Cape Cod Living

What's the summer look like?

2020-05-10T10:47:00.000-04:00

We're on the down slope. The State of Massachusetts has had eight consecutive days of declining new cases of Covid-19.

See: https://www.mass.gov/doc/covid-19-dashboard-may-9-2020/download

But, we don't know what the summer will look like.

Baker's task force is scheduled to report on May 18 - jut a week way. Until then, we really won't know with any degree of certainty what activities will be allowed on the Cape this summer.

The marina's and golf courses are open. But, the bathrooms are not. If you have a prostrate problem, you might want to rethink to equipment needs.

Barnstable Town manager, Mark Ells, indicated that the beaches will open provided that residents adhere to strict social distancing. Ells plans to have police, natural resource officers and staff at the beaches to monitor compliance.

See: https://www.southcoasttoday.com/news/20200509/barnstable-not-willing-to-write-off-summer

I don't know whether or not short term rentals will be allowed. Currently, stays under 31 days in length are to allowed. There's a $300 fine for unauthorized rentals.

I don't know if the hotels will be allowed to open.

And, I understand that some second homeowners have been approached by neighbors for crossing the bridge and not self-quarantining for 14 days.

And, there may not be many places to find a meal (or, even an ice cream). Apparently several take-out places witnessed boorish behavior from unruly patrons.

The weather is improving nicely.. The fish are BIG and plentiful. If no one come to visit, it might be the best summer ever (provided you have a place to stay).

I'll focus more on our plans to re-open going forward. Stay safe!

In for the long haul

2020-05-02T07:30:00.000-04:00

We're not seeing a decline in the numbers.

On Friday, the State reported 2106 new cases - that's a three day increase. The percent infected dropped to 15%. That's the good news.

There were 154 deaths.

Channel 5 has the best graphs. Again, the noticeable decline in percent infected is our best hope right now.

See: https://www.wcvb.com/article/coronavirus-covid-19-in-massachusetts-data-charts/31279863

There's a slew of new advisories. Basically you know have to wear a mask when you are off your property this includes neighborhood walks, the beach, and the stores.

The county issued guidelines for the summer. They are planning to keep the hotels and motels shut down for all non-essential travel.

See: https://www.capecodtimes.com/news/20200430/guidelines-issued-for-seasonal-cape-and-islands-visitors

If you need a little vitamin D, you may need to find your sun elsewhere this summer.

If you are interested in plans to re-open the state, you might enjoy this presentation

Mass. High Technology Council COVID-19 Recovery and Return to Work Series: Framework for Restarting the MA

See: https://vimeo.com/414000566

You have to join VIMEO to view the above presentation. Or, you can download the PDF, here:

http://www.mhtc.org/wp-content/uploads/2020/05/20200430-MHTC-COVID-19-Briefing-Summary.pdf

A shot of disinfectant

2020-04-27T08:58:00.001-04:00

If the skeptics are proven correct, you won't be needing a shot of disinfectant with your quarantini.

There's an anonymous twitter account called the Ethical Skeptic that has drawn a large following for his/her reporting on coronavirus. He/she has produced the most legible analytics available.

See: https://twitter.com/EthicalSkeptic

The Skeptic has been producing an Attentodemic Chart. What's that you say?

Attentodemic – a pandemic which arises statistically for the most part from an increase in testing and case-detection activity. From the two Latin roots attento (test, tamper with, scrutinize) and dem (the people). A pandemic, whose curve arises solely from increases in statistical examination and testing, posting of latent cases or detected immunity as ‘current new cases’, as opposed to true increases in fact.

Sure sounds like something we've been doing in MA. As testing ramps up, case detection increases even without increasing hospitalizations. We cling to this new case number, but we should moderate that view with an understanding of "daily percent positive."

We've talked about this percentage.

MA is starting to look okay. We started at around 10-12% positive, peaked at 32% and have gradually trended down. On Sunday there was a pronounced drop in new cases with only 17% of some 9255 tests producing a positive result.

See: https://www.mass.gov/doc/covid-19-dashboard-april-26-2020/download

The US as a whole is doing even better. According to tweet by the Skeptic yesterday was an encouraging day:

A very encouraging day overall. A 32% drop in percent positives in one single day. 269,799 tests with a 10,000 positive case drop to 10.1% positive.
CA dropped from 16% to 5.1% positive - could be just an anomaly of reporting/test arrivals. We shall see.

The weekend numbers in MA are usually a little screwy. By Wednesday, we'll know whether or not the improving trends are for real.

As of Saturday, Barnstable county cases where listed at 772. We're doing well here also, but keep in mind that this case count is up from 255 on April 1st - a three fold increase in just under 4 weeks. This, too, could be an attentodemi, but we won't know if we're out of the woods until we get some more data. Check back on Thursday.

Spoke too soon

2020-04-24T06:33:00.001-04:00

The numbers are surging in East Boston. The city set up a walk-in test facility for the first time and increased the number of daily tests to 14,000. It wasn't that long ago that Baker was trying to get to 3,000 tests a day.

