Thursday, March 20th, 2020. First day of spring. Marci's birthday.
Looks like last post was about 2 weeks after Ivy was born (April 2011). I'm wanting to document our experience with this pandemic of COVID-19 and thought reviving this blog would be an easy way. Not intending for anyone to read it for the time being, but for our own family purposes.
Life is currently like this:
Jeremy and I divorced several months ago, it being final end of December 2019. Iris is 11, Ivy is 8 (very soon to be 9!) and our son Callum was born in July 2016, so he is 3.
There is alot of anxiety amongst most right now due to COVID19. I first learned about it while I was attending a conference in Texas at the end of January. A friend told me the name of coronavirus and advised me to "google it." Side note: I'm famous for saying "google it." I think the young people say "search it up." I learned that from Iris.
I searched it up and was concerned. There had been a case in the US not long before I traveled that had been through OHare, where I traveled through and was returning through. I had had a nasty cough for weeks and was concerned people would think I was infected. I didn't have a facemask. At that time, society thought facemasks might prevent the spread (from catching it). A person next to me on my first plane had an extra facemask and I had commented on how I wished I had one (she was wearing one) and she offered me one. I do think that was good, given I had that cough. Even though I knew it was lingering for weeks and not COVID19 related, others didn't know that.
Anyway, from the end of January, I kept tabs on the coronavirus. Prior to deciding on divorce, we had planned for the kids, my mother and myself to attend Conversa in Costa Rica. This is a Spanish language school. https://www.conversa.com/. Jeremy and I took the kids in June and had found amazing deal on flights over spring break. So we booked shortly after we returned from CR!
As the virus continued to spread, I kept tabs. It became clear to me by the beginning of March that this would spread throughout the United States.
I think it was March 9th (it may have been the 8th or over the weekend) that the president, Donald Trump stated older people (who are more likely to die from this) should remain away from crowds. I believe it was the week before the CDC had given this same advice. The whitehouse, at one point, had contradicted (I think for economic reasons) some of the CDC advice. Working in the medical field and having a strong understanding of immunology, I was airing on the side of caution.
What I hadn't realized, was the shortage of medical equipment for those who needed intense care. On Monday, March 9th, I had a conversation with my mom. I thought if she was affected, she would get medical care, potentially in the hospital due to her underlying pulmonary disease (diagnosis is asthma, she uses an inhaler twice a day preventatively, and sometimes uses the rescue inhaler).
On Tuesday, March 10th, I read a post by a physician friend (Dr. Wendy Schroeder) on Facebook: "Have you heard the term “Flatten the curve”? Well in regard to COVID19, it means staying local and avoiding travel/crowded areas so that each person is less likely to become a vector to spread the virus. Even if you are low risk or without symptoms, you can do your part for the greater good and potentially save lives by slowing the spread. If less people get sick as quickly, we can care for the currently sick people better without overwhelming the medical system and so on and so forth. Then ultimately less will get as sick as severely- it’s MATH people 😜." Here is the pic that she used to accompany the post to explain this:
After I read that, I stayed up quite late reading more. I had figured that upon our return from Costa Rica, I would need staples. I had taken two trips to Costco, the bulk food store, and had purchased a bag of rice, flour and had stocked up on dry beans and lentils. I didn't have easy nonperishables, like canned goods. I knew Woodmans had started doing online pickup. I had felt a sense of urgency to get to Woodmans (grocery store with alot of options and great prices) since Saturday the 5th. Most nights I was tired and didn't feel like dealing with the crows that is always at Woodmans during the day. Late Tuesday/into Wed I spent about an hour on my phone placing an online order for pick-up Wednesday. These were all things that I wouldn't plan on eating in the near future since I had been intending to be out of town effective Friday and had been working on emptying fridge, not filling it.
