Category Archives: Ramblings & BS

Is the US flattening the curve? Yes. Significantly? Who knows.

How do you describe that feeling of watching numbers climb and realizing that you’re watching in real time the most global example of what you’ve studied and taught your entire adult life?

Dread? Excitement? Existence?

When teaching about pandemics we teach students to look retrospectively at the numbers of those that have recovered versus those that have died. We make estimates on the numbers of those that were actually infected based on documentation available (or more recently – on documented confirmation). At about 6:00PM on 27 March 2020 twice as many people had died of covid-19 in the United States as have recovered. Seeing those numbers broke my heart for a moment, so I had to talk it out to myself somewhere.

https://coronavirus.1point3acres.com/en as of 6:26 PM MST 27 March 2020

It’s too early to call what it will look like in the United States in terms of our final numbers with covid-19. At this time these numbers are skewed by post-mortem testing and testing criteria that limits test accessibility to those already in need of medical intervention over home care.

Things might look scary, but don’t give up hope. Update 30 March 2020: and reporting started coming in of recoveries! Part of why this reporting may have been delayed is due to stringent testing criteria.

https://coronavirus.1point3acres.com/en as of 12:47 AM MST 30 March 2020. The criteria most are going by: 2 negative covid-19 swabs with a minimum of 24 hours separation.

The reason for this standard is that there is a very high false negative rate with the rt-PCR based test. If anything goes wrong along the way – say there’s a bad reagent, too low of a sample of viral particles, or something goes wrong that invalidates the test it will come back negative. This is the bane of every graduate student that has ever done rt-PCR. They will tell you their horror stories, especially if they were from poorly funded labs.

For some additional hope.

There’s this amazing power of graphs. We can look at growth of reported cases overtime to project the number of cumulative reported cases in the United States in the future.

I started keeping these to track the projection if we stayed on an exponential number of cases reported (aware of typo – did not plan on using this graph for anything originally)

Even as we have expanded albeit limited testing across the United States the overall rate of growth of total cumulative cases is slowing. While this hope is based on very limited data, could it be that we may actually be flattening the curve?

Equation is changing – are we flattening? I’m not sure. We added a zero. [Does some math]. I don’t know if that’s significant yet.

We’re able to see the slope change as the day to day numbers change. Thus, we can see when our efforts are working. (See below)

Source: https://coronavirus.1point3acres.com/en has the ability to build graphs showing how the US has slowed growth from 28% to 25%. That 3% isn’t much, but it’s something.
Source https://coronavirus.1point3acres.com/en But remember that our reporting is primarily coming from one place right now. Go to the website and visit this graph – it’s actually a movie!

This is part of why we need accurate reporting above anything else. The numbers that only require home care matter. In order to accurately understanding the danger of a disease we have to know how many people have it and are acting as asymptomatic or low symptomatic carriers. This influences anticipatory healthcare planning decisions for patients and facilities. I will address this a bit more later in regards to the limitations of cultural understanding around death, dying, and disease.

Update 30 March 2020: Exciting New Graph! If we start looking at the growth in the number of reported cases since improved surveillance across the United States started around March 19th – Yes, the US is kind of flattening the curve. But not enough. We’re also not far enough in to predict the peak.

We can be hopeful. As of 30 March 2020 we were set to diagnose our 500,000th case on 4 April, 2020. Flattening the curve is succeeding in different parts of the country. I will be addressing this in a new post. As a brief update as of 12:01AM 1 April, 2020, we have moved that projection out to 5 April, 2020. My model is limited by not knowing what the current daily max testing capacity of the United States is yet.

Update 5 April 2020:

Hey, look! We didn’t hit 500,000 cases. That’s incredibly comforting and is a fantastic sign. That said, we still have a backlog of COVID-19 tests, an untested positive population acting as a reservoir to continue infecting our healthy population, and we have no control over this. At this point, it is believed that SARS-CoV-2 will become a seasonal illness in the United States.

Source: Same as before

Remember how I said before that the 500,000th case had been pushed out to 5th April? Now, that’s 6th April, 2020 if only looking at the cumulative cases since the 15,000th case in the United States. What if we look at since 23 March? On this day we had approximately 46,000 confirmed cases, with the next day climbing to 55,000 confirmed cases. This is the date we should look at to consider since 50,000 cases reported.

