Coronavirus and Cargo Cults

It's a busy day in my little community. Today I saw two UPS trucks, an Amazon Prime van, and a Peapod truck. Then just now, a mail truck came by - we already had our normal delivery earlier in the morning, so this one was special delivery. I grew very excited.

Even when I know I didn't order anything, I always get excited when a truck drives by, especially when it slows down near my house. I feel like one of those indigenous people from Melanesia who used to do strange rituals in the hopes that a more advanced civilization would bring them consumer goods, the symbol prosperity. These native populations would build air strips, hoping planes would land, and engage in other acts of sympathetic magic. It was called Cargo Cults.

There's more consumer goods available at stores. Delivery dates are still hard to snag, and Dan likes going shopping. He wears his mask, gloves up, and doesn't dawdle. He has lately come home with so much stuff I've put my foot down and put a moratorium on salmon, chicken, and lamb chops. "I can't close the freezer door." I  complained.

I welcome the fresh produce, which we use weekly. Indeed, I'm probably getting more antioxidants and vitamins weekly than I did in an entire year before. I make fresh salads, cut up fruit, and make one pot stews with potatoes, carrots, and celery. I've made jambalaya with onions, green and red peppers, and celery, and with sausage and shrimp. The fresh produce gets used pretty quickly. So does the bread for sandwiches - both a loaf of rye and a loaf of whole wheat.

But the frozen bagels, frozen veggies, and meats have been piling up in the freezer. When Dan gets salmon, that gets made right away. So, I've declared before he can bring in any more meats and frozen goods, we've got to start using what we've got.

But paper goods are still hard to find. It's loosening up. Dan has found paper towels, tissues, and napkins. Toilet paper supplies are tighter. For the longest time, Amazon still didn't have any. I had gotten two megapacks from Walmart. And Dan snagged some at Safeway. A normal four pack.

As I once said in a blog post about supply chains, people take their social cues from the behavior of others and by visual sights. As long as paper goods aisles are bare in stores and as long as it's hard to buy online, people will hoard. So, even though I technically don't need toilet paper - I've finally used the megapack I bought hack at the end of March and I'm about to start my last megapack, which probably will last another month.

I periodically check online to see what's available even though I'm not really interested in buying. But I've noticed for a month that toilet paper still was not available for delivery. Walmart was limiting it to in store pickup. And friends were still looking for or talking about shortages. So, today, while idling surfing to see what's available, I saw Great Northern Quilted paper. A 12-pack from Amazon.

Yeah, I bought it.

I was curious and checked Walmart. They had Great Northern and Angel Soft and a few other brands. But Amazon was cheaper so I was happy with the purchase. I am not ashamed that I have turned into a semi hoarder that now buys a month in advance -  just about to open my last 12-pack, time to restock. It used to be down to my last few rolls, I'll get some over the weekend.

By the weekend they'll be gone again. I don't want to be that hoarder person. But I also don't want to be the desperate procrastinator whose neighbor has to take pity on them and lend them a roll to tide them over.

On the other hand, disinfectant is still impossible to find. Dan keeps looking for some on every shopping trip and has been for most of April. I've searched online. Just none. I've got at least another month to two month of supplies left. But if I see some soon, I'll overbuy in a minute without a second thought. Who would have thought, just two months ago, we'd all be desperate for Lysol Wipes? Or settle with pathetic gratitude for some off-brand spray bottle from China?

 We are all part of a cargo cult now. That's because our supply chains are still broken. We can now get toilet paper again because it's manufactured in America and they've ramped up supply. The chemicals for disinfectant wipes still come mostly from overseas where they are still providing for their own citizens first.

I'm wondering, if I build an airstrip, would Amazon send a drone with some Clorox?

Burning in a Fire as a Sacrifice

I can't believe it's been two months since I went into self-quarantine, battened down the hatches, and began engaging in strange behavior, like disinfecting all my groceries. Strange behavior, yet in today's world, I have a bunch of friends who would consider me recklessly odd if I didn't do that. It's been two months too since I started blogging again - really more of a vanity project to get me past the coronavirus crisis, and to leave a record maybe for future historians of what life was like during the pandemic of 2020.

That may sound grandiose. But it is exactly by poring over ordinary people's personal diaries, letters, and other contemporaneous  records that historians gain insight into what was really going on during any era.They look behind the official records, newspapers, and accounts by the leaders to examine and gain a better understanding of what life was like for the majority of common people, what the public was thinking, observing, and saying about day-to-day events. So much of what we understand about the everyday lives of ordinary people living through extraordinary events comes precisely from such diaries and correspondence.

With social media, blogs, personal journals, I hope future historians will have a rich motherload of source material to decipher and write about our era. And I hope it won't be kind to Donald Trump, the Republicans who enabled him, and to those governors who rushed to open their states before they were ready. Before they met the CDC guidelines. Before they had adequate testing. Before rates of infection were going down. We met none of the CDC metrics.

