I’m guessing just about everyone who is reading this is in self-isolation. For many of you it will be the first time. For me it’s not. I’ve had to do it before when I was on an immune-destroying chemotherapy regime for my MS. It took down my immune system more thoroughly than the doctors were expecting—so thoroughly that I had to have bone marrow rescue shots. Let me tell you, those are unpleasant: your marrow swells and your bones hurt. Also, it was so long ago that there were no video chat platforms, no Twitter, no streaming video, and very little home delivery of anything but pizza. So this is better. Admittedly, it will last way, way longer, but still: better.
Today I left the house for the first time in two or three weeks to go to a medical centre for a drug that must be given within a narrow timeframe, and can only be administered in a medical setting. They promised me the premises were ‘tightly screened’ and I’d be in no danger. I didn’t believe them—I’m very much in trust-but-verify mode—and went masked and gloved. I’m glad I did. The screening consisted of a woman saying, really fast—as people do when they’ve said exactly the same thing six hundred times already that day—Good morning we’re checking health and symptoms any fever cough headache no awesome here’s a sticker. She did not even really look at me and certainly did not check my temperature. In the building, no one but me was wearing a mask*. In the doctor’s rooms, no one was wearing mask or gloves. I didn’t see anyone use hand sanitiser while I was there. They took my insurance card in bare hands, handled it, then handed me a clipboard and pen assuring me it had all been wiped down. Clearly, they do not have the same understanding of transmissibility I do. When the needles came out, yes, there were gloves—but still no mask. I did not take off mask or gloves untilI could get home, then I washed my hands thoroughly. And I won’t be touching either my wallet or any of its cards for weeks, probably, by which time any viruses hanging out on the plastic will be long dead.
So the thing I want to emphasise in this post is: Take responsibility for what’s in your control. It begins with your own personal hygiene and safety. Do not believe any individual, group, or institution about the precautions they have taken/are taking/will take. Assume everyone and everything is infected and behave accordingly. It’s the only way to be sure. (That and take off and nuke it from orbit…) But then there’s your friends and neighbours, your wider family, your local community… What can you do for them?
Before I talk about that, I want to take a 70,000′ view of where we are now.
Here’s where we are today, 22 March 2020, at 09:45 -7 UTC:
- COVID-19 is in 189 countries and territories and, worldwide, there are 321,278 confirmed cases, of whom 13,699 have died. That’s an overall case fatality rate (CFR) of 4.26%. Of the current active cases 95% are ‘mild’ and 5% are critical. Of the closed cases, 88% were discharged as recovered, and 12% died.
- In the USA, we have 29,214 cases of whom 349 have died. That’s an overall CFR of 1.19%. But we’re very early in the epidemic, so our active cases are 98% mild and 2% critical. And of the closed cases only 34% have been discharged as cured while 66% died.
- In Washington State, we have 1,793 total confirmed cases and 94 dead. CFR = 5.24%. I don’t have figures for active cases. (Based on Chinese data, about 15% of confirmed cases require hospitalisation and 5% need critical care in an ICU. In New York, though, it’s estimated that 18% of all their cases require hospitalisation. And WA has put out an urgent call for retired medical professionals, and those from other states, to come help out.) But of the closed cases, 16.5% discharged as recovered and 83.5% as dead.
- In King County, we have 934 cases with 74 dead. CFR = 7.92%. No numbers for either status of active cases or the number discharged as recovered. Having said that, KingCounty has only tested 23,000 people so far. And the county has made it clear that tests are in such short supply you cannot get tested unless you are in the highest risk group and have ‘concerning’ symptoms. (My interpretation: you practically have to be in acute respiratory distress before they’ll look at you. Things are already bad here. King and Snohomish counties between them have only 4,900 staffed hospital beds, and only 940 of those are critical care. And of those, many are already full of people sick from things other than COVID-19. King County is building field hospitals; Governor Jay Inslee has asked the military to send one of its hospital ships to Seattle so we can access the hundred or so ICU beds. And state medical workers are openly discussing triage. Basically, if you’re old and/or have a preexisting condition, you’ll get ‘comfort’ care, that is, no intubation for you—they’ll save the ventilators for younger, healthy, more-like-to-survive folks.
