COVID-19

When one sits down and analyses the figures reported and with the additional testing and positive to negatives ratios in all the provinces, one begins to see some areas that look more at risk of transmission than others and the recent case counts show that too.

In Santo Domingo and DN the ratio sits at about 20% which suggests no massive amount of transmission but with the population the daily case increase is not to be unexpected. The reports yesterday about the rapid testing and high positivity was a private testing exercise and there are plenty of questionable test kits in circulation, so maybe we can relax a bit.

But when we look at San Cristobal we see big daily increases for the population of the province and 30% positivity which indicates there is more out there.

Azua looks to be problematic too with a sharp uptick and 31.4% positivity.

Peravia in contrast in between both has low daily increases and a positivity of 12%. this could be low testing numbers.

Another area of concern is Espaillat (Moca) with big daily increases and a positivity of 40.7%. There is a problem here along with nearby La Vega still with 25.3%.

As more PCR testing takes place along with MoH rapid testing they will know better.

A intervention of MoH in DN has been agreed from Thursday onward. They need to test track and isolate in this province as well as nearby SD and San Cristobal as priorities imo.

In the early days of the outbreak of covid19 in DR, the Minister of Health referred to it as being mainly affecting the middle and upper classes, and at that time and since the main area of infection has been District National in Santo Domingo. It has since spread to people less well off.

It does strike me that the conditions for it's initial and continuing spread amongst the middle and upper class remain.

We often think that the residents living in tightly packed barrios are at great risk, but wait a minute, the tall apartment blocks of Piantini, Evaristo Morales, Bella Vista and Mirador Norte probably have higher concentrations of people per area and ensure that the circulation of people living in those blocks have to pass through the same parking, elevators, stairs and corridors. Seems  like a good opportunity for covid19. and then these class of people are mobile with maybe more than one car per family and covid19 loves mobility. Then add that these people like to dine and party with their friends. So in the end the fact that they ware their masks and stand 6 foot apart in queues in the Malls for banking may just be a token gesture to beating the virus, because it isn't dropping in those sectors.

Expand that away from the capital and you find the spread is in the towns and we keep reading it is people of significance too. so the middle and political classes in the towns are perhaps behaving the same way.

The sad thing is that the virus has passed to the poorer barrios and probably through people working and interacting with the middle and upper class. And let's hope the spread can be contained in these areas where the new social distancing codes are less well observed.

The serious point I am trying to make here is that those that are mobile and live cities and towns in tall apartment blocks, are mobile and can't stop driving around interacting with friends and have a modern lifestyle may be much more likely to get covid19 than the poor.  And maybe this model of living is the one that has to change and a move away from the urban areas back to the country is going to be a future trend affecting real estate and lifestyle.

covid19 isn't going away soon and we all have to start thinking about how to adapt to a new future and the people that see the business opportunities in change may become the new rich.

The urban to rural shift is afoot already..... from my reading

All sorts of NYC people are looking to rent in suburbia for 3-4 mos and are willing to pay BIGLY for it

Here's the closing argument from today's NYTimes on how pandemics have ended historically

How will Covid-19 end?

Will that happen with Covid-19?

One possibility, historians say, is that the coronavirus pandemic could end socially before it ends medically. People may grow so tired of the restrictions that they declare the pandemic over, even as the virus continues to smolder in the population and before a vaccine or effective treatment is found.

“I think there is this sort of social psychological issue of exhaustion and frustration,” the Yale historian Naomi Rogers said. “We may be in a moment when people are just saying: ‘That’s enough. I deserve to be able to return to my regular life.’”

It is happening already; in some states, governors have lifted restrictions, allowing hair salons, nail salons and gyms to reopen, in defiance of warnings by public health officials that such steps are premature. As the economic catastrophe wreaked by the lockdowns grows, more and more people may be ready to say “enough.”

“There is this sort of conflict now,” Dr. Rogers said. Public health officials have a medical end in sight, but some members of the public see a social end.

“Who gets to claim the end?” Dr. Rogers said. “If you push back against the notion of its ending, what are you pushing back against? What are you claiming when you say, ‘No, it is not ending.’”

The challenge, Dr. Brandt said, is that there will be no sudden victory. Trying to define the end of the epidemic “will be a long and difficult process.”

There is also a cultural phenomenon here, for lack of a better word. Some countries have an easier time with the lock down. Some find it difficult in the US since the country is founded on "independence" and less government and all that. So you have many yahoos here protesting  in defiance of the lock down, and some simply go about their business as best they can.
In the DR you may have a more intense social and economic issue. Denise and I can hunker down with Netflix and enough food in the pantry for a while. Many lives in the DR may depend on getting out and earning money on a day to day basis. Lot of factors at play, but either way when people lose their fear and get frustrated they'll call this a completed event.

