Category: COVID through 2022

All my various postings tracking the COVID-19 pandemic through the end of 2022.

Post #733: Key graphs updated to 6/27/2020.

This post updates some key graphs to 6/27/2020.  Upshot:  No material change in the situation in Virginia.  Virginia continues to get around 500 new cases a day, Fairfax seems to be averaging just over 50, and Vienna 22180 seems to be getting well under one new case per day, on average.

No upticks from re-opening appear in the data so far, for Virginia.  In the national context, Virginia is squarely in the middle of the pack in terms of new cases per capita.  Not getting worse, but not getting better, either.

Continue reading Post #733: Key graphs updated to 6/27/2020.

Post #732: Looking forward to a COVID-19 vaccine

Source:  weareteachers.com

Distributing vaccine via elephant

I wanted this to be a posting on purely technical matters around vaccines, but strayed off course owing to the political elephant in the room.  That’s the room where the vaccines will be stored.  The supply of any eventual COVID-19 vaccine in the US will be controlled by the Federal government.  And by this time, we all know what that means.  It means the vaccine will be used as a political tool, if it arrives under our current President.

I would therefore expect Virginia to be quite far down the list, in terms of when it begins to receive vaccine, and the amount available.  The upshot is that even if AstraZeneca begins delivering units of the British vaccine this fall (some promised as early as September), you’d need to factor in whatever politically-based time penalty the Federal government chooses to impose on your state, in addition to the actual time required to produce a vaccine.

I got to thinking about this because I think schoolteachers ought to be among those who are first in line to be vaccinated.  See next section.  And for that, timing matters dearly.  It’s starting to look like we might actually have some vaccine in hand (via Oxford University and AstraZeneca) early this fall.  AstraZeneca’s CEO is on the record saying they are on track for September delivery of the first doses. 

With that as the timing, offering vaccine to our roughly 3M US school teachers doesn’t seem implausible.  Except that, if you live in a blue state, you’d have to factor in additional time, beyond September.  Not for producing the vaccine, but for paying the likely political penalty for living in a blue state.

I think its worth pointing out that a friends-and-family approach to vaccine distribution will do something that Republicans traditionally hate:  It will reward failure.  And failure’s handmaiden, stupidity.  It’s a fair bet that Arizona will be near the top of the list, mostly due to their governor’s reported devotion to the President.  The President didn’t like masks, so the governor of Arizona made sure no locality in his state could require them.  That, based on the newspaper reporting, was the full depth of the thinking behind their ban on local mask ordinances.

We can also expect that vaccine distribution will be done with the current administration’s hallmark lack of transparency.  The usual talking-out-of-both-sides-of-their-mouths.  The usual contradictory statements by various officials.  The usual lack of not merely accountability, but basic accounting.  I’d say, based on prior behavior, that something as obvious as a simple list of which states got how many doses will not be made public.  At the time when it really matters — this fall — I’d say the odds are excellent that we (the US people) won’t even know where the vaccine is.

Just expect more of the same, that’s all I’m trying to say.  Even when it comes to the distribution of potentially life-saving vaccines.  Figure out the details and then just be prepared for it. Just because this is a life-and-death public health issue, where bungling the delivery could greatly harm US interests, well, don’t expect that to result in a change of behavior.

Once you fully grasp that, you realize that the rest of this posting is just a game of lets-pretend.  So, just for the sake of argument, let’s pretend that we could have a discussion about a rational plan for vaccine distribution.  And then carry that out competently.  Neither of those is likely to occur, but I’m going to work through it, just for the sake of argument.

What can we do for FCPS teachers?  Vaccines and high-quality masks, for starters.

But if, by some miracle, we could do this in a non-political manner, and I were king of the world, I would distribute the first few precious vaccine doses based on occupation.  (This assumes that Arizona and other currently spiking states have finally gotten their collective acts together by this fall.)  You might want to imaging yourself King of the World, and figure out where you’d direct the first doses of vaccine.   Because we might actually have some just a few months from now.

If I were running the show, the first 10M doses would go to:

  1. Hospital employees (6M people)
  2. EMTs and other emergency responders (under 1M people)
  3. School teachers (3M people).

And I believe I might put slaughterhouse workers next.  Along with nursing home workers.  Maybe grocery store workers after that.  And then, only after that, would be various groups based on presumed personal health risk, starting with the elderly.  In other words, I’d vaccinate the occupations with a known high risk of infection. And only after we’d taken care of people who have to go to work to keep the country running, then, sure, let geezers like me have some.

