Saturday, April 04, 2020

Weekend Reading: The Third Week Edition

I should probably stop naming these posts by week, because in awhile that is going to get depressing.

I took yesterday off and feel more refreshed, which is a good thing because I have several emails from the school to read to prepare for next week. Instruction is resuming, although grading doesn't start again until April 27 because the district needs time to distribute laptops to those that need them and also sort out internet connections for families that need them. I have a bunch of links to read through for my 4th grader. Luckily, the 7th grader can mostly handle her stuff herself.

This week, I tried to read less about coronavirus. The idea was that I'd then read more other things. That second part didn't really happen, although I did finally read a few more chapters of my book. I am starting to realize how much I depended on having certain routines for things like grocery shopping and how now that the routines are disrupted, chores that used to take very little time are consuming far more of my time and attention. Even when I am not actually working on them, there is part of my brain whirring away on the various logistical problems we face right now. It is somewhat exhausting and I am working on figuring out how to quiet the noise.

So I don't have a lot of links for you this week. Here's what I do have:

This xkcd cartoon is really beautiful.

If you've been curious about infection rates per capita, there is now a covid tracking source that has that option: It is one of the customization options at covidcounties.org. I am trying not to obsess about the numbers, but I have only a hazy idea of the populations of various California counties and this site helped me put some of the other numbers I've seen in context. Also, Los Angeles county is huge and I didn't realize San Diego county is the next biggest.

The CDC has changed its guidance on masks. This Ed Yong piece explains what we know about their effectiveness and might help you understand why this has become such a contentious issue. My key takeaways from all the things I've read about cloth masks is that we're wearing them to protect other people from us (not to protect ourselves from other people) and they should be a supplement not a replacement for all of the other things we're doing: staying home, staying 6 feet away from others when we do have to go out, and washing our hands a lot.

An opinion piece on why medical workers are at a higher risk from coronavirus. If nothing else has convinced you to leave the medical masks to medical workers, this might.

I had to stop reading this Washington Post article about what went wrong in our response to coronavirus because it was making me too angry. I will come back and read it at some point, though.

This article about what's happening in Wuhan right now is so sad, and the estimates people are making about the true number of deaths based on funeral information - that the real toll may be more than 40,000 people - are absolutely heartbreaking.

Here's another article with some useful tips for safely ordering takeout.

New York is merging all of its hospitals into one system to try to get resources where they are needed most.

Here's a write up on a trial that is getting started on another promising repurposed drug.

Xykademiqz wrote a good post on grocery stores and social class during this pandemic. I've observed similar things here.

This article with tips on social distancing from a man who has lived alone in a cabin in the mountains for years is just delightful. Also, it has some good advice!

Samuel L. Jackson reading an updated version of Go the F*** to Sleep - Stay the F*** at Home:

This is amazing:
Here's your bunny for the week:

Have a good weekend!

Thursday, April 02, 2020

Life in the Time of Coronavirus, Snapshot #3

This will be a short post, but there is something I've noticed that I want to write about before I forget it. It is about how kids are cheering us grown ups on right now. The sidewalks around my neighborhood are all decorated with chalk drawings. Some of this is no doubt due to bored kids doing one of the few outdoor activities still available to them. But most of the clusters of decorations include an encouraging message. "Stay Positive!" said the chalk drawing on a wall I passed today. Other chalk drawings tell me "You can do this!" and other encouraging messages.

Not to be left out, Petunia went out a couple of days ago and wrote a poem in our driveway. Here is her message for us:

Even though the path is rough
You must continue to be tough
Even though you see no light
You must continue and fight

This is written in cheerful bright pink chalk. I wonder what our neighbors think!

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In other news, we're planning a Zoom birthday party for Pumpkin, who turns 13 soon. My husband found an online trivia game she can play with her friends and she seems pretty excited for her party. After her "friends" party we'll have a separate Zoom hangout for family and other grown up friends.

We expect we'll also be celebrating out 15th wedding anniversary and possibly also my birthday in isolation. The kids told us tonight that we could go out for our anniversary dinner... in our backyard. They would be our waitstaff. We may yet hold them to that!

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We've decided that Thursday nights are takeout nights. We've done this twice so far. Both times I have gone to pick up our dinner, because I'll wear a mask. My husband is still coming around to the idea of wearing one. Both times, I have been impressed with how well the restaurant has set up for take out. It definitely feels less fraught than grocery shopping.

