Maybe I’m Coming Late To This Party ..

.. wouldn’t be the first time.

After posting “Updated Symptoms for COVID-19“, I went through my emails in January as I recalled that I felt poorly in January. I had attributed it to my office as the primary AC return vents are therein, and the temperature varies widely. My case was mild .. light fever, chills, foggy head and general aches / pains that went on for about five days. My solution was to WFH where I felt better.

So .. two bits out of this:

  • Did I have it? Not sure .. It was odd, and I’m rarely sick.
  • How would I get an antibody test?

No clue as to either. I’ve written my PCP and Atlanta Blood Services (I donate platelets regularly) to see if I could be tested the next time I donate .. but other than these two avenues, I have no idea how to get a test.

Now, I wrote at length about “The Resolved” .. those who have had the virus where I suggested that antibody testing is critical, and we don’t know (yet) if all detected antibodies are viable against COVID-19, or if they are persistent for all time. Please recall that we receive various ‘boosters’ from time to time to ensure initial inoculations remain viable.

So .. step by step, learning every day, we sort the issues this Novel Coronavirus creates for us .. and we conquer them. Right now the most important and powerful weapon in our arsenal is the ability to avoid transferring the virus amongst ourselves, which replenishes and extends the reservoir that will come back to haunt us.

Stay connected. Stay safe. Stay home.

Updated Symptoms for COVID-19

I just heard on the news that the CDC has updated their symptom list for COVID-19 .. there isn’t a date to confirm if there’s anything new-new (some are new to me). The list includes:

  • Fever
  • Cough
  • Shortness of breath or difficulty breathing
  • Chills
  • Repeated shaking with chills
  • Muscle pain
  • Headache
  • Sore throat
  • New loss of taste or smell

The other bit that looks updated is “Should you Get Tested” .. but note that the only reason to run to the hospital is if you’re showing severe symptoms. That said, “I’m not a Doctor ..” check with yours.

Other guidance that has surfaced takes into account when you may felt any of these symptoms for them to be relevant .. some notes:

Other areas may have had returning visitors from Asia in or around that timeframe .. but at the time we weren’t actively looking for it. There were also some early deaths attributed to pneumonia .. some are being investigated, I’m sure, but these are lower priority than getting testing going.

Recall the virus transmits asymptomatically .. carriers don’t know they have it. This suggests we may be able to surmise the earliest you could have had it (barring returning from Wuhan yourself) is sometime in January. So:

  • If you had similar symptoms in the November-December timeframe, it was most likely a cold or the flu.
  • If you had similar symptoms in the January-February timeframe, it could have been COVID-19 and you may have fought it off with minor discomfort. You also might have the antibodies.

While New York is Ground Zero for the US impact and the broadest testing thus far, they are finding antibody-positive rates as high as 14% from a sample across the state (references to this in “It Takes A Village .. And An Army“) .. this suggests that these people are now immune and could return to work. Still some unknowns:

  • We don’t know ‘how’ immune. Forever? Or for a little while?
  • We don’t know if they can still ‘shed’ the virus if they are exposed again.

I go a bit deeper in “The Resolved” .. albeit this is an earlier post. The main point I land therein is “Testing, Testing, Testing“.

We need more tests.

Stay connected. Stay safe. Stay home.

It Takes A Village .. And An Army

For the ‘new normal’, that is.

It takes a village to:

  • Support each other.
  • Protect each other through our behaviors.
  • Stay connected to each other.

It will take an Army to do Contact Tracing.

The short bit (by no means complete .. I’m sure I’m missing lots) all starts with testing .. well beyond only those who are showing symptoms.

Those who test positive for COVID-19:

  • Self-quarantined.
  • Interviewed for their location and contact history (i.e., where were they in the community, with whom did they interact, etc.).
  • Get well.

Those who test negative for COVID-19:

  • Tested for Antibodies.
  • Interviewed for contact history.
  • Evaluated for their ability to donate antibodies.

Anyone that shows up on the interview list is:

  • Tested.
  • If Positive, see above.
  • If negative, see above.

I am omitting a lot of detail in the above, but that’s the gist.