The third one on the list above is in response to yesterday’s reporting in the Post, that Fairfax teachers have balked at going back to teaching in person. And I have to say, it’s tough to blame them.  Kids are cute little disease vectors in the best of times.  But normally, they’ll just give you a cold or the flu.  Now, older teachers in particular are more-or-less risking death by returning to their in-person teaching positions.

I have always marveled at the fact that in one of the wealthiest counties in the US, parents are asked to send in classroom supplies with their kids each year.  For one thing, it’s ludicrously inefficient, having 200,000 parents each separately shopping for a defined set of items as part of the supply chain required to run your school system.  For another thing, it’s a regressive tax.  For a third thing, in a county where the schools cost about $15,000 per pupil-year, the amount of money involved is chicken feed.

And finally, what you end up with is a rag-tag collection of whatever citizens could purchase locally.  Not necessarily the best or most appropriate items.

And so it goes for face masks.  Do we really want teachers to show up with whatever rag-tag collection of face masks that they have managed to pick up?  Or do we want to step up and provide them with high-quality masks?

I say, let FCPS supply each teacher with two high-quality masks.  FCPS only has about 25,000 employees.  As I understand it, we in the US now have full access to Chinese-made KN95 respirators.  These are functionally equivalent to the US N95 standard, but quality us subject to some uncertainty because the US cannot guarantee the supply chain. (Translation:  you might be sold a knock-off, not the real thing).  And so, the FDA still frowns on their use in hospitals.  It’s legal, but only just legal, to use them.

We need to get out of the mindset that proper, high-quality masks should not be made available to anybody outside of a hospital.  That made sense some months back.  But that was before hospitals figured out a straightforward approach to re-using respirators (masks).  That was before the FDA backpedaled on its ban on use of Chinese KN95 respirators.  That was before China began offering those respirators in large quantities to US buyers.  Hospital workers are at highest risk, for sure.  But they are not the only ones at high risk.  Their narrow interests should not be allowed to dictate US policy in an era when hospitals no longer have to run out of masks.

I still get email offers to buy large quantities of such masks, owing to the fact that I once owned a small health-care consulting business.  Here’s the offer I got yesterday.

Source:  ALG Health.

So if FCPS decided to buy two masks for every employee (or, roughly 50,000 masks), it would cost the grand sum of $82,500.  (You need two, so you can let one dry out while you wear the other one).  The cost is peanuts, in the context of a $3B annual operating budget.

If you want to see how to send students back to school successfully, you have to start studying what other countries have done.   And in Japan, every picture you see of teaching activity shows everybody in a mask.  And not some weird cloth mask that somebody picked up somewhere.  A real mask.  Like so:

Source:  Washington Post.

Not all countries that have returned their children to school have mandated mask use.  But here, given our generally chaotic approach to dealing with coronavirus, I would think that mandatory mask use would be an obvious first step.

The likelihood that FCPS is going to be able to maintain the sort of student discipline seen in Japanese schools is nil.  So there has to be a backup plan.  And I say, that starts with providing every teacher with a high-quality KN95 respirator.  And making sure that teachers go to the front of the line when we finally have a vaccine against COVID-19.

Post #731: EDITED: Two-Tier Testing is now “Pool Testing”; a simple solution to the problem of re-testing within a pool.

Source:  Home Depot.

Please read Post #605, from 4/6/2020.  Germany figured out how to test all of its hospital employees, efficiently, by testing them in batches.  Only when a batch tested positive would they test each employee in the batch.

Here’s my description, from that posting:

The Germans test their hospital employees in batches of ten.  They pool the swabs for 10 employees, test that, and then only when a batch is positive, they test the individual employees in that batch. Man, that’s smart.

From today’s Washington Post, here’s a radical shift in testing strategy that the US National Institutes of Health is just now thinking about:

The approach works this way: Samples from, say, 20 people are combined into a single pool. One coronavirus test is used on the entire pool. If the test comes back negative, researchers know they can move on to another pool of samples. If it comes back positive, only then would each individual be tested.

The US has finally discovered what I termed Teutonic Two-Tier Testing.  Only here the official term is Pool Testing.  (Which I think is an unfortunate choice, even if technically accurate.)

