6 Percent

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I keep seeing people posting this statistic from the CDC that COVID-19 is the only cause of death mentioned for 6% of deaths attributed to it. In other words, people had some other disease or injury in addition to COVID.

The first post I saw about this, the person just captioned it like, "This is interesting..." I left a comment that I [legitimately] didn't know what they were getting at, because yes, it's true that COVID deaths in otherwise totally robust and healthy people are probably rare. But we've been told this whole time that having other health conditions puts people at a greater risk of complications from COVID, and unfortunately this impacts many people. I then suggested the poster look at the CDC's excess deaths data, instead, which would better illustrate the discrepancy around deaths where the cause hasn't been determined. Another commenter made a good comparison to AIDS - most people don't die directly from AIDS, but from pneumonia or some other illness that is exacerbated by the patient's immune deficiency. 

The original poster commented that the comorbidities they were seeing were unrelated things like poisoning and injuries, which they had determined by looking at the ICD-10 codes. These are the codes used to categorize the reason for your visit to or treatment by doctors. Another commenter explained that these codes stay with you for a year. So if someone had been treated for an injury in January, and then died of COVID in June, the code for the injury would still be listed with them. That doesn't mean they died from the injury instead of or in addition to COVID.

I had thought this theory came directly from the person who posted it, who had been poking around the CDC web site and thought they found an interesting discrepancy, but the next day I saw it shared by someone else, tagging groups of like-minded people, and someone in the comments there referred to it as a viral post or theory. So I think it must be going around in circles of people trying to prove that death rates are being overstated. (Edit: This statistic was apparently shared in a tweet by the president, which was later removed from Twitter, but not before enough people got wind of it that they decided to go to the CDC web site and see for themselves.) I've said before that people should be wary of the source when posting data and theories like this, but I guess another caveat should be that even if it comes from a reliable source like the CDC, you also have to understand the data you're looking at before jumping to conclusions or assuming there's some kind of conspiracy or coverup going on 🤷‍♀️

Mental Surge Capacity

I just read the excellent article Your ‘Surge Capacity’ Is Depleted — It’s Why You Feel Awful. It pretty much aligns with how I've felt for the last 5+ months .. Early on I had a handle on this, but as it's dragged on, I've had bouts of discouragement, frustration, and ennui.

A few of my favorite quotes from the article:

“'This is a once in a lifetime experience. It’s expecting a lot to think we’d be managing this really well. ...This is an unprecedented disaster for most of us that is profound in its impact on our daily lives,' says Masten. But it’s different from a hurricane or tornado where you can look outside and see the damage. The destruction is, for most people, invisible and ongoing. So many systems aren’t working as they normally do right now, which means radical shifts in work, school, and home life that almost none of us have experience with. Even those who have worked in disaster recovery or served in the military are facing a different kind of uncertainty right now."

“Our culture is very solution-oriented, which is a good way of thinking for many things ... It’s partly responsible for getting a man on the moon and a rover on Mars and all the things we’ve done in this country that are wonderful. But it’s a very destructive way of thinking when you’re faced with a problem that has no solution, at least for a while.”

"Acceptance doesn’t mean giving up, he says. It means not resisting or fighting reality so that you can apply your energy elsewhere. 'It allows you to step into a more spacious mental space that allows you to do things that are constructive instead of being mired in a state of psychological self torment.'"

"I might have intellectually accepted back in March that the next two years (or more?) are going to be nothing like normal, and not even predictable in how they won’t be normal. But cognitively recognizing and accepting that fact and emotionally incorporating that reality into everyday life aren’t the same."

Dermatologist

Today I had my first medical appointment since the pandemic started ... Actually the first time I had physical contact with anyone but my husband. I went to the dermatologist for my annual skin screening and to have a couple weird moles checked out.

I felt totally comfortable the whole time. The doctor is in a large medical building with several different practices, and they set it up so everyone has to use a single entrance, where they perform a temperature check. They use some kind of thermal scanner that just picks up general heat, so a) everyone who came in got dinged for being too warm, had to wait a minute, and then scanned fine, and b) this doesn't even tell you anything because many people are sick with no fever. And of course all visitors to the building must wear a mask.

