COVID - Costa Rica compared to one county in Delaware

[Wetstuff]

Sussex - just north of me is a county in Delaware. Principally rural/agricultural with a number of chicken processing plants.

Population: 234,000   ..registered COVID cases: 3,800  with 114 deaths


Costa Rica

Population: 5,000,000  ..registered COVID cases: 900  with 10 deaths


I picked Sussex because I know it better than counties in Arkansaw...  and I had heard that CR had some pretty strict restrictions on movement. ..which I could see on the Tamarindo Cam I often check at lunch.  NOBODY out. Only the occasional tire track on the beach. 

It was not 'till about Tuesday when I saw people walking in the morning.  And there were surfers out for the first time in months. Perhaps there was a 'morning only' time period when people were allowed out, so Noon was void of humanity?

https://www.tamarindodiria.com/costa-rica-vacations/tamarindo-beach/webcam/


Jim

[PonoBill]

It's a very strange characteristic of humans, a place like California, that responded quickly and drastically limited the number of cases and deaths, is neck deep in people saying it was all for nothing.

I have a simple question: What would success look like?

My youngest daughter is a hardass. EMT, firefighter (woodland and structure), and a respiratory therapist. She's convinced we didn't need to lock down and do damage to the economy. I said to her "so is the problem you have that not enough people died"? Without a moment's hesitation she said yes. Not enough people have died to justify what has been done to the economy. So I said "what would success look like to you?"

When she didn't answer I said "would it be better if you knew a lot of dead people?"  Cheap shot, yes, but I'm not certain what people are thinking. And I don't know the answer. If we had shut down totally, and stopped the virus dead, so only a handful of people died, would that be failure? How would we know if it was good we did it, or bad that we over-reacted.

[surfcowboy]

Joe from Witches Rock posted a video that laid it out.

Beaches in Tamarindo jut reopened and they are only open for surfing from 5:30 am til 8am. They will roll out opening over time and the country’s borders open June 15th.

My wife and I went to a “Hollywood”party up in the hills on Feb 27th. It was full of actors and other weirdos (I kid but I do not lie) and we had stopped shaking hands. I remember people sort of thought we were weird and joked about it. We laughed that these same people had gotten organic colonic hydrotherapy earlier that same day yet we were weird for not shaking their hands they’d just wiped their noses with lol. That’s all to say that it was not a political statement to do that, just common sense based on watching the news.

I agree with the shutdown, but I also know that had we had a plan and testing and contact tracing in place early we might not have had to shut the whole damn country down and instead could have done it town by town or for less time.

We can argue politics and the reason that all happened but I won’t argue that point. It’s simply been proven all around the world. Even if you wanna throw Sweden at me I’ll tell you that no one in Sweden is waving an AK while yelling that they won’t wear a mask or social distance. It could have been milder, but we weren’t prepared.

CR knew they couldn’t stand the healthcare nightmare so they were careful. Looks like it worked. But yeah, what would success have looked like if we didn’t shut down? No idea, but the dollars to death rate would not have made it worth it I’ll wager.

Flights are cheap. Go spend some cash in CR this summer. They could use some of that stimulus money more than Amazon.

[PonoBill]

I agree with the shutdown, but I also know that had we had a plan and testing and contact tracing in place early we might not have had to shut the whole damn country down and instead could have done it town by town or for less time.

And a pony! We could have all had ponies!

But yes. There's a persistent notion that testing is to let individuals know whether or not they have CV. When you lead with that notion then there are all kinds of unintended consequences and problems with testing. What testing is really for is to determine where you have to apply resources and restrict movement. Start with that and it's obvious that we need testing if life is going to return to normal. Unfortunately the Federal government is currently insane, so the response is fractured at best.

[Wetstuff]

My diminishing processor is increasingly unable to handle all the counter-programming and sinister, un-American factionalism.  Unlike, after 911 (which was similarly ignored in advance) we have split as a nation. We are more like Yougoslavia in 1990 ..as if anybody cares to remember. Those demonstrations at the Michigan statehouse reminded me of the mid-'90s, where 'patriots' like Timothy McVey took it upon themselves to restructure America with a rental truck full of fertilizer.  I realize alternative facts and reality are useful politically when you are unable to actually lead  ..or, god-forbid, do not care about leading.  It is spooky times.  I half-bet on a Gulf of Tonkin style resolution for the Straits of Hormuz along about September.

