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!

Coronavirus and Political Theory: Changes in Latitudes, Changes in Attitudes

This is my new favorite meme making its rounds on Facebook

When I first saw it, I immediately thought of my late mother, a hoarder extraordinaire. When I was growing up, her hoarding annoyed me. Her fridge was always overstuffed. To find the mayonnaise for the tuna salad,  you had to first remove everything hiding it way in the back and then put all that other stuff back.  When she died in 2005, in Fort Lauderdale, I went through her fridge, throwing out her science projects. Fortunately, she never tried to eat any of the spoiled food that she couldn't bear to throw away

Living in Florida in the 1980s, my friends and I secretly made fun of her and her compatriots. You couldn't keep an "all you can eat" buffet restaurant open in the areas near the retirement communities. The seniors would clean them out. Even as we younger people laughed at their behavior, we understood they were formed by years of deprivation - from the Great Depression to the rationing of the WWII years. They could never take for granted the easy prosperity and abundance that we children of the sixties and seventies grew up with. We wasted a lot. Took a lot for granted.

Now as I navigate all the shortages we are facing today, and as I stuff my fridge and steward the food and paper goods to make sure we waste nothing so we don't have to make an unnecessary run to the dangerous supermarkets, I have a whole new appreciation for my mother's frugal ways. I understand her a lot better now.

Meanwhile, Dan, clad in mask and disposable gloves, did a grocery run. This time he came in with ten full bags of groceries - $300 worth. And I wiped down every single one of the items that was practicable with a disinfectant wipe before putting it away - cans of soup and tomato sauce, plastic wrappings on bread (as long as they were double-wrapped), and cardboard boxes. I directed Dan to leave the Bounty paper towels in an out of the way spot that got a lot of sunlight because I read UV rays help dissipate the virus.  I also drew the line at wiping any soft plastic wrapping on produce that was not double-bagged. I don't want an unintended consequence of my fastidiousness to be disinfectant poisoning. I am trying to walk a fine line between protecting us from infection while not killing us with that cure. It makes me crazy,

I know, of course, I won't be disinfecting groceries in the future when the coronavirus has been eliminated (please God soon) and is just a chapter in a history book. Or a funny Facebook meme. But I think there are ways we will be changed by all this. Ways we can't imagine. One of the ways is the political assumptions we accepted without question because they became the conventional wisdom for our generation.

What follows is a guess. Prognostication can be a fool's game so I fully admit it's all speculation.

But I think both libertarianism and Ayn Rand's recent uptick of popularity within Republican circles have taken a big hit. That Cold War novelist and would be philosopher who was popular in the mid-20th Century enjoyed a brief revival first in the 80s and then again in the mid-2000s. There were all kinds of conservative blogs with titles like "Atlas Shrugged" and "Galt's Girl."

The argument over the role of government in our lives has changed too. The belief made popular by Ronald Reagan that "government is not the solution, government is the problem" has collapsed. Despite some hardliners who will never accept it, more and more people from both sides of the aisle are challenging the ideal that  "the era of big government is over," as Bill Clinton declared in 1992. The mistrust that both conservative Republicans and centrist Democrats shared for large government has given way to an appreciation by both of the need for a competent government. We have a renewed recognition of the benefits an efficient government can provide, especially an ability to plan for and act quickly in a national emergency. Only a well run central government can do that to protect an entire country.

With the utter failure of the Trump administration to be prepared for a worldwide deadly epidemic that his own intelligence agencies warned him about back in January, people realize that in a complex, connected, global society we are not an island. We are not a bunch of primitive frontier survivalists who can retreat to some forest fallout shelter. Even in small towns and on farms, we depend on far reaching global communities whose health and prosperity affect our own. We need competent leaders who can manage those risks.

And we need a government that can provide aid in emergencies. When you have to practice social distancing, shut down businesses, put your economy on life support, and throw people out of jobs, you need the Calvary to ride to the rescue. That can't be helped.

So while an incompetent and self-absorbed president and his equally inept and unimaginative aides can only propose opening everything up too soon, endangering health and safety in an inadequate attempt to restart an economy in collapse, other leaders are looking at what our counterparts in other nations are doing. They are watching to see what works and what fails elsewhere. Those more capable officials are paying attention to the examples of those who were too slow to shut down or too quick to open back up. Most public health experts warn bluntly about returning to normal too soon after the curve is flattened, warning the rates of infections and death tolls could shoot back up and defeat all the hard work and sacrifice we've already made. Not to mention it would cause even more human suffering and claim more lives.

