Saturday, June 27, 2020

Weekend Reading: A Mixed Bag Edition

I posted on Twitter last night about how my county's COVID-19 numbers are going in the wrong direction, and I'm worried.  Two weeks ago we were seeing ~150 new cases per day, and a test positivity rate of 2-4%. We'd been there for weeks. I wasn't thrilled to have plateaued at such a high number of cases, but I felt like it was a level at which we could possibly keep things under control with testing and contact tracing.

Now, we've had a week of ~300 cases per day, and three straight days of record high numbers, including 440 new cases yesterday. Our test positivity rate id up to ~6%, and we hit the level of increased hospitalizations that my county identified as a trigger for potentially modifying the health order. We'd previously hit the trigger based on number of community outbreaks for several days in a row.

I no longer feel like we'll be able to keep things under control with testing and contact tracing. I want my county to make changes, and I want us to make the changes fast. The nature of COVID-19 is that our metrics are all lagging indicators of a problem. We've already baked in the next two weeks of cases. What we do now will decide if the numbers we're at in two weeks are a peak or the start of a scary exponential curve.

My county's response so far is to increase its messaging about masks (which have been mandatory here for a long time) and to say it will increase enforcement of people violating the health order. They just shut down another restaurant, so maybe that's for real. I don't think it will be enough. I think we need to shut some things back down - maybe close indoor service at bars and restaurants. I don't think my Board of Supervisors has the political will to do it, though. That makes me sad.

I am tired of watching leaders in successive places make the same mistakes, and sad that it seems my local leaders, after doing so well at first, are now going to make the same mistakes. And I am sad for my family. My kids are being very patient, but I can tell they're struggling at times. We all have shorter tempers and sharper tongues than usual. We are all looking forward to out planned "vacation at home" week, the week after the 4th of July. We are planning to go to the beach, the zoo, and maybe a garden or two. We will probably also rent kayaks and/or standup paddleboards and get out on the bay. I feel like our plans are now at risk due to the rising case numbers. Many of our planned activities will stay safe (kayaking, for instance, is naturally socially distant!) and others may need to be done earlier in the day (e.g., beach outings). We can always hang out in our backyard. It will be OK. But I am still sad, because it didn't have to be this way.

Anyway, let's have some links. I've been thinking and posting a bit more about masks. I think we need to stop trying to convince the unconvincible and focus on normalizing mask-wearing to the point that the 70% if us who are reasonable are wearing them when recommended - i.e., indoors or when within ~6 feet of people outdoors.

I also think it would be helpful to acknowledge the various problems people have wearing masks and suggest solutions.

Along those lines, this thread probably explains why I sometimes feel like wearing a mask while exercising (hiking or running, mainly) exacerbates my asthma:

It is probably NOT actually exacerbating my asthma, but it is triggering the same "can't catch my breath" feeling that I associate with an asthma attack.

The good news is that I find the tube mask (aka neck gaiter) style of mask does not cause this reaction for me. My theory is that this is because the tube mask allows more space for the exhale to dissipate, but I don't really care WHY it works, just that it does!

I can wear a tube mask for long periods of time, even while exercising. And because the tube mask is super easy to pull up and down, I only have to have it up while passing close to someone. As an added bonus, the tube mask style does not fog up my sunglasses.

I have several bamboo tube masks that I bought on Etsy, which I find very soft and comfortable.

My kids both prefer this style, too, for most things. If you search on Etsy for "neck gaiter" you'll find lots of options with cool prints. We have a unicorn print and an outer space print and more on the way. I have also seen them sold by LL Bean and UV Skinz.

Petunia likes to wear the cute earloop style face masks my mom made for her, too - but her ears are too floppy to wear them easily. I solved that by sewing two large buttons on a stretchy headband. She wears the headband, and loops the mask over the buttons when she needs to wear it. She likes that enough that she asked me to make more headbands like this. I bought a three pack of headbands and have been slowly modifying them.

My mom reports that the button trick works on caps, too.