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I'm taking tomorrow off from work. The kids are on spring break and wanted a day to hang out together. I also think I could use a day to try to get myself into a better headspace for the long haul. I need to spend my leisure time in a way that is more revitalizing. I have realized how much I relied on my Friday afternoon rollerblades to release the stress of the week. Without that, and with extra stressors, I am struggling a bit. I think we're supposed to have a nice day tomorrow, so I want to spend some time hanging out under our avocado tree, sorting things out in my head.

Pumpkin has a special walk route she wants to take tomorrow, and Petunia is planning for some extra cuddle time. It should be nice.

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That's all I have tonight. Leave any snippets from your life that you want to share in the comments!

Saturday, March 28, 2020

Weekend Reading: The Second Week Edition

Hello from the second week of sheltering in place! San Diegans proved unable to responsibly handle having beaches to visit so our beaches and parks and trails are all now closed. I am very fortunate to have nice, quiet neighborhood streets to walk but a lot of people are not so lucky. I really think the city needs to figure out a way to allow people to get outside. We are in the early days of all of this, so perhaps they eventually will. I am trying very hard to remember that everyone has been thrust into a situation they never expected to be in and that most people are doing their best to manage.

John Scalzi wrote a good post about this moment in time, and how we all need to be patient. We can be sad, and angry, and frustrated and all of those things, too, but we need to be patient. We are in a situation in which the only way to save a lot of lives is to sort of freeze in place as much as we can. The more patience we can all muster, the better we'll all do.

If you read only one link about coronavirus this week, this Ed Yong article is probably the one you should pick. It is clear-eyed about how we got here but also about where we might go next.

Or at least read this part:


I'm seeing a lot of links to various modeling studies about when the peak will be in different states and while I think those are useful, I don't think they are always being shared with the necessary context for average people to interpret them. Like any model, these models are built on a lot of assumptions and extrapolations from what has happened in other areas. There are still many, many unknowns about the virus and the disease it causes. So a model that predicts X number of deaths if we take one course and Y if we take another is probably useful for comparing X an Y, and maybe even for getting an order of magnitude of the two numbers. But it isn't telling us with certainty when the peak number of cases will come and how many people will die.

What we know with certainty is that more people will suffer and more people will die if we don't keep distance from each other. That is also the only part of this that most of us can control. So we're back at patience.

What else can we do? Wash our hands, of course. But also we should probably all be wearing masks when we're out shopping. Here's a post that does a pretty good job (I think) of summarizing the data in an accessible way. Since there is a shortage of masks right now and I believe strongly we should leave the best options to the people most at risk - primarily health care workers, but also I think grocery store workers and people with serious underlying conditions - I have decided to start wearing the cloth masks I bought to help block the dust while cleaning. I wore one for the first time on Thursday, when I went to pick up take out from a favorite local restaurant. I felt vaguely ridiculous but it worked fine.

The key with cloth masks is that they are still single use - you just wash them after use. Are they as good as a N95 mask? Of course not. But I am not getting my face close to a sick person to examine or treat them. I'm just going to the grocery store. I'll still try to stay 6 feet away from other people. The mask, like my use of cotton gloves, is about trying to reduce risk.  Masks also reduce the risk that you'll spread the virus if you are asymptomatically infected, which is a very good thing.

If all of the talk about gloves and masks and wiping down groceries has you feeling a little panicked, you might find this Washington Post article helpful. It explains why we don't need to worry quite so much about those Amazon deliveries, for instance.

Long term, our way out of this mess is through better testing and then through having treatments for sick people and finally having a vaccine.

On the testing front, Abbott has received approval for a new, fast coronavirus test. The good news about this test is that it uses the same machines a lot of doctors and hospitals already have for flu and strep tests, which means it should help ramp up our testing a lot without requiring a lot of new machine purchases. Of course, it still depends on a sample taken with a nasal swab, and those are still in short supply as far as I know.

Here's a story about a company that makes those swabs and how they're responding to the shortage.

On the treatments front: The first place people are looking is at drugs already approved for other diseases, and then at drugs that have at least been through the Phase I safety trials for other indications. Safety trials are important, even in the current situation. If a drug helps treat COVID-19 but kills your liver or kidneys, it isn't really a good thing.

Derek Lowe at In the Pipeline has been writing an excellent series looking at what's being suggested. Here is his latest post, about some lesser known possibilities.