See: https://www.mass.gov/doc/covid-19-dashboard-april-23-2020/download

There are also a new town-by-town numbers available.

See: https://boston.cbslocal.com/wp-content/uploads/sites/3859903/2020/04/covid-19-city-town-4-22-2020.pdf

The Town of Barnstable continues to have one of the lowest infection rates in the State with 133 active cases and an infection rate of 296 per 100,000 as compared to Boston with 6744 active cases and an infection rate of 970 per thousand.

Brewster had an early out-break, but they have only 64 active cases and an infection rate of 645 per 100,000 compared to Chatham with 8 active cases and an infection rate of 134 per 100,000. Dennis has 42 cases and an infection rate of 317 per 100,000.

My concern is that these rates are not leveling off. The rate of infection is slowly and steadily increasing on the Cape. Hoping the warmer weather in June and July will help. Until then, the rain ought to keep us all safely inside.

Peak day

2020-04-21T09:53:00.001-04:00

Maybe, we've passed the peak.

The State updated their reporting format. It shows that new cases have declined for 4 consecutive days. The percent of positive tests has leveled out just shy of 30%. Barnstable is up to 664 active cases, but still few deaths.

See: https://www.mass.gov/doc/covid-19-dashboard-april-20-2020/download

Hope you enjoy the weather today. Warm and sunny on the Cape. Well, it's not really warm, but it is sunny!

June 8th or later

2020-04-18T07:45:00.000-04:00

It's doesn't look like we'll be out of the woods any time soon. According to a new model by our friends in Washington State, the soonest Massachusetts will be open for business is some time after June 8th.

This model will put a lot of pressure on Baker. He's planning to coordinate a regional opening with New York. We're lagging New York and will likely be the last state in New England to open.

It looks like openings in Virginia and Kentucky could also be delayed until June. Michigan and Minnesota are on a good path. They may be open in May.

It's only been a month

2020-04-15T08:06:00.000-04:00

I'm getting ever so slightly annoyed by all this posturing about opening up the economy.

This public health fiasco has played out in Massachusetts for just over five weeks. The State started publicly posting active case counts on March 6th. I re-opened this blog on March 13th to track those numbers. At the time, I was just trying to wrap my head around what was in store for us.

Back on March 15th, we had 164 Covid-19 cases in Massachusetts. 108 of those where associated with the Biogen Conference. There were 31 cases in Suffolk county and only 1 in Barnstable.

Two weeks latter on April 1st, we had 7738 active cases in Massachusetts including 1624 in Suffolk County and 255 in Barnstable.

Yesterday, we had 28163 cases in Massachusetts including 5872 in Suffolk County and 514 in Barnstable.

Barnstable is clearly lagging, but I'm not seeing an end in sight in Boston.

There is hopeful talk of a peak in a week or two as soon as the 20th of April, but the number of positive tests to new tests is still at only 28%. This approximation of our "Estimated Cumulative Infected" number has a ways to go before our "curve" flattens in a meaningful way.

So, optimistically, one more double and we're done. We'll see how that plays out.

I was hoping we lose this one..

2020-04-13T07:55:00.002-04:00

Massachusetts is now solidly in third pace for the most cases of Covid 19 in the United States. We surpassed California and Michigan with 2615 new cases on Sunday.

See: https://www.worldometers.info/coronavirus/country/us/

We tripled the number of active cases since April 1st jumping from 7738 to 25475. 32% of tests are now positive - up from under 19% just last week. Death count remains low buying Baker more time to get a handle on this situation.

See: https://www.mass.gov/doc/covid-19-cases-in-massachusetts-as-of-april-12-2020/download

I think the numbers are starting to get away from Baker. The other day he said that he expected us to peak at 2,500 new cases a day by April 20th. Due to lax social distancing we've surpassed that number and are now well on our way toward a 50% infection rate. We could be there next week.

The one piece of good news is that the Cape is consistently lagging the state in new cases. I had expected as many as 700 new cases by Sunday and 1500 by next weekend. I'm revising those estimates downward. Expect no more than 700 cases on the Cape by Saturday.

As I've mentioned, we could be at this for a while. Without an effective therapy or a vaccine for the novel coronavirus, the U.S. economy could face 18 months of rolling shutdowns as this outbreak recedes and flares up again

“We’re looking around the world. As they relax the economic controls, the virus flares back up again,” Kashkari said Sunday on CBS’s “Face the Nation.” Kashkari is a voter in 2020 on the Fed’s policy-setting Federal Open Market Committee.

“We could have these waves of flareups, controls, flareups and controls until we actually get a therapy or a vaccine. I think we should all be focusing on an 18-month strategy for our health care system and our economy.”

See: https://www.bloomberg.com/news/articles/2020-04-12/fed-s-kashkari-says-u-s-may-face-18-months-of-rolling-shutdowns?srnd=premium

Like I said, we're going to be at this for a while longer.

Preparing for what's to come

2020-04-09T11:13:00.000-04:00

Dr. Osterholm has released his third segment of his COVID 19 Update to Spotify.

It's free to join Spotify. You just need to open an account to hear his remarks.

