Aren't the latest California directives attempting to adapt to this at least at the county level by tying restrictions to hospital capacity in each county?

https://www.gov.ca.gov/2020/12/03/california-health-official...

Yes, but the other Bay Area counties have chosen to shut down way in advance of that.

My county has about ~30 ICU beds left, yet hasn't triggered the magic state threshold. They are one mass causality incident (plane crash, roof collapsing, etc) from people going without care.

Even if things are OK in San Mateo, they don't have to deal with the cases of people who go there because there are less restrictions. That is the whole point of counties working together.

The thresholds are by geographic area, not counties.

California’s page about this is an easy read: https://covid19.ca.gov/stay-home-except-for-essential-needs/

> The thresholds are by geographic area, not counties.

Which is why I highlighted the situation was quite bad in my county, yet the bay area as a whole hasn't triggered the state mandates. It should be both county and region based.

Other Bay Area counties are seeing numbers skyrocket over the past 6 weeks, and want to act decisively now while they have the best chance to prevent a catastrophic outcome.

In SF case counts have been doubling about every 2 weeks; we started from a low baseline (relative to most of the rest of the USA) but another few doublings and we’ll be in huge trouble.

The state-level mandates are timed to be reactive instead of proactive; if we assume the restrictions are successful at curbing spread, we should enact them ASAP, before our hospitals are on track to be completely overwhelmed. (For that matter we should have taken strong steps before Thanksgiving weekend.)

It is extremely unfortunate that this is hammering small businesses; if the US had responsible federal leadership (if the Senate & White House hadn’t just sat on their hands for 7 months) we could do something about this (fingers crossed for January), but counties and even states have limited ability to provide large-scale relief of the type required.

But waiting to impose the same restrictions until the state mandates kick in, if inaction results in cases continuing to rise along their current trajectory, will lead to even larger economic devastation than decisive action a few weeks sooner.

Stop putting it all on the federal government. It’s also state government’s fault. California only thinks in terms of lockdowns even after all these months. Also look at people’s personal behaviors. I saw more and more people walking around without masks recently. Downtown Burlingame was shockingly bad.

> California only thinks in terms of lockdowns

What are you thinking of? Personally I think we could do much better at hiring contact tracers, getting test sites into vulnerable neighborhoods, doing general community outreach, making sure public-facing workers have sufficient PPE, figuring out how to get infected people places to isolate away from their households, protecting incarcerated people, etc.

But historically the USA has been heavily reliant on the CDC and the federal government more generally to muster resources and coordinate responses. When leadership is entirely absent (and indeed, federal officials are out lying about the pandemic every day), states have a tough time picking up the slack.

> look at people’s personal behaviors. I saw more and more people walking around without masks recently

From what I understand, a major goal of shelter-in-place orders is to convince individual people to act more carefully.

My opinion is that people are tired of the orders and that they will not change people’s behaviors.

What makes you think this is a belief held by a large number of people, rather than a vocal minority?

I am not so much looking at what people are saying rather I am looking at how people are behaving. People are much more relaxed and take time to shop. Some downtowns are quite busy with foot traffic. Those areas have people walking around without masks (supposedly eating or drinking). It is hard to socially distance in those areas.

So we should give up and let the hospitals collapse and an extra few tens of thousands of California residents die?

I was not expressing an opinion as to what to do. Rather I was expressing how I thought people will behave.

If doubling every 2 weeks is your standard, everyone in San Mateo County should stay home. Their case count has more than doubled in the last 1 week, from 137 a week ago to 343 most recently. It was their second-highest case count on record, second to yesterday which was 400 cases.

East Palo Alto and San Jose could be either from pop-density, or from relative # of poor people.

And age, race, types of jobs, family structure, trust in authority, education, and probably more.

San Carlos is white, rich, and old. East Palo Alto it not.

Of course. The real scandal is how bean counting has failed millions of Californians. Are that many people really eking out an existence so marginal, it has no impact on prices for homes, equities, goods and services? Or is there something wrong with what we’re measuring?

It is dense, multi family housing and having to work at jobs that expose you to other people. It isn’t directly race or age.

Well, yeah, those are the factors for which race and age (and wealth) serve a pretty direct proxy in the U.S.

It is flawed lens. For instance there are poor Asian subgroups and there are poor in otherwise rich groups.

Depends substantially on how many people have to work face to face with strangers, and how large households are.

Everyone living in a multi-generational household with e.g. grocery store clerks is at significantly higher risk than a couple of childless yuppies working from home.

