I agree that it's more possible to be asymptomatic and have the virus. I guess what I meant to say is that if the proper precautions were taken I don't see it becoming more of an issue with opening things up versus extending this process out even longer. My point being that I would hope people would be cautious when visiting relatives in nursing homes whether we are still in state mandated quarantine or not.

King Leary said:

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No visitors of any kind. Might need to keep that policy in place indefinitely.

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And I assume you extend it to hospital stays, rehabs -- I have two employees who have relatives with recent strokes now moved to rehabs for PT, that can not be visited...the stress level of that....

makes me even more frustrated with the Wuhan Lab that allowed this to propagate

Cuomo is getting a bit full of himself. I swear I think these people operate in echo chambers.

Packchem91 said:

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Daviewolf83 said:

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Over the past four days, Congregate deaths have averaged 14.3 deaths per day and Non-Congregate deaths per day have averaged 5.25 deaths per day. So on average, Congregate deaths per day are almost three times as many as Non-Congregate (general population) deaths. I agree the focus of the media should be on this factor and not the effect of the virus on the general NC population. I am not sure why this is not getting the focus it deserves.

I have added the latest IHME model data (4/21 version) to the model comparison chart and you can see the results below. The latest update may be the most accurate in tracking the death rate, but we will see how it does over the next few days. I would also point out that the growth in hospitalization rates is basically flat (graph of logarithmic plot is attached). I have just started tracking new daily cases, separating out Congregate and Non-Congregate cases as you can see from the attached graph. The growth rate of new daily cases is also basically flat, as you can see from the graph below.

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Compelling data, and to your point...this SHOULD be part of the daily dialog.

Now, playing devils advocate for what this data means....it's easy to look at and say, shouldn't most of society be able to return to a normal life, with of course some newer safety considerations in place.

But...if we do that, and most of us are fine, or even if we contract the virus, go thru life pretty normally w/o symptoms......then go visit G-momma in the congregate facility, and it suddenly becomes a much more serious thing.
Clearly, we won't get to the point where we never allow family/friends to visit these facilities...so do you propose that screening before admission becomes a requirement? Something more stringent?
How do we keep the BAU lives for the rest of us from exacerbating an issue in the congregate environment?

---

Under Phase 1 and Phase 2 guidelines from the Federal task force, visits to grandma or anyone else are still prohibited. This includes family/friends. So, we should be able to open up the main parts of the economy and still protect Congregate facilities and hospitals. It is not until Phase 3 when you can have some visits to these facilities.

This is why I believe we have to split the populations and look at the general population separate from the Congregate population.

packgrad said:

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Cuomo is getting a bit full of himself. I swear I think these people operate in echo chambers.

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Between that and the nursing homes. Cuomo had a bad day today.

Lol! Front runner for POTD.

King Leary said:

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If Louisville saves the country and football season, I say we let them win our season opener

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Haha. I saw this a minute ago, big happenings at UL!

Daviewolf83 said:

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Packchem91 said:

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Daviewolf83 said:

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Over the past four days, Congregate deaths have averaged 14.3 deaths per day and Non-Congregate deaths per day have averaged 5.25 deaths per day. So on average, Congregate deaths per day are almost three times as many as Non-Congregate (general population) deaths. I agree the focus of the media should be on this factor and not the effect of the virus on the general NC population. I am not sure why this is not getting the focus it deserves.

I have added the latest IHME model data (4/21 version) to the model comparison chart and you can see the results below. The latest update may be the most accurate in tracking the death rate, but we will see how it does over the next few days. I would also point out that the growth in hospitalization rates is basically flat (graph of logarithmic plot is attached). I have just started tracking new daily cases, separating out Congregate and Non-Congregate cases as you can see from the attached graph. The growth rate of new daily cases is also basically flat, as you can see from the graph below.

---

Compelling data, and to your point...this SHOULD be part of the daily dialog.

Now, playing devils advocate for what this data means....it's easy to look at and say, shouldn't most of society be able to return to a normal life, with of course some newer safety considerations in place.