I’ve been following this pandemic—taking notes, doing calculations, reading the studies—since early January. About 10 days ago I licked my pencil, got out my envelope, and did some basic arithmetic. I estimated that if nothing changed, by the first week of April the US would have 3.5 million confirmed cases. Today, despite all the lockdowns, self-isolation, social distancing, and sheltering in place, we are well ahead of that curve. I’d estimated that by 3pm this afternoon we would have 27,456. We have 29,214—and everywhere, in every single region, there are not enough tests to go around. How many cases are there really, today? If I had to guess I’d say 150,000.
Latest reviews of Chinese data suggest an overall CFR of 1.4%. But China has a younger population and, frankly, I believe those who were diagnosed got more focused and organised care because an authoritarian system can act faster when it’s not worried about what its voting citizens think because, y’know, they don’t vote. But what’s great about their healthcare is their public health policies and organisation. Though if you really want a notion of how this pandemic should have been handled right from the beginning, take a look at South Korea. I’ve been following South Korea since the virus first appeared there. They took a stringent—some might say draconian—approach to containment and suppression right from the beginning; they poured effort in public health: tracing and contacting those who might have been exposed, then monitoring them. And it has worked. As a result, they only have 8897 infections and a CFR of 1.17%. That percentage is going up as fewer new cases offset the increasing number of deaths, but I’d be surprised if it went over 1.4% So for a younger population with a government willing to make hard choices to flatten the curve to prevent health system overwhelm, let’s say the CFR will be less than 1.5%. [ETA: I’ve changed my mind. S. Korea’s CFR is creeping up too steadily, too relentlessly. I hope it ends up at less than 2%…].
Sadly, that’s not most of the world. Perhaps a better idea of what’s in store for us in the US could be gained by looking at Europe. In Italy they are running at a CFR of 9.00%. In the UK they are running at a CFR of 4.86%. And these, like those of South Korea, are increasing relentlessly. If you look at the rate at which people in China, Italy, the UK and US were being infected at various stages of their outbreak, you’ll see that the steepest curve of all in this early stage is the US. Steeper than Italy. Steeper than the UK. So what will our CFR be? I don’t know. Compared to Italy and the UK we have a younger population and we have more hospital beds per capita. But we have much less testing, and we started to isolate infected populations much more slowly. Plus we have a fool in charge. The hope for the US lies in its regional government: here in Washington, for example, Governor Inslee, King County Executive Dow Constantine, and Seattle Mayor Jenny Durkan, have consistently made choices based on both science and human compassion. Will our CFR be as bad as Italy? I don’t think so. Will it be worse than China. Yes, I believe it will.
So what does that mean for what’s coming? Nothing good. Do not expect the world to just go back to normal in six to eight weeks. In fact, when the worst passes—and I think it will take at least a year—we’ll be reemerging from our self-isolation into a new normal.
The new normal?
The US economy is not powered by the megacorps; it’s not powered by the military or the government; it’s not even powered by small business. The US economy is powered by the consumer. When we have nothing to spend, the economy suffers. On Thursday, the White House strongly recommended that states not mention specific unemployment figures. Just say, ‘Increasing numbers,’ or ‘More than usual.’ Don’t give exact numbers because we don’t want to frighten the voters. Those numbers are going to be truly horrendous, worse than anything we’ve ever seen. Steve Mnuchin, at Treasury, warned Congress that the unemployment rate could hit 20%. It could. It could also be worse. But given the swift and extraordinary congressional response—which, amazingly, is doing some of the right things—we might all get through this anyway. But it’ll be pretty chaotic along the way.