Once inside, I checked in at my doctor's office area. There was glass up across the whole front desk, and I didn't have to sign anything or do any paperwork, just gave my name. The chairs in the waiting area were spaced out into the lobby, and every other chair was blocked with a sign saying not to sit there.

Usually the doctor has an assistant with her while performing the exam. In what I assume was an effort to limit contact between multiple people, I was only with one person at a time. The doctor herself came to call me from the lobby, wearing a mask, plastic face shield, and paper gown over her scrubs. She let me get changed, then came back to perform the exam. I had one mole removed, and she left and a different nurse came in to set up for the procedure and apply numbing agent. Then my doctor returned to remove the mole herself - again, usually this is done with an assistant. 

I got an elbow bump from her on my way out, and the whole visit took about 20 minutes. Overall, very good experience. I have another medical appointment coming up in a few weeks in the same facility and I feel more at ease about it now. (Still nervous for the dentist, though 🙈)

Reinfection

The big story this week is that there is now documented proof that a person can be reinfected with the coronavirus. Until this point, people who recovered and then got sick again were thought to have not fully cleared the virus from their body in the first place. Or if they were positive, then tested negative, and then tested positive again, maybe the middle test was a false negative (why some places require two negative tests to confirm recovery).

This patient, in Hong Kong, tested positive in March. Then four months later, picked up a different strain while traveling in Spain, and has tested positive again. However, they have no symptoms this time, which means their immune system is working as intended! And also .. this is only one confirmed case. It might be very rare that this even happens.

Supervised School

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Look, I am all for keeping schools closed for in-person learning and activities right now. But I know there are cases where parents aren't available to stay home with their kids all day as they do their online learning, or maybe the kid would even benefit from the structure of just going somewhere else to do their schoolwork in a more structured environment. In my opinion, the solution for this is to have as many students learn from home as possible, leaving ample space throughout all schools to distribute anyone who does need to be on-site.

The school district where I live is 100% virtual through the end of the year, which I really appreciate, and I was happy to see a program announced today for students to attend a full-day, on-site, supervised program to complete their online learning. But I was dismayed to see it's almost $3000 per attendee! That's just not fair.

I'm not a parent, and I'm thankful that I don't have to make these kinds of decisions and trade-offs myself, but if you are in a situation where all adults in the household have to go out to work and nobody can supervise your children doing online learning, it may also be a struggle to afford $3000 per child for someone else to provide this service.

Acceptable Level

Six feet apart,

wearing masks,

washing your hands,

in groups of 25 people or fewer...

...does not mean nobody will catch or spread the coronavirus. It just means that the amount of spread will be kept to an acceptably low level so as not to overwhelm the healthcare system.

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Staycation

My husband and I took the past week off from work. I'd been toying with the idea of renting a secluded lake house or something, as many of my friends have done, but was never comfortable with the idea. So we stayed home, relaxed, and did some local activities. 

Monday: We visited a large botanical garden that's a popular tourist destination in our area. Their precautions include timed tickets to limit guests (advanced reservations preferred), masks and social distancing when around others, and some restrooms are closed. We arrived first thing in the morning. Check in was a breeze, people wore masks and were respectful of distancing, and we were easily able to avoid others, though it was starting to get a bit crowded in some areas by the time we left a couple hours later. I don't think I would have wanted to go if the crowds were like that the whole time.

Tuesday: I suggested we visit an ethnic supermarket we like. I don't know what I was thinking 🤦‍♀️ I've been avoiding the regular supermarket, and that's basically what this place is - plus it's in a more populated area, and is small with narrow aisles. There were several times I wanted to abandon our cart and leave. Lots of crowding, questionable mask use (lots of noses out), etc. I was pretty upset by the time we left, to be honest.

Wednesday: We'd been planning to visit another local garden, but I realized too late that you needed a reservation in advance, and they were already booked for the week. Instead, we went to a nearby national park and strolled around some of the historic areas. It was my husband's birthday, so we got take-out from a favorite fancy steak restaurant, and then I surprised him with a Zoom call with some of his friends.