But...if we do that, and most of us are fine, or even if we contract the virus, go thru life pretty normally w/o symptoms......then go visit G-momma in the congregate facility, and it suddenly becomes a much more serious thing.
Clearly, we won't get to the point where we never allow family/friends to visit these facilities...so do you propose that screening before admission becomes a requirement? Something more stringent?
How do we keep the BAU lives for the rest of us from exacerbating an issue in the congregate environment?

---

Under Phase 1 and Phase 2 guidelines from the Federal task force, visits to grandma or anyone else are still prohibited. This includes family/friends. So, we should be able to open up the main parts of the economy and still protect Congregate facilities and hospitals. It is not until Phase 3 when you can have some visits to these facilities.

This is why I believe we have to split the populations and look at the general population separate from the Congregate population.

---

That makes sense....so what triggers the ability to make those visits again....what infra and/or controls have to be put in place to allow those types of visits?

Packchem91 said:

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Daviewolf83 said:

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Packchem91 said:

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Daviewolf83 said:

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Over the past four days, Congregate deaths have averaged 14.3 deaths per day and Non-Congregate deaths per day have averaged 5.25 deaths per day. So on average, Congregate deaths per day are almost three times as many as Non-Congregate (general population) deaths. I agree the focus of the media should be on this factor and not the effect of the virus on the general NC population. I am not sure why this is not getting the focus it deserves.

I have added the latest IHME model data (4/21 version) to the model comparison chart and you can see the results below. The latest update may be the most accurate in tracking the death rate, but we will see how it does over the next few days. I would also point out that the growth in hospitalization rates is basically flat (graph of logarithmic plot is attached). I have just started tracking new daily cases, separating out Congregate and Non-Congregate cases as you can see from the attached graph. The growth rate of new daily cases is also basically flat, as you can see from the graph below.

---

Compelling data, and to your point...this SHOULD be part of the daily dialog.

Now, playing devils advocate for what this data means....it's easy to look at and say, shouldn't most of society be able to return to a normal life, with of course some newer safety considerations in place.

But...if we do that, and most of us are fine, or even if we contract the virus, go thru life pretty normally w/o symptoms......then go visit G-momma in the congregate facility, and it suddenly becomes a much more serious thing.
Clearly, we won't get to the point where we never allow family/friends to visit these facilities...so do you propose that screening before admission becomes a requirement? Something more stringent?
How do we keep the BAU lives for the rest of us from exacerbating an issue in the congregate environment?

---

Under Phase 1 and Phase 2 guidelines from the Federal task force, visits to grandma or anyone else are still prohibited. This includes family/friends. So, we should be able to open up the main parts of the economy and still protect Congregate facilities and hospitals. It is not until Phase 3 when you can have some visits to these facilities.

This is why I believe we have to split the populations and look at the general population separate from the Congregate population.

---

That makes sense....so what triggers the ability to make those visits again....what infra and/or controls have to be put in place to allow those types of visits?

---

By the Federal guidelines, we have to have had 42 days of reduction in new cases and deaths to reach Phase 3. Additionally, they have to have sentinel testing up and running, so you are able to monitor the at risk populations and be quickly notified if a certain facility or population group begins to show activity above a baseline. This is how the current flu signally works and it is what the Federal government has proposed. I truly believe they will have the testing and systems in place by the time we reach Phase 3. Optimistically, I think it could be the end of Summer at the earliest before we are able to consider moving to Phase 3.

Everyone has to recognize that we will continue to have cases and deaths until a vaccine is found. The government's hope is through the continued work of scientists to find ways to successfully treat the virus until a vaccine is found and by continuing to practice many guidelines such as washing hands, wearing a mask, social distancing in businesses, and staying home when you are sick, we can further open the economy. Also, when flu season hits, there is risk we could spike demand for healthcare capacity, since you would have patients with the flu on top of a continuing flow of patients with Covid-19.