Source: same as before

It’s not changing. There’s enough growth in of confirmed cases in parts of the country that any flattening is being overwhelmed right now. America’s current check up isn’t doing so hot.

A website for further seeing how your area is doing with flattening the curve. It is grading the United States with a D, and I agree.

PPE Shortages

It’s not the fault of our healthcare workers and everyone needs to show gratitude. The United States is facing extreme PPE shortages, resulting in healthcare workers being put at risk for infection and at risk for being vectors of covid-19. Hospital acquired infections have long been a problem in the US due to poor hygiene practices among staff and invasive devices used in hospital settings such as catheters, PICC lines, and IVs. While this has been combatted over recent years by the installation of improved educational programs and the implementation of disease control specialist positions in hospitals and clinics, these measures are useless without sufficient PPE. Washing hands and hand sanitization does only so much. We dedicate a lot of research time and money to this topic.

Diagnostic Testing Has Barriers

Point of Care rapid testing is a luxury afforded us over the past ten years (and toward the end of the 20th century) for strep throat, influenza, drug screenings, and other common “ailments” that bring you in to say hello to someone like me (only using quotes because I included drug screenings). The fact that we have this soon to be available for the coronavirus at all is incredible. Not only will this help with disease surveillance, but we have the ability to accurately study a pandemic in real time on a scale like never before. We could have the ability to intervene and institute true quarantine measures assuming we roll out extensive Point of Care screening for everyone.

But until then, can I even trust this data?

Rituals Around Disease, Death & Dying Complicate Things

How many people are dying at home untested? Remember that across America we have incredibly diverse customs about death and dying.

I recently spoke with friends in New York City and she mentioned that she knew members of certain cultural communities that though they were symptomatic were not getting tested. Part of why this happens is because of cultural beliefs around illness and dying. It’s going to be scary and everyone is reacting in ways that may deter them from getting tested. This will limit our surveillance and will also result in transmission within communities.

In the American South (where I’m from) families conduct home hospice even during severe illness out of pride and the cost of healthcare. Once the family member has died they will contact the local mortician. While it might no longer be legal to do home embalming and many states have prevented home burials, this has never stopped families from caring for the dead. Caring for the ones we love as a final act is one of the most essential acts as a family member that is often robbed of Americans elsewhere across the United States. In twenty to fifty years will we need to do go all paleovirology/anthrovirology (actual fields!) on disinterred bodies to get the actual numbers? Or will we go the route of China with incinerating covid-19 presumed bodies without testing? Will we go the route of the US during 1918? Will we burn it all?

Another thing to consider with any pandemic is how the rituals around death in the home contribute to the spread of a disease. This paper regarding the Ebola pandemic addresses why it is important to understand how we culturally handle death in times of pandemic in order to appropriately control spread.

Future Questions We Will Hopefully Answer:

As we look into ways to protect our healthcare workers with limited PPE we should be reminded that there are other ways we control the spread of disease.

Are healthcare workers on PReP faring better?

Many of the antivirals in PReP and PeP are being tested in the treatment of covid-19. Healthcare workers in Emergency Medicine have recently started turning to PReP and PeP to prevent the spread of HIV as a result of blood born pathogen exposure. Are these healthcare workers faring better than those not on PReP? Only time will tell since the number of workers on PReP reporting is still rather low.

What percent of the population needs to participate in social distancing in order to flatten the curve?

There’s isn’t actually an exact percent. What’s critical is that those at highest risk of being effective vectors for covid-19 during the transmission period of infection while shedding virus are able to infect as few other people as possible. This is a complicated question I’ve broken down into a couple parts.

Who actually needs to be on a stay-at-home order / essential workers only order for us to flatten the curve?

Go Fill Out Your Damn Census So I Have A Better Map

On the U.S. Census map above population density is shown in dark areas. Are you in that darker half? Stay. The 🦆 Home unless you are an essential worker.

Are you NOT in the darker half? Then you should be worried if you hear that there’s community transmission in your county. At that point practice social-distancing.

But you’re not out of the woods yet my friends. I have some more criteria for you:

How far away does your closest neighbor live? If you live in an apartment building – you should stay home. Live out in the country? Congratulations you lucky son of a gun! We’ve shown those city slickers that living in the underserved parts of America with crappy, dying economies that have been sputtering out and suffering at the hands of a global economy and evil corporations ain’t so bad, now is it? Or is it.