To begin with, it won’t fall evenly. Here in Washington, new claims filed for accommodation and food services workers saw a 597.3% increase; educational services, a 569.5% increase; and arts, entertainment and recreation a 255.8% increase. And these are figures from the week that ended a week ago—in other words, about two weeks behind. “This week, every day, the new claims we are receiving are at the level of the peak weeks during the 2008/2009 recession,” Employment Security Department commissioner Suzan LeVine told the Seattle Times. Every single day was worse than peak weeks during the Great Recession. And since then, the situation in Washington has nose-dived. So many people have signed on, or are trying to sign on, for unemployment benefits that the system is failing. Unemployment rates in Washington in 2010, at the height of the Great Recession, hit 10%. The Depression was thought to have reached a peak between 20-25% unemployment (records then were not as accurate). I believe this could be worse—for a while, until the world adjusts its mindset.
Certainly, if this had happened 20 years ago when I was going through my first self-isolation, I wouldn’t be talking about a possible Depression I’d be quite, quite convinced that we were looking at something close to a civilisation-ending event. But so much has changed since then. For one, many of us can work from home; we have more sophisticated delivery systems; we can communicate very handily via various online platforms. In eighteen months, when we have a vaccine and have done all those gold-standard anonymised drug comparison studies and know for sure what works, and have ramped up production of same, it will be safe to fly again. Safe to go on holiday. Safe to eat out, go on a date, go to a convention, to a movie, a play, a reading, an art show, a classroom, a yoga studio, a sports event… But not for at least a year, probably longer. But let’s be optimistic and say a year.
A year. No one knows how to model the economy grinding to a halt for a whole year. If they do, they’re keeping quiet about it—and I can only assume it’s because the answers are unthinkable.
What this means is that the world simply can’t stop for a whole year. We’re going to have to try what they’re trying in China right now: selective and cautious reopening of some industry. Will the virus flare again? Until we have a vaccine, yes. But if it could be kept to small, manageable flares that won’t overwhelm the health system—and if the CFR does in fact prove to be 1.4% or less—then it becomes a trolly problem: individual lives vs. the greater good. I’m glad that’s not a decision within my control.
Everything I’ve said so far is predicated on an effective, affordable vaccine to be widely available within eighteen months. How likely is this? Ten years ago I would have said: Not likely. Now I think it’s entirely possible. Apart from the strides made in a vast numbers of processes that go into vaccine production, over the last fifteen years there have been starts make on vaccines made for other coronaviruses—like the ones that cause MERS and SARS. When those epidemics were contained, the plans for those viruses were shelved. But the SARS virus, in particular, might be a good preliminary candidate. (The virus that causes COVID-19 is called SARS-CoV-2 because it is so genetically similar to the virus that causes SARS.) The world is pouring resources at this problem, and whatever else you want to say about the human race, when we all focus on the same goal, that goal tends to be achieved. So yes, 18 months seems reasonable. And on my ore optimistic days, I think 12-15 months is not impossible. Which mean by summer of 2021 we’ll begin our new normal, whatever it turns out to be.
Zones of Control
But that’s a long way off. So what can we do now? What’s in our control?
My main worry right now—beyond Hey, I might die and People I love might die—is the election. Here in Washington State voting has been postal-only for a while, and you don’t even have to pay for a stamp. For those of you who live in states without postal voting, I’d consider agitating the local Powers That Be to work on that ASAP. Even if everyone committed to it whole-heartedly, and right now, it still might not happen. But if we don’t start right now, it definitely will not. So imagine what no election or a contested election might mean—imagine it for yourself because I don’t have the heart for it right now.
I really want the election to go ahead, and I really want so see all three branches under Democratic control. America has a terrible record of isolationism and xenophobia when it feels threatened (and even when it doesn’t). And COVD-19 is going to be the worst thing that’s hit this continent since white people first brought smallpox and other genocidal infections to these shores, and then turned genocide into policy. A lot of people will retreat to their America First rhetoric—at exactly the time when the human race needs to work together. Pandemics are global problems requiring global cooperation and global solutions. So, yes, let’s make sure we can all vote for a better government.
As individuals, though, there’s also a lot we can do: for ourselves and our immediate family unit, that is, those who live under the same roof; for our slightly wider community, that is, our neighbourhood—the people in the surrounding streets, the small local businesses we used to frequent, the independent contractors we have employed: window cleaners, yard workers, personal tutors, house cleaners, massage therapists, handywo/men; and, of course, for our wider community of friends and family who might live on the other side of the city, state, country, or ocean.