I think it might be a little overly optimistic to think we will have a vaccine in January/February and as I mentioned in a post yesterday, the degree to which this virus seems to be mutating can make it even more difficult. Please remember, most vaccines take 10-15 years to develop and scientists are now trying to do this in 18 months or less. Once there is a vaccine, the focus will be on giving it to the at-risk population first, before extending it to the general population. Given the limited capacity to create vaccine doses, it could take a couple of years to manufacture enough vaccine to provide to anyone who wants it in the US.

Wayland said:

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packgrad said:

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Cuomo is getting a bit full of himself. I swear I think these people operate in echo chambers.

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Between that and the nursing homes. Cuomo had a bad day today.

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He definitely had a bad day. We did not shutdown to eliminate all Covid-19 cases and deaths in the future. At some point, we will reopen and deaths will continue. They will continue even after we have a vaccine. The key is to reduce demand for healthcare capacity and to minimize (not eliminate) deaths.

I imagine the economy will have to reopen before full testing capacity is in place. The key when we reopen is to do the best we can to project the at-risk populations. If we had done this in NC we would be looking at 150 deaths right now instead of almost 300.

Daviewolf83 said:

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Packchem91 said:

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Daviewolf83 said:

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Packchem91 said:

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Daviewolf83 said:

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Over the past four days, Congregate deaths have averaged 14.3 deaths per day and Non-Congregate deaths per day have averaged 5.25 deaths per day. So on average, Congregate deaths per day are almost three times as many as Non-Congregate (general population) deaths. I agree the focus of the media should be on this factor and not the effect of the virus on the general NC population. I am not sure why this is not getting the focus it deserves.

I have added the latest IHME model data (4/21 version) to the model comparison chart and you can see the results below. The latest update may be the most accurate in tracking the death rate, but we will see how it does over the next few days. I would also point out that the growth in hospitalization rates is basically flat (graph of logarithmic plot is attached). I have just started tracking new daily cases, separating out Congregate and Non-Congregate cases as you can see from the attached graph. The growth rate of new daily cases is also basically flat, as you can see from the graph below.

---

Compelling data, and to your point...this SHOULD be part of the daily dialog.

Now, playing devils advocate for what this data means....it's easy to look at and say, shouldn't most of society be able to return to a normal life, with of course some newer safety considerations in place.

But...if we do that, and most of us are fine, or even if we contract the virus, go thru life pretty normally w/o symptoms......then go visit G-momma in the congregate facility, and it suddenly becomes a much more serious thing.
Clearly, we won't get to the point where we never allow family/friends to visit these facilities...so do you propose that screening before admission becomes a requirement? Something more stringent?
How do we keep the BAU lives for the rest of us from exacerbating an issue in the congregate environment?

---

Under Phase 1 and Phase 2 guidelines from the Federal task force, visits to grandma or anyone else are still prohibited. This includes family/friends. So, we should be able to open up the main parts of the economy and still protect Congregate facilities and hospitals. It is not until Phase 3 when you can have some visits to these facilities.

This is why I believe we have to split the populations and look at the general population separate from the Congregate population.

---

That makes sense....so what triggers the ability to make those visits again....what infra and/or controls have to be put in place to allow those types of visits?

---

By the Federal guidelines, we have to have had 42 days of reduction in new cases and deaths to reach Phase 3. Additionally, they have to have sentinel testing up and running, so you are able to monitor the at risk populations and be quickly notified if a certain facility or population group begins to show activity above a baseline. This is how the current flu signally works and it is what the Federal government has proposed. I truly believe they will have the testing and systems in place by the time we reach Phase 3. Optimistically, I think it could be the end of Summer at the earliest before we are able to consider moving to Phase 3.

Everyone has to recognize that we will continue to have cases and deaths until a vaccine is found. The government's hope is through the continued work of scientists to find ways to successfully treat the virus until a vaccine is found and by continuing to practice many guidelines such as washing hands, wearing a mask, social distancing in businesses, and staying home when you are sick, we can further open the economy. Also, when flu season hits, there is risk we could spike demand for healthcare capacity, since you would have patients with the flu on top of a continuing flow of patients with Covid-19.