I make trips away from my apartment here in Moca only to a. pick up money I transfer to myself; 2. to buy food/supplies and 3. to help family. All family have abided by SD rules/curfew/quarantine and we have have gathered 8 of us once for a meal and then relaxed at a pool - maintaining distances. Otherwise, when I do travel by a relative via motoconcho, I see and understand why Moca is spiking upwards. Massive lines at various banks, Claro stores, utility locations etc with minimal SD, and limited numbers using masks. Folks are keeping their distance while shopping in Jumbo and La Serena with enforced spacing outside - the only location with such. Groups of 3 or more, none with masks or keeping their distances are everywhere.  It's going to get far worse here. One thing they are doing is enforcing the curfew plus they have sprayed the roads and roadsides twice now.

They need to enforce the curfew much much more or as you say things will get far worse.

Then the arguments continue Health vs Economy and as in the past the economy always wins regardless of cost to health or anything else.  The pressure on Govs is enormous as seen recently in Europe.  The battle has begun.

Ducketts

Bulletin #54:

Total Confirmed Cases:   10900    Increase:  266
Total Deaths:                         402     Increase:      9
Total Recovered:                 3221    Increase:    351
Total Active Cases:             7277     Decrease: 94
Total ICU:                               131     Total Ventilator:  62
Total PCR Tests:                  45325   Increase:    1042  usual Tuesday drop in tests but at least over 1k today

In Detail Cases Increase:

DN                                                    +120
Espaillat                                           +26
La Altagracia                                    +3
La Romana                                       +5
La Vega                                             +5
Peravia                                              +3
Puerto Plata                                     +5
Hermanas M                                    +3
San Cristobal                                    +25
SPM                                                    +2
Sanchez Ramirez                              +1
Santiago                                             +27
Valverde                                             +1
Monsenor N                                      +8
San Jose                                             +1
Santo Domingo                                +31

Not surprising. Monte Plata has few cases but it borders on Santo Domingo North and East. Suspect the regions will be locked down with restricted movements and rapid testing and government isolation of suspected cases like SFM and POP. Do any shopping today is my advice.

Intervention from Thursday to Saturday will cover Santo Domingo, La Romana, San Cristóbal and Monte Plata

https://listindiario.com/la-republica/2 … onte-plata

The intervention that the Ministry of Public Health will carry out in the districts that have a number of important cases this Thursday, Friday and Saturday, will cover all the municipalities of the province of Santo Domingo, San Cristóbal, Monte Plata and La Romana.

This was detailed on Tuesday by the Minister of Public Health, Rafael Sánchez Cárdenas, while specifying that the intervention was extended at the request of President Danilo Medina.

The minister indicated that what will be done during those three days will be a kind of "sweep", without offering further details.

"A plan has been made that encompasses the great Santo Domingo with all its municipalities, San Cristóbal, Monte Plata and we have included at the suggestion of the President of the Republic La Romana, so that the whole start from next Thursday is a sweeping process that is going to be done in all these provinces ”, advanced Sánchez Cárdenas.

He explained that the fundamental reason for this intervention is the more than 5,000 cases presented by the Dominican capital, which will be carried out with the participation of municipalities, military bodies and other institutions, as detailed so far.

COVID-19: Is the Dominican Republic ready for a reopening? WHO responds

https://hoy.com.do/covid-19-esta-republ … -responde/

For the representative in the country of the Pan American Health Organization (PAHO), the Dominican Republic may be preparing a reopening plan in the midst of the coronavirus, but taking into account that to implement it, it should meet certain requirements that the Organization World Health, because doing it at the wrong time can be terrible for the population.

According to Alma Morales, among the criteria is that there be no more community transmission and to realize this, the country must have a record in the reports for a week.

“Example that 1,700 samples are being made every day. That the DR reports between 100 and 150 new cases, not reaching 200, because it would already be the maximum and that the positivity of the same number of samples does not go beyond 10 percent, "explained the doctor.

During the interview for the El Día program, a PAHO representative said that the second criterion is that the country ensure that there are no geographic areas that are at risk of an outbreak.

"At the moment, the DR maintains areas such as the National District, Santo Domingo where reporting cases continue to increase in relation to the rest of the country, and if we add to this that it has many neighborhoods where there is overcrowding, then we must guarantee that these places have a epidemiological surveillance, identifying the respiratory symptoms and that these people have quick access to the tests, "emphasized Morales.