I don't think any other civilized country - any other developed or emerging nation - has been so behind the testing curve as the US. Nor has any other nation rushed to reopen while rates of infection were still rising. Let history well record that the wealthiest nation that should have been a world leader, as it had always been in the past, stumbled and failed miserably to lead, to protect even its own citizens. Instead, it asked us to sacrifice our health, our safety, our lives for the portfolios of the richest one percent.

No, Donald Trump, we are not warriors. We are sacrifices to your god of Mamon. We are burning in the fire while your cronies dance around the golden calf.

Everything I Learned About Managing Covid-19 I Learned from Gamblers

I come from a family of gamblers. My father’s favorite cousin, and lifelong best friend (they died a couple of months apart, both in their late 90s) was a real Vegas high roller. The casinos used to put him up in their fanciest suites and wine and dine him and his wife for free. They used to comp her expensive clothes. You know he probably dropped more on a losing night at their casinos than the room, food, and clothing costs. Yeah, he won a few over the years, but he told me he knew the house never really loses. That’s because very few gamblers really know when to fold or walk away.

When they’re on a winning streak, they just plow it all right back, whether it’s riding on the turn of a roulette wheel or the flip of a card at the blackjack tables. And if they’re losing, some won’t walk away until they’ve cleaned out the last of their accounts. Even Cousin Hy admits they never should’ve allowed casinos to install ATMs.

Not that Hy couldn’t afford to lose. He was rich. He owned a chain of cleaning stores in Westchester, NY. And as he explained, “What I drop in Vegas is no more than I’d pay if I went to a New York City hotel for a week and took in a bunch of Broadway plays, or if I went on a cruise or a tour of Europe. Truth is I like gambling. It’s my entertainment. And when I lose the amount I’ve allocated for it, I’m done.”

While my parents weren’t high rollers in his category, like most members of our family, they were gamblers too. They used to spend their summers in the Catskill Mountains near Monticello Racetrack. My dad once had a restaurant in Long Island near Roosevelt Racetrack and he got to know the jockeys and horse owners. He once was a part owner of a race horse.

Once when Dan and I were visiting my parents at their bungalow in Monticello, we were out at a Chinese restaurant and over wonton soup and egg rolls, my mother was complaining bitterly about a movie at the local theater costing seven dollars. It wasn’t a first run film. Probably not even a second run once warmed over feature film. The theater just jacked up the prices for the summer season.

“Gougers and cheaters!” she said loudly. She continued her rant at the price gouging and overpriced films and cheating the summer people. My father in his mild voice interrupted her and asked, “So, Marion what did you do instead?”

She ignored him. She kept venting.

“So Marion, what did you do instead.” More ranting. Ignored him. Third time.

“So Marion…”

“Okay, so I lost a hundred dollars at the track. At least they weren’t price gouging and cheating me!” 

It’s my favorite story of how a gambler thinks

I’m not a gambler. In fact, once Dan and I took a train trip with some friends from DC to Atlantic City. It was one of those gambling junkets where you take the train from Union Station to Atlantic City and the casino gives you fifteen dollars’ worth of chips. Well, you can lose that fifteen dollars pretty quick on slots. The truth is slots can be mind-numbingly boring. Or at least I think so. Other than the migraine inducing flashing of lights and dinging of bells and the general cacophony of this blue-grey smoke tinged room, playing slots consists of the same repetitive motion made every two seconds. If you were on an assembly line forced to make that motion to put together a widget, you’d probably hate your factory job. It’s the promise of the big payoff that keeps it exciting for some. I’m not patient enough, nor do I have the attention span for repetitive activities. It’s why I also don’t like most sports. It’s watching people throw balls the same way for hours. You have to care about the outcome for it to be interesting. And I get bored too easily.

Anyway, I got down to the last chip I was willing to spend. Seven dollars out of the fifteen I was given free. Back then, that left me with enough money to buy a good paperback book. So, I fed my designated last chip in the slot machine, pulled the handle (this was back in the days when they were still “one arm bandits,” not push button, which makes them even more boring).

Lights flashed, bells pealed The numbers lined up. I hit the jackpot. It was fifty big ones. Most slots won’t make you rich. Pro tip: the house is never that generous. They just give you a big enough payoff to keep you hooked. It’s called intermittent reinforcement in psychology.

Now this is where a real gambler would plow it all back into the machine for an even bigger return. This is even where an amateur would keep playing. Here’s how it works. Almost everybody thinks the fifteen dollars of chips was the house’s money, not theirs. If they lose all that money – or even if they win a little – none of this money came out of their pocket. It’s still all the house’s. So, if they play it all and lose, they think they’ve lost nothing of their own yet, right?

WRONG!