As to the level of effort. Thursday, New York revealed a report where they expanding their testing activity along these lines, testing 3,000 random people in public spaces over 2 days, in 19 counties and 40 localities. ~13.9% of people tested positive antibodies (which means they are among The Resolved). Some bags of salt as this is early:

  • These were folks who were out and about .. may or may not have been quarantined.
  • Likely not essential workers as out and about during the day.
  • No emphasis to capture any broad scope of age, demographic, race, etc.
  • .. other stuff.

The numbers are big .. if accurate and almost 14% of people are immune, we can work with that number in the journey toward recovery.

It’s an early study, though. Happily, NBC News breaks it down in more detail: “What we can (and can’t) take away from New York’s antibody testing results” .. worth a read as is “Contact Tracing Study“, which links to an early-release CDC paper from a study in China.

Village or Army, it still takes all of us to:

Last, “Please Don’t Inject Disinfectant Into Your Body“. Please.

Stay connected. Stay safe. Stay home.

Please Don’t Inject Disinfectant Into Your Body

Please .. even if you think you are treating yourself for COVID-19. See a doctor.

A note from the makers of Lysol (US) and Dettol (UK): Improper use of Disinfectants.

Be smart.

Stay connected. Stay safe. Stay home.

Georgia on my Mind ..

.. no, not the song. But as to that:

Citing: “Georgia on my Mind” on Wikipedia, and other links.

Ray Charles made the song famous (and so many, many others).

Less-famous side note: I likely played this song with the Tri-City Jazz Band (OMG .. We have a URL for our second album). Maybe we recorded it on the third .. I don’t remember.

Back to business. I was quite surprised to hear that the “Georgia governor to reopen some businesses as early as Friday as other states signal similar plans“.

This, while the graph of COVID-19 in Georgia is still climbing:

20200420_GA Confirmed 01

And COVID-19 stats as of today:

20200420_GA Confirmed 02

.. we are still trending upward, which does not meet the guidelines for “Opening Up America Again” .. like, not even close. I guess the Governors really are calling the shots.

A disturbing quote from the article:

Notably, Kemp said Monday that no local ordinance can restrict the openings, which will be implemented statewide. “In the same way that we carefully closed businesses and urged operations to end to mitigate the virus’ spread, today we’re announcing plans to incrementally and safely reopen sectors of our economy,” he told reporters.

.. so, mayors cannot intercede in this madness. Here’s what the Georgia Governor is opening:

  • Bowling Alleys
  • Fitness Centers / Gyms
  • Barbers / Hair Salons
  • Tattoo Salons
  • Nail Salons
  • Massage Therapy

While all are expected to check employees prior to their shifts and practice social distancing .. I’m not sure that the bulk of the businesses on this list can effectively do their work while staying six feet away from their guests. Note that bars and nightclubs are still closed, and that restaurants are still closed until next Monday.

The Atlanta mayor is perplexed as to why .. note that Greater Atlanta has about half of the population of the entire state: “Atlanta Mayor: I’m at a loss by Governor’s decision to open“.

So am I.

Note that Georgia was among the last to issue a statewide stay-at-home order (see “Ordered and Commanded” on April 1st) .. and now among the first to open.

This looks political, not logical .. And I try not to be political in this forum. I do exercise common sense though, and I hope you do as well.

Stay connected. Stay safe. Stay home.

What’s different?

Just past five weeks since full-time WFH .. I meant to write this at a four weeks, but I have achieved balance.

Four or five weeks .. It’s well past time for a little whimsy. So, what’s been different for me?

  • Getting up earlier (6:00 am).
  • Shorter commute (22 seconds).
  • Starting work earlier (6:00:22 am).
  • Drinking more coffee. Way more coffee.
  • Working out later .. usually during a briefing or learning session .. where my comments are limited and breathlessly-delivered.
  • Increased my workout time and regimen (watch out Dennis Quaid).
  • Shaving less often (candidly, this drives me crazy).
  • Shaving at my desk in schedule gaps.
  • Vacuuming more often, especially around my desk.
  • Showering later in the day.
  • Wearing fewer clothes .. typically a workout kit.
  • Making soup on the weekends for the week.
  • Eating more soup during the week.
  • Perfected my Eggplant Lasagna recipe.
  • Eating more Eggplant Lasagna.
  • Learned how to use my new Small Big Green Egg (thank you Jeff!). This is for when I’ve had enough soup and Eggplant Lasagna. It happens.
  • Dropped 11 pounds so far (about a kilo per week).