I woke up Wed morning knowing the responsible thing was not to travel. I talked with my mom and we decided she should not go with FOR SURE. I didn't have a huge desire to go anyway and was stressed about it, but we had committed to being at the school and had flights. After I spoke with my mom I knew I also didn't want to go. In my profession, I believe one of the most important things we do is helping people with difficult decision making. I studied decision making framework in graduate school. As a new genetic counselor, I thought helping people through the decision making was very difficult and the hardest part of my job. Now, it is one of my favorites and I think such an important skill we have as genetic counselors. My decision making had me at the point that I could envision I would have many regrets if we traveled, but if we stayed home, I didn't see any regrets. I didn't care about the loss of money from the flights. The deposit for the school wasn't very high. I did feel badly the school would have been relying on our income, but they were understanding. The amount of relief I felt after canceling the trip was immense. I hadn't realized how stressed I was about it. I knew on Wed it was the right decision. As the day evolved I stated thinking we should start socially isolating. Ivy wasn't feeling well and I got a call from school that she had a 99.9 degree temp right before noon. I picked her up and didn't let her go to religion (even though she was fine and it was likely an overreaction to bring her home). In fact, I wanted to keep Iris home from religious education, but didn't bring that idea up as I know she really enjoys going. Callum started sniffling and a cough, so to be preventative and protect others (I didn't think he had COVID19 but didn't want others to be concerned) we kept him home from school on Thursday, March 12th. I wanted to keep the girls home Thursday, and brought that up to Iris late Wed, but she was highly against that idea. She is such a good rule follower and doesn't like missing school.
The kids had not (and still have not) seen Jeremy since March 5th. He had traveled with the UWGB basketball teams to the conference championship in Indiana. We decided, since he had been exposed to a potential case, I would keep the kids Thursday night March 12th. Things are evolving, but until we know the big picture, we decided the kids would stay isolated with me at home. My mom is also completely isolated. We continue to reevaluate this. Jeremy's parents, Grandma Linda and Papa Tom, didn't start isolating until Saturday the 14th when they attended church. I asked Linda to share some things with Tom, as I don't think he understood the gravity of the situation. I know they want to help out with the kids, but I was hesitant if my mother would still also be helping me.
After changing our minds several times over the past several days (directly related to the kids behavior) we decided to open up the circle and the kids might be seeing Jeremy on Sunday. We thought it wise, if the kids will no longer be able to see their grandparents for many months, that the kids see Tom and Linda before they see Jeremy. All three kids had a sleep over there last night and I am to be working today (although I am currently documenting all of this for us to look back upon). Last night I made huge progress on organizing things for our basement project (I'll do a separate post about that).
So there is alot of unknown. Last night before bed, I read the local news that WI has had first two deaths. In the US, currently, looks like 14,250. However, we all know this is a gross underestimate as tests are not available for most people and are only being reserved for those with the most severe symptoms and healthcare workers.
Here are some posts I have made on Facebook. I'll copy and paste some of the articles as I expect the links won't be working forever.
I reposted this from a FB friend on March 17th: "If you want to understand what we’re up against, read this sobering analysis. Thanks, Julie Greene! Copying and pasting from Julie’s post: “Here’s the London report that finally got the government’s attention. And I’ll precede it with a useful summary written by my friend Jeremy C. Young. Thanks Jeremy! “We can now read the report on COVID-19 that so terrified every public health manager and head of state from Boris Johnson to Donald Trump to the dictator of El Salvador that they ordered people to stay in their houses. I read it yesterday afternoon and haven't been the same since. I urge everyone to read it, but maybe have a drink first, or have your family around you. It is absolutely terrifying. The New York TImes confirms that the CDC and global leaders are treating it as factual.
Here's a brief rundown of what I'm seeing in here. Please correct me in comments if I'm wrong.
The COVID-19 response team at Imperial College London obtained what appears to be the first accurate dataset of infection and death rates from China, Korea, and Italy. They plugged those numbers into widely available epidemic modeling software and ran a simulation: what would happen if the United States did absolutely nothing -- if we treated COVID-19 like the flu, went about business as usual, and let the virus take its course?
Here's what would happen: 80% of Americans would get the disease. 0.9% of them would die. Between 4 and 8 percent of all Americans over the age of 70 would die. 2.2 million Americans would die from the virus itself.
It gets worse. Most people who are in danger of dying from COVID-19 need to be put on ventilators. 50% of those put on ventilators still die, but the other 50% live. But in an unmitigated epidemic, the need for ventilators would be 30 times the number of ventilators in the United States. Virtually no one who needed a ventilator would get one. 100% of patients who need ventilators would die if they didn't get one. So the actual death toll from the virus would be closer to 4 million Americans -- in a span of 3 months. 8-15% of all Americans over 70 would die.
How many people is 4 million Americans? It's more Americans than have died all at once from anything, ever. It's the population of Los Angeles. It's four times the number of Americans who died in the Civil War...on both sides combined. It's two-thirds as many people as died in the Holocaust.
Americans make up 4.4% of the world's population. So if we simply extrapolate these numbers to the rest of the world -- now we're getting into really fuzzy estimates, so the margin of error is pretty great here -- this gives us 90 million deaths globally from COVID-19. That's 15 Holocausts. That's 1.5 times as many people as died in World War II, over 12 years. This would take 3-6 months.