How far away is the closest interstate, highway, airport, train station, and other means of connection? Ever go to the gas station close to those things? May want to rethink that. Those are going to be your highest risk areas.

There’s a certain percentage of the population that can’t participate in the Stay at Home orders. It’s not their faults and they should be treated with the utmost kindness. They are taking huge risks. If you are a member of this population there are ways to assess how high risk your workplace is (if you’re interested). The actions of everyone else helps to make up for that by creating distance and reducing the number of people available for transmission at all. I know that’s a little messed up, but that is part of the theory behind it.

Source: https://www.census.gov/library/visualizations/interactive/2014-2018-median-age-by-county.html#

What is the median age of your area? Serious question though. Also, how old are you? Yes, this disease is affecting young people and those with conditions that make them more vulnerable. But I want you think about what kind of threat you are posing to the other people in your area by being a vector. If you live in a dark blue area, even if there hasn’t been a reported case in your county yet – staying home or social distancing is protecting this vulnerable population. You don’t want to have helped transmit the first.

source: https://www.unacast.com/covid19/social-distancing-scoreboard

(Update 5 April 2020) What Is Your Social Distancing Score?

You have thought about population density. You have thought about your median age group and how that plays into susceptibility of your area. The actions of those around you also put you at risk. In the flattening the curve check ups on New York, Pennsylvania, and New Jersey I talk about how important social distancing is right now and how big of an impact it is going to have on what we see in the future, such as the one vs. two peaks in New Jersey. But remember that not everywhere can social distance. Pay attention to the areas graded “F” as we address poverty below and in this post here.

Source: https://www.census.gov/library/visualizations/2019/comm/family-gatherings.html Do you live in a multigenerational household or live close by to family and see each other often?

Do you live in a multigenerational household or live close by to family? Do you see them often?

You absolutely need to be trying to stay home. These stay at home orders are critical to you. Illnesses like this can spread through families like wildfire. We love our families, right? Keep our families safe. If you are an essential business employee, it is even more important that you protect your family and isolate from them if possible. In many cases there is caregiving. This is addressed more in this post.

Source: https://www.census.gov/library/visualizations/interactive/2014-2018-poverty-rate-by-county.html#

Do you live in an area that is severely impoverished?

I hate asking this question because it is loaded. Click here for further reading on an additional opinion regarding race and healthcare inequality relating to poverty. Problems with the wealth and resource gaps in America demonstrates the huge gap between the way we treat people and I’m from a deep blue dot on the Chesapeake Bay where those resources aren’t available.

Disease outbreaks are worse in areas where poverty is not appropriately addressed. If you live in an area like this, you need to take stay at home orders seriously and the problem is, you can’t. And it’s not your fault. Our government and humanity are failing you.

I made a new post to address this more. Point is: stay home if you can, but be compassionate with yourself if you can’t.

What is determined to be essential and how do they determine what percentage of the workforce can be considered essential?

Oh. See, here’s the fun part. They don’t. They think of essential services, not the total number of employees this prevents from participating in social distancing. The state governments will figure out why this is really really dumb pretty fast, especially since many are now seeing hiring booms in those fields (like gas stations and weed delivery). I’m not an economist or a business person. People need to eat. This will be a strain on efforts that has to be monitored.

If people are interested in hearing me rant about the topics I’m actually an “expert” (by degrees and academic research/teaching background only) in let me know. If you are I’ll actually go back and edit this rant and dress it up a bit.

Thank you to anyone reading this. Without you this is just a shout into the ether.

Short Story Announcement: “Waking Up” Part 1 “The First Day” and Life Update

My first multipart series is upon us! It went live on Monday, but I’ve been preoccupied with this whole coronavirus thing and writing book reviews.

This first part is short.

I didn’t mean to time the release of a story related to waking up in a hospital with a pandemic. Today is Day 17 of a fever of ~100-101 F (37.7 – 38.3 C). I have ice on the back of my neck as I write this. There will be a delay in the release of part 2.

It’s all surreal, right?

I grew up among hardy people that believed in staying put when the hurricane came and destroyed the town (this literally happened and I was out of school for 2-3 months in high school while we rebuilt the town). One of the places I lived was almost wiped off the map by the 1918 Influenza pandemic. Entire families died – their bodies buried in mass graves next to their homes by the brave neighbors who ventured into the houses later. The houses and all of their belongings were either burned or were left to rot until us, curious, mischievous rural kids with nothing better to do broke in and wandered around those unwired houses like the generations and generations of kids before us. Look but don’t touch. The objects are cursed and haunted by the disease. Even then the belief was that the ghost of the disease persisted and could kill.