What else?

  • I’ve worn out my slippers .. I’m wearing socks with them until the new ones arrive.
  • I discovered my heels don’t like rubber flip-flops .. they crack (my heels, not the flip-flops). Wearing socks with them as well .. the between-the-toe thing is annoying when wearing a sock .. and it looks silly. Amazon?
  • Managing the entryway as a decontamination zone, complete with scary UV light.
  • My dress shoes are all polished.
  • My dress clothes are all dry-cleaned, as are my suits and tuxedos.
  • My shirts are all ironed.
  • My clothes are too big for me. Time for a socially-distanced fitting.

And at home?

  • After over three years in this house, I just realized the topmost railing in my staircase is upside-down. It still is. Now that I’ve written about it, I’ll fix it.
  • My floors sparkle.
  • My sparkly floors are not level.
  • My rugs are beaten to death to remove dust. They now whimper when I approach them.
  • After an unfortunate desire for the house to install an inside pool in my bar in Thanksgiving (i.e., a flood), the work was finally bid and scheduled .. the day before WFH orders. Maybe by next Thanksgiving?
  • The garbage disposal is on its last legs .. see the above.
  • Oh: the master bathroom fan sounds like a 747 (Remember those? We used to fly in them to go to far-away places with strange-sounding names). Again, see the above and above.
  • My Arlo batteries are wearing out at an incredible rate .. too much motion in the house makes them switch on and off and on and off.

On tidiness:

  • Washing my hands and face more often.
  • Cleaning the house more often.
  • Running the dishwasher every day.
  • Washing towels and kits upon any exposure outside.
  • An ‘inside kit’ that I only wear after I shower.
  • Oh: I still sweat .. even whilst just working at my standing (not walking) desk. Go figure.
  • A haircut that is now six weeks old .. think Einstein Hair.

On clothes .. beyond kits, I tried to think of something better to say than Tom Hanks, who, on his SNL skit said: “I forgot how buttons work”.

So have I.

Stay connected. Stay safe. Stay home.

Contact Tracing Study

I’m starting to explore Contact Tracing .. a critical part in detecting the spread.

Some learnings from an early release CDC paper titled “COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020” that I came across today. The Abstract:

During January 26–February 10, 2020, an outbreak of 2019 novel coronavirus disease in an air-conditioned restaurant in Guangzhou, China, involved 3 family clusters. The airflow direction was consistent with droplet transmission. To prevent the spread of the virus in restaurants, we recommend increasing the distance between tables and improving ventilation.

Now it’s important to note that this an early release .. but it contains a lot of contact tracing research. Aa few bits from the report .. many of which we’ve already learned:

  • COVID-19 is spread by respiratory droplets (visible drops or invisible aerosol).
  • It can stay infectious in the droplets.
  • The lighter droplets can ‘hang’ in the air.
  • Air movement can transmit the lighter droplets.

We also know:

  • COVID-19 is incredibly infectious, and may be the most infections in the early stages.
  • Human-to-human transmission was proven early.
  • The incubation period is long enough to allow someone who has it to travel virtually anywhere on the planet.
  • Infected are capable of spreading the virus when showing no symptoms.

This snap from the CDC study:

Annotation 2020-04-20 001140

  • A restaurant. Large tables are circles, small circles are people.
  • Three feet between tables.
  • A1 is the index patient.
  • The air in the room is in motion.
  • Dates of infection noted.

The report goes into more detail .. describing the AC unit has an intake which explains how air could move back to Table C, infecting two people there.

So, knowing this, we must take into account many aspects of social gatherings:

  • Distance apart from each other.
  • Duration together (longer exposer time heightens the risk).
  • Number of people.
  • The physical environment (in this case, air movement is a significant factor)
  • Masks .. not to protect us, but to protect others from us.

Lots to learn.

Stay connected. Stay safe. Stay home.