Lisa Jarvis, at C and EN has an excellent write up about remdesivir, Gilead's drug. Like many antivirals, it is probably most effective given early and there has been some talk about using something like this prophylactically, but it is an IV drug so it isn't a very practical option for either of those uses. The only thing I can think is that perhaps there should be a trial of prophylactic use in high risk medical workers. Of course, trials are now getting underway for treatment of patients, and I hope those turn out well - but read the linked article for why most people in the field don't expect them to be definitive.

By the way, if you saw stories about Gilead getting an orphan drug designation for remdesivir and the stories were framed as this being done for pricing reasons... the actual reason was to speed the regulatory process. They were trying to figure out how to get to larger scale distribution as quickly as they could and have withdrawn that status now that the FDA has other ways for them to do that.

You may have seen news stories about Mt. Sinai in NYC trying plasma treatment - basically, treating patients with the plasma of recovered people. Here's a tweet about a very small, preliminary test of that in China (you can click through to get to the JAMA article if you'd like):

There are people working to isolate antibodies from the blood of recovered patients, too. The idea there is to find a really good one (i.e., one that is strongly neutralizing against the virus), and then make that particular antibody at scale to give as a drug. Note that any antibody drug is going to be an IV drug, too. Here's a tweet from a researcher at The Broad Institute in Boston who is working on this.

I know some biotechs are working on this, too - one has put out a call for recovered patients here in San Diego to volunteer their blood.

I found this thread about what an experienced infectious disease science journalist did and did not predict very useful:

New Zealand has gone to a shelter in place order similar to ours here in California. There is a campaign there to put teddy bears in your windows for kids out walking with their parents to find. I find that delightful.

Still in NZ, this article on how feijoas can get you through lockdown made me laugh because I think feijoas are terrible and they are just about the last thing I'd want to stockpile to get through lockdown. My husband would probably agree with the article, though. As for me, I am eyeing the avocados coming into season on our backyard tree and thinking guacamole is going to get me through. Every time I go to the store, I buy tomatoes, jalapenos, and cilantro... and two bags of tortilla chips.

 Last week, I said I'd try to find non-coronavirus articles to share. This one about a bank in Italy that accepts cheese as collateral is several years old, but fits the bill!

This made me smile:

So did this:

Here's your bunny:
Have a good weekend, everyone! Do whatever you can to build up your patience for the long road ahead of us. For us that means putting out our hammock and walking around our neighborhood. Also probably some more guacamole.

Saturday, March 21, 2020

Weekend Reading: The One Week Down Edition

So, we've made it through one week of "sheltering in place." The order to do so only came Thursday night but it changed nothing about how we have been behaving. Once the kids came home from school last Friday, we switched to a "shelter in place"  mode. To anyone who has not yet received a shelter in place order and wonders what it life is like under one - you can try it out without the order! You probably should try it out without the order.

One week down, who knows how many weeks to go.

The timing of California's order totally messing with my grocery shopping plans - I'd planned to make what I hoped would be my last grocery run for two weeks early Friday morning. My Google maps data indicated that would be a relatively empty time in the shop. But when the order came, I knew there would be another run on the shops (like there was after the schools closed) and decided to go that night. The grocery store is ~2 minutes from my house, so I'd say I got there within 10 minutes from when the order was announced. When I arrived, the shop was pretty empty - it was easy to stay several feet away from other shoppers. When I left, there was a crowd. I got some fruit and veggies, which I had not been able to get last week. The produce section was well stocked. But this week, I couldn't get Pumpkin's lactose-free milk.  Or butter (or margarine). Or eggs. Or juice. Or pasta. Or bread. Or flour. Or bagels. And of course, no paper products of any kind.

I don't know how we get out of this mass panic/hoarding response. I actually don't even know how much is mass panic/hoarding, and how much is people trying to buy a little more to limit the number of times they have to go to the shops. My husband also pointed out that a bunch of people who probably usually eat out most meals are now buying from the shops so that is probably also messing things up.

Despite all the shortages, we have enough food that we will be able to wait a couple weeks before shopping again. My decision to start slowly stocking up back in February (which felt a bit silly at the time) turns out to have been a good one. The person who is going to suffer the most is my lactose-intolerant Pumpkin, who likes a bowl of cereal with her lactose-free milk every morning. We'll run out of that this week. I bought some rice milk for her to try (almond milk was also cleared out), but she's skeptical. Last week when I couldn't get her milk, I bought some toaster waffles. I can make bread and she likes toast. She'll be OK, but I was hoping to let my kids eat their normal food as much as possible.