I have seen some people mention that masks can be hot, which I can see would be a problem in some parts of the country right now. I saw someone of Twitter post an idea to store the masks in the freezer so that they'll be nice and cool when you need one.

Another common problem is that wearing a mask can lead to your glasses fogging up. Pumpkin wears glasses, and this is why she prefers the tube masks. There are also various summaries of advice for avoiding the problem available now. Here's one from the Cleveland Clinic.

I never got back to the post I was going to write about what we "bought" with our initial lockdown. Luckily, Dr. Bob Wachter from UCSF did it for me:
We could have done more, but we didn't get nothing from that lockdown. But this tweet from the end of his thread is true, too:

There is a study out of France showing that elementary kids in an early outbreak region did not transmit SARS-CoV-2 that much. This tweet summarizes and links to the article - but it is important to note that the kids here are age 6-11:

An earlier look at high school kids in the same region indicated they transmitted just about as much as adults. (Here's a write up on that from a long time blogging friend!)

This would argue for focusing on reopening schools for younger kids and leaving the older kids at home - the younger kids are also harder to teach remotely (anecdotal data from everyone I know with a kid in 2nd grade or lower!) and can't be left alone to study at home while parents work. I wish we weren't in a place where we have to think about these things, but we are and so I also wish we'd think about these things with all the info we have in mind.

As it happens, we may end up with a split in our household, where Petunia (5th grade next year) goes to school on campus and Pumpkin (8th grade next year) mostly goes to school online. This was based on their stated preferences, and it is making me feel somewhat better that the data we have indicates this is a rational split, too.

And of course, there is this:
We are NOT really prioritizing opening schools right now. We're engaging in magical thinking about how safe it will be to open schools and hoping for the best.

In other news... California is mandating an increase in electric semi trucks. This is good news!

One thing that is making me hopeful right now is that we seem to be more willing to reckon with the fullness of our history than we have been at any other point in my life. It is not enough, and we have so, so much more work to do. But it is a start.

Michele Norris wrote about George Washington's slaves this week. It is worth your time. It includes the mention of the fact that Washington's false teeth were made from teeth pulled from slaves. This made me think of a fictional story I read about that years ago, by P. Djèlí Clark. It is also really worth your time.

In things that made me smile....

This article about trying out a bunch of different online AirBnB "experiences" was fun.

When we can travel again, I want to go see this shrine in Kyoto!

An explanation for insomnia:

OMG this bird:
I've also really been enjoying following the saga of the bunnies in @SarcastiCarrie's flower pot.

Teddy bears on a roller coaster!

Here's your bunny for the week:

Have a good weekend, everyone!

Saturday, June 20, 2020

Weekend Reading: The Little Bit Ranty at the Start Edition

I started a post on Tuesday about whether we "wasted" the time we bought with stay at home orders. It was going to be a list of the good things we did (lots of clinical trials, for instance) and of the the things I wish we'd done (e.g., make better plans for providing people who live in crowded housing a way to isolate if they get sick).

Then I got an email from our school district about their plans for reopening for the 2020-21 school year, which begins at the end of August here. The info they provided wasn't bad, but it wasn't anything close to an actual plan. There will be three options for next year: fully on campus, fully online, and online with a small number of on campus activities. We have no details about what those options will look like, except that our school district says they only have enough money as of right now to offer in person schooling for half of the school year. If additional funds don't come through, we'll be back to everyone going to school online mid-year. Wheee!

The next step is for us all to fill out a questionnaire about which option we prefer and then our school will put together a plan. Then later this summer, we enroll in one of the options.

OK, fine, I thought. The questionnaire will allow them to gather data to help them craft a good plan. But no, we received the questionnaire on Thursday and it literally just has a question to select your preferred option and a comments field.

Petunia really, really, really wants to go back in person. She hated online school and says she'll do whatever she has to do to go back in person. Pumpkin says she wouldn't mind the online option if all the subjects were taught as well as her history class was in the stay at home period this year. The district says the online option will be "high quality" with more engagement than we got this spring. That makes sense - they've had more time to prepare.