What hasn't escaped some political leaders' notice is how countries like the UK, Netherlands, and Denmark have handled their nations' ensuing recessions and unemployment by replacing the salaries of unemployed workers in order to keep them afloat while they shelter in place safely.

Here in the U.S. one of the Republican Party's rising stars, Missouri Representative Josh Hawley, who once joined a lawsuit to stop the Affordable Care Act, just wrote an op-ed endorsing the idea of providing Americans with up to 80 percent of their salary during this time of severe crisis.

Here is what I propose: Because the government has taken the step of closing the economy to protect public health, Congress should in turn protect every single job in this country for the duration of this crisis. And Congress should help our businesses rehire every worker who has already lost a job because of the coronavirus.

Beginning immediately, the federal government should cover 80 percent of wages for workers at any U.S. business, up to the national median wage, until this emergency is over. Further, it should offer businesses a bonus for rehiring workers laid off over the past month. The goal must be to get unemployment down — now — to secure American workers and their families, and to help businesses get ready to restart as soon as possible.

That would have been inconceivable even a short time ago.  But the changes go even deeper. Here is a post from one of Virginia's oldest, most well-respected conservative blogs, Bearing Drift, from blogger M.D. Russ.

The future is out there, but it is going to be far from great, especially if you are a free market fiscal conservative, something that is now as nearly extinct as a Rockefeller Republican and a Red Dog Democrat. The Federal government, after considerable bickering in Congress over corporate welfare versus workers’ rights, has passed an economic stimulus package that will cost an estimated $2 trillion. In one fell swoop our elected representatives have increased the national debt by almost 10 percent in less than ten days.

This is just the first of several stimulus packages to come. To put that GBN (great big number) into context, the last time the national debt increased 10 percent it took three years (2009-2011) and less than $1 trillion in Federal relief during the Great Recession. Put another way, economists like to express the national debt as a ratio of debt-to-GDP (Gross Domestic Product) which more accurately portrays the ability to not just service the debt but to amortize it.

Russ goes on to outline what he thinks is coming. To be sure, he is not happy with it at all. But he seems to understand the reality and even necessity of the coming changes, in a way that anticipates Hawley's embrace of a large relief package. Russ's litany includes a recognition of the plight of low wage workers and their need for a living wage, the coming public embrace of a single payer healthcare system.

To be honest, I don't see Hawley or Russ as new converts to progressivism so much as sharing a grim recognition that this is what the country will need to get back on its feet after the staggering effects of disease, death, and economic collapse. These are truly dire times unlike anything we've been prepared for. But it's not something you would've seen written in Bearing Drift ten years ago. Or even two months ago.

Finally, the sobering shortages of everything from face masks and other protective gear for first responders and medical workers to consumer goods like disinfectant and toilet paper has led many to question the strength of our supply chains and to conclude we need an industrial policy and a return of at least some crucial consumer manufacturing to America.

The truth is I don't expect most conservatives to ditch years of mistrust for big government to embrace socialist ideas. Indeed, I suspect most of the country, including many liberals, would still reject the label "socialist" for any solution.. But the idea of a Universal Basic Income, which has been bubbling around in fringe libertarian and leftist circles, and which was championed by long shot Democratic candidate Andrew Young is getting renewed attention. So is the once ridiculed concept of Modern Monetary Theory, a long dismissed economic theory from the left fringe.

I think the conversation has changed and a critical mass of people are questioning old, easy  assumptions about the left, the right, the role of  government, free markets, free trade, globalism, deficit spending and neoliberalism.

Free markets are good. But so is regulation to prevent abuse from monopolies. Big business can be as much of a threat to liberty as big government. Regulations protect health, safety, the environment, and our national security.  Global trade is good, but not outsourcing and off shoring all your manufacturing capacity. Limited government leads to liberty, except when the inability to respond to a national emergency kills your loved ones. Too much debt and deficit spending isn't good, except when it is, when it's necessary.