Ourselves and immediate family unit
Here I’m operating under two assumptions:
- That it’s smart to adjust your own oxygen mask first. You can’t help others if you don’t first help yourself.
- I’ve been reading all the research, everything I can get my hands on. Some of it is preliminary and not yet backed by rigorous testing. It’s based on anecdata—but a lot of it. I’m assuming that most readers are willing to trust to start with but then verify before acting on anything I suggest. This works for me, as I frankly don’t have the time, patience, or inclination to provide references for everything I say here. So I’m assuming you will do your own digging. Search engines are our friend.
Observe stringent hygiene and social distancing behaviour
With those caveats in mind, here’s what I am doing and/or advising my loved ones to do (even though, sadly, many of them just can’t/won’t/don’t believe me, think I’m being extreme, and so refuse to listen). A lot of this stuff is tedious, time-consuming, and might seem to be the product of an obsessive, anal retentive mind. Nonetheless, I believe they will improve your chances of staying safe.
- Do not let anyone at all into the house. If you absolutely have to—like you have a plumbing emergency—wear a mask; make the visitor wear a mask and use hand sanitiser before they even ring your doorbell; afterwards, glove up and wipe down every single thing they touched with hydrogen peroxide wipes, or spray surfaced they touched with a weak bleach-and-water solution, then wash your hands, then wipe everything down again. (ETA: the CDC guidelines suggest 4 teaspoons of bleach per quart of water. But as a single cupful—half a pint—of solution is enough to clean most surfaces, and as it should really be mixed fresh every day, I’d suggest using one teaspoon and one cup of water. And, having said that, there’s an argument to be made for using a less fierce concentration, because all the bleach, all the time, is frankly not that great for your lungs. The CDC concentration works out to somewhere between 500-800 ppm, and I think there are arguments to be made for 50-200 ppm—one teaspoon per quart. Better yet, consider old-fashioned dishsoap. Soap is amazingly effective against viruses—like SARS-CoV-2—that are enveloped in a lipid membrane. So if you find the stronger solution bothersome, consider the weaker one. But, again, do remember I’m not the expert here; I’ve just been thinking about this a lot, and talking to friends who are medical professionals. Talk to your trusted medical professional and make a decision that’s right for you.)
- When you absolutely have to leave the house, double-glove and wear a mask. Here’s a fun New York magazine article that might help you wrap your head around the necessity for both. Ignore all that crap about how masks make no difference; of course they do; it’s just that health care professionals need them more, there’s a shortage, and so word was put about to prevent panic buying. It didn’t work, of course, and now people are confused. Don’t be confused: if you have a mask, wear it. You don’t need an endless supply, because they’re reusable. Ditto gloves. (Here’s a handy diagram of how long SARS-CoV-2 remains viable on various surfaces.) If you’re an organised person, with cubbyholes for various things, empty them, label them with days of the week, and when you come in from some unavoidable outside appointment, put gloves and mask in the cubbyhole labelled with the appropriate day, and don’t touch them again for 48 hours. (ETA: Or just bake them in the oven at 70ºC for 30 minutes. Or steam them for 3 minutes in a rice cooker or other pressure cooker.)
- Also before you leave the house, moisturise your face. Seriously: you’re much more likely to itch if your skin is dry. If you moisturise, you’re a little less likely to touch your face.
- When you get deliveries, if they’re non-perishable items, simply don’t touch the boxes for three days; every speck of virus in or on the package will be dead by the time you get to it.
- If you can’t wait, glove up, wipe everything down, open the box, wipe every item, throw away the wipe, wash hands thoroughly, then wipe down everything you might have touched after gloving up the first time.
- At all times stay 3 metres/10 feet from anyone who does not share your living space. Yes, most people say 6 feet. And perhaps that’s true if you’re only thinking of breathing in the droplets someone’s coughed out. But I’m thinking stuff landing on your clothes. I’m thinking of runners and cyclists expelling air with greater than usual force. Also, I use a wheelchair: imagine flight trajectories. Farther away is better.