Meanwhile, San Diego county hit one of its triggers for slowing down reopening: We had seven community outbreaks in a seven day period. In fact, we hit it twice - after announcing we'd hit it on Thursday, we had two more community outbreaks on Friday. A "community outbreak" is a cluster of three or more cases in different households, all caught in the same place.

Three of the community outbreaks reported in the last week started in gatherings in private homes. Others were in a restaurant, a campground, a business, and a "social club" that wasn't supposed to be open. Our health director has said the ban on gatherings in homes will likely stay in place until there is herd immunity, either via a vaccine or accumulation of cases. I think this is terribly misguided. That is at least a year away. You cannot expect that people will not see their friends and family for a year. I think our health authorities need to offer guidance on how to safely have gatherings, i.e., keep them small, distant, and outside.  San Francisco has it figured out and so do many other places. Meanwhile, here in San Diego we're still entirely focused on getting as many businesses open as possible. I predict we'll see a lot more outbreaks from private gatherings, because they are impossible to monitor and prevent and people miss seeing the people they care about.

So anyway, what are we going to do about the school questionnaire? I think we will fill it out saying we prefer the on campus option, and then write some comments about wanting the school to take advantage of our lovely San Diego climate and move as much as they can outdoors. I had been worried by mixed messages about whether masks would be required, but our governor took care of that for me this week. We've been working on finding mask options that work for the kids, and so we're set for all day masking.

But I am also going to accelerate my efforts to teach my kids how to do more cooking. I think that we need to be ready for the scenario in which both adults in the house are sick and the kids have to feed themselves. Luckily, our kids are old enough to do this (they are 10 and 13). Honestly, I should have been pushing more cooking skills already, but they both have a fear of the stove that we'll need to overcome and I've been lazily waiting for them to just outgrow that.

I am just so angry about how we could not find a way as a society to prioritize making it safe for kids to go back to school. My kids have the best possible "learn at home" scenario - their own spaces, their own devices, and two parents with flexible jobs and the educational background to be able to help explain things. And it still sucked for them. My kids will be OK whatever happens in the 2020-21 school year. A lot of kids won't be, for a variety of heartbreaking reasons. Read this Buzzfeed article about how much the stay at home orders sucked for kids, and how unevenly that impact is felt. It just breaks my heart that risking a repeat of this because we can't get our collective act together.

In other news....

Read Jamil Smith's essay on Juneteenth and the difference between emancipation and freedom.

Derek Lowe summarizes what that dexamethasone trial means. My take is that this is good news, but that a lot of doctors were probably already using steroids for the same reason that the trial was done - you would expect a steroid like this might help in a cytokine storm situation. But it is always good to get clinical trial results and I think usage of the drug will probably go up. But I wish we had a more robust public health messaging environment right now, because this is absolutely NOT a drug to take as a prophylactic. It depresses the immune response, which is why it helps the very sick COVID-19 patients. Taking it early in an infection or in an attempt to prevent infection may do harm. As any asthma patient on long-term steroid treatment knows, steroids increase the risk of a respiratory infection. (But they are what we're given if we're having a hard time getting our lung function back to normal after recovering from an infection.)

Anyway, as Derek says, this may reduce the fatality rate (which is good news) but will do nothing to change the course of the epidemic. Right now, our best interventions for changing the course of the epidemic are distancing and masks.

Here's a devastating look at how much our poor response to this epidemic has hurt us.

And we continue to have a poor response, so we'll continue to have more deaths that could have been avoided.  The scenes out of Tulsa as people prepare for the Trump rally are so depressing. People crowding together, joyfully flaunting not wearing masks.

I mean:

I think that even after we bungled the early response, we had a moment in late March/early April when we could have been convinced to rally together and have a better response if we'd had better leadership. But we had Trump and so here we are.

I am mostly done arguing with people about masks. The people who don't think they are necessary now are not really evaluating the evidence and making a rational choice, they are cherry-picking things to post hoc rationalize a choice they are making for other reasons. But Bad Mom, Good Mom has a nice write up on why we wear masks if you or someone you know is in that tiny sliver of people who genuinely aren't sure if the evidence supports mask wearing.