In addition, she said that these would be the main conditions for an adequate reopening, although the authorities also have to guarantee that the health services are prepared for an increase in cases, as was the case in Germany, where a second curve occurred.

"To know if the health service is ready, we must ensure that it has at least 70 percent availability of beds for isolation and 50% of beds available from Intensive Care Units," she stressed.

She also stated that the other indicators that have to do with the reopening plan is that infection prevention and control measures are taken into account .

"But to get to that second stage you have to go through the first one," she said.

The doctor stressed that today the Dominican Republic is not ready for one because it does not meet any of the requirements.

All of this shows we are not ready to loosen restrictions.  Lets see what happens.

The president has requested an extension of his emergency powers. Both the curfew and the stay at home orders expire on Sunday morning!

there is a lot of pressure to loosen and we all know that is going to be a disaster.   However,  continuing on will also lead to consequences!

Senate has already just a session tomorrow to consider an extension in anticipation the President requests it.

https://listindiario.com/la-republica/2 … emergencia

All parties need to agree a plan longer term rather than this 17 day at a time.

DR is not in any position to relax too much later this month. Politicians need to follow the medical advice first and foremost.

Lets see what they do. Issue wont be the senate, they seem to just follow along. The issue with be the deputados where the PLD do not have control of the chamber.

Danilo Medina requests to extend the state of emergency for 25 days

https://www.diariolibre.com/portada/dan … HH18793631

Sums it up. The country is a difficult situation and if it is going to slowly open up it needs plenty of controls in place too.

ANÁLISIS ESTADÍSTICO DE LA EVOLUCIÓN
DEL VIRUS EN LA REPÚBLICA DOMINICANA COVID-19 INFORME #46

https://drive.google.com/file/d/1gltH-t … BmqQ2/view

Looking internationally, living circumstances with extended families living in common quarters (co-morbidities aside) have rougher result, ie, Italy. 

JR

Have very much appreciated your measured and cogent analysis.  If you don't mind I'll add a few thoughts.

JR

I'm seeing wildly divergent numbers reported here (after accuracy of tests are taken into account) for seropositives in the US.

On the one hand they range from as high as 20% to as low as .7% in what was supposedly a truly 'randomized survey'.  The object of the exercise of course was to sort of an additional layer of 'noise' to get to, at least, some idea were we might be along the curve to 'herd immunity'.

(Having been a student of this stuff for 4+ decades I began to ring the bell to my friends via a daily email about 2/1 when COVID checked the last of the 8 boxes of 'what I didn't want to see in a virus).

Usual caveats:

1) What percentage of antibodies are necessary to confer acquired immunity
2) For how long does that effect persist (typically not from season to season with coronaviruses)
3) Rate of mutation rate of COVID (per #2) that may render acquire immunity ineffective.. (if seasonal)
4) (I have yet to be convinced that this is 'seasonal', ie most active at < 50 deg F

So, overall, I'm guessing we are in the second inning.

Immunity, aside from post-survival will depend on a vaccine, and that is another topic, intimidating, logistically, at least.

Regards,

JR

If you refer to a baseball match, perhaps 2nd innings is fair.

R Factor

It  has been explained well to most in Europe and there is a good understanding of it's importance. ducketts as his posts has been monitoring just that in Juan Carlos's statistical reports each day and in DR we are not yet in a position to ease up. Yesterday Dr was at 1.03 which is higher than the worldwide averge of 1.02.

Seven consecutive days of R factor at under 1 is the sign we should be looking for. On that basis DR is probably weeks away from any chance of hitting that, and if they open up more they will keep suffering. As a rough idea look for less than 10% new cases for the number of tests as was mentioned by the DR PAHO representative yesterday.

This is the key to controlling and living with covid19 and deciding when it is time to open up slowly  - and when to lock down again. Economies will likely fail, given time, if they try to operate with R factors above 1.

Here is a recent good article to explain:

https://www.weforum.org/agenda/2020/05/ … -r-number/

COVID-19: what is the R number?

Only time will tell and you're right about many points in your post.

However I really believe ECONOMICS always wins.

Ducketts

Bulletin #55:

Total Cases Confirmed:  11196      Increase:   296
Total Deaths:                        409      Increase:       7
Total Recovered:                3339      Increase:   118
Total Active:                        7448      Increase:   171
Total ICU:                               128      Total Ventilators:   67
Total PCR Tests:                47117      Increase:   1792

Spread of New Cases:

DN                                              +112
Azua                                           +2
Barahona                                   +1
Duarte                                        +2
Espaillat                                      +1
La Altagracia                              +3
La Romana                                 +7
La Vega                                       +1
Monte Cristi                               +1
Peravia                                        +3
Puerto Plata                               +2
Hermanas M                              +1
San Cristobal                              +28
San Juan                                       +1
SPM                                              +1
Sanchez Ramirez                        +4
Santiago                                       +12
Monsenor N                                 +5
Santo Domingo                           +109

Well things are at last happening.  Latest headline from the EU:

"EU seeks rescue package for the holiday & tourism markets by gradually easing restrictions".