If you give me money, for whatever reason, it’s mine now. Maybe I’ll give you back a little. After all, I don’t consider myself a hopeless loser. I’m in Atlantic City. The deal is I’m there to gamble and somebody gave me a plastic cup full of free chips. So, okay, I’ll play a little. But it’s my money now. I’m gonna spend some of it on things I like more than gambling. And if I win an extra fifty dollars, that’s mine too. Yup, I cashed out.

In fairness, I never thought I was there to gamble. I was there because my friends went. And we really mostly went because we like riding trains and it sounded like a fun day.

Dan told that story to my parents when we got together. My mother leaned forward, glanced at me and said quietly to Dan, “See, this is why we think she’s not really ours. Aliens brought her.”

Anyway, I do know something about gambling and the psychology of gamblers. I’ve watched it all my life as a detached observer. And the one thing I’ve learned is there are some risks even a gambler won’t take. Some odds too long, some stakes far too high.

And the way some states, mostly in the South, have chosen to deal with the Covid-19 virus falls in that category of longshot odds and stakes that are far too high, including greater death rates, more suffering, and the very real risks of overwhelming fragile healthcare systems in rural areas unable to cope with spiking numbers of new cases. Places like Georgia, South Carolina, and Tennessee, particularly, are turning themselves into a real time laboratory for the rest of the nation and may go down in history as the base analysis that taught us all what not to do. 

They are striking a deal with a devil at a crossroads: we’ll let thousands die to get our economy going. And they could lose both their citizens and their businesses in the end anyway, just like gamblers who tap out their bank accounts at those ATM machines at the Vegas and Atlantic City casinos. Lots of gamblers aren’t like my family’s Cousin Hy or my parents who know when to stop. Or even like the professional gamblers who make a living out of it by playing the odds and knowing when to fold.

Flying in the face of good medical advice, ignoring public health experts, opening up businesses without adequate testing capacity or enough contact tracers, making what would be a sure to fail attempt to return to normality amid still rising new infection rates and still climbing death tolls is that kind of high stakes gamble most real gamblers wouldn’t take. That’s when even the high stakes high rollers would know to fold.

Let me tell you who does lose their shirt. It’s the down and outers. The ones who are more than just gamblers, they are the gambling addicts. The people who can’t stop until they’ve lost everything they brought, cleaned out their bank accounts at the ATMs, and given their legs as collateral to the loan sharks. They are people like a friend of mine who just lost his job right before we all went on that gambling jaunt in Atlantic City. While others in our group cheerfully lost their freebie fifteen dollars’ worth of chips and then a few extra bucks of their own and quit, this friend kept playing and playing long after his complimentary chips were gone. He kept playing until he dropped a hundred dollars he couldn’t afford. He played and played with grim determination. Just when it was so psychologically important for him to win, to get some glimmer that his luck would turn around, that he in fact wasn’t a loser, he played on, And on. And on. Until he dropped more than any of us. He was a loser.  Not because he had a run of bad luck at the tables. But because he didn’t know when to fold. When to walk away. That’s the most important skill a successful gambler has.

People who want to reopen their states while all the odds are running against them? They’re like my friend who lost his job and ignored the streak of bad luck and kept playing. They don’t know when to hold. When to fold. Don’t be like Georgia, Tennessee, and South Carolina. This virus isn’t bluffing.

The Search for the Cure

Hydroxychloroquine failed.

Back in February and early March, doctors in Wuhan, China reported some promising results using it in some covid-19 patients. And a French doctor, Didier Rauolt, reported success with the antimalarial drug in a small study that was later debunked. It was sloppily done, and the doctor is an outlier and sort of crackpot within the French scientific community. He's popular with the far right for his climate science skepticism, controversial views on some vaccines, and conspiracy theories. I think he's their version of our Dr. Oz or Dr. Drew and some of the other crackpot scientists out there.

The treatment group and the control group were drawn from separate populations: the treatment group were all patients at the institution where the researchers worked, the Méditerranée Infection University Hospital Institute in Marseille, while the control patients came from other hospitals in the south of France. The treatment group (mean age 51.2) was significantly older than the control group (mean age 37.3), introducing another variable that could undermine the meaning of the results. The study was “open label”, meaning the physicians and patients knew which treatment they were receiving. The French researchers also treated some but not all of the treatment group patients with azithromycin, a common antibiotic, another complicating factor that was not randomized.

But even more important than these shortcomings in the design of the study is how the researchers chose to measure and report their results. Forty-two patients were initially included in the study. Three were transferred to the intensive care unit; one died, one left the hospital, aone stopped taking the treatment due to nausea. The other 36 eventually recovered, and those who received the drug cleared the virus from the system faster than those who did not.

If you had only heard about this study from the Fox News assertion of a “100% cure rate”, you might assume that the four patients with poor clinical outcomes (the three ICU visits and one death) had been unlucky enough to be in the group that did not receive the “cure”.