I will emphasize that the German approach was not a secret.  It’s something the German government did, and discussed.  Something that a random blogger such as myself could readily discover.  And write up math problems about.  It was clearly efficient.  It was widely reported within mainstream healthcare industry publications.  Including the a publication under the aegis of The Lancet, where they toss in a further efficiency factor by testing in three stages instead of two.

And this approach is widely used in other health care settings, such as screening donated blood.   So it’s hardly as if the idea of testing in two stages (pooled to screen out many units, then individual to find an infected person within a pool) is new to health care in general.

For the life of me, as the US government and various state governments yammered on about the lack of availability of tests, I could not figure out why we didn’t just copy the Germans.  And now, two-and-a-half months later, faced with a rapidly rising count of new COVID-19 cases, the National Institutes of Health and company are finally stumbling toward this approach.

I guess I need to finish up by pointing out the obvious:  It’s not the lack of physical tests that’s the barrier to screening, in most cases.  It’s the lack of cooperation.

In Germany, they use this approach for hospital employees.  There, presumably, they can be compelled to take a test, and take a test in this manner, as a condition of employment.

In the US, though, citizen cooperation is often the rate-limiting step.  In the case of the infected hairdressers in Missouri (Post #721), only 42 of the 140 potentially infected customers would agree to be tested.  The rest couldn’t be bothered to do it.  So it wasn’t a lack of physical tests that was the problem.  It was the lack of public cooperation.

Plausibly, this is now being brought up in the context of another shortage of physical test kits, brought about by this second wave of the US pandemic.  If so, then this is a great idea, and needs to be given all due consideration.  (The underlying test is a PCR test — that is, it greatly replicates any DNA in the sample.  To me, that nature of the test, and the success in Germany, suggest that there’s no physical barrier to combining multiple swabs in a single test).

But if the idea here is that we’re finally going to get mass screening testing going in the US, I’d say, guess again.  Heck, we can’t even get people to wear masks most places.  We can’t even get people who know they’ve been exposed to COVID-19 to take a test.

But if this were used to ramp up workplace testing of all sorts, then that would a) be completely feasible, and b) be a win-win.  Because, in a workplace, presumably you can require testing as a condition of employment.  I don’t see any barrier to using this for (e.g.) routine screening of meat packing plants.  (Except that — see Post #605 — if the infection rate is high enough, pool testing is less efficient than standard testing.)

I wish them luck with this.  I also wish they’d have just copied what the Germans were doing, months ago.  And I hope they use this concept as part of an overall workplace safety plan, something that I think we pretty clearly need.

Extras for Experts:  Here’s Scientific American’s take on it, courtesy of the Post article.  They seem to suggest that, with sufficiently low rates of positives on the tests, a more sophisticated way of pooling the test swabs can result in not having to do a second test to pin down the infected individuals.  As noted in my Teutonic Two-Tier Testing posting, my take on it is that any such algorithm will not be robust enough to be used in practice.  I would love to be proven wrong on that, but algorithms like that are generally a form of “balance puzzle”, and for those, an unexpectedly high rate of positives will disrupt the algorithm.

Edit:  I thing there’s an obvious, robust, and vastly simpler solution to the problem of having to re-test individuals:  Take two swabs in the first test.  Plausibly, you might even be able to do that in one pass, just using two swabs for the procedure, held together, rather than one.  But, if not, swab each patient twice.

Hold the second swab in reserve.  Then test those second swabs, as needed, if a batch turns out positive.  And, in fact, re-testing using a previously reserved sample is exactly what the Germans do, per this reference.

Either way, properly structured, there would be no need to call back individuals for re-testing.  A person only has to sit still and endure one session of being swabbed, even though the testing takes place in several rounds. Given low public compliance with any sort of request for testing, I think it makes vastly more sense to get what you need, while you have your hands on the patient, rather than hope that you can get the patient to come back.

However you slice it, we need to follow German’s lead on this one.  Right now, they use this approach to screen nursing home staffs.  Everybody who works at the nursing home is tested, and yet, if there are no positive cases, the number of tests required is small.  Seems like a pretty good idea to me.

Post #729: Nine new cases, 6/24/2020, Fairfax County.

Yesterday, 6/24/2020, Fairfax county reported just nine new COVID-19 cases, which is a record low for the post-peak period.  The last time Fairfax reported that few or fewer was exactly three months ago, on 3/24/2020.  And, as you can see above, yesterday’s low count wasn’t due to a glitch in data reporting.  Today’s new case count is just 23.