Anyway, let's have some links.

Here's some advice about how to safely grocery shop right now. And here is a post by a virologist about how to decontaminate things you've bought. Figuring out how many of the more extreme steps to take is the hard part. I wear cotton gloves while shopping. Cotton because I'm saving my small supply of vinyl and latex gloves (which I always keep on hand, thanks to some earlier experiences with norovirus) in case anyone gets sick. Cotton won't work if I touch something wet, but I'm not touching anything wet. Also, I learned good glove technique in grad school so I feel reasonably confident I can wear them without making things worse. Gloves on triggers a habit to be aware of where my hands are at all times. My husband never worked in a lab to learn that habit, and opted to go the "hand sanitize often" route when he went shopping last week. I am sure you can find an online tutorial about glove technique if you want one, but most of what I was taught for the situation where you're wearing gloves to protect yourself (as opposed to protecting your sample from you) boils down to: assume your gloves are contaminated as soon as you put them on. DO NOT TOUCH YOUR FACE.

My process is to put the gloves on as I go into the store. NOT TOUCH MY FACE while in the store. Take the gloves off before opening my car door. Get in and immediately hand sanitize (we have plenty of hand sanitizer, also because of earlier experiences with norovirus). Go home, wash my hands thoroughly. Unload the groceries. Wipe down any plastic with a paper towel soaked in household cleaner, which I change frequently. Put everything away. Wash my hands thoroughly. Clean all counter tops and cupboard doors with household cleaner. Wash my hands thoroughly. Change out of my "going to the shops clothes" and put them straight in the wash pile. Shower.

If you're concerned enough to take measures, you should read the two links above as well as this article from Laurie Garrett that I linked to earlier and make your own decisions about what level of precautions you need. My process is by no means perfect, but it was what I settled on as sustainable and yet still risk-reducing.

I haven't been wearing a mask, but will start doing so, partly because none of us can be sure we aren't infected and so it is nice to try to block the spread of any germs we have. Back when it became obvious we'd be cleaning our own house for awhile, I ordered some cloth masks to help me block the dust (which inflames my asthma). Those arrive Monday. I need to look through our fire/earthquake "go bag" and check what masks I have in there. I think they are N95, bought based on recommendations about how to protect asthmatic lungs during fire season. If they are, I will set them aside to donate to my local hospital if our county has a shortage (right now we do not). Here's one of several articles from experts pushing back on the "don't wear a mask" advice. But don't wear a medical mask, and definitely not a N95, unless you are instructed to do so by your doctor.

If you'd like a better understanding of the results of the early clinical trials on potential COVID-19 treatments, Derek Lowe has provided a nice write up. Click back and forward to read more of his posts about the situation.

If you want a summary of the scientific data about why this particular coronavirus is causing so much trouble, Ed Yong has a good one.

This article by Atul Gawande about preventing spread of coronavirus in health care settings is encouraging. Yes, it was a terrible wasted opportunity that we didn't ramp up production of masks and other PPE (as well as ventilators) in January. There were many, many failures in the Trump administration and elsewhere. I am very angry about that. But that article made me feel less despondent about our chances.

This Atlantic article by two public health experts should also give us hope. It feels like we are in a never-ending lockdown, but there is a way out of it even without a vaccine. I don't trust the Trump administration to lead us there, but State Governors and public health systems are starting to fill the gap. That makes me think it will take longer than it should, but we'll get there.

This op-ed by anti-Trump Republican operated Stuart Stevens is an honest reflection about how we got here and although it won't change any minds, it made me feel better to read it.

Here's where I am at: our Federal government failed. We'll need to find out why later, although I think we can all guess the broad strokes of it. Our state and local governments are stepping up in some places, but not in others. I happen to live in a place where the state and local governments are stepping up, for which I am grateful. We're facing some critical shortages. People are trying to fill the gaps. You have probably seen the articles and tweets about distilleries making hand sanitizer. Fashion houses, theater seamstresses, home crafters, and more are stepping up to make masks. Big businesses are starting to respond and ramp up their production of things, too. We should have gotten into an "all hands on deck" response mode faster, but we lacked good leadership. We're getting there now.

I can't fix any of the mistakes that were made, and I don't have any special skills to offer to the response. The best thing I can do now is stay home and keep my little family healthy, both physically and mentally. I can look for ways to help people in my community who are losing income. I can reach out to friends remotely so that we can all feel better. And that's going to have to be enough.