And yet, those four patients, as well as the patient with nausea and the one who left the hospital early, were all part of the treatment group. They were excluded from the topline results of the study because of the way that the researchers chose to measure and report the results: strictly based on the measurable presence of viruses in nasal swabs taken each day of the study. Since the patients were in the ICU or dead, their samples could not be taken and they were left out of the final analysis. Based on the nasal swabs of just the 36 patients who completed the study, those who received the drug cleared the virus from their systems faster than those who did not.

This is how an experiment in which 15% of the treatment group and 0% of the control had poor clinical outcomes could end up being reported as showing a “100% cure rate”.

I'm actually sad it failed. I think for some people on the left, there was a certain schadenfreude. It was kind of fun watching Trump get egg on his face for going all in on recommendations for an untested drug with serious side effects, especially when the studies came out showing it had no effect on outcomes and harmed more people than it helped. After all, it's fun to say, "I told you so."

Yeah, I get it. But the bigger problem is we still don't have any drug to treat this horrible virus. We still don't have a weapon against it in our arsenal yet.

A vaccine is at least a year or more away. We can't stay in lockdown for a year or more. I get that. But how can we come out when every day brings new and terrible information about what this virus does to the human body - the latest being that it somehow causes blood clots. Some of the people who have died have not succumbed to Acute Respiratory Distress Syndrome (ARDS) but actually to blood clots in their lungs and elsewhere. A Broadway actor, Nick Cordero, had his leg amputated. The more we learn about this novel coronavirus the less good news there is.

Yet, there are states determined to open up prematurely, while their rates of new infection are still climbing, like Georgia, Texas, Florida, and Tennessee. And other places where governors are bravely following scientific advice even in the face of organized demonstrations by the far right and tea party groups.

So, what is the answer?

I don't think we can keep things closed indefinitely. Right now, despite the efforts of the far right fringe, most people are more afraid of their state opening too soon than they are of it staying closed, despite their own economic hardship. At least three polls, Gallup, Pew, and Washington Post have found that more people are pessimistic about things getting better and fear their state reopening too soon. And most disapprove of the way Donald Trump is handling this often for that reason.

Even though nobody wants to be unemployed and people are very worried about how they are going to pay their bills, they understandably are also scared of getting a truly frightening disease that kills and leaves people with damaged organs. They don't want to get this themselves and they don't want their loved ones to get it. Hell, most people are disinfecting and wiping down groceries, taking showers and leaving clothes in the garage every time they go out to the grocery store. Do you think they want to go sit in an office all day with a bunch of coworkers, go to a restaurant, a theater, or gym?

So we have to find a solution that gives us some safety to begin a gradual return to normality. I already talked about the CDC guidelines yesterday. It includes a 14 day period with declining death rates, no new cases, and things slowly reopening in stages. It would be contingent on widespread testing and contact tracing. All that would help in controlling fresh outbreaks, protecting large groups of people But what about those unlucky ones who still contract the disease?

We can't guarantee one hundred percent safety. Let's acknowledge that. Even before this new virus, people got sick. They got serious illnesses and some didn't survive. If this ugly virus never showed up, we would not be one hundred percent safe from disease and death. But we always had tools to fight disease, methods to mitigate the risk, not just to the entire group, but to the individual who still got ill. We had antibiotics for bacterial diseases, chemotherapy for cancers, statins for heart disease, and other drugs and methods for treating illnesses so that more people survived.

Hopefully, we will eventually find a vaccine and this disease will be eliminated, like polio, smallpox, and other diseases before it. Until then, we need stepped up research on antivirals. There's actually a list of different approaches being researched, with antivirals like remdesivir, a drug originally tried for Ebola; EIDD 28; favipiravir, a Japanese antiviral; and several imunosuppressive drugs to control the cytokine storm the virus often causes, where the body's own immune system attack itself.

This older article, which was written before chloroquine flamed out, shows some of the approaches researchers are taking. Other than the chloroquine, studies of the other approaches remain ongoing, along with the search for a vaccine.

So, ultimately, I think we will have a drug treatment as a bridge until we find a vaccine. But even with a drug - or hopefully more than one - the key is still going to be testing. I suspect that just like with other illnesses, the earlier you catch it and treat it, the better the success rate. This is probably true of any virus, where getting an effective drug into a patient while the viral load is still relatively low, will yield the most success.

This desperate search for the cure is an international effort with scientists, labs, and drug companies sharing information to find something. Still, safety cannot be compromised. Before anything comes to market to fight this disease, it has to prove safe. Chloroquine did not meet that standard here, despite a long history of use for malaria and autoimmune diseases like lupus. But in covid-19 sufferers in seemed to increase heart problems and they did worse than those not on the treatment.

Remdesivir was already tested for Ebola and cleared basic safety trials. Unfortunately, it was not effective for Ebola. It also has the drawback of being an intravenous drug, which means it has to be taken in the hospital, or a patient would have to have a port put into their arm or chest to administer it. EIDD is an oral medication, which make it easier to use and more likely to be given for even mild to moderate cases. Both these medications, and any others have to prove both safe and effective specifically for covid-19, And that will take a while. But we are not starting from scratch with any of these. They've already been tested, and in some cases already used, for other diseases. So testing on patients could yield results in a few months, rather than a few years.