Now, it's unrealistic to assume that countries wouldn't do ANYTHING to fight the virus once people stopped dying. So the Imperial College team ran the numbers again, this time assuming a "mitigation" strategy. A mitigation strategy is pretty much what common sense would tell us to do: America places all symptomatic cases of the disease in isolation. It quarantines their families for 14 days. It orders all Americans over 70 to practice social distancing. This is what you've seen a lot of people talking about when they say we should "flatten the curve": try to slow the spread of the disease to the people most likely to die from it, to avoid overwhelming hospitals.
And it does flatten the curve -- but not nearly enough. The death rate from the disease is cut in half, but it still kills 1.1 million Americans all by itself. The peak need for ventilators falls by two-thirds, but it still exceeds the number of ventilators in the US by eight times, meaning most people who need ventilators still don't get them. That leaves the actual death toll in the US at right around 2 million deaths. The population of Houston. Two civil wars. One-third of the Holocaust. Globally, 45 million people die: 7.5 Holocausts, 3/4 of World War II. That's what happens if we use common sense: the worst death toll from a single cause since the Middle Ages.
Finally, the Imperial College team ran the numbers a third time, this time assuming a "suppression" strategy. In addition to isolating symptomatic cases and quarantining their family members, they also simulated social distancing for the entire population. All public gatherings and most workplaces shut down. Schools and universities close. (Note that these simulations assumed a realistic rate of adherence to these requirements, around 70-75% adherence, not that everyone follows them perfectly.) This is basically what we are seeing happen in the United States today.
This time it works! The death rate in the US peaks three weeks from now at a few thousand deaths, then goes down. We hit, but don't exceed (at least not by very much), the number of available ventilators. The nightmarish death tolls from the rest of the study disappear; COVID-19 goes down in the books as a bad flu instead of the Black Death.
But here's the catch: if we EVER relax these requirements before a vaccine is administered to the entire population, COVID-19 comes right back and kills millions of Americans in a few months, the same as before. The simulation does indicate that, after the first suppression period (lasting from now until July), we could probably lift restrictions for a month, followed by two more months of suppression, in a repeating pattern without triggering an outbreak or overwhelming the ventilator supply. If we staggered these suppression breaks based on local conditions, we might be able to do a bit better. But we simply cannot ever allow the virus to spread throughout the entire population in the way other viruses do, because it is just too deadly. If lots of people we know end up getting COVID-19, it means millions of Americans are dying. It simply can't be allowed to happen.
How quickly will a vaccine be here? Already, medical ethics have been pushed to the limit to deliver one. COVID-19 was first discovered a few months ago. Last week, three separate research teams announced they had developed vaccines. Yesterday, one of them (with FDA approval) injected its vaccine into a live person, without waiting for animal testing. Now, though, they have to monitor the test subject for fourteen months to make sure the vaccine is safe. This is the part of the testing that can't be rushed: the plan is to inoculate the entire human population, so if the vaccine itself turned out to be lethal for some reason, it could potentially kill all humans, which is a lot worse than 90 million deaths. Assuming the vaccine is safe and effective, it will still take several months to produce enough to inoculate the global population. For this reason, the Imperial College team estimated it will be about 18 months until the vaccine is available.
During those 18 months, things are going to be very difficult and very scary. Our economy and our society will be disrupted in profound ways. Worst of all, if the suppression policies actually work, it will feel like we are doing all this for nothing, because the infection and death rates will be very low. It's easy to get people to come together in common sacrifice in the middle of a war. It's very hard to get them to do so in a pandemic that looks invisible precisely because suppression methods are working. But that's exactly what we're going to have to do.”"
After I read that, I stayed up quite late reading more. I had figured that upon our return from Costa Rica, I would need staples. I had taken two trips to Costco, the bulk food store, and had purchased a bag of rice, flour and had stocked up on dry beans and lentils. I didn't have easy nonperishables, like canned goods. I knew Woodmans had started doing online pickup. I had felt a sense of urgency to get to Woodmans (grocery store with alot of options and great prices) since Saturday the 5th. Most nights I was tired and didn't feel like dealing with the crows that is always at Woodmans during the day. Late Tuesday/into Wed I spent about an hour on my phone placing an online order for pick-up Wednesday. These were all things that I wouldn't plan on eating in the near future since I had been intending to be out of town effective Friday and had been working on emptying fridge, not filling it.