See: https://open.spotify.com/episode/3pdV5mBECp0ZczdPvPTxhG?si=tAQUmLxBTq2IT_tD7Y11eQ

Michael T. Osterholm is an American infectious disease epidemiologist, regents professor, and director of the Center for Infectious Disease Research and Policy at the University of Minnesota. He authored Deadliest Enemy: Our War Against Killer Germs.

Unlike the WHO, Osterholm saw this one coming. His thoughts on how to prepare for what's to come are worth a listen.

According to Osterholm, we're not going to be out of the woods anytime soon. The best case scenario is 18 months out. And, that is optimistic, because we won't have the tools to re-open the economy until we re-engineer our supply chain. For all the talk of testing, we simply do not have the supply chain in place to deliver the reagents for all the tests we've been promised.

The FDA has highlighted these shortages (but, stopped just short of calling them a shortage).

See: https://www.medtechdive.com/news/fda-chief-warns-of-supply-pressure-on-reagents-for-coronavirus-tests/573999/

This didn't stop Scott Gottlieb from making testing the cornerstone of this plan to re-open America. Gootlieb is a former FDA Chief. He got out while the gettin' was good. Now, he's an "investor" like so many of Trumps trusted advisers.

See: https://www.aei.org/research-products/report/national-coronavirus-response-a-road-map-to-reopening and here: https://www.politico.com/news/2020/04/07/former-fda-chiefs-outline-plan-to-reopen-the-economy-when-broad-testing-in-place-171344

Gottlieb imagines a phased re-opening of the economy anchored on a widespread test program:

Individual states can move to Phase II when they are able to safely diagnose, treat, and isolate COVID-19 cases and their contacts. During this phase, schools and businesses can reopen, and much of normal life can begin to resume in a phased approach. However, some physical distancing measures and limitations on gatherings will still need to be in place to prevent transmission from accelerating again. For older adults (those over age 60), those with underlying health conditions, and other populations at heightened risk from COVID-19, continuing to limit time in the community will be important.

Given the absence of testing capabilities, I don't see our hotels, restaurants and bars doing well this summer. There may be demand for extended stay accommodations as seniors try to get out of the house and get some fresh air. But, I think the overnight stay will be a thing of the past. I do think that there will be demand for week long rentals provided that the rooms have limited kitchen facilities, balconies and good access to restaurant delivery. I don't know about the bus rides. I wouldn't get on a bus this summer. And, I don't know how the bars will be able to re-open any time soon. The prognosis for restaurants is bleak. Industry expert that 25-30% won't even open this year. And, the failure rate of those who try to open too soon will be abysmal.

If you are planning to re-open your business this summer, give Osterholm a listen first.

Another double in six days

2020-04-08T08:24:00.000-04:00

Massachusetts Covid 19 cases doubled in the past six days and that's better than most.

New Jersey, Michigan and Louisiana passed us on the hit parade. Pennsylvania, Florida and Illinois are nipping at our heels. This is one race you want to lose.

See: https://www.worldometers.info/coronavirus/country/us/

The Cape continues to lag incrementally. While our case load topped 405 yesterday, the growth in cases was "only" 60%. On April Fools Day we had 255 active cases in Barnstable.

See: https://www.mass.gov/doc/covid-19-cases-in-massachusetts-as-of-april-7-2020/download

There are no reliable estimates for cumulative infection rate. I've been tracking the percentage of folks who test positive each day. By this measure, we're at 18-19% compared to 15% last week. As testing is made available to more and more people, you'd expect this number to decline. It hasn't.

According to a report by the Imperial College, anywhere from 1 - 15% of the populations of Europe were infected. Spain was at 15%. Italy at 9.8%. Germany is under 1%.

See: https://twitter.com/ScottGottliebMD/status/1247844591811862528

Scott Gottlieb, MD @ScottGottliebMD commenting on these numbers wrote:

In U.S., experts suggest to me rate is lower. My informal survey of thought leaders in this area puts estimate anywhere from 1-5%. Ultimately we must confirm this with serology studies (which are underway). But it falls short of the 50-70% needed to achieve “herd” immunity.

Considering this, Gottlieb is proposing containment strategies to get folks back to work.

See: https://www.aei.org/research-products/report/a-national-covid-19-surveillance-system-achieving-containment/

Here's the full report:

See: https://healthpolicy.duke.edu/sites/default/files/atoms/files/covid-19_surveillance_roadmap_final.pdf

There is a test in your future.

Here is the latest thinking on herd immunity...

See: https://twitter.com/ScottGottliebMD/status/1247840921632333828

If you want to get into the weeds, here is a detailed study of China outcomes...

See: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30243-7/fulltext

For charts on age, sex, and a variety of pre-existing conditions...

See https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics/

These charts are a little grim for my taste.

Just when you think it can't get any worse...

2020-04-06T10:46:00.001-04:00

...it gets better.

There is a lot of talk today that NY is reaching the apex of it's "curve." Gov. Cuomo was quoted as saying, the state is either near the apex of its curve, "or the apex could be a plateau and we could be on that plateau right now."