If you read the news of late, you’ll be reading that re-opening was a bad idea.  This is due to the states where the epidemic now seems to be getting out of hand.

As you read those articles, remember that Virginia in no way met any criteria for “re-opening”.  Case counts were still high and rising when the Governor decided to start lifting some of the stay-at-home rules.  Here’s that same graph, ending on 5/15/2020, the start of Phase I re-opening for most of Virginia:

You have to start asking what we owe our good fortune to.  (So far, at least.).  I’ve been studying the states that are currently “spiking” (however defined), and And to me, it boils down to three big, identifiable factors.

Good government

Good climate

Good sense/relatively low proportion of wackos.

Good government

First, the Governor’s decision to couple re-opening of Northern Virginia with a mandatory mask ordinance seemed like the smart thing to do at the time (Post #702).  If anything, I’d say it was a little late.

In hindsight, as more evidence accumulates, that mandatory mask order has only gotten smarter.  if you go back a few months, systematic reviews of controlled trials of mask use would only go so far as to say that it appeared beneficial.  But as time moved on, and people seriously studied what happened among persons and groups observed to wear masks, (so, not controlled trials), the results appeared far more favorable to mask use.  Now, report of a cross-national study out of VCU that estimates a huge beneficial impact of population use of masks during this pandemic.  That’s data-based, but it’s tough to infer something like that from observational data.

And if you aren’t the type to be persuaded by systematic analysis of the evidence, we now have one spectacular anecdote (Post #721).  It’s the story of 140 people who didn’t get coronavirus, and the only plausible explanation for that is mask use.

I mean, it’s only been three-and-a-half months since the US CDC recommended that everyone wear masks in public public.  And yet, thanks to the Republican politicization of this issue, you still have states and areas where they still haven’t gotten the message.  States where the governor not only would not take action, but literally barred cities and towns from passing their own mask ordinances.

But really, all you have to do is note that when these states get into real trouble, then … and only then … do they consider a mandatory mask order.  That really reveals everything you need to know.  If masks didn’t work, why would they do that?  And if masks do work, why aren’t they doing that already?

Anyway, that’s the level of stupidity we have avoided, merely by having a Governor with good sense.

But it also requires having an opposition party that, by and large, understands that the public health is more important than political grandstanding.  Our state Republican party consists of reasonable people, mostly.  That’s in stark contrast to the national Republican party, or to the Republican parties in some states.  I like to say that I voted for the old Senator Warner (John, R), and I voted for the new Senator Warner (Mark, D), and I think they both have done a great job for Virginia and for the USA.

And it’s not just the Governor’s office where the quality of Virginia government has come through.  Our Supreme Court has, by and large, rejected efforts to tear down the public-health-based restrictions that the Governor has imposed.  So let’s be thankful that we didn’t have a Wisconsin-type event here (Post #709).

Couple that with a sensible, go-slow approach, and all of that works in our favor.  We actually have a government working for us, rather than against us, in this crisis.

Other states are not so lucky.  And I’m almost at the point where I’m willing to predict which “spiking” states will and will not get this back under control, based on the level of stupidity of their respective governors.  E.g., in Idaho, faced with a spike, they took a step back in their re-opening plan, and among other things closed all the bars.  In other states (Texas), the Governor has pretty much said there’s no going back.  Based on that, I’d bet that Idaho gets it under control before Texas does.

Good climate.

I looked at the seasonality of other coronaviruses (Post #714).  But that seasonality data is for Stockholm, Sweden.  Here in the US, there are a lot of mitigating factors.  And the foremost of those has to be air conditioning, and the livability of outdoor spaces during the summer months.

Even at the end of June, it’s still pleasant enough around here that you could reasonably expect to sit outdoors and eat an evening meal.  So, as far north as we are, there are livable outdoor spaces suitable for socializing.  And I think this matters, in a period during which the “spikes” of coronavirus appear to be driven by young adults socializing without precautions.

But today it’s predicted to reach 110 F in Phoenix.  I don’t know this for a fact, but I’d guess that relatively few people choose to dine outdoors in that heat.  And, coincidentally or not, Arizona is the worst of the states right now, in terms of the current Coronavirus spike.

In that climate, indoor air-conditioned spaces would seem to be the sole option for restaurants and bars.  Whatever socializing young adults are going to do there, pretty much all of it will take place indoors.  And that’s exactly the situation you want to avoid, for further spread of COVID-19.