I went onto several airline websites and sure enough they are getting ready to restart.

Let's hope DR, once the R factor is below 1, we can see the same sense prevail.  We really need to see economies move as soon as it is safe.

Ducketts

ANÁLISIS ESTADÍSTICO DE LA EVOLUCIÓN
DEL VIRUS EN LA REPÚBLICA DOMINICANA COVID-19   INFORME #47

https://drive.google.com/file/d/15XuKZL … JPw4k/view

R factor 1.03. Too high and realistically it will take time to drop.

Bulletin #56:

Total Cases Confirmed:   11320        Increase:  124
Total Deaths:                         422        Increase:    13
Recovered:                           3351        Increase:    12
Active Cases:                       7547         Increase:    99 
ICU:                                         128
Total PCR Tests:                 47774       Increase:    657

Distribution of New Cases:

DN                                                 +21
Duarte                                          +3
Espaillat                                        +23
La Romana                                  +3
Monte Cristi                                 +1
Peravia                                          +1
Puerto Plata                                 +6
Hermanas M                                +1
San Cristobal                                +15
SPM                                               +1
Santiago                                       +8
Santiago Rodriguez                    +1
Monte Plata                                 +1
Santo Domingo                           +39

Testing numbers disappointing but the new cases are still 19% positive today and in the early 20 range recently, so the steady upward increase continues day on day and transmission continues and is too high and not controlled for reopening in terms of PAHO guidelines.

Yikes decreases in testing is not good!

Kawasaki Disease:

Maybe we should all start getting used to the hearing about this disease which has been in children in several countries now associated with covid19 and leading to deaths.

https://www.thelancet.com/journals/lanc … S0140-6736(20)31129-6/fulltext

There have been deaths of children in DR too:

https://www.diariolibre.com/actualidad/ … LH18799277

From BBC article today:

Scores of UK and US children have been affected by a rare inflammatory disease linked to coronavirus.

In a number of children it can cause serious complications, with some needing intensive care.

Up to 100 children in the UK have been affected and studies suggest the same reaction is being seen in children elsewhere in Europe.

It is likely to be caused by a delayed immune response to the virus which looks like Kawasaki disease.

In April, NHS doctors were told to look out for a rare but dangerous reaction in children.

This was prompted by eight children becoming ill in London, including a 14-year-old who died.

They all had similar symptoms when they were admitted to Evelina London Children's Hospital, including a high fever, rash, red eyes, swelling and general pain.

Most of the children had no major lung or breathing problems, although seven were put on a ventilator to help improve heart and circulation issues.

Doctors are describing it as a "new phenomenon" similar to Kawasaki disease shock syndrome - a rare condition that mainly affects children under the age of five. Symptoms include a rash, swollen glands in the neck and dry and cracked lips.

But this new syndrome is also affecting older children up to the age of 16, with a minority experiencing serious complications.

Coronavirus: 'My son had symptoms of rare syndrome'
Dr Liz Whittaker, clinical lecturer in paediatric infectious diseases and immunology, at Imperial College London, said the fact that the syndrome was occurring in the middle of a pandemic, suggests the two are linked.

"You've got the Covid-19 peak, and then three or four weeks later we're seeing a peak in this new phenomenon which makes us think that it's a post-infectious phenomenon," she said.

This means it is likely to be something related to the build up of antibodies after infection.

That is a very worrisome development. I have been following it on the news and its scary!

Re - The Virus

This is how I feel
It's the wrapup paragraph from the London Telegraph about political deceit on the subject
=================================================

Which just about captures the spirit of the deceit. Throughout this crisis, our post-Blair leaders have had countless opportunities to level with the public that finding a solution to this crisis might involve taking a risk. Instead it has sold them the old managerial lie that the only solution is to avoid all risks. We may have a new leader, but nothing has changed in British politics

Lets stay  DR  focused please.....

I think the logic applies to all countries who advocate isolation as the solution

There may be some risk involved in getting a solution

The newest thinking advocated that outside is safer than inside
and yet countries push - the Inside approach

Perhaps opening the beaches here would help -
no groupings - social distancing.....

Let's face it, will open up later this month to a limited number of economic activities. It already has to some extent.