See: https://www.cnn.com/2020/04/05/health/us-coronavirus-sunday/index.html

Marty Walsh wasn't taking any chances. He imposed a curfew and recommended the use of face masks by everyone. According to Walsh, we're at the beginning of a surge in the Bay State.

See: https://www.wcvb.com/article/boston-mayor-marty-walsh-covid-19-coronavirus-update-4-5-2020/32045150

According to IMHE, MA will peak on or around April 18th. That will give us time to double the number of cases on the Cape twice more.

See: https://covid19.healthdata.org/

More is known about coronavirus lethality for the elderly.

Researchers on Monday announced the most comprehensive estimates to date of elderly people’s elevated risk of serious illness and death from the new coronavirus: Covid-19 kills an estimated 13.4% of patients 80 and older, compared to 1.25% of those in their 50s and 0.3% of those in their 40s.

The sharpest divide came at age 70. Although 4% of patients in their 60s died, more than twice that, or 8.6%, of those in their 70s did, Neil Ferguson of Imperial College London and his colleagues estimated in their paper, published in Lancet Infectious Diseases.

See: https://www.statnews.com/2020/03/30/what-explains-coronavirus-lethality-for-elderly/

This divide around the age of seventy is being called “the twilight of immunity."

Or, is this just another episode of our own personal Twilight Zone.

How bad is this going to get

2020-04-04T09:28:00.002-04:00

I'm still trying to figure out how how bad this is going to get.

It's not like the flu. It doesn't seem like it will go away in a month (or, two or three). And, now I'm starting to see models that approximate my estimates for peak hospitalizations toward the end of May spilling into June.

See: https://www.covidactnow.org/us/ma

For those of you who want to geek out on the math, model assumptions are found here: https://data.covidactnow.org/Covid_Act_Now_Model_References_and_Assumptions.pdf

Assuming that we're somewhere between poor and strict compliance with recommended social distancing guidelines, we're looking at up to 38,000 hospitalizations in the state of Massachusetts alone. This implies an infection rate well over 28% up to 70% of our population.

As I've mentioned previously, we were at 10% a week ago. We're pushing 16% today. The percentage of individuals who test positive for Covid-19 in Massachusetts in a few weeks could surpass 28% and counting in a few weeks. Were this to occur, this model estimates as many as 17,000 deaths in the State of Massachusetts alone. If we continue with our sloppy self-containment practices, we could see a 70% infection rate and more than 42,000 deaths. These are ESTIMATES, but it doesn't make them any less scary.

I did a detailed review of the "numbers" comparing Barnstable County to Suffolk County (Boston) this morning looking at just the last three days. Boston has higher densities with a slightly younger population with fewer co-morbidities. High blood pressure, obesity, diabetes have all been identified as possible co-morbidities.

As a percentage of population Suffolk is twice as infected as the Cape. A/O 4/3 Suffolk had 2183 cases in a population of 756,000 or 0.0029%. This is twice the surrounding counties of Middlesex (0.0013) and Norfolk (0.0012). Barnstable is in the range of these other two counties at 0.0014. We have fewer cases, but we also have fewer people. The difference between Suffolk and Barnstable may just be the density of the population - more people, smaller stores, increased opportunities for close encounters of the COVID kind.

Our cases are growing incrementally slower as a result. Statewide, new cases are growing at a rate of 16% per day. Barnstable's cases are growing at approximately 12% per day - but this may just be an expression of reduced testing rates. At these rates, we can estimate that Barnstable will have over 694 cases this time next week and over 1500 cases in two weeks time. This implies a still manageable 195 hospitalizations from roughly 20 today. These are estimates. I hope I'm wrong.

Finally, as a result of the social distancing we have done, we have flatten our curve somewhat. But, this also prolongs the amount of time we'll need to stay in isolation. The model above has us sitting at home well into June. The good news is that we might be able to save the season, if we want to experience a "bump" in new cases in July. The idea here is that the virus never really leaves. And, when we all leave our homes and try to resume our lives, there will be more infections.

We'll see how all this plays out. It is best to stay home for now.

The numbers are getting big

2020-04-03T07:31:00.003-04:00

It's been 15 days since week broke 200 case in MA. - 238 to be exact. Back then, roughly 10% of the state population was testing positive. Today, we've tested 56,608 residents and found 8966 active cases - roughly 15% of our population.

Here on the Cape we just cracked 200 plus active cases this week. We're seeing a growing cluster in Falmouth with 57 confirmed cases as of April 1st. Sandwich had 29 cases and Masphee 11.

Cape Cod Healthcare reported that of 1777 tests, 243 tested positive - just under 14%.

See: https://www.capenews.net/falmouth/news/coronavirus-roundup-cases-rise-to-57-in-falmouth-with-three-deaths-on-cape-cod/article_88b8f769-77d6-522b-929d-d34270638220.html

Europeans don't report the number of tests they are performing, but by all other measures we're on the same track as them.

See: https://www.nytimes.com/2020/04/02/upshot/coronavirus-europe-america-comparison.html

Thankfully, Boston is slowly dropping off the leader board. We may see a peak here as expected in a week or two or three.