I woke up Wed morning knowing the responsible thing was not to travel. I talked with my mom and we decided she should not go with FOR SURE. I didn't have a huge desire to go anyway and was stressed about it, but we had committed to being at the school and had flights. After I spoke with my mom I knew I also didn't want to go. In my profession, I believe one of the most important things we do is helping people with difficult decision making. I studied decision making framework in graduate school. As a new genetic counselor, I thought helping people through the decision making was very difficult and the hardest part of my job. Now, it is one of my favorites and I think such an important skill we have as genetic counselors. My decision making had me at the point that I could envision I would have many regrets if we traveled, but if we stayed home, I didn't see any regrets. I didn't care about the loss of money from the flights. The deposit for the school wasn't very high. I did feel badly the school would have been relying on our income, but they were understanding. The amount of relief I felt after canceling the trip was immense. I hadn't realized how stressed I was about it. I knew on Wed it was the right decision. As the day evolved I stated thinking we should start socially isolating. Ivy wasn't feeling well and I got a call from school that she had a 99.9 degree temp right before noon. I picked her up and didn't let her go to religion (even though she was fine and it was likely an overreaction to bring her home). In fact, I wanted to keep Iris home from religious education, but didn't bring that idea up as I know she really enjoys going. Callum started sniffling and a cough, so to be preventative and protect others (I didn't think he had COVID19 but didn't want others to be concerned) we kept him home from school on Thursday, March 12th. I wanted to keep the girls home Thursday, and brought that up to Iris late Wed, but she was highly against that idea. She is such a good rule follower and doesn't like missing school.
The kids had not (and still have not) seen Jeremy since March 5th. He had traveled with the UWGB basketball teams to the conference championship in Indiana. We decided, since he had been exposed to a potential case, I would keep the kids Thursday night March 12th. Things are evolving, but until we know the big picture, we decided the kids would stay isolated with me at home. My mom is also completely isolated. We continue to reevaluate this. Jeremy's parents, Grandma Linda and Papa Tom, didn't start isolating until Saturday the 14th when they attended church. I asked Linda to share some things with Tom, as I don't think he understood the gravity of the situation. I know they want to help out with the kids, but I was hesitant if my mother would still also be helping me.
After changing our minds several times over the past several days (directly related to the kids behavior) we decided to open up the circle and the kids might be seeing Jeremy on Sunday. We thought it wise, if the kids will no longer be able to see their grandparents for many months, that the kids see Tom and Linda before they see Jeremy. All three kids had a sleep over there last night and I am to be working today (although I am currently documenting all of this for us to look back upon). Last night I made huge progress on organizing things for our basement project (I'll do a separate post about that).
So there is alot of unknown. Last night before bed, I read the local news that WI has had first two deaths. In the US, currently, looks like 14,250. However, we all know this is a gross underestimate as tests are not available for most people and are only being reserved for those with the most severe symptoms and healthcare workers.
Here are some posts I have made on Facebook. I'll copy and paste some of the articles as I expect the links won't be working forever.
I reposted this from a FB friend on March 17th: "If you want to understand what we’re up against, read this sobering analysis. Thanks, Julie Greene! Copying and pasting from Julie’s post: “Here’s the London report that finally got the government’s attention. And I’ll precede it with a useful summary written by my friend Jeremy C. Young. Thanks Jeremy! “We can now read the report on COVID-19 that so terrified every public health manager and head of state from Boris Johnson to Donald Trump to the dictator of El Salvador that they ordered people to stay in their houses. I read it yesterday afternoon and haven't been the same since. I urge everyone to read it, but maybe have a drink first, or have your family around you. It is absolutely terrifying. The New York TImes confirms that the CDC and global leaders are treating it as factual.
Here's a brief rundown of what I'm seeing in here. Please correct me in comments if I'm wrong.
The COVID-19 response team at Imperial College London obtained what appears to be the first accurate dataset of infection and death rates from China, Korea, and Italy. They plugged those numbers into widely available epidemic modeling software and ran a simulation: what would happen if the United States did absolutely nothing -- if we treated COVID-19 like the flu, went about business as usual, and let the virus take its course?
Here's what would happen: 80% of Americans would get the disease. 0.9% of them would die. Between 4 and 8 percent of all Americans over the age of 70 would die. 2.2 million Americans would die from the virus itself.