I think it might be a little overly optimistic to think we will have a vaccine in January/February and as I mentioned in a post yesterday, the degree to which this virus seems to be mutating can make it even more difficult. Please remember, most vaccines take 10-15 years to develop and scientists are now trying to do this in 18 months or less. Once there is a vaccine, the focus will be on giving it to the at-risk population first, before extending it to the general population. Given the limited capacity to create vaccine doses, it could take a couple of years to manufacture enough vaccine to provide to anyone who wants it in the US.

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Great info....thanks.

packgrad said:

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Cuomo is getting a bit full of himself. I swear I think these people operate in echo chambers.

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Truly interesting as has been pointed out...economic hardship absolutely can equal death. Moreover...isn't that actually one of the democratic party's main tenets?

PackBacker07 said:

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One time I'm pulling for Louisville.

JasonNCSU said:

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As someone whos wife works in a hospital, "getting a job at the hospital" is not a solution to the problem... She is in week 3 of having hours DRAMATICALLY cut because there is nothing at the hospital but Covid patients... Several of the floors have been shut down all together because they are not doing elective surgeries... The only people working are those taking care of Covid patients...

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Its interesting to see the different responses at different hospitals. My wife is in ICU at her hospital and has actually had to work more and is on call 2-3 days a week when she is not working. The reason for this is because she is considered "at risk" she isn't allowed to work with anyone who may have Covid. The hospital typically has 2 nurses in their 4 bed ICU unit. With a Covid patient they are doing one nurse per person. When the unit has 2 suspected cases she is the one to get the call because she doesn't work with anyone suspected for coverage

https://www.ncdps.gov/storm-update

Briefing time. Let's see how many buzz words we can use today. No, Roy today. Just Cohen, Sprayberry, and the prison dude.

https://www.wdrb.com/news/u-of-l-researchers-develop-promising-tech-that-could-block-covid-19-infection/article_878a2958-84b5-11ea-98a9-ef3c1f902795.html

It looks like the media's methodology for generating death counts has upset the governor and his team. See the following tweet:

I commented back the following to the author of the tweet:

"This might be due to the fact that the media counts include deaths that are not lab verified (based on articles from yesterday) and the governor and his team want to control the narrative on the actual count. I definitely want an accurate count - question is how to get it."

Cohen addressed the death records in her opening comments today. I missed the exact comment, but she directed where the appropriate resource to get them was.

Wayland said:

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Cohen addressed the death records in her opening comments today. I missed the exact comment, but she directed where the appropriate resource to get them was.

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I think they are upset, since the state is basically trying to shutdown their efforts. I do question why a death certificate is a state record and if it is, I would think the portion about cause of death should be redacted. This information seems to boarder on personal medical information and they generally requires a court order to obtain it.

Daviewolf83 said:

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Wayland said:

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Cohen addressed the death records in her opening comments today. I missed the exact comment, but she directed where the appropriate resource to get them was.

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I think they are upset, since the state is basically trying to shutdown their efforts. I do question why a death certificate is a state record and if it is, I would think the portion about cause of death should be redacted. This information seems to boarder on personal medical information and they generally requires a court order to obtain it.

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Again, I missed the exact comment, will have to go back when the replay is posted. But the impression I got was that people were going to the wrong place to get these records and they needed to address the requests to the appropriate offices.

Today was one of the first times I have felt just a hint of acknowledgement in one of these briefings that they might believe that NC is doing well.

No media questions on the huge spike in congregate deaths.

Wayland said:

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Daviewolf83 said:

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Wayland said:

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Cohen addressed the death records in her opening comments today. I missed the exact comment, but she directed where the appropriate resource to get them was.

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I think they are upset, since the state is basically trying to shutdown their efforts. I do question why a death certificate is a state record and if it is, I would think the portion about cause of death should be redacted. This information seems to boarder on personal medical information and they generally requires a court order to obtain it.