See: https://www.nytimes.com/interactive/2020/04/03/upshot/coronavirus-metro-area-tracker.html?action=click&module=moreIn&pgtype=Article&region=Footer&action=click&module=MoreInSection&pgtype=Article&region=Footer&contentCollection=The%20Upshot

I think the Cape is lagging Boston and has a bit longer to run. I'm sorry to say this, but I think we're still a solid three weeks from a statewide peak and possibly five or more weeks from a peak on the Cape. I don't think it will be safe to move around until June.

There is still too much movement on the Cape. I've read dozens and dozens of reports of shoppers visiting 2 or more stores a day to find household items. The package stores are seeing a steady business. And, for whatever reason, I have neighbors who think that painting is an essential service. I don't get it.

Until folks settle down and actually stay home for a few days at a time I have to believe that we'll see a sustained community spread on the Cape and it won't be the New Yorkers causing all this trouble.

Everyone is doing the math a little differently. I'm seeing a fairly steady increase in cases of approximately 15% a day - roughly a double ever six days in Massachusetts. That could accelerate. Other areas with unrestrained community spread are doubling every two or three days, but they have much higher population densities. On the other hand, we have an older population and more co-morbidities.

If Barnstable County is five weeks from it's peak, we should be expecting 10,000 cases - or 5% of the population by the end of April. This math shows that we dodged this bullet. We could be out of way just enough to avoid the huge case loads of more urban areas. But, if we average out at 15% of the year round population of Barnstable County, we could see more than 10,000 cases - many more.

Stay home, folks!

Changes in travel patterns

2020-04-02T08:19:00.000-04:00

The New York Times offered a fascinating study of travel patterns across the country

They mapped when the average distance traveled on weekdays first fell below 2 miles. In the Boston area travel dropped below 2 miles by March 16.

Here in the Cape, our average weekday travel dropped under 2 miles a few days later on March 19th.

In Seattle travel dropped from 3.8 miles on Feb 28th to 61 feet on March 27. 61 FEET!

Unfortunately, the South is in for a world of hurt. Travel in the southern States has not declined with the exception of New Orleans and southern Florida which saw a reduction in travel by March 24th. And, Orlando on March 26th.

See: https://www.nytimes.com/interactive/2020/04/02/us/coronavirus-social-distancing.html

If you're into Twitter, a friend sent a link for healthcare workers anonymously discussing the lack of PPE in their hospitals.

See: https://twitter.com/Covid19Docs?s=09

And, if you don't already know, Charlie Baker and Patriots owner, Robert Kraft, did their job.

See: https://twitter.com/MassGovernor.

Great photo here: https://twitter.com/MassGovernor/status/1245673091986046976/photo/1

Record your health status daily

2020-04-01T08:20:00.002-04:00

This morning, a friend from RI sheltering in their Cape home, wrote that she was seeing an "anti-second-homer mentality" in the news. It's hard to miss. She was a little scared and was considering leaving the Cape.

I agreed with her and even discussed the current situation with my wife last night. Our PCP is in Boston. We both worked in Boston for thirty-five years before retiring to our Cape home last year. We like our doctor and decided to stay with him after the move. Does that make me an out-of-towner?

The xenophobia being expressed in the news and on Facebook is starting to get a little scary. It has to stop. Petitioning the State to close the bridges only serves to make us look ignorant. We'll do long term damage to our economy, if we stop welcoming out of towners to our spit of sand. Besides, Baker would need to declare martial law to close the bridges. Is that what you really want?

Now is the time to be generous and welcoming. Help your neighbors - all your neighbors - even those from out of town.

If you want to do something constructive, listen to this podcast:

http://www.cidrap.umn.edu/covid-19/podcasts-webinars/episode-1-how-we-got-here

We're in for a long haul. The White House estimates are too optimist to be realistic.

The best thing we can do for ourselves is monitor infection rates on the Cape. The folks in Boston have their hands full. They are not paying attention to us. They have their own problems.

What we need is good infection data. Given the absence of testing here on the Cape (and, everywhere else) , I recommend we self report our health status using this site developed by Boston Children's Hospital and Harvard Medical.

See: https://covidnearyou.org/

If you contribute your health status daily and help track the COVID-19 pandemic, we'll know soon enough just how much help we'll need and when we'll need it. That help will need to cross the bridge to get to us.

Your contributions will help public health professionals fight the COVID-19 pandemic here on the Cape and across our Commonwealth.

Thank you!

Stay home. Stay away

2020-03-31T07:48:00.000-04:00

The petition to close the bridges to Cape Cod has over 5,000 signatures now.

See: https://www.change.org/p/change-org-close-the-cape-cod-bridges

I think this sort of publicity is terrible for the Cape. If it weren't for the New Yorkers who visit us in the summer and own second homes here, we won't have the schools, hospitals, fire and police protection that we currently enjoy.

Commenting on this petition, Mark Roberts wrote:

About as effective as a petition to keep out great white sharks.

Apparently, we're seeing similar New Yorker-phobias in the western part of the State. The Boston Herald is reporting that local officials are targeting the short term rental market calling out an ad that promoted "a Berkshire COVID-19 getaway with free toilet paper."