Jim

[SUP Leave]

I'm not sure the comparison from Costa Rica - a tropical country in Latin America  to a county in the NE is apt. The cultures and living conditions are disparate. How many nursing homes are there in CR? What is their GDP and how diverse is their economy? Pretty easy to shutdown a tourist based economy in a monocultural society. Would hazard to guess that people in CR spend more time outdoors than in Connecticut?


In regards to PBills comment regarding his daughter, I think she has a good point. 60% of CV deaths (broadly speaking) are people in nursing homes and care facilities. The question is "how many lives" which is wrong headed and calls into question the morality of the person forced to answer it (nice Dad), it should be how many years lived are you willing to give up?  My point - how long is the average stay in a nursing home?

I pulled this from an NIH study: Median and mean length of stay prior to death were 5 months (IQR 1-20) and 13.7 months (SD 18.4), respectively. Fifty-three percent died within 6 months of placement. Doctors and nurses in Care Facilities call pneumonia "the old persons friend" because it makes short work of them. As an RT I am sure Pbills daughter has plenty of first hand experience in Care Facilities and understands better than all of us, that the quality of life in these places is low. Getting on a vent in a Care Facility is just kicking the can down the road a couple days.

What we are losing in these hodge podge shutdowns from a years lived perspective is hard to calculate. You would have to dive in the weeds and try and get arms around things like: medical procedures missed or put off, suicides due to financial circumstances, spouse and child abuse trauma and long term effects, life spans for people dependent on government, andother psychologic effects. The thing is for we middle class people this shutdown is a luxury. We can whine about masks, and not being able to surf, but there are real problems for our poor and addicted coming from this.

I don't think the math would be too hard to show the shutdowns are causing more loss of years lived than they are saving years lived.

The testing and tracing is going to be interesting to watch unfold. As PBill said, there is really not a central leadership set up for it - the states are going to have to set up their own T and T armies. Here in WA, the National Guard is staffing a call center for T and T. A bunch of guys in camo and combat boots sitting in a call center. They all look embarrassed to be there. WA certainly claims that we are set up for T and T, but the state just lost $200M to a Nigerian unemployment scam, so take any info from us with a big grain of Mortons.

From the outset, even within states there has not been clear guidance as to when or who to test. My friend has a couple of pharmacies set up for testing sites, to get tested you have to fill out an online form and once you get approved you just call the pharmacy and sit in your car to get tested. He told me that in 2 weeks they have seen less than 6 people, but when the shutdowns are lifted more we may see some outbreaks and then they expect to get some action.

[PonoBill]

The hard thing about the math is that the most important variable--how many people would have died if we didn't shut down--is not possible to guess in advance without making some big assumptions. And that variable swings extremely widely depending on your assumptions.

Assume the current death rate for confirmed COVID cases in the USA: 6%, and assume confirmed covid cases is an accurate representation of the total number of infections (of course it isn't). Assume we did nothing and 70 percent of the world's population got it. That's 300 million dead worldwide, 14 million dead in the USA. That's more or less worst case. It seems to me that a fraction of that would justify current shutdowns.

What's the best case? I don't know. Actual covid cases vs. confirmed covid cases might be 50 times higher. Who knows? If it is the death rate is .1 percent. If 70 percent get it that's 5 million deaths worldwide and 230,000 dead in the USA. Would that make the lockdown worthwhile? I don't know. Probably depends on how likely you are to be doing the dying.

The 60 percent number in nursing homes number is likely substantially overstated--not because the number is wrong but because the potential for getting infected is so much higher. It's also a serious triage point. If we let the virus run wild with just some kind of lagging response (if you have mass infections without mass testing, you won't be seeing the effects for two weeks) will that number hold up?

My other daughter probably has a better view of what goes on in care facilities, but she's too exhausted to get much information from. She works at a VA care facility and volunteered to care for the the COVID patients. She's been in strict quarantine for several weeks, living at the care facility instead of being home. Last I heard her patients were doing OK. Not great, but still alive.