, and the initial interview is what takes the longest. This process is getting even more streamlined. Tracing is still very important because it is how we get prospective positives to isolate before they are communicable. Even at a reduced rate, it is useful.

7. Do tracers/investigators experience psychological stress like COVID workers in hospitals do?

Definitely not to the degree that medical professionals dealing with hospitalized cases do. I think we deal more with people’s attitudes as opposed to being in the trenches physically as well.

8. Are most of the people you talk to surprised they got COVID, or did they seem to know they screwed up?

We get cussed out, hung up on. We also have mothers break down sobbing when we tell them their child has COVID. So it can be really bad, and then one person thanks you and it feels at least a little bit more worth it. There’s also little support since everyone is teleworking and no one really understands it unless they do the job. The people I can talk to about it are either frontline workers or doing something revolving around COVID. Please be nice to us though. We are truly trying. Plus we work holidays and weekends and since we are temporary workers we don’t get holiday pay or holidays off. And if we ask for information its not because we want to know your business; it is so we can literally track outbreaks, shared exposure points, determine if you worked while contagious, or other really important things. No one talks about you after we hang up.

9. What percentage of people you deal with think COVID is a hoax?

It’s probably half and half. Some people have symptoms and that usually helps them prepare for the news that they do have COVID. Other people don’t even know they are positive until I call to investigate because everything is moving so quickly. I see a lot of people who know exactly when they were exposed because it was the “one” time they left the house or were around people outside their household. Other people are travelling all over and just lie to you when asked, and sometimes they’ll admit it. It’s genuinely a huge toss up every time I make a call.

10. People of color are disproportionately hit by COVID. Are they more or less likely to cooperate with investigators, or is there no difference?

I would say sometimes they are equal or more willing to answer. I have had more white people than anyone I call who either don’t believe me or I have to spend a good amount of time convincing them I am with the county. People of color that identify as such when I ask them seem less inclined to waste my time. Also I am on the phone and cannot tell race unless they answer that question, so more than a bit skewed in my experience there.

Postscript

I want to thank this person for sharing what it’s like to do their job. Please, if you are contacted by a tracer/investigator, cooperate with them and answer all their questions. It’s the least you can do.

Also, please enroll in CANotify right away! I assume all those who won’t do it because of privacy concerns have already deleted their social media accounts, don’t use credit cards, don’t order from Amazon, use a VPN for Internet browsing, and aren’t registered to vote. But then you wouldn’t be reading this post either!

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