On Restrictions

I get it:

  • We want and NEED to get people back to work. The toll on the individuals and the families who cannot work from home is nothing short of catastrophic.
  • We want to go to the park, to concerts, to sports.
  • We want to get out .. I know I miss my haunt, but while I cannot go there, I’m able to support the business and the staff through curbside pickup (remember to tip the staff!).

Walking and running, being mindful of physical distancing are necessary substitutes, but nothing like the old days. I get this .. we all get this.

We have to respect this. COVID-19 attacks the respiratory system and it attacks rapidly. The outcome? At best, we have mild symptoms and get well. But, a critical case needs oxygen .. the worst cases, a ventilator.

Asymptomatic spread is the biggest risk to us all. Combined with the lack of testing, spread makes us really blind to where the virus is now, and to where it’s spreading. You can be spreading and not even know it. There is an upside: if the less-vulnerable (several definitions for this) are spreading the virus to other less-vulnerable, they may gain levels of immunity. But we have to ask ourselves: are the risks to more vulnerable worth spreading the virus .. given we do not know who has it today?

They’re not. They’re just not. Without testing .. without knowing who has self-resolved or who is currently testing positive, we need to continue and be diligent with our precautions: “Behave Like You Have It ..“, because you might.

Don’t get me wrong: We’re seeing a plateau. A plateau is good .. but it’s a plateau, and in itself, not a decline. It indicates that fewer cases are coming into the top of funnel .. tragically, too many cases are exiting the funnel by passing on. Too many people dying, too many impacted families.

But the saddest part? The deaths are the only number in the funnel that we absolutely recognize, because we lack testing capabilities. Disconnects between manufacturing the tests, delivering the tests and processing the tests are severely impacting our ability to truly understand our status.

The restrictions imposed on us are there for all of us. Your following them protects both you and me, and those you and I both love. Not following them will likely lead to a second wave, which could exceed the severity of our situation now.

We must avoid a second wave.

Stay connected. Stay safe. Stay home.

Bottlenecks

Long one today .. I’m guessing I am the bottleneck .. lots of things happening (and I’m still a day behind).

Regardless of whom is responsible for the virus, the response(s) or any of the other chatter .. It doesn’t matter at this point. Let’s face forward and get through this. We can do it.

On bottlenecks. First, it was testing kits. Then, beds .. then, ventilators. Then, PPE and Healthcare Staff.

  • Happily, the Fed got engaged and converted convention centers to hospitals, sailed two hospital ships to hotspots, pushed companies to produce equipment and deployed military hero doctors to augment our healthcare heroes (oversimplified for brevity).
  • The States rallied their resources, and after lots of contention, managed to reduce the spread, why responding, albeit in crisis mode.
  • More happily .. the American people stayed home. It doesn’t matter who told us to do it (there were a lot of things being said by a lot of leaders) .. ultimately, we followed logic and common sense. We stayed put .. we got smart, if not for ourselves, for the ones we love. We stayed put and respected in-public guidelines for necessary trips.

Then, the curve shifted. Projected deaths (worst-case, of course), fell from 2.2 million to ~100,000 .. still a horrifying number, to be sure. Hospital admissions and intubations are all down. I covered off on this in “The Numbers are Good ..“. On that:

  • We didn’t need all the beds. Excellent. Resources could be deployed elsewhere.
  • We didn’t need all the ventilators. Even better: we can share with other countries who are not as well-equipped as we are.
  • After managing in crisis mode, we were able to relieve the healthcare heroes with military hero doctors.

We still need testing kits .. while there are a lot of them out there, there are lots of variants, spread about in a lot of places. This still needs to be centrally-managed, as does how, and who can receive a test.