See: https://www.bostonherald.com/2020/03/30/cape-codders-petition-close-the-bridges/

There will be serious dislocations in the real estate market later this year and next. Back in 2009 five of my closest neighbors went into some sort of foreclosure proceedings. Only one lost his home, but others lost years of work and depleted their savings.

NPR is reporting that there are now more than 340 hospital workers at four major hospitals testing positive for COVID-19:

Massachusetts General Hospital confirmed to NPR on Monday afternoon that 115 of its staff members have tested positive for COVID-19; Beth Israel Deaconess Medical Center told NPR on Monday afternoon that it has 62 employees who have tested positive for the coronavirus. Additionally, Boston television station WBZ reported Monday that Tufts Medical Center has 61 employees who have tested positive. Additionally, a WBZ reporter stated on Monday afternoon that Brigham and Women's Hospital said that it had 107 employees who were positive for COVID-19.

See: https://www.npr.org/sections/coronavirus-live-updates/2020/03/30/824170756/four-boston-hospitals-report-significant-numbers-of-employees-have-the-coronavir

Gov. Charlie Baker reportedly said that the state expects to see a surge in positive cases sometime between April 7 and April 17 — and that he anticipates a great deal of need in the health care sector, including for medical supplies, beds and ventilators.

See: https://www.nbcboston.com/news/local/mass-gov-baker-to-give-update-on-coronavirus-response/2099373/

It's been suggested that this surge in MA will be worse than New York, but I just don't see it. We don't have the population densities of the Elmhurst neighbor in Queens. We're crowded together in some sections of Boston, but not like New York.

See: https://boston.cbslocal.com/2020/03/28/mgh-surgeon-coronavirus-in-massachusetts-future/

I do think that the Cape could experience a rapid surge in cases peaking as much as two weeks after Boston. I'm guessing we could see as many as 24,000 cases of community spread from the grocery and package stores. There is still way too much movement here on the Cape. This won't end well.

For projections on for demand for hospital beds and expected deaths by state:

See: https://covid19.healthdata.org.

If you'd like to contribute to our understanding location specific COVID-19 cases, check out this crowd sourcing site from the Boston Children's Hospital and Harvard Medical. You health information will remain anonymous. You only need to leave your phone number if you want reminders.

See: https://covidnearyou.org/

We'll see in a couple of weeks how all this shakes out. It's like waiting for the plague.

Not so fast - another 30 days of lock-down

2020-03-30T08:03:00.000-04:00

We're starting to see some cases in the Town of Barnstable. According to an update on a new website for the Town of Barnstable Board of Health:

As of this morning (3/27/20), a total of nineteen (19) Town of Barnstable residents tested positive for COVID-19. The Health Division public health nurses continue to contact those who were infected to ensure they are appropriately isolated and with those who have come into contact with them to take the required quarantine precautions.

See: https://barnstablehealth.com/2020/03/27/board-of-health-update-23/

Last night, Trump extended the lock down by 30 days to April 30th. I'm glad someone talked some sense into Trump. All of my research shows that the soonest we'll reach any sort of peak is mid-April. And, that's just the peak. It will take a little while after that for things to settle down. Realistically, I'm targeting the first of June as a potential point in time when I might consider moving around again. I expect that businesses will be allowed to reopen in some areas in May, but that is optimistic and will only extend the pandemic.

Our numbers are grim. Massachusetts is projected to have as many as 1800 deaths - 80 per day at the peak on or around April 16th. That means we could have 30-40 thousand cases. The 5,000 cases we're reporting now could double two or three times in the next two weeks. And, that's the good news.

See: https://covid19.healthdata.org/

I saw a petition floating around last night to close the bridges. It was getting a new signature every second. I don't think Gov. Baker will respond to such foolishness, but I do understand the concern of folks signing that petition. These are scary times.

You know that New York City, New Orleans, Detroit and Chicago are all at risk now. In Elmhurst, Queens folks are so densely packed into housing that there is non opportunity to self-quarantine. This virus will have to burn itself out. There will be carnage and there isn't anything anyone can do in a situation like this.

There is also talk now of several emerging hotspots in Florida. If you want to see something really scary check out this video on cell phone usage on one beach in Ft. Lauderdale during Spring Break.

See: https://digg.com/video/a-visualization-of-the-potential-spread-of-the-coronavirus-connected-to-a-single-beach-during-spring-break

Just from watching this you can see how easily this virus spreads. Florida closed it's boarders last night, but it's too late. They should be closed in January and Mardi Gras should have been canceled in February.

There will be restrictions on our beaches this summer. Many beaches down south have already been closed. We'll know more in June. I expect that they'll restrict parking to thin the crowds. We'll know more later as this drama plays out.

Be safe. Be strong.

They haven't closed the bridges quite yet

2020-03-29T08:40:00.002-04:00

Barnstable County issued a statement on March 27th regarding out of state travel and they included this phrase in their state...

"Individuals traveling to Cape Cod from off-Cape and out of state are to self -quarantine for 14 days to avoid spreading the virus."