Thursday: Truly a day off!

Friday: We visited a local arboretum and garden. We had both grown up minutes from this place, but had never been! We were there first thing in the morning, and it was a great experience - the weather was beautiful, the paths were shady, there were only a few others there, and many of the trails were marked as one-way, so you didn't have to worry about crossing others on the narrow walkways. We covered everything in about an hour, which was a nice morning activity.

Even though we never left home (and I was still checking in with work, and my husband was still working on his side projects), it was a nice, relaxing week. And we got to see some things in our own area we probably never would have if we hadn't been avoiding travel.

Mail-In Ballots

 Even though we're still months away from the general election, the big news this week has been about voting, specifically voting by mail. While voting by mail has benefits over voting in person at the polls even in normal times, during a pandemic it's especially important because it helps people continue to distance and not congregate, touch a bunch of communal stuff, etc. I voted by mail in the primary election earlier this year, and it was a great process - I got to take my time researching the candidates, didn't have to make a special trip anywhere, and didn't have to schedule it around work, etc.

However, for the fall election, the president has straight up said he has been dismantling the US Postal Service. They're removing machinery to make the service less efficient, they've placed people in charge who have financial interests in the post office's competitors, and the USPS has already warned most states that they can't guarantee on-time delivery of mail-in ballots based on their current guidelines. The president is working to erode faith in the postal system, believing that his supporters will still be the ones who go vote in person, while his opponents will responsibly stay home and vote by mail and be disenfranchised due to lateness.

A couple things about that...

1. In addition to ballots, there are a lot of other things that are sent by mail, some of which his constituents may like: medication, checks, bills, letters from grandkids, dog sweaters, etc. 
2. There are other places to return your ballot than a mailbox. For example, many communities offer drop boxes, or you can deliver it directly to the county election office or even turn it in at your polling place on election day. 

But here's the dumbest thing I've seen yet: people are posting all over social media about how they don't trust mail-in voting and they are totally going in person in November. Then a lot of people add something like, "Vote in person or by absentee ballot, not mail-in." Um... absentee ballots and mail-in ballots are the exact same thing. The only difference is that you have to provide an "excuse" for an absentee ballot. How do I know this for sure? Because last November, I was traveling out of state on election day, so I requested an absentee ballot and mailed it back. This year, the law changed in my state to allow "no excuse absentee ballots" (i.e. mail-in voting), and in the spring, I requested a ballot in the mail and mailed it back. The process and the documents I received were exactly the same in both cases. Also, it was the same piece of paper that I would have received at the in-person polling place.

Anyway, I have already requested my mail-in ballot for November. I will probably deliver it myself to the election office, or at least use a community drop box, depending on what's set up by then. But I do not plan to wait around in lines and crowds during a pandemic.

Two Opinions

Throughout this outbreak/epidemic/pandemic, I've found myself wavering between two opinions.

Back in February and March, I was between, "This is nothing and will all blow over," and "We need to prepare right now for a months-long lockdown and I should have been stockpiling canned goods and planting a vegetable garden."

Then in the spring, I was between, "This is going to become a really dire situation with supply chains breaking down, and jobless people looting for food," versus "People will follow medical advice and do what they need to do and things will get under control."

Now I'm vacillating between, "People are slowly coming around [to things like masks], putting policies in place [like prohibiting certain types of activities], and making difficult decisions [like starting school online], this will all be okay," and "Our opportunity to control this disease is ending and people aren't doing enough."

I've been saying for a while, this all seems fun now, in the summer, when we can move certain businesses and activities outside. But I don't think anyone is going to want to enjoy patio dining in November and December, at least not in my area of the country, so if businesses want to be able to open more broadly anytime soon (or have more people feel comfortable patronizing them), we need to take action now. So far, we've only dealt with this disease in the spring and summer in the US. As more necessary activities move back indoors, where chances of transmission of the virus are higher, plus the regular seasonal cold and flu start circulating more, things could become very dire. I'd seen some writing about this a while ago, and thought maybe we were at least past that harsh prediction, but this STAT article, Winter is coming: Why America’s window of opportunity to beat back Covid-19 is closing, came out yesterday and is all over the place today. "Unless Americans use the dwindling weeks between now and the onset of 'indoor weather' to tamp down transmission in the country, this winter could be Dickensianly bleak, public health experts warn."