We still need ways to test everyone who needs a test .. I’ll detail below, but who “needs” a test needs to change dramatically. A quick summary (for more detail, please see “Testing, Testing, Testing“) .. some new, and some adjusted terms:

  • Diagnostic: A point-in-time test that returns Positive / Negative for COVID-19. Typically administered to people with symptoms and critical asymptomatic individuals.
  • Antibody: Detects antibodies in your system which will be present if you’ve had COVID-19, and may be immune to reinfection. Typically administered to people who have recovered, but could be expanded to individuals who think they’ve had a mild case at a point in the past.
  • Sentinel: Broader test methodology that administers Diagnostic tests to asymptomatic individuals. This test looks for positive results that will identify groups for Contact Tracing to uncover more positive results. This will help to identify the spread.
  • Contact Tracing: This methodology retraces the steps of a person who tested positive to determine with whom they interacted. Tracing helps to determine who may need to receive a Diagnostic test. This tracing will reveal suspect clusters that may be geography, social, workplace, school and so on.

Then, the test flow:

  • Take the test .. requires a swab of nose or throat, saliva or blood (depending on the test).
  • Process the test .. requires a lab.
  • Lab processing requires reagents (chemicals that facilitate detection), as well as other materials.
  • Get results.
  • Act on the results (typically quarantine).

Again, lots of variants of these tests from different manufacturers .. variants on processing capabilities and capacities in various labs, but overall, tests can be processed.

So .. who should be tested (besides EVERYONE)? The science suggests:

  • Folks with symptoms should be tested using the Diagnostic test.
  • Folks without symptoms should be tested with the Diagnostic test as Sentinels. If positive, invoke Contact Tracing. Note that asymptomatic people are reservoirs for the virus .. they store it and spread it, and evidence is suggesting they are at their peak contagious levels before they show symptoms.
  • Folks who have gotten over it should be tested with the antibody test.

Some good testing news: “Hundreds of Detroit cops back from COVID-19 quarantine” .. because they were tested. These are officers and firefighters who were quarantined because they were exposed .. We need this in all 50 States and territories straight away.

But now, bottlenecks remain:

  • Is the test kit you need available in your area?
  • If it is can you get it?
  • Can the test be processed in a practical amount of time?

Kits and capacity. But even if the kits exist, the capacity to process the tests at an industrial level simply isn’t there. Yes: you can get a test, but you may not be able to get it processed.

For now. We’ll get this sorted with the proper levels of management and coordination between The States and The Fed.

Stay connected. Stay safe. Stay home.

The Numbers are Good ..

They are .. we’re seeing progress because of our mitigation efforts. Even the hardest-hit New York is seeing a downturn.

However, COVID-19 has not changed:

  • is still highly-contagious .. droplets, aerosol and contact.
  • Transmits without symptoms .. some who have it don’t know and may unintentionally spread it.
  • Is still ~10x as deadly as the flu .. we are still trying to understand the actual denominator
  • Remains on surfaces for longer than you’d think.

The overall health situation has not changed:

  • No widespread testing.
  • No vaccine.
  • No reliable therapy.
  • With the exception of “The Resolved“, no way of knowing who has had it already.
  • Medical workers are still the front line and we must protect them.

The testing situation has not changed:

  • How do you get a detection test? The CDC has a Self-Checker that looks for symptoms.
  • How do you get an antibody test?
  • How do know if you’ve been exposed?
  • How do you know if you’re contagious?
  • We’re not doing reliable contract tracing .. This may not even be widely possible until May.

Personal protection activities have not changed:

  • Stay home.
  • Wash your hands.
  • Cough into your arm.
  • Don’t shake hands.
  • Don’t touch your face.
  • Wipe down surfaces.
  • Keep a two-meter distance from others.
  • If walking / running don’t follow too closely behind others.
  • Wear a mask to protect others from your droplets.
  • In short .. “Behave Like You Have It“.

On work:

  • Who can go back to work safely?
  • If only the Resolved, are there enough workers to justify opening offices? Stores? Malls?
  • Which workers should go back to work first?
  • Is there a way that workers could consider temporary positions in essential roles?
  • How will employers keep workers safe? I talk about this a bit in “The ‘New Normal’ .. ‘New-New Normal’?

As the weather turns, we all want to get out. We want to get back to our jobs, our parks, our bars, our restaurants, our churches as soon as we can. I’d like to go to the grocery without hazmat gear. I need a hair cut (candidly I need them all cut).

The Federal Government wants to open the country ‘with a bang’ .. but there’s simply no evidence that enough has changed for this to occur without endangering the public. Please pay attention to the science.

Stay connected. Stay safe. Stay home.

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