On that note, stay tuned for a short story exclusively posted here since I’m taking a week off. Don’t expect it to be edited well because, frankly, I feel like s***.

Take care and I hope everyone is staying well. As always, thank you for reading. Without you I’m writing words into a void.

UPDATE (26 March 2020):

Today WaffleHouse closed 365 of its 1,627 US locations. That thing I mentioned above about being from an area that was regularly destroyed/impacted by hurricanes and my town was DESTROYED by a hurricane?

Check out this thing called the Waffle House Index – it’s used by FEMA to determine how bad a natural disaster is in the United States based on the number of Waffle Houses still open in an area. I’m not joking. It’s a real thing. Waffle House is historically known for being open 24/7/365 and has called itself a “trucker shelter” during inclement weather.

We live in interesting times.

New Short Story And A Lot of Vulnerability: “Stronger”

Wedding picture!

Before you read this post, please take a moment to read my short story on Coffee House Writers here.

Read it? Alright then. Let me take a deep breath. It’s time for me to get vulnerable with you. These emotions are weird and difficult for me.

This piece is fiction, but there are pieces of this story that are true. I left out parts. I toned it down. I changed names, places, and made up new people and circumstances. Hannah is fictional. My partner is my best friend, he would never abandon me, and is one of the most understanding human beings on this planet – don’t you dare think that this story is in any way about him. Time to clarify some things just in case.

What is based on truth is the public transportation incident that the main character experienced as well as other aspects of trauma. I’m unusual. There was never a time in my memory before vitiligo and for that I am grateful. I never experienced loss, though it has grown. When my parents first took me outside as an infant and I started to tan it was there. Family members talked. They knew it affected me, but when I heard the words “deformed” and “disfigured” I internalized it. Growing up in very remote areas of the United States, even today there are people that believe it is a mark of demonic possession or worse. Luckily, I have a loving amazing family.

The public transportation incident in the story is based on when I lived in San Francisco. In 2016, an elderly woman beat me with her cane during evening rush hour while yelling, “Leper,” and, “Stop Touching Me!” I was not touching her. No one said anything or stopped her, but they sure stared at me. I got out early and walked the rest of the way home. Try and imagine the terror of being beaten in public by an old woman in front of a crowded light rail train car in rush hour while no one said a word. You there yet? Cool.

I didn’t include every example of vitiligo changing what someone saw or how they acted toward me in the story. I have been refused service at restaurants because they didn’t want a “leper” touching their plates or tables (this happened in Niagara Falls, ON). Questions like “when were you in a fire?” or later, after years of working in laboratories, “were you in an accident?” are always a fun time. These are the examples that come to mind.

This has been my whole life. And I’m white. Imagine what it would be like for someone with darker skin than mine. Indeed, one review mentioned, “In a study of 53 [vitiligo] patients in India, major depressive disorder was reported in 57% of patients, social phobia in 68%, and suicidal ideation in 28% (high risk 8%; low risk 21%). These findings stress the need for psychological and/or psychiatric intervention (Ramakrishna and Rajni, 2014). Papadopoulos et al. (Papadopoulos et al., 1999) reported that counseling and cognitive behavioral therapy could improve self-esteem, body image, and overall QoL [Quality of Life] in patients with vitiligo.”

Now, let’s flip vitiligo to any other visible disfigurement or disability a child internalizes as being their fault because it impacts a child’s life significantly. It’s your turn to help a kid with a completely different life face that internalization and you’re thinking of becoming involved in foster care like I am. There are additional realities that you need to face. Over 35% of children in foster care have a parent with a substance abuse disorder and have been exposed to substances. Given the age range that my partner and I are looking to foster with intent to adopt, the reality is that our future foster children will likely have been exposed (directly or indirectly) to alcohol, methamphetamine, benzodiazepines and/or opioids at some point. They could have addictions of their own. One study suggests that kids that have been through foster care will develop substance abuse issues later in life if they don’t do so while in the foster care system. It’s complicated.