But as of today the virus is still spreading and increasing at a rate higher than the world average and we don't know where are all the cases. So it is a huge risk and there will be downsides. I suspect the first phase is still several days away but before months end.

And the state of emergency looks like it will be extended following interviews with representatives of congress from the opposition this morning - 17 days is my bet with a reduced curfew sought after this period ends Sunday.

So maybe construction workers, builders merchants and car workshops and sales may be happier by months end. Then a period to see how transmission progresses before the next move.

DR will have to live with this and people and business will have to adapt.

As for tourism, it has to be one of the very hardest industries to open up. It is very hard to avoid people conglomerations in the whole process. One asymptomatic can wreak havoc. But international tourism, bars and restaurants was in Phase 5 so maybe 3 months away.

Give an inch they take a mile. That is reality! 

Too many do whatever the hell they can get away with. 

Just make every moron sign a health care waiver and let them loose! 

See who starts screaming when healthcare here is grossly overrun!  Simple let those who won't follow the rules die.

Planner-
It is already happening....

the monkey is out of the cage

Maybe not in SD but other parts of the country are operating on a new level...
Reduced grouping, more social distance, and masks

Yes the difference is that healthcare is the same for those who do what they want and those who follow the law.

You want to break the rules then back of the line for publicly funded healthcare.

Simple.

https://www.diariolibre.com/actualidad/ … FE18856425

15 days approved by Congress - back to Senate.

Stupid tribal politics!

More will be needed to gradually open up the economy from later this month and over the next few months.

But as the other thread and Lishali's post, the President could use the existing Medical laws in a medical crisis to keep borders closed, use face masks limit people conglomeration.

If there are no extensions after June 1
There are no curfews....

The gate swings open and the horse leaves the barn

They will announce something Saturday or Sunday. Current one expires 6 am monday

This will not be the last period of emergency powers and Leonel's party said:

On their side, Henry Merán, spokesman for the People's Force, said that if a series of recommendations are approved, they will continue to approve the extensions.

https://noticiassin.com/diputados-aprueban-extension-del-estado-de-emergencia-por-15-dias/

So the numbers will be there even if the PRM say no more. It will be conditional.

Politically they all know that by being seen to not deal with covid19 - and there could be ar worse situation at the end of the month - could be risky.

and:

Government public health adviser says it would be dangerous to lift state of emergency


https://cdn.com.do/2020/05/14/asesor-de … mergencia/

To keep certain businesses closed and night curfews the constitutional approval is needed.

But as Lishali pointed out in the other thread the closing of borders and wearing masks for example can be decreed using the Medical act in a medical emergency.

Expect them to be looking for better transmission signs later this month to start Phase 1 of the re-opening. As a guide how long the total re-opening could take look at the leaked plan.

Interesting article but the last few paragraphs caught my attention in that this all needs more time to agree and coordinate and it is beginning to look like many hotels won't open until end of the year. Fits in with the domestic tourism start up first.

How would the Dominican hotel industry change after its reopening?

The new protocols would imply changes in restaurants, bars, common areas, rooms and sanitation.

https://www.diariolibre.com/economia/co … EE18857524

..........

"These protocols would require an international certification, which gives greater guarantee to them. They must be endorsed by audit institutions, with recognition of the main tour operators, "he said.

However, the former president of Asonahores considered that for the protocols of the sector to work they must be unified: for various destinations and for all aspects of Dominican tourist activity.

“This implies that there are defined protocols for airports, hotels, transfers (transport of tourists), the transfer of employees and the management of excursions. Something integrated ”, he pointed out.

Opening of the sector

Regarding the reopening of tourism in the country, the head of Asonahores said that she told President Danilo Medina that the sector needs 30 to 45 days, before the economy opens, "because we do not function as a factory."

“We have to talk to the airlines, set everything up, work with the tour operators. Not opening in July could cause some large hotel chains to open in December, because opening in August is not entirely convenient because September and October are dead months, "said Paola Rainieri.


I'm guessing that even the small hotels will have to comply.

As I have said before the tourism sector is one of the most complicated to manage with covid19 because of all the people conglomerations involved from start to finish.

ANÁLISIS ESTADÍSTICO DE LA EVOLUCIÓN
DEL VIRUS EN LA REPÚBLICA DOMINICANA COVID-19  INFORME #48

https://drive.google.com/file/d/11h6N18 … pkkGk/view

We get far less tests yesterday and of course the number of new cases drops. Had there been 2000 tests with sufficient medical supplies, I am sure the new cases would be 400 to 500 at a positive rate c 20% then there would be no drop in the transmission rate. R 1.01 drop stated is questionable after such a one day drop in testing.