Most of all, what has changed is that Ayn Rand's philosophy about the "virtue of selfishness" has been replaced by a greater appreciation for self-sacrifice and altruism in a crisis. Howard Roark and John Galt, two of Ayn Rand's most beloved characters, are no longer cultural heroes even on the right. They've been replaced by firefighters, EMT workers, nurses, and doctors. Our newest heroes are checkout clerks and gig workers who are willing to brave a deadly virus to keep those of us more vulnerable supplied with lettuce, milk, bread, and, yes when it's available, toilet paper.  When this is done, I think there will be a new appreciation for and celebration of the common man and woman who works on the front lines for us. And a finer appreciation for community and civic responsibility. We are also going to appreciate our neighbors, friends, and families. We have rediscovered we really are all in this together.

America Was Sucker Punched By Our Own President In His Coronavirus Response

I have tried to keep the political out of this blog and to focus more on personal essays rather than opinion pieces. That's been a deliberate decision. I spent a lot of the mid-2000s as a political essayist and the bulk of my writing used to be advocacy journalism - yeah, it actually has a real name. I tried to be the blog version of a political columnist, offering analysis and opinion and trying to influence my readers. That's not what I want to do this time. I am looking more for a creative outlet that focuses more on narrative and observance. More on the personal.

But it's hard to deny that sometimes the personal is political. It would be wrong to publish articles and essays on life during a deadly pandemic while ignoring the political dimensions, especially the incredible way an unfit president has betrayed and weakened our country beyond recognition.

I am going to take it as a given that most of my readers agree with me that Trump was never a fit president. He never was presidential; never had the gravitas, knowledge base, or interest in developing it, for the job.

But nowhere has that been more apparent than now. Like others, I prayed we would not have a real crisis during Trump's administration. The crises I feared were terrorist attacks, economic downturns, security breaches. I never dreamed it would be a deadly pandemic that would go down in the books for being as deadly as the Pandemic of 1918.

Trump has always been impulsive, defiant, and disdainful of facts, evidence, and expertise. That has been well-documented. Indeed, it is why his followers voted him in. He was the big middle finger to all the elites and experts they perceived as looking down on them. I'm not sure their anger is entirely unjustified. It was those economic experts who minimized their pain at job losses as well-paying manufacturing jobs fled overseas, after all, with nothing coming into their communities to replace what they lost.

Bu it was also the middle finger to science that predicted the environmental depredations of global warming, a true crisis, and probably in part responsible for a rise in pandemics, among other ecological dangers.

So, with all that in mind, I am going to document, even though it's all information already out there in public, the ways Trump has mismanaged the response to the pandemic and how that has caused incredible suffering and death, some of which could have been avoided.

First, let me say, as others have, Trump is not responsible for the pandemic. But he bears large responsibility for how badly mismanaged it has been.

Indeed, some of the lack of foresight goes back to 2018, as this Vox article shows, when his administration dismantled the White House team in charge of pandemic response, which had been set up under the Obama administration in response to an earlier outbreak of Ebola in 2014.

It began in April 2018 — more than a year and a half before the SARS-CoV-2 virus and the disease it causes, Covid-19, sickened enough people in China that authorities realized they were dealing with a new disease.

The Trump administration, with John Bolton newly at the helm of the White House National Security Council, began dismantling the team in charge of pandemic response, firing its leadership and disbanding the team in spring 2018.

The cuts, coupled with the administration’s repeated calls to cut the budget for the Centers for Disease Control and Prevention (CDC) and other public health agencies, made it clear that the Trump administration wasn’t prioritizing the federal government’s ability to respond to disease outbreaks.

That lack of attention to preparedness, experts say, helps explain why the Trump administration has consistently botched its response to the coronavirus pandemic.

And botched is actually a kind way of putting it.

This pandemic did not hit us suddenly and without warning. Far from it. The outbreak began in Wuhan, China at the end of December. To be sure, at the beginning, the Chinese Communist government hid the true nature of the emerging and mysterious illness and downplayed its deadliness. China was slow to share any of its information, and I believe when this is over, they must be held accountable on the world stage for their role in its deadly spread.

But by early January, our intelligence community was reporting to the White House that a new disease was emerging and we needed to start planning for what could be a deadly outbreak. Trump, time and again, showed little interest.