None of this is without risks. And none of them might work. But they are currently our best hope until a vaccine comes along.

Coronavirus: Roadmap to Recovery

On Friday, we once again invited our downstairs neighbor to come up for supper. We ordered takeout from Hopsfrog, one of our favorite local spots - I've known owners Costas and Maria for years and years, since they bought the original restaurant, Fritters, and renamed it. That was back in the mid 1990s. That was when Maria didn't know my name and she called me "the lady."

As always, I'm torn between the guidelines to shelter in place and not have visitors and the impulse to help a neighbor. Michael is 70, responsible, goes out once a week for groceries, and stays in like we do. In fact, I'd say my husband, Dan, probably goes out more often than Michael. But none of us are traipsing around in crowds. And Michael's cat, Frodo, is dying. So, we take the somewhat calculated risk of keeping a neighbor and long time friend from getting unbearably lonely.

Michael lost a friend to covid-19. He was a coworker who had had a stroke years ago and has been in The Virginian, a long term care facility. The last time Michael saw his friend was around Christmas time when a group of retirees from the National Archives went to visit and took him out to lunch. Michael got an email about his friend's passing. Suddenly, everything got very real, very fast.

So, I was very glad we invited Michael up. It was a mitzvah.

Over cocktails, London broil, mashed potatoes, and good Cabernet, we discussed politics, current covid events, and reminisced about our misspent youth. Michael told us about moving to Boston after college to work at Harvard Library and getting an apartment with a musician friend. Their first night there, they discovered an infestation of roaches. They left their stuff and crashed with friends and when they returned, all their stuff, including the musician's very expensive guitars had been stolen. It crushed them.

Dan regaled us with stories about how his apartment at law school in Memphis was infested with fleas, among other misadventures. Within six weeks, he'd left law school.

I didn't have any experiences that dramatic. But we all told tales about our student trials, travails, and triumphs, and howled with laughter. Somehow, it's funnier looking back than it ever was living through it at the time.

After dinner, we found reruns of the Smothers Brothers Comedy Hour from 1967 on one of those cable stations that specialize in nostalgia TV. Tommy and Dickie, and the Who all looked so impossibly young.

Sometimes nostalgia can be dangerous. It can remind you of all you've lost. After watching a reminder of that more idealistic time, I longed for the normalcy we've given up in the age of coronavirus. As much as I sometimes feel secure in my cocoon, I know what we are doing, though necessary for public health and safety, is not sustainable long term. Even with every government infusion of money to help people and businesses, there comes a point where the economy has to open back up. And it has to do it safely. A sudden spike in deaths will only wipe out every sacrifice we've made. And it will tank the economy even worse. If the number of new cases and new fatalities spike upward, I guarantee the recession will take an equally strong spike downward, plunging us into an even more serious depression.

So, what will a recovery look like?

The White House has issued some guidelines. They include a downward trajectory of new cases, declining hospital admissions and lower death rates for a fourteen day period. They also recommend robust testing for all healthcare workers and at risk populations, including new blood tests to test for antibodies so we have a better grasp of the true rate of infections and the real mortality rate from this highly contagious virus.

Reopening the economy would entail at risk populations still sheltering in place while younger people and those generally in lower risk categories begin to return to workplaces. Even in those workplaces, social distancing should be maintained. And when possible, employers should be lenient in allowing people to telework from home. Travel should remain limited to essential trips, and gathering spots should limit the numbers of people allowed to congregate.

Schools would remain closed. Theaters and gyms would be able to open if they can practice strict hygiene and social distancing. Bars would remain closed, and elective surgeries could resume only on an outpatient basis.

In phase two, vulnerable populations would continue to shelter in place. Restrictions on non essential travel would be lessened or removed. Other things would gradually open. And only in phase three would those in vulnerable populations finally be able to stop sheltering in place. But some social distancing and other precautions would remain.,

None of the phases talk about a true return to normal - crowded bars and restaurants, people moving about freely and freedom from fear (remember, one of Norman Rockwell's Four Freedoms?).

All of this happy scenario stuff is really contingent on testing. We can see when hospital admissions go down, when people stop dying, and we can assume some gradual loosening of restrictions are okay. But without widespread testing, we won't know if cases begin to uptick until they spike once again. We won't know, in other words, until an outbreak has already spilled into the hospitals and until it's too late. We could easily find ourselves back at square one, with an even weaker recovery and public trust in institutions in tatters.

The plan of gradual reopening in carefully calibrated phases is a good one, if you have testing and contact tracing. In Singapore and South Korea, they had that testing all along and were able to quickly quarantine all those infected, trace their contacts and quarantine them too, and the rest of the population never had to go into draconian lockdowns. While their economies took a hit too, it was nowhere as bad as in China, Europe, or the U.S.