- Imagine anything anyone has touched is covered in bright red paint. If you brush it with your sleeve, then take your jacket off, it’s now on your hands. Whatever you touch will be contaminated.
- Carefully consider the kind of sex you have. You don’t just have to worry about kissing: the virus has been isolated from both urine and faeces. No one yet studied other bodily fluids but I’d recommend lots of showers using lots of soap.
Be zealous about your physical health
Much of this stuff comes from my understanding of various metabolic processes that I’ve gained from thinking and reading about MS for twenty years. They make sense to me. Many doctors disagree with my thinking—but not all. So whether or not you follow any of this advice is entirely up to you. I am not a physician; this is not medical advice. If some of this stuff is totally new to you, do consider the possibility of allergies and other contraindications. (Some people, for example, have unpleasant retinal consequences with hydroxychloroquine/Plaquenil at high doses. And those who take meds for type II diabetes should avoid it.)
- Increase your exercise
- Stop smoking
- Reduce alcohol—and stop drinking altogether if you’re infected
- Consider nutraceuticals to reduce HbA1c, for example purified anthocyanins such as elderberry supplements
If you test positive:
- take acetaminophen/paracetamol for fever and aches rather than ibuprofen/aspirin/nap
- do not fry or grill on high heat: oil smoke will irritate the fuck out of your lungs
- eat foods low in carbs and high in iron
- stop drinking completely
- eat your anthocyanins in any way you can (except for the wine, of course)
- if you happen to have just filled a prescription for hydroxychloroquine, take those pills. There’s a lot of anecdata from China and Italy about this heme polymerase inhibitor reducing illness duration and severity. I’ll stop short of suggesting that everyone else should ask your primary care physician to write you a prescription right now, just in case, because there are in fact populations of people—those with lupus, with rheumatoid arthritis, and, y’know, actual malaria—who really need the drug and whose conditions have been proven to benefit from taking it and who are beginning to find it difficult to fill their prescriptions. But once the supply ramps up, and it will, it’s worth giving it a go. But do, please, remember allergies and other contraindications.
- Preserve your emotional and psychological well-being
I’m a writer. I’m disabled. I’ve spent a lot of time with no one but myself for company. The way I stay fairly even-keeled is a mix of structure, self-indulgence, and maintaining contact with the outside world. Staying fit in mind and body is all about self-care. My routine has not changed much in the last 6 weeks, except for three things: no more visits to pubs, coffee shops, and restaurants (sigh); more video chats (yay!); and an hour a day reading and thinking about COVID-19.
- For me, the most important thing is structure: I go to bed and get up at my usual time. Eat breakfast, lunch, and dinner, ditto. Start work at the usual time. Take breaks to play with the cats. Take breaks to feed the cats. Take breaks to rescue the cats and/or rescue household items from the cats (yes, I’ll do another Kitten Report soon). I finish work at roughly the same time every evening, at which point Kelley and I settle down with a glass of wine and discuss our day. Even though we’re both under the same roof 24×7, there’s always a surprising amount to discuss. We try to make sure that this hour is purely about and for us: it’s not a time to make lists or plans, but to just talk, just be sweeties. Then we have dinner, then watch an hour or less of TV. When we go to bed we do not check email, or get on Twitter, or watch our screens.
- Do things to make yourself happy. For me, this is a mix of good food, good wine, good conversation, physical contact, and being outside under the trees. There’s more, of course, and if you really want to know what matters to me, read the Dozen daily delights. You could do worse than try it out. What makes me unhappy and stressed is hours and hours on Twitter or watching the news. If I need to check out, I read comfort books (see Good books for hard times).
- Exercise! This is the part I’m currently finding the hardest. I can’t get to the gym, and zooming about at the park is only possible for me when it’s been dry for a while and the paths are (sort of) accessible. I’ve had a basic indoor exercise routine for years, but for various reasons, late last year that began to break down, and I’m just trying to restart it. Like any good habit, it takes much, much longer to set it than to break it—exactly the opposite for bad habits, tuh. But exercise is amazingly important for both your physical and mental health. So, yeah, I’m working on it.