The next time someone asks me for definitive evidence that masks work, I will ask them for definitive evidence that masks don't work and be done with it. Arguing with these people is a waste of time and energy.

Here is a good thread on a recently reported study of asymptomatic SARS-CoV-2 infections in Wuhan. The fact that they see evidence of potential lung damage in some members of this group is pretty sobering.

Even before the pandemic, I'd been thinking a lot about how to balance my love of travel with the impact of travel. This essay captures that ambivalence really well.

In other travel news: authorities in Alaska removed the bus made famous in "Into the Wild" because people wouldn't stop risking (and occasionally losing) their lives to go see it.

This is a really interesting interview with one Romney to Johnson to Bloomberg voter who was participating in Black Lives Matter protests in DC.

A perfect response:

And here are some fun things:

I looked up the YouTube channel of the two actors mentioned in this story out of Singapore and it was delightful.

This thread made me smile:

Here's a beautiful bird:

Here's your bunny for the week:

Have a good weekend, everyone!

Saturday, June 13, 2020

Weekend Reading: The Facing Reality Edition

This was the week when I finally accepted that we're not going to bring SARS-CoV-2 transmission rates down here, even in San Diego where we've done a decent job of keeping them from rising. When we send our kids back to school at the end of August, we'll be sending them back to something far from normal - I don't know yet if the school year will be abnormal because it is a hybrid of online and in person, because it is all in person but with heartbreaking rules that keep our kids from interacting much with their peers, or because we've said "oh well" and sent them back to seemingly normal classes with the fear of bringing a potentially deadly disease home to their families.

I am pretty angry about this, but that is neither here nor there.

I think my county is opening up more than seems prudent - bars and movie theaters opened here yesterday - while at the same time not providing good guidelines on how people can safely see their friends. This to me is a recipe for a slow-moving catastrophe. Our decisions mean that the virus will be spreading in our community for the foreseeable future, possibly until we get a vaccine and make enough of it to vaccinate widely. But we're focusing on opening businesses and not on giving people real guidance for how to adjust to this new normal we've decided to make for ourselves.

There are plenty of articles out there about how to evaluate risk, but I think the advice would carry more weight if it came in the form of public health recommendations. For the most part, it won't, because no recommendation is going to include "go to the movie theater," and too many of our political leaders desperately want people to go spend money at businesses even if that puts their health at risk.

And even when public health officers do issue orders, they don't always get the back up they need from political leaders. Look at what happened in Orange County with masks. The public health officer issued an order requiring masks and received threats. She resigned and her temporary replacement has rescinded the order.

This is not an isolated thing. Public health officials are resigning, retiring, or sometimes getting fired by hostile political leaders, all over the country.

I am not aware of any such backlash against our public health orders here in San Diego. When I've gone out to stores, everyone was wearing masks.  However, when my husband went to pick up takeout from a local restaurant last week (not long after restaurants were allowed to reopen for onsite dining), he reported that staff and everyone picking up takeout were wearing masks. The people waiting for tables? Not so much, despite the fact that the health order says they have to keep their masks on until they are seated.

Also, we're reopening for tourism now, too, and at this time of year our biggest source of tourists is Arizona, which seems to be headed for real trouble with coronavirus and also does not require masks. Will local tourism establishments enforce the mask order on visitors who are not used to be required to wear masks? I am skeptical.

So anyway, my husband and I are trying to figure out what a safe and sustainable lifestyle will be right now, with the idea that we're stuck in this spot in between OK and crisis for probably at least another year.

One thing we did is finally give in to Petunia's pleas for a fuzzy pet. Meet Daisy, our new hamster:

In that picture, she's enjoying some time out of her cage exploring her playpen. Petunia has been doing a lot of research about how to be a good hamster owner, and is so far delighted with her new pet, even though Daisy sleeps way more than Petunia would like during the day. (Hamsters are nocturnal, after all.)