So, Arizona can have as much good government as it can muster.  Or not.  What it has, in the summer, is nowhere to go but inside.  Not so, here.

 

Good sense

In so far as I know, in Virginia, nobody made death threats against the Virginia Department of Health, based on a mask ordinance.  As occurred in California.  Nobody has shot a store clerk for having the temerity to require a mask.  (By contrast, the one no-mask-no-service exchange that I witnessed — at the Merrifield Home Depot — was a model of civility).  We didn’t have an private army storm the state house, which I think was a Wisconsin thing.

I don’t think we’ve even had any prominent public figures trash-talking mask use.  (I just did a quick search, and only found the usual right-wingnut bloggers.)

We’ve had a couple of lawsuits to try to repeal parts of the COVID-19 restrictions.  But all of those that I followed seemed to me to be at least somewhat reasonable (or irrelevant, affecting a very small population).

And, more to the point, at least in this area, compliance with that mask order has been good.  In fact, compliance with all of the COVID-19-related orders has been pretty good.  We had one pastor on the Easter Shore cited for defying the limits, but it was a nonsense case — there were 16 people in an otherwise-empty church, when the limit was 10.  And that got tossed out in court — again, a sensible decision.

We had one guy, back in April, flagrantly defying any limits on the size of his church assembly (which were at that point merely guidance, not law).  But in a fit of irony, or perhaps the hand of God, he died from COVID-19.  This providing a great example, if nothing else.

So, in general, Virginians seem to be pretty reasonable about this whole thing.  So far.  Mask use is good enough, around here, that anyone in the grocery store without a mask really stands out.  And, really, that’s about the best you can hope for.

Summary.

Source:  NY Times, as of 6/24/2020.

In summary, it strikes me that you have to have at least these three factors in place to avoid the fate that (e.g.) Arizona is now facing.

First, your state government can’t be stupid.  You can’t (e.g.) do nothing, ban mask ordinances, pretend there’s no problem, politicize mask use, throw out public health restrictions based on legalisms, and so on.  Any attempts to engage in that behavior are likely to earn you a major coronavirus penalty.

Second, you’ve got to able to keep people from crowding together indoors.  (And, to a lesser extent, outdoors.)  Because people have cabin fever, particularly young adults.  If you live in a place where people are not going to choose to do their dining, drinking, and dancing outdoors, then you are always going to be running the risk of mass spreading events.

And where indoors is the only realistic option, you’ve got to have major players that have good sense.  This includes restaurants and bars, sure, but to a very large degree it also includes churches.  To the extent that you’ve got a lot of big, mainstream churches — all of which have issued sensible guidance, including restrictions on singing, mandatory mask use, and so on — then you’ve got a leg up.  But if you’ve got large churches that ignore good sense, then that’s going to be your cross to bear.

Finally, your citizens need to have some common sense, and a willingness to obey the law.  The common sense of the average American is certainly a slender reed upon which to hang recovery.  But the fact is, if the bulk of your citizens disobey an ordinance, there is little that the government can do.  You simply don’t have enough cops and courts to enforce a rule that affects literally every adult who is out in public, if that rule is ignored by most.  This is very much a case of mob rule, and you have to hope that you’re in with a reasonably smart mob.

I see the states that are spiking now as two sorts.  One is the states that are failing along one or more of those dimensions.  Pick the state, I’ll tell you where I think they are failing.

But there’s a second contingent that has simply been surprised by this spike, and is now moving as fast as possible to contain it.  I’d put (e.g.) Idaho and possibly Utah in this category.  My guess is, they’ll get their act together sooner rather than later, and it will not get out of hand in those states.

Regardless of whether you buy that argument, I think we can all be thankful that Virginia isn’t one of the “spiking” states.  And let’s keep it that way.

Post #728: Key graphs updated to 6/22/2020.

This post updates some key graphs to 6/22/2020.  I think, given the national context, I have to switch from complaining that we haven’t beaten COVID-19 back yet in Virginia, to being thankful that Virginia remains place of stability in an otherwise volatile US scene.

Anyway, not much has changed.  And in this context, that’s a good thing.  Virginia continues to get under 500 new cases a day, Fairfax under 100, and Vienna 22180 seems to be getting about one new case per day.