In other news, I'd been convinced for the past few weeks that I had a dental appointment today. I've seen a lot of interviews with epidemiologists and other experts who say they wouldn't go to the dentist at all right now unless it was an emergency, so I was nervous, but figured this is probably as safe as it'll ever be around here... I was getting myself mentally prepared to have someone inside my mouth, but, I realized this morning when I found that my two calendars didn't match that today was my original appointment, and I've been rescheduled for October. On one hand, I'm relieved that I don't have to deal with this right now, but on the other hand, who knows what things will be like in two months? Coincidentally, I saw an article today about going to the dentist during a pandemic, and they say if the positive testing rate in your area is below 5%, it's a safe time to go. It's 5.1% right now in my state, and 3.5% in my county, so hopefully it's the same or better by October 😕

Let's Talk About Masks Again

As divisive as masks were earlier in the summer, at this point it seems like even anti-mask people have resigned themselves to the fact that they're going to need to wear them for the time being, just to be in society without people glaring at them. Besides a quick blip of "masks give you Legionairres' disease" (spoiler: no they don't), most of the theories about negative effects of masks seem to have quieted down.

There are still people saying that masks may not hurt, but don't help either, citing the fact that Europe and other places never really implemented mask wearing, and they're now reopening their economies. While that may be true, the outbreaks in these counties never reached the staggering levels it has in the US. Considering how far gone things are here, we should be taking every possible precaution to prevent further spread of this disease, and masks are a simple and safe way to do that.

Finally, let's talk about people's choices in terms of what mask they wear, and how they wear it. For the most part, the people I have personally seen wearing masks in public are wearing them correctly - not a lot of "chinstraps" or noses hanging out. And of course, I would prefer that all people wear masks and wear them correctly. But, if being able to pop your nose out once in a while is the thing that makes it bearable for you, as opposed to not wearing a mask at all, I'm ok with that. Given the choice, I guess I'd rather have someone's mouth covered than their nose, just because of spitting while talking and such (and assuming they still cover their nose when they sneeze). There have also been many studies about the most effective style and material mask to wear. While some materials are more effective than others, again, I'd rather you just cover your face holes with something, and if a certain type of fabric makes it more bearable for you and makes you more likely to wear a mask, even if less effective, I'm ok with it. However, I did just see this interesting research about the most effective masks that found that neck gaiters are actually worse than not wearing a mask at all! I know a lot of people favor this style, because they can pull it down like a neck scarf when not in use, but I have problems with that as well (all the constant touching of the mask, and holding the outside part so close to your face). So maybe word will get out that these will become a less widespread option.

Either way, everything we're doing in order to be in public or with others - masks, hand washing, distancing, etc. - is not going to 100% prevent you from getting sick. Nobody ever said it would. But it's not pointless. The goal is just to keep the amount of sick people to a reasonable and manageable level. So if you really want to keep from getting sick, you know what you need to do: stay home.

Family Friendly

This weekend my close family got together for our first group visit since the pandemic started. We took a number of precautions:

• Limited number of people (five)
• Outdoors
• Spaced well over 6 feet apart
• Wearing masks
• No eating or drinking (it was like 90°, so a couple people did push their mask aside briefly for a sip of water)

Was this overkill? Probably. But considering we had in the group a nonagenarian, a COVID survivor, people with auto-immune conditions, and someone who regularly interacts closely with others, we were willing to take all these precautions, and we had a really nice visit, except for all the bug bites I got while sitting in the grass.

The Future and the Past

I've seen a couple good articles in the last few days that give good future and historical perspective for our current situation.