- Reaching out remotely to family and friends. This is another thing I’m sometimes not very good at. Many of my people are in different time zones, and I make a mental note to call/email/message someone only to remember about it when it’s either too late or too early. Again, this is something I’m working on. But as with exercise, I’m always happier for having done it.
- Forgive yourself. You will have days when you forget to do something, or just can’t bear to do what you think you should. There will be days when you just don’t want to get out of bed. On those days, give in. Curl up with two bars of chocolate and a pot of tea. Watch crap TV. Weep self-indulgently. Write bad poetry and listen to sad songs. Then get up next day, get outside under the trees, call a friend, do some exercise; you’ll feel better.
What it all boils down to is self-care. Look after yourself!
Our immediate community
This blog post is getting very long, so I’ll make this section short and general rather than specific.
- Neighbours. Our closest and best neighbour just moved—and I mean two days ago—but this cul-de-sac is pretty tightly knit. We have each others contact info and do reach out to check in and see how others are doing. Email is fine, but at some point consider a group walk around the neighbourhood with dogs and kids—making sure everyone stays the right distance apart. After that, consider Zoom or Google Hangout or FaceTime happy hour: kicking back with a drink and just chatting. Here’s where you’ll find out if someone has extra masks/gloves, hand-sani, toilet roll, milk or whatever, and if someone else needs same. Here’s where you can help each other. I’ve heard of some neighbourhoods in Seattle turning their Little Free Libraries into Little Free Pantries.
- Local business. Do you have a couple of favourite restaurants? Get food delivered from them (and tip very well—what might in other times be obscenely well), buy gift certificates—for yourself or others—so that when things reopen, the small business might still be there for you to patronise. Do you have a local bookstore that you love? Order books from them online—even audio books; again, buy gift certificates. Ditto hair salons.
- Contractors and gig workers. Do you usually have yard work? Massage? Someone clean your house? A handywo/man who does odd jobs? Consider sending them money if you can afford it; or buy gift certificates if they offer them.
- Nonprofits. Arts nonprofits are seriously hurting right now because many have had to cancel their big fundraisers. Send them money. Pet shelters are desperate for foster care for their four-footed charges. If you can, offer to take a couple of cats or dogs for a while.
- Local medical and retail workers. Hospitals and some medical offices have to stay open. Remember the doctors, nurses, admin workers and technicians are human beings, not miracle workers. Be kind, try to be reasonable when they can’t give you what you want immediately, for example a test, or a prescription for hydroxychloroquine. This is doubly true for people who work in supermarkets and pharmacies: they are overworked, underpaid, and super stressed. They are exposed all the time to people who might be infected and contagious. They are being yelled at by frightened customers who are panicking about their food/toilet roll/chocolate supply. So if you can’t find what you want on the shelf, take a breath. You’ll live—maybe your neighbour has extra. No one will starve. And we never have any idea what another is going through. Do you want to be the arsehole who yelled at a young woman who was doing her best to find you what you need, while at the same times she’s fretting about her two-year-old, about her aged mother, about how she’s going to pay her rent now that her girlfriend’s been fired from her food service job? No, you don’t want to be that person.
No one knows where we’re heading or what it’ll be like when we get there. So be kind. Be patient. Be cheerful. Don’t let yourself be ruled by fear. Choose love and compassion. Forgive yourself and others. Stay connected to others. Take your joy where you can. Try to assume good intent. If you feel bad, be kind to yourself. And remember that some people out there will be in a bad way, mentally, physically, emotionally, and financially. If you can spare anything extra—money, kindness, patience, a mask, the benefit of the doubt, a moment to listen—you might brighten one small corner of the world. Do your best to be a fine human being. And we might all get through this.
*I had a handful of N95 masks left over from the horrible wildfire summer of 2018 so I didn’t need to buy any—we keep two in my car, two in Kelley’s car, and two for the house. [ETA: We’ve now given some away, so now we’re down to the bare minimum, which makes me extremely uncomfortable. But is my comfort worth someone’s life? No.] We also already had a box of nitrile gloves. But I ordered some thin, washable gloves, too.
- Preserve your emotional and psychological well-being