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Again, I missed the exact comment, will have to go back when the replay is posted. But the impression I got was that people were going to the wrong place to get these records and they needed to address the requests to the appropriate offices.

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According to the article last night the media have been going to Register of Deeds and health departments to get this information. The biggest issue I have is they are making medical determinations in the absence of Covid-19 being listed as one of the causes and making assumptions about the cause of death. The county health departments are doing this as well, but they are supposed to do it in consultation with medical doctors and the coroner if there is any questions. The media are not doing consulting with the coroner or the attending medical doctor. If they asked a medical doctor who was responsible for the patient, he would refuse to answer.

The risk is the media are potentially over-counting and reporting deaths as Covid-19 that are not Covid-19. The Register of Deeds is responsible for maintaining all death certificates and in the case of Iredell County, they have refused to provide this information to the media and I suspect others have as well.

I will provided some additional information with regards to death certificates later today. My wife was formally a HIPAA privacy officer and has also been a medical records director in healthcare facilities. She has requested death certificates on numerous occasions in the past when closing out files on former patients. She said they are state records, but there are guidelines on who they can be released to and from what she has been able to find, news media may not have legal standing to obtain these records. She said it is possible they found a loophole, but from what she knows, media are not allowed to have the full record. She said that the death certificates at one time were more tightly controlled, but one of the late changes made to the HIPAA rules before they went into effect, made them more readily available to certain parties.

As promised, here is the state statute on death certificates. I have highlighted (bolded) the section on death certificates and who can have access to them. One thing they media may be trying to claim is they are using this information for "medical research purposes." This is likely the loophole they are trying to exploit. I think it is headed for court, unless Governor Cooper changes his mind.

130A-93. Access to vital records; copies.
(a) Only the State Registrar shall have access to original vital records and to indices to the original vital records. County offices authorized to issue certificates and the North Carolina State Archives also shall have access to indices to these original vital records, when specifically authorized by the State Registrar.
(b) The following birth data, in any form and on any medium, in the possession of the Department, local health departments, or local register of deeds offices shall not be public records pursuant to Chapter 132 of the General Statutes: the names of children and parents, the addresses of parents (other than county of residence and postal code), and the social security numbers of parents. Access to copies and abstracts of these data shall be provided in accordance with G.S. 130A-99, Chapter 161 of the General Statutes, and this section. All other birth data shall be public records pursuant to Chapter 132 of the General Statutes. All birth records and data are State property and shall be managed only in accordance with official disposition instructions prepared by the Department of Natural and Cultural Resources. The application of this Chapter is subject to the provisions of Article 1 of Chapter 121 of the General Statutes, the North Carolina Archives and History Act. The State Registrar and other officials authorized to issue certified copies of vital records shall provide copies or abstracts of vital records, except those described in subsections (d), (e), (f) and (g) of this section, to any person upon request.

(c) The State Registrar and other officials authorized to issue certified copies of vital records shall provide certified copies of vital records, except those described in subsections (d), (e), (f), and (g) of this section, only to the following:
(1) A person requesting a copy of the person's own vital records or that of the person's spouse, sibling, direct ancestor or descendant, or stepparent or stepchild;
(2) A person seeking information for a legal determination of personal or property rights; or
(3) An authorized agent, attorney or legal representative of a person described above.
(c1) A funeral director or funeral service licensee shall be entitled upon request to a certified copy of a death certificate.
(c2) An agency acting as a confidential intermediary in accordance with G.S. 48-9-104 shall be entitled to a certified copy of a death certificate upon request.

(d) Copies, certified copies or abstracts of birth certificates of adopted persons shall be provided in accordance with G.S. 48-9-107.
(e) Copies or abstracts of the health and medical information contained on birth certificates shall be provided only to a person requesting a copy of the health and medical information contained on the person's own birth certificate, a person authorized by that person, or a person who will use the information for medical research purposes.