Germany, generally acknowledged as the outstanding model for handling this in Western Europe, unveiled its plans to reopen. It too has done the testing and contact tracing all along. While it gradually phases in its return to work, it will continue that. With widespread testing, at the first uptick, you can get infected populations in quarantine quickly and limit infections from spreading. They have a fine tuned instrument with surgical precision. The rest of Europe, and even more, the U.S. has a blunt, dull instrument.

In the U.S., we are still grappling with severe shortages of tests. Three months into this, while Trump has been clowning in a sham of a daily update, he has still failed to come up with a true national plan to increase testing capacity. States have been struggling to do this and meet the other medical needs of their citizens on their own or in cooperation with neighboring states. The governors have provided amazing leadership in California, Washington State, New York, Maryland, Virginia, Michigan and Ohio. And in places like Florida and South Dakota pretty dismal and reckless lack of leadership as they've followed an unserious reality star president over a cliff.

The truth is the most capable governors struggling to keep their state safe and all the phased in and cautious reopenings can only do so much, though, until we get some treatments to truly cut the risks of reopening. That is going to take the scientific community. It would go a lot faster and have a greater shot of success with a competent president and a well-coordinated effort. But the states and the scientific community nationally and globally aren't waiting for the Trump administration to lead the way.  Trump already he proved he's not capable of real leadership.  We are all on our own, forging alliances despite, not because of the Trump administration.

Next Up:  The Next Horizon; The Search for the Cure

Cornavirus: Flattening the Curve and Buying Time Part 1

I have a confession. I honestly don't think I am going to survive this pandemic.

Oh, I don't want to get melodramatic. For now, I am fine. Indeed, safely ensconced in the sheltering bubble of my condo townhouse, I feel protected. I breathe in and repeat the mantra: "In this minute, right now, I am safe," I breathe it out too. Whenever I read another article on how bad it is, or some new dreadful symptom or complication caused by this still mysterious virus, whose full destructive capability we only starting to learn, I breathe in and out and remind myself that at this moment, I am safe.

But when our leaders - the president, the governor, some state senators - start to agitate for reopening businesses, lifting the shelter in place, returning to normal, I get a swift, white hot, boiling shot of cortisol and adrenaline that shoots from my limbic system right into my bloodstream, sending my heart pounding, my pulse racing, and my temples throbbing while I hyperventilate. You get the picture.

And yet on some deeper level less connected to my amygdala, I know and acknowledge that we can't stay in self-imposed quarantine for a year to 18 months. That's not realistic and the economic hardship and pain that will cause is a valid concern too. Yes, we do have to balance public health and the economy. We cannot live without paying rent and bills. We cannot live without people willing to provide services like manufacturing, selling, and delivering the goods we need even while some of us have had the luxury of huddling in our safe spaces. Somebody has already been out there every day making it possible for us shelter in place. They've been taking risks for the rest of us.

Yet, when some of our leaders privilege the economy over public health and safety it sounds offensive. When they talk about acceptable numbers of deaths and acceptable risk, it raises my hackles. Whose risk? Whose death is acceptable? Who do you want taking that risk for you? And do you know the value of life, or just the price of commodities?

Right now, it's appropriate for the federal government, the states, and the municipalities to be starting the long range planning for a reopening. But we need transparency and criteria for when all that will happen. Too often, the focus seems to be shifting to arbitrary timelines and calendar dates divorced from data.

So, it might be helpful to talk about what was our goal when we all went into quarantine. What did we hope to accomplish?

We were told it was to flatten the curve. In Wuhan, China, where the novel coronavirus first emerged, it caused pandemonium (same root as pandemic?). The virus spread like wildfire, overwhelming hospitals, creating shortages of ICU beds, medications, and all important ventilators. Patients were dying as much from shortages of supplies and medical personnel to care for them as from the actual virus. And doctors and nurses began to succumb because of lack of personal protective equipment (PPE).

Then Covid-19 spread to Italy to a prosperous region in the North. Unlike China, which for a long time kept a clamp on news about how bad the epidemic was, in Italy we got a full, unvarnished look at how coronavirus raced through the population, creating shortages of lifesaving equipment, ravaging people, bringing down medical staff. In Italy, we witnessed the sight of streets choked with coffins and frank discussions about rationing ventilators. Triage became the word of the day as bioethicists wrestled with criteria for deciding who lived and who would be allowed to die.

That's when the rest of the world came up with the strategy of sheltering in place to stop this highly contagious pathogen from spreading so quickly. China was the first to use draconian lockdowns, forcing their people to stay at home until new infections stopped rising. Italy did the same as the only solution to stop the steady march of corpses to coffins to graves.

Plotting the graphs of rising death rates and rising new infection rates, the goal became to flatten out that  line on a graph by reducing new infections. The object was to keep the rate of infection low enough that hospitals would not become so overwhelmed they couldn't care for patients or run out of lifesaving equipment. It was never to eliminate all virus cases, it was to keep the number of patients low enough to make hospital treatment manageable.