Instead of beefing up our national stockpile of emergency medical supplies and equipment, Trump ignored the threat. And as the deadly virus began spreading beyond China, Trump continued to downplay it all the way up until the end of March.

By early March, when Italy's healthcare system was collapsing and their death tolls were reaching shocking levels, Trump was assuring his followers that they had nothing to worry about. He was calling the virus a hoax - as he does all bad news. Among his dumb statements was one promising that one day, when it warmed up, the virus would be gone, "like a miracle."

He resisted early calls for shutting down nonessential business, social distancing, and closing schools and government buildings. And when he finally bowed to a reality that could no longer be denied, he did so grudgingly and still sending mixed messages. On the one hand, yes, he finally, far too late, urged states to shut down nonessential business, only to reverse himself and insist they should reopen by April 12, He wanted churches filled for Easter - a nod and dog whistle to his fact and evidence-challenged evangelical base.

Even now, he holds daily public briefings, surrounded by two of the most respected infectious disease specialists and public health experts, Dr. Anthony Fauci and Dr. Deborah Birx, only to undercut their advice. And he keeps pushing unproven and possibly dangerous remedies like chloroquine and azithromycin as a treatment for Covid-19.

This is only a brief description of the panic, denial, and dysfunction that has emerged as the administration's response to a modern day plague. The Washington Post has a detailed description of of all that has been botched.

 Despite these and other extreme steps, the United States will likely go down as the country that was supposedly best prepared to fight a pandemic but ended up catastrophically overmatched by the novel coronavirus, sustaining heavier casualties than any other nation.  

It did not have to happen this way. Though not perfectly prepared, the United States had more expertise, resources, plans and epidemiological experience than dozens of countries that ultimately fared far better in fending off the virus.

Not only should we have been best prepared, we actually had the most warning. This originated in China. Cases were popping up throughout Asia. We had a window to what was working in countries like South Korea and Singapore, where early, aggressive testing, contact tracing, and acting quickly to quarantine infected people limited the spread of disease and saved lives. Indeed, we also saw the terrible results of failing to act quickly when Italy's healthcare system became overwhelmed.

We watched for about three weeks as the situation in Northern Italy's most prosperous region became the site of stacked up body bags, shortages of ventilators and mounting death counts. A group of doctors from Italy got together and issued a public letter pleading with the rest of the world to take aggressive measures quickly to avoid their fate, becoming a charnel house

Even as that was unfolding, Trump was in denial, underplaying the threat, cracking jokes, and urging people to ignore warnings. Meanwhile, the CDC had botched development of accurate tests, For weeks after it finally sank in with all but the densest that we were fast sinking, the CDC was so short on tests that they were denying sick people needed testing. Their guidance was ridiculous. Ignoring obvious virus symptoms, their criteria was only the most serious of cases with known contact with other covid-19 patients could be tested. People showing up in ERs were denied tests and often sent home and told to simply self quarantine and self care.

This lack of testing, by the way, will continue to hamper our efforts to recover. With lack of accurate data about true infection rates, how will we even know for certain when it's receding and ending the shutdowns is safe? The truth is, we have so severely under counted the number of cases that an accurate count and successful recovery is probably impossible. We may well end up back at square one with even higher death counts later when we all come back out, possibly too quickly, because we simply don't know what we don't know. Absent adequate data, effective public health policy is impossible.

Here's another example of the CDC's flubbed response. For weeks, CDC guidelines were to not wear masks in public because, according to the CDC, they did not protect against covid-19. But contradicting themselves, they said masks were needed by health care workers to protect them. Of course, in a shortage, those at the front line caring for the sick need all the protective gear, including medical grade masks. But the CDC insisting they weren't protective except when they were, didn't earn them any credibility. And it only confused an already mistrustful public.

Never mind the question of why there was such a dire shortage of masks and gowns for hospital workers and other first responders in the first place. The obvious fact is masks do, in fact, offer some protection. At very least, along with social distancing, they keep an infected person from spreading their germs to healthy people. And they offer some protection - again, along with distancing - to healthy people by at least slowing down the spread of droplets and maybe lowering the viral load a healthy person is exposed to.