See: https://www.barnstablecounty.org/2020/03/27/13776/

This statement effectively separates Cape Cod from the rest of humanity. You can leave, but you can't come back without a 14 day self quarantine.

I don't know what legal authority the County has to restrict or otherwise impose conditions on a bridge crossings. The Governor has explicitly stated that all roads and bridges in the Commonwealth are open and I expect that an emergency order requires a vote of some sort.

According to a Boston Globe article from last year:

"For more than three years, the Massachusetts State Police have been using cameras to record the license plate number of every vehicle that enters and leaves Cape Cod, building a vast and growing database that now counts more than 100 million trips.

Authorities say they use the technology to track or locate suspects in cases involving violent crime or drug trafficking, for example, or to find missing and abducted people."

See: https://www.bostonglobe.com/metro/2019/04/06/the-state-police-know-every-time-you-drive-off-cape-cod/ydJthj2DQYn6TKcstpPYYM/story.html

It is my understanding that our "home rule" charter allows the County to make Emergency declarations as follows:

Section 2 – 9. Emergency Ordinances.
The assembly of delegates, in appropriate circumstance to meet a public emergency affecting life, health or property, may adopt emergency ordinances. No emergency ordinance shall be used to grant, renew or extend a franchise; or to regulate the rate charged for any service.
Emergency ordinances shall be submitted in the same manner as other proposed ordinances, but, every emergency measure shall be plainly designated as such and shall contain a preamble, which shall be separately voted upon, which declares that an emergency exists and which describes the emergency in clear and specific terms.
The affirmative vote of delegates representing two-thirds of the population of Barnstable county shall be necessary to adopt any emergency ordinance.
Every emergency ordinance shall automatically stand repealed on the sixty-first day following its adoption.

See: https://www.barnstablecounty.org/regional-government/assembly-of-delegates/home-rule-charter/

I'd love to hear your thoughts on this topic.

Is it time to close the bridges?

2020-03-26T12:50:00.001-04:00

Update: The numbers are moving so quickly, that it is hard to keep track of them. This chart my be easier to read:

MA +2417 -21204 H 219 D 25
CT +1012 n -5488 H 125 D 21
RI +165 -1366 H 138 D -
NY +37258 -84846 H 6844 D 385

A/O 3/26/2020

Seven days ago, we reported that "statewide, we now have 328 cases up 72 from yesterday. This (was) the highest one day spike since March 10th."

If you compare these numbers to Italy, you can see that there is reason for concern. On Feb. 23, Italy reported 229 cases. Two days later reported cases jumped to 323. On Feb. 29, Italy reported 1128 cases. Two weeks later on March 14, confirmed cases exploded to 21,157.

Last night MA reported 2417 case and 25 deaths - more than a five fold increase from just a few days ago. We knew this would happen, because Governor Baker delivered on his promise to do 3,500 tests per day. The silver lining is that the percentage of positive tests has actually declined from over 10% to just under 10%.

https://covidtracking.com/data/state/massachusetts/

Still, IF the rate of increase in positive test results increases five-fold or six -fold every week for the next two weeks, we'll have as many as 20,000 positive cases.

https://www.worldometers.info/coronavirus/#countries

Thankfully, Germany and the US have had very low death rates - only 3 per million while Italy has experienced an astonishing 124 deaths per million in a very short time. The "country of Massachusetts" with seven million residents (and, more than a few New Yorkers on the islands) is experiencing approximating 2 deaths per million. That number could increase, but it is promising.

New York isn't faring quite as well. New York has more than 30,000 of the nation's more than 65,000 corona-virus cases, and 285 of its residents have died from the virus to date. That's approaching 20 deaths per day.

https://www.cnn.com/2020/03/26/health/elmhurst-hospital-new-york-13-deaths/index.html

A friend from NYC wrote: "It feels like AIDS meets 9/11. Eerie, pensive, worried. With the usual Gotham mix of compassion, kindness, and grumpiness."

My one concern is that Covid-19 cases in CT are growing as the virus appears to be moving north. CT now has 1012 cases and 21 deaths. Those numbers are moving up and I track them using the chart above.

With luck, this virus will move slowly north and the warmer weather will stop it in it's track before it crosses the bridge enforce. I'm wondering if we should close the bridges for a few months. Couldn't hurt.

Where are we on treatment options for COVID-19

2020-03-25T18:21:00.000-04:00

This is an excellent video worth reviewing for available treatment options for COVID-19 with Annie Luetkemeyer, Professor of Infectious Diseases at UCSF, who is an expert on the treatment of viral infections.

On March 24, 2020, Bob Wachter interviewed her on the evidence behind potential treatments for COVID-19 (including chloroquine/hydroxychloroquine, remdesivir, and others), as well as how to assess new and existing drugs in a pandemic.

Don't take the fish tank cleaner. Let's these folks figure this out.

The perfect "deadpan" by Baker

2020-03-23T07:12:00.005-04:00

I like how Baker is handling himself during this troubled time. Here's a clip of him discussing the influx of seasonal home owners in Nantucket.