In slightly less coronavirus-y news:

One thing this lockdown is showing is just how much our activities pollute the air we breathe.  See, for instance, our SoCal air which is remarkably clean right now. This has been helped by getting some rain this week, but still:

It is probably too much to hope that we'll learn from that and change our behaviors when we get back to whatever the new normal will be, but if we do, we'll need mass transit. Matt Yglesias makes the case that we need to bail out our mass transit systems now.

 True:

This made me laugh:

Here's your bunny for the week:
Have a good weekend, everyone! We'll be writing a menu plan that uses some of the odds and ends in our pantry as well as the fresh stuff I was able to buy Thursday night, making oatmeal-chocolate chip bars, and figuring our where to direct some more money to help everyone weather this. Also on the agenda are a walk on the beach, some Chinese lessons over Zoom, and a Google Hangout with my parents and some friends. I hope you find some things that make you happy, too.

Tuesday, March 17, 2020

Life in the Time of Coronavirus, Snapshot #2

After I finished work today, I drove Pumpkin down the hill to her friend's house, where she dropped off a box with a gift she'd made inside of it. She left it on the doorstep, not even ringing the doorbell, and then we drove home.

It was like a teenage prank, except it was her wanting to give her friend a gift to cheer her up and this was the safest way.

As we drove down the hill, it seemed like a normal night - people out walking their dogs or just out for a walk, families with kids out for bike rides or playing in the street. But if you paid attention you noticed what was not normal. All the kids were in family groups. No one was playing with friends. The walkers crossed the street when someone approached from the other direction. There were no little clusters of dogs yapping at each other while their owners held their leashes.

San Diego is not on a "shelter in place" order like the San Francisco area is, but life has definitely changed. Our bars and restaurants are closed, serving take out or delivery only. Movie theaters are closed. I don't actually know if all gyms are closed, but I got an email today from the YMCA saying they are closed.

Pumpkin has talked on a video chat with her friends both days this week. Petunia was jealous, so today Pumpkin kept the call open with one of her friends, so that Petunia and the friend's little sister (who is one of Petunia's good friends) could talk. It was nice, and made Petunia very happy. I'll have to work out a way for her to video chat with more of her friends.

My work closed all its offices worldwide today. Many of us had already been working from home. Now everyone is. One of my main clients is in Seattle. They are a couple weeks ahead of us on the work from home thing, and have adopted a culture of "cameras on" in our meetings. Today, I joined them in that. It was fun to see their home offices and they got a kick out of the large collection of LEGO behind me (on top of my husband's desk). Next time, they may get to see my kitchen: My husband and I compare meeting schedules in the morning to work out who gets the office and who moves to the dining room table at different times.

There are news stories circulating saying that taking ibuprofen or other NSAIDs for fever may make COVID-19 worse, and recommending taking acetaminophen instead.  There's a little circle of science/pharma folks on Twitter trying to figure out if there is any data to support this. No one has found any. As close as I can tell, the source is a letter in Lancet describing a HYPOTHESIS about why people with diabetes and hypertension may be at elevated risk. Here is a Twitter thread with the latest, and embedded in it is an earlier thread that led me to that Lancet letter:

Maybe this hypothesis is right, maybe it isn't. But if you don't already have Tylenol in your home, you aren't likely to get it now. We have children's acetaminophen because my kids like the flavor of that better than children's ibuprofen (cherry vs. grape or bubble gum). I found a bottle of acetaminophen and a bottle of acetaminophen PM. Both expired in 2014. Oops.

I started stressing about this yesterday. I went on Amazon to see if I could order acetaminophen but even as I went there I knew I would not be able to do so.  I seriously considered asking my husband to go to the drug store to try to get a bottle, but he rightly pointed out that (1) there was unlikely to be any on the shelves, and (2) an unnecessary trip to the drug store would definitely put us at higher risk. There is no actual evidence that ibuprofen use would do so.

So I wrote "tylenol" on the list of things to look for next time we go to a drug store, but we decided not to make a special trip out.

And I reflected on human nature and fear and how I'm not really any different from the people who went out and cleared the shelves of toilet paper.

I'll close this snapshot with one of the nice things about this week. I decided to take a walk every weekday, as long as it isn't raining. I usually do this when I'm working in the office, so I decided I should keep my habit at home. One or both of the kids have joined me each day. It was a beautiful day today, so we stopped as we walked up the hill home and admired the view.


Stay healthy, everyone.