From the Washington Post, A coronavirus vaccine won’t change the world right away - as I've been saying, it really bothers me when people are like, "Oh once there's a vaccine, I'll ___," like everyone just goes out the next day, gets a shot, and the world is back to normal. It will still be years after the discovery of an effective vaccine before the world is anything close to "normal." Which then leads to The Atlantic's article, The Coronavirus Is Never Going Away. Their best case scenario is that we get it under control with vaccines and treatments, and it becomes a regularly circulating seasonal respiratory virus. They also postulate that the other four "common cold" coronaviruses also started as pandemics, before becoming commonplace.

I also read this fantastic article from Nova, What polio in post-WWII America can teach us about living in a pandemic. Of course I knew about the mid-20th century polio epidemic, but I didn't realize how many similarities there were to the current pandemic - for example, children having to stay indoors and away from friends, closing public places where people may gather, and turning to the radio for both entertainment and education while school openings were delayed. Of course, unlike today, people seemed to throw their trust into science and the government. Even after an initial vaccine sickened and killed numerous children, parents still had their children vaccinated. And people were maybe so into science that they went overboard with any treatment that may possibly help, like dousing everything with the chemical pesticide DDT. Once a safe vaccine was discovered, it was still many years before they were able to distribute it enough to effectively control the disease in the US.

Hopefully we can learn from the past, and be ready to face the future.

August Life

On Friday night, we went to a drive-in theater. I had seen an article a couple weeks ago in a local Facebook group about this pop-up drive-in company that was setting up in our area, and immediately booked tickets just for something to do. They are mostly showing classic and kids' movies, but we went to see "Palm Springs," a new comedy/romance/sci-fi(?) film that unfortunately totally missed its opportunity to release in theaters ... but as a "Groundhog Day" type "time loop" movie, it's sort of apropos for the time we're in. The movie was good, and besides a lack of signage entering the drive-in area, the whole thing was pretty well organized. They did have a little snack booth and port-a-potties, but we used the bathroom before we left home and brought our own snacks 😂 They required attendees wear masks when outside their cars, and everyone I saw walking around seemed to respect that. You could play audio via an app on your phone, or the car radio - due to technical issues, we ended up trying both, and neither was foolproof, but it sounds like they're working on improvements. Overall, it was a good experience, though I don't think I'd go to see an old movie I could watch from the comfort of my couch - but might consider it for another new release I was interested in.

Over the weekend, a hurricane/tropical storm formed in the Caribbean and made its way toward the east coast. Isaias grazed Florida before making its way up the east coast, hitting my area on Tuesday morning. We had flooding rains for much of the day, followed by high winds. There were tornado watches and warnings throughout the day, but none in my immediate area. Luckily, our power didn't go out, though I know there are many outages in the region. There was also major flooding in our area, especially near creeks and rivers that overflowed. We had just a little water in the basement, but a few minutes with the shop vac took care of it. We got very lucky this time! Meanwhile, Isaias has continued north toward New England, and I believe is expected to hit Maine and Canada at some point...

Last night, the school board in the district where I live voted to offer remote instruction only, through winter break (i.e. through the end of the year). I guess they'll see how things are looking later in the year to determine the plan for 2021. I've seen mixed reactions in local Facebook groups - luckily, none seem particularly angry or upset. I think most parents are relieved not to have to make the decision on whether to send their children back to the school building. But of course, learning from a computer at home is not ideal, especially if parents have to work, and so a lot of people are looking to form "pods" with other families, hire some sort of tutor, or send their children to a private school. I saw someone mention that the state teachers' association refused to allow any school district to come back in person. I don't know how accurate that is or what kind of force is behind it, because I know teachers in our state who are still on track to be back in the classroom full time. People are saying that the teachers are upset because they want to be back at work. I know many teachers, and while they are sad to be away from their students and in a challenging situation to teach, they are more upset about being forced to be in the classroom and put themselves, their families, and their students at risk. This will certainly be an interesting year, and even though I don't have kids, I'm definitely interested to see how this all plays out. Schools that have reopened already have students and teachers testing positive and quarantining.