You have to wonder how we can go through re-opening with no apparent impact, but elsewhere, not so.  As far as anybody can tell, all it takes is obeying Japan’s Three C’s, plus maybe a fourth C (cocktails) for drinking.  If you go to fill-in-the-blank, and it’s crowded, or crowded with people not wearing masks, or crowded with such people eating and drinking — don’t go in.  That’s not rocket science.  But apparently that’s too complicated for residents of many other states.  Let’s hope that it doesn’t reach that point for Virginia.

Continue reading Post #728: Key graphs updated to 6/22/2020.

Post #727: Analysis of new COVID-19 Cases in NoVA, by ZIP code

Below:  Growth in cases/capita over the last two weeks (ending 6/21/2020), annualized, by ZIP code.  Larger dots = faster growth.  Only the size of the dots matters, not how closely they are spaced.

Source:  Analysis of ZIP-level COVID-19 case counts from the Virginia Department of Health.  Population data by ZIP from simplemaps.com.

This morning I decided to do a little study of recent growth in COVID-19 across Northern Virginia ZIP codes.  To cut to to the chase:

  1. There is no “leveling-out” or “catch-up” of infection rate differences across ZIP codes.  To the contrary, ZIP codes that have been hit hard up to now continue to be hit hard.  Those that were spared so far continue to be spared.
  2. High growth in cases is concentrated in lower-income areas, with only the occasional exception.  High-income areas have largely been spared.
  3. There is no relationship between population density and recent case growth.  That differs from my analysis of about a month ago, where the then-existing cases per capita were higher in the more urbanized areas of NoVA.

Details follow

Continue reading Post #727: Analysis of new COVID-19 Cases in NoVA, by ZIP code

Post #725: I guess the school of hard knocks is better than no school at all.

Source: Japanese Ministry of Health, Labor, and Welfare.

It should be “Four Cs!”.  Closed spaces, crowded places, close-contact settings, and cocktails.  See Post #723.

In tourist-dependent Florida, the last thing the gov’ner wants to do, to respond to a spike in COVID-19 cases, is this:  ” …  announce plans to step up enforcement of social distancing practices in bars and nightclubs. ”

And yet he has done it.

Now, to be clear, he only did that after exhausting all plausible lies about that increase in cases (it’s due to testing, it’s due to migrant labor).  But he did say it.  Eventually, he was able to deal with reality, even if it’s bad for tourism.  But only as a last resort.  And only after a rapidly expanding epidemic knocked some sense into him.

I put him in the same category as the public health director in Post #721.  Sure, the CDC says to wear masks.  Sure the evidence is there to suggest a benefit from that.  But it’s not like he’d actually wear one.  Until masks averted a major outbreak on his home turf.  And spared his community from a bunch of hard knocks.

Shoot, just look locally.  We’ve gone from having our mayor-elect publicly defending Giant Food’s no-mask policy, to having the Governor (finally) impose a mandatory mask policy for public indoor spaces.  All that took was about a month, and about another 25,000 COVID-19 cases, to get from A to B.  Just a few hard knocks.

The continued spread of this disease isn’t some sort of complicated rocket science.  It’s not magic, or fate, or anything like that.  It’s the three Cs.  Which ought to be the four Cs, as above.

The real shame here is that when epidemiologists bother to calculate R, the number of new infections that each infection creates, it is, on average, in most areas, something like 1.05.  Get the damned R number below 1.0, and the damned pandemic will shrink.

We’re that close.  We need just that little bit more diligence, and we can get there.  And yet we can’t quite get the ball over the goal line.

Other countries get it.  Why are we so stupid?  Ben Franklin nailed it centuries ago:

“Experience keeps a dear school, but fools will learn in no other, and scarce in that.”

Unfortunately, what Franklin said then is an apt description of the USA now.  The only way some people will learn is in the school of hard knocks.  And so, all you can do is sit back and watch those hard knocks occur.

As that happens, I’ll ask you not to lose sight of the hog-slaughter cycle (Post #G01).  We haven’t really seen that take hold, yet, in these most recent outbreaks.  That, meaning an apparently uncontrollable growth in cases occurring after authorities have “hit the brakes” on the behavior that was the original source of the outbreak.  But if that happens, even the most right-wing of our governors would probably be prompted to act.  For some people, you really need to hit them over the head with something, before they’ll wake up.  And if that’s what it takes, then that’s what it takes.  That’s the America we live in.