See: https://www.wcvb.com/article/nantucket-issues-stay-at-home-order-through-april-6/31874647

We now have 24 confirmed cases in Barnstable - up from 2 on March 18th. Overall in MA, we've jumped from 256 to 626 in six days.

See most recent data: https://www.mass.gov/doc/covid-19-cases-in-massachusetts-as-of-march-22-2020/download

We are NOT doubling every two or three days like NYC which is excellent news, but the total number of cases continues to increase.

If you look at positive tests (646) to total tests (6128) we're running at just above a 10% infection rate which I understand is comparable to New Rochelle in NY State.

See MA data: https://covidtracking.com/data/#MA

I heard that NY is showing a 25% infection rate hence the call for extraordinary Federal resources.

See: https://www.governor.ny.gov/

Trajectories for global coronavirus outbreak

2020-03-21T10:26:00.001-04:00

According to these two charts courtesy of the Financial Times, this COVID 19 outbreak in the United States is spreading at a FASTER trajectory than Italy. We're doing okay on the Cape with only 9 official cases and no deaths on Friday, but other parts of the country are seeing rapid case load increases.

See: State by State comparisons

Source: Financial Times - Trajectories by Country

According to Justin Wolfers @JustinWolfers, a University of Michigan economist, no other country has been this far into the pandemic and still had the number of cases growing at the rates the U.S. is seeing.

If weeks of social distancing don't slow this growth, we'll be on track to outpace China in total cases.

Source Financial Times - Deaths by Country

Spain and Italy have had more deaths attributed to coronavirus than China did at the same stage of their outbreak.

But, the trajectory of deaths in the United States has steeped in just the past five days.

This may be why we are hearing more and more about the possibility of nation-wide stay at home order.

If these trajectories don't flatten soon, we'll all be sitting at home shortly.

In fifteen days we'll know if we're like Italy

2020-03-20T07:18:00.000-04:00

We've self quarantined for a week now. I'm getting a little fat, but I'm generally in a good mood. It feels like we've dodged a bullet - so far.

It's hard to predict what happens next.

We're starting to see community spread and the number of cases on the Cape doubled to six overnight. Reportedly,

Town officials in Falmouth and Harwich announced their first cases Thursday, and Cape Cod Senior Residences in Bourne released a statement saying a resident in the independent living wing had been hospitalized in intensive care with a positive diagnosis for COVID-19, the disease caused by the virus.

Cape Cod Senior Residence is an affordable housing facility with eighty-seven residents at the site of the old Barnstable County Hospital.

Statewide, we now have 328 cases up 72 from yesterday. This is the highest one day spike since March 10th. If you compare these numbers to Italy, you can see that there is reason for concern. On Feb. 23, Italy reported 229 cases. Two days later reported cases jumped to 323. On Feb. 29, Italy reported 1128 cases. Two weeks later on March 14, confirmed cases exploded to 21,157.

See: https://www.worldometers.info/coronavirus/country/italy/

Next week will be key. If confirmed cases triple by early next week, we'll know that we're in for a world of hurt.

How much longer?

2020-03-19T09:01:00.001-04:00

It looks like the State has been able to ramp up testing to include commercial labs.

The Department of Health posts "stats" daily and now indicate the source of each test. LabCorp and Quest have preformed over 500 tests to date.

You can find these numbers at mass.gov. These are from the March 18th download.

What isn't indicated is the backlog. The Globe is reporting on equipment and test kit shortages. And, test backlogs what vary from a few days to a week. This needs to improve. Eventually, we may all need to be tested more than once.

The Guardian is reporting that repeated tests have been the key to containing the virus in Italy.

The small town of Vò, in northern Italy, where the first coronavirus death occurred in the country, has become a case study that demonstrates how scientists might neutralise the spread of Covid-19.
A scientific study, rolled out by the University of Padua, with the help of the Veneto Region and the Red Cross, consisted of testing all 3,300 inhabitants of the town, including asymptomatic people. The goal was to study the natural history of the virus, the transmission dynamics and the categories at risk.
The researchers explained they had tested the inhabitants twice and that the study led to the discovery of the decisive role in the spread of the coronavirus epidemic of asymptomatic people.

I'm not sure how long it will take us to ramp up this level of testing, but I expect that it will be difficult for most people to get back to work without a test. That could take a while.

If you have symptoms and want to get tested in Barnstable

2020-03-18T08:35:00.000-04:00

Instructions for Receiving COVID-19 Testing from the Barnstable County Deartment of Health and Environment

Call your doctor.
Your doctor will screen you over the phone and determine if you should be tested.
If your doctor determines you should be tested, he or she will fax your information and a prescription for testing to Cape Cod Healthcare.
Cape Cod Healthcare will then call you to set up an appointment at the test site.

REMEMBER you must have an appointment to get tested or you will be turned away.

Note: If you are experiencing SERIOUS symptoms and do not have a primary care provider, please visit the triage tents located outside of Cape Cod Hospital and Falmouth Hospital for screening.

See: https://www.barnstablecountyhealth.org/newsroom/important-instructions-for-getting-covid-19-testing