Pumpkin didn't really want a pet but is glad we got a hamster and not a dog (Petunia's first choice). Pumpkin wants another bookcase for her room. She'll get that soon, too, because if I'm going to tell my kids we're mostly stuck at home for longer than I want to admit, I'm going to try to give them the things that they say makes that bearable.

We've also started seeing some friends, and allowing our kids to see some of their friends. However, all meet-ups are outdoors with everyone at least 6 feet apart and with precautions around food and bathrooms. We're also keeping our social schedule pretty sparse.

We're looking at the list of reopened things and trying to think about what activities we think offer the best ratio of fun to risk for our upcoming "staycation." We're all taking the week after the 4th of July off and will try to have fun.

Anyway, I have a few links for you:

Lest we get too laid back about the coronavirus risk: There were reports this week of the first US lung transplant for a coronavirus patient. The patient is in her 20s.

Comparing how we've handled coronavirus with how New Zealand has handled it is a bit depressing, but if you want to read a summary of New Zealand's response: here is a good one.

There was good news out of Missouri: The two sick hairdressers did NOT infect everyone else, probably because they (and all their clients) were wearing masks.

Really, the evidence that getting a majority of people to wear face masks really would help keeps piling up. The people who decided to make face masks a political battleground have done so much harm.

Derek Lowe had good summaries of where we're at with antibody treatments and also with vaccines. Both posts have some cautious good news but also a warning about the very real challenges still ahead.

Former CDC director Tom Frieden wrote a really good piece on how we're looking at the wrong metrics and suggested some better ones.

This is a bit of a gut punch:

I have mostly written and shared links about COVID-19 in this post, but I am reading things about the protests and the chance we have right now to make some real progress on our long-standing problems of racism and police brutality. I have taken some small, unfocused actions (mostly donating money) but need to figure out what more to do. I will try to do that and write about it soon. In the meantime, please don't take my relative quiet on this as an indication that I don't care. I do care. I am reading and thinking how best to take action.

Somewhat related to that, here is a really good flowchart on when to use African-American and when to use Black (and yes, the emerging style guide is to capitalize Black):

There has been a lot of churn about public health experts not condemning the Black Lives Matter protests. This thread is an excellent response to that:

And now for a happy thing:

This tweet made me smile, and if you want to know why and also enjoy some really fun sci fi, read Space Opera, by Catherynne Valente

And here's your bunny for the week:

Have a good weekend, everyone. Wear your mask!

Saturday, June 06, 2020

Weekend Reading: Just a Few Links this Week

I lost most of my morning to an almost-migraine. I had the symptoms that tell me it would be wisest to go back to bed (the beginnings of a headache, a woozy feeling, and feeling very cold), so I did.  So now it is 11:30 and I'm still in my PJs and the sum total of my accomplishments so far are making toast for Petunia and hanging a load of laundry on the line. Let's just say that the weekend to do list has a lot more than that on it.

I had a few things I really wanted to share, though, so I decided to go ahead and write a short post.

If you read only one thing, read Whose Grief, Our Grief, by Saeed Jones.

I am about 2/3rds of the way through Ezra Klein's recent podcast with T-Nehisi Coates and it is outstanding. There's a lot of good stuff in there, but don't miss Coates' take on the progress represented by this moment of protest. It is right at the start.

Anne Helen Petersen has been tweeting a thread of protests in small towns and cities across the country. It is amazing.

She wrote about why this matters, too.

I found Dahlia Lithwick's essay on why these protests are different than earlier protests in the Trump era really insightful.

Geneviéve Jones-Wright, who recently ran to be San Diego's district attorney, wrote about why we need a better police oversight board here.

Meanwhile, in the pandemic....

The NY Times had a useful piece on how to hug right now.

Ed Yong wrote about "long haulers" - people who are still experiencing symptoms months after getting infected with SARS-CoV-2.

My local paper wrote a good piece about case investigators and contact tracers.

Derek Lowe provides an update on trials of remdesivir and to tocilizumab. There's some encouraging news in there, but nothing that makes me inclined to be willing to get close to other people without a mask.

And another antibody drug enters trials.

Here's a bunny for you:

Have a good weekend, everyone!