A few days ago Dr. Birx admitted as much and CDC guidelines on this were reversed. They were honest that medical grade masks should be reserved for hospital staff because there was a shortage. But, yes, everybody venturing out should use some homemade face covering.

In all this, from the very top, starting with the president, to his political appointees to the CDC there has been a botched effort. From emergency preparedness to early response, to a coherent message and effective policy everything has been fumbled and mismanaged.

Americans deserve better. And absent that better, we deserve a deep dive when this is done so we are never caught so unprepared or badly served again.

Looking Out My Front Door and the Risks and Blessings of Neighbors

Looking out my front door

I have to confess that Dan and I have failed to do one of the recommended things during this coronavirus pandemic. While we have stringently observed social distancing, only going out to buy needed groceries, and washing hands scrupulously, we have invited our downstairs neighbor, Michael, up a couple of times.

I do it with a great deal of trepidation. But he is 71, retired, and social distances himself as much as we do. Like us, he's been careful to only go out for grocery shopping. Indeed, he goes out only once a week, less than Dan has gone shopping (though Dan's consolidated and reduced his outdoor foraging too). The thing is our neighbor lives alone.

We all, along with one other neighbor, an 85 year old widow, Shirley, used to go out to dinner every Friday night and then come back to our house to watch Rachel Maddow and Bill Maher. Those were some of my favorite times, being with these dear neighbors we've known for over 30 years.

Our last dinner out was in early March as the true seriousness was starting to hit. Indeed, we went to a popular spot in Fairfax City, a place where you usually need reservations on a crowded Friday night. Keeping a safe social distance was not a problem this night, though. There were only three other tables there. The staff catered to us.

The following week, after we'd all already been housebound the entire time. We ordered a pizza from Villa Bella, in Burke, where they did curbside delivery. We brought it home and invited our neighbors. Shirley declined but Michael came over. It was the last Bill Maher appearance for a couple of weeks as he announced he would take a hiatus. And we all parted that night with the unspoken understanding that we too would take a hiatus on our weekly get togethers. That was two weeks ago.

This week, another of our favorites in Burke, Hopsfrog Grille just opened up for curbside business as well. My favorite bartender from there, Josh, called to let us know. We found the menu online and called Michael and Shirley. She again declined, but Michael, who lives alone, eagerly accepted. I can only imagine how hard this self quarantine must be for somebody living alone. At least, Dan and I have each other to talk to and just to have physical proximity. There's a comfort to having a loved one's physical presence in the house, even when you are in separate rooms.

So, Friday night, we ordered from Hopsfrog. I made Michael and me Manhattans, we served some wine, chatted and dined and then retired to the living room to watch Rachel and Bill Maher, back from his hiatus and broadcasting live from his home on his iPhone.

As the number of cases grow, as the risk goes up exponentially, I'm not sure how long we will continue to invite Michael over. It breaks my heart because he's alone. But each person is not just an individual risk. Each person carries the risk of every person he has come in contact with. Even with all of us practicing all the good hygiene, the risks go up. He has to go out. Dan goes out. I stay home more and more, except for brief walks alone. But not only is Michael a greater risk to us each week. We both present a risk to him - indeed a double risk. So, I just don't know.

Today, though, Michael called Dan with a special request. Michael's cat, Frodo, is dying and Michael wanted a last picture of himself with Frodo. Without even stopping to question, Dan grabbed his camera to go down to Michael's condo to take the photo. Risky?

Yes. As I said, every contact outside your immediate home is a big risk. But sometimes human kindness and basic decency demand a calculated risk. I hope we are not behaving irresponsibly. We all of us are limiting social contact outside the home, washing our hands, donning masks and gloves, and doing all the other things recommended. And we are only seeing the person in the apartment directly under us.

Meanwhile, a lady Dan and I work with (she used to be Dan's office manager before she got promoted and Dan got me to do that work), offered us some cloth masks. Her mother and some others are making them for nurses and she offered us about four. Dan and I will take two (and launder them after each use) and give the remaining two to Michael and Shirley.

Later today, when Dan was out walking, he ran into another neighbor who told him that she'd made a Costco run. She got lots of paper towels, something we were beginning to run low on and hadn't seen on store shelves for a while. She promptly brought Dan out two big mega rolls.

Neighbors. They are a blessing. In all times but especially now.