Copies of or abstracts from any computer or microform database which contains individual-specific health or medical birth data, whether the database is maintained by the Department, a local health department, or any other public official, shall be provided only to an individual requesting his or her own data, a person authorized by that individual, or a person who will use the information for medical research purposes.

The State Registrar shall adopt rules providing for the use of this information for medical research purposes. The rules shall, at a minimum, require a written description of the proposed use of the data, including protocols for protecting confidentiality of the data.
(f) Copies, certified copies or abstracts of new birth certificates issued to persons in the federal witness protection program shall be provided only to a person requesting a copy of the person's own birth certificate and that person's supervising federal marshall.
(g) No copies, certified copies or abstracts of vital records shall be provided to a person purporting to request copies, certified copies or abstracts of that person's own vital records upon determination that the person whose vital records are being requested is deceased.
(h) A certified copy issued under the provisions of this section shall have the same evidentiary value as the original and shall be prima facie evidence of the facts stated in the document. The State Registrar may appoint agents who shall have the authority to issue certified copies under a facsimile signature of the State Registrar. These copies shall have the same evidentiary value as those issued by the State Registrar.
(i) Fees for issuing any copy of a vital record or for conducting a search of the files when no copy is made shall be as established in G.S. 130A-93.1 and G.S. 161-10.
(j) No person shall prepare or issue any certificate which purports to be an official certified copy of a vital record except as authorized in this Article or the rules. (1983, c. 891, s. 2; 1985, c. 325, s. 1; 1991, c. 343, s. 1; 1993, c. 146, s. 3; 1995, c. 457, s. 7; 1997-242, s. 1; 2010-116, s. 4; 2015-241, s. 14.30(s).)

WRAL is saying to expect stay at home to be extended tomorrow due partly to high deaths. Government better be able to discern between congregate and non congregate.

https://www.wral.com/coronavirus/cooper-to-outline-nc-reopening-plan-driven-by-data/19067407/

Wayland said:

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WRAL is saying to expect stay at home to be extended tomorrow due partly to high deaths. Government better be able to discern between congregate and non congregate.

https://www.wral.com/coronavirus/cooper-to-outline-nc-reopening-plan-driven-by-data/19067407/

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The tide is turning and turning rapidly on state and local governments. People have grown tired of not having any rights and the ones taking the time to look past what the media is saying and actually look into the numbers, are the ones who have gotten the protest started.

I think people would be fine with obeying stay at home orders if they felt a plan was in place. A plan to get back to normal on a set timeline.

Hell I'm starting to get a little antsy and my job hasn't been impacted by the virus.

I appreciate someone is asking some of those questions in the embedded letter. I still hope questions on congregate are asked.

https://www.newsobserver.com/news/local/article242200621.html

RunsWithWolves26 said:

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Today has been further proof that these white house press conferences are a total waste of time. You've got the president of the United States yelling and arguing with the media and the media yelling and arguing with the president and neither accomplishing a damn thing. These briefings, IMO, are totally pointless at this point. Nothing informative is coming from them. Just a bunch of idiots yelling at each other because they can't stand each other.

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I agree. And I'll also say they've been pointless since they began.

PackBacker07 said:

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RunsWithWolves26 said:

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Today has been further proof that these white house press conferences are a total waste of time. You've got the president of the United States yelling and arguing with the media and the media yelling and arguing with the president and neither accomplishing a damn thing. These briefings, IMO, are totally pointless at this point. Nothing informative is coming from them. Just a bunch of idiots yelling at each other because they can't stand each other.

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I agree. And I'll also say they've been pointless since they began.

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Don't actually agree with that. I believe and feel like when they first started and the doctors were doing most of the explaining, they were informative. For about 2 weeks now, that hasn't been the case and it's just been a case of a bunch of children screaming at each other because they don't get their way

This explains Mecklenburg County response.

https://www.instagram.com/tv/B_SBtqQHIv9/?igshid=yvr9s0vrgskb

Not to take away from the seriousness and actual info in this thread...but really thought this was as spot on as it was funny