It gets worse. Most people who are in danger of dying from COVID-19 need to be put on ventilators. 50% of those put on ventilators still die, but the other 50% live. But in an unmitigated epidemic, the need for ventilators would be 30 times the number of ventilators in the United States. Virtually no one who needed a ventilator would get one. 100% of patients who need ventilators would die if they didn't get one. So the actual death toll from the virus would be closer to 4 million Americans -- in a span of 3 months. 8-15% of all Americans over 70 would die.
How many people is 4 million Americans? It's more Americans than have died all at once from anything, ever. It's the population of Los Angeles. It's four times the number of Americans who died in the Civil War...on both sides combined. It's two-thirds as many people as died in the Holocaust.
Americans make up 4.4% of the world's population. So if we simply extrapolate these numbers to the rest of the world -- now we're getting into really fuzzy estimates, so the margin of error is pretty great here -- this gives us 90 million deaths globally from COVID-19. That's 15 Holocausts. That's 1.5 times as many people as died in World War II, over 12 years. This would take 3-6 months.
Now, it's unrealistic to assume that countries wouldn't do ANYTHING to fight the virus once people stopped dying. So the Imperial College team ran the numbers again, this time assuming a "mitigation" strategy. A mitigation strategy is pretty much what common sense would tell us to do: America places all symptomatic cases of the disease in isolation. It quarantines their families for 14 days. It orders all Americans over 70 to practice social distancing. This is what you've seen a lot of people talking about when they say we should "flatten the curve": try to slow the spread of the disease to the people most likely to die from it, to avoid overwhelming hospitals.
And it does flatten the curve -- but not nearly enough. The death rate from the disease is cut in half, but it still kills 1.1 million Americans all by itself. The peak need for ventilators falls by two-thirds, but it still exceeds the number of ventilators in the US by eight times, meaning most people who need ventilators still don't get them. That leaves the actual death toll in the US at right around 2 million deaths. The population of Houston. Two civil wars. One-third of the Holocaust. Globally, 45 million people die: 7.5 Holocausts, 3/4 of World War II. That's what happens if we use common sense: the worst death toll from a single cause since the Middle Ages.
Finally, the Imperial College team ran the numbers a third time, this time assuming a "suppression" strategy. In addition to isolating symptomatic cases and quarantining their family members, they also simulated social distancing for the entire population. All public gatherings and most workplaces shut down. Schools and universities close. (Note that these simulations assumed a realistic rate of adherence to these requirements, around 70-75% adherence, not that everyone follows them perfectly.) This is basically what we are seeing happen in the United States today.
This time it works! The death rate in the US peaks three weeks from now at a few thousand deaths, then goes down. We hit, but don't exceed (at least not by very much), the number of available ventilators. The nightmarish death tolls from the rest of the study disappear; COVID-19 goes down in the books as a bad flu instead of the Black Death.
But here's the catch: if we EVER relax these requirements before a vaccine is administered to the entire population, COVID-19 comes right back and kills millions of Americans in a few months, the same as before. The simulation does indicate that, after the first suppression period (lasting from now until July), we could probably lift restrictions for a month, followed by two more months of suppression, in a repeating pattern without triggering an outbreak or overwhelming the ventilator supply. If we staggered these suppression breaks based on local conditions, we might be able to do a bit better. But we simply cannot ever allow the virus to spread throughout the entire population in the way other viruses do, because it is just too deadly. If lots of people we know end up getting COVID-19, it means millions of Americans are dying. It simply can't be allowed to happen.
How quickly will a vaccine be here? Already, medical ethics have been pushed to the limit to deliver one. COVID-19 was first discovered a few months ago. Last week, three separate research teams announced they had developed vaccines. Yesterday, one of them (with FDA approval) injected its vaccine into a live person, without waiting for animal testing. Now, though, they have to monitor the test subject for fourteen months to make sure the vaccine is safe. This is the part of the testing that can't be rushed: the plan is to inoculate the entire human population, so if the vaccine itself turned out to be lethal for some reason, it could potentially kill all humans, which is a lot worse than 90 million deaths. Assuming the vaccine is safe and effective, it will still take several months to produce enough to inoculate the global population. For this reason, the Imperial College team estimated it will be about 18 months until the vaccine is available.
During those 18 months, things are going to be very difficult and very scary. Our economy and our society will be disrupted in profound ways. Worst of all, if the suppression policies actually work, it will feel like we are doing all this for nothing, because the infection and death rates will be very low. It's easy to get people to come together in common sacrifice in the middle of a war. It's very hard to get them to do so in a pandemic that looks invisible precisely because suppression methods are working. But that's exactly what we're going to have to do.”"
No comments:
Post a Comment