Once the rate of infection was flat for a couple of weeks, the goal would be to begin to restart life and get people back to school and work. With more testing and contact tracing, public health officials hoped to be able to monitor how well that was working. And with vigilance, they'd watch for any uptick in new infection and move quickly to re-shut school and business until it went back down. That, of course, meant halting startups, shutdowns, restarts, hope, disappointment, and maybe more hope.

It wasn't perfect. And it wouldn't guarantee anybody real safety. After all, even with robust testing, by the time you have the positive test, it may be too late for your personal health and
safety, even if your uninfected coworkers are still safe from you and the hospital still has the capacity to treat new cases. The biggest drawback, after all, is we still don't have any effective drug or treatment for those already sick. The best medical experts can offer is supportive therapy to keep the patient as comfortable as possible and to treat symptoms while the patient rides out the infection, hoping their immune system will kick in and fight the virus off. Ventilators, after all, don't kill viruses, they breathe for a patient whose lungs have been infected until the patient's immune system fights off the virus and recovers. Or doesn't recover. Ventilators treat symptoms. They don't kill viruses. About half the patients who go on ventilators don't recover. But without a ventilator, many more of those patients would die.

So, a second goal - or more a second hope - began to emerge. That is buying time. Some medical experts hold out hope of developing a vaccine in about a year to 18 months. Other researchers are racing to find an antiviral that can treat the actual pathogen. We already have antivirals and the very controversial antimalarial, hydroxychloroquine, which showed some promise in a very small clinical trial. Of course, more and better clinical trials need to be done. But it is possible to have one or even several medications that can treat and slow down the virus within several months, maybe even by the summer.

Hospitals, universities, and private labs all over the globe are sharing information and working cooperatively to find new medical treatments for the novel coronavirus. Meanwhile, testing capacity is finally ramping up. All that might be worth waiting for.

I know it's unrealistic to talk about waiting until the middle or end of 2021 to get back to normal. And I know our cratering economy is harming a lot of people. My husband, as part of his jobs, is on calls all the time about the astronomical unemployment rate. One day a few weeks ago, we went into DC so he could sign hundreds of emergency checks for unemployed union workers. So, we are cognizant of effects on the economy and the human toll that takes too.

But might buying some time for a an effective treatment be worth the extra sacrifice if what we are talking about is a few months?


In Part 2, I will talk about what a roadmap to reopening should look like

Cornavirus: Loved Ones, Harm's Way and Hotspots

Hyacinth called me today.

Hyacinth has been my friend since she became my mother's caregiver in 2003, after mom had her first stroke. Originally from Jamaica, Hyacinth has a lilting island accent and she would yell, "Marion!" to get my mother's attention to get her to eat, do her physical therapy exercises, walk, and just to keep her engaged. Hyacinth tended my mom and did some light cleaning of of my folk's small condo in Fort Lauderdale. And she played poker with my dad. They both cheated.

Once Dan played poker with the two of them when we were down there visiting. Hyacinth winked at Dan and gave him a sly grin. And Dan knew she was on to my dad's tricks. When my mom finally passed away, after a second stroke in 2005, Hyacinth stayed on to care for my dad. Unlike my mother, he wasn't sick then. Mostly, she just came cleaned the house, played cards with him for a few hours, went shopping with him, and kept him company. And they played practical jokes on each other.

Hyacinth had a key to get into his apartment. Once, she came up and found him lying on the floor in the early morning sunlight. With her own heart racing, she leaned over him to see if he had a pulse. His eyes flew open and he said, "Boo."

Between laughs she threatened, "I am going to get you, old man." And she did too.

I think she kept him alive five years longer than he would have lasted by keeping friendship, pranks, and laughter in his house.  But finally, he succumbed to the ravages of a lifetime of smoking and a history emphysema, and lung cancer.

I went down to Fort Lauderdale to be with him when he went into hospice care. When he was taken to the hospital to the special hospice wing, I called family who lived locally so they could say their good-byes. At first the doctor and nurses thought he'd rally and be able to go home for a few weeks, maybe even a few months. But surrounded by family, he deteriorated rapidly. I think he was ready. Indeed, when I first arrived at his hospice room, he had out his favorite picture of my mom from when they were newlyweds. He was staring at it wistfully. I told him, "I'm going to miss you a lot, but I will be okay. It's okay to go to mommy."

A day later. he slipped into a coma. I leaned over at one point, and whispered to him, "I know I said I was okay and you could go to mommy, but damned, I didn't mean this fast."

 I heard his labored breathing, the only sound in his room. Then, his death rattle started - yes, it's a real thing. I'd always read or heard about it in novels but now I heard it. After watching his bed and listening to his struggle to breath for most of that day, singing him songs, and praying for him, Dan and I left his bedside to get a quick dinner and a few hours sleep. At about ten that night, a hospice nurse called to tell us that if we wanted to say our truly last good-bye to my dad, we should get back to the hospital right now.