We’re not looking for a perfect child. We will love a child with an addiction – even if it was a choice of coping mechanism in the moment or however it started. We already love people with addictions. They aren’t broken and they can be successful if given the support they need.

Readers don’t like ugly stories and I get it. The world is ugly enough as it is. They don’t like thinking about the fact that therapeutic foster care homes are severely underfunded. But here’s the thing, foster care produces brilliant minds if given the chance, and, as a reminder, here’s a list of successful people that survived the American foster care system. Any names look familiar? Steve Jobs? Colin Kaepernick? I have met successful doctors, scientists, and lawyers that fought their way to where they are now through this underfunded system. I love people from this system and look forward to loving more of them.

Want to help make change? Donate your time as a mentor or become a foster parent. Respite care can be for anything from a couple hours to a couple days and helps kids in foster care and families within your community that may need temporary childcare. Mentoring involves spending time with a kid to provide them with a role model and someone to spend time with. Multiple organizations, such as the Boys and Girls Club and Big Brother Big Sister offer mentoring opportunities. CASA (Court Appointed Special Advocates) is a great way to support children going through the legal system – a terrifying process for kids. Before donating money, look to your local community first.

Anyways – this story is dedicated to an incredible young person named Olivia. There’s my soapbox. I’ll get back to writing my short stories and book reviews. These emotion things are weird.

What does everyone do with these stupid referral links and codes? Why not experiment with manipulating search engines.

Haskell is on a heating pad under a blanket, hiding from the Montana winter

Like everyone else on this planet on the internet involved in the modern economy, I have started accumulating referral links and codes for products I actually use. I am left with a giant question: WHAT THE HECK AM I SUPPOSED TO DO WITH THESE?

In my opinion, referral links are used to feast upon social capital and provide some monetary reward in exchange – primarily in reducing the cost of products to the person sharing the link.

Fine.

I have such mixed feelings about social marketing. As indie authors and reviewers, we rely on social marketing. I decided to devise an experiment. In many ways, this post is about passive social marketing. Happy to explain – someone wants to try out a product and gets on a search engine looking for a referral link. By searching for a referral link they end up on a blog. By ending up on that blog, they click around a little bit more and discover they want to buy someone’s book thanks to a review I’ve written (at least, that’s the goal).

So here’s the referral link post. I will update it occasionally. It will contain referral links (not affiliate links – there is a difference). These are all products I (or my partner) am actively using and am happy to answer questions about if you ask me directly – Twitter will get you the fastest response. I will not talk about them otherwise – I am not an “influencer”. DO NOT TAG THE BRAND. As a friendly reminder, I talk about books and I’m sticking to that. You can use these links with or without talking to me first. Once I stop using these products, I will remove the links.

If this doesn’t seem to benefit anyone (including authors – please let me know if you see no increase in sales) I will edit it with an update on what I learned. The fun thing about WordPress is that I have access to analytics tools that give me the ability to look at insights specific to this post.

If this does seem to benefit everyone in getting more books sold and increasing overall website traffic, I will start requesting additional referral links and codes from other indie authors and reviewers. Same rules as above will apply.

Referral Links/Codes:

Hum Nutrition Referral Code: 1E4424
Details – $10 off first order + $10 off next order for the referrer

Update (3/26/2020): This code has worked (in terms of both drawing traffic & resulting in at least 1 referral)

ClassPass Referral Link: http://class.ps/ncJRh
Details – discounted first month of membership (it is an auto-renewing subscription) + $30 off next month of membership for referrer (based on my current geographic location)

Phlur Referral Link: http://fbuy.me/v/laura_6621
Details – $5 off first order + $10 off next order for the referrer (I have opinions on this one)

Basic Man Referral Link: https://www.getbasic.com/refer/Jacob-HXEXXQSD
Details – $10 off the first order + $10 off next order for the referrer (okay, this one is actually my partner’s subscription)

Tesla Referral Link: https://www.tesla.com/referral/jacob11641
Details – $250 off of a solar panel or 1,000 miles of free supercharging. (If ANYONE uses this one, I will be flummoxed)

ThredUP Referral Link: http://www.thredup.com/r/HPIG6E
Details – $10 off first purchase + $10 off next purchase for referrer

I don’t have any more referral links to add between the two of us, so I need your referral codes for products you actively use. I do not want to list more than 10 codes/links to start, so I have 4 open spots.

Preference is given to authors I have previously worked with or am working with in the immediate future.