Probably both

Nine months into this it would be nice if we had good data on the risk factors of transmission. I know it’s a tricky virus to trace but shouldn’t we have better info on which activities demographics, etc are the most risky by now?

We do know the risk factors. It's a respiratory disease that spreads when people who are breathing are near each other. We don't need a random control trial to tell us that practicing with your brass band can spread it. The solution is to stay very far from everyone until the disease is wiped out. Only very intelligent libertarian contrary Americans think we don't have the information we need.

That is not very helpful advice when you have to manage risk while trying to eat, work, live, and stay healthy. Stats certainly exist on where some of the 16,000+ cases in San Mateo were transmitted.

Exactly what information do you lack? If you are hungry eat at home. Work at home if possible. Exercise at home. "Live" is too vague to address.

You are substituting instructions for information. I lack information. For example:

Has anyone in San Mateo caught covid eating at a restaurant? How many?

Has anyone in San Mateo caught covid grocery shopping? How Many?

Has anyone in San Mateo Caught covid exercising outside? How many?

Has anyone in San Mateo Caught covid at school? How many?

There's no way to get the information you desire without Big Brother level tracing. And even then the error bars are huge. Symptoms set in days after exposure, and transmission is uneven at best.

Full disclosure: I've had covid.

We assume we were exposed at the clinic, where our kid needed emergency medical treatment. But if so, only one of us was with the child indoors -- in a cleaned room with a doctor in full PPE and us in masks -- and treatment lasted less than 5 minutes.

But by the time we experienced onset of symptoms, days later, we had been in close proximity with my in-laws (they need care and were part of our bubble) for over 24 hours. Luckily, they developed no symptoms and tested negative.

So 5 minutes of exposure to an asymptomatic carrier at the clinic likely transmitted the virus to us, but 24 hours in close contact failed to transmit the virus to my in-laws.

The delay of onset and inconsistent transmission patterns make this virus exceedingly difficult and expensive to track. Your questions are unanswerable.

>There's no way to get the information you desire without Big Brother level tracing.

As I responded to the sibling comment, I don't think that is accurate. Of course many, if not most cases can not be traced, many certainly can be. Some people know exactly where they got covid, and who they exposed, and where.

The US has 50,000 full time contact tracers working to collect this information. Surely there is some data by now?

>Your questions are unanswerable.

IF the question is categorically unanswerable (which I don't believe), contact tracing programs should be disbanded.

Contract tracing != "gathering evidence of transmission in any particular location/context."

Instead, please think of it as "one of the most powerful, non-medicinal, mechanisms for interrupting disease transmission."

It accomplishes this through its overt actions: attempting to alter the behavior of potential and exposed contacts by encouraging quarantining for an appropriate length of time and to get tested if symptoms develop.

> Contract tracing != "gathering evidence of transmission in any particular location/context."

I disagree. Understanding how and where COVID spreads has been an essential part of contract tracing in all of the countries that have successfully implemented it. This data is absolutely collected by tracers.

It’s dangerous to not put much credence in where people think they got the virus. We have all kinds of biases that mean we are not going to be very good at this.

Here are some examples of data supporting the unanswerable questions, complete with business addresses with known case count.

http://publichealth.lacounty.gov/media/coronavirus/data/cont...

http://publichealth.lacounty.gov/media/coronavirus/locations...

They just don’t have the data.

Look I got covid while wearing a mask. Infection was either at a grocery store. Or while walking at a park. Or while at a dog park. Or who knows.

How do you log that in your stats?

You log it as "unknown community transmission". While you obviously can't trace everyone, California has 10,000 contact tracing staff [1] and has spent most of the pandemic with less than 5,000 confirmed cases per day [2]. These individuals are working every day to collect data, so I am sure it exists.

If you get a positive test, contact tracers may ask you where you went and who you interacted with. They then call those people and ask them to get a covid test. IF the contact tests positive, then rinse and repeat. [3]

If I live alone and only leave my house to grocery shop, it is pretty clear where I got covid. Similarly, if Bob had covid, I had dinner with Bob, and now I have covid, it is pretty safe to assume I got at dinner.

Anecdotally, I had a friend who tested positive and the contact tracer told them that they had likely contracted while it shopping at a big 5 several days earlier.

https://coronavirus.jhu.edu/contact-tracing/state-survey-res...

https://91-divoc.com/pages/covid-visualization/states.html

https://covid19.ca.gov/contact-tracing/

The virus is now endemic in the worldwide human population, plus some animal reservoirs. Even with widespread vaccination it will never be wiped out.

I wonder how much those differences in close areas matter because of people traveling locally for work, coming into contact with people from other areas, etc.