We flew out the door. En route, I called Hyacinth on my cell phone. She would've been so hurt if I hadn't told her. We pulled up at the hospital at the exact moment she and her husband, Chamberlain, did and walked into my dad's room together. They stayed with Dan and me until my father's final breath. Suddenly, the room, which had been so noisy with death rattle, was silent. Utterly, eerily silent. I called the hospice nurse, Nicole, one of my dad's favorites.

She looked at him sadly and said, "Good-bye, Irving, this world isn't for you anymore."

Hyacinth and I still keep in touch. We are joined together by shared experiences, both the laughter and the tears. She still works as a home healthcare aid, still comforting the sick and elderly and their families, still making last days more comfortable. And Hyacinth, going into all those old people's homes in Fort Lauderdale is now elderly herself. She lost Chamberlain a few years ago. And now she works in one of Florida's hot spots.

After speaking to Hyacinth, I called my cousin Alan. I hadn't spoken to him or his wife Ronda in months. Alan and Ronda live in Bergen County, New Jersey. It's a hot spot too. Bergen is a bedroom community that feeds New York City's offices its professional and business people. It's a close hop by car or public transportation into the city.  Bergen has been among the most hard hit spots in the tri-state area around New York City. Ronda told me they have three friends who died of the virus. They know countless more in just their little town who have caught it. So far, they've remained safe.

Compared to my modest safety routines, they take draconian steps to keep the virus at bay. They have a large home with a big yard and a connecting garage. When Alan goes out to take his walk, he puts on his outdoor clothes. When he returns, he takes them off, goes immediately into a shower and then changes to indoor clothes. Ronda does not go out. She used to go to a gym; now she works out in their den. When they bring groceries in, they leave packages in the garage for three days first. If it's perishables, they remove and discard the outer wrappings and transfer food into their own containers before bringing it into the house for the fridge or freezer. They work hard to keep everything threatening out of their home.

I let the threat in and neutralize it to the best of my ability. Without a garage I don't have any other choice. When I first started wiping down groceries, Dan would give me dubious looks. But lately, he's been helping me disinfect our groceries. We've got a good assembly line going, where he hands me stuff right from the bags, I wipe them down and put them on a clean counter and then we wash our hands and  put it all away. But neither of us changes clothes or showers when we go out. I thought he'd think they were excessive when I told him what Ronda and Alan do. So it surprised me when he said, "Well yeah, look at where they live. Of course they have to do all that. We would too"

Dan is one of the last people to panic or overreact. In fact, I've always secretly thought he was the kind of optimist who gets everybody else into trouble with his sunny confidence that everything will be okay. He's the guy whose default is "calm down; it's going to be okay." So, when he says to be cautious, it would behoove you to take it seriously and be cautious indeed.

Then, I spoke to my cousin Linda, who lives in an even hotter hot spot. She's in lower Manhattan. During the aftermath of 9/11, her neighborhood had a toxic fog from the airplanes exploding into the towers that lingered in the air for months. She smelled chemicals, soot, and death from the Twin Towers as the miasma floated from the Wall Street to Houston and Grand Streets.

I worry most about Linda. She lives in a high rise building on the 13th floor. She takes elevators and walks through narrow hallways before she can get anyplace. Linda shops - she has to to get groceries. Delivery services are spotty and the waits too long. In a small Manhattan apartment, you really can't stock up or store more than a week's worth of supplies. And she takes walks for her sanity. She does as much social distancing as possible in the situation, avoiding the most crowded times in her supermarket, sticking to empty streets, keeping a wide berth from others, and not entering an elevator with other people when at all possible. And lately she wears a homemade mask.

So, four of the people I care most about all live in hot spots and harm's way. So do I. Northern Virginia, part of the dense Washington DC Metro area, is supposed to be an emerging hot spot, with Fairfax County"s numbers of new cases and deaths climbing. But we get glimmers of hope too. Our hospitals have not yet been overwhelmed and we are not expecting a shortage of ventilators and other crucial supplies, though people are sewing or donating masks, and they are scrambling for other protective equipment, as every other region is.

Despite a slow start and a reluctance to shut down restaurants, bars, and other nonessential businesses, our governor seems to have done the right thing, after all, and is expressing a determination not to open up again too soon and undo the hard work and sacrifice we've already made.

Of course, our economy is in shambles. Same as everywhere. We have the same debates about when it will be safe to open back up. And the same fears. Wait too long and it is unsustainable for business and the economy. Be too impatient and the death rate goes up. Behind every number, every statistic in that mortality rate is a flesh and blood person with loved ones they leave behind to mourn.

Every number is a Hyacinth, Ronda, Allen, Linda, Dan, and you and me. And our parents, children. We are all in harm's way. All in hot spots. And we all long for normality.

Be safe, wash your hands, and stay inside!